Fats and oils

Fats and oils

While sweet foods like fruit most surely delight the senses, it is fair to say that what the body really craves is fat. Perhaps the reason is that compared to proteins and carbohydrates fats are a more abundant source of energy. With our comparatively huge brains, 60% of which are made entirely from fat, our evolution as a species can be defined by our drive to acquire this nutrient. Imagine if you were sitting around a campfire 200,000 years ago with an empty belly – what food would most satisfy your hunger? Sure, fruits and vegetables have their appeal, but if you don’t want to spend all day chewing vegetation, what food fills your stomach best, and then gives you energy to do other stuff? Beyond any other food, fat was prized by traditional peoples all over the world, and as the rendered essence of an animal or a plant, was a kind of valuable currency that could be stored and traded for other goods. In Ayurveda, fat is the most nourishing of foods, and in Hinduism is equated with the goddess Lakshmi, the bringer of wealth, beauty and abundance. Everyday in India millions of people massage their bodies with oil to keep them youthful and healthy. Fat protects, comforts and soothes. Fat is like money in the bank.

Despite the traditional auspiciousness of fat there is perhaps no better example of a group of foods that have been so clearly targeted and maligned. Beginning in North America in the early 1900’s, and then soon after in Europe and now spreading all over the world, industry and government have been trying to wean people away from their traditional high fat diets. Armed with an apparent avalanche of research reported on by the media, consumers have been led to believe that fat is killing them, regardless of the fact that the prevalence of our most common illnesses such as cardiovascular disease, cancer and diabetes have been steadily increasing since this marketing campaign began.insideayurveda_banner_960px
Even though this low fat marketing blitz that has permeated our fast-food culture for several decades now, the evidence for the benefits of eating a high fat diet is slowly being accumulated by scientific research. The difficulty thus far in validating the benefits of dietary fat is partly because research models continue to lump all dietary fat into the same category. For example, both French fries and herring oil are rich in fat, but clearly one will make you very sick if you eat it regularly, while the other is something humans been thriving on for tens of thousands of years. Often the claim is that the problem is saturated fat and cholesterol, and yet traditional peoples have survived for millennia on such fats. In China the traditional cooking fat has always been lard, and when researchers began studying this population, the Chinese people had lower rates of diseases such as diabetes when compared to Western countries. Flash-forward to modern times and now much of the Chinese population are using refined cooking oils – and sure enough – their disease rates such as diabetes are starting to match the West. If saturated fat and cholesterol were ever truly harmful to humans, we would have died off long ago.

Also known as lipids, fats refer to a diverse range of chemicals including triglycerides, cholesterol, phospholipids, steroids, carotenoids, vitamins (A, D, E, K) and locally-acting hormones called eicosanoids. Like carbohydrates, lipids are comprised of carbon, oxygen and hydrogen, but the amount of oxygen in a lipid is much less, making for fewer polar covalent bonds. This means that lipids are insoluble in polar solvents such as water, but soluble in non-polar solvents like alcohol. This makes fats quite different from proteins and carbohydrates, and is the reason why lipids such as cholesterol must be bound to proteins such as LDL or HDL, in order to be transported in the blood.

When we speak of dietary fat we are referring exclusively to triglycerides, comprised of a three-carbon glycerol molecule that forms the backbone, and three (tri) fatty acids attached to each carbon in the glycerol molecule. The fatty acids are comprised of a chain of carbon atoms that have a variable size and shape, with hydrogen atoms attached on the side and at the end. When hydrogen atoms fill up every spot available on the carbon chain it is called a saturated fatty acid (a). When two adjacent carbon atoms form a double bond in the chain it is called monounsaturated fatty acid (b), i.e. ‘mono’ referring to the single double bond, and ‘unsaturated’ referring to the fact that the fatty acid isn’t completely ‘saturated’ with hydrogen. A third type of fatty acid is called polyunsaturated (c), meaning that there are two or more (i.e. ‘poly’) double bonds on the fatty acid chain. The following diagram illustrates these differences:
A given triglyceride may be comprised of different types of fatty acids, and so rarely is a fat completely saturated or unsaturated. The following chart lists common dietary fats and oils, and the different types of fatty acids each contains:

Saturated fats tend to be solid at room temperature and are commonly found in animal fats such as lard and butter, but are also present in plant oils such as coconut and palm kernel. Saturated fats are relatively stable and are thus a better choice for cooking and especially frying (p. 121). In comparison, dietary fats rich in monounsaturated fatty acids are more unstable, but certainly more stable than oils rich in polyunsaturated fatty acids, which oxidize quickly when exposed to heat, oxygen or light. One of the key issues that relates to fats is their role in the production of compounds called eicosanoids, including prostaglandins, leukotrienes, prostacyclins and thromboxanes. Eicosanoids are derived from linoleic and linolenic acid, two types of polyunsaturated fatty acids that the body cannot synthesize, and hence are called essential fatty acids. Linoleic acid is an 18-carbon fatty acid also called the omega 6 fatty acid because the first double bond is six carbons from the end, whereas linolenic acid is an 18-carbon fatty acid called an the omega 3 fatty acid because the first double bond is three carbons from the end. Linoleic acid and its active metabolite arachidonic acid (AA) are converted into a series of eicosanoids that tend to have a pro-inflammatory effect, whereas linolenic acid and its metabolites including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) tend to have an anti-inflammatory effect. During our human evolution the consumption of omega 3 and 6 fatty acids was about equal, but with our relatively recent dependence upon cereal grains and vegetable oils in our diet and in animal feed, the ratio of essential fatty acids we consume has become skewed in favor of omega 6 fatty acids. The net result of this imbalance is that we have a tendency to produce more pro-inflammatory eicosanoids, a feature that has been linked to chronic diseases including allergies, asthma, arthritis, cardiovascular disease and cancer.[1] Although our daily requirement for both omega 3 and 6 fatty acids is rather small, given that the average person consumes upwards of 17 times the amount of omega 6 relative to omega 3,[2] many practitioners recommend omega 3 fatty acid supplementation as a counter-measure. There are issues with this recommendation however (see discussion under fish oil, below), and a more sustainable measure is to eat a diet that is naturally rich in omega 3 fatty acids, emphasizing pasture-raised animal produce, wild meat and fish, leafy greens, sea vegetables, and seeds such as chia and hemp seed.

Apart from the fats naturally found in the foods we eat, the fats we cook with must be extracted from their original source whether from animals or plants. The fat in milk called butterfat is extracted by first skimming off the cream, churning it into butter (p. 176), and then rendering off the pure butterfat from the milk solids to make ghee (p. 194). Animal fats including tallow, lard or fish fat are generally extracted by heat, such as boiling or roasting, and in industrial operations undergo further processing and refinement. Animal fats from poultry (schmaltz), beef (tallow), or pork (lard) can be rendered by carefully trimming the meat from the fat, and then slowly roasting the fat over an even heat (see p. 195).

The simplest method to extract an oil from a plant is the expeller press, which applies a mechanical pressure to express the oil. This low-tech method is used for many of the traditional vegetable oils we eat, from sources that have a high percentage of fat and are thus relatively easy to express, including olive (30% fat), sesame (50% fat), palm kernel (50% fat), almond (50-65% fat) and coconut (65% fat). The expeller process generally has a minimal impact on the quality of the oil, but under very high pressures temperatures can reach upwards of 120˚F/49˚C, high enough to cause some oils such as flax seed to oxidize.[3] In some cases the nut or seed is boiled or roasted before expression to render the oils more conducive to extraction, or in more recent times, non-polar synthetic solvents such as hexane are used. Such intensive techniques allow processors to express oil from sources such as grape seed (6% fat), corn (12% fat) and soy (20% fat) that are otherwise very difficult to express with an expeller press, and were never part of the traditional diet. Several of these newly introduced oils are sourced as by-products from other industries, such as grape seed from the wine industry, or cottonseed oil from the cotton industry.

While the expeller press typically yields a high quality product, when intensive methods of extraction are used the purity, quality and taste of an oil can be dramatically affected. As a result these oils require further processing, which may include degumming, neutralization, winterization, bleaching, deodorization (steam distillation) and hydrogenation. Some of these processes utilize chemicals and solvents to remove natural constituents such as waxes, gums, free fatty acids, vitamins and sterols. During deodorization in particular, the oil is heated to temperatures as high 446-500˚F (230-260˚C) for as long as several hours. Hydrogenation is a last step in which the oil is heated in a chamber with a metal catalyst and exposed to pressurized hydrogen gas. This is done to saturate oils rich in polyunsaturated fatty acids with hydrogen, turning it into a kind of saturated fat that allows it to be solid and shelf-stable at room temperature.foodasmedicine_facebook_1200x627Hydrogenation is a process that fundamentally changes the physical structure of an unsaturated fatty acid, flipping hydrogen atoms across the double bond between two carbon atoms, changing them from cis (‘same side’) to trans (‘across’) configuration. Transfats have come under a lot of fire lately based on research that hydrogenated oils are associated with a higher risk of cardiovascular disease, diabetes and cancer. But ‘transfats’ are not the issue per se. In fact some transfats play a useful role in human health, like vaccenic acid and conjugated linoleic acid (CLA), both of which are naturally occurring in butterfat. More recently, researchers have linked trans-palmetoic acid, found in whole fat dairy products and meat, with a significant reduction in the risk of atherosclerosis and diabetes.[4] The label of ‘transfat’ obscures the real issue, which is the way industrial processing dramatically alters the structure of the fats we eat, removing essential fatty acids, vitamins and antioxidants, leading to nutrient deficiencies and gross imbalances in the ratio of fatty acids in the diet. Significant damage also occurs when oils rich in polyunsaturated fatty acids are heated during processing, altering their intrinsic structure as well as generating disease-causing lipid peroxides.[5], [6]

The following is a list of the best fats and oils for cooking, and the upper limit for cooking temperatures:

  • organic butter: low-medium heat: 300°F/150°C
  • extra virgin sesame oil: low-medium heat, 350°F/175°C
  • extra virgin coconut oil (not copra): low-medium heat, 350°F/175°C
  • organic lard or tallow: medium heat: 370°F/188°C
  • extra virgin olive oil: medium heat, 405°F/210°C
  • extra virgin almond oil: medium heat, 420°F/216°C
  • organic palm and palm kernel oil: medium heat, 455°F/235°C
  • organic (grass-fed) ghee: high heat: 485°F/252°C

Note that I have not included many of the cold-pressed vegetable oils commonly touted as being a valuable source of essential fatty acids, including canola, walnut, pumpkin, hemp, flax, sunflower, safflower or perilla oil. Nor do I include essential fatty acid supplements such as borage, evening primrose and black currant oil on this list. While many of them such as walnut, flax and hemp seed are rich in fat, none were ever used as food oils since shortly after pressing they rapidly begin to oxidize, causing adjacent fatty acids to link together and polymerize. This makes them effective ‘drying oils,’ traditionally used in paints and varnishes to seal and preserve wood – but not as food. Apart from the damage that occurs to these oils during processing and storage, cooking these oils has also been shown to generate health-damaging lipid peroxides[7] (see p. 121, in Food As Medicine).

To lengthen shelf life and preserve the quality of cooking oils, store them under cool, dry conditions. Even if a fat is naturally high in saturated fatty acids, factors such as humidity, heat, light and oxygen will all promote rancidity. Generally speaking, no fat or oil should be used for high-heat cooking.

Different types of fats have different properties, and traditional cultures have provided us with a detailed framework of what they are and how to use them. Fatty foods are typically reserved for people suffering from a vital deficiency, displaying signs such as weight loss, depressed immunity and weakness. Fatty foods are particularly useful for nourishing the brain during both gestation and childhood, to restore women after pregnancy, and in older people who show signs of wasting. In his excellent book on diabetes management, Dr. Richard Bernstein suggests that increasing the intake of fat upwards of 40% of the total caloric intake can be very helpful to stabilize blood sugars and insulin levels in diabetics.[8] In Ayurveda, fatty foods are typically avoided in the obese, in people with weak digestion, or in the presence of excess mucus, congestion or fever. Fatty foods (but not essential fatty acids) are also avoided in active multiple sclerosis (urusthambha), a disease in which the immune system attacks the fatty tissues of the nervous system.

Among the fats described by Ayurveda ghee is perhaps the most celebrated. Prepared from cultured butter, ghee has a sweet taste and is cool, heavy and wet in quality. Balancing to both vata and pitta, ghee is considered to be a rasayana, helping to enhance and maintain vitality. Internally ghee is used to treat exhaustion, nervous system disorders and diseases of the liver. Topically ghee is anti-inflammatory and finds special utility in diseases of the eyes and skin, especially when prepared with bitter-tasting herbs such as barberry (Berberis spp.) and the Ayurvedic herbal formula triphala. Like honey, ghee is yogavahi, meaning that it contains the ability to augment the effects of any medicinal agent it is combined with. It is often combined with honey for its nutritive effects, but never in equal quantities. Although generally good for digestion, ghee can block the channels of the body and promote congestion if there is a lot of ama (toxicity).

Sesame oil (taila, gingelly oil) is another highly recommended food oil, and is the primary medium for the many different types of medicated oils used in Ayurveda. Sesame oil has a sweet flavor, and is warm, heavy and wet in quality, used to balance vata, enhance strength, nourish sexual function and clear the complexion. Applied topically sesame nourishes the skin and nervous system, helping to balance vata in the muscles and joints. Coconut oil is a fat frequently used in the south of India. It has a sweet flavor and a cool, wet and heavy quality, making it suitable to balance both pitta and vata. It is applied to reduce heat and inflammation, and to nourish and protect the skin. Most coconut oil comes from roasting the dried fruit (copra), which damages the integrity of the oil. Extra virgin coconut is preferred, either pressed from the dried fruit mechanically, or skimmed and purified from the fermented fruit. Olive oil and almond oil are both sweet in flavor, have a warm, heavy and wet quality, and are excellent to balance vata. Animal oils, including lard and tallow, are sweet in flavor and warm, heavy and wet in quality, and are useful for balancing vata. When used topically as medicated oils and salves, animal fats are much better absorbed, and are better carriers for medicinal herbs than vegetable oils. Among the different oils marrow fat is the most nourishing and balancing to vata; extracted from bones by boiling in water, cooling, skimming off the fat, and then reheating at low temperatures to remove any remaining water.

Fish oils, derived from fatty fish including herring, menhaden and ooligan (smelts), were exceptionally important foods utilized by many traditional peoples all over the world. They were typically produced by fermenting the freshly caught fish for up to two weeks, and then rendering off the oil by simmering at low heat in water. Rich in fat-soluble vitamins including vitamins A, D, E and K as well as omega 3 fatty acids, these rendered oils were not only an important dietary supplement, they were a valuable commodity for all coastal peoples, and were traded with interior peoples for other goods such as animal pelts and dried meat. In North America these ‘grease trails’ were extensive trading routes that extended deep into the interior, well beyond the Rocky Mountains, from Alaska all the way south to northern California. Recent scientific interest in the health benefits of fish oils has spawned a relatively new industry, and these oils are now found in the marketplace as a ubiquitous health food supplement. To meet consumer demand however, this type of fish oil is a highly refined product, and has undergone extensive processing to remove the characteristically fishy taste of traditional oils, as well as impurities and biological toxins. While there is research suggesting a benefit in consuming omega 3 fatty acids there is very little data on the effect that refinement has on the purported health benefits of fish oil concentrates. Rich in polyunsaturated fatty acids including eicosapentaenoic (20:5) and docosahexaenoic (22:6) acid, fish oil appears to be even more unstable than vegetable oil, and undergoes rapid deterioration under even optimal storage conditions, giving rise to health-damaging constituents.[9] , [10] , [11] Although there are clear benefits to eating oily fish, contradictory evidence raises questions about the stability of fish oil supplements if more than a month old from the date of manufacture.

The above article is taken from the book Food As Medicine: The Theory and Practice of Food, by Todd Caldecott.

References

[1] Simopoulos AP. 2008. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 233(6):674-88
[2] Simopoulos AP. 2006. Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomed Pharmacother. 60(9):502-7.
[3] “We have found in our laboratories at NDSU (Pizzey and Hall III, unpublished data) that hexane extracted flaxseed oil oxidized relatively quickly under slightly elevated temperatures (40°C) and in the presence of sunlight. Compared to freshly extracted oil, samples stored under sunlight had a 200 fold increase in peroxide values within 12 days while samples stored in the dark at 40°C had peroxide values 50 fold higher by day 12.” Available from: http://www.ameriflax.com/default.cfm?page=flax_ndsu
[4] Mozaffarian D, Cao H, King IB, Lemaitre RN, Song X, Siscovick DS, Hotamisligil GS. 2010. Trans-palmitoleic Acid, metabolic risk factors, and new-onset diabetes in US adults: a cohort study. Ann Intern Med. 153(12):790-9
[5] Godwin A, Prabhu R. 2006. Lipid peroxidation of fish oils. Indian Journal of Clinical Biochemistry. 21(1):202-204
[6] Wolff R. 1993. Further Studies on Artificial Geometrical Isomers of a-Linolenic Acid in Edible Linolenic Acid-Containing Oils. JAOCS 70(3):219-224
[7] Prabhu HR. 2000. Lipid peroxidation in culinary oils subjected to thermal stress. Indian Journal of Clinical Biochemistry. 15(1):1-5
[8] Bernstein, Richard. 1997. Dr. Bernstein’s Diabetes Solution. New York: Little Brown and Company, p. 318
[9] EFSA Panel on Biological Hazards (BIOHAZ). 2010. Scientific Opinion on Fish Oil for Human Consumption. Food Hygiene, including Rancidity. EFSA Journal. 8(10):1874. Available online: http://www.efsa.europa.eu/en/efsajournal/scdoc/1874.htm
[10] Pak CS. 2005. Stability and quality of fish oil during domestic application. The United Nations University, Fisheries Training Program. Unpublished thesis. Available from: www.unuftp.is/static/fellows/document/pak05prf.pdf
[11] Fritsche KL, Johnston PV. 1988. Rapid autoxidation of fish oil in diets without added antioxidants. J Nutr. 118(4):425-6

Let them eat salt!

Let them eat salt!

If you have been keeping abreast of the news lately, you might have come across a news story that highlighted a recent study published in the New England Journal of Medicine (NEJM), which found that salt consumption wasn’t associated with an increase in systolic blood pressure in either men or women, after controlling for factors like age (1). Given that health authorities have been saying for years that salt increases the risk of hypertension, these recent findings are another wrench in works for low-salt proponents.

This is not to say that very high salt consumption is safe. There is good evidence that reducing salt intake from 9-12 g per day, in large part from eating junk food and prepackaged foods, to less than 7 g per day, does promote a significant fall in systolic blood pressure (2). The problem is getting a handle on what exactly this means, particularly when these same changes seem to have no effect on lipid levels, and the risk of dying from cardiovascular disease is at best weakly associated with high salt consumption (15% increase in risk). Once again, as I addressed in an earlier blog, we need to make sure that we don’t confuse our objectives, and remember that hypertension isn’t so much a disease as it is as diagnostic sign. Just because we can alter the findings of one diagnostic sign through various interventions, doesn’t necessarily mean that we have altered the course of the disease. It is really just another example of failing to see the forest for the trees.

Despite these rather unconvincing findings, authorities continue to suggest that we’re consuming too much salt, with the US Food as Drug Administration (FDA) suggesting that we consume less than 2.3 grams per day, and the American Heart Association (AHA) going even further by recommending that we consume no more than 1.5 grams. After all, if eating too much salt is a bad thing, dramatically reducing our consumption must therefore be a good thing – right?

Nope.

In another recent study published by the NEJM (3), researchers compared the health outcomes of patients that followed the very low sodium diet recommended by the FDA and AHA, consuming less than 3 g per day, and found that they had a higher risk of death or cardiovascular than those who consumed more than 7 grams per day:

salt_deaths

Shocked? You shouldn’t be, because it’s not the first time we’ve seen these kind of results. A study published in the Journal of the American Medical Association (JAMA) in 2011 found much the same thing, after following 3,681 people for almost a decade that were eating either a low, moderate, or high salt diet (4). And while researchers again found that excessive salt intake was associated with an increase in systolic high blood pressure, they found that a low-sodium diet was significantly associated with higher mortality from cardiovascular causes:

According to the USDA and Health Canada, the average North American consumes only about 3.4 g of salt on a daily basis, which according to the latest research, suggests that most of us are consuming salt at the low end of the spectrum. Personally, I found these results surprising, especially considering just how much prepared and packaged food we eat, which is notorious for containing the high levels of salt which appeals to our tastebuds, activates our appetite centre, and stimulates impulse purchases. But it seems that even with what is still perceived as relatively high salt consumption, most of us are eating salt within a range that is associated with the least risk. Besides which, we’re talking about very small differences in risk, regardless of how much salt we eat. There are far bigger fish to fry, for example, when we compare the effects of eating too much salt, to the consumption of a high carbohydrate diet, which increases the risk of diabetes by 44% and the risk of CVD by 25% (5).

In Āyurveda, salt is a flavor that is an essential part of the diet, and to help maintain good health. Salt stimulates the appetite, promotes the flow of glandular secretions, and assists with the assimilation and absorption of food. It is described as viṣyañdī, meaning that it promotes tissue secretion, and sūkṣma, because salt opens the channels and promotes the easy passage of the feces, making it helpful in constipation. Salty flavor is hot, heavy and wet in quality, and helps to reduce and balance vāta, the component of the humoral theory in Āyurveda that is most closely associated with function of the nervous system. Sodium accounts for almost half the osmolarity of the extracellular fluid, playing a key role in conducting electrical impulses throughout the body.  With excessive sweating or diarrhea, the loss of sodium and other electrolytes disrupts the function of the nervous system, leading to issues including nausea and vomiting, headache, mental dysfunction, fatigue, irritability, weakness, cramping, seizures, and loss of consciousness. Often people will think to drink water when they’re dehydrated, but without the addition of electrolytes such as sodium, the water will go right through them and the problem will likely get worse. Although medical organizations like to suggest oral rehydration packets loaded with sugar to restore electrolytes, research has shown that a traditional Āyurvedic salted rice soup (e.g. peya) is far more effective (6).

While I am an advocate for consuming salt, like anything, there is a down-side too. Apart from the overt effects of hypernatremia, which is almost impossible to achieve from dietary consumption, the excessive consumption of salt irritates the mucous membranes, and can lead to inflammation. In a similar fashion, excessive salt weakens digestion and promotes congestion, leading to a feeling of heaviness and lethargy. In this way, salt consumption is limited in kapha (congestive) and pitta (inflammatory) conditions in Āyurveda, but even with these contraindications, it is never eliminated entirely.

Perhaps the most important issue to consider when it comes to salt is the source. Most commercial sources of table salt are prepared from pure sodium chloride, to which various ingredients are added, including anti-caking agents (e.g. sodium aluminosilicate), and if the salt has been iodized, the addition of alkalis (e.g. sodium carbonate) and stabilizers (e.g. dextrose, sodium thiosulfate). I don’t recommend this salt for a number of reasons. Apart from the synthetic anti-caking agents and other additives, pure sodium chloride is a highly refined product, as pure NaCl doesn’t exist in nature. Typically derived from either marine sources (e.g. sea salt), or mined from prehistoric salt deposits (e.g. rock salt), natural salts contain a diversity of nutrients including calcium, magnesium and potassium, as well as a host of trace minerals. The net effect is that these natural salts moderate the direct influence of sodium in the body, and because salt craving can often be a sign of a mineral deficiency, helps to address the root cause of nutrient imbalances.

In Āyurveda, there are five basic groups of salt, called the pañca lavaṇa:

• saindhava lavaṇa
• sauvarcala lavaṇa
• viḍa lavaṇa
• sāmudra lavaṇa
• audbhida lavaṇa

Consumed not just as a flavor or condiment, the pañca lavaṇa are viewed as therapeutic agents, used singly or in combination, found in many different formulas used both internally and topically, such as Bhāskaralavaṇa cūrṇa and Saindhavādi taila.

Jamts Davs
Saindhava lavaṇa is considered to be the best among salts, mined for thousands of years at the feet of the Himalayas in the Sindh region of the subcontinent. It is derived from the ancient Tethys Sea that at one time separated the subcontinent from Asia. Also known as pink salt, sendha namak or Himlayan salt, saindhava is a light-colored rock salt with a mild taste and sweetish-salty flavor. Saindhava is stated to alleviate all three doṣāḥ (doshas), enkindle digestion, restore electrolytes, benefit the eyes, reduce burning sensations, and enhance fertility.

Sauvarcala lavaṇa is another type of rock salt mined in the Sindh regions and elsewhere, but contains significantly higher levels of iron sulfide, providing for its blackish-red color and characteristic sulfurous odor. Also known as black salt, kala namak, sonchal or sanchal, sauvarcala is considered best for digestion and to balance vāta.

Viḍa lavaṇa is an artificially-prepared salt, made by boiling the powders of saindhava, Āmalakī, Harītakī and sarjakṣāra (sodium carbonate) in water until it is completely evaporated. Naturally rich in ammonium chloride, viḍa is black in color, and possesses an alkaline, salty flavor. It is used to correct kapha and vāta, reducing heaviness in the chest and promoting good digestion, and the proper excretion of feces and gas. Viḍa lavaṇa is generally not used for dietary purposes.

Sāmudra lavaṇa is unrefined sea salt, prepared by evaporating off the moisture from seawater. It is made all over the world, and is differentiated from refined salt by containing a high density of trace minerals, giving it a greyish, rather than pure white appearance. It has a mildly warming energy, and acts to enhance digestion, reducing vāta and the expulsion of flatus, and is only slightly aggravating to pitta and kapha when consumed in larger amounts.

Audbhida lavaṇa is a type of salt that is collected and purified from the soil by calcination, and is rich in sodium bicarbonate. It has an alkaline taste and action, and is considered to be difficult to digest, greasy in quality, cold in energy and acts to reduce vāta. It is used therapeutically, but is generally not added to food.

How to get rid of rosacea

How to get rid of rosacea

Rosacea is a common skin disorder that manifests as a red spotty rash typically found on the face, including the forehead, chin, nose and cheeks, but can also affect other regions of the body such as the eyes, chest and back. Sometimes referred to as the “adult acne”, rosacea is more common during middle age and is three times more likely to affect women. Although a specific cause has not yet been elucidated, rosacea has been linked to a variety of factors including chronic infection, poor digestion, improper diet, medication side-effects, and lifestyle factors. Chronic cases of rosacea often manifest as small bumps and pustules along with a generalized increase in local redness, often accompanied by red eyes, as well as burning or stinging sensations. If left untreated, chronic rosacea can lead to telangiectasia (dilation of superficial blood vessels on the face) as well as rhinophyma, in which the nose gradually becomes bulbous and red from chronic inflammation. There is also evidence that rosacea can lead to the development of basal cell carcinoma.

Over the last 20 years of practice, I have treated rosacea many times, but earlier in my career, I found myself struggling to get results. In Ayurveda, rosacea has all the characteristics and qualities of a pitta disorder, which is more or less synonymous with a state of chronic inflammation. Over the years, however, I found that the typical pitta-reducing treatments didn’t always have a positive effect. Similar to the typical recommendations, I had patients avoid spicy foods and potential irritants like coffee and alcohol, as well as hot weather, excess sunlight, and temperature extremes, in conjunction with an antiinflammatory diet and herbs. In some cases this approach was sufficient, but there were still patients that weren’t completely better. Unsatisfied with these results, I continued to look for better ways to address the condition. Although I don’t have a magic wand to make rosacea disappear, through experimentation and practice, I have been able to come up with some very useful measures that can be used to resolve rosacea permanently.

1990677_1_Rosazea_26094588.original.large-4-3-800-0-0-1800-1350

The human microbiome

If it isn’t perfectly clear by now, we humans are not autonomous organisms separate from nature. We exist as part of the ecology, and likewise, each of us maintains our own microbiome: a collection of micro-organisms that we originally acquired at birth that has grown and evolved to become a highly intimate part of our body. Our skin in particular contains an enormous diversity of microbes, with about 1000 different species of bacteria including the Propionibacteria that play a role in teenage acne, Corynebacteria that can cause diptheria, Staphylococci that are frequent causes of skin infections, and Lactobacillus, which is commonly used as a probiotic supplement. Not just bacteria, however, our skin plays host to a diversity of other organisms including fungi such as Candida that cause yeast infections, and Trichophyton species that cause athlete’s foot and jock itch. Understanding the complexity of the human microbiome is key in the treatment of many diseases, and no less so in rosacea, particularly considering the research which suggests that disturbances or alterations in the human microbiome can result in inflammatory skin disorders. For example, Helicobacter pylori is a bacterial pathogen commonly implicated in peptic ulcer disease, but some research is showing that this pathogen may also play a role in rosacea (1). This is an interesting finding, because it supports an age-old assertion in traditional medicine that what is happening in the skin can be a reflection of what’s happening in the gut. In a similar fashion, researchers have linked a condition called Small Intestine Bacterial Overgrowth (SIBO) to rosacea, demonstrating that when the antibiotic rifaximin is used to eliminate the bacterial pathogens from the small intestine, a significant proportion of patients with rosacea note an improvement in their condition (2).

Demodex mites in situ; isolated Demodex folliculorum specimen

Demodex: arthropods in your skin

Apart from the issue of gut health, it has been suspected for a number of years that rosacea could be the result of an infection with a tiny parasitic mite called Demodex (D. folliculorum, D. brevis). Although a normal part of the human microbiome, when the right factors are present, the population of Demodex can increase, resulting in an inflammatory reaction in the skin from both bites as well as the feces produced by the mites (3). Demodex in particular, thrives on the waxy sebum secreted by our skin, and when temperatures increase in the spring and summer, we produce more sebum, facilitating the growth of Demodex. This explains why rosacea seems to get worse with sun exposure or an increase in temperature. However, this association doesn’t explain why oily-skinned teenagers tend not to get rosacea, why rosacea seems to increase in prevalence with age, and why it is often associated with dry skin. One suggestion is that as we age, the skin becomes more dry, fragile and brittle, providing more opportunity and surface area for the Demodex mite to thrive (4). Certainly we see this same dynamic in other skin infections, such as toenail fungus, which grows into the cracks and fissures of aging, dehydrated skin. Likewise, it has been suggested that altered fat metabolism as we age results in the production of sebum and other factors that encourage the growth of Demodex. Thus, ensuring that the skin is properly hydrated is a key element in the treatment of rosacea, as is ensuring a proper balance of essential fatty acids in the diet, as well as promoting proper fat digestion. The key to getting rid of Demodex, however, is to take measures to restore digestion and the gut ecology, and using topical remedies that can kill the mites.

The role of altered immunity

Another feature to consider in rosacea is the issue of altered immunity. Rather than being a distinctly separate feature of rosacea, alterations in immune function that promote the inflammation of rosacea seem to be generally linked to gut health. Although the connection may seem obtuse, over 60% of immune cells are located in the gut wall, and thus when the gut ecology goes sideways, the impact is an upregulation of inflammation by the body’s immune cells. The idea that rosacea could be in part an immune disorder was given credence recently when researchers discovered that rosacea sufferers have greatly elevated levels of stratum corneum tryptic enzymes (SCTE), in conjunction with elevated levels and altered function of the antimicrobial peptide called cathelicidin.(5). When these two components are elevated, SCTE enzymes act on cathelicidin to give rise to peptides that directly promote skin inflammation. The trigger for the increased production of SCTE enzymes and cathelicidin appears to be a bacteria called Bacillus oleronius that has been isolated from the Demodex mite (6). The presence of this bacteria alters the function of toll-like receptors (TLRs) which are part of the body’s defense against microbes. Patients with rosacea have been shown to express an elevation in TLR activity, which in turn leads to increased cathelicidin synthesis. Interestingly, TLRs also play a role in vitamin D3 metabolism, enhancing the the enzymatic conversion of the precursor 25(OH)D3 to 1,25(OH)2D3, the active form of vitamin D3 in the body. This is important because 1,25(OH)2D3 also regulates cathelicidin production, and research has demonstrated that rosacea sufferers may have high serum vitamin D levels compared to controls (7), providing a direct link between sun exposure and the worsening of rosacea symptoms. Although it isn’t clear what factors alter TLR activity, some research suggests that glucocorticoid creams used to reduce skin inflammation enhances TLR activity, and thus may contribute to rosacea (8).

Putting it all together

While there clearly isn’t just one cause when it comes to rosacea, the research in combination with my own clinical experience suggests that rosacea is at its root an immunological disorder that is precipitated by a variety of factors, including diet, gut health, and lifestyle factors including skin care and sun exposure. Taking all this into consideration, this is a breakdown of how I approach a patient with rosacea.

1. Restoring a healthy microbiome.

In consideration of the role that our microbiome plays in immune health, it is vitally important to restore the gut ecology in rosacea. To achieve this, I typically recommend the consumption of lactic acid bacterial (LAB) ferments, such as sauerkraut, kimchi and pickled foods on a regular basis, about one cup daily eaten with food. I do not, however, recommend other kinds of ferments including SCOBYs like kombucha, as they inoculate the gut with unhelpful organisms such as yeast. In this regard, it is vitally important to make sure that the diet is low in sugar and refined carbohydrates when treating rosacea, as this will tend to promote inflammatory changes in the gut microbiome that are in turn reflected in the skin. If there are issues with SIBO, a diet low in fermentable fibers is helpful to limit bacterial growth, but more active measures may need to be undertaken to inhibit the pathogens involved, using antibacterial herbs such as neem leaf, garlic bulb, turmeric root, wormwood leaf, and Oregon grape root. Likewise, if you regularly take drugs that impair gut function, including antibiotics, NSAIDs, proton pump inhibitors, antacids and opiates, these can also play a big factor in SIBO, and hence contribute to rosacea. In addition to the consumption of live culture foods, I also have patients apply the pickle brine directly to the skin a few times a day, to inoculate the skin with lactic acid bacteria. These bacteria compete with pathogenic bacteria for nutrients, as well as produce inhibitory substances such as bacteriocins and organic acids that can kill or limit the growth of bacterial pathogens (9). Applying pickle juice to your rosacea seems like a rather unsophisticated and simplistic remedy, but I have found it very helpful in my practice to restore the health of the skin. Just remember that if you’re going to use the pickle juice topically as a probiotic, that you apply it to the skin AFTER you have applied treatments to kill Demodex, so as not to kill the probiotic organisms.

Azadirachta_indicaNeem (Azadirachta indica)

2. Dealing with Demodex

While not all cases of rosacea will involve the Demodex mite, the evidence that Demodex is an active player in many cases of rosacea is undeniable, although as I have stated, the bacteria that colonize Demodex may also play a role. Regardless, the goal here is to get rid of this infestation and prevent its recurrence. Remember, however, that Demodex is a normal component of our microbiome, so the measures we’re undertaking are meant to limit Demodex populations, not wipe them out completely. In part we can achieve this by using live culture pickle juice as I mentioned, and while this does encourage healthy skin, it isn’t directly lethal to the Demodex mite. For this purpose, we have a number of options, including herbs with miticidal (mite-killing) activities, including neem and wormwood, avoiding those which might otherwise be effective if they didn’t cause skin irritation (e.g. garlic) or temporarily stain the skin an unpleasant color (e.g. turmeric). As part of my protocol for dealing with Demodex, I have patients prepare a facial scrub and mask. For example:

  • coarsely ground green mung beans – 50 g
  • neem leaf, finely sieved powder – 50 g
  • white sandalwood, finely sieved powder – 50 g

Mix all the above ingredients together, and use a small handful with a little bit of water to make a paste. The paste can then be used as a facial scrub, gently rubbing the mixture over the affected area to exfoliate and remove the mites. If the area is too sensitive or irritated to use as a scrub, I have patients use the paste to make a mask, which is then applied over the affected area. When the mask dries, and starts to fall off about 15-20 minutes later, it can be gently removed with water. Both neem and sandalwood have miticidal properties and are anti-inflammatory, and in particular, the sandalwood has long been used in India as a skin care agent. Following this, I have the patient apply a tincture of miticidal herbs, such as neem, wormwood, black walnut hull, quassia and pau d’arco to the face with a cotton ball. Not only do the herbs kill the mites, but the alcohol from the tincture also has an inhibitory activity. Another excellent miticide is tea tree oil, which can be applied undiluted to the skin to inhibit Demodex, used by itself or in combination with neem oil.

Santalum_album_leaves_and_flowers_04Sandalwood (Santalum album), leaves and flowers

3. Restoring the skin

In traditional herbal medicine, the state of the skin reflects the health of the blood, which itself is a refinement of the foods we eat in our diet. Thus anytime we see skin issues, we need to direct our attention to the nature of our diet and the health of the gut. Overall, I tend to recommend a low-carbohydrate diet in rosacea, that is rich in nourishing fats, with plenty of leafy greens and bitter foods to upregulate the liver, and correct the altered fatty acid synthesis that plays a role in abnormal sebum production in rosacea. In this regard, avoiding oils and foods rich in omega 6 fatty acids is generally a good idea, as is taking a herbal remedy to upregulate liver function, including bile stimulants (cholagogues) such as Oregon grape root, dandelion, and bupleurum root. Likewise, because of the strong immunological role for rosacea, potentially antigenic foods including wheat (i.e. gluten) and dairy should be removed from diet. Sugar in particular is bad news for the skin, as most people can observe that when they eat sweets, they typically will have some kind of skin eruption. To help heal and moisturize the skin, I recommend avoiding conventional soaps and shampoos, which are extremely drying and irritating, and completely destroy the delicate bacterial ecology of the skin. We need to remember that a healthy bacterial ecology serves as a component of the immune system, so if we weaken our bacterial ecology, we essentially weaken our immune system. Instead of soap, I recommend the daily application of oil to the body, a practice in Ayurveda called abhyanga. When oil is applied to the skin it has a cleansing activity, saturating the surface and penetrating deep below the epidermis to rehydrate, dissolve grime, and exert a mild antimicrobial activity. Choosing the right oil, however, is an important consideration, as some oils such as coconut are comedogenic, and could cause pimples in some people. I don’t have any issue using coconut oil when the skin looks very dry and fragile, but otherwise, I tend to suggest non-comedogenic oils such as almond, apricot, sesame or castor oil. These oils can be rubbed on the face after treatment to rehydrate, and can be a carrier oil for essential oils such as lavender, which not only smells nice, but also has a mild miticidal effect. Another measure that is effective for restoring the skin is the regular application of mid-stream morning urine. This can be collected in a clean glass and applied fresh to the affected area with a compress or cotton ball. Although many will balk at the idea of putting urine on their face, it’s important to note that many skin cosmetics contain urea to take advantage of its unparalleled ability to moisturize the skin. Dry, flaky skin typically occurs due to a reduction in its urea content, and thus rosacea sufferers that exhibit these symptoms in particular will definitely benefit from this measure. Not only does urea and urine moisturize and hydrate the skin, it also helps to promote wound-healing, accelerating the process of cellular renewal, and also has some anaesthetic properties, reducing the irritation and burning sensations that often accompany rosacea. As a purely symptomatic measure, fresh aloe gel scraped from the leaf rind and applied as a fresh poultice to alleviate burning sensations and overcome dryness.

These are only some of the major recommendations I employ in the treatment of rosacea. One thing I haven’t spent much time talking about is the sun and vitamin D3, but it’s worth discussing further. As I previously stated, rosacea sufferers often experience a worsening of symptoms with sun exposure, and likewise, some rosacea sufferers may have elevated levels of circulating 1,25(OH)2D3. Although the research seems to imply that sun avoidance and limiting vitamin D3 is a good idea, it’s important to note that a significant proportion of rosacea sufferers in one study (i.e. 38%), had lower than normal levels of vitamin D3 (10). My suggestion here is to get your vitamin D3 level checked, and if it’s high, reduce your sun exposure and vitamin D3 supplementation accordingly. Otherwise, if you have rosacea, supplement with vitamin D3 to achieve optimal levels, and make sure to limit your sun exposure, wearing protective clothing and wide-brimmed hats in sunny weather. And in keeping with the recommendations of Ayurveda I discussed at the outset, try to follow a regimen that generally helps to reduce heat and inflammation (pitta), avoiding stimulants like caffeine, chocolate and alcohol, nightshades (e.g. potato, tomato, eggplant), pungent-tasting foods (e.g. chili, garlic, ginger), and sour-tasting foods such as yogurt, vinegar, and citrus. As you improve, however, these foods should cease to be an ongoing issue.

DSC_0005“Arthropods? On me?”

As a last note, I want to mention that pet owners may acquire Demodex mites from their pets, particularly if their immune system is weak. Although cats and dogs have their own species-specific mites such as D. canis and D. cati that aren’t supposed to jump to humans, I have seen several patients, including myself, acquire mite infections from their pets, even if the dog or cat is otherwise healthy. Remember, Demodex is a normal part of our shared microbiome, so just because a dog or a cat has mites doesn’t mean that they have mange or are unhealthy. But if you love to rub faces with your pet(s), let them sleep in your bed, or on your clothes, you are running the risk of infection. Thus, if you are a pet owner with rosacea, it might be time to change your lifestyle arrangement. Once the dog or cat is removed from your personal area, it’s also a good idea to thoroughly wash your sheets and clothes in hot water with borax and soap, and maybe buy new pillows. For the extra paranoid, you can apply diatomaceous earth to your mattress and areas surrounding your bed, but please make sure to wear a proper ventilator, because regardless of what the “authorities” say, inhaling DE or any super fine dust is really hard on your lungs.

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