Some musings on meal times

Some musings on meal times

One of the central tenets of eating in traditional medicine, is that we probably eat too much. According to an ancient Chinese legend, when the people of earth were starving the Emperor of Heaven gazed down upon them with compassion, and called the Ox god to him. “The people are starving,” the Emperor said, “but if they work hard they could produce enough food to eat once every three days. Please fly down to earth and tell them this message.” The Ox god did as he was told, and on his way flying down from Heaven, began to recount what the Emperor had told him. “Oh my, what did he say again?” the Ox god asked himself. “If the people work hard, they can eat… hmm… three times…? Yes, that’s it! They can eat three times a day!”

When the Ox god arrived on earth, he called all the people to him, and told them that the Emperor of Heaven said that if they work hard they can produce enough food to eat three times a day. The starving people were overjoyed with the news, and the Ox god feeling happy and satisfied, flew back to Heaven. When he arrived, however, the Emperor was furious. “Why did you tell the people to eat three times a day?” the Emperor glared at the Ox god. “That is more food than they can produce by themselves!” So as punishment for his grievous error, the Emperor sent the Ox god back down to earth, and compelled him to become a plough animal, to till the soil so the people could plant enough food to eat three times daily.

chinese ox

In Ayurveda too we also find a similar idea, that it is better to eat less food, less frequently, suggesting that if we are otherwise healthy, we should only need to eat twice daily. This is also reflective of the dietary pattern of pre-agrarian peoples, including the First Nations and other indigenous peoples that traditionally subsisted on hunting and gathering, observing a morning and late afternoon meal. And despite the oft-repeated recommendation by modern nutritionists, to eat 5-6 small meals a day, the science demonstrates exactly the opposite, suggesting that eating less food, less frequently appears to enhance longevity. This research has sparked a lot of interest in the subject of intermittent fasting.

While I continue to view the calorie-model of nutrition as overtly simplistic, there are some basic principles of physics at work here. The notion that acquiring food energy in excess of our metabolic need for it – whether its a protein, fat or carbohydrate – will cause metabolic problems such as obesity and diabetes isn’t at issue here. But what are we to make of a recently published study, widely reported in the media, suggesting that meat consumption is specifically at play?

According to the paper originally published by JAMA, researchers found that a “high animal protein intake was positively associated with mortality and high plant protein intake was inversely associated with mortality”. In the conclusion of the paper, the researchers suggested that by substituting plant protein for animal protein we could lower the overall risk of mortality. The problem with this study, however, is that the conclusions aren’t supported by the data. First off, this is an epidemiological study, utilizing nothing more than a questionnaire to find broad associations between factors such as diet and lifestyle. While the authors should know better than to make such claims, it’s very clear that the science-naive journalists who report on these studies have never learned that association does not equal causation. I have addressed this issue elsewhere, for example, when I examined the issue of bacon consumption being linked to cancer:

In the present study, the link between meat consumption and disease risk probably has less to do with diet than with health consciousness generally. For example, people that consciously eat more vegetables are more likely to be health aware over all, drinking less alcohol, not smoking, and taking care to get regular exercise. In fact, when these variables are taken into account, the paper in JAMA suggests as much, stating that “these associations were confined to participants with at least 1 unhealthy lifestyle factor based on smoking, heavy alcohol intake, overweight or obesity, and physical inactivity, but not evident among those without any of these risk factors.” This is apart from the fact that the purported risk from consuming a 10% increase in animal protein intake is linked to a 2% increase in overall mortality, which is by any measure, statistically insignificant.

Unlike the specious conclusions of this kind of armchair research so widely reported in the media, when researchers actually roll up their sleeves and conduct clinical research, the results they report are consistently contradictory. This type of research, which is the gold standard when it comes to scientific validation, demonstrates that diets rich in animal products confers a metabolic advantage over the alternatives, decreasing the risk of obesity, diabetes, cardiovascular disease, and dementia, consistently out-performing high carbohydrate diets. This evidence is further bolstered by a huge body of frequently ignored evidence demonstrating a clear link between metabolic issues such as obesity, and excess sugar/carbohydrate consumption. This correlation between carbohydrates and metabolic issues is so powerful that even following a healthy lifestyle pattern, such as regular exercise, isn’t sufficient to ameliorate its effects. Thus if you want to dramatically reduce your risk factors for disease, reduce the amount sugar and simple carbohydrates in your diet – and don’t worry about the animal products.

I began this piece today by talking about meal time frequency, relating the Chinese legend of Ox god messing up the instructions given to him by the Emperor of Heaven. So please don’t think that while I advocate for continuing to include animal produce in the diet, as humanity has for millions of years, that I am talking about over-eating. In fact, the way I get people to eat LESS in their diet, is by eating MORE fat and protein in the morning for breakfast, eating very little or nothing during the day, and enjoying a lighter, carbohydrate-rich meal for supper. As the saying goes, “breakfast like a king, dine like a pauper.” I discuss this dietary pattern in greater detail in an earlier blog on breakfast, and it remains one of the most important recommendations I can make to improve both physical and mental health.

By the way, there’s also no reason why this same approach can’t be undertaken in a vegetarian diet. I have had several patients over the years for whom this was a dietary restriction. As long as they were comfortable eating dairy and/or eggs, it is something I can work it. There’s also precedent for the practice of a low-carbohydrate breakfast in India, unlike the sweet foods that most eat today. For example, drinking large amounts of dahi (fresh liquid yogurt) was a traditional breakfast food eaten in the Punjab. Likewise in the south of India, a fermented steamed rice cake, traditionally made partially milled rice and urad dal, was eaten with a spicy vegetable lentil soup and generous mounds of fat-rich coconut chutney. Eating this way is also more appropriate in warmer climates, and during warm seasons, where animal foods aren’t required to the same degree to maintain the natural heat of the body.

Spicy Saag – Nettle style

Spicy Saag – Nettle style

A few days ago on facebook I wrote little post on Nettle, and how it could be used as a substitute for a recipe in Food As Medicine called Spciy Saag. Well, yesterday I went into the forest and harvested nettle, along with some miner’s lettuce (Claytonia sibirica) and cleavers (Galium aparine) which all grew in the same area. It’s amazing how many wild edibles there are, probably growing in your backyard. For this recipe, any green vegetable can be used, although Nettles are particularly favored due to their high nutrient content.  Here’s a little history on Nettle, taken from my monograph at

Nettle has a long history of use all over the world as a food, medicine and textile fiber. Weiss properly calls Nettle a ruderale, meaning that it tends to grow around human settlements (1988, 261). Grieve states that the common name of Nettle is derived from the German noedl meaning ‘needle,’ possibly from its sharp sting, or in reference to the fact that it once furnished thread and cloth before the introduction of flax and hemp into Europe (1971, 575). ‘Net’ is stated as being the passive participle of ne, a verb that in many Indo-European languages such as Latin and Sanskrit, means ‘sew’ or ‘bind,’ respectively (Grieve 1971, 575). Nettle was at one time highly esteemed as a textile fiber, and is highly durable, once thought to be the only real equivalent to cotton, used by the third Reich during the second world war as a textile in manufacture of German uniforms (Grieve 1971, 575; Wood 1999, 482). Beyond its importance as a fiber however, Nettle has long been regarded as an important and nutritious green vegetable, one of the first edible green growing things of spring, picked young and eaten steamed or in soups, said to be a good corrector of the bowels. The body of the famous Tibetan yogi Milarepa is said to have turned green from consuming nothing other than Nettle during his meditations. Despite being classified as a weed in many parts of the North America, Nettle was at one time highly prized commodity in rural areas, where the English poet Campbell recounts of his travels, “In Scotland I have eaten nettles, I have slept in nettle sheets, and I have dined off a nettle tablecloth” (Grieve 1971 575). More recently Nettle has been used as a commercial source of chlorophyll, and Weiss states that this color has been used in Germany as a food coloring agent for canned vegetables (1988, 262; Mills and Bone 2000, 490).

Here is the recipe for Spicy Saag, from Food As Medicine:

Saag refers to any kind of stir-fried greens in Indian cookery, prepared with the characteristic Indian spices such as cumin and black mustard seed. While spinach is most commonly used nowadays, saag can be made with any kind of greens, such as amaranth greens found in Chinese markets as hin choy and Indian markets as chaulai. I frequently use the kale and chard in my garden. To boost the nutrient content, I also add in other herbs such as fresh cilantro and fenugreek (methi), or use curry leaf instead.

1-2 lbs of amaranth greens, chopped into 1 inch chunks
½ bunch finely chopped fenugreek (methi)
½ bunch finely chopped cilantro; or, 1-2 sprigs of curry leaves
one-thumb sized piece of fresh ginger, grated
1 tbsp cumin
1 tbsp black mustard seed
½ tsp hing powder
2 tbsp coriander powder
½-1 tsp turmeric
½-1 tsp black pepper
1-2 tsp pink salt (sanchal)
2-3 tbsp ghee

Melt ghee in a wok or large saucepan at medium heat, and when it begins to glisten add in fresh ginger, cumin and black mustard seed. If you are using curry leaf instead of cilantro, slide the leaves off the curry sprig and into the pan. When the mustard seeds just begin to pop, add in hing, coriander, turmeric, black pepper and pink salt. Stir for a half minute and then add in amaranth greens, turning the heat up a little higher. Cook veggies for about 2-3 minutes on high heat, then reduce it back to a medium heat. Continue to cook, stirring frequently, just until the leaves turn a bright, brilliant green. Serves 2-4 people.

For variations, use different herbs and spices. Have a little gas? Add some ajwain, crushed fenugreek seed or fennel seed. Maybe today the kapha is a little thick and heavy? Add in some red chili powder. Or instead of cilantro or curry leaf, try some Thai Basil instead.

Raw Food Reality Hour

Raw Food Reality Hour

A few months back I addressed the issue of veganism in my blog, and provided a series of snippets and references from my book, suggesting that a long term vegan diet – especially in women and children – can be dangerous. This post generated a fair amount of reaction by vegans, but it also opened up the possibility of a more nuanced, well-reasoned approach to this issue. Today I want to continue this debate, by addressing the issue of raw foodism. The following is taken from my book, Food As Medicine, and is a compilation of my thoughts on this issue:

Today there are an increasingly large number of people claiming that raw food is the best way to eat most or all of your food, informed by the theories of early 20th century advocates such as Edward Howell, Ann Wigmore and Herbert Shelton.  Like veganism raw foodism has become a kind of underground social movement that equates social change with dietary choice.  Broadly speaking raw foodists usually lay claim to one or two camps: those that only eat raw vegetable foods such as raw vegans, fruitarians and sproutarians, and the other that also or exclusively eats raw animal products.

Historically there are very few examples of raw food cultures.  One notable example are the Inuit peoples, an aboriginal group of northern Canada called ‘Eskimo’ (‘eaters of raw meat’) by their southern Cree neighbors.  While it is true that the Inuit do eat some raw fish and meat, the idea that they traditionally ate raw food exclusively is contradicted by ethnographic reports.[i] Besides the Inuit the only other indigenous groups that regularly eat raw meat also live in circumpolar regions, where frigid temperatures prevent against microbial growth and food-borne illness.

Raw foodism maintains several arguments, central of which is the idea that raw food contains vitally important enzymes that aid in digestion, and that by cooking food we destroy them.  Taken at face value this theory seems to have a rational basis, but it doesn’t account for the fact that the body produces far more enzymes in its digestive secretions than are found in the food itself.  If it were true that these enzymes were necessary for digestion it would stand to reason that the body would not need to produce its own enzymes, when in reality the body produces up to five liters (1.3 gallons) of digestive juices on a daily basis.  Like all proteins, enzymes are denatured and digested in the gut into their constituent peptide fragments, rendering them devoid of any significant enzymatic activity.

Raw foodism suggests that raw food has a higher nutrient value than cooked food, but what this fails to take into account is the issue of bioavailability.  While cooking does reduce the nutrient content in some foods, it dramatically enhances nutrient bioavailability, offsetting any loss in nutrients by reducing the energy required for digestion and assimilation. According to anthropologists humans have been cooking food for more than a million years, and in the process have undergone both anatomical and physiological changes that reflect our reliance upon it.[ii] Compared to our primate cousins, humans have a much smaller gut and yet characteristically larger brains (i.e. a higher encephalization quotient).  Research suggests that cooking enhanced the efficiency of nutrient absorption, allowing for the evolution of a much smaller absorptive surface and hence smaller digestive tract, while at the same time boosting the energy intake required for the characteristically larger and more complex human brain.[iii]

Some raw foodists also believe that cooking destroys naturally occurring microbes such as Lactobacilli that support gut health and prevent disease.  Unless the raw food has been fermented to allow these “friendly” bacteria to out-compete other microbes however, raw food may also contain pathogenic bacteria such as Campylobacter, Clostridium, Salmonella and Escherichia coli. Other potential pathogens in raw food include pathogenic viruses (e.g. norovirus, enterovirus, hepatitis A virus), pathogenic fungi (Aspergillus, Fusarium) and parasites (Giardia lamblia, Entamoeba histolytica) that can cause both acute and chronic illness.  In contradistinction to the claim that raw food is healthy, there are an estimated 76 million food-borne illnesses each year in the United States, accounting for 325,000 hospitalizations and 5,000 deaths, all from eating raw or improperly cooked food.[iv] This is not to suggest that raw food is necessarily unhealthy, but that there are certain risks that need to be taken into consideration.

The last of the major arguments put forward by raw foodists is that cooking food results in the formation of toxins including glycotoxins, heterocyclic amines, transfats and nitrosamines.  Here the argument for raw food finds its most strength, but much of this concern relates to specific cooking methods rather than cooking itself.  In some instances raw food does have apparent benefits over cooked food, but these theoretical issues need to be weighed against empiricism and traditional practices.  Although often couched in simplistic terms, the issue of raw versus cooked food isn’t as black and white as many believe.

From a traditional medical perspective raw food can be eaten as part of a healthy diet but always with an eye to the nature of the food and the capacity of digestion.  According to Ayurveda people that have strong digestion (pitta) can usually tolerate raw food on a regular basis, but consuming raw food all the time aggravates the quality of coldness in the body (vata, kapha), diminishing digestive activity and vital energy – a notion supported by anthropological evidence.[v]Although support for a raw food diet is weak in traditional systems such as Ayurveda and Chinese medicine, raw food has special therapeutic application in the treatment of disease and in particular to promote detoxification (p. 216).

[i] Stefansson V. 1913. My life with the Eskimo. New York: MacMillan p. 176-8.  Available online:

[ii] Wrangham R, Conklin-Brittain N. 2003. Cooking as a biological trait. Comp Biochem Physiol A Mol Integr Physiol. 136(1):35-46.

[iii] Carmody RN, Wrangham RW. 2009. The energetic significance of cooking. J Hum Evol. 57(4):379-91

[iv] Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. 1999. Food-related illness and death in the United States. Emerg Infect Dis. 5(5):607-25

[v] Boback SM, Cox CL, Ott BD, Carmody R, Wrangham RW, Secor SM. 2007. Cooking and grinding reduces the cost of meat digestion. Comp Biochem Physiol A Mol Integr Physiol. 148(3):651-6