Monday, March 25, 2013

Drs. Francisco Cervantes and Marivic Torregosa, and the 2013 Ancestral Health Symposium

Last year I traveled to South Korea to give presentations on nonlinear structural equation modeling and WarpPLS (). These are an advanced statistical analysis technique and related software tool, respectively, which have been used extensively in this blog to analyze health data, notably data related to the China Study.

I gave a couple of presentations at Korea University, which is in Seoul, and a keynote address at a conference in Gwangju, in the south part of the country. So I ended up seeing quite a lot of this beautiful country, and meeting many people. Some of my impressions regarding health and lifestyle issues need separate blog posts, which are forthcoming.

One issue that kept me thinking, as it did when I visited Japan a few years ago as well, was the obvious leanness of the South Koreans, compared with Americans, even though you don’t see a lot of emphasis on dieting there. Interestingly, this phenomenon also poses a challenge to many dietary schools of thought. For example, consumption of high-glycemic-index carbohydrates seems to be relatively high in South Korea.

The relative leanness of South Koreans is probably due to a combination of factors. A major one, it seems, is often forgotten. It is related to epigenetics. This term, “epigenetics”, is often assigned different meanings depending on the context in which it is used. Here it is used to refer to innate predispositions that don’t have a primarily genetic basis.

Epigenetic phenomena often give the impression that acquired characteristics can be inherited, and are frequently, and misguidedly, used as examples in support of a theory often associated with Jean-Baptiste Pierre Antoine de Monet, better known as Lamarck.

A classic example of epigenetics, in this context, is that of a mother with type II diabetes giving birth to a child that will develop type II diabetes at a young age. Typically type II diabetes develops in adults, but its incidence in children has been increasing lately, particularly in certain areas. And I think that this classic example is in part related to the general leanness of South Koreans and of people in other cultures where adoption of highly industrialized foods has been relatively slow.

In other words, I think that it is possible that a major protection in South Korea, as well as in Japan and other countries, is the cultural resistance, particularly among older generations, against adopting modern diets and lifestyles that deviate from their traditional ones.

This brings me to Drs. Francisco Cervantes and Marivic Torregosa (pictured below). Dr. Cervantes is the Chief Director of Laredo Pediatrics and Neonatology, a pediatrician who studied and practiced in a variety of places, including Mexico, New Jersey, and Texas. Dr. Torregosa is a colleague of mine, a college professor and nurse practitioner in Laredo, with a Ph.D. in nursing and a research interest in child obesity.

As it turns out, Laredo, a city in Southwestern Texas near the border with Mexico, seems like the opposite of South Korea in terms of health, and this may well be related to epigenetics. This presents an enormous opportunity for research, and for helping people who really need help.

In Laredo, as well as in other areas where insulin resistance and type II diabetes are rampant, there is a great deal of variation in health. There are very healthy folks in Laredo, and very sick ones. This great deal of variation is very useful in the identification of causative factors through advanced statistical analyses. Lack of variation tends to have the opposite effect, often “hiding” causative effects.

Drs. Cervantes, Torregosa, and I had a presentation accepted for the 2013 Ancestral Health Symposium (). It is titled “Gallbladder Disease in Children: Separating Myths from Facts”. It is entirely based on data collected and analyzed by Dr. Cervantes, who is very knowledgeable about statistics. Below is the abstract.

Cholesterol’s main role in the body is to serve as raw material for bile acids; the conversion of cholesterol to bile acids by the liver accounts for approximately 70 percent of the daily disposal of cholesterol. Bile acids are then stored in the gallbladder and secreted to aid in the digestion of dietary fat. It is often believed that high cholesterol levels cause gallbladder disease. In this presentation, we will discuss various aspects of gallbladder disease, with a focus on children. The presentation will be based on data from 2116 patients of the Laredo Pediatrics & Neonatology. The patients, 1041 boys and 1075 girls, are largely first generation American-born children of Hispanic descent; a group at very high risk of developing gallbladder disease. This presentation will dispel several myths, and lay out a case for a strong association between gallbladder disease and abnormally high body fat levels. Gallbladder disease appears to be largely preventable in children through diet and lifestyle modifications, some of which will be discussed during the presentation.

Many people seem to be unaware of the fact that cholesterol production and disposal are strongly associated with secretion of bile acids. Most of the body's cholesterol is used to produce bile acids, which are reabsorbed from the gut, in a cyclical process. This is the reason behind the use of "bile acid sequestrants" to reduce cholesterol levels.

The focus on gallbladder disease in the presentation comes from an interest by Dr. Cervantes, based on his many years of clinical experience, in using gallbladder disease markers to identify and prevent other conditions, including several conditions associated with what we refer to as diseases of affluence or civilization.

Dr. Cervantes is unique among clinical practitioners in that he spends a lot of time analyzing data from his patients. His knowledge of data analyses techniques rivals that of many professional researchers I know. And he does that at his own expense, something that most clinical practitioners are unwilling to do. Dr. Cervantes and I will be co-authoring blog posts here in the future.


dearieme said...

Since I have nothing to say about these good people, will you indulge me with an off-topic question?

I see many references to the merits of the Mediterranean Diet. Yet when I've visited Italy, I've seen large consumption of bread and huge consumption of pasta. I rather doubt that that's what medical people mean by a Mediterranean Diet. Am I wrong to doubt it?

Ned Kock said...

Hi dearieme. The Mediterranean Diet is, to the best of my knowledge, mostly centered on consumption of olive oil, legumes, vegetables, fruits, dairy in the form of cheese and yogurt, and seafood. Wheat-based products are part of it, certainly not its focus, and with an emphasis on unrefined products. It is hard to go wrong with a diet like this; it is a diet with a relatively high nutrient-to-calorie ratio.

Unknown said...

I come from the Mediterranean part of Turkey. I have been to Greece and Italy and these countries/regions have similar diets.

I have to say this: Yes, bread is a big part of Mediterranean diet. And it`s wheat bread.

When this is the case, it becomes very difficult to blame wheat and wheat products:)

Stipetic said...

I've lived in Greece for the past 12 years. In my experience, bread is almost exclusively used to soak up the "papara" at the bottom of the Greek salad bowl (olive oil and tomato juice mixture). Otherwise, almost as much bread is cleared from the table as was put on it to begin with. Bread has a symbolic nature. It reminds the old people of lean times, thus making them appreciate times of aplenty. There are two things present at every meal: olive oil soaked foods and feta cheese.

My dad lived in 1950's Naples, Italy, and has similar memories(pizza, which was a small crust with a bit of tomato sauce on top--and pasta were small-portioned appetizers).

Today, the Mediterranean diet has devolved as can be seen by the increasing obesity rates in both countries (mainly Greece, however).

gallier2 said...

Same in France. While baguette is highly appreciated and considered important (culturally), it is objectively not that central to meals. The official statistics say that French consume 130g/day of bread, but that doesn't mean that the whole 130g are eaten. I have observed very often in restaurants and canteens, that many people waste much bread during meals, using only the white and disposing of the crust or simply using the bread as an eating ustensile. A food pusher to get difficult items on the fork.

Unknown said...

Interesting observations. My experience is completely different. Maybe I should have said "wheat consumption"

I think the best way is to check the stats. I tried to find wheat consumption per country, per capita etc, but I couldn`t find a good source showing wheat consumption in different countries.

Then, I found this:

Italy is #1 and Greece #4. Even France is in the list. There is no country from Asia.

Pasta is made of wheat (over 90%). Then, how can we explain Italy`s Mediterranean diet dilemma? Or is there no dilemma at all?

Unknown said...

I should also add that Italy is the birthplace of pizza. Pizza's main ingredient is refined grain (flour) and Italy should be on top of the list of pizza consuming countries.

What I have been reading lately is that refined grains are bad for us.

Ned says he lost a lot of weight, he feels better by eliminating refined grains from his diet in addition to some other factors like using the right oils (e.g. coconut oil), exercise etc. And I believe him because when I eliminate wheat products from my diet, I lose weight, I feel better as well.

However, I believe there must be a solid explanation about why Mediterranean is healthy even though it includes refined grains in pastas and pizzas in Italy.

J. Stanton - said...


Health, as related to diet, is not a matter of "you must do everything perfectly, or you will be just as sick as someone who eats only food purchased at gas stations." There are many, many diets which are healthier than the Standard American fact, I'd wager the standard diets of most countries are healthier. That doesn't mean the typical Italian diet (or any other diet) is just means it's somewhat less bad than the typical American diet.

(This is the standard metric used to paint whole grains as "healthy": they're compared to refined grains, not to grain-free alternatives.)

There exist many other complicating factors. To choose just one, dose-response curves aren't linear, and Americans still eat a lot of bread, pasta, and wheat products. It might be that eating slightly less wheat with every meal doesn't improve health, and that the benefits are only seen when consumption is reduced more the point where the frequency of its consumption drops measurably, not just the amount per meal.

These are just a few of the problems one encounters when trying to derive useful information from population studies...and since I'm edging into Ned's field, I'll stop here.


Congratulations on your upcoming presentation! Mine was accepted, too, so I'll see you again this year. Let's make sure we block out more time to talk than we managed last year.


Ned Kock said...

Very valid points Ugur. It is a complex, multi-faceted issue, depending on the nature and extent of refining, the overall food mix, and other factors.

Part of the solution to this puzzle can be found in the extent to which wheat-based products displace other nutritious foods:

If someone uses bread to soak up low-calorie nutrient-rich broths, for example, the impact that bread has in his or her health may be significantly different than if bread is consumed by itself.

Eat bread with margarine, and you have a nasty combination of high-calorie, very high industrialized omega-6 fat intake, with very low nutrition value.

Ned Kock said...

Congrats JS! We’ll meet again soon. Definitely, let’s coordinate as we get closer to the date.

Stipetic said...

Great points as always J and Ned (and good luck to both of you at AHS). When will they have a European-based AHS? ;-)

Ugur, as a tourist maybe you ate or noticed a lot of tourists eat pizza and pasta, I don't doubt it. Italy is a great tourist destination and caters to tourists. What I'm saying is that the Italian's themselves, at least traditionally, ate both pizza and pasta in small portions as these were appetizers. Pizza only had tomato sauce on it and pasta was eaten plain with butter. The main meal was typically meat, during times of availability. Breakfast was predominantly eggs, which has now been replaced with cereals, etc.

I don't doubt stats showing wheat "consumption" up in Italy and Greece. I think this is based on food disappearance data rather than actual consumption (especially in Italy, who are still rather a lean people). So, I don't trust this type of data. Regardless, I don't doubt for a second that wheat consumption is up in these countries. It's just not as prevalent as people might have it.

Greece has now surpassed the UK as the fattest people in Europe, so something has gone on in Greece in the last 30 years to account for this (my money is on processed goods, which were hard to find 30 years ago, but are everywhere now and corn/sunflower oil which is popular now despite olive oil still constituting 80 percent of the store ailes. And sugar...them sweet goods--a lot of them Turkish, like baklava, etc--are everywhere). Anyway, it was nice discussing this with you. All the best.

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David Isaak said...

To neglect bread and get back to the gallbladder, there have been many studies that associate gallstones with large and rapid weightloss.

If I recall, there was a study published a few years back (I can no long seem to lay my hands on it--it may have been in the journal "Gut") that found this problem only occurred with rapid weightloss on low-fat diets. Makes sense to me--eating fat empties bile from the gallbladder.

Do you or your medical pals know anything about this?

Ned Kock said...

Hi David. Gallstones are relatively common in those who are morbidly obese and lose weight after a bariatric procedure:

I have not heard of it being associated with weight loss due to dieting, but that may be because there are no studies on it. You brought up an interesting issue.

Often patients recovering from a bariatric procedure will also have severe limitations on what they can eat without feeling ill, fatty foods being among them.

Ned Kock said...

Another study investigated gallbladder “emptying and GS formation were assessed using ultrasonograms preop and at 3, 6, 9, and 12 months postop …”, and they found “no differences in emptying between groups”. So the problem may be specifically related to the bariatric procedure; a whopping 71 percent developed gallstones. Here is the link:

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