Month: January 2024

The Elusive Body Recomposition Quest

The vegan fitness world is aflutter and atwitter about a new documentary miniseries on Netflix called You Are What You Eat: A Twins Experiment. The show follows a recent Stanford experiment in which pairs of identical twins were randomly assigned vegan and omnivore diets and their metrics were followed for eight weeks. Everyone I talk to about this is a certifiable fitness nerd–including myself–so here is the link to the actual JAMA publication and here is the write-up from the Stanford comms department. In the areas of cardiovascular health and telomere length, the subjects on the vegan diet did better than their omnivore twins:

At three time points — at the beginning of the trial, at four weeks and at eight weeks — researchers weighed the participants and drew their blood. The average baseline LDL-C level for the vegans was 110.7 mg/dL and 118.5 mg/dL for the omnivore participants; it dropped to 95.5 for vegans and 116.1 for omnivores at the end of the study. The optimal healthy LDL-C level is less than 100.

Because the participants already had healthy LDL-C levels, there was less room for improvement, Gardner said, speculating that participants who had higher baseline levels would show greater change.

The vegan participants also showed about a 20% drop in fasting insulin — higher insulin level is a risk factor for developing diabetes. The vegans also lost an average of 4.2 more pounds than the omnivores.

But when it got to weight and body composition, things got a lot trickier. A big challenge in comparing weight loss and muscle gain has to do with the distribution of macronutrients across the two diets: a higher consumption of protein supports muscle growth. I fished out the table from the supplement comparing the macro contents of the diets, which shows that protein provision and consumption among the vegan group was significantly lower than among the omnivorous group. This was true both for the Trifecta meals and for the self-provided ones.

On one hand, this sets up the vegan group to fail: they had fewer muscle building blocks than their omnivore counterparts. On the other hand, this situation may not be all that dissimilar to how vegans and omnivores eat in the wild. For all the good times we have mocking omnivores who inquire “where we get our protein,” when someone is actively strength training and striving to build muscle the quest for protein feels a little bit like nutrition Tetris. I should know: last year I read Stacy Sims’ wonderful book Next Level, about women athletes in perimenopause and menopause. Sims, who studies exercise physiology and is a leading voice in the quest to recognize the uniqueness of female physique (“women are not small men”), emphasizes the importance of lifting heavy, eating protein, improving explosive power through sprints and HIIT, and building strong bones through plyometric sets. It was because of that (and with the help of coach Celeste St. Pierre, as well as coaches Karina Inkster and Zoe Peled) that I changed my training regime quite dramatically. With the new emphasis on strength, I’ve joined the ranks of vegans who are strategic about the protein content of their meals. Sadly, the nutrition breakthrough study we are all waiting for, which will uncover the life-giving properties of pasta with tomato sauce, is not in the cards, and in addition to a lot of protein in my meals, I’m also emphasizing it in my snacks (more on that in a bit.)

But the problem of body composition is by no means endemic to vegans. As Prof. Gardner explains on the show, nutrition studies are notoriously untrustworthy because they require human compliance in areas that are difficult to measure. To try and counter this problem, the research team provided the twins with prepared meals from Trifecta for the first four weeks. The twins also received terrific strength coaching. But it turned out that the twins did not follow these plans to the letter. The subjects who were interviewed said that they skipped carbs (the meals seemed “too carby” to them) and added a lot of cardio to the strength workouts; the nutritionist scolded them for “wasting all that beautiful muscle” that they were building on the diet. Other subjects really struggled to eat enough to build muscle. This fantastic article by powerlifter and strength training coach Casey Johnston explains what’s what. If you’ll look at her avocado diagram, you’ll immediately grasp the problem with conventional dieting: one wants to lose fat, so one cuts calories, but in the process loses muscle as well. When one despairs of the diet and regains the weight, that weight is fat–so now one is bigger but has lost muscle. The next diet will lead to more loss of fat and muscle combined, followed by regaining fat but not muscle, etc. etc. In other words:

What I learned from the twins experiment is that reversing this trend by eating very little or by doing heaps of cardio is a quest destined to fail. For a while, at the beginning of a quest journey, beginners might see a change in body composition that encompasses both muscle gain and fat loss. But after that magical “newbie gains” period, body recomposition becomes much more elusive, and the only way to accomplish it is by periodizing one’s goals: spending a few months bulking (eating more, building more muscle *and* fat) and then a few months cutting (eating less but still strength training to lose the fat):

I know people whose lives revolve around lifting and the gym, and who can devote a considerable portion of their brain space to grams of protein and weightlifting sets. And if I had more time, I might become one of those people; as it happens, I’m working *and* studying full time, which is why I have paid people to do the thinking for me (I just follow the workouts on the app and try to watch my macros). Thankfully, we live in the future: some of my new snacks include conveniently packaged lupini beans and the most wonderful vegan Italian prosciutto and carpaccio (these are not cheap treats, alas. I really hope to see high quality vegan meats, etc., become less expensive in the very near future). The more profound aspect of this is that it is hard, but essential (I think), to leave behind the vacuous appearance-related aspirations and to make the journey about function: gaining muscle and becoming stronger is its own reward.

Here’s how I know: when my beloved father got ill, when I was training regularly, I flew out to be with him at the hospital, and packed a bunch of stuff in my wheelie bag, as I didn’t know how long I was going for. Or was it a trip to a conference? Anyway, it was when I was still increasing weights quite frequently from workout to workout. When I got inside the plane, I braced myself for the dreaded lift of the wheelie bag into the overhead compartment (“lady, do you need help?”). Reader, IT WAS CHILD’S PLAY. I was truly amazed at how much spending 20 minutes in my garage a few times a week improved my quality of life.

I’ve now spent a few months sitting on my butt and doing nothing in the exercise and fitness department: I’ve been busy with my new scholarly pursuits, and the grief and horror have been too great. But I’m not helping anyone, least of all myself, by eating things that make me unwell and letting go of my strength, mobility, and agility. So, it’s back on track for me. The dream of a dramatically chiseled and trim appearance is over. I’m going to focus my attention on aggressively improving my quality of life, so that I can continue to productively contribute my efforts to the world–raising my son, finishing my new schooling, launching a new scholarly adventure, forging a fresh career path, building new community–for many years to come.

The Zero-Sum Game of Epidemiology

One of the problems of siloed reporting is that, in times of serious conflict, each side can remain isolated from news of suffering and horror on the other side. It’s understandable that parties to the horrific war in the Middle East can’t muster the attention, let alone the compassion, to read news from the “other side,” which explains why a San Francisco man telling of the slaughter of five family members by Hamas was met with jeers, horns, and pig noises, and why Matt Dorsey’s request that the sexual violence against Israeli women be similarly denounced yielded yells “liar” from my fellow San Franciscans. In my very institution, an educated, erudite, well-dressed man, a former colleague of many years, stood before an audience of 200 and ascribed facts of the massacre to “disinformation.”

But the problem goes both ways, and the Israeli press is not reporting on the humanitarian crisis in Gaza (nor is it easy for international orgs to do so). The Israeli’s public’s attention and capacity to feel for Gazans is pretty low. And, as Itamar Mann explains, if there’s anything good about the Hague tribunal taking place as I write, it is that it airs some of these realities, which we ignore at everyone’s peril.

There’s one particular aspect to this disaster that we cannot and should not ignore, regardless of where one stand politically: the war is unearthing a serious public health crisis, including diseases. And as Chad Goerzen and I explain in our forthcoming book Fester, seeing disease through a siloed zero-sum game framework is a horrific mistake. Here’s NPR covering the WHO report about this public health crisis:

MARTÍNEZ: All right, wow, so really bad. How have things gotten so bad?

DANIEL: Well, Gaza’s health infrastructure has really crumbled amidst Israel’s bombardment and ground offensive. The WHO says more than half of Gaza’s hospitals are no longer functioning. And that’s because Israel has accused Hamas of harboring fighters and weapons in and around those hospitals and under them in tunnels, putting them in the line of fire [H.A.: this wording implies the accusations were not true; they were, of course]. Plus, the conditions inside Gaza are a perfect storm for the spread of infectious disease. There is intense overcrowding, colder winter weather and a lack of clean water, sanitation and proper nutrition, which are services that are difficult to secure under Israel’s near-total siege of Gaza. Here’s Amber Alayyan, deputy program manager for Doctors Without Borders in the Palestinian territories.

AMBER ALAYYAN: It’s just sort of a cauldron of possibility of infectious disease. This really just is an infectious disaster in waiting.

MARTÍNEZ: And that brings us back, I suppose, to the World Health Organization’s prediction that disease could endanger more lives than military action.

DANIEL: Exactly. And it’s why global health groups are racing to ramp up disease surveillance efforts.

Anyone getting sick and dying from a preventable disease in the shadow of conflict is a tragedy. There are heartbreaking reports of Gazan children suffering from horrendous diarrhea and infections. But when one is overwhelmed with grief and rage it’s hard to see that. What should not be hard to see, though, is that viruses and epidemics don’t take sides.

I’ve had plenty of opportunity to see the zero-sum game mentality in action. In Chapter 4 of Fester we recount the public debate about vaccination priority. You’ll be able to notice the same thinking error problem right away:

Advocates were trying to combat disturbing news: kowtowing to public pressure not to prioritize prisoners, CDPH removed prison populations from tier 1B of vaccination. This misguided zero-sum thinking—based, of course, on the myth of prison impermeability—reflected similarly worrisome developments nationwide. In Colorado, for example, the first draft of the vaccine distribution plan prioritized the prison population, but the governor later backtracked, “sa[ying] during a media briefing that prisoners would not get the vaccine before ‘free people.’” His response caused public uproar and was reported in national media outlets.

Similarly, in Wisconsin, parroting the old law-and-order playbook, assemblymember Mark Born tweeted, “The committee that advises @GovEvers and his department tasked with leading during this pandemic is recommend- ing allowing prisoners to receive the vaccine before 65 year old grandma?”

And, in Tennessee, health officials placed the state’s prison population last in line, because a state advisory panel tasked with vaccine prioritization, which acknowledged that prison populations were high-risk, concluded that prioritizing them could be a “public relations nightmare.” Documents reported that the panel understood the problem: “If we get hit hard in jails it affects the whole community. Disease leaves corrections facilities and reenters general society as inmates cycle out of their sentencing,” the document read, adding that when inmates get the disease, “it is the taxpayers that have to absorb the bill for treatment.” But while corrections workers were bumped up to one of the earliest slots, incarcerated people—including those who met the state’s age qualifications for earlier vaccinations—were relegated to the last eligible group.

I knew this was public health idiocy even as it was happening, and wrote an op-ed about that for the Chron. In addition to the heightened mortality and supbpar healthcare in prisons, there was another important consideration that should have led everyone, bleeding-heart liberals and hard-line law-and-order folks alike, to clamor for prison vaccines:

Second, prisons must be prioritized because vaccinating behind bars protects everyone in the state. It is imperative to understand the role that prison outbreaks play in the overall COVID picture of the state. As of today, all but two CDCR facilities have COVID-19 outbreaks, and numerous prisons have suffered serious outbreaks with hundreds of cases. Months of analysis I have conducted, superimposing the CDCR infection rates onto the infection in California counties at large, show correlations between pandemic spikes in prison and in the surrounding and neighboring counties. Vaccinating people behind bars protects not only them, but also you and yours.

The result was disastrous but predictable. In Chapter 5 of Fester we show how prison outbreaks impacted the overall COVID-19 picture in California. Our epidemiological analysis, which relies on the Bradford Hill criteria, included a counterfactual model in which the outbreaks in prison were controlled. The results were striking:

Together, these show that due to the extraordinarily high prevalence of COVID-19 cases inside CDCR facilities, particularly during the year 2020, these facilities had a large influence on their regions, far more than their rela- tively small population and isolation would suggest. Note the difference between the total casualties in Marin County with and without the counter- factual—58 deaths, 22 percent of the COVID-19 deaths in Marin for this period—and the difference between the total casualties in California with- out CDCR facilities—11,974 deaths, or 18.5 percent of the COVID-19 deaths in California for this period. Furthermore, the outbreaks in San Quentin and CDCR occurred before vaccinations were publicly available and before effective treatments for COVID-19 were developed, making them particularly high impact on mortality.

That’s close to 12,000 preventable deaths in the state of California–outside prisons–that are causally attributable to the outbreaks in prisons. We point this out because even people who can’t find compassion for their fellow Californians behind bars should wake up to the fact that, if the incarcerated population ails, all of us are put at risk.

Israeli newspaper coverage does not feature the dire epidemiological threat, because people’s attention is focused on the more direct existential risk from the war (especially with the possibility of a northern front becoming more and more real every day.) In the overall noise of political partisanship we could forget how densely populated the Middle East is, and how soldiers go in and out of Gaza. We also forget how easily epidemics travel the world and could quickly spread beyond the Middle East. I realize I’m speaking to a wall of partisanship, rage, and fear. I worry that the halt in the process of releasing hostages and prisoners is going to make this as much of a quickening sand situation as Lebanon was, and that eventually the public health outcomes will decide this conflict, to the detriment of everyone.

Spaghetti Courgetti with Vegan Crab

Looking for some light entertainment to help me sleep, I came across Mary Berry‘s new show Love to Cook. It’s sometimes difficult to watch cooking shows in which the ingredients are animal products, because the dissonance between the lightheartedness and the food served is hard to stomach (excuse the pun). But in this case, I watched the series armed with the notion that we live in the future, and in a world where hard-boiled vegan eggs and mushroom root carne asada exist (and are terrific) I can easily veganize whatever she makes.

Lucky for me, Mary Berry made an incredible dish that marries spaghetti, spiralized zucchini, and tinned crab–and I already know how to make fantastic vegan crab meat. It’s the same recipe as Melissa Huggins’ recipe for vegan crab cakes, minus the breadcrumbs, and you can make the whole batch and keep it in the fridge to make crab cakes or more pasta the next day. With a few substitutions, here are the ingredients:

1 cup cooked garbanzo beans
1 cup hearts of palm, drained
1 tbsp vegan mayo
1 tsp vegan worcestershire sauce
1 teaspoon lemon juice
1 teaspoon dijon mustard
1/4 cup sliced leek
1-2 nori sheets
1 tablespoon fresh parsley
1 tsp Old Bay seasoning

Toss all of these in the food processor, process until combined and a bit chunky, and keep in fridge.

Then, proceed to follow Mary Berry’s recipe for the spaghetti, substituting several hefty spoonfuls of the vegan mix for the crab meat. I’m a protein hoarder these days (back to strength training!) so I used Banza linguine. You’ll need

1 package Banza spaghetti or linguine
6 tbsp olive oil
1 large onion or two small ones, thinly sliced
1 red chilli, deseeded and diced (I used a tiny bell pepper, just for color, because I don’t like things that are too spicy these days)
2 garlic cloves, crushed
3 large zucchini (about 500g/1lb 2oz), spiralized into spaghetti-like strands, or, if you’re lazy like me, the already-spiralized variety available from Whole Foods
about 1/2-2/3 cup of the vegan crab mix
juice of ½ lemon
Small bunch of dill, chopped

While the Banza cooks in boiling water with some salt, heat up olive oil in wok and add onion, chili, and garlic, and wilt some, for about 3-4 mins. Then, add the zucchini and toss a bit (2 mins or so). After a couple of minutes, add the vegan crab mix and toss (2 mins or so). At this point, the Banza should be ready; drain and toss in the wok with everything else. Drizzle lemon juice and sprinkle dill to finish. Good stuff.