NNR5 Chapter Energy

NNR5 Chapter Energy 

My answer to the NNR5 Public Consultation on Energy

 

 

The human organism is always striving for survival and homeostasis. In order to survive the person needs to eat food. Food consists of macronutrients and micronutrients.

 

The micronutrients are covered elsewhere.

 

The macronutrients are the energy suppiers as well as building material for the body.

There are three macronutrients, protein, fat and carbohydrates. They all contain carbon as an energy source.

 

Protein

Proteins consist of the building blocks amino acids. There are about 20 amino acids in the animal body. Humans can make about ten amino acids from scratch and the remaining about ten amino acids the person has to eat to be able to use them. So protein is an essential part of the food. Without protein we will not survive for long.

 

The amount of protein in the food should be at least 0.5 grams of animal protein per kg body weight. This is enough for a newborn child to increase 50 % in length during the first year and should be enough for the rest of the life [1].

 

We have a limited storage facility of free amino acids. Any excess of protein is deaminated and the rest is converted to short fatty acids or short alcohols that can be used in the metabolism.

 

Those short fatty acids and short alcohols can enter the central metabolism in the body, more about that later.

 

We have tens of kg of muscles with about 20 % protein.

 

On the cellular level cells contain a lot of different structural, signalling, building and other kinds of protein molecules, all necessary for survival. Muscle cells contain great amounts of contracting proteins to be able to move the body and parts.

 

No normal animal protein is toxic to humans.

 

Fat

The major functions of fat is energy production, energy source, energy storage and padding delicate organs in the body.

 

We have tens of kg of fat in the body. We can store several hundred kg of fat.

 

Fats consist mainly of triglycerides (three fatty acids connected to a glycerol molecule) but there are free fatty acids, monoglycerides, diglycerides, phospholipids as well as other lipids and lipid like molecules.

 

The major composition of fat is shy of 50 % saturated fats (SAT), shy of 50 % monounsaturated fats (MUFA) and the rest, about 5 %, is polyunsaturated animal fats (PUFA) with carbon atom numbers of at least 20 C.

 

The fatty acid composition is about the same for all warm blooded animals as they have the same body temperature around 37ºC. This is because fats must have a correct melting temperature for proper function. Arctic fish have much higher PUFA concentration as PUFAs have much lower melting temperature compared to animal fat.

 

This is shown beautifully by placing butter, olive oil and canola oil taken from the fridge on a plate and let it sit on the table. The canola oil is still liquid at fridge temperature, the olive oil is partly solid at fridge temperature and the butter is definitely solid at fridge temperature.

 

At room temperature both oil fats are liquid but butter is solid. When temperature rises above 30º C then also butter melts into liquid form.

 

So arctic fish must have higher concentration of PUFA to survive due to it’s lower organism temperature.

 

Salmon has 3.3 g PUFA and bacon has 2.8 g PUFA. This means that 100 g salmon can be replaced by 118 g bacon to achieve the same amount of PUFA. Also 100 g salmon can be replaced by 35 g lard.

 

So as long as we eat animal fat we will always get enough PUFA.

 

We also have to realize that vegetable PUFAs usually are nonelogable to animal long chain PUFAs in our body. Vegetable omega-6 are inflammation producing and if more than 20 g per day also causing cancer, well known by the old transplantation surgeons as well as Livsvmedelsverkets civil servants.

 

Animal fats in the form of phospholipids are essential to our cell membranes as they separate cells and organelles form each other and intracellular as well as extracellular environments. Also in all membranes there are about the same number of cholesterol molecules as phospholipids molecules to make the cellular and other membranes stable and supportive.

 

So the lipids of all kinds are essential to life.

 

Lipids and fats are also necessary making up the cushioning around delicate structures in the body. Fat is also an excellent energy source for the body.

 

Also fat tissue and fat cells in muscles is normally the major source of acetylcoenzyme A (AcCoA or activated acetic acid) which is the only energy producing molecule in the cellular mitochondria. See the Krebs cycle for more biochemical and energy details.

 

This means that all animal fat are essential to us and they are nontoxic as they consist of the same fats in the same proportions as our own fat. The animal fats also requires the least remodeling and exchange due to the same reason.

 

Fat is also the most energy dense macronutrient so persons can eat smaller portions to have enough energy. Also, fat is the most satisfying macronutrient.

 

Carbohydrates

 

Carbohydrates are the third kind of macronutrients. Carbohydrates consists of sugars. So carbohydrates are equivalent to sugars.

 

Fibers consists of polymers of glucose that no warm blooded animal can digest. Herbivores are using microbes to digest fibers like cellulose to short chain fatty acids, less than 7 carbon atom long chains. Those short or volatile fatty acids are completely water soluble and can thus be taken up directly in the blood and then transported directly to the liver for further use and can enter the central metabolism in the body, more about that later.

 

Humans are unable to digest fibers as we lack the fermenting microbes and fermentation tank like the 1 hL four parted ventricle of a normal cow.

 

So fibers lack energy in humans, easily contolled by eating pure fibers and check the lack of hydrogen gas production the digestion of fibres always cause.

 

Starches all consists of polymers of glucose easily degraded in the intestinal tract by a lot of enzymes down to single units of glucose.

 

Other common disaccarides are sucrose (consists of glucose and fructose), lactose (glucose and galactose), maltose (glucose and glucose). Disaccarides can not be absorbed by the intestines, so they have to be digested by common enzymes to their monosaccarides. Those monosaccharides like glucose (most abundant), galactose (animal sugar) and fructose (vegetable sugar).

 

A human of 70 kg has a low glucose concentration of 3-6 mmol/L in the blood to supply the Red Blood Cells (RBC) with energy as RBC lack mitochondria.

 

The normal blood concentration of 3-6 mmol/L is equal to the amount of 1.5 to 3 grams of glucose in the total blood volume of 5.6 L.

 

The RBC utilize glucose anaerobically via the RBC-specific Rapoport-Luebring pathway including 2,3-diphosphoglycerate (2,3-DPG) that is required to release oxygen from the hemoglobin molecule. Then the 2,3-DPG is transformed to lactic acid and 2 molecules energy rich ATP.

 

When having 5 g glucose, without insulin and a theoretical immediate uptake, the glucose level will increase to around 15 mmol/L which is a toxic concentration of glucose.

 

By having more than 15 to 25 g glucose in the blood (>30-50 mmol/L) the normal person will very shortly die from acute glucose intoxication.

 

Glucose and fructose are toxic at higher concentrations than 6 mmol/L the monosackarides are nonenzymatically glycating the lysine amino acid residue in proteins and thus changing the morphology and may change the function of the protein.

 

The most famous glycated protein is HbA1c where the attached glucose/fructose molecule destroys the oxygen transport function of hemoglobin.

 

This glycation of proteins is the major problem with carbohydrates.

 

When the person has carbohydrates the blood glucose rises immediately which releases insulin. The insulin has a lot of actions in order to normalize the blood glucose level. The insulin slows down the intestinal uptake of nutrients, inhibits the AcCoA production from fat and protein because the monosaccaride concentration just has to be normalized as the body otherwise will die from acute monosaccaride intoxication.

 

Read more about the wonderful insulin molecule and functions at reference below [2] .

 

There are no essentiality of eating carbohydrates. All sugars the human body needs is happily produced by the liver. And the liver can always produce enough sugar.

 

The logic behind NNR4 recommendation to have 50-60 % of the energy (%) is totally missing. As excess of carbohydrates increase the insulin level for long times thus decreasing the fat energy expenditure and that carbohydrates are partly converted to fat and thus increasing body weight the amount of carbohydrates has to be minimized.

 

It is also after the introduction of NNR with a in the 1980-ies that the epidemy of diabetes and obesity rose inexplicably. The only change in the environment is the exchange of fat to carbohydrate as major energy source.

 

It’s OK to have vegetables ad libitum as they do contain small absolute amounts of carbohydrates.

 

The amount of fruit should be limited due to the fact that most fruit contains the same amount of sugars as soft drinks, about 10-12 grams per 100 g

 

The amount of grain and grain products like bread, pizza, pasta contains 30-90 g carbohydrates per 100 g of grain product. Thus grain products should be restricted to small amounts realizing that many persons are gluten intolerant and should then be totally excluded.

 

 

Energy

The intake of energy is recommended by NNR4 to 2.5 Mcal (2 500 kcal) for women and 3.2 Mcal for men. As long as the carbohydrate intake is less than 100 g per day the population will normalize the body weight. So this recommendation can be propagated to NNR5.

 

All weight reduction diets have a common denominator:

Carbohydrate reduction.

 

Just compare a NNR4 diet with 50 E% carbohydrates and 0.8 Mcal to a low carbohydrate diet with 2.5 Mcal and 16 E% carbohydrates.

 

This means that the NNR4 starvation diet contains 100 g carbohydrates, the person loses weight, is always hungry and the person will starve to death, usually within a year.

 

On the other hand the low carbohydrate diet contains 100 g carbohydrates, the person loses weight, is always satisfied and the person can eat that kind of food for decades.

 

Both diets are shown to give the same weight decrease in the short term but the famine dieter is unable to continue for more than a few months or the diet will be lethal. The lowcarber can have delicious food for decades and keep the weight loss.

 

The first law thermodynamics tells us that in an isolated system energy in equals energy out.

 

But the human body is not an isolated system. And we have to realize that we also have to obey the second law of thermodynamics as well as the hormonal control of the body. This means that the body can regulate the efficiency between 0 and up to less than 100 %. The most part will be heat.

 

We also have to realize that fat does not increase the insulin level. Excess protein may and carbohydrates always increase the insulin level to normalize the glucose level. So insulin changes the normal fat burning metabolism to carbohydrate burning and fat generating metabolism to survive.

 

The obesity care have tried to have obese patient to eat less and run more. This hypothesis has been disproven many times during the last 35 years. But it seems that the obesity care units were unable to realize these results.

 

So by having ad libitum food consisting of normal amounts of protein, maximum 100 g of carbohydrates and 70-90 E% mostly animal fat the population will in a few years regain normal weight, decrease disease burden and a better general health.

 

NNR5 macronutrient recommendation

 

Proposal of NNR5 nutrition recommendations to healthy individuals based on the old trustworthy sciences physiology, biochemistry and endocrinology:

 

Summary of NNR 2012 recommendations to healthy individuals

 

NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins.

 

NNR 2012 recommends a normal daily intake of essential animal protein of at least 0,5 g/kg bodyweight.

 

NNR 2012 recommends an upper limit of 100 g of carbohydrates/sugars per day [3].

 

NNR 2012 recommends a sufficient intake of essential fats to satisfy the energy and metabolic requirements.

 

NNR 2012 recommends an upper limit of 20 g per day of vegetable omega-6 polyunsaturated fats. [4], [5].

 

NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.

 

NNR 2012 recommends an upper limit of one fruit per day.

 

 

 

The conclusion of food consumption changes between NNR4 and NNR5 to promote health in Nordic populations

                                                                            

Increase............................Unchanged.......................Limit to per day

Fat, preferably animal......Protein from meat..........Limit Carbohydrates to 100 g.

.............................................Vegetables.......................Limit Omega-6 PUFA to 20 g.

.........................................................................................Limit fiber to 25 g                  .

.........................................................................................Limit fruit to one                    .

 

 

 

 

 

Background information for NNR 2012 recommendations

From NNR5

Recommendation for carbohydrates, fibre and added sugar

http://www.slv.se/upload/NNR5/NNR5%20Carbohydrates.pdf

 

...............Mikael Fogelholm

................The data on health effects of dietary fibre and fibre-rich foods are very strong.[6]

................Recommendations in NNR 2012:

................Adults: Intake of dietary fibre should be at least 25-35 g/d,

.................i.e. approximately 3 g/MJ.

.................Children: An intake corresponding to 2-3 g/MJ is appropriate for children from

.................2 years of age.

..................From school age the intake should gradually increase to reach the recommended

..................adult level during adolescence.

 

Comment by BH

According to present recommendations in NNR4 children should have about double the amount of fiber per kg bodyweight as an adult. Adults are recommended about 30 g/day or 0,4 to 0,6g/kg while children are supposed to have 3 g/MJ which will be 12 g fiber per day or 1,2 g/kg. This is due to recommendations are associated to the amount of energy eaten instead of kg bodyweight. Children have a higher energy intake per kg bodyweight due to the fact that they need more energy to grow and need more energy to compensate for a larger skin surface heat loss per kg bodyweight than adults.

 

As fibers are associated to an increased risk of colon cancer [7], [8], there is an increased risk that children and adults get colon cancer with the present recommendations.

 

So the new recommendations should be:

 

NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.

 

...................Mikael Fogelholm

...................Intake of added sugars should be kept below 10 E%.

...................Limitation of the intake of added sugars from particularly sugar-sweetened

...................beverages and sugar–rich foods is recommended in order to reduce the risk for

...................type 2 diabetes, weight gain and dental caries.

....................•A limitation of the intake of added sugars is also necessary to ensure an

....................adequate intake of essential nutrients and dietary fibre, especially in children

....................and adults with a low energy intake.

 

Comment by BH

In NNR4 there is a recommendation to keep intake of added sugars to below 10 E%.

 

It seems that the NNR4 have disregarded that carbohydrates and sugar are synonyms as they recommend a limit of carbohydrates in the form of “added sugar” but recommend 50-60 E% of carbohydrates in a day.

 

 It is good that NNR 2012 will limit the intake of sugar to ensure an adequate intake of essential nutrients. All kinds of carbohydrates consists of sugar which are nonessential and contains 1 to 1/1 000th (or less) of minerals and vitamins compared to food of animal origin [9]. Then we have to re-establish what the essential nutrients are.

 

So the new recommendations should be:

 

NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins, preferable in the form of animal proteins and fats which contain enough minerals and vitamins.

 

Vegetables are insufficient in amino acids, all fatty acids including long chain polyunsaturated fatty acids, minerals and vitamins [10] but vegetables are excellent to improve the visual impression of food. Fruit with 10 % sugar content may decrease to maximum one fruit per day

 

......................Also, the NNR 2012 finds no justifications to include a diet-based

......................recommendation for GI in NNR.

 

Comment by BH

This is correct as GI is a partial and indirect measurement of carbohydrates, we are just measuring the glucose level in the blood, we are not measuring all other sugars like fructose, galactose nor are we measuring the continuous insulin level that delays the uptake of sugars in an attempt to normalize a too high blood glucose level.

 

Also, the SBU report Mat vid diabetes of 2010 found no justification to include a diet-based recommendation for GI

 

So an added recommendations should be:

 

NNR 2012 finds no justifications to include a diet-based recommendation for GI in NNR.

 

......................Also, NNR4 recommends specific “quality” of fat.

 

Comment by BH

As all mammals have the same temperature of 37ºC, they all have the same animal fat composition with the same melting temperature for correct function. This means animal fat has shy of 50 % saturated fat, shy of 50 % monounsaturated fat and about 5 % polyunsaturated fat. This is the ideal mixture of fats and the fat has a correct melting temperature to support correct function of fat in tissues and cell membranes.. 

 

 Conflict of Interest

Mikael Fogelholm is Editor-in-Chief for the publication Food & Nutrition Research where all the research behind the NNR5 is published. Food & Nutrition Research is owned by Swedish Nutrition Foundation (SNF) whose members are the food industries.

 

So all the research is published in a publication that has serious Conflict of Interests. And Fogelholm has not declared his Conflict of Interest as an Editor-in-Chief in his CoI decaration to NNR5.

 

 

Mora 2013-04-08

 

Björn Hammarskjöld

M.D., Ph.D.

Independent scientist in Nutrition



[1] Livsmedelsverkets databas modersmjölk

[2] Insulin, Tack för att det finns!  http://kostkunskap.blogg.se/2013/march/insulin-tack-for-att-det-finns.html

[3] Based on old fashioned physiology, biochemistry and endocrinology, e.g. Lagerholm, J., Hemmets Läkarebok, Fröléen & Comp, Stockholm, 1921 and Ganong, W., Medical physiology, Lange Medical Publications, Los Altos, CA, USA 1971.

[4] Wirfält, Mattisson et al Postmenopausal breast cancer is associated with high intakes of omega6 fatty acids (Sweden). Cancer Causes Control. 2002 Dec;13(10):883-93.

[5] Ramsden, Zamora et al Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013;346:e8707 http://www.bmj.com/highwire/filestream/629053/field_highwire_article_pdf/0/bmj.e8707

[6] SBU rapport Mat vid diabetes 2010. No scientific support for NNR4 recommendations.

[7] Park Y, et al. Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. JAMA 2005; 294: 2849-2857.

[8] Fuchs CS, et al. Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women. New Engl J Med 1999; 340: 169-176, 223-224.

[9] Livsmedelsverkets databas http://www7.slv.se/Naringssok/

[10] Livsmedelsverkets näringssök http://www7.slv.se/Naringssok/


Statistikkollaps i Läkartidningen

Kommentar i Läkartidningen som väntar på moderering. Inskickad 2013-04-26. Kompletterad 2013-04-29

Läkartidningen nr 17-18 2013 sid 882-5 Riskfaktorer för hjärt-kärlsjukdom

http://www.lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2013/04/Riskfaktorer-for-hjartkarlsjukdom/ 

 

Intressant artikel om diabetes och blodtryck.

 

I tabellen i Figur 2 syns tydligt att patienter med sockersjuka har minsta riskkvoten (0,90) för hjärt-kärlsjukdom vid ett systoliskt blodtryck mellan 135-139 mm Hg.

 

Sedan finner jag att man delar upp patienterna i ojämna grupper.

 

Den första gruppen består av 452 patienter med blodtryck mellan 100-115 mm Hg.
Intervall 15 mm Hg

 

Nästa grupp består av 651 patienter med ett blodtryck på 15-119 mm Hg. Här har givetvis Nyckfelstrisse varit framme och tappat bort den första siffran som borde vara 1 så att blodtrycket skulle vara 115-119.
Intervall 5 mm Hg

 

Nästa grupp består av 4 878 patienter med 120-129 mm Hg.
Intervall 10 mm Hg

 

Den fjärde gruppen består av 4 722 patienter med trycket 130-134 mm Hg.
Intervall 5 mm Hg

 

Den femte gruppen består av 5 173 patienter med 135-139 i blodtryck.
Intervall 5 mm Hg

 

Den sjätte gruppen består av 19 165 patienter med mer än 139 mm Hg.
Intervall mer än 50 mm Hg

 

Man lägger förvånansvärt nog ihop alla med ett högre blodtryck än 139 i en stor hög utan att fortsätta den variabla uppdelningen av patienter i olika stora grupper med blodtryck inom gruppen om 5-15 mm Hg.

 

Detta är en besynnerlig uppdelning av patienterna stridande mot gamla hederliga statistiska grundregler.

 

Det går alltså att avgöra att patienter med sockersjuka bör ha ett blodtryck om 135-139 mm Hg eftersom det ger den minsta risken för hjärtsjuka. Men hur ser de följande 5 mm Hg intervallen ut?

 

Kurvan i Figur 2 talar för att patienter med sockersjuka bör ha ett systoliskt blodtryck i intervallet 120-150 mm Hg för en oförändrad risk för hjärt-kärlsjukdom. Men det går inte att utläsa av artikeln.

 

Sammanfattningsvis: Denna artikel ger stöd för att patienter med sockersjuka kan ha ett blodtryck mellan 120 och 150 mm Hg. Dagens rekommendation om att patienter med sockersjuka ska ha ett blodtryck under 130 mm Hg synes vara felaktig.

 

Denna artikel får underkänt på grund av att registerdata misshandlas på ett förskräckligt dåligt sätt.

 

Som det ser ut saknar artikeln oberoende granskning. Läkartidningen hade tidigare en stämpel som visade vilka artiklar som var granskade av oberoende kollegor. 

 

 

P.S.

Har inte kommit in ännu 2013-04-29 varför jag skrev en ny kommentar:

Figur 2 visar att blodtrycket hos patienter med sockersjuka kan ha ett systoliskt blodtryck på mellan 120-150 mm Hg med samma risk för CVD.
Så rekommendationen att patienter med sockersjuka ska ha ett blodtryck lägre än 130 mm Hg synes vara felaktig.
Minskar man sedan mängden kolhydrater i maten till mindre än 25 g per dag så minskar blodtryck och läkemedelsbehov.

Läs mer på http://kostkunskap.blogg.se/2013/april/statistikkollaps-i-lakartidningen.html

D.S.


Livsmedelsverkets nya Bra mat i skolan

Livsmedelsverket har enligt ett pressmeddelande 2013-04-18 gett ut en ny vägledning som kallas Bra mat i skolan.

 

Tyvärr ges den ut innan Nordiska NäringsRekommendationer 2012 (NNR2012 eller NNR5 som den också kallas) har kommit ut. NNR2012 avser man utges under sommaren 2013. Men ännu har den sista remissomgången inte publicerats.

 

Det är därför synnerligen olämpligt att ge ut en ny version av Bra mat i skolan. Det är slöseri med skattemedel att göra det. Bra mat i skolan måste göras om efter det att NNR5 presenterats. Men detta kan också ingå i den strategi som Livsmedelsverket har för att säkerställa att NNR5 överensstämmer med den av SBU underkända NNR4.

 

Vid en snabb genomläsning finner man en mängd felaktigheter i eposet från Livsmedelsverket.

 

För det första verkar man fortsätta att arbeta efter NNR4 (den version som kom ut 2004-5) och som i sin helhet underkändes av Statens beredning för medicinsk utvärdering (SBU) i dess rapport från 2010.

 

Detta innebär att NNR4 inte får användas som underlag för kostrådgivning över huvud taget. Därmed faller hela underlaget till Bra mat i skolan.

 

Så det räcker egentligen med detta konstaterande. Och släng sedan denna version av Bra mat i skolan i den elektroniska papperskorgen, sudda bort alla ettor och nollor.

 

I det militära fick man lära sig när man gjorde fel. Då blev ordern:

GÖR OM!

GÖR RÄTT!

 

Det blir samma order till Livsmedelsverket.

 

Här kommer ett förslag till Livsmedelsverket för en omarbetad version som stämmer med fysiologin, biokemin och endokrinologin från förra seklet, alltid lika aktuella kunskaper.

 

 

Livsmedelsverket har en vacker men ofullständig tabell med rekommendationer.

 

Låt oss gå igenom tabellen och justera allteftersom.

 

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 Livsmedelsverkets tabell i Bra mat i skolan

 

Tabell 1. Åldersanpassade referensvärden för energi- och näringsinnehåll i en genomsnittlig skollunch, motsvarar 30 procent av rekommenderat dagligt intag (RI) enligt SNR 2005.

Ålder (år)…………………………………6–9……...10–12……..13–15……..16–18

Energi per portion (MJ) 30 %.....................2,3…………2,8…………3,1………...3,4

(25–35 %)…………………………..(1,9–2,7)…...(2,3–3,2)…..(2,6–3,6)…..(2,8–3,9)

Energi per portion (kcal) 30 %.................550…………660………...750………...810

(25–35 %)…………………………(460–650)….(550–770)…(620–870)….(680–950)

Protein (g)…………………………….14–28………17–33……..19–37……….20–41

Mättat fett (g) Högst……………………..6,2………….7,4…………8,3………….9,0

Fleromättat fett (g)………………….3,1–6,2……..3,7–7,4…….4,1–8,3……..4,5–9,0

Fibrer (g)………………………………….7…………….8…………...9…………...10

Vitamin D (μg)…………………………2,3…………...2,3…………2,3…………..2,3

Vitamin C (mg)…………………………12……………15………….23……………23

Folat (μg)………………………………..39……………60………….90…………..120

Järn (mg)……………………………….2,7……………3,3…………4,5…………..4,5

Salt (g) Högst………………………….1,4*…………..1,7*………...2,0*………….2,1*

* Bör användas som ett riktvärde och långsiktigt mål eftersom det i dag kan vara svårt att uppnå i praktiken. 1,7 g salt motsvarar 0,7 g natrium.

 

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Här kommer förslaget till en bättre tabell.

 

År är bra som grov indelning men man bör kanske ta med en grov uppskattning av vikten hos barnen. Vikten varierar normalt med ±20-30 % inom varje årskull och här klumpar man ihop treårskullar i samma kolumn varför vikten kan variera ännu mer. Men låt oss sätta en ungefärligt vikt för varje kolumn bara man är medveten om den stora variationen i vikt.

Så det blir en rad till med en grov uppskattning av vikten i de fyra ålderskategorierna.

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

 

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Energimängden som anges i MJ med två siffrors noggrannhet bör nog anges med endast en siffras noggrannhet baserat på den stora variationen i vikt hos barnen inom gruppen. Två siffrors noggrannhet är för ”exakt”.

Så då blir raden så här.

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Energi……….MJ……...2………3………4……...5

 

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Energimängen som anges i kcal och tre siffror bör med samma resonemang anges med en signifikant siffra i form av Mcal (1 Mcal=1 000 kcal)

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Energi……….MJ……...2………3………4……...5

Energi……….Mcal…..0,6……0,7…….0,8……0,9

 

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Mängden protein anges i gram och intervallet är mer än tillräckligt om man äter animaliskt protein men är klart otillräckligt vid vegetarisk kost. När man äter animaliskt protein räcker det med 0,5 g/kg kroppsvikt, vackert visat vid amning. Det bör påpekas att en vuxen människa om 70 kg har omkring 10 kg protein i kroppen. Så animaliskt protein saknar skadeverkningar i kroppen. Så den raden lämnas oförändrad.

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Energi……….MJ……...2………3………4……...5

Energi……….Mcal…..0,6……0,7…….0,8……0,9

Protein………g……….19…….24……..29…….36

 

***********************************************

 

Sedan kommer man till mängden fett. Här har man delat upp fett i mättat fett och fleromättat fett och utelämnat enkelomättat fett.

 

Men totalmängden fett anges inte. Inte heller anges hur mycket kolhydrater barnen bör äta. I och med att Livsmedelsverket bara rekommenderar mängd protein så innebär det att fördelningen mellan kolhydrater och fett lämnas helt fritt. Det är bra men skolor har en tendens att inte kunna välja. Man vill ha en norm att gå efter.

 

Eftersom mängden kolhydrater och fett samvarierar inverst så låt oss vänta med fett tills mängden kolhydrater är fastställda.

 

Mängden kolhydrater bör enligt den gamla fysiologin inte överstiga 1 hg per dag oavsett ålder. Mer kolhydrater leder bara till övervikt och sockersjuka.

 

Då bör lunchen ha högst 30 g kolhydrater. Så då för vi in raden för kolhydrater i tabellen

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Energi……….MJ……...2………3………4……...5

Energi……….Mcal…..0,6……0,7…….0,8……0,9

Protein………g……….19…….24……..29…….36

Kolhydrater…g……….30…….30……..30……..30

 

***************************************

 

Sedan kommer man till det sista makronäringsämnet, fett. Man måste ha i åtanke att en vuxen människa kan normalt innehålla mer än 10 kg animaliskt fett och i extremfall uppåt 400 kg animaliskt fett utan att dö av fettet. Och knappt 50 % av denna vikt är mättat fett! Det verkar som om Livsmedelsverket ignorerade kunskapen om att animaliskt fett har mycket likartad fettsyrasammansättning oavsett art. Fettsyrasammansättningen är knappt 50 % mättat fett, knappt 50 % enkelomättat fett och resten, omkring 5 %, är fleromättat fett.

 

Livsmedelsverkets begränsning av mättat fett saknar helt vetenskapligt underlag och, om den används, begränsar man totalmängden fett till endast 16 g fett till lunch. Det blir 22 E% fett och det är under den gräns om minst 30 E% fett som Livsmedelsverket anger. Raden med mättat fett utgår då den saknar vetenskaplig grund.

 

Animaliskt fett innehåller omkring 5 % fleromättat fett med normalt minst lika mycket fleromättat fett av omega- 3 som omega-6. Vegetabiliska fleromättade fetter är för korta för att djur ska ha direkt nytta av det fleromättade fettet. Djur har sedan ett enzym som kan förlänga vegetabiliska fleromättade fetter till animaliska fleromättade fetter. Människan har klent med detta enzym men kor, grisar och höns har betydligt bättre och effektivare enzymer. Så det är klart bättre att våra växtätande djur bygger om vegetabiliska fetter till animaliska fetter. Det enda som man då behöver göra är att äta djur med det optimala fettet specialanpassat för människan.

 

Eftersom det finns mycken kunskap om att vegetabiliska fleromättade fetter av omega-6-typ orsakar cancer och inflammation i kroppen så bör mängden fett av omega-6-typ begränsas i maten till under 5 gram per dag oavsett ålder [1]. Genom att ersätta omega-6-fett med animaliskt fett blir det automatiskt rätt fettsyrasammansättning och raden med minimimängd fett av omega-6-typ tas bort.

 

Mängden fett barnen ska äta är redan bestämd av totalmängden energi minus energin från protein minus energin från kolhydrater.

 

Så då blir det enkelt med nästa rad i tabellen.

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Energi……….MJ……...2………3………4……...5

Energi……….Mcal…..0,6……0,7…….0,8……0,9

Protein………g……….19…….24……..29…….36

Kolhydrater…g……….30…….30……..30……..30

Fett………….g……….45…….54……..63……..71

 

*********************************************

 

Sedan kommer man till övriga ämnen som Livsmedelsverket tas upp.

 

Fibermängden bör minskas till minde än 0,35 g/kg kroppsvikt så då blir fiberraden i tabell 3 enligt följande.

 

Tabell C Övrigt

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Fibrer högst…….g……...2……...3……..4………5

 

****************************************

 

Mängden vitamin D3 bör uppgå till minst 125 µg/dygn till vuxen om 70 kg för att säkerställa en fysiologisk nivå av vitamin D3 i blodet om 125 nmol/L. Raden blir som följer.

 

Tabell C Övrigt

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Fibrer högst…….g……...2……...3……..4………5

Vitamin D……µg……..15…….20……30……..40

 

********************************************

 

Vitamin C, folat och järn är bra. Så dessa rader lämnas oförändrade.

 

 ********************************************

 

Sedan kommer man till raden med salt.

 

All gammal fysiologi visar att man aldrig kan överdosera salt då vuxen person filtrerar ut omkring 1 gram salt per minut. Barn filtrerar ut på samma sätt. Nyfödda har första dygnet ett intag motsvarande 70 g salt till vuxen för att säkerställa att det nyfödda barnet slipper att dö av saltbrist [2].

Svårigheten är att återabsorbera tillräckligt med salt för att upprätthålla saltkoncentrationen i blodet till 141 ±4 mmol/L. Genom att äta tillräckligt med salt per dag slipper man dö på grund av saltbrist [3]. Det är alltså livsviktigt att barnen i skolan får mat med tillräckligt mycket salt för att barnen ska må bra.

 

Så raden om salt i tabell 3 blir så här:

 

Tabell C Övrigt

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Fibrer högst…….g……...2……...3……..4………5

Vitamin D……µg……..15…….20……30……..40

Vitamin C……mg……..12…….15……23……..23

Folat………….µg……..39…….60……90……120

Järn…………..mg…….2,7……3,3…...4,5…….4,5

Salt Minst……..g……….2………3…….4………4

 

***************************************************

 

Sammanfattningsvis blir det mycket enkelt att ge barnen en fysiologiskt näringsriktig kost genom att följa den gamla hederliga fysiologin från förra seklet.

 

Energimängderna är gamla kunskaper och ungefärliga men de fungerar fortfarande.

 

Mängden protein, omkring 15 E%, stämmer väl med livsmedelsverkets rekommendationer och fysiologin.

 

Mängden kolhydrater, omkring 15 E%, stämmer väl med livsmedelsverkets rekommendationer [4] och fysiologin.

 

Mängden fett, omkring 70 E%, stämmer väl med livsmedelsverkets rekommendationer [5] och fysiologin.

 

Mängden salt i maten bör vara minst 10 g/dag till vuxen och motsvarande mängd till barn baserat på vikten, stämmer väl med fysiologin.

 

Så då är det bara att följa kunskapens väg i stället för Livsmedelsverkets till synes kunskapsbefriade och fria fantasiers väg i Livsmedelsverkets nya vägledning.

 

Mora 2013-04-20

 

Björn Hammarskjöld

F.d. överläkare i pediatrik

Filosofie licentiat i biokemi

Oberoende senior vetenskapsman i nutrition

 

 

Extramaterial

 

Tabell A Makronäringsämnen

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Energi……….MJ……...2………3………4……...5

Energi……….Mcal…..0,6……0,7…….0,8……0,9

Protein………g……….19…….24……..29…….36

Kolhydrater…g……….30…….30……..30……..30

Fett………….g……….45…….54……..63……..71

 

 

Tabell B Energiprocent

Ålder ………år…….6–9   10–12   13–15   16–18

Protein……..E%.........13…….14…….15…….16

Kolhydrater..E%.........20…….17…….15……..13

Fett………...E%.........67…….69…….71……...71

 

Tabell C Övrigt

Ålder ……….år……...6–9...10–12…13–15..16–18

Vikt ………..kg……19-25...25-35…35-45…45-75

Fibrer högst…….g……...2……...3……..4………5

Vitamin D……µg……..15…….20……30……..40

Vitamin C……mg……..12…….15……23……..23

Folat………….µg……..39…….60……90……120

Järn…………..mg…….2,7……3,3…...4,5…….4,5

Salt Minst……..g……….2………3…….4………4

 

 

Livsmedelsverkets pressmeddelande visar på exempel

http://www.slv.se/sv/grupp3/Pressrum/Nyheter/Pressmeddelanden/Tid-att-ata-och-mer-miljotank-lyfts-fram-i-nya-rad-om-skolmat/

Exempel ur råden Bra mat i skolan:

§                          Maten är god och lagad av bra råvaror. 
Håller fullkomligt med

§                          En eller gärna flera alternativa rätter finns att välja på, med fördel ett vegetariskt alternativ som alla får ta av. 
Håller med men vegetariskt alternativ är ofysiologiskt och kan utgå

§                          Eleverna får möjlighet att sitta vid bordet och äta i cirka 20 minuter. 
Håller fullkomligt med

§                          Lunchen serveras mellan kl 11-13, varje elev äter vid samma tidpunkt varje dag. 
Håller fullkomligt med

§                          Köttkonsumtionen hålls nere. 
Felaktigt och ofysiologiskt påstående

§                          Skolorna ställer miljökrav i samband med inköp av livsmedel. 
Håller med

§                          Köket har rutiner så att elever med allergi och överkänslighet inte blir sjuka av maten. 
Håller fullkomligt med

§                          Skolmåltiden används som ett pedagogiskt verktyg i undervisningen. 
Håller fullkomligt med

§                           

Jag håller med om det mesta som Livsmedelsverkets pressmeddelande tar upp, normalt självklara saker som inte ens skulle behöva tas upp i ett normalt artigt, vänligt och omtänksamt samhälle.

 

Men. Varför ska man hålla ned köttkonsumtionen? Äter vi gräsbetat kött oavsett art så äter gräsätaren upp det gräs som annars skulle torka och ruttna till koldioxid och metan. Så gräsätare är metansänkor på samma sätt som skog är koldioxidsänkor. Dessutom är gräsbetarna självgående, självgödslande jordförbättrare till skillnad från traditionellt konstgödslat och utarmande jordbruk.

 

 


[1] Wirfält, Mattisson, Irene (numera vid Livsmedelsverket) et al Postmenopausal breast cancer is associated with high intakes of omega6 fatty acids (Sweden). Cancer Causes Control. 2002 Dec;13(10):883-93.
Malmö Diet and Cancer Study: Department of Medicine, Surgery and Orthopedics, Lund University, Sweden. 

[2] Aperia, Broberger, Herin, Zetterström Salt content in human breast milk during the three first weeks after delivery. Acta Paediatr Scand; 1979; 68; 441-2

[3]  http://kostkunskap.blogg.se/2012/july/livsmedelsverket-och-salt-del-3.html

http://kostkunskap.blogg.se/2012/july/svar-fran-livsmedelsverket.html

[4] Livsmedelsverkets Rapport nr 1 SNÖ från 2003 sidan 5, st 2 nedifrån.http://www.slv.se/upload/dokument/rapporter/mat_naring/RapportSNO.pdf

[5] Livsmedelsverkets Rapport nr 1 SNÖ från 2003 sidan 5, st 2 nedifrån.http://www.slv.se/upload/dokument/rapporter/mat_naring/RapportSNO.pdf

Björn Hammarskjöld

 

 

Hur ska vi få tillräckligt med animaliskt omega-3?

Idag äter man för mycket omega-6 i förhållande till omega-3. Så därför ”måste” man äta omga-3 för att kompensera det hög omega-6-ätandet.

 

Låt oss börja tänka.

 

Jaha, då måste man äta omega-3 från andra källor. Vad finns det för andra källor?

 

Fisk!

 

Där finns det mycket animaliskt omega-3 enligt Livsmedelsverket!

 

Slutsats: Alltså fiskar vi ut haven på fisk för att komma åt fiskens omega-3.

 

Men detta är inte en hållbar politik. Utan fisk svälter först andra rovfiskar ihjäl och sedan svälter även människan ihjäl på sikt.

 

Verkar inte vara någon höjdare.

 

Låt oss börja tänka igen.

 

Var får fisken sin omega-3 ifrån?

 

Jo, alger och krill!

 

Bra! Då kan man ju fiska ut både alger och krill vilket innebär att fiskarna inte får mat och först svälter algätande fiskar och valar ihjäl, sedan kommer andra rovfiskar att svälta ihjäl och sedan svälter även människan ihjäl på sikt.

 

Attans! Verkar inte vara någon höjdare den idén heller.

 

Låt oss börja tänka på allvar och utanför den berömda lådan.

 

Första frågan: Vad är människans naturliga föda?

 

Svar på den första frågan är att människans artegna föda består av animaliskt kött, animaliskt fett och animaliska kolhydrater.

 

Andra frågan: Varför äter människan omega-6?

 

Svar på den andra frågan är att människan luras av myndigheterna att äta billiga vegetabiliska oljor rika på cancer- och inflammationsdrivande omega-6.

 

Tredje frågan: Hur löser man problemet?

 

Den geniala lösningen är den enklaste tänkbara lösningen. (The K.I.S.S! principle)

 

1. Låt bli att äta omega-6-rika vegetabiliska oljor.

2. Ät animaliskt kött, animaliskt fett och animaliska kolhydrater, alltså artegen kost.

 

Låt våra bytesdjur äta bra oljor som är omega-6-fattiga och omega-3-rika som raps- , linfrö- och olivoljor. Våra bytesdjur, ko, gris, höna, älg med flera, är duktiga på att omvandla vegetabiliska korta fleromättade fettsyror till animaliska längre fettkedjor. Människan är dålig på den omvandlingen. Nu finns det ”rapsgris” med ”nötsmak” på grund av rapsoljan i grisens mat.

 

Vi behöver äta små mängder, inte ens ett gram, omega-3 och omega-6 per dag, i ungefär likstora mängder.

 

Lax innehåller 2,3 g omega-3 per 100 g varav 2,1 g är animaliskt omega-3. Man behöver äta fisk 1 gång per vecka. Det blir 0,3 g omega-3 per dag enligt Livsmedelsverkets egna rekommendationer.

 

Sidfläsk innehåller omkring 0,3 g omega-3 per 100 g.

 

Så det räcker att äta något hg sidfläsk per dag för att tillgodose behovet av animaliskt omega-3 eftersom förlusterna är små, man gör allt för att behålla de fleromättade fetter som behövs samtidigt som man förbränner dem som finns i överskott.

 

Så man behöver inte äta fisk för att få i sig tillräckligt med omega-3, det räcker med sidfläsk eller annat animaliskt fett.

 

Det är precis det som är människans artegna kost. Den kost vi har ätit för att överleva och föröka oss till dags dato.

 

Det räcker att äta vanlig, artegen mat för att man ska behålla ett jordklot i balans för att säkra våra barns framtida mat.

 

 

 


NNR 2012 Energy Short version

Summary of NNR 2012 recommendations to healthy individuals

 

NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins, preferable in the form of animal proteins and fats which contain enough minerals and vitamins.

 

NNR 2012 recommends a normal daily intake of essential animal protein of at least 0,5 g/kg bodyweight.

 

NNR 2012 recommends a sufficient intake of fats to satisfy the energy and metabolic requirements.

 

NNR 2012 recommends a sufficient intake of salts including sodium chloride of at least 7,5 g (or at least 3 g sodium) per day to satisfy the metabolic requirements.

 

 

Limitations of intake

 

NNR 2012 recommends an upper limit of 100 g of carbohydrates/sugars per day.

 

NNR 2012 recommends an upper limit of 20 g per day of vegetable omega-6 polyunsaturated fats.

 

NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.

 

NNR 2012 recommends an upper limit of one fruit per day.

 

NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.

 

NNR 2012 finds no justifications to include a diet-based recommendation for GI in NNR.


NNR5 Energy

NNR5 Energy

This is what I have sent to the NNR5 Public Consultations part three

 

The human organism is always striving for survival and homeostasis. In order to survive the person needs to eat food. Food consists of macronutrients and micronutrients.

 

The micronutrients are covered elsewhere.

 

The macronutrients are the energy suppiers as well as building material for the body.

There are three macronutrients, protein, fat and carbohydrates. They all contain carbon as an energy source.

 

Protein

Proteins consist of the building blocks amino acids. There are about 20 amino acids in the animal body. Humans can make about ten amino acids from scratch and the remaining about ten amino acids the person has to eat to be able to use them. So protein is an essential part of the food. Without protein we will not survive for long.

 

The amount of protein in the food should be at least 0.5 grams of animal protein per kg body weight. This is enough for a newborn child to increase 50 % in length during the first year and should be enough for the rest of the life [1].

 

We have a limited storage facility of free amino acids. Any excess of protein is deaminated and the rest is converted to short fatty acids or short alcohols that can be used in the metabolism.

 

Those short fatty acids and short alcohols can enter the central metabolism in the body, more about that later.

 

We have tens of kg of muscles with about 20 % protein.

 

On the cellular level cells contain a lot of different structural, signalling, building and other kinds of protein molecules, all necessary for survival. Muscle cells contain great amounts of contracting proteins to be able to move the body and parts.

 

No normal animal protein is toxic to humans.

 

Fat

The major functions of fat is energy production, energy source, energy storage and padding delicate organs in the body.

 

We have tens of kg of fat in the body. We can store several hundred kg of fat.

 

Fats consist mainly of triglycerides (three fatty acids connected to a glycerol molecule) but there are free fatty acids, monoglycerides, diglycerides, phospholipids as well as other lipids and lipid like molecules.

 

The major composition of fat is shy of 50 % saturated fats (SAT), shy of 50 % monounsaturated fats (MUFA) and the rest, about 5 %, is polyunsaturated animal fats (PUFA) with carbon atom numbers of at least 20 C.

 

The fatty acid composition is about the same for all warm blooded animals as they have the same body temperature around 37ºC. This is because fats must have a correct melting temperature for proper function. Arctic fish have much higher PUFA concentration as PUFAs have much lower melting temperature compared to animal fat.

 

This is shown beautifully by placing butter, olive oil and canola oil taken from the fridge on a plate and let it sit on the table. The canola oil is still liquid at fridge temperature, the olive oil is partly solid at fridge temperature and the butter is definitely solid at fridge temperature.

 

At room temperature both oil fats are liquid but butter is solid. When temperature rises above 30º C then also butter melts into liquid form.

 

So arctic fish must have higher concentration of PUFA to survive due to it’s lower organism temperature.

 

Salmon has 3.3 g PUFA and bacon has 2.8 g PUFA. This means that 100 g salmon can be replaced by 118 g bacon to achieve the same amount of PUFA. Also 100 g salmon can be replaced by 35 g lard.

 

So as long as we eat animal fat we will always get enough PUFA.

 

We also have to realize that vegetable PUFAs usually are nonelogable to animal long chain PUFAs in our body. Vegetable omega-6 are inflammation producing and if more than 20 g per day also causing cancer, well known by the old transplantation surgeons as well as Livsvmedelsverkets civil servants.

 

Animal fats in the form of phospholipids are essential to our cell membranes as they separate cells and organelles form each other and intracellular as well as extracellular environments. Also in all membranes there are about the same number of cholesterol molecules as phospholipids molecules to make the cellular and other membranes stable and supportive.

 

So the lipids of all kinds are essential to life.

 

Lipids and fats are also necessary making up the cushioning around delicate structures in the body. Fat is also an excellent energy source for the body.

 

Also fat tissue and fat cells in muscles is normally the major source of acetylcoenzyme A (AcCoA or activated acetic acid) which is the only energy producing molecule in the cellular mitochondria. See the Krebs cycle for more biochemical and energy details.

 

This means that all animal fat are essential to us and they are nontoxic as they consist of the same fats in the same proportions as our own fat. The animal fats also requires the least remodeling and exchange due to the same reason.

 

Fat is also the most energy dense macronutrient so persons can eat smaller portions to have enough energy. Also, fat is the most satisfying macronutrient.

 

Carbohydrates

 

Carbohydrates are the third kind of macronutrients. Carbohydrates consists of sugars. So carbohydrates are equivalent to sugars.

 

Fibers consists of polymers of glucose that no warm blooded animal can digest. Herbivores are using microbes to digest fibers like cellulose to short chain fatty acids, less than 7 carbon atom long chains. Those short or volatile fatty acids are completely water soluble and can thus be taken up directly in the blood and then transported directly to the liver for further use and can enter the central metabolism in the body, more about that later.

 

Humans are unable to digest fibers as we lack the fermenting microbes and fermentation tank like the 1 hL four parted ventricle of a normal cow.

 

So fibers lack energy in humans, easily contolled by eating pure fibers and check the lack of hydrogen gas production the digestion of fibres always cause.

 

Starches all consists of polymers of glucose easily degraded in the intestinal tract by a lot of enzymes down to single units of glucose.

 

Other common disaccarides are sucrose (consists of glucose and fructose), lactose (glucose and galactose), maltose (glucose and glucose). Disaccarides can not be absorbed by the intestines, so they have to be digested by common enzymes to their monosaccarides. Those monosaccharides like glucose (most abundant), galactose (animal sugar) and fructose (vegetable sugar).

 

A human of 70 kg has a low glucose concentration of 3-6 mmol/L in the blood to supply the Red Blood Cells (RBC) with energy as RBC lack mitochondria.

 

The normal blood concentration of 3-6 mmol/L is equal to the amount of 1.5 to 3 grams of glucose in the total blood volume of 5.6 L.

 

The RBC utilize glucose anaerobically via the RBC-specific Rapoport-Luebring pathway including 2,3-diphosphoglycerate (2,3-DPG) that is required to release oxygen from the hemoglobin molecule. Then the 2,3-DPG is transformed to lactic acid and 2 molecules energy rich ATP.

 

When having 5 g glucose, without insulin and a theoretical immediate uptake, the glucose level will increase to around 15 mmol/L which is a toxic concentration of glucose.

 

By having more than 15 to 25 g glucose in the blood (>30-50 mmol/L) the normal person will very shortly die from acute glucose intoxication.

 

Glucose and fructose are toxic at higher concentrations than 6 mmol/L the monosackarides are nonenzymatically glycating the lysine amino acid residue in proteins and thus changing the morphology and may change the function of the protein.

 

The most famous glycated protein is HbA1c where the attached glucose/fructose molecule destroys the oxygen transport function of hemoglobin.

 

This glycation of proteins is the major problem with carbohydrates.

 

When the person has carbohydrates the blood glucose rises immediately which releases insulin. The insulin has a lot of actions in order to normalize the blood glucose level. The insulin slows down the intestinal uptake of nutrients, inhibits the AcCoA production from fat and protein because the monosaccaride concentration just has to be normalized as the body otherwise will die from acute monosaccaride intoxication.

 

Read more about the wonderful insulin molecule and functions at reference below [2] .

 

There are no essentiality of eating carbohydrates. All sugars the human body needs is happily produced by the liver. And the liver can always produce enough sugar.

 

The logic behind NNR4 recommendation to have 50-60 % of the energy (%) is totally missing. As excess of carbohydrates increase the insulin level for long times thus decreasing the fat energy expenditure and that carbohydrates are partly converted to fat and thus increasing body weight the amount of carbohydrates has to be minimized.

 

It is also after the introduction of NNR with a in the 1980-ies that the epidemy of diabetes and obesity rose inexplicably. The only change in the environment is the exchange of fat to carbohydrate as major energy source.

 

It’s OK to have vegetables ad libitum as they do contain small absolute amounts of carbohydrates.

 

The amount of fruit should be limited due to the fact that most fruit contains the same amount of sugars as soft drinks, about 10-12 grams per 100 g

 

The amount of grain and grain products like bread, pizza, pasta contains 30-90 g carbohydrates per 100 g of grain product. Thus grain products should be restricted to small amounts realizing that many persons are gluten intolerant and should then be totally excluded.

 

 

Energy

The intake of energy is recommended by NNR4 to 2.5 Mcal (2 500 kcal) for women and 3.2 Mcal for men. As long as the carbohydrate intake is less than 100 g per day the population will normalize the body weight. So this recommendation can be propagated to NNR5.

 

All weight reduction diets have a common denominator:

Carbohydrate reduction.

 

Just compare a NNR4 diet with 50 E% carbohydrates and 0.8 Mcal to a low carbohydrate diet with 2.5 Mcal and 16 E% carbohydrates.

 

This means that the NNR4 starvation diet contains 100 g carbohydrates, the person loses weight, is always hungry and the person will starve to death, usually within a year.

 

On the other hand the low carbohydrate diet contains 100 g carbohydrates, the person loses weight, is always satisfied and the person can eat that kind of food for decades.

 

Both diets are shown to give the same weight decrease in the short term but the famine dieter is unable to continue for more than a few months or the diet will be lethal. The lowcarber can have delicious food for decades and keep the weight loss.

 

The first law thermodynamics tells us that in an isolated system energy in equals energy out.

 

But the human body is not an isolated system. And we have to realize that we also have to obey the second law of thermodynamics as well as the hormonal control of the body. This means that the body can regulate the efficiency between 0 and up to less than 100 %. The most part will be heat.

 

We also have to realize that fat does not increase the insulin level. Excess protein may and carbohydrates always increase the insulin level to normalize the glucose level. So insulin changes the normal fat burning metabolism to carbohydrate burning and fat generating metabolism to survive.

 

The obesity care have tried to have obese patient to eat less and run more. This hypothesis has been disproven many times during the last 35 years. But it seems that the obesity care units were unable to realize these results.

 

So by having ad libitum food consisting of normal amounts of protein, maximum 100 g of carbohydrates and 70-90 E% mostly animal fat the population will in a few years regain normal weight, decrease disease burden and a better general health.

 

NNR5 macronutrient recommendation

 

Proposal of NNR5 nutrition recommendations to healthy individuals based on the old trustworthy sciences physiology, biochemistry and endocrinology:

 

Summary of NNR 2012 recommendations to healthy individuals

 

NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins.

 

NNR 2012 recommends a normal daily intake of essential animal protein of at least 0,5 g/kg bodyweight.

 

NNR 2012 recommends an upper limit of 100 g of carbohydrates/sugars per day [3].

 

NNR 2012 recommends a sufficient intake of essential fats to satisfy the energy and metabolic requirements.

 

NNR 2012 recommends an upper limit of 20 g per day of vegetable omega-6 polyunsaturated fats. [4], [5].

 

NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.

 

NNR 2012 recommends an upper limit of one fruit per day.

 

 

 

The conclusion of food consumption changes between NNR4 and NNR5 to promote health in Nordic populations

                                                                            

Increase                     .                         Unchanged               .                Limit to per day                   .

Fat, preferably animal    ......................Protein from meat     .   ....Limit Carbohydrates to 100 g.

                                      .........................Vegetables                 . .... Limit Omega-6 PUFA to 20 g.

                                                                        .............................................Limit fiber to 25 g                  .

                                                                        .............................................Limit fruit to one                    .

 

 

 

 

 

Background information for NNR 2012 recommendations

From NNR5

Recommendation for carbohydrates, fibre and added sugar

http://www.slv.se/upload/NNR5/NNR5%20Carbohydrates.pdf

 

 Mikael Fogelholm

The data on health effects of dietary fibre and fibre-rich foods are very strong.[6]

Recommendations in NNR 2012:

Adults: Intake of dietary fibre should be at least 25-35 g/d,

i.e. approximately 3 g/MJ.

Children: An intake corresponding to 2-3 g/MJ is appropriate

for children from 2 years of age. From school age the

intake should gradually increase to reach the recommended

adult level during adolescence.

 

Comment

According to present recommendations in NNR4 children should have about double the amount of fiber per kg bodyweight as an adult. Adults are recommended about 30 g/day or 0,4 to 0,6g/kg while children are supposed to have 3 g/MJ which will be 12 g fiber per day or 1,2 g/kg. This is due to recommendations are associated to the amount of energy eaten instead of kg bodyweight. Children have a higher energy intake per kg bodyweight due to the fact that they need more energy to grow and need more energy to compensate for a larger skin surface heat loss per kg bodyweight than adults.

 

As fibers are associated to an increased risk of colon cancer [7], [8], there is an increased risk that children and adults get colon cancer with the present recommendations.

 

So the new recommendations should be:

 

NNR 2012 recommends an upper limit of fiber intake of 25 g per day to an adult and an upper limit of 0,35 g/kg to a child.

 

Mikael Fogelholm

Intake of added sugars should be kept below 10 E%.

Limitation of the intake of added sugars from particularly sugar-sweetened beverages and sugar–rich foods is recommended in order to reduce the risk for type 2 diabetes, weight gain and dental caries.

•A limitation of the intake of added sugars is also necessary to ensure an adequate intake of essential nutrients and dietary fibre, especially in children and adults with a low energy intake.

 

Comment

In NNR4 there is a recommendation to keep intake of added sugars to below 10 E%.

 

It seems that the NNR4 have disregarded that carbohydrates and sugar are synonyms as they recommend a limit of carbohydrates in the form of “added sugar” but recommend 50-60 E% of carbohydrates in a day.

 

 It is good that NNR 2012 will limit the intake of sugar to ensure an adequate intake of essential nutrients. All kinds of carbohydrates consists of sugar which are nonessential and contains 1 to 1/1 000th (or less) of minerals and vitamins compared to food of animal origin [9]. Then we have to re-establish what the essential nutrients are.

 

So the new recommendations should be:

 

NNR 2012 recommend an adequate intake of essential nutrients of protein, fat, minerals and vitamins, preferable in the form of animal proteins and fats which contain enough minerals and vitamins.

 

Vegetables are insufficient in amino acids, all fatty acids including long chain polyunsaturated fatty acids, minerals and vitamins [10] but vegetables are excellent to improve the visual impression of food. Fruit with 10 % sugar content may decrease to maximum one fruit per day

 

Also, the NNR 2012 finds no justifications to include a diet-based recommendation for GI in NNR.

 

Comment

This is correct as GI is a partial and indirect measurement of carbohydrates, we are just measuring the glucose level in the blood, we are not measuring all other sugars like fructose, galactose nor are we measuring the continuous insulin level that delays the uptake of sugars in an attempt to normalize a too high blood glucose level.

 

Also, the SBU report Mat vid diabetes of 2010 found no justification to include a diet-based recommendation for GI

 

So an added recommendations should be:

 

NNR 2012 finds no justifications to include a diet-based recommendation for GI in NNR.

 

Also, NNR4 recommends specific “quality” of fat.

As all mammals have the same temperature of 37ºC, they all have the same animal fat composition with the same melting temperature for correct function. This means animal fat has shy of 50 % saturated fat, shy of 50 % monounsaturated fat and about 5 % polyunsaturated fat. This is the ideal mixture of fats and the fat has a correct melting temperature to support correct function of fat in tissues and cell membranes. 

 

 

 

Mora 2013-04-08

 

Björn Hammarskjöld

M.D., Ph.D.

Independent scientist in Nutrition



[1] Livsmedelsverkets databas modersmjölk

[3] Based on old fashioned physiology, biochemistry and endocrinology, e.g. Lagerholm, J., Hemmets Läkarebok, Fröléen & Comp, Stockholm, 1921 and Ganong, W., Medical physiology, Lange Medical Publications, Los Altos, CA, USA 1971.

[4] Wirfält, Mattisson et al Postmenopausal breast cancer is associated with high intakes of omega6 fatty acids (Sweden). Cancer Causes Control. 2002 Dec;13(10):883-93.

[5] Ramsden, Zamora et al Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013;346:e8707 http://www.bmj.com/highwire/filestream/629053/field_highwire_article_pdf/0/bmj.e8707

[6] SBU rapport Mat vid diabetes 2010. No scientific support for NNR4 recommendations.

[7] Park Y, et al. Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. JAMA 2005; 294: 2849-2857.

[8] Fuchs CS, et al. Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women. New Engl J Med 1999; 340: 169-176, 223-224.

[9] Livsmedelsverkets databas http://www7.slv.se/Naringssok/

[10] Livsmedelsverkets näringssök http://www7.slv.se/Naringssok/


Hjärtsvikt och statiner

I Sverige har antalet personer inlagda på sjukhus på grund av hjärtsvikt minskat från 26 058 år 1998 ner till 22 273 år 2001. Det är en minskning med 3 785 på tre år.

Om den trenden hade fortsatt nio år till fram till 2011 så hade det bara varit 9 656 patienter som lagts in på sjukhus på grund av hjärtsvikt. (Turkos linje (Båda i början) i diagrammet nedan)

Från 2003 har det dock varit en långsam stegring av antalet patienter med 1,1 % per år från 21 182 år 2003 till 23 044 år 2011 i stället för en årlig minskning om 1 262 fall per år eller 7 %/år. (Gul kurva (Båda) i diagrammet nedan)

Så det finns för närvarande 13 388 fler fall av hjärtsvikt än som kunde förutses med ledning av siffrorna mellan 1998 och 2001.

Då kan man börja fundera på vad är orsaken till att antalet patienter med hjärtsvikt har ökat från 2003 i stället för att minska enligt trenden mellan 1998 och 2001.

Skillnaden är stor, 239 %.

Med för litet CoQ10 kan mitokondrierna inte fungera och bränna ättiksyra till ATP och hjärtat får för litet energi vilket leder till att hjärtat inte orkar pumpa som i sin tur leder till hjärtsvikt.
 
Den enda förklaring jag kan tänka mig är det stora användandet av kolesterolsänkande statiner som man vet orsakar hjärtsvikt genom att minska produktionen av coenzym Q10 (CoQ10). CoQ10 är absolut nödvändigt för att mitokondrierna ska kunna producera energirika ATP, cellens energiförråd.
 
Slutsats:
Jag kommer alltid att vägra äta statiner.


Källa: www.Socialstyrelsen.se Statistikdatabas Antal inlagda patienter med diagnos ICD10 I50 Hjärtsvikt

 
 

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