Doctor, What Should I Eat?

Since I approach nutrition from a health standpoint, I'm always writing and talking about nutrients: fiber, protein, fats, etc. But most of us don't think in these terms; we think about eating in terms of food. So when it comes to translating my recommendations for a Mediterranean type diet into actual meal planning, where do you begin? Particularly if you don't have much experience with cooking, or you live alone, it can feel overwhelming to think about preparing healthy meals.

Fortunately, there are plenty of resources out there. Beyond the usual cookbooks, there are also websites that can help you out. If you are particularly trying to cut down on sugar, Dr. Mark Hyman has the perfect program for you, with his 10-Day Detox Diet -- either online or in print. For general healthy meal planning, there is a free website called the Dr. Gourmet Diet Plan that holds your hand into the world of the Mediterranean diet, step by step and recipe by recipe.  This site even has different plans for singles, families, diabetics, gluten-free, and more.  For even more recipe ideas, check out the down-to-earth blog Eating Rules.

And at the grocery store, don't forget about the handy NuVal tags to make quick comparisons on which foods are the best choices.

So the next time you hear the advice to increase your veggies or decrease your sugar intake, you now have a roadmap on how to actually implement that in your life.

Beyond the Paleo: Is it Really the Perfect Diet?

There has been explosive interest in the last few years in eating like our ancient, pre-agricultural ancestors:  following a hunter-gatherer pattern that would have been the norm in the Paleolithic Era (the "stone age").  The idea behind this is that agriculture has only been around for about 10,000 years, which is barely a blip on the evolutionary time scale.  Therefore, our genes are still adapted mostly to eating grass-fed meat, eggs, fish, fruits, nuts, and vegetables.  Foods that were introduced with agriculture - especially grains and beans - are harder to digest, and (so the logic goes) may actually contribute to health problems.

With my studies of biology in college, I am all on board the argument of genetic adaptation.  However, I think we need to look at the Paleo Diet critically to determine if it's really the healthiest way to eat.

• Peer-reviewed, published scientific studies about the Paleo Diet (of which there are fewer than ten) have mainly focused on short-term changes in specific parameters, like body weight, blood sugar, and blood cholesterol levels.  While there is definite benefit in these areas, the research has not gone as far as to prove lower risk of chronic disease or mortality (i.e., risk of dying early).
• The complete elimination of grains contradicts many studies that show decreased risk of chronic metabolic diseases.  Last month, Chinese researchers published data on over 367,000 participants, showing decreased all-cause mortality (that is, dying for any reason) with high consumption of fiber-rich whole grains.
• The argument that our genes have not had time to adapt to an agricultural diet ignores some biological nuances.  Sometimes genetic mutations can confer an advantage, and spread quickly -- the best example of this is the ability to produce the lactase enzyme into adulthood, which appeared just a few thousand years ago.  This allowed some populations to survive better than their neighbors, by taking advantage of dairy as a source of nutrition.  Another wrinkle is the relatively new field of epigenetics, which has found that though our genetic code may not change much, certain genes may be "turned on" or "turned off" (biochemically) in response to environmental pressures.  This can happen within a single generation, and the changes can even be passed on to offspring.

The Paleo Diet can serve some important functions.  As a structured system, it is a good way to break our addiction to sugar and refined carbohydrates, which is one of the leading causes of chronic disease.  By eliminating many common foods, the Paleo Diet can also serve as a tool to help identify foods that may be causing inflammatory reactions in the body.  For the long term, however, I still recommend the Mediterranean Diet (including - gasp! - whole grains), which has a mountain of evidence on improved health outcomes and longer lifespan.

Time to Throw Out Your Herbs - the New York Attorney General Says So

Ah, yes.  This is one of those headlines that rears its head every few months -- another "supplement effectiveness disproved, once and for all!"  The New York attorney general recently released a report, along with cease-and-desist letters, for the herbal supplements sold by four major retailers.  The retailers were Walgreens, Wal-Mart, Target, and GNC. The issue was that DNA analysis of many of these herbal products showed none of the actual herb claimed on the label. There were plenty of dire quotes about "false advertising," and "an unbelievably devastating indictment of the industry."

This sounds like an open and shut case, but let's take a little but a closer look. The first problem is with the testing method. Mark Blumenthal of the American Botanical Council gave a great concise explanation about why the DNA testing that was done was inappropriate for this type of research.
The main take away points are:

• DNA testing does not test for botanical extracts, only whole herb products
• There was no microscopic or chemical testing (techniques much more widely used to confirm herb quality) for confirmation
• The analysis was performed by a researcher with no background in botanical medicine
• There was no repeat confirmation by a different lab
• Trace contamination of other plants, or even common fillers (rice, potato, etc.) would show up on DNA analysis, since this test only shows the presence of those plants, not their quantity

Contrary to the attorney general's statement, this test did not prove widespread fraud in the supplement industry. However, there is also the concern that these store brands are being held up as the standard for the entire supplement industry.  A professor at Harvard Medical School stated that "mainstream retailers like Wal-Mart and Walgreens...are expected to be the absolute highest quality."

Wait, what? There are very likely our quality control issues with many supplements, especially cheap store brands. That is why I often recommend professional supplements for my patients when we want a specific therapeutic effect. Some people wonder why a bottle of supplements by Metagenics, Integrative Therapeutics, Vital Nutrients, Ortho Molecular Products, or Thorne Research costs twice as much or more than a "comparable" product at the drugstore. The answer is quality control. These professional brands spend the time and money to independently verify each batch of raw ingredients that they use, as well as the final product, to ensure quality and potency.  You wouldn't want to buy a pharmaceutical medicine that hadn't undergone rigorous quality control -- why would you accept less from your supplements, if you are depending on them for your health?

I wouldn't throw out my supplements just yet. Especially if you got them from a trusted source.

Is Your iPad Killing You?

Regular readers and patients know the importance of a good night's sleep to health.  Low quality sleep, and getting fewer than seven hours of sleep per night, have been associated with chronic diseases such as cardiovascular disease, as well as shorter lifespan. Two recent studies highlight some of the hidden thieves of sleep in our modern world.

Researchers at Brigham and Women's Hospital in Boston compared people who read on an iPad screen before bed to those reading a traditional paper book before bed. The study confirmed what has long been suspected: that exposure to a screen decreases sleep quality, shortens the amount of REM sleep, and leads to worse moods and poor productivity the next day. Ideally, you should avoid all light-emitting screens for at least an hour before bedtime.  The main problem seems to be with the blue wavelengths of light, that suppress our body's natural melatonin production. If you really have to read a screen late in the evening, use a physical filter that blocks bluelight, or use free software such as f.lux that achieves the same effect. For Android users, there are several apps available, such as Twilight.

Another problem associated with difficulty sleeping is the presence of intrusive or repetitive thoughts. Interestingly, researchers at Binghamton University have discovered that one of the best way through to cease anxious thoughts is actually to get to bed earlier. Staying up late at night and having a short duration of sleep just aggravate the problem.

It can be a challenge to adjust your habits to get to bed earlier, but it's worthwhile. Maybe you could stop watching those electronic screens late in the evening. If repetitive thoughts are actually preventing you from falling asleep, you could try and herbal sleep aid such as valerian root, or a do-it-yourself behavior modification programs such as SleepStar.

When you sign up for SleepStar, use code PetersND25 for a discount.

Jacob A. Nota, Meredith E. Coles. Duration and Timing of Sleep are Associated with Repetitive Negative Thinking. Cognitive Therapy and Research, 2014; DOI: 10.1007/s10608-014-9651-7

Good Nutrition Made Even Easier

If there's one thing that's consistent in the field of nutrition, it's that information is always changing.  With the barrage of latest headlines about the scientific research on nutrition, how can we cut through the confusion and make healthy choices?  I usually spend a fair amount of time reading Nutrition Facts labels at the grocery store, weighing the pros and cons of each item.

Enter NuVal:  a user-friendly information system at the grocery store.  NuVal was developed by top nutrition researchers, led by David Katz, MD, of Yale.  It combines all the latest research about what makes a food healthy, and giving it a single numerical score from 1 (worst) to 100 (best).  The formula is complex, taking into account factors such as fiber, vitamins and minerals, sodium, calories, sugar, trans fats, and more -- but the end result is one simple number.

The best part of NuVal?  For grocery stores that choose to use it, it's right on the shelf, in black and white.  I first heard of this new system at a nutrition seminar last fall, and was surprised when I noticed the NuVal numbers on the shelf tags at Meijer a few weeks ago.  The numbers are small, so you have to squint a bit to read them, but they are there.  This is a very convenient way to compare foods in the same category, so you can quickly make better nutritional choices.

White pasta?

Or how about some whole grain pasta -- 30 points higher!

Yikes!  Just because a food is "organic" does not mean it's a healthy choice.

Of course, you still have to get a balanced diet of different types of healthy foods (ideally based around a Mediterranean-type pattern) -- you can't eat all asparagus all the time just because it has a NuVal of 100.  But if you can "trade up" to higher NuVal scores within the categories of foods you like, you'll notice the difference in your health.

Is It Time to Eat? A Surprisingly Important Question

'Tis the season for making New Year's resolutions.  Perhaps your resolutions include healthier eating and losing weight.  There is certainly plenty of info in my past articles on how to construct a healthy diet that will help you live longer and prevent chronic diseases. One element that may have been overlooked in all the scrutiny over what to eat is when to eat. There is growing evidence that restricting our eating to certain times of the day leads to more easily maintaining a healthy body weight.

Several authors and experts have been touting so-called "intermittent fasting," which consists of only eating between the hours of 10 AM and 6 PM, for example. Another version of this approach involves eating normally five days per week, but essentially fasting (taking in less than 500 calories) on the other two days.  The idea behind this is that a more prolonged period without food discourages fat storage, and allows our body to switch its metabolism over to burn our stored fat supplies.

A recent study in mice (1) seems to support this idea. In this study, two groups of mice were allowed to eat as much as they wanted. One group had food available at all times, while the other group only had food available for a 12-hour period each day. The group with the more restrictive time ate about the same number of calories as the other group, and yet maintained a healthy body weight, while the unrestricted group became obese.  The time-restricted mice were even able to reverse obesity and prevent type-2 diabetes.  Cholesterol balance improved within two weeks, and blood sugar control improved within a few days.

A related study (2) showed how this intermittent fasting can change the composition of the gut microbiome.  A healthier blend of friendly intestinal bacteria leads to leaner body weight.

It's too soon to translate these results directly to humans, but there have been some small human studies that point to the benefits of this approach.  One study found that intermittent fasting led to the same amount of fat loss as traditional calorie-restricted diets, but preserved much more healthy lean tissue. (3)

In a way, all of this seems to hearken back to traditional Chinese and Ayurvedic medicine: these systems used more poetic language to recommend against eating late into the evening or at night.  Whatever the reasoning, the outcome seems to be the same -- better health when we pay more attention to eating at the right time of day.

Listen to an interview with one of the researchers:  You Are 'When' You Eat 

1.  Amandine Chaix, Amir Zarrinpar, Phuong Miu, Satchidananda Panda.  Time-Restricted Feeding Is a Preventative and Therapeutic Intervention against Diverse Nutritional Challenges.  DOI: http://dx.doi.org/10.1016/j.cmet.2014.11.001

2.  Amir Zarrinpar, Amandine Chaix, Shibu Yooseph, Satchidananda Panda.  Diet and Feeding Pattern Affect the Diurnal Dynamics of the Gut Microbiome.  DOI: http://dx.doi.org/10.1016/j.cmet.2014.11.008

3.  Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings.  Transl Res. 2014 Oct;164(4):302-11. doi: 10.1016/j.trsl.2014.05.013. Epub 2014 Jun 12.

Taking a Stand... for Chairs

Sitting, and its effects on health, is a hot topic these days.  I recently wrote a review of current research, showing how excessive sitting increases our risk of chronic disease and death; it even cancels out the benefits of regular exercise.

It seems like I'm hearing more about this everywhere I turn. The excellent radio show, 99% Invisible, just ran an episode on the health effects of sitting, and how it relates to the history (and future) of chair design. I encourage you to read or listen to this fascinating show.