Are You at Risk for Pneumonia with this Medication?

One of the foundations of health is a good night's sleep.  Lack of sleep can lead to consequences including obesity, aggravation of pain conditions like fibromyalgia, poor memory, and even increased risk of cardiovascular disease.  With all the benefits of getting a good night's sleep, it might be tempting to do whatever it takes to correct sleep problems -- including taking pharmaceutical sleep aids.  But let's step back and consider the consequences first.

A common class of medications prescribed for sleep (and anxiety) is the benzodiazepines ("benzos") -- with trade names like Xanax and Valium, or generic names alprazolam, diazepam, and others.  The main problem with these drugs is well known:  they're addictive, and can lead to physiological dependence.

A new study published this month (1) found an unexpected danger with benzos:  a 54% increased risk of pneumonia.  Pneumonia is one of the more serious complications of seasonal influenza, which I wrote about last week.  If you're currently taking benzos for sleep, or considering them, think about all the natural ways you can improve sleep instead.  Of course, discuss changing your medication with the prescribing physician, since it's best to wean down carefully on this type of drug.  Now if you're thinking, "I've tried all that natural stuff before!  It didn't work," my response is... really?  Everything?  Review the list below, and give these suggestions an honest try for a period of several weeks.


IMPROVING THE QUALITY OF YOUR SLEEP

1. Maintain consistent sleep and wake times. Do not push yourself to stay up past the initial signs of sleepiness. This can create epinephrine production, causing more difficulty getting to sleep later. It is good to have a “getting ready for bed” routine to relax and prepare your body for sleep. Avoid taking naps if you have trouble sleeping at night.

2. Reserve the bed for sleep and sex only. Do not read, watch TV, eat, or worry in bed. Solve daily dilemmas outside of the bedroom. If you find that you’ve been lying awake in bed for 15-20 minutes, get out of bed.  Do something mundane until you feel sleepy, and then go back to bed. Repeat this as often as needed.

3. Your sleeping environment should be quiet, cool (70 degrees or less), and comfortable. The room should be clutter-free. Reduce the amount of ambient light as much as possible. Electronic devices such as clocks, stereos, TVs and computers generate electromagnetic fields that can disturb sleep for some people. Experiment with moving these into another room or using EMF shields. Feng Shui, the Chinese art of placement, can be valuable in creating an optimal sleeping environment.

4. Exercise regularly. Exercising during the day or early evening decreases the time it takes to get to sleep and increases the amount of deep sleep obtained. Most people do better avoiding exercise late in the evening.

5. Exposure to sunlight early in the morning and late in the afternoon or evening encourages a strong circadian rhythm. The hormone melatonin, which helps create a sleep state in the body, is suppressed in light and secreted in darkness.

6. As much as possible, ensure complete darkness at night.  Darkness encourages your body’s natural production of melatonin.  Do not fall asleep with the TV or lights on.  Turn off all screens (TV, computer, video games, etc.) 30-60 minutes before bedtime.  If you wake at night to go to the bathroom, do not turn the light on.  Even this brief exposure to light at night may suppress your melatonin significantly, drastically reducing the quality of your sleep.

7. If you have problems with waking during the early hours of the morning, have a small protein snack just before bed to ensure consistent blood sugar levels throughout the night. Consistently get exposure to sunlight as late in the day as possible.

8. Improving overall health will improve the quality of your sleep. Work towards improving or eliminating health problems. Treatment modalities such as Neurostructural Integration Technique will help to relax the body. Effective stress management is essential.


THINGS THAT RELAX THE BODY AND PREPARE IT FOR SLEEP

• Warm baths, possibly adding Epsom salts or lavender oil
• Meditating for 5-30 minutes
• Breathing exercises, progressive muscle relaxation (various recordings are available) or any other means of inducing the “relaxation response”.  Daily practice brings greater results.
• Special acoustic recordings that increase specific brain wave patterns for relaxation and sleep
• Botanical treatments and aromatherapy using herbs and their essential oils (examples include chamomile, valerian, vervain (verbena), hops, lavender, passionflower, avena (oat straw), lemon balm and scutellaria (skull cap).  Consult Dr. Peters for dosages and recommendations.
• Calcium and magnesium supplementation.  Consult Dr. Peters for dosages and recommendations.
• 5-hydroxytryptophan (5-HTP) or melatonin supplementation may be necessary in individual cases.  Consult Dr. Peters for dosages and recommendations.

THINGS THAT INTERFERE WITH SLEEP

• Although alcohol may make you fall asleep, the sleep obtained after drinking is fragmented and light.
• The stimulating effects of caffeine may last up to 10 hours in some people. Avoid it in the afternoon if getting to sleep is a problem. Caffeine is present in coffee, green tea, black tea, chocolate and some medications (pain relievers, decongestants, thermogenic weight loss products, energy supplements, etc.)
• The stimulating effects of nicotine (first- or second-hand smoke) can last several hours.
• Sleeping pills, aside from being highly addictive and full of side effects, decrease the amount of time spent in deep sleep and only increase light sleep.
• B-vitamin supplements can increase energy that keeps some people awake, if taken before bed. Take B-vitamins earlier in the day.
• Do not go to bed with a very full stomach. Large quantities of protein are stimulating to the body as digestion occurs. It’s best to finish eating at least three hours before going to bed.

1.  The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort.  Thorax doi:10.1136/thoraxjnl-2012-202374.  

Flu Season: Here with a Vengeance

Influenza has arrived early this year, and it looks like it's gearing up to be a nasty one:  both the H1N1 and H3N2 strains of influeza A virus have been identified, as well as influenza B.  According to the Centers for Disease Control and Prevention (CDC), the rate of infection is still low this week in Illinois, but is high in southern states like Alabama and Mississippi.


Remember, this is the respiratory flu we're talking about (sore throat, fever, fatigue, muscle aches), not the "stomach flu" (more properly called gastroenteritis).  The CDC recommends flu vaccines for everyone, though there is no scientific evidence for this approach.  Furthermore, the flu vaccine might prevent flu virus infection, but does absolutely nothing to protect against related viruses that cause flu-like illnesses.  Are there good natural alternatives for preventing and treating the flu?

My first recommendation to everyone at this time of year is to get a blood test for vitamin D levels.  The proper test is called 25-hydroxyvitamin D, and the optimal level should be between 40 and 100 ng/ml.  Research has shown a clear connection between low blood levels of vitamin D and risk of catching the flu.  Flu season can span anytime from October to May – the same time period that we don’t get enough sun exposure to produce vitamin D naturally through the skin.  Coincidence?  If you have low vitamin D levels now, it’s critical to supplement at high doses under a doctor’s supervision.  Without a blood test, a supplement of 1,000-2,000 International Units per day is advisable through the winter.

Remember good hygiene – wash hands frequently, and avoid touching your eyes, nose, and mouth.  There is no need to use antibacterial soap, since this does no better than standard soap in protecting against infection.  Get a good night’s sleep to support your immune system.  For supplemental support, look into herbs such as astragalus, larch, and elderberry, as well as extra vitamin C and zinc.  If you’re exposed to people with flu or other respiratory illnesses, use a neti pot or squeeze bottle with plain salt water to rinse the nasal passages, twice a day.

Flu vaccination is important for those with asthma and other lung problems; for nursing home residents and health care workers; and for those with suppressed immune systems.  For the rest of us, take care of yourself naturally.  At the first sign of illness, use supplemental support often:  elderberry and andrographis every two hours for 24-48 hours can help to shorten the duration and severity of your misery.

Natural Medicine Myth #5: One-A-Day

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol, cinnamon, systemic candida, and acai berry.

Those of you who know my articles and recommendations will find it no surprise that therapeutic lifestyle changes are the foundation of naturopathic medicine:

• diet
• exercise
• sleep
• stress management

In many cases, though, specific nutritional and herbal supplements can be critical for supporting a patient's vis medicatrix naturae:  the healing power of nature.  Particularly in the case of complex or chronic disease, such supplements are often necessary for a certain period of time.

One thing that often surprises patients is the dosages I recommend for many nutritional and herbal supplements.  I think that many of us have been conditioned by "One-A-Day" multivitamins to think that all supplements work that way.  In fact, this under-dosing is a key reason why many folks find that self-treatment with herbs and supplements is ineffective.

As an example, take one of my favorite supplements:  fish oil.  The beneficial components of fish oil are the long-chain omega-3 fatty acids, EPA and DHA (that's eicosapentaenoic acid and docosahexaenoic acid for you nutritional biochem geeks out there).  Some folks take one softgel a day of fish oil -- 1000 milligrams!  Sounds like a lot, doesn't it?  Well, research shows that for general cardiovascular health, you should take around 1000 mg of omega-3 fatty acids per day.  "Well, great, then," you think, "I guess I'm covered."  Hold it right there:  fish oil supplements are not 100% omega-3 fats; each softgel might have only 300-400 mg of omega-3s.  So now you're faced with 3-4 softgels per day to get the recommended amount.  Do you see why I recommend liquid cod liver oil so often now?  Much easier to blend a teaspoon into a breakfast smoothie, yielding 1200 mg of omega-3s.

If you already have conditions such as high triglycerides that can benefit from omega-3 supplementation, now you need to up that dose to 2000-3000 mg per day:  7-10 softgels, or 2 - 2.5 teaspoons of liquid.  Omega-3 fats can benefit so many different conditions, such as autoimmune diseases, skin problems, menstrual cramps, depression, and anxiety -- as long as you're taking the proper dose.

Feel a cold coming on?  Yes, zinc lozenges can help -- as long you get a total dose of at least 75 mg of zinc per day (be sure to take with food, to avoid stomach upset).  Herbs such as echinacea, and my favorite combo of lomatium (Lomtium dissectum) and osha (Ligusticum porteri), are wonderful immune boosters -- just be sure take a dose every 2 hours during those first couple of days of a cold.  Less than that, you might as well skip it.

Nutritional and herbal supplements require these larger doses since they work synergistically to support the body's natural functions, rather than to suppress symptoms like pharmaceuticals.  So shift your mindset, and reap the benefits that nature has to offer.

Are "Superfoods" Really that Super?

You've probably heard of phytonutrients, those beneficial compounds in plant-based foods that help protect us against chronic diseases.  In particular, some foods, such as broccoli and blueberries, are so packed with these phytonutrients (such as polyphenols) that they've been dubbed "superfoods."

New research out of Kingston University in London has challenged this notion, finding that most of these phytonutrients don't even get absorbed from the digestive tract into the bloodstream.  So while they may benefit cells in the test tube, they can't benefit our body's cells if they don't get absorbed.  This has been trumpeted with pithy news articles about "debunking exaggerated health claims and benefits" of phytonutrients.

Before you throw out the broccoli, and start scarfing down the Twinkies you've stockpiled since the demise of Hostess, keep a few points in mind:

• This research was not actually done on people, but on a laboratory model simulating the intestinal wall.  There's no guarantee that the absorption works the same way in humans; if it did, pharmaceutical companies could save gobs of time and money that they spend examining pharmacokinetics -- how substances are actually absorbed and metabolized in living people.
• The researchers say "some compounds may have a local effect in the gut itself..."  This is not trivial.  Much previous research has focused on the relationship between the health of the GI tract and the health of the rest of the body, and the interaction of stuff in our GI tract with GALT (gut-associated lymphatic tissue) influencing inflammation and immune signalling in distant parts of the body.
• Epidemiological studies (looking at populations of real people) have shown that eating greater amounts and more variety of fruits and veggies leads to better health outcomes.  I'll take that over a simulation experiment any day.

Always look beyond the headlines of health news and ask yourself, is this conclusion reasonable?  Does it concur with the rest of the evidence out there?  Is it taking all the variables into consideration?  This seems to be one case where researchers have leaped to conclusions once again.

Researchers challenge super food claims.  Kingston University London, Monday 1 October 2012.

Natural Medicine Myth #4: Acai Berry

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol, cinnamon, and systemic candida.

If you've been to any sites on the World Wide Web in the past several years, you've probably heard of the miracle fruit called acai berry.  Its touted health benefits range from weight loss to treatment for high cholesterol, high blood pressure, and beyond.  There is no shortage of testimonials about these effects, and the ads about acai are often disguised as phony "news investigations."

The first thing to consider about such claims is that even though testimonials are emotionally compelling, they do not comprise any sort of scientific evidence.  Many of the actual scientific studies about the benefits of acai were done in vitro (that is, in the test tube) -- meaning that any benefits for people actually ingesting acai are purely a guess.

What do we actually know about acai?  This species of palm tree (Euterpe oleracea) is common in South America, and produces an antioxidant-rich fruit.  This fruit is an important staple in the diet of some native Amazonian peoples.  The antioxidant qualities of acai have contributed to its reputation as a "health food."  Howerver, analyses of this fruit show that its antioxidant content is lower than that of blueberries, mango, strawberries, and grapes.

If you've been around the natural health scene for a while, you've seen this before.  Prior to acai, the miracle fruit was goji berry.  Then there was mangosteen, and oh yeah -- noni juice!  Remember that oldie but goodie from the '90s?

People like a good story -- really, it's what makes us human.  We like stories of exotic fruits from faraway lands with mysterious-sounding names.  Does that mean all those anecdotes about health benefits are false?  Maybe not -- if folks are eating the Standard American Diet (S.A.D.) of fast food, processed food, and junk food, then consumption of any fruit or vegetable is bound to improve their health!

Wouldn't it make more sense to eat some healthy fruits grown locally in our own region, like blueberries?  Without the thousands of miles of transportation, they retain much higher levels of their nutrients and antioxidants.  Enjoy the abundance we have right here of colorful fruits and veggies.  Save the exorbitant cost of acai and other miracle fruits; enjoy a good book or movie for your story.

Did You Enjoy that Extra Hour of Sleep this Weekend?

Welcome back to standard time, folks... did you remember to set your clocks back this weekend?
One more question:  did you notice it was much easier to adjust to the time change this weekend than to the switch to daylight savings time in the spring?  It seems logical, since we "gained" an hour of sleep on Saturday night.  But even beyond that, this is the one weekend out of the year when the external clocks match most closely to our internal biological clocks.

Yes, we do have a biological clock -- a part of the brain called the suprachiasmatic nucleus (SCN); its job is to keep track of the daily cycle of our body's functions (also known as our circadian rhythm).  Research has shown that for most folks, the SCN is actually set to a 25-hour cycle, which means that we have to reset it every day based on cues in our environment.  That's why it's easier to stay up late, but harder to wake up earlier in the morning.

Up till about 200 years ago, our biological clocks mostly relied on the signals of sunlight to reset ourselves each day.  With the advent of reliable timekeeping, we now go by a strict 24-hour day; with electric lights, we can give in to our tendency to want to stay up later, if we choose.

Use the "extra" sleep you got this weekend to honor your body's natural circadian rhythm.  Don't complain about the early sunset, but rather use it as a signal to get to bed at a reasonable time -- and enjoy the earlier sunrise these days.  Sleep is one of the foundations of health, and most adults need around 7-8 hours per night.  Getting adequate sleep helps not only with our daytime energy, but also with preventing diabetes, cardiovascular disease, and obesity.

This is a repost of an article that appeared in 2011.

Is Vitamin D Good for the Heart or Not?

Based on much recent research linking low levels of vitamin D to increased risk of heart disease, this is something I measure in all of my older patients.  If low, supplementation is simple, cheap, and can effectively raise those levels back up.  This is especially important at this time of year, since the sun is not strong enough to produce any vitamin D from skin exposure at our latitude.

A recent study in the Journal of Clinical Endocrinology & Metabolism (1) looked at the question of whether or not supplementing with vitamin D can change cardiovascular risk.  This was one of the first actual placebo-controlled clinical trials to examine the question.  Half the participants got vitamin D3 (a good quality form of vitamin D), and the other half got placebo.  At the end of the study, they examined cardiovascular risk markers, such as blood cholesterol, blood pressure, and C-reactive protein, and found no significant difference between the groups.  The conclusion?  Quoting from the New York Times:

“The study actually shows that vitamin D does not protect you against heart disease,” said Helen M. Macdonald, a senior lecturer at the University of Aberdeen in Scotland, who led the study. “That’s not what people want to hear, but it’s true.”

Now hold on a minute.  The researchers are making a huge assumption:  that the risk markers of cholesterol, C-reactive protein, etc., are synonymous with heart disease.  The thinking is that if something (in this case vitamin D) does not affect those traditional risk markers directly, there is no impact on heart disease.   However, it is well known that a significant percentage of heart disease and heart attacks occur in people with normal cholesterol levels and blood pressure.  Perhaps vitamin D is an independent risk factor -- that is, it could protect against heart disease without changing those other parameters.

The way to  really tell this for sure experimentally would be to use actual cases of heart disease as the end point of vitamin D supplementation.  This study was a good first step, but the error in logic on the part of the researchers is glaring.  In the meantime, I'll keep checking blood levels of vitamin D on my patients over age 40 as part of an overall cardiovascular risk assessment, using the naturopathic principle of "Treat the whole person."

1.  Vitamin D₃ Supplementation Has No Effect on Conventional Cardiovascular Risk Factors: A Parallel-Group, Double-Blind, Placebo-Controlled RCT.  Published online before printAugust 3, 2012, doi:10.1210/jc.2012-2126
The Journal of Clinical Endocrinology & Metabolism, October 1, 2012 vol. 97 no. 103557-3568

Natural Medicine Myth #3: Systemic Candida

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol and cinnamon.

In the 1980s, a medical doctor by the name of William Crook published a book called The Yeast Connection.  The gist of it is that many symptoms of fatigue, joint pain, depression, etc., are the result of by-products of yeast overgrowth in the body.  Eating a diet that starves the yeast (eliminating sugar and refined grains) can therefore resolve these symptoms.  Sometimes anti-yeast medications may be required also.

Is yeast real?  Of course -- Candida albicans, the main yeast species that Dr. Crook refers to, is part of the normal flora of our intestinal tract in small amounts.  When there is an overgrowth of candida, it can cause gastrointestinal (GI) bloating, indigestion, and constipation or diarrhea.  Overgrowth in the genital tract cause those annoying vaginal yeast infections; candida from the GI tract can serve as a reservoir for recurring infection.  And indeed, waste products produced by candida in the GI tract can be absorbed and cause more widespread symptoms in the body.

So why am I calling this a myth?  The problem is with misperceptions surrounding candida:

1. You can diagnose candida overgrowth from a symptom questionnaire.  There are many, many problems in the body that can lead to fatigue, joint pain, etc.  Doing a stool test to check for yeast, or a urinary organic acid test to check for yeast by-products, are the only ways to know for sure that intestinal candida is the culprit.  In that case, specific anti-yeast therapies (pharmaceutical or natural) may be needed.  However, doing a "cleanse" for candida or parasites without evidence is most likely a waste of effort.
2. "Whole-body candida."  Some folks get the impression that candida is growing throughout the bloodstream or other parts of the body, besides the GI or genital tracts.  This only occurs in severely immunocompromised conditions, such as AIDS.  The by-products from yeast might be high in the bloodstream, but not the organisms themselves.
3. You need to avoid all yeast and mushrooms on an anti-candida diet.  Candida is part of the fungus kingdom -- a completely separate branch of life from plants, animals, and bacteria.  However, it is only one species.  Baker's yeast is a completely different species (Saccharomyces cerevisiae), and mushrooms are of many other different species.  Avoidance of everything in the fungus kingdom is akin to saying that because you are allergic to cats, you need to avoid elephants, trout, ladybugs, bald eagles, and everything else in the animal kingdom.  One particular yeast -- Saccharomyces boulardii -- is even considered a powerful probiotic (beneficial organism) that helps boost our immune response (1,2). 
4. You need to kill all candida in the body in order to be cured.  This is a well-nigh impossible task.  All of us have some candida in the GI tract, along with hundreds of other species of microorganisms.  Our normal flora is more like a complex rainforest ecosystem, rather than the one or two species present in a probiotic supplement.  The key is in the balance, and making sure that there isn't overgrowth of candida.

Now you might be thinking, "OK then, Mr. Smartypants, then why do I feel so much better on the anti-candida diet?"  Look at the foundation of it again:  eliminating sugar and refined grains (white flour).  Now compare that to any of a number of other diets (Atkins, South Beach, Paleo, blood type diet, etc.).  What do they all start with?  Eliminate sugar and refined grains.  Each then goes on to an elaborate set of specific rules, and reasoning behind it.  But maybe it all boils down once again to the fact that this approach cuts out most of the junk food in the Standard American Diet (S.A.D.), and replaces it with nutrient-dense whole foods.  Of course you're going to feel better!  This approach gives your body the bioavailable vitamins, minerals, and phytonutrients it needs.  It also eliminates the blood sugar and insulin roller coaster brought about by these refined, high glycemic index foods.  

Before jumping on an extreme diet, take a look at whether or not you're even getting the recommended five to nine servings of fruits and veggies per day.  It's always easier to add things into our diet first, than to take things out.

1.  Systematic review and meta-analysis of Saccharomyces boulardii in adult patients.  World J Gastroenterol. 2010 May 14;16(18):2202-22.

2.  Interaction of Saccharomyces boulardii with intestinal brush border membranes: key to probiotic effects?  J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):532-3.

Natural Medicine Myth #2: Cinnamon

Starting with last week's article about policosanol, I have been outlining five of the most common misperceptions I encounter in the field of natural medicine, and examine some more effective alternatives.

Myth #2:  Cinnamon controls blood sugar (or even "cures" diabetes).
T'ype 2 diabetes and "pre-diabetes" (insulin resistance) are on the rise in the U.S., thanks to the prevalence of junk food, and an increasingly sedentary lifestyle.  These conditions involve a breakdown of the body's ability to regulate blood sugar, so that it goes too high.  High blood sugar itself may not sound very threatening, but it basically puts aging on fast-forward, dramatically increasing the risk of heart disease, kidney damage, and vision and nerve problems.  Recent research even suggests that blood sugar at the high end of the "normal" range represents a significant risk factor.

Folks in the natural health field emphasize (or should emphasize) specific diet and exercise changes as the foundation to diabetes prevention and treatment.  We also, when necessary, recommend nutritional supplements to help bring down high blood sugar levels.  One of the most popular in recent years has been cinnamon, since it is safe, commonly available, and has been shown effective in lowering levels of hemoglobin A1c (HbA1c, the blood test for 3-month average blood sugars).  I often recommended this to patients myself, until some recent clarification from my colleague, Jacob Schor, ND, of Denver Naturopathic Clinic.  A recent meta-analysis (a study of studies) showed that cinnamon does indeed lower HbA1c to a statistically significant extent (1).

Huzzah!  So what's the problem?  A closer look at the data shows that the average effect of cinnamon was a 0.09% decrease in HbA1c.  Clinically, this is barely a dent in blood sugar.  "Statistically significant" just means that the math panned out.  By comparison, studies showed that weight loss and regular exercise can drop HbA1c three times as much as cinnamon (2).  Berberine, an extract from various herbs such as Oregon grape route, barberry, and goldenseal, taken at doses of 500 mg, three times per day, lowered blood sugar twenty-two times as much as cinnamon (3).

If you are having blood sugar problems, or are already diabetic, don't rely on cinnamon to control it (for pity's sake, don't use some of the research as an excuse to reach for a cinnamon roll!).  It's a great spice, but not great medicine.

1. Akilen R, Tsiami A, Devendra D, Robinson N. Cinnamon in glycaemic control: Systematic review and meta analysis. Clin Nutr. 2012 May 12.
2.   Nilsen V, Bakke PS, Gallefoss F. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial. BMC Public Health. 2011 Nov 25;11:893.
3.  Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008 May;57(5):712-7.

Top 5 "Myths" in Natural Medicine

As a doctor of naturopathic medicine, I have years of experience and training to respect the vis medicatrix naturae, or healing power of nature.  This is foundational to our approach to health.  I also have a background in science, and know that it is important to examine natural methods of health care to see if they are valid and effective.

That is why (though it might be dangerous to step on some toes) I like to clarify common misperceptions:  My goal is to help patients be as healthy as possible, not to be wedded to a particular idea.  Therefore, over the next few articles, I will present five common myths I often encounter, in no particular order.

Myth #1: Policosanol is a good alternative to cholesterol-lowering medication.
Policosanol is an extract of the sugar cane plant that made big news about ten years ago, with studies showing it was very effective at lowering blood cholesterol levels (1).  The nutritional supplement industry responded with a deluge of policosanol products.  However, much of that early research was conducted in Cuba, the source of the sugar cane--the raw material for policosanol production.  Follow-up studies conducted on larger populations, showed little to no clinically significant cholesterol-lowering effects of policosanol (2, 3).  Even though this well-designed research was published in 2006, policosanol sales continue to this day.  More recent research from 2011 (4) found that even a form of policosanol modified to make it better absorbed from the gastrointestinal tract failed to make a significant dent in cholesterol levels.  Some recent studies showing benefits used policosanol in combination with red yeast rice and berberine, two natural compounds that have been proven time and again to be effective in lowering cholesterol.  It's highly likely in these studies that the policosanol could have been left out, without affecting the results.

With all this evidence against policosanol, why are sales still so brisk today?  Well, in the midst of bashing the evil of Big Pharma companies, we sometimes forget that supplement companies are businesses, too, driven by market forces.  As long as there's a demand for policosanol (based on those biased studies from 10-15 years ago), they'll keep selling it.  Sorry, folks--supplement companies are not selfless crusaders for health; they're driven by the profit motive.  It's the American way.

I stopped recommending policosanol in 2006, in favor of much more effective treatments.  I also like to remind patients that high cholesterol is not a disease; it's a risk factor for cardiovascular disease (CVD).  I put the emphasis on lifestyle factors for CVD prevention, and look at modifying other risk factors too (such as high-sensitivity C-reactive protein and blood levels of vitamin D).

Next Time:  Cinnamon for blood sugar control

1.  Policosanol: a new treatment for cardiovascular disease?  Altern Med Rev. 2002 Jun;7(3):203-17.

2.  Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial.  JAMA. 2006 May 17;295(19):2262-9.

3.  Comparative lipid-lowering effects of policosanol and atorvastatin: a randomized, parallel, double-blind, placebo-controlled trial.  Am Heart J. 2006 Nov;152(5):982.e1-5.

4.  Modified-policosanol does not reduce plasma lipoproteins in hyperlipidemic patients when used alone or in combination with statin therapy.  Lipids. 2011 Oct;46(10):923-9. Epub 2011 Jul 8.

More Good News for Chocolate

Ah, how times change.  Just a few years ago, chocolate was undoubtedly in the junk food category, yet a flurry of recent research has confirmed its benefits to cardiovascular health.  The latest is a study from Sweden published last month (1) that showed that higher chocolate consumption cut men's stroke risk by 17%.  And it didn't need to be much -- just an average of about 2 ounces per week, compared to non-consumers.  The key seems to be the flavonoids in cocoa:  compounds that have antioxidant activity, and improve endothelial function (the inner lining of large blood vessels).

Prior research showed cardiovascular benefits from dark chocolate, which have a higher cocoa content (55-90%) than milk chocolate (30%).  So for maximal benefit, reach for the dark chocolate.  This also avoids the high amounts of sugar and saturated fat in milk chocolate, which can contribute to obesity and metabolic syndrome.

It might take time to get used to the less sweet taste of dark chocolate, but with small amounts (1/2 - 1 ounce per day), your palate will adjust.  My advice?  Become a chocolate snob.  Buy good quality dark chocolate, and really focus in and enjoy that little tidbit, rather than cramming down a whole bar of cheap milk chocolate.


1.  Chocolate consumption and risk of stroke:  A prospective cohort of men and meta-analysis.  Neurology. 2012;79:1223-1229. Published online August 29, 2012.

Why I'm Still Eating Organic Foods

A study about organic food published this month in the Annals of Internal Medicine (1) made big headlines, mostly along the lines of "organic food is no better for you than conventionally grown food."  As usual, the headlines tend to gloss over the details of the research that was conducted.  Several points are worth noting, to decide whether or not organic fruits, vegetables, eggs, and meat are worth the extra cost:

• This was a review study, not primary research.  That is, the authors combed through existing articles from the past 15 years to extract the data.  This can confuse the issue, since the previous studies were done in different settings and for a variety of purposes.
• Organic produce does not contain significantly higher levels of vitamins or minerals than conventionally grown produce.
• Eating organic food leads to lower exposure to synthetic pesticides and fertilizers, but the authors point out that the exposure from conventional foods was mostly within the "allowable limits" set by the US government.
• Organic chicken and pork have a greatly reduced risk of carrying antibiotic-resistant bacteria ("superbugs" that are particularly dangerous and difficult to treat).

My view on some of the conclusions reached:

• It has been well known for a long time that organic fruits and veggies are not superior in vitamin or mineral content.  However, some studies have suggested that they do have a higher content of phytonutrients -- those compounds produced by plants that help protect us against cancer, cardiovascular disease, and other chronic health conditions.  Plants are basically chemical factories; without the "protection" of synthetic pesticides, they must cook up their own natural protective compounds, and we get the benefits when we eat those plants.
• Even though pesticide residue on conventional produce is within "safe" limits for daily consumption, we must remember that those chemicals are lipophilic (literally, "fat-loving").  They can stay in our fat tissue for a very long time.  How long?  A by-product of the pesticide DDT (which was banned in the US in 1972) was still present at significant levels in adults' fat tissue two decades later (2).  So it's not about keeping the daily dose in a "safe" range; it's thinking long-term about these carcinogenic compounds (3) building up in the body.
• While we're on the topic, those synthetic chemicals can even contribute to obesity and diabetes (4).
• Avoiding antibiotic-resistant bacteria is always a good idea; avoiding the residue of antibiotics in meat is also a good idea, since that may disrupt the normal, beneficial microorganisms in our digestive tract.

So for many fruits, vegetables, and meat, I'm sticking with organic.  If you need to budget your grocery dollars, check out the Environmental Working Group's analysis of which foods are highest and lowest in pesticide residue.

1. Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review.  Ann Intern Med. 4 September 2012;157(5):348-366
2. Organochlorine pesticides and polychlorinated biphenyls in human adipose tissue.  Rev Environ Contam Toxicol. 1991;120:1-82.
3. Adipose tissue levels of organochlorine pesticides and polychlorinated biphenyls and risk of non-Hodgkin's lymphoma.  Environ Health Perspect. 2004 Jun;112(8):854-61.
4. Obesity and persistent organic pollutants: possible obesogenic effect of organochlorine pesticides and polychlorinated biphenyls.  Obesity (Silver Spring). 2011 Apr;19(4):709-14. Epub 2010 Jun 17.

When Does a "Normal" Blood Sugar Test Mean a 53% Increased Risk of Cardiovascular Disease?

Answer:  When it's at the upper end of the normal range.

A fasting blood glucose (FBG) test is one of the most common labs I order.  The normal range for FBG is 60-99 mg/dl.  If this reading of blood sugar is much too high (greater than 126 mg/dl) on two separate tests, that is the definition of diabetes.  The most common type of diabetes that comes on later in life is called type 2 diabetes mellitus, and is associated with obesity.  That borderland of 100-125 mg/dl is called impaired fasting glucose, and indicates that a person on the way to developing diabetes.

So why all this fuss about blood sugar?  The problem is that high blood sugar (and the high insulin levels that accompany it) put aging on fast-forward -- putting you at much greater risk for heart disease, kidney disease, eye problems, and nerve problems.  It literally takes years off your life.  The complex interrelationship between high blood sugar, insulin resistance, and chronic disease has been called metabolic syndrome.

Knowing this, researchers in Israel published findings last week (1) that indicate that the problems don't just suddently start once your FBG climbs over 100 mg/dl.  Adults who had FBG of 95-99 mg/dl (still "normal") had a fifty-three percent increased risk of cardiovascular disease compared to those with FBG of less than 80 mg/dl.

What does this mean for you?  If your doctor tells you that your blood sugar test came back normal, ask for the number.  If it's over 95 mg/dl, you are at a significantly increased risk for stroke, heart attack, and coronary heart disease.  Follow a healthy lifestyle, including a low-glycemic index diet and exercise, to aim for a FBG of less than 80 mg/dl.

1.  Fasting Glucose Levels Within the High Normal Range Predict Cardiovascular Outcome.  Am Heart J. 2012;164(1):111-116.

Great Science on What We Should Eat

In recent years, medical researchers have recognized some common denominators in chronic degenerative diseases:  insulin resistance, long-term inflammation, high blood pressure, and cholesterol imbalance (to name a few).  In fact, several of these factors have been grouped together to form metabolic syndrome, a constellation of symptoms including at least 3 of the following 5 conditions:

• Fasting blood sugar (glucose) ≥100 mg/dL
• Blood pressure ≥130/85 mm Hg
• Triglycerides ≥150 mg/dL
• HDL-C ("good cholesterol") < 40 mg/dL in men or < 50 mg/dL in women
• Waist circumference ≥40 inches in men or ≥35 inches in women

I often talk to patients about dietary factors to reduce these risk factors, mainly focused on low glycemic index foods -- healthy foods that stabilize blood sugar and insulin levels throughout the day.  In a recent study (1), researchers used a dietary intervention for overweight middle-aged adults that significantly improved many of these markers for cardiometabolic risk.  Key components of the diet included the following:

• Antioxidant-rich fruits and veggies
• Omega-3 fatty acids (from fish oil)
• A focus on low glycemic index meals
• Viscous dietary fiber and plant sterols/stanols
• Whole grains, soybeans, and almonds
• Probiotic bacteria supplement

Sound familiar?  If you've been through FirstLine Therapy with me, this sounds an awful lot like that diet plan.  Most of these factors are available through sensible consumption of whole foods.  Some are more easily obtained through supplements (probiotic bacteria) or medical food meal replacements (viscous fiber, plant sterols/stanols).  And the results for good adherence to this diet?

• Total cholesterol decreased by 26%
• LDL ("bad cholesterol") decreased by 34%
• hs-CRP (a marker of systemic inflammation) decreased by 29%
• Systolic blood pressure dropped by 8%

Once again, science is showing that a common-sense, supplemented Mediterranean diet is as good as pharmaceuticals for improving cardiometabolic health -- without the side effects.

1.  Juscelino Tovar; Anne Nilsson; Maria Johansson; Rickard Ekesbo; Ann-Margreth Åberg; Ulla Johansson; Inger Björck.  A Diet Based on Multiple Functional Concepts Improves Cardiometabolic Risk Parameters in Healthy Subjects.  Nutr Metab. 2012;9(29).  Accessed August 29, 2012 at http://www.medscape.com/viewarticle/766177

Transitions

It's that time of year.

Yes, the weather is still blazing summer heat (though we've finally been getting a break now and then!), but we hit a transition in the last couple of weeks.  Somewhere in there, we reached the point where it's still dark outside when my 5:30am alarm goes off.  There's about a three-month period -- six weeks on either side of the summer solstice -- when I get to awake to glorious dawn light.  It's a natural part of our physiology:  It's much easier to get up and get started on the day that way, than to feel like my alarm is going off in nighttime darkness.

So this is my reminder that we're starting on the back half of the year, approaching autumn, sliding gradually toward the winter solstice, the days becoming shorter and shorter.  We're even getting back into the school year routine.

As we approach this transition, it's a good time to reflect on our health habits.

• I get energized in the early morning darkness with a contrast shower (most important as the weather gets cooler).  
• Take an inventory of your eating habits:  Did you take advantage of the abundant fresh fruits of summer, or use the hot weather as an excuse to indulge in too much ice cream, barbecue, and diet soda?  Reorient your thinking to the rich fall harvest of healthy veggies and lean meats.  
• As the days get shorter, it's also a time to think about getting your blood levels of vitamin D tested, since low levels of this "sunshine vitamin" have been associated with cardiovascular disease, autoimmune disease, seasonal affective disorder, and polycystic ovarian syndrome, to name a few.  
• And if the summer led to relaxation of your exercise routine, time to get back into some physical activity, since it's so critical to your health.

Even as we still enjoy the summer warmth, start thinking ahead to make the rest of the year vibrantly healthy.

Time to Go Gluten-Free?

I recently wrote an article about the growing popularity of gluten-free (GF) diets, and some healthy ideas for GF snacking.  A recent study (1) found that celiac disease, a genetic intolerance to wheat gluten, is much more prevalent in the United States than previously thought -- about two million Americans have celiac disease, and most don't know it.

My previous article goes into more detail about the difference between celiac disease, and the less severe (and also less well-defined) condition called gluten intolerance.  The authors of the current study found that many people who follow a gluten-free diet (GFD) do not have actual celiac disease.  According to a report about this study on Medscape,

...the authors emphasize that embarking on a GFD without first confirming the diagnosis of CD is not a good idea.

“Symptomatic improvement of gastrointestinal symptoms after gluten withdrawal is considered a poor predictor of a CD diagnosis,” the authors note. "Self-treatment with a GFD is not recommended and should be discouraged.”

 Okay -- read that last paragraph again.  They're saying that feeling better is not a good reason to avoid gluten.  You must have celiac disease in order to follow a GF diet.  Huh?  Now there is conventional medical thinking at its finest:  You can't have the medicine unless you have a specific disease.  In this case, the medicine is a GF diet.  There is absolutely no reason to keep eating gluten if you feel better while avoiding it!

Just remember one caveat:  If you decide to experiment with a GF diet, maintain healthy, balanced food choices.  Don't just substitute our gluten-saturated Standard American Diet (S.A.D.) with gluten-free versions of junk food.  A lot of foods marketed as GF are highly processed.  Stick with the whole foods approach, and kick your health into high gear.

1.  The Prevalence of Celiac Disease in the United States.  Am J Gastroenterol advance online publication 31 July 2012; doi: 10.1038/ajg.2012.219

So Obvious, It's Revolutionary

One of my main recommendations for folks who are having trouble sleeping is a simple one:  Turn out the lights.  I've heard folks say they "can't" fall asleep without surfing the web right before bedtime, or having the TV on in the bedroom.  But late night exposure to light suppresses the body's natural production of melatonin, our main sleep hormone.

Melatonin is produced by a tiny gland at the base of the brain called the pineal gland.  The pineal gland releases melatonin in response to darkness, and this signals the brain to go into sleep mode.

Recent findings have shed more light (so to speak) on the importance of darkness and melatonin.  Melatonin has antioxidant effects in the body that protect against cancer.  Nurses who work the night shift (and therefore get round-the-clock light exposure) produce less melatonin, and are at significantly higher risk for breast cancer (1, 2).

A new study found that even low light levels in the sleeping room at night can produce symptoms of depression (3).  Granted, this study was done using hamsters, but the biological effects were clear:  depressive symptoms after four weeks of dim light at night.

Depression?  Insomnia?  Cancer risk?  Turn out the lights:  shut off all screens (TV, computer, iPad, smartphone, etc.) 30-60 minutes before bedtime.  Get rid of the night lights and television in the bedroom.  You might even want to move that bright LED alarm clock away from your head.  Allow a few weeks for your body to readjust to what is becoming a scarce, but highly valuable, commodity:  darkness.

1. Cancer Epidemiol Biomarkers Prev. 2012 Apr;21(4):609-18. Epub 2012 Feb 7.
2. Cancer Causes Control. 2006 May;17(4):539-45.
3. T A Bedrosian, Z M Weil and R J Nelson.  Chronic dim light at night provokes reversible depression-like phenotype: possible role for TNF.   Molecular Psychiatry , (24 July 2012).

If You Value Freedom, Then Read On

This Independence Day, my family watched the movie 1776, a dramatic reminder of the birth of our nation, and the risks the founding fathers were taking to stand for freedom from tyranny.  The Declaration of Independence was not just a piece of paper -- it was a set of principles that was carefully crafted and debated, with at least one founding father resigning from Congress rather than participate in what he viewed as treason.

We carry the legacy of liberty two hundred thirty-six years later, and indeed, it is what makes our country great.  Not perfect, but still an order of magnitude above so many oppressive regimes in the world.  With this tradition of freedom so firmly etched into our national identity, it's sometimes challenging to get the message that certain boundaries do make us healthier and happier.

We live in the land of endless choices:  two hundred channels on cable, but nothing worthwhile to watch.  Fifty varieties of pasta sauce on the grocery store shelf.  Clothing in any color or style imaginable.  Is this what our founding fathers fought for?

The most famous phrase in the Declaration of Independence is "life, liberty, and the pursuit of happiness."  Did you know that when it comes to choices, more is not always better?  Dr. Barry Schwartz has done rigorous research in this area, and found that more options increase happiness -- up to a point.  Beyond that, we become increasingly anxious, or even paralyzed, by the number of choices we're faced with.




With so many choices, we are led to believe (especially by the marketing industry) that there is some option out there that is perfect for us.  Paradoxically, though, we often end up regretting what we chose, because we imagine that one of the other options out there might be better still.

In the area of health care, pharmaceutical companies advertise prescription drugs directly to consumers.  Why market something to the general public that needs to be prescribed by a physician?  So that we go to our medical doctor and demand that drug, rather than relying on the expertise of the doctor to prescribe what is best for our health.

We suffer from too many options -- fast food, processed food, endless sources of electronic entertainment to deprive us of exercise and sleep.  In this sense, naturopathic medicine is counter-cultural:  a major principle we have is vis medicatrix naturae, or the healing power of nature.  In other words, get back to the basics -- simple, nourishing food, restful sleep, regular physical activity, and conscious methods of stress management.  Discover how to fit these into your life, and be on constant guard for the seduction of excessive choice under the guise of "liberty," that in reality detracts from our life and pursuit of happiness.

Exercise, Sunrise, and a Reminder

You've probably gotten the message by now that exercise is essential to health and longevity.  Newer research (performed locally here at the University of Illinois) even shows that resistance exercise helps prevent cognitive and memory decline in the elderly.  The question often comes up, though:  What type of exercise is best?

Different forms of physical activity can serve different purposes.  For example, if fat loss is the goal, then a specific program of "burst" training, such as Sprint-8, has been shown to boost the body's production of human growth hormone, leading to significant decrease in fat tissue.  This approach uses very short (30-second) bursts of maximal effort (e.g., on a stationary bike), followed by 90 seconds of low-to-moderate effort, repeated over 8 intervals.  With warm-up and cool-down, this translates into a 20-minute workout that, performed properly three times per week, can provide more fat-burning punch than 45 minutes of daily walking.

No matter what type of exercise is chosen, the key is to provide some variety and enjoyment.  Here's a secret:  for a long time, I resisted exercise, because of negative associations with team sports (just look back at my P.E. transcripts).  Gradually, I learned that exercise can be (a) enjoyable, (b) done in a non-competitive atmosphere, and (c) more about health than image.

This morning, I went cycling across Lake Vermilion (Danville folks are familiar with the Denmark Road causeway).  I love this route early in the morning, with the sunrise over the water, spying a blue heron on the strand, and being watched warily by a family of raccoons.  In spite of our ongoing drought, the trees all along the shore provide a luxuriously green border.  This natural setting is exercise for the soul, at the same time that I'm exercising my body.  In fact, there's plenty of scientific evidence that exposure to natural surroundings can decrease blood pressure, stress hormones, and improve immune function.  In Japan, this is called Shinrin-yoku, literally "taking in the atmosphere of the forest," or just Forest Therapy for short.

This past weekend, I went kayaking in Kickapoo State Park:  another opportunity for Shinrin-yoku, and a great upper body workout.  I got to thinking that this would be a wonderful form of cardiovascular and strength exercise for those with hip and knee pain.

My bicycle route also took me past a small cemetery -- a reminder of the final destination for all of us.  It's also a reminder of the steps we can take to maximize the years of our life, and maximize the health and well-being we pack into those years.  Every choice we make can have an impact on our health -- choose wisely.

The Key Nutrient for Weight Loss, Lowering Cholesterol, and Controlling Blood Sugar

When you think of nutrients, do you think of vitamins and minerals?  These are essential components of a healthy diet -- and best consumed in whole food form, rather than from supplements in most cases.  Something else we don't always think of as a nutrient, but is just as critical to health, is dietary fiber.

When you hear "fiber," you may think of a bottle of Metamucil, to help with constipation.  While it's certainly true that that is a benefit of a fiber supplement, whole food sources are much better.  Supplements tend to contain just one kind of fiber, called insoluble fiber, which helps to clean out the bowels - that by itself is important to health and quality of life.  But you can go beyond that:  Whole food sources of soluble fiber are associated with obesity prevention, lower blood cholesterol, better blood sugar control, and even lower risk of colon and breast cancer.

So how much is enough?  Most Americans get about 8-14 grams of fiber per day, but even mainstream nutritional guidelines recommend 25-35 grams per day!  If you're eating the Standard American Diet (S.A.D.), start working on increasing your fiber intake to improve your health.  This is best done gradually, to avoid digestive upset.  Also, don't just reach for a fiber supplement -- make fiber-rich foods a part of your daily diet:

• Vegetables
• Flaxseed (grind 2 Tablespoons daily)
• Pears, prunes, pineapple
• Legumes (beans)
• Nuts (almonds, hazelnuts, walnuts)

Pots and Pans

If you've read my blog or heard me speak, you know I'm an advocate of eating whole, natural foods as the best path to health -- no matter what specific diet you follow.  The one thing that eating more healthy foods from scratch requires is more time in the kitchen.  Just think of it -- up till about 70 years ago, folks didn't have a choice but to spend a good chunk of the day cooking.  The advent of fast food and processed "convenience" foods brought with them the promise of "freedom" -- the word that makes every American heart sing.

But what are we free to do?  Spend more time on our butts in front of the TV or computer?  My very busy family manages to find time to fit home-cooked meals into our daily schedule -- it's just a matter of readjusting priorities.  And in the evening, when it's my turn to do the dishes, I reflect on how this is not just a chore -- it's part of the gift of good health for my family.

Bad for the Body, Bad for the Mind: Are You Eating this Harmful Ingredient?

One of the key markers of a highly-processed diet is trans-fatty acids, or trans fats.  These abnormal fats are a result of either deep frying or a process called hydrogenation, which is used to extend the shelf life of packaged foods.  Doughnuts, cookies, crackers, French fries, or almost any fried fast food are rich sources of this insidious killer.

Numerous studies in recent years have found that these are more of a culprit in raising the risk of heart disease, stroke, and diabetes than the oft-maligned saturated fats.  Recently, researchers have found that trans fats have an impact on mood and behavior as well.  Spanish researchers in 2011 found a direct relationship between intake of trans fats and risk of depression.  On the flip-side, consuming monounsaturated fats (such as olive oil and avocados), or polyunsaturated fats (such as fish oil, nuts, and seeds) decreased depression risk.

Just a few months ago, researchers at the University of California San Diego found that higher trans fat intake is associated with increased aggression and irritability.  And once again, the polyunsaturated fats correlated with increased agreeableness and reduced impulsivity.  While this doesn't prove that trans fats cause increased aggression, it just adds to the mountain of evidence for avoiding this toxic ingredient.

One caveat:  trans fats are harmful in and of themselves, but they are also a marker for highly processed foods.  And one thing that American food manufacturers are good at is manipulating processed foods to follow the latest trends in nutritional awareness -- just look at the labels touting "Trans Fat Free," "Low-Carb," "Low-Sodium," etc.  Your best bet is to stick as much as possible to real, whole foods -- foods as close to their natural plant or animal source as possible.

Non-Toxic Ways to Avoid Mosquito Bites

Summer has arrived:  Backyard barbecues, swimming, hiking, cycling... and, of course, mosquitoes.  The bites of those little critters are not only annoying and itchy, but may carry harmful viruses, such as West Nile virus and St. Louis encephalitis virus.  Outside of the U.S., mosquitoes may carry even more dangerous diseases such as malaria and dengue fever.

Many people are concerned about the toxic effects of conventional insect repellents, which contain chemicals such as DEET (N,N-diethyl-meta-toluamide).  DEET remains popular because it's so darned effective.  If you want to avoid this synthetic compound, what are natural alternatives that actually work to keep these bugs at bay?

• Natural insect repellents that have been tested to actually work on par with DEET include catnip oil (yes, the same catnip that your cat loves!), and lemon eucalyptus oil (the Centers for Disease Control actually recommend this for prevention of spread of West Nile virus).  There are commercially available sprays that contain these herbs.  By the way, skip the Avon Skin-So-Soft -- its bug-repelling reputation is greatly exaggerated.
• Think outside the spray:  physical repellents include backyard tiki torches (whether they contain citronella or just plain oil -- it's the smoke that drives mosquitoes away), and fans.  Set up an oscillating fan on your patio pointed out toward the yard -- mosquitoes will literally be blown away!

Enjoy a safe, non-toxic summer!

Put Down that Bagel Till You Read This...

Once upon a time, grains (wheat, rice, millet, etc.) were the darlings of nutrition:  plant-based, full of fiber, vitamins, and minerals.  They formed the base of the old food pyramid, with recommendations to eat 6-11 servings per day.  But like a plot twist in a Christopher Nolan movie, grains have become vilified over the last 10 or 15 years:  empty calories, the real reason Americans are getting fatter.  From the Atkins Diet to the South Beach Diet, and now the Paleo Diet, "carbs" are now the whipping boy of popular nutrition.  Is this reputation justified?

First of all, what do these diets mean when they say "carbs"?  Short for carbohydrates, they're referring to the highly processed and refined grain products such as white bread, bagels, most breakfast cereals, pasta, and white rice.  Of course, as any student in my beginning nutrition class could tell you, carbohydrates are also in healthy foods such as fruits, vegetables, nuts, and beans.  So first and foremost, we need to distinguish the type of carb we're talking about, before we label it with that four-letter word.  Yes, those highly refined grain products are low in fiber, vitamins, and minerals, and contribute to difficulties in blood sugar regulation that can lead to increased hunger, weight gain, and eventually even insulin resistance or diabetes.

The trend over the last decade has been to throw the baby out with the bathwater, though.  Whole grains (100% whole wheat, brown rice, millet, and quinoa, to name a few) are nutritional powerhouses, and make sense as part of a balanced diet that includes lots of vegetables, moderate amounts of fruit, as well as nuts, seeds, beans, and moderate amounts of meat or eggs.

A 2005 study published in JAMA compared several different types of diet with wildly different proportions of protein, fats, and carbohydrates.  The results?  As long as folks adhered to it, they all lost weight and improved their cholesterol levels.

I've seen a lot of fad diets over the last couple of decades.  My personal hypothesis is that they all work to some extent for two simple reasons:

1. They provide a structure for including more healthy foods in the diet, especially vegetables, while cutting down on portion sizes and total calories.
2. They almost all start off by cutting out the refined grain products (bad carbs).  Some go on to restrict all grains (Atkins, Paleo, etc.), but either way, this eliminates most of the junk food from the Standard American Diet (S.A.D.).

Uh-oh, there it is.  Get rid of the cookies and muffins, and eat more veggies.  Sounds like what Grandma told you, doesn't it?  It's not mysterious or complicated.  Frankly, that's what drives the sales of diet and nutrition books:  the promise that the author has some secret to health and weight loss, but you must follow their plan to the letter (no matter how bizarre).

So eat your grains -- as long as they're whole grains.  And eat other healthy foods, too.  Then you can write your own book about how easy it is!  For more inspiration, check out these common-sense resources:

• Eating Rules
• Michael Pollan