As you might expect, it depends on the kind of fat. As I wrote about a few weeks ago, the standard advice from the 1970s and 80s about following a low-fat diet turned out to be less healthy than including "good" fats from foods like nuts and olive oil. Another recent scientific paper from Australia, published in the British Medical Journal, further blows to top off the old dietary fats advice, showing that saturated fat may not be as bad as we thought it was.
A few decades ago, researchers started noticing a correlation between intake of saturated fats (from foods like meat, dairy products, and shortening) and cardiovascular disease. The recommendation, therefore, was to replace these fats with healthier polyunsaturated fats from vegetable sources. In this study, researchers examined data about 458 men, half of whom received advice to replace saturated fats with omega-6 oils from vegetable sources. The other half (the control group) received no specific dietary advice. After about seven years, it turned out that the death rate in the omega-6 group was 17.6%, versus 11.8% in the control group. Heart disease rates were also 60% higher in the vegetable oil group.
Wait. Take a look at those numbers. Don't we all know that a saturated fat laden cheeseburger will just clog up our arteries as we're sitting there? Isn't this why all the lard and shortening have been replaced with "healthy" vegetable oil for frying?
It turns out that not all polyunsaturated fats are created equal. There are two major categories of PUFAs: omega-6 and omega-3. Ideally, the ratio of our intake of omega-6 to omega-3 should be about 2 to 1. A higher intake of omega-3 fatty acids has been shown over and over again to decrease cardiovascular disease risk, and lower mortality rates. However, the current ratio in America is about 20 to 1, omega-6 to omega-3. This is a major reason why chronic degenerative diseases continue to escalate in this country. Maybe it's those french fries that are killing us, not the burgers.
So what are we to do with this information? No, this is not carte blanche to go and scarf down as much meat as you want; we still know that a plant-based eating pattern such as the Mediterranean diet is highly protective overall. For cooking, use smaller amounts of healthy saturated fat, such as extra-virgin coconut oil. Extra-virgin olive oil is also a good choice, as a source of monounsaturated fats (and yes, contrary to popular belief, you absolutely can cook with it). A fish oil supplement is a must for most people, to ensure adequate omega-3 intake. Skip deep-fried foods altogether, since the omega-6 fats in the vegetable oils may actually increase our mortality risk (either by themselves, or by transformation into trans fats).
The more we learn, the more we'll untangle which fats are good for us!
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 doi: http://dx.doi.org/10.1136/bmj.e8707 (Published 5 February 2013).
Monday, June 24, 2013
Monday, June 17, 2013
Conventional Medical Doctors Acknowledge Supplement for Prostate Cancer
Conventional physicians are not always known for their open-mindedness about natural therapies, such as nutritional and herbal supplements. However, in light of good scientific research, they cannot keep their eyes closed to the benefits.
Results of a new research study were presented at the 2013 annual meeting of the American Society of Clinical Oncology that showed a new supplement led to significant lowering of prostate specific antigen (PSA) levels in prostate cancer patients. This was a randomized placebo-controlled trial, which is considered the highest level of scientific evidence available in the medical world. The supplement, called Pomi-T, is a combination of well-known cancer fighting botanicals, including turmeric, green tea, broccoli, and pomegranate.
This study examined 203 men who had been treated for prostate cancer, but had a relapse of elevated PSA. Half of the subjects were randomized to receive Pomi-T, and half received a placebo. After six months, the botanicals group had a 63.8% lower increase in PSA versus the placebo group. They were also three times as likely to have stable or even lower than baseline PSA levels versus the placebo group. Furthermore, there were no significant side effects from the supplement.
The medical community, which historically has been skeptical, if not downright antagonistic, towards nutritional supplements, heralded this research for two important reasons. Firstly, the design and quality of the supplement was closely monitored. This is important, since many off-the-shelf supplements are questionable in terms of their quality and purity. Secondly, this study was well designed, and had enough subjects to draw good statistical conclusions. Many times, when you read about "clinical research" on a supplement manufacturer's website, this is based on a handful of subjects, with no placebo control.
Remember, too, that any supplement is an addition to a healthy lifestyle: good diet and regular exercise. But if you are dealing with prostate cancer, this supplement looks like a good fit. If you can't find it, you can find supplemental forms of each of the components; just be sure to get standardized products from reputable manufacturers. When it comes to cancer, don't bet your life on the cheap stuff off the shelf at Wal-Mart.
2013 Annual Meeting of the American Society of Clinical Oncology. Abstract 5008. Presented June 3, 2013.
Results of a new research study were presented at the 2013 annual meeting of the American Society of Clinical Oncology that showed a new supplement led to significant lowering of prostate specific antigen (PSA) levels in prostate cancer patients. This was a randomized placebo-controlled trial, which is considered the highest level of scientific evidence available in the medical world. The supplement, called Pomi-T, is a combination of well-known cancer fighting botanicals, including turmeric, green tea, broccoli, and pomegranate.
This study examined 203 men who had been treated for prostate cancer, but had a relapse of elevated PSA. Half of the subjects were randomized to receive Pomi-T, and half received a placebo. After six months, the botanicals group had a 63.8% lower increase in PSA versus the placebo group. They were also three times as likely to have stable or even lower than baseline PSA levels versus the placebo group. Furthermore, there were no significant side effects from the supplement.
The medical community, which historically has been skeptical, if not downright antagonistic, towards nutritional supplements, heralded this research for two important reasons. Firstly, the design and quality of the supplement was closely monitored. This is important, since many off-the-shelf supplements are questionable in terms of their quality and purity. Secondly, this study was well designed, and had enough subjects to draw good statistical conclusions. Many times, when you read about "clinical research" on a supplement manufacturer's website, this is based on a handful of subjects, with no placebo control.
Remember, too, that any supplement is an addition to a healthy lifestyle: good diet and regular exercise. But if you are dealing with prostate cancer, this supplement looks like a good fit. If you can't find it, you can find supplemental forms of each of the components; just be sure to get standardized products from reputable manufacturers. When it comes to cancer, don't bet your life on the cheap stuff off the shelf at Wal-Mart.
2013 Annual Meeting of the American Society of Clinical Oncology. Abstract 5008. Presented June 3, 2013.
Monday, June 10, 2013
Fish Oil is Dead... or Is It?
If you're a patient or a regular reader of my articles, you know that one supplement that I often recommend is fish oil -- a good source of omega-3 fatty acids. These fats are essential to our health, because our bodies cannot make them from any other type of fat. The many benefits of omega-3 fats include:
- Cardiovascular health benefits
- Immunomodulation
- Anti-inflammatory effects
- Psychological and behavioral health improvement
- Improved bone density
A large study published recently in the New England Journal of Medicine (1) has called into serious question the well-established cardiovascular benefits of fish oil. Italian researchers divided a group of over 12,000 subjects into two groups: one received 1 gram of omega-3 fats from fish oil per day, the other 1 gram of placebo (olive oil). These were high-risk patients: people with multiple cardiovascular risk factors such as high cholesterol, type 2 diabetes, or even established atherosclerosis. The outcome? After 1 year, there was no difference in the rates of death, non-fatal heart attack, or stroke between the two groups.
What are we to conclude from this? The sound-bite headlines trumpet "Fish Oil is Worthless!" Some eminent cardiologists agree. But let's peel back the layers, and examine the flaws in this otherwise large and impressive study.
- Dose. 1 gram of omega-3 fats is not a high dose at all, especially in this population of high-risk patients. For my patients with any cardiovascular risk factors, I recommend 1.5-2.5 grams of omega-3 fats per day. And remember, a 1 gram (1000 mg) fish oil softgel only contains about 300 mg of omega-3s. For cardiovascular health, 5-8 softgels per day are required. An alternative would be to take a concentrated form of fish oil, or to use liquid cod liver oil. I take about 2 teaspoons of cod liver oil daily, which supplies around 2.5 grams (2500 mg) of omega-3s.
- Quality. There is a wide variability in the quality of fish oil products. A pharmaceutical-grade form is best, which is screened for impurities, and has less chance of being rancid. The form used in the study is not specified.
- Lab Values. One of the main ways that omega-3 fats benefit the cardiovascular system is by lowering triglyceride levels -- data about patients' triglyceride levels were not included in the study. Also, how well were the diabetic patients maintaining blood sugar control? Poorly controlled blood sugar is a major risk factor that a little fish oil won't overcome.
- Choice of "Placebo." A placebo (inactive pill) is necessary in research studies to compare to the active intervention, to account for the fact that people's expectations about receiving care can have a strong therapeutic effect. This is know as the placebo effect. But is olive oil a good choice as an inert comparison? There is a mountain of research about the cardiovascular benefits of the Mediterranean Diet, whose foundation is daily olive oil use. Just a few weeks ago, I wrote about the PREDIMED study, which found that an olive oil-supplemented Mediterranean diet resulted in a 30 percent decreased risk of cardiovascular disease.
- Other Benefits of Omega-3 Fats. Now granted, the list of other benefits was not being looked at in this study, but some commentators really threw the baby out with the bathwater on this point. Cardiologist Eric Topol, MD, called fish oil a "no-go," a "nada effect," and even "implores" his patients to stop taking it. Really? That's quite an exercise in ignoring the large body of research on fish oil for multiple body systems.
As always, I urge you to look past the headlines, and consider the whole research picture. Don't throw out your fish oil on the basis of this one flawed study.
Monday, June 3, 2013
I Have a Gut Feeling They're on to Something.
You know you're mostly not human, right?
When you count the microorganisms living in your gastrointestinal tract, skin, and respiratory tract will, there are ten times as many bacterial cells as human cells in your body. We are ecosystems, rather than single organisms. If 20th century nutrition was the discovery of vitamins, proteins, carbohydrates, and other nutrients, 21st century nutrition will be the study of how nutrients affect those 90% of nonhuman cells within us.
These friendly bacteria (also known as normal flora or probiotics) play an important role in our gastrointestinal health, allergies, normal immune system functioning, and maintaining a normal body weight. Some intriguing early animal studies found that probiotics could even decrease symptoms of depression. In the June issue of the journal Gastroenterology, researchers at UCLA published the first study showing a direct effect of probiotics on the human brain. And no, this does not mean that people were shoving yogurt into their ears.
Researchers divided a group of 36 healthy women into three subgroups: the first received two servings of yogurt with probiotics daily; the second subgroup received non-fermented milk products; and the third subgroup received no special foods.
After four weeks, these women underwent psychological testing while in a functional MRI (fMRI) -- an imager that examines real-time brain activity, rather than just taking a static image. The probiotic subgroup showed significantly reduced activity in brain areas associated with emotional variability and pain. Translation? Probiotics made them less moody!
The importance of this study is that it proves that gut bacteria can have a direct impact on human brain functioning, specifically in the areas of emotions and pain perception. It did not examine what the exact mechanism of action is. We also have to be a bit cautious with this study, because these were healthy volunteers, with no gastrointestinal or psychological disorders.
Nevertheless, this just adds another piece of evidence that indicates that tending to the complex "rain forest" within us, with fermented foods and lots of dietary fiber, is probably more important than taking high doses of any single nutrient.
Tillisch K et al. Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity. Gastroenterology June 2013; 144(7):1394-1401.
When you count the microorganisms living in your gastrointestinal tract, skin, and respiratory tract will, there are ten times as many bacterial cells as human cells in your body. We are ecosystems, rather than single organisms. If 20th century nutrition was the discovery of vitamins, proteins, carbohydrates, and other nutrients, 21st century nutrition will be the study of how nutrients affect those 90% of nonhuman cells within us.
These friendly bacteria (also known as normal flora or probiotics) play an important role in our gastrointestinal health, allergies, normal immune system functioning, and maintaining a normal body weight. Some intriguing early animal studies found that probiotics could even decrease symptoms of depression. In the June issue of the journal Gastroenterology, researchers at UCLA published the first study showing a direct effect of probiotics on the human brain. And no, this does not mean that people were shoving yogurt into their ears.
Researchers divided a group of 36 healthy women into three subgroups: the first received two servings of yogurt with probiotics daily; the second subgroup received non-fermented milk products; and the third subgroup received no special foods.
After four weeks, these women underwent psychological testing while in a functional MRI (fMRI) -- an imager that examines real-time brain activity, rather than just taking a static image. The probiotic subgroup showed significantly reduced activity in brain areas associated with emotional variability and pain. Translation? Probiotics made them less moody!
The importance of this study is that it proves that gut bacteria can have a direct impact on human brain functioning, specifically in the areas of emotions and pain perception. It did not examine what the exact mechanism of action is. We also have to be a bit cautious with this study, because these were healthy volunteers, with no gastrointestinal or psychological disorders.
Nevertheless, this just adds another piece of evidence that indicates that tending to the complex "rain forest" within us, with fermented foods and lots of dietary fiber, is probably more important than taking high doses of any single nutrient.
Tillisch K et al. Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity. Gastroenterology June 2013; 144(7):1394-1401.
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