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.

Gamification

Healthy lifestyle habits:  we know we should do them, but sometimes, it just seems like work.  Yes, Dr. Peters, I know that a Mediterranean diet and exercise will decrease my risk of dying, but it's just one more thing to add to the daily to-do list.  A phenomenon has popped up in recent years that makes it just a little less onerous to keep our minds and bodies fit:  gamification.  Gamification can be defined as transforming real-world tasks into games, to make them more fun and engaging.

There are obvious examples that help with exercise motivation:  console games such as Wii Fit, the Just Dance series, Your Shape, and others that provide entertainment, scores to improve upon, and even goal setting.  My latest favorite game to help with physical activity takes this a step further -- out of the living room and into the larger world.  Ingress is a free sci-fi themed game that uses your smartphone's GPS to interact with locations in the real world.  Notable landmarks and outdoor public art are "exotic matter portals" that can be hacked.  I have found that this makes walking not a chore, but something that I just want to do a little more of, to reach the next portal.


Maybe points in a game are not enough to keep you going -- okay, how about cold, hard cash?  AchieveMint does just that, rewarding you with money for engaging in healthy lifestyle habits.  MindBloom is a "life improvement" app that helps with planning and keeping on track with diet, exercise, and even mental and emotional health.

We can keep our brains fit with games, also.  Attention span may be improved with rhythmic activities like the stepper game in Wii  Fit.  We strengthen our memory "muscles" by learning new things, such as foreign languages.  I have been working on French, Spanish, and German with a free web-based service called DuoLingo.  Earning points and keeping up an unbroken streak of practice days really drives me to stick with it.  Lumosity offers free and paid options to challenge and stretch many different brain abilities.

People are very good at sticking with games they enjoy (just think of all the wasted hours with Candy Crush Saga!).  So instead of choosing a couch magnet, make your next game one that adds years and quality to your life.

Please note:  I have no financial relationship with any of the games mentioned.  I do request that if you play Ingress, you join the Enlightenment faction, just because you will be so much cooler.

Healthy Food? Blech!

One of the main impediments that many people cite in avoiding healthy foods is taste.  When the average American is faced with the choice between a Frappuccino and a kale salad, it's no mystery which one will be chosen.  Our brains are hard-wired to seek out fats, sugar, and salt for survival -- but with the modern food-industrial complex, these once-scarce resources are available in virtually endless supply in our country.  I've gone into a lot of detail previously on what constitutes a healthy diet:  Mediterranean-style eating, high in fiber, low in refined flours and sugars, with moderate amounts of healthy fats (such as olive oil and nuts) and lean proteins (such as legumes and fish).  So how do we get over the hurdle of transitioning to this style of eating... and more importantly, how do we adopt this on a permanent basis?  It can be easy to stick with any "diet" for a few weeks, but long-term health requires a lifestyle change.

Kids.  As a parent, I know how challenging it can be to introduce healthy foods in the face of the "beige diet:" chicken nuggets, corn, bananas, pizza, cereal, cookies.  The key here is persistence and repetition:  Food experts tell us that it can take 10-12 times of encountering a new food before young children will accept it.  Just keep putting that broccoli on their plates, and requiring at least one "thank-you bite."  Eventually, they'll get used to it.

Adults.  Are we just "in the habit" of eating unhealthy foods -- or are we actually addicted to them? While this term is controversial, there have been studies that show the same brain areas light up on functional MRI in response to refined sugar as they do for cocaine (1).  In 2007, a rat study found that the animals actually preferred the sweet stuff over cocaine when given a choice (2).

So how do we break this addiction?  Mark Hyman, MD, recommends approaching it the same way you would with any other addiction:  go cold turkey.  In this case, it means absolutely no sugar or refined grain products for at least 10 days.  This gives a chance for the taste buds and (more importantly) the reward centers of the brain to hit the reset button, so that we are not so sensitized to the sweet stuff.  We can then actually start tasting other foods, and they taste better by comparison.

A small pilot study by researchers at Harvard and Tufts Universities (3) used functional MRI to measure brain reward response in overweight and obese individuals before and after a structured low-glycemic index diet.  This plan, called the iDiet (or "instinct diet"), overcomes the natural tendency toward sweets by substituting healthier ingredients in familiar dishes, encouraging more frequent eating of healthy meals to avoid hunger, and involving interpersonal support.  After 24 weeks, the reward centers of the brain showed less reponse to high-calorie foods, and more response to low-calorie foods.  In plain English, this proves that on a neurological level, the brain can be rewired to enjoy healthier foods.

So it takes some effort, but it shows that old habits can be changed.  Dr. Hyman emphasizes that willpower is not the issue here:  the combination of our neurobiology with what K. D. Brownell (4) calls a "toxic food environment" creates a trap for us.  A structured kick-start might be just what we need to turn over a healthier leaf.

1. Avena N et al.  Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake.  Neurosci Biobehav Rev. 2008; 32(1): 20–39.  Published online May 18, 2007. doi:  10.1016/j.neubiorev.2007.04.019
2. Lenoir M, Serre F, Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698.
3. Pilot randomized trial demonstrating reversal of obesity-related abnormalities in reward system responsivity to food cues with a behavioral intervention.  Nutrition & Diabetes (2014) 4, e129; doi:10.1038/nutd.2014.26.  Published online 1 September 2014.
4. Brownell KD, et. al. Personal responsibility and obesity: a constructive approach to a controversial issue. Health Aff (Millwood). 2010 Mar-Apr;29(3):379-87

Health Facts Proven, Once and For All!

This is the headline would like to see, whenever we hear about the latest scientific research in the media.  However, even with the best scientific journals, pinning down "the truth" in medicine can be a tricky business.  I think that science is important in guiding our health care decisions this, but we must be wary about overreliance on so-called evidence-based medicine.

At the most basic level, any time there is a health claim, you have to ask whether it comes from a credible source or not.  Testimonials or "studies" conducted by a product manufacturer that actually involve only a few subjects are not valid sources to draw any hard conclusions.

Okay, so can we rely on the well conducted studies in the major medical journals?  Well, they are better, but they still need to be taken with a grain of salt.  There are many sources of errors for the data and conclusions in major scientific studies:

• Bias: researchers themselves are biased to interpret their data in a way that supports their hypothesis; journals commonly exhibit publication bias, being more likely to publish studies that agree with previous research findings
• Difficulty with randomization: the "gold standard" of medical research is the randomized controlled trial (selecting research subjects at random to receive either the active therapy or placebo).  However, achieving true randomization, and controlling adequately for confounding factors is more difficult than is commonly believed.  These issues can lead to drawing wrong conclusions.
• The decline effect: sometimes, a new research headline will grab us with its dramatic statistics.  As further research is conducted in the same area, however, it often turns out that the new therapy is not as effective as it seemed at first.  There are many theories as to why this occurs -- the simplest being that this is just "regression to the mean" as more data are gathered -- but the significance is that if treatment decisions are made based on early evidence, it might lead us down the wrong path.  One of the most dramatic examples of this is what are called "second-generation" antipsychotic medications.  These medications (such as Zyprexa) were initially found to be incredibly more effective than older drugs at controlling schizophrenic symptoms.  As further research has been conducted, it now appears that the newer drugs are no more effective than the old ones (and may even be less effective).

So what does this mean about our reliance on scientific research?  The biggest take-home message is that we have to look at the big picture, rather than chasing down every rabbit hole of the latest headline.  A healthy diet and exercise are irrefutably good for our health.  Indeed, it may be argued that the most significant improvement of human health in the last 200 years was brought about by modern sanitation (clean drinking water and good sewer systems).  Everything since then may just be splitting hairs.

Labos C.  It Ain't Necessarily So: Why Much of the Medical Literature Is Wrong. Medscape, 9 Sep 2014.

Are You Sitting Down? Think Again...

Imagine two co-workers:  one slim, the type who can seem to eat anything without gaining a pound -- and therefore does not feel the need to exercise; the other one overweight, but who works out regularly.  In spite of your latter colleague's efforts, he has found it very difficult to lose weight.  Which one is at greater risk for health problems down the road?

The answer is not so clear-cut, since both obesity and physical inactivity have been linked to chronic diseases:  cardiovascular disease, diabetes, osteoarthritis, etc.  If you were forced to choose, though, it appears more and more that keeping physically active is the more important variable for decreasing health risks.

• Australian researchers (1) recently found that being sedentary accounts for about half the risk for cardiovascular disease in middle-age women -- more than obesity, high blood pressure, or even smoking.
• Recent studies in BMJ (the British Medical Journal) found that for older adults, light daily physical activity decreased the disability associated with knee arthritis (2), and poor physical fitness nearly quadrupled the risk for all-cause mortality (death by any cause) (3).
• While many studies have focused on light-to-moderate exercise, a new study in the Journal of the American College of Cardiology looked at something a bit higher impact -- namely running -- and found that running, even as little as 5-10 minutes per day, decreased cardiovascular and all-cause mortality risk by 30-50%. (4)
• Author Nilofer Merchant has compiled the research, and calls sitting the "new smoking" -- the big public health scourge that needs to be addressed in the 21st century.

What can you do today to incorporate more physical activity?

• Park a little further from your destination
• Walk the dog a little further each morning
• Jog in place during each commercial break on TV

Our bodies are designed for exercise throughout life -- so keep it moving!

1. Br J Sports Med. Published online May 8, 2014.
2. Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: prospective cohort study.  BMJ 2014;348:g2472
3. Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study.  BMJ 2014;348:g2219
4. Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk.  J Am Coll Cardiol. 2014;64(5):472-481. doi:10.1016/j.jacc.2014.04.058

Many People Would Rather Receive Electric Shocks than Engage in this Healthy Habit

"Holistic medicine" does not just mean substituting herbs for prescription drugs; it means looking at the whole person -- body and mind.  Stress has a powerful impact on our mental/emotional health, as well as our physical health (via the neurologic and endocrine systems).  To that end, I often teach people techniques such as quiet breathing exercises to improve stress management.

Quiet breathing, meditation -- these fall along the continuum of being alone with our thoughts, which is something most modern Americans are not accustomed to.  This has always been the case, but it seems to have gotten worse lately, with the 24/7 accessibility of technology.  Being alone with our thoughts has been proven to help decrease the stress response, which can improve our health in a variety of ways.  These techniques fall under the category of what I call "simple, but not easy:"  simple in concept, but not easy to perform.  A lot of people find that their mind rebels when faced with a lack of constant input.

Though I know from personal experience how challenging it can be to sit quietly with one's thoughts, researchers at the University of Virginia recently investigated this phenomenon through an interesting experiment.  They recruited adults to sit quietly alone in a room for about 15 minutes.  The volunteers were asked not to fall asleep.  The only activity they were allowed, other than just thinking, was to press a button that would administer a mild electric shock.

Now one would think that people would avoid this painful stimulus.  I mean, how hard can it be to just sit for 15 minutes?  The researchers were surprised, therefore, when 25% of female subjects and fully two-thirds of male subjected shocked themselves at least once.  Yes, most people preferred deliberately self-inflicted pain to sitting quietly for 15 minutes.

The researchers concluded that the conscious human mind is designed to engage with the world, which may be why this exercise is so difficult for many people.  That's why I recommend a variety of techniques to help people enjoy the benefits of quieting the mind:

• Focus on the feeling of the breath moving in and out of the lungs.
• Use visualizations, such as light moving in and out of your body.
• Use a mantra (repetitive word, with or without meaning) to engage the cognitive mind while allowing the rest of the mind to settle down.
• Use the techniques of Mindfulness Meditation:  actually focusing on the sensory input around you (rather than tuning it out), but without judgment or evaluation.
• Engage in "moving meditation," such as walking a labyrinth.

You might need to experiment to find which methods work best for you, but it is definitely worthwhile to make this a part of your daily routine.

1.  Just think: The challenges of the disengaged mind.  Science 4 July 2014: Vol. 345 no. 6192 pp. 75-77.
2.  What’s So Bad About Being Alone With Your Thoughts?  Science Friday, July 11, 2014.

Another Secret to a Smaller Waistline

There has been a lot of speculation about the increasing rates of obesity over the last few decades.  Many of the causes of this phenomenon are well known, and I have covered them in past articles: the move from whole foods to more processed foods, a decrease in physical activity with the rise in technology, and the increasing intake of both regular and diet soda pop.  One factor that often gets overlooked in this equation is the importance of a good night's sleep.

Researchers in the UK (1) recently published the results of a survey of over 100,000 women covering a 10 year period.  They found that light exposure at night disrupted the normal circadian rhythm (day-night cycle), and led to increased body mass index, and increased waist circumference.

If you are trying to shed pounds by increasing exercise, then bravo!  Just don't exercise late in the evening.  Night should be a time for winding down, decreasing activity, and definitely minimizing exposure to light (no falling asleep with the TV on).  The infographic below is a handy reminder of what's known as good sleep hygiene.  Use it to optimize your sleep, and maintain a healthier body weight.

1.  McFadden E et al.  The Relationship Between Obesity and Exposure to Light at Night.  Am J Epidemiol. 2014;180(3):245-250.

More Good News for Coffee

By now, you've probably heard that coffee is not the no-no that natural health experts used to think it was.  True, if you drink a lot of it, it can have negative effects such as disrupting sleep, increasing anxiety, and over the long term, exhausting your adrenal reserves.  In fact, you may recall that researchers have even found the cut-off for how much is too much:  more than four cups (32 fluid ounces) per day increases the risk of death.

If you drink coffee in moderation, add to its benefits a decreased risk of metabolic syndrome and non-alcoholic fatty liver disease (NAFLD).  This was reported in a new meta-analysis (a study of studies), though the mechanism of protection is not clear.

Metabolic syndrome is a spectrum of health problems associated with our modern poor diet and sedentary lifestyle habits, 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

Your liver is the major organ of detoxification, as well as the master of regulating nutrition and metabolism in the body.  NAFLD, as its name implies, refers to the accumulation of fat in the liver that impairs its function, caused by unhealthy diet rather than alcohol intake.

As always, be sure to consume that coffee in moderation, and minimize (or skip altogether) the milk and sugar.

Aliment Pharmacol Ther. 2013;38(9):1038-1044. 

The Skinny on Fat

In the 1970s and 80s, fat was the bad boy of nutrition.  Since then, research has reminded us of so many of the “forgotten” good things about fat -- from the benefits of omega-3 fatty acids, to absorbing our fat-soluble vitamins and beyond.  As research goes on, more facts come to light to dispel our fears of this nutrient.

A few months ago, I reported that a Mediterranean diet rich in olive oil and nuts decreases the risk of cardiovascular disease by 30% compared to a low-fat diet.  Further analysis (1) of the data from this study (the PREDIMED study from Spain) found that the monounsaturated fat-rich Mediterranean diet also decreased diabetes risk by a third.  This is huge:  cardiovascular disease and diabetes are two of the biggest causes of death and morbidity in this country.  Focusing on low glycemic index foods like whole grains, legumes, fruits, and vegetables, as well as losing our fear of healthy fats like extra-virgin olive oil, can spell out huge health benefits.

Furthermore, a meta-analysis (a study of studies) published in the American Journal of Clinical Nutrition in 2010 (2) tore down one of the most sacred cows of nutrition and health research:  the "evil" of saturated fat.  The authors found no association of saturated fat intake with cardiovascular disease or stroke in the best-designed nutritional studies available to date.  This is mind-boggling, since everyone "knows" that chomping on a cheeseburger will instantly make your arteries clog up.  The jury is still out. but it appears that the ratio of unsaturated fat (from sources like olive oil, fish oil, or nuts) to saturated fat is more important than the absolute amount of saturated fat.  Translated into English, this means that at least half of your dietary fat should come from these healthier sources.  One word of caution, though, is that omega-6-rich fats such as vegetable oil might actually be bad for the heart.

As we sort through all of this evidence. it looks like the best recommendations we have to date are:

• Overall, a low-fat diet is not healthier for most people.
• Balance saturated fat intake (meat, dairy, coconut oil) with healthier fats (olive oil, nuts, avocados).
• Use vegetable oils sparingly (canola, corn, peanut oil).
• Do all of this in the context of a varied, fiber-rich, low glycemic index eating pattern, such as the Mediterranean Diet.

1.  Ann Intern Med. 2014;160(1):1-10-10. doi:10.7326/M13-1725
2.  Am J Clin Nutr 2010;91:535–46.