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.

Are You Missing This Important Supplement for Childhood Behavioral Problems?

Behavioral problems in children often start during the preschool years.  Making sure that kids have a healthy, balanced diet, as well as plenty of physical activity, can make a big difference in kids' behavior.  One "supplement" that is becoming more overlooked these days is one of the foundations of health in naturopathic medicine: sleep.

Recent research from the Albert Einstein College of Medicine in New York City (1) examined almost 9000 preschool aged children, and looked at the relationship between sleep and behavior.  They found that kids who average fewer than 9.44 hours of sleep per night have a 30 to 40% higher rate of anger, impulsivity, overactivity, and tantrums.  Significantly, these kids were also 80% more likely to be aggressive.  More than two hours of television viewing per night was also associated with worse overall behavior.

Inadequate sleep for adults may result in mood problems, increased pain sensitivity, and even a greater risk of diabetes and cardiovascular disease.  Now, we have further evidence of just one more way that sleep is critical for kids as well.  Follow these guidelines to ensure a good nights rest for your little ones:

• Stick with a scheduled bedtime and wake-up time.  Aim for at least 10 hours of sleep per night.  So if the kids have to be up at 7 AM, make sure they're in bed by 9 PM.
• Turn off all screens (TV, computer, smartphone, tablet, etc.) at least one hour before bedtime.
• Keep the bedroom cool and dark to make falling asleep easier.
• If your child is having trouble falling asleep, consult your naturopathic physician before trying any sleep aid -- even natural ones.

1.  Scharf RJ et al.  Nighttime Sleep Duration and Externalizing Behaviors of Preschool Children.  J Dev Behav Pediatr. 2013;34:384-391.

Coffee: Superfood or Death Sentence?

Earlier this year, I outlined some of the amazing health benefits associated with regular coffee consumption.  These include a decrease risk of chronic diseases such as diabetes, Alzheimer's disease, and endometrial cancer; pain reduction as among its benefits too.

Now, new research from the Mayo Clinic (1) makes us pause and reflect on how much is too much of a good thing.  I often hammer that old adage, "all things in moderation;" in this case, moderation appears to be 4 cups of coffee per day.  More than that raises the risk of death for people under age 55.

Researchers looked at data from the Aerobics Center Longitudinal Study, which examined dietary habits and health data from over 43,000 participants over the course of 31 years.  For folks under the age of 55 who drank more than 28 cups of coffee per week, all-cause mortality risk increased by over 50% for men, and more than doubled for women.  The direct cause of this association is unknown, but seems to be unrelated to coffees cardiovascular effects.

One of the important points to keep in mind is that a "cup" in this study is defined as 8 fluid ounces; the cutoff point therefore seems to be about 32 ounces per day.  The "cup" markers on your coffee pot are 6 ounces each, so the limit would be about five of those cups.  If you prefer to get your coffee on the go, this would translate into only two "grandes."

This study leaves a lot of questions, such as the association of caffeine on health (the study didn't differentiate between regular and decaf coffee), the actual biological mechanisms of coffee (it has hundreds of phytochemicals besides caffeine), and the confounding factor of smoking with coffee consumption.  In the meantime...  Come on, people, four cups per day should be plenty for anyone.  In fact, beyond the first one or two cups of the day, why not explore the benefits of other healthful beverages such as green tea?

1.  Liu J, Sui X, Lavie CJ, et al. Association of coffee consumption with all-cause and cardiovascular disease mortality.Mayo Clin Proc 2013; DOI:10.1016/j.mayocp.2013.06.020.

Coffee: Pain Reduction, Weight Loss, and More

For decades, it's been a given in natural health circles that coffee is a no-no. It's commonly one of the first things that people are asked to give up when going on a detox program, or any other recommendations for improving their health. Over the past decade or so, though, evidence has been mounting that there are actually many health benefits for that morning cup of joe.

One of the latest findings is that coffee may help to reduce pain.  In 2012, Norwegian researchers found that coffee drinkers reported about a 25% lower pain score than non-coffee drinkers in a simulated office work environment. This difference was true whether participants had chronic pain or not.

Other benefits that have been reported for coffee in recent years include:

• decreased risk of endometrial cancer, Parkinson's disease, Alzheimer's disease, and type 2 diabetes
• enhanced muscle growth
• assistance with weight loss (with green coffee bean extract)

The research on green coffee extract for weight loss was a small human trial, involving only 16 subjects. Doses used were in the range of 700 to 1000 mg per day.  However, the results were striking, and so far, and this supplement seems safe. It is inexpensive, and worth a try for a few months.

The main benefits of coffee seem to be related to its phytonutrient content-- those health promoting compounds found in plants that have antioxidant and other beneficial effects on the human body. These benefits seem to hold true whether the coffee contains caffeine or not. So if you're concerned about caffeine, due to its acute blood pressure raising effects, or its detrimental effects on sleep, you can drink decaf, and still enjoy the preventive medicine aspects of coffee.

One last thing to keep in mind: many of the health benefits of coffee can be counteracted if you add a lot of milk and sugar to it. The high saturated fat and empty calories would be more than enough to outweigh the phytonutrient effects.

For me, I'll be enjoying my cup of black half-caf in the morning all the more.

Another Nail in the Coffin for Diet Soda

All right, Dr. Peters, will you lay off the diet-soda-bashing melodrama?

No.  The answer is no.

You've read my articles before about how diet soda actually promotes weight gain rather than weight loss, and more seriously, raises the risk of stroke significantly.  Is that Diet Coke fix worth a brain attack that could lead to permanent neurologic deficit, or even death?

Now French researchers have published findings (1) that consumption of lots of diet soda more than doubles the risk of developing type 2 diabetes, compared to non-soda drinkers.  This is an even higher risk than regular soda drinkers!  As you know, type 2 diabetes is like aging on fast forward, accelerating the development of cardiovascular disease, nerve problems, kidney disease, eye problems, and other complications.  But wait -- how much is "a lot" of diet soda?  More than about 600 ml per week.  Or for us Americans, about 20 fluid ounces.  Yes, just one 20 oz. bottle per week.  Know anyone who drinks more pop than that?

So let's look at the arguments of the beverage industry:

• "Diet soda is a good choice for those trying to lose weight, since it contains zero calories."  FALSE
• "Diet soda is a good choice for diabetics, since it contains no sugar."  FALSE

Consider the alternatives:

• Get a reusable water bottle, and make pure water your go-to drink.  Add a squirt of real lemon or lime juice for a little flavor, if you miss it.  No need to replace one highly processed food (diet soda) with another ("designer" waters).
• Green tea:  go beyond the Lipton -- there are many different varieties, with flavors that should appeal to everyone.  And how about a 20-30% lower risk of cardiovascular disease as a bonus?

1.  Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale–European Prospective Investigation into Cancer and Nutrition cohort.  January 30, 2013, doi: 10.3945/​ajcn.112.050997.  Am J Clin Nutr March 2013 ajcn.050997

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.