Good Nutrition Made Even Easier

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

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

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

White pasta?

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

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

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

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.

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.

Will Fat Kill You, or Make You Live Forever?

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).

Just Say NO to High Blood Pressure!

It has long been known that compounds known as nitrates have a beneficial effect for the cardiovascular system.  The most common example of this is nitroglycerin, a drug that is used for angina (chest pain due to spasm of blood vessels).  Nitrates are transformed by bacteria in the mouth to nitrites, which are then converted in the blood into nitric oxide (NO).  NO relaxes blood vessels, which can lower blood pressure.

In addition to pharmaceutical nitrates, attention has been focused recently on whole foods sources of nitrates.  Two studies took a look at the effects of beetroot juice on blood pressure.  In 2012, Australian researchers (1) found that consuming beetroot juice significantly lowered systolic blood pressure for up to 6 hours, compared to placebo.  Beets are a good source of nitrates, which the body can convert into NO.

But 500 g of beetroot juice is quite a bit.  Some clever Brits (2) therefore compared drinking liquid beetroot juice to consuming a special beetroot enriched bread.  They found that both were equally effective in lowering blood pressure, and the bread may be more palatable.  Furthermore, in their study, they noticed that the blood pressure lowering benefits persisted for 24 hours.

One caveat to keep in mind is that both of these studies were performed with healthy subjects.  However, eating more vegetables is definitely good for your health anyway, so increasing your beet intake is a good idea if you're trying to lower your blood pressure.  You can also look at other vegetables that are high in nitrates, such as radishes, carrots, and lettuce.  And don't forget the blood pressure lowering benefits of chocolate for dessert!

1.  Coles, L and Clifton, P.  Effect of beetroot juice on lowering blood pressure in free-living, disease-free adults: a randomized, placebo-controlled trial.  Nutr J. 2012; 11: 106.

2.  Hobbs DA, et al. Blood pressure-lowering effects of beetroot juice and novel beetroot-enriched bread products in normotensive male subjects. Br J Nutr. 2012 Dec 14;108(11): 2066-74. Epub 2012 Mar 14.

Red Meat and Heart Health: The Gut Bacteria Connection

There's been a lot of debate over the years as to whether or not red meat consumption increases our risk of developing heart disease. In the past, much of the research has focused on the high levels of saturated fat and red meat, and their impact on blood cholesterol levels. A new study just published this month in Nature Medicine suggests a new mechanism: the difference in the type of gut bacteria between meat eaters and non-meat eaters.  A nice summary of the study was discussed recently on the National Public Radio show, Science Friday.

The main focus of this new study is a compound called L-carnitine, which is found in abundance in red meat. The intestinal bacteria found in omnivorous humans (compared to vegetarians or vegans) are more likely to metabolize L-carnitine into a compound called trimethylamine-N-oxide (TMAO).  High levels of TMAO accelerate the process of atherosclerosis.

The findings of this study are consistent with the well-known pattern of the Mediterranean diet, which places a great emphasis on plant-based foods, and recommends red meat only once or twice per month (see the pyramid diagram below). The Mediterranean diet is the pattern of eating among people in Italy, Greece, and other Mediterranean regions, that has been associated with protection against chronic disease, and greater lifespan.  This study has generated considerable outrage and debate, especially among proponents of high-meat diets, such as the Paleo diet. However, there is much more research about the health benefits of a Mediterranean eating pattern.

Once again, we're just beginning to scratch the surface of the importance of the ecosystem living in our intestinal tract.  I recently reported that the normal flora living in our gut can have an influence on obesity and weight loss.  If the first hundred years of nutrition research has focused on identifying nutrient compounds, deficiency conditions, and toxicity, then the next hundred years could be looking more at the effects of normal flora on our health.

Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis.  

Nature Medicine

 

(2013)

 

doi:10.1038/nm.3145.  

Published online

 

07 April 2013

Chocolate: Health Food or Not?

At this time of year, perhaps you've finished off your Valentine's Day chocolate, only to be looking forward to some chocolate in your Easter basket soon.  Americans definitely need to cut down on sweets:  The high sugar and saturated fat content in most milk chocolate can be a contributor to obesity and metabolic syndrome (a combination of insulin resistance, high blood pressure, and abnormal blood lipid levels).

On the other hand, the evidence for the health benefits of chocolate have been accumulating more and more in recent years.  The perks seem to be related to the flavanol content of the cocoa bean (Theobroma cacao).  The higher the cocoa (cacao) content, the better:  and dark chocolate (55% cacao or higher) is your best bet.  Eating an average of about one ounce per day can really boost cardiovascular and general health, including:

• Decreasing stroke risk by 14% for women (1) or 17% for men (2)
• Decreasing risk of heart failure in older women by 26-32% (3)
• Modestly reducing blood pressure (4-7)
• Decreasing "bad" cholesterol (LDL), and increasing "good" cholesterol (HDL) (8-9)
• Improving cognitive function (10)
• Most surprising of all:  decreasing body mass index (BMI) (11).  In other words, chocolate can lead to weight loss!

Just remember to enjoy your dark chocolate in moderation, as part of an overall nutrient-dense Mediterranean-type diet, including lots of fruits and veggies, nuts, legumes, lean protein, and healthy fats such as extra virgin olive oil.

1. Larsson SC, Virtmo J, Wolk A. Chocolate consumption and risk of stroke in women. J Am Coll Cardiol. 2011;58:1828-1829.
2. Larsson SC, Virtamo J, Wolk A. Chocolate consumption and risk of stroke: a prospective cohort of men and meta-analysis. Neurology. 2012;79:1223-1229.
3. Mostofsky E, Levitan EB, Wolk A, Mittleman MA. Chocolate intake and incidence of heart failure: a population-based prospective study of middle-aged and elderly women. Circ Heart Fail. 2010;3:612-616.
4. Ried K, Sullivan TR, Fakler P, Franks OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2012;8:CD008893.
5. Buijsse B, Weikert C, Drogan D, Bergmann M, Boeing H. Chocolate consumption in relation to blood pressure and risk of cardiovascular disease in German adults. Eur Heart J. 2010;31:1616-1623.
6. Taubert D, Roesen R, Lehmann C, Jung N, Schömig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007;298:49-60.
7. Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med. 2006;166:411-417.
8. Jia L, Liu X, Bai YY, et al. Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2010;92:218-225.
9. Mursu J, Voutilainen S, Nurmi T, et al. Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med. 2004;37:1351-1359.
10. Desideri G, Kwik-Uribe C, Grassi D, et al. Benefits in cognitive function, blood pressure, and insulin resistance through cocoa flavanol consumption in elderly subjects with mild cognitive impairment: the Cocoa, Cognition, and Aging (CoCoA) study. Hypertension. 2012;60:794-801.
11. Golomb BA, Koperski S, White HL. Association between more frequent chocolate consumption and lower body mass index. Arch Intern Med. 2012;172:519-521.

Good Bacteria = Smaller Waistline?

Research in the area of normal flora -- the "good," or beneficial bacteria that live in our gut -- has been exploding in recent years.  It has been known for a long time that supplementing with probiotics (those friendly bacteria like Lactobacillus and Bifidus) can help with conditions ranging from eczema to allergies to irritable bowel syndrome.  But the list of benefits of proper microbial balance keeps growing -- and it seems like the more we know, the more we realize how much we don't know yet.

Recently, Chinese researchers (1) found a connection between the microbes in our gut and the problem of obesity.  Mice that were bred to be resistant to obesity, in spite of a high-fat diet, rapidly gained weight when injected with a bacteria from the human gut called Enterobacter cloacae.  They hypothesize that a harmful substance produced by these bacteria, called endotoxin, contributes to insulin resistance.  Insulin resistance is a major contributor to overeating and obesity, and the hallmark of type 2 diabetes.  Think of insulin as a key to open the door to your cells so they can take in blood sugar for energy; insulin resistance is where the lock on the cell doors gets worn and rusty, making it more difficult for insulin to do its job.  Insulin levels rise, which contributes to widespread inflammation in the cardiovascular system, and promotes fat storage.

In the same article, the researchers report a case study of a man who lost 66 pounds in 9 weeks by switching to a diet that promoted good bacteria growth in the intestinal tract.  The harmful Enterobacter was reduced to undetectable levels.

Now before you pop an acidophilus supplement or grab a Yoplait, expecting miraculous weight loss, we need to look a little more closely at the diet supplied to this test subject.  It was very high in fiber, to feed the good bacteria in the gut, and also included traditional Chinese fermented foods that might seem challenging to our palates.  Fermented foods are beginning to look more important than probiotic supplements, simply because of sheer numbers:  supplements might have anywhere from 1 billion to 20 billion bacteria per serving, which sounds like a lot, until you realize that there are about 100 trillion bacteria in your gut!  Traditional fermented foods have much higher levels of good bacteria than supplements.  We're not talking about most commercial yogurts, which are crammed with sugar and have questionable amounts of active bacterial cultures; we're talking about plain yogurt, kefir, miso, traditional sauerkraut, and kimchi, to name a few.

We've barely scratched the surface on research into our normal flora -- not just in the gastrointestinal tract, but also on the skin, respiratory tract, and genitourinary tract.  It makes sense that they would have such a huge influence on our health:  there are ten times as many bacterial cells as human cells in our bodies!  We are really more of an ecosystem rather than a single organism.  Perhaps in the future there will be much less emphasis on therapeutic nutrition, except as it applies to how it influences our flora.

1.  An opportunistic pathogen isolated from the gut of an obese human causes obesity in germfree mice.  The ISME Journal advance online publication 13 December 2012; doi: 10.1038/ismej.2012.153

Exercise for Weight Loss: Take a Hint from Goldilocks

This is the time of year when many folks' New Year's resolutions include shedding a few (or a lot) of those excess pounds.  A healthy, balanced diet with proper portion control is the place to start, of course.  And starting an exercise program has tremendous health benefits, even beyond the waistline.  New research suggests, though, that more is not necessarily better -- even with something as healthy as physical activity.

Researchers at the University of Copenhagen in Denmark (1) explored the question of the effect of amount of exercise on weight loss.  They looked at overweight sedentary men, dividing them into three groups:

• a control group (no exercise)
• moderate exercise (300 calories burned per day, or about 30 minutes of running or cycling)
• high exercise (600 calories burned, or about 60 minutes per day)

After 13 weeks, they examined weight loss in the three groups.  Not surprisingly, the control group showed no change in weight.  The high-exercise group lost an average of about five pounds -- respectable, but actually less than expected, given the number of calories these gentlemen were burning.  But the moderate exercisers actually lost more weight:  about seven pounds on average, or forty percent more than the high-exercise group!  What could account for this Goldilocks effect -- not too much, not too little, but just right?

There is one major factor that the researchers did not examine:  body composition.  In other words, how much muscle and fat did each subject have at the beginning and end of the study?  The high exercisers were probably gaining more muscle than the moderate group, resulting in a lower net weight loss.  For this reason, I like to measure body composition (via bioimpedance analysis) at my clinic to more accurately track changes over time.  Lead scientist Mads Rosenkilde admits that if the study extended beyond 13 weeks, the metabolic benefit of increased muscle mass might become more noticeable in the high exercisers.

Nevertheless, there are at least two major pitfalls that the researchers identified for the high-exercise group.  The increase in calories burned seemed to lead to a compensatory increase in food intake -- this was most likely unconscious, a result of altered hormonal control over hunger signals (the set point theory).  A unique aspect of this study is that the subjects were equipped with motion sensors, to record their physical activity outside of the formal exercise periods.  The high exercisers were actually more sedentary the rest of the day compared to the moderate group -- perhaps due to fatigue, or perhaps they just felt they "deserved" more rest.

This study gives us plenty of food for thought on physical activity.  But like everything, let's take it in the context of all research, not just the latest headline:

• Any exercise is better than none at all.
• If you are using a lower intensity exercise such as walking, it might take 45-60 minutes to hit that 300 calorie burn goal.
• Short bursts of high-intensity exercise have been shown to have greater metabolic benefit overall than prolonged sessions of more moderate intensity exercise:  The improvement in insulin sensitivity can lead to better weight management with as little as 60 minutes per week. (2)

1.  Body fat loss and compensatory mechanisms in response to different doses of aerobic exercise--a randomized controlled trial in overweight sedentary males.  Am J Physiol Regul Integr Comp Physiol. 2012 Sep 15;303(6):R571-9. doi: 10.1152/ajpregu.00141.2012. Epub 2012 Aug 1.

2.  Just HIT it! A time-efficient exercise strategy to improve muscle insulin sensitivity.  J Physiol. 2010 September 15; 588(Pt 18): 3341–3342.

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.

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