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. 

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.

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.

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