Why I'm Still Eating Organic Foods

A study about organic food published this month in the Annals of Internal Medicine (1) made big headlines, mostly along the lines of "organic food is no better for you than conventionally grown food."  As usual, the headlines tend to gloss over the details of the research that was conducted.  Several points are worth noting, to decide whether or not organic fruits, vegetables, eggs, and meat are worth the extra cost:

• This was a review study, not primary research.  That is, the authors combed through existing articles from the past 15 years to extract the data.  This can confuse the issue, since the previous studies were done in different settings and for a variety of purposes.
• Organic produce does not contain significantly higher levels of vitamins or minerals than conventionally grown produce.
• Eating organic food leads to lower exposure to synthetic pesticides and fertilizers, but the authors point out that the exposure from conventional foods was mostly within the "allowable limits" set by the US government.
• Organic chicken and pork have a greatly reduced risk of carrying antibiotic-resistant bacteria ("superbugs" that are particularly dangerous and difficult to treat).

My view on some of the conclusions reached:

• It has been well known for a long time that organic fruits and veggies are not superior in vitamin or mineral content.  However, some studies have suggested that they do have a higher content of phytonutrients -- those compounds produced by plants that help protect us against cancer, cardiovascular disease, and other chronic health conditions.  Plants are basically chemical factories; without the "protection" of synthetic pesticides, they must cook up their own natural protective compounds, and we get the benefits when we eat those plants.
• Even though pesticide residue on conventional produce is within "safe" limits for daily consumption, we must remember that those chemicals are lipophilic (literally, "fat-loving").  They can stay in our fat tissue for a very long time.  How long?  A by-product of the pesticide DDT (which was banned in the US in 1972) was still present at significant levels in adults' fat tissue two decades later (2).  So it's not about keeping the daily dose in a "safe" range; it's thinking long-term about these carcinogenic compounds (3) building up in the body.
• While we're on the topic, those synthetic chemicals can even contribute to obesity and diabetes (4).
• Avoiding antibiotic-resistant bacteria is always a good idea; avoiding the residue of antibiotics in meat is also a good idea, since that may disrupt the normal, beneficial microorganisms in our digestive tract.

So for many fruits, vegetables, and meat, I'm sticking with organic.  If you need to budget your grocery dollars, check out the Environmental Working Group's analysis of which foods are highest and lowest in pesticide residue.

1. Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review.  Ann Intern Med. 4 September 2012;157(5):348-366
2. Organochlorine pesticides and polychlorinated biphenyls in human adipose tissue.  Rev Environ Contam Toxicol. 1991;120:1-82.
3. Adipose tissue levels of organochlorine pesticides and polychlorinated biphenyls and risk of non-Hodgkin's lymphoma.  Environ Health Perspect. 2004 Jun;112(8):854-61.
4. Obesity and persistent organic pollutants: possible obesogenic effect of organochlorine pesticides and polychlorinated biphenyls.  Obesity (Silver Spring). 2011 Apr;19(4):709-14. Epub 2010 Jun 17.

When Does a "Normal" Blood Sugar Test Mean a 53% Increased Risk of Cardiovascular Disease?

Answer:  When it's at the upper end of the normal range.

A fasting blood glucose (FBG) test is one of the most common labs I order.  The normal range for FBG is 60-99 mg/dl.  If this reading of blood sugar is much too high (greater than 126 mg/dl) on two separate tests, that is the definition of diabetes.  The most common type of diabetes that comes on later in life is called type 2 diabetes mellitus, and is associated with obesity.  That borderland of 100-125 mg/dl is called impaired fasting glucose, and indicates that a person on the way to developing diabetes.

So why all this fuss about blood sugar?  The problem is that high blood sugar (and the high insulin levels that accompany it) put aging on fast-forward -- putting you at much greater risk for heart disease, kidney disease, eye problems, and nerve problems.  It literally takes years off your life.  The complex interrelationship between high blood sugar, insulin resistance, and chronic disease has been called metabolic syndrome.

Knowing this, researchers in Israel published findings last week (1) that indicate that the problems don't just suddently start once your FBG climbs over 100 mg/dl.  Adults who had FBG of 95-99 mg/dl (still "normal") had a fifty-three percent increased risk of cardiovascular disease compared to those with FBG of less than 80 mg/dl.

What does this mean for you?  If your doctor tells you that your blood sugar test came back normal, ask for the number.  If it's over 95 mg/dl, you are at a significantly increased risk for stroke, heart attack, and coronary heart disease.  Follow a healthy lifestyle, including a low-glycemic index diet and exercise, to aim for a FBG of less than 80 mg/dl.

1.  Fasting Glucose Levels Within the High Normal Range Predict Cardiovascular Outcome.  Am Heart J. 2012;164(1):111-116.

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

So Obvious, It's Revolutionary

One of my main recommendations for folks who are having trouble sleeping is a simple one:  Turn out the lights.  I've heard folks say they "can't" fall asleep without surfing the web right before bedtime, or having the TV on in the bedroom.  But late night exposure to light suppresses the body's natural production of melatonin, our main sleep hormone.

Melatonin is produced by a tiny gland at the base of the brain called the pineal gland.  The pineal gland releases melatonin in response to darkness, and this signals the brain to go into sleep mode.

Recent findings have shed more light (so to speak) on the importance of darkness and melatonin.  Melatonin has antioxidant effects in the body that protect against cancer.  Nurses who work the night shift (and therefore get round-the-clock light exposure) produce less melatonin, and are at significantly higher risk for breast cancer (1, 2).

A new study found that even low light levels in the sleeping room at night can produce symptoms of depression (3).  Granted, this study was done using hamsters, but the biological effects were clear:  depressive symptoms after four weeks of dim light at night.

Depression?  Insomnia?  Cancer risk?  Turn out the lights:  shut off all screens (TV, computer, iPad, smartphone, etc.) 30-60 minutes before bedtime.  Get rid of the night lights and television in the bedroom.  You might even want to move that bright LED alarm clock away from your head.  Allow a few weeks for your body to readjust to what is becoming a scarce, but highly valuable, commodity:  darkness.

1. Cancer Epidemiol Biomarkers Prev. 2012 Apr;21(4):609-18. Epub 2012 Feb 7.
2. Cancer Causes Control. 2006 May;17(4):539-45.
3. T A Bedrosian, Z M Weil and R J Nelson.  Chronic dim light at night provokes reversible depression-like phenotype: possible role for TNF.   Molecular Psychiatry , (24 July 2012).

If You Value Freedom, Then Read On

This Independence Day, my family watched the movie 1776, a dramatic reminder of the birth of our nation, and the risks the founding fathers were taking to stand for freedom from tyranny.  The Declaration of Independence was not just a piece of paper -- it was a set of principles that was carefully crafted and debated, with at least one founding father resigning from Congress rather than participate in what he viewed as treason.

We carry the legacy of liberty two hundred thirty-six years later, and indeed, it is what makes our country great.  Not perfect, but still an order of magnitude above so many oppressive regimes in the world.  With this tradition of freedom so firmly etched into our national identity, it's sometimes challenging to get the message that certain boundaries do make us healthier and happier.

We live in the land of endless choices:  two hundred channels on cable, but nothing worthwhile to watch.  Fifty varieties of pasta sauce on the grocery store shelf.  Clothing in any color or style imaginable.  Is this what our founding fathers fought for?

The most famous phrase in the Declaration of Independence is "life, liberty, and the pursuit of happiness."  Did you know that when it comes to choices, more is not always better?  Dr. Barry Schwartz has done rigorous research in this area, and found that more options increase happiness -- up to a point.  Beyond that, we become increasingly anxious, or even paralyzed, by the number of choices we're faced with.




With so many choices, we are led to believe (especially by the marketing industry) that there is some option out there that is perfect for us.  Paradoxically, though, we often end up regretting what we chose, because we imagine that one of the other options out there might be better still.

In the area of health care, pharmaceutical companies advertise prescription drugs directly to consumers.  Why market something to the general public that needs to be prescribed by a physician?  So that we go to our medical doctor and demand that drug, rather than relying on the expertise of the doctor to prescribe what is best for our health.

We suffer from too many options -- fast food, processed food, endless sources of electronic entertainment to deprive us of exercise and sleep.  In this sense, naturopathic medicine is counter-cultural:  a major principle we have is vis medicatrix naturae, or the healing power of nature.  In other words, get back to the basics -- simple, nourishing food, restful sleep, regular physical activity, and conscious methods of stress management.  Discover how to fit these into your life, and be on constant guard for the seduction of excessive choice under the guise of "liberty," that in reality detracts from our life and pursuit of happiness.