Top 5 "Myths" in Natural Medicine

As a doctor of naturopathic medicine, I have years of experience and training to respect the vis medicatrix naturae, or healing power of nature.  This is foundational to our approach to health.  I also have a background in science, and know that it is important to examine natural methods of health care to see if they are valid and effective.

That is why (though it might be dangerous to step on some toes) I like to clarify common misperceptions:  My goal is to help patients be as healthy as possible, not to be wedded to a particular idea.  Therefore, over the next few articles, I will present five common myths I often encounter, in no particular order.

Myth #1: Policosanol is a good alternative to cholesterol-lowering medication.
Policosanol is an extract of the sugar cane plant that made big news about ten years ago, with studies showing it was very effective at lowering blood cholesterol levels (1).  The nutritional supplement industry responded with a deluge of policosanol products.  However, much of that early research was conducted in Cuba, the source of the sugar cane--the raw material for policosanol production.  Follow-up studies conducted on larger populations, showed little to no clinically significant cholesterol-lowering effects of policosanol (2, 3).  Even though this well-designed research was published in 2006, policosanol sales continue to this day.  More recent research from 2011 (4) found that even a form of policosanol modified to make it better absorbed from the gastrointestinal tract failed to make a significant dent in cholesterol levels.  Some recent studies showing benefits used policosanol in combination with red yeast rice and berberine, two natural compounds that have been proven time and again to be effective in lowering cholesterol.  It's highly likely in these studies that the policosanol could have been left out, without affecting the results.

With all this evidence against policosanol, why are sales still so brisk today?  Well, in the midst of bashing the evil of Big Pharma companies, we sometimes forget that supplement companies are businesses, too, driven by market forces.  As long as there's a demand for policosanol (based on those biased studies from 10-15 years ago), they'll keep selling it.  Sorry, folks--supplement companies are not selfless crusaders for health; they're driven by the profit motive.  It's the American way.

I stopped recommending policosanol in 2006, in favor of much more effective treatments.  I also like to remind patients that high cholesterol is not a disease; it's a risk factor for cardiovascular disease (CVD).  I put the emphasis on lifestyle factors for CVD prevention, and look at modifying other risk factors too (such as high-sensitivity C-reactive protein and blood levels of vitamin D).

Next Time:  Cinnamon for blood sugar control

1.  Policosanol: a new treatment for cardiovascular disease?  Altern Med Rev. 2002 Jun;7(3):203-17.

2.  Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial.  JAMA. 2006 May 17;295(19):2262-9.

3.  Comparative lipid-lowering effects of policosanol and atorvastatin: a randomized, parallel, double-blind, placebo-controlled trial.  Am Heart J. 2006 Nov;152(5):982.e1-5.

4.  Modified-policosanol does not reduce plasma lipoproteins in hyperlipidemic patients when used alone or in combination with statin therapy.  Lipids. 2011 Oct;46(10):923-9. Epub 2011 Jul 8.

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.

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