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.

For Clear, Healthy Skin, Take Care of the Gut

Eczema is a troubling skin condition that affects millions of Americans.  The itchy rash of eczema is due to an atopic reaction: an inappropriate inflammatory response by the immune system.  One thing that has long been known to help eczema, especially the type associated with food allergies, is the use of probiotics supplements (those beneficial bacteria).  Sometimes we think of probiotics as only helping with digestive problems, but their beneficial effects extend throughout the body.  These effects range from helping with obesity to depression to autism.

A new review study (1) clarified the effects of probiotics in eczema and food allergies.  The author clarified that probiotics taken orally have a balancing effect on our immune system (immunomodulation).  This is because most of our immune tissue is located along the lining of our digestive tract.  The interaction of probiotic bacteria with these immune cells sends chemical signals to the immune system in the rest of the body, to make sure it's not overactive or under-active.  Think of it as a toning workout for our immune system.

Probiotic supplementation seems to be most effective at preventing and treating eczema from ages 0 to 2.  Prenatal probiotic supplementation by the mother can also have a strong preventive effect.

The type of probiotic matters, also.  The most beneficial effect was seen with Lactobacillus rhamnosus, but the author emphasized that the chief consideration for immunomodulation is the diversity of microbes in the gut.  For this, it's important to maintain a high fiber diet, to provide the prebiotic nutrients necessary to feed these helpful critters.  Another key to microbial diversity is to declare a truce in the "war on bugs:"  let your kids play in the dirt.  Get rid of the antibacterial hand soaps.  Take it easy on the Clorox wipes.  By decreasing our exposure to germs, this kind of over-attention to hygiene may actually be one of the big contributors to the increased incidence of allergies and eczema over the last couple of decades.

1.  Kuitunen M.  Probiotics and Prebiotics in Preventing Food Allergy and Eczema.  Curr Opin Allergy Clin Immunol. 2013;13(3):280-286. 

Another Key to Childhood Behavioral Problems: Avoid This at All Costs

Aggression.  Inattention.  These issues just seem to be getting more and more prevalent in kids all the Time these days.  Last month, I told you how inadequate sleep can greatly increase the risk of aggressive behavior in children.  Recent research has uncovered another culprit in this growing problem:  soft drinks.

Researchers at Columbia University in New York examined almost 3000 children, looking at the average soda consumption and behavioral habits of five-year-olds.  They used maternal reports of the amount of soda consumed, and an assessment called the Child Behavior Checklist (CBCL).  The results?  Even one soda per day significantly increased problem behaviors.  And with higher soda consumption, the aggression just gets worse.  Four soft drinks per day doubled the score for inattention and withdrawn behavior, and almost quintupled the aggression score, compared to kids who drank no soda.  These differences remained significant even after controlling for other factors, such as intake of other sweets, level of physical activity, and maternal depression.

Interestingly, the researchers did not differentiate among types of soft drinks: regular versus diet, caffeinated versus decaffeinated.  So it is unclear whether this is an issue with sugar, caffeine, or just a marker of an overall poor diet.  Not surprisingly, the American Beverage Association capitalized on this uncertainty to state that this study does not prove that soft drinks cause any problem behaviors.  Sure.  Just like they have said that artificial sweeteners are a good alternative to sugar, when science has shown that diet soda is linked to dangerously increased stroke risk and diabetes risk in adults.

To me, this is just another reason to say that pop is an unnecessary health risk, no matter what your age.

Sugila S et al.  Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds.  J Peds 21 August 2013.

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.

Amazing Breakthrough for Depression - You Won't Believe What It Is!

Depression is not just "feeling blue," but rather a significant mental health condition that can affect one's whole life.  The CDC estimates that one in 10 American adults is depressed.  Depression goes hand-in-hand with poor outcomes in chronic health conditions like cancer, diabetes, cardiovascular disease, and obesity, in addition to the more obvious negatives social and behavioral effects.

For this reason, antidepressants have become one of the most widely prescribed classes of drugs in the US over the last 20 years.  The most common of these are the SSRIs, such as Prozac (fluoxetine).  While these medications can help people to live more normal and productive lives, they do come with significant side effects, such as sleep disturbances, loss of libido, weight gain, and even an increase in suicidal ideation.

There is good research about natural alternatives for mild to moderate depression, such as aerobic exercise and St. John's wort.  Exciting new research out of India has highlighted a safe alternative for major depression: curcumin.  Curcumin is the active compound in the herb turmeric.  This was a relatively small study, involving 60 patients with major depressive disorder.  They were divided into three groups: one group received fluoxetine, 20 mg daily; the second group received curcumin, 1000 mg daily; the third group received a combination of the two.  Outcomes were measured using the Hamilton Depression rating scale.  There was no statistical difference in the response rate among the three groups, and at the end of six weeks, the change in Hamilton score was comparable in all three groups.

This is big news.  Depression is a serious health condition, but the side effects of SSRIs are further complicated by the difficulty that patients have in coming off these medications.  On the contrary, the "side effects" of curcumin include:

• protection against neurodegenerative diseases such as Parkinson's and Alzheimer's,
• enhanced gastrointestinal health,
• protection of the liver against toxins,
• anti-inflammatory effects from muscles and joints,
• and more.  

One thing to keep in mind about curcumin, however, is that most standardized extracts are poorly absorbed from the intestinal tract.  It is best to use curcumin that is complexed with phosphatidylcholine (such as Curamin [BCM-95--the type used in this study] or Meriva), or used in conjunction with black pepper (piperine).

A last note of caution: if you are currently taking antidepressant medications, do not discontinue them abruptly.  Consult with your prescribing physician about weaning down gradually on the dosage, to avoid withdrawal effects.  It is perfectly safe, however, to start taking curcumin while still on the pharmaceutical antidepressant.

1.  Efficacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial.  Phytother Res. 2013 Jul 6. doi: 10.1002/ptr.5025. [Epub ahead of print]

More News about the Gut's Role in Autism

Last week, I highlighted new evidence about the link between gluten and the symptoms of autistic spectrum disorder (ASD).  Hot off the presses, we have another study about a gut-autism link.  Researchers at Arizona State University (1) found a significant difference between the normal flora (bacteria in the gastrointestinal tract) of children with autism and non-autistic children.  In particular, autistic children had lower levels of three types of bacteria:  Prevotella, Coprococcus, and Veillonellaceae.  These were identified from fecal samples taken from children ages 3 to 16 years.  These organisms, especially Prevotella, are important for carbohydrate digestion, and maintenance of healthy biodiversity in the gut ecosystem.  Impairment of carbohydrate digestion may leave these kids more susceptible to developing the leaky gut and gluten sensitivity described in last week's article.

While this research is intriguing, it still presents us with a chicken-or-egg dilemma: do disturbances of gut bacteria contribute to the development of ASD, or are children with ASD more susceptible to gut flora imbalances by some other mechanism?  We are only in the very early stages of identifying all the complexities of the trillions of microorganisms that live inside of us.  Now that we have identified the human genome, the next step is to tackle the human microbiome:  the identification of all of those microbial species in their proper proportions to maintain good health.

Over the next 20 years or so, our current probiotics supplements will look like primitive stone tools.  Hopefully, we can get to the stage where we can supplement with specific organisms like the ones identified in this study (none of which are available in current probiotics supplements).  Otherwise, we may have to look more seriously at fecal microbiota transplantation as an important technique for many health conditions, not just C. difficile infection.

Related posts:

• I Have a Gut Feeling They're on to Something.  
• Good Bacteria = Smaller Waistline?

1.  Kang D-W, Park JG, Ilhan ZE, Wallstrom G, LaBaer J, et al. (2013) Reduced Incidence of Prevotella and Other Fermenters in Intestinal Microflora of Autistic Children. PLoS ONE 8(7): e68322. doi:10.1371/journal.pone.0068322