Time to Throw Out Your Herbs - the New York Attorney General Says So

Ah, yes.  This is one of those headlines that rears its head every few months -- another "supplement effectiveness disproved, once and for all!"  The New York attorney general recently released a report, along with cease-and-desist letters, for the herbal supplements sold by four major retailers.  The retailers were Walgreens, Wal-Mart, Target, and GNC. The issue was that DNA analysis of many of these herbal products showed none of the actual herb claimed on the label. There were plenty of dire quotes about "false advertising," and "an unbelievably devastating indictment of the industry."

This sounds like an open and shut case, but let's take a little but a closer look. The first problem is with the testing method. Mark Blumenthal of the American Botanical Council gave a great concise explanation about why the DNA testing that was done was inappropriate for this type of research.
The main take away points are:

• DNA testing does not test for botanical extracts, only whole herb products
• There was no microscopic or chemical testing (techniques much more widely used to confirm herb quality) for confirmation
• The analysis was performed by a researcher with no background in botanical medicine
• There was no repeat confirmation by a different lab
• Trace contamination of other plants, or even common fillers (rice, potato, etc.) would show up on DNA analysis, since this test only shows the presence of those plants, not their quantity

Contrary to the attorney general's statement, this test did not prove widespread fraud in the supplement industry. However, there is also the concern that these store brands are being held up as the standard for the entire supplement industry.  A professor at Harvard Medical School stated that "mainstream retailers like Wal-Mart and Walgreens...are expected to be the absolute highest quality."

Wait, what? There are very likely our quality control issues with many supplements, especially cheap store brands. That is why I often recommend professional supplements for my patients when we want a specific therapeutic effect. Some people wonder why a bottle of supplements by Metagenics, Integrative Therapeutics, Vital Nutrients, Ortho Molecular Products, or Thorne Research costs twice as much or more than a "comparable" product at the drugstore. The answer is quality control. These professional brands spend the time and money to independently verify each batch of raw ingredients that they use, as well as the final product, to ensure quality and potency.  You wouldn't want to buy a pharmaceutical medicine that hadn't undergone rigorous quality control -- why would you accept less from your supplements, if you are depending on them for your health?

I wouldn't throw out my supplements just yet. Especially if you got them from a trusted source.

Is Your iPad Killing You?

Regular readers and patients know the importance of a good night's sleep to health.  Low quality sleep, and getting fewer than seven hours of sleep per night, have been associated with chronic diseases such as cardiovascular disease, as well as shorter lifespan. Two recent studies highlight some of the hidden thieves of sleep in our modern world.

Researchers at Brigham and Women's Hospital in Boston compared people who read on an iPad screen before bed to those reading a traditional paper book before bed. The study confirmed what has long been suspected: that exposure to a screen decreases sleep quality, shortens the amount of REM sleep, and leads to worse moods and poor productivity the next day. Ideally, you should avoid all light-emitting screens for at least an hour before bedtime.  The main problem seems to be with the blue wavelengths of light, that suppress our body's natural melatonin production. If you really have to read a screen late in the evening, use a physical filter that blocks bluelight, or use free software such as f.lux that achieves the same effect. For Android users, there are several apps available, such as Twilight.

Another problem associated with difficulty sleeping is the presence of intrusive or repetitive thoughts. Interestingly, researchers at Binghamton University have discovered that one of the best way through to cease anxious thoughts is actually to get to bed earlier. Staying up late at night and having a short duration of sleep just aggravate the problem.

It can be a challenge to adjust your habits to get to bed earlier, but it's worthwhile. Maybe you could stop watching those electronic screens late in the evening. If repetitive thoughts are actually preventing you from falling asleep, you could try and herbal sleep aid such as valerian root, or a do-it-yourself behavior modification programs such as SleepStar.

When you sign up for SleepStar, use code PetersND25 for a discount.

Jacob A. Nota, Meredith E. Coles. Duration and Timing of Sleep are Associated with Repetitive Negative Thinking. Cognitive Therapy and Research, 2014; DOI: 10.1007/s10608-014-9651-7

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.

Is It Time to Eat? A Surprisingly Important Question

'Tis the season for making New Year's resolutions.  Perhaps your resolutions include healthier eating and losing weight.  There is certainly plenty of info in my past articles on how to construct a healthy diet that will help you live longer and prevent chronic diseases. One element that may have been overlooked in all the scrutiny over what to eat is when to eat. There is growing evidence that restricting our eating to certain times of the day leads to more easily maintaining a healthy body weight.

Several authors and experts have been touting so-called "intermittent fasting," which consists of only eating between the hours of 10 AM and 6 PM, for example. Another version of this approach involves eating normally five days per week, but essentially fasting (taking in less than 500 calories) on the other two days.  The idea behind this is that a more prolonged period without food discourages fat storage, and allows our body to switch its metabolism over to burn our stored fat supplies.

A recent study in mice (1) seems to support this idea. In this study, two groups of mice were allowed to eat as much as they wanted. One group had food available at all times, while the other group only had food available for a 12-hour period each day. The group with the more restrictive time ate about the same number of calories as the other group, and yet maintained a healthy body weight, while the unrestricted group became obese.  The time-restricted mice were even able to reverse obesity and prevent type-2 diabetes.  Cholesterol balance improved within two weeks, and blood sugar control improved within a few days.

A related study (2) showed how this intermittent fasting can change the composition of the gut microbiome.  A healthier blend of friendly intestinal bacteria leads to leaner body weight.

It's too soon to translate these results directly to humans, but there have been some small human studies that point to the benefits of this approach.  One study found that intermittent fasting led to the same amount of fat loss as traditional calorie-restricted diets, but preserved much more healthy lean tissue. (3)

In a way, all of this seems to hearken back to traditional Chinese and Ayurvedic medicine: these systems used more poetic language to recommend against eating late into the evening or at night.  Whatever the reasoning, the outcome seems to be the same -- better health when we pay more attention to eating at the right time of day.

Listen to an interview with one of the researchers:  You Are 'When' You Eat 

1.  Amandine Chaix, Amir Zarrinpar, Phuong Miu, Satchidananda Panda.  Time-Restricted Feeding Is a Preventative and Therapeutic Intervention against Diverse Nutritional Challenges.  DOI: http://dx.doi.org/10.1016/j.cmet.2014.11.001

2.  Amir Zarrinpar, Amandine Chaix, Shibu Yooseph, Satchidananda Panda.  Diet and Feeding Pattern Affect the Diurnal Dynamics of the Gut Microbiome.  DOI: http://dx.doi.org/10.1016/j.cmet.2014.11.008

3.  Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings.  Transl Res. 2014 Oct;164(4):302-11. doi: 10.1016/j.trsl.2014.05.013. Epub 2014 Jun 12.

Taking a Stand... for Chairs

Sitting, and its effects on health, is a hot topic these days.  I recently wrote a review of current research, showing how excessive sitting increases our risk of chronic disease and death; it even cancels out the benefits of regular exercise.

It seems like I'm hearing more about this everywhere I turn. The excellent radio show, 99% Invisible, just ran an episode on the health effects of sitting, and how it relates to the history (and future) of chair design. I encourage you to read or listen to this fascinating show.

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.

Healthy Food? Blech!

One of the main impediments that many people cite in avoiding healthy foods is taste.  When the average American is faced with the choice between a Frappuccino and a kale salad, it's no mystery which one will be chosen.  Our brains are hard-wired to seek out fats, sugar, and salt for survival -- but with the modern food-industrial complex, these once-scarce resources are available in virtually endless supply in our country.  I've gone into a lot of detail previously on what constitutes a healthy diet:  Mediterranean-style eating, high in fiber, low in refined flours and sugars, with moderate amounts of healthy fats (such as olive oil and nuts) and lean proteins (such as legumes and fish).  So how do we get over the hurdle of transitioning to this style of eating... and more importantly, how do we adopt this on a permanent basis?  It can be easy to stick with any "diet" for a few weeks, but long-term health requires a lifestyle change.

Kids.  As a parent, I know how challenging it can be to introduce healthy foods in the face of the "beige diet:" chicken nuggets, corn, bananas, pizza, cereal, cookies.  The key here is persistence and repetition:  Food experts tell us that it can take 10-12 times of encountering a new food before young children will accept it.  Just keep putting that broccoli on their plates, and requiring at least one "thank-you bite."  Eventually, they'll get used to it.

Adults.  Are we just "in the habit" of eating unhealthy foods -- or are we actually addicted to them? While this term is controversial, there have been studies that show the same brain areas light up on functional MRI in response to refined sugar as they do for cocaine (1).  In 2007, a rat study found that the animals actually preferred the sweet stuff over cocaine when given a choice (2).

So how do we break this addiction?  Mark Hyman, MD, recommends approaching it the same way you would with any other addiction:  go cold turkey.  In this case, it means absolutely no sugar or refined grain products for at least 10 days.  This gives a chance for the taste buds and (more importantly) the reward centers of the brain to hit the reset button, so that we are not so sensitized to the sweet stuff.  We can then actually start tasting other foods, and they taste better by comparison.

A small pilot study by researchers at Harvard and Tufts Universities (3) used functional MRI to measure brain reward response in overweight and obese individuals before and after a structured low-glycemic index diet.  This plan, called the iDiet (or "instinct diet"), overcomes the natural tendency toward sweets by substituting healthier ingredients in familiar dishes, encouraging more frequent eating of healthy meals to avoid hunger, and involving interpersonal support.  After 24 weeks, the reward centers of the brain showed less reponse to high-calorie foods, and more response to low-calorie foods.  In plain English, this proves that on a neurological level, the brain can be rewired to enjoy healthier foods.

So it takes some effort, but it shows that old habits can be changed.  Dr. Hyman emphasizes that willpower is not the issue here:  the combination of our neurobiology with what K. D. Brownell (4) calls a "toxic food environment" creates a trap for us.  A structured kick-start might be just what we need to turn over a healthier leaf.

1. Avena N et al.  Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake.  Neurosci Biobehav Rev. 2008; 32(1): 20–39.  Published online May 18, 2007. doi:  10.1016/j.neubiorev.2007.04.019
2. Lenoir M, Serre F, Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698.
3. Pilot randomized trial demonstrating reversal of obesity-related abnormalities in reward system responsivity to food cues with a behavioral intervention.  Nutrition & Diabetes (2014) 4, e129; doi:10.1038/nutd.2014.26.  Published online 1 September 2014.
4. Brownell KD, et. al. Personal responsibility and obesity: a constructive approach to a controversial issue. Health Aff (Millwood). 2010 Mar-Apr;29(3):379-87