Wednesday, May 2, 2018

The Daily Dozen


Every day there seems to be a new research study on healthy eating or lifestyle habits, along with a new diet or exercise recommendation. How can you sort out what’s proven from the “fad” of the week, and then make the necessary changes in your family’s routine.

Dr. Greger (nutritionfacts.org) is a well-known guru of healthy eating who writes an interesting column. He has pulled together a Daily Dozen nutrition and lifestyle tips which he tries to follow. They are all well proven and might give you a place to start if you are interested in changing your own health routine.

It is important to stress that these tips are just a guide, suggestions, and not a list of absolute “must dos”. The Daily Dozen is just a tool to get you started.

It’s interesting to note that Dr. Greger encouraged his family engaged by using an erasable white board on the refrigerator with check boxes for each item. But reaching their daily goal soon became just another piece of the family’s routine and the white board was moved to the garage.


The recommendations are generally food focused with two lifestyle goals as well.


Foods


  1. Beans (legumes).  Legumes are a key to keeping your colon bacteria (the microbiome) happy. You should have three ½ cup servings a day. Split peas, chickpeas, lentils, and tofu count as legumes, as does pea soup and hummus.
  1. Flax Meal. One tablespoon a day. Flax contains lignans, a potentially anti cancer compound, at a concentration one hundred times higher than other foods.  And the other poorly absorbed plant fibers in the flax also help keep that microbiome in balance. Mix the flax meal with applesauce and you can take credit for a fruit serving along with your fiber.
  1. Berries. One halfalf cup every day. Fresh or frozen. These along with other colored vegetables are loaded with micronutrients and antioxidants.
  1. Fruit. One medium apple or other piece of fruit (orange, banana, pear) a day. Or substitute one cup of cut up fresh fruit or a half cup of dried fruit.
  1. Cruciferous vegetables. One half cup a day. Broccoli, cabbage, collards or kale. Cruciferous vegetables contain sulforaphane, which is not found in other green leafy vegetables.
  1. Greens. Two servings. One serving is a cup of leafy vegetables or half cup cooked such as kale or spinach. And if you had an extra half-cup of broccoli, you can count that as well.
  1. Other vegetables. Two one-half cup servings. Carrots, asparagus, anything that is not leafy.
  1. Whole grains. This one is easy in a western diet. One half cup of oatmeal. One half cup of cooked pasta. One tortillas or one slice of bread. Or popcorn (three cups) for an evening snack.
  1. Nuts. One-quarter cup.  A great snack mid morning when you are tempted to open the refrigerator. Peanut butter counts as well!
  1. Tumeric.  One-quarter teaspoon. I don’t think its alleged anti cancer properties are as proven as Dr. Greger’s other recommendations, but I’m including it as it is his Daily Dozen.


Lifestyle


  1. Ninety minutes (total per day) of brisk walking or 40 minutes of more intense exercise such as jogging, swimming, or biking. It does not need to be consecutive. You can break it up over the day.
  1. Water.  Five glasses. As with the Tumeric, I’ve seen articles questioning the benefit of five glasses of water.


At first glance, this list looks overwhelming. But when you think about it, a peanut butter sandwich with a banana covers the nuts, fruit and whole grains for the day. And a big salad with a few nuts, tomatoes, and other vegetables covers a lot of ground.

The advantage of starting with a list is that it helps keep things balanced and on track. It reminds you what you may need to buy at the store, and helps with meal planning, especially if you are making dinner and want to add categories you’ve missed during the day. And before long, your choices second nature and the list can go back in the drawer.

If you want to give it a try, there is even a smart phone app called Dr. Greger’s Daily Dozen  (in the Apple App Store for sure) that will take the place of that white board or sticky notes on the refrigerator.


References:

https://nutritionfacts.org/video/dr-gregers-daily-dozen-checklist-2/

Sunday, March 25, 2018

First the fat, then it was the salt and now it’s our sugar.



Cut back on your sugar and carbohydrates? Increase the fat in your diet? Ten years ago fat was the killer in our diet and carbohydrates the answer to preventing heart disease, the bane of our fast food society.

Dr. Atkins (of Atkins Diet fame) was one of the first to suggest that sugar, not fat was the reason for our epidemic of obesity. A recent review of 23 studies in 2017 supported this claim with the observation that study participants on a low carbohydrate diet often lost 2-3 times as much weight as the low fat groups. 

And even more interesting, many of the low carbohydrate group lost weight without any calorie restriction. 

The appetite suppressing effects of dietary fat were associated with an unexpected reduction in participants’ total daily calories. This “fat effect” is why we often take a trip to the refrigerator within a few hours of a chinese meal (generally low fat) and can find ourselves skipping that early lunch after a breakfast of bacon and eggs (high fat).

Then there were the studies showing that excess sugar increased the risk for heart attacks and strokes. In 2014 the Journal of the American Medical Association published a study showing that that North Americans who ate 25 percent of their calories as sugar had a fatal heart attack rate 2.75 times that of those who ate less than ten percent as sugar calories.

A meal high in sugar--or a sugared drink--leads to a rapid rise in blood sugar. Unless that extra sugar is used by exercising muscles (one of the reasons a good walk after dinner is a healthy habit), it is converted almost immediately to a type of fat called triglycerides.
These in turn cause fatty deposits in the lining of blood vessels and are the reason for the increased risk for a stroke or heart attack.

Even cancer has been linked to a high sugar diet. Rapidly growing cancer cells get almost all of their energy from sugar in a process that is oxygen-independent, while normal cells get their energy from fats, protein, and sugar in a process that is dependent on oxygen.

This observation led to speculation that the occasional cancerous cell (resulting from a spontaneous mutation) would have a better chance of survival in the presence of a high blood sugar. The theory is supported by a recent study showing an increased risk of colon cancer recurrence in patients with higher total daily carbohydrate diets.

Why has it taken so long for this to be sorted out? That is a story in itself and a great example of why industry funded research should always be suspect.

In the 1940s there was an ongoing argument in the medical literature on the role of fats versus sugar as the major risk factor for heart disease. To quote from an online blog by Dr. Mirkin, “... in 1965, John Hickson of the Sugar Research Foundation (now the Sugar Association) wrote to Harvard researchers asking them to write an article showing that sugar was safe and healthful. He paid them $6,500 and asked them to review only the research papers favorable to the sugar industry.”

This was the first step in a cascade of events that demonized fat and promoted sugar as heart healthy. And it has taken 50 years for the real facts to come to light.

But the wheel turns and we are now coming back around to our grandmother’s advice to eat a balanced diet. The healthiest approach is not an artificially low fat versus low sugar diet, but instead about eating a balanced diet—a bit of meat, occasional fish, a side of pasta, and several portions of fruit and vegetables. And getting rid of that sugar bowl in the kitchen and on the table.

It won’t be easy. Evidence from PET scans shows the same brain activity changes with the over consumption of sugar that we see in drug or tobacco addiction. And when you talk to someone who has tried to limit the sugar in their diet, their story reminds you of the withdrawal symptoms described by smokers and alcoholics. That is several weeks of withdrawal symptoms with a long term residual urge to have that piece of candy or sugared cereal. 

But in their next breath the successful will just as quickly tell you how much better they feel. So to keep you and your family healthy, it is time to think about taking that sugar bowl off the table….and then out of the kitchen.



References
https://www.ncbi.nlm.nih.gov/pubmed/23136358   
Dietary glycemic load and cancer recurrence and survival in patients
with stage III colon cancer: findings from CALGB 89803.





Tuesday, March 6, 2018

Three tips to jump start that weight loss resolution.


The last few cold days of Winter are here. That can only mean that the longer days of Spring are just around the corner. This is ideal time to see how you’re doing with your New Year’s resolutions, especially that plan to lose a few pounds after the holiday food blitz. If you have been having trouble moving your numbers the right way, these three tips may help you re-energize your program.

Quality over quantity
The traditional approach to weight control (dieting) is based on rigorous portion control and counting calories. Eat fewer calories than you expend each day and watch the dial on the scale plummet. But a recent study suggests that it is the quality of your diet, not quantity is more important.
One study was done to see if there were any advantages of recommending a low fat versus a low carbohydrate diet. Both groups were instructed on cooking and eating nutrient-dense, minimally processed whole foods whenever possible. One group was instructed on low carbohydrate foods and the other on low fat alternatives. Both were asked to try to cut down on portion size, but neither was asked to count calories. At the end of a year both groups lost an equal amount of weight. And participants were most surprised that they did not have to restrict or even think about calories to do so.
The conclusion? Losing weight is not as much about limiting fats or carbohydrates as it is about changing your eating habits to focus on whole foods (those you prepare at home and are not pre-processed and packaged ready to eat).  
This may require changes to your lifestyle - more cooking at home, no more quick lunches in the car after a drive-thru lunches at McDonalds - but using whole foods (more vegetables, less added sugar, fewer refined grains) will be healthier as it helps you control your weight.
And after you have shed those unwanted pounds, the same whole food approach, once you have changed your eating habits, is easy to maintain.

No white at night

When you eat the balance of your daily calories is as important to any diet plan as your total daily calories
Calories, especially carbohydrate calories (the “white” foods - bread, pasta, rice) eaten early in the day are metabolized preferentially by active muscles over the following three or four hours. And any carbohydrates not used for immediate energy needs are processed into into fat and stored for future use.
Thus, it makes sense to eat the bulk of your calories early in the day (before 2 PM) when it is most likely you will be up and about at work or doing chores and errands. If you make dinner the big meal of the day, a larger percentage of the meals calories will go directly to fat. If you want to minimize that happening, take a walk (it doesn’t have to be a long one) right after dinner.
A good goal might be a 25-50-25 caloric split for breakfast-lunch-dinner.

Consider fasting
There is solid science behind fasting. An English study compared a traditional calorie restricted diet with one that kept total weekly calories the same but added fasting two days a week (they did allow 700 calories on those two days). Over the three-month study, the average weight loss of the fasting group was twice that of the traditional diet group.  And sixty-five percent of those who fasted intermittently lost weight, compared to only 40 percent of those on calorie-restricted diets.
One fasting approach is to adopt a weekly meal plan that includes five days of a normal diet and two “fasting” days.
A second idea would be to modify your daily routine to extended the fasting period to 16 hours (you already have seven or eight while you are sleeping) and then plan your meals for the remaining eight hours. This has been called a 16:8 plan. This is not an absolute and a few bloggers with work shift challenges have suggested that 14:10 works as well.
For an extended daily fasting period, the meal to skip is the late evening meal. When a morning fast was compared to an equivalent evening fast, equal weight was lost, but blood markers of inflammation increased in the morning fast group.
With the daily fast scenario, dieters that move towards two meals a day with just a snack or salad for dinner. One small study compared two groups of women on similar low-calorie diets. One group ate 700 calories for breakfast, 500 for lunch and 200 for dinner, while the other group reversed that with 200 - 500 - 700. Over three months, the large breakfast group lost twice as much weight as the large dinner group.

The message seems clear, eating fewer calories in the evening appears to prove the adage: Eat breakfast like a king, lunch like a prince and dinner like a pauper.

Monday, January 22, 2018

Cleansing

Feeling a bit low on energy? A few more headaches than usual? Googling treatment options quickly leads to websites suggesting you may be suffering from an accumulation of toxins.  And a good cleanse will turn things right around!


Cleansing has been around since the time of the Egyptians in 1500 BC.  In 500 BC, Hippocrates, often referred to as the "Father of Medicine", suggested using enemas for fever therapy.


The benefits of a cleanse are based on the theory of autointoxication. This is the belief that food not absorbed in the upper intestinal tract passes into the colon where bacterial digestion or fermentation occurs (this part of the theiry is true - see my article on the microbiome https://adoctorsrx.blogspot.com.au/2017/06/the-microbome-and-your-health.html ).  


But the theory then goes on to postulate the formation of “poisons” which are absorbed into the bloodstream and are a major factor in the development of a variety of chronic disease states.


Cleansing increased in popularity in the early 1900’s until a medical paper in 1919 discounted the theory of autointoxication. When it became clear that the scientific rationale was erroneous, and colonic irrigation was not merely useless but potentially dangerous, the practice was condemned by the American Medical Association as quackery.  The practice of cleansing then went into a decline until its resurrection by alternative health providers in the 1990s.


We now know that the multiple bacteria inhabiting the colon, the microbiome, do indeed metabolize unabsorbed carbohydrates, but instead of being poisons, these short chain fatty acids are necessary for our health. They can reduce the inflammation that aggravates arthritis, lower cholesterol, and may prevent certain cancers. This knowledge would suggest that colon cleansers or laxatives would reduce the absorption of these beneficial nutrients.


In 2009, a systematic review of the worldwide medical literature found “no methodologically rigorous controlled trials of colonic cleansing support the practice for general health promotion.” Yet this practice continues to be recommended by alternative medicine providers.


There are two approaches to cleansing - by mouth and by rectum (colonic enemas or lavage).  Both may use large volumes of water (up to 16 gallons for a “colonic”). And the solutions often contain other substances such as herbs or coffee.


These procedures are not risk free. Large volumes of fluid, even if just salt water, can lead to major shifts in the body’s water balance (especially risky if you have kidney or heart problems), and the herbal supplements are not without their potential side effects (imagine how you’d feel if you suddenly drank the caffeine equivalent of 3 or 4 Starbuck’s Grande coffees).


And finally there is the risk of actual physical injury from the enema paraphernalia leading to an intestinal infection or even a perforation of the bowel.

In summary

  1. Colon irrigation is unproven as far as benefits while it has a real risk of adverse effects.
  2. The devices that practitioners use for the procedure are not approved for colon cleansing by the US Food and Drug Administration. Inadequately disinfected or sterilized irrigation machines have been linked to bacterial contamination.
  3. Colon cleansing practitioners are not licensed by a scientifically based organization. Rather, practitioners have undergone a training process structured by an organization that is attempting to institute its own certification and licensing requirements.


If you feel you are carrying around a colon burdened by bad bacteria and toxins, a safer approach might be an increase in daily fiber (flax is easy) and perhaps a probiotic yogurt to shift the bacterial population.

References:

https://www.drmirkin.com/morehealth/9811.html

Thursday, December 21, 2017

The Flexitarian Diet

Is there a single change to your diet that would have the greatest positive impact on your health? It is reducing the amount of red meat you eat per week and replacing those calories with extra fruits and vegetables.


Although red meat is the principal source of protein in a traditional American diet, research has linked its consumption with an increased risk for cancer, diabetes and cardiovascular disease. By simply eliminating meat from your diet, you can add up to 1.5 years to your life expectancy. Combined with other pieces of a healthy lifestyle you could gain as much as a full 7 years.




But Americans love their steaks and hamburgers. Are there any dietary alternatives to the full, all or nothing, vegetarian diet? Fortunately there is - the flexitarian diet.

A flexitarian diet is also plant based but without a complete rejection of meat and animal products. With four or more meatless meals per week, its approach to meat as an occasional side dish or garnish is much more adaptable to a family's dietary requirements and a busy schedule.
  
It is estimated that true vegetarians account for 3 percent of the American population, the number of flexitarians could be as high as 40 percent. These include many people who eat mainly vegetarian dishes at home but are happy to eat meat dishes when eating out at restaurants or when they sit down for a meal at the homes of family and friends.

The health advantages are demonstrated by a study showing that following a flexitarian diet for just four weeks decreases the total cholesterol levels of participants by almost 20 points. Other studies show a balanced vegetarian diet also lowers the risk of high blood pressure, stroke, diabetes and even cancer.

The diet’s flexibility also helps with implementation, letting the “consumer” slowly add plant-based foods while they cut back on red meat. The threshold for a beginner flexitarian generally starts at two meatless days per week (a total of 26 ounces of meat or poultry per week) slowly advancing to the expert level with five or more meatless days a week (9 ounces of meat or poultry per week).

Are there any disadvantages to becoming a flexitarian? A full vegan has to be sensitive to avoiding deficiencies in such micronutrients as vitamin B12, calcium, iron and zinc. But eating meat just once a week protects the flexitarian from this risk.

Another potential negative factor is that the low fat content of a plant based diet increases the odds of  getting hungry between meals. That is easily countered by increasing the use of healthy oils (olive oil) and cheeses in cooking and snacking on nuts (with the added benefit of their healthy oils).

If you decide to embark on the flexitarian journey you will not only be improving your health, but that of your environment. A quarter-pound hamburger (equivalent to slightly less than one meatless day) requires almost seven pounds of grain and forage, 53 gallons of water for drinking and irrigating feed crops, 75 square feet for grazing and growing those feed crops and 1,000 BTUs of fossil fuel energy for feed production, enough to power the average microwave for 18 minutes.


The best news is that you can multiply this benefit by five when you reach the expert level!