Nutrition and Breast Cancer

Thanks to recent research in nutrition, dietary strategies are helping many more women survive breast cancer and go on to live long, healthy lives. 

Often enough, evidence reveals these strategies may work by influencing inflammation, the immune system, and insulin responsiveness. However, there is no nutritional therapy that is yet "proven" to treat cancer directly or increase survival.

According to large trials of diet and breast cancer such as the Women's Healthy Eating and Living (WHEL) randomized trial and the Women's Intervention Nutrition Study (WINS) trial, as well as small intervention studies, a lower calorie diet leading to controlled weight reduced mortality. 

The reason - being overweight or obese appears to increase mortality because of higher risk of metastasis. Crash dieting is not the key, only healthy weight loss and patients should consult a nutritionist for planning meals. 

Patients should note that diets too low in calories can lead to loss of muscle mass, which is already a side effect of chemotherapy, and that generally leads to an increase in fat mass. 

As far as types of foods, red meat should be avoided because it's associated with increased risk of breast cancer. Saturated fat should be avoided as much as possible since it increases estrogenic stimulation of breast cancer growth. 

A low-fat, high-fiber diet is associated with suppressed estradiol levels. The diet should be based on plenty of plant-based proteins (soy, wheat), eggs, fish and low-fat dairy (whey). 

High-carb diets are also associated with increased mortality, but so are very low-cab diets. The diet should focus on obtaining a moderate amount of complex carbs (mainly from whole grains, fruits, and vegetables) rich in fiber. Blood sugar control is encouraged through eating complex carbs and obtaining regular exercise. 

Patients should seek to obtain higher levels of long-chain omega-3 fatty acids (DHA and EPA) such as from fish oil because low levels are associated with more proinflammatory markers. 

Because high dietary intake of fruits and vegetables are associated with greater breast cancer survival, it's easy to suggest that taking supplements of phytochemicals may increase survival. However, meta-analyses suggest no single vitamin/phytochemical solely improves outcomes. Instead it's best to focus on consuming more of whole fruits and vegetables.

Phytoestrogens such as from soy (isoflavones) and flax may, in fact, lower risk of breast cancer and improve survival of breast cancer. Because they mimic estrogen and bind to estrogen receptors, they may inhibit cancer cell growth. However, more research is needed before suggesting as a treatment especially in high-risk women and postmenopausal estrogen-receptive positive breast cancer patients.  Note that it could be that simply replacing meats with soy foods leads to weight management that increases breast cancer survival.

Eating foods rich in iodine such as sea vegetables or using iodized salt may anticarcinogenic effect possibly by optimizing thyroid function. Additionally, maintaining a high vitamin D status may help reduce risk cancer and improve prognosis although more research is needed to understand the relationship.  

Reference 

Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

10 Steps for Patients with Cholesterol-Induced Cardiomyopathy

Cardiomyopathy is characterized by a weakened, enlarged or inflamed cardiac muscle. The disease may be in primary stages (asymptomatic) or secondary stages (symptoms such as shortness of breath, fatigue, cough, orthopnea, nocturnal dyspnea or edema) with main types being dilates, hypertrophic, restrictive, or arrhythmogenic (1). Treatment may include drugs such as ACE inhibitors and beta blockers, implantable cardioverter-defibrillators, cardiac resynchronization therapy, or heart transplant (1). Factors leading to cardiomyopathy may include alcohol consumption, smoking, obesity, sedentary lifestyle, smoking and high-sodium diet (1).

Hypercholesterolemia can lead to fatty streaks in blood vessels that result in decreased flow of blood through arteries. The advent of hypercholesterolemia may be directly related to cardiomyopathy as it’s well established as a risk factor in inducing systolic and diastolic dysfunction (2). Statins such as Lovastatin are commonly prescribed because of efficacy for lowering cholesterol levels and they act by inhibiting HMG-CoA reductase to deplete mevalonate (3). Mevalonate, a precursor to cholesterol is also a precursor to coQ10 and squalene (4). Mevalonite, however, is also the precursor to coQ10 and squalene. Both of these are vital nutrients with profound effects on the body.

Patient Recommendations

I would advise a patient with cholesterol-induced cardiomyopathy to adhere to the following protocol:

1. Quit smoking – If the patient smokes, he is doing himself a grave disservice as smoking can increase oxidation of cholesterol leading to atherosclerosis. It may be an underlying factor in his cardiomyopathy.

2. Regular exercise – If the patient doesn’t exercise already, then he should begin an exercise program to strengthen his heart. I would advise only short periods of exercise combined with adequate rest as opposed to aerobic training because it would prevent exhaustion or excessive stress on the heart (9).

3. Get blood pressure checked regularly – Hypertension can be present without any symptoms and can be an etiological factor in cardiomyopathy. At ages past 60 there begins to be a higher risk of developing hypertension as well as declining muscle mass replaced by fat mass. A DASH eating plan (low-fat dairy products, lean meats, rich in fruits and vegetables) can assist in lowering or maintaining healthy blood pressure levels.

4. Lose weight if necessary – Overweight and obesity is an additional risk factor for hypertension (and hypercholesterolemia) because it increases volume of blood flowing through blood vessels. Along with exercise and a DASH eating plan, a weight-management program to lower calories steadily for 1-2 pounds per week can help a person lose weight effectively and safely.

5. Eat a diet high in soluble fiber – Diets high in soluble fiber are associated with lower levels of cholesterol. Soluble fiber such as from oats and psyllium hulls are shown to reduce blood cholesterol by inhibiting absorption of cholesterol from food as well as reabsorption of cholesterol through enterohepatic circulation.

6. Supplement with coQ10 (100 mg) – CoQ10 production peaks in the mid-20s and begins to decline with only around 50 percent production in patients past age 60. Additionally, statin therapy creates further decline in coQ10 synthesis for reasons discussed above. This patient could benefit from regular daily coQ10 supplementation in 100 mg doses. The CoQ10 will serve to support creation of energy and mitochondrial biogenesis in cardiac tissue to help maintain strong heart function.

7. Enjoy enough sunshine and take a vitamin D supplement – As people become older they are more susceptible to vitamin D insufficiency or deficiency, which as discussed earlier may lead to a weakened heart as suggested by emerging studies. Support for heart health can be achieved by keeping 25(OH)D to levels in the plasma to “sufficient” amounts (32 ng/mL) through sensible sun exposure (maybe along with exercise) and/or supplementation with vitamin D.

8. Supplement with D-ribose and l-carnitine – Both supplements can support elevated energy levels in cardiac tissue leading to improved heart function. In a randomized, double-blind crossover trial, D-ribose has been shown to improve diastolic function parameters and improve quality of life in patients with cardiomyopathy (10). L-carnitine combined with coQ10 and omega-3 fatty acids has been shown to improve cardiac function in dilated cardiomyopathy (11).

9. Eat leafy greens – Apart from the extra dietary fiber, the magnesium in leafy greens can be an additional support for heart health. Magnesium has a role in supporting healthy blood pressure levels and regulating heart function (12).

10. Eat fish regularly or take a quality fish oil supplement (4g daily) – Greater levels of EPA and DHA omega-3 fatty acids in the diet combined with coQ10 and l-carnitine has been shown in research to improve cardiac function in dilated cardiomyopathy (11).

Reference List

1. Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: an overview. Am Fam Physician 2009;79:778-84.

2. Huang Y, Walker KE, Hanley F, Narula J, Houser SR, Tulenko TN. Cardiac systolic and diastolic dysfunction after a cholesterol-rich diet. Circulation 2004;109:97-102.

3. Littarru GP, Langsjoen P. Coenzyme Q10 and statins: biochemical and clinical implications. Mitochondrion 2007;7 Suppl:S168-S174.

4. Scharnagl H, Marz W. New lipid-lowering agents acting on LDL receptors. Curr Top Med Chem 2005;5:233-42.

5. Jeya M, Moon HJ, Lee JL, Kim IW, Lee JK. Current state of coenzyme Q(10) production and its applications. Appl Microbiol Biotechnol 2010;85:1653-63.

6. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.

7. Visvanathan R, Chapman I. Preventing sarcopaenia in older people. Maturitas 2010.

8. Ahmed W, Khan N, Glueck CJ et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res 2009;153:11-6.

9. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

10. Omran H, Illien S, MacCarter D, St Cyr J, Luderitz B. D-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Fail 2003;5:615-9.

11. Vargiu R, Littarru GP, Faa G, Mancinelli R. Positive inotropic effect of coenzyme Q10, omega-3 fatty acids and propionyl-L-carnitine on papillary muscle force-frequency responses of BIO TO-2 cardiomyopathic Syrian hamsters. Biofactors 2008;32:135-44.

12. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Wadsworth, 2009.

Low muscle mass linked to diabetes

Being overweight is a risk factor for type 2 diabetes; however, a new study shows losing weight alone may not be enough to reduce risk of type 2 diabetes in people with low muscle mass and strength, particularly if they are over the age of 60.

These are the findings of new research from Dr. Preethi Srikanthan of University of California, Los Angeles, and colleagues who performed a cross-sectional analysis of 14,528 people from National Health and Nutrition Examination Survey III.

Dr. Srikanthan and colleagues concluded that age-related muscle loss, or sarcopenia, was associated with greater insulin resistance; and, sarcopenia, independent of obesity, may be an early predictor of diabetes. This association of sarcopenia and insulin resistance was strongest in those who were 60 years and older, the researchers warn.

Apart from these poor health outcomes, sarcopenia in older adults is also clearly associated with other health outcomes such as increased risk of falls, hip fractures, bone loss (osteopenia) and physical disability.
Several earlier studies suggest similarly that a direct correlation exists between sarcopenia in people ages 60 and older and greater risk of insulin resistance, metabolic syndrome, type 2 diabetes and cardiovascular disease, regardless of body weight.

Study Reference: Srikanthan P, Hevener AL, Karlamangla AS, 2010 Sarcopenia Exacerbates Obesity-Associated Insulin Resistance and Dysglycemia: Findings from the National Health and Nutrition Examination Survey III. PLoS ONE 5(5): e10805. doi:10.1371/journal.pone.0010805

Briefly on Detoxification Systems

Every day we are exposed to toxins, or xenobiotics, that are found in our food, water and environment. The body also makes toxins within itself. These all must be either stored such as in muscle or fat or they are  detoxified and eliminated via the feces or urine.

The body's main detoxification organ is the liver, but can also happen in the intestine and other organs. The detoxification systems handle a wide range of compounds mainly by two steps: phase I and phase II detoxification. 

Phase I detoxification is a reaction that entails functionalization of the compound, breaking it down. The major P450 enzymes are generally involved in phase I detoxification. Most major drugs and exogenous toxins are metabolized this way. At times the product of phase I detoxification can be more harmful than the original product.  

Phase II detoxification is a second reaction that generally follows phase I detoxification. It entails transforming a phase I reactant through conjugation (typically to an amino acid, such as in glucuronidation or sulfation) to become water soluble. When it's water-soluble, the toxin can be excreted in the urine. 

Although the phases of detoxification are not yet well understood, it is clear through observational studies that there are a variety of factors that can inhibit or induce detoxification. An inducer of detoxification can be a a toxin itself or a compound in the diet. 

In a typical detoxification support plan, a nutritionist may suggest various nutrients to support or upregulate phase I cytochrome P450 enzymes and phase II conjugation pathways. 

The plan would generally seek to increase glutathione levels in the body such as with n-acetyl cysteine or cysteine or spare glutathione such as with silymarin. 

The plan may also support detoxification in other ways by increasing antioxidant status with coenzyme Q10, vitamin A, vitamin C, or selenium. Or, it may provide B vitamins to act as co-factors for enzymes.  

Reference

http://www.thorne.com/altmedrev/.fulltext/3/3/187.pdf 

62-yr-old Woman with Hypertention, Ventricular Hypertrophy and Congestive Heart Failure

One of the considerations with congestive heart failure is the need for fluid restriction and the patient will need to work her doctor to be able understand how much she should be getting daily.

Sodium restriction is important for bringing down the blood pressure. In the case of this woman, I would employ a DASH diet to bring down her blood pressure with emphasis on plenty of fruits and vegetables as well as dairy products such as yogurt to obtain regular amounts of calcium.
Since being overweight contributes to higher blood pressure, if she is overweight, then the DASH diet should be combined with a weight loss program by restriction of calories.

Regular aerobic exercise can also support healthy blood pressure levels. I'd recommend about 30 minutes three times weekly.

Because of her condition, I'd also recommend supplementation with CoQ10 to support the function of the heart. If she has a low vitamin D status, which is associated with higher blood pressure, then I'd also recommend a vitamin D supplement.

Gallstone Development

Gallstones develop in the gallbladder, a small organ that stores and releases the bile made by the liver. Bile is a dark green fluid containing bile salts and cholesterol. The gallbladder releases bile into the small intestine to assist in digesting fats more efficiently. However, if the bile is contains high concentrations of cholesterol, then stones too difficult for the bile salts to dissolve may develop (1).
Losing weight too quickly or fasting can cause development of gallstones. The quick weight loss and fasting is thought to disturb the balance of bile salts and cholesterol (2;3).

The risk may increase if consuming a diet too low in fat. Avoiding fat reduces frequency of gallbladder emptying. This, in turn, may cause cholesterol to accumulate and lead to greater risk of forming stones (3;4).

References

1. Dowling RH. Review: pathogenesis of gallstones. Aliment Pharmacol Ther 2000;14 Suppl 2:39-47.

2. Wudel LJ, Jr., Wright JK, Debelak JP, Allos TM, Shyr Y, Chapman WC. Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res 2002;102:50-6.

3. Festi D, Colecchia A, Orsini M et al. Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well). Int J Obes Relat Metab Disord 1998;22:592-600.

4. Vezina WC, Grace DM, Hutton LC et al. Similarity in gallstone formation from 900 kcal/day diets containing 16 g vs 30 g of daily fat: evidence that fat restriction is not the main culprit of cholelithiasis during rapid weight reduction. Dig Dis Sci 1998;43:554-61.

Homocysteinemia and Pernicious anemia

Pernicious anemia, a megaloblastic anemia caused by B12 deficiency, is associated with hyperhomocysteinemia. Because B12 is needed for methionine synthase to methylate homocysteine to methionine, a deficiency causes an accumulation of both homocysteine and methylmalonic acid (1). When both are elevated, marking the pernicious anemia, it can lead to progressive demyelination and neurological deterioration.
A folate deficiency may also result in megaloblastic anemia. If homocysteine is elevated but not methylmalonic acid, then the result is probably a folate deficiency. It is important for treatment to be correct. Large doses of folate can correct, or "mask," symptoms of pernicious anemia, which can result in irreversible neuropathy (2).
References

1. Devlin TM. Textbook of Biochemistry with Clinical Correlations. Philadelphia: Wiley-Liss, 2002

2. Pagana, K.D., Pagana, T.J. Mostby's Manual of Diagnostic and Laboratory Tests, 3rd ed. Mosby Elsvier, 2006

Before Taking a Statin, Read This

I thought this was an interesting article from Businessweek a couple of years ago and was blown away by the numbers showing that few people actually receive any benefit from statins.

If you don't read it, then here are a few tidbits from the article that I thought would give it to you in a nutshell:

• ...for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit.
• ...an estimated 10% to 15% of statin users suffer side effects, including muscle pain, cognitive impairments, and sexual dysfunction
• "There's a tendency to assume drugs work really well, but people would be surprised by the actual magnitude of the benefits,"
• For anyone worried about heart disease, the first step should always be a better diet and increased physical activity. Do that, and "we would cut the number of people at risk so dramatically" that far fewer drugs would be needed...
• "The way our health-care system runs, it is not based on data, it is based on what makes money."  

It's amazing how much industry and their marketing overstate claims and directly affect the beliefs of people in these drugs. This kind of influence in our healthcare system desperately needs to be fixed.

Predicting a Heart Attack with CRP

Currently, the existing biomarkers for a cardiac event include B-type natriuretic peptide, tro-ponins and C-reactive protein. C-reactive protein is an acute-phase protein released in response to inflammation.

Recently, the development of a high-sensitivity assay for CRP (hs-CRP) has been made available. The assay works because it can accurately reflect even low levels of CRP. There have been quite a few prospective studies that have shown that an assay of a baseline CRP can be used as a marker for cardiovascular events.

When patients have a test that shows elevated levels, it is even a better marker than LDL cholesterol for predicting events such as myocardial infarction. An elevated test, however, can also mean hypertension, metabolic syndrome or diabetes, or a chronic infection.

In addition, Lipoprotein (a), or Lp(a), when combined with C-reactive protein, can increase the predictive value of a cardiac event. This is especially true for those who have normal cholesterol levels. The reason is that the lipoprotein promotes vascular inflammation that affects the atherogenic process directly.

Reference

Pagana, K.D., Pagana, T.J. Mosby's Manual of Diagnostic and Laboratory Tests, 3rd ed. Mosby Elsvier, 2006.

How to Rid Yourself of Statin-induced Muscle Pain

When a patient is on a statin, nutritionists should advise that they don’t have to suffer from the side effects of statin-associated muscle pain (myalgia). Studies are showing that supplementation with two key compounds are useful for decreasing the pain. The first is ubiquinone (coenzyme Q10, coQ10) and the other is cholecalciferol (vitamin D3).

Statins such as Lipitor, Zocor and Mevacor reduce cholesterol synthesis by directly inhibiting the enzyme HMG-CoA reductase and deplete production of its product, mevalonate (1). Mevalonite, however, is also the precursor to coQ10 and squalene. Both of these are vital nutrients with profound effects on the body.

CoQ10

CoQ10 is a lipid-soluble antioxidant playing a protective effect in the membranes of every cell in the body. In that capacity, it serves to protect against oxidative damage to cells. Equally important, the compound is necessary for electron transfer in the mitochondrial electron transport chain for producing energy (2). Without it, our muscles could not function in their full capacity.
Supplementation with coQ10 combined with statin treatment helps reduce muscle pain (not to mention improve energy levels). According to a double-blind study in 2007 at Stony Brook University, which compared coQ10 supplementation (100mg/d) with vitamin E (400 IU/d), showed that patients taking the coQ10 had 40 percent decrease in the severity of their pain (3).

Vitamin D

Squalene is important because it is the precursor for 25 hydroxyvitamin D (25(OH)D) as well as other steroid hormones. For this reason that, it is suggested that statin drugs can lead to 25(OH)D insufficiency or deficiency. Vitamin D is not only critical for speeding up calcium absorption for bone health, but emerging studies are finding that it’s also vital for the health of muscles (4).
Low vitamin D levels are also associated with statin-induced muscle pain. When researchers from the Cholesterol Center at the Jewish Hospital in Cincinnatti in Ohio treated myalgia in 38 statin-treated patients with vitamin D (50,000 IU/week for 12 weeks), 35 of the patients experienced 92 percent reduction in pain symptoms (5).

Reducing muscle pain with supplementation

If you must take a statin, then supplementation can be to your advantage. As in the studies, supplementation with coQ10 at 100 mg in an absorbable form can potentially help to keep pain under control by replenishing coQ10 that is lost. In addition, keeping 25(OH)D to levels in the plasma to “sufficient” amounts (32 ng/mL) through supplementation with vitamin D and sensible sun exposure can go far to reduce pain.

Reference List

1. Scharnagl H, Marz W. New lipid-lowering agents acting on LDL receptors. Curr Top Med Chem 2005;5:233-42.
2. Jeya M, Moon HJ, Lee JL, Kim IW, Lee JK. Current state of coenzyme Q(10) production and its applications. Appl Microbiol Biotechnol 2010;85:1653-63.
3. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.
4. Visvanathan R, Chapman I. Preventing sarcopaenia in older people. Maturitas 2010.
5. Ahmed W, Khan N, Glueck CJ et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res 2009;153:11-6.

How a Patient May Avoid An Angioplasty

Angioplasty is a procedure performed by inserting a catheter with a deflated balloon into an affected artery, then inflated to open the artery. Sometimes a stent, or mesh tube, is left to keep it open. The procedure does come with some risk, in fact, having the potential of inducing a heart attack.

If a patient is uncomfortable with an angioplasty, there are now other alternatives that may be just as effective without the procedure.

Medical researchers, for example, have been evaluating the combined approach using anti-coagulants, thrombolytic therapy (clot-dissolving drugs) and cholesterol-lowering drugs. According to Dr. Eric J. Topol of the Cleveland Clinic, the treatment has been deemed effective in at least a few small studies (1).

Other cardiologists look to intensive-lipid therapy alongside dietary supplements such as fish oil and vitamin D. According to Dr. William Davis, the integrated therapy has been shown to help slow progression of atherosclerosis and even reverse it in asymptomatic adults (2).

Along with treatment, the patient should adopt exercise and special dietary considerations to help provide a complete comprehensive treatment of risk factors including control of hypertension, obesity and type 2 diabetes (3). For this patient, diet should be low in saturated and trans fat, high in fiber, and provide optimal levels of nutrients such as omega-3 fatty acids, and vitamin D for lowering cardiovascular risk (3).

A DASH eating plan can help to meet diet goals. The eating plan, which has been found to lower blood pressure within 15 days, features low-fat dairy products, fish, and lean meats as well as plenty of whole grains, fruits and vegetables. Recently, a study found that a DASH eating plan combined with exercise helped subjects to reduce blood pressure, lose weight, improve mental function, and improve cardiovascular fitness (4).

References

1. Topol EJ. Integration of anticoagulation, thrombolysis and coronary angioplasty for unstable angina pectoris. Am J Cardiol. 1991 Sep 3;68(7):136B-141B.
2. Davis W, Rockway S, Kwasny M. Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults. Am J Ther. 2009 Jul-Aug;16(4):326-32. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19092644
3. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
4. Smith PJ, Blumenthal JA, Babyak MA, Craighead L, Welsh-Bohmer KA, Browndyke JN, Strauman TA, Sherwood A. Effects of the Dietary Approaches to Stop Hypertension Diet, Exercise, and Caloric Restriction on Neurocognition in Overweight Adults With High Blood Pressure. Hypertension. 2010 Mar 19. [Epub ahead of print]

Atherosclerosis

Atherosclerosis refers to accumulation of a thick sludge in patches that merge to form large plaques, called atheromas, in artery walls. The plaque is made up of cholesterol and other fats, macrophages, cell "junk", calcium, and tissues.

LDL cholesterol is associated with atherogenesis because as it becomes oxidized it can induce endothelial cells to attract blood-borne monycytes, transforming them into macrophages and trapping them in endothelial spaces (1).

The macrophages then engorge themselves with cholesterol and fat creating "foam cells. Then, once engorged, they release inflammatory cytokines that only lead to even more macrophages creating more foam cells (1).

Along with damaged smooth muscle cells, the foam cells then form the sludge plaque, or fatty streak, that narrows lumen as it grows larger causing blood flow to to become restricted (1).

Medications

There are various drugs that can help to slow or reverse atherosclerosis, which include cholesterol-lowering drugs such as statins, anti-coagulants such as warfarin to inhibit clotting, antiplatelets like aspirin to keep platelets from forming clots, and medications such as ACE inhibitors or calcium channel blockers to lower blood pressure (2).

If atherosclerosis becomes severe, surgery may be needed. A procedure called an angioplasty can be performed by inserting a catheter with a deflated balloon into an affected artery, then inflated to open the artery. Sometimes a stent, or mesh tube, is left to keep it open.

Other surgeries involve endarterectomy, where fatty deposits are surgically removed from walls, or thrombolytic therapy in which drugs are inserted into arteries to dissolve clots (2).

A bypass surgery (such as a CABG, coronary artery bypass surgery) involves using another part of the body or a tube to allow blood to flow around an affected artery (2).

Lifestyle changes

It is possible to change the course of atherosclerosis -- even possibly reverse it -- by adopting a few lifestyle changes. These include stopping smoking, exercising regularly, eating right and lowering stress.

- Smoking in itself oxidizes LDL cholesterol and hastens the damage of arteries.
- Exercise improves blood flow and can induce the development of new blood vessels to lower the pressure on affected arteries.
- Eating right should include adopting strategies such as managing portions for weight management, a DASH-style diet for lowering blood pressure, limiting saturated and trans fatty acids and adopting polyunsaturated fats to lower triglycerides, and eating a high-fiber diet to lower cholesterol levels (1).
- Limiting stress in life through relaxation and sleeping well helps to avoid rises in blood pressure.

Overall, it's very likely that almost half of us will die from atherosclerosis or complications relating to it. Almost all of us have fatty streaks and plaques already developing. These are disheartening figures for those of us who wish to do all we can to fight back.

Luckily, our nutrition and medical knowledge continues to improve and new technologies are also forming.

One program of interest is the one promoted by cardiologist Dr. William Davis in his book Track Your Plaque, who promotes actively "tracking" the progression of plaque development (3).

In addition, Dr. Davis and fellow scientists have studied the effects of combined therapies involving niacin or statins, fish oil, vitamin D and other means to slow or reverse "hardening of the arteries" (4).

Reference List


1. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Wadsworth, 2009.
2. http://www.mayoclinic.com/health/arteriosclerosis-atherosclerosis/DS00525/DSECTION=treatments%2Dand%2Ddrugs
3. http://www.trackyourplaque.com
4. Davis W, Rockway S, Kwasny M. Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults. Am J Ther. 2009 Jul-Aug;16(4):326-32. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19092644

Sodium: How much is right for you?

Sodium’s association with high blood pressure is well known. However, sodium also plays a large role in keeping you healthy. It’s important to know how to strike the right balance.

Along with potassium, sodium is essential for fluid balance, facilitating the flow of water in and out of cells to bring nutrients in and take wastes away. Sodium also has a role in the regulation of blood pressure and helping muscles and the heart relax. Each sodium ion contains an electrical charge, acting as an electrolyte, which allows transmission of nerve impulses to the brain and throughout the body.

Sodium levels in the body are controlled by the kidneys. If the body doesn’t receive enough sodium daily—a chronic problem for our early ancestors—then the kidneys retain sodium. When the body has a high enough amount, then the excess sodium is excreted in the urine.

At times, sodium levels may fluctuate. If a person has a dysfunctional kidney, then the body may retain too much sodium, which can result in edema, or swelling in the legs and feet because sodium attracts water. In contrast, diarrhea or vomiting may result decreased sodium levels, a condition known as hyponatremia.

How sodium regulates blood pressure is not entirely understood, but there is an established link between high sodium intake and high blood pressure. As expected, there is also a link between sodium reduction and lower blood pressure.

The sodium-hypertension relationship may also have to do with how sodium interplays with other minerals such as potassium and calcium. Potassium, for example, appears to assist the kidneys in shedding excess sodium. Lowering sodium intake also helps to conserve calcium, which may affect blood pressure.

Recommendations for Sodium

The Institute of Medicine is recommending an Adequate Intake of sodium at 1,500 mg per day for adults and children 9-13 as well as 1,000 mg and 1,200 mg per day for children ages 1-3 and 4-8, respectively. These levels are considered appropriate for replacing daily losses via sweat and urine. The need for sodium may be slightly greater if exercise produces excessive sweating or if a person has symptoms of vomiting or diarrhea.

On average, however, most adults in the U.S. consume about 3,200 milligrams or more a day. With these figures, it is easy to understand why high blood pressure affects nearly 75 million Americans. The average intake is well above the Institute of Medicine’s Tolerable Upper Intake Level of 2,300 milligrams per day for adults and 1,500mg, 1,900mg and 2,200 mg for children ages 1-3, 4-8 and 9-13, respectively.

Cutting sodium intake daily tor recommended levels is important and it doesn’t have to be difficult with these three simple strategies:

Sodium Strategy #1: Limit processed or prepared foods high in sodium. Most sodium in the diet doesn’t come from the salt shaker, but from processed and prepared foods. Thus, the best way to lower sodium is to reduce intake of processed foods or replace them with low-sodium alternatives. This includes ready-to-eat packaged foods such as potato chips, fast-food meals such as burritos, and highly salted meals prepared at restaurants.

Sodium Strategy #2: Learn to enjoy food without salt. Taste food before salting it; the food may already be salty enough or it may be enjoyed without salt. In fact, salty is an acquired taste. The body and taste buds can easily adjust to less salt. Studies have shown that as people reduce salt intake and stick to a relatively lower intake of sodium, they will naturally begin to prefer foods with less salt. When eating at home, try not having the salt shaker on the table and, if eating out, simply move salt shakers to another table. When preparing food, try using less salt and seasoning food with spices or salt-substitutes instead. Keep an eye on store-bought spice blends, though, as many may contain high amounts of salt.

Sodium Strategy #3: Balance sodium with potassium-rich fruits and vegetables. A clear association exists between higher potassium intake from fruits and vegetables and lower blood pressure regardless of sodium intake. Potassium helps the kidneys in promoting sodium excretion, reduces urinary calcium and magnesium (which influence blood pressure), supports smooth vascular muscle health, and helps with regulation of blood pressure.

Less Sodium in a DASH

Most people who are interested in maintaining healthy blood pressure levels would do best to follow a DASH (Dietary Approaches to Stop Hypertension)eating plan. In the well-known DASH-sodium study, which was conducted by the National Heart, Lung and Blood Institute, people following the diet lowered blood pressure in just 14 days even without reducing salt intake.

The DASH eating plan includes consuming a diet rich in low-fat, low-sodium dairy products, fish, chicken and lean meats as well as large amount of whole grains, fruits and vegetables.

When a person is concerned about blood pressure, the best advice nutritionists can give is to begin following a DASH eating plan combined with regular exercise and weight management. In fact, according to a recent study in Hypertension, this plan helped people reduce blood pressure, lose weight, improve mental function, and improve cardiovascular health.

Taking the Pressure Off of Sodium

It’s extremely easy to place all of the blame for society’s high blood pressure woes and medical costs on sodium, but the mineral’s role in the body should not be ignored. Sodium is essential for good health and too little could lead to other health issues, including deficiencies in iodine, which is mainly provided in the North American diet from iodized salt.

While lowering sodium consumption can lead to a natural preference for foods with less salt, it’s important not to cut salt out completely. Because the body requires some sodium to function properly, avoiding salt entirely might backfire, and cause cravings for high-sodium foods. As with almost all vitamins and minerals, the key to healthy sodium intake is always balance with other nutrients. A DASH eating plan and strategies for maintaining a healthy intake (such as those given above) can help you achieve this balance of nutrients for healthy blood pressure levels and optimal health.

Reference

Dyuff RL, American Dietitic Association. American Dietetic Association Complete Food and Nutrition Guide, 3rd edition. 2006. Wiley.

More reason to love olive oil

I use one particular olive oil for cooking and another extra-virgin olive oil to mix with some balsamic vinegar for my salads. Olive oil, as the staple source of fatty acids in the Mediterranean diet, has also been heavily researched for its health benefits especially in comparison to other sources of fat such as butter, corn or soy oil.

On April 20, a study in BMC Genomics was published that found that olive oil eaten at breakfast modified gene expression in patients with metabolic syndrome (1). The breakfast caused the changes in mononuclear cells after intake of the olive oil and repressed pro-inflammatory genes (1).

The study was performed on 20 patients in a double-blind randomized trial (1). The researchers noted that many of the genes were also implicated in type 2 diabetes, dyslipidemia and obesity (1).

The study adds to evidence that olive oil helps reduce inflammation unlike other oils such as butter (2) and, thereby, adds to the reasons why the Mediterranean diet is associated with lower risk of cardiovascular disease (3).

References

1. Camargo A, Ruano J, Fernandez JM, Parnell LD, Jimenez A, Santos-Gonzalez M, Marin C, Perez-Martinez P, Uceda M, Lopez-Miranda J, Perez-Jimenez F. Gene expression changes in mononuclear cells from patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil. BMC Genomics. 2010 Apr 20;11(1):253. [Epub ahead of print]

2. Bellido C, López-Miranda J, Blanco-Colio LM, Pérez-Martínez P, Muriana FJ, Martín-Ventura JL, Marín C, Gómez P, Fuentes F, Egido J, Pérez-Jiménez F. Butter and walnuts, but not olive oil, elicit postprandial activation of nuclear transcription factor kappaB in peripheral blood mononuclear cells from healthy men.Am J Clin Nutr. 2004 Dec;80(6):1487-91.

3. Bellido C. Perez-Jimenez F, Alvarez de Cienfuegos G, Badimon L, Barja G, Battino M, Blanco A, Bonanome A, Colomer R, Corella-Piquer D, Covas I, Chamorro-Quiros J, Escrich E, Gaforio JJ, Garcia Luna PP, Hidalgo L, Kafatos A, Kris-Etherton PM, Lairon D, Lamuela-Raventos R, Lopez-Miranda J, Lopez-Segura F, Martinez-Gonzalez MA, Mata P, Mataix J, Ordovas J, Osada J, Pacheco-Reyes R, Perucho M, Pineda-Priego M, Quiles JL, Ramirez-Tortosa MC, Ruiz-Gutierrez V, Sanchez-Rovira P, Solfrizzi V, Soriguer-Escofet F, de la Torre-Fornell R, Trichopoulos A, Villalba-Montoro JM, Villar-Ortiz JR, Visioli F. International conference on the healthy effect of virgin olive oil. Eur J Clin Invest. 2005 Jul;35(7):421-4.


David

Fibromyalgia

Fibromyalgia, or chronic fatigue syndrome, has increased by 200 to 400 percent in the last decade and now affects approximately 6-12 million Americans. It's a syndrome with symptoms of hormonal, sleep and autonomic control dysfunctions.

Those with fibromyalgia often suffer from widespread pain in muscles, poor sleep, and low energy levels. Co-existing conditions are food reactivities and irritable bowel syndrome, migraine headaches, chronic sinusitis, restless leg syndrome and sleep apnea.

Medical treatment may include analgesics for pain relief such as with acetaminophen or NSAIDS. Most will require treatment for hypothyroidism with Armour Thyroid. A Cortef prescription or supplementation with adrenal glandulars or licorice is also helpful for adrenal support. Lastly, sex hormone therapy may be needed.

Nutritional support may include supplements of iron to guard against iron-deficiency anemia,which may contribute to lacking energy, as well as coQ10, which is fat-soluble antioxidant needed in the mitochondria for production of energy. In addition, acetyl-l-carnitine may be helpful for supporting mitochondrial energy and d-ribose may help increase energy and reduce pain.
Reference
1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

Preventing Lung Cancer

My dear second cousin died of lung cancer last night at midnight. This is a horrible disease and it strikes so quickly. The cancer metasticized and reached his lymph nodes and then I think he and we all knew. It's a sad day for our family. It happened so fast and it pains me that I couldn't have been with him when he passed.

Of course, as a nutritionist, my thoughts turn to what could have been done to prevent this awful day from happening. As you look through the scientific literature, of course, you end up figuring that quitting smoking is key to guarding against risk. I know my cousin had quit, but perhaps it was too late.

The only other way to help prevent this disease is simply to be sure to eat plenty of fruits and vegetables daily. The high amounts of phytonutrients probably either help to upregulate antioxidant enzymes protecting cells or act simply act as antioxidants to cells. The result is less potential damage to cell DNA.

Maybe, however, skip out on the veggies high in beta-carotene because of association with higher risk of lung cancer (the beta-carotene apparently can bind to carcinogens in smoke and potentially increase damage to DNA). That's according to the famous CARET study from Finland where beta-carotene supplements appeared to increase risk of lung cancer in smokers and those with exposure to asbestos.

I'm going to add at my cousin might have been a lot better off without all the stress. He had a high amount of stress in his lifestyle. The stress itself, science is beginning to show, leads to more oxidative stress on cells. Perhaps the constant fight-or-flight response does add stress biochemically, but it should be immediately obvious that stress in our lives leads us to eat poorly, eat less fruits and vegetables, and have have poor habits like smoking.

We all could benefit from less stress in our lives. And it leads me to pause and think, I need some good stress-management techniques. Ones that I choose such as nature walking weekly may not be enough. Sooner rather than later I need to begin a steady exercise program, eating regularly, maybe delegating some projects.

Just some thoughts.

Sent from my iPad

Losing weight easy on the Zone Diet

The power behind Dr. Barry Sears's Zone diet is that it offers people simple techniques to be used as part of their eating plan, which makes lower-calorie eating on a high-protein, moderate-carb plan simply easier to follow. 

I've made a list below of a few of the techniques that I've used successfully  to help "stay in the zone," as Dr. Sears calls it, and keeping to a 40-30-30 ratio of carbs, proteins and fats: 

Protein - Decide on the amount of protein you should have by comparing size (e.g. of a chicken breast) with the thickness of your palm.  

Carbs - If it's a "good" (high-fiber; low-glycemic) source of carbs, then the portion should equal the size of  two fists, but if it's a "bad" source (low in fiber; high-glycemic) the portions should equal the size of one fist

Fats - If the protein has fat, don't add any. If it doesn't, then choose nuts or olive oil.  

Simple, right? Then, just eat frequently throughout the day by never letting five hours pass without a snack or meal. And you can generally apply it to a DASH-style, Mediterranean-style or Paleo-style diet.

The Zone diet ratio of protein/carbs/fats is all about keeping your body working efficiently while keeping blood sugar and calories in check. It's not about being complicated or restrictive -- which ultimately the greatest cause for diet failure because it leads to bingeing.

Cordain vs Campbell

I recently read what is entitled the "Protein Debate" between Loren Cordain, a paleo diet proponent, and Colin Campbell, a plant-based diet proponent. Given that I'm simply a graduate student without any specific adherence to either diet philosophy, i found the debate to be fascinating. Both had strong points to defend their positioning. In short, this is how it goes:

• Loren Cordain argues that because nutritional science is a young, evolving science with little agreement as to what is correct in eating for the general population, they should have a "guiding paradigm" based on the diet of our hunter-gatherer ancestors. The paleolithic diet would be one that include high amounts of protein from lean meats and minimally processed foods of paleolithic resemblance.

• Colin Campbell argues that nutritional science is not young (it's older than many other sciences) and, that, although knowledge of ancestral diets may be helpful, "biological complexity" throws out its use as a reference standard (after all, high calorie intake from meat may have increased likelihood of reproduction, but not guarded against disease). The priority should be given to searching for dietary factors that cause "collective disease and health outcomes" to guide nutritional recommendations.

You decide. They could, in fact, both be right and wrong on different levels. David

What causes Autism

Any connection between autism and childhood vaccines?

I don't really "believe" in much unless backed by science. I realize that the connection of vaccines and autism is a touchy subject and that there are opposing viewpoints. Eventually, however, reason must come into the picture and, despite what our opinions are, we need to rely on evidence to guide decision making.

Just last February, The Lancet retracted the study by Dr. Andrew Wakefield that had linked vaccines with autism. The medical journal cited flaws and unethical activity in connecting autism with vaccines (1). This was the study that had launched the first wave of groups against vaccines like Jenny MccCarthy's Generation Rescue. And I think everyone needs to all get over this and continue to see vaccines for what they are, life-saving medicines.

I know that just discounting vaccines' role in autism is not enough to appease a lot of people who fear for their children. After all, according to the CDC, 1 in 110 children in the U.S. now have autism. If not vaccines, than what is making this happen?

Vitamin D Theory

I, for one (being the vitamin D nut that I am), have high hopes for what's been dubbed the "Vitamin D Theory". The theory suggests that our autism epidemic began at or around the same time as did our epidemic of vitamin D insufficiency (2). If there is a link, then it would explain why there is a higher rate of autism among blacks and there should be a higher rate among children who are not in the sun for sufficient amounts of time.

According to Dr. John Cannell writing in Vitamin D Council's January newsletter, "The 'all autism is caused from vaccinations' crowd cannot accept the Vitamin D possibility as it threatens their core beliefs. They simply cannot change their minds" (3).

Then again, there's not much yet to support the vitamin D link, but Dr. Cannell adds "...organized medicine would say you should stop the vitamin D and watch your son deteriorate, which is why slavery to evidence based medicine is fine for scientists and unethical for practitioners" (3).

References

1. CNN. Medical Journal retracts study linking autism to vaccine. Available at: http://www.cnn.com/2010/HEALTH/02/02/lancet.retraction.autism/index.html

2. Vitamin D Council. http://www.vitamindcouncil.org/health/autism/vit-D-theory-autism.shtml

3. Cannell J. Vitamin D Newsletter. 2010 Jan 30.

Thoughts on High Fructose Corn Syrup

There are some really wacked people on the Internet who try to blame the whole obesity epidemic on HFCS, fructose or agave and are misguiding everyone. I liken it to the same misguidance that occurred in 1980s when everyone was scared of fat.

You shouldn't just cut out HCFS and replace it regular sugar or another caloric sweetener. It's really overeating, the overabundance of calories much of it from sugar, that in general contributes to this obesity problem.

What our real problem is is that our brains are wired for fats, carbs and salt that has led us into this obesity crisis now. As a whole, our species needed this wiring to seek out nutritious foods that helped us survive.

But in this modern world of aplenty, the answer to our obesity problem is to control our brains (or trick them with artificial stuff) and use simple discipline, portion control and balanced, nutritious meals.

Sucralose (Splenda)

Sucralose has been on the market for about two decades now and has been touted as a quite the wonderful artificial sweetener. The safety profile of sucralose has been excellent in adults and it has already helped many with type 2 diabetes to manage blood sugar without having to give up on many of their favorite foods and beverages.

Because of increased use of Sucralose over the years, however, high concentrations of it has been popping up in the environment and there have been worries about how the artificial sweetener may influence infants, children and even animals. One big worry has been potential affects on brain growth.

Two Swedish researchers, Dr Viberg and Dr Fredriksson set out to study the possible neurotoxicity of sucralose in mice. They gave just mice an oral dose of 5-125 mg of sucralose per kilogram bodyweight per day on days 8 through 12 immediately after their birth.

Then, the researchers killed the mice and analyzed their brains. They checked for key proteins and found no alterations that would indicate a disturbance to neuronal development.

Thus, they concluded, sucralose "seems to be a safe alternative for people", and possibly even during pregnancy, as it does not affect growth and development of the brain.

Reference

Viberg H, Fredriksson A. Neonatal exposure to sucralose does not alter biochemical markers of neuronal development or adult behavior. Nutrition. 2010 Jan 27. [Epub ahead of print]

High cola intake may cut sperm count, reports Danish study

Men who drink a few too many Diet Coke or some other cola-like beverages daily may have fewer sperm, according to a new study.

The study, published in the April 15, 2010 issue of American Journal of Epidemiology (1), had examined the semen quality of more than 2,500 young Danish men who had been recruited upon was evaluated for fitness and military service.

They found that those subjects who reported on a questionnaire that they consumed high amounts of caffeine (more than 800 mg per day) or high intakes of cola (more than 14 half-liter bottles per week) had reduced sperm concentration and total sperm count. On the other hand, the consumption of only moderate amounts of caffeine (less than 800 mg per day) or low amounts of cola (less than 14 half-liter bottles per week) were not associated with any similar effect on sperm concentration or count.

There was no association established between caffeine from tea or coffee and influence on sperm count.

The Copenhagen researchers of University of Denmark of Growth and Reproduction concluded that they "cannot exclude the possibility of a threshold above which cola, and possibly caffeine, negatively affects semen quality" (1).

They added, "Alternatively, the less healthy lifestyle of these men may explain these findings" (1).

Still, if you're interested in maintaining your vitality (who isn't?), it may be better to avoid the cola!

Caffeine and Semen Quality

There have been several studies that have investigated caffeine and a possible association with semen quality, which have led to conflicting results.

Previous to this study on high intakes of cola, there had been a pregnancy cohort in 2008 on more than 5,000 males that evaluated semen quality in association with prenatal coffee and caffeine exposure (2).

The study, also from Denmark, found that although high caffeine intake didn't have any significant effect on semen quality, it did lead to increased testosterone concentrations (approximately 14 percent) in the men (2).

So, until more research is conducted, there's still no need to give up on the coffee.

References

1. Jensen TK, Swan SH, Skakkebaek NE, Rasmussen S, Jørgensen N. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol. 2010 Apr 15;171(8):883-91. Epub 2010 Mar 25.

2. Ramlau-Hansen CH, Thulstrup AM, Bonde JP, Olsen J, Bech BH. Semen quality according to prenatal coffee and present caffeine exposure: two decades of follow-up of a pregnancy cohort. Hum Reprod. 2008 Dec;23(12):2799-805. Epub 2008 Aug 28.

Luo han guo - a source of xylitol

Louo han guo is a fruit that has been recently hyped up and marketed as a natural sweetener. What is it really? It's really just a source of xylitol. Xylitol is a natural sugar alcohol, which is not digested as easily by the body lending fewer calories per gram than regular sugar. The polyol also has a slight cooling effect, which you would recognize while eating sugarless gum like Trident.

Xylitol was first discovered and isolated in Sweden from birch bark. It is also now widely used in Sweden (where it was first isolated) and used in all sorts of candies there.

Regular use of xylitol is associated with significant reduction of cavities and tooth remineralization (1). Why? Because research shows that xylitol doesn't contribute to tooth decay and, unlike other sugar alcohols like erythritol, it may even help fight cavities by a mechanism of confusing cavity-causing bacteria to eat it and basically die.

Reference

1. Mäkinen KK. Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review. Int J Dent. 2010;2010:981072. Epub 2010 Jan 5.

Summing up Low-carb

Low-carbohydrate diets may do wonders for quick weight loss (mostly from water loss) and to improve glucose and insulin levels, but they are not without their adverse effects (1-2).

The body needs carbs for energy. Without sufficient amounts, muscle catabolism and protein will result, the break down of fat stores for fuel will result in incomplete fat oxidation, and an excess of acidic ketones will be produced. Diets too low in carbs can lead to ketoacidosis (1).

However, moderately low-carb diets such as the Mediterranean diet, which includes plenty of fruits, vegetables and monounsatured oils are a good choice for long-term health (2).

References

1. Nix, S. (2005). Williams' Basic Nutrition & Diet Therapy. Philadelphia: Mosby.

2. Shai, I., Schwarzfuchs, D., Yaakov, H., Sahar, D.R., Witkow, S., et al. (July, 2008). Weight loss with a low-carbohydrate, Mediterranean or low-fat diet. The New England Journal of Medicine, 359:229-241.

Does low-calorie dieting cause you to "yo yo" because of lowered metabolism?

This post came out of a question from someone who asked a question related to whether or not eating a very low calorie diet would lead to a "yo yo" effect caused by lowered metabolism, stoping weight loss and causing weight gain upon eating normally again.

There is no evidence suggesting that a "yo yo" effect would occur from low-calorie dieting, nor would lowering calories too far "stop" weight loss altogether. Truth is, calorie restriction does reduce metabolic rate, you would lose weight at a rate that is lower than normally expected, but if you started eating normally again, your metabolism would speed back up again.

In 2006, Heilbronn et al. studied the effects of calorie restriction (CR) on metabolism. The researchers published in JAMA the results of a six-month randomized controlled trial on CR and how it made an impact on biomarkers of metabolism as well as longevity and oxidative stress in overweight adults.

The subjects were paid and placed in one of the following groups: a control group, a CR group (25% reduction from baseline), a CR group with exercise (12.5% reduction, 12.5% increase activity), and what they called a very-calorie diet (890 kcal/d) followed by weight management at 15 percent weight reduction.

By the third month, metabolism had slowed (measured in part with plasma T3 levels) in both CR and very low-calorie diets. At six months, metabolism had slowed in the CR, CR with exercise, and very low-calorie diet groups.

Everyone lost weight in the intervention groups. Those on the very-low calorie diet lost the most, but they also lost the most muscle. From that same study, the researchers were the first to find reduced oxidative stress and DNA damage from CR in humans.

So, what do we know? We know that if you also drop even to 500-800 kcal per day that, despite slower metabolism (your body's survival mechanism), you still would lose weight albeit at a lower rate (as stated before).

What some researchers have tried to do since then to "trick" the body to not slow metabolism. They do it by staggering the calories with alternate-day CR/fasting or intermittent CR/fasting. These are interesting topics of research and may show up as new weight-loss fads of the future.

I don't recommend people drop calories or lose weight too quickly because it leads to too much loss of hard-earned muscle and, possibly, gallstones (if you're not drinking enough water and eating small meals throughout the day). In my experience, I've also seen quite a few people go lower than 800 calories per day for weeks and end up without energy, getting sick and looking pretty frail.

It's best, I think, to stick with losing only 1-2 pounds per week (by dropping calories steadily and increasing activity to keep muscle up) and then eventually keeping diet within 800-1200 kcal/d range.

Undigested meat in the colon

When you have undigested meat proteins in your colon, they will basically do what they do when thery are outside the colon: they rot. The rotting, or decay, is characterized by a release of foul-smelling chemicals.

One such chemical is cadaverine--the same that gave "cadavers" their name because of the smell they emit--which is the result of protein hydrolysis or the decarboxylation product of lysine. It's similar in structure to putrescine, putrescine itself produced from rotting activity.

Rotting flesh in the colon gives off a horrible odor and the smelly chemicals can become apparent in a person's breath, feces or urine. The person may suffer from the foul odors for a good while as the long process digestion or elimination of the meat continues.

To help speed things along, it's important to maintain a diet high in dietary fiber, specifically insoluble fiber, which helps increase rate of transit in the colon. Insoluble fiber comes from the "woody" parts of plants such as wheat bran and vegetable skins.

No one should have to put up with "the smell of death" after a meal. To avoid offensive gas and bad breath, just eat smaller portions of meat and be sure to also include some salad and extra vegetables.

Reference
Lecture notes by Albert Grazia, M.S.

Green tea EGCG in low doses boosts fat oxidation by amounts comparable to caffeine

Several studies have reported that green tea improves weight loss, which has largely been attributed to its content of caffeine. A pilot study, however, reports that green tea's main antioxidant catechin, epgallocatechin-3-gallate (EGCG), may also have thermogenic potential.

Thielecke et al of Germany report in the April issue of European Journal of Clinical Nutrition that consumption of EGCG at low doses taken after meals may contribute to increased fat oxidation similarly to caffeine (as much as 35 percent). The same effects of EGCG were not demonstrated while fasting.

The German researchers employed by DSM Nutritional Products performed a randomized, double-blind, placebo-controlled trial on 12 men that were screened for health problems, drugs and smoking. They also excluded men that had taken any dietary supplement within a week of the study.

Each male volunteer consumed an encapsulated supplement over three days (weeklong wash out in between) of either a low dose of EGCG (300mg), high dose of EGCG (600mg), caffeine (200mg), a combination of low-dose EGCG and caffeine (300mg EGCG/200mg caffeine), or a placebo.

The subjects were fed a standard meal of bread, butter, cheese, ham, tomato and cucumber according to the individual energy requiremens of each volunteer, calculated as 5 kcal/kg body weight with 50 percent enrgy from carbohydrates, 35 percent from fats, and 15 percent from proteins. They were prohibited from drinking caffeinated drinks during the study.

Fat and carbohydrate oxidation rates were calculated using a relatively new "respiratory quotient" that measures variance of oxygen consumption (VO2) and carbon dioxide production (VCO2). After three days of each treatment, the researchers took anthropometric measurements for body weight and BMI.

Here are their reported findings:

- 10 of the 12 successfully completed all five supplementation periods
- No adverse effects were reported
- There was no significant difference in fasting blood glucose and insulin from the different supplements
- Energy expenditure was not affected by EGCG
- Caffeine alone and in combination with green tea did have a pronounced effect on fat oxidation
- High dose EGCG boosted fat oxidation by a non-significant 20 percent
- Low dose EGCG surprisingly boosted fat oxidation by 33 percent after meals similarly to caffeine, but not before meals
- Low EGCG (300mg) and caffeine (200mg) maximized fat oxidation, increasing it by 49 percent, after meals

The researchers conclude: "This pilot study provides for the first time evidence that a single green tea catechin, EGCG, can increase fat oxidation in obese men, at least within 2 h after meal intake. Within this postprandial phase, EGCG is equipotent with caffeine with regard to fat oxidation."

My thoughts:

Why did the high dose EGCG not exhibit the same effects as the low EGCG? I understand that there may be a threshold point that is reached by caffeine and EGCG and its influence on fat oxidation, but I have a hard time buying that a low dose of EGCG may be more effective than a high dose. To that end, I'd like to see similar studies appear to clarify the relationship of EGCG on fat oxidation.

However, I am definitely glad to learn that we now know that EGCG does influence fat oxidation and that its effects of potentially improving weight loss have been pinned down to this mechanism instead of others such as reducing fat absorption. I am also glad to confirm that EGCG has no effect on body composition by means of influencing energy expenditure (meaning an influence on how many calories a person burns in a day).

I will continue recommending three or more cups of green tea a day, with or without the caffeine, for helping patients improve their weight loss. Despite the study, however, I think that across the board the most important reason why we continually see patients losing greatest amounts of weight while drinking green tea daily is because they are, at the same time, replacing their sugary beverages such as fountain drinks.

Reference

Thielecke F, Rahn G, Böhnke J, Adams F, Birkenfeld AL, Jordan J, Boschmann J. Epigallocatechin-3-gallate and postprandial fat oxidation in overweight/obese male volunteers: a pilot study. European Journal of Clinical Nutrition advance online publication 7 April 2010; doi:10.1038/ejcn.2010.47.

Whole milk better for your heart?

Every nutritionist knows (or should know) that a DASH eating plan is incredibly effective for helping patients to lower their blood pressure. A staple on the plan are low-fat or non-fat dairy foods (think 2 percent or skim milk versus whole milk) because they are considered more heart healthy than full-fat dairy, but the results of a 16-year prospective study just published in the European Journal of Clinical Nutritianare suggesting otherwise.

Bonthuis et al are calling for more studies to assess whether or not full-fat dairy may have more cardioprotective benefits than low-fat or nonfat dairy (1). The researchers found that among more than 1,500 adult Australians regularly consuming dairy products, those with highest consumption of full-fat dairy had reduced mortality when compared with those who ate low-fat dairy (1). This was after adjusting for possible confounders such as calcium and vitamin D. Most of the deaths of the participants in the study were related to cardiovascular disease and cancer (1).

The study overall confirms that dairy deserves to continue to be part of DASH and a previously published cohort from Australia that dairy could lower all-cause mortality (2). The study also questions recommendations of avoiding full-fat dairy for long-term protection against chronic disease.

Where did the recommendation to go for the low-fat dairy come from anyway?

The recommendation appeared because of studies that found that low-fat dairy was associated with lower blood pressure, but that full-fat dairy was not. Somewhat recently, the National Heart, Lung, and Blood Institute Family Heart Study in 2006 found an inverse association between prevalent hypertension and consumption of a diet containing dairy low in saturated fat (3).

Given the newest Australian findings, the dairy and blood pressure relationship may be dependent on the fatty acid make-up of the dairy. Could there be something about Australian dairy sources that are cardioprotective? The researchers no doubt must have this data and I imagine less saturated fat and more omega-3s would be involved in their results.

So, don't go switching to whole milk yet. If you like that full-fat flavor, then consider drinking omega-3-fortified dairy.

Just last month in March, a double-blind, cross-over study confirmed that omega-3-fortified dairy foods improved lipid profiles decreasing cardiovascular risk factors (4). The dairy improved omega-3 index, lowered total cholesterol, lowered LDL cholesterol, and lowered triglycerides significantly (4).

Once again, the fact of the matter is that it is the amount of omega-3s in any food that may truly determine how cardioprotective the food really is, as well as its lack of saturated fat and trans fat. Milk is no exception to this nutritional rule.

Reference

1. Bonthuis M, Hughes MC, Ibiebele TI, Green AC, van der Pols JC. Dairy consumption and patterns of mortality of Australian adults. Eur J Clin Nutr. 2010 Apr 7. [Epub ahead of print] Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20372173.
2. van der Pols JC, Gunnell D, Williams GM, Holly JM, Bain C, Martin RM. Childhood dairy and calcium intake and cardiovascular mortality in adulthood: 65-year follow-up of the Boyd Orr cohort. Heart. 2009 Oct;95(19):1600-6. Epub 2009 Jul 29.
3. Djoussé L, Pankow JS, Hunt SC, Heiss G, Province MA, Kabagambe EK, Ellison RC. Influence of saturated fat and linolenic acid on the association between intake of dairy products and blood pressure. Hypertension. 2006;48:335.
4. Dawczynski C, Marin L, Wagneer A, Jahreis G. n-3 LC-PUFA-enriched dairy products are able to reduce cardiovascular risk factors: A double-blind, cross-over study. Clinical Nutrition. Mar 19. [Epub ahead of print]

Getting to the Bottom of Hemorrhoids

When a patient has hemorrhoids (most prevalent in males over 50) then it is always important to evaluate hydration and dietary fiber intake because constipation contributes to risk (1). Sufficient regular water intake and fiber helps to encourage regular bowel movement and alleviate symptoms of constipation.

One can't get to the bottom (excuse the pun) of hemorrhoids, however, without also evaluating the patient's level of activity. A sedentary lifestyle is a major risk factor (spicy foods and alcohol intake are also risk factors) (2). Sitting too long in an office chair, an automobile, in front of the TV, or on a toilet increases pressure on veins in the anus. Exercise promotes circulation and alleviates pressure on the veins, which helps to shrink hemorrhoids and prevent them in the future.

I am also a fan of flavonoids (in particular, micronized purified flavonoids, or Daflon at 500mg) for use with hemorrhoid therapy. There has been at least a few double-blind, placebo-controlled trial that showed flavonoids relieved symptoms associated with hemorrhoids and reduced frequency and severity of hemorrhoid flare-ups (1-4). The evidence behind use of flavonoids, I realize, is limited because of methodological errors and possible bias (5), but in my experience (which I will not explain) they work well.

References

1. Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol. 2005 Dec;29(12):1270-4. Available at http://www.em-consulte.com/article/100126.
2. Jiang ZM, Cao JD. The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Curr Med Res Opin. 2006 Jun;22(6):1141-7.
3. Danielsson G, Jungbeck C, Peterson K, Norgren L. A randomised controlled trial of micronised purified flavonoid fraction vs placebo in patients with chronic venous disease. Eur J Vasc Endovasc Surg. 2002 Jan;23(1):73-6.
4. Lyseng-Williamson KA, Perry CM. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs. 2003;63(1):71-100.
5. Struckmann JR. Clinical efficacy of micronized purified flavonoid fraction: an overview. J Vasc Res. 1999;36 Suppl 1:37-41.
6. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, Guyatt G. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006 Aug;93(8):909-20.

Heartburn and Diet

Heartburn is an awful feeling that almost everyone has suffered from at some time in their lives. It's disheartening to hear that in the USA about 44 percent suffer every month and, worse yet, about 10 percent suffer every day (1). There's no need for the continual pain from heartburn (or taking the drugs to avoid it or treat it). With a little knowledge of what causes heartburn and change in diet, anyone can avoid heartburn for life.

GERD

Chronic heartburn, or gastroesophageal reflux disease (GERD), is a result of reflux of gastric acid and gastric contents re-entering the esophagus. Depending on the amount of acid refluxed and heartburn severity, mucosal damage can cause the esophagus to become irritated and painfully inflamed (2). Although the esophagus can heal pretty well, GERD mucosal damage can potentially leads to more serious outcomes such as increased risk for erosive esophagitis, strictures, Barret's esophagus and even adenocarcinoma (1).

Gastric acid amounts, which peak about 2-3 hours after meals, have more of a chance to reflux if a person is in a reclining position (2). Certain foods can also cause the lower esophageal sphincter to relax increasing risk of heartburn, namely alcohol, fatty foods and chocolate. Alcohol and coffee also can cause increased gastric acid secretion increasing risk. As you can imagine or may have experienced, the worst events of heartburn happens to people in the evening after eating a large fatty meal accompanied by alcohol, coffee and chocolate.

Peptic Ulcer

Heartburn can also be the result of a peptic ulcer, or duodenal ulcer that is chiefly caused by infection from Helicobacter pylori or, to a lesser degree, overuse of aspirin or NSAIDs (1). NSAID produces ulcers by blocking the production of prostaglandins in the cyclooxygenase-1 pathways (3). What H. pylori does to cause the ulcers is cause acid to be secreted at higher rates (hypersecretion), which is not good for the gut and produces the discomfort. The rate of secretion also can be corrected by eradicating the H. pylori (1). Whatever can help to modulate acid secretion is also considered therapeutic, which includes H2-receptor antagonists and proton pump inhibitors (1).

Dietary Therapy

Dietary therapy should focus on avoidance of heartburn trigger foods while encouraging healing with other foods as well as improving immune resistance to harmful bacteria such as H. pylori.

A word on low-carb diets

Although there does appear to be a few proponents of a high-protein, low-carb diet as therapeutic for both GERD and peptic ulcer disease, I was not able to find any clinical evidence to back up claims on blogs and Web sites that the diet would help with heartburn, or specifically that a low-carb diet would help eradicate bacterial infection. The interest in low-carb dieting is prevalent, however, and if nutritionists choose to recommend one such as Atkin's, then they should make patients aware of possible unwanted side effect from eating additional fatty foods that may cause increased possibility of heartburn as stated earlier.

Therapeutic Fiber and Probiotics

Dietary therapy for GERD and peptic ulcer disease should begin with a diet higher in fiber, preferably soluble fiber (1-3). According to a prospective cohort study on more than 51,000 male adults in 1986, dietary fiber from beans, tofu, peanuts, and other nuts (all rich in soluble fiber) reduced risk of peptic ulcer disease more than other foods rich in insoluble fiber (3). Dietary fiber helps to normalize gastric motility and soluble fiber can support growth of healthy gut flora (1). To best help prevent both diseases, patients should strive to eat a diet high in fruits, vegetables and legumes.

After antibiotic therapy in peptic ulcer disease, probiotic foods such as yogurt, kefir and sauerkraut can be therapeutic. Probiotics can help support GERD as well by helping to normalize symbiosis. The probiotic bacteria can help repopulate gut flora and they will thrive on prebiotics found in fruits, vegetables and legumes (1). A healthy gut flora can help normalize symbiosis and improve immune resistance to infection.

Avoiding Triggers

What a diet should not do is cause any additional stress to the patient, which include heart burn triggers. GERD patients should limit fatty foods, caffeine, alcohol, chocolate, garlic, onions and peppermint that can relax the lower esophageal sphincter (1). In addition, acidic foods such as peppers, citrus juice and tomato juice should be avoided to limit recurrence of pain from inflammation in the esophagus (1).

On the other hand, there is no evidence for avoiding spicy foods (surprising to me) or milk, alcohol or coffee as they have not been linked as causal factors for peptic ulcer disease (2). Milk, however, can exacerbate symptoms after infection (1). Those with risk of peptic ulcers should also avoid aspirin and NSAIDs with direction from a doctor.

Other advice

GERD therapies
- Avoid large meals, finish eating at least three hours before bedtime, relax, eat slowly, chew food, sleep well, keep their head up during digestion (1;2).
- Because being overweight and smoking are risk factors for GERD, a weight-loss program and quitting the cigarettes can help avoid heartburn (1).
- Try a food allergy elimination diet to determine if there's a challenge from gluten, dairy, eggs, etc (1).
- Take digestive enzymes to avoid maldigestion as necessary (1).
- Take glutamine for as it is the preferred fuel for gut lining and can help encourage faster healing (1).

Peptic ulcer therapies
- Although there is limited evidence on how much it helps, eating broccoli and brussel sprouts may help upregulate antioxidant enzymes and protect and repair gastric mucosa (1;2).
- Cook broccoli and other foods to avoid infection with H. pylori or E. coli (1).
- Drinking green tea, eat berries and drink red wine since they contain catechins, quercetin and other flavonoids that inhibit H. pylori proliferation and have anti-inflammatory effects (1).
- Take zinc-carnosine since it helps to inhibit H. pylori proliferation and shortens duration of treatment with antibiotics (1).

References

1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
2. Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins, 2009.
3. Ryan-Harshman M, Aldoori W. How diet and lifestyle affect duodenal ulcers. Review of the evidence. Can Fam Physician. 2004 May; 50:727-732.

Vitamin D and Crohn's disease

Vitamin D deficiency may actually contribute to Crohn's disease because the hormone modulates the immune system. According to endocrinologists at McGill University, vitamin D appears to turn on genes to encode antimicrobial peptides that fight against intestinal invaders (1). The immune support may help avoid inflammation associated with an autoimmune response in Cronh's disease.

This may explain why Crohn's disease is more prevalent in Northern latitude countries. It also suggests that increased vitamin D could assist in avoiding Crohn's disease in the future.

How do these findings affect what we know about ulcerative colitis? I hope we find out soon.

Reference

1. McGill University Health Centre (2010, January 27). Vitamin D supplements could fight Crohn's disease. ScienceDaily. Retrieved March 31, 2010, from http://www.sciencedaily.com­ /releases/2010/01/100127104904.htm

Managing Diverticulitis After Treatment

It is well documented that a diet low in insoluble fiber is considered the main etiological factor in leading to diverticulitis. The intake of insoluble fiber speeds up transit of food and increases bulk reducing pressure on the intestine (1). On the other hand, intake of red meat appears to increase risk (1).

Patients treated for diverticulits are often prescribed antibiotic therapy and recommended to stay on a low-fiber diet and reintroducing insoluble fiber gradually (2). In some cases, surgery is needed (2). Afterward, nutritionists would recommend gradual increases of fiber because a diet high in fiber can lead to high amounts of gas and forceful diarrhea (2-3).

Because of possible damage in the intestine, nutritionists should also evaluate patients are at higher risk of malnutrition. Malnutrition can lead to slow healing and recovery as well as deterioration of muscle, respiratory and immune function (4). To receive adequate nutrients, higher protein intake as well as supplements of certain vitamins such as B12 and minerals such as calcium may be needed (4).

A weight-management program may help to avoid diverticulitis in the future. According to a prospective cohort study, subjects with a BMI, waist circumference and waist-to-hip ratio that categorized them as obese had an increased risk of diverticulitis and diverticular bleeding (5).

Nutritionists may also recommend probiotics along with prebiotics to support growth of healthy intestinal flora after antibiotic therapy (4).

References

1. Korzenik JR. Case closed? Diverticulits: epedemiology and fiber. J Clin Gastroeneterol. 2006 Aug;40 Suppl 3:S1 12-6.
2. Kotzampassakis N, Pittet O, Schmidt S, Denys A, Demarines N, Calmes JM. Presentation and treatment outcome of diverticulitis in younger adults: a different disease than in older patients? Dis Colon Rectum. 2010 Mar;53(3):333-8.
4. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
5. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding 2008;136(1):115-112.

Helping a Patient Manage IBS and Diarrhea

When IBS is diarrhea-predominant, a doctor may prescribe an antimotility agent to assist patients with symptoms (1). He or she may also prescribe an antibiotic if the IBS is a result of small intestinal bacterial overgrowth (1).

As a dietary aid for patients, a nutritionist may suggest soluble fiber such as from oats because it can help act against symptoms such as diarrhea by helping bind fat and slow emptying of food from the stomach into the small intestine (2).

The soluble fiber can include prebiotics such as fructo-oligosaccharides or resistant maltodextrin, which support growth of healthy intestinal bacteria. The prebiotics taken in conjunction with probiotics particularly after antibiotic therpay may help with promoting the growth of the good bacteria. This integrative therapy can help to alleviate symptoms by promoting competition against small intestinal bacterial growth (3).

Nutrionists should recommend suspending intake of insoluble fiber such as from wheat and cereal grains and limiting poorly-digested carbohydrates and sugar alcohols as these can worsen symptoms (4). Patients may find benefit from following an exclusion diet whereas trigger foods are eliminated and then, if thought advisable, reintroduced gradually (4).

References

1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
2. Bijkerk CJ, de Wit NJ, Muris JWM, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irratble bowel syndrome in primary care? Randomized placebo controlled trial. Brit Med Jour 2009;339:b3154. Available at http://www.bmj.com/cgi/content/abstract/339/aug27_2/b3154. Accessed on March 31, 2010.
3. American College of Gastroenterology (2008, October 10). How Effective Are Probiotics In Irritable Bowel Syndrome?. ScienceDaily. Available at http://www.sciencedaily.com­ /releases/2008/10/081006092656.htm. Accessed on March 31, 2010.
4. Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative view. J Am Diet Assoc. 2009 Jul;109(7):1204-1.

Low-carb diets and dehydration

It is well known that dehydration is a potential adverse effect of a ketogenic diet, which is one higher in fat with adequate protein and lower in carbohydrates.

Nutritionists should be watchful, in particular, of those who use ketogenic diets as therapy for certain conditions such as epilepsy and type 2 diabetes.

A study in epileptic children on ketogenic diets, for example, found dehydration to be the "most common early-onset compllication"and higher in those who fasted (1-2). The dehydration could be partly blamed on the incidence of GI tract adverse effects (1).

When treating those with type 2 diabetes with a ketogenic diet, it is advisable to instruct drinking up to eight 8 oz. glasses of water daily. There may also be need for adjusting those recommendations if certain medications were used such as diuretics.

According to the researchers who performed an intervention trial on those with type 2 diabetes and a ketogenic diet that resulted in a few adverse effects, the following was concluded: "Until we learn more about using low carbohydrate diets, medical monitoring for hypoglycemia, dehydration, and electrolyte abnormalities is imperative in patients taking diabetes or diuretic medications" (1).

The lower carbs can have a diuretic effect on the body, which should lead clinicians to be aware and make recommendations for increased water intake as necessary.

References

1. Duschowny MS. Food for thought: The ketogenic diet and adverse effects in children. Epilepsy Curr. 2005 July;5(4):152-154. Available at: Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198735/?tool=pmcentrez

2. Kang HC, Chung da E, Kim DW, Kim HD. Epilepsia 2004;45:1116-1123. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198735/?tool=pmcentrez

Kidneys: Animal vs Veggie Protein

I was curious to know what it is about animal protein in general that would affect kidneys more than vegetable protein. So I went searching for a study.

There was a human intervention trial from the Dept of Internal Medicine in Texas that I found, which had evaluated animal protein-rich diet on kidney stones and calcium. The study took 15 subjects and fed them either vegetable protein, vegetable and egg protein or animal protein for 12 days in three different periods (1). What the study found was that the animal protein diet "conferred an increased risk for uric acid stones" but a lesser risk than the vegetarian diet for "calcium oxalate or calcium phosphate stones" (1).

Because my question really wasn't sufficiently answered by this study, I decided to pursue what National Kidney Foundation had to say. Finally, I found a publication they put out referencing nutrition and speaking to vegetarian diets in which they basically state that the veggie diets aren't "rich in higher quality protein" (2), but that also that the best sources of vegetarian protein may be ones lower in potassium and phosphorus depending on kidney dysfunction.

At best, the main focus on kidney health is a balance between protein and carbs because too few leads to more protein break down as well as protein with sodium (lower is better), phosphorus (lower is better), calcium, potassium (sometimes higher, sometimes low is better) and, of course, water amounts for keeping kidneys functioning well (2).

References

1. Breslau NA, Brinkley L, Hill KD, Pak, CY. J Clin Endocrinol Metab. 1988 Jan;66(1):140-6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/2826524

2. National Kidney Foundation. Nutrition and Early Kidney Disease. Available at: http://www.kidney.org/atoz/pdf/NutriKidFail_Stage1-4.pdf

Why Evidence-based Nutrition

As a result of my profession in science communications, it is a fact of life that I come in to work to find 1-2 papers to read every morning on my desk. I must read an average of between 10 new scientific papers weekly. They can range from culture studies, animal studies, human clinical trials, epidemiological studies, meta-analyses or simply review articles.

As a writer who specializes in topics of nutrition, I am continually faced with the labor of assessing just how “big” the news coming from the study really is, whether or not it merits more attention by our research and sciences team, and whether or not we should communicate it to the public.

If I had any special talent for pointing out flaws or problems in studies, I would be thrilled. I don’t. Not at all. Lucky for me, however, I work with a few knowledgeable scientists with a keen awareness for what’s hot and what’s definitely not.

I doubt that many of my own colleagues share the same luxury that I have for being able to pass a study by an experienced nutritionist to help me place it in proper perspective for our audiences. This is simply evident by an Internet search for nutrition articles and a judgment of how other health writers handle their material.

Relying on experts to sift through the journals has been a unique experience, one that has been inspiring—which is why I now have hopes of ultimately gaining expertise of evidence-based nutrition (EBN) myself. EBN is simply true science and research, after all, and it informs decisions and practice.

It is my view that nutrition is a young science that is maturing quickly. I share a similar positive optimism for the field as Walter Willet, who has written of a merge of nutritional sciences with epidemiology to provide greater knowledge more quickly (1).

I follow with Willet’s assertion that nutritional research approaches are improving (that it won’t take us 100 years to discover flaws in dietary recommendations such as partially hydrogenated oils, for example(1)), and my interest is piqued in learning, as I would expect, that the study of genomics will further influence the future of nutrition.

While evidence-based nutrition and medicine may appear controversial to a few, I cannot see any other way for me, as I long to live in a world where science and statistics (even if we don’t “get” them) govern our understanding, not our often-flawed personal judgments.

I welcome the new process of nutritional epidemiology referenced by Willet that he expects will provide “vast and unprecedented information” (1). For that matter, I expect to be intensely studying as continual information appears over the next decade or so.

To achieve what Trisha Greenhalgh advises in her wonderful primer on evidence-based medicine, How to Read a Paper, it is my expectation to come away with the ability “not only to read papers, but also to read the right papers at the right time” (2) to best guide my decision making.

References

1. Willet WC. Nutritional epidemiology issues in chronic disease at the turn of the century. Epidemiol Rev. 2000;22(1):85-86. Available at: http://epirev.oxfordjournals.org/cgi/reprint/22/1/82.pdf

2. Greenhalgh T. How To Read A Paper: The Basics of Evidence Based Medicine. Malden, MA: Blackwell, 2006, p. 2.

How much water do I drink?

I've been perusing through Dr. Batmanghelidj's book Your Body's Many Cries for Water. Yes, I'm well aware that it does not entirely scientific and does have a few claims that could be regarded as sensationalism for water (excess cholesterol is a result of too little water intake, really?).

I was intrigued, however, at some of the references to the possibility of chronic dehydration as an influence on disease and the beginnings of cellular aging, which can fuel chronic disease.

Plus, anyway, I needed to write a paper on water.

So, of course, I had to ask myself, "How much water do you drink?"

So here goes my diet for today:

8am: 1 cup of green tea (with 1 yogurt/protein shake/fruit)

10am: 1 cup of yerba maté (a habit passed from Argentine mom)

12pm: 1 cup iced tea (with chicken salad lunch)

2pm: 1 shot espresso

4pm: 1 cup yerba maté

6pm: 1 glass red wine (with 1 cup lentil-asparagus soup dinner)

9pm: 1 cup green tea

(Plenty of liquid, but no straight glasses of purified H2O.)

I suppose that from a nutritional standpoint, it appears I did pretty OK for the day and plenty of antioxidants from fruit, veggies, tea, maté, coffee, and red wine. I am simply trying to stick to a relatively decent DASH eating plan.

Although I didn't feel dehydrated (I drank about 7 cups of liquid), given what I have now read about water I'll probably have to reconsider what I'm doing.

I'm especially alarmed at the possible effects of chronic caffeine diminishing ATP and alcohol's influence on vasopressin causing dehydration. (And here I thought the regular tea, coffee and occasional red wine were pretty OK habits.)

It does make sense to me that cells would best function when well-hydrated. After all, as stated in the materials, life began in water, or an ancient primordial swamp.

No doubt in my mind that given our origins from the sea that it's water intake that is truly necessary for entire body's proper function (along with a bit of salt).

As the water-relationship makes common sense to me, I can see how I might recommend it as integrative therapy in certain situations, although I would hang back from calling it "prevention" or "cure" of disease without some considerable evidence-based research.

I admit I had no idea something like a low-grade "chronic dehydration" existed and could exist despite food and liquid intake and affected directly by caffeine and alcohol.

It seems to me that, since water represents pretty much the starting point of nutrition (at least from a cell's and ancient fishapod ancestor's standpoint), the topic of water intake definitely should be part of all nutrition programs.

My thoughts,

David

What's the most dangerous item on a fast food menu?

When I first saw the movie Super Size MeI was first pretty shocked that someone would actually risk his own body this way. Then, I was shocked at how quickly this guy was able to gain weight. This may simply be because I don't tend to gain any weight even after stuffing myself day after day. Of course, I've never tried to stuff myself with McDonald's day after day. Maybe that would do it. It did for this guy. And it does for our children. Sure opened my eyes.

What's the most dangerous item on the fast food menu?

I remember a time when I was younger I would go off with my grandpa to Burger King. He'd say, "Let's get you a Whopper. They're only a buck." I'd gush with enthusiasm. He'd buy me one. He'd buy himself too.

My grandpa died of heart disease. I blame it on those Whoppers. I blame them because they're cheap and because the name itself, like the Big Mac, suggest that you're getting a lot of meat for your money. What you're really getting is a gimmick and a lot of saturated and trans fat. I have no doubt that Burger King Whoppers (they ate them all the time) are what killed both my grandfather and my grandmother.

Why Statins May Require You Take Extra CoQ10 and Vitamin E

Statins are drugs used to lower cholesterol by blocking cholesterol synthesis in the liver (1). By lowering total and LDL cholesterol, in effect, they help lower risk of heart disease and death (1). The most commonly known statin drugs are simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), and rosuvastatin (Crestor).

Currently, it is theorized that as statins block cholesterol synthesis, they also block synthesis of coenzyme Q10 (2). This is unfortunate because coenzyme Q10 plays a key role in the mitochondria in the electron transport chain, as an antioxidant and as a regenerator of vitamin E (3).

Statin therapy, then, could potentially lead to deficiencies of both coenzyme Q10 and, possibly, increase the need for vitamin E in cells (4). It has been theorized that deficiencies in both coenzyme Q10 and vitamin E are why statins cause statin-related muscle pain and statin-related myopathy (3-4).

References

1. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA. 1999 Dec 22-29;282(24):2340-6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10612322
2. Schaars CF, Stalenhoef AF. Effects of ubiquinone (coenzyme Q10) on myopathy in statin users. Curr Opin Lipidol. 2008 Dec;19(6):553-7.
3. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Wadsworth, 2009.
4. Galli F, Iuliano L. Do statins cause myopathy by lowering vitamin E levels? Med Hypotheses. 2010 Apr;74(4):707-709. Epub 2009 Nov 6.

What are blood thinners and how do they work?

Blood thinners, or anticoagulants and antiplatelet agents, are drugs to thwart blood clotting of which could block flow of blood to your heart causing a heart attack or your brain causing a stroke.

Common anticoagulants are Coumadin, Warfarin and Heparin. It controls the rate in which clotting can occur and prevents them from forming inside blood vessels and the heart. It can also help prevent existing clots from enlarging.

Common antiplatelet agents are Aspirin, Plavix (clopidogrel bisulfate) and Ticlid (ticlopidene hydrochloride). As the name suggests, they keep platelets from aggregation to prevent possible clotting, specifically where an injury to a blood vessel may have occurred.

Blood thinners aren't associated with any specific nutrient deficiency, but are contraindicated taken with foods and supplements high in vitamin K1 (a clotting factor) or large amounts of vitamins E and C. They are also contraindicated with alcohol, certain herbs and teas, and other dietary agents that cause thinning of blood.

Reference

http://www.nlm.nih.gov/medlineplus/bloodthinners.html