29 January 2011

Losing weight without developing gallstones

Gallstones are estimated to affect 1 in 10 people in North America. Those who are obese have a higher likelihood of developing gallstones. Most at risk of gallstones as a result of obesity are Native Americans, the elderly, and Caucasian women in their forties who haven’t yet reached menopause.

Gallstones are so named because they 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 contains high concentrations of cholesterol, then stones too difficult for the bile salts to dissolve may develop.

Because gallstones usually form without any symptoms, most people don’t know they have them or may feel only minor symptoms such as abdominal pain after eating a fatty meal. However, if a stone becomes lodged in a bile duct causing blockage, it can result in sudden pain in the abdomen, back or right shoulder.

Cholecystitis, or gallbladder disease, which is caused by duct blockage, infection or inflammation, is one of the most common digestive diseases. Pain from duct blockage can become intense and lead to hospitalization and surgery. In the U.S. alone, gallbladder surgeries approach 700,000 annually, costing approximately $6.5 million.

Surgery costs increase if gallstones and duct blockage or infection cause the pancreas to become inflamed. The resulting pancreatitis can lead to severe or life-threatening complications. The major cause of acute pancreatitis in North America is gallstones.

Link to Obesity and Losing Weight Too Quickly

Because of obesity’s major role in the formation of gallstones, weight management is critical for decreasing the likelihood of developing them. Obesity is thought to increase risk of gallstones because of elevated production of cholesterol, which in turn increases the concentration of cholesterol in bile.

Paradoxically, losing weight actually increases risk of developing gallstones among obese people, especially amongst those who lose large amounts of weight rapidly. Although not entirely understood, nutritional and medical scientists think that losing weight too quickly may shift the balance of bile salts and cholesterol, causing increased concentrations of cholesterol. Gallstone risk may also be increased by consuming a diet too low in fat or avoiding fat, which reduces the frequency of gallbladder contractions and results in fewer chances of gallbladder emptying.

As always, individuals with a high risk for gallstones should follow medical advice in treatment. Medical researchers have studied methods that obese people can lose weight while reducing risk of gallstone developments. Statin regimens and bile salt therapies have had mixed results. A drug called ursodiol has shown much promise in helping to dissolve cholesterol in bile and prevent gallstones.

There have also been successes such as employing modifications in diet to help reduce risk of gallstones. Along with following a doctor’s advice, individuals can consider these weight-management strategies, which have shown promise based on epidemiologic studies or in clinical trials for losing weight as naturally and safely as possible.

Three Steps to Help Lower Risk of Gallstones While Losing Weight

Step 1: Avoid very low-calorie dieting, losing no more than 1-2 pounds per week.

Overall, research studies have found that obese people who lost 3 pounds or more weekly had a greater likelihood of developing gallstones. This may be because they are more likely to experience an imbalance between bile salts and cholesterol, as well as irregular gallbladder emptying.

For these reasons, people who are obese or who are at high risk for developing gallstones should also avoid skipping meals or fasting.

By eating three steady meals throughout the day and losing weight at a slower rate, obese people can reduce the weight-loss risk factor in gallstone formation. To ensure steady weight loss at 1-2 pounds per week, calorie intake should be reduced by only 500 to 1,000 calories. Weight loss is also influenced by activity, which may require eating more calories to compensate for calories burned.

Step 2: Avoid saturated fats and eat small amounts of monounsaturated or polyunsaturated dietary fat daily.

Foods high in saturated fats, trans fats and cholesterol are all associated with increased risk in gallstone formation. However, foods high in polyunsaturated or monounsaturated fats (from olive oil or high-oleic sunflower oil) may help lower cholesterol saturation and reduce risk of gallstone formation.

A randomized clinical trial on obese subjects compared a low-calorie diet (900 kcal/d) with 30 grams of fat per day with a low-calorie diet (520 kcal/d) with less than 2 grams of fat per day. After eight weeks, not one of the subjects on the diet with 30 grams of fat per day had developed gallstones. The researchers were led to conclude that dietary fat ensured regular gallbladder emptying and reduced bile cholesterol saturation.

A 10g threshold of fat per meal is now considered to be most efficient at maximizing gallbladder emptying, which can support healthy weight loss while reducing risk of formation of gallstones.

Furthermore, according to one randomized, double-blind, placebo-controlled clinical trial, fish oil in amounts of almost 12 grams per day may work comparatively to ursodiol in reducing risk of gallstone formation in low calorie diets.

Step 3: Avoid refined sugar and strive for a diet high in fiber.

In epidemiologic studies, there is a higher association of gallstones in those who ate greater amounts of refined sugars. In contrast, long-term consumption of relatively high amounts of dietary fiber has been correlated with reduced risk of gallstone diseases.

The risk appears to be even lower if the amount of fiber consumed comes from sources rich in insoluble fiber found in whole grains, fruits and vegetables. Soluble dietary fiber such as found in oats and legumes also appears to be protective, showing reduction of gallstone formation in animal studies.

Diets higher in fiber and lower in refined sugars will also assist in weight loss. Refined sugars, found in high amounts in sodas and desserts, contribute to high calorie intake, which contributes to obesity. Dietary fiber is filling, providing a satiety effect, but offers little or no calories that would contribute to weight gain.

Individuals should increase dietary fiber to recommended levels (25 to 30 grams daily) gradually.

Safe Road to Optimal Health

Once again, each of these steps is a natural dietary habit that will help lower the risk of developing gallstones and support losing weight safely. Apart from diet, getting regular exercise daily is also helpful. And, for every pound lost gradually, the ultimate achievement is reduced risk of gallstones in the future.

Beyond reduced risk of gallstones, the end-benefits of healthy weight management are profound including improved activity and mobility, improved health of organs such as the heart and brain, and reduced risk of diseases such as type 2 diabetes and cardiovascular disease. Healthy weight management improves overall health and wellness at every level.

27 January 2011

No evidence of dairy and heart disease link

New research has once again confirmed after systematically analyzing 17 studies that there is simply no evidence to substantiate claims of a link between dairy and higher risk of cardiovascular disease or death.

The evidence, in fact, shows just the opposite—drinking milk slightly reduces the risk of coronary heart disease (1). In addition, multiple studies show that milk and dairy proteins (whey and casein) may actually protect the heart by helping to maintain lower blood pressure, lower blood sugar, and lead to reduced bodyweight (2-4).

The renowned, epidemiologic and nutrition researcher Walter Willet, Ph.D., and his group at Harvard, conducted this huge analysis by looking at various types of dairy intake, ranging from milk intake to total high-fat dairy products and total low-fat dairy products and correlating to risk of cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality. This study was a meta-analysis of many prospective cohort studies in healthy men and women (4).

Although it's always a challenging task to summarize published studies' data on food intake, Willett’s group is easily recognized as having the epidemiological expertise of doing such an analysis. Results from the group's careful analysis show:

  • a statistically significant inverse association between milk intake and cardiovascular disease.
  • no significant relationship between CHD, stroke, and all-cause mortality (including cancer) and total dairy of all types (high-fat, low-fat)
When they examined data on total dairy products or total high-fat dairy intake there was still no impact on CHD, but these results were based on a much smaller number of studies.

A notable strength of this methodology was the use of an advanced statistical approach for trend estimation of summarized dose-response data. This method provides uniform analysis of different studies, exposure categories and range of intakes; as well as greater power using full spectrum continuous exposure data.

These data, published in the January issue of the Journal of American Clinical Nutrition, clearly show that milk intake does not lead to cardiovascular, heart, stroke or any mortality (including cancer) and may even be beneficial in reducing cardiovascular diseases.

Several mechanisms have been discussed over the years concerning the beneficial effects of low-fat dairy intake on lowering blood pressure. For example, data from the famous DASH eating plan show systolic blood pressure reduction with a healthy diet. Inclusion of low-fat dairy products or dairy proteins showed a potential anti-hypertension effect possibly due to the natural mineral content found in dairy, particularly phosphorous.

These types of studies do not show cause and effect, but do, in fact, show that there is not an increased risk of heart disease, cardiovascular disease, stroke or all-cause mortality by drinking milk. One can only hypothesize why these associations exist—a clear possibility is that milk drinkers are taking extra dietary care by consuming natural products, perhaps in place of sugar-laden soft drinks. Diet quality is the key in reducing risk of chronic disease.

CVD is the main cause of death in the Western world claiming 17 million lives each year. Since saturated fat intake is associated with heart disease, dairy foods have often been blamed for contributing to CVD; however, the science community has yet to agree because of many conflicting studies. Although most epidemiological studies have failed to show an effect of dairy on CVD, a few have shown a positive correlation.

Likely confusion arises when results from dissimilar studies get lumped together in hopes of finding the "answer." However, combining evidence from epidemiological, case-control, prospective study designs with different age groups, genders, countries and numbers of subjects may easily explain the mixed results.

  1. Soedamah-Authu SS, Ding EL, Al-Delaimy WK, Hu FB, Engberink MF, Willet WC and Geleijnse JM. Milk and dairy consumption and incidence of cardiovascular disease and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 2011; 93: 158-71.
  2. Petersen BL, Ward LS, Bastian ED, Jenkins AL, Campbell J, Vuksan V. A whey protein supplement decreases post-prandial glycemia. Nutr J 2009;8:47.
  3. Frestedt JL, Zenk JL, Kuskowski MA, Ward LS, Bastian ED. A whey-protein supplement increases fat loss and spares lean muscle in obese subjects: a randomized human clinical study. Nutr Metab (Lond) 2008;5:8.
  4. Fluegel SM, Shultz TD, Powers JR, Clark S, et al. Whey beverages decrease blood pressure in prehypertensive and hypertensive young men and women. International Dairy Journal; 1010; 753-760.

22 January 2011

CoQ10 Adds to Mediterranean Diet’s Anti-Aging Benefits

Elderly men and women who supplement Mediterranean-style meals with coenzyme Q10 (coQ10) enjoy greater antioxidant protection and could slow aging, a Spanish study finds (1).

In a randomized crossover trial, University of Cordoba researchers assigned 20 healthy adults (ages 65 and older) to one of the three dietary protocols for the duration of four weeks: a traditional Western-style diet rich in saturated fats, a Mediterranean-style diet rich in olive oil, or a Mediterranean-style diet supplemented with coQ10 (200 mg/day in capsules).

The scientists found that the combination (Mediterranean-style meals and coQ10) improved antioxidant activity and reduced cellular oxidative stress in the subjects more successfully than the Mediterranean-style or Western-style diet alone.

The Mediterranean-style diet protocols also exhibited greater heart-protective benefits in comparison to the Western-style diet. The scientists noticed a significantly greater decrease in HDL cholesterol (the “good” cholesterol) levels in response to the Western-style meals.

Writing in the December issue of AGE, the authors concluded that the effect of the Mediterranean-style diet rich in olive oil, in combination with coQ10, may have “favorable effects on the aging process” and on the prevalence of age-related conditions.

Previous studies, noted by the authors, have found that the olive-oil rich diet supplemented with coQ10 also improves capillary blood flow and helps maintain healthy blood pressure.

Mediterranean-style diet

A Mediterranean-style diet generally includes greater amounts of fruits, vegetables, whole grains, and olive oil; at least two servings of fish and seafood per week; moderate amounts of poultry, eggs, cheese and yogurt; and fewer meats and sweets.

In this study, the Mediterranean-style diet consisted of 15 percent of calories as protein, 47 percent as carbohydrate, and 38 percent as fat (24 percent monounsaturated fats [from virgin olive oil], 10 percent saturated fat, and 4 percent polyunsaturated fatty acid).

The Western-style diet consisted of 15 percent calories as protein, 47 percent as carbohydrate, and 38 percent as fat (12 percent monounsaturated fats, 22 percent saturated fats, and 4 percent polyunsaturated fats).

Several other studies have pointed to anti-aging benefits from the Mediterranean-style diet. One such study, just published by researchers at Rush University, of Chicago, in the American Journal of Clinical Nutrition linking the diet to a healthier brain in older age (2).

CoQ10 and Oxidative Stress

CoQ10 is a major fat-soluble antioxidant found in all cell membranes, especially within mitochondrial membranes. It’s one of the cell’s most potent scavengers of free radicals, neutralizing the lipid peroxyl radicals that damage cell membranes, proteins and DNA.

Antioxidants are the body’s first line of defense against free radicals and byproducts of metabolism that could lead to cellular decline and dysfunction.

The ability of humans to synthesize coQ10 declines 20 percent for every decade of life after the age of 21. This reduction leads to deficiency, weakness and fatigue throughout the body.

Lower coQ10 levels in tissues and cells can allow for more damage on nearby lipids, proteins and DNA. Because coQ10 is chiefly instrumental (along with selenium) for the regeneration of vitamin E, another potent fat-soluble antioxidant, the diminished coQ10 levels also lead to declines in levels of vitamin E.


1. Yubero-Serrano EM, Delgado-Casado N, Delgado-Lista J et al. Postprandial antioxidant effect of the Mediterranean diet supplemented with coenzyme Q(10) in elderly men and women. Age (Dordr ) 2010.
2. Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr 2010.

19 January 2011

Sweet Sugar Alcohols

You’ve probably noticed sugar alcohols before in chewing gum, candies, baked goods, ice cream and diet drinks. These products are also often labeled “sugar free”, “low in calories”, “diabetic-friendly”, and even “tooth-friendly”. Suspicious? We don’t blame you—when you see the words sugar and alcohol together, there’s plenty of reason to start asking questions. However, upon learning a little about these ingredients you’ll find they have unique benefits.

Sugar alcohol sounds worse than it is because chemists create names based on structures—it’s not the type of alcohol that makes you drunk! Sugar alcohols are so named because they are little carbon rings with OH (oxygen-hydrogen) groups on them, also called polyols. These polyols are naturally found in many plants and are easily recognized by the human body (in fact, human cells produce their own sugar alcohols such as sorbitol).

Fewer calories, greater flavor

The truth is that sugar alcohols, when used in correct amounts, can be safe, natural and healthy. They do provide sweetness and energy, but they have fewer calories than sugar (1-3 per gram versus 4 per gram). This results in a low impact on blood sugar and insulin levels, which is why sugar alcohols are often used in products intended for diabetics.

Some sugar alcohols can also be fermented by friendly probiotic bacteria that make up a healthy intestinal flora. A healthy intestinal flora helps support your immune system and can help improve digestion. In addition, sugar alcohols are seldom able to be metabolized by oral bacteria, which is why they’re “tooth-friendly”. They avoid promotion of tooth decay and cavities.

When used in foods, sugar alcohols can be especially useful. They provide bulk and texture that makes foods and candies more enjoyable to consumers. They enhance and deliver a lasting flavor of sweetness as well as provide a “cooling effect”. Particularly in baked goods, they help prevent browning when exposed to heat and also help those foods stay moist over time.


Not all sugar alcohols are the same. There are many with varying attributes. Maltitol, for example, acts in a different way than, say, xylitol. Maltitol is a disaccharide like sucrose (table sugar) and has almost the same level of sweetness and other properties. This makes it very useful for replacing table sugar while offering fewer calories and avoiding promotion of tooth decay.

When consumed, maltitol is broken down by enzymes to glucose and sorbitol. The glucose is easily absorbed, but the sorbitol is resistant to digestion. Because of its resistance to digestion, sorbitol works in similar fashion to prebiotic fiber, fermenting and feeding that helpful intestinal bacteria.

With maltitol, however, there is a concern about overconsumption, especially in people who are unused to sugar alcohols. Consuming an excess of 10g may cause bloating. And, in absence of soluble fiber, consumption of 20g or more can cause loose stool or diarrhea. You’d have the same laxative effect from eating too many fruits like plums, prunes, apples, pears and cherries. These fruits are all high in sorbitol.

Xylitol and Erythritol

What about xylitol and erythritol? These sugar alcohols are not quite as sweet as sugar or maltitol. And they have a stronger cooling effect than any of the other sugar alcohols. You’d recognize their flavor from sugar-free chewing gum. Like maltitol and sorbitol, they offer fewer calories than sugar and don’t promote tooth decay.

Unlike their counterparts, however, xylitol and erythritol are unlikely to ferment and cause bloating or diarrhea. They are considered non-fermentable because intestinal bacteria have difficulty digesting them. After consumption, most erythritol is absorbed easily into the bloodstream, while xylitol is absorbed more slowly.

Xylitol is notable because it’s found to be more effective than other sugar alcohols in reducing cavities. According to recent studies, primarily from Finland, xylitol may not only reduce potential cavities from forming, but even strengthen teeth. Its mechanism is thought to occur by attracting and “starving” cavity-producing bacteria. The Finnish were the first to extract xylitol from birch, but it’s found in many plants, fruits and vegetables, especially berries, plums and raspberries.

Erythritol is naturally found in grapes, melons and mushrooms, as well as in fermented foods like wine, beer and cheese. Because of its ultra-low impact on blood sugar, you’ll also find erythritol often paired with sugars to lessen its blood-sugar effects in foods, with other sugar alcohols, or with natural sweetening herbs such as stevia in natural sweetener packets.

Reference: Brown A. Understanding Food: Principles and Preparation, 3rd ed. Wadsworth, Cengage Learning. 2008.

17 January 2011

Brussels sprouts in olive oil

For some fun, I've decided to take pics of some foods I eat and write a bit about them.

For example, these Brussels sprouts in olive oil.

I made a bunch of them for my family and me. They all declined, even my grandma. So I ended up eating them for dinner and for breakfast!

But seriously, they're not only delicious (an acquired taste, I guess), but they're also packed with fiber, carotenoids, vitamins, and minerals.

In addition, like other cruciferous vegetables they do contain some sulfur-rich chemicals that are potentially cancer-protective.

These chemicals are called glucosinolates. When they are chewed they end up as hydrolysis products like indole-3-carbinol.

The breakdown products appear to stimulate the body to eliminate carcinogens more easily and/or by inhibiting cells from becoming cancerous.

They might even induce genomic effects, increasing production of glutathione S-transferases, which metabolize isothiocynates and several other compounds including known carcinogens.

According to epidemiological evidence, eating cruciferous veggies can lower risk of lung, colorectal, prostate, and breadt cancer.

That's why I try to eat cruciferous at least twice a week.

Why the Brussels sprouts? Why not enjoy other cruciferous like broccoli, cabbage, cauliflower, and bok choy?

Mainly, it's because I love the sprouts, especially with olive oil as pictured here. The complexity of its flavor is what I go for really.

But also because they have roughly four times as much glucosinolates than other types of cruciferous veggies.

That's a heavy dose of cancer protection for each sprout!

- Posted using BlogPress from my iPhone

10 January 2011

Vitamin D status affected by obesity

People who are overweight or obese are more likely to have lower circulating levels of vitamin D and may have trouble with conversion to its hormonally active form, a Norwegian study suggests.

These findings, published in the Journal of Nutrition, may partially explain why carrying extra pounds raises risk of several poor health outcomes linked to low vitamin D. The hormonally active form is critical for maintaining cell health, strong bones, a strong immune system, and a healthy heart and brain.

University of Oslo researchers observed almost 1,800 people for six years—about 62 percent obese and 11 percent morbidly obese as indicated by Body Mass Index (BMI)—and found an inverse relationship between higher BMI and serum concentrations of circulating 25(OH)2D and the hormonally active 1,25(OH)2D.

A seasonal variation of both vitamin D metabolites in the obese subjects provided clues that excess weight disturbed the complicated conversion (hydroxylation) of the circulating 25(OH)2D to hormonaly active 1,25(OH)2D in the kidneys.

The authors suggest that measurement of both serum concentrations, 25(OH)2D to 1,25(OH)2D, in overweight and obese persons may be valuable because of “the reduced bioavailability” of the fat-soluble vitamin that “accumulates in excess body fat and muscular tissue.”

The research confirms prior studies’ findings that people who are overweight or obese may need to obtain higher amounts of vitamin D from sun exposure, diet or supplementation. In addition, achieving a healthier BMI is predicted as a way to improve vitamin D status.

Several other factors affect vitamin D status, and include lack of sunlight exposure, skin with higher melanin content (darker skin), older age, low dietary intake, and impaired ability to absorb vitamin D from the diet.

Source: Lagunova Z, Porojnicu AC, Vieth R, Lindberg FA, Hexeberg S and Moan J. Serum 25-Hydroxyvitamin D is a Predictor of Serum 1,25-Dihydroxyvitamin D in Overweight and Obese Patients. J Nutr 2011; 141: 112-117. doi: 10.3945/​jn.109.119495.

My thoughts:

I found this to be an interesting paper. The point is that one of the big reasons for why obesity leads to poor health is because it wrecks your ability to use a powerful hormone, vitamin D. People overweight need more vitamin D to cope, plus will improve vitamin D status when they lose weight. A big deal.

09 January 2011

Tucson shooting suspect's possible schizophrenia

I am deeply shocked and saddened as I know many of you are by the news of the senseless shooting that happened in Tucson.

As a resident of Chandler, Ariz., I also found that the incident hit a little too close to home; so, admittedly, I was quick (as many others were) to turn to news reports that offered possible reasons for the heinous act -- politics of the day often pointed out as a motive.

After all, Jared Loughner did target a congresswoman and his Web rantings did wreak of politics. Also, Loughner listed several political books among his favorite reads including Mein Kampf, Animal Farm, and The Communist Manifesto.

However, one book not as often mentioned by the media that caught my eye was this one: One Flew Over the Cuckoo's Nest -- this novel, by Ken Kesey, is one I think reveals more about Loughner than the others.

In short, here's the novel's plot: the setting is a mental hospital, and the tale (in a nutshell) is of a "sane" patient, McMurphy, who has a skewed sense that he has entered a world of psychological control, one that he must escape whatever the cost.

After a failed attempt at freedom and the death of his friend, McMurphy finally takes matters into his own hands, and attacks the "Big Nurse" who symbolically represents all the oppression and brainwashing. It's a kind of suicide act, which eventually has him paying the ultimate price when he is given a lobotomy.

I'm reminded of McMurphy when I read Loughner's disconnected comments in a YouTube video he made before the incident about an imagined fear that the government is "implying mind control and brain wash" of the people, controlling their "grammar structure", and tricking them into believing lies about the U.S. flag.

I'm also reminded of schizophrenia. I'm no psychologist, so a thorough diagnosis is obviously warranted, but I've had the experience of having a person close to me be diagnosed with schizophrenia, and witnessed first-hand the irrational fears they have of the world.

So to me, it appears that Loughner exhibits classic signs of this mental disorder, and that he may have a delusion, or an abnormal interpretation of reality, where the U.S. is one big Cuckoo's nest.

Loughner may have acted in what appears to have been politically motivated, but I think we need to think deeper, and it may serve us all to cease from pointing fingers at political rhetoric (although I agree it should be toned down). Let's look at what's really going on here: mental illness. Loughner did something sick, because he is sick.

What should really be part of our conversation today is how we as a society can do a better job at recognizing the signs of mental illness, such as schizophrenia, and how we can best provide care and treatment to those that suffer from it.

Schizophrenia affects around 2.2 million people in the U.S. alone. Proper diagnosis must be performed by a qualified individual, but we should all at least be somewhat aware of what symptoms to look for and here they are from WebMD:

- Social withdrawal
- Depersonalization
- Loss of appetite
- Loss of hygiene
- Delusions
- Hallucinations
- The sense of being controlled by outside forces

At times, schizophrenia can lead sufferers to behave psychotically, become depressed, cause self-harm, make threats of suicide or violence, commit suicide or acts of violence. The risk of violence from a person with schizophrenia is small, but it can become greater with substance abuse.

We need to spread the message: people who think someone they know someone that may have one or more symptoms of schizophrenia, or know someone with the disorder who has discussed suicide or violence, should help them receive medical care immediately.

In ending this post, I'll just say that my thoughts are with U.S. Rep. Gabrielle Giffords -- who I just learned may have a chance at recovery despite a bullet through her brain -- as well as with the thirteen people who were injured, and the families of the six people who died.