Wednesday, December 26, 2018

Should you eat only low fat or no fat dairy products? The answer may surprise you.

This advice plus other advice to limit saturated fats rapidly led to a massive shift in America to use of low and no fat dairy products from whole fat diary. Unfortunately, for whatever reasons, today America has an epidemic of obesity, overweight, metabolic syndrome, diabetes and perhaps now an increasing incidence of cardiovascular disease.   

Was the dairy advice correct or not? A recent perspective article in the J of the American Medical Association asked experts and suggests that the answer is simply not clear. 

One observation is that Americans use cheese primarily to create pizzas, cheeseburgers and junk foods, while Europeans use cheese as cheese itself.

What is known about the health benefits or non-benefits is based on observational studies which amount to associations rather than clear cause and effect as would be found in a randomized trial where some group gets full fat diary and the other does not. Still, observational studies at least give directions for consideration. 

In the PURE study of 136,000+ individuals 35-70 years of age, a higher intake of dairy fat was actually associated with lower risk of cardiovascular events and mortality. “Whole fat dairy seemed to be more protective than nonfat or low-fat dairy”

Another approach is to look at biomarkers, in this case by examining the blood content of three specific fatty acids are primary derived from dairy products. It turned out that when 16 such studies were pooled with 63,00 participants, those with higher levels of the three fatty acids were less likely to develop diabetes during the time of the trial. 

What about weight gain? It turns out there is no clear-cut evidence that full fat dairy is more likely to lead to weight gain than low fat or no fat diary consumption. An expert quoted in the article noted that there is no strong data to show that full fat diary leads to more weight, more cardiovascular disease or more metabolic syndrome. Rather observational studies suggest just the opposite. 

Another expert interviewed suggested that the key is not to worry about any one ingredient in the diet but what is most important is the overall dietary pattern. This makes good sense to me.

Rubin, R, Whole-fat or nonfat dairy? the debate continues, J Amer Med Assoc, 2018; 320:2514-2516

Some 40 years ago, the Dept of Agriculture recommended a switch to no or low-fat milk and dairy products as part of the effort to reduce the consumption of saturated fats.

Sunday, December 23, 2018

New Years’ Resolutions for Health and Wellness

It is just about the first of January so this might be a good time to think about New Year’s resolutions related to health and wellness.

But first where did the concept of resolutions begin? We know the Babylonians used them in about 2,000 BC during the spring planting time. In their system they promised the gods to pay their debts and to do well by others.

Many cultures worried that the sun would not come back after the winter solstice. Perhaps the days would stay short or even get shorter. So, they prayed to the various gods to have the sun return. 

Julius Cesar started what we know today as the solar calendar. January was the first month and it was named after the god Janus who was two-headed. He could see the year to the rear and the year ahead. He was the god of doors and arches because, again, he could see forward and back. He was also very importantly the doorkeeper to heaven. So, the Romans promised Janus with resolutions of good character and to be good to others. 

In the Jewish tradition in the past and still today one spends the time from Rosh Hashana (the Jewish New Year) through Yom Kippur (the day of atonement) in prayer and reflection. Is it a time to ask forgiveness and to grant forgiveness and to look toward how one can do better in the coming year. 

As the Roman Empire embraced Christianity, the Roman form of resolutions was discarded in favor of reflecting on past mistakes and resolving to improve over the coming year. In the middle ages, the knights took what was known as the “peacock oath” - to maintain the tenants of chivalry.
Today most resolutions are not a compact with a God but rather with one’s self; the resolutions are mostly secular and focus on self-improvement. 

One might think it easy to keep a resolution that you have created for yourself; but it is not. In a 3,000 person poll a few years ago, fifty-two percent said at the beginning of the year that they were confident that they could keep their resolution(s.) However, eighty-eight percent failed. One technique that did help with success was to tell the resolution to others, to make it public. 

Since most of us would like to remain as healthy as long as possible and with that perhaps live a longer time then may I suggest that you consider “The 7 Keys to Healthy Aging” that have been noted here and there in these posts. Remember that they all involve lifestyle modifications toward good nutrition, regular exercise, stress reduction, enhanced sleep, no tobacco, intellectual challenges and social engagement. For more see "Longevity Decoded - The 7 Keys to Healthy Aging"  

As a resolution or two, consider to eat modestly, eat a wide variety of vegetables and fruits, and cut way back on sugar and white flour. Do not forget that healthy fats are important; they can be found in foods such as fish, nuts and seeds, avocados and olive oil. Include a long period of time between the last meal of the day and the first meal of the next day. Breakfast is “breaking the fast” and if that fast can be at least twelve hours that gives time for the cells of the body to do repair and maintenance, a very important function. 

As for exercise, it is worth doing both aerobic and resistance exercises on a regular basis. Just walking for thirty minutes five or six times per week is sufficient for aerobic exercise and doing some form of resistance exercise two or three times a week rounds it out. Sone high intensity interval aerobics twice a week will further augment value. There are many resistance exercises that one can do at home such as the plank, sit-ups, push-ups, and squats but it is worthwhile going to a local fitness center to get a more well-rounded muscular work-out. Push your muscles to exhaustion by 12 to 15 reps; take a break and repeat three or four times. 

Reducing chronic stress is absolutely essential but under emphasized. Among the possibilities are meditation, yoga, tai chi, massage, exercise again and deep breathing. 

Most people do not get enough sleep. Adults need about seven and half hours per night, more as an adolescent. This is when your brain cleans out toxins and organizes memory and sort of tamps down the negative emotional issues of the previous day or weeks. Commit to getting good sleep and in part do so by keeping the bedroom dark and quiet with no light or sound interruptions by cell phones, TV sets, etc. In the time before going to bed, avoid overly stimulating movies or TV shows. 

It is essential to have no tobacco at all. Those who smoke have about a decade less longevity. IT is not just lung cancer but many cancers and especially coronary artery disease and stroke. For the 20% of you who still do smoke, look for a smoking cessation counselor who can give you the assistance you need. 

The five keys just reviewed go for all parts of the body. The brain however needs those five plus two more. These are intellectual challenges and social engagement. Like any other organ it needs to be used to be maintained and strengthened. This might be with music, art, dance, learning a new language, whatever, as long as the brain is kept active and stimulated. As to social engagement, humans need to interact with others in an effective manner. The simplest approach here is to make and keep your friends. 

So, there it is, some health and wellness ideas for you to consider for  New Year’s resolution(s). Remember – do not try to do too much. Do not set yourself up for failure. Maybe you want to commit to going to the fitness center three days a week. Maybe getting out more with your neighbors and by interacting in various activities. Maybe working on better sleep. Whatever it is remember to say it out loud to others that this is something that you are going to be focused on. Your success rate will be much better. Making progress on any of these will benefit your health now, assist in preventing the onset of disease in later years and add to your longevity. Best wishes for your resolution successes. 

Monday, November 5, 2018

Nutrition – One of The 7 Keys to Healthy Aging

“If We Could Give Every Individual The Right Amount Of Nourishment And Exercise – Not Too Much And Not Too Little – We Would Have Found The Safest Way To Health,” Hippocrates.
 Two thousand four hundred years ago and it is still the best advice.
Your agenda is health and longevity. This means most of us have to modify our lifestyles. That is the goal. If lifestyles are changed to include appropriate eating patterns and appropriate food intake along with exercise, better sleep, no tobacco and less stress, then health and wellness will follow and persist. This means many fewer chronic illnesses and a longer lifespan. But it is very important to modify lifestyles for the long term, not just a few weeks or months.
A good place to begin is with nutrition and for that a good starting point is to understand and follow the Mediterranean Diet. It consists of extensive fresh vegetables and fruit each day plus regular servings of nuts, seeds and beans along with whole grains such as whole wheat, oats and brown rice, olive oil and fish with a topping of wine but limited meat and very little added sugar. This is widely considered to be a sound, healthy diet. As a general rule it is food prepared “from scratch” in the kitchen, not processed food from the manufacturers nor prepared foods from the corner deli or fast food place.

There are some specifics that should be noted.
Cover your plate with two thirds vegetables and only one third with meat or fish. Make the veggies the major part of the meal. Fresh and local when possible and organic whenever available. Fix them simply such as steaming, stir frying or baking. Fresh vegetables need little seasonings although some herbs are both flavorful and healthy additions. Dark greens should be a frequent part of the meal – spinach, kale, collards, dandelion greens, arugula and Swiss chard are good examples. Spinach, arugula and dandelion make a wonderful salad; toss it with olive oil and balsamic vinegar and perhaps top it with a few slivers of carrot plus some cucumber slices and cherry tomatoes. Consider steaming or stir frying the others.
Fruits are important. Eat a wide variety of types and colors, preferably local and fresh although frozen is fine. Avoid canned fruits as they invariably have added sugar. Berries like strawberries, blueberries, blackberries, raspberries and cherries are high in polyphenols that are valuable for many metabolic processes and especially good for the brain.
Whole grains means just that and not refined white flour as found in most breads, packaged foods such as most cereals, pasta, cakes, pies, cookies, and yes even pizza. Refined white flour has essentially no nutritional value so it is essential to avoid all of these, with perhaps a rare treat or two. It follows that trips to the fast food outlet are verboten. Fats are fine in moderation and indeed are essential. Get them from olive oil, avocados, nuts and seeds and from fin fish. Avoid trans fats. Keep omega 6 fatty acids to a minimum; they are found in many commercially baked goods.
It is critical to avoid sugar. This is difficult since we have been trained to desire sweet tastes and sugar of various types is added to many packaged foods, sodas, yogurts and of course ice cream. The limit per day is 25 grams for women and 37 grams for men. To put this in perspective, a can of soda has the full complement of sugar for a man and is well over that for a woman. One more reason to avoid fast foods. When you buy cheese avoid ones with food colors; real cheese has natural color. Yogurt is very healthy but most brands add fruit, flavoring and a lot of sugar. Look to also see that the cultures are “live;” many are not and essentially all flavored yogurts and those with sugar added have no live cultures.
Fish are high in omega 3 fatty acids – the good fats. You need them and can’t create them in your body so it must come from your foods. Most beef comes from animals that have been placed in small pens for months and fed a diet of grains like corn and soybeans so as to fatten them up. But this fat is mostly omega 6 fatty acids which is pro inflammatory. Unfortunately, the USDA labels the fattest beef as “prime.” Beef from cattle that have been grazed their entire life have minimal omega 6s and do have omega 3 fatty acids but the amount pales compared that found in salmon, mackerel or sardines. Another important point – find meats that do not have additives, either on the range, the feed lots or added after butchering. Antibiotics, growth hormone, nitrites and other additives are likely adverse to your gut health.
Chickens are usually raised in buildings so that they never see the light of day before slaughter but do have antibiotics in their feed and may be stimulated with hormones to grow larger. Look instead for poultry from farms that use no additives and let the chickens fun free. And with all meats avoid these that have added liquid “to retain moisture.” Get real chicken and real beef, lamb or pork, additive free and pasture grazed.
Buying organic vegetables and fruits and grass-fed meats are more expensive for sure. But the health benefits outweigh the costs.

Is there anything that you can eat? Yes, dark chocolate, preferably 85% cocoa or more. It is inherently healthy. So is coffee. It is not only OK but healthy to have alcohol in moderation.
You are eating not just for yourself but also for the bacteria in your intestines – the gut microbiota (microbiome.) The 100 trillion of them need nourishment so that they can help maintain your immune system, your intestinal lining cells and so that they can produce various nutrients that your cells in various organs use for energy. Their “food” is the fiber that your intestinal enzymes cannot digest but which the bacteria love. The best sources are in vegetables and fruits. Consume inadequate fiber and the “good” bacteria are starved. If meanwhile, you eat sugar, refined white flour or too much alcohol, you will be feeding the “bad” bacteria with detrimental results. That, of course, is a common combination in the standard American diet but it leads to increased intestinal permeability (“leaky gut”), local and systemic inflammation, passage of toxins into the bloodstream and the induction of a variety of complex chronic illnesses. So, treat those bacteria well. The foods like veggies with their high fiber content that benefit the gut microbiota are called prebiotics. Foods that include bacteria and yeasts that are known to be healthy are called probiotics and are found in many foods like live culture yogurts, live culture Kefir, non-pasteurized sauerkraut, kim chi and other fermented foods. Have some regularly.
To recapitulate – aggressively avoid added sugars; eat lots of veggies of a wide range of colors including dark green leafies; include only whole grains and not too much. You need good fats as found in olive oil, nuts and seed, and lots of fish. Dairy, eggs and poultry are best if it comes from grass fed animals. Same for beef, pork and lamb in limited quantities. Include some wine and plenty of water. Be sure to include plenty of fiber foods and probiotic foods as well. Local, fresh and organic are preferable.
This combination will keep you healthy and keep your intestinal bacteria happy as well. When they are happy, you will be healthier
A final word comes again from Hippocrates; “All disease begins in the gut.” 

Still the best advice only now we begin to understand just why he was correct.

Next post – Keep moving!

Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).