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Don’t Trust Science Blindly

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The world of scientific articles is like shark infested waters; be constantly on the alert, that ANY article published in even the most reputable journals might bite you.

The Clinical Journal of the American Society of Nephrology published an article in their July issue (Vol. No.1 ) which caused me nothing short of a hypertensive crisis (sudden elevation of blood pressure to possibly harmful levels). Why? Because articles of this kind find their way very quickly into the mainstream media, and lead to harmful, even dangerous recommendations to the general public.

Needless to say, that, as the crusader that I am, I feel compelled to unravel this article for you, in case you come across its conclusions in some well meaning magazine that you purchase next time you’re at the air port’s news stand.

The title of the article is innocent enough: Comparative effects of low-carbohydrate high-protein versus low-fat diet on the kidney.

So far so good.

Given the concerns that exist about the deleterious effects on the kidneys when people go on low-carbohydrate / high-protein weight loss diets, the authors decided to perform a randomized, controlled long-term trial: between 2003 and 2007, 307 obese adults without serious medical illnesses at three US academic centers were randomly assigned to either a low-carb / high-protein or a low-fat weight loss diet for 24 months. The main outcomes the study addressed were kidney function criteria (I will spare you the technical details, but you can always look into the original article, which I will list at the bottom). From their results, the authors concluded, that in healthy, obese individuals, a low-carb / high-protein weight loss diet over 2 years was not associated with noticeably harmful effects on the kidneys, compared with a low-fat diet.

Sounds great, doesn’t it?

Well, let’s look closer – real close – at this article, shall we?

The participants were between 18-65 years old, 208 women and 99 men, with BMI’s between 30-40, categorizing them as obese individuals. No one was allowed into the study if they weighed more than 300 lb. These people were then randomly assigned to either one of the two diets.

153 participants ended up on the unlimited fat / limited carbs diet, based on Dr. Atkins’ New Diet Revolution.

The other 154 participants were placed on a low-fat, calorie restricted diet (1200-1500 cal for women, 1500-1800 cal for men).

Let’s see how they defined this “low-fat” diet:

  • 55% of calories from carbohydrates
  • 30% of calories from fat
  • 15% of calories from protein

In addition, all participants received comprehensive, face-to-face group behavioral treatment weekly, for 20 weeks, every other week for another 20 weeks, and then every other month for the remained of the 2-year study period. Pretty intense stuff. Certainly not the kind of support people usually get, when they go on a drastic diet.

So, what happened?

Since they pretty much excluded anyone with any kind of medical problem – even people who had blood pressures of 140/90 (whether they were treated or not) – at the end of the study, no one in the Atkins group had any apparent kidney problems, based on the parameters the authors set. Which led them to the victorious conclusion above.

Not so fast.

What really happened here?
For starters, let’s look at the two diets; one is well known, the Atkins diet, which by now has been reviewed more times than I can count, and the conclusions are always the same: yes, there is initial weight loss, but at the price of putting the body into the most unnatural and unhealthy state of ketosis (keto-acidosis), which is only encountered, when an individual is severely ill. Long term effects of the diet are multiform: higher rates of heart disease, high cholesterol, kidney damage and more. Besides: it’s a DIET, meaning, no one can stay on it for life, it is simply unsustainable. And so, people gain the weight back, in which case they go back on “the diet”, thus joining the roller-coaster of dieting Jo-jos. Those, too, have deleterious consequences on long term health. A vicious cycle. One can not live on a DIET, eating must be a life style.

Let’s see what the control group ate, those on the “low fat” diet: not only was their calorie intake restricted, but 30% of their calories came from fat. That is NOT a low-fat diet, not by any stretch of imagination. Based on recommendations from the NIH (National Institute of Health) and the IOM (Institute of Medicine), no more than 15-20% of calories should ever come from fat, out of which no more than 7% should be saturated. The average American diet is hardly worse at 35-40% fat from calories.The control group is just as miserable as the study group – plus, they are HUNGRY.

No wonder then, that the drop out rate in both groups was astronomical: 52% in the Atkins groups and 46% in the control group, so that data for each study parameter was quite limited.

For those, who decided to stick it out, the rewards were few and disappointing: according to the authors, “[…] weight loss was similar in both groups… at around 7%”

Wait a second: so, after eating one of the unhealthiest diets on the planet in the name of weight loss (Atkins), or going to work and to bed hungry every day (AND eating lots of fat), both groups had the SAME weight loss?

But it gets worse: let’s do a quick calculation to see what 7% weight loss really mean. For the sake of argument, someone weighing 250 lb at the beginning of the study lost a mere 17.5 lb over TWO years! You have got to be kidding.

But at least they all had happy kidneys – happy end!

The end points of this study are so irrelevant, that they might have been the occurrence of head aches or pimples, just as well. Taking otherwise (still) healthy adults, who happen to be obese and subjecting them to an unhealthful diet, just to show that the few remaining ones (those who didn’t drop out) didn’t have damaged kidneys, is not furthering the science of healthy weight management in any form or fashion. Had they included weight loss and successful adherence to the diet as study end points as well, their conclusions would have been much less triumphant, but a whole lot more relevant, don’t you think?

The fact, that both the study and and the control groups received intensive group support and still failed both diet protocols, are very important insights, which the authors prefer to drop completely in their discussion.

And what about those who did drop out? Was it because they FELT sick, or maybe BECAME sick? No information there.

Yes, esteemed readers of my blog, this is science. And the authors did not receive any funds from the Atkins people either. They did this study in full faith.

Wanna bet that these “great study results” will be cited pretty soon in a magazine or nutrition newsletter out there? I am certain of this, because it has happened so many times before – see my first blog post about CSPI. This is a sad and dangerous state of affairs, since the public must rely on rehashed and digested scientific information. My advice: choose your sources wisely. Websites like www.PCRM.org, www.drmcdougall.com, www.jeffnovick.com and www.nutritionfacts.org are some of the best sources of information out there. You can rely on their truthfulness and validity 100%+. And with time, who knows, maybe WE, the crusaders, will win the battle against misinformation and manipulation after all…

I shall remain optimistic.

Bibliography:

  1. Friedman AN,Ogden LG et al. Comparative effects of low-carbohydrate high protein versus low fat diets on the kidney. Clin J Am Soc Nephrol 7;2012:p.1-9
  2. Lagiou P, Sandin S, Lof M, Trichopoulos D, Adami HO, Weiderpass E. Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ. 2012;344:e4026
  3. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction. JAMA 2005;293:43-53.
  4. McDougall Newsletter. Atkins Was Grossly Overweight and Sick– But the Media Loves the Dead Guy. February 2004.

“When In Rome…

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…do as the Romans do.”My latest travels took me to the ancient, modern, exciting, eternal city of Rome. No, the photo above is not retouched. The sky was REALLY that blue. It’s been 12 years since my last visit there, but this time I fell in love. Hard and irreversible. This city has everything: 2000 years of history, all the modern amenities of life in the 21st century, culture, trash in the streets, and above all: food that seems to come from heaven.

The closeness to heaven is implied by the omnipresence of St. Peter’s Basilica’s rooftop, visible from almost everywhere. But the Vatican does not hold a monopoly on heaven on earth.

Romans – and Italians in general – have always cherished their foods in a simple, unadulterated way. Rome is the city with the largest agricultural use of its territory in the world. Yes, Romans – and Italians in general – prefer to eat what they grow. What a concept.

Neighborhood markets are the most natural and accepted thing in the world.

Eating in season? What do you mean? How else would we (the Romans – and the Italians in general) eat?

Strawberries in February? No. We don’t do that. This is an original citation from the owner of a wonderful tiny Osteria (Restaurant) in Trastevere, a suburb of Rome.

His tiny kitchen serves an even tinier dining room that is packed to the gills with Italian customers: the food is simple, his pasta is home made, as well as all the other ingredients.

The menu changes by the minute: as the items listed are being consumed, they get stricken off the menu with a pencil! Better be early!

One thing that becomes quickly obvious, is that the foreign tourists are overweight, while the Romans are (still mostly) thin. That is no joke.

You can guess who is who.

What is an example of “fast food” in Rome?

Answer:

These are being sold everywhere. But interestingly, I observed that it’s mostly the locals who buy them (they are really cheap), while the tourists indulge in huge cones of GELATO: after all Italy is famous for it, right?

But that is not the only reason why Romans are trimmer than their foreign guests.

Rome has many, many, many stairs.

And Romans walk a lot every day; the city is pedestrian-friendly, with many areas closed off to vehicular traffic.

The only way to know a city, is to walk it.

That’s how I fell in love with Rome.

Phytochemicals – a term for daily use

It’s time to talk about phytochemicals, and make this term a household name.

Just think about it: it sounds like a plot, an animal conspiracy to insure the untimely demise of carnivores and longer lives of vegetarians: the more animal foods people eat, the greater their risk of dying from chronic diseases such as heart disease, cancer and diabetes. When people switch to a plant based, whole foods diet, their risk for such diseases miraculously diminishes.

By now, many people know about the benefits of adding fruits and veggies to their diets: plant foods are low in saturated fats and completely free of cholesterol. Plant foods are rich in fiber – animal foods are 100% fiber-free. The proteins in plant foods PROTECT against heart disease and kidney disease, while animal protein INCREASES exactly those risks. Fruits and vegetables are rich in antioxidant nutrients like vitamin C, E and beta-carotenoids.

But just when you thought, we knew all there was to know, in come the PHYTOCHEMICALS.

Phyto is Greek for “plant”; these are the naturally occurring chemicals that are responsible for the flavor, color, smell and texture in all fruits and vegetables. While phytochemicals are not currently considered essential nutrients, volumes of research studies are accumulating to support their strong and consistent beneficial effects on health.

Phytochemicals are not there for OUR benefit, but for the plants’: they help regulate plant growth and protect the plants from disease and insects. How lucky for human kind that exactly THOSE compounds work miraculous wonders for the human body. NO component in ANY animal food does that – another proof that humans were meant to consume primarily plant foods.

While veggies and fruits are considered our primary sources of phytochemicals, many legumes, whole grains, nuts, seeds, herbs and spices provide impressive contributions to our intakes. Tens of thousands of phytochemicals are scattered throughout the plant kingdom. The largest category of phytochemicals is PHENOLIC compounds, a group of over 4000 different chemicals. Within this category, there are several subgroups, the three most important being:

  • Flavonoids: concentrated mainly in veggies, fruits, green tea and soybeans.
  • Phenolic acids: found mainly in whole grains, berries, cherries, grapes, citrus and other fruits.
  • Tannins: found in lentils and other legumes black and green teas, grapes and wine.

Phenolic compounds have been found to have powerful antioxidant, anticancer and anti-cardiovascular disease effects.

Another large and extremely powerful group of phytochemicals is TERPENES. They include

  1. Carotenoids (lykopene, beta-carotene and lutein) found in carrots, tomatoes, leafy green vegetables and other fruits and veggies
  2. Limonoids found in citrus fruits

In addition to the a fore mentioned powerful antioxidant, anticancer and anti-cardiovascular disease activities, these compounds reduce the effectds of aging and macular degeneration of the eyes.

A third major category of phytochemicals is the SULFUR-CONTAINING CHEMICALS such as

  1. Organo-sulfur compounds found in garlic
  2. Isothiocyanates, such as sulforaphane (view my previous post in this) in cruciferous vegetables.

These compounds have powerful anticancer and immune-enhancing abilities which have been demonstrated in the lab as well as in large population based studies.

What makes matters complicated – and VITALLY IMPORTANT – is that phytochemicals must act syngergistically for their effect, in order to produce the benefits observed. That is why they must be consumed as WHOLE food nutrients, and not as synthesized powders or pills, where their effects are NOT present. While interest in phytochemicals has spurned a whole new market for supplements and designer foods, NONE of these have shown the benefits observed from consuming the WHOLE food containing these substances: in fact, isolated administration of vitamin E was found to increase the risk of death when administered as a synthetic supplement.

While some foods stand out as real powerhouses, variety is the real key to a phytochemical-rich diet. Aim to make these foods part of your daily, regular meals, and you will have a phytochemical feast!

Watch out for my next blog; lots of examples on how to build a phytochemical feast at every meal!

Bibliography:

  1. Miller ER et al.: Meta-analysis: high dose vitamin E supplementation may increase all-cause mortality. Annals Int Med; Jan 2005: vol 142, p 37-46
  2. King A et al.: Characteristics and occurrence of phenolic phytochemicals. J Am Diet Assoc 99,2 (1999), 213-218
  3. Hughes JS: Understanding phytochemicals in fresh fruits and vegetables. ISHS Acta Horticulturae 875: 2009 Southeast Asia Symposium on quality and safety of fresh and fresh cut produce
  4. Khawaja O. et al: Chocolate and coronary heart disease: a systematic review. Current Atherosclerosis Reports, Vol 13, No 6 (2011), p. 447-452
  5. Davis B. et al: Becoming vegan. The complete guide to adopting a healthy plant-based diet. Book published by Book Publishing Company, 2000

How is your gut feeling today?

We don’t talk about out gut, digestive system, large intestines – small intestines for that matter – as part of everyday conversation. When we do, it’s because something went wrong: indigestion, “stomach bug” (there is no such thing) and other euphemisms are recruited.

On TV, we are told in many ads, that “the purple pill” cures all, that diarrhea / constipation can be remedied by another pill, that fiber comes in a Metamucil container and once dissolved in water, becomes invisible. Did I mention the special yogurts, that have probiotics in them, and cost of course more?

Once again, the rule applies: do NOT buy/eat/consume anything you see advertised on TV. There is so much wrong with all of the above…

But today’s topic will be about the large intestines, the colon, the GUT:

For many years it was believed that the main function of the large intestine was the resorption of water and salt, and the facilitated disposal of waste materials. That’s exactly what I learned in medical school.

Not so: Far from it.

For starters: 70% of our immune system is located in the digestive tract, which starts at the mouth and ends at the anus.

But imagine this: there is such a complex microbial ecosystem in our large intestines, that it should be considered a separate organ within the body, with a metabolic capacity which exceeds the liver by a factor of 100. The human colon harbors a highly comples microbial ecosystem of about 200g living cells at concentrations of 1012 microorganisms per gram of gut content, the highest recorded for any microbial habitat on earth.

The intestinal microbiome is therefore closely involved in the first-pass metabolsim of dietary compounds. What does this mean? Many of the hugely important nutrients like polyphenols and lignans, that we must obtain from plant food, aren’t even present as such in the plant foods we eat, but are synthesized in our large intestines, thanks to that microbial ecosystem I described above. This has dramatic consequences for our health: lack of plant foods along with the destruction of the vigorous microsystem in the gut will certainly lead to disease.

Take lignans for example: these are chemical compounds found in plants (like flax seed). They play key roles in cell metabolism, acting as antioxidants among many other functions. Many lignans are only present as precursors in certain plants, and are converted as the active metabolite in the large intestines. Low lingnan status has been reported to be related to an elevated risk of breast cancer. It is also well known, that lignan status is reduced by antibacterial medications (antibiotics).

A Finnish research study looked at just that, and found that pre-menopausal women using long-term medication for urinary tract infections showed a possible elevated risk for future breast cancer.

As flax seed goes, it is one of the most important oilseed crops in the world. The seed provides oil rich in omega-3, alpha-linoleic acid, high quality proteins, and “lignans” – actually precursors of lignans. In fact, it has the highest content of “lignans” of all plant food for human consumption. But without the “good” bacteria in our large intestines, we cannot assimilate, metabolize and benefit from any of these nutrients.

Flax seed is inexpensive, it comes in brown and gold colors, and should always be bought as a whole seed. Pre-ground seeds have lost a tremendous amount of their precious nutritional content.

At home, use a simple coffee grinder, that you can purchase for around $17.- at your supermarket or Target store. Grind just enough seeds to last you for a week, and store the ground seeds in an airtight container in the fridge.

1-2 tablespoons of ground seed per day should be added to any of the following:

  • breakfast cereal
  • sprinkle on salad
  • sprinkle on cooked veggies or soup
  • sprinkle on fruit

It has a pleasant nutty taste, and blends right in. The seeds should not be cooked, but eaten raw, after grinding. Adding flax seed meal (finely ground seed) to pancake, muffin or cake batters will always enhance the nutritional content, even if high temperatures will destroy some of its nutritional value.

Take care of your gut. It is one of the most important organs contributing to your health and well being. (There are no unimportant organs).

Don’t take your good gut-feeling for granted!

Bibliography:

  1. Possemiersa S., Bolcaa S., Verstraetea W., Heyerick A.: The Intestinal microbiome: a separate organ inside the body with the metabolic potential to influence the bioactivity of botanicals. Filoterapia, Vol 82, Issue 1, January 2011, p 53-66 Presented at the DSHEA 2012 Symposium Chicago
  2. Knekt P., Adlercreutz H., Rissanen H., Aromaa A., Teppo L.: Does antibacterial treatment for urinary tract infection contribute to the risk of breast cancer? Br J Cancer. 2000 March; 82(5): 1107-1110
  3. Singh K., Mridula D., et al: Flax seed: a potential source of food, feed and fiber. Critical Reviews in Food Science and Nutrition 51:210-222 (2011)

What’s on YOUR salad?

All plant based, whole food eaters follow these two basic rules:

  • Eating the tastiest, most satisfying foods possible
  • Getting the maximum nutritional-buck-for-calorie while doing it

The craze for fat-free salad dressings has been the biggest scam – along with all the other fat-free processed foods out there: fat had to be replaced for the sake of taste with something else. And that “something else” is SUGAR.

The absolute WORST part of all the bottled salad dressings is, that

  1. they are devoid of absolutely ALL nutrients: no vitamins, no antioxidants, no phytochemicals, NOTHING
  2. they are HIGH in SODIUM
  3. they contain a lot of added sugar
  4. they contain lots and lots of fat (if not fat free)

This is just a typical example: two table spoons provide over half of their calories from FAT.

Bottled salad dressing is the epitomy of processed, empty food. It does NOT belong on a fresh salad.

So, what’s the alternative?

Answer: your imagination!!!

Let me show you how to get started:

The idea behind building your own nutritious, perfect salad dressing follows the two basic rules stated above. Based on that, here is one of my MANY versions of a salad dressing.

Goji berries: they are nutritional power houses as far as anti-oxidant and other phytochemical contents are concerned. Forget the juice, the pill, the extracts! Buy dried berries, just as you would buy raisins and other dried fruit, and have them on hand at all times.

Walnuts: are a phenomenal source of Omega 3 fats, and other powerful nutrients, as many studies have shown. Buy in bulk and keep them in an airtight container in the fridge; they last for months!

Rice Vinegar: delicious. You can of course substitute the vinegar of your choice. But give this one a try: it is mild and aromatic.

Mustard: everyone has THAT in their fridge!

Miso Paste: now THERE is a superfood, if I have ever known one. I am partial to the South River brand because of the way they manufacture it. It’s “alive” with enzymes and protein, and a superb condiment. Check out their website for excellent information on miso in general. And try out different flavors; I have all of them in the fridge!

Garlic Powder: another kitchen staple to have!

Take a one-cup measure, and fill it with 1/2 cup Goji berries, then cover them with hot filtered water to the one-cup mark. Let sit for about 30 minutes or so: the Goji berries need to soak and absorb the water.

Next, all ingredients listed go into the Vitamix or blender:

  • Goji berries and the soaking water
  • 1/2 cup walnuts (can also be pre-soaked)
  • 1/2 cup (rice) vinegar
  • one heaping teaspoon Miso paste
  • one heaping teaspoon mustard
  • 1/2 teaspoon garlic powder

Blend everything to a liquid consistency, and adapt seasonings as necessary, as well as more liquid (either water or vinegar) for desired consistency. Store the dressing in an airtight container in the fridge.

Voila: your super-nutritious, fresh, delicious salad dressing. And the sky is the limit.

Next time use fresh or frozen raspberries as your starter ingredient; add flax seed (not oil!) or almonds as your fat source, and season away! Avoid salting the dressing; prefer seasonings like Miso or herbs instead. Honey or agave can make for wonderful sweetness, but so can soaked dry fruit like dates or raisins!

Start playing – and don’t forget to share your discoveries!!