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In this issue:

• Eat Food: Michael Pollan’s Advice on Eating.
• How Much of Medical Practice Is Evidence Based: Not for the Squeamish
• Do Cholesterol Lowering Drugs do Any Good?
• More News on Vitamin D
• Green Flowers and Healthy Chocolates

 

The Best Nutritional Advice We Know: In Seven Words

Very short version: “Eat food. Not a lot. Mostly plants.”

Short version: NY Times article by Michael Pollan: “Unhappy Meals: www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?pagewanted=all

Complete version: Michael Pollan. In Defense of Food: An Eater’s Manifesto. 2008. Penguin Press, $21.95 (232p)

Eat food.

1. Don’t eat anything your great-great-grandmother wouldn’t recognize as food. Sorry, but at this point Moms are as confused as the rest of us, which is why we have to go back a couple of generations, to a time before the advent of modern food products. There are a great many food like items in the supermarket your ancestors wouldn’t recognize as food (Go-Gurt? Breakfast-cereal bars? Nondairy creamer?); stay away from these.

2. Avoid even those food products that come bearing health claims. They’re apt to be heavily processed, and the claims are often dubious at best. Don’t forget that margarine, one of the first industrial foods to claim that it was more healthful than the traditional food it replaced, turned out to give people heart attacks. When Kellogg’s can boast about its Healthy Heart Strawberry Vanilla cereal bars, health claims have become hopelessly compromised. (The American Heart Association charges food makers for their endorsement.) Don’t take the silence of the yams as a sign that they have nothing valuable to say about health.

3. Especially avoid food products containing ingredients that are a) unfamiliar, b) unpronounceable c) more than five in number – or that contain high-fructose corn syrup. None of these characteristics are necessarily harmful in and of themselves, but all of them are reliable markers for foods that have been highly processed.

4. Get out of the supermarket whenever possible. You won’t find any high-fructose corn syrup at the farmer’s market; you also won’t find food harvested long ago and far away. What you will find are fresh whole foods picked at the peak of nutritional quality. Precisely the kind of food your great-great-grandmother would have recognized as food.

Not A Lot

5. Pay more, eat less. The American food system has for a century devoted its energies and policies to increasing quantity and reducing price, not to improving quality. There’s no escaping the fact that better food – measured by taste or nutritional quality (which often correspond) – costs more, because it has been grown or raised less intensively and with more care. Not everyone can afford to eat well in America, which is shameful, but most of us can: Americans spend, on average, less than 10 percent of their income on food, down from 24 percent in 1947, and less than the citizens of any other nation. And those of us who can afford to eat well should. Paying more for food well grown in good soils – whether certified organic or not – will contribute not only to your health (by reducing exposure to pesticides) but also to the health of others who might not themselves be able to afford that sort of food: the people who grow it and the people who live downstream, and downwind, of the farms where it is grown.

“Eat less” is the most unwelcome advice of all, but in fact the scientific case for eating a lot less than we currently do is compelling. “Calorie restriction” has repeatedly been shown to slow aging in animals, and many researchers (including Walter Willett, the Harvard epidemiologist) believe it offers the single strongest link between diet and cancer prevention. Food abundance is a problem, but culture has helped here, too, by promoting the idea of moderation. Once one of the longest-lived people on earth, the Okinawans practiced a principle they called “Hara Hachi Bu”: eat until you are 80 percent full. To make the “eat less” message a bit more palatable, consider that quality may have a bearing on quantity: I don’t know about you, but the better the quality of the food I eat, the less of it I need to feel satisfied. All tomatoes are not created equal.

Mostly Plants

6. Eat mostly plants, especially leaves. Scientists may disagree on what’s so good about plants – the antioxidants? Fiber? Omega-3s? – but they do agree that they’re probably really good for you and certainly can’t hurt. Also, by eating a plant-based diet, you’ll be consuming far fewer calories, since plant foods (except seeds) are typically less “energy dense” than the other things you might eat. Vegetarians are healthier than carnivores, but near vegetarians (“flexitarians”) are as healthy as vegetarians. Thomas Jefferson was on to something when he advised treating meat more as a flavoring than a food.

7. Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks. Confounding factors aside, people who eat according to the rules of a traditional food culture are generally healthier than we are. Any traditional diet will do: if it weren’t a healthy diet, the people who follow it wouldn’t still be around. True, food cultures are embedded in societies and economies and ecologies, and some of them travel better than others: Inuit not so well as Italian. In borrowing from a food culture, pay attention to how a culture eats, as well as to what it eats. In the case of the French paradox, it may not be the dietary nutrients that keep the French healthy (lots of saturated fat and alcohol?!) as much as the dietary habits: small portions, no seconds or snacking, communal meals – and the serious pleasure taken in eating. (Worrying about diet can’t possibly be good for you.) Let culture be your guide, not science.

8. Cook. And if you can, plant a garden. To take part in the intricate and endlessly interesting processes of providing for our sustenance is the surest way to escape the culture of fast food and the values implicit in it: that food should be cheap and easy; that food is fuel and not communion. The culture of the kitchen, as embodied in those enduring traditions we call cuisines, contains more wisdom about diet and health than you are apt to find in any nutrition journal or journalism. Plus, the food you grow yourself contributes to your health long before you sit down to eat it. So you might want to think about putting down this article now and picking up a spatula or hoe.

9. Eat like an omnivore. Try to add new species, not just new foods, to your diet. The greater the diversity of species you eat, the more likely you are to cover all your nutritional bases. That of course is an argument from nutritionism, but there is a better one, one that takes a broader view of “health.” Biodiversity in the diet means less monoculture in the fields. What does that have to do with your health? Everything. The vast monocultures that now feed us require tremendous amounts of chemical fertilizers and pesticides to keep from collapsing. Diversifying those fields will mean fewer chemicals, healthier soils, healthier plants and animals and, in turn, healthier people. It’s all connected, which is another way of saying that your health isn’t bordered by your body and that what’s good for the soil is probably good for you, too.

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How Much of Medical Practice is Evidence Based?

From: Ralph Moss: Cancer Decision Newsletter Archives 5/11/2008.

Many procedures, drugs and treatments that were once considered the standard of practice and scientifically based eventually are discredited and discontinued. How can that be if the practice of medicine has a strong scientific basis. Or does it?

This question has been investigated by the British Medical Journal Clinical Evidence, an offshoot publication of the venerable British Medical Journal. As Ralph Moss writes in a recent newsletter, this journal seeks “to provide physicians and patients with the best available evidence, garnered wherever possible from randomized, controlled clinical trials (RCTs), which are considered to be the most reliable and rigorous standard for measuring treatment effectiveness. The journal describes itself as ‘the international source of the best available evidence for effective health care'”.

To do this the journal assembled a distinguished team of advisors, peer reviewers, experts, information specialists and statisticians. They reviewed scientific studies regarding approximately 2500 treatments, asking the question “What proportion of commonly used treatments are supported by good evidence, what proportion should not be used or used only with caution, and how big are the gaps in our knowledge?” .

What did they conclude?

• 13 percent have been found definitely beneficial.
• 23 percent are rated as likely to be beneficial
• 8 percent can be classified as a trade off between benefits and harms
• 6 percent are clearly unlikely to be beneficial;
• 4 percent are likely to be ineffective or harmful,
• and a whopping 46 percent – almost half of all treatments reviewed – are rated as being of unknown effectiveness.

Scary? As the journal acknowledges, these figures suggest that most treatment decisions rest not on solid evidence obtained through properly conducted clinical trials, but on the individual preferences of clinicians, unsupported in the majority of cases by any concrete evidence of benefit.” (Italics inserted) The question that you might ask a physician when she or he recommend a drug, or surgery, (or diet or supplement) or you might ask of a drug company when they advertise a new product is “what evidence do you have that this treatment is effective and how sound is that evidence?” This is a legitimate and important question.

Reproduced by kind permission of BMJ Clinical Evidence

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Do Cholesterol Drugs do Any Good?

Statins and other cholesterol lowering drugs “are the best-selling medicines in history, used by more than 13 million Americans and an additional 12 million patients around the world, producing $27.8 billion in sales in 2006. Half of that went to Pfizer for its leading statin, Lipitor.” Statins certainly reduce cholesterol, but up to 20% of people taking them get side effects. Do they really prevent death and disease? What is the level of evidence of their effectiveness? James M. Wright MD (no relation to Peggy) a professor at the University of British Columbia, is also director of the government-funded Therapeutics Initiative, whose purpose, like that of the British Medical Journal Clinical Evidence, is to analyze the data on particular drugs and figure out how well they work. Wright’s team was “analyzing evidence from years of trials with statins and not liking what it found.” First, Wright concluded that these drugs can be “life-saving in patients who already have suffered heart attacks, somewhat reducing the chances of a recurrence that could lead to an early death.” But Wright was surprised to find that there was

• “no benefit in people over the age of 65, no matter how much their cholesterol declines, and
• no benefit in women of any age.”
• “a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials.” But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization-despite big reductions in “bad” cholesterol.”

“Most people are taking something with no chance of benefit and a risk of harm,” says Wright.

This is a controversial topic, and not a simple one. Our understanding is that:

• In many people cholesterol is not the prime culprit, but rather a marker and collaborator with an unhealthy metabolism (Inflammation, insulin resistance, endothelial dysfunction, nutritional deficiencies, etc). We believe that lowering cholesterol through healthy diet, exercise, stress management and to a lesser degree through supplements is beneficial but largely because the lowered cholesterol coincides with other healthy changes in metabolic function.
• There are several subgroups of people who probably do benefit from lowering cholesterol with statin drugs if lifestyle and supplements are not sufficient. These include people who have progressive but asymptomatic hardening of the arteries. Sometimes this can be revealed through tests like high resolution ultrasound of the carotid artery or blood tests for harmful sub fractions of cholesterol. These subgroups may also include people with other known risk factors (diabetes, strong family history in primary relatives, etc.) They, like people who have known heart disease, benefit from drugs although this benefit is diluted in studies by the large number of people who gain little benefit.

We see many people in our practice who cannot tolerate statins due to side effects, or prefer not to take them. We find that most people (but not all) are able to reduce their blood fats (as well as improve their overall health) through lifestyle change and supplements.

A recent Business Week lead article gives an excellent description of Professor Wright’s and other current research in treatment of hardening of the arteries and their association with cholesterol problems.
http://www.businessweek.com/print/magazine/content/08_04/b4068052092994.htm

Update on Vitamin D

Here are some excerpts from the Vitamin D Newsletter, an up-to-date, informative and very readable work of love by John Cannell, MD. http://www.vitamindcouncil.org/releases.shtml This is a periodic newsletter from the Vitamin D Council, a non-profit group trying to end the epidemic of vitamin D deficiency. Dr Cannell notes that The American Medical Association (AMA), the nation’s largest physician organization, at its annual meeting in Chicago voted to adopt a new public health policy regarding Vitamin D. It called on the FDA to re-examine the current Daily Reference Intake Value for Vitamin D in light of new scientific findings. “The health benefits of Vitamin D are plentiful, such as strong bones and a reduced risk of breast cancer and cardiovascular disease,” said AMA Board Member Steven Stack, M.D. “It’s time to take a good look at the current daily recommended level of Vitamin D and ensure that Americans know the appropriate levels so they can reap the full health benefits.” Current research suggests that the Upper Limits for adults, established in 1997, is overly conservative. The AMA’s statement was timely in light of another study published a few days later followed 3600 patients for 7 years. The investigators found that in that time period twice as many people with the lowest vitamin D levels died than those with the highest levels. (Dobnig H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008 Jun 23;168(12):1340-9.) The epidemic of Vitamin D deficiency is attracting increasing attention in the lay press such as:

• Deborah Kotz, US News & World Report, wrote a great story about it: Time in the Sun: How Much is Needed for Vitamin D? See:
  http://health.usnews.com/articles/health/living-well-usn/2008/06/23/time-in-the-sun-how-much-is-needed-for-vitamin-d.html?PageNr=1
• A Washington Post article: Rob Stein, Washington Post; Some Seek Guidelines to Reflect Vitamin D’s Benefits:
  http://www.washingtonpost.com/wp-dyn/content/article/2008/07/03/AR2008070303822.html

John Cannell, MD from the Vitamin D Council, who publishes the newsletter. offers the following advice: (The full text can be found at the website)

How much vitamin D should I take?
“Everyone’s situation is either a lot, or at least a little, different. How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and – probably – how ill you are. As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, northern people need more than southern people, dark-skinned people need more than fair skinned people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people. “This is what I’d do. If you live in Florida and sunbathe once a week, year around, do nothing. If you use suntan parlors once a week, do nothing. However, if you have little UVB exposure, my advice is as follows. Well children under the age of two should take 1,000 IU per day, over the age of two, 2,000 IU per day. Well adults and adolescent between 80 pounds and 130 pounds should start with 3,000 IU per day, over 130 pounds but less than 170 pounds, 4,000 IU per day and over 170 pounds, 5,000 IU per day. Two months later have your doctor order your first 25-hydroxy-vitamin D blood test. Yes, start the vitamin D before you have the blood test. Then adjust your dose so your 25(OH)D level is between 50 and 70 ng/ml, summer and winter. These are conservative dosage recommendations. Most people who avoid the sun – and virtually all dark-skinned people – will have to increase their dose once they find their blood level is still low, even after two months of the above dosage, especially in the winter.

What blood test should I have?
“The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D [25(OH)D]. Get your levels above 50 ng/ml, year around. Unfortunately, about 10-20% of the doctors in the USA order the wrong test. They order a 1,25-dihydroxy-vitamin D, thinking that by measuring the most potent steroid in the system, they are getting useful information. They are not. 1,25-dihydroxy-vitamin D is an adaptive hormone; it goes up and down with calcium intake. When 25(OH)D levels are low, the body compensates by increasing the amount of the potent steroid, 1,25-dihydroxy-vitamin D. Thus, a common cause of high 1,25-dihydroxy-vitamin D is low 25(OH)D or vitamin D deficiency”

My blood test came back at 120 ng/ml. Am I toxic?
“No, vitamin D toxicity has never been reliably documented with 25(OH)D levels less than 200 ng/ml. Ranges for humans living and working in the sun are between 50 and 100 ng/ml.”

What is the ideal level of 25(OH)D?
“We don’t know. However, thanks to Bruce Hollis, Robert Heaney, Neil Binkley, and others, we now know the minimal acceptable level. It is 50 ng/ml. In a recent study, Heaney et al enlarged on Bruce Hollis’s seminal work by analyzing five studies in which both the parent compound, cholecalciferol, and 25(OH)D levels were measured. It turn out that the body does not reliably begin storing the parent compound (cholecalciferol) in fat and muscle tissue until 25(OH)D levels get above 50 ng/ml. The average person starts to store cholecalciferol at 40 ng/ml, but at 50 ng/ml, virtually everyone begins to store it for future use. That is, at levels below 50 ng/ml, the body is usually using up the vitamin D as fast as you make it or take it, indicating chronic substrate starvation, not a good thing.” (Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4. Heaney RP, Armas LA, Shary JR, Bell NH, Binkley N, Hollis BW. 25-Hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions. Am J Clin Nutr. 2008 Jun;87(6):1738-42.)

You can read the answers to other questions asked of Dr Cannell in the newsletter. These questions include:

• How often should I have a 25-hydroxy-vitamin D blood test?
• Does it matter what reference lab my doctor uses?
• Where should I get my vitamin D supplements?
• My doctor prescribed Drisdol, 50,000 IU per week. What is it?
• Why are you against cod liver oil?
• When I asked my doctor for a 25(OH)D blood test, he just laughed and said it was all idiotic. What can I do?
• The vitamin D Council takes money from Bio Tech Pharmacal and Lifespan Nutrition and now you are a consultant for Diasorin. With those conflicts, how can I believe what you say?

“Green Flowers” and Chocolates to Live for

Confused about Eco Labels? Go to http://www.greenerchoices.org a free service of Consumer Reports, and go to the screen about ecolabels. Make your next gift of flowers or chocolate a safe treat for your honey and yourself. At the same time, these labels can help ensure your purchase will benefit the planet and the people who produce them.

Some of the most delicious dark chocolates you will find are sustainable, organic and fair trade. These include Rapunzel, Green and Black, and Newman’s Own. Look for the following labels (more info from Consumer Report at their Eco-labels center.

Organic chocolate is produced without most synthetic pesticides and fertilizers, or genetic modification. Growers also emphasize the use of renewable resources and conserving soil and water to enhance environmental quality. Search for “organic chocolate” online or look for options at natural and gourmet grocery stores.

 

Fair Trade chocolate is produced by farmers and workers in developing nations who receive a “fair” price for their product. Trade is done directly between farmer-owned cooperatives and buyers. Crops are grown using soil and water conservation measures that restrict the use of harmful pesticides. To find Fair Trade Certified products, visit TransFair USA.

 

Rainforest Alliance chocolate is grown using integrated pest management systems that limit the use of pesticides and fertilizers. Crops are grown using water-, soil-, and wildlife-habitat conservation measures. Farm laborers are paid salaries and benefits equal to or greater than the legal minimum wage of their countries. For a product directory, visit the Rainforest Alliance.

 

Similarly, sustainable flowers will not harm you, the grower or the environment. Look for these sustainable flower labels.

Organic flowers are grown without most synthetic pesticides and fertilizers, or genetic modification. Growers also emphasize the use of renewable resources and conserving soil and water to enhance environmental quality. To find organic flowers, visit Organic Bouquet, California Organic Flowers, or Diamond Organics

 

Veriflora flowers are grown using water-, soil-, and habitat-conservation measures. The use of pesticides and fertilizers is also restricted. Farm laborers are compensated and protected according to international, national, or locally recognized standards. For a list of products and to learn more about this label, visit Veriflora.

 

Fair Trade flowers are produced by farmers and workers in developing nations who receive a “fair” price for their product. Trade is done directly between farmer-owned cooperatives and buyers. Crops are grown using soil and water conservation measures that restrict the use of harmful pesticides. To find Fair Trade Certified flowers, visit 1800flowers.com.

 

Biodynamic flowers are grown without the use of synthetic pesticides, fertilizers, genetic engineering, or animal by-products. Additionally, flowers may not be grown in areas subject to strong electromagnetic fields. To find biodynamic flowers, visit Organic Bouquet or Harms Vineyard and Lavender Fields.

 

Finally, locally grown flowers which may or may not be certified, are another option. These are available at local Farmer’s Markets and Whole Food Market in Charlottesville. In other communities, to find out if there’s a seller near you, check Local Harvest, a searchable database of local agricultural products.

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