Tuesday, December 24, 2013

Does Alcohol Keep Me Warm?

Yesterday I was listening to this rather entertaining story on NPR's "All Things Considered" involving variations on eggnog/holiday drinks: Don't Knock the Nog Until You've Tried this One.  I am definitely in the "eggnog is icky" camp (and I'm dairy allergic) but I like hearing tales of recipe improvement, so I was listening happily until the person being interviewed made the off the cuff remark about "some booze to keep you warm."  Some of you might be wondering if this is true, particularly if you remember the Bugs Bunny cartoons where St. Bernard dogs were used in avalanche "rescues" like this one:
Some of you might also get a warm, flushed feeling when you drink alcohol, as do I.  Unfortunately, whether it's brandy, rum, or even the gin in the martini (assuming cartoon St. Bernard dogs prefer gin), the booze will not serve to keep you warm while you're skiing, working outside, or chasing rabbits.  When you drink alcohol, even a swallow or two, the blood vessels under your skin artificially dilate and your warm blood moves closer to the skin, so you feel a temporary wave of warmth.  The problem, however, is that the warm blood moves away from your internal organs and causes your core temperature to drop.  If you were going to be outside in cold temperatures for a long period of time, you will be at an even higher risk of hypothermia.  Also, if you drink enough to impair your judgement, you might not come inside out of the cold when you need to, putting you at more risk.  So if you are planning on being outside for a long period of time, avoid the alcohol until you have the opportunity to be in a heated room.

While we are talking about myths, apparently the belief that St. Bernard's carried mini kegs of brandy around their necks while working as rescue dogs isn't true either.  The belief started after a 17 year old painter named Edwin Lanseer painted Alpine Mastiffs Reanimating a Distressed Traveler in 1820 after being impressed by the site of these personable dogs trained by monks for alpine rescue.    There is no other evidence that they actually carried brandy casks or that the monks actually thought it would be a good idea.

Take home message--Avoid alcohol if you are going to be working or playing out in the cold.

Tuesday, December 17, 2013

Supplement Specifics

This week is not starting of well for those who hope to make money from selling vitamin supplements, particularly multivitamins.  As summarized in this article three major studies published indicated that the use of a multivitamin did help ward off problems that strike fear into the hearts of many Americans: cancer, cognitive decline, and cardiovascular events.  

One of the highlights of this article was this quote: "I think this is a great example of how our intuition leads us astray," Salzberg told Shots. "It seems reasonable that if a little bit of something is good for you, them more should be better for you. It's not true. Supplementation with extra vitamins or micronutrients doesn't really benefit you if you don't have a deficiency." (emphasis mine).

When I pasted this article on my Facebook feed I people point out that they take [insert vitamin here] for [insert medical problem here].  Yes, of course you do.  You are taking a SPECIFIC vitamin at a SPECIFIC dose for a SPECIFIC problem.  That is different than throwing a random bunch of things and a problem that may or may not exist and not have any evidence that it's helping you.  "But I don't eat right" is another admission that I've heard from my patients over the years.  Well, you probably don't, but if you take a multivitamin to make up for your, lack of vegetables, you might still be getting too much of one thing and too little of another to really help.  And of course, as stated in the news article, some people take a multi w/o regard for how certain vitamins might actually increase the risk for certain conditions at high doses, might exacerbate a condition you already have, or might interact with a medication that you are taking.

I have actually covered a similar topic over a year ago in this post, which includes info on why taking a multi probably doesn't help your less than stellar diet, and also talked about who may or may not benefit from a vitamin D supplement.  Some of you are probably still wondering if you might need to have a supplement for a specific condition, so here are some questions to ask yourself.  And of course, get a blood test to verify that you are deficient and discuss your supplementation with a trusted physician and/or pharmacist so that you do not do yourself any harm.

1) Do I have a health condition that might keep my body from absorbing certain vitamins or minerals?  For example, if you have had gastric bypass surgery, you might need to supplement with B-12 as you may not produce enough of a substance call intrinsic factor to effectively absorb this from food.

2) Do I follow a diet that eliminates certain food groups/is considered restrictive by the culture I live in?  For example, if you are vegan, you won't get B-12 from plant sources because plants do not typically store B-12.  The "usual" plant sources, like seaweed, can actually contain substances that can keep you from absorbing B-12 (link), so you might be better off taking a supplement.

3) Do I take medications that can cause me to be deficient in certain vitamins/minerals? I have a lot of patients that are on diuretics ("water pills") for congestive heart failure, etc.  This medicine also can cause them to lose a lot of potassium in the urine, and so they need to take potassium supplements to compensate.  The supplements are usually pretty large doses, however, so they need regular lab work to make sure the potassium doesn't go to high (which could be fatal).

4) If I have a known deficiency, can I realistically eat the amount of food required to measure up to the amount in a supplement? For example, if you go to donate blood and find that your blood test was a tenth of a point off, you could probably just be extra conscious about your iron intake until your next attempt at giving blood.  If your iron levels are low enough that your physician is recommending a supplement, however, you might have to eat the equivalent of 2-2.5 pounds of liver per day to get the supplement equivalent.  I like liver, but not that much, nor would I want to pay for it.  I would take a supplement.

5) Do I have a condition that can be helped by large doses of a certain vitamin/mineral (that is backed by evidence)? See my previous post about supplementation with omega-3 in the presence of high triglycerides in HIV/AIDS patients treated with anti-retrovirals.  And remember, you will have to be monitored frequently to make sure that the potential side effects of those large doses are not outweighing the benefits.

Take home message--Find out if you really are deficient in something before taking a supplement that you don't need or could actually harm you.  If you do need to supplement, work closely with your physician to make sure you are getting the amount that you need of that specific vitamin/mineral.

Monday, December 9, 2013

Too (En)Riched for My Blood?

I just got a reminder e-mail for my regularly scheduled blood donation at one of our local blood donation centers.  I always appreciate the reminders mostly so I can make sure my smartphone/calendar reminders are set up, but also because the donation also changes my eating/drinking/exercise habits around that time.  I usually do not have a problem with the before donation tests that assesses my hemoglobin (the protein in my red blood cells that carries iron), but I know plenty of people that have shown up for their donation and were told that they did have a low hemoglobin.  So this was on my mind when this particular infographic showed up in my Facebook news feed:
And so the "is this true?" part begins.

First of all, I have a problem with the use of the word "anemia."  Anemia by itself means that there is a reduced number of red blood cells and/or hemoglobin in the blood; however, there are hundreds of different types of anemia and a variety of causes depending on what type you have (Which you can read more about here).  If you are "anemic" because of blood loss from falling and cutting yourself on a sharp object, for example, then you are going to need a transfusion and eating certain foods isn't going to help you.  Hopefully that type of example would be obvious, but I try not underestimate what people what people will and won't do, particularly if medical care is not readily available to them for whatever reason.  But for the sake of seeking out the original intent of this infographic, however, we will assume that this infographic speaks to anemia as a result of limited intake of iron.

Second of all, we also need to recognize the type of iron that your body absorbs the best from from food (aka the most bioavailable) is a type of iron called "heme iron" that is only found in animal protein sources (Link with links to other sources).  So if someone is looking to get what is truly best absorbed, vegetable sources or non-heme iron simply does not fit the bill.  The other related problems are that sometimes you are not going to eat enough of a certain food, like garlic, to be considered a good source of iron, and most plant tissue contains something called phytic acid which can prevent iron from being absorbed by the body (Phytic acid by itself is not bad, it's how plants store the mineral phosphorus and might actually play a role in keeping us from absorbing too much of certain minerals. Like anything else, it's the amount that matters).  So as a primary way of preventing anemia, I wouldn't put any of these on my top eight list.

"That's nice SkepticRD, but I refuse to eat animal products for [insert reason here] or I have trouble buying sources of heme iron for [insert reason here] and what I really want to do is see if there is something I can do to help me absorb non-heme iron better."
Fair enough.  First of all, go back to this link to find other, and sometimes better, sources of non-heme iron that are not listed here.  Second of all, when it comes to beans, nuts, and grains you can try soaking (48 hours or more), sprouting, and cooking to activate the enzymes in the plants that break down phytic acid.  Third, you can include more vegetables that have been fermented in your diet.  Fourth, you can make sure that you eat the non-heme iron foods with vitamin C rich fruit and vegetables.  Fifth, be aware of foods that you are eating that are rich in calcium as they can also prohibit absorption of iron rich foods.  Sixth, you can realize that there is a lot of work involved in doing all of the above steps, and you might want to have some compassion on those who choose to get their iron from heme sources.

Take home message---If you have anemia, discuss this with your physician to try to determine what type of anemia and potential causes.  If you need to improve your diet, go for the heme sources or be prepared to do a little more work for the non-heme ones.


Thursday, November 21, 2013

Bananas as the Perfect Food?

Searching for the perfect food?  The one that provides all your nutrition needs?  One that will save you from having to prepare food?  One that that you can spend your limited food budget on?  Well, if you read this post about bananas, you might think you have found your holy grail: After reading this, you’ll never look at a banana in the same way again.  Does any of this information have any use?   Let's look at each one.

**Some of this I have already covered in previous posts, here, here, and here.

1) (Opening paragraph)--"Bananas contain three natural sugars – sucrose, fructose and glucose combined with fiber. A banana gives an instant, sustained and substantial boost of energy."

Well, yes, the banana does contain "natural sugars" and fiber.  All fruits do, some just have more per portion than others. (As opposed to "refined sugars?"  Or "artificial sweeteners?"  Which means you are probably not eating fruit....) I will also point out, for those of you haven't taken (or have forgotten) basic chemistry, you will find that sucrose is actually a disacharide made up of the monosaccharides glucose and fructose, so you could just say "bananas contain carbohydrate" and be less redundant.  I think the "energy" they are referring to the carbohydrate converting to blood glucose within about 15 minutes to two hours after consumption (depending on what you ate with it).  If your blood glucose is low, you will feel better after eating a banana (or any fruit, really), but that rise in blood glucose is only going to last for maybe an hour or two.  Hardly sustainable.
**If you have diabetes and experience a blood glucose level below 70 mg/dL, fruit might work in a pinch but you will have to do less peeling/chewing if you consume 4 oz fruit juice or consume 3-4 glucose tablets.

2) Depression

No one food is going to cure your depression, as I have written about here.  And in a previous post I stated this:
"Bananas do contain serotonin, and some people who have depression have a shortage of this, but the serotonin found in the banana does not cross the blood-brain barrier. If someone has been eating poorly, eating a banana or another carbohydrate rich food might give them a temporary sense of well being, but it won't last. Bananas could be worked in to an otherwise healthy meal plan to help overall depression but they are not a cure unto themselves."

3) PMS

If you read the above links, I mentioned this before.  Hint: The answer is "No."
They also mentioned blood glucose regulation causing you to feel bad--which is true--if you have uncontrolled diabetes or even prediabetes eating to control those conditions can help you feel better.  But one banana contains roughly 30 grams of carbohydrate--about the amount per meal that a person with diabetes could have (if they are trying to stay about 100 grams per day, some people need less).  Not everyone is going to want to use up their carb selection on a banana (or eat just half a banana).  As far as B6 is concerned; a banana only contains about 0.4 mg per banana and the studies on blood glucose regulation used much higher doses.  And the results were poor as well.


Your body absorbs iron the most efficiently from "heme" sources, which usually means animal products.   For those who choose to be vegan or vegetarian, however, and are trying to find a variety of non-heme sources, you want to have foods that contain at least 3.5 mg iron per serving (best) or on the low range of 0.7 mg (serving).  The banana weighs in 0.26 mg/serving so no help there.  If you are low in iron, you might need short term supplementation under a physician's guidance.  (The dose that your physician might use is probably on the lines of 26 bananas per day or ~1.5-2 pounds of liver for the non-vegetarians, which is not really realistic to consume).


Already discussed.  But let me repeat: Remember that you can also get potassium from all meats, fish like salmon, avocados, apricots, legumes, leafy greens, etc. I suppose bananas might be a convenient source for some, but not the only one.


I actually had trouble finding a reliable source that said that this "study" even took place.  Although if the students were skipping meals and not getting enough fruit and vegetables this may have contributed to better performance.  Again, I suppose the bananas were a convenient source of potassium.


Well yes, they do have fiber, but so do other fruits and vegetables.  If you absolutely hate other fruits and vegetables I suppose this would be preferable to taking a fiber supplement.


It looks like we might need a hangover primer here, but guess what, we already talked about that too (in the videos in the link).
The fruit by itself can give you some well needed carbohydrate if low blood glucose levels are making you miserable, and the potassium in the banana could help with the hydration too.  As far as bananas "calming" the stomach acid, there have been some animal studies that indicate that bananas might speed the healing of stomach ulcers, but there may not be much of a change of pH.  Milk does contain some potassium as well, but as far as the "soothing" of the system, which of the eleven body systems are you referring too? 


From a previous post: "There was a small study done in India back in 1990 hat used a banana powder to treat GERD, but that is not the same as eating a whole banana. Anecdotally, some people complain of worse GERD symptoms after eating bananas. If you are unable to handle too much fructose, like yours truly, it could be that the resulting intestinal gas puts pressure on the lower esophageal sphincter. There does not seem to be any harm in trying the banana powder for GERD as long as you are working to find out what is causing the problem."


We are not sure exactly what causes morning sickness, it might be the change in hormones or possibly the lower blood sugar levels, we don't know.  But if it is a blood sugar problem, you actually don't want to be snacking on bananas or other high carbohydrate foods.  The hormonal changes in pregnancy can lead to insulin resistance, which means that the cells in the body do not allow the insulin to "upload" glucose into them like the body usually does.  As a result the pancreas needs to produce more insulin to keep the blood glucose regulated.   Sometimes the pancreas can't keep up, and the result is gestational diabetes, which all pregnant women need to get screened for.  How this relates to banana/carb intake is that if you eat too much carbohydrate (remember one banana has 30 grams), your body has to try to produce extra insulin to handle the resulting glucose load, and that overproduction of insulin can cause you to have a blood glucose "crash" later on (if you have gestational diabetes and take insulin, you have to minimize your carb intake to avoid having to take high doses of insulin).  Making sure that you get most of your calories from protein and good fats, while filling in with 30-45 grams of carbohydrate at each meal (depending on what the weight gain limit is) will be more likely to prevent those blood sugar crashes.  Will it help with morning sickness?  Maybe, we don't know.


Previous post: "Lots of anecdotal information on this one, but no studies that I could find. I wouldn't recommend trying this if you have already scratched and have an open wound though."


       1)  I think they might be talking about bananas as anti-anxiety as opposed to working on the nervous system, so see above comments on depression.  Surely they couldn't be talking about calming they voluntary or involuntary nervous system--I don't necessarily want my nervous system calmed down because it might involve stopping my heart or my digestive system.  Read this for a brief overview of our wonderfully complex nervous system.
        2) See "morning sickness" for why overloading on carbohydrates does not stabilize a person's blood glucose.

See above for "heartburn."  Also, regular consumption of bananas might help increase the production of the mucus that normally protects the stomach lining against acid, but the banana itself does no "coating."


Bananas do not reduce fever, nor do they keep you from having bad "qi" since the latter does not exist.

15) When you compare it to an apple, it has FOUR TIMES the protein, TWICE the carbohydrate, THREE TIMES the phosphorus, five times the vitamin A and iron, and twice the other vitamins and minerals.
1) An apple has zero grams of protein.  Do the math.
2) Let's see, I can only have 30 grams of carbohydrate at this meal so I could eat one apple and something else or I could eat a whole banana.  I like volume and variety, so apple it is!
3) An apple has zero phosphorus.  Do the math.
4) An apple has zero vitamin A.  You know what you have to do.
5) Covered iron above.
6) Really?  How much math do you have to do?

Take home message--Bananas are good source of potassium and fiber.  No magic.

Wednesday, November 20, 2013

Food cravings?

In just a few months we in the western world will be begin a new year, and with that new year some of us decide that it is a good time to change the way we eat.  Of course some people find themselves quickly derailed by a "craving" for [insert previously eaten food here].  A food craving is defined as an intense desire to consume a specific food, stronger than simple "normal" physical hunger.  Just about anyone who has changed the way the eat, even those who have been successful, can tell you a story about how they have longed for something that is no longer part of "the plan."  Food cravings are just one more obstacle that a lot of people have when it comes to achieving whatever the health goal is, so it's not a surprise (to me anyway) that one of the more popular ideas that pops up periodically is the idea that if you are craving a specific food you must be "deficient" in some type of micro nutrient (aka vitamin or mineral).  I've seen a variety of these "articles" floating around on social media (and spouted by well meaning relatives and friends trying to help you not eat whatever you are craving), but I think I managed to find a summary chart:
Food cravings

I am pretty sure some of you some of you saw immediately that the website had "naturopathy" in the title and decided to dismiss it outright.  For more on the quackery that labels itself naturopathy read this piece at sciencebasedmedicine.org.  For those of you who were still curious and managed to read all of it; unfortunately there is no evidence that cravings are actually a sign of micro nutrient deficiency.  Lets take the every popular "I'm craving chocolate so I must be low in magnesium" statement.  Symptoms of magnesium deficiency often include agitation and anxiety, restless leg syndrome, sleep disorders, irritability, nausea and vomiting, abnormal heart rhythms, low blood pressure, confusion, muscle spasm and weakness, hyperventilation, insomnia, poor nail growth, and even seizures.  That's not to say that if you are feeling irritable eating a magnesium rich food source, or taking a supplement, won't help you feel better, but there is no mechanism in your body to increase your cravings for chocolate.  (And I know those of you struggling with tobacco addiction are wishing fervently that eating nuts would help you stop smoking.....if only it were that easy).

When it comes to foods high in calories (usually via carbohydrates and fat), keep in mind that humans have long been able to survive times of famine throughout history due largely to our ability to store excess calories, consumed during times of plenty, as body fat. So you might say that craving high calorie foods is part of our omnivorous/eat-whatever-we-can-find-to-survive programming.  Since those of us that have regular access to food are usually dependent on cheap, easy to obtain refined carbohydrates and processed fats; when we take that away, even though our mind knows we are improving our diet, our body is still wanting to that easy access to store up calories in case of a famine so we don't feel good.  Think about people who start a very low carbohydrate plan, like Atkin's induction diet; many of them experience fatigue, irritability, nausea, and intense cravings for sugar because the easy source of blood glucose has been removed.  After a few days the body will start using ketones for energy and they will usually start to feel better, but some people still feel horrible after a week or so and resume their former eating habits with a vengeance.  Or think of someone who decides to become vegan without learning about alternate protein sources and they try to survive on pasta; they go from getting adequate protein and fat to very little and they probably don't feel so good.  They either go back to eating cheeseburgers or they just try to fill up on more pasta and take in even more calories.

And then there's the "other parts" of eating, the parts that associate certain foods with good memories, family and friend celebrations, and the fact that certain parts of our brain (hippocampus, insula, and caudate) that control for memory and sensing pleasure are activated during food cravings.  Think about how many people who have tried to change their eating dread holiday celebrations with family and friends because they know that the "comfort foods" abound.

So now that you no longer have the excuse of "I want chocolate so I'm going to claim a magnesium deficiency" to fall back on, what could you do to manage your cravings and still change your eating lifestyle?
1) Plan to eat at least 3 meals per day.  If you are just starting out with a lifestyle change, now is not the time to think about fasting.
2) Make sure that you have protein, fat, and vegetables at each meal, if you are not diabetic, make sure that you include unprocessed carbohydrates like fruit, sweet potatoes, etc.  By making sure that you have the minimum of your protein needs and by allowing yourself to have the healthier fats, you can take the edge off the "starving" feeling.  If you have Type 2 diabetes or prediabetes, or some other insulin resistant related condition, limiting the carbohydrates will keep your body from having to over-produce insulin and inflate your hunger.
3) Clean out your kitchen.  Most of us do not lay awake thinking about the leftover pork loin, but we might lay awake thinking about the cookies.  Keep the temptation unavailable.
4) If you can find a lower calorie/lower carbohydrate option that tastes good, feel free to use a small amount daily.  (Your low carb ice cream only stays low carb if you eat about 1/2-1 cup per day.  You know who you are.)
5) If you are eating a "substitute" that you find that you don't like, stop eating it so you don't eat it and then whatever you are craving. (I'm old enough to remember rather unpalatable foods like Molly-mcbutter, etc.)
6) Get the small bag of candy, cookies, or one piece of pie, instead of the family size/the whole pie. Enjoy each bite.  
7) Some people do better with going cold turkey off certain foods, some people do better with gradual changes.  You know you the best.
8) If you do indulge in a craving, go back to your regular healthy eating habits as soon as possible.  Don't try to starve yourself the next day or you'll wind up back in the same cycle.  Shaming/punishing yourself doesn't usually work.
9) Find ways to stay busy in between meals so you don't eat because you are bored.
10) Start learning to bring your own meals and snacks to work so that you don't wait to long to eat and start working on whatever is left in the break room.
11) When you do enjoy your well planned treats, try to do so with supportive friends or family.  Nothing kills the enjoyment by other people judging you for eating foods of your own choosing.

Take home message--eating an overall healthy diet that contains all the essentials can help manage cravings, but there are no specific foods that will do so.

Thursday, November 14, 2013

Holiday Diet Tips?

This time of year is an interesting time to be a dietitian (at least in the northern hemisphere).  If you are not being asked about magical foods to cure what ails you, you are getting asked to write articles about how to avoid weight gain during the time between roughly between October 31 and February 14 known as the "holiday season."  It's an important topic to people who really want to maintain the hard work they've been doing the rest of year but still want to engage in the "usual" family and cultural traditions that are important.   Actually addressing it is problematic, however, because this is not a topic that has a lot of double blind studies to back it up, and there are also some social implications too as I was reminded by when I read this quite amusing (to me) blog post entitled simply Horrible Holiday Diet Tips.  In other words, we don't really have a lot of "proven" advice to give and some of the advice really falls into the "shame your fat friends and relatives" category as opposed to actually being helpful.   Unfortunately, non of this stops people from asking/worrying about getting through the holidays, so I've decided to address a short collection of some common diet tips and see if there is an physical or behavioral science to back it up.  Keep in mind that this advice/discussion is for people genuinely looking for healthy eating tips; some people might just want advice on how to deal with less than supportive family at holidays.  If you are the latter, there is a companion piece to the above blog post over here.

1) Eat a Big Bowl of Fiber Cereal and Drink Lots of Water Before A Party to Avoid Snacking.  Obviously this one comes straight from the blog post above.  I can see where this advice comes from, since fiber is suppossed to slow down the emptying of the stomach, people trying to lose weight have been told to eat fiber cereal/apples/take metamucil  before any meal (not just holiday ones) in the hopes that they will fill up faster (the water is also there to help the fiber "swell" and enhance fullness).  Unfortunately, there haven't been any good studies that show that this is actually the case, and remember those "fiber cereals" are usually anything but low calorie. (Link)  So, she's right in that you might not eat as much at the party because you are spending too much time in the bathroom.  If  you know you are going to be consuming alcoholic beverages later you probably do want to start hydrating before so you are less likely to be hungover later.

2) Save Your Calories For the Party by Eating Light During the Day.  (Thanks again Ragan!)  In this post I talked about the pro/cons of intermittent fasting.  So, for those of you who fall into the category of people whom this might benefit, and are already practicing it, this tip probably sounds like your everyday life.  As a practice to start on the day of the party, however, this is a really bad idea as you probably will be ready to eat everything in sight.  Eating healthy takes a lot of work, don't expect to change your biological programming to eat food all in one day.

3) Make it easier on your guests by offering light and satisfying appetizers, etc.  If you are like my friend Jennifer, who does amazing gluten free baking, and have brought some tasty gluten free treats for you and your celiac disease friends to share, I think that is very courteous.  If you are vegan and have made it clear to your guests that you don't wish to have animal products served in your house, I think you are setting boundaries for yourself that others should respect.  If you are inviting your low carb friends over to show off how many things you can wrap with bacon, great.  But, I don't know of any studies that showed that you as the host could somehow slow anyone's holiday weight gain, as you can't control what they ate before or what they will eat after the party.  Be courteous, but don't police them.

4) Substitute  [insert trendy "good" ingredient] for [insert trendy "bad" ingredient] for a delicious low calorie treat!  Well, maybe.  As someone who eats gluten free and enjoys cooking, using and learning about new substitutes is part of my daily life, not just the holiday season.  But not every substitute makes something lower calorie, lower carbohydrate, etc.  You have to actually look at the label and/or analyze the recipe to see if what you are getting is actually any healthier.  Sounds pretty basic but some people get caught up in the hurry of the holidays and don't check.  But this is another area where people get caught up in the "little" things and forget that the evidence favors people enjoying a drink of regular eggnog in the context of a "most of the time" caloric/carb restriction. 

5) Suggest a walk or other activity after the main holiday meal.  Another well maybe.  Going for a walk can obviously remove you from easy access to food which can save a few calories.  Holidays with family can also be a stressful time for some people, and going outside for a walk or other activities to temporarily remove yourself from a stressful situation can just be a nice act of self care.  I think where I have seen some people get in trouble though is that they really think the walk will burn enough calories to compensate for overeating (you know who you are), and after a heavy meal you probably won't be walking/running/biking that fast.

6) Use a smaller plate.  I sometimes wish there was a link between plate size and all the hormones and GI system receptors that code for satiety, but it looks like people are more likely to eat until full regardless of plate size (Link).  You

Take home message--There is no magic trick to keep you from gaining weight during the holidays.  If you have found a plan/lifestyle change that is working well for you the rest of year (which for most people means eating a certain way 80-90% of the time), you will have to keep up that way of eating during the holidays.  Do make sure that you find ways to stay in touch with those who have been supporting you so far.

Tuesday, November 12, 2013

Honey as an antibiotic?

We are in to cold and flu season, and with that comes everybody and their mother giving you advice on their favorite cure and/or symptom relief.  I managed to see this one in my feed the other day:

Sounds pretty good doesn't it, particularly if your throat has been hurting so bad you have trouble swallowing.  But is there any evidence for it?

The slipperiness of the gelatin probably will feel good and make it a little easier to swallow, which might actually help you feel better and maybe you can even take in more liquids and other nourishment that your body needs while your sick.  You can also get similar relief from hot tea, etc, but some of need variety after days of drinking the same old broth, etc.

The statement about the honey killing the bacteria that might be causing a sore throat is a distortion of the truth.  There have been some small studies indicating that MEDICAL GRADE honey might help heal wounds like pressure ulcers, etc, but there is still a lot more research that needs to be done (Link).  (And yes, I did emphasize MEDICAL grade as you would not want to put something that likely contains botulism spores on an open wound.)  When it comes to an internal problem, such as a sore throat that is caused by a bacterial infection, like strep throat, there is no evidence that honey will take care of it.  You will likely need a course of anti-biotics to cure the problem

What's the harm in using this remedy if you are feeling crummy?  If you are merely seeking relief of your symptoms, nothing (other than I've seen way too many people with diabetes run their high blood sugar up even higher with remedies like this).  If your symptoms indicate you might have strep throat, however, and you don't get this treated, the infection could potentially spread to other parts of your body and even in to your blood stream, and that could be deadly.

Take home message--Gelatin and honey might provide you with symptom relief (just watch the amount if you have diabetes/pre-diabetes), but don't expect it to "cure" the problem.

Also, for those of you new to the blog, I have also talked about:
Honey and allergies, more than once.
Cold Eze
High doses of Vitamin C

Hint: The answer is usually no.

**Update.  Thanks to JP for reminding me that I should have been clearer about the term antimicrobial.  Antimicrobials are substances that are applied to living tissue/skin to prevent infections, hence the use of medical grade honey in treating pressure ulcers, etc.  Antibiotics are substances that actually need to be transported through the lymphatic system to kill bacteria in the body.  Applying a "coating" of honey does not prevent a strep infection from taking hold, and once you have an infection you will need an antibiotic.

Friday, November 8, 2013

Diabetes Month Tip of the Day

How does one get diagnosed with diabetes?
First of all, keep in mind that a “normal” fasting blood glucose level is 70-99 mg/dL and if everything is working as it should in the body, your blood glucose levels shouldn’t budge over that even if you’ve eaten something.
If someone has two consecutive fasting blood glucose levels of 126 mg/dL or greater, or a random blood glucose level of 200 or greater, that is enough for us to diagnose diabetes. 
If the fasting level is between 100-125 mg/dL, this level is called “pre-diabetes,” which is pretty serious as you have a 25% chance of progressing to diabetes in 3-5 years.  Even more worrisome is that there is a developing body of evidence that indicates that some people might develop complications like diabetic retinopathy (eye disease) or neuropathy (nerve damage) at this stage.
Other thoughts
1) One of the other tests that might be done is the oral glucose tolerance test (OGTT) which you can read more about here.  Because this test is more time intensive and costs more it has fallen out of favor, particularly at the hospital where I work that serves a population that has to drive far and wide to get their primary care.  The advantage of this test though, is that if you have noticed "normal" fasting levels but you have seen high "post meal" levels, looking at your post-meal response can actually catch a blood glucose problem early and you can start your intervention earlier.
2) Some of the warning signs that you will often see on diabetes awareness posters include the excessive thirst, excessive urination, and excessive hunger that I discussed yesterday.   These symptoms are most common in Type 1 diabetes which tends to have a more rapid onset, but people with Type 2 can develop these symptoms as well.  Unfortunately, a person can actually have blood glucose levels in the "diabetic" range before  these symptoms develop, and the evidence points to intervening early on to prevent complications of diabetes.  The American Diabetes Association recommends that individuals 45 and over get screened (by looking at the fasting blood glucose) initially at age 45 and then every 3 years.  Some people can get screen at a younger age if you have a parent or sibling with the disease, have a "constellation" of problems like high blood pressure/heart disease/high cholesterol levels, and/or are overweight or obese as defined as having a BMI over 25.  (I know, I know.  Here's a link back to my other post about better ways to examine weight.)
3) If your physician/provider notices a problem with the blood glucose levels, I recommend using that as a wake-up call to change your eating habits to prevent future complication.  Sometimes a person in a high risk group might actually be given medication to help combat the high blood glucose levels, but that is between the individual and his/her medical provider.

Thursday, November 7, 2013

It's Diabetes Awareness Month!

I've been working hard on some educational tips for my co-workers to post everyday during the month of November (at least on the working days).  Since that took away from some blogging time, I figured that I should combine both!  Obviously I am starting on this blog about 7 days late, but I will try to make up for it!!  (And I will get to expand beyond the "tip" format that I am e-mailing co-workers).  So here we go.....

Day 1

What is diabetes?

Diabetes, or diabetes mellitus, is the name given to a group of diseases in which athe main symptom that a person has is high blood glucose (blood sugar).  The blood glucose becomes high either because the body does not make enough of the hormone insulin, or because the body’s cells do not respond properly to insulin, or both in some cases.   There are three types of diabetes:

Type 1:  In this form of diabetes the body does not produce insulin at all and people must take insulin to control the blood sugar and follow a carbohydrate-controlled diet.  People will Type 1 are usually diagnosed before their 40th year and usually present with the symptoms of weight loss, frequent urination, increased thirst, and increased hunger (Those last three are called polyuria, polydipsia, and polyphagia, for those of you who are interested).  This form of diabetes used to be called “insulin dependent diabetes,” “juvenile diabetes,” “or early-onset diabetes.”  These terms were discontinued because they are too confusing and not accurate, particularly since some people are diagnosed "as adults."  Type 1 diabetes only makes up about 5-10% of the cases of diabetes.
Type 2:   This is the most common form of diabetes (about 90% of cases) in the United States and this also makes up the bulk of SkepticRD's case load.   In this form of diabetes the cells in the body do not react to insulin (insulin resistance) or the body does not produce enough insulin, or some combination of both.    If caught early enough this form of diabetes can be treated with a carbohydrate controlled diet and exercise alone.  For those who are diagnosed “later” or who are unable to follow a carbohydrate controlled plan (for whatever reason), they may need to be treated with medications that help sensitize the body to insulin or help the body make more insulin.   Type 2 diabetes is progressive and many people do wind up having to take insulin to control blood glucose levels.
Gestational: This form of diabetes is used to describe elevated blood glucose levels in pregnancy when the woman’s body becomes resistant to insulin.  Some women are able to control this with a carbohydrate controlled diet alone and others may require insulin during that time.  This usually resolves after giving birth, but some women are more at risk for Type 2 diabetes in the future.
Other thoughts:
1) I have had a lot of people with Type 2 over the years tell me that they didn't think they had the "bad kind" of diabetes, particularly if they had not progressed to the point of taking insulin.  I had to follow up with a very frank discussion about how they are just as much at risk for complications (more about that in another post) as someone with Type 1.  And I had to restrain myself from giving a smart aleck answer about how I don't consider any chronic illnesses to be "good."
2) In future blog posts I will also talk more about what a carbohydrate controlled diet plan actually looks like.  I have to keep you all reading don't I?
3) I have worked with an older adult population for my 16 year career, so I don't have a lot of experience in this area, but do have a skeptic related story.  One of my pregnant co-workers was actually told how to "cheat" on her gestational diabetes screening test by someone at her OB/GYN office.  Basically this person told her to follow a carbohydrate controlled plan for two weeks before her test, then if the results were "fine" she could go ahead and start eating her desserts, etc again.  She was at least able to ask me about this and I was able to gently remind her that if she is eating in such a way to control her blood glucose levels BEFORE the test that she should continue to eat in such a way AFTER the test so that her developing fetus would be as less risk for excessive birth weight, pre-term birth, respiratory distress syndrome, etc.  She just delivered a third healthy child so we could all breathe a sigh of relief for now.
See you tomorrow for the next educational tip!

Thursday, October 17, 2013

Newsflash: Rats love Oreos!

If you had the (mis) fortune to be on a low fat diet plan any time since the 1980's, you have probably been given a list of "healthy" snacks that were somehow supposed to satisfy your cravings for...whatever you were craving.  Sometimes they might have actually resembled what you were craving, and sometimes they were actually tasty foods, and sometimes they were just things that you forced yourself to eat because you (likely mistakenly) thought you were being healthy (Does anyone besides me remember Molly McButter?  Yes?  I'll wait while you stop making gagging noises).  One of those items that could be used as part of a healthy snack was rice cakes.  At 35-70 calories they are not too bad, but there really isn't any nutritional value, and they really don't have any taste by themselves.  By the time you actually add "butter flavoring," or cinnamon and sugar, or even peanut butter (used to be my favorite) to those rice cakes, you may no longer have something that's low calorie.  And if you were like a lot of my patients over the years, you'll wind up eating the high-sugar-not-so-low-calorie snack anyway.

Which is why I was interested when I saw various versions of this article appear in my news feed: Why Oreos Are As Addictive as Cocaine to Your Brain.  Really?  Let's look at the evidence and the red flags raised.

1) I couldn't find a link to the original article, but there wasn't one, as the results are to be "presented" at a conference.  So this means there was no peer review where other experts in the field could see if the study methods actually passed muster.

2) Speaking of methods passing muster, I don't this this actually would.  There was a comparison between sweet and creamy (known as having a good mouth feel) and a dry, tasteless rice cake.  If this was a philosophical argument we could safely call this a false equivalence.

3) As far as activating the so-called "pleasure center," our brains are supposed to light up when we eat foods that taste good to us, otherwise we probably wouldn't eat them.    The potential problem here is that when less healthy food is what's convenient and affordable (as well as tasty), people will probably go for that over the homemade almond flour and raw honey version.  (If you try that recipe, just try to eat two, go ahead).

4) Stating the obvious:  This study was done in rats, not humans.  This might lead up to some human studies some day, but we can't really extrapolate this beyond the rat kingdom.

5) "Addiction" also has some social implications that may not quite fit here.  In one of the versions of this article that I read I saw some commenters were (I think justifiably) outraged to see the comparison made; particularly those who had watched the lives of their loved ones destroyed by an illness such as cocaine addiction.  Is someone really going to start lying and cheating just to get Oreos specifically?  (Someone might go to all sorts of lengths to get enough food that can be eaten quickly to survive, but that's to survive, not to feed an addiction).

Take home message--There are plenty of reasons to limit your intake of oreos and other store bought cookies.  Does eating them really have the same ramifications as cocaine?  Too soon to tell.

Thursday, October 10, 2013

Florida Humanists and Supper Club Advice

A few weeks ago I found out that a group that I belong to got a couple awards for our food related service projects.  I was asked if I wanted to pick up the award on behalf of Fellowship of Freethought Dallas at the Humanists of Florida Freethought Conference and I was about to decline since I knew I was going to be traveling later in the month.  Then I got a look at the list of speakers.  Not only are some of those speakers people whom I count as friends, but I saw that James Randi would be the keynote speaker on Sunday.  I felt that as a good Skeptic I couldn't pass up that opportunity so off to Southwest.com I went to use up some miles.

I also found out yesterday that they are offering an opportunity to purchase access to a live stream edition of the conference, so for the price of a movie ticket you too can also watch James Randi and the other big name speakers.  Go here to purchase your ticket, and if you want to add some pithy quotes to your 2014, purchase a calendar here.

One of the awards we at Fellowship of Freethought received was the "Feed the Need" award for outstanding food-related volunteering.  One of more unique events that we do is a monthly supper club for an organization called AIDS Service of Dallas.  A few years ago I was asked to write down some advice for other groups that may want to do something similar, and so here is a reblog that I did for Foundation Beyond Belief.

The Fellowship of Freethought Dallas has been participating in the AIDS Service of Dallas Ewing House Supper Club since January of 2010. The supper club consists of making a nutritious meal for residents of the home one evening a month. Many of the groups who come in are from churches but as far as we are aware FOF Dallas is the only secular group that participates. It is a fun and rewarding experience, and the patients of Ewing House really appreciate everything FOF Dallas does to keep the service friendly and the menu exciting.

For those of you who are interested in participating in a Supper Club in your own community, Melanie from FOF Dallas has the following helpful tips for you and your group!
Melanie Recommends:
  • Get a rough idea of what other groups are serving. The Ewing House has a record book where each group records the meals that they have served. They tend to get A LOT of casseroles, lasagna, people bringing in fried chicken, etc
The people at the ASD homes are very appreciative of anything brought in; however, I know they get bored with the same thing over and over. Who wouldn’t? So we try to use the cooking talents of our group to make unique meals such as stir fry, savory and sweet “pie night” and so on.
  • Create a “theme” for the menu. It helps make sure that everyone makes recipes that go together and you can use it to create a fun atmosphere. This past Thursday we had a Halloween theme and got to give out goody bags to the residents.
  • Make sure you have a sign-up sheet at that all participants do actually sign up for a particular item, that way you won’t have 5 different people bringing the same thing
  • Prepare most of the items, if not all, ahead of time so you’re ready to “heat and eat” once you actually get there.
  • For the first meal, make the foods easy to prepare, transport, and make sure the foods tend to be universally liked. Since our first experience was in January we did soups and chili; easy to make, easy to bring in a pot to reheat on the stove, and “comfort food” for many people.
  • Find out if people in the group have special dietary needs. I found out that one of the residents has celiac disease, and several of our regular volunteers are gluten intolerant as well! I know that that particular resident looks forward to a meal where he will have options that are clearly labeled.
  • Make things from scratch whenever possible. You get to try new recipes and people really do notice and appreciate the effort.
  • If you are the group leader, keep a set of supplies like serving utensils, cleaning supplies, etc. in such a way where you can easily transport them. I keep everything in several large plastic storage tubs and then I can just grab and go when our fourth Thursday of the month comes around!
  • Keep a record of the meals you’ve done and take notes on what works and what doesn’t. I’ve found that out the hard way! Even though all our meals have been successful we’ve had some meals where we ran short or ran way over on food. Fortunately we get to package up the leftovers for the “common” fridge (and they do get eaten!) so we don’t mind if we are a little over. You will want to repeat some successful themes again so that way you can make sure you have enough for next time!
  • Try to eat with the residents/people you are serving as much as you can, otherwise you get so caught up in the serving and cleaning that you forget to have fun!

Tuesday, October 1, 2013

Vinegar for All?

I've mentioned before that I grew up in the Pennsylvania Dutch culture, and one can't grow up in that culture without learning how to be thrifty.  Multi-use items appealed to our sense of thrift, so when someone starts spouting the many virtues of vinegar when it comes to cleaning and/or food preparation, it actually brings back fond memories of how creativity in day to day living was encouraged (creativity of thought not so much, but that is another story).  When people (like our friend Dr. Oz) start talking about vinegar being a super food, or start touting how it "cures" everything from high blood pressure to high blood sugar, then I start to wonder if some one's creativity has overstepped its bounds.  Is there any evidence that consuming vinegar on a daily basis or taking supplements can actually improve any particular health conditions?

Let's start with the somewhat good news.  If you have Type 2 diabetes, there is some evidence that including 2 tablespoons of vinegar per day (in the evening) might improve your morning blood sugar, particularly if your blood glucose readings are already in decent control (Link).   Unfortunately, most of the research done on this topic (including the linked article) includes a pretty small sample size, and we don't know if it helps with people who have poorly controlled blood sugars.  If you are already working hard at controlling your blood glucose levels through carbohydrate control (diet), exercise, and medication/insulin (if applicable) and you wanted to try adding vinegar to your regimen it probably wouldn't hurt, but we don't know how much it might help until we do more research.

When it comes to weight loss, the news it also somewhat good if very, very tentative.  Back in 2005 there was a small study (as in only 12 people) done which indicated those who consumed vinegar with their white bread felt more satiated (aka "full") after eating (and they had better blood glucose levels too).  Once again, since the study is so small we really can't extrapolate that to a larger population.  I can also hear those who are controlling their blood glucose levels with a controlled- carbohydrate eating plan saying "Why don't you just avoid the white bread?" in a fairly grumpy tone of voice, and I have to say I both agree with that statement and sympathize with those who might still want to eat white bread sometimes and minimize the damage.   There is more research to support controlling carbohydrate intake for blood glucose control than there is vinegar, however, so cheaters beware on this one.

When it comes to using vinegar to prevent cancer, lower blood cholesterol levels, or lower blood pressure (a particularly popular folk remedy among my patients), the news is only positive if you are a lab rat as there haven't been any good human studies done.  Some observational studies indicate that people who consume salad with oil and vinegar on a regular basis have a lower risk of heart disease, however, correlation does not equal causation.  Improving your intake of potassium rich vegetables can help improve blood pressure; so if you are more willing to eat vegetables when they have vinegar and a healthy olive oil on them, please do so.

If you can't resist adding vinegar to regimen to help with your blood glucose levels and/or your weight, I would suggest that you either take it straight (if you can stand it) or just add it to your food (which I personally would prefer).  Any time you take a supplement you run the risk of spending more money, taking something that doesn't even contain the listed amount of ingredients, or you take more than a person would normally be able to eat and we don't know what problems that might cause down the road.  (Safe doses do seem to be pretty high on this one at least.)

Take home message--if you use vinegar as part of your plan to increase your vegetable intake that part alone might help with your weight loss, etc, but don't expect the vinegar to help on its own.

Monday, September 23, 2013

Cinnamon for Diabetes?

Controlling diabetes takes work.  If you do all you are supposed to do between checking your blood glucose, exercising, preparing healthy food, checking your feet, etc, it takes up a large chunk of time.  (One very small study estimated that doing all your self care tasks takes up to three hours per day).  So it is not surprising that people who really do want to decrease their blood glucose levels will find ways to try to minimize the amount of work that they are doing.   Often they are hoping that there is a supplement that they can take, and one of the supplements I get questioned about a lot is cinnamon.  But is there any evidence that taking cinnamon helps?

A meta-analysis released in this months Annals of Family Medicine, indicated the answer was "well maybe."  Even though there have been some good randomized studies conducted, the studies are often still too small to be extrapolated to a general population.  And there is also the problem that we still don't have enough evidence to tell people how much to take for them to have a benefit, or how long they have to take it, or even how long it is safe to take it.  I was also interested to see that while there seemed to be a reduction in the fasting blood glucose levels, there wasn't an overall reduction in hemoglobin A1C levels.  Usually when a person has "good" fasting blood glucose levels but a high A1C they are eating something that is causing their blood glucose levels to spike after a meal (often called elevated post prandial levels), so the ingestion of the cinnamon was likely not counteracting whatever they were eating during the day.

Now I do know that there are some of you who are still going to try this, or already trying this at home so to speak, so here are some safety guidelines using what we do know.

1) Taking cinnamon while eating a crappy diet isn't going to help you.  (You laugh, but I get to witness this sort of magical thinking on a daily basis).

2) Cinnamon seems to be safe if taken for up to 6 grams daily for up to six 6 weeks. 

3) If you are using this as a supplement, you will probably want to use capsules.  6 grams per day is roughly about 1.5 teaspoons per day (1/2 teaspoon = 2 grams if I did my math correctly) .  Now think about the last time you put just a 1/8-1/4 of cinnamon on your food, and how that small amount actually gave it flavor without burning like Red Hot Cinnamon candy.  Now think about what putting 6 times that amount on your food would do (feeling the burn yet?).  And as much as I like cinnamon, I only have a limited amount of foods that I want to eat it on (Note to self, try cinnamon bacon tomorrow).  So you will probably get what we call a "therapeutic dose" if you use capsules.

3) Since you are using cinnamon as a drug, it might interfere with certain drugs you are taking, like blood thinners.  Please discuss your medications with a doctor and/or pharmacist before trying this.  This advice applies to all supplements.

4) If you are taking medicine or insulin to control your blood sugars, please inform your provider and/or qualified diabetes educator because cinnamon combined with your other medications could cause your blood sugar to drop too low.  (Ask any person with diabetes why you don't want a low blood sugar.  Death is one reason).

5) If you are taking medicine for blood pressure, please inform your provider as cinnamon combined with those drugs could cause your blood pressure to drop too low.

5) If you have liver disease, seizure disorder, auto-immune diseases, or abnormal heart rhythm, use caution and discuss with your provider.

6) Hopefully the above stated guidelines remind you that "natural medicines" are still medicines and can have some bad side effects if you take too much, take them for too long, or take them with other things.

7) The amount you use in your Cincinnati style chili shouldn't interact with medicines; use it as you would any spice/seasoning to help your new and improved diet actually include food that is tasty.

Take home message--cinnamon shows promise for helping some people with diabetes, but discuss it with your health care team first.

References: Natural Standard Database

Friday, September 20, 2013

What about intermittent fasting?

Before I answer that question, I want to admit from the beginning that talking about fasting elicits a not so rational response in me (i.e. makes me wince).  One of the reasons is, as have mentioned before, I grew up religious, and though fasting was not a requirement, it was often highly encouraged during times of crisis (aka "imploring God to change His mind), as a way of controlling "impure" thoughts (aka "if you fast you won't think about sex as much"), or even as a way of showing solidarity with the poor (In college we would have specified meals where we would donate the cost of that meal from our meal plan to a local cause.  I don't have a problem with the concept, but most of us ate elsewhere and didn't experience hunger).   The second reason is that as a female student in her late teen's/early 20's during the 1990's I was exposed to my fair share of people starving themselves to excessive thinness, a condition know as anorexia nervosa (Hat tip to those who work with people with this problem, it is not my cup of tea).  The third reason is the link between poverty and obesity, a situation fueled by the availability of high caloric food that doesn't actually provide any nutrition (Link), and it reminds me of quote attributed to Eusebius Sophronius Hieronymus (aka St. Jerome, yeah I studied my church history) that states "When the stomach is full, it is easy to talk of fasting."

OK, now that's over with.  Deep breath.

So you are wondering about Intermittent Fasting, are you?  Possibly because of the publication of the The Fast Diet and a similar book called The 2 Day Diet?    Or maybe you have heard about one of the variations where you consume 20% of your usual caloric intake on fasting days or just don't eat in between meals?  Or cutting down to 2 meals per day?  Is there any benefit to all of this when it comes to shedding extra pounds?

Well, maybe.  I have already written two somewhat related posts, a few weeks ago I talked about how it might benefit some people to skip breakfast and how the advice about eating six smaller meals a day is more fallacy than fact.  Basically the concept of intermittent fasting is another technique to get people to 1) eat less (Thank you, Captain Obvious) and 2) not have readily available sources of energy so their body will be forced to draw from the stores (sounds good).  And I am putting the emphasis on technique here, because even though we all know that weight loss comes from reducing your intake of calories, and for those with insulin resistant related problems you need to make sure that you reduce your level of carbohydrate, all the while making sure you get enough protein, fat, etc; how you actually get there is easier said than done.  (Remember the quote from St. Jerome?)   A weight loss plan and weight-gain prevention plan are only as good as they are sustainable, and for some people the thought of cutting out certain things for the foreseeable future seems impossible, so the idea of varying "moderate" eating with "restrictive" eating sounds more doable.

As far as the research is concerned, the human studies are small but positive looking when it comes to helping people lose weight and reduce lipids, improve insulin resistance, etc (One here and another here).  Now, intermittent fasting has also been touted as a way to live longer (particularly if you are a lab rat), but when it comes to studies done in primates, it looks like diet quality and your genetics have the upper hand there. 

So should you practice intermittent fasting to lose weight?  I am going to point you back to this post and this post where I basically discuss the caveats.  I will add that apparently people who have trouble with blood glucose regulation do not do well with this, and men and post-menopausal women tend to fare better than women in their reproductive years.  And this will still require some pre-planning and discipline.  If you know that your co-workers always bring the doughnuts on Tuesday mornings, then maybe that is not the best day to do this.  If your co-workers bring in snacks every single day, then you might have to avoid certain areas of the workplace.  If you live with another person/other people, you will have to have a frank discussion about the support you can expect from them.  This might be an "easier than" technique for you to reduce your intake/help your body use up reserves, but it still requires effort.

Other notes:

1) Yes, I know, some people do have to cut out certain foods for the foreseeable future when they have allergies or huge increases in blood glucose after eating them.

2) Some people have adopted a particular diet that severely limits certain foods groups and still find it sustainable (congratulations, you have worked hard to do so).  That doesn't mean everyone can or will.

3) Make sure that your fasting days are based on healthy protein/fat and vegetables.  Getting all your calories from junk food will be more likely to keep you feeling miserable and hungrier sooner.

Take home message--Intermittent fasting could be a useful technique for loosing weight but it still requires planning.

Thursday, September 19, 2013

More in weight loss supplements--Green Tea Extract

I didn't have to spend too much time talking with Dr. Oz's followers (told you this was a gold mine of blog material!) before the supposed "metabolic boosting" properties of Green Tea Extract came up.   But is there any evidence to support this or are you just back to spending your money?  Let's find out.....

First, let's make sure we are all on the same page when it comes to the word "metabolism."  If you ask for a definition from those of us who work in a medical related field what the definition of metabolism is, you will likely see something similar to this one from the National Institutes of Health: Metabolism refers to all the physical and chemical processes in the body that convert or use energy to keep you running.  So your ability to breathe, have a heart beat, contract a muscle to pick up a fork to pierce that steak, process that steak, poop out the steak, etc is all the result of your metabolism.  Now, usually when all the non-medical people talk about metabolism, they are usually wondering how they can burn off extra body fat/increase their ability to burn calories.  (Usually with minimal effort; you know who your are.)  So if you ask your provider about how to "boost your metabolism," and they wince a little bit, it is because sarcasm took over and she probably thought "Really?  You want to increase muscle contractions and cause cramps?" before she remembered you were talking about burning fat/losing the extra poundage.

Now that my sarcasm bout is temporarily over, let's talk about metabolism as your ability to burn calories, and whether or not green tea/green tea extract increases it.    And in this situation, somebody might actually be on to something.  I had already been doing some research this week, but a Pharmacist co-worker gave me a very helpful website called Natural Standards that covers a lot of alternative therapies including dietary supplements.  When you type in "green tea extract" you will, um, probably see a listing for an article about genital warts (sorry about that), but if you click on "evidence table" you should get to a table with all the different conditions that green tea extract is supposed to help, and if you keep scrolling you will find "obesity." (Link)  You will see that 1) while some studies showed modest weight loss, there wasn't much indication that there was a change in metabolism, 2) where there was change the researchers manipulated the levels of catechins (also called flavanoids) so there was more than the caffeine in the tea at work, and 3) if you were able to go in and read some of those studies that looked more positive you would notice that they are pretty small and/or done in one segment of the population (Link), so we don't know if there will be the same effect in women as in men, elders vs. children, etc.  So the end result is, if you think that taking green tea extract might "boost your metabolism" there is a very qualified maybe.

And of course this type of supplement will usually appeal to those of you are have actually reduced your intake and exercised more but you just....can't....lose...that...last...ten...pounds.  Even if you consider yourself pretty rational and skeptical you might be tempted, so I am going to leave these other considerations here:

1) My new favorite website does give an overview of products studied (here), as it is tough to know whether or not your product actually contains the catechins in the amount that you might want to try.

2) Make sure you look at the amount of caffeine that is in the product and think about what other sources of caffeine  you might consume.  Caffeine consumption over 500-600 mg per day could up your risk for dehydration, insomnia, heart rhythm problems, etc.  In other words, it is a drug, even if it is "natural" and can cause problems if you consume too much.  And if you already have a condition, like Irritable Bowel Syndrome, that is aggravated by caffeine, the capsules will likely aggravate that too.

2a) Keep in mind that the studies that showed promise indicated that the combination of the catechins and the caffeine were what helped the weight loss, not just the caffeine itself.

3) Make sure that you are not taking any medications that could interact with this supplement (Link).

4) Do not overestimate how many more calories you might be burning.  In the study I linked above the participants burned about 180 more calories a day, which might sound like a lot.  Until you realize that 180 calories equals a little over half a cup of ice cream or one of my dairy free desserts.  So if you've got the spoon and that pint out and you think that the green tea extract is going to help, think again.  (You know who you are).

Take home message--green tea extract might have modest impact on weight loss if you have already been following a satisfactory weight loss plan including change of diet and exercise.

Tuesday, September 10, 2013

Garcinia Cambogia: This again?

I apparently don't watch enough TV or visit enough supplement shops (which is probably a good thing).  The other day I was driving home and saw an advertisement for this particular weight loss supplement, garcinia combogia, advertised for 25% off.  Since it was something recommended by Dr. Oz I was already suspicious, and an Internet search confirmed my suspicions.  Once I started to write a blog about it, however, I realized that 1) this "new/amazing" supplement has actually been promoted for more than 15 years and 2) other writer's and bloggers have beaten me to pointing out the lack of evidence. 

So with that, I give you this excellent article written by Julia Belluz and Stephen J. Hoffman over at Slate: Can you trust Dr. Oz?  (Hint, the answer is no).

Let me highlight here that the 1998 study that indicated that the garcinia extract was no better than a placebo for weight loss was a randomized-controlled trial, also known as the gold-standard for a clinical trial.    So if you go on Amazon.com or your other favorite supplement retailer you get to spend about $20-$30 a month for something that works no better than a placebo.  That should be a deterrent to any good skeptic.

I also want to put in a reminder to watch out for the logical fallacy known as the Appeal to Ancient Wisdom.  Just because something is billed as having been "used for hundreds of years" in "insert country that seems exotic to those who live in Western societies here" does not mean that it has any practical medical application today.

Take home message--if you use garcinia extract to lose weight you are spending money that you could put toward your healthy food budget.

Now excuse me, I will go stalk Dr. Oz's website for more blog material.  I might be awhile.

Wednesday, September 4, 2013

Take care of yourself: Get a flu shot

It's September, and if you work in the healthcare like I do, you know that that flu season is fast approaching.  If you are a Skeptic, you probably also know that flu season is prime time for a lot of anti-flu vaccine and "boost your immunity" woo, and so you are creating that special place on the wall for you to bang your head.    As I've said before, I'm sure I will be getting questions about various "alternative" methods of preventing the flu and/or the common cold, although I have already written about many of those before.  But as I was reading one of Dr. Harriet Hall's take down of one anti-flu shot purveyor, I realized that many of the Masters of Woo try to sell you on their product or regimen by pretending that "Get your flu shot" translates into "we don't care about anything else."  Fortunately you have me to remind you that those of us who really want people to stay well are fully aware that there are other evidence-based practices that you can follow to stay well and avoid infectious diseases, such as:

1) Eat a healthy diet with adequate protein, plenty of vegetables, and don't overeat on starches and sugars so that you can keep your usual state of health.  If you have a condition, like diabetes for example, where following a particular diet plan is critical for you to maintain control of your condition, then stay on your plan as much as you can.  If your condition is not controlled, you will be more vulnerable to whatever contagious disease is going around.  Keep in mind too that there is no evidence that anyone specific food will keep you from getting the flu.

2) Wash your hands after using the restroom, before eating, and before touching your face/nose.  This is especially important when you come into contact with what I call "shared equipment," like the handles on a grocery store cart or the handles on the weights at the gym.  I've noticed that some public places actually have hand-sanitizing stations and wipes for cleaning equipment placed at strategic intervals.

3) If you are sick, stay home.  If your kids are sick, keep them out of school (I think this translated into "stay away from children" in the linked post).  If you are feeling ill, and you have friends/co-workers/loved ones who have a condition that causes them to be immunocompromised, stay away from them until you are no longer contagious or have them done masks, etc.  (Easier said than done for people who don't have paid sick days at work, I know.  I wish I had an easy answer for that one).

4) Get adequate sleep as poor sleep can cause you to have a less than optimal immune system.  (Again, easier said than done, although this discussion does sound familiar).

5) If you have a known vitamin deficiency, such as low vitamin D levels, you might need supplementation until your levels are back to normal.

6) Don't overdo the neti-pot, just use it temporarily if your sinuses are irritated.  Overuse can actually deplete the mucus layer in the nasal passages--the reason you have that mucus layer is so it can actually serve as a barrier to infectious agents.  (And keep in mind that a neti-pot will cost you on average about $10-22 depending on what comes with it, and a bottle of saline nasal spray costs you $3.88).

And of course.....

7) Get a flu shot.  Sometimes we don't always get sleep, eat properly, etc and it helps to build up antibodies to an actual illness.  And even if you have an adequate immune system, the people around you may not, so do it to keep them from getting sick as well.

I know, I know, some of you are still thinking, "But the flu shot doesn't cover all strains of flu!"  Of course not, which is why you wash your hands, etc.   And you should also read this thorough, excellent blog post by Dr. Mark Crislip which contains this lovely quote:

 "If you realize that medicine is subtle and nuanced, and often the answers are filled with qualifiers and uncertainty, that the practice of medicine is messy, I think the answer is that the flu vaccine is of benefit. And that the more people who get the vaccine, the greater the benefit for everyone. You do not know how much it pains me to quote Donald Rumsfeld , but he was partly right when he said “You go to war with the army you have, not the army you might want or wish to have at a later time.”

It is true in medicine as well. My army is the vaccine and the data used to support it."

Take home message--Use all the tools you can to stay healthy, including a flu shot.