Tuesday, May 28, 2013

Sacrifice for Longer Life?

One doesn't have to look to far in the history and mythology of human beings to find that the quest for immortality seems to be a universal one.  It can be easy to laugh at the naivete of Ponce de Leon looking for the fountain of youth (or for some of us it is), but what about when we start hearing about how our food (i.e. something right in front of us, if you have the means) could actually help us live longer.  Such was the question raised by a journalist named Michael Mosely in a BBC special.  Sadly, the full special is no longer easily available, but alert reader Jane sent in this article which provides a summary of the points he was exploring.  Is there anything to calorie restriction and helping us live longer?

Looks like we are out of luck again folks.  The "evidence that was mounting" in Rhesus Monkeys turned out to not be mounting so much.  Michael over at Skeptical Raptor has already covered how, even with the use of a primate proxy, there was no evidence that the restriction helped the primate proxies live long.  (Also, Michael's blog has a cute picture of a monkey with a bib, and Primate Proxy is my next band name).

But what about other markers that people look at for health?  This quote from the author indicates he was able to improve some other parts of his life as well: " I stuck to this diet for 5 weeks, during which time I lost nearly a stone and my blood markers, like IGF-1, glucose and cholesterol, improved. If I can sustain that, it will greatly reduce my risk of contracting age-related diseases like cancer and diabetes."

In short, he reduced his intake (of everything most likely), and his health markers improved.  Nothing news worthy here.  But the key is that he found a plan that was SUSTAINABLE for him.  (Yes, I am shouting in order to make my point).   As I have said before, the sustainable, or lack there of is usually what gets people when it comes to losing weight.  How many of us have gone on some type of diet, whether it was changing to veganism, going low carb, etc and annoyed the hell out of our friends on social media or in the work place (you know who you are) with your new found religion, um, diet only to be sheepishly sneaking the donuts in later?  Why?  Because you a) had no long term game plan for how to avoid the donuts (or whatever), b) were doing something completely un-necessary (like avoiding gluten when you don't have celiac disease or some other type of bowel condition), c) were neglecting some important nutrient, like fat, and threw your satiety regulation out of whack, or d) some combination of all the above.  Looks like in this experiment on himself Mr. Mosely, a) knew his limits and came up with a long term plan, b) didn't completely cut everything out forever, c) kept all the macronutrients, just ate less of them, and d) well, some combination of the above. 

He was also right to point out that no, we don't have good human studies for this, and that you better let your doc know what you are doing if you decide to try this.  Permit me to get a little anecdotal on you for a moment; I have more patients than I care to count right now who are on high doses of insulin because they are 1) obese and have a family history of insulin resistance, and 2) their diets contain way more carbohydrate than they should eat for good glucose control.  Sometimes they decided "Gee, maybe my CDE is right in that I should stop eating 4 slices of bread at each meal, and I should do better."  So on their own, without telling anybody, they cut their carbohydrate way down--without telling me or their provider about it.  Soon their blood glucose levels are dropping into a dangerously low range (below 70 mg/dL) and they start having to take tons of glucose tablets to regain normal blood glucose levels, and some of them just give up.  Had they let me or their provider know, we could have come up with a schedule of insulin decreases to support them in their new endeavor.  (Some people are ok to do this on their own, and they do tell me about it, but at least we are communicating!)

The other part of this that makes me uncomfortable is the association between fasting and religion, and I will be the first to admit that this discomfort is not fully rational.  I grew up Mennonite and we did not engage in most of the "High Church" rituals that involve fasting.  Fasting was usually reserved for what I could best decribe as times of crisis; for example, when Gulf War I imminent we were to engage in a day of prayer and fasting to appeal to God to stop this (no, it doesn't make sense).  Fasting was also employed as a way of purifying yourself in some way (young men who had "lustful" thoughts were encouraged to fast periodically in some churches), and reminding you that there was Something outside of you sustaining you.  Quite frankly, as an atheist, when I hear about fasting, particularly when people talk about "cleansing" themselves, not only do I get twitchy because of the bad science, I get upset because are looking at their bodies as something impure.  (Hopefully the rest of you are "over" all of this).

Take home message--Intermittent fasting most likely won't help you live longer.   Intermittent fasting might help you achieve a sustainable plan for losing weight--but ask your doctor first, particularly if you have existing medical problems.

Tuesday, May 21, 2013

Fear of Red Meat

Sometimes I get sent articles or blog posts that have so much misconstrued information that I don't even know where to start.  Alert reader Matthew sent me this blog post: Processed Meats Declared Too Dangerous for Human Consumption.  I'll just try to start at the begining and take it from there.

Most people who enjoy my blog and skeptical viewpoints in general would probably take one look at the name "Dreamhealer" and pretty much stop reading right there as that doesn't exactly state "scienctific information to be given here."  If you did continue on to the first paragraph, you find a another red flag in this statement: "[The World Cancer Research Fund (WCRF) states] Consumers should stop buying and eating all processed meat products for the rest of their lives."   This kind of definitive statement is not usually found in scientific proclamations, as most scientists are aware that whatever conclusions are drawn, someone is working equally hard to disprove it.  And you can actually go to the WCRF website, and with a few clicks (and registration for a detailed report), you will find that they didn't actually say that.  What they did say is that there is convincing evidence that overconsumption of red and processed meat could increase your risk for colon cancer (note, just colon cancer), and that their recommendations are that people limit red meat consumption and consume very little processed meat. (Link here and you can register to download information on full recommendations and the studies that they have evaluated).  Keep in mind also, that the studies that are being evaluated are observational and not the rigorous double-blind studies that you really should have before starting to make recommendations.  We still need observational studies because of the ethics involved in doing dietary double blind studies on humans, but once again, they indicate there is a correlation (and opportunity for future research) and not necessarily a causation.  I always want to nitpick about any differences between feedlot beef and grass-fed beef, but not everyone has ready access to grass fed beef, etc, either.

The next couple paragraphs speak of the evils of nitrites, but the evidence about this is still inconclusive as well (Link).  As a matter of fact, there is research being done in regards to nitrites, including the inorganic type, as a possible treatment for blood pressure (Link).  Of course when substances are being studied to determine their impact on human physiology the researches will use standardized doses of said substance, which is different than people randomly consuming pastrami (and then later forgetting to report it), but there is an indication that nitrites might not be all bad if you watch the amounts.  (And by the way, the whole "processed meat and pancreatic cancer" story was apparently inconclusive as well, as indicated here.  After you look over that, you might want to amuse yourself by looking at another complete misrepresentation here.)

There was also an attempt to sneak in a commentary on the evils of MSG as well.  Michael over at SkepticalRaptor has already covered this here and here.  Feeling lazy about following links?  The title of the second link, "MSG-fussing about nothing" should some that one up pretty well.

I will add in here that I often have to counsel my patients that they need to limit processed meat because I work with a lot of heart failure and kidney failure patients; the more processed anything they eat (including starches) the more likely they are to retain fluid, and have to be given larger doses of diuretics, etc.  If they can eat in such a way that they don't need more medication I would like to help them do so.

Now, I would like to think that all of us are rational all the time, but I know that if you have a family history of colon cancer and/or pacreatic cancer it can be very easy to get more than a little panicky about "news" like this.  So how might you find a balance?
1) Get variety.  Chicken, fish, eggs, game (including buffalo) have protein too, so if you have access to those sources, use them.  If you tolerate vegetarian protein sources you can work those in as well.
2) Stay within your protein needs as I outlined in this post.
3) If you are on a carb controlled plan and/or making sure you get some fat at each meal for satiety, there are other fats besides bacon (I know you are shocked.  I will wait while you clutch your pearls and faint).  I like the taste of avocado on an omelette myself.
4) You can also buy jerky, bacon, lunchmeat, etc that is free of inorganic nitrites/nitrates if you are still leery.  Be prepared to pay more for it, but it is an option.

Take home message--Not overconsuming processed meats is probably a good idea, just like not overconsuming anything is a good idea.  Get a variety of protein sources instead of only from processed meat.

Friday, May 17, 2013

Protein Fears

Protein, and the amino acids that form it, support key functions in our bodies so we do need to make sure we get enough.  Depending on whom you talk to or what you read, however, you might get some different ideas regarding how much is too much or what is too little, and sometimes there are dire warnings given about people who fall out of the range.  I was sent this article for critique by alert reader Jennifer that contained some warnings and reasonings that may or may not be accurrate: Are High Protein Diets Safe?

The author of this post does actually give a nice overview of the role protein plays in our body and of the need to get all the essentially amino acids.  I also liked that it was pointed out that some sources of protein contain all of the essential amino acids (usually animal sources of protein), making them more efficient sources of protein, and some do not contain all the essential amino acids and so they are less efficient (Usually vegetable sources of protein).  (This doesn't mean that they are bad or that they shouldn't be eaten every, just that they are less efficient).  One of the things that was not pointed out, however, is that there are some health conditions and lifestyle choices in which a more "efficient" source of protein might be beneficial.  Currently I work with a population of people tend to have poor appetites related to dementia, medications, surgeries, cancer treatments, etc.  They may not have the desire to eat enough variety of beans, etc (or they don't have the energy level or assistance to cook these type of foods) to get all of the amino acids, so including eggs and other animal protein sources would usually allow them to get more protein with less patient/caregiver burden.  I also work with a lot of people that have diabetes and have to carefully control their carbohydrate intake and would rather deal with eating animal protein sources so that they don't have to deal with the carbohydrates found in lentils, etc.  I also have friends and relatives that are elite ultra-marathoners and triahtletes that require extra protein because of the additional stress their body goes through and don't want to eat all day so they choose to get their protein from animal sources.  And then there are people, like yours truly, who have bowel/intestinal conditions that do not tolerate legumes or grains.  (Please note that I am not AGAINST vegetarian diets for any of these conditions, it just depends on the level of work you can/want to do.  I have math minded diabetic vegetarian clients who carefully controlly their legume intake so they can control the carb intake/blood sugar.  There are vegan athletes who are willing to eat more often and eat more volume at one sitting to get their full contingent of amino acids.  You can make this as simple or as complicated as you wish).

One of the other problems is the emphasis on saturated fat being all bad all the time.  There have been multiple studies detailing this flawed assumption, and I will point you to this particular summary of the research here: What if saturated fat isn't so bad?    Remember, we do actually need some fat for satiety and to make sure we get some omega-3 (and omega-6) which are essential fats--meaning our body needs to acquire them from food sources.  You still want to avoid deep fried foods in order to avoid refined carbs, oxidated fats, excess omega-6s, and extra calories period, but that doesn't mean you have to avoid lamb and only eat oysters.

One thing I found interesting was the reaction that his advice to include soy caused a mild explosion on social networking sites.  I have covered some of the myths regarding soy in a previous post, including that eating all soy, all day, all the time might not be a good idea (and neither is an overconsumption of anything else).  Notice he said "soy is a way to get protein" not "eat soy in everything."  Just a reminder for those of you feeling too lazy to follow my links, throwing some tofu or tempeh in as meat sub sometimes probably won't hurt you, but using processed soy all day might not be ok.

Before I address the comments about kidney function, etc, I want to address what a "high protein" diet actually is.  First of all, most adults need roughly about 0.8-1 gm protein per kilogram body weight (Divide your weigh in pounds by 2.2 to get your weight in kg).  (If you are overweight or obese I would find an online lean body mass calculator and use the same calculation but with your lean body mass).  If you are an elite athlete, you probably need to go up to 1.5-2 gm protein per kg body weight.  I have also seen a few small studies that use roughly about 1.5 grams of protein per kg in obese people, the reason being that people who are going to have to "diet" longer than those of us trying to lose 5-10 pounds will have to work harder at preserving their lean body mass.   Just as a reference point, I have a weight and body fat in ranges that I am content with and my protein requirement is ~53-66 gm of protein per day.  For me a "high protein" intake would be upwards of 80 or more grams of protein per day.

Back to kidney function, if you are a healthy individual in so much that you do not already have kidney disease, there is no evidence that a high protein intake will cause kidney damage (Link).  Wait, go back and read that again--no evidence for healthy individuals.  Now, if you already have known kidney damage the story does change, but it's only a slight change in that you probably just want to stay around 0.8 gm/kg.  Unfortunately I am old enough to remember the days when we as healthy care providers used to put people on low protein diets (0.6 gm/kg) when they had decreased kidney function, but fortunately we had the opportunity to study this and find out a) there was no benefit and b) people who are in stage 3 and 4 kidney disease (where you are just about to go on dialysis) have a decreased appetite anyway and we just want them to eat--so telling people "you can't eat that" really does help the cause.  I do want to state another caveat; sometimes the people who are going on carb controlled diets like Atkin's, etc are people who have been obese and/or had uncontrolled diabetes and high blood pressure for quite some time (this would be the population I work with); so while I have to applaud them for finally deciding to take better care of themselves, the damage to their kidneys is already done, so they need to be careful to get adequate protein but not go overboard.  How do you know if you have kidney damage?  If you have known prediabetes, diabetes Type 1 or 2, and/or high blood pressure, your physician should be doing the appropriate blood and urine exams on a regular basis and can tell you if you have any degree of kidney failure (so if you haven't been seeing a physician on regular basis, go!).

As far as protein intake and kidney stone formation, we are back to another gray area thanks to conflicting studies (Link).  It appears that some people might have a genetic propensity to have uric acid stone formation and a high protein diet might exacerbate this.  Since genetic testing is still not routinely done for this sort of condition, you have to look at your history and ask:
1) Do I have a history of uric acid kidney stones?
2) Do I have a near relative that has a history of kidney stones?
3) Do I have a condition like inflammatory bowel disease or bowel surgery (ex. Gastric Bypass surgery) ? (this alters how you absorb nutrients)
4) Do I have a condition like hyperparathyroidism?
If the answer to any of these questions is yes, you probably want to keep your protein intake to "normal" as listed above, drink plenty of water, and make sure you eat enough fruits and vegetables to keep your urine from being acidic.

When it comes to bone loss, we once again have, you guessed it, a gray area.  It's entirely possible that the older you get the more careful you have to be about your protein intake to have healthy bones, as demonstrated in this study.  Keep in mind that some people have a harder time absorbing nutrients, including protein, once they get to be "older," (which in the literature is usually about 65 years or more), so the higher protein intake might be more beneficial here but not so much for younger people.

One other topic I want to bring up that I didn't addressed in this article is the difference between what is written in books and what people do on their own.  If you actually read the content of and look at the sample menus in books like "The New Atkins for the New You" and "Protein Power," etc the recommendation is to make sure you are getting an adequate amount of protein, not to gorge, and the sample menus might only contain about 70ish grams of protein, so even I wouldn't be too far off.    So if someone tells you they had "x" problem with a particular diet, you have to wonder if they were really following it or if they went off on their own little excursion. 

So what is SkepticRD's take home message from all of this?  First of all, that we all need to figure out what our individual protein needs are, taking into account health conditions, health goals, exercise levels, etc.  If you have a calculator, can read food labels, and have access to calorieking.com (or the like) you can figure this out and control the amount you eat.   Second of all, not all of the scare tactics that have been used in an attempt to keep you off a particular diet might not apply to you or have evidence to back them up.  Third, when it comes to making the choice between animal protein and vegetable protein, each individual has to consider their own health conditions and how much effort you are willing to put into getting.

Thursday, May 16, 2013

It's (s)not true--allergy edition.

Ah, allergy season.  Nothing like having itchy, watery eyes, sneezing like crazy....and having everybody and their mother tell you what their favorite remedy is for avoiding allergies.  But do these remedies have any evidence?

One piece of advice is to avoid dairy to limit increased mucus production, and I have already covered how this is not an evidence-based recommendation here.   Of course, you will get a lot of anecdotal evidence related to avoiding dairy, but let me state once again that anecdotes does not equal evidence.  We do also want to consider that there are other factors at play here.  First of all, if you are already nice and phlegmy, the creamy texture of milk/ice cream/yogurt will probably make you "feel" more phlegmy even if you aren't producing more mucus.  Second of all, when people say they cut out dairy in any way, shape, or form--in the United States that encompasses a lot of foods, not all of them healthy, including, but not limited to, processed cheeses (more added omega-6 oils and starch fillers than protein), yogurts and ice cream (usually added sugar, depending on the type), milk chocolate (added sugar), cheese puffs (refined carbs and omega-6 oils), white bread, tons of pasta, etc.  If you are overweight/obese and you cut out those foods and lose weight, that by itself can ease your breathing.  If you have diabetes/pre-diabetes and you eat so that you stop having blood glucose swings, you will feel better overall and not feel as miserable even if you do experience seasonal allergies.  Third, some people already have an underlying condition, like lactose intolerance, autoimmune problems, irritable bowel syndrome, etc, that requires a limitation and/or avoidance of dairy and/or wheat anyway, to which I remind them that they need to be avoiding things that make them sick anyway!

The local honey remedy is another one that usually starts making the rounds at this time of year as well, and once again I have already covered that before. (The answer is no).

One of the more odd remedies I've seen is taking wormwood to "detox" the system.  Of course I have written about detoxing/cleansing before (like here--the answer is still no), and the reason I find this recommendation odd is that wormwood/sagebrush/mugwort is one of the pollens that actually causes allergic reactions in people.

And here is a new area of research that I am both fascinated and repulsed by, the use of parasitic worms in treating allergies (Link).  That is one that I am going to wait for more research on.

Is there anything that allergy sufferers might be able to try to eat or need to avoid to help relieve symptoms?  Some foods can be given a qualified maybe, particularly if you know what you are actually allergic to.
1) Foods rich in omega-3 fats like salmon or flaxseed.  Unfortunately, we don't really know how much omega-3 a person needs to help alleviate allergy symptoms, but since omega-3s are an essential fat and may reduce inflammation, it's not a bad idea to work this in as part of a healthy diet.
2) Warm liquids like tea and soup.  Drinking these won't prevent allergies, but they might thin out the mucus and help you feel better.
3) If you are allergic to grass--you might have a reaction to foods that are in the grass family, such as corn, wheat, and even rice.  This is likely why some people who go on carbohydrate controlled plans find a reduction in allergy symptoms. If you have diabetes/pre-diabetes you might be needing to reduce your intake of these anyway, and you may not have to avoid these all the time if you monitor how much/when you eat them.  People who are allergic to grass have also reported reactions to celery, peaches, tomatoes, melons, oranges, and figs--keep in mind that these are mostly reports.
4) If you are allergic to ragweed you might also have a reaction to bananas, cucumbers, melons, artichokes, zucchini, and camomile tea.  Now, I know some of you are already weeping at the thought of cutting out these foods and wondering if this is really necessary.  The best method you have available to help determine this is to keep a food diary for at least two weeks and note any reduction in symptoms, then try introducing each food one at a time to see if you experience an increase in symptoms.
5) If you who were eating spicy foods to "clear your sinuses," you might want to rethink that.  Spicy food consumption also can trigger a runny nose, watery eyes, and even sneezing, so if you are already miserable with those symptoms you might not want to make it worse.
6) If you like to have a "hot toddy" as part of your warm liquid regimen, you might want to reconsider that as well.  Since alcohol causes blood vessels to dilate your might feel a little bit more "stuffed up."  Alcohol also contains some naturally occuring histamine as a result of fermentation, and depending on how your body processes that, you might have more symptoms after drinking.  (Side note/disclaimer: As someone who takes full advantage of "alcohol in moderation" guidelines I have not noticed any issues, but you might need to include alcohol in your food diary)

Once again, keep a food diary and keep track of symptoms in the same log book/spreadsheet/app, etc.  You will probably have some people tell you to "listen to your body,"  but I know I will usually forget what my body "tells" me after a day or two, let alone two weeks, so keep track of your data in the way that works best for you.

Take home message--if possible, see an allergist to determine what seasonal allergies you have.  This will help you evaluate which foods you might be eating that are "botanically related" to what causes your allergies.

Wednesday, May 15, 2013

Check it Before You Wreck It (Vitamin D)

I do see a lot of people who want to cover all their bases when it comes to their health.  I do find this admirable on some level, but I also find a lot of people spending time and money trying to cover things that do not need to be covered.  Honestly, when it comes to spending money I have a tendency to roll my eyes and say "it's your bank account" and move on.  When it comes to potentially doing harm to one's health, however, I tend to be a little bit more forceful (when people ask) about really making sure you need whatever you have been taking/supplementing with, particularly when a simple blood test can tell you whether or not you need to take it.

Such is the case with vitamin D supplementation as indicated by this particular study, which indicated that elevating the vitamin D levels beyond a certain point might actually confer some harm. (Link)  Your body normally works pretty hard to keep blood levels of vitamin D (and pretty much everything else) within a certain range, and more of something is usually not better, especially when that more might put you at risk for hardening of the arteries.    Naturally, there should be some more studies done on the potential harm of elevated vitamin D levels, but if a simple blood test could let know whether or not you should spend the money on a supplement and/or potentially increase a risk, why not do it?

I'm sure some of you are going to remind me that in this day and age not everybody has insurance and/or not all insurance plans will cover a blood test.  So you will need to consider if you are part of the high risk for low vitamin D groups as outlined in the article:
1) A female greater than 75 years of age.
2) You have a diagnosis of chronic kidney disease (even if you are not requiring dialysis yet).
3)  A female who is post-menopause.
4) If you are obese, meaning that you have a waist to hip ration of > 0.90 for men and > 0.85 for women (Instructions here: http://www.bmi-calculator.net/waist-to-hip-ratio-calculator/)

I would also add you should consider yourself at risk if you have celiac disease or any other inflammatory bowel condition (as you may have trouble absorbing nutrients if your condition is not controlled) and/or if you have known liver disease.

If you have the blood test done and are put on supplementation per your provider's recommendations, make sure that you follow up with a blood test at least 3 months later and follow up with your physicians recommendations later.  In the meantime, it doesn't hurt to make sure that you also get enough sunlight (as your body knows when to shut off production of vitamin D from sunlight) and eat foods like salmon, sardines, mackeral (or vitamin D fortified foods), to make sure that you get enough vitamin D from the usual sources.

Oh, and I guess I should also mention that "normal" levels pf vitamin D are considered to be between 20 nanograms/milliliter to 50 ng/mL.  Supplements are usually recommended if you are below 20 ng/mL, but deficiency is usually diagnosed at <12 ng/mL.

Take home message--before assuming that you need to supplement, consider your evidence-based risk factors and use the tools available to you (including blood tests) to determine your actual need for supplementation.

Monday, May 6, 2013

Chia seeds for weight Loss?

I wear a button on my ID tag that proclaims that I am "High in Fiber."  It's to show that 1) I am a member of a profession that educates people on fiber needs (or not), 2) I enjoy "fiber arts" such as knitting, crocheting, and possibly spinning, and 3) I have the sense of humor of a twelve year old most days.  Yesterday I was in a circle of people who were all beginning spinners and we were all commiserating on the difficulties of learning spinning.  I've noticed that sometimes said comraderie leads to commiserating and trading tips on other things, and in this case it happened to be upcoming surgeries and weight loss.   My favorite for this event?  "I started drinking two tablespoons of chia seeds in water and in two days I lost three pounds!" 

"Wait, aren't chia seeds what you use to grow the 'fur' on those terra cotta figurines feature in those annoying commercials?"  is probably what you are thinking.   Well, yes, they are from the same plant, but now the seeds are being sold to help [insert your favorite health problem here], including helping people lose weight.  The theory is, if you put chia seeds in water they form a gel, and that gel helps you "feel full" faster, and then you don't eat as much, so you can lose weight.  (Although I think the person who said this just heard "they are supposed to be good for losing weight" and stopped there).  Since the use of chia seeds also date back to Mayan and Aztec cultures, I think there might also be an "appeal to ancient wisdom" fallacy at play here, as well as an "it's exotic so it must be good for me" fallacy.  Does this theory hold up in practice though?

There was actually a single blind study done in 2009 that indicated that chia seeds didn't help change body composition after 12 weeks (Link).  Think about it this way too, even if the addition of chia seeds did help you eat less at breakfast (or whatever meal you decided to take them), if you didn't get enough protein and/or good fats for satiety (or just overate on carbohydrate and messed with the hormones like insulin that play a role in regulating appetite), you will probably try to make up for what you didn't eat at breakfast later on.  So why did that person in your knitting circle lose weight after adding chia?  Chances are they made other changes in their eating habits that promoted weight loss.

Is there any other benefit to adding chia?  Possibly, depending on what other things you are or are not eating.  Chia seeds are a good source of omega-3 fats, so if you don't eat fish on a regular basis or don't wish to supplement with fish oil you could use this as one of your sources.  Keep in mind that the form in non-animal sources (alpha-linolenic acid or ALA) is not as efficiently absorbed as animal sources (docosahexaenoic acid or DHA, and eicosapentaenoic acid or EPA), so if you are vegan or vegetarian you really want to make a point of working those in!  (Flax seed also works, but you have to make sure you grind the flax seeds to actually absorb the good things!).  If you are someone that has trouble eating fruits and vegetables (you know you should eat more vegetables, but you haven't make it yet), chia seeds can help you get some anti-oxidants and fiber.  And if you have irritable bowel syndrome, the soluble fiber in chia can be good for helping absorb water so the stool can be more formed (diarrhea dominant) or softer and easier to pass (constipation dominant).  2 tablespoons of chia can actually give you about 6 grams of protein (about the same amount as one egg), so carbohydrate-concious vegetarians/vegans can use this as a way to work some protein in as well.

Take home message--there could be benefits to including chia seeds, especially for vegans/vegetarians, just don't expect any magic weight loss attributes.

Thursday, May 2, 2013

Digestive Enzymes

If you have any kind of digestive related ailment (like yours truly), you have probably received all kinds of (probably unwelcome) advice from those who like to play doctor on the internet.  I'm sure some of you, like me, have been told (not always nicely) that you need to use "digestive enzymes" to cure whatever ails you.  So that's why I was pleased to see this article which gives a brief overview of who can really benefit from taking enzymes and what kind of enzymes you might actually need.  In short, you only need to take enzymes if you have pancreatic insufficiency (yes, your pancreas helps you digest fat besides making insulin), lactose intolerance (and you just can't resist that bowl of ice cream), or a high fiber diet (e.g. you are a vegan who uses legumes as a primary protein source).  Note that those type of enzymes are usually have a special coating so that the gastric (stomach) juices do not render the enzymes useless and they can actually reach your intestines.    There are a few other enzymes that are often recommended to people, however, that are worth talking about.

1) Papain, also known as "papain enzyme" or "papaya extract." 
Papain does actually contain enzymes that break down proteins, and this is why it is used in enzymatic cleaners (such as those used for contact lenses) or to tenderize meats.   Unfortunately there is little to no evidence to support helping vague "digestive problems" or the more specific "intestinal worms." (Link) Eating papaya doesn't seem to produce any side effects (unless you overeat), but taking the extract in excess might actually cause irritation of the stomach.  So unless you have some money to burn or need a low caloric way to tenderize meat I wouldn't spend the money on this one.

2) Bromelain, also known as "pineapple extract."
Bromelain has actually gotten more attention as something that might be effective for arthritis (osteoarthritis) pain when used in combination with another compound.  When it comes to digestive issues I have seen it recommended to people who have inflammatory bowel disease, like ulcerative colitis, and also for vague "stomach problems."  Once again, there is little to no evidence that bromelain works (Link), and excessive amounts might even cause diarrhea and stomach irritation.  I also found it interesting that people who have allergies to wheat and grass pollen might have a similar reaction if they take bromelain.  If you are just going to eat pineapple your stomach will probably be fine unless you have a problem with GERD.

Take home message--Enjoy pineapple and papaya as part of your daily fruit allowance (just avoid the dried sugar-added versions), taking the supplements will likely cause irritation to your wallet.

Wednesday, May 1, 2013

Garlic brain

One of the major concerns that I see raised by my patients when trying to lose weight is "How can I cut back on food without feeling like I am starving myself?"  Of course we have the discussion about various behavioral techniques (e.g. portioning out your plate ahead of time), and making sure that high satiety vegetables and good fats/protein are adequate at the meals, but that doesn't always stop us from wishing that there wasn't some pill, herb, essential oil, etc that we could take that would shut off our appetite.  It looks like one of those potions that is being touted lately is garlic, as in this little treatise on so-called "super-foods" here.

Fortunately the dietitian quoted in this article had "might" as part of the quote, but I thought I would do a little digging.  And I had to dig quite a bit and I still haven't come up with the source article yet, but I did find a few news articles referring to research done at the Weizman Institute in Israel.  (Unable to link at the time secondary to the internet not cooperating with me today).

 What I found was the following:
1) The studies were done in rats but not in humans, so this could only work in rodents.
2) It appeared as though the allicin was extracted from the garlic and given to the rats.  Which makes me wonder how many garlic cloves I would have to eat to get the same amount, and would it be realistic?
3) It appears as though the rats were given an infusion of the allicin into their GI tracts and then allowed to eat.  Would such a compound survive an oral administration?
As I said, I am still trying to dig up the source article, so I may get some more answers as I keep digging.  Right now, however, it looks like we are in the "well that's nice but let's see how it works on humans first and see how practical it would be in the real world."

Would it hurt to add garlic to your food?  Only if you are allergic I suppose (or you have IBS as too much garlic can be a problem for those on a low FODMOP diet).  I have a lot of patients who are unfamiliar with seasonings other than salt and pepper and garlic can be used as an easy introduction into cooking food for yourself that actually tastes good; if their healthier meal plan actually contains foods that taste good you might be willing to stay on it. (Garlic can help from a behavoiral perspective).  If you add a lot of garlic you might be less inclined to eat as much of certain things for fear of your breath driving other people away from you (also behavioral).  And for some people, even if they like garlic, they have to stop eating because the taste is too strong.  Some of you might find that if the garlic is on something you already tend to overeat on, like pasta, you may not find that it doesn't make a difference.

Take home message--more studies need to be done on garlic to determine if it helps satiety and what form and amounts are required.  In the meantime, it can add flavor to food as long as you are watching your portions and what you eat in the first place.