Can Diet Add Years To Your Life?

Which Foods Have The Biggest Effect On Longevity? 

Author: Dr. Stephen Chaney

Fountain Of YouthEveryone over 50 is searching for the elusive “Fountain Of Youth”.

  • We want to look younger.
  • We want to feel younger.
  • We want the energy we had in our 20s.
  • We want to be rid of the diseases of aging.

The list goes on!

But how do we do that? Pills and potions abound that claim to reverse the aging process. Most just reverse your wallet.

  • Should we train for marathons or bodybuilding contests?
  • Should we meditate or do yoga to relieve stress?
  • Should we get serious about losing weight?
  • Should we get more sleep?
  • Is there some miracle diet that can slow the aging process?

All the above probably slow the aging process, but the evidence is best for the effect of diet on aging. Several recent meta-analyses have looked at the effect of diet on the risk of premature deaths. In this issue of “Health Tips From the Professor” I review a study (LT Fadnes et al, PLoS Medicine, February 8, 2022) that combines the best of these meta-analyses into a single database and provides a provocative insight into the effect of diet on longevity.

How Was This Study Done?

Clinical StudyThis study combined data from recent meta-analyses looking at the impact of various food groups on the risk of premature deaths with the Global Burden of Disease Study which provides population-level estimates of life years lost due to dietary risk factors.

The authors then developed a new algorithm that allowed them to estimate how different diets affect sex- and age-specific life expectancy.

They divided the population into three different diet categories based on their intake of whole grains, vegetables, fruits, nuts, legumes, fish, eggs, dairy, refined grains, red meat, processed meat, white meat, sugar-sweetened beverages, and added plant oils. The diet categories were:

  • Typical Western Diet (TW). This diet was based on average consumption data from the United States and Europe. This was their baseline.
  • Optimal diet (OD). This diet is similar to a vegan or semi-vegetarian diet. However, it was not a purely vegan diet nor a purely semi-vegetarian diet. Instead, it represented the best diet people in this study were consuming.
  • Feasibility diet (FA). This diet recognizes that few people are willing to make the kind of changes required to attain an optimal diet. It is halfway between the Typical Western Diet and the Optimal Diet.

To help you understand these diets based on the foods the study participants were eating, here are the comparisons in terms of daily servings:

Food TW Diet FA Diet OD Diet
Whole grains 1.5 servings 4.3 servings 7 servings
Vegetables 3 servings 4 servings 5 servings
Fruits 2.5 servings 3.75 servings 5 servings
Nuts 0 serving* 0.5 serving* 1 serving*
Legumes 0 serving** 0.5 serving** 1 serving**
Fish 0.25 serving 0.5 serving 1 serving
Eggs 1 egg 0.75 egg 0.5 egg
Dairy 1.5 servings 1.25 servings 1 serving
Refined grains 3 servings 2 servings 1 serving
Red meat 1 serving 0.5 serving 0 serving
Processed meat 2 servings 1 serving 0 serving
White meat 0.75 serving 0.6 serving 0 serving
Sugar-sweetened beverages 17 oz 8.5 oz 0 oz
Added plant oils 2 tsp 2 tsp 2 tsp

*1 serving = 1 handful of nuts

**1 serving = 1 cup of beans, lentils, or peas

Using their algorithm, the authors asked what the effect on longevity would be if people changed from a typical western diet to one of the other diets at age 20, 60, or 80 and maintained the new diet for at least 10 years. The 10-year requirement is based on previous studies showing that it takes around 10 years for dietary changes to affect the major killer diseases like heart disease, cancer, or diabetes.

Finally, the authors improved the accuracy of their estimates of the effect of diet on longevity by taking into account the quality of each study included in their analysis. I will discuss the importance of this below.

Can Diet Add Years To Your Life?

The results were impressive.

The authors estimated that if people in the United States were to change from a typical western diet to an “optimal diet” and maintain it for at least 10 years,

…starting at age 20, men would live 13 years longer and women would live 10.7 years longer.

…starting at age 60, men would live 8.8 years longer and women would live 8 years longer.

…starting at age 80, both men and women would live 3.4 years longer.

But what if you weren’t a vegan purist? What if you only made half the changes you would need to make to optimize your diet? The news was still good.

The authors estimated that people in the United States were to change from a typical western diet to a “feasibility diet” and maintain it for at least 10 years,

…starting at age 20, men would live 7.3 years longer and women would live 6.2 years longer.

…starting at age 60, men would live 4.8 years longer and women would live 4.5 years longer.

…starting at age 80, both men and women would live ~2 years longer.

The authors concluded, “A sustained dietary change may give substantial health gains for people of all ages for both optimized and feasible [diet] changes. [These health gains] could translate into an increase in life expectancy of more than 10 years. Gains are predicted to be larger the earlier the dietary changes are initiated in life.”

Which Foods Have The Biggest Effect On Longevity?

The algorithm the authors developed also allowed them to look at which foods have the biggest effect on longevity. The authors estimated when changing from a typical western diet to an optimal diet, the greatest gains in longevity were made by eating:

  • More legumes, whole grains, and nuts, and…
  • Less red and processed meat.

The authors concluded, “An increase in the intake of legumes, whole grains, and nuts, and a reduction in the intake of red meat and processed meats, contributed most to these gains [in longevity].”

However, this conclusion needs to be interpreted with caution. We also need to recognize that an “optimal diet” was defined as the best diet people in this study were eating. In addition, the effect of different foods on longevity depends on:

  • The quality of the individual studies with that food, and…
  • The difference in consumption of that food in going from a western diet to an optimal diet.

For example:

  • Legumes, whole grains, nuts, red & processed meat made the list because the quality of data was high and the difference in consumption between the typical western diet and optimal diet was significant.
  • The quality of data for an effect of fruits and vegetables was also high. For example, one major study concluded that consuming 10 servings a day of fruits and vegetables a day reduces premature death by 31% compared to consumption of less than 1 serving a day. However, the difference in consumption of fruits and vegetables between the western and optimal diets in this study was small, so fruits and vegetables didn’t make the list.
  • Eggs and white meat didn’t make the list because the quality of data was low for those foods. Simply put,  that means that there was a large variation in effect of those foods on longevity between studies.
  • Other foods didn’t make the list because the quality of data was only moderate and/or the difference in intake was small.

So, the best way to interpret this these data is:

  • This study suggests that consuming more legumes, whole grains, and nuts and less red & processed meats has a significant beneficial effect on health and longevity.
  • Consuming more fruits and vegetables is likely to have a significant benefit on health and longevity, but you would need to consume more than people did in this study to achieve these benefits. In the words of the authors, “Fruits and vegetables also have a positive health impact, but, for these food groups, the intake in a typical Western diet is closer to the optimal intake than for the other food groups.”
  • Other foods may impact health and longevity, but the data in this study are not good enough to be confident of an effect.

What Does This Study Mean For You?

This study is the best of many studies showing the benefit of a more plant-based diet on health and longevity. It particularly encouraging because it shows:

  • You can achieve significant benefit by switching to a more plant-based diet late in life. You get the biggest “bang for your buck” if you switch at age 20. But even making the switch at age 60 or 80 was beneficial.
  • You don’t need to be a “vegan purist”. While the biggest benefits were seen for people who came close to achieving a vegan or semi-vegetarian diet, people who only made half those changes saw significant benefits.

As I said above, this is a very strong study. However, the underlying data come from association studies, which can have confounding variables that influence the results.holistic approach

For example, people who eat more plant-based diets tend to weigh less and exercise more. And both of those variables can influence longevity. Each study attempted to statistically correct for those variables, but they still might have a slight influence on the results.

However, I don’t see that as a problem because, in my view, a holistic approach is always best. As illustrated on the right, we should be seeking a lifestyle that includes a healthy diet, weight control, and exercise.

As for supplementation, both the vegan and semi-vegetarian diets tend to leave out whole food groups. Unless you are married to a dietitian, that means your diet is likely to be missing important nutrients.

The Bottom Line

A recent study asked whether changing from the typical western diet to a healthier, more plant-based diet could influence longevity. The results were very encouraging. The study showed that:

  • Changing to a healthier diet could add up to a decade to your lifespan.
  • The improvement in lifespan was greatest for those whose diets approached a vegan or semi-vegetarian diet, but a significant improvement in lifespan was seen for people who made only half those dietary improvements.
  • The improvement in lifespan was greatest for those who switched to a healthier diet in their 20’s, but significant improvements in lifespan were seen for people who didn’t change their diet until their 60’s or 80’s.

In terms of the foods that have the biggest effect on longevity.

  • This study suggests that consuming more legumes, whole grains, and nuts and less red & processed meats has a significant beneficial effect on health and longevity.
  • Consuming more fruits and vegetables is likely to have a significant benefit on health and longevity, but you would need to consume more than people did in this study to achieve those benefits.
  • Other foods may impact health and longevity, but the data in this study are not good enough to be confident of an effect.

The authors concluded, “A sustained dietary change may give substantial health gains for people of all ages for both optimized and feasible [diet] changes. [These health gains] could translate into an increase in life expectancy of more than 10 years. Gains are predicted to be larger the earlier the dietary changes are initiated in life.

An increase in the intake of legumes, whole grains, and nuts, and a reduction in the intake of red meat and processed meats, contributed most to these gains. Fruits and vegetables also have a positive health impact, but, for these food groups, the intake in a typical Western diet is closer to the optimal intake than for the other food groups.”

For more details about this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Can Your Diet Cause You To Lose Your Mind?

What Is A Mind-Healthy Lifestyle? 

Author: Dr. Stephen Chaney

Cognitive-DeclineMost of us look forward to our golden years – that mystical time when we will be free from the workday pressures and have more time to spend with friends and family doing the things we love.

But cognitive decline can cast a dark cloud over those expectations.

  • By the age of 65, 11% of adults suffer from some degree of cognitive impairment.
  • And by the age of 80 the percentage of adults suffering from cognitive impairment has increased to 26-30%, depending on which study you cite.

The results of cognitive decline can be devastating.

  • First you start to lose the cherished memories of a lifetime.
  • Then comes confusion and an inability to perform basic tasks and participate in your favorite activities.
  • Eventually you may reach a stage where you no longer recognize the ones you love.

In short, cognitive decline can rob you of everything that makes you you.

The causes of cognitive decline are complex, but recent studies have pointed to the role of chronic inflammation in cognitive decline. If that is true, it is a good news – bad news situation.

  • The bad news is:
    • Some increase in chronic inflammation appears to be an inevitable consequence of aging.
    • Chronic inflammation can be caused by certain diseases that are beyond our control.
    • Chronic inflammation can be triggered by viral or bacterial infections.
  • The good news is that chronic inflammation is also controlled by your diet and lifestyle. For example, as I said above, chronic inflammation is often triggered by a viral infection, but whether the inflammation is mild or severe is strongly influenced by diet and lifestyle.

In this issue of “Health Tips From the Professor” I share a study (S Charisis et al, Neurology, In Press, November 10, 2021) showing that diets high in inflammatory foods increase the risk of dementia. Then, I answer 3 important questions.

  • Can your diet cause you to lose your mind?
  • What is a mind-healthy diet?
  • What is a mind-healthy lifestyle?

How Was This Study Done?

Clinical StudyThe data for this study were taken from the first three years of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a study designed to look at the effect of diet on dementia and other neuropsychiatric conditions in the Greek population.

There were 1059 participants (40% male, average age = 75 at the beginning of the study) in this study. At the beginning of the study the participants completed a food frequency questionnaire administered by a trained dietitian. The foods were broken down into individual nutrients using the USDA Food Composition tables adapted for foods in the Greek diet.

The diet of each participant was then rated on a 15-point scale ranging from pro-inflammatory to anti-inflammatory based on something called the Diet Inflammation Index (DII).

Simply put, the DII is a validated assessment tool based on the effect of food nutrients on 6 inflammatory biomarkers found in the blood (IL-1β, IL-4, IL-6, IL-10, TNF-α, and CRP). Nutrients that decrease these markers are considered anti-inflammatory. Nutrients that increase these inflammatory biomarkers are considered pro-inflammatory.

For example, anti-inflammatory nutrients include:

  • Carotenoids and flavonoids (found in fruits and vegetables).
  • Omega-3 polyunsaturated fatty acids (found in cold-water fish, walnuts, flaxseeds, and chia seeds).
  • Monounsaturated fatty acids (found in olive, avocado, and peanut oils).
  • Fiber (found in minimally processed plant foods).
  • Antioxidants, most B vitamins, and vitamin D.
  • Magnesium and zinc.
  • Garlic, onions, most herbs & spices.

Pro-inflammatory nutrients include:

  • Refined carbohydrates.
  • Cholesterol.
  • Total fat.
  • Saturated fats.
  • Trans fats.

The participants were followed for 3 years, and all new diagnoses of dementia were recorded. The diagnoses were confirmed by a panel of neurologists and neuropsychologists.

Can Your Diet Cause You To Lose Your Mind?

Forgetful Old ManAs described above, the diet of each participant in the study was rated on a 15-point DII (Diet Inflammatory Index) scale ranging from pro-inflammatory to anti-inflammatory. The association of the DII score of the participant’s diets with the onset of dementia was evaluated in two ways.

  • Each one-point increase from an anti-inflammatory diet to a pro-inflammatory diet was associated with a 21% increase in the risk for dementia.
  • In other words, even small changes in your diet can have a significant impact on your risk of developing dementia.

The investigators then divided the participants into three equal-sized groups based on the DII score of their diets.

  • The group with the highest DII scores were 3 times more likely to develop dementia than the group with the lowest DII scores.
  • In other words, a major change in your diet can have a major effect on your risk of developing dementia.

The authors concluded, “In the present study, higher DII scores (indicating greater pro-inflammatory diet potential) were associated with an increased risk for incident dementia [newly diagnosed dementia]. These findings may avail the development of primary dementia strategies through tailored and precise dietary interventions.”

What Is A Mind-Healthy Diet?

Vegan FoodsThis and other studies show that an anti-inflammatory diet is good for the mind. It helps protect us from cognitive decline and dementia. But what does an anti-inflammatory diet look like?

One hint comes from analyzing the diets of participants in this study:

  • Those with the lowest DII scores (most-anti-inflammatory diets) consumed 20 servings of fruit, 19 servings of vegetables, 4 servings of beans or other legumes, and 11 servings of coffee or tea each week. That’s almost 3 servings of fruit and 3 servings of vegetables every day!
  • Those with the highest DII scores (most pro-inflammatory diets) consumed only half as many fruits, vegetables, and legumes.
  • In short, a diet rich in fruits, vegetables, and legumes is a good start.

I have described anti-inflammatory diets in more detail in a previous issue of “Health Tips From the Professor.” Let me summarize that article briefly.

Anti-inflammatory foods include:

  • Colorful fruits and vegetables.
  • Whole grains.
  • Beans and other legumes.
  • Nuts, olive oil, avocados, and other sources of monounsaturated fats.
  • Fatty fish and other sources of omega-3 fatty acids.
  • Herbs and spices.

Pro-inflammatory foods include:

  • Refined carbohydrates, sodas, and sugary foods.
  • Foods high in saturated fats including fatty and processed meats, butter, and high fat dairy products.
  • Foods high in trans fats.
  • French fries, fried chicken, and other fried foods.
  • Foods you are allergic or sensitive food. For example, gluten containing foods are pro-inflammatory only if you are sensitive to gluten.

If your goal is to reduce chronic inflammation and keep your mind sharp as a tack as you age, you should eat more anti-inflammatory foods and less pro-inflammatory foods.

Of course, we don’t just eat random foods, we follow dietary patterns. It should be apparent from what I have Mediterranean Diet Foodscovered above that whole food, primarily plant-based diets are anti-inflammatory. This is true for diets ranging from vegan through semi-vegetarian, to the Mediterranean, DASH, and MIND diets.

All these diets are anti-inflammatory and likely protect the brain from cognitive decline. However, the best evidence for brain protection is for the Mediterranean, DASH, and MIND diets.

  • The Mediterranean and DASH diets have been shown to prevent cognitive decline in multiple studies.
  • The MIND diet is a combination the Mediterranean and DASH diets that was specifically designed to prevent cognitive decline. It has been shown to cut the risk of developing Alzheimer’s disease in half.

What Is A Mind-Healthy Lifestyle?

Diet is just one aspect of a holistic approach for reducing cognitive decline as we age. Other important factors include:

  • Reduce excess body weight.
  • Exercise regularly.
  • Get adequate sleep.
  • Reduce and/or manage stress.
  • Eliminate smoking and reduce alcohol consumption.
  • Socialize with friends and family who support you. Numerous studies have shown that a strong support network reduces dementia risk in the elderly.
  • Keep your brain active. Work crossword puzzles. Learn new things. An active brain is forced to lay down new neural pathways.

The Bottom Line 

Recent studies have suggested that chronic inflammation increases the risk of cognitive decline and dementia as we age. Some causes of chronic inflammation are beyond our control, but others, such as diet, we can control.

Recently, a precise scoring system called the Diet Inflammatory Index (DII) has been developed. This scoring system allows studies to look at the correlation between the inflammatory potential of the diet and cognitive decline.

A recent study enrolled 1,000 participants with an average age of 75 in a 3-year study to determine the impact of diet on cognitive decline. The association of the DII score of the participant’s diets with the onset of dementia was evaluated in two ways.

  • Each one-point increase from an anti-inflammatory diet to a pro-inflammatory diet was associated with a 21% increase in the risk for dementia.
  • In other words, even small changes in your diet can have a significant impact on your risk of developing dementia.

The investigators then divided the participants into three equal-sized groups based on the DII score of their diets.

  • The group with the highest DII scores were 3 times more likely to develop dementia than the group with the lowest DII scores.
  • In other words, a major change in your diet can have a major effect on your risk of developing dementia.

The authors concluded, “In the present study, higher DII scores (indicating greater pro-inflammatory diet potential) were associated with an increased risk for incident dementia [newly diagnosed dementia]. These findings may avail the development of primary dementia strategies through tailored and precise dietary interventions.”

For more details and a description of mind-healthy diets and a mind-healthy lifestyle read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are We Killing Our Children With Kindness?

The Danger Of Ultraprocessed Foods 

Author: Dr. Stephen Chaney

fast foodIt breaks my heart when I see a mom and her children in the checkout line of a supermarket with a cart filled with sodas, sweets, and convenience foods and devoid of fresh fruits and vegetables – or when I see fast food restaurants packed with parents and their children.

I get it. Our kids love these foods. It seems like an act of kindness to give them the foods they crave. But are we killing our children with kindness?

Let me explain. The human brain is hardwired to crave sweets, salt, and fat. In prehistoric times each of these cravings had a survival benefit. For example:

  • Mother’s milk is naturally sweet. It only makes sense that babies should crave the nutrition source that is essential for their early growth and development.
  • Fruits provide a cornucopia of vitamins, minerals, and phytonutrients. But fruits were scarce and seasonal in prehistoric times. Their sweetness provided an incentive for early man to seek them out.
  • Some salt is essential for life. Yet in early history it was scare. It was worth its weight in gold.
  • In prehistoric times it was feast or famine. The human body has an unlimited capacity to store fat in times of plenty, and those fat stores carried early man through times of famine.

Today most Americans live in a time of food abundance. There are fast food restaurants on almost every street corner and in every shopping mall. We think of famine as the days we skipped lunch because we were busy.

Yet these cravings remain, and the food industry has weaponized them. They are churning out an endless supply highly processed foods and beverages. These foods are not being designed to improve their nutritional value. They are designed to satisfy our cravings and lure us and our children into consuming more of them every year.

Scientists have developed a classification system that assigns foods in the American diet to different groups based on the degree of processing of that food. As you might expect, the best classification is unprocessed foods. The worst classification is called “ultraprocessed foods”. [I will describe this classification system in more detail in the next section.]

It is time we asked how much ultraprocessed foods our children are eating and what it is doing to their health. That is the topic of the study (L Wang et al, JAMA, 326: 519-530, 2021) I will discuss today.

How Was This Study Done?

Clinical StudyThe data for this study were obtained from NHANES (National Health and Nutrition Examination Survey) dietary data collected from 33,795 American children (ages 2-19, average age = 10) between 1999 and 2018.

NHANES is a program conducted by the CDC to survey the health and nutritional status of adults and children in the United States. The survey has been conducted on a continuous, yearly basis since 1999.

The dietary data are collected via 24-hour dietary recalls conducted by trained interviewers, with a second recall administered over the phone 3-10 days later to improve the accuracy of the data.

  • Children aged 12-19 completed the dietary survey on their own.
  • For children aged 6-11, a parent or guardian assisted them in filling out the survey.
  • For children aged 2-5, a parent or guardian filled out the survey for them.

The foods and beverages consumed by the children were divided into 4 major groups based on the extent of processing using a well-established classification system called NOVA. The 4 groups are:

1) Unprocessed Or Minimally Processed Foods.

  • This includes whole foods and foods that are minimally processed without the addition of oils, fats, sugar, salt, or other ingredients to the food.
  • Examples of minimally processed foods include things like oatmeal, nut butters, dried fruit, frozen fruits or vegetables, and dried beans.

2) Processed Culinary Ingredients.

  • This includes recipes from restaurants or in-home cooking that add small amounts of oils, fats, sugar, salt, and seasonings to whole foods.

3) Processed Foods

  • This includes foods made in factories by the addition of salt, sugar, oil, or other substances added to whole or minimally processed foods.
  • Examples include tomato paste, canned fruits packed in sugar syrup, cheese, smoked or cured meat.

4) Ultraprocessed Foods

  • These are industrial formulations created in factories mostly or entirely from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories (flavor enhancers, colors, and food additives).
  • Examples include sugar sweetened beverages; sweet or savory packaged snacks; chocolates and candies; burgers, hot dogs, and sausages; poultry and fish nuggets, pastries, cakes, and cake mixes.

Are We Killing Our Children With Kindness?

Obese ChildAs I said above, the important question is, “Are we killing our children with kindness when we give them the sugary drinks, sweets, convenience foods, and fast foods they crave?” After all, the foods we give them when they are young are the ones they are most likely to select when they get older.

Let’s start by looking at how pervasive these foods have become. That was the purpose of the study I am discussing today, and the results of this study are alarming. When they looked at the changes in food consumption by our children between 1999 and 2018:

  • The percentage of calories from ultraprocessed foods increased from 61.4% to 67%. That means:
    • Today, more than 2/3 of the calories our children consume daily come from ultraprocessed foods!
  • The percentage of calories from unprocessed and minimally processed foods decreased from 28.8% to 23.5%. That means:
    • In the span of just 19 years the diets of our children have gone from bad to worse!
  • Ultraprocessed foods were more likely to be consumed away from home and at fast food restaurants.

When the investigators looked at individual categories of ultraprocessed foods:

  • The percentage of calories coming from ready to heat and eat dishes like frozen pizzas and other frozen meals or snacks increased from 2.2% to 11.2%.
  • The percentage of calories coming from sweet snacks and desserts increased from 10.7% to 12.9%.
  • The percentage of calories coming from sugar sweetened beverages decreased from 10.8% to 5.3%.
    • This is potentially the only good news from this study.

The authors concluded. “Based on NHANES data from 1999 to 2018, the estimated energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.”

“These results suggest that food processing may need to be considered as a food dimension in addition to nutrients and food groups in future dietary recommendations and food policies.”

The Danger Of Ultraprocessed Foods

Fast Food DangersThis study clearly shows that ultraprocessed foods have become the mainstay of our children’s diets. Forget a balanced diet! Forget “Eat your fruits and vegetables”! Our children’s diets have been fundamentally transformed by “Big Food, Inc”.

You might be saying to yourself, “So, they are eating their favorite processed foods. What’s the big deal? How bad can it be?” My answer is, “Pretty Bad”. I chose the title, “Are we killing our children with kindness”, for a reason.

When you look at what happens to children who eat a diet that is mostly ultraprocessed foods:

#1: Their nutrition suffers. When the investigators divided the children into 5 groups based on the percentage of calories coming from ultraprocessed foods, the children consuming the most ultraprocessed food had:

  • Significantly higher intakes of carbohydrates (mostly refined carbohydrates); total fats; polyunsaturated fats (mostly highly processed omega-6-rich vegetable oils); and added sugars.
  • Significantly lower intakes of fiber; protein; omega-3 polyunsaturated fatty acids; calcium; magnesium; potassium; zinc; vitamins A, C, D, and folate.
    • The low intake of fiber means our children will be less likely to have health-promoting friendly bacteria and more likely to have disease-promoting bad bacteria in their guts.
    • The low intake of calcium, magnesium, and vitamin D means they will be less likely to achieve maximum bone density as young adults and will be more likely to suffer from osteoporosis as they age.

#2: They are more likely to become obese. Remember, these are foods that are made in a factory, not grown on a farm.

  • They are high in fat, sugar, and refined carbohydrates. That means they have a high caloric density. Each bite has 2-3 times the calories found in a bite of fresh fruits and vegetables.
  • As I said earlier, the food industry has weaponized our natural cravings for sweet, salty, and fatty foods. They feed their prototypes to a series of consumer tasting panels until they find the perfect blend of sugar, salt, and fat to create maximum craving.
  • And if that weren’t enough, they add additives to create the perfect flavor and “mouth appeal”.
    • It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and obesity in both children and adults.
    • It is also no wonder that the rate of childhood obesity has almost quadrupled (5% to 18.5%) in the last 40 years.

#3: They are more likely to become sick as adults and die prematurely.

  • Obesity; high intake of fat, sugar, and refined carbohydrates; and low intake of fiber, omega-3s, and essential nutrients all contribute to an increased risk of diabetes, heart disease, and some cancers.
    • It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and increased risk of diabetes, heart disease, some cancers, and premature death in adults.
    • It is also no wonder a recent study found that type 2 diabetes in children has almost doubled between 2001 and 2017.

The data are clear. When we allow our children to subsist on a diet mostly made up of the ultraprocessed foods they crave, we may be giving them, not love, but a lifetime of obesity and declining health instead. And yes, we may be killing them with kindness.

Instead, my recommendations are:

  • expose your children to a variety of fresh fruits, vegetables, and minimally processed foods at an early age.
  • They will reject some of them, and that’s OK. Introduce others until you find whole, minimally processed foods they like. Reintroduce them to some of the foods they initially rejected as they get older.
  • Don’t keep tempting ultraprocessed foods in your house.
  • You may just succeed in putting your children on the path to a healthier diet and a healthier, longer life.

The Bottom Line

It breaks my heart when I see a mom and her children in the checkout line of a supermarket with a cart filled with sodas, sweets, and convenience foods and devoid of fresh fruits and vegetables – or when I see fast food restaurants packed with parents and their children.

I get it. Our kids love these foods. It seems like an act of kindness to give them the foods they crave. But are we killing our children with kindness?

It is time we asked how much ultraprocessed foods our children are eating and what it is doing to their health. A recent study did just that. When they looked at the changes in food consumption by our children between 1999 and 2018:

  • The percentage of calories from ultraprocessed foods increased from 61.4% to 67%. That means:
    • Today, more than 2/3 of the calories our children consume daily come from ultraprocessed foods!
  • The percentage of calories from unprocessed and minimally processed foods decreased from 28.8% to 23.5%. That means:
    • In the span of just 19 years the diets of our children have gone from bad to worse!

This study clearly shows that ultraprocessed foods have become the mainstay of our children’s diets. Forget a balanced diet! Forget “Eat your fruits and vegetables”! Our children’s diets have been fundamentally transformed by “Big Food, Inc”.

You might be saying to yourself, “So, they are eating their favorite processed foods. What’s the big deal? How bad can it be?” My answer is, “Pretty Bad”. I chose the title, “Are we killing our children with kindness”, for a reason.

When you look at what happens to children who eat a diet that is mostly ultraprocessed foods:

  • Their nutrition suffers.
  • They are more likely to become obese.
  • They are more likely to become sick as adults and die prematurely.

For more details about this study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Best Way To Reduce Risk Of Breast Cancer

What Does The American Cancer Society Say About Reducing Breast Cancer Risk? 

Author: Dr. Stephen Chaney

breast cancerBreast cancer is a scary disease. The American Cancer Society tells us:

  • 281,000 women will be diagnosed with invasive breast cancer in 2021.
  • 43,000 women will die from breast cancer in 2021.
  • The good news is that both prevention and treatment of breast cancer have gotten much better:
    • The 5-year survival rate is 90%.
    • The 10-year survival rate is 84%.
    • For women over 50 the death rate has decreased by 1%/year between 2013 and 2018 (mainly due to recognition that hormone replacement therapy is a risk factor for breast cancer).
  • The bad news is:
    • The cost of breast cancer treatment can range from $50,000 to over $180,000.
    • The side effects of breast cancer treatment can be brutal.
      • For example, there is an effective treatment to prevent breast cancer recurrence for some forms of breast cancer, but many women discontinue the treatment after a few years because of the side effects.

So, wouldn’t it be wonderful if there were some simple changes you could make that would dramatically reduce your risk of developing breast cancer in the first place? There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Dr. Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness.

What Is The Best Way To Reduce Risk Of Breast Cancer?

AwardThe first study (RM Tamimi et al, American Journal of Epidemiology, 184: 884-893, 2016 was designed to identify the major modifiable risk factors for invasive, postmenopausal breast cancer (The term “modifiable risk factors” refers to those risk factors that are under your control.

The study utilized data collected from the Nurses’ Health Study between 1980 and 2010. During that time 8,421 cases of invasive breast cancer were diagnosed in 121,700 postmenopausal women in the study. The study looked at the effect of nonmodifiable and modifiable risk factors on the development of invasive breast cancer in these women.

  • Nonmodifiable risk factors included current age, age at which menstruation began, height, age of first birth, number of births, weight at age 18, family history of breast cancer, and prior benign breast disease.
  • Modifiable risk factors included weight change since age 18, alcohol consumption, physical activity level, breastfeeding, and postmenopausal hormone therapy use.

Here were the results from the study:

  • All the risk factors included in this study accounted for 70% of the risk of developing invasive breast cancer in postmenopausal women.
  • Modifiable risk factors accounted for 34.6% of the risk of developing invasive breast cancer in postmenopausal women.

When they analyzed the effect of modifiable risk factors on the risk of developing invasive breast cancer separately:

  • 44 pounds of weight gain since age 18 increased the risk by 50%.
  • Postmenopausal hormone replacement use increased the risk by 35%.
  • More than one alcoholic beverage/day increased the risk by 32%.
  • Low physical activity increased the risk by 7%.
  • Lack of breastfeeding increased the risk by 5%.

What About The Effect Of Diet On Breast Cancer Risk?

You may be wondering, “What about the effect of a healthy diet on my risk developing invasive breast cancer?” Unfortunately, the study I described above completely disregarded the effect of diet on breast cancer risk.

However, the second study (MS Farvid et al, International Journal of Cancer, 144: 1496-1510, 2019) I will discuss today partially addresses this issue. It uses the same database as the first study and looks at the effect of fruit and vegetable consumption on the risk of developing invasive breast cancer.

When this study compared high versus low intake of fresh fruits and vegetable on the risk of developing invasive breast cancer:

  • Women eating >5.5 servings/day of fruits and vegetables had a 11% lower risk than women consuming ≤2.5 servings/day.
  • Women consuming >2.5 servings/day of fruit had a 9% lower risk than women consuming ≤0.5 servings/day.
  • Women consuming >4.5 servings/day of vegetables had a 9% lower risk than women consuming ≤0.5 servings/day.

While all fresh fruits and vegetables contributed to this effect:

  • The most protective fruits were berries and cantaloupe & melons.
  • The most protective vegetables were yams & sweet potatoes, green leafy vegetables (such as kale, mustard greens, and chard), and cruciferous vegetables (such as Brussels sprouts).

The authors concluded, “Our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.”

Now we are ready to answer your question, “Which lifestyle changes are most effective for reducing your risk of developing breast cancer?” If we combine the two studies and rank order the modifiable risk factors, it would look like this.

#1: Minimize weight gain during your adult years.

#2: Don’t use postmenopausal hormone replacement therapy unless absolutely necessary.

#3: Drink little or no alcohol.

#4: Eat a healthy diet with lots of fresh fruits and vegetables.

#5: Be physically active.

#6: Breastfeed when possible.

What Does The American Cancer Society Say About Reducing The Risk Of Breast Cancer?

American Cancer SocietyThe advice of the American Cancer Society is remarkably similar. Here are their recommendations:

  1. Get to and stay at a healthy weight.

After menopause, most of your estrogen comes from fat tissue. Having more fat tissue increases the amount of estrogen your body makes, raising your risk of breast cancer. Also, women who are overweight tend to have higher levels of insulin. Higher insulin levels have also been linked to breast cancer.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can also have other health benefits and is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

3) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

4) It is best not to drink alcohol.

Research has shown that drinking any alcohol increases the risk of breast cancer. If you choose to drink alcohol, the American Cancer Society recommends that women have no more than 1 alcoholic drink on any given day. A drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

5) Think carefully about using hormone replacement therapy.

Studies show that HRT using a combination of estrogen and progestin increases the risk of breast cancer. This combination can also lead to increased breast density making it harder to find breast cancer on mammogram.

Talk with your doctor about all the options to control your menopause symptoms, including the risks and benefits of each. If you decide to try HRT, it is best to use it at the lowest dose that works for you and for as short a time as possible.

The Bottom Line

Breast cancer is a scary disease. The good news is that detection and treatment of breast cancer has improved over the past decade. The bad news is that treatment is expensive, and the side effects can be brutal.

There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness in the article above.

For more details about these studies, my ranking of the top 6 strategies for reducing your risk of breast cancer, and the American Cancer Society recommendations, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does An Apple A Day Keep Diabetes Away?

A Holistic Approach To Preventing Diabetes 

Author: Dr. Stephen Chaney

VillainLow carb enthusiasts will tell you that carbohydrates are the villain. They tell you that cutting carbohydrates out of your diet will reduce your risk of obesity, diabetes, heart disease, and cancer.

If they limited their list of villainous foods to foods with white flour and/or added sugars, many nutrition experts would agree with them. There is widespread agreement in the nutrition community that we eat far too much of these foods.

However, I don’t have to tell you that many low carb diets also eliminate fruits, whole grains, and beans from their diets based solely on the carbohydrate content of these foods. Is this good advice? Is there any data to back up this claim?

The short answer is no. In fact, most studies suggest the opposite is true. I have covered these studies in previous issues of “Health Tips From The Professor”. For example:

  • In one issue I covered studies showing the people consuming primarily plant-based diets weigh less, have less inflammation, and have a lower risk of diabetes, heart disease, and high blood pressure than people consuming the typical American diet.
  • In another issue I shared studies showing that women consuming a plant-based low carb diet weigh less, and have reduced risk of diabetes and heart disease than women consuming a meat-based low carb diet.

However, these studies looked at the effect of the whole diet, not individual components of the diet.

This week I will review a study (NP Bondonno et al, The Journal of Clinical Endocrinology & Metabolism, 2021, doi:10.1210/clinem/dgab335) looking at the effect of fruit consumption on the risk of developing type 2 diabetes.

Next week I will review a study looking at the effect of whole grain consumption on the risk of developing type 2 diabetes.

How Was This Study Done?

Clinical StudyThis study made use of data from the Australian Diabetes Obesity And Lifestyle Study. This study recruited 7675 Australians 25 years or older from 7 states and territories in Australia in 1999 and 2000 and followed them for 5 years. The characteristics of the study population were:

  • Gender = 45% male, 55% female
  • Average age = 54 years
  • Average BMI = 26.8 (slightly overweight)
  • Did not have diabetes at time of entry into the study.

The participants filled out a food frequency questionnaire at the time of entry into the study. This questionnaire was used to analyze:

  • the amount of fruit consumed.
  • the amounts of vegetables, red meat, and processed meat consumed.
  • how many calories were consumed.

At the time of entry into the study several measurements were taken that assessed whether the participants had an increased risk of developing diabetes (otherwise known as pre-diabetes). These included:

  • Fasting plasma glucose and insulin levels.
  • A 2-hour glucose tolerance test. The results of this test were used to calculate insulin resistance and insulin sensitivity.

The study also recorded any participants who were diagnose with diabetes over the next 5 years.

Does An Apple A Day Keep Diabetes Away?

AppleThe data from this study were statistically adjusted for confounding variables (Other variables that might affect the risk of diabetes). Many confounding variables were included in the adjustment, but the ones of interest to us are age, sex, physical activity, obesity, caloric intake, and intakes of alcohol, vegetables, red meat, and processed meat.

After adjustment for all these variables the results were:

At the beginning of the study:

  • Fruit intake was inversely associated with insulin levels and insulin resistance.
  • Fruit intake was directly associated with insulin sensitivity.

In other words, the more fruit people ate, the less likely they were to have prediabetes at the time they entered the study.

At 5 years:

  • Fruit intake was inversely associated with diabetes.
  • Fruit juice had no effect on diabetes risk.

In other words, the more fruit people ate, the less likely they were to develop diabetes 5 years later. Fruit juice, on the other hand, had no beneficial effect on diabetes risk.

  • The benefit of fruit intake plateaued at 2-3 servings a day.

In other words, you don’t need to become a fruitarian. A modest intake of fruit (2-3 servings a day) is all you need.

In case you haven’t noticed, 2-3 servings of fruit a day matches USDA recommendations – and the recommendations of almost every other governmental and medical organization. What do they know that you didn’t know?

The most commonly eaten fruits in this study were apples (23%), bananas (20%), and oranges and other citrus fruits (18%). Enough people ate these three fruits that their effects on the risk of developing diabetes could be analyzed separately.

  • The beneficial effect of each of these fruits plateaued at about one serving a day.

In other words, an apple a day does keep diabetes away. However, apples can’t do it alone. You need a variety of fruits for optimal benefit.

The authors concluded, “A healthy diet including whole fruits, but not fruit juice, may play a role in mitigating type 2 diabetes risk.”

A Holistic Approach To Preventing Diabetes

Myth Versus FactsThis study explodes the myth that you should avoid fruits if you want to prevent diabetes. Yes, fruits do contain sugar, but:

  • They also contain fiber, which slows the absorption of that sugar.
  • The sugar is trapped in a cellular matrix, which must be digested before that sugar can be released. That also slows the absorption of sugar.

This is why fruit consumption reduces the risk of diabetes while fruit juice consumption does not.

However, I don’t want to give you the impression that you can reduce your risk of diabetes just by consuming more fruit. You need a holistic approach. Here are diabetes prevention tips from the American Diabetes Association.

  1. Get more physical activity.
    • The greatest benefit comes from a fitness program that includes both aerobic exercise and resistance training.

2) Get plenty of fiber.

    • Include fruits, vegetables, whole grains, beans, and nuts in your diet.

3) Lose extra weight.

    • One recent study showed that losing as little as 7% of your body weight and exercising regularly could reduce your risk of developing diabetes by almost 60%.

4) Skip fad diets and simply make healthier food choices.

    • “Low-carb diets, the glycemic index diet, and other fad diets may help you lose weight initially. But their effectiveness at preventing diabetes and their long-term effects aren’t known. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients.”

5) See your doctor on a regular basis and have your blood sugar tested, especially if you are overweight, have a family history of diabetes, or are over 45.

The Bottom Line

Low carb enthusiasts tell you to eliminate fruits from your diet if you want to reduce your risk of developing diabetes. Is this true? Is it good advice?

A recent study put this advice to the test. The study recruited 7675 Australians 25 years or older and followed them for 5 years. It correlated fruit intake with measures of prediabetes at the beginning of the study and correlated fruit intake with the onset of diabetes over the next 5 years. Here is what the study found.

  • The more fruit people ate, the less likely they were to have prediabetes at the time they entered the study.
  • The more fruit people ate, the less likely they were to develop diabetes 5 years later.
  • The benefit of fruit intake plateaued at 2-3 servings a day. In other words, you don’t need to become a fruitarian. A modest intake of fruit (2-3 servings a day) is all you need.

The most commonly eaten fruits in this study were apples (23%), bananas (20%), and oranges and other citrus fruits (18%). Enough people ate these three fruits that their effects on the risk of developing diabetes could be analyzed separately.

  • The beneficial effect of each of these fruits plateaued at about one serving a day.

In other words, an apple a day keeps diabetes away. However, apples can’t do it alone. You need a variety of fruits for optimal benefit.

The authors concluded, “A healthy diet including whole fruits, but not fruit juice, may play a role in mitigating type 2 diabetes risk.”

For more details about this study and a holistic approach to reducing your risk of diabetes recommended by the American Diabetes Association, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Is Nitrate From Vegetables Good For Your Heart?

Are Nitrates Good For You Or Bad For You? 

Author: Dr. Stephen Chaney

health benefits of beetroot juiceWe have known for years that fruits and vegetables are good for our hearts. We have assumed that was because whole fruits and vegetables are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. But could there be more?

Recent research has suggested that the nitrates found naturally in fruits and vegetables may also play a role in protecting our hearts. Here is what recent research shows:

  • The nitrates from fruits and vegetables are converted to nitrite by bacteria in our mouth and intestines.
    • Fruits and vegetables account for 80% of the nitrate in our diet. The rest comes from a variety of sources including the nitrate added as a preservative to processed meats.
    • Although all fruits and vegetables contain nitrates, the best sources are green leafy vegetables and beetroot. [Beet greens are delicious and also a good source of nitrate, but beetroot is the part of the beet we usually consume.]
  • Nitrite is absorbed from our intestine and converted to nitric oxide by a variety of enzymes in our tissues.
  • Both reactions require antioxidants like vitamin C, which are also found in fruits and vegetables.

Nitric oxide has several heart healthy benefits. For example:

  • It helps reduce inflammation in the lining of blood vessels. Inflammation stimulates atherosclerosis, blood clot formation, and is associated with an increased risk of heart disease.
  • It relaxes the smooth muscle cells that surround our blood vessels. This makes the blood vessels more flexible and helps reduce blood pressure.
  • It prevents smooth muscle cells from proliferating, which prevents them from invading and constricting our arteries. This, in turn, has the potential to reduce the risk of atherosclerosis.
  • It prevents platelet aggregation. This, in turn, has the potential to reduce the risk of heart attack and stroke due to blood clots that block the flow of blood to our heart or brain.

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. This study (CP Bondonno et al, European Journal of Epidemiology, doi.org/10.1007/s10654-021-00747-3) was designed to answer that question.

How Was This Study Done?

Clinical StudyThis study made use of data from the Danish Diet, Cancer, and Health Program. That program enrolled 53,150 participants from Copenhagen and Aarhus between 1993 and 1997 and followed them for an average of 21 years. None of the participants had a diagnosis of cancer or heart disease at the beginning of the study.

Other characteristics of the participants at the time they were enrolled in the study were:

  • 46% male
  • Average age = 56
  • BMI = 26 (20% overweight)
  • Average systolic blood pressure = 140 mg Hg
  • Average diastolic blood pressure = 84 mg Hg

At the beginning of the study, participants filled out a 192-item food frequency questionnaire that assessed their average intake of various food and beverage items over the previous 12 months. The vegetable nitrate content of their diets was analyzed using a comprehensive database of the nitrate content of 178 vegetables. For those vegetables not consumed raw, the nitrate content was reduced by 50% to account for the nitrate loss during cooking.

Blood pressure was measured at the beginning of the study. Data on the incidence (first diagnosis) of heart disease during the study was obtained from the Danish National Patient Registry. Data were collected on diagnosis of the following heart health parameters:

  • Cardiovascular disease (all diseases of the circulatory system).
  • Ischemic heart disease (lack of sufficient blood flow to the heart). The symptoms of ischemic heart disease range from angina to myocardial infarction (heart attack).
  • Ischemic stroke (lack of sufficient blood flow to the brain).
  • Hemorrhagic stroke (bleeding in brain).
  • Heart failure.
  • Peripheral artery disease (lack of sufficient blood flow to the extremities).

Is Nitrate From Vegetables Good For Your Heart?

strong heartIntake of nitrate from vegetables ranged from 18 mg/day (<1/3 serving of nitrate-rich vegetables per day) to 168 mg (almost 3 servings of nitrate-rich vegetables per day). The participants were grouped into quintiles based on their vegetable nitrate intake. When the group with the highest vegetable nitrate intake was compared to the group with the lowest vegetable nitrate intake:

  • Systolic blood pressure was reduced by 2.58 mg Hg.
  • Diastolic blood pressure was reduced by 1.38 mg Hg.
  • Risk of cardiovascular disease was reduced by 14%.
  • Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.
  • Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.
  • Risk of heart failure was reduced by 17%.
  • Risk of peripheral artery disease was reduced by 31%.
  • Risk of hemorrhagic stroke (bleeding in the brain) was not significantly reduced.

Two other observations were of interest:

  • Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion. However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.
  • Only about 21.9% of the improvement in heart health could be explained by the decrease in blood pressure. This is not surprising when you consider the other beneficial effects of nitric oxide described above.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Are Nitrates Good For You Or Bad For You?

ConfusionYou are probably thinking, “Wait a minute. I thought nitrates and nitrites were supposed to be bad for me. Which is it? Are nitrates good for me or bad for me?”

It turns out that nitrates and nitrites are kind of like Dr. Jekyll and Mr. Hyde. They can be either good or bad. It depends on the food they are in and your overall diet.

Remember the beginning of this article when I said that the conversion of nitrates to nitric oxide depended on the presence of antioxidants? Vegetables are great sources of antioxidants. So, when we get our nitrate from vegetables, most of it is converted to nitric oxide. And, as I discussed above, nitric oxide is good for us.

However, when nitrates and nitrites are added to processed meats as a preservative, the story is much different. Processed meats have zero antioxidants. And the protein in the meats is broken down to amino acids in our intestine. The amino acids combine with nitrate to form nitrosamines, which are cancer-causing chemicals. Nitrosamines are bad for us.

Of course, we don’t eat individual foods by themselves. We eat them in the context of a meal. If you eat small amounts of nitrate-preserved processed meats in the context of a meal with antioxidant-rich fruits and vegetables, some of the nitrate will be converted to nitric oxide rather than nitrosamines. The processed meat won’t be as bad for you.

What Does This Study Mean For You?

spinachYour mother was right. You should eat your fruits and vegetables!

  • The USDA recommends at least 3 servings of vegetables and 2 servings of fruit a day.
  • Based on this study, at least one of those servings should be nitrate-rich vegetables like green leafy vegetables and beets.
  • If you don’t like any of those, radishes, turnips, watercress, Bok choy, Chinese cabbage, kohlrabi, chicory leaf, onion, and fresh garlic are also excellent sources of nitrate.
  • The good news is that you may not need to eat green leafy vegetables and beets with every meal. If this study is correct, one serving per day may have heart health benefits. That means you can enjoy a wide variety of fresh fruits and vegetables as you try to meet the USDA recommendations.

Finally, if you don’t like any of those foods, you may be asking, “Can’t I just take a nitrate supplement?”

  • For blood pressure, there are dozens of clinical trials, and the answer seems to be yes – especially when the nitrate comes from vegetable sources and the supplement also contains an antioxidant like vitamin C.
  • For heart health benefits, the answer is likely to be yes, but clinical trials to confirm that would take decades. Double blind, placebo-controlled trials of that duration are not feasible, so we will never know for sure.
  • Moreover, you would not be getting all the other health benefits of a diet full of fresh fruits and vegetables. Supplementation has its benefits, but it is not meant to replace a healthy diet.

The Bottom Line

We have known for years that fruits and vegetables are good for our hearts. We have assumed that was because whole fruits and vegetables are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. But could there be more?

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. A recent study was designed to answer that question.

When the study compared people with the highest vegetable nitrate intake to people with the lowest vegetable nitrate intake:

  • Blood pressure was significantly reduced.
  • The risk of cardiovascular disease was reduced by 14%.
  • Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.
  • Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.
  • Risk of heart failure was reduced by 17%.
  • Risk of peripheral artery disease was reduced by 31%.
  • Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion.
  • However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Of course, you may have heard that nitrates and nitrites are bad for you. I discuss that in the article above.

For more details about this study, information about vegetable nitrate supplements, and what this study means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

If You Want To Be Green, You Have To Eat Green

What Is The Planetary Diet?

 Author: Dr. Stephen Chaney

Earth DayEarth Day was last Thursday. You have recommitted to saving the planet. You plan to recycle, conserve energy, and turn in your gas guzzler for an energy efficient car. But what about your diet? Is your diet destroying the planet?

This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019) serves as a dire warning of what will happen if we don’t change our ways. I touched on this report briefly in a previous issue of “Health Tips From The Professor”, but this topic is important enough that it deserves an issue all its own.

The commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The commission described the typical American diet as a “lose-lose-lose diet”. It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win-win diet”. It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet”.

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about our environment…If you care about saving our planet, there is no other choice.

How Was The Study Done?

The study (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019) was the report of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This Commission convened 30 of the top experts from across the globe to prepare a science-based evaluation of the effect of diet on both health and sustainable food production through the year 2050. The Commission included world class experts on healthy diets, agricultural methods, climate change, and earth sciences. The Commission reviewed 356 published studies in preparing their report.

If You Want To Be Green, You Need To Eat Green

Factory FarmWhen they looked at the effect of food production on the environment, the Commission concluded:

  • “Strong evidence indicates that food production is among the largest drivers of global environmental change.” Specifically, the commission reported:
    • Agriculture occupies 40% of global land (58% of that is for pasture use).
    • Food production is responsible for 30% of global greenhouse gas emissions and 70% of freshwater use.
    • Conversion of natural ecosystems to croplands and pastures is the largest factor causing species to be threatened with extinction. Specifically, 80% of extinction threats to mammals and bird species are due to agricultural practices.
    • Overuse and misuse of nitrogen and phosphorous in fertilizers causes eutrophication. In case you are wondering, eutrophication is defined as the process by which a body of water becomes enriched in dissolved nutrients (such as phosphates from commercial fertilizer) that stimulate the growth of algae and other aquatic plant life, usually resulting in the depletion of dissolved oxygen. This creates dead zones in lakes and coastal regions where fish and other marine organisms cannot survive.
    • About 60% of world fish stocks are fully fished and more than 30% are overfished. Because of this, catch by global marine fisheries has been declining since 1996.
  • “Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems. Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”
  • The world’s population is expected to increase to 10 billion by 2050. The current system of food production is unsustainable.

Food ChoicesWhen they looked at the effect of the foods we eat on the environment, the Commission concluded:

  • Beef and lamb are the biggest contributors to greenhouse gas emissions and land use.
    • The concern about land use is obvious because of the large amount of pasture land required to raise cattle and sheep.
    • The concern about greenhouse gas emissions is because cattle and sheep are ruminants. They not only breathe out CO2, but they also release methane into the atmosphere from fermentation in their rumens of the food they eat. Methane is a potent greenhouse gas, and it persists in the atmosphere 25 times longer than CO2. The single most important thing we can do as individuals to reduce greenhouse gas emissions is to eat less beef and lamb. [Note: grass fed cattle produce more greenhouse gas emissions than cattle raised on corn because they require 3 years to bring to market rather than 2 years.]
  • In terms of energy use beef, lamb, pork, chicken, dairy and eggs all require much more energy to produce than any of the plant foods.
  • In terms of eutrophication of our lakes and oceans, beef, lamb, and pork, all cause much more eutrophication than any plant food. Dairy and eggs cause more eutrophication than any plant food except fruits.
  • In contrast, plant crops reduce greenhouse gas emissions by removing CO2 from the atmosphere.

What Is The Planetary Diet?

Planetary DietIn the words of the Commission: “[The Planetary Diet] largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils. It includes a low to moderate amount of seafood, poultry, and eggs. It includes no or a very low amount of red meat, processed meat, sugar, refined grains, and starchy vegetables.”

When described in that fashion it sounds very much like other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable. Here is a more detailed description of the diet:

  • It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.
  • It allows the option of adding one serving of dairy a day (It turns out that cows produce much less greenhouse emissions per serving of dairy than per serving of beef. That’s because cows take several years to mature before they can be converted to meat, and they are emitting greenhouse gases the entire time).
  • It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.
  • It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.

This is obviously very different from the way most Americans currently eat. According to the Commission:

  • “This would require greater than 50% reduction in consumption of unhealthy foods, such as red meat and sugar, and greater than 100% increase in the consumption of healthy foods, such as nuts, fruits, vegetables, and legumes”.
  • “In addition to the benefits for the environment, “dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10.8-11.6 million deaths per year globally.”

What Else Did The Commission Recommend?

In addition to changes in our diets, the Commission also recommended several changes in the way food is produced. Here are a few of them.

  • Reduce greenhouse gas emissions from the fuel used to transport food to market.
  • Reduce food losses and waste by at least 50%.
  • Make radical improvements in the efficiency of fertilizer and water use. In terms of fertilizer, the change would be two-fold:
    • In developed countries, reduce fertilizer use and put in place systems to capture runoff and recycle the phosphorous.
    • In third world countries, make fertilizer more available so that crop yields can be increased, something the Commission refer to as eliminating the “yield gap” between third world and developed countries.
  • Stop the expansion of new agricultural land use into natural ecosystems and put in place policies aimed at restoring and re-foresting degraded land.
  • Manage the world’s oceans effectively to ensure that fish stocks are used responsibly and global aquaculture (fish farm) production is expanded sustainability.

What we can do: While most of these are government level policies, we can contribute to the first three by reducing personal food waste and purchasing organic produce locally whenever possible.

What Does This Mean For You?

confusionIf you are a vegan, you are probably asking why the Commission did not recommend a completely plant-based diet. The answer is that a vegan diet is perfect for the health of our planet. However, the Commission wanted to make a diet that was as consumer-friendly as possible and still meet their goals of a healthy, environmentally friendly, and sustainable diet.

If you are eating a typical American diet or one of the fad diets that encourage meat consumption, you are probably wondering how you can ever make such drastic changes to your diet. The answer is “one step at a time”. If you have read the Forward to my books “Slaying The Food Myths” or “Slaying the Supplement Myths”, you know that my wife and I did not change our diet overnight. Our diet evolved to something very close to the Planetary Diet over a period of years.

The Commission also purposely designed the Planetary Diet so that you “never have to say never” to your favorite foods. Three ounces of red meat a week does not sound like much, but it allows you a juicy steak once a month.

Sometimes you just need to develop a new mindset. As I shared in my books, my father prided himself on grilling the perfect steak. I love steaks, but I decided to set a few parameters. I don’t waste my red meat calories on anything besides filet mignon at a fine restaurant. It must be a special occasion, and someone else must be buying. That limits it to 2-3 times a year. I still get to enjoy good steak, and I stay well within the parameters of the Planetary diet.

Develop your strategy for enjoying some of your favorite foods within the parameters of the Planetary Diet and have fun with it.

The Bottom Line

is your diet destroying the planet? This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report serves as a dire warning of what will happen to us and our planet if we don’t change our ways.

The Commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The Commission described the typical American diet as a “lose-lose-lose diet”. It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win-win diet”. It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet”.

The Planetary Diet is similar to other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable (for details, read the article above).

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

Do Antioxidants Reduce Diabetes Risk?

What Diet Is Best For Reducing Your Risk Of Diabetes?

ConfusionI don’t need to tell you that nutrition is confusing. The headlines change day to day. One day antioxidants are good for you. The next day they are worthless. What are you to believe?

That is why I knew you would be skeptical when you saw recent headlines saying things like, “Antioxidants reduce your risk of diabetes” or “An antioxidant-rich diet may prevent diabetes”. You are probably waiting for the other shoe to drop.

You are waiting for the next headline telling you to ignore the previous headlines.

That is why I decided to analyze the study (FM Mancini et al, Diabetologia, 61: 308-316, 2018) behind the headlines and tell you whether the headlines were true or false. More importantly, I wanted to put the study into perspective so you could apply the findings to your life.

How Was The Study Done?

Clinical StudyThe data for this paper came from the Interaction of Genetic and Lifestyle Factors on the Incidence of Type 2 Diabetes (InterAct) study. French women born between 1925 and 1950 were enrolled in the study beginning in 1990.

Women were excluded from the study if they had pre-existing cardiovascular disease, diabetes, or cancer.

In June of 1993 a very extensive dietary questionnaire was mailed to all participants. The antioxidant capacity of each of the foods in the diet was estimated using an existing database, and the total antioxidant content of each woman’s diet was calculated.

A total of 64,223 women (average age = 52) completed the questionnaire and were followed for 15 years. During that time 1751 of the women developed type 2 diabetes.

The study correlated the total antioxidant content of the diet with the risk of developing type 2 diabetes. Coffee was excluded from the analysis because the antioxidants found in coffee are high molecular weight compounds, and it is not clear how well they are absorbed.

The major sources of antioxidants in the French diet were fruits (23%), vegetables (19%), wine (15%), tea (10%), and chocolate (2%). Whole grains and beans are also good sources of antioxidants, but the French (and Americans) don’t eat enough of them to influence their total antioxidant intake.

In case you were wondering why wine and chocolate were among the five top sources of antioxidants, remember this is the French diet we are talking about.

Do Antioxidants Reduce Diabetes Risk?

Diabetes and healthy die The authors of the study divided the women into 5 groups (quintiles) based on the antioxidant content of their diets. Quintile one had the lowest antioxidant intake, and quintile five had the highest antioxidant intake.

Compared to the women in quintile one (lowest antioxidant intake), the risk of developing type 2 diabetes was decreased by:

  • 15% for women in quintile two.
  • 30% for women in quintile three.
  • 38% for women in quintile four.
  • 39% for women in quintile five (highest antioxidant intake).
  • As you might guess from the data above, there was an inverse association between total antioxidant content of the diet and type 2 diabetes up until somewhere between the third and fourth quintiles.
  • Above that antioxidant level, the relationship between dietary antioxidant content and risk of developing type 2 diabetes plateaued.

The authors concluded, “Our findings suggest that the total antioxidant capacity of the diet may play a role in reducing the risk of type 2 diabetes in middle-aged women. As type 2 diabetes represents a high disease burden worldwide, our results may have important public health implications.”

What Diet Is Best For Reducing Your Risk Of Type 2 Diabetes?

While most of the headlines talked about the effect of antioxidant intake on the risk of developing type 2 diabetes, we need to remember that the study was done with antioxidant-rich foods. That raises 3 important questions.

#1: Is it the antioxidants or the foods that decrease the risk of developing type 2 diabetes?

Diabetes-&-Vitamin-CThis was a diet rich in fruits, vegetables, and tea with moderate amounts of wine and chocolate. Although they didn’t make it to the top 5 in this study, whole grains and beans are also a good source of dietary antioxidants. In short, this was a very healthy diet.

That represents a complicating factor. For example, fruits and vegetables are also good sources of non-antioxidant phytonutrients that appear to have health benefits. They are also a good source of fiber and the healthy gut bacteria that eat the fiber.

In short, this study shows that healthy foods reduce the risk of developing type 2 diabetes. Since oxidative stress is thought to play a role in the development of diabetes, it is logical that antioxidants in these foods may help prevent diabetes. However, in reality, we don’t know how much of the risk reduction is due to the antioxidant content of the foods and how much is due to other components of the foods.

#2: Is it healthy foods that decrease the risk of type 2 diabetes, or is it due to decreased intake of unhealthy foods?

food choiceThe skeptic in me wants to ask, “Is the diabetes risk reduction due to the healthy foods included in the diet or does it derive from the fact that those foods displaced unhealthy foods from the diet?” It is also legitimate to ask whether people who eat healthier foods also followed a healthier lifestyle.

Fortunately, the data from this study puts those questions to rest. Compared to women in the lowest quintile of antioxidant intake, women in the highest quintile of antioxidants intake from diet:

  • Drank more sugar-sweetened and artificially sweetened beverages.
  • Ate more processed meat.
  • Ate more calories.
  • Smoked more.
  • Were just as likely to be overweight.

These women were more physically active, but in other ways their diet and lifestyle were no better than women with much less antioxidant intake.

However, we do need to remember that these are French women. Their overall diet and lifestyle is much better than American women. For example, at their worst:

  • 30% were overweight or obese compared to >60% for American women.
  • Intake of processed meat was less than ½ serving/day.
  • Intake of sugar-sweetened beverages was less than 1 ounce/day and intake of artificially sweetened beverages was 1.3 ounces/day.

#3: How much healthy foods do your need to include in your diet to reduce the risk of type 2 diabetes?

fruits and vegetablesThe fact that the beneficial effect of adding antioxidant-rich foods to your diet reduced the risk of developing type 2 diabetes up to a point and then plateaued has important implications. It means you don’t need to be a vegan to reduce your risk of type 2 diabetes. You just need to include enough healthy foods in your diet.

“How much healthy foods”, you might ask. If we look at the point at which the benefit of eating antioxidant-rich foods plateaued in this study, the women were eating:

  • 5-6 servings of fresh fruits and vegetables per day.
  • 4 cups of tea/day.
  • 7 pieces of chocolate/day.
  • 1 glass of wine/day.

If you are an American who is consuming less tea, chocolate, and wine than the French, you will probably want to aim for 6 or more servings of fresh fruits and vegetables per day and include whole grains and beans in your diet.

In a previous issue of “Health Tips From the Professor” I reviewed a study that looked at the optimal intake of fruits and vegetables for various other diseases. That study reported:

  • 10 servings per day is optimal for reducing the risk of heart disease, stroke, and premature death.
  • 6 servings per day is optimal for reducing the risk of cancer.

This study suggests 6 servings of fruits and vegetable per day is likely to also be optimal for reducing the risk of developing type 2 diabetes.

The bad news is that the average American eats one serving of fruit and less than 2 servings of vegetables a day. The good news is that each added serving of fruits and vegetables reduces your risk of disease and premature death. The same is probably true for whole grains and beans, but they weren’t specifically included in these studies.

What About Supplementation?

vitamin COf course, some of you will be tempted to say, “Changing my diet is hard. I’ll just take antioxidant supplements.” Will that work. If we are talking about individual antioxidant supplements, the answer is a clear, “No”. Numerous clinical studies have shown that.

However, one study looked at a holistic approach to supplementation and found that it significantly decreased the risk of developing type 2 diabetes over a 20-year period. That is encouraging, but you need to know that the people in that study were not just consuming antioxidant supplements. They were also consuming:

  • Supplements containing B vitamins, calcium, magnesium, and trace minerals.
  • Plant-based protein supplements that replaced some of the animal protein in their diet.
  • Omega-3 supplements.
  • Probiotic supplements.

So, just as was true for the diet study discussed above, antioxidant supplements may be beneficial in reducing the risk of developing type 2 diabetes. However, it is not possible to separate the benefits of antioxidant supplements from the other supplements included in the study.

The Bottom Line

You may have seen recent headlines claiming, “Antioxidants reduce your risk of diabetes”. The study behind those headlines was actually looking at the effect of antioxidant-rich foods like fruits and vegetables at decreasing the risk of developing type 2 diabetes.

The study did show that increasing the amount of antioxidant-rich foods in your diet decreases your risk of developing type 2 diabetes.

Since oxidative stress is thought to play a role in the development of diabetes, it is logical that antioxidants in those foods may help prevent diabetes. However, in reality we don’t know how much of the risk reduction is due to the antioxidant content of the foods and how much is due to the phytonutrient and fiber content of the foods.

There was an inverse association between total antioxidant content of the diet and type 2 diabetes up until somewhere between the 5 and 6 servings per day of fresh fruits and vegetables. At that point. the beneficial effect of eating antioxidant-rich foods plateaued. Eating 6 servings per day of fresh fruits and vegetables appears to be optimal for reducing the risk of developing type 2 diabetes.

To put that into perspective, a previous study that looked at the optimal intake of fruits and vegetables for various other diseases reported:

  • 10 servings per day is optimal for reducing the risk of heart disease, stroke, and premature death.
  • 6 servings per day is optimal for reducing the risk of cancer.

The bad news is that the average American eats one serving of fruit and less than 2 servings of vegetables a day. The good news is that each added serving of fruits and vegetables reduces your risk of disease and premature death. The same is probably true for whole grains and beans, but they weren’t specifically included in these two studies.

Of course, if you really wish to prevent or reverse type 2 diabetes, a holistic approach including weight control, exercise, diet, and supplementation is best.

For more details, including a more detailed discussion of supplementation, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

 

Finally, you should also never think of supplementation as a replacement for a healthy diet. If you wish to reduce your risk of developing type 2 diabetes, I recommend a holistic approach that includes weight control, exercise, diet, and supplementation.

Which Foods Should I Avoid?

What Is Nutritionism?

In Defense Of FoodRecently, I have been reading Michael Pollan’s book “In Defense of Food”. Yes, I know the book has been around for a long time. Normally I read the scientific literature rather than popular health books. However, in the past few weeks I have had a lot more time to read books, so I decided to read this one.

Some of the things he says are “off the wall”. As he readily admits, he isn’t a scientist or a medical doctor. However, a lot of what he says is “right on”. He echoes many of the things I have been talking about for years. But he does a masterful job of pulling everything together into a framework he calls “nutritionism”.

If you have a chance, I highly recommend that you read his book.

I will briefly summarize his discussion of nutritionism below. I will also share some scientific support for what he is saying. Finally, I will close by sharing what the Bible says on the subject.

What Is Nutritionism?

Low Fat LabelSimply put, nutritionism is the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them. I use the term “belief” purposely. As Michael Pollan puts it: “As the ‘-ism’ suggests, nutritionism is not a scientific subject, but an ideology.”

What Michael Pollan is referring to is taking food constituents like saturated fats, cholesterol, sugar, carbohydrates, polyunsaturated fats, monounsaturated fats, fiber, antioxidants, and probiotics and labeling them as either “good” or “bad”.

As he points out, that leads to debacles like the creation of margarine as a substitute for butter. Of course, everyone reading this article knows that we subsequently found out that the trans fat in margarine was worse for us than the saturated fat in butter. He offers many other examples like this.

He also points out that the nutritionism concept has given free rein to the food industry to replace whole foods with processed foods that are cholesterol-free, sugar-free, low-fat, low-carb, or high in fiber, omega-3s, etc. He says that these foods are seldom healthier than the foods they replace. I agree.

Finally, he points out that the scientific support for the classification of individual ingredients or foods as “good” or “bad” is weak. That’s because when scientists design a study that removes a chemical constituent or a food from the diet, they have to replace it with something. And what they replace it with determines the outcome of the study. I give some examples of this in the next section.

The essence of Michael Pollan’s message is:

  • The effect of an individual nutrient or chemical constituent on your health depends on the food it is found in. Forget the fancy nutrition labels. Whole foods are almost always healthier than processed foods.
  • The effect of a food or food constituent on your health also depends on your overall diet. We should be thinking about healthy diets rather than the latest “magical” or “forbidden” food.

I will discuss these points below.

Which Foods Should I Avoid?

Question MarkNow, let’s get to the question, “Which Foods Should I Avoid?” If we are talking about whole foods, the short answer is “None”. As I said in my book, “Slaying The Food Myths”, “We have 5 food groups for a reason”.

For example, if we are talking about plant foods, each plant food group:

  • Has a unique blend of vitamins and minerals.
  • Has a unique blend of phytonutrients.
  • Has a unique blend of fiber.
  • Supports the growth of a unique combination of beneficial gut bacteria.
  • Dr Strangelove and his friends are telling you to eliminate whole grains, fruits, and legumes (beans) from your diet. Recent studies suggest that might not be a good idea. Here is one example.

If we are talking about animal foods, each animal food group:

  • Has a unique blend of vitamins and minerals.
  • May have unique components that are important for our health. [Note: This is an active area of research. Theories have been proposed for which components in animal foods may be important for our health, but they have not been confirmed.]
  • Vegan purists will tell you that you have no need for meat and dairy foods. Recent studies suggest otherwise. Here is one example.

With that as background, let’s turn our attention to nutritionism and look at some of science behind claims that certain food components are either good for us or bad for us.

Saturated Fat. Saturated fat is the poster child for nutritionism.lowfat

First, we were told by the American Heart Association and other health organizations that saturated fat was bad for us. Recently Dr. Strangelove and his friends are telling us that saturated fat is good for us. Instead of limiting saturated fat, we should be limiting carbs by cutting out fruits, whole grains, and legumes. Both cite clinical studies to support their claims. How can this be?

Perhaps a little history is in order. When the American Heart Association recommended that we decrease intake of saturated fat, they were envisioning that we would replace it with monounsaturated and polyunsaturated fat in the context of a healthy diet of fruits, vegetables, whole grains, and legumes. That never happened.

Big Food quickly realized that if the American public were to follow the AHA guidelines, it would be disastrous for their bottom line. So, they sprang into action. They mixed sugar, white flour, and a witch’s brew of chemicals to create highly processed, low fat “foods”. Then they told the American public, “Don’t worry. You don’t have to give up your favorite foods. We have created low fat alternatives.”

This is the essence of what Michael Pollan refers to as nutritionism. By marketing their fake foods as low fat Big Food created the halo of health. In fact, Big Food’s fake foods were less healthy than the foods they replaced. Americans got fatter and sicker.

Now let’s look at the conflicting claims that saturated fat is bad for us or good for us. How can clinical studies disagree on such an important question? The answer is simple. It depends on what you replace it with. You need to consider saturated fat intake in the context of the overall diet.

I discussed this in a previous issue of “Health Tips From the Professor”, but let me summarize it briefly here. The American Heart Association tells us that replacing half of the saturated fat in a typical American diet with:

  • Trans fats, increases heart disease risk by 5%.
  • Refined carbohydrates and sugars (the kind of carbohydrates in the typical American Diet), slightly increases heart disease risk.
  • Complex carbohydrates (whole grains, fruits & vegetables), decreases heart disease risk by 9%.
  • Monounsaturated fats (olive oil & peanut oil), decreases heart disease risk by 15%.
  • Polyunsaturated fats (vegetable oils and fish oil), decreases heart disease risk by 25%.
  • Unsaturated fats in the context of a Mediterranean diet, decreases heart disease risk by 45%.

My advice: Saturated fat is neither good for you nor bad for you. A little bit of saturated fat in the context of a healthy diet is fine. A lot of saturated fat in the context of an unhealthy diet is problematic.

fatty steakRed Meat. Is red meat bad for you? Like saturated fat, it depends on the amount of red meat and the overall diet. I covered this in detail in “Slaying The Food Myths”, but let me summarize briefly here:

According to the World Health Organization, red meat is a probable carcinogen. If we look at the postulated mechanisms by which it causes cancer, they can be mostly neutralized by components of various plant foods.

My advice: An 8-ounce steak with fries and a soda is probably bad for you. Three ounces of that same steak in a green salad or stir fry may be good for you.

I should make one other point while I am on the topic. Dr. Strangelove and his friends have been telling you that grass-fed beef is better for you than conventionally raised beef. Once again, that is nutritionism.  Grass-fed beef is lower in saturated fat and high in omega-3s than conventionally raised beef. That may be better for your heart, but it has no effect on the cancer-causing potential of red meat. It doesn’t give the license to eat 8-ounce steaks on a regular basis. You still want to aim for 3-ounces of that grass-fed beef in a green salad or stir fry. 

High-Fructose Corn Syrup. This one seems to be on everyone’s “naughty list”. You are being told to read labels, and if the food has high-fructose corn syrup on the label, put it back on the shelf. But is that good advice?

It turns out that all the studies on the bad effects of high-fructose corn syrup have been done with sodas and highly processed foods. This should be your first clue.

Of course, as soon as high-fructose corn syrup gained its “bad” reputation, Big Food started replacing it with Sugar Comparisons“heathier” sugars. Does that make those foods healthier?

The answer is a clear “No”. Both chemically and biologically, high-fructose corn syrup is identical to sucrose (table sugar), honey, molasses, maple syrup, coconut sugar, date sugar, or grape juice concentrate. Agave sugar is even higher in fructose than high-fructose corn syrup. This is your second clue.

Substituting these sugars for high-fructose corn syrup doesn’t turn sodas and processed foods into health foods. This is nutritionism at its worst.

My advice: Forget reading the label. Forget trying to avoid foods with high-fructose corn syrup. Avoid sodas and processed foods instead.

Sugar. Once the public started to realize that natural sugars in processed foods were just as bad for us as high-fructose corn syrup, sugars became “bad”. We were told to avoid all foods containing sugar in any form. In fact, we were told we needed to become “label detectives” and recognize all the deceptive ways that sugar could be hidden on the label.

Apple With Nutrition LabelI have discussed this in detail in a previous issue of “Health Tips From The Professor”.

Let me just summarize that article with one quote, “It’s not the sugar. It’s the food. There is the same amount and same types of sugar in an 8-ounce soda and a medium apple. Sodas are bad for you, and apples are good for you.” If you are wondering why that is, I have covered it in another issue of “Health Tips From the Professor”.

Before leaving this subject, I should mention that nutritionism has risen its ugly head here as well. Big Food has struck again. They have replaced sugar with a variety of artificial sweeteners.

Once again, nutritionism has failed. Those artificially sweetened sodas and processed foods are no healthier and no more likely to help you keep the weight off than the sugar-sweetened foods they replace. I have covered the science behind that statement in several previous issues of “Health Tips From the Professor”. Here is one example.

My advice: Forget about sugar phobia. You don’t need to become a label detective. Just avoid sodas, sugar-sweetened beverages, and sweet processed foods. Get your sugar in its natural form in fruits and other whole foods.

low carb dietCarbs. Dr. Strangelove and his friends are now telling you that you need to avoid all carbs. That is pure nutritionism. Carbs are neither good nor bad. It depends on the type of carb and what you replace it with.

Once again, clinical studies have given conflicting outcomes. Each side of the carbohydrate debate can provide clinical studies to support their position. How can that be? The answer is simple. It depends on what assumptions went into the design of the clinical studies. I have written several articles on this topic in “Health Tips From the Professor”, but let me give you one example here.

In this example, I looked at two major studies. The PURE (Prospective Urban Rural Epidemiology) study included data from 135,000 participants in 18 countries. In this study, the death rate decreased as the % carbohydrate in the diet decreased. The low-carb enthusiasts were doing a victory dance.

However, it was followed by a second, even larger study. The ARIC (Atherosclerosis Risk In Communities) study included 432,000 participants from even more countries. In this study, the death rate decreased as the % carbohydrate decreased to about 40%. Then a curious thing happened. As the % carbohydrate in the diet decreased further, the death rate increased.

How can you explain this discrepancy? When you examine the PURE study:

  • The % carbohydrate only ranged from 70% to 40%.
  • The data for the PURE study was obtained primarily with third world countries. That is an important distinction because:
    • In those countries, it is primarily the well to do that can afford sodas, processed foods, and meat.
    • The poor subsist on what they can grow and inexpensive staples like beans and rice.
  • Simply put, in the PURE study, the type of carbohydrate changed as well as the amount of carbohydrate.
    • At the highest carbohydrate intakes, a significant percentage of the carbohydrate came from sugar and refined grains.
    • At the lowest carbohydrate intakes, most of the carbohydrate intake came from beans, whole grains, and whatever fruits and vegetables they could grow.

When you examine the ARIC study:how much carbohydrates should we eat aric

  • The % carbohydrate ranged from 70% to 20%.
  • The ARIC study added in data from the US and European countries. That is an important distinction because:
    • Low carb diets like Atkins and Keto are popular in these countries. And those are the diets that fall into the 20-40% carbohydrate range.
    • Most people can afford diets that contain a lot of meat in those countries.
  • Simply put, at the lower end of the scale in the ARIC study, people were eating diets rich in meats and saturated fats and eliminating healthy carbohydrate-containing foods like fruits, whole grains and legumes.

My advice: The lesson here is to avoid simplistic nutritionism thinking and focus on diets rather than on foods. When you do that it is clear that carbs aren’t bad for you, it’s unhealthy carbs that are bad for you.

Which Foods Should I Avoid? By now the answer to the question, “Which Foods Should I Avoid?” is clear. Avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).

What Does This Mean To You?

Questioning ManNow that we are clear on which foods you should avoid, let’s look at the flip side of the coin. Let’s ask, “Which foods should you include in your diet?

As I said at the beginning of this article, “We have 5 food groups for a reason”. We should consider whole foods from all 5 food groups as healthy.

Of course, each of us is different. We all have foods in some food groups that don’t treat us well. Some of us do better with saturated fats or carbs than others. We need to explore and find the foods and diets that work best for us.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

What Does The Bible Say?

Let me start this section by saying that I rely on the Bible for spiritual guidance rather than nutritional guidance. However, as part of our church’s Bible reading plan, I was reading 1 Timothy. A passage from 1 Timothy 4:1-5 leapt out at me. It reinforces the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in.

“The Spirit clearly says that in later times some will abandon the faith and follow deceiving spirits and things taught by demons. Such teachings come through hypocritical liars, whose consciences have been seared as with a hot iron. They…order people to abstain from certain foods, which God created to be received with thanksgiving by those who believe and who know the truth. For everything God created is good, and nothing is to be rejected if it is received with thanksgiving, because it is consecrated by the word of God and prayer.”

Interesting.

The Bottom Line

In this article, I have discussed the concept of “nutritionism” introduced in Michael Pollan’s book “In Defense Of Food”. He defines nutritionism as the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them.

What Michael Pollan is referring to is taking food constituents like saturated fats, cholesterol, sugar, carbohydrates, polyunsaturated fats, monounsaturated fats, fiber, antioxidants, and probiotics and labeling them as either “good” or “bad”. He points out that when we accept these simplistic labels, we often end up creating foods and diets that are less healthy than the ones we were trying to replace.

At the beginning of the article, I asked the question, “Which Foods Should I Avoid?” I then looked at several foods or food groups we have told to avoid, including saturated fats, red meat, high-fructose corn syrup, sugar, and carbs. When you look at the science behind these recommendations from the lens of nutritionism, you come to two conclusions:

  • We should avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).
  • Whole foods from all 5 food groups should be considered as healthy.

Of course, each of us is different. We all have foods in some food groups that don’t treat us well. Some of us do better with saturated fats or carbs than others. We need to explore and find the foods and diets that work best for us.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

For more details and a bible verse that supports the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Preparing For The New Normal

Can Supplements Strengthen My Immune System?

COVID-19The United States and the rest of the world are facing the biggest challenge of our lifetimes. COVID-19 has killed hundreds of thousands of people and decimated economies around the world.

As of the publication date of this article we have no vaccine and only one treatment option that appears to be about 30% effective in a preliminary clinical trial. People are scared.

The question I get asked most often is: “Can supplements protect me from COVID-19”. That’s not a question I can answer with confidence. The few studies we have are small and preliminary. Plus, there is too much we still do not know about COVID-19.

However, there are studies about how diet and supplements affect the immune system. I can answer the question, “Can Supplements Strengthen My Immune System”, with confidence. That will be the focus of this article.

However, before covering that, let me take an objective look at what our “New Normal” will be like and how we can prepare for it.

Preparing For The New Normal

ProfessorAs a scientist I am appalled by the divisive and hyper-partisan arguments about how we should be handling the COVID-19 pandemic. This is a time when our country should be united against a common enemy. Instead I see myths and lies propagated on both sides of this important issue.

The press only magnifies the problem by repeating the myths without fact checking. Whether they are on the left or the right, the media only repeats myths that fit their narrative. As a result, people like you are confused and scared.

Let me try to give you a more objective and scientific view of what the “New Normal” will look like, and how we can prepare for it.

Let’s start with one of the biggest arguments over the past few weeks – when should we reopen our country. This argument is based on the myth that if we wait long enough, the virus will be gone, and life can return to normal.

Nothing could be further from the truth. In reality viruses don’t work that way. They continue to circulate through the population at low levels. Whenever we emerge from our homes and resume our daily lives, the virus will be lurking. There will be flare-ups. There will be hot spots. There will be deaths. And the press will report every one.

So, the question should not be when we emerge. It should be how we emerge. We should emerge cautiously. We should continue to take appropriate precautions. These precautions will become our “New Normal” until we have an effective vaccine. By now, you probably have the CDC precautions memorized, but let me repeat them here:

  • If you are sick, stay home until you recover. If your symptoms worsen, contact your doctor right away.
  • If you are exposed, get tested right away and self-quarantine for 14 days if you test positive.
  • When you go out, wear a face mask and practice social distancing. When you get home, wash your hands in soap and water for 20”.
  • For now, we will need to avoid the customary handshake (and if you are from the South like me, the customary hug).
  • If you are very old or very sick, you should stay home as much as possible. If you have a loved one in this category, you should do everything in your power to protect them from exposure.
  • The guideline that is hardest to project into the future is the one on crowd size. It is hard to predict what the CDC will recommend about crowd size as part of our “New Normal” a few months from now. However, because this virus is extremely contagious, it may be risky to attend any gatherings where there are large, tightly packed crowds for the foreseeable future. This could include some of our favorite things – like movies, live theater, night clubs, and sporting events.Myth Versus Facts

Finally, there is another big myth, namely that the virus will simply disappear once we have a vaccine. Vaccines reduce your risk of exposure because fewer people are carriers of the virus. However, coronaviruses never disappear. They continue to circulate in the population for decades.

Even after we have a vaccine, people will still get sick from COVID-19. People will still die from COVID-19. The difference is that we will no longer hear about COVID-19 cases and deaths on the nightly news. Those cases and deaths will just become part of the statistics that the CDC collects on flu-like illnesses each year – and everyone ignores.

Now that I have discussed what the “New Normal” will look like and summarized the CDC guidelines for reducing your exposure to COVID-19 as the lockdown eases, let me add another guideline of my own:

  • Keep your immune system as strong as possible.

Why Is Keeping Your Immune System Strong Important?

strong immune systemIt is no secret that the media likes to focus on bad news. It is the bad news that draws people in and keeps them coming back for more.

Pandemics are no different. It doesn’t matter whether we are talking about the Spanish flu, SARS, MERS, or COVID-19. We focus on cases and deaths – the bad news. We ignore the good news – there are millions of people who were infected and had no symptoms.

However, if you have been listening closely to what the experts have been saying rather than relying on the media for your information, the good news is obvious.

  • 80-85% of people who have tested positive for COVID-19 have mild or moderate symptoms. Their symptoms are no worse than they experience with the seasonal flu.
  • Preliminary antibody tests suggest that the number of people infected with COVID-19 who experience no symptoms may be 10 to 40 times higher than reported cases.
  • The experts say that the difference is a strong immune system. They tell us that it is people with weakened immune systems that suffer and die from COVID-19.

So, how do you keep your immune system strong? Let’s start by looking at the role of supplementation.

Can Supplements Strengthen My Immune System?

MultivitaminsThose of you who follow me know that I consider supplementation as just one aspect of a holistic approach to health. However, I am starting with supplements because the question I am often asked these days is: “Can supplements protect me from COVID-19”.

As I said at the beginning of this article, that is not a question I can answer with confidence. Instead, the question you should be asking is, “Can Supplements Strengthen My Immune System?”

As I mentioned above, the experts are telling us that it is people with weakened immune systems who suffer and die from COVID-19. That means it is important to keep our immune system as strong as possible.

How do we do that? Here is what an international group of experts said in a recent review (PC Calder et al, Nutrients, 12, 1181-1200, 2020).

1) “A wealth of mechanistic and clinical data show that vitamins A, B6, B12, C, D, E, and folate; trace elements zinc, iron, selenium, magnesium, and copper; and omega-3 fatty acids EPA and DHA play important and complementary roles in supporting the immune system.”

2) “Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections, and an increase in disease burden.”

They then made the following recommendations:

1) Supplementation with the above micronutrients and omega-3 fatty acids is a safe, effective, and low-cost strategy to help support optimal immune function.

    • They recommended 100% of the RDA for vitamins A, B6, B12, C, D, E, and folate and minerals zinc, iron, selenium, magnesium, and copper in addition to the consumption of a well-balanced diet.
    • They recommended 250 mg/day of EPA + DHA.

2) Supplementation above the RDA for vitamins C and D is warranted.

    • They recommend 200 mg/day of vitamin C for healthy individuals and 1-2 g/day for individuals who are sick.
    • They recommend 2000 IU/day (50 ug/day) for vitamin D.

3) Public health officials are encouraged to include nutritional strategies in their recommendations to improve public health.

Their recommendations could be met by a multivitamin that provides all the micronutrients they recommend, an omega-3 supplement, and extra vitamins C and D.

What Else Should I Do To Strengthen My Immune System?

healthy foodsAs I said above, supplementation is only one part of a holistic approach to a strong immune system. Here are the other components of a holistic approach:

1) It starts with a healthy diet.

    • Eat foods from all 5 food groups.
    • Eat plenty of fruits and vegetables. They provide antioxidants and phytonutrients that are important for our immune system.
    • Eat plenty of high fiber foods. Include whole grains and beans in addition to fruits and vegetables. That’s because the friendly gut bacteria that strengthen our immune system need a variety of fibers from different food sources to feed on.
    • Eat oily fish on a regular basis.
    • Avoid sodas, sugary foods, and highly processed foods.
    • Avoid high fat diets

2) Get adequate sleep. For most of us, that means 7-8 hours of sleep a night.

3) Maintain a healthy weight.

4) Get adequate exercise. Aim for a minimum of 150 minutes of moderate intensity exercise each week.

5) Manage stress and anxiety in healthy ways. Yes, that means if you let the news about COVID-19 cause anxiety, you are weakening your immune system. You may want to turn off the news and try prayer, meditation, yoga, or whatever relieves stress for you.

The Bottom Line

In this article, I summarized the “New Normal” we face as we emerge from lockdown and how to navigate the new normal as safely as possible. If I were to summarize this article in a few short sentences, this is what I would say:

Until we have an effective vaccine the “New Normal” is a world in which a dangerous virus is lurking in the community, waiting to strike the unprepared.

Forget all the angry rhetoric about when we should emerge from lockdown. The important question is not when we emerge. It is how we emerge.

We don’t need to stay huddled in our homes, fearful to leave, unless we are very old or very sick.

We do need to take appropriate precautions when we leave home based on the recommendations of the CDC. None of us are invincible as far as this virus is concerned. More importantly, if we bring the virus home, we may kill the very people we love the most. We need to follow the guidelines.

We should also make sure that our immune system is as strong as possible through a holistic combination of diet, supplementation, adequate sleep, exercise, weight management, and stress reduction.

For more information on CDC COVID-19 Guidelines, click here.

For more details about preparing for the new normal and diet & supplementation recommendations, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Health Tips From The Professor