Omega-3-rich Foods Protect Bone Health

Alpha linolenic acid, the omega-3 fat found in walnuts and flaxseed, promotes bone health by helping to prevent excessive bone turnover--when consumption of foods rich in this omega-3 fat results in a lower ratio of omega-6 to omega-3 fats in the diet.

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Other studies have shown that diets rich in the omega-3s from fish (DHA and EPA), which also naturally result in a lowered ratio of omega-6 to omega-3 fats, reduce bone loss. Researchers think this is most likely because omega-6 fats are converted into pro-inflammatory prostaglandins, while omega-3 fats are metabolized into anti-inflammatory prostaglandins. (Prostaglandins are hormone-like substances made in our bodies from fatty acids.)

In this study, 23 participants ate each of 3 diets for a 6-week period with a 3 week washout period in between diets. All 3 diets provided a similar amount of fat, but their ratio of omega-6 to omega-3 fats was quite different:

• Diet 1 provided 34% total fat with omega-6 and omega-3 fats in amounts typically seen in the American diet: 9% polyunsaturated fats (PUFAs) of which 7.7% were omega-6 and only 0.8% omega-3 fats, resulting in a pro-inflammatory ratio of 9.6:1.
• Diet 2, an omega-6-rich diet, provided 37% total fat containing 16% PUFAs of which 12% were omega-6 and 3.6% omega-3, a better but still pro-inflammatory ratio of 3.3:1.
• Diet 3, which provided 38% in total fats, was an omega-3-rich diet, containing 17% PUFAs, of which 10.5% were omega-6 and 6.5% omega-3, resulting in an anti-inflammatory ratio of 1.6:1.

After each diet, subjects' blood levels of N-telopeptides, a marker of bone breakdown, were measured, and were found to be much lower following Diet 3, the omega-3-rich diet, than either of the other two.

The level of N-telopeptides in each diet also correlated with that of a marker of inflammation called tumor necrosis factor-alpha (TNF-alpha). Diets 1 and 2, which both had a significantly higher ratio of omega-6 to omega-3 fats, resulted in much higher levels of TNF-alpha than the diet high in omega-3 fats from walnuts and flaxseed.

Practical Tip: To decrease excessive bone breakdown and protect bone health, make omega-3-rich flaxseed and walnuts, as well as cold water fish, frequent contributors to your healthy way of eating.

Reference:

Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007 Jan 16;6:2.

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Integrative Medicine Conference News

I just returned from the Integrative Medicine Conference for Health Care Organizations held April 12-14, 2007, in San Diego, CA. This was a very interesting three days attended by healthcare professionals and directors of integrative medicine clinical programs, academics, economists and researchers.

There were several presentations from integrative medicine leaders who are now showing successful models of integrating natural medicine into conventional hospital and clinical settings. Especially encouraging is the emerging research showing better patient outcomes.

Most thought-provoking for me were the lectures by Jennifer James, PhD, and Martin Merry, MD. Dr. James is a cultural anthropologist from Seattle who has been studying the cultural transformation underlying the huge public movement towards natural/integrative/holistic approaches to healthcare. She made several strong points that were insightful for me:

1. The current chaos in healthcare, while unpleasant for both practitioners and patients, creates the opportunity for fundamental change. But, while many may appreciate and welcome the new ideas, they do not want to let go of what they have learned and do not want to be made to feel they were "wrong" in the past.
   
   This helped me understand why many dedicated conventional healthcare professionals seem to find it so hard to accept well-documented natural therapies when this might imply that the pharmaceuticals they have used for so long are possibly not be as good and more dangerous.


2. We cannot expect healthcare change to come from the federal level as there is no strong political leadership, and too many vested interests resist any real change. The solutions will come at the state level.
   
   This was encouraging to me since this means local action by dedicated activists has the best chance to develop models that can then be evaluated and adopted more widely when they are shown to be effective.


3. As cultures advance, they become more kind. Healthcare is kindness-manifested. I liked this one! It resonated deeply with me, and I could see the same sense of appreciative self-understanding in others in the audience. Caring about others' health is the source and core of what I do.


4. Flattening of the hierarchy gives patients greater involvement in their own health care decisions. This is consistent with my perspective that each patient is his or her own best doctor.

Dr. Merry has been involved in healthcare quality improvement programs for almost 30 years. His message focused on the causes of the unacceptably high level of medical error and the necessary solutions.

He believes that most errors are due to "First Curve" or "physician-centered" thinking. This is manifested by our current healthcare system. Merry asserts that the old model of centering systems on the expert craftsman, which worked so well in the past, no longer works in our modern world. Increased complexity, increased amounts of information and broader patient access to information and technology that were once reserved to the specialist, all result in demands for a different way of functioning.

First curve care, even when optimally practiced, still yields what is called "4 sigma error," i.e., about 6,000 deaths due to errors for every 1 million patient interventions (and this does not include patient injury, which according to some studies may be as high as 25% of interventions1). The goal, of course, is to have no injuries or deaths due to medical errors.

Merry believes this is simply not possible in a physician-centered system. According to published research, most medical errors in hospitals are due to lack of communication amongst the professionals involved in a patient's care. As long as the system is physician-centered, these communication errors will continue to happen.

The "second curve" model is centered on the patient. All involved in providing care are fully engaged and regularly communicating. The hierarchy is flattened, and the needs of all involved are met, not just the primary doctor or the patient, and a culture of safety and excellence pervades the organization.

Merry presented a most interesting example: currently in the first curve medical system: When a woman goes to see her doctor because of the possibility of breast cancer, it takes 1 to 8 weeks before she knows the result of the biopsy. These are defined as the "sleepless nights." There is no real reason for the delay other than the long string of communications that have to occur before the patient is finally informed. In a second curve system, the patient is informed in 2 hours. Yes, the same day after a short delay, not endless days of worry later.

Merry believes that integrative medicine has already moved a long ways into the second curve model and is the future of healthcare. Nice to hear a non-IM physician recognize the importance of our movement!

Conclusion. This conference was a very positive experience, documenting the great strides this new medicine is making.

¹ Gandhi TK, et al. Adverse drug events in ambulatory care. BMJ. 2003;348:1556-64

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Tomatoes and Broccoli Team Up to Save Men's Lives

Photo Credit: J. Bowman

Tomatoes and broccoli -- vegetables each known for their cancer-fighting actions -- are even more effective in combating prostate tumors when both are a daily part of the diet, shows a landmark study published in Cancer Research.

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"When tomatoes and broccoli are eaten together, we see an additive effect. We think it's because different bioactive compounds in each food work on different anti-cancer pathways," noted John Erdman, Professor of Food Science and Human Nutrition at the University of Illinois.

Erdman and doctoral candidate Kirstie Canene-Adams fed male rats one of 5 different diets, starting one month before the animals were implanted with prostate tumors, and then compared the effects of the different diets to surgical castration or treatment with finasteride, a drug commonly prescribed for men with enlarged prostates.

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The diets contained one of the following: 10% tomato, 10% broccoli, 5% tomato plus 5% broccoli, 10% tomato plus 10% broccoli, or lycopene (23 or 224 nmol/g diet).

Both tomato and broccoli were in the form of powders made from whole foods, so the effects of eating the entire vegetable could be compared to just consuming a single compound as a nutritional supplement -- in this case, lycopene, a carotenoid found in tomatoes.

After 22 weeks, when the rats' prostate tumors were weighed, the 10% tomato/broccoli combination outperformed all other diets, shrinking prostate tumors by 52%.

Broccoli alone decreased tumor weight by 42%, and tomato alone by 34%.

Lycopene alone (23 or 224 nmol/g diet) came in last, reducing tumor weight by 7% and 18% respectively.

The only treatment that approached the tomato/broccoli diet's level of effectiveness was castration -- not a desirable choice for most men, although it resulted in a 62% reduction in prostate tumor weight. Said Erdman, "As nutritionists, it was very exciting to compare this drastic surgery to diet and see that tumor reduction was similar."

"Older men with slow-growing prostate cancer who have chosen watchful waiting over chemotherapy and radiation should seriously consider altering their diets to include more tomatoes and broccoli," said Canene-Adams.

To get the prostate health benefits seen in this study, a 55-year-old man would need to consume 1.4 cups of raw broccoli and 2.5 cups of fresh tomato, 1 cup of tomato sauce or 1/2 cup of tomato paste daily, said Canene-Adams.

Erdman noted that this study shows eating whole foods is better than taking isolated nutrients. "It's better to eat tomatoes than to take a lycopene supplement--and cooked tomatoes may be better than raw tomatoes. Chopping and heating make the cancer-fighting constituents of tomatoes and broccoli more bioavailable," he said.

Practical Tips: The phytonutrients in tomatoes become more concentrated and bioavailable when tomatoes are cooked into a sauce or paste and are eaten with a little oil, but those in broccoli will be greatly lessened if this vegetable is overcooked, so steam or saute broccoli lightly.

Also, the healthful compounds in broccoli form after it has been cut, but cooking stops this process. For optimal nutrient formation, cut broccoli florets in half or into quarters, depending on their initial size, and let sit for 5 minutes before cooking.

It's easy to enjoy both broccoli and tomato at lunch, dinner or as a snack:

• Have a bowl of tomato soup and a salad with added broccoli florets for lunch.
• Add lightly steamed broccoli florets to the tomato-paste toppings on your favorite pizza.
• Healthy saute broccoli florets along with other favorite vegetables, such as onions and mushrooms, add to pasta sauce and use to top whole wheat pasta or brown rice.
• For a quick snack, serve raw broccoli florets along with the carrot and celery sticks, dip and crackers, and toast your prostate's health with a glass of tomato juice.

Reference:

Canene-Adams K, Lindshield BL, Wang S, Jeffery EH, Clinton SK, Erdman JW Jr. Combinations of tomato and broccoli enhance antitumor activity in dunning r3327-h prostate adenocarcinomas. Cancer Res. 2007 Jan 15;67(2):836-43. Epub 2007 Jan 9.

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Fat and Inflammation

True or false: Fat cells are special storage centers for depositing excess fat. Too much body fat puts extra stress on our heart and causes heart disease. If you answered "true," you are correct. If you answered "false," you are also correct - because researchers have discovered something about fat cells that no one has ever suspected.

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For most of their research history, fats cells (adipocytes) have been treated as fundamentally inactive cells that play a very limited role in our metabolism. Because fat cells have been regarded as simple storage centers for excess fat, the problems they bring to obesity have traditionally been regarded as physical problems. Fat makes us too big. It makes us too heavy. The excess weight contributed by fat puts too much stress on our heart and our joints.

Over the past five years, this traditional view of fat cells has been proven incorrect. Fat cells are anything but simple storage centers for fat! When excess fat is stored up in a fat cell, the fat cell goes to work metabolically and begins to act like an inflammatory trigger. It begins to produce a whole set of messaging proteins that are used by many kinds of cells to signal inflammation. It's this chronic, underlying layer of inflammation that links obesity to type 2 diabetes, and to cardiovascular disease as well. In addition, the elevated levels of inflammatory chemicals causes some people to experience a sense of always having a mild case of the flu, leading to chronic discomfort.

References:

1. Barros, R.; Moreira, A.; Fonseca, J.; Moreira, P.; Fernandes, L.; de Oliveira, J. F.; Delgado, L., and Castel-Branco, M. G. Obesity and airway inflammation in asthma. J Allergy Clin Immunol. 2006 Jun; 117(6):1501-2.
2. Bayes, B.; Granada, M. L.; Pastor, M. C.; Lauzurica, R.; Salinas, I.; Sanmarti, A.; Espinal, A.; Serra, A.; Navarro, M.; Bonal, J., and Romero, R. Obesity, adiponectin and inflammation as predictors of new-onset diabetes mellitus after kidney transplantation. Am J Transplant. 2007 Feb; 7(2):416-22.
3. Feve, B.; Bastard, J. P., and Vidal, H. [Relationship between obesity, inflammation and insulin resistance: new concepts]. C R Biol. 2006 Aug; 329(8):587-97; discussion 653-5.
4. Greenberg, A. S. and Obin, M. S. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr. 2006 Feb; 83(2):461S-465S.
5. Mascitelli, L. and Pezzetta, F. Obesity, inflammation, and risk of atrial fibrillation or flutter. Am J Med. 2006 Jul; 119(7):e9; author reply e11.
6. Sbarbati, A.; Osculati, F.; Silvagni, D.; Benati, D.; Galie, M.; Camoglio, F. S.; Rigotti, G., and Maffeis, C. Obesity and inflammation: evidence for an elementary lesion. Pediatrics. 2006 Jan; 117(1):220-3.
7. Schwarzenberg, S. J. and Sinaiko, A. R. Obesity and inflammation in children. Paediatr Respir Rev. 2006 Dec; 7(4):239-46.
8. Wang, Y. H. and Cai, L. Diabetes/obesity-related inflammation, cardiac cell death and cardiomyopathy. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2006 Dec; 31(6):814-8.
9. White, P. J. and Marette, A. Is omega-3 key to unlocking inflammation in obesity? Diabetologia. 2006 Sep; 49(9):1999-2001.

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Technorati Tags: health and wellness, obesity, fat, C-Reactive protein

Diet: Choose Cloudy Apple Juice

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Cloudy apple juices may contain up to four times the amount of protective polyphenols compared to clear apple juices, suggests a study in the January 2007 Journal of the Science of Food and Agriculture (Oszmianski J, Wolniak M, et al.) Polyphenols in apples, including their flavonoids, have antioxidant, anti-inflammatory and cancer-preventive properties.

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Researchers from the Agricultural University of Wroclaw and the Medical University of Warsaw evaluated the polyphenolic content of clear and cloudy apple juices from Idared and Champion varieties. Cloudy juices, especially those prepared from the Champion variety, had a much higher content of procyanidins (a type of flavonoid) than clear juices.

According to the study, the process of producing clear apple juice involves adding enzymes to remove the pectin and starch content of the cloudy juice—a process that may also lessen the polyphenol content of the clear juice produced.

The researchers found that while cloudy juice from Champion apples contained 1,044 milligrams of polyphenols per liter, clear juice made from Idared apples contained only 250 milligrams per liter.

When the juices' ability to neutralize free radicals was measured, cloudy Champion apple juice neutralized 93% of the radicals after 3 minutes, compared to only 24% for the clear Idared juice.

Reference:

Oszmianski J, Wolniak M, Wojdylo A, Wawer I. Comparative study of polyphenolic content and antiradical activity of cloudy and clear apple juices. Journal of the Science of Food and Agriculture. Published Online: 15 Jan 2007.

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Technorati Tags: health and wellness, natural foods, diet, apple juice