Good Bugs vs. Bad Bugs

Did you know that your digestive tract is filled with bacteria? There are actually ten times more bacteria cells in your digestive tract than there are cells in your entire body: one hundred trillion bacteria compared to your ten trillion cells!

Because there are so many bacteria, and the good ones play such an important role in your health that they are called probiotics (pro = for, biotics = life), they are sometimes thought of as an extra helpful organ in your body.

Our digestive system is supposed to be filled mostly with good bacteria like Acidophilus species and Bifidobacter. When our gut is filled with good bacteria, they out-compete any bad bacteria that enter our bodies on food and drink, and prevent the bad guys from taking up residence.

The tables can quickly turn when we are exposed to too much bad bacteria at once (think potato salad that has sat out for hours at a long picnic) or when an antibiotic treatment kills not only the bad bugs, but most of the body's healthy bacteria, too. The bad bacteria then have an opportunity to colonize the walls of the intestines, injure them, and cause problems, like severe diarrhea.

Not only do good bacteria crowd out the bad guys, good bacteria support our health in a number of other ways:

• Good bacteria digest fiber. Fiber is carbohydrate from plants that humans cannot digest, but bacteria can. Plant fiber not only provides good bacteria with food, but the byproducts of their digestion then serve as food for our intestinal cells. This is an unusual way for cells to be fed. Cells normally receive their nourishment from blood after food has been digested into nutrients and absorbed into the blood stream. In this case, the nutrients released from the fiber by good bacteria are not absorbed into the bloodstream, but feed the cells of the intestines directly.
• Good bacteria produce some B vitamins and vitamin K for the body's use. B vitamins are essential for both energy production and nervous system function. Vitamin K is necessary for blood clotting and functions as an antioxidant.
• Good bacteria even help produce enzymes that digest drugs and hormones. Probiotic bacteria produce enzymes that not only detoxify potentially harmful compounds themselves, but communicate with our liver, telling it to increase its production of needed detoxification enzymes.
  

If you're not convinced yet that it is natural and healthy to have bacteria living in your gut, here are some fascinating facts:

• When babies are born, their intestines are sterile, meaning that they are free of bacteria. Within 6 hours of birth, a baby will have over a billion organisms living in his or her gut.
• Breast milk contains not only good bacteria, but also a substance called bifido growth factor, which helps the probiotic bifido species of bacteria grow in the baby's intestines.
• The profile of different species in a baby's gut is affected by whether s/he was born vaginally or by caesarian, in a hospital or at home, fed breast milk or formula, and if the mother is exposed to antibiotics or antimicrobial herbs.
• By age 2, the baby's digestive tract will reach the adult level of colonization: 100 trillion bacteria.
  

Fermented foods, such as yogurt, kefir, tempeh, and sauerkraut, are good sources of these health-promoting bacteria.

1. Collins MD, Gibson GR. Probiotics, prebiotics and synbiotics: approaches for modulating the microbial ecology of the gut. Am J Clin Nutr 1999;69:1052S-7S
2. Holzapfel WH, Haberer P, Snel J, et al. Overview of gut flora and probiotics. Int J Food Microbiol 1998;41:85-101
3. Murray M, Pizzorno J. Probiotics. In: Pizzorno J, Murray M, eds. Textbook of Natural Medicine. 3rd edn. Edinburgh: Churchill Livingstone, 2005.
4. Hanaway P. Balance of flora, galt, and mucosal integrity. Altern Ther Health Med. 2006;12:52-60
5. Sult T. Digestive, Absorptive and Microbiological Imbalances. In: Jones D. ed-in-chief, Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine, 2005.

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Why Weight Loss Diets Don't Work

The equation should be simple: eat less + exercise more = lose weight. Yet, researchers generally find that weight loss diets only cause people to lose about half the weight that would be predicted by this simple model.

Researchers have known for more than 50 years that the amount of weight loss seen with reduced-calorie diets tends to be much less than would be predicted. Even worse, weight loss seems to start off at a rapid clip, then weight plateaus or even drifts back upward by the end of the first six months.

An article published in the American Journal of Clinical Nutrition attempted to figure out why this phenomenon occurs. They looked at three potential explanations:

1. that people eating low calorie diets absorb food more efficiently, getting more nutrition from less food;
2. that people eating low calorie diets slow their metabolism down to match their dietary intake; or
3. that people demonstrate reduced ability to follow low calorie diets for long periods of time.

The reviewers were able to present compelling evidence that food absorption and changes in metabolism were not enough to explain the difference between expected and measured weight loss in clinical research. Because of this, they concluded that people tend to drift away from low calorie dietary strategies, compromising their effectiveness.

This is no big surprise to doctors or nutritionists. We just discussed in a recent blog another in a series of research trials where weight loss was compromised by poor compliance with dietary recommendations.

A more interesting question is why people do a poor job of following diets over time. This is a much harder question to answer, but I would like to suggest a few possibilities:

• Counting calories is hard. Diets that have successfully controlled diabetes, blood pressure, and cholesterol have focused more on patterns of food intake (kinds of foods eaten and general quantity) than absolute amounts.
• Diets based on numeric goals don't necessarily eliminate the worst food choices. I find the most effective weight loss strategies are the ones that eliminate most of the extra calories from nutrient-starved processed foods, especially refined sugars and fatty, salty snacks.
• Low calorie diets often leave people hungry. Hungry people snack, and this compromises their diet. Foods high in fiber tend to prolong the feeling of fullness (or satiety) after meals. High dietary fiber is almost always a key focus of my weight loss diet instructions.
• Weight loss diets need to be flexible. As a doctor, I find weight loss diets to be a process of trial and error, and sometimes compromises are needed in some areas to make the overall diet one that my patient is willing to follow. A diet one person finds acceptable may not work for another person. Researchers use uniform strategies in their studies and I believe this is why they almost always see poor compliance impair results.

Whole foods is the bottom line. I believe no weight loss diet will ultimately be successful unless it prioritizes whole foods. Not only do whole foods help control weight, but virtually every epidemiological study shows that whole foods diets reduce the risk of most diseases.

References:

1. Heymsfield SB, Harp JB, Reitman ML, et al. Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective. Am J Clin Nutr. 2007;85:346-54
2. Gardner CD, Kiazand A, Alhassan S,, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9):969-77.
3. Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43-53

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Is the Atkins Diet Really Superior to Other Weight Loss Diets?

A new clinical trial published in the Journal of the American Medical Association showed that women following the Atkins diet lost more weight over a one-year period than women following other dietary plans. Expect supporters of the Atkins-style low-carbohydrate diets to cite this research as proof that their diet is superior to older low-fat weight loss diets that remain the standard of care in most medical settings.

In this new study, participants followed one of four diets for the entire year. The diets were as follows:

• Atkins Diet: a low-carbohydrate, high-protein strategy
• Ornish Diet: a very-low-fat, vegetarian diet
• Zone Diet: a diet that attempts to balance protein, carbohydrates, and fats at every meal
• LEARN Diet: a diet that follows a more traditional low-fat, high-fiber strategy

In addition to losing more weight than the people assigned to the other diet strategies (about 10 pounds, compared with about 5 in other groups), the Atkins diet participants had favorable changes in their cholesterol levels and no changes in blood sugar control or blood pressure. Critics have long been concerned about the possibility of the Atkins Diet leading to dangerous changes in each of these three important areas.

Color me unconvinced. I don't believe that this study teaches us anything about the relative efficacy of any diets. This is because the average participant in this study didn't even come close to following the recommended dietary strategy. The people assigned to the Ornish Diet, for instance, on average ate three times as much fat as this diet allows. Similarly, people following the Zone diet were supposed to get 30% of their calories from protein, but only managed to get 20% by the end of the study. It would have been very useful to see a little more information about what the food sources of the calories were (e.g., did the carbohydrates come from sweets or fruits and vegetables) to know more about why people failed to meet prescribed diet interventions.

The Atkins Diet participants were the closest to actually following the recommended diet, perhaps explaining the better outcome in this group. A similarly designed trial published in JAMA two years ago showed no real difference among any of these diets in weight loss efficacy.

My concern with the Atkins dietary strategy is that people following this diet over a period of years may develop health problems related to the high total fat and saturated fat content of the diet. Previously published research indicates that diets high in saturated fat can lead to insulin resistance (an important step toward diabetes), high blood pressure, and high cholesterol. While in the short term, the weight loss from the Atkins Diet may mask this effect, over a period of years, this effect would seem likely.

A much more important and obvious point than relative diet efficacy, at least to me, is the evidence that people do not easily adopt new diet strategies. Even though each person in this diet was given eight weeks of intensive dietary counseling, the diets people reported at the end of a year looked very little like the diets they were supposed to be eating.

It is my belief that the best way to build a weight loss diet is to start with understanding of the person's current diet. Then, work together with that person to identify and intervene with the most problematic aspects of that diet and finds ways to move to a more whole foods diet. This approach is far more effective than starting with a one-size-fits-all strategy, meets the individual's specific needs, and sets a diet up for success rather than failure.

References:

1. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9):969-77.
2. Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43-53.
3. Rasmussen O, Lauszus FF, Christiansen C, et al. Differential effects of saturated and monounsaturated fat on blood glucose and insulin responses in subjects with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1996;63(2):249-53.
4. Thomsen C, Rasmussen O, Lousen T, et al. Differential effects of saturated and monounsaturated fatty acids on postprandial lipemia and incretin responses in healthy subjects. Am J Clin Nutr. 1999;69(6):1135-43
5. Rasmussen BM, Vessby B, Uusitupa M, et al. Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects. Am J Clin Nutr. 2006;83(2):221-6

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Whole Health

Photo Credit: Mari

With the release of the new whole-wheat Krispy Kreme donut, we find ourselves reflecting on what it is to be a health food.

Yes, the whole wheat Krispy Kreme donut has 3 times as much fiber as its white counterpart, but that's still less than half the amount provided by a small pear. Both donuts have equal amounts of sugar and fat (almost 20% of your daily value in 1 donut). In fact, both donuts contain more trans fat than saturated fat! (Even more harmful than LDL-cholesterol raising saturated fat, trans fats not only increase LDL, but also decrease protective HDL-cholesterol.)

In another example of supposedly healthful improvements that don't fix the core problem, some restaurants are making their deep-fat fryers trans-fat free. While excluding trans fat is great, the oil used in commercial deep fat fryers is generally changed only once a week, so the fat, which is heated to high temperatures all day long every day, becomes highly oxidized and loaded with free radicals harmful to our tissues, even without the trans fat.

But is this the best way to criticize an aspiring health food? Maybe we should instead complain because we can't imagine a donut growing.

An Introduction to Whole Foods

What are whole foods? Minimally processed foods that once had a life of their own and retain the vast majority of their nutrients, such as an apple, a fish, and brown rice.

Processed foods typically have most of their nutrients removed and chemicals added to bleach, color, preserve, modify the texture, and add back flavor. Their chemistry may also be altered in a harmful way (such as the oil being oxidized when exposed to high heat, air, and light).

Even refined grains in the U.S. are good sources of the vitamins B1, B2, B3. Why? Not because they are naturally present in whole grains since they are refined out during processing, but because they are legally required to be added back in to prevent people from developing severe deficiency diseases, such as berberi and pellagra.

But B vitamins are far from all that's lost in the refining process. There are thousands of beneficial phytochemicals (non-vitamin, non-mineral compounds), such as polyphenols, that are continuously being discovered in plant foods, which are eliminated during processing. It is neither practical nor financially viable for food manufacturers to add back in all of the healthful compounds we currently know about that were originally provided by the whole food.

Since people began analyzing the constituents of foods in labs, they have viewed foods as a sum of their parts. But foods are a lot more than their vitamins, minerals, protein, fat and carbohydrate, and overemphasizing the importance of a single compound causes trouble. For example, when we remove naturally occurring fat to make a food low-fat, we typically lose the fat-soluble vitamins, A, D, E and K as well.

Fad diets are a great example of latching onto a component of food, like carbs, fat, or macronutrient ratios, instead of focusing on whether the food itself promotes health. When we look at populations of the world in which people live long and healthy lives, we find that they enjoy a colorful and varied diet of whole foods, and that when they begin to eat processed foods, their rates of diabetes, heart disease, and cancer skyrocket.

Finding Real "Health" Food

Photo Credit: Mary Gaston

Real health foods are whole, nutrient-dense and minimally processed. Even though there is one whole food ingredient in the new Krispy Kreme donut, it is not a health food because the rest of its ingredients are heavily processed, and it is cooked in an unhealthy way. Whole wheat bread products should be satisfyingly chewy, not soft and weightless like white bread.

Real health foods often need refrigeration, but usually require little or no packaging. If they are packaged, their ingredient list will be short and comprised of words you recognize as foods. Shop the perimeter of the grocery store and don't go down the aisles, or better yet, shop at a farmer's market offering locally grown foods.

References:

1. Suzuki M, Wilcox BJ, Wilcox CD. Implications from and for food cultures for cardiovascular disease: longevity. Asia Pac J Clin Nutr. 2001;10(2):165-71.
2. Weisburger JH. Lifestyle, health and disease prevention: the underlying mechanisms. Eur J Cancer Prev. 2002 Aug;11 Suppl 2:S1-7.
3. Nutrition and Physical Degeneration by Weston Andrew Price. (La Mesa, CA: Price-Pottenger Nutrition Foundation; 2004)

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Java - No Jive, It May Be Good for You

Photo Credit: .shyam.

I frequently lecture to both conventional and professional audiences. A question I am often asked, "Is coffee bad for me?" As I like to make my answers based on data, this has been difficult to answer as the coffee research has been surprisingly inconsistent. Happily, several recent studies have finally provided clarity.

In the ongoing debate over whether coffee is good or bad for health, a number of recent studies suggest that - if you don't have high blood pressure or problems clearing caffeine - American's favorite brew may do a lot more than perk you up in the morning.

Recent epidemiological (population) studies suggest that coffee may help lessen risk of several chronic diseases, including type 2 diabetes, Parkinson's disease and liver disease (cirrhosis and hepatocellular carcinoma). (Higdon JV, Frei B.,Critical Review Food Science Nutrition 2006; Montella M, Polesel J, et al. Int J Cancer 2007; Kalda A, Yu L, et al. J Neurol Sci. 2006)

Data gathered on 88,259 women in the Nurses Health Study II found that coffee drinkers lowered their risk of type 2 diabetes by 13% if consuming 1 cup per day, 42% for 2-3 cups per day, and 47% for 3 cups per day, compared to non-coffee drinkers.

Interestingly, coffee's beneficial effects were not due to caffeine: these reductions in disease risk were similar for those drinking decaffeinated as well as caffeinated coffee, filtered coffee, and even instant coffee. (van Dam RM, Willett WC, et al., Diabetes Care 2006)

Although caffeine has been considered as a possible risk factor for breast cancer, research suggests otherwise - at least in premenopausal women. A study in the January 2006 issue of the Journal of Nutrition found that among premenopausal women, consumption of regular (caffeinated) coffee was associated with linear declines in breast cancer risk.

A 40% reduction in risk of breast cancer was seen in premenopausal women drinking at least 4 cups of coffee a day. On the other hand, no clear associations were seen between breast cancer risk and intake of black tea (which also contains caffeine) or decaffeinated coffee. Something else about coffee-most likely its rich concentration of heterocyclic compounds with strong antioxidant activity and polyphenols with anti-cancer actions-is responsible.

Coffee may offer special benefits as we age. If you're over 65 and don't have high blood pressure, daily coffee consumption may offer protection against both cardiovascular disease and cognitive decline:

Data collected for the first National Health and Nutrition Examination Survey Epidemiological (NHANES I) by James Greenberg and colleagues at the City and State Universities of New York (American Journal of Clinical Nutrition, 2007, 85 (2): 392- 398), revealed that those over 65 with normal blood pressure who drank at least 4 caffeinated beverages a day had a 53% reduced risk of death from cardiovascular disease. However, no cardiovascular benefit was seen from coffee consumption in participants with stage 2 hypertension or in those younger than 65.

Results of the FINE study, a long term health study that began in 1966, when 676 healthy men born between 1900 and 1920 in the Netherlands, Finland and Italy, were enrolled, suggest that coffee helps men retain their mental edge as they age (van Gelder et al. European Journal of Clinical Nutrition (2007) 61: 226-232).

Over a 10-year period, study participants' thinking ability was assessed using the Mini-Mental State Examination. Results showed that men who drank 3 cups of coffee a day had half the cognitive decline of the men who never drank coffee.

Men who consumed coffee had a 10-year cognitive decline of 1.2 points (4%). Non-consumers experienced a cognitive decline of 2.6 points. An inverse and J-shaped association was observed between the number of cups of coffee consumed and cognitive decline, with the least cognitive decline for 3 cups of coffee per day (0.6 points).

The cognitive decline seen in coffee drinkers was 1/4 the decline the decline in non-consumers.

Animal studies may explain why. In mice with the rodent equivalent of Alzheimer's disease (amyloid-beta induced brain cell atrophy), trigonelline, an active constituent of coffee beans, has been shown to regenerate brain cells (dendrites and axons), resulting in memory improvement.

The caffeine naturally present in coffee, while potentially harmful for the caffeine-sensitive, may give athletes who tolerate it well a significant edge. A small study by UK researchers suggests that caffeine may not only improve alertness, but may boost carbohydrate delivery to cells by up to 26%, enhancing available energy and therefore potentially improving physical performance.

In one study, bicyclists underwent 3 two-hour exercise sessions, cycling at approximately 64% of their maximum output. During each session, the cyclists consumed one of three beverages. All beverages tasted the same, but one contained sugar (glucose), another contained glucose and caffeine, and the third, a control drink, was flavored water (no calories or caffeine). Samples of blood and expired air were taken from the athletes at 15 minute intervals to measure how quickly they absorbed and utilized the carbohydrate. When drinking the beverage containing caffeine, the athletes' carbohydrate oxidation (ability to burn sugar to produce energy) increased by 26%.

While caffeine is present not only in coffee, but in chocolate, drugs, and cola, this study suggests that a cup of coffee with a little sweetener-we prefer honey since it provides other benefits besides glucose-before your workout may improve your performance.

Coffee Caveats

Persons with or at increased risk of developing high cholesterol levels should drink only filtered coffee. Epidemiological studies have linked consumption of boiled, but not filtered, coffee with increased risk for cardiovascular disease (CVD). Moderate daily consumption of filtered coffee, however, has not been associated with any adverse cardiovascular effects.

Why should unfiltered coffee increase CVD risk while filtered coffee does not? Coffee contains two diterpene compounds, cafestol and kahweol, which promote an increase in blood levels of cholesterol but are removed when the coffee is filtered. (Ranheim T, Halvorsen B., Molecular Nutrition and Food Research, 2005)

If you are sensitive to caffeine-if coffee gives you the jitters or a cup of coffee in the afternoon keeps you up half the night-caffeinated coffee can increase your risk of a heart attack.

Caffeine is metabolized by an enzyme in the liver called cytochrome P450 1A2 (CYP1A2). There are different versions of the gene for this enzyme, one of which is associated with slow and the other with a fast rate of clearance of caffeine from the body. Individuals who have inherited the gene variant CYP1A2*1F allele metabolize caffeine slowly-these are the folks who get speedy and stay awake all night after a couple of cups of coffee or a piece of chocolate-while individuals with the gene variant CYP1A2*1A allele metabolize caffeine rapidly-these people can top off a night out with an espresso and a chocolate mousse and fall asleep an hour later.

Researchers from the University of Toronto, Canada, investigated whether this genetic variation in the gene that detoxifies caffeine could explain the inconsistency in studies, some of which show risk of non-fatal heart attack increases with coffee consumption while others do not. The team determined the genotype and assessed the intake of caffeine from coffee between 1994 and 2004 in 4,018 subjects from Costa Rica: 2,014 who were patients who had had a first acute non-fatal heart attack and 2,014 controls.

Results indicted that 55% of patients and 54% of controls carried the slow *1F allele. Carriers of this allele older than age 59 who consumed 2-3 cups of coffee per day had a 36% increased risk of heart attack, and those who drank 4 or more cups per day had a 64% increased risk.

However, among carriers of the rapid *1A genotype older than 59, coffee consumption resulted in a reduced risk of 25% for those consuming 1 cup, 22% for those consuming 2-3 cups, and 1% for those drinking 4 or more cups daily.

Even more pronounced increases and decreases in risk were seen in individuals younger than 59 years of age:

Among younger individuals with the slow *1F allele, consuming 1 cup of coffee daily increased heart attack risk by 24%, 2-3 cups increased risk by 67%, and 4 or more cups increased risk 133%!

Correspondingly, individuals younger than 59 with the rapid *1A genotype lowered their risk of heart attack by 52% when drinking 1 cup of coffee daily; 2-3 cups a day lowered risk by 43%, and 4 or more cups daily resulted in a reduction in heart attack risk of 17%.

Women who are trying to conceive or are pregnant should play it safe and avoid caffeine, including that found in tea, chocolate, sodas and some over-the-counter medications, as well as regular coffee.

Once again, the reason lies in our genes. Women who carry the Val/Val polymorphism of a detoxification enzyme called CYP450 1B1 are at increased risk for first-trimester miscarriage, and, particularly in smokers, caffeine consumption further increases this risk.

CYP450 1B1 is not a major player in the processing of caffeine in the liver, but instead plays a role in the metabolism of caffeine among pregnant women via action in the uterus. Smoking increases risk since it is known to induce production of CYP450 1B1.

The CYP1B1 Val/Val polymorphism is very common, so avoiding caffeine is a good idea for women who are trying to conceive or are pregnant.

And giving up coffee while pregnant may be easy, even for those who ordinarily love it. An increased aversion to coffee is, along with nausea and vomiting, a consistent early feature of a healthy pregnancy.

Practical Tip:
For adults with normal blood pressure who have no difficulty clearing caffeine-those with the CYP1A2*1A allele-consuming moderate amounts of coffee (3-4 cups/d providing 300-400 mg/d of caffeine), may offer a number of health benefits.

References

1. Hancock DB, Martin ER, Stajich JM, Jewett R, Stacy MA, Scott BL, Vance JM, Scott WK. Smoking, caffeine, and nonsteroidal anti-inflammatory drugs in families with Parkinson disease.Arch Neurol. 2007 Apr;64(4):576-80.
   PMID: 17420321


2. Kalda A, Yu L, Oztas E, Chen JF. Novel neuroprotection by caffeine and adenosine A(2A) receptor antagonists in animal models of Parkinson's disease. J Neurol Sci. 2006 Oct 25;248(1-2):9-15. Epub 2006 Jun 27. PMID: 16806272
   Higdon JV, Frei B. Coffee and health: a review of recent human research. Crit Rev Food Sci Nutr. 2006;46(2):101-23. PMID: 16507475


3. Montella M, Polesel J, La Vecchia C, Dal Maso L, Crispo A, Crovatto M, Casarin P, Izzo F, Tommasi LG, Talamini R, Franceschi S. Coffee and tea consumption and risk of hepatocellular carcinoma in Italy. Int J Cancer. 2007 Apr 1;120(7):1555-9. PMID: 17205531


4. Ranheim T, Halvorsen B. Coffee consumption and human health--beneficial or detrimental?--Mechanisms for effects of coffee consumption on different risk factors for cardiovascular disease and type 2 diabetes mellitus. Mol Nutr Food Res. 2005 Mar;49(3):274-84. PMID: 15704241


5. van Dam RM, Willett WC, Manson JE, Hu FB. Coffee, caffeine, and risk of type 2 diabetes: a prospective cohort study in younger and middle-aged U.S. women. Diabetes Care. 2006 Feb;29(2):398-403. PMID: 16443894
   Baker JA, Beehler GP, Sawant AC, Jayaprakash V, McCann SE, Moysich KB. Consumption of coffee, but not black tea, is associated with 40% decreased risk of premenopausal breast cancer. J Nutr. 2006 Jan;136(1):166-71. PMID: 16365077


6. Greenberg JA, Dunbar CC, Schnoll R, Kokolis R, Kokolis S, Kassotis J. Caffeinated beverage intake and the risk of heart disease mortality in the elderly: a prospective analysis. Am J Clin Nutr. 2007 Feb;85(2):392-8.


7. van Gelder BM, Buijsse B, Tijhuis M, Kalmijn S, Giampaoli S, Nissinen A, Kromhout D. Coffee consumption is inversely associated with cognitive decline in elderly European men: the FINE Study. Eur J Clin Nutr. 2007 Feb;61(2):226–232. Epub 2006 Aug 16. PMID: 16929246


8. Tohda C, Kuboyama T, Komatsu K. Search for natural products related to regeneration of the neuronal network. Neurosignals. 2005;14(1-2):34-45. PMID: 15956813
   Yeo SE, Jentjens RL, Wallis GA, Jeukendrup AE. Caffeine increases exogenous carbohydrate oxidation during exercise. J Appl Physiol. 2005 Sep;99(3):844-50. Epub 2005 Apr 14. PMID: 15831802


9. Cornelis MC, El-Sohemy A, Kabagambe EK, Campos H. Coffee, CYP1A2 genotype, and risk of myocardial infarction. JAMA. 2006 Mar 8;295(10):1135-41. PMID: 16522833


10. Karypidis AH, Soderstrom T, Nordmark A, Granath F, Cnattingius S, Rane A. Association of cytochrome P450 1B1 polymorphism with first-trimester miscarriage. Fertil Steril. 2006 Nov;86(5):1498-503. Epub 2006 Sep 14. PMID: 16978616


11. Cnattingius S, Signorello LB, Anneren G, Clausson B, Ekbom A, Ljunger E, Blot WJ, McLaughlin JK, Petersson G, Rane A, Granath F. Caffeine intake and the risk of first-trimester spontaneous abortion. N Engl J Med. 2000 Dec 21;343(25):1839-45. PMID: 11117975


12. Hey E. Coffee and pregnancy. BMJ. 2007 Feb 24;334(7590):377. PMID: 17322215

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• WebMD Video: Truth About Coffee
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Technorati Tags: coffee, caffeine, health-and-wellness

All Sugars Are Not the Same

Our country's sweet tooth has grown to striking proportions. During the 1970s and 1980s, we were able to keep our sugar habit at a relatively stable 3.5 ounces per day. But then we discovered liquid sweeteners - including the grand champion sweetener in today's marketplace: high fructose corn syrup (HFCS). While our total sweetener consumption has increased by more than 25% and now averages over 4.5 ounces per day, HFCS now accounts for half of our total sweetener intake.

So what, you say! Dextrose, sucrose, glucose syrup, HFCS - isn't it all processed, refined sugar? Doesn't it all provide a similar amount of calories per teaspoon?

From a natural medicine perspective, we would have to answer both questions "yes" and "no." Yes, because all the sweeteners listed above are indeed highly-processed, nutrient-poor sugars, providing approximately 10-15 calories per teaspoon. But no as well, because these sugars are not simply "calorie packages." Each of these sweeteners has a different chemistry, a different origin, and a different way of impacting our metabolism. In natural medicine, it's the unique nature of every food and nutrient that matters most - in the exact same way that our unique, individual nature must always serve as the context for our personal health decisions.

The unique nature of HFCS may pose some special problems for our health, according to an admittedly preliminary research study published in the March 2007 issue of Hepatology. By adding corn-derived fructose syrup to the drinking water of rats, researchers were able to identify certain metabolic changes that took place in the rats' metabolism. These changes had not previously been expected. The extra-sugar addition to the rats' diet did indeed provide them with too many calories. But is also affected their liver function by causing increased formation of fat, and it went through a different processing pattern than the simple sugar fructose.

In other words, fructose syrup made from corn and ordinary fructose sugar found in fruit are not the same. They do not have the same nature. In technical science terms, fructose syrup is capable of disrupting leptin signals from fat cells, and also capable of altering the function of a protein receptor on the fat cell nucleus called PPAR-alpha. The naturally occurring fructose in fruit is not capable of these same effects. The ability to trigger changes in leptin signaling and PPAR-alpha function changes makes the sugar in fructose syrup more than just a sugar. According to this study, and precisely because of its unique effects, HFCS might be able to increase risk of obesity in a way that is unrelated to the calories it contains.

Of course, we're only talking about a single animal study. It's impossible to draw any firm conclusions about human health from a single animal study, or even 50 animal studies. We need to learn much more about the processing of HFCS inside human beings. After learning more, we need to see if our observations hold true over and over again, and with human beings from all walks of life, of all ages, and with all kinds of health histories. Only then will we be able to draw any scientific conclusions.

But in the meantime, we can still remind ourselves that all sugars are not the same, and the unique nature of high fructose corn syrup might be something worth thinking about.

References:

1. Haley S, Reed J, Lin B-H et al. (2005). Sweetener consumption in the United States. Economic Research Service, United States Department of Agriculture, Beltsville, MD
2. Roglans N, Vila L, Farre M et al. (2007). Impairment of hepatic Stat-3 activation and reduction of PPARalpha activity in fructose-fed rats. Hepatology Mar;45(3):778-88.

Related Topics:

• Sugary Drinks Linked to Obesity Rise
• Sweet Addiction

Technorati Tags: health and wellness, diet, nutrition, sugar, high fructose corn syrup

When Patients Go Alternative

The scenario is becoming more and more familiar. A patient is on the examining table, the physical exam completed, and with a furtive look in his eye, says: "By the way, Doc, I've been taking Siberian ginseng for the past couple of months, and I'm wondering if it might cause any problem with my blood pressure pills." This event is usually followed by a few seconds of uncomfortable silence.

Americans are increasingly using unconventional therapies for everything from the common cold to cancer. They are mixing botanicals with blood pressure meds and acupuncture with antidepressants. However, 70% of CAM users do not tell their physician. So why aren't they telling their conventional doctor? The fact is that the majority of patients withhold such information because they fear embarrassment or censure. More surprisingly, this reluctance to confess applies not only to alternative therapies, but also to over the counter products and drugs prescribed by other physicians.

So what should your physician do when you finally inform him or her that you have been taking a botanical medication they know nothing about? The first order of business is to not scare you back into silence with judgmental attitudes. If the product has scientific backing for efficacy and safety, they should support its use while keeping an eye out for potential adverse effects. If it does not, they should gently guide you into making an informed decision as to whether to discontinue the product and possibly search for another approach, alternative or conventional (or both). Of course this would require that your doctors educate themselves as to the supplement in question, something they are unlikely to do given the time constraints of daily life.

But there is a solution. The conventional MD may not know about unconventional therapies, but they should know where to ask. The obvious choices are the pharmacist and the naturopathic physician, which brings us back to the definition of integrative healthcare. Collaboration. Appreciation of another's knowledge. Putting the patient before ego. Practitioners recognizing that they are not the source of healing, but the means by which patients discover, or actually rediscover, their own innate capacity to regain health. Both becoming active partners in choosing therapies consistent with communal values and philosophical beliefs, acknowledging that the basis of any relationship, therapeutic or other, is open communication and trust - both the trust that you will reveal the truth, and the trust that your doctor will listen and advise without judgment.

References:

1. Eisenberg DM, Kessler RC,, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N ENGl J Med. 1993;328:246-252.
   
2. Complementary and Alternative Medicine (CAM) in the United States
   Committee on the Use of Complementary and Alternative Medicine by the American Public
   Board on Health Promotion and Disease Prevention
   Institute of Medicine
   The National Academies Press
   Washington, DC
   www.nap.edu
   Executive Summary page 10, 2005
   

Related Topics:

• Taking Supplements? Tell Your Doctor
• National Center for Complimentary and Alternative Medicine

Technorati Tags: alternative medicine, complimentary medicine, integrative medicine, CAM, supplements, health-and-wellness