Wednesday, May 22, 2019

Live longer, avoid cancer, and lose weight: research shows that making your own food may be your most important decision

Living longer and feeling better is often a matter of which food we eat when we’re hungry – and it looks like we’d be all be better off if we stop choosing commercially-processed food.  This includes those convenient ready-to-eat protein bars, heat-and-eat meals, and food from restaurants or grocery store delis.  Multiple studies show commercially processed food to be associated with increased weight gain [1], a shorter life [2], and more cancer [3].  In one of the most recent studies [1], participants were randomized to either a diet of unprocessed food or a diet of highly-processed food: both diets were matched for calories, sugar, fat, fiber, and other major nutrients.  Those eating the highly processed foods gained weight over the period of the study, while those eating unprocessed foods lost weight; although they were offered the same amount of food, they apparently simply ate less.  There appears to be many reasons why processed foods cause more harm (see pages 59–61 of Good Food, Great Medicine, 4th edition), including chemical alterations during processing, additives, calorie density, and less appetite suppression.  The fact that those eating less processed foods were also more likely to be at lower risk of common diseases is a bonus worth considering!
 
My recommendation:
For optimal health, one of the best decisions we can make for ourselves and our family is to prepare our food from scratch as much as possible.  It takes some extra time, but the rewards are unbeatable.  Get together with family and friends and make home cooking a part of your life.  Bring a lunch to work.  Keep snacks simple and homemade, and put together a repertoire of easy dinners.  Teach children how to help in the kitchen when they’re young and cook when they’re older.  There are lots of meal planning ideas, recipes, and snack suggestions in Good Food, Great Medicine, pages 134–146.  Call our office at 503.291.1777 to sign up for a disease reversal class or schedule an appointment for a one-on-one medical consultation (goodfoodgreatmedicine.com).

Miles Hassell MD

[2]Schnabel, L. et al. JAMA Intern Med 2018; doi:10.1001 (NutriNet-Santé Study)
[3]Fiolet, T. et al. BMJ 2018;360:k322 (NutriNet-Santé Study)

Thursday, February 21, 2019

Good bugs for a better mood

Want a better mood – with less help from drugs?  Try increasing the good bugs in your GI tract!  The mechanism for benefit may be the ability of your gut microbes to produce butyrate, a short chain fatty acid with a wide range of metabolic effects, including strengthening the epithelial defense barrier [1], a layer of cells that line the gut to resist invaders like toxins and bad bugs.  In fact, it is increasingly evident that a healthy gut microbiome is also associated with a multitude of other health benefits such as better weight management, less cancer, diabetes, heart disease, and more.  Now that should help improve your mood!    

My recommendation:
There are many non-drug options for treating depression and anxiety, including targeted diet therapy, fitness, weight management, light exposure, and heat therapy; this study adds powerful support for eating more probiotic foods such as plain kefir and yogurt (meaning unsweetened, with milk and active cultures as the only ingredients) as well as foods like salt-cured sauerkraut and kimchi for a healthier gut microbiome and mood.  Although there is a subgroup that does very well on medications, be aware that the lifestyle prescription on pages 23-24 of Good Food, Great Medicine (4th edition) is arguably more powerful medicine.  For more on how and why to choose probiotic foods, see page 49.    

Miles Hassell MD

Monday, February 18, 2019

Joint steroid injection? Think twice…

There are ongoing concerns that steroid injections for painful knee osteoarthritis [1,2] may have the negative effect of accelerating joint breakdown while having no benefit – including for pain control – compared to placebo injections.  This is in addition to data showing that even short-term steroids (as well as other anti-inflammatory medications) have significant potential for harm to overall health.

My recommendation:
This is an area of legitimate debate; however, given both the uncertainty regarding the benefit and the potential harm, I strongly recommend that patients exhaust all other options before having steroid injections.  The alternative is a plan that includes meticulous attention to diet, weight, blood sugar management, appropriate exercise, and topical or oral pain medications.  There are some nutritional supplements that may help, and targeted physical therapy can make an enormous difference.  Occasionally I use lidocaine injections without steroids and see excellent results.

Keep the most important goals in mind: less pain and improved function in the short term, and avoiding further joint breakdown or joint replacement in the long run.  Make sure you have all options in view.  (See my 5/1/2017 blog post on corticosteroids for more information about short-term oral steroids.)

Miles Hassell MD

[2] McClindon, T. et al. JAMA 2017;317:1967-75

Wednesday, May 2, 2018

High vitamin D supplementation may be harmful, even if blood level of vitamin D is low

Vitamin D deficiency is common, but a review [1] of hundreds of well-done studies suggests that vitamin D supplements are generally not helpful for problems other than bone health and respiratory illness.  Current data suggest that:
  • In most circumstances we should not take more than 1,000–2,000 units of vitamin D3 daily
  • Blood level of vitamin D should be about 20-40 ng/ml; higher levels are associated with harm
The authors of the review point to evidence indicating that low vitamin D levels are the consequence, not the cause, of ill health.  This is particularly concerning in light of the evidence that high blood levels of vitamin D seem to increase risk of death, falls, and cancer.  
 
My recommendation:
Get vitamin D through natural sources rather than supplements.  A blood level of 20–40 ng/ml is a reasonable target, but I only recommend supplementing with 1,000–2,000 IU of vitamin D3 daily if you are not able to get enough vitamin D from natural sources like oil-rich fish (salmon, tuna, sardines, etc.) and non-burning sunlight on as many square inches of bare skin as is socially acceptable.  Mushrooms which have been exposed to ultraviolet light for a few hours may emerge as another useful vitamin D supplement.  Despite decades of research it is still not known if taking vitamin D supplements will provide the same benefits, or if people who naturally have higher blood levels of vitamin D are healthy for some other reason.  For more detail and some useful general resources on nutritional supplements, see page 89 of Good Food, Great Medicine, 3rd edition – and then check out Salmon Cakes (page 227), Tuna and White Bean Salad (page 232), and Sardine Pâté (page 152) for a few of our favorite ways to improve vitamin D levels! 

Miles Hassell MD
 
[1] Autier, P. et al. Lancet Diabetes Endocrinol 2017;5:986-1004

Tuesday, April 3, 2018

Drinking coffee is healthy everywhere – except in California?

The California court system has ruled that coffee retailers must warn consumers about small amounts of acrylamide (a naturally-occurring substance widely present throughout the food supply) in roasted coffee beans.  Like many compounds found in everyday foods, it has been shown to cause cancer when given (1) to animals at high doses, and (2) in isolation, conditions not present with humans drinking coffee.   An analogous argument would lead to a ban on apples, because apples contain cyanide (they really do!).  The fact is that people who drink coffee appear to be significantly healthier than those who do not, with less risk of heart disease, atrial fibrillation, diabetes, dementia, depression, respiratory illness, and all-cause death.   

My recommendation:
  1. Continue drinking coffee but skip added sweeteners and commercial milk substitutes.  (For details on the health benefits of coffee see pages 36-37 of Good Food, Great Medicine – 3rd edition.)
  2. Be wary of recommendations using reductionist arguments that don’t stand up to scientific evidence or critical thinking.  We need be able to counter irrational judgments with thoughtful reasoning – our health depends on it.
  3. Eat an apple with your coffee – it helps keep the doctor away!

Miles Hassell MD

Thursday, March 15, 2018

Let’s stay healthy, strong, and independent as we age by making good food and activity choices today

A 2017 British study looking at the impact of a good diet on our physical performance confirms again that eating more vegetables, whole fruit, and whole grains -- and less processed foods like white bread, added sugar, and processed meat -- not only improves overall current health, but also dramatically improves our physical and mental strength, balance, agility, and vigor as we get older.  This naturally leads to fewer broken bones and greater independence.

My recommendation:
The food choices mentioned in the study fit the pattern of a whole food Mediterranean diet, which has consistently been shown to be beneficial for healthy aging – a high consumption of vegetables and whole fruit, whole grains, beans, good fats like extra-virgin olive oil, eggs, unprocessed meat, and moderate alcohol.   Whole food sources of protein, vitamin D, and antioxidants have been associated with improved muscle mass, strength, and physical performance in older age.  The benefits?  Less frailty and more independence, with a healthier brain and joints at every age.  For more information and sources on graceful aging, see pages 15-16 in Good Food, Great Medicine, 3rd edition.       

Miles Hassell MD
 
[1] Robinson,S. et al. J Gerontol A Biol Sci Med Sci 2017;00:1-6

Thursday, March 8, 2018

Want to reduce weight or diabetes risk? Chew slowly!

This is science speaking, even though it sounds a bit like something our mothers might say!  A study of 1,083 Japanese men and women comparing fast, normal, and slow eaters was presented at the American Heart Association’s Scientific Sessions in 2017. [1] The study found that fast eaters had:
  • 5 times more new-onset metabolic syndrome than slow eaters
  • increased waist circumference and overall weight
  • higher blood glucose levels
  • lower levels of good HDL cholesterol
Also, the fast eaters in the study reported eating dinner 2 hours before sleeping and snacking after dinner, both high-risk habits for weight gain.  Previous studies have confirmed these findings, so this isn’t new news.  When we spend more time chewing our food, we feel satisfied sooner – the stomach takes about 20 minutes to get a message to the brain that we’re full. 

My recommendation:
Chewing our food slowly is definitely a good idea for both weight management and overall health.  It’s also a good idea not to drink your calories, and there are at least two reasons for this:
  1. Chewing is an important first stage of the digestion process, so it also benefits gut health
  2. Concentrated liquid calories like smoothies and juice can be a weight and blood sugar trap, even when made from whole foods
Eating a whole food Mediterranean-style diet with plenty of vegetables, fruit, beans, nuts, whole grains, and unprocessed meat naturally requires more chewing.  On the other hand, the more foods are processed, the smaller their particle size, and the faster we can eat them.  To read about other reasons to avoid processed food and liquid calories, see pages 9 and 74-75 in Good Food, Great Medicine, 3rd edition. 

Miles Hassell MD