Strange but true: heart disease and cancer rates are falling!

An interesting trend has come to light that definitely seems surprising: less people are dying from heart disease and cancer, and the incidence of cancer is dropping!  According to a recent study in the New England Journal of Medicine [1] age-specific heart disease deaths worldwide dropped by 39% between 1990 and 2013 and the SEER database reports that over the last 10 years of records, cancer incidence in the U.S. has fallen an average of 0.9% per year.  Also, cancer death rates have trended down and 5-year survival has improved. [2]  

The reason these diseases are becoming less common is most likely multifactorial: better lifestyle choices, better diagnostic abilities, and better treatments probably all play a role.  However, it’s important to note that one of those factors is patient-powered – better lifestyle choices.  The most profound impact we can have on our own heart disease or cancer risk is what we choose to put in our shopping carts and on our table, and our choice to stay active and get enough sleep.  For a wealth of practical strategies to help incorporate those choices into your own life and transform your health with lifestyle medicine, see Good Food, Great Medicine. 

Miles Hassell MD

[1] Roth, G.A. et al. NEJM 2015;372:1333-41

[2] http://seer.cancer.gov/statfacts/html/all.html

Over-the-counter pain relievers: don't assume they're harmless

A commonly underrated hazard is the use of pain medication, including over-the-counter favorites like acetaminophen (Tylenol and others).  Patients often take them for fairly minor pain, sometimes with the idea that the “anti-inflammatory” or some other effect will improve healing.  However, a new study [1] in the Annals of the Rheumatic Diseases (ARD) warns that even standard doses of acetaminophen (or paracetamol, as it’s known in the UK) taken regularly can damage kidney function, especially with higher dose levels.  This doesn’t mean we shouldn’t take any pain medicine for an injury, or that acetaminophen is especially harmful compared to other pain relievers; it does remind us to be respectful of harmful side effects from these medications, and to only use them when necessary.  (Although this 2015 study only looked at acetaminophen, most pain relievers have been found to have comparable risks.)  Some steps to consider are applying heat, ice, massage, physical therapy, supplements, or activity modification – for example, if something hurts when you move, rest it as much as possible.  Any persistent pain needs appropriate medical evaluation, but talk to your physician about other alternatives to over-the-counter pain medications. 

Miles Hassell MD

[1] Roberts, E. et al. Ann Rheum Dis 2015;0:1–8. doi:10.1136/annrheumdis-2014-206914 

Read this only if you’re getting older

We all want to maintain healthy brains and well-functioning bodies as we age.  So how do we do it?  The most powerful tool available to us appears to be a Mediterranean diet rich in good fat, and yet another 2015 study agrees. [1]  In a four-year randomized controlled trial studying age-related cognitive decline, participants 55–80 years old were divided into three groups.  Two groups followed a Mediterranean diet supplemented with either 1 liter of extra-virgin olive oil per week or 30 grams of mixed nuts (walnuts, almonds, and hazelnuts) daily, and the third group followed a careful low-fat diet.  Those on the Mediterranean diet with nuts or olive oil had better brain function at the end of four years than those on the low-fat diet.  This builds on 60 years of high-quality studies supporting an omnivorous Mediterranean diet pattern.  The low-fat doctrine has dominated the past half-century, but it’s time to face the good fat facts!  Want a quick Mediterranean diet summary?  See Fat Is Good, Bagels Are Bad.  For a practical and easy-to-read resource on the day-to-day application of Mediterranean diet principles see Good Food, Great Medicine (3^rd edition – especially pages 15-16 on Aging Gracefully).  It also includes 185 recipes featuring plenty of raw nuts and extra-virgin olive oil. 

Miles Hassell MD

[1] Valls-Pedret C. et al. JAMA Intern Med 2015;doi:10.1001/jamainternmed.2015.1668

Know anyone with atrial fibrillation?

You might – atrial fibrillation (AF) is a heart rhythm disorder we are seeing more and more frequently.  AF carries a high risk of stroke, and there are many treatments to lower this risk and reduce symptoms; the most common treatments include anticoagulants to make the blood less likely to clot.  While these blood thinners reduce stroke risk, they have their own dangerous side effects (including, not surprisingly, a bleeding risk), often require frequent blood tests for monitoring, and do not completely eliminate the stroke risk.  Happily, our chance of developing AF is much lower if we choose to eat well and stay active.  There is also good news for those who have atrial fibrillation and are overweight: if you make sensible food choices and do moderate exercise to achieve at least 10% weight loss, and maintain those habits, you are 76% more likely to have AF disappear without using drugs or other interventions!  This is based on the results of a 5 year study of 355 overweight patients with AF, published last month in the Journal of the American College of Cardiology.[1]  It reminds us that good lifestyle choices are critical in treating disease as well as preventing it.  Using lifestyle medicine, people can often not only reverse AF and many other diseases, but also avoid the cost and side effects of drugs and medical procedures.  What a deal! 

Miles Hassell, MD
 

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[1] Pathak, R. et al. J Am Coll Cardiol 2015;doi:10.1016/j.jacc.2015.03.002

Chili (con Beans and con Carne)

Chili (con Beans and con Carne) Page 235

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This can be simple or complex, fancy or plain, vegetarian or not.  You can use whatever beans you like.  I cook my own beans (see page 198) or use canned pinto beans.  You can make it hot, or tame like this version.  You also may prefer a soupier chili than this one.  We generally serve chili over brown rice, but a decadent alternative is to serve it over Easy, Cheesy Polenta (page 217).   

(Serves 4 – 6)

¼ cup extra-virgin olive oil

2 medium-large onions, ¼-inch dice (6 cups)

1–2 bell peppers, diced (1½–3 cups)

Optional: 1–2 jalapenos, seeded, finely diced

1–2 tablespoons freshly crushed garlic

 2 tablespoons chili powder

1 tablespoon ground cumin

1 teaspoon oregano

1 fat tablespoon honey

2 teaspoons salt

1 teaspoon freshly ground pepper

1 pound ground or chopped meat (see note)

-or- chopped leftover cooked meat, especially leftover Ono Oven Smoked Pig (page 240)

1 can (28 ounces) crushed tomatoes    

3 cups cooked beans (15-ounce can is about 1½-cups drained beans)

Optional:  1 cup chopped cilantro, if available

Onions, bell peppers, and jalapenos sauteing
in extra-virgin olive oil.

Sauteed vegetables cooking with garlic
and an assortment of spices.

This chili is hearty and delicious with the addition
of flatiron steak.

Here I am quickly browning the meat.

This is the finished chili after simmering for
30 minutes over very low heat. 

1.     Heat oil in 6-quart heavy pot over medium high heat and sauté onions briskly for about 8 minutes, then add peppers (and jalapenos, if you have them) and cook for 5 more minutes, or until onions and peppers are tender.  Stir in garlic and seasonings and cook for another few minutes.

2.  Keeping heat at medium-high, push vegetables to the sides of the pot and add meat.  Sauté briskly until browned. 

3.  Add tomatoes and drained beans.  Bring to a simmer and cook very gently, uncovered, for about 30 minutes, stirring from time to time.  Avoid letting the chili boil.  Keep in mind that the longer you cook it, the drier it gets.  Taste for flavor – the chili may need a dose of bottled fire of your choice, depending on the amount of beans and/or meat you ended up using. 

4.  Add cilantro within an hour of serving, to maintain color and flavor, or serve on the side.  (If made in advance, let cool completely, uncovered, before storing in refrigerator.)

Note:

4 I like to either serve chili with sides of Pico de Gallo and Avocado Salsa (both on page 175) or with side dishes of topping options like grated sharp cheddar cheese, sliced green onions or diced mild white onions, diced avocado, extra chopped cilantro, and minced fresh jalapenos.

Chopped meat versus ground meat

Ground beef or pork (or whatever meat you like) works fine, but I like to chop my own – the texture is completely different than ground meat.  My choice is flatiron steak, which is fairly tender and rich, and I use a very sharp chef’s knife – mine is 11 inches, which makes easy work of it.  I ignore the tough connective tissue that always seems to run across the underside of the steak – I chop it finely and it is unnoticeable.  The meat is even easier to chop if you put it in the freezer until it’s semi-frozen – at least 30 minutes.  (The flatiron steak I get is sold in handy vacuum packs, which makes it easy to just slip it in the freezer.)  The almost-frozen meat is steadier under the knife and faster to chop.  It’s worth the extra work, in my opinion.   

Take a walk on the sunny side

Even after years of running I can still feel that familiar wave of dread as I laced up my tennis shoes and walked in to P.E. class. That terrifying moment when my gym teacher announced we would be doing timed sprints that day, and escape was futile. The instant I heard the whistle my mouth would go dry, my legs turned to jelly, and my lungs would burn as I tried to keep up with my classmates. Running on the playground was fun! Running for physical fitness was pure agony. I understand how daunting exercise can seem, and how easy it is to avoid. However, I also know that there is no denying (as hard as I might try) the immeasurable benefits of living an active lifestyle. For those of us that need convincing, here is an excerpt from Good Food Great Medicine (p. 50) listing some of the rewards of exercise:

• Reduces overall risk of a heart attack by 47% and lowers risk of premature death in those with heart disease by 26%.
• Is equal or superior to medications for managing risk for heart disease, stroke, and type 2 diabetes.
• Prevents and treats peripheral vascular disease.
• Reduces cancer, depression, and dementia.
• Reduces risk of osteoporosis.
• Improves heart disease risk factors including LDL and HDL cholesterol, triglycerides, blood pressure, and lipid oxidation.
• Improves flexibility in the arterial walls and blood clotting function, and helps the heart repair damaged blood vessels and from new arteries when necessary- the “do-it-yourself coronary artery bypass” effect.
• Improves neurohormonal function, insulin resistance, weight management, and immunity, and slows aging within the genetic material of your cells.
• Eases symptoms of pain and stiffness, lowers inflammatory load, and improves energy.
• Improves sleep. 

Are you also haunted by repressed exercise memories? Never fear! Nowadays there are so many ways and places to exercise that it doesn’t have to be the scary ordeal of my childhood. Even everyday tasks like weeding, vacuuming, and swinging a hammer count. Here are a few ways that I like to fit exercise into my life: Running the stairs at work, walking during lunch or while I make phone calls, walking to the grocery store, lifting free weights at home, or doing lunges, squats and toe lifts whenever I get a chance. I also belong to a local gym and enjoy trying new classes. My favorite motivational tool is an exercise buddy to hold me accountable. Avoiding the gym becomes a bit trickier when a friend is there waiting for me.

My running buddy is about three feet tall, 55 pounds,
and has no qualms about using the side of the trail as a public restroom.
 His name is Bruce, Bruce the dog. I have found no limit to his energy,
 which has done wonders for my exercise habits. 

These are two of my human running buddies on a beautiful day in Forest Park.
Bruce was nice enough to take the picture. 

Miles’ Postscript: 

The extraordinary range of benefits for daily exercise are so great that they seem to many people to be unbelievable. We would all do well to look again at Malea’s list above, and take a moment (or two) to think about the difference daily exercise could make in each of our lives. Let’s consider just the cancer, depression and dementia bullet. Look at the numbers: 30% reduction in cancer risk, a benefit for depression that exceeds that for antidepressants, and about a 50% reduction in dementia. Whoa! That’s the payoff associated with just one of those 10 bullet points! So quit reading and go take a walk. RIGHT NOW! Get going! 

Did you say crackpot?

One of the first recipes I tried from Good Food, Great Medicine was the homemade granola. It was love at first bite. The fact is that I have always loved cold breakfast cereal in the mornings. It takes weeks to go bad and I feel like a king when I stand in the grocery aisle in front of all those options. Then the day came when I discovered that even whole grain cereal might not be living up to the promises on the box. I was already avoiding the sugary cereals– your Cap n’ Crunches and Cookie Crisps– but surely the bland grown up versions were okay? Unfortunately I learned that, even without added sweetening, these commercial ready-to-eat breakfast cereals are so highly processed that they behave more like sugar in your body and are anything but natural (p. 97 GFGM 3^rd edition). The more I thought about it though, the more it made sense – how often do you come across a honey oat cluster bush or a peanut puff tree? So I made the painful break from my beloved breakfast.

Here is a fresh batch of homemade granola (p.131). It is cooked low and slow
 to preserve the healthy oils in the nuts and seeds. It also has just a little bit
of honey and cinnamon for sweetening. These are all whole food ingredients,
but moderation is always good to keep in mind. If left to one's own devices,
 this granola would disappear faster than you could say Abracadabra!

It was difficult at first, and I still wanted something to satisfy my cravings for cold milk and crunchy cereal. That was when I found my new love, homemade granola. I was surprised by how easily I could throw together the ingredients and leave them in the oven for a couple of hours without fuss. I like to add all sorts of roughly chopped nuts and seeds to my version. My nut chopper speeds up this process and spares my hands from my somewhat overzealous chopping. I find the granola to be especially scrumptious with plain full-fat yogurt, fruit such as a banana or berries, some cinnamon, and a drizzle of honey to curb the tartness of the plain yogurt. It is also good when served with whole or 2% milk, or kefir (p. 143).

My morning yogurt parfait. 

I will admit that a hot breakfast filled with protein and good fat sticks by me a bit better than the granola. For example, I like ground beef with vegetables from the night before or a piece of fresh fruit. Sometimes I break the beef up while it sautes in a pan, or I form it into a hamburger patty (for breakfast!) with a slice of cheddar cheese on top. If I don't feel like beef, some fresh ground sausage (p. 49), lamb, or black beans (p.22) are tasty alternatives. Or I might cook a couple of whole eggs, fried, scrambled, etc., with a little cheese, some sauteed vegetables, and/ or a piece of fresh fruit. Frittatas are another egg option, and they can be cooked the night before and reheated for a savory hot breakfast the next day (pp.133-134). I usually cut the frittata into portions and eat a piece each morning.

This is my version of the Spinach Frittata (p. 134) with eggs, sausage,
feta, and a whole lot of vegetables. I replaced the spinach with a red pepper and
bunch of asparagus. Nothing against spinach, but it seems to go straight to my forearms.

One of the most simple whole grain breakfasts is the crock pot cereal (p. 128), with a handful of chopped nuts, milk, and a bit of honey. Nicknamed Dr. Hassell’s "Crack Pot Cereal", it is a mixture of intact whole grains (half oat groats and half whole rye or barley) cooked overnight in a crock pot. I find these grains in the bulk sections of local grocery stores. I also occasionally cook up some steel-cut oatmeal (p. 129) and use the leftovers to make the Nutty Oatmeal Custard on the same page. This smells irresistible when its cooking, and waiting the ten minutes it takes to set outside the oven feels like an eternity. Another way I start my mornings with whole grains is to toast one or two slices of Breadzilla and top them with nut butter and jam or butter with honey. (To make your own nut butter, see page 149 in GFGM).

Nutty Oatmeal Custard (p. 129). I made this for a brunch with friends
and it was eaten in no time.

Breadzilla (p.252) toasted with peanut butter (p. 149) and blackberry jam.
Now all I need is a glass of whole milk to wash it down.

If I find myself hankering for a leisurely weekend breakfast that is on the sweeter side, I turn to waffles with toppings galore.  

Here is my waffle using the oatmeal pancake recipe on page 130.

Buon Appetito!

Malea

Miles’ Postscript: Malea raises a couple of important issues. The first is that commercially prepared ready-to-eat cereals, even the whole grain ones, have been processed to such a degree that the starches are metabolized very quickly and act more like sugar than grain (GFGM p. 46). Plus there is usually added sugar and starch, especially in commercial granola. The second issue involves the rumor that grains are harmful to health, based on opinions presented in some current books. The hard evidence shows the opposite: true whole grains are associated with better health overall, lower death rates, and less heart disease, stroke, infections, obesity, and diabetes (GFGM p. 23). The best whole grains are the absolutely unprocessed grains, like the Crack Pot Cereal that Malea mentioned. We should mention, however, that it is wise to limit even whole grains if you are struggling to meet your weight loss goals (p. 76). Focus first and foremost on filling up on vegetables, protein, and good fats. 

Worried about the fat in whole milk yogurt? Don’t be. Dairy foods, such as plain unsweetened yogurt, kefir, and aged cheeses, are also associated with better health outcomes, and dairy fat has a unique nutritional profile that we talk about on page 31. So eat well, with lots of variety, mostly at home, and not too much!

Dine in tonight

To keep me civil while operating heavy machinery on the commute home from work, I usually snack on something like almonds and a piece of fruit. The effect typically wears off right about the time I arrive at my house, so to avoid eating the first thing I see I have developed a few quick-but-healthy meals. One favorite is a combination of roasted vegetables, roasted chicken thighs, and brown rice or quinoa. To keep it interesting I vary the protein or grain that I serve with vegetables, such as black beans and quinoa one night and steak and brown rice on another. On certain evenings there is nothing better than a couple of fried eggs with a slice of toasted Breadzilla (p. 252 Good Food, Great Medicine 3^rd edition), sharp cheddar cheese, and some vegetables on the side. It’s amazing how many combinations you can make with this formula. Meal planning does take preparation, but it saves me time in the long run and helps me to make good choices on a daily basis.

My Mediterranean meal with lamb, feta, and roasted vegetables.

Most vegetables are delicious when roasted – carrots, bell peppers, asparagus, onions, potatoes, fennel, zucchini, to name a few. I usually include three or four of the following in one batch: Brussels sprouts, sweet potatoes (or yams), beets, cauliflower, parsnips, squash, or eggplant. Ask my roommates – there is nothing better than the smell of roasting Brussels sprouts in the air. And don't knock a parsnip till you try it! Vegetables that I might find unappealing when prepared any other way are delicious after the insides soften and the outsides crisp and caramelize in the oven. (Look at pages 169-174 GFGM for roasting instructions).

This is one of my favorite combinations of vegetables to roast.
I toss them with olive oil, salt, and pepper, and roast them
 at 450 degrees for 30-40 minutes. 

 A pan of roasted chicken thighs is one of the easiest chicken dishes a person can make. This recipe takes almost no prep work and provides a delightful lunch or dinner for several days afterwards. In the past I shied away from this part of the chicken, and mainly ate boneless, skinless chicken breasts. Now I find I really enjoy the taste of chicken thighs with crispy flavorful skin, and the good fat and protein keep me pleasantly full. If you don’t like the texture of the skin, it is easy to substitute skinless chicken thighs or just remove the skin after it’s cooked. I season the chicken with my favorite spice combinations, stick them in the oven at 400 degrees for 50 minutes, then pull them out when they are brown and the meat is tender. I eat them with roasted vegetables, in a salad, on an open-faced Breadzilla sandwich (p. 105), or even alone when I need a quick snack. Or if you’d like to tackle a whole chicken, try Just Plain Old Roast Chicken (p. 221).

Here is a picture of the roasted chicken thighs
 (p.220 GFGM 3rd edition) with the skin but no bone.
You might also want to try the very delicious honey mustard variation
 mentioned in the note on page 220. 

For me, the key is to not let myself get too hungry in between meals. I always make sure to have a mid-morning and mid-afternoon snack with good fat, fiber, and protein (pp. 77-79), like the aforementioned handful of almonds with an apple, banana, or any fruit in season. The almonds are easy to store in my purse or lunch bag for any outing. I also like a cup of plain full-fat yogurt (Nancy’s or Brown Cow), with a sliced banana, cinnamon, and a drizzle of honey for sweetening. Cottage cheese is another option that tastes great with a banana or fresh nectarine. To hit my vegetable quota for the day, I snack on carrots, celery, cucumbers, broccoli and bell peppers with a slice of sharp cheddar cheese.  If you like to dip your vegetables, some tasty choices are hummus (p.148), homemade ranch dressing (p. 145), or nut butter (p. 149).

Need more variety in your meals? Take a look at pages 96-108 of GFGM. Whether you are searching for side dishes, vegetarian options, meat dishes, or snacking suggestions, this is a good resource to keep in mind.

Now let's start cookin'!

Malea

Miles’ Postscript: The importance of the combination of protein, good fat and fiber.
Including protein, good fat, and whole food fiber in every meal or snack is a key to eating well without feeling deprived, and is a particularly valuable tool for anyone wanting to lose weight, reverse type two diabetes, or beat food addictions. This combination:

·        Lowers the rise of blood sugar and insulin

·        Improves the sense of satisfaction

·        Takes longer to digest

·        Delays the return of hunger

·        Suppresses sugar cravings

This leads to better blood sugar control, lower heart disease risk factors, and weight loss with minimal deprivation. Calorie for calorie, protein and fat satisfy the appetite more than carbohydrates, so you will feel more “full” with a serving of protein rich food than with the same amount of calories in carbohydrate form. A higher-fat whole food Mediterranean-style diet is associated with better weight control and less diabetes, heart disease, stroke, cancer, dementia, and depression. The naturally-occurring fat that has historically been part of the food we eat makes it more satisfying, improves flavor, reduces carbohydrate cravings, slows the rise of blood sugar after eating – and, like protein and fiber, delays hunger.  Finally, fiber from whole foods such as vegetables, fruit, beans, and whole grains is associated with reduced cancers and infections, as well as reduced heart disease, diabetes, obesity, and cholesterol. (See pp 77-79 in GFGM 3e)