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

Wednesday, February 28, 2018

Low-tech choices beat high-tech treatments for keeping our tickers ticking: study shows coronary artery stent no better than placebo for stable angina

A 2018 randomized controlled trial [1] compared placing a coronary artery stent to open up a severely clogged artery to a placebo procedure for stable angina, and found that the stent procedure made no difference to the outcomes and was potentially harmful.  (Angina is typically chest pain or other symptoms due to clogged arteries in the heart.)  In contrast, randomized controlled trials [2] have shown the Mediterranean diet reduced cardiac events by up to 70% and deaths by 56% in patients with heart disease; in similar head-to-head trials, [3] exercise has been better than stents for patients with heart disease.

My recommendation:
Medications, coronary artery stents, and surgery all have an important role to play in treating heart disease, and have contributed to a dramatic reduction in heart disease risk over the last 30 years. However, remember that our food and activity choices are likely even more important than the high-tech approaches for both preventing and treating heart disease.  For information and references on using a whole food Mediterranean diet, weight management, and exercise to help keep our tickers ticking and trouble-free, see pages 59-92 in Good Food, Great Medicine, 3rd edition.

Miles Hassell MD

[2] Lorgeril, M. et al. Circulation 1999;99:779-85
[3] Hambrecht, R. et al. Circulation 2004;109:1371-8

Wednesday, January 17, 2018

Get up and move! You’ll live longer and feel better

Are chairs the new cigarettes?  It looks like it.  A 2017 study links sedentary behavior to increased death from any cause, regardless of our exercise habits or time in the gym.  The longer we sit, the higher the risk – and it rises by over 50% if you sit more than 12 hours a day. [1]  Whoa! 

My recommendation:
If our job requires us to spend most of our working hours sitting in front of a screen, we simply need to remind ourselves to
  • Stand up and (if possible) walk around every hour or so
  • Make use of the stairs (if any) where we work
  • Think about having “walking meetings” rather than sitting around a table
At home, carve out 30 minutes of screen time each day to do something active (hmm. . . about the length of our favorite show?) perhaps several short bursts of low-tech high-intensity activities like skipping rope or climbing stairs, which may even be more effective.   In any case, get a little short of breath and sweaty every day.  For suggestions on how to make exercise work for you, and some impressive evidence for the health benefits of staying active at any age, see pages 50–55 in Good Food, Great Medicine, 3rd edition.

Miles Hassell MD