The "Healthwatch" blog is written by Dr. Michael Jacobson, D.O., CHM Medical Consultant
According to the Great Fat Debate, total and saturated fat aren't the issues
April 2012
For decades the medical and scientific communities have warned Americans of the evils of fat—especially saturated fat—and have said we should cut down on the percentage of fat in our diets. I’ve echoed these recommendations (with some important distinctions) and abide by them myself.
Therefore, I read with great interest the results of a recent conference on nutrition, referred to as The Great Fat Debate. Among others, two prominent Harvard nutrition experts participated: Walter Willett, MD, DrPH; and Dariush Mozaffarian, MD, DrPH.
Dr. Mozaffarian, an associate professor of epidemiology, began the debate with a presentation that included a blockbuster claim: “the proportion of calories from total fat has no appreciable effect on risk of [coronary heart disease (CHD)] or cancers.”
He explained that the advice to reduce total and saturated fat intakes was based on three types of studies: ecologic (the examination of disease rates and patterns in communities rather than in individuals); short-term “biomarker” studies (studying the effects of a specific nutrient on a particular blood test, such as LDL cholesterol); and animal experiments.
All of these studies are limited and have one thing in common: they don’t really show causation. In other words, scientists can’t use study results to conclude that one specific factor causes heart disease.
In order to claim causation, studies must be designed so that they:
1. examine individuals, not communities
2. control for other factors that may affect the issue or variable in question
3. are unbiased (i.e. blinded)
4. examine clinical endpoints (i.e. look at rates of death or disease occurrence, not just blood tests that may or may not show a risk factor for disease)
5. are of sufficient size and duration to allow for predictions to extend to the general population—to the rest of us who were not involved in the research study
For example, HRT (hormone replacement therapy—estrogen and progesterone products) was found to reduce LDL cholesterol. Since higher LDL cholesterol has been associated with higher rates of heart disease, experts presumed that HRT would protect against heart disease. Doctors therefore placed millions of Americans on HRT medication.
Eventually, additional studies revealed that HRT didn’t reduce heart disease risk and potentially increased breast cancer risk. The general recommendation to put all menopausal women on HRT was withdrawn—but perhaps too late for some women who suffered the consequence of cancer.
Excessive focus on total and saturated fat has many Americans accustomed to scanning food labels and choosing “low fat” options. The problem is that many low fat foods have replaced the saturated fat content with carbohydrate (starches and sugars).
However, foods with high sugar—especially refined sugar—and starch content actually increase CHD risk! Conversely, CHD risk is reduced when saturated fat is replaced with polyunsaturated fat from vegetable oils or with monounsaturated olive oil.
Evidence shows that it’s not the amount of overall fat content or the percentage of saturated fat in your diet that really counts. Instead, the overall quantity of calories and the quality of your diet are critically important.
A high quality diet has multiple benefits, including lowering blood pressure; improving the health and function of the delicate inner lining of blood vessels (endothelium); reducing clotting and inflammation; stabilizing blood sugar; improving heart functions and controlling weight gain. Weight control programs with higher fat content (rather than higher calories) reduce weight more effectively than high carbohydrate programs.
Dr. Mozaffarian concluded his debate comments by saying, “The focus of modern dietary recommendations to prevent chronic diseases should be on healthful foods and dietary patterns, including greater consumption of fruits, vegetables, nuts, fish, moderate dairy, and vegetable oils; consumption of whole-grain foods in place of refined starches and sugars; and avoidance of sugar-sweetened beverages, processed meats, and foods that contain partially hydrogenated vegetable oils. Such diets are naturally higher in beneficial fatty acids, minerals, vitamins and antioxidants, phytochemicals, and dietary fiber, and are lower in salt, saturated fat, and trans fat.”
His advice reminds me of the three simple principles that Rex Russell, MD, articulated in his book, What the Bible Says About Healthy Living:
1. Eat what God designed for food.
2. Don’t alter His design.
3. Don’t let any food become your god.
In my book The Word On Health, I expanded on these principles to build a dietary strategy from Scripture that puts attention to health and fitness in the proper context of our relationship with our Creator. (To order a copy of The Word on Health for $15, call 1-800-791-6225, ext. 5993. I receive no benefits from the sale of this book.).
Mozaffarian, D. (2011). The Great Fat Debate: taking the focus off of saturated fat. Journal of the American Dietetic Association 111(5): 665-666.
Willett, W. C. (2011). The Great Fat Debate: total fat and health. Journal of the American Dietetic Association 111(5): 660-662.
Russell, R. (1996). What The Bible Says About Healthy Living. Ventura, Regal Books.
Jacobson, M. D. (2000). The Word on Health: A Biblical and Medical Overview of How to Care for Your Body and Mind. Chicago, Moody Press.
Overcooked meat doubles prostate cancer risk
March 2012
Cooking burgers and steaks until well done—especially by barbecue grilling and other superheated methods—can add to the risk of prostate cancer that has been associated with high consumption of red meat.
Researchers at University of California in San Francisco compared approximately 500 men with an aggressive form of prostate cancer to a similar sized cancer-free control group. Each study participant completed detailed dietary questionnaires that measured their previous year’s intake of various foods.
Men who consumed the highest amount of ground beef and fatty processed meats (such as salami) had more than double the risk of aggressive prostate cancer than men who reported the lowest intakes of these foods. Surprisingly, other types of meats—including poultry, bacon and low-fat hot dogs—didn’t appear to increase prostate cancer risk.
The researchers took the study further by examining the subgroup of men with the highest intake of burgers and how they prepared their meat. The scientists found that most of the increased risk of aggressive prostate cancer was confined to those who preferred their meat well done. Men who preferred meat cooked medium or rare had a much lower increase in risk (about 10 percent).
Prior research shows that cooking red meat at high temperatures often produces compounds that can cause cancer in laboratory animals. These compounds include heterocyclic amines and polycyclic aromatic hydrocarbons.
Another research study sponsored by the cherry farming industry noted that grilling ground beef mixed with cherries significantly reduced the production of these cancerous compounds. (To my knowledge, there has not been a follow-up study to prove that adding cherries to meat before grilling actually reduces cancer risk.)
Regardless, these findings are consistent with my understanding of the production of cancer-causing substances in the intestinal tract. For example, when nitric acid from processed meats or as a byproduct of ammonia fertilizer—which can come through groundwater and other food and water sources—is ingested, it sometimes combines with free amino acids in the gut (present from protein ingestion, such as in meats) to form cancer-causing nitrosamines.
However, if vitamin C is present, it blocks the formation of nitrosamines. As I wrote in my book, The Word on Health, maintaining a diet rich in fruits and vegetables may help protect against cancer. We know that such dietary choices are associated with reduced risk of many diseases.
Prostate cancer is the most common cancer in men. If an American male lives long enough, he’s highly likely to develop prostate cancer. However, most of these cancers don’t grow fast enough to be fatal. Most men with prostate cancer die of other causes. Aggressive prostate cancer is the greatest source of concern because it is more deadly. Aggressive forms of prostate cancer have what is known as a high Gleason score; slower-growing prostate cancer Gleason scores are low.
The University of California study was limited in that gathering data from nutritional questionnaires can sometimes be inaccurate due to “recall bias.” Furthermore, there was no delineation between whether meat was cooked at home, in restaurants and elsewhere. However, the study’s conclusions are consistent with many other studies with which I am familiar and should encourage us to be careful about how meat is prepared.
One note of caution: undercooking also is associated with significant risk, such as the hazard of ingesting E. coli bacteria. This is especially true of ground beef, since bacteria that reside on the outside surface of meat get ground up into the meat. Bacteria in the center of meat are much less likely to be destroyed by heating.
Editor’s note: To purchase a copy of The Word on Health for $15, call 1-800-791-6225, ext. 5993.
Jacobson, M. D. (2000). The Word on Health: A Biblical and Medical Overview of How to Care for Your Body and Mind. Chicago, Moody Press.
Punnen, S., J. Hardin, et al. (2011). Impact of meat consumption, preparation, and mutagens on aggressive prostate cancer. PloS one 6(11): e27711.
Battling the slouch for perfect posture
February 2012
When I was young, I had a bad habit of slouching forward, especially while seated at the dinner table. My father used to come behind me and poke me in the back to get me to improve my posture. I didn’t like his approach at the time, but now I wish I had cooperated.
Today, with perhaps two or more decades of life still to live, I find my posture suffering. I slouch often, especially while sitting.
I think this tendency is amplified by many hours at a computer monitor, something I never dealt with when I was young.
The strain caused by anterior head carriage
A wide variety of excellent articles on posture are found on www.livestrong.com, where I log my daily food intake and energy expenditure to maintain successful weight loss.
Dr. Adalbert Kapandji, an orthopedic surgeon and published author of a physiology textbook, says that for every inch the head is positioned forward of where it should be, an extra 10 pounds of tension is exerted on the tissues in the upper back and neck.
Formally known as “anterior head carriage,” a forward head position can cause tension headaches and a variety of other musculoskeletal problems by placing a constant, abnormally high strain on the muscles and connective tissue of these regions. Normal posture means the head and upper back are carried in such a way that, looking from the side, the earlobe bisects the center of the shoulder, which then lines up with the hip, and finally the outside bone of the ankle (lateral malleolus).
According to author Martin Hughes, forward head carriage is a common cause of tension headaches because it results in tight levator scapulae muscles, as well the trapezius muscle and muscles in the sub occipital area deep underneath the skull’s base.
In addition, the “control centers” for the sympathetic nerves that innervate the arteries in the brain are located in the upper part of the neck. When chronic tension and stretching irritate joint capsules and ligaments, they “protest” by sending signals that communicate with these sympathetic ganglia, thus disrupting their function. As a result, they can contribute to abnormal spasm and dilation of the blood vessels in the brain, resulting in vascular headaches such as a migraine.
It should come as no surprise that poor posture also is associated with neck pain. I recall hearing about a plastic surgeon who had to stop performing surgery because the chronic forward head carriage he maintained during operations eventually caused him great pain.
The chronic pain, tension and spasm in the neck and upper back also contribute to the formation of painful nodules known as “trigger points” in the upper back. In addition, an often-overlooked complication of poor posture is a significant reduction in lung capacity. In other words, slouching forward reduces the total amount of air the lungs can take in and push out.
A program for flexibility and strength
Even people with good posture should consider a program to minimize anterior head carriage and have the best upper back and neck function. A good set of exercises can be found online at www.arc4life.com.
As with many exercise programs, the goals are improved flexibility and mobility and increased strength. Of course, before beginning a program you should consider consulting your physician, particularly if you have head or neck problems.
To improve flexibility and motion, you can take your neck through a range of motion in each direction (do these steps in the following order):
1. Cervical flexion: Gently flex your neck to touch the chin to the chest.
2. Cervical extension: Gently bring your head back as far as it will go, so that you are looking up at the ceiling. Repeat these steps five times.
3. Lateral flexion (side-bending): Gently side-bend your neck to bring your right ear as close to your right shoulder as it will go. Bring it back to a neutral position, then bend your left ear to your left shoulder as far as it will go. Repeat this exercise five times.
4. Rotation: Gently turn your head, rotating it to the right as far as it will go, as you attempt to bring your right ear past your right shoulder. Once there, hold for a few seconds, then rotate your head back to the left as far as it will go and hold it there for a few seconds. Repeat this exercise five times.
5. Upper back side-bend: Place your hands behind your head and your feet shoulder-width apart. Bend your upper body to one side without bending at the waist (stretching the upper torso) as if you were trying to touch your upper elbow to the ceiling. Hold for a few seconds, then bend to the opposite side and hold for a few seconds. Repeat this exercise five times.
6. Behind-the-back hands to the floor: Keep your feet shoulder-width apart and clasp your hands behind your back with your elbows straight. Pull downward toward the floor. Hold a few seconds and relax. Repeat this exercise five times.
To strengthen the neck and upper back muscles, simply use your hands to exert resistance against the head as you attempt to push your head in the following isometrics:
1. Place both hands on your forehead and attempt to push your head backward while resisting with your head and neck. Hold for five seconds and relax. Repeat this exercise three times.
2. Place your right hand on the right side of your head and push your head to the left, while resisting with your head and neck. Hold for five seconds, then slowly relax. Do the same thing on the left side. Repeat this exercise three times.
3. Place both hands behind your head and try to push your head forward while resisting. Hold for five seconds, then slowly relax. Repeat this exercise three times.
4. Finally, place the heel of your right hand against your right temple and turn your head to the right while resisting. Hold for five seconds. Do the same thing on the left. Repeat this exercise three times.
Following this training regimen should improve flexibility, mobility and strength. Remember to take it easy, do not exercise to the point of pain and consult your physician accordingly.
Hughes, M. (2011, 12/9/2011). Forward Head Posture Symptoms. Retrieved December 8, 2011, from http://www.livestrong.com/article/124223-forward-head-posture-symptoms/#ixzz1fPYOkk7x.
(2011). Neck Exercises for Stiff Neck, Neck Pain Relief, Decreased Mobility, Decreased Range of Motion + Strengthening the Neck Muscles. Retrieved December 9, 2011, from http://www.arc4life.com/site/615058/page/993935.
How to identify a stroke
January 2012
Though stroke doesn’t cause nearly as many deaths as heart disease or cancer, it’s still one of our country’s leading causes of mortality. Stroke also disables thousands of people. My mother suffered immensely from a series of strokes before the last one eventually took her life two years ago.
Clot-busting drugs such as those used in the early hours following a heart attack have shown promise in treating stroke. However, the key is to get to the emergency room quickly. Many stroke sufferers don’t seek medical care for 12 to 24 hours, which places them outside the window for use of clot-busting agents.
To benefit from these medications, stroke sufferers must get to the hospital and receive the drug within three to six hours. That’s why it’s so important to recognize signs of a stroke. If you don’t know them, now is a great time to learn.
When my mom had her first stroke, within minutes of her arrival at the emergency room The Stroke Team from University of Cincinnati sent a neurologist to evaluate her condition. The Stroke Team developed the Act F.A.S.T. mnemonic to assist non-medical personnel in recognizing and responding to a stroke quickly. Here it is:
• Face: Does the person have facial numbness or weakness, especially on one side?
• Arms: Is there numbness or weakness, especially on one side?
• Speech: Does the person have difficulty speaking or slurred speech?
• Time: If any of the above symptoms are present, it is time to call 911 and get immediate help.
Some people have criticized this mnemonic as inadequate because it primarily captures the signs or symptoms of ischemic strokes, which involve a blood clot. Though 80 percent of strokes are ischemic, the Act F.A.S.T. may miss the 20 percent of strokes that occur due to hemorrhage (bleeding) in the brain.
Thus, the Stroke Collaborative developed a second mnemonic, touted as more comprehensive. Its motto is Give Me Five for Stroke and asks five questions:
• Walk: Is the person’s balance off?
• Talk: Is speech slurred or is the face droopy?
• Reach: Is one arm weak or numb?
• See: Is vision gone or partially lost?
• Feel: Is there a severe headache?
If any of these symptoms are present, 911 should be called.
Please commit these to memory or they aren’t useful to you when the person you’re with may be having a stroke.
When I was trying to recall the mnemonic for this article, I couldn’t remember it! For that reason, I offer a third, easy to remember alternative that uses the word “stroke.” The first three questions are in common use today. By adding the last two, it covers most signs of stroke:
Smile: Is one side droopy?
Talk: Is speech normal, or is it slowed or slurred?
Reach: Is one arm weaker?
Optics: Is vision partially or completely lost?
Kinetics (i.e. motion): Is the person dizzy or unsteady on his feet?
Excruciating: Does the person have a severe headache?
Most strokes are painless and involve some kind of weakness. For example, stroke sufferers may suddenly drop something they are holding and find that they can’t grip anything. Strokes don’t cause chest or arm pain—those symptoms may instead indicate a heart attack.
Please take the time to identify a tool that helps you remember the signs of stroke and get help as soon as any of those signs appear.
Trelogan, S. (2008). Will You Act F.A.S.T. or Give Me 5 For Stroke? Caring Currents. Retrieved November 16, 2011, from http://www.caring.com/blogs/caring-currents/stroke-mnemonics-act-fast-or-give-me-5-for-stroke.