I am amazed sometimes at the things my patients do to (for?) themselves in the name of trying to find natural ways to be more healthy. Even more amazing to me is the incredibly unnatural things they do that they natural. We are in a society where doing unnatural things to be more natural is the natural thing to do. Mainstream western medicine is almost by definition unnatural. We try to encourage patients to do what is not natural to them in terms of lifestyle behavior modification(if it was natural to eat well, exercise more, stay thin, etc. we would be doing it). We give medications and do procedures and tests to find and cure natural diseases like diabetes, pneumonia, strep throat, appendicitis, … The increased life expectancy and improved health of first world citizens has come about in large part by unnaturally supplying clean water, unnaturally separating sewer from drinking water supplies, and immunizing against and treating natural diseases. We almost eliminated childhood rickets by adding vitamin D to the bread and mild supplies. We prevent tooth decay by using fluoride containing toothpaste and getting preventative dentistry. As a society we seem behave in a way that supports our belief that preventing diseases and improving health by unnatural means is a desirable goal Yet there is something alluring about the word natural. I see ads for natural makeup, natural foods, and natural medications. Here are some of the most unnatural things I can think of that patients do to themselves, often at the advice of a naturopath:
Enemas of all types: Naturally things come out of the anus, and move from top to bottom on the gastrointestinal tract. Is there much less natural than squirting stuff up your rectum? I hear about coffee enemas, and nearly every web site about naturopathic remedies has an enema product to sell usually priced at $60-80 for proprietary ingredients. The theory is that somehow removing the waste material from the distal bowel improves bowel function and overall health. Does it work? I doubt it, but whether it works or not, it is a stretch to call it natural to squirt coffee up your rectum.
Mega doses of vitamins: Naturally our food contains small to modest doses of vitamins. There is some evidence in this day of eating a lot of refined foods we may miss out on some trace minerals and vitamins. A multiple vitamin daily is probably reasonable for many people. There is some evidence that higher doses of some vitamins, especially vitamin D is beneficial. Yet I see many patients who spend a large percent of their limited income on large amounts of redundant vitamins, usually of a proprietary and therefore expensive brand, in hopes of improving their health. This is both unnatural and of unproven efficacy. I often see patients on a multiple vitamin, two or three types of B-complex vitamins, supplemental vitamins C, D,E, B-12, co-enzyme Q-10, calcium, other minerals, and often also mixtures of so many other ingredients I cannot read all the labels in less than several minutes. This seems nuts to me. Spending this money on fresh fruits and vegetables would be far more likely to help, and would truly be natural.
Natural herbal supplements: Somehow if a substance is derived from plant matter it seems to be assumed to be healthy. Obviously some famous exceptions exist, hemlock, nightshade, etc. I appreciate that Eastern medicine, and possibly native American healers have some basis for their remedies, but I doubt that the sales people at the mega-supplement stores have the expertise to help patients be more healthy, and instead primarily make their bosses more wealthy. Taken at the recommendation of a bonefide naturopathic practitioner or other expert these may be reasonable, but taken at the advice of a retail salesperson they are sketchy at best.
This month our favorite nutrition expert sounds off on pervasive nutrition myths. Hear what Brooke has to say on DrPullen.com the first day of every month.
April Fool’s Day Myth-Information – by Brooke Douglas RD
From ‘loading up on grapefruit’ to ‘fasting in order to jump start your diet’, how do you separate fact from fiction? In the spirit of April Fool’s Day – let’s turn our focus to some of the most pervasive diet and exercise myths and put them to rest — once and for all.
Myth #1: To jump-start your diet, you should fast.
Fact: Not so fast! Skipping meals for extended periods of time is actually the best way to sabotage a diet! Though fasting may temporarily help you lose weight, it’s predominantly water weight. Not eating for extended periods can cause mild to severe fatigue and dizziness. Once you become ‘over-hungry’ all common sense is lost. This is when what I call ‘defensive’ eating sets in. Often excessive hunger, deprivation and physical weakness makes you respond like a Hoover vacuum and you’re bound to reach for high-calorie, high-fat and nutritionally poor choices in that state of mind. So, in fact, the more you don’t eat, the more likely you are to overeat in the end. Myth #2: Calorie restriction is the key to weight loss.
Fact: While nutrition is more than half the weight loss battle, drastic caloric restriction is not the way to win the war. By dropping your caloric intake below 1200, you run the risk of slowing down your metabolism. As a result, your body will use your hard earned muscle for energy instead of fat.
In addition, extremely low calorie restrictive diets are hard to stick to, leave you feeling deprived, and usually end in disappointment. If that isn’t enough, when calorie consumption is too low you lack the energy to power through your workouts.
Having said that, you would be surprised how fast the calories add up. So keep a food record and stick to your maximum calorie, fat and fiber goal numbers, as established with a Registered Dietitian or call Brooke! Myth #3: Low-Carb (high protein) diets are the most effective route to weight loss.
Fact: Before you ban your bread, consider this: Research used to suggest that obese people could lose more weight on a low-carbohydrate diet than on a conventional low-fat diet. Yet, the benefits demonstrated turned out to be small and short-lived. Multiple long-term studies which compared low-carb dieters to low-fat dieters found that low-carb dieters began regaining the weight they lost after six months. Worse yet, by the end of the year, they were no better off than the low-fat group. And here is my point about moderation not deprivation, because the dropout rate among all groups studied was extremely high. Proof that it really is about striking a balance between what you consume and what you burn. To do that for the long haul, you have to choose a diet that is sustainable, hence moderation!
Myth #4: Eating grapefruit will help you burn fat.
Fact: That eating grapefruits will help you lose weight is one of the most persistent among diet myths — and just when you think it’s gone, it resurfaces and becomes all the rage again every few years. There is no food that has intrinsic “fat-burning enzymes” that magically melt fat from your body. There was one study that demonstrated the effectiveness of a grapefruit inclusive diet, however, it was small, isolated, and there is some question as to whether the citrus industry sponsored the research. If you want to eat grapefruit as part of a well-rounded diet, go for it. Ruby Red grapefruits are rich in lycopene — an antioxidant that protects against heart disease and breast cancer – incorporate it and other lycopene-rich foods such as tomatoes and watermelon into your diet each day.
Exercise alone does not seem to be effective in preventing weight gain once a woman is already heavy. The latest JAMA issue reports on a huge study trying to see if different levels of exercise prevent weight gain in women. This study looks at the 34,000 women in the Women’s Health Study, a huge cohort of women which has already reported on aspirin use and other variables. The results are not encouraging. Regular exercise was only associated with lack of weight gain in women who were thin (BMI<25) at the start of the study. Women who ranged from upper normal weight (BMI 25-30) to obese (BMI >30) gained weight even if they exercised regularly. The only group of women who did not gain weight over the 13 years of follow up in the study were thin women who exercised regularly for 60 minutes daily of moderate to high intensity exercise. This page effectively describes Aspirin side effects. The take home messages of this study are:
Starting early with prevention of obesity is key. Once overweight it is far more difficult to prevent further weight loss. Multiple prior studies have demonstrated how difficult it is to achieve sustained weight loss.
Calorie restriction is needed to prevent weight gain once overweight. Exercise alone is not sufficient.
The conclusion of this study sums it up pretty well.
“In conclusion, in this large prospective study of women consuminga usual diet, sustained moderate-intensity physical activityfor approximately 60 minutes per day was needed to maintainnormal weight and prevent weight gain. These data suggest that the 2008 federal recommendation for 150 minutes per week, while clearly sufficient to lower the risks of chronic diseases, is insufficient for weight gain prevention absent caloric restriction.Physical activity was inversely related to weight gain onlyamong normal-weight women; among heavier women, there was norelation, emphasizing the importance of controlling caloricintake for weight maintenance in this group.” JAMA. 2010;303(12):1173-1179
I know I’m worn down by the US obesity epidemic. Many patients clearly overeat, others are also too sedentary, and some just seem to be obese genetically. Regardless it seems that the only patients who really lose weight in my practice figure it out themselves. I wish I had an answer for everyone who asks me about weight loss. Sounds like I’m not alone. See Roni Caryn Rabin’s article in this week’s NY Times discussing the sad fact that US doctors and patients are not even talking to each other about obesity.
Doctors recognize obesity as a health problem. So why is it so hard for them to talk to their patients about it?
A new report released on Tuesday by the STOP Obesity Alliance, a collaboration of consumer, provider, government, labor and business groups, suggests both doctors and patients are frustrated with the conversations they’re having about weight.
More good news for coffee drinkers. I can remember spending time explaining why my patient in the hospital after a heart attack could not have their morning coffee, because it might cause a life threatening arrythmia. It looks like I wasted my breath and deprived them needlessly. A recent study reported on MedPage Today shows moderate coffee intake is not only not associated with more arrhythmias, but coffee drinkers may actually have less serious cardiac arrhythmias.Coffee Not Linked to Serious Arrhythmias
By Todd Neale, Staff Writer, MedPage Today
Published: March 02, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
SAN FRANCISCO — Contrary to conventional thinking, drinking lots of coffee appears to be associated with a lower risk of hospitalization for an arrhythmia, researchers found.
In a long-term prospective study, patients who reported drinking at least four cups of coffee a day were 18% less likely to be admitted with a heart rhythm disturbance than those who drank no coffee at all (RR 0.82, 95% CI 0.70 to 0.90), according to Arthur Klatsky, MD, a senior consultant in cardiology at Kaiser Permanente Division of Research in Oakland, Calif. Tea consumption did not have a similar effect.
The findings, which were presented at the American Heart Association’s Conference on Cardiovascular Disease Epidemiology and Prevention here, were unexpected, Klatsky said, because patient reports of palpitation or forceful heartbeat after drinking coffee are not uncommon.
People who can’t tolerate coffee or caffeine should avoid both, Klatsky said in an interview, advice that should not change based on the results of the study. But, he said, people who regularly drink a moderate amount of coffee should be reassured. “There’s no reason, even if they have a heart rhythm problem or risk of a heart rhythm problem, why they have to give up the coffee,” he said. However, he continued, “we’re not going to recommend that people drink coffee to prevent rhythm problems.” Kenneth Ellenbogen, MD, director of the electrophysiology and pacing lab at Virginia Commonwealth University in Richmond, said the findings contradict what clinicians have been telling patients with arrhythmias — that they should avoid coffee.
“I think the take-home message from this very important epidemiologic study is that most people can drink coffee, even several cups of coffee, without increasing their risk of having a significant heart rhythm disturbance that would require hospitalization,” said Ellenbogen, an AHA spokesman.
Although conventional wisdom dictates that coffee can increase the risk of arrhythmia, few studies have explored the relationship, according to Klatsky.
So he and his colleagues analyzed data on 130,054 men and women who were treated at Kaiser. As part of a baseline medical check-up between 1978 and 1985, all participants completed a questionnaire that included information on coffee, alcohol, and tea consumption. Most were not asked to differentiate between caffeinated and decaffeinated coffee.
Through follow-up, 2.6% were hospitalized for an arrhythmia; half had atrial fibrillation.
When coffee drinking was evaluated as a continuous variable, increasing consumption was associated with decreasing risk of hospitalization (P<0.001).
The findings were consistent across types of rhythm disturbance and patient subgroups. In particular, patients with cardiorespiratory symptoms, or a history of such symptoms, at baseline had a similarly reduced risk.
Controlling for smoking, age, sex, ethnicity, alcohol, body mass index, and education did not substantially affect the findings.
In the small subset of 11,656 patients who provided specific information on their coffee consumption, it appeared the risk reduction was primarily attributed to caffeine, Klatsky said, although the small numbers precluded drawing firm conclusions.
The observational study could not establish a causal relationship, but Klatsky said it was plausible that caffeine could protect against arrhythmias by blocking the action of adenosine.
Adenosine is a nucleoside that causes drowsiness and sleepiness in the brain, and caffeine counteracts its effects by attaching to its receptors.
The chemical also has actions in the heart, affecting the conduction system, endothelial function, and recovery time of the cardiomyocytes. Caffeine’s antagonistic effect on adenosine could affect the development of arrhythmias, although this is speculative, Klatsky said.
“I do think this [study] is going to surprise people,” he said. “I think conventional wisdom is that coffee can cause palpitations and it can cause rhythm problems. I think, though, that conventional wisdom is not always right, and the data that were available before this study really do not support the idea that moderate amounts of coffee provoke rhythm problems.”
The study was supported by a grant from the Kaiser Foundation Research Institute and the Robert Wood Johnson Foundation.
The authors did not make any financial disclosures.
Primary source: American Heart Association’s Conference on Cardiovascular Disease Epidemiology and PreventionSource reference:
Hasan A, et al “Coffee, caffeine, and risk of hospitalization for arrhythmias” CCDEP 2010; Abstract P461.
Portion control is one of my problems. Most foods seem like Lay’s potato chips to me, I can’t have just one. Brooke has suggestions.
PORTION CONTROL: Don’t Go Overboard!
No one wants to gain 10# at the end of one year? But in order for the weight to ‘creep’ on, all you have to do is eat 100 extra calories per day. If you want to lose 20# at the end of one year? Then eat 200 less calories daily. Healthful living involves nutrition education not just on WHAT you eat, you must also become more aware of HOW MUCH you eat!
The next time you pour yourself a bowl of cereal, STOP before you pour the milk on. Get out a measuring cup and see how much your ‘typical pour’ is? Is it ¾ cup or is it 2½ cups? Most cereals call for about a cup – about the size of a tennis ball. For meat, you want about 3 oz/meal – about the size of a deck of cards. Portion size makes a big difference when you are adding up the calories per serving. Especially when you discover that you are eating 4 or 5 servings … according to the label.
We all eat in food ruts. We eat the same foods every week to ten days. So take the time, (just once or twice) to check the true quantity you are eating. Then do the math! It’s a great idea to write down what you eat in any given day in order to figure out how many calories you are eating. Can you shave 100 calories from each meal by eating a smaller portion? If you saved 300 calories a day you could lower your blood sugar, blood pressure, cholesterol levels and lose 30# in just one year without too much effort!
Here are some tips:
Use smaller plates and cups
Read Nutrition Facts Labels
Order small or a la carte
Beware of big baked goods
Share large entrees
Don’t eat out of the bag
Don’t eat in front of the TV
Eat before you go out
The difference between a smaller portion and a super-sized portion could be much more than you realize. For example:
LargeSmall
French fries 570 250
Burger 730 260
Soda 310 150
Cookie 470 110
Ice cream 560 230
Totals 2,640 1,000
Awareness is key! Becoming more aware of common portion sizes is a good idea, especially if you have never paid attention in the past to how much you are really eating!
Dark chocolate. How can you not love it. Treat your valentine with a relatively healthy treat, and feel good about it. All things in moderation of course. About.com has a good sumary of the research supporting the health benefits of moderate consumption of chocolate. This post is only half “tongue-in-cheek.”
Female athletes, especially basketball and soccer players have up to 6 times as many ACL tears as their male counterparts at similar competative levels. We are way past deciding if girls/women should be involved in sports like soccer, basketball, lacrosse, and other rigorous sports. What we need to recognize is that men’s bodies and women’s bodies are different in more ways that their reproductive organs. When my daughter, who was 13 at the time, had an ACL (anterior cruciate ligament) knee injury I was amazed to learn that this was extremely common.
Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer.
Some research suggests that such a wonder treatment already exists. It’s vitamin D,
Brooke Douglas, an excellent nutrition expert, wrote this article from my office’s newsletter, and I think it’s worth sharing with a broader audience. Though I’m convinced the way to eat healthy is to shop and prepare our own meals, here are some hints for when you do find yourself looking for fast food.
Drive-Thru Nutrition: Fast And Healthy!
While a super-sized value meal can give you a day’s worth of calories and fat in just one meal, you can exit the drive-thru with a healthier meal. With fast food chains an accepted part of our busy lifestyles, it’s important to learn how to make good choices. Here are some ways to make fast food work for you and your family.
April Fool’s Day Myth-Information
This month our favorite nutrition expert sounds off on pervasive nutrition myths. Hear what Brooke has to say on DrPullen.com the first day of every month.
April Fool’s Day Myth-Information – by Brooke Douglas RD
From ‘loading up on grapefruit’ to ‘fasting in order to jump start your diet’, how do you separate fact from fiction? In the spirit of April Fool’s Day – let’s turn our focus to some of the most pervasive diet and exercise myths and put them to rest — once and for all.
Myth #1: To jump-start your diet, you should fast.
Fact: Not so fast! Skipping meals for extended periods of time is actually the best way to sabotage a diet! Though fasting may temporarily help you lose weight, it’s predominantly water weight. Not eating for extended periods can cause mild to severe fatigue and dizziness. Once you become ‘over-hungry’ all common sense is lost. This is when what I call ‘defensive’ eating sets in. Often excessive hunger, deprivation and physical weakness makes you respond like a Hoover vacuum and you’re bound to reach for high-calorie, high-fat and nutritionally poor choices in that state of mind. So, in fact, the more you don’t eat, the more likely you are to overeat in the end.
Myth #2: Calorie restriction is the key to weight loss.
Fact: While nutrition is more than half the weight loss battle, drastic caloric restriction is not the way to win the war. By dropping your caloric intake below 1200, you run the risk of slowing down your metabolism. As a result, your body will use your hard earned muscle for energy instead of fat.
In addition, extremely low calorie restrictive diets are hard to stick to, leave you feeling deprived, and usually end in disappointment. If that isn’t enough, when calorie consumption is too low you lack the energy to power through your workouts.
Having said that, you would be surprised how fast the calories add up. So keep a food record and stick to your maximum calorie, fat and fiber goal numbers, as established with a Registered Dietitian or call Brooke!
Myth #3: Low-Carb (high protein) diets are the most effective route to weight loss.
Fact: Before you ban your bread, consider this: Research used to suggest that obese people could lose more weight on a low-carbohydrate diet than on a conventional low-fat diet. Yet, the benefits demonstrated turned out to be small and short-lived. Multiple long-term studies which compared low-carb dieters to low-fat dieters found that low-carb dieters began regaining the weight they lost after six months. Worse yet, by the end of the year, they were no better off than the low-fat group. And here is my point about moderation not deprivation, because the dropout rate among all groups studied was extremely high. Proof that it really is about striking a balance between what you consume and what you burn. To do that for the long haul, you have to choose a diet that is sustainable, hence moderation!
Myth #4: Eating grapefruit will help you burn fat.
Fact: That eating grapefruits will help you lose weight is one of the most persistent among diet myths — and just when you think it’s gone, it resurfaces and becomes all the rage again every few years. There is no food that has intrinsic “fat-burning enzymes” that magically melt fat from your body. There was one study that demonstrated the effectiveness of a grapefruit inclusive diet, however, it was small, isolated, and there is some question as to whether the citrus industry sponsored the research. If you want to eat grapefruit as part of a well-rounded diet, go for it. Ruby Red grapefruits are rich in lycopene — an antioxidant that protects against heart disease and breast cancer – incorporate it and other lycopene-rich foods such as tomatoes and watermelon into your diet each day.
Have you met with a Registered Dietitian lately?
www.NutritionAuthority.com