Tuesday, April 29, 2014

Don't Fall Prey to The Licensing Effect

Although I cannot find the original source of this term, the 'licensing effect' is commonly referred to as the subconscious phenomenon whereby increased confidence and security due to one action tends to lead that same individual to worry less about the consequences of a counter-productive action.  In other words, they think that one action gives them a license to perform a different action.

For example, suppose a person is prescribed a statin, a cholesterol lowering drug, because his physician is concerned that the patient's cholesterol is too high thereby increasing the risk of heart disease.  The reason for high cholesterol can range from hereditary factors to a diet high in fats, such as fried foods, that are capable of raising cholesterol levels.  So following the advice of his physician, the patient fills the prescription and begins to take the statin confident that his cholesterol will be lowered and his risk for heart disease decreased.

Over the ensuing days, weeks, and months as the patient uses the drug, he feels like his cholesterol is no longer a concern.  So when he comes across french fries, pizza, cake creams made with trans-fats, etc., he doesn't think twice of the potential harms of eating such foods.

You may say that's ridiculous. No one could be that foolish to not realize the consequences of eating these unhealthy foods known to cause long term heart issues for many. (I say many, because of the lucky few who seem to get away with eating anything and everything like my friend Steve.)

If you are one of those naysayers, you may have trouble with a new study that showed
that people who took statins in 2009-2010 consumed more fat and calories than those who took the drugs 10 years earlier.

That's right, they experienced a "licensing effect" to eat more.

And in case, you thought everyone ate more, that was not the case. There was no similar increase in fat and calorie intake among people who didn't take statins, according to the University of California, Los Angeles (UCLA) researchers.  Furthermore, their analysis of U.S. National Health and Nutrition Examination Survey (not always perfect nor reliable, but pretty good) data showed that statin users in 2009-2010 consumed 9.6 percent more calories and 14.4 percent more fat than statin users in 1999-2000.

The clever ones among you may think that people who need statins probably always consumed more calories and fat and that's why they needed the statin in the first place. You would be wrong as statin users in 1999-2000 consumed fewer calories and fat than people who didn't take the cholesterol-lowering medications.

That has clearly changed per the study that was published online April 24 in JAMA Internal Medicine and simultaneously presented at the Society of General Internal Medicine annual meeting in Denver.

This licensing effect is far more ubiquitous than just the statin example.

Many people are under the illusion that taking prescription medications and supplements will somehow protect them from eating too much, especially of foods that are unhealthy for most humans.I saw this with patient after patient.  They thought everything was okay because their blood pressure  was within normal range on blood pressure medication, their blood sugar was within normal range because they took metformin, their cholesterol was within normal range because they took a statin, etc.  They thought that if the tests are normal then everything was okay. They didn't realizing that simply lowering cholesterol doesn't prevent heart attacks. In fact, statins typically prevent one heart attack among every 100 users. That's right, 1 out of 100. That shouldn't give anyone a real sense of protection. (However, don't stop your statin without consulting your physician.)

So please don't make the mistake of thinking you can eat whatever you want, and sit around all day and and do nothing simply because you take some pills and supplements..

Consider this a friendly warning. Your license has been revoked.

Friday, April 25, 2014

Diets Are For Dummies

Just in case you think I meant that I have a diet for you that even a dummy can follow, I don't. My headline really says it all--only a dummy would go on a diet.

Over the past few months, I have spent considerable time reviewing all sorts of diets including intermittent fasting, low carb, low fat, high protein, vegan, gluten-free, calorie counting, calorie restricted optimal nutrition (CRON), paleo, etc. and have come to an educated conclusion that the notion of going "on a diet" is just plain foolish.

What, you may say?  Don't some people need to lose weight? Aren't diets merely a means to an end? What's wrong with trying different schemes to lose weight until you find one that works? These are all valid questions, but unfortunately diets collectively seem to do more harm than good.

First, the science is pretty clear that the more diets one tries, the more likely that person is to never successfully lose weight and keep it off.

Second, as most diets are simply focused on weight loss, they ignore something far more important--your health. In most cases, restricting calorie absorption to less than calorie expenditure will result in weight loss. However, such approaches often are not nutritionally sound and can actually be quite inflammatory to the human body, which can lead to systemic illness.

Third, what often works for one person may not work for you or even be harmful. For example cutting out gluten when you have no gluten insensitivity or celiac disease also deprives you of glucasin, a peptide known to decrease inflammation by reducing interleukin-6. Eating lots of protein in the form of meat and eggs can increase cardiovascualr disease even as you lose weight.

So what did I learn from all the studies and books I read?

Diets don't work but principles do.  So here are my take-away principles of eating healthy.

1. Human beings do not need a lot of food to stay healthy and vibrant. Think like the Okinawans who practice hora hachi bu, which means to eat until you are 80 percent full.  Once your nutritional needs are met, excess nutrients are not only unnecessary, but may be harmful. There is growing evidence that eating less versus more is the healthiest route as it requires your body to exert less effort to break down, absorb and dispose of what it doesn't need.. So it doesn't matter when you eat what, but make sure that the foods you eat contain all the essential nutrients.

2. Although the science is inconclusive regarding organic versus conventional grown, natural versus processed, it appears prudent to avoid chemicals whenever possible.  Everybody reacts differently to different chemicals and the human body is fairly adept at eliminating toxins, but one can never say conclusively that any certain chemical will not have a negative effect on you.  I wouldn't get paranoid about it, but caution is indicated in severely restricting your exposure to chemicals in the foods you ingest. (It doesn't hurt to limit chemicals you are otherwise exposed to as well.)

3. Eat when you are hungry. The conventional wisdom to eat three times a day, or the oft recommended multiple small meals has no irrefutable science to support it.  It is clear that early man could not easily regulate access to food. It is also clear that we don't exactly know what effect this had, but I think it is reasonable to conclude based on the absence of (or conflicting) evidence to suggest otherwise that eating regularly may not have any proven benefit (other than perhaps scheduled toileting for some) as long as nutritional needs are met.

4. You need to get B12 naturally from fish, chicken or meat.  Wild fish is my favorite, but it should not be eaten in excess anymore than any other nutritionally sound foods. Three to four times a week will more than suffice.

5. Nuts are a great source of minerals and far less fattening than most people think because unless the nut is completely grounded, much of its fat is not absorbed due to being tied up with its fiber.

6. Natural food rich in both soluble and insoluble fibers are great, but like everything else should be eaten in moderation.

7. Avoid any overcooked or burnt food.

8. Eat fruits, but don't feast on them as too much fructose may be a problem.  You can eat them at any time of the day or night. Vegetables can also be eaten at any time, but again there is no value in excessive consumption.

9. If you are around foods you want to avoid, expect to eat them eventually. Therefore, limit your exposure to such foods by not purchasing them for others, having them at your home, or staying exposed to them for extended periods of time like a piece of chocolate cake in front of you at a wedding. Push it away or move away, but staring at it is fraught with danger.

10. Limit you exposure to restaurant or prepared food containing unknown ingredients.  What you don't know may be harmful to you in a myriad of ways.

11. If you are a compulsive eater or suffer from an eating disorder like a sugar addiction, consult a health certified psychologist to help identify the root cause of your eating problem and get cognitive behavioral therapy to address the issue. Some people need help and you need to figure out if you are one of them. Repeated dieting and failure to sustain weight loss is a good indicator that you are in need of trained help.

12. Avoid diet pills like appetite suppressants. They are never a good long term-solution and just will add to your total frustration.

The goal with these principles is that dieting, even under best case scenarios, only sometimes achieves short term weight loss results, but is often followed by long-term frustration.

Don't be a fool. Eat (enough) to live as opposed to diet for weight loss. It's the best advice that anyone can ever give you.

Sunday, April 6, 2014

Monkeying Around With Longevity

The search to extend human longevity spans the ages. More recently, scientists have repeatedly shown that restricting the intake of calories while continuing to supply essential nutrients extends the lifespan of flies and yeast by as much as 40 percent. An additional research vector that captured much attention were animal studies with rodents that suggested similar benefits from caloric restriction. 

Although positive results were not seen with all strains of rodents, some rodents were shown to live significantly longer when their calories were limited.  As with all animal studies, scientists wanted to know if these benefits extended to more complex creatures that more closely resemble humans--such as primates--better known as monkeys.

When the National Institute of Aging (NIA) completed their studies with monkeys in 2012, the NIA's conclusion was that that caloric restriction made no difference. This hardly put the controversy to bed, but it did seem to dampen some enthusiasm for this approach to extending human longevity.

This past week, a new study from the University of Wisconsin stirs up new hope for reconsidering this strategy. Over 25 years, Wisconsin researchers studying rhesus monkeys, considered by some the best proxies for humans, found a significant reduction in mortality and in age-associated diseases among those monkeys fed calorie-restricted diets. The study, begun at the University of Wisconsin-Madison in 1989, is one of two ongoing, long-term U.S. efforts to examine the effects of a reduced-calorie diet on nonhuman primates.

The study of 76 rhesus monkeys, reported Monday in Nature Communications, was performed at the Wisconsin National Primate Research Center in Madison. When the monkeys were 7 to 14 years of age, they began eating a diet reduced in calories by 30 percent. The comparison monkeys, or the control group, which ate as much as they wanted, had an increased risk of disease 2.9 times that of the calorie-restricted group, and a threefold increased risk of death.

So which study is correct?  According to the Wisconsin researchers the reason for the discrepant results is that the NIA monkeys that were in the control group versus the intervention group were actually already on calorie restricted diets and that's why no difference was found in longevity between the two groups. Also, the NIA monkeys were consistently slimmer (and presumably healthier) that the Wisconsin monkeys, who were allowed to eat what they wanted. (I guess even monkeys, particularly captive ones, overeat when enabled to do so.) The NIA was apparently more careful with all their monkeys to limit their food intake regardless of the study.

How did the Wisconsin researchers reach this conclusion? Through their own experience in monkey research, and by reference to an online database recording the weight of thousands of research monkeys, the Wisconsin researchers concluded that the NIA controls were actually on caloric restriction as well. “At all the time points that have been published by NIA, their control monkeys weigh less than ours, and in most cases, significantly so” stated Ricki Colman, a senior scientist at the Wisconsin Primate Center, who presently co-leads the project.

More importantly, the NIA control group monkeys were also found to live longer on average that most other monkeys, and the Wisconsin researchers theorized that this was due to even a small reduction of calories. The big conclusion was that it seems that the small caloric restriction in the NIA control animals had its own benefits, suggesting that a reduction of as little as 10 percent could meaningfully retard aging.

As these studies were very expensive to conduct and will therefore not be repeated any time soon, the question remains do primates benefit from calorie restriction as long as they get all essential nutrients? The Wisconsin study would suggest that for rhesus monkeys, the answer is yes.

So what does that mean for us humans?

According to the Wisconsin researchers, they were“not studying [caloric restriction]...so people can go out and do it, but [rather] to delve into the underlying causes of age-related disease susceptibility...It’s a research tool, not a lifestyle recommendation."

Although the helpful mechanism of why caloric restriction may be beneficial has not been fully identified, it is believed to have something to do with the "reprogramming of the metabolism. In all species where it has been shown to delay aging and the diseases of aging, [calories restriction]... affects the regulation of energy and the ability of cells and the organism to respond to changes in the environment as they age.”

One of the first break-downs in metabolism results in diabetes, which can be seen as “an inability to properly respond to nutrients.” Diabetes damages a whole range of human capabilities including the functioning of muscle, fat and blood vessels. "The Wisconsin scientists began to see diabetes among the control animals while they were still in the prime of life, within six months after beginning their study. The contrast with the restricted animals could not have been more dramatic" Colman said. “Until two years ago, we did not have evidence of diabetes in any caloric-restriction animal, but we had a significant number of diabetes, or pre-diabetes, metabolic syndrome, in the control animals.”

Although it is generally accepted that very few people can tolerate a 30 percent reduction in calories, the study does merit consideration.  Primarily because “the basic biology of caloric restriction in rodents, worms, flies and yeast seems to carry over to primates," it appears worthwhile to identify the underlying mechanism for this result in order to better understand the potential benefit to human primates who are genetically so closely related to rhesus monkeys.

The bottom line here is that as long as they all get their essential nutrients it would appear across multiple species, from simple worms to far more complex primates, that eating less is better than eating more. It's not a large stretch to extend that logic to homo sapiens. Accordingly, even cutting back on 10% of your calories may have a huge effect on your longevity--adding years of healthy living to your life.  And that's not something to monkey around with.

Wednesday, April 2, 2014

If Money Grew On Trees...

Many parents like me have often expressed to their children that "money doesn't grow on trees." The point of this admonishment is obvious: money is not something one comes by naturally; rather, making money requires time and effort.

I've been thinking a lot about this old adage lately. What if money did grow on trees? Would that make money any less valuable or difficult to come by? Is there any relationship between money growing on trees and your health?

In the back of my house, I have two fruits trees: a grapefruit tree and a lemon tree. Both were planted by our gardener about seven years ago. The first tree has never so much as produced a single grapefruit. The other tree sprang a few lemons its first year and since then has meagerly grown an annual--wait for it--solo lemon. The problem is obvious. Neither the gardener nor I have properly nourished (trees like humans can't function properly without adequate nutrition) the soil around the trees to enable the trees to effectively grow fruits. True, the trees get a fair amount of rain and more than adequate sunshine.  But if even one component of what is needed to grow fruits is missing--you get no fruits.

Now let's imagine that money was like a fruit that grew on trees.  In order to harvest such money, effort would have to be expended to ensure that the tree was properly taken care of. First, the tree would need to be in the proper climate to grow.  It would need sufficient water and nutrients in its soil. Also, during a certain season (did you think it grew year round?--fruits don't), when the money was sufficiently ripe, it would need to be harvested. This would require physical work. If you let the money just fall to the ground, animals would grab it. If you didn't want to do the work or didn't know what to do, you would have to hire a gardener. That costs money as well.

On the other side of my house there is a loquat tree. (For the curious, the loquat is a species of flowering plant in the family Rosaceae, native to south-central China. It is a large evergreen shrub or small tree that grows yellow fruit.) The loquat is one of my wife's favorite fruits and for good reason. It is truly succulent.  Each year we try to take down as many loquats as possible. However, many are beyond our reach and many of those within reach are grabbed by unknown others (they just disappear). By the end of the season, animals have also joined in the feast by consuming those that fall to the ground. We could hire someone to pick the higher branches of the tree for us, but we calculated that it would be less expensive to simply go to a store and buy the loquats.

Also, if we had a money tree, it would need to be protected against infection. For example, a palm tree near my house recently died. It apparently died because of benign neglect. We recognized something was wrong two years ago when we called in the experts. One told us it was a fungal infection. Two others said it was malnourished. I believed the second two--it was less expensive to go that route than pay thousands for a fungal treatment. So I begged my gardener to feed it. He claimed he did and yet the other day, I noticed it was dead.  My gardener's response: an infection killed the tree and he is not responsible for infections. Ouch. Then without permission, he cut it down.  (Time for a new gardener?)

Now let's imagine if my recently departed palm tree was a money tree.  That's easy to imagine because it was.  This was a beautiful palm tree that I had paid a lot of money to have planted (and would have to pay even more to a new gardener now to replace). It also had great value to me aesthetically as it sat prominently in front of my house.  Despite its value, it still bit the dust. I had tried to do right by it, but let it down. My tree was gone; my money (tree) was lost.

One last fruit tree story.  A neighbor has an avocado (actually a fruit) and mango tree. Each year when the fruits are ripe for picking, she barters the fruits for things she needs. In other words, they have real financial value, similar to a farmer harvesting his own fruit trees for sale.

By the way, it would obviously make a big difference what denomination of money my tree would grow. If it was a mere $1, then a harvest of one hundred would yield an annual $100. That would definitely not justify the cost of growing the money. At $5, it would be $500.  Even at $100, it would only yield $10,000 if they were all harvestable.  But at that value, you would definitely need to employ very effective and costly security measures to keep others away so your expenses would further increase.  Obviously, the higher the denomination the better, but under $100 would still require a lot of trees with plenty of land (which can be expensive) to support them to make a good living.

So when I summed up the costs of successfully maintaining a fruit tree, let alone assuring that it gave a bountiful harvest each annual season, one thing was perfectly clear to me. Fruit trees are money trees and so money does grow on trees.

So the next time you hear or read that money doesn't grow on trees, perhaps you will remember the stories of my fruit and palm trees and realize that it really does. Parents would be wise to teach their children that even if money did grow on trees (which arguably it does), in order to fully realize its value would take much time, effort, and not the least of, money.  The lesson here is regardless if money does or does not grow on trees, in order to make money you have to invest (no pun intended) your time, effort, and even money in doing so.

The same can be said for your health and wellbeing. Like a healthy tree full of fruits, your body requires nurturing and conscious effort to stay healthy.  My palm tree met a premature death. My fruit trees don't live up to their potential. Try not to let the same happen to you by recognizing the value of planting the seeds of a healthy life and harvesting the fruits of your labors...(puns obviously intended.)

Otherwise, you may never live to realize the full bloom of your life.