Super Immunity - Not!

When I hear the word "Super," my thoughts race back to my childhood and my dalliance with  Superman, the DC Comics superhero from the planet Krypton who gains super powers from exposure to our sun. We all know the old rephrase that he's "able to leap tall buildings in a single bound, faster than a speeding bullet, more powerful than a locomotive." We also all know that he's a fictional character and such powers simply do not exist. Yet, like my older brothers, I could not get enough of the comic books and TV shows featuring the super fellow and other super heroes.  Everyone loves the idea of something super.

During my residency, the word "super" took on new meaning. Whenever I needed a lab result right away, I would write that I needed it STAT. However, I found that since every resident would write STAT on every blood work request, the lab began to dismiss the qualification. It then became necessary to write "SUPER STAT" to try to differentiate my request from the others. Soon, all my fellow residents were equally connoting "SUPER STAT" on each request and that too lost significance. It then became a game of how many "SUPERs" you could add before STAT. It wasn't uncommon to see "SUPER SUPER SUPER SUPER SUPER SUPER STAT" on a lab slip. The lab techs, I am sure, got a good chuckle, from our efforts of one-upmanship.

Today, "super" seems to have a new affixation. People love to attach it to all sorts of concepts related to health and nutrition. Case in point is a new book just featured on The Dr. Oz Show (yes, he's back for a new season) titled Super Immunity by Dr. Joel Fuhrman. In general, I think Fuhrman is a highly reputable doctor who fully understands the value of healthy eating. Notwithstanding, I have to take exception to his, or anyone's, concept of super-immunity or super foods or super anything for that matter. The reason is that I can find no evidence whatsoever to support the concept of super immunity or super foods. From my perspective, a food is either health promoting or it is not. It either supports a healthy immune system or it does not. You get the drift.  I don't know about you, but I don't want my body to do anything but function properly and that includes my immune system. In fact, I love wild Salmon, but I would never call it a super food (because it's not--it's just a healthy source of protein, fatty acids, etc.).

You may think this is a question of semantics, but I think there is much more at stake here. Dr. Fuhrman would be the first to tell you that eating properly is not a question of adding healthy foods to your diet; rather, it is a matter of building a foundation of healthy foods. Yet, when you suggest to the public any suggestions of quick fixes, eg. super foods, you run the risk of people thinking that they can balance unhealthy foods with such super-foods. This is how people are confused into believing the popular adage that eating healthy means "eating in moderation." Bad foods will often neutralize the benefits of healthy foods, super or otherwise.  Moderation simply doesn't apply to certain foods like trans-fats, sucrose, high fructose corn syrup, etc.

A writer, speaker, or doctor must choose his or her words carefully as to not mislead the reader, listener, or patient. I know this from first-hand experience. Through my lecturing, I have learned the importance of choosing the right words so as to not lead listeners to wrong or invalid conclusions. For example, I can't make a general statement that medications are bad (although not a fan of many due to indiscriminate use, many medications serve useful purposes) for fear that someone may stop all their medications inappropriately. I know because this has happened. Nevertheless, I heard Dr. Fuhrman make such a statement on the Oz show. I also can't say that a little bit of neurosis about one's health can contribute to longevity because someone may take that as a reason to start obsessing about every facet of their health. I know that because unfortunately that also happened.

Some doctors may feel it is appropriate to take liberties with superlatives like "Super" to grab attention with the good intention to deliver important information. (Isn't the road to hell  paved with good intentions?) I feel it strains credibility and undermines the ultimate message.  Let's leave "Super" to Superheroes and let's stick to science instead of science-fiction when it comes to dispensing health advice. Otherwise, it won't be long before you see a book with the title SUPER SUPER SUPER SUPER SUPER IMMUNITY trying to grab your attention.

Can You Trust Andrew Saul?

Mark Twain once wrote, "Don't take advice from a health book. You could die from a misprint."

Although Twain passed about 102 years ago, I think that advice was prescient and equally applies today to health books, newsletters, websites, blogs (including mine), etc. This isn't the first time you've heard this warning from me and you should be pretty confident it won't be the last.

My compunction against such marketing-driven news sources is that I find most of them consistently misleading and most importantly derived from suspect sources of authority. For the fifth time in as many months, I have come across yet another self-proclaimed expert in nutrition with a no less than dubious PhD from yet another mail order program.

In this case, it's Andrew Saul whose PhD, as he describes on his website, doctoryourself.com, hails from a "non-traditional PhD program," from the non-accredited, degree mill called Greenwich University. His degree in Ethology, which is the scientific study of animal behavior, apparently makes him an expert comfortable telling people to "Doctor Yourself" and "Fire Your Doctor," two of his book titles.

I was asked to consider the writings of Saul based on his apparent success as a prolific author and proponent of dietary supplements. The little I have read so far leads me to best describe his writing as gibberish, not worthy of further contemplation. Nevertheless, I promised an associate I would read in entirety Saul's book "Doctor Yourself," and I will report my conclusions upon completion.

What I find most dismaying is that the real PhDs in nutrition seem to do a poorer job of making their writings well known. It seems the higher the quality of the authorship, the more difficult for the writing to gain widespread circulation. Perhaps the truth simply isn't that interesting?

BTW, I picked up the Mark Twain quote above from Saul's website (and confirmed its accuracy independently).  I guess his website is good for something after all.

I apologize for the negative tone of this blog, but someone needs to bring this type of information to light and there are very few others doing so.

The problem is, as Twain once also eloquently wrote, "A lie can travel halfway around the world while the truth is still putting on its shoes."

Caveat Lector!

Busting Myths: Does Dr. Oz Have A Monopoly?

Yesterday, I wrote about Dr. Oz's suggestion to snack with up to 200 calories two hours before eating your dinner in order to lose weight. There seemed to be no good logic to doing so. Imagine my surprise when today I get an email from RealAge.com, which is at least partially owned by Dr. Oz (see http://www.realage.com/press-release-sharecare) with the headline, "3 New Weight Loss Myths Busted."

Here is my favorite myth the article clams to bust.

"Myth 1: Eat five mini meals throughout the day.
The initial idea was to eat small, healthy amounts of food every couple of hours to keep blood sugar levels steady and energy high. The trouble is, many people end up eating what amounts to five full meals. "I find that people do much better when they sit down and have three balanced meals a day with two small snacks in between," says nutrition counselor Katherine Tallmadge, MA, RD. "Real meals stave off hunger. If you eat tiny bits throughout the day, you're hungry all the time."

This is diametrically opposed and mutually exclusive to Dr. Oz's concept of eating a small meal, which he calls a 200 calorie snack, two hours before dinner. Which is it? He probably doesn't even know, but busting myths seems to be one of his favorite concepts on his show. It's as if he has a monopoly on doing so. However, I never thought that in the span of one week, I would see him connected to both creating and busting a myth.

Here is another myth supposedly debunked by the article.

Myth 2: Eat less by using small plates. Studies have shown that large plates lead to more eating because they make portions look smaller, but the small-plates idea only works if there's a limited amount of food to put on the plate. In a recent diet study at Texas Christian University in Fort Worth, Texas, 10 overweight and 10 normal-weight women were randomly assigned a large or small plate for eating lunch on two different days, then allowed to serve themselves. The result? The ladies ate until they were full, regardless of plate size. "Make what you need, or measure the amount before putting it on a plate, then put things away," recommends Tallmadge, who was not involved in the study. "It's having easy access to food that keeps you eating more."

Contrary to what RealAge would have you believe, there is actually science that confirms the small plate approach to weight loss. See http://smallplatemovement.org/doc/big_portions.pdf for a review of the science. Brain Wainsink of Cornell University is one of the leading food investigators in the U.S. After reading his book, Mindless Eating, I am more inclined to trust his studies over the new study. I also know it works because it worked for me. I switched from a larger to a smaller bowl for my breakfast and never missed a beat on my way to a 20+ pound weight loss. Either way, with the conflicting study results, I hope you agree that this does not fall into the myth-busting category; however, it should fall into the sensationalistic headline one.

Here's a quote from Dr. Oz's website under the title "5 Diet Myths Making You Gain Weight" about the small plate issue:

"Dieters have been advised to eat from smaller plates in order to limit the amount they eat. Why? Because smaller plates make regular portions look larger. However, new research published in the Journal of Human Nutrition and Dietetics found that plate size had no impact on the calorie consumption of either normal weight or obese individuals. Despite these findings, Dr. Oz still recommends using small plates to help guide you in terms of how much you eat. But use them the right way – a small plate is not an excuse to pile on food vertically or go back for seconds."

So what are we expected to trust? The Dr. Oz Show or a website Dr. Oz has ownership in?


The third myth the article purports to bust is "it doesn't matter what meal plan you're on because you'll lose weight as long as you stick to it." Really, any food you eat as long as you stick to it will help you lose weight? The study the article referenced used 5 specific plans. There is definitely more than one way to lose weight, but the meal plan (and total number of calories) will always matter.

It is because of articles such as this one and the Dr. Oz Show that there is so much confusion out there that allows anyone to claim he or she is busting a myth. Besides, I caution trusting anyone that constantly claims they are a myth-buster. Wouldn't it be better if shows and websites just presented the science in layperson's terms and let intelligent people make the decision on their own. I think so. Do you agree?

Supplement peddlers, supplement peddlers every where, Nor any drop of truth to drink.

In the Rime of The Ancient Mariner, the epic 18th century poem penned by Samuel Taylor Coleridge, there is a famous stanza: 

Water, water, every where,

And all the boards did shrink;

Water, water, every where,

Nor any drop to drink.

The poetry speaks to the frustrations of thirsty sailors aboard a ship surrounded by uncharted waters they dare not drink. Like the craving sailors, I too long to quench my thirst for truth while surrounded by a rising sea of misinformation.

Although I’m not looking to disturb the tranquility of this relaxing 4th of July holiday, I hope you will forgive my trespass as I call out another pill pushing would be health expert adding more confusion to the churning sea of questionable data.

I previously wrote how you can't believe everything you read and I called it Caveat Lector, which in Latin means "Let the reader beware!"  Of course, the obvious question is then how can you trust what I write, and I acknowledge that this is more than a fair question. My forthright response is that I don't have any agenda other than to improve people's health and make the world a better place.

Most people who read my blog will never be my patient for a variety of reasons ranging from they don't live near my office to they already have a doctor they love.  Also, I don't sell anything so I never have to persuade you to buy something from me or extol its virtues for financial gain. Most importantly, I have been blessed that through my hard work, both during my schooling and my entrepreneurial ventures, and a more than a deserving measure of good fortune, I am financially independent.

Finally, I spent many years in schools, both medical and business, and consider myself a life-long learner in search of truth and understanding.  This search for the truth is first and foremost for my own sake, and I often self-remind regarding the dangers of fooling yourself.
But that is not all that drives me. Although not as religiously observant as I was growing up, I still consider myself a religious person.  Accordingly, having studied the Bible extensively when I was young, I remain ever mindful of the biblical prohibition that states "Do not put a stumbling block in front of a blind person." This biblical phrase is jointly understood to mean that one should not deceive someone simply because he or she can and also that one must be mindful of those at a disadvantage as to adjust one's approach and not take advantage of them.

Therefore, it is with great sincerity and purpose that I challenge many people in this country, doctors and laypersons alike, who seek to deceive others into taking action likely to yield no benefit other than to the person pushing the advice or product. Today, I have a case in point.

A patient of mine sent me this morning a newsletter published by a person named Nan Kathryn Fuchs. Fuchs states that she has a PhD, but despite my best efforts, including reviewing her own website, I could not determine the discipline of her PhD and what university granted it. Interestingly, I am not the first to ask this question as the question was previously posted on the internet and it received no response. So I wrote (Dr?) Fuchs today an email asking about the subject matter of her degree and the source of it, and I await her response.  My research in Fuchs did reveal that she is affiliated with an organization called MSIA.

Here's an excerpt from Wikipedia describing MSIA in which Fuchs is quoted.

"MSIA is a nondenominational and ecumenical church, the stated purpose of which is to "teach Soul Transcendence, which is becoming aware of yourself as a Soul and as one with God, not as a theory, but as a living reality. Controversy has surrounded MSIA: it has been accused of being a cult by some former members and by the Cult Awareness and Information Centre and claims have been made that one of its founders Roger Hinkins had unethical sexual relationships with members. MSIA has also been accused of being an "offshoot" of Lifespring, a private, New Age/Human Potential Training company founded in 1974. According to Nan Kathryn Fuchs, a devoted member of MSIA for 13 years and a minister who served on the Ministerial Board for a number of years..."

I respect the full variety of religious perspectives, but this group sounds illegitimate and cultish, and I can't say for certain based on such little detail. 

So why all the fuss then about Fuchs?  Her newsletter with the heading, Women's Health Alert, had a main article titled, "Are the benefits of supplements real?" The article goes on the quote a new report issued by the prestigious and ethical sounding Council for Responsible Nutrition (CRN) titled "The Benefits of Nutritional Supplements (4th Edition), which found consistent and adequate health benefits from using supplements. 

In fact, here's my favorite quote from Fuch's newsletter.  

 

"For years, conventional medicine has pooh-poohed the need for supplements. They used to say you didn’t need them at all — unless you had scurvy. As people began to see their incredible health benefits, though, the medical establishment had to adjust. But they’ve done so very reluctantly. In fact, some still insist supplements just give you expensive urine.

Well, all the naysayers who insist that nutritional supplements are unnecessary better get ready to make more adjustments in their thinking. The Council for Responsible Nutrition (CRN) has a reply in the form of an updated comprehensive report citing sound scientific studies that prove otherwise."

There is only one problem. By their own description, "The Council for Responsible Nutrition (CRN), founded in 1973 and based in Washington, D.C., is the leading trade association representing dietary supplement manufacturers and ingredient suppliers."

Not hard to imagine that the business trade group representing supplement companies would come out with a report stating that supplements have benefits.  Even if accurate, it would be foolhardy to trust such a report under the circumstances. Fuchs, taking cover under this questionable report, and denigrating the reluctant medical profession (why do you think ii is by and large resistant?) in the process, nevertheless uses it to peddle her own supplements.  

What a surprise. Forgive my sarcasm, but it is just incomprehensible to me that any sane person would read this newsletter seriously, let alone buy a product from Fuchs.

There are many such people in this country trying to peddle unneeded and potentially harmful products on an unsuspecting and trusting populace.  I will continue to identify them and call them out as I come across them. If Fuchs writes back, I will in fairness share her reply about her education.  In the interim, whether from Fuchs or other people who write to tell you supplements are good and then in turn, try to sell some to you, I say Caveat Lector and Caveat Emptor, let the reader and buyer both beware!

A Hodgepodge of New Studies

Making Sense of Two Recent Testosterone Studies:

I am always trying to make sense of the studies I come across. In the past couple of days, I came across two studies involving testosterone, the male hormone. One study showed that overweight men who suffered from hypogonadism (a medical term which describes a diminished functional activity of the gonads, the testes in males) who received testosterone lost weight; the other study showed that men who suffered from hypogonadism who lost weight increased their testosterone to a level where they no longer had hypogonadism (incidence of hypogonadism went from 20% to 11%, about a 50% improvement).

After reading the two studies, I had to ponder for a while how they related to each other and then it came to me. Although I claim no absolute certainty in these conclusions, it seems that for certain overweight men, increasing testosterone, either endogenously (from within) or exogenously (from outside) helps them lose weight. Given the choice, it would seem better to naturally increase a hormone as opposed to getting it from some other derived source. The best way to do so if you are overweight is to change your diet to the a mostly plant-based diet, increase your exercise to moderately-intense 150 minutes per week, and get at least 7 hours of sleep a night.

Are Vitamin D Blood Tests Always Accurate?

Apparently not. A recent study showed that 40% of the time, blood-labs misdiagnose Vitamin D deficiency by reporting lower than actual levels. This may not be true for all labs or all types of equipment used. The equipment/tests that seemed to be the worst offenders were the Architect and Centaur-2 tests. The liquid chromatography/mass spectrometry (LC/MS) test is the gold standard and can generally be relied upon. So the next time you have a test, ask what equipment they are using and consider going to another lab with LC/MS equipment for greater peace of mind.


Is There A Link Between Vitamin B6 and Heart Disease?

A new study shows a link between low Vitamin B6 levels and increased risk for heart disease. The study does not show causality, which means it isn't clear if the low Vitamin6 causes the heart disease or the heart disease causes the low Vitamin B6. It is possible that the inflammation often seen in heart disease may decrease blood levels of the vitamin. Nevertheless, it is important to maintain adequate levels of all vitamins, including B6, so I include the reference table below for your edification.

This table is not meant to be a recommended diet; rather, it is meant to give you a representative sample of sources of Vitamin B6 in regularly available foods.  A healthy diet is one that contains fruits, vegetables, nuts, legumes (beans), whole grains, and fat from fatty fish like Wild Salmon and Wild Cod. It can also include some olive oil, limited red wine, and very occasional chicken or meat. This is often referred to as the Mediterranean Diet and it still seems to pack the most bang for the buck.
Food	Milligrams (mg) per serving	Percent DV*
Chickpeas, canned, 1 cup	1.1	55
Tuna, yellowfin, fresh, cooked, 3 ounces	0.9	45
Salmon, sockeye, cooked, 3 ounces	0.6	30
Chicken breast, roasted, 3 ounces	0.5	25
Breakfast cereals, fortified with 25% of the DV for vitamin B6	0.5	25
Potatoes, boiled, 1 cup	0.4	20
Turkey, meat only, roasted, 3 ounces	0.4	20
Banana, 1 medium	0.4	20
Marinara (spaghetti) sauce, ready to serve, 1 cup	0.4	20
Ground beef, patty, 85% lean, broiled, 3 ounces
Waffles, plain, ready to heat, toasted, 1 waffle	0.3	15
Bulgur, cooked, 1 cup	0.2	10
Cottage cheese, 1% low-fat, 1 cup	0.2	10
Squash, winter, baked, ½ cup	0.2	10
Rice, white, long-grain, enriched, cooked, 1 cup	0.1	5
Nuts, mixed, dry-roasted, 1 ounce	0.1	5
Raisins, seedless, ½ cup	0.1	5
Onions, chopped, ½ cup	0.1	5
Spinach, frozen, chopped, boiled, ½ cup	0.1	5
Tofu, raw, firm, prepared with calcium sulfate, ½ cup	0.1	5
Watermelon, raw, 1 cup	0.1	5

*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin B6 is 2 mg for adults and children age 4 and older. However, the FDA does not require food labels to list vitamin B6 content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

Dr. Oz and Dr. Hyman Make Quite A Pair of Showmen!

The other night, I happen to catch Dr. Mark Hyman on a local PBS affiliate. Having heard Dr. Hyman speak at the American College of Preventive Medicine conference in February 2012 in Orlando to a group of doctors, I was keen to hear what he had to say to a layperson TV audience.

It started out innocently enough. He spoke about the dangers of diabetes and obesity, the need to eat well, get plenty of exercise, etc.  Then the garbage started. He started touting the need for special blood tests like the NMR LipoProfile test for cholesterol particle size, the need for a special blood test to identify insulin resistance, and the need for everyone to take dietary supplements. My recollection of his speech at the convention to doctors was that he made no mention of the need for these tests or for dietary supplements (other than to me when I questioned him about his own usage).

I'm not surprised that he didn't do so in front of a sophisticated audience; but, I was flabbergasted why he was now singing another tune to a raptly attentive and susceptible TV audience. I didn't have to wait long for my answer. As the show ended, there was a reference to organizations that had helped fund the show.  Among the sponsors were NMR LipoProfile, the company that sells the cholesterol test, and Metagenics, a company that sells supplements.

I was so disappointed that Mark Hyman had essentially sold out his audience. People don't need more blood tests than the conventional tests to tell them that they have a cholesterol or blood sugar problem. Does it really matter if you have a 33% versus a 38% relative risk of developing diabetes or heart disease? Either way, you should make lifestyle changes to avoid them.

These tests are by and large, in my opinion, just plain ridiculous and unnecessary and they only serve to line the pockets of the companies that sell the tests and the doctors who order them with reckless abandonment.  Patients don't need more tests from doctors; they need more time, guidance, and support from them. In my opinion, for whatever it's worth, Mark Hyman is another doctor gone astray by the lure of fame and money.

Of course, he's not the first, and he's not alone. He has his good friend Dr. Oz to keep him company.

Today, I was contacted by a Canadian reporter doing a story on Dr. Oz. She let me know that she had cited my blog in a previous story she wrote about Oz and directed me to the story.

I have often wondered if Dr. Oz actually believes it when he says that a supplement he promotes is as good as he claims or it is all showmanship. If the Dr. Oz quote from her article is accurate, it appears that he doesn't truly believe in his "miracle cures" and "magic pills." For example, in regards to raspberry ketones, he believes that it may have, at best, a marginal benefit.  He is actually quoted as saying that raspberry ketones have the value of a "nudge."  A "nudge" does not quite match the characterization of raspberry ketones as an amazing weight loss product as he claimed on his show.

The article goes on to reveal Dr. Oz's main excuse for pushing so many different products on an unsuspecting audience--which is to give people hope. After reading the article, I can only conclude that he makes such pronouncements at best to make himself seem like  a savior by giving people hope, albeit false hope at that, and at worse to make some money by promoting the sale of a product.  

Read his own words in describing himself. I couldn't make this up:

"There are three words to describe what I do. I’m a doctor. This comes from the Latin docere, teacher. I’m a physician, which comes from the Latin, physica, science. I’m a medicine man, which means healer. To help someone else, you have to have science, you have to be able to heal, and you have to be able to teach. They all work together. In Western medicine, we put a disproportionate (emphasis) on the science part."

Did he really say a "disproportionate (emphasis) on the science part." Really? What should we rely upon when it comes to your health? Opinions? Anecdotes? Marketing? 

Here's another Latin word that seems to be lacking in Dr. Oz's vernacular.  It's veritas, which means truth. Used in the motto of many leading universities including Harvard, Yale and Duke, it is the essence of education to seek and find truth.  If he were a true teacher, he would espouse the truth. It is a shame that Dr. Oz feels his audience doesn't deserve or can't handle the truth.  Instead, he gives them false hopes in the name of good TV and money-making.

May I speak for others when I say we all would like some veritas from Oz and Hyman if they wish to be considered true teachers?

I'm Sorry To Be A Party Pooper, But...

Many people love chocolate for obvious reasons. When they hear it's good for them, that's just frosting on the cake (pun intended). Over the next day or so, you are going to see and hear a tsunami of headlines, yet again, about the heart benefits of eating dark chocolate. The headlines will blare how dark chocolate prevents cardiovascular events.

This breaking news will be the result of a modeling study that predicts that patients with metabolic syndrome who eat dark chocolate every day could have 85 fewer events per a population of 10,000 over 10 years. The study, conducted by Chris Reid, PhD, of Monash University in Melbourne, Australia and colleagues was supported by a grant from a pharmaceutical company.  (For more about metabolic syndrome, please read end of blog).

The researchers used a Markov model to assess health effects and associated costs of daily consumption of plain dark chocolate compared with no chocolate in a population with metabolic syndrome but without diabetes or cardiovascular disease.

That's my first problem with the study.

It wasn't a gold standard randomized double blind controlled study. It wasn't even a good observational study. It was a mathematical calculation, and at that it only showed a benefit of .85 (yes, point eighty five) fewer heart related events per 100 people, and of the heart events, they are predicting .15 fewer events leading to death. That means for every 1000 people who eat the chocolate, there would be 1.5 fewer deaths.

Okay, you say, I get to eat chocolate and maybe I'll be the one guy or gal out of a thousand that benefits from it. So here's my real problem with the study. As a modeling study, it also made assumptions about the type of chocolate that was consumed. The researchers wrote, ""Evidence to date suggests that the chocolate would need to be dark and of at least 60% to 70% cocoa, or formulated to be enriched with polyphenols." There is no reference to the sugar content of the chocolate.

True, dark chocolate in high concentrations (usually over 75% cacao) contains polyphenols, which are healthful antioxidants. However, the sweetness in the dark (or sometimes called bittersweet) chocolate always comes from added sugar of one sort or another. This sugar is usually not healthy and is also fattening.

I know from personal experience that when I added for the purported health benefit (and the taste) one small piece (1/8 of a bar) of dark chocolate a night with 75% cacao (the higher the cacao the more sugar needed to make it enjoyable), my weight started to slightly increase from that one solo change. I stopped the practice.

If you think that this was a study that should make you go out and buy some dark chocolate, here is what the researchers said about their own study.

Reid and colleagues noted that the study was "limited by its reliance on the Framingham algorithm, which may underestimate risk in a high-risk population, and by assumptions about the risk of death following a cardiovascular event." Furthermore, "the study was also limited by the assumption that the benefits of dark chocolate, which have only been observed in short-term trials, extend to 10 years."

By the way, there are many non-processed rich sources of polyphenols in fruits and vegetables such as blueberries, black berries, strawberries, red grapes, eggplant, etc., so you don't need to eat chocolate to get your daily dose.

In conclusion, dark chocolate is better than regular chocolate. The higher the percentage of cacao, the more healthy polyphenols it contains, but watch out for the increase in carbohydrates. Nibble on no more than 1/8 of a bar at any given time. Most importantly, if you want to eat it, do it for the taste, because the heart benefits are still inconclusive.

More on Metabolic syndrome

From PubMed

Insulin resistance syndrome; Syndrome X

Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke and type 2 diabetes .

Causes, incidence, and risk factors

Metabolic syndrome is becoming more and more common in the United States. Some estimate it as affecting 25% of the U.S. population. Researchers are not sure whether the syndrome is due to one single cause, but all of the risks for the syndrome are related to obesity.

The two most important risk factors for metabolic syndrome are:

• Extra weight around the middle and upper parts of the body (central obesity). The body may be described as "apple-shaped."
• Insulin resistance, in which the body cannot use insulin effectively. Insulin is needed to help control the amount of sugar in the body. As a result, blood sugar and fat levels rise.

Other risk factors include:

• Aging
• Genes that make you more likely to develop this condition
• Hormone changes
• Lack of exercise

People who have metabolic syndrome often have two other problems that can either cause the condition or make it worse:

• Excess blood clotting
• Low levels of inflammation throughout the body

Symptoms

• Extra weight around your waist (central or abdominal obesity)

Signs and tests

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:

• Blood pressure equal to or higher than 130/85 mmHg
• Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
  
  • Men - 40 inches or more
  • Women - 35 inches or more
• Low HDL cholesterol:
  
  • Men - under 40 mg/dL
  • Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

Tests that may be done to diagnose metabolic syndrome include:

• Blood pressure measurement
• Fasting glucose test
• HDL cholesterol level
• LDL cholesterol level
• Total cholesterol level
• Triglyceride level

Treatment

The goal of treatment is to reduce your risk of heart disease and diabetes. Your doctor will recommend lifestyle changes or medicines to help reduce your blood pressure, LDL cholesterol, and blood sugar.
Recommendations include:

• Lose weight. The goal is to lose between 7% and 10% of your current weight. You will probably need to eat 500 - 1,000 fewer calories per day.
• Get 30 minutes of moderate intensity exercise, such as walking, 5 - 7 days per week.
• Lower your cholesterol using weight loss, exercise, and cholesterol lowering medicines, if needed.
• Lower your blood pressure using weight loss, exercise, and medicine, if needed.

Some people may need to take daily low-dose aspirin.
People who smoke should quit.

Expectations (prognosis)

People with metabolic syndrome have an increased long-term risk for developing cardiovascular disease and type 2 diabetes.

Complications

• Atherosclerosis
• Diabetes
• Heart attack
• Kidney disease
• Nonalcoholic fatty liver disease
• Peripheral artery disease
• Stroke
  

Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

Just Look In the Mirror

I read an interesting article yesterday on the Fox Business website titled DIY health care: The trouble with direct-to-consumer health screenings. DIY stands for Do It Yourself.

The gist of the article describes the dangers associated with participating in unsolicited screening tests offered by commercial, usually mobile, companies. The article states that if "you get a letter in the mail inviting you to participate in a simple, potentially lifesaving screening to assess your risk for stroke, abdominal aortic aneurysms and other scary stuff, you should probably toss it out with the rest of the junk mail."

The article gives several reasons. One reason is the perils of self-diagnosis. (See my blog from March 14 titled, Are You A Doctient?) The article states, "People might buy direct-to-consumer health screenings for their own self-diagnosis and self-treatment for symptoms of disease. "It's difficult for the lay public to really appreciate the nuances and wholly understand the difference between screening and diagnostic testing. Many patients seek screening tests for symptom diagnosis. These patients can be dangerously falsely reassured by normal results if they have chosen the wrong test, or even led in the wrong direction with abnormal results."

The article adds, "Additionally, many of the medical screening tests are not supported by evidence-based guidelines and therefore expose patients to tremendous and unnecessary harm. "The data has shown that many of these tests [when used for disease screening] will produce far more harm than benefit for most patients." (See my blog on April 5 about unnecessary tests).  

One more consideration. According to Linda Sherry, director of national priorities for Consumer Action, agrees. "These tests have limited or no diagnostic value and may trigger stress [and] fear, and encourage further, more expensive testing to rule out false positives. Insurance won't pay for them unless they are ordered by a doctor for diagnostic reasons, not preventive reasons."

If you're looking to save money, "you can take your own blood pressure at most pharmacy chains and many communities have health screening days designed to educate people about symptoms that might require follow-up," says Sherry.

Read more: http://www.foxbusiness.com/personal-finance/2012/05/02/diy-health-care-trouble-with-direct-to-consumer-health-screenings/#ixzz1toa6ivop

On a personal note, I participated in such a screening program about a year ago offered by Lifeline Screening. I went for the whole megilla. I did so as part research and part curiosity. A routine blood sugar measurement revealed that I had a 105 level. Such a level is construed as elevated. (by the way, I noticed the tech eating a fruit shortly before th test and contact witht eh fruit could have skewed my result.) 

When sharing the blood results with me, the concerned technician told me that I was pre-diabetic and I should "watch" my number. The absurdity of the statement struck me immediately. What did "watch" my number even mean? He didn't tell me to consult with a physician. He just told me to "watch." Did he mean for me to use his services again to see how the number changed? He didn't say, but I suspect as much. Being pre-diabetic is a warning sign that requires intervention before you progress to full blown diabetes. Telling me to "watch" my number was worthless.

So what's a person to do?  I say instead of relying on marketing solicitations for tests that you probably don't need and should generally only be ordered by a physician when you do need them, let me offer some practical alternatives.

First get on a scale. Then calculate your BMI. Here's a good site to calculate it:

http://www.nhlbisupport.com/bmi/  

If your BMI is over 25, you are in unhealthy territory. Over 30 you are in a real danger zone. Over 40, start saying your goodbyes if you don't do something immediately about it.

Next measure your waist circumference. If you have a bulge around your waste, that typically means you are accumulating the unhealthy type of fat cells called white fat cells. They predict problems and just like with an elevated BMI, you should initiate changes to your lifestyle to improve your health prospects.  I recommend starting with a physician consultation and then moving on to a nutritionist and fitness instructor. If stress and/or sleep are a problem, consult a psychologist as well.

Finally, take a long, hard look at your naked self in the mirror. Do you see a healthy, vibrant, relaxed, age appropriate person in the mirror or a tired, slumped, over- or under-weight, stressed-out individual? Be honest with yourself. If you look good, you probably feel good and you are probably doing well. But if you look worn-out, haggard, depressed, older than your age, I think it's time to get serious about your health and to develop a personal wellness plan.By the way, while you are looking, check for any abnormal growths on any aspect of your body front and back, top and bottom.

Try doing this once a month to take stock of your life and health. It's free, it's easy and it will provide much valuable information that will not lead to unnecessary and expensive testing. So the next time you get a solicitation from a testing company, try making an airplane out of it for fun. Nevertheless, listen to your body and if you have any concerns, consult a physician.

Money and obesity. Is there a link?

It's a staple of popular belief, even cited by First Lady Michelle Obama, that poor neighborhoods are food deserts, generally void of healthy fare. As a result, it is believed that  socioeconomically challenged people are nutritionally disadvantaged because they cannot access nutritionally-sound food, which results in increased solicitation of fast food restaurants and a higher incidence of obesity. Well it turns out, based on two new studies, that such neighborhoods may, in fact, be food swamps, concentrated with a high density of grocery stores and supermarkets in addition to the fast food establishments.

To quote the NY Times, "Such neighborhoods not only have more fast food restaurants and convenience stores than more affluent ones, but more grocery stores, supermarkets and full-service restaurants, too. And there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents."

Okay, so I guess you may say we can cross that cause off the obesity list.  I say hold your horses.

First, even though stores like groceries and supermarkets may be present, the studies revealed nothing about pricing. Over the course of my lifetime, I have read and witnessed numerous cases of predatory pricing in poorer neighborhoods. There have been a number of publicly reported mortgage scams involving companies charging higher rates and costs to poorer people. I know of clothing stores located in poor neighborhoods that charge a premium for their wares because they know that convenience is more important for their customers who can't easily get to malls and mainstream stores to shop comparatively. So just because the stores are in the neighborhoods doesn't mean they sell affordable healthy food.

Second, it takes more time, effort, and decision-making to prepare healthy food versus buying fast food.  In his book, Willpower, Roy Baumeister lays out a cogent argument that willpower is a function of decision-making--the more decisions you make the less willpower you have. He bases this on studies that show that decisions require neurotransmitters which rely on blood sugar. As decisions are made, sugar is depleted, and fatigue takes hold unless sugar is replenished. (This is not an excuse nor should it be construed as a reason to consume white sugar products; rather, it merely indicates that eating throughout the day complex carbohydrates found in fruits and vegetables allows for better decision-making.)

Baumeister gives the example of the car buying experience. Devious or clever car dealers, you make the call, exhaust your decision-making ability early with your choosing the free stuff such as interior and exterior colors and then wait until the end of the process to entice you with the expensive add-ons. (Next time you buy a car, eat well before you go and start with the add-ones.) Another example he gives in that in the Israeli penal system, paroles are less likely to be granted before lunch and at the end of the day, and more likely at the start of the day and after lunch. The reason he gives is that when their decision-making has been taking place for a while, the parole board members become more wary of making bad decisions and err on the side of caution by denying parole. The study he cites states that it made no difference whether it was an Arab or Jew that were up for parole; instead, the time of day was a major deciding factor. (By the way, the Israeli's addressed this finding by providing fruit snacks to the parole board members throughout the day.)

It's been said that the only people who think more about money than rich people are poor people who think of nothing else. Applying Baumeiter's thesis to poor people, by the time they need to make dinner plans, they are mentally depleted from the numerous decisions they needed to make all day, which are far in excess of the more affluent. So let's cut poor people some slack for making poor dietary decisions at the end of the day.

Now don't get me wrong. I'm not condoning this sad state of affairs nor dismissing it as incurable. The facts remain that poor people experience more obesity than wealthier people, although there are plenty of overweight and even obese "rich" people and plenty of fit and well-nourished "poor" people. Nevertheless, society has a serious problem wanting a definitive solution.

The solutions to the obesity epidemic are not easy regardless of what some pundits argue. It will take the concerted effort of public and private crusaders to teach people the true value of good food choices,  provide consistent access to affordable "healthy" foods, and the support and guidance of the the health care industry to effect real change. The pace to date has been slow but the topic has gotten much attention of late and let's hope it stays on everyone's radar and a solution is found.

In the interim, here's a new recipe my daughter shared with me. Kale, a type of cabbage-like, green leafy vegetable, has the highest nutrient density of virtually any vegetable and should be part of a healthy diet.

Cut off and put the the leaves of Kale into a bowl
Tenderize the leaves with lemon juice.
Add a touch of olive oil and a dash of salt.
Cut mango slices into the salad and add pumpkin or pine nuts.
You may also add a tsp of honey if needed.

This salad blows me away and I suspect you will love it as well. Hearty appetite!

An Enemy of The People

It's been some time since I read Henrik Ibsen's An Enemy of the People, a novel about a town doctor decrying the health risks associated with the hot springs in the town which everyone thinks is otherwise healthy and is also key to their economic futures.

I belong to a group of health, wellness, and fitness professionals on LinkedIn. In response to a comment about who takes supplements, I weighed in about the tsunami of recent data that suggests that supplements may actually be harmful. Given that many members of the group sell such supplements, the reaction was swift and harsh. The doctors in the group who sell such supplements took an even angrier stance. It was as if I was threatening their livelihood, which I was apparently doing by speaking out against rampant supplement use.

I'm not surprised. We all know the effect that money can have on certain people. The arguments went back and forth with me asking for scientific evidence that their supplements work to prolong life and them countering it doesn't matter what the science shows as long as people say they feel better. Of course that led to a discussion about the placebo effect, but that resulted in my being lectured on people having a right to express their opinion. I agree that people have the right to express an opinion. I simply don't agree that they can state as fact that which lacks any supporting evidence.

However, what I found most interesting were the people who contacted me privately to say they agreed with me. Apparently, they were afraid to address the angry crowd directly.

Unable to refute me scientifically, the arguments turned more poetic with quotes from Robert Frost and some authors unknown to me.

Notwithstanding, by the end of the discourse, I was able to answer some people's questions, such how to treat a Vitamin D deficiency and perhaps, I was no longer the lone doctor warning the town of the dangers that lurked within. My day as an enemy of the people was done-at least for now.