Was George W. Bush's stent necessary?

The controversy surrounding the proper treatment of stable heart disease was highlighted this week by former President George W. Bush’s decision to have a stent placed, even though he had not had a heart attack and was not experiencing angina (chest pain caused by restricted blood flow to the heart). During an annual exam, his stress test showed an abnormality; then an angiography showed a blockage, and President Bush and his physicians decided to proceed with stenting. Of course, we don’t know all the details of President Bush’s condition, but the situation brings to light an important issue in healthcare in the U.S.: having a stent placed in the absence of symptoms is common in the U.S., but is it good medicine or malpractice?

Heart

I have written previously about the COURAGE trial – a large and important study published in 2007, whose conclusion was that angioplasty and stent procedures (percutaneous coronary interventions or PCI) did not offer any survival advantage over medications alone. After five years of follow-up, the group of patients receiving PCI did not have fewer heart attacks or cardiac deaths than the group who received optimal medical therapy (OMT; modest lifestyle changes plus anti-platelet, blood pressure-lowering, and cholesterol-lowering medications).1  Later on, meta-analyses of COURAGE and similar trials have confirmed the lack of advantage of PCI over OMT.2,3 Further studies confirmed that PCI also did not provide any advantage over OMT for relief of angina symptoms (read more here).4 In light of this data, 2012 guidelines from the American Heart Association and related health agencies recommend medical therapy and lifestyle changes rather than these interventional or surgical procedures for first-line treatment of most patients with stable ischemic heart disease to reduce the risk of heart attack and death.

So, having an angioplasty or stent procedure does not provide any added protection against heart attacks or cardiac deaths in patients with stable coronary artery disease. But is there any harm in performing these procedures?  

With every surgical procedure, there are risks and side effects. These aggressive coronary interventions carry the risk of serious adverse outcomes, such as bleeding complications, heart attack, stroke, and death.5 Stenting is appropriate and can be lifesaving in emergency situations, for immediate clearing of an artery and restoration of blood flow. But as the COURAGE trial has shown, for stable patients, stents do not offer benefit. In addition, stenting is of course more expensive than medications and lifestyle changes, adding to our current health care spending crisis. A cost-effectiveness analysis of the COURAGE trial estimated that PCI added $10,000 to the lifetime cost of treatment without providing any significant gain in lifespan.6 Multiply that $10,000 by the number of angioplasty and stent procedures performed in the U.S. every year, which is about 492,000 (the vast majority are non-emergency procedures).7

PCI is not a long-term solution to coronary artery disease.  Approximately 21% of stent placements clog up again (called restenosis) within 6 months, and about 60% of arteries treated by angioplasty and stenting eventually will undergo restenosis.8,9 PCI treats only a small portion of a vessel, while atherosclerotic plaque continues to develop at many sites throughout the cardiovascular system.  Most often the most risky and vulnerable plaque areas are not those that are most obstructing and treated with stenting.  It is worse because the patient is led to believe they are now protected and continues the dangerous eating style that was the initial cause of the heart disease; consequently, the heart disease progresses. 

President Bush needed aggressive nutritional counseling and potentially life-saving nutritional information. It sounds like he was not properly informed of these studies documenting the ineffectiveness of PCI and the value of the proper dietary intervention. If not, I consider that malpractice. Every potential candidate for angioplasty (PCI) should know that their disease can be effectively reversed via superior nutrition and that surgical interventions are not protective against future events. Remember too, that almost half of all those on optimal medical therapy for high cholesterol and high blood pressure, still ultimately suffer heart attacks. Was President Bush informed about Dr. Ornish’s Lifestyle Heart Trial, which scientifically documented that lifestyle changes alone can reverse coronary artery disease? Even President Clinton could have shared his experience and expertise, since he worsened after his PCI and is doing well after adopting a healthy vegan diet. Who knows what happened, but it seems unlikely given the media reports. It sounds like President Bush was misinformed about PCI by his doctors and given the false impression this procedure was life-extending and lifesaving. Certainly the media reports are giving this impression to the American people that this procedure was necessary for him.

Every day, patients are counseled to undergo these unnecessary and potentially dangerous procedures by their cardiologists. Instead, an arterial blockage should be seen as a wake-up call, a motivating factor to pursue optimal health via superior nutrition and exercise. Optimal medical therapy is not enough; heart disease is preventable and reversible with optimal nutritional therapy, which produces dramatically more effective results than PCI or OMT and dramatic protection against future cardiac events. In my clinical experience with hundreds of patients with advanced heart disease, I have seen dramatic and consistent reversal of heart disease, relief of angina symptoms, and future freedom from heart disease in those who have chosen to follow my Nutritarian eating style.  President Bush and his doctors had an opportunity to be a public example to educate and motivate other Americans to change their dangerous ways. I hope in the future President Bush has the opportunity to make a lifesaving decision based on accurate information, before it is too late.

 

Read stories of heart disease reversal with a Nutritarian diet.


References:
1. Boden WE, O'Rourke RA, Teo KK, et al: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-1516.
2. Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, et al: Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet 2009;373:911-918.
3. Stergiopoulos K, Brown DL: Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med 2012;172:312-319.
4. Relief from Angina Symptoms: Percutaneous Coronary Intervention Not a Clear Winner. 2010. Journal Watch General Medicine. Accessed July 1, 2010.
5. Angioplasty and stent placement - heart. MedlinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/007473.htm. Accessed July 1, 2010.
6. Weintraub WS, Boden WE, Zhang Z, et al: Cost-effectiveness of percutaneous coronary intervention in optimally treated stable coronary patients. Circ Cardiovasc Qual Outcomes 2008;1:12-20.
7. Go AS, Mozaffarian D, Roger VL, et al: Heart Disease and Stroke Statistics--2013 Update: A Report From the American Heart Association. Circulation 2013;127:e6-e245.
8. Agostoni P, Valgimigli M, Biondi-Zoccai GG, et al: Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J 2006;151:682-689.
9. Hanekamp C, Koolen J, Bonnier H, et al: Randomized comparison of balloon angioplasty versus silicon carbon-coated stent implantation for de novo lesions in small coronary arteries. Am J Cardiol 2004;93:1233-1237.

Devastating bee losses threaten the food supply

In recent years, you have most likely heard about Colony Collapse Disorder (CCD), a mysterious and devastating loss of bee colonies in the U.S., Canada and Europe.  The first reports of these unexplained and catastrophic bee deaths began in 2006. In the 2006-2007 season, CCD affected about 23% of commercial U.S. beekeepers, and some beekeepers lost 90% of their hives. Since then, CCD has showed no signs of slowing; substantial yearly losses of bees, 30 percent or higher, have become the norm.1,2

Bee. Flickr: blathlean

In 2007, some answers began to surface. Scientists began to identify viruses in U.S. bee colonies that had suffered CCD.1 Soon, it was known that healthy and CCD-stricken colonies were plagued with numerous viruses and parasitic microbes, and seemed to have impaired ability to produce proteins that protect against infection.2,3  Scientists then began to ask whether there was an environmental factor that was causing the bees to be vulnerable to viral attack.

In early 2012, two studies published in Science implicated a class of pesticides called neonicotinoids.

In these studies, bees exposed to neonicotinoids exhibited a reduced growth rate, produced fewer queens, or  had impaired navigation and food-gathering abilities; the scientists concluded that neonicotinoids, although the commonly encountered doses may not be directly lethal to bees, could contribute to CCD in an indirect way, by harming bees’ abilities to grow, return home to their hives or get adequate nutrition.4-6 Now that several additional studies have now found similar negative effects on bee behavior and cognition, evidence that neonicotinoids harm bees and are a major contributor to CCD has grown more convincing.7-9

Neonicotinoids began to be used in the 1990s, as less-toxic-to-humans alternatives to organochlorine and organophosphate pesticides.  An important point about these pesticides is that they are usually used in a “systemic” manner; when crops are treated, the pesticides spread throughout all parts of the plant, including the nectar and pollen. Bees are exposed to these pesticides via many major commercial crops including canola, corn, cotton, sugar beet and sunflower; plus many vegetable and fruit crops.5,6,10

Bans on neonicotinoids in Europe; not in the U.S.

The pesticide industry and some scientists claim that the evidence against neonicotinoids is not yet conclusive, but it has been convincing enough for some agencies to propose bans on these pesticides as a safety measure. The European Food Safety Authority, for example, produced a report in January 2013 concluding that neonicotinoids pose unacceptable risks for bees and should not be applied to flowering crops. As a result, a 2-year suspension was proposed in the European Union, and  was passed in late April – it will go into effect December 1.11,12 Currently, France and  Germany have partial bans on neonicotinoid use.13

In March, a coalition of beekeepers and environmental interest groups filed a lawsuit against the U.S. Environmental Protection Agency, alleging that they have failed to protect bees and the crops they pollinate by rushing neoniconitnoids to market with inadequate review. The EPA has accelerated its schedule for reevaluating the safety neonicotinoids, however the review itself is scheduled to take another five years.  The USDA and EPA released a joint report last week on U.S. honeybee health, stating that multiple factors contribute to bee colony declines, and that further research is required to determine the risks posed by pesticides. However, the report does acknowledge , “Laboratory tests on individual honey bees have shown that field-relevant, sublethal doses of  some pesticides have effects on bee behavior and susceptibility to disease.”

What can we do?

This is a sincere emergency to our organic farming movement and to the global food supply, to lose the natural way flowering plants are pollinated.   Bees are crucial for pollination of many crops such as apples, almonds, and citrus fruits. According to the U.N., about 70% of the crops that provide 90% of human food are pollinated by bees.14 We are dependent on bees, and they are disappearing rapidly. It is alarming to say the least.

Online petitions (sign here and/or here) have been started, aiming to urge the EPA to take action before 2018 and suspend neonicotinoid use on flowering crops frequented by bees as a safety precaution.  You can also take action at home.  Since wild bee populations are also declining, in part due to loss of habitat, you can help by providing bees with new habitats. You can plant a garden of vegetables and plenty of bee-friendly flowers, or even become a backyard beekeeper (find information and resources here and here). Additionally, by purchasing local and/or organic produce and eating primarily unrefined plant foods, you avoid monetarily supporting the largely genetically modified crops (corn, canola, sugar beets, etc.) that neonicotinoids are primarily used on.

 

Image credit - Flickr: blathlean 

References:


1. Grant B: Culprit of bee woes identified? 2007. The Scientist. http://www.the-scientist.com/?articles.view/articleNo/25405/title/Culprit-of-bee-woes-identified-/. Accessed May 9, 2013.
2. Runckel C, Flenniken ML, Engel JC, et al: Temporal analysis of the honey bee microbiome reveals four novel viruses and seasonal prevalence of known viruses, Nosema, and Crithidia. PLoS One 2011;6:e20656.
3. Grant B: Bee calamity clarified. 2009. The Scientist. http://www.the-scientist.com/?articles.view/articleNo/27605/title/Bee-calamity-clarified/. Accessed May 9, 2013.
4. Richards S: Pesticide Problems for Bees. 2012. The Scientist. http://www.the-scientist.com/?articles.view/articleNo/31886/title/Pesticide-Problems-for-Bees/. Accessed May 9, 2013.
5. Henry M, Beguin M, Requier F, et al: A common pesticide decreases foraging success and survival in honey bees. Science 2012;336:348-350.
6. Whitehorn PR, O'Connor S, Wackers FL, et al: Neonicotinoid pesticide reduces bumble bee colony growth and queen production. Science 2012;336:351-352.
7. Gill RJ, Ramos-Rodriguez O, Raine NE: Combined pesticide exposure severely affects individual- and colony-level traits in bees. Nature 2012;491:105-108.
8. Williamson SM, Wright GA: Exposure to multiple cholinergic pesticides impairs olfactory learning and memory in honeybees. J Exp Biol 2013.
9. Palmer MJ, Moffat C, Saranzewa N, et al: Cholinergic pesticides cause mushroom body neuronal inactivation in honeybees. Nat Commun 2013;4:1634.
10. Grossman E: Bee protection: US in spotlight as EU bans pesticides. 2013. Guardian Environment Network. http://www.guardian.co.uk/environment/2013/apr/30/bee-protection-us-eu-bans-pesticides. Accessed
11. Flores G: A Political Battle Over Pesticides. 2013. The Scientist. http://www.the-scientist.com/?articles.view/articleNo/35058/title/A-Political-Battle-Over-Pesticides/. Accessed May 9, 2013.
12. Cossins D: Europe to Ban Neonicotinoids. 2013. The Scientist. http://www.the-scientist.com/?articles.view/articleNo/35355/title/Europe-to-Ban-Neonicotinoids/. Accessed May 9, 2013.
13. U.S. Environmental Protection Agency. Colony Collapse Disorder: European Bans on Neonicotinoid Pesticides [http://www.epa.gov/pesticides/about/intheworks/ccd-european-ban.html]
14. Jolly D: Europe Bans Pesticides Thought Harmful to Bees. 2013. The New York Times. http://www.nytimes.com/2013/04/30/business/global/30iht-eubees30.html?_r=0. Accessed

 

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Sugary drinks linked to hundreds of thousands of deaths worldwide

Just a week after the New York Supreme Court struck down Mayor Bloomberg’s proposed large sugary drink ban, which would have prohibited the sale of beverages larger than 16 ounces in many food outlets, research was presented at an American Heart Association meeting that linked consumption of sugar-sweetened beverages to hundreds of thousands of deaths worldwide – 180,000 deaths per year.

Soda bottles. Flickr: dcJohn

Fruit-flavored drinks, sports drinks, energy drinks, soda, sweetened iced teas, etc. are consumed in huge quantities in the modern world. The average American consumes 22.2 teaspoons of added sugar daily, equating to 355 calories. Teens consume even more – 34.3 teaspoons or 549 calories a day, and half of the added sugars in the typical American diet come from sweetened drinks, mostly soda.1, 2

It is no secret that these sugary beverages are a threat to human health. Sugary drinks have very low satiety value, and extremely low to zero micronutrient content; the link between these beverages and weight gain is well-documented.3 However, these liquid calories carry more danger than excess calories alone – sugary drinks are powerfully disease-promoting.

Sugary drinks provide their huge calorie load with no fiber, and no chewing required; the sugar is consumed and then hits the bloodstream almost instantly. The surge of glucose in the blood (and fructose in the liver) sets off complex pathways in the body that, over time, contribute to insulin resistance, increased visceral fat mass, elevated cholesterol, triglycerides and blood pressure, and cancer cell survival and proliferation.4-8 Consumption of added sugars or sugar-sweetened beverages has been linked to diabetes, cardiovascular disease, and cancers.2, 9-15 There are also strong links between hyperinsulinemia (excess insulin in the blood, a consequence of excess blood glucose) and certain cancers.7, 16-19  

Researchers gathered data from the World Health Organization on sugary drink consumption, obesity and chronic disease in 114 countries. Knowing that sugary drinks promote obesity, and obesity is a risk factor for chronic diseases, they investigated the association between sweetened beverage consumption and obesity in the different countries, and then analyzed deaths from obesity-related chronic disease.  

These are their conclusions – estimates of the number of deaths per year that may be attributed to sugar sweetened beverages:20

  • Total deaths worldwide: 180,000

  • Total deaths in the U.S.: 25,000

  • Deaths from diabetes worldwide: 133,000

  • Deaths from cardiovascular disease worldwide: 44,000

One-hundred and eighty thousand deaths each year could possibly be prevented by simply drinking water instead of soda?

These estimates don’t even take into account the added sugars in breakfast cereals, baked goods, candy and ice cream that are so prevalent in the American diet – not to mention the oils, fried foods, white flour, white rice and animal products. Imagine the number of deaths that could be prevented, the health care costs that could be saved, and the excellent health our nation could enjoy by not just cutting out sugary drinks, but following a health-promoting Nutritarian lifestyle. Preventable diseases are our major killers, and we have the power to protect ourselves with superior nutrition.

It is clear that sugary drinks are disease-causing and each of us can make the simple choice to avoid disease-causing substances. The addictive properties of excessively sweet foods may make this choice difficult for many people, but hopefully research like this will reach many who are sick and overweight on the American diet, and help them to build the motivation they need to abstain from disease-causing sugary drinks. 

 

References:
1. Center for Science in the Public Interest. Sugar: Too Much of a Sweet Thing [http://cspinet.org/new/pdf/infographic_full.pdf]
2. Johnson RK, Appel LJ, Brands M, et al: Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009, 120:1011-1020.
3. Malik VS, Schulze MB, Hu FB: Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006, 84:274-288.
4. Stanhope KL, Schwarz JM, Keim NL, et al: Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 2009, 119:1322-1334.
5. Cohen L, Curhan G, Forman J: Association of Sweetened Beverage Intake with Incident Hypertension. J Gen Intern Med 2012.
6. Maersk M, Belza A, Stodkilde-Jorgensen H, et al: Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr 2012, 95:283-289.
7. Arcidiacono B, Iiritano S, Nocera A, et al: Insulin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp Diabetes Res 2012, 2012:789174.
8. Port AM, Ruth MR, Istfan NW: Fructose consumption and cancer: is there a connection? Curr Opin Endocrinol Diabetes Obes 2012, 19:367-374.
9. Fagherazzi G, Vilier A, Saes Sartorelli D, et al: Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr 2013.
10. Malik VS, Hu FB: Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages. Curr Diab Rep 2012.
11. Malik VS, Popkin BM, Bray GA, et al: Sugar Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A Meta-analysis. Diabetes Care 2010.
12. Basu S, Yoffe P, Hills N, et al: The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PLoS One 2013, 8:e57873.
13. Bernstein AM, de Koning L, Flint AJ, et al: Soda consumption and the risk of stroke in men and women. Am J Clin Nutr 2012.
14. Friberg E, Wallin A, Wolk A: Sucrose, high-sugar foods, and risk of endometrial cancer--a population-based cohort study. Cancer Epidemiol Biomarkers Prev 2011, 20:1831-1837.
15. De Stefani E, Deneo-Pellegrini H, Mendilaharsu M, et al: Dietary sugar and lung cancer: a case-control study in Uruguay. Nutr Cancer 1998, 31:132-137.
16. Bowker SL, Majumdar SR, Veugelers P, et al: Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin: Response to Farooki and Schneider. Diabetes Care 2006, 29:1990-1991.
17. Gunter MJ, Hoover DR, Yu H, et al: Insulin, insulin-like growth factor-I, endogenous estradiol, and risk of colorectal cancer in postmenopausal women. Cancer Res 2008, 68:329-337.
18. Gunter MJ, Hoover DR, Yu H, et al: Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 2009, 101:48-60.
19. Pisani P: Hyper-insulinaemia and cancer, meta-analyses of epidemiological studies. Arch Physiol Biochem 2008, 114:63-70.
20. 180,000 deaths worldwide may be associated with sugary soft drinks. American Heart Association Meeting Report.

Americans have poorer health and shorter lives than peers

A new report from the Institute of Medicine and the National Research Council revealed bleak statistics on the comparative health of the citizens of the United States compared to sixteen other high-income countries.

The report revealed that Americans have been dying earlier, on average, than almost all other countries. Of the sixteen countries ranked, American males ranked last in life expectancy and American females ranked sixteenth out of seventeen. The report notes that this trend has been ongoing and progressively worsening since 1980; Americans are dying prematurely with poorer health during their lives. The report states:

“The tragedy is not that the United States is losing a contest with other countries but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”

The report identified nine key areas in which Americans demonstrate poorer health status; a few of note are the direct results of poor nutrition and lifestyle habits: obesity, diabetes and heart disease. Out of the 17 countries, the U.S. was ranked 2nd in the number of ischemic heart disease deaths and 3rd in diabetes deaths. Americans consume more calories per person than any other country in the world, and our eating habits are killing us. Obesity was a significant contributor to the shortened life expectancy observed in Americans; obesity accounted for 42 percent of the reduction in life expectancy American females and 67 percent of the reduction in males.

It is well known that the U.S. spends more money on health care per person than any other nation.

Photo of falling money

The report noted that Americans have greater “control” over blood pressure and cholesterol levels, and still have the next-to-highest death rate from ischemic heart disease. We take more medication for heart disease risk factors, and yet are more likely to die from heart disease. We spend the greatest amount of money, and die the earliest. More medical care does not buy better health.

It’s time for our country to wake up. Our health, happiness, and economic stability are suffering at the hands of our dietary choices.

There were several additional non-nutritional factors that contributed to the relatively short life expectancy of Americans, including infant mortality rate, injuries and homicides, drug-related deaths, HIV and AIDS.  In addition to disease-causing eating habits, behavioral factors such as drug abuse, lack of seat belt use, drunk driving and gun violence are contributing to the poor health and shorter lifespan of Americans. The report also cited deficits in our health care system, higher levels of poverty and income inequality than other countries, and geographical environments built around cars, which discourage physical activity.

Clearly, there are some issues not under our individual personal control that must be tackled by public policy. However, this report also highlights those factors that we as individuals can address – today – to increase our own likelihood for a long and healthy life: our weight and our risk for type 2 diabetes and heart disease.

Excess weight, heart disease, and diabetes are inevitable consequences of the standard American diet plus inactivity, but they are not truly inevitable. We can prevent these conditions by making wiser food choices and prioritizing physical activity. Each of us must take responsibility for our own health and longevity. A high-nutrient diet based on protective plant foods is an excellent place to start.

 

Reference:

Institute of Medicine of the National Academies. U.S. Health in International Perspective: Shorter Lives, Poorer Health. January 9, 2013. http://www.iom.edu/Reports/2013/US-Health-in-International-Perspective-Shorter-Lives-Poorer-Health.aspx

Overweight people live longer; yeah right!

Right on the front page of every newspaper and news outlet today was “Overweight People Live Longer." Two-thirds of Americans are overweight or obese, and they are generally aware excess fat on the body is not healthy.  So when word of a study like the recent one on body mass index (BMI) categories and mortality starts spreading through the news outlets, everyone listens, and many take the conclusions to be fact. Sadly this kind of news coverage does a disservice to an already overweight and misguided public, allowing them to believe that their excess body fat won’t harm them and influence many to maintain or add some pounds.  I wonder how much more breast cancer and how many needless deaths this information will cause. 

This was a meta-analysis, pooling data from different studies that analyzed death from all causes with consideration of various BMI categories (normal weight: 18.5 – 24.9; overweight: 25.0 – 29.9; obesity: 30 or greater). The researchers found a small (6 percent) reduction in the risk of all-cause mortality for overweight compared to normal weight individuals, and an 18% increase in risk for obese compared to normal weight individuals.1

Does that mean almost every study on fitness, and the benefits of dietary excellence in the last 40 years was wrong?  So, should we nutritarians pack on some extra pounds, exercise less, eat some cheese doodles and lounge on the couch watching more TV, so we can live longer?  Hah, and the moon is made of green cheese too.  This paper found an association here between lower BMI and a slight decrease in mortality rate, but for a variety of reasons, this is bad science and should never have been reported.

This study is essentially worthless because it did not exclude people with chronic disease recorded at baseline.  Sick people become thinner.  It is well known that illnesses cause a lower body weight.  The American diet is so disease-causing and weight-promoting that almost all relatively healthy people become overweight, leaving mostly the chronically ill and those with occult illnesses (not yet diagnosed) at a normal or near normal weight. 

A number of medical conditions may cause unintentional weight loss, including depression, anxiety, alcoholism, drug addiction, autoimmune diseases, occult cancer and digestive disorders. What proportion of the normal weight group had one or more of these conditions?  The study did not say, but the list below suggests that it’s a large proportion of those in the normal weight category.   The fact is, the American diet is so fattening and unhealthy that if someone is eating the American diet and is not overweight, they most likely have something wrong with them. Below is a list of conditions that cause weight loss, and the estimated prevalence of these conditions in the general population:

  • Alcoholism – 12.5%.2
  • Anxiety disorders - 18%.3
  • Asthma - 7.7%.4
  • Autoimmune Disorders – 7.6-9.4% 5
  • Celiac disease – 1%.6
  • COPD – 5.1%.4
  • Depression – 8%.7
  • Drug addiction – 2.6%.8
  • Irritable Bowel Syndrome – 10%.9

Depression, Anxiety and Alcoholism alone could account for the findings in this study and affect about 20 percent of the population.  Plus the study did not consider subclinical disease, in other words medical problems that have not yet been diagnosed.  For example, there are many with some hidden cancer, not yet diagnosed (called occult cancer) that keeps them thin.  Studies like this always underestimate the impact of overweight and obesity on premature mortality. 

Plus, the only measured outcome was all-cause mortality.  We still see increasing mortality from diabetes and heart disease as weight increases and the increased mortality in the normal weight group was from more unusual causes.  We also know that the overweight live a lower quality life – with heart disease, arthritis, or another lifestyle-related disease or disability. Excess weight is known to increase the risk of type 2 diabetes, heart disease, stroke, elevated blood pressure and cholesterol, liver disease, gallbladder disease, sleep apnea, arthritis, and impotence and infertility.10 Let’s not ignore all that.  

In the end, what we can conclude from this study is that many researchers are confused about health and nutrition and because of that their work can just add more confusion.   With the majority of Americans significantly overweight many must be rejoicing in line at those fast food joints after hearing this today.  So please don’t skip the gym and head out to Drunkin Doughnuts tonight for some deep fried flour and sugar with artificial colorings and flavorings.  There is no getting around, you are what you eat.    

 

References: 

1. Flegal KM, Kit BK, Orpana H, et al: Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013;309:71-82.
2. Hasin DS, Stinson FS, Ogburn E, et al: Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2007;64:830-842.
3. National Institute of Mental Health: Anxiety Disorders. http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml. Accessed January 3, 2013.
4. Akinbami LJ, Moorman JE, Bailey C, et al: Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief 2012:1-8.
5. Cooper GS, Bynum ML, Somers EC: Recent insights in the epidemiology of autoimmune diseases: improved prevalence estimates and understanding of clustering of diseases. J Autoimmun 2009;33:197-207.
6. Talluri SK, Besur S, Talluri J: Abstract #74: A Population-Based Survey of Celiac Disease in the United States. In 2012 National Conference on Health Statistics; 2012.
7. Centers for Disease Control and Prevention: FastStats. Depression [http://www.cdc.gov/nchs/fastats/depression.htm]
8. Compton WM, Thomas YF, Stinson FS, et al: Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2007;64:566-576.
9. El-Serag HB: Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord 2003;3 Suppl 2:S3-11.
10. U.S. Centers for Disease Control and Prevention: Overweight and Obesity Causes and Consequences. [http://www.cdc.gov/obesity/adult/causes/index.html]

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Dr. Fuhrman discusses nutritional research with Dr. Dean Ornish

 by Jerry Deutsch
Executive Director,Nutritional Research Foundation

 

A meeting of two of the most respected leaders in the field of nutrition and nutritional research took place last week when Dr. Fuhrman and Dr. Ornish met in California. 

Dr. Ornish and Dr. Fuhrman

 

As the Executive Director of the Nutritional Research Foundation I was very fortunate to attend this meeting and now write about it.  

As there are not many physicians and clinical nutrition researchers with their common interests and expertise, Dr. Fuhrman and Dr. Ornish had been communicating by phone and email.  It is hard to believe that it has taken this long for them to meet in person and become friends.  Last week Dr. Fuhrman visited Dr. Ornish’ s research facility in Sausalito,  California and discussed mutual research interests, and areas of agreement and those nutritional issues still in question.  Dr. Fuhrman presented and explained some new findings and research in this field as well as his vast clinical experience over 20 years and his findings. 

Dr. Ornish was enthusiastic about his own new areas of research and shared interesting findings in his ongoing and upcoming studies about cancer prevention and reversal, brain messaging and longevity that he is working on.  It was fascinating, promising and important work.  Dr. Fuhrman’s eyes lit up as he listened intently. Dr. Fuhrman shared his findings on nutritional density, fatty acids, the aging brain and maximizing disease reversal in various conditions and individuals with varying metabolic tendencies.  

They also talked about their families, personal interests and prior shared experiences; the good and the bad.  The time flew by and soon Dr. Fuhrman and I had to leave for some other meetings.  But before we left they both expressed a very strong desire to meet again soon.

Dr. Fuhrman and I then headed out to meet with other leading nutritional researchers in the Bay Area, including at CHORI (Children’s Hospital of Oakland Research Institute) and the BUCK institute. Dr. Fuhrman lectured, presented his findings to the scientists at CHORI and we had private meetings with many scientists doing cutting edge research in the health and nutrition fields.  We discussed a potential ground-breaking joint research project with Dr. Brian Kennedy (CEO of the Buck institute) and had more exciting and productive meetings with some of the country’s top scientists there.  What a great week of fun, sharing, learning and collaborating.  I must also say ‘thank you’ to Howard and Ellen Weiss for arranging these meetings.

The Nutritional Research Foundation is committed to supporting and funding research in the effects of a high nutrient dense style of eating.   We are currently raising funds for a Dr. Fuhrman inspired Breast Cancer Prevention Study.  Information about this and other studies is available at NutritionalResearch.org

 

 

 

Dr. Fuhrman has a "growing" presence in Africa

Something powerful, inspiring and incredibly heartwarming is happening in some of the poorest regions in Africa thanks to an organization called Organics4Orphans. There are people who can be considered true angels and Dale Bolton is among the these admirable people.  He is the founder of Organics4Orphans, an organization which brings Dr. Fuhrman’s nutrient-rich diet to orphaned children in Kenya, Ethiopia, Zambia, Uganda and Nigeria.  Not only are these children no longer starving or malnourished, thanks to Bolton’s team at Organics4Orphans, but they are learning what to eat to thrive. Given that there is a staggering 30 and 40 million orphaned children in Africa as a result of the AIDS/HIV epidemic, the implementation of this project as widely as possible is a goal Bolton and his team know is well worth achieving.

Organics4Orphans

As it stands, infectious diseases account for almost 70% of deaths in Africa and mortality rates from chronic diseases, such as cardiovascular disease, cancer, respiratory disease and diabetes are accelerating at a rate never before seen in the developing world.  African health care systems are weak and ill equipped to handle this new wave of chronic disease sufferers. Given severe economic limits in healthcare, priorities remain linked to treating infectious and parasitic diseases rather than chronic, diet-related diseases. This is one reason why the work of Organic4Orphans is so critical; the team is quite literally saving the lives of children whom might otherwise develop a chronic disease for which medical care would not be available.   Dr. Fuhrman’s work is focused on preventing diseases such as infections, heart disease and cancer with superior nutrition, and avoiding needless medical care and medical interventions.    

This is no small feat and you might be wondering how some of the poorest countries in the world are able to access an array of healthful fruits and vegetables to feed all of these children so healthfully. However, it is entirely possible! This is how it works: Organics4Orphans employs a $500 a year budget for each village it sponsors and uses these funds to buy all the tools, seed, and fencing required for organic agriculture.  Employees and volunteers teach mothers and orphans how to make their own fertilizers, use natural pesticides and how to save their own seeds.  Most of the projects involve a dozen mothers who look after and teach 50-100 children why it is essential to learn how to grow and eat healthy, nutritious foods.  The result? Each child can flourish on a healthy diet for no more than $10 per child per year.

As Bolton has stated, “The amazing thing is that this type of organic growing is really designed for Africa and can even be cultivated in semi-arid areas.” In addition to learning how to farm and grow their own gardens, the mothers and children in the program are taught why it is necessary for them to consume a variety of nutrient-rich foods.  This is where Dr. Fuhrman comes into play. Dr. Fuhrman’s nutrient density charts are quite a boon as they are a visual aid to show mothers and the children they look after that they simply cannot live off of cornmeal without developing significant nutrient deficiencies and how to design the healthiest diet possible.  As cornmeal addiction is a real problem amongst many Africans, there is much to be gained from teaching them that they need to eat a variety of colorful fruits and vegetables.  Dr. Fuhrman’s charts do a superb job of showing them just this and they study his teachings, and implement a balanced and highly nutritious diet-style

Those who work on Bolton’s team are called Organic Agri-Nutritional Trainers or OATs.  Beginning this April, Bolton will implement a twelve-week training program for OATs volunteers.  Dr. Fuhrman’s books are employed for classroom nutrition training.  Bolton’s goal is to reach the world’s 50 poorest countries and to spread the concept by educating locals in different countries who can pass on what they’ve learned.  He’s explained that after funding each community for four years, they are able to grow enough food to not only feed themselves, but also cultivate enough food to sell.  Bolton remembers one woman in her fifties who, after eight months of training, was able to produce enough food to feed her five grandchildren and a handful of others.  She was even able to afford her own mattress for the first time in her life.  Now if that isn’t empowering, I don’t know what is.

For more information on Organics4Orphans and ways to get involved please visit: www.Organics4Orphans.org.    

Eating for Health AND Weight

Earlier this week, the New York Times published an opinion piece by Dr. Dean Ornish entitled “Eating for Health, Not Weight.”

Dr. Ornish states, “Perhaps the biggest misconception is that as long as you lose weight, it doesn’t matter what you eat. But it does… Some diets that may help you lose weight may be harmful to your health over time.”

To illustrate his point, Dr. Ornish brought up a recent study that made news: the study compared three different diets all containing the same amount of calories: a low-fat, high-glycemic load diet, a moderate-glycemic load diet, and a very low-carbohydrate, low-glycemic load diet. The study aimed to figure out which type of diet would work best for maintenance of prior weight loss. A decrease in calorie expenditure (“slower metabolism”) is expected upon weight loss – when you weigh less, you require fewer calories. The researchers found that the very low carbohydrate diet produced the smallest decrease in calorie expenditure compared to pre-weight loss levels. The conclusion was that the low-carb diet may be preferable for maintaining weight loss, because the smaller decrease in calorie expenditure would theoretically make it possible to eat more calories than on the other diets and maintain the same weight.1

News like this sends a dangerous message to the American public, making low-carbohydrate diets seem very attractive: “as long as you lose weight, it doesn’t matter what you eat. Dr. Ornish adds, “never underestimate the power of telling people what they want to hear — like cheeseburgers and bacon are good for you.”

A faster metabolism does not mean better health; in fact, it likely means the opposite. Also, the number of calories burned daily on each of these diets is irrelevant because it is probable that none of the diets were healthful (the actual foods eaten on these diets were not reported, only details on carbohydrate, protein, and fat content). Weight, though important, is not the only measure of health. Based mainly on low-nutrient animal products, low-carbohydrate, high-protein diets are associated with impaired endothelial cell function, increased risk of diabetes and cardiovascular disease, and greater incidence of death from cardiovascular disease, cancer, and all causes.2-6  What good is weight loss if the weight loss diet brings on heart disease, diabetes, and/or cancer?

Dr. Ornish makes an excellent point in his article. The only thing is, we should also make the point that the diet-style most favorable for health is also the most favorable for weight loss. You don’t have to choose one or the other.

Putting the emphasis on health instead of weight takes one off the dieting merry-go-round, and into a healthful, sustainable eating style that produces effortless weight loss as a side effect. For weight loss and for health, macronutrient composition (low-carb, low-fat, high-protein, etc.) is not the important factor – maximizing micronutrient density by eating healthful foods and avoiding disease-causing foods is the key.

Our nation’s eating habits are beyond fattening – they are destructive to our physical and emotional health.

 The addictive nature of the unhealthy foods at the core of the Standard American Diet is not merely disease-causing and fattening; but also destructive to the intellect and emotional well-being; the SAD contributes not only to diabetes, heart disease, and cancer, but also to depression, dementia, and even criminal behavior.  These eating practices are destructive to our own health and the health of our children, possibly even their children – the current American diet is likely fueling an future explosion in human suffering due to childhood cancers, autoimmune diseases, and further increases in rates of the lifestyle diseases that already plague Americans.

Dr. Ornish says “About 75 percent of the $2.8 trillion in annual health care costs in the United States is from chronic diseases that can often be reversed or prevented altogether by a healthy lifestyle.”

The only reason a nutritarian diet is not promoted by all as the answer to our nation’s health problems is that it is not favorable to the pharmaceutical industry, the high-tech medical procedure and medical industries, and the powerful food interests and chemical industry that heavily influence government.  Powerful economic forces favor the status quo.

The wide adoption of a nutritarian diet by the masses could have a major impact on global warming, save Medicare, booster our sickly economy burdened with massive health care costs, and increase American intelligence, productivity and competitiveness.

An overwhelming amount of evidence indicates that we can win the war on cancer in America with a nutritarian diet too.   We can donate billions to publicize almost worthless mammograms and pay drug companies to search for more chemotherapeutic agents, or we can practically wipe out breast cancer right now. If I was in a position of political influence and power it would be G-BOMBS in every pot. G-BOMBS are the super foods I recommend eating every day for excellent health – greens, beans, onions, mushrooms, berries, and seeds.  While helping to bring our bodies to their ideal weight, these foods exert powerful anti-cancer, cardioprotective, and anti-diabetic effects, and they fuel our bodies’ natural healing, antioxidant, and detoxification systems. Read more about G-BOMBS.

If you want weight loss AND excellent health, eat your G-BOMBS (instead of counting your carbs).We all have some influence and the best place to start is the health revolution that begins with you.  

 

References:

 1. Ebbeling CB, Swain JF, Feldman HA, et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012;307:2627-2634.
2. Wycherley TP, Brinkworth GD, Keogh JB, et al. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. J Intern Med 2010;267:452-461.
3. de Koning L, Fung TT, Liao X, et al. Low-carbohydrate diet scores and risk of type 2 diabetes in men. Am J Clin Nutr 2011;93:844-850.
4. Fung TT vDR, Hankinson SE,Stampfer M, Willett WC, Hu FB. Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: Two Cohort Studies. Ann Intern Med 2010;153:289-298.
5. Trichopoulou A, Psaltopoulou T, Orfanos P, et al. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr 2007;61:575-581.
6. Lagiou P, Sandin S, Lof M, et al. Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ 2012;344:e4026.

 

Body Odor: Do Nutritarians Smell Better?

In the biography of Steve Jobs by Walter Isaacson, Isaacson reports that as a vegan, Jobs believed that he smelled better than omnivores and didn’t need to bathe as often as his meat-eating colleagues. With this mindset entrenched in his meat-loathing brain, Steve was reported to rarely shower and to smell as if he hadn’t bathed in weeks (at least during the hippie days of his 20s and into his 30s), which was literally probably the case. Putting Steve’s reluctance to jump in the tube aside, was Steve onto something? Do people that avoid meat actually smell better than those that consume animal products regularly? Given that Americans spend millions of dollars each year on personal care products, perfumes and deodorants, it’s worth looking into the effects of diet on body odor.

Girl smelling flower. Flickr: GoodNCrazy

While I would love to report that numerous scientists have taken the same thirst for knowledge on this subject as I do, it appears I’ve got no such luck. However, there is one study that seems to support this hypothesis. Anthropologists at the University of Charles, Czech Republic, were curious enough to conduct a study on the effects of diet on body odor.1   The researchers had women judge the body odor of men fed a vegetarian or non-vegetarian diet and determine which body odor they found more “attractive”. The result? Overwhelmingly, the women judged the body odor of men on a vegetarian diet to be “significantly more attractive, more pleasant, and less intense”. If we go by this study, our noses certainly are happier when we spend more time out in a garden as opposed to a meat packing factory. Ladies, if you’ve got a fella who cares about his pungency, this study may just be the perfect strategy to convert him to a nutritarian diet.

In the absence of an adequate intake of phytochemicals and other micronutrients, cellular detoxification is impaired which elevates cellular free radical activity, priming the body with more toxic substrate. Conventional eaters build up inflammatory by-products. So it does make sense that especially a nutritarian eating all those free-radical-fighting foods that prevent the accumulation and elimination of toxins such as lipid peroxidases and aldehydes, would smell better even without a collection of studies to support this.

What comes out of our bodies reflects what we put in them and body odor is strongly influenced by what’s being emitted by our sweat glands. What is going to smell more unpleasant? A 98.6 degree carrot that has been decaying for a days or a piece of meat left to decay at 98.6 degrees? Or how about a hormone pumped, antibiotic loaded, factory farmed piece of meat like 99 percent of the meat sold to consumers in this country? Anyone want to test this?

Besides serving the role of cooling the body, our sweat is supposed to help us excrete toxins. That’s why sweating is an important part of maintaining good health. As the largest organ in our bodies, our skin excretes plenty of toxins via sweat glands. And thank goodness they do! We do live in a world full of toxins, after all. Our armpits, therefore, actually have an important function in getting rid of these toxins. Have you been thankful for your armpits today?

The scent that we emit is a result of the intentional excretion of toxins that the body is trying to get rid of. If somebody smells like they just took a dip in a garbage dump, that’s probably because they are eating the standard American diet, which is full of “garbage”. I have therefore concluded that meat, junk foods, fast foods and other dietary atrocities just cannot be conducive to smelling desirable.

There is scientific support for my viewpoint. The report in the Charles University, Czech Republic, study read, “ Axillary body odor is individually specific and potentially a rich source of information about its producer. Seventeen male odor donors were on “meat” or “nonmeat” diet for 2 weeks wearing axillary pads to collect body odor during the final 24 hours of the diet. Fresh odor samples were assessed for their pleasantness, attractiveness, masculinity, and intensity by 30 women. We repeated the same procedure a month later with the same odor donors, each on the opposite diet than before. Results of repeated measures analysis of variance showed that the odor of donors when on the nonmeat diet was judged as significantly more attractive, more pleasant, and less intense. This suggests that red meat consumption has a negative impact on perceived body odor.”

Even though this was the only study I could find on our dietary composition and body odor, informal polls and interviews abound in which people report to prefer the smell of nutritarians and vegans/vegetarians. On one forum I found someone write, “My friend has quite strong body odor, but after she became full vegan, the smell has got lighter. At least when I sit next to her, I feel more comfortable”. Others expressed similar sentiments.

Besides meat, foods contributing to an unattractive body odor include refined white flour, sugar, hydrogenated oils and other processed ingredients. I am convinced a diet of leafy green vegetables, other nutritious vegetables like tomatoes and mushrooms, fresh fruits like berries, and nuts and seeds will result in the alluring body scent that we all seek (that is, if you maintain a regular shower routine, unlike Steve Jobs!).

Can you all relate or have any of you noticed that people eating a healthful diet tend to have a more pleasant smell? Uh oh, now I ’m not sure. My father just came back dripping wet after a tough tennis match, and I would swear he ate bacon and hamburgers. Unlike Jobs he claims he showers every week, whether he needs it or not. Maybe it is just a father-daughter thing.

 

Reference:

1. Havlicek J, Lenochova P. The Effect of Meat Consumption on Body Odor Attractiveness. Chemical Senses 2006. 31(8):747-752.
 

 

 

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Video: Texas doctor (and diet book author) chooses Eat to Live to help his patients lose weight

A news station recently followed the story of family practice physician Dr. Douglas Cluff of Irving, Texas, who places a copy of my book Eat to Live in every exam room. Dr. Cluff published his own book on healthy eating and weight loss in 2007, but now advises patients that need to lose weight to follow the Eat to Live program.  I have never heard of this doctor before and do not know him, but I applaud him. He obviously is a warm and caring individual and very special physician. I am grateful for his support and enthusiasm to do the best for his patients, and proud of him and other very dedicated family physicians, many who set a high bar for ethics and compassion.

Read the news story here.

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