Disease Proof : Disease Proof : Health & Nutrition News & Commentary : Dr. Joel Fuhrman

Obesity is a known health risk. The number of epidemiological studies that have linked excess weight to cardiovascular disease, cancer, diabetes, other chronic conditions, and increased risk of death is staggering.^1,2 In fact, the cutoff points for BMI into overweight and obese were created to reflect increased risk of disease and death due to excess fat.³

Then there is the “obesity paradox.” This is the term used to describe the opposite of the usual finding - there are certain groups of people, usually those with severe chronic diseases such as heart failure and kidney disease, in which a higher BMI seems to be associated with a decreased mortality risk.^4,5

Elderly persons are another group in which an obesity paradox has been observed in some studies.⁶ However, this observation is not consistent – other studies have reported an increased risk with higher BMI in adults over age 70 or 75, similar to younger age groups, and others have shown no association at all.^7-11 Overall, the relationship between BMI and mortality in the elderly has been unclear.

Several explanations have been proposed to explain the paradox – these are a few examples:

• BMI is not a true indicator of body fat – older persons tend to have more body fat at the same BMI as younger adults.³ One study found that greater waist circumference in the elderly was associated with increased mortality risk, but greater BMI was associated with decreased risk. In these individuals, greater BMI may reflect greater fat-free mass, rather than greater body fat. Waist circumference and fat-free mass may be more important indicators than BMI for obesity-associated health risks in the elderly.^12,13
• Unintentional weight loss may be involved – many older persons in these studies who are at a low or normal BMI may be there because of disease-related weight loss. Weight loss in elderly has been shown to be associated with negative health outcomes, presumably for this reason.¹⁴ So a study of elderly persons that only takes one weight measurement and does not measure weight change over time is inherently flawed.
• Another issue with the length of studies is that weight gain late in life is probably less dangerous than weight gained earlier in life and then maintained for many years – being obese for 50 years results in more cumulative damage than being obese for 15 years. The earlier you become obese, the greater the risk of death.^15,16 Therefore, long-term data (decades, not years) is needed to get an accurate picture of health risks in the elderly due to obesity.

New research has attempted to reconcile the contradictions in previous studies by using long-term data. Although the researchers used BMI rather than waist circumference, they used two weight measurements 17 years apart, and followed subjects for a total of 29 years – importantly, they only included subjects who maintained a similar weight over the first 17 years – this helped to remove any potential effects from late life weight gain or disease-related weight loss.

Men (age 75-99) who maintained a BMI greater than 22.3 had a shorter life expectancy by 3.7 years, and an 88% increased risk of death during the study period compared to men with a lower BMI. Men who maintained a BMI greater than 27.3 had double the risk of death compared to those with a BMI less than 22.3. Women in the same age group who maintained a BMI greater than 27.4 shortened their life expectancy by 2.1 years, and had a 41% increase in risk of death compared to women with a lower BMI.^17,18

This new study leads us to conclude: no matter what your age, carrying excess weight for a significant length of time is dangerous – in fact, it can be deadly.

References: 

1. Guh DP, Zhang W, Bansback N, et al: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC public health 2009;9:88.
2. McGee DL: Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 2005;15:87-97.
3. U.S. Centers for Disease Control and Prevention: About BMI for Adults. http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Accessed
4. Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al: Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008;156:13-22.
5. Schmidt D, Salahudeen A: The obesity-survival paradox in hemodialysis patients: why do overweight hemodialysis patients live longer? Nutr Clin Pract 2007;22:11-15.
6. Oreopoulos A, Kalantar-Zadeh K, Sharma AM, et al: The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009;25:643-659, viii.
7. Calle EE, Thun MJ, Petrelli JM, et al: Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999;341:1097-1105.
8. Janssen I, Mark AE: Elevated body mass index and mortality risk in the elderly. Obes Rev 2007;8:41-59.
9. Grabowski DC, Ellis JE: High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc 2001;49:968-979.
10. Kuk JL, Ardern CI: Influence of age on the association between various measures of obesity and all-cause mortality. J Am Geriatr Soc 2009;57:2077-2084.
11. Stevens J, Cai J, Pamuk ER, et al: The effect of age on the association between body-mass index and mortality. N Engl J Med 1998;338:1-7.
12. Janssen I, Katzmarzyk PT, Ross R: Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 2005;53:2112-2118.
13. Zamboni M, Mazzali G, Zoico E, et al: Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005;29:1011-1029.
14. Woo J, Ho SC, Sham A: Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatr Soc 2001;49:737-746.
15. Adams KF, Schatzkin A, Harris TB, et al: Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763-778.
16. Sun Q, Townsend MK, Okereke OI, et al: Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study. BMJ 2009;339:b3796.
17. Singh PN, Haddad E, Tonstad S, et al: Does excess body fat maintained after the seventh decade decrease life expectancy? J Am Geriatr Soc 2011;59:1003-1011.
18. Contrary to Earlier Findings, Excess Body Fat in Elderly Decreases Life Expectancy. 2011. ScienceDaily. http://www.sciencedaily.com/releases/2011/08/110811151325.htm. Accessed September 29, 2011.

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Last weekend the first Nutritarian Food Festival was held in beautiful Aspen, Colorado.  It was organized and co-chaired by renowned chef, Martin Oswald, who owns the Pyramid Bistro on Main Street; the first, fully nutritarian restaurant in America.  Dr. Fuhrman said the cook-off contest between the top chefs in town, making their best nutritarian dishes, was a blast! The entire event was a great success and widely received by the public due to Martin’s vision and dedication, and everyone’s hard work. Welcome to Disease Proof, Martin.

How did you discover nutritarian eating and cooking that eventually led to opening the Pyramid Bistro?

I heard about Dr. Fuhrman many years ago, but it wasn’t until someone in the health section of Whole Foods in Denver introduced me to his books again. I saw the nutrient density guides and recognized the chef-friendly approach of Dr. Fuhrman’s plan. It was one of those, "Nutrition meets chef" moments!

From your perspective as a renowned chef and owner of the first nutritarian restaurant in the United States, what was the highlight of the Nutritarian Food Festival for you?

The highlight for me was to see all these chefs from competing restaurants, and nutritionists with different backgrounds, come together and push forward a bigger idea. As you may know, Colorado is the only state with under 30% obesity rate so it makes sense to join forces to create a tipping point right here. I think Dr. Fuhrman has come up with the right approach that everyone can embrace.

Was it hard to bring so many chefs together to organize such an event for an entire community & city?

Yes, first of all we only had about two months to get the chefs to read and learn the guidelines. Then they had to approve it with the restaurant owner, and all this was done at the height of the busy summer season. For example, the winner, Miles Angelo, caters all summer long and it was difficult for him to switch gears.  I'm very appreciative of everyone’s efforts who participated in the events. 

With the nutritarian health revolution on the horizon, what do you see the restaurant industry’s role will be in helping to repair our broken healthcare system?

I'm very fortunate to live here in Aspen and meet some of the great thinkers of our time. For instance, while I was proposing a non-profit approach to spread more information on nutritarianism, some prominent people told me it would make much more sense to come up with a business model that is for-profit and encourage others to do the same.  The Pyramid Bistro had a great first year and people have asked me to open in other locations, which is so important for a nutritarian revolution.

The role of restaurants will be to work much closer with nutritionists in order to prevent obesity and other health related issues. By working with nutritionists and then creating dishes that everyone can enjoy we can make a real difference in peoples’ lives that will ultimately lead to a healthier nation.  

Do you have any final comments to share with the Disease Proof reader?

Talk to your favorite waiter, restaurant owner, or chef about Dr. Fuhrman’s nutritarian eating-style.  By encouraging them to include nutrient dense items on their menus, you just might start a food revolution in your own hometown!

Thank you Martin for pioneering this exciting vision to promote nutritarian food choices in restaurants all across America and beyond!  Best wishes of great success ~ bon appétit! 

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Being overweight is not harmless – excess fat is the major factor responsible for insulin resistance and resultant type 2 diabetes, and a risk factor for a plethora of conditions including heart disease, stroke, hypertension, high cholesterol, liver disease, gallbladder disease, respiratory problems, arthritis, and infertility.¹  Being overweight is thought to be responsible for over 100,000 new cancer cases each year in the U.S. alone, and both overweight and obesity are associated with a greater risk of death from all causes. 

Recent findings in the field of obesity research have given us two more reasons to keep one’s weight in check. 

1. Excess weight may restrict blood flow to certain areas of the brain, impairing brain function and possibly fueling more overeating.
2. Even just a few extra pounds on someone with a “normal” BMI may increase risk of death from heart disease.

1.  Brain function

Obesity in mid-life is already known to increase the later risk of dementia, suggesting that excess weight has detrimental effects on the brain.²  The high blood pressure, arterial stiffness, and insulin resistance that come with excess weight could be the factors that harm the brain.

In this particular study, the researchers compared overweight and normal weight subjects (average BMI 28.43 and 21.79, respectively) using an imaging technique that measures blood flow in specific areas of the brain.  They focused on the prefrontal cortex, an area of the brain that governs focus, impulse control, and executive function (which includes decision-making, planning, and working toward goals).

In overweight subjects compared to normal subjects, they saw a decrease in blood flow to the brain overall, and also specifically to the prefrontal cortex.  Because of the unique functions of the prefrontal cortex in regulating impulse control, they concluded that excess weight has the potential for driving further overeating by reducing blood flow to this area.³

Conversely, another recent study has found that losing weight can improve memory.   Subjects underwent memory, concentration, and problem solving tests before and 12 weeks after bariatric surgery.  Memory performance had improved after 12 weeks.  Importantly, the baseline tests also revealed that the obese subjects and cognitive impairment. Of course, bariatric surgery is not a safe way to lose weight, but this study makes the point that the brain begins to work more effectively when excess fat begins to disappear.⁴

2.  Risk of death from coronary artery disease

Obesity is a known risk factor for heart disease, but a new meta-analysis has reported that a little “excess belly fat” can increase the risk of death from coronary artery disease even for people whose body mass index (BMI) is in the normal range.   BMI is an imperfect indicator of the health risks associated with obesity, taking only height and weight, and not body fat percentage or fat distribution, into account. Many scientists believe that waist circumference and/or waist-to-hip ratio are better measures of overweight and obesity.  Certainly, these are better indicators of visceral fat, which is more metabolically active and thought to be more harmful. Nevertheless, both high BMI and large waist circumference are associated with increased risk of death.  

The meta-analysis included data on over 15,000 coronary artery disease patients, and found that those who had “central obesity” (which was evaluated based on waist circumference and waist-to-hip ratio) are at a greater risk of death.  This was true not only for obese patients, but normal weight patients as well.  In obese patients, central obesity increased risk by 93%, and in normal weight patients by 70%.⁵

In order to enjoy excellent health, in addition to eating high-nutrient foods, we must also strive to respond appropriately to the signals of true hunger so that we avoid overeating.  Too many calories, even from healthy natural foods, will translate into excess fat on the body and therefore health risks.

It should be noted that eating right gives you the ability to lose food addictions and be in better control of your cravings, but food is all around us and people can still overeat for recreation.  

References:

1. U.S. Centers for Disease Control and Prevention. Overweight and Obesity: Health Consequences. http://www.cdc.gov/obesity/causes/health.html 

2. Fitzpatrick AL, Kuller LH, Lopez OL, et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol. 2009 Mar;66(3):336-42.

3. Willeumier KC, Taylor DV, Amen DG. Elevated BMI Is associated With Decreased Blood Flow in the Prefrontal Cortex Using SPECT Imaging in Healthy Adults. Obesity (2011) 19, 1095–1097

4. Gunstad J, Strain G, Devlin MJ, et al. Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis. 2010 Oct 30. [Epub ahead of print]

5. Coutinho T, Goel K, Corrêa de Sá D, et al. Central obesity and survival in subjects with coronary artery disease a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol. 2011 May 10;57(19):1877-86.

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What was your life like before discovering Dr. Fuhrman’s nutritarian eating-style?

I was fat, tired, had “brain fog” much of the time, and I felt ashamed of myself. When I first discovered Dr. Fuhrman and the nutritarian eating style, I was 50-years-old, 256 pounds, I had asthma and allergies, and I’d been struggling with my (increasing) weight for a number of years. 

How did you feel then?

I felt hopeless – utterly powerless to change my life and my health. I was always tired and was beginning to have some health issues (a shoulder problem and a sciatica issue), that the doctors affirmed were caused or aggravated by my obesity. 

Most of all, the excess weight had a huge impact on my self-image. I was acutely aware of being fat; it impacted my identity professionally and personally. It kept me from trying new things or going new places as I knew that I would be the fattest person wherever I went. I wondered how people could take me seriously professionally (I’m a minister in a church) when I was so obviously out-of-control with my own eating. Of course, the biggest issue was that I didn’t respect myself.

I also felt sad for my kids that their mom was so fat and inactive; and it certainly has contributed to challenges in my marriage, although my husband has never criticized my weight. 

Tell us about your Eat to Live journey.

In 2005, I had read John Robbins’ book Diet for a New America and committed to begin vegan for a whole spectrum of reasons he addresses so well: heart issues, cancer, world hunger, animal cruelty, environmental issues, and when I joined Earthsave I saw an ad for the first edition of Eat to Live. I ordered the book, found it compelling, lost 40 pounds, but didn’t learn enough about cooking or adapting to challenges to stick with it so I gained back the weight, plus 5 more pounds. Then last spring I realized that I needed to come to terms with my weight problem again. I wanted to feel as good as I had in 2005 while following Eat to Live so I recommitted on Mother’s Day 2010. I lost 20 pounds by Father’s Day and have continued to lose weight at a slower pace since then. Altogether I’ve lost 53 pounds since last Mother’s Day. 

I’ve had work conferences, family visits, and international travel to deal with during this past year, as well as the usual special occasions. I knew that one of the things I was going to have to learn to do is how to decide when to make an exception and eat off-plan, when to go hungry, and how to get back on-plan after an exception. When I committed to ETL again, I made up my mind that this would be for the rest of my life; but I knew that I couldn’t keep the commitment unless I figured out how to make exceptions (as a choice, not as a failure of will) and how to get back on track. 

Someone else may choose to eat birthday cake (I haven’t had to – I make the Healthy Chocolate Cake), or to make an exception for a dinner date with a spouse (my husband hates eating out), or to make foods for children (mine are grown).  I have to eat out at restaurants regularly; I go to non-nutritarian conferences; I get invited to church members’ homes and want to be gracious; and most recently, I traveled through Scotland and England with my son for two weeks and didn’t want to be obsessing about food. Making the choice to eat off-plan in those situations has cost me weight loss, and has sometimes reignited cravings that I had kicked; but this is a commitment that I’ve made for the rest of my life, and I now know that when I choose to eat off-plan there will be a price to pay. For me, knowing that I have the choice, if I want to, to eat a ‘forbidden’ food, helps me keep the commitment.*

I still have a long way to my goal weight so I’m re-evaluating what I’m eating, and trying to get as close to 100% as possible; plus, I’ve realized that I need to be more consistent with daily exercise. 

How do you feel now?

I feel great! I feel such a sense of energy and zest. I feel healthy, resilient, happy, and grateful. I’m no longer defensive or embarrassed, and I can meet people and try new things without fearing that I’ll be thought of as simply a fat person. 

Before I started Eat to Live, I was plagued with allergies (ragweed, cats and dogs) and took Zyrtec everyday.  Now, even during ragweed season, I rarely take it.  I used to also have awful gastric reflux/heartburn and carried a large bottle of Tums with me everywhere: work, car, home, etc.  Now, I'm not even sure if there are any in the house, because I don't need them.

Do you have any success tip(s) to share with others?

 

• Most important ~ “know yourself”. Some people do better asking a lot of themselves; others do better succeeding with one change at a time, and then building on that success. 

• Join and be active on the Member Center. Nutritarian eating is very counter-cultural, and having the support of others who are making it work is really helpful. I have now met in- person five people from the Member Center, and some of the other members have been so helpful to me over the past year – not only in nutritarian eating, but in everything from recipes to travel tips to sharing clothes and knitting tips! 

• Learn new recipes. In my life, I can get away with not much variety – I like the same smoothie most of the time and the same salad most days. But even this week I changed the salad completely, and learning a variety of soup and main dish recipes has been critical to succeeding…especially when my family is around and I cook for them.

• Be gentle with yourself. I try to treat myself to non-food treats as part of learning how not to be a food addict. For example, I bought a beautiful, African grass basket to take to the market; I get a massage regularly; and I try to buy clothes that make me feel pretty, even though I won’t fit in them very long. If I feel good about myself, I’m better at staying on-plan.

• Don’t worry about pleasing others. I still struggle with this, because of being a minister and not wanting my own food choices to be seen as judgmental of others, but most of the time, I’m able to do this part.

• Exercise. Again, I am “in process” on this – but I know it’s important, and I am going to make it work. 

• To the extent that you can afford it, buy good tools to make cooking fun. I purchased all new pots and pans for free with points from my debit card. I bought a couple of good knives, a VitaMix,  and a small food processor. These tools make cooking much easier.

• Plan, plan, plan, plan…and don’t forget to plan. When I’m hungry, I don’t always choose as well, so I need to plan ahead so that I will be able to make good choices. If I remember to take along beans, some seeds, dressing, etc., then even a bowl of lettuce can be satisfying.  

• And when you fail, start right back the next choice (not the next day).

• Seek help and advice from those who are successful and more experienced. 

• Keep a food log.

 

In a nutshell, what has nutritarian eating done for you? 

Nutritarian eating has given me my life back, and it’s given me hope, energy, wellness, and joy.  It’s enabled me to leave shame behind – I never even knew I was feeling shame all the time.

Congratulations Suz for recommitting to eat for health for the rest of your life!  

* Dr. Fuhrman says that planned compromises are permissible on occasion as long as they do not become consistent choices.  Such compromises should involve just one meal, or one dish, not stretches with days or weeks off the program.  The achievable goal is to make repeated excursions into the standard American diet not something you would prefer or tolerate.  Many nutritarians have evolved to find such SAD meals repulsive. Marginal weight loss results and lack of protection against diseases later in life are the result of repeated compromises. 

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• Mom is tired so she stops by Dairy Queen on the way home from the late afternoon soccer game. She orders a Blizzard for herself and dipped cones for the children. There are some chips and leftover slices of pizza at home if anyone gets hungry before bed.   Lately she’s been too wiped out to care.

• Junior is sitting in front of the computer munching on Doritos for supper. Dad and Mom don’t mind because they are lounging in their lazy boys watching the news while eating cheddar melts and curly fries. Later on they plan to dig into the two quarts of fudge ripple and butter pecan ice cream that’s in the freezer. Cooking and setting-the-table for dinner are obsolete words in their household. 

• Baby is teething and cranky but the frazzled Mom has discovered that McDonald’s salted fries do the trick to quiet him down every time. Her two-year-old is also a happy camper when eating a Happy Meal in Playland. Mom has found the perfect place of serenity to escape to while eating Big Macs and chocolate sundaes at the golden arches.  

• When the new parents held their twins for the first time, they had ideals for excellent nutrition. However, one by one, those ideals were tossed by the wayside in the flood of social events and birthday parties. Hotdogs, donuts, cake and ice-cream took over the best of logic and common sense. The pressure to fit in overcame the desire to be healthy. Today their teens eat chicken nuggets, cheeseburgers, or pizza pockets most nights of the week.                  

In a study conducted by RAND Corporation, alcoholism increases the risk of chronic illnesses by 12%; cigarette smoking increases the risk of chronic illnesses by 25%; and obesity increases the risk of chronic illnesses by 67%.¹

We have laws established to govern and prohibit the sale of both cigarettes and alcohol to minors, yet gluttonous eating that leads to obesity and poor health is practiced everywhere; especially by adults who are setting the example and leading the way by promoting the dangerous lifestyle. 

An infant is encouraged to eat French fries that develops into an addiction for salty, high fat, processed foods in the preschool years; which snowballs into craving bags of chips and slices of pizza during the pre-teen / teen years. Chronic fatigue from malnutrition is replaced by Pepsi, coffee and energy drinks that become the drugs of choice through college and beyond. Over time, hypertension, heart disease, diabetes, fatigue, and depression become the accepted and expected, All-American diseases; stimulating the economy by keeping drug reps employed, pharmaceutical companies in business, and surgical suites well staffed. 

When a faulty crib or playpen is recalled a wise parent returns the product. 

When crossing a busy street a careful guardian holds a child’s hand.

When danger lies ahead a prudent caregiver changes paths.

A victim is one that is [intentionally or unintentionally] injured, harmed, or destroyed by another.

 

Are children the innocent victims of our vices?

¹ RAND Corporation; “The Health Risks of Obesity”; © 2002

 image credits - Flickr: babies by paparutzi; Pepsi Max by Lord Biro

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We all know the expression, “pigging out;” aka binge eating / ravenous gorging. 

Addiction is a repeated action that has the potential to evolve into a dangerous and downward spiral that only gets worse. If one continues in daily nibbling, those innocent snacks can easily and quickly turn into pigging out; which will lead to self-sabotage.  It's pretty predictable.   

When I was in my early twenties, I was athletic, fit and weighed a healthy weight. If someone would have told me that in ten years I’d be 100 lbs overweight, I wouldn’t have believed them! No way in a million years would I ever let myself weigh THAT much! But it happened. One nibble turned into two, which turned into three, four, five, six . . . which eventually turned into a full-blown, binge eating disorder; resulting in obesity and poor health for twenty long years. Those years were like existing in a dark prison cell with no exit sign.   

Dr. Fuhrman clearly states that snacking is overeating, and overeating will sabotage excellent health. Those who nibble consume more calories, and snacking is usually done when not truly hungry. It’s easy to reach for that handful of nuts after watching Junior’s soccer game. (If those same nuts are consumed with greens at mealtime, the absorption of phytochemicals is enhanced by 10 fold!) It’s easy to nibble on that package of carrots or dried fruit while putting groceries away. Oh my, and don’t forget those enticing food samples laced throughout the grocery store on Saturday mornings! “Just one bite” never hurt anyone. Wrong. In all truthfulness, if we want to live in optimal health, nibbling and snacking need to be eliminated from our vocabulary altogether. Period.  No compromise.  No excuses.*

                                                   SAY NO TO NIBBLING 

Let’s all enjoy the privilege of living in excellent health for the rest of our lives!

Previous posts related to this topic: “The powerful snare of compromise”  and "Eating occasions"

* Dr. Fuhrman states that a rare exception to snacking would be if one ate too little at a meal or couldn’t get to the next meal and were truly hungry; in that case the “healthy snack” would be appropriate.

image credit - Flickr: thebittenword.com; lululemon athletica

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It is becoming more widely known that obesity can lead to a premature death – but what about those who fall in between healthy weight and obese?  A new study suggests that even “a few extra pounds” can be dangerous.

This comes just a few months after a large study that concluded that waist circumference was associated with risk of death from all causes. These two studies used different methods of measurement, but they agree on a very important point – even a small amount of excess weight increases the risk of death. In the waist circumference study, even people who had a normal body mass index (BMI; calculated based on height and weight) were at greater risk of death if they had a 4-inch larger waist compared to others in their BMI category – that four extra inches of abdominal fat translated into a 16% (men) and 25% (women) increase in mortality risk over a nine year period.

Last week, another article was published in the New England Journal of Medicine in which the researchers analyzed risk of death from all causes according to BMI. The data they analyzed came from 19 different studies and included 1.46 million people across the U.S., Europe and Australia. The results were dramatic. The risk of death from all causes was elevated just above the ‘normal’ BMI category and continued to climb as BMI increased. Those who were overweight but not obese were still at risk.

Compared to individuals with BMI of 20-24.9, the increased risk of death was

• 13% for those with BMI 25.0-29.9
• 44% for those with BMI 30.0-34.9
• 88% for those with BMI 35.0-39.9
• 251% for those with BMI 40.0-49.9[1]

Of course, the risk is greater with more excess weight, but the key finding is that even with a moderate amount of excess weight, there is a significant increase in the risk of death.

Sixty-eight percent of Americans are overweight or obese, and about half of this group fall into the overweight but not obese category. These studies would therefore suggest that 68% of Americans are dying prematurely because of their excess weight. The prevalence of processed foods and junk food has gotten most Americans completely out of touch with hunger and satiety signals. Nutrient-dense eating, resulting in the recognition of true hunger, is an effective method for reaching and maintaining a healthy weight.

Reference:
1. Berrington de Gonzalez, A., et al., Body-mass index and mortality among 1.46 million white adults. N Engl J Med, 2010. 363(23): p. 2211-9.

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October is National Breast Cancer Awareness month, and I want to raise awareness that childhood diets are the major cause of adult cancers, including breast cancer. [1] I also want to raise awareness that women are not powerless against breast cancer – mammograms for ‘early detection’ are not the only defense and do not even offer significant benefits. The most important thing to be aware of is that women can achieve meaningful risk reduction with powerful preventive lifestyle measures.

The American Institute for Cancer Research estimates that 40% of breast cancers are preventable through diet and lifestyle measures. I propose that we could prevent much more than 40% of breast cancers in the future, if we can ingrain healthy habits in our children at a young age.

Early studies found wide international variations in breast cancer rates, originally generating the hypothesis that nutrition is a major determinant of breast cancer risk. Obesity is a significant risk factor for breast cancer:

• Gaining one pound per year during adulthood can double breast cancer risk after menopause.
• Obesity alone is thought to be responsible for 17% of breast cancers.
• Obesity is associated with greater tumor burden and poorer prognosis in breast cancer patients. [2, 3]
• Production of inflammatory molecules and estrogen by body fat, as well as elevated insulin and insulin-like growth factor (IGF-1) levels are thought to contribute to obesity-related breast cancer risk. [2]

Plenty of experts have predicted that the explosion of childhood obesity we have seen in recent years will result in crisis proportions of heart disease and diabetes in the future, but cancer seems to be ignored. Today, over 30% of children are overweight or obese. [4] Clearly, with all the research demonstrating that obesity is a major risk factor for breast cancer, our young girls are in danger.

The prevalence of early puberty, another established risk factor for breast cancer, has been consistently increasing over the past 100 years. Today, by the age of 8, 18.3% of Caucasian girls, 42.9% of African-American girls, and 30.9% of Hispanic girls have already entered puberty. Obesity, soft drinks, and excessive animal protein are the likely culprits (Read more).

This is a grim indication of things to come – when these girls reach adulthood, tragically we will see an upsurge in breast cancer cases. With the increases in fast food and processed food consumption in America in the last 20 years, I predict a tragic explosion in pre-menopausal breast cancers in our country in the next 20 years.

Breast tissue is most vulnerable to carcinogenic influences when it is growing and developing – during childhood and adolescence. Children are also especially susceptible to weight gain during adolescence. [5] Thus, this window of time is when a healthy diet is absolutely crucial. Animal studies have demonstrated that a high-fat diet or a body fat promoting diet during puberty promotes abnormal development of breast tissue and production of inflammatory molecules, which in turn may promote tumor growth.[6, 7] Adolescent diet was examined in the Nurses’ Health Study – greater consumption of vegetables during high school was associated with a decreased risk of breast cancer, and high glycemic index foods were associated with an increased risk. [8]

The typical American childhood diet of chicken fingers, French fries, and mac and cheese is not harmless – it is creating a cancer-friendly environment in children’s bodies.

As parents, we must feed our children healthful foods from an early age. This is the most effective protection from future chronic disease that we can provide for them. Healthy eating is a lifetime commitment, and we can give our children a head start. Our goal should be to instill healthy habits in our children so that they grow up at a healthy weight, appreciating healthy food and exercise, and hold on to those habits as adults. In order to do this, we must set a positive example, focusing on nutrient-dense, health-promoting foods.

New research is revealing the protective effects of natural foods against breast cancer. For example, mushrooms have anti-estrogenic activity, and regular mushroom consumption is associated with a 60% decrease in cancer risk. [9] Cruciferous vegetables such as watercress, other leafy greens, and broccoli contain compounds known to inhibit cancer cell growth. [10, 11]

Instead of wearing a pink ribbon, eat vegetables, onions and mushrooms – and make sure to feed some to your kids.

References:

1. Maynard, M., et al., Fruit, vegetables, and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort. J Epidemiol Community Health, 2003. 57(3): p. 218-25.
2. Cleary, M.P. and M.E. Grossmann, Minireview: Obesity and breast cancer: the estrogen connection. Endocrinology, 2009. 150(6): p. 2537-42.
3. Abrahamson, P.E., et al., General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev, 2006. 15(10): p. 1871-7.
4. Ogden, C.L., et al., Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA, 2010. 303(3): p. 242-9.
5. Jasik, C.B. and R.H. Lustig, Adolescent obesity and puberty: the "perfect storm". Ann N Y Acad Sci, 2008. 1135: p. 265-79.
6. Olson, L.K., et al., Pubertal exposure to high fat diet causes mouse strain-dependent alterations in mammary gland development and estrogen responsiveness. Int J Obes (Lond), 2010. 34(9): p. 1415-26.
7. Michigan State University: High-fat diet during puberty linked to breast cancer risk later in life. 2010; Available from: http://news.msu.edu/story/8233/.
8. Frazier, A.L., et al., Adolescent diet and risk of breast cancer. Cancer Causes Control, 2004. 15(1): p. 73-82.
9. Zhang, M., et al., Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. Int J Cancer, 2009. 124(6): p. 1404-8.
10. Clarke, J., R. Dashwood, and E. Ho, Multi-targeted prevention of cancer by sulforaphane. Cancer Letters, 2008. 269(2): p. 291-304.
11. Higdon, J., et al., Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacological Research, 2007. 55(3): p. 224-236.

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Asthma has skyrocketed in the U.S. – the prevalence of asthma doubled between 1986 and 2005. Obesity is known to mechanically compromise proper function of the lungs and airways and is associated with asthma-related inflammation. Increased prevalence of asthma in obese individuals has been demonstrated in several studies, and there exists a dose-response relationship such that as BMI increases, asthma risk increases. Obesity is thus an independent risk factor for asthma. It is now widely believed that the rise in childhood obesity is a causative factor for the recent rise in asthma. [1, 2]

In addition to obesity, metabolic abnormalities in children and teens, such as high cholesterol, high triglycerides, and hyperinsulinemia, regardless of body weight have now been associated with asthma. This means that even if a child is of normal BMI, the standard American diet is likely taking its toll on lung function, producing early metabolic abnormalities that may set the stage for asthma, obesity, diabetes, and other chronic disease. [3]

In adults who already have asthma, previous data has been inconclusive when trying to determine whether obesity affects asthma severity. However, there is a strong connection between poor nutrition and asthma, including evidence that a single high-calorie, low-nutrient meal can spark airway inflammation, which can exacerbate asthma symptoms. Asthmatic adults consuming a single high-calorie, low nutrient meal, high in animal protein and added fat (1,000 calories worth of fast food hamburgers and hash browns) showed increased airway inflammation four hours later. Researchers compared this to a 200 calorie meal, which did not increase inflammation. [4]

Obesity, resulting from the cumulative effects of years of overeating low-nutrient, high-calorie food is a risk factor for asthma. However, deleterious effects of a low-nutrient diet on lung function occur even in the short term, and can begin early in life. Collectively, these studies tell us that asthma is another disease whose major causes include poor nutrition and a sedentary lifestyle.

Since asthma is both a lifestyle- and inflammation-related disease, dietary changes and weight loss are effective at improving asthma symptoms. A high-nutrient diet floods the body with protective micronutrients, reduces inflammation, and promotes weight loss – allowing the body to resolve the risk factors for asthma mentioned above (obesity, high cholesterol, etc.). Dr. Fuhrman has had much success using a high-nutrient diet to treat patients with asthma – many recover completely and no longer need asthma medication. He recently conducted a survey of hundreds of nutritarians, in which 82% of respondents with asthma reported a significant improvement in their symptoms after switching to a high-nutrient diet. Here is just one example:

“Dr. Fuhrman has truly been a blessing to me and my family. My husband has lost weight as so has my 11-year-old son. My son had put on a lot of weight and has asthma, making it almost impossible to complete the running portion of a physical challenge in gym class. But a couple of weeks ago, I had tears in my eyes as he crossed the finish line without wheezing!

I have more energy and have never felt this good. I tell everyone I know about Eat To Live and Eat For Health and will continue to sing Dr. Fuhrman’s praises.

-Jean”

References:

1. Sutherland, E.R., Obesity and asthma. Immunol Allergy Clin North Am, 2008. 28(3): p. 589-602, ix.
2. Canoz, M., et al., The relationship of inflammatory cytokines with asthma and obesity. Clin Invest Med, 2008. 31(6): p. E373-9.
3. Cottrell, L., et al., Metabolic Abnormalities in Children with Asthma. Am J Respir Crit Care Med, 2010.
4. High-fat meals a no-no for asthma patients, researchers find. ScienceDaily. , in American Thoracic Society 2010 International Conference. 2010: New Orleans, LA.

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Meridia (Sibutramine) is an appetite suppressant, and is prescribed by physicians to help obese individuals lose weight. Meridia works by blocking the reuptake of certain neurotransmitters in the brain related to appetite. Meridia was shown to reduce food intake and body weight compared to placebo in several trials[1]. However there is no such thing as a drug without side effects.

Concerns regarding adverse cardiovascular events led to a large clinical trial in order to assess Meridia’s safety. On September 15, an FDA advisory committee is scheduled to decide whether to keep Meridia on the market, based on the final results from the trial, which were published last week in the New England Journal of Medicine. In 2009, preliminary results from the trial prompted European health officials to withdraw the drug from the market. Meridia may soon be withdrawn in the U.S. as well [2].

The trial evaluated cardiovascular events in subjects assigned to either Meridia or placebo over approximately three years. The trial’s 10,000 participants were overweight or obese individuals over age 55 with either cardiovascular disease, type 2 diabetes, or both. The average weight loss on Meridia was 9.5 lbs. Although the researchers found no increase in death rates among Meridia users, they did find a 28% increase in risk of heart attack, and a 36% increase in risk of stroke. [3]

Weight loss is beneficial for overall health, in part because it helps to reduce the risk of cardiovascular disease. So essentially, this drug is having the exact opposite of its intended effect. Plus the weight loss in this trial was miniscule – 9.5 lbs. is inconsequential for someone who is obese. Dr. Fuhrman’s nutritarian diet-style has been shown to result in an average weight loss of 53 lbs. after two years[4], and healthy eating does not carry an increased risk of cardiovascular events – it only reduces risk.

The bottom line: there are no shortcuts to weight loss or to good health.

References:

1. Tziomalos, K., G.E. Krassas, and T. Tzotzas, The use of sibutramine in the management of obesity and related disorders: an update. Vasc Health Risk Manag, 2009. 5(1): p. 441-52.
2. Heavey, S. Diet drug Meridia study renews calls for U.S. ban. 9/1/2010 9/9/2010]; Available from: http://www.msnbc.msn.com/id/38962866/ns/health-diet_and_nutrition/.
3. James, W.P., et al., Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med, 2010. 363(10): p. 905-17.
4. Sarter, B., T.C. Campbell, and J. Fuhrman, Effect of a high nutrient density diet on long-term weight loss: a retrospective chart review. Altern Ther Health Med, 2008. 14(3): p. 48-53.

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