An Apple A Day

It is nice to report good news. In this case, the good news is that a recent study of prostate cancer found that drinking coffee reduced risk.

It is always essential to view dietary studies skeptically. There are so many reasons they can be misunderstood, or just plain wrong. The world is too complicated to neatly study it. It is very difficult and ethically dubious to conduct ideally controlled dietary research. A little story about such presumptions might help.

One day a student in the homeopathy class I used to teach in the UCSF medical school inadvertently dramatized the assumptions one can make about research overlooking the requirements of studies in the real world. Seeking to discredit my research credentials, he belligerently demanded to know where my lab was. I pointed out that, despite the advantages to science, people just do not like being locked up in cages for the convenience of scientists.

Wild humans, living in their natural environment, have an annoying habit of eating a variety of mixed up food items with such unpredictability that their eating patterns seem almost whimsical. It is as if they actually select what they eat based upon some internal preference or external appearance. They/we are then extremely poor experimental subjects. I hope he went into basic sciences research or had some humanistically transformative experience. He did apologize, so there is hope for his wizened soul.

Although still far from certain, the most reliable research data comes from intervention studies. One group of people, exactly the same as another group, is treated differently and watched to see what happens. Yes, this is potentially every bit as creepy as the medical student’s thoughtless question. Studies of the long-term effects of dietary differences are essentially impossible. Would you volunteer for a study where someone else would tell you what you could and could not eat for a decade or two?

Despite the inevitable weaknesses, this study is relatively compelling. That is because the effect was proportional to the amount of coffee consumed. In other words, a bit of coffee reduced the risk, while a lot of coffee reduced risk a lot. Six cups a day (not unusual in Scandinavia where the study took place) reduced the risk of developing of prostate cancer by 20% and the death rate from prostate cancer by 60%. Coffee would seem then to prevent the worst forms of prostate cancer.

As the risk reduction persisted when the coffee was decaf, the most likely anti-cancer effect is the antioxidants in the coffee. Now, if that theory holds water (sorry), a cup or two of Mediterranean coffee, which typically has 50x higher levels of antioxidants then the coffee most of us drink, should have really powerful effects. It would also be a more tolerable means to achieve the results. Six cups of coffee a day would have me bouncing off the ceiling, not just the walls. Other studies, including studies of high blood pressure and Alzheimer’s, suggest that coffee has benefits beyond the buzz and flavor desired by so many. The blood pressure study specifically considered Mediterranean-style coffee (finely ground coffee heated in water short of boiling temperatures), which is very different from the coffee most of us drink. Due to the uncertainties of such research, the complexity of compounds in “coffee” and the fact that many people react badly to some types of coffee, further study is warranted. Unlike most medical research, I am sure that recruiting subjects will not be a problem!

Water For Weight Loss

An interesting weight loss study found that people who drank 2 cups of water before each of their three daily meals lost five pounds more than the unwatered folk in the trial. This was a small study, with only 48 people, all of whom were between 55 and 75 years of age. All the subjects were on a diet restricting their calories. Over a 12 week period those in the water group averaged about 15.5 lb weight loss, while the other subjects lost 11 lbs.

Now, someone can slap a fancy label on bottles of water, rename it and roll out a scientifically-substantiated advertising campaign. Just kidding, aren’t I?

Doctors and Diet
I became interested in the health effects of diet long before I thought seriously about going to medical school. As my interest grew, I found a physician who became my mentor and encouraged my nutritional studies. He also inspired me by demonstrating the effects of nutritional interventions with his patients. (See his books DIET AND NUTRITION and RADICAL HEALING, both impressively still in print after decades).

In medical school a few of us created a student group that brought in outside experts on healing alternatives to broaden our education. Although I am proud of that effort and the fact that the group is still functioning over 30 years later, I am dismayed that it is still necessary. A new study makes it very clear just how necessary. Even considering uncontroversial, basic nutrition training, medical education is woefully anemic.

That student group (we called it the Humanistic Medicine Committee), sponsored one lunchtime lecture every week. During the time I was there we also organized two weekend seminars. One of those was on birthing alternatives. Because we felt it was so urgently important, the first of these seminars was on nutrition. Just over 80 out of 460 first and second year medical students attended. Pathetically, those students DOUBLED the number of hours of nutritional instruction they received during medical school. For the others, the extent of their nutritional training was a one hour lecture each day for two weeks in our first year biochemistry class. The lecturer’s lack of enthusiasm for healthy nutrition was revealed during one of those lectures when he sniveled about “the odor of the rancid fatty acids from those organic muffins you in the back row are eating”. Guess where I sat. I was forced to do my own studies. Bizarrely, my medical school was renowned for much of the most important research on human nutrition ever since Ancel Key’s landmark studies of the effects of starvation on World War II conscientious objectors.

In the mid 1980′s the National Academy of Sciences recommended that US medical students receive a minimum of 25 hours of nutritional instruction. A new study shows that only a small minority of medical schools require that of their students.

I fully accept that my interests and perspective were and are unusual. That was evident even as a college undergraduate. When I went for the mandatory career planning interview required by my university, the counsellor unsuccessfully attempted to convince me that, because of my interest in nutrition I should become a dietician instead of going to medical school. However, I am confident that my decision was correct. Instead I wonder if, reflecting their disinterest in nutrition, many doctors should have been routed towards some other career.

The best solution would be for medical education to teach more nutrition, but the most important goal might be to educate docs about how important nutrition really is. If the medical community truly recognized the importance of a healthy diet, this ridiculous educational vacuum would be filled quite quickly. Just think of how much better hospital food might also become.

Egg Recall

The salmonella-contaminated egg recall is an opportunity to think about numbers. Nearly 1/2 billion eggs have been recalled. That is 1-2 contaminated eggs for every American. 500 million is a staggeringly huge number of eggs. However, the most important questions, “why” and “how”, come down to a very small number. That number is 2. All of those eggs came from just 2 farms. That number “2″, almost-the-smallest-possible-number is the most startling fact of this case. The idea of 2 farms producing half a billion eggs is shocking. The number 2 also accounts for the problem. Mega-industrial farming inevitably leads to cross contamination of waste with food. Such a concentration of animals makes them extremely vulnerable to the spread of disease amongst the animals and those who would use them as a food source. Sure these farms were already notorious for their long track record of health violations, so no one should be too surprised. But how could such bizarre living circumstances ever be healthy? Absolutely the companies are at fault as is the lack of governmental regulation. But we are seriously deluding ourselves to think this sort of problem, as well as rising antibacterial resistance with new “superbugs”, are not dead certain consequences of consuming the products of such a dysfunctional approach to agriculture. Support your local farmer!

Ginseng
Ginseng has long been one of the most popular herbs. As a young man in Minnesota, I knew of people wild crafting ginseng in the local woodlands. A recent quality investigation found that nearly half of the ginseng products tested either did not meet the standards claimed on the product label or were contaminated by lead.

Chromium
Weight loss products are probably the most likely product to be either adulterated or contaminated, right next to herbal preparations imported from Asia. One of the most popular weight loss supplements is chromium. Although the form I recommend (polynicotinate) is safe, I do not like the more common “picolinate” form. Much worse, hexavalent chromium, the kind made notorious by Erin Brocovich, was found in 3 of 8 chromium supplements when tested by an independent laboratory.

Muscle Supplements
Most people think of body builders when they think of muscle-building supplements. They also suffer from the very wrong impression that the products used to this end are the sort of thing that gets your name in the paper for the wrong reason or are at least damaging to your health. Not so. Just like eating well and taking care of yourself in many ways can also help you build muscle, there are a number of supplements which build muscle mass and make you healthier, when used correctly. In recent years we have been learning a great deal about utilizing these approaches to help people who need to build muscle, not to win some contest, but to lose weight or simply move around better. For example, there is quite a bit of scientific evidence supporting the use of creatine in the treatment of Parkinson’s disease.

Most players on a high school football team ended up in the hospital several days ago. Confused families and media ignored the unsafely designed practices (intense muscle work, twice a day, in extreme heat) of an inexperienced first year coach and instead blamed the problem on creatine.

Creatine is an amino acid abundant in meat and a useful training supplement for those seeking to increase their skeletal muscle mass (that includes us aging old folks as well as young football players). Despite widespread use accepted by the NCAA and high school authorities, as well as hundreds of studies demonstrating the safety of creatine, myths persist that it can cause everything from kidney damage to muscle cramps.

As I have lectured on creatine since 1998 and the evidence even then strongly refuted these misconceptions, I find such lasting ignorance disturbing. While it is kind of these families to think well of their new coach, the harm suffered by much of this high school football team is certainly due to his careless and over-aggressive training, not creatine. It is unfortunate that such unscientific “knowledge” is perpetuated. As some of you know, I am a member of the editorial board of the Journal of the International Society of Sports Nutrition. The ISSN issued this commentary -

http://archive.constantcontact.com/fs055/1101391748198/archive/1103638431468.html

You may have noticed that there is a campaign underway to get Americans to drop their salt intake. This has included discussion of measures as radical as creating a legal limit on salt (sodium) in processed food. Although there is a lot that is good about this, it can also create confusion. I have had patients suffer serious consequences from their attempt to follow public health advice about avoiding added salt.

Here is the problem. Processed food is packed with salt. Way too much in there for sure. People who eat the way humans should eat, avoiding all that processed food, do not consume so much salt. You are getting the idea now. When those very health conscious people, eating real, non-processed food, obediently drop their table salt, they learn why salt is an essential for humans and collecting it so much a part of human culture. Remember even Sam wanted it for his cooking kit in the Lord of the Rings. Orcs, trolls, evil wizards, fine; but not without salt.

So, if you eat much in the way of processed food knock off the salt, or better still knock off the processed food. If you don’t eat much processed food and don’t have high blood pressure, don’t worry about it. Some of us actually need to eat salty food to keep our blood pressure high enough.