There are two fats that are essential to humans.  Alpha linolenic (Omega 3) and linoleic (omega 6) are required in our diet because our bodies can’t make them.  Other fats that are "conditionally essential" include, gamma-linolenic acid (an omega-6 fat), lauric acid (a saturated fat), and palmitoleic acid (a monounsaturated fat).  Conditionally essential means that most people do not make enough for health.  There are other omega fatty acids such as omega 7 and omega 9.  They are not required in the diet but do play a role.  (To a chemist, the omega followed by a number means that we start counting carbon atoms at the end of the carbon chain and the number is the point that we find the unsaturated spot.  The unsaturated spot has what we call a “double bond” between the carbons instead of having hydrogen atoms attached.)  Interesting to note, omega 7 break down products create “old person smell”.

Balance omega 3 and omega 6
In essence, the omega 3 and omega 6 play  “yin and yang” roles.  Omega 6’s are involved in inflammatory reactions in the body and omega 3’s are involved in anti-inflammatory reactions.  Both are needed but there needs to be a balance.  The current estimate of a proper balance is perhaps 4 parts omega 6 to one part omega 3.  Scientists estimate that our prehistoric ancestors ate a diet that was closer to 2 to 1 or even 1 to 1 rather than 4 to 1.  Scientists also estimate that most Americans eat a diet that may have as much as 60 times more omega 6 than necessary and not nearly enough omega 3.  Most people have a ratio between 15 and 20 to 1.  

Consequences from too much omega 6
What is the consequence of so much omega 6?  A huge problem is that omega 3 and omega 6 are processed by the same enzymes.  That means they are competitive.  In effect, excess omega 6 erases the potential benefit of omega 3.  We end up with nothing to shut off inflammatory processes.  Most disease has an underlying inflammatory component or even cause.  This imbalance has been implicated in higher rates of diabetes, cancer, heart disease, stroke, arthritis and skin disorders. 

Why so much omega 6?  
Commonly used oils such as peanut, sesame, safflower, sunflower, canola, rice bran, and corn oil are heavy in omega 6.  Also, most grains have a very high omega 6 content, the most obvious being wheat.  Animals that eat grass or algae have fat that contains omega 3.  That would mean grass fed herbivores (cattle, deer, etc.) and sea creatures (both algae eaters and the animals that eat them).  Olive oil and flax oil are omega 3 heavy.  Macadamia and avocado are also good sources.  Grape seed oil, coconut oil and clarified grass-fed butter are good oils for high temperatures.

Omega recommendation
Omega 3 consumption is recommended by health organizations around the world.  The public confusion seems to lie with omega 6.  The clear solution is to avoid omega 6 as much as you can.  Omega 6 is in so many food items that you will eat plenty no matter what you do.

--Dave

photo by Dave Hutt, www.dmddigitalphoto.com

Diagnosis Diabetes

The diagnosis of diabetes can be very upsetting for anyone.  It is certainly inconvenient.  It can be deadly.  Diabetes can mean pills, injections, blood tests, doctor visits, big changes in diet, and big changes in lifestyle.  That assumes that the patient decides to address the disease.

Common Sense Medicine
A friend and colleague recently got that diagnosis.  As I have observed, my medical and dental friends are no less likely to be in denial than anyone else.  They do have a better idea of the consequences.  He asked me what he should do.  I have seen many patients that were suffering the effects of diabetes, my relatives included.  I know from the current science that it is not inevitable to go blind, have kidney failure, lose sensation, and lose limbs.

Anti-Inflammatory Diet
I told him what I knew.  Nothing I invented.  It is in the scientific literature.  It is almost common sense.  Avoid grains(high glycemic and contain high omega 6), eat high quality protein, avoid chemicals that have bad side-effects, eat food that decreases inflammation, eat fiber, eat only small amounts of simple sugars, and get a moderate amount of regular exercise. Test what you eat by checking blood sugar often.  Everyone is a little different.  He did exactly that.  In about three weeks, he lost 15 pounds.  His blood sugar readings have dropped into normal range.  He is excited to find out what his lipid tests and HbA1c will look like in a couple months.  

Empathetic Healthy Doctor
This experience will make him a better doctor and his health may well be better than if he maintained his habits and didn’t get the diagnosis of diabetes. He will certainly have greater empathy for his patients that have diabetes. A blessing in disguise.  Pray it is.

--Dave

Death by Soda
Soda and other sweetened drinks cause180,000 deaths around the world each year, according to research presented at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.  They contribute to obesity which increases diabetes, cardiovascular disease, and cancer.

AHA Recommendations
Mexico has the highest consumption of sugary beverages and the highest death rate linked to sugary beverages, at 318 deaths per million adults.  Japan has the lowest consumption of sugary beverages and the lowest death rate at 10 deaths per million adults.  Based on various scientific studies, the American Heart Association recommends that adults consume no more than 450 calories per week from sugar-sweetened beverages.  Please realize that means 3 cans per week.  Each can typically has about 40 grams of sugar.

Artificial Sweeteners
That does not mean that artificial sweeteners are better.  Many of the sweeteners have been shown to spike blood insulin levels.  People that consume artificial sweeteners become fatter than people that consume sugared drinks for several reasons.  Drink water.

--Dave

PS  If you are going drink soda, drink something really good.  I must admit that
I enjoyed the soda in the picture.

Christina Warinner, Ph.D. had a fascinating TED talk this past January 2013.  She is a post-doctoral fellow at the University of Oklahoma.  Ostensibly, she was debunking the “Paleo” diet as described in popular culture.  She had some very valid points that she could back up with some good science.  

Paleo food
She pointed out that most of the food available to modern people is a modern agricultural construct.  Boccoli, almonds, tomatoes, chicken eggs, etc. did not exist in paleolithic times.  The paleolithic versions often were very small, they were seasonal, and they contained toxins that limited consumption.  Many foods that could support a small population of hunter/gatherers cannot support a modern, large, static population. A solution for modern people has been that the current food supply is often full of preservatives that inhibit bacterial growth. What does that do to the healthy bacteria that needs to live in our systems? We don’t know.

Ancestral diets
What do we know about real paleolithic diets and people? The available resources varied widely throughout the world.   It was fresh.  It was the whole food.  Generally, it was not highly processed.  It often had a high level of fiber.  They ate very lean meat.  They also ate the bone marrow and the organs.  Many populations ate some grain and legumes but it was limited to the time of year and not a large quantity. They ate much, much less simple sugar.  She pointed out that one 32 ounce soda contains approximately the same amount of sugar as 8.5 feet of sugar cane.  A paleolithic person couldn’t possibly eat that much.  

Diet diversity
Most paleolithic people ate a diet that was very diverse. It was also seasonal.  People today eat a large portion of their diet focused on three species, corn, wheat, and soy.

Healthy eating
The conclusion she finally came to was that we can learn from what paleolithic people ate but we cannot possibly duplicate it.  What I heard from her is that the premise of eating what our ancestors ate in concept is correct, but the popular interpretation, the “cave man diet”, is a distortion.  High diversity, high quality lean meat, high fiber, whole food, with a low carbohydrate content is consistent with what is known about paleolithic diets and what is known to be healthy.

--Dave

Photograph by Dave Hutt, www.dmddigitalphoto.com

A study was very recently published in The Lancet reporting on atherosclerosis in pre-industrial mummies.  They studied the preserved remains of people from Egypt, Peru, ancestral Puebloans, and Unangans from the Aleutians.  They found that in all cases there was cardiovascular disease.  It should be noted too that Ötzi, the 5000 year old frozen man from the Alps, also had cardiovascular disease.  In their conclusion, they state that this may well invalidate the idea that indigenous diets would protect people against cardiovascular disease.  I disagree.  All of the mummies studied, with the exception of the Unangans, were from cultures that engaged in agriculture and ate grains.  The Unangans were the only hunter/gatherers in the sample.  There were five Unangan mummies studied and of that, three had cardiovascular disease.  The confounding factor is that they lived in such a cold, windy climate that their homes were thick earthen mounds that continuously had fires for warmth.  They were extremely sooty.  Breathing soot will cause atherosclerosis.  The authors suggest that atherosclerosis “is an inherent component of human aging and not characteristic of any specific diet or lifestyle.”  They also go on to say that there may be factors that we do not understand.  That may be true.  I would say that the study suggests that the advent of agriculture and or environmental factors (soot for instance) could be the primary causes in the development of cardiovascular disease.  These mummies have both of those factors in common with contemporary people.

--Dave

www.thelancet.com    Published online March 10, 2013    http://dx.doi.org/10.1016/S0140-6736(13)60598-X

Discussion of the Mediterranean diet has been popular in the media for years.  The results of a multi-center study of the diet, the PREDIMED, were recently published in the New England Journal of Medicine.  There were 7,447 participants studied between 2003 and 2011.  Three diet variations were studied.  Mediterranean diet supplemented with olive oil,  Mediterranean diet supplemented with tree nuts (almonds, walnuts, and hazelnuts), and a low fat diet.  After five years the two Mediterranean diets showed a highly significant 30% reduction in the risk of suffering a cardiovascular death, a myocardial infarction or a stroke compared to the low fat diet.  This study runs directly contrary to the commonly held belief that low fat diets are better to protect the cardiovascular system.  It does suggest that the type of fats are important.

--Dave

Ramón Estruch, Emilio Ros, Jordi Salas-Salvadó, Maria-Isabel Covas, D.Pharm., Dolores Corella, Fernando Arós, Enrique Gómez-Gracia, Valentina Ruiz-Gutiérrez, Miquel Fiol, José Lapetra, Rosa Maria Lamuela-Raventos, Lluís Serra-Majem, Xavier Pintó, Josep Basora, Miguel Angel Muñoz, José V. Sorlí, José Alfredo Martínez, Miguel Angel Martínez-González. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. New England Journal of Medicine, 2013

Photo by Dave Hutt, www.dmddigitalphoto.com

Xylitol is a  good substitute for table sugar (sucrose), tasting good with little or no aftertaste.  The very low glycemic index (stimulates insulin production very little) makes it a very attractive sweetener for diabetics and people with metabolic syndrome.  It is not an artificial sweetener, having been derived from birch bark.  It interferes with tooth cavity bacteria activity and even seems to aid remineralization of teeth.  Besides tooth bacteria, it also inhibits other bacteria in the ears and respiratory tract. Studies have not shown toxicity in humans, even at very high consumption levels.  There may be a mild laxative effect in some people as shown in a study of children consuming more than 2 ounces per day.  Adults have consumed as much as a pound in a day with no ill effect.

If you decide to use xylitol, be aware that it is toxic to dogs.

--Dave

The Gallup Wellbeing Survey is an ongoing project tracking the health and wellbeing of Americans over time.  Part of what they track is self reported obesity, diabetes, and hypertension.  In summary, they are tracking metabolic syndrome.  It is very predictive for cardiovascular disease among other disease consequences.  The states with the highest rates of obesity were West Virginia and Mississippi with 33.5% and 32.2% respectively.  The lowest obesity rates were in Colorado and Massachusetts with 18.7% and 21.5% respectively.  The average rate is 26.2% for the US.  This is all self reported.  In general, the same high obesity states also had high rates of diabetes and hypertension.  Keep in mind that obesity, when self reported, is significantly underestimated.  

Obesity now surpasses smoking and alcohol abuse as a major health problem.  We are getting fatter and suffering the associated health consequences.

--Dave

http://www.gallup.com/poll/160892/coloradans-least-obese-west-virginians-third-year.aspx?utm_source=tagrss&utm_medium=rss&utm_campaign=syndication

I read widely in the scientific literature.  Of course, it is in areas that interest me.
I try to be careful that I discern good science from bad.  That is why I pay particular attention
to the thoughts of good scientists who exhaustively review literature with an effort to avoid personal bias.  I have been enjoying a recent book, Perfect Health Diet, by two Ph.D’s that were stimulated to investigate why they had health problems.  Neither is directly involved with healthcare, one being an astrophysicist and the other a molecular biologist.  They came to the conclusion. based on 5 years of sifting through both good and bad science, that essentially the so called “paleolithic diet” is the correct approach.  I must admit that I had come to that belief as well based on much less science and more on observation of myself and my patients.  Essentially, limiting grains, simple sugars, and dairy products have made a big difference for me, my family, and other people that I know.  It took me a very long time, over 30 years, to do that.
I am enjoying the information gathered in this book.  Yes, it does agree with my bias.  But, if someone else agrees with my opinion, it must be correct.  (wink)

--Dave



“Let food be thy medicine and medicine be thy food”
― Hippocrates