10 Memorable Wellness Moments in 2017: Fasting, Bob Harper, What the Health, Keto Diets and a Brain Bonus
1) Stents in Stable Angina: ORBITA and Placebo
The results from a study called the ORBITA trial were blasted as headlines such as “‘Unbelievable’: Heart Stents Fail to Ease Chest Pain”) in the New York Times.
The results of the ORBITA trial were presented and published in November 2017. A group of 200 patients with chronic stable angina chest pain and at least one artery blocked at least 70 percent on a catheterization were treated with optimal medication and either a sham procedure where no stent was inserted or an actual heart artery stent. The principal finding was that there was no significant change in the primary outcome, which was a change in exercise time from baseline for stent versus the sham treatment. The results also showed no significant change in angina severity score or physical limitation and no significant change in angina frequency from baseline versus sham.
So, are stents worthless? The answer is no but studies dating back at least a decade point to the fact that stents for those with no symptoms or with stable heart symptoms are usually not indicated. For decades data that a whole foods, plant-based diet, exercise, and stress management can halt and reverse heart disease has been available and is what I recommend in my preventive cardiology practice.
The Bottom Line: Question, get second opinions, and always ask why if you are being asked to schedule and elective heart stent placement.
2) Fasting Mimicking Diets: The Smarter Fast
Defined as “abstinence from eating,” the potential medical benefits have increasingly been substantiated in animal and medical research projects and now extend to boosting brain power. I have been using a form of periodic fasting called a fasting mimicking diet (FMD) in my clinic with my patients. This diet is the evolution of decades of pioneering work on longevity by Dr. Valter Longo and his team at the University of South California. Dr. Longo is recognized as a leading expert on longevity (if not the expert) and has done great work in describing the basic biochemical pathways by which cells age. The FMD program was patented by Dr. Longo after years of basic and preliminary research in yeast and animal models. The diet decreases calories to 1,100 on the first day and then to around 800 the next four days for five days overall. The nutrients are key and include plant-based whole foods. Dr. Longo’s team analyzed the effects in a human clinical trial that was published earlier this year. One hundred healthy subjects participated in this study; half of them followed a Prolon FMD five days a month for three months, and the other half ate their usual diet. Profound differences were seen in terms of weight loss, visceral fat loss, drops in blood pressure, blood sugar, blood cholesterol, and markers of inflammation in the FMD group.
Even more profound was the drop of insulin-like growth factor 1 (IGF-1), which is a biomarker for cancer growth, and an increase in stem cell production, which is a marker for regeneration of cells. In fact, the Prolon FMD program is marketed by Dr. Longo’s teams at USC as a program that promotes regenerative and rejuvenating changes, which is unique from all other data published for fasting programs.
The Bottom Line: If you are in a health rut or looking for the most scientifically supported plan to boost to your metabolism and achieve weight control, the FMD program is the fasting agenda of choice and perhaps THE science story of 2017.
3) Growing List of Benefits of Plant Based Diets
You are probably aware that plant-based diets have been shown decades ago to prevent and reverse heart disease, the #1 killer in the Western world, but new research points to additional benefits of a plant-based diet.
1. Type 2 diabetes:
In a long-term study from Finland of over 2,000 men followed over 19 years, replacing even 1 percent of calories from animal proteins with plant proteins lowered the risk of developing diabetes by 18 percent.
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2. Liver disease:
A growing health concern is called nonalcoholic fatty liver disease or NAFLD. In an analysis of over 3,000 subjects in the Netherlands, increased dietary proteins from animal sources (meat) were associated with a greater risk (reaching 50 percent higher) of developing NAFLD.
In a study of processed red meat consumption and asthma symptoms, eating cured red meat over four times a week increased the odds of having worsened asthma by 76 percent.
4. Colon cancer:
The world was caught off guard in October 2015, when the World Health Organization announced their results of a comprehensive analysis demonstrating that processed red meats like bacon and hot dogs cause colorectal cancer. In a more recent analysis, 400 studies were examined. They found that the risk of colorectal cancer increased by 12 percent for each 100 gm/day eaten of red and processed meats. Whole grains and vegetables decreased the risk.
In an analysis of 21 studies examining diet and depression, eating red and processed meats increased the risk of depression by over 25 percent while fruits and vegetables had the opposite relationship.
6. Stomach cancer:
Researchers combined 42 studies relating diet to stomach cancer and found that higher intake of red meat increased the risk by 70 percent while processed red meat increased it by 80 percent over those that shunned meats.
7. Head and neck cancer:
In a study from the Netherlands of over 120,000 subjects followed for over 20 years, consumption of processed red meat was associated with developing cancers of the head and neck. The risk was increased as much as 50 percent compared to the low- or non-meat eaters studied.
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8. Gestational diabetes:
Developing diabetes during pregnancy, known as gestational diabetes, can complicate pregnancies and have an impact on the health of the offspring. In a recent analysis, the highest red meat consumption of any kind increased the risk of gestational diabetes by over twofold. Once again, processed red meat also increased the risk by about double over low-meat eaters.
The Bottom Line: Plant based diets are growing in popularity and the science is expanding for multiple advantages over diets based in animal foods. The food story of 2017 was plants, plants and more plants.
4) Gluten Free Diets are a Concern for Most
There is no argument that those with Celiac Disease and some persons with autoimmune disorders benefit from avoiding foods rich in gluten and related compounds found in wheat and other grains. The 164 million entries on Google indicate that interest in a gluten free diet (GFD) has not lost any momentum. Five new research studies on the topic that indicate that the GF diet is not appropriate for the rest of us.
1. Reduced risk of exposure to toxic heavy metals.
Rice and fish are often favored on a GFD, but these foods may concentrate toxic heavy metals like arsenic, mercury, cadmium, and lead. In one study, researchers evaluated blood samples in 11,353 subjects, 55 of whom had celiac disease. They found that in people who were observing a GFD, blood levels of mercury, lead, and cadmium were higher than in those who did not avoid gluten. The increased burden of toxic heavy metals was found in those with and without celiac disease following a GFD.
2. Lowered risk of type 2 diabetes.
Scientists presented data at the American Heart Association in March 2017 from 199,794 subjects whose dietary histories had been followed for over 30 years. The presentation reported that those subjects who ate the most gluten had the lowest risk of type 2 diabetes upon follow-up. Believe it or not, the group eating the highest amount of gluten foods compared to the lowest group had a 13 percent lower risk of diabetes. The major sources of gluten were pizza, muffins, pretzels, and bread.
3. Decreased likelihood of heart disease.
The Harvard School of Public Health analyzed over 100,000 subjects for 25 years, collecting data on dietary histories periodically. During the follow-up period, over 6,000 cases of new coronary heart disease were identified. Participants with the highest intake of gluten had a rate of heart disease significantly lower than those with the lowest intake of gluten. After adjustments for intake of refined grains, gluten consumption was associated with a 15 percent lower risk of developing coronary heart disease. The researchers concluded that “the promotion of a GFD for the purpose of coronary heart disease prevention among asymptomatic people without celiac disease should not be recommended.”
4. Reduced risk of colorectal cancer.
The world was abuzz in October 2015 when the World Health Organization announced their findings that processed red meats like bacon were not only associated with cancer but directly caused cancer as a Class 1 carcinogen. An updated analysis was just released that confirmed these findings. Also reported in the study was how whole grains (containing the gluten family of chemicals) reduce colorectal cancer risk. In fact, colorectal cancer risk decreased by 17 percent for each 90-gram-per-day increase in consumption of whole grains. We have known for years that high-fiber diets prevent disease, and 100 percent whole grains are a great source of fiber.
5. Avoidance of excess calories.
In a study presented this week in Europe, an analysis of the nutritional composition of foods in a GFD versus their gluten-containing counterparts revealed that the foods for a GFD had significantly more calories, protein, saturated fatty acids, and often sugar. Over 600 products were evaluated and this disparity was found particularly in breads, pizzas, and flours.
The Bottom Line: Enjoying whole grains is nourishing and constitutes a health dietary pattern for most. A diet comprised mostly of minimally processed, generally or exclusively plant-predominant foods in time-honored, balanced combinations — where the preferred beverage for satisfying thirst in almost all situations is water, is the foundation for health.
5) The Soy/Cancer Myth Resolved
The word on the street that soy is a dangerous food that destroys your health is pervasive widespread. However, the overwhelming majority of the scientific data, including a new study in 2017 on breast cancer survivors, argues the opposite. Here are a few of the older studies and the new one that made headlines.
1. Soy and heart attacks
Chinese researchers studied 1,312 cases of first-time heart attack sufferers and 2,235 control subjects. An unhealthy dietary pattern increased the risk of heart attack while an increased intake of vegetables, fruits, and tofu were associated with a significant drop in heart attack rates.
2. Soy and breast cancer
Japanese researchers performed an evaluation of research and identified studies that showed everything from a slight to a significant reduction in breast cancer with increased soy food intake. Additionally, a meta-analysis of 35 studies from Asian countries was performed to examine soy intake and breast cancer risk. Soy intake significantly reduced breast cancer risk by 40 percent in both pre- and postmenopausal women in these countries.
3. Soy and overall mortality
The Singapore Chinese Health Study examined more than 52,000 men and women free of chronic diseases at entry between 1993 and 1998 and followed them all the way through 2011. During that time, there were more than 10,000 deaths. A pattern of eating a vegetable-, fruit- and soy-rich diet was associated with up to a 25 percent lower risk of dying during the study period and was also linked to fewer heart and cancer deaths.
4. New data on breast cancer survival
In an analysis performed by investigators at the Friedman School of Nutrition Science at Tufts University, the intake of isoflavones — the plant-based estrogen or phytoestrogen found in soy — was related to survival in over 6,200 women with breast cancer followed for almost 10 years. In the women who had estrogen-receptor-negative cancer, the group with the highest isoflavone (soy) intake had a reduction in all causes of death by 21 percent. In women with estrogen-receptor-positive cancer or on hormone therapy, soy had a neutral effect on survival and did not increase any adverse outcomes. The lead study author, Dr. Fang Fang Zhang, indicated that “for women with hormone receptor-negative breast cancer, soy food products may potentially have a protective effect. Women who did not receive endocrine therapy as a treatment for their breast cancer had a weaker, but still statistically significant, association.”
The Bottom Line: Soy is a health food and the new data puts an end to the Soy Myth. While no one endorse “fake foods”, organic edamame, tofu and fermented tempeh can be enjoyed without worry.
6) What the Health Film
The documentary What the Health received a huge amount of attention in 2017 and was the reason thousands if not millions of people adopted plant based diets this year. There were reports that restaurants serving healthier fare saw an uptick in customers attributing the change to the film, including my family owned GreenSpace Cafe. Critics of the of the movie rallied around a statement in the film by Neal Barnard, MD that “sugar does not cause diabetes”. A careful review of the science behind that statement was one of the most discussed health topics of 2017.
1) Type 1 diabetes is not caused by sugar. All agree on this as type 1 diabetes is considered an autoimmune disease leading to destruction of the insulin producing cells in the pancreas. However, patients with type 1 diabetes can develop and reverse insulin resistance (IR) in their muscles and liver so understanding the origin of IR is important.
2) Do other organizations agree that sugar does not cause type 2 diabetes? Actually, the opinion that sugar in the diet does not cause type 2 diabetes is a common viewpoint. The Joslin Diabetes Center calls it a “myth” that sugar causes diabetes. Similarly, the British diabetes organization also maintains it is a myth that sugar causes diabetes. Finally, the American Diabetes Association lists the sugar=type 2 diabetes a myth but goes on to say that “type 2 diabetes is caused by genetics and lifestyle factors. The American Diabetes Association recommends that people should avoid intake of sugar-sweetened beverages to help prevent diabetes”. An association between sodas and the risk of type 2 diabetes has been seen in studies.
3) Fat-rich diets raise blood sugar more than sugar-rich diets. Nearly 100 years ago healthy volunteers were fed diets rich in fat or carbohydrate and their blood sugars were monitored. The results showed blood sugar skyrocketed after that fat rich meals to twice as high a level. At a cellular level, elegant studies show that accumulation of fat droplets and not carbohydrate stores in liver and muscle cells contributes to IR and type 2 diabetes. These droplets result from raising levels of fats in the blood from animal fats like chicken, beef, cheese and fish and even vegetable fats in excess. Of course, most processed foods have too much sugar and fats so they are double trouble.
5) Fruit Intake May Be Protective. In a recent and massive study of over 500,000 subjects followed over 7 years, the more frequently those studied ate fruit, the lower was their risk of developing type 2 diabetes. The lead researcher indicated wisely that “the sugar in fruit is not the same as the sugar in manufactured foods”.
The Bottom Line: When I spoke to Gerald Shulman, MD of the Yale University School of Medicine, he indicated that “it is not so much dietary content as it is calorie excess. Processed foods are calorie dense and low in satiety leading to overeating and excess calories and weight”. Less is more when it comes to sugars, processed foods, and added oils and fats.
7) American Heart Association Statement on Fats
On June 15, 2017, a Presidential Advisory of the American Heart Association (AHA) published a statement on dietary fats and health that created more of an uproar than many anticipated. Although many data points supported their recommendations, such as the food plate published by the Harvard School of Public Health food plate 2011, a group of naysayers responded to the AHA in often ugly and threatening statements.
The Presidential Advisory from the AHA concluded that:
· Randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced cardiovascular disease by approximately 30 percent –similar to that achieved by cholesterol-lowering drugs, known as statins.
· Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of cardiovascular disease.
· Several studies found that coconut oil — which is predominantly saturated fat and widely touted as healthy — raised LDL cholesterol in the same way as other saturated fats found in butter, beef fat and palm oil.
· Replacement of saturated fat with mostly refined carbohydrate and sugars is not associated with lower rates of CVD.
· An accompanying editorial to the Presidential Advisory gave an example indicating that “if the cheese is replaced with walnuts, a rich source of polyunsaturated fat, risk is reduced 25%. In addition to the healthier fat profile, the walnuts — like other whole plant foods — also provide a host of other benefits such as vitamins, minerals, antioxidants, phytonutrients, and fiber.”
The Bottom Line: The scientific statement was clear in language: eat far less or no meat, dairy, and cheese and consume more foods like oatmeal, almonds and walnuts. Coconut oil in the diet is not supported as a health food.
8) Lessons from the Healthiest Tribe: The Tsimane
The Tsimane are a tribe living in Bolivia in villages of about 60 to 200 people that made headlines in 2017because of their surprising longevity and freedom from heart disease.
In data published in the journal Lancet, the results of coronary artery calcium scoring (CACS) using CT imaging in 705 adults reported. Surprisingly, 85% of the tribe tested had no risk of heart disease because of a CACS of zero, 13% had low risk and only 3% had moderate or high risk. Even those over age 75 years were healthier than expected with only 8% moderate or high risk on the CT heart scan. These results are the lowest reported levels of vascular aging of any population recorded to date. By comparison, a US study of 6814 people found that only 14% of Americans had a CT scan that suggested no risk of heart disease and half (50%) had a moderate or high risk.
The Tsimane have a lifestyle including hunting, gathering, fishing and farming, where men spend an average of 6–7 hours of their day being physically active and women spend 4–6 hours. The diet of the Tsimane was composed largely of complex carbohydrates (72%) high in fiber such as rice, plantain, manioc, corn, nuts and fruits. Protein constituted only 14% of their diet largely from animal meat caught in the wilds. Their diet is very low in fat with only 14% of their calories being fat calories.
The Bottom Line: In an era when the debate about dietary fats have led to public confusion, the remarkably low-fat diet of the Tsimane, in addition to hours of activity daily, is a pattern supported once again for youthful heart arteries. Their exceptional heart health speaks volumes about not following that trend or high animal food diets in general.
9) Ketogenic Diets (Ultra Low-Carb) Soar and Crash
It would be hard in 2017 to have missed the wave of recommendations to lower “carbohydrates” to minimal levels and focus on meals higher in fat and protein to promote the use of ketone bodies as fuel. A high-profile example in the news was the launch of a start-up called Virta Health in March, 2017 to teach a low-carb diet to those with type 2 diabetes.
The science on ketogenic diets as a general health strategy is tiny as the majority of medical articles relate to refractory epilepsy. A series of disturbing studies about the long-term use of ketogenic diets on survival have appeared in the medical literature and were a focus of media discussion in 2017.
1) Noto et al. This meta-analysis of 272,216 subjects studied for diet and mortality reported that the risk of “all-cause” mortality in those responding that they followed a low-carbohydrate diet was approximately 30% higher than other subjects.
2) Li et al. The Harvard School of Public Health studied over 4,000 men and women who had survived a heart attack. Those eating a lower carbohydrate diet higher in animal protein and fat was associated with a higher risk of all-cause and cardiovascular mortality. This increase was not identified in those responding they ate a plant-based low-carbohydrate diet.
3) Sjogren et al. In an analysis of over 900 elderly Swedish men, a Mediterranean diet pattern reduced mortality while a carbohydrate restricted diet was associated with a 20–40% increase in all-cause and cardiovascular mortality respectively.
4) Fung et al. In an analysis of nearly 130,000 subjects followed by the Harvard School of Public Health, subjects following an animal food based low carbohydrate diet had increase in all-cause, cardiovascular and cancer mortality while there was a reduction in mortality in those following a plant based similar diet pattern.
5) Snell-Bergeon et al. In a series of type 1 diabetics, a higher protein and fat diet was associated with more heart artery calcification, a marker of atherosclerosis, while a higher carbohydrate based diet was associated with a lower burden of artery calcification.
6) Lagiou et al. In a research group of over 42,000 Swedish women, respondents with a dietary pattern of higher protein and low-carbohydrate was associated with higher all-cause and cardiovascular mortality.
7) Trichopolou et al. In a Greek population of nearly 23,000 subjects, those following a low-carbohydrate and higher protein diet had higher all-cause, cardiovascular and cancer mortality.
The Bottom Line: Would patients sign up to reverse their DM2 if they were aware of the potential risks raised by these studies? Should they be informed of these concerns? Should you be if you are following a low-carb diet month after month? As discussed above, a plant-based diet low in sugar and protein for just 5 days a month, called a fasting mimicking diet, shows promise for the future for a more reasonable and beneficial use of ketone bodies.
10) Bob Harper’s Heart Attack and Lipoprotein a
When Bob Harper, celebrity trainer on The Biggest Loser series, collapsed and nearly died in February, 2017 the obvious question was, “how could that happen”? We celebrate his recovery and his efforts admit the missed warning signs so that others will be on the alert for silent heart disease starting to surface. But how did he develop coronary artery disease at age 51? Harper did a public service by announcing that learned that he carries a high level of a form of cholesterol known as Lipoprotein (a), something I have written on previously in regards to Harper’s health journey. A few comments are timely.
1) What is Lipoprotein (a)?
Lipoprotein (a) is also known as Lp(a), Lp little a, or the “sticky cholesterol”. It is a particle in the blood that carries cholesterol, fats and proteins. It is inherited and diet, exercise, and statin medications like Lipitor have little impact on lowering the level of Lp (a).
2) How common is Lp (a)?
Approximately 20–30% of people have high levels of Lp(a). That means over 60 million people in the USA alone have elevated levels. It is elevated more commonly in African-Americans and those of Asian background. All that is needed to check on this is a simple blood test that is widely available and not expensive. However, is not included in most standard cholesterol panels. Levels of Lp(a) are reported in different units, either mg/dL or nmols/L. A normal level is less than 30 mg/dL or less than 75 nmols/L.
3) Who needs to be checked?
The European Society of Atherosclerosis recommends widespread measurement of Lp(a) for the public at risk but this has not reached most doctor’s offices. I believe everyone should find out early in life if they carry this silent artery clogger. However, certain groups without question should ask for the test. These include:
• You have a family member with early heart disease or stroke (men younger than 55 years of age and women less than 65 years of age)
• You know of a family member with high Lp(a). If a parent has high Lp(a), their children have a 1:2 chance of being high.
• You suffered a heart attack or stroke with no other known risk factors. This might describe the status of Bob Harper and a thorough evaluation of laboratory findings, as I previously described, is recommended.
• Your cholesterol is high despite taking a statin medication. It might be the LDL cholesterol in Lp(a) that is adding to the result and was not previously measured separately.
5. What can be done about a high Lp(a)?
To date, most attention has been to correct lifestyle and all other factors in patients with a high Lp(a). This is wise. This would include:
• Eat a healthy diet. People with high Lp(a) appear to benefit from a whole food, plant based diet or a Mediterranean Diet emphasizing vegetables, whole fruits, whole grains, and legumes while limited dairy, meats, eggs, added sugars, and refined grains.
• Exercise 30–60 minutes a day.
• Stop smoking
• Control your weight to keep your waistline thin.
• Lower stress with 7–8 hours of sleep along with relaxation like yoga or meditation.
There is no direct inhibitor of Lp(a) at this time. A variety of supplements, all of which I use in patients in my specialized heart longevity center, are known to lower Lp(a). Niacin or vitamin B3 lowers Lp(a) effectively while it also lowers LDL-cholesterol and triglycerides and raises HDL-cholesterol. Other than flushing after large doses, this agent has been used for decades with safety. L-carnitine is an amino acid that lowers Lp(a) and has been shown in other studies to improve outcome after heart attacks. New injectable drugs used to lower cholesterol are now FDA approved and also lower Lp(a).
The Bottom Line: The dramatic story of Bob Harper continues to be played out in the public eye as it is teaching us much about survival and recovery. The focus now needs to shift to early detection, prevention and reversal for the general public. Ask your health care provider to check your Lp (a) level along with your standard cholesterol panel.
11) Brain Bonus
There were at least 3 notable wellness moments in 2017 focused on brain health including:
- The publication of The Alzheimers Solution by Dr. Sherzai. The husband and wife scientist-clinician scholars provided compelling data that lifestyle saves brains.
- Researchers from the Memory and Aging Project followed 960 participants over 5 years who had 2 cognitive assessments and also had a food frequency questionnaire completed. The consumption of green leafy vegetables was associated with slower cognitive decline. The greens eaters showed brain ages 11 years younger than those who ate the least greens!
- New data from the John Hopkins University supports the notion that the healthier the diet, the fewer the problems in MS patients. In original research published in Neurology, the quality of diet and the symptoms and disability of patients with MS were analyzed in 6,989 patients with MS. . Patients with MS in the highest category of healthy diet score had the lowest level of disability and depression. They also had the least fatigue, pain and cognitive impairment.