Canned Foods and BPA

A few years ago, manufacturers of baby bottles made an aggressive effort to eliminate bisphenol A (BPA) from their products.  The effort was widely hailed as an excellent, pro-health, consumer-friendly move and parents across the country rejoiced.  BPA is a known endocrine disruptor.  This means it changes the way that hormones function in the body.  While minute amounts to an adult may not be very disruptive, no one really knows how much is safe.  The impact on children; we know even less.

While BPA has been removed from many children's products, it is still widely used in other areas.  The inside of canned foods is known to have BPA.  A study reported in the Journal of the American Medical Association examined adult volunteers who ate one can of soup per day for 5consecutive days.

Researchers found that his lead to BPA levels in the urine that were 1,221% higher than people who did not eat soup out of cans during that time frame.  That is not a type.  It was 1,221% higher!

The only way to show up in urine is if BPA was absorbed into the blood in the first place (presumably from dietary intake).  While this research isn't damning of BPA in and of itself.  It does indicate significant exposure to BPA to the average American.  It's is not uncommon to open a can of tuna, soup or other food product.  If you buy much of your food, you must realize that quite a bit of restaurant food also comes out of a can (depending, of course, on where you choose to dine).

There is quite a bit of research showing the potential of BPA to be harmful to our health.  The fact that exposures are this high is very alarming.  Remember this as you open your next can of beans.  That low glycemic, high protein, high fiber treat may come along with a spoonful of endocrine disruptors.

Mom's diet during pregnancy

Parents have enormous influence over what their children eat.  In the early years, children eat only what they are given.  As time goes on, they begin to make their own food choices; largely shaped by parents.  It turns out that the influence (specifically from mom) may begin much earlier than initially thought.

Children may actually have their flavors sculpted while still inside the womb!   This is an idea that has been spread through folklore from one generation to the next.  But a new study in Current Diabetes Reports seems to confirm this idea.

The concept is called "prenatal flavor learning."  The study found that:

"the flavors of the foods in the maternal diet are found in the amniotic fluid swallowed by the fetus, with the fetus developing a preference for those flavors that is shown to persist in infancy."

In other words, the baby could taste what Mom tasted and preferred those tastes even as an infant.  I especially appreciate another line from the authors,

"This is an empowering concept for a pregnant woman."

It shows that developing a child's taste for healthy foods begins with Mom when she is pregnant.  It certainly continues after birth as the parents model healthy eating and behavior.

Mom's healthy pregnancy diet has a dual benefit.  It provides bountiful nourishment to the developing child and programs his/her taste buds to continue that healthy trend after birth.

More good news for fruits and veggies

A new study out of Loma Linda University shows that people who follow a vegetarian diet had a "substantial and independent reduction in diabetes incidence." 

Researchers found that among the black population, a vegan diet lead to a 70% reduction in diabetes risk.  A vegetarian diet was also impressive and cut the risk of diabetes by 53%.

The study examined over 41,000 people (7,172 black) Seventh Day Adventists.  While the results were similar among white participants, it is important to note that Seventh Day Adventists generally abstain from alcohol and tobacco. 

The study also found that exercising 3x per week decreased risk of diabetes by 35%.   This is another win for people advocating a plant based diet and regular exercise... in other words; a healthy lifestyle.

Fruits, veggies and sperm

Your diet clearly influences your heart health.  It definitely influences liver health.  It certainly influences brain health.  Without a doubt, it influences your bone health.  Diet influences muscle health.  Now- there is compelling research that suggests that it also influences sperm health.  

After studying 188 men between ages 18-22, researchers found that those men who ate a healthy diet had sperm that were better "swimmers."  The sperm count and shape did not vary depending on the diet, but sperm from poor eaters moved around much less.  In other words, their motility was compromised.  

"The main overall finding of our work is that a healthy diet seems to be beneficial for semen quality," said Audrey J. Gaskins, lead author of the first study.  USA Today

While this research has been lacking previously, it should come as no surprise  Did we really think that nutrition could be vital to so many other cells and tissues in the body, EXCEPT for sperm?  

This research simply adds onto the millions of other reasons we should be eating well.

Good news for Fruits and Veggies

What causes disease; bad genes or bad environment (diet, exercise etc.)?  This has been the age-old question that has actually already been answered.  The answer is, "both."  The more nuanced perspective questions the relative influence of both of those variables.  We all know that genes don't change; that is basic biology.  However, the expression of those genes is known to be modifiable.  

A recent study suggests that fruits and vegetables may actually play a significant role in modifying the expression of a genetic profile that promotes heart disease.  When a group of people with that high risk genotype ate lots of raw fruits and vegetables, they had a much lower risk of having a heart attack.  In fact, the people (with the same high risk genotype) who did not eats lots of produce had 2 times the risk of having a heart attack.  This article in TIME magazine reviews the research and states,

That suggests that diet can make a real difference in heart disease risk, even when that risk is genetically based. "It means that perhaps our family history, or genetic risk, is modifiable," says Anand (one of the co-authors of the study)  "Despite not being able to change our genetics, if we are able to modify the effect or expression of our genes. That's exciting."

It is great to see science validating the effects of a healthy diet.  A healthy diet has the real potential to modify the expression of your genes.  I wonder what a bad diet does to the expression of those hazardous genes.

Good bacteria

I opened up the paper today and right there on the front page of the Washington Post (Oct. 11, 2011) was the headline that screamed, "'Good bugs'  may be the key to staying healthy."

What a way to start the morning... good news all around!  For years, clinicians have been touting the significance of the beneficial bacteria in the body.  We are still very far from knowing the details and all the benefits they bring, but it was so good to see a very main stream outlet think this news worthy of the front page.  Not that long ago, the folks that advocated probiotics and yogurt consumption were thought of as grungy, granola-loving, hippie health nuts.  In less than a decade, that has turned around to the point where there is genuine interest from conventional health care professionals, doctors and researchers alike.  The article quotes Rob Knight, a professor at the University of Colorado as saying,

"In terms of potential for human health, I would place it with stem cells as one of the two most promising areas of research at the moment."

The author of the piece, Rob Stein, writes,

"Moreover, scientists are becoming more convinced that modern trends — diet, antibiotics, obsession with cleanliness, Caesarean deliveries — are disrupting this delicate balance, contributing to some of the most perplexing ailments, including asthma, allergies, obesity, diabetes, autoimmune diseases, cancer and perhaps even autism."

These bacteria are so important.  It leads to the question, what is causing a disruption in the balance, health or functionality of these populations of bacteria.  If these bacteria are potentially involved in all these diseases, then what causes their dysfunction?

When you take a step back from this piece and assess it in its entirety, it paints a very clear picture that most chronic diseases process are multifactorial. If most chronic diseases have a multifactorial origin, then shouldn't the therapeutic effort also be multi-pronged? 

To say it differently, while many pharmaceuticals have enormous potential, doesn't it stand to reason that in the absence of healthy lifestyle, even the most powerful drug will be handcuffed in terms of efficacy.   If Mr. Stein is reporting accurately and many scientists are concerned that diet and other variables are disrupting the delicate balance, then how can we restore health in the absence of a healthy diet?

Science will always reveal greater insight into the mysteries and complexities of our physiology.  But while we are waiting for more and more truth to emerge, let's also keep in mind that science also often validates "common sense" principles as it pertains to health.

Is Junk Food Cheaper

There was a great piece in the New York Times this week asking the question, "Is Junk Food Really Cheaper?"  The author, Mark Bittman, is a strong advocate of common sense nutrition.  If you read through his books, you'll see that he doesn't advocate extremely strict diets and generally takes an enormous amount of pleasure in food.  So of course, I'm a fan.

In his current piece, he argues that a family of 4 could reasonably spend $28 at McDonalds for a single meal while a much healthier meal of chicken, veggies and salad would put the family back a mere $14.  He quotes Marion Nestle (another person I admire):

“Anything that you do that’s not fast food is terrific; cooking once a week is far better than not cooking at all,” says Marion Nestle, professor of food studies at New York University and author of “What to Eat.”

In a statement that smells of "tough love", he tells us:
The real challenge is not “I’m too busy to cook.” In 2010 the average American, regardless of weekly earnings, watched no less than an hour and a half of television per day. The time is there.

It's clear that we need to spend more time in the kitchen.  That means all of us...men, women and children.  We all have busy lives.  If you have kids, then your life is even busier.  But the only way to combat epidemic levels of chronic disease in the U.S. is one bite at a time.  You always knew that eating healthy was important.  But isn't it nice to read that junk food is just as damaging to your wallet as it is to your waistline. 

More on Junk Food

Are your tax payer dollars partially responsible for the fattening of America?  The California Public Interest Research Group released some alarming numbers this week in a report titled, ""Apples to Twinkies: Comparing Federal Subsidies of Fresh Produce and Junk Food."  They state, "from 1995-2010, $16.9 billion in federal subsidies went to producers and others in the business of corn syrup, high fructose corn syrup, corn starch and soy oils."

"If these agricultural subsidies went directly to consumers to allow them to purchase food, each of America's 144 million taxpayers would be given $7.36 to spend on junk food and 11 cents with which to buy apples each year — enough to buy 19 Twinkies but less than a quarter of one Red Delicious apple apiece," CALPIRG officials said in a statement.

I don't want to get into the discussion (for the moment) about whether or not high fructose corn syrup is a bad as we've heard.  In fact, the corn syrup industry has done a fine job introducing doubt (concerning corn syrups risks/benefits) into the public eye.  But let's realize that the vast majority of products containing these products are not healthy.  Are they incredibly bad?  Some are, some probably are not.  But they certainly are not health-inducing.  

The politics of these subsidies is enough to make your head swirl.  So let's dodge that debate and re-frame this information.

Many people have said, "If you want to know a man's priorities, watch where he spends his money."  In general, this will tell you what he prioritized; fun, scholarship, television, social activities, kids activities etc.  If we place this same question in the context of federal spending, is it fair to ask, "Uncle Sam- where are your priorities when it comes to food and health?"  The answer is disappointing and discouraging.

Soda and sweet drinks

The leading sentence in this article from U.S. News and World Report says it all.

"On any given day, half the people in the United States guzzle a sugary beverage like soda, sports drinks, or sweetened bottled water."

This leads up to nearly 175-273 extra calories per day.  To be clear, these are calories that you don't need.  There is no nutritional value and absolutely no positive health impact that these calories bring.  No vitamins, no minerals, no phytonutrients, no benefit.

As the article states, it's easy to dismiss this as a mere 175 calories.  But understand that when we talk about "empty calories" that is really a misnomer.  Those words mean the calories are empty of nutrients.  But it doesn't mean that those calories have no effect.  Actually, rather than saying "empty calories", we should call them "harmful calories."

There is a significantly increased risk of diabetes and metabolic syndrome in people that consume these sugary drinks regularly.  To put this in perspective, there are 26 million American diabetics and almost 80 million with metabolic syndrome.  That's over 100 million Americans with a significant blood sugar problem.  With a population of about 310 million (about 1/3 kids and 2/3 adults), that means about 1 in 2 American adults has a blood sugar problem.

So look around you.  In a football stadium filled with 80,000 screaming fans.  About half of them currently suffer from a blood sugar disorder that could have been easily prevented. This will lead to fatigue, some cancers, heart disease, mood disorders, chronic pain and a lot more.  

I suppose from a certain point of view, you could still argue that the 1 can of sugar soda per day is not a dealbreaker.  Maybe... maybe not.  But imagine if your childing is failing out of school because he is having a hard time keeping up.  Then he argues, "Mom- I just want to watch 30 minutes of TV after dinner.  What's wrong with that?"  Most of us could agree that for a straight A student, perhaps it's no big deal.  But when you're coming from behind, every moment counts.  Once you fall further behind, it becomes even harder to catch up.  Most of us has experienced this at some point in our life; in school, at work, with debt.

One out of 2 Americans are "behind" when it comes to their health.  That sugar soda a day is certainly not the sole determining variable.  But it certainly doesn't help matters.

Breaking news! Eating food can lower cholesterol!

A paper was recently published in the Journal of the American Medical Association showing that foods can lower cholesterol levels; specifically... LDLs (the so-called "bad cholesterol").  The foods that were used in the experimental group were:

- margarine enriched with plant sterols

- viscous fibers such as oats and barley

- soy protein from soy milk, tofu or soy “meats”

- peanuts and nuts from trees

- peas, beans and lentils

That doesn't mean you should go out and stock your fridge with only these items.  In fact, any well balanced plant-based diet will do.  

For those of you who are regular readers, you know that I hate when pharmaceutical companies sponsor research that shows that their drugs are awesome.  Well, this particular study was partially funded by food companies.  And the 8 of the 20 authors received fees from these companies.  So I guess the pendulum swings both ways.  The food company Unilever provided funding (Bertolli pasta, Lipton teas, Slimfast, Hellman's mayonaisse) as did grain manufacturer Viterra.

More Good News for Vitamin D

We've heard about the wonders of vitamin D.  The list of benefits only seems to grow.  It appears that vitamin D has the potential to protect against colon cancer.  Over 142,000 Americans are diagnosed with colon cancer each year and over 50,000 Americans die from it.

New research demonstrated that activation of the vitamin D receptor protected against the development of malignant tumors.  Additionally, it protected against the development of larger and more aggressive tumors.  Keep in mind that most Americans have vitamin D deficiency (or insufficiency).  Whatever term you want to use (which depends on the actual levels), the key point here is that the vast majority of us are walking around with low levels of vitamin D. 

Consider these other risk factors from the Mayo Clinic.  Low fiber/high fat diet, sedentary lifestyle, obesity , diabetes, smoking and alcohol.  Throw in low vitamin D and you can see that many of us have colons that are ticking time bombs.

Strange Headlines

"Milk Better Than Water to Rehydrate Kids"

I just read this amazing headline and read through a piece describing this research.  It was conducted at McMaster University and followed 8-10 year old children.  The researchers found that milk led to better hydration after exercise.

The research director, Brian Timmons, states, "Milk is better than either a sports drink or water because it is a source of high quality protein, carbohydrates, calcium and electrolytes...milk replaces sodium lost in sweat and helps the body retain fluid better. The milk also provides protein, needed by children for muscle development and growth, not found in the other drinks."  

There is no doubt that hydration is important.  But from a purely physiological perspective, it just doesn't make sense that milk hydrates better than water.  Discussing the presence of carbohydrate and protein in the context of hydration is a red herring.  Extreme protein deficits can certainly impair hydration levels but after normal exercise for 8-10 year olds, it is very unlikely that there were protein-related hydration issues.

The icing on the cake here is the disclaimer at the end:

"The study is funded by Dairy Farmers of Canada."

One has to ask, "Can this research be trusted?"  The people that make milk funded study to see if milk is better than water.  Surprise!  It is better than water.  

Is this kind of terribly biased research worthy of an actual headline?  I don't want to go into a tirade on milk.  If you've read my posts on milk, you know that it deserves an objective look.  But research like this clouds the picture and is darn near propaganda.  It's marketing under the guise of research.  Ugh.

Salt 4- Sympthetic nervous system

We've previously discussed the function of the autonomic nervous system (ANS).  The ANS is fundamentally divided into the sympathetic (fight or flight) and parasympathetic (rest and digest) divisions.  As a general rule, our body is predisposed toward sympathetic dominance when we don't take care of ourselves.  In other words, when you don't eat/sleep/exercise well & carry too much stress, your body tends to become imbalanced in this department and drive toward overexpression of the sympathetic nervous system.

For example, your blood pressure tends to go up.  Your heart rate tends to go up.  Your ability to digest food goes down.  You respiration rate tends to go up.  All of these are associated and caused by the sympathetic nervous system.

As mentioned, Americans consume way too much salt.  It appears that salt drives the sympathetic nervous system towards overactivity.  A paper from the University of Texas states,

"In recent years, studies have shown that SNA (sympathetic nervous activity) can rise as a result of both acute and chronic increases of body fluid osmolality. These findings have raised the possibility that salt-sensitive cardiovascular diseases could result, at least in part, from direct osmosensory activation of CNS sympathetic drive"   J Phys 2010 Sep 15(Pt18) ;588:3375-84

Much of our brain (in its well state) is dedicated toward suppressing this sympathetic drive.  In other words, it keeps the sympathetics in check.  With excessive salt intake, we predispose toward this heightened sympathetic condition.  Remember that as you cook your dinner tonight.

Salt 3- Why we need it

Without sodium, you would die.  All cells in the body have electrical properties.  Some cells actually depend very heavily on these electrical properties in order to function appropriately.  Whenever a brain cell activates, it depends on a precise balance of sodium rushing into a cell and eventually being pumped back out.  Oddly enough, when sodium rushes into a bunch of cells in a coordinated pattern, our brain is allowed to function as it should. The same thing holds true for muscles.  Without sodium, your muscles would never have an opportunity to contract.

Sodium needs to be in a certain concentration in the blood and around your cells.  "Concentration" refers to how much sodium is present in a given volume of fluid.  For example, let's take 1 teaspoon of sodium and put it in 1 liter of water.  It will taste somewhat salty.  But if I double the amount of sodium and add 2 teaspoons, it will taste more salty because there is more sodium per any given drop of water.  This is more concentrated.

If we now take 3 teaspoons of salt and put it in 50 liters of water, we may not even taste it!  While there is more sodium, it is far less concentrated in the solution.

If we begin to mess around with sodium concentrations, then bad things will happen.  Several years ago, a woman lost her life because she diluted the sodium in her body with way too much water. She drank way too much water and experienced something called hyponatremia.  When this happened, sodium was not able to dance in and out of cells as it normally would and cells began to shut down.

Clearly, sodium is necessary to life.  But as we know, if "a drop is good", it is not necessarily true that "a cup is better."  More is not better.  Balance is necessary.

From this foundational understanding of sodium's behavior in human physiology, we can begin to explore the problems with high sodium in our diets.

Salt 2- Confusion

There was a great piece published in TIME magazine this week regarding salt.  It discussed a controversial study that suggested that sodium reduction may not be as important as once thought.  The piece in TIME also referenced a boldly written article in Scientific American titled, "It's Time to End the War on Salt: the zealous drive by politicians to limit our salt intake has little basis in science"

There's quite a bit of confusion and as discussed in the articles referenced above, there are many scientific papers that ping-pong back and forth debating the influence of salt on overall health.  Nearly all of these studies look at salt's influence on hypertension; a very well-described risk factor for cardiovascular disease.

If you read enough of these types of stories, you realize that ultimately, the conclusion is, "We don't know enough.  We have some ideas but need further research to see what bears out."  The interpreted message for some is, "Therefore, we will eat as much salt as we want since science can't prove that salt is bad."

I hate to 'cut and paste' but this last paragraph from the TIME piece is great:

In the end then, there may be no simple answers. Researchers and public health officials who support population-wide efforts to curb sodium intake have a vast body of evidence to support their point of view. For decades now, they can say, we have seen studies that suggest — but, yes, they only suggest — that salt is deadly. And those who don't support efforts to curb salt consumption can claim, often correctly, that the evidence against salt is merely suggestive.

In other words, you can interpret this particular body of science to support your views and frankly, no one can prove you wrong at this point.  While the policy wonks can have a field day debating both sides of this, where does that leave the average consumer?

So as a person who advocates for the average consumer (I am not a policy maker and have no relationship to any food companies), I'll tell you that frankly, you should eat less salt.  There is enough evidence from a physiological perspective that tells us that too much salt is bad.  Bad enough to kill you?  Maybe not- in and of itself. But certainly bad enough to contribute to several vicious cycles of physiological demise that can be very difficult to break.  

We'll explore.  But the science combined with a healthy dose of common sense will show us that we take in too much salt and that is bad. 

Salt 1- Easy Does It

Everyone has heard the concerns over salt. The health community has generally recommended that daily salt intake be restricted to 1500mg.   This is enough to cover all of our basic needs for sodium. The USDA states that even if we exceed that amount, we really should not go any higher than 2300mg daily (tolerable upper limit);  this is about 1 teaspoon of salt.   The average American consumes 3,436 mg of salt a day with the vast majority consumed through processed foods or restaurant foods. 

To give you some sense of what these numbers mean:

• 1 Big Mac and medium fries alone contain 1310 mg of sodium.
• Two slices of Pizza Hut's pepperoni pizza have 1220 mg
• 6 inch turkey sandwich at Subway has 810mg of sodium.
• One Footlong Italian Sub at Subway has a whopping 3,440 mg of sodium!   That's more than twice the sodium we need in an entire day! 

It's probably an understatement to say the American's consume too much salt.  In fact, the Centers for Disease Control estimates that thousands of lives could be saved each year if we simply cut down our salt consumption.

In the next few posts, we'll take a look at salt and whether there's enough evidence to scare us away from that shaker.

Reversing diabetes

Sorry for the long delay between posts.  This article was really encouraging and I wanted to share with you all.  Nearly 26 million Americans have diabetes with the vast majority of those people having type 2.  Type 2 diabetes is characterized by insulin resistance.  Once insulin resistance kicks in, there is a domino effect of physiological demise.  Bad stuff happens; very bad.  

The nice part about type 2 diabetes is that is 100% manageable.  Some diseases are very difficult to treat; diabetes is not one of them.  In fact, you could even argue that up to a certain point, diabetes (type 2) is curable! That's what these researchers found.  It was a very small sample size, but the results are not only encouraging but somewhat predictable.

Eleven volunteers were newly diagnosed diabetics.  After following a 600 calorie per day diet for 8 weeks, there disease disappeared!  Blood sugar levels returned to normal and the pancreas improved its appearance and function.  Three months after the study was completed, 7 out of 11 were still diabetes free.

There are 2 ways to look at this.  First, you could say that eating a 600 calorie per day diet is not realistic in the long run.  The participants in this study consumed nothing but liquid drinks and non-starchy vegetables.  It doesn't seem like a lot of fun so may have little application for real people in the long run.  Who wants to live like that forever?

The other way to look at it (and the preferred way), is to understand that you can reverse early diabetes.  While this study doesn't directly say the following, I would argue that even in severe diabetes, you can make the disease regress and dramatically improve the functioning of your body.  Eat well.  Food has enormous potential to heal you.  

What would happen on a less restrictive diet coupled with regular walking?  What about a 1200 calorie per day diet with a regular yoga class?  1400 calorie per day diet with resistance exercise and yoga together?  The possibilities are endless.

You don't need to be on a liquid diet with lettuce and broccoli alone.  You can eat tons of veggie and reasonable amounts of other real foods and still have the same effect.  Perhaps it will be 9 weeks rather than the 8 weeks of this study.  Perhaps it will take 4 months?  But you will move in the right direction.  That is a guarantee.

Gluten in the news

There are a few more things about osteoporosis that I want to get out there.  But I came across this article on ccn.com today and thought I'd pass it along.  This is actually a very sensible article on gluten.  It differentiates between celiac disease and the increasingly popular "gluten sensitivity."  Give it a read.

Osteoporosis 8- Fruits and Vegetables

Most people are aware that calcium is a crucial part of bones.  More recently, there has been much discussion on the benefits of vitamin D.  From a purely reductionist standpoint, we could go on all day about the significance of magnesium, protein, phosphorus, boron, vitamin C, potassium and other nutrients that are vital to bone health.  This is a great review article that describes the benefits of several of these key nutrients.  But the authors sum it up succinctly by concluding:

"Bone health rests on a combination of several factors including on an adequate dietary pattern....

Optimal protection of bone requires a diet rich in dairy products (mainly fat free), fruit and vegetables and adequate amounts of meat, fish and poultry."  Arq Bras Endcrinol Metabol 2010 Mar;54(2):179-85

In other words, a well-balanced diet is necessary for optimal bone health.  Some of you may disagree on exactly what a "well-balanced diet" looks like.  Should you include dairy as these authors suggest?  Is the inclusion of meat, fish and poultry absolutely necessary?  While there may be some disagreement on the details, all authorities agree on the benefits of fruits and vegetables.  In fact, one study concluded that plant based calcium sources and that dairy intake was not essential.

"Osteoporosis, which has become a serious public health concern, is influenced by diet, especially calcium intake. Dairy products are a good source of calcium, but plant calcium may also be important in populations that do not consume a large amount of milk....Our results suggest that high dietary intake of calcium, especially plant calcium, reduces the risk of osteoporosis and increased bone mineral density in postmenopausal Korean women. Vegetables may be an important source of calcium and may also provide vitamins and minerals that exert additional beneficial effects on the bone."  Nutr Res 2011 Jan;31(1):27-32

Vegetables.  You really can't have strong bones without them.

Osteoporosis 7- Oxidative Stress

You may have heard the term "free radicals."  If not, then you've probably heard the term "antioxidants."  We talk about antioxidants in fresh fruits and vegetables.  Beauty creams often boast of their antioxidant content and makers of nutritional supplements often tout the antioxidants in their products. 

Science has long known that free radicals, when left to their own devices, often wreak havoc on body systems. For example, you may have heard of LDL as the "bad cholesterol."  Well, oxidized LDL is generally regarded as far more toxic in its ability to damage blood vessel walls.  The point is, oxidative stress (in the absence of plenty of antioxidants) is a bad thing.

Is there any role in osteoporosis?  Not surprisingly, oxidative stress can be very damaging to bones.  In this particular study, scientists found that oxidized LDL (yes- the same thing that vigorously promotes hear disease) is involved in shutting down activity of bone-producing cells.  Realizing that bone producing cells (osteoblasts) are always in a precise dance with bone degrading cells (osteoclasts), oxidized LDL will effectively disrupt that carefully orchestrated dance. 

Another study of healthy post-menopausal women also showed that oxidative stress increased bone resorption (breakdown of bone).

Does a diet rich in antioxidants (fruits and vegetables) help osteoporosis?  Absolutely.  We'll examine this further in the next post.

Osteoporosis 6- Chronic Stress (addendum)

I wanted to another thought on cortisol and the influence on bone.  Many people have heard of cortisone.  You may have received a cortisone injection for a nagging tendinitis or recurrent musculoskeletal complaint.  Many physicians will limit the number of cortisone injections a person can receive at the same site per year.  In other words, if you have an injection in the elbow, most physicians will not allow more than 3 per year.  The primary concern is the potential side effects including bone loss and joint damage to the area it is administered.

The point here is not to discuss the correct use of cortisone injections.  Personally,  I feel they can be remarkably helpful in some situations.  But understand that cortisone and cortisol are biochemical siblings.  They are very similar in function.  If doctors worry about cortisone destroying bone, then we are right in our thinking that chronic cortisol production in the body (due to stress) also wreaks havoc on bone.

Osteoporosis 5- Chronic Stress

There are 2 types of stress responses in our lives; a short term response and a long term response.  The short term response is considered to be governed by the sympathetic nervous system.  The long term response characteristically involves the release of glucocorticoids, namely cortisol. 

We've already discussed the fact that many people have overactive sympathetic nervous systems.  This has an immediate impact on bone.  We saw in a previous post that sympathetic dominance will inhibit osteoblast activity and increase bone resorption (breakdown).   In fact, much has been written about the more typical stress response seen in America; a prolonged short term response layered over an ongoing long term response.  It's worth noting here the influence of the long term response on bone health.

A 2008 paper does a good job describing the role of stress.
"Cortisol excess inhibits bone formation, increases bone resorption, impairs calcium absorption from the gut, and affects the secretion of several hormones (in particular gonadotropins and GH), cytokines, and growth factors, influencing bone metabolism." 

Remember that cortisol is considered a "stress hormone" and is released in times of physical, emotional or psychological stress.  It is a normal response but in a stressed out world, tends to get hyperactive.  The authors continue,

"Subclinical hypercortisolism, a condition of impaired hypothalamic-adrenal axis homeostasis without the classical signs and symptoms of glucocorticoid excess, is a recently defined entity, which has been shown to be associated to increased bone resorption, bone loss, and high prevalence of vertebral fractures regardless of gonadal status."

You could still ask, "is this common or a rare event?"  The authors conclude,

"recent data suggest that subclinical hypercortisolism is a common and underrated finding in patients with established osteoporosis."   J Endocrinol Invest 2008 Mar;31(3):267-76

There are scores of papers the describe the role of stress in degrading bone health.  Attempts to manage osteoporosis without considering the stress response will likely fall short.

Osteoporosis 4- Magnesium

There's a lot of talk about the importance of calcium.  This is warranted.  But another very essential mineral often gets left behind in the discussion.  Magnesium has a huge role in maintaining bone health. Nearly 2/3 of your bodies magnesium is stored in bones.  Unfortunately...

"About 60% of adults in the United States do not consume the estimated average requirement for magnesium, but widespread pathological conditions attributed to magnesium deficiency have not been reported. Nevertheless, low magnesium status has been associated with numerous pathological conditions characterized as having a chronic inflammatory stress component."   Nutr Rev 2010 Jun;68(6):333-40

Among women, who are far more susceptible to osteoporosis, "the average dietary Mg intake... is 68% of the RDA, indicating that a large proportion of our population has substantial dietary Mg deficit."  This level of magnesium deficiency has the effect of, "decrease in osteoblasts and an increase in osteoclasts..." J Am Coll Nutr 2009 Apr;28(2):131-41

What's equally concerning is that researchers found that magnesium deficiency led to an increase in production of inflammatory signals like substance P, TNFalpha and IL1beta.  (We will address inflammation in a separate post).

It is clear that when dietary magnesium is low, there are a few ways that your bones suffer; bone making cells decrease activity, bone degrading cells increase activity, and inflammation will degrade bone. 

Pumpkin seeds, spinach, swiss chard, almonds, black beans and navy beans are excellent sources of magnesium.

Osteoporosis 3- Fight or Flight

The so called "fight or flight" response is mediated by something called your sympathetic nervous system.  It is considered your short-term stress response (your long-term stress responses is mediated by a different but very closely related system).  Many individuals experience chronic activation of this "fight or flight" system.  In reality, this physiological response is supposed to engage when needed and then turn off when there is no immediate need for it.  Unfortunately, our crazy world and busy lives often induce chronic activation of your sympathetic system.

For example, it is well known that obesity promotes excessive sympathetic activation.  We are still learning why this happens, but several ideas have been proposed.

"Several mechanisms have been proposed to explain the SNS activation in obese subjects; increased leptin concentration, hyperinsulinemia, obstructive sleep apnea, decreased arterial baroreflex sensitivity, elevated plasma angiotensin, obesity-related kidney disease and lack of exercise." Int J Hypertens 2011; Jan 20:642416.

Even in non-obese individuals, it is not uncommon to have excess sympathetic activation.  This is consistent with the dramatic rates of hypertension, fast resting heart rates, poor digestion, erectile dysfunction etc.  All these problems, while multi-faceted, have a layer of excess sympathetics.  Now let's consider bone health.

Does the sympathetic dominance commonly seen influence bone metabolism?  The answer is, yes.

"...increasing clinical and experimental evidence has driven attention towards the pivotal role of the sympathetic nervous system (SNS) in bone remodeling" Ageing Res Rev 2011 Jan 22.

"...sympathetic nervous system inhibits bone formation and increases resorption due to the binding of catecholamines to receptors located in osteoblasts."  Eur Rev Med Pharmcol Sci 2009 May-Jun;13(3):157-62

What does this mean for the average person concerned with their bone health?  It means calm down your sympathetic nervous system.  I realize this presents a big bag of worms that poses the question, "how do you calm down sympathetics?"  We'll address some of the science at a later point, but for now...a healthy lifestyle; eating lots of plants, regular exercise, stress management, lots of water and general avoidance of the "bad stuff."  I realize this isn't exactly a thrilling game plan.  But when you understand that a poor lifestyle influences bone health in a myriad of ways, it is my hope that that will be greater motivation for you to stick to it.  

If we were to stop this series right now, a healthy diet would help bones because:

1.  Decreasing sodium would decrease calcium excretion.

2.  You would calm down sympathetic dominance which would in turn, stop irritating the bones.

We'll continue on and expand our understanding of the many variables that influence bones.

Osteoporosis 2- Salt (& Hypertension?)

We all know that excessive amounts of salt are not good.  The link between sodium and hypertension is very well established although we're still learning more about the many ways that salt is damaging.  Salt can also adversely influence bone health. In fact, there is some suggestion that hypertension and bone health may be related.

Dietary calcium has long been considered an essential part of managing hypertension.  Researchers are unclear on exactly how calcium is helpful, but it seems to be necessary.  Calcium supplements have thus far been controversial in lowering blood pressure as several studies indicate no effect.  (As a side note, this is further evidence that food is far more important than supplements).  But why all the talk about hypertension when we're discussing osteoporosis?  Because the two conditions appear to be linked.

This paper cites a genetic link between the two conditions and it cites several studies that show that managing blood pressure can actually improve bone health.  ACE inhibitors are a common medication used to lower blood pressure; a helpful side effect is that they seem to help bone density.  Don't consider this my endorsement of a purely pharmacological approach to managing bone density.  Consider this as evidence that the biology of the two conditions are connected.  So what?

It has long been known that excess salt intake will increase calcium excretion through the kidneys.  In other words, the more salt you ingest, the more calcium you will pee out.  When so many Americans struggle to take in sufficient amounts of calcium, it would seem wise to keep as much of it in our body as possible.  In fact, people with higher sodium intake have been shown to have lower bone mineral density.

Step number 1 in improving bone health; watch your salt intake.  It may help lower your blood pressure too.

Osteoporosis 1- Intro

Ten million Americans have osteoporosis.  Another 34 million Americans have osteopenia (low bone density).  To say it differently, 44 million Americans have unhealthy, weak bones.  For women over the age of 50, half will break a bone due to low bone density.  For men over 50, nearly 25% will break a bone due to low bone density.  

In some regards, osteoporosis is not quite as "scary" as major killers like heart disease or cancer.  It may also not have the mystique of autoimmune diseases like multiple sclerosis.  But consider this; 20% of people who break a hip will be dead within 1 year.  That number increases to 25% at the 5 year mark.

Osteoporosis significantly increases the chances that you will break a hip.  Interestingly, the number 1 cause of hip fractures, accounting for 90%, is falling.  Fall prevention is another topic entirely and can be addressed a number of ways.  For this series, we will concentrate our attention on bone health.

Bone health, or lack of it, has serious consequences for average Americans.  It is worth our time to investigate the causes of osteoporosis and our best bet in avoiding bone loss.  Yes, yes- the usual suspects are involved; make sure you take in enough calcium, vitamin D and get enough exercise.  But is there more to the story?  We'll discuss osteoporosis in the coming series.

Weight Watchers Update

Last November, Weight Watchers took a bold step and dramatically improved their program.  For those of you who aren't familiar, Weight Watchers (WW) is a system that has been around for decades to help people lose weight.  Their primary method has been to attach a point value to foods and then encourage clients to stay within a certain number of points per day.  

While many people have found much success with the program, nutritionists have often had a love-hate relationship with WW.  Their strict adherence to the 'calorie model' of weight loss lead to all kinds of common sense violations. For example, some clients would eat a candy bar that "costs" a lot of points and then skimp on food elsewhere so they stayed within the allowance.  In fact, the WW website sells a variety of candy bars, ice creams, baked goods and other "junk foods" while advertising the number of points they contain.

To their credit, WW decided to read up on current research and completely re-vamped their entire system of points.

"We used to say 'A calorie is a calorie is a calorie,' " says Karen Miller Kovach, chief scientific officer and registered dietitian for the organization. "We recognize now that nutrients that provide those calories ... also have an impact on the body. The new formula is completely different than how we originally calculated."  Jan 10, 2011 LA Times

 Under the new system, most fruits and vegetables are zero points!  That means you can enjoy them all you want.  Under the old system, bananas were worth 2 points; now they are 0 points.  Successful weight management is not about "counting calories."  It is about choosing the right foods the vast majority of the time.  From there, your physiology will stabilize and you will have the foundation for successful weight loss.

Kudos to Weight Watchers for keeping up with research. 

Multiple Sclerosis 9- Yoga & Exercise

The health community has had an evolving view of exercise over the past few decades. For example, in individuals with low back pain, the conventional wisdom of the 1980's was to have plenty of bed rest. The consensus in 2011 is that people with low back pain should move regularly and in a safe, controlled manner.  

Even the management of Parkinson disease has changed in the past few years.  

"For many years, exercise was not a recommended rehabilitation strategy for persons with a diagnosis of idiopathic Parkinson's disease (PD). Since it was believed that exercise had no measurable effect on PD, or might worsen the underlying pathology, it was to be avoided... A rich vein of bench and translational research now suggest non-pharmacological approaches, such as exercise or physiotherapy, have a far greater effect on the cardinal features of PD than previously believed."  Eur J Phys Rehab Med 2009. Jun 45(2):215-29

Exercise seems to be of benefit in any health condition; MS is no exception.  A 2004 study published in Neurology found that people with multiple sclerosis who regularly exercised or practiced yoga had significantly less fatigue than those who did not.  Another study in 2010 found that yoga improved symptoms of MS and the researchers suggested, that yoga "should be considered in the future as possible complementary treatments."  

Admittedly, there are many gray areas in prescribing exercise to people with MS. We are still unclear on how often, which method and what intensity is ideal.  The best suggestion seems to be, "Find a way to move your body regularly.  Nothing extreme, just move."  When that happens, there seems to be general improvement in MS symptoms.

 
Over the past 9 posts, I've been writing about options to complement the conventional care of MS.  There is no magic cure, no simple pill to take and no easy way out of this.  But there are options to feel better and reduce symptoms.  To close out this series on MS, I will refer to a 2009 paper published in Quality and Primary Care.  The title of the article is "Managing multiple sclerosis in primary care: are we forgetting something?" I've quoted extensively here but it is well worth the read.

"...studies suggest that nutrition, sunlight, exercise, stress and social factors can all modulate the rate of progression of MS and the level of disability....If lifestyle approaches do offer potential avenues for therapy, this raises important questions regarding the management of MS in primary care. More widely prescribed conventional medicines have been studied in more detail but are only modestly effective and may have significant side-effects. Are we presently neglecting the most effective approach of combining the non-drug or holistic approach with the best of conventional pharmaceutical therapies, and if so what are the implications of this omission?"  

Multiple Sclerosis 8- Dairy

In 1976, there was a quiet suggestion that consumption of dairy products may be related to MS.  In 1992, an epidemiological study was published that also showed some association between MS and milk.  Intrigued by the possibility, researchers at Oxford set out to determine whether childhood milk allergy had any relationship to MS.  Published in 2010, the study found no relationship between childhood milk allergy and development of MS.

I've written about the risks of milk consumption previously. It is worth noting that in addition to the risks I described earlier, some of the proteins found in cow's milk (butyrophilin) exhibit cross reactivity with proteins found in myelin.  In other words, some proteins in milk look like proteins in your brain.  A 2000 study in the Journal of Immunology found that these proteins in milk may influence the immune response that triggers demyelinating events. These findings were replicated in 2004 as researchers found that butyrophilin can influence the immune response to myelin.

Another problem with dairy is the prevalence is lactose intolerance.  While some may view lactose intolerance as a mere inconvenience, researchers expand on this:

The symptoms of lactose intolerance are caused by gases and toxins produced by anaerobic bacteria in the large intestine. Bacterial toxins may play a key role in several other diseases, such as diabetes, rheumatoid arthritis, multiple sclerosis and some cancers.  Sci Prog 2005;88 (Pt3):157-202

There are certainly good things that go along with milk.  It is the world's richest source of calcium.  But consider the other potential costs.  Along with the hormones, windup of the insulin IGF-1 axis, casein related problems, generation of beta casomorphin, potential cross reactivity with myelin protein & consequences of lactose intolerance, there is much potential for immunological aggravation.  Given this evidence, I do not believe it is in your best interest to regularly consume milk.

Multiple Sclerosis 7- Oxidative Stress 2

In the last post, we established that oxidative stress occurs when there is inappropriate activation of the immune system as in multiple sclerosis.  This oxidative stress can be just as damaging as the disease process itself.  In this post, I'd like to focus on a broad counter-measure to the hazards of oxidative stress.  A flippant, generic response may simply be, "increase ingestion of antioxidants and take a good broad-spectrum antioxidant supplement."

But in order to approach our therapy with "eyes wide open," we need to consider oxidative stress in a broader sense, not just in multiple sclerosis patients.

1.  Hyperglycemia induces oxidative stress.  Life Sci 2010 Aug 14;87(7-8):197-214

2.  Pollution causes oxidative stress.  Biomarkers 2010 Sep;15(6):538-45.

3.  Smoking causes oxidative stress.  Biomarkers 2009 Jul;14 Suppl 1:90-6

4.  Trans fats (cookies, cakes and pies )cause oxidative stress.  Lipids 2007 Sep; 429):787-99. 

5.  Chronic alcohol use causes oxidative stress. World J Gastroenterol 2010 Dec 28;16(48):6035-43

The list goes on and on and on.  The point is; if you are a human being, you are subject to many triggers that promote oxidative stress.  This is true whether you are a man or woman, adult or child, with MS or without MS.  While we have built in antioxidant systems, they require the intake of healthy foods.

If you have MS, not only do you have an immune disorder that promotes oxidative stress, you also live in a world that promotes oxidative stress.  You are subject to a "double whammy."   What this means, if we are being honest, is that while other people may choose to eat junk food or enjoy other vices "in moderation", you are not "other people."  Those "other people" eating junk food "in moderation" are very likely to suffer other ill health consequences.  The health statistics in the United States seem to bear that fact out.

I strongly encourage you to be absolutely disciplined in your diet.  The amount of fresh vegetables you consume should make other people think you are weird.  Your avoidance of junk foods and other vices should make others think you are weird.  Multiple sclerosis is a dramatic disease and its successful management requires dramatic actions.  A salad a day is not enough; you must be extreme.  

Imagine a raging forest fire destroying acres of beautiful land.  Then imagine a group of campers 2 miles away gathering wood to start a campfire.  What if they argued, "Don't worry.  The fire is going the other way.  Things are OK on this side of the forest."  It's absurd isn't it?  Your immune system is that raging fire.  Don't tempt it by adding fuel to the flames.