Monthly Archives: July 2008

Two Big Fish: How Fish Oil Can Save your Life and your Breath

Two Big Fish:  How Fish Oil Can Save your Life and your Breath

Competency # 13 Good Fats, Bad Fats

Reference: Reference:  JACC July 2008 Sekikawa et al pp 417-424

AJCN July 2008 Olsen et al

Two stories on fish oil in one week.  This is kind of fun.  First, from Japan and the Journal of the American College of Cardiology.  Dr. Sekikawa looked at three populations of men to see if their vascular disease measures were different.   He looked first at 281 Japanese men living in Japan.  Then, 281 Japanese Americans, born and raised in America.  Then, 308 American Caucasians who had lived their entire lives in America.  They conducted ultrasounds of carotid arteries to see how thick they were and how much plaque they had.  They also tested coronary artery calcification and serum fatty acids.  Finally, they assessed the amount of fish these three groups ate.  What they found was that the Japanese eat about 1.3 grams of fish oil a day in the form of whole fish.  CA and JA eat much less, about .2 grams.  The Japanese men had much higher blood levels of omega-fatty acids, as would be expected from their diets.  And the Japanese men had much, much less plaque in their arteries, despite smoking more.  We know that Japanese men have a dramatically lower death rate from coronary artery disease than Caucasian or Japanese American men.  They concluded that higher levels of omega fatty acids in your blood are an independent predictor of coronary artery disease, irrespective of your racial background.  Add that to smoking, high blood pressure, diabetes… (Vit D)

Then there is the Copenhagen Asthma Study.  They recruited 533 women to take fish oil, olive oil or placebo in the last 10 weeks of their pregnancy.  Then they followed them for 16 years.  The women who got the fish oil had a 63% reduction in asthma in their children.  Your balance of Th1 cells to Th2 cells is established very early in life (like before birth), and that balance seems to set you up for allergies all your life.  Your allergic profile, once established, is much harder to change down the road.  The DHA and EPA omega fatty acids that are the principle active ingredients in fish oil compete with arachidonic acid to result in lower production of inflammatory eiconsinoids.  Isn’t that a mouthful?  This is a good study as they were able to follow 522 of the kids 16 years later, with the effects noted and statistically significant 16 years down the road.  The “hazard ratio” for allergic asthma was reduced 87%.  87%!   Enough already.

WWW: What will work for me?  I take a gram of fish oil a day.  Three big gelatin capsules.  I’ve done if for three years now.  Wish I had done if for 20.  It’s likely that coronary artery disease starts very early.  It’s become a habit for me now.  What’s interesting me to is that my hayfever in spring and fall have gotten dramatically better in the last three years.  I didn’t think about that until I read this article about the asthma stuff from Denmark.  If you aren’t taking fish oil, start.  If you are taking blood thinners, talk to your doctor, have your blood thinner monitored while you start.  But start

Low Carb and Mediterranean Diets Beat Low Fat on the Scale

Low-Carb and Mediterranean Diets Beat Low-Fat on the Scales    Number 224

Competency # 2 The Best Diet: DASH and OMNI Heart

Reference: New England Journal of Medicine, July 17, 2008 Shai et al  Results of the DIRECT Trial

We’ve been teaching low fat diets for years.  “If you want to lose weight, eat a low fat diet.”  Well, get over it.  It was wrong.   Sorry.  We made a mistake.  It’s time to put that one to bed and move on.  This article is the funeral dirge.  Let’s just put low fat into the ground and stop obsessing about it.  We’ve all done it.  We’ve all tried.  It didn’t work.  In fact, on the 1978 standard food pyramid that advocated for low fat diets, the average American gained some 15 pounds and we went from 14% obese to over 30% obese in some states.  Avoiding fat seems so reasonable.  After all, there are 9 calories in a gram of fat and only 4 in a gram of carbohydrate.  And it was fat around our bellies and on our hips that seemed to collect so easily.   Oops.

What Dr. Shai and company did was offer three diets in a randomized fashion to 322 folks for 2 years.  About 52 years old.  BMI about 31.  Sounds like me and you.  The low fat was calorie restricted.  The Mediterranean arm was calorie restricted.  The low carb was UNRESTRICTED.  Eat as much as you want.  Just no white carbs or sugar (well, 20 grams a day for the first two months, then up to 120 a day later – sort of like the Atkins diet).

Guess what happened?  They all lost weight, yes.  But the low carb and Mediterranean lost about twice as much, and didn’t regain it.  In fact, the low fat women didn’t lose anything (but small numbers).  The Mediterranean folks had better control of their blood sugar.  The low carb folks did better on their lipids.  And the two together did better on markers of inflammation (C-reactive protein).  Now, the participants were 85% male and there weren’t enough diabetics in the study to really tell what happens with diabetes.

There are those who will say, “You can’t lose weight when you stimulate insulin”.  White carbs and sugars drive insulin up.  Insulin drives fat into your cells.  Your fat cells will not release fat when there is insulin in your blood.  Carbs make you release insulin.  Low fat diets are, by definition, higher carbs.  You can’t lose weight eating carbs.  Now remember.  It’s the RIGHT fats that count.  Not saturated animal fats.  Eat olive oil, nuts, fish oil and flax seeds.

The study was done in an ideal setting.  All the participants could come to a place where their lunch could be prepared.  They all met with dieticians for multiple sessions of teaching, support, monitoring and all the community and relationship that brings.  But we know that counseling, connecting, and relating is half the battle.  Care providers talking to their patients works.  In fact, it works twice as well as anything else.  And this study shows you can make it work for two years.  Not just one.  And keep it off.

WWW:  What will work for me.  Well, I weigh myself daily, usually with a sigh of resignation.  “Oh well” I say.  This gives me renewed hope.  First step, less white sugar.  Second step, no white bread.   Third step, small snacks with some almonds thrown in.  Beautiful cherries are in season.  Splurge.

How to Double Your Weight Loss before you Double Yourself

How to Double Your Weight Loss before you Double Yourself

Competency # 2  The Best Diet

Reference: American Journal of Preventative Medicine, August 2008,  Time Magazine 8/1/08

Brian Wansink, Mindless Eating, 2007 (Best book out there on managing your surroundings)

This idea is pretty simple.  If you keep a food diary when on a diet, you double your weight loss, plain and simple.  Double.  That’s it.  This comes from a huge research study.  Lot’s of other strategies failed.  Keeping a diary worked.  Don’t read any more.  It’s too painful for me.

So much of the day, we eat without thinking about it.  As Brian Wansink demonstrated so eloquently in his brilliant book we reviewed last year, Mindless Eating, we have very little insight into the amount of food we eat.  It all comes down to the very subtle cues in the world around us.  He shows in his book, even with graduate students in his research program, that you can change the amount of food people eat just by changing very subtle cues in their environment.  For example, if you pass out small bowls for snacks at a party versus one quart bowls, you can change the amount of snack food your guests eat by some 50%.   Same principal works for candy dishes on your desk or soda glasses at the movies or stale popcorn in the ER break room.  If you have an open dish, you eat 6-7 pieces of your own candy every day.  If it’s covered, you’ll eat less.  If it’s opaque, even less.  If it’s on the counter behind you, less yet.  (Lesson: use smaller plates; you’ll eat less and still be satisfied.  Don’t put food in sight.  You will eat it without thinking about it.)

Keeping a diary is raising the barrier to eating mindlessly.  If I have to write it down, I have to describe it and measure it.  How many ounces?  How big a piece? And the data sits there for all to see.  That extra little mental effort is a big pain, so I just rather not eat it.  Like a spoiled, entitled teenager, I huff off with my diary in my pocket and just have a little snit.  But I don’t eat it.

And the merging science of sugar is becoming more clear.  Just a wee bit of sugar helps the medicine go down. And everything else go down that it’s added to.  Do an experiment in your home.  Buy some plain, generic, peanut butter and set it beside a commercial brand that has corn sweeteners in it.  Taste a tiny taste of both.  Which do you want a second teaspoon of?  You picked the sugared one, right?  That’s because we now know that the same parts of our brain that fires up with fireworks when we take drugs of various kinds (heroine, cocaine, morphine…..) is the same part of your brain that stands up and says “Yippee” when you eat sugar.  You are hard wired to eat more whenever sugar gets close to your tongue.  Like an addiction, sugar gives you a high.  A wee bit of sugar becomes another bite, and another bite and another bite.  Sweet used to mean you had found ripe fruit and you should gorge quickly before the mangos went bad and the season was over, or before you got chased away by a bigger competitor.

No more big competitors to chase you away, just you and your conscience, and your spouse.  Your inner elephant, your subconscious, is a raging wild animal that is much stronger than you if you don’t get good tools to control him/her.  A food diary forces you to make your food choices consciously.  Once you are thinking, your rational side can control that devilish elephant.  A food diary is step two on the twelve-step program to recovery.  Step one is to stand up and say, “My name is ______, and I love sugar…”

WWW. What Will Work for Me?  Well.  I opened the fridge this week after 9:30 pm when we were in the middle of some shoot-em-up cop show.  I only had three minutes to find something yummy.  My adrenaline was pumping.  The Greek God Honey Yogurt carton was there with only one bite out of it, full fat, unbelievably delicious, sweet, sweet honey flavor.  I didn’t get a bowl.  I just took one bite, then another, and another.  Finally, I just plain sat down with the whole carton, without thinking, glued to the TV.  I gave my dog the empty carton, 20 huge tablespoons later. It was just delicious.  However, I didn’t feel full yet….    So, I’m starting a diary.  I need to learn how to keep track better than that.  And you?  Are you so innocent?  Of course, this couldn’t possibly apply to you…  (Note pads are available at your nearest Walgreen’s.  Join me)