Monthly Archives: October 2009

What One Month of Being A Vegan Will Do for You

What One Month of Being A Vegan Will Do for You

Reference:  China Study by Colin Campbell, Barnard, Am Jr of Medicine, 2005 p 991

Go ahead.  Throw down the gauntlet!  Make a challenge!  And then, walk the walk.  This is my report card of a one-month trial of being a vegan.  I read Dr. Bernard’s study.  I read the China Study.  Both state that you can make a dramatic difference in your metabolic syndrome risk very quickly if you follow a high fiber, plant based diet with no animal products.  But is it do-able?  Could I do it?  That’s the real challenge. I have metabolic syndrome.  Will it work for me?  How about sugar?

I gave it a try.  Here were my rules.  If I was going to try getting rid of animal products completely, I would have to give myself some slack.  I would not let myself get hungry.  I would always eat until full and not feel deprived.  If I was hungry, I could have anything plant based that I wanted, whenever I wanted.  And no sugar.  Stevia sweetener, but no sugar.  And no extra exercise. (Walk about 7-10 miles a week)

What happened?  Well, I made if for 5 weeks.  I was never hungry.  I averaged about 17 servings of vegetables and fruits a day.  I ate pounds and pounds of almonds, walnuts, peanut butter.  And I discovered a lot of cool recipes.  Indian food is just delicious!  India has about 10 commonly used lentils that make wonderful soups and stews.  And curry is really meant to be a vegetarian dish.  Cabbage curry, potato curry, peas and beans, cauliflower and spinach, coriander and potatoes, eggplant….. the list is as long as your imagination.  After making two or three, I got the hang of it.  It only takes about 20 minutes to whip together a nice spicy curry while the brown rice is simmering.  And a good curry gets better with age.  Together, Holly and I had lots of other culinary adventures too.  We went to friends’ houses and made vegetarian dishes and made it a treat to visit.  We made a huge vegetarian chili with lots of beans.  We found all the fast food subs and wraps and other recipes that are vegan.  They are out there.  You can eat out and be a vegan,  “Could you take a triple batch of those vegetables and stir fry them with some peanut sauce?” works.

My weight dropped 9 pounds, without ever being hungry.  It hasn’t come back in the month since either.  My blood pressure went from 110/75 to 86/60 without being dizzy.  My fasting blood sugar dropped from 101 to 88.  My cholesterol went from 189 to 154. My LDLs from 130 to 107.   Not bad.  Not bad at all.  In just a month, I reduced my risk for metabolic syndrome dramatically, without ever being hungry.  And 9 pounds.

WWW: What will work for me.  We are learning that our food talks to and turns on our genes.  The food we eat isn’t just simple calories in a simple chemistry experiment.  Our genetic heritage is what we are.  How we eat sets off our genetic story.  Plant based foods turn off the genes that make us store fat.  Or was it the loss of sugar?   Can you give it a try?  Can you start by just changing breakfast?  Try getting used to soy milk instead of cow…. Can you go one day a week of meatless, sugarless?  Learn a new recipe or two.  Remember, you can eat till full, and still lose weight.

Vitamin D and Flow Mediated Dilation: Link to Heart Disease

Topic:  Replace Vitamin D and Make Your Blood Vessels Happy

Competency:  # 17 Vitamin D

Reference:  Tarcin et at J Clin Endo Meta Oct 2009 p4023

Now, this is downright fun!  This is a well-done study comparing young, healthy men with low vitamin D levels (average 8 ng) to normal vitamin D levels (32ng) and what happens to their blood vessels as a result of Vit D replacement.  First of all, how did they replace it?  300,000 IU as a shot, once a month for three months.  That is the same as 10,000 IU a day for three months.  All with no side effects.  Nifty.

Second, what they found when they raised the D blood level.  Blood pressure dropped by 7/7 points.  That’s huge by itself.  Then, they found that Flow Mediated Dilatation (how much your artery stretches and relaxes with a pulse is called FMD) improved to normal, which was a about a 30% increase.  That’s part of why the blood pressure dropped.  They also found through multiple measures that “Oxidative Stress” decreased dramatically as they normalized the Vit D.  Finally, leptin was increased back to normal.  Leptin tells your brain that you are full.  With inadequate D, your leptin is low, and you eat too much because your brain doesn’t get the signal that you feel full and that you are deficient in leptin. This all points to a pattern of your arteries being prone to damage when your D is too low.  They don’t stretch as much, making your blood pressure higher.  Your arteries get more inflamed and your appetite is off kilter so you continue to provide too many calories by eating too much.   It’s all a perfect setting for damaged arteries.  It may not happen in just a month or two, but after twenty years you have a heart attack at age 42 and wonder how it happened.  No one put the picture together for you and told you that this was yet another reason to take that irresistible Vitamin D.

This study is a landmark study for a variety of reasons.  First of all, the authors were bold enough to use a replacement dose of D that focused on getting folks back to the same blood level as their control peers.  Their peers had an average level of 32 ng.  To get healthy young men with a blood level of 8 ng up to a blood level of 32 ng required 300,000 IU a month for three months.  That is almost a million units over 3 months.  This was done with no toxicity.  This may help explain why prior studies in which D was given at 200 IU or 400 IU a day for a couple of months might not have shown much effect.  By focusing on the dose given instead of the blood level achieved, study subjects in many past negative D studies might never have gotten to therapeutic blood levels. In my opinion, 32 ng is still low as it is not what your body would naturally obtain by living in a sun rich environment.  55 ng is my target.

The pattern is falling together.  Many other studies show that Vit D is low in folks who have metabolic syndrome and that blood pressure will drop when adequate D is prescribed.  This study adds another reason to take D.  The summary is simple.  Low Vit D is as risky for you as any other risk factor for coronary artery disease.

WWW.  What will work for me.  I’m taking vitamin D every day and my last level was 70.  Some folks think that may be a bit high.  I’m sticking with it.  The risks of coronary artery disease are real and very evident.  I have yet to find any risks with D supplementation that match it.   A kidney stone here and there can be awful, but nothing like sudden death from a heart attack.

The Atkins Diet May not Be So Bad

Topic: You May Not be at Risk with Atkins After All?

Competency #2: DASH OMNI and Other Evidence Based Diets

Reference: Reference:  American Journal Clinical Nutrition 2008:87: 567-76 Keogh et al from Adelaide, Australia. (Published Yesterday!)

Atkins must be bad for you!  I’ve told everyone that for years.  It can’t possibly be okay to eat all that saturated fat.  That message is deeply engrained in all of our standard teaching.  Ask any sober medical person and you will get that cautious, but firm answer.  And we have data to prove it.  We can show you studies that demonstrate fancy terms that will just blow you away with medical shock and awe.  “Flow mediated dilatation”.  “Pulse wave velocity”.  How about those two?  If that’s not enough, we bring out E- and P-selectin, intracellular adhesion, tissue-type plasminogen activator. Adiponectin.  These are really great Big Boggle terms.  Worth at least 40 points next time you play Scrabble.

Those are all various measures that we have used as we study the effect of saturated fats on your arteries.  And they have shown in the past that a one-time meal results in “bad effects” from saturated fat.  After a high fat meal, your arteries show poor FMD (“Flow mediated dilatation”). We do know that obesity is associated with arteries that don’t stretch well with a pulse wave moving down (FMD).  That’s associated with coronary artery disease.  FMD is not WMD, like in Iraq, but just about as bad for you and me.

Dr Keogh and her team looked at weight loss diets.  What they found was that a low carb diet resulted in much better weight loss than a low fat diet, and had no bad effect on any of the endothelial markers.  Arteries got better with weight loss.  Period.  And more weight was lost with low carb diets.  This is a very big crack in the wall.  We now have a serious challenge to the dogma.  A low carb diet works for weight loss.

We have to look back to 1930 when Dr. Donaldson in New York City treated 17,000 obese folks with a very simple diet.  6 oz of porterhouse steak with two oz of added fat, 3 times a day.  No carbs.  Everyone lost weight.  No one complained of being hungry.  He said the only failures were those who couldn’t stop the carbs.  That was WAY before Atkins.  Let me repeat.  Everyone lost weight, no bad side effects.  (Clue: no one ate FRUCTOSE either.  Remember that)

WWW: What will work for me?  Oh dear.  I have to change my tune.  I’ve been an Anti-Atkins guy for years.  Data is hard to swallow.  But this is good data.  And people lost weight.  I gained three pounds over delicious, luscious spring break.  So, back to the scales.  I’m off carbs this week.  And eggs, yogurt, cheese, meat and raw veges and fruit is all I’m eating.  No white carbs.  My shock and awe was the scales.  Time to bring out the FMD data and get back on track.  Could it be the fructose?  What about the omega fats?

Acts of Unexpected Kindness

Topic: Acts of Unexpected Kindness: Perfect Food for Your Soul

Competency # 25  Community

Reference: Sonya Lyubomirsky, “The How of Happiness” Published 2008

Sonya Lyubomirsky is our leading social scientist studying happiness.   She is a professor of psychology at UCLA.  This is one lovely book that I’ve just devoured with fascination.  Her research shows some interesting issues in regards to “happiness”, her focus and interest.  For one, about 50% of your happiness is genetic.  You get that half dealt to you.  You can prove that from twin studies who are identical versus fraternal.  If you are naturally a sunny personality, be grateful for your genes.  If you aren’t, the good news is that the remaining half has room to wiggle.

Only about 10% of your state of happiness comes from your circumstances.  This means fully 40% comes from activities you have control over.   Ten percent circumstances explain a lot about folks who win lotteries not being any better off after a year or so.  It also gives hope to anyone who has had a personal life blow dealt to them.  Your natural baseline will come back in time.

Sonya gives us 12 tools to work with in this book.  To introduce you to her ideas, I’m just going to highlight the concept of “Acts of Kindness”.  Most of us are charitable and kind out of altruistic and decent community motives.   That’s good.  Hang on to that.  But you can do more.  Intentionally planning acts of kindness into your day will make you personally happy.  The pursuit of happiness!  It’s good for your own mental health.

There’s just a bit of nuance to how you do it.   As she says, “Timing is everything”.  Pick one day of the week and plan to do one big act, and a couple of little ones.  Interestingly enough, doing something every day doesn’t lead to an increase in happiness scores.  You just get burdened and resentful.  You have to do it in bunches, a big one or three little ones.  But all must happen on one day, and with intentional planning.  Let yourself revel in the planning.  Make a meal for someone.  Write a thank you letter. Take time to do an errand that’s unexpected.  It doesn’t have to be far from home.  Do it for your coworkers, your spouse, your kids or your teacher.

And “Variety” is the spice of life.  You can’t get into a rut.  A new idea, a new plan, a new plot to surprise someone is critical to get the “happiness effect”.  The winner is “both of you”.  Your recipient gets a sweet, unexpected surprise.  You feel good inside.  Your happiness score goes UP.    It doesn’t take money.  It takes time and attention.  Writing a letter, making a phone call, helping someone weed their garden, take out their trash or cross a street is all that it takes.  It takes some effort to think up the variety and plan ahead.  It can be as little as giving the gift of “Hello, John”.  Calling someone by name and greeting them with a smile, works wonders if you aren’t in the habit of doing it.   Make it into a habit, one day a week.  Soon, it will become part of you as you learn the new habit.

WWW:  What will work for me?  I need a little food for the soul.  This is a sacred time of year for many of us in our faith traditions.   I’m trying to think about how I can relate gently and kindly to the world I encounter.  I’ve tried this now for two weeks and Sonya is onto something.   We are a nation in the pursuit of happiness, aren’t we?  When I look around and see people I admire and want to emulate, I see the kindness of their actions and their intentions.  In the hospital world, we call it “Planetree Service”.  In my faith community, we call it “Smiles and Trials.”   At home, call it your own happiness.  You are the real winner.

Chili Peppers: “Your Genes Are Hot, Hot, Hot”

Chili Peppers: “Your Genes Are Hot, Hot, Hot”

Reference: # 14 SUPERFOODS

Reference:  Kang, Obesity 2009 Oct 1

We didn’t say your “Jeans  are Hot.”  We said your GENES.  How do chilies make your genes get “hot?”  Actually, chilies are “cool.”  Here’s how.   Chili peppers are very widely consumed.  Ever since Christopher Columbus brought them back from Central America, chilies have captured taste buds around the world, much to our benefit.  It’s not just their flavor that’s so great.  It turns out that the spice in chilies does some really “cool” stuff to your genes, and quickly.  When you eat chilies, the active ingredient, capsaicin, rapidly induces your internal cellular control mechanisms to put out anti-inflammatory chemicals.  With a tiny bit of capsaicin added to their food, obese mice can be shown to have a marked decrease in their insulin resistance and all the inflammation that comes along with it.  Kang and his fellow researchers (see reference) were able to demonstrate the production of messenger RNA off of DNA that produced new chemical markers that in summation made the mice much more insulin sensitive.  Perhaps most importantly the capsaicin turned off NFB.

What’s NFB?  It’s the master of inflammation.  If you would imagine, inside your cells, you have the boss of bosses, the Don Corleone of inflammation driving around in his Cadillac, cruising the neighborhood of your liver.  When you eat a really bad meal (say an extra large milkshake full of saturated fat and sugar) it’s sort of like throwing a brick through the windshield of that spanking new Caddy. NFB gets really, really mad.  You don’t want to make NFB mad.  Your cells go nuts.  Everybody runs for cover because all the bodyguards come out from their hideouts and start shooting their machine guns in every direction.  Now we call the bullets they shoot nice confusing little names like TNF and IL-6.   Those bullets, IL-6 and TNF are produced because NFB is the master controller that turns on the genes that make them.  The net effect is all about inflammation and damage to your cells.  IL-6 and TNF are the key mediators to liver cell death, fibrosis of the liver, and inflammation of the liver.

Is this fuzzy, confusing picture coming into focus for you? Our food turns on our genes very quickly and effectively.  There really isn’t a difference between drugs we take for their chemical effect, and the chemical effect we get from the food we eat.  Both cause multiple chemical reactions that are masterminded through rapid expression of genes.  Capsiacin from chilies works this way. as does curcumin from turmeric and sulforaphane from broccoli..  The anti-inflammatory effect is mediated by the very effective and efficient modulation of our internal genetic code.   It doesn’t take much.  Tiny, tiny doses can have a very beneficial effect, quite quickly.  Within minutes your liver cells respond with inflammation, trying to attack the invader who threw the brick through the window, or with soothing and calming anti-inflammation – all depending on what you eat.

You can choose the effect on your body by food choices you make.  The effects don’t happen overnight.  Nothing happens in a week.  The effects are very tiny.  In fact, you can get away with it for 15, 20, or even 30 years.  You can’t get away with it for 40-50 years.  Bad food habits accumulate over time.  Getting a heart attack at age 50, cancer at age 60, Alzheimer’s at age 70 are not random events brought about by bad luck.  They are the predictable consequences of lifestyle choices you and I make every day of our lives.  The food we eat turns on our genes, for better or for worse.

WWW: What will work for me?  Well, well.   I want to find out the difference between better and worse.   I love chilies.  And turmeric just happens to be right up there with my favorite foods.  Those two spices are key ingredients to curry.  Just thinking about it makes me want to stir up a nice batch of cauliflower and potato curry.  Lots of vegetables, lots of spices, no saturated fat, no sugar.  Keep NFB happy and quiet in his caddy.  Keep my genes nice and cool.

Recipe for Cauliflower Curry

(prep time 10 minutes, cooks in 15)


Exact same recipe can be used for cabbage, pea and potato, mixed vegetables with various squashes, eggplant……lots of different vegetable combinations.  Remember to fry the spices first just to get some flavor going, and don’t let them burn on the bottom.  Add the water and simmer.

Fry 1 Tbsp of black mustard seed in ½ cup canola oil until seeds stop popping (1 min)

Add 1 tsp of whole cumin seeds, 1-3 tsps of ground chili peppers (to taste)

Add one nice big chopped up onion

1 tbsp of chopped garlic.  Add some fresh chopped ginger here for variety

Some folks like 1-2 tbsps of ground coriander at this point, or garam masala too but you can leave them out for simplicity if you want.

Stir stir stir

Stir in 6-7 diced red potatoes

Stir in the cauliflower (one head)chopped into nice sized pieces

Sprinkle a tablespoon of turmeric over the whole mixture

Stir stir stir

Add a cup of water or two to let everything simmer for 15 minutes.  Three or four chopped tomatoes add some great flavor and pretty red color.  Or a can of tomatoes

Sprinkle on a bunch of freshly chopped cilantro just before serving.

Salt to taste

Serve with brown rice or heated up chappatis (whole wheat tortillas)


Fiber and Fertility

Fiber and Fertility

Competency #: Fiber

Reference:  Gaskins et al AJCN Oct 2009 The BioCycle Study

Fiber is a hot topic.  The American Diabetes Association recently set targets of 14 grams of fiber per 1000 calories.  Considering that most Americans eat about 15-16 grams of fiber a day, this would be a doubling of their intake.  Interestingly enough, we probably evolved eating as much as 100 to 150 grams of fiber a day and many indigenous cultures around the world consume 40-80 even now.  The European EPIC study looking at fiber content in diets found that poorer Roumanians and Bulgarians ate out of their gardens and small farms. Their diets contained much more fiber and they had much less heart disease and colon cancer.  Studies in North America have confirmed that higher fiber reduces breast cancer risk and is associated with lower risks for stroke, diabetes, cardiovascular disease and colon cancer.  That’s a pretty good package.

How does fiber do it?  It probably speeds up the transit time of food through your gut and disallows the reabsorption of all the hormones, fats and other poisons your liver excretes in your bile.  Having lots of volume to work with just “flushes” the bad stuff out.  Dr. Burkitt (famous African missionary surgeon) noted that the healthiest Africans always had the largest bowel movements, twice a day, and never had appendicitis, gall bladder disease, diverticulitis or colon cancer which are all staples of western surgery.

What is the Biocycle Study?  No one has ever investigated what fiber does to pre-menopausal women.  There has been some research that suggests that it is the life time of estrogen exposure that makes for high breast cancer risk, and that is related to the amount of animal protein we eat (China Study).  The more protein eaten, the earlier onset menarche starts and the later menopause ends, and the higher estrogen is throughout the life cycle.  Does that mean fiber might be a way to lower estrogen?  You bet!  That was the premise of this study.  That is what they found.  Sure enough, higher fiber was associated with lower estrogen levels throughout the cycle.  They also found lower levels of LH and FSH, the two hormones that set off ovulation.  For every 5 grams of extra fiber a day, there was a 78% increase in “anovulation.”  No egg, no fertility.  Now, the initial numbers were small so a 78% increase over a small number is still small, but statistically significant.

WWW:  What will work for me.  This is interesting.  The effect on fertility is certainly no method of birth control.  But we live in an “estrogenized” world where lots of chemicals have estrogen effects on men and women.  Lowering all our estrogen effects may be helpful.  Our livers can excrete the stuff, and we can get rid of it if we eat enough fiber.  This study confirms we can get a lower blood level of a universal hormone by the amount of fiber we eat.  Now, if you want to have kids and get pregnant, a few months of ice cream and cookies might be just fine.

A Beer Belly is the Same as a Soda Belly

A Beer Belly is the Same as a Soda Belly

Competency #11 Sugar and Fructose

Reference:  The Bariatrician, Robert H. Lustig, September 2009

Dr. Lustig is a full professor of pediatric endocrinology at UC San Francisco.  He asks the question, “How are the Atkins Diet and the Japanese Diet the same?’”  One is very high protein and fat, the other is all carbs with no fat.  The answer is that they both work.  They work, not because they are boring or they reduce calories, but because they both exclude fructose.

The biology of fructose is becoming clear.  When you eat table sugar (50% fructose) or most American processed foods that contain HFCS (high fructose corn syrup that is 55% fructose) you get a load of fructose to your liver.  Fructose cannot be metabolized anywhere but in your liver and your liver does something very interesting.  It breaks down fructose in a fashion very similar to alcohol, forcing your liver to make fats at almost the identical rate at which a similar amount of alcohol would do.  Those fats are the damaging LDL types that not only damage your arteries and your liver, but they ship fats out to be stored to the rest of your body.  Dr. Lustig elegantly shows that two slices of bread (120 calories of white carbs, all glucose) actually gets handled quite well by your body with only 1 gram or so going to bad fats in your blood.  120 calories of beer (1 glass) ends up with 40 grams of damaging fats, and a lot of damage to your liver.  In addition, 120 calories of soda (1 can), or Kool-Aid, or orange juice which are sweetened with HFCS result in 40 calories of damaging fats coming out of your liver, just like with the alcohol.

We thought going on a low fat diet in America would help us lose weight.  We all have avoided fats and switched to carbohydrates in which food manufacturers have put fructose as a sweetener.  (Go to the grocery story and try and find a low fat yogurt that doesn’t have sugar in it, or a loaf of bread that doesn’t have HCFS in it)  But fructose is not glucose.  Fructose is called a sugar but is actually an “aldehyde” that is metabolized very, very differently.  Its net metabolic output is fat.  Bad fat.  When you eat a high fructose load, you are actually eating a high fat food.

Nature supplies us with the antidote from fructose.  When we eat fruit, we get fiber and antioxidants.  The 6% fructose in an apple or a pear comes with abundant fiber and balanced vitamins that negate the potential problems.  So fruit seems to be fine, in part because the fiber pushes the fructose down into the colon faster where its digested by bacteria to safer products, makes you feel full faster, slows down your eating and negates the bad effects.

A lot of us middle-aged folks have bellies we aren’t happy with.  We may not drink beer.  But we sure eat sugar.  Nowhere in the world do we see bellies like we see in America.  Nowhere else in the world do folks eat as much processed sugar.

WWW.  What will work for me.  It’s time to become a processed sugar fanatic.  I’m off sugar.  I’m reading labels this month like crazy.  Very interesting, I’m finding that it’s not so hard to avoid the carton of fully sweetened yogurt.  And I’m down a notch on the belt.

How to Lose Weight without Exercising Differently

How to Lose Weight without Exercising Differently

Competency # 4 Activity

Reference:  Barnard et al, Effects of a Low Fat Plant Based Diet, Am Jr of Medicine 118, 991 (2005)

Losing weight is just about the hardest thing we ever do.  I have had many people come to me and say, “I think the only way to keep your weight normal is to feel awful part of every day.”  Many of us are just confounded.  No matter what we do, we can’t lose weight.  Weight Watchers, Jenny Craig, the list is long of companies and organizations helping you to lose weight.  They stay in business because no one seems to be able to do it successfully and keep it off.  Being overweight leads to all sorts of problems with high blood pressure, diabetes, heart disease…

Wait a minute!  There’s hope.  From George Washington U in DC comes a great little study in which overweight women were given two diets.  Both groups were told not to worry about changing exercise amounts or to worry about what they ate.  The control group was told to follow the National Cholesterol Education Program (NCEP) diet.  The study group was vegan.  No animal products.   The vegan diet was 10% fat, 15% protein and 75% carbohydrates (whole foods, whole grains, legumes).  Animal products, nuts, nut butters, added oils, olives and seeds were “proscribed” (forbidden).  Each group had a weekly support group in which they were given cooking lessons, group discussions and support from a physician and a dietitian.

The vegan group lost 12.76 pounds, eating as much as they wanted.  The NCEP group lost 8.36 pounds, also eating to satisfaction.  Both groups got much better at insulin sensitivity and glucose tolerance.  Here is what is really interesting.  This weight loss is what you see with 1200 calorie energy restricted diet, but neither group was energy restricted.  The “thermic effects” of food was also significantly different for the vegan group.  The extra fiber in the vegan group makes for more calories burned as heat.  A recent review of many studies shows that increasing fiber by 14 grams a day results in a 10% reduction in energy intake.  Clearly, that must mean that our brains are happy and feel full when our stomachs have a greater volume of fiber in them.   Our body temperature is up a degree or two.

With what we know about fructose now, we could add a caveat.  A vegan diet that avoided sugar completely, but allowed you to eat all the avocados, nuts, but butters, seeds etc. that you wanted might be the next study to review.  That hasn’t been done yet.  It’s coming.

WWW: What will work for me.  The challenge is the palatability of the food.  I need to eat food I look forward to eating.  I clearly need to learn new recipes.  Indian food has thousands of curries that are vegetarian and just delicious.  West African peanut stews are great.  Mediterranean humus, Chinese stir-fries, Okinawan sweet potatoes.  There are recipes out there.  With three weeks of vegan eating, including no sugar, my weight is down 9 pounds while eating 17-22 servings a day of fruits and vegetables, and not feeling hungry.  All the peanut butter I want too!