Monthly Archives: May 2011

The Friday Fish Fry is Toast!

The Friday Fish Fry is Toast!

Competency: Good Fats

Reference:  Circulation: Heart Failure Belin et al from UCLA  May 25, 2011

Everyone should eat more fish right?  It reduces heart disease, right?  Wrong!!! Oops!  There is nuance.  If you follow 85,000 post menopausal women for 10 years you can find some interesting data about how people eat and what impact that has on their subsequent health.  Taking women who eat fish five times a week or more, and compare them to those who eat fish rarely or not at all, you will find a 30% difference in heart failure.  Not heart attack, but heart failure.  Heart failure kills 20% of folks within a year of the diagnosis, so it is a nasty diagnosis and can result in a life of disability with shortness of breath, inability to walk up stairs or exercise and all-around limited activity.  The women who ate more dark fish had 30% less heart failure.  That’s good.  Considering 5,000,000 Americans have heart failure, this has implications for a lot of us.

But the beneficial effects of eating fish worked ONLY for those who ate their fish baked or broiled, not fried.  If it was fried the benefit not only vanished, but the effect was WORSE.  And the real benefit came from eating darker fish like salmon, mackerel and bluefish, not from whiter fish like tuna, sole and cod.  Atlantic salmon contains between three and six times the amount of omega fats as does cod or sole, so it may be the omega fats.  The researchers focused on omega fats with extra questionnaires and found some surprises.  In this study, the benefit of omega fats by themselves were not as remarkable as the whole fish.

But what does that say for the fish fry of cod on Friday night?  Milwaukee lives for its Friday night fish-frys.  This study showed that ONE serving of fried fish a week increased the risk of heart failure 48%.  Not decease, increase!  This is a problem.  Could it be the French fries that come along with the fried fish?  Could it be the fats it is fried in?  All may be true.  But it argues for the baked option on Friday night instead of the fried.

What’s the explanation?  I think there is an issue with the higher heat of frying.  Omega fats are delicate little critters that are chemically altered quite easily.  The higher heat of frying could really alter omega fats into trans fats of various kinds.  Baking and broiling can be higher heat too so that may not be all of it.  I think another possible explanation is that the oils used for frying are often vegetable oils that are heavy on omega-6’s.  These are precursor molecules to inflammatory eicosinoids.  It may be the higher intake of omega 6’s is harmful.

WWW: What Will Work for Me?  Oh well.  Can’t use the fish fry as my excuse of getting more fish.  That’s one of my favorite Friday night things to do.  Time to check out the places that have broiled or baked fish, and then only if they have mackerel or salmon, because cod doesn’t do it either.  It just doesn’t work for me to stay at home and eat sardines out of a can.  So focus here:  darker fish like salmon, mackeral or bluefish, and then it has to be broiled or baked.  Make it zesty with a blackening but not frying.  The day of the fish fry needs to fade away, unless you want to fade first.


Written by John Whitcomb, MD

How Fructose is Being Sold to You! The Unsuspecting

How Fructose is Being Sold to You!  Hot off the Presses!

Competency:  Fructose and Sugar Metabolism

Reference:  New York Times, May 4th, Advisory Board May 6th, and many others

“Sugar is getting a bad rap” reads the first line in the New York Times.  Oh dear.  How terrible!  Sugar’s reputation is being “dissed”.  So here is the study that has been widely spread around in the media for you to ponder.  And then buy sugar.

Premium athletes, in this case 10 cyclists, in a double blinded triple cross over study were given various sports drinks containing glucose or fructose to see which rebuilt the volume of their livers back faster.  With premium exercise, you do exhaust the stores of energy in your liver of glycogen which is glucose all lined up ready to be used.  That makes your liver smaller.  You can store some 400 calories of freely available sugars in the form of glycogen in your liver.  Glucose is not an efficient way to store calories so the human body only saves 400 calories of space for glucose storage. The rest goes to fat which is much more efficient.  Premium athletes will burn up that much energy quickly and have a shrunken liver to show for it.  Hence, something to measure to see how fast it comes back.  You can be very precise in your measurements with MRI scanning with isotopes to trace exactly the end result of your intervention.  What this study showed was that fructose rebuilds the volume of your liver faster than glucose.  The fructose drinkers regained 9% of liver volume, the glucose drinkers only 2%, with an overall difference of half.

Ok.  That makes it look like we ought to drink fructose containing drinks if we are premium exercisers.  Doesn’t it?  And who do you think might have a vested interest in your believing that?  And why would the New York Times have suddenly available an extremely attractive looking female athlete drinking some solution on their lead article, to associated in your brain the value of drinking fructose?   I smell a rat.

Fructose overwhelms your liver, no matter how you drink it.  And it doesn’t get changed into glycogen as much as it is changed into fat.  I would have some questions for the study here that I couldn’t find the answer to.  We know for cold hard facts that fructose results in fatty liver.  Can the MRI tell the difference at the molecular level that it’s fat the liver has made instead of glycogen?    I believe the volume of the liver was fat, not glycogen, with the fructose drinks and that in the long term, that would be damaging to the liver and to all the arteries in the body as the consequent inflammation caused by fats in your blood gets distributed.

I wouldn’t be so suspicious if the article hadn’t showed up in every venue you can think of.  Even the prestigious, staid Advisory Board put it out on their web site.  This speaks to me of a PR department for the sugar industry busily out there making copy for harried editors to put in their column that catches your eye and surprises you.  Don’t get taken!  I remain skeptical.  If you would like to see the real physiology of fructose, I forward you to theYoutube lecture by Dr. Lustig, pediatric endocrinologist at the University of California, San Francisco.

WWW. What will work for me?  Stay away from fructose.  It’s one of our great poisons.  Period.  Any way you can, find a way to cut down your sugar consumption. Even if you think you are a premium athlete, go for other foods.  And only after watching Dr. Lustig can you start drinking the drinks brought to you by the sugar advisory board and widely distributed to every newspaper, magazine and web site in America.   Nice try, guys.  And this is from a guy who loves sugar and secretely sneaks a candy bar whenever there are no witnesses!  I’ll try to think fondly of my tender liver sucking that fructose up.

Acticle on the physiology of functional MRI scanning


Written by John Whitcomb MD

Infants and Viral Pneumonia from RSV Reduced 85% with Vitamin D

Infants and Viral Pneumonia from RSV Reduced 85%

Competency:  Vitamin D


RSV is a scary pneumonia.  It hits infants, often within a couple of weeks of delivery.  They look sick.  They wheeze.  Their chests bend in with their effort.  I have spent 33 years being petrified of these kids because there isn’t much you can do for them except put them on a ventilator.  And their mothers are living in sheer terror.  Every child gets it by age two, but most hardly know it other than a bad cold.  But we still have a couple of hundred thousand admissions to the hospital every year for newborns whose little chests are almost collapsing with their effort to breathe.  “It’s just bronchiolitis from RSV”, we say, and shrug our shoulders.

Well! No longer.  This article shows you can cut RSV some 85% if you take Vitamin D supplementation during pregnancy.  The researchers in this study took 156 neonates and measured their cord blood PROSPECTIVELY for vitamin D.  (That’s as close as you can get to a randomized controlled trial.) They they waited to see who got sick.   What they found was a very strong association between the D level in the cord blood and mother taking a D supplement, AND the child then getting RSV or not.  The authors suggest that the recommended level of 600 IU for pregnancy women is woefully inadequate.  In fact, this column has reviewed Drs Hollis and Wagner’s work from S. Carolina where they showed it takes about 4000 IU a day to have a baby born with a Vit D level in the 50 ng range.  A mother’s blood level strongly correlates with the baby’s blood level.  Fifty ng is what you get when you have adequate sunshine year around, and work outdoors, and don’t wear clothes.  Sort of like what we did prior to 10,000 years ago.

How does D do all that?  We’ve learned about D and bones until we can rote recite it.  What folks don’t hear is that fundamentally Vitamin D makes your stem cells turn into mature cells and do their function properly.   We humans have at least 3000 different kinds of cells, and each starts as a stem cell.  To mature, we need D.  That works in bones as well as white cells.  Mature while cells can kill viruses.  Our reviewed study from Japan last year showed that D doubled the effectiveness of a flu shot in children.  Flu is another deadly virus.  So, D is working by stimulating the stem cells for those lymphocytes that kill viruses.  Magic!

And what did our recent national guidelines come out saying?  600 IU a day is enough!  That’s enough for BONE HEALTH only.  It’s not sufficient to get to 30 ng reliably and 30 ng is the threshold where we know Vit D stimulates the production of cathelicidin, your bodies natural antibiotic.    To get to 30 reliably, you need 3000 IU a day.  To get to 50 reliably, you need 5000 IU a day.

What I find most unique is that many researchers in D are taking 5000 IU a day.  And we keep wringing our hands about how to prevent early infant mortality, particularly in Milwaukee, the city with the highest level in the country.  Our newspaper is running Sunday front page featured articles about reducing early childhood deaths.  And now we have a paper to show us how to reduce one of the most common infant pneumonia.  Hopefully our editors and community organizers will read this paper.  Or perhaps you can forward it to them.

WWW.  What will work for me.  It’s time to call for community action for higher D level supplementation for pregnant women.  Hollis and Wagner first showed us the way.  Now we have Belderbos and Heuben.  Every pregnant woman I know hears it from me.  Help me out here.  Spread the word.  Every pregnant woman you know!   A pregnancy lasts 9 months.  You can buy enough D for that time for $ 8 as Sam’s Club.  People ask me if I’m worried about the liability in OB.  I believe the weight of liability has shifted to those who knowingly don’t check and provide D for pregnant women.

Written by Dr. John E Whitcomb

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Being a Desk Potato is Worse than You Thought

Being a Desk Potato is Worse than You Thought – So Do the Hokey Pokey

Blair et al,  Sedentary Behaviors Increase Risk of  CV Mortality in Men  Medicine and Science in Sports and Exercise,  May 2010, 42 [ 879

Competency:  Exercise and Movement

Sitting, sedentary, and resting is what we do.   All day long.  Knowledge workers, using our minds, testing our intellect, that’s what we are.  Warriors of the keyboards!  Dying on the job.  Heart disease, diabetes, expanding waist lines……

That’s just what most of us do all day long.  We have a keyboard, a cubby, a computer screen and there we sit.  Now, for those of us with virtue who get up and get sweaty every day with our 40 minutes of brisk walking, well, that good but not enough.  Episodic exercise isn’t all you need every day.  And don’t get me wrong.  The Honolulu Retired Men’s Study showed that walking two miles every day cuts mortality in half.  So, just walking for 40 minutes every day has huge benefits.  Our Federal guideline for exercise that calls for 30 minutes a day of exercise is right on the money.  No question.

But it’s a bit more complex than all that.  It’s not the episodic exercise that’s the only key.  It’s prolonged sitting by itself that’s a problem.   That’s what Dr. Blair’s paper found, reported last week on NPR and published in the Journal Medicine and Science in Sports and Exercise.  Taking a precise measurement of movement every day, and comparing groups of men Blair found that sitting at a desk, sedentary for 23 hours a week had 67% greater risk of death from heart disease than folks who reported only 11 hours a week of sitting.  The explanation was thought to be that our bodies simply go into idle mode when large muscles relax to sit for long periods of time.  It’s not just being sedentary that’s a problem.  You can be very active part of the time but sedendary for long periods, and still have risk.  That sedentary period by itself is an additional huge risk for vascular disease.  It adds to the exercise story and explains why we haven’t seen the benefit from exercise that we thought we should have seen.  Those of us who are exercising once a day aren’t doing all we need to.

To stay healthy, you have to do more than exercise one isolated time each day.  You have to get all your large muscles thinking about burning fuel intermittently, all day long.   In fact, the NPR article cites an Australian studyin which folks got up and moved for just a few minutes at a time had better markers of metabolic function.  It only takes a minute or two.  Episodic large muscle movement is the key.

WWW. What will work for me.  You don’t go to the Y every day?  You can help yourself out with something much more simple.  Stand up every hour for one minute, do a bit of Hokey Pokey, march in place, a couple of deep knee bends, anything to get your big muscles moving.  That is all it takes.   Not only does it wake up your brain, but it wakes up your metabolism.  Your waist size will be smaller, your cholesterol better, your blood sugar will be better and your risk of heart disease will drop by more than half.  This is worth it.  I live in a tri-level.  Stairs everywhere I go.  Time to stop complaining about it.  Can you take an extra set of stairs each day.   Once is good, twice is better, three times is virtue, four… oh my, angelic.  And richly reward the person next to you when you see them doing it.  Do it together.  Group Hokey Pokey is kind of fun.  Sort of like summer camp at work.