Chocolate - A Not So Guilty Pleasure

Attention chocolate lovers! Did you see chocolate flurries falling from the virtual sky around the middle of June? If you did, that’s because the journal Heart published an article about the relationship between regular consumption of chocolate and the risk of cardiovascular disease.(1) The paper is called “Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women.” The journal also issued a press-release about the paper. Both the paper and the press-release are available electronically for journal subscribers - I don’t have access. I did what I could and read the abstract of the paper. The abstract was written by the researchers and summarizes what they did, how they did it, and their conclusions. This week, I write about chocolate.

Chocolate
https://www.flickr.com/photos/gemsling/542272611/

What's with all the fuss about chocolate?

Besides tasting good, why do researchers keep investigating chocolate? It’s all about cacao beans. Chocolate and cocoa are made from cacao beans. Cacao beans are rich with plant chemicals (phytochemicals) called polyphenols. Flavonoids are a class of polyphenols. Cacao beans contain numerous flavonoids including catechin, epicatechin and procyanidin. (3,4) I ran a quick search of “chocolate” at ClinicalTrials.gov on July 6, 2015 and found 254 studies listed. Of these, 33 studies are actively recruiting or are just about to start recruiting participants. We are going to hear more about chocolate for years to come.

At this point, research suggests that flavonoids may function to improve heart health, lower blood pressure and reduce the risk of cardiovascular disease. Flavonoids are suspected to work by reducing oxidative damage (they act as antioxidants), promoting relaxation of the arteries, and triggering signaling pathways that reduce inflammation. (3,4) It is still unclear exactly how flavonoids from cacao beans work in the body and if flavonoids work together or individually to exert an impact. Researchers continue to work on finding answers to these questions and many others I can’t imagine.

According to a 2012 paper, consuming 50 grams of powdered cocoa daily may have a modest effect on lowering high blood pressure.(2) However, cocoa has only been shown to lower high blood pressure 1-3 mmHg and appears to be less effective in people over 45 years. Evidence doesn’t support adding cocoa or chocolate to an existing blood pressure therapy because the potential effect is minimal and it introduces your body to additional sugar, saturated fat and calories. (2,4)

News coverage about the paper “Habitual chocolate consumption”

On June 19, 2015, about two days after the paper was electronically published, National Public Radio aired a story on Morning Edition. The title of the story overstated the results made by the researchers. The news story itself was more balanced than the title. 

CBS news and Science Daily also issued reports about the research. The contents of their reports were remarkably similar and I assume – but don’t know for sure – that they were written off of the same press-release.

• CBS News: Heart health benefits of chocolate

• BMJ. (2015, June 15): Chocolate for your heart: Eating 100 g of chocolate daily linked to lowered heart disease and stroke risk. ScienceDaily. Retrieved July 6, 2015 from www.sciencedaily.com/releases/2015/06/150615191518

All three of these news pieces included strengths and weaknesses of the research. They also indicated that the research did not prove cause and effect, that people should not change their diet as a result of the research and that other factors may have influenced the results (such as memory recall about foods that were previously consumed, body composition, etc.). By reading the news articles, I learned that people who consumed the most chocolate were regularly eating up to 100 grams of chocolate a day. That is equivalent to about 2.5 chocolate bars each day. That is a lot of chocolate, sugar, calories and fat! 

A unique finding of this study, according to the news articles, is that participants ate a lot of milk chocolate (rather than dark chocolate). Milk chocolate contains lower levels of flavonoids compared to dark chocolate. Research has focused on flavonoids, but other factors in milk chocolate may have contributed to the association researchers found – perhaps milk proteins may have played a role. We just don’t know.

The news reports all emphasize that a take home message from the “Habitual chocolate consumption...” paper is that people concerned about heart health may not need to avoid chocolate. 

My take home message is that science worthy ≠ news worthy.

What did the research study reveal?

The researchers asked whether a relationship existed between regular chocolate intake and the risk of developing cardiovascular problems like heart attack and stroke later in life.(3) To answer their question, the research group examined data obtained as part of the the European Prospective Investigation into Cancer (EPIC)-Norfolk study. They were able to assess information from more than 20,900 adults. They learned about the foods people ate using a survey tool called food frequency questionnaire (FFQ).

• FFQs are a good way to assess the types of foods people eat because foods are organized into categories. 
• FFQs also assess the frequency and quantity of different food categories a person eats over the course of a given period of time, like six months or a year. As you can imagine, memory recall can be a problem. 
• It can be hard to understand how to fit foods into categories. FFQs are useful and important tools for nutrition research, but they aren’t perfect – nothing is.

After collecting baseline information, researchers followed up with the participants to find out about what types of cardiovascular disease events may have developed over the years. They analyzed data and assessed whether an association existed between regular chocolate consumption and cardiovascular disease events. Their results revealed that

• people who ate the most chocolate were less likely to have coronary heart disease than people who ate the least amount of chocolate; and
• people who ate the most chocolate were less likely to have a stroke compared to people who the least amount of chocolate.

Final thoughts

This study contributes to the growing body of research about the potential benefits of chocolate and cocoa, but the researchers did not reveal breakthrough information that will impact lives today. Physicians are not going to make recommendations for patients based on this study. This paper is valuable for flavonoid, chocolate and cocoa researchers. Most research does not lead to brilliant, breakthrough and life changing information. It contributes to a body of knowledge that leads to bigger moments in science and better health care decisions.

More research is needed to understand what the results of this research study mean and how cocoa and chocolate may work in the body to impact heart health.

Chocolate contains flavonoids, sugar, fat, and calories. If you like chocolate and there is no medical reason you must avoid it, enjoy it as part of a balanced, varied diet. Remember to make room for it in your eating plan and that evidence doesn’t support consuming chocolate to prevent or treat disease. 

If there is any magic, it is in moderation.

References

1. Kwok CS, Boekholdt SM, Lentjes MA et al. (2015) Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women. Heart.

2. Fogleman CD (2013) Effect of cocoa on blood pressure. Am Fam Physician 87, 484.

3. Linus Pauling Institute: Phytochemicals - Flavonoids. website. http://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/flavonoids. Accessed July 6, 2015.

4. Mayo Clinic: Supplements - Chocolate. website. http://www.mayoclinic.org/drugs-supplements/chocolate/background/hrb-20058898. Accessed July 6, 2015.

#chocolate4health

#chocolate

Melatonin and Food

As a nation, we’re tired. About 35% of American adults get less than 7 hours of sleep each day, according to results from the Behavior Risk Factor Surveillance System survey reported by the Center for Disease Control in a Morbidity and Mortality Weekly Report. Our national lack of sleep may be related to our plugged-in way of life, irregular work schedules, and conditions like obstructive sleep apnea and insomnia. Inadequate sleep is associated with increased risk of car accidents, problems at work, and chronic health issues like obesity, type 2 diabetes, heart disease and depression.(CDC-Sleep)

As a nation, we like quick fixes and food. It is not surprising that a June 22, 2015 search of  “melatonin and food” yielded 795,000 hits. Here are but a few examples of what I found:

• RD.com: Foods that help you sleep
• Onegreenplanet.org: Foods that help produce melatonin - oats, bananas and more
• Foxnews.com: Foods to help sleep
• Nutritionfacts.org: Foods with natural melatonin
• Naturalsociety.com: 8 foods naturally increase melatonin sleep

Can you eat your way to better sleep? Is there melatonin lurking in your food? Is the key to a good night of sleep just a matter of eating certain foods before bed? 

Overview of melatonin

Melatonin is a hormone produced by the pineal gland. When light hits the eyes signals are sent from the retina to the hypothalamus in the brain. 

"Circadian rhythm labeled" by National Institute of General Medical Sciences - Circadian Rhythms Fact Sheet. Licensed under Public Domain via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Circadian_rhythm_labeled.jpg#/media/File:Circadian_rhythm_labeled.jpg

In the hypothalamus, there is a region called the suprachiasmatic nucleus (SCN). The SCN acts as our biological clock. 

• The SCN responds to signals from the retina by transmitting messages throughout the body, including the pineal gland. 
• The SCN tells the pineal gland to stop producing and sending out melatonin in response to environmental cues such as light. Cues like light tell the brain it is time to be awake.

The body's production of melatonin is impacted by the environment. Melatonin production can be inhibited by natural sources of light like the sun as well as artificial sources of light like indoor lighting, televisions, computer monitors, and phone screens. 

• As daytime fades and the body's exposure to light diminishes, the SCN proportionately reduces how much inhibitory signals it sends to the pineal gland. This allows the pineal gland to start producing and releasing melatonin. 
• As melatonin levels gradually rise in the blood, the body begins to prepare for sleep. You start to feel drowsy. 
• This is when the body is ready to prepare for sleep but we often don't (can't) listen to those signals.
• Melatonin levels remain high through the night and start to fall away in the early morning. 

The body works very hard to maintain its 24-hour body clock – its circadian rhythm – and the pineal gland and melatonin are one part of a greater system. For more information about the pineal gland, melatonin, and SCN, check out the Howard Hughes Medical Institute.org: Biointeractive - Human SCN . Here is information about circadian rhythms and non-24 hour clocks in people who are totally blind National Sleep Foundation: Non-24, facts and prevalence.

Are there foods I can eat to increase my melatonin levels?

Many foods contain melatonin. The amount of melatonin in foods is small and varies from crop to crop and animal to animal (Peuhkuri K. et al.) According to a web-post by Garcia Ray at the Cleveland Clinic Wellness, cherries, corn, red grapes and bananas are examples of foods with melatonin. The melatonin produced by the pineal gland drives the melatonin levels in the blood. The melatonin the body makes has the greatest influence on your melatonin status. It remains unclear what (if any) impact melatonin from food has on the human body.

When I searched foods and melatonin, I found articles that emphasized bananas, oats, oranges, tomatoes, almonds, walnuts, fish, milk, and cherries. For most people, these are good foods to include as part of healthy lifestyle. At this time, there isn’t research to support eating these foods for their melatonin content or melatonin boosting potential. 

Some writers suggested eating or drinking these foods as dessert or before bed. That is an individual decision based on your dietary preferences and health. Regardless of whatever and whenever you eat, remember that what you eat and drink contributes to your overall daily nutrient and calorie intake. It doesn’t matter if it is part of a bedtime snack, dessert, dinner, etcetera. It can be easy to forget to make room in your eating plan for something new. Tart cherries get more attention in research and public media than some other foods regarding their melatonin content. One cup of tart cherry juice may contain just as many calories as a can of regular soda (around 100 to 120 calories). If you changed nothing else in your life but added one cup of tart cherry juice every day, then that could easily lead to 5 to 12 pounds of gradual weight gain over one year.  

Final thoughts

Going to bed and waking up at consistent times, controlling the light sources in your environment, getting regular exercise, and engaging in meditation and relaxation are techniques that promote better sleep. Currently, there isn't evidence to support eating certain foods to increase human melatonin levels. 

Please discuss any concerns you have about the quantity or quality of your sleep with your primary healthcare provider. 

An example of sleep from an expert.

Citations

• Sleepfoundantion.org: Sleep topics/melatonin and sleep (accessed June 22, 2015)
• CDC.gov: Features - Sleep (Accessed June 22, 2015)  
• CDC: Morbidity and Mortality Weekly Report (Accessed June 22, 2015)
• HHMI.org: Biointeractive - Human SCN (Accessed June 22, 2015)
• Peuhkuri K. et al. (2012) Dietary Factors and Fluctuating Levels of Melatonin. Food & Nutrition Research 
• Garcia Ray at the Cleveland Clinic Wellness: Melatonin for insomnia - reviews (Accessed June 22, 2015)

#melatonin

Omega-3 Supplements

One of my hobbies involves roaming supplement aisles. I like to see what’s for sale.  Whenever I look at the omega-3 supplements I see something new.

By Wuhazet (Henryk Żychowski) (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

There are supplements made from fish, krill, algae, flax, and hemp just to name a few sources. It can be overwhelming to stand in the aisle deciding what to do. I recently read a lot of literature about omega-3 supplements and this week I’ll summarize what I learned about omega-3 fats and supplements made from fish, krill, flax, algae, and hemp. 

What are essential fatty acids?

• Omega-3 fatty acids and omega-6 fatty acids are polyunsaturated fats (PUFAs) that we need to eat because the human body cannot make them.

• Sources of omega-3 and omega-6 fatty acids:
• Omega-3 fats (examples): fatty and cold water fish (salmon, tuna, halibut), seaweed, walnuts, walnut oil, flaxseed, flaxseed oil, canola oil, and soybean oil. We tend not to get enough omega-3 fats in the diet.
• Omega-6 fats (examples): 1 tablespoon of safflower oil, sunflower oil, soybean oil, or corn oil. A typical American diet contains 10 times more omega-6 (linoleic acid) than omega-3 fatty acids.(1) We easily get enough omega-6 fatty acids.

• There are 2 kinds of omega-3 fats – EPA and DHA. We need EPA and DHA so that our bodies can make other fatty acids that are important for the body to properly function. Alpha-linolenic acid (ALA) is an omega-3 fatty acid. Flaxseed and walnuts contain a lot of ALA. The body can convert only a  very small amount of ALA to EPA and DHA. ALA is a healthy fatty acid, but we don’t seem to be able to use it to make EPA and DHA, which our bodies use to make other fatty acids.

Are omega-3 fatty acids good for the heart?

• Most research shows that diets that contain lots of omega-3 fatty acids are associated with a reduced risk of heart disease, lower blood pressure, lower heart disease, less death with heart disease, and less incidence of stroke.(2, 3) But when a group of researchers systematically analyzed published research results from other studies and considered the evidence all together, they found no protective association between greater omega-3 intake and lower risk of heart disease in people with preexisting conditions.(5)

Are omega-3 supplements healthy?

• Bioavailability refers to how much of a substance (omega-3 fatty acids) the body is able to use. Not everything that you ingest is bioavailable. For example, you may have heard that iron is difficult to absorb – it has low bioavailability.

• As different sources of omega-3 supplements are introduced we have to find out if they are bioavailable, particularly in reference to the standard of fish (usually salmon). Algae oil and krill oil appear to be highly bioavailable. They are readily absorbed and used by the body. (4, 5). However, emerging research shows that different sources of omega-3 fatty acids work in different ways. While algae oil, krill oil and fish oil are all bioavailable they do different things in the body. So switching one source for another may not be entirely comparable. But, it isn’t at all clear if or how much that matters.

• While most evidence supports that a diet rich with omega-3 foods is associated with reduced risk of heart disease, it isn’t at all clear  if omega-3 supplements have the same effect.(2, 3, 6, 7) Omega-3 supplements do not appear to have a consistent impact on inflammatory markers that are associated with heart disease. (8)

• Sometimes physicians recommend that people with very high triglycerides take omega-3 supplements. According to the American Heart Association, consuming medically supervised doses of omega-3 supplements lowers triglycerides for patients.(9) Research shows that taking pharmacological doses of omega-3 fatty acids helps lower triglycerides for patients with clinically elevated levels. The amount needed to lower high triglycerides is not realistically attainable through diet and so it is necessary to take a supplement. Therefore, this is considered a pharmacological dose and must be medically supervised. Omega-3 supplements interfere with certain medications so it is important to discuss supplement use with your doctor.

• Evidence indicates that flaxseed oil supplements are bioavailable and may be associated with improved blood pressure and blood lipid profiles. (1, 8, 10) Flaxseed oil contains ALA.

• Hempseed oil is a source of ALA. It has not been well studied yet. Emerging evidence suggests that ALA from hempseed oil is bioavailable. (11) This is an understudied area of research.

• DHA and the adult brain. DHA is present in nerve cells, the central nervous system, in the brain and in the eyes. Infant formula is supplemented with DHA because it is needed for brain development. Because of the role of DHA in the brain and central nervous system, there is interest in finding out if omega-3 fatty acids play a role in dementia, including Alzheimer’s disease. I expect we will learn more about omega-3 fatty acids and dementia in years to come. Some emerging research suggests that there is an association between altered omega-3 levels and dementia, although it is unclear what, how, or why. In 2012, a meta-analysis of data showed that omega-3 (EPA) levels were lower in predementia patients and that all levels of omega-3 (EPA, DHA, and total omega-3) in patients with dementia. (12) An epidemiological study noted an association between higher levels of omega-3 DHA and a lower risk of developing dementia (13). However, giving people DHA supplements has not been shown to reduce or delay the onset of dementia. (14) More research is needed to understand if and how omega-3 fatty acids impact the adult brain.

So many kinds of omega-3 supplements

Sources of EPA and DHA

• EPA and DHA are the omega-3 fatty acids that the body uses to make other fats.

• Fish and krill oil contain EPA and DHA and algae oil contains a lot of DHA.

• Sometimes on the supplement label it will say that a supplement contains a specific amount of EPA, DHA or EPA+DHA.

• Algal (algae) oil has become more popular recently because it is a vegetarian option and it is considered more sustainable than fish or krill because it is a plant and can be grown.  

• Fish oil supplements are usually made from a variety of different types of fish like anchovies and salmon.(1) Krill are crustaceans that look like tiny shrimp.  Krill oil has become a popular alternative to fish oil because krill is a less popular dietary fish and so it is more available to be used for a supplement.

• When I was doing research, I learned that algae are the only producers of omega-3 fats. I always knew that we get most of our omega-3 fats from eating fish, seafood, or seaweed but I didn’t realize that fish and seafood didn’t make omega-3 fats either! They get it from algae. It really isn’t surprising that interest in algae as a human source of omega-3 fatty acids has increased.(15) It is considered a renewable and more sustainable source of EPA and DHA.

Sources of alpha-linolenic acid (ALA)

• ALA is the omega-3 fatty acid present in vegetables, seeds and nuts. You can easily find flaxseed, flaxseed oil, and supplements made of oil from flax. These provide ALA. Dietary sources from liquid oil like you find in the refrigerator section, ground flax, or flaxseed are dietary options and alternatives to supplemental sources.

• Hempseed oil is not as readily available in stores. It is available online and in specialty shops.

Final Thoughts

Omega-3 fatty acids are healthy, polyunsaturated fats that the body needs. Research supports the use of the medically supervised use of omega-3 fatty acids for people with very high triglycerides. Whether eating more omega-3 fats is solely responsible for improving other aspects of heart health remains unclear. It is possible, and likely, that other dietary and lifestyle factors also contribute to the positive associations many researchers detect. 

The Dietary Guidelines for Americans recommend eating fish at least 2 times per week with an emphasis on fatty / cold water fish because they are a good source of omega-3 fatty acids that provide EPA and DHA. Krill and algae (like seaweed) also provide omega-3 fatty acids that contain EPA and DHA. Flaxseed, walnuts, soybean oil, and hempseed oil, etc. mostly contain a omega-3 fat called alpha-linolenic acid. The body doesn't make very much EPA and DHA from ALA, but research indicates that ALA may exert its own health benefits. 

By eating a variety of foods in moderation you get fats (like EPA, DHA, and ALA), carbohydrates, proteins, vitamins, minerals, fiber, and phytonutrients (plant chemicals) that your body needs to survive and thrive. It is not truly possible to mimic this through supplements, pills, shakes, and other non-food combinations. 

It is important to discuss supplement use with your healthcare practitioner and pharmacist. Supplements may interact with medications. The supplement industry is not regulated like the pharmaceutical industry (despite how you may feel about drug companies, they undergo more regulation and scrutiny than the supplement industry). What's in that supplement - part 2

References

1. Vannice G, Rasmussen H. Position of the Academy of Nutrition and Dietetics: Dietary Fatty Acids for Healthy Adults. Journal of the Academy of Nutrition and Dietetics.114(1):136-53.

2. Kris-Etherton PM, Harris WS, Appel LJ. Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease. Circulation. 2002;106(21):2747-57.

3. Omega-3 Fatty Acids and Health. Fact Sheet for Health Professionals. National Institute of Health, Office of Dietary Supplements.;  http://ods.od.nih.gov/factsheets/Omega3FattyAcidsandHealth-HealthProfessional/#disc.

4. Arterburn LM, Oken HA, Bailey Hall E, et al. Algal-Oil Capsules and Cooked Salmon: Nutritionally Equivalent Sources of Docosahexaenoic Acid. J Am Diet Assoc. 2008;108(7):1204-9.

5. Wu WH, Lu SC, Wang TF, et al. Effects of Docosahexaenoic Acid Supplementation on Blood Lipids, Estrogen Metabolism, and in Vivo Oxidative Stress in Postmenopausal Vegetarian Women. Eur J Clin Nutr. 2006;60(3):386-92.

6. Flock MR, Harris WS, Kris-Etherton PM. Long-Chain Omega-3 Fatty Acids: Time to Establish a Dietary Reference Intake. Nutr Rev. 2013;71(10):692-707.

7. Rizos EC, Ntzani EE, Bika E, et al. Association between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: A Systematic Review and Meta-Analysis. JAMA. 2012;308(10):1024-33.

8. Barcelo-Coblijn G, Murphy EJ, Othman R, et al. Flaxseed Oil and Fish-Oil Capsule Consumption Alters Human Red Blood Cell N-3 Fatty Acid Composition: A Multiple-Dosing Trial Comparing 2 Sources of N-3 Fatty Acid. Am J Clin Nutr. 2008;88(3):801-9.

9. Fish 101 American Heart Association Accessed February 20, 2015 2015; https://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Fish-101_UCM_305986_Article.jsp.

10. Tur JA, Bibiloni MM, Sureda A, et al. Dietary Sources of Omega 3 Fatty Acids: Public Health Risks and Benefits. Br J Nutr. 2012;107 Suppl 2:S23-52.

11. Schwab US, Callaway JC, Erkkila AT, et al. Effects of Hempseed and Flaxseed Oils on the Profile of Serum Lipids, Serum Total and Lipoprotein Lipid Concentrations and Haemostatic Factors. Eur J Nutr. 2006;45(8):470-7.

12. Lin PY, Chiu CC, Huang SY, et al. A Meta-Analytic Review of Polyunsaturated Fatty Acid Compositions in Dementia. J Clin Psychiatry. 2012;73(9):1245-54.

13. Schaefer EJ, Bongard V, Beiser AS, et al. Plasma Phosphatidylcholine Docosahexaenoic Acid Content and Risk of Dementia and Alzheimer Disease: The Framingham Heart Study. Arch Neurol. 2006;63(11):1545-50.

14.  Fares H, Lavie CJ, DiNicolantonio JJ, et al. Omega-3 Fatty Acids: A Growing Ocean of Choices. Curr Atheroscler Rep. 2014;16(2):389.

15. Deckelbaum RJ, Torrejon C. The Omega-3 Fatty Acid Nutritional Landscape: Health Benefits and Sources. J Nutr. 2012;142(3):587S-91S.

#omega3supplements

Alzheimer's Disease and the MIND Diet

Are you worried about Alzheimer's disease? Did you recently hear about the MIND diet? News outlets and magazines grabbed onto the press release from Rush University Medical Center and circulated it. The press-release has been circulating since March 16, 2015.

I can’t share with you the details of the research because I don’t have access to it yet. The research article that explains the research and the results is not available in print yet. I’ve been waiting for a month now to find out if the article will be embargoed or if it will be available to non-journal subscribers once it actually is available in print. As of May 11, 2015 the article remains listed as “in-press” and unavailable to non-journal subscribers. Draft versions of the article have been available to journal subscribers since February or March and now the rest of us finally can purchase 24-hour limited access to the corrected-proof of the article but I’m not willing to do that. In all fairness, corrected-proofs are basically the final version of the article, but I’m opposed to the practice of selling drafts or proofs of journal articles. Only final versions of articles should be available online and in print.

The reality is that the “MIND diet associated with reduced incidence of Alzheimer’s disease” paper has been circulating for a couple of months now and it is time for to write about it. At least as much as I can.

What’s the MIND diet?

MIND stands for Mediterranean-DASH Intervention of Neurodegenerative Delay. It was developed by Martha Clare Morris, ScD, a nutritional epidemiologist, and her research team based at Rush University Medical Center.

"Berries (USDA ARS)" by Scott Bauer, USDA ARS - This image was released by the Agricultural Research Service, the research agency of the United States Department of Agriculture, with the ID K7229-19 http://commons.wikimedia.org/wiki/File:Berries_(USDA_ARS).jpg#/media/File:Berries_(USDA_ARS).jpg

The researched-based eating plan combines parts of the Mediterranean way of eating (Nutrition Tuesday: Mediterranean Diet), the DASH diet (Nutrition Tuesday: Glycemic Index, DASH Diet and Heart Health) and research that suggests certain fruits (berries like blueberries and strawberries) may have properties that help to protect the brain. The researchers spent years working to understand what dietary components may work together to protect the brain from degeneration. They came up with the MIND diet. 

Based on a description of the diet I found at Rush University’s website (Rush University Medical Center News - Diet May Help Prevent Alzheimer's) the MIND diet emphasizes 15 foods – 10 types of foods to eat and 5 types of foods to limit for the promotion of brain health.

Foods included in the MIND Diet	Foods to limit in the MIND diet
Green leafy vegetables	Butter and margarine
Vegetables	Cheese
Nuts	Sweets, pastries
Berries	Fried food, fast food
Whole grains
Fish
Poultry
Olive oil

Rush University Medical Center News - Diet May Help Prevent Alzheimer's

Does the MIND diet prevent Alzheimer’s disease?

Dr. Morris and colleagues published the results of an observational study. Participants in their study came from people already participating in a bigger study called the Rush Memory and Aging Project (MAP). Dr. Morris' group evaluated the types of foods consumed by 923 people ages 58—98 and the development of Alzheimer’s disease over an average of 4.5 years. Researchers assessed what people ate through a type of survey called a food frequency questionnaire. This allowed them to ask questions about how frequently people consumed different groups or types of foods like berries, nuts, green leafy vegetables, fried foods, cheese, etc. They also assessed how many people developed Alzheimer’s disease during the observational period. According to an article about the study that appeared in a trade magazine, Today's Dietitian,  114 people developed Alzheimer's disease during the course of the study. 

This was an observational study. This was not an intervention study. This means that the researchers did not change anything about people’s diets or lifestyle. They just watched. Observational studies NEVER determine cause and effect. Observational studies look at how different factors relate to one another. In this case, how adherence to the MIND diet, Mediterranean diet, and DASH diet related to the development of Alzheimer’s disease.

Here is what they found according to the scientific abstract and press releases.

1. Strictly following the MIND diet, Mediterranean diet, or the DASH diet was associated with a lower incidence of Alzheimer’s disease. All 3 of those diets were associated with lower numbers of people developing Alzheimer’s if they strictly followed the eating plan.
2. Moderately following the MIND diet was associated with a lower incidence of Alzheimer’s disease. This was the result that the researchers got most excited about because it was unique and potentially most palatable to people. It suggests that even when people only sometimes followed the guidelines they found a possible health benefit.  

Again, this study doesn't show cause and effect. The researchers observed a phenomenon and are working on other studies to try to understand these results. Their current and future work includes younger participants and research about the way the diet impacts blood flow to the brain. More research is needed to understand if the diet really does protect people from developing Alzheimer's and if so how it works.

Should I change my diet?

In the United States, the USDA’s MyPlate, the DASH diet, and the Mediterranean diet are recognized as healthy and balanced dietary approaches. Based on the limited information published online about the MIND diet, it appears to be a hybrid of the Mediterranean and DASH diets but further specifies eating berries and drinking 1 glass of wine per day. In the U.S., if you are of legal age to drink and if you drink alcohol, it is recommended that you do so in moderation. If you don't drink alcohol, it isn't recommended that you start. Moderation means no more than 1 serving of alcohol per day for women and 2 per day for men. At this time, there is not enough evidence to advocate adopting the MIND diet over other diets.

Final thoughts

Alzheimer’s disease is brutal. My mom has it, my uncle had it, and my aunt has it. I’m always looking for ways to avoid this horrific familial curse but I also suspect it is unlikely we'll find a single one-size fits all magic cure in my lifetime. 

The role of nutrition in brain health is exciting, new, and largely unexplored. I look forward to reading this research paper one day. I also look forward to following this line of research throughout, well, the rest of my life. We don’t know much about the impact of nutrients on the adult brain in terms of cognitive decline. I’m particularly interested about the cumulative impact of nutrition and exercise on the aging brain. 

Discuss your concerns about Alzheimer’s disease with your primary healthcare provider whether it is for yourself or on the behalf of a loved one. If you are interested in the MIND diet, talk to a dietitian or your primary healthcare provider and together decide if it is right for you. As I said, this is a new area of research.

References

• NCBI (PubMed): MIND diet associated with reduced incidence of Alzheimer's disease
•  Wall Street Journal (online), April 20, 2015: A Diet Might Cut the Risk of Developing Alzheimer’s.
• Today's Dietitian: MIND Diet May Significantly Protect Against Alzheimer's Disease
• Rush University Medical Center (press release, March 16, 2015): MIND diet may significantly protect against Alzheimer's disease
• Rush University Medical Center (news): Diet may help prevent Alzheimer's

#alzhiemer'ssucks

If ever, oh ever a wiz there was, the Wizard of Oz is one because...

As I've said before and will no doubt say again, we are bombarded with information about food, diet, nutrition, health and fitness. It can be hard to discern fact from fiction and we turn to people with appropriate credentials for help. But people like Dr. Oz undermine the entire healthcare and research profession.  His careless and reckless promotion of products and unproven health gimmicks on his TV show is dangerous. As a cardiologist, I assume he subscribes to basic standards of care that include practicing evidence-based medicine. As a physician, he is a medical scientist. As a physician he has ethical obligations.

Because he is a physician, viewers assume Dr. Oz provides accurate and reasonable information about products and treatments that will help. And sometimes he does. Unfortunately, he also provides lots of information about quack products, remedies and treatments on his television show. 

The Dr. Oz Show exists solely because Mehmet Oz, MD is an articulate, charismatic physician. He is a cardiologist at Columbia University. It is reasonable for Dr. Oz’s viewers to expect that he would apply an evidence-based, scientific and ethical approach to his TV show as, I assume, he does in his clinical practice. Unfortunately, this is not the case.  

Our entire healthcare system is built on a foundation that people trust doctors and he continues to abuse this trust. Even after being called out on this by Congress and by medical professionals, Mehmet Oz refuses to take any responsibility or accountability for his actions. Dr. Oz, you are not a TV host like Meredith Vieira, Regis or Oprah. You cannot market yourself as a physician and then act irresponsibly. That is not the way it works and you know that.

I usually sublimate my loathing of Dr. Oz because I know people watch his show and enjoy it, whether for entertainment or for information. I know some people find his information and explanations of biologically related health concepts helpful and useful. That is good. So, I often hold my tongue and refrain from writing about him. I can’t hold back anymore because of the egregiousness of his disrespect of science, medicine and public health. I am not alone.

An example of advertising from around the 1890s. It's a product called Hamlin’s Wizard Oil. They said it was “the greatest family remedy for rheumatism, neuralgia, toothache, headache, diphtheria, sore throat, lame back, sprains, bruises, corns, cramps, colic, diarrhea, and all pain and inflammation! Sold by all druggists.” Sound familiar? (Dr. Oz has not promoted this product, to my knowledge! Of course, I don't think it exists anymore).

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By U.S. Library of Congress, from a print by Hughes Lithographers, Chicago. [Public domain], via Wikimedia Commons

Dr. Oz and Columbia University

As you have probably heard by now, a group of physicians wrote a letter to Columbia University asking that Dr. Oz be removed from their medical faculty (Dr. Oz's profile at Columbia University). He is not just on faculty there, he is the vice chair of the surgery department.

According to an excerpt from the letter, the physicians wrote that “...Dr. Oz is guilty of either outrageous conflicts of interest or flawed judgements about what constitutes appropriate medical treatments, or both. Whatever the nature of his pathology, members of the public are being misled and endangered, which makes Dr. Oz’s presence on the faculty of a prestigious medical institution unacceptable.” I completely agree. So do more than 1000 physicians, at least according to a social networking survey the results of which were reported by Tanya Lewis with LiveScience.com on April 24, 2015 and picked up by Yahoo! News on April 25, 2015.

• UT San Diego, April 23, 2015: Dr. Oz goes to war with his critics
• NPR, April 17, 2015: Physicians urge Columbia to fire Dr. Oz for promoting quack treatments
• ABC News Go, April 16, 2015: Physicians want Dr. Oz gone from Columbia Medical
• US News, April 16, 2015: Dr. Oz needs to go, other docs say

Columbia University disagrees. A university spokesperson told a reporter from the Associated Press that the university is “committed to the principle of academic freedom.” As am I, Columbia University. I strongly believe in academic freedom. However, do you really expect me to believe that The Dr. Oz Show is an example of academic freedom? From what I've learned, Dr. Oz is an administrator at Columbia, so I’m not sure if academic freedom is really the same issue for him as it would be for a regular faculty member. Also, what academic freedom of his needs protecting? At best, he overstates the benefits of unfounded quack treatments and products and profits from it. The public needs protecting from him. I’m disappointed that Columbia University views this as academic freedom and wants to be affiliated with this.

Associated Press, April 23, 2015: Dr. Oz mounts spirited defense against critical letter

Follow the yellow brick road... all the way to a Senate hearing in Washington

Do you remember back in the summer of 2014 when the Senate Subcommittee on Consumer Protection called Dr. Oz to a hearing? They called him out about his promotion of quack weight-loss products. Being asked by a U.S. Senate subcommittee to explain himself did nothing to encourage Mehmet Oz, MD to reform his sketchy ways. Oh that sexist, egotistical, lying hypocritical bigot- oops! Sorry, that is a description of Franklin M. Hart, Jr from 9 to 5 (IMDB - 9 to 5) and not Dr. Oz. As far as I can tell, Oz is a bit of a liar with an enormous ego – a cardiologist hell-bent on riding the laxative-laden slippery slope all the way down from respected surgeon to snake oil salesman.

Here are some articles about when Dr. Oz went to Washington, DC:

• Washington Post: How a fake doctor made millions from ‘the Dr. Oz Effect’ and a bogus weight-loss supplement
• CNN, June 19, 2014: Congressional hearing investigates Dr. Oz 'miracle' weight loss claims
• LA Times, June 18, 2014: Dr. Oz doubles down on bogus weight loss products at Senate hearing

Dr. Oz says it’s not his fault

Dr. Oz’s reach is immense and he is probably the most influential physician in the U.S. When his name is associated with a product more people buy it. When his name is associated with a treatment, more people try it. It’s not surprising that manufacturers want a piece of Dr. Oz – they want on his show, they want his name on their goods. According to Dr. Oz’s team, a lot of products carry his endorsement without actually having it. At least that is what it says on his website.

In May 2013, the Dr. Oz Show launched their “It’s Not Me” campaign to try and dissociate Dr. Oz from companies that attached his name to products and treatments but did not get his permission (and, I speculate, pay for the rights to use his name). The details of the Dr. Oz Show’s position about this issue and problem can be found at The Dr. Oz Show, May 6, 2013: "The Dr. Oz Show" Launches "IT'S NOT ME" Campaign to Inform and Warn Viewers About Rogue Marketers Engaging in Copyright Infringement And Illegal Use of The Dr. Oz Name

To me, the problem of name rights and usage was foreseeable. Talk shows are venues to sell things – products, remedies, movie tickets, books, etc. A talk show about health, disease, dieting, fitness, and wellness has a finite number of legitimate topics. At some point, topics and issues are invented. Viewers are reeled in with promises of magic cures. As Dr. Oz knows, there is no magic and there are no shortcuts when it comes to heath.

Final thoughts

I’ll leave you this week with a link to Dr. Oz’s response to the physician letter calling for Columbia University to remove him from the faculty. This is the response posted by The Dr. Oz Show on their website. It is biased and it does not address the issues in the letter. The context of the physicians’ letter is not addressed. He responds with deflection and distraction. He discusses other non-relevant issues. These may be issues worth discussing in other contexts but not as his response to allegations of his promotion of quack-treatments and bogus science. He does NOT address the issues discussed by the physicians. This is propaganda. I find this sad and scary – scary because so many millions of people will view this and take it at face value. 

Dr. Oz fights back - his exclusive reaction to his critics

The other link I wanted to post but cannot find yet is for a segment on the April 26, 2015 episode of Last Week Tonight. 

Link to John Oliver's clip about Dr. OZ

The Daily Beast, April 26, 2015: John Oliver Obliterates Dr. Oz: The Worst Person Ever on TV in Scrubs, Including Katherine Heigl

Water

I love water. I like it at room temperature, piping hot and ice cold. I need it to make coffee. I am one of “those” people who always carries a reusable, washable water bottle with me as if I’m moments away from succumbing to dehydration. I guess I am afraid of running out of water, although that has never happened. At least not yet.

I used to buy bottled water almost every day. I didn’t care what brand it was. I liked the smoothness and tastelessness of bottled water. I felt empowered when I drank it because I purchased bottled water over sugary soda. I didn’t like diet soda at the time so drinking bottled water was a big deal for me. Drinking water is better than soda in terms of calories but is it better than tap water? Was it worth my money?

No, it wasn’t.

In the United States we have clean drinking water. We bottled-water drinkers bought ocean front property in Olathe, Kansas. According to Sizer & Whitney’s textbook, Nutrition Concepts & Controversies, 13th edition (2014), about 7% of U.S. households use bottled water and at a notable price. It costs between 250 to 100,000 times more to use bottled water than tap water. In 2014, total sales of bottled water reached $13 billion.

Ian James, Desert Sun, March 8, 2015: Bottling Water Without Scrutiny

How is bottled water different from tap?

Our drinking water comes either from surface sources (from rivers, springs, and snowmelt) or from the ground (from beneath the earth’s surface). What makes bottled water different is that it might come from out-of-state and the water might have been disinfected with ozone instead of chlorine. Ozone makes some bottled water taste distinctly different than tap water. Basically, that’s it. You get to pay for processing, shipping and, of course, corporate profits. If you like flavored or carbonated water, you can pay for that too.

California, the drought, and bottled water

I was born and raised in the Kansas City, Missouri area. It rains there all year round and it snows in the winter. When there is less precipitation, people let their grass “go dormant,” as my mother used to say.  If there is a shortage of rain, why waste it on the grass when there are more important uses for water? Maybe it is a carryover from the days when the Heartland was the breadbasket of the country. Maybe it is the result of living through tornado seasons and being continuously reminded of the power and force of nature. Whatever, this is not the prevailing perspective of the collective conscious of California. I live in San Diego and I am proud to call this city and the state of California my home. But, prudence, in general, is not part of our state motto. For example, it took 4 years of an official drought before Governor Jerry Brown issued state-wide mandates calling for conservation. Here is a link to an article about the executive order issued by Gov. Brown on 4/1/2015

Ray Sanchez, CNN.com Apil 2, 2015 (update): Low California Snowpack Ushers Mandatory Water Restrictions.

Here is an image of a California riverbed taken in 2009, at least according to the caption. I cannot help but wonder why it took so long to issue state-wide mandates about water use and restrictions. 

By National Oceanic and Atmospheric Administration (National Oceanic and Atmospheric Administration) [Public domain], via Wikimedia Commons

We moved to California last summer. As we drove across the country we talked about water, the ongoing drought and ways to conserve. This is an issue we never stop talking about. I’m sure if our cats were people, they’d ask us to shut-up about it already. We do what we can to conserve and recycle water.

As part of my ongoing conservation efforts, I decided to purchase bottled water. I hiked downstairs to the local grocery store to survey my options. I studied the packaging to find out where the bottled water came from. Disgust, surprise, and disappointment best describe my response to discovering that the bottled water at my local store all comes from California. I’m talking about brands like Arrowhead, PureLife, Calistoga, Crystal Geyser, and generic brands. 

By Ivy Main (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

What the hell? Can I really conserve water by purchasing and using water from California? Feeling enraged and clinging to the hope that this was a store-specific issue, I optimistically went to check out other stores in downtown San Diego. Sadly, I found the same bottled water selection at every store. I know that bottled water isn’t better than tap water, but I thought it was at least better than no water at all. I wonder.

In the news

There are 108 licensed water bottling facilities in California, according to a March 8, 2015 article published on the Desert Sun. Nestlé has 5 of the large facilities that pump and bottle millions and millions of gallons of water each year under multiple labels including Arrowhead, DeerPark and PureLife. 

In California, Nestlé has plants in Sacramento, Livermore, Los Angeles, Ontario, and Cabazon. According to a Minpress.com article posted on March 20, 2015, Nestlé’s Sacramento location continues to pump 80 million gallons of water per year out of Sacramento aquifers during these years of drought.  

An environmentalist group called Crunch Nestle Alliance along with Native American groups and private citizens are actively working to try to stop the reckless pilfering of the California’s water supply. The group wrote a white paper (White Paper from Essence of Life Project - The Future of Water). 

Nestlé is not the only company bottling water in California considering there are 108 facilities, however, Nestlé may be the biggest offender and has gotten the most media attention. Other companies with a presence in California include, but are not limited to, PepsiCo (Aquafina), Coca-Cola (Dasani), and CG Roxanne (Crystal Geyser and Alpine Spring).

Preliminary data from the Beverage Marketing Corporation as reported by Ian James in the March 8, 2015 Desert Sun article "Bottling Water Without Scrutiny" indicates that in 2014 water purchases were up 6.1% in 2014. California sells water to companies at low rates and provides minimal industry oversight or regulation. It’s no mystery why companies keep putting water into bottles, even during a terrible drought.

Here are a few other news stories covering the drought and concerns about bottled water.

• Dan Bacher for IndyMedia at MintPressnews.com, March 20, 2015: Nestle Continues Stealing World's Water During Drought

• Leslie Shaffer, CNCBC.com, March 24, 2015: Nestle Chairman: Time to Turn Off the Water Taps                             

• Antony Currie, Blog Reuters, March 28, 2015: Nestle Called Out for Bottling, Selling Water During California Drought

Agriculture

The agricultural focus of California boggles my mind because most of the state gets little rain, relies on importing water and snow-pack melt to meet its state-wide water needs. Agriculture uses more water in California than any other industry and right now farmers are suffering. Farms in the San Joaquin Valley reportedly are no longer getting water from the state (Krik Siegler, NPR, April 7, 2015: California Farmers Gulp Most Of State's Water, But Say They've Cut Back).

California produces the majority of the U.S.’s produce including foods like broccoli, lettuce and tomatoes (Krik Siegler, NPR, April 7, 2015: California Farmers Gulp Most Of State's Water, But Say They've Cut Back). In fact, California’s Central Valley produces 90% of the grapes, broccoli, almonds, and walnuts (Renee Montagne Interview on NPR, April 9, 2015: Calif. Farmers Face Harsh Realities In Drought-Stricken Central Valley) we eat in the U.S. The Central Valley also produces rice, tomatoes, garlic, pistachios, blueberries and other produce. All of this requires water. Water we don't have right now.

Samuel Sandoval, PhD, Cooperative Extension Specialist in Water Management at the University of California, Davis was interviewed by NPR on April 9, 2015 (Renee Montagne Interview on NPR, April 9, 2015: Calif. Farmers Face Harsh Realities In Drought-Stricken Central Valley). Dr. Davis explained some realities of agricultural water use and the impact of this current drought. He said “...one walnut is about five gallons [of water], one pistachio about one gallon of water or one almond, one gallon. A pound of blueberries uses 48 gallons [of water].” According to Dr. Sandoval, some farmers near Fresno don’t have any water left at this point. In 2014, the economic cost of the drought including damaged and lost crops, livestock, dairy and job losses reached $2.2 billion.

The decimation of local, regional and sustainable farming practices in favor of centralized and commercialized agricultural practices have left the entire country vulnerable to the consequences of one state’s drought. 

Desalination

San Diego County imports most of its water from the Colorado River and Northern California. It's beautiful here but it doesn't rain much. The ocean is beautiful and immense but it isn't drinking water. It isn't water we can use to water crops. 

It took over 12 years to plan and approve the project, but it finally happened and San Diego County is getting its first desalination plant in Carlsbad (Carlsbad Desalination Project). Through a multi-step process, desalination takes water from the ocean, removes impurities and minerals, and leaves behind usable and safe water. For every 2 gallons of ocean water, the process yields 1 gallon of usable water. Because it comes from the ocean, it is considered a sustainable source of water. The Carlsbad desalination plant is expected to provide San Diego County with 50 million gallons of usable water per day, which equates to water for about 300,000 people. About 3.1 million people live in San Diego County. 

• Jeff Daniels, CNBC.com, April 6, 2015: Drought of '15: Desalination won’t save California

• NPR, April 5, 2015: Will Turning Seawater Into Drinking Water Help Drought-Hit California?

Final Thoughts

If you happen to be in California and you see wet sidewalks, green grass, or other nonessential uses of water, please ask questions. Golf courses should not be green unless they are made of turf or were painted. Restaurants shouldn't give you water unless you ask for it. Think before you use water. Every drop counts.

https://www.flickr.com/photos/nagaon/4453432565/

Audie Cornish, NPR, April, 2, 2015: California Water Experts Explore How To 'Live With' Long-Term Drought

Kurtis Alexander, SFGate.com, March 17, 2015: California drought: State OKs sweeping restrictions on water use