Exercise: Key Messages

1) What you eat can also impact on a host of significant diseases.  This is the same list as exercise, and more: allergies, asthma, skin problems, acne, macular degeneration, chronic fatigue, IBS, frequent illness, gout, kidney stones, gall bladder disease, appendicitis, muscle and joint soreness, and more.  Your diet also impacts most important biomarkers of disease.

2) There is no one diet that solves everyone’s problems.   We are are unique and special snowflakes. People have done well (and probably poorly) on virtually every published diet, from Atkins to Ornish to Mediterranean to vegan/vegetarian to  Zone diets.  You may need to follow a variety of dietary principles, or need to try different diets that your doctor might suggest to you.  Popular diets in the press that you may have read about can be assessed and supervised by your doctor.

3) For a wide variety of symptoms consider a dietary element.   If you have ongoing gastrointestinal complaints, such as Irritable Bowel Syndrome, or recurring migraines, joint aches, fatigue, iron deficiency, skin problems, even asthma, there may be a dietary link.  Some foods that are thought to be healthy for most, cannot be tolerated by others. Many populations cannot digest the lactose in dairy products, several components in wheat, or the raffinose or stacchyose in beans.  Don’t be afraid to do some experiments, and talk to your doctor about what might work.  Even consider a brief fast to test your theory out.  Unfortunately, there are not easy tests for most of these problems, as they are not a true “allergy” in most cases.

4) Whole foods are generally better choices than processed foods. The more a food has been processed, the more nutrient depleted the food is, and the more likely it has had various additives included that are unlikely to have been tested for long term safety.  Whole foods may cost more, but you get more as well, and especially in an integrated, natural form that your body is probably better conditioned to digest and absorb. The more the cells of the food have been preserved, the more “whole” and unprocessed it is.  Processed foods often increase the risk of overeating as well, as they are digested too quickly, and may cause hypoglycemia.  There is probably no such thing as a healthy baked good.

5) Avoid trans fats.  These are artificially created fats that do not occur in nature, and are strongly associated with pro-inflammatory effects on blood vessels and therefore increases risk of heart disease.  These occur in margarines and alot of refined food products.

6) Don’t avoid all fats.  Although low-fat diets have been promoted for decades, it is now known that several kinds of fats are health-promoting, if not vital to healthy function.  This includes especially omega-3 fatty acids, which are best found in cold water fishes, such as salmon, mackerel, sardines and herring.  Although mono- and polyunsaturated fats are considered healthful, some are unstable with cooking, and refined oils are, well, refined.  Humans have not eaten processed oils through most of human history.

7) Avoid any foods that contain refined starches or refined sugars, including high-fructose corn syrup.  Sugar consumption 100 years ago was only about 5-10 lbs per person per year in North America, but it has zoomed up to an estimated 150 lbs per person per year by 2010.  There is no precedent for this.  We are eating more white flours products that ever before, in part due to the low fat movement and the desire for cheap and convenient food.  This change associates strongly with increasing rates of obesity and diabetes, which have at their core impaired carbohydrate intolerance.  Sugars and refined starchy carbohydrates are known to be pro-inflammatory, and adversely affect both cholesterol and triglyceride levels, which in turn, increases heart disease risk.

8) Be aware that some foods contain anti-nutrients that interfere with absorption of some minerals.  Calcium, iron, magnesium and zinc are all vital minerals that share a common pathway of absorption, that can be precipitated by phytates (common in the hulls of nuts, seeds and grains); they are also chelated by several  flavonoids, which reduce absorption and and also inhibit digestive enzymes. One mineral supplement can interfere with absorption of another mineral in the diet. Trypsin inhibitors and lectins (found in legumes) also interfere with digestion.

9) Eat a variety of fresh fruits and vegetables every day.  In whole form, these foods are the closest to what our species have eaten for most of our existence, and are therefore most likely to contain the nutrients we need to survive.  Hundreds of studies done over the last several decades have repeatedly demonstrated the healthfulness of eating these foods, which are excellent sources of a multitude of micronutrients.  The exception is white potatoes, which have been associated with adverse health effects due to its high glycemic index.

10) Don’t drink your fruit.  Dietary refined sugars have been increasingly linked to chronic disease and inflammatory changes, and this includes fructose.  There is as much sugar in a can of pop as there is in a glass of juice, and liquid calories do not provide satiety, leading to overeating.  Whole fruit comes with many other nutrients and fiber, and is a natural source of water.

11) Healthful diets can include meat, shellfish and fish, especially if they are minimally processed.    Grass-fed and wild meats are generally better than grain-fed.  Wild fish is usually better than farmed, although there are some exceptions.

12) Nuts and seeds in moderation are generally healthful if unprocessed.   These are high in protein, vitamins and fiber when unprocessed, and can be useful to curb appetite in small amounts. Unfortunately,some nuts are also strongly associated with allergic reactions, and some contain some anti-nutrients that may interfere with absorption of other nutrients.

13) If you follow the above principles dietary supplements are usually unnecessary.   Getting your nutrients from whole foods over vitamin and mineral supplements is a more reliable, cheaper and more complete way to get all of your nutrient needs.  Science, by its nature is reductionist, causing us all to look at one nutrient at a time, yet our bodies use nutrients in a complex and orchestrated way that is profoundly dissimilar from taking concentrated nutrients in isolation.

14)  If you are reading labels, you are already in trouble.  Labels imply that this is a processed food, and health claims most often imply a food depleted of nutrients. Yet there are only a handful of foods on supermarket shelves that contain 4 or less ingredients that are recognized as food.  Author Michael Pollan (In Defense of Food, 2008) calls these products “food-like substances.” If you don’t recognize the ingredients, don’t buy food chemistry, as it is not associated with health.

15) Learn how to prepare 10 easy to make, inexpensive, healthful meals that can save your life (and/or your family’s lives).   Our current generation of young people have grown up with a warped perspective on food–they don’t know where it comes from, they don’t know how to cook, they see a major source of food as packaged convenience foods or fast-food restaurants.  Most of what they think are every-day foods didn’t exist even 50-100 years ago!

16) Embrace eating as your ancestors did by preparing whole foods, and growing your own.  Too many of us fuel our bodies in our cars and give no time or thought to what we put in it.  Treat your body like a temple—it is the only one you will ever get.  What you put in your tank matters!

 

Diet as Medicine

screenshotDespite the strong and likely justified belief that dietary changes can significantly alter a wide variety of disease risks, the topic remains contentious, with thousands of popular diets (check some out here) published, all proporting to improve health in some way.  These all have varying degrees of science behind them, although it takes considerable sleuthing to sort out what are observational studies that only imply cause and effect simply by association.  And, as it happens, nutritional research is hard to do because of the unreliability of food questionnaires, the costs of metabolic lab studies, and the difficulty of holding one variable constant while others are not in fact inversely affected.  It is often very hard to tease out the important element(s) within a diet that may be the linchpin in a given disease.

Traditional and modern diets vary considerably; high fat, low fat, medium fat, high carb, low carb, high animal food, high plant food. And they come with a multitude of confounders:  Seventh Day Adventists are often held up as having a healthy diet, yet their lower mortality rates may also be associated with lower incidences of smoking, alcohol consumption, better sleep, healthier exercise patterns, and a strong supportive community.  Many diets seem to offer benefits due to their high fruits and veggies content, but these diets may also have less refined foods such as refined oils and sugars as well.  Further, it appears that higher fat, salt and protein intakes have been a proxy for a country’s development, with inherent differences in fast food availability, access to refined foods, activity, stress, pollution, medical support, poor sleep, and loneliness– all possible confounders.

screenshotAnd what of the difficulty to accurately tabulate death rates of given diseases in underserviced and rural areas, especially when some countries report sudden death as a distinct entity?  Is the “French Paradox” just a statistical anomaly?  How do we explain the fat intakes of the traditional Innuit, who eat virtually no plant-based foods? And how do we reconcile significantly different food guidance systems in different countries, especially when these documents are created with stakeholders in place, namely the food industry, as occurs in Canada—are we not all the same, or are these politicized documents? And how is it that the understanding of, and the approach to, the epidemic of obesity seems to be so limited as to be ineffectual?  One would think, with the strong association with multiple other diseases, such an “epidemic” would stimulate an urgent response from a wide variety of sources, yet there is almost nothing.  How bad does it have to get? Confusion reigns in the marketplace.

Nevertheless, we plod on.  Despite the seeming hopelessness of this exercise, trends and common themes appear, although we are often forced to make sufficient conclusions from insufficient premises. Given the best seller lists, patients have done well on a wide variety of diets, so it may be that we are all special snowflakes, and one size does not fit all.  The n = 1.

What follows is a summary of various diets, the main principles and evidence behind them. So for the busy clinician who does not have the time to read these latest books, we can provide you with a one minute snapshot of what the diet proports to do, with more links to more references.  As well, a number of daily blogspots will be offered as well that are easily subscribed to if interested.  We hope to also be able to help you develop clinical strategies to help your patients improve their diets, and how to monitor the process.