The Wide-Ranging Role of the Microbiome

What goes in your stomach can influence countless disorders, from cancer to asthma. Dr David Johnson surveys the latest data underlining the ever-increasing importance of a low-fat, high-fiber diet.

Source: The Wide-Ranging Role of the Microbiome

 

Anyone who’s been reading my blog probably won’t be surprised by my linking to this article (you may have to subscribe to medscape to read the full article).

Basically, the gist is that diet effects the kinds of bacteria in one’s GI tract. The good kinds of bacteria (that promoted by a low fat, primarily plant based diet) helps reduce risk of diseases like colon cancer, breast cancer (the former by producing short chain fatty acids and the latter by altering the reabsorption of estrogen that has been chemically altered by the liver and secreted into the GI tract).

 

Older Athletes Have a Strikingly Young Fitness Age – The New York Times

Older Athletes Have a Strikingly Young Fitness Age – The New York Times.

For me this is an exiting and interesting story.  As I have said in earlier posts, exercise is important.  This just reinforces the notion that exercise, even if started later in life, does help health.  I won’t wax poetic about how exercise is a “veritable fountain of youth” as I try to avoid being overly dramatic with health care claims.

Lost Posture: Why Indigenous Cultures Don’t Have Back Pain.

Lost Posture: Why Indigenous Cultures Don’t Have Back Pain : Goats and Soda : NPR.

I see a lot of people with back pain in my office. There are times I think it’s the common cold of pain. Though I don’t consider things like the radio, newspapers, TV  my main source of medical information (I prefer journals like “The Annals of Internal medicine” and “The New England Journal of Medicine” and things like grand rounds [a form of continuing medical education for doctors]), sometimes I come across things like this are interesting.

Often times if something is common one might forget to ask why it’s so common.   With a lot of people developing  back pain finding ways to prevent it or treat it before it becomes chronic is important. If this theory holds up, It’s worth pursuing.

Motion is Medicine

If there was a medication that you could take that would help reduce weight, reduce the chances of developing disorders such as diabetes, dementia, and  osteoporosis, I think most people would take it. If the side effects of this medication (even in the absence of dementia, depression, fatigue, etc) were a better mood, a better ability to concentrate, less fatigue, even more people would probably clamor to take it.

There is such a medication: exercise. Some medical societies, such as the American College of Sports Medicine state that “exercise is medicine”. The current recommendations for the minimum amount of exercise is 150 minutes a week of moderate exercise. This comes out to 20 minutes 7 days a week or 30 minutes 5 days a week. Walking is an example of moderate exercise often used to give people an idea of what the effort level of moderate exercise is. One should be walking slowly enough that one could talk and not be out of breath, but fast enough that one couldn’t sing. When my patients state they can’t find the time to do 20 minutes a day, I encourage them to find 10 minute periods through the day to walk. Obviously for some forms of exercise (swimming, playing a game of basketball, etc), this would be impractical to do.

Some research indicates that exercise has an anti-inflammatory effect in the body. Other research seems to indicate increased sensitivity to insulin, increases in various other hormones (or decreases in others), it is likely the mechanism for the beneficial effect of exercise is due to more than one pathway. That is to say that rather than, say deceased inflammation is the cause for improved mood or a decreased risk of dementia, it is likely that improved insulin sensitivity, anti inflammatory effects, etc all act in concert to improve health in people who exercise regularly. When talking with my own patients I tend  to avoid talking about why it works  and prefer to talk about the kinds of exercising they could/should be doing.

Though I encourage people to do weight bearing exercises such as walking, jogging, basketball, etc, I also realize that there needs to be some accommodation. For someone who’s morbidly obese or has severe arthritis that limits, at least initially, how much they can walk I might suggest stationary bicycles, water aerobics or something like tai chi (which is a weight bearing exercise, but because one isn’t jumping around as much as with things like basketball) the stress on joints is lower. I also realize that if someone doesn’t like a particular form of exercise, that person’s less likely to do that than a form of exercise they enjoy doing. Prescribing exercise isn’t a “one size fits all” solution to promoting health.

For people who’ve read many of my earlier posts, have probably noticed that I’ve focused less on medication and more on lifestyle issues such as diet. This post is no different. Many of the most common diseases I see in the office are most commonly caused by, for lack of a better word, poor lifestyle choices.By this I mean having a poor (read “western”) diet and not exercising enough. Once one has hypertension, type two diabetes, obesity, etc, lifestyle changes might not be enough to totally reverse  or cure a particular problem in a specific patient. However even if one needs an antihypertensive, diet and exercise don’t become less important.

The Pantry Prescription

With this blog post, I realize I run the risk of sounding like one of those people that touts a new food every day or month (drink pomegranate  juice for it’s high anti-oxidant content. You’ll live to 100!! it’s the next superfood!!!!). As I’ve pointed out, when evaluating health claims for foods/pills/etc it’s probably better to evaluate the claims as how they relate to endpoints such as decreased risk for disease, death, etc. rather than take something just because it’s a good antioxidant or has other reputed health benefits.

Anyhow, if someone were to ask me what kinds of foods should I eat/have handy, here are a few things I’d probably suggest. It is not an exhaustive list by any means. Of course if one has allergies to any of these foods, then they shouldn’t be on that person’s list of foods to have:

#1) Olive Oil. This makes my list because of the health benefits associated with intake. There is an inverse relationship with olive oil intake and the risk of dementia (that is, the more you take, the lower your risk of developing dementia). I has a lot of anti-oxidants in it as well as healthy fats. It’s good for heart health as well. It is important to mention that it’s important to use it IN PLACE of other fats, not just add it to a bad diet. That is, use olive oil in place of animal fats, coconut oil and other saturated fats.

#2) Canola oil. It’s high in Omega-3 fatty acids which are associated with lower risk of death due to heart disease, dementia, etc.  It has a higher flash point than olive oil so can be used to cook at higher temperatures (and has a less strong taste which can be important with some foods).

#3) Flax seed/flax seed oil/ground flax. Flaxseed is also a good source of omega-3 fatty acids. However these are medium chain omega-3 fatty acids (as opposed to the long chain omega-3 fatty acids which are found in fish. It is the longer omega-3 fatty acids which have been shown to have health benefits). Not all of the fatty acids are converted to long chain omega-3 fatty acids in the body, but any little bit helps, and any that takes the place of fully saturated fatty acids or trans fatty acids is a good thing. Fish such as tuna, salmon, and sardines, to name a few, are better sources for long chain omega-3 fatty acids.

#4) Legumes, any combination of them you might want (legumes include peanuts, lentils, any type of bean). In combination with a cereal (e.g. rice or wheat) will provide all the essential amino acids (make up a “complete protein”). The health benefits get even better if it’s a whole grain you pair the legumes with.

#5) Tree nuts such as almonds, walnuts, cashews, etc. Though relatively high in calories – they  tend to be high in fats – they are healthy. They contain some fiber. The fats they have tend to be the healthier types of fats and tend to be high in fat soluble antioxidants. Using a handful of nuts such as almonds to stave off hunger pains can help keep someone from consuming even more calories at dinner due to hunger. And they’re better for you than sugary/starchy foods such as crackers.

#6) Eat many different fruits and vegetables. The greater the variety the better. One study showed that blueberry intake reduced the chance of developing diabetes by 40 % (however this is only one study. Whether this is close to the “real number” blueberry intake reduces risk would be determined by looking at/doing more studies). Other fruit intake also reduced risk of certain diseases, for example,  apple intake is associated with a lower risk of developing emphysema.  Rather than relying on one “super food” or whatever fruit is the fad of the day, having a variety of fruits is probably better. Each fruit and vegetable has a different mixture of antioxidants and phytochemicals. The different phytochemicals probably have different affinities for different tissues (this is my supposition here. I have no proof to back it up other than a feeling it might be the case) and by having a variety of foods, it’s likely that more parts of the body will be protected.

#7)  A variety of spices. I would put turmeric high on the list of spices to have as it appears that the curcumin (a substance found in turmeric) is a rather potent anti oxidant and anti inflammatory agent. However, I would make the same argument about spices that I make about fruits and vegetables above. The greater the variety the better.

Notice I have not put on the list meat, poultry, milk or other sources of animal protein.I wouldn’t say avoid them, unless you have a  particular cultural or moral stand on eating animal products. I only mention fish because of the healthy fatty acids some fish contain. Limiting the amount of meat one has is important for maintaining health.  However the amounts of each, frequency of using these in diet is a topic for another time.

 

The Prevention Prescription, part 3

In my previous two posts I’ve written about different kinds of prevention (eg, primary, secondary, etc as well as vaccination which is a form of primary prevention). In this post I am going to talk about a couple of different things relating to prevention.

The first is that there are preventative measures which sometimes fall into more than one category. By this I mean that if we counsel someone to change their diet and exercise more because they’ve had a heart attack, give them aspirin, a statin, etc. that we’re engaging in tertiary prevention. However if they are on their way to becoming diabetic but because of the change in diet and increase the amount of exercise they do, and therefore lower their risk of Diabetes Mellitus, then one could argue that’s primary prevention (or secondary if they have metabolic syndrome…).

I’m a firm believer in using medication to lower cholesterol, blood pressure, etc when and if appropriate. However, I think we give short shrift to diet, exercise and sleeping enough as preventative measures to prevent or delay multiple medical problems.  Even if someone needs to be on medication, lifestyle changes are important to keep up. Exercise and diet do not become less important just because someone’s started medication. One recent study published in the New England Journal of Medicine comparing intensive lifestyle changes+usual care as compared to usual care did not reduce death. However there was evidence for a better quality of life and less need for medication, at least early on. There is a lot of evidence that enough exercise and good dietary practices can prevent and delay Diabetes. And for those that are cost conscious, a half an hour a day of walking is a lot cheaper than most medications!

There is a push by some physicians to actually prescribe exercise the same way we prescribe medications. Books have even been published on the matter!!

The Prevention Prescription, Part 2

In my last post I talked about vaccination, which is a form of primary prevention: it is the prevention of disease. There is also the concept of secondary prevention. In the case of secondary prevention, one has already has a disorder and doesn’t know it. Secondary prevention prevents the disease from getting to the point where it causes symptoms or complications (this is paraphrasing the definition on the CDC website). The example the CDC website uses is excising/taking a biopsy of a suspicious skin lesion before it becomes cancerous. Colonoscopy could also be put in the category of secondary prevention if pre cancerous polyps are found and removed before they become cancerous.

Sometimes it can be difficult to convince people to do some secondary prevention. Colonoscopy is one such item it is sometimes challenging to convince people to do. It is inconvenient as one needs to take a day off from work (if one is of working age and is working), has to have someone who’s willing to drive them home and requires taking things to clean their colon out so the colonoscopy can be done. When someone has a problem that can only be diagnosed by colonoscopy (eg: weight loss, fevers, and blood in the stool which could be a sign of inflammatory bowel disease, for example) people are worried enough about their health to get it.

Tertiary prevention is when one is trying to prevent complications or side effects of a disease which is already present. Examples of this are anticoagulation in people with atrial fibrillation, use of ACE inhibitors to prevent or slow kidney disease in diabetics.

In my next post I’ll take more about prevention and why it’s important.

Related articles