Medical Bits – Vol. 1.4: Your Health – A Healthy Diet
As you all know, access to clean drinking water, eradication of food-borne diseases, vaccinations, plentiful food supply and a healthy diet, have all contributed to a progressive increase in longevity and vitality in those longer years of life. A complete diet consists of caloric balance from the three main macronutrients: Carbohydrates providing 45-65% of total caloric intake, Protein about 10-35% and Fat 20-35% with the addition of fiber.
Our caloric intake should be simple: Avoid refined sugars, choose carbohydrates with a low glycemic index (whole-grain vs. refined-grain and fruits, nuts or vegetables instead of white rice, potatoes or pancakes), avoid trans fatty acids present in many processed and fast foods and limit cholesterol/saturated fat to less than 10% of daily caloric intake.
More than 40% of American adults are obese, and 66% are overweight! Many factors, of course, lead to such “epidemic”. Plentiful food, sedentary life-style, genetic factors and constant temptation and access to refined sugars which upon ingestion, stimulate the dopaminergic pleasure centers in our brains!
You may wonder about the benefits of “Fads Diets” noisily advertised from countless books and magazines. The bottom-line: Maintain your caloric balance if at ideal body weight and strive to remain within that normal BMI! (body mass index). Of course, it is self-evident that an imbalance in caloric intake/expenditure will lead to progressive weight gain with the nefarious consequences that we all know. Unfortunately, we witness an epidemic of type II Diabetes Mellitus (DM) driven by a rise in the “waist-line” and the consequent insulin resistance associated with such abdominal fat. In many nations such as Central America and Saudi Arabia, almost 50% of the adult population suffers from type II DM! Despite coordinated efforts to reduce sugary drinks by the WHO (World Health Organization), the industry with the support of the current administration has fought back to side-step those regulations.
We cannot emphasize enough how important it is to keep our weight within normal range for our metabolic and vascular health!
The time is always right to do what is right.
Keep in mind
- Fiber (portion of vegetables that cannot be digested) higher intake reduces cardiovascular disease. In a pooled analysis of 330000 participants, every 10 g increase in fiber consumption was associated with 27% reduction in death from coronary heart disease. The benefit also applied to patients with established coronary disease and it is known to have a protective effect against DM. Fiber sources: https://health.gov/dietaryguidelines/2015/guidelines/appendix-13/
Micronutrients and supplements
- Sodium: consume less than a teaspoonful (2.5 gm) per day. No salt on the table. Choose fresh vs. frozen and pre-packed meals.
- Calcium and Vitamin D3: 1000-1200 mg of calcium and 600-1000 IU of Vitamin D3.
- A multivitamin daily seems reasonable. Additional supplements and pharmacologic doses of specific vitamins have not been shown to be beneficial.
How about specific sources?
- Red meat: associated with higher mortality, but it may be mostly due to consumption of processed red meats.
- Fish: > 4x/wk associated with a decreased risk of coronary events.
- Nuts: peanuts, tree nuts, walnuts all reduce cardiovascular risk.
- Alcohol: moderate consumption of 1-2 drinks used to be encouraged as it improves lipid profiles, but a recent large publication demonstrated that any consumption is possibly deleterious. The Global Burden of Disease Study 2016 gathered data from 195 Nations over 15 yrs.
- Sweetened beverages of any kind (sodas, Gatorade, Powerade, etc.) should be avoided.
- Coffee: likely lowers risk of liver and uterine cancers and up to 3-4 cups/daily healthy if tolerated.
- What about “FADS DIETS”? Mediterranean vs. Low-Fat vs. Low-cholesterol vs. Vegetarian vs. DASH vs. Organic diets, etc.
- NO significant difference in outcomes if the principles above are respected.
- What if we failed and manage to gain some weight?
- Weight loss of 5-7% of body weight has numerous health benefits reducing cholesterol, blood pressure, diabetes and cardiovascular morbidity and mortality!
- Eliminate “cheap calories”: snacks, candies and caloric /sugary beverages.
- Portion Control.
- Long-term healthy exercise and nutritional habits.
- Metabolic rate declines by 2% per decade and muscle mass declines by 0.3-0.5% annually. More difficult to slim down as we age.
- Prolonged caloric restriction may be associated with longevity with reductions in insulin, core temperature and oxidative DNA damage.
- An un-controversially warming planet may mandate additional analysis, as livestock contributes almost 15% of green-house gases released into the atmosphere annually. Animal based protein has the highest carbon-footprint. Beef and lamb are the worst offenders. I invite you to review this article as you decide what and how much to put on your plate: https://www.nytimes.com/interactive/2019/04/30/dining/climate-change-food-eating-habits.html
- Organic produce/products consumption may result in lower pesticide exposure and lower risk of some cancers such as Lymphoma but inconclusive. Be careful as regulatory definitions are not standardized and it may hurt your wallet!
- Medications may be considered if unable to achieve 4-8% in weight loss after 6 months, which is associated with major cardiovascular and metabolic benefits. Options include: Lorcaserin, Orlistat, Liraglutide, Phentermine/Topiramate and a few others. The selection is based on tolerance and risk factors which you may want to discuss with me at the office. Metformin is helpful as well but not considered a “dieting-pill”.
As we discussed last month, Universal Health Care is an attainable and worthy goal for our Nation. This perspective article offers some insight into how to build on our current system to achieve further coverage of fellow citizens: https://www.nejm.org/doi/full/10.1056/NEJMp1901532?query=featured_home
And in case you missed this article reported by the NYT, a single work out may jog not only your muscles but also your memory centers!
Debunking Myths: Q&A
Vitamins are organic molecules that are essential in SMALL AMOUNTS for normal metabolism. They cannot be synthesized by our body and therefore must be ingested to prevent disease. Minerals are also essential micronutrients. This does not mean that large doses or “pharmacologic doses” of vitamins are beneficial to our health. Numerous population based studies have been completed, with equivocal results. In conclusion: Take a multivitamin daily and a total of 1000 IU of Vitamin D3 and… be happy! More is not best and certainly not better!
I have an egg-allergy. I can’t get the influenza vaccine. Myth! You can get the vaccine without any concerns. Even patients with history of egg-induced anaphylaxis have been safely immunized with influenza vaccine since it is highly purified and not contraindicated.
I have a history of GBS (Guillain-Barre Syndrome) or CIDP (Chronic inflammatory Demyelinating Polyneuropathy) and can’t receive any vaccines. Myth! In studies, no patients developed recurrent GBS or CIDP after immunization. The GBS Foundation recommends avoidance of the vaccine suspected to have caused disease if administered within 6 weeks of disease onset.
I have Pernicious Anemia and require B12 shots. Myth! Oral intake of 500-1000 ucg B12 daily is safe, cheaper and equally effective! The higher dose ensures adequate amounts become absorbed by the intestine, even in cases of Pernicious Anemia or distal small bowel resection (where B12 / Intrinsic factor complex is incorporated.
We will address other “myths” in future communications. In the meantime, keep cool, eat a nutritious and diverse diet, stay active and be happy! The only fountain of youth proven by science, experience and millennia are exercise, laughter, humor and a good positive attitude! Enjoy every minute of the JOURNEY! Cheers! CP.
With offices in Los Angeles, California and Richmond, Virginia, SignatureMD (signaturemd.com) is one of the nation’s largest firms providing initial conversion and ongoing support services to concierge medicine physicians. SignatureMD currently partners with more than 160 affiliated primary care physicians and specialists across 31 states, and its network is rapidly expanding.