Author: Monica Reinagel, MS, LDN

Farmed Salmon Gets an Anti-Inflammatory Makeover

by Monica Reinagel, MS, LDN

The latest nutrient data from the USDA shows that farmed Atlantic salmon has undergone what is perhaps the most dramatic nutritional makeover in history.

Salmon is known for being rich in anti-inflammatory omega-3 fatty acids and, as you know, the anti-inflammatory diet is very big these days. (The recognition of inflammation as a key factor in heart disease and other common diseases was hailed by Time Magazine as one of the Top Ten Medical Breakthroughs of 2008.)

In 2006, I caused quite a stir by pointing out in my book, The Inflammation Free Diet Plan, that farmed salmon was actually highly inflammatory. When I first published the IF Ratings, a 3-ounce serving had an IF Rating of -491.

As I (and others) pointed out, farmed Atlantic salmon was quite high in arachidonic acid, an inflammatory fatty acid from the omega-6 family. The problem was that farmed salmon were being fed a diet rich in omega-6 vegetable oils rather than a more natural diet of omega-3 rich fish and algae. As a result, their flesh was unnaturally high in omega-6 fats.

Fish farmers apparently got the message! Big changes in aquaculture practices have resulted in farmed Atlantic salmon that is much lower in arachidonic acid…so much lower, in fact, that the most recent samples tested by the USDA had an IF Rating of +775 per 3 ounce serving!

So, after years of warning people to avoid farmed salmon, especially if they were trying to follow an anti-inflammatory diet, I’m now putting farmed salmon back on the menu!

The China Study: Does Dairy Cause Cancer

by Monica Reinagel, MS, LDN

China_study_5 Dear Monica, I enjoyed your post on diet and breast cancer.  However, I cannot believe that you did not mention the direct relationship between the intake of casein (milk protein) and the growth of mammary tumors.  T. Colin Campbell in his The China Study outlines how this protein turns on tumor growth and the lack of it in the diet turns off cancer growth. “

Before saying anything else, let me first say that I completely support anyone who does not care to consume dairy products, for whatever reason.  Dairy is certainly not essential to a healthy diet. There are plenty of other ways to get calcium and vitamin D. (And those who do not consume dairy need to take care to be sure they do.)  I recently did a podcast episode on the pros and cons of dairy. You can listen to it here.

Now, to Campbell’s book: Lots of people commenting on this blog over the years have referenced this book as a definitive scientific rationale for various dietary practices.  Obviously, Campbell’s prose is compelling. But I have to be honest with you: The science behind his conclusions is less so.

You’re right: There are recent (2007) studies showing that milk increases the incidence of chemically-induced breast tumors in rats.  Interestingly, I also found a 2007 study showing that soy milk does the same thing. And another (2006) showing that fermented milk (yogurt) prevented tumors; and another (2001) showing that soy protein was preventive.

It appears that studies on things that cause or prevent tumors in rats injected with carcinogens might not provide a definitive answer to the question: Do dairy products cause breast cancer in humans? For that, it makes sense to turn to studies that compare what people eat to their risk of breast cancer.

Do dairy products increase breast cancer risk in humans?

The so-called “China Study” was a nutritional analysis conducted in rural China in the 1980s. This study purportedly found a link between the intake of animal protein and an increased risk of cancer and other disease.  In the intervening 20 years, many researchers have tested this conclusion, specifically with regards to dairy and breast cancer.  Here’s a brief sampling:

2007 American Journal of Clinical Nutrition (5000 subjects in England and Scottland): Childhood dairy intake was not associated with breast cancer risk.

2007 Cancer Epidemiology (2000 subjects in U.S.): Reduced breast cancer risks were associated with increasing milk consumption from ages 10-29, probably because of the cancer-preventive effects of vitamin D.

2006 Cancer Causes and Controls (5000 subjects in Italy): Consumption of milk and diary products did not increase breast cancer risk (and, in fact, consumption of skim milk slightly reduced risk).

2005 Journal of the American College of Nutrition (meta-analysis of 52 different studies):  Evidence does not support an association between diary product consumption and the risk of breast cancer.

2005 Nutrition and Cancer (study looking back 30 years and across 38 countries): No substantial effect of milk consumption on risk of breast (and other) cancers.

2004 American Journal of Clinical Nutrition (meta-analysis of 46 studies): No strong association between the consumption of milk or other dairy products and breast cancer risk.

2002 Journal of the National Cancer Institute (90,000 women followed for 16 years): “We found no association between intake of dairy products and breast cancer in postmenopausal women. Among premenopausal women, high intake of low-fat diary foods was associated with a reduced risk of breast cancer.”

2002 International Journal of Epidemiology (meta-analysis of 8 prospective studies involving 350,000 subjects in N. America and W. Europe): “We found no significant associations between intake of meat or dairy products and risk of breast cancer.”

Dairy is not essential to a healthy diet but it does not appear to cause breast cancer

Obviously, I would have had to have continued for quite a bit longer to work my way back to the China study. But there didn’t seem to be much reason to continue. (And I wasn’t cherry-picking, either…these are the studies that came up in response to my query!)

So, let me end this post the way I began:  Dairy products are not essential to a healthy diet. Feel free to eliminate them. But I don’t actually see evidence to suggest that doing so will reduce your risk of breast cancer. And, in fact, because dairy products are one of the only sources of vitamin D in the American diet, eliminating them might well increase your risk if you’re not careful to get that nutrient from other food sources.

Let’s Put This New Fructose Study In Perspective

by Monica Reinagel, MS, LDN

A recently published study is going to fuel the hysteria over high-fructose corn syrup. It’s a terrific study. But, contrary to the headlines you are sure to see over the next days and weeks, it does NOT prove that high fructose corn (HFCS) syrup is the cause of the obesity epidemic. Let’s take a closer look.

Researchers at the University of Florida found that rats who were fed a diet that was very high in fructose eventually became resistant to the hormone leptin.  Leptin is a hormone that regulates your appetite and disposition toward weight gain.  In the second half of the study, they switched the leptin-resistant rats to a high-calorie (high-fat) diet. The rats ate a lot more and gained a lot more weight than rats who had not been on a high-fructose diet. (Read more about the study: “Fructose hampers hormone that controls appetite.“)

Now, what does this tell us about the effects of high-fructose corn syrup on humans? Very little.

Aside from the obvious issue (the study was done in rats, not humans), the study had absolutely nothing to do with high fructose corn syrup. The diet that brought about leptin resistance was about 60% fructose, and contained no other form of sugar.  The typical (awful) American diet contains about 35% sugar, about half of which (roughly 17%) is in the form of fructose.

Incidentally, if every bit of HFCS in the food supply was replaced by regular old cane sugar, our fructose intake would still be around 17%.  That’s because high fructose corn syrup contains about the same amount of fructose as sugar.

Like the best research studies, this one poses far more questions than it answers. For example, I’m dying to know whether you’d get the same results at 50% fructose. Or 40% or 30%. What’s the threshold at which the effect starts to set in?

Secondly, I’d love to know whether you’d get leptin resistance with similar amounts of glucose or sucrose?  In other words, how much of this effect is specific to fructose and how much is just sugar? What’s more significant: the amount of total sugar in the diet or the amount of fructose? How does dietary fat affect things? (In the study, the rats ate an extremely low-fat (5%) diet and the fat was lard.)

I imagine that researchers are queuing up to design studies that will answer these questions and more. (And we’re still only talking about rats…)

Those who read this blog (or listen to my podcast) know that I think the hysteria over high-fructose corn syrup is misplaced. We should be alarmed by the amount of sugar in the American diet and what it is doing to our health. I think it probably is directly connected to our rising rates of obesity, whether through leptin resistance or other means. But I don’t think it’s worth worrying about high-fructose corn syrup, per se, while we’re still getting 35% of our calories as sugar.

This whole thing reminds me a little of people who are freaking out about gas prices and dependency on foreign oil.  They’re trading in their cars for models that will improve their gas mileage from 27 to 30 mpg.  But it never occurs to them to drive fewer miles.

Here’s what we all agree on

I am sure that large quantities of fructose will cause health problems in rats and humans. I’m pretty sure that large quantities of any form of sugar will do that. Of course, the specific problems that develop will vary depending on what type of sugar you’re over-consuming. Fructose is hard on the liver while glucose is more challenging to the pancreas.

But rather than argue about which form is more dangerous, what about working the problem from the other end of the equation? I”m talking about the “large quantities” part of the sentence.

Eat less sugar and you probably don’t need to worry about HFCS

The World Health Organization recommends that you limit your intake of added sugars to 10% of calories.  They’re not talking about sugars that are found naturally in whole foods, like fruit or milk. They’re talking about refined sugars in things like candy, baked goods, soft drinks, and condiments.

For most Americans, this would mean cutting their sugar intake by two-thirds.  Whether or not HFCS is really that much worse than other forms of sugar (I’m still not convinced it is), I’m pretty sure that if we simply cut our consumption to a reasonable level, it simply wouldn’t matter.

Call me crazy.

Breast cancer and diet: Is there a link?

by Monica Reinagel, MS, LDN

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Google “breast cancer diet” and you’ll find dozens, if not hundreds, of links to diet plans that claim to reduce your risk of breast cancer. But can the right diet really prevent breast cancer or improve your chance or survival if you have breast cancer?

Unfortunately, we just don’t know for sure. One of the most controversial questions is whether or not a low-fat diet reduces the risk of breast cancer.  Big population studies suggest that fat consumption is linked to breast cancer risk. That is, populations with higher fat intake have higher breast cancer rates. But clinical trials designed to test this theory have been inconclusive.

Soy is another area of controversy.  Soy contains phytoestrogens that can act as weak estrogens in the human body. Some believe that soy estrogens may stimulate the growth of estrogen-sensitive cancers. Others argue that the weaker soy estrogens are protective because the block the activity of stronger human estrogen.  Studies have yet to convincingly prove the case one way or another but to be on the safe side, most experts recommend soy foods be consumed in moderation.

People who eat more fruits and vegetables and less red meat have a reduced risk of cancer overall–although scientists have so far been unable to pinpoint exactly which foods or combinations of foods may be responsible.  There’s no doubt that fruits and vegetables are full  of anti-oxidants and cancer-fighting nutrients. But so far, the protective benefits of individual foods or nutrients have only been shown in the laboratory or in animals, not in humans.  Studies on nutritional supplements have been particularly disappointing.

Despite what the magazines and book authors may claim, there is no convincing proof that any particular diet or combination of foods reduces your risk of breast cancer specifically. But that doesn’t mean there’s nothing you can do. In fact, there are three things you can do that will DEFINITELY reduce your risk of breast cancer and improve your odds of survival if you are diagnosed.

The best breast cancer prevention diet

The best breast cancer prevention diet is the one that helps you maintain a healthy weight.  Being overweight is a primary risk factor for breast cancer. In addition to containing cancer-fighting compound, fruits and vegetables are low in calories. Eating more fruits and vegetables can help you lose weight and improve your nutritional status at the same time.

The next most important thing you can do to reduce your risk is to limit your consumption of alcohol to no more than one drink per day.  If you do drink alcohol, be sure that you are getting enough folic acid. A large study conducted in Australia suggests that adequate folic acid intake can negate the increased breast cancer risk associated with moderate alcohol consumption.

And, finally, your breast cancer prevention diet should include at least 30 minutes of physical activity every day. Studies show that moderate exercise is highly protective against breast cancer and vastly improves survival rates among women with breast cancer.

More resources:

Does diet affect breast cancer risk? Journal of Breast Cancer Research
Recommendations for Cancer Prevention American Institute of Cancer Research
Foods that Fight Cancer American Institute of Cancer Research
Diet and Lifestyle and Survival from Breast Cancer Sprecher Institute for Comparative Cancer Research

Vitamin D: Now I’m a believer

by Monica Reinagel, MS, LDN

One of the most electrifying sessions I attended at Andrew Weil’s Nutrition and Health Conference in April was one given by Dr. Michael Holick on Vitamin D.  Dr Holick is a well-known, even notorious, name in nutrition research circles. He’s been insisting for years that vitamin D deficiency is far more wide-spread and dangerous than anyone realizes and he has a reputation (which he himself promotes!) of being a bit of a kook.

A few years ago, he was famously booted from the Boston University dermatology faculty for making heretical statements about the benefits of moderate UV exposure (which stimulates the production of vitamin D in the skin) and has been chided and derided by the dermatology establishment ever since.

I thought I had a pretty good idea of what to expect from Holick’s presentation; it would be all about the miraculous powers of vitamin D and the dire consequences of deficiency.  I tend to take these sort of Wonder Nutrient presentations with a grain of salt.  When you spend your whole life researching a single compound–like many of these researchers do, I think you can start to lose your sense of perspective. As the old saying goes: When you’re holding a hammer, everything starts to look like a nail.

The evidence is always reasonably compelling. And by the end of every Wonder Nutrient presentation, you find yourself thinking, I really should start taking that, and I should probably start recommending it to my patients, too. The problem is that after a few dozen of these presentations, you (and your patients) have a list of 40 nutrients that you “need” to be taking.

It’s probably a backlash against too many Wonder Nutrients but, as many of you know, I’m not all that big on dietary supplements. Whenever possible, I think it’s better to meet your nutritional needs with actual foods. I myself take very few supplements.  And I have become immune to the persuasive power of Wonder Nutrient lectures.

And yet, after hearing Dr. Holick’s presentation, I literally stopped on my way back to the hotel to buy a bottle of vitamin D (1000IU).

First, I’ve gotta say, if you ever have a chance to see this guy speak, don’t miss it. All 1,200 of us in the audience were blown away (300 slides in 50 minutes). But it wasn’t just his over-the-top presentation that made me break my ban on Wonder Nutrients.  It was the cumulative impact of the data.

To me, the most compelling reason why vitamin D is really in a category of its own, and why most people need far more vitamin D than they can ever get through their diet, is this: Our bodies were not designed to meet our vitamin D requirements through dietary sources–we evolved to produce vitamin D in our skin, when the sun hits it.

That’s why people who originally lived further from the equator have lighter skin–it allows more UV rays to penetrate, which compensates for the weaker rays at those latitudes. The traditional diet of the northern and southern latitudes is also more likely to include oily fish, the richest dietary source of vitamin D.

But now, most of us spend most the daylight hours indoors. Any skin that is showing is slathered in sunscreen to prevent skin cancer and wrinkles. We don’t eat much cod liver.  We get most of our vitamin D from fortified dairy products and vitamin supplements, but it’s not nearly enough to meet our requirements.

Holick claims that the majority of Americans are chronically and dramatically D-deficient.  Among those at particular risk are those with dark-skin, the elderly, the obese (because vitamin D tends to become trapped in fat cells) and anyone living about the 35th parallel (which runs through Arizona and Georgia).  That is the latitude above which it is impossible to manufacture vitamin D in the winter months, even (as Holick to colorfully pointed out) you were to stand on the roof stark naked from noon to 3pm every day.

So what?

Every cell in the body has a receptor for vitamin D. Low blood levels of vitamin D are strongly linked to increased rates of cancer, osteoporosis, chronic pain syndromes, multiple sclerosis, rheumatoid arthritis, Type I diabetes, and  hypertension.

In fact, if you chart deaths from colon cancer, prostate cancer, or multiple sclerosis geographically, you can pick out the 35th parallel by eye because the difference in mortality rates is so much higher above that line. (Deaths from multiple sclerosis are 100% higher above 37 N. than below it! )

There’s much more to Dr. Holick’s argument (about 280 slides worth) but suffice it to say, I’m a believer.  Vitamin D is now one of only three nutrients I take as supplements (along with fish oil and calcium).

Dr. Holick and others are compaigning to have the government recommendations for vitamin D increased from the current recommendation of 200 – 600IU (depending on your age) to 1,000IU of vitamin D3 (cholecalciferol) for everyone. Based on his data, I support that recommendation.

Note: Vitamin supplements containing vitamin D2 (calciferol) are only about half as potent as D3 (cholecalciferol). Also, be cautious with sources that contain both vitamin D and vitamin A (such as supplements or cod liver  oil) and be sure that the amount of vitamin A (retinol) that you’re getting from all sources does not exceed 10,000IU.

For more information on vitamin D and health, visit Dr. Holick’s site at http://vitamindhealth.org/

Greetings from the 5th Annual Nutrition and Health Conference

by Monica Reinagel, MS, LDN

[Archival: Originally published on my (discontinued) NutritionData.com Blog]

Monicadrweil I’m writing to you from sunny Phoenix, where I’m attending the 5th Annual Nutrition and Health Conference, hosted by Dr. Andrew Weil and the Program in Integrative Medicine at the University of Arizona.

The sessions I’ve attended so far have been full of great, practical insights into how we can make our diets healthier. I can’t wait to to share this information with you in more detail! I only have a few minutes before the next session begins but wanted to dash off a quick post with some of the highlights so far.

In the opening session this morning, Dr. Weil set the stage for the rest of the conference with some general observations about diet and the role it plays in our long-term health.  A few nuggets:

On fat: Low-fat diets (less than 20%) are not only unsatisfying and difficult to stick to, but they don’t appear to be necessary for good health.  Dr. Weil argues (and I agree) that diet containing 30 to 40 percent of calories from fats is perfectly healthy. Of course, what kind of fats is important. Most of the fat in your diet should come from monounsaturated sources, such as extra virgin olive oil or canola oil.

At the same time, Dr. Weil points out that there’s no reason to be paranoid about saturated fat:

“You need to limit your intake of saturated fats but you don’t need to be afraid of them. Set a budget for your saturated fat consumption [I recommend 10% of calories–MR] and then decide how you want to spend it. If you love butter or ice cream, spend your saturated fat budget on those foods. Personally, I love cheese, so that’s what I choose to spend my saturated fat calories on.”

On protein: We’ve been trained to think in terms of “good” and “bad” carbs and fats but we tend to think of proteins as all “good” calories.  The problem with protein foods, says Dr. Weil, is what often comes along with them.  Conventionally-raised livestock may contain antibiotics, hormones, pesticide residues; fish may contain mercury, PCBs, and other contaminants.

Most of us could get along on a lot less protein than we are currently eating. Dr. Weil recommends  getting 10 to 20% of your calories from protein– and much of it from vegetarian sources.  Those with diminished kidney function may want to eat an even lower-protein diet to save wear and tear on the kideys:

“One thing I see in traditional medicine is that we wait too long before we tell people with kidney disease to start restricting protein. We wait until they are in kidney failure.  If we started them on a low-protein diet ten years earlier, at the first signs of declining kidney function, we could probably avoid or at least delay the onset of kidney failure.”

On essential fatty acids and balance:  With all the emphasis on getting more omega-3 fatty acids, we’ve started to think of omega-6 fatty acids as “bad” nutrients. Dr. Weil reminds us that omega-6 fatty acids are essential for good health!  The problem is one of balance.

“The body is designed to function in a state of dynamic tension–between forces that push and forces that pull. We need to support both forces in equal measure to remain healthy.”

And consider this: The amount of omega-3 you need to consume to keep your body in balance is directly related to the amount of omega-6 in your diet, Weil points out.

“It takes very little fish oil to balance the blood chemistry of someone eating a diet that is very low in omega-6 fatty acids. But for most Westerners, who consume a huge amount of omega-6 in their diets, it takes an enormous amount of fish oil to accomplish the same goal.”

There was so much more to report, but I’m out of time for the moment. I’ll post updates throughout the conference and will also post in greater detail on some of the more interesting research after I get home. Wish you were here!

Is Fasting a Good Way to Lose Weight?

by Monica Reinagel, MS, LDN

People fast for many reasons: as a religious observance or spiritual ritual, as a political protest, in preparation for medical procedures, or as an occasional health practice.   And studies have confirmed that short-term fasting can have a number of health benefits. Yet fasting for the purposes of losing weight is not generally seen as a good idea.

Fasting Doesn’t Teach You How to Eat Better

One argument is that you need to learn healthy eating habits in order to achieve long-term weight control. Fasting is by necessity a short-term strategy. Sooner or later, you have to begin eating again. And skills such as exercising portion control, choosing more nutritious foods and fewer empty calories, eating more vegetables and whole grains are not developed by fasting.

And we’ve all heard the argument that people who skip meals (whether one or a whole day’s worth) tend to eat more calories later to compensate. (More on that in a moment.) But a series of new studies, summarized in the U.S. News and World Report, suggest that there may be a legitimate role for modified fasting as a weight loss tool.

Fasting as a Dieting Strategy

A group of researchers in Louisiana conducted a small study in which overweight subjects ate just 20% of their normal caloric intake every other day. On the days in between, they ate as much as they wanted. On average, they lost about 8% of their body weight over the next two months.

Inspired by these results, Kenneth Webb decided to try his own version of the program. Webb calculated his daily calorie requirements (you can calculate yours with this Daily Needs Calculator) and ate just 30% that many calories every other day. On the alternate days, he ate 130%.  Over the course of about seven months, he lost 30 pounds. Not surprising, because he reduced his overall calorie intake by about 20%. But Webb says his one-day-on, one-day-off routine has a psychological advantage: He claims that it’s easy to be disciplined for a single day, knowing that the next day he’ll be eating as much as he wants–with no guilt.

Health and Anti-Aging Benefits of Fasting

There appear to be health benefits to fasting as well. Short-term fasting has been shown to reduce the risk of heart disease, improve insulin sensitivity, and slow the cellular aging process.   Some research suggests that fasting every other day may be almost as effective (and far less difficult) than the practice of calorie restriction.

Still, fasting isn’t for everyone.  For some, going an entire day on just a few hundred calories is simply too uncomfortable. For others–especially anyone who has struggled with eating disorders–the alternating sequence of fasting and feasting may lead to out-of-control binging.  You’ll have to be the judge of whether this strategy is a good fit for your lifestyle, disposition, and relationship to food.

And if you do decide to try it, remember that when calories are limited, the quality of them matters even more.  On your fasting days, be sure to concentrate on nutritious foods like fruits, vegetables, and lean protein.

A final thought: We’ve all been led to believe that skipping meals is an ineffective way to lose weight. But research from Cornell University suggests that restricting calories for one meal per day may be an effective weight loss strategy.

In a small, 2-week study, one group was given a 200 calorie (kcal) lunch (such as a cup of yogurt or bowl of soup) and another was given a 600 calorie (kcal) buffet lunch.  Both groups were allowed to eat as much as they wanted the rest of the day.  Surprisingly, those who ate only 200 calories for lunch didn’t seem to compensate by eating more the rest of the day. In fact, their daily calorie intake was, on average, precisely 400 calories less than those who ate the larger lunch, leading to weight loss.

Time for you to weigh in (so to speak!) on this interesting topic:

Have you ever tried modified fasting as a weight control strategy? How did it work for you?

Do you think every other day fasting would be a workable lifestyle? Easier than dieting every day?  Or do you think its just a gimmick?

Would the possible health benefits of fasting, aside from weight control, motivate you to try this approach?

I look forward to your comments and discussion!

Modified Fasting: a good weight control strategy?

by Monica Reinagel, MS, LDN

Mpj042253000001 People fast for many reasons: as a religious observance or spiritual ritual, as a political protest, in preparation for medical procedures, or as an occasional health practice.   And studies have confirmed that short-term fasting can have a number of health benefits.

Yet fasting for the purposes of losing weight is not generally seen as a good idea.

One argument is that you need to learn healthy eating habits in order to achieve long-term weight control. Fasting is by necessity a short-term strategy. Sooner or later, you have to begin eating again. And skills such as exercising portion control, choosing more nutritious foods and fewer empty calories, eating more vegetables and whole grains are not developed by fasting.

And we’ve all heard the argument that people who skip meals (whether one or a whole day’s worth) tend to eat more calories later to compensate. (More on that in a moment)

But a series of new studies, summarized in the U.S. News and World Report, suggest that there may be a legitimate role for modified fasting as a weight loss tool. Continue reading “Modified Fasting: a good weight control strategy?” >