Thursday, May 31, 2012

Talking With Kids About Nutrition

As kids advance in age and education, they can understand more complicated topics and more details, but no matter what the age, there are some messages that stay consistent. Today, I spent a few hours teaching 5th and 6th graders the names of vitamins and minerals (vitamin A, B vitamins, calcium, potassium, etc), and their basic effects on the body, but I didn’t particularly expect the kids to retain it all. Many adults have a hard time keeping these things straight, and this sort of knowledge isn’t always important in promoting health – in the same way that memorizing dates doesn’t help you understand important themes in history, memorizing facts about vitamins’ sources doesn’t help you establish healthy habits.

What I emphasize as being most important when talking to kids is eating a variety of colors of food, including reds, oranges, greens, blues and purples. Many health professionals are making similar recommendations for healthy eating, because a broad color array of vegetables ensures intake of a broad range of nutrients. This was driven home for me when one of the students told me that her father wouldn’t let her leave the dinner table until she’d eaten at least three different colors of food, and another told me that at her camp last summer, a competition was held to see how many different colors of food the campers could eat in a week – two moments that made me hopeful for a generation of good eaters to come.

Beyond practicality and ease of comprehension, there’s sound science behind the recommendation that people eat a variety of food colors. The carotenoids in carrots, tomatoes, squash, and yams are what give them their red or orange colors, and are potent antioxidants in the body. The green in leafy green veggies comes from chlorophyll of course, but leafy greens pack a powerful punch of vitamins and especially minerals. Finally, many blues and purples (and some reds) come from antioxidants called proanthocyanidins, a group of non-vitamin nutrients that have especially strong action in the cardiovascular system. No one of these substances can fix all of the body’s problems, but taken together, these nutrients help to prevent many diseases.

I also like to talk about a variety of colors because it interests children. Numbers and long names don’t mean much to 10-year-olds, but colorful pictures of food get them chattering, and leaning out of their seats to answer questions. It’s this interest in and engagement with food that gets kids eating new foods, discovering favorites, and hopefully forming lifelong habits that will prevent disease down the road.

Finally, encouraging kids to eat colorful food is as notable for what it excludes as what it includes. Many kids today are on what some refer to as the ‘white food diet’, i.e. bread, potatoes, pasta, chicken, and other similarly ‘inoffensive’ foods. Many of these ‘white foods’ are heavily processed, and stripped of minerals and vitamins – they may have some B vitamins as a result of fortification or innate nutrition, but gone are the many antioxidants that are necessary for healthy growth and cellular function. While these foods can certainly be part of a healthy diet, encouraging children to eat colorful diets treats these foods as part of a palate, not the only thing on the menu. Children sometimes favor these foods for their own individual reasons, but given the right prodding, they can be convinced to embrace vegetables as well.

Teaching healthy eating habits to kids is vitally important. To be sure, they might not all become rabid locavores as a result, but the effort is an important one, especially as we’ve been neglecting it here in the US for several generations. I like to use the analogy of taking out the garbage – it’s nothing that we really like to do, but it’s a necessary part of daily living, and if we clean up our little bit of garbage every day, it’s not a huge effort. If, however, we let it go for weeks or years, it becomes a BIG problem that requires a massive effort to fix. What was once contained by the garbage can spreads outside the can, and then to the rest of the kitchen, and then to other rooms, until it starts damaging the house. Likewise, the nutrients in vegetables help clean up our body’s small messes every day, when they’re not a big problem. Unfortunately, if we don’t, the mess gets bigger and bigger, spreading to different organs, and eventually causing real damage – at which point, it’s a lot harder to fix the problem.

The point is this: We all teach our kids to take out the garbage. We should all teach them how to eat vegetables. Fortunately for us, teaching kids about vegetables can be a lot more fun than teaching them to clean up after themselves.

Monday, May 28, 2012

How Super Is This Fruit? Part 2

A few weeks ago, I posted an article about the flaws inherent in the 'superfoods' craze - what defines a food as being super, who gets to decide that, and whether it's all just marketing anyway - and this week I'm following up with an article from the Wall Street Journal on a related topic, ORAC value. For those unfamiliar with the ORAC value, ORAC stands for Oxygen Radical Absorbance Capacity, and the ORAC value is used as a measure of how potent of an antioxidant a given substance is. The measure is often used in marketing supplements and superfoods as a way to make the product stand out. Unfortunately, the ORAC measure has significant limitations. The ORAC test only measures a plant's ability to absorb one kind of oxygen radical (oxygen radicals are unstable, disease-causing compounts quenched by antioxidants), which leads to some skewing of results towards certain types of antioxidants but not others. Additionally, a substance's ability to perform in a lab test doesn't necessarily translate to it's ability to prevent disease - many compounds that are excellent antioxidants are too large to be absorbed by the body, while others might perform well in the lab, but struggle to find an effective place within the body's complicated biochemistry. To be sure, antioxidants are important, but we don't need lab values to tell us what to eat - thousands of year of human history have produced antioxidant rich, health-promoting diets in countries all over the world, and it's just a matter of paying attention to those traditional diets.

Monday, May 21, 2012

Great Video From Senator Tom Harkin

Two weeks ago, a couple hundred naturopathic physicians came to Washington, DC to talk to their senators and representatives about the importance of naturopathic medicine. As part of the event, Senator Tom Harking (D-IA) took time out of his schedule to record this video welcoming us to the capitol. I'm very proud to share this video, which Sen Harkin recorded with no script or prompter - a rarity among politicians. Sen Harkin is the Chairman of the Senate Committee on Health, Education, Labor and Pensions, and bears a lot of responsibility when it comes to our nation's health policies. It was an honor to know that this video was recorded with such sincerity.

Thursday, May 17, 2012

Cinnamon and Type II Diabetes

Of all of the herbal medicines that have gained attention in the past twenty years, few have generated the same enduring interest that cinnamon has. Of course, turmeric has now gathered piles of research large enough to cow skeptics, but turmeric doesn’t have quite the same appeal – even those of us who are great fans of curry wouldn’t think of sprinkling a little turmeric on a meal to enhance the flavor, and it remains largely an herb that people take as a supplement, but not in their food. Cinnamon, by contrast, evokes a warm familiarity from many Americans, who associate it with apple cider, oatmeal, and other delicious foods – is it any wonder, then that we’ve been excited to learn of its medicinal properties? The research into cinnamon has found that it can be quite effective in helping to manage type II diabetes, and in doses that would be added to food. I’m trying to keep this article short and sweet, so I’m only going to touch on meta-analyses and research reviews today – these are both types of scholarly articles that compile data from several smaller studies and draw larger results.

Before going into the meta-analyses surrounding cinnamon, let me mention dosing. A 2010 study found that cinnamon was effective in lowering both hemoglobin A1C (HbA1C) and blood pressure over a period of twelve weeks. Non-significant decreases were also observed in fasting blood glucose, waist circumference, and BMI. Without discussing the effects observed, let me mention that the dose of cinnamon used was 2 grams per day. According to the research I have done, this equates to a little bit less than a half teaspoon of ground cinnamon, or, to put it in other terms, exactly as much cinnamon as you’d want to add to a bowl of oatmeal to make it taste delicious. This, I think, is cinnamon’s true appeal – you can add it to your food in palatable levels and get true medicinal effects. A final note about this study – it found that cinnamon lowered HbA1C by about 0.40%, a number that may be unfamiliar to some, but to a diabetic, this is an important decrease.

Of course, supplements are available, but many of these are simply water extracts of cinnamon. Most supplements made from herbs are made using solvents to extract active compounds, which are then purified further so that just a few components are present in the final product. Cinnamon, by contrast, is largely extracted using water methods, and these extracts are generally not processed further. Cinnamon is largely effective in its natural state and doesn’t require a lot of extra work to get great benefit from it.

Several studies have found that cinnamon has significant effects on fasting blood sugar in type II diabetics. The pool of articles on the topic is somewhat small, and the meta-analyses and research reviews reference many of the same works, so it’s not surprising that they share conclusions. One team of researchers found that, after compiling eight clinical studies of cinnamon or a cinnamon extract, it was clear that cinnamon had a very strong effect on lowering blood sugar. They even quantified this effect, saying that, on average, cinnamon lowered blood sugar by 0.49 mmol/L. Many of us in the US are probably not familiar with this measure of blood glucose, but it’s equivalent to about 10 mg/dL. This isn’t an earth-shatteringly large number, but to a person working to lower their blood sugar through diet and lifestyle changes, this number could make a significant difference.

A research review working from eight studies found that cinnamon could reduce blood sugars in a type II diabetic by 10-29%. These numbers are well over the 10 mg/dL difference noted previously. Were they borne out by other studies, these numbers would have the potential to be extremely clinically significant. I always tend on the conservative side of things, so am waiting to see if these numbers can be reproduced. A final review found results similar to these results, but did not find significant changes in HbA1C.

Of course, no body of scientific evidence would be complete were it not for research contradicting it, and of course we find that another group of researchers, compiling data from five studies on cinnamon, found no significant benefit from cinnamon on either HbA1C, fasting blood glucose, or lipids (cholesterol). In a clinical setting, of course, we often have to weigh conflicting evidence, and make a decision based on the patient’s unique needs and situation.

As always, if you’re interested in managing your diabetes by using cinnamon, do so in concert with a health care provider. Diabetes is far too complicated a condition with far too serious outcomes to consider managing it on your own. A physician needs to monitor your condition and progress, and can help direct you along the way. Cinnamon has some great potential benefit, but this may not be the case for all people, and you’ll need to have a provider who can help direct you through challenges. Finally, remember that diet and lifestyle are the two most important determinants of a person’s health, and that any herb or medication is a tool, a thing which can’t of its own accord make a person healthy. Health comes from dedication, work, positive thought, and belief in one’s own ability to overcome challenges to emerge stronger and healthier.

Monday, May 14, 2012

An Infographic about Obesity

As we're all aware at this point, obesity is a major problem in the United States. It predisposes to a large array of illnesses, and it's reached an epidemic status. There are, however, solutions. They're not easy, but they're also not impossible to achieve - check out this great infographic to get your mind working this Monday morning.

Thursday, May 10, 2012

Butterbur and Seasonal Allergies

Most NDs and other health professionals familiar with natural products think of Butterbur in relation to migraine headaches, but a colleague of mine recently told me that there was surprisingly strong evidence for butterbur in regards to seasonal allergies. Of course we’re still in the midst of an allergy season that seems like it will never end, so I thought I’d mention this here. I’ve done a number of articles on the topic of allergies and am adding this one to the list.

So of course, there are a variety of recommendations I make during allergy season, including quercetin, vitamin C, bromelain, and probiotics, not to mention eating plenty of veggies, drinking water, and getting exercise. Sometimes, however, even this can be too little to tame seasonal allergies, and even more interventions are needed. Allegra and Claritin are well known OTC treatments for allergies, but I regularly see patients who don’t want to take these medications, either because they are seeking a more natural treatment, or because they suffer side effects when they take them. So what options are out there?

A 2002 study found that a specific extract of butterbur, known generically at ZE 339, but marketed in the US as Petadolex, is as effective as cetirizine (Zyrtec) in alleviating seasonal allergic rhinitis. This was a reasonably large, randomized study. It wasn’t placebo-controlled, as it was designed to establish equivalence of ZE 339 to cetirizine, not superiority of the product to placebo. This is a unique place to ‘jump in’, so to speak, and later studies were left to establish superiority to placebo retrospectively, if you will.

The first study to do so was performed in 2004, a study which compared the butterbur extract to fexofenadine (Allegra) and a placebo, to add another layer of evidence. The study found that butterbur was superior to placebo (as we would have expected), and was as effective as fexofenadine in alleviating nasal symptoms, as well as physiologic measures of allergic response. The study was smaller than the previous one, but again, adds evidence. An additional study of 186 patients, which compared ZE 339 to placebo, but with no comparison to drugs, found that it was indeed superior to placebo, and that higher doses of the herbal extract produced better results.

A 2005 study, the largest of these three studies, included 330 patients, and assessed ZE 339’s effectiveness compared to placebo and fexofenadine. The extract was found to be superior to placebo, and showed a trend towards being as effective as fexofenadine, though this finding was not statistically significant. This result was perhaps a bit disappointing, in that the comparison to the drug was not statistically significant, but nonetheless, the superiority to placebo is still important evidence.

Taken together, these provide fairly strong evidence that this natural product should be considered as a potential treatment for seasonal allergies. However, it is not without potential side effects – in some ways, Petadolex straddles the line between herb and drug, and should be used only under the supervision of a licensed health professional. I often find that many patients and practitioners expect herbs to be entirely free of side effects, and while many herbs are very safe and what side effects they do have are limited, that’s not universally true. Petadolex is generally very well tolerated with few side effects, but there are some potential side effects that practitioners would have to screen for. The take home message for patients is that if you’re interested in treating your allergies naturally, talk to a practitioner. If you’re a practitioner, consider that Petadolex has a proven track record of efficacy, but be aware of safety guidelines for butterbur generally and Petadolex specifically.

Monday, May 7, 2012

DC FLI 2012

Today's blog is going to be short and sweet as I've got a long day of lobbying ahead of me. For those unfamiliar, the DC FLI (short for DC Federal Legislation Initiative) is a yearly event that brings NDs from around the country to DC to lobby their senators and representatives. This year, we're seeking inclusion in a wide variety of Health and Human Services programs, as well as inclusion in Veterans Affairs programs, and will be asking our congresspeople to help us achieve those ends.

For those of you who aren't in DC this weekend, but are interested in helping out, click this link to be connected to a form letter that will be sent on to your senators and representatives. Thanks in advance for helping out - together, we can improve our nation's healthcare system.