Archive for Op-ed
As regular readers here know, I sometimes get so ahead of the curve that you may, with all apologies to the Talking Heads, ask yourself;“…how do I apply this? You may ask yourself, who is that crazy Dr. Mike? You may tell yourself, this is not a normal doctor. You may tell yourself, this is too tasty to be good for me!”
But what the heck, that’s why folks stop by the Rx Pad; when they want answers-not just recipes! Along those lines, over a year ago, I wrote an article detailing the big business and little effect of fish oil supplements. To refresh your memory you can read the article here: Dr. Mike’s Fish Oil Article from Outside.com (http://www.outsideonline.com/fitness/nutrition/Is-Fish-Oil-the-New-Snake-Oil.html). In a krill shell, the article details that fish oil and krill oil supplements, which can cost a whale of a monthly subsidy, provide no significant reduction in cardiovascular mortality. They do, however, provide for big business sales. Despite the somewhat misleading advertisements, they are only approved by the FDA for the reduction of high triglycerides; not for the prevention or reduction of heart attacks. This is in contradistinction to the many studies demonstrating the positive cardiovascular benefits of a diet rich in fish and seafood that contain the omega 3-fatty acids (also known as n-3 fatty acids).
One of the best studies to date was recently published confirming the conclusion I shared with readers over a year ago. The study comes from the group of Italian researchers who form the Risk and Prevention Study Collaborative Group. It was published in the May 9th issue of The New England Journal of Medicine. They examined over 12,500 participants, about half of whom received 1 gram of polyunsaturated fatty acid (PUFA) fish oil (with both eicosapentaenoic and docosahexaenoic acids) daily. The doses were at those levels believed to reflect a more than adequate amount to show a benefit, if any existed.
The study looked at patients with multiple cardiovascular risk factors and those with coronary artery disease but no history of heart attack; in other words, those patients at an increased risk of a myocardial infarction, MI or heart attack. After a median follow up of five years, there was no difference in outcomes between the groups. There was no reduction in cardiovascular death or disease for those taking the supplements. This held true even if those who took the supplements did not take aspirin, statins or at baseline did not consume many foods rich in omega-3 fatty acids. If there was any group which should show a benefit, even a small benefit, it should have been apparent in this subgroup. The study also showed no benefit in reducing death from any coronary cause, lethal heart dysrhythmias (like ventricular fibrillation) or sudden cardiac death.
Dr. Eric Topol, a leading cardiologist with Scripps Clinic in La Jolla, California, now calls fish oil supplementation a “no-go…Fish oil does nothing…it is a nada effect.”
Previous studies like the Alpha Omega trial had looked to see if this type of supplementation could provide benefit to those patients who had a heart attack in the past (post -MI). The OMEGA trial looked at initiating this type of supplementation when patients presented with a heart attack (acute MI). Those studies reached the same conclusion as the researchers for this study. They found that their “findings provide no evidence of the usefulness on n-3 fatty acids for preventing cardiovascular death or disease in this population.”
Risk and Prevention Study Collaborative Group. n-3 fatty acids in patients with mutiple cardiovascular risk factors. N Engl J Med 2013; 368:1800-1808.
I have received a tremendous amount of inquiry this week regarding a recently released report that splashed dire and perhaps somewhat eggs-aggerated warnings throughout the media. This Canadian study was published in the journal, Atherosclerosis. In this observational trial, over 1250 men and women with average age of 61.5 years attended a university vascular prevention clinic, “filled out questionnaires regarding their lifestyle and medications, including pack-years of smoking, and the number of egg yolks consumed.” The eggs consumed per week were then converted over a longer time course to represent a measurement called “egg-yolk years.” The study participants also had “baseline measurement of TPA by duplex ultrasound.”[i] This refers to a measurement of the total plaque area (TPA) of any blockages found in the carotid arteries as assessed by ultrasound testing. The researchers found that the “plaque area increased linearly with age after age 40, but increased exponentially with pack-years of smoking and with egg-yolk years.” Their conclusion was that the “size of egg yolks appears to be approximately 2/3 that of smoking…Our findings suggest that regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease.”[ii]
Let’s now examine the study. The hypothesis upon which the study was based, as noted by the authors was that increasingly “the potential harm from high cholesterol intake, and specifically from egg yolks, is considered insignificant.”[iii] Since eggs and other high cholesterol foods were first demonized when the cholesterol hypothesis was put forth, much as been learned. At the time of the initial concern over dietary cholesterol intake, it was thought that if one consumed foods high in cholesterol that would raise your cholesterol and thus translate into more heart attacks, strokes, etc. Since that time we have learned a lot. Firstly, it is not just the cholesterol level that matters, what really matters is the level of oxidized cholesterol in the lining of the arteries as this is what initiates an inflammatory response. This level depends upon amounts and types of lipoproteins (structures composed both of proteins and fat compounds that transport fats like cholesterol in the mostly aqueous and saline blood-remember oil (fat) and water do not mix). There is a highly genetic variable component in this equation. When it comes to cholesterol and intake, the end result is much more dependent upon certain types of saturated fat intake and genetics than actual ingested cholesterol. For example, a study looked at serum cholesterol levels of men and women 5 hours to 54 days after receiving a food load of 465mg (US daily recommendation is 300mg/day) cholesterol or 54 days of 2 eggs every day. The result; the “serum cholesterol level of some subjects increased and others decreased.”[iv] That is why after the initial fright, foods like eggs and shrimp have been placed back on the menu of a healthful, balanced diet. Foods, unless excessively outrageous in cholesterol content, are best evaluated in terms of certain saturated fat contents, processing and other additives rather than absolute cholesterol content. It is interesting to note, that a reassessment of the blood cholesterol levels of 912 participants of The Framingham Study (from which some of the original cholesterol caveats were derived) showed that within “this population differences in egg consumption were unrelated to blood cholesterol level or to coronary heart disease incidence.”[v] Studies have even shown that in general, there is little correlation between saturated fat intake and cardiovascular disease.[vi] The prepackaged snack food chips loaded with artificial flavors, sodium and processed ingredients that boast “zero cholesterol” are not a more healthful food than some lovely fresh shrimp or a poached egg. It appears that the entire study may be biased as the result of an a priori argument.
Beyond a bias in the hypothesis, the study itself begs several questions. Dietary recall, while often the only option, is notoriously flawed as a mechanism by which to accurately reflect food product intake. Secondly, while most folks can remember eating a steak and labeling it as such, a steak is not usually an ingredient in other food products. Eggs are ubiquitous. It is not clear whether, for example, someone who frequently ate pasta (made with an egg containing pasta dough) had the egg content contained in that food accounted for in their “egg-yolk years”. Thus the true amount of egg consumption in the groups may be inaccurate. There was no mention of correlating highly processed meats such as sausage and bacon that are commonly purchased in the mega-markets. Several studies have correlated regular consumption of these products (as opposed to fresh, less processed red meat) with the development of cardiovascular disease and diabetes. If the persons eating eggs more often also more often consumed bacon and sausage (common egg accompaniments), these items may provide an alternative source to the findings. Additionally, this was a correlative study with no morbidity or mortality endpoints.
Moreover, the findings themselves are a bit questionable. While TPA has proven a better measure then simply examining the carotid intimal medial thickness, it is still fraught with limitations. The ultrasound assessment is technically demanding and sensitive to operator acquisition. The researchers did not use more objective measures like CT or MRI quantitative analysis which would be less susceptible to operator variability. The addition of femoral arterial measurement can supply further data and increase sensitivity and specificity versus carotid artery measurements alone. While the negative predictive value of these tests is high, there is still debate as to its positive predictive value. This means that if the test says you have no plaque, it is unlikely you will have a cardiovascular event. A negative result (no plaque) predicts no disease. However, if it finds there is disease it is not necessarily a great predictor that you will have a cardiovascular event in the future.[vii] No commentary was provided on the lesion characteristics, like a measure of echogenicity, which in some studies identifies higher risk lesions irrespective of TPA. Finally, and perhaps most importantly, while these patients were being seen in a vascular prevention clinic, no data regarding actual vascular events for any patients are identified. In other words-so what? We have no idea if the measurements, if they even proved true amongst all the aforementioned issues, mean anything at all. Do these findings translate into meaningful clinical events? We have no idea. The study did not even consider known risk factors and influencing variables like exercise and waist circumference before drawing the conclusion that “egg yolks should be avoided by persons at risk of vascular disease.”[viii]
The media release following the study bought into the hype and immediately started recommending that you “make that an egg-white omelet instead.” It is an erroneous conclusion based on the study data because the study could not tell you if it was the egg whites that caused the increased TPA! This promulgation and fear mongering of tired and unproven hypotheses and suppositions continues to keep us bound in a maelstrom of ignorance eating a highly processed, adulterated diet that results in an increasingly large and ill population. Wholesome foods like eggs are currently accepted as part of a balanced, healthful diet. With the current fad to decrease carbohydrates, eggs may be even more important. A study looking at overweight men put on a carbohydrate restricted diet (CRD), markers of inflammation (which are elevated in conditions like diabetes associated with obesity) were measured. It was found that “eggs make a significant contribution to the anti-inflammatory effects of CRD, possibly due to the presence of cholesterol, which increases HDL-C and to the antioxidant lutein which modulates certain inflammatory responses.”[ix]
I watched the Julia Child marathon on PBS the other day, reliving my childhood. She lived a wonderfully iconic and incomparable life until the end of her very productive 92 years adhering to a simple maxim:“Learn how to cook — try new recipes, learn from your mistakes, be fearless and above all have fun.”…small helpings, no seconds, no snacking, and a little bit of everything.” And she loved eggs.
For further discussion on topics like this and others, see “Eating Well Living Better”, available at amazon.com: Eating Well, Living Better (the book)
[i] (Spence, Jenkins, & Davignon, 2012)
[ii] (Spence, Jenkins, & Davignon, 2012)
[iii] (Spence, Jenkins, & Davignon, 2012)
[iv] (Kummerow FA, 1977)
[v] (Dawber TR, 1982)
[vi] (Patty W Siri-Tarino, 2010)
[vii] (Griffin M, 2010)
[viii] (Spence, Jenkins, & Davignon, 2012)
[ix] (Joseph C Ratliff, 2008)
Dawber TR, N. R. (1982). Eggs, serum cholesterol, and coronary heart disease. American Journal of Clinical Nutrition, 36:617-25.
Griffin M, N. A. (2010). Plaque area at carotid and common femoral bifurcations and prevalence of clinical cardiovascular disease. International Angiology, Jun;29(3):216-25.
Joseph C Ratliff, G. M. (2008). Eggs modulate the inflammatory response to carbohydrate restricted diets in overweight men . Nutrition & Metabolism , Volume 5, Number 1 (2008), 6, DOI: 10.1186/1743-7075-5-6.
Kummerow FA, K. Y. (1977). The influence of egg consumption on the serum cholesterol level in human subjects. American journal of Clinical Nutrition, 30:664-73.
Maria Luz Fernandez, M. C. (2010). Revisiting Dietary Cholesterol Recommendations: Does the Evidence Support a Limit of 300 mg/d? . Current Atherosclerosis Reports , Volume 12, Number 6 (2010), 377-383, DOI: 10.1007/s11883-010-0130-7 .
Patty W Siri-Tarino, Q. S. (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American Journal of Clinical Nutrition, vol. 91 no. 3 535-546 .
Spence, J. D., Jenkins, D. J., & Davignon, J. (2012). Egg yolk consumption and carotid plaque. Atherosclerosis, doi:10.1016/j.atherosclerosis.2012.07.032.
As adults, I have been told, we are to put away childish things. However, I do not believe this means the lessons that we learned as children. I do believe it involves shelving delusions of mythical clinics where youthful looks are made eternal and philosopher stones of super-foods that reverse the aging process. While you are at it, forget about magic potions, pills and foods that instantly remove unwanted flab. The only miracle about miracle diets is that people keep buying into them.
Want to get rid of flab? Eat less crap and more wholesome food. And exercise. Sexy? No. Trendy? No. Easy? No. Reality? Yes.
I am also certain adult conversations involve discounting the incantations of self-proclaimed mages and wizards. Remember The Wizard of Oz? You either know the story, watched the movie, read the book or some combination of the above. What lesson did you take home?
Was it that the Wizard couldn’t give the Tin Man a new heart? It wasn’t because he was uninsured; it was because a healthy heart is ultimately a personal responsibility and dealing with what you were dealt from the genetic pool. The Tin Man had a fine heart and you can’t give someone something they already have.
Was it that the Wizard couldn’t give the Scarecrow a brain? Fancy packaging is just that, a fancy package and a label; a piece of paper does not buy common sense. There’s no pill or procedure to fix stupid. The key is to know what you don’t know.
So when major talk show personalities abdicate any sense of responsibility and say that whatever the Wizard of Oz tells them to do, they do; they are idiots. And they influence millions to jump like lemmings into the idio-sea with them.
Case in point: The Doctor of Oz proclaimed in a show that aired in February 2012 that raspberry ketone is a “miracle fat-burner in a bottle.”
Raspberry ketone, 4-(4-hydroxyphenyl) butan-2-one, is an aromatic compound naturally found in raspberries (Rubus idaeus). It is a common ingredient used for flavoring of foods and drinks; it is also one of the most expensive flavoring agents in the food industry So far, so good-if a bit pricey.
In an animal model study, ingesting raspberry ketone along with a high fat diet significantly reduced weight gain, visceral fatty tissue, and liver triglyceride content. It’s thought that raspberry ketone might increase lipid metabolism and reduce obesity by increasing norepinephrine-induced lipolysis and thermogenesis. In vitro evidence (in a test tube, not a living system) also suggests that raspberry ketone might decrease secretion of adiponectin, which is involved in lipid and glucose metabolism and in body weight. Even better.
It may also play a potential role in cancer prevention, increasing skin elasticity (make you look younger) and even regrow hair. Starting to sound too good, in a snake oil kinda way?
Nature is all about balance, as I have mentioned on many occasions. What She giveth, she may taketh away or otherwise extract. The chemical structure of raspberry ketone shares some significant similarities with synephrine. This is another naturally occurring compound found in the bitter orange. Synephrine is generally recognized as safe (GRAS) when applied topically (for said hair restoration) and when ingested in amounts normally found in food. Now here’s the rub when do more than rub it on; it may be unsafe when consumed orally for medicinal purposes. Bitter orange juice and extract have been safely used, short-term in healthy adults in small controlled trials. The concern is that bitter orange can cause potentially severe adverse effects in some patients due to its stimulant effects. There are case reports of ischemic stroke (a type of stroke), and cardiotoxicity (untoward effects on the heart) including tachyarrhythmia (fast heart rhythms), cardiac arrest (sudden death), syncope (passing out), angina (chest pain), myocardial infarction (heart attack), ventricular arrhythmia (potentially lethal heart rhythms), and death in otherwise healthy patients who have taken bitter orange extract alone or in combination with other stimulants such as caffeine.”1
There are now several reports suggesting raspberry ketones may have the same potentially serious side effect profile, including feelings of shakiness and cardiac palpitations.2
This miracle moniker was distributed with no reliable information about adverse reactions to raspberry ketone when used in humans. Point of fact, there are no reliable clinical studies that have even evaluated safety or adverse reactions of medicinal dosages like those recommended. So remember, Dorothy defeated the sugary witch all by herself, because she knew intuitively what she had to do, did it and accomplished the task because she believed in herself, not in what the Doctor behind the surgical mask told her:
No matter where you have heard it
Or who has said it
Even if I have said it
If it does not agree with your own experience
And your own common sense
1Penzak SR, Jann MW, Cold JA, et al. Seville (sour) orange juice: synephrine content and cardiovascular effects in normotensive adults. J Clin Pharmacol 2001;41:1059-63.
Nykamp DL, Fackih MN, Compton AL. Possible association of acute lateral-wall myocardial infarction and bitter orange supplement. Ann Pharmacother 2004;38:812-6.
Keogh AM, Baron DW. Sympathomimetic abuse and coronary artery spasm. Br Med J 1985;291:940.
Nasir JM, Durning SJ, Ferguson M, et al. Exercise-induced syncope associated with QT prolongation and ephedra-free Xenadrine. Mayo Clin Proc 2004;79:1059-62.
Firenzuoli F, Gori L, Galapai C. Adverse reaction to an adrenergic herbal extract (Citrus aurantium). Phytomedicine 2005;12:247-8.
Gange CA, Madias C, Felix-Getzik EM, et al. Variant angina associated with bitter orange in a dietary supplement. Mayo Clin Proc 2006;81:545-8.
Jordan S, Murty M, Pilon K. Products containing bitter orange or synephrine: suspected cardiovascular adverse reactions. Canadian Adverse Reaction Newsletter 2004;14:3-4.
2Adverse Event Report. Raspberry Ketone. Natural MedWatch, April 27, 2012.
From all of us who enjoy the wonders of Freedom and Liberty, a “Thanks” to all of those who by serving, make it so.
This is Twitter’s fault. I read a tweet about how Paula is going Kid Krazy. Then, with the irresistible compulsion of a traffic wreck, I had to see more. Airing May 30th and again June 6th, Paula’s Best Dishes is indeed ‘Kid Krazy.’ Is this really a good idea?
Firstly, traditional Southern cooking while delicious; in certain hands is not exactly a paragon of healthful eating. It can be given to excesses in certain ingredients (read here FAT and SUGAR) and in the quantity of said ingredients (read here LOTS of fat and sugar). And the cuisine of Ms. Deen has less restraint in these areas than her muumuu.
Secondly, while promoting her cookery, which includes all the ingredients for a diabetes pot pie-except the supplemental insulin; she developed diabetes herself. Did she come clean and announce her condition? No. Did she address the dietary aspects of living with diabetes? No. Did she start to modify her program and address portion sizes-or even her own size? No. Did she at least mention if that you’re going to consume more sweets than Orson Wells on a 3 day candy-land bender you might want to look into an exercise program? No.The one thing it seems Paula was doing during the ensuing years before she made a public announcement regarding diabetes was securing for herself a lucrative contract as a spokesperson for…ready…a diabetes drug!
While she was hiding her sweet side she was busy promoting her latest children’s cookbook at the time; Paula Deen’s Cookbook for the Lunch-Box Set. This little gem offered cheesecake for breakfast and chocolate cake for lunch. Don’t take my word for it, Barbara Walters noted when Ms. Deen visited The View, “You tell kids to have cheesecake for breakfast. You tell them to have chocolate cake and meatloaf for lunch. And french fries… Everything you have here is enormously fattening.”
But hearken, ye of jaded view, now she is promoting a ‘healthy twist on her classic recipes.’ What qualifies someone to be an ‘expert’ in healthy cuisine on the television, I have no idea. It does not seem any medical, nutritional, physiological or dietetic knowledge is prerequisite. Like the sage on a recent television show telling people to eat with their non-dominant hand to slow down and consume less. And spill half their food in their lap; your date will be so impressed at the calories you saved by hiding your food in your crotch. Oh, and put carbonated water in your wine to cut calories. Why are you drinking it in the first place? You can also piss in my glass and that will limit consumption of any wine. Along with leaving a steaming dump on my plate; I guarantee that will compel me to eat less. But while it may work, none of that means it is a well advised strategy.
Yet perhaps Ms. Deen has actually exchanged her dessert shovel for a salad fork; what’s on the menu for her kids’ show? Well, there’s cheesy quesadillas featuring butter and sour cream. There’s green eggs and ham featuring eggs, bread and processed meats like ham-oh and more butter. But the kids are alright, she serves some healthy yogurt pops for dessert. In between there is some rendition of a meatball made with several canned goods. Don’t want to miss out on your daily dose of BPAs. All this and Paula claims she is The Matron of Moderation? The only message I see from this Gordon Gekko of Gastronomy seems to be “Gluttony is Good.”
Putting Paula Deen in front of your kids to teach them healthful eating habits is like putting Bernie Madoff in charge of the Treasury. Worse it’s like giving Bernie your kid’s piggy bank-and their pancreas. Might as well put Captain Jack in charge of the rum. At least he tells you he is a pirate. He is honestly dishonest. There is that whole code thing, you know. What is Paula’s code beyond a buck? The networks continue to air her old programs with their self destructive message. Her new ones just can’t seem to break with her tried and true formula that had brought her such success. When she is queried about the her cuisine, her response is, “All things in moderation.”
My prescription is that bit of advice be applied to her, her food and her programming. And for those particularly susceptible, like kids, I think she garners an XXX-tra large label. No one under eighteen allowed to view -it could be hazardous to their waistlines, and their health.
If you agree please ‘like’ and share on FB! Let’s try for 100 ‘likes’ before this thing airs!
For those that missed it, here is the recap of the radio interview about The Affordable Healthcare Act and its implications; a detailed and apolitical commentary. If you enjoy this, please pass it along and share. It is important people know the information so we can all make up our own minds, based on the data. Thanks again to Josh Tolley for allowing us to discuss on the program!
A Cardiologist’s Recipes for Health
Its’ not unusual for a cardiologist to encourage patients to eat a healthy diet. But how many physicians can get specific, let alone inspiring, with their cooking advice? Meet Mike Fenster, MD, a board-certified interventional cardiologist and a chef.
Check out Dr. Mike’s newarticle in this month’s Basil Magazine,
link here: Dr. Mike’s latest Basil Magazine article
For those looking for some rational to indulge in some buttery goodness, here’s our recent discussion with that purveyor of posing politcal puzzles, Josh Tolley on The Josh Tolley Show