Diet and Fertility

The quick answer:  The decline in fertility is an indictment of the modern dietary.  A healthy diet of whole foods, including the fats found in eggs, is essential to conception.

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Conception

I was once an officer in a medical device company that developed catheters to treat hard-to-reach organs, via the blood vessels.  We developed a method of treating brain aneurysms that saved lives and won us some fame.  Our products were also used to treat liver cancer, giving people a most precious gift—a little more life to live. 

One day we got the idea our catheters could treat a rising problem for women—infertility.  The most common cause of female infertility is failure to ovulate, but blocked fallopian tubes also defeat conception.  So we started a new company, hiring a very capable woman as CEO.   The goal:  Use our catheter technology to access, diagnose, and treat fallopian tube disorders.  The company, named Conceptus Inc., was also a success.

Infertility

I’ve followed the rise of infertility as a result, and appreciate the anguish of couples who want children but can’t conceive.  About 1 in 8 couples have difficulty conceiving.  There are various causes; about 1/3 of infertility is from the man, another 1/3 is from combined or unknown causes, but about 1/3 is due to the woman, mainly failure to ovulate. 

The topic of female infertility got the attention of scientists at the Harvard School of Public Health; they had an enormous database in the Nurses Health Study, started in 1976.  Because it studied long-term effects of the Pill, they had collected information about attempts to conceive.  An analysis of the data led to an idea that hadn’t gotten much attention:  Failure to ovulate is related to health, particularly diet.  An excellent book followed, The Fertility Diet: Groundbreaking Research Reveals Natural Ways to Boost Your Chances of Getting Pregnant.  From this study and book, here are ten things that improve a woman’s chances for a child (foruntately, these tips have been covered in previous Healthy Changes):

#1  Avoid trans fats.  Hydrogenation creates toxic trans fats and we addressed the primary risk in Healthy Change #2: Never buy deep fat fried foods.  All hydrogenated foods should be avoided.

#2  Use healthy plant oils, such as olive oil or canola oil.  We covered this in Healthy Change #11:  Enjoy traditional fats like butter and olive oil (in moderation).

#3  Eat more plant protein (grains, legumes, nuts) and less animal protein.  You’ll recall we covered this in Healthy Change #20:  Eat twice as much plant protein as animal protein. 

#4  Reduce blood sugar and insulin levels by eating a diet of whole foods (low glycemic index, or G.I.) rather than refined carbs.  We’ve built the case for eating a low G.I. diet in multiple posts, particularly “Are Carbs Good or Bad” with Healthy Change #13:  Write a weekly menu that includes vegetables (4-5/day), whole grains (3/day), and legumes (1/day).

#5  Enjoy a daily serving or two of saturated fat (whole milk, ice cream, or full-fat yogurt).  A surprise finding was the link between skim and low-fat milk and infertility.  Who would have guessed?  Saturated fat has been demonized so much you’re likely surprised to see it recommended, so welcome to the proper role of saturated fats, covered in Healthy Change #11, noted above. 

#6  Take a multivitamin containing folic acid and other B complex vitamins.  This blog has advocated natural sources of vitamins, but want-to-be mothers should consult their doctors.  For all others, we propose Healthy Change #17:  Get your vitamins the traditional way, with a whole food diet of vegetables, legumes, fruits, nuts, whole grains, and a little meat.  (Plus a little noontime sun for vitamin D.)

#7  Get plenty of iron, but from whole foods, not red meat.  A series of posts advocated a whole foods diet, but Healthy Change #22 recommended sparing intake of meat, with minimal processed meat. 

#8  Drink plenty of water, minimize alcohol, coffee and tea, and avoid sugary drinks.  This blog advocates water also, with a little fruit juice, as in Healthy Change #6:  Drink lots of water; make it your main drink.

#9  Aim for a healthy weight (a BMI from 20 to 24 was defined as healthy), but losing 5-10% if overweight can restart ovulation.  In our posts “The Skinny on Overweight” and “The End of Diets” we explored how a healthy diet naturally results in a healthy weight.  Unfortunately, a lot of shame has been put on the overweight.  Shame doesn’t motivate as powerfully as truth. 

#10 Exercise daily; if you’re already exercising step it up a little but not to excess.  Healthy Change #5:  Get at least 30 minutes of exercise, most days of the week.  It’s best if you sweat.  Other posts talked about stretching and resistance exercises.

The study didn’t address the issue of male impotence except to infer that what was good for the goose was most likely good for the gander.  (The guys need to take better care of their health too; in the last 50 years, it's reported, male semen counts have fallen 50%.)

Reduced-fat Milk

The last Healthy Change addressed milk, and the Harvard fertility study did also.  The conclusions were a surprise that confounded what we’ve been told about fats (read it twice to be sure you got it right):

• The more low-fat dairy in a woman’s diet, the more likely she was to have trouble getting pregnant.
• The more full-fat dairy, the more likely she was to get pregnant. 

Harvard scientists were astonished by the finding that reduced-fat dairy was harmful to the creation of life and could only cautiously recommended saturated fat for couples at conception.  This actually shouldn’t be a surprise; our most critical organ, the brain is mostly fat, and a baby’s optimal food, the mother’s breast milk, is full of fat, especially saturated fat.  In our home, we enjoy saturated fat in moderation; after all, it makes everything taste better.

The Bottom Line

The primary goal of every species is the creation and nurturing of the next generation.  Nothing else matters so much.  The modern diet is linked to two major ills: the rise of chronic disease, as well as overweight and obesity.  Now we've added a third calamity—infertility.  So diet reformation is not just about our health, it’s about the creation of life.

As noted above, there’s a remarkable alignment of the Healthy Changes with the findings of the Harvard fertility study.  So if you’ve had difficulty conceiving in the past but have followed the Healthy Changes over the last year and now find yourself pregnant, it’s just fine with me if you want to name your child “Skip”. :)

Eggs

We used to hear that eggs were bad because the yolk was full of fat.  People were making omelets of egg whites alone, or buying egg substitutes processed to remove much of the fat.  Imagine—low-fat eggs.  Now we’re told that eggs are back in favor.  You can safely enjoy 4, or even 6 per week, we’re told.

There’s been controversy about battery feeding and confinement of chickens in crowded cages.  The response of the industry was to take the doors off the cages—most eggs now are advertised as “cage free”.  It's one more demonstration of the power of informed shoppers voting with their dollars.

The chicken's feed remains an issue however.  A researcher named Artemis Simopoulos, on a trip to her native Greece, brought back some eggs from chickens fed the traditional way—roaming about eating bugs, seeds, grass, and a little fine gravel.  The eggs were tested and found to be ten-fold higher in the omega-3 fats essential to health, and higher in vitamins, compared to our commercial eggs. 

The healthiness of the egg, Dr. Simopoulos concluded, is tied to the healthiness of the hen.  Even for hens, diet is important.  Adding flaxseed to the feed provides more omega-3 fats in the egg, mostly of the short-chain type.  Adding seaweed or algae adds omega-3 fats of the essential long-chain type.   You pay more for these but in a prior post we pointed out that this is actually an affordable source of omega-3 fats. 

This past weekend I visited a most remarkable farmer’s market—in San Francisco, at the old Ferry Building on the Embarcadero.  It’s a place where you can actually meet the person who raised the food.  I visited with a friendly egg farmer with a handsome mustache, Charlie Sowell from the Rolling Hills Ranch, who put his hen houses on wheels, so he could move them around the pasture by day and close them up at night for safety.  The hens eat the traditional way, from Nature’s bounty.  Traditional?  I hope Charlie is the future too. 

Please comment on your experience with diet and fertility, or finding eggs from healthy chickens.

Photo by Kelli Nicole

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Milk Products

The quick answer:  In this post we address four topics—organic milk, powdered milk, probiotics, and cheese.  Use cheese to make healthy foods that don’t taste that great, tasty.

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So Proud of You

Last night I told the beautiful wife, “I’m really proud of our [blog] readers; their comments on milk have been outstanding.  They really get it.”  The beautiful wife rejoined:  “You should tell them.”  So I just did.  Thank you.

What to drink?

Diet reform works best when good food drives out bad food—reform is hard if you just take things away.  In the last post, Healthy Change #45 suggested drinking milk sparingly, if at all, until less processed milk is again available.  If enough people reduce their milk intake, I believe traditional milk will become available to people who don’t own a cow and a pasture.

A reader from Hawaii said he milks his own cows and shares raw milk with his neighbors.  Sounds like a good life.  On the other hand, a reader who works in a government office warned there are frequent incidents of salmonella, E. coli, etc. from raw milk.  So we need to be vigilant.  But I wish some scholar would compile a list of confirmed illnesses due to raw milk products and compare that to the list of people becoming ill from modern processed milk.  That would be a revelation!

On the subject of drinks what does the average American drink?  Here’s a list, ranked by quantity:

1. Water
2. Sugar drinks (including diet drinks)
3. Coffee
4. Beer
5. Milk
6. Juices
7. Tea
8. Liquor

Now, if you follow the Healthy Changes of this blog, your list is much simpler:

1)   Water, lots of water, per Healthy Change #6,

2)   Pure fruit juice (nothing added except water to dilute),

3)   A tie, depending on your taste, between milk (the least-processed available) and herbal tea. 

Now that's a food reformation!  Did you notice we omitted sugary drinks, of which Healthy Change #1 allows one 12 oz. serving per week, or diet drinks (also weekly, per Healthy Change #31)?  A consequence of drinking just one soft drink per week is you lose the taste and may rarely consume them.    

Organic milk?

I promised a comment on organic milk.  You can get it in most stores at about twice the cost of regular milk—is it worth it?  You’ll remember from the last post we had a few issues with modern milk, including:

1. The practice of pasteurization and homogenization, which change the nature of milk.
2. Milking cows deep into the next pregnancy, which results in elevated levels of chemically potent bovine hormones.
3. Lack of natural pasture feeding (especially the spring grass, so rich in omega-3 essential fats and vitamins).

For milk to be certified organic, it must be produced free of “synthetic chemicals, hormones, or antibiotics.”   Unfortunately, organic milk doesn’t solve the above problems.  Lets look at them again:

1. Organic milk is still pasteurized and homogenized.  Worse, it’s typically “ultra-pasteurized”, which employs higher temperatures (200 degrees F, for at least 15 seconds) to achieve a longer shelf life.  Is this good for the consumer?  The pasteurization problem may have gotten worse.
2. The organic regulations don’t restrict milking during the cow's next pregnancy, so this problem isn’t solved.
3. Pasture feeding was not originally required for “organic” milk; there was simply a vague reference to pasture access.  In 2010 the USDA regulation was strengthened to require pasture feeding for the full length of the local grazing season, at least 120 days, with 30% of diet to be pasture grass (during the season).  So “organic” cows should get some pasture grass, though this rule seems hard to enforce.

The milk in our refrigerator today is “Horizon Organic”.  Good name—the logo has a leaping, happy cow with a bell around its neck.  Got to love that.  Using the dairy plant code on the carton, I found it was processed at the White Wave-Morningstar plant in Industry, CA.  (Anyone can check the source of their milk by going here and entering the code imprinted on the carton.  There should be two codes: one is the batch code, the other the dairy plant code.)

Checking Wikipedia, I learned that White Wave is owned by Dean Foods, the largest milk producer in the U.S., second only to Nestle globally.  A mega-corporation!  More informed now, I’m trying to think of a reason why I should pay twice the price for ultra-pasteurized organic milk!  From what I can see, the USDA organic rule made it possible to double the price of milk in exchange for minor quality improvements. 

This seems a bad example of how the close ties between mega-corporations and the USDA turn reform into a corporate bonanza.  The quest for traditional milk is still before us but I doubt it will come from a mega-corporation.

Powdered Milk

Powdered milk is a bigger issue than most realize because reduced fat milks (like skim or 2%) usually have powdered milk added to improve the consistency—the USDA doesn’t require this to be reported as an ingredient.  Powdered milk, or dry milk solids, is also added to processed foods.  So we should ask about the healthiness of powdered milk.  Milk is dried to a powder by pumping it through tiny orifices at pressure, into a column of heated air.  During the drying, cholesterol in the milk is oxidized (a possible cause of arterial plaque), milk proteins are denatured, and nitrates (possible carcinogens) are formed. 

Some warn of the dangers from powdered milk but I don’t find hard proof it isn’t safe to eat.  What’s surprising is the lack of sound research on long-term safety.  Like many food innovations, we use it based on short-term testing.  A generation ago, people saved money by using powdered milk in the kitchen, even mixing it with regular milk.  My parents did this when times were tough and I have done it also.  Not any more.  Until the subject is better researched, I’ll avoid powdered milk, though I do keep some around for emergency use.  It's better than starving.

Probiotics

Probiotics refers to the addition of live but healthful microorganisms to certain foods.  The name is interesting because it contrasts with antibiotics—pro referring to the use of beneficial bacteria.  Microbes commonly used include Lactobacillus and Bifidobacterium (the latter must be good, it was originally found in the gut of breast-fed babies).  In antiquity, bacteria were used to preserve milk products—think of yogurt.  Some say the Biblical reference to “milk and honey” spoke to a recipe for yogurt—a way to preserve milk before refrigeration. 

In the last post, a reader living in Outer Mongolia noted that yogurt was a common food, eaten either wet or dried, and thought to be good for the teeth.  In folk medicine yogurt is used to treat stomach upsets, eczema in children, and urinary-tract or vaginal infections.  It may also be beneficial for irritable bowel syndrome.

There is occasional excitement for probiotic foods, perhaps by food companies looking for new products.  Unfortunately the benefits of a specific food are difficult to prove so foods are promoted without hard proof.  It may sound like I’m not a big fan of probiotics, which leads to a story:

A friend was diagnosed with bladder cancer.  His treatment consisted of quarterly visits to the urologist who inserted a scope up his urinary tract to check the bladder for new growths.  If new growths were found—about 50% of the time—a return visit was made to use a different scope to excise the growth.  There’s nothing fun about any of this.  He didn’t complain but I wondered how he could avoid counting the days until the next visit.

When a friend has an illness, though I’m not a doctor, I try to do a little research on the subject.  In this case I read about a Japanese fermented-milk drink called Yakult.  I had never heard of it but the maker claims it’s the world’s leading probiotic drink.  Anyway, there is some evidence that Yakult is helpful for bladder cancer, though this isn’t supported by rigorous science.  It’s a folk remedy.  I told my friend about this and he took immediate action—for nearly two years he has consumed a Yakult each day.  Result?  No new tumors growing in his bladder.  Even better, the doctor said exams could cut back to every six months.  Now this is just an anecdotal story, please don’t make more of it than that, but I’ve wondered if the doctor now suggests Yakult to other patients.

Cheese

Cheese is made from milk curdled with rennet, which comes from the stomach of the same species, be it cow, sheep, goat, or buffalo.  Aging, bacteria, and traditional flavors complete the process.  Cheese is mainly fat and protein—little lactose remains due to bacterial action—and can have a long shelf life, especially if rind covered.  Milk for cheeses that cure longer than 60 days is usually not pasteurized, nor homogenized.

In recent years the variety of cheeses in grocery stores has increased so much it’s hard to find the one you want.  (Why don’t they arrange them alphabetically?)   Cheese consumption has soared as milk intake has declined, so what about the healthfulness of cheese?  The Center for Science in the Public Interest claims cheese is our #1 source of saturated fat and recommends eating just 2 oz. per week.  We probably eat a little more, but it seems a reasonable guideline.  We do need more research on the merits of saturated fat.  It’s gotten such a bad name in the last generation that no one would think to give it to a baby, would they?  Yet mother’s breast milk is rich in fat and most of it is saturated.  Actually, if you eat meat sparingly, you won’t eat very much saturated fat (unless you like to gnaw on a cube of butter).

The bigger issue is what is on the plate with your cheese.  Most of the increased cheese intake is tied to the rise of pizza chains.  Pizza as made in Italy (thin crust, lots of tomato sauce and vegetables) can be a healthy meal.  Pizza in the US has become a form of fast food—I don’t see many that look healthy. 

Here’s a cheese rule:  Forget about pizza—the proper use of cheese is to make vegetables tasty.  I looked through Page and Doreneburg’s The Flavor Bible, which suggests the best flavors for cooking every kind of dish.  The vegetables that are good for us but seldom served, like cauliflower, squash, roots, and tubers, are all made delectable with a cheese sauce, whether it be Romano, Parmesan, Gruyere, Roquefort, or your basic cheddar.

Please comment on your use of cheese to improve the family diet.  (Sorry I wrote so much; this could have been two posts.)

The Untold Story of Milk

The quick answer:  Today’s milk may not be the perfect food.

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Mankind has safely consumed the milk of cows for millennia; that’s how I read the history.  The Bible raises no issue with milk; in fact, the Promised Land is described as a land of “milk and honey.”  The early Pilgrims enjoyed milk from goats and cows.  Some of what we know of them comes from the division of the common herd in the 1627 Division of Cattle.  A century ago milk was described as “the perfect food” and people were encouraged to drink a quart daily.  But this was all before the Industrial Revolution turned the family cow into a business.  The industrialization of milk caused rising concern about the healthfulness of modern milk.  Look at what thoughtful people are writing:

• The Milk Book:  The Milk of Human Kindness is Not Pasteurized, Dr. W. C. Douglass II, 1984/2003
• Don’t Drink Your Milk, Dr. Frank A. Oski (past chief of pediatrics at Johns Hopkins) 1996
• Milk-The Deadly Poison, Robert Cohen, 1997
• The Untold Story of Milk: Green Pastures, Contented Cows and Raw Dairy Products, Ron Schmid, 2003
• Devil in the Milk: Illness, Health and the Politics of A1 and A2 Milk, Keith Woodford, 2007
• The Untold Story of Milk, Revised and Updated: The History, Politics and Science of Nature’s Perfect Food, Ron Schmid, 2009
• The Raw Milk Revolution: Behind America’s Emerging Battle Over Food Rights, David Gumpert, 2009
• Whitewash: The Disturbing Truth About Cow’s Milk and Your Health, John Robbins, David Gumpert, 2010

The Industrialization of Milk

Here are three positions on milk:

1. Milk’s bad:  Some, especially vegans, argue against the consumption of animals and their products, including milk.  No other mammal, they note, drinks milk beyond the first year, or consumes milk from another species.
2. Olden is best:  Others argue for dairy products from healthy animals, processed traditional ways (no pasteurization, homogenization, manipulation of fat content, etc.). 
3. Milk’s OK:  The dairy industry spends billions encouraging us to drink modern milk, including versions altered to reduce fat.

To understand what is right for your family, we should look at the history.  The drive to reduce the cost of mass produced food is unrelenting and can lead to unhealthy practices—this is a repeating problem with modern food.  Beginning in the 1800s, distilleries for alcoholic drinks were located near cities and a market was sought for the used, fermented grains.   Someone had the bright idea to build dairies next to the distilleries and feed the discarded mash to milk cows.  So cows were taken from the pasture to the city and fed distillery swill.  The cows weren’t healthy and neither was the milk—they couldn’t make it into butter or cheese but they could sell it as “swill milk.”  During this time child mortality was on the rise; by 1840 half the deaths in the major east coast cities were of children.  Milk wasn’t the only cause, but swill milk from diseased cows was judged to be a significant cause of infectious disease in children and concerned citizens cried for reform.  

Pasteurization:  Two reform programs were proposed, which typify how we approach food today.  The programs had contrasting philosophies but the men behind them had something in common—each had lost a child to milk-borne disease.

• Dr. Henry Coit, in 1889, proposed that milk be collected only from healthy cows using sanitary methods, and that dairies that met the necessary hygiene standards be certified.  A committee of volunteer doctors was assembled to implement a certification program.
• Mr. Nathan Straus, a co-founder of Macy’s, proposed a solution that was simple, cheap, and quick: pasteurize the milk. 

 Pasteurization won out—simple solutions usually do—and combined with other public health improvements (potable water and sewers) child mortality began to fall.  Lost in the public debate were several key facts:  First, pasteurization reduces bacteria but does not sterilize, so standards had to be set for how much surviving bacteria milk could contain (quite a bit is allowed).  Second, though pasteurized milk has fewer bacteria, it still contains the carcasses of dead bacteria, a cause of immune system inflammation.  Third, the heat of pasteurization changed the nature of milk; for example, it reduced the available vitamins, as well as enzymes beneficial to the lactose intolerant.  This was a new product, untested by time.  In California a doctor named Francis Pottenger placed cats on a diet that included either raw milk or pasteurized milk.  The cats eating the raw milk were healthier and lived longer, but few have heard of Pottenger’s cats. 

The battle over pasteurization left a legacy in public health departments—for generations afterward, they would vehemently oppose the right of citizens to consume raw milk.  The government vendetta against California’s Alta Dena Dairy that forced them from the raw milk business is a matter of record.

Homogenization:  Milk could now be shipped further distances, thanks to the longer shelf life from pasteurization, so the separation of milk and cream became a cosmetic issue.  The solution was homogenization, a process where milk with cream is pumped at high pressure through very small holes.  The fat is broken into smaller fragments that now remain in solution, rather than floating to the top.  These fragments tend to quickly oxidize but if the milk is then cooked (pasteurized) this is prevented, though you now have a new fat molecule unproven by tradition.  The public resisted homogenization in the beginning, but it gained acceptance in the years around WWII.  Some have linked the rise of atherosclerosis and heart disease to pasteurized and homogenized milk, but other risk factors, including increased intake of sugar and trans fats (from the hydrogenation of processed vegetable oils), and the rise of cigarette smoking confused the issue. 

Milking Pregnant Cows:  It’s known that milk and dairy are a risk factor for breast cancer, which raises a question about bovine hormones in milk.  The practice of milking cows deeper into the next pregnancy began in the ‘20s when milk prices were low and dairymen were struggling.  It was another of those untested experiments to reduce cost.  Hormone levels, including estrogen and progesterone, soar as pregnancy progresses, and are in the milk we drink.  This introduces a new hypothesis:  Is there a link between certain cancers (breast, prostate, colon, ovarian, and testicular) and these ingested hormones? 

Gammaa Davaasambuu, a PhD from Mongolia, is studying the subject, using data from Harvard’s Nurses Health Study.  Read about her work here.  In the US cows are milked 300 days a year, deep into the next pregnancy; as a result this milk contains 33-fold more hormones (per one study).  In Mongalia, by tradition, cows are milked just 150 days, so milk is relatively free of hormones and is neither homogenized or pasteurized.  Dairy foods account for 60-80% of the hormones we consume in the US.  When Monigolian children are given our milk, their serum hormone levels rise.  How to reduce hormone ingestion, until more is known?  Drink less milk.  Another option, drinking reduced fat milks (hormones are carried by the fat) may introduce other problems, discussed in the next post.

Milk-related diseases:  It’s strange this popular drink has so many disease issues not resolved by proper scientific research.  Here is a partial list of disease concerns that merit further study:

• Milk, or a virus in milk, is thought to play a role in juvenile type 1 diabetes.
• Children's runny noses and chronic ear aches are sometimes linked to milk intake.
• Homogenized milk is theorized to be a cause of atherosclerosis of coronary arteries.
• Osteoporosis, in the Nurses Health Study, is linked to milk intake.  Milk contains calcium, but it also contains protein that tips the acid balance and interferes with calcium absorption.
• Higher intake of milk, as noted, is tied to increased risk of certain cancers.
• Intolerance and allergies:  About ¾ of the world population is lactose intolerant or allergic.

Monsanto and rBGH:  The controversial use of Monsanto’s recombinant bovine somatotropin (rbST, or rBGH) to increase the milk output of cows is well published.  Thanks to the public's response, the practice is in decline so is not discussed in this post, except to note the power of an aroused public. 

The Bottom Line

I like whole milk.  I enjoy it on my breakfast compote and it’s also a good drink to cleanse the mouth of flavors (most flavors are fat soluble).  I like cheese too.  So what is my position on milk?  Here it is:

1. I drink it sparingly; I’ve started to date cartons I open, to track my intake.  My goal is to drink less than ½ gallon weekly.  This goal reduces animal protein intake per Healthy Change #20: Eat twice as much plant protein as animal protein.
2. We try to buy less-processed milk.  We haven’t converted to raw milk yet, but I’ve tried some and liked the taste.  I wish it were more available, which would also make it more affordable.  One thought on price:  If you look at the price of dairy (cheese, butter, and milk) in the circa 1936 ad from Heavy’s Market shown here, you’ll see they’ve actually dropped in relative price over the 75 years.
3. I dream a dream, that one day we can all buy milk like the people in Mongolia—from healthy pasture-fed cows, free of bovine hormones, not homogenized, and not so full of bacteria it must be pasteurized. I would pay more for good milk.

Please comment:  Share your milk experience.  Have you a solution to the possible problems of modern milk?

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Photo from the State Library of South Australia.

A Visit to Trader Joe’s

The quick answer:  Supermarkets went astray when they chose profits over the health of their customers.  Alternative stores, like TJ’s, offer better choices.

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Another Store Visit

It’s complicated, you know, to try and change one’s diet.  Change is hard to do alone, and some may get a little grumpy if they’re lectured too much.  Eric Hoffer, San Francisco’s longshoreman philosopher, now deceased, observed that when we’re free to choose, we choose to do what our friends are doing.  It’s a form of gridlock: we pick friends that are like us, and then limit our choices to what they’re doing. 

Still, in every social group, there are a few who act as catalysts, introducing some “new thing.”  Unfortunately new things tend to be vices more than virtues, so there’s this downward spiral in societies.  It’s bleak, except Eric Hoffer also noted this saving human trait: “Action is at bottom a swinging and flailing of the arms to regain one’s balance and keep afloat.” 

That sounds like the food reformation: a flailing of arms—and tongues—as together we rediscover how to eat and be well. 

Our society is at a tipping point.  The rates of obesity and chronic disease are ever increasing.  The treatment of these diseases grows increasingly complex and now costs more than the average person can afford.  To complicate matters, Congress generously decreed that every person is entitled to this unaffordable care.  So now the modern diet not only can destroy us, it can also bankrupt and destroy our nation.  So when we speak of a food reformation, it’s about more than our family’s survival, it’s also about the survival of the world’s greatest democracy.

The way our family shops for food is changing.  We still go to the supermarket, mainly because it’s closer and has a large variety, but we buy less.  For the larger food quantities we go to Costco; we get other produce and bulk foods at Sprouts (used to be Henry’s) or a new store, Growers Direct; and the beautiful wife loves Trader Joes (TJ’s).  In a new series of visits, we check out the stores that help us eat better, starting with TJ’s.  But first, a little history.

The Rise and Fall of the Supermarket

Two generations ago, grocery stores were small and local.  My grandfather borrowed $200 and started one in tiny Lincoln, CA, called “Heavy’s Cash & Carry.” Grandpa knew his customers personally; during the Depression he helped those worst off to survive.  In the next generation the variety of processed foods grew without restraint and stores got bigger; we grandly called them supermarkets.  What was once a small, local business became a large regional business.  In all this growth, profits became more important than people, or their health. 

The food corporations got big too, and their brands became valuable.  Supermarket chains stopped caring what their customers ate and simply rented their shelf space out to the food corporations to better promote their brands.  Brands were little more than a means to get more money for over-processed foods.  Caveat emptor.

The 10 Best Things at Trader Joe’s

At TJ’s the brand game is kaput—most of the food has the TJ brand.  So their food is cheaper but it tastes better than the stuff from the supermarkets.  It’s a brilliant strategy:  Sell cheaper food that tastes better.  My main criticism of TJ’s is they're agnostic about nutrition.  They sell lots of candy, cookies, and other processed foods, for example.   I visited the local TJ’s to see what's healthy; here is my top ten:

Salad in a box:  Right by the door as you walk in you find the prepared salads.  I counted 12 different kinds, including shrimp & surimi, and grilled chicken salad with hard-boiled egg.  The price seemed good, $3.49 for an 11 oz. serving. 

Lunch:  TJ’s offers a healthy alternative to fast food.  Right by the salads they had sushi, $3.29; wraps, $3.49; and ready-to-heat pizzas, $3.49 for 10 oz.  I’m not a big fan of prepared foods, but these were fresh with a short shelf life (meaning no preservatives), and offered good value.

Vegetables:  TJ’s makes it easier to eat vegetables.  As a rule, it’s best to buy foods as little processed as practical.  But as I studied the produce section something stood out:  90% of the produce is packaged and a lot of it is minimally processed.  This lets TJ pack a lot of variety into a limited shelf space—part of the TJ value advantage is the small size of the stores.  Best products:

     Mirepoix—I didn’t know what mirepoix (a traditional blend of three aromatic vegetables: carrots, onions, and celery) was until I started making soups.  So I was amazed to learn you can buy pre-made mirepoix.  We used it last week to make a chicken noodle soup from half a chicken carcass.  $2.99 for 14.5 oz.

     Root vegetable blend—this is a mix of cubed roots: rutabaga, turnips, and parsnips.  I wasn’t sure if I had ever eaten these before but I knew they were healthy so got a package to use in a soup.  $2.99 for 16 oz.

     Julienne Sauté—a mix of onions, bell peppers, squash, zucchini, carrots, and oregano all washed, cut in strips, and ready to sauté or stir-fry.  $2.49 for 9 oz.

French Baby Beets, peeled and steam-cooked, ready to eat cold or hot.  This has more preparation—they’re cooked, but in France so how cool is that?  I know beets are healthy but due to a childhood aversion I have a hard time eating them.  I liked these because they aren’t pickled, the beautiful wife thought them a little tart, but they are French.  (Good subject for a post: recipes that use beets.)   $1.99 for 8 oz.

Nitrite/Nitrate-free lunchmeats:  Supermarkets like a long shelf life but TJ’s sells some meats uncured (2-month shelf life).  They also have uncured bacon (cooked).

Breakfast cereals:  TJ’s doesn’t live by the more-fiber-than-sugar rule, but they did have two affordable breakfast cereals that qualified:

     High Fiber Cereal (looks like All Bran), 9 gm. fiber and 5 gm. sugar per serving.

     Shredded Bites (looks like Shredded Wheat, bite-size), 5 gm. fiber, no sugar. 

Frozen sockeye salmon, at a good price, $10.99 per lb.  I grabbed a package.

Bread, with more fiber than sugar, whole wheat ($2.99 for a 24 oz. loaf) and sprouted whole wheat ($3.44/loaf).  I tried the sprouted wheat and it was good for store bread, but not as dense or flavorful as homemade.

Soup:  TJ’s Creamy Tomato Soup is a winter favorite, lots of tomato taste though there is added sugar (10 gm. per serving).  $2.29 for 32 oz.

Flowers.  OK, it’s not actually food, but where else can you get a bunch of flowers for just $3.99 or $5.99?  I grabbed a bouquet of blue lilies for the beautiful wife.

Summary

TJ’s is okay, I decided.  They offer better value and taste than the supermarket and make it easier to eat right (if you have the discipline to walk by the candy, crackers, cookies and alcohol).  And it’s a fun place, as much a party as a store.  Can the supermarkets get their mojo back?  I wonder.  Ever hear of a supermarket banning Twinkies? Maybe they’ll change, time will tell, we need them on the side of the food reformation.  Everyone, these days, pretends to care about the public health, but only a few walk the talk. 

Please comment:  What’s your favorite store?  How has your shopping changed as you’ve turned to healthier foods?  What are your secrets to smarter shopping? 

The Power of Friends

The quick answer:  Your friends, and their friends, and their friends, not only shape you, they shape your body!

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Four centuries of history, in a paragraph

You’re gaining in wisdom when you understand how progress can be both beneficial and harmful.  Here’s an instance:  We were taught in grammar school how the arrival of European explorers to the New World was progress.  But to the Inca, Maya, and Aztec civilizations it was a catastrophe.  There is, however, a sort of balancing of accounts in life.  The explorers introduced devastating diseases and other ills to the New World, but they brought back a fashionable addiction—tobacco.  (The New World also made sugar affordable to all, but that’s another story.)  There were two deadly outcomes:  tobacco, in its different uses, was a factor in 19^th century tuberculosis, and, via cigarettes, in 20^th century cancer (and not just lung cancer). 

There is a fascinating book, The Cigarette Century, The Rise, Fall, and Deadly Persistence of the Product That Defined America, that can help us understand how to win the food reformation.  No nation has avoided the cigarette addiction.  The rise and fall of this deadly pestilence in any nation can be divided into four stages, each covering several decades and totaling about a century.  The phases:

1. Cigarette smoking starts as an edgy fad, practiced mainly by young men.  In the U.S. this occurred during WWI when cigarettes, quick and easy to use, fit the demands of a soldier’s day, and later the faster post-war life style.
2. In this phase, smoking becomes fashionable and popular.  Cigarettes use rises to 50-80% for men, with acceptance by young women a decade behind.  For the U.S., use peaked in the post-WWII years.  Lung cancer and emphysema take 3-4 decades to develop, so early users—on the surface—appear unaffected.
3. This is the mature phase: Male use settles in around 40% with female use at 35%.  Evidence of the addictiveness and harmfulness of cigarettes grows, but the tobacco corporations have the money and influence to confuse the issues and buy off national politicians. Public health workers and reformers begin to fight against cigarette use, but their victories are few.
4. The end game: a growing body of truth about smoking morbidity and mortality can no longer be swept under the carpet.  The turning point in the U.S. was the Surgeon General’s 1964 Report on Smoking and Health.  With time, in growing numbers, thoughtful people begin to quit smoking, while local governments and businesses restrict smoking.  Although the tobacco corporations are able to control Congress, they cannot control every city, county or business.  In the end, the most powerful institutions (think of Congress, the FDA and USDA, or the American Cancer Society) are seen to have failed in their duty of care for the public; funny how reform comes from regular people.  The U.S. is currently at the end of this phase; smoking has declined to 20%, persisting among the young and less-educated poor. 

Cigarette smoking is an American invention, but the above scenario is playing out in every nation.  The rise and fall of cigarettes gives us vital clues about how we can win the food reformation.  The food-like junk offered by Food Inc. will have its fall, just as did cigarettes.  This brings us to another recent book: Connected: The Surprising Power of Our Social Networks and How They Shape Out Lives

Social Networks

You’ve heard that just six degrees of separation exist between us and anyone in the world?  It’s hard to believe the world is so connected but it is, and that has a lot to do with how people are able to quit the addictive practice of smoking.  Connected explains that though we can reach practically the whole world in six degrees of separation, we are mainly influenced by just three degrees—your friends, their friends, and the next layer of friends. 

Think of your Christmas card list, the 50 or so people you care about the most.  Then add in the 50 people on those people’s Christmas card list that most influence your friends; now we have 2500 people.  Add to those, the next layer of Christmas card recipients (50 x 2500 = 125,000 people).  Now throw out the duplicated names, the relatives you aren’t so connected to, and you still have a large body of people in the network that has shaped, and continues to shape, each of us. 

In the book Connected, researchers went to the Framingham Study, a three-generation project that studied one small town to understand what causes heart disease.  The study actually failed, in my view, but it did have a large body of information about habits like smoking, and also a list of people’s friends.  When a computer diagram of the social network for Framingham people was constructed, it became apparent that people didn’t stop smoking all by themselves.  They did it in the company, and with the support, of friends.  Moreover, those friends who did not quit smoking tended to drift out of the network, relocating to smoking groups. 

In the beginning, before smoking was undeniably linked to cancer, it didn’t matter who in a network smoked.  But when it became unfashionable, it did matter and people who didn’t smoke drifted away from those who did, linking to new friends.  So in the end there was a new dichotomy: nonsmokers and smokers. 

The research also looked at overweight and obesity and found a similar pattern.  People who grow obese tend to do it with their friends and those who don’t will tend to exit the old group.  The rise of social media (think Facebook) brings new power to our network of friends—today we’re more connected than ever.  Now think about the blogs you like to visit, like this one.  Blogs add new branches to our social network, and they influence us.

Bottom line:  The battle for food reformation can be won through social networks. 

If you go back to nutrition books from the ‘20s and ‘30s as I have, you’ll find people arguing for much the same thing as today:  less of sugar, meat, and processed foods; more fruits, vegetables, and whole grains.  WWII and the prosperity that followed derailed that movement, but it’s back in our face, driven by the frightening rise of overweight and chronic disease.  In these battles, the major institutions often disappoint.  They get fat, bureaucratic, and despite their power, timid.  The power to fight comes, as always, from the people and people today have a powerful new advantage, social networks linked by the Internet.  The food war that has lasted a century could be resolved in a decade, with the help of social networks of friends.  Together we can learn how to eat well, reform the modern diet, reshape Food Inc., and save the world.  That’s our humble goal.

Please comment; how do friends empower change in your life?

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Hero Docs

The quick answer:  The modern diet was invented in America and like an ancient plague is now spreading around the world.  The cure could also come from America.  Here are four docs who effectively preach the gospel of good diet and health.

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Hero Docs

Nearly 20 years ago, David Halberstam wrote a bestseller about the Vietnam War titled The Best and the Brightest.  Vietnam, despite the valor of those who fought and died, was a horrible mistake, the book concluded.  Worse, the string of bad decisions that put us in that unwinnable war, were made by the best and brightest people our society could muster. 

Halberstam meticulously demonstrated that really smart people, despite their best efforts, could fail the public they serve.  His phrase, “best and brightest,” seems an apt introduction to the topic of this post: doctors.  I like doctors; taken together, I think they’re the best and brightest of our society.  But like the soldiers of Vietnam, they also fight an unwinnable war—the war against chronic disease, which is a product of our modern lifestyle.  They write prescriptions for pills, but the problem is what we eat.  It doesn’t have to be that way.

A handful of these doctors, like Halberstam, have seen a better way, and have spoken openly.  They’re pioneers, in my view.  Rather than “going along, to get along,” they have gone against the grain, and called for radical change.  They not only practice medicine, they do research, and become public advocates.  Their message: Prevention is better than treatment; simple lifestyle changes are superior to expensive drugs and high-tech procedures.  Like others who take unpopular stands, they’ve faced derision and censure from the powers that be.  Here are four practicing physicians with their own bestsellers:

Cardiology

Heart disease is too profitable to cure.  A cynical statement, don’t you think?  The docs who perform the bypass operations, or slip stents into your coronary arteries, make a lot of money.  Likewise for the drug and medical device companies.  Hospitals have invested billions in coronary care wards, surgical suites, and cath labs; for some, coronary treatments provide half their income.  When the big bucks flow, such an enterprise, like a run-away train, takes on a life of its own and isn’t easily stopped—even if there’s a better answer.

But a handful of doctors have dared to speak up.  They’ve pointed out that these pricey procedures are just treating symptoms and aren’t really extending life.  And they have gone to the root of the problem and argued for making lifestyle changes, big changes.  In their mission, a few have become well known:

Dr. Dean Ornish:  A Texas kid who graduates summa cum laude from the University of Texas, then attends Baylor College of Medicine, isn’t likely to leave the Lone Star state.  But Ornish did; he served his internship and residency at prestigious Mass General, and then crossed the country to practice and teach cardiology in San Francisco.  Some call it Bagdad by the Bay, justifiably, but it was also just up the 101 highway from Silicon Valley, ground zero for the digital revolution. This was during the ‘80s and change was in the wind, especially along the 101.

The rising star in cardiology was CABG, coronary artery bypass graft surgery, a procedure that sawed open your chest and replaced occluded heart arteries with veins cut from your leg, or arm.  Surgeons who did CABG procedures were the rock stars of the hospitals.  But a new paradigm was coming—less invasive procedures.  Just down the 101 from Dr. Ornish, a medical device start-up named ACS, for Advanced Cardiology Systems, was using balloon catheters, and then stents, to prop open those diseased coronary arteries. 

But Ornish had a zero invasive procedure in mind: cure heart disease by removing what caused it—the modern lifestyle.  He organized a study that treated 28 heart disease patients with diet (low-fat, plant-based whole foods), smoking cessation, stress management (including yoga and meditation—this was San Francisco, after all), and exercise.   (You may, ahem, note the similarity between Ornish’s program and the lifestyle advocated in this blog.)  For comparison, a control group of 20 patients received the conventional treatment, mainly drugs. 

The result was dramatic:  After one year the test group’s progression of coronary blockage was stopped, and for 82% of the patients reversed.  In the control group the progression of artery blockage continued unabated.  The results were reported in a top medical journal, Lancet.  Did the world adopt the Ornish program?  No, revolutions don’t happen that easily, especially when it involves the dismantling of lucrative enterprises.

Ornish appealed to the public, with the 1990 book Dr. Dean Ornish’s Program for Reversing Heart Disease.  The application of lifestyle change to other diseases followed, and a 2008 book, The Spectrum: A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health.  Ornish also founded the nonprofit Preventive Medicine Research Institute, and worked with Nobel laureate Elizabeth Blackburn, PhD, to show that lifestyle changes can lengthen telomeres, the ends of chromosomes that control how long we live.  Ornish is a hero, but there are others.

Dr. Caldwell Esselstyn, Jr:  This is a guy who walked the fitness talk—he won an Olympic gold medal in 1956 in 8-oared rowing.  As a surgeon at the prestigious Cleveland Clinic, and chair of their Breast Cancer Task Force, he grew dissatisfied with the treatment of cancer and heart disease—treating symptoms with pills and procedures seemed like surrender; it wasn’t the same as curing the disease, or protecting future victims. 

Esselstyn started an experiment with 22 patients suffering from severe coronary artery disease.  The treatment included a low-fat vegan diet (just 10% of calories from fat), use of cholesterol-lowering drugs, and group therapy sessions with Dr. Esselstyn and his wife. 

Of the 22, 11 were still following the program after five years, and examination showed that the progression of blockage had been stopped, and in some cases reversed.  More important: none had suffered heart attacks.  Esselstyn published a bestseller, Prevent and Reverse Heart Disease, and collaborated with Dr. T. Colin Campbell in the recent movie, “Forks over Knifes.” 

Nutrition:  There’s a growing awareness of the importance of diet and lifestyle in disease prevention, but as a nation we have just begun to actually change the way we eat and live.  The pendulum is poised to swing, however, and two doctors are active advocates of dietary change:

Dr. Neal D. Barnard is a major spokesman for the idea that a healthy diet can prevent and treat disease.  If you’re reading this blog you likely agree, but Barnard goes one step beyond the diet presented in this blog (a home-cooked diet of fruits, vegetables, legumes, nuts, whole grains, and sparing meat).  He advocates zero meat, or a vegan diet, though he comes from a family of ranchers.  Barnard is also a leading opponent of the Atkins diet, which basically replaces carbs with meat. 

In 1985 Barnard founded the Physicians Committee for Responsible Medicine (PCRM), to promote the benefit of plant-based diets, oppose harmful medical practices, and the use of animals in medical research.  In 1991 he organized the Cancer Project to inform the public about the role of a plant-based diet in cancer prevention and survival.  Earlier this year PCRM actually sued the US government for pushing food guidelines that lacked scientific evidence (specifically, the recommendation for meat and dairy, as well as the confusing food pyramid).  Some of Barnard’s books:

• Diet:  See his 1990 book (updated in 1995), The Power of Your Plate: Eating Well for Better Health, a book supplemented with the advice of 17 experts.  In 1994 he wrote, Food for Life:  How the New Four Food Groups Can Save Your Life. 
• Diabetes:  With an NIH grant, Barnard studied the power of a plant-based diet to heal type 2 diabetes and published a 2006 bestseller, Dr Barnard’s Program for Reversing Diabetes.  The study showed his diet more effective than the program of the American Diabetic Association.
• Overeating:  In 2004 Barnard published Breaking the Food Seduction: The Hidden Reasons Behind Food Cravings—And 7 Steps to End Them Naturally. 
• Weight loss:  See A Physician’s Slimming Guide: For Permanent Weight Control.  Barnard later studied the role of gene expression, the power of the body to regulate the expression of certain genes through diet, and wrote Turn Off the Fat Genes: The Revolutionary Guide to Losing Weight.
• Pain management:  Barnard, in 1999, issued Foods That Fight Pain: Revolutionary Strategies for Maximum Pain Relief. 
• Cancer:  The Cancer Survivor’s Guide: Foods That Help You Fight Back. 

Dr. Joel Fuhrman is a former world-class figure skater, family physician, nutrition researcher, and author.  Reflecting his work as a diet-focused family physician, he addresses a variety of medical conditions:

• Fasting:  This was discussed in a prior post, but Fuhrman, impressed how animals stopped eating when ill, researched a book on the benefits of fasting: Fasting and Eating for Health: A Medical Doctor’s Program for Conquering Disease 
• Immune system:  Searching for ways to strengthen the immune system of patients, Fuhrman wrote, Super Immunity: The Essential Nutrition Guide for Boosting Your Body’s Defenses to Live Longer, Stronger, and Disease Free,
• Weight loss:  Two series, Eat to Live, and Eat for Health, address the problems of the modern diet and advocate a plant-based diet.

Please comment:  Who has influenced you to eat better?  What made you ready to change?

Why Hair Matters

The quick answer:  There’s a link between acne, male pattern baldness, heart disease, and hormone-related cancers.  The solution:  a whole foods diet, sparing of animal products.

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The Milk-Acne Theory

Acne has been linked to an inflammatory diet high in sugar and milk products and low in whole foods—the modern diet.  (Other causes of inflammation include food allergies, and protracted stress.)  The suspected role of milk and dairy products in acne was mentioned in the last post, but merits further attention. 

In the ‘60s Dr. Jerome K. Fisher, a Pasadena, CA, dermatologist, studied 1000 acne patients and found a link to milk intake, when compared to teens studied in NYC.  The Pasadena kids consumed more milk and had more acne.  Fisher’s work was presented at a 1966 ADA meeting, covered here by Time Magazine.

The Time Magazine article noted that hormones like testosterone were a trigger for acne, and suggested (from Fisher’s work) that progesterone from cow’s milk played a similar role.  In the 1920s, hard times for dairy farmers led to the practice of milking cows further into the pregnancy of the next calf, exposing consumers to higher levels of bovine hormones like progesterone.  Progesterone breaks down into androgens that trigger the acne cycle in upper body pores.  Dr. Fisher also studied the role of dietary sugar and stress in acne, noting surges of acne after school finals, and a decline by the end of a carefree summer.  (The first time I read this excellent Time article it was free; the second time it required a subscription.)

In the ‘70s other studies linked bovine hormones increasingly found in milk butterfat with follicle DHT testosterone associated with acne, and baldness.  Unfortunately, further study was not funded so the issue of milking pregnant cows and the health impact on consumers was ignored.

Today, three highly regarded doctors—Dr. Danby, a dermatologist and Dartmouth Med School professor, Dr. C. A. Adebamowo (who earned a 2^nd doctorate at Harvard studying the link between dairy and acne), and Dr. W.C. Willett, the respected head of Harvard School of Public Health—maintain a website that addresses the milk-acne theory.  For the scientifically minded, a copy of Dr. Fisher’s original paper is posted.  To see an insightful animation on follicle maturation and acne development, go here.

Testosterone 101

The topic of our last post, acne, leads to this week’s topic, premature baldness.  Both occur in the pores that grow hair, and both are driven by the hormone testosterone.  Some testosterone facts:

• It’s the male hormone, but women have it too, about 1/10 as much.  Women have less but—no surprise here—are more sensitive to its action.
• It’s the primary anabolic hormone, linked to muscle, bone, and hair growth.
• It’s also androgenic, driving male sexual development and aiding female maturation.
• It’s mainly produced in the testes (or ovaries), but also in the adrenal glands.
• Interestingly, falling in love reduces the male level and increases the female level, with the nice result that male/female behavior becomes more alike.  (The proof is when you go to a sad movie and both cry at the same time—very scary for the guy.)
• Fatherhood also reduces testosterone level, increasing the paternal caring instinct.
• There is a seasonal cycle too, with higher levels in the fall, when the nights grow longer.
• There’s a nice story here: the testosterone explosion of puberty drives men to fall crazily in love; being in love and having children reduces testosterone while increasing the caring instinct; during the adult years testosterone levels slowly decline as the family grows, with the result that aggression and risky behavior are replaced by benevolent affection and wisdom.  The final product—a grandfather.

In the hair follicles, enzymes convert about 5% of testosterone to a more potent form, dihydroxytestosterone, or DHT, which brings us to the subject of baldness.

For Men

Anyone else noticed how many virile young guys are going bald?  It’s driving a new hairstyle: no hair—as in the shaved head reminiscent of Mr. Clean.  What’s driving this, and does it have to do with diet?  Is male pattern baldness another chronic disease?  Here are some facts:

• Male pattern baldness runs in families—there’s a genetic influence.
• A high level of testosterone is linked to hair loss.  A 1942 study of men who had their testes removed (the main source of testosterone) found that even in bald families, the men kept their hair.  (One small job benefit for those eunuchs.)
• How is hair lost?  In the hair follicle, testosterone is converted to the potent hormone DHT that in excess can kill the follicle.  (While DHT is linked to baldness on the head, it’s perversely tied to unwanted hair growth elsewhere.)
• An excess of DHT testosterone in the hair follicles causes first acne, then hair loss, later BPH (enlarged prostate), prostate cancer, and even heart disease. 
• Testosterone is tricky—guys need a little to be romantic, but too much leaves them like Samson after Delilah, hairless.

Diet and DHT Testosterone

Can diet play a role in healthy DHT testosterone levels?  This is another topic where the science doesn’t get funded, but there are some clues to the hormone imbalance behind acne, baldness, and possibly heart disease and the hormone-related cancers. Hair loss, meaning male pattern baldness beginning with the crown, is an important indicator of health.  Hair does matter.

Studies show that DHT testosterone can be managed through healthy exercise, stress management, and a whole foods diet.  Studies suggest these dietary improvements:

• Reduce animal products like meat, milk, and dairy.  Organic milk, though its twice the price, has fewer bovine hormones.
• Eat more cold-water fish, the source of omega-3 essential fats, and less omega-6, found in vegetable oils and margarine.
• Enjoy fruits, vegetables, seeds, and nuts.  They’re rich in vitamins, minerals like zinc, fiber, and antioxidants.
• Eat whole grains; minimize refined carbs, sugar.

Night Shade Plants

On the subject of antioxidants, cooks should be aware of the nightshade plants, a large group that includes potatoes, tomatoes, peppers, and eggplant (shown above).  They’re nutritious, rich in antioxidants, so fit the list above, but they do contain alkaloids that may be inflammatory to some.  This isn’t well documented, but reactions may include eczema, rashes, and joint discomfort similar to arthritis.  If you have these problems, consult your doctor.  Otherwise, include these plants in your diet:

Potatoes:  After wheat, corn, and rice, potatoes feed the world.  “How the Potato Changed the World, in the November Smithsonian, recounts how planting potatoes from the New World stabilized the food supply of Europe in the 1700s, ending the cycle of famines, and enabling the rise of the West.  It’s true that potatoes have a high glycemic index, but there’s still a place for them in a healthy diet.  Store them in the dark and remove any green spots or sprouts.

Tomatoes:  Rich in the antioxidant lycopene, tomatoes are good for your heart as well as the bones.  Loaded with phytonutrients, they regulate fats in the blood stream (are claimed to be as helpful as the statin drugs), and protect against blood clots.  Diced tomatoes add moisture and flavor to a baked potato.  Cooking tomatoes, as in sauces, improves the bioavailability of lycopene antioxidants.

Peppers:  With tomatoes, bell peppers are among the richest sources of vitamin A, the carotenoid antioxidants, and other phytonutrients.  Laboratory studies have suggested they’re protective of certain cancers.  Enjoy them at any stage of ripeness—green, yellow, or red.

Eggplant:  After reading about eggplant, we resolved to add them to our menu.  They’re rich in phenolic antioxidants.

Please comment, and share your experience with acne, or baldness.  Does any reader have difficulty with nightshade plants?  Also, we’re looking for a tasty eggplant recipe.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Diet and Acne

The quick answer:  Know someone troubled by acne?  Let them know the importance of a healthy diet in minimizing risk.  But first, a word about salt.

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The Salt Nanny

Nanny talk is a problem in nutrition. 

People need wisdom to navigate the food jungle, but all too often we get nanny talk that worries over symptoms without giving solutions.  Most recent example:  The CDC just released more information on an old subject—salt.  Most of us exceed the 2300 mg/day salt limit (about a tsp.).  It’s actually worse; many of us—either by age or illnesses like diabetes, kidney failure or hypertension—should live by the lower 1500 mg limit.  The media coverage of the CDC report was full of nanny talk.  Here are three profound thoughts overlooked by the media:

1. You don’t control the salt you eat.  Typically people add just 6% (by one account) of their daily salt via the table saltshaker.  Other people add the rest, typically in processed snacks and foods or restaurant meals.  So the advice to add less salt is just nanny talk.
2. The issue of potassium is overlooked.  The ratio of sodium (table salt is 40% sodium) to potassium in our diet is more important than total salt, as discussed here.  This post cited a study conclusion that those eating the highest proportion of sodium to potassium were 46% more likely to die of heart disease (than those eating the lowest ratio).  That’s a big difference in mortality. 
3. It’s best to cook your own food.  The sodium: potassium ratio is really your diet ratio of purchased to home-cooked food.  Purchased food is high in sodium, because salt is the cheapest flavor.  Natural foods are high in potassium, thus have a healthy sodium: potassium ratio.  Why is the CDC afraid to simply say, eat less factory food and more home-cooked food?

The CDC can’t help us if they continue to tiptoe around Food Inc.  When enough people stop buying factory and fast foods high in sodium, Food Inc. will change its habits.  We should live so long.

Acne

Lets talk about skin disease, like acne, psoriasis, or eczema.  Acne is the most common, and the most troubling for teens (and some young moms).   It’s been around, the ancient Greeks and Egyptians described it.  The Greek term for acne derived from the word for “first shave”, or puberty.   Risk of acne has increased with the modern lifestyle; it’s rare among indigenous people eating native diets.  Considering all that is spend on medical research, we know little about the cause of acne.  Doctors have been reluctant to link acne to diet, or use diet in their treatment, though the evidence for a dietary link has grown.

In the past a toxic chemo agent, isotretinoin (marketed as Accutane, now Rosaccutane) was blithely dispensed by doctors for acne.   Parents were often unaware of the toxicity of the drug.  Finally the FDA stepped in and imposed strict limits on the use of isotretinoin.  We also used to hear that chocolate or fried foods should be avoided, but this never had solid supporting evidence.

Teens at risk for acne should pay attention to the following dietary risk factors (for more information visit Dr. Joel Fuhrman’s post on this subject):

1.  Glycemic load:  Glycemic index (G.I.) refers to how fast the carbs in food are digested into blood glucose.  In the post, “Is Sugar Toxic?” we discussed the danger of sugar in our diet.  Sugars and other refined foods have a high G.I., as discussed here.  The total of high G.I. foods eaten is called the glycemic load.  A high glycemic load causes a spike in blood glucose, which is followed by a spike in blood insulin, which triggers a spike in insulin-like growth factor 1 (IGF-1).  It’s a chemical roller coaster ride racing towards inflammation, out-of-control hormones, excessive skin oil production, and acne. 

2.  Whole foods:  A diet of natural foods rich in vitamins, minerals, antioxidants, and omega-3 fats appears to be protective of acne.  Zinc, carotenoids (vitamin A precursors), and vitamin E reduce the risk of acne, it seems, though more research is needed.  Because relatively few dollars are budgeted for healthy diet research, the full benefit may not be discovered in our lifetime.  In the meantime, I would eat a healthy diet as though my skin, and my life, depended on it.

3.  Dairy:  I enjoy milk, but in retrospect it would have been better to avoid it during my teen years.  An emerging body of research is tying milk, especially skim milk, and milk products to teen acne risk. 

Summary:  Diet, along with regular exercise, adequate sleep, and avoidance of excessive stress, is critical to avoiding the chronic diseases.  Acne can be considered an early chronic disease, usually preceded only by dental caries.  Prevention of acne begins with eating whole foods, avoidance of high G.I. refined foods, and minimal dairy.  There are also topical treatments for acne, and, if conditions warrant, a competent doctor can prescribe drugs.   But the starting point should be a healthy diet.

Please comment:  Share your experience with acne and skin health.

Saving Face

The quick answer:  Your skin can’t stay young forever—time will have its way.  But there’s no hurry to get old either.

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The Last Reunion

I recently escorted the beautiful wife to her 50^th high school reunion.  She had been the senior class treasurer, winning with the unbeatable slogan: “Don’t be square. Vote for Clare”. There was a memorial of yearbook photos of those who had died—a surprising number.   Those who attended looked pretty good—but people whose life has gone poorly don’t attend reunions, do they?  These smiling faces were life’s survivors.  There was a ritual to meeting one from so long ago: first they would look at each other’s face, wondering if they had been friends; then they would check the name badge, but still not be sure; finally, one would begin to speak and the old personality would emerge, not so much changed by the years, and they would laugh and hug each other.  You couldn’t watch without smiling.

The outward signs of aging intrigued me.  From a distance the stooped posture caused by osteoporosis was the first sign.  For the guys, the ability to grow hair was the next tip.  Close up, the evidence was right there in the face.  The healthiest had just a few lines around the eyes, but others had the deep grooves and pale sagging skin that comes with years of wrong living.  If you never write a memoir, leave a picture—the face will tell your story.  The beautiful wife, I should note, looked radiant.  On the way home she was pensive, sad for those who had died, yes, but more for those whose dreams had died. All in all, glad to have come, but ready to call it the last reunion.

Skin

Your skin is not just your largest organ, weighing around 8 lbs., it provides all these functions, and more: 

• Protects against the bangs and bumps of life,
• Is a barrier against invading pathogens,
• Insulates (with the help of a fat layer) against the cold,
• Keeps moisture in, but sweats a little out when you need cooling,
• Is self-renewing; the outermost cell layer changes monthly,
• Changes color, by producing melanin, to protect against summer sun,
• Acts as a solar battery, receiving radiant energy from the sun to make vitamin D and other products.

Extrinsic Choices

Skin health reflects two forms of aging: intrinsic, fixed by our birth heritage, and extrinsic, the result of lifestyle choices.  There’s a cycle at work: health typically peaks in our late 20s and then begins the inevitable decline.  Because few work on their health before 30, our focus is to slow the decline after we’ve peaked. 

Skin ages as collagen (the main protein in our connective tissue; the source of gelatin when you make stock) output slows, and elastin (the elastic, fibrous glycoprotein in connective tissue) degenerates with time.  In this way the skin grows thinner and loses its youthful color, wrinkles form and deepen, and gravity has its inevitable way. 

Shakespeare made a word picture of this process when he observed how, “rosy lips and cheeks within [Time’s] bending sickle’s compass come . . . .”  But it’s not necessarily bad; Shakespeare was praising the love that grows with time.  A new form of beauty is found in the weathered face of those who've lived well—when comeliness matures into character.  The pictures above are of my Father; they're bookends, taken at the edges of his manhood.  Handsome in the beginning; at the end his face oozed character.  And those wrinkles—they’re packed with wisdom.  

Slowing Time’s sickle

Still, despite the benefits of old age, there’s no need to rush.  The aging of skin is hurried along by excess sun exposure, the use of alcohol or tobacco, overuse of harsh soaps, the modern diet of processed foods, lack of exercise, excessive stress, and too little sleep.  Here are ways to slow down Father Time:

1. No toxins:  Avoid the use of tobacco, and don’t drink alcohol.  In different ways, they’re both bad for your skin. Ditto for trans fats.
2. Exercise:  Aerobic exercise increases the flow of oxygen and nutrients, while stretching exercises tone the peripheral muscles.
3. Reduce stress:  We talked about managing excessive stress here.  Happiness is the antidote to stress.  A smile lifts the muscles of your face; laugh away your cares.
4. Get adequate sleep:  Discussed here.
5. Eat a varied diet of whole foods:  The key here is to eat natural foods rich in vitamins, minerals, fiber and antioxidants.  Include sources of omega-3 fat as discussed here.

Yes, I know, I didn’t mention avoiding sunshine, or the use of sunscreens.  It’s critical to avoid sunburns as well as excessive unprotected exposure.  But as noted here and here, we also need natural vitamin D and full spectrum light.

Healthy Change:  I had a backpacking buddy when I was a bit younger; a person I admired, so comfortable in his own skin.  I have great memories of our ascents on Sierra peaks.  But he was taken from us too soon, by melanoma cancer.  So this Healthy Change is dedicated to his memory:

Please comment.  Got a secret lotion?  Share what works for you to protect your skin.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Aunt Kate’s Chili Sauce

The quick answer:  Every family has favorite recipes that have been handed down; sometimes there's a story attached.  But first, a caution about supplement pills.

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A Brief History of Supplements

Has any nutritional discovery captured the public fancy quite like vitamins?   You may not remember, it started a century ago, but there was magic to vitamins—lives could be saved by taking a tiny quantity of these vital molecules.  Vitamins led to the false idea that a single nutrient, captured in a pill, could remedy a deficient diet.   Vitamin supplements became a business, a big business, using factory-made versions packaged as pills.  

Today many take vitamin pills as an umbrella insurance policy against poor eating habits, thinking it can’t hurt.  So that’s the question:  Can vitamins taken outside of a doctor’s care be unhealthy?  The answer may be yes.  A study in the prestigious English journal Lancet found that people who take multivitamins felt justified to eat fast food, or exercise less.  

A couple of years ago the N.Y. Times ran a cautionary article titled, “News Keeps Getting Worse for Vitamins.”  The article summarized recent studies and questioned the non-prescribed use of vitamins.  This week the N.Y. Times ran another article, “More Evidence Against Vitamin Use.”  This article referred to two new studies:

Prostate cancer:  A 35,000 man trial of vitamin E (400 IU) and selenium (200 ugm) supplements against prostate cancer was stopped in 2008 when it appeared the supplements might actually be causing prostate cancer.  Further follow-up, just released, showed 17% more prostate cancer among those getting the supplements. 

Recent large studies have demonstrated that the current model of PSA screening and biopsy don’t reduce prostate cancer mortality.  Worse, they add a lot of mental and physical suffering for no clear benefit. This post advised that "the best protection (against prostate cancer) is prevention through lifestyle reform."

Supplements for women:  A recent report in The Archives of Internal Medicine on 38,000 Iowa women studied for 19 years, revealed “a higher risk of dying for women using multivitamins and other supplements compared with women who did not.”  Only calcium supplements were associated with improved mortality.     

If I had a health condition and my doctor prescribed vitamin or mineral supplements, I might ask a few questions but I would follow his or her guidance.  Otherwise I follow our earlier post where we discussed vitamins and suggested the best source was the traditional way—through a varied diet of vegetables, fruits, nuts, whole grains, and a little meat.      

Skeletons in the closet

We were just up in the Rocky Mountains of Utah, enjoying the fall season.  The beautiful wife decided to make chili sauce using a family recipe and the old farmhouse was soon filled with fragrant odors.  At the end of the summer, tomato vines are full of partially ripened tomatoes that will just rot.  As a kid, I found them useful for throwing on Halloween, but you can also make them into chili sauce.  It helps if you have some apples lying around.  Everyone loves this chile sauce.  It’s good with meat, you can use it in 1000 island dressing, and I always have it with omelets.  Whenever we have it, I think of Aunt Kate.

Got any old skeletons in your family closet?  Here’s a story, but I’m keeping our skeleton out of sight.  The Depression was pretty hard for my Mom and her widowed mother; they barely got through it.  Fortunately they lived near a strong woman we all remember as “Aunt Kate,” though she was actually a great-aunt to me.  Aunt Kate looked out for my Mom, shared the milk from her cow, made sure they had food in the house, and was like a second mother.  “The only problem,” my Mom recalled about her second mother, “was if I did something wrong, I heard about it twice.”  It worked, I believe, for Mom is a very good woman.

A family tragedy happened during this time—so terrible it was carried in newspapers all across the country.  That’s about all I’m going to say.  It involved a sister of Aunt Kate and when Kate went over to offer condolences, well, things got out of hand.  Maybe Aunt Kate made the mistake of saying something like, “This wouldn’t have happened if you’d followed my advice.”  I really don’t know what she said, but her visit so upset the sister that a bad fight broke out and they both wound up in front of the Justice of the Peace.  I said Aunt Kate was a strong woman but her sister was too, and given the tragedy that had happened, the judge took sympathy with the sister.  His judgment against our saintly Aunt Kate was unbelievably harsh:  six months in jail. 

Kate was so shocked and angered by the injustice of it all that she just threw a fit.  Women may be sweet on the outside, but they have a fire within.  Have you ever seen a wronged woman in full rage?  For the poor judge, I think, it was like looking into an active volcano and he began to backtrack.  “Sentence suspended,” he offered, “if you’ll all just stay away from each other.” 

And that’s what happened.  Like boxers, each sister retreated to her corner of the ring and they never spoke again, as far as I know.  It affected everyone; the children and grandchildren didn't socialize either.  Nearly three generations have passed and we’re just now getting acquainted.  One cousin lives near me; she’s a delightful person and it’s a pleasure to get together, though there is the sadness for the lost years.  But not all was lost—Aunt Kate left us her recipe for chile sauce. 

Aunt Kate’s Chili Sauce Recipe

Ingredients:

12 large peeled tomatoes

12 peeled apples

3 large yellow onions

3 green peppers

2 stalks celery

1 pint apple cider vinegar (Vinegar provides acid essential to this method of sterilization.)

¼ cup salt

2-1/2 cups sugar

1 tsp each of ground mustard, black pepper, ground cloves, and ground cinnamon

Directions:

• Grind tomatoes, apples, onions, and celery and place in a heavy pot.  (If tomatoes are very juicy some fluid can be set aside and added later, if needed.)  Bring to boil and simmer 40 minutes, stirring as needed.
• Add vinegar, salt, sugar, and spices.  Simmer 2 hours at low heat, or until desired consistency, stirring every 15 minutes to avoid scorching.
• Sterilize canning bottles in dishwasher.  Ladle hot chile sauce into bottles and seal with fresh lids sterilized in boiling water.  Lids will “pop” when they seal.

Please comment with recipe requests or ideas.  Brook Andreoli just sent 86 pages of “tried and true” nutrition recipes from her nutrition and cooking club.  Thanks Brook; we’re working our way through them and hope you’ll let us post some.  And we have a backlog of other recipes readers have suggested.  We’ll test them all and share our favorites.