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Nutrition and Chronic Disease
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Nutrition and Chronic Disease - April 21, 2005 4:02:00 AM
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JLS_PT_OCS
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This is a thread to discuss the role of nutrition in the treatment/prevention of chronic disease.
This topic, especially the topic of a Vegan (strict vegetarian, meaning no animal products including dairy and eggs) diet came up in another thread.
It is so controversial, and the true research findings so confused by industry and government lobby groups, that it rates it's own thread.
Here is the quoted discussion that started it:
CoreConcepts wrote:
Jason,
I am going to continue our vegan/health benefits discussion on this thread. Here was your last thought on the subject.
"Briefly, a vegan(whole foods, plant-based diet - no meat or dairy products/eggs) has been shown to reduce both the incidence and the progression of CAD.
There are volumes of evidence for this in terms of epidemiological studies, and some significant evidence in interventional studies.
Exercise alone has not been shown to be beneficial for CAD.
Your statement about a vegan diet not reducing risk factors is curious. Surely consumption of saturated fat is well known as a risk factor for CAD, and a vegan diet reduces that. Epidemiological studies show that those on a mostly vegan diet have extremely low rates of CAD, even when they are relatively inactive.
Hey, I'm all for exercise, too, but we shouldn't oversell it if the research isn't there, right?"
My take is this: It is very difficult to establish that vegan/vegetarian diets are exclusively attributable to reducing disease risk such as cardiovascular disease, blood pressure, blood lipids, etc. This is primarily due to the fact that there is such a wide range in terms of how vegetarians eat and live. Are any of these "numerous epidemiological studies" you meantion in the absence of other lifestyle changes such as exercise? It has been well documented that vegans/vegetarians generally exercise far more and smoke far less than do non-vegetarians. Conversely, you could still technically be a "vegan" and eat refined carbohydrates, sugars/pastries and other snacks high in trans fats. This would obviously negate any advantage to a diet low in saturated fat. In terms of exercise... I agree, exercise alone is often not sufficient, but I maintain that neither is diet alone if you are sitting on your duff all day. It takes a holistic and often aggressive approach to reverse the course of certain dieseases.
Numerous studies show important and quantifiable benefits of the DIFFERENT COMPONENTS of vegetarian diets, namely the reduction of risk for many chronic diseases and the increase in longevity. The components in question are vegetables and fruits (which have independently been shown to reduce the risk of many diseases). Whole grains are also valuable components of a healthy diet.
So let me put this I'll put this question out to you - Do you not think that one who is active could achieve the same health benefits as vegan's/vegetarians if one ate adequate vegetables/fruits/whole grains but also enjoyed meat? What I am getting at is that the absence of meat per se, is not the key factor here - it is the high consumption of veggies, fruits, whole grains, heatlhy fats and exercise.
"Surely consumption of saturated fat is well known as a risk factor for CAD, and a vegan diet reduces that".
Perhaps, but the evidence here is remarkably scanty. The proposition that dietary fat is unhealthy is based on the fact that high intakes of saturated fat elevate cholesterol and thus increase the risk for atherosclerosis, which in turn raises risk for CAD. Having said that, the link between high cholesterol and CAD is FAR stronger than the link between high saturated fat intake and high cholesterol. Also, saturated fats are FAR from the only cause of heart disease, which is multifactoral. In fact, the results of studies on the etiology of HD are inconclusive at best and contradictory at worse. Many other factors are likely more culpable in causing HD - lack of exercise being a big one, family history, high glycemic carb intake, CRP, Homocystene, smoking to name a few. Moreover, a high intake of saturated fat is will only raise cholesterol in the presence of too many calories. This is the one of the Atkins deceptions - people on Atkins eat less calories, therefore the cholesterol levels don't change and actually improve in some cases.
To summarize - vegetarian/vegan diets (when practiced without high intakes of refined carbs/sugar/trans fats) can be very effective when combined with other lifestyle interventions. No more effective, however - than a diet with moderate amounts of meat if the veggie intake is the same.
****************************************
I replied:
In fact, it is exactly the consumption of animal protein that is the problem, and not necessarily the fat or cholesterol. They are only useful in that they can somewhat correlate with animal protein consumption.
A strict vegetarian diet (less than 5% animal products to include dairy and eggs) is associated with remarkable reductions in health risks, including CAD, even in the most INACTIVE populations.
You are right in that these effects are difficult to measure in any population due to the multiple factors and difficulty of following a cohort.
A recent study, called the China Study, has recently been completed. It has been referred to as "the grand prix of epidemiological studies" and it's findings are currently being published in numerous peer-reviewed publications.
[URL=http://www.thechinastudy.com]www.thechinastudy.com[/URL]
- website is extensively referenced in the literature.
I will be happy to post some of the studies to support these points, as I am sure everyone is saying what I said two years "why didn't anyone tell me this before? or how can this be true?"
Ask the powerful meat and dairy industry lobbies.
I used think the Vegan thing was some granola tree-hugging hippie foolishness, but when I actually sat down and applied the same critical thinking and evidentiary standards to this that I do to research in exercise science and physical therapy, I was astounded. Not to mention shocked.
Jason.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 21, 2005 4:14:00 AM
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JLS_PT_OCS
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Measuring these effects...
It is hard to control all the variables in human health, and nutrition research especially has to contend with many uncertainties and confounding factors.
We currently study nutrition the way we study drugs...we take one component of a program or one nutrient, add it to a diet, and note the effects. By only changing one small nutrient or portion of the diet at a time, we are supposedly being "scientific" and reducing bias. However, what we really end up doing is making such small changes that no effects are noted. This fuels the fire for those who say that no nutritional changes will change your health outlook. But poor research design is to blame.
Recently, in the physical medicine research, we have begun to think about "classification" based treatment and promoting 'intention to treat' designs that expose patients to a course of treatment the way it actually would be done in the clinic. Then, all of a sudden, the reseach results change, and larger effect sizes are noted.
If you break down the therapy treatment into enough small parts, no change will ever be noted.
For example, let's take a program of lumbar stabilization exercise for lower back pain. It's efficacy is well documented in the research literature.
How about we take 4 different groups, and study this: one group gets hip stretching exercises, another gets transversus (TrAbd) work just in supine, another gets TrABD work just in standing, another gets a prone Multifidus isometric. Do you expect any differences between groups?
Of course not. While all of those are a component of a very successful intervention, if you break it down and just use tiny component parts, you will never understand or see the effect size.
The same can be said for nutritional research.
You cannot have everyone on the same basic program, change a vitamin here or a couple of vegetables there, and expect to see a change. It is unrealistic and flawed at it's basic level.
The Harvard Nurse's Study is a great example. Everyone in that study was basically on the same generally poor diet and fitness program. They changed a few things here and there, and tried to see any changes. What do you think they found?
You're right. No dietary or exercise effect was found for ANY intervention. You can see the basic flaw here. That is as true of nutritional research as it is for physical medicine research.
This new and enormous epidemological and interventional study, The China Study, answers just those questions.
It was performed with impeccable research design and it's findings are being published in major peer refereed journals even now.
But don't take my word for it. Buy the cheap book and start pulling up the EXTENSIVE references therein.
Look hard and find out for yourself.
You'll find when you apply the same standard of evidence and research rigor to nutrition research as we do to physical medicine research, the results are quite clear.
Good luck.
Jason.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 21, 2005 6:49:00 AM
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coreconcepts
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Jason,
Excellent post. What I hear you saying is that nutritional research is short-sighted, meaning we are changing variables which are too small to promote significant change in disease risk. I have to agree. We live in a faddish society - one that is marred by deceptive advertising and junk science. We do need to look at diets more holistically then we currently are. No one food will heal just as no one food will harm.
It is no secret that the North American diet needs a massive overhaul. Realistically, however, change needs to take place slowly and gradually for most individuals. From a preventitive standpoint, I think adding a serving or 2 of veggies per day and replaceing pop with water and adding some exercise will do wonders in preventing many diseases.
My opinion is that there are various avenues towards optimal health. I think the pendulum has swung to various extremes when it comes to dietary "ideals". I can do neither the vegan thing nor the Atkins thing. I have no problems with people who follow those diets, but I have a problem with them telling everybody else they should eat that way (like the "vegan taliban" PETA and Atkins Nutritionals). I think if people ate well 80% of the time, and saved the other 20% for indulgences - we would all be a much healthier population. I realize that our perceptions may vary considerably as to which foods should be categorized where, but we can all agree taht eating a variety of whole foods is central to any diet.
As for the China Study, definately know of it and am familiar with some of its hyptheses. Will certainly read the book and browse the website for more detailed analysis.
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Re: Nutrition and Chronic Disease - April 21, 2005 7:54:00 AM
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coreconcepts
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A few more thoughts as I had to step out...
It is difficult to compare different dietary strategies/fads/methods/guidelines against each other due to the aformentioned variability within each. I think that with any "diet" or "guideline", there needs to be some leeway and room for substitution - provided the substitutions are reasonably healthy. In short, there is no one "perfect" guideline for anyone. Food preferences, ethnicity, culture, allergies, belief systems/religion, socio-economics and geography all play a part in what we eat. Our Canada Food Guide (almost identical to your food guide pyramid) is good, but there continues to be fundamental flaws such as; a lack of differentiation when it comes to carbs and fats. For example, there is no strong emphasis on eating whole grain carbs in favour of refined grains. Also, all fats and oils are lumped together, as though they are all bad for us. Studies have shown that most diets do promote weight loss if (and that's a BIG if) people stick to them. To use the Atkins example again, you WILL in fact lose weight on this diet. The weight, however will be mostly water and glycogen. After a year, there is no significant difference. The key factor in that study (which Atkins followers gloated over, but diliberately don't mention) was the substantial 50% drop-out rate in the Atkins group. At the end of the day, no matter how healthy or effective Atkins apoplogists claim it is - the diet remains unreasonably restrictive and nutritionally deficient. WRT vegan diets - again, I am all for it if you can stick with it. (Emphasis on that last point). I applaud Dean Ornish for his efforts and his demonstrating that you can, in fact reverse CAD. His plan, however is also restrictive (even he now admits that there is no reason to eliminate or restrict nuts and other "healthy" fats). He also recommends exercise, prayer and meditation (you will need lots of prayer if you follow this plan!). Further, with vegan diets you do have to be especially careful that you are getting enough nutrients (B12 as an example).
Just wondering Jason, are you a vegan? If so, what differences have you noticed in yourself since you became one?
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Re: Nutrition and Chronic Disease - April 21, 2005 9:39:00 AM
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coreconcepts
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The following are some interesting nuggets on nutrition/disease, epidemiology, sports performance, joint heatlh, supplements etc. presented by various nutrition experts and researchers.
Sherry Ogasawara, RD
- Review of 200 studies on relationship of fruits and vegetables and risk of various cancers finds there is no magic fruit or vegetable (that one is for all the "mangosteen juice" distributors).
- People who eat higher amounts of produce have half the risk of cancer
- The average American eats 1.5 veggies and less than 1 fruit per day.
The rest of these are as summarized by Chris Shugart of T-Nation Magazine.
Liz Applegate, Ph.D.
- Eat more fiber: at least 25 grams a day for women, more for men. Most people only get 10-15 grams per day. Eating more fiber at breakfast leads to eating less calories at lunch.
- Eat only yogurt with live cultures (healthy bacteria). Try kefir too, which is apparently some type of liquid yogurt stuff.
- Eat two and a half quarts of fruits and veggies a day. Yep, the recommendation has gone up from five to nine servings a day. Get plenty of deep green leaves and give pomegranates a shot.
- Eat more fish and flax.
- Choose low GI (glycemic index) foods pre-exercise and most other times, but eat/drink moderate GI foods like sports drinks during exercise.
- Low GI equals low hunger.
- Adding lemon juice to foods can help lower the GI.
- The best post-workout solid food to help with recovery is a sandwich according to Dr. Applegate. Choose whole grain bread, a lean meat and adds tons of veggies. About 40-80 grams of carbs and 10-20 grams of protein is about right.
- Two must-use supplements: calcium for women and a multivitamin.
- Forget the myth that "the water in sodas and coffee doesn't count because of diuretic effects." This isn't true. (Dr. Lowery and I recently discussed this too. He agrees for the most part.) However, you can't count alcohol.
Nutrition for Joint Health, Dr. Kristine Clark, Ph.D., RD, FACSM
- It's a myth that running breaks down cartilage. It's not as simple as wear and tear. Usually, it's a very slow catabolic process.
- Look at your shoes. If they're worn down unevenly, you could have joint problems.
- The fatter you are, the higher your chance of getting osteoarthritis (OA). Losing just a little excess fat could reduce surgery of the knee in OA cases by 24%.
- About 1200-1500 mg of glucosamine and chondroitin sulfate appears to be an effective dose. However, it must be used daily for at least three months to see results.
- 84% of glucosamine/chondroitin supplements on the market don't meet label claims. In all fairness, some actually contained more active ingredient than what the label claimed, but you'd better do your research before buying these products.
- Ten grams of collagen hydrolysate shows cartilage regeneration in 4-6 weeks.
Review of Popular Weight Loss Supplements, Laura Kruskall, Ph.D., RD, FACSM
• Chitosan peddlers claim that it "traps dietary fat" and prevents it from being absorbed by the body, but studies have shown that it traps an insignificant amount or none at all. Researchers often pick through stool samples in these types of studies looking for globs of fat. And you thought your job was ****ty.
• Chromium picolinate is an essential trace element, but it's been shown to have no affect on body composition. Might be good for type II diabetics though.
• Carnitine doesn't work for weight loss, but it might be good for heart patients.
• Conjugated linoleic acid (CLA) has strong animal data regarding fat loss, but doesn't seem to do much for humans. More research needed.
• HCA seems to suppress appetite in animals, but human studies have been mixed. Skip it.
• Green tea (ECGC plus some caffeine) does seem to lead to a little fat oxidation and increased energy expenditure if you drink five cups a day. The studies are looking good, but the data concerning the amount of active compounds is lacking.
These studies were done with whole leaf tea, not those green tea pills you may have seen. No one knows yet whether the pills offer the same effects. Overall, green tea might be good for a dieter, but there's not really enough info yet.
• People who have higher calcium intakes have lower rates of obesity. Those who consumed calcium containing foods (three servings a day) showed more abdominal fat loss than those taking calcium supplements. Low fat dairy is recommended.
CDC's Response to the Obesity Epidemic, William Dietz, MD, Ph.D.
• Japan spends half as much as the US on health care, but the Japanese have a better life expectancy than Americans. Why? Americans are fat and most Japanese aren't.
• 13% of a teenager's caloric intake comes from soft drinks. I say that teens need 100% of their asses kicked for drinking that much **** pop! They need haircuts too. (Yeah, I'm officially old now.)
• Breastfed babies are less likely to become obese.
• White men are the least obese. Black women are the most obese. In teens, Mexican Americans are the fattest, but every group is getting fatter across the board. How's that for racial unity?
• Blacks watch over four hours of TV per day. Hispanics watch an average of three and a half hours, and whites watch just under three hours per day. Note how this corresponds to the obesity rates.
• 25% of obese adults were also obese children.
• To prevent a relapse after weight loss, you need an hour of exercise per day. It takes less than that to prevent obesity.
• Responsible schools should offer healthier choices in vending machine, move healthy foods to the front of the lunch lines, and increase PE time.
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Re: Nutrition and Chronic Disease - April 21, 2005 12:03:00 PM
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JLS_PT_OCS
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Interesting tidbits.
I don't know how much I agree with all of them, especially the "cartilage regeneration" one, was that a lab study or an in vivo study?
I agree that a Vegan diet (and yes, I'm a vegan) seems harsh to most people. I also think an hour of exercise a day seems just as harsh.
I don't think most people in the Western world would consider my (or your) regimen of diet and exercise even remotely realistic.
But to paternalistically (if we're both men :) ) declare that the average person can't think for themselves or won't do what we know by scientific inquiry to the best route, smacks of arrogance. On both our parts.
When a client comes to you, or a patient to me, do you tell them what YOU think they are likely to adhere to, or do you tell them what the optimal program is, and let them decide for themselves?
Hopefully your answer is door #2. I know mine is.
I think we have an ethical responsibility to be truthful with patients, even if the answers aren't what we like or what the patient is going to like. I tell people all the time that I don't get paid for telling them what they want to hear, I get paid for telling them the best available evidence for their individual case. Don't you?
After I tell patients what kind of exercise and rehab program/ frequency is best, we then discuss what THEY want to do. I don't start by treating people like children, deciding for them what kind of exercise or rehab regimen they are likely to follow. Now, I'm not saying you do that, I don't mean to be harsh, but many nutrition "experts" are doing just that. Again, I don't know you and you seem very intelligent and knowledgeable, so don't take that personally.
Ah, vitamin B12. I hear this quite often, and I understand where you're coming from here. B12 is found many places, usually in the dirt that fruits and vegetables are grown in. This is placed in the soymilk that I drink as well as in the vitamins I take, but it is also widely available in breakfast cereal, not to mention organically grown veggies. Which as you might have guessed, I eat a lot of. :)
I can think of two things that have really changed my health status and my overall well being the most. The first was exercising regularly, the second was becoming a vegan. I feel better, my digestion is better, I get sick less often, etc. These could all be placebo effects, however, in all fairness. I knew what I was doing was very healthy, so it may be that my brain just responded in kind.
Anyway, gotta go, but thanks for your interest as well as your thoughtful and well-spoken posts.
Jason.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 21, 2005 12:53:00 PM
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coreconcepts
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From: Vancouver, BC
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Jason,
Once again - thank you for insightful thoughts. To your question "When a client comes to you, or a patient to me, do you tell them what YOU think they are likely to adhere to, or do you tell them what the optimal program is, and let them decide for themselves?"
This is an excellent question. The answer lies somewhere in the middle as there is usually a varying gap between what strategies are "ideal" and what strategies my clients are willing to follow. (On a side note, we find the happy medium where the client will see results and not feel deprived, exhausted or miserable - this point is usually more towards the "ideal"). I certainly agree with your sentiments in that as professionals, we have a responsibility and a moral obligation to give our (patients for you, clients for me) the straight goods when it comes to courses of action and expctations. I think where we differ lies in the disparity between our professions. Where there may be an "ideal" course of action in many circumstances in rehab, there is likely more variance when it comes to exercise prescription and dietary recommendations. Having said that, certain outcome goals require certain purposeful actions on the part of my clients. I tell them "if you want outcome x, this is what it is going to take". From there, they will either give it a shot, or settle for slower progress. We will often try different strategies based on what the client is willing to/can do and break through obstacles as they come up and increase their adherance. Of course, there are certain aspects of the lifestyle plan that are non-negotiable - but there is some give in terms of some of the more minor details. I guess what I am trying to say is that psycho-social and behavioural factors influence my course of action moreso than yours. I have the luxury of having more options that way, whereas particular interventions based on careful and specifc evaluations may dictate a more specific plan of action.
By the way, that's great that you've found a way of life that has endowed you with more vigor and less sickness.
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Re: Nutrition and Chronic Disease - April 21, 2005 1:00:00 PM
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JLS_PT_OCS
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I see your point, but I think, especially nutritionally, there are clear answers now. I would give a person the best option, then talk about how realistic that is for them.
The person's answer may lie somewhere in the middle, but our suggestion should always be the most ideal, don't you think?
Yeah, I "feel" better, but who can say if it's the diet or my brain?? In all fairness, placebo is just as likely as far as something as amorphous as "feeling better".
The health effects in terms of chronic disease however, are the result of the diet.
I'll post some articles soon.
Thanks
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 21, 2005 5:47:00 PM
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Lukey
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Jason,
May I ask, how long have you been vegan?
Luke
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Re: Nutrition and Chronic Disease - April 21, 2005 6:27:00 PM
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Diane
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[QUOTE]B12 is found many places, usually in the dirt that fruits and vegetables are grown in. This is placed in the soymilk that I drink as well as in the vitamins I take, but it is also widely available in breakfast cereal, not to mention organically grown veggies.[/QUOTE]Jason, this is the first time that I ever heard of B12 being available in anything but animal products (esp. red meat) or fermented soy (tempeh or miso). Do you have a link or a study I could read on this new (to me) info?
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Re: Nutrition and Chronic Disease - April 22, 2005 4:19:00 AM
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JLS_PT_OCS
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From: USA
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B12 is found many places, and animal products are only one such source.
It's kind of like vitamin D, your body makes it when exposed to sunlight, but it is also widely supplemented in (of all things) dairy products. There is some research to support the notion that many vitamins do not work in the body the same way if they come in as supplements, but that's another story. :)
I have been a vegetarian for 2 years, and a vegan for about 6 months. Coincided with when I read the research about the terrible health effects of not just meat, but animal protein in general. I only changed when there was such a volume of convincing research to prove the case.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 22, 2005 5:05:00 AM
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Lukey
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Jason,
I don't want to be a downer as a vegan diet does work for some people, but you are in the 'honeymoon' period of veganism.
I have had extensive experience with vegans as a nutritionist, friend to dozens of former vegans, and a former vegan myself. I know only 2 vegans out of more than thirty who are still healthy after 10 years.
Most people feel wonderful, clean and light for about 2-3 years. Then men usually start to look a bit on the skinny side, if they aren't ploughing into refined carbs and heaps of fat which of course gives them a kind of weak flabbyness. Women usually don't lose a lot of weight, or they actually gain, but menstrual problems and lethergy is common. For some people the changes start faster. Digestive problems (bloating and gas) and mineral deficiency symtoms, from a high intake of fibre and phytates, becomes 'normal'. Many people (inluding myself) describe a brain fog that comes on so slowly that you don't realise its there until you start eating animal protein agian.
I nearly killed myself on a vegan diet when I was 25, despite the research (and my vegan diet was 'perfect')
If you start to feel that things aren't quite right in a little while, please add few eggs and a bit of fish and organinc chicken back in your diet. I promise you with be healthier that all the stubborn sickly vegans out there.
Luke
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Re: Nutrition and Chronic Disease - April 22, 2005 5:36:00 AM
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JLS_PT_OCS
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From: USA
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Wow.
I think your heart is in the right place, man, let me say that first off. I appreciate your concern and your willingness to help.
But I think your citation of anecdotal evidence and use of broad generalization is not a good way to convince anyone of anything.
I think us Americans especially are so arrogant when it comes to how we do things that we are unwilling to see the benefit of other approaches, even when the evidence is right before our eyes.
This is nothing about you pesonally, Luke, and I do appreciate your concern.
How do you explain the fact that a significant portion of the world's population is either completely vegan or like me, about 98% vegan?
How do you explain world class athletes who are vegan and have been for many years?
Did you see the movie "Spider-man"? You remember how Toby McGuire looked with no shirt on? He's a vegan and has been for several years, did that seem sickly to you?
How about Shaolin monks from china, you know, the Kung-Fu guys? Seen them in action? Like all chinese buddhists, they are vegan.
But you see my point about anecdotal evidence. For every sickly person you show me, I can show you a healthy person.
But the available research (sorry, forgot my book today, will post next week) supports that people live their whole lives on this diet and do so very successfully. Even athletes.
Our culture has so successfully pushed dairy products and meat on us that we are programmed to think it is necessary and healthful.
But there is now conclusive data that it is not.
Like anyone who starts on something and sees positive results, I have acknowledged that much of the good feelings may purely be placebo, maybe even all of them. But the risks of chronic disease are very different than than such generalized "good feelings".
The findings in quality research do not lie, especially a study this big, and this well done, on so many levels.
Thanks for your concern and your interest, I do sincerely think you are trying to help, and I appreciate that.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 22, 2005 8:26:00 AM
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coreconcepts
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Jason to answer your question (a few posts ago), although there are generally clearer answers now when it comes to nutrition, I feel that specifically, there are many options within the realms of healthy eating. As an example - don't eat too much, cut back on refined grains, eliminate trans fat, reduce saturated fats while increasing omega-3 fatty acids, eat more vegetables and fruits, whole grains and exercise. These are general guidelines, and I feel it important to not be too rigid in terms of the specifics - in other words, no need to micromanage. We have such amazing variety when it comes to healthy food choices that I would have a hard time pinpointing an "ideal" way of eating. As an example, if a client loves steak, burgers, pasta dishes, etc. I would advise he/she to choose one of those dishes and eat them once a week, rather than 3 times a week as they are used to. I would honestly have to see some substantial literature correlating moderate amounts of meat with anything negative to change that recommendation for my clients (or myself for that matter). I guess the point is that it is all relative, and in my experience - slower, gradual changes work far better in the long run than do drastic ones. Instead of telling someone who eats dessert every night to stop eating any sugar, I will suggest eating half of what they currently eat and on 3-4 days out of the week rather than 7. Will this impede their progress? In the short term, perhaps. But over the long haul, I believe it to be more effective.
Another example is exercise... I would like to see a certain amount of accumulated, intentional movement over the course of the week. I personally do not car how it is performed so much as I car THAT it is performed.
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Re: Nutrition and Chronic Disease - April 22, 2005 11:23:00 AM
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srcase
Posts: 551
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From: Michigan
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Jason,
Just wondering....were you implying a few posts back, that you give your patients nutritional advice??
Sarah
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Re: Nutrition and Chronic Disease - April 22, 2005 1:37:00 PM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Core-
Good post, totally agreed, a sensible, slow approach is needed for everyone, and there is a range of healthful eating.
I am by no means advocating that everyone adopt a vegan diet immediately.
Just that we should be giving advice based on science and not on what we think they are likely to do. The art of both our jobs is that we need to match our education and available research with the patient/client's needs and desires.
Sounds like you are doing just that, and that's great!
Sarah- Sure I do. Don't you? I don't design diet programs for people or advise them on what to eat for treatment of a medical condition such as renal insufficiency or diabetes, I don't set up diets for weight loss purposes, either. I refer to dietitians for all of this. But if someone asks me if drinking more milk will help them heal from their stress fracture or recover from their ORIF, I tell them no. If someone asks how much protein they should be eating to help build muscle while they are doing their rehab program, I tell them. If I have the information, why wouldn't I? I don't pretend to be a dietitian (we have excellent ones to refer to), but I do know and can advise about how certain nutition choices might impact their rehabilitation or recovery. I summarize the current research on things like creatine and glucosamine for interested patients also.
I thought anyone would do that, though...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 22, 2005 10:17:00 PM
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Lukey
Posts: 180
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From: Australia
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Jason,
I'm glad you took me in the right vein. I know how touchy this subject can be. I just get a little squirmy when I think of someone going through what I and many friends went through. Yes, I know anecdote is not ideal but it's good to be aware of possiblities.
I have a ethical idealist streak in me and I was disappointed when I realised I would not survive as a vegan. I really hope it works for you, but please be aware that many bodies just aren't made for it.
There are a lot of myths perpetuated by both sides of the meat vs no meat debate. And as you know, 'research' can often show exactly what the researcher wanted it to. Was this study comparing a vegan diet to a population eating the typically gross amount of poor quality, grain fed meat common to a standard American diet? Did the study control for factors such as other typical differences in lifestyle between people who chose a vegan diet and people who don't question their lifestyle habits at all? Was there a group included who eat a diet high in fresh fruit and vegatables, nuts, some grain and organic/game meats, with no poor quality dairy, trans fats and refined sugars? I learned subjectively that the research you are referring to didn't apply to me. I hope that it does apply to you.
One question. "a significant portion of the world's population is either completely vegan or like me, about 98% vegan". Really? And is this 'data' vegan by circumstance or by choice. What are the longevity and morbidity rates of vegans in the third world, which I'm sure make up the bulk of the population this refers to? By the way, even chimps are below 98%; in the dry season they eat up to 65gms of monkey per day! Human ancestors have been eating meat for about 3 million years, which is plenty of time to adapt. I don't think there is a single traditional culture that was/is 100% vegan. I'm sure that we will have to evolve again to thrive on an agrarian diet, and the way we are treating the planet probably even a synthetic one - God forbid. But it won't be my genes that participate in this ;-D
Oh, and no offence taken - I'm not American.
Luke
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Re: Nutrition and Chronic Disease - April 23, 2005 4:50:00 AM
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Diane
Posts: 1480
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Jason, about the B12 thing, do you have a link or a study I could read on this new (to me) info? About B12 found in veggies etc?
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Re: Nutrition and Chronic Disease - April 23, 2005 6:22:00 AM
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Synergy
Posts: 589
Joined: March 11, 2004
From: Forney, TX
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Diane,
Here's a pretty decent link to what you may be seeking. I will be the first to admit that I need a little "brushing up" on my nutritional education. I did find something within this article that Jason may or may not know about. In the 'Dietary Sources' section, it stated that most reliable sources of B-12 are in meats, dairy products, and eggs.
However, there's evidence that it is also present in plant food sources such as Spirulina. The author goes on to say that the plant food sources of B-12 can be misleading in that the B-12 present is merely an analogue, a compound structurally similiar to B-12, but not quite the "real deal". These analogues may actually be harmful to the body and may increase the risk of B-12 deficiency.
Anyways, just some interesting tidbits. :)
[URL=http://www.vegsoc.org/info/b12.html]Vitamin B-12[/URL]
_____________________________
Chris Adams, PT, MPT
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Re: Nutrition and Chronic Disease - April 23, 2005 6:57:00 AM
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Diane
Posts: 1480
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Thank you Chris. This info is congruent with my current knowlege base on the matter. My understanding is that spirulina is sort of in between "plant" and "animal" catagories because it is such a primitive organism, which is why it is touted as having B12 that "works" (but not according to this source..). I'm sure Dorian Sagan ("Microcosmos") would have an opinion about that. How gross, that the B12 from veggies is from the manure used to grow them, and careless washing. Yum.
About veganism, been there, done that (7 years), gained weight. Back to eggs, salmon (wildcaught) and chicken and beef (organically raised), once in a long while, extremely well-cooked pork, and lots of salad, veggies, fruit, low fat dairy.
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