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Re: Nutrition and Chronic Disease
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Re: Nutrition and Chronic Disease - April 28, 2005 2:31:00 AM
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Sebastian Asselbergs
Posts: 1117
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From: Barrie, Canada
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Jason: "But I would venture to guess that no one here smokes. "
You have OBVIOUSLY not seen my golf drive off the ninth tee - straight into the parking lot...
I like the points you folks have made, but especially the "be careful and slow approach"; the individual variations of metobilsms are so significant at times, that any dogmatic approach is guaranteed to fail in at least a good number of people - and even be harmful. The risk of doing harm is so much greater when a professional like a PT or chiro or MD is touting a "medically sound" new fad nutritional programme (diet) - patients are almost as likely to be influenced by them as by the "famous- people-are-doing-it-and-see-how-they-look" marketing...
Great thread.
BTW: "Midnight Oil" - Diesel and Dust album - rocks! And Oz needed that after the BeeGees and Olivia (sweet, but....)
The list of references and links are very interesting and helpful.
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Mundi vult decipi
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Re: Nutrition and Chronic Disease - April 28, 2005 2:33:00 AM
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Sebastian Asselbergs
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"metobilsms" - this is a new spelling of metabolisms as you probably deduced...Not a name for the inability to type with more than three fingers...
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Re: Nutrition and Chronic Disease - April 28, 2005 2:41:00 AM
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JLS_PT_OCS
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Luke-
Totally agree that diet is very personal and some people will respond differently to different things.
You mention cereal companies - actually I never said that companies have nothing to gain, I was talking about individuals promoting plant-based diets. The cereal industry is promoting a product, not a lifestyle, and their influence in agriculture is miniscule compared to the Meat and Dairy industries. But, like everything else, don't take my word for it, find out for yourself if you're interested. See how much money these groups contribute to political campaigns of individuals and the "education" of physicians and dietitians.
I appreciate again your anecdotal stories of the bad health consequences to be wrought by a vegan diet. I have to tell you, several years ago I once suffered quite a bit with seasonal allergies, and I found the more I ate pizza the better they got. Honestly. Should we recommend this as an allergy treatment, or should we dispense with the "I know someone who..." popular culture urban myths? People tell me they tried to exercise, but their knee hurt, so they quit. Should they just not exercise if it hurts their knee? What's the problem, the concept of exercise or the way they are going about it? Diet's no different.
I enjoyed the "research" I found on those sites you posted, they were full of personal opinions and claims of research proving this and that, but strangely (can't tell you I was suprised) there was a lack of published peer-reviewed evidence to support their claims. One site had even named certain "factors" supposedly found in animal fats after the authors of the site! And claimed extraordinary health benefits of same, again not supported by evidence. Amusing, and definitely kept me smiling. I think this illustrates well the confusing environment of health and nutrition information that plagues consumers.
I think advice to people such as "eat in moderation, stop worrying and get on with your life", while certainly common sense, are not consistent with available evidence on the etiology of disease. Certainly smoking in moderation sounds like a good deal to a smoker, but do medical authorities really recommend that? I think our Western (sorry to americanize it before, I rarely speak internationally :) ) culture includes diet, and to say anything bad about our diet is seen as some sort of refutation of culture. That is part of why so many people want to view diet outside the context of health and disease. They have a deep belief, conditioned since birth, that there is nothing wrong with their diet, and want to believe that some sort of simplistic moderation aphorism will save them. It is indeed sad that it won't. Both of our countries are in the lead in terms of Western diseases such as cardiovascular disease, colon and breast cancer, and heart attack. I think that should tell us a lot. It tells me that if I live like most of the people in my country, I will have the same disease profile. No, thanks.
I don't want to force information on anyone, or TELL anyone what to do. Like I tell my patients, I just want to make sure they have the most current scientific information, so they can make the choice that's right for them. If that's butter and beef, great. If it's tofu and vegetables, great. But our job should be to provide quality information, not opinions or stories of what happened to Uncle Morty who tried veganism one summer. Clearly, as PTs, we provide information that is pertinent to fitness and rehabilitation, pain management options, etc, but the principles are no different.
Luke, thanks very much for the ongoing discussion, I appreciate your interest, your insight and intelligence, as well as our courtesy together. It's so hard these days to find a place where people can disagree without being disagreeable, and I'm glad this is one of them. Have a great day.
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 28, 2005 3:11:00 AM
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JLS_PT_OCS
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The question came up about the effects of a vegan diet on incidence of health problems other than cardiovascular disease. Here are some research citations exploring the relationship with common cancers: breast, prostate, large bowel. I guess by now, I don't have to say that a vegan diet is associated with dramatic reductions in rates of breast, prostate, and colorectal cancer. Here is some solid evidence for that:
Wu AH, Pike MC, Stram DO "Meta-analysis: dietary fat intake, serum estrogen levels, and the risk of breast cancer." J. National Cancer Institute 91 (1990)
Pike MC, Spicer DV, Dahmoush L, et al. "Estrogens, progestogens, normal breast cell proliferation, and breast cancer risk." Epidem. Revs. 15 (1993)
Adlercreutz, H "Western diet and western diseases: some hormonal and biochemical mechanisms and associations." Scand. Journal Clinical Lab. Invest. 50 (Suppl.201) 1990
Heber D, Ashley JM, Leaf DA "Reduction of serum estradiol in postmenopausal women given free access to low-fat, high carbohydrate diet." Nutrition 7 (1991)
Boyar AP, Rose DP, Wynder EL " Recommendations for the prevention of chronic disease: the application for breast disease." Am J Clin Nutr 48 (3suppl) 1988
Jansen MCJF, Bueno-de-Mesquita HB, Buzina R, et al. "Dietary fiber and plant foods in relation to colorectal cancer mortality: the Seven Countries Study." Int Jour Cancer 81 (1999)
Trock B, Lanza E, and Greenwald P. "Dietary fiber, vegetables, and colon cancer: critical review and meta-analysis of the epidemiologic evidence." J National Cancer Institute 82 (1990)
Bingham SA, Day NE, Luben R, et al "Dietary Fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study." Lancet 361 (2003)
O'Keefe SJD, Kidd M, Espitalier-Noel G, et al. "Rarity of colon cancer in Africans is associated wiht low animal product consumption, not fiber." Am J Gastroenterology 94 (1999)
Lee ML, Wang R-T, Hsing AW et al. "Case-control study of diet and and prostate cancer in China." Cancer Causes and Control 9 (1998)
Chan JM, Giovanucci EL "Dairy products, calcium, and vitamin D and risk of prostate cancer" Epidemiol Revs 23 (2001)
Allen NE, Appleby PN, Davey GK, et al "Hormones and diet: low insulin-like growth factor I but normal bioavailable androgens in vegan men" Brit J Cancer 83 (2000)
Please don't take my word for it, you know I'm a vegan, so I'm biased. Buy the China Study, look up the relevant citations as I did, and make your own decision about what you want to do with your health. Look at the available evidence, for and against, and make the choice that's right for you.
The evidence IS out there...
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 28, 2005 3:40:00 AM
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Lukey
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From: Australia
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Jason,
Your final sentiments are reciprocated.
You must have ended up in different sites to the links I posted. The first two articles had over 230 peer-reviewed references listed. Just so you know, I didn't direct you to them with any other ageneda than to point out that there is another side to the story.
The anecdotes I give are not meant to be evidence that everyone must eat meat, they are only to make the point that the research you refer to may not be applicable to everyone (for various reasons). I think your knee analogy is perfect, which is why myself and many others have not continued to be vegan. You may be able to jog until you are very old.
You will note that my reference to moderation was made only after the suggestion that people discover for themselves the best diet for their body (whether this is in accordance with culture or not) and only once certain types of food had been completely eliminated. I don't know if the comparison with smoking is totally appropriate here. People generally don't knowingly eat poison. It is widely known in the community now that smoking is toxic. However the toxicty of man-made additives and highly processed and denatured foods is still in many cases not completely understood and is even less well known by the public. I would never suggest that anyone eat whatever is available in moderation and I'm unsure how you came to that conclusion.
Luke
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Re: Nutrition and Chronic Disease - April 28, 2005 6:21:00 AM
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JLS_PT_OCS
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From: USA
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Luke-
Checked the links again and found those citations you mentioned. Sorry I missed them the first time around, sometimes I just don't click on the right stuff. :) You are entirely right in that those sources have a lot of references.
Thanks for your patience and courtesy, as usual.
I did examine some of the key resources that support the hypotheses cited, most notable the cholesterol does not equal heart disease theory. I think the studies contained in those sites are not convincing when compared to the China Study data, and this is why:
1. Does not address the issue of animal protein consumption, only discusses cholesterol intake to address the problem (taking the "see, nothing works" approach to prevention, always my favorite)
2. Focuses on making the point that dietary cholesterol intake isn't related to blood cholesterol intake (on this we are agreed, it is the animal protein that does it).
3. Makes a lot of assertions from basic science without a strong epidemiologic or cohort study base (this isn't bad in itself, but the China Study results are so supported)
4. Makes the mistake I alluded to earlier, does not really study impact of whole foods plant based diet (vegan), only uses studies that manipulate small variables such as chol intake and veg intake, while keeping everyone on the same generally poor diet.
We agree that not all studies agree, this is as true in physical medicine research as in nutrition research. But if the balance of evidence is considered, and the most current and highest quality data examined, you'll find it clearly supports the whole foods, plant based diet.
The knee analogy was intended to make the point that if the knee hurts when working out, don't stop working out. Find a better way to do it, consult with a professional that can help.
If the diet is hard or there are untoward consequences (weight gain, "sickliness"), don't abandon a proven preventive intervention, seek the services of a professional (meaning dietitian and/or medical physician) and find a better way to do it.
I wasn't trying to say you were asking people to eat everything in life in moderation, I was trying to say that there is some clear evidence that a moderation approach to diet may be little better than pigging out.
http://www.vegsource.com/esselstyn/moderation_kills.htm
The China Study data, and some of Esselstyn's published work, suggest that a cholesterol level of 160-200 is almost as bad as the 200-250 when considering incidence of cardiovascular disease. Only when the cholesterol levels drop below 150 do we see a significant drop in risk. Among those with blood cholesterol below 150mg/dl, the rate of heart disease was almost zero.
Yet some studies you cite point to no difference in cholesterol vs disease, and this was all addressing cholesterol levels in the 160-270 range from the charts I saw. Also they don't address animal protein consumption, they only talk about chol intake, and they say "See, told you so, no increased risk.."
So you see what I mean about study design?
I like comparing this to smoking because everyone "knows" smoking is dangerous and leads to increased death and complication rates (even without a placebo controlled cohort study to conclusively prove any of that). Yet everyone also "knows" that there is nothing wrong with what they personally consider a "sensible" diet. Ah, there's the rub. There's more convincing evidence, from a statistical point of view, that animal protein causes cancer and heart disease than there is that smoking causes cancer and heart disease! Seems extreme, I know. I thought it couldn't be true. Then I looked closer, and was surprised.
You said, "People generally don't knowingly eat poison." You're right. They don't know what it is they are eating, and I'm trying to change that. :)
I by no means am trying to tell anyone what to eat, only to present the most current and highest quality evidence from the literature.
Luke, I'm very glad you have found a diet that works for you. Along the way, you have learned more about nutrition than 99% of the world's population. And that's a good thing.
Thanks again for the great discussion...
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 28, 2005 3:39:00 PM
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Lukey
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From: Australia
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Jason,
I have been to cities in China and seen the types and quality of the food they eat. It doesn't surprise me one bit that people in the villages are healthier. But does this study really prove that moderate amounts of quality animal protein (in the abscence of trans-fats, non-foods and highly refined / denatured products) causes CVD and cancer?
Just so you know, I also support and follow a natural wholefoods, plant based diet, but I don't think there is enough evidence to say that it should be a plant exclusive diet.
Hu FB, Willctt WC. Optimal diets for prevention of coronary heart disease. JAMA. 2002;288:2569-2578. [QUOTE] We selected 147 original investigations and reviews of metabolic studies, epidemiologic studies, and dietary intervention trials of diet and CHD.] [Compelling evidence from metabolic studies, prospective cohort studies, and clinical trials in the past several decades indicates that at least 3 dietary strategies are effective in preventing CHD: substitute non-hydrogenated unsaturated fats for saturated and trans-fats; increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources; and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence. Many issues remain unsettled, including the optimal amounts of monounsaturated and polyunsaturated fats, the optimal balance between omega-3 and omega-6 polyunsaturated fats, the amount and sources of protein, and the effects of individual phytochemicals, antioxidant vitamins, and minerals. [/QUOTE]Despite common misperceptions, this report found no strong evidence for a link between risk of cardiovascular disease and intake of meat, cholesterol, or total fat.
Luke
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Re: Nutrition and Chronic Disease - April 28, 2005 4:12:00 PM
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nari
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Luke and Jason
just to pop in here with a comment:
Evidence for this and that causing high or higher risk for CHD and other pathologies seems to keep on changing, almost from year to year. In the cholesterol debate, it is now accepted that some people have a naturally high figure (from 6 onwards) and nothing significantly changes that raised figure; there was no strong evidence that these elevated cholesterol levels caused a higher risk of CHD. There is some dissent now about the role cholesterol (LDL and HDL)plays in CHD.
The more we learn, the more complex and confusing it becomes, it seems.
On an aside, I got to know one of the local cardiac surgeons some years ago (he was a patient) and he was intrigued with the fact that people on healthy and active lifestyles, no relevant family history,nonsmokers, nondrinkers, still rolled up with coronary occlusions and requiring CABGx4 and so on. He reckoned there was a link that no-one has worked out yet...
Nari
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Re: Nutrition and Chronic Disease - April 28, 2005 8:37:00 PM
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Randy Dixon
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Just to make a quick chime without an extensive research effort. The CHD model has shifted from a cholestrol caused one to a inflammatory model. It seems about 30% of the population respond to the cholestrol model as we know it, but the other 70% react much less predictably. This is why we now are hearing more about getting C-reactive protein and homocysteine levels checked.
This would still imply a diet emphasizing vegetables is superior, it would not necessarily support a vegan diet, and there is some reason to believe a pure vegan diet would be less desirable.
Personally, I love steak and I drink gallons of Pepsi. I can't defend my love of meat, morally, ecologically or physically. But now thanks to Jason, I have tremendous guilt about it and I am going to go punish myself by eating ****** fries until I'm sick. That will teach me.
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Re: Nutrition and Chronic Disease - April 29, 2005 2:21:00 AM
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Lukey
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Randy,
Your post just inspired a great new line for Homer Simpson - Hhhmmm, informed choice, …arrrgghh!!!!
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Re: Nutrition and Chronic Disease - April 29, 2005 5:02:00 AM
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JLS_PT_OCS
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From: USA
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Randy, let me know how the ****** fries treat you!
As an aside, our government in the USA (why we are letting these people tell us what to eat, I'll never know) count ****** fries as a vegetable for school lunch programs!
Speaking of dogmatic agenda!
Luke-
Thanks for the citation. That analysis, while helpful, is still based on many studies that have the flaws I have previously identified.
Think of it like physical medicine research, and the classification discussions we are currently having there. The vast majority of studies about this still are not studying a whole foods, plant-based diet (meaning in this sense, almost no animal products), merely keeping everyone on the same generally poor diet and manipulating a few variables here and there. The few epidemiological and cohort studies that include vegans or near-vegans are enough to tip the scales toward some of the findings the report suggests.
But to me, that is what is so conclusive about the China Study data.
Just as I believe the newer studies on back and neck pain using classification systems are much stronger than previous studies lumping all patients into the same category and giving them the same treatment. I essentially ignore meta-analyses done on studies of poor quality or done with design flaws. Shouldn't we be all be doing that?
Randy brings up an excellent point about inflammatory reactions, CRP, and homocysteine. This is a major emphasis on the discussion of the China Study data. Let me post some interesting research about the kinds of inflammatory reactions are found in the vascular system after consuming animal protein. Note: they usually use Casein, or cow mild protein, for these studies, which is why I went from Vegetarian to Vegan.
Homocysteine is an amino acid found in....animal protein. If you get sufficient B12 and are on a vegan diet, homocysteine levels should remain low.
In those who are deficient in B vitamins (regardless of diet), hyper-homocysteinemia is reported.
McCully KS "Homocysteine theory of arteriosclerosis: development and current status." In: Gotto AM, Paoletti R (eds) Atherosclerosis Reviews Vol 11 pp157-246
Here is a study, albeit on vegetarians, exploring biomarkers of inflammation, cardiovascular dz risk, and antioxidants.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15474873
Nari brings up a common concern among laypeople and medical personnel alike: the studies keep changing, supposedly showing this one day and that another day.
To me, that is again what is so convincing about the most recent data - it is conducted in a much more controlled way, and able to take into account so many factors. It clearly shows that the it is the whole foods plant based diet itself, and not individual components of it, that is so beneficial.
And hey, the book is cheap, if anyone is interested, give it a read, check out the citations. You might be surprised what you find.
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 29, 2005 5:36:00 AM
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JLS_PT_OCS
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I neglected to answer Diane's Vitamin B12 question. Sorry, Diane.
Vitamin B12 is found in organic soil, and readily absorbed by vegetables when they are grown there. Eating "sanitized" vegetables in the typical "lifeless" soil (speaking of micro-organisms) as many of us in developed countries do, we probably do not get enough B12.
B12 deficiency is occasionally a problem in vegans, and it is something we have to watch out for. It is supplemented in our soymilks and in our soy and vegetable protein meals, as well as in multivitamins.
Actually, low B12/cobalamin levels have been associated with ELEVATED homocysteine levels, even in vegans! Doh!
So we do need to make sure we get enough.
Mozafar A "Enrichment of some B-vitamins in plants with application of organic fertilizers." Plant and Soil 167 (1994)
Hope that helps.
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 29, 2005 5:47:00 AM
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Diane
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Hmmnn... at least two of these studies talk about removal of gluten as being a notable factor. In one of the two the RA patients went to lacto ovo, and in the other had fish oil.. so, not strictly vegan?
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Re: Nutrition and Chronic Disease - April 29, 2005 6:18:00 AM
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JLS_PT_OCS
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Yes, gluten can be a factor, it is thought as a food allergen. It does not appear to be a factor for everyone, yet another classification issue?
Lacto ovo can also be an effective diet, but much of the research is on the vegan diet. Certainly if both diets work equally well, patient should find the one that works best, if relief from RA symptoms is the only issue. I have not seen lacto ovo vs vegan diets compared in this population.
Fish oil is used as a supply of Omega fatty acids (notably -3 and -6) both of which can be found supplemented in modern vegan foods and vitamins. The fish part is just about convenience of accessing those fatty acids. I get the same through my fortified soymilk, multivitamin, and flax. So I guess it depends on how strict you want to be. I would not refuse to call a diet vegan if it just had some fish oil capsules added. Certainly I eat some bread products made with milk, and sometimes there is some cheese or eggs in baked products that I eat from time to time out of the house. But to me, being 98% vegan is about as good as it's gonna get. The China Study research subjects did consume some very insignificant amounts of animal protein, putting them in the about 98% vegan area.
Excellent question. (as usual)
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 - May 9, 2005 8:29:00 AM
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Diane
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Wasn't sure where to put this article, however I think it belongs on one of these food/diet/nutrition threads.
[URL=http://www.eurekalert.org/pub_releases/2005-05/wuso-nfi050905.php]New fat is needed to clear old fat from the system[/URL]
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Re: Nutrition and Chronic Disease - June 13, 2005 1:45:00 AM
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JLS_PT_OCS
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From: USA
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Nicole-
The China Study has some excellent data on vegan diet and autoimmune diseases, it's well worth the cost!
I brought my copy back home, but will try to post some citations when I get a chance...
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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