Research: Loneliness Raises Blood Pressure

From a new study released in the March Psychology and Aging, as described by the Associated Press:The loneliest people studied had blood pressure readings as much as 30 points higher than those who weren't lonely, suggesting that loneliness can be as bad for the heart as being overweight or inactive, the researchers said.

Atkins Diet: Not What this Doctor Ordered

According to Dr. Fuhrman's books, Americans consume about 40 percent of their calories from animal products, which has contributed to the increase of cancer and heart disease in the past fifty years. So how does this information impact high-protein weight-loss plans like the Atkins diet? Consider this passage from Eat to Live:

The Atkins diet (and other diets rich in animal products and low in fruits and unrefined carbohydrates) is likely to significantly increase a person's risk of colon cancer. Scientific studies show a clear and strong relationship between cancers of the digestive tract, bladder, and prostate with low fruit consumption. What good is a diet that lowers your weight but also dramatically increases your chances of developing cancer?

A meat-based, low-fiber diet, like the one Atkins advocates, includes little or no fruit, no starchy vegetables, and no whole grains. Following Atkin's recommendations could more than double your risk of certain cancers, especially meat-sensitive cancers, such as epithelial cancers of the respiratory tract.1 For example, a study conducted by the National Cancer Institute looked at lung cancer in nonsmoking women so that smoking would not be a major variable. Researchers found that the relative risk of lung cancer was six times greater in women in the highest fifth of saturated-fat consumption than those in the lowest fifth.

The March 18 issue of Lancet includes research suggesting that the Atkins diet can also cause some other major health complications. Steven Reinberg of Healthday News reports on a case from the study:

The patient had followed the Atkins diet, including Atkins supplements. She went to the hospital with difficulty breathing and was diagnosed with a condition called ketoacidosis.

Ketoacidosis results when dangerously high levels of acids called ketones build up in the blood. Ketones are produced in the liver during starvation. A low-carbohydrate diet such as Atkins can lead to ketone production, Lessnau's team notes.

"She had to be admitted to the intensive care unit," Lessnau said. "The diet actually caused her acidosis."

Lessnau is surprised that this problem with the Atkins diet has not been reported before. "This is something that is not well-diagnosed or may be underreported," he said.

"The Atkins diet is not a safe diet in everybody," Lessnau said. "It can cause potentially life-threatening problems."

Dr. Fuhrman says most weight loss plans are a waste of your money.

For more about how Dr. Fuhrman does recommend losing weight, read this outline, and these thoughts on diets.

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European Research: Restricting Animal Products Reduces Weight Gain, Cancer

In Eat to Live Dr. Fuhrman warns against eating regular quantities of animal products, refined grains, and oils, urging you instead to get most of your calories from vegetables, fruits, legumes, seeds, and raw nuts:

Vegetable and fruits protect all types of cancers if consumed in large enough quantities. Hundreds of scientific studies document this. The most prevalent cancers in our country are mostly plant-food-deficiency disease. Raw vegetables have the most powerful anti-cancer properties of all foods.

Research shows that those who avoid meat and diary have lower rates heart disease, cancer, high blood pressure, diabetes, and obesity.1

Studies have confirmed that individuals consuming a vegetarian diet (one based on plant matter and not dairy or refined grains) live longer than non-vegetarians and almost never get heart attacks.

With this in mind, consider this recent weight loss study from the European Prospective Investigation into Cancer and Nutrition. The eating habits of 22,000 people, meat eaters and vegetarians, were tracked over five years. In the end results found that all participants gained a few pounds, but individuals who adopted a vegetarian or vegan diet gained the least. Reuters reports:

"The weight gain was less in the vegans than in the meat-eaters and somewhere in between in the other groups," said Tim Key, of Britain's Cancer Research UK charity and the University of Oxford, who conducted the study.

"The lowest weight gain was in people who changed their diet to eat fewer animal products," he told Reuters.

In addition to stressing the importance of physical activity for sustained health, the study also comments on the link between diet and cancer:

[The study] also showed that diet is second only to tobacco, as a leading cause of cancer, and, along with alcohol, is responsible for nearly a third of cancer cases in developed countries.
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Ambien: Sleep and a Snack

It may seem strange, but one side effect of the popular sleeping pill Ambien is reportedly a sleep-related eating disorder, which causes some Ambien users to unknowingly sleepwalk into their kitchens, raid the refrigerator and gorge on snacks. Stephanie Saul of The New York Times reports:

"These people are hell-bent to eat," said Dr. Mark Mahowald, who is director of the Minnesota Regional Sleep Disorders Center in Minneapolis and is researching the problem.

He and colleagues are preparing a scientific paper based on their findings that a sleep-related eating disorder is one of the unusual side effects showing up with the widespread use of Ambien. Researchers at the Mayo Clinic in Rochester, Minn., have made similar findings.

By coincidence, just a couple of days ago on Followhealthlife, while discussing caffeine, Dr. Fuhrman said:

Of course, I would prefer people not engage in addictive habits in general, because that inevitably leads to eating more food to treat their addictive withdrawal symptoms, and continues their addictive relationship with food and drink contributing to their ill health in general.

Busy Week for Coffee

Last week's story about the genetic factors associated with coffee consumption stirred up discussion.

Yesterday Dr. Fuhrman reacted to a related study in The Journal of the American Medical Association.

Today there's word of new dangers hidden in your cup of joe--in the study, researchers detected a potentially damaging "fight or flight" response in test subjects who had a lot of caffeine.


Caffeine Freaks: Get Tested

Following up on last week's news linking coffee consumption with risk of heart attacks Dr. Fuhrman provides some additional thoughts on the study printed in The Journal of the American Medical Association:

This article notes that some people are homozygous for a gene that controls caffeine elimination in the liver and others are heterozygous. So, similar to the genes for eye color, in this case a person who inherits only one dominant gene will detoxify caffeine slower--and therefore be more at risk for its heart attack promoting properties.

Of interest was the strong association with the non-fatal heart attacks occurring in younger people. Noting that some individuals who metabolize caffeine slower, and thus eliminate it slower, have double the heart attack risk compared to non-caffeine drinkers or those who metabolize caffeine quickly.

Bottom line, if you drink coffee, and are unwilling to cut back to one cup a day or less, at least get this test to see if you are a slow caffeine metabolizer.

Of course, I would prefer people not engage in addictive habits in general, because that inevitably leads to eating more food to treat their addictive withdrawal symptoms, and continues their addictive relationship with food and drink contributing to their ill health in general.

Research: Vitamin B Ineffective Against Heart Disease

Gina Kolata writes in The New York Times:

A widely promoted B-vitamin regimen for the prevention of heart attacks and strokes has shown no beneficial effects in people at high risk, researchers are reporting in two new studies.

The widely accepted hypothesis was that B vitamins -- folic acid, vitamin B12 and vitamin B6 -- could protect against homocysteine, an amino acid that some doctors said was as important and dangerous a risk factor for heart disease as cholesterol.

Studies of populations had shown that the higher the homocysteine level in the blood, the greater the risk of heart attacks and strokes. And studies of animals had indicated that homocysteine could actually damage the tender linings of arteries, setting the stage for atherosclerosis.

B vitamins, however, reduce blood levels of homocysteine. The vitamins, which are found in a variety of foods, have no known harmful effects. And if people take the vitamins as supplements, their homocysteine levels plummet. About 35 percent of Americans take B vitamins, mostly in the form of multivitamin pills, according to the Council on Responsible Nutrition, a trade group.

So it seemed reasonable that taking the vitamins would be protective. It might be even better than taking statin drugs, some said, which are well established to prevent heart disease by lowering cholesterol levels.

It was not, the new studies found.

This is another example of the blind leading the blind. The problem is the way research is conducted in general and our typical medical approach in trying to give every patient some cookbook response to their high homocysteine level, rather than treating every patient as an individual.

High Homocysteine Levels Are Markers for Poor Diet
In my experience, a high homocysteine level is mainly important as a marker indicating a diet low in vegetables, especially the folate rich greens. In other words, it is one of the blood signs of a poor diet.

Fixing the homocysteine level without fixing the diet shouldn't be expected to do much because it is hundreds of important nutrients and factors that are missing not just the folate. A pill can't take the place of the symphonic effect of a diet that is naturally folate and nutrient rich.

One of the researchers quoted in The New York Times, Dr. Salim Yusuf of McMaster University in Hamilton, Ontario, has a similar, but vaguer idea. Again, Gina Kolata:

The most likely explanation for the studies' results, Dr. Yusuf said, was that homocysteine levels were not the cause of disease. Instead, he said, they are probably a sign of heart disease, much like fever is a sign of infection. Treating a fever with aspirin does not cure the infection, and lowering homocysteine levels with B vitamins does not cure disease either.

The Bottom Line For Your Health: High Homocysteine Levels Still Must be Addressed These studies show that homocysteine lowering therapies do not work on a gross scale to reduce heart attack deaths---but that does not mean that a person who has a significant homocysteine elevation should not address the cause of such an elevation.

I am in the process of revising my book Cholesterol Protection For Life (the new version will be available in about a month) and recently wrote about this issue. Here are some relevant excerpts:

Is homocysteine an important indicator of heart disease?

Maybe and maybe not, it depends on how high your homocysteine level is and the cause of the elevation. Homocysteine is an independent risk factor for heart disease. That means even if your cholesterol is favorable, heart disease can sometimes be caused by an elevated homocysteine.

A high homocysteine can also be a contributory cause of high blood pressure and place you at higher risk of stroke. Homocysteine can be elevated secondary to increased need for B12, B6 or folate. It is rare, but still possible for a person with a perfect diet and ideal cholesterol levels to develop chronic disease from an elevated homocysteine level.

Theoretically, most people eating a plant-based diet rich in vitamins, especially folate, only have to be concerned with consuming adequate B12 to assure a normal homocysteine level. However, there are other causes. Some uncommon cases of individuals who have a very high homocysteine level, normal B12 (documented by a methylmalonic acid, MMA test) and also normal folate levels on blood tests. These people should be instructed to take extra folate as they likely have a genetic defect converting folate to its more active form.

After reviewing scores of medical studies on the relationship between high homocysteine and the increased risk of Alzheimer's, stroke, heart attack and dementia one has to conclude that there is a clear cut relationship between high homocysteine and serious disease. However, this is a complicated subject, where confusion abounds, and the right way to lower homocysteine or whether we should attempt to lower it at all is still debated. Clearly we have more to learn as more time and further research is revealed in years to come.

One reason there is such contradictory information in the scientific literature is because the researchers appear to have such poor working knowledge of excellent nutrition and are not targeting the therapy to match the corresponding cause(s) of the homocysteine elevation. Instead, both researchers and most physicians are simplistically giving the same conventionally-designed, nutritional supplement to a cohort of patients with different causes for the high homocysteine.

Physicians think about high homocysteine as only one problem, like high cholesterol, when there could be multiple reasons for the abnormality, so often the solution does not fit the problem. There should not be a one size fits all solution to an elevated homocysteine.

Homocysteine levels above 20 micro mol/l are associated with a 10 fold increased risk of heart attack compared to levels below 9 micro mol/l. 1 These high elevations of homocysteine should not be ignored. Doing so could result in an easily avoidable medical tragedy.

For example, homocysteine can be elevated from:

  • A poor diet, low in folate-containing vegetables.
  • A B12 deficiency
  • An uncommon defect in conversion of folate to the active form (even in a person eating a healthy diet)
  • Kidney disease

Address High Homocysteine Levels With Recommendations Targeted to the Cause
Consider an abnormal homocysteine that may require treatment above 15, not above 10. Levels between 10 and 15 have not been consistently associated with worse outcomes.2
If one homocysteine is elevated above 15, make sure a blood level of B12, and MMA (methlymalonic acid) and a folate level is drawn.

Mild elevations of homocysteine between 10 and 15 do not appear to place people at higher risk. In most of these cases, the mild elevation is just a marker for a low nutrient diet in general and the correct treatment is the improvement of the entire diet, not just a supplement to lower homocysteine. Folate alone in these cases cannot compare with the value of actually eating a diet rich in folate and gaining all the other essential cardio-protective compounds that are found in natural plant foods. It is similar to taking a cholesterol-lowering drug instead of eating healthfully; a pill cannot take the place of the full symphony of dietary elements that contribute to heart and vascular health.

When the abnormality (elevated homocysteine) is due to B12 deficiency it is wise to take more B12. Whether you are consuming sufficient B12 or not is best ascertained by a normal MMA (methylmalonic acid) because a B12 level in the 200 to 400 range, which is considered in the normal range could still be abnormal. Paradoxically, MMA is actually a better marker for B12 deficiency than B12 itself. If the MMA is elevated a B12 deficiency exists, even if the B12 is in the normal range. When this is the case, extra B12 is the correct treatment for the elevated homocysteine.

If the folate level is excellent (15 - 25) and the B12 level is normal (as documented with a normal MMA) and the homocysteine is still significantly elevated,then the cause of the elevation is most likely a genetic defect in folate conversion. In this case, folate (or folic acid) supplementation may not be totally effective; because the patient is just taking more of the folate that they don't convert effectively to begin with. They don't need more folate, rather they need more of the biologically active form of folate that they don't make well (called methyl tetrahydrofolate or formyl tetrahydrofolate.)

So if the B12 is normal and the folate is normal, and the homocysteine is still significantly elevated, it may make more sense to take a supplement containing additional tetrahydrofolate, and not just pile on huge doses of folate (folic acid) attempting to drive the homocysteine down with overwhelming high doses of folate.

In conclusion, it is wise to target therapy based on known deficiencies and not just blanket patients with high dose supplements that they do not need. Nevertheless, an attempt to uncover the cause of the homocysteine elevation and lower it accordingly may be an important intervention for patients with unique needs.

Medical Research Still Has a lot of Questions to Answer About Homocysteine.
In the meantime, it should be recognized that a vegetable-based diet rich in fresh produce with fruit, beans, raw nuts and seeds, naturally low in saturated fat and in sodium is our most powerful protection against disease. It lowers blood pressure as much as drugs and, in heart patients, is at least twice as effective at reducing death rates and heart attacks as drugs.3 The day may come when a physician, who does not offer such a diet to his heart patients is himself at high risk for being sued for malpractice.

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Delving Into the Archives

Even though it's only a few months old, Followhealthlife has already accumulated a pretty big library posts and podcasts on various health topics. If you ever feel like searching through those archives (either by clicking on a topic at the left and then scrolling through relevant results, or better yet typing a keyword in the search box at the upper left) you'll see there's all kinds of interesting stuff.

Here's a rundown of some of the more popular posts from our first few months:

Forecasting 2010: Will Half of American Kids be Overweight?

According to the Associated Press recent studies predict that by 2010 nearly half of the children in North and South America will be overweight. If present trends continue about 38 percent of all children will be fat. Many experts are alarmed:

"We have truly a global epidemic which appears to be affecting most countries in the world," said Dr. Philip James, chairman of the International Obesity Task Force and author of an editorial in the journal warning of the trend.

The percentages of overweight children also are expected to increase significantly in the Middle East and Southeast Asia. Mexico, Chile, Brazil and Egypt have rates comparable to fully industrialized nations, James said.

He estimated that, for example, one in five children in China will be overweight by 2010.

"They're being bombarded like they are in the West to eat all the wrong foods. The Western world's food industries without even realizing it have precipitated an epidemic with enormous health consequences," he said.

For more information on the childhood obesity epidemic read the following posts: Warning Labels from the Surgeon General on Soda?, Childhood Obesity: Growing In The Wrong Direction, Stopping Childhood Obesity--Thinking Outside the Box, and New York Nixes Full-Fat Milk in Schools.