Onlyourhealth : Onlyourhealth : Health & Nutrition News & Commentary : Dr. Joel Fuhrman

First the redcoats, now the red leaves! Last week Followhealthlife looked at a study published in the Journal of the American Medical Association showing the British are healthier than Americans. This week new research indicates our neighbors to the north are healthier too. MSNBC reports:

Americans are 42 percent more likely than Canadians to have diabetes, 32 percent more likely to have high blood pressure, and 12 percent more likely to have arthritis, Harvard Medical School researchers found. That is according to a survey in which American and Canadian adults were asked over the telephone about their health.

This graph from the Associated Press shows additional health disparities found during this study:

The knee-jerk reaction to this study (other than panic) is to point to Canada's national health insurance program as an explanation. Some researchers adhere to the idea, but others dismiss it as anecdotal:

Canada's national health insurance program is at least part of the reason for the differences found in the study, Dr. Steffie Woolhandler, a co-author of the Canadian study said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.

James Smith, a RAND Corp. researcher who co-authored the American-English study, disagreed. His research found that England's national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.

"To me, that's unlikely," he said of the idea that universal coverage explains international differences.

Research like this is fascinating. But it does little improve your health, no matter where you live. In the meantime do your own research. Check out all the research on a nutrient-rich vegetable-based diet and how it can protect against diseases such as cancer, diabetes, heart disease, etc.

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Wall Street Journal health journalist Tara Parker-Pope reports preventing breast cancer is not just a grown-up issue:

A growing body of evidence shows that a woman's risk for breast cancer may be determined far earlier in life. Cellular changes that can lead to cancer likely begin in childhood when breast tissue is just beginning to develop.

So while strategies like diet, exercise and -- for high-risk women -- prevention drugs like Tamoxifen may help stave off breast cancer in midlife, scientists are also beginning to look at prevention efforts for young girls. What's increasingly clear is that the health decisions parents make for their daughter in preschool, adolescence and the late teen years have the potential to dramatically alter her risk for breast cancer as she becomes a woman.

Parker-Pope explains childhood exercise is an import factor in cancer prevention:

Encourage exercise at a young age. Exercise early in life appears to lower a girl's hormone levels, and potentially delay the onset of her first period. The average age of first period today is about 12, but some girls start periods as early as nine or 10. Girls who don't get their periods until the age of 13 or 14 have a lower lifetime risk for breast cancer.

Exercise before puberty lowers body fat and also damps down hormone production by the pituitary gland, keeping hormone levels low longer and thereby delaying menstruation. "It's important to start things young," says Anne McTiernan, director of the Prevention Center at the Fred Hutchinson Cancer Center in Seattle and author of the book "Breast Fitness." Dr. McTiernan suggests an hour of daily exercise for girls, including recess and gym class.

Parker-Pope goes on to point out the importence of a healthy diet in young girls' lives:

Limit Junk Food. Some research suggests that diet early in life and into adolescence can influence breast-cancer risk. In February, a Harvard study suggested a child's preschool diet could affect breast-cancer risk. Women who frequently ate french fries in preschool had a 27% higher risk for breast cancer as adults.

Modest reductions in fat intake during puberty can lower levels of hormones in a girl's body. Girls who eat diets higher in fiber appear to get their first period later. Some evidence suggests that increasing soy in the teen diet can also lower long-term breast cancer risk. Even though the data on adolescent diet and breast-cancer risk are mixed, it makes sense to encourage girls to eat fruits and vegetables and avoid unhealthy fats.

In The Wall Street Journal, the connection between healthy practices at a young age, and cancer later in life is news, and they should be saluted for being among the first major media outlets to really make the connection. Dr. Fuhrman looked at a lot of the same research in researching his book Onlyourhealth Your Child last year. The connection between childhood diet and exercise, early menstruation, and cancer is a major theme of his book, which has an entire chapter on the causes of cancer and other illnesses.

In this excerpt, Dr. Fuhrman explains the trademarks of the standard American Diet (SAD) contribute to earlier puberty in girls, which heightens lifetime risk of breast cancer:

The average age of onset of menstruation in the nineteenth century was seventeen, whereas in the last fifty years in Western industrialized countries, such as the United States, the average age of onset of menstruation is twelve. The over-nutrition and heightened exposure to animal products, oil, and saturated fats2 earlier in life induces a rapid earlier growth and an earlier puberty. Earlier age of puberty increases one's lifetime exposure to estrogens and is associated with a higher incidence of breast cancer years later.

Cohort studies, which follow two groups of children over time, have shown that the higher consumption of produce and protein-rich plant foods such as beans and nuts is associated with a later menarche, and the higher consumption of protein-rich animal foods�-meats and diary�-is associated with an earlier menarche and increased occurrence of adult breast cancer.3

Hopefully this is just the beginning of word starting to spread to parents that what they feed their young children can have a big effect on lifelong health.

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From Dr. Fuhrman's book Eat to Live:

*Note: this recipe has been updated. See the update at the bottom of the post.*

Making this soup involves more time and effort than the other recipes, so you might want to make a huge amount and save it in the refrigerator for the whole week. It tastes so good that a patient of mine who owns a fine restaurant offers it on his menu.

1 cup dried split peas and/or beans
4 medium onions
6-10 zucchini
3 stalks leek
5 lbs. carrots
2 bunches celery
1 cup raw cashews
2 tbsp. VegiZest
1 package mushrooms, any type (optional)

Place the beans and 4 cups of water in a very large pot and start cooking them, covered, on the lowest flame possible. Take the outer skins off the onions and place them in the covered pot. Do not cut them up, put them in whole. Add the zucchini, uncut. Cut the bottom roots off the leeks and slice them up the side so each leaf can be thoroughly washed, because leeks have lots of dirt hidden inside. Throw away the last inch at the green top. Then place the entire leek (leaves uncut) into the pot. Juice the carrots and celery in a juice extractor. Add the juice to the pot. While the soup is simmering, chop up the mushrooms (if desired). By the time you get to this stage, the zucchini, leeks, onions should be soft.

This next step only works if you have a Vita-Mix, a powerful blender, or a food processor. Ladle some of the liquid from the pot into the machine. Use tongs to remove the soft onions, zucchini, and leeks. Be careful to leave the beans in the bottom of the pot. In a few separate batches, completely blend together the onions, zucchini, and leeks. Add more soup liquid and cashews to the mixture, and blend in. Return the blended, creamy mix back to the pot. Add the textured vegetable protein and the mushrooms, if desired. Simmer another 20 minutes, and you have my soup that is famous the world over. I know a doctor who makes and freezes my soup and sells it to his patients to cure everything from sinusitis to cancer. It's not really a cure, but it sure does taste great.

UPDATED RECIPE (2012):

Ingredients:
1/2 cup dried split peas
1/2 cup dried adzuki or cannellini beans
4 cups water
6-10 medium zucchini
5 pounds large organic carrots, juiced (5-6 cups juice; see note)*
2 bunches celery, juiced (2 cups juice; see note)*
2 tablespoons Dr. Fuhrman's VegiZest (or other no-salt seasoning blend, adjusted to taste)
1 teaspoon Mrs. Dash no-salt seasoning
4 medium onions, chopped
3 leek stalks, cut lengthwise and cleaned carefully, then coarsely chopped
2 bunches kale, collard greens or other greens, tough stems and center ribs removed and leaves chopped
1 cup raw cashews
2 1/2 cups chopped fresh mushrooms (shiitake, cremini and/o white)
Instructions:
Place the beans and water in a very large pot over low heat. Bring to a boil, reduce heat and simmer. Add the zucchini whole to the pot. Add the carrot juice, celery juice, VegiZest and Mrs. Dash.

Put the onions, leeks and kale in a blender and blend with a little bit of the soup liquid. Pour this mixture into the soup pot.

Remove the softened zucchini with tongs and blend them in the blender with the cashews until creamy. Pour this mixture back into the soup pot. Add the mushrooms and continue to simmer the beans until soft, about 2 hours total cooking time.

* Freshly juiced organic carrots and celery will maximize the flavor of this soup.

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A new study shows the British are healthier than Americans despite U.S. health care spending per person that is more than double what Britain spends.

The study, published in the Journal of the American Medical Association concludes:

The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well.

Conclusion
Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.

No one is sure why the two similar cultures have such different results. Gina Kolata of The New York Times takes a crack at it.

The question of which country is healthier, Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina and others say, turns out to be a perfect illustration of an issue that has plagued American medicine: the more health problems you look for, the more you find. And Americans, medical researchers say, are avid about looking.

The British, doctors say, are different.

"The U.K. has a tradition of independent and perhaps more skeptical primary-care practitioners who are probably slower to label and diagnose people and more reluctant to follow guidelines than their U.S. counterparts," says Dr. Iona Heath, a general practitioner in London. "I have heard it argued that the U.S. believes more in the perfectibility of humanity and the role of science than the Europeans."

Some people call it disease-mongering, says Dr. Lisa Schwartz of Dartmouth Medical School. She once calculated that if everyone had the recommended tests for blood cholesterol, blood sugar, body mass index and diabetes, 75 percent of adults in the United States would be labeled as diseased. And new diseases arise by the minute, she says, her favorite example being "restless legs."

Maybe it's overanalysis. Maybe it's stress. Maybe it's something else. We can all guess why it might be that Americans are "sicker" than Brits even though we spend more money on healthcare. (Your thoughts?)

But one thing is certain: the killer diseases in America today, afflictions like type-II diabetes, cancer, and heart disease, need not ruin your health no matter where you live. On Followhealthlife we have trotted out study after study showing that we could make a huge dent in those diseases by abandoning the standard American diet (SAD) in favor a diet based on vegetables, fruit, legumes, nuts, and seeds.

This post summarizes many of the benefits of a healthy diet in preventing disease. Here is a collection of some of the most important research behind Dr. Fuhrman's work. The role diet can play in precenting cancer is discussed in detail here and here. Dr. Fuhrman says you need not settle for diabetes and that there is a counter attack for heart disease.

The result? Let's not wait around until researchers unravel the mystery of what makes English people seem to be healthier. Instead, let's do what has already been shown to be effective preventing and reversing the chronic diseases that are killing so many of us, starting with a plant-based, nutrient-dense diet that is effective in both Americans and the British.

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HealthDay reporter Meryl Hyman Harris reports that the connection between obesity and cancer is, sadly, a well-kept secret.

More U.S. citizens know the correct number of judges on American Idol than know that being fat helps cause cancer.

According to a new poll of more than 2,000 adults for the American Cancer Society, just 8 percent were aware of the link between being overweight and cancer risk, but 65 percent knew how the popular TV show works.

Experts say the obesity-cancer connection needs a lot more press.

The problem "has to do with communication from the health profession, which includes us as registered dieticians," said David Grotto, a spokesman for the American Dietetic Association. "We need to do a better job of communicating the risk of obesity with many types of diseases."

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Wal-Mart, the nation's largest grocery retailer, will soon be selling a vast array of organic products, including organic produce, breakfast cereals, and macaroni and cheese. According to The New York Times the move is an attempt broaden its appeal to urban and other upscale consumers. The initiative has met mixed reviews, Melanie Warner reports:

Wal-Mart's interest is expected to change organic food production in substantial ways.

Some organic food advocates applaud the development, saying Wal-Mart's efforts will help expand the amount of land that is farmed organically and the quantities of organic food available to the public.

But others say the initiative will ultimately hurt organic farmers, will lower standards for the production of organic food and will undercut the environmental benefits of organic farming. And some nutritionists question the health benefits of the new organic products. "It's better for the planet, but not from a nutritional standpoint," said Marion Nestle, a professor of nutrition, food studies and public health at New York University. "It's a ploy to be able to charge more for junk food."

Nestle makes an interesting point. Just how beneficial is all this organic food?

In a previous post entitled "Is Organic Safer?" Dr. Fuhrman talks about organic produce:

Organic food is certainly your best bet, to further limit exposure to toxic chemicals. No one knows for sure how much risk exists from pesticide residue on produce, but here's what we do know: the younger you are, the more your cells are susceptible to damage from toxins. It seems wise to feed our young children organic food whenever possible.

Of course, wash your vegetables and fruit with water and when possible, use a drop of dishwashing detergent and then rinse well to remove all detergent residues for a little more efficient cleaning. Specialty pesticide removal products have not clearly demonstrated any more effectiveness than mild soap and water.

Besides the heightened exposure to chemicals and pesticides from animal products, the most hazardous pesticides are used on some plant foods responsible for the majority of the plant-food-related dietary risk. These foods with the most pesticide residue are: strawberries, peaches, raspberries, blackberries, grapes, cherries, apples, and celery. Imported produce is also more likely to contain higher levels of pesticides.1

There is another reason to feed our children organic food when possible. Organic food usually has more nutrients than conventional.2 One study performed at the University of California at Davis found that foods grown organically had higher amounts of flavonoids, which have protective effects against both heart disease and cancer. The researchers found flavonoids were more than 50 percent higher in organic corn and strawberries. They theorized that when plants are forced to deal with the stress of insects, they produce more of these compounds, which are beneficial to humans.3 Overall, organic foods taste better, and organic agriculture protects farmers and our environment.

But here's the important thing to remember: when it comes to nutrition, what you eat is much more important than whether it's organic or not. Processed cereal, frozen pizza, and macaroni and cheese don't magically become health foods when they're organic. And, watermelon or apples don't become unhealthy when they're not organic. Again Dr. Fuhrman:

The large amount of studies performed on the typical pesticide-treated produce have demonstrated that consumption of produce, whether organic or not, is related to lower rates of cancer and disease protection, not higher rates. Certainly, it is better to eat fruits and vegetables grown and harvested using pesticides than not eating them at all. The health benefits of eating phytochemical-rich produce greatly outweigh any risk pesticide residues might pose.

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When people think cancer they inevitably think chemotherapy. For some patients the link is so strong that they request chemotherapy even if their doctor doesn't recommend it. But The New York Times claims more and more doctors are questioning the role of chemotherapy in treating breast cancer. Gina Kolata reports:

Today, national guidelines call for giving chemotherapy to almost all of the nearly 200,000 women a year whose illness is diagnosed as breast cancer. In the new approach, chemotherapy would be mostly for the 30 percent of women whose breast cancer is not fueled by estrogen.

So far the data are tantalizing, but the evidence is very new and still in flux. And even if some women with hormone-dependent tumors can skip chemotherapy, no one can yet say for sure which women they might be. Some doctors have already cut back on chemotherapy, but the advice a woman gets often depends on which doctor she sees.

It hasn't yet inspired wholesale changes in treatment.

"It's a slightly uncomfortable time," said Dr. Eric P. Winer, who directs the breast oncology center at the Dana-Farber Cancer Institute in Boston. "Some of us feel like we have enough information to start backing off on chemotherapy in selected patients, and others are less convinced."

Among the less convinced is Dr. John H. Glick, director of the Abramson Cancer Center of the University of Pennsylvania. Dr. Glick tells his patients about the new data but does not suggest they skip chemotherapy. After all, he notes, the national guidelines were based on results from large randomized clinical trials. And the recent data indicating that some women can skip chemotherapy are based on an after-the-fact analysis of selected clinical trials.

"We're in an era where evidence-based medicine should govern practice," Dr. Glick said.

For years Dr. Fuhrman has insisted chemotherapy isn't the sun, the moon, and the stars in breast cancer treatment. He explains in a previous post entitled Diet, Chemotherapy, and the Truth: How to Win the War on Cancer:

Chemotherapy has contributed to the progress made against cancer deaths from fast-growing cancers, such as leukemia, lymphoma, testicular cancer, and childhood cancers such as osteogenic sarcoma. But for the major cancers affecting most adult Americans, chemotherapy adds less than one year of disease-free life to those treated�

Does Chemotherapy Work?
Let's see how effective chemotherapy actually is with a few common cancers.

• A meta-analysis of chemotherapy for postmenopausal, estrogen receptor-positive women (the largest group of women with breast cancer) pooled the six largest studies to get the most accurate data on survival and complications. Here is what researchers concluded about the group treated with standard chemotherapy: "No significant survival benefit was observed."1
• In non-small cell lung cancer (the most common type), the 5- year survival is only about 10 percent. In stage 4, when the cancer has spread to distant sites, the 5-year survival is only 1.6 percent. After looking at multiple studies, it appears that treatment generally results in a very slight improved survival rate at 1 year, but this advantage disappeared at 30 months of follow-up.2
• Even in small cell lung cancer where chemotherapy has proven effectiveness in life extension, the benefit adds only a few months of life, not years. And during this time the patient can experience serious�even life threatening�side effects from the treatment.

No doubt this uncertainty among doctors further complicates an already difficult situation. Dr. Fuhrman provides some advice for those confronting cancer:

Every patient has to make her own decision. But if I were a woman with postmenopausal breast cancer, I would opt for surgery, without radiation and without chemotherapy, and would then pursue an aggressive nutritional protocol. I also would include antiestrogens if the tumor histology showed it to be estrogen receptor-positive.

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