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Category: healthy living

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Women: if you sit at work all day, and then you sit 6 or more hours during your leisure time, then you are at significantly greater risk of developing any cancer (compared to women who sit for fewer than 3 hours a day during leisure time). And the odds for certain cancers (multiple myeloma, ovarian cancer, and invasive breast cancer) are greatly increased. That 30 minutes at the gym doesn't cancel out the negative effects of sitting all day. But interestingly, this pattern didn't apply to men. From Medscape:

Leisure Time Sitting Increases Cancer Risk in Women

Women who sit 6 or more hours a day during their leisure time have a 10% greater risk of developing any cancer compared with women who sit for fewer than 3 hours a day. In addition, they are more likely to develop certain site-specific cancers, such as invasive breast cancer, ovarian cancer, and multiple myeloma. However, no similar pattern emerged for men.

"So when we think about independent risk factors for many types of cancer, and definitely for invasive breast cancer, you want to tell women to maintain a physically active lifestyle, to maintain a healthy weight, to limit their alcohol consumption, and now you also want to tell them to reduce their time spent sitting," she said.

The findings come from an analysis of data on some 69,260 men and 77,462 women enrolled in the American Cancer Society Cancer Prevention Study II Nutrition. All participants were cancer-free on enrolment. Between 1992 and 2009, 18,555 men and 12,236 women were diagnosed with cancer. On average, men were followed for 13.2 years, and women were followed for an average of 15.8 years.

"In women, leisure-time spent sitting was associated with a statistically significant higher risk of total cancer incidence...after adjustment for physical activity, [body mass index (BMI)], and other potential confounders," the authors report. Sitting 6 or more hours a day during leisure time was also associated with a 65% greater risk for multiple myeloma, a 43% greater risk for ovarian cancer, and a 10% greater risk for invasive breast cancer compared with women who sat less than 3 hours a day during leisure time. The association between longer sitting times and endometrial cancer was statistically significant before adjusting for BMI, but was attenuated when adjusted for BMI.

The same pattern was not seen in men in this study. Leisure time spent sitting was not associated with cancer risk in men, with the exception of an 11% higher risk associated with sitting time among obese men.

"There are a lot of individuals whom I would describe as 'an active couch potato.' " Dr Patel said. "People are going to the gym and maintaining a healthy weight, but they spend the majority of the rest of their time in sedentary activities — sitting at work, sitting in the car, sitting at home — so you really have to think not just of that 30 minutes a day where you are intentionally engaging in physical activity, but what does the rest of your day look like?"

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The key finding in this research (they studied mice, but this process would also happen in humans) is that: the presence of microbes specifically blocks the immune cells responsible for triggering allergies. Once again we see the importance of a healthy and diverse microbiota (the community of microbes within us), and the need to nurture it from birth. Studies have shown the importance of the first year of life in establishing a healthy microbiome and the development of the immune system. A number of studies have shown that the presence of pets or animals (e.g., living on a farm) reduces the incidence of allergies in children.From Science Daily:

Role of microbiota in preventing allergies

The human body is inhabited by billions of symbiotic bacteria, carrying a diversity that is unique to each individual. The microbiota is involved in many mechanisms, including digestion, vitamin synthesis and host defense. It is well established that a loss of bacterial symbionts promotes the development of allergies. Scientists at the Institut Pasteur have succeeded in explaining this phenomenon, and demonstrate how the microbiota acts on the balance of the immune system: the presence of microbes specifically blocks the immune cells responsible for triggering allergies. 

The hygiene hypothesis suggests a link between the decline in infectious diseases and the increase in allergic diseases in industrialized countries. Improvements in hygiene levels necessarily lead to reduced contact with microbes that is paralleled by an increased incidence in allergic and autoimmune diseases, such as type 1 diabetes.

Epidemiological studies have substantiated this hypothesis, by showing that children living in contact with farm animals -- and therefore with more microbial agents -- develop fewer allergies during their lifetime. Conversely, experimental studies have shown that administering antibiotics to mice within the first days of life results in a loss of microbiota, and subsequently, in an increased incidence in allergy.

However, until now, the biological mechanisms underlying this phenomenon remained unclear. In this study published in Science, the team led by Gérard Eberl (head of the Microenvironment and Immunity Unit at the Institut Pasteur) shows that, in mice, symbiotic intestinal microbes act on the immune system by blocking allergic reactions.

Several types of immune response can be generated in order to defend the organism. The presence of bacterial or fungal microbes provokes a response from immune cells known as type 3 cells. These immune cells coordinate the phagocytosis and killing of the microbes. However, in the case of infection by pathogenic agents that are too large to be handled by type 3 cells (such as parasitic worms and certain allergens), the cells that organize the elimination of the pathogen, but also allergic reactions, are known as type 2 cells.

In this study, scientists at the Institut Pasteur have shown that type 3 cells activated during a microbial aggression act directly on type 2 cells and block their activity. Type 2 cells are consequently unable to generate allergic immune responses. This work demonstrates that the microbiota indirectly regulates type 2 immune responses by inducing type 3 cells.

These results explain how an imbalance in microbiota triggers an exaggerated type 2 immune response normally used to fight large parasites, but that also leads to allergic responses....In terms of allergy treatment, a hitherto unexplored therapeutic approach consists therefore in stimulating type 3 cells by mimicking a microbial antigen in order to block allergy-causing type 2 cells.

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It turns out that we also have microbes called archaea living in and on our bodies. They are part of our microbiome (community of microbes living in and on us, which also includes bacteria, viruses, and fungi). Archaea constitute a domain or kingdom of single-celled microorganisms. These microbes are prokaryotes, meaning that they have no cell nucleus or any other membrane-bound organelles in their cells. Archaeal cells have unique properties that separate them from bacteria and eukaryotes. Archaea were initially classified as bacteria and thought to only exist in extreme environments (such as hot springs and salt lakes), and given the name archaebacteria, but this classification is now outdated. We now know that archaea live in less extreme places, including oceans, marshlands, animals, and humans.

So little is known about archaea that not even medical schools discuss this topic. This may be due to the fact that we currently don't know of any archaea that are human pathogens (that is, that cause illness) or parasitic. They are generally viewed as mutuals (the relationship is beneficial to both organisms) or commensals (they benefit, but don't help or harm the other organism). Humans appear to have low levels of archaea, and so far they have  been found in the human gut (part of digestion and metabolism), on the skin, and in subgingival dental plaque (and perhaps involved with periodontal disease). But studies rarely look for them. We don't know the importance or roles that they play in our bodies (but there are suspicions), but it turns out that drugs such as statins and the antibiotic metronidazole  are eliminating them.

Note that methanogens are archaea that excrete or produce methane as a metabolic byproduct in anoxic (no oxygen) conditions such as the gut. They help digest our food. The species Methanobrevibacter smithii  has been shown to be present in up to 95.7% of humans studied, and found to be the most abundant methanogen in the human gut, comprising up to as much as 10% of all anaerobes found in a healthy individual's colon. Anaerobes are organisms that require oxygen-free conditions to live. Some of the June 2015 article (by M. N. Lurie-Weinberger and U. Goph) excerpts from PLOS:

Archaea in and on the Human Body: Health Implications and Future Directions

Although they are abundant and even dominant members of animal microbiomes (microbiotas), from sponges and termites to mice and cattle, archaea in our own microbiomes have received much less attention than their bacterial counterparts. The fact that human-associated archaea have been relatively little-studied may be at least partially attributed to the lack of any established archaeal human pathogens. Clinically oriented microbiology courses often do not mention archaea at all, and most medical school and biology students are only aware of archaea as exotic extremophiles that have strange and eukaryotic-like molecular machinery. Since archaea have been known to be associated with the human gut for several decades, one would think that human microbiome studies may unravel new facets of archaea–human interactions...  ...continue reading "We Have Archaea In and On Our Bodies"

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The following article excerpts are from the talk "Food and Brain" about the best foods for the brain, at the annual 2015 meeting of the American Psychiatric Association (APA). This is in the new emerging field of food psychiatry, or how certain foods and diet influence the brain. The data is emerging that we can positively influence mental health through dietary interventions. For ex.: recent work reported that adults who followed the Mediterranean dietary pattern the closest over 4.4 years had a significantly reduced risk of developing depression (by 40% to 60%).

One key comment was: "Perhaps diet is the closest we've come to prevention in psychiatry." Some foods that are especially beneficial for the brain: seafood, greens, nuts, legumes (beans) and occasional dark chocolate. Use smaller amounts of meat (more as flavorings rather than just eating huge chunks of it) on top of a plant based diet. Also mentioned were the benefits of turmeric (because of the curcumin in it) and rosemary. And focus on improving the whole dietary pattern rather than just eating or not eating certain foods.

Note that BDNF is Brain-derived neurotrophic factor. This is a protein that acts on the brain, the nervous system, and it is very important for learning, memory, and higher thinking. So increasing BDNF levels is good. And remember, what's good for the brain is also good for the body and microbes - it's all intertwined. From Medscape:

Beans, Greens, and the Best Foods For the Brain

Dr Ramsey, in collaboration with the new International Society for Nutritional Psychiatry, is in the process of developing a standardized "brain food diet." "Food is a very effective and underutilized intervention in mental health," he started off. "We want to help our patients have more resilient brains by using whole foods...by helping get patients off of processed foods, off of white carbohydrates, and off of certain vegetable oils."

Though the field is in its infancy, food psychiatry is increasingly being embraced by clinicians and researchers, as a paper published earlier this year in the Lancet Psychiatry attests. "Although the determinants of mental health are complex," the authors wrote, "the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology." ..."The data are very promising that we can positively influence mental health through dietary interventions," commented Dr Ramsey.

"Hominid diets have changed drastically through millions of years of evolution.,,,But only in the past 100 years has our diet drastically switched from a whole foods diet to one that is more processed and high in refined carbohydrates; that includes more vegetable fats rather than meat fats; and preservatives, emulsifiers, and other additives, which appear to have contributed to a decline in our collective health.

Early humans evolved in the African Rift Valley, which is near a seacoast. It's possible that whatever evolutionary spark occurred that made us human occurred here, in part due to reliable access to seafood—oysters in particular—which glutted our brains with omega-3 fatty acids and cholesterol (our brains are composed of 60% fat). Oysters and other mollusks are also very high in nutrients, including B12, which is commonly deficient in people consuming vegan or vegetarian diets and is necessary for myelin and neurotransmitter function. 

A number of studies have linked the Mediterranean diet (high in fish oils, nuts, and grains and including maybe a little red wine) with advantageous effects on neurologic and mental health. Dr Deans cited recent work reporting that adults who followed the Mediterranean dietary pattern the closest over 4.4 years had a significantly reduced risk of developing depression (40%-60%)....When taken together, most of these dietary pattern studies, which have been conducted all over the world, consistently show that traditional, pre-processed diets are the healthiest, including for the brain. ..."Eat the rainbow," he says, given that bold, bright colors in nature tend to signify valuable vitamins and phytonutrients (the reds, purples, and greens in particular).

Seafood: Seafood is packed with brain-healthy omega-3 fatty acids. These healthy fats are also abundant in plants like chia and flax, but plant-based sources aren't as efficiently converted to docosahexaenoic acid (DHA), an important structural component of neuronal membranes. DHA also influences the expression of brain-derived neurotrophic factor (BDNF), which can benefit people who have mood and anxiety disorders. Bivalves like mussels, oysters, and clams are the top source of vitamin B12 as well as zinc: Six oysters (only about 10 calories each) provide 240% of our recommended daily B12 intake and 500% of our recommended zinc intake! Seafood is also a leading dietary source of vitamin D (we don't get it all from the sun) as well as iodine and chromium. Although many people worry about mercury in fish, Dr Ramsey provided an easy way around the concern: Eat small fish like sardines, anchovies, and herring, which typically don't accumulate toxic levels.

Leafy greens: A great base for a brain-food diet, leafy greens are a good source of fiber, folate (derived from the wordfoliage), magnesium, and vitamin K. Perhaps surprising, kale, mustard greens, and bok choy provide the most absorbable form of calcium on the planet, more so than milk. Greens also provide flavanols and carotenoids that have beneficial epigenetic influences (eg, including upping hepatic toxin processing). 

Nuts:... Nuts are packed with healthy monounsaturated fats. They help keep us full and also aid in absorbing fat-soluble nutrients. Nuts also provide fiber as well as minerals like manganese and selenium. A serving of 22 almonds (just 162 calories) contains 33% of our recommended vitamin E, plenty of protein, and minerals, including iron. One study from 2013 found that the Mediterranean diet augmented with nuts is associated with significantly higher BDNF levels in patients with depression.

Legumes: Dr Ramsey is pro-meat, but he acknowledges that many people are eating far too much and the wrong types of meat, and that nuts and legumes are a great alternative source of protein and nutrients...Some data suggest that vegan and vegetarian diets are associated with improved mood. But as previously mentioned, these dietary patterns can result in B12 deficiency, which has been associated with brain atrophy and developmental delay. Hence, supplementation is important in this population. Vegetarianism has also been linked with depression, anxiety, and eating disorders, as well as increased healthcare utilization and worse quality of life. These negative associations also could be due to the fact that it's harder to absorb nutrients like zinc, iron, and certain omega-3s from plants.

"The notion that the vegan diet is the healthiest diet on the planet is probably incorrect," said Dr Ramsey, before explaining that he just feels that we should approach meat in our diets differently....We want to help patients use beef and seafood more as flavorings on top of a plant-based diet." A modest amount of meat in the diet has its benefits, including nutrient availability: Hemoglobin-derived iron is up to 40% more absorbable than plant-based iron. Unlike most plants, meat provides all of the amino acids necessary for protein synthesis. Dr Ramsey emphasized the importance of seeking out leaner, grass-fed meats if one has the means.

The understanding of how microbiota contribute to our mental and medical well-being is rapidly advancing....One of the most powerful interventions to alter our microbiome is diet. Research shows that stressed mice experienced changes in the gastrointestinal microbiota, reflecting the gut-brain relationship. There are 260 million neurons connecting the gut and the brain; furthermore, many commensal gut bacteria make neurotransmitters and communicate with the brain via the vagus nerve....Although the science of probiotic therapies is relatively young, it's clear that these commensal organisms co-evolved with us and are adapted to our diet.

Finally, to close out the session, Dr Ramsey returned to the stage and asked, "So, can you eat to build a better brain? We think that you can if you focus on dietary patterns and not a single food here or there." He also reminded the audience to help their patients identify and increase their consumption of nutrient-dense foods and to "eat the rainbow,"..."I don't know of anything else that can potentially decrease the risk of depression in a population by 40%," he concluded. "Perhaps diet is the closest we've come to prevention in psychiatry."

...Evidence suggests that curcumin, an ingredient in turmeric, increases BDNF. Other research has found that populations that eat more curry have a decreased risk for dementia, while rosemary extract may help prevent cognitive impairment. "Many spices seem to have healing properties," Dr Ramsey commented.

Although the "Food and the Brain" session at the American Psychiatric Association annual meeting focused on what to eat in the interest of brain health, intermittent fasting might also be beneficial for the brain. In addition to helping maintain a healthy weight, fasting induces ketosis. Ketone metabolism has been shown to be beneficial for the brain and improve cognition in patients with mild cognitive impairment or Alzheimer disease. Keep in mind that fasting can come with risks for some people, particularly diabetics, and should be discussed with a healthcare provider.

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Once again, research shows that eating lots of fruits and vegetables is beneficial to health - this time because high vitamin C concentrations in the blood is linked to lower risks of developing cardiovascular disease and early death. And it's food that they looked at, not supplements. From Science Daily:

Vitamin C related to reduced risk of cardiovascular disease, early death

New research from the University of Copenhagen and Herlev and Gentofte Hospital showshealth benefitsthat high vitamin C concentrations in the blood from the intake of fruit and vegetables are associated with a reduced risk of cardiovascular disease and early death.

As part of the study, the researchers had access to data about 100,000 Danes and their intake of fruit and vegetables as well as their DNA. "We can see that those with the highest intake of fruit and vegetables have a 15% lower risk of developing cardiovascular disease and a 20% lower risk of early death compared with those who very rarely eat fruit and vegetables. At the same time, we can see that the reduced risk is related to high vitamin C concentrations in the blood from the fruit and vegetables," says Camilla Kobylecki, a medical doctor and PhD student at the Department of Clinical Biochemistry, Herlev and Gentofte Hospital.

Among other things, vitamin C helps build connective tissue which supports and connects different types of tissues and organs in the body. Vitamin C is also a potent antioxidant which protects cells and biological molecules from the damage which causes many diseases, including cardiovascular disease. The human body is not able to produce vitamin C, which means that we must get the vitamin from our diet.

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The wonders of nature! A small study found that taking a 90 minute walk in "natural" (wild) environments boost mental well-being by reducing rumination  (obsessive, negative thoughts focused on yourself). It is thought that rumination is associated with increased risk for depression and other mental illnesses. Rumination actually shows up in MRIs scans as increased activity in a brain region called the subgenual prefrontal cortex, an area of the brain that regulates negative emotions. The researchers suggest that these findings support the need for natural areas (parks) in urban areas.There have been a number of other studies finding that nature reduces stress and improves well being. Bottom line: take a walk in nature to feel better. From Medical Xpress:

Walking in nature found to reduce rumination

A team of researchers working at Stanford University has found that people walking in a "natural" environment tend to engage in less rumination...Biomedical researchers believe that some instances of both anxiety and/or depression come about due to what they call rumination—constantly flogging oneself with criticism of past mistakes and some studies have suggested that living in an urban environment might contribute to an increase in rumination. In this new effort, the researchers sought to learn if it might be possible for people to lessen the degree of rumination they engage in by simply going for a walk in a natural setting.

To find out, the team enlisted the assistance of 38 reasonably healthy adult male and female individuals—they were asked to participate in a study that consisted of taking questionnaires and undergoing fMRI scans before and after going for an hour and a half walk. The volunteers were split into two groups, one got to walk in a grassy area near the Stanford campus that was lined with lots of trees—the other group found themselves marching around in a strictly urban setting. The questionnaires were designed to illuminate rumination, while the fMRI scans focused on the subgenual prefrontal cortex—prior research showed it tended to light up during periods of rumination.

Afterwards, the researchers analyzed and crunched the data from the questionnaires and brain scans and came up with a rumination score which they then used to compare people in the two groups. They found that rumination remained level for the urban walkers but fell on average from 35.4 to 33.1 for the nature walkers. This the team claims, shows that taking a walk in a natural environment setting can reduce rumination, and possibly reduce symptoms of anxiety and depression, though they acknowledge that their sample size was small and suggest more research will need to be done to confirm their findings.

This study reveals a pathway by which nature experience may improve mental well-being and suggests that accessible natural areas within urban contexts may be a critical resource for mental health in our rapidly urbanizing world.

 Views from the nature (A and B) and urban (C and D) walks the participants took (PNAS)

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This shouldn't be surprising. Of course staying home and making your own meals is the healthiest! Restaurant meals tend to have very large portions, frequently with rich sauces, and the meal choices tend to be heavy on fat and salt. Think of all the fried foods, rich sauces, meats,breads and butter, and desserts available. At home you can limit excess, control the food ingredients, and eat only healthy foods. From Medical Xpress:

Restaurant meals can be as bad for your waistline as fast food is

Restaurant and fast-food meals increase people's daily intake of calories, fats, cholesterol and sodium. Credit: Diana Yates 

When Americans go out to eat, either at a fast-food outlet or a full-service restaurant, they consume, on average, about 200 more calories a day than when they stay home for meals, a new study reports. They also take in more fat, saturated fat, cholesterol and sodium than those who prepare and eat their meals at home.

These are the findings of University of Illinois kinesiology and community health professor Ruopeng An, who analyzed eight years of nationally representative data from the National Health and Nutrition Examination Survey, which is conducted by the National Center for Health Statistics. An looked at 2003-10 data collected from 18,098 adults living in the U.S.

His analysis, reported in the European Journal of Clinical Nutrition, revealed that eating at a restaurant is comparable to - or in some cases less healthy than - eating at a fast-food outlet. While people who eat at restaurants tend to take in more healthy nutrients - including certain vitamins, potassium and omega-3 fatty acids - than those who eat at home or at a fast-food outlet, the restaurant diners also consume substantially more sodium and cholesterol - two nutrients that Americans generally eat in excess, even at home. 

Fast-food and restaurant diners consumed about 10 grams more total fat, and 3.49 grams and 2.46 grams, respectively, more saturated fat than those who dined at home. Eating at a fast-food outlet adds about 300 milligrams of sodium to one's daily intake, and restaurant dining boosts sodium intake by 412 milligrams per day, on average, An said. 

An also found striking differences in the effects of dining out on different groups."African-Americans who ate at fast-food and full-service restaurants took in more total fat, saturated fat, sodium and sugar than their Caucasian and Hispanic counterparts who dined out," An said. "The effect of fast-food restaurant consumption on daily total energy intake appeared larger among people with lower educational attainment," An said. "And people in the middle-income range had the highest daily intake of total energy, total fat, saturated fat and sodium when they dined at full-service restaurants." 

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There used to be alternative medicine, but it has evolved to what is now called integrative medicine. There are integrative centers even at some if the most prestigious medical institutions in the USA (Harvard, Mayo Clinic,etc). Integrative medicine is part of the medical establishment, so there is an emphasis on treatments that can be scientifically investigated, and conventional medical treatments are also used as needed. But there is a concern with wellness, with looking at the whole body, at prevention and treating chronic diseases (such as heart disease and diabetes) that take years to develop and are tied to the ways people think, feel, and live their everyday lives (so they look at stress, diet, lifestyles).

What I especially like is the quote taught in medical schools: “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half.” That alone is a good reason for a person to take responsibility for living the most healthy lifestyle that they can (to focus on wellness and prevention), rather than depending on medicines for "treatments" and "cures". Excerpts from The Atlantic:

The Evolution of Alternative Medicine

Back in the 1990s, the word “alternative” was a synonym for hip and forward-thinking.... That was the decade when doctors started to realize just how many Americans were using alternative medicine, starting with a 1993 paper published in The New England Journal of Medicine. The paper reported that one in three Americans were using some kind of “unconventional therapy.” Only 28 percent of them were telling their primary-care doctors about it.

Enough Americans had similar interests that, in the early 1990s, Congress established an Office of Alternative Medicine within the National Institutes of Health. Seven years later, that office expanded into the National Center for Complementary and Alternative Medicine (NCCAM), with a $50 million budget dedicated to studying just about every treatment that didn’t involve pharmaceuticals or surgery—traditional systems like Ayurveda and acupuncture along with more esoteric things like homeopathy and energy healing.Some thought the NCCAM’s work was too far outside the mainstream....

In an email, Briggs confirmed that her center’s mission has shifted over the years...”That change became more pronounced a few months ago, when Congress removed the word “alternative” from the NCCAM’s name, redubbing it the National Center for Complementary and Integrative Health (NCCIH). 

The idea of alternative medicine—an outsider movement challenging the medical status quo—has fallen out of favor since my youth. Plenty of people still identify strongly with the label, but these days, they’re often the most extreme advocates, the ones who believe in using homeopathy instead of vaccines, “liver flushes” instead of HIV drugs, and garlic instead of chemotherapy. In contrast, integrative doctors see themselves as part of the medical establishment. “I don’t like the term ‘alternative medicine,’” says Mimi Guarneri, a longtime cardiologist and researcher who founded the Academy of Integrative Health and Medicine as well as the integrative center at Scripps. 

After visiting the NIH center and talking to leading integrative physicians, I can say pretty definitively that integrative health is not just another name for alternative medicine. There are 50 institutions around the country that have integrative in their name, at places like Harvard, Stanford, Duke, and the Mayo Clinic. Most of them offer treatments like acupuncture, massage, and nutrition counseling, along with conventional drugs and surgery.

The actual treatments they use vary, but what ties integrative doctors together is their focus on chronic disease and their effort to create an abstract condition called wellness. In the process, they’re scrutinizing many therapies that were once considered alternative, subjecting them to the scientific method and then using them the same way they’d incorporate any other evidence-based medicine.

It’s hard to talk about integrative health without using abstract terms like wellness, vitality, and healing...For a long time, though, the medical profession was so busy treating acute illness that it didn’t put as much attention on preventing heart disease, diabetes, or cancer...The bigger problem, says Hyman, is that most doctors aren’t well equipped to treat chronic disease. “We have an acute-disease system for a chronic-disease population,” he told me. “The whole approach is to suppress and inhibit the manifestations of disease.” 

The question is how integrative doctors try to restore balance—and the answer varies. Many of them focus on diet to a degree that goes far beyond the usual guidelines about avoiding salt or trans fat. They’ll look for undiagnosed food sensitivities or hormonal imbalances, with the idea that these problems account for many chronic health complaints and cause even more serious breakdowns over time. There’s a lot of emphasis on intestinal bacteria. “We now know that so many separate things are linked to what’s going on in the gut,” Hyman told me, alluding to a growing body of literature linking the microbiome to everything from cancer to mood disorders. Guarneri, the cardiologist who founded the integrative center at Scripps, told me integrative health is highly personalized. 

Integrative doctors tend to favor treatments that are—as Briggs, the NCCIH director, put it—“amenable to scientific investigation.” Several of the doctors I interviewed told me they don’t prescribe homeopathic remedies, for instance, because there’s no evidence to support them....When integrative doctors do employ alternative-seeming treatments, it’s usually to manage pain or reduce stress. 

Aside from these variations, there’s another reason it’s hard to define integrative health: It doesn’t exist in a vacuum. Its practitioners are part of the same medical establishment as other doctors, going to the same conferences and publishing in the same journals. They’ve influenced and been influenced by major trends in medicine—for instance, the movement toward patient-centered medicine, or the backlash against the overuse of drugs and surgery that the New Yorker writer Atul Gawande calls “the epidemic of unnecessary care.”

Data: CDC Report on Multiple Chronic Conditions Among Adults; Chart: Lauren Giordano / The Atlantic

When Blackwelder teaches family medicine at East Tennessee University, he says he reminds his students to stay open to treatments that once seemed esoteric, as long as they show some promise. “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half,” he says. “We find things out by remaining inquisitive, being open to exploring new ideas when a question is asked. We should never just say we’ve got it all figured out, because we rarely do.”At a time when one in two American adults has at least one chronic disease, it’s safe to say there are a lot of things medicine still hasn’t figured out. 

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The study results of 218 overweight, postmenopausal women who had insufficient levels of vitamin D (like most people) at the beginning of the study found that weight loss (including exercise), in combination with vitamin D supplementation, had a greater effect on reducing chronic inflammation than weight loss alone.

Current thinking is that chronic inflammation is linked to various chronic diseases as well as cancers. So reducing chronic inflammation is good. From Medical Xpress:

Weight loss plus vitamin D reduces inflammation linked to cancer, chronic disease

For the first time, researchers at Fred Hutchinson Cancer Research Center have found that weight loss, in combination with vitamin D supplementation, has a greater effect on reducing chronic inflammation than weight loss alone. Chronic inflammation is known to contribute to the development and progression of several diseases, including some cancers.

"We know from our previous studies that by losing weight, people can reduce their overall levels of inflammation, and there is some evidence suggesting that taking vitamin D supplements can have a similar effect if one has insufficient levels of the nutrient," said lead and corresponding author Catherine Duggan, Ph.D., a principal staff scientist in the Public Health Sciences Division at Fred Hutch. 

To explore this question, Duggan and colleagues recruited 218 healthy, overweight older women who had lower-than-recommended levels of vitamin D (less than 32 ng/mL). The women then took part in a 12-month diet and exercise program (including 45 minutes of moderate-to-vigorous exercise five days a week). Half of the study participants were randomly selected to receive 2,000 IU of vitamin D daily for the duration of the year-long trial, and the other half received an identical-appearing placebo, or dummy vitamin. 

At the end of the study, all of the participants had reduced levels of inflammation, regardless of whether they took vitamin D, "which highlights the importance of weight loss in reducing inflammation," Duggan said. However, those who saw the most significant decline in markers of inflammation were those who took vitamin D and lost 5 to 10 percent of their baseline weight. These study participants had a 37 percent reduction in a pro-inflammatory cytokine called interleukin-6, or IL-6, as compared to those in the placebo group, who saw a 17.2 percent reduction in IL-6. The researchers found similar results among women in the vitamin D group who lost more than 10 percent of their starting weight. While IL-6 has normal functions in the body, elevated levels are associated with an increased risk of developing certain cancers and diabetes and may be implicated as a cause of depression, Duggan said.

Inflammation occurs when the body is exposed to pathogens, such as bacteria or viruses, which puts the immune system in overdrive until the "attack" ceases and the inflammatory response abates. Overweight or obese people, however, exist in a state of chronic inflammation. This sustained upregulation of the inflammatory response occurs because fat tissue continually produces cytokines, molecules that are usually only present for a short time, while the body is fighting infection, for example.

"It is thought that this state of chronic inflammation is pro-tumorigenic, that is, it encourages the growth of cancer cells," she said. There is also some evidence that increased body mass "dilutes" vitamin D, possibly by sequestering it in fat tissue."Weight loss reduces inflammation, and thus represents another mechanism for reducing cancer risk," Duggan said. "If ensuring that vitamin D levels are replete, or at an optimum level, can decrease inflammation over and above that of weight loss alone, that can be an important addition to the tools people can use to reduce their cancer risk."

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Foods with trans fats. Credit: Wikipedia.

Finally the FDA is phasing out the use of artificial trans fats in foods (found in partially hydrogenated vegetable oils) within 3 years. It turns out that even though for many years scientists and the medical community pushed foods such as margarine (which have trans fats) as healthier than saturated fats such as butter, they were wrong. Instead the trans fats are linked to cardiovascular problems.

We can thank 100 year old Frank Kummerow for the ban, and for warning about trans fats for six decades! He is still drinking whole milk, eating eggs and butter, but he does avoid "fried foods, margarine, and anything associated with partially-hydrogenated oils". Other foods that are currently viewed as healthy by the medical community are extra virgin olive oil and coconut oil. However, please note that canola oil, currently viewed as a healthy and safe alternative to partially hydrogenated oils, also contains trans fats (due to the manufacturing process) and should be avoided. Also keep in mind that companies are allowed to say they have zero trans fat of they contain less than 0.5 grams per serving (which means the trans fats can add up over the course of a day). From The Washington Post:

The 100-year-old scientist who pushed the FDA to ban artificial trans fat

No one was more pleased by the Food and Drug Administration's decision Tuesday to eliminate artificial trans fats from the U.S. food supply than Fred Kummerow, a 100-year-old University of Illinois professor who has warned about the dangers of the artery-clogging substance for nearly six decades."Science won out," Kummerow, who sued the FDA in 2013 for not acting sooner, said in an interview from his home in Illinois. "It's very important that we don't have this in our diet."

In the 1950s, as a young university researcher, Kummerow convinced a local hospital to let him examine the arteries of people who had died from heart disease. He made a jarring discovery. The tissue contained high levels of artificial trans fat, a substance that had been discovered decades earlier but had become ubiquitous in processed foods throughout the country.

Later, he conducted a study showing that rats developed atherosclerosis after being fed artificial trans fats. When he removed the substance from their diets, the atherosclerosis disappeared from their arteries.

Kummerow first published his research warning about the dangers of artery-clogging trans fats in 1957. More than a decade later, while serving on a subcommittee of the American Heart Association, he detailed the massive amounts of trans fat in the shortening and margarines lining grocery shelves, and helped convince the food industry to lower the content in certain products.

Despite Kummerow's research and warnings over the years, artificial trans fats remained a staple of processed food for decades. Well into the 1980s, many scientists and public health advocates believed that partially hydrogenated oils were preferable to more natural saturated fats. And the food industry was reluctant to do away with artificial trans fats, which were cheaper than their natural counterparts, extended shelf life and gave foods desirable taste and texture.

Frustrated by the lack of action, Kummerow filed a 3,000-word citizen petition with the FDA in 2009, citing the mounting body of evidence against trans fat. The first line read: "I request to ban partially hydrogenated fat from the American diet."

In the 1990s, more and more studies had shown that trans fats were a key culprit in the rising rates of heart disease. The advocacy group Center for Science in the Public Interest also petitioned the FDA in 1994 to require that the substance be listed on nutrition labels -- a move that the agency put into place in 2006. In 2002, the Institute of Medicine found that there was “no safe level of trans fatty acids and people should eat as little of them as possible.” As the dangers of trans fat became clearer, public opinion also shifted, and food companies increasingly removed the substance from products, though it remained in a broad range of foods, from cake frostings to baked goods.

Four years after filing his petition and hearing nothing, Kummerow sued the FDA and the Department of Health and Human Services in 2013, with the help of a California law firm. The suit asked a judge to compel the agency to respond to Kummerow's petition and "to ban partially hydrogenated oils unless a complete administrative review finds new evidence for their safety."

Three months later, the FDA announced its plans to effectively eliminate trans fats by saying that the substance no longer would be assumed safe for use in human foods. Tuesday's action finalizes that initial proposal, and manufacturers will have three years to reformulate products or to petition the agency for an exception.