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Published on Leave a comment on Health Benefits of 5 Days of Calorie Restriction

Do you want to live longer and be healthy at the same time? Some possible ways may be to restrict the calories in the diet (every day) or to practice intermittent calorie restriction (a fasting mimicking diet a few days a month or even each week, such as the 5:2 diet). Previous studies in animals and humans have suggested that periodic fasting can reduce body fat, cut insulin levels, and provide other benefits. Studies in animals found that sharply restricting calories (calorie restriction or CR) daily resulted in longer, healthier lives, but it is unknown if the benefits of chronic calorie restriction also holds true for humans, and even if it might be dangerous. And really - how many people would actually want to reduce their calorie intake by 25% or more day in and day out for years? Intermittent calorie restriction seems much, much easier.

Two recently published studies suggest health benefits of calorie restriction diets - chronic calorie restriction in adult rhesus monkeys, and intermittent calorie restriction (a fasting mimicking diet a few days a month) in humans.

Researchers at the Univ. of Wisconsin–Madison and National Institute of Aging reanalyzed two studies they had originally done with conflicting results, and now they reported in Nature Communications that chronic calorie restriction produced health benefits (such as lower incidence of cancer, cardiovascular problems) and longer life in rhesus monkeys. Since these primates have human-like aging patterns, they thought that CR would also have similar benefits in humans - a longer, healthier life.  The researchers describe one monkey they started on a 30 percent calorie restriction diet when he was 16 years old (late middle age for rhesus monkeys), and that he is now 43 (a longevity record for the species). They found that in nonhuman primates calorie restriction is beneficial when started in adulthood (especially late middle age in males), but does not improve survival when started in juveniles (young animals) - and in fact they tended to die at an earlier age than the normal diet group of primates.

In the other study (in Science Translational Medicine), research suggests it is possible to gain anti-aging benefits with a “fasting-mimicking diet,” practiced just five days a month. 100 healthy adults (aged 20 to 70) were randomly assigned to either a group following a low-calorie "fasting-mimicking" diet (FMD) five days a month, for 3 months, or a normal diet control group. After 3 months, the control group also went on the fasting mimicking diet. Test subjects followed a 50 percent calorie restricted diet (totaling about 1,100 calories on the first day) and 70 percent diet (about 700 calories) on the next four days, then ate whatever they wanted for the rest of the month. The calorie-restricted diet was low in calories, sugars, and protein, was 100 percent plant-based, and featured vegetable soups, energy bars, energy drinks, and a chip snack, as well as mineral and vitamin supplements. (Note that Longo and Univ. of Southern California are both owners of L-Nutra, the company that manufactures the diet. But Longo says he takes no salary or consulting fees from the company.)

But it still wasn't easy for the test subjects to follow the 5 days of restricted calories per month because there was a 25% drop out rate. Health benefits (about a 6 pound weight loss, smaller waistlines, lower blood pressure, lower levels of inflammation, and better levels of glucose, triglycerides and cholesterol, etc.), showed up after the third month and persisted for at least three months—even after subjects had returned full-time to a normal diet. They lost body fat, but lean muscle mass remained unchanged. They found that the benefits were greater for people who were obese or otherwise unhealthy. In summary, the researchers said that 3 cycles of the 5 days per month of fasting-mimicking diet improved the levels of a variety of "markers/risk factors associated with poor health and aging and with multiple age-related diseases" (such as cancer, diabetes, heart disease, etc).

Other researchers say there is no need to suffer through such extreme diets, but to instead follow a healthy lifestyle, which includes a healthy diet (with lots of vegetables, fruits, legumes, seeds, whole grains, and nuts), and to exercise. And remember - nowhere does following restricted calorie diets mean you'll live longer - just that you should be healthier as you age (hopefully). There are no guarantees in life...

From Science Translational Medicine: Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease

Mice that fast periodically are healthier, metabolically speaking. To explore whether fasting can help people as well, Wei et al. studied 71 people who either consumed a fasting-mimicking diet for 5 days each month for 3 months or maintained their normal diet for 3 months and then switched to the fasting schedule. The fasting-like diet reduced body weight and body fat, lowered blood pressure, and decreased the hormone IGF-1, which has been implicated in aging and disease. A post hoc analysis replicated these results and also showed that fasting decreased BMI, glucose, triglycerides, cholesterol, and C-reactive protein (a marker for inflammation). These effects were generally larger in the subjects who were at greater risk of disease at the start of the study. A larger study is needed to replicate these results, but they raise the possibility that fasting may be a practical road to a healthy metabolic system.

From Nature Communications:  Caloric restriction improves health and survival of rhesus monkeys

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Published on 5 Comments on Vitamin B3 and Glaucoma

Image result for eyes A recent study had great results in preventing glaucoma or stopping the progress of glaucoma by supplementing the diet of mice with vitamin B3 (nicotinamide). But now the research needs to see if this also holds true for humans.

Glaucoma is a common neurodegenerative disease that results in vision loss. Two main risk factors are increasing age and high intraocular pressure (pressure in the eye). The researchers said that their next step is testing B3 in human glaucoma patients. So stay tuned...

Vitamin B3, also known as niacin, is an essential vitamin for health, but both deficiencies and too high doses have negative health effects. It is recommended that adults get between 14 mg to 18 mg of niacin per day. Since it is not stored in the body (the excess will be excreted in urine), then you need to get a continuous supply from your diet.

As seen in so many other studies of vitamins and minerals, there is no evidence of adverse effects from the consumption of naturally occurring niacin in foods, but one can get too much from supplements (along with negative health effects).

What foods are good sources of B3 (niacin)? Foods highest in B3 (niacin) are tuna, chicken, turkey, but other good sources are anchovies, salmon, sardines, red meat, peanuts, nuts, seeds, eggs, mushrooms, dairy foods. lentils, beans, potatoes, and grain products.

From Medical Xpress: Vitamin B3 prevents glaucoma in laboratory mice

In mice genetically predisposed to glaucoma, vitamin B3 added to drinking water is effective at preventing the disease, a research team led by Jackson Laboratory Professor and Howard Hughes Medical Investigator Simon W.M. John reports in the journal Science. ...continue reading "Vitamin B3 and Glaucoma"

Published on Leave a comment on Gut Microbe Differences Between Active and Sedentary Women

A new study found differences in gut microbes between active women (they exercised at least the recommended amount) and those that are sedentary. When the gut bacteria were analyzed with modern tests (genetic sequencing) the active women had more of the health promoting beneficial bacteria such as Faecalibacterium prausnitzii, Roseburia hominis, and Akkermansia muciniphila than the sedentary women. The sedentary women also had some bacterial species not seen in the active women. The researchers said that exercise "modifies the composition of gut microbiota" (the gut microbes) in a way beneficial for health.

And what is the recommended minimal amount of exercise? The World Health Organization recommends at least 3 days of exercise per week for 30 minutes at a moderate intensity. Note that exercise can mean doing exercises, but it can also include walking briskly, intense housework (scrubbing, vacuuming with lots of bending, etc.), gardening (digging, raking, etc), or shoveling snow, etc. In this study the group of active women had at least 3 hours of physical exercise per week. Note that a sedentary lifestyle is associated with a high incidence of chronic diseases such as cardiovascular disease, cancer and diabetes, while physical exercise or activity has metabolic and immune health benefits (prevents disease).

But...reading the full study, the research also showed that the active group ate more fruits and vegetables - which we know has an effect on the gut microbiome and feeds beneficial bacteria. Although the diets of the 2 groups of women were similar in total carbohydrates, protein and fat content eaten, the active women ate more fruits, vegetables, and fiber, and the sedentary group ate more processed meat. So it looks like both exercise and a good amount of fruits and vegetables may be important for nurturing beneficial bacteria. By the way, the 3 species of beneficial bacteria mentioned currently are not found in any probiotic supplements on the market. (Earlier posts on the beneficial F. prausnitzii and Akkermansia muciniphila). From C. Bressa et al research article in PLoS ONE:

Differences in gut microbiota profile between women with active lifestyle and sedentary women

Physical exercise is a tool to prevent and treat some of the chronic diseases affecting the world’s population. A mechanism through which exercise could exert beneficial effects in the body is by provoking alterations to the gut microbiota, an environmental factor that in recent years has been associated with numerous chronic diseases. Here we show that physical exercise performed by women to at least the degree recommended by the World Health Organization can modify the composition of gut microbiota. Using high-throughput sequencing of the 16s rRNA gene, eleven genera were found to be significantly different between active and sedentary women. Quantitative PCR analysis revealed higher abundance of health-promoting bacterial species in active women, including Faecalibacterium prausnitzii, Roseburia hominis and Akkermansia muciniphila. Moreover, body fat percentage, muscular mass and physical activity significantly correlated with several bacterial populations. In summary, we provide the first demonstration of interdependence between some bacterial genera and sedentary behavior parameters, and show that not only does the dose and type of exercise influence the composition of gut microbiota, but also the breaking of sedentary behavior. ...continue reading "Gut Microbe Differences Between Active and Sedentary Women"

Published on Leave a comment on Should Pregnant Women Be Warned To Avoid Licorice?

Avoid eating licorice during pregnancy? That licorice is a food to avoid during pregnancy (or only eat in tiny amounts) will be news to many. Most people think of licorice (or liquorice) as a candy, but it can also be used as a herbal medicine that can have negative health effects, especially in large doses (e.g, high blood pressure, loss of potassium). The licorice flavor comes from the root of the plant (licorice root). Licorice contains glycyrrhizin, which is in black licorice candy, and in some chewing gums, ice creams, syrups, soft drinks, supplements, herbal teas, and other products.

In 2016, the government of Finland warned against consuming licorice (including black licorice and salty licorice) during pregnancy. In the United States, the FDA does not warn pregnant women about eating licorice or licorice root. The National Institutes of Health (NIH) recommends that pregnant women avoid consuming large amounts of licorice root in food or taking it as a supplement. But how about small amounts of licorice? And what are possible effects during pregnancy?

A recent study in Finland compared children (average age of 12 1/2 years) whose mothers had either consumed little to no licorice during pregnancy or had consumed large amounts of licorice (high glycyrrhizin levels were calculated as more than 500 milligrams per week). Note that 500 mg glycyrrhizin is equal to 250 grams or 8.8 oz licorice. The researchers found that children whose mothers ate large amounts of licorice during pregnancy  were about 7 points lower on IQ tests, had poorer memory, and had higher rates of attention deficit/hyperactivity disorder problems than those whose mothers had eaten little or no licorice during pregnancy. High-consumption group girls had earlier and more advanced puberty, and were taller and heavier than those in the low-licorice group.

The researchers wrote that glycyrrhizin results in "glucocorticoid overexposure", which may affect the developing fetus, and the effects persist into early adolescence. The study researchers concluded that pregnant women should be informed that consumption of licorice and other food products containing glycyrrhizin may be associated with harm to their developing baby. A little licorice candy here and there during pregnancy seems to be OK (so don't panic!), but licorice or licorice root is not something that should be eaten or drunk (e.g.,in a tea) regularly. From Science Daily:

Pregnant women should avoid liquorice

A new Finnish study supports food recommendations for families with children in that women should avoid consuming large amounts of liquorice during pregnancy. The limit for safe consumption is not known. In the study, youths that were exposed to large amounts of liquorice in the womb performed less well than others in cognitive reasoning tests carried out by a psychologist. The difference was equivalent to approximately seven IQ points. Those exposed to liquorice also performed less well in tasks measuring memory capacity, and according to parental estimates, they had more ADHD-type problems than others. With girls, puberty had started earlier and advanced further.

The Glaku study carried out by the University of Helsinki, the National Institute for Health and Welfare and the Helsinki and Uusimaa hospital districts compared 378 youths of about 13 years whose mothers had consumed "large amounts" or "little/no" liquorice during pregnancy. In this study a large amount was defined as over 500 mg and little/no as less than 249 mg glycyrrhizin per week. These cutoffs are not based on health effects. 500 mg glycyrrhizin corresponds on average to 250 g liquorice.

Researchers suggest that pregnant women and women planning pregnancy should be informed of the harmful effects that products containing glycyrrhizin -- such as liquorice and salty liquorice -- may have on the fetus. In Finland, this is already reality. In January 2016, the National Institute for Health and Welfare published food recommendations for families with children, in which liquorice was placed in the 'not recommended' category for pregnant women. According to the recommendations, occasional consumption of small amounts such as a portion of liquorice ice cream or a few liquorice sweets is not dangerous.

As a result of animal experiments, the biological mechanism of the effects of liquorice is well known. Glycyrrhizin intensifies the effects of stress hormone cortisol by inhibiting the enzyme that inactivates cortisol. While cortisol is essential to the development of a fetus, it is detrimental in large amounts. It has long been known that glycyrrhizin causes higher blood pressure and shorter pregnancies in humans, but such long-lasting effects on the fetus have not been proven before. [Original study.]

Published on Leave a comment on Eating An Egg A Day May Be Beneficial?

Remember all the dietary advice that for years told us to avoid or limit consumption of eggs - that since they were high in cholesterol, they were bad for us and would increase our risk for heart disease? And the nonsense that we should only eat the egg whites while throwing out the yolks? Hah...That advice was wrong, which another recent study confirms.

Eggs are an amazingly nutritious food. They’re loaded with high quality protein, healthy fats, vitamins, minerals, high in choline (a brain nutrient), biotin, antioxidants, lutein, and zeaxanthin. One review of studies (involving millions of people) looked at whole egg consumption  and found that high egg consumption (up to one egg per day) is not associated with increased risk of coronary heart disease or stroke, and in fact there was a reduced risk of hemorrhagic stroke. Only among diabetics was there an elevated risk of coronary heart disease with high egg consumption (up to 1 egg per day). Another study found a lower risk of type 2 diabetes in middle-aged men (see post).

A recent study from Finland found that neither cholesterol nor egg intake (eating one egg per day) was associated with an increased risk of dementia or Alzheimer's disease in Finnish men who were followed for 22 years. Instead, eating eggs was associated with better cognitive performance in certain areas such as executive function, which includes memory, problem solving, and planning (they were given neuropsychological tests). From Science Daily:

High cholesterol intake and eggs do not increase risk of memory disorders

A new study from the University of Eastern Finland shows that a relatively high intake of dietary cholesterol, or eating one egg every day, are not associated with an elevated risk of dementia or Alzheimer's disease. Furthermore, no association was found in persons carrying the APOE4 gene variant that affects cholesterol metabolism and increases the risk of memory disorders. APOE4 is common in Finland.

The dietary habits of 2,497 men aged between 42 and 60 years and with no baseline diagnosis of a memory disorder were assessed at the onset the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, in 1984-1989 at the University of Eastern Finland. During a follow-up of 22 years, 337 men were diagnosed with a memory disorder, 266 of them with Alzheimer's disease. 32.5 per cent of the study participants were carriers of APOE4.

The study found that a high intake of dietary cholesterol was not associated with the risk of dementia or Alzheimer's disease -- not in the entire study population nor in the carriers of APOE4. Moreover, the consumption of eggs, which are a significant source of dietary cholesterol, was not associated with the risk of dementia or Alzheimer's disease. On the contrary, the consumption of eggs was associated with better results in certain tests measuring cognitive performance. 

Published on Leave a comment on Environmental Pollutants and Gut Microbes

What things in our environment have an effect on the microbes living within us? We now know that gut microbes are important for our health in many ways, and that thousands of species of bacteria, as well as viruses, fungi, and other microbes normally live in a healthy person's gut. We refer to these microbes as the human microbiota or human microbiome. When the community of gut microbes is thrown out of whack (dysbiosis) there can be a number of negative health effects, including diseases. Researchers are just learning about all the microbes within us and their importance in health and disease. [See all posts on the human microbiome.]

Past posts have discussed such things as antibiotics, emulsifiers, different foods and diets, heartburn drugs, etc. having an effect on the human microbiome, but what else? A recent study from China reviewed some environmental pollutants and their effects on gut microbiota - as shown in both human and animal studies. They reviewed studies on antibiotics, heavy metals (arsenic, cadmium, lead), persistant organic pollutants or POPs (organochlorine pesticides, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers, and polycyclic aromatic hydrocarbons or PAHs), pesticides (permethrin, chlorpyrifos, pentachlorophenol, epoxiconazole and carbendazim, imazalil), emulsifiers, nanoparticles (e.g., silver nanoparticles), and artificial sweeteners. They found that all these environmental pollutants had effects on gut microbes - with some effects lasting for years. Their conclusion: gut microbes are very sensitive to drugs, diet, and environmental pollutants. By the way, notice that popular food ingredients such as emulsifiers and artificial sweeteners were considered "environmental pollutants" by the researchers.

Excerpts from Environmental Pollution: Effects of environmental pollutants on gut microbiota

Environmental pollutants have become an increasingly common health hazard in the last several decades. Recently, a number of studies have demonstrated the profound relationship between gut microbiota and our health. Gut microbiota are very sensitive to drugs, diet, and even environmental pollutants. In this review, we discuss the possible effects of environmental pollutants including antibiotics, heavy metals, persistent organic pollutants, pesticides, nanomaterials, and food additives on gut microbiota and their subsequent effects on health. We emphasize that gut microbiota are also essential for the toxicity evaluation of environmental pollution. In the future, more studies should focus on the relationship between environmental pollution, gut microbiota, and human health.

Thousands of species are found in the gut microbiome, and the majority of these species belong to six bacterial phyla: Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria, and Verrucomicrobia (Eckburg et al., 2005). Gut microbiota are highly dynamic and have substantial interindividual and intraindividual variation....The gut microbiota are very essential for host health. They participate in the regulation of many physiological functions. The gut microbiota reside in our intestinal mucus layer and even participate in shaping the mucus layer (Jakobsson et al., 2015). They help us to digest food (such as fiber); synthesize vitamins and amino acids (Spanogiannopoulos et al., 2016); play very important roles in energy metabolism and storage, immune system modulation, growth, and neurodevelopment; and can even regulate our behavior.... The occurrence of many diseases is correlated with altered gut microbiome composition (Lange et al., 2016). Gut microbiota dysbiosis is considered to be a potential cause of obesity (Cani et al., 2007; Fei and Zhao, 2013). However, gut microbiota are very sensitive to drugs, diet, and environmental pollutants.

Although most environmental pollutants do not directly target gut microbiota, some pollutants can enter the body and interact with the gut microbiota through different pathways. A number of previous studies have shown that exposure to environmental pollutants can alter the composition of the gut microbiome, leading to disorders of energy metabolism, nutrient absorption, and immune system function or the production of other toxic symptoms (Jin et al., 2015c; Zhang et al., 2015b). In the present review, we conclude that different kinds of environmental pollutants can induce gut microbiota dysbiosis and have multiple potential adverse effects on animal health. 

Heavy metals in the environment have become a severe health risk in recent years (Liu et al., 2016a). As a common form of environmental pollution, heavy metals are associated with a wide range of toxic effects, including carcinogenesis, oxidative stress, and DNA damage, and effects on the immune system..... Recently, several studies have stated that heavy metal exposure could also lead to gut microbiota dysbiosis, indicating that study of gut microbiota provides a new approach to analyze the mechanisms of heavy metal toxicity

Immune system function is tightly coupled to our gut microbiome. Gut microbiota and their metabolites can interact with both the innate immune system and the adaptive immune system (Honda and Littman, 2016; Thaiss et al., 2016).... Alterations in the gut microbiome can disrupt the balance between the host immune system and gut microbiota, induce immune responses, and even trigger some immunological diseases. Furthermore, immune system imbalance may influence the microbiota metabolites. For example, trimethylamine, which is absorbed from food by gut microbiota, can induce atherosclerosis (Chistiakov et al., 2015).

Published on Leave a comment on Vitamin D and Frequent Headaches

I saw mention of this study in a number of places - that low vitamin D levels are linked to chronic headaches. A little too soon to know if that is really true -  the researchers in this study looked at the blood vitamin D levels of 2601 men just one time, and did not give vitamin D supplements to the men to see if this changed the frequency of migraine headaches. The researchers themselves pointed out that other studies looking at this same issue have had mixed results. And they themselves pointed out that low blood levels of vitamin D (serum 25(OH)D concentration) was associated with a markedly higher risk of frequent headache in men. Associated does not mean caused.

Yes, low vitamin D levels is linked to a number of health problems (see all vitamin D posts). But at this point I think that it's a case of "wait and see" to see if vitamin D levels have something to do with headache frequency. Perhaps other micronutrients are important, perhaps something else. Note that in the study they used below 50 nmol as the measure for low vitamin D levels. In the USA, that translates into below 20 ng/ml, which everyone agrees is too low (a deficiency). The best source of vitamin D is sunlight - which is why it's called the "sunshine vitamin". From Science Daily:

Vitamin D deficiency increases risk of chronic headache

Vitamin D deficiency may increase the risk of chronic headache, according to a new study from the University of Eastern Finland....The Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, analysed the serum vitamin D levels and occurrence of headache in approximately 2,600 men aged between 42 and 60 years in 1984-1989. In 68% of these men, the serum vitamin D level was below 50 nmol/l, which is generally considered the threshold for vitamin D deficiency. Chronic headache occurring at least on a weekly basis was reported by 250 men, and men reporting chronic headache had lower serum vitamin D levels than others.

When the study population was divided into four groups based on their serum vitamin D levels, the group with the lowest levels had over a twofold risk of chronic headache in comparison to the group with the highest levels. Chronic headache was also more frequently reported by men who were examined outside the summer months of June through September. Thanks to UVB radiation from the sun, the average serum vitamin D levels are higher during the summer months.

The study adds to the accumulating body of evidence linking a low intake of vitamin D to an increased risk of chronic diseases. Low vitamin D levels have been associated with the risk of headache also by some earlier, mainly considerably smaller studies.

Published on Leave a comment on Focus On Healthy Lifestyle, Not Just On Tests And Screenings

The wonderful blog posts of Dr. John Mandrola (physician, blogger, and columnist at Medscape) are always thoughtful, and this latest points out things a number of studies have pointed out for a while. Which is to stop obsessing or focusing on "preventive tests" and screenings and numbers, and instead focus on a healthy lifestyle - which means getting regular exercise or physical activity, don't smoke cigarettes, maintaining a healthy weight, and eating a healthy diet with lots of fruits, vegetables, nuts, seeds, whole grains, and legumes (think Mediterranean-style diet).

Don't want overdiagnosis and overtreatment (here, here, here, and here). Excerpts from Dr. John M:

I am changing…

The main thing that has changed about me is my views as a doctor, especially when it comes to dealing with people who complain of nothing. Medicine is most pure when we treat people with illness. The infirmed come to us with a problem and we use our intelligence, experience and procedural skills to help them. It’s immensely gratifying. The joy of helping people still negates the stifling burden of administrative nonsense. I’ll do your damn corporate safety modules one more year because helping sick people get well feels so good.

But when people complain of nothing, our first job is to do no harm. I know prevention of disease is better than treating it, but the process of prevention gets dicey. When we prescribe things (screening tests, statins, aspirin, diabetes drugs etc) to people who complain of nothing, we should have the highest evidence these therapies deliver benefit. Too often, we cite eminence rather than evidence.

I’ve come to believe the medical profession is too paternalistic, too arrogant. I fear the medicalization of the human condition. These days, I order fewer tests. Medical tests put people into the “system,” on the metaphorical train of healthcare. This train accelerates quickly, and it’s often hard to get off. Even a simple echo scares me. I could tell you stories.

More often than not, I tell patients to stop checking their “numbers.” If they insist on health numbers, I favor three–the scale, the belt size and a Timex to measure walking speed.

A 2002 article from Dr. David Sackett (a pioneer of evidence-based medicine) perfectly captures my views on preventive medicine. It’s called The Arrogance of Preventive Medicine. It’s worth a look, now more than ever.

Published on Leave a comment on Heart Attacks Run In The Family? Healthy Lifestyle Can Really Reduce Risk

 Image result for human heart in human body wikipedia Heart attacks run in the family? Does this mean you are doomed to also have a heart attack? Well, the good news from a large study is that a healthy lifestyle (with at least 3 of these 4 behaviors: not currently smoking, not being obese, regular physical activity at least once per week, and eating a good diet)  lowers the risk of a heart attack by nearly 50% even in those with a high genetic risk for heart attacks. (This is compared to those with an unhealthy lifestyle, which is none or only one healthy behavior.)  In this study a healthy diet was one with lots of fruits, nuts, vegetables, whole grains, fish, and dairy products, and a reduced amount of refined grains, processed meats, red meat, sugar-sweetened beverages, and trans fats.

The researchers also reversed the question and asked: "If you happen to inherit good genes, can a bad lifestyle offset that? We actually found yes." The risk of heart attack is also reduced nearly 50% in those people with good genes and a good lifestyle. BOTTOM LINE: Healthy lifestyle counts, no matter whether heart disease and heart attacks run in the family or not. There is an interaction between the two, From Science Daily:

Following a healthy lifestyle can greatly reduce genetic heart attack risk

It is well known that following a healthy lifestyle -- not smoking, avoiding excess weight and getting regular exercise -- can reduce the risk of heart disease. But what about people who have inherited gene variants known to increase risk? A study led by Massachusetts General Hospital (MGH) investigators has found that, even among those at high genetic risk, following a healthy lifestyle can cut in half the probability of a heart attack or similar event. 

"The basic message of our study is that DNA is not destiny," says Sekar Kathiresan, MD...."Many individuals -- both physicians and members of the general public -- have looked on genetic risk as unavoidable, but for heart attack that does not appear to be the case."  

In order to investigate whether a healthy lifestyle can mitigate genetic risk, the multi-institutional research team analyzed genetic and clinical data from more than 55,000 participants in four large-scale studies. Three of these studies....followed participants for up to 20 years. Each participant in the current analysis was assigned a genetic risk score....The investigators used four AHA-defined lifestyle factors -- no current smoking; lack of obesity (defined as a body mass index less than 30); physical exercise at least once a week; and a healthy dietary pattern -- to determine a lifestyle score, whether participants had a favorable (three or four healthy factors), intermediate (two factors) or unfavorable (one or no healthy factors) lifestyle.

Across all three prospective studies, a higher genetic risk score significantly increased the incidence of coronary events -- as much as 90 percent in those at highest risk. While known risk factors such as a family history and elevated LDL cholesterol were also associated with an elevated genetic risk score, genetic risk was the most powerful contributor to cardiac risk. Similarly, each healthy lifestyle factor reduced risk, and the unfavorable lifestyle group also had higher levels of hypertension, diabetes and other known risk factors upon entering the studies.

Within each genetic risk category, the presence of lifestyle factors significantly altered the risk of coronary events to such an extent that following a favorable lifestyle could reduce the incidence of coronary events by 50 percent in those with the highest genetic risk scores. Among participants in the BioImage study, both genetic and lifestyle factors were independently associated with levels of calcium-containing plaque in the coronary arteries, and healthy lifestyle factors were associated with less extensive plaque within each genetic risk group. [Original study]

Published on Leave a comment on Vegan Diets During Pregnancy?

I've been asked whether vegan diets are safe during pregnancy. And I've always said that I don't know, but that avoiding all meat, fish, eggs, and dairy concerns me. Vegan diets are diets without meat, fish, dairy, honey, and eggs (no animal derived food), but while vegetarian diets also avoid meat, they do include eggs, honey, milk, and dairy products. Thus it is very important that anyone following a vegan diet plan meals carefully to get all the necessary nutrients. For example, soda and french fries are vegan, but are not good nutritionally.

There are a number of nutrients that probably need to be supplemented in vegan diets during pregnancy, especially B-12, iron, zinc, iodine (can get by using iodized salt), and omega-3s, and that's not even discussing micronutrients. So it was good to see this article by Dr. Drew Ramsey (Columbia University, NY) raising those same concerns about nutrient deficiencies during pregnancy, and pointing out that very few studies have looked at vegetarian and vegan diets in pregnancy - that the evidence is "scant". This topic is so controversial that as of today there were 85 comments by health professionals after the following Medscape article - both strongly pro and con, and studies given that show that vegans tend to have lower levels of a number of nutrients measured (zinc, iron, omega-3s, etc).

There are also reports of babies exclusively breast-fed by vegan mothers (here and here) who did not take vitamin supplements that developed nutritional deficiencies (especially B-12, vitamin K, and vitamin D). This is because what a mother eats is what the baby gets during pregnancy and breast-feeding.

On the other hand, the Academy of Nutrition and Dietetics came out with a position statement in 2016 stating that "appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes". But that article (in the Journal of Academy of Nutrition and Dietetics) then goes on in depth about several nutrients that can be lower or deficient in vegan diets unless supplements are given (B-12, iodine, etc). From Medscape;

Are Vegan and Vegetarian Diets Safe During Pregnancy?

Are vegan and vegetarian diets safe during pregnancy?....Vegan and vegetarian diets are plant-based diets....Plants, in general, are a great choice, especially colorful plants, because they tend to be more nutrient-dense. Plant-based diets have been linked to a number of health benefits, such as lower body mass index and lower rates of obesity and diabetes, as well as conferring some benefits. Certainly, vegan and vegetarian diets have higher amounts of certain nutrients like magnesium, folate, and fiber, all of which are generally consumed in very low quantities in Western diets.

Focusing on pregnancy, there are two important papers to note. The first, which got me very interested in this issue, was a series of pooled case reports by Drs Dror and Allen in 2008.[1] They looked at 30 cases of severe vitamin B12 deficiency during pregnancy in vegan women with pernicious anemia. Among the 30 vegan women who had B12 deficiency during pregnancy, about 60% of their offspring had severe developmental delays and 37% had cerebral atrophy.... The clinical importance of this is to partner with our patients who are eating plant-based diets and ensure that they have adequate levels of vitamin B12, as well as iron, zinc, and long-chain omega-3 fats during pregnancy.

The second article to take a peek at is from the British Journal of Obstetrics and Gynaecology in 2015.[2] This was a systematic review that looked at all of the literature after screening out the papers. The authors found about 13 papers focusing on maternal and infant outcomes, and about nine of those looked at nutrient deficiency. The main headline of this review is that there are no randomized clinical trials of vegan or vegetarian diets in pregnancy. It is very hard to make a clear clinical recommendation. The epidemiologic data were heterogeneous. As the researchers called it, it was "scant." That is certainly true. Overall, there were no clear associations with bad outcomes. There was some increased risk for hypospadias in one of the larger trials that looked at vegan and vegetarian diets during pregnancy.

The main concern is that vegan and vegetarian diets put patients at risk for a number of nutrient deficiencies—vitamin B12 in vegan diets (and even for vegetarians), iron, zinc, and the long-chain omega-3 fats. Just a quick moment on the long-chain omega-3 fats: Dietarily, these only come from fatty fish and seafood. They are bioconcentrated. They start in algae, but they get bioconcentrated in our food supply via seafood. It is very hard to get those during pregnancy. Certainly, a lot of healthy babies have been born to vegetarian and vegan women. You can supplement, but given the benefits we see with omega-3 fats in patients with things like mood disorders or a history of psychotic disorders, I think it is important to consider the long-chain omega-3 fats. If someone is not going to get those in their diet but has a history, risk, or propensity toward mood disorders, think about supplementation. 

Excerpts from the review study (mentioned above) in BJOG: Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review.

To review the literature on vegan-vegetarian diets and pregnancy outcomes [in healthy pregnant women]....None of the studies reported an increase in severe adverse outcomes or in major malformations, except one report of increased hypospadias in infants of vegetarian mothers. Five studies reported vegetarian mothers had lower birthweight babies, yet two studies reported higher birthweights. The duration of pregnancy was available in six studies and was similar between vegan-vegetarians and omnivores. The nine heterogeneous studies on microelements and vitamins suggest vegan-vegetarian women may be at risk of vitamin B12 and iron deficiencies.

CONCLUSIONS: The evidence on vegan-vegetarian diets in pregnancy is heterogeneous and scant. The lack of randomised studies prevents us from distinguishing the effects of diet from confounding factors. Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.