LiveLongAgeWell

The H1N1 (swine) flu pandemic is dangerous, yes, but also fascinating as a study of how different countries are responding and how theories change quickly. Here in Brazil, where it is winter and prime flu season, the massive city São Paulo has pretty much closed down all schools for the next two weeks, affecting over 6 million students. And just a few weeks ago, public health officials were theorizing that obesity alone appeared to be a major risk factor for developing a serious case, or of dying of the influenza.

Many of the people with H1N1 in ICUs seem to be obese, and the United States—with the epidemic of obesity affecting, amazingly, about 34 percent of the population—has had a much higher death rate than Japan, for example, with less than 2% of the population obese.

Now, the U.S. Center for Disease Control has decided that obesity, on its own, doesn’t seem to be a risk factor. Still it’s worth remembering that fat cells, especially those deep in the abdomen, secrete substances that cause a chronic state of low-level of inflammation in the body, and as a result, obesity depresses your immune system making you more susceptible to most any infection, or even cancer.

So if you are living in the summer now but have worries about flu in the upcoming seasons, you would do well to get yourself in shape and try to lose as much fat as possible to keep your immune system functioning well. If you smoke, have a plan to quit before the fall. Besides that, you can markedly cut your risk of flu by three simple measures: keeping at least a meter (3 feet) away from anyone sick, washing your hands multiple times during the day (especially after you touch surfaces in public areas), and avoid touching your nose, eyes, or mouth, because that’s how you infect yourself.

Know that these influenza viruses, fortunately, don’t penetrate through your skin, and if you remember to always wash your hands well before touching your face, you are much less likely to become infected.

OK, now another way to keep healthy and fit—eat your “greens”…Here is Part II, How to eat greens! (last week was background information):

•    When you try greens and don’t love the taste right away, consider that kale, the king of the greens, contains about 10 times more of that fantastic anti-oxidant lutein as does broccoli. The high fiber content in greens will help you control your weight, your cholesterol, as well as your blood sugar. If you have a family history or particular concerns with breast, ovarian, or colon cancer, you should eat some greens every day. If you smoke, daily greens might give you some protection from the carcinogens in cigarettes. So these truly are superstar vegetables, and you can develop a taste for them.

•    Kale is probably the healthiest of the bunch, but collards are excellent as well, and the flavor tends to be a bit smoother. The plants harvested during cooler weather may taste better, and look for smaller leaves. Spinach is a green, and a good way to start, but you should venture forth and experiment with the more potent ones. You might slowly add bits of raw kale into your daily salad, or add finely-cut collards to soup. Kale comes in different colors and varieties. Mustard greens have somewhat of a spicy, racy taste. Over a few months try them all and see which you like the best.

•    When preparing, cut out any tough stems, and to make life easy, try frozen greens or find bags of pre-washed, cut greens. You can lightly sauté them in olive oil, and try adding lemon, pine nuts, and some red pepper flakes. Look at the DDD appendix for more hints on finding recipes. One note for those on blood thinning medication: the high vitamin K content in greens could interfere with your medication, but rather than avoiding greens, research suggests greens might help protect you from the bone-thinning effects of those medications, so discuss with your physician.

Today I’m posting a chapter from my  book-in-progress: How To Drop Dead Dancing In Your 90s….here is Part I of GREENS!

Kale. Collards. Mustard Greens. Beet Greens. Dandelion Greens. Swiss Chard. Spinach. All “greens”, and, except for spinach, they are foreign to most American diets. Despite having a taste that many might also regard as foreign—too strong, even bitter—to increase your odds of dancing into your 90s you should move beyond salad and the more conventional vegetables and start adding these more exotic  “greens” into your routine.

Taste bud research suggests some people are genetically programmed to despise the taste of greens, and if that includes you, try making an extra effort, because these are the vegetable superstars. Some nutritionists feel they have more value per calorie than any other food.
Perhaps greens have such a distinctive taste because they are so primitive. Unchanged for thousands of years, originally from Asia and Africa, hearty and easy-to-grow kale was among the first vegetables brought by the colonists to the New World. Later, American slaves popularized collards, and greens became part of “soul food”. Unfortunately they were often considered throwaways—vegetables for poor people—until scientists discovered that they were actually so nutritionally rich, and now greens are enjoying a renaissance.

They are full of fiber and low in calories, bursting with vitamins A and C, iron, calcium and various other minerals, and those mysterious “phytochemicals” such as lutein and the more impressively named zeaxanthin; these are the most exciting components in greens, the substances that protect our cells from cancer, age-related vision problems, and maybe dementia. An extra benefit: many American diets are deficient in vitamin K, and greens are the absolute best natural source for this vitamin.

Like most vegetables, adding greens to your diet will help keep your cardiovascular system healthy, and lower your risk of stroke. But greens are much more potent—studies suggest that a green-rich diet is associated with a significantly lower risk of lung, breast, ovary, colon, and bladder cancer. Most research indicates about a 20 to 50 percent lower risk of these cancers in people who eat lots of greens. The mechanism seems to be that the phytochemicals trigger a genetic signal that stimulates the activity of detoxifying enzymes in our liver, so carcinogens are neutralized before doing damage.

Scientists (and drug companies) are working furiously to treat osteoporosis, and along with the importance of calcium and vitamin D, vitamin K is a new star for keeping our bones strong. The Framingham Heart Study showed that those with the highest vitamin K intake had a 65% decreased risk of hip fractures! If true, eating a good amount of greens certainly is a much cheaper and safer and perhaps a more effective way, compared with medications, to lower your risk of disabling bone fractures. And, as we will discuss further in the PROTECT chapter, greens intake probably dramatically cut the risk of cataracts and macular degeneration (the most common form of age-related vision loss).

Next: Greens, Part II

In honor of our mothers, let’s consider some advice many of them have given—perhaps your own mother said “eat your carrots…you’ll see better at night”—now let’s just update that with the latest information. It’s a nice coincidence because a few days before Mother’s Day, the journal Ophthalmology came out with a report on the best (nutritional) advice to prevent macular degeneration, the progressive loss of function in the retina of the eye and the most common cause of adult visual loss. (Click on this link for a “macular degeneration simulator”.)

One reason macular degeneration is so worrisome is that it’s so common: 10% of people over 65 are affected, and that rises to 30% for people over 75. Your risk is higher if you have a history of smoking, and with a close relative with macular degeneration, your lifetime risk rises to 50%. So it’s good to know there is something you can do to help diminish this threat as we get older besides a carrot-a-day…

Here’s what the analysis of the diets of over 4000 people in the Age-Related Eye Disease Study suggested to keep your vision good as you get older:

1. Eat a low-glycemic index diet. The glycemic index is a rating of how foods spike your blood sugar once they are absorbed, and the less the spike, the better. Slow absorbing foods are best. Particularly bad are white bread, starchy foods such as potatoes, and sugary pastries. Best are whole-grain breads, nuts, proteins, and vegetables.

2. Try to get a wide range of antioxidants from fresh fruits, vegetables, nuts, and perhaps eggs. Especially good are green leafy vegetables, spinach, kale, broccoli, and when you buy lettuce, stick to the dark green romaine style rather than the wimpy pale “head lettuce” or “American lettuce”. Other good sources of the vision-beneficial antioxidants are eggs, beans (especially black), and again, nuts and whole grains.

3. Try to get lots of vitamin C from citrus fruits.

4. Omega-3 fatty acids are great for your eyes (as well as your brain), and you can best get those from fatty fish, such as salmon.

So go ahead and eat a carrot-a-day, it’s great advice, but if you are really concerned about keeping your vision intact as you get older, and particularly if you have a positive family history, there are plenty of other dietary measures you can take. Don’t wait…add to your shopping list: oranges, broccoli, spinach, whole-grain bread, romaine lettuce, nuts, and salmon!

Last post we discussed research showing that people who eat more red meat have a higher risk of cardiovascular disease and cancer. During this ten year study, those who ate the most (red) meat had a significantly higher risk of dying of any disease.

Still, many people enjoy eating red meat, and there are some nutritional benefits. Red meat is a great complete protein and vitamin B12 source, both of which are difficult to obtain from vegetables (but fish for example provides both).  This study and others have shown that those who eat “white” meats such as poultry and particularly fish, have a lower risk of heart disease and cancer, so switching from red to white is the first thing to consider for meat eaters. Here are some other measures red meat eaters can take to diminish the risks:

1. Eat smaller quantities less often. Try to limit to two- to three times per week and keep to about 6 ounces per serving (the size of a deck of cards).

2. If you eat processed meats (like hot dogs and bacon), look for nitrate-free products, as nitrates are a known carcinogen (be aware though that nitrate-free meats need more careful refrigeration, as nitrates are normally used as a preservative to decrease bacterial growth).

3. Don’t char meat! Cooking meats at high temperature—especially on a grill—giving a black crust, forms many carcinogenic substances. Cook (thoroughly to avoid bacterial problems) at more medium temperatures.

4. Look at the sell-by date when you buy. Buy the freshest you can, avoiding oxidized, brown-tinged pieces.

5. Buy the leanest cuts to avoid saturated fat, known to increase the risk of breast and colon cancer. Bison, leaner than beef, is a good alternative. The fat in meat is where any pesticide residue or hormones are concentrated.

6. Consider buying organic, grass-fed beef. It may be safer as you avoid any risk of extraneous chemicals, and it is said grass-fed beef contains a higher concentration of the healthy omega-3 fatty acids.

7. At the same meal you have red meat, make sure you also eat several different vegetables, which may counteract the cancer-causing properties in the meat. Cruciferous vegetables such as broccoli, kale, collard greens, mustard greens, cabbage, cauliflower, and Brussels sprouts have especially been shown to be cancer-fighters.

8. Consider drinking a glass of red wine along with a red meat meal. Red wine is full of cancer-fighting polyphenol compounds, and some data suggests these might minimize absorption of the carcinogenic substances in the saturated fats of meat.

If someone were to ask me to name the worst cancer, I would say cancer of the pancreas. This cancer has received much media attention recently. Patrick Swayze is now fighting it, and it killed Luciano Pavarotti and Professor Randy Pausch (author of The Last Lecture).  Even the president of the American Medical Association died of pancreatic cancer last year.

The survival statistics are grim: after diagnosis, only about 25% of the afflicted live even one year, only 5% survive five years. It is so deadly because this cancer is typically diagnosed late, after it has spread, and surgery in those cases won’t cure. While there is hope that new and experimental drugs will work better, standard chemotherapy usually gives disappointing results. It also tends to be one of the most painful cancers. Victims often quickly lose lots of weight and become yellow with jaundice.

The pancreas—which produces digestive juices and hormones involved in food metabolism—is buried deep in the abdomen below and behind the stomach, and this deep location masks symptoms until it has spread beyond the pancreas. The liver, close by, is a prime target. Clearly, it’s a disease you want to avoid, and fortunately medical researchers have identified some measures you can take to significantly cut your risk:

1.    Don’t smoke. Smokers suffer a two to five times risk of getting pancreatic cancer. But if you smoke and quit, after five to ten years of not smoking, your risk goes down to that of a non-smoker.

2.    Eat lots of fruits and vegetables, especially dark green and highly colored ones. These vegetables contain more cancer-inhibiting phytonutrients. Think tomatoes (high in lycopene), soy, broccoli, blueberries, carrots, cranberries, and many others. In general the darker, richer, more vibrant color the better!

3.    A diet high in legumes and whole grains seems to cut the risk. One reason may be because these foods help fill you up and keep you from getting obese.

4.    Avoid obesity! Especially central, or abdominal obesity is thought to be a risk factor for pancreatic cancer. If you are overweight, work on numbers 2 and 3 above, and as a minimum for exercise, start moving and walking more. For example, take the stairs rather than the elevator, and park your car farther from the store entrance so you are forced to walk more.

5.    Minimize your red meat consumption, especially processed meat. It may be the high level of iron or the fat in red meat are the carcinogenic components, and for processed meats (non-fresh meat), the high sodium and nitrates might be the problem. Also, meats cooked at high temperature, and charred or grilled meats are especially believed to be loaded with cancer-causing substances.

6.    Floss your teeth! Yes, it is thought that those with bad oral hygiene, gum inflammation, and periodontal disease have a higher level of inflammatory substances in their body, and these can spark a pancreas cancer. Men with periodontal disease have a 64% higher risk!

7.    Make sure you are getting enough vitamin D. Vitamin D deficiency is common world-wide, and studies have suggested those who get adequate vitamin D cut their risk of pancreatic cancer by 50%. For more on vitamin D, I recommend this article from the Harvard School of Public Health.

In future posts, I will discuss each of these hints in more detail, but in the meantime, the above is food for thought…and make that food highly colored vegetables!

Last Wednesday I presented some information about average weight gain during the holidays, and while the problem may be exaggerated in the media, none of us wants to arrive at New Year’s needing to make a weight loss resolution. More significant, the data indicates that whatever weight you gain during the holidays is especially difficult to lose and keep off, and that year after year, many people’s weight may creep up because of the those cumulative gains.

When we think of high calories, we might think more about what we eat, and less about what we drink, but beverages could be a big part of the problem. There was an interesting WebMD feature last week regarding the best and worst beverages for weight loss. You can watch the slide show here, or if you don’t want to slog through fifteen pages (and see lots of ads), you can read my summary below. I have added my own spin on their recommendations.

Let’s start with the drinks BAD for your diet:

SODA: The single biggest source of calories in the American diet, and switching to diet soda is of questionable help (paradoxically, may just induce you to eat other sweet foods). Best to avoid.

FANCY COFFEES: The ones you buy at coffeeshops with the fancy names that cost $3 to $6. May have close to 600 calories in a large. I detailed these in a recent post.

WINE COOLERS: A 12 oz. bottle may have 190 calories and 22 gm. of carbs. Regular wine or a mix of wine and sparkling water much healthier.

FANCY COCKTAILS: If add sugary syrups, chocolate, or cream watch out. For example, a white Russian has over 700 calories, and a super-size margarita more than 1000. Yikes!

Here are the QUESTIONABLE drinks:

FRUIT JUICE: May have as many calories as soda, but at least has nutritional value. Look for “100% Fruit Juice” on label, and note the calories per 8 oz. serving. Mix with water or sparkling water to cut calories.

SMOOTHIES: If someone else makes for you, probably full of calories. Make your own with low-fat milk and fresh fruit.

Now, the GOOD beverages:

WATER: May fill you up so you eat less. Pass on the bottled water and go for filtered tap water.

VEGETABLE JUICE: Lower in calories than fruit juice and usually more nutritious (look for ones with more fiber, which helps control hunger). Try to find “Low Sodium” versions, as regular often full of salt.

COFFEE: If black, calorie-free. Full of great anti-oxidants, and caffeine is healthy for most people. Again, see my recent post for details.

GREEN TEA: WebMD says it helps with weight loss but that effect is small. Still, it has some caffeine and is full of great phytonutrients, so drink up.

LIGHT BEER: About 50% less calories than regular beer.

LOWER-CALORIE ALCOHOL DRINKS: Not on the WebMD list, but for some people, can be both healthy and low-calorie. This is the topic for next Monday, just in time for New Year’s.

This Wednesday “A Simple, Inexpensive, And Valuable Last-Minute Gift”. In the meantime, enjoy your Holidays!

Since cancer and heart disease are the number one and two causes of death in the U.S., I would love to report that taking vitamins will lower your risk, but several recent research reports cast doubts at least on vitamins C and E. Actually, these recent studies are part of a research trend showing that many vitamins—taken in pill form that is—have not been as effective as many had hoped for in preventing various diseases.

There is even the suggestion that taking some vitamin pills, particularly the B vitamin folic acid or vitamin E, might increase your chance for certain diseases, but the data is inconclusive and controversial, and further analysis is needed (and being done). Still, caution seems to be in order as far as taking vitamin pills.

At the recent American Association for Cancer Research “Frontiers in Cancer Prevention” meeting, the results of a 10-year long study were presented. This was a randomized clinical trial (the best type of research study), and it followed nearly 15,000 physicians. Some were given 400 IU of vitamin E every other day, some 500 mg. vitamin C every day, and others given placebo (dummy) pills. After a 10-year period the number of cancers was analyzed, and those who had taken the vitamins showed the same cancer rate as those who had taken the placebo. They also measured the rate of heart attack, heart failure, stroke, and angina, and again there was no benefit for the group that took the vitamins.

People who eat a diet full of fruits and vegetables seem to have a lower cancer risk, so it was hoped this long-term vitamin study would show similar benefits. Does this mean that vitamins have no benefit? No, but it does indicate that perhaps the only way to get the anti-cancer and heart-protective benefit, at least for these vitamins, is through your diet, and not through pills or supplements. Most likely there are many more substances in fruits and vegetables, particularly “phytochemicals“, that are more important for disease prevention than the vitamin content.

The status of vitamins in the medical literature will be unsettled for some time; for example, while vitamins C and E are falling out of favor, other vitamins such as D and B12, even in supplement form, are currently showing promise. And keep in mind that today we only considered if these vitamins help decrease the risk of cancer and heart disease; we haven’t touched on other diseases, such as cataracts, where vitamin supplements might be effective. I will discuss this in future posts and more completely in my book.

The trends though in vitamin research indicate this general recommendation: get your vitamins through a diet rich in a variety of fresh vegetables and fruits. Don’t rely on pills. As further vitamin research is released (a good study is underway on multivitamin pills), I will report it here.