Food & Nutrition

Should I go gluten-free?

gluten-warning

The takeaway first

The last five years or so the gluten-free diet has been the most popular way of eating. Even the recent Wimbledon winner Djokavic and the New York Yankees slugger Mark Teixeira have adopted this new way of eating, which excludes wheat, rye and barley. While there is a real, clinical disease called celiac disease, where eating gluten products cause severe gastric problems, the type I’m talking about today is non-celiac gluten sensitivity. Most importantly, I want to know whether the whole thing is…BS.

By the way, Mark Teixieria hit a game winning homerun (update 8/10/15: 30 HR’s) this weekend. Not bad for a 35 year-old baseball player coming out of a year of injuries. He is having one of his best years at an age where most baseball players steadily decline. (I’m a NY Yankees fan)

Just saying…

What is celiac disease?

This disease is an autoimmune disease where your immune system attacks your intestines—but only when there is gluten in your diet. The fancy medical term for the process is small intestinal immune-mediated enteropathy (just in case you want to sound smart at your next cocktail party). Celiac disease occurs in 1% of the population, and the main symptoms include abdominal bloating and pain , chronic diarrhea , pale, foul-smelling, or fatty stool and rapid weight loss . Other common symptoms like chronic fatigue and irritability occur as a result of poor absorption of nutrients.

What is gluten?

Gluten is a protein made out of glutenin and gliadin. The elasticity created when the pizza man kneads dough before throwing it in the air is made from glutenin and gliadin combination. That’s the same molecule that gives bread its chewy texture. Gluten also traps carbon dioxide, which, as it ferments, adds volume to the loaf.

Why would non-celiac people want be on a gluten-free diet?

About 20% of Americans want gluten-free foods (I too choose gluten-free often). The reason why non-celiacs want to eat gluten-free is because they just simply feel great when they’re not eating glutinous grains. Symptoms like gastric bloating, irregular bowel movements and even headaches and joint aches have been relieved just by excluding gluten from the diet. These people suffer from what’s called non-celiac gluten sensitivity. The very first case of non-celiac gluten sensitivity was reported in the mid-1970s where a few young women reported gastric distention

and irregular bowel movements (Cooper et al., 1976) and experienced great relief when they cut gluten out of their diets. Only when gluten was re-introduced did the symptoms return (Ellis et al. 1978).

The science behind a gluten-free diet

Many would say there isn’t any science behind it at all

They just haven’t looked.

In one study, 920 adults without celiac disease and with irritable bowel syndrome (IBS) who self-reported gluten-based sensitivity were asked to maintain a gluten-free diet for 4 weeks. After about two weeks, one group was introduced again to wheat where 30% of them (the wheat group) developed IBS symptoms: abdominal pain, bloating and altered stool consistency (Carroccio et al., 2012).

Another study looked at 34 patients with IBS who self-reported gluten sensitivity and whose non-celiac status was confirmed by expert investigators. They received 16g of gluten per day or placebo for up to 6 weeks. Within the gluten group, 68% reported irritable bowel symptoms, such as abdominal pain, bloating, and stool inconsistencies, compared with 40% in the placebo group.

When comparing baseline parameters, patients with non-celiac gluten sensitivity are generally more likely to have nutritional deficiencies, another autoimmune disease, a lower mean BMI, and weaker bones than the general population; however, non-celiac gluten-sensitive people usually don’t have these extra problems.

In a case series of 1,000 patients with progressive ataxia (loss of control of body movements), 18% of patients were found to be sensitive to gluten consumption (Hadjivassiliou et al., 2013). This doesn’t mean that gluten gives you ataxia, though.

Small studies have even associated gluten consumption to depression (Peters et al. 2014) and psychotic, schizophrenic events (Kalaydjian et al. 2006). While these studies to not prove cause and effect, the association is pretty compelling.

For non-celiac endurance athletes, a short-term gluten-free diet had no overall effect on performance. It didn’t help gastrointestinal symptoms, wellbeing, or indicators of intestinal injury or inflammatory markers (Lis et al., 2015). Of course, this study was performed for about one week and to truly see benefit from a gluten-free diet it take about 90 days of complete abstinence from glutinous consumption.

Criticism of gluten-free diets

One Consumer Reports video makes several claims against the gluten-free label. I have problems with this video.

For example, the video claims, “Fat and sugar are sometimes used to replace the oomph in foods that gluten usually fulfills.” Yes, this may be true, but this claim has just as much oomph as saying that we shouldn’t be vegan because some donuts are vegan.

Sure, some foods marketed as gluten-free are crap, but that’s the worst way to be gluten-free.

The Consumer Reports video also claims that gluten-free foods are “not fortified with the same nutrients that foods with gluten [are fortified with].” Folic acid and iron are two examples given. My response? You can get folic acid, iron, and every other nutrient from foods that naturally contain them. Countless foods that are gluten-free are not marketed as such. Green leafy vegetables, for example, have all the folate and iron you could ever dream of, but nobody is calling them gluten-free.

There are two other big criticisms of gluten-free diets. Some say that gluten-free foods are expensive, but I reply that only the gluten-free label is expensive. All fresh produce is gluten-free, but it lacks the label. Why? Because produce has enough nutritional value on its own that it doesn’t need help from the gluten-free marketing campaign.

My take on gluten-free diets, and what you should do

I prescribe a gluten-free diet to all of my patients because it seems to relieve pain and inflammation. This is my experience, and I do whatever solves my patients’ problems.

Therefore, if you have pain or inflammation, I would suggest you try a gluten-free diet for 90 days. This doesn’t mean you have to buy gluten-free products or offer up your wallet as a ritual sacrifice to the gluten-free gods. All it means is that you cut out bread and pasta.

Same goes for my prostate cancer patients – they go mostly gluten-free as gluten wrecks the gut of most people and promote inflammation. In order to beat cancer you must have a strong gastro-intestinal system

If going gluten-free, follow these simple tips:

All fruits are naturally gluten-free. Eat those that have a low-glycemic index

All vegetables are naturally gluten-free. Eat plenty.

All meat, unless it’s processed, is naturally gluten-free. Go for the best fish (my

favorite is vital choice). Also go for grass-fed, organic meats.

Eggs are naturally gluten-free too, and very good for you. Get those from farms or farmers markets where the chickens roam freely and eat naturally (including worms.)

Many grains like quinoa and buckwheat are gluten-free. Eat them too.

As always, don’t eat processed foods or crappy gluten-free foods. But if you want a treat and will do a 90 day test, then eat a gluten-free treat.

Go easy on the alcohol, even if it’s “gluten-free.” By the way, tequila is gluten-free (wink, wink)

I suspect Djokovic’s and Teixeria’s gluten-free dietary benefits is mainly quicker recovery from the stress induced from playing their respective sport.

I know when I am 100% gluten-free, I can play long games of basketball or train for hours without feeling much pain afterwards.

If you have not done so, try going gluten-free. If anything, you will enjoy the challenge. OK maybe “enjoy” is an overstatement.

References

Carroccio, A. et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am. J. Gastroenterol. 107, 18981906 (2012).

Cooper, B. T., Holmes, G. K., Ferguson, R., Thompson, R. & Cooke, W. T. Proceedings: Chronic diarrhoea and gluten sensitivity. Gut 17, 398 (1976).

Ellis, A. & Linaker, B. D. Non-coeliac gluten sensitivity? Lancet 1, 13581359 (1978).

Kalaydjian, A. E., Eaton, W., Cascella, N. & Fasano, A. The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr. Scand. 113, 8290 (2006).

Hadjivassiliou, M. et al. Transglutaminase 6 antibodies in the diagnosis of gluten ataxia. Neurology 80, 17401745 (2013).

Lis D, Stellingwerff T, Kitic CM, Ahuja KD, Fell J. No Effects of a Short-Term Gluten-free Diet on Performance in Nonceliac Athletes. Med Sci Sports Exerc. 2015 May 12.

Lis DM, Stellingwerff T, Shing CM, Ahuja KD, Fell JW. Exploring the popularity,

experiences, and beliefs surrounding gluten-free diets in nonceliac athletes. Int J Sport Nutr Exerc Metab. 2015 Feb;25(1):37-45.

Peters, S. L., Biesiekierski, J. R., Yelland, G. W., Muir, J. G. & Gibson, P. R. Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity—an exploratory clinical study. Aliment. Pharmacol. Ther. 39, 11041112 (2014).

 

Don’t Get Stoned this Summer

5_most_common_back_pain_1_2

Takeaway First

Kidney stones are on an upswing as the days get warmer. Quite a few of our patients are passing stones at our clinic in New York. There are many things you can do to prevent kidney stones, but above all: drink tons of water.

Kidney stone facts:

Kidney stones are most common in Caucasian men and least common among African-American females.

Calcium kidney stones are made of 80% calcium oxalate (CaOx).

It has been suggested that kidney stone risk increases in hot climates.

Frequent or intense exercise can cause an increase in kidney stone formation.

While only about 10% of men will develop kidney stones in their lifetime, that percentage goes up to 30% if there is a family history.

What exactly are kidney stones?

Kidney stones are exactly what they sound like. They are stones (little rocks, but sometimes not so little—ouch!) that form when minerals accumulate in your kidneys. Most of the time these stones pass through the system without causing much pain or discomfort. Other times, if the stone become bigger than 3 mm, they pass with excruciating pain.

I mean, EXCRUCTIATING PAIN. If you have ever passed a stone, you know what I’m talking about.

Women patients who have passed stones and delivered babies have said delivering babies is like a walk in a park compared to passing a kidney stone.

The pain often starts at the lower back (flank), and it radiates down to the groin. This pain is caused by pressure in a part of your body between your kidneys and bladder called the ureter, which itself is only 3-4 mm wide.

What increase your likelihood to make stones?

Other than genetic causes (where your body simply likes to make stones), there are two main causes: being overweight and dehydration.

So, yes, losing weight and drinking tons of water can really help.

What else can you do to stop making kidney stones?

Drink a ton of water. You should urinate 2 liters of urine every day.

Take 500 to 1000mg of magnesium citrate every day.

Take Vitamin B6—25 mg daily. A B6 deficiency increases urinary oxalate, which may lead to kidney stones.

When magnesium is used in conjunction with vitamin B6, it has an even greater effect.

Drink lemon juiceabout one-half cup of pure lemon juice (enough to make eight glasses of lemonade) every day. Lemon juice raises citrate levels in the urine which protects against calcium stones.

Drinks to avoid: orange and grape juice and soda. You do not need to avoid coffee and alcohol, but DO NOT need to be avoided, but remember that these cause dehydrationso drink, drink, drink (water, that is).

What to do if you are a kidney stone former (that you thought you shouldn’t do)

Forget about eating a low-oxalate diet. My patients who eat a lowoxalate diet become fat and increase their risk of heart disease and cancer. This approach is disastrous for overall health because many protective foods high in oxalates are vegetables, fruits and nuts – all things I highly recommend. In fact, recent research has demonstrated that a diet high in fruits and vegetables DECREASES the risk of kidney stones (Turney et al. 2014).

It has been suggested that people who form kidney stones should avoid vitamin C supplements, because vitamin C can convert into oxalate and increase urinary oxalate. Initially, these concerns were questioned because the vitamin C was converted to oxalate after urine had left the body. However, newer trials have shown that as little as 1 gram of vitamin C per day can increase urinary oxalate levels in some people, even those without a history of kidney stones.

In one case report, a young man who ingested 8 grams per day of vitamin C had a dramatic increase in urinary oxalate excretion, resulting in calcium-oxalate crystal formation and blood in the urine. On the other hand, in preliminary studies performed on large populations, high intake of vitamin C was associated with no change in the risk of forming a kidney stone in women, and with a reduced risk in men. This research suggests that routine restriction of vitamin C to prevent stone formation is unwarranted.

Bottom line on preventing kidney stones?

Drink 4 to 8 cups of lemonade made with a least a half a cup of freshsqueezed lemon.

Drink enough water, about 10 glasses a day, and aim to produce about two liters of urine.

Take magnesium citrate, potassium citrate and vitamin B6 supplements.

Avoid drinking grapefruit juice.

Eat plenty of ALL fruits and vegetables. If you get kidney stones frequently, then avoid only spinach and almonds which are very high in oxalates. But eat plenty of the others.

References:

Gershoff S, Prien E. Effect of daily MgO and vitamin B6 administration to patients with recurring calcium oxalate kidney stones. Am J Clin Nutr 1967;20:393-399.

Will E, Bijvoet O. Primary oxalosis: clinical and biochemical response to high-dose pyridoxine therapy. Metabolism 1979;28:542-548.

Turney BW1, Appleby PN, Reynard JM, Noble JG, Key TJ, Allen NE.Diet and risk of kidney stones in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Epidemiol. 2014 May;29(5):363-9.

 

What science still hasn’t told us about red meat

red meat

The Takeaway First

Despite the huge conversation that health professionals and consumers alike are having about the effects of consuming red meat on human health, scientific research hasn’t quite settled the score. A new paper (Klurfeld, 2015) published this past May highlights the many limitations of the studies we have done. So what do we have left…?

Study Details

  • David Klurfeld highlights some flaws in the current literature surrounding red meat. In order to know for sure whether red meat causes diseases long-term, for example, we would need a longitudinal study (where subjects are tracked for several decades) with an extremely large sample size. Not only have we not done this, but we can’t; it’s too expensive.
  • Besides, says Klurfeld, supposing we had the money, scientists can’t feed red meat to humans on the premise that it might cause them to become diseased. It’s unethical.
  • The nature of observational studies and the immense amount of data that researchers collect enables such studies to find (potentially) thousands of statistically significant correlations, many of which may simply be false positives.
  • Some influential studies that have found significant associations between meat consumption and colorectal cancer are clouded by confounding variables such as daily caloric intake and smoking.
  • While known toxins such as tobacco and alcohol increase risks of lung cancer and liver cirrhosis ten- to thirty-fold, eating meat does not increase the risk of any disease by more than 50 percent.

My Take on Meat

It seems from this paper that we should be cautious when we say that eating or not eating red meat poses a danger to our health. Not only are the data limited and easy to skew, but the data on the increased risk of disease forces us to ask, “How much of a difference does this really make?”

In my opinion, we should not be worried about meat so much as wheat and simple carbs like pasta, bread, cookies, and flour. Meat should only worry us when it’s in excess or excessively cooked, as one study has shown that charred meats contain carcinogens (Zheng et al. 2009).

Of course, I have long believed, and still believe, that individual differences can make or break a diet for anyone. This is why I design an individualized anti-cancer lifestyle plan for each of my patients. For patients whose baseline risk for disease is elevated due to heredity or past behavior, I adjust their plans accordingly.

What You Should Do

When our modern methods fail to provide satisfying answers to these questions, we can be sure of one thing: uncertainty about how much does not equal a license to let ourselves go. In other words, it would be detrimental to your health if you used uncertainty as an excuse for irresolution and made a habit of saying, “Well, since we don’t really know, I guess I’ll just stick to my usual breakfast of three fried eggs and half a pig.”

While we may have reasons to be skeptical about the “statistically significant correlations” that bring smiles to every researcher’s face, we cannot afford to be wishy-washy about our commitment to a balanced diet of whole foods. Balance, unlike meat, has well-known effects. Moderation in all things—that’s the key.

References

Klurfeld, D. M. Research gaps in evaluating the relationship of meat and health. Meat Science(0). doi: http://dx.doi.org/10.1016/j.meatsci.2015.05.022

Zheng, W., & Lee, S.-A. (2009). Well-done Meat Intake, Heterocyclic Amine Exposure, and Cancer Risk. Nutrition and Cancer61(4), 437–446. doi:10.1080/01635580802710741

On Juicing…

juicing

On Juicing

Overview

A common question I get asked daily is on the value of juicing.  I tell you, if you want to get a nice, constant and non-stimulant burst of energy, there is nothing like a nice squeezed fresh veggie juice. Try it and you will see what I am talking about.

The Downside of Juicing:

  1. It’s an acquired taste ( so is diet soda’s and lots of people drink diet soda – which is sooo nasty.) It’s worth getting used to.
  2. Can be a pain in the behind to clean the machine when made at home
  3. Can be expensive (anywhere between $7 to $9 of a 16-ounces juice)

The upside? Read on….

Why juice?

Juicing is a cornerstone treatment in many natural cancer therapies. Juicing provides cells with live enzymes and oxygen rich fresh food. It provides concentrated enzymes and nutrients that help detoxify the body and allow it to heal sufficiently to get rid of stored toxins.

  1. Rapid absorption. Juicing helps you absorb a large amount of nutrients and plant chemicals nearly instantaneously since the fiber is left behind in the pulp. Wait a minute, isn’t fiber important? Yes it is, however, the purpose of juicing is to get rapid aborptions of nutrients and therapeutic plant chemicals to flood your cells. You can ( should and will) get plenty of fiber from the consumption of whole fruits, vegetables and grains.
  2. Efficient consumption of vegetables. With one glass of vegetable juice you probably consume more vegetables than most people do in one week.
  3. It may help fight and prevent cancer. There seems to be hundreds of protective phytochemicals (plant chemicals) in all plants. Proanthocyanidins and caritnoids are just some of them. For example; broccoli contains indole -3 – carbinol that seems to have protective properties against prostate cancer. That is just one out of over one hundred protective chemical discovered and studied. Why wait for all phytochemicals to be discovered? Juice up and protect yourself.
  4. Gives you energy. Juicing is better than coffee or over the counter energy products for long-term sustained energy. Plus it helps you with the first 3 points of this list unlike energy products, which have detrimental effects.

Juicing is not all you need

Juicing has very no essential fat, no protein and no fiber. Unless you are doing a juice fast, you still need to eat wholesome meals. You can drink a fresh squeezed juice either before or after a meal.

Start slow

If what your juicing is too concentrated (like wheat grass , for example) it can be nauseating. You should feel good and experience more energy within a short-time.

Use Organic whenever possible. Farmer’s market produce is also good. Make sure to wash well. If organic and farmer’s market produce is not available use produce that are LEAST contaminated with pesticides.

If you cannot buy all your juicing vegetables and fruits organically – these are a must to buy organically: apples, celery, sweet bell peppers, peaches, strawberries, nectarines (imported), grapes, spinach, lettuce, cucumbers, blue blueberries, potatoes ( not for juicing either way) – In other words, AVOID for juicing unless they are organic or not from famer’s market.

NOTE: produce from farmer’s market is typically organically cultivated but they do not announce it because there’s a hefty price for the organic stamp from the USDA. They simply often do not want to pay the extra cost.

Juicing for starters

To enjoy juicing start with vegetables that are more pleasant tasting: Celery, cucumbers, carrots (not more that one or two sticks at time), apples ( not more than one apple) – all organic.

After you get used to juicing add: Red leaf lettuce, Green Leaf lettuce, Romaine lettuce, Endive, Escarole, Spinach, parsley, bok choy, cilantro.

Bitter vegetables to juice: Kale , Collard Greens , Dandelion Greens ,  Mustard Greens (probably the most bitter). Just two or three sticks should be enough

To make it appetizing: add lemon, lime half an apple and a small piece of fresh ginger (gives it a kick).

Do not store your juice for more than 24 hours. Instructions on storing fresh squeezed juices:

  • Put your juice in a glass jar with an airtight lid and fill it to the very top. Mason jars work just great. There should be a minimum amount of air in the jar as the oxygen will “oxidize” and damage the juice.
  • Immediately store it in the refrigerator and consume it through out the day. It is best to drink it as soon as possible or within 24 hours of juicing.

Making the juice vs. buying by the juice made

Either way is fine. Finding a reliable health food store that makes fresh, organic juices can be challenging in some places. If doing it yourself there are three main concerns: Buying a reliable juicer that is durable and juices well. 2. Finding one that is easy to clean. 3. One this is affordable. Good juicers run between $200 to $1000. I find the best ones to be around $300 or so.

If a juicer is a pain in the (beeeep) to clean – you’re likely not doing it.

I have two favorite juicers:  Omega J8005 Nutrition Center Single-Gear Commercial Masticating Juicer or the Breville 800JEXL Juice Fountain Elite 1000-Watt Juice Extractor ( like this one slightly more)

I like these juicer’s for a few reason’s:

  1. It makes juice at low temperature which helps retains enzymes and nutrients

  2. It’s relatively easy to clean

  3. It’s relatively inexpensive for the quality