Food & Nutrition

How to Eat for Teenage Boys to Get Big Safely

I started lifting weights at thirteen years of age. I remember the Christmas when I got my first weight set. They were vinyl with sand in them, about 110 pounds for the set.

Remember those?

All I did back then, every day, was bicep curls and military presses. EVERYDAY. No legs. Crazy right? I seriously thought that having big arms and chest was the way to attracting more girls, look tough and play better football. That was retarded thinking at it’s best.

This approach was an attempt to get huge. That was the term used back then and still used I hear.

“ I’m gonna get huge!”

The reality is that most teenage boys want to get muscular. There’s no way around that. And many take desperate measures to get there including the intake of anabolic steroids.

Quick fact:

Teenage boys can’t build muscle until the age of 14. Their testosterone is way too low, not that different from girls at that age. Training before this stage should focus on body weight exercises like push-ups, pull-ups and sit-ups and less on weight training.

Some kids want to desperately weight lift before 14 years of age. I did. That’s OK. The focus should be on light weight training and to master the form and technique of the movement.

Let me repeat, if you influence your teenage son, and I hope you do, make sure they master form and technique before they increase the weight on their lift. This is crucial to avoid injuries and get the most from their training.

And don’t worry; your teenage son will not stunt his growth by lifting weights. That’s a myth.

How can teenage boys get big safely

The first thing is that you and your child need to understand his body type.

There are three basic human body types:

  1. the endomorph, characterized by a preponderance of body fat, especially around the waist, even with normal eating habits and physical activity.
  2. the mesomorph, marked by a well-developed musculature, often with little effort. This body type is the one we love to hate as guys in this category naturally have broad shoulders and chest.
  3. the ectomorph distinguished being long and lanky with very little fat or muscle. It’s all

By the way, if you know American football, wide receivers are typically ectomorphs, linemen are endomorphs and middle linebackers and running backs are mesomorphs. This can provide an image of what each body type looks like.

Ectomorphs are hard gainers and need to eat A LOT. I am talking about at least six to eight meals a day, including protein shakes, regular meals, and snacks. Some experts think they should get up at 2 o’clock in the morning and have a snack. Crazy. But true.

Nutrition for teenagers to get big

Eating right is the most important part of gaining muscle. You can lift until the cows come home, but eating properly fuels the muscles to grow after training.

Eat good food and leave out the crap. When I was a teenager, I ate everything in site, good and bad, and that was foolish. I always felt sluggish though I was getting bigger. So was my waistline. It wasn’t good.

Protein, or more importantly, the metabolites of protein, amino acids are most essential for muscle growth.

How much protein should a teenage boy eat?

Roughly a teenage boy should eat about one gram (1g) of protein per pound of body weight.

Note: I mistakenly said 20g a day on the Thrive Child Summit. What I meant was that protein coming from egg and whey could only be absorbed at about 20 g at one time to get 1.8g of leucine, an important amino acid for muscle growth. Eating meat would take over 100g to get 1.8 g of leucine. (Reidy & Rasmussen, 2016)

The timing of protein intake can be within 2 hours after weight lifting. Most people think one should have a protein shake immediately after a workout to get as much amino acids and leucine in the muscle. That is not true. After a workout, you have about a 2-hour window where muscle feeds on protein for growth. (Joy et al. 2013)

How about those protein powders in the nutrition stores? Are they worth it?

First of all, kudos to those sport nutrition companies with the big tubs of protein powder for their marketing skills. You feel like your growing just by looking at those labels with enticing names like Carnivor max big steer and Nitro tech whey gold.I feel my muscle growing out of my shirt just by thinking about it now.. 🙂

Again it’s all about the amount of leucine you get from a protein source.

Whey is a good one. Pea protein is also good as 25 g of yield 1.8g of leucine and it’s a good option for vegans or people on a plant-based diet.

A note on Creatine to help teenage boys

Creatine is in many sports supplements and protein powders. It’s also one of the most studied nutrients for athletic performance.

Here’s what you need to know…

Creatine is relatively safe to take and does not cause kidney or liver damage. (Kreider et al. 2003)

A review found creatine to have no effects on the liver or kidney function in over months of supplementation in both young and old population. Still, teenage kids with liver and kidney problems should stay away from creatine just to be safe. (Kim et al. 2011)

Creatine does not stimulate muscle but it can help you get an extra rep or two, say , on a bench press,  or help sprint faster, not longer. In other words, creatine help improves anaerobic movements but does not benefit aerobically. (Bemben & Lamont, 2005)

The safe amount to take is 5g a day. Some athletes take a loading dose of 5g / 4x / day during a loading dose period for one to two weeks and 5g / day maintenance after that.

The Takeaway on How Teenage Boys Should Eat to get Muscles

Teenage boys should eat a lot of fruits and vegetables along with lean meats and fish for muscle growth. Six meals a day may be required. No junk food.

Protein powder’s are safe. Teenage boys trying to get big consume smoothies with protein powders anyway, so might as well direct them in the right direction.  It’s better than the alternative (‘roids). Whey protein is good; this is my favorite whey protein powder as it is one of the cleanest in the market with vanilla extract as a sweetener. It is also made from grass-fed cows.

Pea protein for vegans or vegetarians is also good as it delivers 25g of leucine per serving.

Creatine is safe to consume at about 5 g / day. The loading dose of 5g/ 4x / day for one to two weeks is also safe and moderately effective. Kids with kidney problems should NOT ever do a loading dose of creatine at 5g/ 4x / day.

Ectomorphs have to eat more and work hard to gain size and muscle. But it can be done.

Endomorphs should eat about 4 meals a day as they get big easily , mostly fat if this group of animals are not careful

Mesomorph can eat 4 to 6 meals a day as this group muscles up quickly.

Lastly, the focus of this post is 100% on nutrition to gain muscle. Every situation is different. For example, some people have dairy and whey allergies, so whey protein is not an option for that person.  And this is a blog post not an article in a scientific journal so there might be one or two things missing I’m sure, but not much.

Also, there are no training tips here as this is only on nutrition to get big. Teenage boys can’t grow if they don’t eat right.  I am working on an e-book that will come out soon on training kids to get big without steroids. Stay tuned.

One last thing with regards to training… don’t forget leg days! 🙂

 

Reference:

Reidy, P. and Rasmussen, B. (2016). Role of Ingested Amino Acids and Protein in the Promotion of Resistance Exercise-Induced Muscle Protein Anabolism. Journal of Nutrition, 146(2), pp.155-183.

Joy, J., Lowery, R., Wilson, J., Purpura, M., De Souza, E., Wilson, S., Kalman, D., Dudeck, J. and Jager, R. (2013). The effects of 8 weeks of whey or rice protein supplementation on body composition and exercise performance. Nutrition Journal, 12(1), p.86.

Kreider, Richard B.; Melton, Charles; Rasmussen, Christopher J.; Greenwood, Michael; Lancaster, Stacy; Cantler, Edward C.; Milnor, Pervis; Almada, Anthony L. (2003). “Long-term creatine supplementation does not significantly affect clinical markers of health in athletes.” Molecular and Cellular Biochemistry. 244 (1–2): 95–104.

Kim, Hyo Jeong; Kim, Chang Keun; Carpentier, A.; Poortmans, Jacques R. (1 May 2011). “Studies on the safety of creatine supplementation”. Amino Acids. 40 (5): 1409–1418.

Bemben MG, Lamont HS; Lamont (2005). “Creatine supplementation and exercise performance: recent findings”. Sports Medicine. 35 (2): 107–25.

 

 

Can Creatine Help Improve Performance?

Creatine is an extremely popular supplement used to improve exercise performance (1).

It has been studied for 200 years, and is one of the most scientifically valid supplements (2).

In addition to exercise, creatine may also have health benefits (3).

This article explains how creatine improves exercise performance.

What Does Creatine Do?

Creatine’s main role is to enhance energy production in cells.

To understand how it works, you need to understand something about how your cells produce energy.

The most basic form of energy in cells is a molecule called adenosine triphosphate (ATP). This is the “energy currency” your cells use to perform many of their functions.

ATP is a limiting factor in high-intensity exercise, because it runs out quickly when you are working hard.

This brings us back to creatine. About 95% of the body’s creatine is stored in your muscles, in the form of a molecule called creatine phosphate (4)

Creatine phosphate can help you replenish the “energy currency” ATP, giving your muscle cells the capacity to produce more energy.

The more creatine you have, the more energy your muscle cells can produce during high-intensity exercise. This leads to enhanced performance (5).

Although creatine’s primary benefits are enhanced energy production, it can also increase strength and help you gain muscle (6).

Creatine for Strength and Power Exercises

Creatine is also one of the best supplements available for strength- and power-based exercise (14, 15).

This is because ATP energy is crucial for these exercises. They are often short in duration (under 30 seconds) and performed at a very high intensity.

One 6-week training study found that creatine helped add a further 15% weight (11 lbs or 5 kg) to a 1-rep max bicep curl (16).

A weight training study found that creatine increased maximum squat and bench press strength. (17)

The same study also reported a 20% increase in testosterone levels for the creatine group, compared to only 5% in the group not taking creatine (17).

For college football players, creatine improved 6-second sprint performance and total workload for strength training, a key factor for improving strength and power (15, 18).

Another study tested explosive power and weight lifting strength, finding that creatine helped improve explosive jumps and the amount of repetitions for bench press (19).

 

Creatine and Endurance Exercise

Even though creatine is beneficial for short-duration, high-intensity exercise, research shows that it has less benefit in lower-intensity endurance exercise.

One cycling study compared creatine’s effects in both high and low-intensity, finding it only improved high-intensity performance (20).

A large review of the research also found significant improvements for short-duration work, but less of a benefit for endurance exercise (21).

Endurance exercises are low in intensity, and rely less on rapid ATP regeneration. This makes creatine’s role less significant, and explains these findings (22).

However, one possible benefit of creatine is its ability to improve your training sessions, which may improve endurance performance in the long term.

In one study, it improved the number of intervals and subsequent amount of training endurance athletes could complete (23).

Bottom Line

Creatine is one of the most scientifically valid supplements on the market.

One form, creatine monohydrate, has been studied the most extensively. It’s also the cheapest type available.

A typical dose is 3–5 grams per day, but you can also take 20 grams for 5 days, to rapidly elevate muscle creatine stores.

In high-intensity exercise, creatine can improve performance by up to 15%, and it can also increase strength and help you gain muscle.

Creatine has little to no benefit for lower-intensity endurance exercise, but may be beneficial if you also include high-intensity exercises in your training.

Additionally, creatine is safe for long-term use. No research has shown any long-term issues in healthy individuals.

News Update: Sugar is STILL Sugar on the Holidays

The Holidays are a time for many things—depending on who you ask.

They’re a time for giving.

They’re a time for family.

They’re a time for relaxation.

They’re a time for reflection.

And, for most of us, whether we’d like to admit it or not, they’re a time for EXCEPTIONS.

“OK, I’m normally pretty good with controlling my sugar consumption, so I’m going to splurge on Christmas and have a cookie. OK maybe two. Or maybe…”

“Hanukkah’s only one week of the year…so I can probably handle an five jelly donuts today.”

“I hardly ever see my family. What’s a few extra chocolate dipped bananas going to do? Live a little,  right?!”

The Holidays are truly magical; like magic, our common sense completely disappears and we think our bodies are suddenly immune to bad lifestyle choices. A few extra cookies, a few extra jelly donuts, a few extra chocolate dipped bananas—all your body sees is sugar. Sugar. Sugar.

And simple carbohydrates like bread, pasta and all products made from flour is sugar.

The Holidays are a time for many things—but they’re not a time to pretend.

Sugar is sugar, and if you think it’s something else, now is the time to stop!

Here’s what refined sugars do to your body:

  • They provide zero nutrients and a lot of Calories. (Hence “empty Calories.”)
  • They cause the bacteria in your mouth to produce extra acid, which erodes your teeth.
  • They put your pancreas on overdrive, which depletes the blood of sugar, which (over time) exhausts your liver, pancreas and adrenal glands.
  • They require vital nutrients in order to be digested, which means your body quickly runs out of B-vitamins, calcium and magnesium. (Whole foods contain sugar, but they also contain these vital nutrients, so they fuel their own digestion.)
  • They increase the body’s production of cytokines—aka, inflammation.

For anyone who are at risk for or recovering from any cancer, especially prostate and breast cancer, sugars are especially dangerous. Diets high in refined sugars tend to make us gain weight, and obesity is associated with increased cancer risk—prostate cancer included. In addition, too much sugar will—frankly—make you feel like crap. You’ll exercise less, so you’ll feel even worse.

I don’t mean to make it sound like a “slippery slope,” but my point is this: whatever you think you’re getting from eating that extra dessert—it’s not worth it. Be mindful when eating during the holiday and stay in control.

So you’re telling me I shouldn’t eat my mom’s signature dessert?

Look, I’m a family man. I know what it’s like to be at a dinner table where it doesn’t matter what you’re eating as long as you’re eating. I know what it’s like to be surrounded by desserts on the Holidays. The pressure is on.

I’m not telling you to reject what your mom cooks because it has too much sugar in it. All I want you to do is to recognize that sugar is sugar, even on the Holidays. If you have to eat it, eat it and enjoy it. But don’t fool yourself.

Even on the Holidays:

    • Calories are still calories
    • Sugar is still sugar
    • Healthy food still
    • You’re still in control of your food choices.

Most importantly, laugh a lot and have fun this holiday season.

Be well.

Will Dietary Supplements Harm You?

supplement-rich-diet

Will Dietary Supplements Harm You?

The Takeaway First

You may have heard a report showing that 23,000 emergency room visits every year are due to children and young adults taking dietary supplements. Scary, right? Not exactly. In this post, I’ll talk about why we need to be careful about hype and misinformation, and what you need to do to take supplements safely.

The Details

It has been estimated that 23,000 emergency room visits every year involve children and young adults who have taken dietary supplements (Geller et al., 2015). Every year, 2,100 people are hospitalized due to adverse side effects of supplements. With the exception of sexual enhancement and body building supplements, women are more affected than men.

  • Weight loss and energy products caused over 71% of adverse events with symptoms of faster heart rate, palpitations and chest pain.
  • Close to 60% of the study participants were between 20 to 34 years olds.
  • Reports were collected from 2004 to 2013.
  • Among those 65 years and older, choking on pills, mostly calcium pills, was most prominent side effect.
  • The number of ER visits and hospitalization was only 5% of those from pharmaceutical medications.
  • No deaths were reported from the consumption of dietary supplements.

(Geller et al. 2015)

My Take On This

Comparing dietary supplements to pharmaceutical drugs, a common occurrence, is inadequate. They work much differently and the intelligent use of both can be extremely helpful in improving health. Of course, I tend to begin with natural therapies first and work from there.

But it is worth noting that Geller and his research team did report that the 23,000 hospitalizations caused by supplements was tiny compared to the hospitalizations caused by pharmaceutical meds, but most reports keep ignoring that fact.

It is important to keep in mind that over 700,000 people get hospitalized from using pharmaceutical medicine annually (Budnitz et al. 2005). That’s about 2.5 people for every thousand. Additionally, medical drugs have caused 2,100 reported deaths over the past eight years. (Shepherd et al. 2012)

There are problems in the supplement industry, no doubt. There are tainted herbal sexual enhancement formulas, like what Lamar Odom was taking a few weeks ago. And young kids are notorious for consuming too many supplements designed to make them gain muscle and lose fat.

Also, weight loss supplements can have side effects if consumed at very high amounts because many contain stimulants such as caffeine or bitter orange (sineprhine). Stimulants decrease appetite and burn fat, but when taken at high amounts they can cause heart palpitations and chest pain.

What Should You Do?

Numbers are all relative. In 2013, there were over 4,000 pedestrian deaths compared to 188 by flight. But mortality from airplanes is far more impactful. When huge numbers are thrown at you by the media, they do not mean anything unless there is a reference point.

As always, don’t believe the hype.

A bigger problem than the hype and misinformation is tendency of people to take dietary supplements haphazardly, without expert guidance. Occasionally there will be an unwanted side effect (though this is uncommon) but the most common problem is inefficacy – either from using the wrong combination of nutrients or from too small a dose.

Who should you talk to? Experts in the use of dietary supplements are naturopathic doctors, functional medicine practitioners or certified nutrition specialists (CNS). Experts on the therapeutic use herbs include, but not limited to, professional members of the American Herbalist Guild.

With few exceptions, health store clerks don’t know more than you do about supplements. They just work there.

The Bottom Line

If you have seen that a group of supplements work for you, continue them. The chances of getting an adverse reaction are minimal. Always seek the guidance of an expert. Don’t believe the hype. Be smart. Be well.

References

Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015 Oct 15;373(16):1531-40.

Budnitz DS1, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006 Oct 18;296(15):1858-66.

Shepherd G1, Mohorn P, Yacoub K, May DW. Adverse drug reaction deaths reported in United States vital statistics, 1999-2006. Ann Pharmacother. 2012 Feb;46(2):169-75.

On Lamar Odom’s Tragedy and on ‘Herbal Viagra’

Lamar Odom

On Lamar Odom’s Tragedy and on ‘Herbal Viagra’

Basketball is my favorite sport. I like all levels of basketball: college, professional, Olympic, even high school. Here in New York City, high school basketball is big, and as a result, we praise any high school kid who is really good at the sport and follow their career.

One such player is Lamar Odom, who was a high school phenomenon at Christ the King high school in Queens, New York during the late 90s. He went on to have respectable a 10-year career on the NBA, although he may be better known to the masses as Khloe Kardashian’s ex-husband. Three days ago, he was found unconscious with white material oozing out of his mouth at a brothel near Las Vegas, Nevada.

Today, October 16, 2015 he is on life support at a hospital in Nevada.

Lamar Odom’s story is perplexing, tragic and simply sad. He has had a long history of addiction and substance abuse. What happened on October 13, 2015 that sent him to (what might possibly be) his death bed?

What we know:

Odom was snorting cocaine before a near fatal fall. He also took 10 tablets of “natural” sexual energy pills called Reload.

What’s scary about Reload is that the FDA issued a warning that this unnatural supplement contains sildenafil (Viagra) hidden in the ingredients list on the label.

Cocaine is a stimulant, causes the heart to beat faster and increases blood pressure. That level of stress to cardiovascular system can lead to a heart attack. Combining Viagra with cocaine can tear the body’s main artery, the aorta, which reduces blood to the brain. The overall outcome is often a stroke.

How big of a problem is the sexual supplement industry?

A very big problem. Virtually 25% or about 300 supplement formulas of sexual enhancement supplements are tainted with either Viagra, Cialis or Levitra.

This is a very big problem for two main reasons:

1. Taking ED pharmaceuticals unknowingly can be deadly as they cause widening of the arteries. This can be harmless and even beneficial in moderation, but too much can lead to low blood pressure. Excessively low blood pressure stresses the heart.

2. The bad publicity also stains the good players in the supplement industry, those who make legitimate and safe sexual health supplements.

Effective (truly natural) dietary supplements are not event driven; instead, their benefits accrue over time. Clinically, I notice that it takes about a week or so of daily use before experiencing satisfactory blood flow to sexual organs. A responsible sexual health formula gradually builds stamina, nourishes blood vessels, and improves your production of nitric oxide, which improves blood flow.

How to spot drugtainted sexual performance supplements:

  • If it sounds too good to be true, it is too good to be true.
  • Avoid supplements that claim to make your penis bigger. No dietary supplement does that.
  • Avoid anything sold in small packets of 2 to 10 pills.
  • Avoid anything with an FDA warning similar to those found on ED drugs. For example, “do not use with nitrates or do not use if you have heart disease or high blood pressure.”
  • Avoid supplements that promise fast results. No natural agent or combination of agents work that fast.

What should you do?

Buy supplements from trustworthy manufacturers, and do not expect immediate “home runs” when consuming them. Be suspicious of “magic in a bottle” claims. Understand that there is no short cut for improving your sexual health and vitality.  

Only by eating nourishing foods, exercising vigorously, making smart lifestyle choices, and consuming highquality dietary supplements will you earn your results, defy your age, and reclaim the sexual vigor that you once enjoyed. 

Here is an FDA list of sexual supplements shown to contain ED drugs.

Lamar Odom’s grim condition will require a miracle to overcome, I suspect. I wish our hometown basketball star, his two teenage kids and the rest of his family strength during this difficult period.

Happy #NationalCoffeeday ! Is Coffee Good or Bad for you?

IMG_1151Is coffee good or bad?

According to a study published in the New England Journal of Medicine, coffee is good for you.

Details of the study:

  • Over 400,000 men and women were analyzed were followed from baseline (1995–1996) until the date of death or December 31, 2008, whichever came first,
  • Among participants who completed the 24-hour dietary-recall questionnaire, 79% drank ground coffee, 19% drank instant coffee, 1% drank espresso coffee, and 1% did not specify the type of coffee they consumed.
  • With questionnaire’s assessing diet and lifestyle, a total of 33,731 men and 18,784 women died.
  • Participants resided in six states (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and two metropolitan areas (Atlanta and Detroit)
  • As compared with men who did not drink coffee, men who drank 6 or more cups of coffee per day had a 10% lower risk of death, whereas women in this category of consumption had a 15% lower risk. Similar associations were observed whether participants drank predominantly caffeinated or decaffeinated coffee.
  • Inverse associations were observed for deaths due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, but NOT for deaths due to cancer.
  • Note: Coffee drinking men had a slightly, non- statistically significant increase risk of cancer (Freedman et al, 2012)

My take on this:

Freedman’s study suggest’ that a dose-dependent amount of coffee of 6 cups a day, decaf or regular can protect against a variety of disease associated death’s except cancer. It is unclear why coffee drinking men had a slight increase in mortality. Does this mean men should stop drinking coffee? Or should men “gulp the java” for its decrease in mortality from other non-cancer related conditions?

Interestingly, another large prospective study in 2011 showed that men who drank three or more cups of coffee a day, decaf or regular, had a decrease chance of developing high risk, lethal prostate cancer (Wilson et al. 2011).

I think the take home message is the following:

Coffee seems to have protective qualities and one should not give up coffee for unproven health reasons. The typical mugs of coffee often used is the equivalent of 2 cups. 2 mugs a day or 4 cups a day should be more than enough.

The non-coffee drinker does not need to start drinking coffee if he or she choose’s not to. All studies cited are epidemiological and as valuable as they are, especially when studying a large population, they are not conclusive.

Mix green tea into the picture. Variety is key for disease protection with food as it is with beverages. Green tea has shown to have protective qualities in numerous studies including is one large prospective Japanese study that looked at over 49,000 men (Kurahashi et al. 2008).

It does not matter if it’s decaf or regular – so unless caffeinated coffee bothers you, drink the “high octane” kind. Caffeine may not be harmful, even possibly protective and it may keep you alert and your metabolism high.

Those who should probably abstain:

  • Men suffering from prostatitis or prostate enlargment – caffeinated beverages aggravates urinary symptoms. Decaf may be OK.
  • Women (and men) suffering from interstitial cystitis. A recent study suggest’ that caffeine consumption may aggravate symptoms (Friedlander et al. 2012). This includes caffeinated tea as well. Again, decaf may be OK.
  • Those with high blood pressure should probably abstain as well. While coffee drinkers with normal blood pressure will probably not become hypertensive from drinking caffeinated or decaffeinated coffee, hypertensive men and women should skip.

Finally, none of the studies cited mention whether or not adding milk or sugar makes a difference. I would guess it does. It would be only a guess. However, a drop of milk and a dab of sugar is likely harmless. Straight black is probably best.

References:

Freedman ND, Park Y, Abnet CC, Hollenbeck AR, Sinha R. Association of coffee drinking with total and cause-specific mortality. N Engl J Med. 2012 May 17;366(20):1891-904.

Wilson KM, Kasperzyk JL, Rider JR, Kenfield S, van Dam RM, Stampfer MJ, Giovannucci E, Mucci LA. Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study. J Natl Cancer Inst. 2011 Jun 8;103(11):876-84.

Shafique K, McLoone P, Qureshi K, Leung H, Hart C, Morrison D. Coffee consumption and prostate cancer risk: further evidence for inverse relationship. Nutr J. 2012 Jun 13;11(1):42.

Friedlander JI, Shorter B, Moldwin RM.Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int. 2012 Jun;109(11):1584-91.

Kurahashi N, Sasazuki S, Iwasaki M, Inoue M, Tsugane S. Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol 2008; 167: 717

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