This Just In from The Journal of the American Medical Association

As a health writer, I have accessed to embargoed studies that can't be written about until a specified date. I'm glad to say that the embargo on this one expired Monday July 28, so this may be the first place you're reading about this phenomenal study officially published in Monday's Archives of Internal Medicine, a sister publication of JAMA.

This study examined the association between type 2 diabetes, weight gain and- get this- the consumption of soft drinks and fruit drinks. They looked at over 43,000 women over the course of ten years, during which almost 3,000 of the women developed Type ll diabetes.

The findings were disturbing.

The women who drank two or more soft drinks per day had a 24% increase in their risk for diabetes. So far, not too shocking. But here's the kicker: The women who drank two or more fruit drinks per day had a 31% increase in their risk (grapefruit juice and orange juice were not statistically associated with the risk).

This is important. We've been brainwashed into thinking these crummy "fruit drinks" are healthier than sodas, when- as any reader of this newsletter knows- they're not. "Consumption of fruit drinks conveyed as high an increase in risk as did consumption of soft drinks", the researchers wrote. The higher the consumption of soda, fruit juices, fortified fruit drinks and Kool-Aid, the higher the risk. "The public should be made aware that these drinks are not a healthy alternative to soft drinks with regard to risk of Type ll diabetes", the authors wrote.

In a related study, researchers from Addenbrooke's Hospital in Cambridge analyzed blood vitamin C levels and fruit and vegetable intake in over 21,000 people who didn't have diabetes at the beginning of the study. Over 12 years, 735 participants developed diabetes. But the odds of developing diabetes was- get this- a whopping 62% lower for those who had the highest levels of vitamin C in their system.

Fruits and vegetables are a great source of vitamin C, and in my opinion, it never hurts to take a vitamin C supplement as well.

It's worth pointing out that homemade juice from combinations of vegetables and fruits have an awful lot of potential benefits, especially if they're not too high in sugar. (I'm pretty sure that the study that found increased risk for diabetes from fruit drinks wasn't talking about the kind of juice you make at home with your Vita-Mix.) It's also worth pointing out that an apple is a very different "animal" from a pasteurized apple juice "drink" that is marketed as a healthy alternative to soda. (It's not.)

Have You Ever Considered Getting a Coach?

What do Michael Jordan, Kobe Bryant, Tiger Woods, Roger Federer, opera singer Leontynne Price and virtually every major high performance athlete have in common?

Give up? It's simple: They all had (or have) coaches.

The big difference between therapy and life-coaching is that therapists are great at figuring out why things happened. Life coaches are great at helping you make things happen. When I was in "coaching school" they likened a therapist to a passenger in your car looking out the rear view mirror and helping determine where you'd been; a coach would be riding shotgun, helping determine where to go.

Now don't get me wrong. I was trained in psychology and I'm all for therapy. But it's fundamentally different from coaching, just as coaching is different from consulting. A consultant is an expert who provides answers. A coach is a person who asks the right questions so that you can provide the answers.

Coaching is an incredible tool if you're trying to lose weight. A coach can help you identify exactly where you're getting in your own way, and can hold you accountable for keeping (and making) promises- to yourself as well as to others. Studies show that the kind of support offered by a coaching program seriously increases the odds of weight loss success.

At various times in my career- even when things are going great- I've used a coach to help me laser in on strategies that could (and did) take me to the next level. I've been fortunate enough to have one of the best- Laurie Gerber, President of the Handel Group Private Coaching.

I've been so impressed with the Handel Group that I've partnered with them to come on as a guest speaker in two of their ongoing group coaching programs that focus on weight loss and health. The time commitment is only 3 months, and the cost is a very modest $200 per month. I'll be a guest speaker (on issues relating to nutrition, health, weight loss and the like) in both groups- one that starts on Monday Aug 11 (6:45 - 7:45 Eastern Time) and one that starts on Tues, Sept 9 (7PM - 8PM).

All sessions are done on the phone, and it's easier and more comfortable than you can imagine.

If you're interested in finding out more please call 800-617-7040 or e mail coach@handelgroup.com.

The Handel Group is also offering a free 20 minute phone session so that you can find out more about coaching and decide if it's for you. I strongly advise you to take advantage of that free offer. Even if you decide coaching's not for you, I can practically guarantee you'll get value out of the call. What have you got to lose?

Building a Better Brain

I once asked my good friend, nutritionist Robert Crayhon, what he would do if he could wave a magic wand and make one single change in the American diet. He didn't miss a beat. "I'd put every pregnant woman in the country on fish oil" he said.

The human brain is about 60% fat by weight, most of it a particular kind of omega-3 fat called DHA (docahexanoic acid). Virtually every study that's looked at behavioral or cognition problems from ADHD to delinquency to aggression has found extremely low levels of omega-3 fatty acids in the population studied. (There was even a study of murderers in prison that found the same thing.) This does not mean- let me underline- that taking omega-3's is a cure for ADHD, nor that taking them will prevent homicide. But it's a curious connection that seems to hold up in study after study. Your baby's brain- and yours- thrives on omega-3's. They're incorporated into the cell membrane, making it easier for information (like neurotransmitters) to get in and out- one reason why they're being studied at Harvard (by Andrew Stoll, MD, among others) for their potential to improve mood and lift depression.


Fernando Gomez-Pinialla, "a fish-loving professor of neurosurgery and physiological science at the University of California, Los Angeles" believes strongly that changes in our diet can enhance our cognitive abilities. He just completed a review published in Nature Reviews Neuroscience that looked at over 160 studies on food and the brain. He believes- as do many of us- that some foods are so potent in their effects that the mental health of entire countries may be linked to them.

Dr. Gomez-Pinilla reviewed studies that showed the benefits of omega-3's (fish oil) included improved learning, memory, resistance to depression and bipolar disorder, schizophrenia, dementia, ADHD and dyslexia.

But, as the Economist points out in a recent article, omega-3 is just the tip of the nutritional iceberg.

Take folic acid. Last year, the prestigious medical journal Lancet published research showing that folic-acid supplements can help those between 50-70 years old ward off cognitive decline. The research found that people taking folic acid supplements did better on measures of memory and verbal fluency, and processed information faster. There's also evidence that folate deficiency is associated with clinical depression.

Then there are the category of vitamins, minerals and phytochemicals known as antioxidants. Despite a pretty regular thumping in the anti-supplement mainstream press, these compounds protect against all sorts of damage to your cells and DNA. Dr. Gomez-Pinilla points out that the brain in particular is highly susceptible to "oxidative damage" (the kind that anti-oxidants protect against), largely because the brain consumes a ton of energy and the metabolic reactions that release this energy also generate oxidating chemicals.

One reason that gingko biloba is such a good supplement is that it is a powerful antioxidant that seems to work preferentially in the brain.

Then there's the brain building properties of foods like blueberries. I've put blueberries on every list of "superfoods" that I've ever written about. Like many foods, blueberries contain a huge number of plant compounds, not all of which have been evaluated. But one group of these compounds that has been identified is the polyphenols which have been shown to reduce oxidative damage in animals. Substances in blueberries boost the ability to learn and retain memories, something demonstrated in the lab of James Joseph, who likened the effect of blueberries on rats to finding "the rat fountain of youth".

There's also super-nutrients like acetyl-l-carnitine, GPC (glyceroPhosphoCholine) and Phosphatidyl Serine, not to mention alpha-lipoic-acid. I take these on a daily basis and my reading of the research has led me to the conclusion that it's a prudent strategy for increasing the odds that my brain won't turn to mush as I turn 60. Oh wait a minute- that already happened. A couple of years ago. OK, how about 70? Or 100?

You may not be able to prevent natural disasters, catastrophes, unforeseen head traumas, or even the effect of a really, really bad hand of the genetic cards- but eating the foods that continue to show up in the diets of the longest lived people with all their marbles intact- and taking the supplements that have the most brain-protecting promise- seems like an awfully smart strategy to me.

After all, I can't prevent some idiot with a blood alcohol level off the charts from driving on the freeway next to me- but that doesn't stop me from wearing my seatbelt.

As my grandmother used to say: "Couldn't hurt!"

THAT NEW LOW-CARB vs LOW-FAT STUDY

This week, a new study on diet and weight loss grabbed more headlines than a Britney sighting. You might have seen it reported on the Today Show, or read one of the many (misleading) headlines: "Low Carb Diet Beats Low-Fat in Diet Duel" (MSNBC), "Low Carb Diet Best for Weight, Cholesterol" (Associated Press), or- the most reasonable- "Study Fuels Low-Fat vs. Low-Carb Debate" (Wall Street Journal).

Because of the importance of this study- which after all was published in the ultra-conservative New England Journal of Medicine- I'm going to deviate from our usual newsletter format and focus exclusively on this study, which- like many diet studies- was poorly reported and somewhat misunderstood.

For starters, here's what actually happened:

Israeli researchers recruited 322 moderately obese subjects and randomly assigned them to one of three dietary groups.

Group one followed a low-carb diet without any restriction on calories. For the first two months they limited their carbohydrate intake to 20 grams a day (the exact amount on the Induction Phase of Atkins) and were then encouraged to increase their intake of carbs up to a maximum of 120 grams a day of carbs. (Sharp eyed readers might note that 120 grams of carbs hardly constitutes an Atkins diet, even during the most generous "maintenance" phase. For someone eating 1500-1800 calories a day diet, that would be between 25-40% of calories from carbs, closer to "The Zone" than to Atkins. But I digress.)

In contrast, both the Mediterranean and the low-fat groups were calorie limited: 1500 calories a day for women and 1800 for men. The low-fat group followed the standard American Heart Association guidelines (30% of calories from fat). The Mediterranean group were allowed up to 35% fat, mostly from olive oil and nuts, and were counseled to substitute beef and lamb with poultry and fish.

Interestingly, all three groups lowered their calories significantly compared to where they started, even though the low-carb group wasn't specifically told to do so, meaning the low-carb group "naturally" ate less calories without even trying. (This is an important point, since I've long maintained that a low-carb diet is easier to follow for many people-- especially those with sugar addictions-- because it doesn't stimulate the appetite like high-carb diets frequently do.)

Fast forward two years: the low-carb group lost the most amount of weight, the low-fat diet brought up the rear and the Mediterranean group was in the middle.

The weight loss results, however, were only part of the picture. The low-carb group had the highest increase in HDL ("good, protective cholesterol"), most improvement in cholesterol ratio, and the greatest reduction in triglycerides- an important risk factor for heart disease that I firmly believe is more important than cholesterol- (triglycerides didn’t budge in the low fat group).

It gets better. Low-carb dieters saw their C-Reactive Protein go down the most. C-Reactive protein is a very good measure of inflammation, something I think we need to be way more concerned with than cholesterol. Inflammation is a silent killer and a component of every degenerative disease from heart disease to obesity. Incidentally, C-Reactive Protein levels barely budged in the low-fat group.

Now for the "bad" news. The actual amount of weight lost on all three diets was pretty pathetic-- average of about 12 pounds for the low-carb group, 10 for the Mediterranean group and 7 for the low-fat group- statistically significant results, but pretty depressing considering this was over a two year period! Remember, though, those numbers were averages- some people lost a lot more (the highest number of pounds lost was lost on the low-carb approach, by the way).

So the first question that comes to mind is this: Did the subjects actually stick with their diets?

This is an impossible question to answer perfectly, and it's not the researchers fault. Short of locking folks in a metabolic ward for two years and counting every calorie served to them and left on their plate, there's no way to completely track compliance with any diet- people cheat, misunderstand the instructions, underreport what they ate, forget, and occasionally outright fib.

But the researchers were smart, and worked with what they had. In Israel, the biggest meal of the day is eaten at lunch, and in this study, everyone participating worked at the same facility and ate lunch at the company cafeteria. The employers cooperated fully with the researchers- all food was labeled and color coded, plus the subjects gave written reports about what they were eating outside company hours. If you're a researcher working with "free living" subjects, that's pretty much all you could hope for. Still, we all know what an evening (or a morning) or a weekend can do to sabotage any plan.

So, a lot of weight lost? Not really. But what's really remarkable about the results is that they didn't gain any weight over 2 years (and managed to lose some to boot!) Most people in that demographic (slightly obese, middle aged), left to their own devices, would continue to pack on the pounds. The fact that these people not only didn't gain but actually lost- albeit not that much- shows that there's hope.

This program shows that employers can actually make a big difference. What worked here- besides the diet programs themselves- was the group support, the counseling, the accountaility and the change in choices that was made available at their workplace.

That's a pretty optimistic finding, if you ask me. (Employers and schools- take notice!)

Most important of all, the study shows that there are health benefits to a low-carb approach that go way beyond weight loss. Lowered C-Reactive Protein, lowered triglycerides and increased HDL is nothing to sneeze at and a nice slap in the face of the establishment that keeps telling us how "unhealthy" low carb diets are!

And call me crazy- I can't help wondering if the low-carb group would had lost even more weight if they had eaten less than the 120 grams of carbs these folks ate, all the while keeping calories at a moderate, reduced amount and incorporating other lifestyle changes like exercise and stress reduction. Can you imagine? A more reasonable level of under 100 grams a day (or even less) might have made a lot of difference- that's a level that seems to work the best for people who have problems with sugar, insulin and carbohydrates in general.

The best we can say about this important study is that it got a lot of attention (after all this was the New England Journal) and gave credibility to the researchers stated conclusion that there are other ways to go besides low-fat. And to the conclusion that no one program works for everyone, and that some people may be more metabolically suited to low-carb (just as some may thrive on vegetarian or raw food diets).

And as far as the dismal weight loss results, let's just remember that weight loss is a tough nut to crack- but with the right match between program and person, the right social support system, a level of determination and commitment, it can be done.

And frequently is- often with much more dramatic results than were seen in this study.

L-Carnitine and Energy (and Fat Loss to Boot!)

When I wrote Natural Cures I talked about the heart healthy combination of Carnitine and CoQ10 and in my book on natural ways to boost energy (coming in January) I talked about the same pairing, calling L-Carnitine and COQ10 an "energy cocktail" (OK forgive me for being a little less than rigorously scientific here, but "energy cocktail" is a good shorthand).

Now a study in the American Journal of Clinical Nutrition shows that L-Carnitine does indeed reduce both physical and mental fatigue and increase cognitive function, at least in older people.

The researchers actually tested centurians aged 100-106 (!) who reported fatigue after even the slightest exertion (OK, let's give them a break, they're over 100!). The researchers gave half the group 2,000 mg of L-Carnitine and half the group a placebo.

After 6 months the Carnitine group experienced a reduction in physical fatigue, a reduction in mental fatigue, a reduction in fatigue severity and better cognitive function scores. Not only that, get this, they also experienced a significant reduction in fat mass and gains in total muscle mass. And their walking capacity improved as well.

Even though there isn't a ton of research on Carnitine and weight loss, many clinicians routinely use it for this purpose. Nice to know that fat loss (and muscle gain) was a "side effect" of this study on cognitive function and fatigue! (Not a bad side effect, if you ask me.)

Now granted, most of the readers of this newsletter are younger than 100. So we have to do a little extrapolation from the research and play "connect the dots".

But if this highly fatigued population benefited significantly in so many ways (more energy, less fat, better cognition) from 2,000 mg of Carnitine a day, it stands to reason that it might be helpful, don't you think?

The study- "L-Carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centurians: a randomized and controlled clinical trial"-- appeared in the Am J of Clinical Nutrition 2007 Dec; 86(6): 1738-44. You can get carnitine in the powder form (easy to take) or in combination with CoQ10.

If You Love Animals (or If You Have Ever Been in Love)

Last week I blogged about the healing power of pets, something I know a lot of you feel very strongly about (as you know I do too).

If you're one of those people (like me) who often doesn't take time to open the many videos and forwards you get every day, please make an exception for this one. Trust me on this.

Scrambled Eggs at the Buffet? Not So Fast!

One of the "safest" things to order for breakfast in a restaurant from a "low carb" or even blood sugar management point of view is eggs. And one of the most popular ways to eat them is scrambled.

Now the last thing I want to do is add to your anxiety about food choices (we're already too close to becoming totally paranoid about what to eat and what not to eat) but here's something worth thinking about when you consider how you take your eggs.

You're probably aware of the (in my opinion, highly misguided) level of paranoia about cholesterol that exists in this country. In fact, the cholesterol in eggs is one of the reasons why people order egg white omelets (also highly misguided as you've heard me say many times).

But what you might not know is that the beginnings of this whole cholesterol madness started back in 1913 when a Russian researcher named Nikolai Anitschkov fed cholesterol to rabbits who later developed a kind of atherosclerosis (cholesterolosis) .

Of course rabbits are vegetarian and never eat cholesterol in the wild, but that's another story. Nearly 50 years later, another researcher tried to duplicate Anitschkov's research, but he was very careful about not letting the cholesterol lie around the rabbit cages where it was exposed to air, which of course, causes it to oxidize pretty quickly.

And guess what? The rabbits didn't develop atherosclerosis.

Now all the nutritionists and MDs I respect have said for years that cholesterol isn't a problem in the body until it's oxidized, though that message tends to fall on deaf ears as a 20 billion dollar a year industry continues to demonize cholesterol of any kind in any amount (but that's another story). The point is that oxidized cholesterol actually is a problem. And unfortunately, when you scramble eggs you break up the yolk (where the cholesterol is found) and expose the cholesterol in it to a lot more air (and potential oxidative damage) than you would if the yolk were whole (as for example in poached or hard boiled eggs).

Again, I'm not- repeat not- telling you this so that you will be afraid to eat scrambled eggs. And if you eat them fairly soon after scrambling and cooking, and if you're healthy in every way and taking your antioxidants (or eating plenty of antioxidant rich foods), you should be fine.

But I do think you might want to think twice about serving yourself the scrambled eggs in a breakfast buffet, particularly when it's a good bet they've been sitting out there in the light and air for hours.

The Healing Power of Pets

Animals make people feel better. There's a ton of reasons for that, but we all know its true (at least most people reading my newsletter do!)

Now science is backing up what we all know in our gut. A study in the American Journal of Cardiology found that men who had heart attacks were more likely to be alive after four years if they owned a dog (I prefer to call dog "owners" guardians, but that's just me.)

In another study, half of a group of 48 stockbrokers with hypertension (high blood pressure) were told to adopt a dog or a cat. After six months, the pet owners showed significantly lower blood pressure than the control group.

There's a dog (or cat) out there for everyone. And as I've said many times, opening your heart to someone or something does as much for you as it does for them.

In one study, nursing home residents given a plant to take care of had better medical outcomes than the group that had nothing to care for.

Caring heals- whether it's expressed through community, volunteering, contributing to charity, taking care of a plant or an animal or a person or anything else that opens your heart and moves your consciousness out to something outside yourself.

Brazil Nuts and Selenium

You've probably heard me tout the benefits of selenium before. This important mineral is not only a powerful antioxidant, but has been found to be a marker for a number of different things. For example, prostate cancer rates in China were found to be lower when selenium is high, and according to research published in the January 2007 Archives of Internal Medicine, daily selenium supplements appear to suppress the progression of the viral load in patients with HIV infection. In discussing Hepatitis C, Burt Berkson, MD, PhD told me "Selenium acts as a birth control for the virus".

Recently, researchers from New Zealand asked a group of adult volunteers to consume either two Brazil nuts, 100 mcg of selenium as a supplement, or a placebo for 12 weeks. Even though the nuts averaged just 53 mcg of selenium, at the end of the 12 weeks, the nut eaters had increased their blood levels by over 64% while the supplement takers had increased theirs by a still very respectable 61%. The nut eaters also had more than twice the blood levels of an important selenium-dependent enzyme, glutathione peroxidise.

Should you throw out your selenium supplements? I'm certainly not going to. But why not eat four Brazil nuts a day just as insurance? They taste better than the supplements, (duh) and you may very well improve not only your selenium levels but your glutathione peroxidase levels even more.

My Not-So-Excellent New York Times Adventure

Last week, Tara Parker Pope - one of the most fair minded and intelligent science and health reporters in America- published a blog that quoted liberally from a piece I had written on healthy foods. The article- entitled "The 11 Best Foods You Aren't Eating"- was the NY Times most e-mailed article for the week and generated over 800 comments (and counting).

The purpose of the article was simple: to suggest some foods that you might be overlooking that were great for you for a host of reasons. It was lighthearted and fun, and used popular terms like "superfoods" in the same way we use the term "superstars" or "supermodels"- not as a scientific category, but more as a colloquial way of talking.

It clearly pointed out that these were not the only 11 great foods on the planet, but rather, some of the ones you might not have thought of that deserved a look. It was kind of akin to suggesting some new exercises to try at the gym that might be a good alternative to the bench press.

Now in fairness to the Times readers, about 99% of the comments were highly favorable and complementary.

Some were not.

Somewhere around comment 600, I was being accused of claiming that sardines cure cancer.

I had mentioned beets, which have 148 mcg of folic acid, a rather small quantity of this all-important birth defect preventing, homocysteine lowering B vitamin. Comment: "Doesn't Bowden know folic acid causes cancer?"

Later, a smarmy comment: "Who is Bowden anyway? Is he a Registered Dietitian?" implying that without this credential nothing I said should be taken seriously. This is like questioning the knowledge base of an expert on religion by asking to see his Taliban credentials.

Another dismissed my information on nutrition because I'm not a medical doctor, which is like dismissing a tennis pro's information on tennis rackets because he's not an accountant.

Poster 536 suggested everyone disregard this list because it was all processed food (there wasn't a processed food on it unless you count the processing necessary to stuff pumpkin into a can or fresh blueberries into a bag)

So what's the take home?

Perhaps the Times readers would have preferred me to say: "There's absolutely no provable scientific evidence for the health benefits of any foods or supplements, and I've got a doctor right here to back me up, right next to the PhD who says there's no such thing as global warming. So don't worry, be happy and keep eating your McDonald's. Enjoy and good luck.

The article and comments are still going strong.
You can read and/or comment on The 11 Best Foods You Aren't Eating at NYTimes.com