Is Eating Deli Meats Really That Bad for You?

Is Eating Deli Meats Really That Bad for You?

Q. Is eating deli meats really that bad? Does it make a difference if it’s organic, nitrate-free or uncured?

A. Meat and poultry are excellent sources of protein, B vitamins and certain minerals, but consuming even small amounts of processed meat increases the risk of colorectal cancer.

“We see a 4 percent increase in the risk of cancer even at 15 grams a day, which is a single slice of ham on a sandwich,” said Dr. Nigel Brockton, director of research for the American Institute for Cancer Research. Eating a more typical serving of 50 grams of processed meat a day would increase the risk of colorectal cancer by 18 percent, a 2011 review of studies found.

Unprocessed red meat, by comparison, increases cancer risk only at amounts greater than 100 grams a day, and the evidence for that link is limited, Dr. Brockton said, adding that the institute advises people to “limit” red meat but “avoid” processed meat.

There is some evidence suggesting an association between processed meat and stomach cancer. And a recent study found an increased risk of breast cancer among women who ate the most processed meats.

Processed meat refers to any meat, including pork, poultry, lamb, goat or others, that has been salted, smoked, cured, fermented or otherwise processed for preservation or to enhance the flavor. The category includes hot dogs, ham, bacon and turkey bacon, corned beef, pepperoni, salami, smoked turkey, bologna and other luncheon and deli meats, sausages, corned beef, biltong or beef jerky, canned meat and meat-based preparations and sauces, among others.

Many of these meats tend to be high in salt and saturated fat, though lean and low-sodium options are available.

Processed meats are often cured by adding sodium nitrite, which gives them a pink color and a distinct taste, or by adding sodium nitrite and lactic acid, which provides a tangy taste, according to The American Meat Institute. In the past, nitrates, in the form of saltpeter, were traditionally used. Nitrates or nitrites inhibit the growth of botulism and scientists suspect they may be involved in the formation of cancer-causing compounds in the body. (Vegetables also contain nitrates and nitrites, but eating them is not associated with an increased risk of cancer.)

Some products that claim to be “natural” or “organic” may say they are processed without nitrites or nitrates, and the label may say the item has “no artificial preservatives” or is “uncured.” But nutritionists warn that food manufacturers may still add vegetable powders or juices such as celery juice or beetroot juice that contain naturally occurring nitrates, which are converted to nitrites either in the food itself or when they interact with bacteria in our bodies.

The food label will state that there are “no nitrates or nitrites added,” but an asterisk will often lead to a fine-print addendum with the clarification, “except those naturally occurring in celery juice powder,” sea salt or a vegetable juice.

As a result some “natural” or “organic” roast beef and turkey breast, or other products cured with sea salt, evaporated cane juice, potato starch, or natural flavorings or seasonings, may end up with just as high a nitrite content as meats with sodium nitrite added.

Adding to the confusion for consumers is that the U.S.D.A. requires these meats be labeled “uncured” because they are produced without added nitrites or nitrates.

“The average person goes to the store and sees claims like ‘organic, ‘natural,’ or ‘no added nitrates or nitrites,’ and they assume those meats are safer, and they’re not,” said Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest, a food safety advocacy group.

The bottom line: If you’re trying to avoid processed meats in order to reduce your risk of cancer, it may be hard to know whether products labeled “natural,” “organic,” “uncured,” or “nitrate and nitrite free” fall into this category or not.

The C.S.P.I. has been urging the Department of Agriculture to require labels on processed meats and poultry that identify the products and inform the public that frequent consumption may increase the risk of colon cancer. A spokeswoman for the U.S.D.A.’s Food Safety and Inspection Service, Veronika Pfaeffle, said recently that the petition, filed in Dec. 2016, is still “under review.”

How to Lose Weight, With the Help of Technology

How to Lose Weight, With the Help of Technology

There are about as many approaches to weight loss as there are kinds of food, and both doctors and dieters argue passionately about which ones work best.

Fortunately, technology can help. It can not only help dieters find their own best path, but it can also make dieting itself easier, smoother and more supportive.

I know this from personal experience. When I recently took on a tough diet regimen, apps, websites and real-world gadgets were a crucial part of the process. They made changing my eating habits a lot easier—gathering advice from friends, tracking my calories and figuring out how to get past the dieting doldrums.

Here are seven ways I used technology to facilitate my weight loss.

1. Find a path with the help of online friends.

A year ago, I decided to get serious about losing the 40-plus pounds I gained after I left my job and returned to working from home. The prospect felt truly daunting.

So I turned to my favorite source of wisdom: Facebook. With so many different publications and websites flogging weight-loss advice, I figured that asking my friends would be the fastest way to narrow the list of possibilities and decide what would be worth investigating.

Dozens of friends weighed in with personal recommendations and experiences. The suggestions came down to three basic camps: join Weight Watchers; just eat healthily and in moderation; or try the ketogenic diet—a very low-carb, high-fat diet that has become somewhat trendy.

I’d always been skeptical of counterintuitive approaches to eating, but I also knew I needed something that would work fast enough to keep me motivated. I did some online research (because I always fact-check whatever I read on Facebook!), sought the advice of a physician who specializes in weight-loss and metabolic issues (as everybody should do), and decided to give keto a try.

2. Track progress with a smart scale and apps.

I established my baseline weight using an inexpensive smart scale that also synced my daily weight, body-mass index and body-fat level to an app on my iPhone. I also measured my waist, belly, bust and hips, so that I would be able to track my progress in inches as well as pounds.

Even though many people recommend weighing yourself no more than once a week—so that you don’t get misled by the inevitable daily fluctuations—I weighed myself at least every other day. Why? I’d chosen an approach that promised faster results in return for strict discipline. Seeing my weight tick down virtually every time I stepped on the scale reinforced my commitment. And because I was recording my progress automatically, through my scale’s Bluetooth-connected app, I could bask in seeing steep declines in my weight, BMI and body-fat percentage.

Ms. Samuel adds 16 grams of almonds to her Cronometer food log.
Ms. Samuel adds 16 grams of almonds to her Cronometer food log. PHOTO: GRANT HARDER FOR THE WALL STREET JOURNAL

3. Log every bite with a nutritional calculator.

Many of my Facebook friends emphasized the importance of tracking food intake to monitor calories and other nutritional data. I’d always seen that practice as a mix of narcissism and self-torture. But everything I read about the ketogenic diet made it clear that logging was essential to keeping my carb intake low enough.

I used the Cronometer app to track my intake, and installed it on both my phone and computer. I figured I’d be more successful recording every meal and snack if I was never more than one click away from my food logger.

It worked out exactly as I’d hoped. Cronometer helped me ensure that I was within my calorie and carb limits. (To speed up my weight loss, I’d settled on an aggressive calorie goal of 1,200 to 1,300 a day.)

What’s more, because Cronometer showed very detailed data for everything I ate, I could spot any potential nutritional deficits. Its “Ask the Oracle” feature made those easy to address, recommending foods high in protein, potassium or vitamin D—whatever was on my personal agenda.

4. Track your eating when your hands are full.

I soon discovered one major obstacle to food logging: If I was making myself a meal with more than three or four ingredients, I couldn’t count on remembering the items or quantities I needed to log. I tried keeping my phone handy as I cooked, so I could enter the quantities, but I found it cumbersome—and I kept getting food on my phone!

So I decided to use the Amazon Echo we keep in our kitchen to dictate my foods. As I made my morning scramble, I added each ingredient by dictating things like, “Echo, add one ounce of cheddar to foods eaten” or “Echo, add 50 grams of spinach to food eaten.” Once or twice a day, I transferred the items on my foods-eaten list to my Cronometer app and crossed them off the Echo list. It was a small hassle, but it worked.

A shelf full of low-carb, keto-friendly snacks helps Ms. Samuel stick to her regimen.
A shelf full of low-carb, keto-friendly snacks helps Ms. Samuel stick to her regimen.PHOTO: GRANT HARDER FOR THE WALL STREET JOURNAL

5. Boost your calorie burn with a fitness tracker.

Exercise wasn’t a huge part of my personal game plan, but I knew I needed to increase my activity level to achieve my goal. To keep myself motivated, I connected my Apple Watch to my food logger, so I could see how many calories I burned each day through physical activity (in my case, by walking). I allowed myself a little more leeway with my calorie count on days when I could see I’d been particularly active.

6. Get support and reinforcement from online buddies.

Like many weight-loss methods, keto has a large community of devoted adherents, and I soon learned to turn to this community whenever I ran into trouble. In addition to hundreds of keto blogs and recipe sites—which were useful in learning the basics and figuring out what to cook—I discovered the Reddit groups that are the de facto hub for keto dieters. When I needed to find a keto-friendly chewing gum or figure out what I could eat in a Japanese restaurant or how to get past first-month keto boredom—I mean, how much broccoli and chicken can one woman eat?—the keto subreddit had the solutions I needed.

7. Celebrate your success online.

Just as I shared my weight goal with Facebook, I found it helpful and motivating to let people know about my progress.

By mid-August—five months after I asked Facebook for a weight-loss method—I hit 143 pounds, the exact weight I was at before my 42-pound weight gain.

I celebrated by increasing my daily caloric intake to maintenance levels, about 1,650 calories a day for my weight and height. Within a few weeks, I had a sense of how much I could eat each day. At that point, I released myself from the obligation of logging every single thing I ate. These days, I log my food only if I see my weight tick up past the 143-pound mark, at which point careful tracking for a couple of days seems to get me back down.

I know how easy it was for me to gain 40 pounds by just taking my eyes off the scale, so I’m committed to tracking my weight (and, when needed, my food intake) as part of my personal health care. Technology makes it easy, and the support and encouragement of social-media friends make it even more rewarding.


This article was originally published in The Wall Street Journal. Read the original article.

Fiber Is Good for You. Now Scientists May Know Why.

Fiber Is Good for You. Now Scientists May Know Why.

A diet of fiber-rich foods, such as fruits and vegetables, reduces the risk of developing diabetesheart disease and arthritis. Indeed, the evidence for fiber’s benefits extends beyond any particular ailment: Eating more fiber seems to lower people’s mortality rate, whatever the cause.

That’s why experts are always saying how good dietary fiber is for us. But while the benefits are clear, it’s not so clear why fiber is so great. “It’s an easy question to ask and a hard one to really answer,” said Fredrik Bäckhed, a biologist at the University of Gothenburg in Sweden.

He and other scientists are running experiments that are yielding some important new clues about fiber’s role in human health. Their research indicates that fiber doesn’t deliver many of its benefits directly to our bodies.

Instead, the fiber we eat feeds billions of bacteria in our guts. Keeping them happy means our intestines and immune systems remain in good working order.

In order to digest food, we need to bathe it in enzymes that break down its molecules. Those molecular fragments then pass through the gut wall and are absorbed in our intestines.

But our bodies make a limited range of enzymes, so that we cannot break down many of the tough compounds in plants. The term “dietary fiber” refers to those indigestible molecules.

But they are indigestible only to us. The gut is coated with a layer of mucus, atop which sits a carpet of hundreds of species of bacteria, part of the human microbiome. Some of these microbes carry the enzymes needed to break down various kinds of dietary fiber.

The ability of these bacteria to survive on fiber we can’t digest ourselves has led many experts to wonder if the microbes are somehow involved in the benefits of the fruits-and-vegetables diet. Two detailed studies published recently in the journal Cell Host and Microbe provide compelling evidence that the answer is yes.

In one experiment, Andrew T. Gewirtz of Georgia State University and his colleagues put mice on a low-fiber, high-fat diet. By examining fragments of bacterial DNA in the animals’ feces, the scientists were able to estimate the size of the gut bacterial population in each mouse.

On a low-fiber diet, they found, the population crashed, shrinking tenfold.

Dr. Bäckhed and his colleagues carried out a similar experiment, surveying the microbiome in mice as they were switched from fiber-rich food to a low-fiber diet. “It’s basically what you’d get at McDonald’s,” said Dr. Bäckhed said. “A lot of lard, a lot of sugar, and twenty percent protein.”

The scientists focused on the diversity of species that make up the mouse’s gut microbiome. Shifting the animals to a low-fiber diet had a dramatic effect, they found: Many common species became rare, and rare species became common.

Along with changes to the microbiome, both teams also observed rapid changes to the mice themselves. Their intestines got smaller, and its mucus layer thinner. As a result, bacteria wound up much closer to the intestinal wall, and that encroachment triggered an immune reaction.

After a few days on the low-fiber diet, mouse intestines developed chronic inflammation. After a few weeks, Dr. Gewirtz’s team observed that the mice began to change in other ways, putting on fat, for example, and developing higher blood sugar levels.

Dr. Bäckhed and his colleagues also fed another group of rodents the high-fat menu, along with a modest dose of a type of fiber called inulin. The mucus layer in their guts was healthier than in mice that didn’t get fiber, the scientists found, and intestinal bacteria were kept at a safer distance from their intestinal wall.

Dr. Gewirtz and his colleagues gave inulin to their mice as well, but at a much higher dose. The improvements were even more dramatic: Despite a high-fat diet, the mice had healthy populations of bacteria in their guts, their intestines were closer to normal, and they put on less weight.

Dr. Bäckhed and his colleagues ran one more interesting experiment: They spiked water given to mice on a high-fat diet with a species of fiber-feeding bacteria. The addition changed the mice for the better: Even on a high-fat diet, they produced more mucus in their guts, creating a healthy barrier to keep bacteria from the intestinal walls.

One way that fiber benefits health is by giving us, indirectly, another source of food, Dr. Gewirtz said. Once bacteria are done harvesting the energy in dietary fiber, they cast off the fragments as waste. That waste — in the form of short-chain fatty acids — is absorbed by intestinal cells, which use it as fuel.

But the gut’s microbes do more than just make energy. They also send messages.

Intestinal cells rely on chemical signals from the bacteria to work properly, Dr. Gewirtz said. The cells respond to the signals by multiplying and making a healthy supply of mucus. They also release bacteria-killing molecules.

By generating these responses, gut bacteria help maintain a peaceful coexistence with the immune system. They rest atop the gut’s mucus layer at a safe distance from the intestinal wall. Any bacteria that wind up too close get wiped out by antimicrobial poisons.

While some species of gut bacteria feed directly on dietary fiber, they probably support other species that feed on their waste. A number of species in this ecosystem — all of it built on fiber — may be talking to our guts.

Going on a low-fiber diet disturbs this peaceful relationship, the new studies suggest. The species that depend on dietary fiber starve, as do the other species that depend on them. Some species may switch to feeding on the host’s own mucus.

With less fuel, intestinal cells grow more slowly. And without a steady stream of chemical signals from bacteria, the cells slow their production of mucus and bacteria-killing poisons.

As a result, bacteria edge closer to the intestinal wall, and the immune system kicks into high gear.

“The gut is always precariously balanced between trying to contain these organisms and not to overreact,” said Eric C. Martens, a microbiologist at the University of Michigan who was not involved in the new studies. “It could be a tipping point between health and disease.”

Inflammation can help fight infections, but if it becomes chronic, it can harm our bodies. Among other things, chronic inflammation may interfere with how the body uses the calories in food, storing more of it as fat rather than burning it for energy.

Justin L. Sonnenburg, a biologist at Stanford University who was not involved in the new studies, said that a low-fiber diet can cause low-level inflammation not only in the gut, but throughout the body.

His research suggests that when bacteria break down dietary fiber down into short-chain fatty acids, some of them pass into the bloodstream and travel to other organs, where they act as signals to quiet down the immune system.

“You can modulate what’s happening in your lung based on what you’re feeding your microbiome in your gut,” Dr. Sonnenburg said.

Hannah D. Holscher, a nutrition scientist at the University of Illinois who was not involved in the new studies, said that the results on mice need to be put to the test in humans. But it’s much harder to run such studies on people.

In her own lab, Dr. Holscher acts as a round-the-clock personal chef. She and her colleagues provide volunteers with all their meals for two weeks. She can then give some of her volunteers an extra source of fiber — such as walnuts — and look for changes in both their microbiome and their levels of inflammation.

Dr. Holscher and other researchers hope that they will learn enough about how fiber influences the microbiome to use it as a way to treat disorders. Lowering inflammation with fiber may also help in the treatment of immune disorders such as inflammatory bowel disease.

Fiber may also help reverse obesity. Last month in the American Journal of Clinical Nutrition, Dr. Holscher and her colleagues reviewed a number of trials in which fiber was used to treat obesity. They found that fiber supplements helped obese people to lose about five pounds, on average.

But for those who want to stay healthy, simply adding one kind of fiber to a typical Western diet won’t be a panacea. Giving mice inulin in the new studies only partly restored them to health.

That’s probably because we depend on a number of different kinds of dietary fiber we get from plants. It’s possible that each type of fiber feeds a particular set of bacteria, which send their own important signals to our bodies.

“It points to the boring thing that we all know but no one does,” Dr. Bäckhed said. “If you eat more green veggies and less fries and sweets, you’ll probably be better off in the long term.”

This article was originally published in The New York Times. Read the original article.

Is There a Downside to Going Gluten-Free if You’re Healthy?

Is There a Downside to Going Gluten-Free if You’re Healthy?

Q. Is there a downside to following a gluten-free or grain-free diet for someone who is not highly sensitive to gluten? Are there any benefits?

A. A gluten-free or grain-free diet can pose risks and is not recommended for someone who is not highly sensitive to gluten. Such a diet is also unlikely to provide any benefits.

“There’s no reason for someone who feels well to start a gluten-free diet to promote wellness,” said Dr. Benjamin Lebwohl, director of clinical research at the Celiac Disease Center at Columbia University. “It is not an intrinsically wellness-promoting diet.”

One of the main problems in avoiding gluten-containing grains like wheat, rye or barley as well as other grains is that it can reduce the overall quality of someone’s diet. “The most common issue people run into when starting a gluten-free diet is fiber intake often plummets,” Dr. Lebwohl said. Fiber is important for overall digestive health, so inadequate intake can lead to constipation and other bowel problems; it may also make you not feel as full, which can lead to excess calorie intake and potential weight gain. While grains aren’t the only source of fiber available, they are a good one, and most Americans fail by a long shot to get the recommended intake of about 20 to 40 grams a day, depending on gender and age.

If following a gluten-free diet means eschewing whole grains, that can be especially problematic, because whole grains are associated with numerous health benefits, especially for heart health. As part of a healthy diet, high intake of whole grains has been associated with reduced risk of heart disease, some cancers, Type 2 diabetes, obesity and death from numerous causes, including infections and respiratory diseases.

“Gluten-free substitute foods tend to have more fat, more sugar and more salt than gluten-containing counterparts, in general,” Dr. Lebwohl added. Gluten provides elasticity in dough and helps thicken various processed foods, so it can also be found in products like energy bars and deli meats. To compensate for the loss of texture, Dr. Lebwohl said, “gluten-free substitutes are often less healthy.”

Starting a gluten-free diet can also “interfere with the ability to detect celiac disease,” said Dr. Lebwohl, because the two abnormalities picked up by the primary testing tools for celiac disease — a blood test, which looks for certain antibodies, and a biopsy, which looks for intestinal damage — can normalize after just a few weeks of eliminating gluten.

“One of the frustrating scenarios for both doctor and patient is when a patient has a number of symptoms, starts a gluten-free diet, feels a lot better — maybe 90 percent better — but we still don’t know if they have celiac or not,” he said. “If someone is experiencing symptoms that might be related to celiac disease, that person should get tested first, before starting a gluten-free diet.”

While much has been written in books and online sources about the purported benefits of avoiding gluten, such as weight loss, cognitive well-being and overall wellness, these claims are not supported by evidence. Though some patients with irritable bowel syndrome, or I.B.S., may see symptoms improve after cutting out gluten-containing foods, research suggests it’s likely to be a result of something other than gluten.

Only about 1 percent of Americans have true celiac disease, a serious autoimmune disorder, and should follow a strict gluten-free diet. Another 6 percent or so have non-celiac gluten sensitivity, a milder condition tied to digestive problems and other symptoms that does not result in a positive test for celiac disease; observing whether symptoms improve after a trial elimination of gluten is the main method of diagnosis.

For everyone elsefollowing a gluten-free diet is not advised. Still, a 2013 report by the NPD Group, a market research firm, found that as many as one in three Americans were trying to avoid gluten.

“The potential adverse health effects of gluten in those sensitive to it have reverberated in cyberspace, creating the impression that gluten is a bona fide toxin, harmful to all,” writes Dr. David L. Katz, director of the Yale-Griffin Prevention Research Center in his forthcoming book, “The Truth About Food.” “This is false; gluten is not ‘bad’ for those tolerant of it, any more than peanuts are ‘bad’ for people free of peanut allergy.”

“Avoiding whole grains because you’ve heard gluten is bad is like avoiding whole fruits because you’ve heard fructose is bad,” Dr. Katz said in an interview. A diet without gluten is most often associated with the inclusion of what he calls “ultra-processed, gluten-free junk foods” and the exclusion of highly nutritious whole grains. “Avoiding it systematically produces net harm both to diet and to health.”


This article was originally published in The New York Times. Read the original article.

Keto, gut health and fasting are all the rage. Are they worth all the hype?

Keto, gut health and fasting are all the rage. Are they worth all the hype?

As January nears its conclusion, how are you doing with your New Year’s health resolutions? How’s your willpower holding up on that keto diet? Are those probiotic supplements making your gut happy?

These new and shiny health trends have skyrocketed in popularity. Celebrities sing the praises of stunt diets and esoteric supplements. Intermittent fasting, it seems, has become big with the local tech bro scene.

Me, I’ve never been one for resolutions, especially the dietary kind, because, hey, I work in food. (I also don’t like other people telling me what I should and shouldn’t eat.)


That said, for a few weeks now, I’ve been following an anti-inflammatory diet. Currently I am avoiding booze, bread, pasta and processed sugar; basically, all of the tasty things that make life fun. The thing is, I’m actually feeling better. I’m not certain of the reason, but my joints seem to be aching less, I’m sleeping better and have more energy. Still, I miss doughnuts.

When it comes down to it, we all want to feel better, and what we put in our bodies (or don’t) is a big part of that. However, making heads or tails of these diet and health trends can be mind-boggling.

I recently spoke with Danica Cowan, M.S./R.D., a registered dietitian and nutritionist at UCSF’s Osher Center for Integrative Medicine, to learn more about these trends — what they are, what works and what is plain old marketing hooey.

The ketogenic diet

Probably the highest profile diet right now is the ketogenic diet, or keto for short. By consuming foods that are high in fat and minimizing carbohydrate intake, it’s designed to get the body to burn fats instead of carbs, and to reach a metabolic state known as ketosis.

However, there are two kinds of ketogenic diets, says Cowan: the one used to treat certain medical conditions, and the fad type used for weight loss.

The medical diet, which has been around for decades, was originally intended to treat pediatric epilepsy and can be pretty effective for that, Cowan says. There’s also a lot of emerging research about the ketogenic diet and its effect on lowering inflammation in the brain, as well as diabetes.

As for the fad diet, however, casual fad dieters are probably not in ketosis; instead, most people may simply be on a low-carb diet with extra fat.

In general, the ketogenic diet is not intended to be followed for a long period of time, says Cowan, and as such, researchers don’t fully know yet the long-term effects that the diet may have.

“The thing that makes me nervous about the keto diet is the unlimited permission to eat all the fats they want, including unhealthy fats,” says Cowan.

So, before you reach for that extra helping of bacon — which Cowan reminds us is not a health food — it’s important to work with an experienced dietitian or nutritionist who understands the keto diet, “because you’re basically changing the way your body functions.”

Intermittent fasting

Exactly what it sounds like, intermittent fasting is a catch-all term that can mean everything from going without food for a couple of days a month to simply lengthening the amount of time between finishing dinner and eating breakfast.

For those of us who love food and take pleasure in eating, the idea of fasting may seem extreme, but Cowan believes there are potential benefits in this approach.

Having more time between meals allows the body more time to rest and repair itself. The routine’s flexibility means that it can be relatively easy for people to incorporate it into their daily schedule. Even if you decide that intermittent fasting isn’t for you, Cowan does encourage people to stop eating about two to three hours before bed.

Gut health

Wander the aisle of your neighborhood market and you’ll spot all sorts of foods and drinks touting that they’re infused with probiotics and prebiotics. But what exactly are probiotics and prebiotics, and what do they do?

Probiotics are live bacteria that are ingested with the intention that they will take up residence in your intestines. Prebiotics are the food for the probiotics and can be found in high-fiber sources like fresh fruit, vegetables and whole grains. As a result of eating prebiotics, probiotics produce short-chain fatty acids, which have beneficial effects on the gastrointestinal system.

As for all those energy bars, cereals and other prepared foods that are marketed as being loaded with pre- and probiotics, Cowan recommends approaching those with a healthy dose of skepticism.

“Most food marketing is b.s.; some have science behind it; 95 percent of it is marketing,” says Cowan. “Adding something healthy to something unhealthy does not make it healthy.”

Generally speaking, Cowan recommends using refrigerated supplements over shelf-stable ones, and ideally, they should have at least 10 strains of different bacteria. To have an impact, they also have to be taken regularly.

Other sources that are great for promoting a more gut-friendly diet: fermented foods, especially yogurt (plain and unsweetened), kimchi, sauerkraut, lacto-fermented pickles and kefir. Kombucha, which contains a lot of yeasts, can be problematic for some people with gastrointestinal concerns. (It is, however, a good replacement for soda.)

What a lot of these diets have in common, says Cowan, is cutting out unhealthy foods. “At the end of the day, if you’re eating more whole, unprocessed foods and less processed junk, that’s going to benefit anyone,” she says.

Be mindful about eating habits, and prioritize what works for you. Above all, be kind to yourself, Cowan says. “People beat themselves up about what they eat or don’t eat, and that’s not healthy.”

This article was originally published in Wired. Read the original article.



QUOTE-UNQUOTE UNHEALTHY FOOD. That’s how Christy Harrison, one of a new group of rogue dieticians, describes Chicken McNuggets. I can’t get enough of how she, formerly a food purist and determined orthorexic, uses that quote-unquote locution on her podcast Food Psych, a deceptively sweet piece of heresy that takes aim at the pieties, sophistries, and perils of diet culture.

At its heart, Harrison’s podcast is an intensive project of pop deconstruction—and if liberation is your goal, it works. It’s ecstatic. It’s terrifying. But while an antidiet project can almost certainly make you happier, freer, and more productive than you are now, you may also be fatter. So there’s that.

A podcast about dieting that might lead to weight gain? Yes, I realize: no. But a friend pushed Food Psych on me, and now I never miss an episode. What once sounded to me like modish self-help has become an authentic philosophical endeavor, chronicled in academic papers, podcasts, books, and social media. At the same time, in seeming to put up for grabs the self-evident connections between food, weight, and health, it can smack of disquieting science denialism.

I’d argue it’s not, and I’m prepared to spell that out. In the past 15 years, public health journals have steadily documented the health risks posed by food restriction. Moreover, the antidiet project is above all a cultural one—a breaking of chains that makes a priority of sustained mental health over the illusion of bodily thinness.

The work of the antidiet crowd asks anyone touched by diet culture to entertain the possibility that body weight doesn’t, in itself, cause health issues. Some activists challenge dieters to exit the cult of food restriction by doing rad things like skipping the gym and eating salty, fatty, sugary fast food (including McNuggets)—whenever the spirit moves you. As rites of passage into freedom go, this one is pretty great and includes the jubilant breaking of a legitimate taboo. For chronic dieters like myself, it also demands a measure of courage. Because, let’s face it, in eating trans fats you’re not just preempting your chances of ever matching Balenciaga’s beauty ideal. You’re crossing the World Health Organization, which still maintains that fast and shelf-stable foods are unsafe at any dose.

To me, the most staggering scientific suggestion in the antidiet movement is that there might not be a causalrelationship in the familiar correlation between higher body weight and health issues. According to figures like Harrison, the one thing we can say for certain about people who get labeled “fat” is not that they have deposits of adipose tissue that interfere in observable ways with heart health and blood sugar. What we can say is that fat people in America, number one, experience weight stigma and, two, are always or often on diets.

How could these slippy-slidey phonemes about diet culture ever have had any moral sway over me?

Weight stigma can be brutal, dramatically affecting everything from work and travel to romance. At the same time—rather than sadistically goad people in bigger bodies into some mythical food regimen that turns them thin for good—it “poses serious risks to their psychological and physical health,” according to a 2010 paper in the American Journal of Public Health. The risks of weight stigma might even be greater than the risk of weight itself.

Then there are the dangers of dieting. According to studies in the American Journal of Physiology–­Endocrinology and Metabolism (2014) and Evolution, Medicine, and Public Health (2016), food restriction of almost any form—famine, elimination diets, wellness diets—routinely upsets hormonal regulation, potentially setting off serious mental and physical health problems and, paradoxically, weight gain.

Some of Food Psych’s experts identify as fat. Some must regularly check their “thin privilege.” But in keeping with the rigor of their critique, “thin” and “fat” are recognized as cultural conceits without objective correlates. So diet critics decline to use numbers like pounds, calories, or dress sizes to identify bodies. For those who have long attended compulsively to body size and its relation to food purity, categories, and quantity, numbers seem to shimmer with moral significance—and the ever-present possibility of moral failure on the scale.

A central aim of the antidiet project is to divest the language of bodies and food of all its moral content. That’s why the critics focus so hard on language. Harrison just won’t let the words “healthy” or “unhealthy” (or for that matter “wellness,” “overweight,” or “clean eating”) slip the bonds of her pointed quotation marks. And to hear her take her rapier punctuation to the truisms around food, bodies, and exertion is to feel the wires loosen in your head. Quote-unquote overeat. How could these slippy-slidey phonemes about diet culture and the body ever have had any moral sway over me?

Pulling the pins out of tenacious cultural conceits can start anywhere. You can confront what seem like immovable beliefs about justice, nationhood, money, almost anything—and find they’re not as solid as they seem. I finally took in, on Food Psych, the idea that body size and food consumption might, just might, not be the be-all and end-all of health and well-being, and that worrying about body size and food consumption—and haphazardously dieting in sync with those worries—might be compromising, rather than improving, my life.

Another important component of freeing oneself from diet mentality is, like it or not, Instagram. It seems that skipping the notorious thin­spiration accounts, which show skeletal bodies to inspire dieters, and instead following feeds that show portraits and selfies of people in bigger bodies opens the eyes. Cellulite—that invented disease—comes to seem somehow lacy, as writer Brianna Snyder puts it. Bat wings and saddlebags and muffin tops—gaze long enough and it just happens: Those bodies come to appear beguiling, nurturing, aspirational. You start to crave ease rather than emaciation.

But even if you can warm up to the idea of beauty at any weight, what do you do about eating? Isabel Foxen Duke, an especially acerbic diet critic, has one powerful suggestion. Never eat anything while resolving not to eat it ever again. With this, she submits another word for deconstruction: “tomorrow.” Anytime you’re eating something while telling yourself you’re not going to do this tomorrow, she says, you’re in peril of mental poisoning. Probably you’re pumping out sickening cortisol, but at the very least you’re pumping out thoughts: What I’m doing now is shameful, horrible, “unhealthy,” and I won’t do it tomorrow. When you do, you deepen your own sense that you can’t be trusted, that your appetites are excessive, thereby interfering with the dynamics of tasting, swallowing, digesting, and even liking food.

Definitely radical. Maybe too radical. For those of us who have come to believe we’d fall off the edge of the earth if we ate freely, what can we truly expect from renouncing dieting? The answer from Foxen Duke is simple: If you’ve been seriously restricting, your body may become bigger. If you’ve been bingeing in response to earlier deprivation (a “diet”), your body may become smaller. In either case, you’ll see that the pounds of flesh you’ve given your years and money and work to losing and gaining and losing and gaining are hardly catastrophic. They may even be lacy.


This article was originally published in Wired. Read the original article.

Who Really Needs to Be Gluten-Free?

Who Really Needs to Be Gluten-Free?

The gluten-free craze is unlikely to go away anytime soon. Many people say they feel better after adopting a diet free of gluten, a protein found in wheat, barley and rye, even though relatively few gluten avoiders have been given diagnoses of celiac disease, an autoimmune condition that can attack the intestines and other tissues when gluten is consumed.

Approximately one person in 140 is known to have celiac disease, which can remain silent for decades and become apparent at any age. The true incidence may be a lot higher. In a Denver study that followed children born from 1993 through 2004 into their teen years, 3.1 percent turned out to have celiac disease.

“That’s an unbelievable number of Americans who may be affected,” said Dr. Joseph A. Murray of the Mayo Clinic, an international expert on the disease.

While the health consequences of celiac disease have been well documented, other reasons a person’s health might be improved by avoiding gluten include a sensitivity to gluten or something else in wheat (the major source of gluten in Western diets) and the placebo effect — a genuine benefit inspired by the belief that a chosen remedy actually works.

Gluten sensitivity does not cause the intestinal and other organ damage wrought by celiac disease, although people with it tend to experience an array of symptoms. The health of three members of my family with non-celiac gluten sensitivity improved significantly when they eliminated gluten; one, who had struggled in vain for nearly a decade to lose weight, lost 40 pounds easily when she cut gluten from her diet.

Despite the current focus on gluten, there are probably many people walking around with celiac disease who don’t know they have it. The disorder can induce a host of vague and often confusing symptoms, the true cause of which may not be determined for a decade or longer. Among possible symptoms: abdominal pain, bloating, gas, chronic diarrhea, or constipation; chronic fatigue, anemia, unexplained weight loss, or muscle cramps; missed periods, infertility or recurrent miscarriage; vitamin deficiencies, discolored tooth enamel, bone loss and fractures.

Some people assume that the way they feel is normal and never mention their distress to a doctor, or if they do, doctors may dismiss the complaints as “nothing to worry about” or attribute them to another cause.

The fact is, however, that celiac disease can remain silent for many years, during which time hidden damage can occur with lifelong, sometimes irreversible, health effects. And as a report for the United States Preventive Services Task Force that reviewed the evidencerecently stated, many of these “adverse health consequences” are “potentially avoidable.”

These factors suggest that a screening program to detect hidden disease might be health-saving for millions of people, especially children whose growth can be impaired and who may suffer other long-term problems from undiagnosed and untreated celiac disease.

However, after a thorough review of published reports, the task force did not endorse a screening program — not because it considers the condition not serious or because there is no screening test. Rather, the task force said, there is still not enough evidence to answer “key questions related to benefits and harms of screening for celiac disease in asymptomatic individuals.”

Among the areas that need more research, the task force concluded, are how accurate screening tests really are; whether screening and identifying people as having celiac disease can cause harm; and whether treating screen-detected disease improves the health, survival and quality of life of people who otherwise might not be treated.

The task force noted, for example, that no studies looked at the potential upside or downside of screening adults, adolescents or children who have no symptoms. The team concluded that a lot more well-designed research was needed before a screening recommendation could be justified as medically sound.

Meanwhile, millions of Americans are self-treating with gluten-free diets. This has its advantages and disadvantages. If avoiding gluten makes people feel better, if they can afford the sometimes more costly gluten-free foods, and if avoiding gluten doesn’t turn them into social pariahs, most reasonable people would say, “Why not?”

A main disadvantage of self-treatment without a diagnosis is that an accurate result of the tests for celiac disease requires that the person regularly consumes gluten. Avoiding this protein would mask a positive finding on a screening blood test and biopsy evidence of damage to the intestines that can result from eating gluten.

“There’s a simple blood test for celiac, but it must be done before you change your diet,” Dr. Murray said in an interview.

Aside from intestinal damage, failing to detect asymptomatic celiac at an early age can result in poor bone development and suppressed growth, Dr. Murray said. This can create “a high risk for fractures both before and after a diagnosis of celiac, which might not happen until age 40 or 50,” he explained.

When undiagnosed celiac results in persistent fatigue or infertility, “you can lose years of quality of life that you can’t get back,” Dr. Murray said.

If symptoms are subtle, he added, “people can be sick for so long, they don’t know what health is. They don’t recognize their symptoms and don’t complain to the doctor. If the whole population were screened and people with celiac were found and treated, it could result in no health consequences.”

That, however, would require rigorous adherence to a gluten-free diet. Without a medical diagnosis of celiac and an explanation of its possible consequences, people are likely to be less careful about what they eat.

There is also a potential medical downside to diagnosis and treatment. “Contrary to what many people think, a gluten-free diet is not necessarily a healthy diet,” Dr. Murray said. “When people with celiac go on it, they often gain weight, especially fat weight, because they are no longer malabsorbing nutrients. They are also more likely to develop metabolic syndrome,” which raises the risk of heart disease and Type 2 diabetes.

Until evidence is developed that could justify screening the entire population for celiac, Dr. Murray advocates screening “everyone in the at-risk group,” which would include family members of celiac patients and everyone with Type 1 diabetes, premature osteoporosis and anemia, which may be signs of celiac disease. He also advised that people with chronic bloating, mouth ulcers, chronic headaches or fatigue should be tested.

Others who may be at risk for celiac include people with tingling or numbness in the arms and legs, thyroid disease, rheumatoid arthritis and Sjogren’s syndrome.


This article was originally published in The New York Times. Read the original article.

Excess Weight Contributes to More Than 7 Percent of Cancers

Excess Weight Contributes to More Than 7 Percent of Cancers

More than 7 percent of cancer cases in the United States are attributable to excess body weight, a new study reports.

Previous studies have established an association between body fat and at least a dozen cancers, with the highest risks for liver, uterine and esophageal cancers.

The new report, in JAMA Oncology, found that from 2011 to 2015, among people 30 and older, 4.7 percent of cancers in men and 9.6 percent of those in women were attributable to excess weight — some 37,670 cancers in men, and 74,690 in women every year.

The highest rates of weight-associated cancer are in the South, the Midwest, Alaska and Washington D.C.; the lowest were in the Mountain States, New England and Hawaii. More than 8 percent of cancers in Texas and Washington, D.C., are associated with body fatness, but only 6 percent in Colorado and 5.9 percent in Hawaii.

The lead author, Farhad Islami, a scientific director at the American Cancer Society, said that the fat-attributable portion of cancer cases will be likely to increase in coming years with increasing obesity.

“A range of interventions could be useful,” he said. “Zoning and licensing to encourage more fresh food outlets, taxes on sugary beverages, interventions at school and in the workplace. It’s important to have authorities at the state and local level implement some interventions to lower body weight.”

This article was originally published in The New York Times. Read the original article.

A physician’s warning on the keto diet

A physician’s warning on the keto diet

The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake oil and sanctified medical therapy.

For starters, the keto diet is not new. Nearly a century ago, prior to the discovery of insulin by Frederick Banting and Charles Best, the keto, or ketogenic, diet was used as a crude way to stave off high blood sugar levels, which was then inevitably fatal. By foregoing carbohydrates, the body utilizes fat, either stored or consumed, as its main energy source without raising blood sugar levels. In the process, ketones are produced, and thus giving the diet its name.

By avoiding carbohydrates altogether, blood sugar levels do no spike, but the underlying glucose resistance may still be present. Although some small non-randomized studies show improvements with the diet, a larger meta-analysis of diabetic patients on either the ketogenic diet or a high-carbohydrate, low-fat diet for more than one year showed no difference in hemoglobin A1cs or glycemic levels between the two diets. If the diet produces results no different than a high-carbohydrate, low-fat diet, then what about its effects on weight loss?

The diet’s initial ability to induce weight loss may non-trivially be related to its ketone production. Since ketones are osmotically active, they can induce a diuretic-like response, causing dieters to lose fluid-related weight, especially during the beginning of the diet. Those early results can serve to positively reinforce dieters and may be crucial in deciding whether to continue dieting, particularly in the face of restrictive dietary options and the malaise associated with the transition, dubbed “the keto flu,” which includes a combination of gastrointestinal distress (especially constipation given the lack of fiber), cramps, dizziness, brain fog, mood disturbances, and/or insomnia.

Long-term weight loss on the keto diet is less mystical than its powers to reduce blood sugar levels: It’s the product of devoted caloric restriction. During the zeitgeist of the last low-carbohydrate craze, which encompassed the Zone, South Beach, Atkins, Paleo and Dukan diets, researchers found that, “In all cases, individuals on high-fat, low-carbohydrate diets lose weight because they consume fewer calories.” Many of the studies done regarding weight loss on the keto diet, including several mentioned in the JAMA article, conspicuously fail to mention daily calorie intake, raising the diets panacea-like allure. However, a closer look shows that these diets are not much better than a low-fat diet. An oft-cited meta-analysis comparing low-carb ketogenic diets to low-fat diets showed a difference in weight-loss of less than a kilogram after twelve months – a negligible difference. Interestingly enough, another, more-recent, meta-analysis showed no difference in results between low-carb and high-carb diets on weight – or blood sugar levels – after one year.

Proponents of the keto diet will maintain that it can be used for the treatment of obesity and diabetes. But, is it safe? Does the risk of taking on a new diet with safety concerns justify the loss of a few or more pounds? It might if you are so obese or diabetic that you suffer from complications of those diseases, as almost anything will be better than suffering a heart attack or an amputation from diabetes. But perhaps not if you don’t have those comorbidities.

One of my concerns is the unnaturally high amount of fat consumed to maintain ketosis. If the diet had another name, it would be called “the fat diet” as 70-80 percent of calories per day come from fat. The only native population eating this much fat were the Inuit, who were forced to subsist on blubber out of necessity. And perhaps because of the high amounts of saturated and trans fats consumed, the Inuit experienced – despite popular misconceptions – a higher rate of heart disease, strokes, and death compared to non-Inuit and Western populations. The opportunity cost of not eating fruits, vegetables, and complex carbohydrates may have also contributed to their heightened risk.

Currently, there is no long-term data on the safety of the keto diet in adults. The keto diet may not be worth pursuing, even for diabetics or the obese, if we are mortgaging those diseases for higher rates of heart disease or colon cancer, a possibility given the low amounts of fiber consumed on these diets. More, we already know that the diet has not been without consequence for pediatric patients treated with it for refractory epilepsy, which has been ongoing since the 1920s.

From this population, children have developed kidney stones, acidosis, fractures and stunted growth. At the more serious end of the spectrum, children on the diet have died from arrhythmias arising from selenium deficiency and pancreatitis. The possibility of these side effects and possibly others yet to be discovered may tilt the diet out of favor.

However, deliberation over the keto diet or other low-carb diets is often omitted for the purposes of a near-Machiavellian attainment of weight loss or some other health goal. Before embarking on a diet with known adverse effects in children, uncertain long-term safety in adults, and equivocal benefits when compared to other dietary strategies, both patients and physicians alike would behoove themselves to remember that diabetes and obesity are not a product of ketone deficiency but the symptom of caloric excess, dietary indiscretion, and torpor. Let food be thy medicine – but not if it involves a Faustian bargain of your health.




Shivam Joshi is a nephrology fellow. He can be reached on Twitter @sjoshiMD and on Facebook

Is CBD Helpful, or Just Hype?

Is CBD Helpful, or Just Hype?

Suddenly, CBD is everywhere. CBD, short for cannabidiol, a non-psychotropic component of cannabis and hemp, is being promoted as the latest miracle cure. Enthusiasts rave about its supposed anti-anxiety, anti-inflammatory, antidepressant and, well, anti-everything-you-don’t-like effects.

You can get your CBD in a cocktail (a “Stoney Negroni” is being served at a Queens bar), skin creams and coffee. It’s only a matter of time before it turns up in avocado toast.

From pills to edibles, CBD is wildly popular, and it is easily available online and in stores. Indeed, sales are predicted to reach $22 billion by 2022, according to the Brightfield Group, a cannabis market research firm.

I first encountered CBD while on sabbatical a few years back. As I drove up the Oregon Coast Highway, it was hard to miss all the cannabis shops along the Pacific. I stopped in one, perused the menu, and selected two marijuana specials — Nine-Pound Hammer and Trainwreck — and some CBD gummy bears. The cannabis was, well, as advertised, and the CBD candy, as far as I could tell, was a fruit-flavored placebo.

Many of my patients have tried it or want to learn more about it. One of them, an educated, successful and anxious man in his 40s, recently told me he tried mixing CBD oil in his tea, but it didn’t make him calmer. Then he rubbed the oil on his injured knee, and pronounced it a magic cure.

Which invites the critical question: Just how effective is CBD, and for what kinds of ills?

Cannabidiol has little direct effect on the cannabinoid receptors in the brain, so it is largely devoid of the euphoric effects of THC, the major intoxicant in marijuana. But if CBD really had no psychotropic effect at all, it would be hard to understand its popularity. In fact, because it alters the brain’s serotonin receptors and may interfere with the breakdown of anandamide — a cannabidoid that is produced naturally in the brain — it could well affect feeling and thinking.

But what does the evidence show?

In 2017, the National Academies of Sciences, Engineering and Medicine convened a panel of experts to review the health effects of cannabis and cannabinoids. They examined more than 10,000 studies, most of which examined marijuana, not CBD. They found evidence that some cannabinoids — not including CBD — are effective for pain, nausea from chemotherapy and muscle spasms in multiple sclerosis.

When it comes to CBD, the panel found only a few small randomized clinical trials, and concluded that there was insufficient evidence that CBD was effective in treating conditions like insomnia, addiction to cigarettes and Parkinson’s disease, and limited evidence in its ability to treat anxiety.

This year, the Food and Drug Administration approved Epidiolex, a CBD concentrate, for two rare and severe forms of epilepsy, on the basis of several clinical trials.

To be fair, the paucity of data about CBD’s efficacy and safety in part reflects the federal government’s irrational restrictions on cannabis research. Because cannabis is classified as a Schedule 1 drug, you need a license from the Drug Enforcement Administration to research it and, until two years ago, you could use only the cannabis grown at the University of Mississippi.

The good news is that in 2017, the National Institutes of Health funded cannabinoid research to the tune of $140 million, including $15 million on CBD. The F.D.A. also loosened restrictions on CBD research in 2015 and has announced that it is considering “pathways” to allow the sale across state lines of CBD in food and beverages, sales now confined to states that have approved CBD use.

Still, the explosive popularity of CBD is way ahead of any evidence to support its efficacy — or reliable reassurances that it has no serious adverse effects. Where is the healthy skepticism when we need it?

The public, rightly, is quick to demand proof of safety and efficacy when it comes to synthetic pharmaceuticals. Why should natural products, like CBD, get a pass?

Perhaps it’s because many people have romantic and misplaced notions about nature. Some even point out that we come hard-wired with cannabinoid receptors in our brains and they must have a purpose, so why not use them? This is not exactly a persuasive argument: Nature endowed us with our own cannabinoids, so unless you have a deficiency of them or sluggish receptors, you really don’t need supplementation.

Consumers who are still keen on the idea of CBD might want to know exactly what they are getting for their money — considering that the manufacturing of CBD products is completely unregulated.

Here, the evidence is not going to make them happy. A 2017 study in JAMA reported that only 26 of 84 samples of CBD oils, tinctures and liquids purchased online contained the amount of CBD claimed on their labels. Eighteen of them contained THC, which could lead to intoxication or impairment in some individuals. And a quarter had less CBD than advertised. The F.D.A. has likewise found many products that did not contain the amount of CBD they were claiming.

Future studies may show otherwise, but at present CBD looks more like an expensive placebo than a panacea.