We chronicle Teri's harrowing journey that began with a shock & awe diagnosis of acute myeloid leukemia on 2/10/10. Her path has traversed multiple rounds of chemotherapy, remission, fruitless worldwide donor search, relapse, near demise from a superbug, resuscitation by an autologous (self) transplant, birth of her first grandchild Jack, and a mismatched haploidentical/umbilical cord transplant on 2/15/11 and myriad complications. This is her story as fought valiantly to the end.
Wednesday, April 12, 2017
Food for thought - you are what you eat and when you don't
Ben asked me recently about how to eat healthier. I was delighted with his question as it is a
topic I have been digesting ever since I began to deal with my inherited
hypercholesterolemia in my 30’s and practicing the intermittent low-calorie
fasting over the past 17 months.
I will try to summarize several complex themes after which
you’ll wonder if you should be eating twigs and leaves which are full of fiber,
low calorie, gluten-free, plant-based …
I will say that, as a gastroenterologist, you do want your poop to look
like twigs and leaves … If you want to
cut to the chase, you can skip to the recommendations at the end of the blog although
I’m not sure they will make sense without the background below.
Four background themes
- fast intermittently -reduce refined sugar intake -reduce total protein intake to daily
requirements - increase plant-based proteins (reduce animal
Mosley (reviewed a few blogs back) makes a strong case that
many ethnic groups practice intermittent fasting as part of their normal cultural
routine. It also has been known for 70
years that if you reduce calories in a rat, they live longer. Now we know why. Recent animal studies indicate that fasting
turns on several life sustaining processes:
1) increases insulin sensitivity (reversed insulin resistance which is the
physiologic driver of metabolic syndrome, obesity and type 2 diabetes), 2)
increases stem cell production and autophagy (cellular renewal and cleanup), 3)
it increases cancer immunity, and 4)
remodels hippocampus (improves memory) ... and you don’t lose physical or
cognitive abilities while fasting.
Mosley’s major contribution is to translate this concept into a diet plan
that most can tolerate. I have gotten many
friends, spouses, their fathers, their mothers who have had success with this as
well. And, it doesn’t cost anything
(except new clothes).
Taubes reviews the physiology, epidemiology and politics of
refined sugar, especially sucrose (a double sugar with exactly 50% fructose and
50% glucose), fructose (a fruit sugar) and high fructose corn syrup (55%
fructose and 45% glucose). To make a
long story short in the U.S. we are now consuming 114 lbs/year = 17,214
teaspoons of sugar per person per year. How
sweet we are! This geometrical rise over
the past 75 years parallels the mushrooming obesity epidemic. Further, the excess dietary sucrose and
fructose induces constant hyperinsulinism (the fulcrum) that causally links to
metabolic syndrome, obesity, type 2 diabetes, fatty (marbling) liver of
obesity, hypertension, disease, and to my surprise, also gout, cancer and
Alzheimer. Wow, all the ‘Western’
diseases placed under one saccharine umbrella!
Of course, because the definitive long-term study is impossible, we
don’t know if reducing sugar this will reverse these unhealthy trends.
Nevertheless, the epidemiological and biochemical evidence is compelling.
Campbell reviews his animal research and his largest ever
study of diet, lifestyle and cancer performed in China. He has found that excess casein (animal-based
in milk) protein (20% of calories) promotes cancer in rats exposed to a
carcinogen (aflatoxin) where as 5% (normal for body) content does not. It appears that protein intake in excess of
needs – Americans ingest about 3X what they need – leads to higher risk of
cancer. However, if one uses plant based
protein even at the higher dose, the cancers don’t grow. It is both the protein’s quantity and origin.
In populations around the world that eat plant-based diets, cancer is a true
rarity. However, when these same people,
e.g. Asians who move to the U.S. and westernize their diet, their cancer rates
soar and become ‘Americanized’ within 2 generations. Campbell directed a huge study in China
where they eat less protein and less animal protein than in the U.S. Even so the findings still confirmed those of
his animal studies. Since only 2-3% of
the cause of cancer is due to genetic factors, the majority is due to lifestyle
– diet, exercise, environmental exposure.
As I was taught in medical school, we are constantly ‘living in a sea of
carcinogens’ and have to maintain our immune defenses. He suggests that a switch to plant proteins,
will stop the second step (promotion) in cancer progression.
One window into plant-based diets pertains to an amino
acid-like compound I used to study in the lab, called carnitine. One of the scientists at Cleveland Clinic was
looking for the causative
factor in red meat that hardens the arteries since it is no longer simply
cholesterol and saturated fat. He
identified trimethylamine oxide, a degradation product of carnitine produced
by colonic bacteria, that causes atherosclerosis in rats. Does it apply to humans? When he measured levels in humans and
compared it to their degree of coronary heart disease, there was a significant correlation. Because carnitine is a natural bodily substance,
why is a toxic heart-damaging substance produced from it? It turns out the intestinal bacteria do the
dirty job … but only if you are a meat
eater! If you are vegan, you don’t
carry the toxin-producing bacteria!
That’s one reason why vegans have less heart disease than meat
So what are the principles … and most important what do I eat? I will
address the first but leave you to your own devices to individualize to your
palates, to compromise with your desires, to mediate with your significant
other … to arrive at your own menu.
1. Intermittent fasting is an effective way to lose
your abdominal fat storage and then maintain a lower weight.It also reverses insulin resistance (diabetic
tendencies), boosts cancer immunity, and improves memory. There are two ways to
do it, intermittent 1-2X/week at
500-600 kcal/day divided in two small meals, OR, daily eating two regular sized meals such as brunch at 11 and
dinner at 7 and nothing in between.Despite
my antecedent fear of fasting, I find I longer fear fasting or hunger, and its
works to burn my abdominal padding.
2. Limiting your overall protein to your actual needs
reduces cancerous cell growth.The
average American is eating 50+% more than needed.For example, the RDA protein goal is now
recommended at 10% of total calories = 50-60 g protein and a 5 oz steak would
give you 54 g protein, but they typically come as 8, 12, even 24, and 36 oz supersizes.
3. Switching from predominantly animal to predominantly
plant protein, as Dr. Campbell and author Michael Pollan (Omnivores Dilemma)
suggest, gives you further leeway as you could eat 20% of calories as plant
protein (120 grams) and not encourage those cancer cells to proliferate.
4. Sugar (sucrose/table sugar and fructose/corn
syrup) appears to be a very bad player today through its constant stimulation
of insulin secretion.Reducing intake of
refined sugars has the potential to arrest the development of metabolic
syndrome, diabetes type 2, obesity, hypertension, gout, cancer and
Alzheimer.Whoa, cancer and
dementia?Yes.The FDA is suggesting a 42 lb limit down
2/3rds from our current intake from 114 lbs/year.It would mean adjusting taste buds that have
been cranked to the sugary max and using artificial sweeteners to help satisfy those
jazzed taste buds. Fructose in fruits is
5. Fat used to be the dietary villain.A lot of this stemmed from bad press from the
sugar industry that led us down the wrong path for years.Once again it is not how much fat, but it rather
depends upon the origin with plant-derived
being much better than that from animals.So coconut oil doesn’t turn out to be so bad, at least compared to lard.
6. I think antioxidants
may turn out to be very helpful in the long run through its anti-aging and
anti-cancer effects.Many antioxidants are
contained in vegetable and fruit skins (phytochemicals and lycophenes).But to hedge my bet, I’m using one supplement
that is naturally found throughout the body, Coenzyme Q10.I use either ubiquinone or ubiquinol (more
expensive) forms at 200-400 mg/day.
7. I’m personally on a modified Portfolio diet to
reduce my hypercholesterolemia.In a
study published in JAMA in the 1990s, it is equivalent to taking Lipitor!Again, it employs plant-based soy protein
instead of beef and milk, plus steel cut oatmeal and psyllium seed (Metamucil) to
bind cholesterol and facilitate its passage out the rear.This strategy reduced my cholesterol by 60
points without medication.
So a lot of food thoughts to
ruminate and digest, pardon my cud. These
ongoing research findings have certainly given me pause to think in depth about
my diet. For myself, beyond the
Portfolio diet and intermittent low-calorie fasting, I’ve further modified my
diet along the principles above. For
protein, I eat mostly soy, fish, and eggs, with occasional chicken and beef. I eat Chinese style stir fry, mostly
vegetables and dofu with small amounts of meat.
I eat many salads with kale, nuts, and butternut squash. I ingest brown rice with a lower glycemic index
(less like refined sugar with a high glycemic index). And I’m trying to avoid refined sugars which
are ubiquitous. This amounts to less
protein, less animal protein, less animal fat, less refined sugar and more
plant-based protein. But as you can
guess, I crave a steak once in a while, I like my scoop of gelato … and indulge. But I feel
good, can see my toes, and feel better about what I’m eating, for myself and
1)Fast life by Michael Mosley MD (physician and
journalist for the BBC)
2) The case against sugar by Gary Taubes (award
winning science journalist)
3) The China study by T. Colin Campbell PhD (animal
and human researcher from Cornell)