Review: Cardiometabolic Health Benefits of a Plant-based Diet

Plant-based eating patterns continue to soar in popularity and a group of nutrition researchers outline the science behind this sustainable trend in a review paper, entitled “Cardiometabolic benefits of plant-based diets,” which appears as an online advance in Nutrients. The review will publish in a future special edition, entitled “The Science of Vegetarian Nutrition and Health.”

The review outlines how a plant-based diet, which is naturally low in calories, saturated fat, and cholesterol, and rich in nutrients, like fiber and antioxidants, could be one tool, in addition to adopting a healthful lifestyle, used to improve nutrition intake and reduce the risk of heart disease, stroke, obesity, and type 2 diabetes.

The authors, Hana Kahleova, Susan Levin, and Neal Barnard analyzed clinical research studies and reviews published until May 2017. Their research finds a plant-based diet, built around vegetables, fruits, whole grains, and legumes, can improve nutrient intake and help manage body weight and glycemic control, improve cholesterol, lower blood pressure, and reverse atherosclerosis, or the narrowing of the arteries caused by the accumulation of arterial plaque.

“The future of health care starts on our plates,” says Dr. Kahleova, the lead study author and the director of clinical research at the nonprofit Physicians Committee. “The science clearly shows food is medicine, which is a powerful message for physicians to pass on to their patients and for policymakers to consider as they propose modifications for health care reform and discuss potential amendment to the 2018 Farm Bill.”

To understand the health benefits of a plant-based diet, the researchers analyze its structure:

Fiber

Fiber contributes to bulk in the diet without adding digestible calories, thus leading to satiety and weight loss. Additionally, soluble fiber binds with bile acids in the small intestines, which helps reduce cholesterol and stabilize blood sugar.

Plant-Based Rx: Aim to eat at least 35 grams of dietary fiber a day. The average American consumes 16 grams of dietary fiber each day.

Fats

Plant-based diets are lower in saturated fat and dietary cholesterol. Replacing saturated fats with polyunsaturated and monounsaturated fats can decrease insulin sensitivity, a risk factor for metabolic syndrome and type 2 diabetes.

Plant-Based Rx: Swap meat and dairy products, oils, and high-fat processed foods for smaller portions of plant staples, like a few avocado slices or a small handful of nuts and seeds, which are rich in polyunsaturated and monounsaturated fats.

Plant Protein

Vegetable proteins reduce the concentrations of blood lipids, reduce the risk of obesity and cardiovascular disease, and may have anti-inflammatory and anti-cancer effects.

Plant-Based Rx: Legumes, or lentils, beans, and peas, are naturally rich in protein and fiber. Try topping leafy green salads with lentils, black beans, edamame, or chickpeas.

Plant Sterols

Plant sterols that have a structure similar to that of cholesterol reduce cardiovascular disease risk and mortality, have anti-inflammatory effects, and positively affect coagulation, platelet function and endothelial function, which helps reduce blood clots, increases blood flow, and stabilizes glycemic control in patients with type 2 diabetes.

Plant-Based Rx: Consume a high intake of antioxidants and micronutrients, including plant sterols, from whole plant foods, like vegetables, fruits, grains, nuts, beans, and seeds. A plant-based diet supports cardio-metabolic benefits through several independent mechanisms. The synergistic effect of whole plant foods may be greater than a mere additional effect of eating isolated nutrients.

“To make significant health changes, we have to make significant diet changes,” concludes Dr. Kahleova. “A colorful plant-based diet works well for anyone, whether you’re an athlete looking to boost energy, performance, and recovery by enabling a higher efficiency of blood flow, which equates to oxygen conversion, or if you’re a physician who wants to help patients lose extra weight, lower blood pressure, and improve their cholesterol.”

Dr. Kahleova and the study authors recommend using a plant-based diet as an effective tool to treat and prevent cardiometaoblic disease, which they would like to see promoted through future dietary guidelines and nutrition policy recommendations.

Source: Medical News Today

Blood Test Detects a Range of Cancers Earlier

Dennis Thompson wrote . . . . . .

A new genetic blood test might pave the way for detecting early stage cancers that often prove fatal when caught too late, a new study suggests.

The test scans blood for DNA fragments released by cancerous tumors, explained lead researcher Dr. Victor Velculescu.

By reviewing these DNA fragments for mutations found in 58 “cancer-driver” genes, the blood test detects many early stage cancers without rendering false positives for healthy people, said Velculescu, co-director of cancer biology at the Johns Hopkins Kimmel Cancer Center, in Baltimore.

The test detected stage 1 or 2 colon, breast, lung or ovarian cancers between 59 percent and 71 percent of the time when assessing 200 patients previously diagnosed with cancer, researchers found.

“If we are able to detect cancer earlier, our chances of saving lives would be much higher,” Velculescu said. “The survival difference between late-stage and early stage disease in these cancers accounts for over a million lives worldwide each year.”

The test also proved capable of screening out cancer-free people.

Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, called this “important research” that “moves us one step further down the path to developing a blood test that might find cancer earlier.”

“We still need to improve the sensitivity, but this is a step forward. It is a proof of concept,” Lichtenfeld said. “It is not a test that’s going to be available in a clinical laboratory anytime soon.”

To develop a genetic blood test for cancer, researchers must find ways to spot DNA mutations linked to cancer while ignoring natural and harmless mutations that regularly occur in humans, Velculescu explained.

Velculescu and his team developed a genetic scan that essentially “takes a fragment here and a fragment there and uses it to create a picture of what the tumor DNA looks like,” Lichtenfeld said. “That’s what makes it so elegant.”

The research team assembled a panel of 58 cancer-linked genes, and used their scan to look for tumor DNA fragments in the blood of 200 people known to have cancer.

Overall, researchers detected about 62 percent of stage 1 and 2 cancers.

The test specifically spotted early stage colon cancer 71 percent of the time, breast and lung cancer 59 percent of the time, and ovarian cancer 68 percent of the time.

The ability to catch early stage ovarian cancer is particularly needed, Lichtenfeld said. Fewer than one in five ovarian cancers are caught early, when the five-year survival rate is greater than 90 percent. Most are detected after they’ve spread, and by then the odds of five-year survival are 40 percent or less, he said.

“Finding any marker in a stage 1 ovarian cancer patient is very important, because this is a tumor that usually presents at a much later stage,” Lichtenfeld said.

The researchers also directly tested cancerous tissue removed from half of the 200 cancer patients. They found that 82 percent of the tumors contained mutations that correlated with DNA fragments found in the person’s blood.

To check the blood test’s ability to weed out healthy people, the researchers also analyzed blood from 44 volunteers without cancer. No false positives occurred.

That equates to less than one false positive for more than 3.5 million letters of DNA sequenced, since each separate test requires assessment of 80,000 DNA base pairs associated with the 58-gene screening panel, Velculescu said.

Despite these promising results, researchers need to validate the blood test in larger studies, Velculescu said.

More work also needs to be done to improve the detection rate, Lichtenfeld added. “These tests were not able to detect 100 percent of the cancers,” he said.

Finally, cancer doctors must discuss what will be done when technology evolves to the point that such tests regularly find tumors that aren’t life-threatening, Lichtenfeld said. In some cases, treatment to remove the cancer could be worse than leaving it alone.

“What’s going to be so important is to be able to distinguish cancers that will hurt people versus cancers that may not have long-term impact on survival,” Lichtenfeld said.

The report appears in the journal Science Translational Medicine.

Source: HealthDay


Today’s Comic

12 Situations to Try Lifestyle Changes Before Medication

Teresa Carr and Ginger Skinner wrote . . . . . . .

Americans often rush—or get rushed—into taking drugs too quickly.

Sometimes doctors prescribe them for problems—back pain, heartburn, and insomnia, for example—without first giving lifestyle changes a chance.

Or they diagnose people when they’re in the “predisease” stage of a condition—think mild bone loss or slightly elevated blood pressure or blood sugar levels—and immediately start treating them with drugs when simple steps are often enough.

Here, 12 such situations, and what to do instead.

1. ADHD

Drugs: Antipsychotics such as Abilify and Seroquel.

Risks: Side effects include constipation, difficulty breathing or swallowing, dizziness, drowsiness, fast or irregular heartbeat, fever, seizures, and weight gain.

Nondrug options: Behavioral therapy plus educational interventions and exercise. (In some cases, a stimulant such as Adderall or Ritalin may also be necessary, but first consult with a specialist.)

When to consider a drug: Antipsychotics should be used for ADHD only if other psychiatric conditions are diagnosed, such as bipolar disorder.

2. Back & Joint Pain

Drugs: Nonsteroidal anti-inflammatories such as Advil, Aleve, and Celebrex; opioids such as OxyContin and Percocet.

Risks: High doses or long-term use of Advil and related drugs can cause bleeding in the intestines, kidney failure, heart attack, ulcers, and stroke. Opioids can trigger drowsiness, nausea, vomiting, constipation, addiction, and overdose.

Nondrug options: Try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture, or heat.

When to consider a drug: Anti-inflammatories are okay for short-term flare-ups, though even then stick with a low dose and don’t take them for longer than 10 days without talking with your doctor. Opioids should be a last resort and prescribed at the lowest effective dose for the shortest time possible.

3. Dementia

Drugs: Antipsychotics such as Abilify and Seroquel.

Risks: Generally the same as those listed for ADHD, as well as stroke and death.

Nondrug options: Establish a regular routine, do calming activities, and have frequent social contact. It’s also a good idea to rule out underlying conditions that can sometimes lead to disturbed behavior, such as constipation, infection, or hearing or vision problems.

When to consider a drug: If the patient suffers from delusions, hallucinations, or other serious mental illness, or presents a danger to himself or others.

4. Mild Depression

Drugs: Antidepressants such as Celexa, Cymbalta, Lexapro, and Prozac.

Risks: Many side effects, including diarrhea, drowsiness, headaches, agitation, sexual dysfunction, and suicidal thoughts.

Nondrug options: Exercise, meditation, and various forms of talk therapy.

When to consider a drug: If therapy alone isn’t enough or depression is severe. Reassess after six weeks and consider switching drugs if you aren’t getting better.

5. Heartburn

Drugs: Proton-pump inhibitors (PPIs) such as Nexium, Prevacid, and Prilosec.

Risks: Reduced stomach acid, which impairs the body’s ability to absorb certain nutrients and medication, and increases the risk of gastrointestinal and other infections. Long-term use may increase the risk of fractures, dementia, heart attack, and kidney disease.

Nondrug options: Eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid trigger foods, including acidic or greasy meals. For occasional heartburn, try OTC products such as Maalox, Pepcid AC, Tums, or Zantac 75.

When to consider a drug: If heartburn occurs twice weekly or more for four weeks or longer and your doctor diagnoses gastroesophageal reflux disease, which occurs when stomach acid backs up into the esophagus and damages it. In that case, consider a PPI for a few months while your esophagus heals.

6. Insomnia

Drugs: Sleeping pills such as Ambien, Belsomra, and Lunesta.

Risks: Dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

Nondrug options: Cognitive behavioral therapy (CBT) for insomnia, where a provider teaches you good sleep habits and suggests ways to change your behavior, such as cutting out naps or not using your laptop in bed.

When to consider a drug: If you have short-term sleep problems caused by a stressful event such as a death in the family or a divorce, or if CBT alone doesn’t provide enough relief.

7. Low Testosterone

Drugs: Testosterone topicals (such as AndroGel and Axiron), patches (Androderm), and injections (Aveed).

Risks: Blood clots in the legs, sleep apnea, an enlarged prostate, and possibly an increased risk of a heart attack or stroke. Topical forms can transfer to others, causing the growth of body hair in women and, if pregnant, transfer the hormone to their babies. Children exposed to the hormone have experienced enlargement of the penis or clitoris, the growth of pubic hair, an increased libido, and aggressive behavior.

Nondrug options: Treat conditions that can decrease testosterone, such as diabetes or obesity. Also discuss nondrug ways to boost energy and vitality by exercising, getting enough sleep, and couples therapy with your partner.

When to consider a drug: If you have hypogonadism, which is very low testosterone levels caused by a genetic disorder; damage to the testicles from injury or chemotherapy; or another cause.

8. Osteopenia, or Preosteoporosis (Bone Density at the Low End of Normal)

Drugs: Bisphosphonates such as Actonel, Boniva, and Fosamax.

Risks: Diarrhea, nausea, vomiting, heartburn, esophageal irritation, and bone, joint, or muscle pain. Long-term use may increase the risk of thigh fractures.

Nondrug options: Consume foods high in calcium and vitamin D, do weight-bearing exercises such as walking or lifting weights, and quit smoking. Plus take steps to prevent falls by, for example, avoiding sleeping pills and installing grab bars in the bathroom.

When to consider a drug: If bone-density tests show you have full-blown osteoporosis. Even then, consider taking a break after five years to reduce the risk of lasting side effects.

9. Overactive Bladder (Sudden or Frequent Need to Urinate)

Drugs: Anticholinergics such as Detrol and Oxytrol.

Risks: Constipation, blurred vision, dizziness, confusion, and an increased risk of dementia.

Nondrug options: Cut back on caffeine and alcohol, and try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises (repeatedly tightening and relaxing the muscles that stop urine flow).

When to consider a drug: If several weeks of nondrug strategies don’t provide enough relief.

10. Prediabetes (Blood Sugar Levels at the High End of Normal)

Drugs: Blood-glucose-lowering drugs such as Actos and Glucophage.

Risks: Dizziness, tiredness, muscle pain, and in rare cases other symptoms caused by a dangerous buildup of lactic acid and a vitamin B12 deficiency.

Nondrug options: Exercise, eat a healthy diet rich in nonprocessed and nonstarchy foods, and lose weight.

When to consider a drug: If you develop full-blown type 2 diabetes.

11. Prehypertension (Blood Pressure at the High End of Normal)

Drugs: ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics.

Risks: Diuretics can cause frequent urination, low potassium levels, and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums, and less often, breathing problems.

Nondrug options: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

When to consider a drug: If you develop true hypertension.

12. Obesity

Drugs: The weight-loss drugs Belviq, Contrave, Qsymia, and Xenical.

Risks: Constipation, diarrhea, nausea, or vomiting are common. The drugs also cause rare but dangerous side effects, including leaky heart valves with Belviq and liver damage with Xenical.

Nondrug options: If you’ve been unable to lose weight on your own by exercising more and eating less, ask your doctor about formal weight-loss programs.

When to consider a drug: If lifestyle changes have failed and you are obese or overweight and have heart disease or type 2 diabetes. If you haven’t lost at least 5 percent of your weight after three months, stop because it’s unlikely to help.

Source: Consumer Report

Could Big Lifestyle Changes Be Key to Managing Type 2 Diabetes?

Serena Gordon wrote . . . . . .

When it comes to type 2 diabetes management, a new study finds that more is definitely better for lowering blood sugar levels.

The study showed that adding intensive lifestyle management to standard diabetes care (diabetes medication and usual lifestyle change advice) brought blood sugar into a nondiabetic range.

The intensive intervention worked so well that “half of the intervention group did not need glucose-lowering medications to maintain or even improve [blood sugar] control,” said the study’s senior researcher, Mathias Ried-Larsen.

So, what exactly constitutes an “intensive” intervention?

“Patients were prescribed exercise five to six times per week for 30 to 60 minutes per session. That included both endurance and resistance training,” said Ried-Larsen, of Rigshospitalet in Copenhagen, Denmark.

“In the beginning, the exercise was supervised by a coach, but gradually, they were left on their own. Moreover, they received a dietary program with focus on foods rich in fiber, low in saturated fats, lots of fruit and no processed food. We designed the diet for patients to lose weight,” he said.

The study included nearly 100 people from Denmark. All had had type 2 diabetes for less than 10 years, and none had complications from the disease.

The average age of the participants was 55, and nearly half were women. Average A1C level at the start of the study was 6.7 percent. A1C is a blood test that estimates average blood sugar levels over two to three months. An A1C of 6.5 percent or higher indicates diabetes, according to the American Diabetes Association.

Study participants were randomly placed into the usual care group or the intensive lifestyle management group.

After a year, the intensive group lost 13 pounds compared to 4 pounds in the standard management group, the findings showed. LDL cholesterol (the bad kind) and triglycerides (another type of bad blood fat) were reduced more in the intensive group than in the standard group. HDL cholesterol (the good kind) rose more in the intensive group than in the standard group, according to the report.

Average A1C dropped from 6.65 to 6.34 percent in the intensive intervention group, and from 6.74 percent to 6.66 percent in the standard group, the investigators found.

In addition, three-quarters of those in the intensive group needed less diabetes medication, while only one-quarter of the standard care group lowered their medications, the researchers reported.

Not every expert agrees that lowering or stopping diabetes medications is a good idea, however.

Dr. Joel Zonszein is director of the clinical diabetes center at Montefiore Medical Center in New York City.

Zonszein noted that study participants were taking metformin and GLP-1 analogues. “These are good agents. That’s why their A1C was so good at the start. I also treat my patients with lifestyle changes. But it’s not one or the other. Both medicine and lifestyle changes are important,” he said.

“When you use the two together, they work much better,” he added.

Zonszein also noted that the Denmark group was “an unusual population.” None took insulin, and no one had complications. And, at the start of the study, their blood sugar was already fairly well-managed. That would likely be much different in a U.S. population with type 2 diabetes.

One reason Ried-Larsen hoped to lower the need for medication is to save money. Although metformin is available in a generic form and isn’t generally expensive, some of the newer type 2 diabetes medications can be costly.

“I think this study calls for a thorough discussion about the resources we need to allocate to help people to adhere to a lifestyle treatment and what responsibility the society has in this regard,” Ried-Larsen said.

“We do acknowledge that the lifestyle treatment is extensive and could be regarded as not economically viable in clinical care,” Ried-Larsen noted. “However, consider the willingness to introduce newer classes of drugs that come with extreme prices. If we could get doctors and patients to allocate that sort of money and resources to lifestyle treatment, I think we could change things.”

Zonszein added that when people rely solely on lifestyle management, it doesn’t always bring blood sugar levels down enough.

“It’s important to consider the cost-effectiveness of medications along with their cost. A lot of expense comes from treating diabetes complications,” he said.

The report was published in the Journal of the American Medical Association.

Source: HealthDay


Today’s Comic

Why Flat Beer Makes the Best Desserts

Danish Chef Mads Refslund is the co-founder of Noma, one of the most prestigious restaurants in the world, but his first cookbook is about trash. “I had in my brain that my first cookbook would be a restaurant cookbook,” he admits, but his friend and co-author, forager Tama Matsuoka Wong, convinced him to pen something about cooking with wasted food instead. The result is Scraps, Wilt & Weeds, which shows you how to turn things like vegetable juice pulp and coffee grounds into pastas and panna cottas.

“I have always cooked with things no one tends to use because I always thought it was stupid to throw it out,” Refslund explains. “It is money that you are throwing away.” As a chef, he felt it was his responsibility to teach others how to use up foods — like cauliflower cores and fish collars — that are typically tossed without thought. “I think people throw these [perfectly edible] foods away because of a lack of knowledge — they just don’t know how to cook with them,” he says. Leek roots, for example, are trimmed off and binned, but Refslund believes if people realized that the roots could be turned into something delicious, they wouldn’t want to throw it away.

Paired against stark facts — nearly 1 billion pounds of uneaten lettuce goes into the trash each year — the book is filled with ways to turn what you definitely think is garbage into elegant dishes fit for a dinner party. Case-in-point: Refslund’s recipe for a satisfying dessert crafted from old, dried-out bread and stale beer. Yes, stale beer.

The dish is based on the classic Danish porridge known as ollebrod. Back in the day, farmers tended to live off of mainly rye bread and beer, he explains. “When the bread got a little bit old, they would soak it in beer, boil it, and add sugar. If you could afford it, you would eat it with milk. If you really had means, you would eat it with whipped cream.” Refslund’s version of the dish is gussied up with a bit of chocolate and salted caramel ice cream. Count it as breakfast or dessert.

Refslund says that you can use any bread you have lying around, but he prefers dark rye bread for its flavor. As for the beer, he is adamant you use one that is well past its prime. “I realized that when you boil beer to make any recipe, it becomes flat — so why not just use flat beer from the start?”


Flat Beer and Day-old-bread Porridge

Ingredients:

1 pound stale rye (or other) bread, torn into small pieces or crumbled (5½ cups)
2 cups flat beer, preferably dark beer or ale (less than 2 bottles)
1-3/4 cups sugar, half granulated/half brown
3/4 cup heavy cream
1/3 cup dark chocolate chips
apple balsamic vinegar, for serving
salted caramel ice cream, for serving

Direction:

  1. In a medium pot, combine the bread, beer, and sugars over low heat and cook, stirring gently, for about 20 minutes, until the bread is softened and the liquid is absorbed. Add the cream and cook, stirring, for about 10 minutes more, until it starts to thicken. Finally, add the chocolate chips and stir until melted. Remove from the heat and cool. Store in the refrigerator until thoroughly chilled, at least 30 minutes (or up to 2 days).
  2. To serve, spoon into individual bowls, drizzle with apple balsamic vinegar, and add a scoop of caramel ice cream.

Recipe from Scraps, Wilt & Weeds.


Source: Thrillist