Fool’s Gold: What Fish Oil is Doing to our Health and the Planet

I have teaching my Nutrition clients for 20 years to NOT TAKE FISH OILS, or any other oil in supplement form. Fats and oils that are not in their original packaging (nuts, fish, avocado, seeds, etc.) are rancid.  They are rancid as soon as they are exposed to oxygen. They are oxidized, and that renders them carcinogenic.

There is no reason to ever take oils as supplements, it is easy to come by these nutrients by eating seafood, avocadoes, butter, etc. Ingesting fish oils do not protect you from heart disease. A balanced diet that meets your nutrient needs does that. Along with exercise.

Is the evidence for fish-eating better than simply taking a fish oil pill?

Omega-3 is one of our favourite supplements – but a huge new study has found it has little or no benefit for heart health or strokes. How did it become a $30bn business?

Is the evidence for fish-eating better than simply taking a fish oil pill? Composite: Getty

The omega-3 industry is in a twist. Again. Last week, Cochrane, an organisation that compiles and evaluates medical research for the general public, released a meta-analysis – a study of studies – to determine whether or not omega-3 pills, one of the world’s most popular dietary supplements, reduced the risk of coronary heart disease. After comparing 79 trials involving 112,059 people, the researchers could find “little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities”.

I can’t say that I was particularly surprised. Over the past 15 years, more than 20 studies have shown a similar lack of effect. But what does surprise me is how we continue to look at the world of fish and seafood through the amber lens of a fish oil capsule. Omega-3s do something in our bodies – and probably something important. But without the larger context of the marine organisms that contain them, omega-3s get lost in the noise of human metabolism and modern marketing.

The confusion arises in part from the historical baggage of fish oil and the $30bn (£23bn) industry associated with omega-3 extraction. Once upon a time, fish oil solved a major human health problem. But it had nothing to do with coronary heart disease. During the Industrial Revolution, a disease became increasingly prevalent throughout northern Europe: rickets. Malnourished children in sunlight-poor urban slums often ended up bowlegged by adolescence. Researchers eventually pieced the puzzle together and concluded that the disease was caused by a deficiency in vitamin D, which the body naturally generates in the presence of sunlight. And, as it turned out, vitamin D is stored in high amounts within the liver of codfish.

A Norwegian pharmacist named Peter Möller seized upon this finding (and many other anecdotal stories about the curative properties of cod-liver oil). Using a patented chemical process, he arrived at a product that, he announced to the world, “didn’t taste fishy”. Möller and his advertising team then launched a campaign to institutionalise the regular use of cod-liver oil, regardless of whether you were at risk of rickets or not. The campaign was a success: a spoonful a day became common practice. Möller built his company into an international presence and died in 1869 with 70 cod-liver oil steam factories to his name, churning out 5,000 barrels of the stuff a year. By the time omega-3s started to be a focus of medical research, there was already a rosy feeling around fish oil.

In the early 1970s, the chemist Hans Olaf Bang read in a Danish journal that there were extremely low incidences of cardiovascular disease in Inuit communities of Greenland. He and his assistant, Jørn Dyerberg, travelled to Uummannaq on the north-west coast of Greenland to investigate. At the time of the expedition, Bang didn’t quite know what he wanted to test for. They probed and palpated 130 local people, measured height and weight, and came home with a lot of blood.

“We had these 130 precious samples of blood,” Dyerberg told me in his lab in Copenhagen recently. They estimated that in 20 years, the traditional Inuit diet would have changed to the western diet, and Dyerberg remembers Bang saying: “‘There will never be anyone who can do this again, so let’s do whatever we can!’ And we decided to do fatty acid analysis.”

The result of their analysis was a hypothesis that is an exemplary “association study”. In an association study, multiple factors are logged and a hypothesis of correlation is drawn from the findings. In the case of the Bang and Dyerberg Inuit study, they found that: 1) Inuit people in Greenland had a diet high in omega-3 fatty acids and blood lipid levels of omega-3s much higher than their western contemporaries. 2) Inuit people also had, according to public health records, markedly lower rates of coronary heart disease. They hypothesised that therefore 3) omega-3s might reduce the risk of coronary heart disease.

This was backed up by further laboratory studies that did show, in vitro, that omega-3s were involved in anti-inflammatory reactions. But – and this is a big but – while correlations abound for omega-3s and heart disease, the real trouble has always been in showing causation. That is where this latest round of studies comes in.

The Cochrane study and the others that preceded it have one thing in common: they are meta-analyses of “randomised control trials” (RCTs). That is, trials where patients are given a supplement at random and tracked over time against another set of patients given a placebo. Most statisticians consider these trials to be the very top of the evidence pyramid. But it is these studies that have at times proven troublesome for Omega World. Each time RCTs come to light that show little or no effect, Omega World tends to blend its counterargument with evidence from association studies because, as a recent industry reply to the Cochrane report put it, “it’s all connected”.

When it then turns to the RCTs, the industry, as would be expected, looks for different explanations as to why positive health outcomes weren’t reported. In the burst of RCTs preceding Cochrane, the Omega World line was that these most recent trials did not show benefits because things such as statins, stents and other forms of cardiovascular intervention masked the anti-inflammatory effect of fish oil pills; earlier RCTs had shown a fairly significant effect, but none of those treatments existed at the time of those trials.

The industry also, and I believe rightly, pointed out that studies often failed to look at omega-3 blood lipid levels before and after supplementation. In other words, it’s not really a fair trial if you don’t know where the patients started with respect to the omega-3 levels in their blood. If we only measure effect without looking at omega-3 levels in the blood at the outset, aren’t we doing the dietary equivalent of testing how far a car can drive without checking how much petrol is in the tank at the start?

With Cochrane, the latest industry argument is that the study’s authors cut out a number of different forms of cardiac ailments, thus skewing the stats. In particular, it notes that Cochrane failed to include “sudden cardiac death” and “sudden cardiac mortality” in its list of outcomes. Since nearly half of all patients first report heart disease to their doctors by suddenly dropping dead, this is not an insignificant exclusion.

But the fact that the industry’s arguments shift with each new, damning meta-analysis gives you pause. What is going on? Is there an international conspiracy to discredit omega-3s? Or does Omega World keep moving the goalposts? When I posed this question to Ellen Schutt, the executive director of the Global Organization for EPA and DHA Omega-3s, probably the world’s most prominent omega-3 advocacy organisation, she made it seem as if the problem didn’t even exist. “As a matter of fact, we track media sentiment … and have found many more positive omega-3 stories than negative, in general. Of course, the negative stories are the ones that catch people’s attention. As we both know, negative stories are much more interesting and the media is definitely guilty of sensationalist ‘clickbait’ headlines such as: ‘Omega-3s don’t work.’”

As sympathetic as I am to the trials of Omega World, as studies continue to poke holes in aspects of the omega-3 cardiovascular argument, I can’t help thinking there is something else going on. Because, while the fish oil supplement business is a big deal, it is also a sheen on the surface of a much deeper pond. Long before omega-3 supplements became popular, an industry arose that used the same omega-3-rich creatures not for medicine, but for an odd array of agricultural and industrial purposes.

Ultimately, it was this so-called “reduction industry” that created the oily-fish extraction system that now consumes millions of tonnes of marine wildlife every year. Today, one in every four kilograms of fish caught is reduced into oil and meal and used for agriculture, land animal husbandry and, most recently, fish farming, AKA aquaculture.

The reduction industry has appeared in different forms under different ownership over centuries of human history. In the 18th century, it targeted whales, reducing northern hemisphere cetacean populations into isolated pockets of endangered species in order to make lamp oil and lubricants. In the 19th and early 20th centuries, it shifted to the southern hemisphere, reducing 390,000 of the 400,000 great whales that once roamed the Southern Ocean to margarine, nitroglycerine and other “marine ingredients”.

In the latter half of the 20th century, it shifted again and targeted small, oily fish such as anchovies, sardines and herring. In the late 1940s and early 1950s, the largest reduction operation in human history arose off the coast of Peru in pursuit of the Peruvian anchoveta. The Peruvian anchoveta is by far the largest single species catch by tonnage in the world, some years comprising as much as 10% of all fish caught. And although Peruvian anchoveta are as delicious as any anchovy on Earth, an industry-influenced Peruvian law dictates that more than 95% of the catch must go to the reduction industry.

Each decade brings a different use for all those anchovies. In the 1940s, they were used for fertiliser. In the 50s and 60s, chicken feed. In the 70s, pet food and pig feed. In the 80s and 90s, aquafeed for salmon and other carnivorous fish. And now, the most elite product of the reduction industry: dietary supplements.

And it is not just Peruvian anchoveta that are reduced into fish meal and oil. All told, the reduction industry removes from the ocean 20m-25m tonnes annually – the equivalent of the combined weight of the population of the United States. The omega-3 industry argues that some vendors are turning to much more sustainable options, such as algae-based omega-3s and fish oil reclaimed from recycled byproducts.

Nevertheless, the reduction industry marches on into new territory. Most recently, it has begun targeting Antarctic krill, the keystone prey species of the entire Antarctic ecosystem. Two years ago, when I asked the then chief executive of the largest krill extractor in the world why it had launched a $200m fishing operation in the Southern Ocean to take food out of the mouths of whales, he noted that krill oil is a “phospholipid” and making it much more “bioavailable” means that consumers can take a much smaller pill. Why was this important? Consumers who chose krill oil over fish oil would be much less likely to suffer the horrors of a fishy burp.

Amid all the conflicting reports, there is one bit of data that shines out: fish and seafood can bring considerable health and environmental benefits. Fish, in addition to providing us with omega-3s, delivers protein with far fewer calories than meat: 100g of salmon contains 139 calories and 23g of protein. By comparison, 100g of beef contains 210 calories and 20g of protein.

Harvesting wild fish from well-managed stocks requires a fraction of the carbon as farming terrestrial livestock. Similarly, fish farming puts a lesser burden on the Earth in terms of carbon and freshwater use than pretty much any form of terrestrial animal husbandry. We could make the farming of fish even more carbon- and resource-efficient if we used alternative ingredients for fish food based on algae and food waste. And if you consider growing “filter feeders” such as mussels, clams and oysters, the benefits are even more extreme. These bivalves don’t have to be fed anything, and make water cleaner even as they grow fatter. They provide protein 30 times more efficiently than cattle.

Is the epidemiological evidence for fish-eating better than simply taking a fish oil pill? Again, we are stuck with the problem of correlation versus causation. It is very difficult to feed someone a fish in such a manner that they don’t know they are eating a fish. Hence an RCT of seafood-eating hasn’t really ever been done. Most of the studies around seafood are association studies. And, while one such study associated eating fish twice a week with a possible reduction in mortality of 55,000 lives a year, we don’t know what a fish-eater does with the rest of their life beyond eating fish.

But what we do know is this: the omega-3 industry and the reduction industry that bred it removes fish from the water in a way that doesn’t put protein on our plates – it just puts pills in our cupboards. Is this the way we want to continue to do business with the planet?

Paul Greenberg is the author of The Omega Principle: Seafood and the Quest for a Long Life and a Healthier Planet (Penguin Press).


The Many Health Benefits of Broccoli

two heads of broccoli

 

These mini trees are notorious for being pushed off the plates of kids around the world, but broccoli’s reputation as one of the healthiest veggies still rings true.

Broccoli belongs to the cruciferous vegetable family, which includes kale, cauliflower, Brussels sprouts, bok choy, cabbage, collard greens, rutabaga, and turnips. These nutrition powerhouses supply loads of nutrients for few calories.

If you are trying to eat healthier, cruciferous vegetables like broccoli should be at the very top of your grocery list. If you or your kids are not big fans of broccoli, be sure to read the how to incorporate more broccoli into your diet section for tips and delicious recipes.

This MNT Knowledge Center feature is part of a collection of articles on the health benefits of popular foods. It provides a nutritional breakdown of broccoli and an in-depth look at its possible health benefits, how to incorporate more broccoli into your diet, and any potential health risks of consuming broccoli.

Possible health benefits of consuming broccoli

Broccoli belongs to the cruciferous vegetable family.

Consuming fruits and vegetables of all kinds has long been associated with a reduced risk of many lifestyle-related health conditions.

Many studies have suggested that increasing consumption of plant foods like broccoli decreases the risk of obesity, diabetes, heart disease, and overall mortality.

It may also promote a healthy complexion and hair, increased energy, and overall lower weight.

Fighting cancer

Eating a high amount of cruciferous vegetables has been associated with a lower risk of cancer; particularly lung and colon cancer. Studies have suggested that sulforaphane, the sulfur-containing compound that gives cruciferous vegetables their bitter bite, is also what gives them their cancer-fighting power.

Researchers have found that sulforaphane can inhibit the enzyme histone deacetylase (HDAC), known to be involved in the progression of cancer cells. The ability to stop HDAC enzymes could make sulforaphane-containing foods a potentially powerful part of cancer treatment in the future. Sulforaphane is now being studied for its ability to delay or slow cancer with promising results shown in melanoma, esophageal, prostate, and pancreatic cancers.

Other easily recognized cruciferous vegetables include cauliflower, Brussels sprouts, kale, turnips, and cabbage, as well as the lesser-known arugula, broccolini, daikon, kohlrabi, and watercress.

Another important vitamin that broccoli contains, folate, has been found to decrease the risk of breast cancer in women. Adequate intake of dietary folate (in food) has also shown promise in protecting against colon, stomach, pancreatic, and cervical cancers. Although the mechanism behind the protection is not understood, researchers believe that it may have something to do with folate’s role in DNA and RNA production and the prevention of mutations.

Improving bone health

Poor vitamin K intake is linked with a higher risk of bone fracture. Just one cup of chopped broccoli provides 92 micrograms of vitamin K, well over 100 percent of your daily need. Consuming an adequate amount of vitamin K improves bone health by improving calciumabsorption and reducing urinary excretion of calcium.

Broccoli also contributes to your daily need for calcium, providing 43 milligrams in one cup.

Looking younger

Broccoli is rich in vitamin C.

The antioxidant vitamin C, when eaten in its natural form (in fresh produce as opposed to supplements) can help to fight skin damage caused by the sun and pollution, reduce wrinkles, and improve overall skin texture.

Many people automatically think of citrus fruit when they think of vitamin C, but did you know that broccoli provides 81 milligrams in just one cup? That is more than what you need in an entire day.

Vitamin C plays a vital role in the formation of collagen, the main support system for the skin. Vitamin A and vitamin E are also crucial for healthy looking skin, both of which broccoli provides.

Improved digestion and natural detoxification

Eating foods with a natural fiber like broccoli can prevent constipation, maintain a healthy digestive tract, and lower the risk of colon cancer. Adequate fiber promotes regularity, which is crucial for the daily excretion of toxins through the bile and stool. Recent studies have shown that dietary fiber may also play a role in regulating the immune system and inflammation.

Protection from chronic disease

According to the Department of Internal Medicine and Nutritional Sciences Program of the University of Kentucky, high fiber intakes are associated with significantly lower risks of developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases.

Increased fiber intake has also been shown to lower blood pressure and cholesterol levels, improve insulin sensitivity, and enhance weight loss for obese individuals.

Nutritional breakdown of broccoli

According to the USDA National Nutrient Database, one cup of chopped raw broccoli (approximately 91 grams) contains 31 calories, 0 grams of fat, 6 grams of carbohydrate (including 2 grams of sugar and 2 grams of fiber) and 3 grams of protein.

Just one cup of broccoli provides over 100 percent of your daily need for vitamin C and vitamin K and is also a good source of vitamin A, folate, and potassium.

Broccoli ranks among the top 20 foods in regards to the ANDI score (Aggregate Nutrient Density Index), which measures vitamin, mineral, and phytonutrient content in relation to caloric content.

To earn a high rank, a food must provide a high amount of nutrients for a small amount of calories.

How to incorporate more broccoli into your diet

Broccoli is famously one of the least favorite vegetables of many, along with its cruciferous cousin, Brussels sprouts. But what if you have just been storing and preparing it wrong?

Fresh, young broccoli should not taste fibrous, woody, or sulfurous. To make sure you get the best tasting broccoli, store the unwashed vegetable in loose or perforated plastic bags in the crisper drawer of the refrigerator. Only wash broccoli right before eating, as wet broccoli can develop mold and become limp.

Broccoli left at room temperature becomes fibrous and woody. You may not be able to tell by looking, but the flavor of broccoli continues to diminish the older it gets.

Broccoli can be added to wraps, pasta, pizza, or even made into a soup with onion and garlic.

Quick tips to enjoy more broccoli:

  • Keep it simple and sauté chopped broccoli drizzled with olive oil, cracked black pepper, and minced garlic.
  • Chop raw broccoli and add to your next wrap.
  • Top your flatbread or pizza with chopped broccoli before roasting.
  • Make your own pesto or pasta sauce and add broccoli.

Possible health risks of consuming broccoli

If you are taking blood-thinners, such as Coumadin (warfarin), it is important that you do not suddenly begin to eat more or less foods containing vitamin K, which plays a large role in blood clotting.

It is the total diet or overall eating pattern that is most important in disease prevention and achieving good health. The key to a healthful diet is to eat a variety of foods, rather than to concentrate on individual foods.


Eating Processed Meats Has Been Linked to Serious Psychiatric Problems

Oh, great. Bacongate 2.0.

Bacon

MIKE MCRAE

19 JUL 2018

Nitrate-cured meats – things like beef jerky or bacon – have been linked to extensive periods of hyperactivity, insomnia, and attention loss in people experiencing manic episodes.

Research conducted by Johns Hopkins University on patients receiving care for manic symptoms found they were over three times more likely to have ever eaten processed meat products than patients being treated for other psychiatric conditions, such as schizophrenia.

“We looked at a number of different dietary exposures and cured meat really stood out,” says the study’s lead author Robert Yolken.

“It wasn’t just that people with mania have an abnormal diet.”

The exact mechanism behind the link isn’t yet clear, but a follow-up experiment on rats fed jerky with their plain old rat chow resulted in increased movement and altered signalling in their hippocampus.

Changes were also noted in the rats’ gut microflora, hinting at a possible stepping stone between the nitrates in the meat and effects on their nervous system.

Taken all together, the results provide a strong suggestion that a diet rich in many varieties of ham, jerky or salami just might play a role in the development of mania-related conditions in at least some people.

Bipolar disorder is a chronic mental health condition characterised by dramatic swings in mood and energy levels, including mania. Episodes can last weeks, or even months, and can coincide with depression and psychosis.

The condition affects as many as one in 25 people at some time in their life, significantly impacting productivity and taking a serious toll on personal and community wellbeing.

Surprisingly little is known about the condition’s causes. There are strong hints of a genetic predisposition, though as with most neurological conditions there’s a lot more going on than a wonky gene or two.

Environmental factors that affect early development, from infections to maternal smoking, have been explored as possible explanations. Stress, head injuries, and preterm births are also considered potential risk factors.

Diet is yet another area attracting significant attention, with studies suggesting a westernised diet and higher glycemic loads might contribute to the development of symptoms.

For this study, the researchers used medical records to categorise more than 700 volunteer patients as having either mania, bipolar depression, a major depressive disorder, or schizophrenia.

They gave each patient a survey that asked questions such as, “Have you ever eaten locally procured dry cured meat”? and “Have you ever eaten undercooked fish such as rare tuna?”

Those in the mania category had an unusually high number of patients who’d consumed processed meats.

“Future work on this association could lead to dietary interventions to help reduce the risk of manic episodes in those who have bipolar disorder or who are otherwise vulnerable to mania,” says Yolken.

The addition of nitrogen compounds in the form of sodium nitrite or potassium nitrate has been used to preserve meats for centuries, preventing decay, adding colour and reducing oxidation.

Nitrogen compounds in meat products have been linked with cancer in the past (never forget the great Bacongate of 2015 when the World Health Organization changed the carcinogen classification of processed meats).

But in this case it’s the nitrogen compounds’ influence on bacteria in our gut that could end up being the culprit. And this isn’t the first time nitrates in processed meats have been found to affect our health via our personal microbes.

Variations in microflora were deemed responsible for an overzealous digestion of nitrates in the diets of people who experienced migraines, causing their blood vessels to dilate more than usual and cause intense pain.

Our brains and the bacteria in our guts have a complicated relationship, one we’re still learning more about as we find connections between our bugs and our emotional state, the development of Parkinson’s disease, and even risk of strokes.  

So, it wouldn’t be a total shocker if further research confirms manic symptoms in bipolar can be exacerbated or even caused by certain microflora reacting to nitrates in our meats.

None of this means you need to ditch the jerky entirely. But to those who experience manic episodes, this might be useful information to perhaps help make their issues a little less severe.

This research was published in Molecular Psychiatry.


Diabetes Defeated by Diet: How New Fresh-Food Prescriptions are Beating Pricey Drugs

I have been teaching my clients how to heal from diabetes through nutrition for 20+ years.  It is not that hard.

  • Spending on diabetes drugs in the U.S. reached $53.7 billion last year, more than double what it was in 2013.
  • Roughly 100 million Americans have diabetes or prediabetes.
  • The Fresh Food Farmacy program, being tested by Geisinger Health System in Pennsylvania, which includes education and free nutritious meals, can lower diabetes treatment costs by 80 percent.
  • The high-fat, low-carbohydrate ketogenic diet is being used by new health-care start-up Virta Health, which aims to treat 100 million patients by 2025.

At first glance Sami Inkinen, an elite triathlete and co-founder of the real estate company Trulia, and Rita Perkins, a grandmother of eight in central Pennsylvania, have little in common.

But they do share one thing: Both have grappled with diabetes.

“I thought, This is absolutely nuts,” Inkinen recalled of his diagnosis with prediabetes. “It was really a personal experience and a shocking experience that a world-class triathlete can become type 2 diabetic or prediabetic.”

For Perkins it was less of a surprise. Diabetes ran in her family, she said, and her weight had reached 300 pounds before she lost about 100 just through increased walking. But her diet was still bad, and she struggled to control her blood sugar.

Now things have turned around for both Perkins and Inkinen. And their paths were both through food.

In Shamokin, Pennsylvania, about 75 miles northwest of Allentown, Geisinger Health System is trying something new for some of its diabetes patients.

Instead of relying solely on drugs to manage the disease, doctors are writing prescriptions for certain patients to enter its Fresh Food Farmacy program: 15 hours of education about diabetes and healthier living, followed by 10 free nutritious meals a week for participants and their families.

Dietitian Anna Ziegler selects fresh produce for a Fresh Food Farmacy patient.

Geisinger

Dietitian Anna Ziegler selects fresh produce for a Fresh Food Farmacy patient.

“In health care we spend an awful lot on drugs and devices because it’s business,” said Dr. Andrea Feinberg, Geisinger’s medical director of health and wellness. “But we spend a very small amount on preventive medicine. … It’s sort of like we’re upside down and backward.”

The program targets people with diabetes and food insecurity, those for whom it’s not always clear where the next meal will come from.

“We understand the relationship of food insecurity and the impact that poverty has on developing certain lifestyle conditions, like type 2 diabetes,” Feinberg said. She added that the goal is “to diminish complications of diabetes and also close the meal gap to end hunger.”

The program, started 18 months ago, is a partnership with the Pennsylvania Food Bank. So far, it’s enrolled 150 patients, feeding a total of about 450 people a week.

Rita Perkins, her husband and three grandchildren who live with them are among those families. For Perkins the program has been transformative.

Each week, she visits the Farmacy and picks out food with guidance from a nutritionist. Perkins said the food, along with what she learned in the course about managing diabetes, has changed not just her approach to eating but also her family’s.

“Before, I’d never buy this stuff; I would never buy fresh fruit,” Perkins recalled. “Money was tight. And now since I get this stuff for free, I can put it on the table for the kids.”

Since she started the program, Perkins said her weight has dropped to 134 from 179. She walks all over town and said her doctors are evaluating the doses of her diabetes medications. Her blood sugar, measured by an A1C test, has been a steady 5.8 percent for the last six months (normal A1C, according to the National Institutes of Health, is below 5.7 percent).

“If a new diabetes drug became available that could double the effectiveness of glucose control, it would likely be priced considerably higher than $6 per week (and if it wasn’t, the pharmaceutical firm’s stockholders would be in revolt).”-Andrea Feinberg , Geisinger’s medical director of health and wellness

Those results aren’t atypical. On average, patients in the program have seen their A1C levels drop from a pre-enrollment level of 9.6 percent to 7.5 percent, Feinberg and colleagues wrote in an April article in NEJM Catalyst that they called “Prescribing Food as a Specialty Drug.”

“Clinically, we see great outcomes,” Feinberg told CNBC. “The impact is that we really know long-term that we’ll see a decrease in incidence of heart disease, the No. 1 killer here in the United States, because if you improve the diabetes, improve your cardiac risk factors, you have less heart disease as well.”

The program also should save money. With operational costs of $2,400 per patient each year, early findings show costs for patients in Geisinger Health Plan dropped by 80 percent: from an average of $240,000 per member per year, to $48,000 per member per year.

“If a new diabetes drug became available that could double the effectiveness of glucose control, it would likely be priced considerably higher than $6 per week (and if it wasn’t, the pharmaceutical firm’s stockholders would be in revolt),” Feinberg and her colleagues wrote.

Indeed, spending on diabetes drugs in the United States reached $53.7 billion last year, more than double what it was in 2013. The number of prescriptions in that time rose 18 percent, to 227 million, according to data from industry researcher IQVIA.

Ketogenic diet led to drop in blood glucose, weight and drug usage

Almost 3,000 miles away, in San Francisco, Inkinen got his startling diagnosis: He was pre-diabetic even as he set records in endurance sports (in 2014 he and his wife rowed across the Pacific Ocean, from California to Hawaii, he said on his blog: 2,750 miles in 45 days and 3 hours, setting a speed world record for two people.)

His solution? The ketogenic diet, a high-fat, low-carbohydrate way of eating that’s enraptured many in Silicon Valley.

“There is a way to reduce insulin resistance without exercise, without dieting or without bariatric surgery, using the traditional ketosis,” Inkinen told CNBC. “But to deliver this type of treatment, you would need technology and the ability to continuously monitor and deliver care.”

Inkinen’s online real estate information company, Trulia, was sold in 2014 to Zillow for $3.5 billion. So naturally, the next step for Inkinen was to start a new company. He teamed with a doctor and a scientist, Stephen Phinney and Jeff Volek, and founded Virta Health.

Virta connects patients virtually with doctors and coaches who help tailor the ketogenic diet to their lifestyles and monitor certain biomarkers daily.

In a trial of about 260 patients, published last year in JMIR Diabetes, Virta’s treatment led to reductions in blood glucose, weight and use of diabetes medication after 10 weeks. After a year A1C levels were down an average of 1.3 percent, diabetes medication usage was down 48 percent, and body weight was down 12 percent.

To cardiologist Ethan Weiss, who sits on Virta’s scientific advisory board, the outcomes are strong enough to recommend the program to his patients.

“For people with type 2 diabetes headed toward bariatric surgery, to have this result, that they’re coming off almost all insulin, coming down on almost all other diabetes medicines, losing weight, feeling like they control their diet, I think it’s an awesome thing to recommend,” said Weiss, an associate professor of medicine at the University of California San Francisco.

While most of the metrics move dramatically in the right direction — Inkinen says 60 percent of patients see their diabetes reversed in a span of between two and nine months — Weiss notes one data point that may not. Levels of LDL, or so-called bad cholesterol, appear to rise on the ketogenic diet. But he notes a distinction in the type of LDL that goes up, saying it may not be the type that leads to clogged arteries. And he says LDL levels can be controlled with drugs called statins, like Lipitor, if that’s a concern (though he said to him it’s not).

Virta’s program, which costs $370 a month after a $500 initiation fee if patients pay out of pocket, also saves money, according to Inkinen, who estimates an average savings of $9,600 per patient in the first 24 months in drug and medical costs. After the first year the cost drops to $199 a month.

The company is working to expand to more coverage from insurers and employers, with the goal of reversing diabetes in 100 million people by 2025.

That’s about the number of Americans with diabetes or prediabetes, according to the Centers for Disease Control and Prevention.

As usage — and costs — of diabetes medicines rise, both Geisinger and Virta are showing that food, along with a healthy dose of education and support, can go a long way in changing the course of this disease.


Berries Stimulate Cancer-Fighting Enzyme

Bowl of Blueberries

Raspberries, blueberries, and other berries contain natural pigments known as anthocyanins which give them their deep color. Numerous studies show that anthocyanins fight the inflammation that leads to aging.  A new study from the University of Eastern Finland shows that anthocyanins increase the function of an enzyme in cancer cells that fights cancer called sirtuin 6 enzyme (SIRT6).

Sirtuins are enzymes that regulate the expression of genes that control the function of cells through key cellular signaling pathways. Aging causes changes in the function of sirtuin, and these changes contribute to the development of various diseases.

“The most interesting results of our study relate to cyanidin, which is an anthocyanin found abundantly in wild bilberry, blackcurrant and lingonberry,” says the study’s lead author Minna Rahnasto-Rilla.

Cyanidin increased SIRT6 enzyme levels in human colorectal cancer cells. The researchers also found it decreased the expression of two cancer genes — Twist1 and GLUT1. At the same time, cyanidin increased the expression of the tumor-suppressing FoXO3 gene in cells.

The findings that anthocyanins increase the activation of SIRT6 lays the foundation for the development of new cancer drugs.

The study’s findings were published in Scientific Reports.

A 2017 study published in the Journal of Nutritional Biochemistry found that pigs fed a high-calorie diet supplemented with purple potatoes, which are high in anthocyanins, lowered their risk of developing colon cancer. Pigs fed purple potatoes had levels of an inflammatory protein called interleukin-6 that were six times lower than that of pigs on a regular high-fat diet. Interleukin-6 is associated with the development of cancer.

The study authors suggested that a daily cup of fresh or frozen berries fights the inflammation that leads to aging.

A study from the U.K.’s University of East Anglia found that people who ate the most blueberries and strawberries — three or more servings a week — reduced their risk of a heart attack by a third when compared to women who ate berries once a month or less. Experts believe berries’ heart-healthy effects are due to anthocyanins, which help prevent the buildup of plaque in arteries.

© 2018 NewsmaxHealth.


An Ode to Caramelizing Onions (and How To Do It Right)

Making caramelized onions is one of the simplest yet most striking acts of kitchen magic there is. Butter and salt are the only ingredients you need besides the onions themselves. The process isn’t complicated, though it does take time—which is the most important element of all. Properly caramelized onions require at least a full hour, if not more, but the investment is so worth it.

For some (like me), the time spent is even a pleasure. At least, it is when I’m in the mood for the task. Isn’t that ever the case?

I always love to eat, and often love to cook, but sometimes balk at the mere idea of the kitchen. Even a job as relatively simple as prepping a pound of Brussels sprouts to roast can make me gnash my teeth and turn to a can of tuna instead. On better days, I’ll chop a bunch of stuff and tend a mix of different pots and pans, but my diced tomatoes will never be uniformly sized, my garlic will nearly always be grated instead of minced with a knife, and I might not bother thawing shrimp before chucking them in boiling water, or even browning meat if it’s going into a sauce (I know). Call it laziness—it definitely is, in part—or more generously, just say I’m not necessarily a purist when it comes to  technique. Caramelized onions, however, are an absolute exception; I will not use shortcuts, and if I can’t commit to an hour by the stove, I’ll just eat something else. Browned onions can work if I simply want something to top a burger, but truly, madly, deeply caramelized onions cannot be rushed.

Well, actually, they can, or at least can be hurried along; I simply have a (probably illogical) bone-deep aversion to any fast-track tactics. If you’re not such a stickler, Alton Brown has a microwave method that seems vaguely alarming, even before you get to the commenters attesting that their onions caught fire when attempting this trick. Other sources suggest adding sugar or baking soda to a standard pan to speed up or enhance the caramelization. If you hew to classic low and slow, neither are necessary, but it’s understandable if you don’t always have the patience (or time). Unfortunately, they will almost always need some amount of babysitting, and here we reach the limitations of the Instant Pot; it makes a mushy mess out of them, and they’re only a wan shade of blonde to boot. Conversely, if time’s not an issue but you still need to be elsewhere, slow cooker caramelized onions look promising:

Allegedly, you can use plain old water to speed things up, but I never do. Part of it is just innate stubbornness, but mostly, I love the process of “properly” caramelizing onions—which means something different to everyone who has an opinion about it, of course. And any way you cook them, they’re said to freeze beautifully. We’ve never had any left, and I hadn’t thought about cooking them just to have on hand later, but that might need to change…

My own method (fine-tuned to my personal preferences, middling and finicky electric stove, and other idiosyncratic kitchen equipment) is as follows:

  1. Peel and slice way more yellow onions than it seems like I’ll need; I usually use at least five small to medium, and prefer to halve them down the meridian, then cut the eastern and western hemispheres into half moons.
  2. Get out a large, heavy bottomed pan—I own two cast iron skillets, but they’re both smaller than my sturdy off-brand stainless steel sauté pan, so I use that. The thinner aluminum pan in the drawer is inferior, but I’ll break it out as back-up if I need a ton of onions.
  3. Set the pan(s) over medium-high heat for about a minute, then add a big pat of butter, then a little more butter.
  4. Heat the fat until the butter melts and is just sizzling, swirl the pan to commingle it with the oil and coat the bottom, then slide in the onions—usually, I’m aghast at how many there are, and worry the pan is so crowded they’ll never cook down, but know from experience that they will, eventually. (If I started with a smaller amount, it probably wouldn’t take so long to caramelize them, but then I’d also have less end product, and I am, sadly, both gluttonous and resistant to change.)
  5. Sprinkle a generous pinch of salt over the onions and stir them over medium-high heat for several minutes, until they’re translucent and slick and starting to look like they’re on the long, slow road to total collapse. (I stir almost constantly so as not to let them brown at this point, but if a few spots have some color, I don’t sweat it—metaphorically, anyway.)
  6. Once the onions are all limp and see-through and have released some liquid, I turn the heat down to medium and continue to cook them, stirring fairly often, paying attention to sound and smell as well as slowly developing color, decreasing the heat again whenever it seems prudent. Eventually, it’s turned to the very lowest setting, and I just keep communing with the onions, stirring now and again, for a long, leisurely time. They always look fairly unpromising for quite a while, but gradually, they take on a pale straw color that in turn deepens to yellow and then to gold, and much, much later, become a fully burnished, dark brown mass of pure flavor that looks like it might just about fill up an 8 ounce measuring cup, despite the fact that I’d swear I started out with a quart of onions, at least.

It’s the ultimate in cozy domesticity, which sometimes appeals above all else. But if it sounds tedious, and even frustrating, I get that. (So do recipe writers, which is why they often lie about how long it takes.) That’s also why I don’t usually caramelize onions on work nights. And why I’ve sometimes cooked two pans’ worth at once, so I have a little more to show for my efforts once they’re over. But sometimes I want to just sink into and savor the process itself.

Maybe it’s another form of cooking as meditation (“carameli-zen“?), though I don’t quite think of it that way. It simply has such acute sensory appeal: the initial hard sizzle of the raw onions subsiding to a gentle murmur until you’re in an almost silent kitchen (ideally); the steadily intensifying perfume of the browning sugars (which will linger in the house and on your clothes for at least a full day afterward, but is nice at the time anyway); the easy slide of the worn-satiny wooden spoon (or silicone spoontula, in my case) through the slowly melting onions; the alchemy of watching crisp, firm, white vegetable flesh collapse into sticky, golden-brown shreds; and then of course, the ultimate reward is the deep, richly sweet taste. It’s all enchanting—and better yet, it gives me the opportunity to hunker down in the kitchen and read a back issue of a dearly departed magazine (RIP Gourmet and Lucky Peach), or a food-focused book (Nigel Slater’s Notes From the Larder is a current fave) in between casual but consistent bouts of stirring. Rather than a chore or any sort of drudgery, it’s heaven. To me, anyway. When I’m in the mood for it.

Barefoot Contessa

A little (or a lot) of caramelized onions add lavish, sweet savor to pretty much anything, from pizza and tacos to hamburgers and sandwiches in general, but I’ve probably cooked down fifty pounds of alliums over the past several years for the Barefoot Contessa’s pan-fried onion dip alone. I made it once for Christmas Eve and that was it; it became my signature dish, whether I wanted it to or not, and I’m not allowed to go too long without making it for a party, probably for the rest of my life. Luckily, I’m okay with that (and it is delicious). In fact, I settle in and cook the onions even longer than Ina’s recipe calls for (and cook more of them too). Sometimes, say 10 minutes before I want to take them off the heat, I stir in a dash of balsamic vinegar and a squirt of grainy mustard to give the onions even more oomph before cooling them and folding them into the dairy medley, but it’s the extra-long time luxuriating in a pan that really makes them—and the dip itself, and anything else they touch—so special.

I just ensure I have the afternoon free and something good to read, maybe crack a beer and drag a dining chair up to the stove for good measure, and in the end, it feels like a couple hours very well spent.


Scientists Have Found a New, Healthier Way to Cook Broccoli

SIGNE DEAN

8 FEB 2018

Lately, broccoli has been gaining a reputation as an excellent vegetable due to its high levels of a particularly beneficial compound called sulforaphane.

With some early-stage studies showing how this compound plays a role in blood sugar control and potentially even has anti-cancer benefits, it’s no wonder that broccoli pills are on the rise.

But a 2011 study has shown that eating the whole vegetable gets you more sulforaphane than taking a supplement – so a team of Chinese researchers has been on the case of finding the best way to cook broccoli.

They have a clear winner – but it’s a hard sell if you have better things to do.

The interesting part is that sulforaphane doesn’t just sit there in the broccoli florets, ready to be consumed. Instead, the vegetable contains several compounds called glucosinolates.

It also contains the enzyme myrosinase, which plants have evolved for defending themselves against herbivores. Through what’s known as ‘myrosinase activity’, the glucosinolates get transformed into sulforaphane, which is what we want.

To kick myrosinase activity into gear, you need to do damage to the broccoli, so you’d think cooking would do the trick.

Unfortunately, studies have shown that common broccoli cooking methods, like boiling and microwaving, seriously reduce the amount of glucosinolates in the vegetable – even if you just zap it for a couple minutes. And myrosinase is super-sensitive to heat, too.

Hence, by far the largest amount of sulforaphane you can get from broccoli is by munching on raw florets. Ugh.

This got the team of researchers thinking about the results of stir-frying – the most popular method for preparing vegetables in China.

“Surprisingly, few methods have reported the sulforaphane concentrations in stir-fried broccoli, and to the best of our knowledge, no report has focused on sulforaphane stability in the stir-frying process,” the researchers noted in their study.

The team bought a bunch of broccoli from the local market and set to work, measuring the levels of compounds in the vegetables as they went.

First, they basically pulverized the broccoli, chopping it into 2 millimeter pieces to get as much myrosinase activity going as possible (remember, it happens when broccoli is damaged).

Then they divided their samples into three groups – one was left raw, one was stir-fried for four minutes straight after chopping, and the third was chopped and then left alone for 90 minutes before being stir-fried for four minutes as well.

The 90 minute waiting period was to see whether the broccoli would have more time to develop the beneficial compounds before being lightly cooked.

And that’s exactly what the team found – the broccoli that was stir-fried right away had 2.8 times less sulforaphane than the one left to ‘develop’ for longer.

“Our results suggest that after cutting broccoli florets into small pieces, they should be left for about 90 minutes before cooking,” the team concluded, adding that they didn’t test it but thought “30 minutes would also be helpful.”

We’re not sure we’re willing to commit to all that effort, though. The team does say they’re looking into ways to reduce the chopping needed, so watch this space – or just eat some raw broccoli.

The study was published in the Journal of Agricultural and Food Chemistry.