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The Meatloaf Syndrome: “I would do anything…”
By | December 1, 2011
Okay. So I have all these patients who want to lose weight, reverse their diabetes or “prediabetes,” lower their blood pressure and cholesterol, and reduce their chronic pain, insomnia, and stress.
Neither they nor I are big fans of using prescription medication to do these things. They don’t want to take a weight-loss pill three times a day, an antidepressant, two blood-sugar pills three times a day (or three insulin shots a day), an ACE inhibitor and a diuretic, a statin, a narcotic and an NSAID (+/- a muscle relaxer), plus the stool softeners and antacids to counteract the effects of the pain meds, and a sleeping pill (or two) every night. They don’t even really want to take a handful of vitamins and “natural” supplements, three or four times a day. They just want to be well.
And very often they will say wistfully, “Gosh, I’d do anything to be healthy again.”
And I have taken to saying, “Anything? You would do anything?”
The reading I have done recently, and the patients I’ve talked to, at length (since most of my office appointments are an hour long, with plenty of time to talk), have convinced me that in many cases it is possible to improve health overall by making a very minor change in a person’s diet.
That change is, eliminating animal-based foods.
Here is my reasoning.
It appears that diets high in animal-based foods, even if they also contain some fruits and vegetables (and none of us really eat as many fruits and vegetables as we think – food diaries always suprise us!), produce a kind of generalized low-grade inflammation throughout the body.
What is inflammation? It is the most basic function of the immune system. In the popular military motif, the immune system “attacks invaders” to “defend the body.” (Of course the story is more complex that that – more like the complex relations between trees and grasses, fungi and worms, mammals and reptiles, birds and fish, all interacting within the same ecosystem. In this case, the ecosystem is a person’s own body.)
This interpretation of inflammation tells us that, among other things, the immune system over time tends to “mistake fatty deposits for intruders.” An alternative interpretation may be that, within the immune system, certain elements function to reduce excess/unnecessary fat cells, or to reduce the amount of lipid stored in fat cells. One of the effects of inflammatory cytokines, after all, is to produce “sickness behavior,” which includes loss of appetite. The whole story undoubtedly includes both, for complex organisms tend to have systems that both “attack” and “nuture.”
It appears that animal-based foods – meat, poultry, fish, milk, eggs – contain a fair amount of inflammatory mediators themselves. They are also very high-calorie, promoting obesity. The evidence is pretty good that a person, by not eating animal foods, can attain a healthy weight, normalize their body’s responses to nutrients (including cholesterol compounds and blood sugar), and reduce the effects of stress responses.
Of course there is plenty of anecdotal evidence of this. Witness the personal transformation of the average patient (overweight, with high blood pressure and cholesterol, and just not feeling very well) seen in the documentary about nutritionists leading the research in this field, Forks Over Knives. I myself know several people (and am married to one) who were surprised that, when they switched to a plant-based diet, they not only lost weight, but felt so much better than they had expected. Better energy. Better sleep. Better mood. And if they were under medical supervision, their doctors were likewise surprised and pleased.
My young and glamorous spouse notes, for the record, that he not only quit eating animal foods – he also quit drinking soda and eating chips and candy bars. He doesn’t smoke cigarettes, and never overdrinks. He doesn’t need to take any prescription medications or even vitamins, and he pretty much eats as much as he wants.
Is it difficult to quit eating animal foods? Depends. I have shopped and cooked for vegans for more than 15 years, in several different geographical locations (urban to rural), in several different family structures (all ages), and at several different income levels, including on food stamps. I developed some flexible strategies, and am currently putting together a cookbook to share them. But here are some basics:
~ If you live where I do, the stores and restaurants are all full of vegetarian versions of regular American fare, from vegan pizzas to vegan pot pies. There are 8 kinds of vegan milk, from soy to hemp, for your granola, not to mention a million soy yogurts. You may eat better than you ever have in your life.
~ If you live in an area that does not have so many options, you will probably want to concentrate on recipes from Asian, Mexican, and Italian traditions, leaving the meat out of the recipes, or substituting something, like tofu or mushrooms, for the meat. You’ll want to have a sandwich before you go out to a restaurant with your “meater” friends – because you may very well be limited to salad for supper. Forget about restaurant breakfasts, unless you love oatmeal and fresh squeezed OJ (yum).
~ If you are on a budget, rice and beans will be your mainstay for a while. Did you know you can make your own veggie burgers at home, from rice and beans (and other ingredients)? Frozen veggies are cheaper than fresh, and they keep better. (Skip the organic vegetables until you can afford them.)
~ Maybe you are on a budget, and do not have much time to spend in the kitchen. Get a new-used crockpot from the Salvation Army store – throw in a rice cooker, if you find one. (You can cook lots of things in it, not only rice.) Also look for plastic food storage containers, and buy a Sharpie (permanent marker, to date frozen foods.) You will be able to throw together soups and sauces before work or school, and they’ll be ready at the end of the day. Many of us cook a double recipe, and freeze half for another day. Canned beans, by the way, are instant, as opposed to dried, and they’re still cheap.
~ Does your family hate the whole idea? Too bad! Think about how much it will cost you – and them – to take 20 pills a day, because that’s where many of us are headed. Imagine how nice it would be, to feel strong and energetic again. Just because your family prefers to be less healthy doesn’t mean you should enable them. However, to ease the transition, you can temporarily commit to spending a little more on “meat substitutes” (like “garden burgers” and “tofu pups”). Put the soymilk in a pitcher or a reusable glass milk bottle, in the fridge. Put the vegan margarine in a butter dish or butter-crock. Be patient. It usually takes about 3 weeks for kids, and 8 weeks for grownups, to completely adjust to the change.
I wrote this article because, when I was telling my (meat-eating, soda-drinking) dad about my ideas, he said, “Is this just something you made up, or do others say the same thing?” I did a 20-minute Internet search on PubMed, the national scientific research database, and found these abstracts below (emphasis added). I got all excited. I hope you will, too.
The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity.
Barnard ND et al. Am J Med. 2005 Sep;118(9):991-7.
Department of Medicine, George Washington University School of Medicine, Washington, DC, USA.
This study investigated the effect of a low-fat, plant-based diet on body weight, metabolism, and insulin sensitivity, while controlling for exercise in free-living individuals. In an outpatient setting, 64 overweight, postmenopausal women were randomly assigned to a low-fat, vegan diet or a control diet based on National Cholesterol Education Program guidelines, without energy intake limits, and were asked to maintain exercise unchanged. Dietary intake, body weight and composition, resting metabolic rate, thermic effect of food, and insulin sensitivity were measured at baseline and 14 weeks.
RESULTS:
Mean +/- standard deviation intervention-group body weight decreased 5.8 +/- 3.2 kg, compared with 3.8 +/- 2.8 kg in the control group (P = .012). In a regression model of predictors of weight change, including diet group and changes in energy intake, thermic effect of food, resting metabolic rate, and reported energy expenditure, significant effects were found for diet group (P < .05), thermic effect of food (P < .05), and resting metabolic rate (P < .001). An index of insulin sensitivity increased from 4.6 +/- 2.9 to 5.7 +/- 3.9 (P = .017) in the intervention group, but the difference between groups was not significant (P = .17).
CONCLUSION:
Adoption of a low-fat, vegan diet was associated with significant weight loss in overweight postmenopausal women, despite the absence of prescribed limits on portion size or energy intake.
Vegetarian diets and childhood obesity prevention.
Sabaté J, Wien M. Am J Clin Nutr. 2010 May;91(5):1525S-1529S. Epub 2010 Mar 17.
Department of Nutrition, School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
The increased prevalence of childhood overweight and obesity is not unique to industrialized societies; dramatic increases are occurring in urbanized areas of developing countries. In light of the consensus that obesity is a significant public health concern and that many weight-loss interventions have been unsuccessful in the long term, an exploration of food patterns that are beneficial in the primary prevention of obesity is warranted. The focus of this article is to review the relation between vegetarian diets and obesity, particularly as they relate to childhood obesity. Epidemiologic studies indicate that vegetarian diets are associated with a lower body mass index (BMI) and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI (in kg/m(2)). Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children. Plant-based diets are low in energy density and high in complex carbohydrate, fiber, and water, which may increase satiety and resting energy expenditure. Plant-based dietary patterns should be encouraged for optimal health and environmental benefits. Food policies are warranted to support social marketing messages and to reduce the cultural and economic forces that make it difficult to promote plant-based dietary patterns.
Anti-inflammatory effects of plant-based foods and of their constituents.
Watzl B. Int J Vitam Nutr Res. 2008 Dec;78(6):293-8.
Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany. bernhard.watzl@mri.bund.de
Inflammation is a pathological condition underlying a number of diseases including cardiovascular diseases, cancer, and chronic inflammatory diseases. In addition, healthy, obese subjects also express markers of inflammation in their blood. Diet provides a variety of nutrients as well as non-nutritive bioactive constituents which modulate immunomodulatory and inflammatory processes. Epidemiological data suggest that dietary patterns strongly affect inflammatory processes. Primarily the intake of fruit and vegetables as well as of whole wheat is inversely associated with the risk of inflammation. In addition to observational studies there are also data from human intervention studies suggesting an anti-inflammatory potential of these plant foods. At the level of bioactive compounds occurring in plant foods, primarily carotenoids and flavonoids seem to modulate inflammatory as well as immunological processes. In conclusion, there is convincing evidence that plant foods and non-nutritive constituents associated with these foods modulate immunological and inflammatory processes. By means of anti-inflammatory activities a plant-based diet may contribute to the lower risk of cardiovascular diseases and cancer. A high intake of vegetables, fruit, and whole wheat as recommended by all international nutrition authorities provides a wide spectrum of bioactive compounds at health-promoting concentrations.
Diet and inflammation.
Galland L. Nutr Clin Pract. 2010 Dec;25(6):634-40.
Foundation for Integrated Medicine, New York, NY 10010, USA. lgallandmd@aol.com
The emerging role of chronic inflammation in the major degenerative diseases of modern society has stimulated research into the influence of nutrition and dietary patterns on inflammatory indices. Most human studies have correlated analyses of habitual dietary intake as determined by a food frequency questionnaire or 24-hour recall with systemic markers of inflammation like high-sensitivity C-reactive protein (HS-CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-?). An occasional study also includes nutrition analysis of blood components. There have been several controlled interventions which evaluated the effect of a change in dietary pattern or of single foods on inflammatory markers in defined populations. Most studies reveal a modest effect of dietary composition on some inflammatory markers in free-living adults, although different markers do not vary in unison. Significant dietary influences have been established for glycemic index (GI) and load (GL), fiber, fatty acid composition, magnesium, carotenoids, and flavonoids. A traditional Mediterranean dietary pattern, which typically has a high ratio of monounsaturated (MUFA) to saturated (SFA) fats and ?-3 to ?-6 polyunsaturated fatty acid (PUFAs) and supplies an abundance of fruits, vegetables, legumes, and grains, has shown anti-inflammatory effects when compared with typical North American and Northern European dietary patterns in most observational and interventional studies and may become the diet of choice for diminishing chronic inflammation in clinical practice.
The effects of diet on inflammation: emphasis on the metabolic syndrome.
Giugliano Det al. J Am Coll Cardiol. 2006 Aug 15;48(4):677-85.
Division of Metabolic Diseases, Center of Excellence for Cardiovascular Diseases, University of Naples SUN, Italy.
Reducing the incidence of coronary heart disease with diet is possible. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. This review examines the epidemiologic and clinical evidence concerning diet and inflammation. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while prudent dietary patterns cool it down.
Association of metabolic syndrome risk factors with selected markers of oxidative status and microinflammation in healthy omnivores and vegetarians.
Sebeková K. et al. Mol Nutr Food Res. 2006 Sep;50(9):858-68.
Research Base of Slovak Medical University, Bratislava, Slovakia.
Conditions predisposing to metabolic syndrome (MetS) are associated with increased oxidative stress and inflammation. We studied, in vegetarians (n = 90) and omnivores (n = 46), the impact of the dietary regimen on the occurrence of MetS risk factors (RFs: BMI, blood pressure, glucose metabolism and lipid profile) in relation to oxidative status (advanced glycation end products (AGEs), advanced oxidation protein products (AOPPs), malondialdehyde, ferric reducing ability of plasma, vitamins A, E, C, beta-carotene and superoxide dismutase activity) and microinflammation (C-reactive protein, leukocytes and neopterin). The proportion of subjects without/positive for one or two MetS RFs was comparable between the groups. From the components of MetS only immunoreactive insulin levels differed significantly (95% CI: omnivores: 5.0-7.1 microU/mL, vegetarians: 4.5-5.4, p = 0.03). Omnivores had lower AOPP (omnivores: 0.29-0.36 micromol/g albumin, vegetarians: 0.36-0.52, p = 0.01) and beta-carotene levels than vegetarians, they consumed more calories, proteins, fat and saturated fatty acids, and less fibres, beta-carotene and vitamin C. Multiple regression analysis revealed vitamin E and AOPP levels as the most important independent determinants of MetS RFs. The vegetarian diet seems to exert beneficial effects on MetS RFs associated microinflammation. Whether the vegetarian diet may counteract the deleterious effects of elevated AOPPs and AGEs, remains to be elucidated.
Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis.
Adam O et al. Rheumatol Int. 2003 Jan;23(1):27-36.
Medizinische Klinik Innenstadt der LMU, Ziemssenstrasse 1, 80336 Munich, Germany.
Patients with rheumatoid arthritis (RA) improve on a vegetarian diet or supplementation with fish oil. We investigated the effects of both dietary measures, alone and in combination, on inflammation, fatty acid composition of erythrocyte lipids, eicosanoids, and cytokine biosynthesis in patients with RA.
Sixty-eight patients with definitive RA were matched into two groups of 34 subjects each. One group was observed for 8 months on a normal western diet (WD) and the other on an anti-inflammatory diet (AID) providing an arachidonic acid intake of less than 90 mg/day. Patients in both groups were allocated to receive placebo or fish oil capsules (30 mg/kg body weight) for 3 months in a double-blind crossover study with a 2-month washout period between treatments. Clinical examination and routine laboratory findings were evaluated every month, and erythrocyte fatty acids, eicosanoids, and cytokines were evaluated before and after each 3-month experimental period.
RESULTS:
Sixty patients completed the study. In AID patients, but not in WD patients, the numbers of tender and swollen joints decreased by 14% during placebo treatment. In AID patients, as compared to WD patients, fish oil led to a significant reduction in the numbers of tender (28% vs 11%) and swollen (34% vs 22%) joints (P<0.01). Compared to baseline levels, higher enrichment of eicosapentaenoic acid in erythrocyte lipids (244% vs 217%) and lower formation of leukotriene B(4) (34% vs 8%, P>0.01), 11-dehydro-thromboxane B(2) (15% vs 10%, P<0.05), and prostaglandin metabolites (21% vs 16%, P<0.003) were found in AID patients, especially when fish oil was given during months 6-8 of the experiment.
CONCLUSION:
A diet low in arachidonic acid ameliorates clinical signs of inflammation in patients with RA and augments the beneficial effect of fish oil supplementation.
Diet and cancer
Drew, J. World J Gastrointest Pathophysiol. 2011 August 15; 2(4): 61–64.
Rowett Institute of Nutrition and Health, University of Aberdeen, Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, United Kingdom.
Obesity and associated reduced consumption of plant derived foods are linked to increased risk of colon cancer as well as a number of other organ specific cancers. Inflammatory processes are a contributing factor but the precise mechanisms remain elusive. Obesity and cancer incidence are increasing worldwide, presenting bleak prospects for reducing, or preventing, obesity related cancers. The incidence of these preventable cancers can be achieved with greater understanding of the molecular mechanisms linking diet and carcinogenesis. Janice Drew has developed a research program over recent years to investigate molecular mechanisms related to consumption of anti-inflammatory metabolites generated from consumption of plant based diets, the impact of high fat diets and associated altered metabolism and obesity on regulation of colon inflammatory responses and processes regulating the colon epithelium. Comprehensive strategies have been developed incorporating transcriptomics, including the novel gene expression technology, the GenomeLab System and proteomics, together with biochemical analyses of plasma and tissue samples to assess correlated changes in oxidative stress, inflammation and pathology. The approaches developed have achieved success in establishing antioxidant and anti-inflammatory activity of dietary antioxidants and associated genes and pathways that interact to modulate redox status in the colon. Cellular processes and genes altered in response to obesity and high fat diets have provided evidence of molecular mechanisms that are implicated in obesity related cancer.
Again, that was a very simple twenty-minute internet search, not even using any special doctor resources! There is lot of data to support this approach. My mission is to spread the word, and give you ideas on how to make it easy. Because if you say, “I would do anything,” I’ll take you up on it!
Stay tuned for Dr Leigh’s “inflammation transformation” cookbook, appearing here sometime soon (ish).
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