by Barbara Berkeley, MD
Are you driven crazy by the daily dietary directives that scroll beneath the news and pop up on the front pages of the papers? I am.
The internet has given us the ability to learn of every speculation about diet and every study...whether small, large, well-constructed, or poorly run. Media reporting does not discriminate between these. Pretty much everything is offered with equal weight, which leaves it to us to figure out if the latest dietary pronouncement is gold or dross. Since it takes a convincing weight of evidence (many studies) to ensure that guidelines are worth adopting, we can be pretty sure that most of the stuff we read can be considered thoughtfully, but not necessarily acted upon.
Modern technology is great, but it is also anxiety provoking. When you can view the entire world and all it's experiences, it's easy to have FOMO. When everyone you know on Facebook is posting pictures of their perfect families and blemish-free lives, it's hard not to feel envious and ineffectual. And when every day brings another blaring directive about how to live, what to eat and how to exercise, it becomes confusing and overwhelming pretty quickly.
The sands are shifting constantly. Is salt ok or isn't it? Is all the ruckus about vitamin D important or not? Is dairy bad? Is grain bad? Is meat bad? We feel we need to act in response to each one. Yes even the truths we take as gospel often turn out to have feet of clay.
Take omega 3 fatty acids for example.
For the past number of years, one unassailable dietary recommendation has been to increase the amount of omega 3 on our daily plate. Omega 3 has been the golden child of diet, proported to heal coronary arteries, to cure depression, to prevent arrhythmias and to keep our blood free of clots. It is demonstrably true that ancient diets contained a much higher ratio of omega 3 to omega 6 fats than modern diets do. Because omega 6 fats tend to promote inflammatory chemicals and we want our body to be generally less inflammatory, we've assumed that increasing omega 3 should do the job.
But over two dozen rigorous studies of fish oil have shown no benefit in the prevention of heart attack and stroke in high risk patients. Per the NY Times Well Blog:
All but two of these studies found that compared with a placebo, fish oil showed no benefit.
And yet during this time, sales of fish oil more than doubled, not just in the United States but worldwide, said Andrew Grey, an associate professor of medicine at the University of Auckland in New Zealand and the author of a 2014 study on fish oil in JAMA Internal Medicine.
“There’s a major disconnect,” Dr. Grey said. “The sales are going up despite the progressive accumulation of trials that show no effect.”
Why no effect? We've always looked to the Inuits who eat large amounts of omega 3 and have few heart attacks for evidence that fish oil works. But during the past week, further information about omega 3s has emerged from a study of Inuit populations. Ancient Inuit diets consisted almost solely of fish and blubber...all with high levels of omega 3 acids. It turns out that the cardiac protection that Inuits get from omega 3 fatty acids may be linked to a genetic response to this diet over centuries. Over the past 20,000 years or so, Inuits may have evolved to handle large loads of omega 3. Europeans, on the other hand, do not carry this modulating gene. Are large doses of omega 3 a good idea for them? Not yet known.
Here's another one. On September 15, the US Preventive Services Task Force issued the recommendation that adults ages 50 to 69 with a 10% risk of heart disease should take a daily low dose aspirin for prevention of cardiovascular disease and colon cancer. They recommend that you do this for at least ten years.
But here's the rub. The American Cancer Society recommends against taking aspirin for cancer prevention. And cardiovascular authorities like Dr Steve Nissen from the Cleveland Clinic are utterly against the idea as well. Regarding the USPSTF Nissan said, ""I think the evidence in favor of a benefit for prophylactic aspirin for primary prevention is weak, there is very clear evidence of harm, and I don't think their advice is prudent."
So do you stock up on aspirin or leave the cupboard bare?
Let me digress with the following fairy tale, one of my childhood favorites. This tale jumps to mind frequently these days:
Lazy Jack
Once upon a time there was a boy whose name was Jack, and he lived with his mother on a common. They were very poor, and the old woman got her living by spinning, but Jack was so lazy that he would do nothing but bask in the sun in the hot weather. His mother could not get him to do anything for her, and at last told him, one Monday, that if he did not begin to work for his porridge she would turn him out to get his living as he could.
This roused Jack, and he went out and hired himself for the next day to a neighbouring farmer for a penny; but as he was coming home, never having had any money before, he lost it in passing over a brook.
"You stupid boy," said his mother, "you should have put it in your pocket."
"I'll do that the next time," replied Jack.
Well, the next day, Jack went out again and hired himself to a cowkeeper, who gave him a jar of milk for his day's work. Jack took the jar and put it into the large pocket of his jacket, spilling it all, long before he got home.
"Dear me!" said the old woman; "you should have carried it on your head."
"I'll do that the next time," said Jack.
So the following day, Jack hired himself again to a farmer, who agreed to give him a cream cheese for his services. In the evening Jack took the cheese, and went home with it on his head. By the time he got home the cheese was all spoilt, part of it being lost, and part matted with his hair.
"You stupid lout," said his mother, "you should have carried it very carefully in your hands."
"I'll do that the next time," replied Jack.
Now the next day, Lazy Jack again went out, and hired himself to a baker, who would give him nothing for his work but a large tom-cat. Jack took the cat, and began carrying it very carefully in his hands, but in a short time the cat scratched him so much that he was compelled to let it go.
When he got home, his mother said to him, "You silly fellow, you should have tied it with a string, and dragged it along after you."
"I'll do that the next time," said Jack.
So on the following day, Jack hired himself to a butcher, who rewarded him by the handsome present of a shoulder of mutton. Jack took the mutton, tied it with a string, and trailed it along after him in the dirt, so that by the time he had got home the meat was completely spoilt. His mother was this time quite out of patience with him, for the next day was Sunday and she was obliged to do with cabbage for her dinner.
"You ninney-hammer," said she to her son, "you should have carried it on your shoulder."
"I'll do that the next time," replied Jack.
Well, on the Monday, Lazy Jack went once more and hired himself to a cattle-keeper, who gave him a donkey for his trouble. Now though Jack was strong he found it hard to hoist the donkey on his shoulders, but at last he did it, and began walking home slowly with his prize. Now it so happened that in the course of his journey he passed a house where a rich man lived with his only daughter, a beautiful girl, who had never spoken. And she had never laughed in her life, and the doctors said she would never speak till somebody made her laugh. So the father had given out that any man who made her laugh would receive her hand in marriage.. Now this young lady happened to be looking out of the window when Jack was passing by with the donkey on his shoulders; and the poor beast with its legs sticking up in the air was kicking violently and heehawing with all its might. Well, the sight was so comical that she burst out into a great fit of laughter, and immediately recovered her speech and hearing. Her father was overjoyed, and fulfilled his promise by marrying her to Lazy Jack, who was thus made a rich gentleman. They lived in a large house, and Jack's mother lived with them in great happiness until she died.
What's the point? Well, Jack followed directions to the letter, but without thinking about them and without applying them to his own particular situation. Obviously, doing that is foolish and generally doesn't lead to the happy ending Jack blundered into. Our constant tinkering with diet and medications amounts to one of the largest uncontrolled experiments in health ever undertaken. Sadly, there is no useful data that can be gleaned from this huge experiment, because we are constantly changing the rules and the variables are so enormous. We are constantly being given directions and, too often, we are following them like Jack...without regard to whether they fit our particular needs.
Avoid being Lazy Jack. Don't simply change diet or habits because you read something on the crawl under Wolf Blitzer. Instead, use your own personal yardstick to gauge the successes of your health regimen. If you are doing well in these areas, it is probably not necessary to change things much. Remember that every one of us is different and that includes our dietary requirements, the foods that make us fat, the amount we can eat, and the foods and medicines that react badly with our bodies.
If you are not doing well in one or more of these areas, it's time for a well-considered change. If you are doing fine, you probably don't need to change much.
1. Your weight is stable in the normal to low overweight range.
2. Your blood pressure is normal. (Top number in the 120s or lower is best).
3. Your blood sugar after fasting the night before (not eating from midnight on) is under 100.
4. You do not have a great deal of fat in the belly area.
5. You are not suffering from diseases of inflammation or autoimmune disease (like rheumatoid arthritis, inflammatory bowel disease, psoriasis, multiple sclerosis, lupus, etc..)
6. Your cholesterol and triglycerides are not extremely elevated.
7. You are not a smoker.
8. You drink alcohol in small amounts only.
9. You are able to exercise freely and have good tolerance to exertion.
10. You sleep well for the most part.
11. Your mood is good for the most part.
Remember that medicines (and dietary changes) are things that DO something to you. We have learned a lot in the past ten years about the fact that seemingly benign medicines (like non steroidal anti-inflammatories, for example) can cause unintended harm (increased risk of cardiac events). So don't just jump for the newest pill, even if the marketing looks lovely. Always make sure you have a good reason to medicate. It may turn out that taking fish oil simply because it works for the Inuit is no different that carrying a lump of cheese home on your head. To the best of your ability, make sure the medicines and diet you choose fit you and preserve your particular form of health.