Rheumatoid Arthritis

Monica Aggarwal is a cardiologist at the University of Florida medical center who developed rheumatoid arthritis five years ago. At the time she was in her 30's, had just had three children in rapid succession, was working hard, sleeping little and stressed. An aggressive drug regime improved her arthritis but she was still very sick from all her medications. Although she was a lifelong vegetarian she realized lifestyle including diet was playing a role in her disease. She started yoga, got more sleep and gave up dairy which allowed her to wean her drugs. Now she is again an active cardiologist and does triathlons.

Western lifestyle has lead to an explosion of heart disease, cancer, Alzheimer's and auto-immune conditions like rheumatoid arthritis. A genetic predisposition to disease is triggered by lifestyle choices. Diet affects the gut microbiome with resultant bowel wall damage and the development of "leaky gut." Toxic bowel contents reach the bloodstream, cause chronic inflammation and disease is triggered, the variety depending on genetic predisposition.

Aggarwal is changing the paradigm at the University of Florida: all cardiac patients get a plant based menu; the staff cafeteria offers many healthy whole plant foods; medical students, residents and fellows all receive training in nutrition science and the importance of lifestyle in chronic disease.

Aggarwal's rheumatoid factor, a marker for her disease, remains very high but she has been symptom free off all medications for four years.

                     Caloric Density

Anthony Lim practices lifestyle medicine in Santa Rosa where he works at Kaiser, TrueNorth and the McDougall program. He observed that many patients become discouraged when they lose weight but plateau at a level above optimal. They may become frustrated and return to old eating habits since weight loss was their primary reason for diet change.

Lim suggests that allowing unlimited eating of healthy foods may fail for weight loss if caloric density is not considered since dilatation of the stomach plays a major role in satiation. Stretch receptors around the stomach signal satiety. Eating enough food to fill the stomach but limiting calories is best done by eating mainly low calorie dense foods.

He measures food groups by average calories per pound. His numbers:

                          Vegetables- 100

                           Fruit-  200

                           Whole unprocessed starches like potatoes, oatmeal-  520

                           Pasta or Legumes-  600

                           Meat- 800

                           Processed starches (even whole grain bread and whole grain cold cereals)-  1500

                           Sugars and Dried fruit-1500

                           Junk food (chips, cookies)-  2300

                           Seeds and Nuts- 2800 (very healthy but limit to 1 ounce/day if trying to lose weight)

                           Oils and Fats- 4000

His cut off for unlimited quantities is all foods at 600 or less.

Lim suggests limiting or avoiding healthy snack bars, meat substitutes and starting the meal with low calorie dense foods. His ideal dinner plate is half veggies and half legumes and healthy starches.

               A Cardiologist Speaks

Joel Kahn is an interventional cardiologist, professor at Wayne State University in Detroit who actively advocates plant based eating to prevent and treat heart disease. He has his own restaurant for patients and the public where only healthy whole plant foods are served. Kahn's presentation consisted of a review of scientific studies supporting the importance of this diet in heart disease. They included:

   Ridler's work on hsCRP (heart sensitive C reactive protein)-- CRP is the basis of a blood test measuring inflammation; hs is the fraction of CRP which best reflects the form of inflammation which effects the heart and blood vessels. Chronic inflammation is critical in the progression of dangerous atherosclerotic plaques, the kind that lead to heart attacks. hsCRP is increased greatly with obesity, mainly proportional to visceral fat, the cause of a pot belly. A meat based diet and elevated blood sugar are also associated with elevated hsCRP.
  A recent study from NYU which compared a WFPB diet with the recommended American Heart Association diet showing much lower hsCRP with WFPB plus better patient compliance- it's a tastier, more satiating diet.
  Valter Longo's research on longevity conclusions- a low calorie "Mediterranean" diet with very little meat and processed carbs, especially sugars prolongs life. Cancer promoting IGF-1 levels are very low on this diet with improvement in diabetes, multiple sclerosis and response to cancer chemotherapy.
  Saturated fats and vegetable oils damage bowel lining with resultant "leaky gut" and subsequent chronic inflammation.
  A long term high animal protein ketotic diet has been examined in nine published studies all of which showed much higher mortality. This is one of the worst, perhaps the worst, diets ever studied. 

                    The Plantrician Project

This week Deb and I attended the 6th annual Plant-Based Nutrition Conference in San Diego. We had also attended this conference a few years ago in San Diego but they rotate locations (next June NYC; next September San Francisco.) Attendees are mostly health care professionals learning about effects of diet on health with an emphasis on the evidence that whole food plant based eating is the key to preventing and treating most chronic diseases. This conference was a sell out with over 1000 attendees from all over the world. Our only complaint was the huge size with the personal touches being lost. Business is booming for healthy eating!

We've now been to dozens of conferences which look at nutrition effects on medical issues and are always delighted to meet the other attendees: some patients, some devotees of a vegan lifestyle for a variety of reasons, and medical professionals seeking to improve what they can offer patients. Deb and I agree the best part of these conferences is talking to those searching for the truth about food's impact on health (and the planet.) This week was no exception. Our first meal was shared with a woman from Hungary who was attending a plantrician conference for the second time. She works for a health care company and is exploring what information is available to clinicians using diet in their practice. Other attendees we met included a family of dentists from Beverly Hills who encourage patients to use diet for health; a senior psychiatrist from Johns Hopkins who eats plant based himself and considers it an important part of medical care; a dermatologist from San Diego who uses plant based dietary therapy to treat some patients with great success in acne and psoriasis; a primary care physician from St. Thomas, Virgin Islands whose practice emphasizes whole food plant based diet; several nurse practitioners and physician assistants who incorporate information and advice about healthy diet in their daily work.

Subsequent posts will review specific meeting content.

                        Celiac Disease

Recently I discovered that I have celiac disease, an auto-immune disorder provoked by wheat gluten and similar grain proteins. Wheat, rye and barley are not tolerated by celiacs and must be avoided for life. Some are exquisitely sensitive and a trace will provoke strong symptoms; others can tolerate very small quantities of these proteins but the intolerance is never outgrown. Unfortunately many processed foods contain traces of gluten. For example some, but not all, soy sauces use wheat. Obviously this makes eating in Asian restaurants and any other place not careful with food cross- contamination a potential problem. Some bread crumbs dropped on a "gluten free" dish may be all it takes to provoke severe diarrhea and further bowel damage.

Cells lining bowel are harmed because of the body turning on itself (auto-immunity.) This can lead to chronic diarrhea, bloating, weight loss, fatigue, an unusual skin rash and malnutrition due to essential nutrients not being well absorbed. Anemia, various vitamin deficiencies and osteoporosis are all common sequelae and may be associated with depression.

Several genes have been identified as important in the development of celiac disease but many people with those genes don't develop the disease. Ireland has one of highest rates of celiac disease in the world but exact numbers are not known. In the United States the incidence is estimated at little less than 1%, with most cases undiagnosed. Celiac disease may first present at any age from infancy on, and other auto-immune diseases like type 1 diabetes and thyroiditis are not uncommon. Diagnosis is by a combination of family and medical history, blood antibody tests and small bowel biopsy. A confirmed diagnosis requires strict lifelong gluten abstinence even if symptoms are mild since progression with possible severe outcomes like cancer and lymphoma can occur.

https://en.wikipedia.org/wiki/Coeliac_disease  (British spelling of celiac)

                         Eating Patterns

More and more interest and research on health effects of eating timing has popped up in the scientific literature recently. A previous blog discussed the value of intermittent fasting, concluding that longevity and freedom from chronic disease were greatly improved by periods of fasting which can be as simple as not eating for a consecutive 12 to 16 hours daily.

The brain has a master clock which governs sleeping and waking dependent on exposure to bright light. Every other organ has a similar clock: the pancreas produces less insulin at night; the human gut and its microbiome also have a rhythm with the genes of the gut itself and its bacteria switching on and off at the same time.

People who interfere with this normal circadian rhythm by staying up too late have increases in weight, blood pressure and blood sugar. Night shift workers typically have poorer health.

More extreme periods of daily fasting have surprisingly powerful effects. Prediabetic men who are limited to only eating in a six hour window each day have improvement in blood pressure, less hunger, and less insulin secretion compared to those allowed to eat over a 12 hour window. If laboratory animals are given a poor quality diet with around the clock food access they get fat and sick. The same diet and food quantity limited to an eight hour window does not cause obesity or disease.

Significant health improvements, especially in weight and blood sugar, are seen if most calories are consumed early rather than late in the day.

A recent book, The Circadian Code, by Dr. Satchin Panda of the Salk Institute reviews his and others' research on eating patterns.

                        Milk and Sugar

Recent books examine the history and problems of two major foods.

Milk! by Mark Kurlansky is filled with arcane information that only a quiz show addict or dairy farmer could love. One of his topics is the difference between various mammalian milks. Human milk is very different than that of other species; it is the only really good food for infants. Children who are breast-fed are typically 2 to 3 inches taller, more confident and emotionally healthy, much less allergic. Their IQ is 15 to 20 points higher. In spite of this, our government recently attempted to block a United Nations plan encouraging breast-feeding world-wide. Our food manufacturers make big profits from infant formulas.

James Walton's Sugar- The World Corrupted From Slavery to Obesity is an historical, environmental and health triple header. Shortly after early European settlement in the Western hemisphere sugar production became the major business and drove most of the need for slaves. Sugar plantations created enormous wealth in Europe and the Americas, dominating policy decisions on slavery, trading and international relations. In the 21st century large amounts of land are wasted to produce high fructose corn syrup, cane and beet sugars for immense quantities of an addicting, unhealthy food used in most highly processed foods and beverages. It's a dismal story, again reflecting public policy benefitting business and harming citizens.