A recent study published in the Journal of the American Dietetic Association found a three-fold increase in the metabolic syndrome in children eating the least amount of dietary fiber when compared to the group eating the most. There were no differences when consumption of saturated fat or cholesterol was analyzed however.

The researchers recommend focusing on increasing fiber in the diet, and not worrying so much about finding low-fat foods. That does not mean teens should fill their diets with fat-filled foods, but it does mean seeking out nutrient-dense foods high in fiber.

This makes sense to me. Most low-fat foods today are those processed foods that have been filled with sugar to make up for lack of taste that comes with low-fat options. Replacing fat with sugar in foods is what has contributed to the current obesity and diabetes epidemic this country now faces. Up to 30 percent of teen’s dietary intake comes from beverages and sugary snacks. This has to change.

But change can be tough. Joseph Carlson, the lead researcher, stated, “The trick is getting people into the groove finding the foods that they enjoy and that are convenient.”

The statistics are screaming at us from many different sources. Our diets and lifestyle have to change in order for us to see significant health improvements. This begins in childhood. I recommend that adults consume at least 35 grams of fiber daily. For children and teens, I recommend adding 5 grams to their age. So a 13 year old should eat 18 grams of fiber daily. How can you add fiber back into your diet, and the diet of your family?

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The benefits of omega-3 oils from fish were first noticed in Inuit populations of Greenland. Researchers noticed that these people consumed high amounts of fat, yet did not develop heart disease or experience heart attacks like people in the Western world. Thus began studies of the Inuit diet in which beneficial omega-3 fatty acids from fish—EPA and DHA—were found to be the heart-protective components.

Many thousands of studies later, the benefits of omega-3 fish oil are still being found in many different areas of health. In a new study of Yup’ik Eskimos in Alaska, researchers evaluated the effects of a high-fat fish-based diet on disease markers in obese Eskimos. The rate of obesity in these people is similar to that in the lower US—the difference is the source of dietary fat. In the US, saturated and trans fats are high in the diet, and healthy polyunsaturated fats, like omega-3s, are low.  

In obese Yup’ik Eskimos with the highest blood levels of EPA and DHA, blood triglyceride and C-reactive protein (a measure of overall inflammation) were the same as normal weight people. In those Eskimos with the lowest EPA and DHA levels, however, blood triglyceride and CRP levels were high. High triglycerides and CRP levels are risk factors for the development of cardiovascular disease and possibly diabetes.

Results of this study suggest that omega-3 fatty acids EPA and DHA found in fish may have health protecting effects even in obese people. More studies are needed to confirm these results, but this study is promising.

Now, don’t get carried away and think you can eat all the fatty foods you want and just pop a fish oil supplement. Instead choose healthy fats as part of your diet with plenty of fish on the menu, and supplement that with omega-3s from fish oil to be sure you’re getting enough of these great fats. Just be sure to look for a fish oil that meets International Fish Oil Standards (IFOS—look for the IFOS seal on the bottle).

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According to the Centers for Disease Control (CDC) 12 percent of children aged 2 to 19 years are obese—triple the number it was in 1980. This increase is attributed, in part, to the Standard American Diet (SAD), a poor diet high in refined carbohydrates, bad fats, and sugar, and low in high-fiber foods like whole grains and fruits and vegetables.

A recent study takes a look at fat intake of pregnant women and fat accumulation in their children by age 3. Specifically, the study looked at the status of two types of polyunsaturated fatty acids (PUFAs)—omega-6 and omega-3. These fats are both essential to the diet. The Standard American Diet is very high in the omega-6 fatty acids, found in vegetable oils and grains like corn. Omega-3 fatty acids, however, are not consumed in adequate amounts, creating an imbalance in the ratio of omega-6 to omega-3s.

Omega-3 fatty acids, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) found primarily in fish, promote optimal development of the fetal brain and immune system. Many women in the U.S. do not consume enough of these beneficial omega-3s. In a study published in the American Journal of Clinical Nutrition, researchers assessed mid-pregnancy intake of omega-3 and omega-6 fatty acids and tested plasma fatty acid levels of the mother and umbilical cord fatty acid levels of the infant to determine omega-3 status. At age 3, body mass index (BMI) and skin fold measurement were taken to determine obesity in the children.

The odds of obesity in 3-year-olds were two to four times higher when cord blood had a high ratio of omega-6 to omega-3 fatty acids. When maternal intake of omega-3s was higher, or when the omega 3/6 ratio was closer to recommended levels, the odds of childhood obesity were lower.

It has long been known that omega-3s, especially DHA, are necessary for brain development of the fetus and infants. The study also found that only three percent of mothers consumed the recommended 200 mg of DHA per day in the last month of pregnancy, when DHA is most rapidly transferred from the mother to fetus. This study is building the evidence that omega-3 fatty acids provide a variety of benefits for infants and children that go beyond brain and eye development.

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Antibiotics are overused for conditions they do not treat, such as viral infections like cold or flu. Antibiotic overuse is leading to antibiotic resistance, one of the major challenges facing medicine today. But antibiotic resistance is not the only consequence of the average 10 – 20 courses of antibiotics children receive by the age of 18. An under-appreciated negative effect of too many antibiotics is the killing of beneficial bacteria, as highlighted in the recent Nature journal article, “Antibiotic Overuse: Stop the Killing of Beneficial Bacteria.”¹

From the article, written by Martin M. Blaser, head of the department of medicine at New York University’s Langone Medical Center:

“Early evidence from my lab and others hints that, sometimes, our friendly flora never fully recover [after antibiotics]. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fueling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.”

This gut microbiota alteration is likely a contributing factor to the increase in antibiotic resistance seen in such “superbugs” as Clostridium difficile and methicillin-resistant Staphylococcus aureus, Blaser further explained.

Studies by Les Dethlefsen, David Relman, et al, have also found permanent alterations in gut microbiota after antibiotic treatment. These researchers investigated the effects of ciprofloxacin on gut microbiota changes over a period of 8 to 10 months in two studies—one with two courses of antibiotic treatment, the other with one.^2,3 Each study involved extensive stool sample analysis by 16S pyrosequencing (one rDNA, one rRNA) in three subjects over many months.

In one study, gut composition closely resembled its pretreatment state four weeks after antibiotic treatment. However, several bacterial groups did not recover even six months later. In the second study, gut composition stabilized by the end of 10 months, but it differed from its original state. The study concluded, “Antibiotic perturbation may cause a shift to an alternative stable state, the full consequences of which remain unknown.”

Blaser recommends reducing antibiotic use during pregnancy and childhood, citing that between one-third and one-half of pregnant women receive antibiotics during pregnancy in the U.S. and developing countries. “Each generation could be beginning life with a smaller endowment of ancient microbes than the last,” he stated, “Particularly the 30 percent or so of infants born via Cesarean.”

The search for effective alternatives to traditional antibiotics is on, as researchers from all over the world are testing new possibilities in the hopes of heading off the antibiotic-resistance disaster at the pass. One recent study highlighted the use of a commensal E. coli strain which was re-engineered  by adding fragments of DNA to the bacterium that allows it to sense the presence of the pathogenic bacteria known as, Psuedomonas aerugenosa. Pseudomonas is a superbug responsible for infections in the lungs, urinary tract, blood, and on wounds and burns. Upon sensing the Pseudomonas pathogen, the E coli released a potent toxin which killed up to 90% of the pathogen.⁴ It will be exciting to see if this technology holds up in forthcoming animal and human trials.

I believe the future will likely include widespread use of large amounts of commensal bacteria, probiotic bacteria and prebiotics, as well as genetically altered bacteria, to manage bacterial infections. We may even have a whole armamentarium of slightly altered commensal/probiotic bacteria on hand for certain infections. Antibiotics are already assuming a lesser role, and the CDC has a major program to remind physicians to be more discriminating in antibiotic use.⁵ So perhaps the future of pharmaceutical antibiotics will be their judicious use, in combination with various bacterial therapies, and this will become the standard of care. It will be very interesting to watch the unfolding of all the new research.

References

1.  Blaser M, “Antibiotic overuse: Stop the killing of beneficial bacteria.” Nature. 2011 Aug 24;476(7361):393-4.
2. Dethlefsen L, et al., “The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing.” PLoS Biol. 2008 Nov 18;6(11):e280.
3. Dethlefsen L and Relman DA, “Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation.” PNAS. 2011 Mar 15;108 (Suppl 1):4554-4561.
4. Saedi N, et al., “Engineering microbes to sense and eradicate Psuedomonas aeruginosa, a human pathogen.” Mol Sys Biol. 2011 Aug 16;7, no 521. Online ahead of print.
5. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a1.htm

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.  

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An interesting study published in the journal Obesity points out that eating more soluble fiber, like that from apples and beans, and moderate exercise will selectively decrease belly fat.¹ The authors don’t seem to know why it is selective to belly fat, and not subcutaneous fat (fat just under the skin). I think one reason would be that the intake of high amounts of soluble fiber promotes growth of beneficial bacteria that produce short chain fatty acids, both of which may control some of the inflammation in the gut. Chronic inflammation causes marked increase in insulin resistance, and therefore, storage of more belly fat. Controlling this inflammation is key, and as we see, can be done by consuming soluble fiber.

Here are some recently discovered points that support the above concepts:

• Eating a high fat and sugar diet decreases the number of beneficial bifidobacteria and increases the number of potentially pathogenic gram negative bacterial species in the gut.
• As these potentially pathogenic bacteria die they release cell wall lipopolysaccharides (LPS) which happen to also be better absorbed through the gut lining when eating a high-fat, high-sugar, low-fiber diet on a regular basis. The LPS molecules easily pass through the epithelial gut lining and hit the gut immune system where they activate white blood cells including neutrophils, monocytes, and macrophages that all then release inflammatory cytokines: TNF alpha, IL-6 and IL-1 beta. These inflammatory cytokines can trigger inflammation in the small blood vessels throughout the body but probably start with the blood vessels in the intestines, causing endothelial dysfunction. This has been proven by measuring a significant decrease in blood vessel wall flexibility within minutes to hours after eating a high-fat, high-sugar meal.²  
• Conversely, supplementing with bifidobacteria and eating a plant-based, high-fiber diet seems to decrease translocation of LPS through the gut epithelial lining and may help prevent the negative effects of high-fat diet induced metabolic diseases.³
• The vascular inflammation in and around the intestinal tract, which is 20 or more feet in length, can stimulate stem cells adjacent to the blood vessel walls (known as stem cell pericytes) to develop into fat cells or adipocytes which accumulate wherever there are blood vessels in the abdomen—that’s almost everywhere!
• The inflammatory fire continues as the abdominal fat, or visceral fat (some people call it VAT) continues to produce more inflammatory cytokines (IL- 6, TNF alpha, etc.) that flow into other blood vessels, stimulating more stem cell conversion into fat cells or adipocytes.
• It is interesting that both vitamin D and stem cells are stored at high levels in abdominal fat. Perhaps the vitamin D is trying to cool down the inflammation and the stem cells are there to respond according to the body’s information: either make fat or something else.  

It makes sense that exercise  was found helpful for reducing abdominal fat. Exercise has many benefits. For one, it produces more adiponectin to help reverse the situation. Adiponectin is an anti-inflammatory hormone made in fat that both decreases inflammation in fat and travels to the pancreas to help sensitize and balance the release of insulin which can help reverse metabolic imbalances.

So it is pretty simple—eat your plant-based, high-fiber diet, supplement with probiotics (including good amounts of bifidobacteria), and exercise moderately on a regular basis.  Then be patient. The accumulation of abdominal fat, along with all the problems caused by this fat, including heart attacks and cancer, is reversible.

1.  Hairston KG, et al., “Lifestyle Factors and 5-Year Abdominal Fat Accumulation in a Minority Cohort: The IRAS Family Study.” Obesity (Silver Spring). 2011 Jun 16. doi: 10.1038/oby.2011.171. [Epub ahead of print]

2.  Plotnik GD, et al., “Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal.” JAMA. 1997 Nov 26;278(20):1682-6.

3.  Cani PD, et al., “Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia.”

Diabetologia. 2007 Nov;50(11):2374-83.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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To me, a very interesting gut connection is that of microbial gut balance to obesity, a condition plaguing one-third of Americans. Studies are very new on this subject of the link between the gut and obesity. In fact, there have only been a few. But boy are they changing how the world looks at the gut—namely, they’re really starting to look!

This new study builds on previous animal studies by looking at the effect of a probiotic (Lactobacillus plantarum) on weight loss. It is already known that there is a difference in the gut flora between obese and lean individuals. This new study found that when rats fed a high-energy-dense diet (high fat, high calorie) were also given L. plantarum, they did not gain as much weight as the animals who did not receive the probiotic. Another group received the less-friendly E. coli bacteria and gained more body fat than those who didn’t.

That’s right—changing the gut bacteria influenced the amount of weight and fat these animals gained. This is an exciting study, because it is just the beginning of what will be a fascinating journey linking the gut to obesity, and all the many conditions related to obesity.  

I’ve known for a long time that in order to heal the body, you have to first heal the gut. In order to heal your gut, however, you have to understand the importance of its function. The gut is not merely a food processor—food in, poop out—but rather gut function is the very foundation upon which your health is built. With an unhealthy digestive tract—and there are many different ways the digestive tract can be unhealthy—you will be less able to heal your body. So start with your gut. What are you waiting for?

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The American Heart Association (AHA) released a scientific statement this week on triglycerides and cardiovascular disease. In the statement, certain lifestyle factors—diet and exercise—were considered with regard to their effects on lowering triglycerides. Almost one-third of Americans have high triglycerides. Since 1976, average triglyceride levels have risen alongside the growing epidemic of obesity, insulin resistance, and type 2 diabetes, all of which can lead to cardiovascular disease. 

The AHA statement recommends the optimization of nutrition-related practices, which can result in a marked triglyceride-lowering effect ranging between 20% and 50%.  They recommend the following:

• Weight loss
• Reducing simple carbohydrates
• Increasing dietary fiber
• Eliminating trans fats
• Reducing fructose (mainly high-fructose corn syrup)
• Reducing saturated fats
• Eating a Mediterranean-style diet (high in fresh fruits and vegetables, high fiber, lean meats, healthy fats)
• Consuming marine-derived omega-3s

These recommendations are right on, and in line with what I have been recommending for years—not just for a healthy heart, but for overall health and well being. 

The statement made a point of talking about the importance of marine-based omega-3s.  Here’s a quote:

“Non–marine-based PUFAs [like canola, flaxseed, walnuts] have not demonstrated consistent reductions in triglycerides; this may reflect very low conversion rates of alpha-linolenic acid [ALA]…to the active triglyceride-lowering omega-3 compounds EPA and DHA.”

While ALA is a great source of omega-3s, it takes many complex steps in the body to convert it to the heart-healthy DHA and EPA, which are naturally found in fish oil.  Further, they state:

“Because the amount needed for significant triglyceride lowering (2 to 4 g) is difficult to attain through diet alone on a daily basis, supplementation with capsules may be needed.”

That’s why I recommend fish oil supplements—it’s not easy to get all that EPA and DHA from eating fish alone.  And then you have to worry about the contaminants found in fish… (that’s another blog).

I know that for a while now, the AHA has been recommending EPA and DHA fish oil for high triglycerides.  It’s nice to see this statement together with other recommendations for supporting heart health.  Cardiovascular disease is such a huge problem in this country, and it can largely be avoided by incorporating the lifestyle changes mentioned above. 

Right on AHA!

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A very interesting study was just published in the journal Archives of Internal Medicine documenting the association between high dietary fiber intake and lower risk of dying from some of the most common killers—heart disease, cancer, and diabetes. This was a huge study with over 388,000 participants aged 50 to 71.

The nine-year study looked at dietary fiber intake and found men’s intake ranged from 13 to 29 grams per day, and women’s fiber intake from 11 to 26 grams per day. Over a nine-year period, those who had the highest intake of fiber (29.4 grams in men and 25.8 grams in women) had a 22 percent lower risk of dying from certain diseases than those participants who consumed the lowest levels of fiber. Subjects with the highest daily intake of fiber were at lower risk of dying from cardiovascular disease and infectious and respiratory disease compared with the lower fiber intake group.

Researchers noted that fiber “has been hypothesized to lower the risk of coronary heart disease, diabetes, some cancers, obesity, and premature death because it is known to:

• Improve laxation by increasing bulk and reducing transit time of feces through the bowel;
• Increase excretion of bile acid, estrogen, and fecal procarcinogens and carcinogens by binding to them;
• Lower serum cholesterol levels;
• Slow glucose absorption and improve insulin sensitivity;
• Lower blood pressure;
• Promote weight loss;
• Inhibit lipid peroxidation; and
• Have anti-inflammatory properties.”

I recommend at least 35 grams of fiber daily for those very reasons noted above. High daily intake of fiber has so many health benefits. Unfortunately, however, the average American only consumes between 10 and 15 grams daily— and that’s not nearly enough.

It can be difficult to obtain 35 grams of fiber from the diet, so fiber supplements are a great way to increase fiber intake. In addition, consuming plenty of whole grains, fruits and vegetables (and fewer bad fats, refined grains and sugars) will help to boost your daily fiber intake.

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We often think of processed food, in general, as being not as healthy as fresh food.  But unfortunately, it is becoming increasingly difficult to see processed foods as unhealthy with labels like, “reduced fat,” “natural,” or even “organic.” The truth is, while organic processed foods may be a little better for you than traditional processed foods, it’s better to minimize their consumption altogether.

A recent report published in the Journal of the World Public Health Nutrition Association has grouped processed foods into three types:

Type One Processing does not much alter the nutritional quality of food, and can sometimes even improve it. This type of processing involves cleaning, removing inedible parts, grating, squeezing, drying, parboiling, freezing, etc.

Type Two Processing involves extracting or purifying certain substances from the original food. This may include pressing, milling, refining, hydrogenating, using enzymes or additives, etc.

Type Three Processing involves the creation of durable, accessible, convenient, attractive, ready-to-eat or ready-to-heat products that are excessive in total fat, bad fats, sugar and sodium, and low in micronutrients, other bioactive compounds and dietary fiber.

The report outlines how Type Three processed foods are the biggest problem when it comes to obesity, because the finished products, even though they are often presented as healthy, are by their very nature quite unhealthy.

Here is the report:

The Big Issue is Ultra-Processing

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Oh, the vicious cycles that lead our health in a downward spiral, seemingly never-ending. When it comes to obesity, there are a number of these detrimental cycles. One involves the brain.

Pleasure receptors (known as D2 receptors) exist in the brain and are involved in—you guessed it—feelings of pleasure. Well, a recent study has found that obese people have fewer pleasure receptors and they overeat to compensate for this lack of pleasure. But overeating weakens the ability of the pleasure receptors to respond, creating yet more need to fill this pleasure void.

When you eat, dopamine is released in the brain. The more dopamine that is available, the more pleasure that is experienced. But with fewer dopamine receptors, obese people need to eat more to feel the same amount of pleasure as their lean counterparts.

This is a recipe for disaster, and explains why it can be so difficult for obese people to lose weight. I know that cravings can come from imbalances in the body and brain. That’s why I formulated Crave Be Gone. If you experience cravings (especially to carbs) then you might want to make those craves behave!

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