New Dietary Guidelines Ignore Science

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The federal government has issued dietary guidelines every 5 years since 1980. They are the ones that came out with the food pyramid, and most recently gave limits for sugar, saturated fat, and sodium (salt). These guidelines affect many things, including what children get served for lunch at school.

For the first time ever, the Department of Health and Human Services and the Department of Agriculture, under the direction of the Trump administration, is limiting the scope of the committee. They gave them a list of 80 questions, and said they are not to consider anything outside that list. Those questions do not include health risks such as too much salt, red meat, and processed foods.

The nature of science is that with ongoing research things change. Most of you can probably recall getting conflicting diet recommendations over the years. We were told to avoid fats, as we subsequently got collectively heavier, then ketogenic diets said the opposite. Alcohol can decrease heart disease, then studies showed it can increase breast cancer. That’s why it’s important to periodically review the literature and adjust recommendations if warranted.

Why would the Trump administration want to limit the committee? For one thing, they have generally been anti-science in many areas, such as global warming. For another, as they say, follow the money. Thirteen out of 20 of the committee members have food industry ties. This compares with two of 12 members in 2015. You can read more details in a Washington Post article.

Health care costs have been going up at a rate higher than inflation for many years. Although there are many reasons for this, part of it is because people are getting more obese. This leads to such health issues as diabetes, hypertension, heart disease, and arthritis. The new rules effectively says that corporate interests trump human health. So that corporations can profit more, we will pay the price in our health, and in our future medical bills.

The statute (Public Law 101-445, 7 U.S.C. 5341 et seq.) that required the guidelines specifically says that the Dietary Guidelines be based on the preponderance of current scientific and medical knowledge. As that wouldn’t be the case, unless the restrictions are removed, I expect that from 2020 to 2025 I’ll be advising my patients to follow the 2015 guidelines.

Sesame Chicken

sesamechicken

I often suggest my patients use smart phone apps to help them with their diet, in particular Lose It! or MyFitnessPal. Both progams have the ability to scan a bar code of a food item, which will then show the amount of calories, protein, fat, carbohydrates, etc for a given portion size. Not having any food in my exam rooms, I grabbed the box of tissues to show how to scan the bar code. Lose It! identified it as Sesame Chicken!

Healthy Kitchens, Healthy Lives

 

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Dr. David Eisenberg with his son and daughter demonstrating healthy cooking.

I recently attended the 11th Healthy Kitchens, Healthy Lives Conference put on by the Harvard School of Public Health and the Culinary Institute of America. It was a literally delicious combination of lectures from physicians, dieticians,  chefs, and others.

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Chef Adam Busby of the Culinary Institute of America

There were 411 people registered for the course, coming from 35 states, and internationally from 29 countries. Including spouses, faculty, chefs, and exhibitors, more than 550 people attended. For those registered, 59% were physicians, 11% nutritionists, 5% nurses & nurse practitioners, 5% masters of public health, and 20% others (chefs, psychologists, physical therapists, exercise trainers, physician assistants). The majority of physicians were internal medicine and family medicine, but also pediatrics, OB/GYN, sports medicine, psychiatry, anesthesiology, cardiology, endocrinology, and surgical specialties. A diverse group, indeed.

We had lectures from top notch physicians, dieticians, chefs, and others. Many were book authors. I already made a couple of recipes from Suvir Saran autographed book.

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Dr. Eward Phillips talking about exercise.

They fed us well, with something like 350 different healthy dishes to try.

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We also had a hands on kitchen session, then ate our own cooking.

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Chef Thomas Wong

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Now the challenge is how to use all the information and get my patients to eat healthier. As a start, I’ve posted some healthy recipes on Pinterest.

Ask the Doc: Statins and Exercise

On this site I’m unable to answer patient specific questions, but as time permits, may answer questions of a general interest.

Question:

Let me know what you think of this article. Strenuous exercise has not seemed to bother me taking Lipitor 20 mg for several years. However, I am wondering about the effects on my muscles as I am currently ramping up exercise both running and weight lifting. Will enough exercise improve my cholesterol level enough to quit taking Lipitor? Long term effects of Lipitor? I don’t know.
http://well.blogs.nytimes.com/2012/03/14/do-statins-make-it-tough-to-exercise/

Answer:

As the article points out, about 10% of people may experience muscle aches from taking statin medications such as Lipitor. It referenced an article that showed that rats were not able to exercise as long if taking atorvastatin (Lipitor), and they showed increased oxidative stress and problems with mitochondria, cell’s powerhouses.

You should always be careful when evaluating animal studies, as they may not apply to humans. Given other data, however, it would not be surprising if there was a similar problem in people who exercise and take statins.

The questions is what to do. As with most medications, one needs to balance the risks versus the benefits. Statins clearly save lives, but the degree of benefit depends on one’s risk. The more cardiovascular risk factors one has (hypertension, diabetes, hyperlipidemia (high cholesterol), smoking, family history, etc.), the more one has to gain from medication, and the more likely I would recommend patients tolerate side effects if we couldn’t come up with a better option. For someone at relatively low risk, a statin may not be worth taking if causing side effects.

I certainly always advocate diet and exercise to manage problems with cholesterol and triglycerides (fats). The problem is that for most people, it’s easier said than done, and people either just don’t make sufficient changes, or they don’t maintain them. Also for some people, their genetics are just too strong. With the wrong genes you may have a high cholesterol despite being thin, eating vegetarian, and exercising regularly.

Another option is to take coenzyme Q10 (CoQ10) or ubiquinone if you are taking a statin. It’s known that statins decrease this enzyme in the mitochondria and it may be the reason statins cause muscle pain and weakness. It is not proven to work, though the supplements appear to be safe. A study in Japan showed that pitavastatin (Livalo) did not decrease coenzyme Q10 nearly as much as atorvastatin (Lipitor). Whether it causes less muscle problems is unknown at this time.

For patients that I feel need medications to lower their cholesterol, yet are unable to tolerate a statin, or refuse to take one, I offer other alternatives, such as niacin (Niaspan, Endur-Acin, Slo-Niacin), colesevelam (WelChol) or ezetimibe (Zetia). There are pros and cons for each option. Sometimes people tolerate one statin, and not another, or may do better with a combination of a low dose statin and another agent.

So there’s no easy answer to your question. Different patients have different solutions.