Your Wellness Lifestyle Starts Here
Some of the worst dietary advice is given to athletes of all ages. The misinformation starts in middle and high school, when well-meaning but misinformed coaches often instruct student athletes to eat more protein, use sports drinks for hydration, and consume dairy products for strong bones. Supplements are almost always recommended by trainers for body builders and other adult athletes with the promise that they contribute to more rapid muscle development and better performance. Diet and supplement recommendations are delivered with the implication that results are virtually assured and usually without any explanation of the potential risks. Furthermore, other dietary patterns, such as more plant-based diets are almost never discussed, except to dismiss them as not adequate for helping athletes to train and perform.
Supplements, in particular, are a concern, and the results of a new study should encourage even more people to avoid them. This study included 356 men between the ages of 18 and 55 who had had testicular cancer and 513 controls. Researchers looked at many factors, including exercise, smoking, drinking, family history, and the use of supplements for building muscle. The researchers concluded that muscle-building supplements, particularly those that contained both creatine (which is a hot topic right now) and protein, and those with testosterone-boosting androstenedione, significantly increased the risk of testicular germ cell cancer. Lead researcher Tongzhang Zheng said, “The observed relationship was strong. If you used them at an earlier age, you had a higher risk. If you used them longer, you had a higher risk. If you used multiple types, you had a higher risk.”
The researchers also noted that many supplements contain unknown ingredients that can increase the risk of cancer, citing a study that showed that 15% of supplements that did not include hormones on the labels contained anabolic androgenic steroids which have been associated with testicular cancer in animal studies.
The incidence of testicular germ cell cancer is rising in both the U.S. and Europe, and is the most common malignancy in men between the ages of 15-39 years of age. While many other factors are most certainly contributors, including poor diet, supplements to boost sports performance increase the risk even more, and should be avoided.
Athletes should be informed that optimal performance can be achieved without high-protein diets and supplements; in fact more and more athletes are finding that sports performance is enhanced by eating a more plant-based diet. Athletes do not need to choose between optimal performance or optimal diet. In fact optimal diet leads to optimal performance.
Li N, Hauser R, Holford T et al. “Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts.” British J Cancer March 31 2015;112:1247-1250
Niamh Michall “Muscle-building supplements linked to testicular cancer risk.”
Nutraingredients-usa.com April 14 2015
Wellness Forum Health
Stress Paralyzes Immune Cells
A research team in Australia led by immunologist Scott Mueller injected a stress hormone, norepinephrine, into the bloodstreams of mice. The purpose was to see how immune cells responded to stress hormones. Within just a few minutes, T-cells stopped moving. To make sure it was the stress hormone and the injection itself, the researchers performed the same experiment using dopamine, which had no effect on immune function.
To further research the issue, researchers infected the mice with herpes simplex virus (HSV). After two days the mice were treated with a molecule called Iso that mimics the action of adrenaline, a stress hormone. This also stopped the action of T-cells and dendritic cells for over two hours. When another substance called salmeterol, which acts on the same receptors, was injected two times per day for three days, there were fewer virus-specific T-cells at the sites of infection. Additional experiments with mice injected with melanoma cells or malaria parasites showed the same result – stress hormones and substances that mimic them suppress immune function.
There are other mechanisms at work too:
- In response to intense fear or stress, messages from the brain are sent to the endocrine system
- The adrenal glands release adrenaline and noradrenaline
- The body gets ready for fight or flight
- The heart beats faster, and blood pressure rises to send more blood to the arms and legs
- Extra glucose and fat are released for energy
This cascade of events works well for short-term situations in which people must act quickly to survive but does not work well when lower-level stress and anxiety becomes a chronic condition.
Stress also activates responses like inflammation, which helps to repair damaged or infected tissues. Inflammation causes white blood cells to flood an area where an injury has occurred, and release cytokines and recruit macrophages to clean out debris and dead cells. Inflammation is helpful for healing injury; not so much when stuck in the “on” position due to being in a continuous state of fight or flight.
Remaining constantly stressed about viruses makes you more likely to get sick from viruses. Here are some recommendations to reduce your stress:
- choose sources of information that do not result in increased stress
- carefully choose the people you hang around with – some have become toxic sources of stress and panic
- focus on strategies like eating well, exercising, getting out in the sunlight, drinking water – you will feel less stressed about health if you are healthy
- practice gratitude – thinking about what is good in life shifts the focus from the things that are not as good.
Devi S, Alexandre YO, Loi JK et al. “Adrenergic regulation of the vasculature impairs leukocyte interstitial migration and suppresses immune responses.” Immunity 2021 Jun;54(6):1219-1250
Building a Muscular Body for Health and Longevity
Did you know that as we age, we "disintegrate"? Nursing homes are full of folks who did not age well.
Building muscle strength is protective for our health. Frailty is destructive to our health.
Muscle is a functional metabolic organ and poor muscle strength is an independent predictor of poor health outcomes for the elderly who do not engage in proper strength training.
Skeletal muscle is the largest organ in the body by mass-30% to 50% of total body mass-depending on fitness level. Muscle is considered an endocrine organ contributing to metabolic function, hormone regulation and disease prevention. Muscle plays a part in preventing Type 2 diabetes because it plays a role in glucose metabolism. Muscle controls glucose and lipid levels, which results in reduced risk of diabetes. Muscle loss results in reduced glucose clearance, which then increases the risk of Type 2 diabetes. Energy expenditure, or calorie burn, is related to how muscular you are as well, with exercise playing a more minor role.
Most people in westernized countries lose muscle as they age. This is referred to as sarcopenia. The average muscle mass of a young healthy person ranges from 77 to 110 lbs. Contrast that to an elderly woman that has not engaged in strength training with only around 29 lbs. of muscle mass.
Muscle burns more calories than fat. A young person loses around 0.5% muscle mass per year. By the time we are in our 50s-60s, it accelerates to 3% per year. It is an imperceptible change which leads to that moment in life when we wake up one day and say, "how did I get so overweight and out of shape?!" Sarcopenia has been happening!
Early signs include not being able to climb stairs like we used to, not being able to lift something heavy that never gave us trouble in the past, and falls, to name a few. This all leads to a loss of independence.
Life spans are shorter for people who are not muscular and recovery from diseases can take longer due to complications that develop in older and frail people. During illness, the body depends on nutrients stored in muscle to promote better immune response and tissue repair. People with limited muscle reserves therefore have a harder time recovering from illness, including cancer.
The only solution to this is strength training. Eating a high protein diet does not help. Muscle mass also contributes to lower levels of inflammation and muscle releases myokines like interleukin 6 that lowers inflammation. Inflammation is a major influence in promoting all of the diseases that we don't want to get, like cardiovascular disease, arthritis, cancer.
Aerobic exercise helps, but strength training helps more! Another benefit of strength training is that it directly stimulates mitochondrial biogenesis and improves mitochondrial function, which impacts energy production and improves the function leading to increased endurance and lower risk of disease and lower risk of early death.
Strength training is key to preventing osteoporosis and improving bone mass if you have already lost some bone mass.
Just walking is not enough because strength training impacts bones that walking does not, like hips and spine. 10,000 steps a day does not build strength, or even aerobic capacity. You are just "marking time".
Be willing to do what needs to be done for your long-term health. It's fun to be a strong person.
Did you know that you can rebuild your brain with exercise?
In a previous blog, I wrote about the brain's capacity to rewire itself based on repeated thoughts and experiences. This is called "neuroplasticity". If you are a scripture reader, the apostle Paul points to neuroplasticity when he says, "be transformed by the renewing of your mind." (Romans 12:2) The more you do or think something, the more neural pathways you create. Our goal should be to create strong pathways by setting our minds and actions on positive thoughts and habits, reinforcing them daily. Whatever "rut" you think you are stuck in, well, you are not if you don't want to be. We have the ability to change, to transform.
When we exercise, we are also creating new neural pathways. People who exercise have physically different brains.
- The hippocampus, which is key for memory, is stimulated by exercise that increases heart rate. Out of shape people grew new blood vessels in the hippocampus after just 12 weeks of exercise. Aerobic exercise that is good for the heart is good for the brain. Higher levels of aerobic fitness is associated with increased hippocampus volume.
- Exercise has been shown to reverse age-related shrinkage of the brain. Klotho, which is a hormone associated with longevity and protection against cognitive decline, show increased levels after only 20 minutes of intensive aerobic exercise.
Alzheimer's is almost always a diet and lifestyle induced disease, and exercise plays a key role in prevention as well as a diet rich in fruit and vegetables, high in fiber and low in fat. Physical activity
affects the brain’s immune cells, which results in lowered inflammation in the brain.
Microglia are immune cells in the brain which clear away debris and dying cells that result from injury or infection. Microglia also stimulate production of new neurons, which communicate with other cells, a process called neurogenesis that is involved in learning and memory. Microglia shift from a resting state to an activated state in order to do their jobs. When signals from pathogens or damaged cells activate the microglia, they produce pro-inflammatory molecules which are needed to repair damage to resolve infection or injury. The bottom line is that if we eat well for our health, we will be eating well for our brain!
Are you ready to transform your mind? Is it still in a rut? Are you believing the negative spin that you tell yourself? Once you buy into the lies you tell yourself, you risk that it will certainly play itself out.
We remain committed to making learning about health interesting and fun. You CAN take control of your health and make better and more informed decisions about what you eat, how you exercise, and other optimal lifestyle changes.
Liz Fattore
Certified Food Over Medicine Instructor
Diet & Lifestyle Intervention
How often do you hear that someone is "addicted to food"? Did you know that there is no such condition and that there is a downside to calling abnormal eating a "food addiction"?
Humans are hard-wired to experience pleasurable feelings from eating and sex to ensure both personal survival and survival of our species. Food is different from other "addictive substances" – we can give up alcohol and cigarettes without endangering our survival, but we must eat to survive. It’s fair to say that we are all addicted to food for this reason. When we eat, dopamine is released, and we feel good, which is nature’s way of making sure we eat again.
If "addiction" is not driving overeating, what is? Overeating and binge eating are compulsive behaviors that involve food. An important purpose for compulsive behavior is to relieve stress and discomfort. The person who regularly overeats or binges uses food much in the way that some people use alcohol or drugs. But there is a very important difference. A person can abstain from alcohol and drugs for an entire lifetime, but cannot abstain from food.
Research shows that the particular substance that a person uses to reduce pain and discomfort is less important than the reason for use. This is why not all people who use drugs become addicted. During the early 1970s it was common for U.S. soldiers to use heroin while stationed in Vietnam. They often had to be admitted to detox centers to withdraw after returning home. After detox, over 90% of soldiers stopped using heroin and never used it again.
At the same time, heroin use was increasing in the U.S., but the situation concerning discontinuation was quite different. Addicts found it much more difficult to quit, and many were admitted to rehab centers multiple times and never stopped using drugs. What made this situation even more confusing was that the soldiers in Vietnam were using much stronger heroin than the heroin used by drug addicts in the U.S. American soldiers should have had a much more difficult time withdrawing, but they did not. The reason: Why people use heroin is more important than the physical action of the drug.
Soldiers were using heroin to deal with the horrors of war. When they returned home, the threat was gone, so the need for heroin was gone for most of them too. On the other hand, the reasons why many American addicts continued to use heroin remained unresolved, which is one of the reasons they returned to the drug time and time again.[1]
Conventional treatment for "food addiction" usually involves some form of abstinence from certain foods such as sugar, white flour, desserts, or bread. The rationale is that person can’t have any of these foods because eating them will "trigger" a return to abnormal eating patterns.
There are several problems with this strategy. The first is that abstention from particular foods rarely works. Sooner or later the person eats bread or cake or a cookie.
Another is that this strategy relies on perfectionism and all-or-nothing thinking, two of the most common cognitive distortions that drive people to seek therapy. Perhaps most important is that the success rate for abstinence programs overall is very low, even with substances for which there is more clear evidence of harm and addiction like drugs and alcohol. And abstention does not address the psychology of use. If it did, there would be no need for abstention.
The reality is that poor habits and carrying excess weight are indications of a bigger problem – life! Most chronically overweight, serial dieters, in addition to an abnormal relationship with food, have other issues and thinking patterns that interfere with success, such as, unrealistic goals and an inability to set boundaries.
The goal should be to help the overweight person change his or her thinking and behavior patterns AND to learn how to have a normal relationship with food. ALL people who want to have a normal relationship with food CAN have a normal relationship with food IF they are willing to change their minds and adopt new thought patterns and behaviors.
Humans are hard-wired to experience pleasurable feelings from eating and sex to ensure both personal survival and survival of our species. Food is different from other "addictive substances" – we can give up alcohol and cigarettes without endangering our survival, but we must eat to survive. It’s fair to say that we are all addicted to food for this reason. When we eat, dopamine is released, and we feel good, which is nature’s way of making sure we eat again.
If "addiction" is not driving overeating, what is? Overeating and binge eating are compulsive behaviors that involve food. An important purpose for compulsive behavior is to relieve stress and discomfort. The person who regularly overeats or binges uses food much in the way that some people use alcohol or drugs. But there is a very important difference. A person can abstain from alcohol and drugs for an entire lifetime, but cannot abstain from food.
Research shows that the particular substance that a person uses to reduce pain and discomfort is less important than the reason for use. This is why not all people who use drugs become addicted. During the early 1970s it was common for U.S. soldiers to use heroin while stationed in Vietnam. They often had to be admitted to detox centers to withdraw after returning home. After detox, over 90% of soldiers stopped using heroin and never used it again.
At the same time, heroin use was increasing in the U.S., but the situation concerning discontinuation was quite different. Addicts found it much more difficult to quit, and many were admitted to rehab centers multiple times and never stopped using drugs. What made this situation even more confusing was that the soldiers in Vietnam were using much stronger heroin than the heroin used by drug addicts in the U.S. American soldiers should have had a much more difficult time withdrawing, but they did not. The reason: Why people use heroin is more important than the physical action of the drug.
Soldiers were using heroin to deal with the horrors of war. When they returned home, the threat was gone, so the need for heroin was gone for most of them too. On the other hand, the reasons why many American addicts continued to use heroin remained unresolved, which is one of the reasons they returned to the drug time and time again.[1]
Conventional treatment for "food addiction" usually involves some form of abstinence from certain foods such as sugar, white flour, desserts, or bread. The rationale is that person can’t have any of these foods because eating them will "trigger" a return to abnormal eating patterns.
There are several problems with this strategy. The first is that abstention from particular foods rarely works. Sooner or later the person eats bread or cake or a cookie.
Another is that this strategy relies on perfectionism and all-or-nothing thinking, two of the most common cognitive distortions that drive people to seek therapy. Perhaps most important is that the success rate for abstinence programs overall is very low, even with substances for which there is more clear evidence of harm and addiction like drugs and alcohol. And abstention does not address the psychology of use. If it did, there would be no need for abstention.
The reality is that poor habits and carrying excess weight are indications of a bigger problem – life! Most chronically overweight, serial dieters, in addition to an abnormal relationship with food, have other issues and thinking patterns that interfere with success, such as, unrealistic goals and an inability to set boundaries.
The goal should be to help the overweight person change his or her thinking and behavior patterns AND to learn how to have a normal relationship with food. ALL people who want to have a normal relationship with food CAN have a normal relationship with food IF they are willing to change their minds and adopt new thought patterns and behaviors.
References:
[1] Lance Dodes MD, Zachary Dodes. The Sober Truth: Debunking the Ba Science Behind 12-Step Programs and the Rehab Industry. Beacon Press.
Pam Popper, Wellness Forum Health President
Americans have become the unhealthiest people in the world. They are taking more drugs than ever before, more are obese, and lifespans are shortening. In 1900, the average life expectancy for Americans was 47 years, and by 2019 it reached 79 years. But in 2020, U.S. life expectancy dropped to 77 years and in 2021, further dropped to 76.4 years, according to the CDC. (Murphy SL, Kochanek KD, Xu J, Arias E. Mortality in the United States) In fact, life expectancy in countries like Columbia is higher than in the U.S. (Lauren Irwin. US trailed dozens of developed nations for average life expectancy: research. The Hill November 7 2023 https://thehill.com/policy/healthcare/4298072-us-trails-developed-nations-average-life-expectancy/#:~:text=The%20U.S.%20ranked%20in%20the,around%20the%20world%20fell%20by%20 )
One of the major contributors to this downhill trend is the abandonment of personal responsibility for health, and the search for quick fixes like drugs and supplements and diets that lead to fast weight loss. Here’s what the quick fixes have in common: They don’t work, and they often make things worse. Take GLP-1 inhibitors for weight loss, for example. Wellness Forum Health has advised against these drugs since they were first approved in 2014, stating that they would lead to worsened health and even increased obesity in the long term. They were right. Recent evidence shows that while short-term weight loss is significant, changes in body composition while taking the drugs lowers metabolism and leads to other concerning health issues.
You might have seen Sharon Osborne in the news lately, sharing about her health situation due to taking this drug for weight loss. She knew nothing, nor was informed of, the terrible risks and side effects. Ozempic is a Type 2 diabetes drug, not to be used for weight loss.
According to trial results published in the New England Journal of Medicine, about 40% of the weight lost while taking GLP-1 inhibitors is muscle mass. Muscle burns more calories than fat – 14 calories per pound per day vs 3 calories per pound respectively. (Zurlo F, Larson K, Bogardus C, Ravussin E. "Skeletal muscle metabolism is a major determinant of resting energy expenditure." J Clin Invest 1990 Nov;86(5):1423-1427)
Loss of muscle mass can lead to physical instability and weakness, which can lead to disability and an inability to live independently. Frailty is one of the most common reasons for ending up in nursing homes. No one aspires to spend their final years in one of these places, but if you are not physically capable of living on your own, this is where you will end up.
When patients stop taking GLP-1 inhibitors, either due to economic factors, side effects or both – the rebound weight gain is fast and significant, and the person is even worse off than before taking the drug.
Maintaining a lean body is advantageous for health for several reasons, including:
People who have muscular bodies have a higher basal metabolic rate, which results in higher calorie burn, as mentioned before.
Muscles use glucose for energy, which helps with glucose control, which is particularly important since most obese people are diabetic or on their way to becoming diabetic.
Skeletal muscle serves as an endocrine organ, regulating hormones including those that enhance energy expenditure.
When patients stop taking GLP-1 inhibitors, either due to economic factors, side effects or both – the rebound weight gain is fast and significant, and the person is even worse off than before taking the drug.
Maintaining a lean body is advantageous for health for several reasons, including:
People who have muscular bodies have a higher basal metabolic rate, which results in higher calorie burn, as mentioned before.
Muscles use glucose for energy, which helps with glucose control, which is particularly important since most obese people are diabetic or on their way to becoming diabetic.
Skeletal muscle serves as an endocrine organ, regulating hormones including those that enhance energy expenditure.
The bottom line is that we can expect that the new weight loss drugs are going to create to a bigger problem than the mess created by opiates. Millions of people are taking them, and their weight loss is temporary at best. At some point, both the cost and the side effects will result in discontinuation for many, if not most. Companies with self-funded health plans are already starting to exclude coverage for them due to the expense. And multiple lawsuits have already been filed for injuries and deaths related to the drugs. In the future, doctors and medical centers may refuse to prescribe them due to liability concerns. What will happen to people who opted for this quick fix? They won’t just be back to where they started from, but worse off – because it will be even harder for them to lose the excess weight they’ve carried for a very long time.
The quick fix is never a real fix. It just postpones doing the things that have been proven to improve health – changing thinking patterns, adopting new diet and lifestyle habits, and taking responsibility for self. (Pam Popper, Wellness Forum Health)
According to a systematic review and meta-analysis that included 42 studies and almost 47,000 patients, cancer patients with high levels of muscle strength and cardiorespiratory fitness (CRF) had a lower risk from death from any cause. This relationship held true even for patients with advanced-stage cancers. All-cause mortality decreased by as much as 46% for patients who were fit, when compared with patients who were weaker and had lower CRF.
The authors wrote: "Assessing physical fitness, particularly muscle strength and CRF, is crucial for predicting mortality in cancer patients. Implementing tailored exercise prescriptions to enhance these physical fitness components throughout the cancer continuum may contribute to reducing cancer-related mortality."[1]
An even larger systematic review and meta-analysis included 12 studies with 1.3 million cancer patients and examined the relationship between muscle strength, CRF and cancer mortality. This review showed that muscle strengthening activities were associated with a 13% lower risk of mortality, and that mortality was even lower - 28% - when aerobic activity was included.
The authors wrote that this was likely based on several mechanisms:
Changes in body composition which lowered body fat. Excessive body fat is a risk factor for cancer.
Higher body fat also contributes to insulin resistance, which in turn leads to higher levels of insulin-like growth factor (IGF-1). Insulin and IGF-1 can increase cell proliferation and reduce cellular apoptosis.
Weight loss: obesity is correlated with negative changes to the intestinal microbiome, which results in increased production of pro-inflammatory molecules and hormones including estrogen.
Strength training increases muscle mass, which improves glucose control and improves immune function.
Physical activity improves circulation which reduces hypoxic environments in which tumors can thrive.[2]
A large body of evidence from many sources supports exercise as an integral part of a strategy for surviving cancer. Kelly Turner is the author of Radical Remission : Surviving Cancer Against All Odds. The book resulted from her interviews with almost one thousand patients with advanced cancer who survived. While they collectively used dozens of strategies, they all used nine, which were described in detail in the book. She subsequently started the Radical Remission Project to train coaches, conduct research, and gather even more survival stories. After she and her team worked with cancer patients for a few years, she added exercise and movement as the tenth important strategy that increases survival.
Many cancer patients are unhealthy and lack fitness at the time of diagnosis. Instead of encouraging them to improve their health and become fit, oncologists often insist that diet has nothing to do with cancer risk or survival, and many discourage physical activity, instead advising patients to rest. Friends and family often agree.
This was the case for Ruth Heidrich, one of the reality patients who appeared in the hit film Forks Over Knives. Ruth was diagnosed with metastasized breast cancer in her 40s. She not only survived, but thrived thanks to adopting a plant-based diet as recommended by Dr. John McDougall, and vigorous exercise. She said in the film that her friends were telling her, "Ruth, you’re a cancer patient, you should be resting." She responded, "I just knew that if I built a strong body, I could beat this." And she did, going on to compete in triathlons and run marathons well into her 80s.
Pam Popper, President
Wellness Forum Health
[1] Bettariga F, Galvao D, Taaffe D et al. "Association of muscle strength and cardiorespiratory fitness with all-cause and cancer-specific mortality in patients diagnosed with cancer: a systematic review and meta-analysis." Br J Sports Med 2025 Jan; published online ahead of print
[2] Nascimento W, Ferrari G, Martins CB et al. "Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies." Int J Behav Nutr Phys Act 2021 May;18:69
An article posted on Medscape compared the results of plant-based eating, bariatric surgery, and drugs like GLP-1 inhibitors for weight loss to determine which option led to the most long-lasting results. The clear winner: plant-based eating.[1] The article included data from several studies to support this conclusion. A systematic review and meta-analysis showed that 49% of patients who underwent bariatric surgery regained at least some of the weight they lost, and many patients regained a significant amount of weight. Those who were the worst off had Roux-en-Y bypass surgery, with 64% of those patients regaining weight.[2] I’ve written before about the dismal results for GLP-1 inhibitors, and the author of the Medscape article shares my concerns. One trial showed that patients taking the drugs lost weight, but one year after discontinuation, participants regained 2/3 of their weight back.[3] This is not surprising. Permanent weight loss can only take place when people commit to changing their habits, when they learn to make time for self-maintenance, and when they develop a normal relationship with food. Obviously, drugs cannot and do not result in these types of changes. Additionally, the side effects are heinous. Side effects include low blood sugar, nausea, heartburn, vomiting, stomach pain, diarrhea, constipation, sore throat, symptoms of stomach flu, dizziness, thoughts about self-harm, signs of thyroid tumor-like swelling or lump in the neck or trouble swallowing, symptoms of pancreatitis, gall bladder disease, kidney disease, and stomach paralysis.[4] The meds increase the risk for vision loss, which is not usually regained after discontinuation.[5] All of this sounds dismal, but there is a much better way to lose weight – plant-based eating, as the Medscape author concludes. A five-year study led by Dean Ornish, and published in 1998 compared a group of patients who consumed a plant-based diet, engaged in aerobic exercise, received training in stress management, and who had group support with a usual-care control group. The plant-based group lost almost 24 pounds at the end of one year and kept over half of it off 5 years after the intervention. The control group experienced worsening health with continued progression of coronary atherosclerosis.[6] Another study compared outcomes for patients who were obese or overweight with at least one comorbidity. One group consumed a low-fat whole food plant-based diet while the other received standard care. At 6 months, BMI reduction for the plant-based group was 4.4 vs 0.4 for the standard care group.[7] Other studies have shown similar results,[8] [9] and many report not only weight loss, but lower plasma cholesterol, lower blood pressure, reduced fasting glucose levels and other improvements in markers of health. These studies are over 20 years old, and none of them included portion control, which people do not like and almost never maintain. We don’t need more research; rather we just need to pay more attention to the existing body of evidence for guidance on how to help patients lose weight and improve their health. A major impediment is that there is so much less money to be made teaching people how to eat plants than there is in making, distributing and prescribing drugs. This can be changed, however, by forcing medical institutions and health professionals to follow informed consent laws. There are two ways to accomplish this; one is to teach patients to demand objective information from their providers BEFORE making any health-related decisions in non-emergency situations. We teach our members to do this on their own since real INFORMED discussions rarely take place in medical offices. The other option is lawsuits against health professionals and institutions that do not do this. If failure to make informed consent an integral part of medical care becomes expensive enough, providers and institutions likely will change. In the meantime, here is what a doctor SHOULD tell an overweight or obese patient about his/her situation and choices. "I’m concerned about your weight, because it places you at significantly higher risk of coronary artery disease, cancer, diabetes, musculoskeletal disorders, and premature death. I strongly encourage you to do something about this before it gets worse. There are three options. I’ll tell you about each and then send you home with some written material to study. #1: Bariatric surgery. There are significant side effects, and you will likely gain back some or all of the weight you lose. You will suffer from severe nutritional deficiencies that cannot be resolved with supplements. You will eat tiny amounts of food for the rest of your life and if you revert to eating larger portions you will feel sick for a while, stretch out the stomach again, and end up back where you started from. #2 Weight loss drugs, like GLP-1 inhibitors. Side effects include low blood sugar, nausea, heartburn, vomiting, stomach pain, diarrhea, constipation, sore throat, symptoms of stomach flu, dizziness, thoughts about self-harm, signs of thyroid tumor-like swelling or lump in the neck or trouble swallowing, symptoms of pancreatitis, gall bladder disease, kidney disease, and stomach paralysis. If you stop taking the drugs, you’ll likely regain most if not all of the weight you lost, and the side effects may not go away. #3 I can teach you how to eat delicious, low-fat plant food 3-6 times per day – as much as you want of it. You’ll need to invest some time in learning how to do it right, and how to shop and cook. You’ll have to change your mindset about food, and perhaps address psychological issues that cause you to overeat. But if you do this and stick with it, you’ll achieve normal weight, and if you are taking drugs for conditions like blood pressure and type 2 diabetes, you will probably be able to discontinue them. Which would you like to do?" I think most people would choose option three. From Pam Popper, President Wellness Forum Health [1] Betya Swift Yasgur. Nutrition, Drugs, or Bariatric Surgery: What’s the Best Approach for Sustained Weight Loss? Medscape Jan 10 2025 https://www.medscape.com/ [2] Reis MG, Guimaraes LF, Moreira G et al. "Weight regain after bariatric surgery: A systematic review and meta-analysis of observational studies." Obesity Med 2024 Jan;45:100528 [3] Wilding JPH, Batterham RL, Davies M et al. "Weight regain and cardiometabolic effects after withdrawal of semaglutude." Diab, Obes, Metab 2022 Apr;24(8):1553-1564 [4] https://www.drugs.com/ozempic. [5] Hathaway JT, Shah MP, Hathaway DB. Et al. "Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglitude." JAMA Ophthalmol 2024 Jul;142(8):732-739 [6] Ornish D, Scherwitz LW, Billings JH et al. "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease." JAMA 1998;280(23):2001-2007 [7] Wright N, Wilson L, Smith M, Duncan B, McHugh P. "The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes." Nutr Diabetes 2017 Mar;7(3):e256 [8] Barnard N, Scialli A, Turner-McGrievy G, Lanou A, Glass J. "The effects of a low-fat, plant-based dietary intervention on body weight, metabolism and insulin sensitivity." Am J Med Sept 2005;118(9):991-997 [9] Barnard N, Scialli A, Turner-McGrievy G, Lanou A, Glass J. "The effects of a low-fat, plant-based dietary intervention on body weight, metabolism and insulin sensitivity." Am J Med Sept 2005;118(9):991-997 |
The Centers for Medicare and Medicaid Services (CMS) 2022 National Quality Strategy is described as an "ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals." This sounds great, and it would be if there were any possible way for this initiative to fulfill its promise. But, as with many programs operated by the government, high-quality outcomes are not likely to occur..
Most doctors and most patients know that diet, exercise, hydration, sleep, and other lifestyle factors are important determinants of health. Clinical practice guidelines for many conditions include recommendations that diet and lifestyle intervention should be the first and is the best treatment. Many studies have shown that type-2 diabetes can be reversed with a whole food plant-based diet (WFPB).[1] [2] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events, even in people who have been diagnosed with severe coronary artery disease.[3] [4]
So why aren’t more doctors spending more time during office visits to discuss these types of health improvement strategies with their patients? The answer might surprise you. Quality measures used to evaluate the performance of doctors and reimbursement schedules do not take into consideration issues such as improved health outcomes and reduced costs of care. For example, adherence to medication is rewarded, even if the patient does not experience any health improvement at all. Diet and lifestyle education requires more time than most medical institutions allocate for patient visits, which further incentivizes prescribing instead of engaging in meaningful discussions about health.
Thus, in most cases, patients are not informed about diet and lifestyle change as an option or an alternative to medication. A commonly held misconception is that most Americans would rather just take a pill than change their diet and increase their exercise. But the reality is that this choice, along with the risks and benefits of both options, is not presented to most patients most of the time.
Lifestyle medicine is now a medical specialty, and since certification began in 2017, 2500 physicians have become board-certified. In addition to the limitations already mentioned, a survey found that over half of lifestyle medicine clinicians receive no reimbursement for offering such services. And some programs that are eligible for reimbursement offer so little money that clinicians cannot afford to spend time on them.[5]
One program that is reimbursed adequately is intensive cardiac rehabilitation. It’s underutilized and one of the reasons may be that patients are required to co-pay for visits. For the program to work, visits need to be scheduled frequently, increasing the expense to patients, and creating yet another barrier to real health improvement.
One of the best illustrations of just how dysfunctional the current system has become is what happened to a lifestyle medicine family practice physician who prescribed lifestyle change instead of a statin drug to a patient with hyperlipidemia. Within just three weeks, total cholesterol dropped from 226 mg/dl to 171 mg/dl and triglycerides dropped from 132 mg/dl to 75 mg/dl. This was obviously a great outcome for the patient. But the CMS 5-Star Rating System assigned the physician a Grade C, which placed the doctor’s previous 5-star rating at risk. The reason was that scores are largely based on medication compliance. The physician was penalized even though the outcome was much better than would be expected from treatment with a statin.[6]
There are other ways the system can punish doctors for curing people. The sicker the patient, the higher the reimbursement rate from Medicare, because it is assumed that care will cost more. The physician who reverses type 2 diabetes with diet is penalized because diabetes is no longer listed as a condition the patient has, so Medicare pays the doctor less money. In other words, Medicare pays doctors to manage, not reverse disease.[7]
There are now over 2500 quality measures for doctors to pay attention to, and curing people is not one of them. This sad state of affairs reinforces our advice that consumers must take responsibility for their health and should not outsource decisions about treatment to their doctors.
[1] Anderson JW. "Dietary fiber in nutrition management of diabetes." In: G. Vahouny, V and D Kritchevsky (eds), Dietary Fiber: Basic and Clinical Aspects." Pp.343-360. New York: Plenum Press,1986.
[2] De Natale C, Annuzzi G, Bozzetto L et al. "Effects of a Plant-Based High-Carbohydrate/High-Fiber Diet Versus High–Monounsaturated Fat/Low-Carbohydrate Diet on Postprandial Lipids in Type 2 Diabetic Patients." Diabetes Care 2009 Dec;32(12):2168-2173
[3] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[4] Esselstyn CB, Ellis SG, Mendendorp SV, Crowe TD. "A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physicians’ practice." J Fam Practice 1995 Dec;41(6):560-568
[5] Padmaja Patel MD. How PCPs Are Penalized for Positive Outcomes From Lifestyle Change. Medscape October 13 2023
[6] IBID
[7] IBID
Pam Popper Wellness Forum Health
There are many misunderstandings about the ketogenic diet, ranging from the conditions for which it can be useful to the right way to adopt it. Many people claim to be eating a ketogenic diet who are not doing so, and many of the claims currently being made about the diet are patently false. The ketogenic diet is a high-fat, low-carbohydrate diet that has been used since 1921 as an effective treatment for several forms of epilepsy. While primarily used for children, there is some evidence that some epileptic adults may benefit too. The best experts on the diet are at Johns Hopkins Children’s Center. The mechanism of action that explains the efficacy of the ketogenic diet is that it mimics a fasting state, and fasting has been known to be an effective treatment for seizures since ancient times.[1] Within a short time after beginning a fast, the body stops using glucose and converts to using stored fat for fuel, a state known as ketosis. During ketosis, ketones are produced, which are useable as a substitute source of energy for both the body and brain. The ketogenic diet results in the same effect. Restricted carbohydrate intake results in burning dietary fat for fuel, which allows for an extended period of time in a fasting state. Fat stores are used up within a relatively short period time, while living off of dietary fat intake can continue for much longer periods of time. Research shows that the diet works when implemented properly. A 2001 study at Johns Hopkins showed that 75 out of 83 epileptic children who consumed a ketogenic diet for a year had either partial or full resolution of their symptoms and improvement was sustained after stopping the diet.[2] In another study, 65 epileptic children between 18 and 24 months of age were assessed before starting and after one year on the diet. For those who remained on the diet (52%), mean seizure frequency decreased from an average of 25 seizures per day prior to the diet to less than 2 per day, and was accompanied by significant improvements in both attention and social functioning.[3] A meta-analysis of 11 studies showed that 16% of children experienced complete resolution of seizures, 32% experienced a 90% reduction, and 56% had a greater than 50% reduction in seizures.[4] While ketogenic diets can be effective, there are side effects. One study of pediatric patients treated with the Johns Hopkins protocol showed that during the first 4 weeks, dehydration and gastrointestinal complications were common, and infectious diseases, aspiration pneumonia, hyperuricemia, hypoglycemia, electrolyte imbalances, acidosis, hepatitis, and acute pancreatitis have been reported. After 4 weeks, patients remain prone to all of these complications except dehydration, pancreatitis, and hyponatremia. In almost 15% of patients, osteopenia, kidney stones, hydronephrosis, iron deficiency anemia, and cardiomyopathy developed after one month in ketosis. Some patients dropped out of the study due to the side effects of the diet.[5] Vomiting, constipation, kidney stones and an increase in plasma cholesterol are common. Kidney stones can be prevented by supplementing with potassium citrate, and cholesterol levels return to normal after the diet is stopped.[6] The bottom line is that while the diet is effective for most children who adopt it, there are side effects, and patients must be carefully monitored while using the diet for medical treatment. The diet is only adopted for a short period of time, and for many parents of epileptic children, the benefits outweigh the risks since drugs used to treat epileptic children are often ineffective and have even more side effects. Interest in ketogenic diets has increased recently, in part because of the positive effects fasting has been shown to have on cancer patients. Animal studies have shown that fasting is effective for reducing the side effects of chemotherapy, and for decreasing circulating IGF-1 levels, a known risk for cancer.[7] The same effect has been shown in human subjects.[8] Fasting can be an effective strategy for both preventing and treating cancer because cancer cells are weakened and normal cells are strengthened in response to food restriction.[9] The reason is that humans have historically lived for long periods of time with limited food and sometimes no food at all. Normal cells are adept at surviving under these circumstances, converting to burning ketones for fuel, while cancer cells cannot live on ketones. Water-only fasting can be undertaken by many people for a few weeks, and obese people can fast for several months. But people cannot fast indefinitely, and some aggressive cancers, particularly brain cancers like glioblastoma, do not completely resolve after a few weeks of fasting. Traditional treatments are notoriously ineffective for these patients, who have grim prognoses and usually only a few months to live after diagnosis. Thomas Seyfried, Ph.D., has spent his career studying the use of metabolic therapies to manage mainly chronic and difficult-to-treat conditions like epilepsy and brain cancer. In his book, Cancer as a Metabolic Disease, he provides extensive documentation showing that cancer is not a genetic disease, but rather a mitochondrial metabolic disease. This is not a new idea, but one that was largely forgotten as very profitable cancer treatments such as surgery, chemotherapy and radiation became standard practices. He proposes the use of several therapies which include calorie restriction, fasting, and a ketogenic diet for addressing difficult-to-treat cancers. He presented a lecture on this topic during our 2016 conference, citing a few case reports, one of whom was a woman who lived for 7 ½ years after her diagnosis, almost unheard of for glioblastoma patients. And this brings me to the current misunderstandings about the ketogenic diet, which originate both from those who advocate a plant-based diet and those who promote Paleo and other diets. First, the Paleo diet and the Atkins diet are not ketogenic diets. Just eating animal foods while restricting grains and beans, or eating a high-saturated fat diet will not result in ketosis, which is required for the diet to have any therapeutic effect. A ketogenic diet requires the assistance of well-trained professionals because the macronutrient make-up of the diet must be exact and consistently maintained. A keto monitor is required, and patients must test themselves several times per day to make sure they remain in ketosis. Second, due to the side effects of the diet, some of which are quite serious, the ketogenic diet should only be adopted by patients for whom the benefits outweigh the risks. For example, a glioblastoma patient with only a few months to live is better off staying alive while taking potassium supplements to avoid kidney stones than dying with low plasma cholesterol levels. On the other hand, the risks of side effects from the ketogenic diet are not warranted for a person who wants to lose weight or reverse type 2 diabetes. Low-fat, plant-based diets have been proven to be effective for these purposes without the negative side effects. On the other hand, advocates of plant-based diets can become almost apoplectic when the ketogenic diet is mentioned for treatment. A diet high in fat and that restricts healthy carbohydrate foods like potatoes seems like heresy to them. They think that a very low-fat plant-based diet is the answer for everything. It’s the answer for a lot of things, but not everything. Those who take this stance - a one-size-fits-all approach to treating patients - are both practicing reductionism and abandoning the use of clinical judgment, which is desperately needed in the practice of medicine today. People are not all the same, and their age, limitations, medical history and current state of health must all be considered when making any health-related recommendations, including those concerning diet. Dietary advice must be tailored to the particular condition of the patient, and often must be combined with other treatments that include dietary supplements, cognitive therapy, exercise, physical therapy, and some conventional treatment. It is important to avoid dogmatic adherence to ideas, and to think outside the box as we seek solutions for our healthcare crisis. In summary, the ketogenic diet is an option to be considered for very specific situations for a very small percentage of people. It requires a rigorous and disciplined approach in order to be effective, and almost always involves hiring an expert for assistance. The diet has serious side effects, which should be disclosed to patients before adopting the diet, and which make it a good choice only when the potential therapeutic benefit outweighs the risks. [1] Huffman J, Kossoff E. "State of the ketogenic diet(s) in epilepsy." Curr Neurol Neurosci Rep 2006 Jul;6(4):332-340 [2] Freeman J, Kossoff E. "Ketosis and the ketogenic diet, 2010: advances in treating epilepsy and other disorders." Adv Pediatr 2010;57(1):315-329 [3] Pulsifer M, Gordon J, Brandt J, Freeman J. "Effects of ketogenic diet on development and behavior: Preliminary report of a prospective study." Dev Med Child Neurol 2001 May;43(5):301-6. [4] Lefevre F, Aronson N. "Ketogenic Diet for the Treatment of Refractory Epilepsy in Children: A Systematic Review of Efficacy." Pediatrics 2010 Apr;105(4) [5] Kang H, Chung D, Kim D, Kim H. "Early- and late-onset complications of the ketogenic diet for intractable epilepsy." Epilepsia 2004 Sep;45(9):1116-1123 [6] Freeman J, Kossoff E. "Ketosis and the ketogenic diet, 2010: advances in treating epilepsy and other disorders." Adv Pediatr 2010;57(1):315-329 [7] Lee C, Safdie FM, Raffaghello L, et al. "Reduced levels of IGF-I mediate differential protection of normal and cancer cells in response to fasting and improve chemotherapeutic index." Cancer Res 2010 Feb 15;70(4):1564-72 [8] Safdie F, Dorff T, Quinn D et al. "Fasting and cancer treatment in humans: A case series report." Aging (Albany NY) 2009 Dec; 1(12): 988–1007. [9] Brandhorst S, Longo V. "Fasting and Caloric Restriction in Cancer Prevention and Treatment." Recent Results Cancer Res 2016;207:241-266 |
