Being a member of and representing Wellness Forum Health gives me access to a plethora of vetted and researched science, such as how to accurately read and interpret medical and scientific information, and how to make choices about food. I also have learned how to avoid "majoring in the minors," or focusing on things that make no difference. It’s sometimes difficult to avoid falling into this trap since sensational claims about ingredients used in processed foods make headlines and help marginal people to develop a following quickly. A good example is the focus on minor ingredients in processed foods, like carrageenan, which is found in products like plant milks, yogurt, and frozen pizzas and burritos. I have often wondered about that ingredient and it's nice to have researched information. If you think that carrageenan or any other substance is causing you distress, then avoid it. But the amount that is added in processed foods is minimal, and processed foods should not be a major part of your diet.
Carrageenan is a polysaccharide extracted from red edible seaweed called Irish moss. It has no nutritional value but is used in food manufacturing as a gelling, thickening, and stabilizing agent. Carrageenan is commonly found in processed foods like ice cream, yogurt, soy and other plant milks. The product has only been called "carrageenan" since 1889, but carrageenan has been used under different names as an ingredient in cold and flu remedies and as a gelling agent in foods going back to 400 AD.
There is some debate about the safety of carrageenan, mainly due to misreporting and taking research findings out of context. Some researchers have reported that carrageenan causes inflammation, ulceration, colitis, and colorectal tumors in animal experiments. But there are reasons to question the conclusions of some of these researchers, and their claims have never been validated in human studies. One reason why carrageenan is not likely to be harmful to humans is it is not broken down through the digestive process and therefore its constituents cannot be absorbed through the intestinal tract.
Carrageenan is different than its degraded byproduct, which is called poligeenan, a processed form of carrageenan consisting of small molecular fragments that can be absorbed into the bloodstream. Part of the misunderstanding about carrageenan is that some have assumed that digestion would break carrageenan down into poligeenan, but this is not true because most mammals, including humans, lack the enzymes to facilitate this process. Carageenan is not degraded by stomach pH or by the microflora in the GI tract.
Some of the fear about carrageenan is based on several animal and in vitro studies conducted by various research groups at the University of Chicago headed by Dr. Joanne Tobacman, which concluded that carrageenan causes intestinal inflammation, colonic carcinogenesis, glucose intolerance, and insulin resistance.[1] [2] [3] [4] Tobacman and her colleagues also wrote a paper based on a time trend analysis in which they reported a correlation between the increased intake of carrageenan and the increased incidence of breast cancer. It is easy to establish correlation, but carefully conducted research establishes cause and effect relationships for only a small percentage of correlations. In fact the authors acknowledged the limitations of their analysis when they wrote, "although time-trend correlations represent a weak form of evidence, when significant positive correlations are found, they can support further evaluation."[5] The European Commission Scientific Committee for Food reviewed Tobacman’s findings and concluded that they "…did not support the hypothesis that breast cancer may be causally related to intakes of carrageenan..." and that "..such correlations might be found for any dietary component or chemical to which there has been increasing exposure during the twentieth century."[6]
Other criticisms of Tobacman’s research include that the studies involved in vitro cell lines and animals, and her group’s findings were different than other peer reviewed studies showing that carrageenan does not cause the health issues her group identified. For example, the only side effects of feeding rodents diets with 5% carrageenan were loose stools and diarrhea, and it would be difficult for a human to consume this much carrageenan.[7] Another study that involved administering both low and high doses of carrageenan to rats showed that there were no treatment-related effects on urinalysis, hematology, organ weights, ophthalmic, macroscope or microscope findings for either low-dose or high-dose rats, and the gastrointestinal tract of the rats remained normal.[8] And many say that Tobacman’s is confusing the toxicity of poligeenan with carrageenan when these are actually two different substances.[9]
There are several other criticisms of carrageenan research in general, including study design. In addition to using poligeenan, studies have involved giving carrageenan to animals in drinking water. This results in more exposure of the intestinal mucosa to carrageenan than when it is bound to protein in food. Another issue is the amounts of it used in some studies. In many, animals were given over 1000 mg/kg/d, considerably more than the 18-40 mg/kg/day commonly consumed by humans.[10]
A group headed by James McKim conducted research to determine if Tobacman’s findings were valid. His group looked at each effect identified by her group using the same cell lines and adding controls. McKim’s group also increased the concentrations of carrageenan and the number of exposures, and reported that they were unable to replicate the Chicago group’s results. The findings of McKim’s group are in alignment with the majority of studies showing that carrageenan is not broken down during digestion or by gut bacteria, and is not absorbed in the intestines. They hypothesize that impurities in or contamination of carrageenan in the Chicago group’s studies may have been responsible.[11]
McKim’s research was funded by the International Food Additives Council and the FMC Corporation, both of which have a vested interest in showing that carrageenan is safe. However, there are mitigating factors that reinforce the validity of McKim’s research findings. First, carrageenan is considered safe by regulatory agencies in other parts of the world that generally have much more stringent criteria for evaluation than U.S. regulatory agencies, including the European Parliament and Council, and The Food and Agriculture Organization Expert Committee on Food Additives.[12] The World Health Organization Joint Expert Committee on Food Additives looked at the use of carrageenan in infant formula and concluded that "…the use of carrageenan in infant formula or formula for special medical purposes at concentrations up to 1000 mg/L is not of concern."[13] And many independent and non-industry backed research groups have concluded that carrageenan is safe.
In spite of this, the public remains confused, mainly because research findings like Tobacman’s, some of which have not been replicated by other groups, and some of which involve pure speculation, are taken out of context. At this time, I do not think that evidence supports the need to avoid carrageenan when used as an additive in foods.
Carrageenan is a polysaccharide extracted from red edible seaweed called Irish moss. It has no nutritional value but is used in food manufacturing as a gelling, thickening, and stabilizing agent. Carrageenan is commonly found in processed foods like ice cream, yogurt, soy and other plant milks. The product has only been called "carrageenan" since 1889, but carrageenan has been used under different names as an ingredient in cold and flu remedies and as a gelling agent in foods going back to 400 AD.
There is some debate about the safety of carrageenan, mainly due to misreporting and taking research findings out of context. Some researchers have reported that carrageenan causes inflammation, ulceration, colitis, and colorectal tumors in animal experiments. But there are reasons to question the conclusions of some of these researchers, and their claims have never been validated in human studies. One reason why carrageenan is not likely to be harmful to humans is it is not broken down through the digestive process and therefore its constituents cannot be absorbed through the intestinal tract.
Carrageenan is different than its degraded byproduct, which is called poligeenan, a processed form of carrageenan consisting of small molecular fragments that can be absorbed into the bloodstream. Part of the misunderstanding about carrageenan is that some have assumed that digestion would break carrageenan down into poligeenan, but this is not true because most mammals, including humans, lack the enzymes to facilitate this process. Carageenan is not degraded by stomach pH or by the microflora in the GI tract.
Some of the fear about carrageenan is based on several animal and in vitro studies conducted by various research groups at the University of Chicago headed by Dr. Joanne Tobacman, which concluded that carrageenan causes intestinal inflammation, colonic carcinogenesis, glucose intolerance, and insulin resistance.[1] [2] [3] [4] Tobacman and her colleagues also wrote a paper based on a time trend analysis in which they reported a correlation between the increased intake of carrageenan and the increased incidence of breast cancer. It is easy to establish correlation, but carefully conducted research establishes cause and effect relationships for only a small percentage of correlations. In fact the authors acknowledged the limitations of their analysis when they wrote, "although time-trend correlations represent a weak form of evidence, when significant positive correlations are found, they can support further evaluation."[5] The European Commission Scientific Committee for Food reviewed Tobacman’s findings and concluded that they "…did not support the hypothesis that breast cancer may be causally related to intakes of carrageenan..." and that "..such correlations might be found for any dietary component or chemical to which there has been increasing exposure during the twentieth century."[6]
Other criticisms of Tobacman’s research include that the studies involved in vitro cell lines and animals, and her group’s findings were different than other peer reviewed studies showing that carrageenan does not cause the health issues her group identified. For example, the only side effects of feeding rodents diets with 5% carrageenan were loose stools and diarrhea, and it would be difficult for a human to consume this much carrageenan.[7] Another study that involved administering both low and high doses of carrageenan to rats showed that there were no treatment-related effects on urinalysis, hematology, organ weights, ophthalmic, macroscope or microscope findings for either low-dose or high-dose rats, and the gastrointestinal tract of the rats remained normal.[8] And many say that Tobacman’s is confusing the toxicity of poligeenan with carrageenan when these are actually two different substances.[9]
There are several other criticisms of carrageenan research in general, including study design. In addition to using poligeenan, studies have involved giving carrageenan to animals in drinking water. This results in more exposure of the intestinal mucosa to carrageenan than when it is bound to protein in food. Another issue is the amounts of it used in some studies. In many, animals were given over 1000 mg/kg/d, considerably more than the 18-40 mg/kg/day commonly consumed by humans.[10]
A group headed by James McKim conducted research to determine if Tobacman’s findings were valid. His group looked at each effect identified by her group using the same cell lines and adding controls. McKim’s group also increased the concentrations of carrageenan and the number of exposures, and reported that they were unable to replicate the Chicago group’s results. The findings of McKim’s group are in alignment with the majority of studies showing that carrageenan is not broken down during digestion or by gut bacteria, and is not absorbed in the intestines. They hypothesize that impurities in or contamination of carrageenan in the Chicago group’s studies may have been responsible.[11]
McKim’s research was funded by the International Food Additives Council and the FMC Corporation, both of which have a vested interest in showing that carrageenan is safe. However, there are mitigating factors that reinforce the validity of McKim’s research findings. First, carrageenan is considered safe by regulatory agencies in other parts of the world that generally have much more stringent criteria for evaluation than U.S. regulatory agencies, including the European Parliament and Council, and The Food and Agriculture Organization Expert Committee on Food Additives.[12] The World Health Organization Joint Expert Committee on Food Additives looked at the use of carrageenan in infant formula and concluded that "…the use of carrageenan in infant formula or formula for special medical purposes at concentrations up to 1000 mg/L is not of concern."[13] And many independent and non-industry backed research groups have concluded that carrageenan is safe.
In spite of this, the public remains confused, mainly because research findings like Tobacman’s, some of which have not been replicated by other groups, and some of which involve pure speculation, are taken out of context. At this time, I do not think that evidence supports the need to avoid carrageenan when used as an additive in foods.
[1] Bhattacharyya S, Xue L, Devkota S, Change E, Morris S, Tobacman J. "Carrageenan-induced colonic inflammation is reduced in Bcl10 null mice and increased in IL-10-deficient mice." Mediators Inflamm 2013’2013:397642
[2] Bhattacharyya S, O-Sullivan I, Katyal S, Unterman T, Tobacman J. "Exposure to the common food additive carrageenan leads to glucose intolerance, insulin resistance and inhibition of insulin signaling in HepG2 cells and C57BL/67 mice." Diabetologia 2012 Jan;55(1):194-203
[3] Battacharyya S, Feferman L, Borthakur S, Tobacman J. "Common food additive carrageenan stimulates Wnt/ β-catenin signaling in colonic epithelium by inhibition of nucleoredoxin reduction." Nutr Cancer 2014;66(1):117-127
[4] Battachyyra S, Dudeja P, Tobacman J. "Tumor necrosis factor alpha-induced inflammation is increased but apoptosis is inhibited by common food additive carrageenan." J Biol Chem 2010 Dec 10;285(50):39511-22
[5] Tobacman J, Wallace R, Zimmerman M. "Consumption of carrageenan
and other water-soluble polymers used as food additives and incidence of mammary carcinoma." Medical Hypotheses 2001a;56(5):589-598
[6] Scientific Committee on Food.(2003a) Opinion of the Scientific Committee on Food
on carrageenan. Brussels: European Commission; 5 March.
(SCF/CS/ADD/EMU/199 Final).
[7] Weiner M. "Food additive carrageenan: Part II: A critical review of carrageenan in vivo safety studies."
Critical Reviews in Toxicology 2014;44(3)
[8] Weiner M, Nuber D, Blakemore W, Harriman J, Cohen S. "A 90-day dietary study on kappa carrageenan with emphasis on the gastrointestinal tract." Food Chem Toxicol. 2007 Jan;45(1):98-106..
[9] Cohen S, Ito N. A critical review of the toxicological effects of carrageenan and processed eucheuma seaweed on the gastrointestinal tract." Crit Rev Toxicol 2002 Sept;32(5):413-44
[10] Weiner M. "Food additive carrageenan: Part II: A critical review of carrageenan in vivo safety studies."
Critical Reviews in Toxicology 2014;44(3)
[11] McKim J, Baas H, Rice G, Willoughby J, Weiner M, Blakemore W. "Effects of carrageenan on cell permeability, cytotoxicity, and cytokine expression in human intestinal and hepatic cell lines." Food and Chemical Toxicology October 2016;96:1-10
[12] http://www.naturalproductsinsider.com/blogs/formulating-foods/2014/07/fao-who-carrageenan-safe-in-infant-formula.aspx
[13] Joint FAO/WHO Expert Committee on Food Additives (JEFCA) 2015 "Safety evaluation of certain food additives, WHO Food Additives Series: 70."
Prepared by the Seventy-ninth Meeting of the Joint FAO/WHO Expert Committee on Food Additives (2015) http://apps.who.int/iris/bitstream/10665/171781/3/9789240693982_eng.pdf?ua=1
[2] Bhattacharyya S, O-Sullivan I, Katyal S, Unterman T, Tobacman J. "Exposure to the common food additive carrageenan leads to glucose intolerance, insulin resistance and inhibition of insulin signaling in HepG2 cells and C57BL/67 mice." Diabetologia 2012 Jan;55(1):194-203
[3] Battacharyya S, Feferman L, Borthakur S, Tobacman J. "Common food additive carrageenan stimulates Wnt/ β-catenin signaling in colonic epithelium by inhibition of nucleoredoxin reduction." Nutr Cancer 2014;66(1):117-127
[4] Battachyyra S, Dudeja P, Tobacman J. "Tumor necrosis factor alpha-induced inflammation is increased but apoptosis is inhibited by common food additive carrageenan." J Biol Chem 2010 Dec 10;285(50):39511-22
[5] Tobacman J, Wallace R, Zimmerman M. "Consumption of carrageenan
and other water-soluble polymers used as food additives and incidence of mammary carcinoma." Medical Hypotheses 2001a;56(5):589-598
[6] Scientific Committee on Food.(2003a) Opinion of the Scientific Committee on Food
on carrageenan. Brussels: European Commission; 5 March.
(SCF/CS/ADD/EMU/199 Final).
[7] Weiner M. "Food additive carrageenan: Part II: A critical review of carrageenan in vivo safety studies."
Critical Reviews in Toxicology 2014;44(3)
[8] Weiner M, Nuber D, Blakemore W, Harriman J, Cohen S. "A 90-day dietary study on kappa carrageenan with emphasis on the gastrointestinal tract." Food Chem Toxicol. 2007 Jan;45(1):98-106..
[9] Cohen S, Ito N. A critical review of the toxicological effects of carrageenan and processed eucheuma seaweed on the gastrointestinal tract." Crit Rev Toxicol 2002 Sept;32(5):413-44
[10] Weiner M. "Food additive carrageenan: Part II: A critical review of carrageenan in vivo safety studies."
Critical Reviews in Toxicology 2014;44(3)
[11] McKim J, Baas H, Rice G, Willoughby J, Weiner M, Blakemore W. "Effects of carrageenan on cell permeability, cytotoxicity, and cytokine expression in human intestinal and hepatic cell lines." Food and Chemical Toxicology October 2016;96:1-10
[12] http://www.
[13] Joint FAO/WHO Expert Committee on Food Additives (JEFCA) 2015 "Safety evaluation of certain food additives, WHO Food Additives Series: 70."
Prepared by the Seventy-ninth Meeting of the Joint FAO/WHO Expert Committee on Food Additives (2015) http://apps.who.int/iris/
Diet and Type-2 Diabetes StudyAccording to the Centers for Disease Control (CDC), 13% of U.S. adults have diabetes. Incidence increases with age and reaches 26.8% for Americans aged 65 years or older.[1] Almost all healthcare providers agree that diet is important for managing diabetes and for reducing the risk of co-morbidities which include cardiovascular disease and related events. Unfortunately, research shows that a minority of diabetics achieve glycemic control with diet.
A recent study might provide some inspiration for type-2 diabetics to pay more attention to diet. Participants in this nonrandomized crossover study were adults who had type 2 diabetes, required insulin, had a BMI of at least 27, and A1C levels between 6.5 and 9.5.
Fifteen participants were enrolled in a 4-week trial with sequential one-week phases:
Baseline, Dash 1, WFPB and a second week of the DASH diet
The diets were all ad libitum (subjects could eat as much as they wanted) and meals were provided.
First, a description of the two intervention diets:
Dietary Approaches to Stop Hypertension (DASH) does not require the elimination of any food but rather emphasizes consumption of more fruit, vegetables, whole grains, and low-fat dairy, while intake of saturated fat and sugar are reduced.
A whole foods plant-based diet (WFPB) emphasizes beans, whole grains, and fruits and vegetables; and minimizes or excludes animal foods, added fats, and added sugars.
Both diets have been shown in previous studies to lower blood pressure,[2] [3] plasma cholesterol,[4] [5] and blood sugar.[6] [7] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events in people who have been diagnosed with severe coronary artery disease.[8] [9]
Results:
Twelve of the fifteen subjects completed the study. One subject dropped out due to an unexpected surgery; one due to a car accident; and one subject started a new job and could not continue the weekly assessments.
Total calories were lower during all three intervention phases as compared to the baseline diet. By the end of the DASH 1 phase, total daily insulin requirements were 24% lower than baseline. By the end of the WFPB phase, total daily insulin requirements were 39% lower than baseline. When the DASH diet was resumed, insulin requirements increased 15% from the end of the WFPB week.
Average daily blood sugar was 22–24% lower with both intervention diets as compared to baseline, but the WFPB diet resulted in the lowest fasting blood sugar.
Insulin resistance decreased by 30.0% during DASH 1 and 49% during the WFPB diet. Insulin resistance during DASH 2 remained 28% lower than baseline. Insulin sensitivity was 17% higher at the end of DASH 1, 38% higher at the end of the WFPB diet, and then decreased almost to baseline by the end of DASH 2.
Weight decreased during all three phases, with a 3% lower weight at the end of the third week compared to baseline. Total, HDL, and LDL cholesterol were all lowest at the end of the WFPB week and total and LDL cholesterol significantly increased upon returning to the DASH diet.[10]
Conclusions:
Both DASH and WFPB diets, without calorie or portion restriction, result in significant and rapid reductions in insulin requirements for insulin-dependent type-2 diabetics. Subjects consuming these diets also experienced decreased total and LDL cholesterol; and lower leptin, weight, and c-reactive protein (a marker for inflammation). It is not possible to completely isolate the effect of each diet since there were carryover effects from week to week. But a pattern was observed: the benefits from the DASH diet were significantly greater when subjects switched to a WFPB diet. When the DASH diet was resumed, the benefits began regressing back toward baseline.
Limitations:
This was a small study, but one of the advantages of small studies is that researchers often can better control variables. For example, in this study meals were provided, which may not have been practical or affordable with more participants.
The breadth of the effect is a counter for the small study size. It is much easier to find effects in larger studies with hundreds of subjects, but often these differences are statistically significant but clinically meaningless. In this case, the effect was not just statistically significant, but clinically very meaningful. The short follow-up time is also a limitation, but the results were significant and immediate, and such results might incentivize people to continue to adhere to better diets in order to improve their health.
Bottom line: More plant food intake leads to better health and the more plant food consumed, the better the outcomes.
A recent study might provide some inspiration for type-2 diabetics to pay more attention to diet. Participants in this nonrandomized crossover study were adults who had type 2 diabetes, required insulin, had a BMI of at least 27, and A1C levels between 6.5 and 9.5.
Fifteen participants were enrolled in a 4-week trial with sequential one-week phases:
Baseline, Dash 1, WFPB and a second week of the DASH diet
The diets were all ad libitum (subjects could eat as much as they wanted) and meals were provided.
First, a description of the two intervention diets:
Dietary Approaches to Stop Hypertension (DASH) does not require the elimination of any food but rather emphasizes consumption of more fruit, vegetables, whole grains, and low-fat dairy, while intake of saturated fat and sugar are reduced.
A whole foods plant-based diet (WFPB) emphasizes beans, whole grains, and fruits and vegetables; and minimizes or excludes animal foods, added fats, and added sugars.
Both diets have been shown in previous studies to lower blood pressure,[2] [3] plasma cholesterol,[4] [5] and blood sugar.[6] [7] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events in people who have been diagnosed with severe coronary artery disease.[8] [9]
Results:
Twelve of the fifteen subjects completed the study. One subject dropped out due to an unexpected surgery; one due to a car accident; and one subject started a new job and could not continue the weekly assessments.
Total calories were lower during all three intervention phases as compared to the baseline diet. By the end of the DASH 1 phase, total daily insulin requirements were 24% lower than baseline. By the end of the WFPB phase, total daily insulin requirements were 39% lower than baseline. When the DASH diet was resumed, insulin requirements increased 15% from the end of the WFPB week.
Average daily blood sugar was 22–24% lower with both intervention diets as compared to baseline, but the WFPB diet resulted in the lowest fasting blood sugar.
Insulin resistance decreased by 30.0% during DASH 1 and 49% during the WFPB diet. Insulin resistance during DASH 2 remained 28% lower than baseline. Insulin sensitivity was 17% higher at the end of DASH 1, 38% higher at the end of the WFPB diet, and then decreased almost to baseline by the end of DASH 2.
Weight decreased during all three phases, with a 3% lower weight at the end of the third week compared to baseline. Total, HDL, and LDL cholesterol were all lowest at the end of the WFPB week and total and LDL cholesterol significantly increased upon returning to the DASH diet.[10]
Conclusions:
Both DASH and WFPB diets, without calorie or portion restriction, result in significant and rapid reductions in insulin requirements for insulin-dependent type-2 diabetics. Subjects consuming these diets also experienced decreased total and LDL cholesterol; and lower leptin, weight, and c-reactive protein (a marker for inflammation). It is not possible to completely isolate the effect of each diet since there were carryover effects from week to week. But a pattern was observed: the benefits from the DASH diet were significantly greater when subjects switched to a WFPB diet. When the DASH diet was resumed, the benefits began regressing back toward baseline.
Limitations:
This was a small study, but one of the advantages of small studies is that researchers often can better control variables. For example, in this study meals were provided, which may not have been practical or affordable with more participants.
The breadth of the effect is a counter for the small study size. It is much easier to find effects in larger studies with hundreds of subjects, but often these differences are statistically significant but clinically meaningless. In this case, the effect was not just statistically significant, but clinically very meaningful. The short follow-up time is also a limitation, but the results were significant and immediate, and such results might incentivize people to continue to adhere to better diets in order to improve their health.
Bottom line: More plant food intake leads to better health and the more plant food consumed, the better the outcomes.
Reprinted from Wellness Forum Health
[1] Centers for Disease Control. National Diabetes Statistics Report 2020. Estimates of Diabetes and its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
[2] Appel LJ, Moore TJ, Obarzanek E et al. "A clinical trial of the effects of dietary pattern on blood pressure. DASH Collaborative Research Group." NEJM 1997 Apr;336(16):1117-1124
[3] Berkow SE, Barnard ND. "Blood pressure regulation and vegetarian diets." Nutr Rev 2005 Jan;63(1):1-8
[4] Appel LJ, Sacks FM, Carey VJ et al. "Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial." JAMA 2005 Nov;294(19):2455-64
[5] Macknin M, Kong T, Weier A et al. "Plant-based, no-added-fat or American Heart Association diets: impact on cardiovascular risk in obese children with hypercholesterolemia and their parents." J Pediatr 2005 Apr;166(4):953-9,e1-3
[6] Azadbakht L, Fard NRP, Karimi M et al. "Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial." Diabetes Care. 201 Jan(1); 34: 55-57
[7] Barnard ND, Cohen J, Jenkins DJ, et al. "A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes." Diabetes Care 2006 Aug;29(8): 1777-1783
[8] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[9] 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
[10] Campbell TM, Campbell EK, Peterson DR et al. "The acute effects of a DASH diet and whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type-2 diabetes." Diabetes Res Clin Prac 2023 Aug;202:110814
[1] Centers for Disease Control. National Diabetes Statistics Report 2020. Estimates of Diabetes and its Burden in the United States. https://www.cdc.gov/diabetes/
[2] Appel LJ, Moore TJ, Obarzanek E et al. "A clinical trial of the effects of dietary pattern on blood pressure. DASH Collaborative Research Group." NEJM 1997 Apr;336(16):1117-1124
[3] Berkow SE, Barnard ND. "Blood pressure regulation and vegetarian diets." Nutr Rev 2005 Jan;63(1):1-8
[4] Appel LJ, Sacks FM, Carey VJ et al. "Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial." JAMA 2005 Nov;294(19):2455-64
[5] Macknin M, Kong T, Weier A et al. "Plant-based, no-added-fat or American Heart Association diets: impact on cardiovascular risk in obese children with hypercholesterolemia and their parents." J Pediatr 2005 Apr;166(4):953-9,e1-3
[6] Azadbakht L, Fard NRP, Karimi M et al. "Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial." Diabetes Care. 201 Jan(1); 34: 55-57
[7] Barnard ND, Cohen J, Jenkins DJ, et al. "A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes." Diabetes Care 2006 Aug;29(8): 1777-1783
[8] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[9] 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
[10] Campbell TM, Campbell EK, Peterson DR et al. "The acute effects of a DASH diet and whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type-2 diabetes." Diabetes Res Clin Prac 2023 Aug;202:110814
The Scoop on Vitamin DWe need it, but what is the best way to get it? First things first, it is not a "vitamin", it is a hormone. Let's explore:
• Vitamin: Something the body needs but cannot produce. Must be procured from external sources (ideally food).
• Hormone: Something made by the body in one place that carries instructions needed in another, or several other places.
Fun Facts about Vitamins:
• There are 13 for humans
• 4 are fat-soluble
• 9 are water-soluble
Fun Facts about Hormones:
• There are about 50
• Produced in endocrine glands and tissues
• Some fat soluble, some water-soluble
Science about the D family:
• It’s a fat-soluble*, secosteroid (seco…steroid)
• The biologically active form is called calcitriol:
• 1,25-dihydroxycholecalciferol
* Means we can’t readily excrete excess
So, if D is a hormone, how is it produced in the body? It starts in the lower layers of the epidermis. When the sun meets our skin, UVB rays convert readily available 7-dehydrocholesterol into Vitamin D3. Then it’s off to the liver and the kidneys for “activating” (turned into 1,25-dihydroxycholecalciferol)
How much is enough?
Low D, first and foremost, is a sign you are not getting enough sun, not that you need to rush off to the pharmacy.
D is measured in I.U. (international units) when getting it from external sources. It's always good to keep daily intake under 4000 IUs.
Serum blood level tests, 25 (OH)D, (the OH stands for hydroxy), are known to be inaccurate. Different testing companies have different levels of what they call normal.
The minimum target is 20 ng/ml (nanograms per milliliter), The happy medium is 30 ng/ml. There is no additional benefit above this.
We can't overdose from sun exposure, although we could burn and that's not good either. Getting 10-20 minutes of sun around noon-ish, twice a week, will do. Darker skin colors require 3 to 10 times more. Sunscreens with harmful chemicals can cause collateral damage. If you are planning to stay in the sun longer, physical blocks are better. Think hats, sunglasses, rash guards, zinc or titanium oxide. And if you are worried about living in the northern climates with no sunshine in the winter, know that the D hormone produced in the body by the sun is stored in the liver and our fat cells. When our body needs it, it calls for it and activates it!
Taking too much of a Vitamin D supplement can cause nausea, vomiting, weakness, insomnia, nervousness, and more. Overdose of Vitamin D supplements can cause kidney damage. It can also increase the risk of cancer, heart disease, prostate cancer in men, and higher LDL cholesterol.
What are the benefits from getting our Vitamin D from the sun? It builds strong bones through managing your calcium levels, helps manage levels of magnesium and phosphate, has a role in cancer prevention, enhances immune system performance, enhances bone absorption of minerals, promotes healthy cellular growth, and reduces inflammation.
Remember, there are NO super foods or super supplements. Your Vitamin D level is low as a result of illness or not enough sunshine. Get your Vitamin D from the Sun, not tanning salons. It also naturally occurs in salmon, mushrooms, sardines and breast milk.
Supplementation should be the last resort. Our bodies are elaborately set up via highly sensitive biological systems to produce the exact right amount of Vitamin D we need at every moment. Fortified foods and pills have a one size fits all system with fixed dosages designed to provide too much or too little. And remember, Vitamin D is not water soluble, so if you ingest too much the body cannot readily correct via excretion the way that B vitamins and Vitamin C get excreted because they are water soluble. Our "cleansing organs" must purge us of something (excess Vitamin D in a synthesized hormone form) that we were never designed to get rid of. That puts undue stress and strain on them.
The vitamin supplement industry is highly monetized and "pharmaceutical-ized". The 2022 market for Vitamin D was $1.34 billion dollars. Marketers have taken advantage of bad diet and lifestyle habits and contributed to making us think that a handful of supplements a day will make us feel better.
Sitting in the sun is not bad. Research shows that women who avoid the sun have shorter lives. Avoiding the sun has similar risk factors as smoking. Sunshine deficiency may also contribute to decrease in insulin's responsiveness, Mutiple Sclerosis, and cardiovascular disease.
So, there you have it. I am sure that a lot of you have been told by your doctor that you NEED to take a supplement. This is not defensible with science, but the decision is always yours, once you know all the facts. The bottom line is to be an informed consumer!
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
The objective of Nurture Your Health is to learn how to remain or become a healthy person, rather than to remain or become a sick patient. Most people do not pay attention to their health until they are sick. It is important to prioritize learning about health and investing time and resources in adopting the right diet, engaging in the right exercise, and paying attention to other factors that lead to optimal health. Make learning about health interesting and fun. Use this information to take control of your health and make better and informed decisions about what you eat, which lifestyle choices you make, and the medical care you receive.
This information is not a substitute for medical advice.
I talk often about forming and maintaining healthy lifestyle habits. This topic seems to cause anxiety because we find it difficult to find a place to start. These anxious thoughts make us feel out of control. We want the quick solution, but we know that there aren't any shortcuts.
We want solutions, but what we really need are attitudes. You don't need an easier life, but rather an attitude of perseverance. 1
Attitude precedes outcome. And attitude equals mindset.
I read recently that everything you do in life either lifts you up or tears you down. There are always things to be torn down and discarded, but your life is a treasure to be valued and protected.2 Yes, we have busy lives, which makes it all the more important to schedule in rest. I am not referring to falling into bed at night and passing out, exhausted. And it certainly is not laying on the sofa with the TV on and scrolling Facebook or Instagram.
I attended a sweet time of prayer this week and heard that rest is not inactive-it is a deep sweet restfulness of the soul. Depending on your family obligations, it can be anywhere from 3 hours a week, a day a week, two days a month, even a day a month. The important thing is to schedule it for yourself, just like you do your hair appointment. Persevere and protect this time for yourself until it becomes a habit.
Forming a healthy habit requires motivation for the outcome and motivation for the effort to achieve the outcome. Focus on the payoff. For example, getting up every day to go to work is a habit. The payoff is that you become known as a dependable person, you earn recognition, and you collect a paycheck. This is a good habit! And even when you don't have the motivation on a particular day to go to work, the habit is a default decision that serves you well.
Manipulate your environment to serve your habit. Schedule it into your planner so that eventually everyone knows that the 2nd Saturday of the month is mom's/dad's time to go for a long hike, read a book in a park, sit somewhere to journal, sit in a church to pray, or all of the above! Remember that good habits are formed the same way that bad habits are formed: repetition! Having scheduled, healthy, repetitions in your life is a good way to relieve the anxieties of day-to-day life. Having this healthy flow of the day-to-day helps equip you when life throws you a curveball because you will be more resilient. You will have the ability to bounce back because you remember how your healthy habits made you feel better. This applies not only to rest days but also to eating and exercise.
Teaching the Forming Healthy Habits class helps me stay on track as well. It's a daily practice!
Click on the below link if you need inspiration on dealing with anxiety.
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
1. James Clear
2. Marsha Burns
How do you want to live?Hunter S Thompson said on designing your life "Beware of looking for goals; look for a way of life. Decide how you want to live and then see what you can do to make a living within that way of life."
When you think about changing your lifestyle to include healthier habits and an optimal way of eating, you might be thinking of the obstacles that come with it.
There are several impediments to changing routines, particularly when adding new tasks and activities, such as food preparation and exercise. One reason is that people usually do not have large blocks of unoccupied time.
People usually say, “I understand what you are telling me to do and why it is a good idea but I’m so busy now I don’t know how I’ll find time to shop, cook, and exercise.”
Since you don’t have free time now and you can’t manufacture more – we all have to work within a 24-hour day – changing the way you plan and schedule in order to do more with the time you have are the keys to success.
Creating a time management system for yourself can help you fit in your healthy habit changes. It is simple, but requires commitment and the willingness to set and stick with schedules. Remember that it is only by repeating the right behaviors in a stable context over a long period of time that you will form and maintain good habits. I am going to share what has worked for me.
The first thing you will need is a paper planner (yes, paper, not your phone calendar) that allows you to see an entire week at a time with weekend days grouped together. Your planner should also have times to write in your activities from 8AM to 9PM on weekdays, and space for each day to write lists of things to do, reminders, birthdays and other things to remember.
Start by writing in all of the recurring activities you do each year, and the events you have already scheduled. Examples of recurring things would be your monthly book club meeting, piano lessons on Wednesday night at 7PM, and the annual meeting for a charity you support that takes place on the first Tuesday in June. Examples of things you have already scheduled would include things like the Alaskan cruise you are taking in July. Then write in birthdays, anniversaries, the dates you need to file your sales tax returns and all of the other happenings you don’t want to forget. Write in your workday hours, if applicable.
The times not already blocked out are what you have left for everything else, and you should write in the days and times each week you will be doing everything needed to maintain your life. These things include buying a birthday present for the party you are attending next week, taking your car in for an oil change, and of course, shopping for food, batch cooking, and exercise. The key is consistency, both in writing everything in your planner, and keeping the appointments you make with yourself to do the things you have decided are important to you. This system works if you make your mind up to do it.
Sometimes I just don’t feel like doing the things I’ve committed to, like shopping, at a specific time. Most people have to do things regularly that they may not feel like doing in the moment, like filing a tax return, taking care of children, and going to work. At some point you have to make the decision that not feeling like doing it is not a valid reason to not practice good habits. You don’t tell the IRS that you just didn’t feel like filing your tax return, or your employer that you’re just not in the mood to come in today. You have lots of experience in rallying to do things when they need to be done. Toughen up, put on your big girl or big boy pants, and do the right thing!
Doing the same thing over and over is how you develop a routine that can lead to better habits. We all can come up with excuses to justify our bad behavior.
For things to change, you’ve got to change. For things to get better, you’ve got to get better.
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
