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August 2010

More on sitting and mortality
Cholesterol in young adults
Fructose promotes cancer growth
Organic whole wheat bread recipe
Fish lowers macular degeneration

More on sitting and mortality

I have had some reservations about conclusions drawn from an article I reported on last month. In that article, those who sat for an average of more than six hours a day had increased mortality risk. This was independent of how much exercise the subjects did when they were not sitting. I was concerned about this as I was sitting at my computer writing the newsletter.

The data on sitting were derived from questionnaires, and I think many people may inflate the amount of exercise that they get when reporting in this way, so it is possible that the “sitters” actually sat far more than the six hours reported, and the “non-sitters” may also have reported less sitting than they actually do. This would skew the results significantly. Also, it is not clear what counted as sitting (I questioned whether reclining while watching television counted? Does “sitting” on a stationary bike (or a real one) count as sitting? What about in the kayak or sitting in the garden while weeding?)

While I stand, run, walk, swim, and garden a lot, I also spend a lot of time sitting at the computer or with patients in consultation either in person or on the phone, and I am sure it totals more than six hours per day (just getting around to the office or shopping involves sitting in the car and I also sit while I practice music on my recorder). I have a suspicion that the statistics need further investigation and analysis before otherwise-active people worry about the risks from sitting. However, it is still important to get regular exercise and otherwise be physically active independent of how much sitting you do.

Cholesterol in young adults

While high cholesterol is associated with an increased risk of heart disease in adults, researchers in 1985 looked at the cholesterol levels in 3258 participants from 18 to 30 years old. They followed them for over 20 years to see if their cholesterol levels at earlier ages influenced their later risk of developing heart disease.

They did measurements repeatedly over the 20 years to get an average over time of cumulative exposure to triglycerides, LDL-cholesterol, and HDL-cholesterol. Among all participants, 87 percent had elevated LDL or triglycerides or low HDL.

At the end of the study, the researchers evaluated the amount of calcium in the coronary arteries, a strong predictor of future coronary heart disease. However, coronary calcium is not a symptom or disease in itself. (Pletcher MJ,  et al., Nonoptimal lipids commonly present in young adults and coronary calcium later in life: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Ann Intern Med. 2010 Aug 3;153(3):137-46.)

Higher LDL levels were directly related to calcium scores. Among those with the lowest levels of LDL, only 8 percent had elevated calcium scores, while among those with the highest LDL levels 44 percent had elevated coronary calcium. Compared to subjects with LDL below 70 mg/dL, the risk of elevated calcium score was 50 percent higher for those with 70-99 mg/dL, 2.4 times higher for LDL from 100-129, and continuing up for each higher level up to 5.6 times the likelihood of coronary calcification for LDL levels over 160 mg/dL.

This is not to say that young people should take lipid-lowering medication. Participants who were taking such medication at some time during the study were excluded from this analysis. It is clearly important to eat a healthy diet and get regular exercise. Foods that lower cholesterol (and are otherwise healthful) include eggplant, oatmeal and barley, almonds, okra, soy foods, and other fibers such as psyllium or flax seeds. Supplements can also lower cholesterol safely.

Fructose promotes cancer growth

Refined sugar added to the diet is a contributor to a variety of ailments, including diabetes, heart disease, and strokes, as well as obesity. A recent article reported that fructose (one of the sugars found in fruit, but more commonly present in the diet from refined foods containing high fructose corn syrup) promotes the growth of cancer cells. The medical profession and diet organizations have paid little attention to the differences between sugars such as glucose and fructose, often considering them metabolically interchangeable as a source of calories. However, they are transported and metabolized differently, and, while both present health risks, this information suggests additional serious risks from our highly refined, sweetened foods.

Pancreatic cancer cells in culture feed on both glucose and fructose, but the fructose is more associated with proliferation of the cells. It stimulates the activity of an enzyme pathway that makes the cells multiply. (Liu H, et al., Fructose induces transketolase flux to promote pancreatic cancer growth. Cancer Res. 2010 Aug 1;70(15):6368-76.) Unfortunately, even in hospitals, patients are fed refined sugars including fructose, apparently contributing to the spread of cancer.

The sugar and soft-drink industries deny that there is any difference between sugars (and to the extent that they are all unhealthy, they are right), and that singling out high-fructose corn syrup is misguided. They say that there is no solid scientific reason to limit (or tax) foods containing these products (reminding me of the tobacco industry). This new study provides evidence to the contrary.

Organic whole wheat bread recipe

Many people have asked about my easy whole wheat bread recipe. This works for me and takes little time. I grind 3.5 cups of organic whole wheat (for people who do not grind their own, that comes to just under 5 cups of flour or 700 grams by weight). In a large bowl, add 1 tsp (6 grams) of salt and 1.5 tsp (7-8 grams) of rapid rise baker’s yeast, and ¼ cup (30 grams) of toasted sesame seeds (optional, as are herbs and other seeds).

Add 2 cups of warm water (about 475 ml); this amount will vary depending on the humidity and the flour freshness; the dough is moister than other recipes, but should not be too sticky. Mix well for a few minutes with a firm spatula, loosely cover the bowl, and place in a warm spot (I put it in the oven with the light on) for about 2 hours (a bit more won’t hurt).

Put olive oil on a cutting board, put the dough ball on the board, oil your hands, and knead for about 5 to 10 minutes (the board may get sticky; add a bit more olive oil, if needed).

Place the dough in a well oiled Pyrex  loaf pan (4.5x9.5), cover loosely, and let sit in a warm place for 45 to 90 minutes (until it is just above the pan lip but is not overflowing).

Preheat the oven to 425 F (remember to start this before the loaves get too high), and place the loaf in the oven for 45 minutes. (It should rise a bit more in the oven to make a nice rounded top.) Remove from the pan (you may need to loosen the edges) and put on a wire rack to cool for about 15 minutes. That’s it. Easy as pie! (well, bread). Let me know if you have any suggestions.

Fish lowers macular degeneration

Omega-3 oils from fish might reduce the risk of developing macular degeneration (AMD). Evaluating 2520 Maryland residents aged 65 to 84, and using food frequency questionnaires, researchers found a trend toward a reduction of AMD, but overall this was not statistically significant. However, when they looked at subjects with advanced disease, those subjects were significantly less likely to have consumed fish rich in omega-3 fats. (Swenor BK, et al., The Impact of Fish and Shellfish Consumption on Age-Related Macular Degeneration. Ophthalmology. 2010 Jul 12. [Epub ahead of print].)

Those who ate fatty fish such as salmon and sardines, at least once per week, had a 60 percent lower risk of advanced disease than those who ate them less than once per week. AMD is a loss of the most sensitive area of the retina. It is more common in smokers, and it is helped by supplements, including antioxidants (vitamins C and E and beta-carotene), and zinc.

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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.

Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.