Research: November 2014

Could Coffee Protect Your Liver?

>> Monday, November 24, 2014

Despite being one of the most commonly consumed beverages worldwide, the effects of coffee on our metabolism is surprisingly poorly understood. (You can read about the controversial effects of coffee on blood sugars on my previous blog post here.)

Recently, there has been interest in understanding the effects of coffee on the liver. Several studies have shown that liver enzyme tests are lower (which is good) with increasing coffee consumption ('inversely associated' in statistical terminology). Some studies have suggested that coffee consumers have a decreased risk of having a fatty liver, liver cirrhosis (scarring), and even liver cancer. An article from the American NHANES study has even suggested that people who drink 2 or more cups of coffee per day have half the risk of developing chronic liver disease, compared to those who drink less than 1 cup per day.

If coffee really is protective to the liver, an important question arises: is it caffeine that is protective, or something else in coffee? This question was addressed in a recent study published in Hepatology, again utilizing the NHANES database. They found that higher intake of coffee, regardless of whether it was caffeinated or decaffeinated, was associated with lower liver enzyme levels. Components of coffee such as polyphenols, cafestol, and kahweol may be the protective elements, but no one really knows for sure.

While the findings of this study were consistent regardless of body weight or presence of diabetes, I would be interested to know what the non-coffee drinkers were drinking instead. For example, if non coffee drinkers were consumers of Coca-Cola instead, could the soda be having a negative impact on the liver, rather than coffee having a positive impact? More research is needed on many fronts before we will have a good understanding of exactly what is happening here.

Enjoying my java..... :)

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Myths and Misconceptions About Obesity

>> Saturday, November 15, 2014

Some of the biggest barriers to successful management of obesity in our society are the myths and, frankly, garbage, that pervade popular culture, media, and even medical publications. Recently, Dr Chaput and colleagues reviewed both popular media and scientific journals to bring to light the Top 7 Misconceptions about obesity:

1. Obesity is primarily caused by a lack of physical activity or by unhealthy dietary habits.

Clear scientific evidence has shown us repeatedly that the picture is FAR more complex than this. Factors such as insufficient sleep, stress, environmental chemicals, and exposures during fetal life have evidence that is as compelling, if not more compelling, than the traditional concepts of eating the wrong foods and not exercising enough.

2. Obese individuals are less active than their normal weight counterparts.

This is a particularly harmful myth, as it paints the picture that people with obesity are lazy, and creates a harsh platform for weight discrimination and bias. Recent data from the Canadian Health Measures Survey, which used accelerometers to document physical activity, shows that youth with obesity have similar levels of physical activity as youth without obesity. Canadians in general do not exercise enough, and we as a society would benefit from increased physical activity, regardless of body size. (read about Canada's physical activity guidelines here)

3. Diets work in the long term.

Studies have shown that almost all people who lose weight on a diet will regain it within the next 5 years, with the majority regaining it within the first year. The harmful follow up myth from there is that people who regain weight do so because they lack willpower. NOT. TRUE. The truth of the matter is that our genetics have been developed evolutionarily to very powerfully defend body weight, as a survival strategy built over thousands of years of regular famine. The problem is that now, in our society, there is only feast.

4. Weight loss does not have significant adverse effects.

While weight loss certainly has a long list of health benefits, there are potential downsides as well. Weight loss that is too fast increases the risk of gall stones. Weight loss reduces energy expenditure, meaning that less calories are burned by basic metabolic functions in a day, thereby defending body weight and promoting weight regain. Weight loss in some people can increase psychological stress and depressive symptoms. Failed weight loss attempts or weight regain can also lead to issues with self esteem as well as body image issues.

The message is still that weight loss in people with obesity is still most definitely a good thing for health, but these weight loss efforts need to be gradual, sustainable, and partnered with the support that each individual needs to make these efforts a long term success!

5. Exercising is better than dieting to lose weight.

Exercise alone has generally not been found to result in significant weight loss. Think about it this way: if you exercised as hard as you could for 1 minute, you might burn 15 calories. If you ate as fast as you could for 1 minute (picture a big milkshake), you can down 2,000 calories or more. The reality is that because it takes so little food intake to make up for a long period of exercise, exercise alone doesn't usually work. As I say to my patients: focus 90% on the food side of the equation, and 10% on the exercise.

6. Everyone can lose weight with enough willpower.

Untrue. Remember that each of is built differently, with very different genetics either working with us, or in most cases against us, to maintain a healthy body weight. There are also many medical issues and medications that can make it exceptionally difficult to lose weight.

7. A successful obesity management program is measured by the amount of weight lost.

Rather than focusing on the numbers on the scale, a successful obesity treatment program should be focused on the improvement in health. With a permanent lifestyle change, did that person's quality of life improve? Did their diabetes get better? Do their joints hurt less? Did their sleep apnea improve? Does the individual just feel better? These are the bars by which a successful treatment program should be judged.

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Is Eating Organic Really Better?

>> Friday, November 7, 2014

Aggressive marketing campaigns have many of us convinced that eating organic is healthier than conventional fare – to the point where sales of organic food in USA increased by over 7-fold between 1997 and 2010. With organic food costing around twice as much as conventional food, we must ask – is there truly a health benefit to eating organic?

First of all, let’s talk about what is meant by ‘organic’. Organic certification requirements vary worldwide (a potential limitation in itself), but in general, organic foods are produced without synthetic pesticides or fertilizers, without irradiation or chemical food additives, and without the routine use of growth hormones or antibiotics. Organic animals are fed organically produced food and are raised in an outdoor environment where they are free to move around. Also, genetically modified organisms (GMOs) are not used in organic food production.

The question as to whether eating organic is healthier was addressed in a systematic review published in the Annals of Internal Medicine. From 240 identified studies, the following key findings were noted:

1. The differences in terms of nutrients in organic compared to standard fare are minimal.

There is a slightly higher level of phosphorous in organic food, but this is not thought to make a difference in overall health, as phosphorous deficiency is only seen in states of near-total starvation. There are also higher levels of beneficial fatty acids in organic milk and chicken, and a couple of other small nutrient differences of questionable significance.

2. There was no difference in allergic symptoms or outcomes (eczema, wheezing, etc).

3. There was a 30% higher risk for pesticide contamination in conventional produce compared to organic, but the differences in risk for exceeding maximum allowed limits were small. Two studies showed lower urine pesticide levels in children who ate organically.

4. Overall, E coli contamination risk was no different in organic produce, but the results of individual studies was conflicting and the authors noted that more research needs to be done in this area.

5. In chicken and pork, the risk of exposure to antibiotic-resistant bacteria was higher in conventional meat compared to organic meat. However, it’s not clear if this is of importance to human health, because it is inappropriate use of antibiotics in humans (not in the meat we eat) that is the major cause of antibiotic-resistant infections in humans.

6. There are no long term studies on the effect of eating organically on human health.

The authors conclude that eating organically does not seem to have a great health benefit… But who really knows? Long term studies on human health would need to be done to know this answer for sure. I agree that there is not convincing evidence at this time to say that eating organically has big health benefits – but this possibility has not been ruled out. The definition of ‘organic’ is variable worldwide, and the first step to understanding the benefits of organic food would be to at least standardize how we define it.