Category Archives: Diet and Heart Disease

What Can We Learn About Heart-Healthy Lifestyle From The Tsimane People of the Amazon Rainforest ?

The skeptical cardiologist has been in Washington, DC attending the Scientific Sessions of the American College of Cardiology for the last three days in an attempt to upgrade his cardiology knowledge and obtain CMEs for all the various areas he needs CME (echo/nuclear/CT/vascular).

I’ve written some posts for SERMO, a physician social media site,  on interesting presentations from the meeting.

Here’s my take on one paper (published simultaneously in The Lancet) that is of general interest:

I’m a big advocate of coronary artery calcium (CAC) scans for helping make decisions on individual patients with intemediate risk for CAD. Several speakers at this year’s American College of Cardiology Meetings presented convincing data supporting this approach, providing more information to get patients off the fence about taking statins.

However, CAC apparently would be a useless test in the Tsimane (pronounced chee-MAH-nay) people according to a study presented at  the ACC meeting and published simultaneously in The Lancet.

Researchers performed CT scans on 700 of  these “forager-horticulturalist”  people, indigenous to the Bolivian Amazon Rainforest and found very little calcium suggesting that they have an amazingly low rate of atherosclerosis compared to we who have to live in the industrialized world.

Obviously CT scanners are not portable so the Tsimane traveled by river and jeep from the Amazon rainforest to Trinidad, a city in Bolivia and the nearest city with a CT scanner. It took tribe members one to two days to reach the nearest market town by river, and then another six hours driving to reach Trinidad.

85% of the Tsimane people studied had CAC scores of 0. In those over age 75 years, 65% had CAC scores of 0, and just four individuals in their 80s had moderately elevated CAC (> 100). The incidence of CAC > 100 in the entire Tsimane population was 3%, which is about one tenth the prevalence in a matched industrialized population. In addition, incidences of obesity, hypertension, high glucose concentrations, and cigarette smoking were rare overall.

The Tsimane live a subsistence lifestyle that includes hunting, gathering, fishing, and farming. They don’t eat at McDonalds and the men spend almost 7 hours pers day on physical labor. Their diet consists mostly of unprocessed fiber-rich carbohydrates with rice, plantain, manioc, corn, wild nuts, and fruit composing their staples. Fat consumption is 9% of calories versus 23% in the U.S.

Supporters of plant-based diets, of course, seized on these data to support the unsubstantiated claim that meat and dairy consumption is the main cause of atherosclerosis in western civilization.

Hillard Kaplan, one of the authors and a Professor of anthropology at the University of New Mexico said:

 “Their lifestyle suggests that a diet low in saturated fats and high in non-processed fibre-rich carbohydrates, along with wild game and fish, not smoking and being active throughout the day could help prevent hardening in the arteries of the heart. The loss of subsistence diets and lifestyles could be classed as a new risk factor for vascular aging and we believe that components of this way of life could benefit contemporary sedentary populations.”

However, the real cause of the low levels of coronary artery calcification in the Tsimane remains a mystery because this kind of observational study cannot establish causality. Perhaps it is the 17,000 steps a day that they walk  engaging in foraging and horticulturalism. Could it be due to the absence of processed food and added sugar? The Tsimane have high levels of parasitic infections: perhaps that is protecting them.

Of two things I am certain:

-The Tsimane don’t need statins.

-I prefer my lifestyle to munching on manioc and foraging all day.

Semihorticulturally Yours,

-ACP

 

Beware The Bitter Almond

As part of the Health Nuts Project, the skeptical cardiologist has been evaluating walnuts, hazelnuts and almonds which he plans to put in packets and distribute to patients and readers.

Previously, we discovered that most raw almonds from the US have been fumigated with a chemical called propylene oxide and that roasting almonds creates potentially carcinogenic chemicals.

Consequently, after considerable searching, I purchased raw organic almonds from a company called NutsinBulk. These turn out to be from Spain (where pasteurization of almonds is not required) and are quite tasty.

As I was munching on one of these almonds I suddenly noticed an incredibly bitter taste causing me to spit the chewed almond out. My first thought was that this almond had gone “bad” in some way. Perhaps a mold had crept into it. Looking at the pieces I had spit out, however, I could see no discoloration or other visible difference from the “normal” almonds.

Subsequent experimentation has revealed that about one in ten of these almonds is incredibly bitter and there is no way to predict this from  the external appearance of the almond.

The Source of Bitter Almonds

The sweet almond  that we are used to eating in the US is produced from one type of almond tree (Prunus amygdalus var. dulcis) and does not contain poisonous chemicals. However, the bitter almond that I encountered comes from a different type of almond tree (Prunus amygdalus var. amara).

Prunus amara trees were likely the original almond trees but over time the sweet almond trees have been selected for and now dominate. According to the LA Times and Paul Schrade, who provides bitter almonds to restaurants:

Until recent decades, most Mediterranean almond orchards were grown from seed, and the shuffling of genes resulted in a mix of bitter almond trees among the sweet. Growers liked to keep a few bitter trees around because they helped to pollinize the sweet varieties. The inclusion of bitter nuts gave snackers occasional unpleasant surprises, but they deepened the flavor of marzipan, almond milk and glazes for cakes. In Italy, bitter almond paste was traditionally used to make crisp amaretti cookies, and bitter almond extract flavored amaretto liqueur. In Greece, bitter almonds are used in soumada, a sweet syrup. (apparently cooking or adding alcohol eliminates the toxic cyanide)

There’s little large-scale cultivation of bitter almonds left in Spain and Italy, mostly just scattered trees remain, but it is still possible to buy raw bitter almonds at European specialty markets. Morocco and Iran now lead in commercial production of bitter almonds.

What Makes The Almonds Bitter: Amygdalin

The source of the bitterness is amygdalin:

A recessive gene causes bitter almond trees to produce in their shoots, leaves and kernels a toxic compound called amygdalin, which serves as a chemical defense against being eaten. When amygdalin is moistened, it splits into edible benzaldehyde, which provides an intense almond aroma and flavor, and deadly hydrocyanic acid, a fast-acting inhibitor of the respiratory system.

A variety of sources confirm that:

The lethal dose of raw bitter almonds depends on the size of the nuts, their concentration of amygdalin and the consumer’s sensitivity. But scientists estimate that a 150-pound adult might die from eating between 10 and 70 raw nuts, and a child from ingesting just a few.

YIKES!!!When I read this I was shocked. Could it be that consuming 10 of these raw  biter almonds would kill me.? How could I distribute these potentially lethal edibles to my patients?

Amygdalin (Laetrile) , Alternative Cancer Therapy and Quackery

In addition to bitter almonds, significant amounts of amygdalin are found in the stone fruit kernels of apricots, peaches and plums. A synthetic form of amygdalin called Laetrile achieved great notoriety in the 1980s as a cancer treatment. Although research had shown the chemical to be ineffective, it was embraced by “alternative” healers who claimed it was a “natural” cure for cancer which was being suppressed by a conspiracy between the US FDA, big pharma, and the the medical community.

Steve McQueen, suffering from pleural mesothelioma sought the care of a delisted American holistic orthodontist practicing in Mexico, William Kelley. The NY Times reported:

In July 1980, McQueen secretly traveled to Rosarita Beach, Mexico, to be treated by Mexican and American doctors using Dr. Kelley’s regimen. He received not only pancreatic enzymes but 50 daily vitamins and minerals, massages, prayer sessions, psychotherapy, coffee enemas and injections of a cell preparation made from sheep and cattle fetuses. McQueen was also given laetrile, a controversial alternative treatment made from apricot pits.

Although we hear little about Laetrile these days, like most snake oil it is still promoted by alternative medicine. For example, The notorious quack Dr. Mercola still promotes the idea that laetrile is a safe and effective treatment of cancer on his web site with a post that has been viewed over 700,000 times.

You Can Die From Eating Bitter Almonds

Certainly, there is considerable evidence that Laetrile can be toxic or lethal but bitter almonds can also cause lethal cyanide poisoning. A case report describes a woman with colon cancer who turned down potentially curative surgery/chemotherapy and turned to alternative treatments including Laetrile.  A helpful friend gave her a bag of bitter almonds for their “medicinal properties”, whereupon the woman consumed a slurry composed of 12 ground up almonds with water. Within 30 minutes she developed  severe cyanide poisoning with vomiting, abdominal pain, pulmonary edema, severe lactic acidosis and  loss of  consciousness.
Analysis of the bitter almonds showed they contained on average 6.2 mg of cyanide per almond. It is estimated that a lethal dosage of cyanide is 50 mg or 0.5 mg per kg body weight, thus the calculation that 10 almonds could kill someone weighing  60 kg or 132 pounds.
My  Search For Healthy Almonds Continues
The small amount of cyanide one gets from consuming a single bitter almond seems to have little effect. (Although the Mediterranean diet nutritionist Conner Middelman-Whitney , who spent time in Europe and encountered bitter almonds occasionally says that she does remember a weird, numb sensation in the mouth when they were consumed.)  It’s extremely unlikely that one of my patients would consume 10 of the bitter almonds (without reflexively spitting them out as I did) in a short period of time.
When I have consumed them I noticed no adverse effects but after such an encounter I stopped eating the almonds for the day.
However, I’m not interested in testing that theory. (Ability to taste amygdalin or smell cyanide varies between individuals, thus I can’t be certain that the bitter taste would serve as a reliable warning.)
Therefore,  I’ve concluded that I’m not going to distribute these potentially lethal almonds to my patients and will be removing them from the Dr. Pearson Health Nuts Packages.
My search for non-fumigated, non-cyanide-laced , non-carcinogenic almonds continues!
Cyanogenically Yours,
-ACP
N.B. Famous deaths from cyanide poisoning include Hitler and Alan Turing.

 

 

The Impact of Organic Foods On Human Health: European Perspective

The skeptical cardiologist obtains most of his groceries from Whole Foods, something the eternal fiancée insists on.  At least part of my preference is related to Whole Foods’ focus on organic produce and part to their focus on sustainable and healthier meat and fish.

A recent report from the European Parliament reviews the existing scientific evidence regarding the impact of organic food on human health. I think this document, (eu-organic-food) is a reasonable summary of the science in this area. The summary can be broken down into 4 key points:

  1. Very few studies have directly addressed the effect of organic food on human health. They indicate that organic food may reduce the risk of allergic disease and obesity, but this evidence is not conclusive. Consumers of organic food tend to have healthier dietary patterns overall. Animal experiments suggest that identically composed feed from organic or conventional production has different impacts on early development and physiology, but the significance of these findings for human health is unclear.

Meaning: We just don’t have good evidence to support routine use of organic foods.

2. In organic agriculture, the use of pesticides is restricted. Epidemiological studies point to the negative effects of certain insecticides on children’s cognitive development at current levels of exposure. Such risks can be minimised with organic food, especially during pregnancy and in infancy, and by introducing non-pesticidal plant protection in conventional agriculture. There are few known compositional differences between organic and conventional crops. Perhaps most importantly, there are indications that organic crops have a lower cadmium content than conventional crops due to differences in fertiliser usage and soil organic matter, an issue that is highly relevant to human health

My take. A 2014 review concluded that “the frequency of occurrence of pesticide residues was found to be four times higher in conventional crops, which also contained significantly higher concentrations of the toxic metal Cadmium

The review also concluded that ” the concentrations of a range of antioxidants such as polyphenolics were found to be substantially higher in organic crops/crop-based foods…… phenolic acids, flavanones, stilbenes, flavones, flavonols and anthocyanin.

3. Organic milk, and probably also meat, have a higher content of omega-3 fatty acids compared to conventional products, but this is not likely to be nutritionally significant in light of other dietary sources.

My take. I disagree. I wrote about why I only consume full-fat dairy products that are “organic” and come from grass-fed cows here. There are a lot of benefits, beyond increased omega-3 fatty acids, in consuming dairy that comes from cows that eat grass versus corn and are treated properly.

4. The prevalent use of antibiotics in conventional animal production is a key driver of antibiotic resistance. The prevention of animal disease and more restrictive use of antibiotics, as practiced in organic production, could minimise this risk, with potentially considerable benefits for public health.

My take. I agree. Cut out the antibiotics. Other countries seem to be able to do this.

I would also agree with the conclusion of  The Lancet’s editorial comment (Organic Food: Panacea for Health?)  on the EU paper:

Large, prospective, long-term studies are needed as well as deeper examination of agricultural policy and health. Much still rests on the provision of robust multidisciplinary research to guide future food choices for health.

Until we get such studies, I will be erring on the side of caution and consuming food with the least amount of pesticides, cadmium and antibiotics possible.

EUingly Yours,

-ACP

Nutella: Healthy and Natural Spread or Highly Processed, Slickly Marketed Junk Food?

It’s World Nutella day according to Ferrero, the Italian confectonery company and manufacturer of the globally beloved hazelnut-based spread.screen-shot-2017-02-05-at-6-28-42-am

“With Nutella we spread positive energy to families to bring more happiness to the world” we are informed. On this day, apparently, the world should be spreading Nutella on as many food products as possible, ramping up positive energy levels to unprecedented levels.

Here are some of the other products Ferrero sells:screen-shot-2017-02-05-at-9-08-21-am

Three of them are clearly recognized by consumers as candy.

Should Nutella be in the same category as tic-tacs?

 

 

Nutella Ingredients

Perhaps in anticipation of World Nutella Day, a graphic has been appearing on Twitter:

nutella-englisy

detailing the ingredients of Nutella. The English version of this was posted on Reddit on a subreddit that I can’t mention on my family-friendly blog. It is a translation of a graphic that was published in German originally.

screen-shot-2017-02-05-at-8-18-31-am
If you thought you were getting mostly hazelnuts under the lid as this Nutella website graphic implies, you will be disappointed.

I’m not sure where the original data for the graphic came from but it seems to be a reasonable illustration of how much of Nutella is made up of palm oil and sugar. A 2 tbsp serving of Nutella (37 grams) contains 12 grams of fat, 21 grams of sugar and 2 grams of protein. Only about 12% of Nutella comes from actual hazelnuts.

I don’t have any concerns from a cardiovascular risk standpoint with the fat content of either the palm oil or the hazelnuts in Nutella.

But the 5 teaspoons of sugar per serving screen-shot-2017-02-05-at-8-44-16-am

are just still another source of empty
sugar calories adding to the daily dietary glut of sugar consumers face when consuming highly processed foods.

Nutella definitely is a highly processed, highly sugared product that shouldn’t be a regular part of a healthy Mediterranean diet. Most of the ingredients have gone through  complex sourcing and factory processing although their marketing material strains to emphasize the freshness and naturalness of these ingredients.

screen-shot-2017-02-05-at-6-30-27-am

One ingredient not depicted on the now viral graphic of Nutella is vanillin. From Nutella’s ingredient graphic one might think the screen-shot-2017-02-05-at-6-34-38-amvanillin is being extracted from (per wikipedia)

“the seed pods of Vanilla planifolia, a vining orchid native to Mexico, but now grown in tropical areas around the globe.”

In reality, however, the Nutella people,  ” use synthetic vanillin, an aroma identical to the one naturally present in the vanilla pod.”

Is the Palm OIl In Nutella Carcinogenic?

Some question the healthiness of the palm oil in nutella, either due to its high saturated fat content or its carcinogenic potential. A european food safety authority paper in May, 2016 declared certain toxins found in palm oil in particular to be “genotoxic and carcinogenic”

EFSA assessed the risks for public health of the substances: glycidyl fatty acid esters (GE), 3-monochloropropanediol (3-MCPD), and 2-monochloropropanediol (2-MCPD) and their fatty acid esters. The substances form during food processing, in particular, when refining vegetable oils at high temperatures (approx. 200°C)

The highest levels of GE, as well as 3-MCPD and 2-MCPD (including esters) were found in palm oils and palm fats, followed by other oils and fats. For consumers aged three and above, margarines and ‘pastries and cakes’ were the main sources of exposure to all substances.

As a result, According to Reuters, In Italy, some products containing palm oil have been removed from grocer’s shelves and one pastry company has eliminated palm oil from it products, labeling them as “palm oil free.”

High temperatures are used to remove palm oil’s natural red color and neutralize its smell, but Ferrero says it uses an industrial process that combines a temperature of just below 200C and extremely low pressure to minimize contaminants.

Nutella has fought back, defending its use of palm oil, with television and print advertisements.

Healthier Alternatives To Nutella

Conner Middleman, nutritionist , cooking instructor and author of Zest For Life, has shared with me her recipe for Nutritella, a healthier version of Nutella you can make at home. She points out in her intro to the recipe:

Nutella was invented in the 1940s in the Piedmont region of northern Italy, where hazelnuts grow plentifully. Alas, modern, store-bought Nutella contains a mere 13% hazelnut and only a hint of cocoa; the rest is made up of sugar, palm oil and artificial vanilla flavoring. My home-made version of Nutella, on the other hand, contains very little sweetener (in the form of raw honey), 3 tablespoons of flavonoid-rich dark cocoa, and about 90% hazelnuts, which boast a particularly high concentration of antioxidants and healthy fats (mostly monounsaturated). This is not to say that you should eat this spread by the tablespoonful; its high fat content means it’s high in calories and it should be enjoyed in sensible amounts (1-2 tbsp/day). The good news is that a high-fat food such as this one keeps you sated for longer, and because it is made from whole, real foods, it’s not only rich in calories, but also in nutrients! 

Here’s the recipe:

1 cup/125g toasted hazelnuts (Trader Joe’s roasted Oregon hazelnuts work great here; alternatively buy plain, raw hazelnuts and roast them yourself as described below)

½ oz/2 tbsp/15g unsweetened cocoa

3 tbsp hazelnut oil (La Tourangelle is my favorite brand – available in the oils section of good supermarkets or online)

3 tbsp honey or maple syrup

2 tsp alcohol-free vanilla extract (e.g., Trader Joe’s)

6-8 tbsp milk/plant milk/water

If you are roasting the hazelnuts from scratch, preheat oven to 350F. Place nuts on a dry, clean baking sheet and roast for 8 minutes (set timer). Remove and tip hot nuts onto a clean kitchen towel (pictured here).

As they cool, the skins will loosen, crack and flake off. Gather up the towel by its corners and scoop together into a tight bundle. Hold the bundle with one hand and knead the nuts with the other through the cloth to rub the skins off them. Place bundle back on a flat surface and open; lift out the nuts and lightly shake off the skins. (Leave some skin on the nuts – it’s where most of the antioxidants reside.)

If using pre-roasted nuts, start here.

Place the hazelnuts in an electric blender with the cocoa, oil, honey/maple syrup and vanilla extract. Process on “high” for about 30-40 seconds until all the ingredients come together in a coarse paste.

With the motor running, add milk or water (whichever using), a tablespoon at a time, and keep processing until the mixture reaches the desired consistency.

Transfer to a clean glass jar and refrigerate. Keeps for at least 2 weeks.

You can check out Conner’s excellent website, Modern Mediterranean, replete with more recipes and information on the cancer-fighting benefits of the Mediterranean diet,  here. and her You-tube channel here.

Of course, the skeptical cardiologist Heart Nuts project advocates just eating  heartnutsunadulterated hazelnuts along with other healthy drupes, nuts and legumes for snacking and soon we will be distributing these to you using our trademark-pending walnut-auscultating squirrel, Sparky.

Notnutellingly Yours,

-ACP

 

Say Hello To Heart Nuts

The skeptical cardiologist nut project (aka the nutty cardiologist project) now has a logo. Say hello toheartnuts  the world’s only walnut-auscultating promoter of nut consumption. Soon you will see his smiling face on the packets of nuts I’ll be handing out to help defeat cardiovascular disease.

Special thanks to my wonderful Washington University computer-science major and  bass guitar wiz daughter, Gwyneth, for creating the squirrel doctor during her winter break.

I promised 10 bags of nuts and “oodles of glory” to the reader whose name I selected but I can’t identify who proposed Heart Nuts. Let me know who you are and I’ll get the nuts to you.

Now I need a name for the squirrel.

Squirrelly Yours,

-ACP

See here for my post on KIND bars versus Simply Nuts and here for my review of nuts, drupes and legumes and reduced mortality.

N.B. Nuts are recognized as promoting reduced cholesterol, oxidative stress, and insulin resistance thereby reducing the risk of cardiovascular disease.

I’ve focused on their cardiovascular benefits (perhaps mediated by dietary fiber, magnesium, polyunsaturated fats, vitamin E, and antioxidants)  but recent studies suggest  other health benefits that could contribute to improved longevity.

Nuts contain bioactive compounds both known (ellagic acid, anacardic acid, genistein, resveratrol, and inositol phosphates) and unknown which may reduce the risk of cancer or other chronic diseases.

A recent meta-analysis found that consuming one serving of nuts per day was associated with a 15% lower  risk of any cancer and a 22% lower risk of dying from any cause.

Embrace the nuts I say!

 

Sheepshead Fish: Vulnerable and Gender Fluid Yet Mighty Tasty

The skeptical cardiologist and his Eternal Fiancee’ have escaped dreary and oceanopenic St. Louis and are spending a week in allegedly sunny and definitely beachy San Diego.

Upon arrival we took in a Farmer’s Market in Little Italy and stumbled into Ironside Fish and Oyster.screen-shot-2017-01-22-at-9-07-04-am
Always in search of heart-healthy, unique and local fish dishes, I spotted on the menu a luncheon special of sheepshead fish.

Kelly Fukushima is the local fisherman who caught my fish
Kelly Fukushima is the local fisherman who caught my fish.

California sheepshead (Semicossyphus pulcher), the existence of which I was previously unaware, turned out to be a fascinating and most delicious fish.

casheepshead

Before I could order it, I had to verify that I wasn’t contributing to the extinction of a species.  The IUCN Red List of Threatened species lists the CS as “vulnerable” because:

“The natural history of this species, including its limited geographic range along inshore habitat, the likely increasing interest in the fishery and the currently unsustainable fishing levels (according to the models of Alonzo et al. 2004), together with the difficulties in enforcing existing regulations strongly suggest that this species will continue to decline if stronger protective action is not put into place. “

After learning the CS was vulnerable, I had to make a critical decision: should I eat it before it disappeared, robbing me of a chance to ever taste it, or should I order something that wasn’t vulnerable, thus contributing to the preservation of the continuing biodiversity of the planet. I elected to taste it.

Gender Fluid Fish

Further research revealed that the CS transitions from a reproductively functional female at birth, to a functional male during the course of a lifespan in response to social factors (?reverse Bruce Jenner).

According to evolution.berkeley.edu this is termed sequential hermaphroditism:

In some sequentially hermaphroditic fish species, animals develop first as male and then switch to female (a condition called protandry), and in others, the individuals develop first as female and then switch to male (protogyny).

Clownfish (as in Finding Nemo) do the opposite of the sheepshead and are protandrous:

This species lives within sea anemones in groups of two large fish and many small fish. The two large fish are the only sexually mature fish and are a male and female breeding pair. All of the smaller fish are male. If the large breeding female is removed, her male mate changes sex to female and the next largest fish in the group rapidly increases in size and takes over the role as the sexually mature male.

While waiting for the vulnerable and sequentially hermaphroditic sheepshead to arrive, I sampled an equally

img_8160stupendous and heart-healthy side of cannelloni bean cassoulet. Chock full of Mediterranean diet essentials including kale, beans and mustard seeds, it worked really well as an appetizer.

 

Do not make the mistake of looking at this youtube video while waiting for your sheepshead entree’ as I did. The disturbing human-like teeth will not be part of your meal.

Finally, the 4 ounces of CS arrived, perfectly prepared a la plancha,

img_8162with an accompanying lemon butter sauce that was divine. Although butter is not officially a big part of the Mediterranean diet, frequent readers of the skepcard know that dairy fat does not make you fat or promote heart disease, and is fine (in moderation of course) as part of a heart-healthy diet.

Speaking of lingering bad dietary advice, if you investigate the nutritional content of sheepshead at a site like SELF Nutrition, the screen-shot-2017-01-22-at-10-18-54-amold canard that we should be limiting our dietary cholesterol raises its ugly head. Because sheepshead contain significant amounts of cholesterol (presumably from carnivorously munching on shellfish with its scary human-like choppers), the misguided nutritionists at SELF Nutrition and other would-be nutritionistas pronounce it as not optimally healthy.

Semiccossyphusilly Yours

-ACP

PS. If you’d really like to get your nerd on about sequential hermaphroditism check out this graphic showing the independent evolution of this feature across different phylogenetic lineages!

hermaphroditismtree

 

 

 

 

What Does The Death of Robert Atkins Tell Us About the Atkins Diet?

In the spring of 2003 at the age of 72 years, Robert Atkins, the cardiologist and  controversial promoter of high fat diets for weight loss, fell  on the sidewalk in front of his Atkins Center for Complementary Medicine in Manhattan.  He lost his footing on a patch of ice, slipped and banged his head on the pavement.  At the time of his fall his book ”Dr. Atkins’ New Diet Revolution” lead the NY times paper-back best seller list.

He was taken to nearby Cornell Medical Center where a clot was evacuated from his brain. Thereafter he lapsed into a coma and he spent 9 days in the ICU, expiring on April 17, 2003.

screen-shot-2016-11-27-at-8-44-55-amThe cause of death was determined by the New York Medical Examiner to be “blunt injury of head with epidural hematoma.”

An epidural hematoma is a collection of blood between the skull and the tough outer lining of the brain (the dura) which can occur with blunt trauma to the head which results in laceration of the arteries in this area. It is a not  uncommon cause of death in trauma . Actress Natasha Richardson (skiing, see below)  died from this. Nothing about the manner in which Robert Atkins died would suggest that he was a victim of his own diet any more than  Natasha Richardson was.

However, within the year a campaign of misinformation and deception spear-headed by  evangelistic vegans would try to paint the picture that Atkins died as a direct result of what they perceived as a horribly dangerous diet.

Michael Bloomberg, then New York major,  was quoted as saying

“I don’t believe that bullshit that [Atkins] dropped dead slipping on the sidewalk.”

According to the Smoking Gun:

“The 61-year-old billionaire added that Atkins was “fat” and served “inedible” food at his Hamptons home when Bloomberg visited. The mayor’s inference, of course, was that Atkins was actually felled by his meat-heavy diet, that his arteries were clogged with beef drippings. “

Enter The Vegans

Richard Fleming, a physician promoting prevention of cardiovascular disease through vegetarianism and with close ties to an organization  called Physicians Committe for Responsible Medicine (PCRM) sent a letter to the NY Medical Examiner requesting a copy of the full medical examination of Atkins. The NYME office  should have only issued copies of this report to physicians involved in the care of Atkins or next of kin but mistakenly complied with this request.  Fleming, who would subsequently publish his own low fat diet book, conveniently gave the report to PCRM which is directed by animal rights and vegan physicians.

screen-shot-2016-12-18-at-7-50-24-am
From the front page of pcrm.org. The two major concerns of the group are converting everyone to veganism and animal rights.

Neal Barnard, the President of PCRM, in an incredibly unethical move sent the letter to the Wall Street Journal with the hope that the information would destroy the popularity of the Atkins diet, a diet he clearly despises..  Barnard said the group decided to publicize the report because Atkins’ “health history was used to promote his terribly unhealthy eating plan..” The WSJ subsequently published an article summarizing the findings.

To this day, advocates of vegetarianism and low fat diets, distort the findings of Atkins’ Medical Examination in order to depict high fat diets like his as dangerous and portray Atkins as a victim of his own diet.

To scientists and thoughtful, unbiased physicians it is manifestly apparent that you cannot base decisions on what diet plan is healthy or effective for weight loss on the outcome of one patient. It doesn’t matter how famous that one person is or whether he/she originated and meticulously followed the diet. It is a ludicrous concept.

Would you base your decision to engage in running  based on the death of Jim Fixx?  Fixx  did much to popularize the sport of running and the concept of jogging as a source of health benefit and weight loss. He died while jogging, in fact. An autopsy concluded that he died of a massive heart attack and found advanced atherosclerosis (blockage) of the arteries to his heart.

Fixx inherited his predisposition to heart disease and couldn’t run himself out of it. Multiple studies over the years have documented the benefit of regular aerobic exercise like running on longevity and cardiovascular risk.

Would you based your decision to engage in  a very low fat diet based on how Nathan Pritikin died?  Pritikin authored an extremely popular book emphasizing eliminating fat from the diet but developed leukemia and slashed his wrists,  committing suicide at the age of 69 years. Would vegetarians accept the premise that their preferred diet results in leukemia or suicidal depression based on Pritikin’s death?

The Distortion of Atkins Death

The NYME report lists Atkins weight at autopsy as 258 pounds. Low-fat zealots seized on this fact as indicating that Atkins was screen-shot-2016-12-17-at-5-32-56-ammorbidly obese throughout his life.  For example, a  you-tube video of an audio interview of Atkinas online posted by “plant-based coach”  has this obviously photoshopped head of Atkins put on the body of a morbidly obese man. Atkins actually weight around 200 pounds through most of his life and a hospital note on admission showed him weighing 195 pounds. A substantial weight gain of 63 pounds occurred in the 9 days after his admission due to the accumulation of fluid volume and swelling which is not uncommon in the critically ill.

screen-shot-2016-11-27-at-8-42-59-amscreen-shot-2016-11-27-at-8-42-39-am

No autopsy was performed on Atkins but the NYME wrote on the document that he had “h/o of MI, CHF, HTN.”

MI is the acronym for a myocardial infarction or heart attack. As far as we can tell without access to full medical records, Atkins never had an MI. He did have a cardiac arrest in 2002. While most cardiac arrests are due to a cardiac arrhythmia secondary to an MI they can also occur in patients who have a cardiomyopathy or weakness in the heart muscle from causes other than MI. In fact, USA Today reported that Stuart Trager, MD,  chairman of the Atkins Physicians Council in New York, indicated that Atkins was diagnosed with a cardiomyopathy at the time of his cardiac arrest and that it was not felt to be due to blocked coronary arteries/MI. Cardiomyopathy can be caused by viral infections or nonspecific inflammation of the heart muscle and would have nothing to do with diet.

Trager also stated that Atkins, as a result of the cardiomyopathy, had developed heart failure (CHF) and the pumping ability of his heart (ejection fraction )had dropped to 15 to 20%. While CHF can be due to heart attacks causing heart weakness in Atkins case it appears it was unrelated to fatty blockage of the coronary arteries causing MI and therefore not related in any way to his diet.

What Does Atkins Death Tell Us About His Diet 

The information about Atkins death tells us nothing about the effectiveness or dangers of his diet.  In one individual it is entirely likely that a genetic predisposition to cancer or heart disease overwhelms whatever beneficial effects the individual’s lifestyle may have had. Thus, we should never rely on the appearance or the longevity of  the primary promoter of a diet for the diet’s effectiveness.

The evangelists of low-fat, vegan or vegetarian diets like PCRM have shamelessly promoted misinformation about Atkins death to dismiss high fat diets and promote their own agenda. If their diets are truly superior it should be possible to utilize facts and science to promote them rather than a sensationalistic, distorted focus on the body of one man who slipped on the ice and fell to his death.

Epidurally Yours

-ACP

Addendum: Earlier versions of this post cited  MLB pitcher Brandon McCarthy as a victim of a fast ball to the head causing epicardial hematoma. I was corrected by astute reader Fred N who pointed out that McCarthy is still pitching for the Dodgers and was hit by a line drive (off the bat of Erick Aybar). McCarthy had emergency surgery for the epicardial hematoma in 2012. His diet had nothing to do with the epicardial hematoma.

N.B. Natasha Richardson fell while taking beginner skin lessons at a Canadian Ski resort. According to a release from the resort:

Natasha Richardson fell in a beginners trail while taking a ski lesson at Station Mont Tremblant,” the statement said. “She was accompanied by an experienced ski instructor who immediately called the ski patrol. She did not show any visible sign of injury but the ski patrol followed strict procedures and brought her back to the bottom of the slope and insisted she should see a doctor.

“As an additional precautionary measure, the ski instructor as well as the ski patrol accompanied Mrs. Richardson to her hotel,” the statement continued. “They again recommended she should be seen by a doctor. The ski instructor stayed with her at her hotel. Approximately an hour after the incident Mrs. Richardson was not feeling good. An ambulance was called and Mrs. Richardson was brought to the Centre Hospitalier Laurentien in Ste-Agathe and was later transferred to Hôpital du Sacre-Coeur.”

A spokesperson for the resort noted Richardson was not wearing a helmet while skiing and didn’t collide with anything when she fell. Thursday, in the wake of her death, Quebec officials said they are considering making helmets mandatory on ski slopes, according to The Associated Press.”

The last time I skied I found myself falling and banging my head an extraordinary amount. If I ever ski again (in contrast to my resistance to bike helmets) I plan to wear a helmet.

 

Roasted vs. Raw Almonds: Which Are Healthiest And Most Cardioprotective?

As part of the Dr. P Heart Nuts Project, the skeptical cardiologist has been trying to determine what constitutes the best and most cardioprotective almonds.

Previously I decided  that i would not be consuming or handing out almonds pasteurized with propylene oxide (PPO). PPO was used as a racing fuel before being banned and is used in thermobaric weapons (one of my least favorite weapons of mass destruction) and in making polyurethane plastics and is a recognized carcinogen.
Since 2004 almost all “raw” almonds consumed in the US have been treated with PPO.

Cardioprotective Almonds: Best Raw or Roasted?

There are two issues with roasting: are we destroying good nutrients and are we creating bad chemicals?

Effects of Roasting on Good Nutrients

The cardioprotective component of nuts and almonds is presumed  related to phytochemicals, especially phenolics and flavonoids which may act as antioxidants. But truly we don’t know with any certainty which of the many potentially beneficial components-minerals, vitamins, fatty acids, proteins are helpful. And we have little understanding of how roasting, steaming, soaking, fermenting, germinating, or fumigating affects the cardioprotective components.

In terms of measurable important macronutrients, vitamins and minerals there is no significant difference between roasted and raw nuts.

One study  compared consuming roasted versus raw hazelnuts on various cardiovascular parameters. Compared with baseline, consuming both forms of hazelnuts significantly improved HDL-cholesterol and apolipoprotein A1 concentrations, total-C/HDL-C ratio, and systolic blood pressure. These changes would be expected to result in improved cardiovascular outomes.

One argument I hear frequently from patients worried about weight gain is that nuts are very energy dense and therefore will contribute to weight gain if added to the diet or consumed as a snack.

In the roasted versus raw hazelnut study:

However, no evidence for weight gain was observed with the consumption of either raw or dry roasted, lightly salted hazelnuts in the present study, and in fact, small reductions in weight were observed. Results of the present study further add to previous research, which suggests that regular nut consumption results in either no weight gain or less weight gain than predicted This may be explained by dietary compensation, inefficient energy absorption, and an increase in metabolic rate.

Thus, neither roasted nor raw nuts contribute to weight gain.

I particular like one line from the conclusions of this study:

both forms of nuts are resistant to monotony

Really! That is tremendously reassuring because I have always worried  about my nuts getting bored.

Bottom line: Probably little change in the good components of nuts and almonds with roasting.

Effects of Roasting Almonds on Increasing Bad Chemicals

About a third of almonds and nuts are consumed in roasted form because a majority of people prefer the taste created by the Maillard reaction during roasting. Almonds can be roasted at home and the typical recommendation is an oven temperature of 350 degrees which corresponds to 177 degrees Celsius.

An analysis from the Winnipeg Health Authority found that roasting at temperatures higher than 140 degrees Celsius has some potentially worrisome consequences:

Lipid oxidation

-High heat used during the processing of nuts has the potential to develop lipid oxidation products, which include trans fatty acids. Trans fatty acids, while not present in raw nuts, were found to be significantly higher in roasted pistachios, peanuts, and almonds (0.5-0.9g/100g).
-Trans fat is known to increase LDL cholesterol and decrease HDL cholesterol, leading to increased cardiovascular disease risk.
-While roasting temperature was found to substantially increase lipid oxidation, roasting time had less of an effect on lipid oxidation. It is therefore recommended to roast nuts at a moderate temperature (130-150°C), for a longer period of time, rather than roasting at high heat for a shorter period of time (reference here)

Acrylamide

-Acrylamide has been identified as a probable carcinogen to humans. The amount of free aspargine in almonds makes them more susceptible to the Maillard reaction, which results in acrylamide formation. Time and temperature are known determinants of acrylamide formation in foods. Hence, darkly roasted almonds were found to have a much higher amount of acrylamide than lightly roasted almonds. The amount of acrylamide that is initially formed after processing was found to decrease over time. Acrylamide content of almonds therefore differs widely depending on roasting time and temperature, as well as length of time after processing.
-It was observed that almonds processed under roasting temperatures of 140-180°C led to the accelerated production of acrylamide. It is therefore recommended to roast almonds below 140°C

The acrylamide study authors noted that:

Almonds of European origin contained significantly less free asparagine and formed significantly less acrylamide during roasting as compared to the almonds from the U.S. Roasted hazelnuts contained very little acrylamide because of the low content of free asparagine in the raw nut.).

Bottom Line: Roasting almonds has the potential for creating some bad chemicals which might negate their beneficial effects.

I asked Whole Foods (my typical almond source) about the roasting process for their roasted almonds and they responded thusly:

“PPO and chemical methods of pasteurization are against our Quality Standards. Our almonds are pasteurized with steam. Our almonds are roasted with canola oil at 148 degrees (celsius).”

Yikes! Canola oil! 148 degrees! (When I asked Whole Foods did they really mean 148 degrees Celsius, the response was , no, I meant 148 degrees Fahrenheit. The skeptical cardiologist wonders.)

img_7965
The first sack of cardioprotective nuts from Dr. Pearson’s nutshop. There are from the Superior Nut Company. I’m still working on the packaging. They are raw and not treated with PPO.

It appears even Whole Foods roasted almonds have the potential for containing harmful acrylamides and trans-fats therefore when the skeptical cardiologist starts handing out packets of his cardioprotective nuts the almonds will be raw and they will be from Spain just like the almonds consumed in the landmark PREDIMED study that established their heart benefits.

Happy Thanksgiving!I hope you are able to stay resistant to monotony during this festive season.

-ACP

Speaking of resisting monotony, did you know this about thermobaric weapons?

“The [blast] kill mechanism against living targets is unique–and unpleasant…. What kills is the pressure wave, and more importantly, the subsequent rarefaction [vacuum], which ruptures the lungs…. If the fuel deflagrates but does not detonate, victims will be severely burned and will probably also inhale the burning fuel. Since the most common FAE fuels, ethylene oxide and propylene oxide, are highly toxic, undetonated FAE should prove as lethal to personnel caught within the cloud as most chemical agents.”

 


 

The Name For The Nuts Poll: Part Deux

The results of my request for reader input on naming the mixed nuts based on the PREDIMED study I plan to give out to my patients are hot off the presses.

screen-shot-2016-11-02-at-2-50-42-pm

 

 

The winner of the pre-specified names was “Pearson’s Health Nuts.”

Second place went to my personal favorite “Dr. P’s Stroke-bustin’ Nuts.

However, readers submitted some suggestions not in the poll:

screen-shot-2016-11-02-at-2-50-53-pm
And I had one patient bring in her suggestion with a design already created!:

img_7954-1

and one sketch out her suggestion on what appears to be a post-it note:

img_7959
I’ll term this heart (symbol)NUTZ in the poll

Consequently, I’m soliciting your input into a revised poll that incorporates some of the newer suggestions.

There is much excitement here at mixed nut central because the non-fumigated raw almonds have arrived!

Polldaddily Yours

-ACP

 

 

 

Raw Almonds From The Gas Chamber or: A PPO Most Investors Should Avoid

In my previous post highlighting the marketing hype, silliness, and duplicity surrounding Kind bars, I revealed that the skeptical cardiologist would soon begin issuing bags of special stroke-busting  nuts to his patients.

I solicited a catchy name for the sacks.

One reader suggested:

“The Snack” or “Snack?” No one will forget that name.. In the center of a small heart shape on the front of the package will be shown the type of nuts (either written or better as a picture.. )

Another:

How about “Pearson’s Health Nuts?” It could refer to both the nuts and the eaters.

Another:

“Nuts About Nuts!”

The logo is a kindly cardiologist, in a lab coat, peering over the top of his glasses, with a stethoscope draped around his shoulders.

Another

Call it Pearson’s delight!!! I always keep a bag of nuts mixed with raisins, m&ms, almonds and cashews. Have done this for last 3 years. But some times I over eat them. But better than junk food..hope this is ok

(Raisins and M & Ms are right out! Too much sugar)

I’ve created a poll that I would appreciate your voting on. I can guarantee this will be less controversial than the Presidential election.

Raw Almonds: Straight From Fumigation

While exploring where to obtain the best walnuts, almonds, and hazelnuts for these “yet to be named” snacks, I discovered that the vast majority of almonds consumed in the US have been pasteurized by fumigation with an organic chemical called propylene oxide (PPO).

Because of two salmonella outbreaks involving almonds from California, the FDA mandated in 2007 that all California almonds had to be pasteurized either by a steam process or by PPO. Since the PPO process is cheaper, the vast majority of non-organic almonds have been sprayed with PPO. Both PPO sprayed and steamed almonds are marketed as “raw.”

Although I’m not fanatical about choosing organic (with the exception of dairy) I really don’t like the idea of eating things that have been sprayed with PPO.  PPO is primarily used to make polyurethane plastics. The CDC says:

“propylene oxide is a direct-acting carcinogen”

Several online sources state that PPO has been banned in “Canada, Mexico, and the European Union” including this Almond fact sheet from cornucopia.org

https://www.cornucopia.org/almond/Almond_Fact_Sheet.pdf

but it’s more accurate to say that these countries have not approved PPO fumigation.

Consequently, I’m getting my almonds from nutsinbulk.com. They are selling almonds from Spain, grown organically, and they promise there will be no PPO consumed.

Once my nuts arrive and I get them in appropriate sacks with appropriate labels, I’ll start handing them out to my patients.

If anyone has advice on creating such labels and sacks feel free to comment below.

Amandinely Yours

-ACP

P.S. Here’s what the CDC says about PPO

Studies in animals have demonstrated that propylene oxide is a direct-acting carcinogen. B6C3F1 mice exposed by inhalation to propylene oxide developed hemangiomas and hemangiosarcomas of the nasal mucosa. F344/N rats exposed to propylene oxide in air developed papillary adenomas of the nasal epithelium. Degeneration of the olfactory epithelium and hyperplasia of the respiratory epithelium were induced in the nasal cavities of Wistar rats exposed to propylene oxide by inhalation. Squamous cell carcinomas of the forestomach developed in rats administered propylene oxide by gavage. Although epidemiologic data are not available from workers exposed to propylene oxide, the findings of cancer and other tumors in both rats and mice treated with propylene oxide meet the criteria established in the Occupational Safety and Health Administration Cancer Policy [Title 29 of the Code of Federal Regulations, Section 1990.112] for regarding propylene oxide as a potential occupational carcinogen. The National Institute for Occupational Safety and Health therefore recommends that occupational exposures to propylene oxide be reduced to the lowest feasible concentration.