Saturday, March 12, 2005

The Harvard Medical School Guide to Men’s Health by Harvey B Simon, MD 2002

The operating manual for the most important machine that you own.

From Publishers Weekly: While it may not be as hot as the latest issue of Maxim, this new health guide should be required reading for any man between the ages of 18 and 80. The book's success is rooted in the no-nonsense approach of author Simon, the founding editor of the wildly successful Harvard Men's Health Watch newsletter, who has long been urging men to get in shape and stay that way. Simon uses the results of three Harvard studies of more than 95,000 men over the last 25 years to provide five main "answers" (diet, exercise, aspirin and other supplements, moderate alcohol, and behavior modification and stress control) to five main "maladies of men" (disorders of the genital area, sexuality and reproduction, benign prostate disorders, prostate cancer, and kidney and bladder disorders). Along the way, he discusses other topics such as reproductive anatomy, vitamins, depression, Viagra and herbal medications. Though it's packed with provocative data (e.g., "every one of the ten leading causes of death in America is substantially more common in men than women"; "even committed teetotalers who review the data will have to agree that light to moderate drinking appears to reduce a man's risk of angina, heart attack, sudden cardiac death, and ischemic stroke"), the book stays focused on Simon's main message: "Above all, men should concentrate on the basics, on the core issues that remain constant in a sea of change." (Sept.) Forecast: Neither overly serious nor laced with chirpy beer-and-babes humor, this tome should remain a steady seller after trendier books are gone.

My comments are in bold italics

Chapter 3: Perils and Problems

“Men who exercise at least once a week are 36% less likely to develop Type 2 diabetes than sedentary men, and men who exercise 5 or more times per week enjoy a 42% risk reduction.” Exercising once a week is key for diabetes reduction. The extra 4 or more exercise sessions don’t seem to add much extra protection.

“Men with highest homocysteine levels were 290% more likely to develop coronary artery disease than men with the lowest levels. For perspective, a 5 point rise in homocysteine appears as dangerous as a 20 point rise in total cholesterol, each increasing risk by about 20 to 40%.”

Rapid metabolism of homocysteine depends on 3 vitamins: B6, B12 and Folic Acid.

Homocysteine causes disease in four ways:” by producing toxic damage to endothelial cells that line the inner surface of arteries, by increasing the activity of free radicals, by stimulating the enlargement of smooth muscle cells in the layer of arterial walls, and by accelerating the clotting process (this also increases the risk of stroke)”

C-Reactive Protein (CRP) and fibrinogen are clotting factors produced by inflammation. “Low-dose aspirin reduces the risk of heart attack by 55% in men with high CRP levels.” An aspirin a day really can pay off! Actually it only takes a mere 30-40 mg of aspirin (about 1/10 of the normal dosage in a single pill!) to gain the benefit, and to take this small dosage every other day. This tiny dosage will saturate all of the clotting factor in your body, and it takes you about 2 days to generate new clotting factor that is not bound to aspriin. Once bound, the clotting factor cannot unbind. Better to take the lower dosage because once you have saturated the clotting factor, the extra aspirin does no good, and can cause stomach bleeding. More on this later in the book.

“Men with the highest levels of insulin like growth factor (IGF-1) are 430% more likely to develop prostate cancer.” Most likely this is an effect not a cause of the cancer. The cancer cells are secreting this growth factor which encourages tumor growth.

“A person’s DNA sustains an estimated 10,000 oxidative hits per day. Most are repaired, but cancer may result if antioxidants fail.” Such a hit rate means that the fidelity of error correction and antioxidation must be extremely high or we’d all be giant tumors!

Chapter 4 The Answers: Diet

British study pegged the ideal BMI at 22; above that very lean level, each increase of 1 BMI point was associated with a 10% increase in the risk of heart disease and overall mortality. Other studies agree: in Japan the ideal BMI was 22.5 and in the Harvard study, it was 22.6. A BMI of 22 for 5’11” man equates to a weight of 157. I need to lose 10lbs to get to a BMI of 22!

Waist size (inches) / Hip size (inches) = W/H Ratio. “Men with ratios above 1 have 200% the death rate of those with ratios below .85. Men with ratios above .98 are 230% more likely to suffer strokes than men with ratios below .89. That is a big effect from just a few inches.” Wow, one belt notch can double your mortality risk!

“The body can produce most of the fatty acids it needs simply by converting one fat into another. But there are two exceptions: because the body cannot produce linoleic acid (omega 6 fat) [good sources are corn (58%) and soybean (51%)] or alpha-linoleic acid (omega 3) [good sources are flaxseed (50%) and canola (11%)], a dietary supply of these two polyunsaturated fatty acids is essential…”

Oleic Acid (omega 9) is another major fatty acid, and is found in Olive (73%) and canola (53%) oils.

Eicoapentaenoic Acid (another omega 3). “The greatest amounts are in oily, dark fleshed fish that live in deep, cold waters, such as mackerel, herring, striped bass, salmon.”

"Monosaturated fats, particulary Oleic acid (think olive and canola oils), help protect LDL from oxidation… In contrast linoleic acid (think corn, soybean and other vegetable oils), appears to make LDL more susceptible to oxidative damage.”

Eating fish. Here’s the summary:
“Eating 5 to 6 portions of fish per week did not provide any more protection against heart attack than 1 to 2 portions.”
“Eating fish once per week was associated with a decreased risk of sudden death… and a lower overall death rate.”
Eat fish twice a week and get most of the benefit!

What eating fat can do to your prostate:
Alpha-Linoleic acid (think flaxseed and canola oils and omega 3 from plants) may increase prostate cancer “men with high levels of Alpha-Linoleic acid in their blood are up to 340% more likely to develop prostate cancer than men with very low levels.” However, Omega 3 from fish lowers prostate risk; “3 studies from around the world have linked a high consumption of fish with a decreased risk of prostate cancer.” “
“Men who ate the most fat were 179% more likely to develop advanced prostate cancer than were men who ate the least. But not all fats were equally harmful; animal fat was linked to the disease, but vegetable fat was not. Red meat was the chief culprit.”
“Men who ate the most beef, bacon, pork and lamb were 260% more likely to develop prostate cancer than men who ate the least. Men who ate chicken with the skin were at increased risk, but men who omitted the skin were not.”

"Men who ate the most fiber (29 grams/day) enjoyed a 41% reduction in heart attacks compared with men who ate the least fiber (12.4 grams/day)… Each 10 gram increase in daily fiber intake, drops heart disease risk by19%.”
“High-fiber diet can reduce the risk of diverticulosis by 42%; insoluble fiber was particularly helpful.”
“The Health Professionals Study casts doubt on the theory (of fiber reducing colon cancer) by finding no protection against colon cancer from dietary fiber.”

Chapter 5 The Answer: Exercise

Based upon many studies “Doctors including the Surgeon General’s current guidelines have concluded that 2000 calories of exercise (about 20 miles of running or 100 miles of cycling or 5 miles of swimming) per week would provide optimal benefits… vigorous exercise produced greater rewards than less intense activities (sorry to you walkers).”

“Men who exercised to the tune of 1000-1999 calories a week enjoyed a 24% reduction in stroke compared with sedentary men…maximum gain (46% reduction in stroke risk) required 2000-3000 calories a week.”

“The most active men had a 47% lower risk of developing colon cancer then men who exercised the least.”

“Men who burn more than 1000 calories per week have ½ the risk of colon cancer as men who expend less than 1000 carlories per week.”

“Men who burn more than 4000 calories a week have reduced risk for prostate cancer.” No benefit was seen for lower amounts. It seems that you can’t run from prostate cancer unless you are perpetually training for a marathon.

“Regular exercise reduces the risk of Alzheimer’s and other cognitive forms of impairment by up to 50%.”

Chapter 6 The Answer: Aspirin

“Platlets (the thing in your blood that triggers clotting) are extremely sensitive to aspirin…doses as low as 10-30 mg (less than 1/10 of a tablet) can inhibit all the platlets in a man’s body. Once inhibited, they stay inhibited, but since new platlets are entering the blood continuosly (10% are recycled each day, and each platelet last about 10 days), the aspirin must be repeated every 24 to 48 hours to keep the vast majority inhibited.”

“Aspirin is most effective before the early morning hours when platlets are particularly likely to stick together and produce clots.”

“Aspirin was effective in preventing heart attacks in men who had angina. Asprin did not prevent healthy men from developing angina because angina is caused by plaques that produce partial blockages, but heart attacks are the result of clots that form on plaques.”

“A high intake of lycopene (especially from cooked tomatoes) was linked to a 20 to 30% decrease in the risk of prostate cancer, and it reduced the risk of the most aggressive prostate cancer by 50%.”

Chapter 7 An Answer for Some, A Peril for Others: Alcohol

“The most important benefit of alcohol is its ability to boost HDL (good) cholesterol. It does not take much alchohol to do the job – just one or two drinks a day will elevate HDL by 5 to 10%. A 10 point rise in HDL is associated with a 40% reduction in cardiac risk.”

“Men who averaged one drink a day enjoyed a 31% percent lower risk of angina and a 35% lower risk of heart attack; men who averaged two or more drinks a day experienced even greater benefit 56% and 47% respectively.”

“Light to moderate rinking is actually associated with a decreased incidence of diabetes.”

“Men who averaged 1 or more drinks per day were 26% less likely to develop peripheral artery disease than non-drinkers.”

“Two drinks a day was associated with a 50% reduction in the risk of ischemic stroke.”

“Australian men who had roughly one drink a day had a 16% lower death rate than teetotalers.”

“Chinese men who drank up to 2 drinks a day had a 19% lower death rate than non-drinkers.”

Chapter 8 The Answers: Behavior Modification and Stress Control

“Healthy men who lost a wife were 210% more likely to die than healthy men who were not bereaved. The risk was greatest from 7 to 12 months after the loss, but an elevated death rate persisted for more than 2 years.”

“People who attended concerts and plays rarely were 280% more likely to die (during the study period) than were people who attended frequently; occasional concert-goers were in between with a death rate of 160% more than frequent goers.” Go see the ‘Stones concert; for health purposes only of course.

“Social disengagment leads a 200% increase in the incidence of cognitive decline. Men with the fewest social ties had the highest risk of dying from heart disease, circulatory ailments, and even cancer.”

“The median survial for married men (with diagnosed terminal disease) was 69 months, for divorced men 55 months, and for single men 49 months, and for recently separated or widowed men just 38 months.”

“Unmarried men were about 30% more likely to die from prostate cancer than married men.”

“Divorce doubles the suicide rate in men, but doesn’t change the rate in women. It also increases the rate of illness during the first year of separation.”

Chapter 10 Sexuality and Reproduction

“Men who exercise 30 minutes a day are 41% less likely to have erectile dysfunction than sedentary men. Men who drink 1 to 2 drinks a day are 33% less likely to be impotent than a non-drinker.”

“Things that damage blood vessels impair erectile function… the penis acts like one big artery.” That’s the bonus of taking care of your heart and arteries.

Viagra specifically targets PDE5, an enzyme breaks down the chemical cGMP which is needed to increase the bloodflow to the penis. Thus less PDE5, means more cGMP, which means more blood available to the penis, which means… well you get the picture. However, the rest of the circulatory system also uses these same enzymes to a certain extent so “Viagra temporarily lowers blood pressure of normal men by a small amount, typically 5 to 8 mmHg.”

“For a healthy 55 year old, the risk of having a heart attack in any given hour is 1 in a million; sex doubles this risk. For men with heart disease their overall risk is 10 times higher… the chance of suffering a heart attack becomes 20 in a million.”

“At age 40 testosterone levels begin to fall…averaging 1% per year, by age 80, a man’s testosterone level is about ½ of what it was at age 18.”

“Testosterone production waxes and wanes over a 24 hour cycle; production is highest at 8AM and lowest at 9PM.”

Chapter 11 The Prostate: Benign Disorders

“The prostate enlarges by 1.6% a year beyond 40.”

“By age 80, 25% of all men will develop enlarged prostates (Benign Prostate Hyperplasia – BPH) severe enough to require treatment.”

“Men who walk 2 to 3 hours per week are 25% less likely to develop BPH than sedentary men.”

“The consumption of 50g of alcohol a day (3 beers) was linked to a 41% reduction in the risk of BPH.”

If you have BPH, “avoid medications that stimulate the muscles in the bladder neck and prostate. Pseudoephederine (Sudafed) and other decongestants are the chief culprits.”

The facts on Saw palmetto
“When American scientists reviewed 18 randomized controlled trials of saw palmetto in a total of 2939 men, they concluded ‘the evidence suggests that saw palmetto improves urologic function symptoms and urinary flow but further research is needed using standardized preparations to determine long term effectiveness and ability to prevent BPH.”
“When Consumer’s Union evaluated various preparations it found that the amount of the herb in each tablet does not always correspond to the claims on the label – but one brand, the CVS brand, contained what it claimed.”
“Saw palmetto produces few side effects… but if it does not seem to help in 1 to 3 months, it is not worth continuing.”

Chapter 12 Prostate Cancer

“32,000 American men will die from prostate cancer this year… but only 1 in 10 men with prostate cancer actually dies from the disease.”

“42% of a man’s risk of prostate cancer could be explained by hereditary factors… if the study is correct, heredity has a greater impact on prostate cancer than on all other common malignancies, including colorectal (35%) and breast (27%).” Choose your parents wisely I always say.

“Men who have a father or brother with diagnosed prostate cancer are about 200% more likely to develop the disease as men whose families are free of it… A man who has several close relatives with the disease, particularly if the prostate cancers were diagnosed before age 55, is up to 800% more likely to develop prostate cancer himself.”

“Men who have special reason to worry about prostate cancer might decide to forego the cardiac benefits of canola and flaxseed.”

A study of 48,000 men evaluated 46 different fruits and vegetables and found that “dark leafy green vegetables appear to reduce the risk of various malignancies, but they do not protect against prostate cancer… Instead the tomatoes emerged as the only item linked to a reduction in prostate cancer.”

“Men absorb 2.5 times more lycopene from tomato paste than from fresh tomatoes.”

“The men eating the most cereal suffered 19.5 fewer prostate cancer deaths per 100,000… for perspective, the protective effect of cereal was even stronger than the deleterious effect of a high fat diet.”

“Men who ate the most vegetable fat were 60-67% less likely to develop prostate cancer than men who ate the least.”

A Selenium study of 1312 men with an avg age of 63 who were followed for 4.5 years proved “that men who took selenium enjoyed a 63% lower risk of dying from prostate cancer than those who took placebos.”

An additional study of 33,737 men showed that “men with the highest selenium levels (equivalent to a daily intake of 159 micograms) had a 67% lower risk of developing advanced prostate cancer as men with the lowest levels (86 micrograms).”

“Men with a high consumption of calcium (more than 2000 mg/day) had an increased risk of advanced prostate cancer… At the same time, the researchers found that a large amount of fructose was protective. The scientists speculate that calcium and fructose are linked to the prostate by Vitamin D. High levels of calcium can reduce the body’s production of active vitamin D by lowering levels of phosphate; low levels of fructose can have the same result.”

“Men who have a high intake of milk low levels of vitamin D, and a 32% increase in the risk of prostate cancer.” Maybe the milk campaign should say ‘Got prostate cancer?’

Chapter 13 Disorders of the Kidneys and Bladder

“1 in 8 of every American men will develop a kidney stone… the highest risk occurs between the ages of 20 and 50. Men with family history of stone disease are 250% more likely to form stones than men without stone-forming relatives.”

“Everyone who has had a kidney stone should drink large amounts of fluid, enough to pass 2 quarts of urine each day (this requires drinking over 10 glasses of fluid daily).”

“50% of stone-formers have an intestinal defect that allows them to absorb excessive amounts of calcium from food. The biggest surprise is that dietary calcium restriction does not prevent stones. On the contrary, in fact, a low calcium diet seems to make things worse.”

“Men who consumed the most calcium from food were 44% less likely to form stones than men who had the lowest levels of calcium.”

“If dietary calcium is low, the body absorbs more oxalate (the stuff that makes your urine smells after eating asparagus)… The calcium in food normally binds to oxalate, preventing the body from absorbing oxalate. Excess oxalate is excreted in the urine, where it can finally bind with calcium – forming calcium oxalate crystals in the kidney.”

“More than 41,000 American men will be diagnosed with bladder cancer, and more than 8,000 (20%) will lose their lives to the disease.”

“A high intake of fruits and vegetables appears to reduce the risk of bladder cancer, while a high fat diet seems to increase risk… Studies have singled out cruciferous vegetables (think broccoli and cabbage) as protective.”

“Men who drank the most fluid (averaging 2.5 quarts per day) were 49% less likely to develop bladder cancer… men can reduce their risk of bladder cancer by 7% for each additional 8 oz of fluid they drink each day.”

Chapter 14 Other Male Medical Problems

“Half of all men snore… 24% of healthy middle aged men have sleep apnea. If you do not snore, you do not need to worry about sleep apnea.” But if you do it means you have a 50% chance of having apnea!

“4 weekly sessions of brisk walking or low impact aerobics added an average of 42 minutes of nightly sleep to middle aged men with insomnia.”

“At birth, the human body is covered with 5 million hair follicles, including about 100,000 in the scalp. The number of follicles remains constant throughout life, but the activity varies to the stage of a person’s life. For balding men, each successive growth phase grows shorter and each resting phase longer. The hair becomes shorter and finer, and less tightly attached to the scalp.”

“Mild vertex baldness was linked to a 23% increase in coronary heart disease, moderate baldness to a 32% rise, and severe baldness to a 36% increase in risk. Frontal baldness (receding hairline) was not associated with cardiac risk”

My summary:
Exercise at least 2000 calories per week and stay as thin as you can.
Follow the dietary guidelines from the Willett book. Eat less, and eat healthy.
Get vitamin D, selenium, B6, B12, Folic Acid (most multivitamins will do)
Don't drink too much - milk.

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter Willett MD 2001

This is a book by the Harvard epidemologist who has looked at the various longtidudinal studies of health and diet to glean some factual assessments. Very fact based without the hype, helping you to make your own decisions.

First a blurb on the book: from's Best of 2001
Aimed at nothing less than totally restructuring the diets of Americans, Eat, Drink, and Be Healthy may well accomplish its goal. Dr. Walter C. Willett gets off to a roaring start by totally dismantling one of the largest icons in health today: the USDA Food Pyramid that we all learn in elementary school. He blames many of the pyramid's recommendations--6 to 11 servings of carbohydrates, all fats used sparingly--for much of the current wave of obesity. At first this may read differently than any diet book, but Willett also makes a crucial, rarely mentioned point about this icon: "The thing to keep in mind about the USDA Pyramid is that it comes from the Department of Agriculture, the agency responsible for promoting American agriculture, not from the agencies established to monitor and protect our health." It's no wonder that dairy products and American-grown grains such as wheat and corn figure so prominently in the USDA's recommendations. Willett's own simple pyramid has several benefits over the traditional format. His information is up-to-date, and you won't find recommendations that come from special-interest groups. His ideas are nothing radical--if we eat more vegetables and complex carbohydrates (no, potatoes are not complex), emphasize healthy fats, and enjoy small amounts of a tremendous variety of food, we will be healthier. You'll find some surprises as well, such as doubts about the overall benefits of soy (unless you're willing to eat a pound and a half of tofu a day), and that nuts, with their "good" fat content, are a terrific snack. Relying on research rather than anecdotes, this is a solidly written nutritional guide that will show you the real story behind how food is digested, from the glycemic index for carbs to the wisdom of adding a multivitamin to your diet. Willett combines research with matter-of-fact language and a no-nonsense tone that turns academic studies into easily understandable suggestions for living.

I will highlight key points and thought provoking items. As usual my comments are in bold italics.

Chapter 3 Healthy Weight

Prior Body Mass Index (BMI) studies have proven that disease incidence starts to grow exponentially (especially for type 2 diabetes) from a BMI of 21. Implying the optimal BMI was around 21. These first studies neglected to adjust for the fact that smokers tend to be underweight due to appetite suppression from smoking, and terminally ill patients tend to die underweight due to chronic wasting. Adjusting out smokers and terminally ill, leads to a more sobering graph that shows that disease incidence continues to the decline to a BMI of 17. This means that the skinnier you are the better. This is also consistent with the only proven longevity increasing strategy – caloric restriction. The fewer calories you eat, the skinnier you become and stay – and the fewer diseases you are susceptible to contract, leading to the longest possible life.

“Our taste for sweet things, for example, helped early humans sort through leaves to find the tender young ones with a ready supply of energy”. Interesting speculation.

Chapter 4 Surprising News about Fat
“Saturated fats come in gradations of bad. The staturated fats in butter and other dairy products most strongly increase LDL (bad) cholesterol. Those in beef aren’t quite as powerful at boosting LDL, and those in chocolate and cocoa butter have an even smaller impact.” Bad news for fans of dairy, but good news for chocolate lovers.

Monosaturated fats are oils (at room temperature). Olive, peanut, and canola oils as well as avocados and most nuts are excellent sources. Eat these liberally.

Polyunsaturated fats are also oils, but unlike saturated and monosaturated your body cannot synthesize these itself; therefore you must ingest these. These are called essential fats because of this fact. Omega 3 and Omega 6 fats are polyunsaturated that you hear a lot about. Good sources include corn and soybean oil, seeds, whole grains, and fatty fish.

Transfats are man made, and are created from polyunsaturated fats. They are very bad for you. Details will come later.

“With regard to heart disease, the most important lipoproteins are high-density (HDL) and low-density (LDL) and very low-density, which is composed of triglycerides… When your bloodstream carries too many LDL particles, they can end up in wrong places, especially inside cells that line the blood vessels. Once there, LDL is attacked by highly reactive free radicals and transformed into oxidized LDL. Oxidized LDL can damage the artery lining and can also kick off a a cascade of reactions that clog the artery and set the scene for artery blocking blood clots. “

“HDL particles sponge up excess cholestor from the lining of blood vessels and elsewhere and carry it off to the liver for disposal.”

“Triglyceride makes up most of the fat you eat, and most of the fat that circulates in your bloodstream.”

“Replacing 5% percent of total calories at saturated fat with unsaturated (either poly or mono but not trans!) would reduce the risk of heart attack or death from heart disease by about 40%.”

“Replacing just 2% of total calories from trans fat with the same number of calories from unsaturated fats would cut the risk by 50%.”

In 1988 a study was conducted of the ‘Mediterranean diet’ (a diet low in saturated and trans fats, but high in unsaturated fats, especially omega 3 fats). Just 2.5 years into the study, it was ethically stopped early because the results were so compelling – a 70% reduction in deaths of all causes.

Another “study from Holland showed that calories from trans fats not only raised LDL as much as from saturated fats, but also trans fats substantially lowered HDL.” This is why trans fats are so bad! Trans fats also make blood platlets stickier, causing more clotting (which can lead to strokes and heart attacks).

“Women who ate the most trans fats (about 3% of total calories) were 50% more likely to develop heart disease than those who ate the least (about 1% of total calories)… Women with the lowest intake of trans fats and the highest intake of polyunsaturated fats were 70% less likely to develop heart disease when compared with women who ate the most trans fats and the least polyunsaturated fats.”

Omega 3s were originally found to be beneficial because of the study of the low heart disease rates for Eskimos who have a very high fat diet, but most of those fats are omega 3. Since then, dozens of subsequent studies have shown that omega 3 from fish and other sources help prevent heart attack, stroke by improving the balance of cholesterol and limiting inflammation.

“The clearest and most consistent finding from both animal and human studies is that too many calories, regardless of food source, are far more important to the development of breast cancer than dietary fat... cutting daily calories by 30% can drop cancer rates by 80%.”

“Too many calories in relation to exercise levels is the strongest dietary link with colon cancer (fiber and fat are not culprits).”

More evidence for caloric restriction. It is not what you eat, but more important how much (or more accurately how little) you eat.

“Unsaturated fats that decrease the risk of heart disease would not increase the risk of prostate cancer”. Good news, so you can eat those unsaturated fats with impunity upto your daily caloric limit.

“Chicken fat is much higher in polyunsaturated fat than beef, probably the main reason why substituting chicken for red meat is related to a lower risk of heart disease.”

“Eat one or more good sources of omega 3 every day – fish, walnuts, canola, flaxseed are the best sources.”

Chapter 5 Carbohydrates for Better and Worse

Four things contribute to insulin resistance (type 2 diabetes)
1. Obesity. A BMI over 21 starts to dramatically increase your risks.
2. Inactivity. Regularly exercised muscle cells handle insulin and glucose very efficiently. Further the less active you are the fewer muscle cells you have.
3. Dietary Fat. Low intake of poly and mono saturated fats coupled with a high intake of trans fat leads to greater resistance.
4. Genes. Your heritage can play a factor in which case being vigilant on your weight, exercise, and fat intake becomes doubly important.

Studies show the following about fiber and whole grain carbs:

That as little as 7.5 grams of fiber per day compared to a daily intake of 2.5 grams, leads to a 30% reduction in the incidence of type 2 diabetes.

2.5 servings of whole grains per day vs. 1 serving per week lead to a 30% reduction in heart disease for women.

Harvard estimates that eating 1 bowl of high fiber cereal (5 grams) cuts the chance of heart disease by 33%.

Fiber intake doesn’t affect rates of colon cancer. This is a shocker.

My theory on fiber is the following. First fiber is indigestible so it fills you up without costing you any calories, thus reducing your caloric intake. Second, fiber speeds up your digestion and prevents the full absorption of other substances (like certain fats and cholesterol), thus removing additional calories from your intake. Could it be just another form of caloric restriction?

Chapter 6 Choose Healthier Sources of Protein

“Studies have shown a consistent 30 to 50% reduction in heart disease associated with eating nuts several times a week”

“Women who ate the most protein, about 25% of daily calories, were 25% less likely to have had a heart attack or to have died of heart disease than the women who eat the least protein, about 15% of calories.”

But is it safe to eat a lot of protein? Yes, “The amount of protein doesn’t seem to have an effect on the development of type 2 diabetes”. And no, “Women who ate more than 95 grams of protein a day had more broken wrists than those eating an average amount of protein, less than 68 grams a day.” “Extra calcium is needed to neutralize protein related acids. This calcium is mostly pulled from bone.” So too much protein could be dangerous to your bones!

The sad truth about soy protein. Only one major study has proven the benefits of soy protein. Wait’ll you digest the facts and implications before deciding if soy is truly beneficial. “In a 1995 article in the New England Journal of Medicene, a satistical analysis of the results of 38 studies showed that eating 50 (!) grams of soy protein per day (!) in place of animal protein reduced total cholesterol by 9.3% and LDL cholesterol by 12.9%.” Lets take a moment to analyze this. 50 grams of soy equates to 1.5lbs of Tofu or 64 ounces of Soy milk (a whole ½ gallon and it also equates to about 1200 calories.) So given the incredibly large intake of soy, perhaps the reduction of in cholesterol has more to do with the fact that you didn’t eat the animal protein (and animals fats), and less to do with the beneficial nature of soy. The soy just filled you up and prevented you from eating something more harmful. Unfortunately for soy, things get worse. Soy contains phytoestrogens (plant horomones). “Breast tissue removed from women taking soy supplement showed substantial more cell growth and division than the tissue removed from women not taking soy. Animal studies also suggest reason for caution because soy estrogens promote the multiplication of breast cells…” “It’s not wise to go overboard eating soy products.” Couldn’t have said it better.

Chapter 7 Eat Plenty of Fruits and Vegetables

“It appears that fruits and vegetables probably don’t have a blanket anticancer effect. Instead certain classes of fruits and vegetables seem to work against specific cancers.”

35 servings per week (5 per day) were 15% less likely to have a heart attack than those who ate the fewest servings.

30 servings per week lead to a 30% reduction in stroke. Harvard calculates that each daily serving lowers your stroke risk by 6%.

Eating fruits and vegetables also lowers your cholesterol level, although no one knows exactly how. However, the obvious sometimes needs to be stated:
“Since eating more plant foods often means eating less meat and dairy products, lower cholesterol levels may come from eating less saturated fat.” It is not necessarily that fruits and vegetables are good for you. These foods are not as calorie dense as animal foods. If you get full on fruits and vegetables you may live longer since you just didn’t have the room to eat the foods that are really bad for you. This is in alignment with caloric restriction.

“How fruits and vegetables protect the human system from cancer, heart disease, GI problems, or age-related diseases is still something of a mystery.” We have found certain compounds within certain bodily tissues, and we have found those same compounds within certain plants. So far it is speculation that the plants are truly providing the compounds in proper dosage, frequency and potency to have any effect on our biology. It seems to make sense, but studies have not proven that eating more of a particular substance derived from a plant leads to less disease. It seems that the plants have many chemicals that are involved, and isolation leaves something critical behind.

“Those who consumed the most fiber, no matter what the sources, did not have lower risks of colon cancer or colon polyps.” Surprising!

Eat a lot and eat a variety of fruits and vegetables is the key take away.

Chapter 8 You are what you drink

“You may heard that you need to drink 8 eight ounce glasses of water a day in addition to whatever beverages you drink. That’s actually a medical urban legend. It probably comes from the fact that someone who eats 2000 calories of food a day needs about 64 ounces of fluid (to process the energy in those calories).” Most of this water is actually contained within the food you eat itself. Think how much of a glass of milk or piece of fruit or even a piece of meat is actually made of water.

8 oz of grapefruit juice a day appeared to increase the chances of developing kidney stones by 44%.

Coffee and tea drinkers were less likely to experience the following:

To develop kidney stones than non-coffee drinkers. Speculation centers on caffiene which is a diuretic; helping to flush out more water, making it too dilute for kidney stones to precipitate out.

To develop gallstones. Caffiene interferes with cholesterol crystallization, and promotes gall bladder contractions.

To experience suicide. California HMO studies show an almost 50% reduction in suicide rates.

For women, even 2 alcoholic drinks per day can raise her risk for breast cancer by 20 to 25%.

Chapter 9 Calcium: No Emergency

“There’s no solid evidence that merely increasing the amount of milk in your diet will protect you from breaking a hip or wrist or crushing a backbone in later years.”

“For men, a high calcium intake seems to increase the odds of developing prostate cancer, while for women, drinking a lot of milk has been linked with higher rates of ovarian cancer.” Studies have shown that “men who drank 2 or more glasses of milk a day were almost twice as likely to develop advanced or metastatic prostate cancer as those who didn’t drink milk at all”. “More careful analyses, suggest that calcium might be the culprit. Men who took in more than 2000 mg of calcium a day from food and supplements combined were almost three times as likely to develop advanced prostate cancer than men who got less than 500 mg/day.” Point of reference a single glass (8 oz) of milk contains about 350 mg of calcium.

“Breaking a hip in old age can be disabling, even deadly – almost ¼ of older people who break a hip die in the following year.”

“Vitamin D deficiency was much more common among women who had broken a hip than among women who had not.”

“Curiously, countries with the highest average calcium intake tend to have higher (!), not lower hip fracture rates.”

“As your body digests protein, it releases acids into the bloodstream. Calcium drawn mostly from the skeleton, helps neutralize these acids… when it comes to leaching calcium from bone, animal protein is somewhat more powerful than vegetable protein.”
Studies have “found that women who ate the most protein each day were more likely to break a wrist than women who ate the least. The same held true for women who ate red meat more than 5 times a week compared to with those who ate red meat less than once a week.”

Chapter 10 Take Multivitamin for Insurance

“Unfortunately, randomized trials in which volunteers have taken specific antioxidants have not shown much reduction in risk of developing cancer, cardiovascular disease or diabetes.” However, fruits and vegetables have proven such reductions. “This seeming contradiction may mean that you need the whole, complex net of antioxidants (and other chemicals) delivered by fruits and vegetables.”

“Getting plenty of folic acid seems to decrease the risk of developing colon cancer and breast cancer.” “Alcohol blocks the absorption of folic acid, and also inactivates circulation folic acid.” If you drink think about taking extra folic acid – approximately 600 mg/day to decrease the risks of cancer.

“During winter months, the amount of ultraviolet light hitting northern regions above 40 degrees latitude (eg. San Francisco, Denver, Wash DC) is not enough to generate vitamin D.” “A recent study showed that more than half of the people admitted to Mass Gen Hospital were vitamin D deficient.”

“Women who don’t get much vitamin K are twice as likely to break a hip as women who get plenty.” “We estimated that eating a serving of lettuce or other green leafy vegetables a day cut the risk of hip fracture in half when compared with eating one serving per week.” “…A fair number of Americans, particulary young ones, aren’t getting the vitamin K that they need, mainly because they don’t eat enough green leafy vegetables.”

“The 6 vitamins that many people don’t get enough of from their diets are:
Folic Acid
Vitamin B6
Vitamin B12
Vitamin D
Vitamin E
Vitamin K”

A simple multivitamin will fill in any gaps you have.

Chapter 11 Summary

“The healthiest nutritional strategy, summarized in this book includes:
Maintaining a stable, healthy weight under BMI of 25, ideally 21 to 23 or less.
Replacing saturated and trans fats with unsaturated fats
Substituting whole-grains with high fiber for refined grains and limiting sugar
Trading red meat for nuts, beans, chicken, and fish
Eating plent of fruits and vegetables
Using alcohol in moderation
Taking a daily multi-vitamin”

Nothing to it really.