Monday, February 15, 2016

Treating the disease of kings with diet

Gout has long been termed the “disease of kings” because hundreds of years ago in Europe, it was the royalty who were primarily impacted by the disease.

I’ve personally seen how gout can impact not just a person’s life but also all of those around them. I have a family member who suffers from it and have seen how he has struggled with the disease for years, much to the dismay of his wife and children. My grandfather also had it, and I remember when I was young how some days he was essentially bed-restricted from the pain.

Now neither my grandfather nor any other family members are royalty (despite how we may sometimes act). But as it turns out, it’s has nothing to do with royalty, but more often than not is commonly found in overweight and obese people who consume rich foods and drink alcohol. Historically only the very wealthy could afford to eat such foods with such frequency which is why the disease has the reputation it does, but today nearly everyone has access to these debilitating foods, and as such, gout now affects nearly 1-2% of the American population at some point in their lives, and as high as 5% of men over the age of 65. This makes it the most common inflammatory arthritis in men and older women.

For some time we’ve know that foods high in purines tend to trigger and set off gout. Purines are a compound found naturally in certain foods that form uric acid. Gout accrues when that uric acid crystalizes in our joint fluid, causing a very painful form of inflammation. As such, when a person suffers from gout they are told to avoid foods that contain a high level of purines.

Seafood and organ meats are among the highest purine-containing foods (chicken and other meats are high on that list as well). However beans are also surprisingly high on that list of foods with purine.

However a study published in the Annals of the Rheumatic Diseases found that the risk for a gout attack increased five times with the consumption of animal protein when compared to those consuming plant-protein.

So then why are beans always excluded from a gout-prescribed diet? Well Brenda Davis, R.D. figured it out. Most lists of purine containing foods, display the amount of purines found in 100 grams of a food. Now 100 grams of beans is roughly half a dry cup, which when cooked is closer to 1.5 cups. The average serving size for a portion of beans is 1/2 cooked cup.

This means that most lists of high-purine foods are measuring triple the recommended serving size for beans. Imagine if we tripled the serving size of chicken? Most beans fall in the moderate range, and have a purine count of  20-75 mg per serving. 

Diets typically suggest avoiding the highest purine foods which have over 200 mg purines per serving or more (these are typically seafoods and organ meats), greatly reducing foods that contain 100 mg purines per serving (this is where white fish, pork, steak and chicken all fall) and eating no more than one portion  per day of moderate foods, or those that have between 50-100 mg per serving (hello beans!). 

The authors of the above study also cited other studies which found that long-term, habitual consumption of purine-rich vegetables was not associated with an increased risk of gout. That means eating beans may not be a bad thing, even for those suffering with gout.

I would be remiss if I didn’t mention that a different study from the EPIC-Oxford group found that vegans actually had the highest levels of blood uric acid compared to vegetarians, fish eaters, and meat eaters, but the authors did not look specifically at gout, and even still they found that the vegans had the lowest scores for other risk markers of gout, including Body Mass Index. They attributed the high level of uric acid to consumption of soy protein, and a lack of dairy, which may have some benefits for uric acid - although it could have many other serious health risks (see: here, here, here, here, here).

At first this paper seems contradictory from what we normally know. However, this is in fact, one of those papers where they actually over adjust, skewing the end result. They adjusted for BMI, which is the problem. It's problematic because we know that meat consumption leads to weight gain (In fact, according to one EPIC study, chicken is the biggest offender!) Weight gain tends to go hand and hand with higher levels of uric acid, which is why overweight and obese people have much higher incidence rates of gout, so when they adjust the studies statistics, they take the majority of meat eaters out, in favor for the minority whose bodies seem more adapt at processing heavy animal products. Also exercise was not added into the equation, and it remains possible that some of the patients included in the study switched to a vegetarian or vegan diet after they first got gout.

Finally, there may be one fruit that seems uniquely helpful when dealing with this painful disease. The same research team that published on animals vs plants proteins, uric acid, and gout incidence, published a second paper that same year which found that cherries seem to be a particularly protective when trying to control gout. But unlike the EPIC-OXFORD research, this one specifically examined patients suffering from gout.

They studied 633 individuals who were suffering from gout, and found they had a 35% decreased occurrence rate of gout when consuming just 1/2 cup of cherries per day - they did not change anything else (including any medications they were taking) - but simply ate cherries. The other fruits they tested did not have the same benefits.

When patients who were taking medications to help control their attacks added cherries, the researchers saw even greater benefits, reducing attack occurrences by 75% compared to an untreated control. 

Another paper found that fresh, frozen, and even cherry juice all worked well. As little as 1 tablespoon of concentrated cherry juice per day could decrease the flare ups. The cherry juice decreased flare up occurrences by as much as 50%, and nearly 50% of all the patients in the study were able to stop taking their medication for the crippling disease. 

So if you suffer from the disease of kings, you may be able to greatly reduce or completely stop your flare ups by simply making some small changes in your diet, namely minimizing or eliminating alcohol and meats, while increasing your consumption of fruits and veggies (potentially beans as well) and especially by adding cherries (in almost any form - although I haven't been able to track down a study showing the benefits of cherry pies yet!). While all the studies recommended more research be done on treating gout with diet, the only know side effects of eating cherries or even adopting a plant-based diet is better health. 

Schlesinger, N. et al. “Previously reported prior studies of cherry juice concentrate for gout flare prophylaxis: comment on the article by Zhang et. al” Journal of Arthritis 2013 April. 

Schmidt, J et al. “Serum Uric Acid Concentrations in Meat Eaters, Fish Eaters, Vegetarians and Vegans: A Cross-Sectional Analysis in the EPIC-Oxford Cohort.” PLoS ONE 8(2): e56339.

Vergnaud, A.C. et. al. “Meat consumption and prospective weight change in participants of the EPIC-PANACEA study” American Journal of Clinical Nutrition. 2010 August 92 (2).

Zhang, Yuging et al. “Cherry consumption and decreased risk of recurrent gout attacks” Journal of Arthritis 2012 64 (12).

Zhang, Yuging et al. “Purine-rich foods intake and recurrent gout attacks” Annuals of Rheumatic Diseases Sept. 2012, 71 (9).

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Monday, February 1, 2016

Plant Based Pioneers and Gluten-free cornbread

If you’ve ever seen Forks Over Knives (and if you haven’t please stop reading, go watch it, then return here to continue reading) you might remember about how during the Second World War, areas that faced near famine rationing experienced significantly lower mortality from heart disease.

This is true. As this graph from Forks Over Knives demonstrates, that in Sweden (and other areas) where meat and cheese was rationed, or taken from the civilians and sent to the men at the front, mortality from typical western diseases decreased.

However I recently learned a spin off of that story, that I found absolutely fascinating and wanted to share.

A California cardiologist, Lester Morrison had also heard about these statistics and in the first year following the war, he decided to see if a diet mimicking the war-time rationing diets could also help some of his patients.

While the study he concocted was largely ignored during his lifetime, and even today is largely disregarded for various methodical flaws, it still had interesting results, and a large impact on one person who used the results to spawn a movement.

Morrison took 100 post-infraction (ie: sick patients) and divided them into two groups. The first group had no intervention and continued living and eating as they had been. The other group he placed on a low-fat, low-cholesterol diet. He followed these 100 patients for 3 years and then again at the 8th year.

When he first published his piece, those in the diet group had lost, on average 25lbs and also lowered their serum cholesterol. On top of this, the mortality rate in the intervention group was 44% compared to 76% of the non-intervention group. Those in the intervention group also reported a sense of optimism, an increased exercise and work capacity and decreased angina symptoms. In a 1960 follow up, all of the non-intervention patients (that is those who continued living their normal lives) had died. However, 38 out of 50 of those on his low fat, low cholesterol diet were still alive.

As I mentioned above, these results were largely discounted for various reasons, however, Nathan Pritikin, a business man, took the lessons to heart and to their extreme, further cutting out the small amounts of animal products Morrison’s diet allowed. Using such a diet, Pritikin restored his health and his vigor. Shortly before hand, at the age of 42, Pritikin was diagnosed with heart disease and high cholesterol, and at the age of 44 received a further diagnoses of leukaemia. Eating a high-fiber diet of fruits, vegetables, and whole grains, within a shorttime, Pritikin dropped his total cholesterol by more than 100 points, and the angina he was suffering from completely vanished. Further, his cancer went into remission, and remained in remission for the next 27 years before finally returning.

Pritikin is often called the grandfather of the plant-based movement. Despite not having a medical degree, his books became best sellers, and he helped found the Pritikin Centers for Longevity where he and his team published over 100 peer reviewed scientific papers, and was even invited to give talks about nutrition and diseases at some of the countries most prestigious hospitals, including Mount Sinai in New York.

Pritikin eventually took his own life rather than suffering through the treatment for cancer, but upon his death, he did something remarkable, something that no other health "guru" has done since requested an autopsy of his health be published. What they found was even more remarkable. His heart was free of any plaque, and the results were published in the New England Journal of Medicine. At the time, the LA Times  wrote of the publication, “While there were small traces of fatty tissue both in the heart muscle and in the coronary arteries, all four of the major arteries examined were totally free of any restriction--a condition virtually unheard of for a 69-year-old man living in a Western country.” 
While I openly admit that these are just two anecdotal examples, they represent some of the earliest examinations of diet and disease. Today, the impact of these two men are still being felt, as even John McDougall, M.D. author of the Starch Solution credits Pritikin as one of his earliest role models. Today we have far more complex and scientifically-rigours studies, but even some fifty years ago, the lessons were clear. Eat plants, not animals for overall health.

Gluten and Oil Free Cornbread

This gluten and oil-free cornbread is fantastic and a perfect companion to my Quick Three Bean Chili. This recipe is the result of M and I becoming frustrated trying to find a recipe that suited all of our needs. Give it a try and let us know what you think.

1 cup brown rice flour (available for purchase or make your own*)
1 cup finely ground cornmeal
1 cup favorite plant based milk
2 flax eggs – 2 tablespoons of ground flax soaked in 4 tablespoons of water
1 tablespoon baking powder
1 ripe banana
6 medjool dates – pitted (soak the
2 tablespoons apple cider vinegar

There are two different ways to mix all the ingredients. The traditional way, of course, is to place the dry ingredients into a large bowl, mix well. Because this recipe is sweetened with whole fruits, you’ll need to either blend or process the dates and the banana into the milk. It will be thick, but you want it to be thinner than pancake mix, it should pour out of your blender without too much assistance. Now that you’ve prepared your milk, combine the wet ingredients and mixed with the dry ingredients until completely combined.

As a little tip, we prefer to simply the mixing process by adding the dry ingredients slowly into the high powered blender or food processor after blending the fruit into the milk. Blend until all ingredients are completely smooth and well combined.

Let the batter stand for five minutes

While you are preparing your batter, pre-heat the oven to 350. Now pour the batter into a greased pan or pan lined with parchment paper and place it into the oven.

Cook for 22-25 minutes until golden brown. Remove and let cool. Then enjoy in any number of ways with any number of dishes.

*Brown rice flour can be purchased but is also easy to make but simply tossing 1 cup of uncooked brown rice into a blender or food process and processing until the rice is a fine powder.

Hubbard, J. “Nathan Pritikin’s Heart,” (1985) New England Journal of Medicine 313 (1) 52.

Morrison, “Reduction of Mortality Rate in Coronary Atherosclerosis by a low Cholesterol-low Fat Diet.” (1951) Am. Heart J. 42: 538-545.

Parachini, “Autopsy of Pritikin May Renew Debate,” Los Angeles Times July 4, 1985.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.