Vitamin D

Last month I was very lucky to be the minder for Michael Holick, professor of medicine from Boston University during his seminar series on vitamin D in Sydney and Melbourne, Australia. Want to learn fast? Book a professor for four days. They are very clever people.

Every cell has a vitamin D receptor

Michael is a world expert on vitamin D. Just to remind you how young the science of nutrition really is, know this: he discovered the circulating form of vitamin D as a Masters student. This is the same form that is measured when you have a blood test for your vitamin D status. In my youth way back I took cod liver oil by teaspoon to avoid rickets. Will never forget the taste. Now, vitamin D has gone beyond bendy bones. Nearly every cell in your body has a vitamin D receptor. Over 2000 genes are influenced by vitamin D. No surprise that a lack of D has been linked to major conditions from Multiple Sclerosis, heart disease, bowel cancer and breast cancer to diabetes, the flu and depression. Kellie Bilinski, an Australian breast cancer researcher told me that D regulates about 200 genes in breast cancer cell production and low D was directly related to a higher risk of breast cancer. Is there a vitamin D problem in Australia? Yes, for two main reasons. First we have been discouraged to expose our skin to sun during the daylight hours when our skin makes vitamin D in response to the UV rays, mainly due to the realistic fear that we may get skin cancer. The avoidance of the sun by mothers and infants has seen the re-emergence of rickets in Australia. Secondly, for many there is little opportunity to venture outside during working hours. Three out of 10 healthy Sydney office workers have low vitamin D in the summer. They couldn’t even boost their vitamin D over the weekends. Three in four healthy dark-skinned Australians are D deficient in the winter (I might add, that is common around the world. Michael Holick had just been to India where D deficiency is rife). I have specified “healthy” people because we assume they can get outside of their own choosing. There are much higher levels of D deficiency in the elderly and unwell. Around three quarters of hospital inpatients are D deficient. For every 10 nmol/L (25 ng/mL) our D levels rise, there is a 6-8% reduced risk of early death, possibly due to a reduced chance of cancer.

What does it all mean?

First, get your vitamin D levels checked. They will be lowest in September and highest in March in the southern hemisphere; vice versa in Europe and North America. Although there is debate as to the “healthy” blood level of D, every expert is saying you should have at least 50 nmol/L (125 ng/mL), although Michael Holick believes you are better off at 75 nmol/L (187 ng/mL). If we use the latter figure then Dr Rob Daly from Deakin University says that 73% of Australian don’t make the grade.

You will only reach healthy levels of D by getting a judicious exposure to sunlight or taking supplements of 50 mcg (2000 International Units) of vitamin D.

It is very difficult to get enough vitamin D from food alone. Most researchers now agree that you will need to eat 15 mcg (600 IU) a day. With table margarine providing 1 mcg per two teaspoons, oily fish 2 mcg per 100g, D-fortified milk with 1-4 mcg per glass you can see it will be tricky getting your 15 mcg a day. Only one food can provide your daily needs of D in a serve and that is light-exposed mushrooms, but they are only available from some Sydney grocers, although they have been in the US and Canada for a couple of years.

A final thought from Michael Holick. Why did the dinosaurs die 65 million years ago? No brainer. It was vitamin D deficiency caused by the asteroid dust cloud blocking out the sun. Want more? Watch his quick-fire presentation.

The Vegan Diet

Let me introduce you to Donald B Ardell, from Florida, US, a gentleman with much wisdom, an ardent promoter of wellness and someone who has taught me a lot over the 23 years I have known him, especially through the 673 editions of his [http://www.seekwellness.com/wellness/ardell_wellness_report.htm Ardell Wellness Report]. Don is a four-time world champion triathlete in his age group, which is past the seven decades post.

Recently he became what society labels a vegan, someone who doesn’t eat any animal foods whatsoever. Below is my edited version of what Don wrote recently, followed by my response.

  

Don Ardell becomes vegan

Thanks to the initiatives of my dear wife Carol, I have studied and followed a plant-based diet. This way of eating is much more disciplined, focused and restrictive than my usual pretty sensible food pattern that was basically aligned with U.S. Dietary Guidelines. I did not, until recently, see any reason to change my diet pattern, which complemented a lifelong vigorous exercise routine. Prior to the recent change, I ate small portions of lean meats and lots of seafood, along with plentiful fruits and vegetables and only a moderate amount of sweets and fats. I avoided the deadly stuff. While I'm fond and respectful of animals and supportive of living lightly on earth, I have not carried such good intentions to the level of role model in practice. Sure, I was all for environmental sensitivity, but not to the point of becoming an actual vegetarian, let alone going as far as this new plant-based vegan regimen. I enjoyed fish and lean meat dishes, now and then. But, until I got involved in this plant-based situation, I've been more talk, less action. I put aside thinking too much about unpleasant realities, particularly the nature of modern mass harvesting of sea life, the cruelty of slaughterhouse practices, and the chemicals in play that support production speed and shelf life of animal products. My dietary habits took the dramatic new turn I've been describing one day while I was in Burlington, Vermont for the national triathlon championships, staying at the home of my friend Judd Allen, eating feasts of barbecued chicken breasts one night and all-you-can-eat whole lobsters the next. Carol, who stayed home, was watching a television program about the transformation of the appearance and health of former president Bill Clinton. Mr. Clinton, if you have not noticed, is today a lean mean machine, fit and free of the heart problems that plagued him during most of his pudgy, out-of-control years in office. (That last sentence was a reference only to his diet.) The former president has become a born again, plant-eating enthusiast, describing the nature and touting the benefits of his new vegan diet. (Though he does, like yours truly, occasionally depart from perfection by tasting of the forbidden non-fruits every so often.) Mr. Clinton makes frequent reference to the influence of Dr. Esselstyn and his colleagues Dr. T. Colin Campbell, author of the bestseller, [http://www.thechinastudy.com/about.html The China Study] and to Dean Ornish in California, who also has written books about a plant-based approach to [http://www.amazon.com/Ornishs-Program-Reversing-Heart-Disease/dp/0804110387 heart disease avoidance and reversal]. All three were key figures who inspired Mr. Clinton's diet reforms. The former president claims he now lives on beans, legumes, vegetables and fruits. He abstains from all dairy products. He claims the diet has changed his metabolism and accounts for his 24-pound (11 kg) weight loss, which is about what he weighed in high school.       In the CNN interview with Wolf Blitzer, Mr. Clinton said his concern over a worsening heart condition led to radical changes in his eating habits. He did the research and learned that 82% of people since 1986 who followed a plant-based, no dairy, no meat of any kind diet healed themselves. Their arterial blockage cleared and calcium deposits around their hearts broke up. As noted, this interview was fateful for me because my wife was watching. Then she did additional research on her own and, when I returned home from Burlington, I discovered my diet had changed, as well.    Previously, I had paid little attention to the names for those who followed one kind of plant-based regimen or another. I thought vegan was a Star War character - now I am fast becoming one - and I realize it has little to do with science fiction. Actually, the Esselstyn approach is even more ambitious that simple vegetarianism or veganism (if that's even a word): the Esselstyn plan also eliminates oils, dairy and takes aim at a few other things as well, such as caffeinated coffee. I still miss seafood, but less now than in the beginning of this experiment! No, I have not yet given up REAL coffee. After reading about and practicing this approach for a few months, Carol and I had occasion last week to travel to Orlando to attend a lecture by Dr. Esselstyn at the University of Central Florida College of Medicine in Orlando. The good doctor gave a talk, well supported with illustrations that made it easy to comprehend the technicalities of how the plant-based approach reverses heart disease and, best of all, prevents it in the first place. He is an excellent speaker and a charming, knowledgeable and likable person. My only concern was that he looked way too skinny. If I ever start looking that gaunt, I'm going to make my way to the nearest McDonald's.   Thanks to recipes in plant-based cookbooks such as __Forks Over Knives__, the meals served up by Carol have been delicious. I do not feel deprived in any way. I'm not going to exaggerate or get carried away, but I must confess that I am no doubt more beautiful and virtuous than ever because of this diet. In addition, I'm younger, stronger and faster, have higher morale, superior bowel movement and no doubt more antibodies for resisting diseases and Republican presidential candidates. In addition, I'm basically tax exempt and I've been getting better gas mileage. **Glenn’s response** Don, I admire anyone who can change their eating habits. Most adults can't or won't. Be proud that you have the will to do so and then be grateful that you are fortunate enough to do so. This is a planet where broad estimates are that 1-2 billion struggle to get enough calories and 2 billion abuse the freedom from starvation by over-consuming calories. Many of the latter will get a health benefit from choosing your style of eating. A plant based diet is more gentle on the planet than is a burger-centric diet. I am not a vegan, nor likely ever to be. From family history and having had my mitochondrial DNA analysed I have a southern European background where there was a clear survival advantage from consuming dairy foods. I enjoy low-fat milk and yogurt, as well as experiencing cheeses from around the world. Humans have eaten eggs for eons. They are a great source of lutein for protection from macular degeneration, and nothing is easier than an egg for a quick nutritious meal - omelette, frittata etc.  All wise people seem to be in agreement that humans evolved as seafood and meat-eating animals. Early humans were never too far from the sea, estuary or river. There has been a strong argument that cooking gave our brain evolution a kick-start so we would become clever and devise easier and more efficient ways of doing things (we've over-stepped the mark on efficiency now, making slobbishness the default position of many). Considering the diet that allowed humans to prosper as a species, and blending that with both nutrition and an acknowledgement that we will have 9 billion mouths in 2050, I believe the flexitarian diet to be the best for affluent nations. Simply put, for my 21 meals a week, 16 are vegetarian (including dairy and eggs), 2 seafood, 2 chicken, 1 meat, allowing for natural weekly variation. All snacks are vegetarian.  My version of flexitarianism also respects the eating style of others, so I will eat any meal offered to me by friends or relatives. I have lived with a family in Spain and will soon live with a family in Buenos Aires. There I will eat what they eat. This choice is made easier as I don't have any food allergies or intolerances. Will you now get fewer dinner invitations Don? I say to you, with love and respect naturally, that your previous diet is likely to be a better choice. Once you have ticked off 70 birthdays your gut's ability to absorb vitamin  B12 is diminished and a vegan diet is low in B12, as well as being low in iron, zinc and calcium, all essential minerals for long term health. It is believed that vegans need 150% of the recommended dietary needs of iron because iron is less bioavailable from plant sources when compared to animal foods. Sure, you can take supplements to make up the difference, but I suspect that won't suit your thinking. As always Don, it is your choice, and one of the greatest freedoms in life is to have a choice.

Glenn’s response

Don, I admire anyone who can change their eating habits. Most adults can't or won't. Be proud that you have the will to do so and then be grateful that you are fortunate enough to do so. This is a planet where broad estimates are that 1-2 billion struggle to get enough calories and 2 billion abuse the freedom from starvation by over-consuming calories. Many of the latter will get a health benefit from choosing your style of eating. A plant based diet is more gentle on the planet than is a burger-centric diet.

I am not a vegan, nor likely ever to be. From family history and having had my mitochondrial DNA analysed I have a southern European background where there was a clear survival advantage from consuming dairy foods. I enjoy low-fat milk and yogurt, as well as experiencing cheeses from around the world. Humans have eaten eggs for eons. They are a great source of lutein for protection from macular degeneration, and nothing is easier than an egg for a quick nutritious meal - omelette, frittata etc. 

All wise people seem to be in agreement that humans evolved as seafood and meat-eating animals. Early humans were never too far from the sea, estuary or river. There has been a strong argument that cooking gave our brain evolution a kick-start so we would become clever and devise easier and more efficient ways of doing things (we've over-stepped the mark on efficiency now, making slobbishness the default position of many).

Considering the diet that allowed humans to prosper as a species, and blending that with both nutrition and an acknowledgement that we will have 9 billion mouths in 2050, I believe the flexitarian diet to be the best for affluent nations. Simply put, for my 21 meals a week, 16 are vegetarian (including dairy and eggs), 2 seafood, 2 chicken, 1 meat, allowing for natural weekly variation. All snacks are vegetarian. 

My version of flexitarianism also respects the eating style of others, so I will eat any meal offered to me by friends or relatives. I have lived with a family in Spain and will soon live with a family in Buenos Aires. There I will eat what they eat. This choice is made easier as I don't have any food allergies or intolerances. Will you now get fewer dinner invitations Don?

I say to you, with love and respect naturally, that your previous diet is likely to be a better choice. Once you have ticked off 70 birthdays your gut's ability to absorb vitamin  B12 is diminished and a vegan diet is low in B12, as well as being low in iron, zinc and calcium, all essential minerals for long term health. It is believed that vegans need 150% of the recommended dietary needs of iron because iron is less bioavailable from plant sources when compared to animal foods. Sure, you can take supplements to make up the difference, but I suspect that won't suit your thinking.

As always Don, it is your choice, and one of the greatest freedoms in life is to have a choice.

Overweight: is there a population solution?

First, let me be bold and honest. The answer to the question is “No”. Not while we live in an affluent democracy with abundant, relatively cheap food. You may have your own idea for a solution. Certainly there have been many espoused – tax cakes, confectionery and soft drinks, tax fat people, ban advertising of foods you perceive to be evil or just plain ban every processed food. Simple. It seems that we favour controlling the environment to educating and encouraging people to eat intelligently. The public weight loss campaign is a favourite solution offered by governments.

  

Does anyone listen & act?

Obesity Reviews published a paper that considered 60 interventions or policy proposals since 1980. Although presumed to be useful, may public campaigns have uncertain benefits and, indeed, many aren’t even evaluated for effectiveness. The [http://www.drawthelinewa.com.au/ last Australian campaign] showed 55% awareness among adults. So what? I’m aware of many things too but do stuff-all about it. I know I should turn off appliances and not always have them on standby like I do. I know Mugabe is not good for Zimbabwe but haven’t got around to assassinating him. Evaluating awareness and asking people questions about their intentions is irrelevant to success or failure.

The review also suggests that there can be unintentional consequences, such as some adopting unhealthy diet practices to achieve a goal weight. The Singaporean Trim and Fit program was criticised because it might contribute to eating disorders.

Stigmatised sub-class

Being fat is stigmatised, linked to stereotypes of stupidity, ugliness, weakness and laziness. I would imagine that every campaign directed at their weight can’t make them feel better about themselves. In 2008 it was reported that the US state of Mississippi planned to [http://www.telegraph.co.uk/news/worldnews/1577463/Ban-restaurants-from-serving-obese-people.html ban fat people from restaurants], presumably to keep them away from temptation. Bet that would have been helpful. Is this form of discrimination healthy? Should we fire health professionals, airline staff, police or firemen once they are judged to be fat? For some, I would say “Yes”. A 140kg fireman may be a risk to himself. Yet an overweight dietitian may be a more credible voice about healthy eating than one that can barely throw a shadow.

The review argues that public campaigns focus solely on the kilojoule and health benefits of foods and completely forget the social context of food. If you are told to cut out cheese and wine would you be welcome at your grandparents who left Italy in the 1950s to start life in your country? I now refuse to do media interviews about what to eat over Christmas. Hey, no-one listened in the 1980s, the 90s and frankly I no longer care what you eat for Christmas. Overindulge like most do, enjoy it and do some activity to balance things out.

Responsibility

Although I feel that it is my responsibility, and mine alone, to look after my weight and health, not everyone has that capability. If you are unemployed, have a lousy job, live in a threatening household, hospitalised with a severe injury, feel alienated, or can’t speak the local language then I suspect that looking lean may not be a priority; may not even be on the first two pages of your priority list. I doubt if a weight loss campaign offers them anything more than guilt.

Public weight campaigns have a shot-gun strategy – send out a few messages and hope some will stick. That makes them ineffective. The last Australian public weight loss campaign cost you $45 million, a lot of it on commercial TV. There has to be a better use of the money. That campaign is being written up for a science publication. Hopefully the data will prove me wrong.

It has been suggested that we reward “good behaviour” and give bonuses for weight loss such as the police in one Mexican city who received 100 pesos bonus for every kilo they lost. How would you feel if you were a lean local and heard about that? I would gain a kilo in December, lose it in January, gain it back in February, on and on. Nice little earner. Healthy?

What does it all mean?

Frankly, I think you can have any viewpoint on a population solution to overweight, and justify it however you want, but you would be hard-pressed to show that it was effective, and by that I mean effective in permanently changing eating or activity habits to create weight loss in more than, say, 2% of the population over a five year span.

I’d love to see the stairs full of people and the escalator used by only those over 90, parents carting young children or those recovering from a sports injury. I would also love to see people encouraged to eat well for their health, well-being and longevity while never once mentioning their weight. Public health campaigns should be about health, fitness and well-being. Forget weight – too difficult, too dangerous and nobody listens.

Reference: Obesity Reviews 2011; 12: 669-679