Food and Vitamins and Supplements! Oh My! — Longwood Seminar

I am so delighted to welcome you to our first Longwood seminar for 2013 and we are starting a little bit late because we still have people coming in we have well over 500 people here tonight which is really exciting and I think it's truly a tribute to our speakers this is our 13th year offering the mini med school and there are so many familiar faces here cannot manage us to ask if this is your first mini med school fabulous fabulous well we're hoping that you come back year after year as so many other people do so really truly thank you for being here we want to share with you that once again this year our topics were chosen by our Facebook friends primarily and we had over 500 votes and tonight's topic was definitely one of the most popular so we would like to join out invite you now to join us for the three remaining seminars the power of Z's uncovering why sleep is essential to our well-being and how to get more of it which will be held on March 13th it's all in your head building better brains through neuroengineering held on April 2nd and beyond belief exploring the connection between personal beliefs and physical health which will be held on April 23rd so now I have a few announcements and I was I was going to apologize because for five years I've been introducing the seminars and I make the same announcements that every seven-hour year after year but there's a new audience so you'll be hearing this for the first time but we for the first time this year we have live-streaming so if you have friends who were not able to be here tonight you can send them an email and let them know that you can find the link on our website and they can watch this live and the next three seminars also will be live streamed and you will be able to see that through the website we also as you may know videotape and post the links to each of our seminars every year I tell people who are in the front rows you will be in the video if you're sitting in rows one or two no one has ever moved but I feel like I need to let you know that and in an effort to support Harvard sustainability goals you'll notice that we did not print supplemental reading materials this year and we hope you appreciate our need for cost savings and to be green and we want you to know you can find a link to the reading materials online and if you don't have access to a computer if you see our staff at the registration desk they will give you the address and locations for the Boston Public Libraries where you can find a computer if you attend three or four of the seminars you'll receive a certificate of completion for this year for the 2013 series if you attended three or four last year and did not yet pick up your certificate we will have them out of the registration tables you can pick them up later teachers can earn professional development points by by attending all four seminars and you need to complete an evaluation at the conclusion of each seminar you'll find that in the at the registration table you can drop it off after the seminar or just mail it back to us we hope that you'll ask a lot of questions this is a fascinating topic and we will be collecting questions on index cards that our staff will be walking up and down the aisles and we're looking for an engaging question and answer period this evening the Longwood seminars continue to advance electronically a little bit more each year we now have a mobile app the mobile app which you'll find on our website and site includes the 2013 schedule the locations of the seminar and a link to download the supplemental reading materials we will be live tweeting tonight as I believe many of you will be if you would like to be a part of our conversation please use hashtag hms mini mode and finally out of courtesy to our speakers please remember to turn off your cell phones now for why you came tonight's program today's seminar is called food and vitamins and supplements oh my demystifying Nutrition the value of food vitamin and supplements information on diet trends vitamins and supplements are everywhere newspapers magazines television radio if you google diet in nutrition over 98 million websites appear and who doesn't have a friend with who's quick to offer advice on the latest weight loss or vitamin fix but the good news is we have experts here tonight internationally recognized Harvard experts who study nutrition ooh or who and who are going to help us navigate through this haze of information that can be confusing and conflicting it's a privilege to have the opportunity to work with these individuals and to have them join us for this tonight you'll hear for three from three of them dr. Eric rim is an associate professor of Epidemiology and nutrition at the Harvard School of Public Health and Harvard Medical School he's the director of the program in cardiovascular epidemiology dr. Howard Sasso is an associate epidemiologist at the division of preventive medicine and aging at Brigham and Women's Hospital and an associate professor of medicine at Harvard Medical School but first you'll hear from dr. Walter Willett who will also be our moderator he as our other speakers as a highly is highly accomplished and his work is quite well known dr. Willa is the chair of the department of nutrition at the Harvard School of Public Health and a professor of medicine at Harvard Medical School thank you for being here and thank you for joining us tonight thank you very much it's really great to be here and see that so many people are interested enough in nutrition to turn out at the end of the day and join us here for another hour and a half or so when you could be at home join enjoying a very good dinner nutrition is a huge topic it covers vast ranges of information about vitamins and minerals and types of fatty acids and proteins and fiber and how they relate to just dozens of different diseases and outcomes so it's in a short period of time like this we can only cover some little bits and pieces of the total topic we're not going to give you a complete up-to-date overview on nutrition it would be very hard to do that but we are as you heard going to focus on two different areas one is weight control and how diet can affect that and second is on minerals and vitamins and particularly supplementation with minerals and vitamins but I think it's quite clear to everyone here that the progress we've made in electronic communications in information technology has helped transmit information in ways that we didn't imagine just a couple of decades ago but it's I think very unclear whether it's really helped people understand diet and health and many other issues any better in fact there's just an overwhelming tsunami of information that almost everyone faces day to day and I can just imagine for someone who's not working in the field of nutrition every day it must be almost impossible to sort out what's believable what you should act on and what's just really a false or completely misleading just as a couple examples of papers that made a lot of got a lot of press over the last year this one study of eggs are nearly as bad for your arteries as cigarettes that's pretty horrible I'm smoking is the number one risk factor for coronary heart disease and eggs if they're really that bad we should not get near them but and that I'm sure took a bunch of people by surprise we were 30 or 40 years ago told that eggs were almost poison capsules for your arteries and we were supposed to get away from them so we did a lot of research other groups had done a lot of research and looking at a consumption of following hundreds of several hundred thousand people for several decades and we just did not see an increase in risk of heart attacks and we published that information and that was I think getting out there that eggs were not as bad as had been made out and then this paper comes along that they're just eggs are just as bad as smoking what's a person supposed to think about and the problem was that the nuances the details of the study were really not described very well it wasn't put in perspective of the in the context of the other information we have this is it turns out was a really completely sloppy little study it was just a cross-sectional view of what's what came into a clinic and they didn't control for things like physical activity it was it was really as bad as a study can be but partly because it was look sensational it got a lot of attention that was that was pretty bad and then I just on January 1st I this paper came out and that Association of all-cause mortality with overweight and obesity a systematic review and meta-analysis and basically this paper said that grade one obesity that sort of mild obesity was not associated with higher mortality and being overweight was actually associated with significantly lower mortality now how many people heard about the study could you raise your hand yeah big part of the audience here how many were confused by this study yeah yeah just as many people that's good and you should be confused by his study because uh yeah well it did get a lot of press and it probably was not by accident that JAMA published this on January first and it was going to be sensationalized and it at least it's a pretty good hypothesis this was not random date that this was published the problem was this this analysis it was not a real new study it was a collection of published papers but at number one emitted about six million people that that were included in other studies but were not included in this analysis for really reasons that were irrelevant and second in this kind of analysis the authors in the comparison group which was the so-called normal weight group enriched that group with people who were smoking people who had cancer other serious illness people were in their 80s and 90s and is all very often happens people become frail and lose weight their muscles shrink away before they actually die and then they end up dying of dementia pneumonia those kinds of things are that's sort of the way we most of us if we survive cancer and heart attacks and get to be 90 that's a normal way of dying we don't just drop dead one day but we often lose weight beforehand so when that's the comparison group and then you compare people are overweight to this group that's over enriched with people who have lost weight because of underlying illness it's going to make the overweight group look good by comparison and even the obese group look good by comparison but anybody who understands this or at least how does it explain to them really it does understand that you're going to get the wrong answer doing that kind of analysis and this also the news didn't pick up that there had been just in the last year or so two very major analyses that were the investigators from dozens of studies around the world actually shared their original data put it all in one computer and analyzed the way you could really separate people who were lean because they were ill who had underlying disease people who were older and losing weight not you could look take them out of the analysis and when they did that as you would expect people were overweight actually did have increased mortality in people or obese had substantially increased mortality so this analysis was just completely misleading and there are layers of problems where this why did JAMA take this in the first place it's I think incomprehensible that they did given much superior Studies on the same topic had been published recently second some of the media did not put this paper in context some papers some papers did actually USA Today did the best job New York Times did a horrible job covering this paper it's that you'd think you would sort of expect the New York Times to do better but they they really do not have not done well covering this kind of health issue so it makes it hard for for the public to sort out this information and part of the trouble is that it's the studies with weird findings like this one that get the attention the studies that showed that people were overweight had higher mortality and people who were obese at even higher mortality that got almost no press it was sort of you know ho-hum to a lot of people and it wasn't going to make the headlines so this study did so on what's the solution to this that it is a really serious problem of course that's why you're here one one solution is to come to these kind of events where you can get into issues in more detail look into the quality of the data the quality of the studies that led to reports we do have a website called nutrition source that our department has if you're interested in that we do try to cover topics like this and give the sort of the backrooms story of what what's going into a report and put that in the context of the the world's literature if you if you want to go that website you just go to google that's that's where I started everything and you type in nutrition source you will come to our website and we do cover background information and and news stories as well but it's it's a challenge so anyway tonight on two topics at least you'll have a chance to get more in-depth state-of-the-art knowledge about where we are and I'm sure you'll have questions and we those and we I look forward to that discussion so leading off we have dr. Eric Grimm you've already heard about Eric a little bit I'm very pleased he's a member of our department of nutrition at Harvard School of Public Health we have really fantastic faculty members there and he's also associate professor at Harvard Medical School and the director of the program in cardiovascular epidemiology dr. rim has a very active research program studying diet lifestyle characteristics and cardiovascular disease and he's published more than 400 articles in the medical literature during his 18 years on our faculty he's also served on many important national committee sets such as the Institute of medicines Dietary Reference Intakes for macronutrients and he has been on the scientific advisory committee of the US dietary guidelines in the review of the 2010 guidelines he's received lots of international awards course goes around the world gives talks at scientific meetings but also Eric very generously contributed a lot of his time to talking to audiences like this non-scientific audiences to help convey the information that that we we've gained with your tax dollar support I would more do what I mention that you all have bought into this is the scientific process when you when you pay your taxes and we hope that will continues we worry about that but these days Eric has also given a series of lectures at the Culinary Institute of America's programs for major food services to really help guide them into preparing healthier menus and he's also participated as a lecturer in the healthy kitchens healthy lives program of The Culinary Institute of America which is for physicians and other healthcare providers trying to fill in the gaps in education that most of us as physicians really experienced during our medical education we we didn't learn too much about nutrition and we've got a lot of work to do to bring the health care community up to speed in any area of nutrition so let me stop here and not take away any more of your time Eric thank you all for coming it's great to be able to be here to share some information with you it's also nice to be able to give a talk in front of my boss so thank you all so I'm going to give a talk on demystifying nutrition and it's meant to be 20 to 25 minutes long so obviously I can't cover everything but this is probably as Walt mentioned a lot of what you know about nutrition is what you've read in books or read online and the question always is is it fat or real now when we had bookstores or more bookstores these used to be huge sections in the bookstores because if you were clever and if you could write a book and if you had a good-looking face you could write a book on nutrition so the question is are they fat or are they real do they work and usually key components of diets that you'd see in those books are to start out it would be sort of flashy sales people good-looking people on the cover that attracts you into the book and then there's a lot of topics that have been covered over the last three decades high fat low fat and then low carb carb Buster's and then glycemic index these are all terms that you probably have heard and are probably confused about protein power and now more recently gluten gluten free and then some people have just scrapped the diets all together and said let's just make shakes mixes blends or just give you pills to solve the problem so you get the idea there's lots of different approaches to this more recently and actually most effectively are when there are groups involved when you don't do this alone when you do it with a spouse a friend a wellness group at work Weight Watchers something whether someone else around you that is in the fight together with you to try to try to lose weight unfortunately there is a lot of outlets for what you get news and I don't want to spend too much time talking about dr. oz but how many of you watch dr. oz ok I wish so here's the here's the deal I got interviewed a month and a half ago by a local media outlet said tell me about very ketones what do you know about this doctor room I said what what are Raspberry Ketones so apparently dr. oz had his show on Raspberry Ketones and they sold off to shelves everywhere because dr. oz a cardiac thoracic surgeon guided people to on what to do about nutrition with the help of a nutritionist who was on one of his shows do you want to know what the evidence is for the benefits of raspberry ketones on human health there has been one study done in China on 24 rats they found some benefit for those rats that were fed 10 percent lard to their diets they found some detrimental effects yet dr. oz starts out the show by welcoming the nutritionist saying tell us about this miracle in a bottle dr. oz actually has a lot of good science on his show unfortunately there's a lot of sensationalism and a lot of shock that goes into it which makes it sound a lot more like snake oil than anything else it's not till the end of this 20-minute segment that he says of course you should follow a healthy diet and exercise it's in the first minute that there's sort of a sales on telling everybody to have this magic pill in a bottle because otherwise you'd have to have 90 pounds of raspberries to get the same amount of raspberry ketones so it scares me when a lot of people get their diet advice from someone on television who essentially gets commercial you could this is his website he's actually paid obviously gets money from people selling supplements to go on this link you have to watch a 10 second commercial about krill oil and omega-3 so obviously there's a lot of money from the food industry going into his show not only the fact that he's selling something that has no data in humid evidence and he has a fair bit of scripting that goes on in this show these are not free conversations that he's having with scientists so please don't get just your evidence from dr. oz so we have created our healthy eating plate with lots of members of our department sort of feeding into it and this is something that you can get from our nutrition source org and this really is 30 years of evidence that we put together on humans and it and it sort of as a bill up or the my pyramid the government US government as a my pyramid and a my plate and this is really sort of sharing that my plate image because I really think this is an important way to think about food about what goes on in plate and this gives us a lot more directives on things we should be eating the other issue with diets is that it's not just what we think is really healthy because all of us know that drinking soda all the time is probably not a good idea and most of the US population knows that and that's what goes on in our slow brain so do we have that idea that process of what a healthy diet is yet when we go to a grocery store and see that huge rack of sugar sweetened beverages sitting on the end of the aisle a lot of people make the decision with their fast brain saying well this is going to taste good it'll be fine just have this one thing where we walk into a fast-food restaurant with great aspirations of what we're going to eat once we smell the french fries and see the menu and say yeah the double cheeseburger is going to be fine with french fries so unfortunately our slow brain and our fast brain don't always make the right decisions but it's very easy for our fast brain to make the wrong decisions because it's triggered by something else so we are all familiar with the obesity problem in this country this was the prevalence of obesity going the lighter states are those that have the lower prevalence of obesity in the darker states are those that have the greater prevalence and this is 25 years ago this is 20 years ago this is in 2006 and this is in 2010 so this is an epidemic of obesity in this country that has not caused by genetics that is caused by the changes in what we eat it's our fast brain making too many decisions based on a commercial we see based on what's placed in front of us based on the fact that it's really are hard to eat healthy in our very busy lives so there are no longer any states that have a prevalence of less than 20% of obesity and obesity is defined as a BMI it's a measure that we use it's based on weight and height and a BMI above 30 represents a 5 foot 4 person weighing 30 pounds of being 30 pounds overweight or a six-foot person being about 70 to 80 pounds overweight so this is Michelangelo's David with a very healthy BMI of 21 every we're thankful that Michelangelo did not do a sabbatical at Harvard because this is what his rendition would have been this is a BMI of 30 just to give you a sense of the difference between the problems we have with diet in this country my apologies to any Michelangelo fans in the audience so now there has been a lot of great science this is not just science on Raspberry Ketones and on magic pills there has been a lot of great science on diets that help in weight maintenance or weight loss and a lot of studies and what we have found over time is that you can't do a study for six months all of us if you sit with us and train us can do a pretty good job of changing our diets for six months however we really yearn for fats we really yearn for foods that we like eating we don't like to be told to eat essentially a low-fat cardboard full diet that it has to taste good to us in order for us to be something that we can want to that we sustain and wants to sustain so lots of different diets have been tested the one that has gotten the greatest tests and the one that we really clearly see an answer for was about a half a billion dollar study funded by the government to look at the effects of a low-fat diet among women 20,000 women were randomized to a low-fat diet and 30,000 women were given what was called usual care essentially given the dietary guidelines and said you should eat this way but people on the low-fat diet over the first year they had 18 meetings with counselors and nutritionists and were trained how to eat a low-fat diet at home and that usually meant sort of healthful and design high in fruits and vegetables and whole grains and they really tried very hard and people as I said over six months to a year can do it if they really keep their mind to it you may not be able to see this the first dot down is the first year this represents how effective the people were in the first year now they didn't lose a lot of weight they lost five pounds and this is with 18 meetings with counselors and dietitians that's a lot of Labor and effort and time and probably would be implausible to do with everyone in this country people lost weight look what happens over time they just give up they just can't do it anymore it doesn't taste good they don't like it and you and by about three or three or four years they're essentially back where they were before and in many cases by the time you got to the end compliance was really terrible in this study and what we conclude is that trying to get people to eat a low-fat diet most types of low-fat diets is very hard to do you can't eat a healthy low-fat diet it's very hard to do and most people eventually yearn for different types of food in their diets so low-fat diets probably are not the solution I should have said they're not the solution here they are the solution is short term if you have to fit into a wedding dress in three months if you have to get into your tuxedo for a reunion it might work for three or six months but that's not what we should think be thinking about in terms of long term health so it's it has poor long-term compliance it is not a long term solution and this is kind of an interesting study that I won't go into all the details but this was done at Tufts but they said let's try four different diets let's do them back-to-back which one's better is it the Atkins the zone the Weight Watchers or the Ornish which is a very low-fat diet and they did them in a school people and they follow them for a year and then on the bottom they mapped how compliant that people were at the end of the year so you can see the people that were most compliant lost the most weight that's weight loss on the y-axis but you can see there was absolutely no difference if you were compliant to the Atkins diet worked to the zone to the Weight Watchers or the Ornish it's essentially was a measure of compliance regardless of what people were being schooled on what to eat so that does suggest to you that for weight loss it may be more important for you to find something that you like and that you stick with and that you don't cheat on and that's something you can find support because that's what will work as opposed to trying to buy a book and being prescriptive so when you are fed the food the diets I've showed you foot so far people were sort of free to roam they were told what to eat but they still were free to roam and go and buy and eat what they wanted this is a study that was done in a nuclear reactor facility in Israel nothing gets into a nuclear reactor facility in Israel so no stacks were being snuck in in Israel most of their main meals are the middle meals so fed people their meals at lunch went to the cafeteria you either got a yellow red or blue meal and this was 60 or 70% of their calories and if they follow people for two years and when you're fed your food people actually they were fed lower calories and they needed the first six months so everybody lost weight but the people that did the best over the course of the two years were people that were on the Mediterranean diet which is high in healthy fats or people that were on a low-carb diet which is higher in protein people that did the worst where people were on a low-fat diet noticed I did lose weight but they didn't they didn't keep it off as well they probably cheated more at home because they really liked the flavor of fat so again this speaks to when you're actually feeding people in a clinic setting this is what works best now the best study ever of the Mediterranean diet was just published last week or two weeks ago from Spain they randomized over 7,000 people to three different arms they actually didn't give him everything that ate they gave them either they either give an advice eat a low-fat diet which is really hard to do in Spain they and they actually weren't very compliant with a low-fat diet or they schooled them how to on how to eat a Mediterranean diet and in some of those people they gave them extra virgin olive oil they gave him a huge leader they delivered to their house every week and said this needs to be part of your diet and the other group they came to their house and they gave them nuts to eat every week and so nuts and I'd have a handful of nuts every every day as part of their diets now this wasn't a weight loss study per se this was to actually look at heart attacks and death from cardiovascular disease and the top right corner you can see how well they did and this was increasing rates of cardiovascular disease and mortality and the ones that did the worst with a black line and that's the control diet that was a low-fat diet the ones that did the best were those that were schooled on the Mediterranean diet and either the extra-virgin olive oil or the méditerranée are the nuts were successful in lowering their rates of cardiovascular disease so this does give us insights into the long term effects of a Mediterranean diet or a diet like this that's high in fruits and vegetables low fat proteins and nuts and in this case extra-virgin olive oil so again I want to emphasize the fact that it's a diet there's not a magic component that you can add to a really bad diet that suddenly makes it good I think nuts and oils are an important component of the Mediterranean diets not something that we had that were consumed to be a magic bullet so really the paramount goal of many diets is to get down to an ideal weight and really it's probably the ease of adherence for you personally that makes it the most important attribute what can you do that you can stick with as opposed to what does Atkins tell me to do and probably the macro nutrient composition may not be as important as as the sort of what's how well you stick with it and what we're finding out more is that as an individual it's hard to stick to any diet I don't care if you do like it after 3 months or after 6 months you get tired of doing something and so you really have to be creative and the way the best ways to be creative are to do it with other people or to have other people egging you on or I have to feel like you have to lose weight with your spouse with your daughter with your colleague at work and so this is one of the best studies of its kind that was done within a clinical setting where they actually was being supported by the doctor it's almost like there's a mini Wellness community within the doctor's office and they had the control group where they sort of gave them some advice at the beginning but the doctor's office wasn't involved and it wasn't the doctor per se they were doing it with sort of remote help with people saying how you doing every week how's it going do you have any questions can I help you and they found sort of the in-person support was just as good as calling someone up every week saying how's it going so if that works for you find something that you really liked and have them call you every week saying hey how's it going but it's better to find a health professional who can answer questions about things you may have in your diet is it good to have it there or is it not good to have it there so the conclusion so far is successful diets for weight loss can emphasize a large range of my of macronutrients although low-fat diets probably are the least effective most types of low-fat diets and I really do think the ongoing counseling sessions are important to achieve and maintain weight loss in all groups and they really can be tailored to the individual so I don't care of your ethnic background they really can be tailored to your ethnic background as long as we find the right healthy foods to fit within that within that diet so the government has said choose myplate.gov and there's lots of information here that the government has a lot of it is quite accurate and really good and they give lots of advice on recipes and things like that again we chose the healthy eating plate because everything is in this one icon there's a lot of great detail here and you can go to our website also to find more information on the science behind it as well as some good information on recipes but I have to emphasize that you shouldn't be in here thinking diets going to be the only way to do it and it was an important part of our healthy eating plate to have stay active at the bottom so I'm hoping that at least some of you walked here and didn't just take the tea or if you did take the tea at least you had a walk here but that exercise is part of your weekly routine and that you do find a way to incorporate that with a healthy diet this is my boss tonight getting some exercise maybe not a good idea to exercise back and forth to Dunkin Donuts but we only do this once a year when we go on a very long bike ride so we're burning off a lot more calories and we're consuming I think that is an important thing to not say I want to just equal my calorie in with my calorie out but to be thinking about burning more calories and then you're consuming so should we all just eat more fat should we just go on Olive Oyl diets well this is not the right way to do it Heart Attack Grill spokesman dies from heart attack it I believe he died at age 51 at the All American Grill which says people over 350 pounds that come and get to eat free this is another interesting perspective this is from an Arby's in Seattle and as a scientist I interpreted this as beef and coronary heart disease two for five dollars I thought it was a truth in advertising but I am from Wisconsin so I realized this brings beef and cheddar not the kinds of fat that we want you to eat again the the diets with good fats are the ones I think that really people find the most success with and this is a blurb from the US Dietary Guidelines from 2010 saying that we should increase the amount of variety of seafood consumed by choosing seafood in place of some of those foods that are higher in saturated fat so the N 3 fatty acids I think are really an important part of a diet and we need about 250 milligrams a day which means that here's a bunch of different types of fish and the average amount of n 3 fatty acids they have in them so if you really only need 250 a day you really only need to have one or two servings of salmon a week some anchovies um you know halibut or trout there's lots of different ways to get healthy n threes and I think a variety are probably important instead of dwelling on just one this information is available on nutrition source org so not all fat is created equal again avoid trans fat that's partially hydrogenated vegetable oils and saturated fat n threes are beneficial if you really don't like seafood take a supplement and then eat more mono and polyunsaturated fat and that's the sort of the liquid cooking oils that you see please don't have your salad with a fat-free salad dressing I don't get it have a little oil in your salad dressing that's healthy oil it shouldn't be cream but it's vegetable oil and that's a healthy oil there's other parts of a of a healthy diet that I couldn't cover tonight because I was talking mostly about weight gain and that's fruits vegetables grains and nuts but those really are the foundation of what is helping people not feel hungry and to keep weight off and this is the components of that but I really like to think of it as food based I hate to take a diet and then dissect it into all the healthy things as opposed to talking about the foods and that's why we have focused on the healthy plate where we do have the types of foods that are most healthy and if you like a pyramid because that's why some people learned in high school or a long time ago that we have a pyramid also with the healthy things at the bottom that are the whole grain actually it's all based on exercise but we have whole healthy grains and fruits and vegetables and legumes and fish and poultry so there depends on how you learn best but I like to visualize a plate because that's how I sit down every day to eat dinner so a Mediterranean style diet I think is from what we found Mediterranean sounds almost like it's exotic like there's no way we can achieve it because we don't live in the Mediterranean I hate to tell you people in the Mediterranean now don't eat the Mediterranean diet so what it really means is fruits and vegetables nuts and legumes and not a lot of high protein big protein portion sizes that when you do have protein its small and that it's you know usually from fish or chicken and it's nice because it's not focused just on restricting fat in fact extra olive oil is extra virgin olive oil as an important part of it it encourages culinary diversity so you actually see the food that you're eating and you prepare the food you touch the food it actually tastes good and you know if you don't like the Mediterranean you can take that style and apply it to an Asian or a Latin type type meal so is there a magic bullet that's something that's always asked to me and there's not a magic bullet so I think that we know there are certain foods that are particularly good dark green leafy vegetables some fruits that are high in anthocyanins but I personally don't like the term superfood it's probably something that dr. oz says every show because it instance' sensationalize something it makes you think like this is it this is the one thing and there is not one thing I think it really is actually variety is what keeps people interested in eating a healthy diet if you just ate blueberries every day all the time it eventually will besides causing some GI distress I think you're going to end up hating blueberries in a few months so I think variety is really the spice of life and I would throw in a little extra dark chocolate at the end for for good for goodness sake I knew I would get a little bit of haze on that one so the overall side summary is there's really no perfect diet adherence rules a day find a diet that has healthy fats in it that will help choose the healthy fats you can do it on a low-fat diet but very very few people are successful at that unprocessed foods are best that helps you really taste the food absorb the food it's lower in sodium you'll feel less hungry I didn't talk about alcohol but it's actually not so bad either for consumed in moderation so that's my summary of an overall healthy diet thank you very much this is where you can find for more information I think we're going to have some questions at the end so if you had questions for me you can write them down and pass them on and we'll take questions at the end of both of our talks thank you yeah we've got a lot of questions here so you better be prepared all right okay let's move on to our second speaker who is also very highly informed and a real expert and in his area dr. Howard Sasso is associate epidemiologist at the divisions of preventive medicine and aging at the Brigham and Women's Hospital and associate professor at Harvard Medical School he has a BA from Stanford mph from George Washington University and a doctorate degree in epidemiology from our School of Public Health he specializes in the epidemiology and Prevention of cardiovascular disease focusing on the role of hypertension physical activity obesity and dietary factors included many including antioxidant vitamins lycopene flavonoids in alcohol weren't important nutrients of course and I also novel biomarkers that underlie the associations between diet and disease risk particularly cardiovascular disease doctor says so is director the nutrition research and co-director of the hypertension research at the division of preventive medicine he's interested in the design and methodology and conduct of epidemiologic studies and randomized trials he leads the physicians Health Study 2 which is a recently completed randomized trial it tested whether common supplemental doses of vitamin E vitamin C in a multivitamin affected risk of cardiovascular disease cancer and other outcomes that was really a seminal study went on for 18 years much longer than any other study to my knowledge has done and that has turned out to be very important doctor says so is also currently testing effects of vitamin D and fish oil supplements on blood pressure in the risk of developing hypertension in the very large vital study which is a large study of indeed vitamin D and omega-3 fatty acids so without delaying I'll turn this over to dr. Cecil good evening thanks for your attention I always great to see crabs like this because I think diet nutrition are such extremely important topics they're the surrounder life right food is life and at the same time you want to learn about how to make food a healthy part of your life and I actually want to start with one simple question how many people here take any type of dietary supplement each day and then how many people take more than one supplement each day pretty good percentage I mean we're not going to call this a scientific study but as you can imagine you know of course most of you are pretty it's a pretty informed group it's throughout our life that we think about taking supplements whether it be multivitamins or a specific supplement for X Y & Z now I want to kind of put it out this idea of what we call the supplement cycle and as much as it's extremely important and I think we should always emphasize the important things in terms of the overall dietary approach and the dietary patterns inevitably when you go to a CVS or you go to a Walgreens or any other or a Costco you're always going to be just as bombarded by lots of choices in terms of supplements and it's really confusing it's not it's not just a matter of like here's one brand of vitamin D or one brand of vitamin C I mean there's like tons of things choose from and it's very difficult from the consumer standpoint to figure out one should I be choosing it and two which one do I choose what's happened over the years with research at least with vitamin supplements is that there's been this pattern the cycle in which there's a lot of interesting studies that come up there's a lot of hypotheses that come up lots of promising studies it leads to a lot of observational studies those seem to provide perhaps the answer maybe even gets on to dr. Oz's show to a certain extent and then supplements get developed that start to focus upon particular elements of a diet or a food and then finally probably too late in the process we start doing these large-scale randomized clinical trials that try to definitively test whether or not these supplements actually work more often than not they haven't and I think that's an important thing to remember at least on on first impression the key is how do we look at the supplement cycle and think about the type of research that's been done in vitamin supplements and particularly when you're listening in the news there's always another study that's coming out saying you should be taking this or should be taking that how do you sort through that and I'll try and provide some perspective on that through the course of the next bit of time so first of all what is a dietary supplement and why do we take them so they're you know without getting in to governmental there is this Act about two decades ago that basically said anything that's a dietary supplement is it's taken by mouth it contains a dietary ingredient which is about as broad as you can get that supplements the diet and and it might include vitamins it could include minerals it include pretty much anything that you can encapsulate and beyond that it also can be in the form of tablets it could be capsules it could be soft gels it could be gel caps liquids I mean pretty much it's a very very catch-all term if you really think about this probably most importantly the US Food and Drug Administration these are considered foods not drugs so if you go to the doctor's office you get diagnosed with hypertension you go on to an antihypertensive medication that drug that you're taking for the most part has gone through rigorous rigorous trials over the course of time lots of taught to determine definitively what the efficacy would be it's not say the side effects won't happen you listen to any commercial these days for any new drug you hear more about all the side effects than you do about the potential benefits but in the case of dietary supplements it's a very very difficult proposition they're not tested nor are they regulated like prescription medications that's something you always have to take very with a certain degree of caution and many people hope of course that these supplements are in fact some sort of a magic bullet for disease prevention and actually I think the notion of any magic bullet just distracts from the general importance of good nutrition a balanced diet everything for the most part in moderation and also proper lifestyle choices whether it be exercise not smoking making sure your weight is under control and just general health so just as we saw with the show of hands before we know that the prevalence of dietary supplements the United States is high so overall about half of US adults take a supplement of any type about a third of US adults or more actually depending on the survey take a multivitamin in particular and the journal patterns that as you get older more of you take supplements just as more women than men take supplements and also on average as you start to develop certain conditions in life you start to be more likely to be taking supplements as well and through the research that's been done people who tend to take vitamin and mineral supplements or people who tend to be older who are women have a healthier diet so a lot of people who already health-conscious in the first place and they're trying to pick the right foods also tend to go to look for supplements to kind of provide an extra little boost somehow or another they also tend exercise more and people who takes uplands supplements also tend to be have been diagnosed with different conditions which makes sense if I went in and I just found out that I have high cholesterol you want to find anything that you can to try and reduce your cholesterol and a lot of times you turn supplements for better for worse to try and reduce cholesterol levels when it's probably just as important if not more important to think about taking perhaps a statin or some other lipid lowering medication or to improve your diet and the other lifestyle choices that we make but in general users tend to be more health conscious so when we think about vitamins and health there's been lots of well done observational studies that have shown that there's been a very consistent association between particularly greater fruit and vegetable consumption and lower rates of cardiovascular disease cancer in many other conditions and we often hear of similarly encouraging research or findings for other foods and other nutrients and a lot of these have very strong mechanistic support the hard part is this so the researchers of course here these studies so we'll be in a room we hear about these studies and we think all right well which which foods which nutrients are responsible for these benefits and how can we understand what the mechanisms are the problem is that there's many companies that hear these studies and they realize so how can we bottle a supplement or create a supplement that we can sell that can capture these benefits to improve health and profit and it's a real concern especially given the fact that we don't regulate supplements in the way that we do drugs and other types of real medications dietary supplement use does tend to increase markedly before randomized trials are actually conducted and clinical trials are really considered be essentially the gold standard to evaluate whether something works or not in the sense that you give a group you take you can take this room for example one half of you will give a supplement that's really a multivitamin and the other half would give a placebo pill or a sugar pill or a dummy pill only that way can you really evaluate what the true legacy is of a particular supplement on health so again the other advantage and this is one of the trade-offs so the the study the trial that dr. rim had alluded to that was the Mediterranean diet that try there was over about four years of time that's an exception to the rule it's actually very difficult to do clinical trials testing Dietary Approaches dietary patterns because of compliance because of the fact that you're asking people to make changes not just in taking a pill but conforming to a diet for a very long period of time and so most of the trials that have tended to have tended to focus on vitamin supplements because it's actually more economical it's much easier in theory to take a supplement for a long period of time than it is to actually conform to a diet which revolves a lot more effort the other thing that's tended to happen is that most of the trials have been done testing vitamin supplements are of vitamin supplements that are much higher doses that you would usually get through diet alone and that becomes an issue of generalizability it'd be nice if you did a vitamin E trial that actually tested what would reflect what you might get from the diet as opposed to such a high dose of vitamin E that doesn't really reflect what you might get from the studies that we saw in observational research that suggested the benefit for taking for consuming foods that have high amounts of vitamin E to reduce cardiovascular disease now most of the trials that have been done looking at vitamin supplements so focused on individual supplements so just a single vitamin or a single mineral in relation to cardiovascular disease cancer and other outcomes and that's included trials with beta-carotene vitamin E vitamin C selenium the B vitamins also fish oil and I can go on and on with this list and I'll walk you through just some of the evidence for some of these nutrients this is an example of what the trials have shown in contrast to what the observational studies have shown so beta-carotene which is primarily usually viewed as carrots but also fruits other fruits and vegetables um there's been a lot of trials that had tested individual supplements of beta-carotene and for example cardiovascular disease and the trans have shown they're all over the map some have suggested there's a potential increased risk others have suggested there's no effect of taking beta-carotene over the long term and then other studies have actually suggested as a potential reduced risk of cardiovascular disease from your perspective when you hear studies that are coming out on another supplement or another nutrient and every time you hear about a particular nutrient or food or dietary pattern if you're hearing something different it's good it's bad it's indifferent that's usually an indication that we just don't really know what the effects are in reality no different than if you're hearing again and again the same message vitamin D reduces the risk of osteoporosis and then you hear it again and again that's usually a good indication that the consistency of the studies or the consistency of the trials in particular are conforming to the idea that this is a real potential effect vitamin E in particular has gotten a lot of studies and I think dr. rim and I can have a very long conversation about the the pros and cons of vitamin E but the interesting thing with vitamin E is that the observational studies are actually quite compelling and it really had to do with the fact of what the the food sources of vitamin E were in the observational studies could be from nuts and then other foods that we know now from the Mediterranean diet are actually quite beneficial but lots of trials have looked at vitamin E and cardiovascular disease and I would say uniformly null but uniformly inconsistent is probably the best way to characterize it at the end of which there's really no obvious recommendation to take my name in E individual supplements to prevent cardiovascular disease the same can be said for vitamin C at least in the context of cardiovascular disease and cancer there's been a lot of trials there's been only actually compared to vitamin E as you just saw this hasn't been as many trials that have tested individual supplements of vitamin C in relation to cardiovascular disease and cancer but that finding is actually been quite consistent in that there's really no effect now the dose of vitamin C that you see in these trials is about 500 milligrams per day which is actually quite low compared to if you subscribe to the Linus Pauling theory of vitamin C which would suggest you should be taking grams upon grams of vitamin C every day but we don't have that type of trial evidence to suggest that there's any benefits to taking that high of a dose so I'd like to focus a little bit more on the concept of multivitamins multivitamins in particular are the most common dietary supplement taken by US adults it's at least a third some estimates actually suggest it might be up to a half if not more the advantage of a multivitamin potentially is that rather than focus on high doses of individual supplements you're focusing on lower doses of the combination of the vitamins minerals that we get naturally in the diet and the primary goal though the multivitamin which is often forgotten is actually to prevent vitamin and mineral deficiency yet most of us take them thinking that well they couldn't hurt there must be some benefit to taking it it's low doses what's the worst thing that can happen the problem that also is that when you go to the store there's not just one multivitamin there's countless formulations to choose from even if whether it's Centrum silver or the one a day or some of the other brands even I think if you go to Costco or Sam's Club they've got so many different versions of a multivitamin to choose from it makes even more complicated when we look at the research in multivitamins we found that the observational studies were actually quite inconsistent some suggested benefits some suggested no effect others risks yet we still keep taking them despite the fact that until recently there were no large-scale long-term trials that had actually tested whether a Android Common multivitamin had any role in the prevention of chronic disease so I'd like to digress a little bit so I'm one trial that I've been involved with over the last decade plus is a trial called the physicians Health Study - and this was a this is the only trial of its kind that's tested a standard multivitamin which happened to be a Centrum silver multivitamin and we tested this nearly 15,000 physicians around the country who were aged 50 years and older at the start and they were followed for more than average for more than eleven years they kept taking either a multivitamin or a placebo without knowing whether it was going to be and unlike what you see in the dietary intervention trials when you're changing diet for a long period of time the compliance when you're taking a pill for better force tends to be higher so after more than a decade of treatment and follow-up more than two-thirds and the men in the trial we're still taking the pills as they as we had asked them to and our two endpoints focused on cardiovascular disease and cancer so the other potential advantage of the supplements that they're easier to test in trials we had a calendar pack that we would send out by mail to these participants it was easy for them to keep it with them and take it and keep track of the days of the month it became a bit of a status symbol so they'd carry these pills wherever they would go around the world and you know it also became a bit of a challenge from among the participants to see who can take the pills the furthest away from home and not to mention trying to get them through customs on times as well so so the nice part though is that you know again we have this is these are trial data that just came out toward the fall of last year now believe it or not there's two lines there it's hard to tell and what this suggests in demonstrates actually quite definitively is that for the outcome of major cardiovascular events taking a multivitamin doesn't do anything for it now if you look at some of the individual endpoints again if you look at the calm that says HR that stands for hazard ratio anything below one suggests that there's benefit anything above one suggests harm there's really no no obvious patterns other than a very small blip that there might be a lower risk of of death from from a heart attack but for the most part we found no effect of a multivitamin on cardiovascular disease when we looked at cancer we actually found a different story now these lines might not look that different from each other but given the fact that these are nearly 15,000 men that were followed for on average 11 years and longer that little difference were that that red line which is the placebo group has higher rates of cancer compared to those who were on the multivitamin and in fact we found after 11 years of treatment and follow-up is that men who are taking a daily multivitamin had an 8% significant reduced risk of total cancer and in fact if you look some of the site-specific cancers the finding was quite consistent and even more interestingly if you look at the very bottom row men who had a history of cancer at the start of the trial actually had a 27% significant reduction in the risk of total cancer so what we found from this trial which is actually in contrast to most of the trials that have been done looking at individual vitamin supplements was that first of all can't forget the main reason you consider taking a multi vitamins to prevent deficiency but we did find that taking a daily multivitamin reduced the risk of total cancer by 8% but had no effect on cardiovascular disease so don't take it for your heart perhaps take it to prevent cancer but there's always limitations with trials that often get lost in the shuffle what about women we didn't study women we studied men so how do those results extend to women I think that remains an open question not to mention we studied men who are 50 and up what about younger adults or younger I mean my kids take multivitamins how is that going to impact their life decades down the road the decision to take a multi mean like any other vitamin supplement needs to be a careful conversation with your primary care physician and at least in the terms of a multivitamin needs to be thought of in the context of its potential reductions in cancer risk and we do have other studies that two other trial results that will be coming out in the coming months looking at eye disease and cognitive functions so you can be on the lookout for that as well now we can go on we can go one to another and another another supplement and stay here for hours but so I mentioned a few others in particular that are often tossed about you'll hear it on different shows you'll see it in advertisements in the stores vitamin D you can actually argue is kind of the vitamin of the day right now no differently than what beta carotene was in the 1970s into the 1980s no differently than what vitamin E was in the 1990s into the 2000s and vitamin D has a lot of good things going for it it's it's got a set of unique risk factors to have low levels of 25 hydroxy vitamin D which I'm guessing many of you might have had measured perhaps at your doctor's office living in northern latitudes is a risk factor avoiding the Sun dark skin pigmentation and there's a lot of good observational studies that have been conducted that have suggested vitamin D might prevent cancer and cardiovascular disease etc etc etc but the trials remain inconclusive so Before we jump to the to the conclusion the assumption that taking something like vitamin D is beneficial we don't know the good news is that we do have a new large-scale trial that has just been initiated over the last few years called the vital trial that is testing in more than what will be about twenty six twenty seven thousand US adults men and women around the country to see what the long-term effects of vitamin D supplements are on these types of conditions push there's other ones so there's a mega three fatty acids thinking about fish intake soy protein thinking about tofu flavonols that you might find in T or in cocoa or dark chocolate whereas there at all which is what you'll see in red wine and lots of other vitamins and minerals and nutrients not to mention all the other herbal supplements that are on the market all virtually all of these particularly the ones that that are a little bit more esoteric you can be sure that the type of trial evidence that you'd want to have for those supplements probably isn't there so what kind of lessons have we learned so despite the lack of benefits seen for many vitamin supplements that we've tested in the larger scale clinical trials their use persists we all still take them now can a vitamin supplement help maybe we don't really know though and it's again always important to consult with your primary care physician to think about what you might consider taking whether it's something that's practical to take or not but keep in mind it's very difficult to know what the optimal doses or what the optimal formulation is there's lots of them to choose from and if anything we know that most chronic diseases are multifactorial in other words we know there's lots of risk factors for cancer lots of us actors for cardiovascular disease hypertension diabetes there's no way that a supplement is going to be representing all those risk factors and it's just as important that we have to remind ourselves to focus on the healthier dietary patterns that we know a lot more about and as one example is doctor rimmed alluded to also the recent trial results of the Mediterranean diet are a good reminder of how a long-term dietary strategy can lead to the Prevention hopefully of cardiovascular disease and there's always gonna be a revolving door of new supplements that going to hit the market and hit the shelves and it's not to say you should never consider taking any of them but be weary of them and be selective and think about whether you really need to take it or not and ideally we'd like to be able to take the supplement cycle where we keep on thinking we have an answer and then we do the trials and we exit out it would be nice to be able to find eventually with research eventually and a way to actually find that answer and get rid of this cycle that we've been in so thank you for your time and attention and we'll go from here hey well thank you very much doctor says oh and dr. rim for some very informed introductions to these topics and I think you're probably well aware that either these individuals could talk for another three or four hours on their own topic there's so much depth and detail that that they're really knowledgeable about but we have a lot of questions here so we have about 15 minutes or 20 minutes according to my watch here so we'll start right off with some of these some questions and maybe I'll pose this one to dr. rim what about organic fruits and vegetables yeah that there's not a ton of science on organic fruits and vegetables what we know right now about organic fruits and vegetables that nutrient wise they have the same nutrients that non-organic foods and vegetables have that's been pretty well tested that growing a organic raspberry you'll get the same amount of whatever flavonoids in the raspberry that you would get if it's an inorganic one what we do know obviously is that the contaminants that are invested ions are not in the organic raspberry for the most part so there are in addition to only few other things that have been seen more in organic fruits and vegetables is that the fruit or vegetable tries to create its own defense system because it's not being sprayed to protect it from the bugs and so there are a few antioxidant compounds that are actually higher in organic fruits and vegetables whether they have more benefit we don't know but it's a few the only few things that have been seen that are a bit higher in organic fruits and vegetables so if you're trying to choose between I can't afford this should I just have the inorganic or the whatever regular fruit and vegetable I would say yes and I'll have the regular fruit and vegetable and and it's better than saying I can't afford to either forget it I'm going to go have crackers great great answer this one is written for dr. rim salmon farmer versus wild looks like your farm salmon had a lot more omega-3 fatty acids in that from your slide someone notice yeah I mean it's easier to fish for farm salmon because they're all sitting at a pen in front of you but if you're thinking about what to eat yeah I mean for the most part the reason that in this particular analysis that we did in the summary literature the farm salmon had more omega-3s is because farmed salmon have what they're fed and so if they are fed fish meal they then have higher amounts of omega-3 than the wild salmon that have to swim around and burn off some of the fat so you'll find that the flavor is somewhat different I think that the evidence from this work that Howie is done that I've done is that regardless of the fish are eating it gives you substantial benefits so there are always you know some concerns I'm worried about the pesticides that may be in the farm salmon because as eating fish meal and runoff from the mountains where it's that's it's such a tiny amount compared to the huge cardiovascular benefit that you get from eating fish that the evidence is so much more overwhelming for benefit from fish regardless of what you're eating then aining my new unproven risk of anything else that may be in the fish so please don't choose fish based on the wild or farmed choose it based on the fact that we having fish instead of a cheeseburger yeah um lots of issues our issues of trade-offs of risk and benefits as dr. room was describing here's another one I'll give to him and it's out what about wine with food or dinner and then another question yes alcohol has been linked with breast cancer is it recommended to eliminate consumption by people at high risk for breast cancer that's a great question I'd like to have how we do a long term clinical trial of alcohol per 10 years it's one of those things I mean wouldn't be ethical to randomize people to not drinking I understand but compliance would be interesting yeah compliance will be interesting we probably get many people to volunteer the this is one of those areas where there's a tremendous amount of observational data and the nice thing is that it's been done in u.s. physicians but it's also been done in people in Finland and people in China people all across the world but have looked at the effects of alcohol and it's not just red wine it's the effects of alcohol whether it be beer gin or white wine it's all very similar there's not tremendously more benefit from having red wine so but it's clear I mean alcohol clearly lowers risk of heart attacks and clearly increases risk of breast cancer now many more of us die of heart attacks and die of breast cancer but nonetheless you don't wake up in the morning and say what am I going to try to prevent today and what supplement should I take or what food should eat because I'm focused on breast cancer today and tomorrow worry about heart disease so you know what for the case of alcohol what we can do is look at studies where they follow people who die of anything you follow a million people follow them for 10 years look at their drinking habits at the beginning at the beginning and who lives the longest people that live the longest are people that drink a drink a day there's no question that people that don't drink don't live as long and people are doing four drinks a day don't live as long the question is what do you do if you know you're at very high risk of breast cancer and in those women I mean I would say it's a shame to eliminate alcohol altogether because heart disease still is the number one killer of women so I think you could drink less I think maybe drinking a couple drinks a week would be okay you still would get some of the cardiovascular benefit and not have the same breast cancer risk so again it's up to the individual it's not a global blanket recommendation you can make and you can discuss that with your position if he or she knows the evidence an alcohol but it's really one of those things where you should not look at tomorrow's headline alcohol whatever it is because there's 35 years of awesome literature this area it's going to be hard to change what's been published over the last 35 years yeah that's I think a good point that this is an area where we have great confidence in the answers the relationship of alcohol to heart disease beneficial and also the relationship with alcohol to breast cancer increased risk and so even when you have the perfect scientific answer it doesn't provide in every case exact guidance as to what an individual can do sort of one the other flip sides of the point that doctor room made if you're really very low risk for heart disease then there's not going to be very much benefit for drinking alcohol in terms of reduction so especially say if a woman's forty five years old and doesn't have cardiovascular risk factors that applies to a lot of people there's almost certainly going to be more harm from the breast cancer than the benefit for reducing cardiovascular risk if the risk is already very low to begin with so it does depend on risk factors in particularly age that we that for women under 55 or 60 of unless they really have substantial heart disease risk the breast cancer risk does does mount up and where we can even see now with one drink every other day there's a measurable small but measurable increase in risk of breast cancer it's it's pretty impressive how sensitive the breast tissue is to alcohol so but it's still it's not an all-or-nothing answer as dr. Ram mentioned if you're for Bret but it does I think probably suggest that women might want to get very good wine and drink it I drop by drop and really enjoy so what about coconut oil is that good for your heart health maybe doctor says so do you want to take a crack at that one yeah I mean by and large I think the short answer is no and I think I'll leave it at that yeah it's one of those issues where we've done thanks to dr. we'll have done an awesome job of taking hydrogenated oils out of the food supply it's estimated that 20 70 80 % of partially hydrogenated oils have been taken out of the food supply because food processors have changed what's in their food because dr. well was so effective getting trans fat on the label so everybody was scared to have trans fats and he took it out there foods some foods are really hard to make without having some oil that's a little bit hard to keep the food a little more solid so if snuck in a little bit of coconut oil or a little bit of palm oil which has a little bit of saturated fat so a small bit is probably not a you know not a terrible thing but it you know it is a source of saturated fat so as a solution of cooking with palm oil or cooking with something as a lot of palm or coconut oil it's probably not the best solution yeah I quite agree with that and there are some dishes from Thailand for example other parts of the world that are made with coconut oil where the flavour is really an essential part of the dish so I think having it now and then where you really do want that flavor but that's fine it's not it's there's a very high amount of saturated fat in coconut oil but it's not poison if you have it in modest amounts but I wouldn't at this point for what we know even though I must say we don't have any long-term studies of coconut oil users still from what we know it would be better for the basic cooking fat to use some other type of more unsaturated fat the place actually where it scares people the most is that when you're getting a dessert or something like that you go well I think I'll have a nonfat cookie instead of the cookie that may be slightly lower calories have a little bit of coconut oil in that case I would actually have the cookie with a little bit of coconut oil one it's fewer calories but the highly processed highly sugared sodium non fat cookie is probably the worst thing that you can do because not only is it higher in calories but you're going to be a lot hungrier an hour or two later because you had a highly processed carbohydrate actually it's what I used to term the snackwell effect so about 10 or 20 years ago they used to be on the shelves this the what they call it snack wells which were these cookies that were basically no fat cookies but had everything else you can want to have in it and that's kind of perpetuate it's kind of propagated itself those are the things to avoid okay an interesting question out what what is coconut oil where did it originate why is it good for you and is it as good as olive oil and there we could talk for a long time about that if it is an example if you go to the web you'll find everything from canola oil being a super good food because it's high in omega-3 fatty acids which is true it is high in omega-3 fatty acids to being toxic and poison and the last thing in the world you'd want to consume but not extra canola oil is a derivative of what did you say canola or coconut canola these like music special story NOLA it's canola right there go that is a better question right so yeah sorry about that thank you Eric but so that the coconut oil is a derivative of the mustard plant that is one of the traditional oils of India and it's interesting I just recently had mustard oil I used to prepare our greens with and it just is incredibly beautifully aromatic and flavorful but the coconut oil was bred to optimize a little bit the fatty acids that were in the traditional mustard oil but all the flavor is taken out of it in the processing of it so it comes from India originally is mustard oil with a is not a high-tech genetic modification but through selection process uses a little bit different in Europe it's called rapeseed well but they figured that wouldn't go over in American kitchens very well so they named it canola oil which is short for Canadian oil because a lot of it is produced in Canada so is it good for you the it's a good oil basically a good oil it is almost entirely unsaturated fat most of its monounsaturated fat but it has an unusually substantial amount of omega-3 fatty acids about 10% and whether that's good for you or how good it is for you really depends on what you're eating in the rest of diet there are parts of the world where people have almost no access to fish and consuming oils that have almost no omega-3 fatty acids in them Bulgaria's one country for example we're studying right now it has the highest heart disease rates in the world now it probably partly due to the almost non-existent omega-3 fatty acids in their diet so for them some coconut some canola oil would be really good because it would add omega-3 fatty acids if you're already eating a fish on a regular basis and maybe consuming some other sources of omega-3 fatty acids it's not so clear whether the additional omega-3 fatty acids that we get from canola oil would really add that much is it so is it as good as olive oil we know with olive oil that people have lived on that for thousands of years and hence the Mediterranean diet that was just studied and that we know is a very healthy oil so I usually use mostly all of olive oil in my diet but I try to have some a source of omega-3 fatty acids in addition to that whether it be fish or sometimes canola oil so it really does again depends on as many things doing nutrition what else you're having in your diet you need some omega-3 fatty acids and canola oil can be a good source if you're thinking about oils to cook with if you try to make a decision in the store what should I buy to cook with it's clearly much better to have olive oil canola oil than it is to have our sort of the hard hardened old time whatever that spread was called right something less in oil yeah dr. rim what does SCD stand for we both have an S CD we both have a Doctor of Science which is the school public tells stuck up way of giving you a PhD okay sorry Oh Dina's who a public elf is not here yeah but yeah Harvard and Hopkins give out doctors of Sciences instead of PhD it's a long story with apologize okay based on your research dr. rim is eating eggs daily a good idea and what about egg substitutes our rather than regular eggs egg beaters for example yeah I think it's the this is a case where moderation is not so bad it's a no it's a complete protein it's a great source of protein all of our studies suggests that up to one egg a day is not so bad in fact it may be beneficial for some chronic diseases it's probably in part because it's a good protein it fills you up a bit more instead of eating instead of an egg instead of eating something which is a process carbohydrate you're eating it a good protein so I do think you know where you may run into problems as when people get to having a 3 or 4 egg omelette every day and I happen to have it with sausage and cheese so you know it's sort of what you're eating your egg with and I do think an egg substitute is fine again I like choosing whole foods instead of sort of recreating my my meal in front of me but if you're if you're really terribly worried about your cholesterol for the most part we should remember that the cholesterol you eat does not correlate very well with the cholesterol it circulates in your blood really what drives the cholesterol in your blood is eating a lot of bad saturated fat and trans fat so the cholesterol you eat is really not as important until you really get up to a feeding a lot of eggs a day so I think it's actually not a bad idea corporate eggs into your diet 3 or 4 a week it's probably just fine that's where evidence shows that there's the greatest health benefits I think if anything it just speaks to the the theme that we're trying to preach here was that diversity of foods as well as moderation of foods don't just put all your chips on one it's almost like the mutual fund of Dietary Approaches right you want to spread yourself relatively thin but also diverse amongst the food groups that we know do the best that's fruits and vegetables whole grains and other foods like that yeah I think this is one area where research is actually giving us confidence so oftentimes researchers view to something that identifies hazards and harms but here eggs were considered a real hazard and we have a lot of data from our research that shows that they're not so harmful after all and it's it's it's fine to introduce eggs in a moderate way is both dr. rim and dr. C so we're describing eye doctor rim I don't know people that have all the questions for you here could you explain further why we should not you slow calorie salad dressings sure there's more questions for me because I went first yeah yeah so what's in a low calorie salad dressing look at the label actually that should be the message for everything everybody when you pick up a food you're trying to decide look at the label look at the order of ingredients is the order of the composition of the of the food you're eating so the first ingredient is the most important one so if you're buying bread make sure the first ingredient says whole-grain whatever instead of wheat flour or oat flour it should say whole-grain so for salad dressing you pick it up and the first ingredient should say canola oil soybean oil olive oil because it's a healthy oil it's a liquid oil it's a model of polyunsaturated fat if you're buying a nonfat oil the first ingredients probably going to be water the second gradients likely be sugar and eventually you'll get down to some guar things and some other things that are words that you and I can't read and don't know what they mean and then there's a little bit more sodium and then there's seasons and flavorings at the end so what is that I mean I guess it's helping you eat your salad but really what you're having is sugared water that's salted down with a bunch of other artificial ingredients so to me that's not a salad dressing it's much easier just to get a little olive oil and put it on and if you'd like or to get a salad dressing where the first ingredient actually is a healthy vegetable oil great there's a couple of topics here on calcium which maybe I'll try to answer it's been a topic of a lot of confusion you know can't answer provide the full story here it's a complicated one this question said I read a small article in science section of the New York Times about calcium supplements for older women it said that most women didn't need extra calcium because they get enough in regular healthy diet too much calcium can cause elevated levels of a protein in the blood that's related to heart attacks another question asked about drinking calcium fortified orange juice and there were some there were some series of articles in the news in the last few days because the Preventive Services Task Force of a real Committee released a report saying that people people should not take months containing a thousand milligrams of calcium and 400 IU of vitamin D and I wish I knew that was going to cause a lot of confusion it was very confusing report that they issued that the big picture here is that the RDA the requirement that that in the u.s. for calcium is almost almost surely very much overstated compared to reality to put in context for women over 50 years of age the official DRI or RDA for calcium in this country is 1200 milligrams a day in England they reviewed the evidence they came up with 700 milligrams a day in the World Health Organization says 500 milligrams a day is adequate and I think the World Health Organization number is probably really the right number that is the kinds of evidence used to set this very high where calcium requirement is just bound to give you the wrong answer and of course the dairy industry loves that very high number because that underlies the recommendation to drink lots of milk for preventing fractures and the evidence is that there's no relationship between high dairy consumption and fracture risk that's been looked at really quite quite exhaustively and there's it just shows no reduction in fracture risk with high dairy consumption so I think this new report was was correct that we don't really need that much calcium that Pelisson I thought was in milligrams added on top of a diet that for most people is probably already adequate but the so in reality I think the bottom line there is if someone's having one or two servings of dairy a day that's enough calcium unless one has a specific medical reason to take more calcium if you're not taking any dairy at all then 500 milligrams a day will add you some insurance you probably don't even need that but it'll make sure you're getting enough if you take 500 milligrams on top of your regular diet which will give you some calcium even if you're not consuming any doing the vitamin D side of the story is of course much more complicated doctor so refer to that a little bit but it is pretty clear that that that 400 IU's a day is probably not enough if but there is quite a bit of evidence that higher amounts at least 800 or thousand international units a day will reduce fracture risk and for me that's good enough if the trials continue to trial show nothing well maybe you might think about whether we need it or not but one of the problems is that trials often don't go long enough to show give you the true answer and doctor says so studies showing the multiple vitamins it was was important study because it did go on for 18 years no other studies going on for that long if they had gone on for a shorter period of time they almost surely would have missed the benefit of taking the multiple vitamin supplement so that I think it's I think it is very rational for people to take extra vitamin D living here in this part of the country where we don't get enough sunlight in our levels blood levels really are low we'll wait course for further data but in the meantime I think that's pretty rational but we don't need all that dairy consumption that seems pretty pretty pretty secure so there's a red light blinking in front of me here I guess well I think we're going to need to stop here we and there are obviously complicated medical questions for an individual basis that the those are the kind of things you really do need to discuss if you have a diagnosis with your physician so thanks very much to our speakers and thank everybody else for joining us here today

Channel: Harvard Medical School

Views: 222,060

Keywords: Harvard Medical School, Longwood Seminars, Mini-Med School, vitamins, supplements, nutrition, food, Walter Willett, Howard Sesso, Eric Rimm

Id: j9E8bUIEsIo

Length: 85min 44sec (5144 seconds)

Published: Fri Mar 08 2013