Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Good to the last drop

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New research suggests drinking coffee might actually be good for you

Coffee drinkers, rejoice!

The heavenly brew, once deemed harmful to health, is turning out to be, if not quite a health food, at least a low-risk drink, and in many ways a beneficial one. It could protect against diabetes, liver cancer, cirrhosis, and Parkinson’s disease.

What happened? New research – lots of it – and the recognition that older, negative studies often failed to tease apart the effects of coffee and those of smoking because so many coffee drinkers were also smokers.

“Coffee was seen as very unhealthy,” said Rob van Dam, a coffee researcher and epidemiologist at the Harvard School of Public Health. “Now we have a more balanced view. We’re not telling people to drink it for health. But it is a good beverage choice.”

As you digest the news on coffee, keep in mind that coffee and caffeine are not the same thing. In fact, “they are vastly different,” said coffee researcher Terry Graham, chair of Human Health and Nutritional Sciences at the University of Guelph in Ontario, Canada. One can be good for you; the other, less so.

“Coffee is a complex beverage with hundreds, if not thousands, of bioactive ingredients,” he said. “A cup of coffee is 2 percent caffeine, 98 percent other stuff.”

Before we rhapsodize further, a few caveats:

Caffeine – whether in coffee, tea, soft drinks, or pills – can make you jittery and anxious and, in some people, can trigger insomnia. Data are mixed on whether pregnant women who consume caffeine are more likely to miscarry. In general, 200 milligrams a day – the amount in one normal-size cup of coffee – is believed safe for pregnant women, said van Dam.

For people with hard-to-control hypertension, a sudden, big dose of caffeine may boost blood pressure because caffeine constricts blood vessels. But decaf is fine. And even caffeinated coffee doesn’t increase blood pressure much once you drink it for a week or so, said van Dam.

In fact, the caffeine in coffee seems to have less of an effect on blood pressure than the caffeine in colas because there are so many other substances in coffee that have the opposite effect physiologically from caffeine.

One final caveat: The new research heralding coffee’s health benefits is not perfect. Most of the studies are observational, that is, they followed people over time and correlated health outcomes with coffee drinking – based on people’s recollections of how much coffee they consumed. The studies don’t prove that coffee was the cause of improved health outcomes.

Still, the sheer volume of the research, and the fact that the conclusions line up so neatly, make it reasonably credible, researchers say.

Now for the good news. Twenty studies worldwide show that coffee, both regular and decaf, lowers the risk for Type 2 diabetes, in some studies by as much as 50 percent. Researchers say that is probably because chlorogenic acid, one of the many ingredients in coffee, slows uptake of glucose (sugar) from the intestines. (Excess sugar in the blood is a hallmark of diabetes.) Chlorogenic acid may also stimulate GLP-1, a chemical that boosts insulin, the hormone that escorts sugar from the blood into cells. Yet another ingredient, trigonelline, a precursor to vitamin B-3, may also help slow glucose absorption.

For both heart disease and stroke, recent studies are reassuring that frequent coffee consumption does not increase risk. In fact, coffee may – repeat, may – slightly reduce the risk of stroke. A study published in March in the journal Circulation looked at data on more than 83,000 women over 24 years. It showed that those who drank two to three cups of coffee a day had a 19 percent lower risk of stroke than those who drank almost no coffee. A Finnish study found similar results for men.

For cardiovascular disease other than stroke, there doesn’t appear to be a preventive benefit from drinking coffee, but there is also no clearly documented harm; the studies looked at the effect of drinking up to six cups of regular coffee a day.

As for affecting cancer risk, coffee research has come up empty – with one big exception: liver cancer. Research consistently shows a reduction in liver cancer risk with coffee consumption, and there is some, albeit weaker, evidence that it may lower colon cancer risk as well.

Coffee also seems to protect the liver against cirrhosis, especially that caused by alcoholism. It’s not clear, either for cancer or cirrhosis, whether it’s coffee or caffeine that may be protective.

With Parkinson’s disease, a progressive, neurological illness, it’s the caffeine, not coffee, that carries the benefit. No one knows for sure why caffeine protects. Several studies show that coffee drinkers, men especially, appear to have half the risk of Parkinson’s compared to nondrinkers. Women also get a benefit, but only those who do not use post-menopausal hormones, said Dr. Alberto Ascherio, a professor of epidemiology and nutrition at the Harvard School of Public Health. All it takes for a measurable reduction in Parkinson’s risk, he said, is about 150 milligrams a day, the amount in an average cup of coffee.

When it comes to athletic performance, it’s clear that it’s caffeine, not coffee per se, that delivers the big boost, said Graham, the researcher from Ontario. In fact, caffeine was once deemed a controlled substance by the International Olympic Committee.

Caffeine is a powerful “ergogenic agent,” meaning it promotes the ability of muscles to work. Studies show that caffeine boosts performance in both very short and very long athletic events, said Graham.

It used to be thought that caffeine worked by stimulating the release of sugar (glycogen) in muscles, but recent research suggests it helps muscles release calcium, allowing muscles to contract with more force. It takes only a medium cup of regular coffee for a 130-pound athlete to see a measurable improvement in performance, Graham added.

One last bit of coffee advice: Don’t drink unfiltered coffee – the kind that is popular in Scandinavia and is made in French presses. Filtered coffee, which most Americans drink, is much better because the paper filters catch a substance called cafestol, which boosts “bad” cholesterol (LDL). Filtered coffee has no effect on either good or bad cholesterol.

If, despite all this good news, you still worry that you’re drinking too much coffee, by all means cut back or quit. But don’t go cold turkey. Abrupt caffeine withdrawal can trigger headaches, noted Dr. Alan Leviton, a neurologist at Harvard Medical School who consults for the National Coffee Association, an industry group. So, taper off instead.

On the other hand, if reading this makes you want an extra cup, go for it. And enjoy it – guilt free!

Comparing apples to organic apples

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We’d like to think pesticide-free food is better for us, but scientific proof remains elusive.

With the recession breathing down our necks, you may be looking for ways to cut the household budget without seriously compromising family well-being. So here’s a suggestion: If you buy organic fruits and veggies, consider going for the less pricey nonorganic produce instead.

I know, I know, abandoning an organic way of life seems unthinkable in this chemical age. But hold the e-mails and hear me out. There really is no proof that organic food, which costs about a third more, is better for us than the conventionally grown stuff.

Yes, it makes sense, intuitively, that crops grown without pesticides should be better for us. It’s appealing, politically, to think that food grown the old-fashioned way, by rotating crops and nurturing the soil naturally, would be superior to food that is mass-produced and chemically-saturated.

Many people feel that way. Sales of organic food and beverages have grown from $1 billion in 1990 to well over $20 billion this year, according to the Organic Trade Association, an industry group.

But the unfortunate truth is that, from a hard-nosed science point of view, it’s still unclear how much better, if at all, organic food is for human health.

“Organic,” for the record, means food grown without most conventional pesticides or fertilizers made with synthetic ingredients, according to the US Department of Agriculture’s website (usda.gov). To carry the “organic” seal, a product must be certified by a federally accredited agent as having been produced according federal regulations. Small farmers are exempt.

Prepared food made with organic ingredients also tends to be processed more gently, with fewer chemical additives, said Charles Benbrook, an agricultural economist who is chief scientist at the Organic Center. The nonprofit research group is based in Boulder, Colo., and supported by individuals and the organic food industry.

But the word organic has not been designated as an official “health claim” by the government. Such a designation is used only when there is evidence of significant health benefits – and so far, that evidence is lacking for organic food.

It’s clear, however, that conventionally grown food has remnants of pesticides on it. A 2002 study in the journal “Food Additives and Contaminants” showed there are more pesticide residues on conventional than organically grown food, even after the food is washed and prepared. There’s also clear evidence that pesticides can get into people, a major reason Environmental Protection Agency regulations exist to keep farm workers from entering recently sprayed fields.

A study by Emory University researchers and others published in 2006 in “Environmental Health Perspectives,” a peer-reviewed journal published by the National Institutes of Health, showed that when children are fed a conventional diet, their urine shows metabolic evidence of pesticide exposure, but that when they are switched to an organic diet, those signs of exposure disappear.

All of which raises the question: How much harm do the pesticides cause?

A number of studies suggest that, at high doses, organophosphate chemicals used in pesticides can cause acute poisoning, and even at somewhat lower doses may impair nervous system development in children and animals. But at the amounts allowed by the government in the American food supply? That’s where nutritionists and environmental scientists seem to part company.

“We don’t have any good proof that there is any harm from fruits and vegetables grown with the pesticides currently used,” said Dr. George Blackburn, a nutritionist at Beth Israel Deaconess Medical Center and associate director of the Division of Nutrition at Harvard Medical School. The real issue is to get people to eat more fruits and vegetables, whether they’re grown conventionally or organically, he added.

“Keeping herbicide and pesticide levels as low as possible does make sense, although there is no clear evidence that these increase health risks at the levels consumed currently in the US, ” said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health.

What is of growing concern, he said, is the meat industry’s increasing use of growth hormones in animals. Those hormones may be linked to breast cancer in women, he said. (The “organic” label on beef means, among other things, that it was raised without antibiotics and hormones. Some nonorganic beef is also raised without hormones or antibiotics, as noted on its label.)

Even if we don’t yet have all the evidence that organic veggies and fruit might be desirable, Benbrook of the Organic Center said it’s time to change the old notion that “there’s nothing wrong with a little pesticide for breakfast.” Over the last two years, he said, “nearly every issue of Environmental Health Perspectives has had at least one new research report” on how pesticides can harm a child’s neurological growth, particularly on “brain architecture, learning ability and markers for ADHD, [attention deficit hyperactivity disorder].” While this falls short of incontrovertible “proof” that properly washed conventional produce can harm us, it does raise red flags, environmentalists say.

Weighing the value of organic foods also means looking at nutrition, not just the danger of pesticides – and there is also disagreement over whether organic food supplies more nutrients.

Researchers at the University of California, Davis, did a 10-year study in which a particular strain of tomatoes was grown with pesticides on conventional soil right next to the same strain grown on soil that was certified organic. All plants were subject to the same weather, irrigation, and harvesting conditions.

The conclusion? Organic tomatoes had more vitamin C and health-promoting antioxidants, specifically flavonoids called quercitin and kaemperfol – although researchers noted that year-to-year nutrient content can vary in both conventional and organic plants.

Other studies have also shown nutritional advantages for organic food, according to the Organic Center, which reviewed 97 studies on comparative nutrition. Benbrook, the center’s chief scientist, says that although conventionally grown food tends to have more protein, organic food is about 25 percent higher in vitamin C and other antioxidants.

Yet a recent Danish study published in the Journal of the Science of Food and Agriculture showed no vitamins and minerals advantage to organic food.

So, what to eat? I side with the nutritionists who urge us to eat more fruits and veggies, regardless of how they’re grown. If you can afford it, common sense, though not necessarily science, would seem to favor the organics. But if you want, split the difference – buy organic for fruits and veggies that are thin-skinned or hard to wash or peel, and go conventional for those, like bananas, that you can peel easily.

Environmental cues affect how much you eat

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Next time you sit down to dinner, dim the lights – but not too much. Both bright light and dim light may make you eat more. Watch the background music, too. If it’s too fast, you’ll eat fast, and therefore more; too slow and you’ll keep eating. And think small for plates – a portion that looks skimpy on a dinner plate looks ample on a salad plate.

The more that researchers study obesity, the more they are finding that portion control is key to successful weight loss. Often, people think they’re eating much less than really are. And these perceptions can be influenced, often outside our conscious awareness, by environmental cues, including lights and music.

There is no question that portion sizes have increased in recent years. Marion Nestle, a professor of nutrition, food studies and public health at New York University, and her colleague Lisa Young, have found that most portion sizes are now two or three times bigger than “serving” sizes, as defined by the US Department of Agriculture and the Food and Drug Administration.

That wouldn’t be so bad, Nestle said, except that research shows that “nobody has any self-control. Everyone, everyone, when presented with larger size portions will automatically eat more calories.” Even dietitians wildly underestimate the number of calories in typical restaurant meals, she said.

“Most people, unless they are anorexic, really don’t have any idea of how many calories they are eating, and the food companies promote this,” said Tufts University psychologist Robin Kanarek. “If you have a small bag of chips, you think it’s a serving. But it’s actually two or two and a half servings. Most people get fooled.”

Whether it’s because we’ve been taught to finish our plates or get our money’s worth in restaurants, most of us eat everything that’s put in front of us, according to surveys by the American Institute for Cancer Research. In 2000, the group found that 67 percent of us finish our restaurant entrees all or most of the time. In 2003, it found that for 72 percent of us, the amount we eat is determined by the amount we are used to eating or the amount we are served “without any attention to hunger, taste, or any other factor,” said the group’s nutritionist, Karen Collins, in an e-mail.

Brian Wansink, who directs the Cornell University Food and Brand Lab, has been a leader in the study of the cues that make us eat too much. In one famous study, he found that people given huge buckets of popcorn at the movies ate an average of 173 more calories than those given smaller containers even though, in both conditions, the popcorn tasted awful because it was five days old.

In other studies, Wansink, who is also executive director of the Center for Nutrition Policy and Promotion at the US Department of Agriculture, has rigged a “bottomless” soup bowl that keeps refilling itself as people eat, prompting people to eat 73 percent more soup. He has also shown that variety on the plate makes people eat more. When people were offered six different jelly bean flavors in a scrambled, disorganized array (lots of visual variety), they ate twice as many jelly beans as when the jelly beans were in an arrangement organized by color.

Wansink’s research also demonstrated the tricky effects of lighting and music on eating.

“The big danger,” said Wansink, “is that we all think we are too smart to be influenced by environmental cues.

“The good news is that it is very easy to reverse these cues and to just as mindlessly eat less.” In fact, he said, most of us won’t even notice if we eat 20 percent more or fewer calories than usual, though we will notice a change of 30 percent.

So, if restaurateurs and food marketers can use environmental cues to get us to eat (and buy) more, we can use the same psychology to take back our waistlines.

At home, for instance, put your dinner on a small plate and pay attention to the “serving” size. A serving of meat, fish, or poultry is about 3 ounces – or about half a can of tuna – but most of us have become accustomed to portion sizes of 8 ounces or more, according to a recent issue of the Tufts University Health & Nutrition Letter.

And serve food on individual plates rather than passing a platter at the table so as not to be tempted into second helpings.

At a restaurant, have two appetizers instead of an appetizer and an entree. Take home the leftovers for a second meal. Or split a meal with someone else. Order two veggies instead of a veggie and a starch.

Ask for salad dressing on the side, ditto for mayonnaise for a sandwich. Don’t waste calories on drinks, except – if you want – for a nice glass of wine. Don’t let music and lighting seduce you into eating more.

And watch out for the mind games you can play on yourself: Since you’ll probably underestimate the calories even in a “healthy” main course, don’t fall into the trap of thinking you deserve a rich dessert because you’ve been so good.

Weight-loss surgery increasingly seen as treatment for diabetes

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Elizabeth Soto used to say no when her husband suggested they go dancing. “I didn’t want to go,” she said. “I felt tired and ugly.” She also was carrying 314 pounds on her 5-foot-7-inch frame and had diabetes.

She had gastric bypass surgery last June and now, at 235 pounds, the 38-year-old Chelsea resident said she feels “energetic and beautiful. I want to go out every weekend.” Even more astonishing, her blood sugar, which goes awry in diabetes, normalized within days of her surgery. A delighted Soto now proclaims: “My diabetes is gone.”

Doctors aren’t quite ready to call weight loss surgery a “cure” for Type 2 diabetes, the most common form. “I would use the term ‘remission,’ because if people regain the weight, the diabetes will come back,” said Dr. Martin Abrahamson, medical director of the Joslin Diabetes Center.

But doctors sure have begun encouraging their patients to get the surgery – for diabetes and a host of other problems. More and more doctors are recommending weight loss surgery to their obese and diabetic patients, and they are beginning to recommend it for less obese people, said Dr. George Blackburn, director of the Center for the Study of Nutrition Medicine at Beth Israel Deaconess Medical Center.

“We’ve all been blown away by the effectiveness of weight loss surgery,” he said. “The most severe type of obesity, leading to all these horrible diseases – diabetes, heart attack, back pain, cancer – can be treated by this surgery.”

Nationally, the number of weight loss operations soared 800 percent between 1998 and 2004, and another 11 percent between 2005 and 2006. Americans get more than 205,000 weight loss surgeries a year, according to the American Society for Metabolic and Bariatric Surgery – a number which is almost certain to keep climbing.

Research has shown that the surgery is getting far safer as it is performed more often. And more than 30 studies have found it effective for treating diabetes.

In the most recent example, a January study by Australian researchers, 60 obese, diabetic patients were randomly chosen to have laparoscopic adjustable gastric band surgery, a less drastic procedure than what Soto had, or regular treatment, which consisted of counseling on diet and exercise, plus medications, if necessary.

The results were stunning. Seventy-three percent of the surgical group were no longer diabetic at the end of the two-year study period, compared with 13 percent in the regular care group. The banding surgery, in which doctors place a balloon-like band around the stomach to make it smaller, had been assumed to be “the least effective operation for Type 2 diabetes, compared to the ‘gold standard,’ gastric bypass,” said Dr. Erik Dutson, an assistant clinical professor of surgery at the UCLA School of Medicine. But it turned that banding, though it acts more slowly, also reverses diabetes.

Last summer, a Swedish study showed that obese patients who had any of several types of surgery were 29 percent less likely to be dead a decade later than patients who had tried to control their weight through diet, exercise, and other methods.

And Utah researchers found a 40 percent reduction in deaths from all causes for obese patients who had weight-loss surgery compared with those who didn’t, as well as a 92 percent reduction in diabetes, 60 percent decline in cancer deaths and 56 percent drop in heart disease deaths for those who had had surgery.

To be sure, the surgery does not cure all problems. Many people still experience nausea, particularly if they eat sweets or greasy foods after the bypass surgery called Roux-en-Y.

Risk for suicide also appears to increase after weight-loss surgery, said Dr. Harvey Sugerman, editor in chief of the journal Surgery for Obesity and Related Diseases, perhaps because some patients “attributed all their depression to obesity. Then they have the operation, which takes care of the obesity, but they are still depressed.

“They thought the surgery would solve all their problems, but it didn’t,” he said.

Another factor in the rise of stomach surgery is doctors’ growing skill. The national in-hospital death rate from weight loss surgery declined from nine deaths for every 1,000 surgeries to two between 1998 and 2004, and has declined even further since then, said Blackburn, who also chairs a panel of 100 experts studying weight loss surgery.

In Massachusetts, the death rate dropped from an already-low average of 3 per 1,000 surgeries between 1998 and 2003 to a three-year average (2004, 2005, 2006) of less than 1 death per 1,000 surgeries, Blackburn said.

And the biggest payoff of weight loss surgery may be yet to come – avoiding surgery altogether if scientists can understand a key question: Why does diabetes get better literally within hours after gastric bypass, even before patients lose weight?

“That’s a very good question – every research center on the planet is working on it,” said Dutson of UCLA.

“There’s a Nobel Prize for anyone who can explain this,” added Dr. Daniel Jones, director of the bariatric surgery program at Beth Israel Deaconess Medical Center.

Researchers already have some clues. In Roux-en-Y surgery, part of the stomach is tied off and the small pouch that is left is connected directly to the small intestine, a procedure that allows food to bypass the upper part of the small intestine. The big plus is that when you “change the plumbing,” the production of insulin is increased, thereby reversing diabetes, Blackburn said.

Doctors suspect that bypass surgery somehow increases levels of a protein called GLP-1, which travels to the pancreas and tells beta-cells there to make insulin. (A new diabetes drug called Byetta seems to work in part through this mechanism.)

As the success of weight loss surgery grows, the number of patients clamoring for surgery is expected to soar further. Since 1991, federal guidelines have said that patients are eligible for weight loss surgery if their body mass index was 40 or more – someone who is 5-foot-6 and weighs 250 pounds, for example – or if it was 35 coupled with another serious condition such as diabetes, sleep apnea or heart disease.

But the recent Australian study pushed the envelope, offering surgery to less heavy patients. The US National Institutes of Health is already forming a committee to revisit its guidelines, Blackburn said.

For Linda Trainor, a nurse who works with weight loss surgery patients at Beth Israel Deaconess, watching obese and diabetic people get better is immensely gratifying. What she enjoys most, she said in an e-mail, “is their final freedom from self degradation.”

Robert Sisson, a 49-year-old manufacturing engineer for Raytheon who lives in South Boston, can vouch for that. Until November, Sisson tipped the scales at 376. Then he had the banding procedure. Now, he weighs 306, and his blood sugar levels are much better.

Hopping off his exercise bike recently to talk, he said, “I should have had it done years ago. My wife is going to get it done this year.” 

Book on fertility and diet stirs buzz, skepticism

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Researchers at the Harvard School of Public Health have created a buzz with their new – and controversial – book, “The Fertility Diet.”

The book doesn’t actually come right out and claim that the new Harvard diet is a cure for infertility. But that’s the message desperate couples could be forgiven for getting, given its title, some of the authors’ public statements, the intense media hype, and, of course, the clout of almost anything with the Harvard imprimatur. That’s why some critics are upset.

The book, by epidemiologists Drs. Walter Willett and Jorge Chavarro and writer Patrick J. Skerrett, is based on the authors’ research, published in the November issue of “Obstetrics and Gynecology.”

In that paper, the authors reported on 17,544 women participating in the Nurses’ Health Study who recorded their diets and their quests to get pregnant in biennial questionnaires.

The study found that women had a lower risk of infertility due to anovulation – the failure to produce a viable egg every month – if they ate a diet that emphasized monounsaturated fats like olive oil over trans fats often found in baked goods; vegetable proteins such as in beans and nuts rather than animal sources such as red meat; whole grains instead of refined carbohydrates that cause too rapid a rise of blood sugar and insulin; some whole milk, a little ice cream or other high-fat dairy products daily; multivitamins containing folic acid; and iron from plants and supplements.

The study is groundbreaking because it “is one of the first times that anyone has shown that what you eat and drink can impact the reproductive system,” said Alice Domar, a psychologist who heads the Domar Center for Mind/Body Health at Boston IVF, one of the country’s largest infertility centers.

But it’s a huge leap to go from a statistical correlation to actually giving advice. The authors veer toward prescription when they say in their book, “We have discovered 10 simple changes that offer a powerful boost in fertility for women with ovulation-related infertility.” Ditto, in a cover story they wrote for the Dec. 10 issue of Newsweek, when they said their recommendations are aimed at preventing and “reversing” infertility – a conclusion Willett defended in an interview.

Observational studies like the Nurses’ Health Study do not prove that a behavior causes or prevents a health problem, only that it might do so. To prove that diet affects fertility, researchers would have to take a group of women with diagnosed infertility and randomly put half on a special diet and half on a regular diet and compare conception rates.

This would be an interventional study, which would have come closer to the “gold standard” of medical research and would have provided the solid ground to offer advice. Such a study could also show how long a woman would need to eat this way to affect her fertility.

Dr. Guy Ringler, a fertility specialist at California Fertility Partners and a board member of the American Fertility Association, cautioned in an e-mail that the new findings are interesting but “not sufficient to conclude that a modified diet in an infertile population would improve fertility. There need to be randomized, prospective studies comparing the different diets before such claims could be made.”

So where’s the harm in a little hype? Since the diet is basically a healthy one, except for the controversial suggestion to eat more high fat dairy, including ice cream, it is unlikely to cause direct harm. But a woman who follows the diet and still doesn’t get pregnant may blame herself, even though the diet isn’t proven effective.

Worse yet, a woman may follow the diet and postpone seeing a doctor. “If you’re 22 and you follow this diet for six months, that’s no big deal. But if you’re 42, you can’t afford to postpone seeing a doctor and try this diet in the meantime,” said Domar.

Dr. Gil Wilshire, a reproductive endocrinologist at Boone Hospital Center in Columbia, Mo., put it even more strongly: “This book is blatantly irresponsible. I am going to be cleaning up the damage from this book for years to come. I will be having women who wasted one, two, three years of their lives with imprecise, ineffective treatment. Those are precious years you can’t get back.”

But the book has obvious market appeal. Infertility is a source of heartache for more than 6 million American couples, although infertility due to problems with ovulation only account for about one-quarter of these cases. The diet won’t help if male biology – such as inadequate production of viable sperm – is the problem, as the authors themselves note. Or if the woman has blocked fallopian tubes or fibroids that impair the lining of the uterus.

All this said, the observations make biological sense, particularly the idea that certain foods may influence levels of hormones involved in ovulation and conception.

For instance, a diet high in refined carbohydrates is detrimental to ovulation because it sends blood sugar and insulin, the hormone that escorts sugar into cells, skyrocketing, Willett said in a telephone interview. Too much insulin makes the ovaries overproduce testosterone, the male hormone. Meanwhile, insulin reduces production by the liver of a protein called SHBG (sex hormone binding globulin), which captures testosterone. The net result of these processes is too much testosterone in the bloodstream, which can impede ovulation.

The ice cream recommendation is surprising, Willett acknowledged, and a bit tricky to explain. But his research suggested that “higher fat dairy products were related to better fertility and lower fat dairy was related to lower fertility. The reason? We’re only speculating, but it may well be that the relatively modest amounts of estrogen and progesterone that are present in the fatty part of whole milk can have a positive effect on fertility,” he said.

The Harvard team is not recommending a switch to high-fat dairy for a whole lifetime – if consumed long-term, high fat dairy products can increase the build-up of fatty plaques in artery walls, contributing to heart attacks.

The take-home message? If you’re having trouble getting pregnant, see your doctor before you hit the bookstore.

Let the post-diet era begin

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Is permanent, significant weight loss really possible?

If you’re talking merely10 to 20 pounds — and nobody knows the actual figure — you probably can diet and exercise your way to a svelter self and stay there, provided you stick with your weight control program rigorously. Forever.

But if you’re among the two-thirds of Americans who are overweight or obese, permanent, substantial weight loss appears to be almost impossible by diet and exercise alone.

Only about 1 to 2 percent of obese people can permanently lose weight through diet and exercise alone, said Dr. Lee  Kaplan, director of the weight center at Massachusetts General Hospital.

“Dieting is like holding your breath,” he said. “You can do it, but not for long. Your body is stronger than your willpower.”

In other words, Americans have probably wasted way too much time, money and hope on diet programs that don’t help enough. It still makes sense, however, to eat as healthily as you can, and to do whatever you can to avoid gaining any more weight.

One famous study conducted at the University of Minnesota during World War II illustrates the ineffectiveness of severe dieting. The researchers put 36 physically and emotionally healthy young men of normal weight on a strict diet, allowing them only half the calories they were used to. The men lost weight, but became psychological wrecks, obsessing about food, bingeing, and, even after the diet was over, eating way too much, often 8,000 to10,000 calories a day, until they regained the weight they had lost, recounted New York Times science writer Gina Kolata in her recent book, “Re-thinking Thin.”

In another classic study in the 1950s, researchers at Rockefeller University in New York City recruited obese people who were so desperate to lose weight that they agreed to live in the hospital for eight months, including a four-month period in which they subsisted on only 600 calories a day of liquid formula. They lost weight, Kolata noted. But, to the dismay of subjects and researchers, they all quickly regained the weight they had lost.

That’s because the basic biochemistry of the body’s weight management system can work against even highly motivated dieters.

When a very fat person loses a lot of weight by diet and exercise, the brain goes into panic mode, reading a complex array of chemical signals as proof of impending starvation. Metabolism slows. The body hangs on to every calorie it can get. The chemical signals that trigger appetite soar, creating a drive to eat so powerful you can’t resist. From the standpoint of evolution, this makes sense: Our DNA was built when we were hunter-gatherers to protect us against starvation not obesity. Consider one of the best-studied weight control hormones, leptin, which is made in fat cells and is designed to tell the brain: “Stop Eating. I’m full.”

“Obese people usually have high levels of leptin because they have so many fat cells making it,” said Dr. Eleftheria Maratos-Flier, an obesity researcher and associate professor of medicine at Beth Israel Deaconess Medical Center. “The heavier you are, the higher the circulating leptin.” In theory, being fat should mean that the brain would be flooded with  “stop eating” signals.

But when people go on severe diets, “they lose more leptin than you would expect. So the brain thinks there is less fat than there ought to be,” which makes people eat more, she said.

And leptin is just one of many hormones involved in weight control. “In the stomach and intestines alone,” Kaplan said, “there are 36 hormones that regulate weight, and another 30 in the brain. The end result of all these chemicals is to keep our energy stores, that is, fat, in balance.”

Put differently, some researchers believe that one reason weight loss programs ultimately fail is that diet and exercise do not change the body’s “set point,” the thermostat-like mechanism in the hypothalamus and other parts of the brain that keep weight fairly constant.

Dr. David Heber, director of the UCLA Center for Human Nutrition, is more optimistic about the effectiveness of dieting. “The set point can be changed. Yes, there are signals to eat and to hoard fat, but having said that, humans do adapt to starvation and do change,” he said. While the hormones that control appetite and satiety do tilt the equation toward regaining lost weight, “psychology trumps physiology. I see people every day who have overcome their genes and kept their excess weight off for decades.”

Many researchers do agree that one weight loss strategy does seem to change the set point — bariatric surgery, the stomach-stapling procedure. Doctors used to think it worked by simply reducing the size of the stomach, preventing people from eating much. Now, they think it works because, with less stomach tissue pumping out hormones such as ghrelin, which stimulates appetite, a person’s appetite and satiety signals may be altered to help them eat less.

So if dieting sets up a battle between our free will and our hormones, are America’s fat masses wasting their time desperately trying to lose weight?

To some, including the National Association to Advance Fat Acceptance, a civil rights organization that is fighting discrimination against fat people, all this suggests not so much a hopeless message as a liberating one. “Most people do not choose to be fat,” said the group spokeswoman, Peggy Howell.  “But once people are fat, it is next to impossible to change that. It’s far healthier to accept who you are and get on with your life than to be obsessed with what goes into your mouth.”

That makes a lot of sense to me, though I resist the idea that our genes are the big culprits because we have basically the same genes today that our skinnier grandparents had.  What’s changed is our lifestyles – more sitting around eating Twinkies, less walking to and from daily activities.

So, here’s my take. Because of the body’s complex biochemistry, it’s very difficult to lose weight once you gain it. So, exercise as much as you can — for general health, in addition to weight control. Eat right — fewer refined carbs, more fruits and veggies — again, for general health. If you’re fat, don’t just blame your genes and let yourself get fatter and fatter.

At the same time, be gentle with yourself, and with fat people you see.

The fading allure of vitamins

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My love affair with vitamins and supplements is over: With a few exceptions — stay tuned — I’m tossing them out.

Things started going south for this romance 13 years ago when a Finnish study of 29,000 male smokers showed a higher rate of lung cancer in men who took beta-carotene and vitamin E and, more shockingly, found that those who took beta-carotene had an 8 percent higher risk of death from all causes. Two years later, an American study reported similar findings for beta-carotene.

My love affair with vitamins and supplements is over: With a few exceptions — stay tuned — I’m tossing them out.

Things started going south for this romance 13 years ago when a Finnish study of 29,000 male smokers showed a higher rate of lung cancer in men who took beta-carotene and vitamin E and, more shockingly, found that those who took beta-carotene had an 8 percent higher risk of death from all causes. Two years later, an American study reported similar findings for beta-carotene.

I’ve never been a smoker, but a red flag is a red flag. Out went the beta-carotene.

Then came the bad news on vitamin E, for which I had had high hopes as a general disease-preventer. A 2004 analysis by Dr. Edgar R. Miller, of Johns Hopkins University, found an increase in deaths from all causes in people taking more than 400 International Units a day of vitamin E. In 2005, the Women’s Health Study of nearly 40,000 healthy women showed 600 international units of vitamin E taken every other day provided no overall benefit for heart disease or cancer.

Out went the vitamin E.

Along the way, I tossed my echinacea, which I once swore by for preventing or shortening the duration of colds. (Never underestimate the placebo effect!) Though proponents still contend the studies are flawed, I now believe the debunkers — among them the researchers who published a major study in 2005 in the New England Journal of Medicine showing that echinacea has no effect on colds.

Did I mention vitamin C? Oh, how I wanted to believe this famous antioxidant would keep me from getting cancer and all those colds! But despite numerous studies, “we haven’t been able to show a benefit,” Miller said.

The latest disillusionment came in February with a Danish study published in the Journal of the American Medical Association. When the researchers pooled the data from 47 reasonably unbiased studies involving 180,938 people, they found a 7 percent increased risk of death from all causes in those taking beta-carotene, a 16 percent increased risk of death in those taking vitamin A, and a 4 percent increased risk of death in those taking vitamin E.

Jeffrey Blumberg , a nutritionist and director of the antioxidants laboratory at Tufts University, among others, said that this study was based on flawed methodology, including the fact that the researchers left out of their analysis a number of studies that might have tipped the results in a different direction. But, to me, that’s clearly not a strong endorsement of vitamins.

(An important caveat here: If I were at risk of developing advanced age-related macular degeneration, a leading cause of vision loss, I would talk with my doctor about taking vitamin C, E, beta-carotene, and zinc. A National Eye Institute study published in 2001 showed that this combination can slow progression of the disease. On the other hand, a study in March in the Archives of Ophthalmology showed no benefit to beta carotene pills alone.)

Multivitamins? Somehow, I can’t part with mine yet, mostly because, try as I might, I still don’t eat enough fruits and veggies. But my faith is slipping. A state-of-the-science conference sponsored by the National Institutes of Health synthesized data from a number of randomized, controlled trials, the gold standard of clinical research. In a paper published in 2006 in the Annals of Internal Medicine, the scientists concluded, disappointingly, that the “evidence is insufficient to prove the presence or absence of benefits from use of multivitamin or mineral supplements to prevent cancer and chronic disease.” (For more, go to consensus.nih.gov.)

Adding to the speed at which the scales have been falling from my eyes is the latest news from ConsumerLab.com, a private company that tests vitamins, both for manufacturers and consumers.

ConsumerLab reported in January that 52 percent of the multivitamins it examined were contaminated with lead, didn’t disintegrate properly, or had more or less of certain ingredients than indicated on the label. While Centrum Silver passed, a multivitamin called AARP Maturity flunked because it failed to disintegrate properly. (An AARP spokesperson said it believes “the validity of the ConsumerLab study is in serious question” and is therefore still “evaluating whether or not to continue to make the product available.”)

A children’s product called Yummi Bears Multivitamin and Mineral flunked, too, because it contained too much vitamin A, which can be toxic. (A spokeswoman for the company said other, independent tests show Yummi Bears products meet all label claims and that there is no basis for concern about vitamin A levels in the product.) Vitamin Shoppe Multivitamins for Women flunked because it had too much lead; a company spokesman said last week that the company has removed the product from stores.

So, what’s left in my dietary supplement drawer?

Not much. Omega-3 fish oils, vitamin D, and calcium. Omega-3’s are still on my “good” list because considerable research suggests they lower the risk of cardiovascular disease and abnormal heart rhythms. In ConsumerLab testing, omega-3 fish oils, thankfully, were found to be free of mercury, PCBs, and other potential contaminants. Vitamin D is still on my list because it helps protect against certain cancers and with absorption of calcium. Calcium is still there because it seems to help protect against bone loss, although recent research has raised some questions, so this might be next to go.

For me, the most pressing question now is how to have the most fun with the handful of twenties I’m not spending on supplements! 

For The Facts on ‘Natural’ Remedies, Go Online

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We Americans now spend an estimated $20 billion a year on dietary supplements and so-called “natural” remedies, many of us blissfully — even willfully — ignorant of the actual medicinal value, or utter lack thereof, in of these products.

It’s not entirely our fault that we buy this stuff so blindly. In 1994, Congress limited the power of the US Food and Drug Administration to regulate supplements and herbal medicines, which now are allowed to get — and stay — on the market unless clear evidence of harm is found.

We’ve been left largely to our own devices to figure out which alternative remedies actually work, and are safe, and which are pure snake oil.

Happily, a few reasonably trustworthy websites have sprung up allowing consumers to evaluate how much credible research there is (or isn’t) for a particular supplement,  how the “natural” remedy in question interacts with other such products or with prescription drugs, and what the major side effects are.

(I put “natural” in quotes, by the way, because the term is meaningless for health products. Pills from health food stores are not intrinsically safe, gentle or non-toxic just because they are called “natural.”  And they’re much less likely than prescription drugs to even contain the ingredients listed on the labels.)

To facilitate comparisons among my favorite sites, I’ve tracked how they rate three of the top-selling products: black cohosh, often used to treat hot flashes; Echinacea, used to treat and prevent colds; and the combination of glucosamine-chondroitin, used to ease the pain of osteoarthritis. In truth, it’s hard to tell how solid the science is for these, and many other, alternative remedies, but some sites do a better job than others at pointing out the products’ shortcomings. Some information on these sites is free, but for details, you often have to pay (typically $15 to $50) per year.

For starters, I recommend the site run by the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health). It is quite helpful and easy to use. To check on echinacea, for instance, go to http://nccam.nih.gov/health/echinacea. The information is succinct, noting that studies show echinacea does not appear to prevent colds or other infections, nor does it shorten the lengths of colds or flu.

For black cohosh, the site says studies are mixed for menopausal relief and notes that it has been linked with liver problems, though the site cautions that it’s not clear if black cohosh is truly to blame. As for glucosamine-chondroitin, the site includes the GAIT study results showing the remedy did not provide significant relief for osteoarthritis patients, except for a small subset of people.

Another of my favorite sites, because it is the most aggressively critical, is www.worstpills.org the creation of Public Citizen’s Health Research Group in Washington, D.C., which takes no money from government or industry and relies on membership fees and product sales. The site is very thorough and put all three of my test supplements in the “Do Not Use” category.

Worstpills.org concludes, for instance, that “there is no significant evidence that black cohosh alleviates menopausal symptoms.” Among adverse effects, it cites two cases in the medical literature of liver transplants possibly linked  to the supplement.

As for echinacea, the site concludes that there is “no convincing evidence” that it reduces the frequency or severity of the common cold.

On glucosamine-chondroitin, www.worstpills.org  includes information from the most recent and most credible study (the so-called GAIT trial, published in February, 2006 in the New England Journal of Medicine) which found a non-commercial form of the combination ineffective except for a subgroup of people with moderate-to-severe pain.

Another good site is www.herbalgram.org  (click on “herbal information”), run by the Texas-based American Botanical Council and its chief guru, Mark Blumenthal. The council gets half its funding from the supplement/herbal industry, and the other half from health professionals and researchers. Despite its industry backing, I find the site thorough, accurate and fairly independent.

On black cohosh, herbalgram.org  put out a special article in March after an Australian government agency warned the substance was linked to liver toxicity. The site goes deep on black cohosh and notes that a leading black cohosh product, Remifemin, now carries a warning label about potential liver toxicity.

On echinacea, herbalgram.org has so much material it’s tough to find a bottom line. It acknowledges the lack of efficacy for treating or preventing colds, but points out that the most recent clinical trial was done with doses that were too low to be effective, Blumenthal said. The group did not evaluate glucosamine-chondroitin because it is not an herbal product.

Consumer Reports is another good site. A few weeks ago, the group added a rating system for “natural” remedies to its website — www.consumerreports.org/mg/natural-medicine/ratings.htm. The massive amount of information in these ratings of 14,000 herbs, vitamins and nutritional supplements comes directly from a respected source used by pharmacists and physicians, the Natural Medicines Comprehensive database, which gets no industry funding and is supported only by subscriptions from physicians and pharmacists.

The Consumer Reports site provides a huge amount of detail about each product and possible interactions with other medications. Despite its vastness, it’s easy to use. It goes easy on black cohosh, calling it “possibly effective” for hot flashes, though it does note possible interactions with drugs like cisplatin, the cancer drug. A “possibly effective” rating means there is some evidence of efficacy and possibly some negative evidence.

The site is also kind to Echinacea and glucosamine-chondroitin, calling them both “possibly effective.” Echinacea, said the database editor, Dr. Phil Gregory in an e-mail, is not effective at all in preventing colds, and is only possibly effective in treating an existing cold. On glucosamine-chondroitin, he said that although the GAIT trial looked at the combination, most research uses glucosamine sulfate alone and that does appear to be effective.

One other government site rates a mention. It’s run by the FDA, and lists dietary supplements the agency has issued safety alerts for (

http://www.cfsan.fda.gov/~dms/ds-warn.html) It has issued no such alerts for black cohosh, echinacea or glucosamine-chondroitin.

 My take on all this is that there are probably some useful, safe supplements out there.

But the whole field of dietary and herbal supplements is basically faith-based medicine, so I’m glad there are some websites to check with to make sure while I think I’m doing myself some good, I’m not accidentallly doing harm.

So, the Low-Fat Diet is Kaput, Now What?

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Last week, researchers conducting a long-awaited study on the effectiveness of low-fat diets dropped a bombshell: Eating a low-fat diet does not appear to reduce the risk of getting breast cancer, colorectal cancer, or cardiovascular disease.

The $415 million study, part of the Women’s Health Initiative, followed nearly 49,000 women aged 50 to 70 over eight years. It was the largest, longest, and best-designed study ever to test the merits of a low-fat diet.

To help sort out what to make of the new research, Globe columnist Judy Foreman and staff writer Carey Goldberg posed questions about the study to five leading experts on diet, heart disease, cancer, metabolism, and preventive medicine.

They all agreed on one thing: Although the study failed to prove a strong link between low-fat diet and better health, “it’s not really license to head for the butter,” as Dr. Michael Thun, chief epidemiologist for the American Cancer Society, put it.

They all pointed to other research though often less definitive than the new study suggesting that the most heart-protective diet includes lots of fruits, vegetables, whole grains, fish, and “good” fats like omega 3 fatty acids and olive oil.

The new study “is probably the final nail in the coffin for low-fat diets,” said Dr. Walter Willett, chairman of the department of nutrition at Harvard School of Public Health. “But people should not conclude that diet is not important. The right dietary choices can make a huge difference in long-term well-being. . . . It’s just this particular diet that doesn’t matter.”

Other excerpts from their responses:

Q: After considering the new data, what diet would you tell your patients to follow?

Does Eating Soy Make you Healthier, or Not?

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Health food advocates have long claimed that soy, he little legume found in everything from tofu burgers to smoothies, can protect against heart disease, ward off   cancer and combat hot flashes.

But those claims are coming under scrutiny, now that a soy food manufacturer, the Solae Co. of St. Louis, Mo., is seeking government approval to tout on its labels soy’s supposed cancer-fighting abilities.

The company’s petition to the US Food and Drug Administration for a new health claim has the support of some soy researchers, but has angered others who say the science simply isn’t there to support it.

Some controversial research in mice even suggests that soy could promote breast cancer. The FDA, which has loosened its rules on what products do and don’t deserve to be sold with health claims, is accepting public comment on the issue until mid-June. (www.fda.gov.)

The company wants its labels to say, in part, that “scientific evidence suggests that consumption of soy protein may reduce the risk of certain cancers,” and in other materials, names cancers of the breast, colon and prostate. The company cites 58 studies in support of its position, but also asks that the labels carry the caveat: “However, this evidence is not conclusive.”

Indeed the evidence is not conclusive.

Most of the evidence comes from epidemiological studies, which look at groups of people to find associations between their habits, such as soy consumption, and their risks of getting diseases. Such studies, however, are not designed to prove that certain behaviors cause or protect against diseases.

Dr. David Heber, director of the Center for Human Nutrition at UCLA, who is sympathetic to Solae’s claim, said, “Soy is an important tool in helping women achieve their personal best body weight and shape, and obesity is a major contributor to breast cancer risk.”

But leaping from that to the idea that eating soy can actually help prevent cancer and other diseases is dangerous business, according to David Schardt, a senior nutritionist at the Center for Science in the Public Interest, a nutrition advocacy group in Washington, D.C. “It doesn’t make sense to urge people to consume these products when we don’t know whether they prevent cancer or make matters worse.”

The notion that soy could make matters worse makes some theoretical sense. Soybeans are rich in weak plant estrogens, specifically genistein  and daidzein, which are called isoflavones. Like the estrogens that humans make in their bodies and buy by prescription, these estrogens could theoretically spur the growth of estrogen-dependent breast cancer cells.

Some hints come from the laboratory of Bill  Helferich, a professor of Food Science and Human Nutrition at the University of Illinois. He has found that genistein from soy can promote the growth of human breast tumors implanted into mice.

In Asia, he said, soy is consumed in minimally-processed forms like tofu, and Asians do have a lower incidence of breast cancer than Americans. The whole soybean contains 30 to 40 percent protein. But many soy products in the US are highly concentrated, and contain up to 90 percent protein. The oncentrated products still contain isoflavones but may be missing potentially beneficial but unidentified compounds, he said.

But Heber of UCLA argues that Helferich’s mouse model is flawed because mice are missing an enzyme in human fat cells that controls estrogen metabolism.In truth, soy has been losing its luster for several years. Nearly five years ago, the FDA became so convinced of soy’s capacity to lower cholesterol that it began allowing manufacturers to put health claims on soy products indicating that it may lower heart disease risk.But since then, the emerging data “has not upheld that health claim,” said Alice Lichtenstein, a professor at the Friedman School of Nutrition Science and Policy at Tufts University. It turns out, she said, that soy has “very little effect” on lowering “bad” or LDL cholesterol. Others note that soy can reduce heart disease risk to the extent that it is substituted for greasy meat.Nor has soy lived up to its promise for combatting hot flashes, said Dr. Sherwood Gorbach, professor of community health and medicine at Tufts University School of Medicine, who only a few years ago was developing a soy supplement for hot flashes and has now abandoned that effort. “We have a patent,” said Gorbach, “but the evidence was not compelling.” Other researchers say soy is somewhat better than placebo, but doesn’t get rid of hot flashes entirely.

But the real battle now is over soy’s alleged anti-cancer properties, and how that goes depends on new thinking at the FDA — which recently weakened its rules on health claims for food and dietary supplements.

In 1990, Congress passed a statute, the Nutrition Labeling and Education Act, which required that FDA-approved health claims for food be based on “significant scientific agreement,” said Bruce Silverglade, director of legal affairs for the Center for Science in the Public Interest, a nutrition advocacy group based in Washington, D.C. The food industry objected, arguing that this requirement violated their first amendment rights to free speech. The FDA ignored the industry’s argument until 2002, when it said it would “permit health claims for foods even if there is no significant scientific agreement” on the benefits, said Silverglade.Last July, the FDA announced it would begin allowing some food companies to make “qualified” health claims, the weaker claim Solae is seeking. In September, Silverglade’s group joined with another Washington-based advocacy group, Public Citizen, and sued the FDA, over this change in policy. A ruling on this suit is still pending.

The bottom line? If you enjoy soy as a food, go for it. But don’t expect miracles, and check with your doctor before upping your soy intake if you already have breast cancer.