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Monday, March 26, 2012

Constipation Can Cause Pants-Wetting and Bed-Wetting

Back in November 2011, I explained that children who “refuse” to have bowel movements in the potty or are “holding” their stool for days on end aren’t misbehaving, they’re constipated. Recently, I saw some published studies (click here and here) that showed that constipation can also cause pants-wetting and bed-wetting accidents. Those studies showed that the problem could often be solved by giving the child laxatives. A better solution would be to feed the child a diet that would prevent constipation to begin with: a plant-based diet with no dairy products.

The standard American diet is a recipe for constipation. That’s because it is low in fiber and includes dairy products. Food that comes from animals (meat, fish, eggs, and dairy products) contains no fiber at all. Processed foods contain little or no fiber, because the fiber has been stripped out by the processing. Dairy products are also a major cause of constipation. The major protein in cow’s milk is called casein. When you digest casein, you first break the casein molecule down into smaller pieces of protein, called peptides. Some of the peptides that come from casein are called casomorphins because they act a lot like the drug morphine. Besides being slightly addictive, casomorphins slow down the muscles that are supposed to move food through the intestines. The result can be severe constipation. In some people, even small amounts of dairy foods (milk, cheese, yogurt) can cause constipation.

Many people in the United States have always eaten a constipating diet. As a result, they may think that it’s normal to go for three or more days without a bowel movement. They may think that it’s normal for bowel movements to hurt. Parents are often unaware that they themselves are constipated. They might be even less aware that their school-age or teenage children are also constipated. If a child is passing small amounts of stool frequently, the parents may have no clue that the poor child’s rectum is distended with stool. As a result, the parents may have no clue as to why their child or teenager is wetting the bed.

A constipated person’s rectum may be so enlarged that there’s not enough room for the bladder. As a result, the bladder simply cannot hold much urine. The pressure from the enlarged rectum can also put abnormal pressure on the nerves that serve the bladder. When you add these two problems together, the result can be loss of bladder control.

Of course, constipation can cause far more serious problems than bed-wetting. Constipation can also cause hemorrhoids and painful anal fissures. It can even cause appendicitis, which can be deadly. If the constipation goes on for years, it can cause other kinds of problems, such as varicose veins. Fortunately, constipation can easily be cured by switching to a high-fiber, dairy-free diet.

Many doctors are convinced that constipation results from people “holding it” for days on end. Dr. John McDougall debunked that idea. In his book Dr. McDougall’s Digestive Tune-Up, he wrote: “One of my medical textbooks states that constipation is caused by failure to answer the urge to defecate. I challenge anyone to ignore the urge after following my dietary recommendations for just a couple of days.”

Wednesday, March 21, 2012

Yet Another Silly Study About White Rice!

If you look at articles about East Asian countries in issues of National Geographic from the early 20th century, you will notice two things. One is that many of the people in East Asia were eating a lot of white rice. The other is that only the rich people and the sumo wrestlers were overweight. That’s because the rich people and the sumo wrestlers were eating something besides rice and vegetables. Back in the 1930s, Dr. Walter Kempner realized that populations that ate a rice-based diet were slim and remarkably free of degenerative disease. After he started teaching his patients at Duke University in North Carolina in the United States to eat a diet consisting of white rice and fruit, they lost weight and reversed their type 2 diabetes. Many of his patients with type 1 diabetes were even able to cut their insulin doses. So why am I seeing studies that are trying to prove that white rice causes diabetes? The latest was just published in the British Medical Journal (BMJ).

One problem with the BMJ study is that it analyzed how much white rice people were eating, but it didn’t account for how much food they were eating and what other kinds of food they were eating. It just looked at a dose effect between servings of rice and health outcomes. That approach is potentially misleading. For example, someone who is in training to become a sumo wrestler probably eats a lot more rice than the average Japanese person does. However, he also eats a lot more meat and drinks a lot more beer. Because of their training diet, sumo wrestlers gain weight and often get type 2 diabetes. Yet it would be extremely difficult for someone to gain enough weight to become a sumo wrestler or even stay overweight on a diet of white rice and vegetables. It would therefore be silly to blame white rice for a sumo wrestler’s weight and blood sugar problems.

The BMJ study provides a classic example of a recurring problem I see in the scientific literature on nutrition. The researchers want to answer a question—in this case, whether white rice makes people fat and contributes to type 2 diabetes. The sensible way to answer that question would be to survey all of the available evidence and then see how it relates to Hill’s considerations for establishing cause and effect in epidemiology. Instead, the BMJ study took a very biased view of only one kind of evidence and then did some fancy math. Then, they came up with a misleading result.

The researchers wanted to know whether consumption of white rice is linked to obesity and diabetes. So they gathered a bunch of studies that asked people about their rice consumption and that followed up to see which people gained weight and got type 2 diabetes. Then the researchers used a mathematical approach called meta-analysis to combine the results of the studies. The biggest problem with this approach is that the researchers chose only one kind of study for their analysis: cohort studies of people who weren’t diabetic at baseline and who were eating whatever they felt like eating. This means that the researchers systematically left out studies that compared rice-eating populations to other populations, as well as the clinical studies of people who lost weight and reversed their diabetes after being taught to eat as much as they wanted of a diet based heavily on rice and vegetables.

We’ve known since the early 20th century that a high-fat diet promotes insulin resistance, which is the underlying problem in type 2 diabetes. In the early 1930s, a British researcher named H.P. Himsworth found that he could cause insulin resistance in healthy young men in a week by feeding them a diet that was 80% fat by calorie. As he replaced fat with starch in his test diet, his subjects’ glucose tolerance improved. He got the best glucose tolerance with the starchiest diet he tested: 80% carbohydrate by calorie.

Starting in 1939, Dr. Walter Kempner found that he got great results by teaching his patients to eat a diet based on white rice, fruit, and fruit juice--plus some added sugar for patients who were losing too much weight on that low-fat diet. Kempner designed this extremely low-fat, low-salt, low-protein diet because many of his patients had kidney problems and high blood pressure. That was back in the days before blood pressure medications. The high carbohydrate content of this diet (>90% by calorie) and correspondingly low fat content helped to improve his patients’ sensitivity to insulin. The Rice Diet Program that Dr. Kempner founded is still helping people lose weight and reverse their chronic illnesses, but now they do emphasize whole grains.

Tuesday, March 13, 2012

But Even Small Amounts of Any Animal-Source Foods Are Bad for You

A major study that has just been published in the Archives of Internal Medicine shows that eating a lot of red meat increases the risk of death, especially the risk of death from heart attacks and strokes and cancer. I’m glad that this message is getting out. However, I wish that people were told the whole story: Nutrition researchers have known since 1994 that eating even small amounts of any animal-based food increases the risk of death. There doesn’t seem to be any safe level of intake. We know that from the China-Cornell-Oxford Project, a massive study that was undertaken in China starting in the 1970s. That study included some populations that were eating extremely small amounts of animal-based foods. It found that there didn’t seem to be any “safe” level of intake of meat, eggs, fish, and dairy foods. 

Of course, people don’t want to hear that they can’t eat any meat. They want to hear that a little bit is okay. They especially want to hear that the foods they like can be part of a “healthy, balanced diet.” Many people especially want to hear that they should dine on expensive seafood instead of eating cheap hot dogs. In reality, however, the scientific evidence has been showing for decades that eating any animal-source food poses a needless risk.

The USDA urges people to eat animal-based foods, even though the scientific evidence clearly shows that that those foods are the major underlying causes of our major causes of death and disability. By doing so, the USDA is violating federal law. According to U.S. federal law (7 USC § 5341 [2011]), the Secretaries of Agriculture and Health and Human Services are expected to issue Dietary Guidelines for Americans at least every 5 years. These guidelines are intended for the general public and “shall be promoted by each federal agency in carrying out any federal food, nutrition, or health program.” The information and guidelines in each report “shall be based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.” In other words, it’s a violation of federal law for the USDA to urge us to eat food that scientific research has shown is bad for us.

The 2010 guidelines urge Americans to eat lots of “protein foods.” Yet nutrition scientists have known since the early 20th century that human protein requirements are so low that they are met automatically if people eat enough unrefined starches and vegetables to get enough calories. The nutritionists who designed European food rationing systems during World War I knew that fact. In 1917, the famous British nutrition researcher Sir William Maddock Bayliss wrote, “Take care of the calories and the protein will take care of itself.” In Denmark, Dr. Mikkel Hindhede designed an almost exclusively plant-based rationing system to prevent starvation during World War I. As a result, Denmark enjoyed the lowest death rate in its history. The people of the United States deserve to know these things. It's a matter of life and death.