I’m always grateful to receive questions from site visitors and those who follow me on Twitter. In many instances, the inquiries posed are quite personal and/or specific in nature. Under those circumstances I reply directly and in a completely confidential and discreet manner. But some questions strike a more universal cord. When that happens, I try to post the answers in one form or another on this site for all to see.

Issues such as the link between alcohol consumption and body fat; flaxseeds for cardiovascular health and the role of diet in relation to breast cancer affect most people in some way, shape or form. They’re also the subject of frequent debate and speculation in the health care community. What is often lacking when discussing these topics is the latest scientific findings.

Question – Does eating a lot of fiber really reduce breast cancer risk? I’m on a low carb diet and I’m sure I don’t reach the recommended amount (of fiber).

Answer – First and foremost, there’s no reason for anyone on a low carb diet to eat insufficient amounts of fiber. Fiber functions beautifully in the context of most diets, including those that restrict carbohydrates. As for the connection between dietary fiber intake and breast cancer incidence, the evidence is quite compelling. Current studies appearing in three prestigious medical journals reveal that a high intake of fiber is inversely associated with breast cancer risk by up 52%. There are two emerging theories that explain this proposed connection: 1) high fiber intake tends to lower circulating estrogen and testosterone levels via improved estrogen metabolism and an elevation in sex hormone binding globulin concentrations; 2) high fiber lowers systemic inflammation (C-reactive protein or CRP and serum amyloid A or SAA). (1,2,3)

Question – You include a lot of flaxseeds in your recipes. I’ve heard that fish is better than flax. Why do you use it so much?

Answer – I agree that flaxseeds aren’t a suitable omega-3 fatty acid replacement for fish or fish oil. I use flaxseeds in recipes because they contribute valuable nutrition besides their fat content. Recent publications in the Nutrition Journal and Nutricion Hospitalaria support my frequent reliance on flax. In one of the trials, the addition of 40 grams of ground flaxseeds/day enhanced antioxidant activity and improved insulin resistance in a group of obese patients. The crossover study compared the effects of flax vs. wheat bran. Wheat bran was deemed ineffective by the authors of the intervention. Another comparison trial pitting flaxseeds vs. cassava powder, also known as manioc or yuca, determined that a high dosage of flax (60 grams/day) was beneficial for cardiovascular health in obese adults. According to the researchers involved, “inflammatory and coagulatory markers tended to exhibit a better outlook in the flaxseed group”. It’s important to note that much lower dosages of flaxseeds do not provide similar protection. This fact was most recently evidenced in a trial employing 7.5 grams of flaxseed daily in a group of postmenopausual women at-risk for breast cancer. Designing studies using such a nominal dosage seems inadvisable and the results should be interpreted with caution. (4,5,6)

Question – I have a beer or two a couple nights a week. It’s one of the few vices I still allow myself. I’m also working out and trying to lean down. Is the beer at odds with my goal?

Answer – The actual evidence linking alcohol use to body fat is a bit contradictory. The latest issue of the European Journal of Clinical Nutrition concludes that “lifetime alcohol use is positively related to abdominal and general adiposity in men”. In women it’s “positively related only to abdominal adiposity”. What’s more, beer was specifically singled out as a bigger risk factor for body fat percentage than wine. On the other hand, some population studies point to various dietary influences (calorically dense, high glycemic and low fiber diets) as playing more prominent roles in body fat accumulation than alcohol. I think that in all likelihood drinking alcohol in moderation is unlikely to lead to a so-called “beer belly” provided that you keep your diet in check the majority of the time. My opinion is partially based on numerous scientific publications examining the link between Mediterranean style diets, which typically include some alcohol and a healthy waist circumference. (7,8,9)

Mediterranean Dietary Patterns Are Associated w/ Lower Waist Circumference

Source: J. Nutr. September 2009 vol. 139 no. 9 1728-1737 (a)

Question – I just read your blog about acai berries. I was really surprised by how negative you were about them. Have you changed your mind at all since writing it?

Answer: I always want to report positive findings about natural foods and products. There’s more than enough warranted and unwarranted negative publicity without me piling on. But the only way to truly support patients and physicians who are interested in natural medicine is to provide accurate information and a reasonable assessment thereof. In the case of acai palm berries, there have been some encouraging developments of late.

• A new pilot study appearing in the Nutrition Journal reports that 200 mg/day of an acai berry pulp supplement reduced LDL (“bad”) cholesterol and post-prandial glucose levels in a group of 10 obese adults. These results must be considered preliminary because the trial only lasted one month and was uncontrolled – using no placebo. (10)
• The April 2011 edition of the Journal of Medicinal Food reveals that 120 ml/day of an acai based juice effectively reduced a marker of inflammation (C-reactive protein) and oxidative stress in 14 patients with limited range of motion. A decline in pain was also documented in this 12 week open label study. (11)

There’s very little that I relish more than being able to change my mind about previously held positions. I have the freedom to do so because my objective accommodates such flexibility. My one and only goal is to provide information that benefits the health of all those around me. Being dogmatic or prideful about past positions simply doesn’t fit in that paradigm. So by all means, let me know if you find reasons for me to reconsider previously held views. I promise that I’ll accept your comments, questions and recommendations in the generous spirit in which they’re sent. This open and respectful exchange of information will not only benefit us, but the whole of medicine and health care.

Be well!

JP