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An Apple a Day

We (the authors and editors) at SBM get accused of many nefarious things. Because we deliberately engage with the public over controversial medical questions, we expect nothing less. It goes with the territory. In fact, if there were a lack of critical pushback we would worry that we were not doing our job.

Still, it is disconcerting to see the frequently-repeated ideological accusations in response to simply evaluating and reporting the evidence. That is what we do here – follow the science and evidence. When that trail leads to a conclusion that some people do not like (usually for ideological reasons) a common response is to accuse us of ideology, malfeasance, being part of a conspiracy, or having conflicts of interest or ulterior motives. That is easier, I suppose, than engaging with us on the science.

One common accusation is that we are shills for the pharmaceutical industry, and downplay or ignore the benefits of diet and “natural” treatments. A search through the SBM archives demonstrates that this accusation is false – we criticize bad science and poor-quality control, regardless of who is committing it. Sometimes pseudoscience is used to promote a drug, sometimes a nutritional supplement, and sometimes pure magic.

We have been consistently critical of the marketing of routine vitamin and mineral supplementation because there is simply a lack of evidence to support it. Scott Gavura will be writing tomorrow on three new studies published recently in the Annals of Internal Medicine, all of which provide further evidence for the lack of a health benefit from routine multivitamin use.

I have found this to be a topic full of irony, because whenever I have taken the position that the evidence does not support routine supplementation, I am commonly accused of being a pharma shill. This is ironic because supplements are largely sold by large corporations, including pharmaceutical companies. Further, what I do recommend is a well-rounded diet instead – eat your five portions of fruits and vegetables a day and have a generally well-rounded diet with appropriate calorie control. I still fail to see how recommending a healthful diet over a product of the pharmaceutical industry makes me a pharma shill – but the ideologues only have so many arrows in their quiver, and they are going to use them.

Specifically the evidence shows that taking a multivitamin is not a substitute for a healthy diet.

A recent paper in the BMJ further makes the point that promoting a healthy diet can have a significant impact on reducing vascular risk. This is not a study, but rather a statistical model that uses existing evidence and asks two questions:

- What would happen if everyone over 50 were offered a statin, and 70% complied?

- What would happen if everyone over 50 were told to eat an apple a day (or one extra portion of some fruit) and 70% complied (and assuming no overall increase in calorie consumption)?

This is what the numbers showed:

The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% (95% confidence interval 9% to 16%) per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12 500). The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10 800).

That statin would save 9,400 lives, while eating an apple would save 8,500 lives per year. Not only is an apple a day just about as effective as taking a statin, it has fewer side effects. The increased statin use would also cause over a thousand cases of muscle disease and 10,000 new diagnoses of diabetes.

The authors did not recommend replacing statin use with eating more fruit. Using statins still has a net benefit to overall mortality. But it does show that a simple nutritional intervention has the potential for a similar benefit, at lower cost and without side effects.

Conclusion

Star Trek’s Dr. McCoy famously said, “I can do more for you if you just eat right and exercise regularly.” This just shows that over 40 years ago (or 250 years from now, depending on how you look at it) the bottom-line best medical advice has not changed.

This is a very strong and consistent signal in the clinical literature. Eat a well-rounded diet with plenty of fruits and vegetables (five portions a day), and exercise regularly, and this will have a significant positive impact on your health and longevity. This simple statement is what all the research boils down to, but this won’t sell many books or supplements.

The evidence also shows that taking vitamins does not substitute for a good diet. In fact one of our criticisms of pushing vitamins is that it may lead to a false sense of security and give people psychological “permission” to persist with a suboptimal diet.

I think it’s important, in fact, to keep our message as simple as possible. I am concerned that getting overwhelmed with all the minute details of specific nutrients and nuanced diets has an overall negative effect on public health, because the more basic messages are getting lost in the noise. There is an entire industry, in fact, based upon that noise (including statistical noise in the research).

If you want to live longer, here is what the evidence clearly shows in terms of lifestyle:

- Eat a well-rounded healthy diet
- Exercise regularly
- Get enough sleep
- Don’t smoke
- Use alcohol in moderation

I would add – get appropriate medical care and screening where appropriate (get your mammograms and colonoscopies). Beyond those basic lifestyle recommendations, there are diminishing returns, with greater and greater complexity and difficulty for smaller and smaller benefit (if any).

The latest publication shows that simple messaging can potentially have a huge impact.

Eat an apple a day (or your fruit of choice, I personally like bananas).

Posted in: Nutrition, Public Health

Leave a Comment (104) ↓

104 thoughts on “An Apple a Day

  1. Kathy says:

    There’s also a move to replace common or garden fruits with exotic (and presumably more expensive) fruits. Just eating whatever is cheap, ordinary and in season isn’t good enough, you have to switch to pomegranates, kiwi fruit or some sort of berry you never heard of, to keep REALLY healthy. There’s a persistent advert keeps popping up on my facebook page to this effect … disguises itself as information … it must cost a small fortune.

    1. Jason says:

      Too coincidental…I just bought a tub of kiwis and five pomegranates because they were the cheapest fruit in the store. Mind you they were on sale. Exotic fruits may not offer any benefits over other fruits and vegetables but they are also not always the most expensive and they do confer variety.

    2. MikeB says:

      Not only that, ignore the “organic” labels. Fruit is fruit. It doesn’t matter whether or not the farmer was wearing a hair shirt while growing it.

      1. Greg says:

        I have read there are certain fruits that are more heavily sprayed, such as apples and strawberries, and because of this, organic is preferable to conventionally grown crops. Are pesticide residues cause for concern?

        1. Lucario says:

          Not if you wash your produce – always a good idea, organic or not, just to get rid of any dirt and germs that might be on it.

          1. Tallise says:

            I go to school at MD Anderson and thy recommend / have recommended in the past as a part of their healthy bites (or some health challenge one year) to eat organic berries because the pesticides don’t wash off as easy/ are absorbed by the thin skinned fruit and the chemicals are bad. However, they also have (to my disappointment) a complementary medicine center here in their main building, and I don’t know what sort of oversight there is for their health initiatives. :/

        2. nancy brownlee says:

          Wash produce carefully, with a little mild detergent (like dish soap) and rinse the hell out of it- the detergent is pretty nasty, all by itself. Then- if you don’t intend to peel- remove the stem end carefully, because pesticides collect in that little depression. Soft fruit, like berries, can be simply rinsed very well and stemmed immediately before eating (they grow fast, don’t get sprayed much.)

          I have undergrad degrees in agriculture and horticulture and had a market garden for years.

  2. Angora Rabbit says:

    Steve, are you sure you didn’t just attend my last lecture of the semester? Exactly the same advice my nutrition students received on Friday. :)

    Adding to this, are the pro-supplement readers of this list aware that the vitamins in their supplements are largely provided by just four companies? Ciba-Geigy, Roche, BASF, and I’ve forgotten the fourth. Big Suppl indeed! About 15yrs ago, the US States Attorneys’ General settled financially with those companies, because they had monopolized and fixed prices. The settlement that was used by many states to support medical research and training.

    Bottom line – Big Suppl IS Big Pharma. Or Big Chem. Take a look at the label – does it say “manufactured by” or “distributed by”?

    Mind, the Annals Int Med study is only reinforcing what the IOM report recommended in about 2001. Paul Offit had an outstanding op-ed in the NYTimes last Sat or Sun – did people see it? Hope it gets discussed here.

    1. goodnightirene says:

      No, I didn’t see it–oddly! But thanks for the info. I think someone could do a whole blog just responding to NY Times “health”/medical articles/blogs.

  3. windriven says:

    “We (the authors and editors) at SBM get accused of many nefarious things.”

    I have a theory about this. The unreasonable blowback (as opposed to genuine disagreements in interpreting data) falls into three broad categories: the Snideleys, the NavelGazers, and the Houses.

    The Snideleys have an agenda that conflicts with the scientific evidence – and they generally know it. The agenda may have its roots in personal gain or in a particular ideology. Snideleys may be quacks like FBA or mainstream such as Pharma marketing types who distort scienc to sell pills. IMHO the Snideleys are by definition beyond the reach of reason.

    The NavelGazers generally have agendas as well but those agendas are rooted in naïveté rather than malice. The natural fallacy and a shocking depth of credulity lure them into believing whatever bit of quackery resonates with their personal pholosophies.

    The Houses are those searching for certainty in an uncertain world. They are often medically naive ( though not necessarily scientifically illiterate) and suffer the House delusion that any ill can be diagnosed and fixed if only the doctor is smart enough. They, or a friend or relative, may be suffering a difficult or intractable disease and they are inclined to pull out all the stops to find a cure.

    There are, of course, many ways to slice and dice the blowers back. I’ve settled on this one as it suggests ways to present evidence that may sway them to the light.

    The Snidelys are almost always refractory because they have an ideological or financial interest to protect. For these, blowback is marketing; advancing the cause. I personally harbor extraordinary contempt for those who prey upon the vulnerable.

    The NavelGazers are convincible I believe – but it isn’t easy. They generally lack scientific sophistication or even a vaguely scientific context from which they can view reality. One of the reasons that I pursue the ‘my list versus your list’ strategy is to provoke NavelGazers who might be lurking to confront the ‘deliverables’ of medicine versus those of their pet quackery.

    The Houses too, I believe, are convincible but in many cases harder even than the NavelGazers because for them it is often personal rather than theoretical. When grandma is dying of something nasty and it doesn’t look as if she’ll live long enough to see the new baby, it is difficult to get people to embrace the inevitability and celebrate the remaining time – because ‘what’s the harm of trying serial coffee enemas and acai smoothies’ when “Dr.” Jones claims to have cured lots of people just like grandma.

    If I believed in a god I’d say you folks do god’s work.

  4. goodnightirene says:

    This is such a simple message, but as you say, one that is tough to make a pot of money on by writing a book–one that usually recommends supplements, or at least some pricy type of intervention.

    I am continually amazed at the relatively poor diets of the people I meet and know, whether or not they subscribe to woo. I am constantly referred to as a “picky eater” or even “nutcase” because I eat little meat and restrict my calories. Lately, I’ve noticed a decrease in luncheon dates, because I do not order much at a restaurant and friends find me “no fun”. Needless to say, the friends are obese, although they refuse statins, and even bp meds, on the grounds that they don’t want to “take pills”–as if it’s a sign of weakness (whereas overeating is not?). Yes, the culture has plenty to answer for, but too many people willingly fall into line and over consume–even if it’s 100% organic.

    1. Young CC Prof says:

      Oh, man, portion size. Yesterday was the holiday part at work, and the two people next to me went through the buffet and FILLED their full-sized plates an inch high. One at it all, one ate most of it. I understand it’s a special occasion and they don’t do that every day, but how is it physically possible to eat that much food at one sitting? How does it even fit?

      1. Calli Arcale says:

        The stomach is very expandable. For a particularly nauseating demonstration of this, watch the Mythbusters test the myth that eating Mentos and drinking diet coke will cause your stomach to explode under ordinary circumstances. Short version: myth busted, since people burp. Long version: after clamping everything shut, they got the stomach to expand so much that it no longer fit in the plastic skeleton they had mounted it into. Seriously — it wouldn’t fit between pelvis and ribcage. Then it finally popped.

        1. Young CC Prof says:

          I suppose I’m just jealous. I have chronic upper digestive problems, which mean I can eat to physical fullness or even major pain without actually feeling sated, and watching people gorge themselves while I want more and can’t have it is always a bit upsetting. Yes, it keeps me slim, no, it’s really not worth it, especially since my diet isn’t even particularly healthy.

      2. AnObservingParty says:

        And if you stand up, you can fit more. ;)

        I used to be overweight, obese really, a combination of poor habits in grad school, stress, and the fact that I LOVE FOOD and I STILL LOVE FOOD. I steadily lost close to 100 lbs–maybe more like 95 since Thanksgiving and probably continuing on through New Years–and have kept it off four years and counting, through portion control, moderation, and exercise. I added veggies (not a fan of fruit in general), cut down on meat, shrank my portions, and just straight up didn’t buy junk food because I have no self-control if something is in front of me. My endurance is up, my BP down (still higher than I would like but in the normal range), sugar and cholesterol is good, blah blah blah. But I’ll tell you, I am always hungry. I don’t understand people who say, “oh, I’m not hungry yet.” What? I can still house an entire pizza by myself. On Xmas Eve I settle myself next to the shrimp cocktail at the buffet line and don’t budge. I cook my own turkey every year just so I can have all that delicious, crispy skin to myself.

        The difference is, I conditioned myself to only do it a few times a year, along with adjusting some other facets of my life. Everything in moderation, including moderation occasionally. But I’ll make up for that turkey skin later, even if it is unhealthy. I know SO many people who just honestly don’t understand the “nuances” of a proper diet, proper portions, and follow buzz words but eschew common sense. What’s the saying? A diet of Twinkies may be “vegan” but it’s not healthy just because it is? And for chrissakes, if you have dangerously high BP, take a beta blocker or whatever.

        1. Anna says:

          Twinkies are definitely not vegan — but Oreos are (in the United States, anyway)!

          1. AnObservingParty says:

            I stand corrected! Whichever delicious junk food that’s bad for you but technically vegan. :)

        2. Greg says:

          Congratulations on your weight loss! I presume you meant to state that you’ve lost close to 100lbs since Thanksgiving 2012? ;-D

  5. Andrey Pavlov says:

    I’ve mentioned it before on this blog, but I was morbidly obese for a large percentage of my life (waistline about 42 inches and BMI ~38-40). Then I dropped about 70lbs and have since dropped to a 32 inch waist and a BMI ~ 23-25. I was asked incessantly and with awe how I did it. When I answered that I changed my diet, ate more healthy foods and a lot less of them and worked out a lot can you guess what the near universal response was? “That’s it?!?!?” Yes, “that’s it.” Because, you know, cutting my caloric intake in half, permanently changing the way and what I eat, and working out an average of 10-20 hours per week is a pretty simple and minimal change, not at all able to explain significant weight loss.

    But the reality is everyone wanted to know what diet I was on, what pills I took, what routine I had. I eat what I want and I adjust what I eat depending on my activity level. I was once chastised publicly by a moderately overweight woman who said I had “ruined” a perfectly healthy meal of a tuna melt by adding bacon to it (yes, tuna melts with bacon, lettuce, tomato, onion, and mustard are awesome… don’t knock it till you’ve tried it). I raised an eyebrow and told her I’d just finished cycling 60 miles and was about to start my night shift in the ER. And I like bacon.

    There is no such thing as an unhealthy food (you can nitpick a few examples but this generally holds true). It is about the totality of your diet and the primacy lays with calorie intake. Exercise is very secondary to weight loss, but very good for overall cardiovascular health. There’s no magic here, just thermodynamics and some biochemistry.

    As for getting accused of nefarious things… I believe it was Tim Ferriss who said that if you are doing something and you get no criticism and negative feedback, then you really aren’t doing anything at all. You can’t expect to say anything worthwhile without ruffling someone’s feathers.

    1. Bobby Hannum says:

      I’ve dropped a lot of weight too, and get the same response. The basics are so simple but people can’t seem to handle that. Calories above all. You can (and someone did) eat nothing but Hostess cakes all day – if those are still around – and as long as you’re eating fewer calories then you’re putting out you’ll lose weight.

      Having said that, this is the website I found that helped me figure out the yes, it was that straightforward: http://www.acaloriecounter.com/diet/

      A) I have no connection to the website. B) It almost seems infomercial-ish but it isn’t (he’s not selling anything) C) He’s the closest I’ve come to a nutritional Mark Crislip/David Gorski.

      And if anybody wants to actually lose weight, you must get a food scale if you can afford it.

    2. goodnightirene says:

      I had the same experience–how did you do it?–but they always lose interest when you tell them, “I ate less and do some exercise, though the main thing is to eat less”. I finally started saying that I found a magic pill and would sell them some for $200 and most people would get wide-eyed before even realizing I was joking.

      Bacon, etc might be all right for you, a strapping young male, but middle-aged women are not likely to do well on more than 1500 calories (or less) a day, so things like bacon (other than the occasional piece, which I save for camping) are not doable. Diet is individual in this sense. The calories that YOU can process without weight gain is what is right for YOU–never mind that the skinny bitch in front of you is ordering that gorgeous pumpkin cranberry muffin with her 1500 calorie “coffee” drink.

    3. Dave says:

      Climbing Mount Everest is not technically difficult, but it’s very hard. Weight loss with diet and exercise fall into the same category for most people.

      I’ve had the same experience as you. I was a little heavy in high school, then discovered long distance running and rock climbing as well as continually watching the portion sizes. No weight problem since, but it is a constant effort.

    4. Greg says:

      I helped my wife lose over 100lbs by getting her to make small, gradual changes in her diet. I could be wrong, but I believe I read somewhere that because your body becomes accustomed to eating certain foods, if you radically change your diet overnight, your body will crave those foods. Whereas if you make gradual changes, slowly replacing unhealthy choices with nutritious foods, your body won’t crave those foods and you will be more successful over the long run. It’s been 4 years since my wife dropped the weight. She has put a little back on, but overall is doing very well by eating lots of fruit and vegetables, few starches and adequate proteins.

      1. Andrey Pavlov says:

        @greg:

        First off, kudos to you and your wife. I personally know how hard weight loss and lifestyle change can be.

        However, I do not know of any data that would support your hypothesis about the suddenness of change. It certainly wouldn’t be a physical craving, but absolutely could be a psychological craving.

        I personally did a very, very, very dramatic change in both diet and lifestyle which led to me losing 70lbs in about 18 weeks. I have since kept the weight off and gotten more fit (though after trudging my way through med school I am not quite as fit as I was at my peak, but still much more fit than I was most of my life). I had the cravings and muscled through it. Now, I still have “fat kid” cravings as my fiance likes to say, and I indulge them… occasionally. I do end up inevitably putting on a few kilos over the holidays and then promptly lose them and then some in the New Year pretty much every year.

        One thing that is common to all diets is that they make you pay attention to what you eat, which leads to you decreasing consumption. Whatever strategy to accomplish that that works for you is just fine and very much a personal preference sort of thing.

        1. Greg says:

          Congratulations on your weight loss! I guess it is a psychological thing. But you’ve touched on an interesting point that I forgot to mention. I had my wife start a food diary so she became very aware of the choices she was making. The basic strategy was to start keeping a diary, include everything other than water, and after a week look at the diary to see where changes can be made. Though it can be difficult, losing weight is very simple once you put your mind to it.

          1. Andrey Pavlov says:

            Thanks!

            It is, IMHO, most likely a psychological thing. There could be some physical component in some way, I just don’t know of it and can’t think of a particularly likely mechanism. Certainly not one that would overshadow the psychological aspects of it.

            And yes, the food diary is an excellent idea. I gave talks on health and nutrition at a local high school and everyone there was surprised to hear that (according to the data I had found) we eat between 250-500+ calories per day in food and drink we don’t even remember having consumed. That adds up!

            And always remember, simple does not mean easy. That is an error I actually frequently see (not that you are making it, but your comment made me think of it).

        2. CHotel says:

          Congrats to everyone! My weight loss was far less dramatic (have so far dropped 16 pounds of the beer gut I gained while doing my B.Sc.Pharm) but followed a similar story: no gimmicks, switched to having a salad and yogurt for lunch everyday instead of whatever option the hospital cafeteria was offering, and started running most days of the week.

          Thinking out loud here, but the cravings could be a physical response to taste receptor changes perhaps? It depends why your diet was unhealthy before and what changes you made to it. I’ve heard of unsubstantiated reports from people that radically cut refined sugar from their diets and then, months down the road, tried (for example) a can of Coke again only to find it horrifyingly sweet. It’s all anecdotal, but if I take my pharmacy-knowledge of receptor sensitivities and up/down-regulation of them after chronic exposure to various stimuli, and apply that to the theory of taste receptors behaving in a similar way, it seems plausible. But then again I don’t know anything about the physiology of taste receptors to know if that is a possibility. If we assume that it is, and imagine a situation like the example I gave, it could follow that all the (randomly picking healthy foods here) spinach salads and quinoa that they switch to could leave them physically craving the sugars that their taste receptors and related reward pathways were used to.

          It’s a stretch, I know, and likely is more of a psychological issue, but thinner things have held greater truths. Perhaps someone with greater knowledge of Anatomy/Physiology than I can tell me if I’m on to something or just crafting a very good story.

          1. Andrey Pavlov says:

            To the best of my knowledge that seems feasible, but unsubstantiated and not particularly likely. I agree that there is certainly up and down regulation of receptors and that could indeed play a role in perceived taste. I am not so convinced that it could lead to cravings – those are, by definition, a CNS phenomenon. In the case of things like cocaine and heroin there is release of CNS neurotransmitters which causes both a downregulation of receptors and a stimulation of the reward system of the brain. In the case of nicotine there is a direct stimulation of all the nicotinic AcH receptors which causes a downregulation. There is also some direct but mostly indirect activation of the reward centers of the brain. The reward center activation makes for the craving (which can be induced by anything, including food, as long as it is perceived as a reward by the person and reinforced over time). The downregulation of receptors means that when the substance is removed, there is not enough intrinsic NT to stimulate the synapses causing physical withdrawal symptoms.

            So food, regardless of receptor changes, could lead to psychological cravings, but I don’t think it would have too much to do with direct effects of taste receptor change (if that even occurs – not sure at all on the literature there).

            But I could be wrong… if anyone else out there knows of any other data or research on the topic?

            1. CHotel says:

              Thanks for the input! I guess my thought process was along the lines of receptor regulation leads to psychological cravings, chronic use from those cravings can change to a physical dependence, cut out the substance can lead to a withdrawal type scenario that manifests as a craving but has a physical component. I guess technically the craving itself is a non-physical response by the brain to counter the withdrawal it senses? You’d think the drug guy would understand addiction better, but brain pathways are very messy and confusing to me, still haven’t got the hang of them. I know the basics such that when I had to do my senior retail practicum I could explain to people starting on opioids the difference between dependence and addiction, but not the deeper details.

              I mainly was unsure of how, if at all, taste was related to the mesolimbic system though, and whether it was a possible scenario.

              1. Andrey Pavlov says:

                My pleasure.

                It is my understanding that we can separate psychological cravings from physical dependence. The former can occur for anything regardless of what it is. As long as it activates the mesolimbic reward pathways it essentially becomes, ahem, Pavlovian.

                Physical dependence is a change in the receptor or NT status that alters the function of central and/or peripheral nerves such that removal of the agent causes malfunction and thus physical symptoms along with the psychological cravings.

                There is, obviously, no bright line where one becomes the other because in a very real sense mesolimbic changes that lead to psychological craving are actual changes in NT and receptor density and pathways.

                Now, I suppose you could say that the change in taste buds constitutes a similar change as in nicotinic AcH receptors in smoking and I would have to agree. But I think it would be misleading to think of the outcomes of that in terms of physical dependence like nicotine even though the process is superficially similar. I once went to Thailand and, since I love spicy food, ate copious amounts of it. After I while my taste buds adjusted and when I came home to the States I found literally everything I ate to be tasteless and bland for around a month afterwards. And then my taste returned to normal. Clearly, something desensitized my taste buds. I just do not know if it was a downregulation of “spicy” receptors at the level of the tongue or whether it was a higher order modulation of the perception of spicy food. Either way, I wouldn’t consider that to be a physical dependence on spicy food despite the clearly obvious changes that occurred as a result.

                So perhaps that direct pathway does play some role in the whole thing, but it seems much more likely that the psychological craving from repeated activation and change in the mesolimbic reward pathways would be at least the far majority player here.

                But, as with everything that has a psychological component, there is much gray area and you can reasonably define in and out any number of things depending on which aspect of it you focus on. It is just my thought – and I am by no means an addiction expert – that being consistent and reasonable in your definitions and descriptions cedes food addiction to a psychological rather than physical dependence.

      2. WilliamLawrenceUtridge says:

        Hi Greg, a note. Diet is supposed to be best for helping you lose weight. Exercise is apparently best for keeping it off. The two of them are a wonderful combination.

        Plus, totally independent of weight loss, exercise is very good for you.

        1. Greg says:

          Hi William,

          Absolutely agree, but how to motivate someone who has been a couch potato (not her fault – due to asthma and an overprotective mother) for pretty much the whole of her life? I set the example for her by going to the gym, getting her a gym membership and having her go to the gym, but she’s not much of a self-starter and after a time did not want to go to the gym anymore. She likes to dance – so maybe some salsa dance lessons or similar energetic dancing would help. Thanks for the reminder!

          1. Kathy says:

            @Greg, that’s a good idea to link exercise to something the person enjoys, like dancing. I had a doctor friend who got me to exercise more by luring me into going on long Nature rambles with him, camera in hand. Far more effective for me than jogging along pavements in suburbia or working out in a (to me, boring) gym.

          2. WilliamLawrenceUtridge says:

            Sorry, can’t help you there. I exercise through rigid adherence to a routine, a treadmill and netflix. You have to find what works for you/her.

      3. ilikemathgrt says:

        I remember when I first decided I needed to change my lifestyle seriously, when at 22 years old I realized I couldn’t walk up and down stairs without getting out of breath. I was never overweight (I actually am about 20lbs heavier now due to weightlifting), but I was a daily smoker, drinker, taco bell consumer, and couch potato. The only way I was able to make any progress was by tackling those weaknesses one by one. The first thing I did was quit the cigarettes, but the deal I made with myself was, “OK, you can drink, eat pizza, play XBOX and generally be totally lazy, but NO SMOKING.” It took nearly 2 years to totally be free of it, and by then, I found that doing things like learning to cook and eating actual vegetables and getting some exercise were so much easier because of the willpower I developed dealing with the tobacco.

    5. Alia says:

      I lost about 50lb, going down from size 18 to size 10. And the only things that I banned from my diet were fizzy drinks and crisps. First I took on exercise, but that was not enought, I even gained weight, because I was thinking “Now that I exercise, I can surely eat more.” And then, one day, I changed my diet, starting with three short questions: “What I eat? How much I eat? Why I eat?” The last one was probably the most important in my case.
      And the funny thing is – now that I’ve reduced my serving sizes, I simply cannot eat too much. An anecdote – a few months after I started my diet, I went to another city with my husband. The road took longer than we expected, then we had to wait in a long line at the conference centre. Anyway after several hours we were really hungry, so we went for a pizza. And even though I was so hungry, and even though the pizza was great, I couldn’t finish it.

    6. AnObservingParty says:

      Congrats, and I feel your pain. The worst is, “did you have surgery?” Nope.

  6. Cholerajoe says:

    I’m surprised no one has accused you of being a shill for Big Farma not Big Pharma since you’re pushing fruit. The only major vitamin one can’t get enough of from the diet is D. If my practice is any indicator, Vitamin D deficiency is rampant. 6 consecutive new patients ages 18-47 have been Vit D deficient. I’m talking 9-20ng/ml. Surprisingly, once the deficiency is corrected, the patients feel much better and in one case, her fibromyalgia-like symptoms disappeared.

    1. WilliamLawrenceUtridge says:

      Vitamin D is the one vitamin that might actually live up to the hype. Someone (Angora Rabbit? Guest post?) should do a post on the most recent set of evidence, the quality of that evidence, and the implications of vitamin D deficiency and supplementation.

      I take a vitamin D tablet 1-3 times per week, whenever I remember, because I work indoors, wear long sleeves, and hate the outside world.

      It has no internet connectivity.

      1. CHotel says:

        We keep asking for a Rabbit-Post. I hope we get one soon.

        I keep meaning to start Vitamin D as well. I’m young, but I also hate the outdoors, and never wear shorts in summer. Also here in Manitoba most of the time when I see the sun between November and February it’s either through a window or on TV.

        If someone could invent like, cyborg trees with built in Wi-Fi, they’d be the richest person ever.

        1. Angora Rabbit says:

          Well, our final was today and we are busy as bunnies with grading. But I am entertaining the fantasy of writing something over the holidays. I do lead a rich fantasy life. I don’t know how the regulars do this AND their normal jobs.

          1. Thor says:

            Yay! Please turn the fantasy into reality. I’m with WLU and CH (and probably many others), in yearning to read a post from you (vit D would be timely, and there is widespread interest). Thanks for your always insightful, knowledgeable comments.

            1. mousethatroared says:

              All we are saaaying is give D a chance. (?)

              Raa Bit – Raa Bit- Raa Bit!

              It’s hard to chant in a comment box and the name AngoraRabbit is not particularly easy to chant, but I third that request for a guest post.

              And how about vitamin D deficiency and auto-immune disease?

              Do you have to get tested or can you just assume if you live in a northern cloudy region and wear sunscreen alot that you’re kinda deficient?

      2. mousethatroared says:

        pfft – that’s what a data plan is for.

    2. Carl says:

      But he’s supposed to be a Monsanto shill, so all of this diet stuff is just a trick to make us eat tEh FranKenBeRReez.

  7. Greg says:

    Great article! Didn’t Hippocrates advocate food as medicine?

    It’s funny how, in the one area of people’s lifestyle where they have the most control, people seem to exercise the least restraint. Too often people use food as a reward, especially when it comes to their children and the reward is usually junk food.

    A healthy diet definitely makes a huge difference, however, junk food is often cheaper than healthy food. If you’re on a limited budget and you have a family to feed, are you going to spend $2 on a bunch of broccoli or spend that same $2 on 4 boxes of Kraft dinner? I consider eating healthfully an investment in my future, but not everyone one looks at that way. Some people are more concerned about what they’ll eat tomorrow let alone worrying about the effects of a poor diet 5 years down the road.

    1. WilliamLawrenceUtridge says:

      But there’s a different level of complication as well – if you’re at risk of macronutrient deficiency, starvation, then you are far, far better off purchasing $2 worth of mac and cheese than you are buying broccoli.

      Of course, hopefully it never comes to that. But given the US government’s cuts to foodstamps, I have no doubt it will for some :(

      1. Andrey Pavlov says:

        Yeah, it boggles my mind that people would think a sentiment of “Hey, lets have everyone chip in and help everyone us via the government” is such a horrible idea. Especially with so many friggin’ Christians around!

        http://freethoughtblogs.com/pharyngula/2013/12/18/capitalism-not-just-an-idea-a-religion/

        1. Nashira says:

          I swear if anyone starts to No True Scotsman about how the food stamp haters aren’t “real” Christians, I’m going to pull my hair out.

  8. Carl says:

    On the recent vitamin hubbub… isn’t it really pathetic that this has been known for years, with more than one study saying it, and yet only now does the “news” explode in the general news outlets due to the specific wording of the title of one editorial catching their attention?

  9. skidoo says:

    Well-said, Dr. Novella, well-said.

    1. WilliamLawrenceUtridge says:

      Is that the apple of discord>

    2. Nashira says:

      Kallisti!

  10. Renate says:

    Five portions of fruit and vegetables? I don’t know how. Most fruit tastes sour, which I dislike and after a while bananas get boring. My bmi is good, I’m as fit as a fidle and the only medicine I need are eyedrops.

    1. Hakainokami says:

      Well frozen can make your dollar go farther and it doesn’t loose nutrients the way fresh vegetables do in the fridge. A 16oz bag of just heads here is 99c. But I don’t see that message much either (except on choosemyplate, they mention it repeatedly). Its all ‘fresh fruits and veggies’

      Per USDA choose your plate (which stopped with confusing ‘servings’ and switched to cups):
      A large apple (3.25 in or more diameter) is 2 cups.

      For kids 2-18 its 1-1/2 cups per day (2 c for older boys). A large apple a day covers that and more. Adults is 1 and 1/2 to 2c so the large apple covers them as well.

      http://www.choosemyplate.gov/food-groups/fruits-amount.html

      1. mousethatroared says:

        Hakainokami “Per USDA choose your plate (which stopped with confusing ‘servings’ and switched to cups):
        A large apple (3.25 in or more diameter) is 2 cups.

        For kids 2-18 its 1-1/2 cups per day (2 c for older boys). A large apple a day covers that and more. Adults is 1 and 1/2 to 2c so the large apple covers them as well.

        “Halelujah! You have just made my day, no month…possibly more. I have a abiding sense of guilty that I don’t get my kids to eat more fruits and vegetables and that I don’t eat more myself. But, by these standards we’re actually doing just fine.

        Now I can focus my guilt on something else.

        1. Hakainokami says:

          I love that they switched to cups! Its so much easier. I had the same experience- I was worried we weren’t getting enough food in my son (he eats mostly fruit and veg but it seams like he barely eats), but once it was in cups by age I could see we are doing pretty well. Toddlers need less food than I thought. The vegetarian conversion for beans and peas helps too as he loves peas and hates most meat, but I can count them towards his meat.

    2. Dave says:

      The above post is correct. A “serving” defined by dieticians is not what the average person thinks of as a “serving”. A serving of meat is the size of a deck of cards. A serving of potatoes is the size of an egg. “Five servings” is not as much as it sounds.

    3. Greg says:

      ” Most fruit tastes sour” Most fruit I eat tastes sweet – pineapple, strawberries, raspberries, apples, oranges, peaches, pears, grapes, honeydew, watermelon etc. etc.

      1. Calli Arcale says:

        Greg — they are very sweet, but they are also all acidic, which is probably what he’s referring to. Watermelons, not so much, but strawberries and pineapple have a very strong tang to them. And personally, the more tang an apple has, the more I like it!

      2. Kathy says:

        Pineapples can be quite sharp tasting if they are not ripe when picked. I had a Damascus moment when I first ate them from my brother-in-law’s farm, ripe and straight out of the field. I felt like breaking out in the Hallelujah Chorus. They were not the same fruit at all.

        1. mousethatroared says:

          I like pineapple, but fresh pineapple often irritates my mouth. Even the lovely ripe fresh pineapple I had in Hawaii. It tastes so good, but the burning…not worth it.

          Canned is fine. No problem with fresh oranges and grapefruit too. Although too many irritate my stomach.

    4. Vicki says:

      Do vegetables also taste sour to you? If you’re not happy with fruit, how about carrots, sweet potatoes,mushrooms, cucumber, lettuces, cabbage… Part of why we get advice to eat an extra apple a day is that it’s probably easier to convince people to replace a cookie or slice of bread with an apple than with the equivalent amount of steamed vegetables.

  11. Michelle D says:

    What about the poorer citizens who can not afford the cost of or the time to cook a healthy diet, adult and children alike? Would you then recommend the vitamins?

    I personally am completely in agreement with you about giving up multivitamins and changing diet, but I know it is not feasible in many cases.

    1. Lost Marble says:

      When I was in university people wondered how I could afford to eat as healthy as I did – we compared costs and it turned out I spent significantly less than they did, cooking also, does not necessarily take that long I could get out a healthy meal in less time than it takes the delivery guy to get to the door.

      1. WilliamLawrenceUtridge says:

        Addressing the economic realities of a healthy diet and cooking is a hugely complicated question, one that would be substantially helped if the minimum wage were upped as suggested (ironically, this would pay fast food workers more, while driving up the cost of the meals they prepare, in turn making non-fast food a more viable option). The difference between a university student cooking and eating good meals, compared to a single parent, working to jobs they have to bus to, to feed two or more children, is substantial.

        I am very, very grateful that I have the job I do, since it means I will probably never have to undertake the complex maths required to balance such a life.

      2. Hakainokami says:

        It also depends on where you are. Where I live its is very easy to buy cheap healthy food. If I had to I could eat well cheaply and with only a microwave. (I did in college, living in a place where fresh food was as cheap as frozen is here.) But having worked north of here in the closest city, for years much of it was a literal food desert. You could find very little in the way of anything I would describe as healthy food ( or even food- I’m hesitant to call tastykake anything food) without a serious bus ride. It was also about 2x as much as the most expensive grocery store in my neighborhood. (Several city initiatives and some hefty donations of time and money from some local institutions have changed this in many places.) Also with younger kids they get picky. If you are already working a job or two and there is only you maybe you don’t have the energy to battle your kids over food. Plus when you have a tiny food budget affording your kid refusing dinner can be hard and makes introducing new foods more fraught with emotion.

      3. Chris says:

        It also depends on how you are raised. My dad was a great amateur and adventurous cook. So I grew up eating a great variety of food from Asian to the entire Americas… from stir-fry to seviche. My dad even made his own tortilla chips before they were sold in bags.

        When I left for college I was given a small cast-iron skillet and a recipe to make a type of quick whole wheat bread with it, along with basic pot, even though I was moving into a dorm. There was a small kitchen every other floor, and it turned out to be useful during spring break when there was no food service and no where else to go. Though the college friends we met in the dorm still tease me about the stew I made with too much pepper, because it was the only seasoning I had.

        When I moved to an apartment I made most of my food, even supplying two apple and two pumpkin pies to a Halloween party at the dorm put on by friends who still lived there.

        My future hubby also moved in with a stack of his favorite recipes he copied from his mom’s collection. When I made the meatballs he told me his mother made them better. So I told him it was his job to make them from then on. He then learned how to cook, and learned what was written were only guidelines used by his mother. Thirty five years later, he is still making the meatballs… our kids love it.

        One thing I have learned with kids is to modify some recipes for greater nutritional impact. I grate carrots into the beef bourguignon, and add carrots, celery and dried basil (herbs have vitamins) into the white sauce for scalloped potatoes.

        Just this evening nineteen year old daughter came down and explained she needed high calorie and high nutrition food because she has been told she is underweight and needs value in her food. Well, we just bought her a wool coat, which we had to have the store staff remove from the mannequin because the other ones were too big (size 4).

        So I made her potatoes fried in duck fat, cooked noodles that she could have with fresh basil pesto (left from making veggie lasagna)… and reminded her there was frozen beef bourguignon and her dad’s chili in the freezer, along with the fact that the dried apple slices from the garden were packed with both calories and nutrients. I also told her the apple butter I made tasted very nice with the brie cheese on bread.

        Yes, you are all welcome to hate her. As a person who struggles to lose weight and keep it off, it is really difficult to purposely make and teach her to make dishes dense in both calories and nutrients.

        1. Nashira says:

          Please don’t talk about hating her. I was very underweight (30ish pounds on average) until my mid-20s, and it sucked. It’s AWFUL when you’re so full but you know you need to eat another 600 kcal, as bad as when you have to stop eating even though you still feel hungry, if you want to stay within your weight loss goals. Or god, having to skip what you feel like eating because the calorie density is too low… bleh.

          1. Chris says:

            I understand. It is a real problem, and something she is trying to address.

    2. Angora Rabbit says:

      Michelle, it is not so much a problem of time but access to healthy choices. Ever try to buy broccoli in the inner city? This is why people like Will Allen (growingpower.org) are so amazing, by bringing healthy food to people who need it so much and teaching them to grow it. This is a wonderful urban movement. There also are terrific movements to bring healthy foods, fruits and veggies and locally produced foods, into poorer neighborhoods as well. And moves so that food stamps (insert current name here) can be used at farmer’s markets. Change is happening.

      But I also recall the woman in an NPR interview who, rightly said, it was cheaper to feed her kids McDonald’s because it filled them up for less money, and money was tight. It’s sad, but I do get it.

      1. Calli Arcale says:

        My husband listened to a piece on NPR (hardly your classic McDonald’s-loving station) that did nutritional analyses of all sorts of foods, and found that the McDouble (which at the time cost $1) was the best nutritional bang for the buck. Not best nutritional value period, but the best for the money. So I completely believe that McDonald’s is a cost-effective way for a family to feed their kids. Best? No. But most practical? Definitely plausible. If you’ve got a mom working two jobs and a dad working three, there is no time to cook, and McDonald’s gives you quite a bit of nutrition for the money. Not necessarily the most balanced meal, but you can do a lot worse.

        I remember a TV show once where three couples each prepared meals equivalent to those at three different restaurants, to see if it would be more cost effective to eat at home or eat out. One went to a 5-star restaurant (the chef gave them a training session before allowing them to go off and reproduce his work), one went to a mid-range restaurant, and the third went to Boston Market Chicken. The 5-star restaurant meal prepared at home was a huge price savings, but left a gargantuan pile of pots and pans in the kitchen and required a lot of labor to produce. (And was really only cheaper when you ignored that they had to buy a fair number of tools that they didn’t already have.) The Boston Market one was the easiest to produce, but interestingly enough, the price was break-even. Factoring in time to produce, the Boston Market meal was cheaper in the restaurant.

        1. Andrey Pavlov says:

          @calli:

          The Boston Market one was the easiest to produce, but interestingly enough, the price was break-even.

          I don’t find that surprising at all. The foods there are generally pretty straightforward, common, and easy to make in large quantities once you have the necessary infrastructure in place. The up front costs are obviously much higher but it then not much harder to cook for 1000 than 10. And then you get a discount on the ingredients because you buy in such quantity. And you make profit over high volume with a lower marginal profit. Changing the menu periodically allows you to switch to whatever is cheaper from whatever is becoming more expensive. That’s actually when the McRib “comes back” – when pork prices drop below a certain threshold.

          Oh, and I’ll stress that there is nothing at all wrong with this model IMO. In fact, typically buffet places like that will have offering of fresh fruits and vegetables and plenty of salad fixings. They may not eat them, but they are at least on offer.

      2. mousethatroared says:

        I will echo what someone said up thread. I think the emphasis on fresh fruits and veggies is unrealistic. One can buy frozen and canned fruits and veggies that fit the bill nutritionally, are easy to prepare and more cost effective. They are generally cheaper to buy and you have much less spoilage. Often kids find them more palatable.

        With frozen or canned vegetable, beans and/or small portions of meat (that one can also freeze to prevent spoilage) One can cook things like chili, bean soup, chicken noodle soup, spaghetti with tomato sauce, stir fry, in a reasonably short period of time on a budget and have little waste.

        The same meals cooked from fresh veggies would be more expensive, more time consuming and more wasteful (oh shoot, no stir-fry, the broccoli went to seed in the fridge).

  12. Sawyer says:

    This is an interesting economic question so I’m not sure if there’s an easy answer. In any population group there’s always that little psychological bastard known as risk compensation, where trying to promote better health using one intervention just causes people to make worse decisions in another. I wonder if this is a larger or smaller effect in the poor regarding nutrition? Good luck studying the science on this without stepping into the political arena.

    In my authoritarian dictatorship, all the idiots wasting money on vitamins would be forced to give their money directly to the malnourished to pay for meals, thus eliminating the dilemma altogether. For some reason I haven’t got much support for this plan yet.

  13. Kov says:

    I came across a quote some years ago on the CrossFit website–probably attributed to Mark Twain or the Buddha or something–that has stuck with me, as bite-sized truisms are wont to do: “People are will do almost anything to lose weight, except eat right and exercise.”

  14. Kov says:

    Ugh, that was poorly edited by me while I rephrased it! It should read: “People will do almost anything to lose weight, except eat right and exercise.”

  15. corky says:

    I just had an eye exam today and the one thing I HATE about my optometrist is that they always try to push “eye health” supplements. Today they asked me if I wanted to participate in a study about macular degeneration sponsored by some supplement company. I said NO. Never trust anyone trying to tell you you need a supplement or pill they sell. If they are making money on selling you something, BEWARE!

    1. Denise says:

      Oh. My ophthalmologist has me taking Theratears capsules (mostly fish and flaxseed oil) since I had laser surgery. I buy them at the drugstore. I confess I never looked into why he recommended them, I just trusted him. I suppose I should find whatever research he relied on in making the recommendation.

    2. Chris says:

      “Today they asked me if I wanted to participate in a study about macular degeneration sponsored by some supplement company.”

      The optometrist at my last appointment told me I was doing everything right to reduce macular degeneration by exercising, eating a balanced diet, not smoking, making sure my blood pressure is under control and getting an eye exam. He said his mother refused to watch her health and was paying the consequences, first with macular degeneration and then an early death.

      Hmmm… has it been two years since I saw him yet?

  16. Ash Simmonds says:

    It seems every time I come across an article which is full of great stuff – there’s always some ridiculous bit of conventional wisdom/broscience thrown in to keep it from being a completely great article. This post is no exception.

    You go on about how you approach everything with science and evidence – yet tout the whole “five a day” and “eat an apple a day” BS. Where on earth is the science and evidence for this?

    (hint: there isn’t – the author was just doing exactly what they say everyone else does when they repeat dogma – it’s just an idealogical position without merit)

    1. Sawyer says:

      Okay I’ll bite: what is BS about it? I’m sure there are arguments that you can make to show there’s no magic threshold of five servings of fruits, but that’s clearly not what this recommendation means in the first place.

      If you walk down the block where I currently live, you will find a large percentage of people that are overweight or suffer other obvious health problems. They are NOT eating five servings of fruits and vegetables. They ABSOLUTELY would be healthier if they ate more. Note that in other comments it has already been pointed out that a serving is relatively small.

      I don’t know how anyone could take offense to this piece of advice. Even the die-hard LCHF nuts generally think it’s okay to eat apples.

      1. Ash Simmonds says:

        People would certainly be better off if they ate five servings of fruit and veg a day than a packet of chips and a donut and a Snickers and a Coke and an ice cream – but that’s not what this is about.

        The point is there’s no evidence that “five a day” or whatever is the right way to go.

        Start here: http://www.zoeharcombe.com/2012/03/five-a-day-the-truth/

        1. Dave says:

          You raise a good point. One problem is that it’s very hard to do proper longterm diet studies. This would require a randomized control group and a test group, starting on different diets at an early age, and being followed (without deviating form the diet- try to get teenagers to do that) for decades and monitoring outcomes. Therefore the studies out there are epidemiologic in nature or are short term. The epidemiologic studies have multiple cofounders. It’s one thing to say that the Inuit, for example, have a low incidence of heart disease and another to say that the cause is they eat very few vegetables and much half-ripe fish. It is known that Seventh Day Adventists, who are largely vegetarian, live longer than their neighbors who aren’t. There may be multiple reasons for this but their diet may play a role. It’s also known that people who eat a traditional mediterranean diet in Greece and Italy have lower incidences of heart disease than Northern Europeans. We know that immigrants form places with a low incidence of coronary disease increase their risk of coronary disease if they move to the US and assume a western style diet, but that’s not all they change. Studies have also been done using questionaires and dietary recall in things like the Women’s health initiative. These are obviously not the best studies but it’s what we’ve got and I suspect the basis for the recommendations. There are nutritionists on this site who might elaborate further as I am certainly no expert on this. I’ve seen three reiterations of what we advise diabetics to eat inthe past 40 years and am sure I willl live to see more.

          I think this is also why a lot of doctors, myself included, only give fairly general dietary advice – the “eat your fruits and vegetables, be sparing on the refined sugars and watch the portion size” kind of advice.

          1. WilliamLawrenceUtridge says:

            Do you really need any advice beyond that? Once a recommendation goes into specifics beyond “eat your fruits and veg, avoid pop and prepackaged stuff”, my inkling is that you’re shading into the “nutritional magic” category – the belief that if you eat certain things (blueberries, acai berry, green coffee beans, whatever) you’ll live forever in perfect health.

            Unless you’ve got PKU, or are a vegetarian, or have some other sort of nutritionally-difficult diet or metabolic problem, do you really need a nutritionist?

            That being said, I think everyone should take a single-semester-long course on nutrition. It helps with perspective.

        2. WilliamLawrenceUtridge says:

          There’s ample evidence fruits and vegetables are good for you. You have to set a threshold. It’s likely to be arbitrary. Five seems reasonable – attainable but high enough to ensure at least some benefits. The fact that there’s not profound scientific evidence behind five, versus six, or four, isn’t a huge deal in my mind.

  17. Gregory Patterson says:

    Very simple & easy pushback against the antiscience antidrug terrorists:
    accuse them of being in league with the DEA and the entire War on Drugs
    that costs millions of US citizens their freedom and costs the taxpayers billions of dollars a year (the exact figure does not matter – make up whatever number one wants – facts are irrelevant to the naturopathic idiots). Accuse them of wanting to take away everyone’s marijuana, aspirin, meth, alcohol, cocaine, tobacco, chewing gum, etc.

  18. Gregory Patterson says:

    The inability of the vast majority of people to calculate cause & effect logically consistently is the reason I strongly oppose testing on animals higher than an insect. So what if some testing on animals might save some human’s life? So would a massive forced redistribution of wealth from the extremely lazy nonworking rich to the poor. But, until I hear people advocate forcing the rich to give up their unearned wealth to the poor in order to save human lives, I will strongly support putting people into prison for testing drugs on animals against their will.

    1. WBailey says:

      This comment gives me mixed feelings, but only because I force myself to be illogically optimistic to avoid falling into a disabling depression. Also some stuff about how people’s ability to perform risk/reward analyses is formed (ideological reproduction blah blah) but mostly the first thing.

      1. WBailey says:

        Also that human might be me so f you and everything else that has ever existed or might someday exist

      2. mousethatroared says:

        wbailey “This comment gives me mixed feelings, but only because I force myself to be illogically optimistic to avoid falling into a disabling depression.”

        I am suffering, once again, from the absence of a like button.

  19. tmac57 says:

    In addition to the medical checkups you mentioned,I think that good dental hygiene and regular dental checkups are not fully appreciated as important factors in long term good health.

  20. Brad Johnson says:

    Naturally Grown or organic Apples are filled with soluble fiber. This fiber has been shown to reduce intestinal disorders, including diverticulitis, hemorrhoids and possibly some types of cancer. It helps control insulin levels by releasing sugar slowly into the bloodstream. It cleanses and detoxifies, which helps eliminate heavy metals, such as lead and mercury.

    1. Scottynuke says:

      All together now…

      [citation needed!!]

      And Happy Holidays to the SBM family! :-)

    2. brewandferment says:

      “Naturally Grown or organic Apples are filled with soluble fiber”

      Huh???? please explain the mechanism of some other growth method that somehow eliminates soluble fiber but still looks, feels, and tastes just the same.

      1. mousethatroared says:

        It’s true! Naturally Grown or organic Apples ARE filled with soluble fiber…they just don’t happen to be MORE filled than conventionally grown apples. :)

        Personally, I usually buy local apple, because I like living near apple orchards and we have more than enough parking lots, big box stores and McMansion developments.

        In addition, without a lot of research, you don’t really know if the organic farming methods used are more or less sustainable than the conventional methods. Sustainability is much more important to me than the imagined health benefits.

        Would be nice if they came out with a “sustainable” label based on validated measures of sustainable farming practices. To me, that would be more useful than the organic label.

        1. Chris says:

          Well, the apple butter made from the espaliered trees that make up my front fence was yummy on crusty French bread with brie and ham.

          I made the butter because I had a glut of apples this year, and even gave a large bag to the food bank, Though they do keep me occupied since each one was covered by a small nylon sock to keep out apple maggot flies. So there were virtually no worms with a non-chemical method.

          Sustainable?, I don’t know. Labor intensive? Yes, very much so. But I like garden therapy.

          1. nancy brownlee says:

            @Chris
            Homemade apple butter is on the top ten list of stuff I miss about my garden and orchard. You just can’t buy the good stuff, the kind with lots of cinnamon and Jamaican allspice… I made cases every year, and stored them under the beds.

            1. Chris says:

              The absolutely only ingredients in my apple butter are apples and very slow heat (to reduce the pulp to sauce then butter).

              1. nancy brownlee says:

                I’ll bet it’s wonderful- but my taste always leans to spice. I did learn a great extra-low-heat trick from a great book called ‘The Self Sufficient Gardener’ John Seymour. Started the big steel pot on the stove, then when a simmer was reached, shoved the pot into a low oven. It was foolproof- no sticking, no scorching, and much less stirring. It worked wondrous well, for me, all those (20) years ago.

              2. Chris says:

                Exactly what I did… create a sauce on the stove, and them move to the low oven!

                It seems the apple sauce and butter have their own spicy flavor. It is a nice tangy sweet taste. Though I do peel them first, since I have this nice slicer/peeler thing I clamp to the kitchen table.

  21. Newcoaster says:

    Good article overall. I only have one small bone to pick with you about
    “appropriate screening”, and then mentioning colonoscopies alongside mammograms.

    David Gorski has written extensively on the use (and misuse) of screening mammograms and generally speaking, as a population based screening tool, they are a good idea for most women of an appropriate age.

    Colonoscopies are a different matter. They are not an appropriate screening tool for the vast majority of patients, but only for a sub-group of people with particular increased risks. They are an expensive, invasive and potentially harmful (up to and including death) way of screening. The good old FOBT (fecal occult blood test) or the more recent FIT (fecal immunochemical test) are far more appropriate for the general population at average risk of colon cancer. If everyone were to have “screening” colonoscopies, it would bankrupt the health care system in Canada. ( no comment on the US, as you still don’t have a health care “system” )

    All of my general surgeon colleagues of course recommend colonoscopy, and many patients feel entitled to this “gold standard” and are disappointed when I tell them they don’t need one, based on best evidence. One has to remember that many surgeons make a large chunk of their income from doing these, and so their lack of bias has to be questioned. There is often disagreement between what we in family practice discuss with our patients, and the information they get from specialists, who by definition have a much narrower view of medicine. I have the same argument with my urological colleagues who insist everyone get PSA blood testing, despite the lack of evidence.

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