Plant-based diet hard but healthy

During my Christmas holiday in the Midwest, I visited two relatives who couldn't stop talking about their new diet. The husband and wife have changed their food choices drastically to follow the very-low-fat, plant-based, vegan diet that led to former President Bill Clinton's substantial weight loss.

My in-laws learned about the diet by reading "Prevent and Reverse Heart Disease," a book by Dr. Caldwell Esselstyn Jr., a retired Cleveland Clinic surgeon. His website, http://www.heartattackproof.com/, says he and his wife have followed the diet for 26 years.

But I've always thought of this as "the Ornish diet." It's the idea that brought Dr. Dean Ornish to fame in the early 1990s.

His research provided the first hard evidence that major lifestyle changes can do what scientists thought impossible: reverse heart disease by unclogging arteries without the use of drugs or surgery.

Ornish is founder and president of the Preventive Medicine Research Institute at the University of California-San Francisco - http://www.pmri.org/index.html.
His two early books - "Dr. Dean Ornish's Program for Reversing Heart Disease" and "Eat More, Weigh Less" - became best-sellers. But the diet didn't seem to take off, primarily because it's so hard to sustain. No meat. No milk. No cheese. No oils.

My relatives seemed to be managing well despite holiday food temptations. And my brother-in-law, who had a heart attack in his 40s, said his total cholesterol has dropped from 570 to 130, without statin drugs. I'm wondering if there are any Observer readers who are finding success with this diet?

Need hip or knee transplants? Get in line.

The demand for hip and knee replacements will outpace the number of orthopedic surgeons available to perform the procedures by 2016, according to a study published this month in the Journal of Arthroplasty.

The study was co-authored by Dr. Thomas Fehring, an orthopedic surgeon with OrthoCarolina's Hip & Knee Center in Charlotte.

“The supply of trained orthopedic joint replacement surgeons soon will not meet the demands of our aging society,” Fehring said in a news release.

"Within five years, patients could have to wait up to a year or more to undergo life-altering hip or knee replacement surgery. That kind of delay simply won’t be acceptable to members of the baby boomer generation who are accustomed to living an active lifestyle and expect to maintain it as they enter retirement.”

According to the study, demand for primary and revision joint replacement surgery is expected to double in 10 years as a result of the aging baby boomer population and obesity epidemic in the United States. At the same time, fewer new physicians are electing to specialize in joint replacement surgery, which means fewer physicians will be available to perform the procedures as older physicians retire and are not replaced.


The study’s findings are based on data from the American Academy of Orthopaedic Surgeons’ database; the AAOS Orthopedic Practice in the United States surveys; the Nationwide Inpatient Sample; and the U.S. Census Bureau.

Vitamin D -- Too much or too little?

After writing about health and medicine for more than 20 years, I understand better than most people that scientific research takes time. One study is never the final word on any question.

But even I found myself sputtering while reading today's newspaper about the new study that says we don't need as much vitamin D as we were recently told we did.

In the past year, I began taking vitamin D supplements because of an apparent deficiency that showed up after I had some laboratory blood tests. I've been taking 2,000 international units from supplements. That's in addition to what I get from milk, fortified cereal and other foods, and sunshine.

This latest study says people of my age need no more than 600 units -- so I might have been getting enough already.

Who else is frustrated by this? And tell me what you're doing about it.

I've posted the Associated Press story below in case you hadn't seen it.


Report: A bit more vitamin D is good, not too much

By LAURAN NEERGAARD
AP Medical Writer

Tuesday, Nov. 30, 2010


WASHINGTON Got milk? You may need a couple cups more than today's food labels say to get enough vitamin D for strong bones. But don't go overboard: Long-awaited new dietary guidelines say there's no proof that megadoses prevent cancer or other ailments - sure to frustrate backers of the so-called sunshine vitamin.

The decision by the prestigious Institute of Medicine, the health arm of the National Academy of Sciences, could put some brakes on the nation's vitamin D craze, warning that super-high levels could be risky.

"More is not necessarily better," cautioned Dr. Joann Manson of Harvard Medical School, who co-authored the Institute of Medicine's report being released Tuesday.

Most people in the U.S. and Canada - from age 1 to age 70 - need to consume no more than 600 international units of vitamin D a day to maintain health, the report found. People in their 70s and older need as much as 800 IUs. The report set those levels as the "recommended dietary allowance" for vitamin D.

That's a bit higher than the target of 400 IUs set by today's government-mandated food labels, and higher than 1997 recommendations by the Institute of Medicine that ranged from 200 to 600 IUs, depending on age.

But it's far below the 2,000 IUs a day that some scientists recommend, pointing to studies that suggest people with low levels of vitamin D are at increased risk of certain cancers or heart disease.

"This is a stunning disappointment," said Dr. Cedric Garland of the University of California, San Diego, who wasn't part of the institute's study and says the risk of colon cancer in particular could be slashed if people consumed enough vitamin D.

"Have they gone far enough? In my opinion probably not, but it's a step in the right direction," added prominent vitamin D researcher Dr. Michael Holick of Boston University Medical Center, who said the new levels draw needed attention to the vitamin D debate and encourage more food fortification.

Vitamin D and calcium go hand in hand, and you need a lifetime of both to build and maintain strong bones. But the two-year study by the Institute of Medicine's panel of experts concluded research into vitamin's D possible roles in other diseases is conflicting. Some studies show no effect, or even signs of harm.

A National Cancer Institute study last summer was the latest to report no cancer protection from vitamin D and the possibility of an increased risk of pancreatic cancer in people with the very highest D levels. Super-high doses - above 10,000 IUs a day - are known to cause kidney damage, and Tuesday's report sets 4,000 IUs as an upper daily limit - but not the amount people should strive for.

And Manson pointed to history's cautionary tales: A list of other supplements - vitamins C and E and beta carotene - plus menopause hormone pills that once were believed to prevent cancer or heart disease didn't pan out, and sometimes caused harm, when put to rigorous testing.

Stay tuned: To help settle the issue, Manson is heading a government-funded study that's recruiting 20,000 healthy older Americans to test whether taking 2,000 IUs of vitamin D really will lower their risk for heart disease, a stroke or certain cancers.

In the meantime, it's hard to consume 600 IUs of vitamin D from food alone. A cup of D-fortified milk or orange juice has about 100 IUs. The best sources may be fatty fish - some servings of salmon can provide about a day's supply. Other good sources are D-fortified cereals.

But here's the report's big surprise: While some people truly are seriously deficient in vitamin D, the average American in fact already has enough circulating in his or her blood - because we also make vitamin D from sun exposure, and because many people already take multivitamins or other D-containing dietary supplements.

Wait a minute: Headlines in recent years have insisted the opposite, that a majority of people don't get enough vitamin D, especially during the winter. What explains the contradiction?

Most testing laboratories are using a too-high cutoff for those blood levels, said report co-author Dr. Clifford Rosen of the Maine Medical Center. The report says at least 20 nanograms is adequate for bone health, while many labs instead list people as low if their blood levels are below 30 ng. Serious vitamin D deficiencies are diagnosed when levels dip well below 20, something that hasn't changed.

Rosen called the state of vitamin D testing "the wild, wild West," and said he hoped that "with this report, we can at least temper people's enthusiasm for just taking tons of supplements."

As for calcium, the report recommended already accepted levels to go along with your daily D - about 1,000 milligrams of calcium a day for most adults, 700 to 1,000 mg for young children, and 1,300 mg for teenagers and menopausal women. Too much can cause kidney stones; the report said that risk increases once people pass 2,000 mg a day.

It's true that most studies link poor health to vitamin D levels that are below 20 ng, said preventive cardiologist Dr. Erin Michos, a Johns Hopkins University School of Medicine professor who wasn't part of the study.

But, "I'm not sure I'm going to dramatically change my practice," said Michos, who pushes her patients to boost their levels until they're between 30 and 50 ng.

EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

A Beautiful Goodbye

When I was young, I thought funerals were a waste of time.


My grandparents died in the 1960s, and my mother took pictures of them in their open caskets.


I thought it was morbid and depressing, and I vowed I'd never have a funeral myself.


Then, I got old enough to watch my father and mother and a close friend die.


I realized how comforting it was to be with friends and relatives and to tell stories about the loved ones we had lost. These funerals were exhausting, but they were also uplifting. Instead of grieving alone, it was good to be part of a community of people saying goodbye and promising to remember.


That is how I think of the day Skylar Tianna Brooks was born.


I was honored to be invited to be with her parents, Shannon and Kip Brooks, at the hospital as they prepared for her birth and celebrated her 99 minutes of life.


Shannon and Kip got to hold their baby and tell her how much they loved her. Their 2-year-old son Jadon got to see his baby sister and touch her perfect fingers and toes. Those of us who had waited outside during the delivery got to see the couple smiling and crying -- but most of all at peace.


After Skylar died, we each got to hold her and have our pictures made with Shannon and Kip, pictures they showed at the memorial service later and have posted on Facebook for all the world to see.


Someone could have thought, as I might have years ago, that this was all morbid and depressing.

But those of us who were there know how beautiful and meaningful it was.


I hated to leave. And the next day, I couldn't stop thinking of how warm and wonderful it had felt in that room with the late afternoon sun shining through the window, casting an other-worldly golden glow.


As one of their friends put it later: "It was magical. A miracle."

Who Are We To Judge?

As expected, the ongoing series about Shannon and Kip Brooks and their decision to give birth to a baby with a fatal birth defect has prompted debate about whether they made the right choice.
One blog reader wrote:: "...Shame on this selfish couple to bring a dead fetus to term..."

On the contrary, many have praised Shannon and Kip for their courage and love in choosing to meet their daughter Skylar if only for 99 minutes.

Most of us will agree with one reader’s comment: "I’m glad I never had to face that decision."
To me, one of the main points of the series is that Shannon and Kip, faced with two terrible choices, made the decision that was right for them even though it might not have been the easiest or most common.

Many parents who have faced similar prenatal diagnoses say they didn't feel they had a choice.
In response to the series, someone I have known for years confided that she "terminated" a pregnancy several years ago when she got the news that her unborn baby had anencephaly.

She had a full-time job and a 3-year-old at home, and although she knew intellectually that she had a choice, she felt pushed toward “termination,” which didn't even seem to equate with abortion.

"What I heard (the obstetrician) say was 'This is what you should do. This is what everyone does in this situation.'...I personally didn't really feel like there was a choice."

Maybe the story of Shannon and Kip will teach health-care professionals to explain the choices more clearly, with the understanding that not all people may choose what is medically most expedient.

And maybe it will teach the rest of us to withhold judgment and respect the difficult choices others are forced to make.

Parents Can Find Meaning in Loss

Until they learned about their own child’s fatal prenatal diagnosis, Shannon and Kip Brooks didn't even know there was such a thing as a "baby loss" community.

Through the Internet, they quickly connected with other parents who had faced similar choices and decided to continue their pregnancies.

Many people ask, Why would anyone do that?

Parents who have been through it can explain it better than anyone.

Here’s Tracy Winsor, a Charlotte mother who had two miscarriages. (She's second from left, back row, in the above photo). Tracy co-founded Be Not Afraid, a group to support parents who give birth despite terminal prenatal diagnoses:

"When you have a (terminal) diagnosis, you have a loss that can’t be fixed. Nothing makes it better," Tracy said. "If you end the pregnancy, you’re still a bereaved person. Everybody wants everybody to be OK. But there are some things you can’t wish away. They just have to be met."

Since 2008, Tracy and other volunteers in her support group have accompanied many mothers during pregnancy, labor and delivery of babies they knew would die.

On Aug. 7, they were at Lake Norman Regional Medical Center in Mooresville when Shannon and Kip (seated in the above photo) welcomed their baby Skylar Tianna, who died 99 minutes later.

From these experiences, Tracy said, "We know we can squeeze some meaning and joy out of this experience…You can carry to term and not be emotionally damaged."

Sandy Buck of Huntersville, the co-founder of Be Not Afraid, lost three babies -- two miscarriages and one stillbirth at 32 weeks. (She's second from right, back row, in above photo.) Like Tracy, she wants to help other parents feel the support she didn't have.

"We're (here) when nobody wants to hear your story about your baby that's going to die," Sandy said. "It's important to see that other people have done this and survived."

Shannon and Kip Brooks: A Remarkable Journey

Last summer, when I first met Shannon and Kip Brooks, I was touched by their willingness to allow me to follow along as they continued a pregnancy anyone would view as tragic. Their baby had been diagnosed with anencephaly – a birth defect that meant her brain didn’t develop early in pregnancy.

When we first talked, they had known this for about three months, and they were focused on trying to help another family by donating their baby’s organs or tissues. I found their story fascinating.

But when I spoke of it with friends and colleagues, reactions I got ranged from puzzlement to horror. I was often asked why parents would choose to carry a baby to term if it was going to die. People seemed to think this would just be a sad story that no one would want to read.

I could never say exactly why I saw it differently. Yes, their story is about grief and loss and a terrible physical deformity. But it’s also about trying to find something good in a bad situation, about finding beauty in pain.

This week, one of my yoga teachers read a passage at the end of class that seemed to express everything I’ve been feeling about Shannon and Kip’s desire to meet their baby Skylar.

The passage is from Marilynne Robinson, a Pulitzer Prize-winning novelist:

"The ancients are right: The dear old human experience is a singular, difficult, shadowed, brilliant experience that does not resolve into being comfortable in the world. The valley of the shadow is part of that, and you are depriving yourself if you do not experience what humankind has experienced, including doubt and sorrow. We experience pain and difficulty as failure instead of saying, I will pass through this, everyone I ever admired has passed through this, music has come out of it, literature has come out of it. We should think of our humanity as a privilege."

Shannon and Kip surely experienced pain and sorrow. They grieved more deeply than they ever have.

Kip expressed his emotions in poetry, a craft he loves but had put aside when life got busy.

Shannon found comfort in a beautiful song, "I Will Carry You," about another couple who chose to continue a pregnancy and meet their baby who lived for only a short time.

Shannon and Kip made the decision to pass through their "valley of the shadow."

Instead of viewing pain and grief as something they could avoid, they let their hearts break.

And they found strength and beauty on the other side.