Last month, the results of the Prospective Urban and Rural Epidemiology (PURE) study were published in the Lancet. The major findings – that a low fat diet in which saturated fats are minimized and replaced with carbohydrates is actually associated with increased all-cause mortality – has caused quite a stir among conservative U.S. nutrition policy makers who have been advocating a low-fat diet for decades. The study included over 135,000 people in 18 countries. It examined the dietary habits, blood biomarkers (like lipids), and survival/disease outcomes over about a 10 year period and included a very sophisticated statistical analysis that accounted for confounders like socioeconomic status. The major findings may surprise you, but they reaffirm my approach to lifestyle and nutrition – real food, eaten in moderate balance, is best for longevity and heart disease. Here’s what they found:

1. Moderate vegetable intake – 3 to 4 servings per day – is associated with the lowest risk of mortality. More vegetables did not confer increased benefit. However, raw vegetables seem to be more beneficial than cooked veggies. How much veggies should we eat? 350-500grams per day

2. Total fat and types of fat were inversely associated with mortality. That is, people eating a higher fat diet, even a high saturated fat diet, survived longer than those consuming a low fat diet. The worst mortality and cardiovascular disease outcomes were observed among people with the lowest saturated fat intake. Yes, that is the opposite of what you’ve been previously told. Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.So how much fat should we eat? About 35% of our daily intake, primarily from polyunsaturated sources like nuts, seeds, and safflower oil. Monounsaturated fats like olive oil and saturated fats from foods such as avocado, macadamia, coconut, and animal products are also healthy.

3. High carbohydrate intake was associated with the worst mortality and cardiovascular outcomes. High carb diets, such as those with lots of sugars, breads, pastas, and processed flour products are the worst for us.

4. High carb diets appear particularly detrimental for low and moderate income populations. This may be because of the high proportion of packaged processed carbs (vs. whole grains) eaten among these populations.

5. Legumes (such as beans, lentils, chickpeas, soy) are associated with lower risk of mortality, and it only takes one serving per day.

Senior author of the PURE study, Dr Salim Yusuf (McMaster University, Hamilton, ON), commented to theheart.org / Medscape Cardiology: “My hope is that our results will stop the whole population from feeling guilty if they eat fat in moderation. While very high fat intake—when it accounts for 40% or more of your dietary intake—may be bad, the average fat intake is about 30% and that’s okay. We’re all afraid of saturated fat, but actually we shouldn’t be. Saturated fat in moderation actually appears good for you.

“Also, you don’t need to stress out trying to eat five or more portions of fruit and vegetables, when three or four will probably have the same benefits. We’ve had enough evangelism in dietary guidelines. We need more moderation.”

He added: “My advice to the general population to lead a healthy lifestyle is don’t smoke and take exercise—those two things are very clearly beneficial. And then I would say maintain a reasonable weight. You don’t want to be too overweight but you also don’t want to be too skinny. Eat a balanced diet—a bit of meat, fish, several portions of fruit and vegetables, but you don’t have to be vegan or eat an excessive amount of plants to be healthy.

“This is good old-fashioned advice. When I showed these results to my mother, she said, ‘Why did you bother doing this study? This is what our grandmothers and their grandmothers have been advocating for centuries.’ And actually she is right.”

Read more yourself – citations

1:Prospective Urban Rural Epidemiology (PURE) study investigators. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017 Aug 28. pii: S0140-6736(17)32252-3. doi: 10.1016/S0140-6736(17)32252-3. [Epub ahead of print] PubMed PMID: 28864332.

2: Prospective Urban Rural Epidemiology (PURE) study investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017 Aug 28. pii: S0140-6736(17)32253-5. doi: 10.1016/S0140-6736(17)32253-5. [Epub ahead of print] PubMed PMID: 28864331.

3:Prospective Urban Rural Epidemiology (PURE) study investigators. Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study. Lancet Diabetes Endocrinol. 2017 Oct;5(10):774-787. doi: 10.1016/S2213-8587(17)30283-8. Epub 2017 Aug 29. PubMed PMID: 28864143.

4: http://www.medscape.com/viewarticle/884937#vp_1

While we are waiting out the Coronavirus, life marches on. You may have a need for a physician to answer questions or take a look at something, whether or not it is related to the virus. You can continue to work with me via Tele-Medicine and Tele-Health. Simply schedule an appointment just like you always would, here https://www.drericaoberg.com/make-an-appointment. Specifics are in the FAQs on this website.

There is a lot of misinformation and fear going around. I recommend staying up to date with the facts using the same resource I am using via PubMed, the original resource for medical research and data. You can read the daily updates here. https://www.ncbi.nlm.nih.gov/books/NBK554776/#article-52171.s6

Another site to determine fact from fiction: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

For more information on using face masks as a precaution with Coronavirus, please see: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

Please take this time to focus on wellness. Connect with your family and household. Make a phone call to someone who may be isolated. It’s a wonderful opportunity to take care of ourselves with attention to rest and rejuvenation. Get in touch if you’d like to revisit your personalized prevention & self-care program; you can do it without leaving the house!

Be Well, Dr. Erica Oberg

As the viral pandemic continues to wreak havoc and disrupt lives and well-being, the news of a promising vaccine seems like a light at the end of the tunnel. Yet, caution with new vaccines is certainly warranted. I’ve always advocated for informed choice in the vaccination space, whether it is for children or adults. I’ve seen a few horrible vaccine reactions, and have seen far more uneventful instances. The worst reaction I’ve treated was a female teen who developed alopecia totalis following an HPV vaccination. She recovered over a two year treatment program, regrew all her hair, and the auto-immune cross-reaction has quieted down. Yet, can you imagine what a devastating few years it was for her – imagine losing all your hair, even eyebrows and lashes, at that delicate time in a young woman’s life! On the other side, I’ve seen more than a few elderly patients suffer months of post-herpetic neuralgia following shingles, which can be largely prevented with a vaccine. If they had been vaccinated, they would not have suffered months of burning and itching pain.

Thus, I’m not here to get involved in a debate over whether vaccination is right or wrong, but to educate my patients as information becomes available, and help them optimize their immune system to ensure that if they do choose (or have to) get a vaccine, they are doing everything they can to have a positive response, without adverse effects. Since the vaccine is just starting to be administered in the E.U. and the pilot trials have been relatively small, even the top specialists and scientists won’t have all the answers, and I’m certainly not claiming that here. Here, I share what I know from nutritional biochemistry, the physiology of immune responses, and clinical experiences over the past 20 years. Here, I share what I plan to do to get my immune system ready, since healthcare workers will likely have to step forward to be among the first.

My first considerations are ensuring all necessary nutrient cofactors are optimized for an adaptive immune response.There are 2 sides of the immune system – the innate and the adaptive. The innate side of the system has gotten a lot of attention lately as it is all about priming the system to respond to a pathogen – vitamin D, zinc, vitamin C, and more are key here. The other side, the adaptive immune system is responsible for activating T cells and B cells starting with the antigen-presentation on the cell surface. This is the immune function we need to focus on to ensure the system responds sufficiently, but not excessively, to a vaccination.

The key nutrients critical for the adaptive immune system include vitamins A, D, C, E, B6, B12, Zinc, Iron, Copper, and Selenium.Also important are the nutrient co-factors that are inhibitory, and may prevent overreaction. These include vitamins D, E, and B6 (note these are multi purpose as these nutrients are co-factors in multiple immune mechanisms) thus they are especially important.

Next, is the consideration of minimizing the risk of an auto-immune cross-reactivity. This has everything to do with ensuring a healthy microbiome and strong intestinal barrier (i.e. – no leaky gut). Key nutrients for this include vitamin D (yes, again), glutamine, and broad spectrum probiotics. Stress, which pushes us into sympathetic mode, will inhibit healthy parasympathetic activity which includes the vagal nerve messages to keep healthy levels of protective mucin and secretory IgA – keys to a healthy lining and barrier in the gut. Thus, it would be wise to prepare for vaccination with calmness and deep breathing, and certainly do not get vaccinated while in a state of panic (perhaps easier said than done!)

Some non-nutrient factors can also be considered pre-vaccination. Exosomes are acellular mRNA packages that send messages to surrounding cells to activate regenerative DNA code, rather than replaying whatever pro-inflammatory cytokine messages that were previously there. While data are preclinical, exosomes trigger IFNγ (interferon gamma) secretion by CD8 T cells, and “probably memory T cells.” Another study found that administration of exosomes along with vaccination “ substantially increases Ag-specific humoral immunity following intramuscular and intranasal vaccination, improving the immunological potency”This holds promise for the role of this therapy for priming a balanced immune response that likely, specifically stimulates the cells that will create the cellular memory for future protection.

Finally, just to cover the bases, I’m adding some traditional wisdom to my vaccine preparation plan. Homeopathy, a gentle energy medicine, has traditionally been used to prevent and counteract vaccine reactions in children. Theosinaminum has a long track record of use, if not a lot of clinical research.

I’ve put together a few options to help you get ready if you think you’ll be vaccinated over the next 90 days.

1. First, I’ve hand-picked a collection of supplements to meet these goals in FullScript – you can link to it here and order with a 10% discount: https://us.fullscript.com/protocols/droberg-vaccine-preparation

2. I’ve formulated a new vaccine support IV protocol to support your response. It includes a new custom vaccine support micronutrient infusion, followed a week later with 3 units of exosomes. These should be done 1-3 weeks before your vaccination. The protocol package includes a follow up booster infusion, designed to be taken 5-21 days after your vaccination.

3. The plan illustrates the full protocol schedule, including when to start.

90 days before:

Start leaky gut protocol, if necessary.

Correct known individual nutrient deficiencies.

Re-focus on anti-stress self-care such as meditation, yoga, time in nature, and better sleep.

15-60 days before:

Start oral supplementation protocol, hold off on homeopathic remedy until you know exactly when you’ll be vaccinated

1 month before:

Schedule your IV series. 2 preceding vaccination – my new vaccinate support micronutrient infusion and about a week later an infusion of exosomes.

You now have the option of receiving your IV’s at Dr. Oberg’s La Jolla office, or the Tourmaline Collective Birth Center in Pacific Beach, or as a house call (minimum 2 family members – additional charges may apply).

2 days before:

Add homeopathic to oral supplement protocol. 3 pellets once per day. Dissolve in a “natural mouth,” meaning away from food or drink or toothpaste by at least 20 minutes.

Day of vaccination:

Breathe and think positive thoughts, for yourself and for the generous gift you are giving humanity by becoming part of herd immunity.

5-10 days after:

Come in for post-vaccine infusion.

Discontinue homeopathic after 5-10 days, depending on how sensitive you feel you are.

For those of you who want to dive into the science, here are 4 excellent articles. Be in touch if you have questions!

Be well, Dr O

https://pubmed.ncbi.nlm.nih.gov/30867162/

https://pubmed.ncbi.nlm.nih.gov/31963293/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253278/

https://www.sciencedirect.com/science/article/pii/S2329050119301494

Last month, I hosted a winter webinar virtual retreat on the theme that so many of us focus on at this time – January renewal and re-commitment to a healthier path. This year, I was joined by my practice manager and talented yogi, Jen Snyder. We discussed some factors that I consider key to wellness (see previous post on Happiness), and then Jen lead us in a gentle yoga session. One of the topics we discussed, due to its overlap in wellness and yoga, is breathing.

While breathing continues under autonomic control even when we are not thinking about it, there are many benefits to bringing the process into your consciousness and learning to breathe better. Firstly, we should appreciate the importance of the exhale in breathing. Jen points out that in high stress, high anxiety daily activities, we tend to hold our breath, or breathe very shallowly. These are normal fight-or-flight responses, but they become dysfunctional when we are trying to stay grounded and clear. When we exhale, we breathe out carbon dioxide which is acidifying. In fact, panic attacks are exacerbated by hyperventilation and the panic-y feelings are a result of the un-exhaled carbon dioxide which affects the brain. This is why the folk-wisdom of breathing into a paper bag works to calm down a panic attack.

Further, when we exhale, we relax the diaphragm muscle, letting it balloon up into the ribcage (see the photo below). Relaxing the diaphragm with full exhalations not only improves your breathing and clarity, it can relax the surrounding muscles improving conditions like low back pain.

Did you know? When we lose weight, specifically fat mass, we lose it through our breath? Fat is oxidized into carbon dioxide and water, which must be exhaled. Here’s a nice article if you want to learn more.

Does all of this discussion about breathing have you intrigued? Learn more in 2 ways! Join Jen (in person at Buddhi Yoga or online, register for either here) on Sunday, March 7th 2:30-4pm PST for a breathing workshop and practice session. Also, join us in a virtual book club with reading and discussing James Nestor’s new book Breath, which has received a top nonfiction of 2020 award. It’s widely available at your local bookshop, online, or on your digital devices. Comment on the book and discuss with us on Facebook here!