The Nature Cure

by Andreas Michalsen

  One thing is for sure: no snacks in between meals! Even if it’s cranberries or chia seeds. Snacking “to go” has long since become a part of our unhealthy daily routine. Surely, the invention of the snack is related to our packed schedules and the dissolution of our biological rhythms by artificial light, shift work, and other things, with one tricky consequence: fast food instead of slow food. But we doctors aren’t completely innocent in this development, either. The disaster probably started with diabetologists. Insulin is a life-saving and beneficial therapy for many diabetics. Since it’s no simple task to adjust the medication in such a way that there is no danger of hyperglycemia or dangerous hypoglycemia, it was easier to recommend snacks to keep insulin at a relatively constant level and prevent peaks in blood sugar levels.

  Today we know that the continuous administration of insulin fosters resistance and thus leads to weight gain. Insulin fattens and so it’s part of the problem, as obesity leads to further diseases. The legend of the healthy snack is equally as nonsensical as the products for diabetics, which were advertised up until a few years ago, which did indeed contain little sugar, but were unhealthy because of their fat content. Then the negative effects of artificial sweeteners came to light along with the fact that they, too, have an effect on the pancreas.

  The “to go” trend is supported by the food industry that probably generates more revenue now with a wide variety of snacks. And the problem is evident. Using a newly developed smartphone app, scientists Satchidananda Panda and Shubhroz Gill conducted a fascinating study: They asked one hundred fifty citizens of San Diego to take a picture of everything they ate over the course of three weeks. The data was then transferred to the study site immediately, and the details were reviewed. While the majority of participants were convinced that they had relatively regular eating behavior, the data showed an entirely different reality: 80 to 90 percent of the participants continuously put something or other in their mouth throughout the day. This kind of unorganized eating behavior equates to pure stress for the body.

  In addition, the citizens of San Diego showed a change of behavior on the weekends. On Saturdays and Sundays, meals were taken much later than on weekdays, which is understandable, but for the body it means an exhausting weekly “metabolic jetlag.” Afterward, Panda and Gill asked eight of the participants who had never taken longer breaks from eating to eat regularly and to refrain from eating for at least eleven hours at a time, even on the weekends—over a total of sixteen weeks. The results were unambiguous: All participants reported an increase in well-being and improved sleep. Their weight dropped 7.3 lbs. on average without any other dieting. Over the following nine weeks, they didn’t put the weight back on.56

  It no longer seems appropriate for people with diabetes to rely on snacks. Scientist Hana Kahleova at the Charles University in Prague has conducted research on dietary therapies for diabetics. Apart from the advantages of a vegetarian diet for diabetics, she was concerned with the frequency in which meals were taken. By means of a randomized study she put it to the test: Fifty-four patients with type 2 diabetes who were receiving medication were divided into two groups. Both groups received the same number of calories over the course of three months, but the first group was asked to take them in two meals (breakfast between 6 a.m. and 10 a.m. and lunch between noon and four p.m.). The second group took the six meals a day often recommended to diabetics, three bigger and three smaller in-between meals.

  The results were clear. After three months, the group that received only two meals a day had lost more weight, and all lab values relevant to diabetes were better in this group. In the two-meal group, fatty livers also improved.57

  EAT LUNCH LIKE A KING

  This automatically presents us with the question: Which meal should we ideally skip? It’s time to question another health myth. Many of us have heard the saying: “Eat breakfast like a king, lunch like a prince, and supper like a pauper.” Scientific evidence for the glory of breakfast, however, is scarce. The fact that it curtails the nightly fasting period makes a case against an opulent breakfast. And why is the life expectancy in Mediterranean countries, where people tend to eat rich meals in the evening (which we consider to be unhealthy), longer than in Middle and Northern Europe? Certainly, there are other factors that are of importance here, such as the climate, temperature, and sunlight, that have an influence on the metabolism. When it’s warm outside, you feel less of a need to warm yourself up from the inside with the aid of calories.

  Instead of breakfast, we should eat lunch like kings. A recently published study attempted to compare a lavish lunch to an opulent dinner. It showed that the participants who consumed the majority of their daily calories at lunch lost weight more easily than those who ate a rich dinner.58 After all, it’s around lunch time that the body requires the greatest amount of energy for keeping its body temperature up—that way, less energy passes into the fat reserves. However, there is a small cultural problem with the issue of an ample lunch. Brain researcher Mattson deducted from his research that it’s important for a healthy body to rest for a while to recover after a stimulus like exercise or a big meal.59 The traditional siesta—a short nap in the early afternoon—has a beneficial effect on a person’s health, but it’s not feasible in most of the United States, because people’s workplaces and homes are too far apart. After all, a siesta shouldn’t be taken in a traffic jam on a highway. But if you can arrange for it, if you are working from home, for example, a siesta after lunch is recommended.

  Ongoing studies will provide more insights into the optimal timing of meals and duration of the fasting period. Scientists at the University of Padua have presented a study on fasting periods of sixteen hours. They examined thirty-four young, healthy athletes. Half of them were asked to eat three times a day at usual times over the course of eight weeks, the other half were supposed to only eat between the hours of 1 p.m. and 8 p.m. whenever possible. In the latter group, the longer period of fasting led to several beneficial metabolic changes. The blood levels of factors accelerating the aging process, such as insulin and IGF-1, as well as inflammatory factors, were lowered. The sports physician Antonio Paoli and his colleagues observed no such changes in the participants who were adhering to traditional meal times.60

  A longer nightly fasting period might even be effective in preventing the reoccurrence of cancer, as suggested by initial results of an epidemiological study conducted in the United States. Here, data collected from about 2,400 women with early-stage breast cancer, who had provided information on their eating rhythm at the beginning of the study, was consulted. Roughly four hundred of the participants suffered from new tumors within the study period of seven years. However, women who did not eat for at least thirteen hours after their last evening meal were significantly less affected by recurrence.61 This was also confirmed by the data derived from animal experiments conducted by Valter Longo, which showed that malignant tissue is unable to cope with a lack of glycose, contrary to healthy tissue.62 Normal cells have the ability to resort to other energy sources, i.e., ketone bodies, in times of hunger. Cancer cells, on the other hand, do not possess such a hybrid motor and for that reason, they are more likely to perish from a lack of sugar.

  If we take a moment to look at the numerous mechanisms that contribute to the protective and healing effects of fasting, it becomes clear that it’s much more useful to fast regularly than to exclusively take a specific medication to influence the bodily processes affected by a disease. Of course, statins, the most commonly prescribed lipid-lowering medication, are effective, just as proton-pump inhibitors are used successfully to block stomach acid, or antidepressants are prescribed to treat depressive diseases. But drugs that block individual molecules unquestionably cause dysfunctions in the entire loop system of the body. Usually, little is known about the complex long-term effects of a drug at the time of its approval. The effects only attract attention years later, when millions of people are already taking t
hese drugs.

  FASTING: A WHOLESOME EXPERIENCE

  A lot of the time, fasting is defined by the restriction in the number of calories or the supply of nutrients, but this aspect alone falls short. Fasting is a wholesome and, for many people, a spiritual experience. Over the course of our lives, we repeatedly experience deficiencies of some kind—a shortage of money, of success, of affection. Zen Buddhism teaches the “seven hungers” that tempt us to eat even though we are not really hungry: the hunger of the eyes, of the nose, of the mouth, of the stomach, of the psyche, of the cells, and of the heart.

  Fasting is a conscious renunciation, a controlled and self-determined experience of deficiency. That’s why successful fasting increases self-efficacy—the insight and the motivation that are necessary for us to change our lifestyle successfully. During fasting, we overcome an existential hunger in a way that gives us physical and mental strength. In Siddhartha, Hermann Hesse describes this wonderfully: “Nothing is performed by demons; there are no demons. Anyone can perform magic. Anyone can reach his goals if he can think, if he can wait, if he can fast.”63

  CHAPTER FIVE

  The Key to Health

  Food as Medicine

  When the topic of nutrition is brought up during my rounds, the conversation with the patient usually becomes very lively. Since we all need to eat, nutrition concerns all of us. The World Health Organization estimates that about 50 to 70 percent of chronic diseases can be linked to poor nutrition—an incredibly high percentage.1 Researchers who deal with prevention have declared that so far, all attempts made to change our lifestyle and our nutritional behavior have failed. These researchers demand stronger directives to be issued by the government, such as printing a traffic-light labeling system (red-yellow-green) on food packaging or imposing a tax on sugary drinks. This may be reasonable, but in my naturopathic opinion, nutritional therapy remains an essential method to bring about change. It is more important now than ever before—we just need to deal with it in a different manner beyond simply counting calories or declaring prohibitions.

  It’s not all that easy to find legitimate scientific data on which to base medical nutritional recommendations. Studies on nutrition are—since they generally happen in everyday life—much harder to conduct than pharmacological studies, for example, that take place in an experimental setting. Moreover, the industry behind this enormous market keeps trying to deliberately obfuscate or repress data that confirms what has already been known for a long time—that sugar, animal fats, and alcohol are quite unhealthy.

  Eating habits are tied to love, comfort, and home—they’re habits we don’t like letting go of and that are influenced by our culture much more than by logic.

  Hardly any other part of our life is so essential to our health, but it is here that medicine is particularly weakly positioned on a professional level. Because who takes care of nutrition? There are dieticians and nutritionists who certainly have a lot of knowledge, but lack day-to-day experience with patients. And so, they end up giving “practical” tips that offer little possibility for implementation. For years, physicians have taken no interest in nutrition whatsoever: Students of medicine learn nothing about it. It was like that when I was studying, and hardly anything has changed today. It is, it must be said, a complete disaster.

  This is almost incomprehensible since interest in nutrition is booming. From cookbooks and cooking shows to ever-new dietary trends and countless self-help books, what we eat has garnered a degree of attention that was unimaginable thirty years ago and is already beginning to be annoying. Back then, when I was doing my first internship in the department for internal medicine at the Humboldt Hospital in Berlin, nutritional medicine was more or less dead. At best, there was something like light food for patients who had recently undergone surgery, and diabetics were advised to have snacks and to count calories and bread units (which is completely outdated today). The unanimous opinion of the internists of old was that “no matter what you eat, the most important thing is that the meds are right.”

  Unfortunately, many physicians still haven’t revised their opinion. Time and again, I hear from patients that when they broached the subject of nutrition, their doctor just dismissed the matter. Many doctors do not acknowledge the fact that nutrition can have a very positive influence on illnesses like rheumatism, hypertension, or headaches. As I have already mentioned, it’s likely that 50 to 70 percent of diseases are connected to deficient nutrition or have, at the very least, become worse because of it.

  Many patients also point out that they don’t even know what is healthy anymore, because for years now, media reports on nutrition have been more and more contradictory. One day fat is bad, the next day it’s good. One day you’re supposed to avoid carbohydrates, but then you’re advised to eat whole grains to prevent cancer. A little red wine is good for the heart, but too much is bad, and so on. What’s actually true?

  AVOID CONVENIENCE PRODUCTS WHEREVER POSSIBLE

  Without a doubt, the food industry and lobbyists of industrial agriculture have massively impinged upon research. In the 1960s and ’70s, for example, when it had long since become clear that sugar was unhealthy, leading scientists at the Harvard Medical School were rewarded with bribes for publishing articles in major magazines and indirectly denying facts by cunning omission—today, we would call this “alternative facts.”2 For decades, big corporations like Coca-Cola have been funding and supporting research teams at universities and “independent” institutions that play an authoritative role in the formulation of nutritional recommendations.3 The meat and dairy industries act with a similarly big influence, especially in the United States.4, 5 Studies were and are systematically designed in such a way that they deliver as positive a result as possible for these foodstuffs under the guise of “science.” Simple methods to achieve this are taking measurements at the wrong time, changing the quantities unrealistically, or providing the control group with worse nutrition.6

  Neurobiology has shown us that the ample consumption of fatty and sweet foods causes the brain to release messengers signaling rewards that are similarly addictive to hard drugs. This is especially true with combinations of fatty and sweet, like in ice cream.7 And withdrawal isn’t pleasant. Only after a while does it feel glorious to eat without a ravenous appetite and compulsion.

  Another issue is that healthy nutrition is often equated with a slimming diet. And so, the question of how obese people can lose weight has been central in past years; 71 percent of Americans are overweight, and of course, losing weight is an urgent wish for many of them.8 Diets do in fact cause us to lose weight in the short run. But most diets are not actually healthy. One example is the Atkins diet—which asks you to consume a lot of fat, animal proteins, and demands an almost complete refrain from carbohydrates like bread, pasta, or potatoes. Since proteins and fats are saturating and the omission of carbs keeps insulin levels low, you do indeed lose weight quite quickly. But the large quantities of animal proteins and saturated fats expedite atherosclerosis. Put cynically, you’ll die earlier, but at least you’ll be slim.

  Losing weight is not tantamount to becoming healthier. People with normal weight do show a lower risk for cancer in the statistical average, but only if they also exercise and eat healthy. Additionally, people who are slightly overweight and physically active are healthier than slim people who don’t exercise.

  The great thing about nutritional therapy is that we don’t have to take any medication or inject ourselves with something or undergo surgery. Eating in and of itself is not exhausting, and certainly not painful. We don’t have to spend any extra time or, if we do it right, any extra money. The only thing that is important is how and what we eat. If you want to interject here that having to eat healthy all the time does indeed hurt your soul, I can comfort you—that feeling goes away. We can change our taste preferences—as it happens naturally over the course of our lives. Do you remember how strange your first sip of bee
r or wine tasted? Or the first bite of cheese when you were a child? Yet still, we got used to it. I used to enjoy drinking wine, but now I don’t drink any alcohol and am doing fine without it.

  Most of us don’t eat to stay healthy—we eat because things that we have gotten used to due to our culture and upbringing taste good to us. In that sense, changing nutritional behavior is both difficult and easy: For my part, I try to convey to my patients that every habit can be changed.

  Each of us has our favorite foods, and if you travel, you’ll find that people all over the world claim to have the best cuisine. Genes alone aren’t enough to explain such preferences sufficiently. It’s our culture and our social environment in particular that seem to be responsible for how tastes are formed.

  DEAN ORNISH, A REVOLUTIONARY CARDIOLOGIST

  “Let food be thy medicine” is a claim attributed to the Greek physician Hippocrates, the forefather of medicine. When I began my time as a medical resident in the ’90s, this way of thinking about medicine had fallen by the wayside. Therefore, I was all the more impressed by a study conducted by the American cardiologist Dean Ornish, who was a young but already very successful doctor at the time. While doing his training at Harvard, he started having reservations, asking himself whether modern medicine wasn’t simply neglecting possible naturopathic courses of treatment.

  Ornish himself had grown up doing yoga and was a vegetarian. In an experiment of his that became famous, the “Lifestyle Heart Trial,” he put the possibilities of nutritional therapy to the test: He invited severely ill cardiac patients to participate and divided them into two groups at random. One group received the usual cardiological treatment with drugs. The other received very intense and exhaustive training in nutrition and methods of stress reduction. For the participants who, up until that point, had been used to the average American diet containing a lot of meat, Ornish’s nutritional therapy meant a radical change. He prescribed them an almost vegan diet, which was also low in fat, for one year—with sensational results: Not only had the participants lost a lot of superfluous weight, their blood cholesterol level and their blood pressure had normalized. But the highlight was that cardiac catheterization showed that the atherosclerosis in the coronary vessels was regressing. In the control group, on the other hand, atherosclerosis, blood fat levels, and hypertension were on the increase over the same period of time. Ornish was able to confirm these results with follow-up examinations five years later and another large-scale study.9, 10