The Secret Power of Fiber

by Carole Jackson>, Bottom Line Health

When we think about making sure that we have the healthiest hearts possible, the first thing that comes to mind is what not to eat. Bye-bye, ice cream sundaes, big steaks and fried chicken! But a new study suggests that what we add to our diets — not what we eliminate — may be even more important.

To find out what our hearts (if not our minds) really want us to eat, I spoke to Joseph Carlson, PhD, RD, director of the division of sports and cardiovascular nutrition at Michigan State University’s College of Osteopathic Medicine in East Lansing and the lead author of the study. His research was published in the November 2011 issue of Journal of the American Dietetic Association.


Dr. Carlson told me that he and his colleagues chose to study teens, in particular, because of the dramatic increase over the past few decades in the number of adolescents with cardiovascular risk factors. And his findings echo what other studies have discovered in terms of adult heart health. They evaluated data from a large federal survey on the health and nutritional status of adults and children. During one part of the survey, 2,100 participants ages 12 to 19 were asked to list everything that they had eaten and drunk in the 24 hours before having a physical exam. Based on their answers, the researchers calculated how many grams of fiber and saturated (“bad”) fat and how many milligrams of cholesterol the youngsters had eaten per 1,000 calories. Then, during the physicals, their cardiac risk factors were assessed.

The results: Compared with those who consumed the most fiber, those who consumed the least fiber were three times more likely to have what’s called metabolic syndrome, which means having at least three of these cardiovascular risk factors — excess abdominal fat… high blood pressure… elevated blood sugar… high amount of triglycerides (blood fats)… and low HDL (“good”) cholesterol. What was even more interesting: Eating less of what we all tend to think of as “bad” foods filled with saturated fat and cholesterol was not associated with a lower risk for metabolic syndrome.

Wait a minute… does that mean that you can throw as much cheese on your omelet as you want — as long as you eat it with whole-grain toast? Unfortunately, no, said Dr. Carlson. Consuming saturated fats and cholesterol can raise your LDL “bad” cholesterol, increase inflammation and hurt your circulation. But these were not components used to evaluate metabolic syndrome in this study. In other words, this research did not show that overdoing saturated fat and cholesterol hurts your cardiovascular health — but we already know that it can. What the study did show, however, is that consuming foods rich in fiber is very powerful for maintaining heart health.


There are many reasons that adding fiber to your meals may lead to better heart health, Dr. Carlson noted. For one thing, he said, it’s very filling — when you eat more of it, you tend to eat less overall, so you are less likely to be overweight. High-fiber diets, he continued, may also improve glycemic response (the effect of food on blood sugar) and dyslipidemia (an abnormal concentration of cholesterol or triglycerides in the blood). Minerals that may reduce the risk for metabolic syndrome, such as potassium and magnesium, are plentiful in a fiber-rich, plant-based diet, he said. And plant-based foods tend to be high in antioxidants, which may offset oxidative stress and inflammation that are elevated in people with metabolic syndrome.

I know it isn’t news to you that fiber is good for you — but really, before reading this, did you appreciate just how important fiber is? Dr. Carlson told me that Americans’ average fiber intake is less than 15 grams a day, well below the recommendation of 25 grams and 37 grams for females and males, respectively. But this goal can be reached by choosing a variety of fiber-rich foods daily, including fruits, vegetables, whole grains, beans, nuts and seeds. Remember, as a bonus, high-fiber foods fill you up, making you less likely to reach for fatty foods — a win-win for your heart.

Joseph Carlson, PhD, RD, associate professor and director, division of sports and cardiovascular nutrition, College of Osteopathic Medicine, Michigan State University, East Lansing.

Jocks Make Better Docs

by Carole Jackson Bottom Line Health

Want to find out if a doctor is any good?

Sure, you can Google his/her name to find out where he trained or what medical awards he has won…or ask friends and relatives for their opinions.

But what about asking if he excelled at playing a team sport in his younger years?

It may seem like a strange question, but a recent study suggests that it’s not, well, completely out of left field.

Researchers in the department of otolaryngology–head and neck surgery at Washington University School of Medicine in St. Louis found that prior excellence in a team sport was a better predictor of overall performance as a doctor in their residency program than the more standard criteria of medical school grades, standardized test scores and letters of recommendation.


Who would have thought that joining, say, a soccer team would boost medical skills more than cramming for an exam?

For the study, researchers asked faculty members to rate 46 recent graduates of the residency program with regard to their overall quality as clinicians. The faculty members rated the graduates using a five-point scale, with 1 meaning “should not have graduated” and 5 meaning “outstanding—I would choose him/her as my doctor.”

The researchers then reviewed each graduate’s residency application, looking at factors such as medical school grades, standardized test scores and letters of recommendation, which all are standard criteria used to judge an applicant’s likelihood of success in a residency program.

They also sent the graduates a simple questionnaire regarding their pre-residency experience in both athletics and music.

Questions included…

    • Do you have established excellence in a team sport? (The researchers made judgment calls in terms of what was considered a “team sport.” If the individual was on a track team, for example, being on a relay team would count, but throwing a javelin would not. The person had to have worked with others in order to win. )
    • Do you have established excellence in an orchestra, band or choir?

Results: Researchers found that there was no correlation between medical school grades, standardized test scores or letters of recommendation and the faculty assessments of who ended up being a good doctor. However, there was a significant correlation between achievement in a team sport and a graduate’s faculty rating. (There was a slight correlation between achievement in music and faculty ratings, but it wasn’t statistically significant.)

To learn more about the study and its findings, I spoke to lead author Richard A. Chole, MD, PhD.

One limitation to the study worth noting is that the particular residency program that was studied is highly competitive. In other words, all the doctors were extremely bright, so there wasn’t an extremely wide range of grades or test scores. “In a residency program where there’s a greater spectrum of grades and test scores, the correlation may not be as strong,” said Dr. Chole. Nevertheless, the findings point to a very intriguing link.


The study shows that there’s a lot more to being a good doctor than being an “A” student, Dr. Chole told me. “What our findings illustrate is that the best doctors tend to be the ones who are good at participating with their colleagues as part of a team, and playing a team sport is great preparation for that,” he said.

So instead of asking our doctors for their diplomas, perhaps we should be asking them for their high school and college yearbooks, so we can see whether they were on basketball, baseball, football, soccer, lacrosse or other sports teams!

Source: Richard A. Chole, MD, PhD, chairman of the department of otolaryngology-head and neck surgery at Washington University School of Medicine in St. Louis. The study was published in Archives of Otolaryngology-Head & Neck Surgery.

When to Skip the Specialist

by Carole Jackson Bottom Line Health

According to the latest statistics on the topic, there’s a good chance that you’ve been seeing a specialist for primary care problems.

For example, maybe you’ve been seeing your ear, nose and throat physician any time that you get a sore throat.

Or you might be the kind of person who goes to an orthopedist every time your back hurts.

But let me ask you this—is that what’s best for your health?

A new study reports that it probably isn’t.


Just how often are we Americans seeing specialists for primary care?

The study reports that over 40% of doctor visits for primary care in the US occur in the offices of specialists. These include both preventive exams and appointments that deal with common symptoms and diseases, such as fever, nasal congestion, anemia and asthma. The research found that all kinds of specialists were treating primary care problems, such as ob/gyns, cardiologists, gastroenterologists and nephrologists.

While the study didn’t delve into why patients were taking primary care concerns to specialists, lead researcher Minal S. Kale, MD, said that one reason may be the growing shortage of primary care doctors.

The number of medical students choosing to go into primary care started falling in the late 1990s. Based on a supply-and-demand analysis done by the Association of American Medical Colleges, in 2010, there were 9,000 fewer primary care doctors than were needed nationwide. And the association predicts that this shortage will grow to 65,800 by 2025—assuming that the Patient Protection and Affordable Care Act (aka “Obamacare”) is fully implemented so that formerly uninsured people can begin seeking medical care. The doctor shortage is worst in rural areas, said Dr. Kale.

Another reason patients go to specialists for routine care—patients may believe that specialists are better qualified to treat them. But past research shows that the opposite is actually true.


Dr. Kale acknowledged that there are certain situations in which it is appropriate to see a specialist. For example, a person in the midst of chemotherapy should certainly see his oncologist, rather than his primary care physician, if he develops a rash…and a person with chronic heart failure should see his cardiologist if he develops chest congestion. But these are symptoms that almost everyone else should discuss with a primary care physician.

“Primary care physicians usually have long-standing relationships with patients, so they tend to have a full understanding of the totality of their medical conditions,” Dr. Kale said. A specialist might look at a patient with a specialist’s eye—in other words, a gastroenterologist may be specifically on the lookout for stomach and intestinal problems if a patient comes in with abdominal pain. He or she might be alert to common causes such as indigestion, constipation, food poisoning, ulcers, gallstones or kidney stones. But a gastroenterologist might not notice that the problem is stemming from another part of the body entirely, such as from a migraine headache or psychological stress. Since primary care doctors deliver preventive health care and treat lots of different conditions on a routine basis, they have more expertise in treating the whole you.

And there’s science that supports Dr. Kale’s point. Other national research from the Primary Care Institute at University of Rochester School of Medicine and Dentistry in New York found that people who used primary care physicians, rather than specialists, as their regular source of health care were more likely to report fewer medical diagnoses and had a lower mortality rate, on average.


So if you’re scheduling your annual, preventive physical or if you’re planning to see a doctor about a common symptom, such as a nagging cough, the message is—call your primary care physician. If you don’t have one, take the time to find one—get suggestions from friends and family members and/or search your insurer’s Web site for in-network doctors. You can always see a specialist later if you need to—but you generally won’t!

Source: Minal Kale, MD, research associate, general internal medicine, The Mount Sinai Hospital, New York City. She is coauthor of a research letter published in Archives of Internal Medicine.