Junk Food May Reduce Heart Attack Deaths

by Kimberly M. Sanders, ND, and Jacob Schor, ND, FABNO

Let’s Start This Train of Thought in Israel

The all-time most popular, most highly processed snack food eaten in Israel is a product named Bamba. It has been sold since 1964 and accounts for 25% of the nation’s snack food market sales. These snacks are made of peanut-flavored puffed corn meal. Think of the American snack Cheetos, leave out the cheese entirely, and instead coat the puffs lightly with peanut butter.

And follow it to England

In 2008 George Du Toit et al., writing in the Journal of Allergy and Clinical Immunology reported that peanut allergy was

10 times as high among Jewish children in the United Kingdom as it was in Israeli children of similar ancestry. This observation correlated with a striking difference in the time at which peanuts are introduced in the diet in these countries: in the United Kingdom infants typically do not consume peanut-based foods in the first year of life, whereas in Israel, peanut-based foods are usually introduced in the diet when infants are approximately 7 months of age, and their median monthly consumption of peanut protein is 7.1 g.

This led Du Toit to “… hypothesize that the early introduction of peanuts to the diet may offer protection from the development of peanut allergy.”¹

Israeli kids do not eat peanuts, but they do eat an awful lot of Bamba.

This hypothesis led these researchers to conduct a large-scale clinical trial in which they introduced peanuts at an early age to infants some of who already tested positive for peanut allergy. The results from this trial were published in February 2015 in the New England Journal of Medicine.²

Peanut Allergy Study

Du Toit’s new study is a randomized, open-label, controlled trial. Infants were first divided into two groups based on wheal formation secondary to skin-prick testing for peanut allergy. Each group was then further divided into two groups, where one group consumed 6 grams of a peanut snack per week and the other group was advised to avoid peanuts. Peanut intake was maximized at 3.9 grams in those who had a positive skin-prick test. The peanut snack was distributed in three or more meals a week until the children reached 60 months of age.

In total, 640 infants between 4 and 11 months old with severe eczema, egg allergy, or both were enrolled in the study. The primary outcome was the proportion of patients with a peanut allergy at 60 months of age as determined secondary to an oral food challenge.

Of the 640 infants, 542 had negative skin-prick tests at baseline and made up group 1. In this group, at 60 months, 13.7% of the avoidance group and 1.9% of the peanut consumption group were allergic to peanuts. This statistically significant difference represents an 86.1% reduction in peanut allergy prevalence.

At baseline, 98 children had positive skin-prick tests and these more sensitive infants made up group 2. At 60 months, 35.3% of the avoidance group and 10.6% of the consumption group were allergic to peanuts. This statistically significant difference represents a 70.0% reduction in peanut allergy prevalence.

A significant increase in wheal size was found only in the peanut avoidance group. Patients who were allergic to peanuts at 60 months also had higher peanut IgE levels at this time. Peanut IgE levels increased over time in both the peanut avoidance and consumption groups, but there were few patients in the consumption group that had very high peanut IgE levels.

This Is a Big Deal

“Food allergies are a growing concern, not just in the United States but around the world,” said National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci in a statement. “For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention.”³

Opposite of What We Thought

These results turn the dietary guidelines about peanuts upside down. In the UK since 1998 and the US since 2000, practice guidelines have advised exclusion of allergenic foods, in particular peanuts, from the diets of infants and of their mothers during pregnancy and lactation.^4,5 Some of you may recall when United Airlines served peanuts as a snack during flights.

This isn’t the first study that cast doubts on the validity of food allergen avoidance during infancy. A 2008 study using data from the 2073 children in the LISA cohort evaluated the relationship between timing of solid food introduction and the presence of atopy at 6 years old. The authors found that delaying introduction of solid foods past 4 or 6 months did not reduce the incidence of developing atopic conditions, and those who delayed solid food introduction had more frequent food allergies.⁶ A 2007 prospective study assessed the association between solid food exposure and eczema. Among 4753 infants, there was an increased risk of eczema for those who avoided egg in their first year of life. The authors of that study rejected the notion of delayed solid food introduction and stated that allergenic foods should not be delayed past 6 months of age in order to prevent atopy. A 2008 paper in Pediatrics milked data from the KOALA cohort in the Netherlands. After analyzing data from 2558 infants in this ongoing cohort, the conclusion was, “More delay in introduction of cow milk products was associated with a higher risk for eczema. In addition, a delayed introduction of other food products was associated with an increased risk for atopy development at the age of 2 years.”⁷

A 2013 study concluded that the trend towards lower egg allergy prevalence in infants fed eggs early in life, when studied against a control group, alleviates concerns that early introduction of allergenic foods would pose an increased risk for allergy.⁸ If nothing else, this study revealed that early introduction of egg does not increase the egg allergy.

But in the recent Du Toit study, it tells us that introducing peanuts at an early age appears to be safe and well tolerated, even in those who have a positive skin-prick test reaction to peanuts, appears to cause no adverse reactions, and most importantly is associated with lower risk of developing an allergy to peanuts later in life.

The past practice of keeping children in an allergen-free bubble during infancy was the wrong approach. Doing so may turn common foods into dangerous allergens. Our national fear of peanuts may have broader implications on general health.

Peanuts Are Not Nuts

Technically speaking, peanuts are not nuts at all. Rather they are peas. Their Latin name is Arachis hypogaea. Arachis is the genus of flowering pea plants. Hypogaea means below (hypo) the earth (Gaea). Peanuts are annual plants. After the plants produce their typical-looking pea-flowers, the flower stalks do something unusual: they elongate, bend over, and push the flower ovaries into the ground where the legume pods mature. Nuts grow on trees. Peanuts are just peculiar peas that ripen underground. It is curious, perhaps a marketing/branding thing, that they are grouped in our minds with nuts. For some reason, though, this works, as both nuts and peanuts have similar health benefits.

Nuts Are Good for Your Heart

Over the years multiple studies have associated nut consumption with health benefits especially in regard to cardiovascular disease morbidity and overall mortality. A 2014 meta-analysis by Lou et al. of 11 studies found that nut consumption was inversely associated with total mortality, though it did not provide information on cause-specific mortality.⁹ Bao et al., in a 2013 report that analyzed data from the Nurses’ Health Study and the Health Professionals Follow-up Study, found that nut consumption was inversely associated with all-cause, cancer-specific, and heart disease mortality.¹⁰ Data from the PREDIMED trial cohort reported that baseline nut consumption was associated with reduced mortality.¹¹ Perhaps the most recent paper on this topic is a meta-analysis by Grosso et al. These researchers combined data to include 354,933 participants, 44,636 cumulative incident deaths, and 3,746,534 cumulative person-years. One serving of nuts per week resulted in a 4% decreased risk for all-cause mortality. One serving per day was associated with a 27% decreased risk of cardiovascular disease mortality.¹² Nuts are clearly good, but it wasn’t clear whether peanuts should receive the same acclaim.

Peanuts Are Also Good

Eating peanuts appears to provide similar benefits as does eating tree nuts. A March 2015 study by Luu et al. found that peanut consumption was associated with the same reduction in mortality rates, and in particular ischemic heart disease, as nut consumption. Actually this new study told us two things: first, peanuts are as beneficial as tree nuts; second, the benefits are seen across racial and socioeconomic lines.

This Luu study examined the association of nut consumption with total and cause-specific mortality in Americans of African and European descent, who were predominantly of low socioeconomic status (SES), and also in Chinese individuals living in Shanghai, China.

Data were extracted from three separate and large cohorts: 71,764 participants were US residents of African or European descent, primarily of low SES. These participants were part of the Southern Community Cohort Study (SCCS) conducted in the southeastern US between March 2002 and September 2009. Another 134,265 participants were drawn from two cohorts in Shanghai, China, the Shanghai Women’s Health Study (SWHS) and the Shanghai Men’s Health Study (SMHS).

Food frequency questionnaires completed by participants allowed assessment of overall nut and peanut consumption. In the Shanghai cohorts, tree nut consumption was rare and the majority of nuts consumed were peanuts. In the US cohort, about half the nuts consumed were peanuts.

Nut intake was inversely associated with risk of total mortality for all 3 groups. Individuals in the upper 20% of nut consumption compared with those in the lower 20%, had a 17 to 21% lower risk of dying during the study follow-up period.

Higher nut consumption was associated with a 30% to 40% lower risk of ischemic heart disease. The nut–mortality association was similar for men and women and for blacks, whites, and Asians and was not modified by the presence of other health conditions. The benefit of eating nuts crossed all racial and economic lines. No difference was seen between eating peanuts or tree nuts.¹³

We Are Talking About Peanuts Here

It would appear that the common health-care belief and practice of delaying introduction of potential food allergens, in this case peanuts, has now been thoroughly disproved. Our national practice of avoiding peanuts has probably increased allergy incidence rather than lowering it. In the long run it may also have deprived many people of an inexpensive food that might provide significant health benefits. While we may not want to be seen as advocates for junk food, the benefits of eating Israeli Bamba, because of the protective effect against developing peanut allergies, might far outweigh our classic concerns about eating empty calories; we might consider an exception to our rules – at least for Bamba.

Kimberly M. Sanders, ND, is a licensed naturopathic physician in Connecticut. She graduated from the University of Bridgeport and completed her CNME-accredited residency training there as well. She was named three-time MVP of the ZRT Cup Competition as a medical student. Dr. Sanders currently owns ArthroWell Naturopathic, a specialty practice in rheumatology. She has undergone extensive pediatric and rheumatology training, and has lectured on the topic of autoimmunity at the annual CNPA and NHAND conferences. Her passion in practice is finding the underlying cause of immune dysfunction and restoring balance to the immune system with functional medicine.

Jacob Schor, ND, FABNO, is a naturopathic doctor and a 1991 graduate of NCNM. He has practiced in Denver, Colorado, with his wife Rena Bloom, ND, ever since. Dr. Schor is a past board member of the American Association of Naturopathic Physicians and a current board member of the Oncology Association of Naturopathic Physicians (OncANP). He is a past president of OncANP and also of the Colorado Association of Naturopathic Physicians (CANP). He is a frequent contributor to the Townsend Letter and the Natural Medicine Journal.

Notes

1. Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008 Nov;122(5):984–991.

2. Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803–813.

http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=article.

3. Study finds peanut consumption in infancy prevents peanut allergy [online press release]. National Institute of Allergy and Infectious Disease. Feb. 23, 2015. http://www.niaid.nih.gov/news/newsreleases/2015/Pages/LEAP.aspx.

4. Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Peanut Allergy. London: Department of Health; 1998. Available at http://webarchive.nationalarchives.gov.uk/20120209132957/http://cot.food.gov.uk/pdfs/cotpeanutall.pd.

5. American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106:346–349.

6. Zutavern A, Brockow I, Schaaf B, et al.; LISA Study Group. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics. 2008 Jan;121(1):e44–e52.

7. Snijders BE, Thijs C, van Ree R, van den Brandt PA. Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: the KOALA Birth Cohort Study. Pediatrics. 2008 Jul;122(1):e115–e122.

8. Palmer DJ, Metcalfe J, Makrides M, et al. Early regular egg exposure in infants with eczema: a randomized controlled trial. J Allergy Clin Immunol. 2013;132(2):387–392.

9. Luo C, Zhang Y, Ding Y, et al. Nut consumption and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis. Am J Clin Nutr. 2014 Jul;100(1):256–269.

10. Bao Y, Han J, Hu FB, et al. Association of nut consumption with total and cause-specific mortality. N Engl J Med. 2013 Nov 21;369(21):2001–2011.

11. Guasch-Ferré M, Hu FB, Martínez-González MA, et al. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med. 2014 May 13;12:78.

12. Grosso G, Yang J, Marventano S, Micek A, Galvano F, Kales SN. Nut consumption on all-cause, cardiovascular, and cancer mortality risk: a systematic review and meta-analysis of epidemiologic studies. Am J Clin Nutr. 2015 Apr;101(4):783–793.

13. Luu HN, Blot WJ, Xiang YB, et al. Prospective evaluation of the association of nut/peanut consumption with total and cause-specific mortality. JAMA Intern Med. 2015 Mar 2.