All Hail The Bean!

What a pleasant surprise to open this week’s Archives of Internal Medicine and find the results of a trial on the benefits of eating legumes–beans, lentils, and chickpeas. This was a real clinical trial, working with a group of people who had mild Type 2 diabetes. During the three-month study period, half the enrollees ate one cup of legumes daily, the other half a comparable amount of whole-grain carbohydrates (breakfast cereals and breads). Periodically, researchers monitored all the usual suspects–weight, blood pressure, cholesterol, and triglycerides–along with hemoglobin A1c (HbA1c), a test that gives your doctor a bird’s-eye view of your average blood sugar levels.

The purpose of using legumes in particular (as opposed to, say, the potentially extinct Twinkie) relates to the glycemic index (GI), which ranks foods based on their effects on insulin and blood sugar.

• Low-GI foods, legumes among them, convert slowly to glucose, the sugar your body runs on, and thus have a low number on the GI.
• High-GI foods quickly spike blood sugar and have a higher number. Examples include refined white flour and wheat flour products (breads, pretzels, crackers) and actual sugar-containing food and drink (cakes, cookies, Twinkies, Coke, fruit juice).

More physicians are finally realizing the real villain in chronic disease isn’t fat, but sugar.  Did you know the average American eats about 120 pounds a year? By reducing sugar intake from all sources, your chances of developing obesity, chronic heart disease, diabetes, and even some cancers drop considerably.

Every time you indulge in a high-GI food your blood sugar quickly rises. In response, your pancreas releases insulin, needed to escort the sugar into your cells, where it’s utilized for energy. After years of this glucose-up, glucose-down cycling, two less-than-desirable shifts occur:

• Your pancreas tuckers out, producing less and less insulin. And without insulin to remove sugar from your bloodstream, blood sugar rises.
• Your cells become resistant to whatever insulin your pancreas is still struggling to produce, meaning cells won’t open up and let in the sugar for use by your body. This, too, leaves sugar in your bloodstream.

These two changes are the basis for all the drugs prescribed for diabetes. One group of pills whips your pancreas to produce more insulin, the other tricks your cells into becoming less resistant to insulin. And while many people can last for years on these drugs, at some point the pills fail and you’re called into your doctor’s office to learn how to give yourself insulin injections.

So you can see how it would be handy for people in the early stages of diabetes, and really all of us interested in longevity, to take some steps to prevent blood sugar spikes. In the bean study, eating up to a cup a day of legumes did people a lot of good. First and foremost was a measurable decline in HbA1c, the most important tracking test for diabetics, with any drop in numbers equalling a reduction in the heart risks linked to  diabetes. In addition to lower HbA1c, bean eaters also lost more weight and waistline inches, and were found to have a small but statistically significant drop in their blood pressures and heart rates compared to the grain eaters.

As you’ve known since third grade, some people digest beans better than others. The reason beans make you toot is a complex sugar (which digests slowly and is therefore responsible for beans’ low GI) called raffinose. Some of us have a shortage of the enzyme alpha galactosidase, needed to break down raffinose. If that describes you, the raffinose passes undigested through your stomach and small intestine before entering your large intestine, which is filled with bacteria that can digest it. This is the process that produces several gasses, notably carbon dioxide, methane, and hydrogen sulfide.

Two steps can help prevent bean-related discomfort. First, soak dried beans overnight in water and rinse in the morning before cooking. This reduces their raffinose content. Second, use Bean-O or Bean-zyme when you eat beans. They contain the enzyme (the alpha galactosidase) needed to digest beans.

The role of inflammation

What surprised me in the journal article was that there was no mention of inflammation and its contribution to chronic disease, even though some of the positive health benefits seen in the study, like the drop in blood pressure, might be due to the relatively low inflammatory effect of beans. In fact, it’s amazing how rarely inflammation (or following an anti-inflammatory eating program) is mentioned in any medical journal. The newly published The Great Cholesterol Myth, by Jonny Bowden and cardiologist Steven Sinatra, MD, states flatly that physicians have been misled by the pharmaceutical industry into cholesterol-phobia and maintains the real villain is inflammation.

As a quick example of this blindness toward the role of inflammation, in this week’s Internal Medicine News, a young rheumatologist, Karmela K. Chan, MD, titles her commentary “Anti-Inflammatory Diet Anyone?” She relates how one of her patients with rheumatoid arthritis refused her conventional medications and instead visited a naturopathic physician who recommended an anti-inflammatory diet. Unlike 99.99% of US physicians, Dr. Chan actually then read something about anti-inflammatory eating and naturopathic medicine and went on to meet Celeste Ruland, ND, a local naturopath, to learn exactly what naturopaths do. Dr. Chan seems relatively open to Dr. Ruland’s idea of “empowering a patient to stay well” and “mind-body balance,” though perhaps Dr. Chan was a tad patronizing with her remark, “This may sound like excessive tree-huggery, but I do think there is some value to this.”

She also gloats just a bit in her epilogue. Eight months later, despite his healthful lifestyle changes, Dr. Chan’s patient had worsened and currently is taking immune modifiers and acknowledging that he’s doing better than when he was on the anti-inflammatory diet alone. Oh well. No one said the transition to integrative medicine would always be seamless.

Be well,

David Edelberg, MD

PS:  A common bean complaint is their lengthy cooking time. You get home from work tired and hungry and you really don’t want to wait an hour for your rock hard dried beans to soften. Get a pressure cooker (your grandmother had one), either stovetop or, even faster, one of the newer electric ones. Beans in ten minutes.