Are superfoods a thing?

I spent a sunny Sunday morning going down the rabbit hole of food-nutrition research. Why? Because someone on the internet said something … with which I disagreed.

A friend posted a short piece about the value of goji berries — a small Asian fruit in the tomato family that’s rich in antioxidants, protein and other important nutrients. Goji (Lycium chinense and L. barbarum) is a powerhouse, for sure.

What got me going, though, was a comment under the post. One woman reported that goji was “one of the first superfoods” she’d ever purchased.

And I thought, really? You’ve never bought cranberries or blueberries or walnuts? Because those are superfoods and they grow right around us.

My journey to herbalism and naturopathic medicine grew out of my concerns for environmental preservation and sustainability. So I always question the value of importing things from far, far away.

If a food or herbal medicine is awesome and we can grow it here without messing up local ecosystems, that’s great! If we can’t, we have to consider the effects on the social and environmental systems of the country of origin (see quinoa) and the environmental cost for shipping (carbon footprint, transport of invasive species).

Are some plants so unique and useful that they justify these costs? Maybe, sometimes.

Or can we find locally abundant, sustainable analogs? Mostly, and often.

With these questions about superfoods in mind, I started down the rabbit hole. I wanted to double check my biases and make sure my assertions were based on fact. Here’s what I found.

What is a “super food?”

“Super food” (or “super fruit,” “supergrain,” etc.) is a marketing label that has no medical or scientific meaning.

None.

It’s a made-up term designed specifically to sell things.

And it works: 2015 alone saw a 36-percent increase worldwide in products marketed as superfoods.

The term is generally understood to mean that a food has exceptional health benefits. (Why aren’t dandelion leaves more often mentioned?) But with no specific definition any food can be marketed as a superfood.

Here’s how Harvard’s School of Public Health defines it:

“There’s no scientifically based or regulated definition for superfood, but generally, a food is promoted to superfood status when it offers high levels of desirable nutrients, is linked to the prevention of a disease, or is believed to offer several simultaneous health benefits beyond its nutritional value.”

Most whole foods meet this definition.

Nearly every vegetable helps fight scurvy, reduces inflammation, promotes bowel health, feeds healthy gut flora, improves mood and has some cancer-fighting potential.

In other words, nearly all vegetables are “linked to the prevention of a disease” or potentially offers “several simultaneous health benefits beyond its nutrition value.”

Take the case of oranges. People have used these for centuries as an effective dietary source of Vitamin C. Oranges “work.”

And yet, when a fruit or vegetable is touted as being high in vitamin C, it is almost invariably compared favorably to oranges. This amazing fruit has twice the Vitamin C of oranges! This one has 10 times the Vitamin C of oranges!

The hype makes us think that oranges are a mediocre source of Vitamin C — and yet they are absolutely sufficient.

What makes a food “super?”

“Superfood” claims are often based on measuring antioxidants in the food.

Antioxidants are part of the plants’ defense system. They’re often colorful compounds the plant creates to protect itself from stressors including pests and disease.

Humans need these, too. Antioxidants protect our cells from damaging free radicals, to which we’re constantly exposed, naturally and otherwise.

Free radicals come from tobacco, alcohol and pollution; chemicals in processed foods; exposure to ultraviolet radiation and even the processes by which your body creates energy from food.

We always need antioxidants because we’re always exposed to free radicals. It’s the circle of life. And it’s one of the reasons you’ve always been told to eat your veggies and fruits.

One common measure of “super”

Some foods are considered “super” because they’re powerhouses of vitamins or minerals. But most often they get the title based on their antioxidant levels.

By this measure, some of the most super of foods include cranberries, blueberries, blackberries (especially marionberries and blackcap raspberries), walnuts and asparagus.

Many common kitchen herbs and spices are also off the charts for antioxidants. Although we only use small amounts, these can contribute significantly to our health.

How super do we need to get?

If some antioxidants are good, more would be better, right? Maybe even “super?”

Herbalist Todd Caldecott takes exception. Saying, for instance, that raw chocolate is loaded with antioxidants

“…ignores the fact that many of these ‘antioxidants’ are actually toxic when consumed in large amounts, interfering with protein digestion and mineral absorption, and in many people, inducing hypersensitivity reactions.”

Remember, the plants made these chemicals to protect themselves from predators. Some of those compounds make the plants’ nutrients less digestible — to both insects and us.

Eat the rainbow

Applying the term “super” to foods deflects attention from simple, healthy eating and turns dietary choices into a competition.

Don’t we already have enough stress in our lives without having to measure one more thing about each item in our grocery cart? (If it’s fun for you to dive deeper, check out the resources below.)

I tell my patients to keep it simple: Eat the rainbow.

Yes, some people need more personalized food plans. But for the most part it’s as simple as eating diverse, colorful whole foods.

Goji, the tomato-family berry that got me started down this rabbit hole, is delicious and nutritious. The best part? It grows easily in many areas, so we don’t have to worry about cultural disruption and environmental footprint.

By all means, grow goji berries if you love them. Or consider growing purple grapes with their seeds — you’ll get a larger crop, edible leaves and shade for your garden.

Resources:

Eating on the Wild Side, by Jo Robinson.*
Writer Jo Robinson does an excellent job of this in her book “Eating on the Wild Side.” She not only evaluates the nutrient profiles for many foods, she also recommends specific preparation techniques to maximize what you get out of them. She offers specific advice about varieties of different fruits and vegetables that will get you the most bang for your buck. (Honeycrisp apples, for instance, have are substantially more nutritious than my previous favorite, Pink Lady.)

Spice Apothecary: Blending and Using Common Spices for Everyday Health, by Bevin Clare.*
This gorgeous book by herbalist Bevin Clare takes food and flavor to the next level. It’s a great introduction to the world of spices, even for folks who don’t love to cook, but has enough detail to intrigue profound foodies and plant geeks. Here’s my video review.

Food As Medicine Everyday: Reclaim Your Health with Whole Foods, by Julie Briley and Courtney Jackson.*
Got questions about the basics of healthy eating? This book by two of my naturopathic-doctor colleagues is foundational. It’s filled with useful information, research citations, easy recipes and concepts even doctors missed in our education.

The nutrition data website gives you great information about many types of macro and micronutrients in foods, and you can adjust it based on the quantities you actually consume.

The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide, by Carlsen, M.H., Halvorsen, B.L., Holte, K. et al. PMID 20096093
This article from the peer-reviewed Nutrition Journal is a great place to get geeky about antioxidant levels in vegetables, spices, drinks and prepared foods.

*Note that these are affiliate links, meaning I might get a few cents if you purchase after clicking.

In late July, a friend invited me to pick newly ripened elderberries in her Portland yard.

She’s got two — just two! — of the shrubs growing, and she can’t keep up. Knowing how coveted they are as medicine, she didn’t want them going to waste.

I eagerly agreed.

Elderberries are a critical tool to enhance immune resilience and improve winter wellness. They’re the only plant medicine singled out in my Immune Resilience Action Guide, and were the subject of a full hour of discussion during my spring Immune Resilience Action Series. They’ve got truly substantial research supporting their efficacy at limiting duration and severity of influenza.

They’re also really easy to make into tasty medicine — and now is the season to do it.

A little bit about elderberries

Elder (Sambucus species) grows in temperate to subtropical climates around the world. They are technically shrubs, having multiple stems rather than a single trunk. Elders range in size from 5 feet to 20 feet, but most garden elders fall in the middle of that range.

The species I prefer for medicine are the ones with the black or blue berries, often Sambucus nigra, S. canadensis or the Pacific Northwest’s native S. cerulea. They’re easy to grow, beautiful and so bountiful!

Elderberries are beloved in large part because of the way they’re prepared: in a syrup or elixir with sugar or honey as a preservative. Not all herbs are super tasty to most palates. Elderberry syrup is a notable exception.

Harvesting + processing elderberries

My friend’s elders were about one quarter ripe, the branches heavy with the black berries. Off one plant we harvested about one and a half gallons of fruit, from which I’ll end up with about three gallons of finished syrup.

I don’t consider myself a very make-y person. I’m a perfectionist and a reluctant cook, so making medicine has to be very simple or I won’t do it. (This is why the medicines I make myself are for myself and my friends, not for patients. I get the professional stuff for them.)

Elderberry syrup became incredibly easy once I wrapped my brain around one idea: It’s basically a strong, simmered tea of berries plus spices, preserved with sugar, honey and/or alcohol.

The hardest part is separating the berries from the stems. I spent an hour the first night doing that to get 8 cups. But my friend taught me a life-altering trick: Freeze the berries on their stems. I filled two baking pans with elderberry panicles, stems pointing up. What took me an hour to do at room temperature took just minutes with the frozen berries. I will do it this way forever when freezer space is available.

Preserving the harvest

As I type this post, I’ve got 8 cups of fresh elderberries simmering in 8 cups of water (use more for dried berries), spiked with a big handful of fresh ginger, three cinnamon sticks and some black pepper. After about 20 minutes I’ll turn off the heat, mash it up and strain off the liquid.

After that, I’ll pour the decoction into jars, add equal parts honey and/or alcohol. I also freeze some of the unamended decoction, to which I can add honey or alcohol later. That saves space, which is handy when you’re starting to run out of canning jars.

Any mid-proof alcohol you like will do. I prefer neutral-tasting vodka from my friends at Deep Woods Distillery. (If you find yourself in Oakridge, Oregon, say hi.) Other folks use tequila, whiskey or rum to good effect.

I like to use raw, local honey whenever possible. (I love what I got from Mickelberry Gardens) Because it goes in after the boiling process, you don’t lost any of its great enzymes. Honey is healing in its own right, helping with coughs and making the medicine go down.

The people’s medicine

The bottom line is that making elderberry syrup is super easy and super cost effective. It’s truly a medicine of the people. If you can access berries in a yard or wild place, the only expenses are the preservatives. But even if you must buy berries, the whole process saves you hugely over buying elderberry syrup at the store.

I strongly encourage folks to make their own. Here’s one recipe from herbalist Rosemary Gladstar, and here’s another from herbalist Dr. Tieroana Low Dog.

If this all sounds like too much work, consider getting this DIY kit from my friends at Mountain Mel’s Essential Goods, an hour out of Portland up on Mount Hood. (Use the code “drorna” to get a 10-percent discount on your order.)

Salúd!

— Dr. Orna

P.S. Is elderberry the right medicine for you? Schedule a telemedicine appointment and we’ll talk about it!

More folks than ever are getting tested for SARS-CoV-2, the virus that causes COVID-19. Access to testing is great, and long overdue.

But the tests themselves remain problematically inaccurate, so remember that a negative test doesn’t necessarily put you in the clear.

The issue is false negatives: tests that don’t detect the virus when a person is actually infected. And these tests we’re using to determine viral presence is prone to false negatives.

This matters because people who test negative may take fewer precautions to protect those around them — even though they may actually be infectious.

If you’re sick, pay attention to your experience rather than your test results — and act accordingly. But if you’re not sick, don’t take the test’s word for it.

How bad is the problem? Researchers at Johns Hopkins School of Public Health scoured the existing scientific literature — both published, peer-reviewed studies and those that are still going through the process — to answer that question. They looked at data for the RT-PCR test, generally a very sensitive way to detect viruses, that is the primary swab-up-the-nose test used to detect active infection.

The short version: At best, one in five tests will have false negatives.

Published in the May 13, 2020 edition of Annals of Internal Medicine, the study found a sweet spot in the progression of infection. Testing on Day 8 of the infection — usually the third day of disease symptoms — is when you’re most likely to get the most reliable results.

Here’s how it breaks down:

• Day 1 of infection (often no symptoms): 100-percent chance of a false-negative test.
• Day 4 of infection (often no symptoms): 67-percent chance of a false-negative test.
• Day 5 of infection/symptom onset: 38-percent chance of a false-negative test.
• Day 8 (three days after symptom onset): 20-percent chance of a false-negative test.
• Day 9 (4 days after symptom onset): 21-percent chance of a false-negative test.
• Day 21: 66-percent chance of false-negative test.

These numbers represent median observations: in half the cases the chances were higher, in half they were lower. This is the middle ground of numbers that have a pretty large spread, especially when testing the early days of infection.

Going with these median numbers, you’ll see that even at the Day 8 sweet spot, one in five tests will falsely report a negative result when the person is actually positive. So at best there’s a 20% false negative rate. On other days, the false negative rate is even higher.

Why are the false negatives so high on a test that is known to be exquisitely sensitive? It may have to do with swabbing technique, or other issues still to be determined.

I get that people want to know what’s going on. I want to know what’s going on. These acute tests (the swab-up-the-nose tests) more usefully inform our actions when they’re positive than when they’re negative.

If you get a positive test, talk to your doctor about appropriate medical care, stay home, stay away from people, and do everything you can to take care of yourself.

If you get a negative test, don’t assume you aren’t sick or that you can’t infect others. If you aren’t on your third day of symptoms (and even if you are), there’s a good chance the test won’t catch your infection.

Be careful, folks. And remember that getting a negative test isn’t the final word.

Salúd!

— Dr. Orna

P.S. Read the full Annals of Internal Medicine article, “Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure.” Here are the key findings if you don’t want to wade through it:

“Over the 4 days of infection before the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreases from 100% (95% CI, 100% to 100%) on day 1 to 67% (CI, 27% to 94%) on day 4. On the day of symptom onset, the median false-negative rate was 38% (CI, 18% to 65%). This decreased to 20% (CI, 12% to 30%) on day 8 (3 days after symptom onset) then began to increase again, from 21% (CI, 13% to 31%) on day 9 to 66% (CI, 54% to 77%) on day 21.”

“Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure.” Annals of Internal Medicine, 13 May 2020.

Photo by Hans Reniers on Unsplash

Good hygiene is one key way we can protect ourselves during the current pandemic. And hygiene applies to both the physical (washing our hands) and the intellectual.

We’ve mostly gotten a lot better about washing our hands. That’s great news, since soap is one of the most powerful tools we have to kill SARS-CoV-2, the virus that causes COVID19 infection. (Here’s my favorite soap company.)

We’re doing less well, however, with our information hygiene. That’s intellectual equivalent of hand washing to protect ourselves from disinformation infection.

Especially on social media, there’s a ton of bad information out there. I get it. We all want there to be answers, ASAP, and we clutch at anything that looks to provide us with those.

It’s easy to favor (and spread) ideas that support what we want to be true, rather than what there’s evidence to believe is true. (As I’ve mentioned before, this is a very real phenomenon called confirmation bias.)

Contrarian answers — those that subvert conventional wisdom — are especially appealing. And that’s even more the case when conventional wisdom offers nothing more than more waiting. (Meteorologist Marshall Shepherd has a great analysis of this effect.)

Both of these tendencies leave us vulnerable to disinformation. And disinformation is both infectious and potentially deadly.

Here are the questions and practices I employ for information hygiene, particularly on social media:

1. Read the whole article. Headlines are often unrelated or outright wrong. I say this as a former newspaper reporter who fought over incorrect headlines a lot. If I post something without reading it first, which I sometimes do to bookmark articles I want to get back to, I always note this.
2. When was this published? Our knowledge of and experience with COVID19 is changing very quickly, so timing matters.
3. Where was this published? Does that outlet have an affirmed bias? Is it actually supposed to be satire? Some excellent thinkers post directly to Facebook, Twitter and Instagram, which leads to…
4. Who is the author? What are their credentials? Lack of credentials isn’t necessarily disqualifying; but the writer needs to use better citations and logic to make their case. Pseudonymous pieces are a big red flag.
5. Is this an opinion piece, news story or scientific study? If opinion, does the author have a financial or political stake in their argument?
6. Does the piece include citations? If the ideas are controversial — or really appealing — check that the citations say what the author says they do. In the absence of citations, search for substantiation on Google, Google Scholar, among your trusted sources or elsewhere.
7. Does the piece argue for “common sense” without giving reasoning behind its conclusions? A good article will give you the logic behind its conclusions. You can look at that logic and decide for yourself if the conclusion is justified.
8. When in doubt, use a fact-checking site. Here’s a great list of options. Also check out this article by Dave Leiber, an investigative columnist at the Dallas Morning News.

Applied like hand washing with soap, this process helps neutralize disinformation and prevent infection.

Here’s how it works in practice: A month or two ago, a Medium post went around suggesting SARS-CoV-2 attacks our blood’s oxygen-carrying capacity. Very interesting! We know how to treat those symptoms, using oxygen, herbs and drugs. So I looked into it.

First problem: the author of the Medium piece used a pseudonym, so there was no way to check their credentials. Second, they quoted a research study, but didn’t cite or link to the study so you could evaluate it. I googled the quotation and found a prepublication article, which was all laboratory findings. Next, I asked my colleagues on Facebook to help me untangle that research. That debunked the whole premise on several fronts, including the fact that no SARS-CoV-2 has been seen in blood at all. Finally, I found an online expert who tore the piece apart — using both logic and citations to do so.

I understand that conventional wisdom resists change, and so remain open to ideas coming from unlikely directions. But I’m doing my best to vet those ideas against what I know of biochemistry, human physiology and clinical efficacy.

So please protect yourself, not just from the SARS-CoV-2 virus, but from disinformation infection, as well.

Salúd!

 — Dr. Orna

P.S. I curate a weekly roundup of pandemic news, vetted as described above. Register to here to get a copy in your inbox.

Photo by Dhaya Eddine Bentaleb on Unsplash.