Neal Barnard's Meal Plan Anti-Inflammatory

I know you've all been wondering about this, and couldn't wait for someone to hurry up and tackle the question. So I used the tools at Nutritiondata to work it out, (depending especially on Monica Reinagel's Inflammation Factor to estimate the inflammatory potential of foods) First I entered recipes for Barnard's Fruit Smoothie, Lebanese-Style Lentils and Pasta, Orange Applesauce Date Cake, Blackeyed Pea and Sweet Potato Soup, and Creamy Poppyseed Dressing. More or less. I got a little agitated with the interface and left out some of the seasonings. Next, I used these recipes to create Menues as Recipes for Breakfast, Lunch, and Dinner from Day 1 of his "7 Days of Healthful Meals". Barnard doesn't talk much about how many calories you should get in a day or what serving sizes to use to meet those requirements, so I guessed on how much oatmeal to serve myself for breakfast, how much soup to have for lunch, etc.

According to Nutritiondata, breakfast was mildly inflammatory, lunch was strongly anti-inflammatory, and dinner was mildly anti-inflamatory. When I added up all 3 meals and the smoothie, I wound up with 1704 calories for the day, an estimated glycemic load of 127, (which some diabetics might consider a tad high), and an inflammation factor of 82, which is mildly anti-inflammatory. That inflammation factor is a good feature. After-meal inflammation seems to be an important contributor to heart disease. It contributes to a whole cascade of bad things, from higher triglyceride levels to smaller cholesterol particles, to high blood pressure, to artery damage, fatty plaque deposits, plaque eruptions, and blood clotting. I was just reading about it all once again in a medscape article about triglycerides -- it's not a pretty picture.

All in all, it looks like Barnard's diet is good for the heart.

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Melamine is still in our foods

A year and a half ago, I said pretty much all I wanted to say about cheap imported food ingredients -- avoid them. It's too easy to sneak in powdered melamine scrap in place of vegetable protein powders, isolates, and concentrates, or powdered milk or eggs. Too easy to replace glycerine with antifreeze. This means avoiding all the processed foods made with these ingredients, too. You can't know where they came from. And the FDA has just blocked the import of all milk products from China, along with pet and laboratory animal feeds.

Hong Kong and South Korea are turning away eggs and egg products because they are contaminated. It isn't clear whether the powdered eggs rejected by South Korea were directly contaminated, or if they were simply came from chickens fed contaminated feed. The levels of melamine in the flesh, milk, or eggs of an animal fed contaminated feed are likely to be much less than the levels of food ingredients directly contaminated with melamine.

product	contamination level
Sanlu milk, reconstituted	~360 ppm
Recalled 2007 pet food	60-70 ppm
Recalled Chinese vegetable proteins	>70 ppm
Egg powder, South Korea	.1ppm - 4 ppm
Hong Kong eggs	3.5 ppm

The FDA says 2.5ppm is the level of concern, except for in baby formula where none (or 25ppb, the limit of detection) is tolerable. This is based on evidence that 50ppm is tolerable (from animal studies?), up from a 2007 LOC of 194ppb to 450ppb, based on a TDI of .63 mg/kg/day, with a "100-fold safety factor".

Using the EU's TDI of .5mg/kg/day, the WHO concludes that the LOC for milk is 25ppm -- 10 times as high as the FDA's LOC.

How about a nice home-made Chipotle-Squash soup instead?

• FDA Melamine Contamination information page
  

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Omega-3 and genetic engineering

Those of us who eat a lot of grains and/or grain-fed livestock are always on the lookout for ways to get more omega-3 fatty acids. That's because grains are skewed toward the omega-6 fatty acids, which are inflammatory, and can contribute to heart disease.

But, wouldn't you know it, Monsanto has been working on the problem. They have developed a soybean that produces a lot of SDA, a compound that like ALA, humans can convert to omega-3 fatty acids EPA and DHA, but which is much more shelf-stable than EPA or DHA. And the soy oil will taste better than fish oil. Their plan is to use it to create a high-omega-3 soybean oil, but perhaps it will find other uses as well. They've concluded their soy oil is safe for rats.

Will they try for a high-omega-3 corn next, for livestock feed to produce high-omega-3 meats?
Is this a good thing or not?

• Monsanto and The Solae Company to Collaborate on Soy-based Omega-3 Portfolio


• Safety assessment of SDA soybean oil: Results of a 28-day gavage study and a 90-day/one generation reproduction feeding study in rats. Fleeman et al. Regul Toxicol Pharmacol. 2008 Aug 31

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USDA Dietary Guidelines 2010

The USDA and HHS has already empanelled a new committee for reviewing the US Food Pyramid, and they've already had their first meeting. Interesting, they are taking comments. Many of the earliest commenters are famous proponants of vegetarian diets, based on their analysis of clinical studies on diet and health. There were 10 comments from the National Dairy Council, but all but one have since been deleted. That's a little bit of a surprise. At least fifty-seven comments have been submitted, but only 30 remain.

Many of the commenters seem to feel the dietary guidelines committee might have some conflicts of interest, and might not adhere to the scientific evidence. Then again, there is scientfic evidence that our diet should be low in carbohydrates and high in protein, evidence that it should be high in carbohydrates and low in fat, or that it should have a "Zone" or "South Beach" balance of macronutrients.

It seems that "everyone" agrees that foods that don't raise the blood sugar and insulin too much are a good idea. Which means more green vegetables, less bread. Inflammation has recently been identified as a big problem for health, which means there is a lot of agreement that foods high in antioxidants are good, omega-6 fatty acids are not as good as omega-3 fatty acids, and that mono-unsaturated fatty acids might be the best. There are still some dissenters on the merits of saturated fats, though many researchers seem to agree they are inflammatory and promote heart disease, especially when combined with quick-digesting carbs. I think we all agree that croissants are not an ideal staple food.

There has been a lot of criticism of the 2005 dietary guidelines since it came out, not the least of which has been the emphasis on bread, pasta, and breakfast cereals as a source of carbohydrates for energy.

I'm a little confused myself. I've got Neal Barnard's book in one hand, and the South Beach diet in the other. The doctors behind both diets have done the studies to show that either diet will improve cholesterol and blood suger -- all the risk factors for heart disease and diabetes. Apparantly, either diet is better than the 2005 guidelines.

Which side up will they turn the pyramid in 2010, and will it make any difference at all?

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Reducing the risk from C-Reactive Protein

Today, statin drugs are in the news. The Jupiter study results, just published in the New England Journal of Medicine, says that patients with high C-reactive protein scores given Crestor "had a 45 percent reduction in serious heart problems and 20 percent reduction in death from all causes compared to those who received a placebo"[1]. The study participants were specially selected. They were all 50 or older, and chosen because they had high C-reactive protein scores, low to normal levels of LDL cholesterol, and did not have diabetes.[2] Many of them were overweight, had high LDL or triglycerides, or had metabolic syndrome.[3]

Crestor reduced the C-reactive protein of the Jupiter subjects by 37%, and their LDL by 50%. The earlier MERCURY trials of Crestor on high-risk patients with LDL cholesterol over 130 mg/dL, showed that Crestor could lower LDL cholesterol to below 70 in higher-risk patients,[4] but did not measure C-reactive protein.

So this study does not suggest that everyone can benefit from statins. It suggests that that the older, non-diabetic but perhaps pre-diabetic patients with high C-reactive protein levels may benefit from statins, whether or not they have high LDL cholesterol.

What is C-reactive protein?
C-reactive protein is related to inflammation in the body. It is very high following an injury (or surgery), and during a bacterial infection. C-reactive protein has been linked to heart disease, though it isn't clear just why. It doesn't seem to cause heart disease,[5] but it seems to be a good way to keep tabs on inflammation.

Inflammation, of course, is bad for the heart. Some foods cause inflammation. Body fat can cause inflammation. So anything that reduces inflammation seems like a good idea. Statin drugs appear to reduce inflammation while lowering LDL cholesterol. Of course, LDL cholesterol is not the best predictor of cardiovascular risk. The American College of Cardiology and the American Diabetic Association both recommend apoB and LDL particle concentration, or non-HDL cholesterol.[6]

C-reactive protein has also been associated with high triglycerides, coffee consumption, high blood pressure, insulin resistance, high protein diets, high fat diets[7], high glycemic index diets, inadequate sleep, too little exercise, depression, and age.

How to reduce C-reactive protein
Exercise, losing weight, reducing triglycerides, controlling blood pressure, getting enough sleep, eating a Mediterranean diet, eating antioxidant foods with meals, and cutting back on "bad" carbs like bread and pasta have all been recommended for reducing inflammation and C-reactive protein.

This is still a new area for medicine. If you get standard blood work done, you won't see C-reactive protin on the lab report. There seems to be evidence that reducing chronic inflammation through diet and exercise is a good idea. So where does that leave me? I'm going to rethink pancakes and muffins, change what I pack in our lunches, lean more towards bulgur and less toward rice, substitute sweet potatoes for potatoes whenever possible, suggest red wine instead of beer, and keep drinking unsweetened cocoa.

I've had a look at the South Beach diet and Neal Barnard's diet, and I'm wondering: what about Thanksgiving? And Christmas?

1. RPT-Crestor study seen changing preventive treatment. Bill Berkrot and Ransdell Pierson. Reuters
2. JUPITER - Crestor 20mg Versus Placebo in Prevention of Cardiovascular (CV) Events. Clinical Trial Registration.
3. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. Paul M Ridker, M.D. et al. WWW.NEJM.ORG. November 9, 2008 (10.1056/NEJMoa0807646)
4. Statin therapy alters the relationship between apolipoprotein B and low-density lipoprotein .... Ballantyne CM et al. J Am Coll Cardiol. 2008 Aug 19;52(8):626-32.
5. Genetically Elevated C-Reactive Protein and Ischemic Vascular Disease. Nordestgaard et al. New England Journal of Medicine. Volume 359:1897-1908 October 30, 2008.
6. CONSENSUS CONFERENCE REPORT: Lipoprotein Management in Patients With Cardiometabolic Risk. Witztum et al. Am Coll Cardiol, 2008; 51:1512-1524, doi:10.1016/j.jacc.2008.02.034 (Published online 27 March 2008).
7. Low Carbohydrate, High Fat Diet Increases C-Reactive Protein during Weight Loss. Turpyn et al. Journal of the American College of Nutrition, Vol. 26, No. 2, 163-169 (2007).

internal link repaired on 27 Feb 2009

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Insulin -- What it Does and Why

In the past few years, we've heard a lot about the relationship of insulin and blood sugar, but there's a lot more to it. Insulin is a complicated hormone with a lot of effects on the metabolism and circulation.

What Insulin Does
When cells receive the insulin signal, they:

• Take up glucose from the blood for fuel. Liver and muscle cells also make glycogen and store it for later in the day.
• Take up fatty acids from the blood to make triglycerides (glycerine plus 3 fatty acids) for storage
• Take up circulating amino acids from the blood to make more proteins
• Take up potassium from the blood
• Slow down the rate at which they break down proteins
• Slow down the rate at which they convert triglycerides into fatty acids
• Slow down the rate at which they convert protein and fat into sugar
• Relax the arterial wall muscle, increasing blood flow, especially to smaller arteries, keeping blood pressure low.

Source: Wikipedia article on Insulin

Why Insulin is Released

When blood sugar rises, the beta cells that produce and store insulin take it up and use it to produce ATP, every cell's quick-energy source. When the level of ATP is high enough, the beta cells start releasing insulin.

But sugar is not the only source for ATP production. And a high-protein or high-fat meal can cause higher insulin than a high-starch meal can. Without even raising the blood sugar.

Insulin Release at Wikipedia

ATP at Wikipedia, Beta-Oxidation at Wikipedia,

An Insulin Index of Foods

Insulin Resistance

When cells encounter a lot of insulin a lot of the time, they start to ignore it. If the situation continues, they become insulin resistant. If the pancreas can manage it, it will release even more insulin. Some of the effects of insulin resistance are:

• High blood sugar after meals, as the cells ignore the signal to take it up from the blood.
• Low blood sugar between meals. The body does not release enough glucose from the previously-stored glycogen to supply the body's energy needs -- this can lead to mental "fogginess"
• Higher levels of triglycerides in the blood
• High blood pressure.
• An increase in fat storage around the abdominal organs.

Source: Insulin Resistance at Wikipedia

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Bulgur -- better than rice

Bulgur wheat has a lower glycemic index than rice. NutritionData estimates the glycemic loads of 100g of brown or white rice at 11, while the glycemic load of bulgur is 7 for the same 100g. This means bulgur is somewhat better for blood sugar and causes less inflammation than rice, which makes bulgur a bit better than rice for preventing or controlling heart disease or diabetes. Every little bit helps.

You can cook whole wheat kernels, or berries, too. The nice thing about bulgur is that it is parboiled -- partially cooked and then dried. This means it cooks faster than raw wheat kernels -- as fast as or faster than rice. Medium or finer grind bulgurs don't even need to be boiled -- just bring to a boil, stir, and soak for 10 to 20 minutes (depending on the size of the cracked grain), then fluff with a fork and serve like rice.

Bulgur may have originated in Bulgaria, and has been eaten all around the Eastern Mediterranean for thousands of years. Some classic dishes are tabbouleh, a cold salad dressed with lemon and mint, and kibbe, a stuffed ball of bulgur.

In the bulk bins of health food stores and large supermarkets, bulgur may be twice the price of store-brand brown rice. In 18- to 24-ounce boxes on the "natural foods" aisle, it may be up to 4 times that price.

Bulgur is wheat. It may not be a good choice if you you suffer from celiac disease or wheat allergy.

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A Better Breakfast

Suppose you've been eating Cheerios for your cholesterol, with a quarter-cup of raisins to get some fruit, and yogurt because you are lactose-intolerant. Sound like a healthy breakfast? There are worse breakfasts, but if you are having trouble with your blood sugar or triglycerides, maybe you can fine-tune this breakfast a bit. Flavored yogurts are high in sugar, and so are raisins. And the starches in Cheerios are very easy to digest. All these foods have high glycemic indices. So what are you supposed to eat for breakfast? How about a nice bowl of cereal and a little fruit? Just make it a better bowl of cereal and a better fruit. All-Bran with unsweetened low-fat soymilk and blueberries certainly seems like an example of a better breakfast.

Cheerios yogurt raisins	All-Bran soymilk raisins	All-Bran soymilk blueberries
1 cup (30g) Cheerios 6 oz (184g) Vanilla low-fat yogurt 1/4 cup (41g) Seedless Raisins   Calories: 390 Fat: 4g Carbohydrates: 80g Fiber: 5g Protein: 14g Est. Glycemic Load: 44 Inflammation Factor: -236	1/2 cup (31g) All-Bran cereal 1/2 cup (112 g) Soy Milk* 1/4 cup (41g) Seedless Raisins   Calories: 237 Fat: 2g Carbohydrates: 60g Fiber: 11g Protein: 8g Est. Glycemic Load: 31 Inflammation Factor: -120	1/2 cup (31g) All-Bran cereal 1/2 cup (112 g) Soy Milk* 1/2 cup (77.5g) Blueberries**   Calories: 153 Fat: 2g Carbohydrates: 37g Fiber: 11g Protein: 7g Est. Glycemic Load: 14 Inflammation Factor: 11

* WestSoy unsweetened low-fat
** Unsweetened, frozen.

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