Less salt, more potassium, calcium, and magnesium

The 2010 USDA guidelines recommend 1500 mg or less of sodium each day for at least half the population -- including anyone over 51, with diabetes, high blood pressure, or kidney disease.

But have you ever looked at a can of soup? One half-cup serving of Campbell's condensed tomato soup has 710 mg of sodium -- that's half your daily allowance in a teacup. Or  make a pot of Wegmans beef chili, and get 1600 mg in a single serving. Luckily, you can find a recipe for Wegmans turkey chili with only 440 mg in a serving.

One thing diet researchers have learned is that potassium, calcium, and magnesium pills don't do much for blood pressure. But eating foods high in potassium, calcium, and magnesium leads to dramatic changes in blood pressure.  In the DASH study, researchers saw significant changes in blood pressure only days after study subjects started the DASH diet.

So eat fresh fruits and vegetables for potassium. Half of what you eat every day should be fruits annd vegetables.  For calcium, eat kale and drink low-fat dairy products, eat low-fat cheeses and yogurts. For magnesium, eat beans and peas, nuts (walnuts or almonds), seeds, leafy green vegetables, and fish like halibut. You'll also get some magnesium in your dairy products. Potatoes, watermelon, and bananas also contain magnesium.

Kale is the super food of the day -- rich in calcium, magnesium, and potassium, low in calories, and high in other important nutrients like iron, vitamins A, B,and C. And low in carbs, fat, and total calories. It is also high in vitamin K, which could be an issue if you taking coumadin (warfarin).

---

Read more here:

• Ways to eat more fruits and vegetables
• Greens -- an Introduction
• Recipe: A big pot of greens
• Recipe: Blackened beef with greens, potatoes, and rutabaga

Read more elsewhere:

• USDA dietary guidelines 2010
• Good sources of potassium, calcium, and magnesium
• How the DASH diet lowers blood pressure
• The best leafy greens

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Get Outside and Move Around in the Sun to keep your blood pressure low

Today is going to be a beautiful sunny day in Pennsylvania. Put on a sweater and get out in the fresh air....

Exercise and vitamin D both help keep your blood pressure low. They also make your heart, lungs, and brain stronger, lose a couple of pounds, preserve bone density and help you sleep well at night. Just get outside in the sun and move around. Or move around inside and soak up the sun separately. You can take your activity level up a notch, 10 minutes at a time, 3 times a day.

Anyone who can go around and around the mall for Christmas shopping can manage a little physical activity every day.

Anything that gets you out of the house is good. If you decide to join a club, volunteer to read with second-graders, or take an art class, you can choose to park a little way from the best entrance, then take an indirect route through the building to give you 10 minutes of walking. Or you can walk around in the mall. Or even join an aerobics or aquasize class, to make exercise less boring.

And remember the sunlight. As little as 10 minutes a day in the sun can give you more vitamin D than you could ever get from a pill.

Keep the stroke away. Move around every day.

• Vitamin D, the Sun, and your Heart
• Safe exercise when you have high blood pressure
• Exercise to sleep better
• Exercise benefits and tips

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Preventing Strokes -- lowering your blood pressure

High blood pressure is the leading risk factor for stroke. It increases your risk for hemorrhagic (bleeding) stroke and for ischemic (blockage) stroke. It damages arteries throughout the body....

Over time, it can create weak places that rupture easily, or thin spots that balloon out from the artery wall. It can make the arteries stiffer, and less able to move blood well. It can accelerate the build-up of fatty plaques, causing narrowing of the arteries. This is why it is important to maintain a healthy blood pressure, day after day after day.

In the short term, sudden spikes in blood pressure can cause problems, too, especially when stroke risk factors are high.

• When blood vessels are already weakened, high blood pressure can cause them to bleed
• If you have unstable plaques on your artery walls, high blood pressure can dislodge them, and the particles can block a narrow place in a blood vessel

This is why it is a good idea to maintain healthy habits every day.

The good news is that high blood pressure can be controlled through diet and exercise, and with the help of blood pressure medications.

A plan for lowering blood pressure would include:

• Becoming more Active
• Getting enough Vitamin D from diet and, especially, from sunlight. Just 10 minutes of direct sun a day could be enough.
• Maintaining a Healthy Weight through diet and exercise
• Reducing salt in your diet, by reducing processed and canned foods, and choosing lower-salt versions of foods like tomatoes and beans
• Getting more Potassium, Calcium, and Magnesium in your diet, by eating fresh fruits and vegetables, lowfat and nonfat dairy products, and beans, seeds, nuts, halibut, tomatoes, potatoes, bananas, watermelon, and leafy green vegetables
• Manage stress.

More reading

• Stroke and High Blood Pressure, the State of Victoria, Australia, Better Health Channel
  
• Stroke and High Blood Pressure, The American Heart Association.

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Preventing a Stroke

If you've just had a mini-stroke, you have a 40% risk of having a big stroke eventually, and about a 10% chance of having that "big one" in the next three months.
You can't bring that risk down to 0 immediately, but you can dial it back considerably. Your doctor will probably recommend a lot of tests. It's hard to see excactly what's going on in every blood vessel in your body, so the doctor will order up blood tests. Blood pressure, blood sugar, cholesterol, triglycerides, C-reactive protein (and A1C, if you are diabetic). The doctor might have something to say about your weight and your physical fitness level, too. Your doctor will set some goals about where all of these values should be, and when they should get there. And maybe even give you some tips on diet and exercise.
But every body is different. Your doctor may or may not have recommended a particular diet or excercise. You can find out about exercise and diet to meet your health goals and reduce the risk of stroke....

If you've read about strokes, you'll know that they can be caused by

• blood vessels getting narrow from growing plaque deposits, and blocking blood flow
• broken bits of blood clots or unstable plaques travelling to a narrow place in a blood vessel (maybe one narrowed by plaque) and blocking blood flow
• damaged blood vessels breaking, causing reduced blood flow downstream, and pooling of blood in the brain at the break

The National Institute of Neurological Disorders and Stroke says the most important treatable risk factors for stroke are

• Lower your High Blood Pressure
  • Increase potassium in your diet, and reduce salt
  • Get enough vitamin D (10 minutes in the sun)
  • Take medication to lower your blood pressure; avoid medications (like decongestants) that raise it
  • Get more exercise
  • Maintain proper weight
• Quit Cigarette Smoking. It raises blood pressure, contributes to heart disease, thickens blood.
• Treat Heart Disease
  • lower your blood pressure (see above)
  • if your doctor says so, take a blood thinner (like aspirin) to prevent clots
  • improve your diet to slow plaque development
  • get checked for coronary artery disease, valve defects, irregular heart beat, or enlargement of the heart, which can all lead to blood clots
• Warning signs or history of TIA or stroke
  • Learn the warning signs of a stroke and be prepared to call 911 early
  • A second stroke could be twice as bad, if it affects a part of the brain doing double duty for the section damaged in an earlier stroke.
• Blood sugar, insulin, and diabetes
  • Reduce blood sugar and insulin to control blood pressure
  • Reduce blood sugar and insulin to protect your blood vessels
  • Reduce blood sugar and insulin to control heart disease
  • reduce blood sugar to reduce the amount of brain damage during a stroke
• Balance your Cholesterol
  • Reduce your LDL to reduce plaque buildup, atherosclerosis, blood vessel narrowing
• Increase your Physical Activity
  • Inactivity is associated with hypertension, heart disease, and diabetes
  • Aim for a good waist circumference to hip circumference ratio -- a high waist-to-hips ratio raises the ischemic stroke risk by 300%

---

References

• Preventing Stroke: Treatable Risk Factors, National Institute of Neurological Disorders and Stroke.
• Vitamin D Levels Linked with Health of Blood Vessels, and Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans.

Read all of "Preventing a Stroke" ...

More about strokes

Within three months of having a TIA [mini-stroke], about 10% to 15% of people will have an actual stroke." That means that, if you have had a mini-stroke in the fall, you have better than a 1 in 10 chance of having a big stroke before winter is over. Maybe just in time for Christmas....

The good news is that "chances of preventing a major stroke with the appropriate treatments following a TIA are excellent". But only if you seek medical attention right away, and follow through "with the treatments and recommendations" of your health care providers.

It means making extra trips to the doctor's office. As many as you need. It means making sure the doctor understands you. It means making sure you understand everything the doctor wants you to do.

It means getting exercise, getting out in the sunlight, and improving your diet.

It means doing your own reasearch, so you can understand what is going on in your body. You are in charge of your own health.

There is plenty of information available about strokes. For example, there is the WebMD Stroke Health Center. You can even find Stroke Risk Calculators online, like this one from the UCLA Stroke Center.

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Diets high in refined carbohydrates and fats are unhealthy

"Chronic consumption of a high-fat, refined-carbohydrate (HFS) diet causes hypertension." That's the first sentence of the abstract of a 2002 study. Diets high in refined carbohydrates and fats have been implicated in weight gain, high blood pressure, diabetes, and heart disease. No debate there. The question is -- what SHOULD you eat?...

Several approaches have been championed:

1. Cut back a little on the fats and refined carbohydrates; eat more "good carbs"


2. Go low-carb; Get most calories from fats; get carbs from green vegetables


3. Go low-carb; Get most calories from proteins; eat more vegetables; only eat "good carbs"


4. Go low-fat; Get most calories from carbohydrates; eat more vegetables; only eat "good carbs"

Option 1 is a modest approach, like the American Heart Association and American Diabetes Association dietary recommendations. And those who follow these recommendations can expect to see modest improvements in the rate at which their health deteriorates. They might see some reduction in high blood pressure, some improvement in their cholesterol, some improvement in blood sugar control, and some weight loss. The big benefit of option 1 is that it is not so terribly different from what everyone around us is already eating. It's easy to find the recommended foods in restaurants and grocery stores, easy to eat a little less white bread, a little more brown rice, a smaller cut of steak, a little less potato, a little more salad.

The other approaches are a bit more radical. Low-carb approaches, from Atkins to South Beach to the Zone to Dr. Bernstein's prescription seek to eliminate the most obvious source of blood sugar -- sugars and easily-digested starches. Once after-meal blood sugar spikes are eliminated, insulin sensitivity improves. Lower blood sugar and lower insulin mean less inflammation, and less variation in blood sugar means fewer incidents of low blood sugar. Carbohydrate cravings sometimes taper off. Patients lose weight, and their cholesterol improves, even if they are eating a fatty diet. Many studies show that these high-protein and high-fat diets perform much better than ADA- or AHA-like diets.

High-carb approaches, like those from Dean Ornish or Neil Barnard, seek to eliminate blood sugar problems through the use of "slow-release" "good carbs" that are not quickly digested. At the same time, they improve insulin sensitivity by reducing the fat in the blood and in muscle cells. Lower blood sugar and lower insulin mean less inflammation, and less variation in blood sugar means fewer incidents of low blood sugar. Patients lose weight, and their cholesterol improves. Many studies show that these low-fat, good-carb diets perform much better than ADA- or AHA-like diets.

The problem with these types of diets is that they are big changes for most of the people who would benefit most from the switch. They involve unfamiliar foods, "weird" food substitutions (fake fats or fake carbs), and, sometimes, supplements to make up for eliminated food groups. An Atkins-like diet requires a lot of vitamin and mineral supplementation to make up for the missing fruits and grains. Barnard's vegan diet requires a B12 supplement to make up for the missing animal products.

The strange thing is, some high-fat foods like meats can raise insulin more than high-carbohydrate foods like popcorn. And high-fat diets can raise blood glucose more than high-carbohydrate diets. Low-Fat diets can do more for endothelial health than low-carbohydrate diets. All of these findings would sem to favor low-fat diets.

But the data is not all in. Studies by proponants of high-fat diets seem to favor high-fat diets, while studies by proponants of low-fat diets seem to favor low-fat diets. Things that most researchers seem to agree on are:

• Diets that cause inflammation are bad


• Foods that contain antioxidants are helpful.


• Fiber is good


• Bad Carbs are bad; low-glycemic-index carbs are the best carbs.


• Omega-3 polyunsaturated fatty acids are better than most Omega-6 polyunsaturated fatty acids.

Christian K. Roberts, Nosratola D. Vaziri, Ram K. Sindhu, and R. James Barnard A high-fat, refined-carbohydrate diet affects renal NO synthase protein expression and salt sensitivity. J Appl Physiol 94: 941-946, 2003. First published October 25, 2002; doi:10.1152/japplphysiol.00536.2002 8750-7587/03

Anthony Accurso,1 Richard K Bernstein et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond). 2008; 5: 9. Published online 2008 April 8. doi: 10.1186/1743-7075-5-9.

Susanne HA Holt, Janette C Brand Miller, and Peter Petocz
An insulinindexof foods:the insulindemandgeneratedby
1000-kJ portions of common foods http://www.ajcn.org/cgi/reprint/66/5/1264.
Am J Clin Nutr 1997;66:1264

Caroline Vidon, Philippe Boucher, Ana Cachefo, Odile Peroni, Frédérique Diraison and Michel Beylot
http://www.ajcn.org/cgi/content/full/73/5/878
Effects of isoenergetic high-carbohydrate compared with high-fat diets on human cholesterol synthesis and expression of key regulatory genes of cholesterol metabolism
American Journal of Clinical Nutrition, Vol. 73, No. 5, 878-884, May 2001

Shane A. Phillips; Jason W. Jurva; Amjad Q. Syed; Amina Q. Syed; Jacquelyn P. Kulinski; Joan Pleuss; Raymond G. Hoffmann; David D. Gutterman http://hyper.ahajournals.org/cgi/content/abstract/51/2/376 Benefit of Low-Fat Over Low-Carbohydrate Diet on Endothelial Health in Obesity
Hypertension. 2008;51:376.)

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Food Choices that improve cholesterol and blood sugar.

A review of studies on how what we eat affects our bodies right after a meal says that, when you eat too much fat or highly-processed carbohydrates in one meal, your blood sugar and triglycerides go up quickly. Your body can't metabolize this excess very well, and you wind up with free radicals, oxidative stress, inflammation, and a stress response. You will have immediate increases in blood pressure, oxidation of LDL cholesterol, C-reactive protein production, and risk of blood clotting. This can go on for longer than four hours after a meal, at which time you'll be nearly ready for another meal....

Post-prandial "glucose excursions" are associated with risk of cardiovascular disease (atherosclerosis or hardening or narrowing of the arteries), which can lead to a heart attack, a stroke, or cognitive decline (where you have more and more trouble with memory and alertness, and become confused more often) -- all because of poor circulation to your heart and brain. On top of that, those spikes in blood sugar and insulin will lead to excess fat deep in your belly (called visceral fat), which increases your risk of diabetes and high blood pressure.

The good news is that most people can slow down the rate at which these bad things happen, or even stop them, just by making a few changes in how they eat. You can probably reduce your risk of heart disease or even lose belly fat.

Eat Better Carbs
Cut down on white bread, white rice, and white potatoes. Substitute pasta, whole unmilled grains (like brown rice and bulgar), and even pasta. Avoid highly-processed foods that have a lot of sugar, high-fructose corn syrup, white flour, and processed starch. Then substitute more vegetables like broccoli and spinach for some of the grains and potatoes. Eat "good carb" fruits like citrus, cherries, and berries.

I tried this one out last Friday. I made a pasta salad, but added quite a lot of chopped vegetables. Little bits of leftover grilled asparagus, red peppers, broccoli, onion, some fresh herbs from the garden, a little carrot and celery, a few peas, and some small red beans. It was colorful and delicious, and there was less room in the bowl for pasta.

Eat better fats
Avoid trans fats and saturated fats. Use modest amounts of olive oil or nut oils, and get some fish oils for their omega-3 fatty acids. The omega-3 fatty acids improve the after-meal triglycerides and reduce inflammation and risk of heart disease.

I'm working on adding one meal of fish per week to my family's menu, and maybe working up to two meals a week. Tuna sandwiches and tuna in the pasta salad go over pretty well.

Eat foods that slow digestion
Like nuts, vinegar, and cinnamon, and high-fiber foods like lettuce, spinach, and broccoli. A nice big serving of green salad dressed with vinegar and a little olive oil can lower your after-meal blood sugar by 25% or more and help you to feel more full. And a very small serving of nuts gives you antioxidants and decreases after-meal oxidative damage.

So I've tried having a small handful of plain, unsalted almonds as an evening snack, as a substitute for a small snack of pretzels. I pack low-sugar fruit cups in the kids' lunches instead of pudding cups, and include a bundle of carrot sticks. I try to serve a green salad or (when I can get them) a fresh beet salad dressed in vinegar. I've also found the kids are less likely to make faces at cooked greens if I serve them with vinegar.

Eat a little lean protein
At each meal to keep your metabolism up. This includes egg whites, fish, game meat (and other very lean red meats), skinless poultry breast, and nonfat dairy protein. They can decrease after-meal inflammation and help with losing weight.

Does nonfat milk on the quick oats at breakfast count?

Eat modest-sized servings
So your body can handle the load. Foods that help you feel full will help. They authors recommend vinegar and high-fiber foods.

We actually bring measuring cups to the table to help with this.

Move
Get 30 minutes or more per day of moderate or stronger physical activity. Even light exercise, if you keep up with it daily, can help. 90 minutes of exercise within 2 hours before or after a meal can cut your after-meal blood sugar and triglycerides in half.

Here's where I could really help myself some more, although the rest of my family doesn't seem to have a lot of problem. I think I'm spending too much time looking for health information and writing about it, and need to spend more time weeding the garden.

Keep a Healthy Weight
Strive for a waist size less than half your height.

Foods that reduce inflammation include fish oil and other omega-3 fatty acid supplements (since they reduce blood triglycerides), deeply-colored fresh fruits and vegetables, nuts, and cinnamon.

I think I've been doing a pretty good job in the last couple of years improving my family's diet. In the next few months, I'm going to put some focus on continuing to improve our carbohydrates, since there's a big benefit there. And I'll continue exploring the anti-oxidants. I really like the idea of improving my health with cocoa and cinnamon.

• J Am Coll Cardiol. 2008 Jan 22;51(3):249-55. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. O'Keefe JH, Gheewala NM, O'Keefe JO. Summary or full article available from medscape.
• Endocr Pract. 2008 Jan-Feb;14(1):112-24. Postprandial dysmetabolism: the missing link between diabetes and cardiovascular events?. Bell DS, O'Keefe JH, Jellinger P.

Last edited (corrected typos) 29 Oct 2008

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Anti-Inflammatory Diet Good for the Heart

An article featured in January's Journal of the American College of Cardiology says blood sugar spikes after a high-glycemic index meal causes a stress response, inflammation, raised triglycerides, blood thickening, and blood vessel tightening. This is called "postprandial dysmetabolism" and it isn't good for your heart. In fact, it's "predictor of future cardiovascular events". The authors of the paper suggest some dietary changes that will improve this situation right away. The PDF is available for download ($4.95) and a summary is available at Medscape.

Some of the highlights from the Medscape summary:

• Eat high-fiber meals and whole grains; get some protein at each meal; avoid white flour
• Avoid highly-processed foods and beverages containing sugar, high-fructose corn syrup, white flour, or trans fats.
• "Berries, dark chocolate, red wine, tea, and pomegranates" reduce inflammation after meals.
• If you must eat a high-glycemic-index meal, seasoning it with "cinnamon slows gastric emptying and reduces [after-meal blood-sugar spikes]"
• Eat nuts 5 times a week after meals
• Season meals with vinegar to lower your blood sugar and feel more full.
• While you are exercising, your blood sugar and triglycerides drop almost immediately.

The abstract also mentions fish oil, but the Medscape summary doesn't have anything more to say about it or omega-3 fatty acids...

• J Am Coll Cardiol. 2008 Jan 22;51(3):249-55. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. O'Keefe JH, Gheewala NM, O'Keefe JO. Summary or full article available from medscape.
• Endocr Pract. 2008 Jan-Feb;14(1):112-24. Postprandial dysmetabolism: the missing link between diabetes and cardiovascular events?. Bell DS, O'Keefe JH, Jellinger P.
  

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How Much Cocoa do the Kuna Drink?

I finally came across a piece of information I've been looking for -- how much flavanoid do the Kuna get from their daily cocoa. Right in the abstract of a 2007 paper from NK Hollenberg (who has done a lot of cocoa research in conjunction with the MARS(TM) nutritional research team), it says that the Kuna living in the San Blas islands get more than 900 mg/day of flavonoids. So if cocoa flavanols really are the factor preventing hypertension, heart attacks, diabetes, and cancer in the San Blas, then the effective dose must be 900mg/day or less. That is potentially a lot of cocoa....

The researchers observed that Kuna populations living in the San Blas had strikingly lower incidence of death from heart disease, stroke, cancer, and diabetes millitus than Kuna living on the Panama mainland.

Of course, cocoa consumption is not the only difference between the two Kuna populations and the information on their death certificates. The authors propose several other potential contributing factors:

• Differential diagnosis -- medical care is not as good on the islands, so some cases of these diseases may have been missed on the islands furthest from hospitals and clinics
• Stress is slightly lower in the islands
• There might be other dietary differences besides cocoa between island and mainland Kuna
• Island inhabitants may have a higher level of physical activity.
• The air and water might be more polluted on the mainland, especially in and near the city.

How to eat more chocolate for your heart -- and how to drink cocoa black

Does Flavanol Intake Influence Mortality from Nitric Oxide-Dependent Processes? Ischemic Heart Disease, Stroke, Diabetes Mellitus, and Cancer in Panama. Vicente Bayard, Fermina Chamorro, Jorge Motta, and Norman K. Hollenberg. Int J Med Sci. 2007; 4(1): 53–58.

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Does Chocolate Lower Blood Pressure?

There has been so much attention paid lately to the effect of cocoa on blood pressure. These studies mostly seem to show a relationship between the consumption of cocoa flavanols and blood pressure. All except for one US study. Now, in a study with funding from Mars (maker of CocoaPro(TM) and CocoaVia(TM) products), researchers observed "blood pressure, heart rate, and glycemic control were unaffected", even at levels of 963mg of cocoa flavanol per day.

That would seem to be a disappointing result..., and you might wonder why the researchers would go to the trouble and expense to get it published. But actually, in this 10-subject "feasibility" study, the diabetic subjects experienced 30% improvement in Flow-Mediated Dialation. This means their arteries were more able to relax, according to a press release from Mars. And any improvement in blood vessel function is good news for diabetics, who are at high risk for heart attacks and strokes. And, according to a Science Daily Article, "blood vessel function went from severely impaired to normal." Which is an enormous improvement.

But why, since cocoa flavanols have been shown to cause blood vessels to relax, doesn't this study show improvements in blood pressure? And why have earlier studies (such as those I mentioned here) shown significant improvements in blood pressure? And why are the people of the autonomous Kuna comarcas of Panama apparantly immune to high blood pressure? Is it the 100% cacao beverage they drink all day long, or something else?

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Is Cinnamon good for the heart?

Cassia Cinnamon (the least expensive species of cinnamon sold in the US) like chocolate, is full of flavanols, which can lower blood pressure. In fact, Cassia has a lot of active compounds in it. Some are beneficial, while some are not. Some researchers have reported such dramatic results that you would certainly want to talk to your doctor before adding large quantities of cinnamon to your diet.

• Water-soluble compounds: flavanols, proanthocyanidins and oxidized proanthocyanidins
  
  • flavanols and proanthocyanidins found in cinnamon might lower blood pressure and improve circulation. (Or it might not)
  • Proanthocyanidins, when mixed with water in a basic solution, will oxidize. Some of these oxidized proanthocyanidins might improve insulin sensitivity
  • methylhydroxychalcone polymer (MHCP) one polyphenol compound, found in several cinnamon species, has stimulate insulin-like responses in living cell experiments.
  • Some other water-soluble compounds could slow down the progression of alzheimer's disease or amyotrophic lateral sclerosis
• Alcohol-soluble compounds: estrogen-like compounds that might help prevent osteoporosis.
• Oil-soluble compounds: coumarin and other essential oil componants

The big problem with cheap and tasty cassia cinnamon is... coumarin, a potent blood thinner, from which the prescription blood thinner Warfarin (known as Coumadin and by other brand names) was derived. In addition to thinning the blood, it can put a strain on the liver, even causing liver damage which is, fortunately, reversible. Coumarin has been used since the 1880's to give perfumes that "green" scent of new-mown hay, and it is found in other plants common around the world. Cassia Cinnamon contains 4% essential oil, of which 7% is coumarin. So it is .28% coumarin. If you eat 1 gram of cinnamon (1/4 teaspoon) of cassia a day, you would get 2.8mg of coumarin The German government recommends a tolerable daily input of no more than .1 mg Coumarin per kg bodyweight, so a person weighing 110 pounds (50 kg) could afford to eat 5mg Coumarin (1.78g of cassia) per day. It is probably a good idea to stay within this safe daily limit for powdered cinnamon.

Since coumarin is not soluble in water, scientist in the lab of leading cinnamon researcher Richard Anderson have made hot water extracts (tisanes) to leave the toxic coumarin behind. They used basic solutions to help dissolve the compounds that help diabetics the most MHCP. Then they found out a polyphenol is important for improving blood sugar. For lowering blood pressure, the flavanols and proanthocyanidins are most important. And these break down in a basic solution. So, for lowering blood pressure, plain hot water might be better. If you were to add 1/4 teaspoon of cinnamon to 1 cup of hot water, and let it steep for a while before filtering through a coffee filter, you would get most of the polyphenols (these researchers, using grape powder, used a centrifuge to recover over 90% of polyphenols from their powdered sample; you'd probably get less through a coffee filter).

So -- is cinnamon good for your heart? The answer seems to be: yes and no. Up to 1/4 teaspoon daily of cassia cinnamon might be risk-free for most adults. It might or might not help bring down blood pressure and/or help improve cholesterol or diabetes. Larger amounts might be bad for you because of the coumarin. You might get the benefit of the flavanols by making tea from your cassia. Or you can use a water-extracted cinnamon extract, like those researchers did.

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How to Eat More Chocolate for your heart

"Eat more chocolate" sounds wonderful. But it's a bit vague. What kind? How much? When? With what? As the designated nutritional expert of the family, it's my job to figure this out.

I know how to eat chocolate. I know how to eat more chocolate. I know what happens if you eat an entire pound of chocolate the day after Valentine's day. And I know that the 100g (3.5 oz) candy bar used in the famous European cocoa studies contains 480 Calories (2008 kilojoules), mostly from sugar and cocoa fat. Not exactly what most of us need...

The Kuna people of the San Blas islands drink 5 8-oz cups a day of ground cacao boiled in water, which seems to make them immune to high blood pressure. But how much cacao? Nobody's saying. Maybe the answer is in this paper that I haven't paid to read because I'm not convinced it has what I'm looking for.

Three famous European studies used the Ritter Sport 100g Halbbitter bar, which contains 500mg of polyphenols. Younger hypertensives saw the most improvement on this diet -- an average of nearly 12 points systolic, 8 ½ points diastolic. Older hypertensives saw smaller improvements at the some dose. Other studies showed that less cocoa means less improvement. The one US study showed no improvement at a dose of 294mg per day. No clues why this study showed different results from all the others.

I figured 500mg of polyphenols seems like a good starting point. There are about 200mg of polyphenols in a half-ounce of 100% cacao (baking chocolate), and 74 calories (mostly from the cocoa butter). There are also about 200mg of polyphenols in a tablespoon of natural cocoa, and only about 12 to 20 calories, depending on the fat content of the cocoa.

Here are some ways to get more cocoa into your diet with out so much fat and sugar:

• Stir a tablespoon of cocoa into boiling or near-boiling water. For a strong and bitter but muddy-looking drink, very different from Swiss Miss.
• Substitute milk for some of the water (Recent studies suggest that milk does not affect the absorption of flavanols, though it might affect their metabolism).
• Stir a tablespoon of cocoa into a bowl of oatmeal. The the carbohydrates may speed up flavanol absorption.
• Or mix some cocoa with melted baking chocolate and a bit of honey to create a confection. The recipe below gives you 1/2 ounce cacoa and 1 1/2 tablespoons of cacao in every serving. Because it uses cocoa powder, it is not as creamy as chocolate, which is conched until very smooth (and lower in bitter flavanols).

Chocolate Cocoa Patties

Recipe By: Family Nutritionist
Serving Size: 4


-= Ingredients =-
1 oz Baking chocolate ; 100% cacao, unsweetened
4 teaspoon Honey
3 tablespoon Cocoa powder

-= Instructions =-
Gently warm baking chocolate until you can stir it. Stir in the cocoa and honey. Form into 4 balls or patties. Cool and eat one per day.

Serving: .1 cups (22g), Calories: 77: Fat: 5g : Sodium: 3mg
Protein: 2g, NetCarbs: 8, K: 186mg
SatFat: 3g, PolyFat: 0g, MonoFat: 2g, Chol: 0mg
TotCarbs: 12g, Fiber: 4g, Sugars: 6g
Calories: 57.0% from fat, 41.6% from carbohydrates 02.6% from protein

NFCS: 6.54g Cinnamon: 0.0g : Fats: 0.84: Sweets: 0.4
PA: 269.1 mg, 1-3 mers: 82.48 mg

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The Right Chocolate for your heart

Chocolate is made from the seeds of the cacao tree. These seeds are rich in flavonoids (aka bioflavonoids), a class of antioxidant polyphenol. Along with some flavonols like quercetin, cacao seeds contain a lot of flavanols like catechin and short chains of flavanols called Proanthocyanidins (aka procyanidins).

Researchers soon concluded that cocoa flavanols (catechins and proanthocyanidins) are responsible for the Kuna peoples' apparant immunity to high blood pressure and began measuring the flavanol content of many foods. Cinnamon (8%), cocoa(.7%-5%), sorghum bran(4%), and grapeseed(3.5%) turn out to be the foods with the most flavanols, with baking chocolate(1.6%) not far behind. Dark (.2%) and milk (.1%) chocolate, with less than one tenth the flavanol content of cocoa, are a bit further down the list.

So it can matter which chocolate you choose.... Different varieties of cacao plant make beans with different amounts of flavanols. Cocoa flavanols are destroyed when the cacao beans are fermented, roasted, or processed with alkali (as in "dutched" cocoa), and when chocolate is "conched", or milled smooth. Some foods combined with cacao products might make it hard for you to absorb the flavanols. Natural cocoa powders contain 3-5% flavanol, while dutched cocoas are about 1% flavanol. Unsweetened (100% cacao) chocolates vary from about 1.9% to 2.5% flavanol, and are about 50% cocoa butter. Dark chocolates vary from about .85% to about 2.0% flavanols.

It is hard to know exactly what any off-the-shelf product contains, unless you happen to have access to some very expensive lab equipment and sophisticated software. Several chocolate companies supported studies to analyze their products via the American Cocoa Research Institute, but will not reveal which values belong to their products. Other companies, not part of the ACRI, may or may not have had their products analyzed, but are not supplying flavanol content information in any case. They may be trying to avoid making illegal health claims for their products.

I've contacted Hershey, Nestle, Baker's Chocolate, and Ghirardelli, asking if they can give minimum values for some products (natural cocoas and 100% cacao bars). The big companies simply chose to email me their answers to slightly different questions, while Ghirardelli told me plainly that they do not measure the flavanol content of their products. Mars promises a minimum of 200mg of flavonols per serving of its CocoaVia(TM) products, which contain proprietary high-flavanol CocoaPro(TM) process cocoa. Barry Callebaut has developed an ACTICOA(TM) process, which is said to preserve 70% of cocoa flavanols, but is not marketing any of its products directly to consumers.

• Hollenberg et al. Cocoa, Flavanols and Cardiovascular Risk. Br J Cardiol 11(5):379-386, 2004
  
• Liwei Gu et al. Concentrations of Proanthocyanidins in Common Foods and Estimations of Normal Consumption. J. Nutr. 134:613-617, March 2004


• Gu, L et al. Procyanidin and catechin contents and antioxidant capacity of cocoa and chocolate products. J Agric Food Chem. 2006 May 31;54(11):4057-61.
  

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Chocolate and Cinnamon are good for the heart

Even a little bit of the right kind can lower your blood pressure and cholesterol. It works much better than tea. And a big piece of chocolate can improve your blood sugar, too. And cinnamon can improve your blood pressure and blood sugar. Cinnamon and cocoa seem to have fewer adverse side effects than prescription drugs.

In a recent Italian study, patients in their 30's reduced their high blood pressure an average of 11.9 points systolic and 8.9 points diastolic after eating a popular German candy bar for only two weeks. Several other chocolate studies are summarized here. And the Kuna people of the San Blas Islands of Panama seem to be immune to high blood pressure -- as long as they drink their cocoa.

With your doctor is monitoring you regularly, the best-case scenario would be a 10-point drop in systolic and 8-point drop in diastolic blood pressure in a couple weeks, putting a prehypertensive back into the normal range. Even a 5-point drop that showed up over a couple of months would be worth celebrating. The worst-case scenario is no change, in which case you've bought and enjoyed chocolate for several weeks, and are no worse off. Unless you have migraines or a chocolate allergy, there is very little risk.

You just need to choose the right chocolate.


1. Cocoa can cause allergic reactions or trigger migraines in some people. Children shouldn't eat too much cocoa or chocolate. Chocolate and cocoa might cause decreased bone density in older women. Or not.
2. Cinnamon rarely causes an allergic skin reaction. Cinnamon can thin the blood and might have an estrogenic effect.

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Perfect Chipotle Meatloaf

At The Perfect Pantry, Lydia writes about Dry bread crumbs, in chipotle meatloaf. I love chipotles, and meatloaf is always a favorite at our house, so this recipe sounds promising. Lydia's suggested serving, though, supplies more than we generally need -- 5 1/3 ounces of meat, 400 calories and 1037 mg of sodium (close to my daily limit of sodium). 581 mg of that sodium comes from the 1 1/2 teaspoons of added salt, 158 mg from the ketchup, 116 from the bread crumbs, 56g from the romano cheese (I assume 2 Tablespoons grated is a fluffy half an ounce), and only 27 mg from the chipotles in adobo sauce (assuming a tablespoon is 14mg of chipotle with adobo).

The recipe is still a good one, if I increase the servings to 10, eliminate the added salt, and switch to low-sodium kethup. Each portion now contains 3 1/3 ounces of lean meat, 240 calories, and 175 mg of sodium -- better for my family!

I compared Lydia's meatloaf to my standby recipe, which has 3 1/3 ounces of ground turkey, 195 calories and 99 mg of sodium. Adding a proportional half tablespoon of chipotles in adobo and one tablespoon of romano cheese would add 9 calories and 30 mg of sodium, for a total of 205 calories and 135 mg of sodium. My recipe is slightly lower in fat because turkey is a leaner meat, and lower in sodium because oats are less salty than breadcrumbs. Because I already have dried chipotles on hand, I'd be just as likely to use them, maybe adding a little cumin nad oregano as well. That would give me about 108 mg of sodium per serving. These small difference might not be important to you unless you are watching your blood pressure or coddling your kidneys.

Turkey Meatloaf

This tasty meatloaf is quick and easy to prepare and low in calories, fat, and sodium. The kids love it.
Recipe By: DASH Eating Plan fact sheet, 2003

-= Ingredients =-
1 pound ground turkey ; lean
1/2 cup Quick oats ; dry
1 large Egg ; whole
1 tablespoon dehydrated minced onion
1/4 cup Low-sodium catsup
2 teaspoon no-salt added Seasoning ; italian, curry powder, etc.

-= Instructions =-
Preheat oven to 375°F
Mix all ingredients together and bake in loaf pan for 30-40 minutes, or until internal temperature is 165°F
Cut into 5 slices.

Nutritional Summary
Each (1/5 of loaf; 123g) serving contains:
Cals: 194, FatCals: 100, TotFat: 3g
SatFat: 2g, PolyFat: 0g, MonoFat: 1g
Chol: 130mg, Na: 98mg, K: 116mg
TotCarbs: 10g, Fiber: 1g, Sugars: 3g
NetCarbs: 9g, Protein: 22g

Food Group Serving(s)
DASH: Vegetables: 0.1: Fruits/Juices: 0.0: Dairy: 0.2: Grains: 0.0: Meat/Fish: 1.1: Seeds: 0.0: Fats: 0.0: Sweets: 0.4
USDA: Vegetables: 0.1: Fruits/Juices: 0.0: Dairy: 0.2: Grains: 0.0: Meat/Fish/Seeds: 3.4: Fats: 0.0: Sweets: 0.4

Nutritional information in this post calculated using bigoven. Food Group Servings calculated in EXCEL using http://www.mypyramid.gov/ and DASH diet references. Nutritional Information for La Costena Chipotle Peppers in Adobo Sauce from Wegman's online product catalog.

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Wegman's -- great source for nutritional information

Wegman's supermarket recently rolled out its new website, complete with nutritional data for every product they sell at every one of their stores. This means lots of information that you can't find even at nutritiondata.com.

For instance -- La Costena Chipotle Peppers in Adobo Sauce provide, in a 3-pepper serving (6 servings in a 7 oz can), 380 mg of sodium. Salty.

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