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.

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Christmas Traditions on a diet

When you decide to change your diet during the holidays, you're in a bit of a pickle. There was just no way to make any changes at Thanksgiving. Potatatoes, stuffing, cranberry sauce, and pies. It's tradition!

Now Christmas is approaching. And guess what. Christmas cookies are a tradition. Lots of sugar, white flour, and saturated fats. I've got low-fat wheat-flour cookies, and sugary no-flour cookies, and sugary, buttery cookies. But I can't make anything decent that matches up with any sort of diet recommended for people watching their triglycerides. No. I don't quite have the hang of the Splenda meringue, so it's off the list for this year. We made the cookies already. And we're sending them to our families and friends. We call these little devils gifts. It's a tradition!

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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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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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Sweet Potatoes -- better than potatoes

Sweet Potatoes: Japanese, Jewel, Okinawa, and Garnet

Sweet Potatoes are sweet. But they aren't potatoes. They're better. They raise your blood sugar and insulin a lot less than real potatoes do. Sweet potatoes have a low glycemic indexof 54, while baked potatoes have a high glycemic index of 85....

This can be important if you are diabetic or pre-diabetic, have heart disease, high blood pressure, high cholesterol or triglycerides. Because, as I've learned, a lot of damage to your heart happens right after a meal that raises your blood sugar too much. And Sweet Potatoes are good sources of Vitamin A, Vitamin C, B6, iron, potassium, and fiber.

Sweet potatoes are not yams, though orange-fleshed sweet potatoes are often called yams. Some people don't like the "pumpkin" flavor and moist, soft texture of orange sweet potatoes. Fortunately, there are other sweet potato choices, from the white-fleshed "Japanese" or "Kotobuki", to the pale yellow "Jersey", to the purple-fleshed "Okinawan". These all have a drier, fluffier flesh, with a mild to slightly nutty flavor.

Sweet potato muffins are still a big favorite of mine, but, more and more, I'm buying the Jerseys and the Japanese to replace baked or roasted potatoes at the dinner table. I think the Japanese "Kotobuki" would make a nice fluffy mash, but I haven't tried it yet.

A 100-gram serving of baked sweet potato has the same amount of carbohydrates (21g) as a 100g serving of baking potato. But the sweet potato has 3g of fiber, 6.5g of sugar, and 7g of starch (is it just me, or are there about 4g of carb missing from that equation?), while the baking potato has 2g of fiber, 1.2g of sugar, and 17.3g of starch.

Photo from Nakashima Farms, Ditty's Saturday Market, Livingston, CA.

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Vitamin D, the Sun, and your Heart

Vitamin D comes from the sun. Higher levels of Vitamin D go with lower blood pressure, better insulin and glucose regulation, a healthier immune system, stronger bones, and less chance of colon, breast, and prostate cancers. The US Food and Nutrition Board has recommended that 200IU (5 mcg) of vitamin D is adequate for young to middle-aged adults, but recent research indicates that might not be enough.

It's hard to get enough vitamin D from food. Fortified milk has less than 100IU per serving. Vitamins for adults usually contain 400IU. But, if you are not getting enough sunlight, a vitamin pill may not give you enough vitamin D...

The most important source for vitamin D is the sun. We can make all the vitamin D we need (up to about 20,000IU in less than an hour) if we get enough UVB rays on enough of our bare skin. A light-skinned person living near Boston can typically get enough vitamin D by going outside in shorts and a short-sleeved shirt, without using sunscreen, 3 times every week from mid-March to mid-October for 5 to 10 minutes between 11AM and 2PM. And be able to store enough to last through the winter, when there is not enough UVB light for making vitamin D. Further north, the "vitamin D winter" lasts longer. Closer to the equator, a person needs less time in the sun. Sunscreen blocks UVB rays -- that's its job. Even an SPF8 sunscreen cuts production of vitamin D by 95%. Darker-skinned people may need 5 to 10 times longer in the sun, depending on the amount of melanin (the dark pigment) in their skin. Older people may not be able to make vitamin D in their skin as quickly. People with liver disease may not be able to produce enough of the provitamin-D₃ that the skin uses to make vitamin D. Obese people may need more vitamin D because so much of it gets stored in body fat. There are a lot of variables.

Exposing your arms and legs to the sun for 20 minutes at the right place and time could get you a dose of 20,000IU of vitamin D -- much higher than we get from food. This means food is not the most important source of vitamin D. Which makes it hard to calculate an RDA for vitamin D from food. But, if people spend more time inside and more of their outdoor time using sunscreen, they'll have to get it from foods and supplements, or risk their health.

So get a little noonday sun every day for as long as summer last. In the Northern hemisphere, Vitamin D summer lasts until October or November, depending on how far north you live. It has already already begun in the northern Australia, and continues all year long in the tropics.

How much vitamin D is too much? Vitamin D toxicity has never been observed in people getting their vitamin D from the sun. Most people are unlikely to have any problem from as much as 10,000 IU/day from supplements. But some medical conditions (lymphoma, sarcoidosis, tuberculosis, and primary hyperparathyroidism) can cause a bad reaction to vitamin D pills.

• Vitamin D3 Daily Dose Forecast from the Institute of Medical Physics and Biostatistics, University of Veterinary Medicine Vienna (Alois Schmalwieser)
• Vitamin D from the Linus Pauling Institute

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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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Food and Mood

What happens when a 9-year old eats a bowl of cereal, runs around for 2 hours in the snow, and then tries to tackle a science fair project? Sudden negativity. Ready to quit the science fair. Convinced that her hypothesis is stupid. Resistant to looking at the graphs we have just made in EXCEL. Refusing to paste the data into her science fair notebook. Contrary and combative. Angry and nearly in tears.

We slogged on like this for an hour before I said to myself "Blood sugar," and declared it to be lunch time. "It is not lunch time, and I am not hungry," she said, so I boiled her an egg, which, predictably, she complained about. But she ate it, with a little orange marmalade, and was soon all smiles and ready to finish her lunch. Afterwards, she had a good attitude, was able to draw some conclusions about the data, and made much better progress on her project.

No surprise, really. Food for thought, though. We've been in the habit of starting the day with grains. Cold cereal or oatmeal with 8 ounces of milk and perhaps a fruit or 6 ounces of orange juice. But, after running around for two hours in the cold, my daughter had run out of energy.

So this morning, I decided to change the balance a little. Add a boiled egg, reduce the oats a little, don't forget the fruit, lose some sugar. First thing in the morning, though, it seems a child's blood sugar is low. No honey? No marmalade? Contrary, combative, angry, and nearly in tears. Eventually, she ate the experimental breakfast, and had the energy to run errands all the way until lunch time, without even stopping for a snack, though she did say she was hungry. Not the same as running around for two hours in the snow and then tackling a science project, but worth thinking about, all the same. Tonight, She boiled 4 eggs, and intends to have one in the morning. With a little orange marmalade.

Of course, I never get grumpy when my blood sugar runs low. Never.

Oatmeal Breakfast	Oatmeal and Egg Breakfast
1/2 cup Quick oats, prepared with water 1/4 cup raisins 1 cup skim milk	1/4 cup Quick oats, prepared with water 1/4 cup Raisins 1 cup Skim milk 1 hard-boiled egg
Each 435g serving contains: Cals: 329, FatCals: 22, TotFat: 2g SatFat: 1g, PolyFat: 1g, MonoFat: 2g Chol: 5mg, Na: 156mg, K: 856mg TotCarbs: 65g, Fiber: 5g, Sugars: 25g NetCarbs: 60g, Protein: 15g	Each 426g serving contains: Cals: 302, FatCals: 18, TotFat: 2g SatFat: 1g, PolyFat: 1g, MonoFat: 2g Chol: 5mg, Na: 154mg, K: 828mg TotCarbs: 60g, Fiber: 4g, Sugars: 25g NetCarbs: 56g, Protein: 14g
Food Group Serving(s) DASH: Vegetables: 0.0: Fruits/Juices: 1.0: Dairy: 1.0: Grains: 1.0: Meat/Fish: 0.0: Seeds: 0.0: Fats: 0.0: Sweets: 0.0 USDA: Vegetables: 0.0: Fruits/Juices: 0.5: Dairy: 1.0: Grains: 1.0: Meat/Fish/Seeds: 0.0: Fats: 0.0: Sweets: 0.0	Food Group Serving(s) DASH: Vegetables: 0.0: Fruits/Juices: 1.0: Dairy: 1.0: Grains: 0.8: Meat/Fish: 0.3: Seeds: 0.0: Fats: 0.0: Sweets: 0.0 USDA: Vegetables: 0.0: Fruits/Juices: 0.5: Dairy: 1.0: Grains: 0.8: Meat/Fish/Seeds: 1.0: Fats: 0.0: Sweets: 0.0

Nutritional information in this posting calculated using bigoven. Food Group Servings calculated in EXCEL using http://www.mypyramid.gov/ and DASH diet references.

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