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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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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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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Carbs don't tell the whole story

According to a 2005 study, the OMNIheart study found a way to improve on the DASH diet -- cut the carbs. But you wouldn't know it from any of the DASH-related websites, which still recommend the same number of servings of grain per day. You might think that family doctors would start handing out prescriptions for OMNIheart instead of DASH to their patients with high blood pressure... But no. Maybe they're all on the South Beach diet now. Maybe the OMNIheart study was a waste of US taxpayer dollars.

According to the OmniHeart paper and the original DASH paper, the macronutrient profiles of the diets stacked up like this:

	Control	DASH	OMNI Carb	OMNI Protein	OMNI Fat	Barnard
Carbohydrates	48%	55%	58%	48%	48%	75%
Fat	37	27	27	27	37	10
Protein	15	18	15	25	15	15

DASH and OMNIheart diets were all markedly better for the heart than control, but the lower-carb Protein and Fat diets did significantly better. Protein was best. But wait! Fat looks like Control here. And it did better? Distribution of macronutrients must not tell the whole story. And then there's Neil Barnard's 2006 trial of a high-carb vegetarian diet that improved triglycerides much more than any of the OMNIheart diets. Of course, Barnard's trial started with diabetics with worse triglycerides, and ran three times as long as the OMNIheart trial. So comparing it to DASH and OMNIheart is a bit like comparing apples to oranges. Still -- the very-high-carbohydrate diet is very effective at improving metabolic syndrome risk factors. It clearly does not cause the blood sugar, inflammation, and cholesterol problems that low-carbers have warned us about.

How can this be? If cutting carbs is a good idea, how can increasing carbs be a great idea? Which side is wrong? Maybe neither side -- there's more to the story. Barnard's diet has a lot of whole grains. And by whole, I mean entire. Not degermed, defatted, polished, ground, cut, rolled, folded, spindled, or mutilated in any way. His diet is very high in low-glycemic-index foods. It is very low in fats, and exceptionally low in saturated fats. He had to cut out animal foods entirely to get there.

It has been well-known for some time that the glycemic index (GI) and glycemic load (GL) of foods can predict their effect on blood sugar, cholesterol, inflammation, and heart health. But I didn't see any of this discussion in any of the studies. The two things the Barnard and OMNI Fat diets have in common are better carbs and less saturated fat than the Control diet.

Wouldn't you like to see these two diets in a cage match? Or else, can someone who has access to all of the data analyze the GIs of the meals and GLs of the diets to look for the correlation?

1. Glycemic index in chronic disease: a reviewL S Augustin et al. European Journal of Clinical Nutrition (2002) 56, 1049-1071. doi:10.1038/sj.ejcn.1601454
2. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. Appel LJ et al. JAMA. 2005 Nov 16;294(19):2455-64
3. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.Appel LJ et al. N Engl J Med. 1997 Apr 17;336(16):1117-24.
   

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Diabetes, overstuffed cells, and changing the way you eat.

I've just read Dr. Neal Barnard's Program for Reversing Diabetes. His main argument starts with reasons why your cells start to resist insulin. Insulin is supposed to signal the cells to take in the sugar that is available in the blood. But, if muscle cells already have enough sugar, or are storing a lot of fat, they start to ignore insulin's signal. The blood sugar stays high for some time, (which can be very bad for the body), and then the energy in the sugar gets used to produce fat, which the body will store in case you need it later.

He decided that diabetes sufferers need to

1. Reduce the fat in their muscle cells to make them more sensitive to insulin's signals and
2. Reduce the amount of sugar in the blood so you need less insulin in the first place.

His solution is a low-fat, high-fiber diet wherein most of your energy comes from slower-release carbohydrate sources, like sweet potatoes, intact grains, legumes, as well as All-Bran cereal, al-dente pasta, and the like. To keep fats low, the diet is vegan. Fats should be "good" anti-inflammatory mono and poly-unsaturated fats. The diet has performed very well in clinical trials. It reads quite a bit like Dean Ornish's diet for reversing heart disease, at least as it appeared in his earlier Eat More, Weigh Less. Only, Dean Ornish was advocating a vegetarian, not vegan, diet. Both books (and their Amazon reviews) contain testimonials and case histories of people who started the diet because their physical condition was so poor they were frightened, and who had spectacular success.

The thing is, an awful lot of people are not going to renounce steak, eggs, milk, and even wild-caught Pacific salmon unless they are awfully scared. And maybe not even then. And, let's face it, while many women often crave carbs, it seems that many men crave meat. And some of Barnard's substitutes (vegetable broth thickened with cornstarch for olive oil on salads) sound time-consuming and simply hideous.

Studies show Barnard's diet is effective for managing glucose and, even reducing or eliminating insulin dependance in diabetics. And it can probably control and/or reverse heart disease as well. It could be promoted as a gold-standard intervention for diabetic and pre-diabetic patients. But if Barnard's diet were the only choice on the menu, I imagine a lot of patients would head for another restaurant.

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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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Diabetes, Carbohydrates, Protein, and Fat

If you wanted to lower your blood sugar and insulin, what would you do? Eat less sugar and starch? Sounds logical. That would mean you'd be getting more of your calories from protein and fat, since you wouldn't be getting as many of them from carbohydrates.

The interesting thing is that "Fish, beef, chicken, and eggs had larger insulin responses per gram than did many of the foods consisting predominantly of carbohydrate."¹. I was surprised when I read about this in the FanaticCook blog, written by an actual nutritionist. In later posts, she dug up more references to studies done on how eating fat affects insulin levels. Turns out, a high-carbohydrate diet was better for insulin levels than a high-fat diet.² And, as the FanaticCook pointed out, a low-fat vegan diet was better than the AHA-recommended diet for the blood glucose and blood lipids in a 100-patient study.³

The Atkins diet has also been shown to improve blood glucose compared to the average American diet. But studies indicate that the "good carb" diet might do an even better job.² It would be interesting to see the comparison in a long-term study.

1. An insulin index of foods:the insulin demand generated by 1000-kJ portions of common foods. Holt, et al. Am J Clin Nutr 1997;66:1264-76
2. Effects of isoenergetic high-carbohydrate compared with high-fat diets on human cholesterol synthesis and expression of key regulatory genes of cholesterol metabolism. Vidon et al. American Journal of Clinical Nutrition, Vol. 73, No. 5, 878-884, May 2001; High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes Study. Marshall et al. Diabetologia. 1997 Apr;40(4):430-8; Dietary Fat and Meat Intake in Relation to Risk of Type 2 Diabetes in Men. van Dam et al. Diabetes Care 25:417-424, 2002
3. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Barnard et al. Diabetes Care 29:1777-1783, 2006

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Healthier Choices: Adapting for diabetics

What do you do when people you care about develop high blood sugar or diabetes? Invite them over for a meal of macaroni cheese, pierogies, and lima beans? Give them a gift basket full of your famous home-baked Christmas cookies and your home town's best artisan chocolates? Yes, I did serve them that high-carb meal, followed by cake and ice cream. It was my child's birthday dinner. I still feel guilty about it. At Christmas, though, I skipped the cookies and made them a nice basket of their favorite cheeses.

What should I serve the next time they are over? Surely, most of the things I've been eating for the last couple of years are pretty good. The DASH diet is pretty well balanced, not too high in blood-sugar boosting refined sugars and carbohydrates, right?

I asked some questions at the Diabetes discussion group at bigoven.com. What do you know? The very first recipe I posted here, a delicious, hearty, one-pot, balanced, healthy meal is not really so well balanced for diabetics. I was told the recipe was high in "net carbs" (total carbohydrates - fiber), because it has so many potatoes, and the serving size really represents an awful lot of food for one meal.

So I used an EXCEL spreadsheet to help me figure how many servings of what food groups I would get by fiddling with ingredients and quantities, and used to figure the nutritional information. I used the EXCEL spreadsheet to help me replace half of the potatoes with rutabaga, and then reduce the number of vegetable servings from 4 to 3 while leaving the meat unchanged. This took a little bit of fiddling and weighing of rutabagas. I used BigOven's nutritional links to help me get to and save information about how many cups of diced rutabaga I can get from half a large rutabaga.

After I was done fiddling with the quantities in the recipe, I updated my recipe in Bigoven to reflect the decisions I had made. Then I used Bigoven's nutritional calculator to tell me how I had done. Success! The original recipe had 367 calories in an enormous, 2-cup serving, and included 55g of carbs with 9g of fiber for a 46g of net carbs. The revised recipe has has 257 calories in a 1 1/2 to 1 3/4 cup serving, features 3 half-cup servings of vegetables, 33g of carbs and 7g of fiber for 26g of net carbs. The group told me I was now on the right track.

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Blackened Beef with Greens, Red Potatoes, and Rutabaga

Here's the diabetic-friendly version of the Blackened Beef recipe I have been working on. If you use , you can download it.


-= Exported from BigOven =-

Blackened Beef with Greens, Red Potatoes, and Rutabaga

Recipe By: Family Nutritionist
Serving Size: 6
Cuisine: American
Main Ingredient: Beef
Categories: Diabetic, Low Fat, Saute, OnePot Meal, LOW SODIUM, DASH, Main Dish

-= Ingredients =-
1 pound lean top round of beef
2 tablespoons paprika
1 tablespoon dried oregano
1 teaspoon chili powder
1 teaspoon garlic powder
1/2 teaspoon freshly ground black pepper
1/4 teaspoon cayenne pepper
1/4 teaspoon dry mustard
2 medium red potatoes ; cut into quarters about 1 inch thick (about 2 cups)
1/2 medium Rutabaga
2 cups Onions ; finely chopped
1 1/2 cups low fat low salt beef broth
1 1/2 cups water
2 cloves garlic ; minced
2 large carrots ; cut into rounds about 1/4 inch thick (1 cup)
3 cups kale ; stems removed, coarsely torn into pieces

-= Instructions =-
Briefly put the beef in the freezer to freeze partially in preparation for slicing thinly.
Mix the paprika, oregano, chili powder, garlic powder, black pepper, cayenne pepper, and dry mustard in a small container with a lid and set aside.
Thinly slice the beef across the grain into strips 1/8 inch thick. Sprinkle the strips liberally with the seasoning mix. (Save any leftover seasoning mix to use for other dishes.) Spray the bottom of a large skillet or stockpot with cooking spray and preheat over high heat. Add the meat and cook, stirring, for 5 minutes.
Add the potatoes, onions, broth, water, and garlic to the skillet. The blackened spices will float to the top of the liquid as it heats. Cover and cook over medium heat for 20 minutes. Stir in the carrots and lay the kale on top. Cook, covered, until the carrots are tender, about 10 more minutes. Serve from the skillet or transfer to a large serving bowl. Serve with crusty bread for dunking.

Nutritional Summary
Each (1 1/2 cups; 441g) serving contains:
Cals: 258, FatCals: 55, TotFat: 5g
SatFat: 2g, PolyFat: 1g, MonoFat: 2g
Chol: 45mg, Na: 205mg, K: 1228mg
TotCarbs: 30g, Fiber: 6g, Sugars: 8g
NetCarbs: 24g, Protein: 22g

Food Group Serving(s)
DASH: Vegetables: 2.9: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.0: Meat/Fish: 0.9: Seeds: 0.0: Fats: 0.0: Sweets: 0.0
USDA: Vegetables: 1.4: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.0: Meat/Fish/Seeds: 2.7: Fats: 0.0: Sweets: 0.0

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I corrected this posting to reflect corrections I made to the recipe after making it this evening (17 Jan 2007)

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