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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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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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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