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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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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What is a mini-stroke?

The biggest thing I've learned recently is that a mini-stroke is a warning that a big stroke is on the way...

A stroke is kind of like a heart attack, only in the brain instead of the heart. Here are some scary pictures

When you have a mini-stroke, an artery is blocked or partially blocked, or else it starts to bleed a little bit. You get symptoms that are like stroke symptoms, but usually milder. Then, when the blockage clears, or when the bleeding stops, the symptoms go away on their own.  The symptoms depend on which part of the brain is affected.  So you could experience anything from trouble talking to unexplained dizzyness to a sudden severe headache.

It's scary.

If you've had a mini-stroke in one part of your brain -- the next time, it could be in another part of your brain. It could be a real stroke next time.

Even scarier -- if you've noticed one mini-stroke, you may already have had several. And never noticed them. You could keep on having them. And never notice. Except that slowly, silently, they can kill a few brain cells at a time. And silently steal away your memories and your ability to think.  This is called vascular dementia. Your doctor might talk about multi-infarct dementia, which is the most common form of vascular dementia.

If you are at immediate risk for another stroke, you probably want to take some immediate steps to decrease your risk.

Their are two main causes of stroke.

• Ischemic stroke is cause by blockages, often blood clots, in small blood vessels, or in arteries already narrowed by plaque build-up
• Hemorrhagic (bleeding) stroke is caused by blood vessels bursting and bleeding, often because they have been weakened by high blood pressure over a long time

To prevent ischemic strokes, you want to decrease inflammation immediately and continue to make choices that will slow down or even reverse narrowing of your arteries.  To prevent bleeding strokes, you want to get your blood pressure under control.

Sunshine, exercise, and a healthy diet will help with artery disease, blood pressure, and inflammation.

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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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How to Eat More Chocolate for your heart, part II

I'm an avid read of Monica Reinegel's NutritionData Blog, because I love data about nutrition. As I was reading Eating chocolate for your heart, I noticed a comment from another of her readers, asking Monica for more information about which brand of chocolate is best for the heart. I had asked myself the same thing a few months back, so I posted my own comment, as chock full of references as cocoa is chock full of useful flavanols. Which the website immediately rejected as spam, on account of all those useful links. A comment like that probably belongs on my own blog. So here it is. In How to Eat More Chocolate for your heart, I decided the easiest way is simply to stir a tablespoon of unsweetened natural cocoa into a bowl of oatmeal or a mug of hot water or milk one to three times a day, for 200 to 600mg of cocoa flavanol (CF). This is because:

• 1 T (5g) Hershey unsweetened natural cocoa PROBABLY has about 200mg CF and 20 Cal, and you can drink it like coffee.
• 1/2 ounce of baking chocolate (100% cacao) PROBABLY has 230-300mg CF and 70 Cal, but it is not much fun to eat.
• 1 1/2 ounces of Ritter Sport Halbbitter (50% cacao) has 200mg CF and 200 Cal -- delicious, if you aren't worried about the extra sugar/fat calories.

I found this out by searching on "cocoa", and "antioxidant". I saw answers at the USDA, pubmed, the American Cocoa Research Institute, Hershey's, and Mars. I learned words like polyphenol, flavan-3-ol, flavanol (not to be confused with flavonol), and proanthocyanidin. I read chocolate-makers' websites, requested research papers they cited at their websites, and asked about the flavanol content of their products. And then I had to make some sense of it.

• Hardly anybody will give you even an approximate flavanol content for their product if it isn't already on the package. It costs money to test flavanol content. It must cost even more to assure that a product always has a certain minimum flavanol content. It might cost them a lot to say a product usually has a certain flavanol content, then get sued when a certain batch had less.
• A paper from Arkansas gave me my best rule of thumb -- as long as the cocoa isn't dutched, the content of antioxidants is proportional to the percentage of nonfat cocoa solids (NFCS) in the product. That's pretty simple. A Hershey PR rep. sent me a copy of the paper, and I found out how much NFCS and antioxidants were in a number of unidentified grocery-store products.
• The USDA has produced a proanthocyanidin database, that shows that cinnamon, grape seeds, and cocoa are highest in proanthocyanidins
• Ritter Sport shared the CF content of their Halbbitter bar with researchers in 2004 -- about 500mg CF per 100g.

How to Eat More Chocolate For Your Heart

Red wine with that burger, please -- study shows flavanols can neutralize some bad chemicals right in the stomach.

Edited 5 Feb 2009 to fix broken links

References

• Gu et al. Concentrations of proanthocyanidins in common foods and estimations of normal consumption.J Nutr. 2004 Mar;134(3):613-7.
• USDA Proanthocyanidin database http://www.ars.usda.gov/Services/docs.htm?docid=5843


• The Hershey Company. Antioxidant activity and polyphenol and procyanidin contents of selected commercially available cocoa-containing and chocolate products in the United States. J Agric Food Chem. 2006 May 31;54(11):4062-8.
• Gu 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. Hershey emailed a copy on my request.
• Taubert, et al. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA. 2003 Aug 27;290(8):1029-30. (Cocoa polyphenol content of Ritter Sport Halbbitter)
• Taubert et al. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med. 2007 Apr 9;167(7):626-34
• Aron, et al. Flavan-3-ols: Nature, occurrence and biological activity. Mol Nutr Food Res. 2008 Jan;52(1):79-104 -- A review of the chemistry and health effects of flavanols.

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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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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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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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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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