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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Melamine is still in our foods

A year and a half ago, I said pretty much all I wanted to say about cheap imported food ingredients -- avoid them. It's too easy to sneak in powdered melamine scrap in place of vegetable protein powders, isolates, and concentrates, or powdered milk or eggs. Too easy to replace glycerine with antifreeze. This means avoiding all the processed foods made with these ingredients, too. You can't know where they came from. And the FDA has just blocked the import of all milk products from China, along with pet and laboratory animal feeds.

Hong Kong and South Korea are turning away eggs and egg products because they are contaminated. It isn't clear whether the powdered eggs rejected by South Korea were directly contaminated, or if they were simply came from chickens fed contaminated feed. The levels of melamine in the flesh, milk, or eggs of an animal fed contaminated feed are likely to be much less than the levels of food ingredients directly contaminated with melamine.

product	contamination level
Sanlu milk, reconstituted	~360 ppm
Recalled 2007 pet food	60-70 ppm
Recalled Chinese vegetable proteins	>70 ppm
Egg powder, South Korea	.1ppm - 4 ppm
Hong Kong eggs	3.5 ppm

The FDA says 2.5ppm is the level of concern, except for in baby formula where none (or 25ppb, the limit of detection) is tolerable. This is based on evidence that 50ppm is tolerable (from animal studies?), up from a 2007 LOC of 194ppb to 450ppb, based on a TDI of .63 mg/kg/day, with a "100-fold safety factor".

Using the EU's TDI of .5mg/kg/day, the WHO concludes that the LOC for milk is 25ppm -- 10 times as high as the FDA's LOC.

How about a nice home-made Chipotle-Squash soup instead?

• FDA Melamine Contamination information page
  

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Omega-3 and genetic engineering

Those of us who eat a lot of grains and/or grain-fed livestock are always on the lookout for ways to get more omega-3 fatty acids. That's because grains are skewed toward the omega-6 fatty acids, which are inflammatory, and can contribute to heart disease.

But, wouldn't you know it, Monsanto has been working on the problem. They have developed a soybean that produces a lot of SDA, a compound that like ALA, humans can convert to omega-3 fatty acids EPA and DHA, but which is much more shelf-stable than EPA or DHA. And the soy oil will taste better than fish oil. Their plan is to use it to create a high-omega-3 soybean oil, but perhaps it will find other uses as well. They've concluded their soy oil is safe for rats.

Will they try for a high-omega-3 corn next, for livestock feed to produce high-omega-3 meats?
Is this a good thing or not?

• Monsanto and The Solae Company to Collaborate on Soy-based Omega-3 Portfolio


• Safety assessment of SDA soybean oil: Results of a 28-day gavage study and a 90-day/one generation reproduction feeding study in rats. Fleeman et al. Regul Toxicol Pharmacol. 2008 Aug 31

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USDA Dietary Guidelines 2010

The USDA and HHS has already empanelled a new committee for reviewing the US Food Pyramid, and they've already had their first meeting. Interesting, they are taking comments. Many of the earliest commenters are famous proponants of vegetarian diets, based on their analysis of clinical studies on diet and health. There were 10 comments from the National Dairy Council, but all but one have since been deleted. That's a little bit of a surprise. At least fifty-seven comments have been submitted, but only 30 remain.

Many of the commenters seem to feel the dietary guidelines committee might have some conflicts of interest, and might not adhere to the scientific evidence. Then again, there is scientfic evidence that our diet should be low in carbohydrates and high in protein, evidence that it should be high in carbohydrates and low in fat, or that it should have a "Zone" or "South Beach" balance of macronutrients.

It seems that "everyone" agrees that foods that don't raise the blood sugar and insulin too much are a good idea. Which means more green vegetables, less bread. Inflammation has recently been identified as a big problem for health, which means there is a lot of agreement that foods high in antioxidants are good, omega-6 fatty acids are not as good as omega-3 fatty acids, and that mono-unsaturated fatty acids might be the best. There are still some dissenters on the merits of saturated fats, though many researchers seem to agree they are inflammatory and promote heart disease, especially when combined with quick-digesting carbs. I think we all agree that croissants are not an ideal staple food.

There has been a lot of criticism of the 2005 dietary guidelines since it came out, not the least of which has been the emphasis on bread, pasta, and breakfast cereals as a source of carbohydrates for energy.

I'm a little confused myself. I've got Neal Barnard's book in one hand, and the South Beach diet in the other. The doctors behind both diets have done the studies to show that either diet will improve cholesterol and blood suger -- all the risk factors for heart disease and diabetes. Apparantly, either diet is better than the 2005 guidelines.

Which side up will they turn the pyramid in 2010, and will it make any difference at all?

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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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Insulin -- What it Does and Why

In the past few years, we've heard a lot about the relationship of insulin and blood sugar, but there's a lot more to it. Insulin is a complicated hormone with a lot of effects on the metabolism and circulation.

What Insulin Does
When cells receive the insulin signal, they:

• Take up glucose from the blood for fuel. Liver and muscle cells also make glycogen and store it for later in the day.
• Take up fatty acids from the blood to make triglycerides (glycerine plus 3 fatty acids) for storage
• Take up circulating amino acids from the blood to make more proteins
• Take up potassium from the blood
• Slow down the rate at which they break down proteins
• Slow down the rate at which they convert triglycerides into fatty acids
• Slow down the rate at which they convert protein and fat into sugar
• Relax the arterial wall muscle, increasing blood flow, especially to smaller arteries, keeping blood pressure low.

Source: Wikipedia article on Insulin

Why Insulin is Released

When blood sugar rises, the beta cells that produce and store insulin take it up and use it to produce ATP, every cell's quick-energy source. When the level of ATP is high enough, the beta cells start releasing insulin.

But sugar is not the only source for ATP production. And a high-protein or high-fat meal can cause higher insulin than a high-starch meal can. Without even raising the blood sugar.

Insulin Release at Wikipedia

ATP at Wikipedia, Beta-Oxidation at Wikipedia,

An Insulin Index of Foods

Insulin Resistance

When cells encounter a lot of insulin a lot of the time, they start to ignore it. If the situation continues, they become insulin resistant. If the pancreas can manage it, it will release even more insulin. Some of the effects of insulin resistance are:

• High blood sugar after meals, as the cells ignore the signal to take it up from the blood.
• Low blood sugar between meals. The body does not release enough glucose from the previously-stored glycogen to supply the body's energy needs -- this can lead to mental "fogginess"
• Higher levels of triglycerides in the blood
• High blood pressure.
• An increase in fat storage around the abdominal organs.

Source: Insulin Resistance at Wikipedia

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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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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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Obesity and Psychological Distress

Incidence of Severe Psychological Distress in US, 2005-2006


Incidence of Obesity in US, 2006

Bix observed that certain parts of the country experience more Severe Psychological Distress than others. A commenter wondered if there was any correlation to obesity in those same states. I plotted Obesity vs Severe Psychological Stress, and it doesn't look to me like a strong correlation. So I would have to assume that other factors besides Obesity are related to Psychological Distress in the US.

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A berry good snack for the kids

At some point, the kids will get bored of even the most luscious farmstand peaches. Here's a quick, icy snack they'll love. Because the milk turns blue.

Icey Berry and Milk Snack
1/2 cup frozen strawberries
1/4 cup frozen Maine or wild blueberries
1/4 cup skim milk, or less if you run out of room in the bowl.

Surprisingly, this will all fit in the same 6-oz bowl.
Put about 1/2 cup large frozen strawberries in a bowl. This will only be 3 or 4, with a lot of empty space between. Pour in 1/4 cup frozen tiny Maine blueberries. They'll fit between the strawberries. Shake them down to the bottom of the bowl. Now add the milk.

Immediately, the milk will freeze into a skin around the berries. Cut or mash the strawberries with a spoon to expose new surfaces for the milk to freeze on. Explain that this is ice milk. Tell them the story about how, when your mother was little, the milkman left milk on the back porch every morning, how some winter mornings the cream floated up to the top of the milk bottle and froze, and how their grandmother's mother stirred it up with vanilla so they could have ice cream with breakfast. The kids will ooh and aah, splash purple milk on the kitchen table, and be perfectly delighted with their special afternoon snack. Notice how you haven't gotten out the sugar bowl. That was easy. Don't forget you need a snack, too.

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Who taught Michael Phelps how to eat?

12,000 calories and no fruit on the plate. As usual, Bix has made me think. Michael Phelps' diet doesn't seem to be hurting his Olympic performance. But it's surprising to see so little produce in his diet. I heard Bob Costas recite the breakfast menu, but I was surprised when I saw the full daily menu in print....

Breakfast: Three fried-egg sandwiches loaded with cheese,
lettuce, tomatoes, fried onions and mayonnaise. Two cups of coffee. One five-egg
omelette. One bowl of grits. Three slices of French toast topped with powdered
sugar. Three chocolate-chip pancakes.

Lunch: One pound of pasta. Two large ham and cheese
sandwiches with mayonnaise on white bread, plus 1,000 calories of energy drinks.

Dinner: One pound of pasta, an entire pizza and even more
energy drinks.

And, according to a 2005 IGN interview, a daily multivitamin.

As a parent, I spend time explaining to my kids why fruit and vegetables make better snacks than cookies, why we don't eat candy when we're hungry, how a sweet-potato muffin can be a better choice than a 4-oz bagel, and why we like to have lots of vegetables during dinner, not just a really big pizza. I explain to them that, if they want to grow up healthy and have the energy and strength to run around and have fun, they need to eat the way I've taught them. Apparantly, that's not strictly true. Michael Phelps' only vegetables come on his morning fried-egg sandwiches, and perhaps in the unspecified pasta sauce, and there's no fruit in his diet at all. Yet he seems to have grown up big, with plenty of strength and energy, and have no health problems -- at least nothing that would interfere with him swimming freestyle and butterfly faster than anyone else in the world.

Of course, even if his foods are low in certain nutrients, he's eating so much that he may be getting what he needs of A, B, C, D, and E and most of his minerals. But what about blood sugar spikes, oxidative stress, arterial plaques, risk of colon cancer, fiber, antioxidants, and omega-3 fatty acids? I didn't worry much about these things when I was 23, either. Even though I wasn't quite as focussed on school as Phelps is on swimming.

Until they ask, I'm not going to confuse the kids by explaining why Michael Phelps' diet is not designed for them -- they aren't 6'4" and 195 pounds, and don't swim 9 miles a day. So they don't eat unlimited "seconds", and are not going to substitute cookies for carrots. Even Michael Phelps doesn't eat cookies. Only chocolate-chip pancakes.

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Sweet Potato Orange Muffins

I'm not an advocate of hiding vegetables. Maybe I have more in common with the authors of "real food for healthy kids," who focus on teaching kids to enjoy filling their plates with healthy, nutritious foods. At the same time, I think it's a great idea to replace some refined or milled grains with fruits and vegetables. Especially after reading how meals high in refined grains cause a couple hours of inflammation that can damage your arteries, how high-fat meals meals cause insulin resistance, and how foods with the right carbohydrates can improve blood sugar, cholesterol, and inflammation.

I don't think that I and my family are ready to renounce ground grains (flours made from white and whole wheat, rye, rice, corn, even cornmeal). And I cannot convince them that a high-fiber orange sweet potato is more delicious than a starchy baking potato. But I can see the logic of replacing a bagel with something less inflammatory. Like a muffin. A muffin? Full of white flour, sugar, and saturated fat? I found a low-fat sweet potato orange muffin recipe from an old volume of Womans Day Low Fat Meals that was an almost perfect match for my fridge full of rejected sweet potatoes... Of course, I changed it up a little. I used 100% whole wheat flour, threw out the egg yolks, reduced the sugar, and increased the cinnamon (everybody loves cinnamon). And I used fresh sweet potato instead of canned. My first attempts had more sweet potato than the rest of my family could tolerate (how is that even possible?), and I learned that the potato ricer goes a long way toward creating a smooth and tolerable sweet potato puree. This newest version seems to be well-tolerated by everyone in the family, and it is my new favorite recipe. I've even tried substituting ground flaxseed for the eggs to turn the recipe vegan, and that works, too.

Sweet Potato Orange Muffins

A moist, rich muffin with a pumpkin-pie flavor

Recipe By: Family Nutritionist
Servings: 16

-= Ingredients =-
2 c Whole wheat flour
2 ts Low-sodium baking powder
2 ts Baking soda
1 1/2 ts Cinnamon
1/2 ts Nutmeg
1/2 ts Allspice
3/4 pound Sweet potatoes ; cooked, mashed/pureed
1/2 c Firmly packed brown sugar
4 large Egg whites
1 c Orange juice
1 medium Carrot ; shredded
1 ts Vanilla

-= Instructions =-
Lightly grease 16 muffin pan cups or line with paper liners. In a medium bowl, flours, baking powder, baking soda, and spices. In a large bowl, mash sweet potatoes. Add brown sugar, eggs, orange juice, carrot and vanilla. Mix well. Add dry ingredients to sweet potato mixture and stir until combined. Fill muffin cups 3/4 full with batter and bake at 400 F for 15 to 20 minutes or until tops are brown. Let cool slightly and remove from pan. Serve warm. Makes 16.

Serving: 1 muffin (77g), Calories: 113: Fat: 0g (4% of Cals): Sodium: 178mg
Protein: 3g, NetCarbs: 21, K: 242mg
SatFat: 0g, PolyFat: 0g, MonoFat: 0g, Chol: 0mg
TotCarbs: 24g, Fiber: 3g, Sugars: 9g

DASH: Vegetables: 0.2: Fruits/Juices: 0.1: Dairy: 0.0: Grains: 0.9: Meat/Fish: 0.0: Seeds: 0.0: Fats: 0.0: Sweets: 0.5
USDA: Vegetables: 0.1: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.9: Meat/Fish/Seeds: 0.1: Fats: 0.0: Sweets: 0.5

Based on a recipe by: Womans Day Low Fat Meals, June 1995

Read all of "Sweet Potato Orange Muffins" ...

Antioxidant chocolate and cinnamon treats

Blog posts are archived forever, but they seem ephemeral. So I wrote a knol encapsulating a lot of the thinking that went into developing the chocolate-cinnamon treats I posted about in June. Since I just figured out ensure these patties have a good texture, I also wrote a knol about keeping chocolate's temper. "Heat gently" means more gently than I had thought!

Read all of "Antioxidant chocolate and cinnamon treats" ...

Carbohydrates or Fats, but not both for Diabetes?

Barnard: low-fat

Bernstein: low-carb

Lately, I've been reading about high-carbohydrate diets that manage or reverse type-II diabetes. But there is another approach -- a low-carbohydrate diet. Both can cite studies that show the diets they've developed help patients much more than the standard ADA-recommended diet. Both diets show dramatic improvements in insulin sensitivity, blood sugar, blood lipids, and weight loss. As far as I can tell, the only thing they agree on is that diabetics should avoid sugar and white bread. How would a person choose between the two programs?

Read all of "Carbohydrates or Fats, but not both for Diabetes?" ...

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.

Read all of "Diabetes, overstuffed cells, and changing the way you eat." ...

Red wine with that burger, please

A group of researchers in Israel discovered that a meal of grilled turkey burger resulted in a lot of oxidizing chemicals in rats' stomachs. But they could counteract that problem by feeding the rats some red wine concentrate with the meals. This concentrate was very high in catechins, the same anti-oxidants found in cocoa. They found that the antioxidants in food started doing their good work right in the stomach, and concluded that there is an "important benefit of consuming dietary polyphenols during the meal."

• J Agric Food Chem. 2008 Jun 10. PMID: 18540628. The Stomach as a "Bioreactor": When Red Meat Meets Red Wine. Gorelik S, Ligumsky M, Kohen R, Kanner J.

Read all of "Red wine with that burger, please" ...

Cocoa after every meal?

As I learned while writing a post two weeks ago, a lot of damage to your arteries can get done right after a meal. When your blood sugar goes way up after a meal, the insulin level follows, and after that your triglycerides go up, and your blood gets "thicker". At the same time, free radicals form, which can cause cholesterol to oxidize, which can lead to arterial plaque. And inflammation can cause plaques to rupture. A ruptured plaque is what caused Tim Russert's heart attack. A ruptured plaque could just as well cause a blockage in an artery of the neck or head, which could cause a stroke...

So, to reduce the risk of a heart attack, it seems like it would be a good idea to reduce plaque formation, and reduce the risk. And, if a lot of this dangerous oxidation and inflammation is happening right after meals that cause a rise in insulin, it would seem that anything you could do to reduce blood sugar or insulin or high blood pressure or triglycerides or inflammation or oxidation would help you a lot. Which is why I wonder, when I read the abstracts of some of the clinical trials of cocoa, chocolate, and cinnamon, exactly when everyone is eating their chocolate. Because it seems to me that the time you need the anti-oxidant the most is when you've got the worst threat of oxidation. And the time you need the insulin mimetic in cinnamon the most is right when you're getting that spike in blood sugar. The time you need something to relax your blood vessels in just when they're getting tense. That seems like a fair series of hypotheses.

I'd like to see someone do a meta-analysis of the papers to see if there is any correlation between when the particiapants are consuming their cocoa or cinnamon supplements and how much effect they get from it. Maybe the difference wouldn't show up in a short-term study.

But, if bad metabolism after meals really increases the risk of coronary artery disease, then maybe a long-term study of coronary artery disease progression and cocoa consumption would turn something up. And, if a little red wine with a meal can counter the oxidation chemicals in a meal, then why not a cup of cocoa, containing 200mg polyphenols after the meal? And why not a little cinnamon after the meal?

I'd like to see a clinical study of the effect of having 200mg of polyphenols during or directly after each of the main meals of the day. Three meals, 600mg in a day. Still less than the Kuna people drink, but quite a lot none the less.

Makes me wish I lived near one of these groups doing cocoa or cinnamon studies. Wouldn't it something to get involved in designing one of those experiments?

Because either cocoa and cinnamon are the greatest discovery since sliced bread (and to be highly recommended to anyone who regularly eats bread or other easily-digested carbohydrates) or they aren't. And I'd really like to know which it's going to be.

• J Agric Food Chem. 2008 Jun 10. PMID: 18540628. The Stomach as a "Bioreactor": When Red Meat Meets Red Wine. Gorelik S, Ligumsky M, Kohen R, Kanner J.

Read all of "Cocoa after every meal?" ...

Good for your heart is good for your head

Take care of your heart if you want to stay smart. Heart disease is bad for your brain. If you can reduce your risk of heart disease, you can reduce your risk of cognitive decline. I just figured that out this week. It was Bix's consideration of cognitive decline in heart disease patients that prompted me to put two and two together...

Lately, I've been focusing on how cinnamon, cocoa, and fish oil are good for the heart. I've been ignoring information about how they're supposed to help your brain stay sharp as you age. Is there a connection? Well, if your coronary arteries are clogging up, other arteries are probably clogging up, too. Like the ones in your head.

Bypass surgery can save your life, and the mild cognitive damage, it causes is usually temporary. But heart surgery can't fix the arteries in your brain. Researchers followed seniors with vascular disease for several years. They all showed cognitive decline over that time, whether or not they had surgery. Seniors with vascular disease all did worse than heart-healthy seniors.

So an anti-inflammatory diet full of choices that improve cholesterol and blood sugar isn't just good for your heart. It's good for your head, too.

• Nature Clinical Practice Neurology (2006) 2, 538-547 (doi:10.1038/ncpneuro0294) Vascular cognitive impairment Ola A Selnes and Harry V Vinters.
• Ann Thorac Surg. 2008 May;85(5):1571-8. Absence of cognitive decline one year after coronary bypass surgery: comparison to nonsurgical and healthy controls. Sweet JJ, Finnin E, Wolfe PL, Beaumont JL, Hahn E, Marymont J, Sanborn T, Rosengart TK.
• Ann Neurol. 2008 May;63(5):581-90. Cognition 6 years after surgical or medical therapy for coronary artery disease. Selnes OA, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, McKhann GM.

Read all of "Good for your heart is good for your head" ...

Cinnamon Chocolates for your heart

Cassia Cinnamon is an even more concentrated source of flavanols than cocoa. So, if, like the Kuna, you wanted 900mg of flavanols to your diet, you could eat 2 1/2 tablespoons of cocoa. or only 3 teaspoons of cinnamon. But you shouldn't eat 3 teaspoons of cinnamon, because Cassia cinnamon contains coumarin. The German government has decided .1mg of coumarin per kg of body weight per day is safe. There are about 2.8mg of coumarin in every gram of Cassia Cinnamon. If you weigh over 124 pounds, you should be safe with 2g (1/2 tsp) of cinnamon per day, as long as you aren't eating any other foods with coumarin in them. If you weigh 185, you can tolerate 3 g (3/4 teaspoon)...

Here's a recipe that's not exactly haute cuisine. It makes four servings of a slightly sweet, strongly cinnamon/cocoa patty. It is not smooth like fine chocolate, because it is made with cocoa powder and cinnamon. All that conching destroys flavanols, anyway. One quarter of this recipe has about 500mg of flavanols, including 3/4 teaspoon of cinnnamon per serving, which provides over 200mg of flavanols and 8.4 mg of coumarin. It should be perfectly safe for someone weighing over 190 pounds who isn't eating other sources of coumarin or other blood thinners. If you weigh less, you can divide the recipe into more, smaller servings to get less cinnamon and flavanols. Of course, you would want to discuss this with your doctor. If you'd prefer to leave out the cinnamon altogether, try the recipe for Cocoa Chocolate Patties

Chocolate, Cocoa, and Cinnamon Patties

Recipe By: Family Nutritionist
Serving Size: 4
Cuisine:
Main Ingredient:


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

-= Instructions =-
Gently warm baking chocolate until you can stir it.
Stir in the cocoa, cinnamon and honey. Allow to cool to a dough, then divide into 4 pieces and form into balls or patties. Cool on the baking chocolate wrapper.

Do not take with milk, butter, or other dairy products.

Serving: .11 cups (24g), Calories: 81: Fat: 5g : Sodium: 3mg
Protein: 2g, NetCarbs: 9, K: 194mg
SatFat: 3g, PolyFat: 0g, MonoFat: 2g, Chol: 0mg
TotCarbs: 14g, Fiber: 5g, Sugars: 6g
Calories: 56.0% from fat, 69.1% from carbohydrates 02.5% from protein

NFCS: 6.54g Cinnamon: 3.0g : Fats: .84: Sweets: 0.4
PA: 512.35 mg, 1-3 mers: 128.45 mg

German government guidelines for safe daily consumption of Cassia Cinnamon, assuming no other sources of coumarin in the diet. Talk to your doctor to discuss what is safe for you.

Body Weight(pounds)	Cinnamon (g)	Cinnamon(tsp)	flavanols(mg)
60	0.97	0.24	78.97
61.6	1.00	0.25	81.08
110	1.79	0.45	144.79
123.2	2.00	0.50	162.16
130	2.11	0.53	171.11
184.8	3.00	0.75	243.24
190	3.08	0.77	250.08
200	3.25	0.81	263.25

Read all of "Cinnamon Chocolates for your heart" ...

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

Read all of "Food Choices that improve cholesterol and blood sugar." ...

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.
  

Read all of "Anti-Inflammatory Diet Good for the Heart" ...

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.

Read all of "How Much Cocoa do the Kuna Drink?" ...

Any-bean hummus good for your heart

Beans -- they're good for your heart. And they all make delicious hummus. Use Lima, kidney, or black beans to make hummus of many different colors and lots of soluble fiber for your heart. Even more soluble fiber than chickpeas.

Hummus makes a good dip for vegetables, and a great sandwich spread. Try a tablespoon or two in a whole wheat pita with some lettuce and tomato. I found a Black Bean hummus recipe in the bigoven archive. It features olive oil, high in mono-unsaturated fat. You could reduce the oil by half if you wished, and increase the lime juice to keep it moist...

Black Bean Hummus

Try this recipe with any kind of beans, canned or home-made in the pressure cooker.

Recipe By:
Serving Size: 8
Cuisine: Uncategorized
Main Ingredient: Beans
Categories: Vegetarian, Vegan, Summer, Boating, Appetizers

-= Ingredients =-
16 oz Black beans
1 tb Tahini
3 tb Olive oil
1 Lime juice
2 clove garlic
Salt & pepper ; to taste
1 ts Ground cumin

-= Instructions =-
In a food processor, combine all the ingredients & process till smooth. Cover & refrigerate till ready to use. Bring to room temperature before serving.
From Geminis MASSIVE MealMaster collection at www.synapse.com/~gemini

(Nutritional Analysis assumes beans cooked without salt, no additional salt added)
Serving: .27 cups (71g), Calories: 136: Fat: 6g : Sodium: 204mg
Protein: 6g, NetCarbs: 10, K: 227mg
SatFat: 1g, PolyFat: 1g, MonoFat: 4g, Chol: 0mg
TotCarbs: 15g, Fiber: 5g, Sugars: 0g
Calories: 42.0% from fat, 29.4% from carbohydrates 04.4% from protein

DASH: Vegetables: 0.0: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.0: Meat/Fish: 0.0: Seeds: 0.8: Fats: 1.1: Sweets: 0.0
USDA: Vegetables: 0.0: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.0: Meat/Fish/Seeds: 0.8: Fats: 1.1: Sweets: 0.0

Read all of "Any-bean hummus good for your heart" ...

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?

Read all of "Does Chocolate Lower Blood Pressure?" ...

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.

Read all of "Is Cinnamon good for the heart?" ...

How to Eat More Chocolate for your heart

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

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

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

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

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

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

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

Chocolate Cocoa Patties

Recipe By: Family Nutritionist
Serving Size: 4


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

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

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

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

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The Right Chocolate for your heart

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

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

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

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

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

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


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

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Chocolate and Cinnamon are good for the heart

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

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

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

You just need to choose the right chocolate.


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

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