Get library books on your Kindle

Plenty of books about diet and health are available for your Kindle. All you need is your library card number. For example, the Montgomery County library lends Kindle books at The Montgomery County Library Overdrive site.

Read all of "Get library books on your Kindle" ...

Get Outside and Move Around in the Sun to keep your blood pressure low

Today is going to be a beautiful sunny day in Pennsylvania. Put on a sweater and get out in the fresh air....

Exercise and vitamin D both help keep your blood pressure low. They also make your heart, lungs, and brain stronger, lose a couple of pounds, preserve bone density and help you sleep well at night. Just get outside in the sun and move around. Or move around inside and soak up the sun separately. You can take your activity level up a notch, 10 minutes at a time, 3 times a day.

Anyone who can go around and around the mall for Christmas shopping can manage a little physical activity every day.

Anything that gets you out of the house is good. If you decide to join a club, volunteer to read with second-graders, or take an art class, you can choose to park a little way from the best entrance, then take an indirect route through the building to give you 10 minutes of walking. Or you can walk around in the mall. Or even join an aerobics or aquasize class, to make exercise less boring.

And remember the sunlight. As little as 10 minutes a day in the sun can give you more vitamin D than you could ever get from a pill.

Keep the stroke away. Move around every day.

• Vitamin D, the Sun, and your Heart
• Safe exercise when you have high blood pressure
• Exercise to sleep better
• Exercise benefits and tips

Read all of "Get Outside and Move Around in the Sun to keep your blood pressure low" ...

Preventing Strokes -- lowering your blood pressure

High blood pressure is the leading risk factor for stroke. It increases your risk for hemorrhagic (bleeding) stroke and for ischemic (blockage) stroke. It damages arteries throughout the body....

Over time, it can create weak places that rupture easily, or thin spots that balloon out from the artery wall. It can make the arteries stiffer, and less able to move blood well. It can accelerate the build-up of fatty plaques, causing narrowing of the arteries. This is why it is important to maintain a healthy blood pressure, day after day after day.

In the short term, sudden spikes in blood pressure can cause problems, too, especially when stroke risk factors are high.

• When blood vessels are already weakened, high blood pressure can cause them to bleed
• If you have unstable plaques on your artery walls, high blood pressure can dislodge them, and the particles can block a narrow place in a blood vessel

This is why it is a good idea to maintain healthy habits every day.

The good news is that high blood pressure can be controlled through diet and exercise, and with the help of blood pressure medications.

A plan for lowering blood pressure would include:

• Becoming more Active
• Getting enough Vitamin D from diet and, especially, from sunlight. Just 10 minutes of direct sun a day could be enough.
• Maintaining a Healthy Weight through diet and exercise
• Reducing salt in your diet, by reducing processed and canned foods, and choosing lower-salt versions of foods like tomatoes and beans
• Getting more Potassium, Calcium, and Magnesium in your diet, by eating fresh fruits and vegetables, lowfat and nonfat dairy products, and beans, seeds, nuts, halibut, tomatoes, potatoes, bananas, watermelon, and leafy green vegetables
• Manage stress.

More reading

• Stroke and High Blood Pressure, the State of Victoria, Australia, Better Health Channel
  
• Stroke and High Blood Pressure, The American Heart Association.

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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.

Read all of "Preventing a Stroke" ...

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.

Read all of "More about strokes" ...

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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Peruvian Beef and Squash Stew

I love winter squash. Not everyone does. Including some members of my family. So I was interested when I saw a recipe in FoodontheFood, from a blogger who quit a CSA that gave her too much squash. But she enjoyed a squash dish made by her mother's Peruvian friend. So I thought my resident squash-haters might not hate it. And they didn't. Just like Tammy Donroe, they were suprised that there's nothing fancy in this dish hiding the squash flavor. Just plenty of garlic and a little bit of time....

-= Exported from BigOven =-

Peruvian Beef and Squash Stew 2

Chopping up all this squash takes some time, but you’ll make a major dent in your squash pile, and, really, isn’t that what matters?

Recipe By: http://foodonthefood.com
Serving Size: 8
Cuisine: Peruvian
Main Ingredient: Pumpkin
Categories: Winter, Fall, Braise, Vegetables, Main Dish

-= Ingredients =-
1 tablespoon olive oil
2 medium onions ; chopped
6 cloves garlic ; smashed
2 tablespoon paprika
2 pound Beef bottom round roast
8 cups Winter squash ; seeded and sliced in half
2 medium tomatoes ; chopped
1/8 teaspoon Pepper ; or to taste
1/4 pound Low Fat Cheddar cheese ; optional

-= Instructions =-
In a large braising pot, heat olive oil until shimmering. Brown meat on all sides. Sauté onions, garlic, and paprika over medium heat until soft.
Add tomatoes, lay pieces of squash over top, cover, and cook over low heat or in oven 30-45 minutes, until squash is soft.
Remove squash from pot, return pot to oven. Cool squash until you can handle it, then scrape it out of the rind. Return squash to pot, mash, stir, and return to heat.. Continue to cook over low heat until the squash cooks down into a thick sauce and meat is tender. Timing will depend on whether you cut meat into 1" stew chunks (15 more minutes) or left it in roast-sized chunks (another hour or so)

Optional: Sprinkle with cheese and cover until melted. Remove from heat and serve over rice.

Without Optional Cheese:
Serving: 1.67 cups (407g), Calories: 345: Fat: 14g : Sodium: 72mg
Protein: 27g, NetCarbs: 19, K: 1505mg
SatFat: 6g, PolyFat: 1g, MonoFat: 7g, Chol: 71mg
TotCarbs: 26g, Fiber: 7g, Sugars: 8g
Calories: 42.0% from fat, 22.0% from carbohydrates 31.3% from protein
RecipePoints: 6.67

DASH: Vegetables: 3.2: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.0: Meat/Fish: 1.3: Seeds: 0.0: Fats: 0.4: Sweets: 0.0
USDA: Vegetables: 1.6: Fruits/Juices: 0.0: Dairy: 0.0: Grains: 0.0: Meat/Fish/Seeds: 4.0: Fats: 0.4: Sweets: 0.0

With Optional Cheese:
Serving: 1.67 cups (421g), Calories: 380: Fat: 16g : Sodium: 158mg
Protein: 31g, NetCarbs: 19, K: 1505mg
SatFat: 7g, PolyFat: 1g, MonoFat: 7g, Chol: 79mg
TotCarbs: 26g, Fiber: 7g, Sugars: 8g
Calories: 43.0% from fat, 20.0% from carbohydrates 32.6% from protein
RecipePoints: 7.53

DASH: Vegetables: 3.2: Fruits/Juices: 0.0: Dairy: 0.5: Grains: 0.0: Meat/Fish: 1.3: Seeds: 0.0: Fats: 0.4: Sweets: 0.0
USDA: Vegetables: 1.6: Fruits/Juices: 0.0: Dairy: 0.5: Grains: 0.0: Meat/Fish/Seeds: 4.0: Fats: 0.4: Sweets: 0.0


** This recipe can be pasted into BigOven without retyping. **
** Easy recipe software. Try it free at: http://www.bigoven.com **

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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.

Read all of "How to Eat More Chocolate for your heart, part II" ...

Baby Lima Beans

My family doesn't like mashed cauliflower. We'd rather have it raw, or steamed with a sprinkling of cheese. It is definitely not a replacement for a big pile of mashed potatoes.
But we did find a "better carb choices" substitute. It's white, has a mild flavor, feels creamy in your mouth, and is popular with the kids. It's easy to cook. It goes well with a little bacon, and makes a nice side dish.

Baby Lima beans! This one is simple:

Cook one cup dried baby limas in enough broth to cover.
Simmer for one hour, adding additional water as necessary.
Season to taste.

Thanks to Mel at dietriffic for reminding me about the latest legume addition to my diet.

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New USDA salmon figures based on too-few samples?

Farm-raised salmon is cheap compared to fresh. You might find farm-raised for $9.00 a pound in the fresh case and $5.99 a pound in 2-pound package of individually-wrapped frozen fillets.

But farm-raised salmon has lately been known to have a lot of omega-6 fatty acids, making it very inflammatory -- just the sort of thing you DON'T want if you are looking for heart-healthy diet choices.

So I was surprised to read that they have suddenly gotten better. The newly-updated USDA database says that the ratio of omega-6 to omega-3 fatty acids in farmed Atlantic Salmon is now a favorable 1:2.6 instead of the former, very unfavorable 7:1 (is that right? 7:1? Who's got a copy of the old database?). So a serving farm-raised salmon has gone from being highly inflammatory to being highly anti-inflammatory. The ratio is not quite as good as for wild Atlantic Salmon (1:12), but since the farm-raised salmon is nearly twice as fatty, you get a bigger anti-inflammatory dose per ounce.

Monica Reinagel proposed that big changes in aquaculture practices have accounted for this change. But I am not sure this change is universal. I quickly searched for "salmon USDA" and came up with a USDA poster presentation from Experimental Biology 2007 giving lipid figures for salmon. Turns out, only 2 samples of farm-raised Atlantic Salmon were tested, from shopping trips to 12 different US grocery stores.

Two samples? Is that representative of all the farmed Atlantic salmon available in the US? How can I know if the salmon I see in my grocery store more closely resembles the new farmed salmon or the old?

Is it normal for the USDA to "improve" its database with data from such a narrow sampling? What other USDA figures should I start distrusting?

• The "old" farmed salmon: Quantitative Analysis of the Benefits and Risks of Consuming Farmed and Wild Salmon. J. Nutr. 135:2639-2643, November 2005


• The "new" farmed salmon: Exler, J. 2007. Nutrient content and variability in newly obtained salmon data for USDA Nutrient Database for Standard Reference. Experimental Biology, April 25, 2007, Washington, D.C. (abstract)

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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.

Read all of "Neal Barnard's Meal Plan Anti-Inflammatory" ...

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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