Rethinking cholesterol

For decades, we were warned to avoid foods containing cholesterol, such as eggs, shrimp, and many other types of seafood. The thought was that dietary cholesterol would contribute to high blood cholesterol.  Now we know better.

Most of the cholesterol in your body is produced by your own liver. A diet high in saturated fats tends to promote the production of cholesterol by the liver.   Dietary cholesterol, on the other hand, does not seem to have this effect. If anything, your liver will adjust its cholesterol production to compensate for the amount of cholesterol in your diet.  That is, if you take in more dietary cholesterol, your liver will make a bit less.

So, isn't it time to put eggs and shrimp back on the heart-healthy menu?  Although both foods contain a good amount of cholesterol, they are both low in saturated fat and rich in good-quality protein and other nutrients.

Contradictory advice?

Back in 2000, the American Heart Association (AHA) revised its recommendations in view of the new wisdom on cholesterol.  For those without high cholesterol or heart disease, the AHA now countenances the consumption of an egg a day.   However, their recommendations on cholesterol intake remain unchanged. For healthy adults, the AHA advises a limit of 300mg of dietary cholesterol per day.  That seems unrealistic--and unnecessary--to me.

I can easily imagine a healthy diet, one that is well within the recommendations on saturated fat (less than 7-10% of total calories), exceeding this limit. For example, if you ate just one egg ( with 213mg of cholesterol) and a shrimp cocktail (90 mg) in the same day, you'd be over the limit for a healthy adut--even though these foods contain only about 2 grams of saturated fat.

Now that we know that dietary cholesterol is not the culprit in high blood cholesterol, I'm not sure what the justification is for this recommendation anymore--especially for those without cholesterol issues.  It seems to me that there are more important things to focus on, such as keeping your saturated fat intake within recommended limits, and eating plenty of eating fiber- and nutrient-rich foods (i.e., veggies!).

For those with high cholesterol, the AHA's recommendations are even stricter...less than 200mg of dietary cholesterol per day, even though several studies have shown that netiher dietary cholesterol nor egg consumption appears to be the culprit in heart disease. I'm not saying that high cholesterol levels don't matter--they do. I'm  just saying that I don't think dietary cholesterol is the reason that people have high cholesterol.

Usually, high cholesterol levels are brought on by a combination of genetics and lifestyle factors (such as not exercising, smoking, poor diet, etc.). The stronger the genetic component, the more likely that diet and lifestyle changes alone will not be enough to bring cholesterol levels down to safe levels. In this case, cholesterol-lowering medications (plus lifestyle modifications!) may be needed. 

If you have high cholesterol, you obviously need to follow your doctor's advice, including his or her dietary recommendations. Limiting your intake of saturated fat, eating a diet high in antioxidants and fiber, exercising and avoiding cigarette smoke are all key factors in treating and preventing heart disease. But if you are doing all of this, and you miss eating eggs and seafood, it might be worth probing to see whether your doctor really feels that drastically limiting your intake of healthy foods that contain cholesterol is necessary.

Folate for strong bones: but what about cancer risk?

When you think about nutrients that build and protect bone density, you probably think of calcium, vitamin D, and magnesium.  Add folate.  A 5-year Italian study found that women with low folate levels lost more bone mineral density. Folate deficiency has also been linked to increased risk of heart disease and Alzheimer's disease.

It would seem that folic acid supplements would be a good idea, but as you may recall from this previous post, there are new concerns that folic acid supplementation may increase the risk of colon cancer, particularly in individuals with pre-cancerous lesions (which may be undetected).

We're between a rock and a hard place with this research. On the one hand, folate deficiency appears to significantly increase our risk of several grave illnesses. On the other hand, folic acid supplementation may increase our risk for another serious condition.

I recently spoke with Dr. Kilmer McCully, author of the Homocysteine Revolution and widely regarded as one of the world's leading experts on folate biology, to see what his recommendations might be in light of these latest developments. It was a long and fascinating discussion.

Here are Dr. McCully's chief observations about the latest research:

1. Although it merits further investigation, the evidence linking the implementation of folic acid fortification policies and an increase in colon cancer rates is extremely inconclusive. The rates of colon cancer began to rise before the policy was implemented and have since  decreased, even though fortification policies continue. The observed increase may have a lot to do with more widespread screening and better detection.

2. Folic acid is a double-edged sword. Folic acid does not cause colon cancer; in fact, it acts to prevent it in healthy individuals. However, if colon cancer is present, folic acid may fuel its growth.

3. Although preliminary research suggested that some people might benefit from taking 1600mcg or more folic acid per day, subsequent studies have shown no additional protective benefit from supplementation beyond 800mcg per day.

4. The form of folic acid used in supplements and in fortification of grain products is substantially different than the form of folate found naturally in foods. The concerns about colon cancer pertain primarily to the synthetic form of folic acid.

Dr. McCully is still strongly of the opinion that the risks of folate deficiency far outweigh the possible risks associated with folic acid fortification. To get the undeniable protective benefits of folate nutrition without undue risk,  Dr. McCully recommends:

1. Get most of your folate from natural food sources, which include leafy greens, legumes, and whole grains.

2. Minimize your intake of synthetic folic acid from supplements and do not exceed 800mcg of synthetic folic acid from supplements and fortified foods.

3. Get regular colon cancer screenings.

ND Tip: Our nutrient analysis lists amounts for both folic acid (the synthetic form found in fortified foods) and food folate (the naturally-ocurring form). This post contains more details about how folate amounts are reported on Nutrition Data.

You can also do a Nutrient Search for either form of the nutrient. The recommended Daily Value for folate intake is 400mcg per day. The government has established 1000mcg/day as the safe upper limit for folate, chiefly to minimize the risk of undetected B12 deficiency. (High folate intakes can mask B12 deficiency.)

Beating heart disease with nutrition (and the "Dirty Harry" diet)

When he was in his 30s, musician Bob Walpole decided he wanted to be healthier.  He went on a low-fat diet, and lost 35 pounds.  “I’ve been interested in nutrition ever since,” he says.   So, when doctors told him last October that he had a 90% blockage in one of his coronary arteries and scheduled him for angioplasty, it came as a bit of a shock.

“I still thought of myself as being pretty healthy, but I guess I really wasn’t.  Over the years, my lifestyle had gotten less active and I'd gradually gotten out of shape and gained weight.  When I ended up in the hospital for heart surgery, it was a wake up call.

“After the procedure, I decided to radically change my diet.  I started shopping for more natural foods and found myself in sections of the store I’d never seen before.  I tried keeping a spreadsheet to track my nutritional intake, but that was so much work, I stopped after four days. It was taking me half the evening to do the spreadsheet.

“Then I found NutritionData and I’ve been logging my meals [using ND's pantry tool] almost every day for the last six months.  The reports make it so easy to see how I am doing. I love the Caloric Ratio Pyramid; I try to keep it right in the center, to balance carbs, fats, and proteins. I also keep close track of my sodium and calorie intake, and pay attention to what kinds of fats I’m eating.

“The nutrition facts label is terrific for getting the quick picture. If I see something off, then I investigate to see what’s throwing things out of balance.  Lately, I’ve started to focus more on the glycemic load and inflammation factor of my diet. I’m becoming convinced that these are really important.

“ND helped me go from 218 pounds to 178. I also got my cholesterol levels down so low that they had to cut my medication dosage in half. My cholesterol had actually gotten too low! (I don’t think they count on people really watching their diet when they set the dosages for these medications.)

“The doctors originally told me that the reason my artery was clogged was mostly hereditary because my diet was pretty good. But I’m convinced now that it really was more about diet. I thought I was eating healthy, but when I really delved into the details, it wasn’t quite what I thought.

“Even though I’m at my goal weight, I still continue to use ND almost every day for reference. Maintenance can be tricky.  How do you relax a little bit without completely letting it all go? Tracking my diet on ND makes me accountable. Sometimes for fun, I plug in what I used to eat —just to see the difference.”

“I’m grateful that I had this scare, because it forced me to be more aware. Sometimes I call it my “Dirty Harry” Diet. I picture Dirty Harry standing behind me with a .45 to my head. Every time I feel like having a doughnut, he asks me, “Are you feeling lucky?”  I turned 60 in January and I feel that I’ve bought myself another 30  years. I’m living proof that you can take control of your health by taking control of your diet!”

If you'd like to be profiled as one of our ND Champions, we'd like to hear your story!  Anyone who has used Nutrition Data to make positive changes in their health and lifestyle can be an ND Champion. Click here for details.

A "smart" food scale weighs in on your diet

An interesting item crossed my desk this week. (Well, actually, it crossed my kitchen counter.) It's a food scale that does much more than just weigh your food. It can also tell you the exact amount of calories, fat, and ten other nutrients that serving contains.  It will also store and tally the values for everything you eat over the course of an entire day. 

Because so many NutritionData users use our site to track and analyze their diets, I thought this might well be a product that you'd be interested in, so I gave it a thorough test-drive. All in all, I was impressed.

Does Heart Health Month make anyone healthier?

Valentine's Day is upon us but that's not the only reason red hearts are everywhere you look. February is also the month in which we focus on Heart Health.  Last Friday was national Wear Red day, a day on which women are supposed to wear red clothing in order to raise awareness about women and heart disease. 

In fact, the whole first week of February is Women's Heart Health Week, leaving us the last three weeks to worry about the guys. By next February, I expect we'll have Kids Heart Health Week, too. Ballooning rates of childhood obesity mean that more and more kids are being diagnosed with heart disease risk factors before they are even out of their teens!

But do these national days, weeks, and months of "awareness" actually have any sort of positive impact on people's health? Here's at least three ways in which they can:

1. Education.  National heart health month brings a lot of media attention to the issues surrounding heart health--and this helps educate the public on things like how to recognize warning signs for heart attacks (they're different for women than they are for men), resources available for those with heart health issues, and lifestyle choices that increase or lower your risk of heart disease.

2. Screening.  One of the goals of Women's Heart Health Week, for example, is to overcome the perception that heart disease mostly affects men.  Even though heart disease is the number one killer of women, most women are more concerned about getting breast cancer than heart disease. As a result, they may be diligent about mammograms but completely overlook regular screening for cholesterol and other risk factors.   Just as we've now been trained to change the batteries in our smoke alarms when we turn the clock ahead every Spring, Heart Health month should remind us to schedule our annual cholesterol check.

3. Prevention. Education and early detection (through better screening) can translate into fewer deaths from heart disease. But ultimately, preventing heart disease comes down to making healthy lifestyle choices. The big three are:

1. exercising regularly

2. getting to and maintaining a healthy weight

3. modulating intake of saturated fats, trans fats, and refined carbohydrates

For many, preventing heart disease will require developing some new habits. Experts say that it takes 3-4 weeks to develop a new habit. The best possible use of Heart Health Month, in my view, would be to make a one-month commitment to a heart-healthy lifestyle. By the end of the month, you may well have developed some long-term habits that will extend the benefits of Heart Health Month far beyond March 1st.

Here's some help to get you started on a heart healthy lifestyle:

If you need to lose weight, check out the NutritionData.com Diet and Weight Loss Center, which is updated daily with expert advice, motivation, recipes, health news, and work-out tips that can help you achieve and maintain a healthy weight.

Looking for heart-healthy recipe ideas? Look no further than our new feature Healthy Dinner Tonight, which offers a new healthy recipe (plus complete nutritional analysis) every day. Subscribe via RSS and get each day's healthy recipe delivered right to your inbox.

Questions about what to eat?  Our Nutrient Search Tool can help you find foods that are low in sodium, saturated fat, and cholesterol and high in fiber, omega-3 fatty acids (or just about any other combination of nutrients you select).

Our Pre-Stocked Pantries make it easier to get starting planning and tracking your diet with pre-selected collection of foods tailored to your health goals.  Choose from heart healthy, low-carb/smart-carb, low-fat/low-calorie and more. Add as many as you like to your pantry.

Heart Health Month 2008 is just beginning. Let's take full advantage of this chance to develop some good habits that will translate into longer and healthier lives!

The debate over salt continues

Is salt bad for you? Is it harmful for everyone or just some people? How much is too much?

These long-standing questions are once again in the news, thanks to a new initiative by the Center for Science in the Public Interest (CSPI) which is urging the FDA to enact new legislation to require food manufacturers to reduce the amout of sodium in packaged foods.  Let's sidestep the question of whether it is the government's (or the CSPI's) role to police what we put in our mouths and focus on the actual underlying question: Is salt really bad for you?

Can celery lower your blood pressure?

Q. My blood pressure goes up and down a lot.  Sometimes it's normal, sometimes, borderline high, and sometimes very high.  There's a history of heart disease striking at a young age in my extended family.  I'm a 52 year-old woman, just over 5'9" tall, and I weigh 145,  so I'm not overweight.  I exercise vigorously about 5-6 times/week, so I'm not inactive.  I'd like to take a nutrition-based approach to the problem, if possible.  Some things I've read say that consuming garlic, celery, cayenne pepper, and apple cider vinegar can help.  What is your advice about these, and about the quantities to take them in?

A. It's not uncommon for blood pressure readings to vary considerably. Some research shows that just the stress of being in a doctor's office can raise your blood pressure temporarily.  It's possible that your blood pressure may be just fine.  But with a family history of heart disease, it's smart to pay attention to possible signs of a problem. (Remember that high blood pressure is only one risk factor for heart disease; others include elevated cholesterol, homocysteine, and C-reactive protein levels.)

It sounds as if you are in excellent health and already doing the most important things: maintaining a healthy weight and getting regular exercise!  Chances are, you have a fairly healthy diet, too. But perhaps some fine-tuning can further reduce your risk of high blood pressure.

The National Institutes of Health recommends the DASH diet (Dietary Approaches to Stop Hypertension).  The DASH diet is low in sodium, fat, and sugar and high in fiber, potassium, magnesium, and other nutrients. On the DASH diet, you do this by limiting your intake of animal fats, processed foods (the primary source of sodium in the diet), and sweets, and loading up on fruits, vegetables, nuts, and whole grains foods. In other words, it's a fairly common-sense healthy diet. You can read more about the DASH diet in the NIH's Guide to Lowering Blood Pressure.

In the context of a generally healthy diet, some of the foods that you mention may also be helpful. This article on Diet Therapy for Hypertension has a good overview of individual foods that may help lower elevated blood pressure and gives recommendations on amounts.  For example, according to Dr. Jacobs, four stalks of celery can be enough to lower your blood pressure! (Maybe all the crunching and chewing is relaxing?)

You can also use Nutrition Data's Nutrient Search Tool to find foods that are high in particular nutrients. For example, here is a list of foods that are high in potassium, magnesium, and calcium, and low in sodium.

Obese America: is high fructose corn syrup to blame?

Commenting on a recent post on fructose and heart disease risk, a reader brought up the issue of high fructose corn syrup and I promised to address this hot topic in a new post.  Let me just say up front that a lot of people are likely to disagree with my view on this subject. But what's a blog without a little controversy once in a while?

For those who haven't been following along, there has been a lot of heat around the widespread use of high fructose corn syrup in processed foods.  Manufacturers can save big bucks by using HFCS in place of more expensive table sugar, or sucrose. (One reason that HFCS is so much cheaper than sugar is that corn is heavily subsidized by our government via the Farm Bill, but that's another story!)

Many products (most notably soft drinks) that used to be sweetened with regular sugar now use HFCS instead. It's also true that the increased use of HFCS in the food supply roughly corresponds to rising obesity rates.  And there is research suggesting that fructose may be more readily stored as fat than glucose, which is metabolized differently.

These facts have led many to conclude that the rise of HFCS in industrial food production has led to our current national health crisis of obesity and related disorders (such as diabetes and heart disease).  Not surprisingly, some saavy marketers have even managed to position sugar as healthy, touting virtuous HFCS-free soft drinks that are sweetened with good old fashioned sugar. But hang on a second.

High fructose corn syrup sounds like it would be high in fructose, right? The truth is that it contains roughly the same amound of fructose as...regular sugar.

Sucrose is about 50% fructose and 50% glucose. Regular corn syrup almost entirely made up of glucose. In order to make it a more appropriate substitute for sucrose, raw corn syrup is enzymatically treated to convert some of the glucose into fructose, bringing fructose/glucose ratio up to that of regular sugar.

Look, I'm not saying HFCS is good for you.  All I'm saying is that HFCS is not higher in fructose than sugar...it's just higher in fructose than regular corn syrup.  Personally, I think the rise in obesity rates has less to do with the influx of HFCS into the food supply and more to do with our increased consumption of soft drinks and other calorie-dense foods.  As portion sizes (of everything) get bigger, our calorie intake increases and we gain weight.

Comments?

Sugar-free doesn't get you off scot-free

Last night on my way home, I drove past a billboard that showed three cans of Diet Coke on a table. The caption was: The 3-Hour Meeting. The thing is, I know people who can (and do) drink a can of diet soda per hour. But if you suggest to a diet-sodaholic that six or eight diet sodas a day might be excessive, they’re likely to argue that there’s nothing wrong with drinking that much. After all, it’s got no calories. It’s practically the same as drinking water, right?

Maybe not.  Evidence is mounting that diet sodas are anything but health-neutral.  First off, diet sodas  don’t appear to help you manage your weight, which is presumably their raison-d'etre, right? Studies show that the more diet soda you drink the more likely you are to be overweight or obese.  Now, this study doesn’t show that diet soda makes you fat. It might be that people drink diet soda because they are already overweight. But it does suggest that drinking diet soda doesn’t help you get any thinner.

And there’s other research suggesting that artificial sweeteners may disrupt your brain's ability to regulate caloric intake, leading you to overeat and gain weight.  There's also some suggestion that diet sodas increase your appetite and cravings for sweets. So instead of satisfying your sweet tooth with a “harmless” calorie-free beverage, you may actually be stoking your cravings for sugar. (I wonder if that’s why so many diet soda drinkers develop what they describe as “addictions” to the beverages?) 

Secondly, diet (and regular) sodas contain phosphates, which can leech calcium out of bones. These days, most teens and young adults are drinking copious amounts of soda during the years when they need to accumulate a lifetime store of bone mass. As a result, they are much more likely to suffer from osteoporosis, and to experience the effects of thinning bones much earlier in life.

And now, research shows that those who drink one or more soda per day (whether diet or regular) are 40% more likely to develop metabolic syndrome, a collection of risk factors that put you on the fast track to heart disease and diabetes.

A harmless indulgence? It hardly seems like it. (And I haven't even mentioned the controversy over the purported toxicity of artificial sweeteners like Splenda and Equal.)

If none of this gives you second thoughts about drinking diet soda, you’re not alone. Here’s at least one writer who feels that sodas are merely the latest victims of the “food police.” 

Personally, I think I’ve seen enough to convince me that anything more than occasional soda is just not worth it. I prefer making my own fizzy drinks with seltzer and fruit juice anyway.  In fact, I just found this cool little gizmo that you can use to make selzer water at home.  It uses a big CO2 cartridge to carbonate filtered, spring or tap water. It's a little like those old-fashioned soda siphons except that one cartridge (which is about the size of a 1 liter bottle of soda) charges about 100 bottles of water and can then be exchanged for a full one, sort of like the propane tank on your gas grill. 

I just bought one for the house and we really like it. It’s cheaper than buying even store-brand seltzer, plus we’re not putting all those plastic bottles in the recycling bin every week.  It's called a Soda-Club Home Soda Maker if you want to check it out.

American diets too high in salt?

Several of the nation's big health agencies (including the American Medical Association, the National Institutes of Health, and the American Heart Association) are on a campaign to reduce the amount of salt Americans eat by half on the grounds that limiting sodium intake will reduce high blood pressure and, consequently, decrease deaths from heart disease. (See "How Much Salt is Safe?" on Medical News Today.)

This is a controversial issue--just google "debate on salt intake" to get an eyeful. Various studies have found that the only people to benefit from reducing salt are 1) those with high blood pressure, 2) those who are genetically salt-sensitive, 3) overweight individuals, and/or 4) those who consume very high-sodium diets (which is sort of common sense).  Some would argue that an across-the-board campaign to cut the amount of salt in every American's diet is unnecessary or over-reaching. (Read for example "Genetics, diet, and lifestyle vs. sodium: the debate continues" on RealAge.com)

Many experts assert that the ratio of sodium to other minerals (particularly potassium) may be more important than the total amount of salt you take in. (See "The Skinny on Salt," by Jeremy Likness.) A 1:1 sodium to potassium ratio is considered ideal, but the typical American diet contains 5 times as much sodium as potassium.

At Nutritiondata.com, we don't think it's our role to dictate dietary dogma. Instead, we try to provide the information you need to make informed decisions about your own nutritional choices. If you're concerned about your sodium intake or feel that you would benefit from reducing sodium, the following tools might be helpful.

1) The Nutrient Search Tool provides lists of foods in every category that are lowest in sodium.  Tip: Somewhere between 70 and 80% of the sodium in our diets comes from prepared and packaged foods. That means that if you avoid packaged foods, you can salt your food to taste without worrying about excessive sodium. (This is my personal strategy to limit excess sodium.)

2) The Total Consumption Report allows you to track how much sodium (as well as potassium and dozens of other nutrients) your daily diet contains.   Tip: Fruits and vegetables are high in potassium. Replacing snack foods with fresh produce can instantly tip the sodium/potassium balance in your favor.

3) The government's Daily Value for sodium is 2,400 mg per day. The American Heart Association recommends a low sodium diet (1,500 mg per day). You can set your own target sodium intake using our Preference Settings.

High on hemp milk?

For those who don't drink cow's milk, there's a new nondairy alternative on the market. Next to the soy, rice, almond, cashew, and oat "milks," you'll now find Hemp Bliss, an organic nondairy beverage made from hemp seeds.  The Latin name of the plant (cannabis sativa) gives away its dual identity. Hemp leaves contain THC, the psychoactive chemical in marijuana.  No THC is found in the seeds of the plant, however.

I recently sampled the new product, which comes in plain, vanilla, and chocolate flavors. Hemp Bliss tastes nothing like milk, but neither do any of the other nondairy alternatives, for that matter.  Each has its own unique non-milk taste. The manufacturer describes the flavor of hemp milk as "nutty." I found it to be slightly metallic--but not unpleasant. If you can get used to soy (or rice or oat or nut) milk, you can get used to this. You might even prefer it. All of the flavors contain added sugar, but the vanilla and chocolate flavors are more highly sweetened than the plain.  Hemp Bliss is not fortified with additional nutrients, such as vitamin A, D, or calcium, and is not suitable for use as an infant formula.

What sets hemp milk apart from the other nondairy beverages is its fatty-acid profile.  Each 8-ounce serving provides 1,200 milligrams of omega-3 fats, which have been shown to lower inflammation and reduce your risk of heart disease.  So if you're looking for a way to get more omega-3 in your diet, you might want to give the new kid on the block a try.  For more information, see www.manitobaharvest.com.

Hemp milk is not yet part of the USDA nutrient composition database, so you won't find it on ND. However, I've created a listing for it using ND's Custom Entry Tool.  Click here to view the entry or add it to your Pantry.

Which is more inflammatory: red meat or chicken?

I just saw this article about diet and inflammation on Ediets.com. As many of you know, I recently wrote a book on this subject, so this is a topic near and dear to my heart! I'm always glad to see articles about anti-inflammatory diets--especially on a popular web site like Ediets--because I think it's important for people to understand the relationship between food, inflammation, and health. But I'm frustrated by the fact that so many of these articles perpetuate certain myths about food and inflammation--in particular, that red meat is inflammatory and chicken is anti-inflammatory.

Many people simply assume that all the foods that we're used to thinking of as "healthy" are anti-inflammatory and foods that we have been trained to view as "unhealthy" are inflammatory. In reality, the research on foods and inflammation challenges some of these assumptions.

A boneless, skinless chicken breast--that Holy Grail of diet food--is low in total fat and saturated fat, it's true. But that's not the whole story. Chicken is also relatively high in arachidonic acid, a fatty acid that directly feeds cellular production of inflammatory chemicals.

Beef tenderloin, on the other hand, is slightly higher in fat than a chicken breast but contains only half as much arachidonic acid and higher levels of anti-inflammatory nutrients such as selenium and zinc. When you look at all the facts, I don't know how you could conclude that beef belongs on the inflammatory list and chicken on the anti-inflammatory one!

My research into this area of nutrition eventually led me to develop the IF Rating system to rate the inflammatory and anti-inflammatory potential of different foods. The IF Rating, which is provided as part of ND's analysis of foods and recipes, can help you choose anti-inflammatory foods and avoid inflammatory ones. For example, you can see that 100 grams of chicken breast has an IF Rating of -21 (mildly inflammatory), while the same sized serving of beef tenderloin rates a +12 (mildly anti-inflammatory). For more information about the IF rating system and the science of food and inflammation, see also InflammationFactor.com

The overall message of the Ediets article is right on target, however. An anti-inflammatory diet can not only reduce discomfort from joint pain, allergies, and asthma, it can also reduce your risk of serious diseases like heart disease and cancer.

Important news but lame advice

While scanning the health headlines online this morning, I came across a story on Medical News Today, entitled How to Maintain Healthy Blood Sugar Levels. The article notes a recent finding that elevated blood sugar levels are linked to a higher incidence of cancer. It's yet another good reason to pay attention to the glycemic impact of your diet, which also influences your risk of heart disease, obesity, and diabetes.

When I say "glycemic impact," I mean the effect that your food choices have on your blood sugar levels.  This important aspect of nutrition, along with the terms glycemic index and glycemic load, is explained more fully on ND's glycemic index topic page and estimated glycemic load help page.

But the Medical News Today article goes on to give some pretty lame advice.  Well, it's fine, as far as it goes....  Eat more vegetables, drink fewer sugary drinks, and maintain a healthy body weight. The doctor also advises you to choose brown rice instead of white and substitute whole wheat for regular pasta.  Not a word about portion size, however, which has a far greater impact on blood sugar levels than whether you eat brown or white rice.

According to the Glycemic Research Institute, the glycemic load (GL) of brown and white rice is virtually the same: about 23 for a three-quarter-cup serving.  For pasta, the differences are slight: A three-quarter-cup serving of white pasta has a GL of 20 vs. 17 for whole wheat pasta.  But how many people actually eat just three-quarters of a cup of pasta?

A restaurant-sized serving of pasta can easily contain three to four cups of pasta, with a glycemic load of 100 or more--well over the recommended total for an entire day!  Substituting whole wheat pasta would lower the GL to 90, which is still going to do a number on your blood sugar.

If you're trying to maintain healthy blood sugar levels, you need to pay attention both to the quality (glycemic index) and the quantity (glycemic load) of your food choices.  ND's total consumption tool can help by estimating the combined glycemic load of your meals and daily consumption. The Glycemic Research Institute recommends that you aim for a total daily glycemic load of 80 or lower, ideally spread evenly among the day's meals.

This year, a big focus on women's heart health

American Heart Month is just about over.  Did you notice the big emphasis on women's heart health this year?  Studies show that women don't take the threat of heart disease seriously enough. Although heart disease is the number-one cause of death for women, most of us are much more worried about our annual mammogram than we are about our risk factors for heart disease. 

It also has taken the medical community a long time to realize that heart disease is not the same in women as it is in men: Risk factors affect men and women differently. Even the symptoms of a heart attack are different for men and women.  While men are more likely to have the classic clutch-your-chest-and-fall-over kind of heart attack, women are more likely to experience subtler symptoms such as nausea and fatigue. As a result, early signs of a heart attack are frequently dismissed both by women as well as by their doctors and emergency room personnel. For more about recognizing the signs of heart attack in women, here's a good article from Tracee Cornforth's blog on Women's Health. 

Dr. Paul Ridker has also introduced a new, improved tool that allows women to more accurately estimate their risk of a heart attack or stroke. In addition to the usual information such as blood pressure and cholesterol, the Reynolds Risk Score takes into account your family history as well as your CRP levels (a measure of systemic inflammation). Because high CRP levels have been shown to be a significant risk factor for women, you should be able to get your doctor to test your levels. If not, you can get them tested at an independent lab such as Lab Safe (www.lab-safe.com).

Once you know your CRP, you can calculate your Reynolds Risk Score with this online calculator.
Even more importantly, you can take steps to reduce your risk factors for heart disease.  You can't change your family history, of course, and even your cholesterol levels are, to a large extent, a matter of genetics. But you can reduce inflammation--and your risk of heart disease--with an anti-inflammatory diet and lifestyle.

Alison Palmer's Health Blog outlines the basic principles of the anti-inflammatory diet. The IF Ratings on ND can also help you choose foods that reduce inflammation and avoid foods that trigger it.

The best chocolate for your heart

What could be better than chocolate for Valentine's Day? In addition to stimulating the release of neurochemicals that make us feel more romantic, chocolate helps keep your heart healthy. Chocolate contains flavonoids that increase the elasticity of your blood vessels, help keep blood clots from forming, and improve cholesterol profiles.  But contrary to popular wisdom, dark chocolate is not necessarily better for you.

It's widely believed that the darker the chocolate is, the more flavonoids it contains. But this is not entirely true. In general, the darker the chocolate, the more cocoa it contains. But much of the flavonoid content may be destroyed in processing, so you can't judge a chocolate bar entirely by its color or even its cocoa percentage.

If you're going to treat your valentine to a gift of chocolate today, look for CocoaVia products, made by the manufacturers of Dove chocolates.  They're processed using a new method that leaves more of the valuable flavonoids intact.  Acticoa, a high-flavonoid chocolate from the makers of Callebaut, should be commercially available in the near future.

One last tip: When you combine cocoa with milk (as in milk chocolate or hot cocoa), a protein in the milk binds to the flavonoids in the chocolate and makes them less absorbable. If you enjoy hot cocoa, consider using soy milk instead of cow's milk.

Oatmeal for cholesterol: improving on a good thing

I'm sure you've heard the news that eating oatmeal every day can help you lower cholesterol. Those folks at General Mills work hard to make sure that we never forget!  But your heart-healthy breakfast doesn't have to be bland and boring.  Adding a quarter teaspoon each of powdered ginger and cinnamon to every serving of cooked oatmeal amps up the health benefits—and the flavor—of your daily bowl.

In addition to being one of my favorite spices, ginger is a potent anti-inflammatory agent. Reducing systemic inflammation has been shown to lower your risk of heart disease andmany other illnesses.  Cinnamon is a terrific complement to ginger, in terms of both its flavor profile and its health benefits.  Cinnamon helps you maintain healthy blood sugar levels by enhancing your sensitivity to insulin.  As heart disease and diabetes often go hand in hand, cinnamon and ginger make a delicious dynamic duo for heart health.

Have you come up with interesting or unusual ways to use cinnamon and ginger in healthy recipes? Post them below!

Orange-fiber sausages: Too good to be true?

Researchers in Spain announced this week that they've produced a low-fat sausage that tastes just as good as the full-fat version. The secret? Ground-up orange peels.  The researchers made several versions of traditional mortadella sausage, using ground pork, seasonings, and various types and amounts of fruit fiber (apple, orange, and peach).  Although it sounds unlikely to me, the taste-testers swore that the low-fat sausages made with orange-fiber tasted just as good as full-fat sausages--but with a third fewer calories. (You can read science writer Katie Law's blog post on the whole sausage-making caper here.)

In addition to cutting fat and calories, fiber adds a big healthy bonus to sausages (or any food). Fiber helps reduce cholesterol, decrease appetite, and prevent colon cancer.  Plus, the peel of oranges and other citrus fruits is rich in quercetin, a potent bioflavonoid that reduces inflammation and allergic responses and protects your cells from free-radical damage.

From a nutritional perspective, these sausages sound great. But I'm still skeptical about the taste. After all, the taste-testers in this study were scientists and lab workers. When these orange-fiber sausages become commercially available (as they surely will), I'll cook up a batch for my friends over at Epicurious.com and we'll give you the real scoop on whether these guilt-free sausages are really as good as the researchers claim.

Broccoli wars: vitamin K and blood-thinners

Q. I take a blood-thinner (Coumadin) and my doctor gave me a list of foods to avoid because they cause an interaction with the medication. The list includes broccoli, cabbage, brussels sprouts, kale, and spinach. Aren't these foods supposed to be super good for you?  What will I be missing if I stop eating these foods?

A. The list that your doctor gave you contains foods that are high in Vitamin K, a nutrient that plays a key role in the formation of blood clots. The clotting mechanism isn't necessarily a bad thing, by the way. It's what keeps you from bleeding to death from a paper cut. But if your blood forms clots too easily, you can have a stroke or heart attack.  Vitamin K does a lot of other important things for you, too. It helps protect against both heart disease and osteoporosis by regulating the way your body stores and uses calcium, for example.

Coumadin (AKA Warfarin) prevents blood clots by blocking the action of vitamin K--and that's why your doctor wants you to avoid foods that are high in vitamin K.  Consuming too much vitamin K will essentially undo the effects of the medication. But you're absolutely right that these foods are some of the healthiest foods you can eat. In addition to vitamin K, foods like broccoli and kale contain important cancer-fighting compounds along with lots of fiber, vitamin A, and other good stuff.

There is a way for you to get all the health benefits of these foods without infering with your blood-thinning therapy--but you'll need to work with your doctor.

Trans fat free, but not fat free

As you've no doubt heard, New York city restaurants are being required to remove trans fats from their menus.  And plenty of others in the food and restaurant industry (like Taco Bell, KFC, and Frito Lay) are getting out in front of the issue by voluntarily removing trans fats from their products. But will a trans fat ban really make us that much healthier?  It all depends on what we replace it with.

Removing trans fats will have the biggest impact on the production of fried foods and pastry--foods which are commonly made using artificially hydrogenated oils.  These are liquid vegetable oils that are chemically altered to make them solid at room temperature. This gives both the oils and the foods made with them a longer shelf-life. But hydrogenated oils are full of trans fats. So now restaurants and food manufacturers have to figure out how to produce crisp fried foods and flaky pastries without them.

Folic Acid vs. Folate: What's the diff?

Q. I’m trying to get more folic acid in my diet. But NutritionData lists four different measurements for folate in foods. Which one should I pay attention to?

A. There’s a lot of good reasons to pay attention to your folate (or folic acid) intake. Folate deficiency can lead to elevated homocysteine, which has been linked to heart attack, stroke, Alzheimer’s, osteoporosis and a host of other diseases. If you are trying get pregnant, getting enough folate will help prevent neural tube defects in your baby. Folic acid’s ability to prevent this devastating birth defect led the U.S. government in 1998 to require food manufacturer’s to fortify certain foods (like bread and cereals) with folic acid.

If you are trying to get more folic acid in your diet, you've come to the right place.  You can see exactly how much folate is in a food by typing it into ND’s Food Search box, which you'll find at the upper right of every page on ND.
You can also find the foods that are highest in folate with ND's Nutrient Search tool. And ND’s total consumption tool makes it easy to see if you’re getting enough folate in your diet on a daily basis.

But when you use these tools, you’ll find the folate content listed like this:

Folate:                                400   mcg
  food folate:                        10.4 mcg   
  folic acid:                          389   mcg
  Dietary Folate Equivalents  673   mcg

Why is it so complicated?