Happy Healthy Long Life

The Healthy Librarian's Latest Lab Test Confessions: Cholesterol, Vitamin D & Vitamin B-12

 

Lab Test True Confessions

 My Adventure in Evidence-Based Living Continues

 

 

 

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It was annual physical examination time.

Although, my health plan said I wasn't due for a new lipid panel for another 3 years--because my last one was just fine--I asked my physician if I could please have a cholesterol test run, anyway.  Curiosity was getting the better of me. I wanted to know how this plant-based no-oil diet was working for me.  I write a health blog, for goodness sakes--and others want to know, too!

Where I work, the annual physical is your qualifying exam if you want to keep your eligibility for the Gold Level health insurance rebate.  $$$ saved!

All your health numbers have to be in order.  Cholesterol in the healthy range, a BMI of less than 26, no hypertension, no smoking, no diabetes, and no out-of-control asthma (I think).  That's pretty much it.   It's all about keeping any chronic conditions in check. Can't argue with that.

Either you figure out a way to do it without drugs--or if you want the big discount, these markers need to be managed with prescriptions.  I prefer to do it without diet--not drugs.

Since I've been eating plant-based for 4 years now, I asked my physician for a B-12 test, and if I could have my vitamin D level tested as well.   

 

Cholesterol Must Be Good for Something, Right?

 

 

 

What About That Cholesterol Test?

 

Believe it or not, this is an improvement over my July 2010 scores.  Take a closer look!   My LDL's dropped 6%.  My HDL's increased 41%.  The LDL:HDL ratio is 1.35   Not too shabby.

Of course my Total Cholesterol went up, but that's just because my HDL's jumped up 23 points & your total cholesterol is just the sum total of LDL's + HDL's + 1/5 of Triglycerides.   In my case:  that's 201.   No worries.

I'm resigned to never having those low-low LDL's that some people get on a plant-based diet.  Not without drugs---and no one's suggesting that I need them, thankfully.  Doesn't concern me a bit.   My body just makes more cholesterol naturally, and that's normal for me.  And the cardiovascular disease story is really more about inflammation, anyway.

I already know where I'd be if I were still eating animal products, oil, & less fiber:  probably with a total cholesterol of over 269 by now, weighing 15 pounds more, and taking blood pressure meds.   So for me, the choice is simple.   I'd rather lower my LDL's, keep my inflammation low, and keep my blood vessels healthy with my diet, rather than with drugs.

And besides, I know from a previous HS-NMR Lipid Profile that my LDL's are mostly the light and fluffy kind. Again, no worries.

As for the increase in HDL's, I'm guessing that comes from two changes I've made since July 2010. Nuts & exercise.  I exercise a lot more, I eat walnuts & chia everyday, & I use cashews in cooking, occasionally.  I figure one of those two things are probably responsible for the HDL rise.

Bottom line, the HDL story is still a research puzzle in progress and numbers don't tell the whole story anyway.   Remember the "Efflux Capacity" of HDL wrinkle?    Nevertheless, I'm thrilled with my LDL:HDL ratio of 1.35.

 

So what if my numbers don't go as low as I was hoping they'd go on a plant-based no-oil diet?  I asked Dr. Esselstyn two years ago.

Dr.  Esselstyn stressed that the health of my blood vessels is dependent upon what I'm eating--in spite of the numbers.  If I'm really eating 100% plant-based, no-oil, all whole grain, very heavy on the greens, beans, fruits, & legumes--no problem!  He says my blood vessels should be thanking me by now.  

Turns out, even the Tarahumara Indians, who had no heart disease to speak of--had LDL levels from 80-115 (my range)--and some had HDLs as low as 26--the kind of numbers that might make a cardiologist pull out a prescription pad. 

They were eating only beans, squash, & corn--not a bit of oil.  Their LDLs were the light fluffy kind and they weren't causing a bit of damage.  And their lower HDLs weren't a problem either, because the Tarahumara's weren't eating anything that was going to turn their LDLs into the small dense dangerous bad guys.  

If you aren't eating any inflammatory endothelial-damaging foods like fats, oils, and animal products---and you're loading up on high anti-oxidant greens you've reached the most important goal of all!  Your numbers will probably reflect this--but don't worry if they don't.

OK, 'nuff said about that.

 

Moving on to Vitamin D & B-12

 

 

 

What About That Vitamin D Test?

 

My Vitamin D level is now 42.9.   RIght were I want it to be.

The last time it was tested it was 34.3, back in February 2010.  Turns out, back then it was measured by a less accurate radioimmunoassay test, which I now know was inflated by about 23%--so it was actually lower than I thought--more like a 26!

 If you follow the Vitamin D research, the "sweet spot" for health benefits seems to fall in the 40-60 ng/mL level.  Right where I've finally landed.  Those benefits include stonger bones, less infections, breast cancer prevention,  decreased mortality, less obesity, diabetes prevention, & cardiovascular benefits. To read what the top vitamin D docs say about benefits of the sunshine vitamin, click here and here.  

To be honest, this is still an emerging area of research, and the jury isn't in yet, but far more studies show health benefits at the higher, rather than the lower end of the spectrum.

Frankly, I was surprised that I "weighed in at" 42.9.  It's summertime & I've been taking 4000 IU's (the Institute of Medicine's upper limit)--yes, you read that right--every single day now for over a year.   Rainbow Light Sour Lemon Gummies.  My daily treat.  The only vitamin I actually enjoy taking.

Looks like it was a good thing that I've been taking the 4000 IU's.  That works for me, but it may be too much or not enough for you.  Everyone is different and unless you get tested, you have no idea where you're at.  Your weight, your skin color, your age, where you live, your sun exposure, your health conditions & what you eat, all make your blood level of vitamin D unique to you!

 

New More Accurate Vitamin D Test 

Here's the reason why my latest vitamin D level was lower than I expected.  My hospital is now using a better vitamin D test, that's much more accurate than what they previously used.

The new test is a liquid chromatography-tandem mass spectrometry test with results about 23% lower than previous tests.  The one previously used was a radioimmunoassay test  (RIA).  

 

Here's the note on the lab test:  "On May 3, 2011, we have transitioned from a radioimmunoassay (RIA) method to a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method.

 
For most patients, the LC-MS/MS method will provide approximately 23%
lower results than seen previously with the RIA method, due to improved
specificity.

 
The reference range for the RIA was 19.6-83.6 pg/mL.

The reference range for the LC-MS/MS is 15.0-60.0 pg/mL.
Reference range applies to VitD 1,25 DiOH Tot only."

 

 

 

About That High B-12 Test?

 

If you're eating a vegan diet you need to take a vitamin B-12 supplement.  The amount in a multivitamin isn't enough.  The amount in nutritional yeast or enriched non-dairy milk, is not enough.  You need a supplement.  No ifs, ands, or buts.

A prominent vitamin B-12 researcher advised Dr. Esselstyn early on to recommend a dose of 1000 mcg of vitamin B-12 to anyone who is following his plant-based diet.  So that's what I take.  I used to remember to take one about 3 times a week, but once I started to leave the bottle in my car I remembered to take one every day.

There are plenty of good reasons to take B-12, even if you aren't planted-based, especially if you're over age 50.   Preventing dementia & brain shrinkage are two pretty good reasons, for starters.  I've written a lot on this subject, so if you want a quickie review on who should take vitamin B-12 & why, click here and here.

Last December 2011 I was fortunate enough to hear Dr. Donald Jacobsen of the Cleveland Clinic interviewed on Dr. Ronald Hoffman's radio show--and here's what he had to say:

 

1. All vegans need to take 1000 mcg of B-12 a day in the form of cobalamin, methylcobalamin is not necessary.

2. Take it sublingually for the most absorption. It's a safe vitamin & you cannot take in too much--any extra is excreted in the urine.

3. We only absorb 10% of B-12--which gives an actual net dose of 10 mcg.

4. B-12 taken intramuscularly is not necessary & that's been proven with research studies.

5. For the most accurate test of B-12 deficiency Jacobsen recommends the MMA (methylmelanic acid test). Note: results are inaccurate in the presence of kidney disease.

6. Jacobsen says the common Serum B-12 test is not an accurate measure because of the way B-12 binds to proteins in the blood. It can say you're level is normal, when it is not.

7. A newer B-12 test, the Holotranscobalamin Test may be a good choice--but, more research is needed. You can listen to the interview here--just 17 minutes long.http://podcast.wor710.com/wor/3231275.mp3

 

Turns out my hospital's lab doesn't use the MMA (methylmelanic acid test) that is recommended as the most accurate way to assess vitamin B-12 levels.   Oh, well, I've got to make due with less than perfect testing, which casts some doubt on my over-the-top test results.  

The hosptial uses the common serum B-12 test--so honestly, I have no idea if I need to cut back my daily dose or not.  I feel fine, and according to vegan dietitian Jack Norris, if you're regularly supplementing with B-12, and you're not experiencing any symptoms, like fatigue or tingling--don't even bother getting tested in the first place--the test results are just not that accurate, in the first place.  According to Norris, if you're supplementing--assume you're OK.  Too bad I found that out after my test.   To read more about B-12 from Jack Norris, click here.

 

Bottom Line:  I Plan to Just Keep on Doing What I've Been Doing

 

Eating plant-based no-added oil (& no sugar) has helped me to lose weight & allows me to eat as much as I want to eat.  

It's lowered my blood pressure, and encouraged me to eat a wider variety of vegetables, fruits, grains, & legumes.   High Nutrient-Density/Low Caloric Density has become my mantra.  It's upped my anti-oxidant intake immeasurably, which is a sure-fine way to curb inflammation.

I'm sticking with my 4000 IU's of vitamin D, for now.  It's got my vitamin D level right where I want it.

As for Vitamin B-12--I'm not sure yet what I'll do.  If it's safe, and you can't get too much, it may not matter if I continue to take it daily, but, I'll likey drop down to just 5 days a week.  I'll ask my doc what she suggests.

 

What about you?

Have you had your B-12 or vitamin D levels tested recently?

Is anybody else eating a plant-based no-oil diet (w/o cheating) and getting a cholesterol test like mine?  

I have a theory that women's cholesterol levels don't decrease with diet as much as men's do, & that's OK.  Has that been your experience?

 

 

 

Girl Talk, a Success Story, and the Best Vegetables to Put the Kibosh on Cancer

 

My Sister-in-Law Today - March 2012

My Sister-in-Law Seven Months Ago - July 2011

 

 

If you received this post via email, click here to get to the web version, with all the links--and to write a comment!

I was really looking forward to this Wednesday.  

My sister-in-law literally "flew in" for a mini-21 hour visit.

We hadn't see each other since last July, when this photo of our hike was taken.  A last minute business trip was scheduled that would bring her within easy driving distance for a quick visit with me & her brother--the Lab Rat.   We live so far away from each other, that we only get a chance to see each other about twice a year.  Next visit:  At the end of July for a family vacation.

For the entire 7 waking hours of our visit we talked non-stop.  Par for the course.

We had lots to catch-up on.

As for the very personal story that follows, she only agreed to share it because I convinced her it would inspire & motivate others.  She's very modest, humble, & private.  It's all her accomplishment--but, I couldn't be happier & prouder of her success story.

 

The Quickie Back Story

 

Back in August 2011 my SIL found out her cholesterol was way too high--and her triglycerides were off the charts.  Her doctor advised her to high-tail it to a cardiologist ASAP--get on statins, and whatever else was needed to get her numbers down.

Just so you know...

• She's been a lifelong exerciser!  She's no couch potato!  She might have weighed more than she wanted to--but she's alway been fit!   She's always been a regular walker, hiker, weight-lifter, & a "sometimes jogger".
• She watched what she ate.  She really tried to avoid the junk food, and ate a Mediterranean style diet--lots of fish, fruits & vegetables, olive, & nuts.  Just like all of us were doing--when we thought we were "eating a healthy diet."   And, we all know how those restaurant meals, and dinner parties add up.

Before making that cardiology appointment she wanted to see if she could turn those numbers around by herself--with diet, rather than drugs.

She wanted to give Dr. Esselstyn's diet protocol a 100% college-try before taking the medication route.

She downloaded a copy of "Prevent & Reverse Heart Disease" for her Kindle.  I sent her all the Esselstyn diet information I had--and I even asked Dr. Esselstyn what he advised her to do to get her triglycerides under control.

A few short weeks after she changed her diet, her total cholesterol level had dropped an amazing 100 points.

 

Fast Forward Seven Months Later on the Esselstyn Plan

 

The girl has stuck to with the program!

OK, maybe some very rare transgressions when she's traveling---but those have been few & far between.

Her tastes have completely changed. She loves the foods she is eating now.

Even at restaurants, she's sticking to plant-based no-oil healthy choices.  Salads, baked potato, steamed vegetables.  Amazing!

She's completely hooked on cooking without oil.  She loves all the flavor-packed plant-based recipes she continually experiments with.  OK, there have been a few losers or "so-so's" here & there.  Doesn't miss meat, chicken, fish, or cheese a bit.  But, barbecue potato chips?  That's a different story--but she's not eating them.

She's lost about 25 pounds, which is significant for her tiny frame--and her Chico size is now down to 00-- double zero, for all you Chico fans--probably an equivalent of a size 6.  Her Gap jeans are size 6, & they're lower-cut, skinny ones.  Woo Hoo!   

She feels great. She's going to kill me for saying this (I told you--she's very modest)--but compliments & questions come her way almost every day,  "You look fantastic.  What's your secret?  What are you doing differently?"

In two weeks she get a full-enchilada lipid work-up---so no numbers to report as yet.

 

 

My Sister-in-Law's Request -

A Sneak-Preview of My Centenarian Strategies Presentation

 

After our non-stop gab fest on Wednesday night, my SIL asked to see a preview of my "almost-completed" Centenarian Strategies presentation.

When we got to a slide that detailed which vegetables had the strongest effect on cancer-cell proliferation--and which veggies are the best bets to prevent cancer, she wanted to know where she could find that post on my blog.

She:  "I don't remember seeing a post about this.  Where is it?  Can you send me the link?"  she asked.

Me:  "Well, I never got around to posting it.  It's only in my presentation."

So, dear readers, below, please find my "Table That's Worth a Thousand Words" presentation slide.

Sure, there's more to say about this research than you can see on two slides--but I'm short on time.  

Quickly, here's how the study was designed.

• Extracts from 34 vegetables were isolated & tested on 8 different tumor cell lines for their ability to inhibit cancer cell growth & proliferation .
• Fresh vegetables were juiced with a Juiceman extractor--and then tested on & against specific unique types of cancer cells; like stomach adenocarcinoma, breast cancer, prostate cancer, lung carcinoma, glioblastoma, medulloblastoma, etc.

 

 

The Best Cancer-Fighting Vegetables

 

The Bottom Line:  The Best Cancer-Fighting Vegetables

 

1. Over 250 epidemiological studies have suggested that people who consume a diet high in fruits & vegetables  reduce their risk of developing cancer.  But, which vegetables are the best bets?
2. Not all fruits & vegetables are created equal when it comes to cancer prevention--and the study's results, convinced the authors that people need to be encouraged to eat the vegetables that will give them the "most bang for their buck" when it comes to preventing cancer.
3. Turns out, the vegetables we eat the most--have the weakest inhibitory effect on cancer cell growth: potatoes, carrots, tomatoes, & lettuce.
4. Evidence shows that the cancer prevention properties of fruits & vegetables are "additive" & "synergistic".  Bottom Line:  Eat a wide  of fruits & vegetables to get the "most cancer prevention bang for your buck".
5. Study weakness: The vegetable juices in the study did not contain water-insoluble (aka fat-soluble) molecules such as lycopene or beta-carotene that are found in the yellow, orange, & green leafy fruits or vegetables, which may have resulted in some underestimations of the cancer-fighting properties of vegetables that contain these fat-soluble phytochemicals--like tomatoes, carrot, broccoli, & spinach.
6. Cruciferous vegetables have potent cancer inhibitory activity against most cancer cell lines.
7. Other vegetables in the Brassica oleracea family, like kale, cabbage, curly cabbage, cauliflower, & broccoli, were the most inhibitory vegetables tested.
8. The best bets for cancer prevention are the cruciferous vegetables, the dark green leafy vegetables, & those in the Allium family, like onions, leeks, chive, shallots, & garlic.   The authors want this message to reach the public.  Pay attention.
9. These vegetables have exceptional "inhibitory" activity against all tested cancer cell lines--including those from the kidney & pancreas:  garlic, leek, green onions, Brussels sprouts, kale, broccoli, & various cabbages.
10. And which vegetables do we eat the least?  That's right!  All the most potent cancer fighters listed in #9.  

 

"Since the formation of tumours is a random event that occurs in a significant percentage of the adult population, the increased consumption of these vegetables with high anticancer properties could play a central role in preventing these tumours to reach a clinical stage, and thus reduce the incidence of several types of cancer."

 

"Antiproliferative and antioxidant activities of common vegetables: a comparative study," Beliveau, R. et al.  Food Chemistry  2009:112:374-380

 

If You Missed It the First Time--Here It Is Again!

The re-posting of My Sister-in-Law's Story

September 05, 2011

Saturday Morning Heart to Heart Girl Talk with My Sister-in-Law - Triglycerides, Esselstyn Diet Success, Restaurant Insanity, Molten Lava Cake, Tortilla Soup - and of course, the Grandkids, Kids, & Husbands

 

 

 


Photo by Vincent Van Der Pas

"When triglycerides go up over 100 we start making abnormal forms of cholesterol--the small dense LDLs that are atherogenic and penetrate much more rapidly into the arteries than normal large LDLs. 
 
When triglycerides start going up--and the changes start around 80-100--nearly everyone with triglycerides over 100 is making significant amounts of small dense atherogenic LDL--above 150 almost all LDL particles are small dense and atherogenic." 

-Dr. Patrick E. McBride, Professor of Medicine and Family Medicine, University of Wisconsin, and a member of the Expert III NCEP Panel setting cholesterol guidelines-

 

 

On Saturday morning, my sister-in-law and I FINALLY had a chance to catch up.  

We talked for an hour staight--which is nothing for us--we'd barely scratched the surface of what we could cover--but we both had to call it quits to get on with the rest of of the stuff on our To-Do Lists.

She had some pretty good news to share--and I asked her if it was OK if I shared it with you.  She said, "Sure! Go ahead."   So here's what we talked about....

 

What's Up with My High Triglycerides?  Help!

 

Here's the back story.

Exactly, one month ago my sister-in-law texted me a cryptic message, "Call me when you have a chance.  Need your opinion."

Turns out, she'd had her annual gyno exam.  Her doc had taken her lipids, and she' had just found out that her total cholesterol was too high--and her triglycerides were off-the-charts high.

 

She: "How can that be?  I really do eat healthy.  I exercise.  My doc wants me to make an appointment with a cardiologist ASAP, but I don't want to go on statins, or take anything for the triglycerides.  Most of my other numbers are OK--the LDLs & HDLs--but the triglycerides are sky-high.  I'd really like to go 100% on the Esselstyn diet first  & see if I can get those numbers down."

Me:  "Well, don't get mad at me for saying this--but I've been there myself--thinking I'm eating a healthy diet, when I'm really eating "a healthy diet at home"...in addition to a load of crap out-of-the-house!  

I know you make healthy meals at home--but it's probably all the rest of the stuff you're eating.  The restaurants, the traveling, the cookies, cakes, & pastries your friends make, the lack of exercise when you're traveling, the wine & rum, the sugar, the dinners at friends', the crusty French bread, yada yada yada.  It all adds up--and bottom line--if you're taking in more calories than your body needs--you can end up with high triglycerides!

Look, I never would have tried the Esselstyn diet 100% if he hadn't challenged me to do it.  You won't know if it works until you do it 100%.  Once I did it 100% & saw the results--I was convinced.

High triglycerides, are bad news.  Definitely see the cardiologist. But, sure-- try the diet first to see if it can make a difference for you.

She:  I've already downloaded Esselstyn's book on my Kindle.  Can you send me any other info you might have that will help?  I've got just 2 1/2 weeks to try this out, before I go out-of-town with my friends.  I know I won't be able to do it 100% on vacation--just not possible--so I'm going to see if I can get a cholesterol test before I leave on vacation to at least see if I'm on the right track. Before I see the cardiologist.

Oh, I've been reading up on triglycerides--but send me anything you might have on the blog that would help.

Here's what I emailed her:

Here's one of the posts I've written about on triglycerides--but this one sums it all up.  NOTE:  In April the ranges for normal all moved downward.  Now, the recommendation for the normal range is at 100 or below (no longer below 150).  But as you'll read, it's best to be at 80 or below. You want to make sure you're making light fluffy LDLs, not the small dense kind.  You might request the NMR particle test.  And here's the link to the new American Heart Association Scientific Statement recommending that triglycerides ought to be at 100 or below--not 150.

You want me to ask Dr. Esselstyn what he suggests you do?

Good luck!

Love you!

My note to all of you:  Please read that post I sent my sister-in-law about triglycerides.  It will tell you everything you ever wanted to know about these bad-boys.  They're an independent risk factor for strokes & cardiovascular disease.  If you've got a lot of belly fat--you probably have high triglycerides.  If you're eating more calories than your body can burn off--you probably have high triglycerides.  To read even more (yeah right!) about the triglyceride stroke/heart connection, click here and here and here.

How Strange is This?  The day after I sent the email to my sister-in-law, Dr. Esselstyn just happened to call me at work with a library question.  Of course, I asked him for some words of wisdom for my sister-in-law & for high-triglycerides in particular.  Darn, I no longer have my notes--but here's what I remembered he said:

• Cut out the sugar--all kinds!  (my note: be sure to read this and this)
  
• Cut out alcohol
• Cut out the white foods--refined flours, pastas, breads, rice, crackers, etc. If high triglycerides are a problem for you--stick to just eating whole grains--and skip foods made with whole grain flours, like breads & pastas.  Even whole grain flours can raise triglycerides in folks who are overweight and insulin-resistant.  Think about it--flours of any kind are "processed" & digest too quickly.  Instead eat quinoa, wheatberries, hulled barley, steel-cut oats.  Flourless sprouted breads, like the Ezekiel brand, are a better choice if you need a bread.
• Remember!  Green leafy vegetables are the Main Event when it comes to making blood vessels "heart attack proof".  Load up on vegetables over grains!
  
• No fruit juices--and be careful not eat too many fruits, either, if you have high triglycerides.  Stick to the ones with the lowest sugar content.  (my note: the fruits lowest in fructose include strawberries, berries, cantelopes, grapefruit, peaches)  Source: AHA statement quoted on CardioBrief
  
• Avoid smoothies made with fruit!  It can cause a rapid rise in blood sugar for some people.  I see it happen a lot!
• Avoid dried fruit--too much sugar!  Especially high sugar fruits like dates & raisins.
  

 

Oh heck--I really really don't want you to miss the Triglyceride Post I emailed to my sister-in-law--so, just in case you don't click that link--I at least want to make sure you get some of the key points:

In A Nutshell--Here's What Dr. Patrick E. McBride is Saying About Triglycerides

• If your triglycerides are under 80 you are making "normal large" LDLs that are not very atherogenic (think atherosclerosis; arterial plaque; hardening of the arteries)

• When triglycerides are over 150 (there are just too many particles floating around with no where to go) they briefly get inserted into the LDLs and change the LDLs into "small dense atherogenic" particles.

• Stealth LDL: That's what you call what was once a normal LDL particle that's been penetrated by free-floating triglycerides.  When triglycerides are too high they are able to change the LDL into "small dense dangerous" LDL that oxidizes very easily (a bad thing) and penetrates rapidly into the arteries. Note: Triglycerides are not supposed to penetrate the LDLs!!

• Normal LDL: It's difficult for normal LDL (large & fluffy) to penetrate into the wall of an artery!

• When triglycerides are between 80-100 you start to  make abnormal LDL.  Some of it starts changing into the "small dense atherogenic" variety at this level.  (If changes start happening over 80--it looks to me like the only safe triglyceride number is under 80!)

• When triglycerides are over 100--according to Dr. McBride--you've turned the corner & "are making at the very least, a significant amount of "small dense" LDL."

• When triglycerides are above 150, almost all of the LDL particles become "small dense atherogenic".

• Dr. McBride served on the III NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that set the guidelines for triglycerides (and cholesterol) back in 2002.  He advocated for the normal level to be under 100--and he strongly believes that the current level will go down to 100 when the next guidelines come out.  Note: in April 2011 the AHA issued a Scientific Statement recommending the new normal be under 100.  Find that here.

• Big clue that your triglycerides are probably too high?  Abdominal obesity aka belly fat.  That's the engine--the symptom--that starts the cascade toward atherosclerosis; heart disease; stroke; type II diabetes.  It's a big reason for triglycerides producing nasty stealth LDL. Read "This Belly Fat is Going to be the Death of Me and Now I Understand Why."  and "Lose That Terrible Horrible Inflammatory Disease-Causing Visceral Belly Fat with Whole Grains? Tufts Researchers Say It Helps!"

• According to Dr. McBride, if you have abdominal obesity, the chances are greater that you are producing the abnormal dangerous "small dense" form of LDL.

• If you overconsume sugar, soda pop, saturated fats, trans fats, refined carbohydrates, and "fried apple pies"--and you are consuming more calories than you need--your body doesn't know what to do with all that junk--and you end up with lots of rich triglycerides--that are very inflammatory and very atherogenic--floating around--just looking for an LDL to penetrate and turn it into "small dense dangerous" LDL!

 

Sister-in-Law Success! 

 

Before my sister-in-law went on her week vacation with her gal pals, she wisely had her blood drawn for a cholesterol test.  She'd been on the Esselstyn diet for just 2 1/2 weeks--eating no-fat, no meat, no cheese, no-oil, no refined grains.

She knew it wouldn't be as good as if she'd been on the diet for 4 weeks--but at least she's get some idea if it could improve her lipids.

 

Test results:  Her total cholesterol dropped 100 points!  Amazing! Full disclosure: for some unknown reason, the lab only measured her total cholesterol--not what she really needed--a full lipid panel.  But she figures the triglycerides & LDLs must be going down if her cholesteol levels came down so much in just 2 1/2 weeks.  She'll be following up with a full lipid panel.

Other good news:  In spite of her one week of transgressions on vacation--she's back to the Esselstyn diet--and she's losing weight.  Best of all, she's losing belly fat!  She's committed to stick with it. She'd rather lower her triglycerides with diet instead of drugs.  Besides, only diet can help reduce weight.

 

What My Sister-in-Law is Up Against.  She Lives in the Southern "Stroke Belt", Her Friends Think Health is All About Genes, Not Diet & Everyone Likes to Eat Out

 

She's swimming against the stream in her neck of the woods.  She's the odd girl out in her social circle.

Everyone loves butter, meat, cheese, pastries, fried foods, good old Southern cooking, and eating out.

Lately, everyone's complaining about being so forgetful.  They thinks it just normal aging. 

Uh??  Think again, folks!

Check out this "hot off the press" article published online in Stroke, Sept. 1, 2011   Buchman, AS etal "Cerebrovascular Disease Pathology and Parkinsonian Signs in Old Age".  It's summarized in the NPR Blog, Shots:

 

"Old people who don't have signs of cardiovascular disease still may have suffered microscopic strokes that don't show up on conventional tests. The small strokes may impair their ability to walk, balance and function just the same.

Scientists examined the brains of 418 priests and nuns after they died. The researchers found that one-third of the brains that had seemed normal using conventional tests while the people were alive actually had damage to tiny blood vessels. The damage was so slight it was impossible to see without a microscope.

The people whose brains had these tiny signs of hardened arteries and stroke were most likely to have had shuffling gait and other movement problems while they were still alive."

 

If you've been eating the standard American diet--and you're eating out a lot, there's a good bet that what we take to be the "normal forgetfulness of aging"--isn't exactly normal.  It could be teeny weeny imperceptible strokes.  Now that's one scary thought!

 

"Dr. Megan C. Leary of UCLA examined over 5,500 MRIs of the brains of 50 year olds & found many had tiny white spots that indicated that they had unknowingly experienced tiny, imperceptible strokes.  These "brain attacks" have the same history and cause as heart attacks.   See "Annual Incidence of First Silent Stroke in the U.S" Cerebrovasc Dis 2003;16(3):280-5.

According to Leary, "'Silent strokes' are epidemic in this country.  While they occur in parts of the brain where they don't cause symptoms right away, the word 'silent' should be put in quotes, because their effects accumulate over the years.''

While a single silent stroke may have no impact, repeated ones lead to memory lapses, mood problems and difficulty walking. They are also a sign that people are especially prone to full-blown strokes.

Keep on eating the same way at age 60, 70, & 80 and there's a good chance that those tiny strokes will add up to increasing memory lapses, and progress on to dementia--depending upon what part of the brain has been affected. 

What's good for the blood vessels of the heart, is good for the blood vessels of the brain."

Dr. Caldwell Esselstyn, Jr., Prevent & Reverse Heart Disease lecture 6/18/2010. see also: The Rotterdam Scan Study;  "Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline," New England Journal of Medicine 2003 Mar 27;348(13):1215-2; "Silent Brain Infarcts: a systematic review,"  Lancet Neurology 2007 Jul;6(7):611-9.

 

As for all that rich Southern cooking--forget about it!  It's killing brain cells and giving the South a new claim to fame:  It's known as The Stroke Belt. 

The "brain-damaging suspects" are likely to be the much-loved traditional Southern diet of fried, salty, & fatty foods along with too little exercise--all of which contribute to hypertension, excess weight, & diabetes--the biggies responsible for stroke risk.

I posted about the brand new REGARDS Study, the Stroke Belt & how the Southern diet is affecting cognitive impairment on July 26, 2011.  No need to repeat what I wrote, just click here to refresh your memories.

 

Two of my favorite quotes about the REGARDS study:

 

"This is a very strong alarm signal.  [The finding suggests that] if you want to keep your marbles, you need to control your blood pressure, excessive weight and other risk factors for stroke."  

Dr. Gustavo C. Roman, the head of the neuroepidemiology section of the American Academy of Neurology, commenting on the article.

[Problems like high blood pressure and diabetes are likely to be "affecting  blood flow to the brain, even if it's not causing a visible stroke.  An undersupply of blood can also cause problems with brain cells that lead to cognitive decline."  

Dr. Kenneth Langa, a professor of Internal Medicine at the University of Michigan, commenting on the article.

 

Restaurant Madness - From "Cook This, Not That"

 

My sister-in-law's friends like to eat out.  Who doesn't?   It's nice to have someone else do the cooking. 

But, once you really know what's in all that restaurant food--most of us will run back to our own kitchens.

Unfortunately, twice a week my sister-in-law has a pretty much mandatory "luncheon meeting" at a restaurant with her business partner.  Sort of non-negotiable. 

Last week, on my weekly public library run I picked up one of those "Cook This Not That" books.  OMG!  I started reading it before I went to sleep--and I couldn't stop interrupting my husband's own reading with, "Listen to this!"   "OMG!  Listen to this one--it's even worse."  

The book shocked me!  No wonder most Americans are overweight.

We haven't a clue what's in that restaurant food--so a big "Thank You" goes out to David Zinczenko & Matt Goulding for collecting all this incriminating nutritional info.  I suspected it--but I really didn't know it was that bad.

And to think how much I used to love Molten Chocolate Lava Cake.  Never again!

 

Chili's Molten Lava Cake - 1,070 calories, 51 g fat, (26 g saturated), 143 carbs

 

No wonder restaurants don't want to post the nutritional info on their menus. 

These aren't the worst offenders--but here's a sampling of some of the meals that even health-conscious folks might consider ordering.

 

Marie Callender's Spanish Omelette:  1,550 calories, 78 g fat (25 g saturated), 2,980 mg sodium

Baja Fresh Chips and Gaucamole:  1,340 calories, 83 g fat (8 g saturated), 950 mg sodium

California Pizza Kitchen Tuscan Hummus with pita:  861 calories, 4 g satuated fat, 1,562 mg sodium

Ruby Tuesday Buffalo Shrimp Quesadilla:  1,465 calories, 89 g fat, 3,528 mg sodium

Houlihan's Fire Grilled BBQ Salmon Salad:  1,182 calories, 61 g fat (9 g saturated), 1,719 mg sodium

T.G.I. Friday's Santa Fe Chopped Salad:  1,800 calories

Panera Bread Tuna Salad on Honey Wheat Sandwich:  750 calories, 47 g fat (9 g saturated), 1,130 mg sodium

Chipotle Grilled Chicken Fajita Burrito:  870 calories, 30 g fat (13 g saturated), 1,940 sodium

Just for kicks, borrow a copy of this book from your library--or check out the worst vegetarian restaurant meals  (check out the side-panel on the left) and then click through the slideshow of the 20 worst new foods in America.

 

  Cook This!  Enlightened Appetite for Reduction Tortilla Soup

 

Enlightened Isa's "Appetite for Reduction"  Tortilla Soup - 223 calories, 1.5 g fat (0 g saturated), 8.7 g fiber

 

 

No conversation with my sister-in-law is complete without sharing recipes--the new finds-that-we've tried out--and loved!

Funny, how she is always trying recipes that I never even noticed--even though we both share a lot of the same cookbooks.  I'm definitely going to reap the benefits of her expert cooking now that she's going Esselstyn.

She:  "Have you tried Isa's Tortilla Soup in Appetite for Reduction?  We all loved it.  But I cut the jalapenos down to just one."

Me:   "Nope.  I never even noticed it in the cookbook.  But I'll check it out as soon as I hang up!"  

And I did, later that day.  A big winner.   Here's my enlightened version.

It looks like a stew or a chili--but it's a soup.  Hearty, spicy, and a big one-bowl meal.

 

Appetite for Reduction Tortilla Soup---My Enlightened Version

click here for the recipe on one page

Serves 6 generously.  Add a salad & an ear of corn for a terrific meal!

 

Ingredients:

1 medium onion, chopped (Isa used a small one)

1 jalapeno, seeded & sliced thinly (Isa says use 2)

1 poblano pepper, seeded & chopped into 1/2 inch pieces (this is the large dark green one--ask your grocer--I had to)  OK to use a sweet green pepper, but go with the poblano!

4 cloves garlic, chopped

(Isa also recommended 1/4 tsp red pepper flakes.  I left these out to see if the soup needed it--and it was hot enough without them--and I like heat!)

1 tsp salt  (optional, always)

28 ounce can of crushed Glen Muir Fire-Roasted Tomatoes

3 cups of low-sodium vegetable broth (plus extra for sauteeing the vegetables)

4 ounces of fresh small corn tortillas--bake or toast these until they are crisp.  Watch them carefully so they don't burn.   (Isa uses 4 ounces of baked corn tortilla chips)

1 tablespoon ground cumin

1 (15 ounce) can of pinto beans, drained & rinsed

1 cup of frozen or fresh corn.  (I like using Trader Joe's frozen Roasted Corn)

1/2 cup chopped fresh cilantro, plus extra for garnishing

Juice from 1 juicy lime

 

Preparation:

1.  Preheat a 4 quart soup pot over medium high heat.  Dry saute the onions, jalapeno, & poblano peppers until the onions are translucent, about 5 minutes.  Add a little vegetable broth if the onions start to stick or dry out--to deglaze the pan.

2.  Add the crushed tomatoes, the 3 cups of vegetable broth, and the cumin to the pot.  Mix well.

3.  Crush the crisped tortillas into crumbs (some bigger pieces are OK) & add about 1/2 of them to the pot--reserving the rest for garnish.   (I ended up adding all of them to the pot, because I didn't read the directions carefully & it thickened the soup, nicely)  You want the crumbs to "melt" into the soup.

4.  Cover, & bring to a boil.  Lower the heat to a simmer, add the beans, corn, & cilantro.  

5.  Simmer for 5 more minutes.

6.  Add the lime juice, taste for seasonings.

7.  Ladle soup into bowls, & top with remaining tortilla crumbs & remaining cilantro.

 

Nutrition Info:

1/6th of the recipe

 

 

 

Nutrition Facts Enlightened Appetite for Reducti The Best Tortilla Soup Serving Size: 1 serving Amount Per Serving Calories 223 Total Fat 1.5g       Saturated Fat 0g       Trans Fat 0g Cholesterol 0mg Sodium 408mg Carbohydrate 46.9g       Dietary Fiber 8.7g       Sugars 12.4g Protein 8.6g Vitamin A 48% Vitamin C 172% Calcium    8% Iron 15%

 

 

 

 

I'd love to hear about your favorite Appetite for Reduction recipes!  

Anyone have some suggestions for "safe foods" when you absolutely have to eat out?

 

 

 

 

 

 

 

 

 

 

Saturday Morning Heart to Heart Girl Talk with My Sister-in-Law - Triglycerides, Esselstyn Diet Success, Restaurant Insanity, Molten Lava Cake, Tortilla Soup - and of course, the Grandkids, Kids, & Husbands

 


Photo by Vincent Van Der Pas

"When triglycerides go up over 100 we start making abnormal forms of cholesterol--the small dense LDLs that are atherogenic and penetrate much more rapidly into the arteries than normal large LDLs. 
 
When triglycerides start going up--and the changes start around 80-100--nearly everyone with triglycerides over 100 is making significant amounts of small dense atherogenic LDL--above 150 almost all LDL particles are small dense and atherogenic." 

-Dr. Patrick E. McBride, Professor of Medicine and Family Medicine, University of Wisconsin, and a member of the Expert III NCEP Panel setting cholesterol guidelines-

 

 

If you received this post via email, click here to get to the web version with all the links.

On Saturday morning, my sister-in-law and I FINALLY had a chance to catch up.  

We talked for an hour staight--which is nothing for us--we'd barely scratched the surface of what we could cover--but we both had to call it quits to get on with the rest of of the stuff on our To-Do Lists.

She had some pretty good news to share--and I asked her if it was OK if I shared it with you.  She said, "Sure! Go ahead."   So here's what we talked about....

 

What's Up with My High Triglycerides?  Help!

 

Here's the back story.

Exactly, one month ago my sister-in-law texted me a cryptic message, "Call me when you have a chance.  Need your opinion."

Turns out, she'd had her annual gyno exam.  Her doc had taken her lipids, and she' had just found out that her total cholesterol was too high--and her triglycerides were off-the-charts high.

 

She: "How can that be?  I really do eat healthy.  I exercise.  My doc wants me to make an appointment with a cardiologist ASAP, but I don't want to go on statins, or take anything for the triglycerides.  Most of my other numbers are OK--the LDLs & HDLs--but the triglycerides are sky-high.  I'd really like to go 100% on the Esselstyn diet first  & see if I can get those numbers down."

Me:  "Well, don't get mad at me for saying this--but I've been there myself--thinking I'm eating a healthy diet, when I'm really eating "a healthy diet at home"...in addition to a load of crap out-of-the-house!  

I know you make healthy meals at home--but it's probably all the rest of the stuff you're eating.  The restaurants, the traveling, the cookies, cakes, & pastries your friends make, the lack of exercise when you're traveling, the wine & rum, the sugar, the dinners at friends', the crusty French bread, yada yada yada.  It all adds up--and bottom line--if you're taking in more calories than your body needs--you can end up with high triglycerides!

Look, I never would have tried the Esselstyn diet 100% if he hadn't challenged me to do it.  You won't know if it works until you do it 100%.  Once I did it 100% & saw the results--I was convinced.

High triglycerides, are bad news.  Definitely see the cardiologist. But, sure-- try the diet first to see if it can make a difference for you.

She:  I've already downloaded Esselstyn's book on my Kindle.  Can you send me any other info you might have that will help?  I've got just 2 1/2 weeks to try this out, before I go out-of-town with my friends.  I know I won't be able to do it 100% on vacation--just not possible--so I'm going to see if I can get a cholesterol test before I leave on vacation to at least see if I'm on the right track. Before I see the cardiologist.

Oh, I've been reading up on triglycerides--but send me anything you might have on the blog that would help.

Here's what I emailed her:

Here's one of the posts I've written about on triglycerides--but this one sums it all up.  NOTE:  In April the ranges for normal all moved downward.  Now, the recommendation for the normal range is at 100 or below (no longer below 150).  But as you'll read, it's best to be at 80 or below. You want to make sure you're making light fluffy LDLs, not the small dense kind.  You might request the NMR particle test.  And here's the link to the new American Heart Association Scientific Statement recommending that triglycerides ought to be at 100 or below--not 150.

You want me to ask Dr. Esselstyn what he suggests you do?

Good luck!

Love you!

My note to all of you:  Please read that post I sent my sister-in-law about triglycerides.  It will tell you everything you ever wanted to know about these bad-boys.  They're an independent risk factor for strokes & cardiovascular disease.  If you've got a lot of belly fat--you probably have high triglycerides.  If you're eating more calories than your body can burn off--you probably have high triglycerides.  To read even more (yeah right!) about the triglyceride stroke/heart connection, click here and here and here.

How Strange is This?  The day after I sent the email to my sister-in-law, Dr. Esselstyn just happened to call me at work with a library question.  Of course, I asked him for some words of wisdom for my sister-in-law & for high-triglycerides in particular.  Darn, I no longer have my notes--but here's what I remembered he said:

• Cut out the sugar--all kinds!  (my note: be sure to read this and this)
  
• Cut out alcohol
• Cut out the white foods--refined flours, pastas, breads, rice, crackers, etc. If high triglycerides are a problem for you--stick to just eating whole grains--and skip foods made with whole grain flours, like breads & pastas.  Even whole grain flours can raise triglycerides in folks who are overweight and insulin-resistant.  Think about it--flours of any kind are "processed" & digest too quickly.  Instead eat quinoa, wheatberries, hulled barley, steel-cut oats.  Flourless sprouted breads, like the Ezekiel brand, are a better choice if you need a bread.
• Remember!  Green leafy vegetables are the Main Event when it comes to making blood vessels "heart attack proof".  Load up on vegetables over grains!
  
• No fruit juices--and be careful not eat too many fruits, either, if you have high triglycerides.  Stick to the ones with the lowest sugar content.  (my note: the fruits lowest in fructose include strawberries, berries, cantelopes, grapefruit, peaches)  Source: AHA statement quoted on CardioBrief
  
• Avoid smoothies made with fruit!  It can cause a rapid rise in blood sugar for some people.  I see it happen a lot!
• Avoid dried fruit--too much sugar!  Especially high sugar fruits like dates & raisins.
  

 

Oh heck--I really really don't want you to miss the Triglyceride Post I emailed to my sister-in-law--so, just in case you don't click that link--I at least want to make sure you get some of the key points:

In A Nutshell--Here's What Dr. Patrick E. McBride is Saying About Triglycerides

• If your triglycerides are under 80 you are making "normal large" LDLs that are not very atherogenic (think atherosclerosis; arterial plaque; hardening of the arteries)

• When triglycerides are over 150 (there are just too many particles floating around with no where to go) they briefly get inserted into the LDLs and change the LDLs into "small dense atherogenic" particles.

• Stealth LDL: That's what you call what was once a normal LDL particle that's been penetrated by free-floating triglycerides.  When triglycerides are too high they are able to change the LDL into "small dense dangerous" LDL that oxidizes very easily (a bad thing) and penetrates rapidly into the arteries. Note: Triglycerides are not supposed to penetrate the LDLs!!

• Normal LDL: It's difficult for normal LDL (large & fluffy) to penetrate into the wall of an artery!

• When triglycerides are between 80-100 you start to  make abnormal LDL.  Some of it starts changing into the "small dense atherogenic" variety at this level.  (If changes start happening over 80--it looks to me like the only safe triglyceride number is under 80!)

• When triglycerides are over 100--according to Dr. McBride--you've turned the corner & "are making at the very least, a significant amount of "small dense" LDL."

• When triglycerides are above 150, almost all of the LDL particles become "small dense atherogenic".

• Dr. McBride served on the III NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that set the guidelines for triglycerides (and cholesterol) back in 2002.  He advocated for the normal level to be under 100--and he strongly believes that the current level will go down to 100 when the next guidelines come out.  Note: in April 2011 the AHA issued a Scientific Statement recommending the new normal be under 100.  Find that here.

• Big clue that your triglycerides are probably too high?  Abdominal obesity aka belly fat.  That's the engine--the symptom--that starts the cascade toward atherosclerosis; heart disease; stroke; type II diabetes.  It's a big reason for triglycerides producing nasty stealth LDL. Read "This Belly Fat is Going to be the Death of Me and Now I Understand Why."  and "Lose That Terrible Horrible Inflammatory Disease-Causing Visceral Belly Fat with Whole Grains? Tufts Researchers Say It Helps!"

• According to Dr. McBride, if you have abdominal obesity, the chances are greater that you are producing the abnormal dangerous "small dense" form of LDL.

• If you overconsume sugar, soda pop, saturated fats, trans fats, refined carbohydrates, and "fried apple pies"--and you are consuming more calories than you need--your body doesn't know what to do with all that junk--and you end up with lots of rich triglycerides--that are very inflammatory and very atherogenic--floating around--just looking for an LDL to penetrate and turn it into "small dense dangerous" LDL!

 

Sister-in-Law Success! 

 

Before my sister-in-law went on her week vacation with her gal pals, she wisely had her blood drawn for a cholesterol test.  She'd been on the Esselstyn diet for just 2 1/2 weeks--eating no-fat, no meat, no cheese, no-oil, no refined grains.

She knew it wouldn't be as good as if she'd been on the diet for 4 weeks--but at least she's get some idea if it could improve her lipids.

 

Test results:  Her total cholesterol dropped 100 points!  Amazing! Full disclosure: for some unknown reason, the lab only measured her total cholesterol--not what she really needed--a full lipid panel.  But she figures the triglycerides & LDLs must be going down if her cholesteol levels came down so much in just 2 1/2 weeks.  She'll be following up with a full lipid panel.

Other good news:  In spite of her one week of transgressions on vacation--she's back to the Esselstyn diet--and she's losing weight.  Best of all, she's losing belly fat!  She's committed to stick with it. She'd rather lower her triglycerides with diet instead of drugs.  Besides, only diet can help reduce weight.

 

What My Sister-in-Law is Up Against.  She Lives in the Southern "Stroke Belt", Her Friends Think Health is All About Genes, Not Diet & Everyone Likes to Eat Out

 

She's swimming against the stream in her neck of the woods.  She's the odd girl out in her social circle.

Everyone loves butter, meat, cheese, pastries, fried foods, good old Southern cooking, and eating out.

Lately, everyone's complaining about being so forgetful.  They thinks it just normal aging. 

Uh??  Think again, folks!

Check out this "hot off the press" article published online in Stroke, Sept. 1, 2011   Buchman, AS etal "Cerebrovascular Disease Pathology and Parkinsonian Signs in Old Age".  It's summarized in the NPR Blog, Shots:

 

"Old people who don't have signs of cardiovascular disease still may have suffered microscopic strokes that don't show up on conventional tests. The small strokes may impair their ability to walk, balance and function just the same.

Scientists examined the brains of 418 priests and nuns after they died. The researchers found that one-third of the brains that had seemed normal using conventional tests while the people were alive actually had damage to tiny blood vessels. The damage was so slight it was impossible to see without a microscope.

The people whose brains had these tiny signs of hardened arteries and stroke were most likely to have had shuffling gait and other movement problems while they were still alive."

 

If you've been eating the standard American diet--and you're eating out a lot, there's a good bet that what we take to be the "normal forgetfulness of aging"--isn't exactly normal.  It could be teeny weeny imperceptible strokes.  Now that's one scary thought!

 

"Dr. Megan C. Leary of UCLA examined over 5,500 MRIs of the brains of 50 year olds & found many had tiny white spots that indicated that they had unknowingly experienced tiny, imperceptible strokes.  These "brain attacks" have the same history and cause as heart attacks.   See "Annual Incidence of First Silent Stroke in the U.S" Cerebrovasc Dis 2003;16(3):280-5.

According to Leary, "'Silent strokes' are epidemic in this country.  While they occur in parts of the brain where they don't cause symptoms right away, the word 'silent' should be put in quotes, because their effects accumulate over the years.''

While a single silent stroke may have no impact, repeated ones lead to memory lapses, mood problems and difficulty walking. They are also a sign that people are especially prone to full-blown strokes.

Keep on eating the same way at age 60, 70, & 80 and there's a good chance that those tiny strokes will add up to increasing memory lapses, and progress on to dementia--depending upon what part of the brain has been affected. 

What's good for the blood vessels of the heart, is good for the blood vessels of the brain."

Dr. Caldwell Esselstyn, Jr., Prevent & Reverse Heart Disease lecture 6/18/2010. see also: The Rotterdam Scan Study;  "Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline," New England Journal of Medicine 2003 Mar 27;348(13):1215-2; "Silent Brain Infarcts: a systematic review,"  Lancet Neurology 2007 Jul;6(7):611-9.

 

As for all that rich Southern cooking--forget about it!  It's killing brain cells and giving the South a new claim to fame:  It's known as The Stroke Belt. 

The "brain-damaging suspects" are likely to be the much-loved traditional Southern diet of fried, salty, & fatty foods along with too little exercise--all of which contribute to hypertension, excess weight, & diabetes--the biggies responsible for stroke risk.

I posted about the brand new REGARDS Study, the Stroke Belt & how the Southern diet is affecting cognitive impairment on July 26, 2011.  No need to repeat what I wrote, just click here to refresh your memories.

 

Two of my favorite quotes about the REGARDS study:

 

"This is a very strong alarm signal.  [The finding suggests that] if you want to keep your marbles, you need to control your blood pressure, excessive weight and other risk factors for stroke."  

Dr. Gustavo C. Roman, the head of the neuroepidemiology section of the American Academy of Neurology, commenting on the article.

[Problems like high blood pressure and diabetes are likely to be "affecting  blood flow to the brain, even if it's not causing a visible stroke.  An undersupply of blood can also cause problems with brain cells that lead to cognitive decline."  

Dr. Kenneth Langa, a professor of Internal Medicine at the University of Michigan, commenting on the article.

 

Restaurant Madness - From "Cook This, Not That"

 

My sister-in-law's friends like to eat out.  Who doesn't?   It's nice to have someone else do the cooking. 

But, once you really know what's in all that restaurant food--most of us will run back to our own kitchens.

Unfortunately, twice a week my sister-in-law has a pretty much mandatory "luncheon meeting" at a restaurant with her business partner.  Sort of non-negotiable. 

Last week, on my weekly public library run I picked up one of those "Cook This Not That" books.  OMG!  I started reading it before I went to sleep--and I couldn't stop interrupting my husband's own reading with, "Listen to this!"   "OMG!  Listen to this one--it's even worse."  

The book shocked me!  No wonder most Americans are overweight.

We haven't a clue what's in that restaurant food--so a big "Thank You" goes out to David Zinczenko & Matt Goulding for collecting all this incriminating nutritional info.  I suspected it--but I really didn't know it was that bad.

And to think how much I used to love Molten Chocolate Lava Cake.  Never again!

 

Chili's Molten Lava Cake - 1,070 calories, 51 g fat, (26 g saturated), 143 carbs

 

No wonder restaurants don't want to post the nutritional info on their menus. 

These aren't the worst offenders--but here's a sampling of some of the meals that even health-conscious folks might consider ordering.

 

Marie Callender's Spanish Omelette:  1,550 calories, 78 g fat (25 g saturated), 2,980 mg sodium

Baja Fresh Chips and Gaucamole:  1,340 calories, 83 g fat (8 g saturated), 950 mg sodium

California Pizza Kitchen Tuscan Hummus with pita:  861 calories, 4 g satuated fat, 1,562 mg sodium

Ruby Tuesday Buffalo Shrimp Quesadilla:  1,465 calories, 89 g fat, 3,528 mg sodium

Houlihan's Fire Grilled BBQ Salmon Salad:  1,182 calories, 61 g fat (9 g saturated), 1,719 mg sodium

T.G.I. Friday's Santa Fe Chopped Salad:  1,800 calories

Panera Bread Tuna Salad on Honey Wheat Sandwich:  750 calories, 47 g fat (9 g saturated), 1,130 mg sodium

Chipotle Grilled Chicken Fajita Burrito:  870 calories, 30 g fat (13 g saturated), 1,940 sodium

Just for kicks, borrow a copy of this book from your library--or check out the worst vegetarian restaurant meals  (check out the side-panel on the left) and then click through the slideshow of the 20 worst new foods in America.

 

  Cook This!  Enlightened Appetite for Reduction Tortilla Soup

 

Enlightened Isa's "Appetite for Reduction"  Tortilla Soup - 223 calories, 1.5 g fat (0 g saturated), 8.7 g fiber

 

 

No conversation with my sister-in-law is complete without sharing recipes--the new finds-that-we've tried out--and loved!

Funny, how she is always trying recipes that I never even noticed--even though we both share a lot of the same cookbooks.  I'm definitely going to reap the benefits of her expert cooking now that she's going Esselstyn.

She:  "Have you tried Isa's Tortilla Soup in Appetite for Reduction?  We all loved it.  But I cut the jalapenos down to just one."

Me:   "Nope.  I never even noticed it in the cookbook.  But I'll check it out as soon as I hang up!"  

And I did, later that day.  A big winner.   Here's my enlightened version.

It looks like a stew or a chili--but it's a soup.  Hearty, spicy, and a big one-bowl meal.

 

Appetite for Reduction Tortilla Soup---My Enlightened Version

click here for the recipe on one page

Serves 6 generously.  Add a salad & an ear of corn for a terrific meal!

 

Ingredients:

1 medium onion, chopped (Isa used a small one)

1 jalapeno, seeded & sliced thinly (Isa says use 2)

1 poblano pepper, seeded & chopped into 1/2 inch pieces (this is the large dark green one--ask your grocer--I had to)  OK to use a sweet green pepper, but go with the poblano!

4 cloves garlic, chopped

(Isa also recommended 1/4 tsp red pepper flakes.  I left these out to see if the soup needed it--and it was hot enough without them--and I like heat!)

1 tsp salt  (optional, always)

28 ounce can of crushed Glen Muir Fire-Roasted Tomatoes

3 cups of low-sodium vegetable broth (plus extra for sauteeing the vegetables)

4 ounces of fresh small corn tortillas--bake or toast these until they are crisp.  Watch them carefully so they don't burn.   (Isa uses 4 ounces of baked corn tortilla chips)

1 tablespoon ground cumin

1 (15 ounce) can of pinto beans, drained & rinsed

1 cup of frozen or fresh corn.  (I like using Trader Joe's frozen Roasted Corn)

1/2 cup chopped fresh cilantro, plus extra for garnishing

Juice from 1 juicy lime

 

Preparation:

1.  Preheat a 4 quart soup pot over medium high heat.  Dry saute the onions, jalapeno, & poblano peppers until the onions are translucent, about 5 minutes.  Add a little vegetable broth if the onions start to stick or dry out--to deglaze the pan.

2.  Add the crushed tomatoes, the 3 cups of vegetable broth, and the cumin to the pot.  Mix well.

3.  Crush the crisped tortillas into crumbs (some bigger pieces are OK) & add about 1/2 of them to the pot--reserving the rest for garnish.   (I ended up adding all of them to the pot, because I didn't read the directions carefully & it thickened the soup, nicely)  You want the crumbs to "melt" into the soup.

4.  Cover, & bring to a boil.  Lower the heat to a simmer, add the beans, corn, & cilantro.  

5.  Simmer for 5 more minutes.

6.  Add the lime juice, taste for seasonings.

7.  Ladle soup into bowls, & top with remaining tortilla crumbs & remaining cilantro.

 

Nutrition Info:

1/6th of the recipe

 

 

 

Nutrition Facts Enlightened Appetite for Reducti The Best Tortilla Soup Serving Size: 1 serving Amount Per Serving Calories 223 Total Fat 1.5g       Saturated Fat 0g       Trans Fat 0g Cholesterol 0mg Sodium 408mg Carbohydrate 46.9g       Dietary Fiber 8.7g       Sugars 12.4g Protein 8.6g Vitamin A 48% Vitamin C 172% Calcium    8% Iron 15%

 

 

 

 

I'd love to hear about your favorite Appetite for Reduction recipes!  

Anyone have some suggestions for "safe foods" when you absolutely have to eat out?

 

 

 

 

 

 

 

 

 

 

A New York Times Magazine Must Read: Gary Taubes Asks, "Is Sugar Toxic?" Could There Be a Cancer Connection?

 

 

 

"Is that piece of chocolate an innocent indulgence?  Or your next hit? We're finding that a sweet tooth makes you just as much an addict as snorting cocaine.

SETTLED on the sofa watching the usual rubbish on TV, I notice that predictable, uncontrollable, nightly craving.  At first I sit there, fighting it. But the longer I fight, the worse it gets. After 20 minutes, I can't concentrate on anything, I feel anxious, and start fidgeting like crazy. Finally, admitting my addiction, I break. I go to the freezer - to my stash of white stuff - and take a hit. Almost instantly, I relax, my brain in a state of bliss as the chemical courses through my veins. Isn't it amazing what a few scoops of ice cream can do?

Before you dismiss my agitation as mere weakness, consider this: to my brain, sugar is akin to cocaine. There is now compelling evidence that foods high in sugar, fat and salt - as most junk foods are - can alter your brain chemistry in the same way as highly addictive drugs such as cocaine and heroin.

Junk foods switch on biological mechanisms that are just as hard to fight as recreational drugs."

-Bijal Trivedi, "Junkie Food: Tastes Your Brain Can't Resist," New Scientist, Sept. 8, 2010-

 

 

If you received this via email, click here to get the web version with the links & photos.

On Monday my husband made a double-batch of Rip Esselstyn's Engine 2 Dark Chocolate Brownies.   He needed to bring something to his Master Gardener meeting--and he figured that as long as he was pulling out all that baking stuff--he'd make a batch for us, too.

Big mistake!  Take my advice.  Do not make these brownies.  Do not have sugary treats in the house.  Just because they don't use butter or oil or eggs--and just because they use cocoa and whole wheat flour--doesn't mean they're good for you.   And it doesn't mean you'll eat less of them.

I rarely eat sugar or cookies or baked goods.  Really.  But if they're in MY HOUSE--who can resist that temptation?  I ate three brownies--one right after the other--and honestly, I physically felt "not so good".

 

Your "Must Read" This Week:  Gary Taubes Looks at the Research in the New York Times Magazine - Is Sugar Toxic?

 

Photo Illustration by Kenji Aoki for The New York Times; Prop Stylist: Nell Tivnan. Source: U.S.D.A. 2009 Estimates.

 

Gary Taubes' excellent NYT Magazine article will appear this Sunday, April 17, 2011.   Here's the link--enjoy!  Well, maybe "enjoy" isn't exactly the right word.   Change that to: Worry, Wonder, Question, Quit Eating Sugar?

If you're a regular blog reader, you know all about the subject of Taubes' article--It starts with Dr. Robert Lustig and his viral YouTube video--"Sugar: The Bitter Truth".   If you missed that post, you can read it here--and skip Lustig's 90 minute video--which was a taping of his University of San Francisco Mini-Medical School Lecture.

 

 

My Advice--Read the Article - But Here's a Taste--Teaser

 

Taubes gets right down to the bottom line, "This brings us to the salient question: Can sugar possibly be as bad as Lustig says it is?"

"If I didn’t buy this argument myself, I wouldn’t be writing about it here," says Taubes.

[For]Varman Samuel, who studies insulin resistance at Yale School of Medicine, the correlation between liver fat and insulin resistance in patients, lean or obese, is “remarkably strong.” What it looks like, Samuel says, is that “when you deposit fat in the liver, that’s when you become insulin-resistant.”

The Cancer Connection: One of the diseases that increases in incidence with obesity, diabetes and metabolic syndrome is cancer.

This is why I said earlier that insulin resistance may be a fundamental underlying defect in many cancers, as it is in type 2 diabetes and heart disease. The connection between obesity, diabetes and cancer was first reported in 2004 in large population studies by researchers from the World Health Organization’s International Agency for Research on Cancer.

It is not controversial. What it means is that you are more likely to get cancer if you’re obese or diabetic than if you’re not, and you’re more likely to get cancer if you have metabolic syndrome than if you don’t.

Cancer Is Rare in Non-Western Diets.  The second observation was that malignant cancer, like diabetes, was a relatively rare disease in populations that didn’t eat Western diets, and in some of these populations it appeared to be virtually nonexistent.

Now most researchers will agree that the link between Western diet or lifestyle and cancer manifests itself through this association with obesity, diabetes and metabolic syndrome — i.e., insulin resistance. This was the conclusion, for instance, of a 2007 report published by the World Cancer Research Fund and the American Institute for Cancer Research — “Food, Nutrition, Physical Activity and the Prevention of Cancer.”

How Does Insulin Resistance Promote Cancer?  So how does it work?  Cancer researchers now consider that the problem with insulin resistance is that it leads us to secrete more insulin, and insulin (as well as a related hormone known as insulin-like growth factor) actually promotes tumor growth.

As it was explained to me by Craig Thompson, who has done much of this research and is now president of Memorial Sloan-Kettering Cancer Center in New York, the cells of many human cancers come to depend on insulin to provide the fuel (blood sugar) and materials they need to grow and multiply. Insulin and insulin-like growth factor (and related growth factors) also provide the signal, in effect, to do it.

The more insulin, the better they do. Some cancers develop mutations that serve the purpose of increasing the influence of insulin on the cell; others take advantage of the elevated insulin levels that are common to metabolic syndrome, obesity and type 2 diabetes. Some do both.

Thompson believes that many pre-cancerous cells would never acquire the mutations that turn them into malignant tumors if they weren’t being driven by insulin to take up more and more blood sugar and metabolize it.

Is the problem caused by sugar or obesity or both?  But some researchers will make the case, as Cantley and Thompson do, that if something other than just being fatter is causing insulin resistance to begin with, that’s quite likely the dietary cause of many cancers.

If it’s sugar that causes insulin resistance, they say, then the conclusion is hard to avoid that sugar causes cancer — some cancers, at least — radical as this may seem and despite the fact that this suggestion has rarely if ever been voiced before publicly. For just this reason, neither of these men (Cantley & Thompson) will eat sugar or high-fructose corn syrup, if they can avoid it.

“I have eliminated refined sugar from my diet and eat as little as I possibly can,” Thompson told me, “because I believe ultimately it’s something I can do to decrease my risk of cancer.” Cantley put it this way: “Sugar scares me.”

 

If you ask me it's not just about sugar.  And it's not just about fat.  It's about both!   And we have more to be concerned about than just cancer!  What about heart disease, stroke, arthritis, joint problems, dementia, the disability that comes with obesity, and more? 

Sugar isn't the sole disease driver of this disability bus.  It's also too much dietary fat, insufficient intake of vegetables & fruit, too little fiber from refined grains, too many calories, and not enough exercise!

My comment on Taubes' article in this morning's New York Times, sums up what I believe.

 

"Fantastic summary of the research by Taubes! Thank you.

Americans overconsume everything that tastes great--sugar & fat & salt. We're programmed to do it.

The worst part---they fill us up, and we have far less interest in the real stuff with all the nutrition---vegetables, fruits & whole grains.

I "mostly" ditched sugar 2 years ago. Nine months ago I ditched the fat. We can argue all we like---but my weight is down to college weight---and I'm 61--and I eat EVERYTHING  "healthy & real" that I want to eat! And as much as I want to eat.

Couldn't feel better--and BP & lipids are now perfect. No more belly fat.   It's not just about the sugar.  It's about the fat, too.  Never lost a pound by just ditching sugar!" 

-The Healthy Librarian, NYT 4/13/11-

 

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Dr. Robert H. Lustig and the Bitter Truth About Sugar - It's the Driving Force Behind Obesity, Type-2 Diabetes, Hypertension, Small Dense LDL Cholesterol and the List Goes On. What's the Cure?

 

Fruit Juice, Soda Pop, Sugar, Honey, Maple Syrup, Agave--Avoid Them All

 

If Mary Poppins hadn't supplied the spoonful of sugar, maybe her charges wouldn't have needed the medicine in the first place!

Dr. Robert H. Lustig, "Just a spoonful of sugar helps the blood pressure go up,"  Expert Rev Cardiovasc Ther. 2010 Nov;8(11):1497-9.

 

If you received this post via email, click here to get to the web version with the not-to-be-missed video & all the links.

Two years ago I decided to "mostly" ditch the sugar from my life.  After "winning" a raffle of three giant boxes of truffles at a work Christmas party, and then downing more of them than I'm embarrassed to admit,  I decided to just swear off sugar.   But, mostly it was about ditching all the saturated fat that's always wrapped up in the kind sugar I craved--like chocolate chip cookies,  "heart healthy" 85% cacao bars, and chocolate desserts. 

Beyond all the empty calories & fat wrapped up in my kind of sugary faves--two years ago I had no idea how bad sugar really was--but I do now.

Right now I'm on a "Bitter Truth of Sugar" High.  And  I'm hoping to convince you all to find the 90 minutes it will take to watch Dr. Robert H. Lustig's  eye-opening University of California at San Francisco's "Mini-Medical School" lecture, "Sugar: The Bitter Truth".  Sure, it's a huge amount of time to stare at a computer screen, but it just may change your life--or at least what you put into your mouth.  And I guarantee it will change what you feed your children or grandchildren.   Take a measly 15 minutes each day to watch it, bit by bit.   You won't regret it.

Honestly, I don't even know where to start when it comes to sharing Dr. Robert H. Lustig's story about how bad sugar is for us.  I first listened to him on my recent flight to Florida via a podcast of his interview with Joe & Terry Graedon on the People's Pharmacy.     I quickly followed that up on Sunday by watching his UC-SF mini-med school lecture, thanks to a recommendation from a physician blog reader in Michigan.  Thank you, Dr. H!

It's not a simple story to tell.  It's like trying to condense a 1000 page "who-done-it", that's a story of political intrigue, corporate greed,  addiction, dietary indiscretion, consumer ignorance, complicated physiological biochemistry, and medical research all rolled into one.   The story includes Richard Nixon, the 1973 Agricultural Secy'. Earl Butz, the sugar & farm lobby, presidential elections, the food industry, brain chemistry, liver metabolism, our taste buds and more--all conspiring to make us fat and sick.  Oh my!   Two years ago I wrote about a part of this story in: King Corn - and the Real Story Behind the Demise of the Family Farm, the Rise in Obesity, Type II Diabetes & Fast Food.

Bottom Line: Sugar has proved to be a major villain in our escalating rates of obesity, type 2 diabetes, hypertension, dental caries, inflammation, non-alcoholic fatty liver disease, insulin resistance, and metabolic syndrome--to name a few.  And it's not just because sugar is empty calories--it goes way beyond that!  It's a downright toxic substance--with adverse affects pretty similar to those of alcohol!   No matter what kind of sugar you can think of, it's all fructose--and fructose is a poison.  And I thought  fructose was harmless substance!   Here's the deal:  once fructose is extracted from a plant's fiber--it becomes bad news.

Lustig's Mantra:  When G-d made the poison, it was packaged with the antidote--like fruit--which is fiber and juice. 

Wherever there's fructose in nature, there's way more fiber.  The only exception is honey,  and that's guarded by bees!  G-d made it hard to get "fructose sugar" without eating the fiber. 

The problem is:  Man figured out a way to extract it!  Not only has man made it easy to get--but the food industry has made it impossible to avoid!

Pre-1975, before the invention of high-fructose corn syrup, Americans ate 63 pounds of sugar a year--today we're up to 156 pounds.  That's 22 teaspoons a day.  The American Heart Association's 2009 Scientific Statement recommends the maximum to be 6 teaspoons for women--9 teaspooons for men.

 

Who Is Dr. Robert H. Lustig and Why Should We Believe What He Says?

 

 

Lustig has the credentials, the clinical and research experience to be an expert on how sugar damages our bodies.  He's  a professor of clinical pediatrics in the Division of Endocrinology at the University of California, San Francisco, where he directs the Weight Assessment for Teen and Child Health (WATCH) Program. His specialty is neuroendocrinology, with a specific emphasis on the regulation of energy balance by the central nervous system.  He's working with overweight and obese kids who either have type-2 diabetes--or are on their way to getting it.  As a neuroendocrinologist he's an expert in the appetite and satiety hormones of ghrelin and leptin. 

He's also a major player in the field of pediatric obesity & has published numerous articles in top medical journals.  Click here for his bibliography.    Not to mention that a large UK study, just published online yesterday in the American Heart Association's journal, Hypertension, "Sugar-Sweetened Beverage, Sugar Intake of Individuals, and Their Blood Pressure.  International Study of Macro/Micronutrients and Blood Pressure",  backs him up on the association of sugar to hypertension.  Lustig knows what he's talking about.

 

If you aren't seeing the video click here.

 

 

 

What's So Bad About Sugar?

What Do I Mean By Sugar? 

• Table sugar made from beets or sugar cane.  
• High-fructose corn syrup made from corn--the kind that's in soda pop & most processed foods.
• Honey made from bees. 
• Agave made from succulents. 
• Maple syrup made from the sap of maple trees.  
• Fruit juice of any kind--even the 100% real stuff.  Yes, that includes o.j.   All fruit juices.

They're all the same.  They are sucrose--which is 1/2 fructose, and 1/2 glucose.  

Glucose is good.  It's the energy of life.  All carbohydrates are glucose--the starches, the pastas, the beans & legumes.  It gives us energy--it can be used by every cell and every organ in our body.

Fructose, on the other hand, is bad news once it's separated from the fiber of whole fruit or plants.  It's completely different from glucose.   

Listen closely:  fructose is metabolized ONLY in the liver and it's metabolized just like fat.  No other organ in the body can metabolize it--and instead of generating energy--it ends up generating FAT.  That's right, the liver turns fructose straight into fat cells--and when your liver generates fat, it becomes insulin-resistant (hepatic insulin-resistance).  So, if you're eating a high-sugar diet--you might as well say you're on a high-fat diet.

What's so bad about insulin-resistance?  When the liver becomes insulin-resistant--it drives up your insulin levels, so instead of burning the energy from the food you are eating,  you store even more of it as fat in your cells,  driving you to eat even more.   Here's why.  As Lustig explains it, sugar/soda pop/juice/dessert-eating Americans are releasing about twice the insulin than they were 25 years ago--and all that extra insulin is driving the food we eat to get stored as more fat, which makes us even more insulin-resistant.

"The higher the insulin goes, the more food you want to eat & the less well your brain is able to get the signal from your gut that you're full.  Leptin, the satiety hormone, is effectively disabled in the presence of insulin-resistance, and you can blame that on all the sugar/fructose that the liver turned into fat. 

The calories-in calories-out theory doesn't work in insulin-resistance or when you're eating too much "sugar/aka fructose"--because once the liver turns the fructose into fat cells you just aren't going to be able to burn all your calories,  because they're trapped in your fat cells--unless you want to starve yourself.  And no one's about to do that.

When leptin isn't being released the way it's supposed to--as happens in insulin-resistance--your brain doesn't know you've already had enough to eat.  It thinks you're starving--so you just eat more.  You end up in a vicious cycle of consumption and then disease."    (Lustig, People's Pharmacy interview)

The Fructose-Cholesterol Connection: When it comes to LDL, the low-density lipoproteins, there are two types: a "neutral" one & a bad one.  The harmless one is large, fluffy, buoyant, and kind of bounces around.  It's just too big to get into the endothelial lining of your blood vessels and start the whole atherosclerosis & inflammation process.  But, the small-dense ones are the ones to worry about, because they can burrow right under the endothelium--and according to Lustig:  Fructose is the biggest generator of small-dense LDL's!   Just ditch the sugar if you care about your arteries & blood vessels! 

Note: In typical cholesterol tests the LDLs are measured with one number, with no differentiation between the fluffy (neutral) & the small dense (bad) kind.  To get a reading on what kind of lipid particles you have,  you need an NMR-lipoProfile test. And don't forget about the triglycerides--they're also driven up by sugar.

Last year research out of Emory University confirmed a statistically significant connection between sweetener consumption & lipid levels,   Welsh, JA et al.  JAMA, April 21, 2010  33:1490-96, "Caloric Sweetner Consumption and Dyslipidemia Among US Adults"  Click here for the article.

 

Think the Less Processed Sugars, like Agave, Maple Syrup, Brown Rice Syrup, or Fruit Juice Are a Better Choice?  Think again.  Part of the Esselstyn diet includes specific instructions to avoid sugar & fruit juice--because of their connection to cholesterol--insulin-resistance-- and type-2 diabetes.  Esselstyn even advises his patients to limit whole fruit to 2 pieces a day--or 3 if that includes berries or grapes.  Too bad, so many plant-based no-oil advocates (myself included) don't think twice about using what we think are better sugar choices--like agave or maple syrup.  Sorry to say, they're just as bad as high-fructose corn syrup, as far as the liver is concerned!

The Fructose-Disease Connection--Just a Few for Starters  

• Ever hear of Advanced Glycation End Products (AGE's)?  I hadn't.  You know how sugar or maple syrup are terrific browning agents for food?  Well, that's an example of AGE's-and the sugar we eat does something similar once it's inside of our bodies.  Fructose is 7 times more likely to form AGE's--the nasty byproducts that are implicated in aging, cardiovascular disease, Alzheimer's, stroke, inflammation, wrinkles (damaged collagen), and the cross-linking of proteins that can cause cancer.  Think of AGE's as browning agents for your arteries' walls.
• Ghrelin dysfunction.  Fructose cannot suppress ghrelin--the hunger hormone--you keep on feeling hungry when you eat sugar.  Ever notice how you can't stop with just one cookie--you always want more?
• Leptin dysfunction. Fructose can't stimulate leptin, either--the satiety hormone that says, "You've eaten enough. Stop!"
• Metabolic syndrome.  Chronic fructose exposure promotes the metabolic sydrome.  No surprise here.
• Hypertension.  Fructose makes a waste product that increases uric acid, that blocks the enzyme our bodies need to make nitric oxide (NO), that "magic gas" that lowers blood pressure, and relaxes blood vessels.  Not a good thing, at all.  Check out the recent large study in Hypertension associating high blood pressure with sugar (the link's above)--or Lustig's Nov. 2010 editorial: "Just a spoonful of sugar helps the blood pressure go up"  Expert Rev Cardiovasc Ther. 2010 Nov;8(11):1497-9.  Sugar & hypertension--no physician had ever told me about that connection before.
• Calories turned into fat.  Fructose increases a process called "Novo Lipogenesis" in normal adults--making 30% of calories from fructose turn into fat--making a high sugar diet, a high fat diet. 
• Elevated triglycerides.  Sugar raises triglycerides--6 days of high fructose feeding will double triglycerides!
• Liver disease.  Too much sugar can cause hepatic dysfunction, also known as, non-alcoholic fatty liver disease, NASH.
• Hepatic insulin resistance.  Fructose can cause liver insulin resistance--making the pancreas work harder--and causing more "food energy" to go straight into fat cells.
• Inflammation
• Hyperinsulinemia
• Leptin resistance/insulin resistance/increased appetite
• Chronic fatigue
• Dyslipidemia
• Pancreatitis
• Obesity
• Fetal Insulin resistance
• Promotes continuous consumption/Habituation/Sugar cravings, similar to addiction.  For more on "sugar addiction" click here and here.

 

The Sugar Cure--Exercise, Fiber, Whole Foods, No Sugar, No Juice

 

Why is Exercise Important to Improved Insulin Sensitivity & Weight Control?

• It's not the Calorie Burn.  You'd have to work-out too many hours to burn off the calories from a candy bar, juice, or dessert.
• Toned Muscles. Exercise, particularly weight-training, improves skeletal muscle insulin sensitivity--because insulin works better in strong lean muscle.
• Exercise Guidelines for Type 2 Diabetes.  The latest guidelines for exercise in type-2 diabetes call for weight/strength training  for  2, or ideally 3 times a week! "Exericse and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement"  Med Sci Sports Exerc. 2010;42:2282-2303.
• Stress Reduction.  Exercise reduces stress and  the release of the stress hormone cortisol--appetite goes down when stress goes down.
• Detoxifies Fructose.  Exercise makes the body's "Citric Acid Cycle" run faster, which detoxifies fructose, improving liver insulin sensitivity--and preventing fructose from turning into fat.

Why is Fiber So Important to Insulin Sensitivity and Weight Control?

• Reduces sugar absorption.  It reduces the rate of sugar/carbohydrate absorption from the gut into the blood stream--which limits the amount of fructose you'll absorb, as well as keeping the insulin levels down.  If you keep that insulin level down, then you shunt less sugar into fat.   Less fructose=less fat in the cells.   That's why refined white flour + sugar is the worst combination.
• Makes you feel full faster.  Fiber makes the food move through the intestine faster.  At the end of the small intestine is a bunch of cells called Peptide YY (PYY), which regulate appetite.  When PYY is released into our bloodstream it goes straight to the brain & that's the satiety signal!  Once you get that "all full" signal, you're not going to eat again until the next meal.  The problem is--with 22 feet of intestine that the food has to pass through before you can get that signal--that takes time--about 20 minutes.  Fiber will speed up the time it takes for the food to move from the stomach to the end of the small intestine.  Lustig tells his patients that they have to wait 20 minutes for seconds. 
• Helps Fat Suppress Insulin Secretion.  Fiber not only interferes with carbohydrate absorption, by slowing its absorption from the gut into the bloodstream, but it does the same thing for fats.  Instead of absorbing all the fats in the small intestine--some of the fats will make it to the large intestine & the colon, where there's a special set of colonic bacteria (called bacteroides) that will digest those fatty acids into short-chain fatty acids--and when they get absorbed they'll SUPPRESS insulin secretion--as opposed to the long-chain fatty acids that STIMULATE insulin secretion.
• Fiber Works Three Ways.  By reducing sugar absorption, making you feel full faster, and suppressing insulin--that's how fiber helps prevent type-2 diabetes and obesity.
• How much fiber do we need?  The USDA says we should eat 25 grams of fiber a day.  Lustig says we need 50 grams of fiber a day.  Our ancestors consumed 100 grams of fiber a day.  The average American gets only 12 grams of fiber a day.  Any wonder that we're overweight, constipated, and insulin resistant? 

 

Lustig's Rules for His UCSF WATCH Pediatric/Teen Patients

 

• Get rid of all sugared liquids!  Only drink water or milk.
• Eat your carbohydrates in their whole natural form with fiber:  fruit, whole grains, etc.
• Wait 20 minutes for 2nd portions
• Buy your (TV or video) screen time minute for minute with physical activity

Does it work?  Yes!

Disturbing Lustig Observations: 

• 6 month old babies who are obese from drinking juice 
• 3 teen liver transplants performed on sugar soda drinkers at UC-SF Medical Center  
• Similac infant formula has 10.3% of its calories as sucrose & 43.2%  as corn syrup solids--a "baby milk shake", no different than drinking a Coke, which has 10.5% sucrose!

 

Lustig's Advice for Adults

 

1. Eat only real food, that comes from the ground. 

2.  No processed food, because that usually has sugar added to it--and the fiber removed--the 2 things that are driving the obesity & chronic metabolic disease epidemic.

3.  Shop the perimeter of the supermarket--not the aisles.  If it's in a box--it's often processed for shelf life--sugar-added, fiber-removed.

4.  Eat only whole-grain bread--that's not the same as whole wheat bread--the fiber is in the whole grain--and the starch stays in the husk in the kernel, which slows the sugar & glucose absorption, so your insulin stys low.

5.  A calorie is not a calorie--and fructose is NOT glucose.

6.  Fructose is a chronic hepatoxin--It's alcohol without the "buzz".

 

Lustigism:  If you reduce the rate of carbohydrate absorption in your gut by eating a high fiber diet--the bacteria will get to it.  Which means, in life you have just two choices:  It's fart or be fat.  The decision is yours!

Any changes all this means for me?  Not much.  I eat plenty of fiber and exercise already.  Sugary desserts are rare treats for me.  But, I always eat wedding cake!  Haven't had sugared soda pop in years.  I'll still use a little maple syrup, agave, or even brown sugar for occasional recipes.  I sweeten my coffee with unadulterated stevia.  I'll think twice about ordering a pina colada, a margarita, or a mojito!  But I'm sure I'll still have one a few times a year.  I am going to eliminate pure juice from my Green Smoothies.  And I definitely will try hard to resist feeding my grandson cookies & ice cream. 

 

 

 

 

 

 

 

 

 

 

 

 

Dr. David Jenkins Finds Monounsaturated Fats - Like Olive and Canola Oils or Nuts - Raise HDLs and Boost Heart Health. There's More to the Story

 

Eat Nuts, Canola and Olive Oil to Boost Heart Health.  Not So Fast!

If you received this post via email, click here to get to the web version with all the links.

If you just heard about Dr. David Jenkins' hot-off-the-press study about how a low-cholesterol diet can be improved by adding monounsaturated fats (MUFA), which are commonly found in nuts, seeds, avocados, and oils such as olive oil, canola oil and sunflower oil, you may want to hear the full story.

According to the press release, patients with mild to moderate elevated cholesterol levels, who followed the cholesterol-lowering Portfolio Diet, that included the addition of monounsaturated fats, increased their HDLs by 12.5% and lowered their LDLs by 35%.   As always--there's more to the story than meets the eye.

Number 1 point left out:  Both study groups who followed the Portfolio Diet (a vegetarian diet high in beans, legumes, fruits, vegetables, and whole grains) experienced a whopping 35% decrease in their LDL levels--whether they were in the low or high monounsaturated fat (MUFA) group.  Click here for the full article.  Click here for the lay-language press release.

In a nutshell:

Researchers randomly assigned 17 men and seven postmenopausal women with mild to moderate elevated cholesterol levels to either a high-MUFA diet or a low-MUFA diet.

Both groups consumed a vegetarian diet that included oats, barley, psyllium, eggplant, okra, soy, almonds and a plant sterol-enriched margarine. In the high-MUFA group, the researchers substituted 13 percent of calories from carbohydrates with a high-MUFA sunflower oil, with the option of a partial exchange with avocado oil.

In the high-MUFA group, levels of "good" cholesterol (high-density lipoprotein cholesterol, or HDL) increased 12.5 percent while levels of "bad" cholesterol (low-density lipoprotein cholesterol or LDL) decreased 35 percent, according to the report in the Nov. 1 issue of CMAJ, the Canadian Medical Association Journal.

What the press release left out from the article:

"There were no treatment differences in terms of changes in triglycerides, LDL cholesterol or apolipoprotein B [between the two groups].

The prescriptive nature of the diet was another limitation, since adherence to a diet may be considerably less for a self-selected diet consumed under real-world conditions.  The long-term effect on self-selected diets remains to be determined, in terms of compliance and in terms of the lipid response and, ultimately, cardiovascular outcomes.

Exercise and moderate alcohol consumptions may be regarded as pleasurable ways of raising HDL cholesterol.  Weight loss and smoking cessation, although effective in raising HDL cholesterol, are more challenging for many people."

-Dr. David Jenkins, St. Michael's Hospital, Toronto, Ontario, lead author of "Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering food in hypercholesterolemia."  CMAJ. 2010 Nov 1. [Epub ahead of print]-  click here to read the full article.

 

There it is!  Exactly what we've all longed to hear.  Now we can safely enjoy nuts, olive oil, and avocados and get healthy at the same time.  Raise our HDLs, increase our apolipoprotein A1 (the component of HDL that helps clear cholesterol from the blood), and lower our C-reactive protein scores (measure of inflammation).

But, hold on, before you load up on nuts and olive oil, consider this.

• Jenkins' dieters had all their meals provided for them for 2 months--measured out precisely.  No estimates here.
• 13% of the carbohydrate calories were taken away from the high-monounsaturated group to make room for the sunflower oil.  And they weren't given nuts or olive oil--it was sunflower oil!  Not exactly the same as just adding 2 tablespoons of olive oil and 2 ounces of nuts to your diet.  Both high and low monounsaturated fat groups in the study were eating about 2400 calories a day--so that meant they substituted 336 calories of the carbs for about 2 tablespoons of oil a day--almost a meal's worth of calories.  Click here to see exactly what the dieters were eating.
• There was no change in weight loss between the two groups (high & low monounsaturated fats) 
• There was no change in triglycerides between the two groups.  And consider this about triglycerides:

"When triglycerides go up over 100 we start making abnormal forms of cholesterol--the small dense LDLs that are atherogenic and penetrate much more rapidly into the arteries than normal large LDLs. 

When triglycerides start going up--and the changes start around 80-100--nearly everyone with triglycerides over 100 is making significant amounts of small dense atherogenic LDL--above 150 almost all LDL particles are small dense and atherogenic."

-Dr. Patrick E. McBride, Professor of Medicine and Family Medicine, University of Wisconsin, and a member of the Expert III NCEP Panel setting cholesterol guidelines-

To read more about the importance of keeping triglycerides low here.

• The large decreases seen in the C-reactive protein test is something very important to pay attention to--and certainly intrigues me--and it wasn't discussed much in the article or press release.  Inflammation is one of the key drivers of heart disease.
• Olive oil may be considered a monounsaturated fat, but it's also high in omega-9, an oleic acid--and maybe not something beneficial to heart health.

"Contrary to our hypothesis, our study found that omega-9 (oleic acid)--rich in olive oil, impairs endothelial function after eating.  If you've been using olive oil because you think it's healthy, it's time to think again. "  Read more about the less healthy attributes of olive oil here.

"The beneficial components (of the Mediterranean Diet) appear to be anti-oxidant rich foods, including vegetables, fruits, and their derivatives. Dietary fruits, vegetables and their products appear to provide some protection against the direct impairment of endothelial functions produced by high-fat foods, including olive oil." (Vogel study: a meal containing olive oil impairs blood flow & vasodilation by 31%--and that was in healthy men)

 -Dr. Robert Vogel-

• From Dr. Lawrence Rudel of Wake Forest University Baptist Medical Center:  Rudel ran a five year study feeding  olive oil and saturated fat to African Green monkeys.  The monkeys metabolize fat in the same way as humans, so they're good stand-ins.. At the end of five years, their autopsies showed that the monkeys who were fed olive oil had higher HDLs (the good cholesterol) and lower LDLs (the bad cholesterol) than the ones fed the saturated fat diet.  The big surprise here:  Both groups had exactly the same amount of coronary artery disease.  The higher HDLs & lower LDLs of the olive oil group were meaningless.  Rudel later repeated the study on rodents, and got the same results.
• According to Dr. Caldwell Esselstyn, low HDLs in the presence of very low LDLs is of little concern--and commonly seen in many of his patients who have eliminated nuts & oils--as well as  successfully prevented or reversed heart disease.  When your LDLs are low (common when oils & animal products are eliminated) you just don't need high HDLs to remove them from the blood.  Many of the Tarahumara Indians, who exhibited no heart disease, had low LDLs & low HDLs. 
• Take a long hard look at the saturated fat content, and the high omega 6 content of most of the nuts--except for the humble English walnuts--which have a nice 4:1 omega-6 to omega-3 ratio.

When considering nuts, look to the English walnut--and be sure to swap out carb calories for the nuts eaten.  7 walnuts = 1 ounce = 185 calories.  For me, since I eat about 1500 a day, that would mean eating about 7 walnuts, which would also mean eliminating a bowl of oatmeal or a whole grain hamburger bun. 

I have to admit, when I cut out nuts & olive oil my HDLs did drop.  But, I'm still sticking to the elimination of added oils--because I love the subsequest weight loss, and the loss of my belly fat--yet I still feel quite comfortable about eating a few walnuts, or a homemade cocoa-walnut-chia bar--especially after burning 400 calories with exercise.  Click here for the recipe.

What's Could Be Wrong with Nuts?  from Jeff Novick, MS, RD, a dietitian who works with  Dr. John McDougall.  Cick here for full link

"The other issue is Omega 6s (and saturated fat) and making sure we do not get in too much of either. Ideally, saturated fat should be under 5% of our calories and the omega 6 to 3 ratio should be under 4:1 with under 2:1 even better.

Unfortunately, some nuts are very high in omega 6s and some are higher in saturated fat. So if you include any of these you would not want to over do them.

Most nuts have little if any omega 3s so they have very very poor ratios of omega 6 to omega 3s.

Black Walnuts are 16:1
English Walnuts 4:1
Pecans are 20:1
Pistachio is 37:1
Pine Nuts are 300:1
Macadamia is 6:1
Hazelnut is 88:1
Cashew is 117:1
Brazil Nut is 1000:1
Almonds 1800:1
Pumpkin Seeds 117:1
Sunflower Seeds 300:1

CA Avocados 15:1
FL Avocados 16.5:1

Flaxseed 3.9:1 ***
Chia Seed 3:1 ***

(***these is a reverse ratio as the omega 3 is higher than the omega 6)

In regard to Saturated fat

Black Walnuts are 5%
English Walnuts are 8%
Pecans are 8%
Pistachio is 8.5%
Pine Nuts are 6.6%
Macadamia is 15%
Hazelnut is 6.5%
Cashew is 12.5%
Brazil Nut is 21%
Almonds are 6%
Pumpkin Seeds 14%
Sunflower Seeds 6.5%

Flaxseed 6%
Chia Seed 6%

CA Avocados 11.5%
FL Avocados 15%

As you can see, most are not bad, but some are fairly high in saturated fat and some are really high in omega 6s. Some of these, like cashews may not be great choices. They are over 12% saturated fat and have a ratio of 117:1 Pumpkin seeds and brazil nuts are also not the best choices as they are also "higher" in saturated fat and have a "higher" ratio.

It looks like English Walnuts would be the best choice by far.

As always, go to the original research article--get the full story--and consider what impact other studies may have on the conclusions.  For me, I'm comfortable with keeping out the added oils, eating walnuts, and an occasional slice of avocado.  And I'm happy to increase my HDLs with exercise, and an occasional glass of Pinot Noir.  Ultimately, we all make our own decisions.

Oops! Take It From Me - Half Dietary Measures to Lower Your Cholesterol Will Result in Half Measure Improvements

"The first thing I do when people tell me that they can't reduce their cholesterol to 150 ml/dL or less is press them on precisely what they eat on Friday or Saturday nights, or what they might have consumed at that seemingly endless weekday meeting where there was "nothing else to eat."

Often, under my questioning, they reveal tiny deviations from the nutrition program--lapses so small that they didn't even take them into account.

--Dr. Caldwell B. Esselstyn, Jr., Prevent and Reverse Heart Disease--

If you've received this via email, click here to get to the web version with all the links.

Let this be a cautionary tale!

I thought I was doing everything right with my diet. I'm eating loads of vegetables, fruits, beans, and whole grains.  I feel wonderful.  I've accrued countless benefits.  But I didn't cut out oil or nuts or avocados.

• Two years ago I "mostly" cut out all dairy, eggs, and meat.  And yes, that includes, cheese, yogurt, chicken, my beloved turkey sandwiches, and fish.
• About one year ago I "mostly" cut out sugar--ditching desserts that deliciously combine butter, oil, flour, and sugar.  But, I didn't cut out super dark chocolate every once-in-awhile.
• I limited my cooking oils to just canola or olive oil, and cut down the amounts considerably.
• I still ate nuts, including almond butter, and my fave Larabars--and I ate them in moderation.
• I still ate avocados. 
• Occasionally, I'd eat humus or baba ganoush that were store-bought or restaurant-ordered & of course they're made with fat-heavy tahini.
• I ordered vegan dishes whenever I ate out--but didn't think too much about the oil used back in the kitchen.  Deep-fried falafel?  Fried onions on top of the Mujadara?  Indian vegetable curries?  You get the picture.  And I never asked the chef for "special orders" made without oil
• Maybe every other month I might eat fish at a friend's house, or at a restaurant. 

I figured I was healthy.  No diagnosed heart disease.  I've exercised for over 35 years.  My weight's fine, even though I'd love to drop a few pounds.  I figured I could successfully follow the Esselstyn/Engine 2/McDougall/Fuhrman plant-based diet-thing "my way"--not exactly "their way"!   Unknowingly, I chose to eat plant-based with moderate fat intake--which isn't exactly what they're prescribing.  Oops on me!

Boy was I in for a surprise!

The Cholesterol Test - Did I Ace It?

My last cholesterol test was 2 1/2 years ago, taken five months before I started eating plant-based.  And because I had squeaked in as "healthy" after my last cholesterol test--I still didn't need any statins--and my health plan wouldn't "authorize" a new cholesterol test for me for 2 1/2 years!  I certainly was curious to see how eating plant-based was affecting my cholesterol--but I was going to have to wait 2 more years to find out.

But, when a new "Employee Wellness/Shape Up" initiative began this year at the medical center where I work--all that changed.  Now--all of sudden I was required to retake the cholesterol test, and all the other tests needed to qualify for a health insurance discount.

Here's the deal:  If you want to "Lock Into" 2009 health insurance rates for 2010 & 2011 you have to prove:

• Your weight is healthy--a BMI below 27 (which is actually overweight). 
• Your blood pressure is normal at 120/80 or below
• You are diabetes-free
• Your cholesterol levels are in the normal range.
• If you flunk any of these tests--you have to "enroll" in a "special help" program to lose the weight, lower the cholesterol, control the diabetes, and lower the blood pressure--before you can get an insurance rebate. 

I was sure I would Ace the cholesterol test that I took on May 6th.  The blood pressure test was the one I was a bit worried about.  I knew I'd pass the weight test.

So, imagine my disappointment when I got back my cholesterol test.  I thought for sure the total would be between 150-170.   Boy, was I mistaken.  Yes, my tests were good enough to be in the so-called "normal range".  I passed the test and I'll get my health insurance discount--but now I know I need to kick it up a notch if I want to beat the family "stroke and heart disease curse".

The results were good enough to still keep me "statin-free".   But, now that I'm eating plant-based, ingesting nary a speck of dietary cholesterol I was expecting a STRAIGHT-A LIPID TEST.  Nope, didn't happen. 

Here are my 2007 & 2010 scores--the bad, and the better.  According to my doctor, I'm one of those people whose cholesterol is affected to a large degree by what they eat. 

The Cholesterol Report Card

                        9/28/07        11/08/07        5/6/10

Total CHO          269                198                209

LDL CHO            157                 117               111

HDL CHO             96                   72                77

Triglycerides       84                   44               103

LDL:HDL Ratio    1:64                                    1:44

**Please note:  Total Cholesterol = LDL + HDL + triglycerides divided by 5.  That why a high HDL will falsely inflate the total.

Half-Measures Bring Half the Expected Results.  Oops!

So I was good enough to get my discount, and stay off of statins--but I wanted to know why my scores hadn't dropped more.  What was I doing wrong?  What was I missing?

The next day I decided to email Dr. Caldwell Esselstyn to get his opinion.  Sending this email felt totally presumptuous, an imposition, and nervy on my part--but I hit the send button before I could talk myself out of it.

• I told him I ate dark chocolate the night before the test
• I let him know I had eaten out the previous weekend
• I told him that I use spray oils, some canola & olive oil
• I let him know I ate nuts, and nut butters
• I asked him why he thought my triglycerides had increased so much.  I was only eating  whole grains & hardly any sugar.

But of course the night before my test I ate an Indian chutney made with sugar.  And a piece of chocolate. And I drank a glass of red wine.  No one had told me that it would also be a good idea to avoid alcohol for 24 hours before the test.  Only later did I find out that alcohol can significantly increase triglyceride levels.  I don't drink often--who knows why I decided to have a glass of wine that night?

The next day was Saturday and I headed out of the house early because I had to work.  As I'm driving to the hospital my cellphone rings at 8:00 am.  I figured it was either my husband trying to find something--or my sister, who was visiting from out-of-town.

Turns out it was Dr. Esselstyn, calling in reply to my email.  As he says, a few people can get away with eating foods like avocados, nuts, and some oil and it won't affect their cholesterol at all.  But, for most people, the least little addition of one of these offenders can keep the cholesterol up, and arteries inflamed.  I'm one of those people.

Dr. E:  I don't know what kind of restaurants you go to, or what you order.  What did you order the last time you went out to eat?

Me:  It was a Turkish restaurant.  I had a salad, without cheese, topped with 4 fried falafels--a bit of salad dressing--and a couple pieces of pita bread with baba ganoush.   White flour, tahini, salad oil, fried foods.  Duh?  What was I thinking?  Funny how easy it is to ignore what is going into your mouth when you're eating out--and thinking, "This is vegan. It will be OK."

Me:  And what about those triglycerides?  Why would they be so much higher than before?  I'm only eating whole grains  (except when I'm not--like the restaurant pita bread)

Dr. E:  For one thing, you can't keep eating chocolate, avocados, and nuts--and cooking with olive oil--and expect stellar cholesterol scores.  And what about dried fruits.  Are you eating those?

Me: Uh, yeah.  My morning steel cut oats are loaded with dates, and raisins, and dried cherries.  Dr. E informed me that these are the most concentrated sugars--I should avoid them--or eat smaller quantities.

I went on to express my concerns about eating too little oil, and asked him if a cholesterol under 150 could ever have negative effects.  Not if you're doing it naturally, through your diet, he told me--like many disease-free native communities have done for years.  And don't worry getting enough fat to absorb vitamins--there's fat in almost all vegetables, beans, and grains.

But, the best part...  Dr. Esselstyn generously invited me to join his next small group 5 1/2 hour appointment that would be meeting in mid-June, where I would get a first-hand understanding of how I could kick up my "healthy eating" a notch, and learn why it's in my best interest to do so.  Like ditching those added oils at home--and lurking in restaurant meals.  And I'll get the chance to have all my questions answered.

I thought I would be able to skip the "no-added-oil-no-nuts-no-avocado" requirement of the Esselstyn diet  But I guess My Way wasn't enough.  Click here to read:  I'm Going to Miss My Olive Oil.  Who Knew It Wasn't So Healthy After All?  Drs. Esselstyn, Ornish, Vogel, and Rudel Did.

Dr. Esselstyn's Heard This All Before

"The first thing I do when people tell me that they can't reduce their cholesterol to 150 mn/dL or less is press them on precisely what they eat on Friday or Saturday nights, or what they might have consumed at that seemingly endless weekday meeting where there was "nothing else to eat."

Often, under my questioning, they reveal tiny deviations from the nutrition program--lapses so small that they didn't even take them into account.

One example: by the time you hold down the nozzle on a popular cooking spray long enough to coat a wok or pan, you'll build up about a tablespoon of oil.

Such transgressions can easily be enough to injure the endothelium's capacity for producing nitric oxide, which in borderline cases can mean the difference between success and failure.  It is the kind of attention to tiny details that makes my program work.

It is true that there are some people without heart disease who strictly adhere to a plant-based diet--no lapses at all--and even so, cannot reduce their cholesterol below 165-170 mg/dL.  (Some researchers have suggested that years of eating fat and cholesterol may compromise the body's natural capacity to reduce cholesterol levels.)

For these people, a modest dose of a cholesterol-lowering medication under physician supervision should take care of the problem.  It is worth noting, however, that anyone who achieves a cholesterol level of 165-170 mg/dL by eating a strictly no-fat, plant-based diet is already doing wonders for his or her health, even without reaching the optimal level.

That person is, by definition consuming large quantities of natural antioxidants, which prevents the body from oxidizing LDL cholesterol into its most dangerous, artery-clogging form."

--from Esselstyn, Dr. Caldwell B.  Prevent and Reverse Heart Disease.  New York: Penguin Group, 2007--

Reconsidering the So-Called Healthy Oils

Drs. Matt Lederman and Alona Pulde appear in the upcoming documentary, Forks Over Knives--they're the physicians who were responsible for turning around the health of writer/director Lee Fulkerson and Joey A. of Tampa.  On their web site they provide an excellent explanation of why oils need to go:

Question: Do you prohibit the use of vegetable oils?  Does this include Olive Oil?

Answer: Thank you for your question and your interest. Our feeling about oils is that they are processed forms of foods high in calories and low in nutrients.  The more a food is processed the less healthy it is! 

Furthermore, vegetable oils including olive oil are NOT health foods! These oils suppress the immune system (increasing risks of infections and cancer), promote atherosclerosis (clogging of the arteries), increase bleeding, cause insulin resistance, and lead to obesity.

With regards to olive oil, we have been misinformed of its “benefit” from observations that people on the Mediterranean diet are healthier than people on the American diet. This is so because their diet consists largely of fruits, vegetables, and grains with little animal products...not because of the olive oil. In fact, they are healthier DESPITE the olive oil in their diet and not because of it! 

That being said, although we highly recommend against the use of vegetable oils, we don’t like to use the word prohibited. So if you feel you have to use a little bit of olive oil or else you will go back to cheeseburgers, milkshakes, and fries...then by all means, use that bit of olive oil. 

However, it might be helpful to know that there are many healthier forms of fat to use out there.  Ground up, unsalted olives are much healthier than the extracted olive oil and still add the wanted olive flavor. 

When you are frying something you can use a fat substitute like juice or vegetable broth to cook with rather than oil. Then you can add a healthier unprocessed form of fat if you want that particular flavor...such as ground up cashews, seeds, or avocado. 

The benefit of using a ground up whole food is that you then also get things like fiber, vitamins, and minerals that are discarded when you extract the oil from the whole food. These nutrients are not only important for your health but also help shut off your hunger signals, ultimately preventing you from overeating.

Finally, we don’t like to use the term “okay” like you are doing something wrong if you don’t follow these rules. Certain oils/fats (olive, canola, peanut, avocado) are less saturated and better for your heart than others (palm kernel, coconut, butter) but we would never say olive oil is a health food.

Also, remember that the most important thing is that we do our best. Meaning, if you are out and wind up eating some oil because there is no alternative and you didn't prepare for the situation...it's not the end of the world or your health.  Rather, just be better prepared for next time. Any move closer towards a low fat plant based diet is not only healthier for you, but will prevent more disease and give you more energy.  So in the end, please don't be too hard on yourself as you do the best that you can!

Cleaning up my kitchen act:  I've already started sauteing with vegetable broth, or other flavored liquids instead of with oil or oil sprays.  It wasn't such a big deal. I'm using parchment paper or a Silpat to roast vegetables, or for "stick-free" baking.  Just yesterday I found a delicious tahini & oil-free red pepper humus.  I've also discovered a fat-free whole grain pizza crust made by Kabuli.  I can do this!

I'd really appreciate any tips, advice, or experiences that you can offer to help me with this new adventure in going oil-free--or almost-oil-free.

The Healthy Librarian's Brain Back-Up: Sugar Raises Triglycerides, Fat Damages the Brain, Marriage and Health, Tips From Integrative Medicine Physicians, Estrogen and the Brain

"Once You're Through Learning, You're Through"

-John Wooden, retired UCLA basketball coach, age 99-

If you received this via email Click Here to get the web-version of this post--with all the links.

OK, guys, bear with me.  I'm going to do something I rarely do--be brief.

I'm long on information and short on time.

If I don't blog now about some of the thought-provoking new articles I've read this week--and some recommendations from readers--they'll get pushed aside by the next new studies or articles to cross my path.

So here's what I've been reading this week:

It's Time to Ditch the Sugar Once and For All!  Sugar is Shown to Increase Triglycerides, Lower HDLs, and Increase the Risk of Metabolic Syndrome, Cardiovascular Disease, and Stroke.

We already know that excess sugar can pack on the pounds, put you at risk for type-2 diabetes, and cause blood sugar spikes that damage the brain--no I'm not making that last one up--click here for "that story".

But here's the "hot off the press" news just published today in JAMA  showing that sugar can raise triglycerides and lower HDLs, increasing our risk of heart disease and stroke.

The JAMA article is based on the latest analysis of data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)--and it backs up recent findings from the Framingham Heart Study. 

Bottom Line:  Increased sugar consumption promotes elevated triglycerides and lower HDLs--which are strong markers for metabolic syndrome and cardiovascular disease.  And if you want to know exactly why high triglycerides are so nasty read my earlier post: "Why You Might Want to Keep Your Triglycerides Under 80. Following the New AHA "Ditch the Sugar" Guidelines Will Help!"

And there's more bad news when it comes to high triglycerides--it increases the risk for strokes. "Bad News: High Triglycerides Are Linked to Stroke Risk. Good News: You Can Do Something About It!"

Being Fat Is Bad for the Brain--New York Times'  writer  & evolutionary biologist Olivia Judson has compiled the latest research on why belly fat is bad for the brain.  Click here for her article, Brain Damage in the April 21, 2010 New York Times.

• Belly fat at age 40 puts one at a higher risk for dementia in one's 70's--California study.
• Folks who were overweight in their 40's had a more rapid decline in their brain function as they aged--compared to their thinner counterparts.  Swedish study.
• A study of middle-age people (44-66 years old) found "that the obese tended to have smaller, more atrophied brains than thinner people."

Judson's well done piece continues with more studies, complete with journal citations, and she speculates as to the reasons why overweight people are at a greater risk for dementia--and more importantly--is it possible to turn the process around?   Seems fairly obvious to me--inflammation, elevated cholesterol, hypertension, type-2 diabetes all affect the blood vessels of the brain--as well as the heart.

To read more about the belly fat--brain connection click here and here.

Is Marriage Good For Your Health?  That All Depends.  But It Pays To Be Nice To Your Spouse!

Tara Parker-Pope's article, Is Marriage Good For Your Health, published in the April 18, 2010 New York Times Sunday Magazine is fascinating.  Click here for the article.

It's a worthy read, based on 30 years of stress/immune function research conducted by the Ohio State University duo, viral immunologist Dr. Ronald Glaser, and his wife, psychiatrist Dr. Janice Kiecolt-Glaser-- as well as researchers from the University of Chicago, the University of Utah, and the University of Virginia.

• Your marriage affects your immune system--for good or for ill.
• A good marriage brings health & well-being--with less chance of having pneumonia, surgery, cancer, and heart attacks.
• A troubled marriage, or a nasty divorce will adversely affect your immune system.
• If you're single and never married--you're apt to be healthier than those who have divorced.
• Any health advantage from marriage comes from the quality of the relationship--not the institution of marriage.

Here are some gems:

1. The Glasers conducted a fascinating experiment on married couples to measure how quickly their skin healed when their arms were subjected to eight tiny blisters--using a dermatologic blistering device.  After the procedure the couples were asked to talk for 30 minutes.  At one session they were asked to talk about subjects that evoked conflict and tension.  At another session they discussed topics that evoked pleasant, loving, supportive feelings.  The results were remarkable.  When couples argued it took a full day longer for the blisters to heal, than when they discussed something pleasant.  The couples who exhibited the highest hostility when they argued, took two full days longer to heal their blisters, than those who had less animosity.

2. "Kiecolt-Glaser told [Parker-Pope] that the overall health lesson to take away from the new wave of marriage-and-health literature is that couples should first work to repair a troubled relationship and learn to fight without hostility and derision.  But if staying married means living amid constant acrimony, from the point of view  of your health, 'you're better off out of it."

3. From Timothy W. Smith's research on couples who have been happily married for around 36 years:  Smith found the quality of one's marriage even affected coronary calcium scores. "The solution isn't to stop fighting.  It's to fight more thoughtfully.  Difficulties in marriage seem to be nearly universal.  Just try not to let the fights be any nastier than they need to be.  Saying, "Honey, you're driving me crazy!", a pat on the back or a squeeze of the hand, all signal affection in the midst of anger. "Most of the literature assumes that it's how bad the arguments get that drives the [negative health] effect, but it's actually the lack of affection that does it."

Advice from the Glasers based on 30 years of studying the effects of stress on health & marriage:

• Take time off together and make sure disagreements don't degenerate into personal attacks.
• Don't fight dirty.  Never go far enough down the road where you hurt each other.  Know enough to avoid those kind of arguments.
• Some level of stress is inevitable--even in the happiest of marriages.  So use those moments of stress as an opportunity to repair the relationship--rather than damage it.
• An on-going disagreement is so uncomfortable.  "It's a pit-in-your-stomach kind of thing.  But when your marital relationship is the key relationship in your life, a disagreement is really a signal to try to fix something."

Advice from Six Top Minnesota Physicians Who Practice Integrative Medicine.

A big "Thank You" to the Minnesota reader who sent me this Minnesota Monthly article, Heal Thyself, by Sarah Moran, that appears in the magazine's May 2010 issue.   Click here to read the sage advice of these six physicians.

"People are clamoring for--doctors who uncover the root cause of illness instead of just treating or masking the symptoms--physicians who take body, mind, and spirit into account and look carefully at the influence of lifestyle habits like diet, activity, and rest."

Dr. Thomas Sult on Digestive Health:

• For digestive health eat whole foods. Unprocessed fruits, vegetables, nuts, seeds, lean protein, and whole grains result in more probiotics, the "good" bacteria in your gut that detoxifies, improves immune function, and aids digestion.
• Choose foods with soluble fiber, like shallots, bok choy, chicory, garlic, and onions.  They encourage growth of good bacteria.
• Eat fermented foods regularly.  Make or find live fermented vegetables, sauerkraut, kefir, kimchi, and miso, which breed probiotics.

Dr. Carolyn Torkelson on Breast Cancer Prevention:

• Maintain a healthy weight.  There's a connection between obesity and breast cancer.  Estrogen production in fatty tissue may be to blame.
• Reduce omega-6 fatty acids, found in fast food, and polyunsaturated vegetable oils, and increase omega-3 fatty acids, found in cold-water fish.  Consider daily supplements of 1-2 grams of fish oil.
• Ask your doctor to check your vitamin D level.  There may be a relationship between low levels and breast-cancer risk.
• Drink green tea.  Its antioxidant properties may decrease risk.

Dr. Henry Emmons on Dealing With Depression and Anxiety:

• Exercise. Mild aerobic exercise quells anxiety.  Vigorous aerobic exercise reduces sluggishness.
• Take a daily B vitamin complex, 2,000 mg of an Omega-3 fatty acid supplement, and 2,000-4,000 IUs of vitamin D
• Calm your mind with meditation, breathing, and yoga practice.
• Develop close, meaningful relationships.
• Eat healthy foods.  Learn your Ayurvedic type to further tailor your diet.

Check out the entire article--it's a quick worthwhile read!

Hormone Replacement and the Post-Menopausal Brain.  Why Timing Is Everything!  Here's Hoping.

Don't miss Cynthia Gorney's balanced ground-breaking article, The Estrogen Dilemma, that appeared in the Sunday April 18, 2010 New York Times Magazine.  Click here for the article.

Millions of women either stopped taking hormones--or decided not to start them after the Women's Health Initiative was abruptly ended in 2002.  Too bad it was studying the wrong kind of hormone replacement--estrogen from the urine of pregnant mares--and a synthetic progestin--Wyeth's Premarin and Prempro.

Gorney does an excellent job of explaining why the W.H.I. didn't end up telling us what we really need to know about the benefits of hormone replacement--or how estrogen can benefit the post-menopausal brain when hormone replacement is started at the right time--within a small window of time--when a women is in her fifties.  But timing seems to be everything.  And the hormone replacement needs to be the bio-identical kind--estradiol and natural progesterone.

"That’s why University of Southern California brain scientist Roberta Diaz Brinton says that the timing hypothesis — the proposition that estrogen could bring great benefit to a woman who starts it in her 50s while having the reverse effect on a woman 10 years older — makes sense even though it is still experimental.

She and other scientists know there are ways estrogen improves and protects the brain when it is added to healthy tissue. It makes new cells grow. It increases what’s called “plasticity,” the brain’s ability to change and respond to stimulation. It builds up the density and number of dendritic spines, the barbs that stick out along the long tails of brain cells, like thorns on a blackberry stem, and hook up with other neurons to transmit information back and forth. (The thinning of those spines is a classic sign of Alzheimer’s.)

But when estrogen hits cells that are already sick — because they’re dying off as part of the natural aging process or because they’ve been damaged by beta amyloid — something else seems to happen. Dropped in as a new agent, like the wrong kind of chemical solvent sloshed onto rusting metal, estrogen doesn’t strengthen or repair. It appears useless.

Sometimes it sets off discernible harm. You may recall additional W.H.I. news a few years ago about hormones increasing the risk for aging-related dementia; those stories emerged from a subgroup of W.H.I. participants who were all at least 65 when they started the hormones. There are arguments about that data, like nearly everything else connected to the W.H.I., but the age factor alone reinforces what Brinton and other timing-hypothesis researchers observe in the labs when they give estrogen to ailing cells.

“It’s like the estrogen is egging on the negative now, rather than the positive,” she said.

“We know that if you give neurons estrogen, and then expose them to beta amyloid, many more will survive. But when we expose them to amyloid and then give them estrogen — now you don’t have survival of the neurons. In some instances, you can actually exacerbate their death.”

And since once again it will be years before we get to the bottom of the estrogen dilemma--and find out if the combination of right timing and taking natural hormones at ever-decreasing doses as one ages--is a wise decision--Gorney leaves us with this to consider:

"Every midlife woman I know keeps redrawing for herself the defensible lines of intervention in the “natural” sequence of human aging.

Obsessive multiple plastic surgeries are silly and desperate. Muscles kept in good working order are not.

Where on that spectrum is a hormones-saturated pharmaceutical patch? What if the timing hypothesis is even partly right?

Suppose all we learn about replacement estrogen, in the end, is that if it’s started early enough it might protect the heart and the brain, and that its chemistry makes some of us feel more the way we did at 40 than the way our mothers did at 65?  Not an elixir of youth. More like . . . reading glasses."

Certainly something to think about!

To read more about the estrogen debate check out:  "Is It Time to Reconsider Hormone Replacement Therapy? Winnifred Cutler's "Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause"

There are even more excellent reads in the April 18, 2010 New York Times Magazine "The Science of Living a Healthy Life"

Consider taking a look at:

Weighing the Evidence of Exercise--Does working out really help your lose weight--or keep it off?

Dr. Does-It-All: He publishes books, writes for magazines and newspapers, hosts TV & radio shows nd still performs surgery every Thursday.  How Mehmet Oz became America's doctor.

Oops!  I did it again.  Thought I'd knock this off in one hour.  Not even close.  Sorry!

Everything You Ever Wanted to Know About Losing Weight, Exercise, Stress, and Cardiovascular Risk from an Expert, Dr. Sharon Alger-Mayer. The Best Diet, How Much Exercise, the Hormone Stress Connection, the Best Phytonutrients, and the Healthiest Carbs

"Why is it so hard to to maintain a healthy weight and good eating habits?  It's multi-factorial.  Genetics loads the gun - but the environment pulls the trigger.

We are all different  genetically in our hunger and satiety cues--the rate at which we burn off calories, our dietary patterns, and the stress-causing changes in our brains."

-Dr. Sharon Alger-Mayer, Associate Professor of Medicine, Division of Clinical Nutrition, Albany Medical College, Albany NY-

"A habit cannot be tossed out the window; It must be coaxed down the stairs a step at a time."

-Mark Twain-

If you are receiving this post via email click here to get to the web version with all the links.

Would you lose weight and start to exercise if it could save you money?

Starting this year almost everyone at my place of work is getting with the Program.  The diet & exercise program.  If lowering cardiovascular risk, and feeling great isn't enough motivation--maybe money will work!  If we want to pay 2009 rates for our health insurance in 2010 & 2011 we need to show that we are either healthy, or we are taking serious steps to get healthy. 

If you have hypertension, elevated cholesterol, diabetes, asthma, are a smoker, or you are overweight (BMI above 27) you need to join a free program (including Curves or Weight Watchers) and reach the set healthy goals by November 2010 to get your rebate.

Everyone, even those of us who are already in good shape--must still participate by joining a small "team" & tracking one or more healthy behaviors:

• Weight loss
• Pedometer steps (and we've all received a free pedometer)
• Daily exercise minutes
• Cups of fruits & vegetables consumed

Yes, it feels "big-brother-ish", but you aren't forced to participate--and frankly, I don't know anyone who isn't.   I've just logged in my exercise minutes, and how many fruits & vegetables I've eaten--and I have to admit, it's a great way to keep me honest--and motivated!

So, now let's bring on our diet and exercise expert--Dr. Sharon Alger-Mayer.

What's Eating You?  Food, Mood, and Cardiovascular Risk

For the past weekend I've been "up to my ears" listening to a fascinating lecture by Dr. Sharon Alger-Mayer--all about how diet, exercise, stress, sleep, belly fat, and brain chemicals affect our cardiovascular risk.

The lecture title says it all:  "What's Eating You?  Food, Mood, and Cardiovascular Risk", Audio-Digest Foundation--Family Practice  58(8): Feb. 28, 2010.  Click here

I'm going to do my best to highlight some of the "new to me" research Dr. Alger-Mayer presents.  Stick with me--there's a lot to cover.

Here's a chance to benefit from the knowledge, experience, and wisdom of a top-notch specialist without making an appointment.  

If I had to sum it all up in 6 key points it would be:

• Eat a diet that is 750 calories less than what you need to maintain your present weight.  Get a diet buddy or join a support group for the best chance of success
  
• The type of carbohydrates you eat makes a big difference and they actually affect your insuling-signaling genes.  Eat Low-Glycemic Carbs!  That means foods like beans, legumes, oats, quinoa, dark rye bread, vegetables, & fruits.
  
• Exercise often--short bouts are best, enough to burn 2800 calories a week, including 11,000 steps a day (5.5 miles), & 2 days of more intense exercise a week
  
• Consider adding phytochemicals like (but not limited to) cocoa, green tea, resveratrol (grapes or wine), acai berries, or hops (rho-iso-alpha-acids)
• Get enough sleep--at least 7.5 hours
• Find a way to manage stress to reduce fat-causing hormones (like cortisol) that pack on belly fat and increase inflammation.  Simplest stress reducers:  Exercise and deep breathing--one deep abdominal breath, hold for count of 4, and repeat.

 Who Is At Risk?  Who Needs to Get With the Program?  Where Do You Begin?

 Lifestyle accounts for more than 50% of the deaths among middle-age women.

72% of cardiovascular mortality can be attributed to lifestyle factors. 

Metabolic Syndrome is what you want to prevent--or get rid of--if you have it.  If you've got a little too much belly fat, elevated blood pressure, high triglycerides, elevated blood sugar, low HDLs, and/or high triglycerides you're at risk for heart attack, stroke, and type-2 diabetes.  We're talking Metabolic Syndrome--and with the right diet, exercise, stress management, and the addition of some potent phytochemicals you just might turn that ship around.

Dr. Alger-Mayer's Prototype Patient:

• 52 year old woman
• High stress job, long hours, finds it hard to find the time to exercise
• Travels for work, eat too many restaurant meals, breakfasts on bagels or pastry, drinks 2-3 glasses of wine at night to wind down
• Poor quality sleep, wakes up frequently
• Feeling depressed, trouble concentrating, anxious, worried about her memory, worried about her health
• Insulin-resistance, high blood pressure, high cholesterol, family history of early heart attack, a history of weight issues, loses weight and puts it right back on.
• 5'6", 228 lbs, BMI of 37, waist circumference of 42" (>35" increases risk), elevated fasting glucose, HDLS & triglycerides are OK, LDL is elevated, C-Reative Protein (inflammation marker) is elevated at 3.4  Click here for BMI tables  Click here for CRP tables & "The Inflammation Connection"
  
• Meets criteria for Metabolic Syndrome even though none of her values are super high
• She is ready to get serious about losing weight and making a change     

Before getting started, here's what Dr. Alger-Mayer asks all her patients to do, because "knowledge is power".

• Keep a 3 day food record of what they are eating day-to-day
• Record how they are feeling--emotions & moods.  What's driving their food choices
• Wear a step counter for 3 days--not to change anything, but to see how active they are during the day
• Keep a 7 day record of their sleep cycle
• What are they doing for fun?  What do they have to look forward to?  What helps to diffuse their stress?

Getting Started When You're Feeling Overwhelmed - Where Do You Begin?

Dr. Alger-Mayer's typical patient is an intelligent bright woman who has struggled with this weight issue for many years. 

It's not just about knowing the issues.  She feels totally overwhelmed & challenged by life & finding the time & energy to make big changes is extremely difficult.

Alger-Mayer says you need to break down the process into a manageable set of goals.  Here's what Ms. Typical Patient wants to know from Dr. Alger-Mayer:

• Is there one diet that would be best for her particular medical risk factors?
• What about exercise? She knows she has to exercise, but how much does she need to do?
• Are there any nutritional supplements that would help?

Let's Talk Diet - What's the Best One?

• When it comes to weight loss--it doesn't matter.  According to a 2009 New England Journal of Medicine study that compared four different weight-loss diets (low vs. higher fat; low carb vs. higher carb; low protein vs. higher protein)--it just didn't make any difference.  All the diets achieved weight loss, and lowered cardiovascular risk factors, decreased waist circumference, and triglycerides.  The fasting insulin level dropped in all the diets except the 65% carb diet.  All 4 diets were basically healthy--they emphasized adequate fiber and low-glycemic carbs, were low in cholesterol, and participants were asked to do 90 minutes of exercise a week.  Most weight loss occurred in the first 6 months of this 2 year study that followed over 800 overweight adults.  Final conclusion: "Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize."
• What did make a difference?  The patients who attended at least 66% of the group support sessions lost the most weight--an average of 20 pounds over 2 years.
• To lose weight, you need to eat 750 less calories than you would need to maintain your present weight.
• Dr. Alger-Mayer emphatically points out that this study DOES NOT MEAN, that diet doesn't matter--and that you can eat whatever you want to, as long as you cut calories.  High fat and simple sugars are not good for you, and will not reduce your cardiovascular risk factors.
• My opinion: Go for plant-based, minimal to no added fats, low-glycemic carbs like beans, oats, legumes, fruits & vegetables, whole-grains, and minimal sugar.  No worries!

A Calorie is Not Just a Calorie.  Carbs Affect Our Genes.  What?

 Some recent landmark studies have confirmed that the kind of carbohydrates we consume actually affect the genes in our abdominal fat--which has a tremendous impact on developing or curbing Metabolic Syndrome.

• The Carbohydrate/Gene Study.  Here's how the the low vs high glycemic carb study played out in 2 groups of people with Metabolic Syndrome.  One group was fed carbs that were high fiber low-glycemic (think oats, beans, quinoa).  The others group was fed carbs that were high fiber high-glycemic (think potatoes, whole wheat bread).  Both carbs had the same amount of protein and fat.  The low-glycemic carb meal produced a low insulin response, and the insulin-signaling genes in the abdominal fat were actually down-regulated.  But after the high-glycemic carb meal,  insulin shot up, and 62 different genes that are linked to the stress response, insulin-signaling and cytokine-mediated immunity were turned on.  Pretty amazing!  This study prompted endocrinologist Dr. David Ludwig to write an editorial called, "Putting your genes on a diet: the molecular effects of carbohydrate."
• Take away point:  The kind of carbs we eat have a significant effect on the gene regulation that affects how our bodies handle insulin--and don't forget that abdominal fat is a marker for an insulin response that is out of whack.  This process has nothing to do with how many calories we consume, or how much we weigh--but it has everything to do with what kind of carbs we are consuming.
• The effect of whole grains vs refined grains on the risk of cardiovascular disease in Metabolic Syndrome.   In this study the two groups being compared both reduced their calories by 500/a day for 12 weeks--but one group ate whole grains while the other consumed refined grains.   After 12 weeks both groups had the same weight loss--but the whole grain group had lost more belly fat, and had a 38% decrease the their C-reactive protein levels (inflammation marker).  The magnitude of the this C-reactive protein reduction was similar to the reduction achieved with statins.   
• Why do we want to eat foods that discourage belly fat--and that will down-regulate the genes in our belly fat?  Belly fat is completely different from the subcutaneous fat that surrounds our bodies. It's called omentum, and it acts just like an organ, secreting its own chemicals and hormones like adipokines that produce angiotensin II, that raises blood pressure. It also secretes tumor necrosis factor, interleukin 6, and C-reactive protein which lead to high blood pressure, insulin resistance, high cholesterol and inflammation that damages our brains & blood vessels. To read more about why you want to ditch the belly fat, click here.
• How do I find out which foods are low-glycemic?  The University of Sydney maintains the most reliable database.  Look for foods that have a glycemic index of 55 or under.  Click Here for the database.  Click Here for their excellent newsletter. Bottom line: you want very grainy "kibbled" least-processed breads & carbs that move slowly through your digestive system.

Why Exercise Matters If You Want to Keep Your Weight Off Forever!

The best data out there on the effect of exercise on weight loss comes from the National Weight Control Registry that was started in 1994 by Dr. James Hill and Dr. Rena Wing in Denver, Colorado.  The registry tracks over 5,000 people who have successfully lost an average of 60 pounds and have successfully kept it off for 5 years or more.  It aims to find out why these people are successful at keeping their weight off.

• The most powerful predictor of successful long-term weight loss is movement!  aka Exercise.
• On average people who have successfully maintained their weight loss, burn off 2800 calories a week which is quite a lot. 
• The calorie burn comes mostly from walking, 11,000 steps a day (that's 5.5 miles), and a higher intensity exercise for 2 days/a week--at an average of 6 METS--which is about an hour of jogging, bicycling, tennis or aerobics.  800 calories of the 2800 were burned as high intensity exercise.
• The exercise doesn't have to be in the form of long workouts--like 60-90 minutes at the gym.  People who had multiple short bouts of exercise on more days lost more weight and achieved similar cardiovascular benefits.

What Nutritional Supplements Can Help with Weight Loss and Reduce My Cardiovascular Risk?

It turns out that Metabolic Syndrome is tremendously impacted by the quality of our diet.   We are now beginning to understand that the phytonutrients in our food--which have nothing to do with calories or weight loss--are metabolically active, and have profound  effects on our signaling systems--and work through the same kinase systems that pharmaceutical drugs work on.

These phytonutrients can affect the insulin-signaling pathways which are closely linked to the inflammatory pathways in our body.

Here are a few examples of some of these active dietary phytonutrients:

• Green tea
• Ginseng
• Cinnamon
• Resveratrol
• Hops - used as the bitter flavoring for beer
• Cocoa

What happens when you add phytonutrient supplements to a high quality Mediterranean Diet?  Magic!!

Dr. Robert Lerman compared two groups of dieters on a super healthy Mediterranean diet high in omega-3s, low glycemic carbs, high quality proteins, and fruits and vegetables for 12 weeks.  One study group was supplemented with the phytonutrient hops (rho-iso-alpha acids) and an extract of acai berries.

Here's how the groups compared after 12 weeks:

• Resolution of Metabolic Syndrome:  43% of the phytochemical group vs. 22% of the diet only group
• Reduction of Framingham 10-year risk scores  dropped by 5.6% in the phytochemical group vs. 2.9% in the diet only group
• Weight loss was the same in both groups
• LDLs were reduced by 17% in the phytochemical group vs. 8.4% in the diet only group
• HDLs were increased by 7% in the phytochemical group vs. 3% in the diet only group
• Triglycerides dropped by 35% in the phytochemical group vs. 14% in the diet only group

Take away point:  The optimum way to use phytochemicals is to consume them as part of a healthy diet in whole foods (think lots of fruits & vegetables), rather than thinking, "I'll just go the health food store & buy some rho-iso-alpha acid pills & then just keep eating my regular diet."  I don't think so.

According to Alger-Mayer, diets high in saturated fat have a negative effect on those protein kinase pathways, and just may wash out the beneficial effects of these phytochemicals.

What Other Whole Food Phytochemical Supplements Does Alger-Mayer Recommend?

Resveratrol

This is the phytonutrient found in the skins and seeds of grapes and of course, in wine. 

• It's known to reduce cardiovascular risk by lowering blood pressure.
• It improves endothelial function (the lining of blood vessels) by increasing that "magic gas" nitric oxide--which makes blood vessels flexible and improves dilation.  Nitric oxide production increased 3-fold in endothelial cells that were "incubated" in red wine.
• It decreases blood platelet aggregation, which means less clumping and clotting
• It's known to activate cell proteins that prevent cell death in bacteria--suggesting a "possible" increase in human longevity.  Who knows?

Cocoa

The Greek name for cocoa means, "Drink of the Gods".  Maybe they were on to something.  Epichatechin is the polyphenol in cocoa that does its magic on the cardiovascular system.

• It lowers blood pressure
• It reduces insulin resistance and improves platelet function
• It increases nitric oxide production--that "magic gas" that improves endothelial function, and it has anti-oxidant and anti-inflammatory properties.
• In a recent meta-analysis in the journal Circulation, 75 grams of dark chocolate for 3 weeks increased HDLs by 14% and decreased LDL oxidation. Lowering blood pressure took even less cocoa to do the job.
• How does cocoa do all this?  It's probably because it increases the availability of nitric oxide, and it also increases arginase--which prevents nitric oxide from breaking down.  It's a 2-for-one!
• Cocoa's best benefit?  It inhibits the kind of inflammation that creates atherosclerotic plaque.
• This study will give you a good reason to drink cocoa daily.  One of the tests for a healthy vasculature is the ability of our blood vessels to dilate.  This study looked at the dilation of arteries after drinking a high flavanoid cocoa drink, compared to a low flavonoid drink.  There was a significant increase in vasodilation with the high flavonoid drink--and nitric oxide levels increased as the level of flavonoids in the cocoa increased.
• Watch out!  Avoid cocoa or dark chocolate that is "Dutch-Processed" or is treated with an alkali to decrease its bitterness--that destroys the flavonoids!

What Does Stress Have to Do with Diet and Weight Loss?

Plenty!  Stress decreases leptin---and low levels of the hormone leptin will increase food cravings even if you aren't hungry.  Stress also increases ghrelin---the hormone that keeps you eating even when you aren't hungry.

Alger-Mayer says that stress reduction is a key factor in managing our food intake--and it even plays a role in our ability to exercise.

What effect does cortisol have on weight loss?

• Stress increases cortisol, which increases the likelihood  of snacking--especially high calorie snacks. 
• It increases belly fat
• Cortisol increases significantly in women who are "high stress reactors"--snacking is strongly associated with daily stressers in women who are "high stress reactors".
• Cortisol-Abdominal Fat Connection. Men & women with a high waist-to-hip ratio had greater cortisol release when under stress than those with a low waist-to-hip ratio--suggesting the release of cortisol in response to stress contributes to abdominal fat.  Click here for a waist-to-hip calculator & chart.
• Rats fed a high-fat, high sugar diet and exposed to long-term stress had a 50% increase in visceral (belly) fat

Top ways to reduce stress

• Exercise.  It reduces stress, anxiety, depression, and raises dopamine--the feel good brain chemical--which may also reduce the craving for high fat, high sugar foods.
• Many of Alger-Mayer's patients tell her that when they exercise they are better able to stick to their meal plan and avoid cravings.  When they get knocked off track, their cravings come back.
• Turns out that wheel-running in rats is a protection against stress, anxiety, and depression.  It also affects their serotonin and noradrenaline (fight or flight hormone) levels, and increases their dopamine--the feel-good hormone.
• Exercise is actually an antidote for high sugar intake!
• How deep breathing helps reduce stress.   Try the "mini"--a simple technique developed by Dr. Herbert Benson, an interventional cardiologist who founded the Mind-Body Institute at Harvard.
• Within one minute of deep breathing you increase the calming parasympathetic system kicks in, the heart rate drops, blood pressure drops, and "yeah",  cortisol drops, too.
• Here's how to do it.  Take a deep breath, expanding into the abdomen.  Hold it for the count of 4, and breathe out.  Repeat.  Doing this simple technique when you start to feel stressed may reduce cortisol, and prevent our cells from being bathed in cortisol, increases our risk of belly fat. To learn more about Benson's technique's click here.
• Figure out a step-by-step plan.  Be clear & specific.  When will you eat?  When will you walk or exercise?  How long?  Find an exercise and diet buddy.  Alger-Mayer recommends Spark People--an online weight-loss community to help you find a group with similar ages and goals as yours.
• Get enough sleep!  Less than 6.5 hours of sleep causes increased hunger, impairs glucose tolerance.  Alger-Mayer suggests going to sleep 20 minutes earlier to start.
• Give yourself rewards for your diet or exercise success.

What am I now going to change after my "appointment" with Dr. Sharon Alger-Mayer? 

• I'm definitely going to to think twice about eating any high-glycemic carbs.
• I'm going to try very hard to get at least 7.5 hours of sleep.
• I'm going to program the free step counter I got from my workplace--and start using it.  I wonder how many steps I'm walking a day?
• I'm going continue with my daily cup of cocoa.
• I'm going incorporate Benson's mini's--the deep breathing technique--as needed.
• And that's enough for now!

Please let me know what you think of this summary.  I really appreciate feedback!

 

Why You Might Want to Keep Your Triglycerides Under 80. Following the New AHA "Ditch the Sugar" Guidelines Will Help!

 

Current NCEP Triglyceride Guidelines - Is the Normal Too High?

Note: As of April 18, 2011 the American Heart Association issued a Scientific Statement Recommending that the OPTIMAL Level of triglycerides be less than 100. click here for more info.

"When triglycerides go up over 100 we start making abnormal forms of cholesterol--the small dense LDLs that are atherogenic and penetrate much more rapidly into the arteries than normal large LDLs. 
 
When triglycerides start going up--and the changes start around 80-100--nearly everyone with triglycerides over 100 is making significant amounts of small dense atherogenic LDL--above 150 almost all LDL particles are small dense and atherogenic." 

-Dr. Patrick E. McBride, Professor of Medicine and Family Medicine, University of Wisconsin, and a member of the Expert III NCEP Panel setting cholesterol guidelines-

 

Sometimes you hear something that makes you shake your head and think, "Why didn't I know that?  Why isn't anyone explaining this?"

On the long ride home from Kiawah last week the radio reception died--I was sick of reading--and I decided to listen to the new Audio-Digest in Internal Medicine--"Lipids: the Good, Bad, Ugly", 56(15): August 2, 2009 that I had packed in my book bag.

Now go dig up your last cholesterol results.  I'll wait.  And if you don't have any test results--pay attention anyway--and make sure you do your best to keep those triglycerides under 80.

In A Nutshell--Here's What Dr. Patrick E. McBride is Saying About Triglycerides?

• If your triglycerides are under 80 you are making "normal large" LDLs that are not very atherogenic (think atherosclerosis; arterial plaque; hardening of the arteries)

• When triglycerides are over 150 (there are just too many particles floating around with no where to go) they briefly get inserted into the LDLs and change the LDLs into "small dense atherogenic" particles.

• Stealth LDL: That's what you call what was once a normal LDL particle that's been penetrated by free-floating triglycerides.  When triglycerides are too high they are able to change the LDL into "small dense dangerous" LDL that oxidizes very easily (a bad thing) and penetrates rapidly into the arteries. Note: Triglycerides are not supposed to penetrate the LDLs!!

• Normal LDL: It's difficult for normal LDL (large & fluffy) to penetrate into the wall of an artery!

• When triglycerides are between 80-100 you start to  make abnormal LDL.  Some of it starts changing into the "small dense atherogenic" variety at this level.  (If changes start happening over 80--it looks to me like the only safe triglyceride number is under 80!)

• When triglycerides are over 100--according to Dr. McBride--you've turned the corner & "are making at the very least, a significant amount of "small dense" LDL."

• When triglycerides are above 150, almost all of the LDL particles become "small dense atherogenic".

• Dr. McBride served on the III NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that set the guidelines for triglycerides (and cholesterol) back in 2002.  He advocated for the normal level to be under 100--and he strongly believes that the current level will go down to 100 when the next guidelines come out.

• Big clue that your triglycerides are probably too high?  Abdominal obesity aka belly fat.  That's the engine--the symptom--that starts the cascade toward atherosclerosis; heart disease; stroke; type II diabetes.  It's a big reason for triglycerides producing nasty stealth LDL. Read "This Belly Fat is Going to be the Death of Me and Now I Understand Why."

• According to Dr. McBride, if you have abdominal obesity, the chances are greater that you are producing the abnormal dangerous "small dense" form of LDL.

• If you overconsume sugar, soda pop, saturated fats, trans fats, refined carbohydrates, and "fried apple pies"--and you are consuming more calories than you need--your body doesn't know what to do with all that junk--and you end up with lots of rich triglycerides--that are very inflammatory and very atherogenic--floating around--just looking for an LDL to penetrate and turn it into "small dense dangerous" LDL!

Why You Should Care About Your Triglyceride Levels

• Triglycerides are an independent predictor of cardiovascular disease and stroke.
• They are an even greater predictor of cardiovascular disease in women, than in men.
• The dangerous duo:  High triglycerides & low HDL.  Add abdominal fat--and you've got a bad news trifecta!
• Even the so-called good-guy HDL turns into an evil twin in the presence of "small-dense" LDLs.  So...if you think just because your HDLs are high you are in good shape and protected--think again!  If your LDLs are small & dense (and that's probably because your triglycerides are  too-high) you are most likely producing "small-dense" HDLs as well, which have impaired function and are less protective than normal HDLs.  Oy!

The Test That Will Tell You If Your LDLs are Normal or Abnormal (Small or Large)

• You can't identify people with small-dangerous-stealth LDLs from the regular lipid panel.
• Again--there is a big clue--without even taking a test.  Abdominal obesity--High Triglycerides--Low HDLs=stealth LDL
• McBride thinks the best test is:  The LipoProfile Nuclear Magnetic Resonance (NMR) Spectroscopy which measures both the number and size of lipoprotein particles.  He says the LDL particle number is the best predictor of how much LDL we deliver to our arteries!
• I've had personal experience with this test.  Pre-vegan diet--2 years ago--I took this test.  Prior to the test my LDLs at the time were on the highish side (129 one time, 157 another), although my triglycerides were always under 80, and my HDLs were always between 72-96.  

My doctor wanted me to go on a low-dose statin, so I requested a test to see whether or not I had the large or small LDL particles.  The doctor was reluctant for me to take the test because she said insurance probably wouldn't cover it.  (better for them to pay for drugs for the rest of my life than test to see if I really need them)

I asked the cost, and she said it was about $125.  I said I'd be willing to pay out-of-pocket for it, because why would I want to go on statins if I didn't need to.  She was skeptical, but we ran the test.

Turns out, the theory of low triglycerides + high HDLs + low abdominal fat proved to be true.  I passed the test with flying colors.  I was mostly producing the large-fluffy LDLs, and for now at least, I don't need statins.

I've since completely changed my diet, and because that NMR LipoProfile was A-OK, my doctor doesn't see the need to run another lipid panel for awhile.  Would love to know how things have changed, though.

My Lab Rat Exercising Husband

This guy is trim.  He runs, bikes, and does yoga.  He competes in ultra-marathons.  For some reason (genetics? diet?) his triglycerides still run over 150, so he was very interested in Dr. McBride's information.  The lab rat story

We've both thought about this and looked at how he eats differently from me.

He's a huge carbohydrate consumer from 8:00 pm till bedtime.  If he starts eating a box of Snyder's Pretzels, or crackers, he doesn't stop until it's finished.  A bowl or two of cereal after dinner--that's common, too.  And he likes an occasional beer or two at night.

Turns out--night-time eating is a triglyceride no-no.  Read the whole story here.

''If the calories are exactly the same, it shouldn't make a difference, but my clinical impression is that people who eat late at night eat more,'' said Dr. Louis J. Aronne, director of the comprehensive weight control program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. They may be eating ''an extra meal, if you will, 'the fourth meal,' as one ad put it,'' Dr. Aronne said.
 
''Eating a big meal just before going to bed has been found in studies to elevate triglyceride levels in the blood for a period of time,'' Dr. Aronne said.

''If you ate 500 calories during the day but walked around afterward, your muscles would be competing with your fat cells for the calories and could burn them up as energy for physical activity,'' he said. ''But if you consume it at bedtime, with no physical activity, the body has no choice but to store the calories away as fat.''

Even before Dr. McBride's triglyceride tip my husband has been seriously curbing his night-time carb-fest and lo-and-behold even his minor belly fat has just melted off.  He's at his lowest weight in years and it's been no sacrifice at all. He realized that the night-time eating was just a lifelong habit that had to go.  He says, "I'm just learned that it's OK to go to bed a little hungry."

In October he has a physical and he's anxious to see just how his mostly-vegan diet + the ditching of night-time carbs will affect his triglycerides and overall cholesterol. 

The American Heart Association Says Cut the Sugar

Last week the AHA issued a statement recommending that Americans drastically limit their sugar intake.  The average intake from 2002-2004 was about 22.2 tsp. or 355 empty calories.  These are true triglyceride boosters!  The statement was published online in Circulation on August 24, 2009, and will appear in print on Sept. 15, 2009.  Click here for the summary.  Click here for the Circulation article.

The AHA points out that excessive sugar consumption (and they include that baddy high-fructose corn syrup) is linked to "several metabolic abnormalities and adverse health conditions".   And they make specific mention of the effect of diets high in sucrose, glucose, fructose--and low in fiber--on triglycerides. 

"In summary, although the mechanisms are unclear, relative to other carbohydrates sources, sugar intake appears to be associated with increased triglyceride levels, a known risk factor for coronary heart disease."

"In some, but not all studies, a higher consumption of high-sugar beverages and foods is associated with evidence of increased inflammation and oxidative stress."

Here's what the AHA recommends:

Women: No more than 100 calories a day of added sugar (we're talking a half a cookie here)
Men:      No more than 150 calories a day of added sugar.

Back in November, 2008 I wrote an extensive post on Triglycerides and how they can be lowered.  Click here  to read more.

The Cleveland Clinic provides excellent info on how foods affect triglycerides.  Click here for that info.

For a summary of Audio-Digest in Internal Medicine--"Lipids: the Good, Bad, Ugly", 56(15): August 2, 2009 click here.

And by the way--I'm quite pleased that I gave up sugar (well, for the most part) in January.  Click here.