Sunday, February 28, 2010

Vegan Nachos!

Who says that nachos always have to have cheese or meat? This recipe is so flavorful, I promise you won’t miss the animal products! The creamy guacamole, hearty beans, salsa and fresh cilantro create a satisfying array of flavors for this simple, healthy snacking dish.

Ingredients:
1 can black beans (rinsed and drained)
1 can pinto beans (rinsed and drained)
dash of cumin
dash of chili powder
salsa to taste
1 avocado
½ lime
fresh cilantro to taste
sea salt



Directions:
Beans: Heat beans in small pot on low/med heat. Add dash of cumin, chili powder and sea salt.

Guacamole: Mash avocado in bowl with fork. Squirt half lime into bowl adding fresh cilantro and continue to mash together.

Spread chips out onto dish and pour desired amount of salsa onto them. Spoon guacamole over chips and salsa. Once beans are heated, pour them over dish, then top with more fresh cilantro. The beans will heat the rest of the ingredients and flavors will marry together. ENJOY!

*Feel free to use this same recipe, but instead of pouring ingredients over chips, stuff into a whole wheat wrap with some brown rice for a healthy, filling burrito!


Benefits of Pinto Beans:
Pinto beans are a very good source of cholesterol-lowering fiber, as are most other beans. Pinto beans' high fiber content prevents blood sugar levels from rising too rapidly after a meal, making these beans an especially good choice for individuals with diabetes, insulin resistance or hypoglycemia. When combined with whole grains such as brown rice, pinto beans provide virtually fat-free, high quality protein. But this is far from all pinto beans have to offer. Pinto beans are also an excellent source of molybdenum, a very good source of folate and manganese, and a good source of protein and vitamin B1 as well as the minerals phosphorus, iron, magnesium, potassium, and copper. Pintos are a great replacement for red meats. A half cup of cooked pinto beans will provide about 120 calories and 10 grams of protein, without the saturated fat.

Green Mountain Gringo Strips: I recommend serving with Green Mountain Gringo Tortilla Strips. They are great tasting, all natural using non-GMO corn and gluten free. You can find them at any health food store, and at most supermarkets.

What does GMO mean? Genetically Modified Organism is the most common usage (though 'manipulated' or even 'mutated' might also be appropriate!) The acronyms GEO (Genetically Engineered Organism) or simply GM or GE are also used. Genetic engineering is a radical new technology that forces genetic information across the protective species barrier in an unnatural way. Why be concerned? One of many good reasons is that these laboratory-created mutations are unlabeled, virtually untested and on grocery shelves everywhere.

Keep it fresh!
- Lauren

Body fat and disease: How much body fat can I lose in one day?

Body fat is not an inert deposit of energy. It can be seen as a distributed endocrine organ. Body fat cells, or adipocytes, secrete a number of different hormones into the bloodstream. Major hormones secreted by adipose tissue are adiponectin and leptin.

Estrogen is also secreted by body fat, which is one of the reasons why obesity is associated with infertility. (Yes, abnormally high levels of estrogen can reduce fertility in both men and women.) Moreover, body fat secretes tumor necrosis factor-alpha, a hormone that is associated with generalized inflammation and a number of diseases, including cancer, when in excess.

The reduction in circulating tumor necrosis factor-alpha and other pro-inflammatory hormones as one loses weight is one reason why non-obese people usually experience fewer illness symptoms than those who are obese in any given year, other things being equal. For example, the non-obese will have fewer illness episodes that require full rest during the flu season. In those who are obese, the inflammatory response accompanying an illness (which is necessary for recovery) will often be exaggerated.

The exaggerated inflammatory response to illness often seen in the obese is one indication that obesity in an unnatural state for humans. It is reasonable to assume that it was non-adaptive for our Paleolithic ancestors to be unable to perform daily activities because of an illness. The adaptive response would be physical discomfort, but not to the extent that one would require full rest for a few days to fully recover.

Inflammation markers such as C-reactive protein are positively correlated with body fat. As body fat increases, so does inflammation throughout the body. Lipid metabolism is negatively affected by excessive body fat, and so is glucose metabolism. Obesity is associated with leptin and insulin resistance, which are precursors of diabetes type 2.

Some body fat is necessary for survival; that is normally called essential body fat. The table below (from Wikipedia) shows various levels of body fat, including essential levels. Also shown are body fat levels found in athletes, as well as fit, “not so fit” (indicated as "Acceptable"), and obese individuals. Women normally have higher healthy levels of body fat than men.


If one is obese, losing body fat becomes a very high priority for health reasons.

There are many ways in which body fat can be measured.

When one loses body fat through fasting, the number of adipocytes is not actually reduced. It is the amount of fat stored in adipocytes that is reduced.

How much body fat can a person lose in one day?

Let us consider a man, John, whose weight is 170 lbs (77 kg), and whose body fat percentage is 30 percent. John carries around 51 lbs (23 kg) of body fat. Standing up is, for John, a form of resistance exercise. So is climbing stairs.

During a 24-hour fast, John’s basal metabolic rate is estimated at about 2,550 kcal/day. This is the number of calories John would spend doing nothing the whole day. It can vary a lot for different individuals; here it is calculated as 15 times John’s weight in lbs.

The 2,550 kcal/day is likely an overestimation for John, because the body adjusts its metabolic rate downwards during a fast, leading to fewer calories being burned.

Typically women have lower basal metabolic rates than men of equal weight.

For the sake of discussion, we expect each gram of John’s body fat to contribute about 8 kcals of energy, assuming a rate of conversion of body fat to calories of about 90 percent.

Thus during a 24-hour fast John burns about 318 g of fat, or about 0.7 lbs. In reality, the actual amount may be lower (e.g., 0.35 lbs), because of the body's own down-regulation of its basal metabolic rate during a fast. This down-regulation varies widely across different individuals, and is generally small.

Many people think that this is not much for the effort. The reality is that body fat loss is a long term game, and cannot be achieved through fasting alone; this is a discussion for another post.

It is worth noting that intermittent fasting (e.g., one 24-hour fast per week) has many other health benefits, even if no overall calorie restriction occurs. That is, intermittent fasting is associated with health benefits even if one fasts every other day, and eats twice one's normal intake on the non-fasting days.

Some of the calories being burned during John's 24-hour fast will be from glucose, mostly from John’s glycogen reserves in the liver if he is at rest. Muscle glycogen stores, which store more glucose substrate (i.e., material for production of glucose) than liver glycogen, are mobilized primarily through anaerobic exercise.

Very few muscle-derived calories end up being used through the protein and glycogen breakdown pathways in a 24-hour fast. John’s liver glycogen reserves, plus the body’s own self-regulation, will largely spare muscle tissue.

The idea that one has to eat every few hours to avoid losing muscle tissue is complete nonsense. Muscle buildup and loss happen all the time through amino acid turnover.

Net muscle gain occurs when the balance is tipped in favor of buildup, to which resistance exercise and the right hormonal balance (including elevated levels of insulin) contribute.

One of the best ways to lose muscle tissue is lack of use. If John's arm were immobilized in a cast, he would lose muscle tissue in that arm even if he ate every 30 minutes.

Longer fasts (e.g., lasting multiple days, with only water being consumed) will invariably lead to some (possibly significant) muscle breakdown, as muscle is the main store of glucose-generating substrate in the human body.

In a 24-hour fast (a relatively short fast), the body will adjust its metabolism so that most of its energy needs are met by fat and related byproducts. This includes ketones, which are produced by the liver based on dietary and body fat.

How come some people can easily lose 2 or 3 pounds of weight in one day?

Well, it is not body fat that is being lost, or muscle. It is water, which may account for as much as 75 percent of one’s body weight.

References:

Elliott, W.H., & Elliott, D.C. (2009). Biochemistry and molecular biology. New York: NY: Oxford University Press.

Fleck, S.J., & Kraemer, W.J. (2004). Designing resistance training programs. Champaign, IL: Human Kinetics.

Large, V., Peroni, O., Letexier, D., Ray, H., & Beylot, M. (2004). Metabolism of lipids in human white adipocyte. Diabetes & Metabolism, 30(4), 294-309.

Thursday, February 25, 2010

Corn Oil and Cancer: Reality Strikes Again

The benefits of corn oil keep rolling in. In a new study by Stephen Freedland's group at Duke, feeding mice a diet rich in butter and lard didn't promote the growth of transplanted human prostate cancer cells any more than a low-fat diet (1).

Why do we care? Because other studies, including one from the same investigators, show that corn oil and other industrial seed oils strongly promote prostate cancer cell growth and increase mortality in similar models (2, 3).

From the discussion section:
Current results combined with our prior results suggest that lowering the fat content of a primarily saturated fat diet offers little survival benefit in an intact or castrated LAPC-4 xenograft model. In contrast to the findings when omega-6 fats are used, these results raise the possibility that fat type may be as important as fat amount or perhaps even more important.
The authors seem somewhat surprised and pained by the result. Kudos for publishing it. However, there's nothing to be surprised about. There's a large body of evidence implicating excess omega-6 fat in a number of cancer models. Reducing omega-6 to below 4% of calories has a dramatic effect on cancer incidence and progression*. In fact, there have even been several experiments showing that butter and other animal fats promote cancer growth to a lesser degree than margarine and omega-6-rich seed oils. I discussed that here.

I do have one gripe with the study. They refer to the diet as "saturated fat based". That's inaccurate terminology. I see it constantly in the diet-health literature. If it were coconut oil, then maybe I could excuse it, because coconut fat is 93% saturated. But this diet was made of lard and butter, the combination of which is probably about half saturated. The term "animal fat" or "low-omega-6 fat" would have been more accurate. At least they listed the diet composition. Many studies don't even bother, leaving it to the reader to decide what they mean by "saturated fat".


* The average American eats 7-8% omega-6 by calories. This means it will be difficult to see a relationship between omega-6 intake and cancer (or heart disease, or most things) in observational studies in the US or other industrial nations, because we virtually all eat more than 4% of calories as omega-6. Until the 20th century, omega-6 intake was below 4%, and usually closer to 2%, in most traditional societies. That's where it remains in contemporary traditional societies unaffected by industrial food habits, such as Kitava. Our current omega-6 intake is outside the evolutionary norm.

Tuesday, February 23, 2010

Federal panel says 73 million in the us have high blood pressure - my thoughts

I was reading in the news today and read that a federal panel has a familiar prescription to reduce hypertension, something that has the potential to cause heart problems and raise health care costs in this country if untreated (http://www.latimes.com/news/nation-and-world/la-sci-hypertension23-2010feb23,0,4388789.story).  They indicate the incidence of hypertension has increase by 25% in the last decade.  Many packaged and restaurant foods use salt as a cheap way of adding flavor and as we rely on these types of meals, we exceed the recommended daily allowance of salt by at lease 50%.  Many physicians are rushed because of our current health care systems reluctance to pay them for time spent, which has created the quick office visit and the receipt of a script for a drug that will help the kidneys lower your blood pressure artificially (thank you insurance industry for introducing this problematic paradigm - cost effective not!!!!!!!!!). Most physicians would love to spend more time with their patients and would except for the fact it would put them out of business which is why some no longer take insurance and instead charge a fair rate for their time and caring (a better paradigm IMHO).

To summerize, the panel advocates that you
1. Reduce your weight - has a positive effect on blood pressure.
2. Reduce your salt intake.
3. Eat more fruit, vegetables, lean protein.

I would add the following
1. Get evaluated by your chiropractor periodically - studies show problems in the spine will affect blood pressure and getting a periodic adjustment is helpful. Your bodies neurology is part of the equation.
2. Get regular exercise - your cardiovascular system will become more efficient.

Monday, February 22, 2010

Magnesium and Insulin Sensitivity

From a paper based on US NHANES nutrition and health survey data (1):
During 1999–2000, the diet of a large proportion of the U.S. population did not contain adequate magnesium... Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.... Because magnesium intake is low among many people in the United States and inadequate magnesium status is associated with increased risk of acute and chronic conditions, an urgent need exists to perform a current survey to assess the physiologic status of magnesium in the U.S. population.
Magnesium is an essential mineral that's slowly disappearing from the modern diet, as industrial agriculture and industrial food processing increasingly dominate our food choices. One of the many things it's necessary for in mammals is proper insulin sensitivity and glucose control. A loss of glucose control due to insulin resistance can eventually lead to diabetes and all its complications.

Magnesium status is associated with insulin sensitivity (2, 3), and a low magnesium intake predicts the development of type II diabetes in most studies (4, 5) but not all (6). Magnesium supplements largely prevent diabetes in a rat model* (7). Interestingly, excess blood glucose and insulin themselves seem to reduce magnesium status, possibly creating a vicious cycle.

In a 1993 trial, a low-magnesium diet reduced insulin sensitivity in healthy volunteers by 25% in just four weeks (8). It also increased urinary thromboxane concentration, a potential concern for cardiovascular health**.

At least three trials have shown that magnesium supplementation increases insulin sensitivity in insulin-resistant diabetics and non-diabetics (9, 10, 11). In some cases, the results were remarkable. In type II diabetics, 16 weeks of magnesium supplementation improved fasting glucose, calculated insulin sensitivity and HbA1c*** (12). HbA1c dropped by 22 percent.

In insulin resistant volunteers with low blood magnesium, magnesium supplementation for four months reduced estimated insulin resistance by 43 percent and decreased fasting insulin by 32 percent (13). This suggests to me that magnesium deficiency was probably one of the main reasons they were insulin resistant in the first place. But the study had another very interesting finding: magnesium improved the subjects' blood lipid profile remarkably. Total cholesterol decreased, LDL decreased, HDL increased and triglycerides decreased by a whopping 39 percent. The same thing had been reported in the medical literature decades earlier when doctors used magnesium injections to treat heart disease, and also in animals treated with magnesium. Magnesium supplementation also suppresses atherosclerosis (thickening and hardening of the arteries) in animal models, a fact that I may discuss in more detail at some point (14, 15).

In the previous study, participants were given 2.5 g magnesium chloride (MgCl2) per day. That's a bit more than the USDA recommended daily allowance (MgCl2 is mostly chloride by weight), in addition to what they were already getting from their diet. Most of a person's magnesium is in their bones, so correcting a deficiency by eating a nutritious diet may take a while.

Speaking of nutritious diets, how does one get magnesium? Good sources include halibut, leafy greens, chocolate and nuts. Bone broths are also an excellent source of highly absorbable magnesium. Whole grains and beans are also fairly good sources, while refined grains lack most of the magnesium in the whole grain. Organic foods, particularly artisanally produced foods from a farmer's market, are richer in magnesium because they grow on better soil and often use older varieties that are more nutritious.

The problem with seeds such as grains, beans and nuts is that they also contain phytic acid which prevents the absorption of magnesium and other minerals (16). Healthy non-industrial societies that relied on grains took great care in their preparation: they soaked them, often fermented them, and also frequently removed a portion of the bran before cooking (17). These steps all served to reduce the level of phytic acid and other anti-nutrients. I've posted a method for effectively reducing the amount of phytic acid in brown rice (18). Beans should ideally be soaked for 24 hours before cooking, preferably in warm water.

Industrial agriculture has systematically depleted our soil of many minerals, due to high-yield crop varieties and the fact that synthetic fertilizers only replace a few minerals. The mineral content of foods in the US, including magnesium, has dropped sharply in the last 50 years. The reason we need to use fertilizers in the first place is that we've broken the natural nutrient cycle in which minerals always return to the soil in the same place they were removed. In 21st century America, minerals are removed from the soil, pass through our toilets, and end up in the landfill or in waste water. This will continue until we find an acceptable way to return human feces and urine to agricultural soil, as many cultures do to this day****.

I believe that an adequate magnesium intake is critical for proper insulin sensitivity and overall health.


* Zucker rats that lack leptin signaling

** Thromboxane A2 is an omega-6 derived eicosanoid that potently constricts blood vessels and promotes blood clotting. It's interesting that magnesium has such a strong effect on it. It indicates that fatty acid balance is not the only major influence on eicosanoid production.

*** Glycated hemoglobin. A measure of the average blood glucose level over the past few weeks.

**** Anyone interested in further reading on this should look up The Humanure Handbook

Lindeberg on Obesity

I'm currently reading Dr. Staffan Lindeberg's magnum opus Food and Western Disease, recently published in English for the first time. Dr. Lindeberg is one of the world's leading experts on the health and diet of non-industrial cultures, particularly in Papua New Guinea. The book contains 2,034 references. It's also full of quotable statements. Here's what he has to say about obesity:
Middle-age spread is a normal phenomenon - assuming you live in the West. Few people are able to maintain their [youthful] waistline after age 50. The usual explanation - too little exercise and too much food - does not fully take into account the situation among traditional populations. Such people are usually not as physically active as you may think, and they usually eat large quantities of food.

Overweight has been extremely rare among hunter-gatherers and other traditional cultures [18 references]. This simple fact has been quickly apparent to all foreign visitors...

The Kitava study measured height, weight, waist circumference, subcutaneous fat thickness at the back of the upper arm (triceps skinfold) and upper arm circumference on 272 persons ages 4-86 years. Overweight and obesity were absent and average [body mass index] was low across all age groups. ...no one was larger around their waist than around their hips.

...The circumference of the upper arm [mostly indicating muscle mass] was only negligibly smaller on Kitava [compared with Sweden], which indicates that there was no malnutrition. It is obvious from our investigations that lack of food is an unknown concept, and that the surplus of fruits and vegetables regularly rots or is eaten by dogs.

The Population of Kitava occupies a unique position in the world in terms of the negligible effect that the Western lifestyle has had on the island.
The only obese Kitavans Dr. Lindeberg observed were two people who had spent several years off the island living a modern, urban lifestyle, and were back on Kitava for a visit.

I'd recommend this book to anyone who has a scholarly interest in health and nutrition, and somewhat of a background in science and medicine. It's extremely well referenced, which makes it much more valuable.

6 Things You Can Give Up for Lent That Will Help the Environment

Not sure what you can give up for Lent this year? Try one of these green resolutions and see how simple steps can make a BIG difference for the environment!

Give Up Plastic (and Paper) Bags

Neither paper or plastic is a good choice when checking out at the grocery store. Twelve million barrels of oil were used to make the 88.5 billion plastic bags consumed in the US last year. And it takes four times more energy to make paper bags! The best choice is reusable shopping bags made of cotton, nylon or durable, mesh-like plastic. Put a few reusable shopping bags in your car so you have them handy on your next shopping trip. And if you happen to forget your reusable bag (as we all do!), choose paper if you will recycle it or plastic if you will reuse or recycle it.

Give Up Meat

Going meatless, even just once a week, may reduce your risk of chronic preventable conditions like cancer, cardiovascular disease, diabetes and obesity. It can also help reduce your carbon footprint and save precious resources like fresh water and fossil fuel. In place of chicken, beef, or pork, just look for protein from beans, legumes, eggs, nuts and seeds instead. The water needs of livestock are tremendous, far above those of vegetables or grains. An estimated 1,800 to 2,500 gallons of water go into a single pound of beef, while tofu produced in California requires 220 gallons of water per pound. On average, about 40 calories of fossil fuel energy go into every calorie of feed lot beef in the U.S. Compare this to the 2.2 calories of fossil fuel energy needed to produce one calorie of plant-based protein. Moderating meat consumption is a great way to cut fossil fuel demand. Visit Meatless Monday for more information on decreasing your meat consumption, and for great recipe ideas!

Give Up Paper Towels

No matter how you look at it, paper towels create waste. During your next trip to the grocery store, buy some reusable microfiber towels, which grip dirt and dust like a magnet, even when they get wet. When you are finished with them, toss the towels in the wash and reuse them again and again. They are even great for countertops and mirrors. When you absolutely have to use disposable towels, look for recycled products. If every household in the United States replaced just one roll of virgin fiber paper towels (70 sheets) with 100 percent recycled ones, we could save 544,000 trees.

Stop Buying Bottled Water

Did you know that it takes 26 bottles of water to produce the plastic container for a one-liter bottle of water, and that doing so pollutes 25 liters of groundwater? Don’t leave a trail of plastic water bottles in your wake! Stop buying bottled water. Use reusable water bottles instead made from materials like stainless steel or aluminum that are not likely to degrade over time. You can find aluminum bottles in most stores now, for as low as $15. If you choose a plastic water bottle, check the number on the bottom first: Plastics numbered 3, 6 & 7 could pose a health threat to you, so look for plastics numbered 1, 2, 4 or 5.

Give Up 2 Degrees

Electric power plants are the country's largest industrial source of the pollutants that cause global warming. By snuggling under a blanket on the couch on a snowy winter night instead of turning up the heat, or enjoying the breeze from a fan in the height of summer instead of turning up the air conditioning, you can save pounds of pollution, as well as some money off your utility bills. Set your thermostat in winter to 68 degrees F (20° C) or less during the daytime and 55 degrees F (13° C) before going to sleep or when you are away for the day. And during the summer, set thermostats to 78 degrees F (26° C) or more.

Stop Receiving Unwanted Catalogs

Each year, 19 billion catalogs are mailed to American consumers. All those catalogs require more than 53 million trees and 56 billion gallons of wastewater to produce -- and many of us don't even know how we got on so many mailing lists! So grab that stack of catalogs piling up on your coffee table and clear out the clutter. Visit CatalogChoice.org to put a stop to unwanted catalogs. Within 10 weeks, your mailbox will be empty of unwanted catalogs. A less cluttered mailbox means less pollution, less waste and less of the pollution that causes global warming.

Adapted from NRDC Simple Steps February 2010

Keep it fresh!
- Lauren

Welcome Home Jill!!!

Just dropping a quick note to say WELCOME HOME JILL!!!

Our 3rd Healthy Chick is finally back in the Garden State from Kigali, Rwanda. She accomplished some amazing things with Project Rwanda and I am sure they were sad to see her go, but we couldn't be happier to have her back!

yay! we love you, Jill!!!

Sunday, February 21, 2010

Adult Track and Field in Toms River NJ 2-21-10 - Check it out

I had the pleasure of being the medical staff of a USATF NJ  track and field meet at the Toms River bubble.  I helped quite a few athletes today, some of which are world class.  Where do world class athletes go after they did the olymipcs?  They are often found doing events just like these in NJ and other states.  I worked with athletes from as far away as Maryland and from the tri state area.  Above is a photo as a 200 yard sprint began.  Here is a long jump that was done at todays meet as well.  Many runners often do not know why they have tightness or pain.  My job is to help them feel better and to also give them guidance as to where they can go to get help and to help them perform better while at the event by working on them, taping their feet (many runners have body style issues) and occasionally I am called into emergency service like I was today for someone who got injured performing the high jump.  This was a wonderful event to be a part of.

Saturday, February 20, 2010

Avandia Diabetes Drug, another one bites the dust

The New York Times reported today that avandia (http://www.nytimes.com/2010/02/20/health/policy/20avandia.html) which has been given to those with type 2 diabetes is responsible for 500 heart attacks and 300 cases of heart failure monthly.  So much for the drug paradigm under allopathic ideals being safe.  Many doctors having seen the writing on the wall for this one have switched to other meds. 

Meanwhile, there is a growing amount of evidence that the sweetner corn based fructose may have alot to do with obesity and many of the cases of diabetes that occur. The mayo clinic gives these recommendations (http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=treatments-and-drugs) however, their opinions are based on not the why but the management.  

It is my opinion that there are larger issues at work to find out why people develop the disease and are there better ways to treat it other than medication on the horizon?  I also believe that what you eat determines your health in a big way.  There are alternative regimens that offer non drug alternatives to management (http://altmedicine.about.com/cs/conditionsatod/a/Diabetes.htm) which may have as much or more validity that the pharmaceutical model now accepted but is of questionable long term safety.  Maybe we need to rethink what we do, what we eat and make those changes a cultural phenomenon.  

I do not endorse the sites I posted here but do ask you read everything and form your own opinions.  

What should be my HDL cholesterol?

HDL cholesterol levels are a rough measure of HDL particle quantity in the blood. They actually tell us next to nothing about HDL particle type, although HDL cholesterol increases are usually associated with increases in LDL particle size. This a good thing, since small-dense LDL particles are associated with increased cardiovascular disease.

Most blood lipid panels reviewed by family doctors with patients give information about HDL status through measures of HDL cholesterol, provided in one of the standard units (e.g., mg/dl).

Study after study shows that HDL cholesterol levels, although imprecise, are a much better predictor of cardiovascular disease than LDL or total cholesterol levels. How high should be one’s HDL cholesterol? The answer to this question is somewhat dependent on each individual’s health profile, but most data suggest that a level greater than 60 mg/dl (1.55 mmol/l) is close to optimal for most people.

The figure below (from Eckardstein, 2008; full reference at the end of this post) plots incidence of coronary events in men (on the vertical axis), over a period of 10 years, against HDL cholesterol levels (on the horizontal axis). Note: IFG = impaired fasting glucose. This relationship is similar for women, particularly post-menopausal women. Pre-menopausal women usually have higher HDL cholesterol levels than men, and a low incidence of coronary events.


From the figure above, one can say that a diabetic man with about 55 mg/dl of HDL cholesterol will have approximately the same chance, on average, of having a coronary event (a heart attack) as a man with no risk factors and about 20 mg/dl of HDL cholesterol. That chance will be about 7 percent. With 20 mg/dl of HDL cholesterol, the chance of a diabetic man having a coronary event would approach 50 percent.

We can also conclude from the figure above that a man with no risk factors will have a 5 percent chance of having a coronary event if his HDL cholesterol is about 25 mg/dl; and about 2 percent if his HDL cholesterol is greater than 60 mg/dl. This a 60 percent reduction in risk, a risk that was low to start with because of the absence of risk factors.

HDL cholesterol levels greater than 60 are associated with significantly reduced risks of coronary events, particularly for those with diabetes (the graph does not take diabetes type into consideration). Much higher levels of HDL cholesterol (beyond 60) do not seem to be associated with much lower risk of coronary events.

Conversely, a very low HDL cholesterol level (below 25) is a major risk factor when other risk factors are also present, particularly: diabetes, hypertension (high blood pressure), and familial hypercholesteromia (gene-induced very elevated LDL cholesterol).

It is not yet clear whether HDL cholesterol is a cause of reduced cardiovascular disease, or just a marker of other health factors that lead to reduced risk for cardiovascular disease. Much of the empirical evidence suggests a causal relationship, and if this is the case then it may be a good idea to try to increase HDL levels. Even if HDL cholesterol is just a marker, the same strategy that increases it may also have a positive impact on the real causative factor of which HDL cholesterol is a marker.

What can one do to increase his or her HDL cholesterol? One way is to replace refined carbs and sugars with saturated fat and cholesterol in one’s diet. (I know that this sounds counterintuitive, but seems to work.) Another is to increase one’s vitamin D status, through sun exposure or supplementation.

Other therapeutic interventions can also be used to increase HDL; some more natural than others. The figure below (also from Eckardstein, 2008) shows the maximum effects of several therapeutic interventions to increase HDL cholesterol.


Among the therapeutic interventions shown in the figure above, taking nicotinic acid (niacin) in pharmacological doses, of 1 to 3 g per day (higher dosages may be toxic), is by far the most effective way of increasing one’s HDL cholesterol. Only the niacin that causes flush is effective in this respect. No-flush niacin preparations may have some anti-inflammatory effects, but do not cause increases in HDL cholesterol.

Rimonabant, which is second to niacin in its effect on HDL cholesterol, is an appetite suppressor that has been associated with serious side effects and, to be best of my knowledge, has been largely banned from use in pharmaceutical drugs.

Third in terms of effectiveness, among the factors shown in the figure, is moderate alcohol consumption. Running about 19 miles per week (2.7 miles per day) and taking fibrates are tied in forth place.

Many people think that they are having a major allergic reaction, and have a panic attack, when they experience the niacin flush. This usually happens several minutes after taking niacin, and depends on the dose and whether niacin was consumed with food or not. It is not uncommon for one’s entire torso to turn hot red, as though the person had had major sunburn. This reaction is harmless, and usually disappears after several minutes.

One could say that, with niacin: no “pain” (i.e., flush), no gain.

Reference:

von Eckardstein, A. (2008). HDL – a difficult friend. Drug Discovery Today: Disease Mechanisms, 5(3), 315-324.

Friday, February 19, 2010

Steroids for asthma and better alternatives through chiropractic

Today I had read in the NJ Star ledger about the problems with the current inhalers such as advair (see below)
"GlaxoSmithKline (GSK) shares are down about 1.5% after the U.S. Food and Drug Administration warned against long-term use of its asthma treatments, Advair and Serevent. Advair is the British pharmaceutical firm's best-selling product, but could now suffer a serious blow following regulators' call for further study of potential health risks. Advair had total sales of 1.366 billion euros ($1.859 billion) in the fourth quarter of 2009, of which more than half -- 704 million euros ($958 million) -- came out of the U.S.

The new label warning isn't limited to Glaxo's meds; Novartis's (NVS) Foradil and AstraZeneca's (AZN) Symbicort are affected as well. The four widely used asthma treatments belong to a class of drugs known as long-acting beta agonists (LABAs), which open airways. Other steroid-based meds control inflammation. The new label warns that LABAs "should never be used alone in the treatment of asthma in children or adults," and should be used only for the "shortest duration of time required to achieve control of asthma symptoms," then discontinued. These medicines can actually worsen asthma symptoms, the FDA said, "leading to hospitalization in both children and adults and death in some patients with asthma." 

One of the methods that has helped many asthma sufferers is chiropractic care.  The reason I believe it is helpful is that the chiropractic adjustment normalizes the bodys neurological response and also makes rib movement improve with the adjustment.  In order to properly breathe, the ribs must expand.  Rib misalignments and muscular tightness from many attacks can be relieved by chiropractic intervention.  The side effects are only some soreness after the adjustment which will typically dissapate quickly.  Seeing a chiropractor is much safer and does not cause more attacks of asthma as these drugs do.  Most medical providers should consider this as an alternative to the classic urge to recommend steroids for inhalation treatment.  The other benefit is that since the musculoskeletal system is part of a system , so as this improves functionally, so do other body functions and mechanisms as well.  For instance, it is not unusual for stomach problems to also improve from those same spinal treatments.

The more we hear about drugs and their side effects, the more I recommend people see a chiropractor and make this a larger part of their wellness strategy.

Woman's Best Friend....

This is a really hard blog to write and I suppose it's not entirely appropriate for the 3 Healthy Chicks Blog about living fresh and local but I think for any blog to actually reach people, it needs to be authentic. Personal experience lends itself to authenticity and it is also therapeutic for me..so with that in mind I am going to try to actually finish this entry... I've been working on it for almost 10 days now.

First of all, let me apologize for my lack of updates over the past 2 weeks. It has been a rough one.....on Monday, February 8th I had to put down my 11 1/2 year old Great Dane, Cheyenne. It was the most challenging, heartbreaking and inevitably selfless decision I have ever made. I am still in the midst of the grieving process and as much as I know it was the right decision I continue to fight the guilt over choosing to euthanize my best friend.

On February 6th, Stephen and I came home after dinner and Cheybees howled, jumped in circles and brought us her huge doggie bone with a silly smile on her face. We walked her and then settled in for bed. When I woke up the next morning, Chey wasn't in her dog bed, but was laying lethargically at the foot of our bed. I tried to get her up, but she wanted no part of it. I figured she was just being lazy, as she is definitely not a morning dog. I let her sleep for another hour and then got her up.

I struggled to get all 112 pounds of her moving and outside. She's a geriatric dog and sometimes has rough mornings with her arthritic hips, but could barely walk. I wanted to ignore what was happening. In my heart I knew something was very wrong. We brought her to Red Bank Veterinary Hospital. Ex-rays revealed she had bone cancer in her right hind leg. The vet explained, this form of cancer is one of the most aggressive and painful. I could choose to amputate the leg and follow up with chemotherapy or simply administer pain medication for her comfort and let nature take it's course.

Given Cheyenne was well past her life expectancy, I chose to take her home and make her as comfortable as possible. Stephen and I took her home and carried her into the bedroom. I gave her additional pain medication and she drifted to sleep. I spent the day in bed with her stroking her velvety soft ears thinking about the past 11 years of our lives together. I remembered bringing her home to New Orleans from Belle Chase, LA during hurricane Georges and how tiny she was at 10 weeks old.


She used to sleep on my head when she was that young. And might I offer a bit of advice to new puppy owners...allowing your new bundle of joy to sleep on your pillow on your head is not the best idea. On the third night of this sleeping arrangement, Chey woke up to make her way off the bed and onto the puppy pads but didn't quite make it and promptly peed on my face.

I loved her anyway.

This beautiful, gentle, loyal, loving and kind being brought so many riches to my life, one blog post can't even begin to do our friendship and connection justice. She taught me how to be a parent. She taught me patience. And I can honestly say, she taught me how to love with no holds barred. I will cherish every single memory of the time we spent together. Hiking Adirondack peaks, chasing seaweed monsters in Ocean Beach, San Francisco, body surfing in Cape Cod and eating roasted cauliflower with vegan cheese. Who knew a Great Dane could do such things!??

After spending 9 hours in bed on Sunday without moving more than her head to reach up to give me one of her nose kisses, I knew as much as I loved her, I had to let her go. I called my father and asked him to drive down to Jersey from the Adirondacks. By Monday morning she still hadn't moved from the cozy spot on my bed and I could tell that her pain was increasing and the medication was no longer helping. She looked beautiful, loving...and so very tired cuddling her favorite moo cow toy.

At noon, I called the hospital and told them it needed to be done soon. At 2pm my father arrived. At 3pm Stephen and my dear friend Tatum came home early from work. The four of us spent the remaining 3 hours on the bed with her loving her up and treating her to a Reeses Peanutbutter Cup. Chey kept picking her head up to look at Stephen. I think she was making sure he was there, to take care of me when she was gone. At 6:30pm my housemate and veterinarian Danee came home. I laid behind Cheyenne in our favorite spooning position stroking her head telling her how much I loved her. She was surrounded by the most important people in her life. At 6:45pm she looked up once more to Stephen, sighed and was gone. I have never felt such emptiness and pain.

I suppose that with each day that passes it gets easier, but the hurt is still so fresh. When I work from home, the spot on the couch next to me is empty. There are no paw prints in the snow in the back yard. There's no booty swirls or nose kisses. And I don't know how long it will be before I am able to make roasted cauliflower with vegan parmesan, regardless of nutritional content.

I just miss my best friend.

~ Terra

Friday Friend Shout Out - NEW Yoga Basin in Asbury Park!

This week's Friday Friend Shout Out is to the NEW beautiful yoga studio and juice bar in Asbury Park, NJ, Yoga Basin!

Yoga Basin is both a yoga studio and all-natural juice/smoothie bar. The yoga studio will offer everything from gentle flow classes to hot yoga classes with many different in between. They will feature workshops and celebrations regularly including nutrition seminars, drum circles, kirtans and full moon celebrations. Their all natural juice/smoothie bar will provide delicious vegan goodies and healthy drinks. They've got a lovely indoor/outdoor cafe style set up too!

I've been fortunate enough to have been asked to join their staff as a holistic health counselor and couldn't be more excited. Please stay tuned for my monthly nutrition seminars that I will be holding with another holistic health counselor and yoga teacher at the studio, Erin Denardo. Our first one will be on March 6th (time TBA) on Healthy Shopping. I'll keep you posted!

The founders of Yoga Basin, Reggie and Rick Wegel, have had a clear vision on what they wanted their yoga studio to be and will finally be sharing this vision at their GRAND OPENING tomorrow February 20th at 6:30pm! They've formed an eclectic staff who share their same vision and hopes for all who visit the studio. I wish them the best of luck with their new studio in Asbury and encourage you to stop in for a class, juice or workshop very soon! Yoga Basin is located at 603 Mattison Avenue in Asbury Park, NJ 07712. Make sure to check out their website, it's gorgeous, just like the studio!!! Please become a friend on Facebook too!

Keep it fresh!
- Lauren

Wednesday, February 17, 2010

Fight heart disease with heart healthy foods

By Valerie Manbeck
Clinical Dietitian, Rouge Valley Health System


Did you know that by changing the foods you eat, you can reduce your chances of heart disease?

By introducing more heart-healthy foods into your diet, you can fight your chances of having a heart attack.

Changing the foods you eat certainly isn’t easy. However, knowing which foods to add and which to eliminate can help kick-start your way towards a heart-healthy diet.

Here are some of the top five easy tips to help you on your way to a more heart-healthy diet:

1. Limit unhealthy fats.

Limiting saturated and trans fats is linked to a decrease in blood cholesterol levels, which lowers your risk of developing heart disease. A high blood-cholesterol level can lead to plaque build-up in your arteries, increasing your risk of a heart attack.

To reduce saturated fats, try cutting down on ‘fatty’ meats like sausages or bacon, and replacing them with leaner meats. Lean meats, like poultry and fish, and low-fat dairy products such as skim or one per cent milk, are good options.

To reduce trans fats, limit foods made with shortening or partially hydrogenated vegetable oil. Instead, choose healthier fats like olive and canola oils. Nuts and seeds also contain healthier fats. But remember that all types of fat are high in calories, eating these foods in moderation is key here.

2. Choose foods with omega-3 fatty acids.

The impact that omega-3 fatty acids have on lowering your chances of heart disease are enormous. These foods can help decrease your overall risk of heart disease.

Eating ‘fatty’ fish such as, salmon, tuna, sardines, mackerel, trout, and herring at least twice a week is a great way to incorporate omega-3 fatty acids into your diet. Good sources include salmon, sardines, and herring.

3. Eat more fruits and vegetables.

A diet rich in fruits and vegetables does wonders for your waistline and helps to thwart heart disease. These two food groups are also low in calories, and full of fiber and anti-oxidants, which are keys to preventing and slowing damage to blood vessels.

Look for colourful fruits and vegetables. For example, mangos, carrots, spinach, broccoli and sweet potatoes are all good choices. Whenever possible, opt for fresh or even frozen fruits instead of fruit juices. Aim for two to three fruit servings a day, and at least four servings of vegetables each day. Try two at lunch and two at dinner, to get your vegetable servings in.

Adding fruits and vegetables to your diet isn’t as hard as you might think. Try keeping veggies like broccoli, carrots or cauliflower washed and cut up in your refrigerator. Choose recipes that feature fruits or vegetables as the main ingredient, such as fruit salads or stir-fry. And try not to cover vegetables with butter, dressings or creamy sauces, as many of these are high in fat.

4. Reduce salt.

Consuming a lot of salt can contribute to high blood pressure, a risk factor for heart disease. So, reducing your salt intake is a key part of a heart healthy diet.

The Heart & Stroke Foundation recommends that you eat less than 2,300 milligrams of sodium (one tablespoon or five mililetres of salt) a day. For those who have been diagnosed with high blood pressure (hypertension), sodium intake should be limited to 1,500 milligrams (two-thirds of a teaspoon) a day.

And while not reaching for the salt shaker is a good start, cutting back on processed foods is even more important. Much of the salt many of us eat comes from canned or processed foods, like canned soups and frozen dinners. Eating fresh foods and making your own soups and stews can help reduce your salt intake. And if you do prefer the convenience of canned foods and frozen meals, look for those with reduced sodium. Also, try other herbs and spices instead of table salt to flavour your food.

5. Go for soluble fibers.

Increasing your intake of soluble fiber is a great way to lower your blood cholesterol. Good sources of this fiber include oats, psyllium-enriched breakfast cereals (e.g. Kellogg’s All Bran Buds), ground flax seeds and citrus fruit. Adding ground flax seeds to your yogurt, apple sauce or hot cereal can be an easy way to add soluble fiber to your diet. Simply grind the seeds in a blender and stir in with a teaspoon.

Tuesday, February 16, 2010

Dissolve Away those Pesky Bones with Corn Oil

I just read an interesting paper from Gabriel Fernandes's group at the University of Texas. It's titled "High fat diet-induced animal model of age-associated obesity and osteoporosis". I was expecting this to be the usual "we fed mice industrial lard for 60% of calories and they got sick" paper, but I was pleasantly surprised. From the introduction:
CO [corn oil] is known to promote bone loss, obesity, impaired glucose tolerance, insulin resistance and thus represents a useful model for studying the early stages in the development of obesity, hyperglycemia, Type 2 diabetes [23] and osteoporosis. We have used omega-6 fatty acids enriched diet as a fat source which is commonly observed in today's Western diets basically responsible for the pathogenesis of many diseases [24].
Just 10% of the diet as corn oil (roughly 20% of calories), with no added omega-3, on top of an otherwise poor laboratory diet, caused:
  • Obesity
  • Osteoporosis
  • The replacement of bone marrow with fat cells
  • Diabetes
  • Insulin resistance
  • Generalized inflammation
  • Elevated liver weight (possibly indicating fatty liver)
Hmm, some of these sound familiar... We can add them to the findings that omega-6 also promotes various types of cancer in rodents (1).

20% fat is less than the amount it typically takes to make a rodent this sick. This leads me to conclude that corn oil is particularly good at causing mouse versions of some of the most common facets of the "diseases of civilization". It's exceptionally high in omega-6 (linoleic acid) with virtually no omega-3.

Make sure to eat your heart-healthy corn oil! It's made in the USA, dirt cheap and it even lowers cholesterol!

Health Care Reform, what is wrong with this picture

Health care reform was attempted by President Clinton and we know how that went.  Along comes a new president who believes he has the conviction and the management style to get it done finally.  I applaud him for this however there are problems that the current reforms fail to address.

1. Our current system is a monopoly with a drug biased ideology. It is based heavily on Allopathy which is very symptom based. In many areas of the world, there are many types of health care providers who feed the system, both drug and non drug based.  In our country, the providers who feed the system (hospitals, specialists, etc are educated and inundated with the philosophy of drug based care supported by pharmaceutical interests. Since there is no true competition (there are provider groups like chiropractors and other complementary providers being used by the public in increasing numbers) to this system, it has become overpriced in many respects and bloated.  Many of the preventative regimens are not preventative at all but are invasive and many of these ideas are pushed as part of preventative care.  Unfortunately, many of these have not been proven to improve our quality of life long term, while it is of high cost and the social costs as well as the cost of treating the side effects of these interventions has been quite high.  Many procedures done to resolve symptoms and many tests done to diagnose them are a result of our lack of understanding of the integrated systems that make up the body.  In other words, the body dysfunctions in systems, and we are the sum of our functioning parts which is part of the whole.  This differs from what health care has turned into which is overspecialization where doctors look at your parts rather than the hole.  In parts of the country with fewer specialists and more primary care, the overall costs are lower and people do better under the healthcare system. Unfortunately, insurance companies have over reimbursed the specailsts and starved the primary care model causing patients to have visits that are more brief even if more time would yield better thought processes, less testing and better doctoring.

2. We need tort reform and we need better medical practices. Malpractice rates for chiropractic have always been very low based on safety and risk, however, many medical providers pay very high rates for their insurance because of lawsuits.  Some of these are justified however, without limits and large pain and suffering rewards, it has pushed the rate of insurance upwards.  Many doctors practice defensive medicine because they can be sued if they avoided a test or for another technicality.  In many instances, it is justified, and in others, it is a product of the fact that physicians are penalized financially if they spend too much time with a patient and rewarded if they order or perform procedures.  This is not only risky, but also has contributed to more doctors being sued and as we learned from the first section of the blog, it has been shown that less is more with regards to patient care.  More specialists costs more but does not make them healthier which leads to further tests, etc.  Some things like childbirth are risky and as long as the doctor did not violate community standards during a childbirth, they should not have to fear reprisals if they did everything right and the delivery did not.  Most OB's have very expensive malpractice which has deterred many from delivering babies which sends the wrong message.  In closing, we need better medical practices that are rewarded for results, not doing more and doctors should be reimbursed for their time, rather than for performing procedures that add further risk.

3. Medical Ethics.  When is technology appropriate and when is it not and at what age do certain interventions have little benefit?  This is a tough question because there are many babies that would not make it without an incubator and even with it may have horrible chronic problems during the rest of their lives.  Other children with genetic malformations or disease processes who would otherwise not survive and kept alive but their quality of life is horrible until the inevitable end.  These excesses are horribly expensive and have little benefit.  Are we really helping by keeping a dying child alive further torturing the child, the family and financially draining them.  This is an ethics question to be sure.

On the other end of the spectrum, when is enough care enough.  At what age do cholesterol lowering drugs serve no benefit.  Recently, a study suggested that men over 85 should no longer have PSA tests because many of them are positive, and the therapy or surgery caused more problems than they had before at great cost.  At what point do we leave them alone?  This is another ethics question.

4. Results orientated reimbursement - Now we have a more is better ethos and about 1/2 of our health care resources for a person gets used up in the last year of life with no change in the outcome.  Doctors with better outcomes of all types should be rewarded.  Cost effectiveness should be rewarded.

5. Paradigm Shift - We need to move from a disease and sickness model to a wellness model.  We need to question the benefits of many tests that justify a drug but do not improve a patients quality of life or have a measurable improvement on ones lifespan.  With all the information on cholesterol lowering drugs, the long term estimate is that these meds may improve life spans a year or two while having many side effects.  Is this type of intervention worth it?

We need to get back to basics, where primary care handles many conditions cost effectively and allow other providers such as chiropractors, natropaths, napropaths, acupuncturists, nurse practitioners and others be point of first contact providers.  In my own profession, we are terrific as first contact for musculoskeletal problems, weather in workers compensation or in general care of the population.  Most medical providers are less comfortable with this but are more comfortable with diseases and hospital coordination.  Provider Groups must work more hand in hand for better patient experiences.

6. Central data bases for health care records with less duplication and better care coordination.  Having all patients medical records will allow for better coordination of care between providers of health care both local and across the country.  Currently, many tests are duplicated because a provider cannot go into a national data base and pick out what they need.  We are closing in on this slowly.

7. Sanity on in and out of network fees. Medicare actually started the upward spiral of medical costs by issuing a blank check in the 1970's when it was young.  doctors sent in bills and Medicare paid it.  Many medical/surgical fees are outrageous and are supported by the fact we have insurance. Coding for health care has become a game, manipulated by providers and by insurers which has helped health care costs march onward.  Insurance carriers have made changes such as primary care doctors no longer being reimbursed for vsiting their patients in the hospital.  Many have hired hospitalists who visit you for a minute, charge you handsomely and report to the doctor.  Many doctor would prefer to visit their own patients but not if they do not get paid.

8. Insurance companies have blown managed care and instead of cost savings, they have squeezed consumers into more restrictive plans for their benefit, not the benefit of the patient.  This yearly bait and switch has allowed insurance carriers to be very profitable and pay themselves and their investors instead of paying for care.  They have become owners of parts of the market and the patients and physicians are merely pawns.  We need a public option run by a non insurance entity who can help explore an evidence based paradigm for better care in the future.  We also should have this paid for by a VAT (value added tax) so it is properly funded rather than our current recommendations which make us partners with the people who created the problem in the first place.  It also makes it so if you lose your job, you still have insurance.  Doctors should be paid fairly for their services, and their patients should be charged fairly for what is done in their best interest.  This is different from the free for all money care we have now.  It is also simpler to have one insurance with one set of rules rather than a medicaid (paid for partially by the states with low reimbursement), medicare (for seniors over 65 mostly, and has better reimbursement for most primary care and point of contact physicians ) and the regular insurance which is all over the place but generally pays poorly in network and way too handsomely out of network.  How about one carrier, properly funded that works toward a model of preventative care that helps the puiblic.

These are some of my questions and thoughts. I know the problem is more complex but our paradigm is broken and is making people broke.  If it does not get fixed (the current proposals do little to fix the paradigm but does address some of the problems of coverage and affordability), the costs will continue to balloon and we will all find ourselves paying cash for care.  This will force the current model into a tailspin and many doctors will likely leave the profession if they cannot earn a living. If the current model does collapse, it could mean true reform of the painful kind.  Hopefully, our government can come together after tuning out some of the noise and put together a better system for all of us.  Health care dollars should go toward healthcare, not corporations and americans should not be drug addicts without realizing they are.  Perhaps, we will find a better way.

Large LDL and small HDL particles: The best combination

High-density lipoprotein (HDL) is one of the five main types of lipoproteins found in circulation, together with very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL), and chylomicrons.

After a fatty meal, the blood is filled with chylomicrons, which carry triglycerides (TGAs). The TGAs are transferred to cells from chylomicrons via the activity of enzymes, in the form of free fatty acids (FFAs), which are used by those cells as sources of energy.

After delivering FFAs to the cells, the chylomicrons progressively lose their TGA content and “shrink”, eventually being absorbed and recycled by the liver. The liver exports part of the TGAs that it gets from chylomicrons back to cells for use as energy as well, now in the form of VLDL. As VLDL particles deliver TGAs to the cells they shrink in size, similarly to chylomicrons. As they shrink, VLDL particles first become IDL and then LDL particles.

The figure below (click on it to enlarge), from Elliott & Elliott (2009; reference at the end of this post), shows, on the same scale: (a) VLDL particles, (b) chylomicrons, (c) LDL particles, and (d) HDL particles. The dark bar at the bottom of each shot is 1000 A in length, or 100 nm (A = angstrom; nm = nanometer; 1 nm = 10 A).


As you can see from the figure, most of the LDL particles shown are about 1/4 of the length of the dark bar in diameter, often slightly more, or about 25-27 nm in size. They come in different sizes, with sizes in this range  being the most common. The smaller and denser they are, the more likely they are to contribute to the formation of atherosclerotic plaque in the presence of other factors, such as chronic inflammation. The larger they become, which usually happens in diets high in saturated fat, the less likely they are to form plaque.

Note that the HDL particles are rather small compared to the LDL particles. Shouldn’t they cause plaque then? Not really. Apparently they have to be small, compared to LDL particles, to do their job effectively.

HDL is a completely different animal from VLDL, IDL and LDL. HDL particles are produced by the liver as dense disk-like particles, known as nascent HDL particles. These nascent HDL particles progressively pick up cholesterol from cells, as well as performing a number of other functions, and “fatten up” with cholesterol in the process.

This process also involves HDL particles picking up cholesterol from plaque in the artery walls, which is one of the reasons why HDL cholesterol is informally called “good” cholesterol. In fact, neither HDL nor LDL are really cholesterol; HDL and LDL are particles that carry cholesterol, protein and fat.

As far as particle size is concerned, LDL and HDL are opposites. Large LDL particles are the least likely to cause plaque formation, because LDL particles have to be approximately 25 nm in diameter or smaller to penetrate the artery walls. With HDL the opposite seems to be true, as HDL particles need to be small (compared with LDL particles) to easily penetrate the artery walls in order to pick up cholesterol, leave the artery walls with their cargo, and have it returned back to the liver.

Interestingly, some research suggests HDL particles that are larger in size, when compared with other HDL particles (not with LDL particles), seem to do a better job than very small HDL particles in terms of reducing risk of cardiovascular disease. It is also possible that a high number of larger HDL particles in the blood is indicative of elevated levels of "effective" HDL particles; i.e., particles that are effective at picking up cholesterol from the artery walls in the first place.

Another interesting aspect of this cycle is that the return to the liver of cholesterol picked up by HDL appears to be done largely via IDL and LDL particles (Elliott & Elliott, 2009), which get the cholesterol directly from HDL particles! Life is not that simple.

Reference:

William H. Elliott & Daphne C. Elliott (2009). Biochemistry and Molecular Biology. 4th Edition. New York: NY: Oxford University Press.

Saturday, February 13, 2010

Want to improve your cholesterol profile? Replace refined carbs and sugars with saturated fat and cholesterol in your diet

An interesting study by Clifton and colleagues (1998; full reference and link at the end of this post) looked at whether LDL cholesterol particle size distribution at baseline (i.e., beginning of the study) for various people was a determinant of lipid profile changes in each of two diets – one low and the other high in fat. This study highlights a few interesting points made in a previous post, which are largely unrelated to the main goal or findings of the study, but that are supported by side findings:

- As one increases dietary cholesterol and fat consumption, particularly saturated fat, circulating HDL cholesterol increases significantly. This happens whether one is taking niacin or not, although niacin seems to help, possibly as an independent (not moderating) factor. Increasing serum vitamin D levels, which can be done through sunlight exposure and supplementation, are also known to increase circulating HDL cholesterol.

- As one increases dietary cholesterol and fat consumption, particularly saturated fat, triglycerides in the fasting state (i.e., measured after a 8-hour fast) decrease significantly, particularly on a low carbohydrate diet. Triglycerides in the fasting state are negatively correlated with HDL cholesterol; they go down as HDL cholesterol goes up. This happens whether one is taking niacin or supplementing omega 3 fats or not, although these seem to help, possibly as independent factors.

- If one increases dietary fat intake, without also decreasing carbohydrate intake (particularly in the form of refined grains and sugars), LDL cholesterol will increase. Even so, LDL particle sizes will shift to more benign forms, which are the larger forms. Not all LDL particles change to benign forms, and there seem to be some genetic factors that influence this. LDL particles larger than 26 nm in diameter simply cannot pass through the gaps in the endothelium, which is a thin layer of cells lining the interior surface of arteries, and thus do not induce plaque formation.

The study by Clifton and colleagues (1998) involved 54 men and 51 women with a wide range of lipid profiles. They first underwent a 2-week low fat period, after which they were given two liquid supplements in addition to their low fat diet, for a period of 3 weeks. One of the liquid supplements contained 31 to 40 g of fat, and 650 to 845 mg of cholesterol. The other was fat and cholesterol free.

Studies that adopt a particular diet at baseline have the advantage of departing from a uniform diet across conditions. They also typically have one common characteristic: the baseline diet reflects the beliefs of the authors about what an ideal diet is. That is not always the case, of course. If this was indeed the case here, we have a particularly interesting study, because in that case the side findings discussed below contradicted the authors’ beliefs.

The table below shows the following measures for the participants in the study: age, body mass index (BMI), waist-to-hip ratio (WHR), total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol, and three subtypes of high-density lipoprotein (HDL) cholesterol. LDL cholesterol is the colloquially known as the “bad” type, and “HDL” as the good one (which is an oversimplification). In short, the participants were overweight, middle-aged men and women, with relatively poor lipid profiles.


At the bottom of the table is the note “P < 0.001”, following a small “a”. This essentially means that on the rows indicated by an “a”, like the “WHR” row, the difference in the averages (e.g., 0.81 for women, and 0.93 for men, in the WHR row) was significantly different from what one would expect it to be due to chance alone. More precisely, the likelihood that the difference was due to chance was lower than 0.001, or 0.1 percent, in the case of a P < 0.001. Usually a difference between averages (a.k.a. means) associated with a P < 0.05 will be considered statistically significant.

Since the LDL cholesterol concentrations (as well as other lipoprotein concentrations) are listed on the table in mmol/L, and many people receive those measures in mg/dL in blood lipid profile test reports, below is a conversion table for LDL cholesterol (from: Wikipedia).


The table below shows the dietary intake in the low and high fat diets. Note that in the high fat diet, not only is the fat intake higher, but so is the cholesterol intake. The latter is significantly higher, more than 4 times the intake in the low fat diet, and about 2.5 times the recommended daily value by the U.S. Food and Drug Administration. The total calorie intake is reported as slightly lower in the high fat diet than in the low fat diet.


Note that the largest increase was in saturated fat, followed by an almost equally large increase in monounsaturated fat. This, together with the increase in cholesterol, mimics a move to a diet where fatty meat and organs are consumed in higher quantities, with a corresponding reduction in the intake of refined carbohydrates (e.g., bread, pasta, sugar, potatoes) and lean meats.

Finally, the table below shows the changes in lipid profiles in the low and high fat diets. Note that all subtypes of HDL (or "good") cholesterol concentrations were significantly higher in the high fat diet, which is very telling, because HDL cholesterol concentrations are much better predictors of cardiovascular disease than LDL or total cholesterol concentrations. The higher the HDL cholesterol, the lower the risk of cardiovascular disease.


In the table above, we also see that triglycerides are significantly lower in the high fat diet, which is also good, because high fasting triglyceride concentrations are associated with cardiovascular disease and also insulin resistance (which is associated with diabetes).

However, the total and LDL cholesterol were also significantly higher in the high fat compared to the low fat diet. Is this as bad as it sounds? Not when we look at other factors that are not clear from the tables in the article.

One of those factors is the likely change in LDL particle size. LDL particle sizes almost always increase with significant increases in HDL; frequently going up in diameter beyond 26 nm, and thus passing the threshold beyond which an LDL particle can penetrate the endothelium and help form a plaque.

Another important factor to take into consideration is the somewhat strange decision by the authors to use the Friedewald equation to estimate the LDL concentrations in the low and high fat diets. Through the Friedewald equation, LDL is calculated as follows (where TC is total cholesterol):

    LDL = TC – HDL – Triglycerides / 5

Here is one of the problems with the Friedewald equation. Let us assume that an individual has the following lipid profile numbers: TC = 200, HDL = 50, and trigs. = 150. The calculated LDL will be 120. Let us assume that this same individual reduces trigs. to 50, from the previous 150, keeping all of the other measures constant. This is a major improvement. Yet, the calculated LDL will now be 140, and a doctor will tell this person to consider taking statins!

By the way, most people who do a blood test and get their lipid profile report also get their LDL calculated through the Friedewald equation. Usually this is indicated through a "CALC" note next to the description of the test or the calculated LDL number.

Finally, total cholesterol is not a very useful measure, because an elevated total cholesterol may be primarily reflecting an elevated HDL, which is healthy. Also, a slightly elevated total cholesterol seems to be protective, as it is associated with reduced overall mortality and also reduced mortality from cardiovascular disease, according to U-curve regression studies comparing mortality and total cholesterol levels in different countries.

We do not know for sure that the participants in this study were consuming a lot of refined carbohydrates and/or sugars at baseline. But it is a safe bet that they were, since they were consuming 214 g of carbohydrates per day. It is difficult, although not impossible, to eat that many carbohydrates per day by eating only vegetables and fruits, which are mostly water. Consumption of starches makes it easier to reach that level.

This is why when one goes on a paleo diet, he or she reduces significantly the amount of dietary carbohydrates; even more so on a targeted low carbohydrate diet, such as the Atkins diet. Richard K. Bernstein, who is a type 1 diabetic and has been adopting a strict low carbohydrate diet during most of his adult life, had the following lipid profile at 72 years of age: HDL = 118, LDL = 53, trigs. = 45. His fasting blood sugar was reportedly 83 mg/dl. Click here to listen to an interview with Dr. Bernstein on the The Livin' La Vida Low-Carb Show.

The lipid profile improvement observed (e.g., a 14 percent increase in HDL from baseline for men, and about half that for women, in only 3 weeks) was very likely due to an increase in dietary saturated fat and cholesterol combined with a decrease in refined carbohydrates and sugars. The improvement would probably have been even more impressive with a higher increase in saturated fat, as long as it was accompanied by the elimination of refined carbohydrates and sugars from the participants’ diets.

Reference:

Clifton, P. M., M. Noakes, and P. J. Nestel (1998). LDL particle size and LDL and HDL cholesterol changes with dietary fat and cholesterol in healthy subjects. J. Lipid. Res. 39: 1799–1804.

Thursday, February 11, 2010

The Yoga of Avatar

I was finally able to see Avatar in 3D last week. After all the hype, I was interested to see if it would live up to what everyone’s been saying, and boy did it ever! I LOVED it, especially its implication. There was such a yogic presence to the storyline. It’s comforting to see a movie do this well with such a beautiful message!

Here’s a breakdown of the yogic elements of Avatar:

Interconnectedness of all beings – the Na’vi link to other beings on the planet through neural-chemical connections. One of the characters, Grace, the biologist played by Sigourney Weaver, calls it a network. And indeed, the whole planet is an organic neural network. The Na’vi practice and believe in an interconnection of all life in balance with nature. Because of this, everything is viewed as sacred.

Unity – when they get attacked, Jake and the Na’vi realize pretty quickly that they’re going to need allies. They rally up the other clans, and together they fight the humans. Even their former predators, the wild animals of the jungle, unite in the battle against the humans and their corporate agenda.

Goddess worshipping – the Na’vi worship Eywa, and believe that all consciousness is infused with her energy. In yoga, this goddess consciousness is known as Shakti, while yoga isn’t exactly a goddess worshiping tradition, there are strong threads of the divine feminine throughout and sects which are devoted to her worship.

Hindu origins - the word “avatar” itself is Sanskrit and is rooted in Hindu mythology (as is yoga). Presently, the word avatar evokes the graphical representation of a computer user, but it’s original meaning is “descent” and it can be “an incarnation or human appearance of a deity, particularly Vishnu.” These incarnations, including one of the most famous, Krishna, have blue skin, and the blue Na’vi beings are themselves meant to evoke Hindu deities.

Rajan Zed, the Hindu statesman who has appointed himself watchdog of American pop culture, has not overlooked these elements. He expressed his initial concerns about the film last spring, and urged James Cameron to “be careful when handling Hindu concepts and terminology.” But he’s been awfully quiet since the film has been on the screens, so perhaps Cameron did a better job than expected.

Despite the strong yogic components of the film, it has managed to become the most popular movie in years and it has captured the collective imagination. It’s fascinating, really, things like the divine feminine and interconnectedness (while not particularly new or radical) aren’t exactly mainstream thinking, but rather yogic! All I can wonder is if the spiritual ideas in the film might just sink in to the viewers, and affect some kind of change in consciousness, somewhere down the line. Let's all hope.

Keep it fresh!
- Lauren

Wednesday, February 10, 2010

Cinnamon Snail Hits the Road!


We have some great news to share for folks in North Jersey! Our friend, Adam Sobel of Certified Orgasmic is hitting the streets of Hoboken, NJ with his vegan food truck, The Cinnamon Snail! Move over Portland, LA, San Francisco and Boulder, Jersey is stepping up to the plate!

This is the nation's very first vegan food truck. Service will kick off on Valentines Day, February 14th, 2010 with the first 100 customers receiving free vegan donuts! (Let me just say, my favorite thing about the Farmers Market in Red Bank is Adam's vegan cinnamon donuts!!)

The Cinnamon Snail websites will be up and running shortly, be sure to bookmark it for future reference. Give Adam a shout out, let him know that 3 Healthy Chicks sent you and remind him that Monmouth County loves him!

Way to go Adam!

Keep it Fresh!
~ Terra

Tuesday, February 9, 2010

Saturated Fat and Insulin Sensitivity

Insulin sensitivity is a measure of the tissue response to insulin. Typically, it refers to insulin's ability to cause tissues to absorb glucose from the blood. A loss of insulin sensitivity, also called insulin resistance, is a core part of the metabolic disorder that affects many people in industrial nations.

I don't know how many times I've seen the claim in journal articles and on the internet that saturated fat reduces insulin sensitivity. The idea is that saturated fat reduces the body's ability to handle glucose effectively, placing people on the road to diabetes, obesity and heart disease. Given the "selective citation disorder" that is common in the diet-health literature, perhaps this particular claim deserves a closer look.

The Evidence

I found a review article from 2008 that addressed this question (1). I like this review because it only includes high-quality trials that used reliable methods of determining insulin sensitivity*.

On to the meat of it. There were 5 studies in which non-diabetic people were fed diets rich in saturated fat, and compared with a group eating a diet rich in monounsaturated (like olive oil) or polyunsaturated (like corn oil) fat. They ranged in duration from one week to 3 months. Four of the five studies found that fat quality did not affect insulin sensitivity, including one of the 3-month studies.

The fifth study, which is the one that's nearly always cited in the diet-health literature, requires some discussion. This was the KANWU study (2). Over the course of three months, investigators fed 163 volunteers a diet rich in either saturated fat or monounsaturated fat.
The SAFA diet included butter and a table margarine containing a relatively high proportion of SAFAs. The MUFA diet included a spread and a margarine containing high proportions of oleic acid derived from high-oleic sunflower oil and negligible amounts of trans fatty acids and n-3 fatty acids and olive oil.
Yummy. After three months of these diets, there was no significant difference in insulin sensitivity between the saturated fat group and the monounsaturated fat group. Yes, you read that right. Even the study that's commonly cited as evidence that saturated fat causes insulin resistance found no significant difference between the diets. You might not get this by reading the abstract. I'll be generous and acknowledge that the small difference was almost statistically significant (p = 0.053).

What the authors focused on is the fact that insulin sensitivity declined slightly but significantly on the saturated fat diet compared with the pre-diet baseline. That's why this study is cited as evidence that saturated fat impairs insulin sensitivity. But those of you with a science background will be able to spot the problem here (warning: nerd attack. skip the rest of the paragraph if you're not interested in details). You need a control group for comparison, to take into account normal fluctuations caused by such things as the season, eating a new diet provided by the investigators, and having a doctor poking at you. That control group was the group eating monounsaturated fat. The comparison between diet groups was the 'primary outcome', in statistics lingo. That's the comparison that matters most, and it wasn't significant.  What the authors relied on for their conclusion was a 'secondary outcome', which is good for forming hypotheses but does not exceed the primary outcome in importance.

So we have five studies through 2008, which overall offer little or no support the idea that saturated fat reduces insulin sensitivity in non-diabetics. Since the review paper was published, I know of one subsequent study that asked the same question (3). Susan J. van Dijk and colleagues fed volunteers with abdominal overweight a diet rich in either saturated fat or monounsaturated fat. I e-mailed the senior author and she said the saturated fat diet was "mostly butter".  After 8 weeks, insulin sensitivity was virtually identical between the two groups. This study appeared well controlled and used the gold standard method for assessing insulin sensitivity, called the euglycemic-hyperinsulinemic clamp technique***.

The evidence from controlled trials is rather consistent that saturated fat has no major effect on insulin sensitivity in humans, at least on time scales of a few months.

UPDATE: other trials have added to this finding.  The large European LIPIGENE randomized controlled diet trial found that substantial differences in SFA intake had no effect on insulin sensitivity over 12 weeks in people with the metabolic syndrome (3b).

Why Are We so Focused on Saturated Fat?

Answer: because it's the nutrient everyone loves to hate. As an exercise in completeness, I'm going to mention three dietary factors that actually reduce insulin sensitivity, and get a lot less air time than saturated fat.

#1: Caffeine. That's right, controlled trials show that your favorite murky beverage reduces insulin sensitivity (4, 5). Is it actually relevant to real life? I doubt it. The doses used were large and the studies short-term.

#2: Magnesium deficiency. A low-magnesium diet reduced insulin sensitivity by 25% over the course of three weeks (6). I think this is probably relevant to long-term insulin sensitivity and overall health, although it would be good to have longer-term data. Sub-optimal magnesium intake is common in industrial nations, due to our over-reliance on refined foods such as sugar, white flour and oils.

#3: Overeating.  Eating too many calories, and accumulating body fat, are probably the primary reason for garden-variety insulin resistance.


* For the nerds: euglycemic-hyperinsulinemic clamp (the gold standard), insulin suppression test, or intravenous glucose tolerance test with Minimal Model. They didn't include studies that reported HOMA as their only measure, because it's not very accurate.

*** They did find that markers of inflammation in fat tissue were higher after the saturated fat diet.