Relationships

Relationships. Something us health counselors like to call "primary food". An aspect of our lives that nourishes us, even more so than ingesting plants and animals. We have romantic, platonic, sexual and professional relationships. Close, intimate and casual relationships, and of course and maybe most importantly, even relationships with ourselves. They are the things that feed our soul. When we are loved and cared for we feel happy and safe. But naturally, relationships can also make us feel vulnerable and insecure, making it difficult to decipher between the healthy ones and the ones that throw us off balance.

How do we decipher between them? How do we decide where the line is drawn? How do we know when a relationship is right or when to accept that it is not working? Is loving somebody enough to make it work?

I have struggled with this for some time. And, admittedly, I still don't know the answer. I am struggling now with these very questions. What if two people love each other but have irreconcilable differences? Do they make it work despite those differences, or do they sever ties and move on? On one hand, the love I feel for this person and feel in return is feeding my desires and nourishing me on so many levels. But on the other hand, knowing that their love for me comes with a price that I am not ready to deal with, tears me apart. Which hand wins out in the end? If I maintain this relationship, will the struggles make it unhealthy and therefore me unhealthy? Or will losing someone I care so deeply about be harder on the soul?

For me, I think the difficulty lies with understanding why I can not accept the love that is being given to me as it is. My own insecurities force me to believe that it is not enough. My fears and doubts force me to think that if its not the way I want it, then it can't be real. Am I creating boundaries for myself that are just fencing me in, and making it difficult for others to enter?

How do I reconcile these thoughts and this relationship so that I can be a happy, healthy person from the inside out? I still don't know, but I do know that it has to start with me. I know that I can not let someone else love me, no matter how little or how much, no matter what the price, if I don't love myself. Doubt can be a powerful thing, and when we doubt another person, we are most likely doubting ourselves. The only way we can nourish relationships with others, is if we nourish the one we have with ourselves first.

Impressions of Hawai'i

I recently went to Hawai'i for the American Society of Human Genetics meeting in Waikiki, followed by a one-week vacation on Kaua'i with friends. It was my first time in Hawai'i and I really enjoyed it. The Hawai'ians I encountered were kind and generous people.

Early European explorers remarked on the beauty, strength, good nature and exellent physical development of the native Hawai'ians. The traditional Hawai'ian diet consisted mostly of taro root, sweet potatoes, yams, breadfruit, coconut, fish, occasional pork, fowl including chicken, taro leaves, seaweed and a few sweet fruits. It would have been very low (but adequate) in omega-6, because there simply isn't much of it available in this environment. Root crops and most fruit are virtually devoid of fat; seafood and coconut contain very little omega-6; and even the pork and chicken would have been low in omega-6 due to their diets. Omega-3 would have been plentiful from marine foods, and saturated fats would have come from coconut. All foods were fresh and unrefined. Abundant exercise and sunlight would have completed their salubrious lifestyle.

The traditional Hawai'ian diet was rich in easily digested starch, mainly in the form of poi, which is fermented mashed taro. I ate poi a number of times while I was on Kaua'i, and really liked it. It's mild, similar to mashed potatoes, but with a slightly sticky consistency and a purple color (due to the particular variety of taro that's traditionally used to make it).

I had the opportunity to try a number of traditional Polynesian foods while I was on Kaua'i. One plant that particularly impressed me is breadfruit. It's a big tree that makes cantaloupe-sized starchy green fruit. Breadfruit is incredibly versatile, because it can be used at different stages of ripeness for different purposes. Very young, it's like a vegetable, at full size, it's a bland starch, and fully ripe it's starchy and sweet like a sweet potato. It can be baked, boiled, fried and even dried for later use. It has a mild flavor and a texture similar to soft white bread. It's satisfying and fairly rich in micronutrients. On the right are breadfruit, coconut and sugarcane, three traditional Hawai'ian foods.

I find perennial staple crops such as breadfruit very interesting, because they're much less destructive to soil quality than annual crops, and they're a breeze to maintain. I could walk into the backyard of the apartment I was renting and pick a breadfruit, soak it, throw it in the oven and I had something nutritious to eat in just over an hour. It's like picking a bag of potatoes right off a tree. Insects and birds didn't seem to like it at all, possibly because the raw fruit exudes a bitter, rubbery sap when damaged. Unfortunatley, breadfruit is a tropical plant. Temperate starchy staples that were exploited by native North Americans include the majestic American chestnut in the Appalachians, and acorns in the West. These are both more work than breadfruit to prepare, particularly acorns which must be extensively soaked to remove bitter tannins.

One of the foods Polynesian settlers brought to Hawai'i was sugar cane. I had the opportunity to try fresh sugar cane for the first time while I was on Kaua'i. You cut off the outer skin, then cut it into strips and chew to get the sweet juice. It was mild but tasty. I don't know if it was a coincidence or not, but I ended up feeling unwell after eating several pieces. It may simply have been too much sugar for me.

Modern Hawai'i is a hunter-gatherer's dream. There are fruit trees everywhere, including papayas, wild and cultivated guavas, mangoes, avocados, passion fruit, breadfruit, bananas, citrus fruits and many others. Many of those fruits did not predate European contact however. Even pineapples were introduced to Hawai'i after European contact. Coconuts are everywhere, and we could pick one up for a drink and snack on almost any beach. The forests are full of wild chickens (such as the one at left) and pigs, both having resulted from the escape and subsequent mixing of Polynesian and European breeds. Kaua'ians frequently hunt the pigs, which are environmentally damaging due to their habit of rooting through topsoil for food. Large areas of forest on Kaua'i look like they've been ploughed due to the pigs' rooting. Humans are their only predators and their food is abundant.

While I was on Kaua'i, I ate mostly seafood (including delicious raw tuna poke), poi, breadfruit, coconut and sweet fruits-- a real Polynesian style hunter-gatherer diet! I swam every day, hiked in the lovely interior, and kayaked. It was a great trip, and I hope to return someday.

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Friday Friend Shout Out - Sarah

This week's Friday Friend Shout Out is dedicated to Sarah Forney. Even though she is my sister, she is still is one of my best friends! And besides, she is friends with Terra and Jill anyway!

Everyone who knows Sarah is familiar with her hilarious sense of humor. When you are hanging out with her, you can be sure that you are going to have a great time!

Sarah has been such an inspiration to me this past year. She has taken on a successful new job working as a freelance director for News 12 NJ (the TV station!) and has enrolled back at school to study history and medieval studies at Rutgers University. She has been completely devoted to work and school. Going to and from classes, the library, study groups, then off to work all weekend long. When she's lucky and can come across some down time, she plays some of her instruments and work on her music.

During this busy time of her life, she's realized how important her health is. She began seeing a holistic health counselor early this Fall, and has been incorporating wonderful lifestyle changes into her daily life. She has been cooking in the kitchen, experimenting with new, fresh foods all while taking notice of how these foods are effecting her body. Sarah has incorporated more whole grains and greens into her diet because she now understands the benefits of these healthy foods. Her health counselor is helping her learn how to balance all the areas of her life (diet, career, lifestyle, etc.) in order to be healthy. Sarah has been positively responsive to all of it!

I admire her studious personality with her schoolwork. She's completely enveloped in her studies because she adores what she is learning. Her excellent grades have shown just how much all of her reading, homework and studying has paid off!

I am very proud of my hard working sister and all of her efforts to improve her health and life goals. Even though we haven't hung out in a while due to her schedule, it makes me happy to know that she is taking good care of herself while she's got so much going on. I am looking forward to her Winter and Spring break so that we can spend some quality time together.

Since Halloween is tomorrow, I included this picture of Sarah when she was a 'whoopie cushion!' Haha!!

Keep up all of your hard work, Sarah!! I love you!

Heart Attack Risk Reduction: The Low-Hanging Fruit

Dr. Yongsoon Park and colleagues recently published a great article in the British Journal of Nutrition titled "Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction". Stated simply, the title says that the fat in your red blood cell membranes, which reflects dietary fat composition, can predict your likelihood of having a heart attack*. More accurately than standard measures of heart attack risk such as blood cholesterol.

Let's cut to the data. The investigators examined the fat composition of red blood cells in people who had suffered a heart attack, versus an equal number who had not. Participants who had heart attacks had less omega-3, more long-chain omega-6, and particularly higher trans fat in their red blood cells. In fact, 96% of the heart attack patients had elevated trans fat levels, compared to 34% of those without heart attacks. This is consistent with a number of other studies showing a strong association between blood levels of trans fat and heart attack risk (ref).

92% of heart attack patients were in the lowest category of EPA in their red blood cells, as opposed to 32% of those without heart attacks. EPA is an omega-3 fat that comes from fish, and is also made by the body if there's enough omega-3 alpha-linolenic acid (think flax and greens) around and not too much linoleic acid (industrial vegetable oil) to inhibit its production. 96% of heart attack patients were in the lowest category for alpha-linolenic acid, compared to 34% of the comparison group. 0% of the heart attack patients were in the highest category for alpha-linolenic acid.

62% of heart attack patients were in the highest category of arachidonic acid (AA), compared to 34% of the comparison group. AA is made from linoleic acid, and is also found in animal foods such as eggs and liver. Animal foods from pasture-raised animals are lower in AA than their conventionally-raised counterparts, and also contain more omega-3 fats to balance it.

The investigators found that low omega-3, high AA and high trans fats in red blood cells associate with heart attack risk far better than the Framingham risk score, a traditional and widely-used measure that incorporates age, sex, smoking status, total cholesterol, HDL, hypertension and diabetes.

If the associations in this study represent cause-and-effect, which I believe they do based on their consistency with other observational studies and controlled trials, they imply that we can have a very powerful effect on heart attack risk by taking a few simple steps:

1. Avoid trans fat. It's found in margarine, shortening, refined soy and canola oils, many deep fried foods and processed foods in general.
   
2. Avoid industrial vegetable oils and other sources of excess omega-6. Eating pastured or omega-3 eggs, rather than conventional eggs, can help reduce dietary AA as well.
3. Ensure a regular intake of omega-3 fats from seafood, or small doses of high-vitamin cod liver oil or fish oil. Flax oil is also helpful, but it's an inferior substitute for fish oil.
   

This study was conducted in Korea. It's a striking confirmation that basic nutritional principles span races and cultures, likely affecting disease risk in all humans.

In the future, I hope that most doctors will measure blood fatty acids to predict heart attack risk, with more success than current approaches. Instead of measuring cholesterol and prescribing a statin drug, doctors will prescribe fish oil and easy-to-follow diet advice**. Fortunately, some doctors are beginning to measure red blood cell fatty acid levels in their patients. The forward-thinking cardiologist Dr. William Davis has discussed this on his blog here. Take a good look at the graphs he posted if you get the chance.


*The title of the study is misleading because it implies a prospective design, in which blood fatty acids would be measured and volunteers followed to see who develops heart disease at a later time point. This study was cross-sectional (also called case-control), meaning they found people who had just had a heart attack and measured their blood fatty acids retrospectively. The other study I referenced above was prospective, which is a nice confirmation of the principle.

**"Eat butter on your toast. Ditch the margarine."