Monthly Archives: July 2007

The Case for Dark Chocolate and Good Health

Chocolate:  The Case for Dark Chocolate and Good Health

Competency # 20: Cuisines of the Long-Lived

Reference: JAMA  July 4th, 2007  vol 298 pa 49  Taubert et al

Hurray, Hurray.  It’s really true.  My inner elephant is dancing for joy. (The visual here is disturbing) He can now lie and cheat and argue and complain the rest of my life, and I will just have to put up with him because he is right.  He can have chocolate and make the case that it’s, “Good for you!”  This is like Christmas in July and Chanukah in Spring.  Let’s all go out and play, because we can have Chocolate, dark brown, tasty, luscious chocolate.  Not only allowed, encouraged!

Bless Taubert et al.  In prestigious JAMA, just last week is a randomized, controlled trial in which even the investigators didn’t know what the participants were getting.  They were all borderline hypertensive, sort of like many of us.  Dark chocolate, rich in polyphenols, was secretly wrapped and distributed with elaborate care to the volunteers.  The volunteers were “sworn to secrecy”.  They knew what they were getting.  Wouldn’t you!  The poor control group got white chocolate.  Bummer.  Now, it was only 6.3 grams.  That’s just a quarter of an ounce or one square of a 16 square chocolate 4 oz chocolate bar.  Participants were given this every day for 18 weeks.  Does this sound like heaven or what?  50% cocoa, but only 2% of daily calories.

Guess what happened!  By 18 weeks, their blood pressure had dropped by 2.9 over 1.9 mm Hg.  That’s about half of what the DASH diet will do for you.  That’s meaningful.  The lower your blood pressure, the longer you live.   They attributed the change to increased S-nitrosoglutathione in their blood.  That’s a compound that is part of making nitric acid that lowers your blood pressure.  Sort of through the same mechanism that nitroglycerin under the tongue helps chest pain get better.  It relaxes arteries and makes blood pressure go down.  White chocolate didn’t do it.  Didn’t matter if you were male or female.  Worked in everyone.  Lowering your blood pressure is so important, it’s the foundation for our evidence based diet.   We want to lower our blood pressure through eating less salt, reducing stress, getting enough sleep.  All the things your mother told you to do.  Now, you can add one she told you not to do.  Eat chocolate every day.  And think how happy you will be.

Ok.  So get real.  How much chocolate?  6 grams.  Not 6 ounces.  One square.  Not the whole candy bar.  No, not a Dove bar, only one eighth of a Dove Bar.  But, it’s “good” for you.

WWW:  Try telling that to your inner elephant. No doubt he will pout.  But Hershey makes a magnificent new product called Hershey Sticks.  Little tiny dark chocolate sticks.  I bet sales go up.  I’m planning on indulging. Occasionally, sort of like having just 4 oz of wine.  Can you stop?  I went to Leon’s last week.  I got the giant hot fudge with pecans.  That’s about 8 weeks supply all at once.  I’ll try

Fiber: The Hidden Miracle Food

Fiber: The Hidden Miracle Food

Competency # 12 Fiber

Reference: American Journal Clinical Nutrition, June 2007

Dietary Prevention of Atherosclerosis!  You can prevent a heart attack by changing your diet.  The epidemic of the 20th century can be changed.  You can change your risks dramatically with the diet you eat.  This study is the first to get to the very heart of fiber and its contribution to this terrible epidemic that steals our loved ones at the prime of their lives.

Looking at the thickness of the carotid artery in the IRAS (Insulin Resistance Atherosclerosis Study), using a multiracial population of middle-aged women, the authors checked for thickness of the artery, in other words, how badly plaque was building up.  What they found was astounding.  There identified a significant inverse relationship between the progression of carotid artery thickening (plaque building up on the way to rupture and artery disease of one kind or another) and how much WHOLE grains the study participants ate.  Not any one component, but the whole grain.  A great point was made to identify that it’s still a mystery as to which component of whole grains matter, the fiber, the germ, or the carbohydrate.  But, refined grains just the white flour purified part, is what is associated with the problem of atherosclerosis.  The refined grain has a high glycemic index, meaning that the sugars from the carbohydrate get into your blood fast.  A whole grain has a much lower index, meaning it gets into your blood slowly.  But a whole grain also has the germ or the protein and vitamin part.  And, most importantly, it has fiber protecting the carbohydrate and germ, slowing digestion.  Maybe most importantly, is that the fiber slows down how fast the sugars get into your blood.

Let’s give an example.  Take two products made from the EXACT same grain, wheat.  Wheaties is a wheat-based cereal that has been ground making the whole grain into whole wheat flour, then made into paste, baked into flakes and put in a box.  The grinding up process dislocates the fiber from around the carbohydrate.  The glycemic index of Wheaties is 80 meaning that your blood sugar goes up 80% as fast as if you ate pure glucose.  Whole grain cereal made from whole wheat grains has a glycemic index of 38%.  That’s half the rate of rise of blood glucose with the exact same food product.  One was ground into flour, one was eaten whole.

It’s not the fiber, it’s not the bran, it’s not the carbohydrate.  Each one tested separately doesn’t figure with a positive effect.  It’s the whole package.  The whole grain has to be whole.  We’ve said this before in this column.  This is now the first evidence-based study in the medical literature to confirm the hunch.  Your carotid artery will thicken and get more diseased, the more refined carbohydrate you eat.  Hmmmmm…

How much whole grain do I have to eat to avoid this effect?  The study used an achievable threshold.  The looked at three items: dark bread or high fiber cereals or granola cereals counted, shredded wheat counted, and cooked cereal counted.  In most research, they call it whole grain if you have greater than 25% of the content being visible whole grain chunks.  This is do-able.  If this level of easy change has the impact of this study, think how much better off you will be with more whole grains!

WWW: What Will Work for me.  The average American eats less than a serving a day of whole grains.  I try to eat at least one with my breakfast cereal which is 100% whole grains.  My Uncle Paul went on a strict Pritikin diet after his 5 vessel heart surgery in 1977.  10 years later, his heart disease had improved dramatically.  Research is now explaining why.  Bread in our house is taking longer to eat up as we gradually are finding more whole food recipes, salads, soups.  It’s a journey.  I’m on it.

(Did I mention the occasional double fudge, chocolate no-fiber Dove bar?)

WHOLE GRAIN CEREAL RECIPE:  Dr. W’s Llama Chow  (Repeat Recipe by Request)

BUY:  quinoa  (whole grain – still covered with fiber)

Take 1 cup of the quinoa and add 2 cups of water and a pinch of salt

Heat to boiling: watching like a hawk to make sure it doesn’t boil over

Simmer 20 minutes with cover on

Cool and put in the fridge: this is about 6-8 servings and lasts a week

Each morning: take a ½ -1 cup dollop, add a cup of almond milk – heat in the microwave

I add a fistful (1/2 – 1) of frozen blueberries

Stevia if you must have a sweetener – you really don’t need one.

2-3 heaping tablespoons of ground flax seed on top, stirred in (10-12 grams of fiber there too)

You wont get hungry till lunchtime!

Summary:  Glycemic index of 38

Two fruit servings (1/2 cup blueberries, )

One calcium serving

15 grams of fiber (1/2-1/3 of my daily goal)


Turmeric: Brushing Your Brain

Turmeric:  Brushing Your Brain

Competency # 16 Minerals

Reference: Proceedings Natl Acad Science, July 16 2007, Fiala et al

You brush your teeth to get rid of plaque.  Or maybe you floss?  Well, if you want to get rid of plaque in your brain, you need to brush there too.  Taking care of your brain is not a passive activity.  There are things you can do that may help you dramatically.  Some of us need more help than others.  But it is not a passive activity.  As long time readers of this column know, brain health is an emerging science that we have followed.   And turmeric is on the list.  Here’s why.

Past research has shown that the more turmeric frail elderly in Singapore eat, the less rate of mental decline they have.  India has boasted a much lower rate of Alzheimer’s than Western countries (about 22%).  Those are epidemiological associations.  Now we have a research article that shows a molecular mechanism that could explain those associations. Mechanisms are the next step in establishing firm, medical proof.  The last step is a randomized controlled trial (RCT).  RCTs take years to run and are very difficult to do.

Brain scientists have been fascinated with turmeric.  It is the yellow in curry that South Asians and Middle Eastern populations have used for centuries to flavor their food.  It is a particularly potent antioxidant.  Turmeric’s associations with better brain health have been known and talked about in the brain health literature for several years now.  The detectives are closing in.  If Alzheimer’s were a crime, the medical CSI Team would be down to the final clues.

In Alzheimer’s, your brain gets injured by plaques of a twisted protein called amyloid-beta.  Normally, you have white blood cells called macrophages that gobble amyloid-beta up and get rid of it.  Turns out that the macrophages in Alzheimer’s folks can’t gobble.  The plaques accumulate.  Doctor Fiala at the Los Angeles VA looked at the genes in the macrophages to see which ones weren’t working.  There were a bunch of genes that are “toll receptors” that switch on and off to identify what to gobble and clean up and what to tolerate.  He found one called MGAT3 that is 300 times more active in the cells of normal folks macrophages than it was in Alzheimer’s.   When the impaired cells were exposed to turmeric (or some of the chemicals in it), those genes switched on.  Half of 73 patients had a complete recovery of activity, half had partial, but all responded.

Dr. Fiala was using levels of turmeric you can’t get from eating.  Soaking in it won’t help either.  But waiting till you are forgetting to take your turmeric might be too late.  And it is completely non-toxic.  It’s been eaten and used in medicinal preparations in India for over 5,000 years.  This insidious illness, Alzheimer’s, may take decades to develop, and may not be all that reversible once in place.  So, like your dentist implores, get rid of that plaque while you still have something to work on.

We still don’t have a randomized controlled trial, unless you count 1.5 billion South Asians as our control group, with a 5,000 year period of study.  I haven’t got time to wait for a randomized controlled trial.  I already forgot to pick up milk on the way home.

WWW:  What will work for me?  I eat curry just 2-3 times a month.  Not enough to get a regular diet of it.  I’ve been to the Indian Grocery store where they have shelves of pickled turmeric.  The Alzheimer’s story is old news there.   But powdered turmeric only costs $ 2 a pound, and that will make 2,000 capsules.   I made my own capsules of turmeric pills, but it is a messy business and sure stains your kitchen counter.  You can buy turmeric at health food stores now too.  This may be a “little bit out there”, but that’s the intent of this column, to explore the boundaries of what’s new.  Andrew Weil called it over two years ago when he stated, “The only two supplements you need to take are turmeric and ginger.”  See you at the Indian buffet?

Soda and Metabolic Syndrome

Soda and Metabolic Syndrome

Competency #3 Metabolism and #11 Sugar

Reference: Circulation. 2008 Feb 12; 117(6):754-61.

NBC News, ABC News, Front page of the Journal Sentinel.  This news sure hit the media today.  Goodness, and what interesting news.  The Framingham Heart Study is particularly good because it has been following 5209 people since 1948.  That’s a large number for a long time.  The short and sweet message is all about the sweet in soda.  Drinking sugared sodas leads to the development of metabolic syndrome.  We sort of knew that because of the extra sugar in “high test” fully-sugared sodas.  Interestingly enough, drinking DIET SODA, also was correlated with developing metabolic syndrome.  If you drink an average of one soda a day, you have a 48 % higher chance of developing metabolic syndrome.  The more you drink, the higher the risk.

What’s going on?  The authors admit they don’t know for sure.  The observation is that there is a strong association between a “life-style” of drinking more soda and developing metabolic syndrome.  They mention other possibilities like the possible presence of a chemical effect from caramel, or advanced glycation products, but reach no conclusions.  I would hazard a guess that a lifestyle of drinking sweet sodas leads to a lifestyle of liking sweet things.  It only takes 50 extra calories a day to gain 5 lbs a year.  Some sweet things are “diet”, but others are pieces of chocolate cake.

Your understanding what metabolic syndrome is, however, is important.  Metabolic syndrome is the precursor to heart disease, vascular disease, stroke, diabetes.  About 75% of us are dying from the cluster of complications that follow these illnesses, which are all preceded by years of “metabolic syndrome”.  You get the label of having it if you have three of the following:  a) men’s waist is over 40 inches, women’s over 35, b) fasting blood sugar is over 100, c) serum triglycerides over 150, d)  blood pressure over 135/85,  e)  HDLs under 40 (men), 50 (women).  Metabolic syndrome HAS NO SYMPTOMS.  You are just middle aged and slightly plump.  Pleasantly plump.  Internally, you are burning away.  Your arteries are rotting.  The clock is ticking until the time comes when something breaks loose from an injured artery and your heart attack presents itself with sudden death, or stroke.  The proverbial horse is out of the barn.

The time to act is now.  We know that drinking calories does not make you feel full.  Your internal measure of appetite is not satisfied by liquid calories.  It would seem to make sense that you could then simply get away from the conundrum by drinking diet calories.   This study challenges that.  Drinking sweet stuff probably leads to liking and wanting more sweet stuff.  I know that’s true with me.

WWW.  What Will Work for Me.  I’m a can-a-day kind of guy.  This study was about me, and you.  This study tells me I make my personal hill harder to climb if I keep exposing myself to sweet stuff.  And I love sugar, of all kinds.  I have been drinking more water recently, mostly because I’m cheap and don’t like the cost.  16 oz of cold brewed Lake Michigan, straight up, might be the drink of choice.  It’s probably the better habit.

More importantly, I’ve made my annual date with my doctor.  My blood sugar is right at 100, my waist size has only recently dropped below 40, my blood pressure is 130/78, my HDLs are 39, my triglycerides were 130 last year.  (How many risk factors do I have: count…. Blood sugar 100 and HDL of 39)…Ok, I get 2 risk factors.  I’m only one away from a “label” of Metabolic Syndrome.  I would like to get down to 1 risk factor this year.  My goal.  Join me.  Seek your doctor, get your risks evaluated.  Let’s support each other and get rid of one each.

Put Your Jeans/Genes on a Diet!

Put Your Jeans/Genes on a Diet!  Your Food as Medicine

Competency # 10 Glycemic Index

Reference: Am J Clin Nutrition: 2007;85:1169  Salsberg and Ludwig et al

You can affect your genes by what you eat!  The proof is in.  The food you eat has a measurable impact on your genes.  This is a really big idea.  If it weren’t for the fact that it’s been around since Hippocrates, and probably before, we would say we were being thoroughly modern.  This is not a new idea, but we now have the facts and the details.  We’ve always assumed that the food we eat gives us calories and building blocks to grow, and medicine takes care of our ills.  Two separate arenas.  Well, move that idea over a little.  We know that the food we eat has an immediate impact on many internal hormones, like insulin.  Does food act like medicine?  Yes, the proof is now in.  Now we know that different foods have an impact on our genes as well.  You can program your genetic response to the food you eat by the food you eat.  Fascinating.

Here is what Dr. Kallio (from Finland) did.  They took 47 people who were middle aged and slightly pudgy.  They had the criteria to be called metabolic syndrome.  They were a little bit overweight, slightly high blood pressure, slightly high blood sugar, slightly high lipids.  Heart attacks waiting to happen.  Alzheimer’s waiting to pick up the pieces later.  Sounds like you and me.  They were given a precise diet that was equal in calories, protein, carbohydrate and fat.  The only difference was that one was a “Low glycemic” and one was “high glycemic”.  That means one was designed to have carbohydrates that got into the blood slowly (low insulin response too), and the other got into the blood fast (with a subsequent high insulin response).  The “low” used rye-pasta as the carbohydrate source.  The “high” used potato-wheat-oats as their source of carbohydrates.   Fast forward 12 weeks and check the activity of the genes in their tummy fat.    Amazing differences.  Using fancy techniques like DNA chain polymerase reactions, they tested the genetic activity of all the genes that regulate your fat making, fat releasing responses.  The low insulin, low glycemic response diet folks had 71 genes that had consistent down regulation.  The high insulin, high glycemic response group had the exact opposite, an up regulation of the activity of the genes and elevation of insulin response.

Insulin is becoming the key to understanding.  We need to think of insulin as the hormone that allows us to binge and save calories for later.  It helps us store fat in response to excess calories.  But it doesn’t just work by itself.  When we set off an insulin response, our bodies are pretty savvy and all of our cells listen and watch what’s going on.   They start changing their internal mechanics and processes (the genes and their DNA expression) to back up the action of the insulin.  Eating food that makes us release insulin every day is training our bodies to store fat, not have the calories ready to use for living life.  Conclusion:  The food you eat can program your “Metabolic computer” to be more efficient at storing fat.

Now, the drug companies are reading this too and going ballistic.  If they can find the exact mechanisms that makes these genes regulated, and invent a precise chemical that will affect those genes, they can sell it for

$ 200 a month to you and say it will help control your insulin response, your pre-diabetes, your risk of heart disease.

Plan B.  Do it on your own.  Here is the key to knowledge.  The food you eat affects you in more than just calories.  The food choices we make play back all the way down to our genes.  For a lot less than $ 200 a month, you can start choosing low glycemic foods, knowing that as you munch, you are doing good things for yourself.  So, spend a little extra and get some classy veggies.  Buy apricots, plums, broccoli and cauliflower.  The stores are brimming with the bounty of summer.

WWW:  What Will Work for Me!  This is a very long explanation for what Grandma said.  Eat your vegetables.  Our carbohydrate source should be MORE whole foods like fruits and vegetables.  Less high glycemic carbohydrates like flour and potato based products.  I don’t eat potatoes very much any more.  And my rice is now brown instead of white.  But can you find me a good recipe for rye?   And make your pasta “al dente”.  Cook it one minute less and lower it’s glycemic index about 10 points.  A little bit chewy makes it much slower digesting, much lower GI index.  And then, just have one cup of it and a giant salad with three or four lovely tomatoes smothered with olive oil on the side.  Yummy.  Putting my jeans on a diet, means I can still fit in my genes.   Rye humor?

Losing Weight the Proper Way

Losing Weight the Proper Way:  Middle Aged Women Succeeding!

Competency # 5 The Way to Eat

Reference: Am J Clin Nutrition 2007;85:1467   June Edition

Ok, if you are a member of Weight Watchers, this is no big deal.  But it has never ever been studied in a randomized controlled trial (RCT).  Now, from Penn State and the team that published the book on “Volumetrics” comes the research study that powers the book.  And RCTs are what modern medicine claims to run on.  This is very important!

It sounds so simple.  It’s nothing short of hitting yourself in the forehead and saying, “Duh”.  Grandma knew this!  Their finding:  eating foods low in energy density helps you lose weight.  That’s it.

The science behind it is interesting.  Turns out we are all programmed to eat a volume of food.  That may be our most sensitive measure of what makes our brain and our stomach feel like they have both had enough and say quit.  You are not really programmed to calories.  Particularly not liquid calories.  And in fact, it only takes an extra potato chip a day to gain 5 pounds a year.  For those who haven’t been gaining 5 pounds a year, consider how accurate your appetite barometer is.

Here is the good news.  You only have to eat 100 calories LESS a day to lose a pound a month.  That’s 10 a year.  And “Volumetrics” is the key to success.  You can eat till you feel full.  The substituting of low calorie, high volume food for high density food is all that it takes.

Now, here is the rub.  You are programmed, deep inside, to always choose the highest calorie, highest fat density food around.  What do you want: cheesecake or an apple?  Both weigh 5 ozs.  Both are 150 ccs of volume.  Given the choice, I’m in for the cheesecake.  My inner elephant has a very clear pattern of behavior.  He rampages and goes for the sweet, fat, salty, chocolate combo every time.  (Snicker Bar, or Hot Fudge with Pecans)

What Barbara Rolls and Julia Ello-Martin did was to instruct 97 women, randomly assigned to several different weight loss strategies/instructions; to eat more fruits and veggies instead of high calorie sweets and baked goods, cut down on fat, and walk more.  Eat as much as they wanted!  And add 1000 steps a day of exercise.   The women who succeeded?  The ones who ate the most fruits and veggies.  And if they also followed the advice to eat less fat, they lost more weight.  After one year: 16 pounds down.  And, interestingly enough, on detailed analysis of their food calendars, they were only eating about 100 calories a day less.  That’s the difference between an apple and ice cream.

WWW:  What will work for me?  This is Weight Watchers.  It’s what I’ve personally done.  I’ve lost 55 lbs in the last 6 years.  That’s about 10 pounds a year.  Here is a research study to show that it works and it sticks.  Now, it’s also changing your environment.  My inner elephant goes crazy when there’s ice cream around.  All the apples, apricots and plums in the world don’t distract my greedy inner elephant who can smell the blueberry cheesecake ice cream through the freezer door.  So, change your environment.  Get that stuff out of the house.  Then, all the plums you want are on the counter.  And the plums right now are gorgeous.  The sugar snaps are in the farmer’s market.  I bought 3 pounds…and then, you do it forever.  Not just to lose 5 pounds.