writer: Dr

One area where people are very confused is about cholesterol in food.

“When I look at some of your recipes I see some of them are way over 250mg cholesterol, for instance your Eggs Benedict with 283mg. I understand eggs are considered a high source so that doesn’t surprise me with the figure. But…..

I have a cholesterol problem and am trying to lower it without medication. I came across your recipes by doing a search. What is considered HIGH cholesterol content in food when looking at a Nutrition Fact section? Just curious as my doctor really wants me on medication. But every time I take it I feel like crap AND it is so expensive compared to just looking after your dietary intake.”

The research into cholesterol is a good illustration of how far we’ve come in the last 15 years with our knowledge about diet and nutrition as well as what really works.

This is a challenging issue because when your cholesterol is high, the first thought is to simply eat less cholesterol, and that’s often what people are told. Unfortunately, the recommendation – usually to consume less than 300 milligrams per day – wasn’t based on the best science and we now know that for most of us the amount of cholesterol we eat isn’t that important.

First and foremost, understand that cholesterol is a type of fat or “lipid.” Also note that while the cholesterol you consume and the cholesterol in your blood stream are the same thing, eating foods that are high in cholesterol doesn’t necessarily raise your “serum cholesterol.” Likewise, it may not have much effect on the “lipid panel” that your doctor looks at as part of the lab work he or she orders. That panel measures total “serum cholesterol,” HDL (often called good cholesterol), LDL (often called bad cholesterol) and triglycerides (another type of fat).

It is also important to know that your body makes its own cholesterol: about 300 mg per day. Some people make more, but most folks with cholesterol problems have difficulty with how the cholesterol is handled in the body for a variety of reasons. While some of this is the result of genetics, other issues include obesity, diet, exercise, distribution of fat and other medical conditions such as diabetes. The thought that consuming more than 300 mg of dietary cholesterol per day caused an increase in serum cholesterol was arbitrary and over the last few years we have come to understand that this is not the case for the majority of us.

We do know, however, that there are some of us whom researchers classify as “hyper-responders.” This group does have a greater increase in their serum cholesterol after consuming dietary cholesterol (although not a tremendous increase). About 1/3 of us might be more sensitive. (Am J Clin Nutr 1985;42:42 1-431) There’s no actual test for this, however. If you are struggling with lowering your cholesterol, it is a good idea to limit high cholesterol foods and see if that makes a difference for you.

There are a number of diet and lifestyle choices that can help you lower your cholesterol:

1. The amount of saturated fat in your food is far more important than the amount of cholesterol, because saturated fat has an effect on serum cholesterol as well as the LDL cholesterol.
2. Consume a higher amount of the “good” fats like monounsaturated fat and polyunsaturated fats. While we used to think that a low fat diet was important, it’s clear that this is not the case either. Concern yourself with consuming about 2 times as much of quality fats (like olive oil or canola oil) than saturated fats (like butter or higher fat red meats).
3. Eat more fiber. There are a lot of great sources including fruits of any kind, veggies, whole grains and cereals, and legumes (beans, peas, etc.).
4. Exercise clearly helps change the cholesterol profile by lowering LDL and raising HDL.

There are a lot of foods that are high in cholesterol that are good for you. Eggs, for example, contain about 250 mg of cholesterol, and each has about 5 grams of fat in the egg yolk (about 2 grams of this is saturated fat). Liver, shrimp, and lobster are other foods that are great for you and have a lot of cholesterol. The research now shows that for most of us, these high cholesterol foods are not a problem.

The research says that you can dramatically lower your cholesterol by changing your diet and exercising more. Medication is necessary for some, no matter how much they change their lifestyle, but the good news is that for those who are taking cholesterol lowering medications, following a healthy lifestyle can lead to as much as a 55% reduction in risk of heart disease over taking medication alone.

The goal is balance, which includes eating less saturated fat, while still eating foods that aren’t boring or bland. Here are some delicious recipes that are great for you and contain eggs, shrimp or liver:

Asparagus Frittata
Shrimp Taco Salad
Calves Liver with Onion and Apple

This table is taken directly from the information on DASH Diet (Dietary Approaches to Stop Hypertension) provided by the USDA.

Just as with people’s expectations of how fast they should lose weight, there’s a disconnect these days between what people weigh and what they think they ought to weigh. There are a few ways to look at what your best weight should be, but Body Mass Index (BMI) is one of the most reliable to help you know what a healthy weight is for you.

The BMI is based on a calculation that estimates weight in relation to height. There are more precise measures of weight, but BMI allows researchers a quick and inexpensive way to compare the weight of different populations. It also lets you compare yourself to the findings of researchers on what is considered a healthy weight.

It is pretty clear that being overweight can have serious effects on health. There are well established connections between obesity and illness with heart disease, diabetes, high blood pressure, breast cancer, colon cancer, arthritis and stroke being the most common problems.

While you have probably heard all of this before, I like to talk with my patients about the real consequences for them of these conditions If your weight leads to having diabetes or a heart attack will you be able to enjoy your son’s wedding? Will you live to see your daughter’s first child graduate from high school? There’s real pain in carrying around too much weight – arthritis of the knees, difficulty breathing, swelling of the ankles, diabetic foot problems – these are the facts of life for many with a high Body Mass Index.

BMI is a rough estimate of body fat. When I say “rough estimate” I mean both – an estimate and a rough one at best. The limitation is that it doesn’t measure body fat directly.

This table shows the range of weights for a normal Body Mass Index. Your Ideal Body Weight should fall between the weights for a BMI of 19 to 25.

For instance, if you are 63 inches tall (5 foot 3 inches), a good range for a healthy weight is between 107 lbs. and 141 lbs. Look at the table below to see if your weight falls within the normal range – or use the BMI calculator in the right-hand column of this page.

Normal Weight Body Mass Index

Here’s what is considered a normal BMI.

Now, for some of you this is going to be shocking information. It is amazing to me how disconnected people are today from what a healthy weight should be. While BMI information is not perfect, it is a pretty good guide — especially for the majority of the population.

Don’t worry, you can get to a healthy weight if you are overweight or obese. It does take some planning and work at taking action, but each day you’ll be making a real difference in your health.

One of the most significant issues today with folks getting too many calories is at lunch. It amazes me how many people don’t make their lunch to take to work with them. It is so expensive to eat out these
days.

Being very conservative, if you eat lunch out each day and it costs $5.00, that’s $25.00 per week or about $100.00 each month. $1,200.00 per year!

Save your money and save your life! Start making your lunch each day and taking it with you. It takes all of 10 minutes to make a sandwich and put it in a bag with a piece of fruit. This is a critical part of
this program. By making your lunch you not only save the money but you are in complete control of the amount of calories you’ll have each day at lunch.

Hidden Valley Ranch. (HVR.)

Three words that are a staple of American cupboards because the folks at Hidden Valley Ranch were the originators of Ranch Dressing. The history is pretty well known to foodies: Steve Henson and his wife offered the dressing at their dude ranch in Santa Barbara, the Hidden Valley Ranch. They sold packets of the dressing mix to customers in the area and in the early 1970s they sold their company, the manufacturing facility they had set up, and the dressing, to Clorox (the ranch itself was sold prior to the sale of the dressing company).

Clorox? Weird but true.

The rest is history, and Clorox through the years reformulated the dressing mix and the bottled dressing. People love the flavor, and in truth it does taste pretty good. The dressing is, however, a good look at how our food has evolved from what was likely a good basic buttermilk dressing recipe with a great blend of herbs and spices into a wholly manufactured product that has some very familiar but also many of the obscure ingredients found in highly processed foods.

Here’s the ingredient list:

vegetable oil (soybean and/or canola oil), water, egg yolk, sugar, salt, cultured nonfat buttermilk, natural flavors (milk, soy), spices, dried garlic, dried onion, vinegar, phosphoric acid, xanthan gum, modified food starch, MSG, artificial flavors, disodium phosphate, sorbic acid, calcium disodium EDTA as preservatives, disodium inosinate, disodium guanylate

The first half of the ingredients – the ones in italics to – are pretty familiar. Almost all of them are ingredients you would have in your home except for the mysterious “natural flavors”. I’m never sure what these are, but this is how the Food and Drug Administration defines the term:

The term natural flavor or natural flavoring means the essential oil, oleoresin, essence or extractive, protein hydrolysate, distillate, or any product of roasting, heating or enzymolysis, which contains the flavoring constituents derived from a spice, fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products, or fermentation products thereof, whose significant function in food is flavoring rather than nutritional…

Maybe that’s not too nefarious, but it is still pretty vague as to what is in your food. You might have some of those items in your cabinet or fridge, but in the dressing it is not likely in a form that you would recognize. As for the other ingredients, like disodium guanylate, it is unlikely that you have them in your spice drawer.

First is cost. A 20 ounce bottle of HVR at the local grocery goes for $4.99. That’s 2 1/2 cups or 20 two tablespoon servings. Most folks actually use 4 tablespoons, but let’s split the difference at a more reasonable 3 tablespoons for the 20 ounce bottle which is more along the lines of 13 servings or 38 cents a serving.

Here’s what it costs to make your own Ranch Dressing:

Simple. Making your own is cheaper by about 3 cents per portion (less if you shop around a bit). Yes, you have to initially purchase a lot more ingredients than the per serving cost in the analysis above, but these are essential ingredients for your pantry that help you expand your ability to cook for yourself.

We have demonstrated this same lower cost principle of making your own meals rather than from pre-packaged products with these analyses of Hamburger Helper and Rice a Roni.

From a health standpoint does this make all that much difference?

Yes. That little bit of time you spend making your own saves you a whopping 145 calories per three tablespoon serving (210 calories for the HVR and 65 if you make your own). There’s a similar reduction in the amount of salt, at 390 milligrams for the bottled dressing and only 210 if you make it yourself. You also get to choose the type of fat by selecting a mayonnaise made with olive oil rather than the soybean oil or canola oil that the HVR is made with.

The most important part is that your homemade dressing tastes better. A LOT better. Flavor, texture, freshness, no weird aftertaste – it’s all there in your own dressing and much more like the same delicious quality of what Hidden Valley Ranch Dressing started out as back in the 1950s.

While there is not a great deal of direct research that links poor diet to increased depression or mental health issues, there’s more than enough indirect evidence for the following:

1. High blood sugars

Obesity, metabolic syndrome, and diabetes are all a function of abnormal processing of glucose. When blood sugars are chronically high, our bodies churn out insulin in an effort to cope with the excess glucose. The excess insulin levels induce a pro-inflammatory state. ¹ This leads to overproduction of reactive oxygen species and thus to oxidative stress. This pro-inflammatory state has been shown to cause disruptions in how the brain processes neurologic impulses. The hippocampus (the brain’s memory formation and processing center) is particularly susceptible to high blood sugars, and wide swings in blood glucose can lead to a decrease in its volume and structure. ²

Similarly, patients with diabetes have an increased risk of Alzheimer’s Disease. The higher insulin levels seen in diabetics appear to impair our ability to clear amyloid beta proteins from the body, a pathologic feature of Alzheimer’s Disease. ³

Amyloid beta proteins are the main component of the plaques in the brain typifying Alzheimer’s Disease, and impaired signaling between brain cells is linked to accelerated brain aging, which includes damage to small blood vessels. Such changes have been shown on MRI in patients with Alzheimer’s, and these lesions, along with other structural changes, have been found to occur at higher rates in diabetic vs. non-diabetic populations. ⁴ This is supported by research that shows poorer cognitive scores in Type 2 diabetics without dementia. ⁵

To help you reduce the risk of diabetes and metabolic syndrome, follow a Mediterranean diet plan. Here’s our guide to understanding a Mediterranean-style diet.

2. Dietary fats

Fat is not the enemy, but for folks who do eat too much fat and fewer quality fats there has been a link with memory loss, especially in those consuming higher levels of saturated fats. This includes functions involving memory, speed, and cognitive flexibility in both the short term and the long term. ⁶ In one study of men, a high fat diet was linked to significantly decreased attention scores. ⁷ In another study, high saturated fat intake was linked to decline in memory, processing speed, and attention measures over a six year period. ⁸

The key is to consume less saturated fat (not none) and higher proportions of omega-3 fatty acids. Omega-3s play a key role in the function of the nervous system, and for those who already had Alzheimer’s, taking omega-3 fatty acid supplements (as opposed to a placebo) were found to slow cognitive and functional decline over a 12 month period. ⁹ The recommended ratio of omega-3 to omega-6 fatty acid intake for an optimal diet is 1.6:1 (think of it as 1.6 teaspoons of omega-3s to 1 teaspoon of omega-6s). Unfortunately the standard American diet contains 14 to 25 times more omega-6 fatty acids than omega-3 fatty acids. ¹⁰

Here are some great recipes that can help you increase your consumption of great quality fats:

Lemon Vinaigrette
Mustard Glazed Salmon with Lentils
Salmon with Southwest Beans and Rice
Pecan Crusted Trout
Tuna and Chickpea Salad

3. Antioxidants

Oxidative stress caused by the inflammatory process plays a role in age-related memory disorders like Alzheimer’s Disease. A substance known as brain-derived neurotrophic factor (BDNF) is critical for brain cell creation, ability to change over time, and regeneration. Positive associations have been seen between omega-3 fatty acid and antioxidant consumption and BDNF production. ¹¹

For example, berries have antioxidant and anti-inflammatory benefits, and higher consumption is linked to increased signaling in the brain, mediating memory. ¹² In a small study of elderly men and women with early memory decline, drinking blueberry juice on a daily basis was shown to significantly improve memory function and reduce symptoms of depression. ¹³ In another study, consuming more strawberries and blueberries was associated with a slower progression of cognitive decline in older women. ¹⁴

Tree nuts are a good source of antioxidants that decrease inflammation, and a randomized cross-over trial of over 200 healthy male and female college-age students showed that their verbal reasoning scores improved after adding walnuts to their diet for eight weeks. ¹⁵

Walnuts have been shown to have the highest level of antioxidant capacity as compared to other nuts. The PREDIMED-NAVARRA trial showed that when nuts were added to a Mediterranean diet, there was a 78% lower risk of having low levels of plasma. ¹⁶

Here are some favorite recipes using nuts:

Sautéed Spinach with Apples and Walnuts
Waldorf Salad
Georgian Cilantro Sauce
Basil Pesto

4. Processed/fast foods

There have been a number of studies that link fast food and processed food consumption with depression. The best quality study was performed in Spain with about 9,000 participants. That research showed that people with the highest consumption of processed foods had almost a 50% increased risk of depression. ¹⁷ Those with a higher Mediterranean Diet score have been shown to have a higher physical quality of life as well as a better emotional quality of life (although the mental health association was not as strong). ¹⁸

In a study of children, those kids consuming fast food on a daily basis were almost twice as likely to experience depression and to experience feelings of worthlessness and anxiety. ¹⁹

There are other links including micronutrient levels such as iron (linked with cognitive decline) and turmeric (shown to reduce memory decline in animal models) as well as magnesium, zinc, and artificial food coloring (linked with ADHD).

These four: reducing blood sugar by following a diet low in simple sugars and high in fiber, increasing the quality of fats in your diet, getting more antioxidants, and stopping consumption of highly processed food – can make a huge difference in your mood and memory now and your risk of memory loss as you grow older.

References

1. Roriz-Filho et al. “(Pre)diabetes, brain aging, and cognition.” Diabetes and the Nervous System 2009;1792(5):432-443

2. Kerti et al., “Higher glucose levels associated with lower memory and reduced hippocampal microstructure.” Neurology 2013;81:1746-52

3. Roriz-Filho et al. “(Pre)diabetes, brain aging, and cognition.” Diabetes and the Nervous System 2009;1792(5):432-443.

4. Akisaki et al. “Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J-EDIT).” Diabetes Metabolism Research and Review 2006; 22:376-384.

5. Geijselaers et al. “Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review.” Lancet Diabetes Endocrinology 2015; 3:75-89.

6. Barnard et al. “Saturated and trans fats and dementia: a systemic review.” Neurobiology of Aging 2014; 35(2): S65-S73.urated and trans fats and dementia: a systemic review.” Neurobiology of Aging 2014; 35(2): S65-S73.

7. Edwards et al. “Short-term consumption of a high-fat diet impairs whole-body efficiency and cognitive function insedentary men.” The FASEB Journal. March 2011, Vol 25.

8. Morris et al. “Dietary fat intake and 6-year cognitive change in an older biracial community population.” Neurology 2004;62(9):1573-9.

9. Shinto et al. “A randomized placebo-controlled pilot trial of omega-3 fatty acids and alpha lipoic acid in Alzheimer’s disease.” Journal of Alzheimer’s Disease. 2014;38(1):111-20.

10. NIH Meeting on the Essentiality of and Recommended Dietary Intakes (RDIs), 1999

11. Arnold et al. “Zinc for Attention-Deficit/Hyperactivity Disorder: Placebo-Controlled Double-Blind Pilot Trial Alone and Combined with Amphetamine .” Journal of Child and Adolescent Psychopharmacology. Nov 2011; 21(1): 1-19.

12. Joseph, James A., Barbara Shukitt-Hale, and Lauren M. Willis. “Grape juice, berries, and walnuts affect brain aging and behavior.” The Journal of Nutrition 2009;139(9): 1813S-1817S.

13. Krikorian, Robert, et al. “Blueberry Supplementation Improves Memory in Older Adults.” Journal of Agricultural and Food Chemistry 2010;58(7): 3996-4000.

14. Devore, Elizabeth E., et al. “Dietary intakes of berries and flavonoids in relation to cognitive decline.” Ann Neur 2012;72(1): 135-143.

15. Pribis, Peter, et al. “Effects of walnut consumption on cognitive performance in young adults.”British Journal of Nutrition 2012;107(9): 1393-1401.

16. Sánchez-Villegas, Almudena, et al. “The effect of the Mediterranean diet on plasma brain-derived neurotrophic factor (BDNF) levels: the PREDIMED-NAVARRA randomized trial.” Nutritional Neuroscience 2011;14(5): 195-201.

17. Sanchez-Villegas, et al Fast-food and commercial baked goods consumption and the risk of depression Public Health Nutrition: 15(3), 424-432

18. Sanchez-Villegas, et al, Adherence to the Mediterranean diet and quality of life in the SUN Project European Journal of Clinical Nutrition (2012) 66,360-368; doi:10.1038/ejcn.2011.146; published online 17 August 2011

19. Zahedi, H, et al, Association between junk food consumption and mental health in a national sample of Iranian children and adolescents: The CASPIAN-IV study, Nutrition 2014; 30 (11-12): 1391-1397).

Roast chicken recipes beg the question: skinless or not?

For years we have been told to not eat the chicken skin. It is one of the foundational pieces of advice when people are taught about eating healthy.

This may be bad advice. Not because you want to eat more calories or more saturated fat –  just the opposite – but eating healthy and eating well is about striking a balance between just that: eating well and eating healthy. And sometimes you want to have a piece of chicken with the skin on. Yes, there are a lot of recipes on the website that call for skinless chicken thighs or breasts. But not all of them.

For years we told people to not eat eggs because they contain high amounts of cholesterol. While this was well intentioned advice, the science now tells us that eggs in moderation are actually a pretty good choice. What is moderation? In the case of eggs, it works out to no more than about 6 per week. Getting past that number and the health risks kick in. That is, however, the same for almost anything. The skin adds about 60 calories, most of it in fat, to a 3 1/2 ounce serving of chicken breast. That’s not a tremendous amount unless you do that every day.

It is not chicken skin that is the culprit, it is the balance between most of the time having the healthier option of skinless chicken breasts with the occasional roast chicken dinner, skin and all. There is a third alternative to the skin or no-skin debate. Roast your chicken with the skin on, bit don’t eat the skin. Testing shows that this technique gives you a moister, juicier chicken, but with the same calories as if you roasted the chicken without the skin.

This Peruvian Chicken recipe calls for roasting the chicken in the oven, but it can be slow roasted on the grill outdoors for even more flavor. Move the chicken away from the hot coals and keep the lid on the grill with the temperature in the same 325°F range.

The chicken itself has bags and bags of flavor on its own. The combination of the simple spices is great, but the soy sauce really brings out an umami punch. Peru might be the first country to have fusion food without reason of fashion. There has long been a large Japanese population and many Asian ingredients have made their way into Peruvian recipes. The main example of this is Nikkei, the name for the sushi that combines Japanese and South American flavors.

As for flavor, the rub for the chicken is best if you use smoked paprika. The combination of the soy and smoke really make the chicken shine. Secondly, if you don’t like your food too spicy, cut back on the number of jalapeno peppers. There is still some heat, but the green sauce will be mellower and still a great complement to the chicken.

Part One | Part Two

DASH and Other Conditions

Researchers in the UK reviewed the available published studies to see if some conclusions might be drawn on the effects of a DASH diet on other heart disease factors.⁵ For their meta-analysis the researchers gathered research articles that were randomized, controlled trials comparing a group following a DASH diet to a control group and measured risk factors including blood pressures, glucose scores, and cholesterol scores. The 20 articles included a total of over 1,900 men and women and the studies lasted from 2 to 24 weeks.

After analyzing the pooled results, DASH diet did result in improved blood pressures, with stronger results seen for those participants with higher starting blood pressures or higher Body Mass Indices. The DASH diet also helped improve total and LDL cholesterol levels, but no effect was seen on HDL cholesterol, triglyceride levels, or glucose scores. The authors do note that “the lack of a significant association between changes in BP [blood pressure] and dietary Na [sodium] intake is unanticipated.”

Polycystic Ovarian Syndrome (PCOS) affects as many as 18% of women worldwide. The name itself describes a fairly common effect of the disorder: multiple cysts on the ovaries that are believed to represent failed ovulation, which is also reflected by the infrequent or completely absent menstruation and infertility that is a symptom of the syndrome. Women with PCOS usually have increased levels of androgens, symptoms of hirsutism or acne and some level of Metabolic Syndrome. This combination of disorders also leads to poor lipid panels as well as higher markers of oxidative stress, which is likely to contribute to PCOS sufferers’ higher risk of breast, endometrial, and ovarian cancers.

In one study of 96 clinically overweight or obese women with PCOS between the ages of 18 and 40, researchers randomly assigned each participant to one of two diets for an 8-week trial: a low-glycemic-index diet or a DASH diet.⁶ Both diets were designed to provide 52% of calories from carbohydrates, 18% from protein, and 30% of calories from total fat, and were calibrated for each woman’s caloric needs at levels designed to induce moderate weight loss.

After assessing the women’s food diaries at the end of the 8 weeks, the researchers could see that the two groups ate essentially the same amounts of carbohydrates, protein, and fats, but those following the DASH diet consumed more whole grains (but fewer grains overall) and far less sugar, along with more vegetables, fruits, nuts, seeds, and legumes. Women on the DASH diet lost more weight (over twice as much, on average), and had lower triglycerides and insulin levels along with higher levels of antioxidant capacity and higher levels of glutathione.

In another study of a moderate-sodium DASH-type diet researchers found that in addition to the health benefits of the eating plan on blood pressure and bone health, DASH diet had a positive effect on improving mood in postmenopausal women.⁷

Other Variations on DASH Diet

Our research and attitudes toward dietary fats has changed dramatically in the last few years. One hurdle with DASH diet is the fairly low amount of saturated fat in the diet: the goal is about 6% of total calories from saturated fats and about 27% of total calories from all fats. For a 2,100 calorie diet that’s about 14 grams of saturated fat and 63 grams of total fat. Researchers in Northern California looked at the role of dietary fat in the context of a DASH diet.⁸

Sixty normal and clinically overweight men and women participated in a feeding study to find out. They were randomly assigned to one of three groups, and that group rotated through three different diets (designed to maintain their weight) in a random order, following each diet for three weeks then following their own usual diet for two weeks. The three diets were as follows:

A control diet of 47% of calories from carbohydrates, 14% from protein, 38% from fat (16% saturated fat), and 141 grams of total sugar.
A DASH diet of 55% of calories from carbohydrates, 17% from protein, 27% from fat (8% saturated fat), and 158 grams of total sugar
A High Fat DASH (HF-DASH) diet of 43% of calories from carbohydrates, 18% from protein, 40% from fat (14% from saturated fat), and 93 grams of total sugar.

After each dietary period the participants were weighed; their waist and hip circumferences measured; blood drawn for cholesterol, glucose, and insulin scores; and their blood pressures were taken. The authors found that both the DASH and the HF-DASH reduced participants’ blood pressures, both systolic (the top number) and diastolic (the bottom number) about the same amount. That’s interesting, because while the amount of sodium in the control diet was right around 3,000 milligrams per day, the DASH and HF-DASH diets only cut sodium to about 2,700 milligrams per day: usually those following a DASH diet are urged to keep their sodium under 2,400 milligrams/day.

The primary goal, however, was whether cholesterol scores were improved as much for the HF-DASH as for the standard DASH diet. While the HF-DASH diet and DASH diet both reduced total cholesterol about the same amount, the DASH diet also decreased both LDL and HDL cholesterol.

With today’s knowledge that processed meats are much more dangerous to your health than red meat (whether beef, pork, or venison), one can hardly blame the National Pork Board for funding research into pork products.⁹ In research looking at 19 clinically obese men and women to participating in a crossover feeding study with an initial 6-week period following one diet was followed by 4 weeks in which they followed their usual diet. Then the participants switched diets and continued for another 6 weeks.

The comparison diets were DASH-style diets that aimed to provide about 2,500 milligrams of sodium per day and the appropriate amount of calories for the participants to maintain their body weight. The difference was that for one six-week period, the participants consumed the vast majority of their animal protein in the form of chicken and fish; in the other, the main animal protein was pork in the form of pork tenderloin and fresh, uncured, and well-trimmed ham. Both diets permitted the participants to consume 2 servings of lean beef per week.

The authors tested the blood pressures of all participants at the start and end of the two diets and found that both diets decreased the participants’ blood pressures about the same amount. Further testing revealed that total cholesterol decreased more when the participants were following the DASH diet that included pork as opposed to the DASH diet including chicken and fish.

On the other hand, HDL cholesterol (the good cholesterol) decreased in those following the pork diet, while HDL increased in those following the chicken and fish diet.

There are drawbacks to this study including its funding and very small size. Regarding the cholesterol results, the authors note that the study was not primarily designed to assess cholesterol changes and suggest that those results should be interpreted “with caution.”

References

(Continued from Part One)

5. Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Brit J Nutr 2015;113(01):1-15. doi:10.1017/S0007114514003341.

6. Effects of DASH diet on lipid profiles and biomarkers of oxidative stress in overweight and obese women with polycystic ovary syndrome: A randomized clinical trial. Nutrition 2014;30(11-12):1287-1293. doi:10.1016/j.nut.2014.03.008.

7. D SJTP, D CANP. A moderate-sodium DASH-type diet improves mood in postmenopausal women. Nutrition 2012;28(9):896-900. doi:10.1016/j.nut.2011.11.029.

8. Chiu S, Bergeron N, Williams PT, Bray GA, Sutherland B, Krauss RM. Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial. Am J Clin Nutr 2016;103(2):341-347. doi:10.3945/ajcn.115.123281.

9. Sayer RD, Wright AJ, Chen N, Campbell WW. Dietary Approaches to Stop Hypertension diet retains effectiveness to reduce blood pressure when lean pork is substituted for chicken and fish as the predominant source of protein. Am J Clin Nutr 2015;102(2):302-308. doi:10.3945/ajcn.115.111757.

Part One | Part Two

The DASH (Dietary Approaches to Stop Hypertension) diet grew out of the Mediterranean diet literature. The original study that helped form the idea of DASH involved 459 adults with prehypertension or stage 1 hypertension.

None of the participants was taking any antihypertensive drugs, and the participants were a 50/50 mix of males and females, with the majority being African American. Over the course of 8 weeks, participants were randomly assigned to one of three diet groups. The diets were prepared for the subjects and picked up at the study center.¹

The control group was assigned to a diet that is similar to what Americans typically consume, and was somewhat lower in potassium, magnesium, and calcium. The next group ate similarly to the control group, but consumed much more fruits and vegetables. The third group consumed solely foods from the DASH diet. The DASH diet has many similarities with the Mediterranean diet, but with more adaptations for American taste. There is less emphasis on seafood and more focus on legumes.

View an example of DASH diet plan.  (Popup window)

After following these strict diet plans, the group who followed the DASH diet had a significant reduction in blood pressure. The group on the fruit and vegetable diet also had a reduction in their blood pressure, but not as significant as the DASH diet group. Most significantly, there was a marked reduction in blood pressures for those with Stage 1 hypertension who were following the DASH Diet. For many patients this would be significant enough to control blood pressure without medication.

DASH Sodium Study

The three diets in the original study contained 3,000 mg of sodium. Researchers wanted to observe the impact of sodium reduction on hypertensive control, so they designed a second study with similar diets but with three varying levels of sodium intake.² One group had a daily sodium intake of 3,000 mg/day, the second group had an intake of 2,400 mg/day, and the third group had an intake of 1,500 mg/day.

After following this diet, there was reduction in blood pressure at all three levels of sodium intake, but the most significant reduction came from the group only consuming 1,500 mg/day. The researchers found that lowering sodium intake to 1,500 mg/day reduced blood pressure by twice as much. When the DASH diet was combined with reducing sodium intake, the results in blood pressure reduction were greater, especially in patients with hypertension.

DASH and Heart Disease

Since poor cholesterol scores and high blood pressure can lead to heart disease, it seems reasonable to think that the DASH diet would help reduce the risk of heart disease and stroke. Yet there have been studies of the DASH diet that did not support that conclusion: in fact, one study showed no difference in blood pressure that couldn’t have been chalked up to the amount of weight lost by the test subjects while on the diet. However, researchers at Harvard, Simmons, and the American Cancer Society noted that the study didn’t thoroughly measure how well the test subjects followed the DASH diet. So they came up with a way to score a person’s diet according to how much (or how little) they typically ate of the various components of the diet.³

The group made use of information collected in the Nurses’ Health Study and included in their analysis those women who over the most recent 24 years filled out a number of detailed questionnaires about their dietary habits. A point was given to each test subject for each of the DASH diet components in their regular diet, while points were taken away for foods that those on DASH should avoid, such as red meat or sweetened beverages. The nurses’ dietary scores were then correlated with the scores of those women who experienced heart disease, heart attack or stroke. They found that the higher a nurse’s DASH score was, the less likely they were to have heart disease or stroke. In fact, those with the highest scores reduced their risk by as much as 26%.⁴

Part Two »

References

1. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997;336(16):1117-1124

2. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001(1);344:3-10

3. Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003;289(16):2083-2093

4. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 2008;168(7):713-720. doi:10.1001/archinte.168.7.713.

Part One | Part Two

The agricultural and industrial revolution made fats and sugars more available and affordable, leading to a typical American diet that is high in fat and refined carbohydrates (high in sugars and simple starches) and low in complex carbohydrates and fiber. Low fruit and vegetable intake have also contributed to the reduction in the amount of fiber in American diets. Because of the convenience and low cost of processed foods, many convenience food items produced in mass quantities are high in chemical content. Sodas, potato chips, packaged sweets, etc. all have large amounts of preservatives, artificial food colorings, and other highly processed ingredients that have all been shown to be detrimental to our brains when consumed in large amounts. Similarly, the explosion of fast food restaurants, the decline of traditional sit down family meals, and an emphasis on the convenience factor have all contributed to rising obesity rates in the US.

There has been a clear rise in overweight and obesity over the past 30 years:¹
72% of men and 64% of women are overweight or obese
32% of children and adolescents are overweight or obese

The standard American diet has contributed to an increasing incidence of cardiovascular disease, hypertension, type 2 diabetes, and obesity. Physical inactivity, larger portion sizes, and increased screen time – whether television or computer screens – are other lifestyle factors contributing to this unhealthy trend in growing waist sizes.

Glucose Dysregulation and Neurocognitive Decline

Obesity, metabolic syndrome, and diabetes are all examples of dysregulated glucose states (when the body does not use or process glucose correctly). Chronic high glucose levels and excess insulin levels induce a pro-inflammatory state in the body which disrupts normal biochemical processes.² This stressed state stimulates an overproduction of reactive oxygen species leading to oxidative stress. This pro-inflammatory state impairs the mechanisms in the body that control immune response and has been shown to cause alterations in brain signal processing. The hippocampus (the brain’s memory formation and processing center) is particularly susceptible to glucose mismanagement and decreases in volume and structure have been found in brains of patients with high serum glucose.³

The impairment associated with chronic diabetes extends beyond neurocognitive decline to an increased risk of Alzheimer’s Disease. Chronic excess insulin levels has been associated with impaired ability to clear amyloid beta proteins (which are the main component of the plaques in the brain typifying Alzheimer’s Disease) from the body and damaging the brain’s ability to regulate signals between brain cells – both pathologic features of Alzheimer’s Disease.⁴

The accumulation of amyloid beta proteins and impaired signaling between brain cells are linked to accelerated brain aging, which appears as microangiopathy (capillaries that are so weakened that they bleed or leak proteins into the surrounding tissue) and is detected by MRI as white matter high intensity lesions. These lesions, along with other structural changes, have been found to occur at higher rates in diabetic vs. non-diabetic populations.⁵

A recent systematic review of the literature showed that poor glucose control, as evidenced by hyperglycemia, high hemoglobin A1c levels, and wide glucose fluctuations are associated with poorer cognitive scores in Type 2 diabetics without dementia.⁶

Choosing Smart Carbohydrates

With impaired glucose management, whether it is obesity, metabolic syndrome, or Type 2 diabetes, being so closely linked with neurocognitive decline and the onset of Alzheimer’s, it’s important to take charge of our food choices, beginning with choosing smart carbohydrates. Cutting down on the amount of simple, refined sugars that are nutrient poor (such as white rice, grits, and sugar-laden foods) and being conscious about choosing complex carbohydrates that are also higher in fiber content (such as brown rice, oatmeal, fruits, and green leafy vegetables, as well as legumes) will prevent our bodies from becoming subjected to sudden glucose and insulin spikes.

High Fat Diets and Poor Cognitive Health

Diets high in saturated fats have been linked to impairments in cognitive functions, specifically functions involving memory, speed and flexibility in both the short term and the long term.⁷ In one study, men were given either a 17% fat diet or 74% fat diet. After 7 days, those consuming the high fat diet had significantly decreased attention scores.⁸ In another study, high saturated fat intake has been linked to decline in memory, processing speed, and attention measures over a six year period.⁹

Multiple studies have linked increasing ADHD rates with an increased intake of the Western diet: one high in total and saturated fats and simple sugars. When recent CDC prevalence maps of ADHD and obesity rates by state were compared side by side, there is a startling parallel between the most obese states and those with the highest percentages of children ever diagnosed with ADHD.¹⁰

References

1. Ogden et al. “Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960-1962 Through 2007-2008” June 2010. http://www.cdc.gov/NCHS/data/hestat/
obesity_adult_07_08/obesity_adult_07_08.pdf

2. Roriz-Filho et al. “(Pre)diabetes, brain aging, and cognition.” Diabetes and the Nervous System 2009;1792(5):432-443

3. Kerti et al., “Higher glucose levels associated with lower memory and reduced hippocampal microstructure.” Neurology 2013;81:1746-52

4. Roriz-Filho et al. “(Pre)diabetes, brain aging, and cognition.” Diabetes and the Nervous System 2009;1792(5):432-443.

5. Akisaki et al. “Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J-EDIT).” Diabetes Metabolism Research and Review 2006; 22:376-384.

6. Geijselaers et al. “Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review.” Lancet Diabetes Endocrinology 2015; 3:75-89.

7. Barnard et al. “Saturated and trans fats and dementia: a systemic review.” Neurobiology of Aging 2014; 35(2): S65-S73.

8. Edwards et al. “Short-term consumption of a high-fat diet impairs whole-body efficiency and cognitive function in sedentary men.” The FASEB Journal. March 2011, Vol 25.

9. Morris et al. “Dietary fat intake and 6-year cognitive change in an older biracial community population.” Neurology 2004;62(9):1573-9.

10. Howard et al. “ADHD is Associated With a ‘Western’ Dietary Pattern in Adolescents.” Journal of Attention Disorders 2011;15:403.

Inflammation is the body’s response to things that might cause damage: this might include dysfunctional cells, invading foreign agents (like a virus or a bacteria) or exposure to toxins. The purpose of inflammation is to attract immune cells to destroy the damaging invader and return the tissue to normal. Acute inflammation is a temporary response, with the probably familiar signs of heat, redness, swelling, pain, and perhaps loss of function.¹

When acute inflammation fails to repair the tissue, chronic inflammation occurs. Inflammatory cells, particularly lymphocytes, macrophages, and plasma cells, become overactive. Macrophages, for example, produce a substance known as cytokine that in essence causes a chain reaction of more inflammation, which can ultimately damage not just individual cells, but also tissues and whole organ systems. Unlike acute inflammation, you can’t usually feel the damage chronic inflammation is doing to your body. This chronic inflammation plays a role in almost all of the top causes of mortality in the U.S..²

The Typical Western Diet Leads to Chronic Inflammation

Inflammatory foods, harmful chemicals, artificial preservatives, smoking, stress, lack of sleep, and excess body fat promote a state of oxidative stress (which is an imbalance between free radicals, which damage cells, and the body’s ability to counteract them) within the body. Excessive free radicals damage the cells and lead to chronic inflammation.³ Diet has a significant effect on the body’s level of inflammation: pro-inflammatory ingredients that the U.S. consumes in large amounts include trans and saturated fats, omega-6 polyunsaturated fatty acids, sugar, artificial preservatives, artificial sweeteners, refined grains, and alcohol.⁴

Saturated fats are usually solid at room temperature and are found in animal fats and tropical oils. They increase LDL levels (the bad cholesterol) and increase your risk of cardiovascular disease.

Trans fats are formed when liquid oils are hydrogenated, which helps keep processed foods such as margarine, shortening, deep-fried foods, fast foods, and commercial baked goods shelf-stable. Trans fats also raise LDL levels and lead to free radical formation, which oxidizes LDL cholesterol and results in inflammation.

Oxidized LDL contributes to atherosclerosis and blood clots in the arteries by causing dysfunction in the endothelial cells (the inner lining of the veins and arteries). Damaged endothelial cells produce cytokines, which help promote the deposition of fat plaques within the arteries. These can lead to blood clots, which can become clots in the heart or brain and cause strokes.⁵

Sugar (glucose) is contained in baked goods, flavored yogurts, candies, soft drinks, and fruit juices, among other products. Interestingly, white bread made with highly refined flours is registered by the body as sugar. Higher levels of glucose in the bloodstream lead to an abundance of reactive oxygen species (a type of free radical), which damage DNA as well as activate the production of advanced glycation end products (AGEs – an oxidant formed when sugars chemically react with proteins). AGEs accumulate in the tissues and contribute to the development of diabetic complications. Additionally, AGEs can oxidize LDL cholesterol and lead to microvascular complications through endothelial cell disruption. AGEs that bind to the a specific receptor, RAGE, trigger a pro-inflammatory cascade, which can lead to scavenger cells (macrophages) attacking affected tissues.⁶

Free Radicals

Saturated and trans fats, alcohol, smoking, artificial preservatives, and stress contribute to free radical production. When free radicals circulate without opposition from protective antioxidants, the membranes surrounding the mitochondria become more permeable and leak contents into the rest of the cell. When the leak is detected by certain receptors, an inflammatory cascade follows, leading to further cell damage. Free radicals that are linked to oxidative stress and AGEs result in chronic degenerative inflammatory disorders, such as cancer and aging.⁷

Advanced Glycation End Products (AGEs)

The advanced glycation end products consumed in the diet also play a role in degenerative diseases. AGEs are most commonly consumed in the form of meats cooked at high temperatures, dairy products, and foods with a high sugar content. AGEs make cells stiffer and dysfunctional by negatively modifying proteins and damaging the molecules the cells secrete that help support neighboring cells. They lead to the oxidation of LDL cholesterol and atherosclerosis.

AGEs can also contribute to degenerative disorder complications (for example, diabetic nephropathy) by accumulating in the tissues. AGEs also bind to a specific receptor, RAGE, which plays a role in the copying of RNA in the creation of cells and the proteins located on the cell’s surface that make the cells stick together, causing atherosclerosis. The binding of AGEs with RAGE is known as AGE-RAGE and also stimulates the movement of scavenger cells to organs throughout the body, leading to damage and dysfunction. AGEs thus play a role in atherosclerosis and heart disease,⁸ diabetic complications,⁹ renal failure, nervous system disorders, and aging.¹⁰

Anti-inflammatory Omega-3s vs. Pro-inflammatory Omega-6s

There are 2 essential fatty acids we must obtain from our diet because our bodies cannot synthesize them: alpha-linolenic acid, an omega-3 fatty acid, and linoleic acid, an omega-6 fatty acid.

Both omega-3 and omega-6 fatty acids are stored as phospholipids in the cell membrane and utilize the same enzymes. Because these polyunsaturated fatty acids (PUFAs) are essential, the ratio of omega-3s to omega-6s in the diet will determine which type predominates in the cell membranes and which types of signaling molecules are created by the cell when it is stimulated by inflammatory hormones.¹¹ A high intake of omega-6s, typical in the Western diet, produces mostly harmful inflammatory hormones. These include those responsible for increased activation of new platelets, which also makes those platelets more likely to stick together; and those responsible for inducing fever. By using the enzymes Omega-6s need to produce these harmful hormones, Omega-3s can keep the omega-6s from being utilized: they are considered anti-inflammatory.¹²

It is important to maintain the recommended 4:1 or 2:1 ratio of omega-3 to omega-6 polyunsaturated fatty acids in the diet, especially because the standard American diet is high in inflammatory omega-6s. Here’s how you can improve your ratio of omega-3s to omega-6s:

• Cook with oils that are high in omega-3s such as olive oil, macadamia nut oil, canola oil, or avocado oil.
• Limit processed, fried, and fast foods.
• Read food labels carefully since many omega-6s are hidden in packaged foods in the form of corn oil, safflower oil, or hydrogenated oils.
• Look for low omega-6 content in dressings and sauces.

The Anti-inflammatory Diet is the Mediterranean Diet

The purpose of the Anti-inflammatory diet is to provide proper nourishment for the body that also protects against chronic inflammation. It shares most of its principles with a Mediterranean style diet.

• Eat a balanced variety of macronutrients.
• Reduce saturated fats.
• Eliminate all foods containing trans fats.
• Eat at least one good source of omega-3 fatty acids every day.
• Eat at least one serving of whole grains at every meal.
• Consume lean sources of protein.
• Move to a predominantly plant-based diet.
• Eliminate processed and refined foods.

The Anti-inflammatory diet is a slight modification of the Mediterranean diet and similarly encourages eating vegetables, legumes, fruits, nuts, whole grains, lean proteins like fish, and good fats such as olive oil. It also emphasizes reducing consumption of full-fat and processed animal meats.¹³

Recommendations

1. Remove refined and processed foods from the diet. Do this by cooking at home as much as possible with fresh and nutritious ingredients.

2. Try to meet daily recommended servings of fruits, vegetables, whole grains, healthy fats and proteins a day. Aim for a rainbow colored plate with ample fruits & vegetables.

3. Avoid omega-6 fatty acids and trans fats whenever possible. Instead, utilize monounsaturated and omega-3 polyunsaturated fatty acids that have anti-inflammatory effects.

5. Be mindful of eating and exercising. Excess body fat itself releases pro-inflammatory cell signaling proteins. Keeping the weight off will naturally decrease the levels of inflammation and stress on the body.

References

1. Cotran, and Robbins. Pathologic Basis of Disease. Eighth ed. Philadelphia: Saunders Elsever, 2010.

2. Centers for Disease Control and Prevention. FASTSTATS – Leading Causes of Death. cdc.gov. April 8,2015. June 2, 2015. http://www.cdc.gov/NCHS/fastats/Default.htm.

3. I S Young, J V Woodside.  “Antioxidants in health and disease.” Journal of Clinical Pathology. 2001;54:176-186.

4. Cannon, Christopher P., and Heidi McIndoo. The Anti-inflammation Diet. New York: Alpha, a Member of Penguin Group (USA), 2014.

5. Viles-Gonzalez, Juan, Valentin Fuster, Juan J. Badimon.  “Atherothrombosis: A widespread disease with unpredictable and life-threatening consequences.” European Heart Journal (2004) 25, 1197-1207.

6. Semba, Richard D., Emily J. Nicklett, and Luigi Ferrucci.  “Does Accumulation of Advanced Glycation End Products Contribute to the Aging Phenotype.” Journal of Gerontology: Medical Sciences. 2010 September, 65A(9): 963-975.

7. Lobo, V. et al.  “Free Radicals, Antioxidants and Functional Foods: Impact on Human Health.” Pharmacognosy Reviews 4.8(2010): 118-126. PMC. Web. 16 June 2015.

8. Barnard, Neal D. Nutrition Guide for Clinicians. Washington, DC: PCRM/Physicians Committee for Responsible Medicine, 2009. pgs. 251-261.

9. Kalousova, M., J. Skrha, and T. Zima. Advanced Glycation End-Products and Advanced Oxidation Protein Products in Patients with Diabetes Mellitus. Physiol. Res. 51:597-604, 2002.

10. Semba, Richard D., Emily J. Nicklett, and Luigi Ferrucci.  “Does Accumulation of Advanced Glycation End Products Contribute to the Aging Phenotype.” Journal of Gerontology: Medical Sciences. 2010 September, 65A(9): 963-975.

11. Keeren, Kathrin, et al.  “Effect of Different Omega-6/Omega-3 Polyunsaturated Fatty Acid Ratios on the Formation of Monohydroxylated Fatty Acids in THP-1 Derived Macrophages.” Biology 2015, 4(2), 314-326.

12. Murray, Robert K. Harper’s Illustrated Biochemistry. New York: Lange Medical /McGraw-Hill, 2006.

13. Salas-Salvado, Jordi MD PHD, Patricia Casas-Agustench BSc, Michelle M Murphy PhD, Patricia Lopez-Uriarte BSc, and Monica Bullo PhD.  “The effect of nuts on inflammation. ” Asia Pacific Journal of Clinical Nutrition 2008;17 (SI): 333-336.