Diet

NUTRITION

General principles of a healthy diet:

Eat lots of fruits and vegetables.
Eat moderate amounts of whole grains (pastas, breads, cereals, and rice).
Eat moderate amounts of nuts and seeds (unsalted, not roasted)
Eat moderate amounts of fatty fish (BEWARE of tuna and farmed salmon)
Limit meat, especially red meat.
Limit fatty, greasy, fried foods.
Use low-fat or no-fat varieties for milk and milk products

Organic foods – see way below in this outline

Whole foods vs. refined foods: primitive diets vs. modern diets and physical degeneration (Weston Price, DDS. Nutrition and Physical Degeneration. 1939)

Weston Price’s review of the research in his “search for the cause of degeneration of the human face and dental organs” led him to conclude that “The evidence seemed to indicate clearly that the forces that were at work were not to be found in the diseased tissues, but that the undesirable conditions were the result of the absence of something, rather than the presence of something.” (16^th Printing. 2004. Pg 21).
Weston Price thus decided in 1930 to travel the world and seek out primitive cultures with no exposure to the “white man’s diet” of refined grains, and analyze the nutrient content of these primitive diets, and correlate this information with careful analysis of the prevalence of dental caries (cavities) and deformities of the dental arch (the cause of the need for orthodontia).
Price visited the Eskimos in Alaska, native American Indians in multiple locations, African tribes, and Australian Aborigines.

He found that the diets were tremendously diverse, depending on geographic location. “Some were based on sea foods, some on domesticated animals, some on game and some on dairy products. Some contained almost no almost no plant foods while others contained a variety of fruits, vegetables, grains, and legumes…However, these diets shared several underlying characteristics…All the diets contained animal products of some sort and all included some salt” (16^th Printing. Prologue. 2004. xv- xvi).
Price found that consumption of primitive diets was associated with a much lower incidence of dental caries, deformities of the dental arch, and tuberculosis!
Analysis of the primitive diets showed “that all contained at least four times the quantity of minerals and water-soluble vitamins of the American diet of his day” and “at least TEN times the amount of fat-soluble vitamins found in animal fats” (16^th Printing. Prologue. 2004. xvi). He attributes much of the insufficiency of vitamins and minerals in the diet to depletion of the soil (pg 392).

USDA (United States Department of Agriculture) Guidelines for healthy eating

1930's - The Basic 12 1940's - The Basic 7 1956 - The Basic 4

Milk, dairy products Milk, milk products Milk
Potatoes, sweet potatoes Tomatoes and fruits Meat
Dry peas, beans, nuts Leafy greens Vegetables and fruits
Tomatoes and citrus fruits Other vegetables and fruits Breads and cereals
Leafy greens and yellow vegetables Butter and fat
Other vegetables and fruits Lean meat, poultry, fish
Eggs Flour and cereals
Lean meat, poultry, fish
Flour and cereals
Butter
Other fat
Sugar

Some argue that the creation of the "Basic Four" was heavily influenced by the meat and dairy industry lobbies. Either way, as scientific understanding of healthy nutrition advanced, it became clearer that the "Basic Four" was an inadequate guide for the public with regard to healthy eating.
The food pyramid released by the USDA in 1992 is an improvement conceptually, but not ideal.

The scientific limitation of the food pyramid based on emerging understanding of nutrition is that it does not distinguish between types of fat or types of carbohydrate and also does not distinguish the source of protein.
Note part of the objective of the USDA in 1992 was to keep things simple for the public

USDA EATING RIGHT FOOD PYRAMID

/ fats \

/       sweets            \
/ milk, meat, nuts, eggs\
/         fruit, vegetables    \
/              grains                 \

The USDA on 4/19/05 revealed ‘MyPyramid’ by turning the old food pyramid on its side, adding exercise in the form of steps up the side of the pyramid, and showing each food group as a triangle in the pyramid from the base to the apex, with the base representing healthier choices within the food group, such as whole grains as opposed to highly refined carbohydrates.

The food groups are grains, vegetables, fruits, milk, meat and beans, and oils.
There are 12 pyramids which provide quantities of food based on individual age, sex, and weight
More information at www.mypyramid.gov – this site is interactive and includes:

§ MyPyramid Plan – quick estimate of how much food to eat based on age, sex, and weight.

§ MyPryramid Tracker – more detailed information on individual diet quality and physical activity status.

§ Inside MyPyramid – in-depth information for every food group.

§ Start Today – provides tips and resources.

This pyramid is more representative of scientific understanding of nutrition than the 1992 pyramid, but many experts feel that it still has shortcomings.

§ A couple of examples include lack of attention to trans fats, and encouragement of excess consumption of dairy.

§ An excellent critique appears in Integrative Medicine: A Clinician’s Journal. 2005. 4 (6). 14-19.

o Note that while there is published data that the Mediterranean diet is associated with increased longevity, lower incidence of metabolic syndrome, decreased risk of cardiovascular disease, and a reduced risk of death from cancer (see references in the section on Mediterranean diet at the bottom of this outline), there is no research to show that the MyPyramid dietary protocol reduces the risk of disease or death.

The USDA in June 2010 replaced ‘MyPyramid’ with ‘MyPlate,’

‘MyPlate’ divides the plate into approximate quarters, with just over ¼ of the plate with vegetables, just less than ¼ of the plate with fruit, ¼ of the plate with sources of protein, and ¼ of the plate with grains (and dairy as a side dish).- more info at www.choosemyplate.gov
A limitation of MyPlate is that the pictorial does not distinguish between refined grains and whole grains.

The Dietary Guidelines for Americans are released every 5 years by the USDA – they were released 1/12/05, and updated in January, 2011

They are based on recommendations from a 13 member advisory committee
The full 70 page report and 9 page consumer pamphlet are available at www.healthierus.gov/dietaryguidelines/
These serve as the foundation for federal nutrition policy and education.
Compared with past guidelines, the 2005 guidelines are much more specific about what to eat and how much to exercise.

§ Shift ½ of grain intake to whole grains

§ Consume 4 ½ cups of fruits and vegetables per day, nearly double the previous recommendation

§ Boost daily physical activity

NOTE that the USDA is the agency responsible for both the food pyramid and promoting the livestock industry, which is viewed by many as an institutional conflict of interest.

In 1991, Time magazine addressed this in an article entitled “Playing Politics with Our Food: While the Food and Drug Administration reforms labels, the Agriculture Department drags its feet, thanks to its cozy relations with the meat industry” (Time. 7/15/91. 57-58).
In 1999, the Physicians Committee for Responsible Medicine (PCMR) sued the USDA, charging that it had hidden from the public information about the background of some members of its advisory committee. It turns out that more than half of the 11 members of the advisory committee have ties to the meat, dairy, and egg industries.
PCMR won the lawsuit in 2000, so during the next revision of the guidelines after the 2001 revision, the advisory committee selection process must be made more public (Natural Health, 4/01).
Some nutrition experts recommend that the Department of Health and Human Services assume responsibility for revising the food pyramid, to avoid the above conflict of interest.
Food Politics (2002) by Marion Nestle, chair of the Nutrition Department at NYU, provides an excellent critique of this inevitable conflict of interest.

NOTE that research sponsored by manufacturers or groups with commercial interest was four to eight times more likely to be favorable than research that wasn’t industry sponsored, and most published studies nowadays are financed by organizations with commercial ties, rather than by the government (PLoS Medicine. 1/07).

Harvard School of Public Health Guidelines for healthy eating - formulated by Walter Willett, MD, DrPH is an alternative construct which is representative of current scientific understanding of nutrition.

WALTER WILLETT PYRAMID (1994)

/ red meat   \
/     sweets      \
/        butter         \
/ fish, poultry, eggs \
/    dairy or Ca suppl    \
/           nuts, legumes       \
/            most veg oils          \
/           fruits, vegetables         \
/              whole grains                \

HEALTHY EATING PYRAMID IN EAT, DRINK, AND BE HEALTHY (2001)

/__________red meat, butter__________\
/_____high glycemic index carbohydrates_____\
/__dairy food or calcium supplement 1-2 times/day__\
/__________fish, poultry, eggs 0-2 times/day__________\
/____________nuts and legumes 1-3 times/day____________\
/_______vegetables in abundance, fruits 2-3 times/day________ __\
/___________whole grain foods and plant oils__________________\
/ daily exercise and weight control _____\

Alcohol in moderation, multiple vitamin

University of Michigan Integrative Medicine Clinical Services has developed and alternative pyramid, released 3/7/05, available as an interactive web-based nutrition tool at www.med.umich.edu/umim. Summary article: (Explore. 2006. 2. 352-356).

HEALING FOODS PYRAMID

/____Accompaniments___\

/_______Lean meats_______\

/___________Fish and seafood__________\

/________________Eggs and dairy_______________\

/____________________Seasonings and healthy fats________________\

/____________________________Legumes___________________________\

/____________________________________Grains___________________________________\

/______________________________________Fruits and vegetables_________________________\

/__________________________________________Water_________________________________________\

The American Institute for Cancer Research (AICR) in 1999 launched the ‘New American Plate’ approach to meal planning – the plate is divided into 2/3 (or more) vegetables, fruits, whole grains, beans, and nuts and 1/3 (or less) sources of animal protein, including lean meat, poultry, fish, cheese, and yogurt.

Andrew Weil, MD has outlined an anti-inflammatory diet pyramid (www.healthyaging.com)

Macronutrient composition of the diet

· Hunter-gatherer societies estimated macronutrient ratio: 19-35% protein, 22-40% carbohydrate, 28-47% fat (Mayo Clin Proc. 2004. 79. 101-108).

· US diet macronutrient ratios according to NHANES III: 15.5% protein, 49% carbohydrate, 34% fat, 3.1% alcohol.

· Macronutrient guidelines from the Institute of Medicine (www.iom.edu) – 20-35% fat, 45-65% carbohydrate, 10-35% protein.

· It is estimated that carbohydrates constitute 70-80% of calories consumed by humans globally.

Fats

Old wisdom:

Polyunsaturated fat is best because it lowers total cholesterol.
Saturated fat is worst because it raises total cholesterol.
Monounsaturated fat is bad because it has a neutral effect on total cholesterol.
Total fat should be limited because of the association between fat intake and atherosclerosis.

New wisdom -the form of fat is very important:

Omega 3 polyunsaturated fats are best for a variety of reasons (see below).
Mono-unsaturated fat is very good because it raises HDL and lowers LDL cholesterol.
Omega 6 polyunsaturated fats are essential in small amounts (3-6% of total calories, which is roughly one tablespoon daily) but should be limited because they may lower HDL cholesterol disproportionately, may trigger free radical chain reactions which increase the risk of cancer and atherosclerosis, and may lead biochemically to increased production of pro-inflammatory prostaglandins.
Saturated fat should be limited; it raises LDL cholesterol (bad cholesterol) and increases the risk of heart disease.
Trans fat is worst - it lowers HDL cholesterol and raises LDL cholesterol, and has a number of other deleterious effects (see below).
Total fat intake can comprise up to 40% of total caloric intake, as long as it is predominantly good fats which are consumed.

Note all fats are calorie dense, containing 9 calories per gram whereas carbohydrates and protein contain 4 calories per gram. This is not bad per se but reminds us of the importance of limiting the quantity of fat consumed.
Note the National Academy of Sciences reported in 1989 that, contrary to previous popular wisdom, total fat intake alone is not associated with heart disease risk.
Note that the ratio of fat to carbohydrate used in the fuel mix for most cells in our body is determined by the prevailing insulin level - hyperinsulinemia (an insulin level that is always high such as in insulin resistant individuals) means the cells are constantly required to burn carbohydrate and dietary fat ends up stored as body fat instead of burned as fuel.
Structural categorization of fat.

Most dietary fat is in the form of triglycerides, which are composed of three fatty acid molecules bound together by a glycerol molecule.
Fatty acids are straight chain hydrocarbon chains with a methyl group (CH3) at one end and a carboxyl group (COOH) at the other end.
Saturated fat is composed of fatty acids with no carbon-carbon double bonds and is solid at room temperature, mono-unsaturated fat is composed of fatty acids with one carbon-carbon double bond and is liquid at room temperature, and polyunsaturated fat is composed of fatty acids with two or more carbon-carbon double bonds and is also liquid at room temperature.
The omega classification of fats is based on the location of the first carbon-carbon double bond, with carbons counted from the methyl end of the molecule.
Fatty acids are classified as very-short-chain (VSCFA) containing 2-3 carbon atoms, short-chain (SCFA) containing 4-6 carbon atoms, medium chain (MCFA) containing 8-14 carbon atoms, and long chain (LCFA) containing 16 or carbon atoms.
Fat in the body exists in two main structural forms:

Straight chain fatty acids – phospholipids, sphingolipids, glycosphingolipids. These are highly modifiable.
Ring-like structures –sterols – cholesterol, phytosterols. These are hydrophobic and rigid in structure.

Functional description of fat – it is a lipid (i.e. substances insoluble in water, soluble in organic solvents, and able to be used by the body).
Functions of fats - energy source, components of cell membranes, precursors to eicosanoids (prostaglandins, leukotrienes), precursors to hormones, regulate gene expression (via activation or inhibition of NF-KB and PPARs).

Butyric acid, a short chain fatty acid, is the preferred fuel for colonic epithelial cells (colonocytes).
Medium-chain triglycerides, and specifically those containing caprylic acid (8 carbon atoms) and capric acid (10 carbon atoms), have been shown to improve the course of many health problems such as pancreatic insufficiency, liver cirrhosis, epilepsy, and glycogen storage diseases.

Fat consumption and satiety

Mediated in part by release of CCK.
The research on satiety in experimental situations shows that fat consumption has a weak effect on satiety; consumption of low energy density foods such as fruits and vegetables has a stronger effect on satiety.

Essential fatty acids – omega 3 and omega 6 polyunsaturated fatty acids are essential in mammals because mammals do not synthesize desaturase enzymes that can insert a double bond closer than 7 carbon atoms away from the methyl end of the carbon chain.

Saturated fat

Saturated fat includes animal fat (red meat, poultry skin, milk products), and tropical oils (palm oil and coconut oil).
Saturated fat consumption raises LDL cholesterol levels – this statement is based on a published meta-analysis of 27 trials (Arterioscler Thromb. 1992. 12. 911-919). Saturated fats in butter and other dairy products have the most detrimental effect on LDL cholesterol, saturated fats in meat have a less detrimental effect, and saturated fats in chocolate have the least detrimental effect on LDL, as per Walter Willett. Stearic acid (the fat in chocolate) is rapidly converted into a oleic acid, a mono-unsaturated fat.
Saturated fat consumption and risk of coronary heart disease – the generally accepted conventional dogma is that saturated fat consumption is associated with an increased risk of coronary artery disease.

Many prospective cohort studies show a correlation between saturated fat consumption and risk of coronary artery disease

These studies include the Nurses’ Health Study in 80,082 women (N Engl J Med. 1997. 337. 1491-1499) and the Ireland Boston Diet-Heart Study in 1001 men (N Engl J Med. 1985. 312. 811-818).
Of note, data from the Nurses’ Health Study indicates that replacing 5% of energy from saturated fats with energy from nonhydrogenated, unsaturated fats could reduce the risk of CHD by 42% (N Engl J Med. 1997. 337. 1491-1499).
Additional data supporting a link between saturated fat consumption and risk of coronary artery disease comes from cross-population studies such as the Japan-Honolulu-San Francisco Study in 11,900 men (J Chronic Dis. 1974. 27. 345-364).

There is however data that fails to show an association between saturated fat consumption and risk of coronary artery disease

A meta-analysis of 21 prospective cohort studies in a total of 347,747 subjects, and with 5 to 23 years of follow up failed to show a correlation between saturated fat consumption and risk of coronary artery disease, stroke, or cardiovascular disease, even when adjusted for age, gender, and study quality (Am J Clin Nutr. 2010 91. 535-546).
In terms of cross cultural data, in two Polynesian populations living near the equator, saturated fat intake is very high, estimated at 47% of total energy, mostly from coconut, but vascular disease is uncommon (Am J Clin Nutr. 1981;34:1552-1561).
The observed association between saturated fat consumption and risk of coronary artery disease in many studies may be a function on how the foods are prepared. Specifically, the association between saturated fat consumption and risk of coronary artery disease might be a function advanced glycation end products and cholesterol oxides which form during the cooking and processing of foods such as dairy and meat (cited by Alan Gaby, MD in a Commentary in Townsend Letter. June 2010. Pg 24).

NOTE that the butyric acid in butter, which is a short-chain fatty acid, plays a critical role from an energy standpoint in supporting the colonic epithelial cells.
Conventional wisdom - it is best to take less than 10% of calories from saturated fat.

Monounsaturated fat

Includes avocados, canola oil, olives, olive oil, and various nuts and seeds.
Olive oil is composed primarily of oleic acid, and omega 9 fatty acid.
Monounsaturated fat intake is associated with lower levels of LDL and total cholesterol, protection against thrombogenesis, reduced LDL susceptibility to oxidation, and better glycemic control (J Nutr. 1999. 129. 2280-2284). In a 12 week crossover trial in 26 college students, those consuming a high monounsaturated fat diet showed less lipid peroxidation than those consuming a high polyunsaturated fat diet (Am J Clin Nutr. 1991. 53. 899-907).
Monounsaturated fat consumption is also correlated with an decreased risk of coronary heart disease, based on data from prospective cohort studies such as the Nurses’ Health Study in 80,082 women (N Engl J Med. 1997. 337. 1491-1499), cross population studies such as the Seven Countries Study in 12,770 men (Circulation. 1970. 41 [4 suppl]. 1-198), and epidemiologic studies such as the Coronary Mortality in France and Finland study (Circulation. 1993. 88. 2771-2779).
BEWARE monounsaturated fat created by hydrogenation of polyunsaturated fat (i.e. stick margarine) is unhealthy because hydrogenation creates trans-configuration fatty acids (see ‘trans fats’ below).

Polyunsaturated fats (PUFA) – these are essential; they cannot be synthesized in the human body (a fact known since 1929)

Omega 3 fatty acids

These are found in fish in the form of EPA (eicosapentanoic acid) and DHA (docosahexanoic acid) and in vegetable sources in the form of ALA (alpha linolenic acid).

ALA is a short chain fatty acid and EPA and DHA are long chain fatty acids - in the human body, only about 15% of ALA is converted to EPA and only about 5% to DHA, and there are a number of identifiable factors which can inhibit this conversion even further (Am J Clin Nutr. 1999. 70. 560S-569S; Curr Opin Clin Nutr. 2004. 7. 137). Conversely, GLA may facilitate conversion of ALA to EPA.
Omega 3 fatty acid content of fish (grams EPA + DHA per 3 ounce serving) - atlantic salmon (1.8), atlantic herring (1.7), whitefish (1.4), pink canned salmon (1.4), bluefin tuna (1.3), atlantic mackerel (1.0), wild rainbow trout (1.0), bluefish (0.8), sardines canned in oil (0.8), blue mussels (0.7), swordfish (0.7), white tuna canned in water (0.7), freshwater bass (0.6). See Consumer Reports 7/03 page 32 for a complete listing of other fish with lesser amounts of DHA (docosahexanoic acid) and EPA (eicosapentanoic acid).
Omega 3 fatty acid content in vegetable sources (7.6 grams ALA per tablespoon of flax oil, 1.6 grams ALA per tablespoon of canola oil, 1.5 grams of ALA per tablespoon of walnut oil, 2.1 grams of ALA per 3.5 ounces cooked soybeans).

· Mechanisms of action of omega 3 polyunsaturated fatty acids (PUFAs) Consumer Reports 7/03

Antiarrhythmic - they may electrically stabilize the heart muscle cells and thus reduce the risk of sudden death due to an arrhythmia. This protection may be effective only for arrhythmia induced by ischemia.
Anti-inflammatory - they are converted into anti-inflammatory eicosanoids (prostaglandins and leukotrienes), and thus may stabilize arterial plaque. EPA inhibits D5D enzyme which converts DGLA to arachidonic acid. In a primary prevention trial, those patients treated with 1.4 grams of fish oil daily showed significant decrease in inflammatory markers hsCRP, TNF alpha, interleukin-6, and leukotriene B4, as compared with placebo (Micallef MA et. al. Atherosclerosis. 9/27/08. epub).
Antithrombotic - they may decrease the stickiness of platelets, reducing the risk of forming a blood clot. Decrease fibrinogen and decrease blood viscosity.
Antiatherosclerotic - they may make the arteries more elastic, reducing the risk of high blood pressure triggering plaque rupture. They may also stabilize plaque - data from a RCT in 188 patients randomized to receive sunflower oil versus fish oil supplements prior to a scheduled carotid endarterectomy found that those who received the fish oil had had thicker fibrous caps covering the carotid plaque (Lancet. 2003. 361. 477-485).
Improve endothelial function.
Improved systemic arterial compliance.
Increase vasodilatation.
They may increase heart rate variability (Chest. 2005. 127. 1102-1107).
High doses reduce the serum triglyceride level, raise HDL, decrease Lp (a), and increase particle size of LDL.
Decrease free radical production.
DHA lowers blood pressure.
DHA reduces insulin resistance in overweight patients, and appears to improve cell membrane receptor function and signal transduction.
Anti-cancer effects – reduce inflammation, reduce angiogenesis, decrease oncogenes, induce cell differentiation, suppress NFKB, suppress apoptosis blocker bcl-2, reduce cachexia (J Nutr. 2002. 132. 3508S-3512S).

For therapeutic uses of omega 3 fatty acids, including supplements, return to Home Page, click on “Dietary Supplements” and scroll to ‘Fatty acids’ then scroll on to ‘Fish oil capsules.’

Omega 6 fatty acids

These are found primarily in vegetable oils (corn, safflower, sesame, soy, and sunflower).
These oils are added to many baked goods and prepared foods.
Cattle are now fed soy meal and corn meal, often rather than grazing, so the fat in animals is composed of predominantly omega 6 fatty acids.
Note pasture raised animals are likely to have more omega 3 fatty acids and less omega 6 fatty acids than animals fed corn meal or soy meal.
LA (linoleic acid) is the fatty acid which is the biochemical precursor to all other omega 6 fatty acids in the body.
Omega 6 fatty acids can be converted either into pro-inflammatory or anti-inflammatory eicosanoids, with research ongoing to determine factors which influence which biochemical pathway is followed.
There is controversy regarding whether higher intake of omega 6 fats is good or bad:

Historically, tens of thousands of years ago, it is estimated that the dietary intake of omega 6 polyunsaturated fatty acids to omega 3 polyunsaturated fatty acids was 2:1 or even 1:1, with 25-50% of protein derived from aquatic sources. Data to support this 1:1 ratio includes carbon and nitrogen isotope measurement of femur collagen, paleoarcheological samples, dental wear patterns, cave art, and artifacts (Richards et al. Proc Natl Acad Sci. 2001). The ratio of omega 6 to omega 3 in the standard American diet is estimated at 20:1 (Am J Clin Nutr. 1999. 70. 560S-569S). An optimal ratio of omega 6 to omega 3 fatty acids is believed to be 4:1 (Am J Clin Nutr. 1999. 70. 560S-569S).
There is evidence that omega 6 fats promote inflammation, thrombosis, and insulin resistance (Lipids. 2001. 36. 1007-1024; Ann N Y Acad Sci. 1997. 827. 287-301; Eur J Clin Invest. 1997. 27. 780-787).
Administration of omega 6 fatty acids removes EPA from cell membranes, relocating EPA from phospholipids to triacylglycerols (J Lipid Res. 1992. 33. 1431-1440). Evidence suggests that EPA must be incorporated into cell membrane phospholipids in order to exert its beneficial effect on eicosanoid metabolism.
There is competing evidence that linoleic acid decreases thrombosis (Am J Clin Nutr. 1997. 65. 1687S-1698S), decreases arrhythmias (Am J Clin Nutr. 1991. 53. 1047S-1049S), and improves insulin sensitivity (Diabet Med. 2002. 19. 456-464).
In a population-based cohort of 1551 middle-aged men whose dietary composition was estimated with a 4-day food record, linoleic acid intake was correlated with a cardioprotective benefit over a 15-year follow-up (Arch Intern Med. 2005. 165. 193-199).
A review of the evidence article concludes that “the relevance of the concept of omega 6: omega 3 ratio to CHD risk is unclear” (Altern Ther Health Med. 2005. 11(3). 24-30).

The first step, and also the rate limiting step, in biochemical conversion of both ALA and LA into longer chain fatty acids is catalyzed by the D6D enzyme - this enzyme requires zinc, magnesium, and vitamins B3, B6, and C as cofactors. Furthermore, hypercholesterolemia, trans fats, and excess sugar consumption impair D6D function (Nutr Clin Pract. 1992. 7. 179-186).
All polyunsaturated fats are biochemically unstable - exposure to heat or air or light cause biochemical breakdown of the fat and free radical chain reactions which may predispose one to atherosclerosis or cancer, and may increase the risk of inflammatory diseases, degenerative diseases, and immune system disorders. For information on how to prevent biochemical breakdown of polyunsaturated fatty acids, scroll down in this outline to ‘Oils.’

CLA, conjugated linoleic acid, is a trans chemical configuration polyunsaturated fat found in small amounts in meat and dairy products which shows promise as a dietary supplement in reducing body fat (Am J Clin Nutr. 2004. 79. 352), increasing muscle mass, and possibly preventing cancer.

One of the isomers acts like ALA, a polyunsaturated fat which inhibits the enzyme responsible for synthesis of precursors of both pro-inflammatory and anti-inflammatory eicosanoids.
However, one of the isomers in the synthetic version (i.e. dietary supplement) causes an increase in insulin resistance in humans, as per Barry Sears, PhD (The Anti-Inflammation Zone. 2005. Pg 90).

Trans (chemical configuration) fats

Existence discovered in late 1800’s; exist in very small quantities naturally in dairy and meat products from cows, goats, sheep, and other ruminants (i.e. CLA).
Artificial trans fat

Fat which is chemically altered either as part of the manufacturing process or by repeatedly heating oils past their smoking point. Trans fatty acids are made by adding hydrogen to polyunsaturated oil molecules (usually omega 6 fats) under high temperature and pressure. Nickel is typically used as a catalyst, then removed by filtration at the end of the manufacturing process. The end result chemically is that hydrogen atoms end up on opposite sides of the fatty acid molecule at the site of a double bond. This alters the structure of the fatty acid (individual molecules elongate and pack closer to one another) and this alteration of structure at a molecular level interferes with the function of the fatty acids in the cell membrane (i.e. altered receptor structure interferes with cell signaling).
Partial hydrogenation was patented in 1903; Crisco in 1911 was the first product marketed with artificial trans fats (Perspective. Ann Intern Med. 2009. 151. 129-134).
At the turn of the century, 79% of US trans fat consumption is artificial trans fats; 21% is from meat and dairy (FDA Consum. 2003. 37. 20-26).
In 2005 in the North America, 25 billion pounds of edible oils were consumed, and more than 9 billion of these were artificial trans fats (Circulation. 2007. 115. 2231-2246).

Reasons that manufacturers use trans fatty acids

Prolongs shelf life (i.e. delays rancidity).
Creates a solid out of a semi-solid (i.e. margarine).
In cookies and crackers and baked goods it is less expensive for the manufacturer to create trans fats than to use saturated fats.
In some snack foods, market research shows that the trans fat is associated with good taste or ‘mouth feel.’

Trans fats in the food supply

Trans fats are found in many snack foods, some margarines, some peanut butter spreads, some breads, and some dry cereals.
Deep-fried fast food products in restaurants may contain 10 grams of trans fat per serving!
In 2000, estimated that trans fats compose 3% of calories in standard American diet, which corresponds to 6 gm/day in an individual consuming 2000 calories per day.

Effective 1/1/06 (based on a 1999 FDA ruling), the trans fat content of all foods is included in the ‘Nutrition Facts’ box on the label.

The caveat is that the FDA allows foods with less than ½ gram of trans fat per serving to list 0 grams of trans fat in the ‘Nutrition Facts’ box.
Foods with less than ½ gram of trans fat per serving still must show this information in the ingredients list – look for the terms ‘partially hydrogenated vegetable oil’ or ‘vegetable shortening’ in the ingredients list.

Historically, it was thought that using trans fats (i.e. margarine) in place of saturated fat (i.e. butter) would be of benefit to individuals; it was hoped that trans fats would have the same favorable effects on lipid profile as natural unsaturated fats. Scientists have known for years though that this notion was incorrect - trans fats increase LDL cholesterol levels as much as saturated fat, but also lower HDL cholesterol levels, whereas saturated fat typically raises HDL, so the effect of trans fats on the lipid profile is double the bad effect of saturated fat (N Engl J Med. 1999. 340. 1994-1998).
Harmful effects of trans fats

Trans fats increase lipoprotein a, raise LDL cholesterol, raise triglycerides, and lower HDL cholesterol (N Engl J Med. 1990. 323. 439-445; J Lipid Res. 1992. 33. 399-410; Am J Clin Nutr. 1994. 59. 861-868; N Engl J Med. 1999. 340. 1933-1940; J Nutr. 2001. 131. 242-245; Am J Clin Nutr. 2003. 7. 1146–1155).
Trans fat intake increases hs-CRP (J Nutr. 2005. 135. 562-566).
Trans fats may be associated with activation of systemic inflammatory responses and endothelial dysfunction (Atheroscler Suppl. 2006. 7. 29-32).
Trans fats may increase the risk of becoming obese, via binding to PPAR nuclear receptors (Hyman M. Ultrametabolism. 2006).
Trans fats interfere with B and T cell functions, impairing immune system function.
Trans fats increase insulin resistance, and increase the risk of developing diabetes.
Trans fats may interfere with fertility.
Trans fats interfere with normal cell membrane function.
Epidemiologic data shows that a diet high in trans fats is associated with a significantly increased risk of coronary heart disease. A 2% increase in the energy intake from trans fat is correlated with a 14-36% increase in the incidence of coronary heart disease – 14% in the ATBC Cancer Prevention Study in 21,930 male smokers (Am J Epidemiol. 1997. 145. 876-887), 28% in the Zutphen Elderly Study in 667 men (J Nutr. 2001. 131. 242-245), 33% in the Nurses’ Health Study in 80,082 women (N Engl J Med. 1997. 337. 1491-1499), and 36% in the Health Professionals Follow-Up Study in 43,757 men (Lancet. 2001. 357. 746-751). Data from the Nurses’ Health Study in 80,082 women indicates that replacing 2% of energy from trans fats with energy from nonhydrogenated, unsaturated fats could reduce the risk of CHD by 53% (N Engl J Med. 1997. 337. 1491-1499). For more information on trans fats and coronary heart disease, return to the Home Page and go to the outline on ‘Prevention of MI’ and the first section on ‘Primary Prevention.’
Epidemiologic data shows that a diet high in trans fats is associated with an increased risk of cancer.

Interesterified Fat

Created by chemically inserting saturated fatty acids into the molecular backbone of vegetable oil to make it more stable (Consumer Reports on Health. 1/09. Pg 12).
Some manufacturers are using this form of fat in place of trans fats; it is unclear though whether interesterified fat is any less harmful than trans fat.

Carbohydrates

Old wisdom:

Refined carbohydrates like white flour and polished rice are acceptable alternatives in the diet to whole grains - they are just as good as energy sources.
The only disadvantage of refined carbohydrates is that they don't have the additional fiber and vitamins.

New wisdom - the form of the carbohydrate is very important:

Refined carbohydrates like white flour and polished rice can deplete the body of nutrients and they temporarily raise insulin levels, which then leads to a drop in blood sugar and hunger a few hours later. Refined carbohydrates and sugar may also suppress immune system function.
The insulin level at a given instant determines the ratio of fat to carbohydrate used in the fuel mix for most cells in our body - the higher the insulin level, the more carbohydrate in the fuel mix. The less fat in the fuel mix for the cells, the more dietary fat is converted into fat stores in the body (i.e. adipose tissue).
Scientists have learned that the glycemic index of carbohydrates is very important. For information on the glycemic index of specific foods, go to www.glycemicindex.com.

Note food sources of carbohydrate include fruits and vegetables and grains - grains are generally more calorie dense than fruits and vegetables (i.e. more calories per unit size) and thus it is easier when consuming grains to inadvertently consume excess calories.
Functions of carbohydrates - energy source, structural element in plant cell walls, structural element in myelin sheath of nerves, cell adhesion, cell development and differentiation, and cell to cell communication.
Structural classification of carbohydrates.

Monosaccharides - 1 saccharide.
Disaccharides - 2 saccharides.
Polysaccharides - more than 10 monosaccharides.

Classification of carbohydrates as simple versus complex carbohydrates.

Specific chemical meaning - simple refers to monosaccharides and disaccharides, complex refers to polysaccharides (this classification does not account for oligosaccharides).
For many years it was automatically assumed that starches would be slowly digested and absorbed, and a few simplistic experiments on raw starches and pure sugars supported this assumption, so for decades this was taught as fact in nutrition courses.
The classification of carbohydrates as simple versus complex is not meaningful from a physiologic perspective.

Some "simple" monosaccharides can have a very complex metabolic role.
We have known since the 1980's, when scientists finally started to study the actual blood-glucose response to common foods (i.e. how the carbohydrates in food change the blood sugar level), that many complex carbohydrates have a greater short term effect on raising the blood sugar than do "simple" disaccharides.

Functional classification of carbohydrates

Sugars - monosaccharides and disaccharides, including glucose, galactose, fructose, maltose (glucose + glucose), sucrose (table sugar: glucose + fructose), and lactose (milk sugar: glucose + galactose).

Fructose (highly concentrated in honey, fruits, and some vegetables).

Fructose does not stimulate insulin secretion and the consequent increase in leptin, a satiety hormone.
Fructose does not require insulin for absorption into cells – once inside the cells it becomes an uncontrolled source of carbon (acetyl Co-A).
Fructose is a highly reactive reducing sugar, and therefore promotes the formation of advanced glycation endproducts.
The fructose in fruits and vegetables is not considered problematic because the fiber in fruits and vegetables markedly slows absorption of the fructose from the GI tract.
Fructose consumption and obesity – a systematic review of 31 isocaloric feeding trials (n=637) and 10 hypercaloric feeding trials (n=119) indicates that fructose does not seem to cause weight gain when it is substituted for other carbohydrates in the diet, but does cause weight gain when added to other carbohydrates in the diet.
Consumption of high fructose corn syrup (i.e. in soft drinks) is strongly correlated with fatty liver, hypercholesterolemia and hyperlipidemia – this may be a causal relationship.
NOTE, from 1970 to 1997, annual per capita consumption of high fructose corn syrup (HFCS) increased from 0.5 pounds to 62.4 pounds, while sucrose consumption decreased from 102 pounds to 67 pounds per year. Intake of HFCS may be more detrimental than intake of sucrose.

HFCS contains 97% monosaccharides (55% fructose, 42% glucose).
Whereas sucrose requires hydrolysis by a gut disaccharidase before its components are absorbed, the fructose and glucose in HFCS are presumably absorbed more rapidly. In the presence of even small amounts of glucose, the absorption of fructose is markedly enhanced, through facilitated transport.

References:

Gaby AR. Adverse effects of dietary fructose. Altern Med Rev. 2005. 10. 294-306.
Sievenpiper JL et al. Effect of fructose on body weight in controlled feeding trials. Ann Intern Med. 2012. 156. 291-304.

Sucrose (table sugar). Sucrose is a disaccharide of glucose and fructose.

Sucrose is a food that may have drug-like effects in some people.
Sucrose is intertwined with our psychology - it is often a reward.
Sucrose is ‘empty calories’ – it dilutes nutrient levels in the diet.
Some health experts believe that sucrose causes immune system suppression. Ingestion of 100 grams (25 teaspoons) transiently reduces neutrophil phagocytosis (Am J Clin Nutr. 1973. 26. 1180-1184).
Sucrose may reduce HDL cholesterol levels; increase serum triglycerides, uric acid, cortisol, and blood pressure; and increase platelet aggregation and fasting serum insulin - this occurs in about one-third of the population (Postgrad Med J. 1969. 45. 602-607; Ann Nutr Metab. 1983. 27. 425-435).
Sucrose intake may exacerbate chronic candidiasis in sensitive individuals.
In sensitive individuals, high sucrose intake contributes to anxiety, depression, fatigue, migraines, PMS, and tension headaches

Despite protest from the food lobby, the World Health Organization in 2002 recommended that a healthful diet should contain no more than 10% of calories from sugar that are not inherently part of a food (i.e. lactose in milk, fructose in fruit). This 10% figure corresponds to 50 grams (13 teaspoons) in a 2000 calorie diet - the average American eats more than twice that much sugar!
Food labels do not distinguish between intrinsic sugar in foods like fruits and extrinsic sugar which is added. Ingredients which indicate added sugar include "corn syrup, crystalline fructose, dextrose, fructose, fruit juice concentrates, glucose, high-fructose corn syrup, high-maltose corn syrup, honey lactose, invert sugar, lactose, malt, maltose, molasses, sucrose, syrup" (Consumer Reports. 1/04. 12-16).
Note that over 200 monosaccharides occur naturally in plants, but the human body is known to use fewer than 10.
The only monosaccharides commonly included in the current Western diet are glucose, fructose, and galactose - the others can be synthesized from these two in the human body, but many factors may interfere with adequate synthesis.
Other important monosaccharides from a functional perspective include mannose, fucose, xylose, N-acetylglucosamine, N-acetylgalactosamine, and N-acetylneuraminic acid.

Oligosaccharides - 2 to 10 saccharides.

Includes fructo-oligosaccharides (FOS), galacto-oligosaccharides, and soy oligosaccharides.
Fructo-oligosaccharides (FOS) and galacto-oligosaccharides escape degradation in the upper GI tract and travel to the large intestine where they selectively support the growth of friendly bacteria which break down undigested carbohydrates into short chain fatty acids which supply 70% of the energy used by the colonic epithelial cells.
Fructo-oligosaccharides are breakdown products from inulin, which is a polysaccharide composed of repeating fructose units with a terminal glucose unit.
Many proteins have oligosaccharide side chains – see ‘glycobiology’ below for more details on the function of oligosaccharides in glycoproteins.

Starch

Polysaccharides which function as the predominant food reserve in plants.
Chemically labeled as either amylose (straight chain glucose polymers) or amylopectin (branched-chain polymers of glucose).
Amylose is less susceptible to digestion than amylopectin due to the tight physical structure.
Biochemically labeled as either rapidly digestible starch, slowly digestible starch, or resistant starch, based on the amount of amylase versus amylopectin – glycemic index is highest for rapidly digestible starch.
Resistant starch when acted upon by friendly bacteria in the colon produces short chain fatty acids (propionate, acetate, butyrate) which supply fuel for colonic epithelial cells.

Fiber

Large carbohydrate molecules (polysaccharides) not broken down by human digestive enzymes (i.e. indigestible).
Fiber is distinguished from starch in that it is a component of cell walls in plants.
Fermented in the colon by bacteria - produces methane gas (flatulence) and short-chain fatty acids which are the energy source for colonic epithelial cells.
Soluble fiber - can be dissolved in water (i.e. forms a colloidal suspension in water).

Some gums, some pectins, some hemicellulose.
Typically found in fruits, vegetables, and nuts.
Delays gastric emptying, increases satiety, decreases cholesterol, glucose, and insulin levels.
Along with resistant starch (see above) serves as fuel for colonic epithelial cells.

Insoluble fiber - cannot be dissolved in water (i.e. does not form a colloidal suspension in water).

Cellulose, some hemicellulose, some pectins, some lignins.
Typically found in cereal.
Creates fecal bulk, binds toxins and bile salts, and decreases the risk of constipation, diverticulosis, and possibly hemorrhoids and colon cancer.
Like resistant starch, acted upon by friendly bacteria in the colon and degraded to short chain fatty acids (propionate, acetate, butyrate) which supply fuel for colonic epithelial cells.

Note the categorization of fiber by the foods that contain it (i.e. cereal fiber, fruit fiber, vegetable fiber) used in many epidemiological studies is not nearly as meaningful from a functional standpoint as the classification of fiber as either soluble or insoluble.
Note that konjac root fiber (glucomannan) and rye fiber appear more potent at lowering cholesterol and blood sugar than wheat fiber, psyllium, oat fiber, or guar gum. Konjac root and rye fiber are sometimes referred to as ‘superfibers.’
The National Cancer Institute recommends 25-35 grams per day of fiber in the diet.

Worldwide consumption of fiber averages 50-75 grams per day.
Intake in the Paleolithic diet estimated at 100-150 grams per day.
Epidemiologic studies indicate that consumption of 75-100 grams of fiber per day may be ideal.
Average consumption in the U.S. is less than 10 grams per day.
One tablespoon of Metamucil contains 3 grams of fiber - 2.4 grams of this is soluble fiber.

One must increase water intake when one increases fiber intake, or the increased fiber can actually worsen constipation.
Increase the amount of fiber in the diet gradually to avoid GI distress.
Fiber intake can affect estrogen status – higher fiber intake is associated with higher serum concentrations of SHBG (and thus less free estrogen) and higher fiber intake is associated with decreased activity of beta-glucuronidase (and thus less enterohepatic recirculation of estrogen).
Remember that fiber may be antigenic (i.e. gluten intolerance).
Remember that fiber will interfere with absorption of vitamins and minerals consumed at the same time.
Fiber and health outcomes

Dietary fiber intake was associated with a significantly lowered risk of total mortality in both men and women, in the NIH-AARP Health Study, during an average of 9 years of follow up in the cohort of 569,167 AARP members, aged 50-71. Dietary fiber intake was associated in this study with lower risk of death from cardiovascular disease, infections, and respiratory disease (and, in men only, cancer). Dietary fiber intake from grains was more highly correlated with improved health outcomes than dietary fiber intake from other sources (Arch Intern Med. 2011. 171. 1061-1068 and invited commentary 1069-1070).
Dietary fiber intake lowers serum cholesterol levels, lowers blood pressure, lowers blood sugar via improved insulin sensitivity, and promotes weight loss (Nutr Rev. 2009. 67. 188-205; Arch Intern Med. 2007. 167. 956-965; J Hypertens. 2005. 23. 475-481; Am J Clin Nutr, 1999. 69. 30-42).

Conditionally essential carbohydrates - humans can synthesize all of the carbohydrates we need to live, so no carbohydrates are essential in the diet. HOWEVER, the amount of certain sugars such as fucose, mannose, and xylose in the diet is often less than required for optimal biochemical functioning in many individuals, so these nutrients may be classified as conditionally essential. See ‘glycobiology’ just below for more information on the eight saccharides believed to play an important role in cell-to cell communication.
Glycemic index (www.glycemicindex.com)

Physiologically based measure of carbohydrate quality - a comparison of carbohydrates based on their immediate effect on blood glucose levels.
The glycemic index measures the rate of digestion.
Glycemic index tables first completed in 1995.
For most foods, the glycemic index correlates well with the insulin index of the food. Dairy products are an exception.
Measurement of the glycemic index

An amount of food containing 50 grams of carbohydrate is given to a volunteer to eat.
Blood glucose is measured at 15, 30, 45, 60, 90, and 120 minutes, and the area under the curve of time versus blood glucose is measured using a computer program.
The response is compared to that volunteer's response to 50 grams of glucose. The glycemic index of 50 grams of glucose is arbitrarily set at a value of 100.
The reference food is tested on several separate occasions and an average value is calculated for that individual.
The average glycemic index values in 8-10 individuals are then averaged to determine the glycemic index value of the food.

Note that some glycemic index charts use a 50-gram carbohydrate portion of white bread as the reference food with a value of 100 - it is possible to convert from the glucose scale to the white bread scale using the factor 0.7 (i.e. the glycemic index of white bread is 70 when the glycemic index of 50 grams of glucose is set at 100).
Note the glycemic index of a meal can be calculated as long as one has access to food composition tables to determine the amount of carbohydrate in each item in the meal - this calculation is demonstrated on page 36 of The New Glucose Revolution (2003). There is some controversy however about the validity of this measurement.
Note that the glycemic index of any given food may vary somewhat based on the ripeness, method of preparation used, growing conditions, number of times reheated.
Remember that the glycemic index is only one factor to consider in determining whether a food is healthy.
Factors which influence the glycemic index value of a food

Starch gelatinization - the less gelatinized (swollen) the starch, the lower the glycemic index. Al dente spaghetti has a lower glycemic index than overcooked spaghetti.
Physical entrapment - the fibrous coat around beans and seeds slows digestion because it takes more time for digestive enzymes to access the starch inside the fibrous coat.
High amylose to amylopectin ratio - amylose is a straight chain starch and absorbs less water than the branched chain amylopectin, and thus is digested more slowly.
Particle size - finely milled flours with a small particle size have a higher glycemic index because it is easier for water and enzymes to penetrate. Thus finely ground wheat fiber, such as is found in whole wheat bread, has a glycemic index similar to its white counterpart.
Viscosity of fiber - viscous fiber has a lower glycemic index.
Sugar - foods with sugar actually have a somewhat lower glycemic index because half of the sugar molecules are fructose.
Acidity - this slows down gastric emptying and is thus associated with a lower glycemic index.
Fat - this also slows gastric emptying.
Protein - this also slows gastric emptying.

The glycemic index is a clinically proven tool in its applications to diabetes, appetite control, and coronary health.

A low glycemic index diet in diabetics leads to better control of blood sugar.
Consumption of high glycemic index foods leads to a transient high insulin level and this drives blood sugar down and increases appetite. Conversely, consumption of low glycemic index foods promotes weight loss in overweight people by delaying hunger pangs.
A low glycemic index diet reduces oxidative stress in the coronary arteries. In the Nurses' Health Study, those with a BMI over 23 who ate lots of high glycemic index foods had twice the rate of heart attack as those eating low glycemic index diets (The New Glucose Revolution. 2003. pg 224).

Glycemic load

Defined as the (glycemic index x grams of carbohydrate per serving) divided by 100.
This value is more helpful in predicting the effect of a particular food on blood glucose level.
For example, carrots have a relatively high glycemic index value of 47, but a low glycemic load value of 3 because there is relatively little carbohydrate in an average serving of carrots.

Protein

Old wisdom:

Protein from animal sources (i.e. meat and milk products) is preferable to protein from vegetable sources because vegetable protein is "incomplete," meaning that it does not contain all 8 essential amino acids.
White meat is preferable to red meat because the bad saturated fat is mostly in the skin rather than in the meat itself. Thus one can avoid excess saturated fat by eating skinless chicken or turkey.

New wisdom:

Incomplete vegetable protein is not a problem as long as one eats a variety of vegetables and grains and legumes over the course of a day, because the combination of these foods provides all 8 essential amino acids; the body does not actually need all 8 in the diet at the same meal.
Red meat provides us with excess arachidonic acid - this fat is converted to prostaglandins which promote inflammation in the body.
Fish is an excellent source of protein because the fat in the fish is a healthy omega 3 fat.
Legumes (beans, peas, lentils, soy products) are excellent sources of protein because they also have lots of fiber and phytochemicals.
Nuts and seeds are excellent sources of protein because they also have lots of fiber and minerals and monounsaturated fat.
Plant-based protein is less atherogenic than animal-based protein, and this seems to be a function of the arginine: lysine ratio, which is higher in plant-based protein.
Limitations of vegetable protein – not as easily digestible and totally lacking in the conditionally essential amino acid taurine (Shealy N. Life Beyond 100. 2005. pg 82).

Amino acid classification (biochemical)

Acid, base, aliphatic, aromatic, based on side chain. Proline has a unique structure.
Branched chain amino acids (leucine, isoleucine, valine) – differ metabolically from all other amino acids.

Amino acids functions

Biochemical building blocks of protein - human proteins are composed of 20 biochemically distinct amino acids.
Cell-cell communication – connexins are amino acid chains which aggregate to form tunnel-like structures called connexons, which embed themselves in cell membranes and facilitate intercellular communication (Tanelian DL. Molecular Fitness: The Connexin Connection to Optimal Health).
Metabolic processes - creatine, carnitine, betaine, taurine, ornithine, and citrulline are amino acids which are not used as building blocks of protein, but are nonetheless important in human metabolism. Many essential amino acids are also important in metabolic processes.

Cysteine is a methyl donor in many biochemical pathways, including conversion of homocysteine to methionine.
Methionine and betaine are also methyl donors. Methylation of DNA is one of the mechanisms of controlling DNA expression.
Cysteine is a sulfur donor for one of the Phase II detoxification pathways.
Gycine, serine, taurine, and glutamine are important in Phase II detoxification.
Arginine is important in the synthesis of nitric oxide, which is important in endothelial function.
The branched chain amino acids can be oxidized completely in the mitochondria to provide energy.
Creatine and carnitine play key roles in energy metabolism.
Glutamine is an important nutrient for mucosal cells in the small bowel and also important in regulation of acid/base balance.
Glutamate is an excitatory neurotransmitter responsible for many neurological functions.

Essential amino acids

Eight of the 20 amino acids in human protein cannot be synthesized by humans, and thus must be consumed in the diet.
Additional amino acids such as taurine cannot be synthesized in quantities for optimum metabolic functioning (i.e. detoxification) - these amino acids are conditionally essential.

Glycoproteins and proteoglycans – important in cell to cell recognition and adhesion.

Glycoproteins contain 1-60% carbohydrate by weight, and have a sialic acid residue at the end of each polysaccharide.
Proteoglycans – 90-95% carbohydrate by weight, all of which is in the form of glycosaminoglycan chains, which are polysaccharides with at least one amino sugar and no sialic acid residues.

Biologically synthesized amino acids are all of the L form chemically, whereas chemically synthesized amino acids are of the combined DL form. The only D amino acids which the body can use are D-phenylalanine and D-methionine.
Nitrogen balance studies are the method of determining protein requirements - the flaw is that this method assumes that all amino acids are equal in terms of their importance to proper function in the body.
Unlike carbohydrates and fats which "burn clean" and break down into carbon, hydrogen, and oxygen; protein produces nitrogen when it is degraded, and this nitrogen must be metabolized by the liver into urea, then eliminated by the kidneys. Thus protein in the diet taxes the liver and kidneys. It is unclear whether this is harmful for a healthy person, but this biochemistry is the basis of recommendations for those with advanced kidney or liver disease to limit protein consumption.
Protein is a diuretic; the kidney must excrete lots of water in order to excrete urea.
Hormonal effects of protein – ingestion of protein stimulates release of glucagon from the liver. A delicate balance must be maintained between insulin and glucagon to maintain a normal blood sugar level and also to maintain the proper ratio of fat to glucose in the bloodstream in terms of the brain depending on glucose for energy needs while the body at rest derives most of its energy needs from fat.
Higher plant protein intake is associated with lower rates of hypertension in epidemiological studies.

Cholesterol – go to Home Page and click on “Cholesterol”

Beware of deceptive labeling. Plant products such as cooking oils do not have cholesterol in them and never have had cholesterol in them. Despite a bold NO CHOLESTEROL label, they are often loaded with unhealthy fat.
The trans fat and saturated fat content of the diet, and possibly the amount of refined carbohydrate in the diet, is a much more important determinant of blood cholesterol levels than the cholesterol content of the diet (80% of total body cholesterol is synthesized in the liver).

Chocolate (Altern Med Alert. 2005. 8. 138-142)

Historically, there has been a dual aspect to chocolate: chocolate as food and chocolate as medicine.
Historically chocolate has been primarily served as a beverage, including by the Olmecs, Mayans, and Aztecs.
Chocolate is produced from seeds of a tropical tree, Theobroma cacao.
A number of psychoactive compounds are found in chocolate

Biogenic amines (tyramine and phenylalanine) – sympathomimetic effects, stimulate dopamine release, MAY modulate mood.
Methylxanthines (theobromine, caffeine, theophylline) – competitive inhibitors of adenosine. Adenosine facilitates sleepiness.
Cannabinoid-like fatty acids (N-acetylethanolamine) – either acts at cannabinoid receptors in the brain or potentiates anandamide.

Chocolate cravings – research suggests that these are a function of the sensory experience of consuming chocolate and not pharmacological factors (Physiol Behav. 1994. 56. 419-422).
Chocolate is rich in a variety of minerals, especially copper, iron, magnesium, potassium, and zinc.
The ORAC value of dark chocolate is higher than that of blueberries, broccoli, and kale. Dark chocolate possesses a higher polypenol content per gram than wine, tea, or berries.
Dark chocolate consumption and potential health benefits. These benefits are attributed to the flavonoid content of cocoa, specifically the polyphenol content, an more specifically to the compound (-)-epicatechin (Proc Natl Acad Sci USA. 2006. 103. 1024-1029).

Antioxidant effects (Am J Clin Nutr. 2001. 74. 576-602).
Reduced blood clotting (J Am Coll Nutr. 2001. 20. 436S-439S).
BP lowering effect (Hypertension. 2005. 46. 398-405; Arch Intern Med. 2006. 166. 411-417; JAMA. 2007. 298. 49-60), with benefit also reported in a meta-analysis of 5 trials (Arch Intern Med. 2007. 167. 626-634).
Improved HDL: LDL cholesterol ratio (Brit J Nutr. 2002. 88. 479-488).
Flavonol-rich cocoa has been shown to induce nitric-oxide dependent vasodilation (J Hypertens. 2003. 21. 2281-2286) and improve endothelial function (J Am Coll Nutr. 2004. 23. 197-204).

In a randomized trial in 25 male smokers, 40 grams of polyphenol-rich dark chocolate produced rapid improvement in endothelial and platelet function (Heart. 2006. 92. 119-120).

Read the food label and look for a cocoa content >60%, and make sure that the label lists chocolate liquor, cacao, or cocoa as the first ingredient.

Flavanol levels currently are not listed on the label.
Heat and chemical reactions as cocoa is made tend to reduce flavanol content.

CocoaVia is a dark chocolate bar made by Mar’s Corp. and has a very high flavanol content and less fat than an ordinary candy bar – 100 mg of flavonoids and only 80 calories per 23 gram serving, compared with a typical chocolate bar with little flavonoids and 250 calories per 43 gram serving. Bars cost about $1 per very small bar and the bars are available in the healthy food section of grocery stores and also at www.cocoavia.com.
Chocolate contains several psychoactive substances – phenylethanolamine (a stimulant) and methylxanthines (caffeine, theobromine, and theophylline - stimulants).
N-acetylethanolamine in chocolate prevents the degradation of anandamide, an endogenous chemical which interacts with the THC receptor.
Stearic acid, a fat which represents approximately 30% of the fatty acids in chocolate is a saturated fat, but does not raise the serum cholesterol (Am J Clin Nutr. 1999. 70. 951-952).
Milk chocolate contains less cocoa than dark chocolate and more hydrogenated fats, milk, or corn syrup. White chocolate typically contains no cocoa at all.
Chocolate may exacerbate migraines and GERD.
Chocolate in large quantities can inhibit sulfation reactions, which are important for detoxification.

Coffee

Coffee and all-cause mortality – coffee is not associated with an increase in all-cause mortality, with a trend noted toward a decrease, based on 24 years of data in 41,736 men the Health Professionals Follow-up Study and 86,214 women in the Nurses’ Health Study. Coffee consumption in these cohorts was estimated by self report (Ann Intern Med. 2008. 148. 904-914).
Coffee and cancer - overall, coffee does NOT increase cancer risk (Eur J Cancer Prev. 2000. 9. 241-256).

Good data that it does not increase the risk of colon cancer (J NCI. 2005. 97. 282-292) or breast cancer; data more limited regarding the association of coffee consumption with other cancers.
May protect against liver cancer. Compared to those who never consume coffee, liver cancer risk in those consuming 1-2 cups per day is 0.52, 3-4 cups per day is 0.48, and 5 or more cups per day is 0.24 (J NCI. 2005. 97. 293-300).
The publicized association of coffee consumption and increased risk of pancreatic cancer has not been confirmed by recent studies, as per 2006 Guidelines published by the American Cancer Society.

Coffee and cardiovascular disease – effect may vary based on genetic polymorphisms, or based on smoking status

An analysis of data in 44,005 men in the Health Professionals Follow-up Study and 88,488 women in the Nurses’ Health Study did NOT show an increased risk of CHD in coffee drinkers. Adjusting for other CHD risk factors, in men the risk was 1.0 for those who drank less than a cup of coffee per month, 1.02 for those who drank 1 cup daily, and 0.72 for those who drank 6 or more cups daily; in women the risk was 1.0 for those who drank less than a cup of coffee per month, 1.02 for those who drank 1 cup daily, and 0.87 for those who drank 6 or more cups daily (Circulation. 2006. 113. 2045-2053).
A prospective study in 127,212 subjects found that coffee consumption was unrelated to CAD risk in never smokers, but associated with a higher CAD risk in ex-smokers and current smokers (Am J Cardiol. 2008. 101. 825-827).
Chronic coffee consumption has a detrimental effect on aortic stiffness (Am J Clin Nutr. 2005. 81. 1307-1312).
Consumption increases the risk of MI in slow metabolizers (variant CYP1A2 1F allele) but decreases the risk of MI in rapid metabolizers (CYP1A2 1A allele), based on a case control study in Costa Rica between 1994 and 2004, examining 2014 cases with first MI and 2014 controls (JAMA. 2006. 295. 1135-1141). Estimated that 50% of Caucasians have slow variant whereas only 14% of Japanese have the slow variant (Cancer Epidemiol Biomarkers Prev. 1994. 3. 413-421).
Acute caffeine ingestion (200 mg) significantly improves endothelial function in subjects with and without CAD, based on data from a cross-over RCT in 80 subjects in which endothelial function was assessed by brachial artery flow-mediated vasodilation (Am J Cardiol. 2011. 107.1255-1261).

Coffee and depression – coffee consumption may be protective, based on data in 50,739 women in the Nurses’ Health Study (Arch Intern Med. 2011. 171. 1571-1578).
Coffee and diabetes – coffee may be protective

Long term coffee consumption is associated with a statistically significantly lower risk of developing diabetes, with this association persisting independent of BMI, smoking status, and other dietary and lifestyle factors.
The relative risk in men consuming >6 cups per day is 0.46 and the relative risk for women consuming >6 cups per day is 0.71. The statistical association with prevention of diabetes was also present in both sexes for consumption of 4-5 cups/day (0.71 in men and 0.70 in women). This data is based on 41,934 men followed from 1986 to 1998 in the Health Professionals= Follow-up Study and 84,276 women followed from 1980-1998 in the Nurses= Health Study (Ann Intern Med. 2004. 140. 1-8).
Further data on 88,259 women in the Nurses’ Health Study II also showed that coffee even at mild-moderate intake is associated with a reduced risk of diabetes – RR = 0.87 for 1 cup daily, 0.58 for 2-3 cups daily, 0.53 for 4 or more cups daily (Diabetes Care. 2006. 29. 398-403).
A systematic review “supports the hypothesis that habitual coffee consumption is associated with a substantially lower risk of type II diabetes” (JAMA. 2005. 294. 97-104).
Lower risk of diabetes also seen in association with coffee consumption after 11 years of follow up in the cohort of 28,812 postmenopausal women in the Iowa Women’s Health Study (Arch Intern Med. 2006. 166. 1311-1316).
Coffee reduces the risk of diabetes in those with impaired glucose tolerance at baseline, based on a prospective study in 317 adults who were part of the Rancho Bernardo Study, and then developed impaired glucose tolerance. In this study, no dose-response relationship was observed (Diabetes Care. 2006. 29. 2385-2390).

Coffee and endometrial cancer – in a prospective study of 60,634 women participating in the Swedish Mammography Cohort, during 17.6 years of follow up, women drinking 4 or more cups of coffee per day had a 25% lower risk of developing endometrial cancer. The reduction in risk was restricted to overweight and obese women (Int J Cancer. 2009. 125. 2413-2417).
Coffee and gallstones – in the Health Professionals Follow up Study in 46,008 men, long term consumption of 2-3 cups of coffee per day was associated with a 40% reduction in the risk for symptomatic gallstones; consumption of 4 cups of coffee per day was associated with a 45% reduction in risk (JAMA. 1999. 281. 2006-2012).
Coffee and HTN – probably does not increase the risk (JAMA. 2005. 294. 2330-2335; Arch Intern Med. 2002. 162. 657-662).
Coffee and Parkinson’s disease – coffee may be protective
Coffee and stroke

No increased risk in the Nurses’ Health Study (Circulation. 2009;119(8):1116-23).
22-25% decreased risk at 10 years of followup in the 34,670 women in the Swedish mammography cohort study (Stroke. 2011;42(4):908-12).

Risks

May increase the risk of anxiety, blood sugar dysregulation, cardiac arrhythmias, fibrocystic breast disease, headaches, infertility, osteoporosis, and urinary stress incontinence.
May cause depletion of calcium and magnesium.

Contains approximately 85 mg caffeine per 8 ounce cup of drip-brewed cup.

There are actually over 60 plant species which naturally contain caffeine – it is hypothesized that this is because caffeine is a natural pesticide (it is stored in specialized vacuoles because it is otherwise toxic to the plant).
Besides coffee and tea, other popular natural sources of caffeine include the kola nut, yerba mate, chocolate, and guarana.

Decaffeinated coffee – as per Dr. David Perlmutter, chemical solvents are used in some cases to decrease the caffeine content of water – make sure to purchase water-decaffeinated coffee.

Eggs

Old wisdom:

Eggs are bad because there are 200 mg of cholesterol in each egg yolk.
Per capita egg consumption dropped from 400 to 250.

New wisdom:

Most individuals do not experience an increase in serum cholesterol in association with increased dietary intake of cholesterol.

Only 20-25% of the population will have a significant increase in serum cholesterol in response to an increase in dietary cholesterol. Possible mechanisms to explain the lack of rise in serum cholesterol in 75-80% include (1) a decrease in efficiency of cholesterol absorption and (2) increased conversion to and excretion of bile acids (N Engl J Med. 1991. 324. 912-913).
A 6 week RCT in 96 hypercholesterolemic men assigned to a low fat, low cholesterol diet containing no eggs versus a low fat diet containing 12 eggs per week found no significant differences at the end of the study in total, LDL, or HDL cholesterol (J Appl Nutr. 1993. 45. 73-84).
A prospective study of the egg eating habits of 37,851 men in the Health Professionals Follow-up Study and 80,082 women in the Nurses’ Health Study showed no difference in risk of heart attack or stroke in those who ate up to one egg a day, compared to those who ate less than one egg a week (JAMA. 1999. 281. 1387-1394).

The fat in eggs is unsaturated fat.
Eggs are an excellent source of protein, phospholipids (i.e. phosphatidylcholine), and a multitude of vitamins and minerals.
Omega 3 enriched eggs are a way of supplementing omega 3 fat intake in the diet.
The downside to egg yolks is that they are rich in arachidonic acid, which is converted into pro-inflammatory eicosanoids. Omega 3 enriched eggs probably contain less arachidonic acid.

Shelton is considered a reputable brand for organic eggs.

Fish (Ann Intern Med. 2004. 141. 977-980)

Scientists have found associations between fish consumption and reduced risk for asthma, dementia, diabetes, kidney disease, and stroke.
USDA estimated that fish consumption in the U.S. increased 50% between 1980 and 2000.
Omega 3 fatty acid content of fish which are sustainably harvested and do not contain excessive mercury or PCBs (grams omega 3 per 3 ounce serving, as per Self Healing 8/08, pg 3) – Pacific herring (sardines) 1.6; Sablefish (black cod) 1.4; European anchovies 1.25; Spanish mackerel 1.25; wild sockeye salmon 0.95; farmed rainbow trout 0.84; Albacore tuna 0.8. See Consumer Reports 7/03 page 32 for a complete listing of other fish with lesser amounts of DHA (docosahexanoic acid) and EPA (eicosapentanoic acid).
Which fish to consume – issues include (1) mercury, (2) PCBs and dioxins, and (3) overharvesting

Fish which include no known risk to the consumer include anchovies, flounder, sole, and farmed clams, farmed rainbow trout, and farmed shrimp.
Fish which are fine to eat in moderation (once/week) include cod, farmed catfish, mahi, mahi, wild salmon, tilapia, and canned chunk tuna.
Fish to avoid include Chilean sea bass, Atlantic cod, Atlantic flounder and sole, grouper, farmed salmon and orange roughly, and red snapper.

Mercury (specifically methylmercury) in fish is an issue:

Methylmercury is found naturally in the environment – it is estimated that roughly half of the methylmercury in the oceans has been there for millennium. Additional mercury is released through industrial practices such as the burning of industrial waste and fossil fuels. Fish are the main source of methylmercury exposure in humans.

· Note that elemental mercury and inorganic mercury are dangerous to humans only when inhaled rather than ingested and thus problematic only for individuals with occupational exposure.

· Note that the mercury in dental fillings is inorganic and thus not dangerous when swallowed.

· Methylmercury is excreted in the feces; inorganic mercury is excreted in the urine.

o Mercury is a neurotoxin, and pregnant women and young children are especially susceptible to its effects.

o The U.S. EPA states that blood levels of mercury greater than 5 micrograms per liter or hair levels greater than 1 microgram per gram are potentially hazardous to the developing fetus, and these levels correlate with an exposure of 0.1 microgram/kilogram of body weight per day.

o Blood levels over 50 micrograms per liter can cause tremor, difficulty with concentration, visual problems, and numbness and tingling in adults – these symptoms do not usually occur unless blood levels exceed 200 micrograms per liter.

o A single 6 ounce serving of some fish can exceed the U.S. FDA recommendation that a 120 pound person consume no more than 38.5 micrograms of mercury per week.

Methylmercury reaches its highest levels in large, predatory fish and in bottom feeders (i.e. crab).

· Fish highest in mercury in terms of mean values of methylmercury concentration in ppm are tilefish (1.45), swordfish (1.00), king mackerel (1.00), shark (0.96) [Perspective: Mercury and Health. N Engl J Med. 2002. 347. 1735-1736]. Other fish highest in mercury as per Natural Resources Defense Council include marlin, orange roughy, tilefish and tuna (Ahi,, Bigeye). For reference purposes, sardines have 0.02 ppm and sardines 0.01 ppm (Consumer Reports. 7/04. 8).

· Fish high in mercury as per Natural Resources Defense Council include bluefish, grouper, mackerel (Spanish, Gulf), sea bass (Chilean), and tuna (canned albacore, yellow fin).

· Fish moderate in mercury as per Natural Resources Defense Council include bass, carpa, cod, croaker, halibut, jacksmelt, lobster, mahi mahi, monkfish, perch (freshwater), sablefish, skate, snapper, tuna (canned chunk light and skipjack), and weakfish.

· Fish lowest in mercury as per Natural Resources Defense Council include anchovies, butterfish, catfish, clam, crab, crawfish, croaker, flounder, haddock, hake, herring mackerel (N Atlantic), mullet, oyster, perch (ocean), plaice, pollock, salmon, sardines, scallops, shad, shrimp, sole, squid, tilapia, trout, whitefish, and whiting.

According to Dr. Andrew Weil, halibut, grouper, and Chilean sea bass are also high in methylmercury, and trout and flounder have moderate amounts of methylmercury (Self Healing. 9/05).
According to Consumer Reports on Health (July, 2006. 20-21), Chilean bass, American lobster, Spanish mackerel, and halibut occasionally contain high mercury content.
Chunk light tuna is generally much lower in mercury than albacore (white) tuna, but the FDA reports that 6% of light tuna samples contain at least as much methylmercury as the average in albacore.
There is scientific debate regarding the extent of the harmful effects of mercury in fish. The Seychelles Child Development Study, initially presented in 2005 found no mercury-related health/developmental problems in this population eating 10-12 seafood meals per week. A landmark 1997 study of Faroe islands people did show developmental problems in children with the highest mercury exposures, but the author attributed much of the risk to whale meat consumption rather than fish consumption. Whale meat does not have high selenium levels (see just below regarding selenium).
Selenium, which is plentiful in wild ocean fish, may cancel some of the harmful effects of mercury – mercury and selenium have a high binding affinity for one another and form a harmless selenium-mercury compound which is excreted. Theoretically, consuming 1-2 Brazil nuts (each Brazil nut contains approximately 100 mcg of selenium) with a portion of fish may protect against the mercury in the fish (Holistic Primary Care. Winter 2006. 4).
Measurement of mercury in blood and urine is inexpensive. A ‘provoked’ test may be more meaningful than a random test.
www.catchofthesea.com, www.tunalovers.com, and www.vitalchoice.com are web sites with information on brands of tuna lower in mercury, as per Dr. Andrew Weil (Self Healing. 9/05).

Polychlorinated biphenyls (PCBs) in fish are an issue:

Flame retardants, electrical equipment, pesticides, paints, varnished, and ink were made with PCBs until banned in 1979.
Environmental levels of PCBs dropped rapidly after the ban in 1979, but they continue to be released from sediment and are mostly insoluble in water, so they accumulate in fish living in polluted waters and some farmed fish.
Fish affected by PCBs in polluted waters vary by locality – check local state advisories at www.epa.gov/waterscience/fish/states.htm.
Accumulation in farmed fish is a function of PCB contaminated feed.
PCBs are thought to be carcinogenic and also appear to affect the central nervous system, cause immune suppression, and cardiovascular disease.
In a study published in 2004, it was reported that PCB levels in farmed salmon sold in the U.S. and Canada were approximately 30 ppb, which is 2-10 times the level in beef and 5 times the amount that EPA guidelines say is safe (Science. 2004. 303. 226-229). The authors concluded that more than 8 ounces of farmed salmon a month posed an “unacceptable cancer risk.” Industry in response to this study is changing the way farmed fish are fed.
Note that EPA guidelines set a much lower limit of acceptable intake of PCBs than does the WHO. One may eat 4-10 meals per month of farmed salmon per month (depending on where the salmon is raised) or 1 meal per day of wild salmon in terms of the WHO guideline for safe exposure to PCBs (Environ Health Perspectives. 2005. 113. 552-556).
Measurement of PCB levels is extremely expensive.

Environmental issues

Over-fishing has led to a decline of as much as 90% of the biomass of large predatory fish such as cod, haddock, and tuna.
Best choices of fish from an environmental perspective include wild Alaskan salmon and Pollack, wild Pacific halibut, herring, sardines, and farmed arctic char.
Fishing in terms of the size of the catch is unregulated in international waters.
“By-catch” which refers to the unwanted marine life caught in fishing nets, is a significant problem. An estimated 88 billion pounds of sea creatures are killed unnecessarily each year. The good news is that much by-catch can be prevented with changes in fishing techniques.
“Catch-sharing” is a potential solution to overfishing which at least in principle has the support of fishermen and conservationists.
Fish-farming is associated with multiple environmental and health issues

§ Many of the world’s fish farms are in Southeast Asia, or South America, where regulations are lax.

§ Fish farms sometimes destroy coastal marshlands and mangrove forests, which are habitats for many indigenous wild fish species.

§ Shrimp and salmon farms often use large quantities of antibiotics to protect the fish from infections.

§ Fish farms are big polluters – they generate tons of filth which diffuses out and adversely affects neighboring ecosystems.

§ Farmed fish may escape and breed with wild fish, resulting in hybrids that don’t reproduce well. Escaped farm fish may also carry parasites foreign host waters.

§ Large quantities of marine biomass are needed to feed the farmed fish.

§ Farmed fish may be fed vegetable oils and even grains, leading to a much lower omega 3 content.

§ Selenium content of farmed fish may be lower, and thus mercury exposure to farmed fish may be a more significant health issue.

§ Not all fisheries are eco-unfriendly though – US farmed tilapia and catfish are raised in an eco-friendly manner, as are farm raised mussels and clams.

Resources regarding information on toxins in fish and ecological concerns regarding overfishing (Self Healing. 5/06. 3)

§ Pocket Seafood Selector – lists fish as eco-best, eco-OK, or eco-worst based on average content of mercury and PCBs. www.oceansalive.org

§ Seafood Watch – categorizes seafood into green, yellow, and red categories based on sustainability. www.seafoodwatch.org

§ Guide to Ocean Friendly Seafood – color-coded key to evaluate abundance, fishing or farming methods, environmental concerns. www.blueocean.org

§ EPA information on toxins by waterway – www.epa.gov/waterscience/fish/states.htm

Labeling issues (Self Healing. 5/06. 3)

There are no USDA standards for ‘organic’ for seafood in 2009 (i.e. this term is not defined for fish from a regulatory standpoint).
As of 2005, it is required to label the country of origin for fish other than sushi, canned fish, and processed fish such as fish sticks (but compliance with this new law may be lax).
Farmed fish has been shown on occasion by independent testing to be erroneously labeled as wild fish.
Trusted label – Marine Stewardship Council’s seal, blue oval, that tells you you’re buying from an environmentally responsible fishery.

Grains

Whole grains contain all three parts of the plant kernel – the outer layer of bran, the inner germ of the plant, and the largest part of the kernel, called the endosperm.

The bran provides fiber, B vitamins, iron, and antioxidants.

The germ provides B vitamins, vitamin E, minerals, and healthy fats.
The endosperm contains carbohydrates.

Refined grains are stripped of the nutritious bran and germ during milling, leaving behind the carbohydrate-rich endosperm.
Enriched grains are refined grains to which the manufacturer has added back some of the vitamins and minerals lost during refinement.
The USDA as of the 2005 Dietary Guidelines specifically recommends 3 ounces of whole grains per day.
Note that when whole grains are ground to flour (i.e. whole wheat flour) the glycemic index can be high even though it is a whole grain product.
Food labels and color

Foods that are mostly or completely whole grain list the word “whole” with the first ingredient. Ingredients are listed in descending order by weight.
BEWARE that healthful-sounding words like ‘multi-grain’ and ‘seven-grain’ are marketing terms and do not mean the product is whole grain.
BEWARE that brown-colored bread is often is often refined white bread with added caramel coloring.
BEWARE that not all foods made with whole grains are good sources of fiber, so check the fiber grams on the label too.

Wheat is a highly hybridized grain; many health authorities recommend minimizing consumption of all wheat products.
Types of grains

Amaranth – gluten free, high fiber content and complete amino acid profile
Barley –high in beta-glucans, which lower cholesterol; tastes similar to oats, contains gluten
Buckwheat – gluten free
Corn – gluten free, grain as well as a vegetable, has the highest level of antioxidants of any grain
Kamut - contains gluten
Millet – gluten free, alkaline, buttery flavor similar to rice
Oats - gluten free, high beta glucan content facilitates cholesterol-lowering
Quinoa – gluten free, quick cooking time, nutty tasting, complete amino acid profile
Rice - gluten free
Rye - contains gluten
Seminola - contains gluten
Sorghum - gluten free
Spelt - contains gluten
Teff - gluten free
Tricale - contains gluten

Meat

Meat consumption and associations with disease and mortality

Data from two prospective cohorts, the Nurses’ Health Study (83,644 women followed from 1980-2008) and Health Professionals Follow-up Study (37,698 men followed from 1986-2008) shows that “red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.” Questionnaires were administered biennially in both of these studies (Arch Intern Med. 2012. 172. 555-563).
Data from 3 cohorts of US adults and an updated meta-analysis concluded that red meat consumption is associated with an increased risk of type 2 diabetes (Am J Clin Nutr. 2011. 94. 1088-1096).
A meta-analysis of data from cohort studies concludes that consumption of red meat and processed meat increase the risk of colon cancer. Gram for gram, processed meat consumption is associated with double the risk of colon cancer, as compared with red meat consumption (PLoS One. 2011. 6. e20456).
A large cohort study (over 500,000 people) with 10 years of follow up showed that higher intake of total red meat and total processed meat was associated with higher mortality (Arch Intern Med. 2009. 169. 562-571).

Relevant issues aside from the nutritional value of the meat include:

Antibiotics given to the animals to promote growth.
Bacterial contamination of ground beef – fresh oregano, 1 tablespoon per pound of burger meat or meat loaf, has an antibacterial effect.
Humanity of the conditions in which the animals are raised.
The type of food given to the animals (i.e. corn and soy versus grass) – see Time 6/12/06 pp. 76-78

Saturated fat content of the meat is lower in grass fed animals (Asia Pac J Clin Nutr. 2006. 15. 21-29).
Omega 3 fatty acid content, CLA content, and vitamin A and vitamin E content are slightly higher in grass fed animals (J Anim Sci. 2002. 80. 1556-1563; Asia Pac J Clin Nutr. 2003.12. S38). The explanation for this is as follows: The first chamber of a grass-fed cow's stomach has a pH of 7, and is colonized by bacteria that synthesize high levels of omega 3 fats and CLA. The first chamber of the stomach of a cow that eats grains is much more acidic, and the acidic pH fosters the growth of bacteria which synthesize far more omega 6 fats than omega 3 fats and CLA. The omega 6: omega 3 content of the meat of a grass fed cow or lamb is similar to that of salmon, 1.5 to 1, whereas the omega 6: omega 3 content of the meat of a grain fed cow is 7 to 1 (Time. 8/30/10. 30-40).
Stomach ulcers and liver abscesses much more common in cows fed a grain-based (corn, soy) diet.
Acid resistant E coli bacteria much more common in the stomach of cows fed corn and soy, and this bacteria can spread from the feces to the meat and cause human disease in those who consume the meat (if not detected by USDA inspections).

Concentration of environmental toxins at the top of the food chain.
Utilization of world resources to raise cattle versus planting vegetables and grains.
Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) are produced by cooking meat.

§ These cause cancer in lab animals.

§ Cooking temperatures in excess of 300 degrees Fahrenheit, cooking times in excess of 2 minutes, charring of food, and frying, grilling, broiling, or BBQ all increase production of these compounds.

§ Minimize production by choosing lean meats, trimming fats, using marinades (combination of vinegar, citrus juice, herbs, spices, and olive oil), microwaving briefly before cooking, and cooking small portions to minimize grill time, cooking with lower temperatures and turn the meat frequently.

BEWARE of deceptive labeling (Consumer Reports. 6/04. 5)

‘Free range’ - defined by USDA as daily "access" to the outdoors. “The USDA considers opening the chicken coop door for 5 minutes each day adequate for the free-range distinction. The animal doesn’t even have to step outside” (Self Healing. 3/07. Pg 3. Pointer on Picking out Poultry).
‘No synthetic hormones used’ is meaningless in poultry and pork because federal law prohibits use of synthetic growth hormones.
Hormone free and antibiotic free in beef by regulation means only that no hormones or antibiotics have been administered within 90 days of slaughter.
The USDA in 2007 required that ‘grass-fed’ cows obtain 100% of their daily calories from grass; prior to this the USDA did not verify the accuracy of this description. Look for “USDA-verified grass-fed” beef.
‘Certified organic’ or ‘certified biodynamic’ are terms verified by the USDA which indicate that the animals are fed no animal parts.

Lean meat by definition contains less than 3 grams of fat per ounce.
Meat when metabolized creates acidic byproducts and some experts hypothesize that slight increases in acidity in the body even when within normal range are harmful.
Arachidonic acid in meat increases production of pro-inflammatory eicosanoids in the body; grass fed beef probably has less arachidonic acid.
Coleman, Manning, B3R, and New Zealand beef are considered reputable brands.
Bison (Time. 3/26/07)

Bison do not tolerate confinement well, so they must be allowed for most of their lives to roam on the range and eat grass, and consequently they are leaner, with less saturated fat. They also likely have a higher content of omega 3 fat than grain fed cows.
Some bison are corralled and fed grain just prior to slaughter, in order to make the meat richer – this type of bison meat is not as healthy.
The USDA has developed regulations for shooting bison in the field, and this is considered more humane than killing them in a slaughter house.

Milk (and dairy products)

2005 dietary guidelines recommend consuming “3 cups per day of fat-free or low-fat milk or equivalent milk products.”
Fat content – mostly saturated fat.

NOTE 2% low fat milk is 2% fat by weight, 35% fat by calories.
When milk is made into cheese the fat is concentrated so the fat content of cheese is often 50-70%.

Ingredients in milk – milk is a complex colloidal dispersion of fat globules (3.9%), and protein (3.5% casein and whey) in an aqueous solution (87%) of lactose (4.9%), minerals, and other minor constituents (0.7%).

Micronutrients

Milk is a good source of calcium, magnesium, phosphorus, potassium, zinc, and vitamins A, B1, B2, B6, B12, and D.
The “Price Factor” (a fat soluble catalyst that encourages optimal assimilation of vitamins and minerals) is present in milk from cows which graze, absent when cows are fed soy or cottonseed

Sugar – lactose.

Estimated that 25% of Americans have lactose intolerance (Pediatrics. 2000. 110. 826-832), and thus may experience bloating, flatulence, and abdominal pain with milk or dairy consumption. Many of these individuals though can tolerate 1-2 cups of milk if spaced throughout the day.
Goat's milk may be easier for some to digest than cow's milk.

Protein – the quality of the protein in milk (i.e. essential amino acid composition) is good.

Whey rarely causes symptoms, and is insulinotropic (Am J Clin Nutr. 2004. 80. 1246-1253) and a potent stimulus for secretion of glucagonlike peptide (Arch Intern Med. 2005. 165. 975-976).
Casein (which is also present in yogurt) based on anecdotes can increase mucous production and aggravate asthma, bronchitis, sinusitis, allergies, and autoimmune problems (lupus, multiple sclerosis, rheumatoid arthritis) in some people.

Fats

Mostly saturated fat.
Contains CLA (amount is 500% higher in exclusively grass-fed cows) which may assist with weight loss and prevent cancer.
NOTE 2% low fat milk is 2% fat by weight, 35% fat by calories.
NOTE when milk is made into cheese the fat is concentrated so the fat content of cheese is often 50-70%.

Enzymes – pasteurization destroys many of the digestive enzymes. The enzyme xanthine oxidase in homogenized milk is surrounded by a protective coating of fat molecules, allowing it to escape degradation by digestive juices and to be absorbed into the bloodstream intact. This substance may promote atherosclerosis (Gaby A. Preventing and Reversing Osteoporosis. 1994. Pg. 117).
Hormones

§ Modern dairy farming involves milking the cows when they are pregnant (because pregnant cows produce more milk than nonpregnant cows), and this practice is associated with higher levels of estrogen and progesterone in milk, which in turn may increase risk of premature sexual development and also breast cancer.

§ 15-30% of cows in the U.S. are injected recombinant bovine growth hormone in order to increase output of milk. These cows are more susceptible to infections and thus receive more antibiotics. Milk from these cows may have higher IGF-1 levels, and this protein may pass into the bloodstream. IGF-1 may increase the risk of breast, colon, and prostate cancer. Organic milk comes from cows which do not receive rBGH and many other countries have banned rBGH because of the adverse effects on cows who are administered this hormone (Self Healing. 1/05).

· Antibiotics - “Milk is allowed to contain a certain concentration of 80 different antibiotics – all used on dairy cows to prevent udder infections. With every glassful, people swallow a minute amount of several antibiotics.” (Newsweek. 3/28/94. 47-51).

Benefits associated with milk and dairy consumption

Breast cancer

Premenopausal – reduced risk seen (J Natl Cancer Inst. 2002. 94. 1301-1311).
Postmenopausal – reduced risk seen (Cancer Epidemiol Biomarkers Prev. 2005. 14. 2898-2904).

Colon cancer – reduced risk seen (Cancer Causes Control. 2000. 11. 459-466).
Coronary artery disease – reduced risk seen (Am J Epidemiol. 1999. 149. 151-161; J Epidemiol Community Health. 2001. 55. 379-382).
DM Type II – reduced risk seen in men in association with dairy consumption, especially low-fat dairy consumption, based on prospective data on 41,254 male participants in the Health Professionals Follow-up Study with no history of diabetes, cardiovascular disease or cancer at baseline (Arch Intern Med. 2005. 165. 997-1003).
Gout- reduced risk seen in men (N Engl J Med. 2004. 350. 1093-1103).
Hypertension – favorable effects seen in prospective studies (Hypertension. 1996. 27. 1065-1072; Circulation. 1989. 80. 1320-1327).
Insulin resistance – strong inverse relationship seen between dairy intake and risk of insulin resistance in overweight young adults in the CARDIA study (JAMA. 2002. 287. 2081-2089).
Obesity – CONTROVERSIAL FINDING

Reduced risk seen in one trial (J Am Coll Nutr. 2000. 19. 754-760).
No benefit seen in a one year trial in 90 obese subjects (Obes Res. 2005. 13. 1344-1353).
No benefit seen in 51,529 men ages 40-75 in the Harvard Health Professional Follow-up Study, when analysis is adjusted for possible confounders (Am J Clin Nutr. 2006. 83. 559-566).

Stroke – reduced risk seen (Stroke. 1996. 27. 813-818).
Weight loss – there are three small published studies showing that milk facilitates weight loss – these studies were funded by the National Dairy Council, and have methodological flaws. Out of 27 RCTs investigating the effects of dairy products on body weight, the only positive ones were the three sponsored by the dairy industry, and conducted by Michael Zemel, PhD. On 6/28/05 PCRM (Physicians Committee for Responsible Medicine) filed lawsuits to stop an advertising campaign claiming that milk facilitates weight loss, and in 5/07 the FTC announced that it was banning the advertisements promoting dairy consumption as a means of achieving weight loss.

Harms associated with milk and dairy consumption (and see just above ‘Ingredients in milk’)

DM Type I – NOTE however that the issue may be an enhanced immunity to proteins in general and proteins in wheat and soy appear to be more potent diabetogens than those found in milk (Arch Intern Med. 2005. 165. 975-976).
Infertility – increased risk of infertility associated with two or more servings of low fat dairy per day, based upon data from 18,555 premenopausal women in the Nurses’ Health Study II (Hum Reprod. 2007. 22. 1340-1347).
Osteoporotic fractures

Despite the advertisements for milk for osteoporosis prevention, epidemiologic and cross cultural data actually show a positive correlation between intake of milk products and osteoporotic fractures (Hippocrates. July/August 1999. 53-55).
A 12 year Harvard study which prospectively tracked the dietary intake and medical histories of 77,761 women showed an increased risk of osteoporotic fractures associated with increased milk consumption (Am J Pub Health. 1997. 87. 992-997).
In a review of 37 studies of dairy or unsupplemented dietary calcium intake in children, adolescents, and young adults, 27 studies found no relationship between dairy or dietary calcium intake and measures of bone health (Pediatrics. 2005. 115. 736-743).

Ovarian cancer – increased risk, based on a meta-analysis (Int J Cancer. 2005). Individual studies which showed an increased risk include the Harvard Nurses’ Health Study (Int J Cancer. 2004) and the Iowa Women’s Health Study (Am J Epidemiol. 1999).
Parkinson’s – increased risk based on data in 388 men and women with Parkinson’s participating in the ACS Cancer Prevention Study II (Am J Epidemiol. 2007. 165. 998-1006).
Prostate cancer

A review of 14 case-control studies and 9 cohort studies concludes that dairy intake “is one of the most consistent dietary predictors for prostate cancer in the published literature (Epidemiol Rev. 2001. 23. 87-92).
In the Physicians’ Health Study in 20,885 male physicians, data at 11 years of follow-up showed a relative risk of prostate cancer of 1.34 in those who consume > 2.5 servings of dairy products compared to those who consume 0.5 servings per day (Am J Clin Nutr. 2001. 74. 549-554).
Analysis of 2776 men in the French SU.VI.MAX Study showed a higher risk of prostate cancer in those with higher dairy and calcium intake. A harmful effect of yogurt consumption on prostate cancer risk was identified in this study (Br J Nutr. 2006. 95. 539-545).
A meta-analysis of 12 studies found that men with the highest intake of dairy and calcium had a higher risk of prostate cancer (J Natl Cancer Inst. 2005. 97. 1768-1777).
In a prospective study in a cohort of 27,028 smokers age 50-69 (ATBC study), increased dairy intake and increased dietary calcium intake was associated with an increased risk of prostate cancer at 17 years of follow-up. Of note, when dietary calcium or calcium from dairy products was controlled for, the association between total dairy intake and increased risk of prostate cancer became statistically nonsignificant (Int J Cancer. 2007. 120. 2466-2473).

Many experts assert that organic milk (Horizon is a reputable brand) is preferable to ‘ordinary’ milk, and that if available, raw milk is best from a health standpoint. Note availability of raw milk is often limited, but raw milk cheese is available in many health food stores.
Review articles

King JC. The milk debate (editorial). Arch Intern Med. 2005. 165. 975-976.
Goldberg JP, Folta SC. Milk: can a ‘good’ food be so bad? Pediatrics. 2000. 110. 826-832.

Nuts

Nuts in general are good sources of protein, fiber, monounsaturated fat, plant sterols, and minerals.
Tree nuts (almonds, Brazil nuts, cashews, hazel nuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts).

All are rich in monounsaturated fat, which is "good fat." Brazil nuts, cashews, macadamia nuts, and pine nuts though do have higher saturated fat content than almonds, hazel nuts, pecans, pistachios, and walnuts.
Almonds are an excellent source of vitamin E. NOTE almonds must be pasteurized in the U.S. (as of 9/07) based on outbreaks of Salmonella traced to raw almonds. Chemical pasteurization in the U.S. may involve the use of propylene oxide, a potential carcinogen. Choosing organic varieties allows one to avoid almonds pasteurized with this chemical (Self Healing. 1/08. Pgs 6-7).

Brazil nuts are an excellent source of selenium.
Hazelnuts are an excellent source of copper and manganese.
Pine nuts are an excellent source of vitamin K.
Pistachios are an excellent source of gamma tocopherol (a form of vitamin E), thiamine and potassium.
Walnuts are an excellent source of alpha linolenic acid (omega 3) and antioxidants

The FDA has approved a qualified health claim for almonds, hazel nuts, pecans, pistachios, and walnuts, stating that there is supportive data that consumption of 1.5 ounces (45 grams) per day reduces the risk of heart disease.
Peanuts (actually legumes and not true nuts) are slightly less healthy overall than many other nuts in terms of having more saturated fat; aflatoxin contamination of peanuts is believed to affect only nuts grown and stored in Africa.
Soy nuts are an excellent source of soy protein, which is associated with cardio protective effects.
Clinical trial data – in general, epidemiologic studies have shown that tree nut consumption decreases the rates of coronary disease events, sudden cardiac death, diabetes, and gallstones. A variety of types of clinical studies have been conducted using almonds, hazelnuts, macadamia nuts, pecans, pistachios, and walnuts (Alt Med Alert. 2007. 10. 17-21).

Epidemiologic studies show an inverse correlation between nut consumption and BMI (Am J Clin Nutr. 2003. 78. 647S-650S).

Epidemiologic studies show an inverse relationship between intake of both almonds and walnuts and the risk of heart disease. The Seventh Day Adventist Study which had more than 31,000 participants found that those who reported eating nuts more than 4 times per week had a 50% lower risk of CAD than those who rarely ate nuts (Arch Intern Med. 1992. 152. 1416-1424). Similar results were seen in the Nurses’ Health Study, with a 35% lower risk of CAD (BMJ. 1998. 17. 1341-1345).

A systematic review of 23 published studies of the effect of nut consumption on lipid profiles found that nut consumption is associated with improvement in blood lipid values. The investigators suggest intake of 50-100 grams of nuts five days per week (J Nutr. 2005. 135. 2082-2089).
In a prospective cohort study of 83,818 women from 11 states in the Nurses' Health Study, nut consumption and peanut butter consumption were inversely associated with the risk of developing type II diabetes (JAMA. 2002. 288. 2554-2560).
Nut consumption was inversely associated with the risk of gallbladder disease in the Health Professionals Follow-Up Study in men (437,305 person years of follow up) [Am J Epidemiol. 2004. 160. 961-968], and in Nurses’ Health Study in a cohort of 80,718 women (Am J Clin Nutr. 2004. 80. 76-81).

For much more information on nuts and their beneficial effects on lipid profiles, and also on cardiovascular events, go to the outline on this website, ‘Prevention of MI’ and scroll down to ‘nuts’ in the category of ‘Primary Prevention – Diet.’

Oils

Exposure of oils, especially polyunsaturated oils, to air or heat or light leads to oxidation of the oil, which produces a rancid oil, which is dangerous to ones health.

Minimize the risk of oxidation of the oil by purchasing all oils in darkened containers to protect from light.
Buy cooking oils in small quantities to protect the rest of the oil in the container from the air in the container once the container has been opened.
Refrigerate oils to protect from heat.

Heating oils beyond their smoking point causes chemical changes which are detrimental to a person’s health. Fast food restaurants do this all the time. Furthermore there is data that there are chemical changes in many oils well below their smoking point – this information should be available from Omega Nutrition, a reputable manufacturer of oils, 1-800-661-3529.

High-heat cooking: best to use coconut oil, peanut oil (organic preferred), or high oleic safflower oil.
Medium-heat cooking: may use olive oil, corn oil, or hazelnut oil.
Low-heat cooking: may use almond oil, sesame oil, sunflower oil, or butter.

Extraction of oil from the plant

The least damaging way to extract oil is to press the nut, seed or fruit until it oozes – this is called “cold-pressed” but it works only with soft raw materials.
BEWARE ‘cold-pressed’ is not defined from a regulatory standpoint in terms of maximum temperature at which the oil is expressed – it means that no added heat has been used, but there is no limit on the temperature achieved as a function of the pressure used to express the oil. These temperatures as a function of the high pressure alone may reach 200 degrees Fahrenheit. Expeller processed oils by voluntary standard should be manufactured at temperatures less than 118 degrees Fahrenheit.
Alternatives to cold-pressed are (1) expeller pressed or (2) chemically processed, in which the plant product is dissolved with toxic solvents and then the oil is refined, heated, and filtered. Oils extracted using chemicals usually will not say this on the label – look for the terms cold-pressed, expeller-pressed, and/or unrefined on the label to indicate that chemicals were not used.
Commercial oils are typically bleached, degummed, deodorized, and then stabilizers are added to the oil to increase shelf life. There is concern that these processes may cause undesirable chemical changes in the oil.

Organic oils are preferable, because many toxins are concentrated in the oil of plants.
Oils high in omega 6 fatty acids may have pro-inflammatory effects in the body, but this is controversial.
Choice of oils (Dr. Andrew Weil):

Almond oil - mostly monounsaturated fats.
Canola oil – probably very good. It is obtained from rapeseed, and consists of mostly monounsaturated fat. Buy organic, expeller-pressed products as per Dr. Andrew Weil (Self Healing. 2/05. 3). The concern with canola oil is that rapeseed oil is toxic to animals and must be irradiated to create canola oil and the long term effects of this are unknown.
Coconut oil/butter – controversy regarding health benefits

Dr. Weil skeptical due to high saturated fat content
Health benefits are the focus of a book by Bruce Fife, The Coconut Oil Miracle (2004).
Heat stable to 375 degrees Fahrenheit.
Contains lauric acid, an antibacterial compound which may boost immunity..
Rich source of medium chain triglycerides, which are readily converted to energy

Corn oil – high in polyunsaturated fats and most often produced at high temperatures and using toxic solvents.
Cottonseed oil – not as high as other oils in polyunsaturated fats, but rich in saturated fat, and contains manufactured and natural toxins. Cotton is often sprayed with pesticides and herbicides banned for use on food crops, because it is not classified by the USDA as a food.
Enova – brand name of an oil touted to facilitate weight loss. Contains chemically altered fats.
Fish oil – this is considered a dietary supplement. For more information on therapeutic uses of fish oil, return to Home Page, click on “Dietary Supplements” and scroll to ‘Fatty acids’ then scroll on to ‘Fish oil capsules.’
Flax oil – this is a source of ALA, a short chain omega 3 fatty acid which is inefficiently converted into longer chain fatty acids
Grapeseed oil – advantage is high smoking point, potential disadvantage is polyunsaturated fat content.
Hazelnut oil – highly unsaturated, may be used as seasoning in cold dishes, but should never be heated.
Macadamia oil - mostly monounsaturated fats., and a very high smoking point, so good for cooking.
Olive oil - very good. It is mostly monounsaturated fat and also has antioxidant-rich polyphenols and flavinoids. Heat stable to 300 degrees Fahrenheit.

Hydroxytyrosol, present predominantly in extra-virgin olive oil, appears to inhibit enzymes which involved in the production of pro-inflammatory eicosanoids. Hydroxytyrosol is also a potent antioxidant with a very high ORAC value. Olive oil rich in this compound can be purchased at www.Olio2go.com – it is expensive as per Barry Sears, Ph.D.
Oleocanthol, a phytochemical with COX-1 and COX-2 inhibiting properties, is found in extra-virgin olive oil, and appears to have anti-inflammatory activity similar to that of ibuprofen (Nature. 2005. 437. 45-46). This phytochemical causes a stinging sensation in the throat.
The polyphenols, which are most abundant in extra virgin olive oil, are cardioprotective – they inhibit platelet aggregation and LDL oxidation (Am J Clin Nutr. 2006. 84. 694-697).
Pomace oil is the lowest grade of olive oil available, manufactured by applying heat and/or solvents to the paste leftover after higher grades of oil have been extracted – it is thus inexpensive.

Palm oil

Palm fruit oil is 50% saturated fat, 40% monounsaturated fat, and 10% polyunsaturated fat, and has moderate antioxidant activity.
Palm kernel oil is >80% saturated fat, and often used in processed foods.

Peanut oil – 50% monounsaturated fats, 30% polyunsaturated fats.
Pistachio oil – mostly monounsaturated fats.
Safflower oil – highest in polyunsaturated fats. Safflower's history as a food plant in the Western world is very recent, and ancient medical texts in India recommend against consumption of this plant as food.
Sesame oil – high in polyunsaturated fats, but richly flavored, and contains small amounts of lignans, including sesamin, which is a direct inhibitor of the enzyme that facilitates production of arachadonic acid.
Soybean oil – also called ‘vegetable oil.’ High in polyunsaturated fats, but inexpensive. Due to difficulty in extracting oil from soybeans, soybean oil is often damaged in the process.
Sunflower oil – second highest in polyunsaturated fats.
Tea oil – advantage is high smoking point (over 400 degrees Fahrenheit) and composition, which is mostly monounsaturated fat, but it is expensive, and available only via www.republicoftea.com. Buy an organic, expeller-pressed product as per Dr. Andrew Weil (Self Healing. 6/04. 7).
Walnut oil - highly unsaturated, may be used as seasoning in cold dishes, but should never be heated.

Salt

Average salt intake in the U.S. in 2005-2006 was 10.4 grams per day for males (2 teaspoons) and 7.3 grams per day for females (USDA data posted on the USDA website).NOTE 1 gram of salt = 0.4 grams sodium. In the U.S. there has been a 55% increase in sodium intake from the 1970s to 2000 (Prog Cardiovasc Dis. 2006. 49. 59-75). 77% of salt comes from processed and restaurant food, 12% occurs naturally in foods, 6% is added at the table, and 5% is added during cooking (J Am Coll Nutr. 1991. 10. 383-393).
The ratio of potassium: sodium in Western diet estimated at 3:1 whereas ratio in Paleolithic diet estimated at 10:1 (Eur J Nutr. 2001. 40. 200-213).
Salt and cardiovascular disease

As of 2012, there are no large RCTs showing that sodium restriction lowers the risk of MI, stroke or death (The Medical Letter. 2012. 54. 13).
A Cochrane analysis of 7 RCTs (n=6489) showed that “Interventions to reduce dietary salt do not reduce mortality or cardiovascular morbidity in persons with normotension or hypertension” (Cochrane Database Syst Rev. 2011. CD009217 as cited in ACP Journal Club. 2012. 156. JC1-4).
A meta-analysis identified only 7 RCTs of dietary sodium restriction in which cardiovascular disease incidence or mortality were used as endpoints; the results of the analysis showed no strong effect of sodium reduction on cardiovascular disease incidence or mortality (Am J Hypertens. 2011. 24. 843).
A meta-analysis of 6 of the above 7 RCTs combined hypertensive and normotensive patients and found a 20% reduction in cardiovascular events in association with dietary sodium restriction, but a nonsignificant 5-7% reduction in overall mortality (Lancet. 2011. 378. 380).
A systematic review and meta-analysis of prospective studies identified 13 studies representing data on 19 independent cohort samples with more than 175,000 subjects. Salt intake was estimated in some studies by 24 hour dietary recall, in others by food-frequency questionnaire, and in others by measurement of 24 hour urine excretion; follow up ranged from 3.5 to 19 years. The higher the salt intake the higher the risk of CVD (RR 1.14) and CVA (1.23). The longer the period of follow up, the greater the risk of CVA. The authors conclude that cutting average salt intake by half might reduce the risk of stroke by 23% and heart disease by 17% (Strazzullo P et al. BMJ. 2009. 339. b4567).
A study exploring the potential impact of modest reduction in dietary salt on US population health, using a computer simulation of heart disease in US adults age 35-84 concludes that reducing dietary salt by 3 grams per day (dietary sodium by 1.2 grams per day) is projected to is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000; the annual number of new cases of CVA by 32,000 to 66,000; the annual number of new cases of MI by 54,000 to 99,000, and the annual number of deaths from any cause by 44,000 to 92,000 (N Engl J Med. 2010. 362. 590-599). This intervention could save $10 - $24 billion annually in health care costs. The conclusion of the editorialist is that “The evidence supporting the call to reduce salt intake as a means of preventing cardiovascular disease is compelling.” (Editorial. N Engl J Med. 2010. 362. 650-652).
A cost effectiveness analysis using a Markov model concluded that “Strategies to reduce sodium intake on a population level in the United States are likely to substantially reduce stroke and MI incidence, which would save billions of dollars in medical expenses.” (Ann Intern Med. 2010. 152. 481-487 and editorial 526-527).
NOTE the conclusion that reducing salt intake will reduce the risk of risk of CVD and CVA is based on the assumption that reductions in BP will reduce the risk of CVA and CHD (i.e. that BP is a surrogate marker). Some experts express concern that reduction in salt intake may unfavorably impact other cardiovascular disease surrogates, and thus reducing salt intake may not reduce risk of CVD and CVA (Commentary. JAMA. 2010. 303. 448-449). See just below for potential harms of reducing salt intake.
NOTE that the results in the individual observational cohort studies have been conflicting (Commentary. JAMA. 2010. 303. 448-449).
Prospective data from NHANES III, with mean follow-up of 14.8 years in 12,267 US adults show that higher sodium intake was associated with increased all cause mortality. In addition, higher sodium to potassium ratios of dietary intake were associated with increased all cause and CVD mortality (Arch Intern Med. 2011. 171. 1183-1191 and invited commentary 1191-1192).

Salt and blood pressure

A Cochrane analysis showed that reducing dietary salt intake lowers blood pressure (Cochrane Database Syst Rev. 2004. 3. CD004937), but only a subset of hypertensive individuals experience a decrease in BP with salt restriction.
A review of 167 studies, mostly small and short-term, found that low sodium intake was associated with reductions of SBP of 1-4 mm Hg in individuals in various ethnic groups without hypertension, and reductions of SBP of 6-10 mm Hg in individuals in various ethnic groups with hypertension (Am J Hypertens. 2012. 25. 1).

Possible harms of a low salt diet

In one study in ~3000 hypertensive men, low salt intake is associated with an increased risk of MI (Hypertension.1995. 25. 1144-1152).
Reduction in salt intake sufficient to lower BP increases sympathetic nervous system activity, decreases insulin sensitivity, activates the rennin-angiotensin system, and stimulates aldosterone secretion (JAMA. 1998. 279. 1383-1391; J Hypertens. 2007. 25. 903-907).
Low salt intake is associated with hyperinsulinemia (J Intern Med. 1993. 233. 409-414).
Low salt diet increases serum cholesterol and LDL (Klin Wochenschr. 1991. 69 [suppl XXV]. 51-57).
Data from NHANES I and NHANES III (Am J Hypertension. 2005. 18. 261) showed that low dietary intake of salt was associated with an increased risk for HTN.
A RCT
In patients with CHF, those randomized to a sodium intake of 1840 mg/day had significantly increased hospitalization and mortality compared to those randomized to 2760 mg/day (Am J Cardiol. 2009. 103. 93-102).
Increases the half life of bromine in the body, based on a study in rats (Chem Toxic. 1983. 21. 379).

Table salt is a processed “food” (Salt Your Way to Health by David Brownstein, MD. 2006)

Refined salt has all minerals (other than the sodium) removed and iodide added. The minerals are removed from the brine with chemicals such as chlorine or sulfuric acid. Next the water is evaporated under high pressure and heat. Dextrose is used as a stabilizer so that iodide will stay in salt. Refined salt is bleached so that it maintains the white color. Refined salt has a very long shelf life. More information on the refining process is available at www.saltinstitute.org.
The National Academy of Science Food Chemicals Codex Sodium Chloride Monograph (1996) permits food grade salt to contain anti-caking, free-flowing, and conditioning agents, such as sodium ferrocyanide, ammonium citrate, and aluminum silicate as long as the additives constitute no more than 2% of the contents of the final food grade salt product.
Refined salt consists of approximately 39% sodium, approximately 60% chloride, up to 2% additives (see just above), 0.01% iodide.

Unrefined salt contains more than 80 minerals and elements in minute amounts, along with the sodium and chloride.

Celtic Sea Salt contains 33% sodium, 50.9% chloride, 1.8% minerals and trace elements, and 14.3% moisture. More information on Celtic Sea Salt is available through The Grain & Salt Society (800-867-7258).
Redmond’s Real Salt contains 37.6% sodium, 59.1% chloride, approximately 1% minerals and trace elements.

Soda

Diet soda – see ‘artificial sweeteners’ below in this outline. In addition to the detrimental effects of the artificial sweeteners, the caffeine prompts conversion of ATP to AMP, and detection of this ‘spent fuel’ may increase appetite and thirst.
In a meta-analysis of 88 studies, the authors found clear associations of soft drink intake with increased energy intake and body weight, and with an increased risk of several medical problems such as diabetes. The studies using the most reliable statistical methods showed the largest effects. Several studies found that the caloric increase is actually greater than that contained in the soda, raising “the possibility that soft drinks increase hunger, decrease satiety or simply calibrate people to a high level of sweetness that generalizes to preferences in other foods… These results, taken together, provide clear and consistent evidence that people do not compensate for the added calories they consume in soft drinks by reducing their intake of other foods” (Am J Public Health. 2007 97. 667-675).
In a study of 91,249 women followed for eight years, those who consumed one or more soft drinks per day were twice as likely as those who consumed less than one per month to develop diabetes.
Consumption is associated with an increased risk of gout in men, with the risk 85% higher in men who consumed two or more servings daily, compared with men consuming no soda (BMJ. 2008. 336. 309-312).
Consumption of one soda daily is associated with a 20% increased risk of coronary heart disease (Circulation. 2012; DOI: 10.1161/CIRCULATIONAHA.111.067017).
Sodium benzoate, a common preservative found in many soft drinks, might damage mitochondrial DNA, based on laboratory data in living yeast cells (accessed 6/19/07 at www.mercola.com). Sodium benzoate, which occurs naturally in berries in small amounts, is used in large quantities to prevent mold in soft drinks such as Sprite, Diet Pepsi, Coca-Cola, and Dr Pepper.
BEWARE that soda with added vitamin C and with sodium benzoate as a preservative may have benzene levels above the EPA limit of 5 ppb for drinking water. In a recent FDA and EPA study, almost 5% of 200 beverage samples had benzene levels above 5 ppb (accessed 1/26/08 at www.mercola.com).

Soy (Consumer Reports. 7/04. 28-31; Alternative Medicine Alert. 2004. 7. 49-55)

Popularity:

By 2005, Americans are expected to spend $4.7 billion on soy foods, an 844% increase over 1990.
Sales of soy supplement pills rose more than 500% between 1997 and 2002 according to the Nutrition Business Journal.

Nutrient composition:

Soy protein contains the 8 essential amino acids also found in animal protein. Soy protein has the highest nutritive value of any plant source; the overall quality of the protein is similar to that of meat or milk or eggs. HOWEVER, soy has suboptimal amounts of sulfur-containing amino acids (cysteine and methionine) and modern processing of soy denatures some of the lysine.
Soy is rich in essential fatty acids, but contains much less saturated fat than animal protein, and no cholesterol.
Soy is rich in minerals, but also rich in phytates, and the phytic acid in soy may interfere with absorption of the minerals.
Soy contains vitamin E, oligosaccharides, lecithin, and saponins, all of which are bioactive compounds.
Soy contains isoflavones (soy foods on average contain 3.5mg isoflavones/gram of protein)

The main isoflavones in soy are genistein, daidzein, and glycitein.
Thought to act as weak estrogens, reversibly binding to estrogen receptors, with a greater affinity for the beta isoform (found mostly in the nervous system, cardiovascular system, bone, and skin) than the alpha isoform (found mostly in the uterus and breast).
There are two types of isoflavones in soy - aglycones and glucosides.

Aglycones are the active ingredient, and are found in fermented soy foods, as a result of enzymatic hydrolysis during fermentation.
Glucosides are aglycones with a glucose molecule attached – the isoflavones in non-fermented soy foods exist in this form. These are converted by intestinal bacteria into the biologically active aglycone form, but the conversion rate is only approximately 60%. Human GI juices do not contain glycosidases.

Daidzein is converted in the gut into a bioactive metabolite named equol which is a more potent, possessing estrogenic activity approximately five times greater than its precursor. The extent of this conversion is dependent in part upon the amount of prebiotic in the diet and in part upon the composition of the GI flora – some lactobacilli such as Lactobacillus sporogenes facilitate this conversion.
Note that ipriflavone is a synthetic derived from soy isoflavones (more information on this compound on this website under the heading "Osteoporosis.").

Categories of soy products:

Fermented soy foods - historical use of soy by the Japanese is use of predominantly fermented products such as tempeh, miso (soup), and natto (a fermented cheese). Fermentation reduces the levels of isoflavones 2-3 fold.
Whole soy foods – there is some historical use of these non-fermented whole foods such as tofu, soy milk and edamame (lightly broiled soybean pods).

Note though that American strains of soya plants have significantly higher levels of isoflavones than Japanese or Chinese ones because of selective breeding in the U.S. to promote pest resistance of the plants.
Edamame is young green beans which are lower in estrogens and antinutrients than the mature plant.

Processed soy – soy protein concentrate, soy protein isolates, texturized soy protein.

These are not whole foods and there is no significant historical use, so safety is unknown.
Made by isolating the soy protein from the carbohydrate and fat.
Often found in cereals, energy bars, patties, crackers, spaghetti sauce, and as an inexpensive filler to lower a food’s overall fat content.

Supplements

Controversy about relative benefit versus risk of soy

10,000 soy-related articles published between 1990 and 2005, and the literature is conflicting, so anyone can selectively use the published literature to argue any point about safety or risk.
Likely that fermented soy foods in moderation are safest, whole soy foods in moderation are safe too, with long-term safety of processed soy products and supplements an unknown.
Regarding the therapeutic health claim for soy and cholesterol-lowering (See Health Benefits just below) the concern of some is that the long-term safety of these quantities of soy, even if consumed in whole foods form, is unknown because it exceeds historical use of 10 grams of soy protein per day. Two FDA scientists formally protested the decision to grant a therapeutic label claim due to lack of data on long-term safety of this magnitude of daily consumption.
An evidence-based report “Effects of Soy on Health and Outcomes” was requested and funded by NCCAM and NIH Office of Dietary Supplements, and published in 2005. It concluded that eating soy protein daily may have some health benefits , but overall the health effects of soy are uncertain and need further investigation. Summary of report available at www.ahrq.gov/clinic/epcsums/soysum.htm or 1-800-358-9295

Health benefits:

Atherosclerosis prevention – soy may be beneficial based on data that genistein inhibits thrombin formation and platelet aggregation, and inhibits cell adhesion and proliferation.
BPH – the beta-sitosterol in soy is beneficial (Lancet. 1995. 345. 1529-1532).
Cancer prevention - data is mixed. Epidemiological studies show a decreased risk of breast, colon, lung, and prostate cancer. The epidemiological data on lung cancer comes from a case control study in 1674 patients and 1735 matched controls (JAMA. 2005. 294. 1505-1510). Soy isoflavones shift estrogen metabolism toward more beneficial metabolites (i.e. 2 hydroxyestrone). Isoflavones interfere with angiogenesis in vitro (Nutr Cancer. 1994b. 21. 113-131). Soy increases synthesis of SHBG and inhibits aromatase.
Cognitive function - data is promising.
Heart rate variability – increased with consumption of soy (Chest. 2005. 127. 1102-1107).
Hot flashes - diets high in soy foods are correlated with a decrease in hot flashes, but data from clinical trials is mixed.
Lowers cholesterol - based on a meta-analysis of 38 controlled clinical trials showing a 9% decrease in total cholesterol and a 13% decrease in LDL cholesterol in patients taking 25-50 grams per day of soy (New Engl J Med. 1995. 333. 276-282), the FDA as of 1999 actually allows a therapeutic label on soy rich foods (6.25 grams of soy per serving) - "capable of decreasing the risk of heart disease." Presumed mechanism of action – reduced hepatic cholesterol synthesis. It has been proposed that only the 1/3 of individuals who convert daidzein to equol benefit from soy with regard to the lipid profile. The ability to convert daidzein to equol appears to be related to specific gut flora.
Osteoporosis prevention - animal data very promising, but human data mixed.
Vaginal atrophy prevention - data is mixed.

Potential health risks:

Soy foods are presumed safe because they have been consumed in Asia for thousands of years - consumption of up to 100 mg of aglycone isoflavones per day (10 grams of soy protein) in food is presumed safe.
The safety of isolated isoflavone supplements is unknown; they are presumed safe.
It is possible that soy may affect an infant's hormone levels or endocrine system.
Soy might stimulate breast cancer cells, or alter the effectiveness of hormonal therapy for breast cancer.
Soy isoflavones 150mg/day for 5 years caused endometrial hyperplasia in 3.9% of women, although no endometrial hyperplasia seen after 2.5 years (Fertil Steril. 2004. 82. 145-148).
Soy may interfere with thyroid function – data would suggest that this occurs only in the presence of an iodine deficiency, and the effect may be offset by iodine supplementation. A RCT in 38 postmenopausal women not on HRT and taking a product with 90 mg/day of isoflavones found no changes in serological assessment of thyroid function (J Med Food. 2003. 6. 309-316).
Soy may block absorption of thyroid supplements.
Soy may increase the risk of calcium oxalate kidney stones.
It is estimated that 5 to 7% of babies and 1 to 2% of adults are allergic to soy.
Soy may increase lipoprotein (a) levels.
Soy intake in men has been associated with a decline in vascular endothelial function.
Some researchers express concern about the consumption of protease inhibitors in soy; cooking destroys these compounds.

Labels on food and supplements:

Consumer Reports found that eleven of the foods analyzed overstated their level of isoflavones.
A food's label often does not distinguish the amount of aglycone isoflavones versus glucoside isoflavones.
When soy protein is used as an inexpensive filler to lower a food’s fat content, it may appear under deceptive label terms such as ‘natural flavors’ or ‘vegetable protein.’

Sugar – see section on ‘Sugar’ in the category ‘Carbohydrates’ at the top of this outline.

Sweeteners

Natural sweeteners

Agave nectar – glycemic index lower than other natural sweeteners, secondary to high ratio of fructose to glucose.
Barley malt – mostly maltose, which does not directly activate an insulin response
Birch sugar and/or Birch syrup
Brown rice sugar – mild sweetener which is a healthier alternative than brown sugar.
Csweet – brand name for a product in which the natural ingredient is brazzein, a sweet protein from the berries of a West African plant named Pentadiplandra Brazzeana, and said to be 1,000 times sweeter than sugar with no undesirable aftertaste.
Date sugar
Erythritol (Sweet Simplicity) – sugar alcohol
Fructooligosaccharides (FOS) – this natural product also serves as nutrition for friendly bacteria in the gut.
Honey – made from flower nectar of honeybee, contains vitamins and minerals and antioxidants.
Inulin – sweet probiotic.
Just Like Sugar – ingredients include chicory root dietary fiber, calcium, vitamin C, and natural flavors from the peel of the orange. www.justlikesugarinc.com
Lohan fruit (Sweet Balance) – 250 times as sweet as sugar, contains a small amount of sugar, and may contain antioxidants.
Maltitol (Nature Sweet) – sugar alcohol
Maple sugar and/or Maple syrup
Miracle berry
Molasses (blackstrap) – originally from Caribbean islands, rich in minerals.
Monk fruit (BioVittoria) – grown in Southern China, 300 times as sweet as sugar
Rapadura – brand name product derived from juice of sugarcane plant.
Sorbitol - sugar alcohol
Stevia (PureVia, SweetLeaf Stevia, Truvia) – 250-300 times as sweet as sugar.

Used for centuries in South America (in small quantities). There is a slightly bitter aftertaste.
Used in Japan as a sweetener, but not approved as a sweetener in the U.S., in Canada, or by the European Union.
Available in the U.S. as a ‘dietary supplement.’
In 1998, a United Nations expert panel identified unresolved concerns about its toxicity.
Animal studies identify reproductive problems, cancer, and interference with energy metabolism as areas of potential concern, especially if large quantities are consumed.
Nonprofit Center for Science in the Public Interest recommends avoiding it.

Sucanat
Tagatose – made from milk sugar, approximately as sweet as sugar with 1/3 the calories and appears safe.
Vegetable glycerin
Xylitol – first manufactured in 1891, became popular in Finland after World War II.

§ Natural substance (a 5 carbon sugar alcohol) found in fibrous vegetables and fruit, and in various hardwood trees.

§ Humans synthesize up to 15 grams per day during normal metabolism.

§ Has 1/3 the calories of sucrose (table sugar), and is approximately 2/3 as sweet as table sugar.

Non-fermentable and cannot be converted to acid by oral bacteria, and thus inhibits plaque formation.
The dose required to prevent cavities is 6 grams/day
Glycemic index is 7 when a scale designating sucrose as 100 is used.

Zsweet – erythritol (a sugar alcohol found in many fruits) – approximately 70% as sweet as sugar. Considered safe by the FDA.

Artificial sweeteners

There is no data and has never been any data that artificial sweeteners assist in weight loss.
They stimulate appetite through the cephalic phase response - the brain associates sweet taste with introduction of new energy (i.e. food) into the body. thinks real sugar is in the system. Production of insulin is triggered – insulin then halts the production of sugar from protein and starch reserves, and facilitates storage in the cells of metabolic fuel circulating in the blood. Since no new energy (i.e. glucose) has actually been introduced into the body, relative hypoglycemia develops, and this triggers hunger, which prompts intake of food.

Acesulfame potassium (Sunett, Sweet One) – 200 times sweeter than sugar, safety questionable based on animal studies.
Aspartame (NutraSweet, Equal)

§ Same energy content as sucrose (4 kcal/g), but 160-220 times sweeter than sugar.

§ Aspartame is composed of phenylalanine (50%), aspartic acid (40%) and methanol (10%). Phenylalanine plays an important role in neurotransmitter regulation. 10% of aspartame by weight is converted to methanol (wood alcohol), which in turn is converted in the body to formate, which can either be excreted or can give rise to formaldehyde, diketopiperazine (a carcinogen) and a number of other highly toxic derivatives.

§ There is concern that one of the metabolites, aspartate, an excitatory neurotransmitter may increase the risk of a variety of conditions, including ADHD, ALS, Alzheimer's disease, brain tumors, headaches, Parkinson’s disease, and seizures.

§ Individuals who are heterozygous for PKU ( approximately 4 million Americans) may be especially sensitive to the effects of aspartame.

§ The methyl esters in aspartame are also of concern, in terms of both neurological and endocrine toxicity.

§ There are published case reports of grand mal seizures, urticaria, angioedema, mania, panic attacks, migraines, and headaches associated with aspartame ingestion.

§ May lead to increased food/calorie intake (Physiol Behav. 1990. 47. 555-559; Int J Obes Relat Metab Disord. 1997. 21. 37-42).

§ Despite review articles which have concluded that aspartame does not increase cancer risk (Regul Toxicol Pharmacol. 2002. 35. S1-93; Ann Oncol. 2004. 15. 1460-1465), there is evidence of carcinogenicity in a study in Sprague-Dawley rats, animals which are deemed a consistent predictor of human cancer risk (Environ Health Perspect. 2006. 114. 379-385).

§ A review concluded that “Aspartame disturbs amino acid metabolism, protein structure and metabolism, integrity of nucleic acids, neuronal function, endocrine balances and changes in the brain concentrations of catecholamines. It was also reported that aspartame and its breakdown products cause nerves to fire excessively, which indirectly causes a very high rate of neuron depolarization. The energy systems for certain required enzyme reactions become compromised, thus indirectly leading to the inability of enzymes to function optimally. The ATP stores in the cells are depleted, indicating that low concentrations of glucose are present in the cells, and this in turn will indirectly decrease the synthesis of acetylcholine, glutamate and GABA (gamma-aminobutyric acid). The intracellular calcium uptake is altered, thus the functioning of glutamate as an excitatory neurotransmitter is inhibited. Furthermore, mitochondria are damaged, which could lead to apoptosis of cells and also a lowered rate of oxidative metabolism, which in turn could lead to lower concentrations of the transmitters glutamate and production of GABA. The cellular walls are destroyed with the result that the endothelial cells of the capillaries are more permeable, leading to a compromised blood brain barrier. Thus, overall oxidative stress and neurodegeneration are present” (Eur J Clin Nutr. 2008. 62. 451-462).

§ As per Mark Hyman, MD, of 166 studies on the safety of aspartame,100% of the 74 studies funded at least in part by industry found aspartame safe, while 92% of the 92 independently funded studies identified potential safety and adverse effect issues (Ultrametabolism. 2006. Pg 99).

§ More information in the movie Sweet Misery: A Poisoned World by Cory Brackett (which can be ordered at www.soundandfury.tv) and the books Excitotoxins: The Taste that Kills by Russell L. Blaylock, MD and Sweet Deception by Joseph Mercola, DC.

Neotame
Saccharin (Necta Sweet, Sweet ‘N Low) – 300-700 times sweeter than sugar; linked with cancer in animals in high doses, but probably safe in humans.
Sucralose (Splenda)

Introduced in 2000; 600 times sweeter than sugar.
This is a sugar alcohol created via chemical substitution of 3 hydroxyl groups with 3 chloride atoms, creating a chlorocarbon (similar in chemical structure to DDT).
There is concern amongst some experts that this chemical structure may adversely affect normal metabolism.
A 2008 animal study found that sucralose reduces good gut bacteria and reduces bioavailability of orally administered medications.
May cause GI side effects in some individuals.
May trigger migraines in some individuals (Headache. 2006. 46. 1303-1304).

Tagatose ((Naturlose)- derived from sugar

Tea

· Derived from the plant Camellia sinensis.

· Black tea is fermented (oxidized), oolong tea is partially fermented, and green tea and white tea are unfermented. Black tea has the most caffeine and is lowest in antioxidants whereas white tea has the least caffeine and is highest in antioxidants.

· Of the approximately 2.5 million metric tons of dried tea manufactured, only 20% is green tea and less than 2% is oolong tea.

· Historically, green tea has been consumed primarily in Japan, China, and a few countries in North Africa and the Middle East.

· Tea contains over 400 volatile compounds, including polyphenols, which are potent antioxidants.

· The four major polyphenols in green tea are EC, EGC, ECG, and EGCG. The usual concentration of total polyphenols in dried green tea leaves 8-12%.

· Tea contains approximately 35-50 mg caffeine per 8 ounce serving. The L-theanine in tea may moderate the effects of the caffeine.

· From a scientific nomenclature standpoint, herbal ‘teas’ are actually herbal infusions, and tea refers only to the beverage derived from the plant Camellia sinensis.

· Practical tips (Self Healing. 12/08)

o Beware that adding ice may cause the polyphenols and caffeine to bind together and sink to the bottom of the cup, where they are less likely to be consumed.

o Beware that adding milk to tea may interfere with the absorption of the beneficial polyphenols.

o Decaffeinated tea - look for varieties that use carbon dioxide and water rather than a solvent such as ethyl acetate, as use of solvents is associated with a lower catechin content.

· Benefits of green tea

o Preliminary data suggests benefits of green tea include antiviral, antifungal, and antioxidant effects; protection against cancer (stimulates apoptosis, antiangiogenic effect), heart disease, and neurological disease; treatment of diabetes, HIV, and inflammatory bowel disease; and increased thermogenesis (Pastore R and Fratellone P. Potential Health Benefits of Green Tea: A Narrative Review. Explore. 2006. 2. 531-539. 68 references; Mayo Clin Proc. 2007. 82. 725-732. 82 references).

o Polyphenols found in tea inhibit the growth of pathogenic intestinal bacteria while leaving beneficial bacteria unharmed (Res Microbiol. 2006. 157. 876-84).

o Green tea consumption has a beneficial effect on endothelial function, improving flow-mediated dilation of the brachial artery in a study in 14 healthy individuals (Eur J Cardiovasc Prev Rehabil. 2008. 15. 300-305). EGCG “can augment nitric oxide status and reduce endothelin-1 concentrations and thereby may impove endothelial function” (Am J Clin Nutr. 2008. 88. 1018-1025).

o Green tea extract reduces BP, LDL cholesterol, and inflammation (Nantz MP et al. Nutrition. Epub 10/8/08).

· Safety of green tea

o May interfere with warfarin, based on case reports (Ann Pharmacother. 1999. 33. 426-428).

o No significant effects on blood counts or blood chemistry profiles of healthy individuals after repeated administration of 800 mg of EGCG daily (Clin Cancer Res. 2003. 9. 3312-3319).

o The tea plant absorbs fluoride (and aluminum), with the amount depending in part on the acidity of the soil (Toxicol Lett. 2003. 137(1-2):111-120). In one study, the fluoride level increased with the decline in quality of the green tea product (J Agric Food Chem. 2004. 52(14):4472-4476). Interestingly, in low-fluoride water, fluoride is easily released from tea leaves into the beverage. Conversely, in high-fluoride water, dried tea leaves are able also to absorb fluoride. Thus, if a cup of tea is made from high-fluoride water, the fluoride concentration of the infusion may actually be lower than the original fluoride concentration of the water (Sci Total Environ. 2006. 366(2-3):915-917).

Vegetables

Many vegetables contain natural toxins which are inactivated by steaming or boiling for a few minutes.
Dr. Andrew Weil specifically recommends against eating raw peas, chickpeas, beans, alfalfa sprouts, lentil sprouts, mung bean sprouts, and white mushrooms.
Avoid celery with brown patches because they are caused by a fungus which contains natural toxins.
Heating vegetables may destroy the enzymes which help us to digest them; this is the rationale for supplemental digestive enzyme therapy.
Steaming vegetables instead of microwaving them will preserve more of the antioxidants in the vegetables.
Cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, collard, kale, radishes, and turnips) probably protect against breast and prostate cancer.

Water

Safety

Information on safety of drinking water by community available at www.epa.gov/safewater/dwinfo.htm and information on certified testing labs available at www.epa.gov/safewater/labs or by calling 800-426-4791.
Allowing tap water to run for 30 seconds before drinking it eliminates much of the lead.
Chlorination of public water is essential at the source to kill bacteria in the water, but if there is residual contamination of water with byproducts of sewage, the chlorine may convert these into carcinogenic agents (chlorine combines with naturally occurring organic matter in water to form trihalomethanes [THMs], which have been linked to an increased risk of bladder and colorectal cancers). Chlorine consumption is not ideal for human health - boiling tap water or allowing it to sit in an open-mouth pitcher for 1-2 days before use eliminates much of the chlorine, because chlorine is volatile and evaporates.
Fluoridation of water is controversial regarding whether there is a beneficial effect with regard to decrease in dental caries – fluoride consumption is not ideal for human health.
The people at greatest risk from contaminants in tap water are the 28 million Americans served by small public water systems which serve fewer than 3300 customers each, because these are inspected less frequently than larger systems. Large systems are usually quite safe. Reports of levels of chemicals present in public water systems are readily available to the public.
Cloudy tap water may signal a problem with parasitic contamination, because cloudy water indicates that the filters at the intake are letting through particles, and thus may be letting through parasites too. Parasites are not effectively killed by chlorination.

Hard water

Contains magnesium and calcium; prevalent east of the Mississippi River.
Deaths from heart disease are less in locations with hard water.
Artificially softened water is unsafe – the magnesium and calcium are often replaced by sodium when water is artificially softened, and this can leach cadmium out of pipes into the water.

Bottled water

Bottled water is classified as a food and therefore not regulated very well, and often may not be much safer than tap water. Aquafina is a brand which is filtered, and thus a good quality brand.
Bottled water sold in soft plastic may be dangerous - there is some concern that chemicals from the plastic leach into the water.

Healing benefits of water – this notion is advocated by Dr. F Batmanghelidj, who suggests daily consumption of 1 ounce of water/kg body weight, and asserts that this high level of daily water consumption can heal allergies, anxiety, asthma, depression, hypertension, migraines, obesity, peptic ulcers, and rheumatoid arthritis.
Water filters (Consumer Reports. 2/12. 44-45; 5/10. 33-35; 5/07. 38-40). To choose a water filter effective for specific contaminants (based upon testing of your water supply), go to www.consumerreports.org and search for “water filters.”

There is no water filter on the market which eliminates 100% of all potentially hazardous substances in tap water.
Purchase a water filter which meets NSF standards, specifically NSF Health Effects Standard 53 for cysts as well as the standards for VOCs (pesticides, herbicides, chemicals), endocrine disrupters (PCBs), trihalomethanes, heavy metals, MBTE, chloramines, and asbestos.
Categories of water filters

Carafe filters remove lead, chlorine, and a variety of sediments, but do not remove nitrates, microbial organisms, or pesticides. They come as pitchers, and cost $20-$40. Replacement filters cost $40-$100 per year.

Advantages – no installation needed
Disadvantages – filter life relatively short; not suited for households requiring more than a couple of gallons per day of filtered water

Faucet-mounted filters remove lead, chlorine, and a variety of sediments. Models vary with regard to what they do not remove. The filter should be briefly flushed before use because the organic contaminants which build up in the filter provide an ideal breeding ground for bacteria. The filters cost $15-$35. Replacement filters cost $30-$100 per year.

Advantages – easy installation and quick switching between filtered and unfiltered water
Disadvantages – slow rate; filter life relatively short; cannot be used with most pull down or spray faucets

Countertop filters remove lead, chlorine, and a variety of sediments, may also remove nitrates, microbial organisms, or pesticides. The filter should be briefly flushed before use because the organic contaminants which build up in the filter provide an ideal breeding ground for bacteria. The filters cost $50-$300. Replacement filters cost $50-$100 per year.

Advantages – good at filtering large quantities of water without modification of plumbing; infrequent changes of filter
Disadvantages – flow rate may be slow; cannot be used with most pull down or spray faucets; create countertop clutter

Undersink filters remove lead, chlorine, and a variety of sediments, may also remove nitrates, microbial organisms, or pesticides. The filter should be briefly flushed before use because the organic contaminants which build up in the filter provide an ideal breeding ground for bacteria. The filters cost $100-$550. Replacement filters cost $50-$150 per year.

Advantages – filters large volumes of water, rarely plugs with sediment; doesn’t clutter countertop, no need to modify faucet, infrequent changes of filter
Disadvantages - generally require installation by a plumber at an installation cost of $120 plus $150, takes up cabinet space; requires a hole in the sink for the dispenser

Reverse osmosis systems remove chlorine, fluoride, lead, nitrates, organic chemicals, microbial organisms, pesticides, and even dissolvable substances. These are the most effective means of removing fluoride. Water is flushed through two carbon filters and a synthetic semi-permeable membrane. Reverse osmosis water is very corrosive to metal pipes, so the units should be installed at the tap, not on the main line leading into the house. Cost of the system is about $150-$900 with an additional $300 for installation. The carbon filters need to be replaced yearly, at a cost of $100-$200. The synthetic membrane screen needs to be replaced every 3-5 years at a cost of $100.

Advantages – removes widest range of contaminants, including arsenic
Disadvantages – bulky and requires plumbing modifications, wastes 3-5 gallons of water for every gallon of water filtered; removes beneficial trace minerals from the water; flow rate may be slow; takes up cabinet space

Refrigerator filters – NOTE one can connect an undersink filter to the fridge and bypass the appliance’s filter.

Advantages - improve taste; convenient
Disadvantages - as per Consumer Reports testing are only so-so at removing impurities; replacement filters are costly

Acrylamide (Consumer Reports on Health. 1/03. Is Your Diet Up-To-Date?)

Proven neurotoxin, and a likely carcinogen, found in many plastics.
Identified by Swedish researchers in various fried high carbohydrate foods such as french fries and potato chips at levels far above that allowed in drinking water by the EPA. Subsequent reports indicate high levels in some breads, cereals, and crackers, but with tremendous variability from sample to sample within the same product.
Clinical significance unclear – there is data that acrylamide can inactivate creatine kinase (CK), thereby depleting the body’s energy stores, and also deplete glutathione, an important endogenous antioxidant.
Data in mice indicate that resveratrol (found in red wine and red grapes), tea polyphenols, and diallyl trisulfide (present in processed garlic) inhibit the body’s ability to retain acrylamide (Xie Q et al. J Agric Food Chem. 2008. epub).
Data in human liver cells exposed to acrylamide shows that curcumin reduces the production of free radicals, and thus curcumin may mediate acrylamide-mediated genotoxicity (Cao J et al. J Agric Food Chem. 2008. epub).

Advanced glycation end products (AGEs)

Formed by the interaction of a reducing sugar and a protein or an amine containing lipid.
AGEs in food are absorbed intact, persist in tissues, increase the immunogenicity of proteins, promote the development of atherosclerosis and complications of diabetes, promote cross-linking of protein, accelerate the aging process, and increase the inflammatory response.
Cooking methods affect AGE content of food significantly – see just below.
AGE content of typical diet is16,000 kU/day, much higher than optimal.
Fructose is a highly reactive reducing sugar, and therefore promotes the formation of AGEs during cooking. Sucrose is not a reducing sugar. Furthermore, the increase in serum fructose concentrations after ingestion of large amounts of fructose may promote the formation of AGEs in vivo.

Cooking methods and health (also see Microwaves below)

Cooking produces cholesterol oxides, lipid peroxides, heterocyclic amines, and advanced glycation end products (see just above).
Cooking method affects advanced glycation end products (AGE) content of food.

Cooking temperature (higher temperature generates more AGEs) – important factor.
Moisture (water inhibits AGE formation) – important factor.
Cooking time (longer time generates only slightly more AGEs) – less important factor.
Microwaving produces relatively few AGEs, but see below for other issues related to microwaving.

Emphasizing boiling, poaching, and stewing over frying, broiling, and roasting may decrease daily AGE intake by up to 50%.

Oven-fried chicken has 9,000 kU of AGEs, whereas boiled chicken has only 1,000 kU of AGEs.
Fast food French fries (100 gm) have1,522 kU of AGEs, whereas a potato boiled for 25 minutes (100 gm) has only17 kU of AGEs.
Roasted walnuts (15 gm) have1183 kU of AGEs, whereas raw walnuts have no AGEs.
Infant formula (100 ml) has 487 kU of AGEs, whereas breast milk (100 ml) has 7 kU of AGEs.

Cookware (also see Microwaves below)

Aluminum – conducts heat well and easy to care for, but aluminum may leach into food, especially acidic food.
Cast iron – iron can leach into the food, especially acidic food, and too much intake of iron can cause health problems (this is an issue primarily for men and postmenopausal women). Enamel coated iron cookware is considered by some to be ideal – it is expensive, and it weighs a lot.
Copper – conducts heat well, but difficult to maintain, and copper may leach into food.
Glass – safest, but does not conduct heat well.
Silicone – nonstick surface, considered safer than Teflon
Soapstone – safe, conducts heat well, BEWARE might crack if exposed to direct flame or wide temperature extremes
Stainless steel – safe, but does not conduct heat well, and some individuals may have allergic reactions to the nickel in stainless steel.

Teflon

o Slippery, heat resistant plastic used to coat pans.

o When heated to 600 degrees, the coating can break and release perfluorooctanoic acid (PFOA).

o In animals, PFOA can cause cancer, immune system damage and death.

o 95% of Americans have traces of PFOA in their blood – sources include waterproof fabrics and electronic parts as well as Teflon pans.

o GOOD NEWS – Consumer Reports (June 2007, pg 7) reports in ‘Up Front’ that testing of air samples showed barely measurable emissions, and that the experts consulted by Consumer Reports agreed that emissions of PFOA from cookware probably don’t contribute much to overall PFOA exposure.

o Sensible precautions – discard pans which have begun to flake, use ventilation when cooking, and don’t put empty pans over high heat.

Food Additives

Approximately 2700 food and chemical additives are allowed into the U.S. food supply, including colorings, sweeteners, preservatives, flavorings, emulsifiers, and humectants.
In 1984 3200 tons of coal tar dyes were added to foods.
The average American eats 14 pounds of food additives per year.
Aluminum (alum) in baking soda and pickles is best avoided.
Benzoates – may trigger ADHD, allergic rhinitis, asthma, erythema multiforme, urticaria, and vasomotor rhinitis in susceptible individuals
BHA and BHT (synthetic preservatives added to foods to prevent rancidity and thus increase shelf life) may promote carcinogenic changes in cells.
Carageenan (Townsend Letter. July 2011. 89-91)

Food grade carageenan is used to improve the texture of foods (also used in cosmetics, pharmaceuticals, and toothpaste), granted GRAS status by FDA in 1959.
Degraded carageenan is a known carcinogen – there is concern that gastric acid and acid contained in foods, as well as the effects of intestinal flora, may cause degradation of food-grade carageenan into a carcinogen.

Food dyes (Self Healing. 4/09. Pg 7)

The 8 synthetic dyes allowed in the US are Yellow 5 (tartrazine) and 6, Red 3 and 40, Blue 1 and 2, Green 3 and Orange B. These are petroleum-based coloring agents.
There are natural alternatives to synthetic dyes, such as beet juice (red) and turmeric (yellow).
There are concerns that synthetic food dyes may be carcinogenic, may cause asthma and hives in adults, and may cause hyperactivity and other behavioral problems in children.
In June 2008, the CSPI petitioned the FDA to ban the 8 approved food dyes.
More information on food dyes and foods containing synthetic dyes at www.iatp.org.

Hydrolyzed vegetable protein, sometimes referred to as just 'vegetable oil' in the ingredients list on the label, contains glutamate and aspartate, both excitatory neurotransmitters which may cause cell death.

Foods which commonly have MSG or hydrolyzed vegetable protein added include soups, salad dressings, steak sauce, croutons, chips, creamy sauces, some gravies, and some gourmet foods.
For more information, read Excitotoxins: The Taste that Kills by Russell L. Blaylock, MD.

Monosodium glutamate (MSG) is a source of excess sodium, and is degraded to glutamate, an excitatory neurotransmitter which in excess may cause death of cells in the brain. In addition, there are case reports of MSG as a trigger for ADHD, asthma, chest pain, depression, epilepsy, fibromyalgia, headaches, perennial rhinitis, and PVCs.
Nitrites which are added to many cured meats can react with protein breakdown products in the digestive tract to form highly carcinogenic nitrosamines. Vitamin C can block the conversion of nitrites to nitrosamines.
Sulfites

May trigger anaphylactic shock, asthma, and urticaria in susceptible individuals.
5-10% of asthmatics experience an exacerbation of symptoms after ingestion of sulfites.

Genetically modified food (GMO)

· Soy, corn, canola are the major GMO foods.

· Rationale for genetic modification – confers herbicide tolerance, or induces production of a toxin by the plant which kills insects.

· Many critics assert that GMO foods have been approved by the U.S. government despite very little human research and some animal research suggesting associated harms.

o Genes inserted into GMO crops may be inserted into our DNA or the DNA of our gut bacteria

o Observational data - animals avoid eating GMO foods

When a gene is inserted into a plant and then cloned, there might be collateral damage in other genes – in one study, 5% of genes were affected when a gene was inserted

May create a new allergen (new protein)
GMO Soy has increased lectin and lignin content, and is epidemiologically associated with increased likelihood of soy allergy

More information is available in the book Seeds of Deception and at www.seedsofdeception.com and at www.GMFreeSchools.org.

Microwaves

Microwaves heat food by causing it to resonate at very high frequencies - this causes a change in the chemical structure of the food that can lead to health problems.

o Microwaving causes the formation of potentially toxic cis-isomers and D-isomers of amino acids.

o Microwaving causes the formation of substantial amounts of lipid peroxides.

A study published in the November 2003 issue of The Journal of the Science of Food and Agriculture found that broccoli heated in the microwave with a little water lost up to 97 percent of the beneficial antioxidant chemicals it contains. By comparison, steamed broccoli lost 11 percent or fewer of its antioxidants.
When microwaving food in plastic containers or on paper plates, carcinogenic toxins may be released into the food.
A Turbo Oven is an alternative to a microwave. Food in a Turbo Oven is cooked from all around whereas food in a convection oven is cooked just from above and below.

Organic foods

Standardized labels effective 10/21/02, based on guidelines published by the USDA in 2000.

In 1990, Congress passed the Organic Food and Production Act (OFPA), which instructed the USDA to establish uniform national standards for organic food and farming. The 1990 law banned the use of additives and synthetics in organic food.
The USDA issued an initial set of standards in 1997 which would allow for the use of genetically modified crops, irradiation, and sewage sludge in organic food production –much of the organic food industry strongly objected to these specifications.
The USDA 2000 guidelines did not allow for antibiotics, hormones, genetically modified crops, irradiation, or sewage sludge in the production of organic products, but did allow for additives and synthetics, and required only that cows “access to pasture,” an undefined term which is unenforceable, meaning that organic meat and milk most often comes from cows fed corn and soy rather than grass, and cows who spend most of their lives in confinement, similar to the cows on non-organic factory farms.
There are more than 50 organic certification agencies that will ensure that food companies and organic farms meet the new standards, as per Natural Health, Oct/Nov 2002.

Terminology

100% Organic - products produced without bioengineering, radiation, antibiotics, growth hormones, fertilizers, or conventional pesticides. It must be at least 3 years since pesticides were used on the land before food grown on that land can be labeled as organic - if at three years the soil still tests positive for pesticide residues, testing needs to be done yearly and the food cannot be labeled as organic until all pesticide residue is gone from the soil.
Organic - at least 95% of the ingredients must be certified organic.
Made with Organic - at least 70% of the ingredients must be certified organic.

Why choose organic? Organic farming is better for the environment, organic foods have less pesticide, and may be more nutritious.

Safety

A longitudinal 15 day study in 23 children in Seattle age 3-11 concludes that dietary intake of pesticides represents a major source of exposure for infants and children and that an organic diet provides a dramatic and immediate protective effect against exposure to commonly used organophosphate pesticides, which are known to cause neurological effects in some humans (Environment Health Perspect at http://dx.doi.org/ and reviewed in Alt Med Alert. 2006. 9. 11-12).
Non-organic crops most likely to be contaminated with pesticides varies over time. The Environmental Working Group periodically updates its list of “dirty dozen” fruits and vegetables most contaminated with pesticides - for an updated list, go to http://www.foodnews.org/, ‘Food News from the Environmental Working Group’ and scroll to the bottom of the page for a ranking for fruits and vegetables with the most to the least amount of pesticide residue. This list is periodically updated.

o Nutritional content – data is MIXED

§ NEGATIVE study - a systematic review identified 162 studies using one of three designs: field trials (comparing adjacent parcels of land), farm surveys (comparing products from organic and conventional farms), and basket studies (comparing foods available through retail outlets). The authors examined only those nutrient categories reported in at least 10 studies (11 nutrients – vitamin C, phenolics, magnesium, potassium, calcium, zinc, copper, total soluble solids, titratable acid, phosphorous, and nitrogen) or at least 4 livestock studies (ash and unspecified fats). The only differences were that conventional crops contained more nitrogen whereas organic crops contained more phosphorous and titratable acid, and these differences might be due to differences in ripeness or fertilizer use (Dangour AD, et al. Am J Clin Nutr. Epub 7/29/09). The studies identified were heterogenous and often of poor quality (Greenfield RH. Commentary. Alt Med Alert. 2009. 12. 97-99).

§ A survey of the literature comparing nutrient content of organic and conventional crops, which used published comparative measurements of organic and conventional nutrient content which were entered into a database for calculation, found that organic crops contained significantly more vitamin C, iron, magnesium, and phosphorus and significantly less nitrates than conventional crops (J Altern Complement Med. 2001. 7(2). 161-73). Some of the original data was presented 2/23/95 by J.B. Pangborn and B. Smith at the 13^th Annual International Symposium on Man and His Environment in Health and Disease, Dallas, TX (cited by Dr. William Rea at IFM International Symposium 4/20/06).

§ Statistically higher levels of total phenolics were consistently found in organically and sustainably grown foods (blackberries, corn, strawberries) as compared to those produced by conventional agricultural practices (J Agric Food Chem. 2003. 51 (5). 1237 -1241).

§ Higher levels of polyphenols found in organically grown peaches (Food Chem. 2001. 72. 419-424).

How to determine quickly if fresh produce is organic – check the Produce Look-Up (PLU) sticker. Organic PLU codes begin with a ‘9’ and have 5 digits.
Why choose ‘local’ produce over organic?

Much organic produce is raised on industrial farms, with conditions similar in many ways to non-organic farms.
Much organic produce is shipped thousands of miles to market, requiring the use of much petroleum to get the food to market.

NOTE in 2005 there are no organic standards for fish.
Reference: When it pays to buy organic. Consumer Reports. 2/06. 12-17.

Prebiotic

Non-digestible food products that provide substrates that nourish the intestinal microflora.
Includes fructo-oligosaccharides (FOS), galacto-oligosaccharides, and inulin.
Food sources of FOS include asparagus, banana, burdock root, honey, Jerusalem artichoke, maple sugar, oats, onion, oats, and rye.

Probiotics – return to Home Page and go to “Dietary Supplements”

Miscellaneous Facts

There is no single diet or set of rules that is right for everyone.
Some dietary systems conflict totally.

Yoga (India): fresh yogurt and white rice are best, brown rice is worst.
Macrobiotics (Japan): brown rice is best, milk products are worst.

In 1978 in the United States, 36% calories come from fat; in 1994, 34% of calories come from fat. Obesity continues to increase nonetheless. This is in part due to substitution of high glycemic index carbohydrates for fat in the diet.
There is a clear epidemiologic association between obesity and consumption of high fructose corn syrup which is in soda and other prepared foods.
Heart disease is 90% less common in Greece even though the diet approaches 40% fat, presumably because most of the fat is monounsaturated fat (i.e. olive oil).

High Protein/Low Carbohydrate Diets (generally defined as 20-60 gm carbohydrate/day, or approximately 20% of daily calories from carbohydrate)

High protein diets initially produce rapid weight loss through a diuretic effect.
High protein diets are contra-indicated in cirrhosis and other causes of liver failure, as well as advanced kidney disease, and relatively contra-indicated in even mild kidney disease. In a subgroup of the Nurses Health Study, high dietary protein intake was associated with a decline in renal function only in women with mild renal insufficiency at baseline (Ann Intern Med. 2003. 138. 460-467).
Side effects – in a 6 month prospective trial funded by the Atkins Center, 70% of participants experienced constipation, 65% halitosis, 54% headaches, and 10% hair loss.
Potential Risks:

May increase the risk of calcium oxalate kidney stones, based on data from a 6 week metabolic study in 10 healthy subjects (Am J Kid Dis. 2002. 40. 265-274).
May increase the risk of osteoporotic fractures in women, based on data in a cohort of 85,900 women followed for 12 years in the Nurses’ Health Study. The association was observed only for animal protein, not vegetable protein (Am J Epidemiol. 1996. 143. 472-479).
May worsen development of atherosclerosis, through mechanisms independent of known markers (obesity, total cholesterol, triglycerides, glucose, fasting insulin, oxidized LDL, inflammatory cytokines) and may impair neovascularization in response to ischemia, based on data in a mouse model of atherosclerosis (Proc Natl Acad Sci U S A. 2009. 106. 15418-15423 as cited in Alt Med Alert. 2009. 12. 125-126).
Associated with impaired endothelial function, as measured by flow mediated dilation of the brachial artery, based on results in a 12 month RCT in 49 overweight or obese patients (J Intern Med. 2010. 267. 452-461).
Dr. Barry Sears argues very low carbohydrate diets are associated with an increase in cortisol so that individuals can break down muscle to create enough glucose for the brain, and that the high cortisol level is the reason individuals regress at 6 months, even if compliant with the diet.
According to Dr. Andrew Weil, high protein diets can aggravate allergies and autoimmune problems.
According to Dr. Andrew Weil, high protein diets impose a considerable workload on the digestive system and may contribute to feelings of fatigue.

Potential benefits

Weight loss - a meta-analysis of RCTs comparing the effects of low-carbohydrate diets without energy restriction to low-fat, energy restricted diets, and with at least 6 months of follow-up found that in the 5 trials with a total of 447 participants who met inclusion criteria, weight loss was 3.3 kg greater (1.4-5.3 kg) at 6 months in the low-carbohydrate group, but equivalent in both groups at 1 year. There were no differences in BP between the two groups. At 6 months, triglycerides and HDL changed more favorably in the low-carbohydrate group, but TC and LDL changed more favorably in the low-fat group. A limitation of the analysis was a high drop out rate of 31-48% in the low-carbohydrate trials individuals and 37-50% of the low-fat individuals (Arch Intern Med. 2006. 166. 285-293).
Increase in HDL – NOTE though that the higher HDL levels noted in the RCTs of the Atkins diet don’t necessarily translate to a lower cardiovascular risk, because the higher dietary cholesterol intake may require a higher HDL level to remove the extra cholesterol from the bloodstream.
Some individuals with symptoms of hypoglycemia on a high complex carbohydrate diet may feel better on a high protein diet.
Individuals who believe that they have a condition labeled by some health authorities as "chronic yeast syndrome" may find that they feel better on the high protein "MEVY" diet (that is meat, eggs, vegetables, and yogurt).

BEWARE of deceptive labeling (Consumer Reports. 6/04. 12-15)

There is not an agreed-upon definition of low-carbohydrate (the FDA is addressing this)
Net carbohydrates generally refers to the total grams of carbohydrates per serving minus the grams of fiber and sugar alcohols. Research shows that this is a meaningful measurement in whole foods, but there is no research to show that this value is of an significance in designer foods with carbohydrate removed and sugar alcohols or fermentable carbohydrates added. This term currently has no legal standing.
Pay attention to the number of calories per serving on the label, not just the grams of carbohydrate, because some low carbohydrate foods have added fat and thus are loaded with calories.

A nice review article is Very-low-carbohydrate weight-loss diets revisited. Cleveland Clinic Journal of Medicine. 2002. 69. 849-862.
Data on 82,802 women in the Nurses Health Study, followed for 20 years, “suggest that diets lower in carbohydrate and higher in protein and fat are not associated with an increased risk of coronary heart disease in women. When vegetable sources of fat and protein are chosen, these diets may moderately reduce the risk of coronary heart disease.” In this study, in which weight loss was not a goal, the low-carbohydrate diet score did not have a significant long-term effect on weight. Low carbohydrate for the purposes of this study was defined as <30% of calories; results were similar when the subgroup with a carbohydrate intake of <20% of calories was analyzed separately (N Engl J Med. 2006. 355. 1991-2002).

Low Fat (High Carbohydrate) Diets

Theoretic advantages – fat is calorie dense (9 kcal/gm versus 4 kcal/gm) and relatively less satiating than protein or carbohydrate (Obes Rev. 2003. 4. 83-90).
Low fat diets can be problematic if simple carbohydrates replace fat – triglycerides will go up and HDL will go down.
The published data on the effectiveness of low fat diets for weight loss, compared with other types of diets, is mixed.

Low glycemic index or load diets

Resting energy expenditure (measured after a 10 hour fast and after achievement of 10% reduction in body weight) decreased less (p=0.04) with a low glycemic load diet than with a low fat diet, even though body composition by DEXA did not differ between the two groups. The difference in resting energy expenditure between the two groups was 80 kcal/day (1 kg = 7500 kcal). Less hunger also reported amongst those on low glycemic load diet (p=0.04). This means that physiologic adaptations that serve to defend baseline body weight can be modified by dietary composition (JAMA. 2004. 292. 2482-2490).
Most studies report beneficial health outcomes with a low GI/GL diet (Clinical update: the low glycameic-index diet. Lancet. 2007. 369. 890-892).
Insulin resistance, serum triglycerides, CRP levels, and blood pressure improved more with low glycemic load diet, compared with low fat diet (JAMA. 2004. 292. 2482-2490).
Weight loss – data from 6 RCTs indicates that overweight and obese people lose significantly more weight on low GI/GL diets than on other diets (Cochrane Database Syst Rev. 2007. 3:CD005105).

Cardiovascular risk reduction – a 12 week RCT in 129 overweight or obese adults assigned to one of 4 reduced-fat, high-fiber diets (1) 55% carbohydrate, high GI (2) 55% carbohydrate, low GI (3) 25% protein, high GI and (4) 25% protein, low GI found that all groups lost a similar amount of weight, but cardiovascular risk reduction was optimized by high carbohydrate, low GI diet (Arch Intern Med. 2006. 166. 1466-1475).

DASH Diet

Designed specifically as a treatment for hypertension – the diet consists of increased fruits and vegetables and low fat dairy products and lean meat, restricted in saturated fat and total fat intake.

· Assessment of diet 7 times over 24 years by FFQ in a cohort of 88,517 nurses in the prospective Nurses Health Study, and calculation of a DASH score at each assessment, based on 8 food and nutrient components (fruits, vegetables, whole grains, nuts and legumes, low fat dairy, red and processed meats, sweetened beverages, and sodium) showed that adherence to a DASH-style diet is associated with a lower risk of heart disease and stroke (Arch Intern Med. 2008. 168. 713-720).

Mediterranean Diet

Seven principle components of Mediterranean diet include (1) plant based foods, (2) locally grown minimally processed food, (3) fish and poultry, (4) infrequent red meat consumption, (5) olive oil as principle source of fat, (6) moderate amounts of red wine with meals, and (7) desserts primarily of fresh fruit.
Studies showing an association between the Mediterranean diet and increased longevity include N Engl J Med. 2003. 348. 2599-2608 and Br J Nutr. 1999. 82. 57-61.
Studies showing a either a decrease in cardiovascular risk or improvement in risk factors in those following a Mediterranean diet include J Nutr. 2005. 135. 410-415 and Nutr J. 2003. 2. 1 and Am J Clin Nutr. 2004. 80. 1012-1018.
A European cohort study (HALE project) shows that the Mediterranean diet in conjunction with physical activity, nonsmoking status and alcohol in moderation is associated with a 50% reduction in all-cause mortality in 70-90 year olds (JAMA. 2004. 292. 1433-1439).
A 2 year randomized, single-blind trial in 180 patients with metabolic syndrome comparing a Mediterranean-style diet (intervention group) with a "prudent" diet similar in composition to the Step I AHA diet found significantly more weight loss in the intervention group (4 kg vs.1.2 kg, P<0.001), a significantly greater decrease in hs-CRP levels (P=0.01), and greater improvement in endothelial function score (P<0.001). Only 40 of the 90 patients in the intervention group still had features of metabolic syndrome at the end of two years, compared with 78 of 90 patients in the control group (JAMA. 2004. 292. 1440-1446).
A large prospective cohort study, the EPIC-Elderly Prospective Study Group which monitored dietary intake in 74,607 men and women over age 60 in nine European countries, found a clear association between a Mediterranean-style diet (polyunsaturated fats were allowed in place of monounsaturated fats in calculating a score to reflect the Mediterranean diet) and increased survival amongst the elderly (BMJ. 2005. 330. 991-995).
A substudy of the PERIMED study in which 772 asymptomatic persons with high cardiovascular risk were randomized to a low fat diet or 1 of 2 Mediterranean diets showed that the Mediterranean diets have beneficial effects on cardiovascular risk factors (plasma glucose levels, systolic BP, cholesterol: HDL ratio, and hs-CRP) after 3 months (Ann Intern Med. 2006. 145. 1-11).
The Mediterranean diet was associated with a reduced all-cause mortality and cause-specific mortality at 5 years of follow up in 214,284 men and 166,012 women in the NIH-AARP Diet and Health Study, a prospective study (Arch Intern Med. 2007. 167. 2461-2468).

· A prospective cohort study in Spain found that healthy patients who adhered closely to this diet had a 35% relative reduction in the risk of developing diabetes (BMJ. 2008. 336. 1348-1351).

A meta-analysis shows that the Mediterranean diet is associated with a reduced risk of cardiovascular disease, cancer, and mortality (Sofi F et al. BMJ. 2008. 337. a1344).
The Mediterranean diet is associated with a decreased risk of Alzheimer Disease, independent of benefit associated with higher levels of physical activity (JAMA. 2009. 302. 627-637).
A 4 year randomized single-center study in 215 overweight individuals newly diagnosed with type II diabetes found that those who consumed a Mediterranean diet had better glycemic control, more favorable changes in coronary risk factors, and a delayed need for antihyperglycemic drug treatment, compared with control subjects who followed a low fat diet (Ann Intern Med. 2009. 151. 306-314).

Vegetarian diet

A vegetarian diet is epidemiologically associated with a decreased risk of cancer, diabetes, diverticulosis, gallstones, heart disease, high blood pressure, and osteoporosis.
Vegetarian diet and mortality in prospective cohort studies

In the Oxford Vegetarian Study in 6000 vegetarians and 5000 nonvegetarians, at 12 years of follow up, vegetarians had a lower total mortality (RR=0.80) and a lower mortality from malignant neoplasms (RR=0.61), with a nonstatistically significant trend toward lower cardiovascular mortality (Appleby PN et al. Am J Clin Nutr. 1999. 70. 525S-531S).
A pooled analysis 5 cohorts, including more than 76,000 men and women with an average follow up of 10.6 years, did find a reduced risk of CV mortality, RR=0.76 (Key TJ et al. Am J Clin Nutr. 1999. 70. 516S-524S).

The American Dietetic Association published a position paper stating that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases (J Am Diet Assoc. 2003. 103. 748-765).
Approximately 2.5% of adults in the U.S. follow vegetarian diets.
Vegetarians tend to have a lower BMI than non-vegetarians.
Adequate carnitine can be a problem, especially in children who are strict vegetarians – this amino acid is essential for conversion of fat into energy (i.e. ATP)
Adequate iodine intake can be a problem if non-iodized salt is used – seaweed and kelp are good vegetarian sources of iodine.
Adequate iron intake can be a problem.

Heme iron in meat is 15-35% absorbed; non-heme iron is 1-7% absorbed. However, digestion in long-term vegetarians may adjust to allow increased percentage of iron absorption.
Absorption of non-heme iron, predominantly found in dark green, leafy vegetables, may be increased up to 5-fold by vitamin C (eat fruits with vegetables).
Iron content of the diet can be increased 4-fold by using iron pots and skillets.
Absorption of heme iron is usually unaffected by the rest of the diet, but absorption of non-heme iron is hindered by caffeine, tea (tannic acid and polyphenols), and phytates found in many legumes and grains
Iron probably competes with other minerals for binding sites at the intestinal wall, so supplements of any one mineral may lead to decreased absorption of other minerals (iron, calcium, copper, zinc, selenium).

Adequate lysine intake can be a problem – lysine is plentiful in legumes, but relatively deficient in wheat.
Adequate omega 3 fatty acid intake can be problematic – consider supplements. There are vegan supplements of DHA made from microalgae; these are expensive.
Adequate taurine (an amino acid) can be problematic – this conditionally essential amino acid which is essential for detoxification/biotransformation is absent in all vegetable protein.
Adequate vitamin B12 intake can be a problem in vegans who do not take supplements. Measuring vitamin B12 levels can be deceiving because vegetarian diets may contain vitamin B12 analogues which will cause a false normal vitamin B12 level (measure MMA). In some vegans, the bacteria in the mouth and the colon make enough vitamin B12 so that deficiency is avoided.
Adequate zinc intake can be a problem, especially at the time of conversion to a vegetarian diet, probably because the intestinal phytase required to break down phytic acid and thus allow absorption of calcium, iron, etc. from fiber, is a zinc dependent enzyme. Zinc supplements, 15-20 mg/day, are probably advisable at the time of transition to vegetarianism.
Foods to include in a vegetarian diet (Natural Solutions. 1/09)

Almond butter -good source of protein, calcium, iron, and zinc.
Miso - fermented soy product which is loaded with protein, iron, and vitamin K.
Nutritional yeast - natural source of vitamin B12.
Quinoa - source of all 8 essential amino acids, good source of iron and zinc, high protein content (truly a seed and not a grain).
Pumpkin seeds - good source of iron and zinc.
Sunflower seeds - good source of iron and zinc.
Tempeh - fermented soy product which is loaded with protein.
Wheat germ - good source of iron and zinc

Resource: Vegetarian Resource Group www.vrg.org.

Diet and cancer (Arch Intern Med. 1993. 153. 50-56)

Experimental data

Increased fat intake is associated with an increased risk of cancer in animal models.
Increased calorie intake is associated with increased risk of cancer.
Linoleic acid intake is associated with increased risk of cancer.
A wide variety of dietary substances exhibit anti-carcinogenic activity in animal models, including vitamins A, C, E, beta-carotene, calcium, selenium, some forms of fiber, and CLA, which is a class of fatty acids closely related to linoleic acid, which are found in dairy products, ruminant animal meat, and turkey.
High dose anti-oxidants in supplemental form may have a paradoxical carcinogenic effect.
Pickled and smoked foods as they are prepared in the United States are probably not carcinogenic. Different methods of food preservation in other countries may be responsible for contamination of food with carcinogens.
Pesticides: intake of man-made pesticides in the U.S. is 0.09 mg/person/day, 50% of which is due to 4 chemicals that are not carcinogens, but intake of natural pesticides is about 1.5 gm/person/day, and many are known carcinogens. Furthermore, stress, such as that induced by insect attacks on plants, leads to an increase in natural pesticide production in plants.

Epidemiologic data

Increased fruit and vegetable consumption is linked with reduced cancer risk. The reasons are not fully known.
Except for the recent National Cancer Institute study of 30,000 Chinese, no other studies document an epidemiologic association between fat consumption and cancer.

Micronutrient Nutrition

Vitamins and minerals – Go back to Home Page and click on “Vitamins and Minerals” for details
Phytochemicals – scientific appreciation of the health benefits of phytochemicals (chemical compounds found in plants) is a much more recent phenomenon than the scientific appreciation of the health benefits of vitamins and minerals.

There may be as many as 1000 different phytochemicals, with over 500 phytochemicals identified in fruits, vegetables, and grains as of 2005
Many of these phytochemicals have more than one function in the body.

Phytochemicals for which dietary intake is associated with health benefits

Allicin - reduced risk of cancer spread and heart attacks, lower cholesterol and blood pressure, enhance infection defenses.

Found in garlic, leeks, white onions.

Anthocyanins (a category of flavonoids) - decrease blood clots, improve night vision, combat macular degeneration, lower blood pressure, and may protect against age related changes in the brain.

Found in beets, bilberries, blackberries, black currants, blueberries, cranberries, elderberries, kidney beans, purple grapes, raspberries, red apples, red cabbage, red onions, strawberries, sweet cherries.
One 8 ounce glass of purple grape juice may be as effective as aspirin at preventing a heart attack.

Beta carotene – reduced risk of cancer and heart disease, increased ability to fight infection, maintenance of good vision.

Found in apricots, butternut squash, cantaloupe, carrots, mangos, peaches, pumpkin, sweet potatoes.

Capsaicin - painkiller, anticancer effects.

Found in chili peppers.

Carotenoids – family of pigments (more than 600 now identified), including alpha carotene, beta carotene, lutein, lycopene, zeaxanthin.
Catechins - decrease oxidation of LDL cholesterol, and may decrease cancer risk.

Found in green tea, and in smaller quantities in black tea.

EGCG – see ‘tea’ above, and specifically benefits of green tea. EGCG is a flavonoid.
Ellagic acid - anticancer effects

Found in raspberries, strawberries.

Flavonoids (flavonoids are a subgroup of plant polyphenols; there are 6 types of flavonoids, as per the Linus Pauling Institute)

Anthocyanins – see above.
Flavanols - Food sources include apples, apricots, green tea, red grapes, red wine
Flavanones - Food sources include citrus fruits and juices
Flavonols - Food sources include apples, blueberries, broccoli, cranberries, kale, leeks, onions
Flavones - Food sources include celery, hot peppers, parsley, thyme
Isoflavones – see just below.

Glutathione - antioxidant and anti-cancer properties.

Found in asparagus, avocado, broccoli, cauliflower, fresh grapefruit, okra, fresh oranges, fresh peaches, white potatoes, squash, strawberries, raw tomatoes, and watermelon.

Indoles - antioxidant properties, reduced risk of breast and prostate cancer.

Found in arugala, broccoli, brussels sprouts, cabbage, cauliflower, horseradish, kale, mustard, radish, Swiss chard, turnip, and watercress.

Isoflavones (a category of flavonoids) - phytoestrogens which combat menopausal symptoms, strengthens the bones, lowers cholesterol levels, raises HDL cholesterol levels, and may decrease cancer risk.

Found in some soy products, including raw soybeans, soy milk, soy nuts, tempeh, and tofu. Not present in soy sauce, soy oil, or in many brands of soy burgers, soy cheeses, or soy hotdogs.
Soy protein is probably a surrogate marker for isoflavones, with 20 - 60 grams per day of soy protein recommended for maximum benefit.

Lutein (a carotenoid) - antioxidant properties, reduced risk of cataracts and macular degeneration, reduced risk of colon cancer.

Found in broccoli, green peas, honeydew, kale, kiwi fruit, leafy greens, romaine lettuce, and spinach.

Lycopene (a carotenoid) - antioxidant properties, anti-cancer properties.

Found in pink grapefruit, guava, tomatoes, and watermelon.

Phenolics – slow effects of aging.

Found in eggplant, plums, prunes, raisins.

Polyphenols - heart protective benefits and anti-cancer properties.

Found in red wine, red grapes, cranberries, dark chocolate, nonherbal teas (black, green, white, and oolong).
Polyphenols are subdivided into categories of flavonoids, phenylpropanoids (i.e. lignins), and tannins.

Quercetin - antioxidant properties. Quercitin is a flavonoid.

Found in broccoli, cherries, red grapes, yellow and red onions, and Italian yellow squash.

Sulforaphane - anti-cancer properties.

Found in bok choy, broccoli, Brussels’ sprouts, cabbage, and cauliflower.

References

Agatston, Arthur. The South Beach Diet

Ballentine, Rudolph. Transition to Vegetarianism
Ballentine, Rudolph. Diet and Nutrition
Batmanghelelidj, F. Your Body’s Many Cries for Water
Blaylock, Russell L. Excitotoxins: The Taste that Kills
Brand-Miller, Jennie et al. The New Glucose Revolution
Campbell, T. Colin. The China Study
Carper, Jean. Food-Your Miracle Medicine
Daniel, Kayla. The Whole Soy Story
Enig, Mary. Know Your Fats
Erasmus, U. Fats that Heal, Fats that Kill
Falon, Sally. Eat Fat, Lose Fat
Falon, Sally. Nourishing Traditions
Galland, Leo. The Fat Resistance Diet
Kushner, RF and Kushner N. Dr. Kushner’s Personality Type Diet
Nestle, Marion. What to Eat
Pollan, Michael. The Omnivore’s Dilemma
Price, Weston. Nutrition and Physical Degeneration
Pratt, Steven and Kathy Mathews. Superfoods Rx: Fourteen Foods That Will Change Your Life.
Quinn, Sheila (ed). Clinical Nutrition: A Functional Approach
Rolls, Barbara and Barnett RA. The Volumetrics Weight Control Plan
Sanders, Lisa. The Perfect Fit Diet
Sears, Barry. The Anti-Inflammation Zone
Weil, Andrew. Eating Well for Optimum Health
Willett, Walter. Eat, Drink, and Be Healthy

Consumer Reports. 1/90. 27 - 40. Fit to Drink?
Hippocrates. 5/94. 30-37. The Man Who Has a Beef With Your Diet.
Consumer Reports on Health. 1/03. Is Your Diet Up-To-Date?
Consumer Reports. 1/03. 33-38. Clear Choices for Clean Drinking Water.
www.aicr.com. American Institute of Cancer Research web site with abundant information on a healthy diet.

Resources

Dr. Leo Galland’s Drug-Nutrient Interactions Workshop Software from Allergy Research Group 800-545-9960 www.allergyresearchgroup.com
Weight, Activity, Variety, and Excess (WAVE) tool – facilitate dialogue between physician and patient; formatted as a pocket card with assessments on one side and recommendations on the other side http://outside.utsouthwestern.edu/chn/naa/wave/wave_instruct.htm (Diabetes Educ. 2001. 27. 352-358)
Rapid Eating and Activity Assessment for Patients (REAP) assesses dietary intake related to 2005 dietary guidelines (J Nutr. 2003. 133. 556S-562S)
National Heart, Lung, and Blood Institute interactive menu planning guide http://hin.nhlbi.nih.gov/menuplanner/menu.cgi
University of Wisconsin Integrative Medicine www.fammed.wisc.edu/integrative/modules Patient Handouts on “The Anti-Inflammatory Diet” and “Detoxification Program: 7 Day Appendix, pgs 1-2

[Last Updated April 14, 2012] [Return to List of Topics]