Interesting Articles in the AJCN

I just received an RSS alert for the American Journal of Clinical Nutrition's latest articles. This upcoming issue is full of very interesting material:

1. Dr. Neil D. Barnard reviews food consumption patterns in the US from 1909 to 2007 (1). This is something I've written about a number of times. The most notable change is that industrial seed oil use has increased by more than 3-fold in the last 40 years, and even more in the last 100 although he doesn't provide those numbers. Butter and lard use declined sharply. Meat consumption is up, but the increase comes exclusively from poultry because we're eating the same amount of red meat we always have. Grain consumption is down, although it peaked around 1900 so it may not be a fair comparison with today:

In the late 1800s, wheat flours became more popular and available due to the introduction of new [high-gluten] wheat varieties, [low extraction] milling techniques, and transport methods, and during this time new breakfast cereals were introduced by John Harvey Kellogg, CW Post, and the Quaker Oats Company. Thereafter, however, per capita availability of flour and cereal products gradually dropped as increased prosperity, improved mechanization, and transport (eg, refrigerated railway cars) increased competition from other food groups. [Then they partially rebounded in the last 40 years]

2. Dr. S.C. Larsson published a paper showing that in Sweden, multivitamin use is associated with a slightly higher risk of breast cancer (2).

3. Soy protein and isoflavones, which have been proposed to do everything from increase bone mineral density to fight cancer, are slowly falling out of favor. Dr. Z.M. Liu and colleagues show that soy protein and/or isoflavone supplementation has no effect on insulin sensitivity or glucose tolerance in a 6 month trial (3). This follows a recent trial showing that isoflavones have no effect on bone mineral density.

4. Dr. Ines Birlouez-Aragon and colleagues showed that high-heat cooked (fried and sauteed) foods increase risk factors for diabetes and cardiovascular disease (insulin resistance, cholesterol, triglycerides), compared to low-heat cooked foods (steamed, stewed) in a one-month trial (4). The high-heat diet also reduced serum levels of long-chain omega-3 fatty acids and vitamins C and E.

5. Dr. Katharina Nimptsch and colleagues showed that higher menaquinone (vitamin K2) intake is associated with a lower cancer incidence and lower cancer mortality in Europeans (5). Most of their K2 came from cheese.

6. And finally, Dr. Zhaoping Li and colleagues showed that cooking meat with an herb and spice blend reduced the levels of oxidized fat during cooking, and reduced serum and urinary markers of lipid oxidation in people eating the meat (6).

The take-home message? Eat stewed meat with herbs, but don't pre-brown it in vegetable oil. Throw out the tofu and have some artisanal cheese instead.

New Review of Controlled Trials Replacing Saturated fat with Industrial Seed Oils

Readers Stanley and JBG just informed me of a new review paper by Dr. Dariush Mozaffarian and colleagues. Dr. Mozaffarian is one of the Harvard epidemiologists responsible for the Nurse's Health study. The authors claim that overall, the controlled trials show that replacing saturated fat with polyunsaturated fat from industrial seed oils, but not carbohydrate or monounsaturated fat (as in olive oil), slightly reduces the risk of having a heart attack:

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs [how do you like the acronyms?]. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Looking at the studies they included in their analysis (and at those they excluded), it looks like they did a very nice job cherry picking. For example:

• They included the Finnish Mental Hospital trial, which is a terrible trial for a number of reasons. It wasn't randomized, appropriately controlled or even semi-blinded*. Thus, it doesn't fit the authors' stated inclusion criteria, but they included it in their analysis anyway**. Besides, the magnitude of the result has never been replicated by better trials, not even close.
  
• They included two trials that changed more than just the proportion of SFA to PUFA. For example, the Oslo Diet-heart trial replaced animal fat with seed oils, but also increased fruit, nut, vegetable and fish intake, while reducing trans fat margarine intake! The STARS trial increased both omega-6 and omega-3, reduced processed food intake, and increased fruit and vegetable intake! These obviously aren't controlled trials isolating the issue of dietary fat substitution. If you subtract the four inappropriate trials from their analysis, which is half the studies they analyzed, the result disappears. Those four just happened to show the largest reduction in heart attack mortality...
  
• They excluded the Rose et al. corn oil trial and the Sydney Diet-heart trial. Both found a large increase in total mortality from replacing animal fat with seed oils, and the Rose trial found a large increase in heart attack deaths (the Sydney trial didn't report CHD deaths, but Dr. Mozaffarian et al. stated in their paper that they contacted authors to obtain unpublished results. Why didn't they contact the authors of this study?).

The authors claim, based on their analysis, that replacing 5% of calories as saturated fat with polyunsaturated fat would reduce the risk of having a heart attack by 10%. Take a minute to think about the implications of that statement. For the average American, that means cutting saturated fat nearly in half to 6% of energy, which is a real challenge if you want to have a semblance of a normal diet. It also means nearly doubling PUFA intake, which will come mostly from seed oils if you follow the authors' advice.

So basically, even if the authors' conclusion were correct, you overhaul your whole diet and replace natural foods with bland unnatural foods, and...? You reduce your 10-year risk of having a heart attack from 10 percent to 9 percent. Without affecting your overall risk of dying! The paper states that the interventions didn't affect overall mortality at all. That's what they're talking about here. Sign me up!


* Autopsies were not conducted in a blinded manner. Physicians knew which hospital the cadavers came from, because autopsies were done on-site. There is some confusion about this point because the second paper states that physicians interpreted the autopsy reports in a blinded manner. But that doesn't make it blinded, since the autopsies weren't blinded. The patients were also not blinded, so the study overall was highly susceptible to bias.

** They refer to it as "cluster randomized". I don't know if that term accurately applies to the Finnish trial or not. The investigators definitely didn't randomize the individual patients: whichever hospital a person was being treated in, that's the food he/she ate. There were only two hospitals, so "cluster randomization" in this case would just refer to deciding which hospital got the intervention first. Can this accurately be called randomized?

Sound the Alarm!

March 23rd is a 'wake-up' call to let people know about the seriousness of Diabetes. Take a short test to see if you or a loved one are at risk for developing Type 2 Diabetes.

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Observed on the fourth Tuesday of March (today), American Diabetes Alert Day is a one-day "wake-up" call to let Americans know about the seriousness of diabetes. Today, the 21st anniversary of this important event, the American Diabetes Association encourages people to take the Diabetes Risk Testto find out if they or their loved ones are at risk for developing type 2 diabetes. Dreamfields Pasta has sent you this email because we care about your health. And, we care about the nutritional needs of thousands of thousands of families who cook with Dreamfields daily. They know that there's more to our pasta than great taste. With the added health benefits of low digestible carbs and high fiber, Dreamfields is the pasta that the entire family can enjoy. - Join the effort to stop diabetes - Get printable version of test - Find out what's happening in your area - Tome el examen de riesgo en espa�ol

Fatty Liver: It's not Just for Grown-ups Anymore

The epidemic of non-alcoholic fatty liver disease (NAFLD) is one of my favorite topics on this blog, due to the liver's role as the body's metabolic "grand central station", as Dr. Philip Wood puts it. The liver plays a critical part in the regulation of sugar, insulin, and lipid levels in the blood. Many of the routine blood tests administered in the doctor's office (blood glucose, cholesterol, etc.) partially reflect liver function.

NAFLD is an excessive accumulation of fat in the liver that impairs its function and can lead to severe liver inflammation (NASH), and in a small percentage of people, liver cancer. An estimated 20-30% of people in industrial nations suffer from NAFLD, a shockingly high prevalence (1).

I previously posted on dietary factors I believe are involved in NAFLD. In rodents, feeding a large amount of sugar or industrial seed oils (corn oil, etc.) promotes NAFLD, whereas fats such as butter and coconut oil do not (2). In human infants, enteric feeding with industrial seed oils causes severe liver damage, whereas the same amount of fat from fish oil doesn't, and can even reverse the damage done by seed oils (3).

So basically, I think sugar and industrial oils are major contributors to NAFLD, and if you look at diet trends in the US over the last 40 years, they're consistent with the idea. Industrial oils are harmful due (at least in part) to their high omega-6 content, which is problematic partially because it disturbs normal omega-3 metabolism. A potential solution to fatty liver is to reduce sugar, replace industrial oils with natural fats, and ensure a regular source of omega-3. I've posted two anecdotes of people rapidly healing their fatty livers using diet changes* (4, 5).

I recently came across a study that examined the diet of Canadian children with NAFLD (6). The children had a high sugar intake, a typical (i.e., high) omega-6 intake, and a low omega-3 intake. The authors claimed that the children also had a high saturated fat intake, but at 10.5% of calories, they were almost eating to the American Heart Association's "Step I" diet recommendations**. Busted! Total fat intake was also low.

High sugar consumption was associated with a larger waist circumference, insulin resistance, lower adiponectin and elevated markers of inflammation. High omega-6 intake was associated with markers of inflammation. Low omega-3 intake was associated with insulin resistance and elevated liver enzymes. Saturated fat intake presumably had no relation to any of these markers, since they didn't mention it in the text.

These children with NAFLD, who were all insulin resistant and mostly obese, had diets high in omega-6, high in sugar, and low in omega-3. This is consistent with the idea that these three factors, which have all been moving in the wrong direction in the last 40 years, contribute to NAFLD.


* Fatty liver was assessed by liver enzymes, admittedly not a perfect test. However, elevated liver enzymes do correlate fairly well with NAFLD.

** Steps I and II were replaced by new diet advice in 2000. The AHA now recommends keeping saturated fat below 7% of calories. Stock up on those skinless chicken breasts! Make sure there isn't any residual fat sticking to the meat, it might kill you. I do have to give the AHA credit however, because their new recommendations focus mostly on eating real food rather than avoiding saturated fat and cholesterol.

7 Really Easy Ways to Save Money at the Grocery Store

And none require buying anything day old or suspiciously on sale. In fact, a few simple shopping adjustments will really make a difference to your wallet. Here are my favorites:  

1. Shop the Outer Aisles

In most markets you'll find the healthiest ingredients on the perimeter of the store�fresh fruits and vegetables, lean proteins including fish and chicken, and fat-free and low-fat dairy products. The inner aisles contain most of the processed foods, including soda, candy, chips, and snack foods. Aside from the fact that they contain empty calories, they also take a big (and unnecessary) bite from your food budget.

2. Buy in Bulk

Bulk items are usually cheaper. That�s because there�s no expensive packaging included, so those savings are passed directly on to you. You also have the freedom to choose how much or how little to buy. Best buys include whole grains, dried beans and legumes, nuts and seeds, and cereals. Some health food stores sell spices in bulk as well.

3. Go Seasonal

Out-of-season fruits and vegetables are sometimes imported, expensive, and often tasteless. Plan menus and choose recipes around what's currently in season. You�ll enjoy better flavor and lower prices anytime of year. (And yes, there is good in-season produce in late winter�citrus fruit, anyone?)

4. Shop Locally

Local grocers carry plenty of regional produce. Farmers� markets are a great source for healthy bargains too.

5. Grow Your Own

Slash your spending even further by supplementing your produce purchases with homegrown items. If you don�t have space for a garden, you can at least grow your own herbs. Plant your favorites in small pots near the kitchen. Take a snip or two as needed.

6. Make It from Scratch

Yes, it takes a little more time, but preparing a dish at home rather than picking up a pre-made version can save up to 50% or more. It also ensures your dish is healthier because you dictate the amount of oil or salt it contains. And best of all, this guarantees no hidden preservatives.

7. Load Up on Legumes

Beans and legumes offer a myriad of health benefits as diverse as their varieties. Black beans, garbanzos, pintos�they�re all excellent sources of fiber. They�re also rich in folic acid, calcium, iron, potassium, zinc, and antioxidants. The complex carbohydrates they contain provide steady energy that lasts well beyond mealtime. A stellar source of protein, legumes may be the biggest money saver of all, as they cost a fraction of the price of most animal proteins.

10 Ways to feed your family for $100 a week!

With planning and a little more time in the kitchen, you can stick to your budget without sacrificing taste or nutrition. Here are 10 tips that can help you feed your family for about a hundred bucks a week.
1. Plan in Advance

Create the week's menu, but leave some room for flexibility. The most important step in sticking to a weekly budget is to come up with a plan for every meal, snack, and beverage you'll need for 7 days. Make sure you account for every item you put in your cart. This will keep you from adding expensive impulse buys that may go to waste.


2. Steer Clear of Convenience

Check your grocery store's weekly circular for discounts and coupons. These specials can be a starting point to plan your meals for the week. Foods packaged for convenience, such as individually boxed raisins, juice, and yogurt, are a no-no for those on a tight budget, says nutritionist Elizabeth Somer, RD, author of 10 Habits That Mess Up a Woman's Diet. Ditto for those 100-calorie packs of cookies. Marinate your own meat instead of buying the premarinated, packaged kind. Swap out those milk or juice boxes in your child's lunch for a Thermos. These options are all less expensive, and the reduction in packaging is better for the environment.


3. Be Brand Blind

If the peanut butter you usually buy is not on sale, but its competitor is, go for the cheaper one. Being flexible with brands lets you score the best deals. Be open to store brands as well. They�re typically the least expensive option for most canned, packaged, and frozen foods and usually taste just as good as their brand-name counterparts.



4. Use Coupons...Wisely - Click coupon links to the left in sidebar

Manufacturers put out 285 billion coupons last year, according to coupon processor NCH, but only a fraction of them are worth using. Many may lead you to purchase unnecessary�and often unhealthy�items loaded with artificial colors, preservatives, and sugar. Your best bet is to use coupons for household staples like beans, yogurt, spaghetti sauce, and pasta. Some of the best coupons can be found for vitamins, cleaning products, laundry detergent, and toiletries such as toothpaste, she says.



5. Consider Your Alternatives

Although that big grocery store may be the most convenient place to shop, it's not necessarily the cheapest. Check out ethnic markets, bag-your-own-warehouses, and farmers� markets, which can often yield better buys on produce, meat, eggs, milk, and fish. Don't rule out deals at a drugstore, either. With reward cards and coupons, you can often score big deals on cereal, granola bars, and beverages.



6. Don't Dismiss the Deep Freeze

When certain fruits or vegetables move out of season or go up in price, consider buying bags of inexpensive frozen produce instead. Growers flash freeze their harvest at its peak, which locks in most of the nutrients. Plus, there's the bonus of not having to wash, peel, or chop them yourself. Frozen veggies make quick, convenient additions to soups and stews, pasta, or rice dishes.



7. Put On Your Apron

One of the easiest ways to eat well on a tight budget is to make some ingredients yourself. If you have a bread maker buried at the bottom of a cabinet, haul it out, and you can cut at least $3 from your budget for each store-bought loaf. Likewise, making your own juice ice pops, salad dressing, hummus, granola, and desserts can shave money off the bottom line without making you feel deprived.



8. Become a Flexitarian

One of the healthiest ways to save money is to swap meat for beans as your protein source a few meals a week. Packed with high amounts of protein, fiber, and antioxidants, beans are one of the healthiest foods out there. They are also one of the cheapest items in the grocery store, especially if you buy them dry and soak and cook them yourself. Try them in burritos, soups, chili, and salads.

Cutting back on meat is not just good for your wallet, it's good for your health as well. Most Americans far exceed the recommended meat and protein allowances for our diet, and with that meat can come unwanted saturated fat.



9. Leftovers Again!

Use last night�s dinner to make tonight�s meal�one of the easiest ways to cut your grocery bill is simply by reducing the amount of food you throw out. Leftover meat can become a base for soup or stew for the next night's dinner. Or serve it on whole grain bread for lunch the next day. Extra vegetables can be paired with eggs to make a frittata or added to tofu for a stir-fry dinner.

Store leftovers in clear containers where you can see them to keep them top of mind�and out of the trash. If the fresh fruit or vegetables in your crisper are in danger of going bad, chop them and freeze for later.



10. Go Less and Buy More

Make fewer trips and buy more of the basics

The fewer times you go to the market, the fewer opportunities there are to fill your cart with impulse buys. Stick to your list and buy a little bit more than you think you need of the basics like milk, bread, and fruit. Most people underestimate how much they will use over the course of a week, say experts.

Ten Minutes About Pesach