Wanna Eat Healthy? Get Your Nitrates!

Think nitrates in your food and eating healthy don’t go together? What’s this gorgeous spinach salad have to do with nitrates? Read on, but let’s start at the beginning.

You’re not going vegan but you want to eat better and you’ll start with baby steps, like I talked about in my previous post.  OK, and here are some popular intentions:

  • Try and eat more leafy green stuff.
  • Definitely cut the hot dogs, ham, bacon, the deli stuff, and “processed” meat, even if it’s lean.  Everyone knows that stuff is “bad” because it has nitrates, right?

Swapping out hot dogs and ham for spinach and beets (the new “in” veggie for 2019, as I mentioned here) would at least cut back on the nitrates, right?  Wrong. 

Where the Real Nitrates Are

Indeed, a bunch of healthy, nutrient-rich veggies like beets, spinach, celery, even iceberg lettuce and broccoli, have more nitrates than that hot dog you snuck in for lunch last week.  Check out this chart from a 2012 report of the nitrate content in foods.  Amounts are in “parts per million” (ppm):

This image has an empty alt attribute; its file name is mushrooms-417101_1280-2.jpg
More nitrates than a hot dog — & it’s healthy food!
  • Beets: 2797 ppm
  • Spinach: 2333 ppm
  • Celery: 1496
  • Mushrooms: 590 ppm
  • Broccoli: 394 ppm
  • Strawberries: 173 ppm
  • Cured sausage (hot dog), cooked: 32 ppm

Are Nitrates in Fruits and Veggies a Problem?

No, and not in other foods either, according to Melissa Joy Dobbins MS, RDN, CDE and known as The Guilt-Free® RD.   “This is a great example of how misinformation can create a “fear factor” when it comes to food. I think most people who are concerned about nitrates/nitrites would be surprised to learn that the majority of these nutrients in our diet are not from cured meats, but from plant foods, namely a variety of vegetables.”

Dobbins’ statement is evidence-based and reflects the conclusion of this 2015 meta-analysis of many studies on dietary nitrates, nitrites, and nitrosamines, which found nitrates associated with a decreased risk of gastric cancer.  The slight increased risk associated with increased nitrite intake was considered weak, and tended to come from weak or poorly-designed studies, which muddied their findings.  Even then, spinach still has more nitrites than cured sausage.

Nitrates & Their Cousins: Nitrites and Nitrosamines

Here are the basics you need to know about these:

  • Nitrates are naturally present in lots of different foods. 
  • Nitrites are also naturally present in foods but most are formed when bacteria in your saliva convert nitrates to nitrites. 
  • Nitrosamines are not naturally present in food but can form in food through several pathways.  Cooking at a high temperature, such as frying cured meat, or when an acid (like stomach acid) is present.  If there’s any concern, it’s with the formation of nitrosamines.  Even then, conversion from nitrite to nitrosamine can be inhibited or stopped by the addition of compounds like ascorbic acid, or “vitamin C”.  Seriously – check the ingredient label of many cured foods like hot dogs and you’ll find “ascorbic acid” is often present. 

“Nitrate-Free” Cured Meat?

There are cured meats labeled “no added nitrates.”  What they add instead is celery powder.  As you’ll see from the table above, celery is loaded with natural nitrate.  There’s no evidence that there’s any difference between the nitrate in celery powder and the nitrate added to “nitrated” cured meat. 

Celery: Fine wherever you find it

Nitrates: The Boil-Down

It’s ironic to know that someone eating a spinach salad is probably getting 10 times more nitrates than the person eating the ham sandwich, but Dobbins noted, “Does that mean we should be afraid of eating vegetables? No. It means we should look at the overall nutrients a food provides and try to consume more nutrient-rich foods and fewer empty-calorie foods.”

It may be that the folks who eat lots of cured meat may also have a less-healthy lifestyle overall.  They may be less likely to engage in regular physical activity, and less likely to eat a lot of veggies and fruits, and may drink more soda or eat more junk snacks.

Cut-To-The-Chase-Advice

Eat all the spinach, beets, mushrooms, celery and broccoli you can fit into your diet.  As for cured meat, I like Dobbins’ approach. Nitrates may not be an issue but balance still is, so don’t go crazy at a cold-cut buffet.  If you like cured meats, make them leaner cuts, like ham, instead of sausage.  And have that ham with lots of veggies – even high-nitrate ones like spinach and broccoli.  A meal loaded with nitrates can, and should, still be healthy.  0000000000000

Learn From a Baby About New Year’s Resolutions

Even a baby who hasn’t seen his/her first New Year can teach us something about making resolutions.  Babies may not think about their health, but this poll done in the UK found the top 3 resolutions for adults:

  1. Lose weight
  2. Get fitter
  3. Eat more healthy

Wisely, the poll also followed up with these people.  Nearly two out of three who made resolutions keep them and more than 4 in 10 broke a resolution within the first month.  Only 1 in 3 kept going for more than a month. 

Resolutions: They’re FOR the Year, so TAKE All Year

Imagine if a baby stopped trying to walk after falling?  Every single human would be immobile.  A broken resolution isn’t a failed resolution!  I wouldn’t even call it broken – just “in progress.”  The flip side is to expect 100% perfection 100% of the time, right from the start.  Ridiculous.  You get up, look at where you tripped up, and move on. 

This study found successful “resolvers” used more behavioral strategies, which, by nature, require more time, because behaviors change slowly.  Every road has a pothole or two, so if you encounter one on your journey, you’re typical and on schedule.  Keep it moving.

Ready, S.M.A.R.T., Go!  –Anytime

Learn from these guys

Never mind January 1, whenever you’re ready, the calendar will support it.  Just see a resolution as its own project.  Give it priority and treaty it with some respect.  This is you, after all.

S.M.A.R.T. is just an acronym for the components of successful goals and objectives, whether in the workplace or your personal space.   The letters have stood for different things over the years, but here’s where they stand now:

  • Specific: keep it simple, something you KNOW you can achieve. “I’m going to eat healthier” isn’t specific.  “I’m going to eat 1 cup of fruit and a cup of vegetables at least 3 days a week” is more specific.
  • Measurable: Note how far you walked, how many vegetables you ate, or whatever your specific objective is. Forget obsessing about every detail.  Again, simple is key here.
  • Achievable: Specific and achievable are two sides of the same coin.  THINK LIKE A BABY here.  Take baby steps!  Set a goal you think is achievable and then reduce the goal by 50% or more.    You can inch up later. 
  • Realistic: Meet yourself where you live.  If you can’t spare a whole hour a day for exercise – or if you’re not in shape yet for that – it’s OK.  I don’t care if you start walking for 5 minutes a day.  You’ll be at this the whole year and you’ll get where you need to go.  An easy goal is the best kind when you’re starting out. If you want to lose 10 pounds of body fat in 3 days, that’s specific but not realistic. 
  • Time-bound: TAKE THE WHOLE YEAR but set small time goals for the baby steps.  You’re building a habit here, and habits take time to become established. 

We want everything done immediately and easily sustained forever.  Let that concept go, because it’ll never happen – for anyone.  Most importantly, THAT’S OK. 

Baby steps & persistence!

Babies Have Vitamin “P”

Back to babies.  They’re loaded with vitamin P – persistence and patience!  Even better – they LOVE the journey and what they accomplish along the way!  Have you ever seen a baby’s expression when they crawl farther, learn to hold a spoon, or stand for the first time?   Give yourself a little credit for taking those baby steps.  They’re the best kind!

Yes, Virginia: There Are 10 Ways to Have Holidays Without Weight Gain

So many people, clients, patients, co-workers over the years, have told me they’ve just given up trying to lose weight during the holidays – that food-festival parties, get-togethers, celebrations and general mayhem that spans the period between Thanksgiving and New Year’s Day.

What is about holidays that cause weight gain? If you know the contributing factors, you can make a plan. Here’s what you’re likely to deal with until New Years:

Workplace food court: The constant brigade of popcorn bins, chocolates, homemade cookies, cakes and sweets, all available all day long.

Drinking: We love eggnog, but it’s the most calorie-laden drink of any year – about 330 calories in a cup. Over-boozing has calories, too – and leads to mindless eating.

Stress-eating: time is short, obligations are long, stress triggers eating whatever is within arm’s reach!

More fooding, less moving: whenever you need a little more time to get things done, it’s easy to borrow from your workouts and walks. It’s also just when you need to burn some extra calories. Ow.

Happiness can be depressing! Everyone seems to be happy but you’re so-so. You’re not alone, either. It’s easy to think food is your BFF during the holidays, and it can be – if you choose the right friends.

Good News

You probably won’t gain much weight during the holidays! This review published last year found that average holiday weight gain in adults ranged from about 1-2 pounds in various studies, not the 5-7 pounds you may have heard about.
But what about you? If holiday weight gain has been YOUR typical, changing that is easier than you think. Take it on as a project and like every project, it needs a good plan. Plans may take some of the spontaneity out of eating, but you’re trading up – for peace of mind and body. That’s totally worth it.

Planning means that you start every day assessing the meals and eating occasions you’ll have and the foods you’re likely to encounter. What does the “no holiday weight gain” plan look like? Here are 10 strategies that put you on a path to enjoying holidays without weight gain:

1. Eat modestly, but don’t skip meals. You’ll just end up being hungry and over-scarfing.

2. Weave in some fiber: Aim for 3 pieces of fresh fruit daily. Aim for 2 cups of veggies, raw or cooked. Think you can’t?  You can – fill up one of those plastic take-out soup containers with cut veggies and it’s two cups right there.

3. Discriminate! Is it a regular store-bought something-or-other that’s loaded with empty calories or is it really tasty? Hold out for something really special. You’re worth it.

4. Never arrive hungry to a party:Eat some raw veggies or a piece of fruit before going to a party or social function. When the edge is off hunger, your focus is on social fun.

5. Go pro: Lean protein keeps you feeling satisfied, and helps prevent blood glucose levels from spiking then plummeting later. About 100-150 calories invested in options like turkey roll-ups, beef jerky, fat-free Greek yogurt, even a fat-free latte will pay off later.

6. Get functional: it’s a social function, so keep the priority on socializing rather than eating.

7. Be the last man (or woman) standing…in line: Always be among the last ones in line for the food. It’ll look a little less appetizing (probably a good thing) and there’s less time to have second portions.

8. Get out of Dodge: Lingering to the end encourages more nibbling.  Be social, sample what you want, then move along.

9. ONE – a singular sensation!  When you see something you want, have it. But one portion. One is the magic number, not a lonely number.  But read #10.

10. Get “hospital-sized”:  Not to eat, just to look at portion sizes. When you’re thinking of a high-calorie food, whether it’s mac and cheese or the Buche de Noel pictured at the top, it’s one “hospital-sized” portion. Keep it there and enjoy it. There will be another treat another day.

Why I Try To Be “Over 30” Every Day

Dee is an inspiration to me.  She has cerebral palsy and is confined to a motorized wheelchair. She has only minimal use of each hand, just enough to move her chair and use a phone if it’s placed into her hand. She’s not only cognitively intact, she’s pretty smart.

I’m lucky. I worked for 33 years with people with special needs, people like Dee.  It’s emotionally difficult work sometimes, but I always got more than I could ever give them. One powerful lesson they taught me was how lucky I was to be physically able-bodied.

She told me once she was fed up hearing what a nuisance people thought it was to take the stairs, walk the dog, or park farther away from your destination to get in a few extra steps. “They sit down all day long but they have a choice. I don’t. If I could walk I’d never want to sit down.”

When we think of chores, she thinks of abilities. Big wake-up call here.

Everyone Needs To Be Over 30

I speak not of years, but of minutes. Thirty minutes of physical activity for at least five days of the week is what’s recommended by the US Physical Activity Guidelines for Americans. How much do we get? The feds survey this info regularly and the latest data show 1 in 4 of us get NO leisure physical activity at all. None. That’s self-reported data, and it may be higher, as people do tend to enhance the amount of physical activity they do.

Flipping the Script on Activity

Many of us cringe when we’re told to be more active. So how about baby steps? How about focusing on being less INACTIVE?

If it’s too overwhelming to go to a gym (I speak not of “joining” because that doesn’t ensure “going”) or if you have little leisure time, then it makes sense to build some activity into your day, a little bit here and there, whenever you can.

Enter the “Exercise Snack”

A food snack is something less than a meal. An exercise snack is something less than a workout. It can take many forms and be done pretty much anywhere. It doesn’t have a minimum time, it just requires moving – anyway you can, and anywhere you can. You don’t need to develop a twitch, just think of doing what some of my physically disabled patients would LOVE to do:

Deliver it.  Why email a memo to someone close by, when you can walk down the hall to speak with them? Follow-up with a memo for the record.

Think glass,  not bottle.  Have one glass of water at a time, rather than brining a bottle to your desk. When you want more, you’ll get up and get it.

DIY: Make a photocopy yourself, get the staples from the supply closet, give the home floor an extra quick vacuuming. It’ll get done your way and it’s another exercise snack.

TV? A 30-minute sitcom only has about 22-23 minutes of actual programming. That’s about 7 minutes of time – in 2 or 3-minute intervals – for exercise snacking.  Get the playing cards, charge your phone, lay out your clothes for the next day, or even fold a few clothes.

Tidy up!  Not a deep clean, just clear the coffee table, run the dishwasher, or hang that coat that’s been there since you got home.

Remember, these are exercise snacks, not workouts, so you’re done after a couple of minutes, but do them several times a day and you’re on your way top getting that 30 minutes. Better still, you’re preventing your metabolism from slowing down. Remember – it’s not about being more active – just less INACTIVE.

It’s an easier goal to achieve and these exercise snacks might lead to bigger things, like “exer-meals”. And if you need motivation, remember: Dee would happily trade places with you.

As for motivation, check this video out of a 4-year-old girl with cerebral palsy, taking her first steps by herself.  You’ll cheer her on as loudly as I did.  Then get up off your chair or the sofa — just because you can!

Holiday Eating: Everything in Moderation…Including Moderation!

Julia Child actually said that line, but I like it, and I LOVE Thanksgiving. It’s my favorite holiday, because it’s not about anything but having a meal with people you care about.

Thanksgiving is also often the year’s biggest – and the richest – meal for most people.  Think about it — even a standard Thanksgiving meal is rich, and “rich” is courteous foodie-speak for “loaded with fat and calories”:

• Turkey with plenty of gravy.

• Stuffing: nearly all recipes are rich with bread or rice and loaded with various fats.

• Potatoes (all colors): mashed, candied, marshmallowed, they get loads of butter and we love them.

• Vegetables and sides? They’re healthy, but on this day they come creamed, buttered, and casseroled, and serve as vehicles for calories, mostly fat ones.

• Desserts are a must. It’s not yes or no, but how many and how much of each?

Even if dessert is a must, weight gain doesn’t have to be.  Read on.

Deposit Some Calories in the Bank

If you’ve been going to the same place for the holidays or having the day at your place you know the basics of what will be served. You know it’ll be a big meal. That’s OK, but plan ahead for it and put “bank” some calories by undereating for a few days before the Big Meal with these tips:

Eat a lean, high-protein breakfast.  Swap the fried egg and bacon sandwich for a couple of hard-cooked eggs, whole grain toast, and fresh fruit. Or go for 8-10 oz. (that’s 1 or 2 of those individual cups) of fat-free Greek yogurt and berries.

Snacks? Keep them to fresh fruit or a small handful of nuts, or even some beef jerky (lots of protein there).

“Sensible” lunch and dinner?  That term always annoys me.  (Who eats a “nonsense” meal?) Here’s what it means: eat smart, eat mindfully, eat deliberately.  Keep added fats to a minimum, so skip anything deep-fried or that has gravy. Keep proteins lean (lean cuts of beef, chicken, fish), and load up on veggies – cooked or raw. Salads? Sure, but use a low-fat dressing or keep the oils to 1 tablespoon.

Desserts?  Let ’em wait for now, other than fresh fruit or fat-free Greek yogurt (I recommend that over regular yogurt because it’s higher in protein, to help you feel full and satisfied with fewer calories.)  Remember, you’re saving up for later.

Your Ace in the Hole

You’re busy, but make a 20-minute walk a priority each day. That’s another 100 or so calories you’ll “bank”. If you’re a gym-goer, this is not the time to slack off. Indeed, you’ll bust some stress in the process and give yourself a mood lift. No downside here.

Be thankful you CAN be active. Anyone physically disabled would tell us to shut up about being too busy to be active. To them, it would be the greatest gift possible. We already have it. Let’s be thankful and not waste the gift.

Do even a couple of these tips and you’ll likely save a few hundred calories each day that you can “spend” having a little more at the Big Meal. Net result: no weight gain!  Happy Day.  You’ve got this.

Family Meals: You Don’t Have To Go Big, Just Go Home

Eating together as a family – however you define your family – has always been a good thing, but now it’s been shown to be a healthier thing, too. This September marks the 4th National Family Meals Month ™, a campaign started in 2015 by the non-profit Food Marketing Institute Foundation to encourage families to eat together more often.

And The Survey Says…

Here’s what a Nielson Harris poll, conducted last year, found about the campaign’s impact among consumers who saw it:

• 4 in 10 (42%) said they were cooking more meals at home.

• More than 3 in 10 are:

    • Making healthier food choices
    • Eating more fruits and vegetables
    • Eating together more as a family

As a nutrition professional, these are big wins. But the bennies don’t stop there. Read on.

This publication from the University of Florida reviewed the benefits of family meals and found:

• Family meals are happening more often. Now 7 in 10 kids eat with their families at least four times a week.

• Family meals strengthen family bonds and teach an appreciation of cultural, ethnic, and religious heritage.

• Teens said that talking/catching up, and spending time with family members was the BEST PART of family meals. Huge win for families and a huge opportunity.

Something that’s better for nutritional, physical, and mental health, improves social behaviors, and contributes to a family’s overall feeling of happiness is as close to a “magic bullet” as you’re going to find. They’re certainly cheaper than eating out or getting take-out. Do they take a little time to prepare? Yes, but show me something, ANYTHING, that does a better job of helping you and your family be healthier and happier and save you money. There isn’t anything better for a family than a meal eaten together. Period.

So What Are the Barriers To More Family Meals?

Despite all these benefits from family meals, they aren’t happening often enough. The top obstacles cited in the FMI survey:

• Scheduling issues – everyone is in different places at meal times.

• Too tired to cook. Takeout or eating out seems easier.

• Too time-consuming to make meals.

• Too many distractions: social media, TV, homework.

But… What’s For Dinner?

Have you noticed that this nutritionist has mentioned very little about things like calories, fats, and added sugars in this post? I’m actually less interested in what you serve than the fact that you’re eating together.

Get the family meal ritual down first. The research has shown that once more family meals start happening, the quality of the meal starts advancing: more fruits and vegetables, fewer empty calories, less sugar and saturated fat. Eat together at home and you’re probably on your way to a better meal.

One rule though: No technology at the table. Each member has a place at the table because they matter. Yes, family meals can be part of esteem-building also

Getting Help: A Few Tips

• Delegate: Older kids an share some meal prep duties. It’s good for initiate communication without being “face-to-face”. Make sure to thank them for their help, too. It reinforces that they’re appreciated.

• Convenience if OK: Bagged greens, frozen veggies, and yes, canned foods like beans and tomato sauce are nutritious and save time. I encourage them.

• Set it up: before work, set the table, get out any pots or pans you’ll need, and anything non-perishable. It really shaves valuable time later.

Dinner IN 30 Minutes? Try Dinner FOR 30 Minutes

Eat more slowly, do more talking. The food won’t go away and you’ll enjoy it more. If the kids are done eating sooner, then have them stay for the full 30 minutes to make conversation. Make it a family tradition and try doing it as often as you can, because #FamilyMealsMonth matters, and it matters all year long.

Direct & “Indirect” Food Additives: Issues Or Non-Issues?

The American Academy of Pediatrics recently released a policy statement on food additives — the direct food additives like nitrates, and indirect ones, like plastic containers that come into contact with food. Their bottom line is that the FDA’s regulatory process doesn’t properly vet food additives and cannot assure us that all of these 10,000 “chemicals” [emphasis mine] are 100% safe.

I like the AAP – really I do – but in this case I wonder if they’re presenting a balanced view of the total body of science on food additives. For example, the statement references studies where additives are “linked” to conditions like impaired thyroid function and immune responses to vaccines, even increased risk for obesity. Yet, many of the referenced studies also admit that such “link” may not be one of cause-and-effect. Moreover, numerous studies not referenced validate the safety of these additives. Getting approval of a new food additive just isn’t easy – nor should it be.

Is ANYTHING 100% Safe?

Not likely, and that includes prescribed medications, but that doesn’t mean we shouldn’t use them when necessary. It would be easy to get suspicious of everything we eat: Are healthy foods like beans 100% safe for everyone?

It’s more useful to me and my patients to put this issue perspective, and to that end I think the AAP statement could have done that better. We DO have the most advanced food delivery system in the world and our FDA is a guide post for similar organizations in other countries.

The AAP’s issue with nitrates is one I don’t get, for example. Nitrates and “processed meats” are buzz words, true. But a food label saying “no nitrates added” doesn’t mean the meat has no nitrates. Celery powder is often a substitute, because celery is a source of natural nitrate, along with green beans, carrots, spinach and collards. Of course, celery powder is also a “food additive.”

If someone is eating processed meat frequently, I’d be more concerned with what it’s replacing in the diet, rather than nitrates per se. Let’s balance the diet and the nitrates become a non-issue.

The Big Picture

As a pediatric nutritionist for over 30 years, I’d love it if we lived in a world without a need for anything “additive”. But we don’t, and in some cases that’s a good thing. After all, food additives have provided some of the best public health interventions. I’m glad I don’t have to see children with neural tube defects anymore, now that folic acid – a food additive – is added to enriched grains. My own mother remembers her grandmother having a goiter and to this day she will only use iodized salt. No fancy sea salt, not even Kosher salt, for her. “You never had to see anyone with a goiter,” she says.

The AAP calls for the FDA to re-examine the regulatory process for approval of food additives, including those additives on the “GRAS” (generally regarded as safe) list. They also note that low-income children are at increased risk, as higher consumers of packaged foods.

Food Additives & Food Budgets

As for affordability, I like that the AAP recommends practitioners “develop a list of low-cost sources of fruits and vegetables.” I’ve worked my entire career with low income patients and helping patients stretch their food dollars goes hand-in-hand with good medical nutrition therapy. Nothing is nutritious until people eat it.

I don’t have the luxury of telling parents that their family’s health is at risk until the feds beef up their regulatory process. I also think there’s a lot that you can do at ANY income level to reduce exposure to additives. The AAP does give some recommendations in the interim, but frankly, they’re the same ones I’ve been giving to my patients on for years, just for general health:

• Make fresh fruits and veggies a big priority in the home eating environment. (Uh, it helps if parents eat them, too, and in front of the kids).

• When microwaving food, put it onto a plate or in a glass container instead of plastic. It just saves worrying about whether the container is microwave-safe to begin with. Also, no plastic wrap when microwaving. Too hot and the stuff melts. Ick.

• Forget the dishwasher for plastic containers. Just wash them by hand. Done.
Finally, if you’re doing these things anyway, then you’re also already minimizing your exposure to food additives. Then the feds can take all the time they want. You’re doing your job and that’s plenty safe.

 

 

 

Lean Red Meat in a Mediterranean Diet? Oh, Yes You Can!

This post is a collaboration with Beef. It’s What’s for Dinner., on behalf of the Beef Checkoff, as part of my role as a member of the Beef Expert Bureau.

In my previous EdibleRx column, I discussed the PREDIMED study, a 2013 landmark multi-center trial that showed how following a Mediterranean diet could reduce the risk of heart attack, stroke, and cardiovascular disease, but that was recently retracted due to flawed methodology. The re-analyzed and republished data showed good, but less dramatic results, than when first published.

Among the hallmarks of a traditional Med diet, one that the typical Greek farmer ate, are the inclusion of olive oil as the preferred fat in cooking, lots of fish, fruits, vegetables, and minimal red meat. Oh, and the glass of red wine.
Red meat? That Mediterranean farmer didn’t eat much because not much was available. Cows were expensive and sheep worked better on the arid land, plus they gave wool and milk to make feta. All based on pragmatism, not fashion. Red meat (usually lamb) was a celebratory dish. My Greek grandfather loved roasting the lamb heads at Easter (knock it, but farmers waste nothing).

Better Med With Red

A new study asks the question: What would happen to cardiovascular risk factors if you ate a Med diet but compensated/replaced some (up to 18 oz/week) of the poultry with lean red meat, keeping consumption of fish, extra-virgin olive oil (EVOO), nuts, and the rest of the Med diet the same?

This study, in the American Journal of Clinical Nutrition, has some credibility.  It’s small, but well done, and it’s a “cross-over” design, so that every participant followed both the Med diet limited in red meat and the Med diet that included red meat (i.e. Med-Red) for 5 weeks each, with about a month in between each phase.
Following both Mediterranean-style diets produced lower total cholesterol levels, but here’s the difference:

• The Med-Red diet lowered total cholesterol significantly more than the Med diet limited in red meat.

• The Med-Red diet lowered LDL-cholesterol, but the Med diet limited in red meat did not.

Blood pressure improved in both groups, regardless of red meat intake. HDL-cholesterol, glucose levels, and insulin were similar and unchanged for both groups.

Revised Results = New Questions

• Is the advice to reduce red meat intake in a Med diet misguided?

• What about lean forms of deli meat (beef and pork)?

From this study, the answer would be “yes” to the first question, but the second cannot yet be answered because it hasn’t yet been tested. It’s possible that processed, lean deli meats (beef and pork) may be able to be included with similar results to the Med-Red diet. “To be continued…”

Interestingly, when I looked at the revised PREDIMED data, specifically the questionnaire that scored the adherence to the Med and control diets, at the 1-year, 3-year, and 5-year follow-up marks, there were no differences in consumption of red or processed meats between the Med diet groups and the control groups, even though the Med diet groups had a lower risk of stroke. Maybe it’s not the red meat that makes the difference here.

Limitations? ALL studies have them. This study was smaller and didn’t last as long as the PREDIMED study, which had a 5-year follow-up.

The study was funded partially by the Beef Checkoff and the Pork Checkoff, but before you make pre-judgements, it was also funded by the National Institute of Health’s Ingestive Behavior Research Center at Purdue University and NIH’s Institute of Health’s Indiana Clinical and Translational Sciences Institute, all reputable organizations. Regardless, the funding organizations had “no role in the design or conduct of the study; collection, analysis, or interpretation of the data; or writing of the manuscript.” The study was fully peer-reviewed.

Cut-To-The-Chase Recommendations

• Stop worrying about “red meat” and focus more on leanness and freshness (i.e. unprocessed).

• Beef in particular has a lot to offer nutritionally, especially nutrients like zinc and iron, but also conjugated linoleic acid, B-vitamins, and more.

• Keep meat lean, keep portions real (4 or 5 ounces are enough, downing a 12-oz. portion doesn’t prove masculinity and your body can’t use all that protein at one meal anyway. Good news is that this study showed you can enjoy up to 18 ounces of lean red meat per week as part of this eating pattern and still see a positive impact on heart health)

• Make sure you have it with plenty of veggies and some whole grains, dressed with a drizzle of EVOO.

If you want a great lean beef recipe I made, check out my recipe for an easy, lean, tasty pot roast here, or for many more check out Beef-It’s What’s for Dinner and this infographic on the Med Diet. The site is loaded with great, heart-healthy recipes.

Is the Med Diet a Dead Diet? No – Despite Retractions

But the Mediterranean diet did get a kick in the keester. The New England Journal of Medicine just published a retraction of the 2013 PREDIMED study because of flaws discovered in the randomization methodology. Basically, it found that about a fifth of the 7447 trial subjects weren’t randomized properly, which could have allowed bias to creep into the data.

PREDIMED was a study on the Mediterranean diet and its impact on cardiovascular disease, specifically heart attack, stroke, and cardiovascular-related death. The study was intended to go on for 7 years but was stopped after about 4 years because the results were so dramatic that it was considered unethical to prevent the participants on the control diet from benefitting from the Med diet.

Subjects were supposed to have been randomly assigned to one of three groups:

• Instruction on the Med diet and provided free extra-virgin olive oil (EVOO);

• Instruction on the Med diet and provided free nuts (about 30 grams daily of a mix of almonds, hazelnuts, and walnuts);

• General advice on a low-fat diet. After 3 years, this group would also have additional dietary instruction.

Where did things go awry?

For about a fifth of the 7447 participants, randomization didn’t happen. They point out several ways the randomization failed for these participants, and these failures didn’t seem intentional or malicious. Probably due to site technicians who were poorly trained, poorly supervised, or sites that just weren’t run efficiently.

The authors completely re-analyzed the results of the study and published them here.

Did the corrected analysis change the results?

Yes. The results are still good, but not as dramatic. The Med Diet with either nuts or EVOO showed benefits only for reducing the risk of stroke, but not heart attack or other cardiovascular event.

We shouldn’t dismiss the Med diet though.  Although the PREDIMED study had flaws, other Med diet studies have shown positive results.

What holds true about the Med diet

• It’s simple and sustainable.

• It uses easily obtainable foods.

• It doesn’t require major dietary changes, yet still has at least some cardiovascular benefits.

As a clinician who has spent years helping people change their eating behaviors, a diet with these attributes hits the tri-fecta.

Where the Med diet could improve

A 14-item questionnaire was used in the PREDIMED study to determine a “MedDiet Score” of adherence to the diet. Some of the questions are a bit odd, if not troubling:

• Why are homemade pastries OK but “commercial bakery” items discouraged?

• Why are “red and processed meats” grouped together? More to the point, why is lean red meat in the same category as fatty, salty sausage?

• There is absolutely no mention at all of dairy foods, milk, yogurt, or cheese, either low-fat or regular? Yogurt and cheese are nutrient-rich and present in a Med Diet, even if not adequately so.

Solution: A “MediterDASHean Diet”

It combines the best of the Med Diet with the DASH (Dietary Approaches to Stop Hypertension) diet. Both emphasize lots of fruits, vegetables, legumes, but DASH makes up for what’s missing from the Med Diet and the diets of most people: dairy nutrition.

The Med Diet, for all it’s advantages, is low in calcium. Even the 2015 US Dietary Guidelines for Americans, which praises the Med Diet, acknowledges the likely lack of adequate calcium in the Med Diet.

A calcium supplement alone cannot replace the nutrition-rich package in dairy foods.  With a MediterDASHean Diet, you just do the Med diet but include at least 2 servings of dairy foods daily – full-fat, low-fat, or non-fat, whatever your calorie needs allow. Personally, I get three servings and happily so.

The Med diet discourages “red and processed meat” but it’s not clear why. It’s even less clear with a new dynamite study that looks at what happens when a Med Diet swaps out lean poultry for lean beef and pork. It’s my next post, so watch this space!

Photo credits: Penne: Petar Milošević – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=59899700  Caprese salad: Jessica Rossi, https://www.flickr.com/photos/jesswebb/3797226962

Can You Be Fit But Fat? New Study Has Some Answers

And can you reduce your risk of a heart attack? That’s what a new study asked, and the results were recently presented at the annual meeting of the American Academy of Sports Medicine (abstract 366, specifically).

It’s the question everyone wants answered, given that nearly 2 out of 3 people in the US are overweight or obese. (The photos on this post are of military personnel. Even they struggle with weight and fitness!) The idea being, do we have to be focused on weight if we’re willing to do our aerobic thing, or strength training, or just leading an active lifestyle, with things like regular biking, tennis, and recreational sports and activities?

New Findings

This research, known as Tromsø Study, was carried out over 34 years, from 1979 through 2013. When you look at heart attack risk, long-term data studies are preferred, but by their nature, it takes a oong time to learn the results. That’s what makes this study more significant. Participants were grouped based on the activity levels they reported:

Low activity – walking, gardening, etc. less than 4 hours per week.
Moderate activity: walking or gardening at least 4 hours per week.
High activity: running, biking or similar things that get the heart rate up, at least 4 hours per week.
Vigorous activity: engaging in competitive sports regularly.

Being active at any weight helps

This is the good news. Highly active people at any weight cut their risk of heart attack by about 12% versus those in the low-activity group.

Those engaging in regular “vigorous activity” cut their risk by 37% overall. Among those who were overweight or obese, the more active they were, the lower their risk of a heart attack.

Being overweight or obese mattered more

Even after adjusting for age, gender, smoking, and activity level, the overweight and obese people had much higher risk for a heart attack than normal weight people. Even active obese people were more than twice as likely as inactive normal weight participants to have a heart attack.

HOLD ON! – This Study Wasn’t Perfect

No study is, and the researchers call out this study’s weaknesses and limitations:

• Heart attack was the only health issue studied. Being active DOES benefit other chronic conditions like hypertension and type 2 diabetes, to name only two, but these weren’t addressed by this study.

• Activity levels were self-reported. Sorry – but people are known to report higher levels of activity than they really engage in.

• Body composition wasn’t studied. The researchers used the body mass index (BMI) to classify people as normal weight, overweight, or obese. It’s possible to be overweight but not overfat, especially if you engage in lots of strength training and are thus very muscular, although this is not as common as you might think. Flipping this around – you can be normal weight and still have too much body fat.

Cut-to-the-Chase Advice

1. Do what you can do. Being active at any weight is better than being inactive. Check with your doctor to see what activities are right for you. Running and high-impact stuff just isn’t right for everyone.  I don’t like “perfect”.  I like “better.”  My colleague Liz Ward’s mantra is, “Better is the new perfect.”  Way to go, Liz!

2. Consistency is everything. Aim to be active every day in some capacity – even if you’re normal weight.

3. Forget trying to be a “perfect” weight. Pick a weight you can maintain. Work on holding it there for a few months, then re-evaluate. Maybe that’s where you’ll stay, maybe you’ll take it down a bit. If you do go for less weight, take it five pounds at a time.

4. For activity: DO WHAT YOU LOVE. Then love that you can do it. I’ve worked for many years with people who have physical disabilities. They’d give anything to have the option to take the stairs or just go for a walk. Embrace the gift of your abilities.