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

For 2019: Beets Go Big Keto’s “King” & “Ya Gotta Have A Gimmick!”

What kinds of diets do consumers want?  My previous post noted the top 3 diets – from a scientific standpoint – but nutritionists say consumers swap what’s safe and sound for what’s fast and flawed, preferring trendy diets like keto and intermittent fasting. 

Pollock Communications and Today’s Dietitian just released their annual survey of registered dietitian nutritionists (RDNs), this year totaling 1,342 respondents, who give their views of what’s tops to consumers. 

,Consumers’ fondness for flashy diets, like keto, is disappointing to RDNs like Dr. Joan Salge Blake, Associate Professor at Boston University and author of the textbook Nutrition and You.  She even says keto will have similar results in the marketplace with the drastic fat-free diets of the 90’s.  Back then, “We saw a plethora of non-fat cookies, (remember Snackwells??), ice cream, and candy products bulging in the supermarket aisles.”  Salge Blake predicts, “We are going to see Keto cookies, ice cream, and candy muscling out low-fat goodies down the supermarket aisles.” She reminds us that fat-free doesn’t mean calorie-free and too many calories of any type won’t help America’s waistline.  

Salge Blake concluded, “Haven’t we seen this movie before?   I think I know the ending.”

Consumers get it right – sometimes

You’ll see from the graphic above that consumers are liking some great foods!  Fermented foods are tops – again.  Good news for yogurt, kefir, kimchi (pictured), tempeh, and other foods that have the great anti-inflammatory properties fermentation often brings.

Other veterans to the list are:

Kimchi: a fermented food that’s tops for 2019
  • Avocados
  • Seeds
  • Nuts
  • Coconut products
  • Ancient grains (think farro and amaranth, among many others)
  • Exotic fruits (like lychees, horned melons, and dragon fruits)

The Newbies

Consumers are “beet”-ing a path to this delicious veggie and high time.  Beets are packed with both nutrients and flavor.  They’re also naturally high in nitrates, which can give a little boost  to exercise endurance. 

Blueberries, a newcomer?  Who’d have thought they’d ever been off the list?  Low in calories and among the best sources of antioxidants, I’d like to see people popping these somewhere into a meal or snack as often as possible.  Fresh or frozen, they’re fantastic. 

Disappointingly, kale got bumped from the #10 spot and replaced by plant-based “milks”.  The “halo” these beverages have is unfounded and kind of ironic, given that there is also consumer preference for “clean eating”, yet these beverages are pretty low in nutritional content, usually have little or no protein, none of the bevy of nutrients natural to real milk, and the only nutrients they do have are usually added. 

Ironically, there is very little of the identifying food in these drinks.  Only 3 or 4 almonds, for instance, are in a glass of almond milk.  Pretty expensive!  The foods these beverages are derived from are fantastic.  Eat almonds, rice, oats, and walnuts.  But milk is a far better beverage for nutrition.  One exception: soy beverages.  Soybeans are high in protein and for my patients who are allergic to milk or are vegan, it’s the closest equivalent.

Amy Myrdal Miller, RDN, president of Farmer’s Daughter Consulting and a member of the elite food organization Les Dames d’Escoffier, has mixed feelings about the survey’s results.  “I love seeing fermented foods at the top of the list. Fermentation creates so many powerful flavor molecules, which can lead to greater enjoyment of foods. But I hate seeing non-dairy milks. Cow’s milk provides so many essential nutrients in a natural, delicious form.”    

Keep in mind, this survey is what RDNs see as the top trends for 2019. Trends aren’t always positive! Facts aren’t always driving consumers’ decisions. Perceived truths are often the drivers, and there is no shortage of myths and misinformation about food and nutrition in the popular media.  

As for that other trendy diet consumers liked, intermittent fasting, isn’t that just a formal way of what we used to call, skipping a meal?

To sum up, here’s the complete list of

  1. Fermented foods, like yogurt
  2. Avocado
  3. Seeds
  4. Ancient Grains
  5. Exotic fruit, like acai, golden berries
  6. Blueberries
  7. Beets
  8. Nuts
  9. Coconut products

Now, make your 2019 about #factsnotfears!

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.

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.

Believing Junk Is Even Worse Than Eating Junk

If you’re of a “certain age” you’ll remember “Vacupants.” You hook up a vacuum to the hole in the special “pants” and the fat melts off.  The idea was that it somehow “vacuumed” away the extra weight.

You might think this could never happen in the age of digital media but you’d be wrong.  It happens plenty, just differently.

The food, nutrition, and diet world is loaded with sensational and extreme headlines and promises.  We gravitate towards the sensational. The promise of a quick fix has a magical way of grabbing your attention and won’t let go.

It’s the modern-day version of the “snake-oil” sales pitch.  You’ve probably seen headlines touting:

• “Lose 10 pounds in 3 days without doing exercise or changing your diet!” (Similar to the Vacupants claim — see how much things have changed?)

• “Lose all the weight you want eating junk food!”

• “This miracle food speeds up metabolism!”

Most common now are diets that spout the total avoidance of a food or even entire food groups. Think about carb- and sugar-phobia that lumps empty-calorie foods together with great foods like beans and fresh fruit. Or the keto diets that demonize most carbs, including whole grains and most fruits and vegetables, and hold the state of ketosis on a pedestal. In truth, ketosis is something that should generally be prevented, not promoted.

Then there’s the scare-tactic approach:

  • “10 Foods You Should Never Eat”
  • “Your Body Can’t Process These 3 Foods”
  • “5 Foods That Cause Belly Fat”

“Absolute” Exploitation

These sensational promises, extreme claims, and headline-grabbers exploit people who are vulnerable, undereducated or just misinformed. Someone with a health issue, including someone trying to lose weight, is vulnerable, even desperate for a solution, making them easy prey for junk science purveyors.  Health issues are sensitive, lots of emotions are involved, making them vulnerable to quick-fixes, magic bullets, and instant cures – just the type of stuff that makes up fad dieting.

Educated people aren’t insulated either. “Vacupants” was marketed as a quick weight loss method.  Laugh if you must, I once had a patient, an educated woman, who admitted she’d bought this gizmo. No, they didn’t work. She’d have been better of if she’d put on some actual sweats and gone walking for half an hour a day instead.

We all like being told something that fits with our values or what we’d LIKE to be true.  Eating junk can be over in a flash but believing junk can continue for years.

10 Red Flags of Junk Science

Tufts University does a nice job of explaining these in detail, but this is the Cuttothechase version:
1. Promises of a quick fix. File “miracle foods” under this one, too.
2. Danger warnings of a single food.
3. Claims that sound to good to be true. Hint: they are too good to be true.
4. Simple conclusions from a complex study. Oversimplifying often indicates taking results out of context or omitting caveats.
5. Recommendations based on a single study. If it cannot be replicated, it’s probably bogus or at least cherry-picked. Pass.
6. Statements refuted by reputable health organizations. If they’re reputable, they require solid evidence. Key word: solid. If they pass on the claim, you should, too.
7. Lists of “good” and “bad” foods. #ridiculous
8. Recommendations made to help sell a product or supplement. This doesn’t mean it’s junk, but if it’s good, check for lots of evidence and organizations that agree.
9. Research that is not peer reviewed. Big red flag for research that’s badly done.
10. Recommendations from studies that ignore differences among individuals or groups. There can be differences between genders, smokers vs. non-smokers, young and old age groups, the works.

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.

 

 

 

Dark Chocolate: Does More = Less for BMI & Waist?

Readers of this column know I’m a lover of good dark chocolate. I make no secret of my interest in finding out all that’s good about the stuff. Here’s the latest:

This recent meta-analysis looked at the effects of eating dark chocolate on body weight, body mass index (BMI) and waist circumference.

Why I Like This Study

• It included randomized controlled trials (RCTs) only. That means “cause-and-effect” results of an intervention. Large population studies can’t do that (no matter what the headlines imply).

• The studies in this meta-analysis all had to investigate cocoa’s or dark chocolate’s (DC) effect on body weight, body mass index (BMI) and waist circumference .

• DC had to be specifically prescribed and compared with a placebo group that did not consume cocoa or DC

• Neatness counted. The authors of this meta-analysis looked only at studies with adults. No animals.

First the bad news: Glass half empty?

There was no significant effect of dark chocolate/cocoa supplementation on BMI, weight, or waist circumference. Bummer. Some studies found a difference, some did not, but when you pool all the studies together and treat them as one huge study, which is what a meta-analysis does, no significant difference in these parameters could be found.

If you’re a glass-half-empty kind of person, this sounds bad, but it really isn’t. DC hasn’t traditionally been known to be a weight-loss aide. Then again, read on…

Saving the best for last…

In studies that lasted longer, 4 to 8 weeks, and that included at least 30 grams of dark chocolate daily:

• There was a significant reduction in BMI and body weight.

• Waist circumference was reduced but only in doses of 45-60 grams daily.

Personally, 30-60 grams of dark chocolate daily would not pose difficulty for me, especially if I knew it would help my waist circumference. It’s means budgeting in about 150-300 calories, but it’s nice to know that there might be justification for moving dark chocolate from the “once-in-a-while treat” to “healthful way to spend discretionary calories.” If it motivates you to get on the treadmill for 30 minutes daily, so you can balance out that extra ounce of DC, so much the better. Hey, #Commitmentiseverything 😉

Here are a few of my latest fave bars.  They’re pricey, but good chocolate isn’t for gulping.  Learning to savor our food just adds to the enjoyment.

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

Latest Cheese Chatter: It’s Better For You Than You Thought!

Who doesn’t love cheese? Whether it’s a grilled cheese sandwich, a baked brie with fresh figs and whole grain crackers (drizzled with a little honey, perhaps?), something grated over pasta, or just some cubed cheddar to have with fruit for an afternoon snack, cheese is not only a big favorite, it’s almost a comfort food.
Cheese is often criticized by those who promote healthy eating, and it’s true that about half the fat in cheese is saturated fat. But do we need to forego one of our favorite foods in order to be healthier? More to the point, does all dairy fat BEHAVE the same way in the body? The emerging science would suggest not, with cheese coming out ahead of butter.

Isn’t butter the same type of fat as cheese?

Pretty much, but a recent meta-analysis (a study that combines the results of multiple research studies) showed that cheese lowered LDL-cholesterol (the bad kind), compared to baseline levels, and butter raised it.
That might seem odd, given that cheese and butter both have fat from the same source – milkfat – and thus has the same proportion of saturated and unsaturated fat.

This is where butter and cheese part ways. Cheese seemed to lower LDL-cholesterol, compared to baseline levels, butter raised it. Cheese also lowered HDL-cholesterol but the LDL figure is usually given more weight, with respect to cardiovascular risk.

A more recent study, a single randomized control trial involving 92 men and women, showed that cheese fared better than butter only on these cholesterol metrics, not on other metabolic factors such as blood pressure or fasting glucose levels, and the LDL-effects were more pronounced in subjects with higher baseline LDL levels.What gives?

The reasons for the differences produced by cheese vs. butter are not totally clear. Top theories are:

• The dairy calcium may be binding with fat in the small intestine, reducing fat absorption and thus cholesterol synthesis.

• Cheese’s fermentation may play a role in impairing cholesterol synthesis and reabsorption in the large intestine. A 2011 study postulated that bacteria in the large intestine may bind to bile acids that, in turn, prevent some cholesterol from being absorbed.

• Some of the fat in cheese (and milk, for that matter) is trapped within the casein matrix, perhaps making some of that fat less available to fuel cholesterol synthesis.

Keeping grounded, without grinding

None of these study results is a license to go out and scarf an 8-oz wheel of brie (much as I’d love to). The 2017 study above also looked at how high monounsaturated fats (MUFA) and polyunsaturated fats (PUFA) stacked up against the butter and cheese diets.

Result: The MUFA and PUFA diets produced lower levels of LDL-cholesterol then either butter or cheese. In other words, cheese fares better than butter, but diets higher in MUFA and PUFA fats seemed to lower LDL cholesterol even more.

Cut-To-The-Chase Tip: Keep eating cheese. It’s loaded with great protein, calcium, and other nutrients and it’s delicious. Keep it to an ounce or two, and pair it with good company, like fruit, vegetables, and whole-grains. For cooking, favor olive or canola oil instead of butter. Healthy eating is NEVER about deprivation, obsession, or perfection. It’s about balance.