veggie pot

I'm going away for the weekend and wanted to empty the fridge so I cooked everything that was in my fridge (except some potatoes):

beets, onion, broccoli, cauliflower, spinach, celery, zucchini, carrots, bag of frozen edamame, and hemp seeds; and herbs from the garden (dill, basil, chives).

The beets, onion, carrots, and broccoli stems take longer so I cooked them for 2 minutes in the pressure cooker, then added the rest (except the seeds), and cooked for another 2 minutes. Then put it into three big tupperware bowls. Then ground 3 Tbsp of hemp seeds and put them in each bowl and stirred.

So this has everything you need: veggies, greens, beans, and seeds. And it tastes great! I love beets and edamame combination, well, and everything else. yummy. so I'll be set with food for the weekend. fun!

july 31

another long day at work which I just finished at 11:30 pm, though we did play this afternoon too. My visitor is gone now. He enjoyed our healthy food. He couldn't believe the smoothies didn't have cream in them. I showed him how to make them today and he wants a good blender now.

brekky: um, 2 smoothies. first a mango-spinach one from the freezer. then I made too much of the visitor smoothies so had some of their leftovers. then I also had some lentils because I was pigging out.

lunch: lots of cabbage salad, raw carrots, celery, peas

dinner: banana-berry sorbet (1 banana, frozen blueberries and hemp seeds blended up in the blender--it was good), and ate some of the food I was preparing for the weekend (veggie-pot). also, grapefruit, and orange.

I wanted a cupcake today. That's why I had the banana-berry sorbet as my first dinner course. And I ate too much today. Maybe I should just get a cupcake at my favorite bakery and get it over with. But after reading Dr. Fuhrman's books, I know that stuff isn't good for you because of the fat, sugar and refined grains. Plus it makes me feel crappy. I actually don't want to eat it, and that's why I didn't give in. I guess I'm at this point where I'm saying, so I can never eat this stuff? I think I'm mourning it a bit. Maybe I should buy some flowers and put them on a grave of cupcakes. ha.

july 30

brekky:  spinach-mango smoothie, 1/4 musk melon.  yummy

lunch:  1/2 cup lentils (cooked with onion, added some dill & basil from the garden, and 1 Tbsp black fig vinegar).   cabbage salad.  corn on the cob with avocado butter.

dinner:  repeat of lunch without the corn on the cob.  grapefruit for dessert.  I really love grapefruit.  It's better than a cupcake.  I should remember that...

busy day, worked from 10 am and still working at 1:45 am.  got a lot done though.

The Perfect Spouse?

Not a comment, but a direct quote from the article that made me laugh out loud:
"In fact, were it to have a liberal arts degree and a steady income, a Vespa scooter would possesses every important quality that a white person looks for in a spouse."

Organic Food No Better

"Our review indicates that there is currently no evidence to support the selection of organically over conventionally produced foods on the basis of nutritional superiority."

July 29

Brekky: 1/2 visitor smoothie. grapefruit

Lunch: the usual this time of year: leftover beans&greens from yesterday; steamed broccoli, cauliflower carrots and new potatoes; corn on the cob + avocado butter. I had 3 pieces of corn! usually have 2 but there was an extra...it was all local and delicious (except the avocado). yum.

snack/dinner. dinner was one long snack. let's see, raw carrots & peas, some grapes, last of the beans&greens (1 cup), 1/2 musk melon, an apple. it was all good. the musk melon was really good, from a local farm. the apple was really good. those are hit and miss these days. I probably shouldn't get them this time of year since they come from so far away, but I want to make cabbage salad tomorrow so I bought some today.

It doesn't seem like too much food but I overate. I'm still in this weird indulgent phase. I stopped at the grocery store and almost bought a cookie. It attracted me because they were freshly made, plus there's the nostalgia factor. Then I thought, I don't even really like these cookies, and I don't like how I feel afterwards, and remember how chocolate affects me? oh yeah, I thought. so how about brazil nuts instead? (talking to myself is like talking to a child). I thought, okay--but then there weren't any brazil nuts. so I was fine and moved on. At least I'm being rational about it. I know if I indulge, where does it stop? do you ever get satisfied? no. it's better to stop before. but I'm still wondering, why am I wanting to to be indulgent? I've got some slightly stressful life issues going on but I've had those before. Maybe I should just think of something else to be indulgent about. I do have an idea though. I buy too much food, especially too much fruit. I shop every few days so I'm going to think about how much groceries you need on that time scale and ration it better. It will save money too, and make it easier to transport on my bike.

july 28

brekky: visitor smoothie, grapefruit

lunch: another pile of veggies & greens cooked in the pressure cooker: tons of collard greens, tomatoes, onion, zucchini, ground sunflower and hemp seeds, white beans, basil, chives, and dill. For preparation tips, see this recipe. For housemate and visitor I also made potatoes, green beans, and sugar snap peas with the same herbs. We also had the usual sweet corn and avocado butter. We have this every day we are home during sweet corn season. We count the days until sweet corn season starts. We reminisce in winter. My computer is named "sweetcorn".


late dinner: a pile of raw veggies and fruit in a bowl that I just ate as finger food. It took a few minutes to prepare. It was totally satisfying. I am weird. why on earth do I sometimes get influenced by society to stray from these simple and lovely meals? Here's what went into my bowl: salad greens, carrots, a plum, some cherries, some grapes, an orange cut into 8 pieces, a bunch of sweet peas. Then I added more salad greens.

homemade granola

this is kind of a weird idea but I liked it. My visitor was eating granola so of course I wanted some too but I wanted healthy granola. So I essentially took the ingredients for a bowl of oatmeal and turned it into granola.

Ingredients:
1/2 cup oats or 1/4 steel cut oats
1/4 cup walnuts, chopped
1 Tbsp date sugar
1/2 cup water? (I didn't measure)

combine everything in a bowl. microwave for 2 minutes. let it sit for a while until all the water pretty much soaks in. maybe microwave and let sit again if using steel cut oats. spread onto a cookie sheet. put in the oven at 275 for...30 minutes? Stir. put it in the oven again for...15 minutes? stir. repeat until it's a consistency you like. longer for crunchy. I found it more entertaining and long-lasting than oatmeal.

The Diet-Heart Hypothesis: Subdividing Lipoproteins

Two posts ago, we made the rounds of the commonly measured blood lipids (total cholesterol, LDL, HDL, triglycerides) and how they associate with cardiac risk. It's important to keep in mind that many things associate with cardiac risk, not just blood lipids. For example, men with low serum vitamin D are at a 2.4-fold greater risk of heart attack than men with higher D levels. That alone is roughly equivalent to the predictive power of the blood lipids you get measured at the doctor's office. Coronary calcium scans (a measure of blood vessel calcification) also associate with cardiac risk better than the most commonly measured blood lipids.

Lipoproteins Can be Subdivided into Several Subcategories

In the continual search for better measures of cardiac risk, researchers in the 1980s decided to break down lipoprotein particles into sub-categories. One of these researchers is Dr. Ronald M. Krauss. Krauss published extensively on the association between lipoprotein size and cardiac risk, eventually concluding (source):
The plasma lipoprotein profile accompanying a preponderance of small, dense LDL particles (specifically LDL-III) is associated with up to a threefold increase in the susceptibility of developing [coronary artery disease]. This has been demonstrated in case-control studies of myocardial infarction and angiographically documented coronary disease.
Krauss found that small, dense LDL (sdLDL) doesn't travel alone: it typically comes along with low HDL and high triglycerides*. He called this combination of factors "lipoprotein pattern B"; its opposite is "lipoprotein pattern A": large, buoyant LDL, high HDL and low triglycerides. Incidentally, low HDL and high triglycerides are hallmarks of the metabolic syndrome, the quintessential modern metabolic disorder.

Krauss and his colleagues went on to hypothesize that sdLDL promotes atherosclerosis because of its ability to penetrate the artery wall more easily than large LDL. He and others subsequently showed that sdLDL are also more prone to oxidation than large LDL (1, 2).

Diet Affects LDL Subcategories

The next step in Krauss's research was to see how diet affects lipoprotein patterns. In 1994, he published a study comparing the effects of a low-fat (24%), high-carbohydrate (56%) diet to a "high-fat" (46%), "low-carbohydrate" (34%) diet on lipoprotein patterns. The high-fat diet also happened to be high in saturated fat-- 18% of calories. He found that (quote source):
Out of the 87 men with pattern A on the high-fat diet, 36 converted to pattern B on the low-fat diet... Taken together, these results indicate that in the majority of men, the reduction in LDL cholesterol seen on a low-fat, high-carbohydrate diet is mainly because of a shift from larger, more cholesterol-enriched LDL to smaller, cholesterol-depleted LDL [sdLDL].
In other words, in the majority of people, high-carbohydrate diets lower LDL cholesterol not by decreasing LDL particle count (which might be good), but by decreasing LDL size and increasing sdLDL (probably not good). This has been shown repeatedly, including with a 10% fat diet and in children. However, in people who already exhibit pattern B, reducing fat does reduce LDL particle number. Keep in mind that the majority of carbohydrate in modern America comes from wheat and sugar.

Krauss then specifically explored the effect of saturated fat on LDL size (free full text). He re-analyzed the data from the study above, and found that:
In summary, the present study showed that changes in dietary saturated fat are associated with changes in LDL subclasses in healthy men. An increase in saturated fat, and in particular, myristic acid [as well as palmitic acid], was associated with increases in larger LDL particles (and decreases in smaller LDL particles). LDL particle diameter and peak flotation rate [density] were also positively associated with saturated fat, indicating shifts in LDL-particle distribution toward larger, cholesterol-enriched LDL.
Participants who ate the most saturated fat had the largest LDL, and vice versa. Kudos to Dr. Krauss for publishing these provocative data. It's not an isolated finding. He noted in 1994 that:
Cross-sectional population analyses have suggested an association between reduced LDL particle size and relatively reduced dietary animal-fat intake, and increased consumption of carbohydrates.
Diet Affects HDL Subcategories

Krauss also tested the effect of his dietary intervention on HDL. Several studies have found that the largest HDL particles, HDL2b, associate most strongly with HDL's protective effects (more HDL2b = fewer heart attacks). Compared to the diet high in total fat and saturated fat, the low-fat diet decreased HDL2b significantly. A separate study found that the effect persists at one year. Berglund et al. independently confirmed the finding using the low-fat American Heart Association diet in men and women of diverse racial backgrounds. Here's what they had to say about it:
The results indicate that dietary changes suggested to be prudent for a large segment of the population will primarily affect [i.e., reduce] the concentrations of the most prominent antiatherogenic [anti-heart attack] HDL subpopulation.
Saturated and omega-3 fats selectively increase large HDL. Dr. B. G. of Animal Pharm has written about this a number of times.

Wrapping it Up

Contrary to the simplistic idea that saturated fat increases LDL and thus cardiac risk, total fat and saturated fat have a complex influence on blood lipids, the net effect of which is unclear, but is associated with a lower risk of heart attacks. These blood lipid changes persist for at least one year, so they may represent a long-term effect. It's important to remember that the primary sources of carbohydrate in the modern Western diet are wheat and sugar. Are the blood lipid patterns that associate with heart attack risk in Western countries partially acting as markers of wheat and sugar intake?

* This is why you may read that small, dense LDL is not an "independent predictor" of heart attack risk. Since it travels along with a particular pattern of HDL and triglycerides, in most studies it does not give information on cardiac risk beyond what you can get by measuring other lipoproteins.

Doing Evil for Good

How odd that in 2 minuted I came across these two quotes from two different websites:

From BTW:
“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.” - C. S. Lewis, God in the Dock, p. 292.
This one from Fools That Dream:
"If I knew for certain that a man was coming to my house with the conscious design of doing me good, I should run for my life." - Thoreau
Think about that! Thoreau and Lewis bedfellows on tyranny, or is that "compassion"?

And to throw in a bonus, here's Sowell on something similar (again from Fools That Dream):
"FDR [also] surrounded himself with highly intelligent people; that is no guarantee of anything except brilliant rationalizations of failure."

july 27 food

Brekky:  visitor smoothie.  this made 2.5 servings.  I had 0.5 serving, gave the others to visitor and housemate.  I also had a grapefruit.

Lunch:  I cooked up some kale from the garden with some carrots, and mixed it in with yesterday's black bean hummus.  I didn't log my food yesterday but for dinner we had black bean hummus and veggies to dip (broccoli, cauliflower, carrots, all local and delicious!), and sweet corn.  I love that black bean hummus.  And I love the fresh veggies this time of year.  can't be beat.  Anyway, so I enjoyed the kale and carrots and hummus too.  I also made potatoes, carrots and green beans for visitor and housemate, topped with parsley and chives from the garden.  The potatoes were new and fresh and really good.  I usually don't eat potatoes but had a few bites.  The corn was fabulous of course, topped with the avocado butter (simply a mashed avocado).  Visitor loves the avocado butter.  I had a peach too.

Dinner:  salad pretty much like this one.  Let's see, it was salad greens, chopped apple, chopped walnuts, sugar snap peas, and blood orange vinegar.     had some cherries and grapes but not too much.  and half an orange.  and a bit of leftover potatoes and beans from lunch.  

visitor smoothie

a smoothie that a visitor would like.  Serves 3

Ingredients:
4 Tbsp hemp seeds or 1/4 cup raw cashews
5 walnuts (about 1/2 oz)
2 bananas
1 bag frozen blueberries
1 bag frozen raspberries or strawberries
12 oz water
2-3 Tbsp date sugar

Combine the date sugar, seeds or nuts, and 4-6 oz water.  Blend until nice and creamy.  Add the banana and berries.  Blend until smooth.

busy and overeating

It's been hectic the last week. I went on a trip, hosted a visitor, gave a sermon at church, and right after that went to the airport to pick up another visitor who will be here all week. All the traveling and visitors have been work-related so I'm working too. I've felt like splurging food-wise. I'm not sure what drives this. True, I've been feeling some stress and I'm sleep deprived. But it also seems to be part of a cycle where you eat well for a while and then want to splurge. And it's partly outside influence---being in close quarters with people who eat very SAD (Standard American Diet) food does influence me. So I'm not sure what the main reason is, or maybe it's just a combination of all those things. We went to a restaurant on Friday and I brought my own food but the restaurant had a lot of vegan options. I was wondering if maybe I should allow myself a nice splurge of vegan food at a restaurant. I have a $50 coupon for one restaurant that has a lot of vegan options. Friday night I drank a sip of wine from a very good bottle my visitor was drinking. It tasted good and I could feel the effect immediately and wasn't sure I liked it. plus I knew I'd feel yucky the next morning. So I didn't want more.

So for the last 3-4 days, I've been debating with myself about whether or not I want to have a planned splurge. I think it's okay since I haven't eaten unhealthy food in a few months, but do I want to? that is the real question. I don't feel so great after a splurge. In the meantime as I've been debating, and this is where I'm getting to after all this rambling, I've been overeating the fruit. I ate a whole watermelon this weekend. I ate some cherries and grapes at 11 pm last night. Okay, in the grand scheme of things, that's not so bad, but I don't feel so great. Too much sugar, even if it's fruit, makes a a little groggy the next morning. Just an observation. I hurt my foot on Saturday so don't plan to exercise much this week so I think I'll try to eat proper amounts of food this week. I'll try to get back to logging my meals too. This week's visitor is easy to host and he enjoys eating our food. He loves the avocado "butter" on the corn on the cob--says it's way better than real butter. Now there's an open-minded chap.

Anyway, the past few days I've been eating our usual kinds of food this time of year: fruit for brekky (cantaloupe, watermelon, or grapefruit) or smoothie (had one sat. morning), corn on the cob and veggies and leafy greens and beans at lunch, too much fruit at dinner along with leftover veggies, and not enough greens at dinner.

MRFIT Mortality

The Multiple Risk Factor Intervention trial was a very large controlled diet trial conducted in the 1980s. It involved an initial phase in which investigators screened over 350,000 men age 35-57 for cardiovascular risk factors including total blood cholesterol. 12,866 participants with major cardiovascular risk factors were selected for the diet intervention trial, while the rest were followed for six years. I discussed the intervention trial here.

During the six years of the observational arm of MRFIT, investigators kept track of deaths in the patients they had screened. They compared the occurrence of deaths from multiple causes to the blood cholesterol values they had measured at the beginning of the study. Here's a graph of the results (source):


Click on the graph for a larger image. Coronary heart disease does indeed rise with increasing total cholesterol in American men of this age group. But total mortality is nearly as high at low cholesterol levels as at high cholesterol levels. What accounts for the increase in mortality at low cholesterol levels, if not coronary heart disease? Stroke is part of the explanation. It was twice as prevalent in the lowest-cholesterol group as it was in other participants. But that hardly explains the large increase in mortality.

Possible explanations from other studies include higher cancer rates and higher rates of accidents and suicide. But the study didn't provide those statistics so I'm only guessing.

The MRFIT study cannot be replicated, because it was conducted at a time when fewer people were taking cholesterol-lowering drugs. In 2009, a 50-year old whose doctor discovers he has high cholesterol will likely be prescribed a statin, after which he will probably no longer have high cholesterol. This will confound studies examining the association between blood cholesterol and disease outcomes.

Thanks to The Great Cholesterol Con by Anthony Colpo for the MRFIT reference.

More Yodelling

I came across this video after looking at the related videos from my previous yodelling post. This is just beautiful. I really don't know how someone yodels, but I definitely respect the skill. This is a different sound and so beautiful.

regular hummus

Here is my plain hummus recipe. I like this more and more as my taste buds change. Okay, this recipe looks almost identical to leangreenmama's, but I promise I didn't steal it. Over time, I finally learned how to do this using sesame seeds instead of store-bought tahini. You have to use the blender for this. It makes a real creamy hummus.

Ingredients:
1 cup dried chick peas or 1 can
juice of one lemon
1/4 cup sesame seeds (raw, unhulled)
1 tsp low sodium tamari or soy sauce (optional)
1/2 tsp ground cumin
1-4 garlic cloves

If using dried chick peas, soak overnight, then cook for 4 hours. or quick soak by boiling in water, then letting sit for an hour. You can pressure cook them in about 12 minutes I think.

I like to cook the garlic so it doesn't taste so strong. This worked well for me: put the garlic in a metal measuring cup or some tiny pot you can put in the oven. Add part of the lemon juice to cover. Bake in the oven for, I don't know, 10-20 minutes, until you just start to smell the garlic.
Next, the sesame seeds. Rinse them and put them in the blender. Add the lemon juice, some cooking liquid from the chickpeas, maybe 1/3 cup, and a few chickpeas, maybe 1/4 cup. Blend up. If you need more volume, add more water and chickpeas, but not too much. Let this blend for a few minutes so it starts to thicken--that's when the sesame seeds are well blended. Then add everything else. Add the bean juice as needed to reach your desired consistency.

trip notes

Just a couple of thoughts about my trip. I don't want to say too much to protect the privacy of my friends. They are gourmet cooks and they made meals like the kind Julia Child used to make, full of meat and fat and dairy. There was lots of alcohol too. It did make me nostalgic for old times when I joined in. I'm sure the food tasted really good, and I used to enjoy a good gin and tonic and a good bottle of wine. So part of me wanted to partake. But since there was nothing vegan, I wasn't tempted. I definitely would have been tempted if it had been vegan gourmet food. But I'm kind of repulsed by animal products now. Anyway, it was interesting. While I did feel a little nostalgic, I also felt very good physically and wanted to keep it that way. I went running one morning and got lost and ended up running about 6 miles, twice my usual amount, and I felt good the entire way. In fact, I speeded up at the end because I was late. I also felt that today's lunch was as fabulous as the gourmet meals that were served up. I don't feel deprived. I think my hosts thought I was, but that's just because I was in their environment without my groceries, so my choices were more limited than usual. I don't mind being limited for a few days. I still ate well. My meals pretty much followed what I planned in this post.

The Diet-Heart Hypothesis: A Little Perspective

Now that we've seen that the first half of the diet-heart hypothesis-- that dietary saturated fat and cholesterol elevate serum cholesterol and low-density lipoprotein (LDL)-- is false, let's take a look at the second half. This is the idea that elevated serum cholesterol causes cardiovascular disease, also called the "lipid hypothesis".

Heart Attack Mortality vs. Total Mortality

We've been sternly warned that high serum cholesterol leads to heart attacks and that it should be reduced by any means necessary, including powerful cholesterol-lowering drugs. We've been assailed by scientific articles and media reports showing associations between cholesterol and heart disease. What I'm going to show you is a single graph that puts this whole issue into perspective.

The following is drawn from the Framingham Heart study (via the book Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.), which is one of the longest-running observational studies ever conducted. The study subjects are fairly representative of the general population, although less racially diverse (largely Caucasian). The graph is of total mortality (vertical axis) by total cholesterol level (horizontal axis), for different age groups: If you're 80 or older, and you have low cholesterol, it's time to get your affairs in order. Between the age of 50 and 80, when most heart attacks occur, there's no association between cholesterol level and total mortality. At age 50 and below, men with higher cholesterol die more often. In the youngest age group, the percent increase in mortality between low and high cholesterol is fairly large, but the absolute risk of death at that age is still low. There is no positive association between total cholesterol and mortality in women at any age, only a negative association in the oldest age group.

Here's more data from the Framingham study, this time heart attack deaths rather than total mortality (from the book Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.): Up to age 47, men with higher cholesterol have more heart attacks. At ages above 47, cholesterol does not associate with heart attacks or total mortality. Since the frequency of heart attacks and total mortality are low before the age of 47, it follows that total cholesterol isn't a great predictor of heart attacks in the general population.

These findings are consistent with other studies that looked at the relationship between total cholesterol and heart attacks in Western populations. For example, the observational arm of the massive MRFIT study found that higher cholesterol predicted a higher risk of heart attack in men age 35-57, but total mortality was highest both at low and high cholesterol levels. The "ideal" cholesterol range for total mortality was between 140 and 260 mg/dL (reference). Quite a range. That encompasses the large majority of the American public.

The Association Between Blood Cholesterol and Heart Attacks is Not Universal

The association between total cholesterol and heart attacks has generally not been observed in Japanese studies that did not pre-select for participants with cardiovascular risk factors (Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.). They also aren't observed on Kitava, where no one seems to have heart attacks or stroke regardless of cholesterol. This suggests that total blood cholesterol as a marker of heart attack risk is not universal. I suspect it would not necessarily apply to someone eating an atypical diet.

Subdividing Cholesterol into Different Lipoprotein Particles Improves its Predictive Value

So far, this probably hasn't shocked anyone. Even entrenched proponents of the lipid hypothesis admit that total cholesterol isn't a great marker. Researchers long ago sliced up total cholesterol into several more specific categories, the most discussed being low-density lipoprotein (LDL) and high-density lipoprotein (HDL). These are tiny fatty droplets containing fats, cholesterol and proteins. They transport cholesterol, fats, and fat-soluble vitamins between tissues via the blood.

The LDL and HDL numbers you get back from the doctor's office typically refer to the amount of cholesterol contained in LDL or HDL per unit blood serum, but you can get the actual particle number measured as well. One can also measure the level of triglyceride (a type of fat) in the blood. Triglycerides are absorbed from the digestive tract and manufactured by the liver in response to carbohydrate, then sent to other organs via lipoproteins.

The level of LDL in the blood gives a better approximation of heart attack risk than total cholesterol. If you're living the average Western lifestyle and you have high LDL, your risk of heart attack is up to twice the risk of someone who has low LDL. LDL particle number has more predictive value than LDL cholesterol concentration. The latter is what's typically measured at the doctor's office. For example, in the EPIC-Norfolk study (free full text), patients with high LDL cholesterol concentration had a 73% higher risk of heart attack than patients with low LDL. Participants with high LDL particle number had exactly twice the risk of those with low LDL number. We'll get back to this phenomenon in a future post.

In the same study, participants with low HDL had twice the heart attack risk of participants with high HDL. That's why HDL is called "good cholesterol". This finding is fairly consistent throughout the medical literature. HDL is probably the main reason why total cholesterol doesn't associate very tightly with heart attack risk. High total cholesterol doesn't tell you if you have high LDL, high HDL or both (LDL and HDL are the predominant cholesterol-carrying lipoproteins). Also from the EPIC-Norfolk study, participants with high triglycerides had twice the risk of heart attack as participants with low triglycerides. Triglycerides and HDL are inversely related to one another, that is, if a person has high HDL, they're likely to have low triglycerides, and vice versa. This has also been consistent between studies.

Together, this suggests that the commonly measured lipoprotein pattern that associates most tightly with heart attack risk in typical Western populations is high LDL (particularly LDL particle number), low HDL and high triglycerides.

In the next post, I'll slice up the lipoproteins even further and comment on their association with cardiovascular disease. I'll also begin to delve into how diet affects the lipoproteins.

July 23

Okay, I can't resist. I kinda think the strength of this blog is the daily log of food prep and intake, because I don't have too many deep thoughts or great insights to offer. I find I learn well by example and I'm probably not unusual in this regard. Also, I want to log it for myself, as I try to improve my diet and achieve "black belt nutritarian" status. I'm not there yet...

My schedule might be changing around with exercise first thing in the morning--that's what I did today. Then I'd have a light breakfast of fruit at about 10 am--light because it's close to lunch. Then my big meal of the day is lunch at about 1 pm. Then scrounge for dinner. You would want to adapt the size and timing of your meals to your schedule too. Here's what I had today.

Brekky: some grapes and brazil nuts. I was grocery shopping after exercise class and got breakfast size portions of both. Well, I got too many brazil nuts and ate them all because I have no self-control. Lesson learned: buy smaller quantities.

Lunch: this was fabulous, as shown in the picture:



















that's sweet corn, and broccoli, cauliflower, and carrots and hummus; and avocado butter for the sweet corn. and blueberries and banana for dessert. the vegetables were all local. they are sooooo goood. Dessert was definitely not needed, because as usual, I snacked a bit while preparing (carrots, sugar snap peas, salad greens).

Dinner was some raw carrots, celery, and sugar snap peas dipped in hummus. and a grapefruit for dessert. I love grapefruit. Oh, I ate some salad greens too.

The Diet-Heart Hypothesis: Stuck at the Starting Gate

The diet-heart hypothesis is the idea that (1) dietary saturated fat, and in some versions, dietary cholesterol, raise blood cholesterol in humans and (2) therefore contribute to the risk of heart attack.

I'm not going to spend a lot of time on the theory in relation to dietary cholesterol because there really isn't much evidence to debunk in humans. As far as I can tell, most diet-health researchers don't take this theory seriously anymore because the evidence has simply failed to materialize. Dr. Walter Willett doesn't believe it, and even Dr. Ancel Keys didn't believe it. Here's a graph from the Framingham Heart study (via the book Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.) to drive home the point. Eggs are the most concentrated source of cholesterol in the American diet. In this graph, the "low" group ate 0-2 eggs per week, the "medium" group ate 3-7, and the "high" group ate 7-14 (click for larger image): The distribution of blood cholesterol levels between the three groups was virtually identical. The study also found no association between egg consumption and heart attack risk. Dietary cholesterol does not raise serum cholesterol in the long term, because humans are adapted to eating cholesterol. We simply adjust our own cholesterol metabolism to compensate when the amount in the diet increases, like dogs. Rabbits don't have that feedback mechanism because their natural diet doesn't include cholesterol, so feeding them dietary cholesterol increases blood cholesterol and causes vascular pathology.

The first half of the diet-heart hypothesis states that eating saturated fat raises blood cholesterol. This has been accepted without much challenge by mainstream diet-health authorities for nearly half a century. In 1957, Dr. Ancel Keys proposed a formula (Lancet 2:1959. 1957) to predict changes in total cholesterol based on the amount of saturated and polyunsaturated fat in the diet. This formula, based primarily on short-term trials from the 1950s, stated that saturated fat is the primary dietary influence on blood cholesterol.

According to Keys' interpretation of the trials, saturated fat raised, and to a lesser extent polyunsaturated fat lowered, blood cholesterol. But there were serious flaws in the data from the very beginning, which were pointed out in this searing 1973 literature review in the American Journal of Clinical Nutrition (free full text).

The main problem is that the controlled trials typically compared saturated fats to omega-6 linoleic acid (LA)-rich vegetable oils, and when serum cholesterol was higher in the saturated fat group, this was most often attributed to the saturated fat raising blood cholesterol rather than the LA lowering it. When a diet high in saturated fat was compared to the basal diet without changing LA, often no significant increase in blood cholesterol was observed. Studies claiming to show a cholesterol-raising effect of saturated fat often introduced it after an induction period rich in LA. Thus, the effect may have more to do with LA lowering blood cholesterol than saturated fat raising it. This is not at all what I was expecting to find when I began looking through the short-term trials.

I recently read a 2003 study that addresses this point directly. Muller et al. (free full text) compared the effects of three controlled diets on the blood cholesterol of 25 healthy women. The diets were:
  1. High in saturated fat from coconut, low in LA
  2. Same as #1, with half the saturated fat replaced by carbohydrate
  3. Low in saturated fat, high in LA, with the same total fat as in #1
The diets were fed to the whole group for three week periods. Investigators found that diet #3 lowered cholesterol and LDL relative to diets #1 and #2. The total cholesterol of women on diets #1 and #2 were not statistically different (p= 0.09), and their LDL was virtually identical. Thus, a very large difference in saturated fat intake didn't affect total cholesterol or LDL when it was replaced by carbohydrate, but it did when it was replaced by LA. The most straightforward explanation is that LA lowers cholesterol and LDL, but saturated fat has little or no effect on either. From the discussion section:

The most important finding of this study was that lowering total saturated fat in the form of coconut oil, from 22.7 to 10.5 E% without change in the P/S ratio [polyunsaturated to saturated ratio], did not lower total or LDL cholesterol, but significantly reduced HDL cholesterol.
I don't claim that this one study settles the question, but does illustrate that saturated fat does not have a large and consistently detectable effect on total or LDL cholesterol.  

Among the many other studies I examined, I found an apparently well-controlled counterexample: Arterioscler. Thromb. Vasc. Biol. 18:441. 1988. In this 8-week study, increasing saturated fat (at the expense of carbohydrate and with LA constant) increased total cholesterol and LDL, while also increasing HDL, and decreasing Lp(a) and triglycerides (the latter three changes are thought to be protective). Decreasing saturated fat from 15% to 6% of calories (drastic), reduced total cholesterol by 9% and LDL by 11% (calculated by the Friedewald equation). The variation between trials may have to do with the specific saturated fatty acids used in each trial, their duration, or some other unknown confounder.
Reading through the short-term controlled trials, I was struck by the variability and lack of agreement between them. Some of this was probably due to a lack of control over variables and non-optimal study design. But if saturated fat has a dominant effect on serum cholesterol in the short term, it should be readily and consistently demonstrable. It clearly is not.

The long-term data are also not kind to the diet-heart hypothesis. Reducing saturated fat while greatly increasing LA certainly does lower blood cholesterol substantially. This was the finding in the well-controlled Minnesota Coronary Survey trial, for example (14% reduction). But in other cases where LA intake changed less, such as MRFIT, the Women's Health Initiative Diet Modification trial and the Lyon Diet-Heart trial, reducing saturated fat intake had little or no effect on total cholesterol or LDL (0-3% reduction). This generally dumbfounded the investigators. The small changes that did occur could easily have been due to other factors, such as increased fiber and phytosterols, since these were multiple-factor interventions.

Another blow to the idea that saturated fat raises cholesterol in the long term comes from observational studies. Here's a graph of data from the Health Professionals Follow-up study, which followed 43,757 health professionals for 6 years (via the book Prevention of Coronary Heart Disease by Dr. Harumi Okuyama et al.): What this graph shows is that at a relatively constant LA intake, neither saturated fat intake nor the ratio of LA to saturated fat were related to blood cholesterol in freely living subjects. This was true across a wide range of saturated fat intakes (7-15%). If we can't even find a consistent association between dietary saturated fat and blood cholesterol in observational studies, how can we claim that saturated fat is a dominant influence on blood cholesterol?

There's more. If saturated fat were important in determining the amount of blood cholesterol in the long term, you'd expect populations who eat the most saturated fat to have high blood cholesterol levels. But that's not at all the case. The Masai traditionally get almost 2/3 of their calories from milk fat, half of which is saturated. In 1964, Dr. George V. Mann published a paper showing that traditional Masai warriors eating nothing but very fatty milk, blood and meat had an average cholesterol of 115 mg/dL in the 20-24 year age group. For comparison, he published values for American men in the same age range: 198 mg/dL (J. Atherosclerosis Res. 4:289. 1964). Apparently, eating three times the saturated animal fat and several times the cholesterol of the average American wasn't enough to elevate their blood cholesterol. What does elevate the cholesterol of a Masai man? Junk food.

Now let's swim over to the island of Tokelau, where the traditional diet includes nearly 50% of calories from saturated fat from coconut. This is the highest saturated fat intake of any population I'm aware of. How's their cholesterol? Men in the age group 20-24 had a concentration of 168 mg/dL in 1976, which was lower than Americans in the same age group despite a four-fold higher saturated fat intake. Tokelauans who migrated to New Zealand, eating half the saturated fat of their island relatives, had a total cholesterol of 191 mg/dL in the same age group and time period, and substantially higher LDL (J. Chron. Dis. 34:45. 1981). Sucrose consumption was 2% on Tokelau and 13% in New Zealand. Saturated fat seems to take a backseat to some other diet/lifestyle factor(s).  Body fatness and excess calorie intake are good candidates, since they influence circulating lipoproteins.

I have to conclude that if saturated fat influences total cholesterol or LDL concentration at all, the effect is modest and is secondary to other factors.

trip update

This smoothie is really good--it's better if it doesn't thaw all the way and you eat it with a spoon.  When it's completely thawed, it has a different consistency than when it was prepared.  Wow, I never thought 4.5 oz of collard greens & spinach would taste  good.  Keep in mind though, my tastes have probably changed--I don't like sweets as much as I used to.  But it's got 2 bags of berries in it!   It's a big one, but it's good on a trip because it fills you up.  The beans are filling me up too, which I need because I don't have as many extras to eat like I usually do at home.   Here's my post on what I brought on this trip.  The frozen smoothies and dishes have stayed frozen and it's working great.  I have an electric cooler plugged in keeping them cool.  It was a tiny bit uncomfortable at dinner last night but that's because we're adjusting to my being so different and bringing my own food, and my hosts are used to preparing lovely meals for their guests.  Everyone feels a little self-conscious about it at first.  Hopefully we'll be all adjusted by tonight.  

okay, I'm here to work.  gotta go.

my eating plan

Here is where I am in my eating plan. At the Health Getaway Dr. Fuhrman talked about different levels of being a "nutritarian", analogous to karate: so white belt, yellow belt, brown belt, black belt. I feel I'm a brown belt but I'm close to being a black belt. I think to get there, I will focus on the simple diet plan in the Eat to Live book where every day you eat 1 lb of raw vegetables (including lots of leafy greens), 1 lb of cooked (lots of leafy greens), 1 cup of beans, 4-5 servings of fruit, and at least 1 oz of raw nuts and seeds (in my case, that should be 2-4 oz). Okay, I don't think I'm going to count the lbs of veggies, or maybe I might try it once just to see if I'm close. To start off, I'm going to aim for 1 cup of beans, 2-4 oz nuts and seeds, lots of veggies, and some fruit. The 1 cup of beans is the part I have been working on since returning from the Getaway. I find I have to regulate the other quantities in order to get this in comfortably. I now see why people say when you eat this way, you won't be hungry. I also want the beans and nuts&seeds to provide protein to add some bulk to my frame if my body chooses to use it. So that's my plan. I will try to be simple at first because that's easiest. I don't like to prepare more than one dish for a meal because of time constraints, so a main dish + salad is too much food prep for me at lunch (the meal I spend most of my time preparing because of house-mate's schedule). So here's a plan that could work for me:


lunch: this barbiebeangreens (my new name for beans, greens, nuts&seeds dish; too dumb?) or this one (my favorite). + sweet corn right now---ooh, I could add it to the main dish. maybe fruit another time. 1 raw carrot while preparing (I love raw carrots).

dinner: leftover barbiebeangreens (or should I call it beangreens?), salad+fruit. 1 raw carrot while preparing

When I'm out, a smoothie + 1/2 cup beans can substitute at lunch or dinner. It satisfies the requirement of the big 4: beans, greens, nuts&seeds, and fruit.

Okay, I'll see if this works and report back...

trip

Tomorrow I'm going on a road trip for 4 days, visiting friends for work and pleasure. As I mentioned in a previous post, they eat a completely different diet from me, truly opposite ends of the spectrum. Fortunately they are not offended at the idea of my bringing my own food. So a few nights ago I made a bunch of smoothies and my tomato-y beans, greens and seeds dish, described in this post. Our friends love Wisconsin sweet corn, so we bought 3 dozen ears today! And I'll bring some random stuff from the fridge that I don't want to go bad--some lettuce and red bell peppers, a couple kiwis. Oh yeah, I made some cashew-orange dressing a few days ago when trying to use up the cashew butter, and froze that into three small jars. So one cooler will just be full of frozen food, another corn, and another miscellaneous stuff. Should be fun! My friends love food and cooking and so do I, we just love different kinds of food. :)

party

Today I went to an afternoon party. It's quite an affair, not fancy, but a lot of work goes into it: My friend builds a home-made mini-golf course in his yard and his partner prepares lots and lots of food. People bring lots of food too. It's almost entirely SAD food (Standard American Diet): cheese and crackers, sausage, barbeque, cake, cookies, brownies, macaroni salads with lots of mayo and meat, potato salads with lots of egg and mayo. It's interesting how my reaction to this situation has changed over time. I'm not tempted by most things, because most greasy stuff looks unappealing to me, though I enjoy some of the smells. The one thing that looked and smelled good to me were the chocolate chip cookies. If they were vegan, I wonder if I would have had some--I'm not sure because even those are starting to look less appealing to me because margarine kind of grosses me out now--big chunks of solid fat with salt? A few hours into the party, watermelon and cantaloupe showed up, and I ate a bunch of that, too much. This was influenced by watching everyone else eat so much. Then when I got home I wasn't hungry for dinner. I ate the rest of my greens, beans, and seeds dish, which was really good. And then I wanted to try my dessert idea in part because I wanted to enjoy a dessert like everyone else did. If I just went by hunger and real desire, I'm not sure I would have eaten anything at all at the party, because we ate a delicious lunch before going. Maybe I would have tried a little watermelon and cantaloupe to enjoy the taste--they were both good but not great. I was planning to go jogging after the party and before dinner, but eating so much of the watermelon and cantaloupe prevented me from doing that.

In conclusion, I've definitely changed very much in my desires and I'm not as much influenced by others' choices as I used to be, though it does still seep in a bit. I find it kind of interesting to observe this change over time. For those who are starting out, I say, if this is the kind of eating plan you want to adopt, and if you keep trying, you will change over time, so be patient and keep trying. If you are like me, you will give in maybe a lot at first but if you can establish an upward cycle where you give in less and less over time, your preferences will change and it will just get easier. It's easy to resist something if it's not appealing.

banana-mango ice cream

Yuck. This is to remind me that I don't like banana mango ice cream or sorbet. I've done this twice already and neither time did I like it. Tonight I wanted to use up a mango before a trip, so I mixed mango, bananas and hemp seeds. It's funny because I love this mango-spinach smoothie that has mangos and bananas in it, but it also has oranges. The oranges must round out the flavor for me. Maybe I should try making mango-banana-orange ice cream next time. I could use a frozen bag of mangos, frozen banana, nuts, and an orange, essentially the smoothie recipe without spinach. but then I may as well make it healthy and add the spinach and make the smoothie. I'm not a huge fan of desserts usually. But I am still influenced by social situations, which is the topic of my next post.

heaven



















beans from the garden, sweet corn picked today from a farm 10 miles away. heaven.
I use mashed avocado (1/2 of one) for butter. yum. Resist the temptation to add anything to the avocado (like herbs, lime juice etc). The corn flavor is most important!

This wasn't enough calories of course. I also had a peach and some leftover beans, greens, & seeds dish (I need a new name for this dish?). Then I resisted the temptation to eat more. I have some food to get rid of before my trip and have a new dessert planned for later on. I was tempted to try it now. I'm full enough...

By the way, this smoothie tastes good. I had a frozen one that I thawed overnight in the fridge and had for brekky today.

okay, I said I wouldn't do a food log as much, but it's the weekend. Plus, I am in such a habit now...

changing the blog

I've been doing this blog for 13 months now. I was planning to do it for a year, to cycle through all the seasons. I think I want to change my approach a bit now. For one thing, I don't have a lot of free time and want to use some of that time for studying to become a "Nutritional Excellence Trainer" for Dr. Fuhrman's program. As a "NET", I'd coach people who want to adopt this program, tailored to their needs: it could involve shopping, cooking, support.

So I'm thinking instead of writing my daily food log, I will give more occasional updates on my eating habits, and still log my recipes (they are useful for me to refer to), and more thoughts and ideas. For example I can write about things I'm learning as I study, or tips I'm learning for how to adopt the program. I'm coaching a friend and her family right now, and definitely learning a lot about what kinds of advice works and what doesn't.

Please send feedback about this idea. Do you like the food log or is it okay with you to change things up a bit?

cost of seeds

I noticed that hemp seeds cost about 6 times more than sunflower. At my store, hemp seeds cost $12.89/lb and sunflower are $2-something. Flaxseeds are similar in price to sunflower. I forget what pumpkin seeds are. So 1 oz of hemp seeds cost 80 cents and the others are only 15 cents (I'll have to look up pumpkin). Let's say I ate 3 oz of seeds a day, 1 from hemp, and 2 from the others. That's still only about $1.10 per day. Considering how much I spend on fruit and berries, this is nothing! So I think I won't worry about the price of hemp seeds!

large collard green smoothie

I've been tweaking this recipe. I don't know why I like this but I do. It's not that sweet compared to others. I have lots of collard greens in my garden so this is a great way to use them. .

Ingredients:
2-4 oz collard greens and/or spinach or chard (note to self: I don't like kale or parsley in smoothies).
1 bag frozen berries (e.g., blueberries, strawberries)
1/2 bag frozen pomegranate kernels (just became available in my co-op, yum!)
2 small oranges, peeled, cut in quarters to remove seeds
2 Tbsp seeds (hemp, flax, sunflower, pumpkin) = 1 oz
1 cup water
1 Tbsp blueberry vinegar (makes the greens less bitter tasting)

put the seeds in the bottom of the blender. add 1/2 cup water, the orange, vinegar, and the greens. Blend until smooth, then add the berries and rest of the water. Makes about 24 oz. You can freeze some for later.

Nutritional info: total calories: 531. carbs 107 g (71%), protein 14 g (9%), fat 12 g (20%).

July 16 -- Sweet corn!

Brekky: finished off the cantaloupe and honey dew melon. and the last ripe peach. yum.

Lunch: Sweet corn season is finally here! We have a corn stand a few blocks from our house with corn picked fresh each day. How great is that?! So of course, lunch was sweet corn. I also made a big batch of greens & beans, using my last kohlrabi and leaves from the garden, some fresh local beets, a little zucchini, black beans, and almond butter instead of seeds. I think I like the ground seeds more than the almond butter. I think I'm not a big fan of the almond butter. Anyway, this is at right in the picture:













For housemate, I made a potato & greens dish. For the corn, instead of butter, mashed avocado tastes fabulous. I have to resist the urge to add anything to it. I didn't resist today and added a few chives and basil, but it's better just plain. Then you taste the sweetness of the corn and the added fat and flavor of the avocado. I think this is better than butter. So you don't have to feel deprived. If you don't have avocado I just like it plain. The corn is really good on its own. Of course, it's been engineered to be way sweeter than it should be probably, which explains why it tastes so good. Here's housemate enjoying her corn:




















Dinner was some watermelon, leftover greens & beans dish, and an apple with almond butter. Again, I'm not a big fan of the almond butter. I did a whole bunch of food prep after this and I guess I ate more than I thought while munching on the food. I occasionally nibbled on the almond butter. Well, I must have nibbled too much because I got really full. I am still full and it's 9:40 am the next morning. I hope I'm hungry by lunch. Anyway, I made a huge batch of greens & beans to freeze and take on my trip. This version was more of an Italian take, like this post. I used eggplant, mushrooms, zucchini, tons of kale from the garden, herbs from the garden (basil, dill, garlic chives), a leek, scallions, fennel, and 2 cans tomatoes (almost done with last year's garden cans!), about 6 cups of cooked canonelli beans (at least, it was 1.5 cups dried) and almond butter instead of seeds. I thought the almond butter would go better with the tomatoes but I still didn't like it as much as seeds. I also added some nutritional yeast. I forgot to get garlic at the store so didn't have that. It was good but I felt it was missing something--maybe the garlic. Maybe a touch of vinegar would be good too. This made a huge batch. I had fun preparing it. Here are four big pots. At top left are the short-cooking vegetables (zucchini, mushroom, herbs, chard), top right are the beans (cooked 8 minutes in the PC), bottom left, ton of kale shrunk in volume using the food processor, then bottom right, the rest of the veggies. I combined the bottom two pots, cooked for 3 minutes in the pressure cooker (PC), then added the short-cooking veggies, cooked for another 2 minutes, then added the beans, nutritional yeast and almond butter. It made about 12 generous cups which I dished into 6 plastic bowls for freezing.
















After this I made 4 giant collard green/spinach smoothies to freeze. Now I'm all set for my trip. We are visiting friends who's eating style is completely opposite of mine--I mean, the complete other end of the spectrum. Everyone agrees we'll all be happier if I bring my own food. I'll just bring the frozen stuff and put it in their freezer. I also made a batch of cashew-orange dressing that I froze. So if they have some salad I'll eat that too.

Helping the Poor

"When Helping Hurts" by Steve Corbett and Brian Fikkert sounds like a great treatment of the issue and worth a look for all of us. Here is a link to read a portion on line. And here's a review from BTW with other recommendations for the book.

July 15

Brekky: 1/4 cantaloupe, 1/4 honey dew melon, a peach, some walnuts (~1/2 oz)

Lunch: avocado-mango salad. 1/2 orange. a carrot while preparing. My salad was big and had plenty of fat in it with the 1/2 avocado and 1/2 cup edamame and 1 Tbsp hemp seeds. But it turned out to be about right. I was hungry by dinner-time. Here's a picture of the big salad:



















Dinner: leftovers from yesterday, the beans, greens, and seeds dish. an apple and an orange. then when I got home I was a bit hungry and I don't want to lose any more weight, and I found some cashew butter on my doorstep (ordered it from Dr. Fuhrman), so I had a carrot dipped in cashew butter. sounds weird but it was pretty good. A banana would have been better but they were frozen. and I was out of apples.

After dinner I made a bunch of smoothies to freeze for housemate. We're going on a road-trip soon and will be bringing lots of food. Plus I don't trust myself with that cashew butter so decided to put most of it in the smoothies.

July 14

brekky: 1/4 cantaloupe, 1/4 honey dew melon. some walnuts and pumpkin seeds (probably 1/2-1 oz total). some salad greens.

Then my stomach was bothering me again. I'm not sure why. I did eat too many cherries last night, but I've done that plenty of times. Last night's smoothie had 4 oz of spinach in it. But I've done that plenty of times. But maybe the combination of that plus the 1 cup of beans a day is too much. I need more food when I don't eat beans, but I probably should cut back on volume when I include the beans. Or maybe I just ate something with some bacteria on it, I don't know.

Anyhow, I therefore ate a light lunch. I just snacked a bit on things as I prepared dinner for later since I wouldn't be home. I made another greens, beans & seeds dish, because I really want to adopt Dr. Fuhrman's advice to eat lots of greens, beans, and nuts and seeds. And I made a nice fruit salad--strawberries, raspberries, mango, and kiwi (2 servings, one for housemate). I ate 1/2 orange while making housemate's orange juice. And I ate some more nuts and seeds, probably 1 oz. That seemed like plenty of food for lunch. Then dinner was those dishes I prepared. It was yummy. I feel fine right now, so hopefully all will be well.

another beans, greens, and seeds dish

This is as easy as this one, just a little different.

Ingredients for 2 servings:
about 5 oz chopped greens (collards, kale, chard, bok choy, etc.)
some starchy veggies (carrot, beets, zucchini)
1 cup beans
3 Tbsp seeds (pumpkin, sunflower, hemp). Hemp make the creamiest sauce, so I like 2 Tbsp hemp, 1 of something else. Grind in coffee grinder
some herbs or spices if you want (today I used a lot of parsley, and some dill and basil).

Cook the greens and veggies and herbs together (easier that way). Collards, kale, carrots, eggplant, and beets take a similar time to cook so I like that combo in the pressure cooker for 3 minutes. or steam for 25 minutes (for collard greens). Add the beans and seeds and the water the veggies cooked or steamed in. It turns into a creamy sauce. I made this today with kohlrabi and its greens, 2 small beets and their greens, and a carrot for the veggies & greens; black beans; and the herbs I mentioned above. It was really good. The beets and carrots made it sweet so it doesn't really need more flavoring. This is in contrast to this version that combines eggplant and mushrooms with tomatoes. zucchini can go in both recipes.

Diet Modification Trials: Notes on Study Design

The other day, my internet meanderings brought me back to a review of fat modification trials conducted by the Cochrane collaboration. This is a not-for-profit group known for its rigorous meta-analyses.

They selected 27 studies that reduced saturated fat or total fat (in some cases along with increased PUFA), and fit several inclusion criteria. The results:
There was no significant effect on total mortality (rate ratio 0.98, 95% CI 0.86 to 1.12), a trend towards protection form cardiovascular mortality (rate ratio 0.91, 95% CI 0.77 to 1.07), and significant protection from cardiovascular events (rate ratio 0.84, 95% CI 0.72 to 0.99). The latter became non-significant on sensitivity analysis.

Trials where participants were involved for more than 2 years showed significant reductions in the rate of cardiovascular events and a suggestion of protection from total mortality ["suggestion" = not statistically significant]. The degree of protection from cardiovascular events appeared similar in high and low risk groups, but was statistically significant only in the former.
"Sensitivity analysis" is a statistical method that allows investigators to take into account the limitations of their model, in this case, the way in which they aggregated the studies' data. Another way of putting their findings is that they found no significant effect of fat modification on mortality or cardiovascular mortality, and they found a reduction in non-fatal "cardiovascular events" (more on this phrase later) only in a subset of the data.

I'll be the first to admit the meta-analysis isn't perfect. They cast too wide a net, not allowing them to distinguish the effect of reducing total fat from the effect of reducing saturated fat. They lumped both together, which from a practical standpoint isn't actually a problem because both sets of studies show essentially the same thing: zilch. But it's still not the best way to conduct a meta-analysis. They also omitted the Sydney Diet-Heart study for mysterious reasons, which was a five year randomized trial that found an increase in mortality in volunteers substituting vegetable oils for animal fat. Then there's the conclusion, which boggles the mind:
Lifestyle advice to all those at high risk of cardiovascular disease (especially where statins are unavailable or rationed), and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates.
Are these the same people who wrote the results section? I don't understand how they arrived at that conclusion from their own results.

In any case, this brings me to my main point. There are two types of outcomes you can measure in these trials: "hard endpoints" and "soft endpoints". Hard endpoints are not subjective. The hardest endpoint is death. Either you're dead or you aren't; there's no room for interpretation there. A bit less hard is death from a particular cause, such as heart attack. In that case, you're definitely dead, but the physician has to guess what you died of. That involves some judgment on the part of the physician and can introduce bias, depending on the study design. The softest endpoints are non-fatal events like angina, bypasses and stents. These depend on the judgment of both the physician and the patient, and are the most susceptible to bias.

The gold standard for controlled trials is a design known as "double-blind", where neither the participant nor the physician knows which group the participant is in. This design eliminates bias from both the participant and the physician side, allowing correction for the placebo effect and subtle bias in diagnosis. This is easy to do for drug trials, where placebo pills look just like the drug. But it's more difficult to pull off in a diet trial, where the patient knows what foods he's eating. Still, it can be done by giving participants similar-looking margarines containing either saturated or polyunsaturated fats, or sometimes by controlling diets in an institutionalized setting.

There have been three double-blind trials comparing the incidence of heart attack and/or mortality in volunteers eating either saturated animal fat or polyunsaturated vegetable fat: the 1968 National Diet-Heart trial (2 years), the 1969 Los Angeles Veterans' Administration trial (8 years), and the 1989 Minnesota Coronary Survey trial (4.5 years). The two studies that reported total mortality found no significant difference between groups. Two out of three found no difference in heart attack deaths. Of the two that reported on non-fatal cardiovascular endpoints, one found a significant difference. The V.A. trial was the only one to find a significant difference in heart attack deaths (18% decrease) and non-fatal events. There were significantly more heavy smokers in the animal fat arm of the V.A. trial, which was an unfortunate consequence of the participant randomization process. So that result is difficult to interpret.

The three double-blind diet trials, with the least potential for bias, really give no support to the idea that saturated/animal fat contributes to cardiovascular disease. As the participants were already eating a diet high in omega-6 to begin with, there is also no detectable effect of increasing omega-6 on cardiovascular health.

Many of the trials of this nature have been "single-blinded", where the participant knows which group he's in, but the physician doesn't. In this case, all endpoints involving death will be unbiased, because the physician deciding the diagnosis is not influenced by knowing what group the patient is in. However, soft, non-fatal events such as angina are still highly susceptible to the placebo effect. This is because they depend on the subjective judgment of the patient, who knows which group he's in.

I think it's interesting to note that very few dietary fat modification trials have found reductions in total mortality, which is the hardest endpoint and the least susceptible to bias. This is reflected in the Cochrane collaboration's findings. However, a number of the non-blinded and single-blinded studies have found differences in non-fatal cardiovascular events, sometimes creating absurd results. For example, in the 1966 Anti-Coronary Club trial, participants in the vegetable oil group had a significant reduction in non-fatal cardiovascular events, but a massive increase in cardiovascular deaths and total mortality. The former result could result from a placebo effect, due to the non-blinded nature of the trial.

The fact that the Cochrane review found statistically significant benefits of fat modification in soft, non-fatal endpoints (for a portion of the data set), but not endpoints involving death, suggests to me that what we're seeing may actually be a placebo effect resulting from the fact that patients were not blinded in the majority of these trials.

The only "fat modification" intervention that consistently reduces total and cardiovascular mortality is omega-3 fat supplementation, ideally in combination with omega-6 restriction. This is supported by the results of the DART trial, the Lyon Diet-Heart trial, the ISIS trial and the the GISSI-prevenzione trial.

Auto-Tune the News

I've seen these videos before, where someone (or something) puts video footage to music (not like you've heard before, I'm sure). This one is particularly well-done, and funny. Enjoy.

I Love Yodelling

I really do. And here's a video that might bring it into the mainstream (A guy can have a dream, can't he?)

July 13

Brekky: 1/4 honey dew, 1/4 cantaloupe, a peach


Dinner: was out so made a mango-spinach smoothie, 1/2 cup black beans, a kiwi, and a plum. After grocery shopping I ate some cherries and blackberries and brazil nuts. so I ate quite a lot, as usual.

I'm going to be out every night this week so I guess I'll be making smoothies every night. I'd make a salad but my meals will have to be quick and salad takes a while to eat. So I guess I'll make some salads at lunch. or breakfast...

beans, geens, seeds and a cream sauce

Ingredients for 1 large serving

4 oz greens (e.g., collards, kale, chard)
a vegetable or two--e.g., carrot, beets (optional)
half of leek or onion
1 small zucchini or 1/2 large
1/2 cup beans
1 Tbsp hemp seeds
1 Tbsp sesame seeds
juice of 1/2 lemon

steam the greens, zucchini, onion, and vegetable. I cooked them in a pressure cooker for 3 minutes. I peeled the zucchini but didn't cut it up, since it cooks faster than collard greens if it's cut up.

In a blender, blend up the zucchini, seeds, and lemon. It makes a nice creamy sauce. Pour that over the vegetables and stir. It's tastes decadent because of the sauce, even though it's healthy. Here I used carrot for the veggie, and black beans.

July 12

ugh, I got sick this morning. I am not sure what I did wrong. Well I ate too many raw carrots and sugar snap peas before dinner last night. That combined with the large (again raw) salad which I probably didn't chew well enough, and the 1/2 cup beans must have overloaded my system. Oh, I also ate a bunch of broccoli sprouts on my salad and I've never tried those before and I wasn't sure how to eat them, eat the whole things or the tops? Maybe I overate those. Anyway, I woke up at 5:30 am and had diarrhea for the next few hours. I'm sure the whole world enjoys reading that. So my meals today were pretty light.

no brekky.

lunch: plum, kiwi, 1/4 honey dew melon. For housemate I made: potatoes, carrots, sugar snap peas and corn, with garden herbs (chives, rosemary, parsley) and ground seeds. I tasted that and it was good. I realized I could have had that instead of the fruit because it was all cooked and easy to digest. I'm a big fan of hemp seeds now. Grind them up, add them to the water the veggies cooked in, and it turns into a creamy sauce!

dinner: peach. then cooked up a kohlrabi + its green leaves (from the garden), a carrot, sugar snap peas, with herbs (chives, tarragon, basil, parsley from the garden) and ground hemp/pumpkin seeds. 1/2 small orange for dessert. Let's hope that settles nicely in my tummy. Oh, for both lunch and dinner, I used the pressure cooker and cooked it up in a few minutes!

Tomorrow I want to get back to the beans. I want to follow Fuhrman's advice and eat 1 cup beans every day. That means I need to cut back on the volume of the other food at lunch and dinner (unlike yesterday I guess)--that should cut back on my food bills too because dried beans are cheap!

July 11

This morning I weighed myself. I felt like I overate this week, and thought for sure my weight would be up, but I was still at 118. I've been trying to eat more beans and nuts and seeds this week to help build muscle--yeah, I want to a buff 49 year old! The beans really do fill you up. I think I'll learn to moderate my intake of other foods so I don't feel too bloated. My boobs have shrunk lately, maybe there's where the weight came off, ha. I think I'm going to need new bras.

Brekky: cabbage and apples. love this. plum. also had sips of housemate's smoothies. I'm changing that recipe, still working on it.

Lunch:
We went on a bike ride and took a bag of carrots and sugar snap peas to dip in the leftover zucchini-sesame sauce. and I also had 1/2 cup bean, fruit salad (strawberries, raspberries, bananas--I don't like the current batch of blueberries at the co-op---too soft), and a kiwi. Housemate had peas and carrots and a candy bar for later. It was a yummy lunch. We were at a popular biking spot and everyone was going to a local coffee shop to eat. I think my lunch was way better!




















Dinner: had the rest of the carrots and sesame-zucchini sauce from lunch while preparing my favorite avocad0-mango salad. also ate an orange, which I really didn't need. oh, and ate 1/2 cup of beans. time to soak some more for cooking tomorrow.






zucchini-sesame sauce

This is a summer version of the tahini-rutabaga sauce (rutabagas last well into winter in Wisconsin). I didn't think to add onions. That would probably be good too.

Ingredients:
1 zucchini (yellow or green)
2 Tbsp sesame seeds, well rinsed
juice of lemon
some water
herbs from the garden or cupboard (optional)

Cook the zucchini in a little water. It cooks fast. In fact, I'm not sure you even need to cook it but I haven't tried it raw yet. I will and edit this if it's good. Combine everything except the herbs in the blender. Blend for a while so the sesame gets ground up. It gets creamy once the sesames are all blended. It gets warm and steamy too. Add the herbs and blend for a second if you didn't chop them fine. My herbs were chives, tarragon, basil, and parsley, because that's what in the garden. This is a good sauce, really good with collard greens. Housemate liked it a lot. She's going to get irritated when she reads this because she will find out it has zucchini in it and she claims to not like it.
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