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Eat. Drink, Be Merry, and Healthy

In Woody Allen’s classic film “Sleeper” a doctor in the future laughingly notes how they once thought hot-fudge sundaes were bad for you and now they’re a healthy staple. Well, we haven’t gotten quite that far, but it turns out that a healthy diet is a whole lot easier to achieve than we thought not too many years ago.

Here’s a nutty thought. Back in the “Dark Ages” of the 1980s I and many others advised going easy on nuts because they’re very high in fat. Then some researchers at Loma Linda University noticed that men and women who regularly snacked on nuts, munching daily on a handful of about an ounce or so, developed less cardiovascular disease than those who avoided those treats.

They didn’t just replace saturated fats of meat and dairy with the polyunsaturated and monounsaturated fats from nuts. Even if their total fat intake, on a percentage basis, was more than that of those avoiding nuts, they still had less heart disease. Study after study found the same thing for every kind of nut, from almonds to walnuts to peanuts and peanut butter.

Going back even further in time, those who thought that the “lipid hypothesis,” that fat and cholesterol consumption was linked to heart disease, was a bunch of malarkey pointed out that Eskimos eat huge quantities of fat and yet are free of heart disease. The realization that marine animals’ fat is primarily polyunsaturated, as compared with our farmed animals’ saturated fat, came as something of a breakthrough. And it wasn’t until quite a bit later that investigators determined that the particular fatty acids, the omega-3s, in salmon and seals and whales protect the heart by greatly lessening the tendency of the body to form clots in the bloodstream.

I remember the shock and disappointment of researchers during a poster presentation at a major medical meeting. They found that the diet of Greeks living on the island of Crete was a whopping forty percent fat. How could that be, they wondered, since the Mediterranean diet and lifestyle appeared to be linked with heart health? Now, of course, we realize that much if not most of that fat comes from foods including olives and olive oil, almonds, avocados, and other foods rich in healthy monounsaturated fatty acids.

In retrospect, one can’t help but wonder why medical authorities didn’t put the pieces together much earlier to realize that not all fat is harmful to health. But then, one must understand that the scientific process is rather like putting together a gigantic jigsaw puzzle. With holes here and there in the puzzle one thinks he sees the “Big Picture,” but as subsequent pieces are added to fill in those holes, the picture might look entirely different. It all takes time.

You and I and everyone else gets frustrated and confused when a newspaper headline touts a newly discovered path to health and weight control only to learn some time later that the path was a dead-end. Oh well, we turn around and find an even better path.

Should We All Become Vegetarians?

Many studies show that vegetarians suffer less degenerative disease and enjoy longer lives. But it’s probably not the foods they avoid—meat, dairy, poultry and fish—but rather what they eat a lot of—fruits, vegetables, whole-grain breads and cereals, nuts and beans—that makes the healthful difference. Just look at the Seventh Day Adventists who consume a lacto-ovo-vegetarian diet. In addition to dairy and eggs, rich in saturated fats and cholesterol, they eat a large amount of those plant foods.

There isn’t a week that goes by when another article published in the medical literature reports finding protection against heart disease and stroke, among other diseases, in men and women whose diets include a wide variety of fruits and vegetables. Whole-grain foods have been linked with protection against cardiovascular disease. Dried beans are rich in soluble fiber that effectively lowers cholesterol levels in the blood.

There are many good reasons to adopt a vegetarian lifestyle. But the pursuit of health isn’t necessarily one of them. Instead, start with a dietary foundation of those healthful plant foods and add equally healthy animal foods including lots of fish and seafood, low-fat and nonfat dairy, and small amounts of low-fat cuts of beef and pork and poultry.

How About a Low-Fat Diet?

During the early days of advocating a low-fat diet, most medical authorities paid most attention to levels of total cholesterol, paying little or no attention to the “good” HDL cholesterol and triglycerides. Following those low-fat diets did, indeed, lower both total cholesterol and the “bad” LDL cholesterol. But HDL counts fell and triglycerides increased. Today we know that both low levels of HDL and elevated triglycerides are independent risk factors for heart disease.

In some cases, in fact, low-fat dieting produced such significant HDL decreases that the ratio of total cholesterol to HDL was either not improved or was actually worsened. That ratio, many doctors believe, is a better predictor of cardiovascular disease risk than either total cholesterol or LDL. And, ironically, since LDL is most typically a calculated value rather than a direct measurement in tests, the higher the levels of triglycerides the lower the LDL, leading to a false sense of security.

The majority of medical authorities today no longer advocate a low-fat or very-low-fat diet in which 20 percent or as little as 10 percent of calories come from fat. A target of 30 percent fat or even a little higher achieves better control of the entire lipid panel—total cholesterol, LDL, HDL, and triglycerides—and is a lot more enjoyable. Moreover, few individuals are willing or able to stick with a low-fat diet and by shooting for a more reasonable fat intake helps assure better long-term compliance.

So What Is The Best Dietary Fat Approach?

The days of counting grams of fat are, and should be, long gone. There are really only two types of fat we want to limit or even avoid entirely.

There’s no doubt that saturated fat found in meats and dairy raise levels of LDL cholesterol, which in turn promotes plaque formation in arteries throughout the body but especially in the coronary arteries supplying blood and oxygen to the heart muscle and the carotid arteries leading to the brain. But there’s no reason to throw the baby out with the bath water.

Supermarkets offer virtually every dairy food in low-fat and non-fat versions. It’s actually difficult to find whole-fat yogurt. Drinking skim, nonfat, milk takes some getting used to, and graduating from whole to 2 percent low-fat to 1 percent low-fat and finally on to skim milk makes the transition a lot easier. Nonfat cheese just doesn’t taste very good and it defies efforts to make it melt; so accept a bit of saturated fat and enjoy a low-fat cheese. I happen to love the non-fat half-and-half products now available. I use it to make mashed potatoes and other dishes calling for cream or half-and-half; it’s terrific in coffee and makes wonderful creamy cocktails such as White Russians.

USDA statistics show that 50 percent of all red meat consumed in the U.S. is in the form of ground beef. So here’s a little trick I use. I look for sales of London Broil or top round steak in supermarkets. I’ll pick up three or four packages, totaling 10 to 11 pounds, and ask the butcher to trim off the rind of fat and then grind the meat. I wind up with the freshest ground beef possible, with a fat content of only 5 percent—about the same as skinless chicken breast. At home I put one-pound packages of the ground beef in the freezer and use it as needed to make chili, Bolognese meat sauce for pasta, tacos and burritos, sloppy joe sandwiches, and meatballs and meatloaf and, of course, hamburgers. For steaks, opt for sirloin or tenderloin, with a fraction of the fat of rib-eyes.

For pork, choose loin and tenderloin and low-fat ham. In fact, I stock my freezer with a few packages of very-low-fat ground pork loin to use half and half with beef to make meatloaf. After all, they don’t call it “beefloaf.” And that ground pork is great for making breakfast patties.

The other sources of saturated fat are the tropical oils palm kernel and coconut, heavy in the myristic and lauric fatty acids known to raise LDL. Those are the same fatty acids that pose a problem with animal fats. Ironically, however, palm oil probably should not be lumped together with the other tropical oils since it has a totally different fatty acid composition, principally palmitic acid that has been found to be in the “neutral” zone. In fact, one of the better margarine choices, Smart Balance, contains palm oil.

You may actually see more use of palm oil in processed and manufactured packaged foods as companies scramble to get rid of the nasty trans fats in their recipes and formulations. Trans fats are formed when oils undergo partial hydrogenation to make them solid or semi-solid for manufacturing purposes, to provide better flavor, and to extend shelf life. They began to appear in foods when the shift away from butter and lard began decades ago.

Now we know that those trans fats are actually worse than the saturated fats they replaced, not only raising levels of LDL but also reducing HDL counts and elevating markers of inflammation within arteries. As of January 1, 2006, companies must list amounts of trans fats per serving in all packaged foods on the Nutrition Facts label.

But don’t trust claims of “zero trans fat” on package labels. Government regulations allow that claim if a serving contains no more than 0.05 gram of trans fat. So if the ingredient list reveals the use of partially hydrogenated oil, you know the product has at least some trans fats. An insignificant amount? Perhaps. But realistically one typically consumes more than one serving at a time, and many foods may have those “trivial” amounts. It all adds up. Try to avoid trans as much as possible.

A New Twist On Cholesterol Control

Instead of only talking about foods to limit or avoid, I believe in recommending foods that can actually help lower cholesterol levels while providing excellent nutrition and delicious taste. Seek out foods rich in soluble fiber, including oats, oat bran, barley, figs, prunes, and all sorts of dried beans. That soluble fiber actually “flushes out” cholesterol from the digestive tract and, as a result, lowers cholesterol significantly.

The newest revolution on supermarket shelves is fortification of foods with phytosterols, the plant sterol equivalents of the animal sterol cholesterol. Phytosterols have almost the same molecular structure as cholesterol, and inhibit absorption of cholesterol since the body can’t tell the difference between those plant sterols and cholesterol. The phytosterols block absorption into the bloodstream where transport normally occurs. Look for foods with the Heartwise and CoroWise logos on foods such as Minute Maid orange juice, Rice Dream dairy alternative, Nature Valley granola bars, and Health Valley cereals. Research at the University of California, Davis, showed that subjects who drank two glasses of Minute Maid Heartwise orange juice daily achieved an eight percent cholesterol reduction. For more information on this new approach to cholesterol control, visit www.corowise.com.

Low-Fat or Low-Carb For Dieting?

As often said, the problem with going on a diet is that one goes off that diet. While either a low-fat or low-carb diet may appeal at first, studies at Tufts University and elsewhere show that compliance after six months plummets. All the weight lost during those first six months quickly returns.

As boring as it may sound, ultimately a successful weight loss program calls for changes in calorie consumption that one can live with for a lifetime. Keep a diary or journal listing all the foods and beverages you consume, emphasis here on the word “all,” daily for about a week. Then critically analyze your own diet. Where are the extra calories you most easily can get rid of? Little things mean a lot. Eliminating or even cutting back on just a few high-calorie, low-nutrient foods daily can produce very satisfying weight loss.

I’ll always remember when my father-in-law, Ben, announced to the family that he intended to lose the unwanted 12 pounds or so around his waist by no longer putting sugar in his coffee. Everyone laughed, thinking such an inconsequential change wouldn’t make any difference. Wrong. One teaspoon of sugar provides 16 calories. Ben put three teaspoons into each of his five to six cups a day. Do the math. Each cup of Ben’s coffee had 48 calories, multiplied by five yielding 240 calories daily and 7200 a month! One little “sacrifice” allowed him to lose two pounds a month. In six months he reached his target weight. And made his dentist happy as well.

I like to recommend what I call “Pre-emptive Snacking.” When most people begin to eat a meal, they’re ravenous. They gobble huge amounts, not letting the body’s blood sugar level rise to a point that signals satiation. The trick is to not be so hungry when you begin a meal. Achieve that by eating a healthy snack—an apple, a handful of nuts, some herring on a few whole-grain crackers—twenty to thirty minutes before each meal. That snack will in effect “spoil your appetite” and allow you to eat more sensibly at major meals.

One factor shows up in every study looking at long-term weight control: physical activity. I use that term deliberately since most people hate the idea of “exercise” and are, indeed, relatively sedentary. The trick is to actively move on a regular basis, doing the equivalent of walking two miles daily, about 30 minutes worth most days of the week. That can take the form of gardening, dancing, walking just a few holes of the golf course rather than riding all of them in a cart, bike riding, doing housework to the tempo of fast music playing, or, of course, just taking a daily walk.

Grandma Had It Right

The recommendations to “eat your vegetables,” “have an apple for a snack,” and “go out and play rather than watching TV,” were right on target. And Grandma probably wasn’t a research scientist. Add to those bits of sage advice a few more. Eat the widest possible variety of fruits and vegetables representing all the colors in the rainbow to get the nutrients and fiber you need. Take the time to truly savor and enjoy your food; don’t gulp it down so fast that your body never realizes you’re “full.” Most important of all, enjoy each and every minute of every day with the realization that good health will make life all the more enjoyable.

The Blood Pressure Cure is available in most book stores, Sam’s Club, and online, including www.amazon.com. Here are some selected tips from the book you can implement starting today.

Robert E. Kowalski is a medical journalist who has spent nearly forty years writing exclusively about health and medical matters. He is the author of eight books, including the New York Times and international best-seller The 8-Week Cholesterol Cure, which put oat bran in the American diet and popularized it around the world. His current book The New 8-Week Cholesterol Cure is a complete rewrite of the original and provides state-of-the-art information on not only cholesterol but also other risk factors for heart disease and how to avoid and control them.

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