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Junk "Food Surveys"
Managing Metabolic Syndrome
Lifestyle As Treatment
Preserving Vision Update
Ask Dr. J: CoQ10 Safety
References
In the Health News
Diet and Disease
Recipe of the Month: Polenta Banana Pudding
Dear Friends,
If you ask the right questions, you can usually get the
survey results that you want, especially in an informal and
unscientific “fluff” piece poll designed for
television or other mass media. This was recently apparent
to me when one of the major TV stations interviewed schoolchildren
about their dietary preferences. The main question that the
interviewer asked, and the one that still sits in my mind,
was “Would you choose to eat a food that tasted good,
or one that was healthy?”
This is a trick question clearly designed to elicit a specific
answer, as almost anyone with common sense, especially teenagers,
would not want to eat something that tasted bad or was tasteless.
The trick, of course, is the unwarranted assumption that
healthy foods do not taste good. In most cultures, people
enjoy healthy foods that taste delicious. Foods with a variety
of flavors and aromas are a delight to the palate without
unhealthy ingredients.
Admittedly, companies who make and sell junk disguised as
foods spend enormous sums on research in an effort to create
products that appeal to taste buds, but their great appeal
is low cost and ready availability. They also lace their
products with fat, sugar, and salt, as well as artificial
ingredients, to hide their lack of real flavors that come
from natural foods, herbs, and spices. Then they spend as
much on advertising directed at vulnerable children that
eventually addict them to unhealthy eating habits. No doubt
they pay a lot to the TV stations that air these silly surveys.
Whole, natural, minimally processed foods are consumed around
the world with great delight. For examples, native foods
in China, India, Japan, Mexico, Thailand, Greece, the Middle
East, and elsewhere are routinely enjoyed by adults and children,
and they are generally healthy. When children grow up eating
these foods, they do not consider themselves deprived of
pleasure. However, they might still be susceptible to advertising
designed to change their eating habits for the worse. Part
of the appeal to children is their natural sweet tooth and
the pleasant “mouth feel” of fats. The appeal
to the the fake-food industry is that white flour, fat, and
sugar are all cheap and highly profitable.
Susceptible children spend much of their time watching TV
(more time than any other single activity except sleep),
and over half the ads they see are for candy, soft drinks,
chocolate, chips, and pastries, as well as restaurant chains.
It is no surprise that they do not see these toxins for what
they are. They see no ads for fruits and vegetables. It is
not surprising that we see an epidemic of childhood obesity.
The teens in the TV program were mostly overweight and possibly
unaware of the connection between their food choices and
their weight, a relation that children (and adults) need
to learn. A pollster might better ask children whether they
would prefer to eat a tasty food or an unhealthy food. They
might get quite a different result from the one that the
glib TV piece suggested.
Metabolic syndrome (MetS)) is
really just a collection of physiological abnormalities that
increase the risk of cardiovascular disease and other health
problems. When they occur together they markedly increase
risk. Although these abnormalities were not new, they were
first described as a syndrome in the late 1980s. The most
commonly discussed abnormality is insulin resistance.
Insulin is the hormone produced by the pancreas that is
required to move sugar (glucose) from the bloodstream into
most cells, such as muscle, liver, and fat cells (although
not brain cells, which do not require insulin to absorb their
fuel). Once inside the cells, the glucose can be burned for
energy. A poor response to insulin leads to high blood sugars
and excessive insulin production.
Other features of MetS (formerly called syndrome X, which
was somewhat confusing as other conditions were also referred
to by that term) include high blood pressure, high blood
triglyceride and total cholesterol with low HDL cholesterol,
and obesity around the waistline. It may also include high
levels of blood clotting factors (such as fibrinogen) and
the inflammatory marker, C-reactive protein (CRP). When someone
has three or more of these conditions, disease risks are
much higher. Unfortunately, this is increasingly being seen
in children.
In addition to cardiovascular disease, metabolic syndrome
increases the risk of developing diabetes, strokes, and peripheral
vascular disease. While many people consider MetS to be the
cause of their obesity, it is far more likely that too many
calories in the diet, too much saturated fat, too many sweets,
lack of exercise, and obesity itself are among the causes
of MetS. The good news is that these are all dependent on
lifestyle choices that someone can change for the better
to reduce their risks of serious disease. Genetic predisposition
plays only a small role in this condition.
You can evaluate yourself for these risk factors with some
minor medical help. You can measure your waist circumference
with a tape measure (a waistline over 40 inches for men and
35 inches for women is indicative). You can also take your
blood pressure yourself. You are at risk if your levels are
greater than 135/85. You can also look at the results of
your blood testing to see if you have elevated triglycerides
(over 150 mg/dl), or a low HDL (under 40 mg/dl for men or
35 for women), or elevated fasting glucose (over 100mg/dl).
For some of the numbers, risks are apparent below those limits,
but these are the criteria for this diagnosis. More sophisticated
testing is not essential, but it is easy for your doctor
to order a fasting insulin (over 10 or 15 uIU/ml is too high,
depending on which experts you accept).
It is clear that exercise and weight
loss are essential lifestyle changes to reverse the MetS
risk factors. In children, a program of high-fiber, low-fat
diet plus daily aerobic exercise dramatically reduced the
indicator numbers. For examples, insulin dropped from 27
to 18, triglycerides went from 146 to 88, systolic blood
pressure reduced from 130 to 117, and diastolic from 74 to
67, among other beneficial changes.
The encouraging news is that the changes were evident within
two weeks, food quantities were not restricted, and the improvements
happened even though the subjects remained overweight. Aerobic
fitness training improves insulin activity and moderates
the effect of specific foods on blood sugar levels (the “glycemic
index” or GI).
The GI refers to the effect on blood sugar when a portion
of a food is eaten by itself. However, several studies in
both diabetics and normal subjects indicate that this is
only minimally useful for diet management. One reason is
that foods are rarely consumed separately; combining foods
and other factors alter glucose effects. While refined sugars
and grains, such as white flour, contribute to insulin resistance,
misconceptions surround the role of whole grains and fruits
in the diet.
Whole grains improve insulin sensitivity and reduce MetS.
In the Framingham study, while a high glycemic index increased
insulin resistance, high whole grain and fruit consumption
reduced it. In a study of 75,521 women, high whole grain
consumption lowered the risk of diabetes. Another study of
535 older adults (60-98) showed that high whole grain intake
markedly reduced MetS and cardiovascular mortality.
Avoid fad diets that claim to help with metabolic syndrome
by avoiding healthy foods. They often exclude such foods
because of their GI. I recommend eating a high-fiber, low-fat
diet of whole, natural foods that are minimally processed,
emphasizing vegetables, fruits, whole grains, legumes, seeds,
nuts, and fish. In the context of this diet, foods such as
carrots and potatoes are fine.
Numerous supplements also help to control blood sugar, lipids,
and blood pressure, and I have written previously about them.
They include chromium (200-1000 mcg daily), cinnamon (1/2
tsp twice a day), and alpha lipoic acid (300-1000 mg), which
help with blood sugar; coenzyme Q10 (200 mg), magnesium (500-1000
mg), vitamins C and E, hawthorn, and taurine, which help
with blood pressure; garlic, fish oil, policosanol, niacin,
red yeast rice, and L-carnitine, which help with blood lipid
levels. Combining diet, exercise and supplements might completely
eliminate the risks associated with metabolic syndrome.
New research shows that omega-3 fatty acids
from fish help to block the development of age-related macular
degeneration (ARMD). Prior studies have shown that high-fat
diets increase the risk. Researchers followed 2335 people
for five years and found that those who ate fish once a week
had 40 percent less ARMD than those who ate it less often.
Those who ate fish three times a week or more had 75 percent
less ARMD.
In another study of 681 twins, those subjects with the highest
fish consumption had about half the risk of ARMD compared
with those whose intake was the lowest. In this study, the
most benefit was seen when consumption of commercial vegetable
oils was the lowest. In this study they also noted that smoking
doubles the risk of ARMD.
In the Nurses’ Health Study, researchers followed
76318 women for 20 years and found that diabetes increased
the risk of glaucoma by about 80 percent. Untreated glaucoma,
an increased eye pressure, can lead to blindness. This is
further evidence of the importance of controlling diabetes
and metabolic syndrome. (Pasquale LR, et al., Prospective
study of type 2 diabetes mellitus and risk of primary open-angle
glaucoma in women. Ophthalmology. 2006 Jul;113(7):1081-6.)
The carotenoids lutein and zeaxanthin are antioxidants that
appear to protect against both ARMD and cataract in a study
of serum levels in 899 subjects. Delcourt C, et al., Plasma
lutein and zeaxanthin and other carotenoids as modifiable
risk factors for age-related maculopathy and cataract: the
POLA Study. Invest Ophthalmol Vis Sci. 2006 Jun;47(6):2329-35.
Q. I am healthy, but have taken 120-150
mg of coenzyme Q10 daily for five years. Might this make
the heart work harder and cause heart failure if I take too
much?
TM, Pennsylvania, via internet
A. Coenyme Q10 is a cofactor for the production of energy
in muscle and other cells. It is especially important for
the heart and brain, but it is not a stimulant. It helps
the heart work harder if it needs to, but it does not “push” the
heart to work harder. It will only help the heart function
optimally while it also protects the heart and other tissues
as an antioxidant.
Taking coenzyme Q10 is extremely safe. Medical researchers
have used up to 3000 mg daily with no side effects. I can
understand your confusion. I recently read in a supermarket
magazine a dietitian cautioning against taking over 100 mg
of coenzyme Q10, incorrectly suggesting that it might harm
the liver. In fact, research suggests that it protects the
liver.
Park SH, et al., Relative risks of the metabolic syndrome
according to the degree of insulin resistance in apparently
healthy Korean adults. Clin Sci (Lond). 2005 Jun;108(6):553-9.
Coulston AM, et al., Effect of source of dietary carbohydrate
on plasma glucose, insulin, and gastric inhibitory polypeptide
responses to test meals in subjects with noninsulin-dependent
diabetes mellitus. Am J Clin Nutr. 1984 Nov;40(5):965-70.
Mettler S, et al., Influence of training status on glycemic
index. Int J Vitam Nutr Res. 2006 Jan;76(1):39-44.
McKeown NM, et al., Carbohydrate nutrition, insulin resistance,
and ...metabolic syndrome... Diabetes Care. 2004 Feb;27(2):538-46.
Liu S, et al., A prospective study of whole-grain intake
and risk of type 2 diabetes... Am J Public Health 2000 Sep;90(9):1409-15.
Pereira MA, et al., Effect of whole grains on insulin sensitivity...
Am J Clin Nutr 2002 May;75(5):848-55.
Jensen MK, Whole grains, bran, and germ in relation to homocysteine
and markers of glycemic control, lipids, and inflammation
1. Am J Clin Nutr. 2006 Feb;83(2):275-83.
Sahyoun NR, et al., Whole-grain intake...metabolic syndrome
and mortality in older adults. Am J Clin Nutr. 2006 Jan;83(1):124-31.
Henriksen EJ, Exercise training and the antioxidant alpha-lipoic
acid in the treatment of insulin resistance and type 2 diabetes.
Free Radic Biol Med. 2006 Jan 1;40(1):3-12.
Jain SK, et al., Trivalent chromium inhibits protein glycosylation
and lipid peroxidation...Antioxid Redox Signal. 2006 Jan-Feb;8(1-2):238-41.
Singh RB, Effect of hydrosoluble coenzyme Q10 on blood pressures
and insulin resistance...J Hum Hypertens. 1999 Mar;13(3):203-8.
Barbagallo M, Dominguez LJ, Magnesium metabolism...and insulin
resistance. Arch Biochem Biophys. 2006 Jun 12; [Epub ahead
of print]
Chua B, et al., Dietary fatty acids and the 5-year incidence
of age-related maculopathy. Arch Ophthalmol. 2006 Jul;124(7):981-6.
Seddon JM, et al., Cigarette smoking,
fish consumption, omega-3 fatty acid intake, and associations
with age-related macular degeneration...Arch Ophthalmol.
2006 Jul;124(7):995-1001.
a. A milk thistle extract, the flavonone
silibinin, destroys lung cancer in mice. Mice were injected
with urethane, and half were fed silibinin in their diet.
Treated mice had significantly fewer large lung cancers than
the controls. Silibinin inhibits the formation of new blood
vessels needed for tumor growth (angioneogenesis). (Singh
RP, et al., Effect of silibinin on the growth and progression
of primary lung tumors in mice. J Natl Cancer Inst. 2006
Jun 21;98(12):846-55.) I wonder why the researchers noted
that they did not use silymarin, the commonly available dietary
supplement, which contains silibinin.
a. Researchers compared 52 overweight/obese
adults with matched normal-weight subjects. The normals ate
more fruit and fiber, 43 percent more complex carbohydrates,
and more total carbohydrates. Compared to the normal weight
subjects, the diet of the overweight/obese subjects contained
more total fat, saturated fat, and cholesterol. (Davis JN,
et al., Normal-weight adults consume more fiber and fruit
than their age- and height-matched overweight/obese counterparts.
J Am Diet Assoc. 2006 Jun;106(6):833-40.)
b. Mediterranean diets reduce risk factors for heart disease.
Researchers compared diets high in fruits, vegetables, whole
grains, and limited amounts of meats and processed foods,
plus either olive oil or nuts and seeds, to a low-fat diet.
Blood pressure, blood sugar, and cholesterol improved more
than in those on the low-fat diet, but the study was short,
did not focus on outcomes (just risk factors), and the low-fat
group had less intense nutrition education. Other information
suggests that healthy low-fat diets that include essential
fatty acids are even more beneficial. Estruch R, et al.,
Effects of a Mediterranean-style diet on cardiovascular risk
factors: a randomized trial. Ann Intern Med. 2006 Jul 4;145(1):1-11.
Polenta is an international food with many names (mealie
pap, ugali, mamaliga, funjie), but it is basically boiled
coarsely-ground corn meal (I grind my own in a Vita Mix).
Put 1 cup of medium coarse corn meal and ¼-½ tsp
salt with 2½ cups of boiling water simultaneously
in a crock pot (mix at the start and once or twice during
cooking). In a food processor blend 3 bananas with 8 oz.
of silken tofu, 1 Tbsp of vanilla, 1 tsp of cinnamon, ½ cup
of shredded coconut, 2 pitted dates, ½ Tbsp of lemon
juice, ¾ tsp of freshly ground nutmeg, and 2 tsp of
orange zest. When the polenta is cooked, place it in a large
mixing bowl with the other ingredients and ½ cup of
soaked raisins. Fold this all together and let it cool in
the fridge in individual dessert bowls or a storage container.
The corn starch will set and thicken it. Serve as is or garnish
with some fresh or frozen organic berries.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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