According to the National Center for Health Statistics, 106.7 million Americans age 20 and older have total blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher. That is 35% of the population of the United States! The epidemic of high cholesterol is mainly due to the fats used in packaged and commercial foods. Cholesterol can be lowered by avoiding hydrogenated fats and eating polyunsaturated fats found in fish, walnuts, and sunflower seeds. Unfortunately, essential fatty acids turn rancid rapidly, and manufacturers avoid them to prevent packaged foods from spoiling while they sit in supermarket shelves.

The worst fats for your health are hydrogenated fats because they increase Low Density Lipoprotein (LDL), the “bad” cholesterol, and they decrease the High Density Lipoprotein (HDL), the “good” cholesterol. Saturated fats like those found in coconut oil and palm kernel oil increase cholesterol levels powerfully, but these are the fats that are used by manufacturers because they do not get stale.

The chart above shows the effects of individual dietary fatty acids on Total Serum Cholesterol, LDL cholesterol, and HDL cholesterol when 1% of the energy from carbohydrates in the diet is replaced by 1% of energy of the specific fatty acids. The chart shows cholesterol increases from lauric acid (C12:0), myristic acid (C14:0), and palmitic acid (C16:0) which are found in coconut oil, palm oil, and butter. Elaidic acid (trans-C18:1), which is present in hydrogenated fats, is the worst because it increases LDL and decreases HDL. The saturated fatty acid stearic acid (C18:0), the monounsaturated oleic acid (C18:1), and the polyunsaturated linoleic acid (C18:2) decrease LDL and increase HDL to various degrees.[1] Here are some steps to lower cholesterol:

• Avoid all hydrogenated fats (they are very common in commercial fried foods and baked goods)
• Reduce sources of saturated fats (butter, coconut oil, palm oil, fat from meats, chicken skin)
• Increase consumption of polyunsaturated fats (fish oil, walnut oil, flax seed oil, grape seed oil)
• Add soluble fiber to your diet (oatmeal, legumes)

Unfortunately, many of the oils available commercially are highly processed. The best thing is not to eat them. Meet your essential fatty acid requirements by eating foods that have the oils, e.g., fish, walnuts, sunflower seeds, etc. Olive oil does not lower cholesterol; it is basically neutral. The reason why olive oil receives a lot of positive promotion is because it is used in the Mediterranean diet, and the Mediterranean diet is associated with lower incidence of cardiovascular diseases, although this is not necessarily because of the oil.

The hardest part in normalizing your cholesterol will be avoiding the vast number of commercial foods that have hydrogenated fats and saturated fats. They include shortening, margarine, butter flavor popcorn, hash browns, french fries, biscuits, baked apple pies, chocolate chip cookies, taco shells, and the list goes on and on. Pay close attention to the food labels.

Learn how to lower your cholesterol

[1] Martijti B Katan, Peter L Zock, and Ronald P Mensink, Effects of fats and fatty acids on blood lipids in humans: an overview, Am J Cli. Nutr., 1994;60(suppl):1017S-1022S.

The National Health and Nutrition Examination Survey database from 2001 to 2004 showed that the average intake of added sugars for all Americans was 22.2 teaspoons or about 355 calories per day.  “Added sugars” are sugars and syrups that are added during processing or preparation of foods as well as sugars and syrups that are added at the table, they do not include the sugars that are naturally present in fruits and whole grains.

In August 2009, The American Heart Association (AHA) issued a recommendation to cut the intake of added sugars.[1]  The publication gives consumers detailed guidance of the upper limit of added sugars in the diet.  The AHA recommendations emphasize a healthy lifestyle and a diet that is rich in fruit, vegetables, low-fat dairy products, high-fiber whole grains, lean meat, poultry and fish. In addition to consuming an overall healthy diet, the guidelines emphasize the importance of a healthy body weight to avoid metabolic abnormalities and adverse health conditions such diabetes and cardiovascular disease.

The problem with added sugars is that they are refined carbohydrates without any vitamin or mineral content.  Sugars are just “empty calories” without any nutritive value.  If you don’t exercise enough to burn them off, the body converts them to fat.

Most American women should consume no more than 100 calories of added sugars per day; most men, no more than 150 calories. That corresponds to about 6 teaspoons of added sugars a day for women and 9 for men.  Soft drinks and other sugar-sweetened beverages are the greatest source of added sugars in the American diet. A 12-ounce can of regular soda contains about 130 calories from 8 teaspoons of sugar or high fructose corn syrup.  This means that even one can of soda per day is too much for the average woman, and this does not count all the other sources of added sugars such as salad dressing, spaghetti sauce, candy, and baked goods.

Learn about weight control and healthy diet

[1] Dietary Sugars Intake and Cardiovascular Health. A Scientific Statement From the American Heart Association, Circulation, 2009 Aug 24, PMID: 19704096 [link]

Yesterday, an old friend invited me for lunch.  The lunch consisted of a bowl of creamed cauliflower spiced with curry powder, a pickled herring rollmop on a slice of French baguette, and a tossed salad with lettuce, radishes, two kinds of olives, quartered tomatoes, and vinaigrette dressing.  Overall, it was a very tasty and healthy lunch.

And then came dessert… There were some chocolates and mini-cupcakes.  I ate half a cupcake, which was basically two small bites, and my friend ate the other half.  She went to the refrigerator and pulled out a container with individually wrapped ice cream bars covered with dark Dove chocolate.  I declined.

My friend, who is quite thin and survived World War II, cocked her head slightly to one side, and with a sly smile asked me “Do you think that you will live one extra day if you don’t eat this?”  Knowing that there are no guarantees in life, I took the ice cream bar and enjoyed it.

Many of the things that happen in life are highly improbable.  If you think about how you met your best friend, or how you met your wife or husband, you will find a long trail of events that had to coincide for things to be the way they are today.   The probability of each of those events is very minuscule, and the combination of all of them together could almost be regarded as a miracle.  By planning for the future, we feel that we are in control of our life, but undoubtedly along the way, circumstances beyond our control will arise that will change our whole life.  We will adapt, and we will continue planning.

Learn about Calorie Restriction

I just returned from a trip to Manhattan, New York.  The streets are packed with taxis, buses, and people walking.  Under the streets, you can hear the constant rumble of subway trains.  New Yorkers use public transportation and have to walk a lot more than other people in America.  Few New Yorkers seem to be excessively overweight.  Maybe this is a mistaken impression.  It is possible that New Yorkers who are overweight avoid going to Manhattan because then they would have to walk.

Over the last 20 years, Americans have become fatter.  Mississippi and Alabama lead the nation in the rates of obesity, but increased obesity is not only happening in the United States.  The obesity epidemic is engulfing the entire world.  Although obesity is a problem mainly in rich countries, the World Health Organization estimates that by 2010 the developing world will have caught up.  Overweight people now outnumber the undernourished.

Why is this happening?  The primary culprits are junk food and artificial foods, particularly sweetened soft drinks that provide only carbohydrate calories without any other nutrients, and hydrogenated fats that cannot be metabolized by the body.  Lack of exercise is a secondary reason.  Here is a list of some of the factors responsible for the increase in obesity.

• We drive to the grocery store because otherwise we cannot carry the big load of groceries home.
• We cannot walk to work or school because the distances are too great.
• We are too busy commuting to have time to exercise, so we don’t exercise.
• We drink too many sugary soft drinks with addictive ingredients like caffeine.
• We eat too many foods that have hydrogenated fats.
• Many staples are over-processed and refined so that they have less fiber and fewer nutrients.
• Food is glorified as a social celebration.  TV programs like the Food Channel describe food preparation without regard for its nutritional content.  Add more butter…, Deep fry it…, Add a cup of sugar…, etc.
• We snack too much and expect that every meal should have dessert.
• We eat too much fast food that is usually too greasy.
• We use food as celebration.  If you have a birthday, how do you celebrate?  You have to eat cake!

Food consumption is promoted very agressively.  Manufacturers cannot make much money from people who fast or eat small meals.  Calorie Restriction and moderate eating are not good for business.

Learn how to lose weight

Last July, Larry Haubner from Fredericksburg, Virginia celebrated his 107th birthday.  He credits his longevity to good nutrition and exercise.  Haubner exercises daily using some old equipment that he keeps in his room and he takes no medications.  The doctor who treats him for free says that he is in good health and that he will probably live a lot longer.

The only problem is that Haubner is broke.  The assisted living center where he lives costs $3,500 per month.  Two years ago, supporters raised $56,000 to help Haubner stay at the center, but the money has run out, and he is still alive.  Haubner never married and has no surviving family or friends who can help him financially.  He receives $1,200 in monthly pension and Social Security payments, but that is not enough to cover his expenses at the assisted living facility.  Without more help, he will have to apply for Medicaid and move to a nursing home.

Calorie Restriction with Optimum Nutrition (CRON) has been shown to extend longevity in many species.  There are many people practicing caloric restriction with the objective of living longer lives in good health, but Social Security is also running out of money.  In recognition of the fact that people are living longer, the age for receiving Social Security has been progressively extended.  Retirement age used to be 65, but it is now 66 for persons born between 1943 and and 1954.  The retirement age will be 67 for those born after 1959.

As Americans get older, the number of people paying into Social Security is decreasing, and the Social Security trust fund will begin to spend more money than it takes in through tax revenue in 2016.  The trust fund from which Social Security payments are made will be unable to pay retirees full benefits by 2037, and the program that subsidizes disabled Americans will run out of money in 2020.

If you are planning to live a long life, you better save a lot of money to finance your old age.

Learn how to budget your income

I recently mentioned the interesting digital human modeling work being done at the University of Washington.

From a published video, I was able to get images corresponding to several important BMI points for a male model, but the video did not have a full range of proportions for a female going from a very thin body to a very fat body.  I contacted Professor Brian Curless at the Department of Computer Science & Engineering at UW and he kindly provided female images for BMI points corresponding to the start of anorexia, minimum normal BMI, middle normal BMI, highest normal BMI, obesity, and morbid obesity.

Although every individual is different, the pictures provide representative images of how a person with a specific BMI might look.  When you compute your BMI, you can refer to the pictures and ask yourself: “Do I really look like that?”  The answer is usually “Yes.”

Try the Body Mass Index (BMI) Calculator

We hear a lot about the “Mediterranean Diet” and its positive effects on health.  A study published in 1970 found that people from Crete had exceptionally low death rates from heart disease, despite moderate to high intake of fat.[1] The Cretan diet consists mostly of olive oil, bread, abundant fruit and vegetables, fish, and a moderate amount of dairy foods and wine.

Many other Mediterranean countries follow similar diets with variations depending on the local resources.  In general, these diets include high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables.  There is moderate consumption of cheese and yogurt, moderate consumption of wine and fish, and low consumption of meat and meat products.  The total fat in this diet is 25% to 35% of calories, with saturated fat at 8% or less of calories.[2]  In addition, people with low rates of heart disease participate in regular physical activity.

Mediterranean cuisine can be very tasty.  You can make your own ravioli with whole-grain flour stuffed with cheese and spinach filling.  Serve the ravioli topped with some marinara tomato sauce garnished with fresh basil, and accompany the meal with a tossed salad dressed with olive oil and balsamic vinegar.  Pour a glass of red wine and enjoy.  This seems much better than taking Lipitor or other cholesterol-lowering drugs.  Don’t you think?

Learn how to make Ravioli

[1] “Coronary heart disease in seven countries”. Circulation 41 (4 Suppl): I1–211. April 1970. PMID 5442782
[2] Willett WC (01 June 1995). “Mediterranean diet pyramid: a cultural model for healthy eating”. American Journal of Clinical Nutrition 61 (6): 1402S–6S. PMID 7754995

Wild blueberries can be found around lakes in acid soil.  The good thing about wild blueberries is that they are free, but you are competing with animals like birds, bears and deer.  Don’t go into the woods alone.  Go with someone else so that you can watch out for each other.  Picking berries in a farm is a lot easier.  In a couple of hours, you can collect many pounds of blueberries.  The cost of picking your own berries is usually less than half of what you would pay at a store.

Wear appropriate clothing because you may get some blueberry stains.  Wear comfortable shoes, and before you go out on the field, spray your pant legs, socks and shoes with insect repellent.  This simple precaution will keep ticks from crawling up your legs.  A hat with a large brim will protect you from the sun.  And don’t forget to take a basket or a bucket with a handle to hold the berries that you collect.  You will probably step on some blueberries in the field.  Clean your shoes when you get back home before stepping on any light-colored rugs.

The best blueberries are plump with a light gray-blue color.  Berries that look red are not completely ripe, but they have a nice tart taste.  Do not pick green blueberries; leave them on the bush so that they can ripen later.  Blueberries tend to grow in clumps.  There are two ways of harvesting them.  You can hold the bucket under the bunch with one hand, while you release the ripe ones into the bucket with the other hand.  But if your bucket is already too heavy to do this, you can leave the bucket on the ground, cup both hands under the bunch of blueberries, and with the tips of your fingers release the ripe ones into your hands.

Blueberries can be frozen without washing, and then they can be rinsed and drained before they are served.  It is also possible to wash the blueberries before freezing them, as long as they are drained well so that the berries freeze individually and do not stick to each other.

Blueberries are low in calories and very nutritious.  One cup of blueberries has 84 calories.  Most of these calories come from about 20 grams of carbohydrates.  One cup of blueberries has about 5% of the daily nutritional requirements of Vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), and B6 (pyridoxine).  In addition, one cup of blueberries has 16% of the RDA for Vitamin C, 6% of Vitamin E, and 24% of Vitamin K.  The blue color in blueberries is due to anthocyanins, and other antioxidant pigments and phytochemicals that may play a role in reducing the risks of some diseases.

There are hundreds of recipes that use blueberries, but the simplest are always the best:

• Add blueberries to your cereal or oatmeal.
• Decorate a fruit salad with blueberries.
• Yogurt and blueberries – Yum!

This is my recipe for a blueberry milkshake with 344 calories:

1-1/2 cup skim milk
1/2 cup blueberries
2 tablespoons whey protein
1 teaspoon flax seed oil

Learn how to lose weight

Kale is a leafy green vegetable belonging to the Brassica family, a group of vegetables that includes cabbage, collard greens, and Brussels sprouts.  Half a cup of chopped, boiled kale has only 18 calories, 30% of the daily requirement (RDA) of Vitamin C, and enough Vitamin A and Vitamin K for the whole day.  Vitamin A is required for the formation of rhodopsin, a photoreceptor pigment in the retina.  Vitamin K controls the formation of coagulation factors in the liver.

The sulfur-containing phytonutrients in cabbage, broccoli and other cruciferous vegetables have been shown to reduce the occurrence of a wide variety of cancers.  It is thought that the sulfurous compounds activate detoxifing enzymes in the liver that help neutralize substances that are potentially carcinogenic.

A study found that people who ate the most cruciferous vegetables had a 29% lower risk of bladder cancer than those eating the least of this family of vegetables.[1]  Another study found reduced intestinal polyps when the diet contained sulforaphane.[2]  Sulforaphane is an isothiocyanate that is present abundantly in broccoli and cauliflower.

Kale, broccoli, and cabbage should be in your menu if you are trying to lose weight while maintaining good nutrition.

Learn more about vitamins

[1] Zhao H, Lin J, Grossman HB, Hernandez LM, Dinney CP, Wu X. Dietary isothiocyanates, GSTM1, GSTT1, NAT2 polymorphisms and bladder cancer risk. Int J Cancer. 2007 May 15;120(10):2208-13. 2007. PMID:17290402.

[2] Hu R, Khor TO, Shen G, Jeong WS, Hebbar V, Chen C, Xu C, Reddy B, Chada K, Kong AN. Cancer chemoprevention of intestinal polyposis in ApcMin/+ mice by sulforaphane, a natural product derived from cruciferous vegetable. Carcinogenesis. 2006 May 4; 2006. PMID:16675473.

Before and After

As the waistlines of Americans expand, so do the number of diet books in library shelves.  There is such a huge number of diet books, that it is impossible to figure out which one is the best.  Every doctor who writes a book claims to have a superior diet, and all doctors criticize each other’s diets.  The average person is completely confused because they don’t know whom to trust.  The problem is compounded because anybody, even celebrities who know nothing of nutrition, can write diet books.

The purpose of a diet is to provide guidelines for healthful eating, but most diet books also give advice about how to lose excess weight.  A basic diet is supposed to provide adequate amounts of protein, essential fatty acids, vitamins, and trace minerals.  The total number of calories can then be regulated to allow weight loss or to maintain weight.  The differences in the diets like Atkins, South Beach, Ornish, and others, depends on the proportions and sources of proteins and fats.  The Atkins diet allows a variety of meats, whereas the Ornish diet is mostly vegetarian.  The big differences in the diets seem to be:

How much exercise should you get? Some diets emphasize exercise as a way of burning extra calories and firming up muscles.

How much protein should you eat? Protein provides satiety and makes you less hungry.  High protein diets like the Protein Power Plan or the Zone Diet say that approximately 30% of the calories should come from protein sources such as meats, poultry, fish, and dairy.

What percent of your diet should be fat? The range can be anywhere from 15% to 50%.  The Ornish diet tends toward the lower end of the range.  The types of fats are also important.  Fats are structural components of the body.  The brain, for example, consists of 60% fat.  Hydrogenated fats and trans fats are harmful for the heart and the brain.  Polyunsturated fats, like those in walnuts, reduce cholesterol levels, whereas saturated fats from animal fats and tropical oils like coconut and palm kernel, increase cholesterol levels.

How many calories should you eat? This depends on whether you want to lose weight or maintain weight for a specific level of activity.  Sedentary people need fewer calories than people who exercise.  One hour of vigorous exercise burns approximately 400 calories.

What proportion of carbohydrates should you eat? This usually is decided by the amount of protein and fat in the diet.  The real question is what type of carbohydrates should be consumed.  Starchy carbohydrates don’t have enough vitamins and nutrients to meet normal requirements, and excess starch is stored as fat in the body.  Leafy green and non-starchy vegetables are nutritionally superior.

How do you spread your calorie intake over time? Some diets say that it better to eat five small meals throughout the day to minimize insulin spikes.  Other diets advocate taking most of the calories in one main meal to get the body into a ketogenic, fat-burning mode during the fasting period.

The success of a diet to lose weight depends being able to maintain a lower calorie intake without being deprived.  This is easier to achieve with high-protein, low-carbohydrate diets.

Learn more about weight control and diets