Tag Archives: Mediterranean Diet

What Is A Plant-Based Diet (And Should I Be On One)?

The phrase “plant-based diet” is being tossed around a lot these days. The skeptical cardiologist never knows what people mean when they use it and so must assume that most of the world is also puzzled by this trendy term.

Is A Plant-Based Diet Code For Veganism?

For some, a “plant-based diet” (PBD) is what vegans eat.

Veganism combines a diet free of animal products, plus a moral philosophy that reject the “commodity status of animals.” Vegans are the strictest of vegetarians, eschewing milk, fish and eggs.

One PBD advocate in the introduction to a Special Issue of the Journal of Geriatric Cardiology,  defines it as follows:

“a plant-based diet consists of all minimally processed fruits, vegetables, whole grains, legumes, nuts and seeds, herbs, and spices and excludes all animal products, including red meat, poultry, fish, eggs, and dairy products.”

You will notice that this cardiologist “excludes all animal products”  and that the qualifying phrase “minimally processed” has crept into the definition.

Forks Over Knives-Whole-food, plant-based diet

The “documentary” Forks Over Knives brought the phrase “whole food, plant-based diet” to national prominence. The movie focused on the diets espoused by Caldwell Esselstyn and T. Colin Campbell. Since its release in 2011 a whole industry based on the Forks Over Knives (FON) brand has been launched. FON uses the following definition:

 “A whole-food, plant-based diet is centered on whole, unrefined, or minimally refined plants. It’s a diet based on fruits, vegetables, tubers, whole grains, and legumes; and it excludes or minimizes meat (including chicken and fish), dairy products, and eggs, as well as highly refined foods like bleached flour, refined sugar, and oil.”

I’ve written detailed posts on the Esselstyn diet here and here. I think it is needlessly restrictive and not supported by scientific evidence. (Esselstyn’s website and book state unequivocally “you may not eat anything with a mother or a face (no meat, poultry, or fish” and “you cannot eat dairy products” which differs from the FON definition.)

The key new terms in the FON approach to note are:

Whole Food. The Oxford English Dictionary (OED) defines whole food as “food  that has been processed or refined as little as possible and is free from additives or other artificial substances.”

Unrefined or minimally refined. The OED defines refined as:

“With impurities or unwanted elements having been removed by processing.”

The FON definition for a PBD then is similar to our first definition-minimally processed vegan-but allows (at least theoretically)  minimal meat, dairy and eggs. The FON Esselstyn/Campbell diets choose to define vegetable oil, including olive oil, as highly refined foods and do not allow any oils.

U.S. News and World Report Definition Of Plant-Based Diets

U.S. News and World Report publishes an annual rating of diets based on the opinion of a panel of nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes and heart disease.

US News defines a plant-based diet as “an approach that emphasizes minimally processed foods from plants, with modest amounts of fish, lean meat and low-fat dairy, and red meat only sparingly.”

This definition is radically different from the first two. Notice now that you can have “modest amounts” of meat and dairy, foods which are anathema to vegans. Also, note that “low-fat dairy” is being recommended, a food which (in my opinion) is highly processed and that lean meat is to be preferred and red meat avoided.

I was happy to see that for the first time, the Mediterranean Diet ranked as  Best Diet Overall, but shocked to find that the Mediterranean diet came out on top of the US News list of “Best Plant-Based Diets.”

Readers will recognize that this is the diet I recommend and follow (with slight modifications). On this diet I regularly consume hamburgers, steak, fish and whole egg omelettes.

The plant-based diet of vegans or of Forks Over Knives is drastically different from the Mediterranean Diet.

For example, olive oil consumption is emphasized in the Mediterranean Diet, whereas the Esselstyn diet featured in FON forbids any oil consumption.

The FON/Esselstyn diets are very low in any fats, typically <10%, whereas the Mediterranean Diet is typically 30-35% fat.

Esselstyn really doesn’t want you to eat nuts and avocados because he thinks the oil in them is bad for you. This is nuts! I’m handing out nuts to my patients just as they were given to the participants in the PREDIMED randomized trial showing the benefits of the Med diet.

Dr. Pearson’s Plant-Based Diet

Since the term “plant-based diet” apparently means whatever a writer would like it to mean, I have come up with my own definition.

With the  Dr. P Plant-Based Diet© your primary focus in meal planning is to make sure that you are regularly consuming a large and diverse amount of healthy foods that come from plants.

If you don’t make it your focus, it is too easy to succumb to all the cookies, donuts, pies, cakes, pretzels, chips, French fries,  breakfast bars and other  calorie-dense but nutrient-light products that are cheap and readily available.

In Dr. P’s Plant-Based Diet© meat, eggs, and full fat dairy are on the table. They are consumed in moderation and they don’t come from plants (i.e. factory farms).

I, like the PBD  definers of yore, have taken the liberty of including many vague terms in my definition. Let me see if I can be more precise:

Regularly = at least daily.

Large amount = 3 to 4 servings daily.

Healthy = a highly contentious term and one, like “plant-based” that one can twist to mean whatever one likes. My take on “healthy” can be seen on this blog. I’m not a fan of plant-based margarines, added sugar, whether from a plant or not, should be avoided, and the best way to avoid added sugar is to avoid ultra-processed foods.

Ultra-processed foods (formulations of several ingredients which, besides salt, sugar, oils and fats, include food substances not used in culinary preparations, in particular, flavours, colours, sweeteners, emulsifiers and other additives used to imitate sensorial qualities of unprocessed or minimally processed foods and their culinary preparations or to disguise undesirable qualities of the final product).

Ultra-processed foods account for 58% of all calories in the US diet, and contribute nearly 90% of all added sugars.

I do like the food writer Michael Pollan’s simple rules to “Eat Food. Mostly Plants. Not Too Much.” and this NY Times piece summarizes much of what is in his short, funny and helpful Food Rules book:

you’re much better off eating whole fresh foods than processed food products. That’s what I mean by the recommendation to eat “food.” Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it’s not really food, and food is what you want to eat.

On Dr. P’s Plant-Based Diet© you can add butter to your leeks and green onions.You can add eggs to your onions, tomatoes and peppersAnd you can eat salads full of lots of cool different plants for lunch.

To answer my titular question-if you are using Dr. P’s definition of a plant-based diet then you definitely should be on one.

Viva La Plant!

-ACP

Dr. P’s Heart Nuts: Preventing Death In Multiple Ways

The skeptical cardiologist has finally prepared Dr. P’s Heart Nuts for distribution. IMG_8339The major stumbling block in preparing them was finding almonds which were raw (see here), but not gassed with proplyene oxide (see here), and which did not contain potentially toxic levels of cyanide (see here).

During this search I learned a lot about almonds and cyanide toxicity, and ended up using raw organic almonds from nuts.com, which come from Spain.

I’ll be giving out these packets (containing 15 grams of almonds, 15 grams of hazelnuts and 30 grams of walnuts) to my patients because there is really good scientific evidence that consuming 1/2 packet of these per day will reduce their risk of dying from heart attacks, strokes, and cancer.

IMG_7965The exact components are based on the landmark randomized trial of the Mediterranean diet, enhanced by either extra-virgin olive oil or nuts (PREDIMED, in which participants in the two Mediterranean-diet groups received either extra-virgin olive oil (approximately 1 liter per week) or 30g of mixed nuts per day (15g of walnuts, 7.5g of hazelnuts, and 7.5g of almonds) at no cost, and those in the control group received small nonfood gifts).

After 5 years, those on the Mediterranean diet had about a 30% lower rate of heart attack, stroke or cardiovascular death than the control group.

It’s fantastic to have a randomized trial (the strongest form of scientific evidence) supporting nuts, as it buttresses consistent (weaker, but easier to obtain), observational data.

Trademark

I applied for a trademark for my Heart Nuts, not because I plan to market them, but because I thought it would be interesting to possess a trademark of some kind.

The response from a lawyer at the federal trademark and patent office is hilariously full of mind-numbing and needlessly complicated legalese.

Heres one example:

"DISCLAIMER REQUIRED
Applicant must disclaim the wording “NUTS” because it merely describes an ingredient of applicant’s goods, and thus is an unregistrable component of the mark.  See 15 U.S.C. §§1052(e)(1), 1056(a); DuoProSS Meditech Corp. v. Inviro Med. Devices, Ltd., 695 F.3d 1247, 1251, 103 USPQ2d 1753, 1755 (Fed. Cir. 2012) (quoting In re Oppedahl & Larson LLP, 373 F.3d 1171, 1173, 71 USPQ2d 1370, 1371 (Fed. Cir. 2004)); TMEP §§1213, 1213.03(a).

The attached evidence from The American Heritage Dictionary of the English Language shows this wording means “[a]n indehiscent fruit having a single seed enclosed in a hard shell, such as an acorn or hazelnut”, or “[a]ny of various other usually edible seeds enclosed in a hard covering such as a seed coat or the stone of a drupe, as in a pine nut, peanut, almond, or walnut.”  Therefore, the wording merely describes applicant’s goods, in that they consist exclusively of nuts identified as hazelnuts, almonds, and walnuts.

An applicant may not claim exclusive rights to terms that others may need to use to describe their goods and/or services in the marketplace.  See Dena Corp. v. Belvedere Int’l, Inc., 950 F.2d 1555, 1560, 21 USPQ2d 1047, 1051 (Fed. Cir. 1991); In re Aug. Storck KG, 218 USPQ 823, 825 (TTAB 1983).  A disclaimer of unregistrable matter does not affect the appearance of the mark; that is, a disclaimer does not physically remove the disclaimed matter from the mark.  See Schwarzkopf v. John H. Breck, Inc., 340 F.2d 978, 978, 144 USPQ 433, 433 (C.C.P.A. 1965); TMEP §1213.

If applicant does not provide the required disclaimer, the USPTO may refuse to register the entire mark.  SeeIn re Stereotaxis Inc., 429 F.3d 1039, 1040-41, 77 USPQ2d 1087, 1088-89 (Fed. Cir. 2005); TMEP §1213.01(b).

Applicant should submit a disclaimer in the following standardized format:

No claim is made to the exclusive right to use “NUTS” apart from the mark as shown."

I’ve gotten dozens of emails from trademark attorneys offering to help me respond to the denial of my trademark request. Is this a conspiracy amongst lawyers to gin up business?

Nuts Reduce Mortality From Lots of Different Diseases

The most recent examination of observational data performed a meta-analysis of 20 prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016.

It found that for every 28 grams/day increase in nut intake, risk was reduced by:

29% for coronary heart disease

7% for stroke (not significant)

21% for cardiovascular disease

15% for cancer

22% for all-cause mortality

Surprisingly, death from diseases, other than heart disease or cancer, were also significantly reduced:

52% for respiratory disease

35% for neurodenerative disease

75% for infectious disease

74% for kidney disease

The authors concluded:

If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013.

If everybody consumed Dr. P’s Heart Nuts, we could save 4.4 million lives!

Meditativeterraneanly Yours,

-ACP

If you’re curious about why nuts are so healthy, check out this recent meta-analysis, a discussion of possible mechanisms of the health benefits of nuts complete with references:

Nuts are good sources of unsaturated fatty acids, protein, fiber, vitamin E, potassium, magnesium, and phytochemicals. Intervention studies have shown that nut consumption reduces total cholesterol, low-density lipoprotein cholesterol, and the ratio of low- to high-density lipoprotein cholesterol, and ratio of total to high-density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels in a dose–response manner [4, 65]. In addition, studies have shown reduced endothelial dysfunction [8], lipid peroxidation [7], and insulin resistance [6, 66] with a higher intake of nuts. Oxidative damage and insulin resistance are important pathogenic drivers of cancer [67, 68] and a number of specific causes of death [69]. Nuts and seeds and particularly walnuts, pecans, and sunflower seeds have a high antioxidant content [70], and could prevent cancer by reducing oxidative DNA damage [9], cell proliferation [71, 72], inflammation [73, 74], and circulating insulin-like growth factor 1 concentrations [75] and by inducing apoptosis [71], suppressing angiogenesis [76], and altering the gut microbiota [77]. Although nuts are high in total fat, they have been associated with lower weight gain [78, 79, 80] and lower risk of overweight and obesity [79] in observational studies and some randomized controlled trials [80].

Nutella: Healthy and Natural Spread or Highly Processed, Slickly Marketed Junk Food?

It’s World Nutella day according to Ferrero, the Italian confectonery company and manufacturer of the globally beloved hazelnut-based spread.screen-shot-2017-02-05-at-6-28-42-am

“With Nutella we spread positive energy to families to bring more happiness to the world” we are informed. On this day, apparently, the world should be spreading Nutella on as many food products as possible, ramping up positive energy levels to unprecedented levels.

Here are some of the other products Ferrero sells:screen-shot-2017-02-05-at-9-08-21-am

Three of them are clearly recognized by consumers as candy.

Should Nutella be in the same category as tic-tacs?

 

 

Nutella Ingredients

Perhaps in anticipation of World Nutella Day, a graphic has been appearing on Twitter:

nutella-englisy

detailing the ingredients of Nutella. The English version of this was posted on Reddit on a subreddit that I can’t mention on my family-friendly blog. It is a translation of a graphic that was published in German originally.

screen-shot-2017-02-05-at-8-18-31-am
If you thought you were getting mostly hazelnuts under the lid as this Nutella website graphic implies, you will be disappointed.

I’m not sure where the original data for the graphic came from but it seems to be a reasonable illustration of how much of Nutella is made up of palm oil and sugar. A 2 tbsp serving of Nutella (37 grams) contains 12 grams of fat, 21 grams of sugar and 2 grams of protein. Only about 12% of Nutella comes from actual hazelnuts.

I don’t have any concerns from a cardiovascular risk standpoint with the fat content of either the palm oil or the hazelnuts in Nutella.

But the 5 teaspoons of sugar per serving screen-shot-2017-02-05-at-8-44-16-am

are just still another source of empty
sugar calories adding to the daily dietary glut of sugar consumers face when consuming highly processed foods.

Nutella definitely is a highly processed, highly sugared product that shouldn’t be a regular part of a healthy Mediterranean diet. Most of the ingredients have gone through  complex sourcing and factory processing although their marketing material strains to emphasize the freshness and naturalness of these ingredients.

screen-shot-2017-02-05-at-6-30-27-am

One ingredient not depicted on the now viral graphic of Nutella is vanillin. From Nutella’s ingredient graphic one might think the screen-shot-2017-02-05-at-6-34-38-amvanillin is being extracted from (per wikipedia)

“the seed pods of Vanilla planifolia, a vining orchid native to Mexico, but now grown in tropical areas around the globe.”

In reality, however, the Nutella people,  ” use synthetic vanillin, an aroma identical to the one naturally present in the vanilla pod.”

Is the Palm OIl In Nutella Carcinogenic?

Some question the healthiness of the palm oil in nutella, either due to its high saturated fat content or its carcinogenic potential. A european food safety authority paper in May, 2016 declared certain toxins found in palm oil in particular to be “genotoxic and carcinogenic”

EFSA assessed the risks for public health of the substances: glycidyl fatty acid esters (GE), 3-monochloropropanediol (3-MCPD), and 2-monochloropropanediol (2-MCPD) and their fatty acid esters. The substances form during food processing, in particular, when refining vegetable oils at high temperatures (approx. 200°C)

The highest levels of GE, as well as 3-MCPD and 2-MCPD (including esters) were found in palm oils and palm fats, followed by other oils and fats. For consumers aged three and above, margarines and ‘pastries and cakes’ were the main sources of exposure to all substances.

As a result, According to Reuters, In Italy, some products containing palm oil have been removed from grocer’s shelves and one pastry company has eliminated palm oil from it products, labeling them as “palm oil free.”

High temperatures are used to remove palm oil’s natural red color and neutralize its smell, but Ferrero says it uses an industrial process that combines a temperature of just below 200C and extremely low pressure to minimize contaminants.

Nutella has fought back, defending its use of palm oil, with television and print advertisements.

Healthier Alternatives To Nutella

Conner Middleman, nutritionist , cooking instructor and author of Zest For Life, has shared with me her recipe for Nutritella, a healthier version of Nutella you can make at home. She points out in her intro to the recipe:

Nutella was invented in the 1940s in the Piedmont region of northern Italy, where hazelnuts grow plentifully. Alas, modern, store-bought Nutella contains a mere 13% hazelnut and only a hint of cocoa; the rest is made up of sugar, palm oil and artificial vanilla flavoring. My home-made version of Nutella, on the other hand, contains very little sweetener (in the form of raw honey), 3 tablespoons of flavonoid-rich dark cocoa, and about 90% hazelnuts, which boast a particularly high concentration of antioxidants and healthy fats (mostly monounsaturated). This is not to say that you should eat this spread by the tablespoonful; its high fat content means it’s high in calories and it should be enjoyed in sensible amounts (1-2 tbsp/day). The good news is that a high-fat food such as this one keeps you sated for longer, and because it is made from whole, real foods, it’s not only rich in calories, but also in nutrients! 

Here’s the recipe:

1 cup/125g toasted hazelnuts (Trader Joe’s roasted Oregon hazelnuts work great here; alternatively buy plain, raw hazelnuts and roast them yourself as described below)

½ oz/2 tbsp/15g unsweetened cocoa

3 tbsp hazelnut oil (La Tourangelle is my favorite brand – available in the oils section of good supermarkets or online)

3 tbsp honey or maple syrup

2 tsp alcohol-free vanilla extract (e.g., Trader Joe’s)

6-8 tbsp milk/plant milk/water

If you are roasting the hazelnuts from scratch, preheat oven to 350F. Place nuts on a dry, clean baking sheet and roast for 8 minutes (set timer). Remove and tip hot nuts onto a clean kitchen towel (pictured here).

As they cool, the skins will loosen, crack and flake off. Gather up the towel by its corners and scoop together into a tight bundle. Hold the bundle with one hand and knead the nuts with the other through the cloth to rub the skins off them. Place bundle back on a flat surface and open; lift out the nuts and lightly shake off the skins. (Leave some skin on the nuts – it’s where most of the antioxidants reside.)

If using pre-roasted nuts, start here.

Place the hazelnuts in an electric blender with the cocoa, oil, honey/maple syrup and vanilla extract. Process on “high” for about 30-40 seconds until all the ingredients come together in a coarse paste.

With the motor running, add milk or water (whichever using), a tablespoon at a time, and keep processing until the mixture reaches the desired consistency.

Transfer to a clean glass jar and refrigerate. Keeps for at least 2 weeks.

You can check out Conner’s excellent website, Modern Mediterranean, replete with more recipes and information on the cancer-fighting benefits of the Mediterranean diet,  here. and her You-tube channel here.

Of course, the skeptical cardiologist Heart Nuts project advocates just eating  heartnutsunadulterated hazelnuts along with other healthy drupes, nuts and legumes for snacking and soon we will be distributing these to you using our trademark-pending walnut-auscultating squirrel, Sparky.

Notnutellingly Yours,

-ACP

 

Sheepshead Fish: Vulnerable and Gender Fluid Yet Mighty Tasty

The skeptical cardiologist and his Eternal Fiancee’ have escaped dreary and oceanopenic St. Louis and are spending a week in allegedly sunny and definitely beachy San Diego.

Upon arrival we took in a Farmer’s Market in Little Italy and stumbled into Ironside Fish and Oyster.screen-shot-2017-01-22-at-9-07-04-am
Always in search of heart-healthy, unique and local fish dishes, I spotted on the menu a luncheon special of sheepshead fish.

Kelly Fukushima is the local fisherman who caught my fish
Kelly Fukushima is the local fisherman who caught my fish.

California sheepshead (Semicossyphus pulcher), the existence of which I was previously unaware, turned out to be a fascinating and most delicious fish.

casheepshead

Before I could order it, I had to verify that I wasn’t contributing to the extinction of a species.  The IUCN Red List of Threatened species lists the CS as “vulnerable” because:

“The natural history of this species, including its limited geographic range along inshore habitat, the likely increasing interest in the fishery and the currently unsustainable fishing levels (according to the models of Alonzo et al. 2004), together with the difficulties in enforcing existing regulations strongly suggest that this species will continue to decline if stronger protective action is not put into place. “

After learning the CS was vulnerable, I had to make a critical decision: should I eat it before it disappeared, robbing me of a chance to ever taste it, or should I order something that wasn’t vulnerable, thus contributing to the preservation of the continuing biodiversity of the planet. I elected to taste it.

Gender Fluid Fish

Further research revealed that the CS transitions from a reproductively functional female at birth, to a functional male during the course of a lifespan in response to social factors (?reverse Bruce Jenner).

According to evolution.berkeley.edu this is termed sequential hermaphroditism:

In some sequentially hermaphroditic fish species, animals develop first as male and then switch to female (a condition called protandry), and in others, the individuals develop first as female and then switch to male (protogyny).

Clownfish (as in Finding Nemo) do the opposite of the sheepshead and are protandrous:

This species lives within sea anemones in groups of two large fish and many small fish. The two large fish are the only sexually mature fish and are a male and female breeding pair. All of the smaller fish are male. If the large breeding female is removed, her male mate changes sex to female and the next largest fish in the group rapidly increases in size and takes over the role as the sexually mature male.

While waiting for the vulnerable and sequentially hermaphroditic sheepshead to arrive, I sampled an equally

img_8160stupendous and heart-healthy side of cannelloni bean cassoulet. Chock full of Mediterranean diet essentials including kale, beans and mustard seeds, it worked really well as an appetizer.

 

Do not make the mistake of looking at this youtube video while waiting for your sheepshead entree’ as I did. The disturbing human-like teeth will not be part of your meal.

Finally, the 4 ounces of CS arrived, perfectly prepared a la plancha,

img_8162with an accompanying lemon butter sauce that was divine. Although butter is not officially a big part of the Mediterranean diet, frequent readers of the skepcard know that dairy fat does not make you fat or promote heart disease, and is fine (in moderation of course) as part of a heart-healthy diet.

Speaking of lingering bad dietary advice, if you investigate the nutritional content of sheepshead at a site like SELF Nutrition, the screen-shot-2017-01-22-at-10-18-54-amold canard that we should be limiting our dietary cholesterol raises its ugly head. Because sheepshead contain significant amounts of cholesterol (presumably from carnivorously munching on shellfish with its scary human-like choppers), the misguided nutritionists at SELF Nutrition and other would-be nutritionistas pronounce it as not optimally healthy.

Semiccossyphusilly Yours

-ACP

PS. If you’d really like to get your nerd on about sequential hermaphroditism check out this graphic showing the independent evolution of this feature across different phylogenetic lineages!

hermaphroditismtree

 

 

 

 

The Name For The Nuts Poll: Part Deux

The results of my request for reader input on naming the mixed nuts based on the PREDIMED study I plan to give out to my patients are hot off the presses.

screen-shot-2016-11-02-at-2-50-42-pm

 

 

The winner of the pre-specified names was “Pearson’s Health Nuts.”

Second place went to my personal favorite “Dr. P’s Stroke-bustin’ Nuts.

However, readers submitted some suggestions not in the poll:

screen-shot-2016-11-02-at-2-50-53-pm
And I had one patient bring in her suggestion with a design already created!:

img_7954-1

and one sketch out her suggestion on what appears to be a post-it note:

img_7959
I’ll term this heart (symbol)NUTZ in the poll

Consequently, I’m soliciting your input into a revised poll that incorporates some of the newer suggestions.

There is much excitement here at mixed nut central because the non-fumigated raw almonds have arrived!

Polldaddily Yours

-ACP

 

 

 

Raw Almonds From The Gas Chamber or: A PPO Most Investors Should Avoid

In my previous post highlighting the marketing hype, silliness, and duplicity surrounding Kind bars, I revealed that the skeptical cardiologist would soon begin issuing bags of special stroke-busting  nuts to his patients.

I solicited a catchy name for the sacks.

One reader suggested:

“The Snack” or “Snack?” No one will forget that name.. In the center of a small heart shape on the front of the package will be shown the type of nuts (either written or better as a picture.. )

Another:

How about “Pearson’s Health Nuts?” It could refer to both the nuts and the eaters.

Another:

“Nuts About Nuts!”

The logo is a kindly cardiologist, in a lab coat, peering over the top of his glasses, with a stethoscope draped around his shoulders.

Another

Call it Pearson’s delight!!! I always keep a bag of nuts mixed with raisins, m&ms, almonds and cashews. Have done this for last 3 years. But some times I over eat them. But better than junk food..hope this is ok

(Raisins and M & Ms are right out! Too much sugar)

I’ve created a poll that I would appreciate your voting on. I can guarantee this will be less controversial than the Presidential election.

Raw Almonds: Straight From Fumigation

While exploring where to obtain the best walnuts, almonds, and hazelnuts for these “yet to be named” snacks, I discovered that the vast majority of almonds consumed in the US have been pasteurized by fumigation with an organic chemical called propylene oxide (PPO).

Because of two salmonella outbreaks involving almonds from California, the FDA mandated in 2007 that all California almonds had to be pasteurized either by a steam process or by PPO. Since the PPO process is cheaper, the vast majority of non-organic almonds have been sprayed with PPO. Both PPO sprayed and steamed almonds are marketed as “raw.”

Although I’m not fanatical about choosing organic (with the exception of dairy) I really don’t like the idea of eating things that have been sprayed with PPO.  PPO is primarily used to make polyurethane plastics. The CDC says:

“propylene oxide is a direct-acting carcinogen”

Several online sources state that PPO has been banned in “Canada, Mexico, and the European Union” including this Almond fact sheet from cornucopia.org

https://www.cornucopia.org/almond/Almond_Fact_Sheet.pdf

but it’s more accurate to say that these countries have not approved PPO fumigation.

Consequently, I’m getting my almonds from nutsinbulk.com. They are selling almonds from Spain, grown organically, and they promise there will be no PPO consumed.

Once my nuts arrive and I get them in appropriate sacks with appropriate labels, I’ll start handing them out to my patients.

If anyone has advice on creating such labels and sacks feel free to comment below.

Amandinely Yours

-ACP

P.S. Here’s what the CDC says about PPO

Studies in animals have demonstrated that propylene oxide is a direct-acting carcinogen. B6C3F1 mice exposed by inhalation to propylene oxide developed hemangiomas and hemangiosarcomas of the nasal mucosa. F344/N rats exposed to propylene oxide in air developed papillary adenomas of the nasal epithelium. Degeneration of the olfactory epithelium and hyperplasia of the respiratory epithelium were induced in the nasal cavities of Wistar rats exposed to propylene oxide by inhalation. Squamous cell carcinomas of the forestomach developed in rats administered propylene oxide by gavage. Although epidemiologic data are not available from workers exposed to propylene oxide, the findings of cancer and other tumors in both rats and mice treated with propylene oxide meet the criteria established in the Occupational Safety and Health Administration Cancer Policy [Title 29 of the Code of Federal Regulations, Section 1990.112] for regarding propylene oxide as a potential occupational carcinogen. The National Institute for Occupational Safety and Health therefore recommends that occupational exposures to propylene oxide be reduced to the lowest feasible concentration.

Choosing A “Healthy” and “Natural” Snack: Kind Bars Versus Simple Stroke-Busting Nuts

The eternal fiancee’ of the skeptical cardiologist (EFOSC) deserves serious kudos for (among myriad other things) challenging his conventional ideas about heart-healthy food and serving as his dietary muse.

However, the EFOSC seems to have a weakness for what I would consider a highly processed, sugared up, over-priced piece of marketing hype—Kind Bars.

I asked the EFOSC recently why she was so enamored of Kind Bars and she told me “I like that they are convenient, you can find them anywhere, they are not expensive and they taste good and they are low in sugar and they are 100 times better than all the other snack bars on the market that are expensive and have tons of sugar and chemicals and disgusting things in them:

She also points out that for frequent business travelers, the bars are more convenient (and often cheaper) than buying  a bag of nuts in an airport kiosk.

She is not alone.

The Booming “Healthy and Natural” Snack Bar Business

The “healthy” snack bar business has been booming lately.

The WSJ points out

“Bar makers are opening the floodgates on nuts, dried meats, cricket flour and other nutrient and protein-rich ingredients to compete for consumers and command top dollar. Many of these ingredients cost more than those found in a traditional cookie—and as sources of protein, ounce for ounce, some of them cost more than a steak.There are 1,012 nutrition bars on the market now, compared with just 226 a decade ago, according to a tally by Valient Market Research in Philadelphia.”

Consumers, attracted by convenience and a desire for “healthy and natural” food are paying more for snacks like Kind bars which have high profit margins.

“The average bar costs about two dollars, up from just one dollar 10 years ago, a sign of how much more consumers are willing to pay, or “diminishing price sensitivity,” as Valient founder Scott Upham calls it. “The cost of ingredients makes up only 25% of the price, and profit margins for bars tend to hover as high as 40% to 50%, compared with only 20% to 30% for most other packaged foods, says Mr. Upham.”

Stores love them because “they are individually wrapped and have a long shelf life, yet they are popular and turn over fast.”

Are Kind Bars And Their Ilk Healthy?

Interestingly, about a year ago, the FDA issued a “warning letter” to Kind asking the company to remove the term “healthy” from its product labels.

Violation 1a. of that letter fingers Kind Fruit & Nut Almond & Apricot for having 3.5 grams of saturated fat per 40 grams of food (the so-called Reference Amount customarily consumed or RACC) which is more than the 1 gram of saturated fat per RACC allowed if is one is going to describe one’s food as healthy.

This is clearly a ridiculous and out-dated requirement: saturated fats are a diverse category of nutrients, some of which are likely very healthy (see my posts on dairy fat or coconut oil). According to these criteria, foods that are clearly very healthy such as avocados, salmon and nuts, cannot be labeled as healthy.

Kind fought back and challenged the FDA and the FDA backed down.

According to the WSJ:

“The FDA said in a statement to The Wall Street Journal that in light of evolving nutrition research and other forthcoming food-labeling rules, “we believe now is an opportune time to re-evaluate regulations concerning nutrient content claims, generally, including the term ‘healthy.’”

However, I don’t think Kind bars are necessarily a healthy good food choice. I think people buy them because they have been slickly marketed as “healthy” and “natural.”

As Marion Nestle points out, when it comes to food labels, “healthy” and “natural” are marketing terms.  Their purpose is to sell food products.

kin-17113-4
Is this the most annoying advertising blather in existence? Is the EFOSC a KINDAHOLIC with an uncontrollable love for KIND and spreading kindness?

The ingredients in the almond and apricot Kind bar are: Almonds, coconut, honeynon GMO glucose, apricots, apple juice, crisp rice, vegetable glycerine, chicory root fiber, soy lecithin, citrus pectin, natural apricot flavor.

Nutrition: 180 calories, 10 g fat (3.5 g saturated fat), 25 mg sodium, 23 g carbs, 3 g fiber, 13 g sugar, 3 g protein

Basically, the healthy part of this Kind Bar is almonds and coconut, which you could purchase for a hell of a lot less than what you are paying for this processed junk.

Also, please note that it doesn’t contain any actual apricots, merely “apricot flavor.”

Also, note that the third ingredient is honey and the fourth is non GMO glucose. What on earth is non GMO glucose? Do we really care whether the added sugar you are pumping into your crappy bars is GMO or non GMO?

Some Kind bars are clearly no healthier than a typical Payday candy bar:

img_7567
Is a KIND bar any healthier than these Halloween treats? Is that Jenny in the background, Dr. Pearson’s marvelous medical assistant?

IAs Crains  writes:

“the packaging of the dark chocolate cherry cashew bar advertises the word “Antioxidants.” In other words, the bar isn’t promoted as being low in sugar, so it’s a fair choice to compare with a PayDay.
The Kind bar has 9 grams of fat—1 gram less than PayDay’s bar. The sugar count, at 14 grams, is 2 grams less than PayDay. So far, so good. But this particular Kind product has a total carbohydrate count 1 gram higher than PayDay, and 1 fewer grams of protein. The bar has 2.5 grams of dietary fiber, a fraction more than PayDay.”

The Kind PR machine responds thusly:

“It is not at all a fair comparison to equate KIND’s Dark Chocolate Cherry Cashew bar to a Pay Day,” a company spokesman said. “This completely ignores the nutrient-rich ingredients that are in a KIND bar, not to mention the exponentially lower level of sodium.”

You can buy 24 Payday bars at Sam’s Club for $14, about 61 cents a bar.

To be fair to the EFOSC, she usually only eats Kind bars that have about 5 grams of sugar.

Preventing Stroke and Heart Attack with 30g of “Mixed Nuts” Daily

In a previous post (Nuts, Legumes, Drupes and Mortality)  I summarized the evidence IMG_3593supporting the cardiovascular benefits of consuming various kinds of nuts.

The PREDIMED trial, in particular, showed a remarkable benefit in reducing heart attacks and strokes when patients ate a Mediterranean diet supplemented with 30g mixed nuts per day (15g walnuts, 7.5g almonds and 7.5g hazelnuts). Walnuts and almonds are actually drupes, but hazelnuts are true nuts.

The  Mediterranean diet, including nuts, reduced the risk of cardiovascular diseases (myocardial infarction, stroke or cardiovascular death) by 30% and specifically reduced the risk of stroke by 49% when compared to a reference diet consisting of advice on a low-fat diet (American Heart Association guidelines). The Mediterranean diet enriched with extra-virgin olive oil also reduced the risk of cardiovascular diseases by 30%.

You can buy 454 grams of walnuts or hazelnuts for $14 , and 454 grams of almonds for $10. Thus, for 46 cents for the walnuts, 23 cents for the hazelnuts and 16 cents for the almonds (total 85 cents) you can recreate the snack that the Spaniards ate in PREDIMED.

This compares to Kind bars which retail anywhere from $1.99 to $3.50.

The PREDIMED investigators explain why they chose these specific nuts:

“WALNUTS. Walnuts differ from other nuts in that they are very rich in omega 6 and omega 3 type unsaturated fats. Moreover, the antioxidants they contain are among the most powerful in the plant world. It should be mentioned that, like omega 3 in fish, nut fats possess important beneficial properties for general health and the heart in particular.

ALMONDS. Almonds form part of many traditional desserts and sweets of Arabic origin, such as nougat. Currently, Spain is the second largest producer and consumer of almonds in the world, after the United States. As with hazelnuts and olive oil, almonds are rich in oleic acid. They differ from other nuts in that they contain more fibre, vitamin E, calcium and magnesium.

HAZELNUTS. Hazelnuts, another widely consumed nut in Spain, are very rich in oleic acid. Furthermore, they are nuts that provide a large amount of folic acid, a vitamin very important for regulating the metabolism, a lack of which can lead to thrombosis and an acceleration of degenerative processes such as arteriosclerosis and senile dementia.”

Unfortunately, I can eat neither hazelnuts nor walnuts (tree nut allergy), but I’ve decided to create for my patients little baggies filled with 30 grams of the magical PREDIMED nut mixture. I’ll give these out during office visits as I explain the glories of the Mediterranean diet (I’ll try to forbear elaborating to them the difference between drupes and nuts).

I need a catchy name for these bags-“Pearson’s PREDIMED bags” or “Stroke-busting nuts?”

If any reader or patient has a suggestion, please add it to the comments.

If I choose your suggestion, I’ll provide you with 10 bags of nuts and oodles of glory!

Hopefully, once I start creating the nut bags, the EFOSC will begin to eschew the faux healthiness of Kind bars and embrace the natural and unmarketed goodness of drupes and nuts.

Kindly Yours

-ACP

Somes notes:

A drupe is a type of fruit in which an outer fleshy part surrounds a shell (what we sometimes call a pit) with a seed inside.  Some examples of drupes are peaches, plums, and cherries—but walnuts, almonds, and pecans are also drupes. They’re just drupes in which we eat the seed inside the pit instead of the fruit!

In PREDIMED:

“Every 3 months a supply of 1,350-g walnuts (®California Walnut Commission, Sacramento, Cal), 675-g almonds (®Borges SA, Reus, Spain), and 675 g hazelnuts (®La Morella Nuts, Reus, Spain) is provided to each participant assigned to the MeDiet+Nuts group.”

 

Jamón Ibérico and The Mediterranean Diet

The skeptical cardiologist recently spent a week in the Basque region of Spain intensively researching dietary and lifestyle choices of this unique area.

Spain borders the Mediterranean and is often included in those countries that are considered to be the source of the Mediterranean diet (MD) which I recommend to my patients.

For a good summary of the Mediterranean “diet pyramid” check out this 1995 article.

The definition of the MD varies, often based on what  bias the definer has for particular foods or macronutrients, but initially was considered to be the food patterns typical of Crete, much of the rest of Greece and southern Italy in the early 1960s. The reason for choosing this time era and geography was based on:

  • very high adult life expectancy with very low rates of coronary heart disease, certain cancers and diet-related chronic disease
  • Data suggested common characteristics of  food availability and dietary intake
  • Epidemiological studies throughout the world on populations with similar dietary patterns suggested a benefit

The diet is closely tied to traditional areas of olive cultivation in the Mediterranean region.

The MD of the early 1960s had the following characteristics:

  • an abundance of plant foods (fruit, vegetables, breads, other forms of cereals, potatoes, beans, nuts and seeds)
  • minimally processed, seasonally fresh and locally grown foods
  • fresh fruit as the typical daily dessert
  • sweets containing concentrated sugar or honey consumed a few time per week
  • olive oil as the principal source of fat
  • dairy products (principally cheese and yogurt and full fat) consumed in low to moderate amounts
  • fish and poultry consumed in low to moderate amounts
  • zero to four eggs consumed weekly
  • red meat consumed in low amounts
  • wine consumed in low to moderate amounts, normally with meals

I stayed in a small beach town, Deba, in Spain which is half way between Bilbao (famous for its Guggenheim museum) and San Sebastian. There were very few non-Spanish tourists in Deba so  presumably the dietary and lifestyle choices I observed are representative of current Basque choices although likely different from the early 1960s.

I found the Basque people in Deba to be welcoming and joyful and European statistics show the Basque to be among the most satisfied with their overall life and job conditions.

Interestingly, the  life expectancy of the Basque population in  2000 in years was  75.8 for men and 83.8 for women, and by  2011 it had increased to 79.3 and 86.1, respectively. The Basque women live longer than women in any other country in Europe.

Walking around the squares of Deba I observed two activities which I would ordinarily have presumed would result in a low life expectancy: lots of cigarette smoking and lots of Jamón consumption.

hanginghamsHam was everywhere in Deba, from the supermarkets to the cafes. A typical appetizer choice was a plate full of Jamón Ibérico. Most of the pintxos (Basque-style tapas) we saw consisted of Jamon on bread.

From  jamon.com (dedicated to the fine art of ham):

jamon“Picture paper-thin strips of dark red ham like petals ringing a hand painted plate. Imagine big honest hams curing in the mountain air. Picture individual hams resting on stands in family kitchens throughout Spain with a long slim knife at hand for any and all to slice a treat.

In Spain, Jamón is hospitality. Jamón is Spain. Of all the European hams, jamón from Spain is the Gold Standard.”

Jamón, dry-cured ham, has been eaten in Spain and other Mediterranean countries since ancient times. There are basically two kinds: hams from rustic and free range  pigs (Iberia, Corsican or Cinta Senese) and hams from intensively-reared white pigs (Serrano, Parma, Bayonne).

Both hams involve a moderate salting and a ripening period of 7-14 months for white pigs and over 20 months for Iberian hams.

When they are finished curing, they have an incredibly complex taste,  distinct marbling, a deep red color and an intense ham flavor.

The most sought after ham is Jamón Ibérico de Bellota: a sub category of Jamón Ibérico” where the pigs are free to roam the meadows of the ‘dehesa’. During the autumn prior to their sacrifice, they are encouraged to gorge on acorns (bellotas) from the holm oak and cork trees, sometimes gaining as much as a kilo of weight a day.”

Health Consequences of Eating Jamón Ibérico.

A 100 g serving of Jamon Iberico contains 375 calories, 200 of them from fat. Of the total 22 grams of fat, 6.5 grams is saturated, 2 grams polyunsaturated, and 13 grams monounsaturated . There are 43 grams of protein and a lot of sodium ( 1.1 grams).

If we follow most current nutritional guidelines we would be advised to avoid Jamon because it is a considered a processed meat and it contains lots of salt and saturated fat.

Despite eating lots of Jamon,  however, the Spanish and Basque do very well in terms of longevity and rates of heart disease.

joxeancider
Our Basque host, Joxean, pouring cider from a giant wooden barrel at a “sagardotegi” or Basque cider house after yelling “Txotx”. See here (http://www.euskoguide.com/food-drink-basque-country/sagardotegi-sidreria-cider-house/)

The Basque good health could be related to any number of factors. They consume lots of fresh fish caught in nearby ports and prepared with lots of garlic and olive oil. (I had the best monkfish of my life in a cider house in the hills near Deba). Fish and olive oil are clearly beneficial dietary components.

They also drink alcohol in varied forms, including locally sourced apple cider, beer and fine local wines from Rioja.

moreflyschThey are active and they have long stretches of beautiful coastline to hike (including this geopark), some of the best surfing beaches in the world, and hills for cycling.

Ultimately, a healthy lifestyle consists of enjoyable and sustainable exercise and an enjoyable, sustainable  and palatable diet composed of  a combination of foods (mostly plants) , interacting in myriad unmeasurable ways. Focusing on specific fat (other than industrially produced trans fats) or sodium content is not a particularly useful approach.

I think Jamon can be considered part of a healthy Mediterranean diet when consumed in moderation and when combined with an active physical lifestyle. It makes a wonderful addition to anyone’s diet.

Jamónly yours,

-ACP

 

 

Why I Recommend the Mediterranean Diet

I recommend the Mediterranean diet (MED) to my patients. Every unbiased, systematic review of the research on diet and heart disease in the last 8 years has concluded that it is the most likely dietary model to provide protection against coronary heart disease. One review concludes

Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD (coronary heart disease) in randomized trials.

The MED is the only comprehensive dietary approach that has been proven to reduce total death  and heart attacks in comparison to standard diets. There are two major randomized controlled trials (the only kind of study that proves the value of a dietary intervention) with this diet.

lyon
From Eric Roehm at http://www.nutritionheart.com

  The first, called the Lyon heart Study,  was in patients who had had heart attacks (secondary prevention) . As this graph demonstrates, those patients randomized to receive instruction on following the Mediterranean diet had a 60% lower death rate and a 70% lower heart attack rate. The second was published last year in the New England Journal of Medicine and was a primary prevention study: that is, participants had not had heart attacks. Participants were randomized to one of three diets: a MED supplemented with extra-virgin olive oil,  MED supplemented with mixed nuts or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and either free provision of olive oil, mixed nuts or small nonfood gifts. The high extra virgin olive oil group ingested an average of 3.6 tablespoons/day (51 grams/day equal to 459 calories/day) of olive oil with 98% of it being extra virgin olive oil. The high nut group ate 8.2% of their total daily calories in the form of nuts, including an additional approximately one ounce packet of nuts (15g of walnuts, 7.5 g of almonds, and 7.5g of hazelnuts) provided by the study coordinators. 7447 persons were enrolled (ages 55 to 80 years) for an average 4.8 years. Those persons following the MED diet (either supplemented with olive oil or nuts) were 30% less likely to have  a major cardiovascular event (heart attack, stroke or death from cardiovascular causes.) There was a statistically significant reduction in stroke rate (≈39%) when considered as an isolated endpoint. We don’t know exactly what components of the MED are the most beneficial.  This trial suggests that olive oil and nuts are at least two of the key ingredient so it makes sense to increase your consumption of these foods. Other studies strongly support fish consumption and alcohol consumption as key components. As I’ve discussed (?ad nauseam) in other posts, full fat dairy and eggs, although banned by most “heart healthy diets”, have not been shown to increase heart disease risk.  Fermented dairy consumption, in particular, in the form of plain full-fat yogurt (not adulterated with sugar) and full-fat cheese is consistently associated with a lower risk of coronary heart disease. Plain full-fat yogurt and full-fat cheese (from goat milk) were consumed by the inhabitants of Crete, the Greek Island on which the original MED was based.

It has to be emphasized that within this pattern of eating you want to be consuming real foods, not processed products of the industrial food industry which have been manipulated to appear healthy due to being “low-fat” or “low cholesterol.”

This is a pattern of eating which is varied, interesting and sustainable.

It’s one that can last a lifetime. ,