Paleo Panacea?

If you have been listening lately, you have probably heard the Paleo Diet sales pitch. And to be sure, many of the Paleo Diet websites you visit will be happy to sell you something. Here are some examples, where you can also get a summary of the plan;,  There are some very healthy aspects to the Paleo Eating Plan. The focus on fruits, vegetables, nuts, seeds and healthy oils over processed foods and sugar is consistent with most other respected healthy eating plans. This plan can work for weight loss since you are eliminating entire groups of food (grains and legumes). These foods are replaced, at least in part, by less calorie dense foods (fruits and vegetables), which should result in overall reduction of calories. However, basing a diet on a guess of what our ancestors ate raises some important questions.

Do we know what our ancestors ate?
Most adherents to the Paleo Diet will authoritatively claim that our ancestors ate mostly meat, or a great deal of meat. While this may be commonly accepted amongst Paleos or even other lay people, you will not find the same agreement amongst anthropologists. The truth is that we really don’t know what our ancestors ate. There is conflicting research regarding the amount of protein in their diet. More importantly, what they ate probably depended on where they lived. Paleolithic people who lived on the Savannahs in Africa, where the majority of early humans lived, ate quite differently than those who lived in arctic areas.  This is important evidence that we have evolved to take advantage of a great variety of food sources.

Should we eat what our ancestors ate?
Even if our ancestors did eat a certain way, eating like them may be overrated. Consider that our ancestors did not have a nearly unlimited supply of calories as we do. In fact, acquiring food was their full-time job. And it took work. It was physical work over long hours, which required a great deal of energy. Our ancestors, therefore, were likely in constant risk of energy deficit. Our situation is quite different. We are in constant risk of energy surplus. We simply take in more calories than we expend. This is the most potent driver of obesity and related diseases. No matter how many days per week Paleo enthusiasts do an hour of CrossFit before spending the day at the office, they are not going to approach the daily energy output of our Paleolithic ancestors. The diet that our ancestors ate, whatever it consisted of, was appropriate for their lifestyle, but not necessarily ours. Meat, as a calorie rich food source, may have been desirable for people constantly at risk of energy deficit. The last thing we need to accompany our sedentary lifestyle is more calorie dense food.

Can we eat what our ancestors ate?
While we don’t know how much meat our Paleolithic ancestors ate, they certainly didn’t eat domesticated beef or pork. If they did eat fowl, it didn’t resemble anything we eat today. Their most abundant meat source had to be what was easiest to catch and kill, which was probably more similar to squirrels and mice than cows and pigs. The meat we eat today is far from Paleo in its nutritional comparison to the meat that our ancestors ate. Wild game would be closest. How many Paleo dieters are using this as their main protein source? Even the recommendation that we consume a similar amount of protein as our ancestors is difficult to follow considering that the range of estimates is so broad, and that the upper level of the range would most likely be toxic. The domesticated plants we eat also differ significantly from the wild plants our ancestors ate.

What is the potential health risk?
It is clear from examining multiple sources of information regarding the Paleo Eating Plan that relatively high meat consumption is part of the plan. This is true regardless of the source of the Paleo information. In fact, meat is often listed before fish and seafood, and before fruits and vegetables. This represents a disconnect between the Paleo Plan and the majority of scientific studies on the relationship between red meat consumption and risk of various diseases, including cardiovascular disease and certain cancers. The body of scientific research supporting this relationship is abundant. Anyone interested in the detail can easily find numerous studies with a simple search in Google Scholar or through your local public library. Red meat consumption has been linked to increased risk of atherosclerosis, stroke, coronary artery disease, colorectal cancer and diabetes. While the exact mechanism for this relationship is not fully understood – our knowledge is constantly evolving – the current evidence is clear that meat consumption correlates with disease and mortality risk.

The Paleo people argue, “But what about our ancestors, they were healthy and ate lots of meat. They weren’t all dying from these ‘diseases of civilization.’ It must be the milled grains and legumes.” Atherosclerosis, coronary artery disease and stroke are diseases of aging. They usually do not manifest until later in life. Our average Paleolithic ancestor did not live long enough to suffer the effects of these chronic diseases. However, CT scans of mummies up to 5,000 years old from various cultures show development of atherosclerosis. Most likely, these individuals died from some infectious disease or injury before heart disease could do them in.

What is the bottom line?
If you want to lose weight, any plan that eliminates entire food groups will probably work if adhered to.  Elimination plans however, are not necessarily the most healthy or sustainable. To eat as healthfully as possible, take the Paleo recommendations and rearrange the order a bit. A better order would look like this: vegetables, fruits, healthy oils, nuts and seeds, fish/seafood, meats. Reduction in starchy foods, without total elimination, is a positive goal considering our over-reliance on these foods, especially the highly refined variety. What you end up with is similar to the Harvard School of Public Health Healthy Eating Plan, which is a good place to start a quest for balanced and healthful eating.

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The confusion continues in the world of diet and nutrition. A new study comes out that seems to conclusively show that a specific diet is better than another at reducing the risk of cardiovascular disease. The study was published in the February 25th New England Journal of Medicine and is the largest randomized study to date comparing efficacy of the Mediterranean Diet to others. This particular study compared two variations of the Mediterranean Diet, one supplemented with olive oil and the second supplemented with walnuts, to a low-fat diet. Many experts are hailing the results as “compelling evidence” of the effectiveness of the Mediterranean Diet in lowering cardiovascular risk. The number of participants in the study was relatively large, 7400 individuals, and the reduction of cardiovascular risk was clearly significant. However there are dissenting voices who claim that the low-fat diet used was not an appropriate comparison since the analysis of intake from this group indicated a fat intake of 37% of calories. A typical low fat diet would recommend a lower percentage of calories from fat.

There is little agreement regarding the best diet to follow for prevention or reversal of cardiovascular disease because there is not a great deal of research comparing cardiovascular outcomes with different diets while controlling for other factors. While this study comparing Mediterranean Diet to a low-fat diet does not drastically change this reality, there are some important points that are illustrated by this study. Critics of the study correctly claim that the control diet should not be considered low-fat. The decrease in fat intake by the control group is a statistically insignificant 2%. In addition, even though the reduction in saturated fat- the type most associated with cardiovascular risk- was greater in the low-fat group, the difference between the Mediterranean group and the low-fat group was statistically insignificant. The bottom line is that the difference in fat intake and saturated fat intake between the groups could not account for the greater reduction of cardiovascular outcomes seen with the Mediterranean diet. So what were the significantly different dietary measures between the two diets? Almost every other measured parameter produced statistically significant changes between the groups, but let’s concentrate on the ones that would be expected to be different between when comparing to a low-fat diet.

Calorie reduction was greater in the low-fat group. The percentage of calories from carbohydrates increased in the low fat group and decreased in the Mediterranean groups. A greater decrease in fiber intake was seen in the low fat group, despite the greater increase in overall carbohydrate intake. Consumption of monounsaturated fats- considered to be heart healthy fats- increased in the Mediterranean group while decreasing in the low fat group. There was also a significant difference in the change in intake of polyunsaturated fats between the groups. We can also see a large difference in change in intake of olive oil and nuts between the two groups with the Mediterranean group having showing a statistically significant greater increase in consumption of these two foods. In fact, in their discussion, the researchers offer the possibility that the differences in cardiovascular outcomes may have been directly related to differences in consumption of these two foods.

So how can we draw meaningful conclusions from this study despite its limitations? The conclusions drawn by the researchers regarding the positive influence of the Mediterranean Diet on risk of cardiovascular disease is consistent with other studies. When reviews are done of the scientific literature, the Mediterranean diet is consistently ranked highest with regard to support of its efficacy by patient-oriented evidence. The evidence for low-fat diet significantly reducing or reversing the risk of cardiovascular disease is not as conclusive. In fact, the largest study conducted, the Women’s Health Initiative Trial, concluded that low-fat diet did not reduce the risk of cardiovascular disease. There is more evidence that type of fat in diet, more than amount of fat, has a meaningful impact on disease risk. This may help explain the success of Mediterranean diet in NEJM study and other studies. It may be the increase in monounsaturated fats from olive oil and nuts, and omega-3 fatty acids from seafood and walnuts that is responsible for the cardio-protective nature of the Mediterranean Diet.

Regardless of whether it is appropriate to call the resulting diet pattern of the control group in the NEJM study “low-fat”, it is clear that there was a significantly greater increase in carbohydrate intake and decrease in overall calories. This would be the goal of a low fat diet. Despite these desirable changes, this diet pattern did not fare as well when evaluated for improvement in cardiovascular outcomes. The fact that this diet pattern did not conform to what many critics would consider a true and healthful low- fat diet may be due to the difficulty in adhering to a restrictive diet plan. The authors report unchanged results even after this group began to receive more intensive diet instruction. Maybe focusing on one nutrient group is not the most effective way to improve the healthfulness of a diet. Maybe it is the Mediterranean Diet focus on foods and not nutrients that is the key to the positive outcomes consistently found.

So where does that leave us in this world of dietary confusion. Keep it simple. Concentrate on food, not nutrients. This is what sets the Mediterranean Diet apart from most others. There are numerous problems in focusing on individual nutrients. Doing so is often unsustainable. Most foods are not made up of just one type of nutrient. Most importantly, the influence of diet on our health status is a function of multiple interactions between the substances we take in, our genetics and other environmental factors. One isolated nutrient does not have the same affect on our health as our average intake patterns. The ambiguous results of scientific studies, involving single nutrients and health outcomes, are evidence of this. Instead of worrying about fats, carbs and protein, eat whole, unprocessed foods whenever possible. Plan your diet with vegetables and fruits as the primary focus. Eat legumes and whole grain products. Then add fish, seafood and lean poultry. Have red meat occasionally. Avoid refined grains, added sugar and packaged foods with a multitude of ingredients (especially ones that you can’t pronounce). Now there is a diet nearly everyone can agree on, regardless of the name!

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Debunking the Debunkers

I believe virtually everything I read, and I think that is what makes me more of a selective human than someone who doesn’t believe anything.

 -David St. Hubbins, fictional lead singer of the fictional band Spinal Tap in the 1984 movie “This Is Spinal Tap”

With so much conflicting information tossed around about weight loss, it is no wonder that there seems to be as many diets as there are people trying to lose weight.  The fact is that there is much we still do not know regarding how the body responds to reduced calorie intake, weight loss and change in body composition.  An article published online in the January 31 New England Journal of Medicine claims to identify and refute common myths about obesity and weight loss.  While this sounds like a worthwhile exercise, there are some serious questions about the methodology and conclusions.

The authors claim, “using internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions.”  However, conflating popular media with scientific literature is troublesome.  Since they are combined in this search, it would confuse whether these “myths” were prevalent in the popular media and scientific literature, just one, or both.  The authors then go on to say that their search of the scientific literature does not support these myths.  How can they claim that these myths are prevalent in the scientific literature if they are also claiming that the literature doesn’t support these claims?  It sounds like they are inventing a problem so they can solve it.

I can go on further about the methodology, but let’s get to the myths and the debunking.  Myths refuted by the authors include:

  • Small changes in food intake or exercise will result in large, long-term weight changes. This is based on the idea that a 3500 calorie change in energy balance equals one pound per week- The authors point out that this does not take into account changes in energy requirements that take place as body mass changes, resulting in the need for further changes in intake or exercise.
  • Realistic weight loss goals increase success- Instead, authors claim that studies indicate more ambitious goals lead to more weight loss, e.g. TV’s Biggest Loser.
  • Slow, gradual weight loss leads to greater success-  The authors refer to a review of weight loss studies that concludes that rapid weight loss resulted in significantly more weight loss at six months.

Another idea that the authors claim there is insufficient evidence to support is that adding fruits and vegetables to the diet results in weight loss.  They state that adding calories from any source will not result in weight loss.

As with most debates, terminology and context are critical to evaluating any claims made or refuted.  This NEJM article may be more about language than science.  For example, evaluating the accuracy of the claim that “small changes in food intake and/or exercise will produce large, long-term weight changes,” requires a definition of small and large in the context of caloric change and weight loss.  What is considered a small change in food intake or exercise?  What is considered a large weight change?  What is considered a long-term weight change?  And is this even a commonly used claim?  It is true that people trying to lose weight are encouraged to commit themselves to modifications that they can actually accomplish.  But small and large are relative terms.  “Realistic” and “achievable” is the terminology more commonly used in weight loss counseling.  And while it is correct that the 3500 calorie rule has limitations, it is still scientifically accurate.  Because of the limitations and the need to account for changes in metabolism, the rule is not appropriate to predict weight loss.  But it is still a useful tool in estimating the lifestyle changes necessary to begin losing weight.

We run into more tricky semantics with the “realistic goals” versus “ambitious goals” argument.  The authors seem to be claiming that ambitious goals result in greater success than realistic goals.  Is ambitious the opposite of realistic?  Can’t goals be ambitious and realistic?  It seems unlikely that anyone would suggest that it is best to set unrealistic (the actual opposite of realistic) goals.  An equally important question is “how do we define these terms?”  Is there a scientific definition for ambitious in relation to weight loss?  Is there one for realistic?  Certainly, any claim of evidence that either one of these types of goals led to greater outcomes would require using accepted definitions of both terms, and ones that are used consistently throughout the literature.  The example of TV’s The Biggest Loser shows how the promise of prize money may be just what is needed to transform an unrealistic goal into a realistic one.

How about the slow versus rapid weight loss debate?  The study cited by the authors concludes that those individuals that experienced rapid weight loss lost more weight in the same time than those that lost weight more gradually.  It seems that the purpose of this study is to restate the definition of rapid!  But there are more semantics at play here.  In the few studies done that examine rate of weight loss, different definitions for rapid and slow are used.  In this study, slow weight loss is defined as less than or equal to 0.5 pounds per month, while rapid weight loss is defined as greater than or equal to 1.5 pounds per month.  Another study defined slow weight loss as less than 1.6 pounds per week, while other studies use percentage of current body weight to define rate of weight loss.  Without standardizing the parameters for rate of weight loss, it is useless to make comparisons. There are also a number of studies that found increase loss of lean body mass with increased rate of weight loss.  Since the goal of weight loss is to lose fat- not bone, muscle and water weight- a limit on rate of weight loss would seem to be an appropriate recommendation.

The most extreme example of manipulation of language in the NEJM article is the treatment of the claim that adding vegetables to the diet will not result in weight loss. Once again, it is technically accurate that adding calories from any source will not result in weight loss.  I am sure that there are examples on the internet, and in other sources that state the recommendation in this manner.  However, the more common, professional recommendation is that increased vegetable intake replace foods with higher caloric density.  It is difficult to imagine that the authors did not understand this distinction when crafting this piece.

One would wonder why the NJEM article is written in this manner, with so much obvious lack of verbal clarity, or why it was written at all.  One possible answer to this question can be found in the 383 word disclosure statement at the end of the article.  The statement is a Who’s Who of the industrial food and pharmaceutical industries.  While no financial support from these companies was disclosed for this particular article, a number of the authors receive income from, and/or serve on the boards of companies from the commercial foods, pharmaceutical, and weight loss industries, and their accompanying foundations and trade groups.  These include McDonald’s, Kraft, Coca-Cola, Novo Nordisk, GlaxoSmithKline, Pfizer, Jenny Craig, International Dairy Foundation, National Cattlemen’s Association, and others.  This fact alone does not disqualify the authors from publishing, nor does it render information in this particular article inaccurate.  However, it does help to explain possible motivation for publishing this particular article, and it does shed light on the semantic ambiguity of the information presented.

The fact is that there is not a great deal of quality, large-scale research that has been done in the area of weight loss from which broad conclusions can be drawn.  The most effective way to lose weight and maintain the weight loss continues to be designing an individualized lifestyle modification plan that is specific to each person.  This plan should take into account the person’s current lifestyle limitations, goals, feeling of self-efficacy, and health status.  Most importantly, these modifications need to be sustainable in order to preserve success.

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The Incredible Edible BEET

When I was growing up, the only thing I knew about Beets was that they were
what Borscht was made of.  Borscht is a cold soup prepared from red Beet roots.  It is
of Ukrainian origin, although it has been prepared historically in other Eastern
European cultures with various other ingredients.  I also knew that I didn’t like Borscht, so
there was no reason to think much more about Beets.

These days I think much more about Beets as they have become a regular part of my diet.  I still however, do not eat much Borscht.  But there are many other great ways to prepare Beets, from roasting to steaming.  I like to serve them with Chevre (Goat cheese), or as a salad with Onions and Apple cider vinegar.  For many of us who like Beets, it is their earthy sweetness that attracts us.  Those on the other side of the “Beet fence,” liken this earthiness to eating dirt.  No worry-when my mother would stress over my fondness for eating dirt as a child, our Pediatrician would assure her that as long as I didn’t consume more than one pound I would be fine!

Modern day cultivated Beets are descendent from the wild Sea Beet that is found along the shores of the Mediterranean, Northern Africa and Southern Asia.  Throughout history, Beets and Beetroot juice have been used for medicinal purposes.  Romans used Beet root as a treatment for fever and constipation.  Beets have also been used to treat conditions of the digestive system and the blood, as well as liver detoxification.  In ancient times, Beetroot juice was believed to be an aphrodisiac. Beets are available in a variety of colors, including deep red, marbled red and white, and yellow-orange.  Each variety has a different flavor profile.

While Beets and Beetroot juice may not be a medicinal cure all, their nutrient composition does endow them with a variety of benefits associated with disease prevention.  One cup of raw Beet root contains 15% of recommended daily amount of fiber.  It is also an excellent source of the B vitamin Folate (37% daily value), and the mineral Manganese (22%), as well as a good source of Vitamin C (11%), and Potassium (13%).  Beets also contain other important nutrients in smaller but significant amounts.  These include other B vitamins, Iron, Magnesium, Phosphorus, Zinc and Copper, as well as some protein.  The pigments that supply Beet roots with their characteristic color play an important role in the prevention of disease.  Studies have shown that these pigments, Betalains, are powerful anti-oxidants that may be protective against cancer, blood vessel plaque formation (the cause of cardiovascular disease), and may also aid in liver detoxification.  They have also been found, along with other substances found in Beet roots to inhibit inflammation, which is associated with lower risk of chronic disease.

Cooking Beet roots will decrease the nutrient content.  The extent to which the nutrient content is degraded depends on the cooking method.  Boiling results in the greatest nutrient loss, while roasting preserves the nutrients best during cooking.  When purchasing Beets, choose the smaller ones and roast them whole.  This is most effective way to prevent nutrient loss.

Beetroot juice has also been found to be effective at lowering blood pressure.  Multiple studies have shown that Beetroot juice lowers blood pressure within as little as three to six hours with the effect lasting up to twenty four hours.   While drinking straight Beetroot juice may not sound very appealing, a more palatable mixture of Beetroot juice with Apple juice 72% to 28% also lowered blood pressure effectively.  One study indicated positive effect on blood pressure with as little as 1 cup of Beetroot juice.  Like leafy green vegetables, it is the high nitrate content of Beetroot juice that is most likely responsible for its influence on blood pressure.  More research needs to be done before Beetroot juice can be recommended for clinical use to treat high blood pressure.  However, since Beet roots can be consumed as part of a healthy diet, individuals with diagnosed high blood pressure or pre-hypertension may benefit from adding Beetroot juice to their daily routine.

So get out the juicer and lower your blood pressure.  You can purchase freshly prepared Beetroot juice at the Juice Bar of most natural food stores, but it is much more economical to juice your own.   Mix the Beetroot juice it with Apple or some other fruit juice to add sweetness.  Or just roast some Beets with dinner.  Toss small ones with Olive oil and Garlic powder, and bake at 400 degrees until soft.  Much tastier than Borscht!

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To Yolk Or To Smoke?

By now, many of you have seen the headlines or read the articles.
– Egg yolks almost as bad for your heart as smoking cigarettes, says study – NY Daily News
– No yolk: eating the whole egg as dangerous as smoking? – LA Times
Egg yolks almost as bad as smoking, researcher says – Vancouver Sun
It was also all over the internet:
– Egg Yolk Consumption Almost as Bad as Smoking When It Comes to Atherosclerosis, Study Suggests AND
Eating egg yolks accelerates atherosclerosis in a manner similar to smoking cigarettes, new research shows.- Science Daily
Egg Yolks Just as Bad as Smoking for Your Heart – Eating egg yolks can be as bad for your health as smoking, a new study says.- Medical Daily
Eating egg yolks as ‘bad as smoking’ – Nursing Times
And of course it was also all over the TV and radio news.  Just when you thought it was safe to eat eggs, we find out that eggs are bad.  Well, not so fast!

This morning, just as I do approximately three times a week, I enjoyed two eggs for breakfast.  I didn’t take out the yolks either.  Am I crazy?  Do I have a death wish?  Should I just take up smoking and get it over with?  I may be crazy, but I don’t have a death wish, nor will I start smoking.  I am also sure that eating eggs is not nearly as bad for your heart and arteries as smoking.  The scientific study that these headlines are referring to is a peer-reviewed article by three Canadian researchers to be published in the journal Atherosclerosis.  The researchers analyzed plaque buildup in carotid arteries of 1262 people referred to Canadian vascular prevention clinics.  They compared plaque buildup of smokers with that of self reported consumers of more than two whole eggs per week.  Despite all of these headlines, at no point in this article did the authors state that eggs or egg yolks are nearly as bad for you as smoking.  They did state that their results suggested a relationship between egg consumption and build-up of arterial plaque within the population they studied.  They concluded that their results suggest that egg consumption should be avoided by individuals at risk of cardiovascular disease.  They go on to acknowledge the limitations of their study, most importantly that they did not consider, nor control for other nutritional and lifestyle factors that may have accompanied egg consumption, and therefore may also have an influence on the buildup of plaque in arteries.  Some of these factors include dietary habits known to correlate with plaque buildup, physical activity level, and waist circumference.

The disconnect between the headlines and the actual conclusions of the researchers leads me to question whether the people writing these news articles actually read the study.  While it is clear that the researchers acknowledged the limitations of their study, these limitations diminish the studies usefulness as part of the overall body of evidence regarding the influence of egg consumption on cardiovascular health.  There are many problems with using the information in this study to conclude that eggs or egg yolks are nearly as bad for you as cigarettes.

First, the authors don’t make this claim.  In fact, scientific research rarely leads to such broad, sweeping, and generalized conclusions.  Most scientific studies, like this one, are limited to the population being observed, and the variables being investigated.  The subjects of this study have all been identified as high risk for developing cardiovascular disease.  The average age of the participants in this study was 62 years. The results of this study cannot be applied to the general population, especially young people and/or those not at high risk of cardiovascular disease.  Drawing conclusions from this is further complicated by the authors’ admitted lack of control over other variables that may have influenced the buildup of plaque including other components of subjects’ diets, level of exercise, and stress.

Correlation between egg yolk consumption and buildup of arterial plaque does not mean that egg yolk consumption causes arterial plaque.  In order to make the jump from correlation to causation, a mechanism for how egg yolk consumption causes buildup of arterial plaque must be identified.  We know how cigarette smoke constricts arteries and contributes to favorable conditions for plaque buildup.  The current body of research, however, mostly contradicts the idea that egg yolk consumption causes buildup of plaque in arteries.  Correlation studies are more useful toward drawing conclusions when there is a correlation between two changes.  For instance, if a study showed that the frequency of cardiovascular disease increased at the same time that egg yolk consumption increased, then maybe there would be more to investigate.  From 1970-1995, egg consumption in the US decreased by 24 percent.  During this time, hospital discharges for cardiovascular disease increased by nearly 3 million.  We see that decreased egg consumption did not correlate with a decrease in incidence of cardiovascular disease.  In fact, the opposite was true.

One medium egg yolk contains approximately two-thirds of the recommended daily amount of cholesterol.  Presumably, it would be the cholesterol in the egg yolk that would be the cause of increased plaque formation.  Studies have consistently shown that dietary cholesterol consumption has little impact on blood cholesterol levels, including the “bad cholesterol” that is associated with cardiovascular disease.  In fact, any rise in “bad cholesterol” found to be associated with egg consumption is matched by a similar or greater rise in “good cholesterol.”  Therefore the ratio of bad to good cholesterol remains unchanged.  It is this ratio that has been found to be a greater indicator of cardiovascular risk than the actual blood cholesterol level.

The manner in which dietary cholesterol is absorbed also contradicts the concept that cholesterol consumption raises blood cholesterol and therefore increases plaque in arteries.  It is questionable whether much of the cholesterol in egg yolk is even absorbed by the body.  On average, approximately half of cholesterol present in the digestive system is absorbed.  Cholesterol absorption is highly influenced by the level of consumption.  As consumption increases, percentage of absorption decreases.  Egg yolks are also high in lecithin, which is known to significantly interfere with the absorption of cholesterol by the body.

The evidence to dispute causation between egg consumption and cardiovascular disease is exhaustive.  That is not to say that egg overindulgence will not increase risk of cardiovascular disease in certain individuals.  Current recommendations are that individuals with high risk of cardiovascular disease limit egg yolk consumption.  This includes those genetically predisposed to cardiovascular disease, and those with other concurrent high risk factors such as Diabetes.

Eggs are a nutrient dense food.  They contain the most digestible and complete protein sources available.  Egg yolks are one of the few foods that naturally contain vitamin D.  They also contain many other important vitamins and minerals and are a great source of choline, an important substance for brain development.  Eggs are relatively low in saturated fat, while high in monounsaturated fats and contain omega – 3 fatty acids.  Eggs consumed in moderation can be part of a healthful, balanced diet.  So there is no need to swear off that omelet.  Just make it a two egg instead of three.


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Mindful Eating

On Saturday, I led the second class in the Nutrition series at Our Family Doctor. The topic was Why We Eat: The Psychology of Eating. In preparing for the class I came across a new resource for approaching the topic. This resource is an intersection between Buddhist principles and traditional thinking about eating habits. The concept that emerges is one of Mindful Eating. There are websites and books written about Mindful Eating. In simplest form, Mindful Eating applies the Buddhist principle of Mindfulness to ones approach to choosing, preparing and consuming food. The synergy that exists between Mindfulness and healthy eating practices is so simple and natural that the connection between the two becomes effortless. The principles of Mindfulness include the following:

• Mindfulness is deliberately paying attention, non-judgmentally.
• Mindfulness encompasses both internal processes and external environments.
• Mindfulness is being aware of what is present for you mentally, emotionally and physically in each moment.
• With practice, mindfulness cultivates the possibility of freeing yourself of reactive, habitual patterns of thinking, feeling and acting.
• Mindfulness promotes balance, choice, wisdom and acceptance of what is.

When these tenets are applied to the act of eating, the following principles arise:

• Allowing yourself to become aware of the positive and nurturing
opportunities that are available through food preparation and consumption by respecting your own inner wisdom.
• Choosing to eat food that is both pleasing to you and nourishing to your body by using all your senses to explore, savor and taste.
• Acknowledging responses to food (likes, neutral or dislikes) without judgment.
• Learning to be aware of physical hunger and satiety cues to guide your decision to begin eating and to stop eating.

The above information as well as much more about mindful eating is available at The Center for Mindful Eating website,

Through Mindful Eating, some of the more dogmatic and restrictive recommendations that we are bombarded with can be loosened, and a larger picture of summary eating behaviors can become the focus. The concept that our relationship with food needs to be one of choice and balance is an antidote to the eat this; don’t eat that information that we have grown accustomed to. It is common when counseling individuals to hear guilt associated with every episode of dessert or overindulgence. The concept of choice and balance is reassuring and a more accurate way of approaching the relationship between food and health. After all, if you were to sit down once and eat an entire chocolate cake, it would have a less deleterious effect on your long term health and body weight than if you were to eat chocolate cake once every day. If you choose to eat a piece of chocolate cake because the opportunity is present, and it brings you enjoyment, then that momentary event should not be judged in and of itself as an unhealthy act. That event will not offset a multitude of other food choices that you might make which would be considered healthy. Overall balance in eating behaviors is more important than single momentary choices. Each choice exists in its moment, but the average of those choices or a balance in those choices is a greater determinant of health.

But even the idea of healthy eating is called into question. A Mindful Eater does not necessarily make individual food choices with a distant health outcome in mind. While not stated, this is consistent with the reality that individual food choices do not cause a specific health outcome. Optimal health is promoted by a combination of proper bodily nourishment, proper mental and emotional nourishment, and appropriate methods of coping with life stresses. The closest that Mindful Eating comes to addressing healthy eating is by advising to choose foods that are “both pleasing to you and nourishing to your body.” The key here is that from the perspective of food, the best way to promote health is to properly nourish your body. This can be done with a variety of food choices, and eating habits. Many different choices may be consistent with the goal of promoting health.

The second great principle that comes from Mindful Eating is “learning to be aware of physical hunger and satiety cues to guide your decision to begin eating and to stop eating.” Adherents of Mindful Eating practices treat the act of eating as one to be experienced completely, with all senses uninterrupted by other tasks or distractions. Food should be experienced completely. In order to achieve this comprehensive encounter, the act of eating should not be accompanied by reading, watching TV or other activities that may take away from the experience of the moment. Of course, this has great value on a spiritual level, but has equal value for the nutritive process. How do we know when to eat, when to stop eating and how much to eat? According to Mindful Eating, our body will supply the cues. The most obvious is hunger, but if we slow down, pay attention and allow ourselves to feel our bodies reaction to food, we will not only enjoy it more, but know when it is time to stop. Eating on the run, lends itself to foods that may not be the most nourishing to our body. When we eat while distracted we need foods that will satisfy us quickly and “loudly.” However, more nourishing foods tend to be more subtle and complex and therefore require our attention to appreciate.

I hope you will visit The Center for Mindful Eating website for more information, and try to incorporate some of the concepts of Mindful Eating into your daily routine.  Also check Our Family Doctor website for the remaining schedule of classes. 


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Welcome to Fred’s Food For Thought

Welcome to Fred’s Food For Thought.  I will be offering my perspective on issues related to food, nutrition and health.  The content will be my perspective as a licensed Nutritionist and Registered Dietitian.  The academic and professional knowledge of Nutrition as it relates to Health and Wellness is very dynamic.  It was not long ago that we thought dietary cholesterol was the biggest killer since smallpox.  Every food package that legally could, claimed to be low cholesterol.  As our knowledge on the relationship between dietary cholesterol and blood cholesterol levels advanced, the sight of low cholesterol food packaging began to disappear.  In other words, yesterday’s truths may be tomorrow’s fairy tale.  The information I will relay here will be based on the most up to date body of research to which I have access, and the recommendations of some of the more respected sources in the field of Nutrition and Health.

Last Saturday, I led the first class in a four session series of Nutrition classes at Our Family Doctor.  The topic was Basics of Nutrition, a quick overview of the main constituents of food and how they are used by the body. We had six attendees who were all very engaged and asked some excellent questions.  The specificity of the questions made me realize how much information about nutrition is publicly disseminated.  This information is not always correct, and much of the information available through popular sources is contradictory.  When considering how to obtain the most adequate nutrition for you and your family, concentrate on balance and variety over specific foods or nutrients.  Balance and variety are concepts you will see repeated often as you visit this blog, because this is the easiest way to ensure optimal nutrition without having an advanced degree in Molecular Biochemistry.

Eat a variety of natural foods with the least amount of processing possible.  This variety of food should be mostly plant-based.  Try not to focus your intake on one type of food, or one group of nutrient.  Also do not try to entirely eliminate one class of food or nutrient from your diet unless you have an allergy, sensitivity or distaste for it.  The exception to this is limiting consumption of highly processed food especially those with added sugar.  Elimination regimens where entire classes of foods and nutrients are avoided completely are difficult to maintain over a long period of time, and may carry the risk of nutrient deficiency or overload.

Ultimately the most appropriate eating pattern includes meals that are consistently around fifty percent non-starchy vegetables and fruit, with the other fifty percent coming from a combination of whole grains and lean protein sources.  This is the pattern that is found in the Harvard School of Public Health Healthy Eating Plate.

The next class in the series is titled Why We Eat: Toward A Healthier Relationship With Food.   We will focus on the psychology of eating, and try to figure out what motivates your eating habits.  Having this knowledge can be useful in controlling eating patterns that are inconsistent with your health goals.  Hope to see you there at noon on Saturday, July 21 at Our Family Doctor, 43 Oakland Road in Asheville.

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