This week, the Journal of the American Medical Association (JAMA) reports that long-term supplementation with either vitamins C (500 mg) or E (400 IU) is ineffective at reducing major cardiovascular events, including heart attack and stroke.

The study was a ten year randomized, double-blind, placebo-controlled trial in low risk, healthy men over 50-years old.

Unfortunately, results do not get any more conclusive than this. Sorry boys, you are going to have to stick with diet and exercise for now.

It was thought that antioxidants such as vitamins C and E may reduce risk of cardiovascular disease by decreasing oxidative damage and reducing inflammation. But it appears that consuming these vitamins in supplement form is ineffective.

It is still a good idea to get enough of these antioxidants from dietary sources, however. Fruit is a good source of vitamin C. Almonds are good for vitamin E. A bonus is that a diet rich in fruits and nuts actually is associated with a lower risk of heart disease.

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Also in JAMA, low-dose aspirin was shown to be ineffective at reducing the risk of cardiac events in patients with type 2 diabetes. This finding is somewhat surprising because aspirin is effective at reducing cardiac events in non-diabetic individuals, and patients with diabetes are considered to be at particularly high risk for heart disease. It was thus reasoned that aspirin should be recommended for people with diabetes. However, in this group of diabetic patients in Japan, aspirin did not the reduce risk of a cardiovascular event.

One thing to note is that this study was relatively small, only 2,539 participants. So it may have lacked statistical power to find a real benefit. If you have type 2 diabetes and are currently taking daily aspirin, I wouldn’t stop just yet.

The good news for everyone is that basic dietary and lifestyle factors are by far the largest contributors to heart disease, diabetes and cancer. You can avoid most of these problems by eating a varied diet of whole foods, maintaining a healthy weight and staying moderately active. I’d choose that over aspirin any day!

Do you take many dietary supplements?

UPDATE: The problems with vitamin C and E supplements were expanded on this week by Tara Parker-Pope at the New York Times Well Blog. It is a great read if you are interested in this topic.

The case for eating breakfast everyday is mounting. We already know that people who eat breakfast are generally thinner than those who do not. They also tend to eat a healthier diet overall. Now new data suggest that the nutritional quality of your breakfast is also important for your health. Surprise!

A study published in the latest issue of the American Journal of Clinical Nutrition is the first to address how your choice of breakfast is correlated with the quality of food chosen during the rest of the day. The scientists combined dietary data from three continuous National Health and Nutrition Examination Surveys (1999-2004) to determine energy density, nutritional quality and variety of foods eaten. They also examined the relationship between breakfast choices and body mass index (BMI). A total of 12,316 people were analyzed.

Eighty percent of people in the study reported eating breakfast. Although breakfast eaters ate more total daily calories during the study, the foods they chose tended to be of lower energy density. Lower energy density foods have fewer calories per gram and are usually associated with more nutritious fare such as fruits, vegetables and grains. Examples of higher energy density foods are meats, cheeses and processed carbohydrates.

Interestingly, breakfasts of lower energy density, such as cereal with milk and fruit, were an indication of a more diverse diet throughout the rest of the day. In other words, participants who ate cereal for breakfast were more likely to report eating a lot of fruits, vegetables, grains, legumes and other healthful foods overall. This was true whether or not breakfast itself was included in the calculation.

People who chose breakfasts of higher energy density ate fewer different kinds of foods, but more pastries and junk foods. Countless studies have shown that dietary diversity is one of the best predictors of good health. This was confirmed in this study, as higher energy density breakfasts predicted fewer beneficial micronutrients consumed overall.

The researchers also found that seventeen percent of people who ate breakfast reported items that could not be “grouped into the major food groups,” things such as pastries, confections and meal replacement drinks and bars. With this the authors of the study point out that a significant percentage of Americans do not eat “real food” for breakfast (somewhere Michael Pollan is smiling and nodding). Not surprisingly, this group comprised the highest average energy density of any type of breakfast.

Women (but not men) that did not eat breakfast had a higher average BMI. This was true regardless of body image or attempted weight loss. In both men and women, breakfast energy density showed a linear positive association with BMI. This means that even for people who do eat breakfast, if you eat foods with higher energy density you will probably weigh more.

In English, what this all means is that although eating breakfast alone does a body good, it is much better if your breakfast is cereal and fruit rather than eggs and meat.

There is no clear cause and effect in an analysis of this kind, however there seems to be a correlation between eating less healthy foods at breakfast and making poor food choices throughout the day. While it is possible that some people simply make unhealthy selections all the time, there is also a possibility that your breakfast choices affect metabolic and hormonal systems that alter your cravings for different foods over the course of the day. Indeed, there are studies showing that people who eat whole grains in the morning have altered insulin responses for nine to twelve hours after eating.

Even if your breakfast choice does not have a direct impact on the rest of your food selections, choosing cereals and fruit will certainly bring you a step closer to better health. Pouring a bowl of whole grain cereal and adding some fruit is pretty simple, and I guarantee you it is easier than making eggs and sausage. Do yourself a favor and save the cakes and donuts for dessert.

This article can also be found at Synapse.

As I mentioned, salad season is pretty much over and I have embarked on a new era of work lunches. This week I am experimenting with roasted vegetables because they can be cooked in large batches and store very well in the refrigerator. They also reheat nicely in the microwave.

It cracks me up to say this, but my vegetable choices this week were cauliflower, golden beets and Brussels sprouts. If you would have told 8-year old me that this is what I would be having for lunch every day this week I probably would have vomited in horror. By some strange evolution that can probably be blamed on San Francisco elitism, last Saturday this unthinkable combination of vegetables just sounded brilliant.

Healthy Breakfast

Monday mornings are rough, but skipping breakfast is not an option. Current wisdom recommends you drink a glass of water and eat breakfast within an hour of waking. The quickest, healthiest thing you can have in the morning is a bowl of cold whole grain cereal with fruit.

But buyer beware. Almost all breakfasts cereals these days claim to be “whole grain.” Yet as you can probably deduce on your own, Cocoa Puffs is not a nutritious breakfast. All that sugar negates any benefit of their “whole grain” health claims.

The Truth About Whole Grain Products

The US Food and Drug Administration (FDA) has defined the requirements that must be met for a manufacturer to use the term “whole grain” on its label (along with the respective health claims):

“Cereal grains that consist of the intact, ground, cracked or flaked caryopsis, whose principal anatomical components – the starchy endosperm, germ and bran – are present in the same relative proportions as they exist in the intact caryopsis – should be considered a whole grain food.” (emphasis added by me)

Understand? To be considered “whole,” grains do not actually have to be intact. Armed with this, manufacturers set to work demolishing grains as normal, then adding back the required ratios of grain parts (germ and bran) to meet the standard. Presto! Magic health in Lucky Charms.

Would you then be surprised if I told you that intact grains are much, much better for you than demolished and reassembled grains?

If you really want the benefits associated with eating whole grains you should be able to see an intact grain in what you are eating; something like an oat, for example. If not, there has definitely been some processing involved, which reduces the whole grain benefits. That being said, processed whole grains are better than purely refined grains (without germ and bran). White sandwich bread is indistinguishable from sugar in my view.

So this is the problem with breakfast, and it is difficult to avoid in cold cereals. Real whole grains are tough and bland, so some demolition and sweetening are almost always necessary for most people to eat them regularly.

Oatmeal is a fantastic choice. Steel cut oats are even better, but they take 45 minutes to cook. When you just want to pour, eat and run you will need a quicker alternative.

My Solution

I first turned to granola. Those grains sure do look intact, right? But take a closer look and you will find granola often contains ungodly amounts of sugar. Though I enjoy granola and occasionally eat it during outdoor activities, I cannot bring myself to eat it every day for breakfast. It is just too sweet and dessert-like for me. You can make your own granola and add less sugar if you have the time. But still.

The good news is there are some products that are whole grain, palatable and not packed with sugar. But making a good breakfast out of them requires a touch of creativity. I have found one company that makes a kind of granola without sugar. Muesli is actually the appropriate term for this kind of cereal. It is regrettably difficult to find, but is available at Whole Foods in a variety of flavors. The company that makes it is called Dorset Cereals out of the UK. It is not cheap, but I only use about 1/4 cup per serving, so a box lasts me several weeks.

Another cereal product I like is the Ezekiel 4:9 brand made by Food for Life. Though these cereals are not exactly intact grains, they are made from many different kinds of sprouted whole grains and are free of flour and other bad stuff. To give you an idea of what they are like, think of Grape Nuts with more flavor.

I wish I could say that these products solved all my problems, but there is also the issue of taste and texture. Both these cereals are very dense, and eating them without any additional sweetness is a little brutal. For this reason I do not eat them alone, but instead mix them with my favorite flake cereal, Nature’s Path Flax Plus.

I also always add fruit. These days I am using pomegranate seeds (see pic), but almost anything will do. I even keep a bag of frozen organic wild blueberries for emergencies. Fruit is sweet, but also very good for you. Hooray, problem solved!!

What is your healthy breakfast?

Breakfast is the best time of day to get whole grains into my diet, and I love it. However breakfast is also my most automated meal, something I usually throw together in a half-awakened daze. On weekdays, morning time is precious and efficiency is the greatest virtue. But on weekends, we have the luxury of making breakfast a little more fun.

On cold weekend mornings, few things are more satisfying than a warm, steaming bowl of oatmeal. Not that weird-flavored stuff in little packages, but real oats boiled with raisins and topped with nuts and cinnamon. Do it right and this meal doesn’t even need any sugar, making it one of the healthiest breakfasts you can eat.

To me, the quality of the Trader Joe’s raisins makes this meal. They do not even remotely resemble those hard little pellets sold by Sun-maid. Rather they are big, plump and colorful. Adding them first with the water and boiling them for a few minutes rehydrates them and makes them even bigger and juicier.

Investing in a high quality cinnamon is a good idea too. I have McCormick Saigon Cinnamon, which is delicious.

Weekend Oatmeal for One

• 1 cup water
• 1/2 cup old-fashioned rolled oats
• 1/3 cup Trader Joe’s Jumbo Raisin Medley
• 1/4 cup crumbled walnuts or pecans
• tons of cinnamon

Add raisins and water to a small pot and bring to a simmer. Simmer 4-5 minutes or until the raisins are plump, then add oats. I usually rinse the measuring cup with some water to free the remaining oats that are stuck to the side. This will provide a bit more liquid as well, which is usually a bonus.

Simmer oats, stirring occasionally until they reach your desired tenderness, about 5 more minutes (add more water if necessary ~1/4 cup). When done, move oats to a serving bowl and crumble nuts on top. I usually add a splash of soy milk (I’m lactose intolerant) at this time to make the oatmeal a little more fluid. Cold milk provides the added benefit of cooling it down a bit, which makes it easier to add the cinnamon; you should avoid allowing too much steam to enter your spice jar. I like to add a lot of cinnamon, so that I can really taste it in every bite.

With this much flavor I doubt you would need any sugar. But if you want to add some more sweetness, a touch of brown sugar or honey won’t kill you.

Mushrooms are a great source of fiber and can provide other nutrients, including potassium and

iron. They contain some vitamins as well, particularly B vitamins.

My other purchases today mark a notable shift from the usual. My goal at the market is always to get at least 5 dinners and 5 lunches for the week. But since my beautiful summer tomatoes are now out of season, I can no longer rely on salads for lunch. This means I also did not buy cucumbers or salad greens. Instead I will try roasting vegetables this weekend and reheating them at work. Stay tuned to find out how that goes.

• Shiitake mushrooms
• Soul Food eggs
• Warren pears
• Dino kale
• Cauliflower
• Brussels sprouts
• Baby leeks
• Golden beets
• Sunchokes
• Flame grapes
• Padrones
• Pasilla pepper
• Giant fuyu persimmon
• Arkansas black apple
• Pomegranates
• Pain epi baguette

Obesity is quickly becoming America’s number one public health concern, and there is little doubt our changing food landscape is largely responsible. To combat negative press and present an image of public responsibility, food industry giants like McDonalds’s and Coca-Cola have announced policies that seem aimed to help consumers make healthier, informed lifestyle choices. However, leading nutrition and public health experts charge that these policies are disingenuous and are closer to advertising than sincere social responsibility.

In the October 15 issue of the Journal of the American Medical Association (JAMA), David Ludwig, MD, PhD, and Marion Nestle, PhD, MPH, published a commentary on the role of the food industry in public health. The question they seek to answer is, “Should the food industry be welcomed as a constructive partner in the campaign against obesity?”

The answer, they argue, can be found in the analysis of scientific data on food industry practices. One such study published in 2006 investigated United States food corporation practices in school nutrition and concluded that food companies “make public promises of corporate responsibility that sound good, but in reality amount to no more than [public relations].” Another study found that McDonald’s continued to use trans fats in their cooking oil until at least 2005, even though they claimed otherwise. (They were required to pay a settlement for deceptive advertising).

Trans fat! There is no amount of trans fat in the diet that is considered safe.

The food industry also heavily funds an independent firm, the Center for Consumer Freedom (CCF), that aggressively lobbies against “obesity-related public health campaigns, legislation to regulate marketing of junk food to children and scientists who advocate for healthier diets.” It is difficult to understand how these practices meet the proclaimed agenda of these companies to increase the health of society.

These issues then raise an interesting question. Why would a food company care about the health of society? Isn’t a food company’s primary goal to make profits for their shareholders? Of course it is, and that is fine. The problem is that the most healthful foods—unprocessed vegetables, fruits and grains—are not nearly as profitable as highly refined and processed foods. This fact makes the industry’s claims to promote health somewhat dubious.

The obvious answer to why a food company might claim to have concern for public health even if health is at odds with its product is that companies must work to maintain a positive image. Advertisers know very well that image and branding have a tremendous impact on sales. Generally our society does care about health and is willing to pay a premium for products they consider to be healthful. Thus these public health campaigns are indeed a form of advertising because they help shape the public image of a company and its products.

How then do these campaigns manifest in society? One example is the voluntary efforts of beverage companies (in conjunction with the American Heart Association and the William J. Clinton Foundation) in 2006 to curb the sale of sugary drinks in schools, one of the largest sources of excess calories for children. Though at first glance this seems like a noble effort by the companies, after much negotiation the agreement ultimately permitted several caloric drinks to remain on campuses, including sweetened vitamin waters and sports drinks. So much for getting those sugary drinks out of schools.

Also, the food industry invests enormous amounts of money to fund nutrition research. However a study published last year in the Public Library of Science (PLoS) journal found that studies fully funded by industry are 4 to 8-fold more likely to have conclusions favorable to industry compared to those with no industry funding. This raises the possibility of a “systematic bias” in scientific research when industry is involved.

Thus the authors conclude that the interests of the food industry are at odds with public health and should be separated from policy decisions. They go on to argue that while market-driven supply and demand works splendidly for many industries, it must be more carefully regulated when public health and safety are involved. This, they say, is the primary reason there are so many safety requirements on cars, and our food supply should be held to similar rigorous standards.

“Modifiable dietary factors cause substantially more illness and death than automobile crashes. Left unchecked, the economic costs associated with obesity alone will affect the competitiveness of the US economy.”

The authors recommend several courses of action. First, the government must “ensure that nutritional policies are based on solid science, rather than special interests.” Second, congress should provide more funding to nutrition research to “help counter the influence of the industry money.” Third, allow an independent body such as the Institute of Medicine to draft dietary guidelines (this task is currently under the control of the United States Department of Agriculture, which is primarily concerned with the well-being of the food industry and not public health). Fourth, restructure agriculture subsidies to “support public health, not commodity producers.” And finally, “reform campaign finance laws to prevent corporate political donations from leveraging the legislative process.”

These recommendations would be a good start to combating obesity in America, but it is important to remember that ultimately the responsibility for your health is in your own hands. If we as consumers decide we would rather buy healthier, less processed foods and purchase them in larger percentages than processed foods, the food industry will certainly notice.

This article can also be found at Synapse.

What role do you think the food industry should play in public health policy?

Voting finally closed on last week’s poll question: Do you like Brussels sprouts?

Asked whether individuals “love em!”, “hate em!”, are “skeptical, but willing to try”, or are a “recent convert,” the most votes (37%) were tallied for love em! Add to this the 25% who claim to be recent converts and another 25% who remain skeptical, but willing to give them a try, and today is an overwhelming victory for Brussels sprouts on the dinner plate.

A mere 12% of voters claim to hate em.

Voters have spoken clearly that Brussels sprouts are no longer considered second class vegetables. They can proudly sit on the dinner plate next to traditional favorites like broccoli and potatoes, without being banished to a side plate to get cold and soggy. Brussels sprouts can rest easily knowing that they will be accepted for who they are, no longer having to disguise themselves under cheese or bacon bits. The myth of separate but equal has finally been put to rest.

It remains to be seen if this verdict will prevail in state and federal courts across the nation.

In other news, for the first time in American history a beet has been elected president of the dinner plate, defeating the turnip in a landslide victory. The beet won over voters by promising to bring change to dinner, and maybe even lunch. With this victory, the culinary landscape of the United States is certainly being redefined.

Also, with the passing of Prop 2 in California yesterday, some animals that share our dinner plates also notched a victory. Despite efforts of the opposition, Salmonella outbreaks may fall to dangerously low levels by the year 2015.

Thanks to all of you who made your voices heard in this election. The final results are listed below.

Poll: Do you like Brussels sprouts?

Love em! 37%
Hate em! 12%
Skeptical, but willing to try 25%
Recent convert 25%

n = 8
(not a scientific poll)

A recent New York Times article questions the conventional wisdom of the value of stretching before a workout. Instead, the best way to prepare for physical exertion is a brief, easy cardio workout followed by a series of sport-specific movements designed to loosen joints and increase blood flow to the muscles you will be using.

Multiple research studies over the last several decades have shown that stretching does not help prevent injury during a workout. Even more surprising is that stretching appears to actually weaken the muscle for a period of up to 30 minutes following the stretch, thereby hurting overall performance.

But this does not mean you should skip your workout warm up. Scientists now recommend that you begin your workout with a light, 5-10 minute aerobic exercise, such as a jog. This movement will increase blood flow to your muscles and make them more pliable and ready for additional exertion.

To improve performance in a specific sport, dynamic stretching is recommended. Dyamic stretching is a way to stretch muscles while moving, a practice that actually does appear to increase muscle power, flexibility and range of motion. Data is also emerging that it reduces risk of injury.

The goal of dynamic stretching is to perform “range-of-motion exercises that activate all of the joints and connective tissue that will be needed for the task ahead,” says Team Running USA coach, Terrence Mahon. For example, runners should do movements that activate hip and knee joints (such as squats and lunges), while golfers should perform shoulder and back movements.

That’s right, even golfers can improve performance with dynamic stretching.

A few of the best dynamic stretches are described in the article.

In sum, the new recommendation for beginning a workout is an easy, 5-10 minute aerobic exercise followed by a five minute recovery, and then a series of dynamic stretches appropriate for your sport. It is important that you complete this warm up immediately before you begin your training. Waiting too long (30 minutes) before beginning your workout can be detrimental, increasing muscle stiffness.

Although I read and believe the accuracy of this story, I think it will be hard for me to stop touching my toes and hanging my heels off a stair before going on a run. It is such a regular part of my routine and feels so natural. But according to this article that may actually be hurting my run.

What do you guys think?

There is something of an art to picking and eating persimmons. Though the number of varietals are small compared to other fruits in season this time of year (apples and pears come to mind), the few that are available have very different properties of color and ripeness.

Two types of persimmons are common in California. Fuyu persimmons are firm, light to dark orange and more flatly shaped, like a tomato. Fuyus are easier to pick than the other most popular persimmon, hachiya, because they are eaten when firm and are more forgiving if you cut them open a little early.

Hachiya persimmons are trickier to pick out. When ripe, hachiyas are soft and heavy. However, unlike fuyus, unripe hachiyas have very high tannin levels which make them sticky and dry on the tongue. Some people refer to this property as astringency. Others call it bitter.

As someone who generally prefers firm fruit, I learned this lesson the hard way. I strongly advise exercising patience when it comes to hachiyas. When ripe, these persimmons are a deep, red-orange in color and often have black streaks on the skin. Hachiyas also have a more tapered bottom than fuyu persimmons, making them heart-shaped.

Rarely are hachiyas ripe when they are for sale, so I usually leave the fruits on the counter for several days until they become soft. While they are ripening, set them top-down on the corolla so their tender flesh does not get damaged under their weight.

Occasionally I have found other persimmon varietals at my local markets. One of my favorites is the chocolate persimmon, which is similar to a fuyu except the flesh inside is brown. These persimmons have a rich and spicy flavor that is reminiscent of, well, chocolate. Definitely try one if you can find them.

Good, ripe persimmons are sweet and have an almost warm flavor. They taste amazingly like autumn, with notes of cinnamon and brown sugar. Persimmons can be eaten raw or cooked into a dessert, but you should not eat them before they are ripe.

Most people do not consume the skins of persimmons, but I usually do. If the skins are tough, however, I will cut them off. The center usually contains a few dark, hard seeds that should not be eaten.

What are your favorite tips for picking and eating persimmons?