Pasta

Is whole grain pasta really better for you than regular pasta? Recently I featured pasta puttanesca greened up with a little kale in the sauce. When one reader made this recipe at home, he opted to use whole grain pasta instead (I used a regular rigatoni).

But if I care about health so much why didn’t I use whole grain pasta originally?

You probably already know that I health-heartedly support the regular consumption of whole grains. But I also hold that there is a huge difference between intact grains and processed whole grains. So yes, brown rice is better for you than white rice, but pasta is different.

Noodles are made of dough and are therefore processed no matter what. For this reason they will never be a pinnacle of health food, but that does not mean that there can’t be a place for them in your diet. Italians eat pasta almost every day, and most of them are healthier than us. The important thing to think about when you are eating pasta–any pasta–is quantity.

So to answer the question, is whole grain pasta better than regular pasta? Maybe a little. But because I do not eat pasta very often, and because when I do eat pasta I eat a normal (aka small) portion, I always buy what I think will taste the best with meal. And for me, that is usually handmade fresh pasta (the soft refrigerated kind), not the whole grain stuff.

If you do not mind the taste of whole grain pasta, go ahead and buy it. It might be slightly better for you than the other kind. But the impact of whole grain pasta on your overall health is really small, so this is not a question to get hung up on.

Want a healthier Italian meal? Add more vegetables.

What is your opinion on pasta and health?

High blood sugar levels are known to accelerate aging and decrease longevity in many different species. Now it seems blood sugar may also be tied to how well you keep your memory as you age.

A new study published in the December issue of the Annals of Neurology examined the effect of high blood sugar on the region of the brain responsible for memory formation, the hippocampus. Researchers examined patients with either diabetes or stroke (in other, non-hippocampus, parts of the brain) and determined that both groups had defects in the hippocampus compared to normal patients, but the problems were in different hippocampal subregions.

What does this mean for you?

New York Governor David Paterson recently proposed a state tax on soft drinks, defending his argument to readers on the CNN website.

After reading his proposal, I agree with him completely. I just wish Starbucks would be forced to carry some of the responsibility as well.

Taxing products known to be deleterious to public health is a proven way to reduce consumption, increase state revenue and raise awareness of the dangers of high-risk commodities (such as cigarettes). There is no reason to suspect New York wouldn’t see similar benefits in the case of soda. Junk foods and soft drinks are currently placing a tremendous burden on our society in both health care costs and lost working hours.

Moreover, high-fructose corn syrup (the primary sweetener in soda) is derived from corn crops that are heavily subsidized by the federal government. These subsidies artificially reduce prices of soda below the true cost of production. It is therefore hard to argue that the proposed tax is putting an unfair financial burden on consumers who wish to drink full-calorie beverages: currently it is the taxpayers who are footing the bill for the bad habits of others.

So although I still favor completely revising the farm bill, taxing consumption is a reasonable alternative.

Another thing to consider is that these products are essentially to candy what crack is to cocaine (quickly ingested poison), so they do indeed pose a unique hazard to American health and are thus an ideal target for the first junk food tax. The current proposal adds a 15% tax to non-diet sodas as well as fruit drinks that are less than 70% real juice, adding only a few cents to each individual purchase–$0.15 to the dollar.

Paterson estimates the tax will raise $404 million dollars in revenue for the state of New York, that would go toward public health programs, including obesity prevention.

Whatever happens, expect a ferocious battle from industry giants (and FOXNews). They will argue for consumer freedom and against the benefits of switching to diet soda (I agree with this one, no kind of soda is healthy), but will conveniently overlook the data linking junk food and soda to obesity, heart disease, diabetes, stroke and cancer, as well as the costs to the American public.

The good news for the rest of us is that if New York does manage to pass this tax it is reasonable to expect California and many other states to follow suit (see trans fat and tobacco), resulting in a tremendous sea change in our nation’s policy toward junk food in general.

This is exactly the change we need.

Currently all Americans are paying for the poor nutritional culture our nation has embraced. The top 3 causes of death in the U.S. (arguably 5 of the top 7) are diet-related. It only makes sense to tackle obesity both as a nation and as individuals to protect our citizens and our economy.

Why Not Starbucks?

Unfortunately, right now it does not seem this tax will extend to the sugary cesspool which is Starbucks.

Did you know that a medium cafe mocha from Starbucks has more calories, sugar, cholesterol and saturated fat than a Krisy Kreme original glazed doughnut? Seriously, don’t go near that stuff.

It seems to me that Starbucks and other mega-chains (Jamba Juice?) selling sugar-blended drinks are just as liable as soda companies for promoting obesity with liquid candy, thus warranting the same burden of taxation.

I am not recommending traditional coffee drinks (espresso, cappuccino, etc.) be taxed–they do not contain sugar–but it is heartbreaking to see Frappuccinos being passed off as a morning pick-me-up when in fact they are no different from a milk shake with caffeine.

In short, I think this tax is a fabulous idea that finally begins to address the true costs of junk food and obesity, and I hope the trend continues.

How do you feel about sugar, taxes and Starbucks?

The US Food and Drug Administration (FDA) is asking the White House to amend its own previous warnings that children and pregnant women avoid seafood for fear of mercury poisoning, the Washington Post reports. The agency argues that the neurological benefits of omega-3 fatty acids, selenium and other minerals are worth the risk of mercury poisoning.

But not everyone is happy about this.

The US Environmental Protection Agency (EPA) and other consumer advocate organizations are outraged by the proposed change, accusing the FDA of catering to fishing industries and ignoring public health. The EPA has called the FDA document “scientifically flawed and inadequate” and an “oversimplification” of the health concerns involved.

There is a large body of scientific evidence that mercury can cause problems in the developing nervous system, so the new recommendations would have to be careful to educate consumers about both the positive and negative aspects of consuming more fish.

I have not seen the report myself, so I cannot pass judgement immediately. However, as I have explained in Synapse the dynamics of fish consumption and mercury contamination are very complicated, particularly for children and pregnant women.

My advice is to be careful with fish regardless of what the FDA report says. While it is extremely important to consume adequate omega-3 fatty acids as well as vitamin D from fish sources, mercury contamination is a serious concern that should not be overlooked.

To get the maximum benefit from fish and minimize mercury consumption

• Eat fish at least twice per week
• Avoid large fish such as tuna, shark and swordfish
• Seek fatty fish such as salmon, sardines and mackerel
• Take vitamin D and omega-3 supplements (fish oil based) when fish is not available
• Enjoy vegetarian sources of omega-3s like soy, flax and walnuts

Recently I have been experimenting with canned sardines and anchovies and they are much better than I expected them to be. I also enjoy canned salmon as well as smoked salmon or lox (but watch your nitrate intake!). If you can afford it, fresh fish is always wonderful.

Do any of you have strong opinions about the FDA report or know if it is available to the public yet?

Vitamin D

For the past several years the data in support of increasing vitamin D intake for every living human has been mounting. This week the American Journal of Clinical Nutrition features a collection of new research articles addressing the trends in vitamin D status and optimal dose recommendations.

This week’s take home lesson: While current research indicates we should be getting more vitamin D than is presently recommended, as a whole our vitamin D levels appear to have decreased in the past 15 years. The best way to combat this deficiency is with vitamin D supplements.

Vitamin D is a fat-soluble prohormone and essential nutrient produced when ultraviolet radiation (UVB) contacts our skin. It is probably best known for its role in bone metabolism (it has been shown to be more important than calcium for maintaining bone health), however recent studies indicate that vitamin D is essential for other physiological process as well.

Low blood levels of vitamin D have now been associated with many different chronic diseases including cancer, coronary heart disease, multiple sclerosis, Alzheimer’s disease, tuberculosis, depression, hypertension, periodontal disease, schizophrenia, seasonal affective disorder and type 1 diabetes.

In light of these findings, many nutrition researchers have argued for increasing recommended levels of vitamin D intake, but making population-wide recommendations have proved difficult for world health agencies because of large variability and uncertainty in vitamin D requirements.

There are several things to consider when evaluating vitamin D status in an individual. Latitude (sun exposure) is probably the single best predictor of vitamin D status. Anyone living in San Francisco or further north cannot get enough sun exposure to achieve sufficient vitamin D status, particularly during the winter months.

Because vitamin D is fat-soluble, it is retained in body tissues for several months after sun exposure. For this reason, people living at far north latitudes are particularly vulnerable to vitamin D deficiency because they frequently do not store up sufficient vitamin D during the summer to sustain their needs during the winter.

To further complicate matters, it is incredibly difficult to obtain vitamin D through dietary sources. Fatty fish and eggs are the only natural sources of vitamin D, though they are probably insufficient to achieve optimal status. Milk and soy products are typically fortified with vitamin D, as are some juices.

Skin pigmentation, sun avoidance and body composition (high body fat) are all associated with vitamin D deficiency. Darker skin tones do not convert sunlight to vitamin D as easily as lighter skin tones. Sunscreen blocks virtually all vitamin D synthesis. Body fat reduces bioavailability of vitamin D tissue stores.

This week’s study by Anne Looker et al, suggests that increased body mass as well as awareness of skin cancer risk and use of sunscreen have contributed to a significant decline in vitamin D levels in north America in the past decade.

The good news is that supplementation does appear to be effective at improving vitamin D status. Though there is still some disagreement on what the optimum blood levels of vitamin D are, it is generally agreed that they are much higher than currently recommended by any world health organization. One of the principle motivations of the present studies is to inform new vitamin D recommendations.

Kevin Cashman et al offers estimations of dietary requirements of vitamin D for healthy adults. They performed a randomized, placebo-controlled study testing the effects of different vitamin D doses and how they effect blood vitamin D levels.

The absolute minimum amount of vitamin D supplementation recommended by the study is 8.7 ug/day, or approximately 400 IU. This was to maintain blood serum levels greater than 25 nmol/L, and is double the current FDA recommendation for people under age 50. However, this suggestion is only sufficient to avoid deficiencies associated with bone loss and not other chronic diseases.

“The data from the present study clearly show that vitamin D tissue stores, developed during summer via exposure of skin to sunshine, were not sufficient to maintain serum 25(OH)D concentrations of greater than 25 nmol/L in most of the population [during winter], and that dietary vitamin D is an absolute requirement to maintain status above this minimum threshold.”

But the recommendations do not stop here. To maintain blood serum levels of greater than 50 nmol/L–a range more consistent with lowering risk of chronic disease–the study recommends 28 ug/day or 1100 IU of vitamin D. To keep blood serum above 80 nmol/L (from all I have read this is what I would recommend), 41 ug/day or 1650 IU is needed.

Remember this is most important if you are overweight, live north of San Francisco, get little sun exposure or have darker skin. Very rarely do I recommend vitamin supplements (they are not usually effective and are sometimes dangerous), but in this case the evidence is unequivocal.

Vitamin D supplements are easier to find than in the past, but they are usually packaged with calcium and are insufficient in dosage. Men should be wary of excess calcium supplementation since it is associated with an increased risk of prostate cancer.

I will continue looking for a good vitamin D supplement and will post when I find one I am happy with. If you have any recommendations, please share them with us.

Look for supplements where vitamin D is in the form of cholecalciferol, or vitamin D3.

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.

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?

Thanks to everyone who took part in my first poll: What is your favorite excuse for not eating healthy?

It seems that the vast majority of you are willing but not always able to eat healthfully, with the most common problems being lack of time or unforeseen forces that prevent you from getting the best meal as often as you would like. Hopefully some of you have found ways to eat healthy most of the time, but nearly everyone could benefit from a few tricks that can help streamline healthy eating so that you come up against these kinds of obstacles less frequently.

The way I see it, the impact of both insufficient time and world obstacles can be diminished with better planning. First, for busy people there are parts of your day that you just need to automate and perform without question. Eat breakfast. Shop on weekends. Cook in large batches (plan for leftovers). Subscribe to a CSA. Stock frozen vegetables. Always have onions, garlic, olive oil, salt, pepper and herbs in the house. Carry healthy snacks. Always have cans of soup at home. If you do these things automatically, your ability to quickly prepare a healthy meal will vastly improve.

Likewise, if you are prepared in advance when something unforeseen prevents you from acquiring your usual healthy meal, you can quickly turn to your plan B without worry or hesitation. For example, I always carry almonds with me in my gym bag. Just 5-10 of them and I can survive a few extra hours at work and make it home safe without pouncing on the first taqueria that crosses my path.

But certainly there are other reasons the world could be against you. One reader suggested I should have actually had an alternative answer: “Unhealthy foods taste good!” I replied that this counts as “the world is against me”, but her comment brings up an important difference that should be addressed. Neglecting to eat healthy because you don’t have time is very different from usually eating healthy but sometimes eating “unhealthy” foods because you like them. I never, ever recommend that anyone sacrifice quality of life for the sake of nutritional ideology.

Good health and healthy eating should improve your quality of life. The occasional indulgence is nothing to be ashamed of so long as it is something you partake in knowingly and with purpose. What I discourage is what you could call “wasting” an indulgence on something insignificant and of low quality simply because you did not have time or were too tired to cook dinner. Butter croissants and gelato are sublime foods that should be treated as such. And if they are made of real ingredients from scratch they aren’t even that bad for you on occasion. The same cannot be said for a Big Mac, which is neither exquisite nor even comes close to approximating real, healthy food.

Another reader suggested that two of the answer choices should be lumped together: “Can’t cook” and “Don’t like vegetables.” I absolutely agree that these two items are related. Proper cooking can make entrails taste delicious. But I have certainly encountered soggy, low-quality, over-cooked vegetables that I wouldn’t wish upon my worst enemy (if I had one). I highly recommend working on your cooking skills and learning to cook vegetables the way you like them. Start with good ingredients and you’re half way there. Personally I have nearly conquered all my former food aversions. Please ask if you are interested in specific recipes or cooking recommendations.

Finally, I am happy that not many of you find eating healthy is too expensive (but I know this is a legitimate concern for many people). I admit, the price of food has gone up significantly and healthier food is undoubtedly more expensive than unhealthy food. For this I offer a few philosophical arguments.

My first proposition is to eat better food, but eat less of it. I realize people don’t like to hear this, but it has been shown that people tend to eat more of the cheapest (highly refined, processed) foods because they are much less satisfying. Also, there are very few people (mainly people with wasting diseases or anorexia nervosa) who would not benefit from eating fewer calories. Calorie reduction is the single most effective way to live longer and prevent diseases like cancer. The only caveat is that nutritional needs must be met. Fortunately this can be done with higher quality foods.

Another consideration is that although food is more expensive now, most Americans are spending far less (%) on food today than they did 50 years ago (and way more on health care!). This is certainly because the market has been flooded with cheap, government subsidized, refined calories (corn, soybeans). Why is this? As Michael Pollan writes in his new book In Defense of Food, “For the majority of Americans, spending more for better food is less a matter of ability than priority.” How much did your T.V. or cell phone bill cost last month? Think about this before denouncing fresh fruit as the root of your financial woes.

My argument is that healthy eating is a delicious way to elevate quality of life now and in the future and actually reduce long-term health costs.

Any concluding thoughts on how to make health eating easier?