Two months ago, the Cleveland Plain Dealer published its own commentary on the obesity epidemic with a series whose cover page spelled out, in large type, the words, “Eat, drink, and be sorry.”  Excuse me?  Eat, drink, and be SORRY?  The actual quote reads, “Eat, drink, and be merry, so that joy will accompany him in his work all the days of his life…”  And herein lies the problem. 

Wendell Berry said that “Eating with the fullest pleasure — pleasure, that is, that does not depend on ignorance — is perhaps the profoundest enactment of our connection with the world.  In this pleasure we experience and celebrate our dependence and our gratitude, for we are living from mystery, from creatures we did not make and powers we cannot comprehend.”

In the movie Chocolat, we hear, “Listen, here’s what I think. I think we can’t go around measuring our goodness by what we don’t do.  By what we deny ourselves.  What we resist, and who we exclude.  I think we’ve got to measure goodness by what we embrace, what we create, and who we include.”

We cannot hope to reverse the epidemic of obesity and diabetes in a culture of deprivation.  It says a lot when people feel the need to demonstrate just how little butter or cream they actually used by squashing together their thumb and index finger.  If the so-called French paradox has taught me anything, it has taught me to be proud that I fried my fresh eggs in butter this morning, and that I drank my tea with real cream.  There is no French paradox.  There are only large numbers of well-meaning individuals who are utterly confused about what constitutes healthy eating.

Most of my obese patients are severely deficient in Vitamin D.  Many are deficient in protein, and in various B vitamins.  Caring for them has taught me that obesity is a malnourished state perpetuated, in part, by a diet that adversely affects certain individuals more than others, and a society that assigns blame to those individuals for the effects of that diet. 

If you google the disease kwashiorkor, which is caused by a severe deficiency of dietary protein, you will find photographs of pale, swollen babies with listless appearances, abnormal swelling around the eyes (called “periorbital edema”), and distended bellies.  I see people who look like that in my office every day.  We all know some people who appear to need more water, and others who appear to need more calories, remaining thin despite the fact that they always take a second helping of everything.  What if some types of obesity are caused by a relative deficiency of protein or fat?  What would be the consequences of eating a low-fat, high-carbohydrate diet to people whose own particular metabolisms require more protein or fat?  Or both? 

If it’s not about depriving ourselves of the healthy pleasures of the table, then what is it about?  I give myself permission to pursue delicious, flavorful food, and here is a very abbreviated list of ideas for where to find it:  In cheeses, especially ones with strong flavors like parmigiana, blue cheese, and extra sharp cheddar.  In herbs and spices, like basil, chili powder, cinnamon, curry, ginger, horseradish, lemon balm, mustard, and rosemary.  In lemon juice, soy sauce, roasted sesame oil, and balsamic vinegar.  In ripe strawberries, peaches, and cantaloupes.  In chives, jalapenos, scallions, and carmelized onions.  In dark, green, leafy vegetables, sun-dried tomatoes, and roasted root vegetables.  In peanuts, hazelnuts, wheat germ and roasted almonds. 

If you’re looking for flavor, chop 2 garlic cloves with 1½ tablespoons lemon zest (peel) and ¼ teaspoon kosher salt.  Mix in 1 tablespoon of olive oil, and then ¾ cup finely chopped parsley.  Finally, add a can of rinsed white beans.  It’s called White Beans & Gremolata, and it’s delicious.

Dean Ornish encourages us to “eat with ecstasy,” knowing it’s a strategy that will last a lifetime.  As opposed to the strategy of portion control.  “Awareness is the first step in healing. When we become more aware of how powerfully our choices in diet and lifestyle affect us—for better and for worse—then we can make different ones.  It’s like connecting the dots between what we do and how we feel.”

Eating well and eating smart are one and the same, so denying ourselves the pleasure of eating dooms us from the start.  I’m not talking here about the food industry’s carefully targeted mix of fat, sugar and salt, identified by David Kessler in The End of Overeating, that hijacks our natural ability to enjoy and appreciate food, and feel satisfied.  I’m talking about color, texture, temperature, and flavor. 

Once upon a time we understood in our bones that eating well and eating smart were one and the same.  When we reclaim that knowledge, then we will reclaim our health as a community. 

This morning my daughter and I stopped by our neighborhood butcher to buy something to grill tomorrow.  Arriving only 10 minutes before closing, we were absolutely astonished to discover that just a few packages of chicken remained, along with some knockwurst and hamburgers.  Not a single steak, roast, chop or rib. 

It seems odd, but we celebrate Memorial Day by eating meat.  It’s a meat lover’s holiday.  Is this a good thing?  Despite the U.S. dietary guidelines, which recommend eating less red and processed meat, I think eating meat is a fine thing.

Dr. Renata Micha, of the Harvard School of Public Health, would probably agree.  She published the results of a very interesting experiment in this month’s journal, Circulation.  Dr. Micha’s team contacted the authors of 20 previously published studies about the effects of eating meat (evaluating a total of 1 million adults in 10 countries on 4 continents), and asked them to go back and separate the results of their raw data into processed (smoked, cured or salted) and unprocessed meat.  All the meat contained similar amounts of saturated fat and cholesterol.  The researchers found that eating the equivalent of one hot dog, or 2 slices of deli meat, per day was associated with a 42% increase in the risk of heart disease, and a 19% increase in the risk of diabetes.  But eating twice as much unprocessed red meat was associated with neither.

It is important to note that they are not saying processed meat caused heart disease or diabetes here.  At this point, they are just saying that they saw an association.  This means it may be the processing, and not red meat itself, that is the problem.  Processed meats contain 4 times more sodium, which increases blood pressure, and 50% more preservatives (like nitrates) than unprocessed meat.  Nitrates promote insulin resistance and hardening of the arteries.  You can learn more about the Dr. Micha’s study here. 

This study and its not-so-surprising results demonstrate a fundamental change in nutrition research.  For a long time, researchers, nutritionists, and government analysts have grouped together various foods in ways that made it difficult to draw conclusions.  Given that they are studying nutrition, it seems to me like a serious oversight.

For example, last year another Harvard University study was published that examined the effects of 3 different diets on mouse blood vessels.  The researchers called the diets “low-carbohydrate, high protein (LCHP),” “standard chow diet (SC),” and “Western diet (WD).”  But they did not explain what they meant by LCHP.  They did not actually explain what they fed the mice.  Did the protein come from grass-fed beef, genetically modified soybeans, or canned cat food?  And what is an SC diet?   How much carbohydrate, protein and fat are “standard”?  What about the WD?  Did those mice get fried chicken, burgers, iceberg lettuce, soda pop and doughnuts?  Also, what do mice in the wild normally eat?  These are crucial questions if we are trying to draw conclusions from what the mice ate.

A second example comes from the nutrition labels on the packages at the grocery store.  In order to determine the amount of white flour or starch in a product, for example, I must add together the fiber and sugar, and subtract that sum from the total carbohydrates.  Determining the polyunsaturated fat content presents a similiar difficulty.  Well, I’m not going to let it worry me this weekend.  I’ll just be grateful that my cousin John came home safely from Vietnam, and then I’ll look forward to a dinner of barbecued chicken, homemade cole slaw and potato salad, and grilled onions, plus some new lettuce from our garden!

For a long time now, my husband has been asking me to help him understand why traditional fats are a very important part of a nutritious diet, and why manufactured fats are not an acceptable substitute.  This post is for him.

The so-called evidence against saturated fat, a significant component of traditional fat, begins with a biochemist named Ancel Keys.  In the 1950’s Dr. Keys said that the risk of heart attack increased with the amount of saturated fat eaten.  In a famous paper on the subject, he confirmed his hypothesis with data from 6 countries: Japan, Italy, Australia, Canada, the United Kingdom, and the U.S.  The problem?  He evaluated a total of 22 countries, and dropped the ones that did not support his hypothesis.  So he excluded the data from the other 16 countries, such as Norway and Holland, with relatively few deaths from heart disease despite a high-fat diet, and Chile, with a high incidence of fatal heart attacks despite a relatively low-fat diet.

In a previous post, I discussed the Framingham Heart Study, the ongoing, 60-year study of what has now become several generations of families in Framingham, Massachusetts.  One of its directors famously stated that, “We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.”  We observe that while saturated fat increases total cholesterol, it is due to a rise in HDL, the good cholesterol. 

What is a saturated fat anyway?  Last week I explained that each carbon atom has a total of four possible binding sites.  I used the example of a commuter train to describe how trans fats are structured.  To continue on this track, I would say that a saturated fat is like a commuter train with all the seats filled.  It is, simply, a chain of carbon molecules in which all the binding sites are filled.

Saturated fats come in different lengths, from short (like 6 carbons) to medium (12 and 14 carbons), to long (like 18 carbons or more).  Each one has a different name.  The saturated fats are very important biologically, not least because they make up 50% of our cell membranes.  Saturated fats help bones to absorb calcium.  They protect the liver when it metabolizes toxins like alcohol and acetaminophen.  Palmitic acid, the 16-carbon saturated fat, helps lungs transfer oxygen between the air and our blood, and protects against asthma and other lung diseases.  Palmitic acid and stearic acid (18 carbons) are preferred nutrients of heart muscle. 

Butter and coconut oil are valuable sources of medium-chain lauric acid (12 carbons) and myristic acid (14 carbons), which support our immune systems and help white blood cells to recognize and destroy viruses, bacteria, fungi, and even tumors.  Saturated fatty acids are involved in the production of many hormones, including insulin.  They signal our brains to feel satisfied after we eat.  So it should not surprise you to learn, given all these biological functions, that saturated fats make up 54 percent of the fat in human breast milk.  Monounsaturated fats make up most of the rest, at 39 percent.  Monounsaturated fats have one open binding site (mono = one).  Polyunsaturated fats make up the remainder.  Polyunsaturated fats have more than one open binding site (poly = many).

Switching gears now, last week’s post drew a lot of comments and additional information about Crisco.  I learned many interesting things, a few of which I will share with you here.  It turns out that the name “Crisco” comes from the phrase CRYstallized Cottonseed Oil, from which Crisco was originally made. 

The story of Crisco begins with William Procter and James Gamble, who were a candle maker and soap maker, respectively, living in southwest Ohio.  Between 1890 and 1905, Procter and Gamble purchased 8 cottonseed mills in Mississippi.  Their goal in purchasing the mills was to secure for themselves an alternative source of raw material for their two businesses.  The making of soap and candles required large supplies of lard (from pigs) and tallow (from beef), the prices for which were controlled at the time by the meat packing industry. 

After they had obtained ready access to large amounts of cottonseed oil, a chemist named E.C. Kayser helped Messrs. Procter and Gamble to develop the process of hydrogenation.  Hydrogenation converted liquid cottonseed oil to a solid form that the men could use to produce more soap and candles.  At the same time, these two brilliant entrepreneurs realized that the newly invented light bulb was causing the market for candles to shrink. So they began to look for another market for their new product. 

Because of its resemblance to lard, P&G decided to market Crisco as a food.  They presented it as cleaner, healthier, cheaper and certainly more modern than lard.  Then they made advertising history with the publication of a free cookbook, each of whose 615 recipes used the new product.  Crisco introduced partially hydrogenated fat to the American diet.  The damage would not become apparent for decades.

Last week I was asked to become a contributing writer on the award-winning food blog “The Jew and the Carrot ” a project of the Jewish environmental organization, Hazon.  I chose to write my first essay about trans fats and non-dairy creamer and margarine.  Even though these products were invented only 100 years ago, they play a major role in what is now considered “traditional” Jewish cooking.  In fact, most people who use them never even consider that our foremothers could not possibly have used them in “the old country,” wherever that may have been.  So what happened?  Two things happened — trans fats and marketing. 

Trans fats are produced by a chemical process called hydrogenation, which means the addition of hydrogen atoms.  Adding hydrogen atoms to liquid fats (oils) thickens them.  Thicken them enough, and they become solid, after which they can be used like other solid fats traditionally used for baking.  Traditional fats, depending on where you grew up, were usually butter, or lard, or coconut oil. 

So the young food science industry had developed a product that acted like fat.  It actually seemed better than butter and lard.  It was much cheaper.  It could be made in enormous quantities, and more simply.  It could be shipped long distances without refrigeration, and its shelf-life was counted in years instead of weeks.  The first cans of Crisco® came off the factory lines in 1911.  Margarine and coffee whiteners came in the years and decades that followed. 

Now the marketing and advertising departments got busy.  Procter & Gamble, the maker of Crisco®, launched a nationwide campaign, actively enlisting the support of various community leaders to endorse their products.  Mazola worked with local women’s groups to organize picnics to teach interested parties how to use their product, and made contributions to those groups for every unit sold.  Other examples abound. 

America became the target of a focused, sustained, and wildly successful marketing campaign.  It took just a couple of generations to unlearn how our great-ancestors had cooked for a thousand years.  It was not long before these inexpensive fats became industry standard in the manufacture of baked goods, breakfast cereals, and the like.  The rates of heart disease began to soar.

Why?  When we eat trans fats, they become incorporated into our organs.  Then those organs become stiff and inflexible.  Blood vessels harden and thicken.  Oxygen-carrying red blood cells can no longer pass through.  When arteries that supply the heart become blocked, the heart becomes starved for oxygen, and its unfortunate possessor develops chest pain.  Blockage of arteries to the brain causes strokes.  And the medical term for blockages in the legs is “peripheral vascular disease.”  We do “bypass” operations to describe both heart and leg surgeries that replace closed blood vessels with open ones.  Trans fats also interfere with all the fat-requiring metabolic processes, such as those involving fat storage, cholesterol synthesis, and reproductive hormones. 

What does the phrase “trans fats” mean?  To understand, we need to consider the chemistry of fats (solid) and oils (liquid).  Although we call them different names depending on whether they are liquid or solid at room temperature, fats and oils are the same chemically.  They are composed of long strings of carbon atoms, each of which has four binding sites that are available to attach to other carbons or hydrogens. 

Think of those four binding sites as two 2-seater benches on a commuter train.  The benches are situated so that they face one another, and the train still has a number of empty seats.  Now two commuters enter the train.  They have the option of sitting either directly or diagonally across from one another.  If they decide to sit directly across, they will be in a chemical configuration that is called a cis arrangement.  All the weight is on one side.  Cis arrangements make a carbon chain lopsided, floppy, and flexible, which is ideal in living, moving organisms. 

If, on the other hand, the two commuters choose to sit diagonally across from one another, they will be in a configuration that is called trans.  Think transportation, transfer, trans-Atlantic.  In this arrangement, the weight of the passengers is distributed across the benches in a more balanced, but less flexible, way.  Trans fats are stiff and stackable.  That is why they are not safe for consumption.  They may act like solid fats on the stove, but they do not behave like fat once they are eaten.  They behave like Legos®.

Trans fats have been banned in other countries, and in several cities throughout the U.S., but they have yet to be banned across our nation.  What the Food & Drug Administration (FDA) has mandated is that food containing less than ½ gram of trans fat per serving may be advertised as ”trans-fat free.”  That’s not good enough.  In the case of coffee whitener, a serving is 1 tablespoon.  This morning I felt like making my coffee extra light, so I put 4 tablespoons, or ¼ cup, of milk into the mug.  If I had used coffee whitener, that would have added up to almost 2 grams of trans fat.  Just for the first cup.  So it would be easy, on any given day, to consume quite a bit of trans fat solely from trans-fat-free food.  That’s a problem.

What are our alternatives?  Skip the Crisco®, and avoid any foods that are advertised as “trans-fat free.”  Even reformulated Crisco contains “less than ½ gram of trans fat per serving.”  Bake as your foremothers did for a thousand years with, yes, butter, lard, or coconut oil, which is a solid below 75 degrees Fahrenheit.  Skip the coffee whitener and use milk or cream.  Or choose tea with honey or lemon.  Drink your coffee black, or try coconut, almond, soy, or rice milk if you’d like.  Decline to make recipes that call for margarine.  Use butter or coconut oil instead. 

We vote every time a bar code passes over a scanner, so don’t buy anything with the words “partially-hydrogenated” in its ingredient list.  There is no place for synthetic trans fats in a healthy community.

On the subject of shopping for and preparing nutritious meals, one piece of advice that I like to share is that it’s best to stick to the outer walls of the supermarket and avoid the center.  So with only a few exceptions, like flour, oil and beans, that’s exactly how I shop.  What does it mean to shop at the edges of the supermarket?  Let me show you what I choose, and where I get it.  I thought that this week I would invite you to join me on a virtual shopping trip to the supermarket around the corner from my home. 

Entering the store now with a cart, I walk straight into the produce section, where I buy the bulk of my groceries.  Most supermarkets are set up so that you have to walk through the fresh fruits and vegetables to get to the rest of the store.  That’s how they increase the chances that shoppers will buy fresh produce while it’s still fresh.  The shelf life of produce is obviously quite short in comparison with the boxed, bottled, and canned items in the supermarket. 

The produce section is easily identified with its enormous mountains of seasonal items, usually well-priced.  Today I pick apples, blackberries, strawberries, a couple of grapefruits, kiwi, sweet potatoes, red leafy lettuce, red and green peppers, a few jalapenos, lemons, asparagus, tomatoes (roma and vine), potatoes, carrots, celery, onions, fresh garlic, and bananas, which make my husband very happy.  At the edge of the produce section are shelves filled with all kinds of nuts, nut butters, and dried fruit.  I get 2 containers of freshly ground peanut butter, and one bag each of dates and dried apricots.  Then I move on. 

At the back of the store now, in dairy, I take whole milk and butter.  Sometimes I find Hartzler’s milk and butter from a family-owned farm about 50 miles away, sometimes not.  If I need eggs, this is where they will be.  I select a few cheeses to add to the substantial pile already in my refrigerator, and I take a pint of cream.  I always keep cream in the refrigerator; a spoonful in my tea is one of my daily morning pleasures.  Cream is also the secret ingredient that turns a light and flavorful vegetable soup into a concoction whose essence is entirely more sublime.  Last year we were lucky to receive an ice cream maker as a gift from my parents, so if I’m organized enough, and inclined to make some ice cream, I buy two pints of cream instead of one. 

I avoid margarines and coffee whiteners, which are placed in the cold section simply to provide the illusion that they require refrigeration.  Keeping them cold makes them seem more like real dairy products and increases sales.  Otherwise, there’s no reason for them to be here.  Or anywhere else, as far as I am concerned.

Now I turn away from the outer wall and head down a long aisle to get a few cans of cooked beans and bags of dry beans.  If I want rice (brown) or pasta (whole grain), I’ll get them nearby.  I venture into the aisles to add mustard, olives, pickles, and cans of tuna to my cart.  Some weeks I need tea, coffee, spices, pet food, baking supplies, foil or detergent.  But otherwise, I stay out of the aisles.  We don’t need chips, breakfast cereals, snack bars, canned soups, sodas, or Hawaiian Punch.  My great-great-great grandparents didn’t eat them, and neither will we.  I turn back toward the dairy, and add 2 large containers of plain yogurt to my cart. 

The frozen section doesn’t have much for me.  Once in a while I buy frozen peas or chopped spinach, and occasionally I am in the market for a frozen pie crust (yes, I have been known to purchase ……) but that’s about it, except for the occasional pints of ice cream.  I look for sales in the premium ice creams, and stay away from brands with long lists of ingredients with unpronounceable names.

The bakery, located just past the frozen section, is where I find a loaf of whole-grain, seeded bread.  I was very happy when, a few years ago, the supermarket decided to carry this bread made by a local, well-known bakery.  Before that, I used to make my final bread selection by choosing a loaf that contained at least 3 g fiber/slice, listed whole wheat as the first ingredient, and — as a tie breaker — felt heaviest in my hands.  I still do that sometimes.

Just past the bakery is the meat section.  This year the supermarket actually began to carry a line of organic, pastured chicken.  Before that, I bought a regular brand.  But even the kids agree that the pastured chicken is truly delicious, so we decided it was worth it.  Now, maybe once a month, I’ll buy a whole chicken to roast with lemons and garlic or thyme from our herb garden.  Other times, I fill a roasting pan with chicken legs and thighs, cover the chicken pieces with generous amounts of onions and tomato sauce, cover the pan with foil, cook it at 325 for 2 hours, and then cook it uncovered at 400 for 15 more minutes.

As I turn for the last time to return to the checkout area, I pass the fish counter.  Once a week, we have tilapia or salmon.  Maybe once or twice a year, I bring home wild salmon.  It’s not cheap, but then again it’s not on my list every week either.  Near the checkout, I stop for olive oil and a large bottle of cider vinegar.  Done.  I purchased almost all of the food my family will consume this week at the edges of the supermarket.

My book group makes the most amazing meals.  There are no assignments; creativity runs wild.  Last week Brigitte brought tomato-basil soup with homemade croutons, Lynne served a quinoa-feta-cranberry salad in a bowl lined with kale, Elaine made a rum cake, or maybe that was Diane.  Beth brought rice balls filled with melting cheese, Nancy brought a claypot filled to the top with bubbly macaroni & cheese, and these are just the dishes I remember!  A few months ago, I took the time to write down a particularly memorable meal that included roasted eggplant appetizer, spinach salad with roasted beets & pomegranates & red onions with white raisins, sweet corn pudding, jarlsberg cheese grated with red onion and served on whole-grain crackers, squash soup, and chocolate-covered strawberries.  There is always a selection of wines, and a scrumptious collection of cheeses and crackers.  Now that’s something we haven’t talked about yet — crackers.

Looking just at the names, it’s nearly impossible to tell which crackers are nutritious.  I mean, who would guess that 10 Ritz Crackers Whole Wheat contain less than a single gram of fiber?  It’s the same for 4 Keebler’s Townhouse Bistro Multigrain crackers, and 10 Nabisco Wheatsworth Stone Ground Wheat crackers.  Less than 1 gram of fiber per serving.  Even Late July Organic Classic Saltines, though they’re made with “organic wheat flour,” contain zero grams of fiber.  Okay, so now what?

I found a smart comparison at www.environmentalnutrition.com, which I give to patients who eat lots of crackers or are just plain curious.  Generally, I recommend that people avoid crackers with less than 3 grams of fiber per serving. 

Which crackers make the cut?  Ak-Mak 100% Whole Wheat Stone Ground Sesame Crackers (but not just because they’re called Stone Ground), Back to Nature Harvest Whole Wheats (but not just because they’re called Whole Wheat), Nabisco Triscuit Thin Crisps (but definitely not the reduced fat ones), Trader Joe’s Multigrain Savory Thins and WASA Multigrain Crispbread, (but not just because they’re called Multigrain), Trader Joe’s Woven Wheat Wafers, RyVita Rye & Oat Bran Whole Grain Rye Crispbread (which pack a walloping 6 grams of fiber per serving), and Mary’s Gone Crackers (my favorite). 

What gives these crackers the fiber that the others don’t have?  Whole-grain flour.  In most cases, the very first ingredient contains the word “whole.”  Whole wheat, or 100% organic whole wheat, or whole-grain rye flour.  The one exception?  Brown rice, which is a whole grain.  So you are looking for either “whole [grain name]” or “brown rice” as the first ingredient.  It has to be the first ingredient. 

Nabisco Wheat Thins 5 Grain Crunch and Keebler Townhouse Wheat crackers, each with less than 1 gram of fiber per serving,  list “enriched flour” first, and “whole wheat flour” second.  Second doesn’t count. 

Nabisco Premium Multigrain Saltine Crackers have 0 grams of fiber per serving, and list “enriched flour” first, “whole grains” second, and “whole wheat flour” third.  Second and third don’t count.  Neither does “rice flour,” the first ingredient in Blue Diamond Almond Nut-Thins, of which you have to eat 16 crackers to get a gram of fiber.

Dare Breton Multigrain and Kashi TLC Crackers Original 7 Grain may sound authentic, but the first ingredient in both is “wheat flour.”  Don’t let that fool you.  Wheat flour is not whole wheat flour.  In fact, most flour is made from wheat, so “wheat flour” doesn’t buy you whole grains.  Also, don’t be enticed by “enriched flour,” which would not have required enriching if it had not been stripped of its germ and bran first.  “Wheat flour” doesn’t count, and neither does “organic wheat flour.”

By the way, these rules apply as well to bread.  “Wheat bread” is just plain old bread, sometimes with brown caramel coloring added to make it appear more nutritious.  That’s not the same as whole-grain bread.
 
You’re almost done, but not quite.  Now look at the nutrition label and check the number of grams of fiber per serving to make sure there are at least 3.  Carr’s Whole Wheat Crackers, and Hain All Natural Wheatettes list whole wheat flour first, but they have 2 grams of fiber per serving.  Not so bad, but not so great either.  You can do better. 

A post about crackers wouldn’t be complete without encouraging you to try your hand at making your own.  Cracker making is a great family activity.  I confess that it’s been a while since I made them myself, but I do remember that they were delicious, and then they were gone.  You’ll find two recipes below, one simple and elegant, and the second somewhat more adventurous.

“Homemade Crackers” from Cooks.com: 
Combine 4 cups whole wheat flour, 1 tsp. salt, and 2 tbsp. sugar.  Cut in ¼ c. butter, and stir in up to 1 ¼ c. milk to make a stiff dough.  Wait 15 minutes, and then roll out the dough to 1/8-inch thick on a lightly floured surface.  Cut into squares, and bake until browned.  The crackers will crisp up as they cool.  No nutrition info on this recipe, but you know what’s in them, because you made them yourself, with whole-wheat flour.

“Four-Seed Snapper Crackers” adapted from Peter Reinhart on the LA Times website:
Heat oven to 300.  Grind 1/8 c. sunflower seeds and 1/8 c. pumpkin seeds into powder in a blender, coffee grinder or mortar & pestle.  Stop before they turn into seed butter.   Combine sunflower and pumpkin seeds with 1/8 c. flax meal, 1/8 c. sesame seeds, 1 c. whole-wheat flour, ¼ t. salt, 1 tbsp. honey, 1 ¼ tbsp. vegetable oil, and 3/8 c. water.  Mix ingredients to form a firm ball of dough. It should not be sticky.  Knead the dough by hand on a lightly-floured surface for about 30 sec.  Add a bit more flour if necessary to keep it slightly tacky but not sticky.

Line baking pans with parchment.  Divide the dough into two equal pieces. On a floured surface with a floured rolling pin, roll each to nearly paper thin. Continually lift or flip the dough so it doesn’t stick to the surface, and dust more flour underneath if need be.  Transfer to baking pan, and cut into rectangular or diamond-shaped crackers. 

Combine the egg with ¼ c. water, and brush crackers lightly with egg wash.  Sprinkle with more sesame seeds, and bake for approx 25-30 minutes.  The crackers will be dry, crisp, and golden brown, and they won’t spread or rise in the oven.  This recipe makes 3-4 dozen crackers, each of which contains a full gram of fiber.

Hearty appetite!

This week’s post is about the glycemic index (GI).  Many people have heard of the GI, but they are not sure what it means, or how to apply it for their own benefit.  Several lines of scientific evidence have shown that individuals who followed a low-GI diet over many years significantly lowered their risk of developing type 2 diabetes, obesity, coronary heart disease and even certain kinds of cancer, compared with those who did not.

The glycemic index was developed at the University of Toronto (my daughter’s alma mater) to provide researchers with a way to compare the rates at which various foods, primarily carbohydrates, raise blood sugar.  Because the GI measures how quickly a fixed portion of food is absorbed into the bloodstream, it therefore correlates with the amount of insulin required.  As we have discussed, the faster you absorb a food, the more insulin you need to catch it and escort it to the cells.  So if your goal is to conserve insulin to the greatest extent possible, the glycemic index provides a way to compare foods, and to select ones with lower ratings.  I would arbitrarily rate a low glycemic index value as below 40, a high GI value as above 70, and 40-70 as mid-range.

Let’s look at some actual ratings at http://www.glycemicedge.com/glycemic-index-chart/.  In the “beans & vegetables” category, most beans are rated low.  No beans are rated higher than 48.  Baked beans are rated that high only because they are prepared with a lot of sugar.  So it isn’t the beans themselves that raise the glycemic index to 48.

Most green (broccoli, celery) and white (cauliflower, mushrooms) vegetables are rated below 25.  Red, yellow and orange vegetables are generally in or near the mid-range.  Instant mashed potatoes are a whopping 74.  Why?  Mashing potatoes begins the mechanical process of breaking down food in preparation for its absorption.  Any time we decrease our body’s work of digestion, we increase the rate of absorption.  The more broken down a food prior to eating it, the less work the stomach has to do, and so the more rapidly the food is absorbed. 

In the breads category, whole-grain breads are the lowest (40) and white breads range around 60-70.  French baguettes are extremely high (94).  Most cereals are in the 70-80 range, except for a few whole-grain products in the 50’s.  Rice chex are 89.  Among grains, instant rice is rated as 87 (consider it pre-digested).  Most pasta is in the low mid-range.  Why is steamed brown rice rated at 50, and boiled brown rice at 72?  I suspect that the increased mechanical action of boiling causes more fiber to break down during the cooking process.  I’d be interested to hear from other readers with ideas about this. 

Crackers (67-82) and cookies (vanilla wafers and graham crackers-mid 70’s) are high because they are generally made from white flour with little or no fiber to decrease absorption.  Oatmeal cookies (55) are better.  Most fruits are in the 30-50 range, with a few higher and a few lower. 

It is very interesting to note that the section with the highest glycemic index values overall is “Snacks & Chips,” including poptarts (72) and french fries (75), neither of which, by the way, would be classified as a snack or chip by me.  I thought poptarts were marketed as a breakfast substitute.  More truth in advertising.   Substitutes are not food.  That makes me wonder if perhaps it is the types of snacks, more than snacking itself, that contribute to our obesity epidemic.  Drinks, predictably, range from tomato juice (38) to gatorade (78).  Overall, the lowest glycemic index sections are dairy, beans, and vegetables.  The worst surprises on the list are the tofu frozen dessert (115) and pretzels (83).  The best surprise is the dairy section in general, and yogurt in particular (14).  Here is more evidence that, in fact, Grains are not Beans are not Fruit are not Vegetables: All Carbohydrates are not Created Equal .

The GI depends not only on the particular food being consumed, nor on associated foods eaten at the same time, but on preparation methods as well.  We can manipulate, to a certain extent, the rate at which we absorb various foods, even those with a higher GI.  Basically, whatever increases the work of breaking down food will lower the GI and, conversely, whatever decreases the work of breaking down food will raise the GI.  The longer it takes to break down food, whether mechanically or chemically, the longer it takes to absorb that food.  It takes time to tease apart the strands of a fiber-rich food to get at what’s inside.  This is why whole-grain breads, with higher amounts of fiber, generally have a lower GI value than white breads.  But, as usual, the buyer must beware.  Many brown breads are treated with enzymes that break down fiber and soften the crust.  This has the effect of raising the GI to levels comparable to those of white bread.  So don’t assume simply that switching to brown-colored bread is worth it.  First, check to be sure that the first ingredient is whole-grain flour.  Secondly, check to see if there are 3 grams of fiber per serving.  It’s no guarantee, but it certainly improves your chances of getting what you think you are paying for.

What else lowers the GI?  Fiber, fat and protein all slow gastric emptying (which means that they make a meal sit in the stomach longer), which reduces a food’s GI.  What else?  Acids like vinegar and lemon juice appear to lower gastric emptying.  And, according to one study, alcohol (though not beer), reduced the GI of a meal by 15%.  

So how best to use this information?  Compare the glycemic indexes of the foods you are considering, and choose the lower.  This approach is similar to that of  “Eat This, Not That,” by David Zinczenko, editor-in-chief of Men’s Health magazine and author of the Abs Diet series, and Matt Goulding, the magazine’s food and nutrition editor.  If you compare the GI values of the recommendations, you will see that in virtually all cases, a lower GI food is recommended as the preferred choice.  It’s not just about calories. 

What are the limitations of the glycemic index?  First, it measures only glucose, and not fructose, a major cause of insulin resistance, high triglycerides, and non-alcoholic hepatitis.  (See Fructose, Fiber, and High Fructose Corn Syrup .)  Secondly, the GI measures the intake of a 50-gram load of a food, even if the usual serving of that food is much smaller.  Despite these two major limitations, it is useful for our purposes. 

From time to time, I get to recommend to a motivated new patient with mildly elevated blood pressure that he or she try the “DASH” diet prior to considering medication.  The DASH diet, which stands for “Dietary Approaches to Stop Hypertension,” and has been recommended by the National Institutes for Health, the National Heart, Lung, and Blood Institute, and the American Heart Association, lowers blood pressure within 2 weeks.  You can check it out yourself at dashdiet.org.

The DASH diet is based on 1) increasing fruits and vegetables, whole grains, nuts, and dairy; and 2) decreasing fat and sugar.  Specifically recommended for lowering blood pressure, it also lowers weight, and the risk of stroke and heart disease.  Combined with exercise, it improves insulin resistance, which decreases your risk of developing diabetes.  The benefits have been seen in people of all ages, from teens to the elderly.

You can see that there is significant crossover between my 4 recommendations and the DASH diet, although we do part company on the amount of grain it recommends and the preference for low-fat dairy.  Let’s just say I respect the fact that everyone is different, and that some folks seem to tolerate grain (whole-grain only) better than others.  If the low-fat dairy recommendation confuses you, I recommend that you do your own little experiment:  Follow the DASH diet as written for a month or two, and then switch to full-fat dairy.  If your pants get tight or your weight (or blood pressure) rises, then you’ll have your answer.  But just for the record, I don’t believe that will happen.  I don’t believe that the fat in dairy and meats is unhealthy.  In fact, I believe those fats are nutritious.  It’s the fats in fast food, snack foods, and commercial baked goods that are the big problem.  All fats are not the same (see “Butter is better.”)

A new study shows that the DASH diet plus regular exercise improves not only blood pressure, but brain power as well.  In a March 2010 study published in Hypertension: Journal of the American Heart Association, 124 men and women were divided into 3 groups.  Over 4 months, one group followed the DASH diet and exercised for 30 minutes three times a week, a second group followed the DASH diet without exercise, and a third group changed neither their eating patterns nor their level of activity. 

At the beginning and end of the study, participants underwent a series of tests that assessed mental skills such as manipulation of ideas, concepts, and planning.  The people who combined aerobic exercise with the DASH diet experienced a 30% improvement in brain function, improved their cardiovascular fitness, lost 19 pounds on average, and lowered their systolic blood pressure (top number) by 16 points and diastolic blood pressure (bottom number) by 10 points.  Wow.  That’s the group I want to be in.

High blood pressure is a huge problem in our country.  It affects at least one-half of adults aged 60 and older and increases the risk of heart attacks, strokes, kidney disease, and dementia.  So why don’t we all eat the DASH diet?  Why don’t all newly diagnosed hypertension patients get referred to a nutritionist to learn to eat this way?  Come to think of it, why should you have to wait until you’re diagnosed with high blood pressure?  Why aren’t school lunch programs based on the DASH diet?  And why don’t children learn these basics in their science and nutrition classes?  I am more than ready to spend my days teaching people how not to become hypertensive and diabetic.  Any takers?
 
How to start improving your nutrition?  Since the average American gets only 2-3 servings of fruits and vegetables each day in total, the DASH diet involves a significant increase in the amount of produce consumed.  As usual, I don’t recommend jumping in all at once.  Instead, pick something from the list below.  In a few weeks, add another choice, and then another a few weeks later.  At some point, you will notice that you feel a lot better.  Then, if you’re like most people, you’ll go back to your old habits.  Don’t worry, it’s temporary.  You just need to see if it’s really the dietary changes that are responsible for the fact that you feel better.  That’s human nature, and it’s how we convince ourselves which investments are worth it.  Don’t take my word for it — take all the time you need, and figure it out for yourself. 

Here are some ways to get started:  
 .Add a serving of vegetables to lunch and dinner. 
 .Bring a piece of fresh fruit to work for midday snack. 
 .Switch to butter, and make your own salad dressing (see “What’s in that salad dressing?”).
 .Use vinegar, herbs, and spices instead of salt. 
 .Have a glass of milk or a piece of cheese or a serving of yogurt three times a day. 
 .Limit meat to 6 ounces a day.  Be aware of portion size; we all need to know what an appropriate serving size looks like. 
 .Change from white rice and conventional pasta to brown rice and whole-grain pasta. 
 .Eat more beans (see “The Lovely but Lowly Bean“).  
 .Choose cheese sticks, nuts and nut butters, raisins and other dried fruits, yogurt (see “Everything You Always Wanted to Know About Yogurt But Were Afraid to Ask“), fresh fruits and vegetables for snacks.

Bon appetit!