Sugar and Addiction

The quick answer:  The objective in eating less sugar is not to replace sugar with sugar-like substitutes, but simply to eat less sugar.  The split pea soup recipe attached delivers wonderful sugar-free flavor.

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Addiction

What’s addiction but the inability to resist harmful behavior.  Though known through out history, the rapid spread of addictive behavior is a phenomenon of our time.  The growing variety of addictions suggests a fundamental human vulnerability triggered by the modern diet and way of living.  Though some people are more vulnerable than others, with repeated exposure anyone is susceptible. 

Food addictions, as we have seen, make a good business for the suppliers.  The success of Coca-Cola, which originally contained cocaine, and of other caffeinated and sugary drinks is testimony to this.  These and other sugary foods are mildly addictive to most, but some find them highly addictive.  A central challenge of healthy eating and living is to live free of addictions. 

Occasionally we hear the refrain, “moderation in all things.”  This is actually a way of saying everything is okay, and we know that isn’t so.  Some things, like tobacco, or trans fats, should be avoided completely.  Other things—like sugar or sugar substitutes—should be minimized.  It would be wiser to say, “moderation in all good things.”

The reader comments to the last post suggest that even diet sodas are addictive and one reader asked for ideas on how to quit.  Serious addiction requires professional help and programs exist to provide such assistance, but here are a few suggestions for the mildly addicted:

1. Make your home a safe place:  If something desirable is in your home, it will be eaten.  So keep your addictions out of the home.  Healthy Change #8, for example, said to “buy candy a piece at a time; never bring a box or bag of candy into the home.”  So if you’re unable to resist soda drinks, just buy one when you do your weekly shopping.  And get a hacksaw and cut the drink holders out of your car.  Ha ha.  
2. Seek friends who don’t share your addiction.  A recent book, Connected: The Surprising Power of Our Social Networks, followed the behavior of people who stopped smoking, a difficult addiction.  Those who were successful gravitated to social groups who didn’t smoke.  Try inviting your friends to quit unhealthy practices with you; the best outcome is when friends improve together.
3. Eat a healthy diet.  Poor nutrition is addictive nutrition—some researchers, for example, describe sugar as “the mother of all addictions.”  The science is not complete but there is evidence of the depressive effect of sugar on neuro-transmitters like serotonin, which leads to addictive behavior to compensate.  The sugar substitutes may also have this effect.
4. Remember you’re being watched.  There is scripture about the sins of the fathers passing to the sons, and their sons.   If you want to protect your children, work very hard at eating well and avoiding addictive behavior.  The generation X’ers who embraced street drugs grew up in a culture where adults abused prescription drugs.
5. Replace your addiction with something better.  Take a walk when you’re tempted to reach for a diet drink.  Water always tastes better after a walk.

Stevia

Readers have asked about stevia as a replacement for artificial sweeteners.  I think the question misses the point—to improve our diet the safest approach is to reduce all sweeteners, not just our sugar intake.  There is no research, to my knowledge, that shows a total health benefit from replacing sugar with any chemical that has the same sweetening effect.  To improve health and longevity, we need to de-sweeten the modern diet and return to traditional flavors.

Look at the history:  A new chemical or product is regularly discovered and marketed to replace one found addictive or unhealthy.  Since sugar was shown to be unhealthy in the amount being consumed, we have seen a series of potently sweet new chemicals being introduced, from saccharine to cyclamate, to sucralose, to aspartame to the most potent yet, neotame (acesulfame potassium).  Short-term, these products are probably safe to use.  The long-term safety remains unknown and may never be known due to the needle-in-the-haystack difficulty of proving what makes us ill among the thousands of foods we eat. 

Stevia is a traditional sweetener in Latin America and is now used around the world, especially in Asia.  China—not generally considered a safe source for processed foods—is a significant exporter of stevia sweeteners.  The leaves, once used intact, are now chemically processed to isolate several of the sweetening molecules.  Two, stevioside and rebaudioside A are marketed in different forms.  Rebaudioside A was approved for the FDA’s GRAS (generally regarded as safe) list in 2009, which simplifies its addition to food products.  Coca-Cola and Cargill developed a stevia product called Truvia, and Pepsi-Co developed PureVia.  The use of these products will grow and we eat at our risk.

We have used stevia products in our home but have stopped.  My beautiful wife didn’t care for the after taste and I decided I just didn’t know enough about how they are manufactured. 

Please comment:  Reducing sugar intake to the AHA guidelines of 6 tsp daily for women and 9 tsp for men is about a 75% reduction for the average American.  The goal is to de-sweeten our diet, not just to replace sugar with non-sugar sweeteners.  Please share your experience with eating less sugar (whatever the form). 

Recipe:  Split Pea with Ham Bone

In the post on legumes I promised to share our recipe for split pea soup.  It’s a traditional dish good for several meals, full of flavor without resorting to sugar.  We started with the Cooks Illustrated recipe, which follows the traditional ingredients for legume soups but took too long.  Split pea soups are a thrifty dish for using ham bones left over from a Sunday dinner.  We cooked this twice, once with a ham bone from the freezer, the second time using cooked ham hock/shoulder from the store.  Because the amount of bone will vary, we wrote the recipe per pound of bone:

Ingredients

1# ham bone with a little meat attached, or a ham hock/shoulder

4-6 cups water, or enough to cover ham bone

1-2 bay leaves

1 cup split peas, rinsed

½ tsp thyme, dried

1 T EVOO

1 medium onion, chopped

1 carrot, chopped

1 celery stalk, chopped

1 T butter

1 garlic clove, minced (optional)

1 new potato, cubed (optional)

Tabasco sauce (optional)

Directions

1. Place the bones with meat in a suitable pot with bay leaves.  Bring to boil and simmer 2-1/2 hours.
2. Remove the bone from the pot and set aside to cool.  Add split peas and thyme to the pot.  Return to boil and simmer 45 minutes until peas are soft.  (Steps #3 and 4 can be done during the 45 minutes.)
3. While the peas are simmering, add olive oil to a frying pan and sauté carrots, celery, and onion about ten minutes, until soft and moisture is evaporated.  Clear a little space in the pan and add butter and optional garlic, then stir into the vegetable mixture. 
4. Remove the meat from the cooled bone(s) and chop into small pieces.
5. Place the vegetable mixture, cubed potato, and meat in the pot of split peas.  Add salt and pepper to taste.  Simmer for 20 minutes.  Add optional Tabasco sauce to taste and serve after cooling.  (During step #5 a green salad can be prepared and served with bread.) 

Note:  Not counting the 2-1/2 hours of step #1, this meal can be prepared in a little over an hour.  Cook it on a day when you have extra time and you’ll have enough leftovers for several more meals.  A 3# ham bone made enough to freeze a quart and provide two dinners and a lunch for two people. 

The diet soda challenge

The quick answer:  America’s love affair with diet drinks was a big mistake.  Our recipe for better health: water, on the rocks, with a slice of lime.

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Heard of the Ornery Rule?  My invention, I confess, but it says you can count on someone finding the stuff you like the most . . . to be unhealthy.  Like sugar.  We’ve taken on America’s love for sugar—excess sugar is our single biggest health problem—with these Healthy Changes:

#1   If you consume sodas or other sugared drinks, limit yourself to one (12 oz.) serving per week. 

#3   Cereal products must be made of whole grains, and have more grams of natural fiber than grams of sugar.

#6  Drink lots of water; make it your main drink.

#8   Buy candy a piece at a time; never bring a box or bag of candy into the home.

#12 Enjoy a healthy mix of snacks by making a daily snack plate.  (Because sugary snacks are often impulsive, this adds the virtue of premeditation to snacking.)  

#25 Don’t skip breakfast.  Start your day with a healthy breakfast rich in antioxidants with more fiber than sugar.

Non-sugar sugar?

A little history?  In the beginning there was no sugar, just natural sweeteners like honey,  By and by, someone discovered how to make sugar from cane and in the 1600s, colonies were established in the New World to meet the growing demand.  Fortunes were built on the sugar trade.  Even before the cotton plantations of the South, slaves were taken from Africa to the Caribbean to work the cane fields.  In Europe, because sugar was so precious at first, it was usually sold in drugstores (apothecaries).  As the effects of eating sugar became apparent, doctors began to warn of its dangers.

During this time there arose in France a lawyer turned food writer named Brillat-Savarin.  In 1825 he composed the first important book on food, The Physiology of Taste.  It became a classic and nearly two centuries later is still a good read.  Brillat-Savarin observes how health concerns about sugar were met with the mindless rejoinder, “sugar hurts nothing but the purse.”   A learned man even promised that, “if sugar should ever again be thirty sous a pound, I will drink nothing but eau sucree.”  He wasn’t alone, which brings us to America’s love affair with sugar alternatives.

In 1890 it was discovered that saccharine gave the taste of sugar without the calories.  Prescribed first for diabetics, it was approved for general use in 1958.  Some remember it for launching Diet Rite and then Tab, the first big diet drink.  With saccharine, it seemed, you really could have your cake and eat it too, if you didn’t mind the bitter aftertaste.  Other artificial sweeteners followed: including cyclamates (no longer approved in the US); and aspartame (NutraSweet, or Equal), the most controversial of the sweeteners.

Coca-Cola, building on the popularity of Tab, introduced Diet Coke, which used aspartame.  Launched in New York City in 1982 with a $100 million advertising campaign, Diet Coke was an immediate success and is now the #2 soft drink, after Coke.  Not to be outdone, Pepsi, Dr Pepper, and Mountain Dew brought out diet versions.  Again, as with sugar, a few doctors spoke out against the danger of artificial sugars but the temptation of both sweetness and slimness was irresistible.

Are diet drinks really healthier than sugar drinks? 

This brings us to the big question:  Are diet drinks healthier than sugary drinks?  Long story short, diet drinks really are unhealthy, but in different ways.  For example:

• Preterm delivery risk:  A 2010 Danish study found pregnant women who consumed one diet drink daily at 38% higher risk for preterm delivery.   There was also a dose response: women who drank four per day had a 78% greater risk.  No such risk was found for sugar drinks.
• Metabolic syndrome:  A nine-year study of 9714 people, age 45 to 64 years, reported in 2007, looked for dietary causes of metabolic syndrome (which we discussed here).  High meat intake was found to be a significant risk but the big surprise was that diet drinks increased the risk 34%. 
• Osteoporosis: There is a longtime link between diet drinks and osteoporosis, but the exact cause remains unknown.  Is calcium leached from the bones to buffer the phosphoric acid?  Or, do soda drinkers just get less calcium from sources like milk?  We haven’t figured it out yet, but perhaps it shouldn’t surprise us that research against highly profitable products doesn’t get funded.
• Kidney stones:  Where does the calcium lost from the bones go?  Some winds up as kidney stones.  An NIH study of kidney stones found two or more cola drinks each day double the risk for stones.  As the most popular drinks, sugar or diet, are colas, urologists will be busy treating those painful stones. The calcium in your diet isn’t the problem—a 1993 study found calcium from food protects against kidney stones. 
• Stroke and heart attack: A U. of Miami study of 2500 Manhattan residents followed over 9 years found a 61% higher risk of vascular events (heart attack, stroke, or vascular death) for daily diet soda drinkers vs those who abstained.  Even after controlling for known risk factors, a 48% greater risk remained.   
• Weight gain:  There’s a bag-full of studies showing diet sodas add rather than reduce weight but this shouldn’t be news.  Back in 1986 a study of 78K women ages 50-69 found nearly 2 pounds per year greater weight gain for women consuming artificial sweeteners vs. women who didn’t.  A pound or two isn’t much, but multiply it by 28 years (since Diet Coke was introduced) and you’re looking at a big gain.

The problem of weight gain for diet soda drinkers was addressed in a Yale review of prior studies.  The conclusion was that artificial sweeteners reinforce the sugar desire, without satisfying it as regular sugar does.  No surprise then that the national weight gain of recent decades parallels the growing use of artificial sweeteners—the more we eat, the more we want. Good for business, but bad for health.

There’s true irony here:  Diet drinks—despite the marketing—don’t make us slimmer, what’s worse they introduce new health risks.  We’ve been through the sugar binge, high fructose corn syrup, saccharine, and aspartame, and the bottom line seems to be that we must return to olden ways and recover our taste for flavors other than sugar, whether real or artificial. A little sugar is okay, but we've gone way past a little.

Healthy Change #31 reads much like our first Healthy Change: 

Budget Wisdom:  Americans spend about $12 billion yearly on soft drinks, I’m told.  Drinking less bottled drinks, way less, and more good old water from your tap (well, after it runs through the charcoal filter) will save you money that can be better used to buy whole foods, as well as your health.  Water on the rocks with a twist of lime—you can't beat it for value, convenience, or healthfulness.

Please comment:  This is a challenge because diet drinks are tempting, especially for moms who want something to pick them up on busy days, which can be everyday.  For this reason I’ve saved it until our 31^st week—after you’ve gained strength from the dietary improvements and extra exercise.  If you’ve successfully cut back on diet sodas, please share your experience.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

The Benevolent Bean

The quick answer: Legumes are underutilized value champions, offering protein, fiber, and a host of nutrients.  Enjoy them most days, in a soup, stew, casserole, or just sprinkled on a salad.

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The Healthy Change for this week advises eating legumes most days.  Before I introduce a book on the subject, let’s look at the twisted trail of the author Ancel Keys, a scientist who shaped the American view of heart disease.  Keys, more than any other person, sold the misguided mantra known as the Lipid Theory of Heart Disease, which posited that coronary heart disease (CHD) could be prevented by eating a low-fat diet, particularly a diet low in saturated fat and cholesterol.  

This conclusion was based on his Seven Countries Study but it was later suspected he chose countries that supported his preconceived notion that dietary fat was the culprit.  In retrospect, choosing different countries would have given a different answer.   Due to Keys’ persistent efforts—he’s often portrayed as an academic bully—the focus of CHD research turned to cholesterol.  It helped that a cheap test for blood cholesterol had been developed—today most everyone knows their cholesterol number and many believe that lowering cholesterol is good for their health.  It’s a curiosity of medicine that the available test can shape the treatment of disease, and cholesterol-lowering drugs grew into an enormously profitable business, though more and more their use is being questioned.

Keys later retired to a charming fishing village on the Italian coast where he became a proponent of the Mediterranean diet which, due to the consumption of olive oil and fish, is low in saturated fats.  He even wrote a book on the diet that became a best seller.  Unfortunately, the cholesterol adventure wasted 50 years in the war against CHD.  Why did I tell this story of science gone awry? Because it reminds that science is often wrong, and we are wise to consider other venerable sources of knowledge, including tradition and scripture.  We’ll invoke all three in this post.

Scripture

Do you remember the food experiment of Daniel and his three friends in the Old Testament?  It may have been the first use of classic experimental design.  Taken captive to Babylon for training, Daniel and his friends were offered the rich food and drinks served at the king’s table.  Daniel demurred, proposing a 10-day experiment wherein he and his friends would eat the simple food known as pulse, and drink only water.  Pulse is a traditional dish of cooked edible seeds, usually leguminous, such as lentils, chickpeas, and, perhaps, foods grown from those seeds.  This plant-based diet was successful as Daniel and friends were later found to look better and test wiser than those eating the king’s fare. Daniel was wise beyond his years.

Wisdom sometimes fails.  Do you remember Esau selling his birthright to brother Jacob for a “mess of pottage”?  It’s another legume story—the dish was likely lentils, plus some bread.

Tradition

The good Lord, it seems, looks after the poor.  In much of the world, the humble legumes on which Daniel excelled are the affordable fare.  The prosperous can get their protein from animal sources, but by tradition the poor must eat the plants at hand—which are actually healthier.  In the post on protein, it was suggested we get 2/3 of our protein from plants, and just 1/3 from animal sources, which is roughly the reverse of how we currently eat.  Have you considered how this protein is also the source of plant life—legumes, whole grains, seeds and nuts?

In our home, the beautiful wife's most recent dinner was a pot of split peas cooked with a ham bone from the freezer.  (Recipe to follow.)  There is a traditional method for cooking legumes:  To the legumes you add three savory vegetables (onions, carrots, and celery) and then three spices (parsley, thyme, and bay leaf) plus salt, pepper, and perhaps a little garlic, then a few bones or a bit of meat (often from the humble pig).  Legumes vary by region, there are thousands of varieties, but most dishes follow this formula.  In Provence, cassoulet is a traditional dish of white beans with savory meats, vegetables and spices, topped with a breaded crust. 

People are different and for some, certain beans bring the bane of flatulence.  To give this post a high tone, we simply refer you to this blog for information.  There is an OTC pill that provides the enzyme to prevent this problem that some may distain as it has a lowbrow name: Beano.

Science

We return now to the errant scientist Ancel Keys and his book on legumes.  Titled The Benevolent Bean, it was first published in 1967 but is now out of print.  It’s a charming introduction to legumes and full of recipes.  Unlike most vegetables, beans are rich in protein.  Keys suggests we double the 7-8 pounds (dry weight) we consume each year, which aligns with this week’s Healthy Change and the USDA's 2010 Dietary Guidelines for Americans.  (The USDA sometimes has the right answer.)

Legumes are not complete proteins (meaning they don’t contain all 8 or 9 essential amino acids) but combining beans with another food group completes the protein profile.  For example, beans are eaten with corn tortillas in Latin American, or with pasta in Italy (pasta e fagioli), or as tofu and rice in Asia.  Besides nutrients and fiber, there’s another benefit to dried beans—shelf life; they’ll last years if properly stored. 

Redemption is found in unusual places.  It’s easy to dislike Ancel Keys because of his dominating role in the cholesterol debacle that badly delayed the battle against heart disease.  Yet I found the book The Benevolent Bean, quite charming.  What made the difference?  The great scientist wrote the book with his wife, Margaret, and the help of their daughters and that, I think, made all the difference.  It's another reminder that the women who cook should be involved in our nation's food decisions.

Budget Wisdom

The two keys to healthier eating also offer the best value.  The keys: 1) eat whole foods, and 2) do your own cooking.  In the last century, older women passing away took their knowledge of cookery with them—their children, seduced by modernity, weren’t interested in olden ways.  Taken in totality, this is a great loss to our planet.  If we find it difficult to cook nutritious meals of whole foods, the answer is to reclaim this lost wisdom.  Perhaps the book clubs, so popular with young mothers, can be expanded to cooking clubs. I saw a program last night where women got together to visit and assemble food dishes for the week. 

A reader referred me to a charming book The Pleasures of Cooking for One by Judith Jones.  Jones was the editor that recovered The Dairy of Anne Frank from the reject pile, and edited all the works of Julia Child and James Beard, and many others.  Though her style of cooking is a little fancy for most, I admired her reverence for the kitchen art, and her determination to carry on making memorable meals after the death of her husband.  In this regard, Judith Jones is a beckoning light upon a hill. 

Please comment

How can we recover the art and discipline of cooking nutritious meals that fit the family budget?

Don't Forget Fiber

The quick answer:  Over the last century, dietary sugar consumption rose as fiber intake declined.  To reduce your risk of overweight and disease, eat more natural fiber than sugar.

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The 20^th Century was a dietary disaster—we’ve said it before, but repetition is a principle of learning.  The industrialization of our food is presented in the graph above that compares traditional diets (Developing Countries) to the modern Western diet. For the thoughtful person, there is much food wisdom in this chart.

The diet of the Western countries makes a good business—not just for the food processors that comprise Food Inc. but also for the medical establishment that treats the resulting chronic diseases.  A premise of this blog is that as we eat and live better, we will have less need of doctors, drugs, and hospitals.  We’ll still die, and perhaps from those same chronic diseases, but we’ll have more years of good health to enjoy, and less years of bad health to endure.  (A younger person diagnosed with cancer, for example, will linger longer than an older less vigorous person with the same disease.  My Father died of cancer in his 90^th year, but it was just a week from diagnosis to his passing.)

Two metrics define the 20th Century damage to our dietary: the year-by-year rise of sugar consumption, and the corresponding decline in fiber intake.  The third Healthy Change established the rule that food products must be made of whole grains and contain more natural fiber than sugar.  Prior posts addressed sugar; this post is about fiber.

The original weight-loss marvel:

Fiber is essentially the structural material of plant cells.  Whether soluble or insoluble (it doesn’t matter which, we need both), fiber is the original weight loss marvel: it provides lasting fullness yet has zero calories.   In addition, fiber optimizes the rate of digestion, slowing the rate that starch enters the blood as glucose (thus softening the swings in blood sugar and insulin that cause type 2 diabetes and fat storage) while speeding the passage of food through the G.I. tract (which reduces the risk of colon cancer). 

Dr. Denis Burkitt

In the course of the year we highlight twelve heroes of better nutrition, including Dr. Denis Burkitt.  Dr. Burkitt served in Africa as a missionary surgeon and his keen study of disease patterns led to the ‘80s bestseller, Don’t Forget Fibre in Your Diet.  (No fiber isn’t misspelled; Burkitt was English.)  The informative graph displayed above is from his book.  Burkitt single-handedly brought the removal of fiber by the industrialization of food to the public consciousness.  From his research—he painstakingly established a large network among hospitals to monitor the incidence of diseases—Burkitt linked the disappearance of dietary fiber with modern diseases like constipation (the first sign of fiber deficiency), type 2 diabetes, heart disease, gallstones, and breast and colon cancers.

Fiber deficiency diseases:

Over the last century fiber was steadily removed from our diet by the rise of processed foods, and the chronic diseases noted above.  Another result—I’ll try to be delicate here—was increased constipation.   (Fiber deficiency isn’t the only cause; other factors include too little exercise or fluid intake, or a diet high in dairy products.)  Most people don’t realize the danger of constipation-caused straining during bowel movements:

• Straining causes hiatal hernias, a condition where the upper portion of the stomach is forced into the chest cavity, which causes the leakage of stomach acid and heartburn.  Rather than diet reform, people take antacids (Alka-Seltzer, Milk of Magnesia, Pepto-Bismol); more recently drugs to reduce acid production (Pepcid, Tagamet, Zantac) have been heavily advertised.
• Straining can force partially digested food into the appendix where it can lodge, become infected, and lead to appendicitis.  Appendicitis is the most common emergency surgery of the stomach.
• Straining can cause bulges or aneurysms in the large colon and the serious disease of diverticulitis.
• Finally, straining is associated with the painful problem of hemorrhoids, which require no explanation.

Foods rich in fiber:

The humble legume—whether pea, lentil, or bean—provides more fiber than any other food.  See here for the legumes highest in fiber.

Besides legumes, foods rich in fiber include (for details go here):

• Whole grains (a 2011 study showed whole grains to be significantly protective of death from all causes),
• Nuts and seeds,
• Fruits, especially berries,
• Vegetables, particularly root vegetables such as yams.

Budget Wisdom:

It’s well known that legumes provide the best nutrition value for your food dollar.  What’s surprising is how little shelf space markets dedicate to dried beans, the very best food value.  Selling for around a dollar per pound, you can feed the family for pennies per serving.  If you’re serious about food value, this week’s Healthy Change is a natural.

Please comment:  Share the ways you include legumes in your family’s diet.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Graph from the book Don't Forget Fiber in Your Diet by Denis Burkitt

Keeping Your Marbles

The quick answer: Hippocrates first observed that what's good for the heart is good for the brain.  Living the Healthy Changes helps to protect your brain from the twin threats of dementia and stroke.  

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Preventing dementia, including Alzheimer’s disease

We went to a funeral the other day for one of the loveliest people you could hope to know.  Her name was Nancy and she left us at a relatively young age.  Nancy was in her mid ‘60s, just entering what should have been her golden years.  But in truth, Nancy had left us some time before, for she died of Alzheimer’s disease.  Alzheimer’s, the most common form of dementia, is growing at a frightening rate.  This post is dedicated to the memory of Nancy, and the proposition that the Word of Wisdom Living lifestyle can reduce the risk of dementia, as well as stroke.

A 2005 Columbia University study found four risk factors that were highly predictive of Alzheimer’s disease (AD).  Per the study, your risk of AD is 240% greater if you have three of these four conditions:

• Smoking,
• Diabetes,
• Hypertension,
• Heart disease.

A 2010 study, also at Columbia, found a strong link between HDL cholesterol—known fondly as the “good” cholesterol, though in fact we need all the forms of cholesterol, just in the right ratio—and the risk for AD.  Those with higher HDL levels (>55 mg/dL) had 60% less risk of AD than those with lower levels.  How do we improve our level of HDL?  Here is a summary:

• Get regular aerobic exercise (more is better).
• Lose excess weight.
• If you smoke, stop.  (Is there no end to the ways tobacco harms the body?)
• Eliminate manmade trans fats (eat nothing hydrogenated).
• Eat whole foods (lower glycemic index plus more fiber and nutrients).  A diet high in sugar is a special risk for AD—those who consume the most sugar have a six-fold greater risk vs. those who eat the least.
• Eat fish (rich in the essential fat, omega-3).
• Get adequate B-complex vitamins (including niacin).

The last protective action—getting adequate B-complex vitamins—brought to mind a study of AD among Catholic nuns reported in the book, Amazing Grace.  In a prior post we discussed the link between the B vitamin folic acid and spinal cord birth defects, particularly spina bifida.

Amazing Grace found a similar protection for folic acid against AD.  It’s most interesting to learn how vitamins that are protective at birth also protect our brain at the end of our lives.

There was also a link between AD and homocysteine, a normal chemical which can be harmfully high when folic acid and other B vitamins are deficient.  In the post on heart disease, elevated homocysteine was an important risk factor.  In fact, if you look over the lifestyle habits that protect from heart disease, you find the same constellation that is protective of dementia.  Because tradition is one of the three sources of wisdom for this blog, we should now honor the ancient physician Hippocrates who said: 

“Food that is good for the heart is likely to be good for the brain.”

A Personal Story

May I tell a story?  In 1991 I took a position with a new medical device company called Target Therapeutics.  With the help of leading doctors, this company founded a new field of medicine called interventional neuroradiology.  Basically we provided doctors with miniature catheters and other tools to treat structural brain disorders by working from inside the blood vessels.  (This was much less invasive than surgery by cracking open the cranium.)  At first we provided catheters for diagnosis but our fame came from an innovative treatment for treating aneurysms.  Yet all the time our big goal—a task still unfulfilled—was better treatment of strokes. 

My work here brought an unexpected moment of closure.  When I was just three years old—this is the short version of the story—I fell out of a moving car and suffered a brain injury that might have proved fatal.  The concussion caused a slow-developing hemorrhage that put increasing pressure on my brain.  As the clot grew over weeks, I became less active, sleeping more and more.  Because the progress was slow, the doctor involved was not concerned.  My parents were frightened, however, and through a serendipitous chain of events my Mom got into the office of a neurosurgeon in San Francisco.  This was during the early years of neurosurgery but the doctor immediately saw the problem and arranged a life-saving surgery not available where I lived.  (Yes, that's me in the picture above, wearing a protective cap during recuperation.)  Years later, while working at Target Therapeutics and observing the use of our products I visited that same hospital where my life had been saved as a child.  I think it was this moment of closure that sparked a continuing interest in promoting brain health.  For this reason, I call your attention to stroke prevention and treatment.

Treating Stroke

Stroke is the 3^rd leading cause of death in the US, causing 160,000 deaths each year.  Because breast cancer has been so well advertised we should note that more women die of stroke than breast cancer.  In fact, strokes are much more easily avoided—up to 80% of strokes are preventable.  It’s a tragedy that our society is not more effective at preventing, or quickly treating, strokes. 

Most strokes are ischemic, meaning a clot blocks an artery in the brain, cutting off the flow of blood and life-giving oxygen to brain cells.  A minority of strokes is hemorrhagic, meaning a blood vessel bursts, usually due to an aneurysm, and leaks into the brain cells.  Avoiding high blood pressure is the first protection against stroke. 

It’s important to remember that when a stroke occurs, it takes 4-8 hours for brain cells to die—a much longer treatment window than in heart attacks.  Therefore, recognizing the signs of a stroke and quickly getting to a major hospital—one with a certified stroke center and interventional neuroradiologists trained in methods of treatment—is essential to survival.  I repeat: essential! (If you don't know the best hospital, get to the biggest one and inquire.)

Borrowing from the success our society had in alerting people to the signs of heart attacks, it’s helpful to see strokes as brain attacks, and be aware of the signs.  Because the brain is separated into two halves, stroke symptoms usually affects one side of the body.  As a public service, the American Stroke Association posts these stroke signs to watch for:

• Sudden numbness or weakness of the face, arm, or leg, especially on one side,
• Sudden confusion, trouble speaking or understanding,
• Sudden difficulty speaking,
• Sudden trouble seeing in one or both eyes,
• Sudden trouble walking, dizziness, loss of balance or coordination,
• Sudden, severe headache, with no apparent cause. 

If someone you know shows these symptoms, respond quickly. 

One other  fact about strokes—strokes can be “tiny”, and these are called “transient ischemic attacks” or TIAs.  With TIAs the above symptoms may pass, but there can be loss of brain cells and the accumulation of TIAs is one cause of dementia.  It’s equally important to see a doctor about TIAs because treatment can prevent a more devastating stroke, as well as progressive dementia.

Preventing Stroke

We should follow Hippocrates’ advice; the following protect both the heart and the brain:  Manage your blood pressure, avoid the use of tobacco and alcohol, eat a healthy diet, get plenty of exercise, avoid or control diabetes, and watch out for TIAs.  One more thing (I hope this isn't too much information): be aware that the heart problem of atrial fibrillation can increase your stroke risk by 500%!  For more information, visit the website of the National Stroke Association.  

Please comment:  We’re not used to thinking of the brain when we discuss diet and other lifestyle improvements.  Have the posts this week helped you to know how to hang on to your marbles?

Healthy Brains

The Quick Answer: For brain health, include natural antioxidants and omega-3 DHA in your diet.
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Want to keep your wits?  Dr. Keith L. Black, chairman of neurosurgery at Cedars-Sinai Hospital recommends these five ways to care for your brain:

1. Add omega-3 and antioxidants to your diet.
2. Get at least 30 minutes of exercise three times per week.
3. Sleep well.
4. Take control of your stress level.
5. Learn something new. 

We have discussed #2, exercise, here and here; #3 & 4 (sleep and control of stress) are planned for future posts.  So lets review #1—dietary omega-3 fats and antioxidants—in this post, beginning with antioxidants.

Glucose, Oxidation, and Antioxidants

The brain never rests so it needs lots of energy.  Though just 2% of our body weight, it consumes 25% of all glucose.  It takes oxygen to burn all this fuel, so the brain also consumes 20% of your oxygen supply.  We learned in a prior post that the body uses oxygen to burn the fuel we eat but the oxidized by-products, called free radicals, can harm cells if not neutralized by antioxidants.  Some of these toxic byproducts are called “advanced glycation end-products,” known by the acryonym, AGE.  It’s a good term because AGEs are theorized to cause the aging of cells that leads to disease and death.  For this reason, a diet rich in antioxidant sources (fruits, vegetables, and whole grains) is essential to protect against free radical aging. 

The neurons of the brains are different from your other cells.  Unlike cells which are regularly replaced, we keep our neurons for life.  So a diet lacking in antioxidants will cause the accumulation of free radicals and AGEs in the brain’s neurons and the result can be dementia.  To keep your wits, eat a diet rich in antioxidants. 

The brain is 60% fat. 

Let me introduce you to Dr. Michael Crawford, who practiced medicine for a time in Africa and studied the fats found in animals.  He learned that wild animals have mostly polyunsaturated fat while domestic animals have more saturated fat.  (He consequently wrote a controversial 1968 article in the New Scientist, “Are Our Cows Killing Us?”)  Because the brain is mostly made of fat, it was inevitable that Crawford would also study the brain.  He was surprised to find that while the composition of fat varied in the bodies of animals according to diet and activity, the brain fat of animals was remarkable consistent, with the essential omega-3 DHA fat comprising 25%.  (We discussed DHA, termed the “Queen of Fats,” in a prior post.) 

You’ll recall that certain vitamins, minerals, and amino acids are essential, meaning the body can’t make them so they must be included in the food supply.  (There are over 50 of these essential nutrients—there should be a deck of playing cards featuring each, so we can learn nutrition while playing cards.)  Among the various fats, the omega-3 and omega-6 fats are essential.  Here's the problem:  We eat too much omega-6 and too little omega-3. 

Because the omega-3 fats have a short shelf life once processed, they have been gradually removed from packaged foods.  The removal of omega-3 fats from the American diet in order to improve storage was discussed in a prior post, “The Worst Food Mistake of The Last Century?”  Dr. Crawford makes omninous comments about the shrinkage of brain mass since humans stopped eating wild meat, which is much higher in DHA than modern feedlot meat. 

There are three main omega-3 fats—known by the acronyms ALA, EPA, and DHA.  We get ALA from plants—all the green stuff we eat.  The irony of ALA is though it’s deficient in the American diet, it’s the most abundant fat on the planet.  There is true irony in this:  The richest nation misses out on the most vital fat because it's too "common."  To address omega-3 deficiency we had the Healthy Change of eating a green salad daily.  The green smoothie is another source.  

The body can process ALA into EPA, and then DHA but at a limited rate.  So for best health, we need to also eat some DHA to protect the brain, eyes, and nerves.   (DHA, ahem, plays an important role in fertility also.)  Here are dietary sources of DHA omega-3: 

• Cold water fish (wild or even farmed salmon, tuna, trout, sardines, shrimp, oysters, and crab),
• Eggs (especially if chickens are free range, or algae is added to the diet),
• Meat (particularly liver, which no one eats anymore) from pastured ruminants (cows, sheep, etc.), 
• The omega-3 fish oil capsules.

A prior Healthy Change, as noted, encouraged eating omega-3 fats daily.  This week’s change is more specific:  Be sure to also get some DHA omega-3 most days.  We try to eat fish twice a week (a tuna sandwich counts), or take a fish oil pill for each missed serving.  Maybe one of our smart readers will invent a sandwich with sardines (because of their small size they’re the safest for mercury).  We also buy the omega-3 eggs. 

Budget Wisdom:  For the parents of newborns, there is no better value than mother’s milk.  Breast milk is high in the omega-3 DHA needed for brain development.  Dr. Crawford’s understanding of the critical nature of DHA led to a 30-year crusade to get it included in baby formula.  Finally, in 2002, DHA was approved for addition in the US, but is still not required.  As a result, for years formula-fed babies received insufficient omega-3 and studies have shown lower IQs and poorer vision as a result. 

Please comment:  For a generation we were incorrectly taught that animal fat was unhealthy, that saturated fat and dietary cholesterol caused heart disease.  Worse, man-made vegetable oils high in omega-6 and trans fats but deficient in omega-3 (due to processing and hydrogenation) were wrongly touted as heart healthy.  Today the healthiness of traditional fats, especially the omega-3s, is being rediscovered.  Please comment and share how this cycle of erroneous teaching has affected you and your family’s health, and what you are doing today to enjoy healthy fats, especially the omega-3s.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Heart Health

The quick answer:  Don’t die of a broken heart—live a muscular lifestyle and eat a whole foods diet.

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The subject this week is heart health.  Have you been with someone during a heart attack, or held a friend’s hand before they entered the hospital cath lab for an angiogram, or visited someone after coronary artery bypass surgery?  It’s pretty scary, isn’t it?  In that moment, we would give anything to have lived better.  Our lives depend on us caring for our hearts.  In the last post we discussed five steps for doing this.   They’re worth repeating:

Based on #1 above, the Healthy Change for the week says: Resist laborsaving devices—incorporate muscular activities into your life.

TV Watching

What’s the exact opposite of muscular activity?   Watching TV—being a couch potato.  There are some terrible TV statistics: By the time the average child turns 18, I’m told, they’ve seen 40,000 murders.  In four hours of Saturday morning TV a child will see 200 commercials glorifying junk food, according to one study.  (Yes, the food corporations slip around the parents and go straight for the kids; they’re the #1 advertiser to children.  There ought to be a law.)  How’s a mom going to compete with that?  No surprise that there’s a correlation between TV watching and obesity. 

We had a wary relationship with the TV when our kids were growing up.  If our TV broke, it might be years before it was replaced.  For a few years we had a Laundromat coin meter attached to the TV and the kids had to earn quarters to watch.  Another time we had a key-controlled switch.  The kids were bright and figured a way around it but they were careful to only do it when we were out.  After a Friday night out with the beautiful wife I’d come home and touch the TV to see if it was warm.  It’s OK, you know, to let the kids think they’re getting away with something now and then. 

I never found time to implement my best idea:  An exercise bicycle with a generator attached that the kids would pump to make electricity to power the TV.   The idea was they should be outside playing and only get enough TV to stay culturally connected, so they wouldn’t grow up weird.  It worked I think, they’re good citizens and all look pretty healthy.  The little girl who drew the hearts above doesn’t have TV service in her home.  Good parents place strict controls on TV watching.

Sodium and Potassium

You read a lot that we eat too much sodium, or, sometimes, that we get too little potassium.  Together they’re medically important so scientists look at our ratio of sodium to potassium.  A recent study looked at 12,267 adults, comparing their sodium-to-potassium dietary intake to the chance of dying.  Turns out that mortality is 46% higher for those with the highest vs. lowest ratio.  Worse, the risk of dying by heart attack is more than doubled.

So how can we eat less salt and more potassium?  Here’s where you mainly get sodium: eating food someone else cooks for you.  Table salt is 40% sodium but we get it from processed foods—fast foods, commercial snacks, and restaurant meals.  If you mainly cook at home using real food, you likely don’t have a sodium problem. 

Where do we get potassium?  From plants, especially nuts, seeds, and legumes, but potassium is found in all fruits and vegetables.  So if you eat a whole foods diet, you get plenty of potassium.  What we discover here is that the sodium to potassium ratio is a marker for processed food vs. plant foods in your diet.  Eat whole foods and you shouldn’t have a worry.

Single Adults

I spoke to some single adults the other night, about nutrition.  They have a tough problem, I think.  They mostly live alone, they work hard all day, and it’s hard to prepare a good meal when you’re the only one eating.  One explained how it’s a lot cheaper to pick something up than buy groceries for just one person.  I don’t think that’s true, but it’s been a long time since I lived alone.  You’d laugh if I told you what I ate during the college years.  Does any group eats worse than college kids?

Lots of kids today weren’t taught to cook when they were growing up.  The group I spoke to seemed like really good people, but they didn’t look healthy.  Driving home I wondered how this blog could be more helpful to single people.  Couldn’t we do something more—to inform, or inspire?

Please comment:  Please share your ideas.  How do you control the TV in your home?  Or, how can people living alone eat healthy?  Thank you for your comments—they make this blog work. 

Healthy Hearts

The quick answer:  Better to learn how to care for your heart then have the doctors “repair” it.  See the seven steps below.

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The motto of this blog, that we all "eat smarter, look better, and live longer" requires us to squarely face the greatest threat to longevity: the chronic diseases.

Chronic disease is a natural and preventable consequence of the mismatch between our biology and the modern lifestyle, especially our diet.  The good news is that while we can’t change our biology, we can change lifestyle.  “Chronic” suggests that symptoms develop slowly over years, even decades.  Dental cavities are an early warning of a diet gone awry.  Our sugary intake leads to other symptoms: high insulin levels, inflammation, insulin resistance, atherosclerosis, high blood pressure, and metabolic syndrome (discussed here). The end result may be an autoimmune disease, cancer, diabetes, or heart disease, this week's topic.

What Causes Heart Disease?

If there were a single cause for heart disease, we would have fixed it by now.  Sadly, a generation of time was wasted on the now-discredited “saturated fat-dietary cholesterol theory.”  The simplest answer is that heart disease has multiple causes, including the following lifestyle factors:

•  Smoking is a significant risk factor.

•  Excessive sugar intake leading to elevated insulin and triglyceride levels is an important cause.  See Gary Taubes’ book, Good Calories, Bad Calories. 

•  Chronic infection is a risk as shown by the link heart disease and gingivitis.

•  Central obesity (fat around the liver and other internal organs) is a special risk, even in people of relatively normal weight.

•  The Stress Theory posits that cortisol, the stress hormone, contributes to heart disease during chronic stress.

•  Lack of exercise is a significant risk; a 1996 study found that even 15 minutes a day reduced risk by almost half.

•  High homocysteine level, a result of vitamin B deficiency, is also a risk factor.  For more on homocysteine, see the N.Y. Times article, “The Fall and Rise of Kilmer McCully.”

•  Trans fats, from hydrogenated vegetable oils, are another cause.

Heart Disease Treatments

The intent of this blog is to provide fresh insight into the power of diet to prevent disease, and not to repeat what you’ve already heard.  You likely know that heart disease is the #1 killer of women as well as men, that women display different warning signs, and that women are slower to seek emergency help.  For more on women and heart disease, go here.   

Though the incidence remains high, deaths from coronary heart disease (CHD) have declined since 1980.  Reasons include better emergency and secondary care, more attention to high blood pressure, and the cutback in smoking.  The result is that people are living longer with heart disease and treatment has become an enormous business for drug and device companies, doctors, and hospitals.  Good business doesn't mean good medicine; the following therapies are getting a second look:

• The campaign against dietary cholesterol has not had a significant benefit, and Dr. Uffe Ravnskov, MD, PhD, questions the evidence for cholesterol-lowering drugs, in books like Fat and Cholesterol are GOOD for You.

•  The survival benefit of coronary artery replacement, is now questioned.  See also, “Is Heart Surgery Worth It?”

•  The use of catheterization to expand or stent coronary arteries, except to reduce persistent angina, may not be the best treatment. 

Preventing Heart Disease

Pioneering doctors have demonstrated that lifestyle improvement, including diet, and appropriate pharmaceutical support may be the best way to treat heart disease.  Dr. Caldwell Esselstyn of the prestigious Cleveland Clinic was among the first to demonstrate that lives could be saved through diet and other changes.  His book Prevent and Reverse Heart Disease, tells the remarkable survival story of 17 patients who followed his protocol.  On the West Coast, Dr. Dean Ornish has a similar program and also a book.  Other doctors have followed these pioneers.  If you Google “preventive cardiology” you get a million hits, a sign of progress.

Here is a short list of preventive measures against heart disease:

1. Develop a muscular lifestyle.  Forget laborsaving devices.  Walk everywhere you can.  Care for your own yard.  Exercise at least 30 minutes most days.

2. If you smoke, stop.

3. Eat a healthy diet of vegetables, whole grains, fruit, nuts, fish, dairy, eggs, and a little meat.  Avoid highly processed foods, especially trans fats.  Keep intake of added sugar below the AHA level.

4. Avoid protracted stress.  Pick your battles wisely.

5. Get plenty of sleep.

6. Have fun—smell the roses, laugh a lot, enjoy friends and family.

7. Get regular physicals but take ownership of your health in partnership with your doctor.  Keep a health log with regular checks of waist circumference, blood pressure, and fasting blood glucose, etc.  

You could add, “maintain a trim waist,” to the list, but this should naturally result from following the seven lifestyle steps.

Budget wisdom:  I have always thought it wasteful to pay for both an exercise club and a gardener.  Cancel the gym membership and buy a hand mower, or plant a garden.  Rediscover the pleasure of long walks.  Without endangering your safety, save a little gas by riding a bike.  (Read about four women who rode across the US to promote preventive cardiology here.)  Try grinding wheat by hand, it’s a good workout (though it does take time).  Wash your own car, and your neighbor’s too.  Take up swimming.  Give your spouse a backrub, and a little loving.  It’s all good—the best things in life really are free.

Please comment:  How is life made more enjoyable by using your muscles?

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Healthy Snacking

 

The Quick Answer:  It's true—snacking can trim your girth.  See the list below for snacks that are tasty, healthy and a good value.

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There’s a strong link between this week’s topic of diabetes and obesity.  By good fortune, the annual report on obesity in America just came out.  In brief, we’re still losing the war against fat.  I couldn’t find a single success story but at least the growth of fat is slowing.  In America—the land of plenty—about 1/3 of adults are overweight, and another 1/3 are obese but this varies with region.

It’s fascinating to look at regional trends.  When both adults and children are considered, Hawaii does the best.  The Western states are next best, followed by New England.  The Southern states do the worst.   The data for diabetes, hypertension, impaired longevity, and stroke, all follow the regional obesity pattern.  Though the South struggles, we all need to do better.

I’m uncomfortable with the public debate against obesity.  First, a load of guilt is laid on the obese and guilt doesn’t motivate long-term change.  Second, overweight is a complex issue and public debate isn’t good at solving such problems.   So here are a couple of observations from hard-earned common sense:

1.     Don't cut calories to lose weight.   Despite all the focus on calories in recent decades, they aren’t the answer to overweight.  Hunger is a powerful force; you can resist it for a while but not forever.  A UCLA meta-study found that calorie-restriction diets actually resulted in an increase in weight for two-thirds of the participants.

2.     Forget about weight and focus on building a healthier lifestyle.  Take care of your health, and your weight will take care of itself.  The low-fat/low-calorie craze was a big mistake because it focused on subtle changes in processed foods, rather than a return to natural, whole foods.

3.     Natural foods are dense in nutrients but low in calories.  Processed foods are the opposite, high in calories and low in nutrients.  If you eat right, you can eat to comfortable fullness and enjoy food as well as a healthy weight.  Oh, add a longer life to the benefits.

4.     Physical activity is key to good health—experts call for at least three hours of activity that makes you sweat, spread through the week.  But it’s more than exercise—the key is to build a lifestyle that uses muscles, rather than laborsaving devices.  Yes, do your own gardening, even if you’re the only one on the block.  (We’ll address the TV—the antithesis of physicality—in a later post.)

5.     For more on finding a healthy weight, take a second look at these past posts: The Skinny on Overweight, and The End of Diets.  And think about making a goal for waist size.

The Healthiest Snacks

As you adopt the weekly Healthy Changes to fit your needs, you create a healthier lifestyle.  In the beginning, we reduced added sugars and eliminated trans fats.  Then we began to increase natural foods, beginning with whole grains, vegetables and fruits.  There’s more to come—the year is just half over—the subject of this week is healthy snacks.  From past comments, here are your favorites:

o   The best snack is a drink of refreshing water—it’s good for you.  Check this Healthy Change.

o   The next best value after water is snacking on leftovers.

o   Seasonal fruits are another bargain.  Checking the produce aisle we found these buys: cantaloupe at $.25/lb, watermelon for $.50/lb, and peaches at $.50 to .65/lb.

o   Popcorn, air-popped, or microwaved in a paper bag.  Sacha adds butter and a little Parmesan cheese. 

o   Homemade bread, especially toast.  My Mom liked toast with sliced avocado.  If you buy yeast in bulk, the price drops under $1/loaf. 

o   Bran muffins; homemade are hard to beat.

o   Kale chips.  Brie says to roast whole leaves with a touch of sea salt at 250 F until dry and crunchy. 

o   Hummus, the new guacamole.  It’s healthy; Michelle has it with veggies or pita chips.  (Maybe a future post on best hummus?)

o   Seasonal veggies.  Whole carrots are a bargain, $.45 to .60/lb. in our survey.  LC likes zucchini, carrots, and cauliflower.  Celery sticks with peanut butter are a tradition but Taylor prefers homemade almond butter. 

o   Green smoothies are a favorite, or any healthy fruit smoothie.

o   Homemade granola (check Katie’s recipe) makes a great snack. 

o   Trail mix, especially homemade, is great too.

o   Nuts are a treat; they cost more so buy direct or in bulk.  Jess gets his from nuttyguys.com. 

o   Dried fruits are best for winter; I like prunes or dates with walnuts or pecans.

o   Cheese is good with homemade bread, crackers (that meet the whole grain rule of more fiber than sugar), in quesadillas, or with apples.

o   Hard-boiled eggs (omega-3 is improved by feeding the chickens natural pasture, flaxseed, or algae).

o   Sardines on crackers—an omega-3 bonus.

o   Edamame, warmed and salted.

Budget Wisdom:  Forget what you hear—healthy food is the best value, all costs considered.  Supermarkets have been fixing up their stores and raising prices lately, but I walked through an alternative store last night (Smart & Final) and was surprised to find nearly all the produce selling for less than 1 $/lb.  (A really healthy food, cantaloupe, was on sale for 25 cents a pound.  It’s today's health bargain.)  I calculated that a family of four could eat eight daily servings of fresh fruits and vegetables for just $135 a month.  (Not including whole grains, another good value, nuts, dairy and a little meat.)

Please Comment:  The 4^th of July reminds that it’s summertime.  Please share your summer menu favorites and we'll add a post on seasonal menus.

Dodging Diabetes

The Quick Answer:  The shopping list is the perfect place to manage snacking—if a snack is in the house you'll likely eat it; if it isn’t you won’t. ____________________________________________________________________

Have a great 4^th of July?  (Clearly I did: I’m a bit late with this post.)  Independence Day is a good time to reflect on the American spirit, the unique virtues as well as the defects that influence how we live, eat, and die.  We are the world’s true pioneers.  No other country is so innovative.  We invented democracy (with a little help from the ancient Greeks), for goodness sake.  And we invented processed foods, soda pop, fast foods, and diet drinks.  We love change.  What other nation would so recklessly experiment with food innovations—like getting half our calories from sugar and other refined carbs—of unknown consequence?   

Books on Diabetes

I like to collect old books on nutrition, not because they’re old, but because they offer lost dietary wisdom.  Here, for example, is the English biochemist R. H. A. Plimmer in his 1925 book, Food, Health, and Vitamins:

“The Americans, with their love of candy, are the largest sugar eaters in the world.  Incidentally, cancer and diabetes, two scourges of civilization, have increased proportionately to the sugar consumption.”   (Bold face added.)

We should have listened to Dr. Plimmer.  I have another book, not as old but just as revolutionary, by John Yudkin, with this long but descriptive title:  Sweet and Dangerous, The new facts about the sugar you eat as a cause of heart disease, diabetes, and other killers.  (First published in England as Pure, White and Deadly.)  Yudkin was the first to speak clearly about the dangers of our growing love for sugar.  People value these books: A used copy of Sweet and Dangerous is offered today at $100 while a copy of Pure, White and Deadly requires $199. 

Of course you can get the information updated at a lower cost with Nancy Appleton’s book, Suicide by Sugar: A Startling Look at Our #1 National Addiction.  Scary titles.

What Causes Diabetes?

Diabetes comprises a disease family that includes type 1, type 2 and gestational diabetes.  Type 1 diabetes, perhaps 5% of all cases, is an autoimmune disease of children that destroys insulin-producing cells in the pancreas.  The cause is unknown but a near-normal lifespan is now possible through improved medical technology.  

Type 2—the subject of this post—is an increasingly common consequence of the modern lifestyle.  How common?  Twenty-six million Americans have Type 2 diabetes, a chronic disease that leads to other diseases, such as heart disease, stroke, and cancer.  Seventy-nine million of us are prediabetic and at risk for full-blown diabetes.  These days, diabetes is a growth industry. 

So what causes type-2 diabetes?  This will drive you crazy but despite all the research, scientists don’t know for sure.  We think of diabetes as the sugar disease but it’s more complicated.  Not everyone who eats a lot of sugar gets diabetes.  There are other factors, including diet, family history, overweight, and lack of exercise.

The best book I’ve read on sugar and disease is Gary Taubes’ Good Calories, Bad Calories; Challenging the Conventional Wisdom on Diet, Weight Control, and Disease.  My conclusion after reading Taubes:  The best way to avoid the risk of overweight and diabetes is to bring sugar intake below the American Heart Association recommendation (6 tsp daily for women, 9 tsp for men), eat a whole foods diet, and exercise at least three hours weekly.  The Healthy Changes of the last six months build a foundation for doing this.

Where do we get most of our dietary sugar?  Sugary drinks (addressed here) and snacks!

Healthy Snacking

We talked about snacking in a prior post and implemented the Healthy Change of using a snack plate.  (Confession:  I sometimes forget and need to remind myself to do this.) 

Four principles for healthy snacking:

1. Commercial snacks are usually the unhealthiest food in the store and the worst value for your money.  Remember: money spent on unhealthy snacks is a vote for that company to succeed.

2. Watch for “boredom” snacking and substitute other forms of variety, like a walk, a chapter from a favorite book, calling a friend, or, ahem, checking your favorite nutrition blog. 

3. The key to healthy snacking is to eat a good (low G.I., whole food) breakfast.  Our worst snacking habits arise from stimulant-craving due to skipped breakfasts. (The danger of coffee, I suspect, is less about the coffee and more about habitually skipping a nutritious breakfast.) 

4. If your waist size is greater than your goal, eat a healthy breakfast and don’t snack after 8:00 pm. 

We’ll talk more about healthy snacks and proven waist-reducing habits in the next post, but just to remind, snacks can be organized in these groups:

•  Veggies

•  Fruits

•  Nuts and seeds (including popcorn)

•  Cheeses and yogurt

•  Leftovers

•  Home-made snacks (like crackers or cookies from healthy recipes).

Which brings us to the healthy change of the week:

If we don’t have unhealthy snacks in the home (or office), we won’t eat them.  If we have healthy snacks available, it’s likely we will eat them.  Pretty simple.  Got a nasty snack you can’t resist?  Buy just one serving, once a week.  The experience of many is that as you eat better, you’ll also snack better. 

Budget Wisdom:  As an experiment, wander the grocery store snack aisles and look at the cost per ounce.  Then compare to the cost of fruits and vegetables or other healthy snack ingredients.  With the exception of certain nuts and seeds, which I love, you save by buying healthy snacks.

Please comment:  Share your favorite healthy snacks.  We’ll collect your favorites into the next post.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.