Saturday, January 8, 2011

With no statin drugs, will this diet lower my LDL cholesterol?

Our family physician, has told me I should reduce the level of my LDL blood cholesterol. I want to do that without a drug called statins, because I am concerned about risk of loss of muscle strength that can be a serious side effect of statins. I hope to do it with a slight increase in the aerobic intensity of my exercise and a sharper focus on our diet. My LDL level was recently measured at 2.95 millimoles per litre (mmol/L. In U.S., 114 mg/d, milligrams per deciliter). Our doctor wants to see that reduced to 1.8, and the Canadian College of Family Physicians agrees that those who have had heart attacks should aim for a level of less than 2. We also want to lower our cancer risks. As it turns out, the best foods that might lower LDL cholesterol (and perhaps boost the good HDL cholesterol) also seem to be largely the best foods that might reduce cancer risks. Diet, of course, is only half the battle. Without regular exercise, almost every day, I don’t think that diet by itself can do the job.

But why blog about it? I do that first for our own benefit. Nutrition is a complex subject. Because science has not yet unlocked all its many mysteries, endless advice from even the most authoritative sources is often uncertain, constantly changing, confusing, and conflicting. Only by writing am I able to organize from such advice a plan that seems to make sense—guidelines for Joan and me to follow. I hope my blog readers will find it interesting, and perhaps even helpful.

A word of caution: if you change your diet in any way because of anything I write, you do so at your own risk. Before making any substantial diet changes, you should consult a physician or a dietitian—or both.

We won’t know whether the diet and exercise are doing what we hope until April 26 when I get the results of my next blood tests. Meanwhile, I’ll blog some recipes and menus that fit our guidelines—such as my recipe for Disgustingly Healthy Muffins and one for the healthiest, best-tasting shepherd’s pie ever.

What we try to never eat
    •Trans fat, the evil fat we’ve all be warned about. It’s found in hydrogenated food. It’s there to keep lard, margarine and other items firm at room temperature; to extend the shelf life of some foods; to keep peanut butter homogenized so that the oil doesn’t separate and float to the top.
    •Refined carbohydrates. Carbos are fuel, converted by our digestive system into glucose and burned by our muscles. Nutrients in natural carbos are largely removed in highly refined cabos. Refined, or simple, carbos drain the body’s store of nutrients; affect the brain and nervous system; and spike insulin production. Refined carbos can mess up our minds, resulting in confusion, irrational thinking, lethargy and moodiness. For kids, school grades suffer. Some have even suggested that refined carbos can contribute to criminal behaviour.  Insulin spikes tend to increase body fat and obesity; may cause inflammation, resulting in heart disease, cancer, and destruction of brain cells See Health Hazards of Refined Carbohydrates. Big sources of refined carbos to avoid include white flour and all baked products with white flour; white or polished rice; refined sugar (mostly white but also brown); and many “fruit cocktail” drinks.
    •Egg yoke and beef liver. See following item on dietary cholesterol.
    • Red meat, more accurately mammal meat, has been linked in a number of studies with increased risk of both heart disease and cancer. Red meat has lots of nutrition and may well be safe in moderate amounts for people not considered at risk for heart disease or cancer—but for those of us who are, why chance increasing the risks? Venison (buffalo, deer, moose, elk) is low in saturated fat and is healthier than most other red meats.

What we will eat as little of as possible.
    •Saturated fat. USDA’s Dietary Guidelines urge Americans to reduce their total fat consumption to between 20% and 30 % of total daily calories, with no more than 10% from saturated fat. Some sat fat comes with such good stuff as mono- and polyunsaturated fatty acids (MUFAS and PUFAS, which help reduced that dangerous LDL cholesterol in your blood).   Saturated fats are saturated with as much hydrogen as found in a natural state. Minimizing sat fat consumption is said to help avoid clogged arteries and heart trouble, although the relationship between sat fat and heart trouble is controversial. Sat fats have also been linked with cancer. Whole milk, including such diary products, such as cheese; red meat; and animal fats (such as lard) are principal sources of saturated fat.

Other things we will limit.
    •Dietary cholesterol. Our bodies normally produce all the cholesterol we need. Advice about dietary cholesterol is conflicting, especially that about egg yoke (see my blog “Controversial food”). Many dietitians now recommend eggs in large part because of the big load of nutrition in the yoke; others disagree. The American Heart Association, the Mayo Clinic, the U.S. Department of Health, among others, still recommend no more than 300 mg a day for healthy people and 200 mg for those at risk, such as heart-attack survivors. One large egg yoke contains 200 mg of dietary cholesterol, or more. Other big sources of dietary cholesterol include whole milk and whole milk products, such as cheese; red meat (1 oz of beef liver has more than 300 mg) and some shellfish, such as shrimp. These big sources, and egg yoke, are excluded from our diet. Other sources of dietary cholesterol, which we will eat, include fish (50 grams in 100 grams of frozen wild Pacific salmon) and no-fat diary products (14 grams in three-quarters of a cup of Loblaw’s no-fat, vanilla-flavoured yogurt).
    •Fruit juice. When the juice is extracted from the fruit, all the fibre and much of the nutrition stays behind in the pulp. What is left isn’t much better than flavoured water and sugar. Better to drink smoothies, which include all the fruit but the peel and pits.
    •Demerara sugar. This is better than refined sugar and possibly better than Splenda, the no-fat, no-calorie, no-carbo sweetener we have been using. Demerara is processed from cane sugar but retains all the natural vitamins and minerals and remains a complex rather than simple carbohydrate. Content is said to be 95% sugar, with 15 calories per teaspoon, and 38 mg of minerals and vitamins, including “lots of potassium.” It is dark brown with large grains that have a slight molasses flavour.
    •Potatoes. These tubers have lots of great nutrition but can cause a big sugar rush, which cause an insulin rush, which cause other problems. We have replaced them with sweet potatoes.

What we will eat every day.
    •Fruits and vegetables are the cornerstones of our diet. We are somewhat increasing the amount we eat to more than eight servings a day. “Eat at least one dark green and one orange vegetable each day,” advises Canada’s Food Guide. Broccoli is the star in our vegetable list. Ounce for ounce, it ranks near the top of vegetables packed with the most nutrition. Dr. Dean Ornish is a strong broccoli advocate. In his best-selling book, Dr. Dean Ornish’s Program for Reversing Heart Disease,” he ranks broccoli as the best vegetable to help fight heart disease.
    •MUFAS and PUFAS, the poly-and monounsaturated fatty acids. Both get credit for lowering total cholesterol and LDL. Much-touted Omega 3 fats are found in some PUFAS. The two most common MUFAS and PUFAS oils are olive oil and canola oil. U.S. Food and Drug Administration says “…eating about 2 tablespoons (23 grams) of olive oil daily may reduce the risk of coronary heart disease due to the monounsaturated fat in olive oil.”  Olive oil has more MUFAS than canola ((74% versus 64%) but more than twice as much saturated fat (14% versus 6%). Olive oil also has polyphenols, said to be a powerful antioxidant that helps lower cholesterol and blood pressure; canola has “the best source of omega -3 fats [which also lower cholesterol] of all popular oils,” says the Canola Council of Canada. It also claims that canola oil is “…the healthiest of all commonly used cooking oils” and the lowest in saturated fat. But when it comes to lowering that LDL, extra virgin olive oil might have an edge. Dr. Bruce McDonald, executive director, Manitoba Health Council, writing in the Canola Council’s web site, states: “Diets containing canola oil have been found equally effective as those containing corn oil, safflower oil, soybean oil and sunflower oil in reducing plasma total and LDL cholesterol in both normal and hyperlipidemic subjects.” That olive oil isn’t mentioned implies that it is more effective in lowering LDL. Bottom line: Canola might be the best oil for cooking, and olive oil the best for salads.
    •Ground flax seed, the richest common plant source of ALA Omega 3 fats and lignans (an antioxidant), and very high in fibre, is probably the most widely recommended health seed. Claims have been made that it is effective in reducing LDL cholesterol and triglycerides, helping clear clogged arteries, and in combatting cancers, diabetes, and Alzheimer’s disease, among other things. Researchers, however, say that more work is needed to validate some of these claims. The Flax Council of Canada says one tablespoon a day is enough. Plant-based Omega 3 is said to be a useful complement to Omega 3 from fish.  Flax seed is best freshly ground, but can be stored up to a month in an opaque contains, the Flax Council advises. Canada is the world’s leading producer of both flax seed and canola oil.
    •Skin cancer-fighting foods. Foods recommended by the University of Maryland’s Medical Centre that might help fight skin cancer include fish, beans, carrots, chard, pumpkin [pumpkin seeds], cabbage, broccoli, flaxseed, celery, onions, tomatoes, apples, cherries, grapes, tea and wine. Nutrition consultant Sherry L. Granadner recommends cooked tomatoes, and “lots of coloured fruits and vegetables, leafy greens, fatty fish… and dark chocolate.”
    •Fish, poultry or Yves soy-based simulated ground beef. For Omega 3 fatty acids, eat fish two or three times a day, we’re loudly and constantly advised. We eat mostly wild Pacific salmon, either frozen fillets or canned (pink or sockeye), and occasionally Pacific cod. Poultry is usually chicken breast, whole roasted chicken (sans skin), or extra lean ground turkey, microwaved to remove even more fat. Soy has been called “The healthiest food you can put on the table,” but a daily diet of too much is said to pose health risks (see my blog article “Will soy food make you sick for life?”)
    •Avocados are said to contain more nutrition and fibre than any other fruit. This is a fruit that’s high in MUFAS and PUFAS, including Omega 3, very low in saturated fat and cholesterol. The downside is that it is also high in calories. We use it mostly in the dressing for our disgustingly healthy winter salad, which we eat about eight months of the year until local tomatoes and other salad greens are in season.
    •Whole grains. Brown and wild rice, wheat, rye, and oats, with an emphasis on oats. Steel-cut oats for breakfast several times a week are a mainstay.
    •Smoothies. We’re trying different fruit smoothies to replace daily fruit juice, using the whole fruit, except the peel and pits.

What we eat every week
    •Tomatoes, cooked, with oil. Tomatoes are at or near the top of the list of the world’s healthiest foods. They are fat- and cholesterol-free; a very good source of dietary fibre; vitamins A, C, and K; a good source of other vitamins and minerals, and the richest source of lycopene, a powerful antioxidant that helps fight heart disease, cancers and macular degeneration. But to get the most of these benefits, tomatoes should be cooked with a little oil (see my blog, “Tomato: top-cancer fighting food”). We use tomatoes in casseroles, soups, chili, pasta sauce, and salsa. Ketchup is also a good source, but look for low-sugar, low salt ketchup. Yet who can resist fresh, raw tomatoes in season? They are the feature of our summer salads, as well as eaten sliced or gobbled whole.
    •Legumes. The legumes we eat are mostly frozen peas, canned red kidney beans, and peanuts. Canned red kidney beans are now available with no added salt, in at least some supermarkets, including Loblaws. Peanuts are really legumes, like peas and beans, but have many of the attributes of nuts. Their relatively high content of MUFAS and PUFAS plus a small amount of resveratol, the ingredient that makes red wine heart healthy, make peanuts an ally in the fight against heart risks. Also said to help reduce cancer risks, especially colon cancer. Peanuts are a good source of protein, but high in calories. We like them in our winter salad, and I love peanut butter. We stick to peanut butter that contains nothing but peanuts, especially no hydrogenated oil (trans fat). Oil will rise to the top of the jar. We store the jar upside-down to mix the oil with the solid stuff.
    •Skim milk and no-fat yogurt.  We eat one of these almost every day for breakfast; skim milk with oatmeal; or yogurt with three fruits and granola. We sometimes have  yogurt and fruit for our dinner desert.

Are vegetables healthiest cooked or raw? Nearly 2,400 years ago, Greek philosopher and scientist Aristotle, argued that vegetables, fruits, and roots are best eaten raw. But it is a many-sided question, and scientists are still looking for answers.

The consensus is that we get more of the nutrition from most vegetables—and, as we have noticed, at least one fruit, tomatoes—when they are cooked. Cooking usually allows our bodies to absorb more of the vitamins, minerals and antioxidants in food, but it can also destroy or leach out some of these good things. One group of important vegetables that we are sometimes advised are most healthiest eaten raw are cruciferous vegetables [broccoli, brussel sprouts, cabbage, collard greens, kale, radishes, rutabaga and turnips and a few others).  But there is mixed advice about this.

We have already noted how cooking increases the “bioavailability” of lycopene, the powerful, cancer-fighting antioxidant found predominantly in tomatoes. In addition, says a report in Scientific American, “Cooked carrots, spinach, mushrooms, asparagus, cabbage, peppers and many other vegetables also supply more antioxidants, such as carotenoids and ferulic acid, to the body than they do when raw.” But heat can also destroy vitamins, particularly vitamin C, when vegetables are cooked.

Heat can easily destroy compounds in cruciferous vegetables that our bodies convert into cancer-fighting antioxidants, dietitian Leslie Beck reports in the Globe and Mail. An enzyme found in broccoli can also be damaged by cooking, adds Scientific American. Too bad, because our digestive system can convert that enzyme into substances that “might block the proliferation of and kill precancerous cells,” as well as help fight a bacterium that “causes ulcers and increases a person’s risk of stomach cancer.”

“On the other hand,” says Scientific American, cooking broccoli and certain other plants forms a chemical compounded called indole—which “helps kill precancerous cells before they turn malignant.” And the George Mateljan Foundation says this: “Broccoli can provide you with some special cholesterol-lowering benefits if you will cook it by steaming. The fibre-related components in broccoli do a better job of binding together with bile acids in your digestive tract when they've been steamed. When this binding process takes place, it's easier for bile acids to be excreted, and the result is a lowering of your cholesterol levels. Raw broccoli still has cholesterol-lowering ability—just not as much.”

How vegetables are cooked is also important. “Water is your enemy,” says Leslie Beck, because boiling vegetables leaches out a significant amount of nutrients. But one study concluded that while steaming and boiling best preserve antioxidants found in carrots, zucchini, and broccoli, boiling was said to be best.

“Comparing the healthfulness of raw and cooked food is complicated, and there are still many mysteries surrounding how the different molecules interact in the human body,” Scientific American concludes. Science is still looking for the answers that Aristotle thought he had found.

What to do?
We cook most of our vegetables except the cruciferous ones, which we eat sometimes cooked and sometimes raw. That should give us the benefits of both raw and cooked cruciferous. Simple, no? We try to make sure our vegetables are never overcooked—especially broccoli.

We boil only a very few vegetables—such as rutabaga— and in as little water as possible. How else to cook rutabaga? Water from boiled vegetables can be added to a pot of soup stock. When you peel and throw away the skins, some of the best nutrition is thrown away with them. Skins can be boiled and that water also added to the soup stock, as Joan has done. But we now peel so few vegetables that I just throw the skins away—perhaps I’m lazy.

We fry nothing. Nor do we sauté. The heat from a hot frying pan can easily turn healthy oil into toxic compounds when onions, mushrooms, peppers or other vegetables are sautéed. Wet sauté, in which water is added to the oil, has been advocated. The water is said to minimize the oil’s contact with the hot pan. I find wet sauté awkward.  I place chopped vegetable in a glass bowl with about a tablespoon of canola-based non-hydrogenated margarine, and nuke them in the microwave for four or five minutes. The vegetables are very nicely sautéed and the oil doesn’t get too hot.

Most of our vegetables we cook in a steamer. If we’re cooking broccoli with frozen mixed vegetables (carrots, corn, peas, beans) the mixed vegetables get about 20 minutes but the broccoli goes into the steam for only the last five minutes. We also bake, grill, microwave, and stir-fry (with water, no oil). Sweet potatoes we bake mostly in the microwave, but in the oven if we’re roasting poultry. We even roast chicken breast, with skin and bones, removing the skin (and bones, too) before eating. Allowing for the little weight of the bones and skin, the cost of the meat in a chicken breast is about one-third the cost of skinless, boneless chicken breasts. And since skin and bones are so easily removed, why pay someone to do the job? Joan boils the scrap bones from cooked poultry, and that really is worth adding to the stockpot.

PS: I hope you’ll stick with me for future blogs as we explore delicious and nutritious recipes that conform with guidelines that I hope will best minimize heart and cancer risk. I promise future blogs to be much shorter.

TAGS. Avocados. Broccoli. Canadian College of Family Physicians. Cancer. Carbohydrates. Cholesterol. Cruciferous vegetables. Diet.  Eggs. Fish. Flax seed. Fruit. Grains. Legumes. Milk. Potatoes. Poultry. Red meat. Saturated fat. Smoothies. Soy food. Statins. Sugar. Tomatoes. Trans fat. Vegetables. Yogurt.


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