Nutrition Hodgepodge

It's been a busy week. I attended a Conversation MAPS training by Merck for diabetes education on Tuesday night. I got my own set of 5 maps and I'm going to start facilitating sessions next month with my patients. These maps are AWESOME! Check out HealthyI for training sessions near you. If you work with a diabetic population, or just want an awesome set of educational tools free of cost, attend one of these sessions -- it was so rewarding!

Because there's so much I want to blog about today, consider this a hodgepodge of nutrition-related news. Here we go!

First up: cholesterol-lowering supplements [1]
Of course there's a TON of supplements on the market touting to be the ultimate cholesterol-lowering aid. Please note, supplements are meant to be used in addition to healthy diet and regular exercise regimens! Additionally, what works for one individual may not work for the next. Please consider the role an unconscious change in diet and/or a placebo affect can alter results of supplement-taking persons [1].

1. Artichoke leaf extract (also known as Cynara scolymus).

• The good: In 2000, a randomized, double-blind, placebo-controlled trial including 150 "high risk" adults (cholesterol > 280) was performed. The trial lasted 6 weeks and LDL-cholesterol (the bad) dropped 23% compared to the placebo group.
• The bad: The results are yet to be replicated. Similar studies show a decrease in cholesterol (-4%), but no major impacts on LDL or HDL have been found.
• The bottom line: Few studies conducted, mixed results, don't expect miracles.

2. Fenugreek.

• The good: Studies from the 1990's show a drop in total cholesterol and LDL, and in some cases, significant drops (as much as -38% in LDL). Fenugreek contains20-50% fiber and thus cholesterol-lowering effects may be attributable to this fact, if nothing else.
  
• The bad: The studies were small and poor quality questioning the validity of results noted above.
  
• The bottom line: Not enough evidence to support the cholesterol-lowering effects of this supplement.

3. Fiber (soluble - found in oats, barley, bran, peas, citrus fruits, and dietary supplements).

• The good: A 1999 meta-analysis performed by Harvard Medical School researchers contained nearly 70 clinical trials assessing the effectiveness of soluble fiber in cholesterol reduction. High soluble fiber intake was associated with reducing in both total and LDL cholesterol in 60-70% of the studies examined. For each gram of soluble fiber added to participant diets, and overall reduction in LDL was estimated at 2 points (in an average of 7 weeks).
• The bad: That's a lot of fiber. The current recommended guidelines state 25 grams of dietary fiber and the typical intake is comprised of a mere 20% soluble fiber. For example, 3 bowls of oatmeal will provide a measly 3 grams of soluble fiber. Supplements? Fine, but many experience GI upset and some prescription interferences.
• The bottom line: A diet high in soluble fiber can lower LDL-cholesterol, however, the drop in LDL will be relatively modest.

4. Fish oil (this is the one I was most interested in reading about!) - also known as omega-3's or EPA and DHA.

• The good: In clinical trials assessing dosing of 3 or more grams, fish oils have been shown to lower triglyceride levels by 10-30%.
  
• The bad: While fish oils do not lower LDL, they have been shown to sometimes cause the opposite: a small rise in LDL-cholesterol.
• The bottom line: Fish oils do lower triglycerides, especially in individuals with high triglycerides. The American Heart Association recommends those with high triglycerides consume 2-4 grams of fish oil a day. Those with heart disease should consume approximately 1 grams a day of EPA and DHA (combined), preferably through the diet and the consumption of fatty fish, such as salmon.

5. Garlic (oil, extract, pill, or natural state).

• The good: A 2000 report on garlic's impact on cardiovascular risk factors showed a small (but measurable) drop in LDL and total cholesterol.
• The bad: Studies to follow showed less encouraging results. A well-executed study performed in 2007 compared raw garlic and commercial garlic supplements over a 6 month period and found no measurable effects in total cholesterol, LDL, HDL, or triglycerides versus the placebo.
• The bottom line: Garlic may lower LDL temporarily but its meaningful effect on cholesterol long-term is questionable.

6. Red yeast rice - a fungus that grows on rice and contains a small amount of lovastatin (a type of statin found in prescription meds).

• The good: Compared to most supplements, evidence in support of red yeast rice is strong. Several high-quality trials have shown red yeast rice to lower LDL-cholesterol by 20-30%, comparable to a statin drug. A 2009 trial performed on patients discontinuing the use of statin drugs, red yeast rice showed a 15% and 21% decrease in total cholesterol and LDL, respectively. Cool.
• The bad: The amount of lovastatin in the supplements vary widely across brands.
• The bottom line: Red yeast rice is a potentially effective way to lower cholesterol, but its potency varies dramatically. Due to safety concerns with statin use, experts discourage the use of off-the-shelf red yeast rice.

The cliff notes version of the rest...

7. Ginseng

• The bottom line: There is not enough evidence to support the use of ginseng for lowering cholesterol.

8. Guggul

• The bottom line: More research is needed; there is not enough evidence to justify the cholesterol-lowering effects of guggul.

9. Niacin

• The bottom line: Niacin boosts HDL (the good), but you should NOT take it without consulting a doctor. Niacin should not be used in lieu of a prescription due to potentially serious side effects.

10. Soy protein

• The bottom line: Soy protein lowers LDL slightly.

Next up, mercury found in ALL fish caught in US streams (!) The government tested fish caught from 300 streams in the US. All the streams contained fish contaminated with mercury and thus the U.S. Geological Survey's research launches a comprehensive examination of mercury contamination [2]. Should this worry us? Maybe so. It was shown that 27% of the fish contaminated contained levels of mercury deemed unsafe by the Environmental Protection Agency for the average fish eater, consuming fish twice weekly. Mercury is a neurotoxin which is especially dangerous to neurological development in infants and fetuses [2]. The waters in urban areas, surprisingly, were less contaminated than those in costal plain streams fed by wetlands and forests, especially in North and South Carolina, Georgia, Florida, and Louisiana. The fish most highly contaminated included bass while the lowest levels of mercury were found in brown, rainbow-cutthroat trout and channel catfish [2]. To check for fish consumption advisories in your area, go here [2].

And up last, some reading material to leave you with. Is saturated fat being falsely accused? Read more!

I had planned to talk about myths surrounding egg consumption, but I'm out of time... it's off to the dog park. Hope Lily get some energy on the ride over! Have a wonderful weekend!

[1]. Hainer, Ryan. Cholesterol-Lowering Supplements: What Works, What Doesn't. CNN Health. August 20, 2009.
[2]. Weise, Elizabeth. Mercury Found In All Fish Caught in U.S.-Tested Streams. USA Today. August 22, 2009.

Omega-3's: How much?

Depends on the research.

A new analysis could lead to a heated debate on omega-3's having its own recommended daily intake levels. Heart-protective benefits of fish oil have been discussed for centuries, but how much do we need? Some cardiologists would like to see an established RDA for omega-3's. Dr. Carl Lavie, medical director of Cardiac Rehabilitation and Prevention at Ochsner Heart and Vascular Institute in New Orleans, advocates such. He recommends people consume at least 500 milligrams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) daily. This recommendation was published in Monday's release of the Journal of the American College of Cardiology. Those with known cardiovascular disease should look to comsume 800-1,000 milligrams of EPA daily [1].

Dr. Steven Nissen, director of cardiovascular medicine at the Cleveland Clinic, says that Dr. Lavie's recommended may be premature and that wide-spread usage of omega-3's does not have compelling evidence in support.

Dr. Robert Bonow paves the way by recommending an increase in fish oil and deems this "good advice" while explaining that the strongest results from fish oil usage are seen in those with pre-established heart disease.

Lavie's recommendation is largely supported by recent research involving 40,000 participants ranging in health status, which revealed a number of potential advantages to omega-3's. For example, in men who had recently experienced a heart attack, those consuming omega-3's were 29% more likely to be alive in two years than their counterparts.

Dr. Rubenfire, director of preventative cardiology at the University of Michigan, explains that he would like to see a "trial in the modern era in patients on other evidence-based treatments such as aspirin, [blood pressure] control, statin and non smoking" to confirm benefits of omega-3's [1]. Fabulous suggestion, in my opinion.

MOST importantly, consumers MUST understand that supplements are not regulated. Therefore, a 1,000 milligram "fish oil" capsule can contain as little as 300 milligrams of EPA+DHA. Buy supplements that are 3rd party tested and approved for use by the U.S. Pharmacopeia (USP). These products may be hard to find, but they are available to consumers for purchase.

What does the boss say? Well, the American Heart Association is on board with omega-3's. The AHA's current recommendation includes 1,000 milligrams a day of combined DHA+EPA for those with confirmed coronary heart disease. For healthy adults, the AHA recommends consuming 500 milligrams a day, approximately the amount found in two servings of fatty fish a week [1]. Fatty fish include: salmon, mackerel, sardines, herring, lake trout, and albacore tuna.

[1]. Peck, P. and Childs, D. Recommended Daily Dose for Omega-3's May Be On the Way. ABC News. August 4, 2009.

7-Day Slim-Down

CNN Health may be on to something. I enjoyed their article, anyways. Here’s the scoop.

Sunday: Bite it, write it.

Keeping a food journal and recording your intake (everything you eat AND drink) certainly aids in accountability. Plus, Robert A. Charles, Ph.D. says you can expect to shed a whopping 5% of your body weight by adopting this habit [1]. Hey, 150-pound people out there…that’s nearly 8 pounds lost!

Monday: Take a multi-vitamin!

Two studies in the British Journal of Nutrition say that taking a multi-vitamin daily can help make you less hungry. Besides, those taking a multi-vitamin daily tend to weigh less and have lower BMI’s [1]. I’m sold on taking one!

Take a vitamin containing 100% of the RDA (recommended daily allowance) for: chromium, copper, folic acid, iodine, manganese, molybdenum, niacin, pathothenic acid, riboflavin, thiamin, zinc, and vitamins B6 and B12 [1].

Tuesday: Circuit train the WHOLE body.

Circuit training burns more calories than traditional strength-training says Dr. Jim Stoppani, author of, “Encyclopedia of Muscle and Strength.” Strength-training is more effective due to the shorter rest periods between sets. Leave about 20 seconds between sets and aim for 3 sets [1].

Wednesday: C-up

The Journal of the American College of Nutrition supports research on the use of vitamin C in fat burning – up to 30% more efficiency when consuming 500 milligrams or more of vitamin C while working out [1]. Plus, it’s good for immune function and wound healing.

Vitamin C-packed foods include: papaya, red bell peppers, broccoli, brussel sprouts, strawberries, oranges, cantaloupe, kiwi, cauliflower, kale, parsley, and lemon juice.

Thursday: Grab a gab partner

Create a weight-loss network. Grab a friend and motivate one another to keep up an exercise routine and healthy habits [1]. Exercising with a friend can not only make the activity more enjoyable, but you’re more likely to keep up with the routine and stay consistent with your regimen.

Friday: Eat the rainbow

Cutting calories can be as simple as adding more fruits and vegetables to the diet, according to the American Journal of Clinical Nutrition [1]. Due to the fiber content and low caloric-density, filling up on fruits and vegetables (5-9 a day every day!) can help decrease the consumption of all other, more calorically dense foods. Challenge yourself to snack on fruits and vegetables only. You may learn to like it…or to at least love the results!

Saturday: Relax!

Ralph LaForge, exercise physiologist at Duke University Medical Center, explains that people make better food choices when they are relaxed. He adds, you’re less likely to suffer from hunger pains when you’re relaxed. Take a few moments to perform some deep breathing when hunger strikes – it may just reduce your instinct to eat or to help curb your appetite for awhile longer.

Try the above each day this week and see how it goes. I’m going to give it a go!

[1]. Rossi, Carey. One Week to a Slimmer You: Focus on the Little Things. CNN Health. July 28, 2009.