"Like a kid in a candy store..."

Yesterday, Mark and I ventured out to a local health foods store, Akins, after being recommended to me by a co-worker. I wasn't expecting much, but it was a most pleasant surprise! I could've easily spent hundreds (maybe even thousands...) of dollars. Unfortunately (maybe fortunately for my bank account and marriage), Mark WAS with me, and I was limited to one basket. And here's what I came home with....

 TOP FIND: Pure Bliss USDA Organic Acai Coconut Energy Bar Bites

...they are soooooooo good! If you love coconut, these are a must-try!

"Light Pasta" -- 130 calories per serving vs. the standard 210

...and check out that FIBER -- 20 GRAMS per 2 ounces!!!!!!!

I typically drink cow's milk, but I LOVE Blue Diamond Almond Vanilla, especially to have on hand for when you're out of milk!

And I finalllllllllllly found a place that carries steel-cut oats! Can't wait to try them!!

I'm out of green tea, so I got this organic blend...and it is yummmmy

I am officially OBSESSED with Terra chips. This blend was out of this world. 6 servings?? Try 2. Oops!

...Pumpkin (and Apricot) Butter!!!!! Other than grains, what could I try it on? It's divine!!! Love fall foods!

This was husband's pick....100% all-natural Red Raspberry and Pomegranate jam

I also got the chance to try Zevia -- the zero-calorie, all-natural soda made with stevia.

I tried the ginger ale and it was YUMMMMMYY!!! I'm excited to try other flavors!

We also went over to a friend's for dinner last night, so I brought the above salad -- romaine, tomatoes, and sunflower seeds tossed with olive oil, red wine vinegar, Parmesan cheese, ground mustard, garlic salt, and pepper. Delicious!

The past 2 days have gone like this for the diabetic diet...

Friday

Breakfast:

6 crackers (1 carb)

2 Tbsp peanut butter (0 carbs)

1/2 pomegranate (1 carb)

1/2 small pumpkin roll slice (1 carb)

cappuccino with 2 Tbsp sugar-free International Delight (0 carbs)

     Total: 3 carbs

Lunch:

1 cup whole wheat pasta (3 carbs)

4 ounce chicken breast (0 carbs)

3/4 cup marinara (1 carb)

2% cheese stick (0 carbs)

     Total: 4 carbs

Snack:

1 small apple (1 carb)

1 wedge Laughing Cow Light (0 carbs)

     Total: 1 carb

Dinner (9pm):

2 Bud Lights (1 carb)

6 ounces chicken (0 carbs)

1/2 cup mashed potatoes (1 carb)

side Caesar salad (0 carbs)

3 slices of bread off a mini loaf (1 carb)

     Total: 3 carbs

Snack: none - late dinner and to bed soon after

Exercise: 4-mile walk

Saturday

Breakfast:

1/4 cup granola (1 1/2 carbs)

banana (2 carbs)

cappuccino with 2 Tbsp sugar-free International Delight (0 carbs)

     Total: 3 1/2 carbs

Lunch:

Acai Berry and Coconut bites (2 carbs)

3 servings of Terra Chips (3 carbs) -- OOPS!

     Total: 5 carbs (spread throughout afternoon)

Dinner (9pm):

3 ounces pork roast - lean (0 carbs)

1 cup slow-cooked carrots and potatoes (1 carb)

2 cups tossed salad (0 carbs)

1/2 cup macaroni and cheese (1 1/2 carbs)

1/2 slice peanut butter fluff pie (2 carbs)

     Total: 4 1/2 carbs (over!)

Snack:

2 graham crackers (1 carb)

1 Tbsp peanut butter (0 carbs)

Exercise: 3-mile run 

Akins also carried 2 of my favorite supplement brands: Carlson's and Nordic Naturals. I know where I'll be getting my supplements from now on!

Off to do my grocery shopping for the week. Husband has requested some tried and true favorites of his: "Fried" Chicken Fingers and Buffalo Chicken Lasagna (both healthy, however!). One hockey game down, one to go!

Omega-3 "Fortification"

First, let's set the record straight. Foods that are "enriched" have nutrients added back which were lost in the refining process. Foods that are "fortified" have nutrients added which weren't originally present in the food item.

So, with all the fortified omega-3 products out there, you can get in your omega-3's from just about any source -- butter, pasta, oil, juice, eggs...just to name a few. These products are not only more expensive, but they're also over-promoting health claims. A serving of salmon can have up to 50x more omega-3 content than most omega-3 fortified products [1].

So is the bang worth the buck? Not likely.

"But what if I don't like fish?" (I know that's the next thing you're thinking...).Well, omega-3 research is still undetermined for use among the general public. We know that elevated triglycerides, personal history of cardiovascular disease, or family history of cardiovascular disease are indications for adequate omega-3 intake or supplementation, however. For omega-3 content in fish, check out this previous blog post.

Bottom line: omega-3 fortified foods are not the end all, be all that advertising leads you to believe. Save the dough for fish or supplements if indicated.

Curiosity has the best of me -- do YOU supplement omega-3's in your diet? I do -- 3 grams a day.

[1]. Enersen, Jean. How Omega-3 Fortified Foods Compare to the Real Thing. King 5. September 4, 2009.

Acai Craze

When yet another patient came into my office carrying a myriad of Acai berry supplements for "weight loss", I figure it's time to address this topic on my blog...

The acai berry is being touted as a "power" food, "super food", and everything in between. Acai berry information can be found scattered across food labels, Oprah, and the all-powerful Google.com. But, what's the real deal? Read on.

The acai berry (pronounced "ah-sigh-ee") is a native to tropical regions of Central and South America, specifically in Brazil. The berry is rich in antioxidants, vitamins, minerals, oleic acid, and potassium...among other things. The berry is dark purple in color and approximately the size of a grape which grows on the acai palm [1]. The acai berry taste is described as being a vibrant blend of berries and chocolate [2]. Yumm! The pulp of acai berries is extremely delicate and is thus only available in pulp, juice, or tablet form.

Boasted as the No. 1 Super Food on Oprah's "Health" site the acai pulp contains [2]:

- 10 times more antioxidants than red grapes
- 10-30 times more anthocyanins than red wine
- a "synergy" of monounsaturated fats, dietary fiber, and phytosterols to help promote heart and digestive health
- an "almost perfect" essential amino acid complex in conjunction with valuable trace minerals vital to muscle contraction and regeneration

While that's all fine and dandy, a few bummers according to the Center for Science in the Public Interest [3]:

1.There is NO evidence supporting the use of Acai berry in weight loss.
2. Free trial offers asking for credit card information (i.e. to pay for shipping) are a SCAM.
3. While acai berry supplements are available, purchase USP Verified products, or those endorsed by companies presented in this article entitled, "What's Really In Supplements?".

CNN Health published an article on weight loss claims surrounding the acai berry supplement. After the berry was discussed by an MD on Oprah and a guest on Rachel Ray last year, the popularity of the berry soared. Oprah and Rachel Ray have since publicly disassociated themselves from sites which claimed weight loss endorsed by the celebrities [3].

Just like most berries, acai has strong nutritional qualities such as anti-inflammation and antioxidant properties. It just so happens that the acai berry is exotic and has been marketed as a "magic ingredient" targeting in health and weight loss advertising [3].

Selling for as much as $40 a bottle, "acai berry is triumph of marketing over science" says Jonny Bowden, a nutrition author. While the berry is not "useless", it's over-hyped according to many nutrition and weight loss professionals. Keri Gans, dietitian and spokeswoman for the American Dietitic Assocaition, recommends that customers turn to local vegetables and fruits as it would be much less expensive. She also warns against one food appearing "too good to be true", or a health "miracle" [3].

According to the Better Business Bureau (BBB), FWM Laboratories received an "F" rating. Other acai berry companies receiving a "F" grade include Advanced Wellness Research, AcaiBurn, FX Supplements, and SFL Nutrition [3].

In short: there's no magical berry coming from Brazil to cure obesity or any other ailment.

Have you tried acai berry juice, pulp, or supplements? Do they really taste like a berry blend + chocolate?!

Off to do some pilates since the rain ruined my plan for a run! Have a great night!

[1]. Blend with Acai. The American Dietetic Association, Public Relations Team. December 11, 2007.
[2]. Dr. Perricone's No. 1 Superfood: Acai. Oprah.com Health.
[3]. Young, Saundra and Park, Madison. Group Challenges Acai Berry Weight-Loss Claims. CNN Helath. March 23, 2009.

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.

Alli for weight-loss?

Does Alli (Orlistat) work? In one word: yes. However, weight loss in addition to the results of calorie restriction and exercise alone are not (yet) proven to be dramatic. Additionally, most research conducted on the drug has been performed on Alli's prescription-strength cousin, Xenical [1].

Donald Hensrud, a preventative medicine and nutrition specialist at Mayo Clinic, explains the mechanism by which Alli produces additive weight-loss effects to the traditional "diet and exercise" regimen . By blocking lipase reactions in the digestion process, Alli prevents some fat from being broken down which results in lower calorie "absorption" [1]. While Alli is designed to work in this manner, it is not a miracle drug; the instructions state that when taking Alli, consuming more than 15 grams of fat per meal can lead to unwanted side-effects such as diarrhea, urgent bowel movements, and flatulence with oily spotting [1]. According to my recent poll, the side effects alone were enough to keep the majority of my blog readers from using Alli to aid in weight-loss effects. Obviously oily anal leakage and discharge can put a damper on...a lot. G-ross.'

Dr. James Anderson at the UK College of Medicine Metabolic Research Group piloted the first study of its kind on the effects of Orlistat (Alli, 60 mg) on mildly to moderately overweight adults desiring weight loss. Over the course of 16 weeks, participants were given 60 mg of Orlistat three times/day, or a placebo. The affects were faborable for the FDA-approved weight-loss drug -- those receiving Alli did lose more weight than their placebo-taking counterparts. Those taking Orlistat lost almost 5% of their initial body weight, averaging between 7 and 15 pounds. Dr. Anderson notes the vital role of exercise and a low-fat diet used in conjunction with Alli for desired and sustained effects [2].

15 grams? Well, that's probably a lot, right? Um, wrong. To prevent those unpleasant side effects, one would likely want to comsume 15 grams of fat or less at each meal...so, let's get some facts on fat.

4 ounces lean beef = 21 grams of fat
1 ounce pepperoni = 13 grams of fat
1 beef hot dog = 17 grams of fat
1 slice cheddar cheese = 9.5 grams of fat
Starbucks latte = 14 grams of fat
1 tablespoon mayonnaise = 11 grams of fat
1 large egg = 5 grams of fat
2 tablespoons peanut butter = 16 grams of fat
14 walnut halves = 17.5 grams of fat
3 slices bacon = 12.5 grams of fat

Knowing that, does 15 grams per meal sound doable? If so, you're my hero. A typical 2,000 calorie a day diet comprised of 30% fat (a typical average) would include 66.7 grams of fat daily. Knowing very well that fat is essential in the diet...raises red flags for me. Yet, the mechanism of action works because fat is the most calorically dense component of food -- 9 calories per gram versus the 4 calories per gram in carbohydrates and proteins.

In short, knowing what you're getting into. Alli is not meant to work miracles, but to be an assistive device. As always, I recommend the old-fashioned "eat less, move more".

Author's note: There's plenty one should know about any pill they're popping, particularly so for weight loss and nutritive effects. Because supplements, including vitamins, are not FDA inspected, they are not tested for purity, potency, or safety. To ensure the quality and safety of your over-the-counter supplements, please refer to the US Pharmacopoeia website for guidance.

[1]. Alli weight-loss pill: Does it work? Mayo Clinic Staff. June 11, 2008.
[2]. University of Kentucky. Does OTC Diet Pill Alli Live Up to Its Name? June 15, 2007.