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The Heat on Red Meat

August 2016

As cooking methods go, we generally recommend grilling or barbequing as a healthier way to cook, since it allows unhealthy fat to drip away. However, there may be another issue with the heat we’re using to cook and the very fat that’s dripping away.

It’s all in the chemistry. When we heat food up, chemical changes begin to happen – some good – like muscle fibres soften giving that tenderness to grilled meat. As well, heat helps to destroy bacteria, which makes food safer to eat.

Here’s the issue: when the fat from animal foods, like meat, pork, and lamb, hits hot coals, it undergoes a chemical transformation, creating compounds called polycyclic aromatic hydrocarbons (PAH). When meat is heated to high temperatures for cooking, we see the formation of compounds called heterocyclic amines (HCA).

What are these compounds and how are they important?

HCAs and PAHs are normal compounds created through chemical changes during the cooking of meat. They have been studied for some time and have notably shown up in reports from cancer institutions from around the world. These compounds are recognized by various health organizations, like the World Health Organization, as human carcinogens. In animal studies, these compounds were shown to be mutagenic, that is, they changed the DNA in animals increasing their cancer risk (National Cancer Institute, 2015). These statements, however, are the stuff news headlines are made of.

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It sounds pretty dire, doesn’t it? Why on earth would any of us want to eat or breathe something that contains potential carcinogens? Let’s put this into perspective. We are, daily, surrounded by a number of noted carcinogens – car exhaust fumes, cigarette smoke, alcoholic beverages, ultraviolet light from the sun. I found this quote and I think it sums it up perfectly, “carcinogens do not cause cancer in every case, all the time”.

An American study done in North Carolina in 2003 looked at colon cancer risk and compared that with meat doneness, estimated HCA intake and cooking method. They found the association between cancer-causing compounds and cancer risk appeared higher in pan-fried meats and meats that are very well done in cooking (i.e. no pink spots). So, the longer we cook meat, the more these compounds will be produced. Current evidence indicates the highest compound forming meats are red meats that are charred, cooked for very long periods resulting in well done pieces of meat compared with grilled chicken and fish, which contain much lower amounts.

A great review by McAfee (2010) summarized the evidence looking at cancer risk and consumption of HCAs and PAHs with meat consumption and they surmised that we can only “speculate on the role of HCAs in carcinogenesis, as exact quantities within cooked red meat are likely to be very small”. In fact, there is no definitive link of cause and effect between these compounds and cancer in human studies. As with any disease, however, there will always be a number of risks and interactions involved, not simply one cause. Just as we know that red wine on its own doesn’t prevent heart disease, we must recognize that other dietary factors and environmental carcinogens will play a role, including some potential protective ones, like eating enough fruit and vegetables.

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Knowing what we know, how can we reduce these compounds in our diets?

In many studies looking at HCAs and PHAs, scientists found that the formation of these compounds were reduced when marinades were used, when meat was thawed using a microwave and when meat was flipped frequently during cooking (Butler, 2003). Beyond this, we can trim off overly charred or blackened sections of meat before eating and to look for ways to lessen cooking time to prevent overcooking, and include meat alternatives (soy, lentils, beans) as great protein sources.

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Bottom Line:

The World Cancer Research Fund’s cancer prevention report from 2007 recommends eating more plant-based foods vs. animal-based ones as a way to prevent cancer risk. This is a recommendation that extends beyond cancer risk reduction, as we recognize the many benefits of plant-based foods. This doesn’t necessarily mean, however, giving up meat altogether (unless you choose to). We know with many diseases where diet is a contributing factor that eliminating one food isn’t a guarantee for prevention. In fact, we know that many foods, including meats, can be healthy and nutritious, in moderation. So, if you’re going to fire up the grill this summer, keep these ideas in mind – modest meat intake, trying out some veggies options and watch the blackened bits.

 

-Samantha

 

Sources:

 Butler, L. (2003). Heterocyclic Amines, Meat Intake, and Association with Colon Cancer in a Population-based Study. Am. J. Epidemiol. 157 (5): 434-445. doi: 10.1093/aje/kwf221

McAfee, A.J. et al. (2010). Red meat consumption: An overview of the risks and benefits. Meat Science. 84,1–13. doi:10.1016/j.meatsci.2009.08.029

National Cancer Institute. (2015). Chemicals in Meat Cooked at High Temperatures and Cancer Risk. http://www.cancer.gov/about-cancer/causes-prevention/risk/diet/cooked-meats-fact-sheet

Schwarcz, J. (2005). Can red meat take the heat? Arts & Opinion. http://www.artsandopinion.com/2005_v4_n6/schwarcz-4.htm

Stewart BW, Wild CP (Eds.). (2014). World Cancer Report. World Health Organization: International Agency for Research on Cancer. http://publications.iarc.fr/Non-Series-Publications/World-Cancer-Reports/World-Cancer-Report-2014

World Cancer Research Fund / American Institute for Cancer Research. (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR.

Photo source: Pixabay.com, Foodphoto.ca

salt

Salty Truth

July 2016

Salt. That tasty, little white crystal that gives French fries a certain something, that made salted caramel a “thing” and is found in almost every food imaginable. What’s the latest on salt? Whether it’s from the Himalyas, pink, white, or otherwise, salt is a chemical compound made up of sodium and chloride. In fact, about 40% of salt is sodium (60% chloride).

French fries

Sodium, while an important mineral to the body, is responsible for a multitude of functions including nerve transmission, balancing fluid levels, which affects blood volume and blood pressure.

A lot of people think of sodium and salt as being synonymous, which isn’t quite right, since sodium is only a part of salt. However, sodium is the mineral oft found in our day-to-day eating that seems to be the problem. Why?

How sodium is a problem?

Because sodium impacts fluid balance in the body, excess amounts can shift this delicate balance. When this happens we see an increase in blood volume, and with this increase in volume, there is an increased workload on the heart. This increased workload causes a rise in pressure within the heart, which we can measure with blood pressure (using a fancy instrument with an equally fancy name, sphygmomanometer). A normal reading is 120/80 mmHg (millimeters of mercury) and a high reading is 140/90 mmHg (130/80, if you have diabetes) (great resource here).

BP cuff

Sodium in the food supply

Sodium is naturally occurring in many foods such as milk, meat, even celery and beets contain some sodium in their raw form (though not a lot). The bigger issue in our food supply is added salt in the diet. This is when food manufacturers add salt or other sodium-containing ingredients (e.g. MSG) to foods for preservation, flavour enhancement, to retain moisture, texture or other reasons. This is where the problem lies.

 

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This spicy kimchi & noodle soup clocks in at 1780mg of sodium – that’s more than the 1500mg adequate intake recommendation for one day.

Traditionally high sodium containing foods tend to include convenience foods, which typically include processed options and fast food meals. More often we see canned goods, like soup and canned vegetables, in this category, but also frozen dinners, deli meat, cheese, pasta sauce, chips and so on.

 

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One serving of this soup contains 1370 mg of sodium, which is almost the entire recommended daily intake of 1500mg.

What does the evidence say?

There is a significant body of evidence from years of scientific studies that indicate reduced sodium consumption lowers blood pressure, in both groups with normal blood pressure and high blood pressure (aka hypertension). As we age, regardless of our blood pressure in our younger years, this pressure naturally rises. Given that many of the foods we eat supply a large amount of this sodium, it makes sense that we reduce our intake of high sodium containing foods.

In Canada, the average sodium intake is roughly 3500mg a day. The current guidelines recommend between 1500- 2300 mg per day (ages 14-50 years). The lower end of this range is the recommended daily intake (RDI), which decreases as we get older (age 51-70 = 1300 mg; age 71+ = 1200mg) (more details here). The top end of the range is termed the tolerable upper limit (UL), that is, the maximum amount recommended before it becomes unhealthy. Obviously, this is a population-based guideline and certain individuals may have different recommendations based on their health, i.e. low blood pressure, kidney disease and so on. If you’re unsure, talk to your family doctor or registered dietitian about what’s best for you.

A recent meta-analysis study (2014) turned the current guidelines on their ear by highlighting issues with too much of a sodium restriction. The study authors stated that strict sodium recommendations aren’t associated with a decrease in all-cause mortality. That is, if you eat less sodium in your diet, your chances of dying from any causes may not necessarily be lower. They also found an association of risk being higher in both low sodium and high sodium groups, but not in moderate sodium users. However, they did find that risk levels were lower if high intake users decreased their intake. You can just see the confusing headlines…

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Beyond this, was an even more recent study from Canada’s McMaster University, which showed increased risks for heart disease, hypertension and mortality with high intakes of sodium. The risks, however, were most significant in people who were already hypertensive, not in people who had normal blood pressure.

What we can extrapolate from all this is that the risk seems highest in populations who are pre-hypertensive and hypertensive, and they are the ones who are likely to benefit most from sodium reductions in their diet. The rest of us, can’t just live it up and scarf down salt by the bucketful, but awareness and healthy choices, will likely suffice. Our sodium guidelines have not changed and we still recommend a balanced diet that is moderately low in sodium, with no more than 2300mg sodium as our upper limit.

What can we do about it?

One of the best ways to lower sodium is look at the proportion of convenience foods (pre-made, from a box/can/container, take away meals, etc.) in your diet vs. fresh, whole food choices. Evidence points us to the DASH diet, which is an acronym for Dietary Approaches to Stop Hypertension, a study that was published in the New England Journal of Medicine.

The DASH diet is high in fruit, vegetables and low fat dairy products with an emphasis on whole grains, less saturated fat, red meats, and refined sugar, and including nuts, seeds and legumes several times a week. I’m usually the one to say, “stay away from diets, diets don’t work!” But, to me, this is simply healthy eating, not a restrictive diet per se. Let’s focus on eating more fruit and vegetables, whole grains and high fibre starchy foods, moderate dairy, and lean protein with an emphasis on plant-based protein foods (dried beans, lentils, soy, nuts & seeds) as well as some poultry and fish, and a wee bit of red meat if you have to. If you can eat healthy food options like these more often, your heart and body will thank you. Advice like this is worth its salt.

-Samantha

Sources:

Blood Pressure Canada (2015). Sodium policy. http://www.hypertension.ca/images/uploads/bpc-sodium-policy-with-endorsementskidney-foundation.pdf

Graudal et al. (2014). American Journal of Hypertension 27(9) http://ajh.oxfordjournals.org/content/27/9/1129.full.pdf+html

Mente, A. (2016). Lancet. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30467-6.pdf

Sacks et al. (2001). A clinical trial of the effects of dietary patterns on blood pressure (DASH). NEJM. 344:3-10.

http://www.nejm.org/doi/pdf/10.1056/NEJM200101043440101

Sodium calculator (2015): https://www.projectbiglife.ca/sodium/

Sodium detector: http://healthycanadians.gc.ca/eating-nutrition/healthy-eating-saine-alimentation/nutrients-nutriments/sodium/detector-depisteur-eng.php

Sodium in the diet: https://www.nlm.nih.gov/medlineplus/ency/article/002415.htm

World Health Organization. (2015). Sodium guidelines. http://www.who.int/elena/titles/sodium_cvd_adults/en/

Photo credits:

Author’s own.

http://www.dishmaps.com/french-fries/13743

 

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Carbs: Friend or Foe?

May 2016

Remember when fat was bad news in the 1990’s? Instead, we piled on more starches (or complex carbohydrates) on our plates. Now, carbs are bad and the trending issue is to avoid them at all costs. It seems the nutritional pendulum has swung far from those fat-free days in the 90’s to the carb-free days of today. But, what is the real story behind carbs?

Nutrition 101

It starts with a little nutrition 101: complex carbohydrates (aka starches) are made of hundreds (or thousands) of units called monosaccharides. In nutrition-ese when all these units are strung together, we call it a polysaccharide. These are essentially your starchy foods or grains, like bread, pasta, oats, and potatoes. (To be clear, simple carbohydrates are a whole other kettle of fish {that we won’t be covering here} and are found in high amounts in fruit, jam, candy, cookies & cakes).

Going back to the carb-heavy years in the 90’s and early 2000’s, the type of carbohydrates people consumed most was more refined starch – with much of the nutritional value depleted or eliminated. This was a problem. A big part of the nutritional value of starches is the fibre and its associated nutrients (usually B vitamins). When this was removed, as is the case with white bread, cakey muffins and many popular breakfast cereals, we tended to eat larger portions because there was so little fibre present to make us feel full or satiated.

 

Also, starchy foods are convenient and tasty– how easy is it to grab bread or a croissant to nosh? Or a bag of chips? Or grabbing a muffin in a drive-thru? Easy peasy, right? It takes a whole lot more work to cook up brown rice, quinoa or bake a sweet potato.

Next up is a little lesson in insulin – this powerful hormone, produced by our pancreas, is the body’s response to a surge of sugar in the bloodstream. I’m not just talking about sugar in your coffee or the cookies you ate after dinner last night. When starchy foods (& simple sugar foods) are broken down and digested by the body they break down to the simplest form of fuel – glucose (or sugar). This glucose is essential for your brain, muscles, etc. Without it, you may feel sluggish or have difficulty concentrating on tasks, for example.

It can be confusing, though, not knowing whether carbohydrates are the real enemy or not with the advent of seemingly credible sources highlighting the ills of starches. The internet, or Dr. Google, as I sometimes refer to the surfeit of online nutrition & medical information, can really muddy the waters of what is evidence-based and what is opinion. But, I am surprised every time I sit down with a patient who happily reports having given up bread, pasta and potatoes.

Let’s look at the evidence

Looking at the scientific evidence, we know with a high level of certainty that high fibre diets are important for decreasing risk for heart disease, obesity and diabetes (among other parameters like blood pressure, cholesterol, etc.). There are innumerable studies that have extolled the benefits as well as being a significant part of many national nutrition guidelines and recommendations for heart disease and diabetes.

When it comes down to it, the argument isn’t whether starch/carbs are good or bad, it’s rather, the TYPE of starch that matters. I went to the scientific literature to see whether the evidence had changed. I even found a study entitled ““Relationship between bread and obesity” from the British Journal of Nutrition! Could it get any plainer? Nope. So, what were their findings?

They looked at obesity and bread consumption in the context of a Mediterranean diet – something similar to the main tenets of Canada’s Food Guide. The Spanish study authors stated, “it appears that the different composition between whole-grain bread and white bread varies in its effect on body weight and abdominal fat”. This again highlights my point that high fibre, whole grain starch choices can (and do) make a difference in a healthy diet.

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In another interesting, though small study of overweight and obese females, researchers studied whether these women were more successful at losing weight when placed in a no bread diet group versus a group that allowed bread consumption. Interestingly, the no-bread group showed almost no differences in weight loss, waist measures and blood markers compared with the bread group. Also, they reported that the no-bread group was much less compliant with their diet regime by the 12-week mark, showing perhaps, that this elimination strategy was not a reasonable, long-term solution.

We can see that there’s no strong evidence to support eliminating starchy foods completely from your diet, even in individuals with diabetes. However, what does make a massive difference to your overall health is whether you’re piling on the refined starchy foods, like white bread, white pasta, white rice, and coffee shop muffins versus higher fibre foods. By cutting back on the lower fibre choices and pulling in more high fibre food choices into your day can make the difference in whether carbs are your friend in the end.

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Summary of some of the benefits of fibre:

  • Cholesterol lowering (particularly with soluble fibre-rich foods)
  • Reduction in obesity/weight management
  • Lower risk of diabetes
  • Lower risk of cardiovascular disease (including heart disease & stroke)
  • Lower blood pressure
  • Improves insulin sensitivity
  • Regularity with bowel movements
  • Better management of GI conditions (reflux, diverticulitis, hemorrhoids)

-Samantha
Sources:

Anderson, J., Baird, P., Davis Jr, R., Ferreri, S., Knudtson, M., Koraym, A.,Waters, V. and Williams, C. (2009). Health benefits of dietary fiber. Nutrition Reviews. 67(4):188–205. http://www.ncbi.nlm.nih.gov/pubmed/19335713

Loria-Kohena, V., Gómez-Candelaa, C., Fernández-Fernándeza, C., Pérez-Torresa, A., García-Puigb, J., & Bermejo, L. (2011). Evaluation of the usefulness of a low-calorie diet with or without bread in the treatment of overweight/obesity. Clinical Nutrition. 31(4):455-61. http://www.ncbi.nlm.nih.gov/pubmed/22209501

Satija, A. & Hu, F. (2012). Cardiovascular Benefits of Dietary Fiber. Curr Atheroscler Rep. 14:505–514. http://www.ncbi.nlm.nih.gov/pubmed/22872372

Serra-Majem, L. & Bautista-Castan ̃o, I. (2015). Relationship between bread and obesity. British Journal of Nutrition. 113, S29–S35. http://www.ncbi.nlm.nih.gov/pubmed/26148919

Photo sources: Foodphoto.ca

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Juices & Smoothies: Health Haven or Sugar Laden?

March 2016

 

Most of the patients I see have recovered from heart attacks and have a renewed sense of health and a strong motivation for healthy lifestyle changes. By the time I see them, they have often tried out some of their own ideas already. One of the most prevalent ideas I get asked about is juices and smoothies.

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You’ve probably seen some of the headlines, heard about the benefits and maybe delved into your own juicing experiments. While I love my patients’ determination for change and good health, we need to balance some of these ideas and headlines with evidence and some common sense.

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So, what’s the truth behind juicing and smoothies? Can we really juice our way to better health?

Benefits to Juices & Smoothies
The perceived benefits are great – convenient, good way to hydrate, great vehicle to pack in a ton of fruit and veggies in amounts you could never possibly eat, nutrient dense packed full of nutrients, antioxidants, vitamins and minerals. Take a vegetable smoothie, for example, it can be a rich source of blood pressure-lowering potassium. Study after study have shown improved health with increased intake of fruit and vegetables. In the Nurses’ Health and Health Professionals studies, researchers concluded that vegetables and fruit were associated with a lower risk of heart disease. Seems like a no-brainer, right?

This is where the answer isn’t so black and white. That is, there is no yes or no answer to the question of whether smoothies and juices are good for you. Frustrating, I know… (I get that a lot). “Yes, they are healthy, but it depends on….”

Downsides to Juices & Smoothies
Sugar, is part of the issue here. That is, if the smoothie or juice is made up completely or primarily of fruit, then the sugar content of the final product will potentially be quite high. Researchers Barry Popkin & George Bray summed up their 2013 findings: “To the best of our knowledge every added amount of fructose [fruit sugar] – be it from fruit juice, sugar-sweetened beverages or any other beverage – adds equally to our health concerns.”

One of the health concerns they refer to is heart disease, a relative newcomer to the sugar game. In fact, researchers over the last decade have begun uncovering more relationships between high sugar intake and heart disease risk, specifically related to consumption of sugary drinks. Depending on the size of your smoothie or juice, you may be drinking the equivalent amount of sugar found in as many as 5 or 6 pieces of fruit or a large cola! Would you sit down to that much fruit in one sitting? Probably not.

This brings up issue #2: portion size. With all these fancy juicers and blenders out there, it’s easy to whip up a batch of liquid produce in large amounts. Large amounts may = higher calories. Once you add your Greek yogurt, protein powder or coconut milk, you’ve added to the already potentially high calorie count.

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Fruit juice as it concerns children has been a targeted issue with many nutrition policymakers. That is, if kids are drinking most of their fluids as juice vs. water, for example, there is a real concern that they will consume more calories than they need setting them up for weight gain and risk for obesity in the future.

Studies have shown that if kids are given 100% fruit juice it is not necessarily related to weight gain as long as it is consumed in appropriate amounts for age and energy needs. Notice the key words: appropriate amounts. Did you know that according to the American Academy of Pediatrics , juice is NOT recommended for kids under the age of 6 months, then only 4-6 oz (½ to ¾ cup) per day for children aged 1-6 years? In Canada, the recommendation for young children is similar. Starting kids off with healthy habits like drinking water first and focusing on eating fruit instead of always drinking it sets them up for future good habits.

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The next concern for me is whether a smoothie is a replacement for your intake of fruit and vegetables every day. I know for a number of people who struggle to eat fruit and vegetables because of dislikes or texture issues, smoothies and juices can be a vehicle to reap some of the benefits they may otherwise be missing. For the rest of us, it can be a quick way to drink the recommended servings of veggies and fruit. But, is it really the best idea to follow daily? I say, no. When we juice and blend, we are essentially breaking down the valuable fibre. While the vitamins, minerals and antioxidant properties are essentially intact – the fibre is not. That is, it’s not going to fill you up in the same way as eating those same veggies and fruit.

In one 2011 study, study subjects were fed one of two breakfasts, both containing the same amount of fibre and calories. The difference was that one breakfast was liquid (juice + fibre) and one was solid (oatmeal + fruit). A measure of satiety or fullness is gastric emptying time, or how long it takes the food to exit the stomach. The oatmeal breakfast’s emptying time was one hour longer than the liquid juice breakfast and subjects rated themselves as fuller, even though the juice had added fibre.

Don’t get me wrong, I have no issue with smoothies or juices as long as they’re not in a large amount on a daily basis (with exceptions for those especially crazy days when you’re dashing out the door). Alternatively, as a good friend pointed out, juicing provided her with the visual cue to stay on target with her healthy eating habits over the day and the week ahead. I love this idea so much! Keeping your smoothies and juices in moderation in the amount of fruit used, how often you drink them in a week, and being mindful of your portion size can make all the difference in whether they work with you or against you.

 -Samantha

Sources:
http://www.telegraph.co.uk/news/health/10293417/Health-myth-of-the-juicing-craze.html
http://www.usatoday.com/story/news/nation/2013/08/03/green-smoothies-nutrition/2518141/
http://www.medicalnewstoday.com/articles/272438.php
http://advances.nutrition.org/content/3/4/506.full
http://advances.nutrition.org/content/6/2/236S.long
http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/recom-6-24-months-6-24-mois-eng.php
http://onlinelibrary.wiley.com/doi/10.1111/j.2047-6310.2013.00171.x/abstract;jsessionid=392193F84A3F246A65FB1E39DBE4A666.f02t01
http://www.fasebj.org/content/25/1_Supplement/328.6.short?related-urls=yes&legid=fasebj;25/1_Supplement/328.6

Photo credit: http://assets.wh.cdnds.net/images/1007/fruit-smoothies-juices-shutterstock__medium_4x3.jpg

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Bah Humbug to New Year’s Resolutions

January 2016

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With the flip of the calendar to 2016, we are inundated with talk of New Year’s resolutions. What’s the #1 resolution? You guessed it, weight loss. As we move into the second week of the New Year, many are still on their resolution “high” as they work toward changing behaviour, be it weight, eating habits, or quitting smoking.

Science plays into this (of course it does!) and findings from a 2007 survey by psychologist Richard Wiseman found that only 12% of people kept their resolution goals. Pretty dismal stats. What it boils down to is willpower and self-control. Humans are pretty stubborn in the way we behave and how we run our day-to-day routines, which makes it challenging to achieve big goals. Interestingly and on a more positive note, those who resolved to change a habit by setting a goal for themselves were significantly more successful than those who didn’t.

For many, success is achieved based on HOW the resolution or goal is set. Exercising five times per week isn’t necessarily a realistic way to start your new year’s goal when you were previously a professional couch surfer. The same goes with diets – whether it’s losing weight or resetting your healthy eating habits, it really makes a difference how you do it.

  1. Start with a realistic goal: Whether you’re setting a goal on January 1st or June 1st, you will have a greater chance of success if you start with a realistic and sustainable goal. Losing 50 lbs in a month isn’t an example of a realistic goal. Remember those SMART goals? Here’s your refresher: specific, measurable, achievable, realistic, timely – pretty self-explanatory, right?
  2. smartgoalsAim for one goal at a time: don’t try to quit smoking and lose inches at the same time, because that isn’t necessarily realistic, is it? Refer to point 1 above.
  3. Write it down or tell someone: research shows that we are more likely to follow through with a goal or resolution if you write it down or make it public in another way (Facebook, Twitter, sticky note).
  4. Involve others: we tend to keep up with a goal if you have a buddy alongside to keep you motivated and on track. It might be your best friend that you go walking with, a personal trainer to help you commit to exercise or a spouse to make healthy meals with.

I’m not a fan of resolutions after seeing the spandex-clad masses at the gym disappear by February and the legions of patients and friends who find the discipline to stick to their goals disappointing at the best of times.

Let’s instead look at the idea of moderation (again) and know that changes to our behaviour and routines need to be done in small steps without drastic changes, for us to really achieve the success we crave. But, what I really liked was how a friend reframed the notion of resolutions to “intentions” instead. I can definitely live with that. So this year, find an intention – something you wish to improve upon or change slightly and work on that to better yourself.

 

-Samantha

 

Sources:

http://www.wsj.com/articles/SB10001424052748703478704574612052322122442

https://www.researchgate.net/publication/11443909_Auld_lang_Syne_Success_predictors_change_processes_and_self-reported_outcomes_of_New_Year%27s_resolvers_and_nonresolvers

http://www.iflscience.com/brain/psychology-new-year-s-resolutions

Photo credit: https://www.socialmediaexplorer.com/digital-marketing/the-importance-of-setting-infographic-objectives/attachment/05fig03/

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5 Holiday Food Traditions: Why we eat what we do during the holidays

December 2015

When you think of holidays, you inevitably think of favourite foods associated with those holidays. Let’s play a quick game of word association. What’s the first thing that comes to mind when you read the following words? Pumpkin pie, figgy pudding, apples dipped in honey, and cake. What popped up for you, when you read those words? Maybe, Thanksgiving, Christmas, Rosh Hashanah, and birthdays?

We associate many food items with celebratory occasions, which often include family and friends. Here are five holiday food traditions and their significance to the holiday.

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  1. Candy Canes

According to Collins’s 2003 book Stories Behind the Great Traditions of Christmas, church records indicate that as far back as the 1600s, churches may have popularized candy canes as a way to quiet children singing in choirs during long church services. A German choirmaster asked a candy maker to bend peppermint sticks to resemble a shepherd’s crook to teach the children stories of the Bible. It appears that the red and white striped candy canes we see today weren’t created until the 1920s, whereas the original candy cane was white.

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  1. Latkes

In Judaism, latkes have particular meaning during the holiday, Hanukkah. Latkes are shredded potato pancakes that are traditionally fried in oil. The oil has significance as it reflects oil found during the liberation of a temple in Jerusalem from religious oppressors. In the temple, the small amount of oil needed to light the menorah was thought to burn for only one night, but in fact it miraculously burned for 8 nights allowing the Maccabees to collect more oil for the celebration.

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  1. Bûche de Noël (Yule Log)

Traditions of the Yule log trace back to the Celts celebrating the winter solstice. To celebrate the shortest day of the year, they would gather logs from the forest to burn. The celebration became more elaborate in the middle ages, with the logs being decorated with ribbons and burned in fireplaces. As wood-burning stoves became more commonplace, burning the log diminished and the celebration further evolved as French bakers created a Yule Log cake in the late 1800s. A traditional Bûche de Noël is rolled, filled sponge cake made to resemble a log, iced with buttercream and decorated with marzipan, candy and other edible decorations.

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  1. Noon Berenj

While Persian new year (Nowruz) isn’t until spring (March 20), the food traditions include many sweets, including Noon Berenj, which is a rice flour-based thumbprint cookie topped with poppy seeds. It is a time of renewal, cleaning and looking ahead to a new year, so there are often many foods with fresh herbs, spinach and eggs.

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  1. Mazoa

Mazoa isn’t so much a food itself, but a collection of fruit and vegetables set in a bowl on the table during the celebration of Kwanzaa to honour the people who work to grow the food. It symbolizes a bountiful harvest and is to be shared by all those around the table. The fruit and vegetables tend to include those that are common to sub-Saharan Africa, and the Caribbean, including yams, okra, bananas and squash. While the food served during Kwanzaa varies greatly, the holiday really symbolizes the notion of community.

Whether you celebrate today or months from now, I wish you peace, happiness and pleasure from the food you eat.

 

-Samantha, Nutrition Detective

 

Sources:

http://www.cbc.ca/news/canada/calgary/christmas-traditions-why-do-we-eat-candy-canes-1.2870554

Collins, A. (2003). Stories Behind The Great Traditions Of Christmas. http://www.acecollins.com/books/traditions.html

http://www.jewfaq.org/holiday7.htm

http://www.thegoodlifefrance.com/christmas-yule-log-buche-de-noel/

http://www.npr.org/templates/story/story.php?storyId=88156775

http://wsav.membercenter.worldnow.com/story/947383/the-history-of-kwanzaa

 

 

Bacon

Bad Bacon?

October 2015

Bacon
Poor bacon. The headlines have not been very nice to bacon this week. Have you seen these headlines?

Crazy headline

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Does red meat or do processed meats really cause cancer? I don’t work in a cancer clinic but I still get asked this question often. What really drives me bonkers is the craziness of the headlines. Are we really one bite of bacon away from an early grave?

The headlines began once the World Health Organization released a monograph of proceedings from the International Agency for Research on Cancer (IARC). A meeting of 22 scientists from 10 countries evaluated the consumption of red meat and processed meat from over 800 studies and concluded that it was cancer causing, or carcinogenic.

They found that for every 50 grams of processed meat (which is roughly, less than 3 slices of deli meat or less than 1 sausage) eaten daily, there was an 18% increase in colorectal cancer. We recognize that this risk on the spectrum of risk is relatively small, but it increased with the amount of red meat eaten. Based on the evidence, they classified processed meats (e.g. bacon, sausage, deli meat, hot dogs, biltong, etc.) “as carcinogenic to humans” and red meat “as probably carcinogenic to humans” (Bouvard et al., 2015).

dietitians-0710 trans-largeBefore you worry that you have to throw away your burgers and Sunday breakfast favourites, let’s take a step back and really look at what this is telling us. It’s not really highlighting much we didn’t already know. In fact, there have been a number of studies published in the past that indicate we should limit red meat, particularly processed meat. A 2007 cancer prevention report recommended to limit intake of animal meat, avoid processed meat and encouraged intake of mostly foods of plant origin (e.g. dried beans, lentils, soy, nuts).

legumes

If we take a more balanced approach, we can see that there are obvious health concerns with eating too much of anything – red meat or otherwise. Vegetarians and vegans in the crowd are oft to extol the virtues of meatless eating, and there are plenty of studies to back up their intake of plant-based proteins, like dried beans, lentils, nuts and soy. Don’t get me wrong, I’m not advocating for eating meat necessarily. Many of us have decreased our red meat consumption. But, I do recognize that giving up meat altogether isn’t always a realistic approach for some people.

In fact, red meat has long been recognized as an excellent source of protein, all our essential amino acids, iron, zinc, selenium and so on. Again, many, if not all of these nutrients are available in plant versions, if you prefer.

So, is bacon really the bad guy here? No. But, realizing that eating more processed meats (compared with other protein options) is linked to higher cancer rates, is significant and shouldn’t be diminished. Cancer patients or survivors may be looking at these headlines with a different lens than those who haven’t travelled the difficult road to recovery and healing. If we can include moderation and mindful choices in our lives, food and otherwise, I think we can minimize the fear (and crazy headlines) and live healthfully (with a little bit of bacon).

 

-Samantha

 

References:

Bouvard V, Loomis D, Guyton KZ, Grosse Y, El Ghissassi F, Benbrahim-Tallaa L, et al. (2015). Carcinogenicity of consumption of red and processed meat. The Lancet Oncology, Published online 26 October 2015; http://dx.doi.org/10.1016/S1470-2045(15)00444-1.

Ferguson, L. (2009). Meat and Cancer. Meat Science. 84 (2010) 308–313.

Marsh, K., Zeuschner, C. & Saunders, A. (2012). Health Implications of a Vegetarian Diet: A Review. American Journal of Lifestyle Medicine. DOI:10.1177/1559827611425762.

McAfee, A. J. et al. (2009). Red meat consumption: An overview of the risks and benefits. Meat Science. 84(2010), 1–13.

McEvoy, C., Temple, N. & Woodside, J. (2012). Vegetarian diets, low-meat diets and health: a review. Public Health Nutrition. 15(12):2287-94. doi: 10.1017/S1368980012000936.

World Cancer Research Fund. (2007). Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Retrieved from: http://www.aicr.org/assets/docs/pdf/reports/Second_Expert_Report.pdf

Photo sources: foodphoto.ca

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The Shift from Weight Loss to Well Being

September 2015

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I’ve been a dietitian for about 15 years so I have seen a lot of patients from private practice, long-term care to hospitals. What I haven’t seen change much in those 15 years is the message that weight loss is the answer for a multitude of conditions and diseases. This was something I was taught in school and believed myself for many years. But, science is funny like that – it changes.

Let’s start with the body mass index or BMI. This is a validated tool that was taught to me as a way to measure health risk. Just about every dietitian and many other health practitioners use this to assess a patient’s risk for disease if BMI is too low or too high. To use the BMI, we require two measurements, weight and height to yield a result. The result can classify a person as underweight, healthy weight, overweight, obese (with varying classes of obesity or morbid obesity) depending on the measurements.

There are reports that indicate BMI isn’t a terribly reliable indicator of body fatness and health risk. That is, this ratio of weight compared to height doesn’t always give us the best information if, for example, you’re looking at an athlete or someone with a very muscular build, but equally with a frail, elderly person, too.

So, why is it used everywhere? It’s a parameter that is easily measurable, and compared and provides hard data to assess a person’s health. Or so, I thought.

This is where things get sticky.

The large scale (Look AHEAD) trial published in the New England Journal of Medicine in 2013 was a big influence to what turned things upside down for me. They found that, after almost 10 years, participants who were overweight or obese with diabetes and lost weight did not lower their chances of a cardiac event (e.g. heart attack, hospitalized chest pain or stroke). This intervention group lost weight with a combination of calorie-reduced diet and exercise.

To be clear, this is not to say that exercise isn’t beneficial; on the contrary, study participants, after 4 years, showed increased fitness levels and some improved blood markers (like blood fats and blood sugar levels). The intervention group in this study was exercising for 175 minutes per week (moderate – intense), or about 25 minutes a day.

The bottom line here is that in a study of over 5000 participants, overweight or obese diabetes study subjects who lost weight did NOT live longer or have less chance of heart attacks, chest pain (angina) or strokes. In fact, they stopped the study early on the basis of “futility” since they weren’t seeing the positive results expected from weight loss.

This is where I like to introduce the notion of a non-weight focused approach to health and well being. We may have been told, chided, or even scolded for weighing a certain weight or to achieve a particular number, whether it’s realistic or not. I want to be a part of a band of clinicians that starts to change this unrealistic goal of weight loss. Let’s focus on what matters – your lifestyle, including healthy behaviours like exercising, eating healthy food, not smoking and managing your stress. Sounds simple, doesn’t it? Behaviours are notoriously hard to change, especially when you’ve done the same thing over and over again. It’s not going to change overnight, so be patient and hop on for the ride.

Let’s start with goal setting – don’t worry, I’m not getting all new-agey on you, but I want you to think about something you’d like to do better than you are doing now. It might be drinking more water, eating more vegetables, getting enough fibre or something along those lines. Keep it small, keep it realistic, keep it specific (aka SMART goal). For example, I will eat vegetables with lunch 4 days a week. Or maybe, I will bring my waterbottle to work and sip on it over the day.

Did you see what I did there? I didn’t have one weight loss goal in the mix – focus on healthy behaviour, how you feel and take the emphasis off the outcome. So, cast the weight scale aside. It doesn’t have to be an earth-shattering goal for you to be successful. Take one step at a time, and it’ll be part of your new routine before you know it.

Sources:

Ahima, R. & Lazar, M. (2013). The Health Risk of Obesity—Better Metrics Imperative. Science. 341. 856-858.

Alharbi, M., Gallagher, R., Kirkness, A., Sibbritt, D., & Tofler, G. (2014). Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes. European Journal of Cardiovascular Nursing. 1–9. doi:10.1177/1474515114557222

Look AHEAD Research Group, Wing RR, Bolin P, et al. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England Journal Medicine;369:145-54.

Look AHEAD Research Group. (2014). Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study. Obesity. 22, 5–13. doi:10.1002/oby.20662

Photo source:

http://www.nytimes.com/2006/12/28/fashion/28Fitness.html?_r=0

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Coconut Oil Confusion

August 2015

50_of_the_best_uses_for_coconut_oil_imageNever in my nutrition career have I witnessed such a dramatic swing in the nutrition pendulum from demonized food to miracle food. Enter: coconut oil.

Coconut oil, the bad

Let’s step back for a minute. Coconut oil’s bad boy reputation dates back to the 1980s when a media campaign highlighted coconut’s high saturated fat content as being responsible for heart disease. This prompted many food manufacturers to replace coconut and other tropical oils with partially hydrogenated oils. We now know that partially hydrogenated oils contain significant trans fat, which we see in higher amounts in many processed foods, and is now widely accepted as being less healthy than saturated fats.

For a long time, all saturated fats were deemed bad for us, including coconut oil. In fact, coconut oil’s fat composition is made up of 90-92% saturated fat. Because of this, coconut oil was considered an unacceptable fat compared with other fat options.  Talking about coconut oil and saturated fat as a whole category caused them to be labelled as unhealthy and created the public health message that all foods high in saturated fat were bad for us.

This is where it gets tricky. Without getting too deep in the mire of nutrition jargon, coconut oil is made up of a number of fatty acids, the majority of which are saturated. While there is more than one type of saturated fat, we now recognize that the type of saturated fat seems to be a key part to understanding coconut oil’s health effects.

canola-fat-chart

The majority of the saturated fat in coconut oil is made up of lauric acid, a type of fatty acid. The reason lauric acid matters is because of its chemical structure – it is a shorter chain length fat compared with other fats, which means it is used by the body differently. Because they are metabolized differently than other saturated fats, more studies are showing the effects of coconut oil on markers like blood cholesterol levels and finding results that are more positive than we realized. This is where coconut oil starts to look different than the above fat comparison chart (canolainfo.org).

Let’s break it down

Early studies looked at populations (usually South Pacific islanders and surrounding areas) that traditionally eat coconut oil and found a trend of lower rates of heart disease. Because the studies were generally small and many were observational studies, we could only say there was an association between coconut oil and heart disease and that one didn’t cause the other. Also, it is important to note that these populations generally have diets with a greater emphasis on fruit, vegetables, and fish and few processed foods than many western diets.

Newer and larger studies, however, show a pattern that all blood cholesterols, especially LDL {bad} & HDL {good}, all increased with coconut oil. But, a blood fat we call triglycerides either increased or decreased, so the overall results here were inconsistent. Interestingly, when compared with butter, people using coconut oil didn’t have as high an increase in their bad cholesterol (LDL) as the butter users. However, vegetable oils such as olive and canola showed the best cholesterol changes than the other fats, even coconut oil. It is generally accepted that when LDL cholesterol levels rise, so does your heart disease risk.

The bottom line

Given the evidence we have right now, there isn’t enough data to support the claims that coconut oil is the ideal or “miracle” choice for use as your main source of fat in the diet. Using olive oil and canola oil are still seen as excellent choices to use in cooking and in your day-to-day diet. You can still use plant-based saturated fats, like coconut oil, in a stir fry to add another level of flavour but there simply isn’t enough evidence to say that as your primary oil, it is the cure-all it is purported to be.

-Samantha

Sources:

Canola Oil Info website: http://www.canolainfo.org/health/chart.php

Eyres, L. (2014) Coconut Oil and the Heart: Evidence Paper. New Zealand Heart Foundation. 1-27.

Hooper et al. (2011). Reduced or modified dietary fat for preventing cardiovascular disease (Review). The Cochrane Collaboration. Issue 7. 1-217.

Micha, R. & Mozaffarian, D. (2010). Saturated Fat and Cardiometabolic Risk Factors, Coronary Heart Disease, Stroke & Diabetes: Fresh Look at the Evidence. Lipids. 45: 893-905.

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Which type of milk does the body good?

July 2015

  
Milk has long been debated as a healthy food choice; cow, soy, almond, rice, even coconut and cashew milks are vying for your attention on the supermarket shelves. The obvious features of milk include high calcium and vitamin D content. Good for the bones, right? But, with so many choices, how do you know which is the healthier one?

I’ve been surprised by the number of patients I’ve seen lately proudly reporting their switch from cow’s milk to a non-dairy alternative. “What prompted the switch?”, I ask. Most of them aren’t sure, but recall a helpful loved one tout the virtues of non-dairy milks as healthier or better for the heart. All this had me wondering about the nutritional specifics of various milks when lining them up side by side. 

We generally understand that cow’s milk contains a certain amount of animal fat (saturated fat) in some varieties (1%, 2%, 3.25% homogenized) and that plant-based milks (soy, almond, coconut) don’t. What’s prompted more competition with cow’s milk is the fact that most non-dairy milks are fortified with calcium and vitamin D (& also some B vitamins), making them nutritionally similar to cow’s milk. 

  
Where things get sticky are with the flavoured milks, regardless of the milk’s origins. Got added sugar? You’ll definitely find them here. So what’s the breakdown? Let’s start with cow’s milk, which contains naturally occurring milk sugar, or lactose. In 1 cup, there’s roughly 12-13g of sugar. We normally don’t get too fussed about naturally occurring sugars in foods because they’re generally combined with other nutrients like vitamins, minerals and sometimes antioxidants (as in fruit & veg). The flavoured milks such as chocolate or strawberry cow’s milks have about double the sugar (25-26 grams), so you can figure about half is added sugar (12-14g). Not ideal. (Trick to downgrade the sugar: pour half a glass of low-fat milk and top it up with, say chocolate milk, and enjoy a treat while controlling the sugar).   

  
Almond milk is up next. I was surprised to read the ingredient list on the original almond milk to find cane sugar the second ingredient in the listing, second only to water! Almonds are third on the listing. What?!  That brings our sugar count to 7 grams in 1 cup. The vanilla rings in at 12 grams of sugar. Lo and behold we do have an unsweetened almond milk which bumps almonds from third place to second in the ingredient list, having nixed the added cane sugar. What’s disappointing to me is that the protein is ridiculously low, yes, only a measly 1 gram/cup. Interestingly, a handful of almonds contains about 6 grams. It looks like eating your almonds will give more nutrition bang for your buck.

  
Soy milk, you’re next. As non-dairy milks go, soy milk was the belle of the ball for many years, until a handful of studies showed a possible relationship between excessive soy intake and  increased breast cancer risk. But no follow-up, large scale studies have been able to consistently replicate these results. So while many breast cancer patients and survivors may choose to avoid soy, much of the rest of the population do not. But I digress…original soy milk contains slightly more fat (4g) than 1% milk (2.5g) and regular almond milk (2.5g) but has substantially more protein (7g) than almond (1g) and slightly less than cow’s (9g). The sugar amounts vary 6-8 grams in original and vanilla varieties but the unsweetened version only clocks in at 1 gram. 

  
Next in line, rice milk. Original rice milk will run you 120 calories, 2.5g of fat, 10g sugar and only 1g protein. Unsweetened rice milk has the same fat and protein as the original but less than 1 gram of sugar. Again, unsweetened versions provide a better nutritional breakdown than many original or regular versions.

  
Of the newer and novel milks, we have coconut and cashew as options. Coconut is very on-trend right now, from using coconut oil on your hair, nails or in a stir fry. It seems there’s not much coconut can’t do. When it comes to coconut milks, however, it runs 5g fat, 6g sugar and only 1g protein. This is pretty similar to almond milk with the exception of fat, which is higher in coconut milk. 

Cashew milk is a lesser known milk alternative but gaining ground in the mainstream market. The overall calories are relatively low (60 kcals) compared to coconut (80 kcals), cow (90 kcals) and soy (100 kcals). The fat is low at 2.5 grams per cup, but the sugar is high (8 g) and the protein almost non-existent (0.5 g). How it differs from the rest of field is its sodium content at 160 milligrams (mg), which is high in comparison to the others and nearing the cut-off for sodium (aiming for less than 200mg/serving or less than 5-10% of the Daily Value).

There is no definitive evidence highlighting one type of milk as nutritionally superior to others. It is interesting though to see how they compare in this mini experiment lining them up side by side. I was particularly surprised by the minimal protein in the nut-based milks given that nuts themselves are an excellent source of protein. The added sugar issue, while ever present in most foods, is easily dealt with by choosing unsweetened versions more often. In cow’s milk, minimizing animal fat is controlled by your choice of milk fat percentage. 

Keeping in mind what is important to your health will help determine the healthiest choice for you. That is, there is no one-size-fits-all easy answer to the question of what is the best, most nutritious milk. It really boils down to what matters to you (i.e. minimizing added sugar, animal fat, sodium, calories) and your health, your personal preference in taste since that (& maybe price) will dictate whether you keep buying and drinking your milk choice.   Drink up and enjoy.

-Samantha