PROPOSED NEW U.S. DIETARY GUIDELINES DO NOT LIMIT CHOLESTEROL

The Dietary Guidelines Advisory Committee plans to drop limits on dietary cholesterol intake when it issues its 2015 update of the Dietary Guidelines for Americans (DGA).  A draft report of the guidelines reportedly no longer regards dietary cholesterol as a “nutrient of concern”.  This is a marked change from the 2010 DGA which advised Americans limiting daily dietary cholesterol to less than 300 mg a day.

Cholesterol is a waxy substance produced by the body which uses it to create hormones, produce bile acids for digestion, make vitamin D and maintain healthy cell walls.  Advice to limit dietary cholesterol dates back 50 years.   However newer research indicates that healthy human bodies control the amount of cholesterol in the bloodstream, and can detect and adjust its natural cholesterol production if dietary cholesterol increases or decreases.  It also appears that the body can excrete unneeded dietary cholesterol, especially if individuals consume adequate dietary fiber.  Experts still caution diabetics and others at high risk for heart disease to be mindful of cholesterol intake because dietary cholesterol likely still has a modest effect on blood cholesterol.

Recommendations to limit saturated (the fats found in meat, chicken skin, and dairy) and completely avoid trans fats (artificial fats used to manufacture baked goods, frosting, and spreads) are still in place.  During digestion, these are absorbed into the bloodstream and transported to the liver, where they are converted into "bad" LDL cholesterol and ample evidence links higher “bad” cholesterol to formation of arterial plaques that can impede the flow of blood and contribute to heart attacks or strokes.  Most foods that are high in cholesterol are also high in saturated fats.  However, some foods that are high in cholesterol are not high in saturated fats.  These include egg yokes, shellfish, and liver.

What to do:  The official recommendations have not been finalized but it appears dietary cholesterol is not a major driver of blood cholesterol among most people.  So, even though cholesterol is still in bold on the nutrition facts labels, focus your gaze more on the amount of saturated and trans fat listed right above cholesterol.  To control your blood cholesterol eat a healthy diet rich in plant-derived fats (i.e. olive oil, nuts, avocado), fruits and vegetables, whole grains, and lean proteins.    Emphasize foods high in soluble fiber such as beans, oats, barley, and gummier fruits and vegetables including avocado, okra, plums, apples, oranges, green beans, and carrots.  Control your weight, exercise regularly, and take cholesterol lowering medicine as prescribed by your provider.

Adapted from articles available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_150917.html

http://www.usatoday.com/story/news/2015/02/10/new-dietary-cholesterol-advice/23174871/

http://www.nlm.nih.gov/medlineplus/news/fullstory_150870.html

http://www.health.gov/dietaryguidelines/2015.asp#meetings

http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/10/feds-poised-to-withdraw-longstanding-warnings-about-dietary-cholesterol/

Source:

http://www.health.gov/dietaryguidelines/2015-BINDER/meeting7/docs/DGAC-Meeting-7-SC-1.pdf

COOKING FOODS, ESPECIALLY MEAT, AT HIGH TEMPERATURES INCREASES RISK OF ALZHEIMER’S & DIABETES

Cooking foods at high temperatures, especially meats and other proteins, alters their composition creating harmful substances that are combinations of sugars and proteins and other large molecules called advanced glycation end products (AGE).  AGE's are naturally produced in the body but when foods rich in AGE's are consumed, the body cannot effectively process them and they can build up over time.  Recent studies add to a growing body of evidence linking greater intake of AGE's with higher levels of chronic systemic inflammation and higher rates of diseases linked with inflammation including heart disease, diabetes, and Alzheimer's.  

In one recent study researchers analyzed food intake records from large studies in the U.S. and France.  From this data, researchers estimated the average AGE content of different diets.  They found a strong link between higher intakes of AGE's and rates of Alzheimer's.  Researchers previously have linked AGEs with Alzheimer’s, and have suggested that these compounds could be one possible cause of the accumulation of amyloid plaques in the brain associated with the disease.

Another recent series of studies found a direct relationship between AGE consumption and insulin resistance.  Insulin resistance, the hallmark metabolic problem that precedes the development of full-blown type 2 diabetes, occurs when the body's cells fail to respond to insulin causing blood sugar to remain elevated.  Researchers randomized diabetes patients to follow either a carb-controlled diabetes diet, that was either high in AGE's or low in AGE's.  Interestingly, researchers found that insulin resistance significantly improved in those on the low-AGE diet but not in those on the high AGE diet.  

What to do:  Aim to reduce your intake of AGE's. AGEs are particularly high in animal-derived foods, especially fatty cuts of red meat,that are cooked at high temperatures.  They are also present in anything that has been charred  or browned such as burnt toast or roasted nuts as well as food items that have been aged such as hard cheeses.   Instead of meats opt for leaner protein sources such as seafood, skinless chicken, lowfat dairy, eggs, and beans.  Instead of high heat cooking methods such as frying, roasting, broiling, and grilling use moist heat methods such as boiling, steaming, poaching, and microwaving.  When grilling, you can reduce the production of AGE's by pre-cooking in the microwave and finishing foods on the grill.  Marinating foods in an acid such as lemon also helps to reduce AGE formation during the cooking process.

Sources:

Perrone L, Grant WB, et al. Observational and ecological studies of dietary advanced glycation end products in national diets and Alzheimer’s disease incidence and prevalence.  Journal of Alzheimer’s Disease. February 2015; 45(3).  DOI:10.3233/JAD-140720

Mark AB, Poulsen MW, et al.  Consumption of a diet low in advanced glycation end products for 4 weeks improves insulin sensitivity in overweight women.  Diabetes Care. January 2014; 37:1 88-95.  DOI:10.2337/dc13-0842.

Uribarri J, Woodruff S, et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. Journal of the American Dietetic Association. June 2010;110:911-916.  DOI:  10.1016/j.jada.2010.03.018

Adapted from articles available at:

http://www.todaysdietitian.com/newarchives/030314p10.shtml

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704564/

http://www.cevk.com/high-temperature-cooking-may-increase-alzheimers-risk-2/

http://www.foodnavigator.com/Science/Crusty-AGE-rich-foods-may-raise-risk-of-heart-disease

http://www.sciencedaily.com/releases/2015/02/150203094144.htm

LOWER BLOOD PRESSURE WITH THE DASH EATING PLAN

Recently, the Dietary Approaches to Stop Hypertension or DASH diet was named the the best overall diet by U.S. News & World Report for the fifth year in a row.  Why does the DASH plan deserve top ratings? The DASH diet, developed by the National Heart, Lung, and Blood Institute (NHLBI), is a lifelong approach to healthy eating that is designed to help treat or prevent high blood pressure. 

Benefits of the DASH Plan

Research has demonstrated those who follow the plan can see reductions in their systolic pressure (the pressure in the arteries when the heart beats) by as much as 7-12 mmHg and diastolic pressure (the pressure in the arteries when the heart is at rest) by 3-6 mmHg.  These changes significantly improve heart and cardiovascular health outcomes. Research also indicates that following the DASH diet reduces risk of osteoporosis, some cancers, kidney disease, obesity, and diabetes. 

Components of the DASH Plan

DASH emphasizes intake of vegetables, fruits, and fat-free/low-fat dairy products and includes healthy amounts of whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils while limiting salt, sweets, sugary beverages, and red meats.  Nutritionally, this means DASH is low in sodium and unhealthy saturated fats while being rich in fiber, protein, and the blood pressure-friendly minerals potassium, calcium, and magnesium.

Below is a table detailing the contents of the DASH diet at 1200 calories, 1600 calories, and 2000 calories.  Everyone has different calorie needs but if you are looking to lose weight the 1200 calorie menu is a good starting place for women and the 1600 calorie level for men.  It may look complicated but going DASH is easy.  Include generous portions of veggies at 2 meals daily, fruit for a snack and dessert, and include a lowfat dairy source at every meal and your basically there.  Detailed information on the DASH plan is available online at: http://www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf.  There you will find menu plans at different calorie levels and for different cuisines including Hispanic, Asian, and Southern. 

The DASH diet was developed when guidelines recommended limiting sodium to 2300 mg, roughly equivalent to 1 teaspoon of salt.  Currently, the average American consumes 2-3 times this amount. It is now recognized that there are additional blood pressure benefits to lowering sodium intake to less than 1500 mg (~2/3 of a teaspoon of salt). Even if you do not add salt at home, you are probably eating too much sodium.  Approximately 75% of our sodium intake is derived from salt added by manufacturers to food products long before they appear on our tables.  Preparing foods from home and avoiding pre-made products is the most effective way to reduce your sodium intake.

DASH Eating Plan Overview
Food Group	Daily Servings				Notes	Significance of Each Food Group to the DASH Eating Pattern
	2000 calorie	1600 calorie		1200 calorie
Grains	8 oz	6 oz		3 oz	-Opt for whole grain or whole wheat options. -Examples include whole wheat bread and rolls, whole wheat pasta, whole grain cereals, oatmeal, brown rice, barley, quinoa, & buckwheat.	-Major sources of energy & fiber -Brans are great sources of magnesium
	1 oz = 1 slice bread, 1/2 cup cooked grains or cereal, or 1/3 cup pasta
Veget-ables	2-3 cups	2 cups		2 cups	-Potassium is lost in cooking water so when cooking opt for steaming instead of boiling or consider drinking the cooking water. -Some vegetables especially rich in potassium include dark leafy greens, potatoes, tomato, beets, squash, broccoli, romaine, & Brussels sprouts.	-Rich sources of fiber, potassium, magnesium -Dark leafy greens rich in calcium & potassium
Fruits	2-2.5 cups	2 cups		1.5-2 cups	-Dark purple fruits such as cranberry, blueberry, pomegranate, cherries, and acai appear especially helpful. -Choose fresh or frozen over canned or dried which often have added sugar. -Standouts for potassium include kiwi, banana, orange, guava, and melons.	-Important sources of potassium, magnesium, & fiber
Fat-free/ low-fat milk and dairy	3 serving	2-3  serving		2-3  serving	-Dairy is naturally high in unhealthy saturated fat so opt for the low or nonfat options.  Use cheese sparingly as it is high in sodium as well as saturated fat. -Consider some of the less common options such as lowfat/nonfat cottage cheese, nonfat ricotta, and lowfat/nonfat plain kefir. -Lactose intolerant persons can take lactase pills, choose lactose-free products (e.g. Lactaid), opt for products naturally low in lactose (e.g. hard cheeses, yogurt), or use fortified substitutes such as unsweetened soy milk.	-Major sources of calcium, potassium, and protein
	Ex: -1 cup milk or yogurt -1.5 oz cheese
Poultry, fish, & other lean protein	7 oz	5 oz		5 oz	-Select only lean cuts of meat; trim away visible fats; remove skin from poultry. -Choose fish and chicken most of the time. -Mostly avoid processed meats as they appear to be especially bad for heart health and are high in sodium. -1 oz of tofu or 1/2 cup of beans can substitute for 1 oz of animal protein.	-Rich sources of protein & magnesium -Many fish are also high in potassium -Fatty fish such as salmon & tuna are good sources of essential omega-3 fatty acids
Nuts, seeds, & beans	4-5  serving  per  week	3-4   serving  per  week		3-4 serving per week	-All types of raw, unsalted nuts are excellent options. -While it is important to be mindful of portions do not shy away from nuts as there is strong evidence of  their heart health benefits. -Try Beano or similar products if you find beans uncomfortably gassy.  Slowly increasing your intake of beans helps to minimize gas symptoms. -Use beans on salads, as spreads and dips, and in soups as well as many other ways.	-Rich sources of energy, magnesium, potassium, protein, & fiber
	Ex: -1/3 cup nuts/seeds -2 Tbsp peanut butter -1/2 cup beans
Oil	3-4 tsp		2-3 tsp	2 tsp	-Choose healthy plant-based oil such as olive as well as fat-rich fish.  -Avoid unhealthy saturated fats (as well as salt) in butter and margarine.	-The DASH study had 27% of calories as fat
Sweets and added sugars	4 or less per week		2 or less per week	1 or less per week	-Note that the allowed portions and serving sizes of sweets here are very limited compared to the average American diet which includes 19 teaspoons of sugar daily. -Try to use the blood pressure-friendly fruits and lowfat dairy products as sources of sweets.	-Studies reveal that high sugar diets increase blood pressure independently of their impact on bodyweight.