Don't Forget Fiber

The quick answer:  Over the last century, dietary sugar consumption rose as fiber intake declined.  To reduce your risk of overweight and disease, eat more natural fiber than sugar.


The 20th Century was a dietary disaster—we’ve said it before, but repetition is a principle of learning.  The industrialization of our food is presented in the graph above that compares traditional diets (Developing Countries) to the modern Western diet. For the thoughtful person, there is much food wisdom in this chart.

The diet of the Western countries makes a good business—not just for the food processors that comprise Food Inc. but also for the medical establishment that treats the resulting chronic diseases.  A premise of this blog is that as we eat and live better, we will have less need of doctors, drugs, and hospitals.  We’ll still die, and perhaps from those same chronic diseases, but we’ll have more years of good health to enjoy, and less years of bad health to endure.  (A younger person diagnosed with cancer, for example, will linger longer than an older less vigorous person with the same disease.  My Father died of cancer in his 90th year, but it was just a week from diagnosis to his passing.)

Two metrics define the 20th Century damage to our dietary: the year-by-year rise of sugar consumption, and the corresponding decline in fiber intake.  The third Healthy Change established the rule that food products must be made of whole grains and contain more natural fiber than sugar.  Prior posts addressed sugar; this post is about fiber.


The original weight-loss marvel:

Fiber is essentially the structural material of plant cells.  Whether soluble or insoluble (it doesn’t matter which, we need both), fiber is the original weight loss marvel: it provides lasting fullness yet has zero calories.   In addition, fiber optimizes the rate of digestion, slowing the rate that starch enters the blood as glucose (thus softening the swings in blood sugar and insulin that cause type 2 diabetes and fat storage) while speeding the passage of food through the G.I. tract (which reduces the risk of colon cancer). 

Dr. Denis Burkitt

In the course of the year we highlight twelve heroes of better nutrition, including Dr. Denis Burkitt.  Dr. Burkitt served in Africa as a missionary surgeon and his keen study of disease patterns led to the ‘80s bestseller, Don’t Forget Fibre in Your Diet.  (No fiber isn’t misspelled; Burkitt was English.)  The informative graph displayed above is from his book.  Burkitt single-handedly brought the removal of fiber by the industrialization of food to the public consciousness.  From his research—he painstakingly established a large network among hospitals to monitor the incidence of diseases—Burkitt linked the disappearance of dietary fiber with modern diseases like constipation (the first sign of fiber deficiency), type 2 diabetes, heart disease, gallstones, and breast and colon cancers.

Fiber deficiency diseases:

Over the last century fiber was steadily removed from our diet by the rise of processed foods, and the chronic diseases noted above.  Another result—I’ll try to be delicate here—was increased constipation.   (Fiber deficiency isn’t the only cause; other factors include too little exercise or fluid intake, or a diet high in dairy products.)  Most people don’t realize the danger of constipation-caused straining during bowel movements:

  • Straining causes hiatal hernias, a condition where the upper portion of the stomach is forced into the chest cavity, which causes the leakage of stomach acid and heartburn.  Rather than diet reform, people take antacids (Alka-Seltzer, Milk of Magnesia, Pepto-Bismol); more recently drugs to reduce acid production (Pepcid, Tagamet, Zantac) have been heavily advertised.
  • Straining can force partially digested food into the appendix where it can lodge, become infected, and lead to appendicitis.  Appendicitis is the most common emergency surgery of the stomach.
  • Straining can cause bulges or aneurysms in the large colon and the serious disease of diverticulitis.
  • Finally, straining is associated with the painful problem of hemorrhoids, which require no explanation.

Foods rich in fiber:

The humble legume—whether pea, lentil, or bean—provides more fiber than any other food.  See here for the legumes highest in fiber.

Besides legumes, foods rich in fiber include (for details go here):

  • Whole grains (a 2011 study showed whole grains to be significantly protective of death from all causes),
  • Nuts and seeds,
  • Fruits, especially berries,
  • Vegetables, particularly root vegetables such as yams.

Budget Wisdom:

It’s well known that legumes provide the best nutrition value for your food dollar.  What’s surprising is how little shelf space markets dedicate to dried beans, the very best food value.  Selling for around a dollar per pound, you can feed the family for pennies per serving.  If you’re serious about food value, this week’s Healthy Change is a natural.

Please comment:  Share the ways you include legumes in your family’s diet.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Graph from the book Don't Forget Fiber in Your Diet by Denis Burkitt


Keeping Your Marbles

The quick answer: Hippocrates first observed that what's good for the heart is good for the brain.  Living the Healthy Changes helps to protect your brain from the twin threats of dementia and stroke.  


Preventing dementia, including Alzheimer’s disease

We went to a funeral the other day for one of the loveliest people you could hope to know.  Her name was Nancy and she left us at a relatively young age.  Nancy was in her mid ‘60s, just entering what should have been her golden years.  But in truth, Nancy had left us some time before, for she died of Alzheimer’s disease.  Alzheimer’s, the most common form of dementia, is growing at a frightening rate.  This post is dedicated to the memory of Nancy, and the proposition that the Word of Wisdom Living lifestyle can reduce the risk of dementia, as well as stroke.

A 2005 Columbia University study found four risk factors that were highly predictive of Alzheimer’s disease (AD).  Per the study, your risk of AD is 240% greater if you have three of these four conditions:

  • Smoking,
  • Diabetes,
  • Hypertension,
  • Heart disease.

A 2010 study, also at Columbia, found a strong link between HDL cholesterol—known fondly as the “good” cholesterol, though in fact we need all the forms of cholesterol, just in the right ratio—and the risk for AD.  Those with higher HDL levels (>55 mg/dL) had 60% less risk of AD than those with lower levels.  How do we improve our level of HDL?  Here is a summary:

  • Get regular aerobic exercise (more is better).
  • Lose excess weight.
  • If you smoke, stop.  (Is there no end to the ways tobacco harms the body?)
  • Eliminate manmade trans fats (eat nothing hydrogenated).
  • Eat whole foods (lower glycemic index plus more fiber and nutrients).  A diet high in sugar is a special risk for AD—those who consume the most sugar have a six-fold greater risk vs. those who eat the least.
  • Eat fish (rich in the essential fat, omega-3).
  • Get adequate B-complex vitamins (including niacin).

The last protective action—getting adequate B-complex vitamins—brought to mind a study of AD among Catholic nuns reported in the book, Amazing Grace.  In a prior post we discussed the link between the B vitamin folic acid and spinal cord birth defects, particularly spina bifida.

Amazing Grace found a similar protection for folic acid against AD.  It’s most interesting to learn how vitamins that are protective at birth also protect our brain at the end of our lives.

There was also a link between AD and homocysteine, a normal chemical which can be harmfully high when folic acid and other B vitamins are deficient.  In the post on heart disease, elevated homocysteine was an important risk factor.  In fact, if you look over the lifestyle habits that protect from heart disease, you find the same constellation that is protective of dementia.  Because tradition is one of the three sources of wisdom for this blog, we should now honor the ancient physician Hippocrates who said: 

“Food that is good for the heart is likely to be good for the brain.”

A Personal Story

May I tell a story?  In 1991 I took a position with a new medical device company called Target Therapeutics.  With the help of leading doctors, this company founded a new field of medicine called interventional neuroradiology.  Basically we provided doctors with miniature catheters and other tools to treat structural brain disorders by working from inside the blood vessels.  (This was much less invasive than surgery by cracking open the cranium.)  At first we provided catheters for diagnosis but our fame came from an innovative treatment for treating aneurysms.  Yet all the time our big goal—a task still unfulfilled—was better treatment of strokes. 

My work here brought an unexpected moment of closure.  When I was just three years old—this is the short version of the story—I fell out of a moving car and suffered a brain injury that might have proved fatal.  The concussion caused a slow-developing hemorrhage that put increasing pressure on my brain.  As the clot grew over weeks, I became less active, sleeping more and more.  Because the progress was slow, the doctor involved was not concerned.  My parents were frightened, however, and through a serendipitous chain of events my Mom got into the office of a neurosurgeon in San Francisco.  This was during the early years of neurosurgery but the doctor immediately saw the problem and arranged a life-saving surgery not available where I lived.  (Yes, that's me in the picture above, wearing a protective cap during recuperation.)  Years later, while working at Target Therapeutics and observing the use of our products I visited that same hospital where my life had been saved as a child.  I think it was this moment of closure that sparked a continuing interest in promoting brain health.  For this reason, I call your attention to stroke prevention and treatment.

Treating Stroke

Stroke is the 3rd leading cause of death in the US, causing 160,000 deaths each year.  Because breast cancer has been so well advertised we should note that more women die of stroke than breast cancer.  In fact, strokes are much more easily avoided—up to 80% of strokes are preventable.  It’s a tragedy that our society is not more effective at preventing, or quickly treating, strokes. 

Most strokes are ischemic, meaning a clot blocks an artery in the brain, cutting off the flow of blood and life-giving oxygen to brain cells.  A minority of strokes is hemorrhagic, meaning a blood vessel bursts, usually due to an aneurysm, and leaks into the brain cells.  Avoiding high blood pressure is the first protection against stroke. 

It’s important to remember that when a stroke occurs, it takes 4-8 hours for brain cells to die—a much longer treatment window than in heart attacks.  Therefore, recognizing the signs of a stroke and quickly getting to a major hospital—one with a certified stroke center and interventional neuroradiologists trained in methods of treatment—is essential to survival.  I repeat: essential! (If you don't know the best hospital, get to the biggest one and inquire.)

Borrowing from the success our society had in alerting people to the signs of heart attacks, it’s helpful to see strokes as brain attacks, and be aware of the signs.  Because the brain is separated into two halves, stroke symptoms usually affects one side of the body.  As a public service, the American Stroke Association posts these stroke signs to watch for:

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side,
  • Sudden confusion, trouble speaking or understanding,
  • Sudden difficulty speaking,
  • Sudden trouble seeing in one or both eyes,
  • Sudden trouble walking, dizziness, loss of balance or coordination,
  • Sudden, severe headache, with no apparent cause. 

If someone you know shows these symptoms, respond quickly. 

One other  fact about strokes—strokes can be “tiny”, and these are called “transient ischemic attacks” or TIAs.  With TIAs the above symptoms may pass, but there can be loss of brain cells and the accumulation of TIAs is one cause of dementia.  It’s equally important to see a doctor about TIAs because treatment can prevent a more devastating stroke, as well as progressive dementia.

Preventing Stroke

We should follow Hippocrates’ advice; the following protect both the heart and the brain:  Manage your blood pressure, avoid the use of tobacco and alcohol, eat a healthy diet, get plenty of exercise, avoid or control diabetes, and watch out for TIAs.  One more thing (I hope this isn't too much information): be aware that the heart problem of atrial fibrillation can increase your stroke risk by 500%!  For more information, visit the website of the National Stroke Association.  

Please comment:  We’re not used to thinking of the brain when we discuss diet and other lifestyle improvements.  Have the posts this week helped you to know how to hang on to your marbles?


Healthy Brains

The Quick Answer: For brain health, include natural antioxidants and omega-3 DHA in your diet.

Want to keep your wits?  Dr. Keith L. Black, chairman of neurosurgery at Cedars-Sinai Hospital recommends these five ways to care for your brain:

  1. Add omega-3 and antioxidants to your diet.
  2. Get at least 30 minutes of exercise three times per week.
  3. Sleep well.
  4. Take control of your stress level.
  5. Learn something new. 

We have discussed #2, exercise, here and here; #3 & 4 (sleep and control of stress) are planned for future posts.  So lets review #1—dietary omega-3 fats and antioxidants—in this post, beginning with antioxidants.

Glucose, Oxidation, and Antioxidants

The brain never rests so it needs lots of energy.  Though just 2% of our body weight, it consumes 25% of all glucose.  It takes oxygen to burn all this fuel, so the brain also consumes 20% of your oxygen supply.  We learned in a prior post that the body uses oxygen to burn the fuel we eat but the oxidized by-products, called free radicals, can harm cells if not neutralized by antioxidants.  Some of these toxic byproducts are called “advanced glycation end-products,” known by the acryonym, AGE.  It’s a good term because AGEs are theorized to cause the aging of cells that leads to disease and death.  For this reason, a diet rich in antioxidant sources (fruits, vegetables, and whole grains) is essential to protect against free radical aging. 

The neurons of the brains are different from your other cells.  Unlike cells which are regularly replaced, we keep our neurons for life.  So a diet lacking in antioxidants will cause the accumulation of free radicals and AGEs in the brain’s neurons and the result can be dementia.  To keep your wits, eat a diet rich in antioxidants. 

The brain is 60% fat. 

Let me introduce you to Dr. Michael Crawford, who practiced medicine for a time in Africa and studied the fats found in animals.  He learned that wild animals have mostly polyunsaturated fat while domestic animals have more saturated fat.  (He consequently wrote a controversial 1968 article in the New Scientist, “Are Our Cows Killing Us?”)  Because the brain is mostly made of fat, it was inevitable that Crawford would also study the brain.  He was surprised to find that while the composition of fat varied in the bodies of animals according to diet and activity, the brain fat of animals was remarkable consistent, with the essential omega-3 DHA fat comprising 25%.  (We discussed DHA, termed the “Queen of Fats,” in a prior post.) 

You’ll recall that certain vitamins, minerals, and amino acids are essential, meaning the body can’t make them so they must be included in the food supply.  (There are over 50 of these essential nutrients—there should be a deck of playing cards featuring each, so we can learn nutrition while playing cards.)  Among the various fats, the omega-3 and omega-6 fats are essential.  Here's the problem:  We eat too much omega-6 and too little omega-3. 

Because the omega-3 fats have a short shelf life once processed, they have been gradually removed from packaged foods.  The removal of omega-3 fats from the American diet in order to improve storage was discussed in a prior post, “The Worst Food Mistake of The Last Century?”  Dr. Crawford makes omninous comments about the shrinkage of brain mass since humans stopped eating wild meat, which is much higher in DHA than modern feedlot meat. 

There are three main omega-3 fats—known by the acronyms ALA, EPA, and DHA.  We get ALA from plants—all the green stuff we eat.  The irony of ALA is though it’s deficient in the American diet, it’s the most abundant fat on the planet.  There is true irony in this:  The richest nation misses out on the most vital fat because it's too "common."  To address omega-3 deficiency we had the Healthy Change of eating a green salad daily.  The green smoothie is another source.  

The body can process ALA into EPA, and then DHA but at a limited rate.  So for best health, we need to also eat some DHA to protect the brain, eyes, and nerves.   (DHA, ahem, plays an important role in fertility also.)  Here are dietary sources of DHA omega-3: 

  • Cold water fish (wild or even farmed salmon, tuna, trout, sardines, shrimp, oysters, and crab),
  • Eggs (especially if chickens are free range, or algae is added to the diet),
  • Meat (particularly liver, which no one eats anymore) from pastured ruminants (cows, sheep, etc.), 
  • The omega-3 fish oil capsules.

A prior Healthy Change, as noted, encouraged eating omega-3 fats daily.  This week’s change is more specific:  Be sure to also get some DHA omega-3 most days.  We try to eat fish twice a week (a tuna sandwich counts), or take a fish oil pill for each missed serving.  Maybe one of our smart readers will invent a sandwich with sardines (because of their small size they’re the safest for mercury).  We also buy the omega-3 eggs. 

Budget Wisdom
:  For the parents of newborns, there is no better value than mother’s milk.  Breast milk is high in the omega-3 DHA needed for brain development.  Dr. Crawford’s understanding of the critical nature of DHA led to a 30-year crusade to get it included in baby formula.  Finally, in 2002, DHA was approved for addition in the US, but is still not required.  As a result, for years formula-fed babies received insufficient omega-3 and studies have shown lower IQs and poorer vision as a result. 

Please comment:  For a generation we were incorrectly taught that animal fat was unhealthy, that saturated fat and dietary cholesterol caused heart disease.  Worse, man-made vegetable oils high in omega-6 and trans fats but deficient in omega-3 (due to processing and hydrogenation) were wrongly touted as heart healthy.  Today the healthiness of traditional fats, especially the omega-3s, is being rediscovered.  Please comment and share how this cycle of erroneous teaching has affected you and your family’s health, and what you are doing today to enjoy healthy fats, especially the omega-3s.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.


Heart Health

The quick answer:  Don’t die of a broken heart—live a muscular lifestyle and eat a whole foods diet.


The subject this week is heart health.  Have you been with someone during a heart attack, or held a friend’s hand before they entered the hospital cath lab for an angiogram, or visited someone after coronary artery bypass surgery?  It’s pretty scary, isn’t it?  In that moment, we would give anything to have lived better.  Our lives depend on us caring for our hearts.  In the last post we discussed five steps for doing this.   They’re worth repeating:

Based on #1 above, the Healthy Change for the week says: Resist laborsaving devices—incorporate muscular activities into your life.

TV Watching

What’s the exact opposite of muscular activity?   Watching TV—being a couch potato.  There are some terrible TV statistics: By the time the average child turns 18, I’m told, they’ve seen 40,000 murders.  In four hours of Saturday morning TV a child will see 200 commercials glorifying junk food, according to one study.  (Yes, the food corporations slip around the parents and go straight for the kids; they’re the #1 advertiser to children.  There ought to be a law.)  How’s a mom going to compete with that?  No surprise that there’s a correlation between TV watching and obesity. 

We had a wary relationship with the TV when our kids were growing up.  If our TV broke, it might be years before it was replaced.  For a few years we had a Laundromat coin meter attached to the TV and the kids had to earn quarters to watch.  Another time we had a key-controlled switch.  The kids were bright and figured a way around it but they were careful to only do it when we were out.  After a Friday night out with the beautiful wife I’d come home and touch the TV to see if it was warm.  It’s OK, you know, to let the kids think they’re getting away with something now and then. 

I never found time to implement my best idea:  An exercise bicycle with a generator attached that the kids would pump to make electricity to power the TV.   The idea was they should be outside playing and only get enough TV to stay culturally connected, so they wouldn’t grow up weird.  It worked I think, they’re good citizens and all look pretty healthy.  The little girl who drew the hearts above doesn’t have TV service in her home.  Good parents place strict controls on TV watching.

Sodium and Potassium

You read a lot that we eat too much sodium, or, sometimes, that we get too little potassium.  Together they’re medically important so scientists look at our ratio of sodium to potassium.  A recent study looked at 12,267 adults, comparing their sodium-to-potassium dietary intake to the chance of dying.  Turns out that mortality is 46% higher for those with the highest vs. lowest ratio.  Worse, the risk of dying by heart attack is more than doubled.

So how can we eat less salt and more potassium?  Here’s where you mainly get sodium: eating food someone else cooks for you.  Table salt is 40% sodium but we get it from processed foods—fast foods, commercial snacks, and restaurant meals.  If you mainly cook at home using real food, you likely don’t have a sodium problem. 

Where do we get potassium?  From plants, especially nuts, seeds, and legumes, but potassium is found in all fruits and vegetables.  So if you eat a whole foods diet, you get plenty of potassium.  What we discover here is that the sodium to potassium ratio is a marker for processed food vs. plant foods in your diet.  Eat whole foods and you shouldn’t have a worry.

Single Adults

I spoke to some single adults the other night, about nutrition.  They have a tough problem, I think.  They mostly live alone, they work hard all day, and it’s hard to prepare a good meal when you’re the only one eating.  One explained how it’s a lot cheaper to pick something up than buy groceries for just one person.  I don’t think that’s true, but it’s been a long time since I lived alone.  You’d laugh if I told you what I ate during the college years.  Does any group eats worse than college kids?

Lots of kids today weren’t taught to cook when they were growing up.  The group I spoke to seemed like really good people, but they didn’t look healthy.  Driving home I wondered how this blog could be more helpful to single people.  Couldn’t we do something more—to inform, or inspire?

Please comment:  Please share your ideas.  How do you control the TV in your home?  Or, how can people living alone eat healthy?  Thank you for your comments—they make this blog work. 


Healthy Hearts

The quick answer:  Better to learn how to care for your heart then have the doctors “repair” it.  See the seven steps below.


The motto of this blog, that we all "eat smarter, look better, and live longer" requires us to squarely face the greatest threat to longevity: the chronic diseases.

Chronic disease is a natural and preventable consequence of the mismatch between our biology and the modern lifestyle, especially our diet.  The good news is that while we can’t change our biology, we can change lifestyle.  “Chronic” suggests that symptoms develop slowly over years, even decades.  Dental cavities are an early warning of a diet gone awry.  Our sugary intake leads to other symptoms: high insulin levels, inflammation, insulin resistance, atherosclerosis, high blood pressure, and metabolic syndrome (discussed here). The end result may be an autoimmune disease, cancer, diabetes, or heart disease, this week's topic.

What Causes Heart Disease?

If there were a single cause for heart disease, we would have fixed it by now.  Sadly, a generation of time was wasted on the now-discredited “saturated fat-dietary cholesterol theory.”  The simplest answer is that heart disease has multiple causes, including the following lifestyle factors:

•  Smoking is a significant risk factor.

•  Excessive sugar intake leading to elevated insulin and triglyceride levels is an important cause.  See Gary Taubes’ book, Good Calories, Bad Calories. 

•  Chronic infection is a risk as shown by the link heart disease and gingivitis.

•  Central obesity (fat around the liver and other internal organs) is a special risk, even in people of relatively normal weight.

•  The Stress Theory posits that cortisol, the stress hormone, contributes to heart disease during chronic stress.

•  Lack of exercise is a significant risk; a 1996 study found that even 15 minutes a day reduced risk by almost half.

•  High homocysteine level, a result of vitamin B deficiency, is also a risk factor.  For more on homocysteine, see the N.Y. Times article, “The Fall and Rise of Kilmer McCully.”

•  Trans fats, from hydrogenated vegetable oils, are another cause.

Heart Disease Treatments

The intent of this blog is to provide fresh insight into the power of diet to prevent disease, and not to repeat what you’ve already heard.  You likely know that heart disease is the #1 killer of women as well as men, that women display different warning signs, and that women are slower to seek emergency help.  For more on women and heart disease, go here.   

Though the incidence remains high, deaths from coronary heart disease (CHD) have declined since 1980.  Reasons include better emergency and secondary care, more attention to high blood pressure, and the cutback in smoking.  The result is that people are living longer with heart disease and treatment has become an enormous business for drug and device companies, doctors, and hospitals.  Good business doesn't mean good medicine; the following therapies are getting a second look:

• The campaign against dietary cholesterol has not had a significant benefit, and Dr. Uffe Ravnskov, MD, PhD, questions the evidence for cholesterol-lowering drugs, in books like Fat and Cholesterol are GOOD for You.

•  The survival benefit of coronary artery replacement, is now questioned.  See also, Is Heart Surgery Worth It?

•  The use of catheterization to expand or stent coronary arteries, except to reduce persistent angina, may not be the best treatment. 


Preventing Heart Disease

Pioneering doctors have demonstrated that lifestyle improvement, including diet, and appropriate pharmaceutical support may be the best way to treat heart disease.  Dr. Caldwell Esselstyn of the prestigious Cleveland Clinic was among the first to demonstrate that lives could be saved through diet and other changes.  His book Prevent and Reverse Heart Disease, tells the remarkable survival story of 17 patients who followed his protocol.  On the West Coast, Dr. Dean Ornish has a similar program and also a book.  Other doctors have followed these pioneers.  If you Google “preventive cardiology” you get a million hits, a sign of progress.

Here is a short list of preventive measures against heart disease:

1. Develop a muscular lifestyle.  Forget laborsaving devices.  Walk everywhere you can.  Care for your own yard.  Exercise at least 30 minutes most days.

2. If you smoke, stop.

3. Eat a healthy diet of vegetables, whole grains, fruit, nuts, fish, dairy, eggs, and a little meat.  Avoid highly processed foods, especially trans fats.  Keep intake of added sugar below the AHA level.

4. Avoid protracted stress.  Pick your battles wisely.

5. Get plenty of sleep.

6. Have fun—smell the roses, laugh a lot, enjoy friends and family.

7. Get regular physicals but take ownership of your health in partnership with your doctor.  Keep a health log with regular checks of waist circumference, blood pressure, and fasting blood glucose, etc.  

You could add, “maintain a trim waist,” to the list, but this should naturally result from following the seven lifestyle steps.

Budget wisdom: 
I have always thought it wasteful to pay for both an exercise club and a gardener.  Cancel the gym membership and buy a hand mower, or plant a garden.  Rediscover the pleasure of long walks.  Without endangering your safety, save a little gas by riding a bike.  (Read about four women who rode across the US to promote preventive cardiology here.)  Try grinding wheat by hand, it’s a good workout (though it does take time).  Wash your own car, and your neighbor’s too.  Take up swimming.  Give your spouse a backrub, and a little loving.  It’s all good—the best things in life really are free.

Please comment:  How is life made more enjoyable by using your muscles?

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.


Healthy Snacking


The Quick Answer:  It's true—snacking can trim your girth.  See the list below for snacks that are tasty, healthy and a good value.


There’s a strong link between this week’s topic of diabetes and obesity.  By good fortune, the annual report on obesity in America just came out.  In brief, we’re still losing the war against fat.  I couldn’t find a single success story but at least the growth of fat is slowing.  In America—the land of plenty—about 1/3 of adults are overweight, and another 1/3 are obese but this varies with region.

It’s fascinating to look at regional trends.  When both adults and children are considered, Hawaii does the best.  The Western states are next best, followed by New England.  The Southern states do the worst.   The data for diabetes, hypertension, impaired longevity, and stroke, all follow the regional obesity pattern.  Though the South struggles, we all need to do better.

I’m uncomfortable with the public debate against obesity.  First, a load of guilt is laid on the obese and guilt doesn’t motivate long-term change.  Second, overweight is a complex issue and public debate isn’t good at solving such problems.   So here are a couple of observations from hard-earned common sense:

1.     Don't cut calories to lose weight.   Despite all the focus on calories in recent decades, they aren’t the answer to overweight.  Hunger is a powerful force; you can resist it for a while but not forever.  A UCLA meta-study found that calorie-restriction diets actually resulted in an increase in weight for two-thirds of the participants.

2.     Forget about weight and focus on building a healthier lifestyle.  Take care of your health, and your weight will take care of itself.  The low-fat/low-calorie craze was a big mistake because it focused on subtle changes in processed foods, rather than a return to natural, whole foods.

3.     Natural foods are dense in nutrients but low in calories.  Processed foods are the opposite, high in calories and low in nutrients.  If you eat right, you can eat to comfortable fullness and enjoy food as well as a healthy weight.  Oh, add a longer life to the benefits.

4.     Physical activity is key to good health—experts call for at least three hours of activity that makes you sweat, spread through the week.  But it’s more than exercise—the key is to build a lifestyle that uses muscles, rather than laborsaving devices.  Yes, do your own gardening, even if you’re the only one on the block.  (We’ll address the TV—the antithesis of physicality—in a later post.)

5.     For more on finding a healthy weight, take a second look at these past posts: The Skinny on Overweight, and The End of Diets.  And think about making a goal for waist size.

The Healthiest Snacks

As you adopt the weekly Healthy Changes to fit your needs, you create a healthier lifestyle.  In the beginning, we reduced added sugars and eliminated trans fats.  Then we began to increase natural foods, beginning with whole grains, vegetables and fruits.  There’s more to come—the year is just half over—the subject of this week is healthy snacks.  From past comments, here are your favorites:

o   The best snack is a drink of refreshing water—it’s good for you.  Check this Healthy Change.

o   The next best value after water is snacking on leftovers.

o   Seasonal fruits are another bargain.  Checking the produce aisle we found these buys: cantaloupe at $.25/lb, watermelon for $.50/lb, and peaches at $.50 to .65/lb.

o   Popcorn, air-popped, or microwaved in a paper bag.  Sacha adds butter and a little Parmesan cheese. 

o   Homemade bread, especially toast.  My Mom liked toast with sliced avocado.  If you buy yeast in bulk, the price drops under $1/loaf. 

o   Bran muffins; homemade are hard to beat.

o   Kale chips.  Brie says to roast whole leaves with a touch of sea salt at 250 F until dry and crunchy. 

o   Hummus, the new guacamole.  It’s healthy; Michelle has it with veggies or pita chips.  (Maybe a future post on best hummus?)

o   Seasonal veggies.  Whole carrots are a bargain, $.45 to .60/lb. in our survey.  LC likes zucchini, carrots, and cauliflower.  Celery sticks with peanut butter are a tradition but Taylor prefers homemade almond butter. 

o   Green smoothies are a favorite, or any healthy fruit smoothie.

o   Homemade granola (check Katie’s recipe) makes a great snack. 

o   Trail mix, especially homemade, is great too.

o   Nuts are a treat; they cost more so buy direct or in bulk.  Jess gets his from 

o   Dried fruits are best for winter; I like prunes or dates with walnuts or pecans.

o   Cheese is good with homemade bread, crackers (that meet the whole grain rule of more fiber than sugar), in quesadillas, or with apples.

o   Hard-boiled eggs (omega-3 is improved by feeding the chickens natural pasture, flaxseed, or algae).

o   Sardines on crackers—an omega-3 bonus.

o   Edamame, warmed and salted.

Budget Wisdom:  Forget what you hear—healthy food is the best value, all costs considered.  Supermarkets have been fixing up their stores and raising prices lately, but I walked through an alternative store last night (Smart & Final) and was surprised to find nearly all the produce selling for less than 1 $/lb.  (A really healthy food, cantaloupe, was on sale for 25 cents a pound.  It’s today's health bargain.)  I calculated that a family of four could eat eight daily servings of fresh fruits and vegetables for just $135 a month.  (Not including whole grains, another good value, nuts, dairy and a little meat.)

Please Comment:  The 4th of July reminds that it’s summertime.  Please share your summer menu favorites and we'll add a post on seasonal menus.


Dodging Diabetes

The Quick Answer:  The shopping list is the perfect place to manage snacking—if a snack is in the house you'll likely eat it; if it isn’t you won’t. ____________________________________________________________________

Have a great 4th of July?  (Clearly I did: I’m a bit late with this post.)  Independence Day is a good time to reflect on the American spirit, the unique virtues as well as the defects that influence how we live, eat, and die.  We are the world’s true pioneers.  No other country is so innovative.  We invented democracy (with a little help from the ancient Greeks), for goodness sake.  And we invented processed foods, soda pop, fast foods, and diet drinks.  We love change.  What other nation would so recklessly experiment with food innovations—like getting half our calories from sugar and other refined carbs—of unknown consequence?   

Books on Diabetes

I like to collect old books on nutrition, not because they’re old, but because they offer lost dietary wisdom.  Here, for example, is the English biochemist R. H. A. Plimmer in his 1925 book, Food, Health, and Vitamins:

The Americans, with their love of candy, are the largest sugar eaters in the world.  Incidentally, cancer and diabetes, two scourges of civilization, have increased proportionately to the sugar consumption.”   (Bold face added.)

We should have listened to Dr. Plimmer.  I have another book, not as old but just as revolutionary, by John Yudkin, with this long but descriptive title:  Sweet and Dangerous, The new facts about the sugar you eat as a cause of heart disease, diabetes, and other killers.  (First published in England as Pure, White and Deadly.)  Yudkin was the first to speak clearly about the dangers of our growing love for sugar.  People value these books: A used copy of Sweet and Dangerous is offered today at $100 while a copy of Pure, White and Deadly requires $199. 

Of course you can get the information updated at a lower cost with Nancy Appleton’s book, Suicide by Sugar: A Startling Look at Our #1 National Addiction.  Scary titles.

What Causes Diabetes?

Diabetes comprises a disease family that includes type 1, type 2 and gestational diabetes.  Type 1 diabetes, perhaps 5% of all cases, is an autoimmune disease of children that destroys insulin-producing cells in the pancreas.  The cause is unknown but a near-normal lifespan is now possible through improved medical technology.  

Type 2—the subject of this post—is an increasingly common consequence of the modern lifestyle.  How common?  Twenty-six million Americans have Type 2 diabetes, a chronic disease that leads to other diseases, such as heart disease, stroke, and cancer.  Seventy-nine million of us are prediabetic and at risk for full-blown diabetes.  These days, diabetes is a growth industry. 

So what causes type-2 diabetes?  This will drive you crazy but despite all the research, scientists don’t know for sure.  We think of diabetes as the sugar disease but it’s more complicated.  Not everyone who eats a lot of sugar gets diabetes.  There are other factors, including diet, family history, overweight, and lack of exercise.

The best book I’ve read on sugar and disease is Gary Taubes’ Good Calories, Bad Calories; Challenging the Conventional Wisdom on Diet, Weight Control, and Disease.  My conclusion after reading Taubes:  The best way to avoid the risk of overweight and diabetes is to bring sugar intake below the American Heart Association recommendation (6 tsp daily for women, 9 tsp for men), eat a whole foods diet, and exercise at least three hours weekly.  The Healthy Changes of the last six months build a foundation for doing this.

Where do we get most of our dietary sugar?  Sugary drinks (addressed here) and snacks!

Healthy Snacking

We talked about snacking in a prior post and implemented the Healthy Change of using a snack plate.  (Confession:  I sometimes forget and need to remind myself to do this.) 

Four principles for healthy snacking:

1. Commercial snacks are usually the unhealthiest food in the store and the worst value for your money.  Remember: money spent on unhealthy snacks is a vote for that company to succeed.

2. Watch for “boredom” snacking and substitute other forms of variety, like a walk, a chapter from a favorite book, calling a friend, or, ahem, checking your favorite nutrition blog. 

3. The key to healthy snacking is to eat a good (low G.I., whole food) breakfast.  Our worst snacking habits arise from stimulant-craving due to skipped breakfasts. (The danger of coffee, I suspect, is less about the coffee and more about habitually skipping a nutritious breakfast.) 

4. If your waist size is greater than your goal, eat a healthy breakfast and don’t snack after 8:00 pm. 

We’ll talk more about healthy snacks and proven waist-reducing habits in the next post, but just to remind, snacks can be organized in these groups:

•  Veggies

•  Fruits

•  Nuts and seeds (including popcorn)

•  Cheeses and yogurt

•  Leftovers

•  Home-made snacks (like crackers or cookies from healthy recipes).

Which brings us to the healthy change of the week:

If we don’t have unhealthy snacks in the home (or office), we won’t eat them.  If we have healthy snacks available, it’s likely we will eat them.  Pretty simple.  Got a nasty snack you can’t resist?  Buy just one serving, once a week.  The experience of many is that as you eat better, you’ll also snack better. 

Budget Wisdom:  As an experiment, wander the grocery store snack aisles and look at the cost per ounce.  Then compare to the cost of fruits and vegetables or other healthy snack ingredients.  With the exception of certain nuts and seeds, which I love, you save by buying healthy snacks.

Please comment:  Share your favorite healthy snacks.  We’ll collect your favorites into the next post.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.


Let us now honor the Luddites

Remember the Luddites?  The very name almost makes us laugh.  In the early 1800s they raged across the countryside of northern England, destroying the textile machines that were taking their jobs.  They’re remembered for their crusade against the advance of the Industrial Revolution—for the naïve believe that progress could be resisted.  The Luddite movement was put down harshly by the powers that were, but there was something to their protest that caught the public fancy.  On the 200th anniversary of their first protests, we still remember their name.

A new, nobler, image of the Luddites was presented in the March issue of the Smithsonian.  The Luddites were not actually opposed to the textile machines—most of them worked in the industry.  Instead, they fought against predatory practices, like putting the young to work at poverty wages without proper training as apprentices.  The rising issue was how to balance the conflicting needs of man and machine.   Business was looking after the machines quite well, thank you, but someone needed to look after the people.  Their movement was a first step in the long march to better treatment of workers.

This brings us to the 20th century march of the Industrial Revolution through our food supply.  We are in a new century now, and the health consequences of the industrialization of food are ever before us.  The first task of the 21st century should be to reinvent—to reform—our dietary with the passion of a Luddite, but with the wisdom history can provide.  We shouldn’t oppose machines that mill flour more efficiently.  But we should oppose the removal of vital nutrients to improve shelf life or appeal to our innate desire for sweetness. 

The roller mill making refined and bleached white flour is bad; a mill suitable for home use is good for those who can afford; but a mill in the grocery store that allowed the purchase of freshly ground whole flour by all would be better.  Industry should serve man, not vice versa.  So we are engaged in a process of reformation that is both wise and creative.  We seek a new paradigm for how to live and be well in the modern time.  And this brings us to gateway recipes. 

Gateway Recipes

In the beginning we thought our readers would be most interested in scientific food studies so we placed less emphasis on recipes.  Instead we have seen a growing interest in what we’ve termed gateway recipes.  Gateway recipes are more than directions for a meal—they open the door to a better way of cooking and eating.  The recipes for the Breakfast Compote and Katie’s Granola are revolutionary because they eliminate the need for unhealthy store-bought cereals.  The recipe for Basic Bread had a similar effect—it showed that bread could be healthier, tastier, and cheaper if made at home.   Dropping French fries from our dietary sounded easier after we tried the Oven-Roasted Fries recipe.  Gateway recipes enable the food reformation and they also send a sharp message to the corporate chieftains that they must reform or become the new dinosaurs.

Cruciferous Vegetables

Named for their cross-shaped flower, cruciferous vegetables are this week’s subject.  The family includes broccoli, cabbage, cauliflower (all shown above), plus kale, Brussels sprouts, bok choy, and radishes, all potent sources of antioxidants, soluble fiber, vitamins, and minerals.  This is reason enough to include them in your diet but studies also suggest they are protective of cancer.  You can read more about Dr. Joel Fuhrman's take here. 

It is impossibly difficult to prove the role of any substance in promoting or preventing cancer.  But there is growing evidence the cruciferous vegetables are protective of colorectal, breast, prostate, lung, and other cancers though further research is needed.  Cruciferous vegetables have no official intake recommended but epidemiological studies suggest at least five weekly servings.

Returning to the idea of gateway recipes, you readers have recommended these cruciferous dishes:

•  For a hold-the-mayo vinegar coleslaw with oregano, go here.

•  For a Broccoli Cheddar Soup recipe look here.

•  If you miss German food, here’s the recipe for a red cabbage dish.

•  And for Pasta with Hashed Brown Sprouts and Pine nuts, go here.

Please comment:  Be a Luddite by sharing recipes that enable healthier living, or suggesting topics for gateway recipe research.


Protecting Your Guy

The quick answer: Remember how good the big hunk looked on your wedding day?  To keep your guy around as long as possible, replace the sugar and most of the meat in his diet with cruciferous vegetables and a few Brazil nuts.  Wives who cook control three of the five factors linked to prostate cancer in men. 


Could I tell a story?  Early in the last century an engineer turned doctor developed a safe process for making intravenous solutions (IVs) and founded a company called Don Baxter Laboratories.  Don Baxter is forgotten now but his IVs became central to medical treatment—it’s rare to see a hospitalized person today who is not hooked up to a number of IVs.  I worked for Don Baxter’s company (later known as McGaw Laboratories) for many years and our products included solutions used in a surgical procedure called TURP.  TURP stands for transurethral resection of the prostate, the standard treatment for men with urination and other problems due to an enlarged prostate. 

The urologists we met were interesting: they were regular guys and if their standing in the pecking order of doctors was humble, they were good at home repairs and tended to have a workshop in the garage.  In 1988 the status of urologists began to rise—a test for detection of prostate cancer (the PSA test) was introduced and a great hope arose that earlier treatment would reduce mortality of the #2 men’s cancer (after lung cancer).  So urologists rose from mere plumbers for men to healers of cancer, or so we thought.

There was a basis for our faith in the early detection of prostate cancer.  In 1943 Dr. George Papanicolaou published a paper of historical importance, “Diagnosis of Uterine Cancer by the Vaginal Smear”.  Basically, he invented the Pap smear screening test, which detected pre-cancerous cells of the cervix and allowed early preventative treatment.  If you look at the graph in our recent post on cancer, you can see the dramatic decline in uterine cancer since WWII, thanks to this good doctor.

So when the PSA test was introduced in 1988, it was presumed a similar triumph over prostate cancer would be achieved.  Men who tested positive were given the standard cancer treatments—slash, poison, burn (surgery, chemotherapy, radiation).  The side effects were dreadful but the benefit women received from the Pap test was not matched for men with the PSA test.  (Two recent studies, ERSPC done in Europe and PLCO done in the US, showed no detectable benefit, or a benefit small enough to not offset the risk, for treatment indicated by PSA testing.  The use of this test remains a topic of debate.)  So prostate cancer seems much like breast cancer (discussed here): the best protection is prevention through lifestyle reform. 

The chart above shows 75 years of cancer incidence for men.  Prostate cancer (PC) is second only to lung cancer, and it’s interesting they have declined in tandem (a delayed benefit of the decline in smoking).  The exact cause of any cancer is unproven but studies have linked these risk factors to prostate cancer:

1. Tobacco:  The more you smoke the greater the risk; overall smokers have 40% greater risk and the risk is doubled for those with >40 pack-years.   (A pack-year is one pack a day, done for one year, etc.)

2. Sugar:  Sugar drives insulin and higher insulin levels are linked to PC risk as well as overweight.  Overweight is a separate risk factor for PC.  A 2008 study showed a 300% greater PC death risk for men with both high insulin (measured by C-peptide) and overweight.  Avoid sugary drinks, refined carbs, and eat a low G.I. diet. 

3. Meat:  Eat meat sparingly; men who eat 5 or more servings weekly have 150% greater risk than those consuming 1 serving.  Conversely, dairy products, especially from pastured cows, contain vitamin K2, which is protective of PC.

4. Vegetables:  Veggies—particularly cruciferous vegetables such as broccoli, cauliflower, and cabbage—are protective against the most deadly PCs.  Include them in your diet most days.  Vegetables, whole grains, and especially Brazil nuts also provide selenium, which is protective of PC.  Eat a few Brazil nuts weekly.

5. Exercise, in the sun:  Men who got three or more hours of vigorous exercise weekly had a 61% lower risk of dying from prostate cancer.  Vitamin D also reduces risk, so consider running on the sunny side of the street.

Budget Wisdom:  Compare the cost of cruciferous vegetables to meat and you’ll find a real savings.  These veggies are also protective of women’s cancers.  An interesting fact:  A generation ago Americans spent about 15% of their income on food and 10% on medical care.  Today the numbers are reversed but you can save by spending wisely on food now and less on medical care, down the road.

Please Comment:  Share your best ideas and recipes for including cruciferous vegetables in the family diet.  In the next post we’ll feature a recipe for coleslaw. 

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Chart found here


Katie's Granola

The Quick Answer:  For a healthy weight, eat more whole foods and fewer refined foods.   And start your day with a good breakfast, like Katie’s Granola (below).


I promised a granola recipe, but first let me comment on a Harvard study just out.  The study analyzed dietary patterns for over 200K people, taken over 8-20 years, and found that over the years, some foods add weight while others are linked to weight loss.  No surprise, I suppose, but which foods do which? 

Weight loss foods—are unprocessed (and low in sugars and starch) and include yogurt (a surprise finding), nuts, fruits, whole grains, and extra helpings of vegetables.  The benefit of yogurt is unclear; it may be the probiotics or just the fact that people who eat yogurt do a lot of other healthy things.  Exercise and adequate sleep are also important habits.

Weight gain foods—are generally processed and include sugary drinks (most impact, because people drink so much), potatoes (French fries, potato chips and plain old baked potatoes), refined grains, red meats, and processed meats.  The farmers in Idaho will defend the baked potato and I’m with them—but I will avoid things deep-fried and try to limit chips to national holidays.  Also, smoking cessation, alcohol consumption, too little/too much sleep, and TV watching are all linked to overweight.

We intuitively knew this, but it’s nice of Harvard to confirm.  Without saying it outright, the study challenges the common practice of calorie counting.  We discussed this in a post, titled The Skinny on Overweight, which stated that eating a variety of whole foods moved us from eating calorie-dense food to eating nutrient-dense foods that had a low glycemic index (G.I.).  You don’t need to go hungry to lose weight; nutrient-dense foods are filling, you won’t eat too much.  Further, a low G.I. diet of whole foods would lower our insulin level and the propensity of insulin to convert excess glucose into cellular fat.  Bottom line:  don’t count calories; buy whole foods.

All this follows the longevity survey discussed in a recent post (Last Person Standing).  A county-by-county survey of the US found a few counties where longevity was improving even more than the leading nations.  (Nations with best longevity include Japan, Sweden and Switzerland.)  But it also found that 85% of our counties were falling further behind.  It was disturbing that in the greatest democracy, we are not all progressing together. 

The Healthy Change of this week is to regularly eat a healthy breakfast.  This is important—people who do so have more vigor and are less tempted by sugary snacks.  Remember the Breakfast Compote, our effort to make a perfect meal?  Two other healthy breakfasts you can make yourself include the Swiss tradition, muesli, and the American invention, granola.  They’re both oat-based with nuts, seeds, and dried fruits.  The main difference is granola is baked and has oil/fat added to bind it together.  Both will keep for a week or two so can be made in advance to save time.

Granola Recipe:  The beautiful wife and I have three daughters.  When they went off to college, our main requirement (I was going to say “only”, but there were a few other parental dictates) was they work to help pay their way, avoid debt, and pick a major that would lead to a paying job.  Reflecting their uniqueness, one is a firefighter, another is a designer, and the last is a photographer.  They all share an interest in healthy eating and the picture above comes from Brooke’s blog, Inchmark, which links to the recipe at Katie Did. 

I call it Katie’s Granola and it is unique because it’s baked in a cool oven (250 F) but for a longer time (2 hours).  Most granola recipes bake at 350F for 15-30 minutes, depending on moisture level.  (Brooke adds more nuts, as shown below.  You might want to add a little salt.)

Katie’s Granola

10 c old-fashioned rolled oats
2c whole-wheat flour
2c wheat germ
2c coconut, shredded or flaked
2 to 3c total of chopped pecans and sliced almonds
Mix above ingredients in large bowl

4T vanilla
1/2c water
2c honey
1c (or less) healthy oil (try coconut oil)

Mix wet ingredients in a medium bowl, then stir into the dry ingredients.  Spread in shallow baking pans and bake about 2 hours at 250 F., stirring gently every 15 minutes.  Cook until golden brown and nearly dry.  Cool and store in airtight containers; refrigerate. 

Budget Wisdom:  You can save money by making your own granola, and you’ll have the confidence that you know what’s in it.  Katie’s recipe is for the frugal—it has fourfold more grains than nuts/seeds/dried fruit.  Other recipes balance the grain quantity with the more expensive nuts/seeds/fruit.  Another savings: because many love it but don't make it, granola makes a great gift and is simpler than wandering the store aisles looking for something people often don't even need.

Please comment:  We’re all moving away from factory-made stuff, towards home-cooked foods that are both healthier and less expensive.  You're inventing a new economy: blending healthful food traditions with new, time-saving methods.  Examples: home-made granola can last a week or two with the refrigerator, and wheat can be fresh-ground with a home grinder.  Please share your creative ideas for healthier living.