Do you think you know which of these is best for you?

What do we really know about fat?  About how fats react in the human body when they are eaten?  Government agencies make a lot of assumptions about fat, and they base that on the popular opinions of physicians and scientists who serve on their advisory committees.  Those recommendations are published, and then are used by many physicians, dieticians, nurses, and other health care professionals as a basis of what to recommend to patients.

But what if those experts got it wrong? When the latest data about fats is examined critically we find out that the recommendations made by those government agencies has no basis in the literature.  However, you will find those recommendations repeated as gospel in almost every website about what to eat and what is healthy for you, even the highly respected websites such as WebMD.com

In the March issue of Nutrition, a highly respected, peer-reviewed, academic publication,  Robert Hoenselaar outlines how the advisory committees not only got their advice wrong, but how they cherry-picked the data (Nutrition 28 (2012) 118-123, Saturated fat and cardiovascular disease: The discrepancy between the scientific literature and dietary advice).

Recommendations from the United States Department of Agriculture (USDA) and European Food Safety Authority (EFSA) regarding consumption of fat are similar

(a) Consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids

(b) Keep the intake of saturated fatty acids as low as possible while consuming a nutritionally adequate diet

(c)  Saturated fat intake should be as low as possible

In 2003, a meta-analysis of over 50 trials was published examining the relationship of dietary fat to serum cholesterol levels (Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serumlipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146–55.).  The conclusion was that saturated fat increases the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) but without changing the ratio of total to the HDL cholesterol.   They concluded that using cholesterol alone as a marker of risk was unreliable. This was because if you replace the saturated fat with carbohydrates or tropical oils if you examine the effects on HDL and apolipoprotein B. They concluded that “… we can never be sure what such fats and oils do to coronary artery disease risk.” To translate that from doctor-scientist language: we can improve some laboratory markers, but really not by any mechanism that makes a difference from what we know.

While a systematic review of randomized trials showed that when saturated fats are replaced by polyunsaturated fats there is a reduction in the laboratory marker for risk of heart disease, there was no association with mortality from heart disease.  To emphasize this: the laboratory values of the patients studied improved, but their mortality didn’t. The review also showed that monounsaturated fat intake significantly increased cardiac events, but no effect from the intake of saturated or polyunsaturated fat. Let me emphasize that: Monounsaturated fats, by at least one study, not only didn’t improve issues with the heart- the patients in that study did worse.

When examining other prospective studies about the risk of saturated fat and cardiovascular disease, there has been a consistent lack of an association between fat intake and heart disease, stroke, or total cardiac events.

Cohort studies show that by replacement of saturated fats with unsaturated fats, or carbohydrates – and examining the hazard ratios for heart attacks and deaths from heart disease were as follows: 0.87 for polyunsaturated fat, 1.19 for monounsaturated fat, and 1.07 for carbohydrates.  For those not familiar with statistics, these are essentially no difference, and if these small statistical numbers are accepted than polyunsaturated fat shows an alarming trend. So here is a study that indicates (with as much precision as most studies these days) that polyunsaturated fats are worse for you than saturated fats.

There is a difference between protection against what we define as risk of heart disease and death from heart disease.  Risk reduction means that we lower the laboratory values of factors we associate with risk – but the end point is death.  In a meta-analysis published in 2010 (Ramsden CE, Hibbeln JR, Majchrzak SF, Davis JM. N-6 fatty acid-specific and mixed polyunsaturated dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 2010;104:1586–600.) examined seven different trials, they found that there was a risk reduction but no change in mortality.  Another study (Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomized controlled trials. Ann Nutr Metab 2009;55:173–201.  ) had eight trials found “There is probably no direct relation between total fat intake and risk of CHD (heart disease).”
The advise of the USDA is reflected in places like WebMD, recounted in public service commercials, and recited as gospel by health care workers everywhere.  Giving false impressions about what an appropriate diet is.

Many of us constantly look for the right things to eat, the right food to feed ourselves and our families.  For that information we choose what we consider informed sources about risk reduction. What we discover is that there is not a clear answer, at least not yet. The differences between these ingredients are not large enough in the studies performed for a reasonable person to make blanket statements.

The only statements about fat that can be made are that trans-fats are bad for a person.  Trans-fats are the fats found in stick margarine, most pastries, and fast foods – but rapidly being eliminated because of their clearly demonstrated bad effects.

Here is what we do know: eating too many calories, be it of fat, carbohydrates, protein, or alcohol will lead to excess weight, and excess weight is a contributor to heart disease, diabetes, and joint problems.

Eat healthy, fresh, delicious food — all in moderation.

One of my favorite chefs – Gordon Ramsay, talking about eggs and a few other things.

Scrambled eggs:

When I first started out in life working in a kitchen one of my jobs was to crack eggs and put them into a large container and then when someone ordered eggs they would be ladled onto a hot griddle and in a minute an order of scrambled eggs would be ready. Turns out, most kitchens make eggs the same way — a hot griddle, very little time, and a fast breakfast.

Fast food eggs are made over too hot a griddle yielding rubbery consistency

Two problems- the eggs have been heated so fast, that the proteins have lost most of their water giving the eggs the consistency of rubber and second, the eggs don’t taste that great.

When my patients who had LAP-BAND surgery complained that eggs became stuck above there band – it was quite clear- they were either making them to hot and fast, or getting them from a restaurant that was doing the same.

Here is the secret to all eggs — think of eggs like sex – you want it slow. When you were a kid, fast may have been ok but now you are an adult- time to earn how to make them.

The perfect scrambled egg has the consistency of custard or yogurt. They are not hard, rubbery, or dried out. Egg whites are a protein called albumin – and like all proteins, when given a high heat they tend to denature (our scientific term) — or lose their water and become curdled, hard, and more akin to eating a wad of bubble gum than the nice custard we desire.

Ingredients:

4 large Eggs
1 T butter – UNSALTED

First DO NOT whisk the eggs together ahead of time. Do this under some heat – and gently. Whisking eggs together begins a mechanical breakdown of the proteins that will result in more rubbery consistency.

Place a non stick fry pan on a low heat. Take a teaspoon of butter and gently coat the bottom of the pan. If the butter can melt – then place four eggs in the pan. Using a silicone spatula gently break the yolks and fold the eggs together. Gently stir the eggs – and every minute take the pan off the heat and continue to stir the eggs. Once the eggs “set” – or are a wet consistency when they are giving off a bit of steam – take them off the heat for the last time. Take the remaining 2 teaspoons of butter and fold them into the eggs. You will see the heat from the pan will continue to SLOWLY cook the eggs. As you stir in the butter the creamy texture of the eggs will form- once they are to that point, remove them from the pan and serve them.

At this point add salt and pepper to taste – not before. If you add salt to the eggs before the mechanical action of the salt, combined with the drying property will pull the water out of the eggs.

There you have it- the pefect scrambled eggs. Want to add some ingredients – I recommend Salsa instead of cheese- more flavor, and far fewer calories than fat.

Two servings if you are trying to lose weight and one serving if you want to gain weight.

Bourdain calls out Deen

Paula Deen who crafted a remarkable, high profile career with her Southern style of cooking, delivered with Southern style charm, announced her diagnosis of  adult onset diabetes (type 2). Now the judgments are pouring in: her food and lifestyle led her to this diagnosis and the pundits are asking for her to “repent.”

As a physician let me be clear here:

Paula Deen’s diabetes is not a deserving fate for what she cooked, it is more a matter of genetics than anything else. For those who are unlucky enough to have the genetic code that predisposes them to diabetes, the odds are they will become its victim, as they get older.  Even the most “in shape” individual, who eats “right” who has the genetics for diabetes can no more avoid that than you can avoid a car accident  if someone misses a stop sign because they are texting.

Perhaps I am jaded – as someone who researches diets and performs weight loss surgery- I’m reminded that HL Mencken said that physicians are not suppose to offer repentance but absolution.  But a body never lies, and while we don’t know the “right” diet,  we do know that  certain foods can kill you.

While the news enjoys the pseudo-feud going on between Deen and one of my favorite writers-chef Anthony Bourdain, we in medicine hope that Paula Deen is using her celebrity to benefit millions who are diagnosed with diabetes. She is also cashing in a check from a sponsoring company;  isn’t that the American way?

The real quote from Bourdain is one anybody can respect, “Honestly, I have no ill will toward her personally. I respect anybody who’s had a trajectory like hers. But I don’t like the brand. If her shtick is food that’s going to rush you along your way to diabetes, then it’s not a brand I particularly like. I am the last person in the world to be advocating for any kind of healthy eating or lifestyle. The only distinction between us, actually, is that my show comes with a parental advisory and hers doesn’t.”

I won’t endorse Paula Deen’s cooking as “healthy” and most of it would cause blood sugar to rise higher than it should.  Food can kill you, but it cannot cure you. Hopefully Paula Deen will use her celebrity to advocate for diabetes education and awareness.  I also wouldn’t mind if she would come out with a few recipes that won’t raise the blood sugar as much as twinkie pie. And just to be fair– eating a little less of poison doesn’t mean it is being “moderate” it just means you are being less stupid. Besides- you can’t eat just one. So, Ms. Deen- lets see some new recipes.

Until then, I’ll be watching Bourdain eat camel cheeks in some far away place, wishing I was there with him.

]]> http://yourdoctorsorders.com/2012/01/paula-deens-diabetes-a-physicians-perspective/feed/ 6 http://yourdoctorsorders.com/2011/11/rack-of-lamb-with-dijon/ http://yourdoctorsorders.com/2011/11/rack-of-lamb-with-dijon/#comments Sun, 13 Nov 2011 06:14:27 +0000 The Doc http://yourdoctorsorders.com/?p=1479

Rack of Lamb is one of the easiest proteins to make- it is healthy and the flavor is great.

First start with a great Rack:

There is debate among people who like their lamb from New Zealand and those who prefer American. My good friend @DolceDebbie doesn’t like American lamb, while Chef Thomas Keller has all of the lamb for his restaurants raised in the United States. Those are complicated arguments- know that both have great lamb.

Ingredients:

1/2 cup of Dijon mustard

1/2 cup of Italian bread crumbs

1 Tablespoon of Fresh Rosemary or two teaspoons of dry Rosemary (get the fresh- it stores a long time)

1 teaspoon of minced garlic

The juice from one lemon

Preheat the oven to 450 degrees

Mix all the ingredients in a bowl and spread the thick paste over the loin (meaty) side of the lamb

Put the lamb bone side down  into a casserole dish or any oven safe dish, or a roaster (two sides to a rack – the meaty side should be up) -

If the oven isn’t ready- it is ok to let this to sit for a bit

Put the dish the center of the oven

Cook for 25 minutes. Then turn the oven off.  Leave in the oven  for another 20 minutes and take out.

Once it is out of the oven leave it on the counter to “rest” for ten minutes

Cut and serve

If the lamb is too rare for your liking – heat up a skillet to medium heat and sear them the lamb for 1 minute per side.

The internet is full of claims of individuals living longer because of some diet, lifestyle, or supplement living longer.  So let us start with this disclaimer:

Anyone who gives absolute statements about one person living longer because they only drink Yak milk, or eat raw foods, or are a vegan, or a pescetarian, or eat raw lion meat – etc. – are making an opinion, not based on data.

The classic example is studies done on Seventh Day Adventists in the 1960’s and 1970’s.  Seventh Day Adventists are vegetarians by choice. They also do not drink alcohol, and they do not smoke tobacco.  Their lifespan was longer when compared to non-vegetarians. However, the study did not adjust for variables such as smoking, alcohol, lower body mass index, and what is called the “healthy volunteer effect.”

In 1999 a metastudy combined data from five western countries and reported mortality ratios.  This broad study showed fish eaters (pescetarians) had a the lowest ratio of 0.82, followed by vegetarians at 0.84.  Occasional meat eaters were at 0.84 and vegans as well as regular meat eaters had a ratio of 1.0.  (The lower the number the longer the lifespan.) – American Journal of Clinical Nutrition Vol 70 (3): 516S-524S – September 1999.

Fish eaters seem to live the longest

One of the most commonly cited studies is the “China Project” where blood samples were pooled from 65 rural counties in China.  Their conclusion was that meat eaters lived less long than those who ate animal proteins.  However, analysis of the raw data from that study leads to the opposite conclusion.  Ultimately the China Study became a best selling book. The books conclusions are the opinions of the author T Collin Campbell, many of those opinions have been refuted by peer-reviewed papers based on the raw data in the study.  One study example came from examination of the stomach cancer data showing that there was an inverse correlation between meat and stomach cancer.  Cancer Epidemiol Biomarkers Prev 1992, 1: 113-118.

Recently reported was the risk of meat consumption and colorectal cancers. Previous studies have been inconsistent so a metastudy was performed and there was an increase in risk of colo-rectal cancers with increased consumption of meat—however, this was “processed” meat- defined as cured or nitrate, or sausages.  The study did not adjust for other dietary habits, lifestyle, or genetic factors.  It should be noted that nitrate cured meats have higher associations with stomach and colo-rectal cancers.

Processed meats appear to increase risk of colo-rectal cancer

Population studies are flawed, and sometimes, the author’s conclusions may not agree with the raw data. There is not clear evidence that one dietary lifestyle is going to significantly increase lifespan if one does not include obesity, smoking, or consumption of fish.

While there are thousands of internet sites concluding that vegans live much longer- there is no study that agrees with that conclusion. What conclusion can you come to? Probably that eating fish is a good thing- eating too much processed food may not be a good thing. Best to pick great parents, don’t overeat, and a bit of red wine and chocolate are not bad things.

Sometimes all you want for breakfast is a cup of coffee-- and that's ok

Everyone knows:  Always   eat Breakfast

There   are   a lot   of   variations   of   this   axiom.

“Breakfast   is   the   most   important   meal   of   the day.”

“Breakfast makes it so you won’t be hungry later.”

“Breakfast jump starts your metabolism”

“You need to eat a large breakfast”

“Breakfast   is   the   most   important   meal   of   the day.”

All of those are FALSE.

Breakfast is NOT the most important meal of the day- so don’t force it. The reality is that most people are not ready to eat breakfast when they first wake up.  So why does “everyone” say this? Some of this data was based on the Iowa Breakfast study- which was more than a single paper- but a group of observations made over a number of years and published. There have been a number of other studies showing that kids who eat breakfast do better in school than kids who do not. However, there are a lot of variables not accounted for in those studies.

In addition- a few other items were not taken into account: if you wake up at 4 am to do chores until 7 am, then have breakfast and go to school, you will do better in school than someone who wakes up at 4 am, does chores and doesn’t get breakfast.

Regarding most breakfast studies — funded by, and poor research  done, from cereal companies. Doesn’t mean they are bad studies- but they all fall into poor categories of evidenced based research.

“Breakfast makes it so you won’t be hungry later.”

A recent study showed that people who eat a large breakfast are not affected by how much they eat later in the day. Meaning that eating a large breakfast won’t keep you from snacking, or eating less the rest of the day.

You wonder where people come up with this idea– but when it is put to the scientific test- the breakfast you consume does not reduce food you consume later. Not one bit. No relation- no correlation.

Breafast buffet is not your friend

“Breakfast jump starts your metabolism”

They also found that eating less in the morning contributed to overall weight loss (if you eat less calories you will lose more weight).  There is a simple truth about weight loss – if you eat more calories than you burn, you will gain weight. If you eat big breakfasts and lots of other calories you will gain weight.  Breakfast does not jump start your metabolism- your body does that.

Again- how would you measure a “jump start” to metabolism? There are ways- but activity itself increases heart rate, breathing, and over all muscle activity. If you take comatose patients and measure their oxygen consumption and carbon dioxide production- and cycle feeds – the feeds do not increase metabolism. Another study took college football players and put them into a hospital and fed them. They were allowed to do a few walks- but not much more.  It was activity that increased metabolism- not food. Any food will increase some metabolism – but a breaking of the fast does NOT do any sort of jump start.

“You need to eat a large breakfast”

Want to just have a smoothie or yogurt or some oatmeal to start your day? Go ahead. You want to wait for a couple of hours after you get up before having something to eat- that works too. But if you eat a large breakfast – you still need to work off those calories.

You think this is an important meal?

The great thing about breakfast foods: You can eat them anytime! Who doesn’t like eggs for dinner? And after a long day- nothing is more refreshing than a blueberry smoothie to take the edge off hunger, and let you relax for a bit.  We have recipes for smoothies containing micronutrients, fibers, and supplements – a simple smoothie can be a pleasant treat after a long day of work, taking the edge off hunger so you can make a great dinner.

For the smoothie and other recipes go to terrysimpson.com

Breaking the chicken down into parts facilitates great cooking, because with such a method you can combine a bit of Sous Vide with some flash frying and have that perfect chicken. Or use it for anyone of a number of great recipes.

Sous Vide will cook the chicken perfectly- but you need to do a flash fry for the Maillard Reaction

It is keeping that chicken together- cooking it whole, making the chicken in such a way that the aroma from the chicken will permeate the house. The ultimate comfort food- and yet, too often when people cook it the chicken skin is soggy, the chicken meat is dry – and we look to sauces to overcome it.

When Jonathan Waxman was voted off Top Chef Masters – he had made chicken. The judges thought that the chicken was too simple, but it was done perfectly. Did those judges ever try to make chicken?
Some of my favorite restaurants for chicken include Zuni in San Francisco- the perfectly cooked whole chicken. That recipe was adapted in our recipe section http://terrysimpson.com/recipes.php – the key for that is salting the chicken a day or two ahead of time and allowing it to dry in the refrigerator. Ad Hoc and Bouchon – of Thomas Keller – who prefers to brine the chicken before roasting it (salting does the same chemical process without the messy brine). Tarbell’s has perfected the pan roasted chicken. Michael Mina’s Sous Vide Chicken provides an amazing flavor profile, that is difficult to  find in many restaurants.

Thomas Keller Knows great chicken- see our review at EatPackGo.com

Jeffrey Steingarten, the food editor for Vogue magazine, noted how the roto-broil 400 made the perfect home rotisserie chicken. It became my mission to find one- which I did, and he is right- this is the perfect rotisserie unit for people. The problem is they don’t make that unit any longer. I managed to find one on e-bay and had it refurbished – if you can find one – get it.  But to check the common ones available, I purchased the Ronco platinum unit (you may have seen Ron Propel’s set-it-and-forget-it infomercials). This produces a moist chicken, but the heat generated does not give the perfect crispy skin – still not a bad unit for the home cook.

The Roto-Broil 400 makes the perfect chicken

We go back and forth in our house- making the chicken on the rotisserie – which is simple, to the oven roasted whole chicken. Both have great qualities, and both leave the house with an aroma of the perfect comfort food. Try our recipes – and see – making a perfect chicken, and doing it well is a great skill. Perfect it over this month, and you will have many years of great dining – and chances are you will find very few restaurants that make chicken as well as you do.

Skin cut away to reveal the perfect chicken- crispy skin, moist meat

Artificial sweeteners are either the saving grace of America, or the devil. The first issue with artificial sweeteners came to light when cyclamates (the first marketed artificial sweeteners) were found to cause cancer in rats. So in 1969 cyclamates were taken off the market. Saccharin was the next agent, but many didn’t like its after taste. Then came aspartame (Equal). This had no bitter after taste and became the favorite until someone started a rumor that aspartame killed ants, and was originally developed as a rat poison – this is untrue on both counts.

First, aspartame was developed as an artificial sweetener and second, it does not kill ants (I tried it, as have a lot of others – sadly it doesn’t work). Splenda does contain calories (because of our FDA regulations it is allowed to be listed as “zero calories” but it is not). Splenda has 3.36 calories per packet (1 gram). It tastes like sugar and is generally easy to cook with – however; one package of Splenda is 600 times sweeter than an equal amount of sugar.

Two other sweeteners have joined the market in the United Sates. Stevia- is a product of several plants and was recently approved as a food additive in the United States, and Truvia (a proprietary blend of Stevia made by Coca-Cola and Cargill the Pepsi produce it PureVia). These are essentially all the same. There are some other sugar-alcohols like Xylitol that function as sweeteners.

The issue with artificial sweeteners has been getting use to the sweet taste, and thus an increase in appetite. In rats that are consuming artificial sweeteners there is an increase in their body weight over time as they increase the amount of food they consume. Not that we are rats – but avoiding the overly sweet taste is important. And there is no accident that while many of my weight loss patients consumes large quantities of “diet cola” – they still consume a lot of calories to go with them. It is also no accident that once our patients get off artificial sweeteners, they lose more weight.

People who drink sodas that have artificial sweeteners have a sixty percent increase in stroke and heart disease. Sixty percent!

How do you gain weight with artificial sweeteners? Since they are so sweet, you naturally want food to balance out the sweetness. Increasing the quantity of food allows you to increase the bitter, sour, and other sensations to balance the sweet taste. Remember, your palate always wants to return to a balance.

Overall –avoid the artificial sweeteners. Still- what is better than artificial sweeteners in soda? Simple water. It is free (unless you are in a city where the water tastes bad) and is regulated more tightly than most things

The rotisserie is one method to make perfect chicken. This unit is at Wm Sonoma

Such dry chickens are not only unpleasant to eat- but are the types of meats that can become stuck causing what we call a food bolus.  With a food bolus you feel as if you swallowed a golf ball. Nothing else will go down. Sometimes you can’t even swallow saliva.

You may have experienced a partial one of these when you swallowed a piece of meat and you could feel it go down.  When it gets stuck- big problem.  My patients with the LAP-BAND must have moist chicken- dry chicken will become stuck and make an otherwise pleasant evening turn into a retching mess.

Chicken recipes they strive for this nirvana of chicken – sometimes with complicated instructions – but there are two methods to cook the perfect chicken. One is cooking the chicken Sous Vide, and then you have the perfectly cooked chicken needing only a quick fry to make the skin crispy. For those who have skinless chicken breasts (no accounting for taste) – Sous Vide is the perfect method to prepare the chicken.

For those who, think that a crispy chicken skin represents the best pleasure – cook the chicken on a rotisserie.  You can buy rotisserie chickens from the supermarket- but often the skin is moist with fat, and the breast is overcooked, although not dry.   If you have a home rotisserie unit you can save this most delightful part for yourself (and once you have had perfect chicken skin, crispy- you will never want to go back.

For those who believe that chicken skin is evil- I would ask you to produce one scientific paper showing such- you can’t find one. The reason you cannot find one is because they don’t exist.  They don’t exist because there is nothing wrong with chicken skin – nothing. It will not raise your cholesterol it will not raise your low density lipoprotein (LDL- remember, bad is lousy – so lousy for LDL  and “happy” for HDL).  You might read “summary “ articles from National councils or consensus reports- but there is not one shred of evidence in the scientific literature that the skin of chicken is “bad” for you – in any manner, anywhere.  Or you can listen to Rocco – a chef with no medical training who wrote a best seller, or you can listen to Dr. Oz, who can’t cite a reference either.  Or you can enjoy chicken skin knowing that a guy who does weight loss for a living says you can eat it.

Buy a rotisserie unit.  There are a bunch of them out there- it is become quite popular,  although I cannot tell you the plus or minus of any one of those units- I can tell you that many do not make the chicken hot enough to crisp the skin.  What to do? Borrow one from a friend- ask around (most of them are in closets) and try one.  If a local fancy food store is demonstrating them- try their product.

I have a 1957 Roto Broil 400 – it is as old as I am but works great (like me).  There are a bunch of great brands out there today- and if any of you have them and they work- please comment.

My Roto Broil 400 was made the year I was born, 1957. Still works great

Until then- your mom was right- the best thing is in the skin  – but not the vegetable skin – it is the chicken skin (oh, and pork belly skin is pretty good too).

Recipe for these is pretty simple.  Have a fresh, whole chicken – remove all the giblets and other parts.  Rub the chicken with extra virgin olive oil. Season the chicken with salt, pepper, and garlic granules.  No need to stuff the chicken.

Truss the chicken- and place in the unit for 15 minutes per pound.  Warning- chicken skin is addicting.

If you have a home rotisserie unit and it works well for you – please comment! Let me know the name, the make and how you make your perfect chicken.