Tuesday, June 28, 2011

Giving Agave another chance

You will likely remember that I have been less than enthusiastic about using agave syrup as a sugar alternative.  Well, today, a friend gave me a totally unexpected present, and it made me realize there's more to agave than I thought.  She gave me a package of Viv Agave.

This product is not a syrup.  It's not sugar as we know it.  It's a little sweet.  My friend tells me it's delicious when used to sweeten coffee.  Since I don't drink sweetened coffee, I'll take her word for it.

It's a fine powder described as "a low glycemic dietary soluble fiber".  On the back of the package, it states that it has "minimal impact on blood sugar, is not insulemic, will not raise triglycerides".  Why?  Because this powder that is also billed as a prebiotic is inulin from the blue agave cactus that grows in Mexico.

I am already familiar with inulin, because I've been growing jerusalem artichokes for a number of years, and they are filled with it.  Inulin is a sugar that is considered to be a soluble fibre.  It doesn't break down in the upper gastrointestinal tract.  Instead, it ferments when it reaches the large intestine.  This is exactly why the tasty tubers growing at the other end of the beautiful yellow flowers are also known as fartichokes

Back to agave inulin.  One tablespoon of this heavenly smelling powder contains 10g of carbohydrates, of which all 10g are fiber.  Sounds great.  I like the fact that inside the deceptively sophisticated packaging the ingredients are really unsophisticated.  There are in fact only two ingredients:  inulin powder and vanilla powder.  How often do you see that these days in something that is packaged?

I made a smoothie for lunch and added a spoonful of Viv Agave instead of my usual generous dash of vanilla extract.  I can't say I tasted the agave, but my smoothie was no less delicious than it usually is.

Next, I went online to look for more information.  Natural News has a good article explaining the pros and cons of eating inulin, concluding that it's generally better to eat whole foods, rather than isolating specific health-inducing ingredients.  This is something that I generally agree with, and so, from a health supplement point of view, I can't say I'm swayed by the agave labeling promising pre- and probiotic advantages.  I'm happy sticking with my ongoing yoghurt and kefir making adventures, and digging up some of my really plentiful jerusalem artichokes in the spring and fall.

Some people complain about constipation when they switch to a low carbohydrate lifestyle, as it usually takes a week or two for the body to adjust to a life without grains, rice and pasta.  A dose of inulin might help to relieve this discomfort during the transitional phase.  Having adjusted to this way of eating a long time ago, I don't think I'll be feeling the need to reach for it in order to benefit from its bowel-loosening properties.

On the other hand, in small quantities, as a mild sweetener or flavour enhancer, I'm pretty sure I'm going to be enjoying my new package of Viv Agave.

Friday, June 24, 2011

Suzanne Somers

If you are a fan of Suzanne Somers, and you are looking for inspiration and menu ideas, her new book, "Sexy Forever" is worth checking out.  I downloaded the ebook version from the library and thought it was a decent read, with quite a few thought-provoking insights about everyday environmental hazards that have the potential to make us unhealthy.

The first part of the book looks at the chemical additives we commonly come into contact with every day:  in processed foods, makeup, household cleaners and the flame retardants in new appliances, and she discusses how the toxins build up in our systems over time in ways that simply didn't occur a hundred years ago, disrupting our endocrine systems and causing obesity and disease, most noticeably after we reach our forties.  I find her arguments very plausible, though not backed up by scientific evidence to the extent I would personally prefer.

She devotes a large section of the book to the supplements and hormone therapy that she believes are instrumental in keeping her feeling and looking youthful and in warding off a recurrence of cancer.  She has quite a few years on me, and she may very well be right.  However, I personally find it a little too "California" for my own liking.  I'm more of the "keep it drug- and supplement-free" mindset myself.

The dietary section of the book presents her eating plans and she provides lots of suggested menus and interesting recipes that fit in very well with what I have been writing about in Carboholics Anonymous.  For her it is a lifestyle too, not a diet of limited duration.  She also recommends a sugar-free, low carb approach.  Her husband is gluten intolerant so she is quite familiar with the elimination of bread from the diet, though her own plans do include limited quantities of whole wheat breads and similar gluten containing foods.

What I find interesting about Somers' dietary approach is that she allows up to 3 carbohydrate portions a day for weight loss, and carb-containing dairy products like milk are included in this total.   So while her plan doesn't involve calorie counting, it has a structure that would appeal to many people. 

She agrees that it is the insulin response to dietary sugars that cause the body to absorb fats, and for this reason, she recommends not mixing carbs with fats.  So, for example, if you eat a small potato, don't eat it with sour cream, butter or cheese.  Or if you wish to start your day with a small portion of fruit, don't add cream to your coffee.  In this respect, the book reminds me of Fit for Life, which was so popular in the late eighties.

In the absence of carbs, Somers has no problem with full fat products, in responsible quantities of course, and, in fact, prefers them to the vast array of low-fat foods which are usually laden with sugars.

I was interested to see that she does use agave nectar (which I understand to be the same as agave syrup) as a sweetener, though the quantities in her recipes are nowhere near to being comparable to the sugars in the standard American diet.

It's not a book I like enough to want to own, but I do think it has some good resources and pause for thought about potential dangers from household chemicals many people take for granted.  Since many people have asked me about recipes that work in a low-carb lifestyle, I think it's definitely a book to look out for in the bookstore.  Or you can check out the Sexy Forever website, which has many resources to complement the book.

Thursday, June 9, 2011

Unpronounceable Ingredients

Marion Nestle, the author of “What to Eat” and creator of Foodpolitics.com said:
My criteria for choosing packaged foods are: nothing with more than five ingredients, no ingredients I can’t pronounce, nothing artificial, and no cartoons on the package.”
She knows a thing or two about good food choices.  She's a professor in the Department of Nutrition, Food Studies, and Public Health (the department she chaired from 1988-2003) and Professor of Sociology at New York University. Her degrees include a Ph.D. in molecular biology and an M.P.H. in public health nutrition, both from the University of California, Berkeley.

This week I discovered the site www.foodfacts.com, where I noticed something interesting about some common foods we tend to think of as healthy.

Most people who are open to vegetarianism, organic and whole foods, instinctively believe vegetarian alternatives to meat-based products are generally healthier choices.  I have a tendency in this direction, even though I certainly can't call myself a vegetarian, and I buy very little, if anything, from the health food aisles.

Case in point:  vegetarian burger alternatives, such as Boca burgers.  Do you know what they are made of?  Here is the ingredient listing for Boca original meatless burgers:

Water, Soy Protein Enriched ( Soy Protein Concentrate Contains,, Caramel Color, Ferrous Sulfate, Niacinamide (Vitamin aB), Zinc Oxide, Calcium Pantothenate, Thiamine Mononitrate (Vitamin B1) [ Vitamin B1], Pyridoxine Hydrochloride (HCL) [ Vitamin B6], Riboflavin (Vitamin B2) [ Vitamin B2], Folic Acid (Vitamin aB), Cyanocobalamin [ Vitamin B12], Wheat Gluten, Contains less than 2% of Methylcellulose, Maltodextrin, Salt, Flavor(s) Natural & Artificial, Onion(s) Dried, Yeast Extract, Sesame Oil, Wheat Germ Defatted, Protein Hydrolyzed [ Corn Protein Hydrolyzed, Wheat Protein Hydrolyzed, Soy Protein Hydrolyzed], Soy Sauce [ Water, Soybean(s), Wheat, Salt], Yeast Extract Autolyzed, Disodium Guanylate, Disodium Inosinate, Succinic Acid)
Compare that to the burgers I make for our family:  I take a one pound package of naturally raised ground beef.  I purchase this in bulk from a local farmer and it's made from only one cow, as opposed to grocery store ground beef, which may be a mix of meat from many different cows.  Divide the meat in four and form four burgers.  Total time spent:  about 15 seconds.

But perhaps you prefer to buy burgers at the grocery store.  President's Choice have a line of sirloin burgers, which come with the following ingredient listing:
Beef, Water, Milk Skim Powder,  Salt, Spice(s)
Another great example is peanut butter.  I was at the grocery store last night, looking at peanut butter.  For years, I have been buying President's Choice peanut butter

Ingredients:  peanuts.

On the shelf, I saw Irresistibles Bio organic peanut butter.  I had never looked this make closely before and was astounded at the ingredient listing.  I don't see it at www.foodfacts.com, but I did find some other products with the same ingredients.  For example, this is what Wegmans Organic Crunchy peanut butter contains:

    Peanut(s) (Organic), Palm Oil (Organic), Sugar (Organic), Sea salt
I don't care how organic palm oil and sugar are.  I don't need them added to my peanut butter!

In my opinion, these examples highlight some interesting thoughts about the food choices we commonly make.  Just because it's vegetarian, it's not necessarily unprocessed.

While I do realize that some of the ingredients with lengthy chemical names are not necessarily poor nutritional choices, in general, it makes more sense to eat foods with fewer additional ingredients.  

This is something that paleo diet proponents and raw food vegans have in common.  It's very interesting that they can be found at opposite extremes of the food choice spectrum, yet both insist on eating foods that meet the same criteria that Professor Nestle recommends.

Wednesday, June 8, 2011

Fasting blood tests

Every time I've had my cholesterol levels tested, I've been instructed to fast the night before heading to the lab for the blood test.  It's probably the same for you.

For some time now, I've been meaning to post an extensive study published in the Journal of the American Medical Association in 2009 that found that fasting makes no difference when it comes to your cholesterol.

The authors also concluded that measuring HDL relative to total cholesterol is no less effective than fractionating LDL.

You will recall that while blood tests can easily identify HDL and total cholesterol, the LDL count is derived by subtracting HDL and triglycerides from total cholesterol using the Friedewald formula.

Since LDL, or low density lipoprotein, comes in differing densities, not all of which are problematic, a more sophisticated, and hence more expensive, blood test is needed than the one we commonly get at our Canadian labs to identify the LDL components more accurately.  This is what is known as fractionating LDL.

You'll think I'm HDL-obsessed, but this study gives us one more reason to focus on the ratio of HDL to total cholesterol for heart health.  LDL, as far as I can tell, is relatively meaningless as far as its predictive powers for cardiovascular problems are concerned. 

Yet manufacturers of products that lower total cholesterol, conveniently don't go into any further detail when their cholesterol-lowering product does nothing to raise HDL.

I won't have an appointment scheduled for a little while yet, but I'm interested to show my family physician this study when I do go.  Where we live, fractionated LDL isn't an option, but I'm curious whether she will prescribe a fasting cholesterol test.   However, I suspect I know the answer to that already.

Tuesday, June 7, 2011

Going for gastric bypass surgery

We were discussing gastric bypass surgery around the dinner table the other day.  That's what happens in medical families.

As always, no names or specifics were mentioned, but the patient in question had gone to Detroit for gastric bypass surgery.  After losing 100lb, she had reached the target weight recommended by her treating physician, and now she was interested in cosmetic surgery to deal with her sagging skin.

The problem is that she is still obese.  Her body mass index (BMI) is over 30.  I have no idea how tall this lady is, but if, for example, her height is 5' 5", this means her weight would be around 180lb.

I know BMI isn't everything.  But it is a quick and easy measurement, especially when you use an online calculator.  A normal BMI lies between 18.5 and 24.9.    The hypothetical 5' 5" lady above would have to need to lose another 30lb to reach the upper end of the normal range.

There is quite a bit of evidence in the surgical literature that points to higher patient complication rates when surgery is performed on people with higher BMI ratios.   The more fat you have, the harder it is for your incisions to heal properly. 

There are also papers that try to justify surgery in such patients, but in my opinion, there is a reason why some cosmetic surgeons with high overheads operate on just about anybody with the cash to pay for a procedure, and sometimes the real risks are conveniently forgotten.  Even otherwise smart people can easily allow the prospect of financial gain to cloud their judgement. 

Necessary surgery is one thing, but when it comes to elective surgery, there's a valid case to be made for carefully screening patients whose weight predisposes them to post-surgical complications.  If money was no object, would you sign up for a breast lift, for example, if you were told the probability of losing a nipple (or worse) was in the region of 10%?  What if the risk was 1%?  Where would your threshold lie?  I'm not saying anybody can accurately quantify these risks.  There are many variables involved, but often times, elective surgery is sold to patients as being virtually risk free.

In my opinion, the story is more complex when it comes to gastric bypass surgery and the subsequent surgeries to remove the sagging skin left behind (Many people are surprised when they learn that while OHIP may cover gastric bypass surgery, a subsequent tummy tuck - costing in the region of $10,000, is not covered).

A severely obese patient who reaches his or her stated target weight by losing 100 lb and  is still technically obese, or at the very least, severely overweight, has not received what they think they signed up for.  It's a horrendously expensive surgery that doesn't address the underlying cause of the obesity.

I have heard plenty of anecdotes of people who underwent gastric bypass surgery and who gained back all the weight they lost.   That's what happens when you don't get to the root of the problem.

Behaviour modification is a big part of the post-surgical treatment of gastric bypass patients, and rightly so.  But you have to wonder how effective it could possibly be when patients are told to eat the "balanced diet" recommended by nutritional bodies that tell us it's ok to eat sugar, and important to eat grains and carbohydrates with every meal.

When this advice results in limited weight loss, it sets patients up for disappointment and failure.  It certainly doesn't eliminate the risks of cardiovascular disease and type II diabetes that accompany clinical obesity.

If behaviour modification can be shown to be effective to bring the patient to a normal weight range, then why not skip the risky surgery altogether, and move straight on to the nutritional part?

If I were considering undergoing this surgery, I would ask a lot of hard questions about the risks.  At the very least, I would want to ask the surgeon what percentage of his or her patients reach a BMI of 25 or lower within 2 years of their surgery, and how many of them are still like that after 5 or 10 years.

I would also want to know about the eating plan and how carbohydrates and sugars fit in their recommendations.

I'll bet the true success rate is a lot lower than prospective patients would like to think.

Those of us who have no intention of going under the knife ourselves are footing massive  provincial hospital insurance bills for this surgery through our taxes.  I shudder to think how much money is being transferred to surgeons and hospital facilities, while the desperate patients don't get the results they have every right to expect.

It all boils down to having realistic expectations.  And from what I can tell, all too often, those expectations don't match up with the reality of gastric bypass surgery.  There are simply too many dollar signs standing in the way of the truth.

Monday, June 6, 2011


I thought this patient report was interesting.  If the words are too small to read easily,  click on the image to blow it up.

I don't usually have much to do with my husband's work, and I seldom see the reports he receives.  But when he showed me this consultation report from a rehab medicine physician the other day, I knew there was a story to tell.

The patient has hand and wrist joint osteoarthritis.  The rehab physician, who presumably sees this kind of case very frequently, sent a list of 8 recommendations.

Not one of them mentioned diet.

Specifically, he did not mention that the patient might notice a reduction in pain if she stopped eating wheat.

Wheat is known to have inflammatory properties.  Actually, it's the protein in the wheat, the gluten, which is the culprit.

While it doesn't affect everybody, I was surprised at how much better I felt after I gave it up.  I knew I didn't have celiac disease, so I wasn't really expecting to discover that I had a gluten sensitivity.  I know quite a few other people who have also noticed fewer joint aches and pains within days of eliminating wheat from their diet.

It seems like such an easy, low cost thing to try, and with none of the potential side-effects that you get with drugs.

I am really puzzled as to why a rehab physician would not be aware of the inflammatory properties of wheat.  Or does he assume his patients wouldn't be prepared to go wheat-free, and that the medical approach is simply easier?

Sunday, June 5, 2011

Are you doing the Becel Challenge?

You may have seen the ads for Becel margarine, which promises to lower your cholesterol.

I came across one in a magazine aimed at baby-boomers, and read the accompanying copy very carefully to find out what kind of cholesterol would be lowered.  It didn't say.

The website was more helpful. This is what I found in the FAQ section:

6) Can my cholesterol level go down too much?

No. Becel pro.activ® lowers LDL (“bad”) cholesterol but does not affect the level of HDL (“good”) cholesterol. Studies show that for most people there is a clear heart health benefit of lowering bad cholesterol levels...
Did you see that?

Becel does not affect the level of HDL.

Do you remember I wrote a post in April about how low HDL levels are the best predictor of coronary heart disease? 
In the Framingham study, for example, low HDL-C values were associated with increases in risk for CHD of approximately 70% in men and of more than 100% in women.
The best way to reduce your risk of coronary heart disease is not what the makers of Becel would like you to believe.  I can say this with confidence because the 6th FAQ on their own website is quite clear that Becel does not affect HDL.

It is the consumption of carbohydrates that affects HDL levels.  But that's a detail you won't find on the Becel site.

If you are eating "heart-healthy" margarine products, can you explain why this would be to your advantage?

Saturday, June 4, 2011

Diabetes needs all the money it can get, with fundraisers like these

One of my friends was telling me this evening about a bake sale they held at work to raise money for diabetes.

The irony of this well-intentioned fundraiser wasn't at all lost on her.

Nor was the irony of previous years' fundraisers, which had variously been sales of:  hamburgers, hot dogs, and last year, pizza.  No doubt the hamburgers and hot dogs were served with the buns, and there is even less doubt that they were the ones made of refined white flour.

It reminded me of a sponsored walk taking place in a park where I went for a jog some time ago.  It was an event to raise funds for the Heart and Stroke Foundation.  Because this is Canada, the generous corporate sponsor, Tim Hortons, had supplied timbits and coffee to the participants.

It occurred to me that there might be healthier, and certainly more imaginative, ideas for food-related fundraisers to support the Diabetes Association and the Heart & Stroke Foundation.

For example, what if a giant paleo barbecue was organized alongside a sponsored bike ride, and the only food served was meat and salad?  And what if the only drink was water? Or a breakfast run followed by hearty helpings of bacon and eggs? 

What would the recipients of the money think of that?  Would they object?  Would they be embarrassed?

And I wonder what the event would do to raise the profile of low carb eating as a means to better health.   The media might make fun of the event, at least in the beginning.  But wouldn't it also be a great opportunity to dispel some of the myths and mistruths surrounding the foods we commonly eat and what they are doing to our health?

What do you think?