The NEW Track Your Plaque Diet: Part 2
Achieving Metabolic Health
The New Track Your Plaque Diet assembles the most up-to-date nutritional lessons to achieve maximal control over weight and correct metabolic and lipoprotein abnormalities. The diet forms the cornerstone of the Track Your Plaque program to stop or reduce coronary plaque.
In the New Track Your Plaque Diet, we aim to:
* Reverse abnormal insulin-sugar responses
* Correct abnormal lipoprotein patterns
* Accelerate weight loss (when appropriate)
* Reduce blood pressure
* Stop or reverse coronary atherosclerotic plaque
We also hope to feel great in the process!
Following a standard low-fat diet will not achieve these more ambitious goals and, in fact, makes success less likely.
No doubt: The New Track Your Plaque Diet is unconventional, introducing concepts that may surprise you. But it works. You will see evidence of it in your lipid panel, your lipoproteins, your waist size, energy level, the mirror.
The days of macronutrient diet control are over
The New Track Your Plaque Diet de-emphasizes the regulation of macronutrient diet composition (i.e., the relative percent of fat, carbohydrates, and protein).
If there's one lesson to take from the dietary adventures of the past half-century, it's that attempts to control macronutrient composition have failed utterly. In particular, diets that reduce overall fat intake - from 40% of calories, to 30%, 20%, even 10% or less - have not held up to studies that examine whether there is a resultant reduction in heart attack, cancer, and diabetes - they do not! (Small reported exceptions exist, such as that of Ornish and Esselstyn, both of whom have had favorable results with extreme vegetarian, low-fat diets. The discrepant experiences may be explained, at least in part, by genetic variations that occur and can bias results in small groups; this will be explored in Part III of the Diet.) In fact, in the Track Your Plaque experience, the majority of people who reduce fat intake tend to struggle more with weight and metabolic derangements.
However, it is also clear that specific foods and food groups do indeed exert unique effects on weight, lipids/lipoproteins, and other metabolic gauges like blood sugar and inflammatory measures. Some foods yield positive effects, others exert outsized undesirable effects. While regulating macronutrient composition may not be of benefit, choice of specific foods does indeed matter.
In particular, the New Track Your Plaque Diet is designed principally to exert maximal improvement of metabolic and lipoprotein patterns. Because small LDL has skyrocketed to become the number one most common abnormal lipoprotein pattern today (usually accompanied by lower HDL, higher triglycerides, higher blood sugar and C-reactive protein), the diet is weighed heavily towards correction of this ubiquitous pattern.
In our experience, the most enduring way to learn how to choose foods is to discuss basic principles of which foods to choose and why. We therefore advocate an approach that does not require you to count calories, regulate relative macronutrient diet composition, or follow complex formulas. Such approaches, in our experience, rarely last long.
Instead, the New Track Your Plaque Diet helps you understand what foods exert what metabolic or lipoprotein effect: what foods generate desirable effects, what foods generate undesirable effects. We also incorporate wisdom gained from viewing human health in an evolutionary sense (i.e. asking what foods humans are meant to eat, what foods are they ill-equipped to eat).
Let's therefore discuss the basic principles of food choice and nutrition that will guide you.
Diet Principle #1: Correct metabolic responses with elimination of wheat and cornstarch
The Basics
Eliminate
* All wheat products
* All cornstarch products
* Fruit drinks and fruit juices
* Candies and other sugary snacks
Over the last several years, there has been an explosion in the prevalence of the collection of abnormalities labeled "metabolic syndrome." You recognize the metabolic syndrome by its characteristic features: protuberant abdomen, higher blood sugar, low HDL cholesterol, higher triglycerides, high blood pressure, and higher measures of hidden inflammatory patterns (e.g. c-reactive protein).
The Adult Treatment Panel-III, the national guidelines for cholesterol management, arbitrarily define metabolic syndrome as having any three of the following: HDL 40 mg/dl or less in men, 50 mg/dl or less in women; triglycerides 150 mg/dl or more; BP 130/85 or greater; waist size 35 inches or more in women, 40 inches or greater in males; blood glucose 110 mg/dl or greater. However, this definition tends to identify only the most advanced cases.
Excessive insulin release, followed by resistance to insulin's action, underlie the response that trigger these phenomena. The most sensitive measure of these phenomena are small LDL particles. More than any other measure, small LDL fluctuates with the ebb and flow of insulin sensitivity.
Small LDL has proven to be the number one most reliable index of insulin responses, often more useful than blood sugars, since extravagant degrees of excessive insulin and insulin resistance can remain concealed when judged by blood sugar. Small LDL, however, serves as a more sensitive marker.
Small LDL has therefore leapt to number one spot on the list of most common abnormalities identified through lipoprotein testing. It also occupies number one spot as most frequent cause of coronary plaque. Over 90% of participants in the Track Your Plaque program begin with a substantial quantity of small LDL.
The features of the metabolic syndrome, small LDL, and excessive weight are all powerfully corrected by eliminating the foods that create them.
Wheat, wheat everywhere
Any food that triggers rapid release of blood sugar also triggers formation of small LDL particles. The list of most flagrant culprits include:
* Wheat products: Breads (whole grain, whole wheat, white, multigrain, etc.), bagels, muffins, pastas, cakes, cookies, pancakes, waffles, pretzels, crackers, breakfast cereals. In fact, foods made with wheat or cornstarch increase blood sugar faster and to a higher level than even table sugar (i.e., they have higher glycemic indexes than table sugar). Wheat, in particular, now dominates the diet of most Americans; it's not uncommon for people to eat wheat products four, five, or more times every day.
* Cornstarch: Tacos, tortillas, corn chips, cornbreads, gravies, breakfast cereals.
* Snack foods: Potato chips, rice cakes, popcorn, candies, pies.
* Rice: white and brown
* Potatoes: especially white and red
* Fruit juices, soft drinks: No, fruit juices are not that good for you. (While they contain healthy components, the sugar load is simply too great for the majority of people.)
* Anecdotally, beer seems to share some of the same characteristics as other wheat-based products. When indulging in alcoholic beverages, dry wines are preferred.
Lesser culprits on the list of small LDL triggers are rice (white and brown) and potatoes (white and red). Rice and potatoes are less offensive, mostly because they do not occupy the same dominant role in diet that wheat and cornstarch-based foods play, though both still trigger blood sugar and small LDL.
If wheat, cornstarch, snacks, and fruit drinks are the most potent triggers of insulin, small LDL, and the entire constellation of abnormalities of the metabolic syndrome, then we can reverse this entire situation by . . . eliminating them. Because wheat products, in particular, are so dominant, just eliminating wheat fixes about 90% of the problem for most people. This includes elimination of wheat and cornstarch products cleverly disguised as healthy, as are many whole grain breads and breakfast cereals.
Eliminating the causes of the problem leads to an extraordinary panel of benefits:
* Weight loss : Rapid, often profound, weight loss ensues (The magnitude and rapidity of weight loss response depends on genetic factors, as well as the starting condition of diet). 20-30 lbs lost effortlessly within the first 3 months is a typical result.
* Reduction in small LDL. Because small LDL particles are such a sensitive index, they respond promptly and dramatically.
* Increase in HDL cholesterol
* Reduction in triglycerides
* Enhanced sensitivity to insulin
* Reduction in blood sugar
* Reduction in blood pressure
* Reduction in inflammatory measures, such as c-reactive protein
Subjective improvements also occur: increased mental clarity, increased energy, improved sleep, more stable moods.
Curiously, a common criticism of this approach is the statement: "But we need wheat (or grains) in our diet!"
Entirely untrue. There are several lines of evidence that persuasively demonstrate that wheat and grains are not necessary components of the diet for long, healthy life. Beyond the fact that a host of abnormal metabolic patterns shift towards normal with elimination, wheat and grains provide no beneficial component of diet that cannot be obtained through other foods. Insoluble fibers (wheat bran) can be readily replaced with the fibers from raw nuts, vegetables, fruits, and non-wheat fibers (below). (In fact, if the calories of wheat are replaced by calories from raw nuts, vegetables, etc., fiber intake actually increases.) B vitamins from wheat are easily replaced by B vitamins from meats, non-wheat fibers, vegetables, legumes, etc. There is no deficiency associated with eliminating wheat from the diet, as people with celiac disease (who need to remove wheat from their diet completely because of allergy to wheat gluten) demonstrate. (But do not confuse our approach of wheat elimination with a gluten-free diet; they are different.)
Wheat addiction, wheat withdrawal
There is an important group of people, perhaps no more than 30% of the population, who experience something that can only be described as "wheat addiction."
These people crave wheat products, eating extraordinary quantities of pretzels, crackers, bread, etc. every day. Cravings occur in approximately two-hour cycles, consistent with sugar and insulin fluctuations that result from wheat products. Missing a snack or meal causes distress: shakiness, nervousness, headache, fatigue, and intense cravings.
They also experience "wheat withdrawal" (or, as the Atkins dieters call it, "induction flu") consisting of fatigue, mental fogginess, and diminished exercise capacity that usually lasts two to five days, sometimes longer. The effect is most prominent when going "cold turkey."
This can be especially hazardous. We've seen people with this tendency successfully go through withdrawal and remove wheat from their diet. But a single cracker, pretzel, or cookie indulgence opens a floodgate of sugar and wheat cravings. The initial 30 lbs lost is rapidly regained. There is no realistic way to keep this from happening except to be aware of the phenomenon. People with this characteristic simply need to be vigilant and not let a single indulgence trigger uncontrollable impulses.
Why does wheat withdrawal occur? It is likely that years of high-carbohydrate eating allow metabolism to become reliant on a constant supply of readily-released sugars. Removing sugar sources forces the body to mobilize and burn fatty acids instead, a process which may not be immediate but requires several days to kick in.
There are two ways to deal with this effect.
One: Taper wheat gradually over a week. However, be warned, some people are so addicted to wheat in particular that they find even this tapered process to be overwhelming, and sometimes going cold turkey is a necessity to break the addiction, just as the alcoholic has to suffer through his/her withdrawal.
Two: Select a time to begin the process when you don't need to be at your top performance, e.g., a week off from work. Perhaps it won't be the most action-packed vacation, but it will allow you to return to work/life in far better shape.
WHEAT FREE TESTIMONIALS BEHIND THE SCENES
Here are some testimonials we've received via The Heart Scan Blog on the effects of removing wheat from the diet:
Barbara W said:
It's true! We've done it. My husband and I stopped eating all grains and sugar in February. At this point, we really don't miss them any more. It was a huge change, but it's worth the effort. I've lost over 20 pounds (10 to go) and my husband has lost 45 pounds (20 to go). On top of it, our body shapes have changed drastically. It is really amazing. I've got my waist back (and a whole wardrobe of clothes) - I'm thrilled.
I'm also very happy to be eating foods that I always loved like eggs, avocados, and meats - without feeling guilty that they're not good for me.
With the extremely hot weather this week in our area, we thought we'd "treat" ourselves to small ice cream cones. To our surprise, it wasn't that much of a treat. Didn't even taste as good as we'd anticipated. I know I would have been much more satisfied with a snack of smoked salmon with fresh dill, capers, chopped onion and drizzled with lemon juice.
Aside from weight changes, we both feel so much better in general - feel much more alert and move around with much greater flexibility, sleep well, never have any indigestion. We're really enjoying this. It's like feeling younger.
It's not a diet for us. This will be the way we eat from now on. Actually, we think our food has become more interesting and varied since giving up all the "white stuff". I guess we felt compelled to get a little more creative.
Eating out (or at other peoples' places) has probably been the hardest part of this adjustment. But now we're getting pretty comfortable saying what we won't eat. I'm starting to enjoy the reactions it produces.
Anonymous said:
My life changed when I cut not only all wheat, but all grains from my diet.
For the first time in my life, I was no longer hungry -no hunger pangs between meals; no overwhelming desire to snack. Now I eat at mealtimes without even thinking about food in between.
I've dropped 70 pounds, effortlessly, come off high blood pressure meds and control my blood sugar without medication.
I don't know whether it was just the elimination of grain, especially wheat, or whether it was a combination of grain elimination along with a number of other changes, but I do know that mere reduction of grain consumption still left me hungry. It wasn't until I eliminated it that the overwhelming reduction in appetite kicked in.
As a former wheat-addicted vegetarian, who thought she was eating healthily according to all the expert advice out there at the time, I can only shake my head at how mistaken I was.
Add non-wheat grains
There are two non-wheat grains that do not trigger the unhealthy effects of wheat and actually provide benefit: ground flaxseed (best) and oat bran and whole oats (second best).
Neither have the addictive potential of wheat. Ground flaxseed is best, since it has virtually no digestible carbohydrates, consisting purely of fiber and protein. Oat products are second best because they do increase blood sugar, though not as greatly as wheat.
Oat bran is the best form of oats, followed by slow-cooked oatmeal (Irish oatmeal, stone ground), followed by "quick." Instant oatmeal should be avoided altogether. (The pre-cooking and cutting involved to abbreviate cooking time causes more rapid release of sugars.) Both ground flaxseed and oat bran can be used as hot cereals (microwaved, for instance, with almond or soy milk with added walnuts, blueberries), or added to foods like cottage cheese, chili, "breading" for chicken and fish.
Other non-wheat fibers, such as rye, barley, quinoa, sorghum, and bulghur, tend to yield responses that are intermediate. While not as undesirable as wheat, they do take a metabolic toll. Therefore, these fibers are best used after the withdrawal process (above) is over, metabolic goals and weight loss have been achieved, and a loosening of diet is permissible. However, if you are among those with a powerful potential for wheat addiction, these foods should remain off your list of safe foods.
THE HEART HEALTHY SCAM BEHIND THE SCENES
Like many scams, this one follows a predictable formula.
It is a formula widely practiced among food manufacturers, ever since food products began to jockey for position based on nutritional composition and purported health benefits.
First, identify a component of food, such as wheat fiber or oat bran, that confers a health benefit. Then, validate the healthy effect in clinical studies. Wheat fiber, for instance, promotes bowel regularity and reduces the likelihood of colon cancer. Oat bran reduces blood cholesterol levels.
Second, commercialize food products that contain the purported healthy ingredient. Wheat bran becomes Shredded Wheat®, Fiber One®, and Raisin Bran® cereals and an endless choice of "healthy" breads. Oat bran becomes Honey Bunches of Oats®, Quaker's Instant Oatmeal, and granola bars. Even if unhealthy components are added, as long as the original healthy product is included, the manufacturer continues to lay claim to healthy effects.
Third, as long as the original healthy ingredient remains, get an agency like the American Heart Association to provide an endorsement: "American Heart Association Tested and Approved."
The last step is easy: just pay for it, provided the product meets a set of requirements, no matter how lax.
You will find the American Heart Association certification on Quaker Instant Oatmeal Crunch® Apples and Cinnamon. Each serving contains 39 grams carbohydrate, 16 grams sugar (approximately 4 teaspoons), and 2.5 grams fat of which 0.5 grams are saturated. Ingredients include sugar, corn syrup, flaked corn, and partially hydrogenated cottonseed oil. Curiously, of the 4 grams of fiber per serving, only 1 gram is the soluble variety, the sort that reduces cholesterol blood levels. (This relatively trivial quantity of soluble fiber is unlikely to impact significantly on cholesterol levels, since a minimum 3 grams of soluble fiber is the quantity required, as demonstrated in a number of clinical studies.) Nonetheless, this sugar product proudly wears the AHA endorsement.
Thus, a simple component of food that provides genuine benefit mushrooms into a cornucopia of new products with added ingredients: sugar, high fructose corn syrup, corn starch, carageenan, raisins, wheat flour, preservatives, hydrogenated oils, etc. What may have begun as a health benefit can quickly deteriorate into something that is patently unhealthy.
There's a clever variation on this formula. Rather than developing products that include a healthy component, create products that simply lack an unhealthy ingredient like saturated or trans fats or sodium.
Thus, a ¾-cup serving of Cocoa Puffs® cereal contains 120 calories, no fiber, 14 grams (3 ½ teaspoons) of sugar—but is low in fat and contains no saturated fat. Proudly displayed on the box front is an American Heart Association stamp of approval. It earned this stamp of approval because Cocoa Puffs® is low in saturated, trans, and total fat and sodium. Likewise, Cookie Crisp® cereal, featuring Chip the Wolf, a cartoon wolf in a red sweater ("The great taste of chocolate chip cookies and milk!"), has 160 calories, 26 grams carbohydrate and 19 grams (4½ teaspoons) of sugar per cup, and 0 grams fiber—but only 1.0 gram fat, none saturated, thus the AHA check mark. (Promise® margarine, made with hydrogenated vegetable oil and therefore containing significant quantities of trans fats, was originally on the list, as well, but removed when the trans fat threshold was added to the AHA criteria.)
It is this sleight of hand of taking a healthy component and tacking on a list of ingredients manageable only by food scientists, or asserting that a product is healthy just because it lacks a specific undesirable ingredient, that is a major factor in the extraordinary and unprecedented boom in obesity in the U.S. Imagine if the chemical industry were permitted such latitude: "Our pesticide is deemed safe by the USDA because it contains no PCBs." Such is the ill-conceived logic of the AHA Heart CheckMark® program and "heart healthy" claims.
It's best we keep in mind the observations of New York University nutritionist and author of the book, Food Politics, Marion Nestle, that "food companies—just like companies that sell cigarettes, pharmaceuticals, or any other commodity—routinely place the needs of stock holders over considerations of public health. Food companies will make and market any product that sells, regardless of its nutritional value or its effect on health. In this regard, food companies hardly differ from cigarette companies. They lobby Congress to eliminate regulations perceived as unfavorable; they press federal regulatory agencies not to enforce such regulations; and when they don't like regulatory decisions, they file lawsuits. Like cigarette companies, food companies co-opt food and nutrition experts by supporting professional organizations and research, and they expand sales by marketing directly to children, members of minority groups, and people in developed countries—whether or not the products are likely to improve people's diets."
Qualms over just how heart-healthy their products are? Doubtful.
Cheerios: How far wrong can diet advice go?
At the start of their Track Your Plaque program, many people proudly proclaim that they start their morning with a heart healthy bowl of Cheerios®.
Take a look at the list of ingredients on a standard box of Cheerios®, the one bearing the American Heart Association's Heart CheckMark® of approval as "heart healthy."
You will see:
First ingredient: cornstarch
Second ingredient: whole wheat flour
Third ingredient: sugar
Fourth ingredient: oat bran
In effect, Cheerios® is sugar with some oat bran on it, little different than Count Chocula®, Berry Kix®, and other sugar cereals. (Both Count Chocula® and Berry Kix® also bear the CheckMark® heart healthy emblem.)
Cheerios® and breakfast cereals are not part of the Track Your Plaque program for heart health.
Diet Principle #2: Don't limit fats, but choose the right fats
The Basics
* Add one of these healthy oils to every meal: Flaxseed, Olive, Canola, High-oleic Safflower
* Include fish at least once per week; supplement omega-3 fatty acids (dose depending on lipoprotein patterns; minimum 1800 mg EPA + DHA per day, ideal 3000 mg per day).
* Avoid hydrogenated oils altogether; permit saturated fats selectively to maintain a threshold of no more than 20 grams per day.
* Limited dairy: No more than 1-2 servings per day milk, cottage cheese, yogurt; preferably 1-2% milk fat. 1-2 oz cheese per day (cultured only).
We've learned plenty of new lessons on gaining metabolic control and improvements in lipoprotein patterns, improvements that also yield better control over weight, yield faster and larger drops in excess weight, and correct the abnormal metabolic fallout of past dietary mistakes. One of the most important new lessons is that fats have come to play a prominent role in the New Track Your Plaque Diet.
For many years, all fats were demonized based on the fact that any fat, good or bad, contains 9 calories per gram, compared to 4 calories per gram of carbohydrate or protein. It rather logically led to the belief that caloric density accounted for weight gain: the more fat that was included in diet, the more weight was gained. The logical corollary was that reducing caloric density of foods would help lose weight.
As we now know, the opposite happens. Although counterintuitive, calorie-dense fats help lose weight or manage it more effectively. The essential feature of food that triggers appetite vs. induces satiety is driven by insulin response, not caloric density.
Carbohydrates, of course, trigger insulin galore. A meal that includes whole grain bread, whole wheat crackers, or whole wheat pasta, for instance, cause a large volume of sugar to be released into the blood. The pancreas responds by releasing a large quantity of insulin to hasten the entry of sugar into the body's cells, which is then stored as energy. Some have likened this phenomenon to the energy storage process primitive humans and wild animals follow in preparation for an extended period of food shortage (e.g., winter). Gorge on carbohydrate-rich foods, such as fruits, roots, and berries?or, in our modern society, breads, pasta, and snacks?and the body stores the energy in preparation for extended caloric deprivation. Of course, in a modern world with unlimited access to carbohydrate calories year-round, deprivation never comes. Instead, continued access to more carbohydrate calories allows more and more storage.
The results are evident all around us in the grotesquely obese in our society, presumably the nation with the best healthcare in the world.
The currently popular nutritional mantra of "eat more healthy whole grains" is therefore much of the explanation behind the national epidemic of obesity and diabetes. It also underlies the enormous explosion in small LDL and related patterns.
In contrast to carbohydrates, fats are the least insulin-provoking, followed by protein as a close second. Less insulin provocation means less storage as fat. It also means that appetite is not recurrently triggered. Instead, satiation ensues. Coincident with the recent re-examination of the role of fat composition of the diet that has led to its "pardon," it's time to talk about adding back fats?plenty of fats?to our diet.
But, while fats all share the same capacity to generate satiety, fail to trigger insulin responses, the various fatty acids that comprise fats do indeed differ in other ways.
The fatty acid line-up
Hydrogenated fat is the one fat that we can all agree that everyone should avoid. This is crucial for success in the Track Your Plaque program. Hydrogenation is the process used to solidify liquid vegetable oils that adds hydrogen groups in an unnatural trans (opposite sides of the carbon backbone) configuration ("trans fats"). Two examples are vegetable shortening and margarines (though recently, more and more manufacturers are using non-hydrogenated canola and other vegetable oils in their margarines).
Manufacturers love to use hydrogenated oils in food processing. You'll find them in baked cookies and cakes, pies, pastries, snack chips, frozen foods, salad dressings and mayonnaise, and many convenience foods. They not only raise LDL cholesterol, but reduce HDL cholesterol, trigger increase of Lp(a), and divert fatty acids towards inflammation-increasing pathways. To see whether a product contains hydrogenated fats, refer to the label of ingredients. If "hydrogenated oil" or "partially hydrogenated oil" is listed on the label, avoid it. (The FDA now mandates that labels specify the inclusion of trans fats.)
Another group of oils that we would like to minimize are polyunsaturated oils. Polyunsaturates are rich in linoleic acid, a principal member of the omega-6 family. While polyunsaturates were widely advocated in the 1980s and 1990s because they modestly reduce LDL cholesterol compared to saturated fats, it has become increasingly clear that linoleic acid-rich oils trigger an inflammatory cascade, yielding increases in such inflammatory mediators as thromboxane. Corn, sunflower, soy, grapeseed, safflower, and cottonseed oils contain abundant omega-6 fatty acids. These oils are best used sparingly. There are better forms of oils to use. Also beware that many processed foods include polyunsaturated oils, in addition to hydrogenated trans fats.
Monounsaturated fatty acids are getting more attention due to the success of the so-called Mediterranean diet in reducing risk of heart attack. The Lyon Heart Study examined the health benefits of a Mediterranean diet rich in olive oil (70% monounsaturated oils), vegetables, and fish, similar to that eaten along the Mediterranean coast in Europe. People following this diet (as compared to an American-like diet of red meat, fast and processed foods.) suffered 40% fewer heart attacks. While monounsaturated oils reduce LDL cholesterol with approximately the same effectiveness as polyunsaturates, monounsaturates do not trigger abnormal inflammatory responses. Oils rich in monounsaturates include olive oil (70%), canola oil (60%), and high-oleic safflower oil (75%; this is distinct from standard safflower oil, which contains negligible amounts of monounsaturates). Extra-virgin olive oil (often green and cloudy, particularly when cool) also contains high quantities of polyphenols, which may further add to health benefits.
Raw nuts are another excellent source of monounsaturates. People often shun nuts because of their high fat content. But much of the fat is monounsaturated. Raw nuts are filling, requiring hours to digest. In fact, eating a ¼ cup or more of raw almonds or walnuts every day can lower cholesterol by 20 points, perhaps due to the monounsaturated oils. As long as they are raw, nuts do not cause weight gain.
Because the four healthy oils exert virtually no ill-effect, but reduce LDL, induce satiety, and smooth insulin-blood sugar excursions, one of the new strategies the New Track Your Plaque Diet includes is that one of these oils be added to every meal, including breakfast-especially breakfast. An oil compatible with each food needs to be chosen, e.g., a teaspoon of olive oil with scrambled eggs, a teaspoon of flaxseed or canola oil mixed with ground flaxseed or oatmeal. The added oils help smooth insulin and blood sugar responses. Because appetite is suppressed, weight loss is also accelerated.
Omega-3 fatty acids, docosahexaenoic acid, or DHA, and eicosapentaenoic acid, or EPA, are in a beneficial class by themselves. Omega-3s are used both as treatment, as well as a preventive nutritional strategy.
Fish are the source for omega-3 fatty acids: cod, halibut, trout, salmon, mackerel, tuna, and sardines. Eating two servings a month is enough to yield a sharp drop in risk of dying of heart attack, but the use of fish oil supplements is a means to ensure higher intakes of omega-3's to achieve maximal benefit. Because the quantity of omega-3s required for maximal effect are much greater than can be obtained with eating fish occasionally, specific supplementation should be considered.
Omega-3 fatty acids are the component of diet in fish-eating cultures responsible for reducing heart attack dramatically (e.g., Japanese women have four-fold higher blood levels of EPA and DHA and 20% of the risk of American women; Japanese men also have four-fold higher levels with 40% of the risk of American men.)
Omega-3's reduce blood pressure, reduce triglycerides, raise HDL and make LDL particles bigger, in addition to reducing risk of heart attack and death. There is evidence that omega-3's can reverse atherosclerosis. When people who've suffered heart attacks eat a diet rich in omega-3's or take fish oil supplements, the risk of dying of heart attack is cut by 35-45%. Evidence suggests that omega-3's have cancer-preventing effects, inhibits Alzheimer's dementia, and help alleviate depression.
Omega-3 fatty acids can also be used to treat specific lipoprotein abnormalities. Triglycerides can be reduced up to 50%; lipoprotein(a) can also be reduced. Higher doses are needed for these purposes. Fish oil also reduces fibrinogen, a blood clotting protein (though fears over the bleeding dangers of fish oil are often ridiculously overblown).
Omega-3 fatty acids are a crucial ingredient in your plaque-control program.
Flaxseed, either as the whole seed or as flaxseed oil, is also a source of omega-3's. However, the omega-3 in flax seed doesn't occur as DHA or EPA, but as linolenic acid (not to be confused with the omega-6 linoleic acid). While linolenic acid is beneficial in its own right, it cannot take the place of the omega-3 fatty acids from fish oil. The conversion of linolenic acid to the active DHA/EPA is inefficient. The quantity of EPA and DHA yielded from flaxseed oil is therefore trivial, less than 1 part DHA/EPA for every 10 parts linolenic acid taken. Flaxseed oil does not yield the same benefits, particularly those on lipoproteins and triglycerides, as that provided by fish oil. Fish oil is the preferred source of omega-3's.
Linolenic acid nonetheless has been associated with reduction in cardiovascular events and is suspected to be at least one of the important components of both Mediterranean and Japanese diets. Linolenic acid provides the building blocks for anti-inflammatory eicosanoid responses, in contrast to linoleic acid (omega-6) that increase inflammatory responses. Flaxseed oil is the most plentiful source of linolenic acid (51%); next are canola (10%) and soy (8%). (While soy and grapeseed also contain linolenic acid, they also contains abundant linoleic acid and are therefore not on our preferred list.) Walnuts, hazelnuts, and ground flaxseed are also healthy sources of linolenic acid.
We now come to the thorny issue of saturated fats. Saturated fats have been the subject of scorn over the past 50 years, originating with early observations that cultures with greater intakes of saturated fat experienced higher risk for heart attack. Public health advice followed to cut all fats, which then led to replacement of fat calories with carbohydrate calories, as well as the initial push for hydrogenated and polyunsaturated oils to replace saturated. It also spawned the national movement to incorporate abundant "healthy whole grains." As many of us now know, this shift in caloric composition backfired, and has played a major role in creating the epidemic of diabetes and obesity. Lipoprotein analysis makes it obvious that reduced fat and increased carbohydrate intake trigger potent heart disease-causing patterns of small LDL, higher blood sugar, higher triglycerides, lower HDL, and inflammation.
Re-analyses of the original saturated fat data suggest that:
* Many of the original observations were made using total cholesterol, rather than LDL and HDL. While saturated fat undoubtedly increases total cholesterol, about half the effect is due to increase in HDL.
* While saturated fats increase total and LDL cholesterol, they increase the large LDL fraction, while carbohydrates increase small LDL. Small LDL is more atherogenic (plaque-causing) than large.
* Not all saturated fats are the same, though they have been demonized as a group. The various fatty acids (lauric, myristic, stearic, palmitic, butyric and others) comprising saturated fats differ in their effects on LDL, HDL, coagulation, etc.
* Foods containing saturated fats consist of a range of different food choices, from egg yolks to red meats to processed cured meats (sausage, hot dogs, bacon), with a wide range of health effects. For instance, processed cured meats like sausages, hot dogs, and bacon have been conclusively and repeatedly found to escalate the risk of multiple cancers, an issue that likely has little to do with their saturated fat content.
It is therefore clear that saturated fats have been criticized unfairly and do not need to be as feared as once thought. However, there are still some lingering concerns with saturated fats:
* Saturated fats occur principally in animal products. In fact, saturated fats may be little more than a surrogate for meat and animal product intake. Data comparing vegetarians to omnivorous populations have shown that vegetarians enjoy an advantage in length of life with fewer cardiovascular events. Higher intakes of animal products, whether due the saturated fat component or some other component (such as animal proteins, iron-containing proteins, nitrogenous by-products) have also been clearly associated with increased risk for prostate, colon, and possibly breast cancers; increased likelihood of diabetes; increased urinary loss of calcium, greater likelihood of osteoporosis, and?paradoxically?loss of lean muscle mass (as compared to low-fat or high unsaturated fat diets) during a weight loss effort.
* Diets rich in saturated fats (and animal products) have been associated with a doubling of likelihood of having higher heart scan scores.
* Saturated fats increase arterial constriction, i.e., "endothelial dysfunction" compared to the action of monounsaturates or polyunsaturates. This may contribute to arterial injury of the sort that encourages plaque growth.
* High intakes of animal products paradoxically block insulin responses, i.e., create a diabetic-like pattern.
* High intakes of animal products increase blood pressure.
* Fats from animal sources are the repository for pesticide residues and hormones in factory farm-raised livestock which, in turn, get passed on to the consumer. (This is less of an issue in grass fed, organic livestock, nor in wild game.)
Effects of saturated fat are very difficult to separate from that of animal products, and the data specifically identifying saturated fat as the culprit in animal products therefore remain inconclusive-but it does not necessarily mean that unlimited animal products are healthy.
Vocal critics of standard "cut saturated fat" advice point out that the clinical studies examining adverse effects all failed to reduce carbohydrate intake to low levels. They argue that much of the adverse health effect of saturated fats only becomes an issue in the presence of carbohydrates and that the effects of saturated fats have not been examined in isolation to truly gain an understanding of their real potential for good or bad. However, many of the studies that reveal the insulin-opposing, inflammatory, and arterial constricting effects of saturated fats were obtained through feeding studies comparing saturated fats to monounsaturates and to polyunsaturates while carbohydrate content was maintained constant. There are clearly differences among the metabolic effects of different fat fractions.
Nutrition is obviously a work in progress, with new evidence continually causing re-examination of the old. For the present, however, the stand on animal products?and saturated fat?from the perspective of the New Track Your Plaque Diet is:
* Lean meats (lean red meats, chicken, and turkey, preferably grass fed, organic, or wild game), eggs or Egg Beaters® should be included. However, for purposes of minimizing risk for cancer and diabetes, animal products, especially red meats, should not be consumed every day, but no more than 3-4 times per week.
* Fish and shellfish do not share the undesirable effects of other animal products.
* A safe or desirable threshold for saturated fat is 20 grams per day. Exceed this and undesirable effects become more evident, particularly inflammatory effects, resistance to insulin, and increases in (large) LDL cholesterol. If efforts to reduce production of small LDL are not undertaken simultaneously, excessive saturated fat can also contribute to enormous increases in both large and small LDL.
* Cured meats that contain sodium nitrite, including bacon, sausage, and hot dogs, should be avoided because of their clear-cut carcinogenic potential confirmed across multiple epidemiologic studies.
* Cheese, provided it is real cultured cheese, can be included (and also provides vitamin K2 in its MK-4 form), 1-2 oz per day.
* Butter in small quantities is included, provided the saturated fat threshold is not exceeded (7 grams per tablespoon).
The role of dairy products
While cheese is safe for any pattern and, in fact, provides additional vitamin K2, other dairy products are conditional.
While milk, cottage cheese, and yogurt are sources for only a modest carbohydrate load, they trigger insulin excessively. We therefore advise including them in only small quantities, e.g., 1-2 servings per day. However, if you are among those with extreme carbohydrate sensitivity, avoidance may be necessary. (Contrary to popular advice, sufficient dietary calcium can come from non-dairy sources, such as green vegetables, especially if normalization of vitamin D levels are achieved.)
Milk, cottage cheese, and yogurt raise large LDL because of the saturated fat content (mostly palmitic acid, a moderate trigger for large LDL). For this reason, lower fat, unsweetened products are preferred to keep total saturated fat content from becoming excessive and triggering large jumps in LDL.
Healthy substitutes for dairy include soy products such as soy milk (preferably unsweetened) and unsweetened almond milk.
Diet Principle #3: Unlimited vegetables, some fruits
The Basics
* Unlimited green vegetables (peppers, cucumbers, lettuces, cabbage, spinach, zucchini, celery, etc.); alliums (onions, garlic, scallions, shallots); sprouts; roots (radishes, carrots); mushrooms (portabella, shiitake, many others); herbs (basil, oregano, mint, coriander, rosemary, etc.)
* Limited starchy vegetables (yams, sweet potatoes, wild rice)
* Minimize white and brown rice; white and red potatoes. Vegetables are easy: Follow the rule of eat vegetables, vegetables, and more vegetables.
Vegetables should serve as your primary source of fiber, phytonutrients (including flavonoids, polyphenols, and carotenoids, the brightly colored substances that confer anti-cancer and heart disease-protecting effects), vitamins, and minerals, but make only a minor contribution to sugar, unhealthy fat, and calorie load. Vegetables are the closest we come to a perfect food group.
Focus on vegetables over and above all other food sources. Take advantage of the vast variety and versatility of vegetables as the foundation of your nutrition program: eggplant; peppers; alliums like onions, garlic, scallions, shallots; cucumbers; zucchini; leafy plants like red leaf, Boston, Romaine lettuces and spinach; sprouts; cabbage; roots like radishes and carrots; celery; mushrooms like shiitake and portabella; herbs like basil, oregano, mints, coriander.
Virtually all plant-based food sources are beneficial. Among the rare exceptions are white and red potatoes and rices (white and brown). While all have some healthy components (e.g., vitamin C and potassium) these vegetables release blood sugar similar to table sugar. These vegetables should therefore be minimized, though not necessarily eliminated (since they generally do not yield the same addictive potential as wheat.) Better choices would include sweet potatoes, yams, and wild rice. Foods like French fries and fried rice should virtually never be consumed.
Vegetables are best eaten fresh, as they are most nutrient dense. Frozen vegetables are a good second choice if fresh is unavailable. Canned vegetables (and canned food in general) should be avoided, not just because of reduced nutrient density, but also because of bisphenyl A released from the lining, a substance associated with 40% increase in heart attack when used habitually.
Phytonutrients from vegetables, including flavonoids, polyphenols, and carotenoids, such as quercetin, luteolin, catechins, anthocyanidins, and literally thousands of others (more than 4000 at last count) are widely believed to be the factors responsible for the marked reduction in cancer, high blood pressure, and heart disease in populations that include greater quantities of vegetables and fruits in their diet. The means by which these benefits are accomplished is an area of active research, with findings pointing towards anti-oxidant effects (e.g., peroxynitrite scanvenging); endothelial health through enhanced nitric oxide synthesis; improved insulin responses; anti-inflammatory effects, including reduced expression of adhesion molecules, abnormal growth factors, and thromboxane; blood-thinning effects, including reduced activation of clot-forming platelets; decreased LDL cholesterol and increased HDL cholesterol; reduced blood pressure.
Vegetables should be eaten first and in unlimited quantities. Seconds, thirds—as long as it's healthy vegetables, eat them in unrestricted quantities and fill up on them before you move on to anything else. This leaves less room to indulge in other foods.
If you find vegetables uninteresting, add unique toppings to increase interest, such as dipping in salsas (with added oils), tapenades, and pestos; mustards, horseradish, wasabi; hummus (add olive oil); bake a mix of vegetables (e.g., eggplant, tomatoes, zucchini, brushed with olive oil).
Fruits, like vegetables, are rich in phytonutrients and therefore share in providing many of the same beneficial effects. However, fruits are far richer in sugar. Some, like bananas, have as much sugar as processed foods like cookies, candy, or breakfast cereals. Despite the benefits of fruits, eating too much (which happens quite often as people shift from less processed foods to whole foods) can still trigger unhealthy patterns, like higher blood sugar, excessive insulin spikes, and inflammation.
It is therefore advised that we limit fruit to no more than two servings per day. Favor berries of all varieties (blueberries, raspberries, strawberries, cranberries, blackberries), citrus, melons, apples, peaches, pears, and kiwis.
Because of high sugar load (>20 grams per 4 oz serving), we should minimize bananas, grapes, mango, and any dried fruit (raisins, dried apricots, figs).
Diet Principle #4: Unlimited raw nuts and seeds
The Basics
Unlimited:
* Almonds
* Walnuts
* Pecans
* Pistachios
* Filberts
* Brazil
* Hazelnuts
* Pumpkin seeds (pepitas)
* Sunflower seeds
* Pine nuts
Nuts are number two in the hierarchy of healthy foods, after vegetables.
Like vegetables, nuts are rich in vitamins and minerals (including magnesium), fibers, healthy oils (rich in monounsaturates), and are wonderfully filling. People who eat nuts have been consistently shown to experience fewer heart attacks (as much as 50% reduction), have lower blood pressure and lower incidence of diabetes.
A diet rich in nuts reduces LDL cholesterol while inhibiting inflammatory patterns. A quarter-cup or more of nuts per day can reduce LDL cholesterol 20 mg/dl or more.
Because heating or roasting changes the structure of oils (oxidation and acrylamide formation, a cancer risk) and make any sugars more available, nuts are best eaten raw. Raw nuts are often sold bulk or in bags; they do not need to be shelled (unless you prefer them that way). They are sometimes labeled "raw," or simply lack any further description such as "roasted."
Dry roasted is second best, but be sure that your nuts are dry roasted with no other processing introduced, such as roasting in hydrogenated cottonseed oil, wheat flour, cornstarch, maltodextrin, salt, sugars, etc., all very common with dry roasted nuts. Processed nuts, often known as party mixes, honey roasted, mixed nuts, beer nuts, etc. should be avoided; these contain distinctly unhealthy ingredients and do not provide the benefits of raw nuts. In fact, these processed versions of nuts are the reason why nuts acquired a bad reputation in past: They increase LDL cholesterol, reduce HDL, increase resistance to insulin, and make us fat. Avoid them.
The best nuts are those with a fibrous coating and include:
* Almonds
* Walnuts
* Pecans
* Pistachios
* Filberts
* Brazil
* Hazelnuts
Less healthy, though still of modest benefit are raw cashews. Peanuts are not nuts, but legumes, and cannot be eaten raw; dry roasted is preferable, provided they are truly just dry roasted with no other added ingredients.
In the world of seeds, healthy choices include:
* Pumpkin (pepitas)
* Sunflower
* Pine nuts
Pumpkin seeds in particular provide a substantial quantity of magnesium of approximately 160 mg per quarter cup; sunflower seeds likewise provide plenty of magnesium, approximately 120 mg per quarter cup.
Both raw nuts and seeds can be consumed in unlimited quantities. Contrary to popular perception, as long as they are raw and unprocessed, they will not cause weight gain.
Diet Principle #5: Unlimited healthy oils
The Basics
Use unlimited flaxseed oil, olive oil, canola oil, high-oleic safflower oil; consider adding a small quantity to every meal
Four healthy (non-marine) oils are advocated in the New Track Your Plaque Diet:
* Flaxseed-Richest in linolenic acid (51%), the so-called non-fish source of "omega-3" (though it will not substitute for fish oil).
* Olive-Rich in monounsaturates (70%) and polyphenols.
* Canola-Second highest in linolenic acid (10%) after flaxseed oil.
* High-oleic Safflower-High in monounsaturates (70%), similar to olive oil (not to be confused with standard safflower oil, which is rich in linoleic acid)
These four oils, when examined in specific feeding studies, do not trigger LDL-raising or insulin-blocking effects peculiar to many other fats (such as saturated). Because all four are also low in the omega-6 linoleic acid, they are neutral with respect to inflammatory patterns or exert modest anti-infllammatory effects.
These four oils can be used ad libitum; add as much as you want to salads and other foods. A useful strategy is to include one of these four oils in every meal, especially breakfast. For example, add 1 teaspoon of olive to scrambled eggs, or 1 teaspoon flaxseed oil to oatmeal or ground flaxseed as a hot cereal. The added oil induces satiety (fullness and diminished cravings), and also reduces insulin and sugar fluctuations. This leads to better weight control and weight loss, particularly when combined with the strategy of reducing or eliminating wheat and cornstarch products.
Of course, oils should never be super-heated (i.e., frying), as it triggers formation of unhealthy oxidative by-products. Minimal or no heating is preferable whenever possible, especially with olive and flaxseed oils, as linolenic acid and polyphenols degrade rapidly with heat. Oils are therefore best added towards the conclusion of cooking, e.g., 1 tsp added to scrambled eggs just after scrambling, olive oil brushed on asparagus or chicken just before removing from the oven or grill.
Diet Principle #6: Foods should be unprocessed
Unprocessed foods are whole foods:
Whole, unprocessed foods are not dried (like instant oatmeal and instant mashed potatoes), not powdered (instant soups, sauces), and not a "mix" (pancake and cake mixes, macaroni and cheese). They do not require reconstitution—adding water and heating, or some similar process. Whole, unprocessed foods are not modified by hydrogenation, desiccation, are not sweetened and don't contain artificial flavorings or colorings.
Unprocessed foods tend to look like they occur naturally. You may have to remove an outer shell (nuts) or skin (oranges, avocados) but they remain essentially intact. Of course, you may need to cut whole foods into smaller pieces, but the basic structure remains the same. Unprocessed foods are generally fresh.
When food is left whole, it retains more of its original naturally-occurring nutrients. It is also digested more slowly, causing a natural slow, gradual rise in blood sugar or none at all. Diabetics who switch to a diet of unprocessed foods commonly witness dramatic drops in blood sugar, often sufficient to reduce their requirements for medication or insulin.
Unprocessed foods are colorful foods. Look at the wonderfully deep colors of plums, eggplant, oranges, tomatoes, and spinach. Colorful foods are rich in flavonoids, naturally-occurring substances that lower LDL cholesterol and raise HDL, lower blood pressure, block abnormal clotting by platelets, blocks the adhesion of inflammatory blood cells to plaque, and may reduce risk of heart attack.
Processing destroys good food!
Processing is not simply heating or drying. Processing often destroys heat-sensitive phytonutrients, oxidizes oils, and raises glycemic index.
Processing frequently involves the addition of undesirable additives to improve taste, consistency, or extend shelf-life—hydrogenated oils, food colorings, sweeteners like corn syrup and sugar, thickeners like cornstarch, and synthetics. They make food look prettier, last longer, and maintain texture and consistency during storage, but do health little good. High-fructose corn syrup is a sweetener that kids love and is found in everything from fruit drinks to spaghetti sauce that raises triglycerides and contributes to undesirable lipoprotein patterns like small LDL and VLDL, and even increases the likelihood of diabetes.
Processed foods are a major culprit behind the national epidemic of metabolic syndrome. Processed foods are all around us. Shelf after shelf, aisle after aisle of eye-catching, colorful, enticing processed foods. Not one or two kinds of cookies or cupcakes to choose from, but hundreds! The temptations are tremendous.
Many people struggle when forced to part with the glitz and glamour of processed foods. Marketing people who create these ads are very clever. They know that advertising can make you feel good about eating certain foods. They want you to feel proud to feed your family a "healthy" dish, sexy if you drink a certain drink (think Coca Cola®), successful if you can whip up a dinner of convenience foods in five minutes.
You'll get none of this reinforcement when you restrict yourself to the world of unprocessed foods. Unprocessed foods are not glamorous. They don't have fancy labels or packaging. You might even have to buy them "bulk." Yet it's the unprocessed, unrefined foods that are powerful tools for health. Whole, unprocessed foods are more filling, take longer to digest, and keep you satisfied longer. Which is more filling, a glass of apple juice or a whole apple? The whole apple will satisfy you longer, provides pectin fiber, and won't provoke a sharp rise in blood sugar like the juice.
Putting the program to work
No question: The New Track Your Plaque Diet may send a tsunami of change across your diet.
But it really doesn't have to be that tough. For instance, have you ever noticed how often you eat the same foods?
For most of us, 20 or so different foods comprise 90% of our meals over the course of a week. We then repeat the same 20 foods, week after week. You may modify preparation and mix combinations, but tend to rely on a small number of food choices. Creating new nutrition habits really means just selecting a handful of healthy new foods and re-organizing meals around these new choices.
There's no need to develop hundreds of new gourmet recipes in order to enjoy your new diet program. Simply choose 10–20 basic dishes you enjoy to provide the basis for your broader diet. (New recipes compatible with the New Track Your Plaque Diet approach will be provided in future.)
A useful trick is to use unique toppings and condiments—mustards (hot, brown, horseradish, Dijon), horseradish, salsa, pico de gallo, tapenades, pestos, wasabi sauces-to add to vegetables, meats, eggs, dips. Whenever choosing oil-based condiments, try to choose those made with olive or canola oils. Avoid non-fat/low-fat salad dressings made with high-fructose corn syrup.
Do your grocery shopping in the outer aisles of the store, where you find produce. You'll avoid the temptations of the processed, high-glycemic index wheat and cornstarch foods in the center aisles. If you're just starting to re-design your diet, you may spend a lot of time reading labels and experimenting with new foods and methods of preparation. But commit yourself to a few months of effort and you'll find that eating healthy will become second-nature.
You will also need to ignore the constant bombardment by the food industry and "official" agencies like the USDA and the American Heart Association repeating the mantra of eat more and more "healthy whole grains." Sometimes, going against the "grain" of conventional advice is difficult with the commercial pressure applied in countless TV ads, magazine write-ups, etc. Interestingly, the conversations from within these organizations are beginning to show doubt over the wisdom of their "eat more grains" advice. But, imagine the consequences if the USDA admitted that the dietary prescriptions of the last 40 years have been largely to blame for the nationwide epidemic of obesity and diabetes! It probably won't happen. Instead, we are likely to witness a gradual, step-by-step backpedaling on the standard advice, inching closer to the sort of diet articulated here.
In the meantime, rather than waiting for the USDA or other agency to catch up to the leading edge of nutritional science, you can choose to reject their outdated message and choose health instead.
Quick Summary
Enjoy unlimited:
* Vegetables
* Raw nuts?raw almonds, walnuts, pecans, pistachios
* Healthy oils?flaxseed, olive, canola, high-oleic safflower
* Lean meats?lean red meats, fish, chicken, turkey, eggs, Egg Beaters®. (Consider free-range, grass-fed and/or organic sources.)
* Non-wheat grains?ground flaxseed, oats
Limited:
* Fruits?berries of all varieties, citrus, apples, nectarines, peaches, melons. Minimize bananas, pineapples, mangoes, and grapes
* Fruit juices?only real juices and in minimal quantities
* Dairy products?No more than 1-2 servings of milk, cottage cheese or yogurt per day, preferably unsweetened. No more than 1-2 oz real cheese (cultured) per day.
* Legumes/beans; potatoes; rice; soy
Never:
* Fried foods
* Fast foods
* Hydrogenated, "trans," fats
* Cured meats?hot dogs, sausages, bacon
* Corn syrup or high-fructose corn syrup containing foods
* Refined wheat flour, cornstarch, rice flour, or potato products?crackers, pretzels, white breads, tacos, chips, tortillas, gravies, breakfast cereals, muffins, bagels, rice crackers, potato chips
Conditional:
Whole grains. Inclusion will depend on your metabolic and lipoprotein patterns. Whole grains include quinoa, sorghum, buckwheat, bulghur, rye.
Next: The New Track Your Plaque Diet: Part III - Special Issues
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