Dr. Chet
Whole Grain Help
I am SO THANKFUL for this article from Dr. Chet Zelasko ... after I read it the other day, figuring out what grocery products really do have whole grain ingredients is a little more simpler.
Hope the info Dr. Chet shares is as helpful to you as it has been to me 
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Carbohydrates are the foundation of energy production in the body. As a nation, we have been on an anti-carb kick for at least a decade since the last time the Atkins diet was popular. Sugar Busters and South Beach also tell you to restrict refined carbs, especially those made with refined grains such as bread, bagels, and pasta. If you’re going to eat grains, you should eat whole grains, they say. So exactly what is a whole grain? Does whole-wheat pasta count? If the label says wheat, is that the right bread to take home? What about chips made with whole grains? You’ll have those answers by the end of this message.
Whole Grains: Unprocessed
You would think defining a whole grain would be easy—and it is. But identifying foods that contain whole grains is most assuredly not easy. In the Dietary Guidelines 2010, they tell us 152 times to eat whole grains (2); then they spend only 169 words in the document advising us how to read labels to determine if a processed food actually contains whole grains. It’s complicated, so I’ll try to be clear how to assess the whole grains in processed foods.
So let’s do the easy part. Whole grains, or foods made from them, should contain all the essential parts and naturally-occurring nutrients of the entire grain seed (1). Simple enough. Corn off the cob, popcorn, and wild rice would fit that definition exactly. Nothing was done other than harvesting it and in the case of popcorn, drying it.
If the grain has been processed (e.g., cracked, crushed, rolled, extruded, and/or cooked), the food product should deliver approximately the same rich balance of nutrients that are found in the original grain seed. The parts of a grain include the bran, the germ, and the endosperm. Therefore, to be called a whole grain a food must retain the same relative proportions of these components as they exist in the intact grain (2). Whole oats used in oatmeal have been flattened and rolled for easy cooking; nothing was removed so that’s also pretty easy. 
Whole Grains: Processed Foods
Now it gets a little more challenging. Nutrition Facts labels don’t contain all the information we need, So how do we determine if a food we want to eat counts as a whole-grain product or not? We need some definitions first.
In order to be considered whole grain, the product must contain at least 51% of its total weight as whole grains or the product must provide at least eight grams of whole grains per ounce-equivalent of the product (2). That would be easy if the grams or percentage were actually listed on the label. It’s not. The FDA says that we can infer how much whole grain is in a product by the placement of the grain in the ingredients list; the whole grain should be the first or second ingredient, after water. For foods with multiple whole-grain ingredients, they should appear near the beginning of the ingredients list. This is not as precise as we might like, but it gives us some direction.
Examples:
I decided to check out some refined carbohydrates to see if they fit the “rules.” I went to our pantry to look at the bread we eat. The first ingredient was whole-wheat flour. They added some other ingredients such as extra fiber from inulin, but overall, it appeared to fit the definition of a whole-grain product.
Then I checked out some cereals. Whole Grain Cheerios claims to be a whole-grain product. The list of ingredients bears that out: whole grain corn and whole grain oats are the first two ingredients. Who hasn’t heard of Shredded Wheat? It’s a whole grain product: the ingredient list gives whole-grain wheat as the one and only ingredient.
How about crackers? I checked out Kellogg’s Special K Multigrain Crackers and it also fits: whole-wheat flour is the first ingredient. Kashi TLC 7 Grain Crackers also fits the bill: unbleached wheat flour is the first ingredient followed by a blend of seven whole grains.
What about pasta? Looks like that fits as well but not as substantive. Barilla Whole Grain Pasta says it has 51% whole-wheat flour in their whole-grain pastas. That barely squeezes by.
Cereal, crackers, and pasta. Okay, but what about chips such as Sun Chips that claim they have whole grains in their chips. Their website claims 18 grams of whole-grain benefits per serving, well within the FDA definition of whole grains. I felt I had to do this research myself, so I bought a bag of French Onion Sun Chips. The first ingredient was whole corn, the third was whole wheat, and fourth was whole-oat flour. Whole-grain product? Yes, it is. What about the second ingredient? Sunflower oil and that’s why one-third of calories come from fat, but that’s a different message.
Caution: Check for These Words
When you look at the packaging, approach foods labeled with the words “multi-grain,” “stone-ground,” “100% wheat,” “cracked wheat,” “seven-grain,” or “bran” with suspicion until you read the list of ingredients. They may not be a 100% whole-grain product. For that matter, they may not contain any whole grains at all, or at least not enough to fit the definition of whole grain. You must read the ingredients list to know for sure.
An Easy Shortcut:
But there’s another way. The Whole Grains Council provides a stamp pictured in this paragraph for whole-grain foods they’ve approved. If you see the symbol, look no further. Note that the stamps come in various denominations, from the minimum eight grams per serving to 47 grams or more, so you can easily add up your whole grains for the day until you get to the recommended 48 grams. This is the best shortcut to healthy eating I’ve seen in a long time. Just remember to adjust for serving size; if a serving is one slice of bread and you have two slices, double the grams per serving.
You can find a complete list of whole-grain products in the Whole Grains Council website using the link below. By the way, the bread in our pantry? It had the whole-grain stamp. I didn’t know what it meant before I did the research for this message.
The Bottom Line:
I’ve synthesized a lot of information to explain whole grains as simply as I could. Part of the problem is that manufacturers love using buzz words that can be deceiving on their packaging. They can even make foods look like they might be whole grain. Paula reminded me that you can be fooled by color; just because a food is darker, that doesn’t mean it has whole grains. For example, the manufacturer might put molasses in bread to add sweetness, and it makes the bread look darker without adding any additional grains.
I think you have the basic information you need to make better choices in selecting the best type of carbohydrates from grains. Choose a variety of grains—some oatmeal, whole-wheat bread, soup with whole-grain barley, a bran muffin with your coffee, and so on. Reading the list of stamped foods at the Whole Grains Council website will really expand your thinking about how easy it is to incorporate more whole grains into your diet. There are foods even kids will easily eat, such as Scooby Doo Cinnamon Grahams and Low Fat Frosted Strawberry Pop-Tarts; I was surprised at how long the Treats list is. The restaurant info includes many of the restaurants you drive by every day, including McDonalds and Burger King—those two don’t offer a lot of whole-grain choices, but at least they make the list. A healthier alternative would be to browse the recipe list—I found some very interesting possibilities there. And when we say whole grains, how many of us think of fresh, frozen, or canned corn? But it’s a perfect example of a whole grain with 70 or more grams in an ear or half-cup serving.
Remember, your body looks for carbohydrates as the first choice for energy. You don’t want to eat them to excess, but they’re a powerhouse of nutrition if you pick the right whole grains, and they come with a side order of fiber plus some antioxidants not found in fruits and vegetables.
What are you prepared to do today?
Dr. Chet
Carrots & Squash
Plainly stated from Dr. Chet ... if you didn't eat carrots or winter squash before, you may begin after you read this article ... Let me know what you think
Eat your Carrots:
Dr. Chet Zelasko
The National Health and Nutrition Examination Survey (NHANES) is the largest nutritional study in the U.S. I’ve written about other reports from it, but today I’m going to pick on a nutrient many of you may not be familiar with: alpha-carotene. You’ve heard of beta-carotene, but there are more types of these phytonutrients called carotenoids. If you don’t eat carrots or winter squash now, I’ll bet you will when I’m done.
Carotenoids
Carotenoids are a group of phytonutrients made by plants with yellow, orange, and red pigments. The most common carotenoids in the typical American diet are alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, and lycopene. Besides having funny names, what do these phytonutrients do?
Some are provitamin-A carotenoids; that means they can be converted to vitamin A if the body needs it. Alpha-carotene, beta-carotene, and beta-cryptoxanthin are these types of carotenoids. Other carotenoids such as lutein, zeaxanthin, and lycopene are not converted to vitamin A.
While we know that carotenoids are good for us, we really don’t know how they do what they do. Are they acting as antioxidants, or do they have some other function? We don’t know yet, but researchers are finding out how they do what they do every day. We do have a good indication that, no matter how they work, they’re good for us.
The Study
Researchers assessed the relationship between alpha-carotene levels and mortality in 15,318 adults in the third NHANES Follow-up Study. Subjects were adults 20 years and older. At the beginning of the study, blood was drawn and analyzed for a variety of nutrients including alpha-carotene. Over the next 18 years, deaths from all causes were recorded. Researchers analyzed the data by quintiles of blood alpha-carotene levels.
As the levels of alpha-carotene increased, the mortality rate decreased from all causes. That includes deaths from all types of cardiovascular disease, cancer, and diabetes. If that isn’t a reason to eat more carrots and tomatoes, I don’t know what is—but there’s even more.
A Closer Look
Drilling down in the results, one variable was interesting. In current smokers, the results were the same: the higher the alpha-carotene levels, the lower the risk of death from all causes. Remember those studies linking beta-carotene supplementation with increased risk of lung cancer in smokers? Maybe a supplement with all carotenoids might have been a better choice than the synthetic beta-carotene-only supplements given to the subjects in that trial.
There were also a couple of other interesting observations. As alpha-carotene increased, so did HDL-cholesterol. Leisure-time activity increased and BMI decreased with higher alpha-carotene levels. That makes sense because people who eat more vegetables are likely to have other healthy habits as well. 
The Bottom Line
This is another study that shows the benefit of eating vegetables and fruit. In this case, yellow-orange (carrots, sweet potatoes or pumpkin, and winter squash) and dark-green (broccoli, green beans, green peas, spinach, turnip greens, collards, and leaf lettuce) vegetables all have a high alpha-carotene content. We should eat servings of them every day. In addition, using a supplement with whole-plant concentrates of these vegetables would also provide additional carotenoids that can benefit our health. But in order to get the benefits, we have to do our part and eat them. Every day.
What are you prepared to do today?
Dr. Chet
Reference: Arch Intern Med. 2011;171(6):507-515
Heart of a Couch Potato
Here's another great article from Dr. Chet Zelasko (read more about him here), this one addressing a very important issue: the link between heart problems and being a couch potato. And, of course, the result may line up with what you're thinking ... but read on to find out for sure =)
And so, here's another one of my soapboxes ... the obesity epidemic (yes, I do believe it is an epidemic) has two sole causes ...
1). Average Americans DO NOT move enough ... period ... and I didn't say exercise; I'm talking about general, every day movement.
2). The average America diet is full of so much junk, our bodies don't know how to effectively process it all anymore.
Bottom line ... our bodies can't process the food we eat and we aren't active enough to get rid of all the excess calories/fat that is consumed ... so now there are health issues including those discussed below and many, many more.
We don't really need more studies giving yet another excuse for obesity (just read one claiming that babies who are fed formula will have a higher chance of being obese -- both my kids drank formula at one time or another, in addition to breastmilk, and both are trim and healthy) ...
What Americans need to do is eat better and move more ... regardless of life circumstances ... it's got to be a priority for everyone. This goes for adults AND kids alike. As Dr. Chet puts it at the end of his article ... Americans need to 'get off the couch and get moving'!!!
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Heart of a Couch Potato
Yesterday (Feb. 4th) was National Wear Red Day® to support women’s heart disease awareness—I hope you remembered to wear red. Because February is American Heart Month, I’m going to do every message on a topic related to heart health this month. The reason is simple: if your heart stops beating, you’re dead. No other aspect of your health really matters at that point because you’re not going to be here anyway. Let’s see what we can do to prevent that from happening.
I’m going to start with a recently published study on television watching, heart disease, and death (1). If this doesn’t at least get you thinking about getting off the couch, I can’t think of anything that will.
The Study
Researchers wanted to see if there was a relationship between watching television and all-cause mortality and CVD events—both fatal and nonfatal combined. Experienced interviewers assessed how much time subjects spent watching television per day and how much time they spent in moderate- to vigorous-intensity physical activity.
The Subjects
Subjects were part of the Scottish Health Survey 2003. Researchers recruited 4,512 men and women 35 and older. The subjects were followed up through 2007 (so far). There was no intervention in this study—the subjects were just tracked after providing the initial information.
The Goal
The researchers wanted to see if there was any relationship between the time spent watching television and the death and illness rate from heart disease. They also wanted to see if BMI, inflammation, and serum lipids could explain any increase in heart disease and mortality.
The Results
This will probably come as no surprise: as the time spent watching television increased, so did death from all causes and the rate of heart disease. There was a 52% increase in mortality for those subjects who watched television four hours or more when compared to those who watched it two hours or less. The increase in the rate of heart disease was even more dramatic. If you watched television four hours or more, you had a 130% increase in cardiovascular disease.
Researchers also found that the couch potatoes had a higher C-reactive protein, a higher BMI, and a lower HDL-cholesterol. Those measures are all indicators of an increased risk of heart disease.
The Bottom Line
A sedentary lifestyle is a prime risk factor for cardiovascular disease and an increased risk of death from all causes. For too many people, watching television is the only prime-time activity. Just because the research compared the highest group with the lowest, don’t think that up to two hours per day is fine. The study was about four years long, so we’ll see what happens as the study follow-up continues. It could be that consistently being less sedentary such as watching television for only two hours every night all year long might be just as bad or worse than watching four hours or more for a short period of time.
The lesson for you? Get up off the couch and get moving.
What are you prepared to do today?
Dr. Chet
Reference: J Am Coll Cardiol, 2011; 57:292-299, doi:10.1016/j.jacc.2010.05.065.
Multivitamins, Part 4
Here is the 4th and final installment of the Multivitamin analysis article written by Dr. Chet Zelasko ... hope you've enjoyed reading his thoughts and opinions!! While all the info was great to read, this last article includes good info for choosing a multivitamin, which I think is quite important and helpful -- not something to take lightly, according to our author. Let me know what you think of the series
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Multivitamins, Part 4
Today’s message is the final part of my analysis of the Prevention magazine article titled “Should You Kick the Multivitamin Habit?” by Sarah Mahoney (1). The article was more sensational than sound as I’ve tried to show in the past three Saturday messages. Was there any merit to the article at all? I think there was, and that’s what I’m going to cover in my final comments on the article.
What and Why
I’ve answered thousands of questions on supplementation from people all around the world. The most important question I ask them is this one: What supplements are you taking and why? If you don’t have a solid answer to that question, you shouldn’t be taking it.
When it comes to a multivitamin-multimineral, the reason is relatively simple: you take it to make up for the nutrients not found in the foods we eat. You should have that type of answer for every supplement you take; it doesn’t have to be the answer that I’d give, but you should have some idea.
Here’s another reason. Some vitamins are added to foods that you might typically eat; if you’re also taking it in supplement form, the
re is the possibility that you may exceed the Tolerable Upper Limit (UL) set by the Institute of Medicine.
Folic acid is the best example. It’s been added to grain products for over 10 years to reduce the risk of neural-tube birth defects. Recent research has shown that it seems to be working. But if you were to eat fortified cereal and breads every day, take a multivitamin with folic acid, and take another supplement with folic acid in it, you could surpass the UL which is set at 1,000 mcg/day. That doesn’t mean it will be harmful, but it does raise the fact that all sources of vitamins contribute to the total. I don’t believe it’s a serious issue, but it is a valid one, so know what you’re taking and why.
Take a Plant-Based Multivitamin
Dr. Neuhouser, the lead author of one of the papers cited in the study, makes this statement:
The vitamin C in a multivitamin is likely just not as effective as the vitamin C in a citrus fruit where it’s also surrounded by fiber and flavonoids and carotenoids. All these nutrients working together are what really keep you healthy.
I’m not sure I agree that vitamin C by itself is not effective, but the rest of the statement is right on target. Dr. Neuhouser was talking about eating food, of course, and we all should eat as many vegetables and fruits as we can. But unintentionally, she supported taking a multivitamin-multimineral with whole-plant concentrates, which is the fruit or vegetable minus the water and the fiber but with all the phytonutrients. That’s the single most important thing to look for when you take a multivitamin-multimineral or most vitamin or mineral supplements for that matter: it should contain whole-plant concentrates. In that way, the chemicals that are naturally found along with the vitamins and minerals will be there to help the vitamins and minerals do what they do to benefit your health. You’ll pay a little more, but how much is your health worth? Generally it’s better to take a lower quality supplement than none at all, but invest in your health by always buying the best you can.
The Bottom Line
I hope this series has helped you understand the arguments raised in that Prevention article. One key problem with the article’s assumptions is that at the end of the day, the experts still haven’t proven one important thing: that the foods that we eat actually have the nutrition they claim they have. Everyone says it, but no one proves it—but that’s an article for another day. For now, you should supplement your diet with a high-quality multivitamin-multimineral that contains whole-plant concentrates. I do, and so does the rest of my family.
What are you prepared to do today?
Dr. Chet
Reference: Prevention. November 2010: 52-59
Multivitamins, Part 3
So, I've decided that this weekend I'm going to post the final 2 parts of the 4-part Multivitamin article that I've posted recently ... to find parts 1 & 2, just type "Dr. Chet" or Multivitamins" into the search bar and they should then appear in the results. The reason for posting the final 2 parts is that I have some other ideas I really want to get to for my Healthy Home posts on Thursdays.
That said, here's part 3 ... enjoy
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Multivitamins, Part 3
In the Prevention magazine article titled “Should You Kick the Multivitamin Habit?” written by Sarah Mahoney (1), the author suggests that research has shown that multivitamins do no good and in some cases may be harmful. I examined two of the largest studies talked about in the article to see if the research backs up the comment.
To repeat, my position is simple: I think we should all take a high-quality multivitamin-multimineral every day because even if we eat a great diet, we just don’t know which nutrients are and are not in the foods we eat due to wide varieties in time of harvest, methods used to preserve food, variations in soil content, storage methods at the central distribution hub, how far the food travels to reach you, how long it sits before you buy it and eat it, and how you prepare it. There are many opportunities for foods to lose nutrition between the farm and your table, so a little nutritional insurance every day is a good backstop. That’s my starting position, so let’s see whether there’s merit or not to this portion of the Prevention article.
Claim: Multivitamins Do No Good
There were two sources for this statement. I reviewed the longest study in last week’s message. In the second study, the statement that multivitamins do no good was the result of a study published in the Archives of Internal Medicine on data collected from the Women’s Health Initiative (2). This study was started almost 20 years ago and has several parts. Three are intervention studies that look at hormone-replacement therapy, calcium supplementation, and diet modification; the other is an observational study. Combined the studies include over 161,000 women.
Researchers collected d
ata on supplement use for all women. After eight years, they collected data on how many women were diagnosed with cancer and cardiovascular disease (CVD). They reported that there was no statistically significant reduction in the rate of any type of cancer or heart disease. Actually, what the researchers really said was much stronger: this study provided convincing evidence multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.
That’s a pretty dramatic statement. Does the data support the statement? Let’s take a look. I’m going to focus on breast cancer and heart attacks because those had the highest number of cases. While there was no statistically significant difference in the rate of breast cancer in the women who took multivitamins versus those who didn’t, there were differences that might have been more profound with a longer follow-up time. Compared with no vitamin intake, those women who took only a multivitamin had a 5% increased risk, women who took a multivitamin-multimineral had a 3% lower risk, and those who took a stress multivitamin (high amounts of B vitamins) had a 6% lower risk of developing breast cancer over eight years.
When it came to heart attacks, there was a 6% increased risk with just a multivitamin, 4% reduced risk using a multivitamin-multimineral, and a 25% reduced risk using a stress multivitamin. Statistically significant or not, there’s some information there that shows that a multivitamin-multimineral or stress multivitamin may have some protective effect. It also shows that taking vitamins alone probably needs to be balanced with minerals.
I had several issues with the research report besides the interpretation of the analyses. The researchers went to great pains to collect the actual labels of the supplements that the women were using. Why didn’t they examine the nutrient combinations in each multi? If you collect the data, and it’s stored electronically, in the age of high-speed computers, it wouldn’t be hard to generate patterns of nutrients that might be better than others. Why collect it if you’re not going to use it?
They also used an odd way of determining who took multivitamins. If a woman took the supplement just once a week, they were included in the “Uses Multivitamin” category. It strikes me that if you’re going to such pains to collect this type of data, you could determine the actual number of times per week the women took the supplements and analyze data by days of use per week. Taking a supplement once a week is like eating a high-fat diet all week and eating fruit one day—what’s the point? That one day shouldn’t mean you’re included in any type of analysis for regularly eating fruit.
There’s one more point. If you look at the 10-year risk of women 50 to 69 getting diagnosed with breast cancer, it’s about 2.5% according to the National Cancer Institute. The rate in the study for eight years was about 0.44%. Why would the risk of this population of women be so low in relation to national statistics?
Claim: Multivitamins May Do Harm
The primary study used for this conclusion in the Prevention article was the Swedish Mammography Study (3). Women were tracked for 9.5 years and divided by those women who used multivitamins and those who did not. Over that time, 974 women developed breast cancer. In the group who did not take multivitamins, 681 women developed breast cancer for a risk of 0.27%. In group who did take multivitamins, 0.34% of the women developed breast cancer. The increase risk of taking the multivitamin was 19%. Another way of looking at the numbers is that over 9.5 years, six additional women out of 10,000 could be diagnosed with breast cancer if they took a multivitamin.
That’s not really the point. One could argue that every case of breast cancer or CVD or any type of disease is serious, and we certainly shouldn’t do anything to promote disease. Fine. But again in this study, why is the 10-year risk of getting breast cancer so low? Remember, the NCI says it’s 2.5% for women in this demographic, and there’s really no difference between Sweden and the U.S. or Canada in the rate of developing breast cancer. When the incidence of breast cancer in the study is so out of line with overall rate outside the study, I have to wonder why.
Lies, Darn Lies, and Statistics
Mark Twain attributed this saying to 19th Century British Prime Minister Benjamin Disraeli: “There are three kinds of lies: lies, damned lies, and statistics.” Many people distrust statistics, believing they’re used to manipulate public opinion. That no doubt happens occasionally, but in any case, statisticians seem to speak their own language.
For example, in everyday life significant means important; in statistics, significant means true. The term “statistically significant” is a threshold a study’s results must pass to be considered valid and not possibly due to chance or an unusual event. And even if a result meets the test of significance, it can still be unimportant in real life. Let’s say a study shows that husbands can get ready to go to a party faster than wives can. So what? Nobody’s 
leaving until they’re both ready.
In the case of these studies, by saying the results aren’t statistically significant the researchers are saying the differences in the two groups may be due to chance—good luck or bad luck. However, it still gets reported and published as if the studies proved something.
Statistical significance is a moving target; the bigger the subject group, the lower the number that must be reached to show significance. Because of the low number of subjects using the stress multi, even a 25% reduced risk of CVD didn’t meet the test to be statistically significant. For those of us who aren’t statisticians, it’s hard to imagine that large a reduction is just luck. If you look at the results of the study and decide that a stress multivitamin-multimineral is probably a good investment—well, I can’t argue with that logic.
The Bottom Line
Two points. First while CVD and breast cancer are important risks for women, regular supplementation has many, many beneficial effects that are also important. And when surveyed, women say their primary reason for taking a multivitamin is to feel better; reducing disease ranks third. No one should make a decision on taking supplements without considering all the pros and cons. For more on this topic, see the Research Update in the Basic Health Info section of drchet.com called Women and Multivitamins.
Second, I don’t think either study provides compelling evidence that the use of a multivitamin-multimineral will have no effect or a negative effect on cancer or heart disease. The Women’s Health Initiative collected data they didn’t use and defined regular supplement use in a very curious way. The Swedish Mammography Study didn’t collect enough data about the multivitamins to know if there could be any pattern. These types of large studies could have at least answered how many days of the week a woman took her vitamin supplement and what made up the supplement. Because neither study did something so basic, the results are rendered suspicious if not plain meaningless.
What are you prepared to do today?
Dr. Chet
References:
1. J Natl Cancer Inst. 2010 Apr 6 Online First.
2. Arch Int Med 2009;160(3):294-301.
3. Am J Clin Nutr 2010;91:1268-72.
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