Is TMAO from Fish, Meat and Eggs Harmful?

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In another confusing nutrition story that should be titled “is there anything left for us to eat?” recent research threw a curveball. Fish, a staple of the Mediterranean diet, as well as meat and eggs may be doing more harm than good thanks to a compound called trimethylamine-N-oxide (TMAO). TMAO is found in fish and produced in the body after eating meat and eggs. TMAO is linked to greater risk for heart attack, stroke and death; yet the research isn’t crystal clear. Is it time to give up fish meat and eggs or ignore the recent media headlines?

This post will cover:

  • TMAO: More than a Gut Reaction—What gives us higher TMAO levels?
  • TMAO and health?
  • The bottom line

TMAO: More than a Gut Reaction

Blood levels of TMAO are ~ 50 times higher after eating fish compared to eggs or beef. The human body absorbs intact TMAO like the kind found in fish, easily. However, the human body’s production of TMAO, after eating foods containing the essential nutrient choline (found in eggs and meat) and the compound l-carnitine (found in meat and pork and in much smaller quantities in chicken breast and dairy products), depends on the makeup of bacteria in your gut, kidney functioning and genetics.

In one study, regular meat eaters produced more TMAO than a vegetarian did after eating steak (which contains ~ 180 mg of l-carnitine). After wiping out their gut bacteria with antibiotics, the carnivores didn’t produce any TMAO after consuming 250 mg l-carnitine. The makeup of gut bacteria in the habitual meat eaters was presumably responsible for greater TMAO production compared to the vegetarian, yet this was a small study and we don’t know anything else about the participants’ diet. Was it the meat that altered gut bacteria or something else in their diet? After all, a steady diet of red meat may mean double cheeseburgers on white bread with regular servings of French fries and soda on the side. This isn’t exactly the diet you want for promoting good bacteria in your gut.

Another study found blood levels of TMAO were greater in those with a less diverse makeup of microbes and greater amounts of a less healthy type of bacteria (firmicutes), compared to one that is healthy (bacteroidetes). A diet higher in saturated fat will promote this environment.

While bacteria seem to influence TMAO production from l-carnitine, l-carnitine also influences the makeup of gut bacteria. A study in mice found those with their gut bacteria wiped out thanks to antibiotics produced a different makeup of bacteria in the gut after consuming l-carnitine while also doubling the risk of plaque buildup in their arteries.

Higher TMAO levels come from:

  • Eating fish
  • Less diverse array of gut bacteria and increased levels of bad versus good bacteria
  • Consuming l-carnitine (mouse study)

TMAO and Health

A few human studies found higher blood levels of TMAO were associated with greater risk for heart disease. However, all research isn’t pointing in the same direction. One study in over 300 patients found blood TMAO levels were not associated with heart attack or heart disease over the course of eight years, following the initial test for TMAO. However, TMAO levels were higher in those with diabetes, patients with metabolic syndrome and those with declining kidney functioning. Another study examined over 800 people between the age of 33 and 55 and found blood TMAO levels were not associated with clogged arteries, insulin resistance (this comes before type 2 diabetes) and inflammatory markers or negative changes in blood lipids suggesting TMAO levels might not contribute significantly to the progression of clogged arteries. However, this study shows TMAO levels were significantly lower than in previous research, showing an association between TMAO and heart disease.

TMAO is considered a risk factor for cardiovascular disease. In those with type 2 diabetes, higher TMAO levels are associated with greater risk for death, heart attack, heart failure and unstable angina (chest pain). Also, higher levels of circulating TMAO are associated with higher risk of death in those with chronic kidney disease and greater risk of certain cancers. Yet, there are several confounding factors. Fish is the primary culprit for higher acute circulating TMAO levels, yet fish-based diets are associated with reduced risk for heart disease. Also, levels of TMAO are dependent upon disease state and the makeup of gut bacteria. Therefore, at this time it isn’t entirely clear which came first – does TMAO cause disease or does TMAO increase due to disease?

The Bottom Line

The story on TMAO isn’t crystal clear, so there’s no reason to avoid fish, meat and eggs in an effort to decrease TMAO levels. All three of these foods are good sources of several nutrients important for health. Though processed red meats are linked to higher risk of colorectal and stomach cancers, when cooked appropriately (lower, moist heat for example) red meat can fit into a healthy diet and deliver important nutrients including iron, zinc and vitamin B12. Eggs are an economical source of protein and contain many nutrients and compounds that contribute to health including two antioxidants important for eyesight.

Though there is no reason to completely avoid these foods, you can alter your diet to help diversify gut bacteria and also increase the amount of good versus bad bacteria. Probiotic rich foods such as yogurt and kefir with live and active cultures, miso soup, tempeh and other fermented foods contain good bacteria. Fiber-rich plant foods (fruits, vegetables, legumes) are important food sources for bacteria to thrive in your body.

Disclosure: this post was sponsored by USFRA. All views are my own and backed by research.

References
Koeth RA, Wang Z, Levison BS et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 2013 Apr 7.

Cho CE, Caudill MA. Trimethylamine-N-Oxide: Friend, Foe, or Simply Caught in the Cross-Fire? Trends Endocrinol Metab 2016 Nov 4. [Epub ahead of print]

Cho CE, Taesuwan S, Malsheva OV, Bender E, Tulchinsky NF, Yan J, Sutter JL, Caudill MA. Trimethylamine-N-oxide (TMAO) response to animal source foods varies among healthy young men and is influenced by their gut microbiota composition: A randomized controlled trial. Mol Nutr Food Res 2016 Jul 5.

Carnitine. Health Professional Fact Sheet, NIH. https://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/

Mueller DM, Allenspach M, Othman A, Saely CH, Muendlein A, Vonbank A, Drexel H, von Eckardstein A. Plasma levels of trimethylamine-N-oxide are confounded by impaired kidney function and poor metabolic control.Atherosclerosis 2015;243(2):638-44.

Meyer KA, Benton TZ, Bennett BJ, Jacobs DR Jr., Lloyd-Jones DM, Gross MD, Carr JJ, Gordon-Larsen P, Zeisel SH. Microbiota-Dependent Metabolite Trimethylamine N-Oxide and Coronary Artery Calcium in the Coronary Artery Risk Development in Young Adults Study (CARDIA). J Am Heart Assoc. 2016 Oct 21;5(10). pii: e003970.

The Truth about Cage-free, Free-range, No Antibiotics, Humanely Raised

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Nutrition claims are confusing. How do you know if you should pay more for a carton of eggs or package of meat based on a claim on the package? Is it legit, or made up by a marketing team to make their food stand out from competitive products on grocery store shelves? This post will help you sort through the confusion on common food claims including cage-free, free-range, antibiotic-free and differences in egg quality scores so you can choose which option is best for you.


free-range, cage-free eggs

Eggs: Cage-Free, Free-Range & AA, A and B Quality

Cage-free (eggs) – “cage-free” refers to the environment the hens (hens lay eggs) live in. Cage-free hens are housed in an environment allowing unlimited access to food, water and freedom to roam. There is no known nutrition difference in eggs produced by hens that are cage-free versus those that are not cage-free1.

AA quality eggs – the shells must be “clean, unbroken and practically normal.” Also, the white must be clear and reasonably firm, with a clear distinction between white and yolk. The yolk must be free from apparent defects. The air cell—the part of the egg that separates the inner shell membrane from the outer shell membrane—for AA quality eggs must not exceed 1/8 inch2.

A quality eggs – the only difference between AA and A quality eggs is the air cell. The air cell for A quality eggs must not exceed 3/16 of an inch2.

B quality eggs – the shells must be unbroken, but may be abnormal or have slightly stained areas. Shells with prominent stains or dirt are not permitted. The egg white can be weak and watery, while the yoke may be dark and large and flattened. Small blood or meat spots may be present2.

Meat and Dairy Claims

Pasture-raised, free-range, free-roaming – the animals have continuous, unrestricted access to pasture (land covered with grass and other plants) throughout their lives. Cattle and sheep must not be confined to a feedlot. Pigs must have continuous access to pasture for at least 80% of their life. You might see “free-range – never confined to feedlot,” on your meat3.

Antibiotic-free or No Antibiotics – all meat, milk and other dairy products are free from antibiotics. Therefore, a package of meat that says “antibiotic-free” is no different from the one next to it that does not carry this claim. When an animal is on antibiotics, their milk is not sold, and they cannot be slaughtered for meat. Instead, the farmer must wait until all traces of medication have cleared the animal’s body before the cow can be milked or the animal can be sent for slaughter. For more on this topic as related to milk, click here.

Humanely raised – this term makes me think of a farmer who knows each animal by name; pets and cares for them daily while attending to their needs. However, this isn’t the case. “Humanely raised” is a term made up by food companies. There is no formal definition and therefore, it is up to the food company to decide what they consider humanely raised. Ignore it. 

Naturally raised – there is no official definition for naturally raised. Therefore, this claim could mean anything. Ignore it.

Grass-fed – there is no universally accepted, standardized definition for the term grass-fed. All cows, sheep and goats eat grass for most of their lives. However, some of these animals are grain-finished—they spend several months on a grain-based diet until they reach their ideal weight. At this time, their diet consists of grains, grass, vitamin and mineral mixes, citrus pulp and other feed as determined by an animal nutritionist based on their dietary needs. Other animals are grass-finished, they consume grass their entire life, and may be given vitamin and mineral mixes as needed. There are no nutrition differences between grain-finished and grass-finished meat.

Food is a very competitive business. Consumers may choose a product based on a variety of factors including great packaging, superior taste and good nutrition value. Food claims may sway your decision; however, be sure you’re getting what you are paying for. Look for claims that are backed by a standardized definition, versus those with no definition.

This post was sponsored by USFRA, all views are my own.

References

  1. Questions and Answers About Shell Eggs. USDA Agricultural Marketing Service.
  1. United States Standards, Grades and Weight Classes for Shell Eggs AMS 56. USDA.
  1. Federal Register. Vol. 67, No. 250. United States Standards for Livestock and Meat Marketing Claims. 67 FR 79552. Federal Department of Agriculture.

Is Saturated Fat Good for You?

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Though largely driven by misinterpretation of the science and cherry-picked population studies, the “Butter is Back” movement comes with very persuasive sound bites followed by arrogant punctuation marks. No wonder so many people hopped on board the bandwagon while looking back, pointing fingers and shouting “health professionals have been misleading us for decades!” Yet the flawed reasoning behind the pro-saturated fat movement comes with a hefty price tag – you could be making food choices that, over time, will increase your risk for cardiovascular disease and type 2 diabetes.

Here’s what I’ll cover in this article:

  • Why is there so much confusion about saturated fat?;
  • The science behind saturated fats, cardiovascular disease (diseases of the heart & blood vessels) and type 2 diabetes;
  • Best food choices for heart health.

Why is there so Much Confusion about Saturated Fat?

There are a few reasons for the confusion about saturated fat (fat that is solid at room temperature such as butter, shortening, coconut oil and the fat on meat) and misinterpretation of the science. First off, some people group all saturated fatty acids (saturated fatty acids make up saturated fat) together as a team. However, there are several types of saturated fatty acids. Some raise LDL cholesterol (the kind that contributes to clogged arteries and is a risk factor for cardiovascular disease) as well as HDL cholesterol (“good” cholesterol, the kind that removes bad cholesterol; SN: drugs that increase HDL do not lower risk of heart disease so there is some considerable debate regarding the role of HDL), others don’t raise LDL cholesterol and some we aren’t quite sure about. Secondly, using population-based studies alone to draw conclusions about saturated fat intake and heart disease is misguided.  These studies are not designed to determine cause and effect (that’s the job of well-designed clinical trials) plus, there are inherent issues with the methods used in many of these studies.  Nutrition research is not easy, especially in humans living their life (those not in a metabolic ward where all factors are controlled and measured including diet and physical activity).

Lastly, some research studies (and the media) take the results way out of context. So, here’s the lowdown based on sound science:

The Science Behind Saturated Fat, Cardiovascular Disease and Type 2 Diabetes

  • There is no dietary requirement for saturated fat. Your body can make all of the saturated fatty acids it needs.
  • Foods high in saturated fat typically increase total, HDL and LDL cholesterol. However, the impact dietary saturated fat has on increasing LDL-cholesterol (the kind that contributes to clogged arteries and an inflammatory cascade in arteries) may depend on the amount of polyunsaturated fat (PUFAs) in your diet (as well as the type of saturated fatty acids consumed).
  • In general, replacing saturated fat with polyunsaturated fat (and monounsaturated fat though there is less evidence for monounsaturated fat) reduces LDL and total cholesterol, both risk factors for cardiovascular disease.
  • saturated fat and cholesterolOverweight, obesity and insulin resistance may reduce the beneficial effects (lowered LDL cholesterol) generally noticed from a reduction in saturated fat intake. *If obese or overweight, losing excess body fat (regardless of the type of diet used to lose the weight) has powerful effects on lowering risk for cardiovascular disease, some cancers, and type II diabetes.
  • Food contains a complex mixture of compounds that may affect cholesterol and cardiovascular disease risk (it is not just the fat). The food “matrix” matters.
  • Many factors impact how a food affects cholesterol and blood lipids (fats) including fats eaten at the same time, overall diet, and carbohydrate intake (and type of carbohydrates consumed – high fiber vs. foods high in added sugar with few other nutrients).
  • There are individual, genetic differences in response to saturated fat intake – your cholesterol might shoot up after eating a diet containing a diet high in the type of saturated fatty acids that raise LDL cholesterol and I might be able to get away with this diet without a problem (blame your genetics or consider it an opportunity to open your taste buds to foods containing less saturated fat; particularly the kind that is artery clogging).
  • Certain saturated fatty acids, or a diet high in saturated fat, may increase risk for type 2 diabetes.

Best Choices for Heart Health

If you are overweight, focus on losing excess body fat. Even small amounts of fat loss will improve health and risk factors for cardiovascular disease. If you have high total and LDL cholesterol, swap foods high in saturated fat for foods high in polyunsaturated fat (liquid oils, nuts, seeds, olives, avocados). Minimize your intake of foods high in added sugars and refined, white flour, carbohydrates. Instead, choose higher fiber carbohydrates as often as possible.

Don’t get sucked into the media headlines written by journalists who could sell ice to an eskimo. Butter isn’t back (for good health anyway). The bulk of your fat intake should still come from foods that are higher in polyunsaturated and monounsaturated fats. However, food is a complex matrix of compounds and therefore, some foods higher in saturated fat may have little to no impact on cholesterol and therefore fit into your diet while contributing to your vitamin and mineral needs and providing plant-based compounds important for good health.

References

Tholstrup T, Hoy CE, Andersen LN, Christensen RD, Sandstrom B. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr 2004;23:169–76.

Nestel P. Effects of Dairy Fats within Different Foods on Plasma Lipids. J Am Coll Clin Nutr 2008, 27(6): 735S–740S.

Hodson L, Skeaff CM, Chisholm WA. The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults. Eur J Clin Nutr 2001; 55(10):908-15

Soerensen KV et al. Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men. Am J Clin Nutr 2014;99(5):984-91.

 

Save Money at the Grocery Store, Improve Health & Save the Earth

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Food: Fruits and vegetables

 

 

Today is Earth Day, a day focused on building a healthy, sustainable environment. Keep the earth healthy, slash your grocery bill and improve your health at the same time. Here’s how:

Avoid Food Waste

In America, food is cheap and always available. This oversupply of food combined with food marketing means we over buy and end up throwing out an average of 31 – 41% of the food we purchase. In addition to throwing your hard earned dollar in the trash can, food waste drains the environment. Rotting fruits and vegetables, the top food wasted, uses fresh water and contributes to ethylene gas, methane and CO2 emissions all of which are harmful for our environment (1). “Food waste now accounts for more than one quarter of the total freshwater consumption and ∼300 million barrels of oil per year” (1). Rotting food produces a large amount of methane gas, a gas that has 25 times the impact of CO2 on global warming (3). Dairy products are second behind fruits and vegetables followed by meat, which has the biggest impact on the environment.
Here’s what you can do to avoid waste:

    1. Use a shopping list to prevent impulse buys. It doesn’t matter if it’s on sale if you will end up throwing it out.
    2. Buy small amounts and only what you need and will realistically use before it goes bad.
    3. Buy frozen and canned versions, which have the same nutrition value and you can use them at your convenience (metal cans are endlessly recyclable)
    4. Keep fruits and vegetables fresh or for longer period of time with products that decrease the production of ethylene gas (find them in your local natural food store in the produce section).
    5. Don’t automatically throw food out when the “use by” date arrives. That date is a measure of quality and not food safety. Assess your food to ensure it is still safe (smell your meat, poultry, fish, dairy, nuts and oils; make sure fruits and vegetables are not molded).
    6. Follow these tips from Reader’s Digest.

Choose Plant Proteins

Plant proteins typically cost less $ than meat, fish and poultry and they cost less in terms of environmental resources to produce – less water, fewer environmental gases produced. Plant proteins also deliver plant-based compounds that protect the body. When choosing plant proteins you may need more, per meal, to get the right amount of muscle building amino acids.  In addition to swapping out some meat-based meals, consider eating smaller amounts of meat and adding a plant protein as a side dish. Here are some excellent choices based on their nutrition profile:

  • Peas, split pea soup
  • Legumes, beans, bean pastas, lentils (I soak lentils for about 45 minutes and add them to a variety of dishes)
  • Soy foods including tofu, tempeh, edamame
  • Nut, bean and other flours –  substitute some of the flour in your  recipe for: pecan, peanut, almond, garbanzo bean, fava bean, black bean and other higher protein flours

Buy Staples in Bulk

Whole Foods, Sprouts, Wegmans and similar stores have a bulk section where you can get everything from black rice to oatmeal. Consider shopping in the bulk isle. You’ll save $ and food packaging!

Grass Fed Lies: The Truth about Organic Milk & Grass Fed Beef

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Grass fed meat

If you’ve been sucking up the extra cost of organic dairy products and grass fed beef, comforted by the fact that you’re doing what’s good for your body, I have some news for you: you’ve gained little more than peace of mind grounded in a marketing scam. There is no meaningful nutrition difference in organic milk, grass fed beef and their conventional (non organic / grass fed) counterparts.

The Truth about Organic Dairy

Organic milk is packed with omega-3 fatty acids, iron and vitamin D, according to an article published Feb. 16 in the British Journal of Nutrition. This meta-analysis examined the results from 170 published studies comparing the nutrient content of organic milk with conventional milk. They suggest organic milk wins by a landslide: it’s nutritionally superior to its conventional counterparts. Though there were no significant differences in saturated fat and monounsaturated fat in organic vs. conventional milk, organic milk has 56% more beneficial omega-3 fatty acids, 41% more conjugated linoleic acid (CLA), significantly more vitamin E and iron than conventional milk. Statistically speaking, they are scientifically correct. Nutritionally speaking, these differences are meaningless.

Organic milk contains 56% more omega-3 fats than regular (conventional) milk (56% more based on the total fat content). However, statistically more than a little bit is still a little bit. Milk is not considered a major source of omega-3 fatty acids in the diet, regardless of milk type. In fact, according to one study, 1 cup of organic whole milk has about 8.2 mg of the omega-3 fatty acid eicosapentaenoic acid (EPA) and 11 mg of docosahexaenoic acid (DHA) compared to 6.2 mg of EPA and 9.1 mg of DHA. That’s a far cry from the 250 – 500 mg of EPA + DHA we should get, on average, each day. Fatty fish are the best way to get EPA and DHA.

milk jug
Organic Milk:
19 mg EPA + DHA

Conventional Milk:
15 mg EPA + DHA

 

 

 

Salmon

Herring, Wild
Salmon, Farmed (Atlantic)
Salmon, Wild (King)
Mackerel, Wild

1,200 mg EPA + DHA

 

 

  • EPA and DHA are heart smart – they lower blood fats (triglycerides) and blood pressure. Plus they’re good for your brain and eyes.

What about CLA? CLA is group of polyunsaturated fatty acids found in meat and milk. There are many proposed benefits associated with CLA including changes in body fat with ultra high supplemental doses of CLA. However, the difference in CLA content is also biologically meaningless – 56 mg in a glass of organic whole milk and 47 mg in a class of conventional whole milk.

The British Journal of Nutrition research also showed slightly higher beta carotene and vitamin E in organic milk. These very small differences may be due to a host of reasons including seasonal variation and breed. Milk is not a major source of these nutrients, so this has no biological impact on human health. If you want iron, eat more red meat, fish and poultry or plant-based sources including beans, lentils and peas (eat these with a vitamin C rich food to increase the absorption of plant-based iron). For vitamin E your best bets are oils, nuts and seeds.

  • Key point: statistical significance ≠ biological relevance.

What about antibiotics and hormones in dairy? I covered that in another blog post. You can read more about it here.

Is Grass Fed Beef Better?

If you’re one of many Americans paying a premium for grass fed beef because it contains more omega-3s and less saturated fat than it’s unassuming conventional counterparts, it may be time to reconsider where you’re spending your grocery money.

The omega-3s in grass fed beef are different than the kind in fatty fish. Fatty fish and algae contain EPA and DHA. There’s a third omega-3 fatty acid, alpha-linoleic acid (ALA), found in plants including walnuts, soybeans, pumpkin seeds, flaxseeds and chia seeds. Grass fed beef contains ALA because flaxseeds are added to their feed. While EPA and DHA lower blood fats (triglycerides) and are tied to heart benefits, ALA does not lower blood fats and is not associated with the same heart health benefits. ALA rich foods also contain a variety of other bioactive compounds that may act independently or synergistically to improve cardiovascular disease risk factors (eat the whole food not just ALA). The human body can convert ALA to EPA and DHA but this conversion process is inefficient. Less than 4% of ALA is converted to EPA and less than 1% makes its way to DHA. ALA ≠EPA + DHA. A 5-ounce serving of grass fed beef contains a whopping 20 to 30 mg of ALA (slight variations in brands of grass fed beef based on the cow’s diet). The Adequate Intake for ALA is 1,600 and 1,100 grams per day for adult men and women, respectively. Eat grass fed beef and you’ll get 2 – 3% of the AI for ALA for men and 1-2% for women.

Grass fed beef and conventional beef have the same amount of saturated fat with some differences in the types of saturated fatty acids. The difference in CLA content of grass fed and conventional beef is tiny. According to a review from Dave et al. (Nutr J 2010;9:10), it ranges from 0.13 – 2.65 (grams CLA/100 grams of fat in the meat) in conventional meat and 0.43 – 5.14 (grams CLA/100 grams of fat in the meat) in grass fed beef depending on the cow and feed. So, you could be getting less total CLA in certain cuts of grass fed beef than conventional beef. 

What about the Bacteria in Conventional Beef?
You cook your beef right? Bacteria is killed during cooking. Moot point.

Is Grass Fed More Sustainable? What about Hormones and Antibiotics?
I will address this and other issues in the next post. Stay tuned….

Organic dairy products and grass fed beef come in beautiful, higher end packaging with natural hues of green and brown outlining their superiority to modest looking products that sit beside them on store shelves. If you love the taste, stick with your organic milk and grass fed beef. But don’t buy into the marketing hype.

References

Circulation 2011;123(20):2292-333.
British Journal of Nutrition 2016;115:1043–1060.
PLoS One 2013; 8(12): e82429.
American Journal of Clinical Nutrition 2001;74:612–9.
American Journal of Clinical Nutrition 1999;69:890–7.
British Medical Journal 1996;313:84–90.
American Journal of Clinical Nutrition 2009;89(5):1649S-56S.
American Journal of Clinical Nutrition 2006;83(6):S1526-1535.
PLoS One. 2013; 8(12): e82429.
Nutrition Journal 2010, 9:10.

 

 

 

 

Meal Planning Made Easy

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salmon with veggies

If you don’t have the luxury of eating in a cafeteria with a variety of options each day, it makes sense to plan your meals ahead of time. Doing so will save you time and money. If saving money doesn’t entice you, consider this: eating at home can help you lose weight. A study published in the Journal of the Academy of Nutrition and Dietetics found the average meal at 360 restaurant dinner meals examined contained 1,200 calories. If you choose to dine at an American, Italian or Chinese restaurant, that meal may cost you a whopping 1,495 calories. Don’t worry, I have no intention of having you replicate the instagram photos from fitness buffs who eat perfectly portioned bland-looking chicken, broccoli and brown rice twice a day, every day. Instead, I am an advocate for taste, variety, and better nutrition. Here are the 4 steps you should take to start planning better-for-you meals ahead of time:

1 – Take Inventory

Go through your cabinets, refrigerator and freezer at least once per month and throw out anything that is past it’s expiration date, freezer burned, molded, and stale or smells bad (smell your cooking oil too and if it doesn’t smell normal, toss it). Half-eaten anything that is more than a day old? Trash. This is also a great time to take inventory of what you have on hand.

2 – Stock Your Kitchen

After taking inventory, decide what you need (sticking to your grocery list will save you from impulse buys you don’t need after looking at your grocery store circular). Essential foods include shelf stable, refrigerator and frozen foods. I like the option of preparing a meal in 5 minutes or less. Frozen and canned items allow me to do this.

Shelf Stable:

  • Beans, lentils and legumes (tip: some lentils can be soaked for just 40 minutes and added to a wide variety of dishes from salads to spouse, stews and grain-based dishes)
  • Bread
  • Canned vegetables, beans, fish and chicken
  • Condiments including chicken, beef or vegetable broth, mustard, hot sauce and any other commonly used condiments
  • Cooking oil – get good quality cooking oil. Pay more for a brand you trust. Olive oil is the most adulterated food on the market so you do get what you pay for.
  • Nutrition bars
  • Nuts, nut butters and seeds (all can be refrigerated; opened nut butters should be refrigerated)
  • Popcorn, whole grain snacks
  • Protein powder
  • Rice, pasta, whole grains, cereals and other similar foods. Grab a few options that you can make in a just a few minutes including couscous. Also, vary your rice, pasta and whole grains – look for black, red or purple rice, bean pastas and more.
  • Soups (boxed, bagged or in cans)
  • Spices & seasonings (including salt and pepper). If you don’t use these regularly get dried spices or refrigerated spices in squeezable tubes.
  • Ziploc bags – these will come in very handy if you travel (always pack food and supplements to go)!

Fresh:

  • Dairy (milk, yogurt, cheese)
  • Eggs (consider egg substitutes for their shelf life)
  • Fresh vegetables and fruits
  • Fish, poultry, meat

Frozen:

  • Fish, poultry, meat
  • Fruit
  • Vegetables

3 – Menu Planning

There are a number of ways you can approach menu planning but one of the easiest ways is to center your meals around the protein rich foods you plan on eating. So for instance, if you choose chicken, lean ground beef and fish, you can center 7 meals on those three proteins. Or, if your week is hectic and you are very busy, you can plan meals around protein-rich foods that take just minutes to prepare such as canned tuna, eggs and rotisserie chicken.

After you pick your protein rich foods, decide on recipes or quick prep meals. You might want to do this by determining what perishable foods you have on hand and need to use. So, let’s say you have mushrooms in the refrigerator and chicken defrosting. If you don’t feel like eating chicken Marsala but you aren’t sure what else you can make with a little flavor, type these words in Google to get other meal ideas “chicken, mushrooms, recipe, quick, easy.” (Also check out Cookinglight.com’s “5 Ingredient Cookbook, Fresh Food Fast”)

After determining which meals you are eating each day of the week, write a shopping list by figuring out any extras you may need to buy and what staple foods you are out of. Be flexible with your list depending on the season and sale prices. Shopping in season often means you will not only get the best looking produce but you will save money too. So for instance, if your recipe calls for sweet potatoes but butternut squash is a steal – go for the squash.  When you make your shopping list, you can do it on an app, in the notes section on your phone, or the old fashioned way with pen and paper. I make mine in the order of the grocery store I am shopping in so I can cross items off one by one without having to scan the entire list to make sure I’m not forgetting something before I move onto the next section of the store.

If the weekly circular tempts you with sugary cereals, cookies and candies on sale, don’t pick it up. You won’t miss out on a bargain because you’ll figure out which healthy foods are on sale when you look for the items on your list – all stores flag these items for you.

Quick sample meal ideas:

  • Rotisserie chicken, 10 minute brown rice (or thawed and microwave brown rice from your freezer), frozen veggies
  • Rotisserie chicken wraps with hummus (spread the hummus on first) and any crunch veggies you desire (shopped carrots, cucumbers etc.)
  • Whole-wheat pasta, spaghetti sauce and frozen turkey meatballs with added veggies such as cooked (or steamed) mushrooms, squash, zucchini
  • Whole wheat pasta, canned tuna, light cream of mushroom soup (either made into a casserole and baked along with frozen peas, ½ cup milk and chopped onions at 400ºF for 20 minutes or you can heat up the soup and mix the ingredients together and eat it.
  • Canned tuna, light mayo, chopped celery and onions for a tuna sandwich.
  • Grilled salmon drizzled with lemon, asparagus and a sweet potato.

4 – Storing and Packing

You can freeze almost any food and reheat it easily. Even brown rice – just cook it, let it cool completely and portion it into zip-loc bags (make sure no air is in the bag) for later. Two important things to remember when freezing foods – freeze them in airtight containers and label them so you know what you made and when it was frozen. The longer you leave food in the freezer the greater the likelihood of texture and taste changes over time (sometimes resulting in freezer burn). Foods that freeze well include:

  • Breads
  • Canned foods (once out of the can of course)
  • Casseroles (keep in mind that mayonnaise and other cream sauces do not freeze well)
  • Egg whites (raw)
  • Grains, cooked
  • Granola (homemade or store bought)
  • Herbs, fresh
  • Nuts, seeds (these should not be kept opened on shelves for long periods of time as they can go rancid)
  • Cheese – some types freeze better than others
  • Fish, poultry, meat (raw meat and poultry freezes better than cooked meat and poultry because of moisture lost during cooking).
  • Fruit, though this must be completely dry and frozen in portions (unless you want it stuck together in big clumps). The texture may change so fresh fruit that is frozen may be best used when blended in shakes.
  • Sauces
  • Soups, stews, stock
  • Yogurt – if you want to eat it frozen. If it defrosts the consistency isn’t so great.

Thaw food in the refrigerator, a microwave or immersed in cold water only (in a leak proof plastic bag submerged in the water that should be changed every 30 minutes), not out on countertops or in kitchen sinks.

Recommended Freezer Storage Time (for quality only, frozen food is safe indefinitely if left frozen).

Food Months
Bacon and Sausage 1 – 2
Casseroles 2 – 3
Egg whites or egg substitutes 12
Frozen dinners 3 – 4
Ham, hotdogs, lunchmeats 1 – 2
Meat, uncooked roasts 4 – 12
Meat, uncooked steaks or chops 4 – 12
Meat, uncooked ground 3 – 4
Meat, cooked 2 – 3
Poultry, uncooked whole 12
Poultry, uncooked parts 9
Poultry, cooked 4
Soups and stews 2 – 3
Wild game, uncooked 8 – 12

See, that wasn’t so tough! Get started planning, preparing and cooking right away. If there are a limited number of dishes you feel comfortable cooking, check out quick and easy cookbooks or resources on line. Each time you try a new recipe you’ll expand your horizons and taste buds and also be able to prepare a wider variety of meals on the fly in the future.

References
USDA. Freezing and Food Safety. http://www.fsis.usda.gov/factsheets/focus_on_freezing/

 

Does Meat Cause Cancer?

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According to a report released today, processed meat is carcinogenic (cancer causing – see the definition below for more detail). After considering more than 800 studies examining the association between meat and cancer, the World Health Organization’s International Agency for Research on Cancer (IARC) Working Group classified processed meats as Group 1, carcinogenic. They based this on convincing evidence from population based studies that eating processed meats causes colorectal cancer. Yet the results aren’t as crystal clear as they seem.

What is Red Meat and Processed Meat?

Red meat – unprocessed mammalian muscle meat – beef, pork, veal, lamb, mutton, horse or goat meat, including minced or frozen meat

Processed meat – meat that is transformed through salting, curing, fermenting, smoking or other processes to preserve the meat and enhance flavor. Processed meats can include other meats or meat byproducts such as blood. Hot dogs, sausages, corn beef, beef jerky and canned meat are all examples of processed meat.

Carcinogenic – compounds that are carcinogenic “do not cause cancer at all times, under all circumstances. Some may only cause cancer in people who have a certain genetic makeup. Some of these agents may lead to cancer after only a very small exposure, while others might require intense exposure over many years,” states the American Cancer Society.

What they Found

Processed Meat:
Though they considered 800 studies, their conclusions were drawn upon 18 cohort studies (this is when scientists follow a group of people that don’t have the disease – in this case cancer – over time to see who does and who doesn’t develop cancer). Twelve of the 18 studies reported positive associations between processed meat consumption and colorectal cancer. Six out of 9 case-control studies (where they look at the diet of people with cancer and compare it to the diet of people without cancer) reported a positive association and a meta-analysis (statistical approach to combining results from several studies) of 10 cohort studies reported a statistically significant dose-response relationship with an 18% increase in risk for every 50 gram (1.5 oz. or about the size of ½ of a deck of cards) of processed meat eaten daily. Yet Dr. Kurt Straif, Head of the IARC Monographs Programme stated “for an individual, the risk of developing colorectal cancer because of their consumption of processed meat remains small, but this risk increases with the amount of meat consumed.” Recent estimates suggest approximately 34,000 cancer deaths per year can be attributed to diets high in processed meats.

Red Meat:
The Working Group classified red meat as “probably carcinogenic to humans” while stating there is “limited evidence in human beings for the carcinogenicity of the consumption of red meat.” If those two statements sound like they contradict each other, here’s why:

The largest body of data they found was from 14 cohort studies (where they follow a group of people that don’t have the disease – in this case cancer – over time to see who does and who doesn’t develop cancer). Seven of the 14 studies showed higher consumption of red meat (as compared to lower consumption of red meat) was positively associated with colorectal cancer. Seven out of 15 case-control studies (where they look at the diet of people with cancer and compare that to the diet of people without cancer) found higher consumption of red meat was positively associated with colorectal cancer compared to lower intake of red meat. “No association was seen in  several high quality studies.” The author suggests that bias and confounding couldn’t be ruled out (other diet and lifestyle variables may have affected the results.

What Makes Processed Meat Carcinogenic?

When meat, fish, or poultry (chicken, turkey, ducks, geese) are cooked over high temperatures, chemical compounds that are known or suspected carcinogens (cancer causing) including N-nitroso-compounds (NOC), polycyclic aromatic hydrocarbons (PAH), advanced glycation end products (AGEs) and heterocyclic aromatic amines (HCA) are formed. High and dry heat including frying, grilling and barbecuing are the worst combination for the production of these chemicals. The 2-page report mentions some of these compounds as “mechanistic evidence” supporting their conclusions while also stating that we don’t know how cancer risk is increased by processed and red meat. (The full report won’t come out for several months).

N-nitroso-compounds (NOC) are found in nitrate-cured meats, smoked foods (fish or meat), malt in beer and whiskey production, pickled vegetables and foods stored under humidity leading to fungi that generate nitrosamines.

Polycyclic aromatic hydrocarbons (PAH) are formed when fat and juices from meat grilled over an open flame drip onto the fire, resulting in flames, and PAHs adhering to the surface of the meat. Smoking meats also leads to the formation of PAHs. PAHs are also found in air pollution.

Advanced glycation end products (AGEs) are harmful compounds formed during dry heat cooking. Though many foods contain AGEs, meats fried or cooked over dry heat have significantly more AGEs than any other food. AGEs accumulate in the human body, affect cell functioning and may contribute to insulin resistance, type 2 diabetes and, as the name implies, aging.

Heterocyclic aromatic amines (HCA) are formed when amino acids, sugars and creatine react at high temperatures. When meat, fish, pork and poultry are cooked at higher temperatures for a longer period of time, more HCAs are formed.

HCAs and PAHs must be metabolized by specific enzymes (a process called bioactivation) before they can damage DNA. Yet the activity of these enzymes varies between people and therefore, one’s risk of developing cancer due to HCA and PAH exposure depends on how they metabolize these compounds.

What this Report Does Not Tell Us

IARC Working Groups examine if exposure to a specific food or compound could cause cancer but does not tell us how likely we are to get cancer. Also, there are many known human carcinogens (UV light – including the UV light in those LEDs lights used to set gel nails, alcohol, the mineral oil you use on wood cutting boards and more) – some many cause cancer after little exposure while others take a lifetime of exposure. Many factors influence the development of cancer including age, gender, family history, and other lifestyle factors (tobacco and alcohol use, weight, diet, physical activity).

How Much Processed & Red Meat is Too Much?

Cancer is a complex disease and no single food causes, cures or prevents cancer. However, as stated by the American Institute for Cancer Research (AICR):

  • A modest amount of red meat does not raise colorectal cancer risk.
  • Eating more than 18 ounces of cooked red meat per week increases the risk of  colorectal cancer.
  • Eating small amounts of processed meat regularly increases risk (of colorectal cancer).

AICR recommends avoiding processed meats and eating no more than 18 ounces of red meat per week (3 oz. = about the amount in a deck of cards). I also suggest making potentially better choices (see the infographic below and the 2nd to last paragraph of this blog post). What about HCAs, PAHs and other compounds? Here’s how you can decrease your intake of these compounds:

cooking meat
Where does meat processed without nitrates fit in? We don’t know. If they are processed without nitrates then they should  presumably contain few to no NOCs making them a better choice than meats processed with nitrates. However, I couldn’t find a single study comparing the compounds in meats produced without nitrates to their counterparts produced with nitrates.

If you aren’t preparing your food at home, take a close look at how it was prepared and cooked so you can minimize your intake of these compounds. If you don’t plan on cutting out processed meats, at the very least, limit your intake of sausage, ham, bacon, hot dogs, pepperoni, pastrami, bologna, corned beef, deli/luncheon meats, salami, nitrite-treated meat or meat products as well as meat preserved by smoking, curing or salting, all of which could increase your risk of cancer.

Disclosures: None, I have no connection to any red meat commodity boards, stock in red or processed meat companies (though I should look up the shorts or consider buying on a dip) or emotional connection to cows, pigs, horses, red or processed meats 🙂

References:
National Cancer Institute. 
American Institute for Cancer Research
Medline Plus.
Nutr Cancer 2008;60(2):131–144.
J Food Sci 2008;73(6):T100-5.
Cancer Sci 2010;101(2):508-16.
Cancer Epidemiol Biomarkers Prev 2012;21(6):905-15.
Int J Cancer 2014;134(1):125-35.
J Am Diet Assoc 2010;110(6):911-16.
Curr Diab Rep 2014;14(1):453.
Ann N Y Acad Sci 2005;1043:533-44.

How Your Body Image Affects Your Weight & Health

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Today I’m going on a slight rant about something that has been on my mind for a while – body image. And because the majority of my clients (all but 1) are male athletes, I don’t run into the overt self-degrading body comments as often as many of my dietitian colleagues who work with women. However, I’ve run into a number of women lately who either put their bodies down, avoid social situations or the beach / pool / bathing suits because they feel “fat”, obsessively cover up their bodies, obsessively diet or exercise (or both) or engage in other self-depreciating comments and related behaviors stemming from how they feel about their body. And I always walk away thinking “one day she is going to look back and think ‘damn I looked good’ and regret wasting so much time and energy hating a body that helped her cross finish lines, hike mountains, pick up small children, build a beautiful garden and do so much more.”

And though I won’t get into the psychology behind body image and self worth or how to improve your body image (you can read more about that in this article), I do want to talk about how this affects a person’s overall health and sense of well-being. First and foremost, the people around you might not notice the subtle behaviors and words you speak (unless you have dietitian or psychologist friends) but your kids will (children, grandchildren, children you teach or coach). Anyone who has spent 5 minutes with a child knows they pick up everything. Now, let’s say you are that female who won’t wear shorts in the summer because you hate the way your legs look. Your little girl will stop wearing shorts and at some point think her legs look bad too. Or maybe you are the grandma who won’t wear a bathing suit to the beach because you can’t fit into the one you wore last year. Your grandkids will wonder why you aren’t going in the water with them. And finally, if you are a coach of young girls, an entire team will learn about how they should be viewing their bodies from what you think of yours.

In addition to affecting the people around you, I’ve noticed that women who don’t love the bodies they live in spend entirely too much time thinking about food and exercise. And by cutting out certain foods, going on cleanses or popular diets or drastically slashing their food intake, they are cutting out a number of nutrients necessary for good health. And the effects might not be obvious at first, but over time they will catch up to you. Cut calories and it will be difficult to get a number of vitamins, minerals and protein in your diet (And when you fall short on protein you will start losing muscle mass. Over time less muscle means you burn a few less calories each day and you won’t be able to exercise as hard in the gym so you burn fewer calories while working out. Both of these make it challenging to keep weight off over time. Plus less muscle means activities of daily living like gardening, picking up kids, or lifting groceries may be tough). Switch to a vegetarian diet and you better really plan on incorporating protein since you will need more total protein to keep and build muscle. Drop dairy and your bones, teeth and nails will suffer over time (yes you can eat kale, spinach and other leafy greens but you will need at least 10 cups of raw leafy greens a day if this is your only source of calcium). I’ve seen women in their 20s with osteopenia (low bone mass, this often comes before the brittle bone disease osteoporosis). And this is just the tip of the iceberg. But, here’s the most important point: your body image affects what you eat (more than just total calories) and don’t eat. And over time I’m going to make a stretch here and say (from observation) that body image-induced changes in diet affect your intake of vitamins and minerals and over time, consistent vitamin and mineral shortages will affect how your body functions and could impair several aspects of health. So, if you feel like you fall into this category of women or men who loathe your body, make the commitment right now to work on this. I promise you that you are wasting time as well as mental and physical energy. Plus, the changes you are making in an effort to keep weight off may be doing more harm than good.