Herbs And Spices Pack More Than Flavor

Adding flavor to your food can be good for your health

When you think of herbal remedies, what comes to mind?  Is it black cohosh, ginko biloba, or echinacea?  Well, look no farther than your spice rack for the healing powers of these unassuming flavor enhancers.  Packed with phytochemicals, these leaves, stems and seeds may ward off a wide range of illness--from cancer to Alzheimer’s disease.  Read on to learn more.

Cinnamon

The bark of a tropical evergreen tree, cinnamon, is used to impart a sweet, spicy flavor to desserts and savory dishes.  An alternate role cinnamon may play is to inhibit bacterial growth, specifically Listeria monocytogenes, which is particularly dangerous for pregnant women, seniors, and those with compromised immune function.  Cinnamon steeped in hot water with tea may act to calm the stomach, lessening nausea and vomiting. Cinnamon may also play a role in blood-sugar regulation.  Of forty-nine herbs, spices, and medicinal plants tested by the US Department of Agriculture for their ability to regulate insulin, cinnamon ranked the highest.

Ginger

A twisted, knotted root common in Indian and Asian cooking, ginger may lessen pregnancy and chemotherapy-related nausea.  Recent research shows that ginger may also help to alleviate arthritis pain.  These findings, although promising, are relatively new and no recommendations are made for ginger to replace traditional osteoarthritis treatment.

Oregano

Oregano is a member of the mint family whose main components, thymol and carvacrol, are potent antioxidants capable of preventing lipid peroxidation and neutralizing food-borne bacteria, such as E. coli, Listeria monocytogenes, and salmonella.  Oregano exhibits stronger antioxidant power than vitamin E.  Other culinary herbs with strong antioxidant activity are rose geranium, sweet bay, dill, purple amaranth, and winter savory.

Rosemary

The use of rosemary in cooking dates back to 500 BC.  It has been used as a food preservative and as a cosmetic fragrance, as well as for medicinal purposes.  It is loaded with a variety of phytochemicals that are proving to be important in the realm of disease prevention.  It has been shown to be beneficial to heart patients, preventing low-density lipoprotein cholesterol oxidation, as well as helping to preserve memory by reducing inflammation and neuron damage.  Carnosol, one of rosemary’s chief constituents, may play a future role in the treatment of liver disease and leukemia.

Sage

The ancient Greeks and Romans used sage as a homeopathic remedy.  Spanish sage may have a future as a treatment for age-related cognitive decline.  It has been shown to mimic the action of certain anti-Alzheimer’s medications.

Thyme

Also a member of the mint family, thyme exhibits strong antioxidant and antimicrobial activity.  Its oils have been shown to disable respiratory pathogens, including those that cause influenza and pneumonia.  It may play a role in cognitive function as well.  Thymol, a primary phytochemical in thyme, may maintain optimal fatty acid balance in aging neurons.

Turmeric

Grown in India and other tropical areas of Asia, turmeric has antioxidant and anti-inflammatory properties owing to the phytochemical curcumin.  Two areas where turmeric’s effects are being shown are in the prevention of Alzheimer’s disease and certain forms of cancer, particularly those of the stomach and colon.

Despite the use of culinary herbs and spices in folk medicine for centuries, research into their ability to prevent disease is young.  They are best consumed in whole food form.  Individual plant chemicals isolated from the herbs may not have the same beneficial actions.  So add a little spice to your life, you may be healthier for it.

The Fallacy of Moderation



What does moderation really mean?

 Moderation is a word that has been used quite often when describing healthy eating and drinking patterns. Webster's Collegiate Dictionary defines moderation as avoidance of extremes or tending toward average. What does this really mean when we are talking about food? Does it mean one cookie a day or one less cookie than we usually eat? Perhaps it means that we don't eat the whole cookie jar? Does it mean once a day, once a week, once a month or once a year? The problem is that it can mean anything that we want it to mean. This isn't good enough when we are talking about promoting healthy eating behaviors. To say "all things in moderation" to me seems like an excuse to maintain the status quo, which arguably is average.

Paula Deen announced this week that she has had type 2 diabetes for the past three years. Her announcement mentioned very little about following healthy dietary habits. Rather, she stated that she has always been a advocate for moderation (there's that word again). Deen's recipes are not known for being healthy and it must be extremely embarrassing for her to have developed a disease that has a strong tie to dietary factors. Regardless of the cause of diabetes, diet and exercise are integral for its management. They are much too important to be passed off by the use of a non-specific word such as moderation. Deen's announcement this week motivated me to write this blog post, but this post is not about her.

The food industry loves the term moderation for the very reason that it is non-specific. Hershey's has created the Moderation Nation to help consumers find balance in their lives. Part of their message is that 100 calories a day of chocolate can fit into your balanced diet. That's fine, if you do not need to lose weight, but about one third of American adults are obese. George Blackburn, MD, PhD, Chief of the Nutritional/Metabolism Laboratory, and Director of the Center for the Study of Nutrition Medicine, which are affiliated with the Beth Israel Deaconess Medical Center in Boston, Massachusetts, reports that for a vast majority of obese Americans, as little as 200 calories a day prevents them from losing the 20-30 pounds necessary to gain significant health benefits(1). That is less than a small package of M&M's (240 calories). Often, that 100 calorie treat becomes a 200 or 300 calorie "nibble" especially when the whole package contains more than 100 calories. The concept of moderation keeps consumers buying products, which is the primary concern of major food manufacturers and restaurants. In the case of Deen's Savannah, GA restaurant, it keeps the line of patrons circling the block waiting to be seated. Moderation promotes sales and keeps the customers coming through the door.

Last month the marketing research group NPD discovered that Americans are following MyPlate guidelines only 2% of the time. That translates to seven days out of the year! That surely is not moderation and I would argue that the message of moderation is not working. MyPlate promotes such a simple concept and advises Americans to consume half of their plate from fruits and vegetables. It doesn't get much easier than that!

So what can we do that is better? The National Heart, Lung and Blood Institute in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases developed the WeCan Program to teach children and families how to choose healthier diets and exercise more. This program uses the Stoplight Approach to teach which foods should be eaten every day (green light), which foods should be eaten in smaller quantities and less often (yellow light) and which foods should rarely be eaten (red light). Another way to define this approach uses the words "Go, Slow, and Whoa." These three simple words convey more meaning than the word moderation and help to underscore that not all foods can be eaten regularly in moderation if you are trying to lose weight. This approach can be used to teach adults how to better control their food intake too and shows great promise in some area weight management programs.

Stoplight symbols have been added to packaged foods in some European countries to help consumers choose healthier diets. It's doubtful that food manufacturers would allow such a system in the United States because many food products would be labeled yellow or red which could potentially negatively impact sales. You can understand why manufacturers prefer the use of the term "moderation" when it comes to promoting healthier diet habits.

Smart phone users can benefit from using the Fooducate application which independently grades thousands of grocery food items and provides a stoplight color code and letter grade to help consumers make appropriate food choices. The app also discusses the reason for the grade so that you can better understand what makes a food more or less healthy.

I encourage you to make a pertinent comment on this post. I will send a copy of The Little Black Book of Foodspiration by Yvette Quantz, RD, CSSD, LD to the first 20 people who leave a comment. If you are one of the twenty, please email me at info@rochesternutrition with you name and address.

Resource:
1. Blackburn, GL and Waltman, GA. Expanding the Limits of Treatment-New Strategic Initiatives. J Am Diet Assoc. 2005;105:S131-S135.

Resistant Starch: The New Carb on the Block

Resistant starch is the next hot topic that you’ll be hearing about in the news, and I’m not talking about the laundry. This is nutrition science discovering new things about how foods impact our health. In the early 1980’s it was discovered that a component of starch could not be absorbed by the small intestine and passed into the large intestine where it was digested by bacteria, releasing beneficial compounds for the cells of the colon. It was identified as resistant starch (RS). RS is different from dietary fiber because it is bound along with other starchy carbohydrates, not the bran or the germ.




RS can be found naturally in legumes, seeds, whole grains, under-ripe bananas, raw potatoes, and (to a lesser extent) processed starchy foods that have been cooked and cooled, such as breads, cereals, potatoes, rice and pasta. A brand of corn has been engineered to contain a large amount of RS for use in food manufacturing; it is called high-amylose corn (Hi-Maize). This isn’t the corn that you eat at your dinner table. High-amylose corn is processed into flour and added to baked goods to decrease the overall absorbable carbohydrate and increase the RS of a product.



There has been a surge of recent research looking at the health properties of RS. Much of the research uses processed products such as Hi-Maize. Some benefits are improved glycemic control, decreased insulin secretion, decreased cholesterol levels, increased fat burning and improved colonic health. Negative effects have been discovered too, especially with highly purified RS diets that do not include the other components of dietary fiber. There is a concern for increased risk of colon cancer in this situation.



The consumption of RS in the US is currently estimated to be about 3-6 grams per day. In developing countries where unprocessed starch consumption is high the intake ranges from 30-40 grams per day. RS intake in China is about 18 grams per day. Research has identified the beneficial intake of resistant starch to be between 10-20 grams per day. With RS, more is not necessarily better, and a healthful intake can be as little as 5% of total carbohydrates.



Over-processing of foods diminishes RS content along with many other nutrients. This is one plague of industrialized food production. Our goal for healthy eating should be to include whole grains, legumes, and seeds while decreasing processed baked goods. Processed and engineered foods are no match for the panoply of nutrients that whole foods provide.



Engineered RS has been developed to be a functional food, a food or dietary component that may provide a health benefit beyond basic nutrition. I wonder if eating high-amylose corn muffins, pasta, or bread will benefit the consumer as much as the manufacturer. Only time, and more research will tell.

Nutritional Beauty

A healthy diet can make you beautiful inside and out

A growing consumer trend is to eat well for naturally glowing skin, strong shiny hair, and inner holistic radiance. We clearly are what we eat, and this mantra applies to more than just health.




Nutritional products have long been used topically to promote beauty. Honey masks, olive oil hair conditioning, and oatmeal baths can trace their roots back to ancient times. Retinol, a vitamin A derivative, and alpha-hydroxy have been shown to improve sun-damage or wrinkles when applied to the skin. Many cosmetics contain antioxidant vitamins, minerals, and plant chemicals. Most recently vitamin K has been discovered to lighten dark circles under the eyes.



The idea of promoting beauty can also be applied from the inside out. A top nutrient in this category is water. Without proper hydration, skin can seem dull and less supple. Antioxidant vitamins C and E, beta-carotene, and essential fatty acids are next in line. Antioxidants neutralize compounds that damage the body including skin. It is no lie that eating your fruits and vegetables can make you more beautiful. A recent study looking at the amount of vitamin C women consumed in their diet showed that those who ate the least amount of vitamin C from food had the most wrinkled appearance. Vitamin C is important for the synthesis of collagen, a protein that helps maintain skin elasticity. Fruits and vegetables are the main source of vitamin C. Another recent study showed that eating more carotenoid containing fruits and vegetables gave the skin a tanned hue when compared with study participants who did not eat the carotenoid containing foods. Carotenoids are the yellow to deep red pigments found in foods. You may say that eating fruits and vegetables provides skin a healthy glow.



The next big beauty secret believed by some estheticians is controlling inflammation from the inside out; not just reacting to a skin problem. Barry Sears, PhD president and founder of Zone Labs, Inc., contends that “inflammation links to all chronic disease, skin degeneration, and the aging process. To stop inflammation, balance protein and carbohydrate ratio at each meal.” Omega-3 fatty acids found in cold water fish such as salmon, walnuts, flax and chia seed exhibit anti-inflammatory properties. An increased intake of linoleic acid, and omega-6 fatty acid found in nuts, whole grains, most vegetable oils, eggs and poultry, is also associated with more youthful looking skin in research studies. Conversely, high intakes of saturated fat and refined carbohydrates abundant in the typical American diet are associated with a more wrinkled appearance.



Companies looking to capitalize on this trend are introducing products containing antioxidants, omega-3 fatty acids and phytochemicals. Will they make you more beautiful? Perhaps, if you already eat in a healthful manner, but drinking a special concoction won’t help if you are eating doughnuts for breakfast, sub sandwiches for lunch and pizza for dinner. And if you smoke, all bets are off. The aging effect of smoking undoes any good that a healthy diet or special supplement provides. Research shows that what matters more than eating a particular food or nutrient to prevent aging is to follow an overall healthy diet. People eat foods in combinations, not one at a time. It is the interplay of nutrients together that seems to provide the greatest anti-aging benefit. Here’s one more reason to eat your fruits, vegetables, whole grains, nuts and seeds. They can make you look marvelous.

Reducing the Costs of Our Healthcare System

Lifestyle interventions are required to adequately address the rise in obesity 

Medicare has recently decided to cover Intensive Behavioral Therapy for Obesity (IBTO). This landmark decision is very important because obesity will now be recognized independently from co-morbidities such as diabetes and heart disease. Medicare recipients who are obese without other health problems will be allowed to receive IBTO without co-pay in the hope of preventing the development of chronic diseases associated with obesity. The potential for saving healthcare dollars is great, but there is one caveat of this new coverage: The most qualified professionals to provide IBTO are excluded from directly billing Medicare for this service.



Intensive Behavioral Therapy for Obesity will include:

1. Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed in kg/m2);

2. Dietary (nutritional) assessment; and

3. Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.



Patients who meet screening eligibility are entitled to:



• One face-to-face visit every week for the first month;

• One face-to-face visit every other week for months 2-6;

• One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement.



Medicare names primary care physicians, clinical nurse specialists, nurse practitioners, and physician assistants as being the only professionals who can bill Medicare for IBTO and the primary care clinic as the only site where IBTO can be provided. This leaves out registered dietitians and clinical psychologists, whose training qualifies them over primary care practitioners to most effectively provide this service. Patients who desire to work intensively with dietitians or psychologists will have to pay for these services on their own.



After reviewing the ruling posted on Medicare’s website and looking over the references that were provided in support of IBTO coverage, I’m stumped by this decision. Many of the references cited had dietary interventions provided by registered dietitians. A 2004 article published in the Annals of Internal Medicine by the Centers for Disease Control and the Primary Prevention Working Group names dietitians among the most qualified providers to administer lifestyle interventions. This same article states, “even the most highly motivated physicians typically have minimal education or training in lifestyle intervention, and they usually have inadequate access in their practice to the resources needed to support lifestyle intervention. Well-intentioned attempts by physicians to practice “lifestyle medicine” with scarce resources can lead to embittered rejection of health promotion.” The article then goes on to state, “No efficacy study had physicians directly involved in delivering interventions.”



Dietitians bill insurance at 85% of the physician rate. It doesn’t make fiscal sense to allow primary care providers to bill at a higher rate for IBTO when they are not trained in this technique and they do not have the time to provide such involved therapy. I hope in the future that Medicare sees the value that registered dietitians and clinical psychologists bring to the treatment of obesity and allows them to bill for this service independently from primary care providers.


Please support the effort to urge Medicare to allow registered dietitians to directly bill for obesity services by signing this White House petition by January 7, 2012.


Reference:
Centers for Disease Control and Prevention Primary Prevention Working Group.
Primary Prevention of Type 2 Diabetes Mellitus by Lifestyle Intervention: Implications for Health Policy. Ann Intern Med. 2004; 140:951-957

Medicare Chooses Inferior Care for Obesity

Preventing dietitians from becoming providers for obesity care is not in the best interest of patients 

I received some good news the other day. Medicare has agreed to cover Intensive Behavioral Counseling for Obesity for eligible Medicare beneficiaries. And then I read the statement released by the Centers for Medicare & Medicaid Services (CMS). Registered dietitians and psychologists will be excluded as obesity care providers. According to CMS obesity counseling must be provided by a “qualified primary care physician or other primary care practitioner and in a primary care setting.” What does this mean? A "qualified primary care physician", according to the Social Security Act is a physician who is a general practitioner, family practice practitioner, general internist or obstetrician or gynecologist. A “primary care practitioner” is defined as a physician with a primary specialty of family medicine, internal medicine, geriatric medicine or pediatric medicine or a nurse practitioner, clinical nurse specialist, or physician assistant." Obesity services must be provided in a primary care setting which CMS defines “as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition.”


The bottom-line is that registered dietitians who are highly trained to intensively counsel obese individuals will not be allowed to bill Medicare for obesity intervention and private nutrition practices that are established and operated by dietitians are not considered an appropriate setting by CMS for nutrition education of these individuals.

I cannot say for certain what was really behind the decision to exclude dietitians from becoming Medicare providers for obesity counseling because Medicare's explanations seem lame to me. The American Dietetic Association described CMS's action with regards to the exclusion of dietitians as follows:

  it appears that CMS excluded RDs for two reasons:

1. CMS believes it lacks the statutory authority to include RDs as providers outside of diabetes and end stage renal disease; and

2. CMS believes it is important that preventive services be furnished in a coordinated approach as part of a comprehensive prevention plan within the context of the patient’s total health care. As such, they believe primary care practitioners are best qualified to offer care in this context.

Apparently Congress has not charged dietitians in the fight against obesity but dietitians are allowed to help people with diabetes and end stage renal disease. Many people with diabetes are obese and when I am counseling them for diabetes management, weight management is always a part of the intervention.

As for "preventive services being furnished in a coordinated approach as part of a comprehensive prevention plan within the context of the patient's total health care," what Medicare fails to see is that it doesn't matter how well care is coordinated if it is inadequate. To date primary care intensive obesity intervention consists of MDs and NPs telling patients that they need to lose weight and referring them to a dietitian. Now that MDs and NPs will be able to bill for counseling for obesity they can remove the dietitian from the equation and bill their services at a much higher rate than the RD would bill and provide less than adequate nutrition counseling possibly after attending a weekend course on obesity management to supplement their one medical scool course in nutrition. I don't mean to disparage doctors, but they are not trained to provide comprehensive nutritional intervention. My husband is a physician and he is the first to admit that most doctor's knowledge about nutrition is lacking. Think about it this way, does Medicare require that physical therapy be provided under the primary care physician's watchful gaze in a primary care setting?

I am always dismayed when I read press releases about new scientific discoveries related to obesity in which the final sentence in the release states that this information can be used to develop a drug to combat obesity. Obesity fighting drugs that have already been released are often recalled because they pose a serious risk to health and can cause death. Humans have existed for thousands of years with minimal obesity until now. We know how to combat obesity and it is not a pill. It is inexpensive but labor intensive and it does not make research and drug companies incredibly wealthy.

A cynical interpretation of this whole debacle is that lobbying from Big Pharma helped to ensure that the practitioners who can prescribe medications would be the only ones whose obesity related services could be covered by Medicare.

It is sad to me that some highly qualified nutrition and behavioral therapists (dietitians and psychologists) will be excluded from treating Medicare recipients. Patients who want to see dietitians and psychologists for nutrition and behavioral counseling will have to pay for these services out of their own pockets (again).

What do you think? Will Medicare provide the most comprehensive treatment for obesity by the most qualified providers?

“Gout” You by the Toe? Kick It with Good Nutrition

Lifestyle contributes to gout 

Gout has long been viewed as a malady suffered by the wealthy, those with means to afford rich foods and wine. Today, gout is the most common form of inflammatory arthritis suffered in men, effecting 3.4 million adult men and an increasing number of postmenopausal women. The incidence of gout is on the rise and lifestyle factors play a significant role in its occurrence.




Gout is characterized by on overproduction of uric acid or a decreased excretion of urate in the kidney. Uric acid is the end product of purine metabolism. Most purines are contained in the human body as DNA. Cells of the body are constantly turning over with the release of genetic material and their consequent breakdown to uric acid. Foods and beverages that we consume can also contribute to the overall uric acid load in the body. When the uric acid level of the body is elevated, crystals can form in the joints. These crystals activate an inflammatory response, which brings on the pain and swelling of gout. The big toe and ankles are common joints affected.



Gout has been shown to be related to the metabolic syndrome, which includes features that increase the risk of heart disease and diabetes such as obesity, elevated cholesterol, high blood pressure, and insulin resistance. Overweight and obesity seem to play a role in both gout and metabolic syndrome. Maintaining a healthy body weight is import in the control of gouty inflammation, however, sensible eating is important. Following a low carbohydrate, high protein diet for weight loss can exacerbate gout.



High protein foods tend to contain more purines with the potential to raise uric acid level, though not all high purine foods have the same ability to cause an attack of gout. Beef, lamb, pork and fish are primary offenders and should be eaten less often and in smaller amounts. A small portion is considered three ounces and is the size of a deck of cards. Most restaurants serve meat in portions of six ounces or greater. Plant foods higher in purines do not seem to bring on gout and do not need to be limited. These include whole grain breads and cereals, oatmeal, wheat germ, wheat bran, mushrooms, green peas, spinach, asparagus and cauliflower. These foods have other health properties that may protect against gout. Low fat dairy products seem to protect against gout and it is recommended to eat at least two servings a day. Dairy products are low in purines and increase the excretion of urate. Vitamin D may also play a role in gout. Many people who have gout are deficient in vitamin D. Urate may prevent the activation of vitamin D, which is believed to have anti-inflammatory properties.



Alcohol has long been known to be a risk factor for gout. Beer is high in purines but alcohol in general may also be implicated. Alcohol is dehydrating and poor hydration increases the risk of gout. Alcohol intake should be controlled; especially beer and special attention should be paid to drinking enough water. This is particularly true when traveling. Many people experience gouty attacks while on vacation. They are dehydrated from their travels and imbibe more than they would at home.



Other diet and lifestyle factors important in the management of gout are:

• Reduced fructose consumption. Fructose is the only sugar that increases urate. Fructose is found most in soft drinks, sweetened juices, apples and oranges.

• Increased fruit and vegetable consumption (except apples and oranges). These foods are known to decrease inflammation with the potential to lower urate.

• Increased vitamin C intake. Vitamin C found in many fruits and vegetables decreases urate. Supplementation of 1500 mg vitamin C daily may be helpful. Vitamin C supplementation should be split throughout the day (500 mg with meals three times a day is suggested).

• Cherries are known for their anti-inflammatory ability. Consumption of cherries and cherry juice decrease gouty attacks.

• Increased physical activity is associated with decreased risk of gout.



As with all diet and lifestyle recommendations, do not undertake dramatic changes in your habits without supervision and advisement from your physician.