Choose Healthy Carbohydrates

Choose Healthy Carbohydrates
Week 4 – Eight Weeks to Wellness Prepared by Don Hall, DrPH, CHES This week we will acquaint ourselves with healthy carbohydrates—and some that aren’t. We’ll also talk about the benefits of choosing healthy carbohydrates. Updated DRH – for Video sereis © LifeLong Health®

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Sponsored by: Lassen Foundation 2801 Williams Rd. Butte Valley, CA 95965 Your name, Health Educator © LifeLong Health®

Unhealthy Carbohydrates
Soda pop Sugar, candy sweets White bread, pastry, soda crackers White rice Refined breakfast cereals French fries Snack foods We are all familiar with unhealthy carbohydrates. They tend to be fattening, are devoid of many required nutrients, and replace healthier alternatives. Examples of unhealthy carbohydrates include: Soda pop Candy and other sweets White bread, pastry, soda crackers Cookies, pie crusts, cake, if made from white flour White rice, refined cornmeal These highly refined carbohydrates contribute to obesity, poor nutrition (they are low in required nutrients), obesity, coronary heart disease, and bowel disease. It’s these unhealthy foods that have given carbohydrates a bad name. Let’s consider what “healthy carbohydrates” are and how they play an important part in promoting health. © LifeLong Health®

Healthy Carbohydrates Are…
Plant based foods that have not been highly refined or processed High in dietary fiber High in antioxidants and phytochemicals Absorbed more slowly, normalizing blood sugar and insulin levels Moderate in calories but high in nutrition Healthy carbohydrates play in important role in good nutrition as shown in this slide. Examples of foodstuffs with healthy carbohydrates are: Oatmeal Brown rice Corn on the cob Beans Lentils Baked yams © LifeLong Health®

Examples Include Fruits Vegetables Legumes Whole grains
Healthy carbohydrates include not only fruits, vegetables, legumes, and whole grains, but also the soups, salads, breads, entrees, and desserts that are put together from those foods. For example: Whole grain cookies, cakes, pie crust Whole grain breads and crackers Whole corn products such as cornbread made from grinding whole corn, corn fritters made similarly, etc Lentil soup, chili, and a host of other hot or cold bean dishes Three-bean salads, any salad with more than lettuce and tomatoes, etc © LifeLong Health®

These Foods Can Help Prevent…
Obesity High blood pressure Diabetes Coronary heart disease Certain cancers Strokes Digestive problems such as constipation and diverticulosis Unrefined carbohydrate foods are protective against many serious health problems. © LifeLong Health®

There are four carbohydrate food choices that prevent disease and promote health
The goal here is not to avoid carbohydrates (as you often hear), but to choose healthy ones. Keep in mind that the Institute of Medicine’s new Dietary Guidelines state that everyone needs a minimum of healthy carbohydrates daily, even in a weight loss program. That minimum is 130 grams per day. The brain needs at least that much to work properly. Average intakes are closer to grams a day, but remember to choose them from healthy sources. Athletes who are very physically active need a minimum of 400+ grams daily to meet physical demands for high performance. The primary muscle fuel for performance is carbohydrate. The brain must have carbohydrate to live. If blood sugar levels get too low, the body converts protein (muscles like your heart) into blood sugar. © LifeLong Health®

Eat More Fruits & Vegetables
#1 High in fiber High in antioxidants High in nutrients Lowest in calories They taste good and are fun to eat! Fruits and vegetables are packed with nutrients the body needs for good health and protective elements that prevent many diseases. They also add color, taste, and sparkle to our meals. Eat salads, fresh fruits and fruit juices, and brightly colored vegetables daily. Aim for 5-9 servings daily! Source: DHHS, U.S. Dietary Guidelines, 2000 © LifeLong Health®

Eat 5-10 Servings of Fruits and Vegetables Daily
Emphasize Greens and cabbage family Dark yellow or orange Tomatoes, onions, salads Citrus, berries A wide variety of other colorful fruits and vegetables Greens are protective to the eyes and studies show they are protective against cancer. The cabbage family is protective against cancer, as is the onion family Citrus fruits are high in vitamin C which is needed by your body every day Colorful berries—such as strawberries and blueberries—are excellent antioxidants Tomatoes have been shown to be protective against prostate cancer All fruits and vegetables are naturally low in calories, and high in substances that protect the body from disease. A high intake helps you live a longer, healthier life. The USDA Food Pyramid recommends 5-9 servings daily. © LifeLong Health®

Fruit and Vegetable Intake and Strokes, Framingham Study
20 year follow-up of 832 men in the Framingham Study For each increment of 3 servings of fruits or vegetables per day, there was a 45% decrease in the risk death from stroke Risk of stroke in men, incidence per 1,000 In this 20 year follow-up study of middle-aged men from the Framingham Study, researchers observed an inverse association between fruit and vegetable intake and the development of stroke. In other words: eating more fruits and vegetables meant experiencing fewer strokes. This data is for ischemic (artery blockage) stroke only. For each increment of 3 servings of fruits and vegetables, there was a decrease of 22% in the risk of all stroke and a 45% decrease in risk of death from stroke. The risk for hemorrhagic (broken blood vessel) stroke was even lower, 0.49 (half the risk). This risk held constant even when adjusting for age, blood pressure, smoking, glucose intolerance, LVH, BMI, and alcohol intake. Ref. JAMA, April 12, 1995, Vol 273, No. 14, P Servings of Fruits and Vegetables per Day Framingham Study, JAMA, Vol 273, No. 14, pp © LifeLong Health®

Vegetable and Fruit Consumption
Women, probability of dying, mid-life, ages 35-69 n=350,000 There are additional supportive results from the American Cancer Society’s Cancer Prevention Study (CPS), the largest prospective epidemiological study ever undertaken. In this sub-group, the cohort includes 200,000 men and 350,000 women, ages 35-69, followed for 6 years ( ), all judged to be healthy at the start of the study. Four major lifestyle factors related to mortality (and longevity) were observed: Smoking Sedentary lifestyle Low intake of fruits and vegetables Obesity The data above show the relationship between vegetable and fruit intake and overall mortality (probability of dying). There was a gradual increase in mortality as the consumption of fruits and vegetables decreased. Comparing the lowest intake (1st quintile) to the highest (5th quintile) resulted in a 38% increase in overall mortality in women (6.5 to 9.0). The 5th quintile was close to 5 servings of fruits and vegetables per day. Reference: Jour. of Health Education, Sept/Oct ‘97, Vol. 28, No.5, High intake Intake by Quintiles Low intake © LifeLong Health® J of Hlth Educ, Vol 28, No. 5

Vegetable and Fruit Consumption
Men, probability of dying mid-life, ages 35-69 n=200,000 Men’s results from the American Cancer Society’s Cancer Prevention Study (CPS), were similar to the women’s study results. Those men with the lowest intake of fruits and vegetables were significantly more likely to die prematurely. . Reference: Jour. of Health Education, Sept/Oct ‘97, Vol. 28, No.5, High intake Intake by Quintile Low intake © LifeLong Health® J of Hlth Educ, Vol 28, No. 5

Best Sources of Antioxidants
Highest Vegetables Kale Beets Red peppers Broccoli Spinach Potato Sweet potato Corn Cauliflower Eggplant Carrots String beans Cabbage Squash Garlic, celery, onions Leaf lettuce Research was done by Ronald Prior at the Jean Mayer, USDA Human Nutrition Research Center, Tufts University, Boston. They used a technique called oxygen radical absorbance capacity (ORAC) to measure the antioxidant capacity of foods in a test tube. They are now testing to see if this same information holds up in animals and humans. Ref. J. Agri. Food Chem. 44: 701, 3426, 1996. © LifeLong Health®

Best Sources of Antioxidants
Highest Fruits Blueberries Strawberries Plums Oranges Red grapes Kiwi Pink grapefruit White grapefruit White grapes Apples Tomatoes Bananas Pears Melons Source: USDA Human Nutr. Research Center, Tufts Univ., J. Agri. Food Chem. 44: 701, 3426, 1996 Research was done by Ronald Prior at the Jean Mayer, USDA Human Nutrition Research Center, Tufts University, Boston. They used a technique called oxygen radical absorbance capacity (ORAC) to measure the antioxidant capacity of foods in a test tube. They are now testing to see if this same information holds up in animals and humans. Ref. J. Agri. Food Chem. 44: 701, 3426, 1996. © LifeLong Health®

Vegetable Intake and Colon Cancer
Cancer Prevention Study II 764,343 adults in study Risk of colon cancer decreased with the more frequent consumption of: vegetables whole-grain breads and cereals regular use of aspirin folic acid also protective In this very large study, colon cancer was negatively associated with the intake of vegetables in the diet. Men with a high intake of vegetables compared to men with a low intake (top and bottom quintiles) had a relative risk of Similarly, women eating more vegetables had a relative risk of 0.62. Colon cancer was associated with LESS of three major factors: Vegetable intake Whole-grains (whole-wheat bread and cereals) Regular aspirin use Men who had all three risk factors (low vegetable intake, no aspirin use, and no whole-grains) had a relative risk of 2.4. Women who had all three risk factors (low vegetable intake, no aspirin use, and no whole-grains) had a relative risk of 2.9 This is a 2-3 fold increase in colon cancer caused by easily made lifestyle changes. Weaker associations were seen for physical inactivity and obesity. J of Nat. Cancer Institute, 85(7): 581-2 Vegetable Intake/Day © LifeLong Health®

Cancer Prevention Guidelines
Choose predominantly plant-based diets rich in a variety of vegetables, fruits, and legumes Maintain a healthy body weight Take an hour’s brisk walk daily Eat five or more servings of fruits and vegetables daily The AICR and the World Cancer Research Fund reviewed all studies on diet and cancer, and then made these recommendations (shown above). These are the first four and the most important. American Institute for Cancer Research © LifeLong Health®

Ways to Eat More Fruits and Vegetables
Keep raw vegetables ready-to-eat in clear containers in the front of your refrigerator for frequent use Keep a supply of fresh fruit on the table or counter: oranges banana, apples, kiwi Eat more salads and include a variety of vegetables: broccoli, peppers, cabbage, tomatoes, carrots, dark salad greens, onions Enjoy stir-fry vegetables, add vegetables to soups Eat fruit salads and finish a meal with fruit as a natural sweet (e.g. orange, berries, melon, dates) Next time you want a snack—think fruits and vegetables instead of sugar and fat. Plan your meals around fruits and vegetables instead of higher calorie and higher fat foods. Dietary Guidelines for Americans, 2000 © LifeLong Health®

Choose whole grains #2 At least three or more servings per day Breads
Cereals Brown rice, oatmeal Whole grain corn, rye Whole grain foods are full of vitamins, minerals, and fiber. The USDA Food Guide Pyramid puts whole grain foods at the base—to serve as the foundation of your diet. The USDA recommends 6 to 11 servings daily. © LifeLong Health®

Whole-Wheat Bread and Heart Disease
Relative Risk of Heart Attack n=26,437 This research data from the Adventist Health Study is based on 26,473 participants. Researchers found a reduction in heart attacks (RR 0.56) for those who consumed only whole-wheat bread compared to those who ate white bread. The relative risk for fatal CHD was 0.74. Ref. Arch Intern Med, Vol. 152, P.1416, July, 1992 In a more recent study of 43,757 male health professionals, the relative risk for a heart attack was 0.73 when comparing the top to bottom quintile of cereal fiber intake. Ref. JAMA Feb. 11, 1996. Kind of Bread Eaten © LifeLong Health® Arch Intern Med Vol 152 P.1416

Whole-grains and Heart Disease
Nurses Health Study 75,521 women followed for 10 years Risk of coronary heart disease was reduced by 25% to 50% in those eating more whole-grains; 3 or more servings a day Risk of Heart Disease (RR) The reduced risk of heart disease (both MI and death from MI) was independent of other risk factors. The relative risk of coronary heart disease was 25% lower for women in the top quintile of intake of whole grains (average intake was 2.7 serv/day) compared to women in the bottom quintile (average intake was less than ¼ serving per day). This relative risk was after adjusting for body mass index, fat intake, physical activity, vitamin use, alcohol use, and other coronary risk factors. The protective effect was even stronger in nonsmokers. Their relative risk was 0.49 when comparing the high to low quintiles and adjusting for other dietary and CHD risk factors. The possible mechanisms for the protective effects of whole grains include: 1. Whole grains are good sources of minerals, vitamin E, dietary fiber, and most of the B vitamins including folate. 2. Whole grains are absorbed more slowly and thus have a lower glycemic index and thus help regulate blood glucose levels, help lower blood LDL levels, and reduce risk of diabetes and heart disease. 3. There are antioxidants in whole-grains and other phytochemicals that may have protective effects. Surveys show that the average intake of whole-grains in the U.S. is about ½ a serving per day. In this study, those in the top quintile who had the lowest rates of heart disease ate about 2 and a half servings of whole-rains daily, primarily from whole-grain breads, cereals, and brown rice. What is the optimum intake? This study showed no threshold amount. That is, the more whole grains the people ate, the lower the heart disease death rate. Reference: Simin Liu, et al, Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study, American Journal of Clinical Nutrition 1999;70:412-9 Servings/day of Whole-grains Amer J Clin Nutr 1999;70:412-9 © LifeLong Health®

Percent Decrease of Nutrients in White vs. Whole-Wheat Bread
Key Minerals % Decrease Calcium 54% Magnesium 84% Phosphorus 69% Potassium 74% Zinc 76% Copper 62% Manganese 82% Key Vitamins % Decrease Pantothenic acid 57% Vitamin B % Folic acid % Dietary fiber 79% Essential fatty acids 47% Phytochemicals and antioxidants are also lost, and protein quality is impaired When wheat is refined into white flour, over 20 nutrients and phytochemicals are lost or significantly reduced (see below). Five are added backed, “enriched”: niacin, riboflavin, thiamine, folic acid, and iron. The rest are lost. Nutrient Percent decrease in white bread compared to whole-wheat Calcium 54% decrease Magnesium 84% Phosphorus 69% Potassium 74% Zinc 76% Copper 62% Manganese 82% Pantothenic acid (B vitamin) 57% Vitamin B6 87% Folic acid 41% Dietary fiber 79% Essential fatty acids 47% Plus, most phytochemicals and antioxidants are lost. Source: USDA, Reference Nutrition Data Base USDA, Reference Nutrition Data Base © LifeLong Health®

Whole Grains and Type 2 Diabetes
Finnish study, men/women, 10 yr study Those eating the most whole-grains had 35% less type 2 diabetes Those with highest cereal fiber intake had 61% less diabetes Type 2 Diabetes (RR) A 10 year study in Finland. Whole grains were linked to lower risk of type 2 diabetes, even after adjusting for BMI, smoking, fruit and vegetable intake, age, etc. This message is clear. Whole-grain cereals protect against type 2 diabetes. Eat more whole-grain breads and cereals daily. Aim for grams of cereal fiber daily for lowest risk of diabetes. Low intake was the first quartile on intake. High intake was the 4th quartile. When looking at cereal fiber, the 4th quartile of cereal fiber (29 g/day) cut the risk of diabetes by 61% compared to the first quartile of cereal fiber intake (12 g/day). Amer J Clin Nutrition, March 2003 Whole Grain Intake © LifeLong Health®

Whole Grains & Risk of Stroke
Risk of Stroke (RR) In the Nurses’ Health study, women who used the most whole grains had the lowest risk of stroke. Notice that women who ate even 1 serving per day had a decrease in risk. Women who ate 3 serving of whole-grain bread and cereals daily had from 40% (all women) to 50% (women who never smoked) lower risk of stroke. Eating whole grains, 3 or more servings daily, is a simple but effective way to reduce risk of stroke, our nations 3rd leading cause of death. Data shown is for ischemic stroke, the most common kind of stroke. Reference Liu S, et al. Whole grain consumption and risk of ischemic stroke in women, JAMA Sep 27, 2000; 284: 72,488, women 12 yr follow-up Whole-grains, Servings/day © LifeLong Health® JAMA Sep 27, 2000; 284:

Whole Grains and Total Mortality
ARIC study, 15,792 people 45-64, 11 yrs Those eating the most whole-grains had a 48% decrease in mortality. After adjusting for BMI, exercise, cholesterol, etc. they still had a 23% lower risk of dying from any cause Mortality, any cause (RR) A 11 year study of people in the Atherosclerosis Risk in Communities (ARIC) study. People who ate the most whole grains (5th quintile, 3+ servings/day) had a 48% lower risk of dying from any cause compared to those who ate least amount of whole grains (1st quintile, 0.1 serv/day). Whole Grains, Servings/Day (quintiles) Amer J Clin Nutrition, September 2003

Choose a Variety of Grains
Whole-grain breads Multi-grain breads Oatmeal breads and cereals Whole-grain Rye High fiber cereals Brown rice Pasta Barley cereal The food guide pyramid recommends 6 or more servings of breads and grains daily, primarily from unrefined sources. Include a variety of grains in your diet. Six or more servings/day recommended primarily from whole-grain sources © LifeLong Health®

Avoid a High Glycemic Load
#3 It protects against… Obesity High blood pressure Heart disease Diabetes Adequate water and hydration is essential for both optimum mental and physical performance. Adequate intakes can also prevent chronic disease such as heart disease, kidney disease, stroke, and bladder cancer. © LifeLong Health®

Concept of Glycemic Index
Glycemic index (GI) evaluates the effect of carbohydrate on blood sugar levels High GI foods raise blood insulin and sugar levels quickly and higher than desirable GI is determined by feeding various carbohydrate foods and comparing their rise in glucose levels compared to equal amounts of sugar (or white bread) eaten on a previous day Here are a few definitions to help you understand the concept of glycemic index. © LifeLong Health®

High energy storage zone
Blood glucose and insulin curves after eating: White bread (solid line) and then Spaghetti (dotted line) (each food is eaten on different days) Hunger Zone High insulin response leads to obesity, insulin resistance and exhaustion Notice that white bread is absorbed rapidly, causing blood sugar and insulin levels to go very high. White bread is considered a high glycemic index food. Foods that continually raise blood sugar levels to high levels increase the risk for both diabetes and heart disease. In comparison, spaghetti is absorbed more slowly (dotted line), thus insulin levels are lower, and glucose levels don’t drop so fast thus reducing hunger. Low glycemic foods help prevent diabetes and heart disease. JAMA May 8, 2002, 287:2415 © LifeLong Health®

High Glycemic Meals Eating high glycemic meals, compared to lower glycemic meals, results in: Higher 24-hour blood sugar levels Higher insulin levels Higher glycosylated hemoglobin levels (HbA1c) Increased hunger following reactive low blood sugar It also results in increased risk for diabetes, obesity, and coronary heart disease Here is a quick summary of why eating heavily of high glycemic foods is not good for the health. JAMA May 8, 2002, 287:2415 © LifeLong Health®

Glycemic Index and Calorie Intake in Children
Obese children ate either instant oatmeal or steel-cut oats—“instant” has a high glycemic index; “steel-cut” is low. Calories were identical for breakfast and lunch. At supper, they ate at lib. After eating instant oatmeal, they ate 53% more calories at supper than after they ate the steel-cut oats. Calories eaten after last meal (%) As a general principle, the more refined or the smaller the pieces, the higher the glycemic index. “Steel-cut oats” are whole oats cut into pieces but not flattened or pre-cooked. To eat at lib is to eat as one chooses. For these children, eating foods with a high glycemic index at one meal resulted in the children’s eating more food at a later meal—half again more calories by the end of the day. Glycemic Index of Breakfast JAMA May 8, 2002, 287:2415 © LifeLong Health®

Glycemic Index and Obesity
Rats fed a high glycemic diet compared to rats fed a low glycemic diet develop marked obesity in 32 weeks. In 16 human studies, 15 studies found lower satiety, increased hunger, and higher voluntary food intake after eating high vs. low glycemic index meals. In research studies, adults are similar to children. After adults ate meals of high glycemic index foods, they were hungrier and ate more and felt less satisfied than when they ate meals of low glycemic index foods. We don’t know how the rats felt after eating a high glycemic diet, but they got fatter! JAMA May 8, 2002, 287:2415 © LifeLong Health®

Glycemic Index of Selected Foods
Foods Glycemic Index White Bread Table sugar Baked potato Cheerios Pancake Cornflakes White rice Instant rice Fruit punch/soda pop 95 Banana Pizza Foods Glycemic Index Oatmeal Orange juice Bran flakes All bran Pasta Baked beans Apple, raw Skim milk Soy beans (soy milk 43) 35 Peanuts Broccoli Here is the glycemic index for a few foods based on comparing the blood glucose response of each food to 100 grams of white bread as the standard. Note: There are two standards: white bread and glucose. Among your resource materials is a Glycemic Index table that includes values for white bread as well as for glucose. This small table is based on white bread. Source: Dr. Willett, Harvard Nutrition Department, (white bread standard) © LifeLong Health®

Glycemic Load A better overall indicator is glycemic load
glycemic index X carbohydrate content of foods Example: glycemic index of mashed potatoes = 122 ½ cup mashed potatoes has 20 g of carbohydrate Glycemic load = 20 X 1.22 = 24.4 Summing the glycemic load of all foods in a day gives the daily glycemic load In the Nurses Health Study, a daily glycemic load greater than 150 was linked to a higher risk of heart disease Glycemic load is more important than the glycemic index. The load reflects the total amount of carbohydrate eaten in relation to its glycemic index. See example above. Using data from the Nurses’ Health Study, a glycemic load greater than 150 per day (for women) is linked to an increased risk of coronary heart disease. A glycemic load over 200 is high risk (see following graphs). Amer. J of Clinical Nutrition 2000; 71: © LifeLong Health®

Glycemic Load and Risk of Heart Disease
Risk of Heart Disease (RR) n=75, yr study In this large study we see that as the glycemic load of a meal increases, so does the risk for coronary heart disease. This increased risk from eating too many high glycemic index foods is a higher risk than even saturated fat intake in this same study population. From Nurses’ health study. Included 729,472 person years of follow-up. Relative risk values shown are adjusted for all CHD risk factors including all dietary fats, dietary fiber, vitamin E, folate, physical activity, etc. Increased risk for CHD was found primarily in women with a BMI of 23 or higher. Lean women were not at risk for a higher glycemic load. Reference Simin Liu, Walter Willett, et al, A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women, Amer. J of Clinical Nutrition 2000, 71: Low glycemic load High glycemic load Glycemic Load Quintiles Amer. J of Clinical Nutrition 2000, 71: © LifeLong Health®

Glycemic Load of Common Foods
Food Glycemic Load Instant rice, ½ C Baked potato, sm. 20 Corn flakes, 2/3 C 21 White bread, 2 s Rye bread, 2 slices 19 Muesli, 2/3 C Food Glycemic Load Banana, Spaghetti, ½ cup Apple, 1 fresh Lentils, ½ C Carrot, Peanuts, 1 oz Broccoli, ½ C <1 This list is the result of having multiplied the carbohydrate in 100 grams of each food by the glycemic index of each food and then dividing the result by the amount of food in a usual serving. Keep in mind that a GL less than 150 is linked to a low risk of coronary heart disease. Isn’t it interesting that whole foods whether cooked or raw have relatively lower glycemic loads compared to refined foods. © LifeLong Health® JAMA May 8, 2002, 287:2415

Glycemic Load Principle
High Glycemic Load Foods Snack foods Fast foods Pastry, cookies Sweets Soda pop White bread/rice Refined carbohydrates Potatoes Low Glycemic Load Foods Fresh fruit & Vegetables Legumes, peas, beans, garbanzos, soy, tofu Nuts Whole-grain breads and cereals including oatmeal and brown rice Protein rich foods Healthy fats For a healthy heart and overall good health, keep physically active, maintain a healthy weight and eat healthfully by choosing foods low in saturated and animal fats and with a low glycemic load. Note: Potatoes have a high glycemic index but are OK to use moderately, especially if you are not overweight and are physically active. © LifeLong Health®

Effect of Glycemic Index and Dietary Fiber on Risk of Diabetes
Women’s Health study Women who ate the least fiber were twice as likely to get diabetes as those who ate the most fiber. Women with the highest glycemic index were 51% more likely to get diabetes then women who ate the lowest GI diet. Overall risk was 2.5 times higher on the low fiber, high GI diet. Risk of Getting Diabetes (RR) Foods high in fiber and with a lower glycemic index, both help prevent the risk of getting diabetes. [Study details] Increasing risk plotted to quintiles for increasing dietary fiber and quintiles for decreasing glycemic index. For those women who ate the most fiber (top 20% and the lowest glycemic index (bottom 20%), they were 2.5 times less likely to get diabetes. Decreasing fiber Increasing Glycemic Index JAMA Feb. 12, ‘97 © LifeLong Health®

Eat More High Fiber Foods
#4 Fiber protects against… Constipation High cholesterol Heart disease High blood sugar Diabetes Certain cancers Obesity The health benefits of eating foods high in dietary fiber are many: Fiber draws water into the bowel and adds bulk which helps prevent constipation. Foods rich in soluble fibers lower blood cholesterol by binding with bile and increasing cholesterol excretion from the body. Fiber may have other effects on lowering cholesterol and reducing the risk of coronary heart disease. Fiber in meals slows the absorption of glucose. This helps prevent the glucose surge and rebound that seems to increase the risk of diabetes. People who eat more dietary fiber are less likely to get diabetes. Foods high in dietary fiber, especially fruits and vegetables, are protective against many common cancers. Foods high in fiber are generally lower in calories (have a low caloric density) and help fill a person up (provides satiety) before they eat too much. Some research shows that high fiber meals protects against weight gain and obesity. © LifeLong Health®

Dietary Fiber Dietary fiber is found only in plant-based foods, primarily unrefined foods Fruits Vegetables Legumes (peas and beans) Whole grains Nuts and seeds Fiber is largely the un-digestible part of the plant. It is not absorbed, so its health benefits occur in the gut. Cooking makes some foods easier to eat, but it does not destroy plant fiber. The primary function of fiber is to move the bowel contents and keep the colon healthy. It also slow the absorption of sugars so that blood sugars don’t rise too fast. This spares the pancreas by decreasing the need for insulin. It also traps cholesterol in the gut and rids it from the body. © LifeLong Health®

Recommended Fiber Intake
Dietary Fiber Men 38+ gm/day Women 25 gm/day Current intake is only grams/day Soluble Fiber (best for lowering cholesterol) 10-25 grams/day Examples: oats and oat bran, psyllium, barley, oranges, bananas, apples The Institute of Medicine (IOM) Food and Nutrition Board recently established new guidelines for dietary fiber (shown in this slide). This is an increase from previous standards, indicating the importance that dietary fiber plays in good health. The National Cholesterol Education Program (NCEP) guidelines also recommend eating more soluble fiber. This kind of fiber is especially helpful in lowering blood cholesterol levels and risk for heart disease. It is also helpful for controlling blood sugar levels. © LifeLong Health® IOM and NCEP Guidelines, 2002

Soluble or Viscous Fiber
Goal Increase to grams per day Soluble Fiber grams Barley, ½ cup cooked Oatmeal, 1 cup cooked Psyllium seeds, ground 1T 5 Apple, banana, peach Orange, grapefruit, pear Beans, cooked, 1 cup Broccoli, ½ cup cooked Brussels Sprouts, ½ cup ckd 3 Carrots, ½ cup cooked Source: ATP 3 TLC Guidelines Soluble or viscous fiber traps excess cholesterol and cholic acid (bile salts) in the gut and excretes them. This is the only portal of exit for cholesterol to leave the body. Viscous fiber also slows absorption of sugars, helping keep blood glucose in a healthy range and preventing diabetes. This slide shows examples of some common foods that are good sources of soluble fiber. Notice that legumes are an excellent source. Reference NIH, Adult treatment panel 3, Therapeutic Lifestyle Change Guidelines, 2002 © LifeLong Health®

Practical Steps To Increase Your Intake of High-Fiber Foods
Now let’s consider some practical steps to increase our intake of high-fiber foods. © LifeLong Health®

Eat More Fruit 1 Fruits fiber, g Apple, 1 medium Applesauce, canned 1/2 C 1.5 Apricots, 3 medium Banana, 1 medium Blackberries, fresh, 1 C Blueberries, fresh, 1 C Cantaloupe, 1 C pieces Kiwi, 2 medium Orange, 1 medium Papaya, half Peach, 1 medium Prunes, 1/2 C cooked Strawberries, 1 C Fruit is a good source of fiber, low in fat and calories, and cholesterol-free. Two to four servings of fruit per day are recommended. Fruit is rich in fiber and fun to eat. The goal is to eat two to four or more servings of fruit every day. Fresh fruit, when available, is best. © LifeLong Health®

Eat More Vegetables 2 Vegetables fiber g Asparagus, 1/2 C cooked Broccoli, 1/2 C cooked Brussels sprouts, 1/2 C ckd Carrot, 1 medium Green beans, 1/2 C cooked Green peas, 1/2 C cooked Greens, 1/2 C cooked Onions, 1/2 C chopped Potato, 1 medium Summer squash, 1/2 C ckd Winter squash, 1/2 C baked 2.9 Sweet potato, 1 med. baked 3.4 Tomato, 1 medium Vegetables are low in fat and calories and high in fiber, vitamins, and minerals. Three to five or more servings of vegetables per day are recommended. Vegetables are an excellent source of dietary fiber. They are strongly associated with protective effects against many cancers. Vegetables are also the lowest calorie food group of any foods. For optimum health, aim for at least three to five servings of vegetables daily. Try to eat some raw vegetables every day, too. © LifeLong Health®

Eat More Whole Grains 3 Whole grains are a good source of fiber. They are usually low in fat, and they tend to fill you up. Six or more servings of whole grains per day are recommended. Grains fiber g Bran Flakes cereal, 3/4 C Bran muffin, Brown rice, 1C cooked Corn tortilla, 1, whole corn 1.0 Grape-Nuts, 1/4 C Oatmeal, 2/3 C, cooked Pancakes, three 4” cakes Pasta, 1/2 C, cooked Shredded wheat, 1 oz Wheaties, 1 C White bread, 1 slice Whole-wheat bread, 1 slice 1.6 Whole grains are an excellent source of dietary fiber and seem to be especially helpful in reducing risk for heart disease. Oat bran is especially helpful in lowering blood cholesterol levels. The goal is to eat whole-grain breads and cereals at least the majority of the time. The Food Guide Pyramid recommends six or more servings of grains daily. Good sources include breads, cereal, pasta, rice, corn tortillas, etc. © LifeLong Health®

Eat More Legumes 4 Legumes are the foods highest in fiber. They are also good sources of protein. Eat at least three or more servings per week. (Daily intake is ideal.) Legumes fiber g Black beans, 1 C cooked Chickpeas, 1 C cooked Chili beans, veg. 1/2 C Hummus spread, 5 T Lentils, 1 C cooked Three bean salad, 1/2 C Tofu, 1/2 C Legumes are excellent sources of dietary fiber and have been shown to reduce blood cholesterol levels when they are added to the diet. Legumes are also excellent sources of protein and are a good replacement for meat. Of all the legumes, soybeans have the highest quality protein. © LifeLong Health®

Choose Fruit/Vegetable Juice
5 Juice fiber g Apricot nectar, 1 C Grapefruit juice, 1 C Orange juice, 1 C Tomato juice, 1C V-8 juice, 1C Soft drink*, 1 can * The soft drink is loaded with sugar and calories but no other nutrients. Pure fruit and vegetable drinks contribute some fiber and are good sources of vitamins. Look for juices without added sugar. Most people today drink soft drinks instead of pure fruit and vegetable juices. While eating the whole fruit or vegetable is better for added fiber, fruit and vegetable drinks are a big improvement, compared to soft drinks that add no nutrients to your diet. Fruit and vegetable juices can provide vitamin C (and vitamin A for tomato and V-8 juice) and other nutrients that contribute toward better health. © LifeLong Health®

Eat Nuts and Seeds 6 Nuts fiber g Almonds, 1 oz Cashews, 1 oz Filberts, 1 oz Mixed nuts, 1 oz Peanut butter, 2 T Peanuts, 1 oz Pistachios, 1 oz Sunflower seeds, 1 oz Pumpkin kernels, 1 oz Nuts are good sources of fiber, protein, and unsaturated fats. Nuts have been found to reduce the risk of heart disease. Nuts and seeds are good sources of fiber and protein. While nuts and seeds are high in fat, the kind of fat they have is mostly unsaturated and protective to the heart. Several studies have documented that people who eat nuts five or more times per week develop heart disease significantly less often than those who don’t eat nuts. © LifeLong Health®

Eat Less Refined Foods 7 Sample Foods fiber g Apple, 1 med Applesauce, canned 1/2 C 1.5 Apple juice, 1 cup Soft drink, 1 can Whole-wheat bread, 1 slice 1.6 White bread, 1 slice Twinkie, Soft drinks, ice cream, candy sugar, butter, margarine Much of the fiber is removed in refined and processed foods. Use more unrefined, natural foods. When foods are refined, for example, when whole wheat is turned into white flour or brown rice is turned into white rice, much or most of the fiber and other key nutrients are lost. Similarly, fiber can be lost when food is processed. For example, a whole apple or carrot is high in fiber. As either becomes juice, most of the fiber is removed. While it’s OK to drink fruit and vegetable juices as part of a meal, eating the whole fruit or vegetable is better (fewer calories and more fiber). For some people, the only fruit or vegetable they get in their diet is from fruit juice or ketchup. Eat a wide variety of fruits and vegetables for optimal health. The most highly refined foods such as sugar, soft drinks, candy, etc., are completely lacking in fiber and most other nutrients as well. © LifeLong Health®

Read Food Labels 8 Nutrition Facts Serving Size 2.5 oz. (71g) Servings per container 4 Amount Per Serving Calories 130 Calories from fat 25 % Daily Value Total Fat 3g 5% Saturated fat 1 g 5% Polyunsaturated fat 0.5g Monounsaturated fat 1.5g Cholesterol 10 mg 4% Sodium 290 mg 12% Total Carbohydrate 18g % Dietary fiber 5g 20% Sugars 1g Protein 8g When buying foods, check the label for fiber content. You will soon learn which foods are higher in dietary fiber. A good way to learn the fiber content of foods is to check labels. The fiber content is shown in grams. Keep in mind that grams is recommended. Compare the fiber content of breakfast cereals, breads, etc. You will learn a lot. © LifeLong Health®

Estimating Fiber Intake
Foods _ fiber g Egg _____ Toast, white bread _____ Butter and jam _____ Glass of milk _____ Turkey sandwich _____ Coke _____ Chips _____ Meat loaf _____ Dinner roll (white) _____ Salad with dressing _____ Coffee with cream _____ Cheese cake _____ Total fiber intake (g) _____ Typical eating record for a busy person Add up how much fiber this person ate for the day Here is a typical meal a busy person might eat. Calculate the grams of dietary fiber in this day’s food intake. Use the tables in your personal guide for calculating fiber intake. © LifeLong Health®

Keep Track of Fiber Intake
Foods fiber g Egg Toast, white bread Butter and jam Glass of milk Turkey sandwich 1 Coke Chips Meat loaf Dinner roll (white) Salad with dressing 2 Coffee with cream 0 Cheese cake Total fiber intake (g) Did you come up with the same total? Is this sufficient fiber for a day? Keep records on how well you do for a day. How did this person do? Is 4.2 grams in a day adequate? What is recommended? (25-38 g/day) What could this person have done differently to improve his or her fiber intake? Add a fruit or two for breakfast (orange and banana) Add vegetables for lunch (carrot sticks, sliced tomato, glass of V-8) For dinner, a whole wheat roll, baked apple for dessert, another vegetable such as broccoli, perhaps vegetarian chili in place of meat loaf. Now, you keep records for a day and see how you do on your fiber intake. This can be an excellent learning experience. You can also do the same thing for glycemic load for a day. Find out how you are doing. © LifeLong Health®

Fiber Quiz Fiber is found only in _____ _____ foods.
Dietary fiber helps prevent _____ and _____, two leading health problems. The recommended intake of fiber is __to __ g per day. The average intake of fiber is about __to __ g per day. Which food is highest in dietary fiber: an apple, a cup of Wheaties® dry cereal, or 1/2 cup of peas? T or F Nuts and seeds are not a good source of fiber? T or F Whole grains can help lower cholesterol levels? You should eat _____ or more servings of fruits and vegetables (high in dietary fiber) every day. Answers: 1. Fiber is found only in plant-based foods. 2. Dietary fiber helps prevent diabetes and heart disease, two major health problems. 3. The recommended intake of dietary fiber is 25 to 38 g per day (set by the American Dietetic Association). 4. The average intake of dietary fiber is about 10 to 15 g per day. 5. Which food is highest in dietary fiber: an apple, a cup of Wheaties® dry cereal, or 1/2 cup of peas? (They are all about the same, 3 g of fiber.) 6. T or F. Nuts and seeds are not a good source of dietary fiber? (False. A serving of nuts or seeds (1 oz.) has 2-3 g of fiber, which is as much or more than a serving of most vegetables (1-2.5 g), and more than a slice of whole wheat bread (1.6 g). 7. T or F. Whole grains can help lower blood cholesterol levels. (True, especially oatmeal, brown rice, and whole-grain breads.) 8. You should eat 5-10 servings of fruits and vegetables (high in dietary fiber) each day. The New Food Guide Pyramid recommends you eat 4-8 servings from breads, cereal, pasta, rice, and other grain products (mostly whole grains) every day. If you do this, you will get plenty of dietary fiber. © LifeLong Health®

www.LifeLongHealth.us MakingHealthyChoices.info
Enjoy meals with healthy carbohydrates! This graphic concludes this presentation. Notes: In some settings you may want to refer to one or more of the slides that follow this presentation—just keep clicking. Using all the slides at once, however, would make a usual presentation overly long If you have PowerPoint software, you can read the Speaker Notes on screen and print one or more slides as desired. If you have the PowerPoint Viewer, you can view the slides on screen and print the Speaker Notes as desired from slides 52 to 82. © LifeLong Health®

Glycemic Index and Obesity
Rats fed a high glycemic diet compared to rats fed a low glycemic diet develop marked obesity in 32 weeks. In 16 human studies, 15 studies found lower satiety, increased hunger, and higher voluntary food intake after eating high vs. low glycemic index meals. JAMA May 8, 2002, 287:2415 © LifeLong Health®

Grains – Glycemic Index
Food G.I. French bread 136 White rice Corn chips 125 English muffin 110 Doughnut 108 Waffle Bread, White 100 Taco shells Rye bread Whole wheat bread 98 Food G.I. Pastry Rice (Basmati) white Pita bread Brown rice Oatmeal cookie Sweet corn Pound cake WW bread, stone ground 76 Bulgur Oat bran bread Pasta © LifeLong Health®

Cereals – Glycemic Index
Food G.I. Barley, pearled, ckd All-bran Oatmeal, old fashioned 70 Whole wheat, quick Kellogg’s mini-wheats 81 Bran chex Wheat kernels, whole 84 LIFE cereal Grape-nuts Food G.I. Corn meal 98 Shredded wheat 99 Cream of wheat 100 Millet 101 Cheerios 106 Corn chex 118 Corn flakes 119 Rice chex 127 © LifeLong Health®

Fruits – Glycemic Index
Food G.I. Cherries 32 Grapefruit 36 Apricots, dried 44 Pear Apple Apple juice 57 Peach Orange Food G.I. Grapes Orange juice 74 Banana Apricots 81 Raisins Apricots, canned syrup 91 Pineapple 94 Watermelon 103 © LifeLong Health®

Legumes/Vegetables Glycemic Index
Legumes G.I. Soy beans 26 Soy milk 44 Lentils Kidney beans 42 Butter beans 44 Split peas 45 Pinto beans Chick peas 60 Peanuts 21 Vegetables G.I. Parsnips Potato baked French fries Pumpkin Potato steamed Beets Sweet corn Sweet potato Carrot Green peas Broccoli, greens, cabbage 20 cauliflower, s. squash © LifeLong Health®

Sugars – Glycemic Index
Sugars G.I. Fructose 32 Lactose Honey High fructose corn syrup 89 Sucrose (table sugar) 92 Glucose 137 Maltose 150 Misc. foods G.I. Milk, skim 46 Milk, full fat 39 Chocolate milk 49 Yogurt, sweetened 51 Soft drink 97 Coca Cola 90 Pizza Tomato soup 54 Soda crackers 106 Dates, dried 146 Tofu frozen dessert 164 Ice cream, full fat 87 © LifeLong Health®

Glycated Hemoglobin (HbA1c)
This test indicates the average blood glucose concentration over the past three months This test is a screening tool for metabolic syndrome or diabetes ( a HbA1c of 7.0 or higher may indicate diabetes) It also predicts increased risk of heart disease and overall mortality even for people without diabetes A glycated hemoglobin (HbA1c) test indicates the average blood glucose concentration over the past three months and is being suggested as a screening tool for diabetes and increased risk of heart disease and overall mortality. Kay-Tee Khaw et al, Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition, British Medical Journal Vol. 322:1-6, Jan. 6, 2001 © LifeLong Health®

Study Findings An increase of 1% in glycated hemoglobin is associated with roughly a: 30% increase in mortality from all causes 40% increase in mortality from coronary heart disease Conclusion from authors of study. 82% of the excess mortality due to elevated glycated hemoglobin levels (5.0 or greater) was among those people without diabetes. Thus, the authors conclude that more lives could be saved by lowering the glycated hemoglobin levels of the entire population than by just focusing on diabetics. This is because only about 5% of the population (aged 45+) have diabetes. Kay-Tee Khaw et al, Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition, British Medical Journal Vol. 322:1-6, Jan. 6, 2001 British Med. Jour., Jan. 6, 2001 © LifeLong Health®

Glycated Hemoglobin and Coronary Heart Disease
Relative risk CHD In a prospective study of 4,662 men in Norfolk (United Kingdom) followed for 4 years, blood sugar levels, measured using glycated hemoglobin, were a strong predictor of coronary heart disease. Men with glycated hemoglobin levels of 5% or greater were at increased risk of ischemic heart disease. There relative risk was about 2.8 times higher, even if they didn’t have diabetes. In persons with diabetes, a high glycated hemoglobin (7.0 or higher) increased the risk of developing coronary heart disease by 5.2 times. This increased risk is after adjusting for age, blood pressure, cholesterol, BMI, smoking, and history of cardiovascular disease. Kay-Tee Khaw et al, Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition, British Medical Journal Vol. 322:1-6, Jan. 6, 2001 n=4662 Glycated Hemoglobin Levels British Med. Jour., Jan. 6, 2001 © LifeLong Health®

Glycated Hemoglobin and Mortality from All Causes
Relative risk of Death This graph shows the increased risk of mortality from any cause in relationship to glycated hemoglobin levels. The predictive value of glycated hemoglobin for total mortality was stronger than that for cholesterol, blood pressure, and body mass index. This increased risk is after adjusting for age, blood pressure, cholesterol, BMI, smoking, and history of cardiovascular disease. People with glycated hemoglobin levels less than 5.0% had the lowest mortality level. Kay-Tee Khaw et al, Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition, British Medical Journal Vol. 322:1-6, Jan. 6, 2001 n=4662 Glycated Hemoglobin Levels © LifeLong Health® British Med. Jour., Jan. 6, 2001

Prevention Strategy Reduce the average blood sugar level of the general population to achieve a glycated hemoglobin level less than 5.0% by: Decreasing excess body fat Increasing the level of physical activity Improving eating habits Decrease the glycemic load in the diet Eat less refined carbohydrates and more foods high in dietary fiber The focus on heart disease prevention has centered primarily around fats and cholesterol in the diet in past years. This study points out the need to also look at those behaviors linked to high blood sugar levels, primarily: Excess body fat Inactivity Nutritional habits, primarily glycemic load, and dietary fiber intake. All of these lifestyle changes can help improve glucose tolerance (help prevent insulin resistance which causes an increase in blood sugar levels). © LifeLong Health®

Oat Bran Bread and Diabetes
Study design 8 diabetic men, 24-week crossover study Ate 6+ servings of high-fiber oat bran bread, muffins, or cereal per day (controls ate white bread) Dietary fiber increased from 19 to 34 g/day 18 g fiber/day from oat bran (9 g soluble fiber) Results Glucose, insulin, and cholesterol levels improved significantly. Diet composition was Carbohydrate 55% of calories Fat 30% of calories Protein 15% of calories Throughout the study, the diet remained constant except for the change in fiber intake. Weight also remained constant. In making the oat bran bread, oat bran concentrate was used at a level of 45% by weight to replace wheat flour. The oat bran bread was similar to whole-wheat bread in texture and was enjoyed by the test subjects. © LifeLong Health®

Oat Bran, Metabolic Changes
Total glucose response dropped 46% Insulin response dropped 19% Total cholesterol levels dropped 14% LDL cholesterol levels dropped 23% HDL levels increased 8% When the body digests food and the rate of glucose absorption is slowed, then blood glucose rises slowly so the insulin released is less. That means blood sugar never gets as high and there is less strain on the pancreas. In this study, for people eating the bread with oat bran concentrate that replaced nearly half (45%) of the wheat (or white) four, the total glucose response area (the area under the curve) dropped from 1,344 milli moles each minute per liter to 724, a decrease of 46%. Glucose maximum values were 13%-15% lower when men ate the high-fiber oat bran foods. The blood glucose didn’t rise as high, therefore less insulin was required. The pancreas was spared. The insulin response area was reduced from 16,954 mU*min/L3 to 13,791, a decrease of 19%; that is, insulin response was one fifth less. Maximum insulin values dropped 11%-15%. For people with NIDDM (non-insulin diabetes milletus), decreased insulin secretion means possible preservation of pancreatic beta cell function. Mean total cholesterol levels dropped from 205 to 176 (a 14% decrease), and LDL cholesterol dropped from 130 to 100 (a 23% decrease). HDL cholesterol levels increased slightly from 37 to 40 mg/dL, an 8% increase. There was also a trend for decreased triglyceride levels (5%). The ratio of LDL-C to HDL-C was 3.5 on white bread and 2.7 on high-fiber oat bread — 25% lower (a ratio less than 3.5 is associated with a reduced risk of atherosclerosis). Throughout the study, body weight and dietary fat intake remained unchanged and did not affect the metabolic response. JADA, 1996; 96: White bread Oat bran bread JADA, Dec. 1996 © LifeLong Health®

Fiber Intake and Heart Disease
The above slide depicts results from a study of dietary fiber and the risk of heart attack (MI) involving 43,757 men from the Health Professionals Follow-up Study. The men completed a 131-food frequency survey which determined their fiber intake. The researchers concluded, “A 10-g increase in total dietary fiber corresponded to a RR of total MI of 0.81.” This results in a reduction of MIs (myocardial infarction, i.e., “heart attack”) by one-fifth. JAMA, Feb. 14, 1996 © LifeLong Health®

Dietary Fiber and Coronary Risk
Fiber Source Relative Risk of MI* Fruits (21% decreased risk) Vegetables (22% decreased risk) Cereals (29% decreased risk) “... higher intake of dietary fiber, particularly from cereal and grain sources, can reduce substantially the risk of coronary heart disease.” JAMA, Feb. 14, 1996 * Decreased risk of heart attack for every 10 gram increase in fiber Notice the researchers’ comment. We can lower our coronary risk. JAMA, Feb. 14, 1996 © LifeLong Health®

Decreased Coronary Risk From Eating Specific Foods
Heart Attack Risk Ate cold breakfast cereal times/week v. seldom Ate carrots 2-4 times/week v. seldom ate carrots Ate an apple daily v seldom ate apples Ate peas daily v. no peas This table shows foods eaten regularly and the relative risk of an MI (myocardial infarction or heart attack) among men in the study. JAMA, Feb. 14, 1996 © LifeLong Health®

Plant Stanols/Sterols
A substance found in plants (soy beans) that lowers cholesterol It is put in margarine. Examples include: Benecol Take Control Research shows that if you eat 2 grams/day of plant stanols/sterols you can lower cholesterol by about 6-15 percent This is one of the easiest ways to lower your cholesterol. Stanols and sterols are natural substances found in soybeans. Studies show they are very effective in lowering cholesterol. All you have to do is spread it on your bread in place of butter. That’s pretty simple! NCEP, ATP 3, Guide to Therapeutic Lifestyle Change © LifeLong Health®

Fruit and Vegetable Intake and Risk of Stroke
Nurses’ health study Nurses who ate the most fruits and vegetables (top 20%) had a 31% lower risk of stroke than people who ate the fewest (bottom 20%). For every serving of fruit or vegetable eaten per day, the risk of stroke drops 6% Relative Risk In this large study, women who ate the most fruits and vegetables had about 1/3 fewer strokes. [Study details] Persons in the highest quintile (20%) of fruit and vegetable intake had a relative risk of ischemic stroke of 0.69 or a 31% decreased risk compared to those in the lowest quintile (20%). For every one serving per day of fruits or vegetables, the risk of stroke drops by 6%, up to six servings per day. The risk is reduced even when holding constant for other stroke risk factors. Individual foods that were found to be most protective include: Cruciferous vegetables (eg, broccoli, cabbage, cauliflower, brussel sprouts) Green leafy vegetables Citrus fruits Vitamin C-rich fruits and vegetables Elements found in these foods that may help explain their protective effect include: potassium (help prevent/reduce high blood pressure), folate (helps reduce high blood homocysteine levels), fiber (helps lower cholesterol levels), and flavonoids (antioxidants which may help prevent damage to arteries). Reference: Joshipura KJ, Willet WC, et al, Fruit and Vegetable Intake in Relation to Risk of Ischemic Stroke, JAMA, Oct. 6, Vol 282, No. 13, Ref. JAMA, p. 1233, Oct. 6, 1999 Fruit/Vegetable Intake by Servings/Day © LifeLong Health®

Foods Most Protective Against Risk of Stroke
Cruciferous vegetables (e.g. broccoli, cabbage, cauliflower, brussel sprouts) Green leafy vegetables Citrus fruits Vitamin C-rich fruits and vegetables Fruits and vegetables are good for you—some are better than others. Fresh and frozen are better than canned. Any fruits and vegetables are better than none. Eat a variety of fruits and vegetables for the most health benefits. Reference: Joshipura KJ, Willet WC, et al, Fruit and Vegetable Intake in Relation to Risk of Ischemic Stroke, JAMA, Oct. 6, Vol 282, No. 13, Ref. JAMA, p. 1233, Oct. 6, 1999 © LifeLong Health®

Plasma Vitamin C and Mortality from All Causes
Relative Risk For each increase in plasma vitamin C there was a decrease in mortality from all causes. From the first to the fifth quintile (20% of the people in each category), mortality rates dropped by half. The decrease in mortality is apparently from the intake of fruits and vegetables which highly correlate with plasma vitamin C levels. When people who took vitamin C in pill form were analyzed separately, there was no association of plasma vitamin C levels with mortality. The Lancet Vol 357: , March 3, 2001 n=19,496 Plasma Vitamin C Quintiles © LifeLong Health® The Lancet, Mar. 3, 2001

Summary Findings For each increase of 20 micro mol/L in plasma vitamin C (equivalent to one serving of fruits or vegetables), mortality rates fell by: 15% for cancer 30% for cardiovascular disease 20% for death from any cause These reductions in mortality remain even after adjusting for possible confounding risk factors such as smoking, BMI, cholesterol levels, blood pressure, diabetes, and supplement use. The Lancet Vol 357: , March 3, 2001 The Lancet, Mar. 3, 2001 © LifeLong Health®

Fruits and Antioxidants
Fruits are excellent sources of antioxidants Blueberries Strawberries Cantaloupe and other melons Kiwi Citrus: oranges, grapefruit, lemons, tangerines Fruits are nature’s desserts. Enjoy them daily. Fresh fruits are best when available. Antioxidants protect your heart and arteries. Fruits are an excellent source. Dietary Guidelines for Americans, 2000 © LifeLong Health®

Diet and Colon Cancer Study of 4,400 American adults
Men and women who ate a diet high in red and processed meats, refined grains and sugar, and low in fresh fruits and vegetables -- doubled their risk of colon cancer. Colon Cancer (RR) According to the American Cancer Society, 46,000 people die of colon cancer every year in the U.S. This makes colon cancer the second leading cause of cancer death (lung cancer is number 1). Investigators studied the eating habits of some 4,400 American adults. Half had colon cancer. The other half were healthy controls. Men and women who ate a diet high in red and processed meats, refined grains and sugars, and low in fresh fruits and vegetables doubled their overall risk for colon cancer. In contrast, people who ate a “prudent” diet, low in red meat and sugars but high in fish, poultry, fresh fruits and vegetables -- achieved a nearly 40% reduction in colon cancer risk. Source: Amer. Jour. Of Epid. 1998;148:4-16. Low in meat, high fruits & veg High meat, low fruits & veg Ref: Amer. J. of Epid., July, ‘98 © LifeLong Health®

Protective Foods for Colon Cancer
Food # of Studies Vegetables Fruit Raw vegetables 3 Cabbage family vegetables 8 Onion family Carrots Tomatoes Here is a list of the number of scientific studies that show which foods are most protective against colon cancer—our nation’s 2nd cause of cancer deaths. Ref: Vegetables, fruit, and cancer prevention: A review, JADA, Oct. ‘96 © LifeLong Health®

Which Foods are Most Protective Against All Cancers?
Food % of Studies Raw vegetables % All vegetables 81% Onion family 79% Carrots % Green Vegetables 77% Tomatoes 70% Citrus fruit 65% All fruits % While all fruits and vegetables seem to be protective against cancer, the ones most protective (that is, the fruits and vegetables for which we have the best evidence) are shown in this slide. Notice that most of the foods that protect against cancer are carbohydrate foods! Ref: Vegetables, fruit, and cancer prevention: A review 212 studies on diet and Cancer Prevention, JADA, Oct. ‘96

Calculate the Glycemic Load of a Carrot
Glycemic index of a carrot is _____. GI (glycemic index) of a carrot = 68 © LifeLong Health®

Glycemic index of a carrot is 68. How many grams of carbohydrate in one medium carrot? _____ Carbohydrate in 100 grams of carrots (about one large carrot) is 6 gm. © LifeLong Health®

Glycemic index of a carrot is 68. How many grams of carbohydrate in one medium carrot? 6 grams Glycemic load = __________. GL of a carrot = 0.68 X 6 = 4.1 © LifeLong Health®

Glycemic index of a carrot is 68. How many grams of carbohydrate in one medium carrot? 6 grams Glycemic load = 0.68 X 6 = 4.1 GI of a carrot = 68 Carbohydrate in 100 grams of carrots (large carrot) is 6 gm. GL of a carrot = 0.68 X 6 = 4.1 Keep in mind that a GL less than 150 is linked to a low risk of coronary heart disease. © LifeLong Health®

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