Dr. Monica Aggarwal

Food Nutrition Myth 3: Popcorners

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Popcorners. Marketed as “gluten free” and “wholesome in a chip.” Ingredients: second ingredient oil which is because they are fried. Then there is whey which is effectively cow’s milk–not a fan. Maltodextrin is a food additive which is plant based. It is like a simple sugar and has a high glycemic index. There is some data that maltodextrin is INFLAMMATORY. It changes gut bacteria and triggers inflammatory disease. Remember inflammatory diseases present to different people in different ways: some get ulcerative colitis or Crohns, others get type I diabetes, others get lupus or rheumatoid arthritis.

What do we know about disodium phosphate. Not a whole lot. It is considered “generally safe” by the FDA. It is a food additive. It used to come from animal bones but now comes from rocks. It is an food “enhancer.” Inorganic phosphates are possibly unsafe–often used in pesticides. There has been data that it accumulates in the body and binds to calcium>>ultimately triggering kidney failure. Loads of foods that dont have this! Foods commonly that do are canned sauces, chips, packaged meats and cheeses to prevent spoilage. All of these additives…

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Food Nutrition Myth 2: “Premium Natural”

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So this is Cabot whipped cream. Says that the product is “Premium Natural.” There is even a dairy farm at the top as part of the marketing logo. First three ingredients: milk, cream and sugar which you would expect because it is after all whipped cream. Then there is mono and diglycerides again. And Carrageenan. It is extracted from a type of seaweed. It is a food additive that is used as a thickener in lots of milk, ice cream and other creamed product. There has been some recent data that links it to causing cancer. Hard to know what to do with it. Not enough data. This is what wedMD says about it “Carrageenan is LIKELY SAFE for most people when taken by mouth in food amounts. There is a chemically altered form of carrageenan that is available in France to treat peptic ulcers. This form is POSSIBLY UNSAFE because there’s some evidence that it might cause cancer.”

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Food Nutrition Myth 1: Bread

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Arnold’s Farmhouse Bread. Bread needs only 3 vital ingredients: flour, water and yeast. That is all that is needed. The more hardy breads have seeds and multiple types of grains. What is in this bread?

First tip: there are a lot more than 3 ingredients on this list. Second: what are monoglycerides? They are fats that are used as food additives to combine things that don’t easily blend together. They may have trans fats in them. What is sodium steroyl lactylate? That is another food additive to make oil and water stay in an emulsion and not separate. It is used to make bread more durable so it doesn’t break in travel. Third ingredient is SUGAR. Fifth ingredient is soybean oil. Seventh ingredient is molasses (sugar). So why do we need all this stuff: it is to keep the bread soft but hardy enough to travel and to prevent spoilage. Lots of additives to get soft bread to travel far distances? Buy your bread at a bakery. Watch out though. Even Whole Foods has bakery bread with unnecessary ingredients. Ask the bakery to print out the ingredients prior to purchase. Roots makes a fabulous multigrain bread. Bread alone makes a great bread. There are breaderies around that are fabulous and fresh. Find one in your area.

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I can eat McDonald’s today. I am still young.

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Heart disease is the number one killer of men and women. In fact, heart disease will kill more women than men. While we are getting better at decreasing heart disease deaths with improved medical care, prevention is the key to the improvements.

People often believe that they can eat whatever they want when they are young because heart disease is not something they have to worry about. NOT TRUE. Heart disease is not a disease of the elderly. It is a spectrum disease that starts in the young. If you look at Korean and Vietnam war soldiers autopsies, there were notable fatty streaks and cholesterol plaque in their heart arteries.

A study was done in JAMA in 1999 that looked at 2876 autopsies of men and women, ages 15-34, who died of external causes. Plaque was noted in ALL of the aortas (pipe that exists the heart and gives the body blood). More than 1/2 of the right coronary arteries (arteries that give blood to the heart so it can pump) in the 15-19 year old age group had plaque and more as the group aged. Fatty streaks were more notable in the black patients, than the white patients.

This is a compelling picture that shows the plaque in the heart arteries. The darker the colors, the more the plaque. Notice the plaque in the youngest group.

What you eat matters. What you feed your children matters. If you think you can feed your children McDonald’s or eat it yourself, think again. You likely already have plaque in your heart arteries. What can you do to change this? Change your diet, decrease the triggers for plaque and prevent inflammation. A moment on the lips, truly is a lifetime in the body.

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Great Question about Elimination diet

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Somebody sent me this great question and I thought I would post it:

Question: Hi Monica! My name is XX and I am on a plant-based diet for treating my RA. I am on Plaquinel and Sulfasalazine and don’t want to be forever. I have limited range of motion of my fingers. I struggle severely with elimination diet. I’m kind of a foodie. Being Vegan is easy, it’s giving up coffee and sometimes the sweet stuff that I struggle with. But I know RA is a bigger struggle. I think I have a mental/emotional block. Anyway I’m also concerned about my overall nutrition because I’m Vitamin D deficient and anemic (not the inflammatory kind). My CRP and ESR have been normal since day 1. All my labs look great in fact besides the above mentioned. I’m just looking for a Doctor who can kind me accordingly. Do you ever do skype consultations or recommend anyone. I live in Colorado but I’m from Baltimore! I appreciate you and the work you’re doing!

Dr. A response: Great question! The acidity of coffee in triggering a leaky gut is debatable. Coffee is considered an anti-inflammatory and in some studies there is suggestion benefit. in overall mortality. Specifically, chronic coffee consumption may bring down blood pressure, improve blood sugar and decrease plaque in the heart.  I drink green tea daily and never gave it up. There is data on tea (both black and green) to show dilation of blood vessels and possible mortality benefit. I am okay with you drinking your coffee unless you think that it is triggering a reaction. Just don’t ruin the coffee with milk and sugar. I also think unprocessed sweets are okay once and a while. I for instance eat a nice dark chocolate periodically and enjoy it. Be creative. When food calls for sugar: add dates, maple syrup or banana. The things to be strict about in your diet are the “no meat and no milk.” Fish may be okay for some people and has a high omega 3 fatty acid content. But so many issues with pollutants in fish these days. Egg should be eliminated because increases cardiovascular risk and RA patients are at higher risk for heart disease. Most vegans are not anemic from low iron. You just need to eat lots of greens. B12 deficiency is possible and B12 has to be supplemented. Vitamin D is interesting. Lots of new data saying how important it is. But most people who live in the north are vitamin D deficient most of the year. Plus we use so much sun block–hard to avoid with the amount of ozone breakdown. Many people need to supplement with vitamin D tabs–not just vegans. Remember Vitamin D is not easy to get for anyone. It is just that in the US, we fortify our OJ and milk with vitamin D. Most almond milks are fortified as well. But if you are significantly low, you may have to supplement. Does that help?

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Am I Spending More to Eat Well?

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Costs of being on a WHOLE grain PLANT based diet.

People often talk about the costs of eating healthy. The discussion about how fast food is cheaper than healthy food comes up a lot in conversation. Is that really true though?

Recall my previous posting on calorie density. Bite per bite, the number of calories we take in with a burger will be so much more than with a veggie stew or a salad. But we feel full based on the amount of food we eat and therefore, often after eating that burger we still feel hungry. The volume of a burger is less than with a salad or stew and so we don’t often feel satiated despite getting in plenty of calories. That makes us eat more food than we need. Plus, with all of sugar and processed foods, we create leptin resistance so our body is unable to feel satiated. Leptin is the hormone responsible for creating the feeling of satiety.

Then, let’s look at the actual foods. The average price for a Big Mac, medium French fries and soda is $ 5.99. 1 pound of lentils (while you would never be able to finish) is $1.29. If you add rice, a 20 pound bag is $8.00. If you add a bunch of kale: that would add another $1-2 per whole bunch. Then, what about tomatoes or slices of pepper: add another 1$. Water: Free. So the rice and lentil dish with a salad on the side is cheaper than Big mac and fries plus you have plenty more for meals to come.

People often say that the burger tastes better. Is that really true? Our taste buds get used to and love what they see. The first time I ate Thai food, I hated it. Now I crave it. Your body needs time to adjust to a new palate. Your gut needs a chance to recover and restore. We can’t fall back on the fact that fast food is cheaper because it isn’t.  It impacts both your wallet and more importantly your long-term health.

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Its not all about Kale. Or maybe it is…ODE TO GREENS OF ALL TYPES

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I have been considering my obsession with kale. I love kale: lacinato kale, green curly kale, red kale. Yum. I talk about it all the time and the importance in our diets. I wear clothes with kale written on it. But, I feel I have neglected so many other greens. No one thing can provide everything that we need—not even kale. We must consider all of these other greens: butterhead lettuce, romaine, arugala, collard greens, Brussel sprouts, turnip greens, spinach, chard, cabbage and more. They all have different proportions of phytonutrients, nitrate concentration and fiber.

Things to remember: Vegetables give us an abundance of fiber, vitamins A and C, iron, magnesium, calcium and potassium. They even have protein. They are rich in phytonutrients and plant sterols. They have alpha linoleic acid which is a precursor to omega 3 fatty acids.

You can look at vegetables by their ANDI score (theirAggregate Nutrient Density Index) which basically is the amount of nutrients per calorie. The more phytonutrients a vegetable has, the higher the index. The ANDI score is one way to look at vegetables. It was created by Dr. Joel Furhman. While I don’t always agree with Dr. Furhman, I do like this score.

Another way to look at vegetables is to look at their anti-oxidant concentration. This is called the ORAC score or the oxygen radical absorption capacity. Free radicals are toxins that can cause damage in our bodies and are believed to increase our risk of cardiovascular disease, cancer and Alzheimer’s disease. Foods with a high ORAC score decrease the free radical formation and have been found in rat models to improve memory and improve the stability of blood vessels in that same model. This concept was developed by Dr. Jean Mayer at Tufts University and an ORAC test was created at the National Institute on Aging in Baltimore, Maryland. It is believed that foods with an ORAC score in the 3000-5000 unit range have the most benefit. See below for chart.

You can also look at the nitrate concentration of foods. This comes under debate because nitrites and nitrates at high levels are toxic to the bodies but in smaller doses are of benefit. Nitrates are known to cause blood vessels to dilate and improve blood flow to end organs. This is a good thing but in high concentrations as are seen in cured meats, they are known to be toxic. The amount in our vegetables is felt to be balanced and not in a toxic amount. However, the direct correlation between nitrate/nitrite concentration on our vegetables and how much is needed to be supportive is unclear.

Here is my ode to the greens that I have neglected. Kale always starts the list but is NOT the only fabulous green vegetable.

  1. Kale: great source of vitamins A, C, and vitamin K. I like it most because it is an excellent source of nondairy calcium. It contains an abundance of potassium and magnesium. It also has iron, protein and a bounty of B vitamins, including folate which helps in brain development. Kale also contains fiber, which is good for lowering cholesterol levels, as well as alpha linoleic acid (ALA), a precursor to omega-3 fatty acids. ALA also has been shown to decrease the risk of heart disease. Omega-3 fatty acids are important in decreasing inflammation and should be part of the daily diet. Kale also has lutein which helps to prevent macular degeneration. In the Nurses’ Health Study, researchers actually found an increase in fracture risk in women who consumed dairy sources for calcium versus those who consumed non-dairy sources of calcium. ANDI score: 100
  2. Collard greens: have many of the same benefits as kale, good source of calcium. ANDI score: 100
  3. Bok choy: rich in calcium, ANDI score: 824
  4. Turnip greens: get the turnip and the greens and have two separate things to eat. Good source of calcium
  5. Mustard greens: spicy, rich in calcium
  6. Broccoli: rich in calcium, ANDI score 376
  7. Cabbage: has lots of vitamin K. Also full of antioxidants. Cook slightly, don’t overcook. I use cabbage with mustard greens, turmeric, and chilies. Can make sauerkraut and coleslaw as well. ANDI score 481
  8. Arugula: high in nitrates which are believed to have in lowering blood pressure. We use medications called nitrates which dilate blood vessels and increase blood flow (a good thing. ANDI score 559
  9. Spinach: has oxalates which can bind calcium. Oxalates decrease with cooking the spinach. High in iron. ANDI score: 739

 

Top-Scoring Fruits & Vegetables

ORAC units per 100 grams (about 3 ½ ounces)

Fruits Vegetables
Prunes 5770 Kale 1770
Raisins 2830 Spinach 1260
Blueberries 2400 Brussels sprouts 980
Blackberries 2036 Alfalfa sprouts 930
Strawberries 1540 Broccoli flowers 890
Raspberries 1220 Beets 840
Plums 949 Red bell pepper 710
Oranges 750 Onion 450
Red grapes 739 Corn 400
Cherries 670 Eggplant 390
Kiwi fruit 602
Grapefruit, pink 483

 

http://www.ars.usda.gov/is/AR/archive/feb99/aging0299.htm

Classification of vegetables according to nitrate content

Nitrate content (mg/100 g fresh weight) Vegetable varieties
Very low, <20 Artichoke, asparagus, broad bean, eggplant, garlic, onion, green bean, mushroom, pea, pepper, potato, summer squash, sweet potato, tomato, watermelon
 

Low, 20 to <50

  

Broccoli, carrot, cauliflower, cucumber, pumpkin, chicory
 

Middle, 50 to <100

  

Cabbage, dill, turnip, savoy cabbage
High, 100 to <250  

Celeriac, Chinese cabbage, endive, fennel, kohlrabi, leek, parsley
Very high, >250  

Celery, cress, chervil, lettuce, red beetroot, spinach, rocket (rucola)

Adapted from: Food sources of nitrates and nitrites: the physiologic context for potential health benefits, Am J Clin Nutr, July 1, 2009, vol. 90 no. 1, 1-10

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Are we too clean? The role of our gut bugs.

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Our gut is like our second  brain. It is the first line of defense against so many toxins that we ingest. It has a significant role in our immune response. Our gut full of bugs. And all of the bugs have their own DNA. These bugs are called our microbiota and their DNA is our microbiome. We are full of bugs (90% bug!) and many argue that we are more bug than we are human! Having healthy gut flora is very important in keeping our bodies strong. We develop our gut flora from birth when we go through our mother’s vaginal canal. We then suck on our parents’ skin. We then crawl on the floor and suck on our toys. We are exposed to other people, our pets and our plants, all of which are covered in bacteria and nourish our gut. We go outside and are exposed to dirt with all of its valuable microbes. We eat the grass and lick things that our pets have licked and we obtain more bugs. This is good. Exposure to small numbers of pathogens will strengthen our immune system. Over time, however, our behaviors have changed, as explained by the “hygiene hypothesis.” As we have learned the importance of sanitation and its role in infection, we clean and sterilize most everything. We know that sanitation prevents the spread of germs and because of this knowledge, we have reduced the number of illnesses that have affected our children. With greater access to medical care, we take our children into doctors with many common ailments. Antibiotics are commonly prescribed by physicians.

But have we gone too far? Is it possible to be overly clean? What is the impact of our hand sanitizers and antibacterial soaps? What is the impact on our bodies of treating all of our illnesses with antibiotics? Are we over-treating illnesses, and could many of them be just watched while our bodies work them out? I know many physicians who feel infections are viral where antibiotics don’t work, but still, maybe because of pressure from patients, will prescribe antibiotics. Are we doing the right thing? With all of these changes in the modern era, we have also noted the onset of so much more allergy, autoimmune disease and inflammatory bowel disease.[i]  The larger families of ages past who lived in less sanitary conditions were not afflicted with these same illnesses. [ii] Perhaps, then we should get a little dirty and not worry about cleaning so much. Something to think about. I don’t use antibacterial soap. I don’t use hand santizers. I just use good ol’ fashioned soap.


[i] Blaser MJ Who are we? Indigenous microbes and the ecology of human diseases. EMBO 2006, Rep 7:956–960

 

[ii] Strachan DP. Hay fever, hygiene, and household size. BMJ; 1989; 299:1259– 1260.

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An Update on Soy

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This is an update on soy. Still lots of confusion and concern out there.

Bottom LINE: Soy products are okay. There is a significant concern regarding soy and its association with cancer that many people are afraid to it. The data does not pan out.

Consider: Asian countries drink soy milk, eat tofu and soy beans (edamame) abundantly and don’t have a higher incidence of breast cancer. Asian countries do NOT have more breast cancer and in fact have a lower incidence. The Western nations, in fact, are leading the pack.

The Details: Soy has received lots of press lately. There have been small animal studies that have linked high doses of soy protein isolate or isolated isoflavones to increased cancer risk. Soy is metabolized differently in humans from rodents so we can’t compare rodents and humans in this situation. Further, human studies on soy protein isolate have not shown any difference from other soy products. We have seen in study that soy products such as soy milk, soy beans and tofu are of benefit to our bodies. In the US, we use a lot of concentrated forms of soy in our supplements and energy bars: a different way to eat soy. While they have not been shown to be of harm, more studies on these highly concentrated/processed soy products are needed.

Soy is full of isoflavones which are natural estrogens. While are estrogens, they appear to have an anti-estrogen effect where they prevent the natural estrogens from binding to the receptors (a good thing). They also have anti-oxidant and anti-inflammatory effects. They stop the formation of estrogen in fat tissue (recall obese patients have more breast cancer than thing patients) and they bind to the estrogen proteins which is another way it prevents estrogen from binding to a receptor. Studies on Asian women who eat soy the most isoflavones (compared to the least abundant eaters) had a significantly less (29%) risk of developing breast cancers. US studies have not found any bad affects either of eating soy. Studies even on breast cancer survivors have shown no detriment. There is data to suggest soy eaters have less prostate and colon cancers.

SO: eat your soy! Enjoy it, often and much. It is a great source of fulfillment for those who are plant based and a nice alternative for all. Don’t be afraid of it. But eat it from natural sources like our Asian country counterparts: soy milk, tofu, edamame. Don’t take a supplement or powder. Stay away from genetically modified soy. Look for the non-GMO words. Organic will be non-GMO. Be natural!

Wu AH, Yu M, Tseng C-C, Pike MC Epidemiology of soy exposures and breast cancer risk, Br J Cancer. 2008 Jan 15; 98(1): 9–14.

Shu, X. The Journal of the American Medical Association, Dec. 9, 2009; vol 302: pp 2437-2443.

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If I eat a vegan diet, what about my calcium intake?

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Calcium is very important in bone development. However, this is not the whole picture. There are many other vitamins such as vitamin D, K and A that are essential to bone development. It is unclear how much calcium we need in our diet. Guidelines recommend 1000mg of calcium per day. We often think about cow’s milk when we think about the main source of calcium. That conception needs to be changed.

Many of us are sensitive to the milk and have a “milk allergy” or “milk sensitivity.” We believe these dairy products trigger a leaky gut.[i] As dairy products enter the gut, the tight junctions break and the breakdown products of milk enter the bloodstream. Our immune system is activated and our bodies develop immune complexes that start attacking parts of the body. In some people, the joints are affected and they develop rheumatoid arthritis. In others, it is the pancreas islet cells that are attacked and they develop Type I diabetes. In others it is lupus, vitiligo (loss of pigment in the skin) or multiple sclerosis. This immune system activation triggers oxidative stress and inflammation. We know that chronic inflammation is a risk for heart disease and cancer. Inflammation is also a trigger for bone breakdown. Then suggesting that we humans drink more milk to decrease fracture risk is a “conceivable contradiction.” [ii]

There are many studies now that suggest a link between increased dairy and cardiovascular risk.[iii],[iv] In a follow-up to the these initial mouse studies, an extensive review was conducted to evaluate humans and milk intake, and one of the studies in the review evaluated people who drank more than three glasses of milk per day versus those who drank fewer than one glass per day. The research found a dose-dependent higher fracture and higher death rate in women who drank more milk.

In the 12-year Nurses’ Health Study, nurses who drank more than two glasses of milk per day had no fewer fractures than those nurses consuming less than one glass of milk per week.[v] Interestingly, in that same Nurses’ study, those who consumed greater amounts of calcium from dairy foods had higher fracture risk. That increased risk was not seen with calcium from non-dairy sources.[vi]

This is really important. In other corroborating research, a meta-analysis of multiple larger trials showed there was no decrease in hip fractures with calcium supplementation.[vii] This means that taking calcium supplements did not decrease rate of fractures. There may even have been a slightly higher fracture risk in people taking calcium supplements who didn’t get adequate vitamin D.

Let’s consider the occurrence of fractures around the world. In countries such as India, Japan and Peru, calcium intake is less than one-third of the daily recommended allowance (300mg per day), and the risk of fractures in those countries is extremely low. The countries with the highest fracture risks are actually those where people drank an abundance of milk, namely Norway, Sweden, Iceland, Denmark and the USA. These studies suggest that maybe drinking milk is not all it’s cracked up to be!

Calcium is definitely important in our diet but it is not the only part of the picture. Don’t get hung up on calcium. Eliminating animal protein has been shown to decrease the necessary calcium requirements. We need vitamins A, D, and K in order to make bones along with our calcium. Most green vegetables have calcium and vitamins A and K! Vitamin D, on the other hand, often requires supplementation because we don’t absorb enough natural sunlight, the source for vitamin D.

Calcium comes from many non-dairy sources, including broccoli, kale, collard greens, turnip greens, bok choy, almonds, sunflower seeds, tahini, dried beans and blackstrap molasses. Flax seeds and sesame seeds are two more great sources of calcium.[viii] Calcium in low-oxalate vegetables such as kale is readily absorbed, so they are viable options for calcium intake in a plant-based diet.[ix]


[i] Deopurkar R, Ghanim H, Friedman J, Abuaysheh S, Sia CL, Mohanty P, Viswanathan P, Chaudhuri A, Dandona P. Differential effects of cream, glucose, and orange juice on inflammation, endotoxin, and the expression of Toll-like receptor-4 and suppressor of cytokine signaling-3. Diabetes Care, May 2010; 33(5): 991-7

[ii] Michaëlsson K, Wolk A, Langenskiöld S, Basu S, Lemming EW, Melhus H, Byberg L

Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 2014; 349: g6015.

[iii] Sonestedt E, Wirfalt E, Wallstrom P, Gullberg B, Orho-Melander M, Hedblad B. Dairy products and its association with incidence of cardiovascular disease: the Malmo diet and cancer cohort. Eur J Epidemiol2011; 26: 609-18

[iv] Huth PJ, Park KM. Influence of dairy product and milk fat consumption on cardiovascular disease risk: a review of the evidence. Adv Nutr2012; 3: 266-85

[v] Feskanich D, Willett WC et al., Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Am J Pub Health; June 1997, Vol. 87. No. 6

[vi] Feskanich D, Williett WC et al. Milk, dietary calcium and bone fractures in women: a 12-year prospective study. AM J Pub Health, 1997; 87 (6): 992-7

[vii] Bischoff-Ferrari HA, Dawson-Hughes et al. Calcium intake and hip fracture risk in men and women: a meta analysis of prospective cohort studies and randomized control trials. Am J Clin Nutr, 2007; 86(6): 1780-90

[ix] Heaner RP, Weaver CM. Calcium absorption from kale. AJCN 1990; 51: 656-7

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