Back Clinic Diets. The sum of food consumed by any living organism. The word diet is the use of specific intake of nutrition for health or weight management. Food provides people with the necessary energy and nutrients to be healthy. By eating various healthy foods, including good quality vegetables, fruits, whole-grain products, and lean meats, the body can replenish itself with the essential proteins, carbohydrates, fats, vitamins, and minerals to function effectively.
Having a healthy diet is one of the best things to prevent and control various health problems, i.e., types of cancers, heart disease, high blood pressure, and type 2 diabetes. Dr. Alex Jimenez offers nutritional examples and describes the importance of balanced nutrition throughout this series of articles. In addition, Dr. Jimenez emphasizes how a proper diet combined with physical activity can help individuals reach and maintain a healthy weight, reduce their risk of developing chronic diseases like heart disease, and ultimately promote overall health and wellness.
A coffee, a caffeinated and an energy soda proved a deadly combination for a South Carolina teenager who died within two hours of consuming them, triggering warnings about the risks of caffeine overdose.
Davis Allen Cripe died on April 26 from a “caffeine-induced cardiac event causing a probable arrhythmia,” the Richland County coroner’s office in the southern US state wrote in a statement.
Two hours before he collapsed, Cripe drank a cafe latte, large Diet Mountain Dew and an energy drink.
Richland County Coroner Gary Watts noted Tueday that such occurrences are “highly unusual.”
“It was mainly due to the time period that he ingested a rapid amount of caffeine that affected his heart,” Watts told The Post and Courier, adding that Cripe had collapsed just 15 minutes after taking the energy drink.
The US Food and Drug Administration recommends that adults consume no more than 400 mg of caffeine per day, which is equivalent to four or five cups of coffee.
“While adults should be mindful of their caffeine consumption, it’s important for parents to know the risks of children and adolescents consuming caffeine,” Jill Michels of the Palmetto Poison Center said in a statement.
“Take the time to talk with your children about the dangers of caffeinated drinks.”
At a news conference on Monday, the boy’s father said his son was very careful about drugs and alcohol.
However, “it wasn’t a car crash that took his life. Instead, it was an energy drink,” Sean Cripe said.
While energy drinks account for just a small segment of the non-alcoholic beverages industry, they are very popular with young people.
Health experts have expressed concern about the drinks’ high caffeine content, which can cause arrhythmia and raise blood pressure in young people.
Energy drinks can contain up to 240 mg of caffeine, according to a 2012 Consumer Reports study.
Conventional knowledge wants us to believe that athletes must eat a high carb diet in order to function at optimum levels. While many people believe this, nothing could be further from the truth. Ben Greenfield conducted extensive tests on himself to prove that it is possible to be a fat burning athlete, and that being a high carb athlete should be a thing of the past.
Ben�s analysis was very detailed and impressive: he had blood work, biopsies, urine and stool samples taken before the study began. He then walked on the treadmill for three hours and retook the blood work, biopsies the urine, and the stool samples, then analyzed the data. The study was called The Faster Study, and the data is available via PDF for those interested in looking at his findings and Ben�s write-up on the experience can be found here.
The Faster Study
When I asked Ben why he did the study, he said it was for his own selfish reasons. He said he was training for an Ironman triathlon at the time and wanted to go faster or at least maintain his speed for longer periods without experiencing the deleterious effects that chronically elevated blood sugar�can cause. He also wanted to avoid the potentially unsettling effects that carbohydrates fermenting in your gut can cause.
Ben also had another incentive: he was diagnosed as having a 17% higher than normal risk for Type 2 diabetes. As a result, he needed to figure out a way to complete an Ironman triathlon without going the traditional route of fueling with gels, bars, and energy drinks.
I can attest that his theory works because I tried it myself: while on an 18 hour intermittent fast, I went on a 3 hour bike ride. By the time I got home, it was 22 or 23 hours before I�d eaten one bite of food, and to everyone�s surprise, I didn�t bonk. Everyone on the ride that day was a seasoned athlete and eating constantly. I was the only one not eating, yet had plenty of energy, even after 20 hours without food. Ben proved that in a laboratory and I successfully tested his hypothesis in a real life situation.
The Faster Diet
In preparation for his experiment, Ben followed a diet of 80 to 90% fat and 5 to 10% carbohydrates. His protein intake would vary depending on the day�s activities. For example, protein intake would be approximately 20% on days he�d run or do weight training. On average, the majority of his diet was fat based. He jokingly said he was banned from Italian restaurants during this time.
While on his high fat/low carb diet, Ben did two ironman triathlons that year (Ironman Canada and Ironman Hawaii.) He stresses that that a low carbohydrate diet does not mean a zero carbohydrate diet. Using Ironman triathlon as an example, participants may be out competing for ten or more hours. When passing someone the on the bike, a person may go from their normal race pace of 250 watts up to 400 watts for a few moments. This surge of energy being exerted can cause a pretty significant glycolytic shift, resulting in the body needing to burn through a high amount of carbohydrates.
Ben took in about a quarter of the amount of carbohydrates that he�d normally consume during the actual event, along with ample amounts of easy to digest proteins, amino acids, easy to digest fats, and medium chain triglycerides. After his triathlon season was completed, Ben added exogenous ketones�to his diet in powder form to increase ketone levels. Ben admitted that he finds the ketones extremely beneficial and says he wish he�d known about them while training for previous triathlons. Personally, I have experimented with exogenous ketones in my own fat burning regime, after learning more about how they work during my interview with Dominic D�Agostino (watch the interview here.)
Study Findings
During that triathlon season, Ben conducted quite a few studies, with a few standing out in particular. In this test, a microbiome analysis was conducted to see how the gut differs between someone who follows a high-carbohydrate diet and someone who follows a high-fat diet.
Fat biopsies were taken both before and after exercise to see to see if his actual fat tissue make-up was any different. Tests were also conducted to see if there was any difference in the ability of his muscles to store carbohydrate and how quickly the muscle would burn through carbohydrates. A resting metabolic test was conducted, which is an analysis of how much fat and carbohydrate is burned at rest. And another measurement was taken to determine how many carbohydrates, fats, and calories are burned during exercise.
What makes these tests interesting is even though most physiology textbooks claim that the average person will burn about 1.0 grams of fat per minute during exercise, the athletes who followed a ketogenic or low-carbohydrate diet for close to 12 month were experiencing fat oxidation values of closer to 1.5 to 1.8 grams of fat per minute. This is significantly higher than what experts expected.
Initially, there was some confusion pertaining to this study because it was called � The Faster Study.� Critics would say Ben wasn�t going any faster on the high fat/low carb diet than those on the high carb diet. What they neglected to understand was the purpose of the study wasn�t to go faster than those on high carb diets. Instead, the goal was to maintain similar speeds while limiting (and possibly eliminating) the chronic fluctuations and elevations of blood sugar.
Ben�s thought process behind the study was simple: If he could go just as fast by eliminating sugars, why not do it? If he slowed down or felt his energy levels being depleted, he�d be forced to ask himself the following questions as an endurance athlete:
What kind of balance did he want between health and performance?
How many years of his life was he willing to sacrifice in exchange for going just a little bit faster?
How much pressure was he willing to put on his joints?
As it turns out, Ben could go just as fast on a carbohydrate-limited diet.
Go Just as Fast, Live Longer
While people are focused on getting faster, the ultimate goal should be to go just as fast and live longer doing it. Unfortunately, many high-carb athletes have a wide assortment of health problems, which can range from joint problems to life threatening emergencies such as heart attacks. Many of them are dying prematurely and don�t realize a contributing factor to their ailments is the high carb diet they had been following for years. Ironically, many athletes are thin but show evidence of degenerative disease indicating years of inflammation and oxidative stress�caused by repeated glucose and insulin spikes. We know this damage is oxidative, is harmful to the cells, and causes premature aging.
There are many studies with research illustrating how endurance sports increase oxidation and aging, but I believe as more research is done this belief will change. Studies by Ben and others show that a fat-adapted endurance athlete does not have the same levels of oxidative stress as high carb endurance athletes. At age 50, I have 8% body fat and can exercise for hours without ingesting carbohydrates because, like Ben, I�m very efficient at fat burning.
I firmly believe Ben�s study proves that people who are efficient at fat burning can burn well over one gram of fat per minute of exercise, whereas before it was believed one gram (or less) was a more realistic number. It should be noted that in order to burn that much fat, a person has to be fat adapted. It�s impossible to accomplish this level of fat burning on a high-carbohydrate diet (read more on how to get fat-adapted here: Part 1 and Part 2.)
Fat Adaption: A trick to Accelerate the Process
Becoming an efficient fat burner takes time. Many of the athletes that Ben coaches have been on a high fat diet for twelve months or more. While the greatest benefits aren�t felt for several months, a person can experience lower blood sugar levels and less oxidation within a few short weeks of starting a high fat diet. However, in order to achieve the mitochondrial density necessary for producing a lot of ATP on a high-fat diet while exercising, a person will need to follow a high-fat diet for at least a year.
It can take anywhere from 6 months to 2 years for a person to become fully efficient at burning fat. While some may balk at how long it can take, it�s not long when compared to the time it may take to become proficient in a sport, learning to play a musical instrument, or getting a college degree.
Adjusting to a high fat diet takes time and patience. To accelerate the process, one can choose to eat within a compressed time window, a strategy known as intermittent fasting. Intermittent fasts can range from 14-24 hours with just liquids being consumed. Intermittent fasting can be a challenge for beginners as the body begins to adapt, but becomes easier with each subsequent fast. I intermittent fast daily and must say it�s been the great contributor to my overall cellular health.
Some side effects beginners may experience while intermittent fasting the first few times may include the following
Fatigue
Nausea
Vomiting
Diarrhea
Headaches
Lack of focus
Bad breath
Lethargy
Joint pain
Minor depression
These side effects are normal as the body eliminates various toxins. Drinking pure water�helps to alleviate some side effects and quickly remove them from the body via urination. Staying focused on the long term is key when embarking on these changes.
Occasionally, I will receive emails from my clients or the doctors of my clients, telling me they are keto-adapted, but they�re not burning fat, they don�t notice any significant changes in their bodies, and they haven�t lost any weight. I explain how this is normal, and the body has to adjust. It takes time for the body to realize it is not starving and that it can begin to burn its own fat for energy. Using my wife as an example, it was almost a year before she was able to use her fat storage for energy. Now, she�s an efficient fat burner and finds it much easier to stay lean.
Not All Fat is the Same
An important aspect of being efficient at fat burning is the type of high fat diet you follow. A plant-rich, ketogenic diet not only limits oxidation and free radical production, but it also causes an increase in stable energy sources due to high fiber content. Having high levels of plant-based chlorophylls in the bloodstream also has the potential to increase ATP production beyond what we fully understand in nutrition science.
Ben encounters many people who follow the Bulletproof Coffee type of approach:
Three cups of coffee with grass-fed butter and MCT oil during the day
Coconut milk with some coconut flakes and some chocolate stevia
Fatty grass-fed steak for dinner
Macadamia nuts for a snack
The problem with this type of diet is there�s very little plant matter eaten, and plants are an integral part of a healthy high fat diet.
Ben Greenfield�s Diet
Ben eats an astonishing 20 to 25 servings of plants per day. He has an enormous backyard garden and eats kale, butter lettuce, bok choy, mustard greens, cilantro, parsley, and tomatoes daily. He says these foods do not count towards his total daily carbohydrate intake, and that eating a high-fat diet does not mean that you�re not eating plants. It�s the opposite. �I eat a lot of plants, a lot of fiber, and it makes a night-and-day difference.�
In order to get 20-25 servings Ben eats huge salads and drinks nutrient dense smoothies. He�ll drink one or two large smoothies a day, using a powerful blender that blends everything from the pit of an avocado to an entire bunch of kale. A sample smoothie includes the following ingredients:
Six to eight different plants (both wild plants and herbs)
Lunch. Lunch is a salad in an enormous bowl filled exclusively with vegetables. Ben will spend 30 to 60 minutes chewing each bite 20 to 25 times and �eating lunch like a cow while I go through emails and things like that during lunch.�
Dinner. Another big salad.
Snack. Snacks are normally smaller versions of the smoothie�he had for breakfast.
He stresses that his salads are extremely large and he prefers thicker smoothies: �If you were to see the size of my salads and the size of my smoothies, you would be shocked. You�d think I would be morbidly obese, but if you dig in and you look at it, it�s really just mostly plant volume. That�s generally what I do, salads and smoothies. I make them so thick I need to eat them with a spoon because I really like to chew my food. Yeah, I�m a smoothie and a salad guy.�
He goes on to say �When I look over the blood and bile markers of people following a high-fat diet, a lot of times I see really high triglycerides and really low HDL, which is often what you�ll see in someone who is eating a ton of animal fats without many plants or without much fiber. I�ll see a lot of CO2 and really low chloride levels, an indicator of a net acidic state, and a lot of biomarkers that aren�t necessarily favorable and that can be a result of a high-fat diet done improperly. I think that�s one important thing to bear in mind, too, is that you don�t want to necessarily eschew plant intake and vegetable intake; you just want to ensure that those are accompanied primarily by healthy fats and oils rather than accompanied by high amounts of protein and starches.�
When it comes to good fats, Ben prefers the following:
Animal fats are eaten sparingly. He�ll eat a grass-fed steak and wild fish a couple of times a week. He also likes pemmican, which comes in a tube that he can snack on while flying or if he needs a quick snack on the go.
When Ben was a bodybuilder, he would aim for 200 grams of protein per day but now only consumes between 100 to 120 grams. Currently, he weighs about 180 pounds and consumes between 0.5 and .8 grams of protein per pound of body weight. He feels this is the amount is sufficient to avoid any loss of muscle.
Ben says he has excellent colonic health. Since he started the high fat diet four years ago, he doesn�t have the fermentation, gas, bloating, or constant gas that many endurance athletes have. He also believes the high fat diet offers a lower risk for things like small intestine bacterial overgrowth (SIBO) and fermentation in the gut.
Diet Variation
In addition to eating a variety of plant based foods, an important eating concept that I have written about is something I like to call �diet variation,� which is basically emulating what our ancestors have done: They were forced into different diet variations seasonally, and in some instances, weekly.
When we look at the Hunza people as an example, they were relying mostly on plant food in the summers to survive. During the cold winter months, vegetables and fruits were scarce or nonexistent, and as a result, they were forced to eat higher-fat foods (meats and animal fats). Over time we can see a pattern: there would be long stretches where their diet consisted mostly of vegetables (summer,) then extended periods of time where their diet was mainly meat products (winter.) This type of seasonal eating created a variation in their diet they had little control over. Today, we have the ability to vary our diet at all times, which can work for us and against us.
I go into ketosis every summer and eat more good fats and protein than I do in the winter, when I eat more healthy carbs. Like Ben, I�m very fat adapted, yet still able to stay in ketosis while eating a lot of plants in my diet. I intermittent fast in the morning and by the afternoon I�m burning high ketones.
One of the popular diet trends these days is the Paleo Diet, where a person is instructed to eat large amounts of protein. Quite frankly, I am not a fan of this diet. I have read many studies on high-protein diets and feel they are not healthy. Eating too much protein can cause weight gain, extra body fat, increased stress on the kidneys, dehydration and other health issues.
If you include the dangers of eating grain fed beef instead of the healthier grass fed beef, we can clearly see how the Paleo Diet could be a recipe for disaster. I tell people as a general rule, eating protein that is equivalent to half your body weight (considering that you�re not morbidly obese) is usually safe and practical. Athletes like Ben (and those who do a lot of strenuous physical exercise) can consume more protein than the average person and utilize it safely. These individuals may require 0.7 to 0.8 grams of protein per day, while the average person only needs .55 grams per day.
Fasting
Ben goes on a 24 hour fast once a month, just to �clean things out a little bit.� He will start the fast Saturday at lunchtime end it at lunchtime on Sunday. Or, he�ll skip dinner on Saturday night and won�t eat again until dinner on Sunday. He�ll drink water, coffee�and tea primarily during the fast, and kombucha on occasion. He also goes on a 12-16-hour intermittent fast daily. The majority of the fast is overnight where he�ll finish dinner around 7:00 or 8:00 p.m. and eat breakfast sometime 9 and 10:30 a.m. During the daily fast, Ben will perform a few low-level exercises in the morning: yoga, foam rolling, or mobility work are exercises of choice.
In addition to daily intermittent fasting, Ben believes a likely factor that helps him to stay lean and maintain a low body fat percentage is taking cold showers. He likes to do one of the following daily:
Fast, perform a low intensity exercises then take cold shower or�
Fast, sit in a sauna for a few minutes, followed immediately with a cold shower.
Ben�s Exercise Regimen
Ben is active all day, but in an unconventional way:
�I generally am active all day long. Today, while I�m writing, doing consults, and reading emails, I�ll walk somewhere in the range of three to five miles at a low intensity like I am right now. When I get up in the morning, I�ll generally spend 20 to 30 minutes doing some deep-tissue work and some mobility work, some foam roller, and some band work for traction on my joints. By the time I get to the end of the day, I�ve been mildly physically active for six to eight hours at just very low-level intensity.
�At the end of the day, I�ll throw in 30 to 60 minutes of a hard workout. That might be a tennis match. It might be kickboxing or jujitsu. It might be some kind of an obstacle course workout with sandbags, and kettlebells, and things like that. It might be a swim. It varies quite a bit, but generally it�s 30 to 60 minutes of something hard in the afternoon to the early evening, then up until that point, low-level physical activity all day long. It�s just tough to quantify because I�m always moving. As far as a formal workout, it comes out to about 30 to 60 minutes a day. We�re talking about a workout where the average heart rate is very close to maximum heart rate, so like a puke-fest style workout. That�s pretty draining from an energy standpoint. Generally, for me to do daily�exceeding 16-hour fasts daily�that gets tough.�
What�s Next For Ben?
Ben is an outdoorsman and wants to experiment with living on the land:
�I�d like to look into more of an ancestral application, a more practical application. I would like to look a little bit more into persistence hunting, something closer to where I live where I�d be going after elk or moose or something like that, preferably in the snow where tracking is a little bit easier, but seeing if it�s doable.
�A five to eight day hunt is realistically what you�re looking at with a bow, or with a spear, or with a close-range weapon, and seeing if it�s possible to actually go and get your own food in the absence of food, just to begin to get people thinking about the state that we live in, the culture that we live in where food is just constantly readily available. What would happen if we didn�t have food but we had to figure out a way to feed ourselves?�
Ben also shares the outdoor life with his children: One day week in the summers, they can only eat the plants they find outside in the garden until dinner. As part of their childhood, he wants them to learn how to take care of themselves. They can use the stove and the blender, stuff like that, but they can�t use ingredients from the pantry, or from the refrigerator. It�s all based on plants.
While many people may think this way of thinking and living is extreme, Ben believes more people can benefit from it if they stay open minded and give it a try:
�I would like to get people more aware of that type of practice because it really goes quite handily with the things that we�ve talked about�fasting and ketosis, and denial of modern food sources and starches and instead just learning how to take care of yourself. I think that there�s a lot of lessons to be had from a health and survival standpoint, and so plant foraging, spreading our message, as well as the potential of seeing the persistence hunting in the absence of any significant sources of calories, to be able to take what allows one to, say, do an Ironman Triathlon with very little calorie intake and then turn that into a more practical level like going out and getting your own meat and stuff. Again, without carrying a bunch of power-bars out with you, I think that�d be a cool little adventure to embark upon.�
A Life of Fitness
Ben believes fitness is a lifestyle, and everyone can incorporate fitness into their daily activities:
If you work in a traditional office setting, put a kettlebell underneath your desk.
Get one of these stools that you lean back on rather than sitting down.
Every time that you go to the bathroom have a rule that you�ve got to do 50 air squats.
�Start to work in those little things throughout the day. You�d be surprise at how fit you can stay and how prepared you can be for a big event without necessarily neglecting your family, your friends, hobbies, or work.�
Ben Greenfield is an inspiration. His research on high fat diets is sure to revolutionize the way athletes view diet and endurance exercise as a whole.
Dozens of studies have found that exercising can lift your spirits by boosting levels of serotonin — the “feel good” hormone — but a study from the University of Connecticut shows the exercise doesn’t have to leave you sweating and panting for breath. If you spend hours at your desk at work or sit at home watching television, just getting up and moving around can reduce depression and make you feel better about yourself.
“We hope this research helps people realize the important public health message that simply going from doing no physical activity to performing some physical activity can improve their subjective well-being,” says study lead author Gregory Panza.
“What is even more promising for the physically inactive person is that they do not need to exercise vigorously to see these improvements,” Panza continues. “Instead, our results indicate you will get the best ‘bang for your buck’ with light or moderate-intensity physical activity.”
Light physical activity is the equivalent of taking a leisurely walk around the mall with no noticeable increase in breathing, heart rate, or sweating, said Linda Pescatello, senior author of the study that was published in the Journal of Health Psychology.
Moderate intensity activity is equivalent to walking a 15-20-minute mile with an increase in breathing, heart rate, and sweating, yet still being able to carry on a conversation. Vigorous activity is equivalent to a very brisk walk or jogging a 13-minute mile with a very noticeable increase in breathing, heart rate, and sweating to the point of being unable to maintain a conversation.
The study tracked the movements of 419 middle-aged adults for four days and then asked them to fill out questionnaires including exercise habits, depression, pain levels, and feelings of well-being.
Researchers found that those who were most sedentary were the least happy. Overall, physical activity improved their sense of well-being. But different levels of physical activity helped some people more than others.
People who were sedentary and engaged in light or moderate physical exercise showed the greatest improvement in their sense of well-being.
“The ‘more is better’ mindset may not be true when it comes to physical activity intensity and subjective well-being,” says Panza. “In fact, an ‘anything is better’ attitude may be more appropriate if your goal is a higher level of subjective well-being.”
Most previous studies found that although exercise increased serotonin levels, the most effective exercises were aerobic, like running, swimming and biking.
There are other simple ways that are clinically proven to increase serotonin levels including massage and getting enough sunlight.
Warding off the joint pain of gout may be as easy as eating right, a new study suggests.
Gout, a joint disease that causes extreme pain and swelling, is caused by excess uric acid in the blood. It’s the most common form of inflammatory arthritis, and its incidence has risen among Americans over recent decades, Harvard researchers noted.
But the DASH (Dietary Approaches to Stop Hypertension) diet — which is high in fruits and vegetables, and low in salt, sugar and red meat — can lower levels of uric acid in the blood.
The American Heart Association has long supported the DASH regimen as a way to help avoid heart disease.
“Conversely, the [unhealthy] Western diet is associated with a higher risk of gout,” said Dr. Hyon Choi, of Harvard Medical School in Boston, and colleagues. The “Western” diet describes the fatty, salty, sugar-laden fare of many Americans.
One nutritionist wasn’t surprised by the new findings, pointing out that the DASH diet is low in compounds called purines, which break down to form uric acid.
“I can see how the DASH diet may benefit someone with gout,” said Jen Brennan, clinical nutrition manager at Lenox Hill Hospital in New York City. “The DASH diet avoids excessive consumption of red and organ meats known to have high purine levels.”
Brennan added that the DASH diet “also encourages high intake of fruits and vegetables. We want to encourage fluids and vitamin C for these patients to help rid the body of uric acid, and fruits/vegetables can support this.”
In their study, the Harvard researchers analyzed data from more than 44,000 men, aged 40 to 75, who had no prior history of gout. The men provided information about their eating habits every four years between 1986 and 2012.
Over the study period, more than 1,700 of the men developed gout.
During 26 years of follow-up, those who followed the DASH diet — high in fruits, vegetables, legumes, nuts, low-fat dairy products and whole grains, and low in salt, sugary drinks and red and processed meats — were less likely to develop gout than those who ate a typical Western diet, the findings showed.
The Western diet is high in items such as red and processed meats, French fries, refined grains, sweets and desserts.
The study wasn’t designed to prove a cause-and-effect relationship. However, the findings suggest that the DASH diet may provide “an attractive preventive dietary approach for the risk of gout,” the researchers concluded.
Choi’s team noted that many people who have high uric acid levels also have elevated blood pressure, or “hypertension” — another reason to switch to the healthier DASH diet.
According to the study’s lead author, Sharan Rai, of Massachusetts General Hospital, “The diet may also be a good option for patients with gout who have not reached a stage requiring [uric acid]-lowering drugs, or those who prefer to avoid taking drugs.” Rai is with Mass General’s division of rheumatology, allergy and immunology.
“And since the vast majority of patients with gout also have hypertension, following the DASH diet has the potential of ‘killing two birds with one stone,’ addressing both conditions together,” Rai said in a hospital news release.
However, more studies are needed to track the diet’s effectiveness in curbing gout flare-ups, the researchers said.
Dana Angelo White is a registered dietitian at Quinnipiac University in Hamden, Conn. She called the new study “another win for the DASH diet, a sensible plan that emphasizes whole foods and a healthy balance of all major food groups. I’m pleased to see a study that highlights the benefits beyond cardiovascular health. If more people ate this way, we would continue to see decreases in all kinds of chronic illness.”
Tossing out the salt shaker may not be enough for your heart health. Most of the salt that Americans consume comes from processed foods and restaurant meals, a new study finds.
In a sampling of 450 U.S. adults, only 10 percent of salt, or sodium, in their diet came from food prepared at home. About half of that was added at the table.
Instead, restaurant meals and store-bought foods — including crackers, breads and soups — accounted for 71 percent of salt intake, the study found.
“Care must be taken when food shopping and eating out to steer clear of higher-sodium foods,” said lead researcher Lisa Harnack.
For prevent harmful high blood pressure, Americans are advised to limit salt intake to 2,300 milligrams (mg) daily, said Harnack, a professor at the University of Minnesota School of Public Health. That’s the equivalent of one teaspoon.
But, more than eight out of 10 Americans exceed this limit “by a mile,” she said.
Food diaries from study participants showed that about 3,500 mg of sodium was consumed a day on average.
The report was published online May 8 in the journal Circulation.
Kathryn Foti, an epidemiologist who wasn’t involved in the study, pointed out that high blood pressure is a leading cause of heart disease and stroke in the United States.
“Reducing salt reduces blood pressure and can help prevent cardiovascular disease,” said Foti, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
“The most effective way to reduce salt is to reduce the content in commercially processed and prepared foods,” added Foti, co-author of an accompanying journal editorial.
She said gradual, voluntary reductions across the food supply could have a large public health benefit.
“Reducing average sodium intake by as little as 400 mg per day could prevent up to 32,000 heart attacks and 20,000 strokes annually,” she said.
The American Heart Association has launched a sodium-reduction campaign to encourage food companies and restaurants to reduce the salt in their products.
Harnack said food companies and restaurants that have pledged to comply “should be commended.”
But, Foti added, doctors should step up their efforts by educating patients about where their salt actually comes from.
“While it’s OK to encourage patients to go easy on the salt shaker, more importantly, physicians should emphasize product selection,” Foti suggested.
She and Harnack recommended reading the Nutrition Facts panel on packaged foods.
Swap out the high-sodium items with lower-salt options, Foti advised. Salt content in many foods varies widely across brands, she noted.
In restaurants where nutrition information isn’t posted, “consumers can request information about the salt content of menu items or ask how foods are prepared,” Foti added.
“And of course, choosing more fresh foods, such as fruits and vegetables, can help you reduce the salt in your diet,” she said.
The study involved 450 racially diverse adults, aged 18 to 74, living in Birmingham, Ala.; Minneapolis-St. Paul; or Palo Alto, Calif.
Between December 2013 and December 2014, the participants were asked to record their daily diet for four 24-hour periods. In addition, the study participants provided samples of salt equivalent to the amount they added at home.
Average salt consumption was over 50 percent more than the recommended 2,300 milligrams, the researchers found.
Salt added while cooking comprised only about 6 percent of sodium consumption, and salt added at the table from the salt shaker accounted for just 5 percent, according to the study.
Salt naturally found in foods made up about 14 percent of dietary sodium, while salt in tap water, dietary supplements and antacids made up less than 1 percent, according to the report.
If you’re doing your best to eat lots of fresh fruits and vegetables, the convenience of pre-washed bagged salads may be too hard to resist. The problem is such products can contain contaminants and foreign substances that can make you sick.
That reality was dramatically spotlighted last month when two people ate fresh salad from a bagged lettuce product before discovering the remains of a bat in it. Further complicating things, the unfortunate were treated for rabies as a precaution (although lab tests later showed the bat was not rabid).
Peter Cassell, spokesperson for the Food and Drug Administration (FDA), noted the case was extremely rare and not a reason for a larger public health concern.
“Packaged salads are generally safe to eat right out of the package,” he said. “Most salads are double-washed or triple-washed and dried under managed conditions. Packaged salads are widely sold for consumer’s convenience.”
But he acknowledged such products can contain contaminants, so consumers need to take precautions to be sure they are not consuming anything dangerous or, at least, unappetizing.
“The most common extraneous materials that can be found in produce grown close to the ground include stones, rocks and dirt,” he noted. “One way consumers can identify and remove these materials is to pour the salad out into a bowl and lightly sift it with clean hands or utensils. There is no need to rewash salads that have already been washed before packaging.”
It’s not the first time that consumers have encountered problems with pre-washed salads, veggies, and fruit. Last year, four people died and 33 became ill from listeria in packaged salads.
Listeria found in food processing plants is not uncommon, but it isn’t always toxic. Dole salads, the problem in the case of listeria, closed the offending plant, issued a recall, and followed FDA requirements to sanitize its processing systems.
The salad with the dead bat was in Organic Marketside Spring Mix, produced by Fresh Express. It was only distributed at Walmart stores in the Southeastern United States.
The odds of finding a bat or dangerous pathogen in your salad are quite rare, experts say. According to Cassell, people can generally trust that pre-washed salads are handled correctly and present little to no risk to the consumer.
But health specialists say a handful of safe food-handling practices, especially for produce, are a good idea for consumers to follow. Among them:
Wash your hands thoroughly before starting to prepare food.
Sort through bagged or boxed greens and/or vegetables carefully.
Rinse thoroughly and inspect the contents of bagged greens, even if they are already pre-washed.
Do not use special “veggie soaps.” They don’t do much and remain on the food that you eat.
Look for “best used by” dates and buy foods accordingly. If food is really fresh it will be better for you.
Cut away damaged or bruised areas on fruits and vegetables. Throw it away if it looks rotten.
Even if you plan to peel the produce, it is a good idea to wash it.
Scrub things like melons or cucumbers with a clean produce brush.
Use a paper towel to dry produce because it can help to get rid of bacteria.
When you purchase and store your produce, bag it and store it separately from other foods like meat, seafood, and poultry.
Refrigerate any produce that is pre-cut or peeled.
Additional advice from the FDA:
Wash hands and surfaces often when preparing food.
Wash your cutting boards, dishes, counters frequently to avoid cross contamination with bacteria and other microbes.
If you use cloth dishtowels to wipe counters clean, make sure you wash them in hot water. Consider using paper towels instead of cloth towels.
Most of us face some risk from foods — even fresh foods — that aren’t properly washed or cleaned, or that may have been contaminated by other foods like fresh meat.
About 48 million cases of foodborne illness occur each year, with one in six Americans becoming ill from some sort of food contamination. Illness usually starts within days after eating contaminated food, and can include vomiting, diarrhea, abdominal pain, fever, and headache.
Most people recover from food poisoning, according to the FDA. But pregnant women, young children, the elderly, and those with weakened immune systems face a greater risk of complications.
The bottom line: Take a look at that pre-washed salad, toss it with some utensils, and be wary, but be aware that it is probably safe, according to Cassell.
For more information about recalls, or to file a complaint about purchased food, visit the FDA Website.
People with celiac disease have to avoid most grains, but oats may be an exception that’s safe, according to a recent research review, so long as the oats are uncontaminated by traces of other grains.
More studies are needed to see whether so-called pure oats available in the real world don’t provoke celiac symptoms. If proven safe, oats could provide celiac sufferers some of the benefits of eating grains that they miss out on following a gluten-free diet, researchers say.
“Oats, compared to other cereals, are a source of good quality proteins, vitamins and minerals and they improve palatability and the texture of gluten-free food,” said study coauthor Dr. Elena F. Verdu.
“For a person diagnosed with celiac disease, adding oats to a gluten-free diet could not only increase food options but also help them follow a better gluten-free diet and have a higher quality of life,” said Verdu, a gastroenterology researcher at the Farncombe Family Digestive Health Research Institute at McMaster University in Hamilton, Canada.
Celiac disease is an autoimmune disorder that affects roughly one of every 100 people in the U.S. For sufferers, consuming even trace amounts of the gluten protein in wheat, barley and rye can trigger an immune response that damages the intestines. Over time, this immune attack can lead to malnutrition, osteoporosis, chronic inflammation and a variety of other problems.
People with celiac disease are also at heightened risk of heart disease and some recent research suggests that might be in part because avoiding gluten causes them to miss out on the heart-protective benefits of eating whole grains.
Oats don’t contain the same celiac-provoking protein found in other grains, the study team writes in the journal Gastroenterology. However, Verdu told Reuters Health, issues have been raised regarding potential adverse reactions to oats by celiac patients, and this has reduced the enthusiasm of adding oats to the gluten-free diet in many cases.
“The first study suggesting that oats may be harmful for patients with celiac disease was published more than 50 years ago. Since then, the addition of oats to a gluten-free diet has remained clouded in controversy,” she said in an email.
For this reason, the review team decided to evaluate the existing evidence. They re-analyzed data from 28 previous studies that included oats in gluten-free diets for people with celiac disease. Eight of the studies were controlled clinical trials; the rest were observational.
The researchers looked at any negative effects on symptoms or blood tests for up to one year of oat consumption.
“In our study, we found no evidence that addition of oats to a gluten-free diet affects symptoms or activates celiac disease. However, it is very important to stress that there were few studies in some of the analyses, the quality of the studies was low and most of them were conducted outside of North America,” Verdu said.
Although the consensus is that pure oats are safe for most patients with celiac disease, contamination with other cereal sources that may contain gluten needs to be avoided, Verdu added.
“The purity of oats will depend on the country of origin and local regulations, and this is why we were surprised to see that most recommendations in North America are still based on studies performed in Europe,” she said.
“Patients who follow a gluten-free diet are sometimes able to consume small quantities of gluten-free oats without adverse reaction,” said Hannah Swartz, a clinical dietitian at Montefiore Medical Center in New York who wasn’t involved in the study.
“Patients who have the most success with including oats in their diet ensure the oats are certified gluten free, and wait one or more years after following a gluten free diet to ensure that gut inflammation has subsided,” she said.
“Patients with celiac disease must first ensure that the oats they are adding are certified gluten free oats. Regular oats used in products that are labeled ‘gluten free’ such as some mainstream cereals are not recommended for patients with celiac disease as there remains the possibility of cross contamination with gluten containing grains during the processing of the oats,” she said.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
