writer: Dr

A very well designed study shows a clear connection between Alzheimer’s Disease and an increased intake of saturated and trans fat.

Certainly in the last few years it has become easier for consumers to know exactly what to do about their diets. It used to be that all fats were bad. We now know that there is more to it than this simple statement, and this research on Alzheimer’s is a good example of how the type of fat is the important factor in eating for good health.

You can make substantial changes in your risk of disease by eating less saturated fat and working to eliminate trans fats. Saturated fats are found in animal fats and eating lean meats can help you control your intake. Often it is saturated vegetable fats that have been created through hydrogenation that are a major source of saturated fat in many people’s diets. Hydrogenation also creates a high percentage of trans fats which is the other culprit in so many diseases.

Martha Morris and her colleagues (Arch Neurol 2003; 60:194-200) studied 815 senior citizens to evaluate the role diet might play in Alzheimer’s Disease. They found a clear correlation between diets high in saturated fat and trans fats and the risk of Alzheimer’s Disease. The results showed almost double the risk of Alzheimer’s dementia in those eating the most of these types of fats. They looked at other factors to see if these might change the results, and there was no difference based on cholesterol intake or the use of Vitamin E, Vitamin C or beta carotene. Interestingly, total fat didn’t matter—nor did whether the saturated fat was of animal origin.

Eating more fats from vegetable sources was protective against people in the study having Alzheimer’s, as was eating a higher proportion of polyunsaturated to saturated fats. Eating more polyunsaturated fats also appeared to blunt the risks of eating a higher percentage of trans fats.

Over the course of the last few years the picture has become clearer and clearer about how important your diet is to your health. Heart disease, stroke, Alzheimer’s, some types of cancers and diabetes are all associated with consumption of a diet high in calories, saturated fats and trans fats.

This does not mean that you can’t have fat. You have to. We know that fat is an essential part of a healthy diet. It’s also part of eating great food. Land animal protein (beef, chicken, pork, etc.)  meat is OK once a week or so. You will find recipes on the Web site using butter but in measured, sparing amounts to add a buttery flavor. You will find richer cheeses alongside lower fat ones. And you will find a lot of great monounsaturated oils like olive oil.

You can eat well, eat healthy, lose weight and live better by making simple choices and changes in your recipes and ingredients.

You might have read about the metabolic syndrome in the newspaper or heard it talked about on the news. The syndrome is not a single problem but a group of abnormal lab tests and body measurements that help identify whether you might be at a higher risk for health problems. Originally the metabolic syndrome was known as syndrome X and has also been called insulin resistance syndrome.

Over the last few years research has led to more clear definition and use of the term metabolic syndrome to describe those meeting three or more of the following criteria:

1. Measurement around the waist greater than 40 inches for men or 35 inches for women.
2. high blood pressure
3. High blood sugar. This is defined as a fasting blood sugar over 110 mg/dL.
4. High triglycerides. This is another type of fat that circulates in the blood.
5. Low levels of high-density lipoprotein — HDL Cholesterol (a level under 40).

Meeting criteria for metabolic syndrome places people at higher risk for developing type 2 diabetes, cardiovascular disease, stroke and heart attack. Having regular evaluation by your doctor to get fasting blood sugar and cholesterol, check your blood pressure and evaluate your weight is more important than ever.

The key to avoiding these health problems is prevention. Beginning exercise younger and making it part of your life is key. Smoking is a major contributor to metabolic syndrome because it lowers the good HDL Cholesterol and smoking also can contribute to high blood pressure.

Controlling your weight with exercise and diet is certainly important to preventing or helping modify your risk of metabolic syndrome. If you are overweight, simply losing 10% of your weight can often lower blood pressure to the normal range. In people with higher blood sugar losing weight often markedly lowers blood sugars.

In many people, lifestyle modification is not adequate, and medications must be used to decrease blood pressure, lower triglycerides and increase the level of HDL (another good reason to keep on top of this with your doctor).

Because problems like high blood pressure, cholesterol abnormalities, high blood sugar and being overweigh are often connected by treating one problem the others will also improve. Losing weight helps reduce blood pressure and lower blood sugar. Lowering blood sugar can often have a positive impact on cholesterol problems.

Take this checklist to your doctor and see if you are at risk.

My waist circumference is _______

My fasting blood sugar is ________

My fasting triglycerides are ______

My HDL Cholesterol is __________

My blood pressure is ___________

Arranging and completing large scale, long term research trials to study people’s lifestyle is a complex task. There are so many considerations to adjust for including variables such as age, gender, race, family history of health problems, smoking, income, and on and on. Also, finding an accurate cross sample of the population is key to any research. Even after all of this is accomplished there is always the question of whether the participants actually made a significant modification in their lifestyle during the study.

Three research papers were published recently reporting the data from the Women’s Health Initiative Dietary Modification Trial. This was a trial with almost 50,000 women who were studied over eight years. One paper reported on whether there was a reduced risk of heart disease and stroke in those who ate a lower fat diet (JAMA 2006; 295:655-666). The other papers were concerned with the effect of a lower fat diet on breast cancer (JAMA 2006; 295:629-642) and colon cancer (JAMA 2006; 295:643-654). At first glance, the research doesn’t appear to show much difference between a low-fat diet and a conventional diet.

There has been criticism amongst scientists that this study wasn’t long enough to show significant change.

There were, however, many other difficulties encountered by the researchers during this trial.

The first flaw is that the participants in the study did not mirror what the typical American eats. In 2003 we ate, on average, 2,757 calories and 106 grams of fat per day. Interestingly, this represents a 63% increase in fat from 1970, when we ate 65 grams of fat per person per day. In 1970, 65 grams of fat represented only 26% of our diet, and we now eat 35% of our calories as fat.

At the beginning of the study, participants ate about 1800 calories per day (much less than a typical American). Of this, 37% was fat, or about 74 grams of fat (again, much less than the typical American). At the end of the study the women in the group eating a low-fat diet were consuming 46 grams of fat while the comparison group was eating 64 grams of fat.

So both groups ate healthier than the typical American at the beginning of the study and both ate healthier at the end of the study. Because there was a reduction in calories and fat consumed in both groups, the results of the study are questionable.

Secondly, there was not much of an increase in fruits and vegetables in the study group. We now know that this is critical to a healthy diet and to reducing heart disease.

A third consideration is that the goal of the study was to reduce fat to 20% of calories. This target was, however, not met. We have very good data that supports a low-fat diet as being effective in preventing heart disease and the goal set by researchers was a good one. Since this wasn’t met the study conclusions are uncertain.

There are other considerations about the results that don’t allow us to draw good conclusions from the information. The women were all over fifty and, while there is research that shows it’s never too late to make lifestyle changes, the follow up time may be to short to show changes in this group significant enough to prevent cardiovascular disease or cancer.

Most importantly, the study wasn’t designed to modify different types of fat. Between the time the study was started and now, we have come a long way in understanding that it is more than just reducing total fat that is important. We know that the type of fat one eats is a critical factor in improving health.

There is good news to be found in the study. When you look at those women who ate the least amount of saturated fat, trans fats and more fruits and vegetables, there was a reduction in the risk of heart attack. Those who ate less than 8.5% of their calories as saturated fat had significantly lower incidence of colon cancer. Likewise, the risk of a heart attack was reduced in those who ate lower amounts of saturated fat, trans fats, and more fruits and vegetables.

The imperfections experienced by scientists with this research don’t cancel out the fact that we have many excellent studies that prove eating fewer calories, less saturated fat, very little trans fats, more Omega-3 fats, more whole grains and more fruits and vegetables helps you live longer and live better.

There has been a lot of discussion and controversy about low-carb diets in the last few years. The inventors of diets like The Atkins Diet, Sugar Busters, South Beach Diet and The Zone Diet would have people believe that the rise in obesity is related to an increase in consumption of carbohydrates. They assert that by simply cutting all carbohydrates from the diet, people will lose weight and obesity will be cured. To support their claims they advance complex theories—none of which have been supported with well-designed research.

Much of the increasing problem with obesity is related to higher carbohydrate intake, but this is because soda and most of the snack foods that people eat today are carbohydrate based. Those foods, like potato chips, crackers, cookies, ice cream and baked goods, are generally very high in fat as well. Most diets, whether they are low-carb or low-fat, will eliminate many of these calorie-dense foods and people will lose weight.

The assertion by the inventors of fad low-carb diets is that it is the low-fat diet that is responsible for overall weight gain and the rise in obesity. This concept is refuted by the publication of a well designed research project on the effect of long term low-fat diet. The Women’s Health Initiative Dietary Modification Trial was designed to test the result of a low-fat, high-carbohydrate, high fiber diet on breast cancer, colorectal cancer and heart disease. The study was not designed as a weight loss program, and the participants were allowed to eat as many calories as they wished. (JAMA 2006; 295: 39-49)

They researchers enrolled a total of 48,835 post-menopausal women in the trial. About 60% were randomly assigned to a control group and were allowed to continue to eat the diets that they had been eating. The remaining 40% were in a group that was given instruction on how to eat a low-fat diet that increased consumption of fruits, vegetables and whole grains.

When the researchers looked at the effect of this diet on weight, however, they found that there was an initial weight loss of about 5 lbs. in the first year. After that, there was no significant gain in weight and the group that used the diet maintained their weight loss over 7 years. This effect was shared across all ethnic groups and it didn’t appear that there were differences in the effect in women who were obese, overweight, or of normal weight.

There was also evaluation of how the different dietary changes may have an effect on weight. Those women who ate less fat had the greatest weight loss. A small number of participants actually increased the amount of fat consumed and that group showed an increase in weight. Those who ate more fruits and vegetables showed a statistically significant weight loss, while eating more fiber showed the same trend (although eating more fiber was not definitively shown to promote weight loss).

This is a well designed large study of post-menopausal women over a period of time significant enough to allow for conclusions to be drawn with confidence. It shows that there is no significant weight gain on a low-fat, higher carbohydrate diet. It does help to refute the assertion that this type of diet is responsible for the trend toward obesity today.

The proponents of a low-carb diet have not had the opportunity to perform long term studies with such a large number of participants. The studies that have been done have been very short term and often show a higher weight loss on Atkins / Zone / Sugar Busters / South Beach type diets in the first three to six months, but weight loss is similar to low-fat, high carbohydrate diets when the studies are longer.

Eating well and eating healthy is about balance. It is not about giving up anything, but about using great fresh ingredients to make food that is delicious and satisfying. It’s pretty easy to reduce the amount of fat in the diet and not give up great flavor, but it is hard to replace great pasta, rice, potatoes, couscous, beans and fruit and eat great food. The research says that giving up carbohydrates isn’t the answer—but that eating a great balance of foods is.

We have known for a long time that eating fish is good for you. Eating fatty fish like tuna and salmon has been shown to reduce the risk of sudden death. There has not been research, however, to show what effect eating fish might have on the progression of the narrowing of arteries that feed blood to the heart. It is the reduction in size of these blood vessels (the coronary arteries) with plaque that doctors call atherosclerosis.

Worsening atherosclerosis leads to the blockage of blood flow and oxygen to heart muscle. It is the lack of oxygen that causes heart attacks and researchers are very interested in what might slow, stop or reverse the progression of this process. There has been excellent research to show that diet, exercise and stress reduction can actually reverse atherosclerotic plaques in the coronary arteries. A group of researchers offers some insight into the effect that eating fish has on the worsening of heart disease in a study published in the American Journal of Clinical Nutrition (2004; 80: 626 – 632).

The researchers studied 229 women with known heart disease. They started by looking at the study participant’s arteries using cardiac catheterization and measuring the degree of blockages from atherosclerotic plaque. The subjects then filled out a questionnaire about their diet. The primary question was whether they ate ≥ 2 servings of fish per week or ≥ 1 serving of tuna or dark fish. (Dark fish include salmon, mackerel, bluefish, sardines and swordfish.)

They also looked at whether the participants were diabetic and then adjustments were made to account for age, other risk factors for heart disease as well as intake of other fats, cholesterol fiber and alcohol.

About three years later they repeated the cardiac catheterization to look at the diameter of the arteries, the percentage of blockage and if any new blockages had developed. The results showed significantly less narrowing of the arteries in the group that ate 2 or more servings of fish per week.

The investigators also looked at the change in arteries according to which type of fish was consumed. When compared to other fish those who ate tuna and dark fish once or more per week had significantly less narrowing. These changes were greater in women with diabetes who consumed tuna and dark fish more than once a week than for those eating it less often. The frequency of eating tuna did not have as significant an effect in non-diabetic women. The results were similar when the investigators looked at whether any new blockages occurred in the three year period.

This is a great piece of research that shows significant slowing of atherosclerosis in postmenopausal women (especially diabetic women) who ate any fish 2 or more times per week. If the fish consumed was tuna or dark fish, slowing of heart disease was associated with a single serving per week. These effects were similar in non-diabetic women but less so and not felt to be statistically significant.

Fish is good, fish is good for you, fish can slow heart disease, eat more fish!

You’ve probably heard that a “Mediterranean Diet” will help you live longer. What is a “Mediterranean Diet”? Essentially, a diet like that of the Greek and Mediterranean regions–a diet low in meat and dairy products, but high in vegetables, legumes, fruits and nuts, cereals, fish, and olive oil, with a moderate alcohol intake.

Recently, though, there’s been some concern that although a Mediterranean diet might be good for your heart, it appears to lead to weight gain and obesity. (And we know that being overweight is NOT good for your heart!) Specifically, surveys done in the European Union indicate that those who most closely adhere to a Mediterranean diet (the Greek population) have a high prevalence of overweight and obesity.

A study published last year in the American Journal of Clinical Nutrition (Am J Clin Nutr 2005;82:935-40) seems to show that a Mediterranean diet does not, in and of itself, lead to weight gain and obesity.

The study included 23,597 male and female volunteers between the ages of 20 and 86 who were recruited to participate in a much larger European study to investigate cancer and nutrition. Subjects who had coronary artery disease, cancer, or diabetes were excluded.

For the study itself, each volunteer was weighed and their height measured so that their Body Mass Index (BMI) could be calculated. Their waist and hip circumferences were also measured and their Waist-to-Hip Ratio (WHR) was calculated. Finally, each volunteer answered a detailed food questionnaire regarding their dietary intake over the past year, which allowed the researchers to assign each volunteer’s adherence to the Mediterranean diet on a scale of 0 to 9, with 9 being the the highest level of adherence to the Mediterranean diet.

Researchers also collected information on the subjects’ level of education, whether they smoked and if so, how much, their level of physical activity, and their average caloric intake, among others.

The results? The researchers found that:

What they did NOT find, however, is any indication that a high level of adherence to the Mediterranean diet actually caused the subjects’ BMI to increase. Even when the researchers did not take caloric intake levels into account, they found that a higher adherence to the Mediterranean diet only increased BMI by 0.21 among men and 0.05 among women. They found similar results for Waist-Hip Ratio, as well. The high level of obesity in Greece? Most likely had more to do with low levels of exercise and overeating than with what type of diet people were following.

The take-home messages are twofold. First, no diet, even a heart-healthy style of eating like the Mediterranean diet, is a magic bullet. You can eat lots of food that is good for you and still risk your health by being overweight. Moderation in eating is key. Second, exercise is critical to low BMI and overall health. You can improve your health by improving your diet, but the only way to be slim AND healthy (because you can be slim and UNhealthy) is to eat right and exercise.

There is evidence to show the long-term effects of caffeine intake among women. That study indicated that not only does caffeinated coffee not cause hypertension, drinking more caffeinated coffee (rather than only a cup or two a day) may actually help prevent hypertension.

There is good news for those who drink caffeinated coffee. A study published in the Journal of the American Medical Association (JAMA, 2005; 294: 97- 104) analyzed multiple existing studies performed both within the United States and in Europe in an effort to discover any connection between coffee intake and the risk of type 2 diabetes (adult-onset diabetes).

In an effort to standardize the various levels of coffee intake defined in the multiple studies, the researchers defined the following categories of consumption for studies performed in the United States versus those in Europe:

The long-term studies included in their analysis ranged from 6 to 20 years in length, and the study outcomes were adjusted for age, BMI (Body Mass Index), sex, and physical activity, among others.

Even though higher coffee consumption was generally associated with a less healthy lifestyle, those who drank the most coffee (6 cups or more per day) had the lowest risk of type 2 diabetes: a 35% lower risk than those who were in the control groups of no coffee (in the US) or 2 or less cups of coffee per day (in the European studies). Those who were in the second-highest level of consumption had a risk reduction of 28%.

But is it the caffeine, or the coffee that has the positive effect? It appears that it’s the coffee.

The studies performed in the US differentiated between decaffeinated and caffeinated coffee because drinking decaffeinated coffee is far more prevalent in the US than elsewhere. The inverse association between coffee intake and risk of type 2 diabetes remained. A study performed in Japan differentiated between caffeinated coffee and caffeine alone, and the inverse association was stronger for the coffee than for the caffeine. Even more interesting, a study performed in Finland differentiated between the type of coffee the study participants drank: drip-filtered coffee (the kind most people in the US drink) versus pot-boiled coffee (i.e., press-pot/French press or Turkish coffee). Finnish risk for type 2 diabetes was higher for those who drank pot-boiled coffee than for those who drank drip-filtered coffee.

Why would coffee have such an effect on our risk of type 2 diabetes? We don’t know for sure. Coffee contains a number of different substances other than caffeine that have been shown to have an effect on antioxidant levels, glucose levels, and insulin sensitivity, Further studies will need to be performed to determine just which combination of chemicals has the effect on type 2 diabetes, but in the mean time, the good news is that you still have a green light to continue drinking coffee.

December 26, 2005
Last updated: March 26, 2024

I’m sure you’ve heard the old saw, too: “Fish is brain food!” While research has shown that eating fish and omega-3 fatty acids have been associated with lower risk of Alzheimer disease and stroke, a study in the Archives of Neurology this month (Arch Neurol. 2005;62:1-5) seems to show that eating fish helps reduce the cognitive decline associated with aging.

This study’s subjects were participants in the Chicago Health and Aging Project (CHAP), which is an ongoing study of residents 65 years and older who live in the same community. Of the 6158 persons participating in CHAP, 3718 persons received cognitive testing at the beginning of the study, with two followup tests three and then six years later.

The subjects also filled out a food questionnaire, which included 4 seafood items:

• Tuna fish sandwich,
• Fish sticks/fish cakes/fish sandwich,
• Fresh fish as a main dish, and
• Shrimp/lobster/crab.

The scientists also measured the amount of omega-3 fatty acids the subjects consumed in each week by adding together the amount of omega-3s in each seafood item that the subjects indicated they ate.

Even after controlling for factors such as race, gender, alcohol consumption, heart disease, or stroke, just one fish meal per week reduced cognitive decline by 10 to 13%. That’s equivalent to being three or four years younger, mentally!

An especially interesting finding in this study was that the results seemed to be independent of the amount of omega-3 fatty acids the study participants consumed.

We already know that omega-3 supplements are not as good as eating fish. This study is yet another reason to, as your mother might have said, “Eat your fish—it’s good for you!”

There’s a good bit of medical myth that says that caffeine will increase your blood pressure. It’s true in the sense that there are short-term clinical studies that show that caffeine intake can raise blood levels of stress hormones associated with hypertension, but these studies have all been only up to a week or so in length. A team of researchers at Harvard published the first study of the effects of long-term caffeine intake among women (JAMA. 2005;294:2330-2335 ).

The study followed two groups of female registered nurses:

1. 53,175 women, 32-55 years of age, between 1990 and 2002
2. 87,369 women, 25-42 years of age, between 1991 and 2003

Any woman who was diagnosed with hypertension was excluded from the study.

Each woman filled out a questionnaire every four years, answering questions about diet, exercise, and caffeine intake. The relevant beverages on the questionnaire were:

• low-calorie cola (e.g., Diet Coke or Diet Pepsi with caffeine),
• regular cola (e.g., Coke, Pepsi, or other cola beverages with sugar),
• tea with caffeine,
• tea without caffeine,
• coffee with caffeine, and
• decaffeinated coffee.

The researchers adjusted their analyses for other risk factors, like family history of hypertension, BMI level, alcohol use, amount of exercise, and use of oral contraceptives.

Their results are very interesting: those women whose caffeine intake was in the midrange of the study (between 144mg and 297 mg per day) had a 14-15% HIGHER risk of hypertension than those whose caffeine intake was less than 45mg per day.

But here’s the interesting part: those women whose caffeine intake was at the high end of the study (over 417mg/day) had almost the same risk of hypertension as those women in the low end of the study.

These results were so surprising that the researchers went on to analyze the results according to what kind of caffeine the women in the study were drinking: coffee, tea, or soda?

Although there was some slight difference between the two groups of women, those women who drank four or more cans (or glasses) of caffeinated soda (regular or diet) had between 37% and 60% greater risk of hypertension than those who drank one or less.

By comparison, those who drank coffee had an increased risk of hypertension of only 6% for those who only drank one cup per day (Those who drank more had no increase in risk or their risk actually decreased.) Those who drank tea had increased risk with four or more cups per day—but only for the women in the second group. For the first group, risk was about the same across all levels of intake.

The good news: There’s no need to cut down on your caffeinated coffee intake just to avoid hypertension.

By now, you probably know that whole grains are better for you than refined flour. Well guess what? Now you’ve got another reason to make sure you’re eating your Wheaties® (or at least the whole-grain version): eating more whole grains seems to help reduce the amount of weight gained as you age.

Two recent (and similar) studies, one focused on women and one focused on men, tracked weight and dietary intake across a period of years:

Men: Number of participants: 27,082 Years tracked: 8 Ages at study start: 40-75 years

Women: Number of participants: 74,091 Years tracked: 12 Ages at study start: 38-63 years

Both studies excluded people with heart disease, stroke, cancer, and diabetes, as these conditions can affect weight, physical activity, and what one is allowed to eat. The researchers used detailed surveys sent out regularly over the tracking period to gain information regarding the subjects’ eating habits. To give you an idea of how detailed they were, the question about whole grain foods gave a choice of nine answers, ranging from “never” (no whole grain foods per day) to “6 or more servings per day”.

Both studies found that although both groups, men and women, gained some weight as they aged, those who ate the most servings of whole grain each day gained the least amount of weight: men gained only one-third as much weight as those who ate the least amount of whole grains. The difference for women was somewhat smaller: women gained two-thirds as much weight as those who ate the least amount of whole grains. Still, those women (and men) who increased their whole-grain intake over the course of the studies weighed less than those who did not increase the amount of whole grains they ate.

There’s even better news for you if you’re a woman, though! Yet another study focusing on women has shown that getting more fiber in your diet may help prevent heart disease and heart attack. This study of 38,480 women without heart disease, stroke, or cancer at the beginning of the study tracked their intake of dietary fiber for 6 years, using a questionnaire similar to the ones used in the other two studies. Once again, more daily fiber meant fewer cases of heart disease or heart attack, even for those women with a family history of heart attack or who had high blood pressure or diabetes.

So what does it all mean? If you want to help keep from gaining weight as you age, eat more whole grains. If you want to avoid heart disease or heart attack, eat more whole grains. Heck, eat more whole grains, period!