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The
field of dietetics encompasses a broad arena of nutrition related
areas such as clinical, community, long-term care, and management
of food service operations. This month I am showcasing 3 of our
local dietitians with a variety of articles all related to improving
your health.
The
first is LENA GILL,
a graduate of Central Washington University's (CWU) dietetics program.
She is currently working at North Star Lodge, Yakima Valley Memorial
Hospital's (YVMH) cancer treatment facility. Lena writes about methods
to make your holiday season more health friendly.
The
second is KATHY EARLY,
a clinical dietitian and certified diabetes educator (CDE) at YVMH.
Kathy recently completed her PhD in nutrition at Washington State
University. One of Kathy's goals is to reduce health disparities
among people with obesity and diabetes-related health concerns.
Kathy provides two articles originally written for children on insulin-resistance.
Take the time to read them if you suspect you, your child, or any
children you work with may have insulin-resistance.
Lastly, CARISSA SUNDSMO
covers some reported heart-healthy benefits of supplementing with
garlic. She just completed her dietetics internship through CWU,
and is currently working towards her masters in nutrition while
also working at YVMH part-time.
- KIM
McCORQUODALE |
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WHAT IS INSULIN RESISTANCE?
By KATHY EARLY, PhD, RD, CDED
If you have been told that your child has insulin resistance, you
have probably wanted to know what that means, how it happened, and
what can be done about it. Insulin resistance is becoming a more
common medical condition these days, likely due to the rising epidemic
of obesity in our society. Insulin is a hormone produced by the
pancreas, which is a small gland that sits behind the stomach. The
pancreas is important because it helps us digest and get energy
from our food, but sometimes this process doesn't work correctly.
Insulin resistance develops when the body produces excess insulin,
but the body's cells don't respond to it. Scientists don't know
why this happens, but it is often related to family history, a sedentary
lifestyle, or being overweight. Certain groups of people, especially
Latinos, African Americans, and American Indians, are at higher
risk for becoming insulin resistant. Sometimes people with insulin
resistance develop darkened pigmentation on the neck, elbows, knees,
or in the armpits (see "Why Won't this Dirt Wash Off?"
below). Being insulin resistant is really not something you can
"feel," but anyone who is overweight could be at risk
for insulin resistance, so if you suspect this, a doctor visit is
warranted. |
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Excess circulating insulin, like that seen with insulin resistance,
can have several unhealthy effects on our bodies. Reducing the pancreas's
ability to produce its own insulin, increasing inflammatory hormones,
and increasing risk for heart disease and stroke are some of the
dangerous side-effects of long-term insulin resistance.
Achieving a healthy body weight is usually the first step to reducing
insulin resistance. Visiting a registered dietitian is an excellent
way to get your family’s eating habits evaluated and see where
changes may be needed. Increasing physical activity goes along with
healthy eating and together, these can produce great improvements
in overall health for the whole family! |
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 WHY
WON'T THIS DIRT WASH OFF?
By KATHY EARLY, PhD, RD, CDED
In some people, insulin resistance can cause a darkened pigmentation
to develop on certain areas of the skin. This condition is called
acanthosis nigricans. It is most commonly seen
around the neck, the armpits, knees, or elbows. In children, parents
may think acanthosis nigricans is dirt that doesn't wash off the
skin no matter how hard you scrub. Researchers don't really understand
why acanthosis develops in some people. Sometimes skin discoloration
can be completely harmless, but it may also be a sign of insulin
resistance.
If you think your child has insulin resistance or acanthosis nigricans,
you should bring him or her in for a visit with their doctor because
insulin resistance is often a precursor to pre-diabetes and type
2 diabetes. Your child may need some blood tests, such as a fasting
insulin level, to try and determine if the acanthosis nigricans
is related to insulin resistance. If so, you will want to consult
a registered dietitian about the best possible food plan and lifestyle
changes that may be helpful for your child. In some cases, medicine
may be prescribed by your child's doctor to help reduce the insulin
resistance.
Having insulin resistance or acanthosis nigricans does not necessarily
mean that your child will develop diabetes, but these conditions
should be taken seriously. Lifestyle changes in diet and activity
for the entire family are often the most important first steps in
addressing these concerns. |
| GARLIC'S
EFFECT ON CARIOVASCULAR DISEASE: A REVIEW OF SCIENTIFIC EVIDENCE
By CARISSA E. SUNDSMO, RD
Introduction
Chopped, minced, whole, crushed, dried or powdered, tablets,
capsules, raw, cooked and in the form of oil, garlic (Allium
staivum) has been used for centuries for medical purposes,
along with its attractive flavoring capabilities in food.
Traditionally, garlic was used as an antibiotic for colds,
sore throat, phlegm in the respiratory tract, asthma, bronchitis,
abscesses, and tuberculosis. Ancient Egyptians used garlic
to cure headaches, tumors, heart disorder and intestinal worms.
Ancient Olympic athletes ate garlic to increase their energy.
Today, however, garlic is most known to cause bad breath,
increase the flavor of our favorite entrees and side dishes,
and possibly be an aid in reducing our risk of heart disease.
Reported Benefits
Garlic has frequently reported benefits of reducing the risk
of heart disease by decreasing cholesterol, blood pressure
and plaque buildup, and by thinning the blood. There have
also been some reported benefits of its ability to prevent
cancers of the stomach and colon. Along with these proposed
benefits, there are a few adverse side effects which include:
bad breath, body odor, heart burn, blood thinning, and interfering
with the effectiveness of Saquinavir, a drug used
to treat HIV.
Theoretical Basis
Garlic's ability to lower the causes of heart disease is due
to its inhibition of enzymes involved in lipid synthesis:
malic enzyme, fatty acid synthase, glucose-6 phosphate dehydrogenase,
and HmG-CoA reductase. The allicin in garlic has been identified
as the active compound responsible for garlic's affects; however,
due to its release once the garlic has been punctured, it
is unlikely that it has any affect within the body after consumption.
The exact mechanism of how garlic reduces cardiovascular risk
by preventing the synthesis of lipids is unknown.
Scientific Evidence
An article published by the Journal of Nutrition presented
research on the effects of garlic on glucose, cholesterol,
and triglycerides using lab rats as their subjects (1). Two
types of garlic were used, boiled garlic and raw garlic. The
rats were given .5ml of aqueous extract of garlic every day
for 4 weeks, and after the 4 week period they were killed.
The control group received no garlic. The blood was collected
to analyze for cholesterol and triglyceride levels and the
serum glucose levels were determined immediately. A statistically
significant difference was found for the affects of raw garlic
on lowering serum triglyceride levels and cholesterol. The
boiled garlic produced no significant differences over the
control. Researchers concluding that raw garlic is more beneficial
than cooked garlic in lowering blood lipids and cholesterol.
Another study was conducted comparing powder garlic tablets
on serum lipids, blood pressure, and arterial stiffness (2).
This study was a randomized, double-blind, placebo controlled
trial. They used 75 healthy volunteers with normal lipid levels.
They included smoking and non-smoking men and women between
the ages of 40-60. Subjects were excluded if they were currently
using medications to reduce blood lipids or blood pressure,
anticoagulation medications, contraceptives, or if they participated
in more than 4 hours of intensive physical activity a week
on a regular basis.
Those included were not allowed to take other dietary supplement
besides a multivitamin and were not allowed to consume more
than 2 cloves of garlic per week. They were asked not to change
their diet or their physical activity habits during the study.
The subjects were randomized into two groups, 38 received
the garlic powder tablets and 37 received the placebo tablets.
Fasting blood samples were collected and blood pressure was
measured before and after the study. No significant differences
were found between the control and garlic groups for total
cholesterol and LDL cholesterol. The garlic group had a significant
increase in HDL cholesterol, with a borderline significant
decrease in triglyceride levels. continued
below. |
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HEALTHY FOODS - HEALTHY
HOLIDAYS
By LENA GILL, RD, CD
"Holiday Tactics"
Sometimes we have ideas (not necessarily good ones) about how we
can deal with all the various temptations related to food around
the holidays. Read below and ask yourself, "Which 'holiday
tactics' have you used?"
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Deprive
yourself of food for a week or even weeks before the holiday?
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Skipped
regular meals and snacks to have one large dinner? |
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Told yourself
the holiday comes only once a year, meaning it’s okay
to overeat? |
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Believed
you couldn't control yourself at this time of year? |
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Thought
"everyone drinks and overeats too much and gains weight
during the holidays," making it OK for you to also? |
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Equated
large amounts of food with having a good time? |
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Ate large
amounts of food during the holiday season because it is a family
tradition? |
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Did you
dramatically change your: Sleep habits? Exercise habits? Rest
& relaxation habits? |
Read through this TYPICAL HOLIDAY MENU and see
if it sounds familiar.
Breakfast
Cereal with milk (1 bowl )-160 calories
Orange Juice (1 glass)-80 calories
Toast, butter, jam (2 slices)-350 calories
Coffee with milk (1 cup)-80 calories
Appetizers
Crackers (2oz)-130 calories
Potato Chips (2 oz)-300 calories
Cheese or Dip (1/4 cup)-200 calories
Dinner
Waldorf Salad (1 cup)-460 calories
Turkey (4 oz)-200 calories
Stuffing (1/2 cup)-250 calories
Gravy (1/4 cup)-100 calories
Cranberry Sauce (1/4 cup)-180 calories
Candied Yams (1/2 cup)-105 calories
Baked Potato, sour cream/ butter-410 calories
Green Beans (1/2 cup)-40 calories
Roll and Butter-350 calories
Wine (1 glass)-100 calories
Dessert
Pumpkin Pie-240 calories
Whipped Cream-100 calories
Ice Cream (1 scoop)-160 calories
Coffee, Liqueur (1 Cup, 1 oz)-180 calories
Evening Snack
Turkey Sandwich with lettuce, tomato & mayo-400 calories
Mincemeat Pie-350 calories
Beer-150 calories
Total = 5,030 calories, 192 grams
FAT !
And that's without any Christmas cookies or candy ?
So, what can we do to avoid the "inevitable" 10 lb. gain
between Thanksgiving and New Years? Here are a few doable ideas
to encourage a healthy holiday season.
Holiday "Survival"
Tips:
- Set Realistic Goals
- Do NOT Skip Meals
- Take Care of Yourself:
- Slow down to decrease stress levels!
- You’ll be a better caregiver when you care for yourself
too.
- Exercise Regularly
- This helps to decrease your stress levels & appetite.
- Remember that for many of us: STRESSED
= DESSERTS.
- Plan Ahead
When Cooking at Home:
- Chew gum
- Freeze goodies in small containers
- Let someone else do the "taste testing"
The "Dining Away From Home"Challenge:
- Snack before you go. Keep in mind that hungry stomachs sabotage
discipline!
- Take a "hostess gift" such as a lower fat dessert,
vegetable and/or fruit tray with a low fat dip, etc.
- Rush to greet people... NOT the food! "Hang out"
at the pool table, not the food table.
- Look over the buffet line and decide what you really want.
You don't need to have a little bit of everything, just your favorites.
Remember: "Moderation, not deprivation."
- Leave food on your plate
- Ask the hostess for the recipe of that special dish that you're
having a hard time resisting seconds of. That way you can make
it later, and not convince yourself you had better eat as much
of it as you want now.
- Be assertive to well intentioned hosts and "just say No!"
And most of all, HAVE FUN!
Here's a healthier version of a holiday favorite, and it's simple
to make too.
Impossibly Easy Pumpkin Pie:
- 1 cup Canned Pumpkin
- ½ Cup Reduced Fat Bisquick Mix
- ½ cup Sugar (Could try using Splenda-Artificial Sweetener)
- 1 cup Skim Evaporated Milk
- 1 tbsp Lite Margarine, softened
- 1 ½ tsp pumpkin pie spice
- ½ cup Egg Substitute
- 1 tsp Vanilla
Directions
MIX: Mix all ingredients, slowly stirring in evaporated
milk
POUR: Pour all ingredients into a pie pan.
BAKE: Bake the pie in a preheated 425° F oven
for 15 minutes. Reduce temperature to 350° F; bake an additional
40-50 minutes, or until a knife inserted near the center comes out
clean. Cool on a wire rack for 2 hours. Serve immediately or refrigerate.
Top with fat-free Cool Whip before serving.
Substitutions that Save:
Try these ideas in your favorite recipes:
- Use half oil, half applesauce in your favorite holiday
breads, cakes, cookies.
- Substitute egg substitute or egg whites for whole eggs (1/4
cup egg substitute = 1 egg; 2 egg whites = 1 egg).
- Use fat free cream cheese, sour cream, or salad dressings
in your favorite dip recipes.
- Serve fat free Egg Nog in small cups.
- Substitute reduced-fat chips and crackers for regular
products, or use Wow Chips, Baked Lays or even make your own baked
tortilla chips from fat free tortillas.
- Use chicken broth (and not butter) in stuffing, potatoes,
and gravy for moisture and flavor.
- Make regular fudge, but just EAT LESS. Why not have
1 piece each day of the real stuff that you eat slowly and savor.
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The effect
of garlic supplementation on oxidized LDLs in subjects with hypertension
was investigated in another study (3). The goal of this research was to
determine whether garlic supplementation in the diet of human subjects
could change levels of oxidized LDLs (the biomarker of oxidative stress),
and to determine if supplementation could decrease elevated blood pressure
levels in subjects with hypertension. This study was a randomized double
blind study with two groups, those with hypertension and those without.
Both groups were given garlic pearls that had 2.5% garlic oil twice a
day for 8 weeks. A significant decline was found in both the mean systolic
blood pressure and dialostic blood pressure in the hypertensive group,
but no difference was found in the control group.
Even though the blood pressure in the hypertensive group declined, it
remained higher than the control group. The total cholesterol levels of
the hypertensive group did decline moderately, but it was concluded to
be insignificant. No significant difference was found in the non-hypertensive
group. The oxidized LDL concentrations declined in the hypertensive group
significantly; there was no effect on the control group. Their conclusion
was patients with hypertension are more vulnerable to oxidative stress,
and that having garlic as a daily supplement in the diet is useful to
reduce high blood pressure and other factors that are associated with
cardiovascular risk.
Conclusions
Two of the three studies reviewed above showed a significant difference
in garlic's ability to reduce the risk of heart disease. The study that
showed no significant difference used subjects with normal cholesterol
levels, which could be a flaw in the study design. It might be difficult
to significantly lower serum lipid levels in individuals with levels within
normal ranges. The third study presented compared a non-hypertensive group
to a hypertensive group. This study found a significant decline in blood
pressure in the hypertensive group. These results suggest that those with
a higher risk for cardiovascular disease may benefit from the use of garlic.
Additional studies not summarized above have shown a decrease in serum
lipid levels in subjects with high serum lipid levels (see references).
A difficulty is that many of these studies have used different types of
garlic and garlic supplements. I suggest more research be completed that
compares and contrasts the effects of the forms of garlic supplementations
available in the marketplace.
The studies reviewed in this article suggest garlic may be beneficial
as an aid in preventing cardiovascular disease and lowering serum lipid
levels in those who have above normal values. My conclusion is using garlic
as part of a regimen of exercise and a healthy diet is beneficial in preventing
cardiovascular disease.
REFERENCES
1) Thomson, M, Al-Qattan, K, Bordia, T, & Ali, M (2006). Including
Garlic In the Diet May Help Lower Blood Glucose, Cholesterol, and Triglycerides
1-3. The Journal of Nutrition, 136, 800-803.
2) Turner,
B, Molgaard, C, Marckmann, P, & Droge, D (2004). Effect of garlic
(Allium sativum) powder tablets on serum lipids, blood pressure and arterial
stiffness in normo-lipidaemic volunteers: a randomized, double-blind,
placebo-controlled trial. British Journal of Nutrition, 092,
701-706.
3)
Dhawn, V, & Jain, S (2004). Effect of garlic supplementation on oxidized
low density lipoproteins and lipid peroxidation in patients of essential
hypertension. Molecular and Cellular Biochemistry. 266, 109-115.
4)
Banerjee K, & Maulik, S (2002). Effect of garlic on cardiovascular
disorders: a review. Nutrition Journal. 1:4,
5)
National Center for Complementary and Alternative Medicine. Retrieved
June 29, 2006, from Herbs at a Glance, Garlic Web site: http://nccam.nih.gov/health/garlic/index.htm
6)
Rahman, K, & Lowe, G (2006). Garlic and Cardiovascular Disease: A
Critical Review 1,2. The Journal of Nutrition. 136, 736-741.
7)
Tang Center for Herbal Medicine Research. Retrieved July 20, 2006, from
Herbal Information Web site: http://tangcenter.uchicago.edu/herbal_resources/garlic.shtml
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