Choose Healthy Carbohydrates Week 4 Eight Weeks to

v Sponsored by: Lassen Foundation 2801 Williams Rd. Butte Valley, CA 95965 v Your

Unhealthy Carbohydrates v Soda pop v Sugar, candy sweets v White bread, pastry, soda

Healthy Carbohydrates Are… v Plant based foods that have not been highly refined or processed v High in dietary fiber v High in antioxidants and phytochemicals v Absorbed more slowly, normalizing blood sugar and insulin levels v Moderate in calories but high in nutrition © 1997 - 2004 Life. Long Health® 4

Examples Include v Fruits v Vegetables v Legumes v Whole grains © 1997 -

These Foods Can Help Prevent… Obesity v High blood pressure v Diabetes v Coronary heart disease v Certain cancers v Strokes v Digestive problems such as constipation and diverticulosis v © 1997 - 2004 Life. Long Health® 6

There are four carbohydrate food choices that prevent disease and promote health © 1997

#1 Eat More Fruits & Vegetables High in fiber v High in antioxidants v

Eat 5 -10 Servings of Fruits and Vegetables Daily Emphasize v Greens and cabbage family v Dark yellow or orange v Tomatoes, onions, salads v Citrus, berries v A wide variety of other colorful fruits and vegetables © 1997 - 2004 Life. Long Health® 9

Fruit and Vegetable Intake and Strokes, Framingham Study v Risk of stroke in men, incidence per 1, 000 v Servings of Fruits and Vegetables per Day © 1997 - 2004 Life. Long Health® 20 year follow-up of 832 men in the Framingham Study For each increment of 3 servings of fruits or vegetables per day, there was a 45% decrease in the risk death from stroke Framingham Study, JAMA, Vol 273, No. 14, pp 1113 -17 10

Vegetable and Fruit Consumption Women, probability of dying, mid-life, ages 35 -69 n=350, 000 High intake © 1997 - 2004 Life. Long Health® Intake by Quintiles Low intake J of Hlth Educ, Vol 28, No. 5 11

Vegetable and Fruit Consumption Men, probability of dying mid -life, ages 35 -69 n=200,

Best Sources of Antioxidants Highest Vegetables – Kale – Beets – Red peppers – Broccoli – Spinach – Potato – Sweet potato – Corn © 1997 - 2004 Life. Long Health® – – – – Cauliflower Eggplant Carrots String beans Cabbage Squash Garlic, celery, onions Leaf lettuce 13

Best Sources of Antioxidants Highest Fruits – Blueberries – Strawberries – Plums – Oranges – Red grapes – Kiwi – Pink grapefruit – White grapefruit © 1997 - 2004 Life. Long Health® – – – White grapes Apples Tomatoes Bananas Pears Melons Source: USDA Human Nutr. Research Center, Tufts Univ. , J. Agri. Food Chem. 44: 701, 3426, 1996 14

Vegetable Intake and Colon Cancer Prevention Study II v 764, 343 adults in study v Risk of colon cancer decreased with the more frequent consumption of: – vegetables – whole-grain breads and cereals – regular use of aspirin – folic acid also protective J of Nat. Cancer Institute, 85(7): 581 -2 © 1997 - 2004 Life. Long Health® Vegetable Intake/Day 15

Cancer Prevention Guidelines 1. Choose predominantly plant-based diets rich in a variety of vegetables, fruits, and legumes 2. Maintain a healthy body weight 3. Take an hour’s brisk walk daily 4. Eat five or more servings of fruits and vegetables daily American Institute for Cancer Research © 1997 - 2004 Life. Long Health® 16

Ways to Eat More Fruits and Vegetables v v v Keep raw vegetables ready-to-eat in clear containers in the front of your refrigerator frequent use Keep a supply of fresh fruit on the table or counter: oranges banana, apples, kiwi Eat more salads and include a variety of vegetables: broccoli, peppers, cabbage, tomatoes, carrots, dark salad greens, onions Enjoy stir-fry vegetables, add vegetables to soups Eat fruit salads and finish a meal with fruit as a natural sweet (e. g. orange, berries, melon, dates) © 1997 - 2004 Life. Long Health® Dietary Guidelines for Americans, 2000 17

#2 Choose whole grains At least three or more servings per day v Breads

Whole-Wheat Bread Heart Disease and Relative Risk of Heart Attack n=26, 437 Kind of

v v v Nurses Health Study 75, 521 women followed for 10 years Risk of coronary heart disease was reduced by 25% to 50% in those eating more whole-grains; 3 or more servings a day Amer J Clin Nutr 1999; 70: 412 -9 © 1997 - 2004 Life. Long Health® Risk of Heart Disease (RR) Whole-grains and Heart Disease Servings/day of Whole-grains 20

Percent Decrease of Nutrients in White vs. Whole-Wheat Bread Key Minerals % Decrease Key Vitamins % Decrease Calcium Magnesium Phosphorus Potassium Zinc Copper Manganese Phytochemicals and antioxidants are also lost, and protein quality is impaired © 1997 - 2004 Life. Long Health® 54% 84% 69% 74% 76% 62% 82% Pantothenic acid Vitamin B 6 Folic acid Dietary fiber 57% 87% 41% 79% Essential fatty acids 47% USDA, Reference Nutrition Data Base 21

v v v Finnish study, 4300+ men/women, 10 yr study Those eating the most whole-grains had 35% less type 2 diabetes Those with highest cereal fiber intake had 61% less diabetes Amer J Clin Nutrition, March 2003 © 1997 - 2004 Life. Long Health® Type 2 Diabetes (RR) Whole Grains and Type 2 Diabetes Whole Grain Intake 22

Risk of Stroke (RR) Whole Grains & Risk of Stroke 72, 488, women 12

v v v ARIC study, 15, 792 people 45 -64, 11 yrs Those eating the most whole-grains had a 48% decrease in mortality. After adjusting for BMI, exercise, cholesterol, etc. they still had a 23% lower risk of dying from any cause Mortality, any cause (RR) Whole Grains and Total Mortality Amer J Clin Nutrition, September 2003 Whole Grains, Servings/Day (quintiles)

Choose a Variety of Grains v v v v Whole-grain breads Multi-grain breads Oatmeal breads and cereals Whole-grain Rye High fiber cereals Brown rice Pasta Barley cereal © 1997 - 2004 Life. Long Health® Six or more servings/day recommended primarily from whole-grain sources 25

#3 Avoid a High Glycemic Load It protects against… – – Obesity High blood

Concept of Glycemic Index Glycemic index (GI) evaluates the effect of carbohydrate on blood sugar levels v High GI foods raise blood insulin and sugar levels quickly and higher than desirable v GI is determined by feeding various carbohydrate foods and comparing their rise in glucose levels compared to equal amounts of sugar (or white bread) eaten on a previous day v © 1997 - 2004 Life. Long Health® 27

Blood glucose and insulin curves after eating: High energy storage zone Hunger Zone White bread (solid line) and then Spaghetti (dotted line) (each food is eaten on different days) High insulin response leads to obesity, insulin resistance and exhaustion JAMA May 8, 2002, 287: 2415 © 1997 - 2004 Life. Long Health® 28

High Glycemic Meals v Eating high glycemic meals, compared to lower glycemic meals, results in: – – v Higher 24 -hour blood sugar levels Higher insulin levels Higher glycosylated hemoglobin levels (Hb. A 1 c) Increased hunger following reactive low blood sugar It also results in increased risk for diabetes, obesity, and coronary heart disease © 1997 - 2004 Life. Long Health® JAMA May 8, 2002, 287: 2415 29

v Obese children ate either instant oatmeal or steel-cut oats—“instant” has a high glycemic index; “steel-cut” is low. Calories were identical for breakfast and lunch. At supper, they ate at lib. v After eating instant oatmeal, they ate 53% more calories at supper than after they ate the steel-cut oats. © 1997 - 2004 Life. Long Health® Calories eaten after last meal (%) Glycemic Index and Calorie Intake in Children Glycemic Index of Breakfast JAMA May 8, 2002, 287: 2415 30

Glycemic Index and Obesity Rats fed a high glycemic diet compared to rats fed a low glycemic diet develop marked obesity in 32 weeks. v In 16 human studies, 15 studies found lower satiety, increased hunger, and higher voluntary food intake after eating high vs. low glycemic index meals. v JAMA May 8, 2002, 287: 2415 © 1997 - 2004 Life. Long Health® 31

Glycemic Index of Selected Foods Glycemic Index White Bread 100 Table sugar 84 Baked potato 104 Cheerios 106 Pancake 119 Cornflakes 120 White rice 102 Instant rice 129 Fruit punch/soda pop 95 Banana 88 Pizza 86 Foods Glycemic Index Oatmeal 82 Orange juice 75 Bran flakes 74 All bran 72 Pasta 71 Baked beans 60 Apple, raw 51 Skim milk 46 Soy beans (soy milk 43) 35 Peanuts 20 Broccoli 15 Source: Dr. Willett, Harvard Nutrition Department, (white bread standard) © 1997 - 2004 Life. Long Health® 32

Glycemic Load v A better overall indicator is glycemic load – – v v glycemic index X carbohydrate content of foods Example: glycemic index of mashed potatoes = 122 ½ cup mashed potatoes has 20 g of carbohydrate Glycemic load = 20 X 1. 22 = 24. 4 Summing the glycemic load of all foods in a day gives the daily glycemic load In the Nurses Health Study, a daily glycemic load greater than 150 was linked to a higher risk of heart disease Amer. J of Clinical Nutrition 2000; 71: 1455 -61 © 1997 - 2004 Life. Long Health® 33

Risk of Heart Disease (RR) Glycemic Load and Risk of Heart Disease n=75, 521 10 yr study Low glycemic load High glycemic load Glycemic Load Quintiles © 1997 - 2004 Life. Long Health® Amer. J of Clinical Nutrition 34 2000, 71: 1455 -61

Glycemic Load of Common Foods Food Glycemic Load Instant rice, ½ C 25 Baked potato, sm. 20 Corn flakes, 2/3 C 21 White bread, 2 s. 21 Rye bread, 2 slices 19 Muesli, 2/3 C 17 © 1997 - 2004 Life. Long Health® Food Glycemic Load Banana, 1 Spaghetti, ½ cup Apple, 1 fresh Lentils, ½ C Carrot, 1 Peanuts, 1 oz. Broccoli, ½ C JAMA May 8, 2002, 287: 2415 13 16 8 6 5 3 <1 35

Glycemic Load Principle High Glycemic Load Foods v Snack foods v Fast foods v Pastry, cookies v Sweets v Soda pop v White bread/rice v Refined carbohydrates v Potatoes © 1997 - 2004 Life. Long Health® Low Glycemic Load Foods v Fresh fruit & Vegetables v Legumes, peas, beans, garbanzos, soy, tofu v Nuts v Whole-grain breads and cereals including oatmeal and brown rice v Protein rich foods v Healthy fats 36

v v Women’s Health study Women who ate the least fiber were twice as likely to get diabetes as those who ate the most fiber. Women with the highest glycemic index were 51% more likely to get diabetes then women who ate the lowest GI diet. Overall risk was 2. 5 times higher on the low fiber, high GI diet. JAMA Feb. 12, ‘ 97 © 1997 - 2004 Life. Long Health® Risk of Getting Diabetes (RR) Effect of Glycemic Index and Dietary Fiber on Risk of Diabetes Decreasing fiber Increasing Glycemic Index 37

#4 Eat More High Fiber Foods Fiber protects against… – Constipation – High cholesterol

Dietary Fiber Dietary fiber is found only in plant-based foods, primarily unrefined foods – Fruits – Vegetables – Legumes (peas and beans) – Whole grains – Nuts and seeds © 1997 - 2004 Life. Long Health® 39

Recommended Fiber Intake Dietary Fiber v Men 38+ gm/day v Women 25 gm/day v Current intake is only 10 -15 grams/day Soluble Fiber (best for lowering cholesterol) v 10 -25 grams/day v Examples: oats and oat bran, psyllium, barley, oranges, bananas, apples © 1997 - 2004 Life. Long Health® IOM and NCEP Guidelines, 2002 40

Soluble or Viscous Fiber Goal Increase to 10 -25 grams per day Soluble Fiber grams Barley, ½ cup cooked 1 Oatmeal, 1 cup cooked 2 Psyllium seeds, ground 1 T 5 Apple, banana, peach 1 Orange, grapefruit, pear 2 Beans, cooked, 1 cup 4 -6 Broccoli, ½ cup cooked 1 Brussels Sprouts, ½ cup ckd 3 Carrots, ½ cup cooked 1 Source: ATP 3 TLC Guidelines © 1997 - 2004 Life. Long Health® 41

Practical Steps To Increase Your Intake of High-Fiber Foods © 1997 - 2004 Life.

1 Eat More Fruit is a good source of fiber, low in fat and calories, and cholesterol-free. Two to four servings of fruit per day are recommended. © 1997 - 2004 Life. Long Health® Fruits fiber, g Apple, 1 medium 3. 0 Applesauce, canned 1/2 C 1. 5 Apricots, 3 medium 1. 4 Banana, 1 medium 1. 8 Blackberries, fresh, 1 C 6. 6 Blueberries, fresh, 1 C 3. 3 Cantaloupe, 1 C pieces 1. 3 Kiwi, 2 medium 4. 0 Orange, 1 medium 2. 9 Papaya, half 1. 4 Peach, 1 medium 1. 4 Prunes, 1/2 C cooked 6. 0 Strawberries, 1 C 3. 9 43

2 Eat More Vegetables are low in fat and calories and high in fiber, vitamins, and minerals. Three to five or more servings of vegetables per day are recommended. © 1997 - 2004 Life. Long Health® Vegetables fiber g Asparagus, 1/2 C cooked Broccoli, 1/2 C cooked Brussels sprouts, 1/2 C ckd Carrot, 1 medium Green beans, 1/2 C cooked Green peas, 1/2 C cooked Greens, 1/2 C cooked Onions, 1/2 C chopped Potato, 1 medium Summer squash, 1/2 C ckd Winter squash, 1/2 C baked Sweet potato, 1 med. baked Tomato, 1 medium 1. 3 2. 0 3. 4 2. 3 1. 1 2. 2 1. 1 1. 3 2. 3 1. 3 2. 9 3. 4 1. 6 44

3 Eat More Whole Grains Whole grains are a good source of fiber. They are usually low in fat, and they tend to fill you up. Six or more servings of whole grains per day are recommended. © 1997 - 2004 Life. Long Health® Grains fiber g Bran Flakes cereal, 3/4 C 5. 0 Bran muffin, 1 3. 9 Brown rice, 1 C cooked 3. 3 Corn tortilla, 1, whole corn 1. 0 Grape-Nuts, 1/4 C 2. 6 Oatmeal, 2/3 C, cooked 2. 7 Pancakes, three 4” cakes 1. 3 Pasta, 1/2 C, cooked 1. 1 Shredded wheat, 1 oz. 2. 6 Wheaties, 1 C 3. 0 White bread, 1 slice 0. 3 Whole-wheat bread, 1 slice 1. 6 45

4 Eat More Legumes fiber g Legumes are the foods highest in fiber. Black beans, 1 C cooked 7. 2 Chickpeas, 1 C cooked 5. 7 They are also good Chili beans, veg. 1/2 C 6. 0 sources of protein. Hummus spread, 5 T 2. 0 Eat at least three or Lentils, 1 C cooked 7. 9 more servings per week. (Daily intake is Three bean salad, 1/2 C 3. 2 Tofu, 1/2 C 1. 5 ideal. ) © 1997 - 2004 Life. Long Health® 46

5 Choose Fruit/Vegetable Juice Pure fruit and Apricot nectar, 1 C vegetable drinks Grapefruit juice, 1 C contribute some Orange juice, 1 C fiber and are good Tomato juice, 1 C sources of vitamins. V-8 juice, 1 C Look for juices Soft drink*, 1 can without added sugar. fiber g 0. 8 0. 5 1. 3 0. 0 * The soft drink is loaded with sugar and calories but no other nutrients. © 1997 - 2004 Life. Long Health® 47

6 Eat Nuts and Seeds Nuts are good sources of fiber, protein, and unsaturated fats. Nuts have been found to reduce the risk of heart disease. © 1997 - 2004 Life. Long Health® Nuts fiber g Almonds, 1 oz. 2. 6 Cashews, 1 oz. 1. 7 Filberts, 1 oz. 1. 8 Mixed nuts, 1 oz. 2. 5 Peanut butter, 2 T 2. 0 Peanuts, 1 oz. 2. 5 Pistachios, 1 oz. 3. 0 Sunflower seeds, 1 oz. 4. 1 Pumpkin kernels, 1 oz. 4. 0 48

7 Eat Less Refined Foods Sample Foods Much of the fiber is removed in refined and processed foods. Use more unrefined, natural foods. fiber g Apple, 1 med. Applesauce, canned 1/2 C Apple juice, 1 cup Soft drink, 1 can 3. 0 1. 5 0. 0 Whole-wheat bread, 1 slice 1. 6 White bread, 1 slice 0. 3 Twinkie, 1 0. 1 Soft drinks, ice cream, candy sugar, butter, margarine 0. 0 © 1997 - 2004 Life. Long Health® 49

8 Read Food Labels Nutrition Facts v v When buying foods, check the label for fiber content. You will soon learn which foods are higher in dietary fiber. © 1997 - 2004 Life. Long Health® Serving Size 2. 5 oz. (71 g) Servings per container 4 Amount Per Serving Calories 130 Calories from fat 25 % Daily Value Total Fat 3 g 5% Saturated fat 1 g 5% Polyunsaturated fat 0. 5 g Monounsaturated fat 1. 5 g Cholesterol 10 mg 4% Sodium 290 mg 12% Total Carbohydrate 18 g 6% Dietary fiber 5 g 20% Sugars 1 g Protein 8 g 50

Estimating Fiber Intake v Typical eating record for a busy person v Add up how much fiber this person ate for the day © 1997 - 2004 Life. Long Health® Foods _ Egg Toast, white bread Butter and jam Glass of milk Turkey sandwich Coke Chips Meat loaf Dinner roll (white) Salad with dressing Coffee with cream Cheese cake Total fiber intake (g) fiber g _____ _____ _____ _____ 51

Keep Track of Fiber Intake Did you come up with the same total? Is this sufficient fiber for a day? Keep records on how well you do for a day. © 1997 - 2004 Life. Long Health® Foods Egg Toast, white bread Butter and jam Glass of milk Turkey sandwich Coke Chips Meat loaf Dinner roll (white) Salad with dressing Coffee with cream Cheese cake Total fiber intake (g) fiber g 0 0. 3 0 0 1 0 0. 4 0 0. 3 2 0 0. 2 4. 2 52

Fiber Quiz 1. 2. 3. 4. 5. Fiber is found only in _____ foods. Dietary fiber helps prevent _____ and _____, two leading health problems. The recommended intake of fiber is __to __ g per day. The average intake of fiber is about __to __ g per day. Which food is highest in dietary fiber: an apple, a cup of Wheaties® dry cereal, or 1/2 cup of peas? 6. T or F Nuts and seeds are not a good source of fiber? 7. T or F Whole grains can help lower cholesterol levels? 8. You should eat _____ or more servings of fruits and © 1997 - 2004 Life. Long Health® vegetables (high in dietary fiber) every day. 53

www. lifelonghealth. us Making. Healthy. Choices. info © 1997 - 2004 Life. Long Health®

Glycemic Index and Obesity Rats fed a high glycemic diet compared to rats fed a low glycemic diet develop marked obesity in 32 weeks. v In 16 human studies, 15 studies found lower satiety, increased hunger, and higher voluntary food intake after eating high vs. low glycemic index meals. v JAMA May 8, 2002, 287: 2415 © 1997 - 2004 Life. Long Health® 55

Grains – Glycemic Index Food French bread White rice Corn chips English muffin Doughnut Waffle Bread, White Taco shells Rye bread Whole wheat bread © 1997 - 2004 Life. Long Health® G. I. 136 125 110 108 109 100 97 92 98 Food G. I. Pastry 84 Rice (Basmati) white 83 Pita bread 82 Brown rice 79 Oatmeal cookie 79 Sweet corn 78 Pound cake 77 WW bread, stone ground 76 Bulgur 69 Oat bran bread 68 Pasta 6456

Cereals – Glycemic Index Food G. I. Barley, pearled, ckd 36 All-bran 60 Oatmeal, old fashioned 70 Whole wheat, quick 77 Kellogg’s mini-wheats 81 Bran chex 83 Wheat kernels, whole 84 LIFE cereal 94 Grape-nuts 96 © 1997 - 2004 Life. Long Health® Food G. I. Corn meal Shredded wheat Cream of wheat Millet Cheerios Corn chex Corn flakes Rice chex 98 99 100 101 106 118 119 127 57

Fruits – Glycemic Index Food G. I. Cherries 32 Grapes 66 Grapefruit 36 Orange juice 74 Apricots, dried 44 Banana 77 Pear 53 Apricots 81 Apple 54 Raisins 91 Apple juice 57 Apricots, canned syrup 91 Peach 60 Pineapple 94 Orange 63 Watermelon © 1997 - 2004 Life. Long Health® 103 58

Legumes/Vegetables Glycemic Index Legumes G. I. Soy beans 26 Soy milk 44 Lentils 41 Kidney beans 42 Butter beans 44 Split peas 45 Pinto beans 55 Chick peas 60 Peanuts 21 © 1997 - 2004 Life. Long Health® Vegetables G. I. Parsnips Potato baked French fries Pumpkin Potato steamed Beets Sweet corn Sweet potato Carrot Green peas Broccoli, greens, cabbage cauliflower, s. squash 139 121 107 93 91 78 77 70 68 20 59

Sugars – Glycemic Index Sugars G. I. Fructose 32 Lactose 65 Honey 83 High fructose corn syrup 89 Sucrose (table sugar) 92 Glucose 137 Maltose 150 © 1997 - 2004 Life. Long Health® Misc. foods G. I. Milk, skim Milk, full fat Chocolate milk Yogurt, sweetened Soft drink Coca Cola Pizza Tomato soup Soda crackers Dates, dried Tofu frozen dessert Ice cream, full fat 46 39 49 51 97 90 60 54 106 146 164 87 60

Glycated Hemoglobin (Hb. A 1 c) v This test indicates the average blood glucose concentration over the past three months – This test is a screening tool for metabolic syndrome or diabetes ( a Hb. A 1 c of 7. 0 or higher may indicate diabetes) – It also predicts increased risk of heart disease and overall mortality even for people without diabetes © 1997 - 2004 Life. Long Health® 61

Study Findings v An increase of 1% in glycated hemoglobin is associated with roughly a: – 30% increase in mortality from all causes – 40% increase in mortality from coronary heart disease British Med. Jour. , Jan. 6, 2001 © 1997 - 2004 Life. Long Health® 62

Relative risk CHD Glycated Hemoglobin and Coronary Heart Disease n=4662 Glycated Hemoglobin Levels ©

Relative risk of Death Glycated Hemoglobin and Mortality from All Causes n=4662 Glycated Hemoglobin

Prevention Strategy v Reduce the average blood sugar level of the general population to achieve a glycated hemoglobin level less than 5. 0% by: – Decreasing excess body fat – Increasing the level of physical activity – Improving eating habits v Decrease the glycemic load in the diet v Eat less refined carbohydrates and more foods high in dietary fiber © 1997 - 2004 Life. Long Health® 65

Oat Bran Bread and Diabetes v Study design – 8 diabetic men, 24 -week crossover study – Ate 6+ servings of high-fiber oat bran bread, muffins, or cereal per day (controls ate white bread) Dietary fiber increased from 19 to 34 g/day v 18 g fiber/day from oat bran (9 g soluble fiber) v v Results – Glucose, insulin, and cholesterol levels improved significantly. © 1997 - 2004 Life. Long Health® 66

Oat Bran, Metabolic Changes v v v Total glucose response dropped 46% Insulin response dropped 19% Total cholesterol levels dropped 14% LDL cholesterol levels dropped 23% HDL levels increased 8% White bread Oat bran bread JADA, Dec. 1996 © 1997 - 2004 Life. Long Health® 67

Fiber Intake and Heart Disease © 1997 - 2004 Life. Long Health® JAMA, Feb.

Dietary Fiber and Coronary Risk Fiber Source Fruits Vegetables Cereals Relative Risk of MI* 0. 79 (21% decreased risk) 0. 78 (22% decreased risk) 0. 71 (29% decreased risk) “. . . higher intake of dietary fiber, particularly from cereal and grain sources, can reduce substantially the risk of coronary heart disease. ” JAMA, Feb. 14, 1996 * Decreased risk of heart attack for every 10 gram increase in fiber © 1997 - 2004 Life. Long Health® 69

Decreased Coronary Risk From Eating Specific Foods Heart Attack Risk Ate cold breakfast cereal 2 -4 times/week v. seldom 0. 83 1. 0 Ate carrots 2 -4 times/week v. seldom ate carrots 0. 59 1. 0 Ate an apple daily v. seldom ate apples 0. 82 1. 0 Ate peas daily v. no peas 0. 52 1. 0 © 1997 - 2004 Life. Long Health® JAMA, Feb. 14, 1996 70

Plant Stanols/Sterols A substance found in plants (soy beans) that lowers cholesterol v It is put in margarine. Examples include: v – Benecol – Take Control v Research shows that if you eat 2 grams/day of plant stanols/sterols you can lower cholesterol by about 6 -15 percent NCEP, ATP 3, Guide to Therapeutic Lifestyle Change © 1997 - 2004 Life. Long Health® 71

v v v Nurses’ health study Nurses who ate the most fruits and vegetables (top 20%) had a 31% lower risk of stroke than people who ate the fewest (bottom 20%). For every serving of fruit or vegetable eaten per day, the risk of stroke drops 6% Ref. JAMA, p. 1233, Oct. 6, 1999 © 1997 - 2004 Life. Long Health® Relative Risk Fruit and Vegetable Intake and Risk of Stroke Fruit/Vegetable Intake by Servings/Day 72

Foods Most Protective Against Risk of Stroke Cruciferous vegetables (e. g. broccoli, cabbage, cauliflower, brussel sprouts) v Green leafy vegetables v Citrus fruits v Vitamin C-rich fruits and vegetables v Ref. JAMA, p. 1233, Oct. 6, 1999 © 1997 - 2004 Life. Long Health® 73

Relative Risk Plasma Vitamin C and Mortality from All Causes n=19, 496 Plasma Vitamin

Summary Findings v For each increase of 20 micro mol/L in plasma vitamin C (equivalent to one serving of fruits or vegetables), mortality rates fell by: – 15% for cancer – 30% for cardiovascular disease – 20% for death from any cause The Lancet, Mar. 3, 2001 © 1997 - 2004 Life. Long Health® 75

Fruits and Antioxidants v Fruits are excellent sources of antioxidants – Blueberries – Strawberries – Cantaloupe and other melons – Kiwi – Citrus: oranges, grapefruit, lemons, tangerines v Fruits are nature’s desserts. Enjoy them daily. Fresh fruits are best when available. © 1997 - 2004 Life. Long Health® Dietary Guidelines for Americans, 2000 76

v Study of 4, 400 American adults v Men and women who ate a diet high in red and processed meats, refined grains and sugar, and low in fresh fruits and vegetables -- doubled their risk of colon cancer. Ref: Amer. J. of Epid. , July, ‘ 98 © 1997 - 2004 Life. Long Health® Colon Cancer (RR) Diet and Colon Cancer Low in meat, high fruits & veg High meat, low fruits & veg 77

Protective Foods for Colon Cancer Food # of Studies Vegetables Fruit Raw vegetables Cabbage family vegetables Onion family Carrots Tomatoes 8 5 3 8 4 4 4 Ref: Vegetables, fruit, and cancer prevention: A review, JADA, Oct. ‘ 96 © 1997 - 2004 Life. Long Health® 78

Which Foods are Most Protective Against All Cancers? Food Raw vegetables All vegetables Onion family Carrots Green Vegetables Tomatoes Citrus fruit All fruits % of Studies 85% 81% 79% 78% 77% 70% 65% 63% Ref: Vegetables, fruit, and cancer prevention: A review 212 studies on diet and Cancer Prevention, JADA, Oct. ‘ 96

Calculate the Glycemic Load of a Carrot v Glycemic index of a carrot is

Calculate the Glycemic Load of a Carrot v Glycemic index of a carrot is 68. v How many grams of carbohydrate in one medium carrot? 6 grams v Glycemic load = 0. 68 X 6 = 4. 1 © 1997 - 2004 Life. Long Health® 83