Protein & Cholesterol Management: NCEP Discussion

In our recent posts, we have provided you with the summary evidence and recommendations from the National Cholesterol Education Program as it relates to the consumption of fats--both good and bad, carbohydrates and certain key nutrients like plant sterols and soluble fiber. In regard to proteins, the National Cholesterol Education Program provides somewhat weaker recommendations. The NCEP recent report states:

"Dietary protein in general has little effect on serum LDL cholesterol level or other lipoprotein fractions. However, substituting soy protein for animal protein has been reported to lower LDL cholesterol. Plant sources of protein are predominantly legumes, dry beans, nuts, and, to a lesser extent, grann products and vegetables, which are lower in saturated fats and cholesterol. Animal sources of protein that are lower in saturated fat and cholesterol include fat-free and low-fat dairy products, egg whites, fish, skinless poultry, and lean meats."

The report continues noting that "Since there are inconsistent findings regarding both the dose and potential benefit of soy protein, soy protein's major role in LDL-lowering may be to help reduce the intake of animal food products with the higher content of saturated fatty acids."

NCEP Evidence Statement: High intakes of soy protein can cause small sreductions in LDL cholesterol levels, especially when it replaces animal food products (Stength of Evidence: A2, B2).

NCEP Recommendation: Food sources containing soy protein are acceptable replacements for animal food products containing animal fats.

Carbs, Proteins & Fats: The NCEP Balance

Carbohydrate: 50-60% of Total Calories* **

Dietary Fiber: 20-30 grams per day (10-25grams from Soluble Fiber)

Protein: 15% of Total Calories
Total Fat: 25-35% of Total Calories*
Monunsaturated Fat: Up to 20% of Total Calories
Polyunsaturated Fat: Up to 10% of Total Calories
Saturated Fat: Less than 7% of Total Calories
Dietary Cholesterol: Less than 200mg/day.

*Allows an increase of total fat to 35% of total calories and reduction in carbohydrate to 50% for persons with the metabolic syndrome. Any increase in fat intake should be in the form of either polyunsaturated or monounsaturated fat. **Carbohydrate should derive perdominantly from foods rich in complex carbohydrates including grains--especially whole grains---fruits, and vegetables.

Plant Sterols: Recommendations from the National Cholesterol Education Program

NCEP Evidence Statement: Daily intakes of 2-3 grams per day of plant stanol/sterol esters will reduce cholesterol by 6-15 percent Strength of Evidence (A2, B1)

NCEP Recommendation: Plant stanol/sterol esters (2g/day) are a therapeutic option to enhance LDL cholesterol lowering.

Plant Sterols or Plant Sterol Esters: Count Correctly!

Here at Kardea, we use natural plant sterol esters that combine the free plant sterol found in soy bean with a safflower oil. Sterol esters are considerably more expensive than the plant sterols, but much of the research in regard to the efficacy of sterols to consistently lower total and LDL cholesterol without adversely lowering HDL (good) cholesterol was based on the sterol ester.

The FDA first approved the sterol heart health claim only for the plant sterol ester. In this claim, the FDA defines that individuals should consume 1.3 grams/day of plant sterol esters to have a meaningful effect on heart health. To make this claim, food manufacturers are required to incorporate at least .65 grams of plant sterol esters into each serving as listed on the nutritional statement. Generally, sterol esters contain about 60% free sterols.

Since then, the FDA has allowed the claims for the free plant sterol. Under this claim, the FDA targets .8 grams of plant sterols per day with each serving containing .4 grams.

Looking beyond the FDA health claims, the National Cholesterol Education Program of the NIH, along with the American Heart Association and the American College of Cardiology, recommends daily consumption of 2 grams/day of plant sterols.

For those of us utilizing a natural and nutritional approach for cholesterol management, we must make certain that we are counting our sterol intake correctly. Kardea seeks to make this as clear as possible. We provide you with the numbers for the free sterol content in our products. For example, our bars contain 1 gram of plant sterols, and we utilize a significantly greater amount of plant sterol esters to reach this level. So, you need two bars per day to reach the NCEP recommendation.

Alternatively, a bar and two tablespoons of our sterol-fortified olive oil will achieve the same results. For recipes using Kardea olive oil with other heart healthy foods, visit www.kardeagourmet.com.

Other products might fit into your lifestyle. If you are a chip snacker, you might try the natural products at Corazonas Foods. One serving contains .4 grams of the sterols. For products containing non-natural ingredients, try Proactiv Supershots and their margerine-like spreads. Lots of other products are available.

There also are plant sterol supplements on the market. Different brands deliver different levels of sterols. Count correctly!

Soluble Fiber--From Hype to Health

Take a walk through the grocery aisle, and you will quickly find many products claiming to be heart healthy.

For many of these products, the heart healthy claims flows from two essential nutritional characteristics. They are low in saturated and trans fats, and they deliver levels of soluble fiber sufficient to meet certain FDA-allowed heart health claims. To make these claims, the FDA requires that the products deliver in each serving at least .75 grams of soluble fiber from oats or barley, or 1.7 grams of soluble fiber from psyllium.

For those of us seeking measurable improvements in our cholesterol levels, success requires consuming substantially greater levels of soluble fiber. The National Cholesterol Education Program of the National Institutes of Health recommends 10-25 grams per day. Depending on your chemistry, consumption at these levels can lower LDL cholesterol by up to 8-10%. Some studies have suggested that results could be more significant.

How much oatmeal is required to reach 10 grams of soluble fiber? Roughly 5 servings, or about 2 lbs of prepared oatmeal. For 25 grams, you would need to consume about 5 lbs of prepared oatmeal, or about 2000 calories per day from oatmeal. Nay!

While oats certainly are a good starting point, I begin the day with a heaping tablespoon (=3 teaspoons) of whole psyllium husk. Psyllium seed husks are nature's most concentrated source of cholesterol-lowering soluble fiber. Where oats are only about 5% soluble fiber, psyllium husks are about 60%. With a tablespoon of psyllium husk, I start the day with 9 grams of soluble fiber (note: start with a teaspoon and work your way up).

5-6 servings of fruits and vegetables through the course of the day gets me another 5-6 grams.

From here, I shoot for the upper levels of the cholesterol-lowering soluble fiber targets. Success typically requires some culinary creativity and an understanding of the sources of soluble fiber.



Here is one recipe that you may find a useful addition to your weekly food choices:

Barley Pilaf
4 Servings of About 1 Cup Each

Barley never came to my mind as something I would crave. Yet, I discovered that barley stands side-by-side with oats as an FDA-endorsed food for promoting heart health by lowering cholesterol. I have since set out to explore how barley could be enjoyed in something other than a malted beverage.

As it turns out, a barley pilaf can be a delicious alternative to the rice, potato or pasta “starch” in protein/starch/vegetable triad my mom insists constitutes a meal.

A pilaf can be cooked to complement any number of dishes. Adapt by incorporating any number of spices. Start with the basic pilaf and create from there.

So, you ask "why don't more people eat barley." Part of the answer lies with the fact that cooking barley can be a bit tricky. If you're not careful, you might find your pilaf with hot cereal qualities---perhaps great for a cold morning but not the best for a dinner. But if you take a bit of care, you barley pilaf can be a great nutritious alternative to high glycemic, low fiber carbs.

Ingredients
1 Cup Rinsed Pearled Barley
2 Cups Water
1 Small Onion-Finely Chopped
2 Tablespoons Extra Virgin Olive Oil (preferably fortified with plant sterols)*
½ Teaspoon Turmeric
Salt & Pepper to Taste

*to double-up on the cholesterol lowering abilities of this dish, I formulated an extra-virgin olive oil with added plant sterols. This olive oil is available through the Kardea Nutrition website
http://www.kardeanutrition.com/products/food.aspx . If you want to reduce total fat, cut recipe to 1 tablespoon of oil.


Direction
Heat a sauce pan over medium heat. When pan is hot, add olive oil and chopped onion. Saute for a few minutes. Add rinsed pearl barley and saute for 5 or so minutes, stirring regularly and making sure that barley does not burn or stick to bottom of pan. Add turmeric and then water to the hot barley and stir. Cover, lower heat and cook until tender but still a bit chewy (30 minutes). Remove cover and on very low heat, let steam escape. Periodically fluff to prevent sticking to bottom of pan. Serve when barley appears about the consistency of steamed rice. This all may sound a bit cumbersome, but it works. The turmeric also give the barley a beautiful yellow color, accenting the visual appeal of an entire meal.


Nutritional Facts
(about a cup of cooked barley pilaf)
Calorie: 240 Calories from Fat: 70
Total Fat: 8g from olive oil; monounsaturated: 5.7g; polyunsaturate fat: 1.15g; saturated fat: 1.15g (4.3% of total calories); Trans fat: 0.0g.
Cholesterol: 0.0
Total Carbohydrates: 40g; Total Fiber: 8g; Soluble Fiber: 2g.
Protein: 5g.
Plant Sterol: .25g

Stepping-Up
You can try adding any number of spices. Try curry or cumin when serving lean meats or roasted root vegetables. Try ginger and currents when serving fish. Serve with a kidney bean chili or black bean salad (recipe in next blog) to create a meal that delivers 3-4g of soluble fiber.

Do You Have A Great Barley Recipe? Can you improve this recipe? Post your thoughts and recipes to this blog to share with the Kardea community.

Natural Cholesterol Management - Numbers are In

In a four month period, I naturally lowered my LDL (bad) cholesterol from 161mg/dl to 131mg/dl (about 19% improvement), increased my HDL (good) cholesterol from 55 to 61 (about a 10% improvement). Total cholesterol was reduced from from 228 (it had been as high as 239) to 201. I am not yet at the "under 200" target, but with my relatively high HDLs and declining LDLs, I was now closing in on some desireable cholesterol levels.

I achieved these goals with a less-than-disciplined, natural approach combining plant sterols, viscous soluble fiber and low levels of immediate release niacin from nicotinic acid.

I always have eaten fairly well. Low in terms of red meat and dairy, low in terms of saturated fats, processed foods and dietary cholesterol. Mediterranean cuisine also has long been a personal preference, and I use olive oil (and occassionally canola oil) in all cooking and food prep. I also eat a fair amount of vegetables and whole grains, and lots of fruit.

My internist had suggested that I might need to consider the use of a medication to achieve better cholesterol levels. As an otherwise healthy 49 male, I was not ready to start a lifetime of medication to create healthier cholesterol levels. I began a search for the alternatives, and found that a number of nutrients ---viscous soluble fibers, plant sterols, niacin and Omega-3 fatty acids --- can collectively enable an individual to substantially improve one's blood lipid profiles.

So, I began developing a personal program that incorporates these nutrients in foods and supplements. More importantly, I was looking to enjoy these foods (food and cooking are my pre-occupation and a source of daily joy). With my somewhat less-than-disciplined approach to consuming soluble fiber, plant sterols and niacin, I achieved the results noted above.

Note on full disclosure: While I weigh about the same amount, I did increase the frequency of exercise from 2 to 4 days per week. My workout intensity also increased.

I am now looking to refine my approach to further improve my blood lipid levels. As someone with year's of experience in the natural and gourmet foods, I also decided to create Kardea Nutrition to develop products that comfortably fit into my daily eating habits (and hopefully yours!). I also do not want these foods to lead to an increase in the total level of calories I take in each day.

My first set of products should be available in early February, but early in Janary, you will be able to log onto my website to see what's coming (http://www.kardeanutrition.com/).

Overall, I am sincerely interested in networking with others that are attempting to manage cholesterol levels naturally. Let's share what is working.....and based in part on these exchanges, I will be developing other foods and supplements that strive to meet the combined goals of delicious, natural, calorie-mindful and effective in terms of natural cholesterol management.