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Things That Might Kill You Volume 1: Trans-fats

Feb 10 2010

Trans-fats have been in the news sporadically in recent years, thanks largely to the bans passed by the New York City Health Department and the Indiana State Fair. Even consumers who don’t read the news have undoubtedly become familiar with the term because of food manufacturers labeling their products “0 Trans Fats!” (often with a small-print “per serving” which usually means there are trans fats in the product, just less than .5 g per serving) or “Trans-fat free!” whether or not they ever contained trans-fats in the first place.

from Ritz 100 calorie packs: http://2.bp.blogspot.com/_QEJr8TD2el0/Sgh4AvvhknI/AAAAAAAAACw/6Ljvrf8r5hU/s1600-h/transfat4.jpg from http://fastfood.freedomblogging.com/2008/07/30/is-fast-food-complying-to-the-new-california-trans-fat-ban/just don't ask them about their msg content

But there still seems to be considerable confusion about what trans-fats are and why they might be bad for your health, which has likely been complicated by the long, stupid demonization of fats qua fats and saturated fats as a supposed cause of high cholesterol and heart disease.

Trans-fats are trans isomers of fatty acids, and although they occur naturally in small amounts in meat and dairy products from ruminants like cows and goats (in the form of vaccenic acid), the primary source of trans-fats in most Americans’ diets is hydrogenated vegetable oils. Most vegetable oils are composed primarily of unsaturated fats, which tend to be liquid at room temperature. criscoIn the early 20th Century, when the U.S. started importing soybeans as a source of cheap protein, soybean oil became readily available as a byproduct and was far cheaper than butter or lard. However, liquid and unsaturated fats get rancid much more quickly than solid fats, have a lower smoke point, and were unsuited to many American culinary traditions—biscuits and pastry crusts or all “short breads”* absolutely depend on solid fats to create their flaky texture, as explained in the note at the end.

Hydrogenation, a process first developed by French and German chemists around the turn of the century,  provided the solution: heating the liquid, unsaturated fats in the presence of hydrogen turned them into solids at room-temperature. Apparently, cottonseed oil was also far cheaper than the beef tallow used in candles, so that one of the first uses of hydrogenated oils. It took a little marketing work to convince people it was also good eating--the major campaign for years was “Use Crisco, it’s digestible!” (okay, actually that probably just reflected the central nutritional concerns of the early 20th C: indigestion and dispepsia, see Hillel Schwartz’s Never Statisfied.

from a 1915 Saturday Evening Post advertisement, see the whole thing at http://freetheanimal.com/2009/05/know-your-fats.html

However, the process of hydrogenation also creates trans fats, and a different kind from the ones present in beef and dairy products. Unlike saturated fats, trans-fats produced through hydrogenation have been repeatedly correlated with coronary heart disease, including fatal heart attacks, in large, long-term epidemiological studies, including the Framingham Study. A review article on the available research on the relationship between dietary fat and coronary heart disease (CHD) published this past September concluded:

According to the classic ‘diet-heart’ hypothesis, high intake of SFAs [saturated fatty acids] and cholesterol and low intake of PUFAs [poly-unsaturated fatty acids] increase serum cholesterol levels and risk of CHD. However, few within-population studies have been able to demonstrate consistent associations with any specific dietary lipids, with the exception of trans fats and n–3 fatty acids.

In other words, everything you've heard in the last decade about trans fats (bad) and omega-3s (good) actually seems to be supported by the available research, unlike everything you've been told for the last five decades about saturated fats.

However, many of the claims about the threat posed by trans-fats allege that trans-fats raise LDL levels. And it's not at all clear to me that anyone should be concerned about the fact that trans fats might be associated with increased cholesterol, even "bad" cholesterol, for reasons I discuss in the second entry on saturated fat. The only thing makes me think trans fats might actually be bad for people's health is the consistent, strong association between trans fat consumption and increased risk of CVD and myocardial infarction. I know correlation =/= causation, and I haven’t found any good evidence about a proposed mechanism. On the basis of the current evidence, it seems like there’s a difference between the naturally-occurring trans-fats and the ones produced by hydrogenation:

The association was only seen for for trans fatty isomers from hydrogenated vegetable oils. The mainly different trans isomers from ruminant fats did not show such an association. A case-control study in 239 people suffering an acute myocardial infarction found that after adjustment for age, sex and energy intake, intake of trans fatty acids was directly related to risk of myocardial infarction [241]. Those with the highest intake of trans fatty acids had twice the risk of myocardial infarction as those with the lowest intakes after adjusting for other cardiovascular risk factors. As with the Nurses Health Study, the association was only seen for trans isomers from partially hydrogenated vegetable oils. (from a 1995 lit review in the British Food Journal)

Is that because the hydrogenated oils contain linoleic acid, and meat and milk with naturally-occurring trans-fats don’t? I don’t know. I think the most interesting finding from Harvard's Nurse's Health Study, which is one of the studies that did show a weak but significant correlation between saturated fat consumption and CVD, is that the consumption of trans fats was associated with a much higher incidence of CVD than saturated fats. That finding, which is nearly two decades old, should probably be pretty infuriating to anyone who’s eaten hydrogenated-vegetable-oil margarine or shortening in the last two decades because it was supposedly a “healthier” alternative to butter or lard. Similar findings in several other studies prompted the more recent review article to conclude:

The observational evidence that TFA are independently associated with increased risk of CHD events is convincing, though based on a more limited body of evidence.

However:

There is probably no direct relation between total fat intake and risk of CHD.

So the persistent recommendation from public health and nutrition authorities to reduce total fat consumption? Not supported by the available evidence. But the reason this isn’t a  "things that won't kill you" entry is because, well, trans-fats might.

What it means for how I eat

The short version: lard before margarine or shortening, except when the lard is shelf-stable or the margarine/shortening is produced using fractionation and palm oil. Read more »

Neglected Pear Bread or When Pears go Pear Shaped--ha! I kill me! or Okay, so it's not that funny but the bread was nice

Feb 8 2010

just a bit past their prime...

“Pears are just so stinkin’ elegant.” –Half-Assed Kitchen

There are few things I love more than a perfectly-ripe pear—just soft enough that you could cut through the flesh with a spoon but not yet grainy or worse, mushy. But that moment seems to come and go so quickly. They sit there on the counter for a week after I buy them, flesh completely unyielding. If I dare to cut into one, it’s inevitably crisp as a good apple, but not nearly as sweet, not at all what I’m looking for in a pear. But then I  look away for a minute—check my e-mail, perhaps, or dare to fall asleep. And that’s it, I miss their few perfect hours. Next thing I know, I have three pears dissolving in my fruit bowl, just barely held together by their increasingly bruised skin.

Usually, at that point, I cut them up and throw them in a basic muffin batter with some powdered ginger. The bits of pear give the muffins an almost custardy consistency, like little pear and ginger-flavored bread puddings. But I got a little busy this week and ended up leaving them to degrade beyond the point where I could even dice them up.

feeling less neglected now, it seems!So I realized that if I was going to get any use out of them at all, it was most likely going to be as part of the moist ingredients, more like the mashed banana in banana bread than the blueberries in a muffin. But most of the recipes I found for baked goods using pears asked for them grated or chopped or shredded, all of which would have required a starting structural integrity far beyond what these pears had. I thought about just substituting them in a recipe for applesauce bread until I came across this recipe which called for canned pears, but involved pureeing them in a blender or food processor. It also called for almond meal, which reminded me of the traditional French tart with thin slices of pear layered over a frangipane base. And although I’m sometimes a little skeptical about advice and recipes I find on About.com, the ultimate selling point was the note about how the recipe had been improved by the addition of baking soda to promote browning and off-set the acidity of the lemon juice. What can I say, I’m a sucker for science.

Which is not to say that I think baking is an exact science. I didn’t have quite enough almonds, so I substituted some ground flax meal. IMG_0166Even after I’d cored and peeled my three sad pears and pared away some of the worst bruising, I had a lot more pear than the recipe called for, so I left out some of the lemon juice. I added a little almond extract, in part to compensate for using less almond meal and in part because I just really like almond extract. And I added just a little cinnamon and nutmeg—not as much as I would have wanted in an applesauce bread, but just enough to give it a hint of spice. I only had one 4x8 loaf pan, so I used a 9x13 for the second loaf and had to leave that one in a little longer. Next time, I’ll probably substitute brown sugar for some or all of the white sugar.

It turned out lovely—the delicate flavors of pear and almond melding with a little brightness from the lemon and warmth from the spices. It’s moist and tender, not too sweet for breakfast or afternoon tea, and definitely better the  second (and third and fourth) day. Not, perhaps, quite as sublime or as elegant as a perfectly ripe pear, but not a bad result at all for pears so badly neglected.

Recipe, including explanations for some modifications in the method which are applicable to all quick breads and butter cakes, and pictures below the jump. Read more »

Things That Won't Kill You Volume 4: Saturated Fat Part II: Cholesterol Myths

Feb 5 2010

image In retrospect, this probably could have been an entirely separate article in the "things that won't kill you" series, as many people still believe that dietary cholesterol (i.e. cholesterol in food) is a bad thing. For example, the article that image was taken from claims:

If you get too much dietary cholesterol (over 300mg a day) the extra cholesterol will accumulate in the walls of the blood vessels, making your LDL (bad) blood cholesterol levels rise. Over time, your arteries will become narrower, which can cut off the blood supply to your heart (causing a heart attack), or your brain (causing a stroke).

However, that's pretty easily dismissed—even Ancel Keys, "Monsieur Cholesterol" himself, never argued that dietary cholesterol was related to serum cholesterol or heart disease. In a 1952 article in Circulation, the journal of the American Heart Association, Keys noted that although rabbits and chickens that eat high-cholesterol diets will develop high cholesterol and atherosclerosis, or hardening of the arteries:

No animal species close to man in metabolic habitus has been shown to be susceptible to the induction of atherosclerosis by cholesterol feeding…. Moreover, even in the favorite species for such  experimentation, the herbivorous rabbit, the necessary concentration of cholesterol in the diet is fantastically high in comparison with actual human diets. Moreover, there is reason to believe that man has a greater power of cholesterol regulation than does the rabbit or the chicken. From the animal experiments alone the most reasonable conclusion would be that the cholesterol content of human diets is unimportant in human atherosclerosis.

Two "moreovers" in one paragraph, people! “Most reasonable conclusion”! Moreover, five decades of subsequent research haven't given anyone any reason to think differently. In 1997, Keys was even more direct:

There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter unless you happen to be a chicken or a rabbit.

Research done in the interim on the relationship between diet and heart disease in humans like the Framingham and Tecumseh studies showed no relationship between cholesterol consumption and blood cholesterol or heart disease. I'm not even going to modify this with "probably" or "as far as we know": There is no reason to believe that how much cholesterol you eat has any effect on your health.

But that doesn’t stop the AHA from recommending that “most people…limit cholesterol intake to less than 300 mg per day” and claiming that “an egg can fit within heart-healthy guidelines for those people only if cholesterol from other sources — such as meats, poultry and dairy products — is limited.” Despite repeated studies showing that egg consumption is not associated with higher serum cholesterol, myocardial infarction, cardiovascular disease, or all-cause mortality. Read more »

NYE 2010 Part II: Admiral’s Punch and Festive Sweets

Feb 1 2010

cocktail in a bowl!

At past New Year’s Eve parties, we’ve mixed cocktails to order, and we never draw such a crowd that that’s a problem. However, I did find the Bon Appetit Foodist article about punch that would be less fizzy –spiked-pineapple-juice and more cocktail-in-a-bowl pretty compelling, both for ease of serving and because it enables you to make a drink that benefits from muddling and sitting and melding and chilling, all of which are either annoying or impossible to do on demand and to order. Also, I thought the recipe that called for little more than cognac, lemon juice, sugar, and sherry with a little nutmeg grated in sounded pretty delicious.

And it was. If I’d mixed three batches, it might…might have lasted until midnight. Of course, then we might all have been in too bad of shape to have any champagne.

As for sweets, I could have just relied on the candies I’d made for Christmas. Candies are useful for catering because they’re, by nature, practically non-perishable, sugar being a preservative and all. Additionally, they’re generally best served at room temperature, can be made weeks in advance, and rarely require flatware or cutlery. But candy just never seems totally satisfying as a dessert to me.

So the challenge was to find sweet fingerfoods that were elegant—most cookies don’t quite say “cocktail party” to me—but wouldn’t degrade too much sitting out for hours. I decided on a flourless chocolate-orange cake, cut into two-bite squares, and shortbread fingers filled with three different flavors of preserves. As a bonus for party-planning, both are best eaten the day after they’re made, so you can make them in advance, albeit not as far in advance as candy.

Flourless Chocolate-Orange Cake

instructions for candied orange zest curls also below

 Shortbread Fingers

these are strawberry-raspberry, blueberry on the plate behind, and out of sight my favorite: apricot-peach

Recipes and more pictures below. Read more »

Salt Headlines That Make The Vein In My Forehead Throb

Jan 27 2010

Salt has been all over the news this week because of a study just published in The New England Journal of Medicine claiming that if everyone in the U.S. reduced their sodium consumption by 3 grams/day, there would be 32,000 fewer strokes, 54,000 fewer heart attacks, and 44,000 fewer deaths every year. The story that got my attention was:

Remaining Arctic Ice Seen Melting Away Completely! (...on a computer screen)

That’s surprising, I thought. Everything I’ve read suggests that the relationship between salt consumption and cardiovascular disease is weak, inconsistent, and probably only valid for 20-30% of the population. So I expected the article to refer to some new research where, you know, “big benefits” were “seen.” As in observed. Like, in the world. And, given the claim about the magnitude, probably also measured.

To their credit, the authors of the study claim no such thing. The numbers are projections based on the application of several assumed effects of salt reduction, adjusted for different demographics and then applied to a model of the entire U.S. population. Thus, the title of the study: “Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease.”

The article seems to grasp the essentially speculative nature of the findings. The very first sentence uses the conditional tense:

…scientists writing in The New England Journal of Medicine conclude that lowering the amount of salt people eat by even a small amount could reduce cases of heart disease, stroke and heart attacks as much as reductions in smoking, obesity, and cholesterol levels.

The headline, on the other hand, seems to have confused the “scientists” with clairvoyants. Never mind doing any checking into the validity of their assumptions.

And the claim about how the benefits compare to smoking and obesity reduction led to a few headlines like this:

webmd salt

This crazypants idea initially sounds a lot like what the study’s lead author claims:

"The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels."

But the logic behind the claim is that a small improvement in the health of every single American would be as significant as a large health improvement in the health of every single smoker:

Dr. Bibbins-Domingo said that for many people the decrease in blood pressure would be modest, which is why, she said, “many physicians have thrown up their hands and said, ‘I’m not going to advise my patients to reduce salt because it’s too hard for patients and the benefits for any individual are small.’

“But small incremental changes in salt, such as lowering salt in tomato sauce or breads and cereals by a small amount, would achieve small changes in blood pressure that would have a measurable effect across the whole population,” she said. “That’s the reason why this intervention works better than just targeting smokers.”

For any given individual, there is no question about whether cutting salt is even close to “as good” as quitting smoking. The evidence for the link between smoking and lung cancer and death is strong, reliable, consistent, and has a clear causal mechanism (carcinogens). The link between salt and cardiovascular disease and death is weak, inconsistent, and still poorly understood.

That latter point starts to get at the problems with the study itself, and not just the headlines it inspired. A number of the assumptions the projection was based on are either demonstrably false or simply unsubstantiated. More on this some other time; for now, a few quotes and links to the essays they come from in Esquire and the medical journal Hypertension:

In a more recent statement, the founder of the American Society of Hypertension, Dr. John Laragh, goes further: "Is there any proven reason for us to grossly modify our salt intake or systematically avoid table salt? Generally speaking the answer is either a resounding no, or at that, at best, there is not any positive direct evidence to support such recommendations."

Studies show that 30 percent of the Americans who have high blood pressure would greatly benefit from a low-sodium diet. But that's about 10 percent of the overall population -- the rest of us are fine with sodium. And drastically cutting out sodium may actually hurt some people. ( "Go Ahead, Salt Your Food")

And:

The available data suggest that the association of sodium intake to health outcomes reflected in morbidity and mortality rates is modest and inconsistent. Therefore, on the basis of the existing evidence, it seems highly unlikely that any single dietary sodium intake will be appropriate or desirable for each member of an entire population.... The decision to adopt a low sodium diet should be made with awareness that there is no evidence that this approach to blood pressure reduction is either safe, in terms of ultimate health impact, or that it is as effective in producing cardioprotection as has been proven for some drug therapies. (Salt, Blood Pressure, and Human Health)

NYE 2010 Part I: Party Nibbles You Can Make Weeks in Advance

Jan 25 2010

Life, as usual, gets in the way of finishing all the half-completed entries on cholesterol, trans-fats, cherry-almond oatmeal muffins, butternut squash soup, pie crust with and without lard, how to make your own sourdough starter, etc. It’s folly to start yet another series of entries I’ll never get around to finishing, but I tried cramming all the things I made for New Year’s Eve into one post, and I just couldn’t do it. 

This is why.

Roughly clockwise from the upper left corner, that’s matzoh toffee, peppermint bark, spicy cheese straws, spiced nuts, goat cheese and fig jam crostini, smoked salmon rolls, more nuts and cheese straws, bacon-wrapped dates stuffed with chorizo, warm crab florentine dip with flatbread and sourdough, flourless chocolate-orange cake, shortbread bars with strawberry-raspberry, peach-apricot, and blueberry preserve fillings, more cheese straws and nuts.

There’s no way I could have made and served that many different things by myself if many of them couldn’t be made in advance. So that’s the theme of the first entry in the NYE 2010 series. These are all things that I made before Christmas. In most cases, I doubled or tripled the recipes and packed most of them into tins and boxes to give as gifts. But I set aside enough to put out on New Year’s Eve. In short, these are handy recipes to have, especially around the holidays.

More pictures and recipes below for Spiced Nuts, Matzoh Toffee, Peppermint Bark, and Spicy Cheese Straws. Read more »