More Good News for Chocolate

Ah, how times change.  Just a few years ago, chocolate was undoubtedly in the junk food category, yet a flurry of recent research has confirmed its benefits to cardiovascular health.  The latest is a study from Sweden published last month (1) that showed that higher chocolate consumption cut men's stroke risk by 17%.  And it didn't need to be much -- just an average of about 2 ounces per week, compared to non-consumers.  The key seems to be the flavonoids in cocoa:  compounds that have antioxidant activity, and improve endothelial function (the inner lining of large blood vessels).

Prior research showed cardiovascular benefits from dark chocolate, which have a higher cocoa content (55-90%) than milk chocolate (30%).  So for maximal benefit, reach for the dark chocolate.  This also avoids the high amounts of sugar and saturated fat in milk chocolate, which can contribute to obesity and metabolic syndrome.

It might take time to get used to the less sweet taste of dark chocolate, but with small amounts (1/2 - 1 ounce per day), your palate will adjust.  My advice?  Become a chocolate snob.  Buy good quality dark chocolate, and really focus in and enjoy that little tidbit, rather than cramming down a whole bar of cheap milk chocolate.


1.  Chocolate consumption and risk of stroke:  A prospective cohort of men and meta-analysis.  Neurology. 2012;79:1223-1229. Published online August 29, 2012.

Why I'm Still Eating Organic Foods

A study about organic food published this month in the Annals of Internal Medicine (1) made big headlines, mostly along the lines of "organic food is no better for you than conventionally grown food."  As usual, the headlines tend to gloss over the details of the research that was conducted.  Several points are worth noting, to decide whether or not organic fruits, vegetables, eggs, and meat are worth the extra cost:

• This was a review study, not primary research.  That is, the authors combed through existing articles from the past 15 years to extract the data.  This can confuse the issue, since the previous studies were done in different settings and for a variety of purposes.
• Organic produce does not contain significantly higher levels of vitamins or minerals than conventionally grown produce.
• Eating organic food leads to lower exposure to synthetic pesticides and fertilizers, but the authors point out that the exposure from conventional foods was mostly within the "allowable limits" set by the US government.
• Organic chicken and pork have a greatly reduced risk of carrying antibiotic-resistant bacteria ("superbugs" that are particularly dangerous and difficult to treat).

My view on some of the conclusions reached:

• It has been well known for a long time that organic fruits and veggies are not superior in vitamin or mineral content.  However, some studies have suggested that they do have a higher content of phytonutrients -- those compounds produced by plants that help protect us against cancer, cardiovascular disease, and other chronic health conditions.  Plants are basically chemical factories; without the "protection" of synthetic pesticides, they must cook up their own natural protective compounds, and we get the benefits when we eat those plants.
• Even though pesticide residue on conventional produce is within "safe" limits for daily consumption, we must remember that those chemicals are lipophilic (literally, "fat-loving").  They can stay in our fat tissue for a very long time.  How long?  A by-product of the pesticide DDT (which was banned in the US in 1972) was still present at significant levels in adults' fat tissue two decades later (2).  So it's not about keeping the daily dose in a "safe" range; it's thinking long-term about these carcinogenic compounds (3) building up in the body.
• While we're on the topic, those synthetic chemicals can even contribute to obesity and diabetes (4).
• Avoiding antibiotic-resistant bacteria is always a good idea; avoiding the residue of antibiotics in meat is also a good idea, since that may disrupt the normal, beneficial microorganisms in our digestive tract.

So for many fruits, vegetables, and meat, I'm sticking with organic.  If you need to budget your grocery dollars, check out the Environmental Working Group's analysis of which foods are highest and lowest in pesticide residue.

1. Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review.  Ann Intern Med. 4 September 2012;157(5):348-366
2. Organochlorine pesticides and polychlorinated biphenyls in human adipose tissue.  Rev Environ Contam Toxicol. 1991;120:1-82.
3. Adipose tissue levels of organochlorine pesticides and polychlorinated biphenyls and risk of non-Hodgkin's lymphoma.  Environ Health Perspect. 2004 Jun;112(8):854-61.
4. Obesity and persistent organic pollutants: possible obesogenic effect of organochlorine pesticides and polychlorinated biphenyls.  Obesity (Silver Spring). 2011 Apr;19(4):709-14. Epub 2010 Jun 17.

When Does a "Normal" Blood Sugar Test Mean a 53% Increased Risk of Cardiovascular Disease?

Answer:  When it's at the upper end of the normal range.

A fasting blood glucose (FBG) test is one of the most common labs I order.  The normal range for FBG is 60-99 mg/dl.  If this reading of blood sugar is much too high (greater than 126 mg/dl) on two separate tests, that is the definition of diabetes.  The most common type of diabetes that comes on later in life is called type 2 diabetes mellitus, and is associated with obesity.  That borderland of 100-125 mg/dl is called impaired fasting glucose, and indicates that a person on the way to developing diabetes.

So why all this fuss about blood sugar?  The problem is that high blood sugar (and the high insulin levels that accompany it) put aging on fast-forward -- putting you at much greater risk for heart disease, kidney disease, eye problems, and nerve problems.  It literally takes years off your life.  The complex interrelationship between high blood sugar, insulin resistance, and chronic disease has been called metabolic syndrome.

Knowing this, researchers in Israel published findings last week (1) that indicate that the problems don't just suddently start once your FBG climbs over 100 mg/dl.  Adults who had FBG of 95-99 mg/dl (still "normal") had a fifty-three percent increased risk of cardiovascular disease compared to those with FBG of less than 80 mg/dl.

What does this mean for you?  If your doctor tells you that your blood sugar test came back normal, ask for the number.  If it's over 95 mg/dl, you are at a significantly increased risk for stroke, heart attack, and coronary heart disease.  Follow a healthy lifestyle, including a low-glycemic index diet and exercise, to aim for a FBG of less than 80 mg/dl.

1.  Fasting Glucose Levels Within the High Normal Range Predict Cardiovascular Outcome.  Am Heart J. 2012;164(1):111-116.