New England Health Advisory

By Inger Pols

In the last issue, I began a series on how to make healthier food choices. I discussed how refined flour is stripped of its nutrients and then “enriched” with lab-created versions of the nutrients. I discussed how flour can spike blood sugar levels and suggested some healthier bread choices. Today, I’m going to look at traditional starch options like pasta, rice and potatoes to see why pasta comes out as the best choice.

I want to talk briefly about why the Glycemic Index is a helpful guide (but not an absolute rule) and look at how it applies to bread to provide context when we look at how pasta, potatoes and rice measure up.

As I discussed on Monday with the bread issue, certain foods spike blood sugar levels. The Glycemic Index is the scientific system that measures and monitors those increases across all carbohydrates. The lower the number, generally speaking, the better because that means the food will be digested more slowly, will result in less insulin spiking and will provide more protection from diabetes, high blood pressure, high triglycerides, heart disease and obesity.

In addition to helping you to avoid certain health conditions, lower Glycemic Index (GI) foods also aid in weight control. A study of overweight teenagers eating a low GI breakfast showed that they ate 45% fewer calories throughout the day than when they began their day with a high GI breakfast. Foods that stimulate insulin have been shown to increase calorie consumption at the next meal and research shows that if calorie intake is equal, eating lower GI food will result in weight loss.

Problems with the Glycemic Index

But there are a number of problems with relying completely on the index as a food guide. First, GI food measurements are imprecise. Generally speaking, the test is done several times and the results are an average of those outcomes.

For example, a baked russet potato has been shown to have a GI value as low as 56 and as high as 111. As a result, it is listed in the high 70s on most indexes. The GI index for fruit increases as it ripens and changes depending on the food processing method and time. Grinding or cooking will increase the GI as will cooking for longer periods of time.

The GI of any one food is also altered significantly based on what it is combined with. I recommend eating healthy fat, protein and fiber with every meal because it reduces insulin spiking and decreases the likelihood that higher sugar foods will be stored as fat. But how much you eat matters too: Some foods have a high GI but you likely wouldn’t eat a lot of them, so their overall “load” is lower, while others may be lower, but you are more likely to consume a good portion. And lastly, individual responses to carbohydrate digestion vary, as do insulin responses, and those responses have been shown to vary based on the time of day the food is consumed.

As a result, the Glycemic Index can be a helpful tool but should not be relied upon in absolute. It is helpful for making relative comparisons and tradeoffs. Something that falls in the 80s is a less healthy food choice than something that lands in the 40s. Generally speaking, it’s a good idea to minimize consumption of foods with scores over 55 on the GI. But some of those foods have great nutritional benefits, so that doesn’t mean you should never eat them. Instead, consume them in moderate portions, on occasion, combined with fiber, healthy fats and protein. It’s easy to see why a processed bakery product might need to be eliminated, but a potato or watermelon can be eaten in moderation.

Now let’s talk about how the Glycemic Index applies to pasta and rice compared to bread.

Bread, Potatoes, Rice and Pasta

In addition to being nutrient devoid, traditional white bread and most whole wheat bread (made from enriched white flour) is high on the Glycemic Index. Typical white or wheat bread and bagels fall in the 70s, while pita bread lands in the high 50s. I love a good French bread as much as the next person, but baguettes fall in the mid-90s!

As you go toward more whole grain products, the Glycemic Index declines, with multigrain bread in the high 40s and sprouted grain breads in the low to mid-40s. Whole grain, multi-grain and sprouted grains are lower GI choices that also offer more nutrient value. (Ezekiel bread, for example, is a complete protein source offering all nine essential amino acids and 18 amino acids in total, all from plants; it’s more than just bread.)

It seems logical that pastas would go much the same way as breads, with traditional white and wheat pastas being significantly higher glycemically than whole grain and sprouted grain versions. But that is not the case.

Earlier I said that white bread and baked potatoes have GI scores in the 70s, but there are some better potatoes choices: Boiled, new or sweet potatoes are all in the mid-50s. In addition, brown rice comes in at 55 on the GI, while white rice shows up between 56-64. (Note: Though the Glycemic Index between brown and white rice may seem close, brown rice has much greater nutrient density and is a better food choice.)

Even though some potatoes and brown rice have levels in the mid-50s on the GI, which makes them viable options on occasion, pastas have an even lower GI. During processing, ungelatinized starch granules get trapped in the sponge-like gluten (protein) network inside the pasta dough. This does not occur in the processing of bread or rice and as a result, pastas tend to have a lower Glycemic Index overall.

Traditional spaghetti comes in at 41 on the GI scale, with its whole-wheat version at 37, making these clear winners, with a few caveats.

An Exception: Brown Rice Pasta

There is one surprising exception: brown rice pasta. Brown rice pasta comes in at a whopping 92 on the Glycemic Index: A surprise to me since brown rice itself is not high on the GI and whole grain brown rice is a nutrient-rich food. I’m still researching what it is about the transformation from rice to pasta that makes brown rice so high on GI scale. But until I learn more, avoid brown rice pasta and stick to traditional pastas.

I do continue to recommend whole grain brown rice as a healthy, nutrient-laden option on occasion; it’s got a host of health benefits and comes in at 55 on the GI scale. (Asian noodles also have a relatively low Glycemic Index, so I recommend experimenting with udon, rice vermicelli or hokkein for variety.)

As always, try to limit serving size and frequency; we Americans tend to eat enormous plates full of pasta whereas Europeans eat much smaller portions. And always cook your pasta al dente: The longer you cook it, the higher the Glycemic Index, as the gelatinous protein network breaks down. (One GI table showed that spaghetti boiled for 10-15 minutes came in at 44, but when boiled for five minutes, it dropped down to 38. Regardless of the exact cooking time, which will vary by product, be sure not to overcook. Try for that al dente firmness that leaves more of the protein intact.)

When you do eat pasta, combine it with healthy fats, proteins and carbohydrates to create a balanced meal; here’s where fresh homemade vegetable sauces made with healthy fats can take your meal to a whole new health level. And here’s a tip if you are concerned about blood sugar: Add some acid like vinegar or lemon to help lower the GI of the meal.

While you do get some additional nutrient value from a whole grain, multi-grain or sprouted grain pasta, the glycemic difference of whole wheat is not significant versus traditional pastas. Some of the newer whole grain and sprouted grain versions have not even been tested yet and while their scores may be lower, the baseline for traditional pasta is pretty good to begin with.

While I encourage you to experiment and try some of these nutrient-rich grain products–variety in food choices is always a good thing–if the taste does not appeal to you, it’s OK to indulge in some traditional pasta on occasion. Mangia!

To your health!

Inger Pols
Editor of New England Health Advisory

P.S. We receive a lot of emails from our readers, but last week, we were honored to receive an actual paper letter! Not only that, but its content was so interesting and thought provoking that we published it on our website. Please take a moment to read it and add comments.

By Inger Pols

This is part five of a series on the supplements I think every adult should take. Previous issues focused on whole-food based multivitamins, ubiquinol, fiber and omega 3. You can read them by clicking here.

The final supplement on the list is vitamin D, which is made in our bodies through sun exposure. But today, we simply don’t get enough direct exposure to sunshine, without sunscreen, to make the vitamin D we need.

Vitamin D helps with bone health by facilitating calcium absorption. It also plays an important role in many other healthy body functions. Vitamin D has been shown to improve immune health and heart health, protect against cancer, autoimmune diseases, depression and a host of other conditions.

Vitamin D deficiency is a major cause for concern as it affects multiple systems in our bodies. Vitamin D deficiency is far more pervasive than previously believed, with research now indicating virtually all adults and children have lower than optimal vitamin D levels.

The only way to know how much vitamin D you need on a daily basis is to get your levels tested a couple of months after you begin to supplement. You want to see levels of 125-200 nmol/L, or nanomoles per liter. (Sometimes test results are reported in nanograms per milliliter or ng/ml. It’s the same test, just a different measurement: Like miles per hour versus feet per second. If your test results are in ng/ml, you will want to see at least 50 ng/ml for optimal vitamin D function.)

Estimates now suggest that 5,000 International Units, or IU, of vitamin D a day or 35 IU per pound for kids or heavier people is appropriate. But some of us need more: I was recently listening to a renowned brain expert say that as a physician, he was shocked when he found out after vitamin D testing that his body required 10,000 IU a day to function at its optimal level since he lives in southern California and is exposed to sunshine all year.

My whole food multivitamin contains 5,000 IU of vitamin D3 and I get plenty of daily summer sunshine, so I don’t take a supplement in summer. But most multivitamins have shockingly low levels of vitamin D3. So even if you are taking a good whole-food multivitamin, you’ll most likely need to add some D3, unless you get time outside without sunscreen every day. And even though my multivitamin provides a good baseline, I still find that I need to supplement with an additional 1,000-2,000 IUs of vitamin D3 during the long New England winters. Unless you are in a warm weather climate, you probably will too.

If you haven’t read my full article on vitamin D, you should check it out. Before we leave the topic of supplements, I want briefly mention three other supplements that did not make my top five list that you may want to consider: collagen, probiotics and DIM.

Collagen

If you read my article on bone health, you know how important collagen is to avoiding bone fractures. You can and should get your collagen from eating good collagen-rich foods like dark green leafy vegetables. But if you find—like many—that you may not be eating enough collagen and you are not taking a good whole-food multivitamin, you may want to consider collagen supplementation.

As I shared in an earlier article, in order to maintain my weight and to prevent blood sugar issues, I try to eat small amounts of protein, healthy fats (omegas 3s) and fiber at every meal or snack. If I am ever in a situation where I am not consuming protein, I will take a collagen supplement (and a fiber or omega 3 supplement if needed) for balance. While not nearly as good as eating the right foods, in a pinch, it’s better than taking in carbohydrates (sugar) without any having protein to balance it out since carbs ingested without a protein counterbalance are stored as fat in the body.

Probiotics/Digestive Enzymes

We’ve all heard of antibiotics: They kill off or inhibit the growth of bacteria. But antibiotics also kill off the healthy bacteria in our digestive tract and inhibit our ability to digest food and to absorb nutrients. Probiotics contain the beneficial flora that your digestive system needs and digestive enzymes that work in your stomach to help break down foods. Both can be damaged by illness, poor diet and antibiotics, so if you have experienced any of those and have not taken a course of probiotics and enzymes afterward, your digestive system is likely not operating at top capacity.

Probiotics and digestive enzymes are also a must if you have digestive concerns such as cramps, constipation, diarrhea, gas or bloating or Irritable Bowel Syndrome. If you struggle with allergies or asthma, food sensitivities such as sugar or gluten, yeast infections or urinary tract infections, rosacea, acne or skin conditions, headaches or migraines, chronic bad breath (halitosis), PMS or hormonal imbalance, or achy joints, you should consider probiotic supplementation.

Depending on how long and how strong your course of antibiotics was, or how severe your digestive concerns are and what your diet is like (if it is very acidic), you may want to stay on probiotics for a while to ensure balance is restored and maintained. At a minimum, you’ll want to take probiotics and digestive enzymes while taking antibiotics and for several weeks afterward. A two to three month supplementation cycle is great for restoring balance and digestive health after any significant stress to your digestive system. Eating yogurt can help, but your body most likely needs more help than yogurt alone can provide.

Even if you haven’t had antibiotics lately or faced a digestive health concern, your system could still be imbalanced from a concern long ago. Probiotics can help restore balance if you have a heavily acidic diet that promotes yeast and causes other imbalances in your digestive pathway. I recommend a month (or two) of probiotic and digestive enzyme supplementation every year to help ensure your digestive system has everything it needs to maximize the nutrient absorption of the food you are eating.

There are many different probiotic strains and each works differently in the body, so you may need to experiment with more than one brand to find the right one. If you are facing a specific issue, research your condition to find the best strains. The right probiotic should make a difference within the first week or two. If you don’t see improvement after two weeks, try another brand with different strains of bacteria. If you are just looking to restore balance annually with no specific concerns, choose a highly rated probiotic that has bifidobacteria and lactobacillus acidophilus in the billions.

DIM or Diindolylmethane

Diindolylmethane, or DIM, promotes healthy hormonal balance through beneficial estrogen metabolism. DIM is a naturally occurring phytonutrient found in cruciferous vegetables (like broccoli, cabbage or collards), which we know are good for us, but do not eat nearly enough of. DIM can balance estrogen by blocking “bad” estrogen and promoting good or beneficial estrogen in our bodies.

For women, healthy estrogen metabolism prevents breast, cervical and uterine cancers; for men, it is required for prostate health. (Men, you have estrogen in your bodies and are exposed to it in foods and the environment as well, so it’s just as important for you!) We are going to be talking more about DIM and prostrate health in Friday’s issue.

Not everyone needs DIM, so it didn’t make my top five list. But if you’re concerned about hormonal balance, fibers, tumors or reproductive cancers or prostate health, DIM is a supplement you should consider taking daily. (I found it quiets my hot flashes.) Generally speaking, unless cancer runs in your family, you are perimenopausal and/or you are already struggling with reproductive issues like fibroids or hysterectomy, it’s something you can wait to take until you’re in your 50s.

Research has shown that most DIM supplements cannot be absorbed; they require microencapsulation. Only one company, BioResponse, has a patented microencapsulation with extended release naoparticles, ensuring predictable absorption. This company is the only brand being used in all the published clinical trials, including those sponsored by the National Cancer Institute, so it’s the one I take and recommend.

To your health!

Inger Pols
Editor of New England Health Advisory

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By Inger Pols

This is part three of a five-part series on the five supplements I think every adult should take. Earlier this week, I sent you parts one and two, which focused on whole-food based multivitamins and ubiquinol. You can read them by clicking here.

Fiber is commonly known for keeping people regular, but did you know that it also helps prevent heart disease and Type 2 diabetes? Fiber is best delivered naturally by eating plant foods, grains and legumes, but most of us don’t eat enough fiber and are deficient in this vital nutrient. It’s not only important to eat enough fiber, but to eat it at the right time as well.

Fiber is a carbohydrate that our body does not digest or absorb. Fat, protein and other types of carbohydrates are broken down and then absorbed, fiber passes through your stomach, small intestine, colon and ultimately out of your body, intact. There are two kinds of fiber necessary for healthy digestion: Soluble, which means it dissolves at least partially in water, and insoluble, which does not dissolve in water.

Insoluble fiber helps with movement through the digestive system. It also increases stool bulk and can assist with regularity. Wheat bran, nuts, vegetables and whole-wheat flour are some sources of insoluble fiber. Soluble fiber dissolves into a gel-like material and helps to lower blood cholesterol and glucose levels. Carrots, peas, beans, apples, citrus fruits, oats, barley and psyllium are examples of soluble fiber sources.

Fiber helps with regular bowel movements and in maintaining bowel health. Some evidence suggests that a high fiber diet can lower the risk of developing hemorrhoids and diverticular disease (when small pouches develop in your colon).

But fiber does more than just keep us regular, it also helps with weight loss and weight maintenance. It slows the absorption of sugar, which helps control blood sugar levels for those with diabetes and has been shown to reduce the risk of developing Type 2 diabetes. Fiber also helps with heart health by lowering cholesterol levels, reducing inflammation and lowering blood pressure.

With all these great benefits, fiber is definitely something we should get more of. But many experts say we are a fiber-deprived nation. According to the National Academy of Sciences’ Institute of Medicine, men under age 50 need at least 38 grams of fiber a day and women of the same age need at least 25 grams. Men over age 50 need at least 30 grams a day, and women need 21. It’s important to note that recommendations are tied to overall caloric intake, so if your daily calorie intake is higher, you need more fiber. And overall, according to the Harvard School of Public Health, more fiber is better.

The typical American consumes 15 grams of fiber a day or less, so most of us have some catching up to do on our fiber consumption. Fiber levels vary significantly by food source, so it’s important to look at what you’re eating to assess how much more fiber you need to consume. Refined or processed foods have little fiber content because the process of grain refinement strips the outer coat or the bran from the grain. Taking the skin off fruits or vegetables will also yield less fiber.

Studies show that whole-grain cereal fibers such as wheat and oat bran have good amounts of fiber, but there’s less research seen on vegetables because it’s easier to brand an oatmeal product than a banana. We often think of bread or whole wheat as a good fiber source, but one slice of whole-wheat/whole-grain bread has only 1.9 grams of fiber, while whole-wheat spaghetti brings in 6.2 grams per cup.

A medium banana or orange yields about 3 grams of fiber, while a cup of raspberries contains 8 grams. A medium carrot contains 1.7 grams and an ounce of almonds (about 23 nuts) contains 3.5 grams. But the real bounty lies in vegetables and beans. A cup of peas comes in at 8.8 grams, a medium artichoke at 10.3 grams, a cup of black beans has 15 grams, lentils 15.6 grams and a cup of split peas packs 16.3 grams of fiber.

In addition to making sure you’re getting the correct overall level of fiber, it’s important to consume fiber with every meal to balance blood sugar levels and to inhibit weight gain. This occurs in several ways: Fibrous foods take more time to chew and so allow time for the signal to reach your brain indicating you are full and should stop eating. Fiber rich foods also tend to make you feel fuller longer, so you eat less.

Fibrous foods tend to have fewer calories by volume than non-fiber rich foods, so eating the same portion size of a food rich in fiber will likely mean you’re eating fewer calories than in a low fiber food. Any time you eat food with high sugar content in isolation, it’s more likely to be stored directly as fat than if it is eaten in the context of a balanced meal. If you eat on the run a lot and find it hard to eat fresh vegetables or beans with your meal, keep a fiber supplement handy and take it with your meal.

It’s important to keep in mind that some of the fiber sources listed above are also high in sugar content. Bread and pasta—even whole-wheat versions—are higher on the glycemic index, as are many fruits and even a few vegetables, meaning they will raise blood sugar level. While they are certainly better than empty calorie processed foods, it’s better to focus more on beans and vegetables, particularly green vegetables, as fiber sources. If you do eat a lot of bread or fruit, try consuming them in combination with vegetables, beans or a fiber supplement.

In America, we often drink our meals, whether it’s a smoothie, a rich coffee drink or alcohol, all of which are high in sugar content. If you’re having a liquid meal or drinking anything with high sugar content without an accompanying meal rich in fiber, you should take a fiber supplement along with your beverage to mitigate blood sugar spikes and to inhibit that sugar from being stored in your body as fat.

Every time I eat a meal or snack, or drink anything with sugar, I either eat or take in supplement form a small amount of protein, fiber and healthy fat, like omega-3s. I also keep extra fiber handy to supplement anytime I eat something not fiber rich. Ensuring that my body has that healthy combination of protein, fat and fiber helps manage blood sugar, keep hormones balanced, and maintain my weight, even if I indulge.

When possible, try to eat a diet rich in fiber from a variety of sources. We tend to eat the same foods over and over again—our go-to favorites—but variety in type and source of fiber, as with all nutrients, is important. So mix it up, but also supplement as needed with capsules or powder containing both soluble and insoluble fiber to ensure your meals and snacks are balanced.

Fiber pills are handy to take when away from home and easy to swallow along with whatever liquid you are consuming. I prefer fiber in pill form, as I can take my base dose in the morning with my other supplements and have additional pills on hand for any time my meal or snack is imbalanced.

Powder forms are another option, as they are readily available, inexpensive and they work fine when you mix them into a smoothie or a liquid you are already drinking.

One caveat: When increasing fiber consumption, do so gradually over the course of several weeks as overloading your body too rapidly can cause gastrointestinal distress. And to be most effective, fiber needs water, so be sure you adequately hydrate as you increase your fiber intake.

To your health!

Inger Pols
Editor of New England Health Advisory