What is papaya

The papaya (Carica papaya L.) also called papaw or pawpaw, is a tropical fruit tree, one of the 22 accepted species in the genus Carica of the family Caricaceae ¹. Its origin is in the tropics of the Americas, perhaps from southern Mexico and neighboring Central America.

Commonly and erroneously referred to as a “tree”, the papaya plant is properly a large herb growing at the rate of 6 to 10 ft (1.8-3 m) the first year and reaching 20 or even 30 ft (6-9 m) in height, with a hollow green or deep-purple stem becoming 12 to 16 in (30-40 cm) or more thick at the base and roughened by leaf scars. The leaves emerge directly from the upper part of the stem in a spiral on nearly horizontal petioles 1 to 3 1/2 ft (30-105 cm) long, hollow, succulent, green or more or less dark purple. The blade, deeply divided into 5 to 9 main segments, each irregularly subdivided, varies from 1 to 2 ft (30-60 cm) in width and has prominent yellowish ribs and veins. The life of a leaf is 4 to 6 months. Both the stem and leaves contain copious white milky latex.

Generally, the papaya fruit is melon-like, oval to nearly round, somewhat pyriform, or elongated club-shaped, 6 to 20 in (15-50 cm) long and 4 to 8 in (10-20 cm) thick; weighing up to 20 lbs (9 kg). Semi-wild (naturalized) plants bear miniature fruits 1 to 6 in (2.5-15 cm) long. The skin is waxy and thin but fairly tough. When the fruit is green and hard it is rich in white latex. As it ripens, it becomes light- or deep-yellow externally and the thick wall of succulent flesh becomes aromatic, yellow, orange or various shades of salmon or red. It is then juicy, sweetish and somewhat like a cantaloupe in flavor; in some types quite musky. Attached lightly to the wall by soft, white, fibrous tissue, are usually numerous small, black, ovoid, corrugated, peppery seeds about 3/16 in (5 mm) long, each coated with a transparent, gelatinous aril.

Figure 1. Papaya fruit

How to eat papaya

Ripe papayas are most commonly eaten fresh, merely peeled, seeded, cut in wedges and served with a half or quarter of lime or lemon. Sometimes a few seeds are left attached for those who enjoy their peppery flavor but not many should be eaten. The flesh is often cubed or shaped into balls and served in fruit salad or fruit cup. Firm-ripe papaya may be seasoned and baked for consumption as a vegetable. Ripe flesh is commonly made into sauce for shortcake or ice cream sundaes, or is added to ice cream just before freezing; or is cooked in pie, pickled, or preserved as marmalade or jam. Papaya and pineapple cubes, covered with sugar sirup, may be quick-frozen for later serving as dessert. Half-ripe fruits are sliced and crystallized as a sweetmeat.

Papaya juice and nectar may be prepared from peeled or unpeeled fruit and are sold fresh in bottles or canned. In Hawaii, papayas are reduced to puree with sucrose added to retard gelling and the puree is frozen for later use locally or in mainland USA in fruit juice blending or for making jam.

Unripe papaya is never eaten raw because of its latex content. [Raw green papaya is frequently used in Thai and Vietnamese cooking.] Even for use in salads, it must first be peeled, seeded, and boiled until tender, then chilled. Green papaya is frequently boiled and served as a vegetable. Cubed green papaya is cooked in mixed vegetable soup. Green papaya is commonly canned in sugar sirup in Puerto Rico for local consumption and for export. Green papayas for canning in Queensland must be checked for nitrate levels. High nitrate content causes detinning of ordinary cans, and all papayas with over 30 ppm nitrate must be packed in cans lacquered on the inside. Australian growers are hopeful that the papaya can be bred for low nitrate uptake.

Young leaves are cooked and eaten like spinach in the East Indies. Mature leaves are bitter and must be boiled with a change of water to eliminate much of the bitterness. Papaya leaves contain the bitter alkaloids, carpaine and pseudocarpaine, which act on the heart and respiration like digitalis, but are destroyed by heat. In addition, two previously undiscovered major D1-piperideine alkaloids, dehydrocarpaine I and II, more potent than carpaine, were reported from the University of Hawaii in 1979. Sprays of male flowers are sold in Asian and Indonesian markets and in New Guinea for boiling with several changes of water to remove bitterness and then eating as a vegetable. In Indonesia, the flowers are sometimes candied. Young stems are cooked and served in Africa. Older stems, after peeling, are grated, the bitter juice squeezed out, and the mash mixed with sugar and salt.

In India, papaya seeds are sometimes found as an adulterant of whole black pepper. Collaborating chemists in Italy and Somalia identified 18 amino acids in papaya seeds, principally, in descending order of abundance, glutamic acid, arginine, proline, and aspartic acid in the endosperm; and proline, tyrosine, lysine, aspartic acid, and glutamic acid in the sarcotesta. A yellow to brown, faintly scented oil was extracted from the sundried, powdered seeds of unripe papayas at the Central Food Technological Research Institute, Mysore, India. White seeds yielded 16.1% and black seeds 26.8% and it was suggested that the oil might have edible and industrial uses.

Papaya nutrition facts

Raw papaya pulp contains 88% water, 11% carbohydrates, and negligible fat and protein. In a 100 gram amount, papaya fruit provides 43 kilocalories. The papaya is regarded as a fair source of iron and calcium; a good source of vitamins A, B and G and an excellent source of vitamin C (ascorbic acid) (75% of the Daily Value, DV) and a moderate source of folate (10% DV).

Table 1. Papaya (raw) nutrition facts

Nutrient	Unit	Value per 100 g
Approximates
Water	g	88.06
Energy	kcal	43
Energy	kJ	179
Protein	g	0.47
Total lipid (fat)	g	0.26
Ash	g	0.39
Carbohydrate, by difference	g	10.82
Fiber, total dietary	g	1.7
Sugars, total	g	7.82
Sucrose	g	0
Glucose (dextrose)	g	4.09
Fructose	g	3.73
Lactose	g	0
Maltose	g	0
Galactose	g	0
Starch	g	0
Minerals
Calcium, Ca	mg	20
Iron, Fe	mg	0.25
Magnesium, Mg	mg	21
Phosphorus, P	mg	10
Potassium, K	mg	182
Sodium, Na	mg	8
Zinc, Zn	mg	0.08
Copper, Cu	mg	0.045
Manganese, Mn	mg	0.04
Selenium, Se	µg	0.6
Vitamins
Vitamin C, total ascorbic acid	mg	60.9
Thiamin	mg	0.023
Riboflavin	mg	0.027
Niacin	mg	0.357
Pantothenic acid	mg	0.191
Vitamin B-6	mg	0.038
Folate, total	µg	37
Folic acid	µg	0
Folate, food	µg	37
Folate, DFE	µg	37
Choline, total	mg	6.1
Vitamin B-12	µg	0
Vitamin B-12, added	µg	0
Vitamin A, RAE	µg	47
Retinol	µg	0
Carotene, beta	µg	274
Carotene, alpha	µg	2
Cryptoxanthin, beta	µg	589
Vitamin A, IU	IU	950
Lycopene	µg	1828
Lutein + zeaxanthin	µg	89
Vitamin E (alpha-tocopherol)	mg	0.3
Vitamin E, added	mg	0
Tocopherol, beta	mg	0.02
Tocopherol, gamma	mg	0.09
Tocopherol, delta	mg	0.01
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Vitamin K (phylloquinone)	µg	2.6
Lipids
Fatty acids, total saturated	g	0.081
04:00:00	g	0
06:00:00	g	0
08:00:00	g	0
10:00:00	g	0
12:00:00	g	0.002
14:00:00	g	0.013
16:00:00	g	0.06
18:00:00	g	0.004
Fatty acids, total monounsaturated	g	0.072
16:1 undifferentiated	g	0.038
18:1 undifferentiated	g	0.034
20:01:00	g	0
22:1 undifferentiated	g	0
Fatty acids, total polyunsaturated	g	0.058
18:2 undifferentiated	g	0.011
18:3 undifferentiated	g	0.047
18:04:00	g	0
20:4 undifferentiated	g	0
20:5 n-3 (EPA)	g	0
22:5 n-3 (DPA)	g	0
22:6 n-3 (DHA)	g	0
Fatty acids, total trans	g	0
Cholesterol	mg	0
Amino Acids
Tryptophan	g	0.008
Threonine	g	0.011
Isoleucine	g	0.008
Leucine	g	0.016
Lysine	g	0.025
Methionine	g	0.002
Phenylalanine	g	0.009
Tyrosine	g	0.005
Valine	g	0.01
Arginine	g	0.01
Histidine	g	0.005
Alanine	g	0.014
Aspartic acid	g	0.049
Glutamic acid	g	0.033
Glycine	g	0.018
Proline	g	0.01
Serine	g	0.015
Other
Alcohol, ethyl	g	0
Caffeine	mg	0
Theobromine	mg	0
Flavones
Apigenin	mg	0
Luteolin	mg	0
Flavonols
Kaempferol	mg	0
Myricetin	mg	0
Quercetin	mg	0
Isoflavones
Daidzein	mg	0
Genistein	mg	0
Total isoflavones	mg	0

[Source ²]

Papaya enzyme

Papain

The latex of the papaya plant and its green fruits contains two proteolytic enzymes, papain and chymopapain ¹. The latter is most abundant but papain is twice as potent. In 1933, Ceylon (Sri Lanka) was the leading commercial source of papain but it has been surpassed by East Africa where large-scale production began in 1937.

The latex is obtained by making incisions on the surface of the green fruits early in the morning and repeating every 4 or 5 days until the latex ceases to flow. The tool is of bone, glass, sharp-edged bamboo or stainless steel (knife or raxor blade). Ordinary steel stains the latex. The latex coagulates quickly and for best results, is spread on fabric and oven-dried at a low temperature, then ground to powder and packed in tins. Sun-drying tends to discolor the product. One must tap 1,500 average-size fruits to gain 1 1/2 lbs (0.68 kg) of papain.

The lanced fruits may be allowed to ripen and can be eaten locally, or they can be employed for making dried papaya “leather” or powdered papaya, or may be utilized as a source of pectin.

Because of its papain content, a piece of green papaya can be rubbed on a portion of tough meat to tenderize it. Sometimes a chunk of green papaya is cooked with meat for the same purpose.

One of the best known uses of papain is in commercial products marketed as meat tenderizers, especially for home use. A modern development is the injection of papain into beef cattle a half-hour before slaughtering to tenderize more of the meat than would normally be tender. Papain-treated meat should never be eaten “rare” but should be cooked sufficiently to inactivate the enzyme. The tongue, liver and kidneys of injected animals must be consumed quickly after cooking or utilized immediately in food or feed products, as they are highly perishable.

Papain has many other practical applications. It is used to clarify beer, also to treat wool and silk before dyeing, to de-hair hides before tanning, and it serves as an adjunct in rubber manufacturing. It is applied on tuna liver before extraction of the oil which is thereby made richer in vitamins A and D. Papain is also used in toothpastes, cosmetics and detergents, as well as pharmaceutical preparations to aid digestion.

Papain has been employed to treat ulcers, dissolve membranes in diphtheria, and reduce swelling, fever and adhesions after surgery. With considerable risk, it has been applied on meat impacted in the gullet. Chemopapain is sometimes injected in cases of slipped spinal discs or pinched nerves. Precautions should be taken because some individuals are allergic to papain in any form and even to meat tenderized with papain.

Papaya health benefits

Papaya has high antioxidant activity ³ and rich in phytochemicals such as flavonoids – quercetin, followed by myricetin and kaempferol (1264.0 mg/kg) ⁴. Different plant parts such as fruit, leaf, seed, root, bark, and flowers have been used as health treatments in tropical countries where it is grown. The seeds of papaya, however, have contraceptive effect on male fertility as well as manifest antifertility, anti-implantation, and abortifacient activity in female rats ⁵ suggesting a possibility to alter sex hormone levels.

Recent studies have shown papaya beneficial effect as an anti-inflammatory agent ⁶, for its wound healing properties ⁷, antitumour as well as immune-modulatory effects ⁸ and as an antioxidant ⁹. A toxicity study (acute, subacute, and chronic toxicity) conducted on Sprague Dawley rats administered with papaya leaves juice of the sekaki variant revealed that it was safe for oral consumption ¹⁰.

The papaya leaf extract/concentrate has been scientifically investigated for pharmacological properties such as anti-microbial, anti-parasitic (antimalarial) activity, anti-cancer, anti-inflammatory and membrane stabilization properties ¹¹. In Sri Lankan traditional medicine the leaf juice of papaya is claimed as a powerful remedy for modulating the immune system. Thus far several in vitro and in vivo experiments have been carried out to investigate the immuno pharmacological properties of the leaf concentrate of papaya. Dharmarathna et al. ¹² observed a marked platelet count elevation in non-thrombocytopenic mice following the oral treatment of papaya extract for seven days. Another study conducted using non thrombocytopenic rats reported a marked increment in platelet counts, mean cell haemoglobin (MCH) and mean corpuscular volume (MCV) following the oral treatment with this leaf formulation for 7 days ¹³. In addition to animal experimentation, the platelet increasing activity of papaya leaf extract has been validated in thrombocytopenia associated dengue patients. An open labeled randomized controlled trial carried out with 228 patients (Treatment = 111, Control = 117) with dengue fever and dengue haemorrhagic fever revealed a significant increase of platelet counts after 40 and 48 hours of oral administration of papaya leaf juice for 3 consecutive days ¹⁴. A pilot study reported an increase of platelet and WBC (white blood cell) counts of dengue patients after 24 h of administration of papaya leaf juice and patients recovered without hospital admission ¹⁵. A similar effect was also observed in an open labeled randomized controlled trial with 30 dengue patients treated with a tablet (Caripill) prepared from papaya leaf extract ¹⁶; A significant increase of platelet counts was observed following oral treatment with this tablet three times daily for five days and exerted fewer side effects and good tolerability. Increase of both platelets and white blood cells (WBCs) were consistent with previous studies established with non-thrombocytopenic ¹², ¹³ as well as thrombocytopenic mice models ¹⁷, ¹⁸. These finding supports the claim that the papaya leaves juice consumption during the course of dengue infection has the potential to induce the rapid production of platelets ¹⁹, which was clearly demonstrated that papaya leaf concentrate may be a potential candidate for further research for treating low blood platelets (thrombocytopenia). However, currently, it is also necessary not to rely entirely on the leaf extract and ignore standard treatment for dengue until the benefits are established. Large scale randomized clinical trials in dengue-confirmed patients is necessary to establish their usefulness ²⁰.

Several test tube studies ²¹, ²² have attributed anti-cancer activities to papaya pectins (the branch of arabinogalactan type II (AGII) structure) ²³.

The papaya seeds had a high content of lipid (29.16%) and protein (25.63%). The lipid in the papaya seeds is considered economically attractive for industrial extraction, especially when compared to conventional oilseed crops such as corn and soybean ²⁴. Traditionally, papaya seeds were used in parts of Asia and South America as a vermifugal (an anthelmintic medicine) ²⁵ and seed preparations were also used in folk medicine due to its abortive properties to favor a good menstrual flow ²⁶. In recent years, many studies have been conducted to utilize the papaya seeds and extensive research has been carried out on the use of the seeds as a source of oil ²⁷, ²⁸, ²⁹, It was reported that the papaya seed oil had an interesting composition (72% of monounsaturated fatty acids with 71% oleic acid) and hence representing a promising source of oleic oil for various applications ³⁰. Furthermore, the papaya seed extract has been pronounced with some special functions such as antibacterial ³¹, anti-fertility ³², ³³, antihelminthic and antiamoebic ³⁴ activities. Previous studies have discovered many bioactive compounds existed in papaya seeds ³⁵, including substantial amounts of carotenoid pigments, isothiocyanate and phenolic compounds ²⁸.

In tropical folk medicine, the fresh latex is smeared on boils, warts and freckles and given as a vermifuge (an anthelmintic medicine). In India, it is applied on the uterus as an irritant to cause abortion. The unripe fruit is sometimes hazardously ingested to achieve abortion. Seeds, too, may bring on abortion. They are often taken as an emmenagogue and given as a vermifuge. The root is ground to a paste with salt, diluted with water and given as an enema to induce abortion. A root decoction is claimed to expel roundworms. Roots are also used to make salt.

Crushed leaves wrapped around tough meat will tenderize it overnight. The leaf also functions as a vermifuge and as a primitive soap substitute in laundering. Dried leaves have been smoked to relieve asthma or as a tobacco substitute. Packages of dried, pulverized leaves are sold by “health food” stores for making tea, despite the fact that the leaf decoction is administered as a purgative for horses in Ghana and in the Ivory Coast it is a treatment for genito-urinary ailments. The dried leaf infusion is taken for stomach troubles in Ghana and they say it is purgative and may cause abortion.

Papaya Allergy

Report has already been made of skin irritation in papaya harvesters because of the action of fresh papaya latex and of the possible hazard of consuming undercooked meat tenderized with papain. It must be added that the pollen of papaya flowers has induced severe respiratory reactions in sensitive individuals. Thereafter, such people react to contact with any part of the plant and to eating ripe papaya or any food containing papaya, or meat tenderized with papain.

References

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What is cantaloupe

Cantaloupe (Cucumis melo species in the Cucurbitaceae family) also known as muskmelon (India and the United States), mushmelon, rockmelon, sweet melon, or spanspek (South Africa) ¹. Cantaloupes range in weight from 0.5 to 5 kilograms (1 to 11 lb). Originally, cantaloupe referred only to the non-netted, orange-fleshed melons of Europe. However, in more recent usage it has come to mean any orange-fleshed melon of Cucumis melo, and has become the most popular melon in North America.

Cantaloupe is normally eaten as a fresh fruit, as a salad, or as a dessert with ice cream or custard. Melon pieces wrapped in prosciutto are a familiar antipasto.

Because the surface of a cantaloupe can contain harmful bacteria—in particular, Salmonella ², it is recommended to wash and scrub a melon thoroughly before cutting and consumption. The fruit should be refrigerated after cutting it and consumed in less than three days to prevent risk of Salmonella or other bacterial pathogens.

Phytochemical analysis of cantaloupe showed the presence of flavonoids, phenols and saponins ³. These phytochemical constituents present in the hydro-methanol extract of cantaloupe seeds and the exact mechanism need to be evaluated.

Figure 1. Cantaloupe

Cantaloupe nutrition facts

Raw cantaloupe is 90% water, 8% carbohydrates, 0.8% protein and 0.3% fat, providing 140 kJ (34 kcal) and 2020 μg of the provitamin A orange carotenoid, beta-carotene per 100 grams. Fresh cantaloupe is a rich source (20% or more of the Daily Value or DV) of vitamin C (44% DV) and vitamin A (21% DV), with other nutrients in negligible amounts (less than 10% DV).

Table 1. Cantaloupe (raw) nutrition facts

Nutrient	Unit		Value per 100 g
Approximates
Water	g		90.15
Energy	kcal		34
Energy	kJ		141
Protein	g		0.84
Total lipid (fat)	g		0.19
Ash	g		0.65
Carbohydrate, by difference	g		8.16
Fiber, total dietary	g		0.9
Sugars, total	g		7.86
Sucrose	g		4.35
Glucose (dextrose)	g		1.54
Fructose	g		1.87
Lactose	g		0
Maltose	g		0.04
Galactose	g		0.06
Starch	g		0.03
Minerals
Calcium, Ca	mg		9
Iron, Fe	mg		0.21
Magnesium, Mg	mg		12
Phosphorus, P	mg		15
Potassium, K	mg		267
Sodium, Na	mg		16
Zinc, Zn	mg		0.18
Copper, Cu	mg		0.041
Manganese, Mn	mg		0.041
Selenium, Se	µg		0.4
Fluoride, F	µg		1
Vitamins
Vitamin C, total ascorbic acid	mg		36.7
Thiamin	mg		0.041
Riboflavin	mg		0.019
Niacin	mg		0.734
Pantothenic acid	mg		0.105
Vitamin B-6	mg		0.072
Folate, total	µg		21
Folic acid	µg		0
Folate, food	µg		21
Folate, DFE	µg		21
Choline, total	mg		7.6
Betaine	mg		0.1
Vitamin B-12	µg		0
Vitamin B-12, added	µg		0
Vitamin A, RAE	µg		169
Retinol	µg		0
Carotene, beta	µg		2020
Carotene, alpha	µg		16
Cryptoxanthin, beta	µg		1
Vitamin A, IU	IU		3382
Lycopene	µg		0
Lutein + zeaxanthin	µg		26
Vitamin E (alpha-tocopherol)	mg		0.05
Vitamin E, added	mg		0
Tocopherol, beta	mg		0
Tocopherol, gamma	mg		0.11
Tocopherol, delta	mg		0
Vitamin D (D2 + D3)	µg		0
Vitamin D	IU		0
Vitamin K (phylloquinone)	µg		2.5
Lipids
Fatty acids, total saturated	g		0.051
04:00:00	g		0
06:00:00	g		0
08:00:00	g		0
10:00:00	g		0
12:00:00	g		0.001
14:00:00	g		0.001
16:00:00	g		0.043
18:00:00	g		0.005
Fatty acids, total monounsaturated	g		0.003
16:1 undifferentiated	g		0
18:1 undifferentiated	g		0.003
20:01:00	g		0
22:1 undifferentiated	g		0
Fatty acids, total polyunsaturated	g		0.081
18:2 undifferentiated	g		0.035
18:3 undifferentiated	g		0.046
18:04:00	g		0
20:4 undifferentiated	g		0
20:5 n-3 (EPA)	g		0
22:5 n-3 (DPA)	g		0
22:6 n-3 (DHA)	g		0
Fatty acids, total trans	g		0
Cholesterol	mg		0
Phytosterols	mg		10
Amino Acids
Tryptophan	g		0.002
Threonine	g		0.017
Isoleucine	g		0.021
Leucine	g		0.029
Lysine	g		0.03
Methionine	g		0.012
Cystine	g		0.002
Phenylalanine	g		0.023
Tyrosine	g		0.014
Valine	g		0.033
Arginine	g		0.029
Histidine	g		0.015
Alanine	g		0.095
Aspartic acid	g		0.136
Glutamic acid	g		0.209
Glycine	g		0.026
Proline	g		0.019
Serine	g		0.042
Other
Alcohol, ethyl	g		0
Caffeine	mg		0
Theobromine	mg		0
Anthocyanidins
Cyanidin	mg		0
Petunidin	mg		0
Delphinidin	mg		0
Malvidin	mg		0
Pelargonidin	mg		0
Peonidin	mg		0
Flavan-3-ols
(+)-Catechin	mg		0
(-)-Epigallocatechin	mg		0
(-)-Epicatechin	mg		0
(-)-Epicatechin 3-gallate	mg		0
(-)-Epigallocatechin 3-gallate	mg		0
(+)-Gallocatechin	mg		0
Flavanones
Hesperetin	mg		0
Naringenin	mg		0
Flavones
Apigenin	mg		0
Luteolin	mg		0.6
Flavonols
Kaempferol	mg		0.1
Myricetin	mg		0
Quercetin	mg		0
Isoflavones
Daidzein	mg		0
Genistein	mg		0
Glycitein	mg		0
Total isoflavones	mg		0
Formononetin	mg		0
Coumestrol	mg		0
Proanthocyanidin
Proanthocyanidin dimers	mg		0
Proanthocyanidin trimers	mg		0
Proanthocyanidin 4-6mers	mg		0
Proanthocyanidin 7-10mers	mg		0
Proanthocyanidin polymers (>10mers)	mg		0

[Source ⁴] References

1. Gur A, Tzuri G, Meir A, et al. Genome-Wide Linkage-Disequilibrium Mapping to the Candidate Gene Level in Melon (Cucumis melo). Scientific Reports. 2017;7:9770. doi:10.1038/s41598-017-09987-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575340/
2. A multi-state outbreak of Salmonella Saintpaul in Australia associated with cantaloupe consumption. Epidemiol Infect. 2009 Mar;137(3):367-74. doi: 10.1017/S0950268808000861. Epub 2009 Feb 9. https://www.cambridge.org/core/journals/epidemiology-and-infection/article/multistate-outbreak-of-salmonella-saintpaul-in-australia-associated-with-cantaloupe-consumption/7E3C7974D27F3D711D7E27BF87F444BB
3. Antipyretic effects of hydro-methanol extract of Melia azedarach Linn. seeds and Cucumis melo Linn. seeds in experimental rabbits. Pak J Pharm Sci. 2017 Jul;30(4):1257-1261. https://www.ncbi.nlm.nih.gov/pubmed/29039323
4. United States Department of Agriculture Agricultural Research Service. National Nutrient Database for Standard Reference Release 28. https://ndb.nal.usda.gov/ndb/search/list

Is coconut milk good for you

One of the main arguments put forward by those who support coconut oil (coconut milk) is that the saturated fat in coconut oil behaves differently to typical saturated fats, preventing any negative effects on health. The evidence states it’s not that simple. In fact, a recent report from the American Heart Association ¹, based on a recent review of clinical trials, advises against using coconut oil due to its high saturated fat content. Saturated fats tend to increase your LDL (unhealthy) cholesterol in the blood and should be eaten sparingly to minimize your risk of developing heart disease.

Coconut milk is particularly high in one type of saturated fatty acid (the building blocks of fats) called lauric acid. This type of fatty acid tends to mimic healthy unsaturated fats by boosting HDL (good) cholesterol. This may make it less concerning than other saturated fats. However, studies show that with the consumption of coconut oil, whilst healthy HDL cholesterol levels appear to rise, so too does total cholesterol and unhealthy LDL cholesterol in the blood ².

Overall, the current evidence shows that coconut oil simply does not stack up against healthy unsaturated fats (like those found in olive oil or canola oil) that lower the bad stuff whilst increasing the good stuff too.

It is also important to remember that you need to look at the whole diet for the prevention of disease. Your body’s systems are complex and require a range of different nutrients for optimal health. Your time is better spent enjoying a varied and full diet of whole foods, fruits, vegetables, legumes, grain-based foods, nuts, lean meats, fish and reduced-fat dairy, rather than focusing on a select set of so called ‘superfoods’ to boost your health. Remember, no one food provides all the nutrients you need.

What is coconut milk

Coconut milk is the liquid that comes from the grated meat of a mature coconut. The opacity and rich taste of coconut milk are attributed to its high oil content, most of which is saturated fat (see Tables 1, 2 and 3 below). Coconut milk is a common ingredient in many tropical and Asian cuisines for curries or other seasonings, meats, vegetables, garnishes, or desserts. Coconut rice is a rice cooked in coconut milk consumed in Southeastern Asia and the Caribbean. Nasi lemak is a Malaysian version of coconut rice, while the same dish is called nasi uduk in Indonesia. Coconut milk is also used throughout Asia for making traditional serabi, an Asian style pancake.

In Southeast Asia, coconut milk is used to make many traditional drinks. Cendol is a popular iced drink from this region containing chilled coconut milk and green jellies made of rice flour. Coconut milk is also used in hot drinks, such as bandrek and bajiguar, two popular drinks from Indonesia. Sweetened coconut milk and coconut milk diluted with water are two popular coconut beverages in southern China and Taiwan. In Brazil, coconut milk is mixed with sugar and cachaça to make a cocktail called batida de côco. Puerto Rico is also popular for tropical drinks containing coconut, such as the piña colada, which typically contains coconut milk or coconut cream.

Coconut milk is traditionally made by grating the white inner flesh of a brown coconut and mixing the shredded coconut meat with a small amount of water in order to suspend the fat present in the grated meat. The grating process can be carried out manually or by comminution, a process that uses a more modern grating machine to facilitate the grating. Coconut milk exists in two grades: thick and thin. Thick coconut milk contains 20-22% fat while thin coconut milk contains 5-7% fat. Thick milk is prepared by directly squeezing grated coconut meat through cheesecloth. Thin milk is produced by soaking the squeezed coconut meat in water and further squeezing the meat until a thinner liquid forms. Thick milk contains soluble, suspended solids, which makes it a good ingredient for desserts and rich and dry sauces. Because thin milk does not contain these soluble solids, it is mainly used in general cooking. The distinction between thick and thin milk is not usually made in Western nations due to the fact that fresh coconut milk is uncommon in these countries and most consumers buy coconut milk in cartons or cans.

Coconut milk has a fat content of 24%, depending on the fat level of the coconut meat and the quantity of added water. When refrigerated and left to set, coconut cream will rise to the top and separate out from the milk. To avoid this in commercial coconut milk, an emulsifier and a stabilizer have to be used.

Canned coconut milk

Manufacturers of canned coconut milk typically combine diluted and comminuted milk with the addition of water as a filler. Depending on the brand and age of the milk itself, a thicker, more paste-like consistency floats to the top of the can and is sometimes separated and used in recipes that require coconut cream rather than coconut milk. Some brands sold in Western countries add thickening agents or emulsifiers to prevent the milk from separating inside the can.

Figure 1. Coconut milk

Is coconut milk healthy

The simple answer is NO due to its high levels of saturated fat. One of the most prominent components of coconut milk is coconut oil. Excessive coconut milk consumption can also raise your blood levels of cholesterol due to the amount of lauric acid, a saturated fat that contributes to higher blood cholesterol. Saturated fat can raise the levels of total cholesterol and low-density lipoprotein (LDL or “bad”) cholesterol in the blood — which, in turn, can increase your risk of developing cardiovascular disease. Cardiovascular disease is the leading cause of death in both men and women in the U.S.

There is currently not enough evidence to recommend you choose coconut oil over healthy fats such as olive or canola oils. Making the switch to coconut oil is likely to lead to less favorable blood fat profiles and potentially increase the risk of coronary heart disease.

Eating a lot of saturated fat can increase the levels of cholesterol in your blood. Having high cholesterol can increase your risk of heart disease, which includes heart attack and narrowed arteries (atherosclerosis). Because of this reason, many health organizations, such as the United States Food and Drug Administration ³, World Health Organization ⁴, International College of Nutrition ⁵, the United States Department of Health and Human Services ⁶, American Dietetic Association ⁷, American Heart Association ⁸, British National Health Service ⁹ and Dietitians of Canada ¹⁰, discourage people from consuming in significant amounts .

• The Dietary Guidelines for Americans ⁶ recommends consuming less than 10% of calories per day from saturated fat by replacing saturated fat with monounsaturated and polyunsaturated fats while staying within recommended limits for calories and total dietary fat.

Table 1. Maximum Daily Amounts of Saturated Fat To Consume To Keep Saturated Fat Below 10 Percent of Total Calorie Intake

Total Calorie Intake	Limit on Saturated Fat Intake
1,600	18 g or less
2,000*	20 g or less
2,200	24 g or less
2,500*	25 g or less
2,800	31 g or less

*Percent Daily Values on Nutrition Facts Labels are based on a 2,000-calorie diet. Values for 2,000 and 2,500 calories are rounded to the nearest 5 grams to be consistent with the Nutrition Facts Label.

[Source ⁶]

• Aim to consume less than 10% of total calories from saturated fat. For people who need to lower their cholesterol, the American Heart Association recommends reducing saturated fat to no more than 5 to 6 percent of total daily calories ¹¹.

Your body needs small amounts of fat to help it work normally. However, some types of fat are healthier than others. There are two main types of fats in food:

• saturated fat
• unsaturated fat

It’s a good idea to eat less saturated fat, or swap foods high in saturated fat for small amounts of foods containing unsaturated fats, to reduce the health risks linked with high cholesterol levels.

Which foods contain saturated fat ?

Foods that are high in saturated fat include:

• butter, lard and ghee (oil made from butter)
• fatty meats and meat products, such as sausages and pies
• full-fat milk
• cream, sour cream, crème fraîche and ice cream
• cheese, particularly hard cheese
• some savory snacks, such as pork scratchings
• coconut oil, coconut cream and palm oil
• biscuits, cakes and pastries
• chocolates and some sweets

Eating less saturated fat

If you eat lots of foods high in saturated fat, it’s a good idea to eat them less often or have smaller amounts of them.

Below are some tips to help you include less fat and less fatty foods in your diet:

• Choose lean meat or skinless poultry instead of fatty meat or meat products
• Trim the visible fat off meat before you cook it
• Grill meat or cook it slowly in the oven instead of frying it
• Choose lower-fat dairy products such as 1% fat or skimmed milk, low-fat plain yoghurt or reduced-fat cheese
• Measure oil with a teaspoon to control the amount you use, or use an oil spray.
• Choose leaner cuts of meat that are lower in fat, like turkey breast and reduced fat mince.
• Make your meat stews and curries go further by adding veg and beans.
• Try reduced fat spreads, such as those based on olive or sunflower oils.

You can also compare nutrition labels to help you choose foods that are lower in saturated fat.

Coconut milk nutrition

In a 100 milliliter (100 g) portion, coconut milk contains 230 Calories and is 68% water, 24% total fat, 6% carbohydrates, and 2% protein (see Table 1). The fat composition includes 21 grams of saturated fat, half of which is lauric acid.

Coconut milk is a rich source (20% or more of the Daily Value, DV) of manganese (44% DV) and an adequate source (10-19% DV) of phosphorus, iron, and magnesium, with no other nutrients in significant content.

Table 1. Coconut milk, raw (liquid expressed from grated meat and water) 

Nutrient	Unit	Value per 100 g
Approximates
Water	g	67.62
Energy	kcal	230
Protein	g	2.29
Total lipid (fat)	g	23.84
Carbohydrate, by difference	g	5.54
Fiber, total dietary	g	2.2
Sugars, total	g	3.34
Minerals
Calcium, Ca	mg	16
Iron, Fe	mg	1.64
Magnesium, Mg	mg	37
Phosphorus, P	mg	100
Potassium, K	mg	263
Sodium, Na	mg	15
Zinc, Zn	mg	0.67
Vitamins
Vitamin C, total ascorbic acid	mg	2.8
Thiamin	mg	0.026
Riboflavin	mg	0
Niacin	mg	0.76
Vitamin B-6	mg	0.033
Folate, DFE	µg	16
Vitamin B-12	µg	0
Vitamin A, RAE	µg	0
Vitamin A, IU	IU	0
Vitamin E (alpha-tocopherol)	mg	0.15
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Vitamin K (phylloquinone)	µg	0.1
Lipids
Fatty acids, total saturated	g	21.14
Fatty acids, total monounsaturated	g	1.014
Fatty acids, total polyunsaturated	g	0.261
Cholesterol	mg	0
Other
Caffeine	mg	0

[Source ¹²]

Table 2. Coconut milk, canned (liquid expressed from grated meat and water)

Nutrient	Unit	Value per 100 g
Approximates
Water	g	72.88
Energy	kcal	197
Protein	g	2.02
Total lipid (fat)	g	21.33
Carbohydrate, by difference	g	2.81
Minerals
Calcium, Ca	mg	18
Iron, Fe	mg	3.3
Magnesium, Mg	mg	46
Phosphorus, P	mg	96
Potassium, K	mg	220
Sodium, Na	mg	13
Zinc, Zn	mg	0.56
Vitamins
Vitamin C, total ascorbic acid	mg	1
Thiamin	mg	0.022
Riboflavin	mg	0
Niacin	mg	0.637
Vitamin B-6	mg	0.028
Folate, DFE	µg	14
Vitamin B-12	µg	0
Vitamin A, RAE	µg	0
Vitamin A, IU	IU	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Lipids
Fatty acids, total saturated	g	18.915
Fatty acids, total monounsaturated	g	0.907
Fatty acids, total polyunsaturated	g	0.233
Cholesterol	mg	0

[Source ¹²]

Table 3. Coconut milk, frozen (liquid expressed from grated meat and water)

Nutrient	Unit	Value per 100 g
Approximates
Water	g	71.42
Energy	kcal	202
Protein	g	1.61
Total lipid (fat)	g	20.8
Carbohydrate, by difference	g	5.58
Minerals
Calcium, Ca	mg	4
Iron, Fe	mg	0.81
Magnesium, Mg	mg	32
Phosphorus, P	mg	59
Potassium, K	mg	232
Sodium, Na	mg	12
Zinc, Zn	mg	0.59
Vitamins
Vitamin C, total ascorbic acid	mg	1.1
Thiamin	mg	0.023
Riboflavin	mg	0
Niacin	mg	0.671
Vitamin B-6	mg	0.03
Folate, DFE	µg	14
Vitamin B-12	µg	0
Vitamin A, RAE	µg	0
Vitamin A, IU	IU	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Lipids
Fatty acids, total saturated	g	18.445
Fatty acids, total monounsaturated	g	0.885
Fatty acids, total polyunsaturated	g	0.228
Cholesterol	mg	0

[Source ¹²] References

1. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
2. https://daa.asn.au/wp-content/uploads/2016/11/Lockyer_et_al-2016-Nutrition_Bulletin.pdf
3. Saturated Fat. https://www.accessdata.fda.gov/scripts/interactivenutritionfactslabel/saturated-fat.html
4. http://apps.who.int/iris/bitstream/10665/43222/1/9241546727.pdf
5. Recommendations for the prevention of coronary artery disease in Asians: a scientific statement of the International College of Nutrition. J Cardiovasc Risk. 1996 Dec;3(6):489-94. https://www.ncbi.nlm.nih.gov/pubmed/9100083
6. Dietary Guidelines for Americans. https://health.gov/dietaryguidelines/
7. http://www.eatright.org/
8. https://news.heart.org/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks/
9. https://www.nhs.uk/livewell/healthyhearts/pages/cholesterol.aspx
10. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146-55. http://ajcn.nutrition.org/content/77/5/1146.long
11. American Heart Association. The Skinny on Fats. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-Fats_UCM_305628_Article.jsp
12. United States Department of Agriculture Agricultural Research Service. National Nutrient Database for Standard Reference Release 28. https://ndb.nal.usda.gov/ndb/search/list

What is barley

Barley (Hordeum vulgare L.) a member of the grass family, is a major cereal grain grown in temperate climates globally. In fact, barley is the world’s fourth most important cereal crop after wheat, rice, and corn. Barley was one of the first cultivated grains, particularly in Eurasia as early as 10,000 years ago. Barley has been used as animal fodder, as a source of fermentable material for beer and certain distilled beverages, and as a component of various health foods. It is used in soups and stews, and in barley bread of various cultures. Barley grains are commonly made into malt in a traditional and ancient method of preparation.

Barley is primarily (70 percent) used as feed for animals ¹. Barley with maize, oat and wheat is one of the most common feed grain of the world. If used as feed, its grain should be ground or cracked to improve efficiency in a given ration. It is overwhelmingly considered as carbohydrates and protein sources in livestock feed. Protein content, which is strongly affected by environmental conditions where barley is grown, changes from 10 % to 15%. The second largest use of barley grain is for malt. Globally, 30 % of the world barley production is used for malting purpose. In addition to barley, wheat and rye are also malted but barley grain has been preferred to other grains. The reasons why barley is commonly used for malt are its husk protecting the coleoptiles during germination process and filtering, firm texture of barley grains and tradition. 90 % of malted barley is utilized for malting beer and the remainder for food substitutes.

Malt is germinated cereal grains that have been dried in a process known as “malting”. The grains are made to germinate by soaking in water, and are then halted from germinating further by drying with hot air. Malting grains develops the enzymes required for modifying the grain’s starches into various types of sugar, including the monosaccharide glucose, the disaccharide maltose, the trisaccharide maltotriose, and higher sugars called maltodextrines. It also develops other enzymes, such as proteases, which break down the proteins in the grain into forms that can be used by yeast. The malt is mainly used for brewing or whisky making, but can also be used to make malt vinegar or malt extract. Barley malt can be substituted into a lot of food stuffs such as biscuits, bread, cakes, desserts, etc.

Traditionally, barley is very important food crop plant in the semi-arid regions of Africa (Morocco, Algeria, Libya and Tunisia), Middle East (Saudi Arabia, Iran, Iraq and Syria), highlands of Nepal, Ethiopia and Tibet, Andean countries of South America (Peru and Chile) and in some Asian counties (China, North Korea and Himalaya). Morocco is leading country in terms of food consumption in the world with 88.3 kg per capita ¹.

Barley is highest in fiber of all the whole grains, with common varieties clocking in at about 17% fiber, and some, such as the variety called Prowashonupana barley, having up to 30% fiber. For comparison, brown rice contains 3.5% fiber, corn about 7%, oats 10% and wheat about 12%. While the fiber in most grains is concentrated largely in the outer bran layer, barley’s fiber is found throughout the whole grain, which may account for its extraordinarily high levels.

But the goodness of whole grains comes from more than fiber. Whole grain barley is high in antioxidants, vitamins and minerals essential to health, too. However, much of the barley eaten in the U.S. is pearled or pearl barley, which is missing some or all of its bran layer.

As it grows in the field, most barley has an inedible hull adhering tightly to the grain kernel. The easiest, quickest way to remove this inedible hull is to scrape (pearl) it off without worrying too much about how much bran comes off at the same time. To make sure you’re enjoying true whole grain barley, look for hulled barley (barley where the inedible hull was removed carefully, keeping any bran loss to insignificant levels) or hulless barley (a different variety that grows without a tightly-attached hull).

Figure 1. Barley grain

Types of Barley

Barley, growing in a field

This is what barley looks like as it grows in the field. Most barley is what’s called “covered barley,” which means it has a tough, inedible outer hull around the barley kernel. This covering must be removed before the barley can be eaten. A less common variety, referred to as “naked” barley, has a covering, or hull, that is so loose that it usually falls off during harvesting.

Figure 2. Barley growing in a field

Hulled Barley (sometimes called Dehulled Barley)

Hulled barley is covered barley that has been minimally processed to remove only the tough inedible outer hull. It’s challenging to remove the hull carefully so that some of the bran is not lost – but that’s what must be done for covered barley to be considered whole grain.

Hulled barley (or covered barley) is eaten after removing the inedible, fibrous, outer hull. Once removed, it is called dehulled barley (or pot barley or scotch barley). Considered a whole grain, dehulled barley still has its bran and germ, making it a nutritious and popular health food.

Hulless Barley

This type of barley has an outer hull that’s so loosely attached to the kernel that it generally falls off during harvesting. This cuts down on processing and ensures that all of the bran and germ are retained.

Barley Grits

When barley kernels are cut into several pieces, they become grits. Read the label carefully: grits from hulled or hulless barley are whole grain, but grits created by cutting up pearl barley are not considered whole grain.

Pearl Barley (not a whole grain)

Pearl barley has been polished, or “pearled” to remove some or all of the outer bran layer along with the hull. If it’s lightly pearled, pearl barley will be tan colored; if it’s heavily pearled, barley will be quite white. Most of the barley found in the typical supermarket is pearl barley. Although it is technically a refined grain, it’s much healthier than other refined grains because (a) some of the bran may still be present and (b) the fiber in barley is distributed throughout the kernel, and not just in the outer bran layer. Pearl barley cooks more quickly than whole grain barley. Dehulled or pearl barley may be processed into a variety of barley products, including flour, flakes similar to oatmeal, and grits.

Figure 3. Pearl barley

Barley Flakes

If barley flakes remind you of oatmeal (rolled oats), it’s because they’re created the same way, by steaming kernels, rolling them, and drying them. As with barley grits, flakes can be made from whole grain barley or from pearl barley, with only the former considered to be whole grains. Barley flakes cook faster, because they’ve been lightly steamed and because of their greater surface area.

Quick Pearl Barley (not a whole grain)

Quick barley is a type of barley flake that cooks in about 10 minutes, because it has been partially cooked and dried during the flake-rolling process. Although barley flakes can be whole grain and technically it would feasible to create quick whole grain barley (similar to quick oats, which are whole grain), the quick barley commercially available today is made from pearl barley and so is not whole grain.

Figure 4. Quick barley

Barley Flour

Barley flour is used in baked goods and as a thickener for soups, stews and gravies. While it contains gluten, the protein that helps baked goods rise, the type of gluten in barley flour does not promote adequate rising on its own, so barley flour is usually used with wheat flour. Look for whole grain barley flour, ground from hulled or hulless barley, not from pearl barley.

Barley meal, a wholemeal barley flour lighter than wheat meal but darker in color, is used in porridge and gruel in Scotland. Barley meal gruel is known as sawiq in the Arab world. With a long history of cultivation in the Middle East, barley is used in a wide range of traditional Arabic, Assyrian, Israelite, Kurdish, and Persian foodstuffs including kashkak, kashk and murri. Barley soup is traditionally eaten during Ramadan in Saudi Arabia. Cholent or hamin (in Hebrew) is a traditional Jewish stew often eaten on Sabbath. In Eastern and Central Europe, barley is also used in soups and stews such as ričet. In Africa, where it is a traditional food plant, it has the potential to improve nutrition, boost food security, foster rural development and support sustainable landcare.

Barley nutrition facts

In a 100 gram serving, raw barley provides 354 calories and is a rich source (20% or more of the Daily Value, DV) of essential nutrients, including protein, dietary fiber, the B vitamins, niacin (31% DV) and vitamin B6 (20% DV), and several dietary minerals (see Table 1). Highest nutrient contents are for manganese (63% DV) and phosphorus (32% DV). Raw barley is 78% carbohydrates, 1% fat, 10% protein and 10% water.

Table 1. Barley hulled nutrition facts

Nutrient	Unit	Value per 100 g
Approximates
Water	g	9.44
Energy	kcal	354
Energy	kJ	1481
Protein	g	12.48
Total lipid (fat)	g	2.3
Ash	g	2.29
Carbohydrate, by difference	g	73.48
Fiber, total dietary	g	17.3
Sugars, total	g	0.8
Minerals
Calcium, Ca	mg	33
Iron, Fe	mg	3.6
Magnesium, Mg	mg	133
Phosphorus, P	mg	264
Potassium, K	mg	452
Sodium, Na	mg	12
Zinc, Zn	mg	2.77
Copper, Cu	mg	0.498
Manganese, Mn	mg	1.943
Selenium, Se	µg	37.7
Vitamins
Vitamin C, total ascorbic acid	mg	0
Thiamin	mg	0.646
Riboflavin	mg	0.285
Niacin	mg	4.604
Pantothenic acid	mg	0.282
Vitamin B-6	mg	0.318
Folate, total	µg	19
Folic acid	µg	0
Folate, food	µg	19
Folate, DFE	µg	19
Vitamin B-12	µg	0
Vitamin B-12, added	µg	0
Vitamin A, RAE	µg	1
Retinol	µg	0
Carotene, beta	µg	13
Carotene, alpha	µg	0
Cryptoxanthin, beta	µg	0
Vitamin A, IU	IU	22
Lycopene	µg	0
Lutein + zeaxanthin	µg	160
Vitamin E (alpha-tocopherol)	mg	0.57
Vitamin E, added	mg	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Vitamin K (phylloquinone)	µg	2.2
Lipids
Fatty acids, total saturated	g	0.482
04:00:00	g	0
06:00:00	g	0
08:00:00	g	0
10:00:00	g	0
12:00:00	g	0.006
14:00:00	g	0.011
16:00:00	g	0.411
18:00:00	g	0.017
Fatty acids, total monounsaturated	g	0.295
16:1 undifferentiated	g	0.006
18:1 undifferentiated	g	0.241
20:01:00	g	0
22:1 undifferentiated	g	0
Fatty acids, total polyunsaturated	g	1.108
18:2 undifferentiated	g	0.999
18:3 undifferentiated	g	0.11
18:04:00	g	0
20:4 undifferentiated	g	0
20:5 n-3 (EPA)	g	0
22:5 n-3 (DPA)	g	0
22:6 n-3 (DHA)	g	0
Cholesterol	mg	0
Amino Acids
Tryptophan	g	0.208
Threonine	g	0.424
Isoleucine	g	0.456
Leucine	g	0.848
Lysine	g	0.465
Methionine	g	0.24
Cystine	g	0.276
Phenylalanine	g	0.7
Tyrosine	g	0.358
Valine	g	0.612
Arginine	g	0.625
Histidine	g	0.281
Alanine	g	0.486
Aspartic acid	g	0.779
Glutamic acid	g	3.261
Glycine	g	0.452
Proline	g	1.484
Serine	g	0.527
Other
Alcohol, ethyl	g	0
Caffeine	mg	0
Theobromine	mg	0
Flavan-3-ols
(+)-Catechin	mg	2.4
Proanthocyanidin
Proanthocyanidin dimers	mg	33.6
Proanthocyanidin trimers	mg	30.6
Proanthocyanidin 4-6mers	mg	27.2
Proanthocyanidin 7-10mers	mg	0
Proanthocyanidin polymers (>10mers)	mg	0

[Source ²]

Table 2. Barley, pearled, raw nutrition facts

Nutrient	Unit	Value per 100 g
Approximates
Water	g	10.09
Energy	kcal	352
Energy	kJ	1473
Protein	g	9.91
Total lipid (fat)	g	1.16
Ash	g	1.11
Carbohydrate, by difference	g	77.72
Fiber, total dietary	g	15.6
Sugars, total	g	0.8
Minerals
Calcium, Ca	mg	29
Iron, Fe	mg	2.5
Magnesium, Mg	mg	79
Phosphorus, P	mg	221
Potassium, K	mg	280
Sodium, Na	mg	9
Zinc, Zn	mg	2.13
Copper, Cu	mg	0.42
Manganese, Mn	mg	1.322
Selenium, Se	µg	37.7
Vitamins
Vitamin C, total ascorbic acid	mg	0
Thiamin	mg	0.191
Riboflavin	mg	0.114
Niacin	mg	4.604
Pantothenic acid	mg	0.282
Vitamin B-6	mg	0.26
Folate, total	µg	23
Folic acid	µg	0
Folate, food	µg	23
Folate, DFE	µg	23
Choline, total	mg	37.8
Vitamin B-12	µg	0
Vitamin B-12, added	µg	0
Vitamin A, RAE	µg	1
Retinol	µg	0
Carotene, beta	µg	13
Carotene, alpha	µg	0
Cryptoxanthin, beta	µg	0
Vitamin A, IU	IU	22
Lycopene	µg	0
Lutein + zeaxanthin	µg	160
Vitamin E (alpha-tocopherol)	mg	0.02
Vitamin E, added	mg	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Vitamin K (phylloquinone)	µg	2.2
Lipids
Fatty acids, total saturated	g	0.244
04:00:00	g	0
06:00:00	g	0
08:00:00	g	0
10:00:00	g	0
12:00:00	g	0.003
14:00:00	g	0.006
16:00:00	g	0.208
18:00:00	g	0.008
Fatty acids, total monounsaturated	g	0.149
16:1 undifferentiated	g	0.003
18:1 undifferentiated	g	0.122
20:01:00	g	0
22:1 undifferentiated	g	0
Fatty acids, total polyunsaturated	g	0.56
18:2 undifferentiated	g	0.505
18:3 undifferentiated	g	0.055
18:04:00	g	0
20:4 undifferentiated	g	0
20:5 n-3 (EPA)	g	0
22:5 n-3 (DPA)	g	0
22:6 n-3 (DHA)	g	0
Cholesterol	mg	0
Amino Acids
Tryptophan	g	0.165
Threonine	g	0.337
Isoleucine	g	0.362
Leucine	g	0.673
Lysine	g	0.369
Methionine	g	0.19
Cystine	g	0.219
Phenylalanine	g	0.556
Tyrosine	g	0.284
Valine	g	0.486
Arginine	g	0.496
Histidine	g	0.223
Alanine	g	0.386
Aspartic acid	g	0.619
Glutamic acid	g	2.588
Glycine	g	0.359
Proline	g	1.178
Serine	g	0.418
Other
Alcohol, ethyl	g	0
Caffeine	mg	0
Theobromine	mg	0
Isoflavones
Daidzein	mg	0
Genistein	mg	0.01
Total isoflavones	mg	0.01

[Source ²]

Table 3. Barley flour or meal nutrition facts

Nutrient	Unit	Value per 100 g
Approximates
Water	g	12.11
Energy	kcal	345
Energy	kJ	1443
Protein	g	10.5
Total lipid (fat)	g	1.6
Ash	g	1.28
Carbohydrate, by difference	g	74.52
Fiber, total dietary	g	10.1
Sugars, total	g	0.8
Minerals
Calcium, Ca	mg	32
Iron, Fe	mg	2.68
Magnesium, Mg	mg	96
Phosphorus, P	mg	296
Potassium, K	mg	309
Sodium, Na	mg	4
Zinc, Zn	mg	2
Copper, Cu	mg	0.343
Manganese, Mn	mg	1.034
Selenium, Se	µg	37.7
Vitamins
Vitamin C, total ascorbic acid	mg	0
Thiamin	mg	0.37
Riboflavin	mg	0.114
Niacin	mg	6.269
Pantothenic acid	mg	0.145
Vitamin B-6	mg	0.396
Folate, total	µg	8
Folic acid	µg	0
Folate, food	µg	8
Folate, DFE	µg	8
Choline, total	mg	37.8
Betaine	mg	65.5
Vitamin B-12	µg	0
Vitamin B-12, added	µg	0
Vitamin A, RAE	µg	0
Retinol	µg	0
Carotene, beta	µg	0
Carotene, alpha	µg	0
Cryptoxanthin, beta	µg	0
Vitamin A, IU	IU	0
Lycopene	µg	0
Lutein + zeaxanthin	µg	160
Vitamin E (alpha-tocopherol)	mg	0.57
Vitamin E, added	mg	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Vitamin K (phylloquinone)	µg	2.2
Lipids
Fatty acids, total saturated	g	0.335
04:00:00	g	0
06:00:00	g	0
08:00:00	g	0
10:00:00	g	0
12:00:00	g	0.004
14:00:00	g	0.008
16:00:00	g	0.286
18:00:00	g	0.012
Fatty acids, total monounsaturated	g	0.205
16:1 undifferentiated	g	0.004
18:1 undifferentiated	g	0.168
20:01:00	g	0
22:1 undifferentiated	g	0
Fatty acids, total polyunsaturated	g	0.771
18:2 undifferentiated	g	0.695
18:3 undifferentiated	g	0.077
18:04:00	g	0
20:4 undifferentiated	g	0
20:5 n-3 (EPA)	g	0
22:5 n-3 (DPA)	g	0
22:6 n-3 (DHA)	g	0
Cholesterol	mg	0
Amino Acids
Tryptophan	g	0.175
Threonine	g	0.356
Isoleucine	g	0.383
Leucine	g	0.713
Lysine	g	0.391
Methionine	g	0.202
Cystine	g	0.232
Phenylalanine	g	0.589
Tyrosine	g	0.301
Valine	g	0.515
Arginine	g	0.526
Histidine	g	0.236
Alanine	g	0.409
Aspartic acid	g	0.655
Glutamic acid	g	2.741
Glycine	g	0.38
Proline	g	1.247
Serine	g	0.443
Other
Alcohol, ethyl	g	0
Caffeine	mg	0
Theobromine	mg	0
Proanthocyanidin
Proanthocyanidin dimers	mg	15.8
Proanthocyanidin trimers	mg	22
Proanthocyanidin 4-6mers	mg	5.3
Proanthocyanidin 7-10mers	mg	0
Proanthocyanidin polymers (>10mers)	mg	0

[Source ²]

Barley soup recipes

Vegetable and Barley Soup

Ingredients

Serves: 8

• 2 liters vegetable stock
• 1 cup (185g) uncooked barley
• 2 large carrots, chopped
• 2 stalks celery, chopped
• 1 tin (400g) diced tomatoes with juice
• 1 zucchini, chopped
• 1 tin (400g) chickpeas, drained
• 1 onion, chopped
• 3 bay leaves

• 1 garlic clove, chopped
• 1 teaspoon white sugar
• 1 teaspoon salt
• 1/2 teaspoon ground black pepper
• 1 teaspoon dried parsley
• 1 teaspoon curry powder
• 1 teaspoon paprika
• 1 teaspoon Worcestershire sauce

Preparation:15min › Cook:1hour30min › Ready in:1hour45min

Directions

1. Pour the vegetable stock into a large pot. Add the barley, carrots, celery, tomatoes, zucchini, chick peas, onion and bay leaves. Season with garlic powder, sugar, salt, pepper, parsley, curry powder, paprika and Worcestershire sauce.
2. Bring to a boil, then cover and simmer over medium-low heat for 90 minutes. The soup will be very thick. You may adjust by adding more stock or less barley if desired. Remove bay leaves before serving.

Vegetable and Barley Soup #2

Ingredients

Serves: 4

• 1 tablespoon olive oil
• 1 medium brown onion, chopped
• 1 large carrot, peeled, halved lengthways, chopped
• 4 middle bacon rashers, trimmed, chopped
• 2 celery stalks, leaves reserved, stalks chopped
• 400g can whole peeled tomatoes
• 1 large zucchini, halved lengthways, chopped
• 1 tablespoon Massel chicken style stock powder
• 1/2 cup pearl barley, rinsed

Directions:

Heat oil in a large saucepan over medium heat. Add onion, carrot, bacon and celery stalk. Cook for 10 minutes or until onion has softened. Add tomato, zucchini, stock powder and 6 cups cold water. Bring to the boil. Add barley. Reduce heat to low. Simmer, partially covered, for 40 minutes or until barley is tender. Chop reserved celery leaves. Stir into soup. Serve.

Barley health benefits

In scientific studies, barley has been shown to reduce the risk of many diseases and to provide important health benefits. Barley offers many of the same healthy vitamins and minerals as other whole grains, but many think its special health benefits stem from the high levels of soluble beta-glucan fiber found in this grain. According to Health Canada ³ and the US Food and Drug Administration ⁴, consuming at least 3 grams per day of barley beta-glucan or 0.75 grams per serving of soluble fiber can lower levels of blood cholesterol, a risk factor for cardiovascular diseases.

A recent review in the journal Minerva Med ⁵, beta-glucans reduce cholesterol, help control blood sugar, and improve immune system function. New research even indicates that beta-glucans may be radioprotective: they may help your bodies stand up better to chemotherapy, radiation therapy and nuclear emergencies.

Barley Controls Blood Sugar Better

Dutch researchers ⁶ used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast.

Barley Lowers Glucose Levels

White rice, the staple food in Japan, is a high glycemic index food. Researchers at the University of Tokushima found that glucose levels were lower after meals when subjects switched from rice to barley ⁷.

Barley Beta-Glucan Lowers Glycemic Index

Scientists at the Functional Food Centre at Oxfod Brookes University in England ⁸ fed 8 healthy human subjects chapatis (unleavened Indian flatbreads) made with either 0g, 2g, 4g, 6g or 8g of barley beta-glucan fiber. They found that all amounts of barley beta-glucan lowered the glycemic index of the breads, with 4g or more making a significant difference.

Insulin Response better with Barley Beta-Glucan

In a crossover study ⁹ involving 17 obese women at increased risk for insulin resistance, USDA scientists studied the effects of 5 different breakfast cereal test meals on subjects’ insulin response. They found that consumption of 10g of barley beta-glucan significantly reduced insulin response.

Barley Beats Oats in Glucose Response Study

USDA researchers fed barley flakes, barley flour, rolled oats, oat flour, and glucose to 10 overweight middle-aged women, then studied their bodies’ responses ¹⁰. They found that peak glucose and insulin levels after barley were significantly lower than those after glucose or oats. Particle size did not appear to be a factor, as both flour and flakes had similar effects.

Barley Reduces Blood Pressure

For five weeks, adults with mildly high cholesterol were fed diets supplemented with one of three whole grain choices: whole wheat/brown rice, barley, or whole wheat/brown rice/barley ¹¹. All three whole grain combinations reduced blood pressure, leading USDA researchers to conclude that “in a healthful diet, increasing whole grain foods, whether high in soluble or insoluble fiber, can reduce blood pressure and may help to control weight” ¹¹.

Barley Lowers Serum Lipids

University of Connecticut researchers ¹² reviewed 8 studies evaluating the lipid-reducing effects of barley. They found that eating barley significantly lowered total cholesterol, LDL (“bad”) cholesterol, and triglycerides, but did not appear to significantly alter HDL (“good”) cholesterol.

Cholesterol and Visceral Fat Decrease with Barley

A randomized double-blind study ¹³ in Japan followed 44 men with high cholesterol for twelve weeks, as the men ate either a standard white-rice diet or one with a mixture of rice and high-beta-glucan pearl barley. Barley intake significantly reduced serum cholesterol and visceral fat, both accepted markers of cardiovascular risk.

Barley significantly Improves Lipids

25 adults with mildly high cholesterol were fed whole grain foods containing 0g, 3g or 6g of barley beta-glucan per day for five weeks, with blood samples taken twice weekly ¹⁴. Total cholesterol and LDL (“bad”) cholesterol significantly decreased with the addition of barley to the diet.

Barley Pasta Lowers Cholesterol

University of California researchers ¹⁵ fed two test meals to 11 healthy men, both containing beta-glucan. One meal was a high-fiber (15.7g) barley pasta and the other was lower-fiber (5.0g) wheat pasta. The barley pasta blunted insulin response, and four hours after the meal, barley-eaters had significantly lower cholesterol concentration than wheat-eaters.

Barley’s Slow Digestion may help Weight Control

Barley varieties such as Prowashonupana that are especially high in beta-glucan fiber may digest more slowly than standard barley varieties. Researchers at USDA and the Texas Children’s Hospital ¹⁶ compared the two and concluded that Prowashonupana may indeed be especially appropriate for obese and diabetic patients.

Greater Satiety, Fewer Calories Eaten with Barley

In a pilot study not yet published, six healthy subjects ate a 420-calorie breakfast bar after an overnight fast, then at lunch were offered an all-you-can-eat buffet. When subjects ate a Prowashonupana barley bar at breakfast they subsequently ate 100 calories less at lunch than when they ate a traditional granola bar for breakfast.

References

1. http://www.fao.org/3/a-au997e.pdf
2. United States Department of Agriculture Agricultural Research Service. National Nutrient Database for Standard Reference Release 28. https://ndb.nal.usda.gov/ndb/search/list
3. Summary of Health Canada’s Assessment of a Health Claim about Barley Products and Blood Cholesterol Lowering. https://www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/health-claims/assessments/assessment-health-claim-about-barley-products-blood-cholesterol-lowering.html
4. CFR – Code of Federal Regulations Title 21. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.81
5. [The biological activity of beta-glucans]. Minerva Med. 2009 Jun;100(3):237-45. https://www.minervamedica.it/en/journals/minerva-medica/article.php?cod=R10Y2009N03A0237
6. Factors related to colonic fermentation of nondigestible carbohydrates of a previous evening meal increase tissue glucose uptake and moderate glucose-associated inflammation. Am J Clin Nutr. 2010 Jan;91(1):90-7. doi: 10.3945/ajcn.2009.28521. Epub 2009 Nov 4. http://ajcn.nutrition.org/content/91/1/90.long
7. [Nutrition education from the perspective of human health]. Rinsho Byori. 2009 Aug;57(8):797-805. https://www.ncbi.nlm.nih.gov/pubmed/19764416
8. High-molecular-weight barley beta-glucan in chapatis (unleavened Indian flatbread) lowers glycemic index. Nutr Res. 2009 Jul;29(7):480-6. doi: 10.1016/j.nutres.2009.07.003. https://www.ncbi.nlm.nih.gov/pubmed/19700035
9. Glucose and insulin responses to whole grain breakfasts varying in soluble fiber, beta-glucan: a dose response study in obese women with increased risk for insulin resistance. Eur J Nutr. 2009 Apr;48(3):170-5. doi: 10.1007/s00394-009-0778-3. Epub 2009 Feb 5. https://www.ncbi.nlm.nih.gov/pubmed/19205780
10. Comparison of hormone and glucose responses of overweight women to barley and oats. J Am Coll Nutr. 2005 Jun;24(3):182-8. https://www.ncbi.nlm.nih.gov/pubmed/15930484
11. Whole-grain diets reduce blood pressure in mildly hypercholesterolemic men and women. J Am Diet Assoc. 2006 Sep;106(9):1445-9. https://www.ncbi.nlm.nih.gov/pubmed/16963350
12. Talati R, Baker WL, Pabilonia MS, White CM, Coleman CI. The Effects of Barley-Derived Soluble Fiber on Serum Lipids. Annals of Family Medicine. 2009;7(2):157-163. doi:10.1370/afm.917. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653960/
13. Effect of high beta-glucan barley on serum cholesterol concentrations and visceral fat area in Japanese men–a randomized, double-blinded, placebo-controlled trial. Plant Foods Hum Nutr. 2008 Mar;63(1):21-5. Epub 2007 Dec 12. https://www.ncbi.nlm.nih.gov/pubmed/18074229
14. Diets containing barley significantly reduce lipids in mildly hypercholesterolemic men and women. Am J Clin Nutr. 2004 Nov;80(5):1185-93. http://ajcn.nutrition.org/content/80/5/1185.long
15. Postprandial lipid, glucose, insulin, and cholecystokinin responses in men fed barley pasta enriched with beta-glucan. Am J Clin Nutr. 1999 Jan;69(1):55-63. http://ajcn.nutrition.org/content/69/1/55.long
16. Carbohydrate digestion in humans from a beta-glucan-enriched barley is reduced. J Nutr. 2002 Sep;132(9):2593-6. http://jn.nutrition.org/content/132/9/2593.long

What are the best carbs to eat

Carbs, short for carbohydrates, are one of three macro nutrients (nutrients that form a large part of your diet) found in food – the others being fat and protein.

While carbohydrates, fat and protein are all sources of energy in you diet, the amount of energy that each one provides varies:

• Carbohydrate provides: about 4kcal (17kJ) per gram
• Protein provides: 4kcal (17kJ) per gram
• Fat provides: 9kcal (37kJ) per gram

In the absence of carbohydrates in the diet your body will convert protein (or other non-carbohydrate substances) into glucose, so it’s not just carbohydrates that can raise your blood sugar and insulin levels.

If you consume more calories than you burn from whatever source, you will gain weight. So cutting out carbohydrates or fat does not necessarily mean cutting out calories if you are replacing them with other foods containing the same amount of calories.

Carbohydrates and protein contain roughly the same number of calories per gram but other factors influence the sensation of feeling full such as the type and variety of food eaten, eating behavior and environmental factors, such as portion size and availability of food choices.

The sensation of feeling full can also vary from person to person. Among other things, protein-rich foods can help you feel full and you should have some beans, pulses, fish, eggs, meat and other protein foods as part of a healthy balanced diet. But you shouldn’t eat too much of these foods. Remember that starchy foods should make up about a third of the food you eat and you need to eat more fruit and vegetables.

Hardly any foods contain only one nutrient and most are a combination of carbohydrates, fats and proteins in varying amounts. There are three different types of carbohydrates found in food: sugar, starch and fiber.

• Sugar is composed of one unit (a monosaccharide, such as glucose or fructose) or two joined units (a disaccharide, such as lactose or sucrose). Sugar is found naturally in some foods, including fruit, honey, fruit juices, milk (lactose) and vegetables. Other forms of sugar (for example table sugar) can be added to food and drink such as sweets, chocolates, biscuits and soft drinks during manufacture, or added when cooking or baking at home.

• Starch, made up of many sugar units bonded together, is found in foods that come from plants. Examples of foods containing starch include vegetables (e.g., potatoes, carrots), grains (e.g., brown rice, oats, wheat, barley, corn), pasta and legumes (beans and peas; e.g., kidney beans, garbanzo beans, lentils, split peas), provide a slow and steady release of energy throughout the day.

• Fiber is the name given to the diverse range of compounds found in the cell walls of foods that come from plants. Total fiber is the sum of dietary fiber and functional fiber. Dietary fiber consists of non-digestible carbohydrates and lignin that are intrinsic and intact in plants (i.e., the fiber naturally occurring in foods). Functional fiber consists of isolated, non-digestible carbohydrates that have beneficial physiological effects in humans. Functional fibers are either extracted from natural sources or are synthetically manufactured and added to foods, beverages, and supplements. Good sources of fiber include vegetables with skins on, wholegrain bread, wholewheat pasta and pulses (beans and lentils).

There are two types of carbohydrates that the body turns into energy: simple and complex.

• Simple carbohydrates are often listed on nutrition labels as “carbohydrates (of which sugars)”. This includes added sugars and the natural sugars found in fruit and milk.
• Complex carbohydrates are also called starchy foods. Starchy foods include potatoes, bread, rice, pasta and other starchy carbohydrates. We should get most of our energy from complex carbohydrates rather than those containing sugar. Try to choose higher-fiber, wholegrain varieties of starchy foods whenever you can by choosing wholewheat pasta, brown rice, or simply leaving the skins on potatoes.

Sometimes you will only see a total figure for carbohydrates on nutrition labels. This includes the carbohydrates from complex carbohydrates and from simple carbohydrates.

Sugars

Sugars occur naturally in foods such as fruit and milk, however we do not need to cut down on these types of sugars. Sugars are also added to a wide range of foods such as sweets, cakes, biscuits and chocolates, and it is these types of sugary foods that we should cut down on, as regularly consuming foods and drinks high in sugar increases your risk of obesity and tooth decay.

Nutrition labels often tell you how much sugar a food contains. This includes added sugars (also called “free sugars”) and the natural sugars found in fruit and milk. You can compare labels and choose foods that are lower in sugar.

How much carbohydrate should you eat ?

The American Dietary Guidelines on healthy eating recommends that just over a third of your diet should be made up of starchy foods, such as potatoes, bread, rice and pasta, and another third should be fruit and vegetables. This means that over half (45 to 65 percent of total calories) of your daily calorie intake should come from starchy foods, fruit and vegetables.

Best carbs to eat for weight loss

Data from the National Health and Nutrition Examination Survey (NHANES) ¹, which looks at food consumption in the US, shows that most of us should also be eating more fiber and starchy foods and fewer sweets, chocolates, biscuits, pastries, cakes and soft drinks with added sugar. These are usually high in sugar and calories, which can increase the risk of tooth decay and contribute to weight gain if you eat them too often, while providing few other nutrients.

It’s important to choose carbohydrates wisely. Your best carbohydrate-containing foods are nutrient-packed foods in several of the basic food groups: fruits, vegetables, grains, and milk and milk products. Choosing these foods within your calorie requirements daily may help your heart stay healthy and reduce your risk for chronic disease.

Fruit, vegetables, pulses and starchy foods (especially wholegrain varieties) provide a wider range of nutrients (such as vitamins and minerals) which can benefit our health. The fiber in these foods can help to keep your bowels healthy and adds bulk to your meal, helping you to feel full.

Cutting out a whole food group (such as starchy foods) as some diets recommend could put your health at risk because as well as cutting out the body’s main source of energy you’d be cutting back essential nutrients like B vitamins, zinc and iron from your diet.

Here’s what you need to know:

• Choose fiber-rich fruits, vegetables, and whole grains often.
• Focus on fruits: Eat a variety of fruits. Make most of your fruit choices fresh, frozen, canned, or dried, rather than fruit juice.
• Vary your veggies:
  • Eat more dark green veggies, such as broccoli, kale, and other dark leafy greens. And try more orange veggies, such as carrots, sweet potatoes, pumpkin, and winter squash.
  • Legumes—such as dry beans and peas—are especially rich in dietary fiber and should be consumed several times per week.
• Make at least half your grains whole grains: Eat at least 3 ounces daily of whole grains. Examples of whole grains are whole-grain cereals, breads, crackers, and pasta. Other examples are brown and wild rice. One slice (1 ounce) of whole-grain bread, 1/2 cup brown rice, and 1/2 cup of oatmeal is equivalent to 3 ounces of whole grains. If you eat a 2,000-calorie diet, you will need approximately each day: 2 to 2 1/2 cups of fruit, 2 to 2 1/2 cups of vegetables, and 6 to 8 ounces of grains (at least 4 ounces should be whole grains). In addition, you should eat nuts, seeds, and legumes 4 to 5 times per week.

Many packaged foods have fiber information on the front of the package.

• For example, the package might say “excellent source of fiber,” “rich in fiber,” or “high in fiber.” The Nutrition Facts label will list the amount of dietary fiber in a serving and the % Daily Value (% DV). Look at the % DV column: 5% DV or less is low in dietary fiber, and 20% DV or more is high.

Check the product name and ingredient list.

• For many, but not all “whole-grain” food products, the words “whole” or “whole grain” may appear before the name (e.g., whole-wheat bread). But, because whole-grain foods cannot necessarily be identified by their color or name (brown bread, 9-grain bread, hearty grains bread, mixed grain bread, etc. are not always “whole-grain”), you need to look at the ingredient list. The whole grain should be the first ingredient listed.

The following are some examples of how whole grains could be listed:

• whole wheat
• brown rice
• quinoa
• buckwheat whole
• oats/oatmeal
• whole rye
• bulgur (cracked wheat)
• sorghum
• whole grain
• barley
• popcorn
• millet
• wild rice
• triticale

How much dietary fiber do I need ?

The recommended dietary fiber intake is 14 grams per 1,000 calories consumed. For example, if you’re a physically active woman who needs 2,000 calories a day, you should be aiming for 28 grams of dietary fiber a day. You could meet this goal by eating 1 cup raspberries (8 grams) and a whole-wheat English muffin (4.4 grams) for breakfast, 1/2 cup black beans (7.5 grams) with lunch, and 1 cup of mixed vegetables (8 grams) with dinner.

How can you increase my fiber intake ?

To increase the amount of fibre in your diet, aim for at least five portions of a variety of fruit and veg a day, go for wholegrain varieties of starchy foods and eat potatoes with skins on. Try to aim for an average intake of 30g of fibre a day.

Here are some examples of the typical fibre content in some common foods:

• two breakfast wheat biscuits (approx. 37.5g) – 3.6g of fibre
• one slice of wholemeal bread – 2.5g (one slice of white bread – 0.9g)
• 80g of uncooked wholewheat pasta – 7.6g
• one medium (180g) baked potato (with skin) – 4.7g
• 80g (4 heaped tablespoons) of cooked runner beans – 1.6g
• 80g (3 heaped tablespoons) of cooked carrots – 2.2g
• 1 small cob (3 heaped tablespoons) of sweetcorn – 2.2g
• 200g of baked beans – 9.8g
• 1 medium orange – 1.9g
• 1 medium banana – 1.4g

What foods contain dietary fiber and how much do they contain ?

Food	Grams of fiber	% Daily Value*
1/2 cup cooked navy beans	9.5 grams of fiber	38% Daily Value
1/2 cup ready-to-eat 100% bran cereal	8.8 grams of fiber	35% Daily Value
1/2 cup cooked lentils	7.8 grams of fiber	31% Daily Value
1/2 cup cooked chickpeas	6.2 grams of fiber	25% Daily Value
1 medium baked sweet potato with skin	4.8 grams of fiber	19% Daily Value
1 small raw pear	4.3 grams of fiber	17% Daily Value
1 medium baked potato with skin	3.8 grams of fiber	15% Daily Value
1/2 cup frozen spinach, cooked	3.5 grams of fiber	14% Daily Value
1 medium raw orange	3.1 grams of fiber	12% Daily Value
1/2 cup cooked broccoli	2.8 grams of fiber	11% Daily Value
* % Daily Values listed in this column are based on the food amounts listed in the table. The Daily Value for fiber is 25 grams.

Do carbohydrates make you fat ?

Any food can be fattening if you overeat. Whether your diet is high in fat or high in carbohydrates, if you frequently consume more energy than your body uses you are likely to put on weight. In fact, gram for gram, carbohydrate contains fewer than half the calories of fat and wholegrain varieties of starchy foods are good sources of fiber. Foods high in fiber add bulk to your meal and help you to feel full.

However, foods high in sugar are often high in calories and eating these foods too often can contribute to you becoming overweight. There is some evidence that diets high in sugar are associated with an increased energy content of the diet overall, which over time can lead to weight gain.

When people cut out carbs and lose weight, it’s not just carbs they’re cutting out, they’re cutting out the high-calorie ingredients mixed in or eaten with it, such as butter, cheese, cream, sugar and oil. Eating too many calories – whether they are carbs, protein or fat – will contribute to weight gain.

When is the best time to eat carbohydrates ?

When you should eat carbohydrates particularly for weight loss is the subject of much debate, but there’s little scientific evidence that one time is better than any other. It is recommended that you base all your meals around starchy carbohydrate foods, try and choose higher-fiber, wholegrain varieties when you can.

Can cutting out wheat help me lose weight ?

Some people point to bread and other wheat-based foods as the main culprit for their weight gain. Wheat is found in a wide range of foods, from bread, pasta and pizza, to cereals and many other foods. However, there is no evidence that wheat is more likely to cause weight gain than any other food.

Unless you have a diagnosed health condition such as wheat allergy, wheat sensitivity or Celiac disease, there is little evidence that cutting out wheat and other grains from your diet would benefit your health. Grains, especially wholegrains, are an important part of a healthy balanced diet. Wholegrain, wholemeal and brown breads give us energy and contain B vitamins, vitamin E, fiber and a wide range of minerals.

White bread also contains a range of vitamins and minerals, but it has less fiber than wholegrain, wholemeal or brown breads. If you prefer white bread, look for higher-fiber options. Grains are also naturally low in fat.

Can eating low GI (glycaemic index) foods help me lose weight ?

The glycaemic index (GI) is a rating system for foods containing carbohydrates. It shows how quickly each food affects glucose (sugar) levels in your blood, when that food is eaten on its own. Some low GI foods, such as wholegrain foods, fruit, vegetables, beans and lentils are foods we should eat as part of a healthy balanced diet. However, using GI to decide whether foods or a combination of foods are healthy or can help with weight reduction can be misleading.

Although low GI foods cause blood sugar levels to rise and fall slowly, and which may help you to feel fuller for longer, not all low GI foods are healthy. For example, watermelon and parsnips are high GI foods, while chocolate cake has a lower GI value. Also, the cooking method and eating foods in combination as part of a meal, will change the GI rating. Therefore, GI alone is not a reliable way of deciding whether foods or combinations of foods are healthy or will help you to lose weight.

What’s the role of carbohydrates in bodybuilding and exercise ?

Carbohydrates, fat and protein all provide energy, but exercising muscles rely on carbohydrates as their main source of fuel. However, muscles have limited carbohydrates stores (glycogen) and they need to be topped up regularly to keep your energy up. A diet low in carbohydrates can lead to a lack of energy during exercise, early fatigue and delayed recovery.

Why do you need carbs ?

Carbohydrates are important to your health for a number of reasons.

Energy

Carbohydrates should be the body’s main source of energy in a healthy balanced diet, providing about 4kcal (17kJ) per gram. They are broken down into glucose (sugar) before being absorbed into the bloodstream. From there, the glucose enters the body’s cells with the help of insulin. Glucose is used by your body for energy, fuelling all of your activities, whether going for a run or simply breathing.

Unused glucose can be converted to glycogen found in the liver and muscles. If more glucose is consumed than can be stored as glycogen, it is converted to fat, for long-term storage of energy. High fiber, starchy carbohydrates release sugar into the blood more slowly than sugary foods and drinks.

Disease risk

Vegetables, pulses, wholegrain varieties of starchy foods, and potatoes eaten with their skins on are good sources of fiber. Fiber is an important part of a healthy balanced diet. It can promote good bowel health, reduce the risk of constipation, and some forms of fiber have been shown to reduce cholesterol levels.

Research shows diets high in fiber are associated with a lower risk of cardiovascular disease, type 2 diabetes and bowel cancer. Many people don’t get enough fiber. On average, most people in the US get about 18g of fiber a day. You are advised to eat an average of 30g a day.

Calorie intake

Carbohydrate contains fewer calories gram for gram than fat, and starchy foods can be a good source of fiber, which means they can be a useful part of your weight loss plan. By replacing fatty, sugary foods and drinks with high-fiber starchy foods, it is more likely you will reduce the number of calories in your diet.

Also, high fiber foods add bulk to your meal helping you feel full. Though you still need to watch your portion sizes to avoid overeating. Also watch the amount of fat you add when cooking and serving them: this is what increases the calorie content.

Starchy foods and carbohydrates

Starchy foods are your main source of carbohydrate and play an important role in a healthy diet.

Starchy foods such as potatoes, bread, rice, pasta and cereals should make up just over a third of the food you eat.

Where you can, choose wholegrain varieties, and eat potatoes with their skins on for more fiber.

You should eat some starchy foods every day as part of a healthy, balanced diet.

During cooking, aim for a golden yellow color or lighter when baking, toasting, roasting or frying starchy foods like potatoes, root vegetables and bread.

Why do you need starchy foods ?

Starchy foods are a good source of energy and the main source of a range of nutrients in our diet. As well as starch, they contain fibre, calcium, iron and B vitamins.

Some people think starchy foods are fattening, but gram for gram they contain fewer than half the calories of fat.

Just watch out for the added fats used when you cook and serve them: this is what increases the calorie content.

Starchy foods and fiber

Wholegrain varieties of starchy foods and potatoes – particularly when eaten with their skins on – are good sources of fiber.

Fiber is the name given to a range of compounds found in the cell walls of vegetables, fruits, pulses and cereal grains.

Fibre that cannot be digested helps other food and waste products move through the gut more easily.

Potato skins, wholegrain bread and breakfast cereals, brown rice, and wholewheat pasta are good sources of this kind of fiber.

Fiber can help keep your bowels healthy and can help you feel full, which means we’re less likely to eat too much.

• This makes wholegrain starchy foods and potatoes eaten with their skins on a particularly good choice if you’re trying to lose weight.

Some types of fiber – present in fruits and vegetables such as apples, carrots, potatoes, oats and pulses – can be partly digested, and may help reduce the amount of cholesterol in the blood.

Tips to eat more starchy foods

These tips can help you increase the amount of starchy foods in your diet.

Breakfast

• Opt for wholegrain cereals, or mix some in with your favorite healthy breakfast cereals.
• Plain porridge with fruit is perfect as a warming winter breakfast.
• Whole oats with fruit and low-fat, lower-sugar yogurt make a great summer breakfast.

Lunch and dinner

• Try a baked potato for lunch – eat the skin for even more fiber.
• Instead of having chips or frying potatoes, try making oven baked potato wedges.
• Have more rice or pasta and less sauce – but don’t skip the vegetables.
• Try different breads, such as seeded, wholemeal and granary. When you choose wholegrain varieties, you’ll also increase the amount of fiber you’re eating.
• Try brown rice – it makes a very tasty rice salad.

Types of starchy foods

Potatoes

Potatoes are a great choice of starchy food and a good source of energy, fiber, B vitamins and potassium.

In the US, you also get a lot of your vitamin C from potatoes – although they only contain vitamin C in small amounts, we generally eat a lot of them. They’re good value for money and can be a healthy choice.

Although potatoes are vegetables, in the US we mostly eat them as the starchy food part of a meal, and they’re a good source of carbohydrate in our diets.

Because of this, potatoes don’t count towards your portions of fruit and vegetables a day, but they can play an important role in your diet.

Potatoes are a healthy choice when boiled, baked, mashed or roasted with only a small amount of fat or oil and no added salt.

French fries and other chips cooked in oil or served with salt are not a healthy choice.

When cooking or serving potatoes, try to go for lower-fat (polyunsaturated) spreads or small amounts of unsaturated oils, such as olive or sunflower oil, instead of butter.

In mashed potato, use lower-fat milk – such as semi-skimmed, 1% fat or skimmed milk – instead of whole milk or cream.

Leave potato skins on where possible to keep in more of the fiber and vitamins. For example, eat the skin when you’re having boiled potatoes or a baked potato.

If you’re boiling potatoes, some nutrients will leak out into the water, especially if you’ve peeled them. To stop this happening, only use enough water to cover them and cook them only for as long as they need.

Storing potatoes in a cool, dark and dry place will help stop them sprouting. Don’t eat any green, damaged or sprouting bits of potatoes as these can contain toxins that can be harmful.

Bread

Bread – especially wholemeal, granary, brown and seeded varieties – is a healthy choice to eat as part of a balanced diet.

Wholegrain, wholemeal and brown breads give us energy and contain B vitamins, vitamin E, fiber and a wide range of minerals.

White bread also contains a range of vitamins and minerals, but it has less fiber than wholegrain, wholemeal or brown breads. If you prefer white bread, look for higher-fiber options.

Some people avoid bread because they’re concerned that they’re allergic to wheat, or they think bread is fattening.

However, cutting out any type of food altogether might mean you miss out on a whole range of nutrients people need to stay healthy.

If you’re concerned that you have a wheat allergy or intolerance, speak to your health care provider.

Bread can be stored at room temperature. Follow the “best before” date to make sure you eat it fresh.

Cereal products

Cereal products are made from grains. Wholegrain cereals can contribute to our daily intake of iron, fiber, B vitamins and protein. Higher-fiber options can also provide a slow release of energy.

Wheat, oats, barley, rye and rice are commonly available cereals that can be eaten as wholegrains.

This means cereal products consisting of oats and oatmeal, like porridge, and wholewheat products are healthy breakfast options.

Barley, couscous, corn and tapioca also count as healthy cereal products.

Many cereal products in the US are refined, with low wholegrain content. They can also be high in added salt and sugar.

When you’re shopping for cereals, check the food labels to compare different products.

Rice and grains

Rice and grains are an excellent choice of starchy food. They give you energy, are low in fat, and good value for money.

There are many types to choose from, including:

• all kinds of rice – such as quick-cook, arborio, basmati, long grain, brown, short grain and wild rice
• couscous
• bulgur wheat

As well as carbohydrates, rice and grains (particularly brown and wholegrain versions) can contain:

• fiber – which can help the body get rid of waste products
• B vitamins – which help release energy from the food we eat and help the body work properly

Rice and grains, such as couscous and bulgur wheat, can be eaten hot or cold and in salads.

There are a few precautions you should take when storing and reheating cooked rice and grains. This is because the spores of some food poisoning bugs can survive cooking.

If cooked rice or grains are left standing at room temperature, the spores can germinate. The bacteria multiply and produce toxins that can cause vomiting and diarrhea. Reheating food won’t get rid of the toxins.

It’s therefore best to serve rice and grains when they’ve just been cooked. If this isn’t possible, cool them within an hour after cooking and keep them refrigerated until reheating or using in a cold dish.

It’s important to throw away any rice and grains that have been left at room temperature overnight.

If you aren’t going to eat rice immediately, refrigerate it within one hour and eat within 24 hours.

Rice should be reheated thoroughly, reaching a core temperature of 70C for two minutes (or equivalent) so it’s steaming hot throughout.

Rice shouldn’t be reheated more than once – it should be discarded. Don’t reheat rice unless it’s been chilled down safely and kept in the fridge until you reheat it.

Follow the “use by” date and storage instructions on the label for any cold rice or grain salads that you buy.

Pasta in your diet

Pasta is another healthy option to base your meal on. It consists of dough made from durum wheat and water, and contains iron and B vitamins.

Wholewheat or wholegrain are healthier alternatives to ordinary pasta, as they contain more fiber. We digest wholegrain foods more slowly, so they can help us feel full for longer.

Dried pasta can be stored in a cupboard and typically has a long shelf life, while fresh pasta will need to be refrigerated and has a shorter lifespan.

Check the food packaging for “best before” or “use by” dates and further storage instructions.

Fruit and vegetables

Fruit and vegetables are a vital source of vitamins and minerals and should make up just over a third of the food you eat each day. It’s advised that you eat at least five portions of a variety of fruit and vegetables every day.

There’s evidence that people who eat at least five portions a day have a lower risk of heart disease, stroke and some cancers.

Eating five portions is not as hard as it sounds. Just one apple, banana, pear or similar-sized fruit is one portion (80g). A slice of pineapple or melon is one portion. Three heaped tablespoons of vegetables is another portion.

Having a sliced banana with your morning cereal is a quick way to get one portion. Swap your mid-morning biscuit for a tangerine, and add a side salad to your lunch. Have a portion of vegetables with dinner, and snack on fresh fruit with natural plain yogurt in the evening to reach your daily fruit and vegetable requirement.

Milk and dairy foods: go for lower-fat varieties

Milk and dairy foods such as cheese and yoghurt are good sources of protein. They also contain calcium, which helps keep your bones healthy.

To enjoy the health benefits of dairy without eating too much fat, use semi-skimmed, 1% fat or skimmed milk, as well as lower-fat hard cheeses or cottage cheese, and lower-fat, lower-sugar yogurt. Unsweetened, calcium-fortified dairy alternatives like soya milks, soya yogurts and soya cheeses also count as part of this food group and can make good alternatives to dairy products.

Beans, pulses, fish, eggs, meat and other proteins

These foods are all good sources of protein, which is essential for the body to grow and repair itself. They are also good sources of a range of vitamins and minerals.

Meat is a good source of protein, vitamins and minerals, including iron, zinc and B vitamins. It is also one of the main sources of vitamin B12. Try to eat lean cuts of meat and skinless poultry whenever possible to cut down on fat. Always cook meat thoroughly. Learn more by reading our page on meat.

Fish is another important source of protein, and contains many vitamins and minerals. Oily fish is particularly rich in omega-3 fatty acids.

Aim for at least two portions of fish a week, including one portion of oily fish. You can choose from fresh, frozen or canned, but remember that canned and smoked fish can often be high in salt.

Eggs and pulses (including beans, nuts and seeds) are also great sources of protein. Nuts are high in fiber and a good alternative to snacks high in saturated fat, but they do still contain high levels of fat, so eat them in moderation.

Worst carbs – How does sugar in your diet affect your health ?

Eating too much sugar can make you gain weight and can also cause tooth decay.

The type of sugars most adults and children in the US eat too much of are “free sugars”. These are:

• Any sugars added to food or drinks. These include sugars in biscuits, chocolate, flavoured yoghurts, breakfast cereals and fizzy drinks. These sugars may be added at home, or by a chef or other food manufacturer.
• Sugars in honey, syrups (such as maple, agave and golden), nectars (such as blossom), and unsweetened fruit juices, vegetable juices and smoothies. The sugars in these foods occur naturally but still count as free sugars.

Sugar found naturally in milk, fruit and vegetables doesn’t count as free sugars. We don’t need to cut down on these sugars, but remember that they are included in the “total sugar” figure found on food labels.

“Sugar is sugar,” whether it’s white, brown, unrefined sugar, molasses or honey, don’t kid yourself: there is no such thing as a healthy sugar.

Your weight and sugar

Eating too much sugar can contribute to people having too many calories, which can lead to weight gain. Being overweight increases your risk of health problems such as heart disease, some cancers and type 2 diabetes.

For a healthy, balanced diet, we should get most of our calories from other kinds of foods, such as starchy foods (wholegrain where possible) and fruits and vegetables, and only eat foods high in free sugars occasionally or not at all.

Tooth decay and sugar

Sugar is one of the main causes of tooth decay.

To prevent tooth decay, reduce the amount of food and drinks you have that contain free sugars – such as sweets, chocolates, cakes, biscuits, sugary breakfast cereals, jams, honey, fruit smoothies and dried fruit – and limit them to mealtimes.

The sugars found naturally in fruit and vegetables are less likely to cause tooth decay, because they are contained within the structure. But when fruit and vegetables are juiced or blended into a smoothie, the sugars are released. Once released, these sugars can damage teeth.

Limit the amount of fruit juice and smoothies you drink to a maximum of 150ml (a small glass) in total per day, and drink it with meals to reduce the risk of tooth decay.

Squashes sweetened with sugar, fizzy drinks, soft drinks and juice drinks have no place in a child’s daily diet. If you’re looking after children, swap any sugary drinks for water, lower-fat milk or sugar-free drinks.

Dried fruit and your teeth

It’s better for your teeth to eat dried fruit as part of a meal, such as added to your breakfast cereal, tagines and stews, or as part of a healthy dessert – a baked apple with raisins, for example – and not as a between-meal snack.

How much sugar can you eat ?

The health department recommends that free sugars – sugars added to food or drinks, and sugars found naturally in honey, syrups, and unsweetened fruit and vegetable juices, smoothies and purées – shouldn’t make up more than 5% of the energy (calories) you get from food and drink each day.

Table 1. Current Guidelines for Sugar Intake

US Department of Agriculture and US Department of Health and Human Services (2015-2020)	Limit consumption of added sugars to <10% of calories per day
World Health Organization (March 2015)	Restrict added sugar consumption to <10% of daily calories
American Heart Association (2009)	Limit added sugars to 5% of daily calories (for women, 100 calories/day; for men, 150 calories/day)

The American Heart Association ² recommends no more than half of your daily discretionary calorie allowance come from added sugars. Your daily discretionary calorie allowance consists of calories available after meeting nutrient needs. This is no more than 100 calories per day for most American women and no more than 150 per day for men (or about 6 teaspoons a day for women and 9 teaspoons a day for men).

This means:

• Adults should have no more than 30g of free sugars a day, (roughly equivalent to seven sugar cubes).
• Children aged 7 to 10 should have no more than 24g of free sugars a day (six sugar cubes).
• Children aged 4 to 6 should have no more than 19g of free sugars a day (five sugar cubes).
• There is no guideline limit for children under the age of 4, but it’s recommended they avoid sugar-sweetened drinks and food with sugar added to it. Find out more about what to feed young children.

Free sugars are found in foods such as sweets, cakes, biscuits, chocolate, and some fizzy drinks and juice drinks. These are the sugary foods we should cut down on. For example, a can of cola can have as much as nine cubes of sugar – more than the recommended daily limit for adults.

Top sources of added sugar in your diet

From cola, chocolate and ketchup to beer, yogurt and soup, find out where most of the added sugar in your diet lurks.

“Added sugar”, such as table sugar, honey and syrups, should not make up more than 5% of the total energy you get from food and drink each day. This is around 30g a day of added sugar for anyone aged 11 and older.

If you want to cut down on sugar, get used to reading food labels, comparing products, and choosing lower-sugar or sugar-free versions.

Products are considered to either be high or low in sugar if they fall above or below the following thresholds:

• high: more than 22.5g of total sugars per 100g
• medium: more than 5g but less than or equal to 22.5g of sugar per 100g
• low: 5g or less of total sugars per 100g

If the amount of sugars per 100g is between these figures, that is regarded as a medium level.

Figure 1. Carbohydrate and sugar content food label

The “Total Sugars” figure describes the total amount of sugars from all sources – free sugars, plus those from milk, and those present in fruit and vegetables.

For example, plain yogurt may contain as much as 8g per serving, but none of these are free sugars, as they all come from milk.

The same applies to an individual portion of fruit. An apple might contain around 11g of total sugar, depending on the size of the fruit selected, the variety and the stage of ripeness. However, sugar in fruit is not considered free sugars unless the fruit is juiced or puréed.

This means food containing fruit or milk will be a healthier choice than one containing lots of free sugars, even if the two products contain the same total amount of sugar. You can tell if the food contains lots of added sugars by checking the ingredients list.

Sometimes you will see a figure just for “Carbohydrate” and not for “Carbohydrate (of which sugars)”. The “Carbohydrate” figure will also include starchy carbohydrates, so you can’t use it to work out the sugar content. In this instance, check the ingredients list to see if the food is high in added sugar.

Ingredients list

You can get an idea of whether a food is high in free sugars by looking at the ingredients list on the packaging.

Sugars added to foods and drinks must be included in the ingredients list, which always starts with the ingredient that there’s the most of. This means that if you see sugar near the top of the list, the food is likely to be high in free sugars.

Watch out for other words used to describe the sugars added to food and drinks, such as cane sugar, honey, brown sugar, high-fructose corn syrup, fruit juice concentrate/purées, corn syrup, fructose, sucrose, glucose, crystalline sucrose, nectars (such as blossom), maple and agave syrups, dextrose, maltose, molasses and treacle.

No added sugar or unsweetened

• “No added sugar” or “unsweetened” refer to sugar or sweeteners that are added as ingredients. They do not mean that the food contains no sugar.

The ingredients lists on food products with “no added sugar” and “unsweetened” labels will tell you what ingredients have been used, including what types of sweetener and sugar. You can often find information about how much sugar there is in the food in the nutrition label.

No added sugar

• This usually means that the food has not had sugar added to it as an ingredient.

A food that has “no added sugar” might still taste sweet and can still contain sugar.

• Sugars occur naturally in food such as fruit and milk. But you don’t need to cut down on these types of sugar: it is food containing added sugars that youe should be cutting down on.

Just because a food contains “no added sugar”, this does not necessarily mean it has a low sugar content. The food may contain ingredients that have a naturally high sugar content (such as fruit), or have added milk, which contains lactose, a type of sugar that occurs naturally in milk.

Unsweetened

This usually means that no sugar or sweetener has been added to the food to make it taste sweet. This doesn’t necessarily mean that the food will not contain naturally occurring sugars found in fruit or milk.

Sugar by Any Other Name

You don’t always see the word “sugar” on a food label. It sometimes goes by another name, like these:

• White sugar
• Brown sugar
• Raw sugar
• Agave nectar
• Brown rice syrup
• Corn syrup
• Corn syrup solids
• Coconut sugar
• Coconut palm sugar
• High-fructose corn syrup
• Invert sugar
• Dextrose
• Anhydrous dextrose
• Crystal dextrose
• Dextrin
• Evaporated cane juice
• Fructose sweetener
• Liquid fructose
• Glucose
• Lactose
• Honey
• Malt syrup
• Maple syrup
• Molasses
• Pancake syrup
• Sucrose
• Trehalose
• Turbinado sugar
• Isoglucose
• Levulose

Watch out for items that list any form of sugar in the first few ingredients, or have more than 4 total grams of sugar.

Below are the six main sources of added sugar in the American diet according to the National Health and Nutrition Examination Survey (NHANES) ¹, with examples of some of the main sweet offenders.

Sugar, preserves and confectionery

• Up to 27% of your daily intake of added sugar

Americans have a sweet tooth. A large chunk of the added sugar in your daily diet (up to 27%) comes from table sugar, jams, chocolate and sweets, with chocolate regularly voted American’s favorite sweet treat. Sugar intake is highest among children aged 11 to 18 years.

Sweet offenders:

• chocolate spread (57.1g of total sugar per 100g)
• plain chocolate (62.6g/100g)
• fruit pastilles (59.3g/100g)

Non-alcoholic drinks

• 25% of your daily intake of added sugar

Perhaps the most surprising source, nearly a quarter (25%) of the added sugar in our diet comes from soft drinks, fruit juice, and other non-alcoholic drinks.

The levels are even higher among children aged 11 to 18 years, who get 40% of their added sugar from drinks – mainly soft drinks, such as cola.

A 500ml bottle of cola contains the equivalent of 17 cubes of sugar. Perhaps more surprising, 100% pure unsweetened fruit juice is high in the type of sugars we need to cut down on. This is because the juicing process releases the sugars contained in the fruit, meaning they can damage our teeth.

Fruit juice contains vitamins and minerals, so one glass (150ml) of unsweetened 100% fruit juice counts towards the 5% of the total energy (calories) intake. To reduce the risk of tooth decay, fruit juice is best enjoyed at mealtimes.

Children should avoid sugary drinks and swap to water, lower-fat milks, and diet, sugar-free and no-added sugar drinks.

Sweet offenders:

• cola (10.9g/100ml)
• squash cordials (24.6g/100ml)
• sweetened fruit juice (9.8g/100ml)

Biscuits, buns and cakes

• 20% of our daily intake of added sugar

America is a nation of “grazers”, preferring to fill up on something that’s quick and comforting, but often high in sugar and fat, such as buns, pastries, biscuits, and other cereal-based foods.

While cereal-based products, especially wholegrains, form part of a healthy balanced diet, try to cut down on varieties high in sugar and fat, which can increase the risk of tooth decay and contribute to weight gain if eaten in excess.

Sweet offenders:

• iced cakes (54g/100g)
• chocolate-coated biscuits (45.8g/100g)
• frosted corn flakes (37g/100g)

Alcoholic drinks

• 11% of our daily intake of added sugar

Some people are unaware of the sugar content in alcohol and don’t include booze when calculating their daily calorie intake.

Alcohol contains more calories (7kcal/g) than carbohydrates or protein (4kcal/g). A standard glass of wine (175ml, 12% ABV, 126kcal) can contain as many calories as a piece of chocolate.

Wine, beer, cider, spirits and all your favorite drinks are made from natural starch and sugar. Fermentation, and distillation for certain drinks, is used to produce the alcohol content.

This helps explain why alcohol contains lots of calories – seven calories a gram in fact, almost as many as a gram of fat. And, of course, additional calories can be present in added mixer drinks.

The average wine drinker in America takes in around 2,000kcal from alcohol every month.

Drinking five pints of lager a week adds up to 44,200kcal over a year, equivalent to eating 221 doughnuts.

Table 2. Alcohol calories

Drink	Calories (kcal)	Food equivalent
A standard glass (175ml) of 12% wine	126kcal	1 Cadbury Chocolate Mini Roll
A pint of 5% strength beer	215kcal	1 packet of McCoy’s salted crisps
A glass (50ml) of (17%) cream liqueur	118kcal	1 Milky Way bar
A standard bottle (330ml) of 5% alcopop	237kcal	3 Lees teacakes
A double measure (50ml) of 17.5% fortified wine	65kcal	1 Asda bourbon biscuit

Tips on cutting down:

• have a few alcohol-free days each week
• try lower-alcohol drinks
• have a smaller bottle of beer instead of a can
• use sugar-free mixers
• swap every other drink for a water or sugar-free soft drink

Dairy products

• 6% of our daily intake of added sugar

Dairy products like cheese and yoghurt form part of a healthy balanced diet. But some dairy products, such as flavored milks, yogurts and dairy-based desserts like ice cream, contain added sugar.

Sweet offenders:

• fruit yoghurt (16.6g/100g)
• fruit fromage frais (13.3g/100g)
• choc ice (20.5g/100g)

Savory food

• 5% of our daily intake of added sugar

Sugar is also found in surprisingly large amounts in many savory foods, such as stir-in sauces, ketchup, salad cream, ready meals, marinades, chutneys, and crisps. A study found some ready meals had more sugar content than vanilla ice cream.

Sweet offenders:

• tomato ketchup (27.5g/100g)
• stir-in sweet and sour sauce (20.2g/100g)
• salad cream (16.7g/100g)

Tips to cut down on sugars

For a healthy, balanced diet, cut down on food and drinks containing free sugars.

These tips can help you to cut down:

Reducing sugar in drinks

• Instead of sugary fizzy drinks or sugary squash, go for water, lower-fat milk, or sugar-free, diet or no-added-sugar drinks. While the amount of sugar in whole and lower-fat milk is the same, choosing lower-fat milk reduces your saturated fat intake.
• Even unsweetened fruit juices and smoothies are sugary, so limit the amount you have to no more than 150ml a day.
• If you prefer fizzy drinks, try diluting no-added-sugar squash with sparkling water.
• If you take sugar in hot drinks or add sugar to your breakfast cereal, gradually reduce the amount until you can cut it out altogether. Alternatively, switch to a sweetener.

Reducing sugar in food

• Rather than spreading high-sugar jam, marmalade, syrup, chocolate spread or honey on your toast, try a lower-fat spread, reduced-sugar jam or fruit spread, sliced banana or lower-fat cream cheese instead.
• Check nutrition labels to help you pick the foods with less added sugar, or go for the reduced- or lower-sugar version.
• Try reducing the sugar you use in your recipes. It works for most things except jam, meringues and ice cream.
• Choose tins of fruit in juice rather than syrup.
• Choose unsweetened wholegrain breakfast cereals that aren’t frosted, or coated with chocolate or honey.
• Choose unsweetened cereal and try adding some fruit for sweetness. Sliced bananas, dried fruit and berries are all good options.

What are the best carbs for bodybuilding

While it is true that resistance training utilizes glycogen as its main fuel source ³, total caloric expenditure of strength athletes is less than that of mixed sport and endurance athletes. Thus, authors of a recent review recommend that carbohydrate intakes for strength sports, including bodybuilding, be between 4–7 g/kg depending on the phase of training ⁴. However, in the specific case of a bodybuilder in contest preparation, achieving the necessary caloric deficit while consuming adequate protein and fat would likely not allow consumption at the higher end of this recommendation.

Satiety and fat loss generally improve with lower carbohydrate diets; specifically with higher protein to carbohydrate ratios ⁵, ⁶. In terms of performance and health, low carbohydrate diets are not necessarily as detrimental as typically espoused ⁷. In a recent review, it was recommended for strength athletes training in a calorically restricted state to reduce carbohydrate content while increasing protein to maximize fat oxidation and preserve lean body mass (LBM) ⁸. However, the optimal reduction of carbohydrate and point at which carbohydrate reduction becomes detrimental likely needs to be determined individually.

While it appears low carbohydrate, high protein diets can be effective for weight loss, a practical carbohydrate threshold appears to exist where further reductions negatively impact performance and put one at risk for lean body mass losses. In support of this notion, researchers studying bodybuilders during the final 11 weeks of contest preparation concluded that had they increased carbohydrate during the final weeks of their diet they may have mitigated metabolic and hormonal adaptations that were associated with reductions in lean body mass (LBM) ⁹.

Therefore, once a competitor has reached or has nearly reached the desired level of leanness, it may be a viable strategy to reduce the caloric deficit by an increase in carbohydrate. For example, if a competitor has reached competition body fat levels (lacking any visible subcutaneous fat) and is losing half a kilogram per week (approximately a 500 kcals caloric deficit), carbohydrate could be increased by 25-50 g, thereby reducing the caloric deficit by 100-200 kcals in an effort to maintain performance and lean body mass. However, it should be noted that like losses of lean body mass, decrements in performance may not affect the competitive outcome for a bodybuilder. It is possible that competitors who reach the leanest condition may experience unavoidable drops in performance.

Table 3. Dietary recommendations for bodybuilding contest preparation

Diet component	Recommendation
Protein (g/kg of lean body mass)	2.3-3.1
Fat (% of total calories)	15-30%
Carbohydrate (% of total calories)	remaining
Weekly weight loss (% of body weight)	0.5-1%

[Source ¹⁰]

Note: It must be noted that there is a high degree of variability in the way that individuals respond to diets. If training performance degrades it may prove beneficial to decrease the percentage of calories from dietary fat within these ranges in favor of a greater proportion of carbohydrate. Finally, while outside of the norm, some competitors may find that they respond better to diets that are higher in fat and lower in carbohydrate than recommended in this review. Therefore, monitoring of individual response over a competitive career is suggested. There is no evidence of any relationships with bone structure or regional subcutaneous fat distribution with any response to specific macronutrient ratios in bodybuilders or athletic populations. Bodybuilders, like others athletes, most likely operate best on balanced macronutrient intakes tailored to the energy demands of their sport ¹¹. While the majority of competitors will respond best to the fat and carbohydrate guidelines proposed, the occasional competitor will undoubtedly respond better to a diet that falls outside of these suggested ranges. Careful monitoring over the course of a competitive career is required to determine the optimal macronutrient ratio for pre-contest dieting.

Timing and consumption of protein and/or carbohydrate during workouts

Questions remain about the utility of consuming protein and/or carbohydrate during bodybuilding-oriented training bouts. Since these bouts typically do not resemble endurance bouts lasting 2 hours or more, nutrient consumption during training is not likely to yield any additional performance-enhancing or muscle -sparing benefits if proper pre-workout nutrition is in place. In the exceptional case of resistance training sessions that approach or exceed two hours of exhaustive, continuous work, it might be prudent to employ tactics that maximize endurance capacity while minimizing muscle damage. This would involve approximately 8–15 g protein co-ingested with 30–60 g carbohydrate in a 6-8% solution per hour of training ¹². Nutrient timing is an intriguing area of study that focuses on what might clinch the competitive edge. In terms of practical application to resistance training bouts of typical length, Aragon and Schoenfeld ¹³ recently suggested a protein dose corresponding with 0.4-0.5 g/kg bodyweight consumed at both the pre- and post-exercise periods. However, for objectives relevant to bodybuilding, the current evidence indicates that the global macronutrient composition of the diet is likely the most important nutritional variable related to chronic training adaptations. Table 4 below provides a continuum of importance with bodybuilding-specific context for nutrient timing.

Table 4. Continuum of nutrient & supplement timing importance

[Source ¹⁰] References

1. National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/nhanes/index.htm
2. American Heart Association – Sugar Intake – http://www.heart.org/HEARTORG/Encyclopedia/Heart-and-Stroke-Encyclopedia_UCM_445084_ContentIndex.jsp?title=sugar%20intake
3. Muscle substrate utilization and lactate production. MacDougall JD, Ray S, Sale DG, McCartney N, Lee P, Garner S. Can J Appl Physiol. 1999 Jun; 24(3):209-15. https://www.ncbi.nlm.nih.gov/pubmed/10364416/
4. Nutrition guidelines for strength sports: sprinting, weightlifting, throwing events, and bodybuilding. Slater G, Phillips SM. J Sports Sci. 2011; 29 Suppl 1():S67-77. https://www.ncbi.nlm.nih.gov/pubmed/21660839/
5. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. Layman DK, Boileau RA, Erickson DJ, Painter JE, Shiue H, Sather C, Christou DD. J Nutr. 2003 Feb; 133(2):411-7. https://www.ncbi.nlm.nih.gov/pubmed/12566476/
6. Energy expenditure, satiety, and plasma ghrelin, glucagon-like peptide 1, and peptide tyrosine-tyrosine concentrations following a single high-protein lunch. Smeets AJ, Soenen S, Luscombe-Marsh ND, Ueland Ø, Westerterp-Plantenga MS. J Nutr. 2008 Apr; 138(4):698-702. https://www.ncbi.nlm.nih.gov/pubmed/18356323/
7. Low-carbohydrate diets and performance. Cook CM, Haub MD. Curr Sports Med Rep. 2007 Jul; 6(4):225-9. https://www.ncbi.nlm.nih.gov/pubmed/17617997/
8. Dietary protein for athletes: from requirements to optimum adaptation. Phillips SM, Van Loon LJ. J Sports Sci. 2011; 29 Suppl 1():S29-38. https://www.ncbi.nlm.nih.gov/pubmed/22150425/
9. Anabolic and catabolic hormones and energy balance of the male bodybuilders during the preparation for the competition. Mäestu J, Eliakim A, Jürimäe J, Valter I, Jürimäe T. J Strength Cond Res. 2010 Apr; 24(4):1074-81. https://www.ncbi.nlm.nih.gov/pubmed/20300017/
10. Helms ER, Aragon AA, Fitschen PJ. Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation. Journal of the International Society of Sports Nutrition. 2014;11:20. doi:10.1186/1550-2783-11-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033492/
11. A perspective on fat intake in athletes. Pendergast DR, Leddy JJ, Venkatraman JT. J Am Coll Nutr. 2000 Jun; 19(3):345-50. https://www.ncbi.nlm.nih.gov/pubmed/10872896/
12. International Society of Sports Nutrition position stand: nutrient timing. Kerksick C, Harvey T, Stout J, Campbell B, Wilborn C, Kreider R, Kalman D, Ziegenfuss T, Lopez H, Landis J, Ivy JL, Antonio J. J Int Soc Sports Nutr. 2008 Oct 3; 5():17. https://www.ncbi.nlm.nih.gov/pubmed/18834505/
13. Aragon AA, Schoenfeld BJ. Nutrient timing revisited: is there a post-exercise anabolic window? J Int Soc Sports Nutr. 2013;10:5. doi: 10.1186/1550-2783-10-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577439/

Best superfoods for men

Most men need to pay more attention to their health. Compared to women, men are more likely to:

• Smoke
• Drink alcohol
• Make unhealthy or risky choices
• Put off regular checkups and medical care

There are also health conditions that only affect men, such as prostate cancer and low testosterone. Many of the major health risks that men face – like colon cancer or heart disease – can be prevented and treated with early diagnosis. Screening tests can find diseases early, when they are easier to treat. It’s important to get the screening tests you need.

The good news is that you can start taking better care of your health today.

Leading Causes of Death in Males United States, 2014

All Males, All Ages Summary	Percent*
1) Heart disease	24.5
2) Cancer	23.4
3) Unintentional injuries	6.4
4) Chronic lower respiratory diseases	5.2
5) Stroke	4.2
6) Diabetes	3.1
7) Suicide	2.5
8) Alzheimer’s disease	2.1
9) Influenza and pneumonia	2.0
10) Chronic liver disease	1.9

*Percent of total deaths in the race category due to the disease indicated. The white, black, American Indian/Alaska Native, and Asian/Pacific Islander race groups include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.

[Source ¹]

The good news is there’s a lot you can do to prevent heart disease.

Healthy Habits

It’s not too late to start healthier habits.

Make eating healthy and being active part of your daily routine. A healthy diet and regular physical activity can help lower your:

• Blood pressure
• Blood sugar
• Cholesterol
• Weight

By keeping these numbers down, you can lower your risk of serious health problems like type 2 diabetes and heart disease.

You can also help prevent health problems by:

• Drinking alcohol only in moderation
• Quitting smoking

How To Keep Your Heart Healthy

What is heart disease ?

When people talk about heart disease, they are usually talking about coronary heart disease. It’s also called coronary artery disease. This is the most common type of heart disease ².

When someone has coronary heart disease (coronary artery disease), the coronary arteries that take blood to the heart are narrow or blocked. This happens when cholesterol and fatty material, called plaque, build up inside the arteries.

Plaque is caused by:

• Too much fat and cholesterol in the blood
• High blood pressure
• Smoking
• Too much sugar in the blood (usually because of diabetes)

When plaque blocks an artery, it’s hard for blood to flow to the heart. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur.

• Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
• A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Over time, coronary heart disease (coronary artery disease) can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.

Take steps today to lower your risk of heart disease. Heart disease is the leading cause of death for both men and women in the United States.

To help prevent heart disease, you can:

• Eat healthy.
• Get active.
• Stay at a healthy weight.
• Quit smoking and stay away from secondhand smoke.
• Control your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Manage stress.

Sodium

You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and “no added salt” foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.

Alcohol

Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:

• 12 ounces of beer
• 5 ounces of wine
• 1½ ounces of liquor

Risk factors for heart disease

Everyone is at risk for heart disease. But you are at higher risk for heart disease if you:

• Have high cholesterol or high blood pressure
• Smoke
• Are overweight or obese
• Don’t get enough physical activity
• Don’t eat a healthy diet

Your age and family history also affect your risk for heart disease. Your risk is higher if:

• You are a woman over age 55
• You are a man over age 45
• Your father or brother had heart disease before age 55
• Your mother or sister had heart disease before age 65

Heart-Healthy Eating

Heart-healthy eating usually include:

• Fat-free or low-fat dairy products, such as fat-free milk
• Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
• Fruits, such as apples, bananas, oranges, pears, and prunes
• Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
• Vegetables, such as broccoli, cabbage, and carrots
• Whole grains, such as oatmeal, brown rice, barley and corn tortillas

Not all fats are bad. Monounsaturated (MUFAs) and polyunsaturated fats (PUFAs) actually help lower blood cholesterol levels.

Some sources of monounsaturated and polyunsaturated fats are:

• Avocados
• Corn, sunflower, and soybean oils
• Nuts and seeds, such as walnuts
• Olive, canola, peanut, safflower, and sesame oils
• Peanut butter
• Salmon and trout
• Tofu

When following a heart-healthy diet, you should avoid eating:

• A lot of red meat
• Palm and coconut oils
• Sugary foods and beverages

Two nutrients in your diet make blood cholesterol levels rise:

• Saturated fat—found mostly in foods that come from animals
• Trans fat (trans fatty acids)—found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.

Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat.

Barley Health Benefits

In scientific studies, barley has been shown to reduce the risk of many diseases and to provide important health benefits. Barley offers many of the same healthy vitamins and minerals as other whole grains, but many think its special health benefits stem from the high levels of soluble beta-glucan fiber found in this grain. According to Health Canada ³ and the US Food and Drug Administration ⁴, consuming at least 3 grams per day of barley beta-glucan or 0.75 grams per serving of soluble fiber can lower levels of blood cholesterol, a risk factor for cardiovascular diseases.

A recent review in the journal Minerva Med ⁵, beta-glucans reduce cholesterol, help control blood sugar, and improve immune system function. New research even indicates that beta-glucans may be radioprotective: they may help your bodies stand up better to chemotherapy, radiation therapy and nuclear emergencies.

• Barley, like all whole grains, reduces blood pressure.
• Eating barley has been shown to lower LDL “bad” cholesterol and may help reduce the risk of heart disease.
• A flood of recent research indicates that barley’s ability to control blood sugar may be exceptional, offering an important tool against rising rates of diabetes.
• Barley has more protein than corn, brown rice, millet, sorghum or rye, and is higher in fiber and lower in soluble (starch) carbohydrates than almost all other whole grains.
• Barley may help you feel full longer, and thereby help you control your weight.
• Barley – even pearl barley – may help reduce visceral fat and waist circumference.

In a 100 gram serving, raw barley provides 354 calories and is a rich source (20% or more of the Daily Value, DV) of essential nutrients, including protein, dietary fiber, the B vitamins, niacin (31% DV) and vitamin B6 (20% DV), and several dietary minerals (see Table 1). Highest nutrient contents are for manganese (63% DV) and phosphorus (32% DV). Raw barley is 78% carbohydrates, 1% fat, 10% protein and 10% water.

Table 1. Barley hulled nutrition facts

Nutrient	Unit	Value per 100 g
Approximates
Water	g	9.44
Energy	kcal	354
Energy	kJ	1481
Protein	g	12.48
Total lipid (fat)	g	2.3
Ash	g	2.29
Carbohydrate, by difference	g	73.48
Fiber, total dietary	g	17.3
Sugars, total	g	0.8
Minerals
Calcium, Ca	mg	33
Iron, Fe	mg	3.6
Magnesium, Mg	mg	133
Phosphorus, P	mg	264
Potassium, K	mg	452
Sodium, Na	mg	12
Zinc, Zn	mg	2.77
Copper, Cu	mg	0.498
Manganese, Mn	mg	1.943
Selenium, Se	µg	37.7
Vitamins
Vitamin C, total ascorbic acid	mg	0
Thiamin	mg	0.646
Riboflavin	mg	0.285
Niacin	mg	4.604
Pantothenic acid	mg	0.282
Vitamin B-6	mg	0.318
Folate, total	µg	19
Folic acid	µg	0
Folate, food	µg	19
Folate, DFE	µg	19
Vitamin B-12	µg	0
Vitamin B-12, added	µg	0
Vitamin A, RAE	µg	1
Retinol	µg	0
Carotene, beta	µg	13
Carotene, alpha	µg	0
Cryptoxanthin, beta	µg	0
Vitamin A, IU	IU	22
Lycopene	µg	0
Lutein + zeaxanthin	µg	160
Vitamin E (alpha-tocopherol)	mg	0.57
Vitamin E, added	mg	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Vitamin K (phylloquinone)	µg	2.2
Lipids
Fatty acids, total saturated	g	0.482
04:00:00	g	0
06:00:00	g	0
08:00:00	g	0
10:00:00	g	0
12:00:00	g	0.006
14:00:00	g	0.011
16:00:00	g	0.411
18:00:00	g	0.017
Fatty acids, total monounsaturated	g	0.295
16:1 undifferentiated	g	0.006
18:1 undifferentiated	g	0.241
20:01:00	g	0
22:1 undifferentiated	g	0
Fatty acids, total polyunsaturated	g	1.108
18:2 undifferentiated	g	0.999
18:3 undifferentiated	g	0.11
18:04:00	g	0
20:4 undifferentiated	g	0
20:5 n-3 (EPA)	g	0
22:5 n-3 (DPA)	g	0
22:6 n-3 (DHA)	g	0
Cholesterol	mg	0
Amino Acids
Tryptophan	g	0.208
Threonine	g	0.424
Isoleucine	g	0.456
Leucine	g	0.848
Lysine	g	0.465
Methionine	g	0.24
Cystine	g	0.276
Phenylalanine	g	0.7
Tyrosine	g	0.358
Valine	g	0.612
Arginine	g	0.625
Histidine	g	0.281
Alanine	g	0.486
Aspartic acid	g	0.779
Glutamic acid	g	3.261
Glycine	g	0.452
Proline	g	1.484
Serine	g	0.527
Other
Alcohol, ethyl	g	0
Caffeine	mg	0
Theobromine	mg	0
Flavan-3-ols
(+)-Catechin	mg	2.4
Proanthocyanidin
Proanthocyanidin dimers	mg	33.6
Proanthocyanidin trimers	mg	30.6
Proanthocyanidin 4-6mers	mg	27.2
Proanthocyanidin 7-10mers	mg	0
Proanthocyanidin polymers (>10mers)	mg	0

[Source ⁶]

Barley Controls Blood Sugar Better

Dutch researchers ⁷ used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast.

Barley Lowers Glucose Levels

White rice, the staple food in Japan, is a high glycemic index food. Researchers at the University of Tokushima found that glucose levels were lower after meals when subjects switched from rice to barley ⁸.

Barley Beta-Glucan Lowers Glycemic Index

Scientists at the Functional Food Centre at Oxfod Brookes University in England ⁹ fed 8 healthy human subjects chapatis (unleavened Indian flatbreads) made with either 0g, 2g, 4g, 6g or 8g of barley beta-glucan fiber. They found that all amounts of barley beta-glucan lowered the glycemic index of the breads, with 4g or more making a significant difference.

Insulin Response better with Barley Beta-Glucan

In a crossover study ¹⁰ involving 17 obese women at increased risk for insulin resistance, USDA scientists studied the effects of 5 different breakfast cereal test meals on subjects’ insulin response. They found that consumption of 10g of barley beta-glucan significantly reduced insulin response.

Barley Beats Oats in Glucose Response Study

USDA researchers fed barley flakes, barley flour, rolled oats, oat flour, and glucose to 10 overweight middle-aged women, then studied their bodies’ responses ¹¹. They found that peak glucose and insulin levels after barley were significantly lower than those after glucose or oats. Particle size did not appear to be a factor, as both flour and flakes had similar effects.

Barley Reduces Blood Pressure

For five weeks, adults with mildly high cholesterol were fed diets supplemented with one of three whole grain choices: whole wheat/brown rice, barley, or whole wheat/brown rice/barley ¹². All three whole grain combinations reduced blood pressure, leading USDA researchers to conclude that “in a healthful diet, increasing whole grain foods, whether high in soluble or insoluble fiber, can reduce blood pressure and may help to control weight” ¹².

Barley Lowers Serum Lipids

University of Connecticut researchers ¹³ reviewed 8 studies evaluating the lipid-reducing effects of barley. They found that eating barley significantly lowered total cholesterol, LDL (“bad”) cholesterol, and triglycerides, but did not appear to significantly alter HDL (“good”) cholesterol.

Cholesterol and Visceral Fat Decrease with Barley

A randomized double-blind study ¹⁴ in Japan followed 44 men with high cholesterol for twelve weeks, as the men ate either a standard white-rice diet or one with a mixture of rice and high-beta-glucan pearl barley. Barley intake significantly reduced serum cholesterol and visceral fat, both accepted markers of cardiovascular risk.

Barley significantly Improves Lipids

25 adults with mildly high cholesterol were fed whole grain foods containing 0g, 3g or 6g of barley beta-glucan per day for five weeks, with blood samples taken twice weekly ¹⁵. Total cholesterol and LDL (“bad”) cholesterol significantly decreased with the addition of barley to the diet.

Barley Pasta Lowers Cholesterol

University of California researchers ¹⁶ fed two test meals to 11 healthy men, both containing beta-glucan. One meal was a high-fiber (15.7g) barley pasta and the other was lower-fiber (5.0g) wheat pasta. The barley pasta blunted insulin response, and four hours after the meal, barley-eaters had significantly lower cholesterol concentration than wheat-eaters.

Barley’s Slow Digestion may help Weight Control

Barley varieties such as Prowashonupana that are especially high in beta-glucan fiber may digest more slowly than standard barley varieties. Researchers at USDA and the Texas Children’s Hospital ¹⁷ compared the two and concluded that Prowashonupana may indeed be especially appropriate for obese and diabetic patients.

Greater Satiety, Fewer Calories Eaten with Barley

In a pilot study not yet published, six healthy subjects ate a 420-calorie breakfast bar after an overnight fast, then at lunch were offered an all-you-can-eat buffet. When subjects ate a Prowashonupana barley bar at breakfast they subsequently ate 100 calories less at lunch than when they ate a traditional granola bar for breakfast.

Oats Health Benefits

Scientific studies have concluded that like barley, oats contain a special kind of fiber called beta-glucan found to be especially effective in lowering cholesterol. The water-soluble, mixed-linkage β-glucan, a form of soluble dietary fibre, is considered the main biologically active component responsible for the capacity of many oat products to lower postprandial glycaemia and fasting plasma cholesterol in human subjects ¹⁸. Many in vitro animal and human studies have shown that water-soluble β-glucan is one of the main bioactive components responsible for a number of the putative health benefits attributed to oat products ¹⁹. In breakfast cereals containing 3 g of β-glucan/serving, high-MW (2,210,000 g/mol) or a medium-MW (530,000 g/mol) lowered LDL cholesterol by ≈0.2 mmol/L (5%). However, when the molecular weight of β-glucan was < 210 000 g/mol, the ability of the breakfast cereal to reduce LDL-cholesterol was decreased by 50 % ²⁰.

Most β-glucan in the oat groat is located in the inner layer of the cell wall that is enclosed by an insoluble cellulosic and hemicellulosic outer layer ¹⁹. It is generally less water soluble than extracted β-glucan material. Because the cell walls in the inner endosperm are thinner than in the aleurone and subaleurone layers, it appears that β-glucan in the milled whole groat is more easily extracted than that in oat bran ²¹, ²². For example, Beer et al. ²¹ has found that the proportion of soluble β-glucan extracted from oat brans and rolled oats, by hot-water extraction in conjunction with a heat-stable α-amylase treatment, was 30–65 and 70 %, respectively. Under physiological conditions, the percentage of extractable β-glucan was also noticeably higher in rolled oats than in bran samples. Based on the results of physiological and human studies to date, there is strong evidence to show that oat β-glucan lowers total and LDL-cholesterol and reduces after meal effect glycaemia and insulinaemia when it is ingested in sufficiently high doses and at a suitably high molecular weight ¹⁸.

• Eating oats helps lower LDL “bad” cholesterol and may help reduce the risk of heart disease.
• Oats help you feel fuller longer, which helps control your weight.
• Oatmeal and oats may help lower blood pressure.
• Oats may help reduce your risk of type 2 diabetes, since their soluble fiber helps control blood sugar.
• Oats help cut the use of laxatives, without the side effects associated with medications.
• Oats are high in beta-glucans, a kind of starch that stimulates the immune system and inhibits tumors. This may help reduce your risk of some cancers.
• Early introduction of oats in children’s diets may help reduce their risk of asthma.
• Oats are higher in protein and healthy fats, and lower in carbohydrates than most other whole grains.
• Oats contain more than 20 unique polyphenols called avenanthramides, which have strong anti-oxidant, anti-inflammatory, and anti-itching activity.

Oats Lower Bad Cholesterol

Researchers at Colorado State University ²³ randomly assigned thirty-six overweight middle-aged men to eat either an oat or wheat cereal daily for twelve weeks. At the end of the three-month period, the men eating the oat cereal had lower concentrations of small, dense LDL cholesterol (thought to be particularly dangerous) and lower LDL (“bad”) cholesterol overall, compared to those in the wheat group, while their HDL (“good”) cholesterol was unchanged.

Oats Help Control Blood Pressure

Using a randomized, controlled parallel-group pilot study ²⁴, researchers followed 18 hypertensive and hyperinsulemic men and women for six weeks, while half of them ate oat cereal (5.52g/day of beta-glucan) and the others ate a lower-fiber cereal (less than 1g total fiber). The oat group enjoyed a 7.5mm Hg reduction in systolic blood pressure and a 5.5 mm Hg reduction in diastolic blood pressure, while the wheat group was unchanged.

Oats and Cardiovascular Disease Risk Markers

High consumption of whole-grain food such as oats is associated with a reduced risk of cardiovascular disease and type 2 diabetes. The present systematic literature review ²⁵ concluded that regular consumption of oats or oat bran has a beneficial effect on total cholesterol and LDL-cholesterol, particularly in hypercholesterolaemic (high blood cholesterol) subjects. The intervention trials described in the present review can generally be divided into three groups depending on the product used in the intervention: oat bran; whole-grain oat cereals; oatmeal. For the studies that showed a significant reduction in total cholesterol and/or LDL-cholesterol, the range of doses used was 25–135 g/d for oat bran, 45–90 g/d for whole-grain oat cereals and 60–150 g/d for oatmeal. So it appears that the form of oats does not really affect the outcome. The doses required to reach a significant effect were also similar. However, studies using amounts below 50 g/d are scarce, and more well-designed dose–response studies are needed to confirm the minimum amount required to have a clinical beneficial effect. The 3–6 % cholesterol reduction described in the larger studies would translate to a 6–18 % decrease in coronary heart disease risk. Some studies reported significant effects on blood cholesterol only 2 weeks after beginning the intervention, so it is likely that the benefits of increasing oats intake start very shortly after changing the diet. How long these effects on blood cholesterol remain if subjects revert to their original diet remains to be determined. However, there is no indication that it would significantly modulate insulin sensitivity. It is still unclear whether increased oat consumption would significantly affect other risk markers for cardiovascular disease risk. More comprehensive, properly controlled intervention trials with adequate sample sizes are required to answer this question ²⁵.

To investigate the effect of bread formulated with 6 g of beta-glucan (oat soluble fiber) on serum lipids in overweight normotensive subjects with mild to moderate hypercholesterolemia ²⁶. Thirty-eight male subjects [mean age 59.8  yr, mean body mass index (BMI) 28.3 kg/m(2)] who were eligible for the study ate an normal diet for a 1-week period. They were then divided into 2 groups: group A (19 subjects), who were maintained on American Heart Association (AHA) Step II diet, including whole wheat bread, and group B (19 subjects), who were maintained on AHA Step II diet containing high levels of monounsaturated fatty acids plus bread containing 6 g of beta-glucan (Nutrim-OB) for 8 weeks. Plasma lipids and glucose were measured at baseline and after weeks 8 in all subjects. All subjects were advised to walk for 60 minutes every day. Six grams of beta-glucan from oats added to the AHA Step II diet and moderate physical activity improved lipid profile and caused a decrease in weight and, thus, reduced the risk of cardiovascular events in overweight male individuals with mild to moderate hypercholesterolemia. The diet with added beta-glucan was well accepted and tolerated ²⁶.

This randomized, double-blind, controlled trial ²⁷ evaluated the influence of low fat, low saturated fat food products that contained free tall oil-based phytosterols (TOP) and oat beta-glucan (from whole oats and bran concentrate) on serum lipid concentrations in adults with mild-to-moderate hypercholesterolemia. The results of this trial suggest that consumption of a group of low fat, TOP and beta-glucan- containing foods is a useful adjunct in the dietary management of hypercholesterolemia ²⁷.

In another randomized controlled trial of comparing oatmeal consumption versus noodle consumption on blood lipids of urban Chinese adults with hypercholesterolemia ²⁸. The oat group (n=85) consumed 100 grams of instant oat cereal versus the control group (n=81) who consumed 100 grams of wheat flour-based noodles daily for 6 weeks. Laboratory and anthropometric measurements were conducted at baseline and at the end of the 6-week intervention. Dietary fiber intake increased significantly in the oat group compared to the control group at the end of the 6-week intervention. Total-, LDL-cholesterol and waist circumference decreased significantly in the oat group compared to the control. HDL-cholesterol decreased significantly in the control group versus the oat group. There were no significant changes in blood pressure, other anthropometric or laboratory measures between the two groups at the end of the intervention ²⁸.

In a 6-week randomised controlled trial was conducted to test whether 1·5 g/d β-glucan provided as ready-to-eat oat flakes was as effective in lowering cholesterol as 3·0 g/d from oats porridge ²⁹. Eighty-seven mildly hypercholesterolaemic ( ≥ 5 mmol/l and < 7·5 mmol/l) men and women assigned to one of three diet arms (25 % energy (E%) protein; 45 E% carbohydrate; 30 E% fat, at energy requirements for weight maintenance): (1) minimal β-glucan (control); (2) low-dose oat β-glucan (1·5 g β-glucan; oats low – OL) or (3) higher dose oat β-glucan (3·0 g β-glucan; oats high – OH). Changes in total cholesterol and LDL-cholesterol (LDL-C) from baseline were assessed. Total cholesterol reduced significantly in all groups ( – 7·8 % in the 3·0 g β-glucan oat group, – 7·2 % in the 1·5 g β-glucan oat group and – 5·5 % in  control groups), as did LDL-C (- 8·4 % in the 3·0 g β-glucan oat group, – 8·5 % in the 1·5 g β-glucan oat group and – 5·5 % in the control group). In responders only, β-glucan groups had higher reductions in LDL-Cholesterol compared with controls. Intakes of oat β-glucan were as effective at doses of 1·5 g/d compared with 3 g/d when provided in different food formats that delivered similar amounts of soluble β-glucan ²⁹.

The United States Food and Drug Administration (FDA) approved a health claim for β-glucan soluble fiber from oats for reducing plasma cholesterol levels and risk of heart disease in 1997. Similarly, in 2004 the United Kingdom Joint Health Claims Initiative (JHCI) allowed a cholesterol-lowering health claim for oat β-glucan ³⁰. In 2007, Health Canada, after careful evaluation, concludes on the basis of new research information that a dose of 3 g/day oat β-glucan consumed as part of a diet “free of saturated fatty acids” or “low in saturated fatty acids” could help to promote cardiovascular health ³¹.

Results of this analysis ³⁰ show that studies conducted during the past 13 years support the suggestion that intake of oat β-glucan at daily doses of at least 3 g may reduce plasma total and low-density lipoprotein (LDL) cholesterol levels by 5-10% in normocholesterolemic or hypercholesterolemic subjects. Studies described herein have shown that, on average, oat consumption is associated with 5% and 7% reductions in total and LDL cholesterol levels, respectively. Significant scientific agreement continues to support a relationship between oat β-glucan and blood cholesterol levels, with newer data being consistent with earlier conclusions made by the FDA and JHCI ³⁰.

 

Oats May Help Reduce the Risk of Type 2 Diabetes

Researchers in Mannheim, Germany ³² carried out a dietary intervention with 14 patients who had uncontrolled type 2 diabetes and insulin resistance. The patients were introduced to a diabetes-appropriate diet containing oatmeal during a short hospital stay, then examined again four weeks later. On average, patients achieved a 40% reduction in insulin dosage – and maintained the reduction even after 4 weeks on their own at home.

Oats May Improve Insulin Sensitivity

Researchers in Chicago ³³ carried out a randomized, double-blind, controlled clinical trial of ninety-seven men and women, in which half of the group consumed foods containing oat beta-glucan, while the other half ate control foods. At the end of the trial period, the oat group showed improvements in insulin sensitivity, while the control group was unchanged.

Oats Increase Appetite-Control Hormones

Australian researchers ³⁴ studied fourteen people who ate a control meal and three different cereals with different levels of oat beta glucan. They then collected blood samples for four hours after each meal, and found a significant dose response between higher levels of oat beta glucan and higher levels of Peptide Y-Y, a hormone associated with appetite control.

Oats #3 Overall, #1 for Breakfast, in Satiety Index

Also in Australia, researchers at the University of Sydney ³⁵ fed 38 different foods, one by one, to 11-13 different people, then asked them to report their “satiety” or fullness every 15 minutes for the next two hours. From this, they ranked all 38 foods in a “Satiety Index.” Oatmeal rated #3 overall for making people feel satisfied and full, and it rated #1 in the breakfast food group.

Oats consumption and risk of cancer and overall mortality

A review of epidemiological studies on the intake of oats and oat-based products and its effect on the risk of chronic disease and deaths was performed ³⁶. Seven studies were identified of cancer risk (two each on prostate and colorectal cancer, and one each on pancreatic, breast and endometrial cancer), and one study on overall mortality.

Oatmeal was one of the components of the healthy Nordic food index, whose association with total mortality was investigated in the Danish Diet, Cancer and Health cohort study (57,053 subjects aged 50–64 at baseline) ³⁷. During 12 years of follow-up, 4126 of the cohort participants died. A one-point increase in the index score was associated with a significantly lower mortality for both men and women. Among the individual index components, whole-grain rye bread intake was the factor most consistently associated with lower mortality. An association was suggested for oatmeal intake for >20 g/d vs. ≤20 g/d was 0·91 in men and 0·97 in women.

In an analysis of 1025 cases of colorectal cancer diagnosed among 57,053 participants in the Danish Diet, Cancer and Health cohort study over a 13-year period, no association was found with the healthy Nordic food index, which includes oatmeal intake ³⁸. Consumption of oatmeal was similar among those diagnosed with colorectal cancer and those who remained free of the disease. The HELGA cohort comprises 108,000 Danish, Swedish and Norwegian people (including the Danish Diet, Cancer and Health cohort), of whom 1123 developed colorectal cancer during a median of 11 years of follow-up. This cohort was analysed for the intake of whole-grain products, including whole-grain oats ³⁹. The intake of whole-grain products was associated with a lower incidence of colorectal cancer; however, no consistent association was observed with the intake of whole-grain oats ³⁹.

In conclusion, few epidemiological studies have been conducted on oats and oat-based products and disease risk: overall, they provide weak evidence of a protective effect of oats intake on cancer risk and overall mortality. No conclusions can therefore be confidently drawn on the presence or absence of a protective effect of oats consumption on cancer risk in epidemiological studies. The available results, however, are limited and primarily based on a single cohort study from Denmark, and are limited by heterogeneity in study populations and dietary exposure assessment methods between studies ³⁶.

Oat Beta Glucans Improve Immune System Defenses

Italian researchers ⁵ reviewed existing research about the positive effects of beta glucans on human health. They found that, in addition to reducing cholesterol and blunting glycemic and insulin response, beta glucans boost defenses of the immune system agains bacteria, viruses, fungi, and parasites.

Oats May Boost Nutrition Profile of Gluten-free Diets

Two recent studies ⁴⁰, ⁴¹ out of Scandinavia show that adding oats to a gluten-free diet may enhance the nutritional values of the diets, particularly for vitamins and minerals, as well as increasing antioxidant levels. Researchers asked 13 men and 18 women with Celiac disease to follow a gluten-free diet with the addition of kilned (stabilized) or unkilned oats. After six months, the addition of stabilized oats resulted in an increased intake of vitamin B1 and magnesium, while the unkilned oats increased intakes of magnesium and zinc. In the second study from Scandinavia, the addition of gluten-free oats allowed people on gluten-free diets to achieve their recommended daily intakes of fiber, as well as increasing levels of a particular antioxidant called bilirubin, which helps the body eliminate free radicals as well as protect the brain from oxidative damage.

Oats Help Cut the Use of Laxatives

Laxative use, especially among the elderly in nursing homes, can lead to malnutrition and unwanted weight loss. Viennese researchers studied 30 frail nursing-home residents in a controlled, blind, intervention trial where 15 patients received 7-8g of oat bran per day. At the end of 6 weeks, 59% of the oat group had discontinued laxative use while maintaining body weight; the control group showed an 8% increase in laxative use and a decrease in body weight ⁴².

Early introduction of oats associated with decreased risk of persistent asthma and early introduction of fish with decreased risk of allergic rhinitis

There are two interesting observations in the present study ⁴³. The first is the apparent association between early introduction of oats and protection against persistent asthma. Oats is a commonly used cereal in Finland, as porridge and bread. It is often grouped together with wheat, rye and barley, but it is not closely related to these; e.g. patients with coeliac disease cannot eat wheat, rye or barley, but can use oats ⁴⁴. Animal and cell experiments suggest that oats may have immunomodulatory and anti-inflammatory properties ⁴⁵, ⁴⁶. The same is true for fish – the second interesting finding was that early introduction of fish associates with a reduced frequency of allergic rhinitis. Fish oils may modulate inflammatory responses and have inconsistently modified the risk of allergic diseases and asthma ⁴⁷.

The present findings imply that delaying introduction of oats in infancy may increase the risk of asthma by the age of 5 years at least in children with genetic susceptibility for type 1 diabetes. These observations need to be confirmed in other populations ⁴³.

Beneficial effects of oats in the gluten-free diet

The present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients’ subjective experiences. Twenty two adult coeliac patients included large amounts of oats in their diet. Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly. The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption.  Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet. All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety. Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects. Including oats can help coeliac patients following a strict gluten-free diet ⁴⁸.

Recent evidence suggests that oats that are pure and uncontaminated with other gluten-containing grains, if taken in limited quantities, are safe for most individuals with celiac disease. For adults, up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g (1/4 cup) per day are safe to consume ⁴⁹.

Table 2. Oats nutritional facts

Nutrient	Unit	Value per 100 g
Approximates
Water	g	8.22
Energy	kcal	389
Energy	kJ	1628
Protein	g	16.89
Total lipid (fat)	g	6.9
Ash	g	1.72
Carbohydrate, by difference	g	66.27
Fiber, total dietary	g	10.6
Minerals
Calcium, Ca	mg	54
Iron, Fe	mg	4.72
Magnesium, Mg	mg	177
Phosphorus, P	mg	523
Potassium, K	mg	429
Sodium, Na	mg	2
Zinc, Zn	mg	3.97
Copper, Cu	mg	0.626
Manganese, Mn	mg	4.916
Vitamins
Vitamin C, total ascorbic acid	mg	0
Thiamin	mg	0.763
Riboflavin	mg	0.139
Niacin	mg	0.961
Pantothenic acid	mg	1.349
Vitamin B-6	mg	0.119
Folate, total	µg	56
Folic acid	µg	0
Folate, food	µg	56
Folate, DFE	µg	56
Vitamin B-12	µg	0
Vitamin B-12, added	µg	0
Vitamin A, RAE	µg	0
Retinol	µg	0
Vitamin A, IU	IU	0
Vitamin D (D2 + D3)	µg	0
Vitamin D	IU	0
Lipids
Fatty acids, total saturated	g	1.217
12:00:00	g	0.024
14:00:00	g	0.015
16:00:00	g	1.034
18:00:00	g	0.065
Fatty acids, total monounsaturated	g	2.178
16:1 undifferentiated	g	0.013
18:1 undifferentiated	g	2.165
Fatty acids, total polyunsaturated	g	2.535
18:2 undifferentiated	g	2.424
18:3 undifferentiated	g	0.111
Cholesterol	mg	0
Amino Acids
Tryptophan	g	0.234
Threonine	g	0.575
Isoleucine	g	0.694
Leucine	g	1.284
Lysine	g	0.701
Methionine	g	0.312
Cystine	g	0.408
Phenylalanine	g	0.895
Tyrosine	g	0.573
Valine	g	0.937
Arginine	g	1.192
Histidine	g	0.405
Alanine	g	0.881
Aspartic acid	g	1.448
Glutamic acid	g	3.712
Glycine	g	0.841
Proline	g	0.934
Serine	g	0.75
Other
Alcohol, ethyl	g	0
Isoflavones
Daidzein	mg	0
Genistein	mg	0
Total isoflavones	mg	0
Proanthocyanidin
Proanthocyanidin dimers	mg	0
Proanthocyanidin trimers	mg	0
Proanthocyanidin 4-6mers	mg	0
Proanthocyanidin 7-10mers	mg	0
Proanthocyanidin polymers (>10mers)	mg	0

[Source ⁶]

Dietary Approaches to Stop Hypertension (DASH)

Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure.

Dietary Approaches to Stop Hypertension (DASH) is a flexible and balanced eating plan that helps create a heart-healthy eating style for life ⁵⁰.

The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
The DASH eating plan is a good heart-healthy eating plan, even for those who don’t have high blood pressure.

The Dietary Approaches to Stop Hypertension (DASH) eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:

• Eating vegetables, fruits, and whole grains
• Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
• Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
• Limiting sugar-sweetened beverages and sweets.

When following the DASH eating plan, it is important to choose foods that are:

• Low in saturated and trans fats
• Rich in potassium, calcium, magnesium, fiber, and protein
• Lower in sodium

Ways to Control Sodium Levels

The key to lowering your sodium intake is to make healthier food choices when you’re shopping, cooking, and eating out.

• Don’t add salt when cooking rice, pasta, and hot cereals.
• Flavor your foods with salt-free seasoning blends, fresh or dried herbs and spices, or fresh lemon or lime juice.
• Rinse canned foods or foods soaked in brine before using to remove the sodium.
• Use less table salt to flavor food.
• Read food labels, and choose items that are lower in sodium and salt, particularly for convenience foods and condiments.*
• Choose fresh poultry, fish, and lean meats instead of cured food such as bacon and ham.
• Choose fresh or frozen versus canned fruits and vegetables.
• Avoid food with added salt, such as pickles, pickled vegetables, olives, and sauerkraut.
• Avoid instant or flavored rice and pasta.

*Examples of convenience foods are frozen dinners, prepackaged foods, and soups; examples of condiments are mustard, ketchup, soy sauce, barbecue sauce, and salad dressings.

Most of the sodium Americans eat comes from processed and prepared foods, such as breads, cold cuts, pizza, poultry, soups, sandwiches and burgers, cheese, pasta and meat dishes, and salty snacks. Therefore, healthier choices when shopping and eating out are particularly important.

Increasing Daily Potassium

The DASH eating plan is designed to be rich in potassium, with a target of 4,700 mg potassium daily, to enhance the effects of reducing sodium on blood pressure. The following are examples of potassium-rich foods.

Table 3. Sample Foods and Potassium Levels

Food	Potassium (mg)
Potato, 1 small	738
Plain yogurt, nonfat or low-fat, 8 ounces	530–570
Sweet potato, 1 medium	542
Orange juice, fresh, 1 cup	496
Lima beans, ½ cup	478
Soybeans, cooked, ½ cup	443
Banana, 1 medium	422
Fish (cod, halibut, rockfish, trout, tuna), 3 ounces	200–400
Tomato sauce, ½ cup	405
Prunes, stewed, ½ cup	398
Skim milk, 1 cup	382
Apricots, ¼ cup	378
Pinto beans, cooked, ½ cup	373
Pork tenderloin, 3 ounces	371
Lentils, cooked, ½ cup	365
Kidney beans, cooked, ½ cup	360
Split peas, cooked, ½ cup	360
Almonds, roasted, ⅓ cup	310

Health Benefits of the DASH Eating Plan

Three trials showed the health benefits of the DASH diet, such as lowering high blood pressure and LDL (bad) cholesterol in the blood

Study Results

Three trials found the following health benefits of the DASH diet.

1. DASH (Dietary Approaches to Stop Hypertension Trial): The DASH diet lowers blood pressure and LDL (bad) cholesterol compared with a typical American diet alone or a typical American diet with more fruits and vegetables.
2. DASH-Sodium (DASH Diet, Sodium Intake, and Blood Pressure Trial): The DASH diet lowers blood pressure better than a typical American diet at three daily sodium levels. Combining the DASH diet with sodium reduction gives greater health benefits than the DASH diet alone.
3. PREMIER clinical trial: People can lose weight and lower their blood pressure by following the DASH eating plan and increasing their physical activity.

1. DASH Trial

This trial included 459 adults, some with and without confirmed high blood pressure, and compared three diets including 3,000 mg daily sodium:

• Typical American diet
• Typical American diet plus more fruits and vegetables
• DASH diet

None of the plans were vegetarian or used specialty foods. After 2 weeks, participants who added fruits and vegetables to a typical American diet or those on the DASH diet had lower blood pressure than those who followed a typical American diet alone. However, the participants on the DASH diet had the greatest effect of lowering their high blood pressure.

Follow-up reports from the DASH trial showed that in addition to improving blood pressure, the DASH diet also lowered LDL cholesterol levels. High blood pressure and elevated LDL cholesterol are two major risk factors for cardiovascular disease.

2. DASH-Sodium Trial

This trial randomly assigned 412 participants to a typical American diet or the DASH diet. While on their assigned diet, participants were followed for a month at a high daily sodium level (3,300 mg) and two lower daily sodium levels (2,300 mg and 1,500 mg). Reducing daily sodium lowered blood pressure for participants on either diet. However, blood pressures were lower for participants on the DASH diet versus a typical American diet. Blood pressure decreased with each reduction of sodium. These results showed that lowering sodium intake and eating the DASH diet is more beneficial for lowering blood pressure than following the DASH diet alone.

3. PREMIER Trial

The PREMIER trial included 810 participants who were placed into three groups to lower blood pressure, lose weight, and improve health. The groups included:

• Advice-only group, did not receive counseling on behavior changes
• Established treatment plan, including counseling for 6 months
• Established treatment plan, plus counseling and use of the DASH diet

After 6 months, blood pressure levels declined in all three groups. The two groups that received counseling and followed a treatment plan had more weight loss than the advice-only group. However, participants in the established treatment plan who followed the DASH diet had the greatest improvement in their blood pressure.

The DASH Eating Plan

The DASH eating plan is easy to follow using common foods available in your grocery store. The plan includes daily servings from different food groups. The number of servings you should have depends on your daily calorie (energy) needs.

To figure out your calorie needs, you need to consider your age and physical activity level. If you want to maintain your current weight, you should eat only as many calories as you burn by being physically active. This is called energy balance.

If you need to lose weight, you should eat fewer calories than you burn or increase your activity level to burn more calories than you eat.

Ways to Control Calories

To benefit from the DASH eating plan, it is important to consume the appropriate amount of calories to maintain a healthy weight. To help, read nutrition labels on food, and plan for success with DASH eating plan sample menus and other heart-healthy recipes.

The DASH eating plan can be used to help you lose weight. To lose weight, follow the DASH eating plan and try to reduce your total daily calories gradually. Find out your daily calorie needs or goals with the Body Weight Planner and calorie chart. Talk with your doctor before beginning any diet or eating plan.

General tips for reducing daily calories include:

• Eat smaller portions more frequently throughout the day.
• Reduce the amount of meat that you eat while increasing the amount of fruits, vegetables, whole grains, or dry beans.
• Substitute low-calorie foods, such as when snacking (choose fruits or vegetables instead of sweets and desserts) or drinking (choose water instead of soda or juice), when possible.

Consider your physical activity level. Are you sedentary, moderately active, or active ?

• Sedentary means that you do only light physical activity as part of your typical daily routine.
• Moderately active means that you do physical activity equal to walking about 1.5 to 3 miles a day at 3 to 4 miles per hour, plus light physical activity.
• Active means that you do physical activity equal to walking more than 3 miles per day at 3 to 4 miles per hour, plus light physical activity.

Table 4 below estimates the number of servings from each food group that you should have. Serving quantities are per day, unless otherwise noted.

Table 4. DASH Eating Plan—Number of Food Servings by Calorie Level

Food Group	1,200 Cal.	1,400 Cal.	1,600 Cal.	1,800 Cal.	2,000 Cal.	2,600 Cal.	3,100 Cal.
Grainsa	4–5	5–6	6	6	6–8	10–11	12–13
Vegetables	3–4	3–4	3–4	4–5	4–5	5–6	6
Fruits	3–4	4	4	4–5	4–5	5–6	6
Fat-free or low-fat dairy productsb	2–3	2–3	2–3	2–3	2–3	3	3–4
Lean meats, poultry, and fish	3 or less	3–4 or less	3–4 or less	6 or less	6 or less	6 or less	6–9
Nuts, seeds, and legumes	3 per week	3 per week	3–4 per week	4 per week	4–5 per week	1	1
Fats and oilsc	1	1	2	2–3	2–3	3	4
Sweets and added sugars	3 or less per week	3 or less per week	3 or less per week	5 or less per week	5 or less per week	≤2	≤2
Maximum sodium limitd	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day

^a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

^b For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

^c Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

^d The DASH eating plan has a sodium limit of either 2,300 mg or 1,500 mg per day.

Table 5. DASH Eating Plan—Serving Sizes, Examples, and Significance

Food Group	Serving Sizes	Examples and Notes	Significance of Each Food Group to the DASH Eating Plan
Grainsa	1 slice bread 1 oz dry cerealb ½ cup cooked rice, pasta, or cerealb	Whole-wheat bread and rolls, whole-wheat pasta, English muffin, pita bread, bagel, cereals, grits, oatmeal, brown rice, unsalted pretzels and popcorn	Major sources of energy and fiber
Vegetables	1 cup raw leafy vegetable ½ cup cut-up raw or cooked vegetable ½ cup vegetable juice	Broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes	Rich sources of potassium, magnesium, and fiber
Fruits	1 medium fruit ¼ cup dried fruit ½ cup fresh, frozen, or canned fruit ½ cup fruit juice	Apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, raisins, strawberries, tangerines	Important sources of potassium, magnesium, and fiber
Fat-free or low-fat dairy productsc	1 cup milk or yogurt 1½ oz cheese	Fat-free milk or buttermilk; fat-free, low-fat, or reduced-fat cheese; fat-free/low-fat regular or frozen yogurt	Major sources of calcium and protein
Lean meats, poultry, and fish	1 oz cooked meats, poultry, or fish 1 egg	Select only lean; trim away visible fats; broil, roast, or poach; remove skin from poultry	Rich sources of protein and magnesium
Nuts, seeds, and legumes	⅓ cup or 1½ oz nuts 2 Tbsp peanut butter 2 Tbsp or ½ oz seeds ½ cup cooked legumes (dried beans, peas)	Almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, split peas	Rich sources of energy, magnesium, protein, and fiber
Fats and oilsd	1 tsp soft margarine 1 tsp vegetable oil 1 Tbsp mayonnaise 2 Tbsp salad dressing	Soft margarine, vegetable oil (canola, corn, olive, safflower), low-fat mayonnaise, light salad dressing	The DASH study had 27% of calories as fat, including fat in or added to foods
Sweets and added sugars	1 Tbsp sugar 1 Tbsp jelly or jam ½ cup sorbet, gelatin dessert 1 cup lemonade	Fruit-flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar	Sweets should be low in fat

^a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

^b Serving sizes vary between ½ cup and 1¼ cups, depending on cereal type. Check the product’s Nutrition Facts label.

^c For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

^d Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

The DASH eating plan is just one key part of a heart-healthy lifestyle, and combining it with other lifestyle changes such as physical activity can help you control your blood pressure and LDL (bad) cholesterol for life.

To help prevent and control high blood pressure:

• Be physically active.
• Maintain a healthy weight.
• Limit alcohol intake.
• Manage and cope with stress.

Other lifestyle changes can improve your overall health, such as:

• If you smoke, quit.
• Get plenty of sleep.

To help make lifelong lifestyle changes, try making one change at a time and add another when you feel that you have successfully adopted the earlier changes. When you practice several healthy lifestyle habits, you are more likely to achieve and maintain healthy blood pressure and cholesterol levels.

Cancer Among Men

Three Most Common Cancers Among Men ⁵¹

1. Prostate cancer (95.5 per 100,000 men)

• First among white, black, Asian/Pacific Islander, and Hispanic* men.
• Second among American Indian/Alaska Native men.

2. Lung cancer (68.1 per 100,000 men)

First among American Indian/Alaska Native men.
Second among white, black, and Asian/Pacific Islander men.
Third among Hispanic* men.

3. Colorectal cancer (44.0 per 100,000 men)

• Second among Hispanic* men.
• Third among white, black, American Indian/Alaska Native, and Asian/Pacific Islander men.

Leading Causes of Cancer Death Among Men

• Lung cancer (52.0 per 100,000 men)

First among men of all races and Hispanic* origin populations.

• Prostate cancer (19.1 per 100,000 men)

Second among white, black, American Indian/Alaska Native, and Hispanic* men.
Fourth among Asian/Pacific Islander men.

• Colorectal cancer (16.9 per 100,000 men)

Third among men of all races and Hispanic* origin populations.

• Liver cancer (9.5 per 100,000 men)

Second among Asian/Pacific Islander men.

What Is Prostate Cancer ?

Prostate cancer is the most common non-skin cancer among American men. Prostate cancer is second only to lung cancer as the cause of cancer-related deaths in American men and is responsible for over 29,000 deaths per year ⁵². One promising approach to reduce the incidence of prostate cancer is through chemoprevention, which has been recognized as a plausible and cost-effective approach to reduce cancer morbidity and mortality by inhibiting precancerous events before the occurrence of clinical disease.

Prostate cancers usually grow slowly. Most men with prostate cancer are older than 65 years and do not die from the disease. Finding and treating prostate cancer before symptoms occur may not improve your health or help you live longer ⁵³.

Risk Factors for Prostate Cancer

Research has found risk factors that increase your chances of getting prostate cancer. These risk factors include:

• Age: The older a man is, the greater his risk for getting prostate cancer.
• Family history: Certain genes (passed from parent to child) that you inherited from your parents may affect your prostate cancer risk. Currently, no single gene is sure to raise or lower your risk of getting prostate cancer. However, a man with a father, brother, or son who has had prostate cancer is two to three times more likely to develop the disease himself.
• Race: Prostate cancer is more common in African-American men. It tends to start at younger ages and grow faster than in other racial or ethnic groups, but medical experts do not know why.

Researchers are trying to determine the causes of prostate cancer and whether it can be prevented. They do not yet agree on the factors that can influence a man’s risk of developing the disease, either positively or negatively.

Dietary Factors and Prostate Cancer

According to the World Health Organization, one-third of all cancer deaths are preventable through an increased consumption of natural compounds able to modulate key molecular signaling cascades that ultimately inhibit cancer cell proliferation and induce apoptosis ⁵⁴. A number of dietary phytochemicals, including:

• Curcumin,
• Ursolic acid,
• Lycopene,
• Epigallocatechin-3-gallate (or EGCG),
• Pomegranate,
• Resveratrol,
• Sulforaphane
• 6-shogaol
• Indole-3-carbinol
• Silymarin

Have shown potential chemopreventive effects in vitro and in vivo in either animal models or in clinical studies on several cancers ⁵⁵, including prostate cancer ⁵⁶.

Curcumin

Curcumin is a polyphenol found in turmeric (Curcuma longa), used as a spice, in food coloring, and as a traditional herbal medicine ⁵⁷. It has been shown that curcumin has health benefits such as antioxidant, anti-inflammatory, and anticancer properties, improvement of brain function, and control of obesity and diabetes.

Ursolic acid

Ursolic acid is a natural pentacyclic triterpenoid carboxylic acid found in many plants including Holy basil, Japanese basil, tulsi, thyme, lavender, catnip, peppermint leaves, rosemary, apples, elder flowers and many others ⁵⁸, ⁵⁹. Ursolic acid has been shown to have apoptotic, anti-inflammatory and anti-tumorigenic effects in various cancer models including prostate, ovary, stomach, intestine, and skin ⁶⁰. Further studies have revealed that ursolic acid has broad-spectrum anti-carcinogenic effects including prevention of DNA damage, inhibition of EGFR/MAPK signaling, inhibition of angiogenesis, activation of apoptotic pathways, and inhibition of Akt/mTOR, NF-κB, Cox-2, and STAT3 signaling pathways ⁵⁹.

Lycopene

Tomato is the main dietary source of lycopene, a red-orange caretenoid, linked with decreased risk of prostate cancer. Lycopene, an O2· quencher, has been shown to reduce the amount of oxidative DNA damage in cell culture and animal studies ⁶¹. There is evidence that lycopene effectively inhibits proliferation of various cancer cell lines with down-regulation of cyclin D1 and consequent cell cycle arrest at the G0-G1 phase of the cell cycle. This growth inhibition is extended to the three broadly used prostate cancer cell lines PC-3, DU-145, and LNCaP cells. In addition normal prostate epithelial cells were observed to be even more sensitive to growth inhibition by lycopene than cancer cells. This is important because the pathologic hyperproliferation of prostate cells in men developing benign prostatic hyperplasia may be positively affected by lycopene ⁶². Lycopene supplementation to rats resulted in decreased IGF-I and IL-6 expression; also a reduction in the expression of 5α-reductase in prostate tumors with subsequent down-regulation of several androgen target genes was noted ⁶³. Lycopene increased the activity of the phase II enzymes GPx, glutathione-S-transferase, and glutathione reductase, as well as glutathione levels in several animal models, presumably due to antioxidant-response element–mediated induction of genes ⁶⁴.

A 3-week tomato intervention study in prostate cancer patients showed an increase in the apoptotic index of hyperplastic and neoplastic cells in the resected prostate tissue along with lower plasma levels of PSA (prostate specific antigen) ⁶⁵. Similar results were obtained when lycopene was given to patients undergoing orchidectomy with subsequent decrease in serum PSA level and reduction in the size of primary and secondary tumors ⁶⁶. Supplementation of tomato products, containing lycopene, helped lower biomarkers of oxidative stress and carcinogenesis in healthy and type II diabetic patients and prostate cancer patients, respectively ⁶⁷. In addition, a phase II study showed that whole-tomato lycopene supplementation had significant results and maintained its effect on PSA over 1 year ⁶⁸. However, a more recently concluded phase II trial shows that lycopene-rich tomato supplement was not effective in patients with androgen-independent prostate cancer ⁶⁹. In addition, lycopene supplementation in men with biochemically relapsed prostate cancer did not result in any discernible response in serum PSA ⁷⁰, and a lack of association between prostate cancer risk and lycopene intake was observed in a multicenter study by Kirsh et al. ⁷¹. In view of these seemingly conflicting results, well-designed studies are necessary to establish the role of tomatoes and tomato products in the prevention and therapy of prostate cancer.

Epigallocatechin-3-gallate (or EGCG)

Green tea, obtained from the plant Camellia sinensis, with its high polypheniolic content has been shown to be an effective chemopreventive agent against various cancers ⁷². The polyphenols present in tea leaves as flavanols, or more commonly known as catechins, are epicatechin, epigallocatechin, epicatechin-3-gallate, and epigallocatechin-3-gallate (EGCG), of which the latter has gained the most attention with respect to its anticarcinogenic activity. Epigallocatechin-3-gallate (EGCG) makes up ∼10% to 50% of the total catechin content and has a higher antioxidant activity than vitamins C and E. Epigallocatechin-3-gallate (EGCG) inhibits cellular proliferation primarily by acting as antioxidants and scavenging the free radicals, by inhibiting the enzymes involved in cell replication and DNA synthesis along with interfering with cell-to-cell contact adhesion, and inhibiting intracellular communication pathways required for cell division.

A case control study, conducted in southeast China during 2001 to 2002, reported a reduced prostate cancer risk with increasing frequency, duration, and quantity of green tea consumption ⁷³. In another study, patients with asymptomatic androgen-independent metastatic prostate carcinoma and progressive PSA (prostate specific antigen) elevation were evaluated after ingestion of 6 g of green tea per day ⁷⁴. Only one patient manifested a decline in serum PSA, and no patient manifested a tumor response on radiographic assessment or physical examination. Thus, a limited antineoplastic effect with a maximum response rate of 2% was seen with green tea ⁷⁴. Similar results were seen in another clinical trial involving patients with hormone refractory prostate cancer. Green tea extract capsules, prescribed at a dose level of 250 mg twice daily, showed minimal clinical activity against the disease ⁷⁵. Both these studies were conducted in end-stage disease, signifying that green tea may be more effective if used in the early stages of the disease or in patient at high risk. In this context, Bettuzzi et al. ⁷⁶ have shown that after a year’s oral administration of green tea catechins, only one man in a group of 32 with high-grade PIN developed prostate cancer compared with 9 of 30 in the control group; a rate of only 3% in men developing the disease versus the expected rate of 30% in men treated with placebo. Hence, large-scale, prospective, randomized trials are necessary to test the efficacy of green tea for the prevention and treatment of prostate cancer.

Pomegranate

Pomegranate, a rich source of polyphenolic compounds, including anthocyanins and hydrolyzable tannins, with a reportedly higher antioxidant activity than green tea and red wine ⁷⁷. Recent studies show that anatomically discrete sections of the pomegranate fruit acting synergistically exert antiproliferative and antimetastatic effect against prostate cancer cells ⁷⁸. Invasion across matrigel by PC-3 cancer cells was found to be inhibited after treatment with combinations of fermented pomegranate juice polyphenols, pomegranate peel polyphenols, and pomegranate seed oil, with a decrease in the expression of phospholipase A2, associated with invasive potential of theses cells ⁷⁸.

One small study from 2006 ⁷⁹ found that drinking a daily 227ml (8oz) glass of pomegranate juice significantly slowed the progress of prostate cancer in men with recurring prostate cancer. This was a well-conducted study, but more are needed to support these findings.

A more recent study from 2013 ⁸⁰ looked at whether giving men pomegranate extract tablets prior to surgery to remove cancerous tissue from the prostate would reduce the amount of tissue that needed to be removed. The results were not statistically significant, meaning they could have been down to chance.

Resveratrol

Resveratrol (3,4′,5-transtrihydroxystilbene), a plant-derived polyphenolic compound with chemopreventive properties, is found in grapes, berries, red wine, peanuts, and other edible products ⁸¹. Resveratrol has been shown to have cardiovascular benefit and anti-diabetic effects in both mice and humans. In addition, Resveratrol was shown to inhibit skin tumor promotion and also inhibit the growth of many cancer cell lines, including breast, prostate, colon and liver ⁸². Resveratrolexerts its diverse biological effects by interacting with specific targeting proteins, probably via its stilbenoid core and hydrophilic side groups, and has been proved to check carcinogenesis at each discrete stage. Cell culture studies show that resveratrol inhibits tumor growth by stimulating apoptosis and arresting cells at different locations in the cell cycle and is associated with modulation of phosphoglycerate mutase and accumulation of endogenous ceramide in prostate cancer cell lines ⁸¹. Its antitumor activity is consistent with repression of Src-Stat3 signaling, as well as protein kinase C–mediated Erk1/Erk2 activation ⁸³. Gene expression studies have provided additional insights into the mechanisms of action of this compound in prostate cells. Resveratrol treatment resulted in decreased expression of genes involved in cell proliferation, apoptosis, and polyamine biosynthesis ⁸³. Although considerable in vitro data exist, well-designed preclinical studies in animal models are required to evaluate the future of this compound as an effective agent against prostate cancer.

Sulforaphane

Sulforaphane, an isothiocyanate phytochemical found in cruciferous vegetables (e.g. broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kohlrabi, mustard, rutabaga, kale, garden cress, bok choy and turnips), is a promising anticancer agent with multiple cellular targets ⁸⁴. Several studies have also implicated Sulforaphane as a promising agent for metastatic castration-resistant prostate cancer, especially since it shows specific toxicity towards transformed cells without significant adverse effect on primary prostate epithelial cells ⁸⁵. At pharmacological doses, Sulforaphane has been shown to slow down the progression of prostate cancer ⁸⁶. A recent study has also documented the ability of Sulforaphane to target the cancer stem cell phenotype ⁸⁷. Mechanistic studies have reported Sulforaphane-induced cell death to be initiated by reactive oxygen species ⁸⁸ and the release of hydrogen sulfide ⁸⁹. These findings clearly suggest that Sulforaphane may be used as a promising adjunct agent to augment the efficacy of anti-androgens against aggressive prostate cancer cells ⁹⁰.

6-shogaol

Ginger (Zingiber officinale) is a well known herb consumed as a spice and food as well as widely used as herbal medicine for various ailments. A number of biologically active ingredients including gingerols and its various derivatives have been identified and synthesized from ginger in recent years. One important class of derivatives are shogaols that are primarily the dehydrated products of gingerols and are found exclusively in dried ginger. Among the shogaols, 6-shogaol has achieved a great deal of attention due to its potent anticancer activity against various cancer cells ⁹¹.

6-Shogaol is a potent bioactive compound in ginger (Zingiber officinale Roscoe), has been shown to possess anti-inflammatory and anticancer activity. In a test tube study ⁹², it was demonstrated that treatment of androgen-dependent and -independent human prostate cancer cells in culture with 6-Shogaol inhibits survival and induces apoptosis. 6-Shogaol also inhibits survival and induces apoptosis in cultured mouse prostate cancer cells derived from HiMyc mice. Importantly, 6-Shogaol was highly effective at inhibiting the growth of HMVP2 cells in an allograft tumor model. These effects of 6-Shogaol were associated with inhibition of both STAT3 and NF-κB signaling and possibly other signaling pathways (e.g., Src). On the basis of these test tube findings, it was suggested that 6-Shogaol has a combination of activity, low toxicity, and biochemical properties that makes it of potential utility as a naturally occurring chemopreventive and/or therapeutic agent in prostate cancer. Overall, the current results suggest that 6-Shogaol may have potential as a chemopreventive and/or therapeutic agent for prostate cancer and that further study of this compound is warranted ⁹².

Indole-3-carbinol

Indole-3-carbinol is a common phytochemical present in a wide variety of plant food substances, including cruciferous vegetables (cabbage, radishes, cauliflower, broccoli, brussels sprouts, and daikon) ⁹³. The glucosinolates contained in these on ingestion are rapidly converted into a range of polyaromatic indolic compounds ⁹⁴ responsible for its biological effects in vivo, among which 3,3′-diindolylmethane is a major component ⁹⁵. Its varied anticancer effects are mediated through the regulation of the cell cycle, cell proliferation, apoptosis, oncogenesis, transcription, and cell signal transduction. The molecular mechanisms by which indole-3-carbinol inhibits cell growth and induces apoptosis in prostate cancer cells involve the inactivation of Akt, mitogen-activated protein kinase, and NF-κB signaling pathways, along with other transcription factors, including SP1, ER, AR, and Nrf2 ⁹⁵.

Indole-3-carbinol, in conjunction with genistein, is able to induce the expression of both BRCA1 and BRCA2 in breast and prostate cancer cell types, suggesting potential relevance to cancer prevention ⁹⁶. Indole-3-carbinol injections given to rats, both i.p. and i.v., were equally effective in inhibiting the incidence, growth, and metastases of prostate cancer cells ⁹⁷. Although a number of studies have been conducted in humans to test the efficacy of indole-3-carbinol as a chemotherapeutic agent for breast and cervical cancers, clinical trial have yet to be carried out for the assessment of indole-3-carbinol against human prostate cancer.

Silymarin

Silymarin, a polyphenolic flavonoid isolated from the seeds of milk thistle has recently gained much attention due to its anticancer properties. Silibinin, isosilybinin, silychristin, and silydianin are various isomers present in the compound, of which silibinin is thought to be the most active ⁹⁸. The underlying mechanism of silibinin/silymarin efficacy against prostate cancer involves alteration in cell cycle progression with induction of CDKIs, Cip1/p21 and Kip1/p27, and a resultant G1 arrest ⁹⁹. Silibinin has shown a strong potential to modulate IGF signaling in CaP cells toward cell growth inhibition with an increased IGF-binding protein-3 gene expression and inhibition of insulin receptor substrate-1 tyrosine phosphorylation ⁹⁹. Silymarin can inhibit nuclear localization and transactivation activity of the AR ¹⁰⁰ with down-regulation of the AR coactivator, the prostate epithelium-derived Ets transcription factor, and several androgen-regulated genes, including PSA, human glandular kallikrein, and an immunophilin, FKBP51 ¹⁰¹. In a randomized, double-blind, placebo-controlled crossover study, a significant delay in PSA progression was seen in patients with a history of prostate cancer and rising PSA levels after radical prostatectomy supplemented with soy, isoflavones, lycopene, silymarin, and antioxidants in their diet ¹⁰². Recently, phase I clinical trials for silibinin have started in prostate cancer patients due to its nontoxic and mechanism-based strong preventive/therapeutic efficacy observed in preclinical models ⁹⁹.

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What are best superfoods for pregnancy

A healthy diet is an important part of a healthy lifestyle at any time, but is especially vital if you’re pregnant or planning a pregnancy. Eating healthily during pregnancy will help your baby to develop and grow. Scientists know that your diet can affect your baby’s health — even before you become pregnant. For example, recent research shows that folic acid helps prevent neural tube defects (including spina bifida) from occurring during the earliest stages of fetal development — so it’s important to consume plenty of it before you become pregnant and during the early weeks of your pregnancy.

Even though many foods, particularly breakfast cereals, are fortified with folic acid, doctors now encourage women to take folic acid supplements before and throughout pregnancy (especially for the first 28 days). Be sure to ask your doctor about folic acid if you’re considering becoming pregnant.

Calcium is another important nutrient. Because your growing baby’s calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which contain some extra calcium.

Your best food sources of calcium are milk and other dairy products. However, if you have lactose intolerance or dislike milk and milk products, ask your doctor about a calcium supplement. (Signs of lactose intolerance include diarrhea, bloating, or gas after eating milk or milk products. Taking a lactase capsule or pill or using lactose-free milk products may help.) Other calcium-rich foods include sardines or salmon with bones, tofu, broccoli, spinach, and calcium-fortified juices and foods.

Doctors don’t usually recommend starting a strict vegan diet when you become pregnant. However, if you already follow a vegan or vegetarian diet, you can continue to do so during your pregnancy — but do it carefully. Be sure your doctor knows about your diet. It’s challenging to get the nutrition you need if you don’t eat fish and chicken, or milk, cheese, or eggs. You’ll likely need supplemental protein and may also need to take vitamin B12 and D supplements.

To ensure that you and your baby receive adequate nutrition, consult a registered dietitian for help with planning meals.

You’ve heard the statistics: in 2007-2008, about one-third of adults in the United States were obese. We know the consequences: increased risks for coronary heart disease, high blood pressure, diabetes, cancer, and other conditions. Most of us would like to lose a few pounds to improve our health. Now women of childbearing age have another motivation for watching their weight: studies show that prepregnancy weight and pregnancy weight gain can impact not only pregnancy outcomes for mother and baby, but also their long-term health.

• Don’t rely on supplements to make up for an unhealthy diet. Vitamin and mineral supplements cannot replace a healthy diet.

Most doctors recommend that pregnant women take a vitamin and mineral supplement every day, in addition to eating a healthy diet. Doctors often recommend this for those trying to get pregnant as well.  Supplements designed for pregnant women are called “prenatal supplements.”

What foods should you avoid ?

There are some foods you should avoid eating during pregnancy because they could cause food poisoning, and the possible presence of bacteria, chemicals or parasites in these foods could harm your unborn baby.

Here is a list of items you should avoid:

• Alcohol. No level of alcohol consumption is considered safe during pregnancy. You should avoid drinking alcohol if you’re pregnant or trying to get pregnant. Do not drink alcohol like wine or beer. Too much exposure to alcohol can seriously affect your baby’s development. Enjoy decaf coffee or tea, non-sugar-sweetened drinks, or water with a dash of juice.
• Caffeine. Avoid diet drinks and drinks with caffeine. You should limit caffeine during pregnancy – avoid having more than 200 milligrams (mg) of caffeine a day. High levels of caffeine can cause babies to have a low birthweight. Too much caffeine can also cause a miscarriage. Caffeine is found naturally in some foods and is added to some soft drinks.
• Fish that may have high levels of mercury (a substance that can build up in fish and harm an unborn baby). You should eat 8 to 12 ounces of seafood per week, but limit white (albacore) tuna to 6 ounces per week. Do not eat tilefish, shark, swordfish, and king mackerel.
• Anything that is not food. Some pregnant women may crave something that is not food, such as laundry starch or clay. This may mean that you are not getting the right amount of a nutrient. Talk to your doctor if you crave something that is not food. He or she can help you get the right amount of nutrients.

Other foods to avoid during pregnancy:

Cheese

Avoid:

• mould-ripened soft cheeses – such as brie, camembert and others with a similar rind, including goats’ cheese
• soft blue-veined cheeses – such as danish blue, gorgonzola and roquefort

Cheeses like this are made with mould and can contain listeria bacteria that cause listeriosis. Although an infection with listeria is rare, even a mild form of this infection in a pregnant woman can lead to miscarriage, stillbirth or severe illness in a newborn baby.

Raw eggs

Eggs produced under the British Lion Code of Practice are safe for pregnant women to eat raw or partially cooked. These eggs have a red lion logo stamped on their shell.

You should avoid any raw or undercooked eggs not produced under the lion code, and any foods that contain them such as homemade mayonnaise.

Make sure eggs without the lion code are thoroughly cooked until the whites and yolks are solid. This prevents the risk of salmonella food poisoning.

Duck eggs, quail eggs and goose eggs should be cooked until the whites and yolks are solid.

Unpasteurised milk

Do not drink raw (unpasteurised) milk, including unpasteurised goats’ or sheep’s milk, or any food that is made of them, such as soft goats’ cheese.

If only raw or green-top milk is available, boil it first.

Pâté

Avoid all types of pâté, including vegetable pâtés, as they can contain listeria.

Raw meat

Do not eat raw or undercooked meat.

Cook all meat and poultry thoroughly so there’s no trace of pink or blood. Be particularly careful with sausages and minced meat.

The latest advice from the Food Standards Agency is that pregnant women should take care when eating cold cured meats such as salami, chorizo, pepperoni and prosciutto, because these meats are not cooked but cured and fermented, so they may contain toxoplasmosis-causing parasites.

It’s best to check the instructions on the pack to see whether the product is ready-to-eat or needs cooking first.

For ready-to-eat meats, you can reduce any risk from parasites by freezing cured/fermented meats for four days at home before you eat them. Freezing kills most parasites, making the meat safer to eat.

Liver

Avoid liver or liver products, such as liver pâté or liver sausage, as they may contain a lot of vitamin A. Too much vitamin A can harm your baby.

Vitamin A

Don’t take:

• high-dose multivitamin supplements
• fish liver oil supplements
• any supplements containing vitamin A

Reducing the risk of toxoplasmosis

Wash fruit, vegetables and salads to remove all traces of soil, which may contain toxoplasma, a parasite that can cause toxoplasmosis.

Pregnancy superfoods list

Maternal nutrition prepregnancy and during pregnancy is important for the health, growth, and development of the fetus and the newborn infant. New research shows that maintaining a healthy weight before and during pregnancy can reduce the likelihood of negative effects for mothers and babies. This theory hypothesizes that term infants who are small for gestational age have an increased risk of cardiovascular disease and type II diabetes in adulthood and that this is due to undernutrition of the fetus ¹.

A healthy diet includes proteins, carbohydrates, fats, vitamins, minerals, and plenty of water. The U.S. government publishes dietary guidelines that can help you determine how many servings of each kind of food to eat every day. Eating a variety of foods in the proportions indicated is a good step toward staying healthy.

Food labels can tell you what kinds of nutrients are in the foods you eat. The letters RDA, which you find on food labeling, stand for recommended daily allowance, or the amount of a nutrient recommended for your daily diet. When you’re pregnant, the RDAs for most nutrients are higher.

Here are some of the most common nutrients you need and the foods that contain them:

Table 1. Pregnancy superfoods list

Nutrient	Needed for	Best sources
Protein	cell growth and blood production	lean meat, fish, poultry, egg whites, beans, peanut butter, tofu
Carbohydrates	daily energy production	breads, cereals, rice, potatoes, pasta, fruits, vegetables
Calcium	strong bones and teeth, muscle contraction, nerve function	milk, cheese, yogurt, sardines or salmon with bones, spinach
Iron	red blood cell production (to prevent anemia)	lean red meat, spinach, iron-fortified whole-grain breads and cereals
Vitamin A	healthy skin, good eyesight, growing bones	carrots, dark leafy greens, sweet potatoes
Vitamin C	healthy gums, teeth, and bones; assistance with iron absorption	citrus fruit, broccoli, tomatoes, fortified fruit juices
Vitamin B6	red blood cell formation; effective use of protein, fat, and carbohydrates	pork, ham, whole-grain cereals, bananas
Vitamin B12	formation of red blood cells, maintaining nervous system health	meat, fish, poultry, milk (Note: vegetarians who don’t eat dairy products need supplemental B12.)
Vitamin D	healthy bones and teeth; aids absorption of calcium	fortified milk, dairy products, cereals, and breads
Folic acid	blood and protein production, effective enzyme function	green leafy vegetables, dark yellow fruits and vegetables, beans, peas, nuts
Fat	body energy stores	meat, whole-milk dairy products, nuts, peanut butter, margarine, vegetable oils (Note: limit fat intake to 30% or less of your total daily calorie intake.)

Folic Acid

Folate is also known vitamin B9 (Folacin, Folic Acid, Pteroylglutamic acid) that is naturally present in many foods. Folic Acid is a form of folate that is manufactured and used in dietary supplements and fortified foods. Our bodies need folate to make DNA and other genetic material. Folate is also needed for the body’s cells to divide.

All women need 400 micrograms of folic acid every day. Women who can get pregnant should get 400 to 800 micrograms of folic acid from a vitamin or from food that has added folic acid, such as breakfast cereal ². This is in addition to the folate you get naturally from food.

If you do not get enough folic acid before and during pregnancy, your baby is at higher risk for neural tube defects.

Neural tube defects are serious birth defects that affect the spine, spinal cord, or brain and may cause death. These include:

• Spina bifida ³. This condition happens when an unborn baby’s spinal column does not fully close during development in the womb, leaving the spinal cord exposed. As a result, the nerves that control the legs and other organs do not work. Children with spina bifida often have lifelong disabilities. They may also need many surgeries.
• Anencephaly ⁴. This means that most or all of the brain and skull does not develop in the womb. Almost all babies with this condition die before or soon after birth.

Table 2. Selected Food Sources of Folate and Folic Acid

Food	mcg DFE per serving	Percent DV*
Beef liver, braised, 3 ounces	215	54
Spinach, boiled, ½ cup	131	33
Black-eyed peas (cowpeas), boiled, ½ cup	105	26
Breakfast cereals, fortified with 25% of the DV†	100	25
Rice, white, medium-grain, cooked, ½ cup†	90	23
Asparagus, boiled, 4 spears	89	22
Spaghetti, cooked, enriched, ½ cup†	83	21
Brussels sprouts, frozen, boiled, ½ cup	78	20
Lettuce, romaine, shredded, 1 cup	64	16
Avocado, raw, sliced, ½ cup	59	15
Spinach, raw, 1 cup	58	15
Broccoli, chopped, frozen, cooked, ½ cup	52	13
Mustard greens, chopped, frozen, boiled, ½ cup	52	13
Green peas, frozen, boiled, ½ cup	47	12
Kidney beans, canned, ½ cup	46	12
Bread, white, 1 slice†	43	11
Peanuts, dry roasted, 1 ounce	41	10
Wheat germ, 2 tablespoons	40	10
Tomato juice, canned, ¾ cup	36	9
Crab, Dungeness, 3 ounces	36	9
Orange juice, ¾ cup	35	9
Turnip greens, frozen, boiled, ½ cup	32	8
Orange, fresh, 1 small	29	7
Papaya, raw, cubed, ½ cup	27	7
Banana, 1 medium	24	6
Yeast, baker’s, ¼ teaspoon	23	6
Egg, whole, hard-boiled, 1 large	22	6
Vegetarian baked beans, canned, ½ cup	15	4
Cantaloupe, raw, 1 wedge	14	4
Fish, halibut, cooked, 3 ounces	12	3
Milk, 1% fat, 1 cup	12	3
Ground beef, 85% lean, cooked, 3 ounces	7	2
Chicken breast, roasted, ½ breast	3	1

* DV = Daily Value. The FDA developed DVs to help consumers compare the nutrient contents of products within the context of a total diet. The DV for folate is 400 mcg for adults and children aged 4 and older. However, the FDA does not require food labels to list folate content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

† Fortified with folic acid as part of the folate fortification program.

[Source ⁵]

Iron

Iron is one of the major trace elements required during pregnancy ⁶. It is suggested that a lack of iron in pregnancy can result in preterm delivery and maternal anemia. Adequate iron is required from conception, throughout the pregnancy and during lactation. Iron deficiency during lactation may be associated with mental retardation ⁷. The recommended daily iron intake for pregnant women is 27 mg/day ⁸.

Good dietary sources of iron (ie. more than 2 mg/serve) include liver, beef, fortified cereals, cashew nuts and baked beans. Although it is believed that iron excess can hinder the absorption of other vitamins, this hypothesis has yet to be fully substantiated ⁹.

Calcium

Calcium is required for the maintenance of skeletal, neuromuscular, and cardiac function ¹⁰. Studies have shown the maternal skeleton is not the source for fetal calcium needs, thus adequate calcium supplementation during pregnancy and lactation (~1000 mg/day) is essential for fetal bone mineralisation.

In pregnant women who are vegetarians, calcium absorption can be poor from foods rich in oxalic acid (beans and spinach) or phytic acid (nuts and grains). In comparison to dairy milk, calcium absorption from soy milk may be as efficient, while calcium absorption from dried beans is about 50% and from spinach only about 10% ¹⁰.

Zinc

Zinc is an important constituent of various enzymes that help maintain structural integrity of proteins and regulate gene expression ¹¹.

It is recommended that pregnant women take 11 mg/day and 12 mg/day during lactation ¹². Nevertheless, it is important to be aware that dietary intake of iron at levels found in some supplements may impair zinc absorption.

Vitamin A

Deficiency in vitamin A has been associated with intrauterine growth retardation, preterm birth, low birth weight, placental abruption and increased mortality of the mother ¹³. Research has also ascertained that vitamin A supplementation can increase haemoglobin concentrations by about 4 g/L in marginally deficient maternal populations ¹⁴. Daily intake of 800 μg is recommended in pregnant women ¹⁵. Breast milk is a good source of vitamin A ¹⁶. However, adequate maternal dietary vitamin A is essential to maintain adequate levels in breast milk

Vitamin B group

The group of B vitamins, which consists of thiamine (B1), riboflavin (B2), niacin or nicotinic acid (B3), B6, folate (B9) and B12, is essential for enhancing the immune system as well as reducing the plasma concentration of homocysteine ¹⁷. Elevated maternal plasma homocysteine levels as a result of vitamin B deficiency may lead to pre-eclampsia, premature birth and low birth weight ¹⁸. Most cases of B12 deficiency in infants are related to maternal veganism or
malabsorption, such as pernicious anemia ¹⁹. Vitamin B12 is found exclusively in animal products including meat, eggs, fish and milk. Excessive vitamin B consumption may result in weight gain, which can potentially complicate labour ²⁰.

Vitamin D

Vitamin D is a group of fat soluble prohormones that help to absorb calcium and phosphorous from dietary intakes, which are required for stimulating skeleton formation of the fetus ¹⁶. Deficiency of vitamin D during pregnancy may result in an infant with rickets or type 1 diabetes mellitus ²¹. The recommended daily intake of vitamin D during pregnancy and lactation is 5 μg/day ²². However, excessive supplementation may be detrimental as it is associated with maternal fatigue and loss of appetite ²³.

Vitamin C

Vitamin C stimulates better absorption of iron ²¹ and therefore helps to reduce the risk of maternal anemia. As an oxidant, it also guards the body against injurious free radicals. Combined with other factors, deficiency of vitamin C is thought to result in difficult labour, but this is yet to be established ²¹. The recommended daily intake of vitamin C in
pregnancy is 60 mg/day ²⁴.

Vitamin E

Vitamin E acts as an antioxidant in the lipid phase of cell membrane by protecting polyunsaturated fatty acid from free radical damage ²⁵. Higher intake of vitamin E has been found to be associated with a decrease in cardiovascular risk, diabetic complications, and certain cancers and cataracts. Vitamin E deficiency may lead to peripheral neuropathy, spinocerebellar ataxia, skeletal myopathy and pigmented retinopathy; however this has only been reported in association with other genetic or malabsorption syndormes, not simply with a diet low in vitamin E ²⁵. The recommended daily intake for pregnant women is equivalent to the normal requirement in women (7 mg/day), but higher during lactation (11 mg/day) ²⁵.

Iodine

Iodine is essential for fetal and neonatal growth and development. Severe iodine deficiency may result in abortion or stillbirth, congenital anomalies, neurological cretinism, or mental deficiency with deafness, spastic diplegia, squint and myxoedematous cretinism ²⁶. It is recommended that pregnant women consume no less than 220 μg/day.

Selenium

Selenium is thought to have an antioxidant property as well as a role in cellular function, muscle maintenance, fertility and cancer prevention ²⁷. Deficiency in selenium can result in osteoarticular disorder, cardiac enlargement, heart failure, arrhythmia and premature death ²⁷. In conjunction with iodine deficiency, selenium deficiency has also been reported to increase the risk of cretinism ²⁷. It is recommended that pregnant women increase their daily intake of selenium to 65 μg/day and to 70 μg/day during lactation ²⁷.

Phosphorus

Phosphorus, in the form of phosphate, is thought to regulate acid base balance in the bloodstream and activate catalytic proteins ²⁸. Deficiency in this mineral, although rare, may result in symptoms such as anaemia, muscle weakness, bone pain, rickets, parenthesis, anorexia, ataxia, confusion, and possibly death ²⁸. Phosphorus is available in a wide range of foods and the recommended intake in pregnancy is similar to that of nonpregnant women.

Figure 1. Foods (sources of micronutrient) for pregnant women aged 19–50 years

Food Cravings During Pregnancy

You’ve probably known women who craved specific foods during pregnancy, or perhaps you’ve had such cravings yourself. Some old theories held that a hunger for a particular type of food indicated that a woman’s body lacked the nutrients that food contains. Although this turned out not to be so, it’s still unclear why these urges occur.

Some pregnant women crave chocolate, spicy foods, fruits, and comfort foods, such as mashed potatoes, cereals, and toasted white bread. Other women crave non-food items, such as clay and cornstarch. The craving and eating of non-food items is known as pica. Consuming things that aren’t food can be dangerous to both you and your baby. If you have urges to eat non-food items, notify your doctor.

But following your cravings is fine as long as you crave foods that contribute to a healthy diet. Often, these cravings let up about 3 months into the pregnancy.

Prenatal supplements

During pregnancy, your needs increase for several vitamins and minerals, like folate, iron, and calcium. You need enough for your growing baby’s needs as well as your own needs. This makes it difficult to get all that you need from food. This is especially true for folic acid and iron: During pregnancy, mothers need to consume enough nutrients to meet their increased needs as well as those of their growing baby ²⁹.

Most health care providers tell women who are pregnant to take a prenatal vitamin every day and eat a healthy diet. Ask your doctor about what you should take.

Take a prenatal supplement instead of individual vitamins or minerals.  This ensures that you and your baby get balanced amounts of the vitamins and minerals you need. A high dose of some nutrients in a supplement, in particular vitamin A, can be harmful to your baby. Too much vitamin A from supplements can cause birth defects.

Don’t take dietary supplements or herbal products on your own. Scientists have not determined the possible risks for your baby of taking most herbal or botanical supplements.  For this reason, avoid them when you are pregnant or breastfeeding. Not all “natural” products are safe, and they are not tested or regulated like other drugs and medicines.

Taking too much of a dietary supplement can have harmful effects. Take the supplement your doctor  recommends. Follow his or her advice about taking any other supplements or herbal products.

Tell your doctor about any supplements you are already taking, including herbal or botanicals, to protect yourself against taking too much. Also, tell your doctor about any other medicines you are taking, to see if there could be interactions of your supplement with these medicines.

Folic Acid

Folic acid, also called folate, is a B vitamin that helps prevent serious birth defects of a baby’s brain or spine. These are called neural tube defects. Getting enough folic acid can also help prevent birth defects like cleft lip and congenital heart disease. These birth defects often happen before most women know they are pregnant. This is why folic acid is important for any woman who could become pregnant as well as those who are pregnant.

• Most prenatal supplements contain 600 micrograms per day of folic acid. This is the amount recommended for pregnant women from food and supplements combined.

For women who are capable of becoming pregnant, 400 micrograms of folic acid from fortified foods or supplements, in addition to the folate from a healthy diet, is recommended. Foods high in folate include orange juice, strawberries, spinach, broccoli, beans, and fortified breads and breakfast cereals.

Iron

Pregnant women need extra iron for the increasing amount of blood in their bodies. Iron helps keep your blood healthy and able to carry oxygen to your cells. Plus, your baby needs to store iron in his body to last through the first few months of life.

Too little iron can cause a condition called anemia. If you have anemia, you might look pale or notice paleness under your nails, and feel very tired. Your doctor checks for anemia with blood tests during your pregnancy.

Most prenatal supplements contain 27 milligrams of iron. This is the amount recommended for pregnant women per day.

What about fortified foods ?

Some foods are fortified with vitamins and minerals that may help you meet your nutrient needs while you are pregnant or breastfeeding. Examples of vitamins and minerals in fortified foods are:

• Vitamin D – Fluid milk, including fat-free and low-fat milk, is typically fortified with vitamin D. Yogurt may also be fortified with vitamin D. Some calcium-fortified fruit juices and soymilk (soy beverage) also have vitamin D added. Check the label and choose products with vitamin D.
• Iodine – Some salt is fortified with iodine, an essential mineral. Choose salt that is labeled “iodized salt.” But remember to keep the amount of salt and sodium you eat low.
• Folic acid – Enriched bread, flour, pasta, rice, and other grain products are fortified with folic acid. Many ready-to-eat cereals are also fortified with folic acid. Check the label and choose products with folic acid.
• Iron – Some ready-to-eat and cooked cereals are fortified with iron. When you are pregnant, choose these cereals to help meet your increased need for iron. Choose cereals that say “iron fortified.”

Medical conditions and allergies

Some women have specific health needs while they are pregnant or breastfeeding, because of a medical condition. These conditions include diabetes, celiac disease, renal disease, and phenylketonuria (PKU). If you have a medical condition, ask your doctor or health care provider for advice about food choices while you are pregnant or breastfeeding.

Other women may have specific needs because of a food allergy, such as egg, nut, or wheat allergy. If you have a food allergy, ask your doctor for advice about food choices while you are pregnant or breastfeeding.

In addition, if you have any allergies, or your family has a history of allergies, ask your doctor about avoiding common food allergens, such as peanuts, while you are pregnant or breastfeeding.

If you are breastfeeding and your baby has a medical condition or a food allergy, visit your doctor and follow his or her advice about your food choices.

Lactose intolerance

If you avoid milk because you are lactose intolerant, the most reliable way to get the health benefits of milk is to select lactose-free milk and milk products or calcium-fortified soymilk (soy beverage).

You can also take a lactase pill or drops that help you digest lactose before eating or drinking milk products. Also, check with your doctor for his or her advice if you have trouble digesting milk products.

In addition, many people who have a problem digesting lactose can usually eat or drink:

• Smaller portions (up to ½ cup) of milk with a meal
• Yogurt or hard cheeses
• Milk on hot or cold cereal

Remember to choose low-fat or fat-free milk, yogurt, and cheeses.

If you do not drink or eat any foods in the Dairy Group, be sure to get the calcium you need from other foods. These include:

• Calcium-fortified juices and other beverages, cereals, or breads
• Tofu (prepared with calcium sulfate)
• Canned fish with bones you eat (such as sardines or salmon canned with bones)
• Soybeans, black eyed peas (cow peas), and white beans
• Some leafy greens (collard and turnip greens, kale, bok choy)

The amount of calcium that can be absorbed from these foods varies. Check with your doctor to be sure you are getting enough calcium from your foods and beverages.

Pregnancy Healthy Weight

Gaining the right amount of weight during pregnancy helps your baby grow to a healthy size. But gaining too much or too little weight may lead to serious health problems for you and your baby.

Too much weight gain raises your chances for diabetes and high blood pressure during pregnancy and after. If you are overweight when you get pregnant, your chances for health problems may be even higher. It also makes it more likely that you will have a hard delivery and need a cesarean section (C-section).

The new findings suggest that, by losing weight before getting pregnant, obese women can reduce their babies’ risk for congenital heart defects. Previous studies have shown that obese women are also at higher risk for pregnancy-related problems, such as high blood pressure, preeclampsia, and gestational diabetes, for having longer labors, and for giving birth by cesarean section. Babies whose mothers were obese during pregnancy are at higher risk for having large bodies, which can lead to injuries during delivery, and certain birth defects. They are also at higher risk for developing Type 2 diabetes, and for developing it at a younger age than those whose mothers weren’t obese during pregnancy.

Although it is important to get to a healthy weight before pregnancy, losing weight during pregnancy, even for obese women, can be dangerous to the developing fetus. Pregnant women need to get the right nutrition and gain the right amount of weight to promote healthy outcomes. Most women need only around 300 extra calories per day during pregnancy.

Gaining a healthy amount of weight also helps you have an easier pregnancy and delivery. It may also help make it easier for you to get back to your normal weight after delivery. Research shows that a healthy weight gain can also lower the chances that you or your child will have obesity and weight-related problems later in life.

• How much weight you should gain depends on how much you weighed before pregnancy.
• It is important to gain weight very slowly. The old myth that you are “eating for two” is not true.
• Do not try to lose weight if you are pregnant. Healthy food is needed to help your baby grow. Some women may lose a small amount of weight at the start of pregnancy. Speak to your health care provider if this happens to you.

During the first 3 months, your baby is only the size of a walnut and does not need very many extra calories. The following rate of weight gain is advised:

• 1 to 4 pounds total in the first 3 months
• 2 to 4 pounds each month from 4 months until delivery

Talk to your health care provider about how much weight you should gain. Work with him or her to set goals for your weight gain. Take into account your age, weight, and health. The total amount of weight you should gain during your pregnancy depends on your weight when you became pregnant. Women whose weight was in the healthy range before becoming pregnant should gain between 25 and 35 pounds while pregnant. The advice is different for those who were overweight or underweight before becoming pregnant.

• If you are gaining too much weight during pregnancy, cut back on the calories you are currently eating or drinking by limiting the calories from added sugars and saturated fats. They can be found in foods like soft drinks, desserts, fried foods, cheese, whole milk, and fatty meats. Look for choices that are low-fat, fat-free, unsweetened, or with no added-sugars. If you gain too much weight during pregnancy, it can be hard to lose the weight after your baby is born. Most women who gain the suggested amount of weight lose it with the birth of the baby and in the months that follow. Breastfeeding for more than 3 months can also help you lose weight gained during pregnancy.

• If you are not gaining enough weight during pregnancy, you need to eat more calories by eating a little more from each food group. Try adding a healthy snack each day, or increasing portion sizes at meals. If you keep losing weight faster than you want to, check with your doctor. If you gain too little weight during pregnancy, you may have a higher risk for a premature delivery and a low birth weight infant.

Weight Gain during Pregnancy

General weight-gain advice below refers to weight before pregnancy and is for women having only one baby.

Table 3. Recommendations for Total and Rate of Weight Gain During Pregnancy, by Pre-pregnancy BMI (body mass index)

*The body mass index (BMI) measures your weight in relation to your height. See the additional links below for a link to an online BMI calculator.

[Source ³⁰]

BMI Calculator Adults. http://resources.nationalacademies.org/Pregnancy/WhatToGain.html

Women who are pregnant with twins are given provisional guidelines. Those in the normal BMI category should aim to gain 37-54 pounds; overweight women, 31-50 pounds; and obese women, 25-42 pounds ³⁰.

What kinds of foods should you eat ?

A healthy eating plan for pregnancy includes nutrient-rich foods. Current U.S. dietary guidelines advise eating these foods each day:

• Fruits and veggies (provide vitamins and fiber)
• Whole grains, like oatmeal, whole-wheat bread, and brown rice (provide fiber, B vitamins, and other needed nutrients)
• Fat-free or low-fat milk and milk products or non-dairy soy, almond, rice, or other drinks with added calcium and vitamin D
• Protein from healthy sources, like beans and peas, eggs, lean meats, seafood (8 to 12 ounces per week), and unsalted nuts and seeds
• Fish
• Polyunsaturated and monounsaturated fats.

Recommendations from the Dietary Guidelines for Americans: The 2015–2020 Dietary Guidelines for Americans  ³¹ states that women who are pregnant or breastfeeding should consume 8–12 ounces of seafood per week, choosing from varieties that are higher in polyunsaturated omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and lower in methyl mercury, such as salmon, herring, sardines, and trout. These women should not consume certain types of fish, such as king mackerel, shark, swordfish, and tilefish that are high in methyl mercury, and they should limit the amount of white (albacore) tuna they consume to 6 ounces a week. The American Academy of Pediatrics has similar advice for breastfeeding women, recommending intakes of 200–300 mg docosahexaenoic acid (DHA) per day by consuming one to two servings of fish per week to guarantee a sufficient amount of docosahexaenoic acid (DHA) in breast milk ³².

Figure 1. Eating Fish: What Pregnant Women and Parents Should Know

[Source ³³]

You should limit the amount of foods you eat that contain:

• Saturated fat
• Trans fat
• Cholesterol
• Sodium
• Added sugars

A healthy eating plan also limits salt, solid fats (like butter, lard, and shortening), and sugar-sweetened drinks and foods.

A MyPlate Daily Checklist ³⁴ for Moms shows the foods and amounts that are right for you at your stage of pregnancy or when breastfeeding. Your plan will be personalized, based on your age, height, weight, physical activity level, and stage of pregnancy or breastfeeding status (pregnancy and breastfeeding options display upon providing your gender and age).

The MyPlate Daily Checklist ³⁴ shows your food group targets – what and how much to eat within your calorie allowance. Your food plan is personalized, based on your age, sex, height, weight, and physical activity level.

Not sure how much to eat from each food group ?

• Use the MyPlate Checklist Calculator ³⁵

Simply enter your age, sex, height, weight, and physical activity level to get a plan that’s right for you. The MyPlate Daily Checklist ³⁵ shows your food group targets – what and how much to eat within your calorie allowance.

For a more advanced experience, you can create a personal daily food plan using the SuperTracker’s MyPlan ³⁶. You will be asked to create a profile, and you can register to save it if you want. You can then use some or all of the SuperTracker’s other features.

• SuperTracker website: ³⁶

To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker ³⁷ from the United States Department of Agriculture Center for Nutrition Policy and Promotion ³⁷. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker ³⁷ to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

Table 4. Pregnancy Daily Food Checklist

[Source ³⁸]

Being Physically Active

Unless your doctor advises you not to be physically active, include 2½ hours each week of physical activity such as brisk walking, dancing, gardening, or swimming. The activity can be done for at least 10 minutes at a time, and preferably spread throughout the week. Avoid activities with a high risk of falling or injury.

Almost all women can and should be physically active during pregnancy. Regular physical activity may:

• help you and your baby gain the right amounts of weight
• reduce backaches, leg cramps, and bloating
• reduce your risk for gestational diabetes (diabetes that develops when a woman is pregnant)

If you were physically active before you became pregnant, you may not need to change your exercise habits. Talk with your health care provider about how to change your workouts during pregnancy.

How much physical activity do you need ?

Most women need the same amount of physical activity as before they became pregnant. Aim for at least 30 minutes of aerobic activity per day on most days of the week. Aerobic activities use large muscle groups (back, chest, and legs) to increase heart rate and breathing.

The aerobic activity should last at least 10 minutes at a time and should be of moderate intensity. This means it makes you breathe harder but does not overwork or overheat you.

If you have health issues like obesity, high blood pressure, diabetes, or anemia (too few healthy red blood cells), ask your health care provider about a level of activity that is safe for you.

How can you stay active while pregnant ?

Even if you have not been active before, you can be active during your pregnancy by using the tips below:

• Go for a walk around the block, in a local park, or in a shopping mall with a family member or friend. If you already have children, take them with you and make it a family outing.
• Get up and move around at least once an hour if you sit in a chair most of the day. When watching TV, get up and move around during commercials. Even a simple activity like walking in place can help.

How can you stay safe while being active ?

For your health and safety, and for your baby’s, you should not do some physical activities while pregnant. Some of these are listed below. Talk to your health care provider about other physical activities that you should not do.

Make a plan to be active while pregnant. List the activities you would like to do, such as walking or taking a prenatal yoga class. Think of the days and times you could do each activity on your list, like first thing in the morning, during lunch break from work, after dinner, or on Saturday afternoon. Look at your calendar or planner to find the days and times that work best, and commit to those plans.

Table 5. Safety tips while being active

Safety Dos and Dont’s
Follow these safety tips while being active.
Do…	Don’t…
Choose moderate activities that are not likely to injure you, such as walking or aqua aerobics.	Avoid brisk exercise outside during very hot weather.
Drink fluids before, during, and after being physically active.	Don’t use steam rooms, hot tubs, and saunas.
Wear comfortable clothing that fits well and supports and protects your breasts.	After the end of week 12 of your pregnancy, avoid exercises that call for you to lie flat on your back.
top exercising if you feel dizzy, short of breath, tired, or sick to your stomach.

[Source ³⁹] References

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2. U.S. Preventive Services Task Force. (2016). Final Recommendation Statement: Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication
3. CDC. (2016). Spina Bifida. – https://www.cdc.gov/ncbddd/spinabifida/facts.html
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5. U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 27. Nutrient Data Laboratory home page, 2014. https://ndb.nal.usda.gov/ndb/
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14. Suharno D, West CE, Muhilal, Karyadi D, Hautvast JG. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. Lancet 1993;342:1325–8.
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16. Allen LH. Multiple micronutrients in pregnancy and lactation. Am J Clin Nutr 2005;81:1206–16S.
17. Herbert B. Vitamin and minerals in pregnancy and lactation. New York: Raven Press, 1988.
18. Bondevik GT, Schneede J, Refsum H, Lie RT, Ulstein M, Kvale G. Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered? Eur J Clin Nutr 2001;55:856–64.
19. Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: Current knowledge and possible mechanisms. Nutr Rev 2008;66:250–5.
20. Lammi-Keefe CJ, Couch SC, Elliot P. Handbook of nutrition and pregnancy. Totowa NJ: Humana Press, 2008.
21. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Chichester, UK: John Wiley & Sons Ltd, 1993.
22. National Health and Medical Research Council. Nutrient reference value for Australia and New Zealand – vitamin D. Available at www.nrv.gov.au/nutrients/vitamin%20d.htm
23. Nath R. Health and diseases: Role of micronutrients and trace elements. APH 2000;67.
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25. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand – vitamin E. Available at www.nrv.gov.au/nutrients/vitamin%20e.htm
26. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand 2005 – iodine. Available at www.nrv.gov.au/resources/_files/n35-iodine.pdf
27. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand – selenium. Available at www.nrv.gov.au/nutrients/selenium.htm
28. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand 2005 – phosphorus. Available at www.nrv.gov.au/resources/_files/n35-phosphorus.pdf
29. Why take a prenatal supplement ? https://www.choosemyplate.gov/moms-pregnancy-prenatal-supplements
30. Weight Gain During Pregnancy: Reexamining the Guidelines. http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf
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35. MyPlate Checklist Calculator. https://www.choosemyplate.gov/MyPlate-Daily-Checklist-input
36. SuperTracker. https://www.supertracker.usda.gov/createprofile.aspx
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What are superfoods

The term Superfood is used often, but not always with the same meaning because there is no official definition of a “superfood” and the European Union has banned health claims on packaging unless supported by scientific evidence ¹. But that hasn’t stopped many food marketers from labelling the health benefits of their product. The food industry wants to persuade us that eating some foods can slow down the ageing process, lift depression, boost your physical ability, and even your intelligence. Superfood is really just a marketing term.

Superfoods are marketed – hard. They give us the idea that we need these special, often expensive and imported foods to be healthy. It’s adding to the myth that it costs a lot of money to eat healthy. For the majority of American, eating more vegetables and less meat would lead to a healthier diet, savings at the checkout and a smaller environmental impact. It’s a win, win, win!

The superfood trend exploits the fact that healthy lifestyle choices, including diet, can reduce our risk of chronic diseases like heart disease, stroke and cancer.

The superfoods claims are not usually backed by strong science. Many foods have been studied for their health effects and then reported in the media with flashy headlines. These studies are commonly:

• Done in petri dishes or animals, not humans
• Use huge, unrealistic amounts of a particular food or specific nutrient in food
• Are done on a small number of people, or for a short amount of time

The problem is that most research on superfoods tests chemicals and extracts in concentrations not found in the food in its natural state.

Many of us want to believe that eating a single fruit or vegetable containing a certain antioxidant will zap a diseased cell.

Garlic, for example, contains a nutrient alleged to help reduce cholesterol and blood pressure. But you’d have to eat up to 28 cloves a day to match the doses used in the lab – something no researcher has yet been brave enough to try.

Foods that have been elevated to superfood status in recent years include those rich in antioxidants (such as beta-carotene, vitamins A, C, E, flavanoids and selenium) and omega-3 fatty acids.

Antioxidants are chemicals thought to protect against the harmful effects of free radicals, which are chemicals naturally produced in every living cell and known to cause cell damage.

However, evidence about this and other health benefits of antioxidants is inconclusive. In a review of the scientific evidence in 2011, the European Food Safety Authority (EFSA) found no evidence that the antioxidant action on free radicals observed in the lab was of any benefit to human health ².

In addition, a 2012 Cochrane Review ³ suggests that certain antioxidant supplements may be harmful. In that systematic review, 78 randomized clinical trials were included with a total of 296,707 participants, who were randomized to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E and selenium) versus placebo or no intervention. Twenty-six trials included 215,900 healthy participants. Fifty-two trials included 80,807 participants with various diseases in a stable phase (including gastrointestinal, cardiovascular, neurological, ocular, dermatological, rheumatoid, renal, endocrinological, or unspecified diseases). A total of 21,484 of 183,749 participants (11.7%) randomized to antioxidant supplements and 11,479 of 112,958 participants (10.2%) randomized to placebo or no intervention died. When all of the trials were combined, antioxidants may or may not have increased mortality depending on which statistical combination method was employed; the analysis that is typically used when similarity is present demonstrated that antioxidant use did slightly increase mortality (that is, the patients consuming the antioxidants were 1.03 times as likely to die as were the controls). When analyses were done to identify factors that were associated with this finding, the two factors identified were better methodology to prevent bias from being a factor in the trial (trials with ‘low risk of bias’) and the use of vitamin A. In fact, when the trials with low risks of bias were considered separately, the increased mortality was even more pronounced (1.04 times as likely to die as were the controls). The potential damage from vitamin A disappeared when only the low risks of bias trials were considered. The increased risk of mortality was associated with beta-carotene and possibly vitamin E and vitamin A, but was not associated with the use of vitamin C or selenium. Therefore the current evidence does not support the use of antioxidant supplements in the general population or in patients with various diseases. The review authors conclusion was : “We found no evidence to support antioxidant supplements for primary or secondary prevention. Beta-carotene and vitamin E seem to increase mortality and so may higher doses of vitamin A. Antioxidant supplements need to be considered as medicinal products and should undergo sufficient evaluation before marketing” ³ .

While the concept of Superfoods or “miracle foods” remains a fantasy, it’s pretty well-established that obesity and alcohol are the two most common causes of major long-term illness and increased risk of premature death.

However for the sake of discussing the idea of superfoods, the simplest way to think of Superfoods is that “superfoods” offer benefits above and beyond their basic nutrient content. For example, antioxidants make berries super, while nuts and avocados have good fats. We focus on Superfoods that are naturally super, but there are also foods that are called super or functional because of ingredients that have been added to them. It is important to note however, that there is no food, including those labelled ‘superfoods’, can compensate for unhealthy eating. People shouldn’t mistakenly believe that they can ‘undo’ the damage caused by unhealthy foods by eating a superfood, because they will continue to hold false belief that they may continue making unhealthy choices that will increase their risk of long-term illness.

When it comes to keeping healthy, it’s best not to concentrate on any one food in the hope it will work miracles.

Top superfoods

Years of nutrition research has consistently shown that eating more wholefoods and plant foods is a good thing. When you think of superfoods, think of all wholefoods!

Fruit, vegetables, lean meats, dairy and wholegrain cereal products are part of well balanced diet, are affordable and readily available. Therefore, all unprocessed food from the major food groups could be considered ‘superfood’. Eat a wide variety of these, and you’ll get all the ‘super’ goodness you need.

Here is a list of top 10 superfoods

• Beetroot
• Blueberries
• Broccoli
• Chocolate
• Garlic
• Green tea
• Goji berries
• Pomegranate juice
• Oily fish
• Wheatgrass

Beetroot juice

Beetroot’s deep, overpoweringly red juice has earned it the reputation as the most bossy of vegetables.

Although the leaves have always been eaten, historically the beet root was generally used medicinally for a range of ailments, including fevers, constipation and skin problems.

Beetroot is a good source of iron and folate (naturally occurring folic acid). It also contains nitrates, betaine, magnesium and other antioxidants (notably betacyanin).

More recent health claims suggest beetroot can help lower blood pressure, boost exercise performance and prevent dementia.

Beetroot and beetroot juice, along with green leafy vegetables, cabbage and celery, are very useful as part of a balanced diet as their nitrate content may help to reduce blood pressure.

However, getting active, reducing the amount of salt in your diet and maintaining a healthy weight are also key strategies for getting your blood pressure under control.

Can beetroot lower blood pressure ?

Beetroot is rich in nitrates. The juice of the beetroot, has potential antioxidant and blood pressure lowering effect ⁴. Beetroot contains nitrate, which while in your body changes to a chemical called nitrite and then to nitric oxide in the blood. Nitric oxide is a gas that opens up blood vessels and aids blood flow. In a preliminary study, people with high blood pressure who drank a cup of beetroot juice each day had a 10 mm Hg decrease in blood pressure over the following 24 hours ⁴.  A well-conducted review of the current evidence from 2013 concluded that beetroot juice was associated with a modest reduction in blood pressure ⁵.

However further long-term trials would be needed and in people at greater risk of heart disease before we could say beetroot was clinically useful.

Does beetroot aid exercise performance ?

Another well-conducted review from 2013 ⁶ looked at research linking beetroot juice to improved exercise performance. The review found that inactive and recreationally active individuals saw “moderate improvements” in exercise performance from drinking beetroot juice. However, the review noted there was very little effect on elite athletes.

Can beetroot help prevent dementia ?

A 2010 study ⁷ suggested that a diet high in beetroot juice may increase blood flow to certain areas of the brain. However, this was a small and short-term study with several limitations and as such does not provide robust evidence that a diet high in nitrates aids cognitive function. Further research is needed in larger numbers of people over a longer period.

A 2014 study ⁸ looked at the effects of beetroot juice on cyclists, who were cycling in a chamber designed to mimic the effects of relatively high altitude (2,500 meters above sea level).

Researchers found that cyclists given the juice had a modest but significant increase in terms of their time trial scores; on average there was a 16 second improvement.

Blueberries

The grandad of the superfood trend, blueberries are a good source of vitamin K. They also contain vitamin C, fiber, manganese and other antioxidants (notably anthocyanins).

Valued for its high levels of antioxidants, some nutritionists believe that if you make only one change to your diet, it should be to add blueberries.

Die-hards claim blueberries can help protect against heart disease and some cancers, as well as improve your memory.

While research on the health claims of blueberries is inconclusive, they are a fantastic choice as one of your five portions of fruit and vegetables a day.

Blueberries are low in calories and high in nutrients, including phenolic compounds with an antioxidant capacity significantly higher than vitamins C or E.

Try adding them to your breakfast cereal, including them in a packed lunch or mixing with low-fat yogurt for a delicious dessert.

Heart health and blueberries

A study in 2012 of 93,000 women ⁹ found that participants who ate three or more portions of blueberries and strawberries a week had a 32% lower risk of a heart attack compared with those who ate berries once a month or less. However, the study could not prove that these fruits definitely caused the lower risk.

Can blueberries combat high blood pressure and atherosclerosis ?

While the evidence is inconclusive, it is thought that blueberries may relax the walls of the blood vessels, which may help reduce this risk of atherosclerosis – hardening of the arteries. Atherosclerosis can increase the risk of a heart attack and stroke.

A small study in 2015 involving 48 post-menopausal women ¹⁰, found that women who were given blueberry powder supplements over the course of eight weeks experienced a small, but clinically significant, drop in blood pressure.

A study ¹¹ from the same year involving 44 adults with metabolic syndrome (a combination of diabetes, high blood pressure and obesity), who were given blueberry smoothies, had less promising results as there was no effect on blood pressure.

A similar finding was presented in a 2013 study ¹² involving 21 men. Though these men were described as healthy so the results may not be applicable for people with underlying chronic diseases.

Though it is important to note that all of these studies were relatively small which gives less “weight” to their results. They also involved different populations so the results may not be applicable to the general population.

Can blueberries prevent cancer ?

There is so far very little evidence that blueberries can help protect against cancer. In laboratory studies on cells and animals, blueberry extracts (such as anthocyanins) have been shown to decrease free radical damage that can cause cancer. However, it is not clear how well humans absorb these compounds from eating blueberries and whether or not they have a protective effect.

Does eating blueberries lead to a better memory ?

A number of small studies have found a link between blueberry consumption and improved spatial learning and memory. However, most of these studies relied on small sample groups or animals. There is currently no evidence of a link between eating blueberries and improved memory.

Broccoli

Broccoli is a good source of vitamin C and folate (naturally occurring folic acid). It also contains vitamins A, K, calcium, fibre, beta-carotene and other antioxidants (notably indole-3-carbinol and sulforaphane).

Can eating broccoli prevent cancer ?

Eating more non-starchy vegetables, such as broccoli, is associated with a reduced risk of some cancers (including mouth, throat and stomach cancers), according to a good quality 2007 review ¹³ of the evidence on cancer prevention by the World Cancer Research Fund. It is possible that some of the compounds in broccoli may have health benefits, but clinical trials are needed to investigate this further.

Does broccoli reduce high blood pressure ?

There is no evidence to suggest broccoli can help lower blood pressure. In a 2010 study ¹⁴, 40 patients with high blood pressure who ate 10g of dried enriched broccoli sprouts for four weeks saw no improvement to the health of their blood vessels and did not reduce their risk of atherosclerosis (narrowing of the arteries).

Can broccoli help prevent cardiovascular disease ?

In a small study from 2012 ¹⁵ of 81 people with diabetes, those in a group that ate 10g a day of enriched broccoli sprouts powder for four weeks saw a reduction in their levels of cholesterol and triglycerides (a type of fat found in the blood), both of which can cause cardiovascular disease.

Does broccoli help in diabetes ?

In a lab study from 2008 ¹⁶, researchers applied the antioxidant sulforaphane to human blood vessels incubated with sugar. They found that sulforaphane appeared to prevent the damage to small blood vessels caused by high blood sugar (which can happen if you have diabetes). However, it is unclear from this study whether sulforaphane would protect a person with diabetes from damage.

Chocolate

Recent interest in the health benefits of chocolate was sparked by studies on the cocoa-drinking peoples of Central America.

Researchers observed that the Kuna Indians of Panama, who drank cocoa as their main beverage, had very low blood pressure, a leading cause of heart disease and stroke.

Chocolate is the processed and sweetened food produced from cocoa. Cocoa is a good source of iron, magnesium, manganese, phosphorous and zinc. It also contains the antioxidants catechins and procyanidins.

Brand experts have sought to associate chocolate – and in particular dark chocolate – with the supposed health benefits of cocoa, which include protection against cancer and stress relief.

It’s important to remember the studies on the health benefits of chocolate have focused on cocoa extracts, not chocolate.

A range of health benefits from the consumption of cocoa products have been investigated, particularly in relation to cardiovascular disease, with early results showing promise. However, the potential health benefit of some compounds in chocolate have to be weighed against the fact that to make chocolate, cocoa is combined with sugar and fat. This means chocolate is an energy-dense food that could contribute to weight gain and a higher risk of disease. As an occasional treat, chocolate can be part of a healthy diet. Eaten too frequently, it is an unhealthy choice.

Can chocolate reduce blood pressure ?

A well-conducted 2017 Cochrane review ¹⁷ of the best available evidence on the effects of chocolate on blood pressure concluded that cocoa products – including dark chocolate – may help slightly (2 mmHg) lower blood pressure.

However, most of the studies were of short duration (between two and eight weeks) and there were some weaknesses in the available research.

The authors of the review say longer-term trials are needed to further our understanding of cocoa’s effect on blood pressure, cardiovascular health and to assess potential adverse effects associated with chronic ingestion of cocoa products ¹⁷.

Can eating chocolate prevent cancer ?

Some limited animal and laboratory research suggests a cocoa-rich diet could offer protection against bowel cancer. But it’s impossible to conclude from research carried out in a laboratory that cocoa can protect people against bowel cancer.

Does chocolate stop stress ?

In a small study from 2009 ¹⁸, 30 healthy people who were given 40g of dark chocolate a day for 14 days experienced a reduction in stress hormones. However, the study, which was funded by a major chocolate manufacturer, had several limitations, including its short study period, and does not provide any evidence chocolate has any benefits or effects on stress.

Do two chocolate bars a day prevent stroke ?

A recent study carried out in Norfolk in 2015 ¹⁹ looked at chocolate consumption and cardiovascular disease. It reported people who ate the equivalent of two chocolate bars a day had a slightly lower risk of stroke than people who never or rarely eat chocolate.

Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events, although residual confounding cannot be excluded ¹⁹. There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk.

Can venous leg ulcers be helped with chocolate ?

Venous leg ulcers are open sores that can develop on the leg or foot, and can take many weeks to heal. People who find it difficult to move around as a result of conditions such as obesity or paralysis are particularly at risk.

A 2013 Cochrane review ²⁰ looked at whether flavonoids, a compound found in chocolate and red wine, could help accelerate wound healing. The study only found weak evidence in favor of flavanoids, but most of these trials were poorly reported, and so had an unclear risk of bias for randomisation, allocation concealment, blinding and methods for addressing incomplete outcome data. There was also a possibility of publication bias.

Garlic

Garlic contains vitamins C and B6, manganese, selenium and other antioxidants (notably allicin).

More recent evidence-based research suggests garlic may be effective against high blood pressure, cardiovascular disease, cholesterol, colds and some cancers.

Garlic is a delicious flavor used widely in Mediterranean and Asian cooking. Studies using high concentrations of garlic extracts have been associated with improved blood circulation, healthier cholesterol levels and lower blood pressure, all of which reduce the risk of cardiovascular disease. However, current evidence does not support the use of garlic supplements to improve health.

Garlic is particularly useful in cooking as it provides an alternative to salt in adding flavor to meals, along with lemon juice, chilli, herbs and spices. Eating less salt is important for avoiding high blood pressure.

Does garlic lower high blood pressure ?

A Cochcrane review from 2012 ²¹ based on 2 trials in 87 hypertensive patients, it appears that garlic reduces mean supine systolic and diastolic blood pressure by approximately 10-12 mmHg and 6-9 mmHg, respectively, over and above the effect of placebo, but the confidence intervals for these effect estimates are not precise and this difference in blood pressure reduction falls within the known variability in blood pressure measurements. This makes it difficult to determine the true impact of garlic on lowering blood pressure ²¹. These patients were given 2 X 100 mg tablets of high potency garlic powder three times daily for 12 weeks.

Can garlic reduce cholesterol ?

A well-conducted review from 2009 ²² of 29 good-quality studies involving a combined total of 1,794 participants concluded that garlic – mainly garlic powder – produced “modest reductions” in total cholesterol levels, an effect driven mostly by the modest reductions in triglyceride, without appreciable LDL “bad” lowering or HDL “good” elevation. Higher baseline line total cholesterol levels and the use of dietary modification may alter the effect of garlic on these parameters. Future studies should be conducted evaluating the impact of adjunctive garlic therapy with fibrates or statins on triglyceride concentrations.

Does garlic prevent the common cold ?

A Cochrane review from 2014 ²³ of the best available evidence concluded there was insufficient evidence regarding the effects of garlic supplements in treating or preventing colds. Most studies that claimed this were poor quality. The review said one reasonably good study suggested garlic may prevent colds, but more research was needed to back up the finding.

Will garlic protect against cancer ?

The evidence is mixed. A 2007 World Cancer Research Fund review ¹³ concluded that garlic “probably protects against” bowel and stomach cancers. A more recent review from 2009 ²⁴ of the best available research on humans concluded there was “no credible evidence” with stomach, breast, lung and womb cancers, but that there was “very limited evidence” that eating garlic may lower the risk of colon, prostate, oral, ovary or renal cell cancers ²⁴.

Green tea

Green tea has been used in traditional Chinese medicine for centuries to treat everything from headaches to depression.

The leaves are supposedly richer in antioxidants than other types of tea because of the way they are processed.

Green tea contains B vitamins, folate (naturally occurring folic acid), manganese, potassium, magnesium, caffeine and other antioxidants, notably catechins.

All types of tea – green, black and oolong – are produced from the Camellia sinensis plant using different methods. Fresh leaves from the plant are steamed to produce green tea, while the leaves of black tea and oolong involve fermentation.

Green tea is alleged to boost weight loss, reduce cholesterol, combat cardiovascular disease, and prevent cancer and Alzheimer’s disease. However the evidence about green tea’s health benefits is inconclusive – the evidence for the majority of these conditions is weak or lacking.

However, as a social drink, green tea appears to be safe in moderate amounts ~ 3 to 5 cups per day (up to 1200 ml/day), providing a minimum of 250 mg/day catechins, so lovers of green tea can continue to enjoy it.

Does drinking green tea protect you from cancer ?

There is no evidence drinking green tea protects against different types of cancer. A Cochrane review from 2009 ²⁵ involving 51 studies, with more than 1.6 million participants, looked for an association between drinking green tea and cancers of the bowel, prostate, breast, mouth and lungs. The authors of the review concluded evidence of a link between green tea and cancer was weak and “highly contradictory”.

A more recent 2015 study ²⁶ looked at the cancer-fighting effects of a compound found in green tea when combined with a drug called Herceptin, which is used in the treatment of stomach and breast cancer. Initial results in the laboratory were promising and human trials are now being planned.

But this shouldn’t be taken as official advice that drinking green tea while taking Herceptin will make it more effective.

Can green tea aid weight loss ?

It’s thought the antioxidants catechin and caffeine found in green tea may have a role in helping the body burn more calories – sometimes referred to as speeding up the metabolism – which can help weight loss.

Green tea preparations used for losing weight are extracts of green tea that contain a higher concentration of catechins and caffeine than the typical green tea beverage prepared from a tea bag and boiling water.

A well-conducted Cochrane review from 2012 ²⁷ of 18 studies involving 1,945 people found no significant effect of weight loss from drinking green tea. Green tea preparations appear to induce a small, statistically non-significant weight loss in overweight or obese adults. Because the amount of weight loss is small, it is not likely to be clinically important. Green tea had no significant effect on the maintenance of weight loss.

Does green tea cut cholesterol ?

A good-quality Cochrane review from 2013 ²⁸ of 11 studies involving 821 people found daily consumption of green and black tea (as a drink or a capsule) could help lower cholesterol and blood pressure thanks to tea and its catechins. The authors of the review caution that most of the trials were short term and more good quality long-term trials are needed to back up their findings.

Another good-quality review from 2011 ²⁹ found drinking green tea enriched with catechins led to a small reduction in total cholesterol and LDL “bad” cholesterol levels, a main cause of heart disease and stroke. However, it’s still not clear from the evidence how much green tea you would need to drink to see a positive effect on your health, or what the long-term effects of drinking green tea are on your overall health.

Can green tea help prevent or delay Alzheimer’s disease ?

Evidence of a positive link between drinking green tea and Alzheimer’s disease is weak. A 2010 laboratory study ³⁰ using animal cells found a green tea preparation rich in antioxidants protected against the nerve cell death associated with dementia and Alzheimer’s disease.

Whether these lab results can be reproduced in human trials remains to be seen. As such, the findings do not conclusively show green tea combats Alzheimer’s disease.

Can green tea lower blood pressure ?

A 2014 survey ³¹ of data from previously published studies looked at the evidence of whether drinking green tea could help lower blood pressure. There was evidence of a modest reduction in people with high blood pressure who consumed green tea. But whether this reduction would lead to clinically significant results, such as preventing the onset of heart disease or stroke, is unclear.

Can green tea prevent tooth decay ?

A small study from 2014 ³² looked at how effective a green tea mouthwash was in preventing tooth decay compared with the more commonly used antibacterial mouthwash chlorhexidine. The results suggested they were equally effective, though green tea mouthwash has the added practical advantage of being cheaper.

Goji berries

Goji berries contain vitamin C, vitamin B2, vitamin A, iron, selenium and other antioxidants (notably polysaccharides).

Various goji berry products are sold as health foods, but the evidence of their health benefits so far comes from scientific studies using purified extracts of the fruit at much higher concentrations than the products contain.

As these products tend to be relatively costly, it makes sense to stick to eating a range of fruits and vegetables rather than spending your money on this one item with no proven health benefits.

Can goji berries improve immunity, cardiovascular disease and life expectancy ?

There is no reliable evidence to support these alleged health benefits. Most of the research into these conditions are small-sized, of poor quality, and performed in laboratories using purified and highly concentrated extracts of the goji berry.

Do goji berries aid wellbeing, brain activity and digestion ?

One small study from 2008 ³³ found a daily drink of 120ml of goji berry juice for 14 days improved feelings of wellbeing, brain activity and digestion. However, the study involved only 34 people and was attempting to measure the effects of goji berry juice on a variety of conditions. The results of the study were inconclusive.

Can goji berries prevent cancer ?

One of the most talked about clinical studies on goji berries is a 1994 Chinese study ³⁴ conducted on 79 patients with various advanced cancers. It found those treated with immunotherapy in combination with goji polysaccharides saw their cancers regress. Unfortunately, information on the design of the study and the goji berry compounds used are lacking, so it is difficult to fully assess the significance of the results.

Pomegranate juice

The Middle Eastern fruit is claimed to be effective against heart disease, high blood pressure, inflammation and some cancers, including prostate cancer.

Pomegranate is a good source of fibre. It also contains vitamins A, C and E, iron and other antioxidants (notably tannins).

Research suggests there may be a benefit, but the evidence around the health benefits of pomegranates are inconclusive. The studies that have found an improvement in existing health conditions were very small and more investigation into the role pomegranate plays in these improvements is needed.

Can pomegranate strengthen bones ?

A 2013 study ³⁵ found evidence that pomegranate strengthened bones and helped prevent osteoporosis. The catch was the study involved mice, not humans.

While the biology of mice and humans are surprisingly similar, we can never be sure that these results will be applicable to us.

Does pomegranate juice slow prostate cancer progress ?

One small study from 2006 ³⁶ found that drinking a daily 227ml (8oz) glass of pomegranate juice significantly slowed the progress of prostate cancer in men with recurring prostate cancer. This was a well-conducted study, but more are needed to support these findings.

A more recent study from 2013 ³⁷ looked at whether giving men pomegranate extract tablets prior to surgery to remove cancerous tissue from the prostate would reduce the amount of tissue that needed to be removed. The results were not statistically significant, meaning they could have been down to chance.

Can pomegranate reduce carotid artery stenosis ?

A good-quality study from 2004 ³⁸ on patients with carotid artery stenosis (narrowed arteries) found that a daily 50ml (1.7oz) glass of pomegranate juice over three years reduced the damage caused by cholesterol in the artery by almost half, and also cut cholesterol build-up. However, these effects are not clearly understood and the study did not say what the results mean for conditions such as stroke.

Is heart disease prevented by pomegranates ?

A well-conducted trial from 2005 ³⁹ on 45 patients with coronary heart disease demonstrated that a daily 238ml (8.4oz) glass of pomegranate juice administered over three months resulted in improved blood flow to the heart and a lower risk of heart attack. The study did not say what the results mean for conditions such as heart attacks, and with such a small trial the positive results reported could be down to chance.

Oily fish

If there’s one food that’s good for your heart, it’s oily fish. Interest in the health benefits of oily fish started when researchers observed that Eskimos, who mainly eat oily fish, had fewer than average heart attacks and strokes.

Oily fish such as salmon, mackerel and sardines are said to help against cardiovascular disease, prostate cancer, age-related vision loss and dementia.

It’s a good source of vitamin D, protein, some B vitamins and selenium. It’s also a rich source of omega-3 fatty acids, a type of fat that is good for our health.

The benefits of eating at least two portions of fish a week, including one of oily fish, include keeping your blood pressure at a healthy level and improving blood lipids, both of which reduce your risk of cardiovascular disease: the biggest killer in the US.

Remember that you can get your omega-3 from a range of oily fish. Tinned sardines and mackerel, for example, are an easy and cheap way to stock up the store cupboard. Eaten on toast with a side salad, this makes a quick, easy and nutritious meal.

Cardiovascular disease

There is now a large body of evidence suggesting that fish consumption, particularly oily fish, reduces your risk of cardiovascular disease.

Studies have found eating oily fish can lower blood pressure and reduce fat build-up in the arteries. The evidence is strong enough to warrant the Dietary Guidelines for Americans that you eat at least two portions of fish a week, one of which should be oily ⁴⁰.

However, there are maximum recommended amounts for oily fish, crab and some types of white fish. There is additional advice for women who are pregnant or breastfeeding, and children and babies.

Recommendations from the Dietary Guidelines for Americans: The 2015–2020 Dietary Guidelines for Americans  ⁴⁰ states that women who are pregnant or breastfeeding should consume 8–12 ounces of seafood per week, choosing from varieties that are higher in polyunsaturated omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and lower in methyl mercury, such as salmon, herring, sardines, and trout. These women should not consume certain types of fish, such as king mackerel, shark, swordfish, and tilefish that are high in methyl mercury, and they should limit the amount of white (albacore) tuna they consume to 6 ounces a week. The American Academy of Pediatrics has similar advice for breastfeeding women, recommending intakes of 200–300 mg docosahexaenoic acid (DHA) per day by consuming one to two servings of fish per week to guarantee a sufficient amount of docosahexaenoic acid (DHA) in breast milk ⁴¹.

[Source ⁴²]

Prostate cancer

The evidence for oily fish’s effect on prostate cancer is inconclusive. Some limited research suggests that eating fish may reduce the risk of developing prostate cancer. However, this is not backed up by other studies, so we can’t be sure of the effect.

Dementia

A 2012 Cochrane review ⁴³ looked into whether consuming more omega-3, a type of healthy fat found in oily fish, could reduce the risk of dementia. The review looked at studies of healthy 60-year-olds who took omega-3 capsule supplements for six months.

The review concluded that there is no preventative effect of decline in brain function and dementia when healthy older people take omega-3. The review suggested that longer-term studies would offer researchers a better opportunity for identifying the possible benefits of omega-3 in preventing dementia.

Vision

A well-conducted review in 2010 ⁴⁴ found there was some evidence that eating oily fish two or more times a week could reduce the risk of age-related macular degeneration – a common cause of blindness in older people. However, the reviewers said the results should be interpreted cautiously, because of weaknesses in the research.

A more recent Cochrane review carried out in 2015 ⁴⁵ looked at whether fish oil supplements could reduce the progression of macular degeneration in people who already had the condition. The results were disappointing, as there was no evidence of any benefit. This review found that omega 3 long chain polyunsaturated fatty acid supplementation in people with age-related macular degeneration for periods up to five years does not reduce the risk of progression to advanced age-related macular degeneration or the development of moderate to severe visual loss. No published randomized trials were identified on dietary omega 3 fatty acids for primary prevention of age-related macular degeneration. Currently available evidence does not support increasing dietary intake of omega 3 long chain polyunsaturated fatty acid for the explicit purpose of preventing or slowing the progression of age-related macular degeneration ⁴⁵.

Rheumatoid arthritis

A 2013 study ⁴⁶ looked at the eating habits of around 32,000 middle-aged and older women to see if oily fish consumption had any influence on them developing rheumatoid arthritis. They did find that women who ate one or more servings of oily fish were 29% less likely to develop rheumatoid arthritis than women who never, or very rarely, ate oily fish.

However, this type of study can never prove cause and effect, as other factors could have been involved.

Schizophrenia

In 2013, the National Institute for Health & Care Excellence ⁴⁷ reviewed the evidence about whether medication based on omega-3 fatty acids could improve the symptoms of schizophrenia. The results were mixed. Four out of the eight studies showed some modest benefit when compared to placebo (a dummy treatment). The other four showed no benefit.

Based on these results, it is not recommended to use omega-3 fatty acid-type drugs as an alternative to existing treatments.

Wheatgrass

Wheatgrass contains chlorophyll, vitamin A, vitamin C, vitamin E, iron, calcium and magnesium.

There is no sound evidence to support the claim that wheatgrass is better than other fruits and vegetables in terms of nutrition. It cannot be recommended above any other choices in this food group.

Nutrition claims for wheatgrass

Despite claims that a 30ml (1oz) shot of wheatgrass contains as many nutrients as 1kg (2.2lbs) of your finest veggies, tests show that, pound for pound, the nutrient content of wheatgrass juice is roughly equivalent to that of common vegetables, such as spinach and broccoli.

Can drinking wheatgrass boost red blood cell production ?

Fans of wheatgrass believe that because chlorophyll and haemoglobin (a protein that carries oxygen around your body) are similar in structure, taking wheatgrass juice enhances haemoglobin production. But as far as evidence goes, there is no scientific proof to support this claim.

Does wheatgrass salve inflammation of the colon ?

A small study from 2002 ⁴⁸ found patients with ulcerative colitis (inflammation of the colon) saw their symptoms improve after they were given 100ml of wheatgrass juice daily for a month. However, the study involved only 21 people and the positive results could have been simply down to chance. As such, the evidence is inconclusive.

Can wheatgrass help people with blood disorders ?

A small study from 2004 ⁴⁹ of 32 patients with a blood disorder called thalassaemia found half of the patients required fewer blood transfusions when 100ml (3.5oz) of wheatgrass juice was taken daily for three years. While interesting, the research has many weaknesses and further research is needed before these findings can be properly validated.

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What is tapioca

Tapioca is a starch extracted from cassava root (Manihot esculenta Crantz). Cassava species, also known as yucca, manioc and tapioca, is native to the northeast region of Brazil, but its use spread throughout South America. The cassava plant was carried by Portuguese and Spanish explorers to most of the West Indies and Africa and Asia. All the parts of the crop are useful either for human consumption (young leaves and roots) or for feeding animal ¹. The plant grows in poor soil and is relatively drought resistant; the tubers are rich in carbohydrates and the leaves contain some protein. Cassava species tolerates drought and has been considered as a well adapted crop facing climate change which could position it as one of the best alternatives for providing food for the rapidly growing world population in future ². Cassava is a dietary staple for more than 600 million people globally ³. Cassava root has many uses. The roots are processed into tapioca flour, tapioca starch and other end products (chips, flakes, biofuel, textile, and glue) ⁴. Although tapioca is a staple food for millions of people in tropical countries, it is devoid of nutrition and low in food energy. The uses of the cassava roots are constrained by some factors. They are perishable; require rapid utilization after harvest and contain sometimes detrimental levels of cyanogenic glycoside ⁵.

Cassava contains cyanogenic glucosides (linamarin and lotaustralin) that are released as hydrogen cyanide, which are thought to protect the plants from insects and other animals ⁶. For human consumption, the cassava plants need to be detoxified, usually by soaking, drying in the sun, boiling, fermentation, or grating with roasting ⁷. These processes allow the cyanogenic glucosides to be released, but depend upon traditional practices, time taken and the availability of water. Neurotoxicity is associated with incompletely detoxified cassava, although the exact mechanisms by which these compounds cause neurological damage is unclear. The toxicity of cyanide is reduced by its transformation to thiocyanate or cyanate, which requires sulphur donors, often limited in malnutrition. Two neurological conditions are mainly associated with bitter cassava: a myeloneuropathy and konzo. The myeloneuropathy manifests as a slowly evolving bilateral sensory polyneuropathy, optic atrophy and sensorineural deafness, and sensory ataxia, is seen in adults (particularly elderly) who have a solely cassava diet ⁸. Konzo is a condition with selective upper motor neuron damage, manifesting as an acute or subacute onset of an irreversible, non-progressive, and symmetrical spastic paraparesis or quadriparesis ⁹. The disease konzo has no cure ¹⁰. Prevention measures such as proper cassava processing, i.e., detoxification of cassava roots before their consumption. Konzo is found in remote poor regions, often occurring as epidemics in times of drought, famine, and war, when the usual detoxifying preparation of cassava are not followed. One country with the highest prevalence of this paralysis is the Democratic Republic of Congo, where konzo can affect up to 5 percent of people in some villages ¹¹. All children in konzo-harboring villages – even without physical symptoms – showed poorer memory than children from konzo-free villages. Those in konzo villages additionally lagged in visual-spatial aptitude and in mental processing. These results suggest that even without physical manifestations from cassava toxins, some children suffer damage and the overall burden of cassava-related brain impact may have been underestimated. Besides myeloneuropathy and konzo, cassava is associated with other neurological disorders. For example, cassava consumption is associated with epilepsy across Africa ¹² and behavioural and emotional problems in Kenyan children ¹³; but it is unclear whether this is a marker of poverty and thus associated with other risk factors, or a result of neurotoxicity. Konzo can be prevented with appropriate preparation of cassava, but it remains unclear whether consumption of cassava has any subtle neurotoxic effects. In view of the reliance of many poor people in many parts of the world on cassava as a staple food, scientists need to determine the full extent of cassava’s effect on the central nervous system (CNS).

Cassava-derived food products (e.g. tapioca flour or starch) are increasingly exported for snack production, animal feed and used as thickening agents in food industries. It is therefore critical to understand the potential neurotoxic properties and the extent of neurodevelopmental risk associated with this staple.

Tapioca flour is naturally gluten free. In developed countries, tapioca starch (flour) is used as a thickening agent in various manufactured foods. In addition to its use for culinary purposes, cassava finds application in industrial products such as an adhesive for laundry purposes, for manufacturing paper, alcohol, butanol, dextrin, adhesive tape, textile sizing, and glue ¹⁴.

Commercially, the tapioca starch is processed into several forms: hot soluble powder, meal, pre-cooked fine/coarse flakes, rectangular sticks, and spherical “pearls”. Pearls are the most widely available shape; sizes range from about 1 mm to 8 mm in diameter, with 2–3 mm being the most common.

Flakes, sticks, and pearls must be soaked well before cooking, in order to rehydrate, absorbing water up to twice their volume. After rehydration, tapioca products become leathery and swollen. Processed tapioca is usually white, but sticks and pearls may be colored. Traditionally, the most common color applied to tapioca has been brown, but recently pastel colors have been available. Tapioca pearls are generally opaque when raw, but become translucent when cooked in boiling water.

Brazil in South America, Thailand in Asia, and Nigeria in Africa are the world’s largest producers of cassava. Currently, Thailand accounts for about 60 percent of worldwide exports.

Figure 1. Cassava

Figure 2. Tapioca pearls

Tapioca nutrition

Tapioca predominantly consists of carbohydrates, with each cup containing 26 grams for a total of 100 calories; it is very low in saturated fat, protein and sodium. It has no significant essential vitamins or dietary minerals ¹⁵. One serving of tapioca pudding contains no dietary fiber, a small amount of oleic acid, and no omega-3 or omega-6 fatty acids ¹⁵.

Table 1. Tapioca starch (finely tapioca ground flour) nutrition facts

[Source ¹⁵]

Table 2. Tapioca flour nutrition facts

[Source ¹⁵] References

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2. Jarvis A, Ramirez-Villegas J, Campo BVH, Navarro-Racines C. Is cassava the answer to African climate change adaptation? Trop Plant Biol. 2012;5(1):9–29. doi: 10.1007/s12042-012-9096-7.
3. Tshala-Katumbay, D, Mumba, N, Okitundu, L et al. Cassava food toxins, konzo disease, and neurodegeneration in sub-Sahara Africans. Neurology. 2013; 80: 949–951
4. Agre A. P., Kouchade S., Odjo T., et al. Diversité et évaluation participative des cultivars du manioc (Manihot esculenta Crantz) au Centre Bénin. International Journal Biological and Chemical Sciences. 2015;9(1):388–408. doi: 10.4314/ijbcs.v9i1.33.
5. Niba L. L., Bokanga M. M., Jackson F. L., Schlimme D. S., Li B. W. Physicochemical properties and starch granular characteristics of flour from various Manihot Esculenta (Cassava) genotypes. Journal of Food Science. 2002;67(5):1701–1705. doi: 10.1111/j.1365-2621.2002.tb08709.x.
6. Cassava, konzo, and neurotoxicity. The Lancet Global Health, Volume 5, Issue 9, e853-e854. http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2817%2930306-6/fulltext
7. Nzwalo, H and Cliff, J. Konzo: from poverty, cassava, and cyanogen intake to toxico-nutritional neurological disease. PLoSNeglTropDis. 2011; 5: e1051
8. Adamolekun, B. Neurological disorders associated with cassava diet: a review of putative etiological mechanisms. Metab Brain Dis. 2011; 26: 79–85
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10. Tshala-Katumbay D, Mumba N, Okitundu L, et al. Cassava food toxins, konzo disease, and neurodegeneration in sub-Sahara Africans. Neurology. 2013;80(10):949-951. doi:10.1212/WNL.0b013e3182840b81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653209/
11. Cassava root causes cognitive damage in Congolese villages. https://www.fic.nih.gov/News/GlobalHealthMatters/january-february-2014/Pages/brain-disorders-cassava.aspx
12. Ngugi, AK, Bottomley, C, Kleinschmidt, I et al. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: Cross-sectional and case-control studies. Lancet Neurol. 2013; 12: 253–263
13. Kariuki, SM, Abubakar, A, Kombe, M et al. Burden, risk factors, and comorbidities of behavioural and emotional problems in Kenyan children: a population-based study. Lancet Psych. 2017; 4: 136–145
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What is wild rice

Wild rice (Zizania aquatica) is not actual rice, but an aquatic grass bearing edible grains that are more closely related to oats, belonging to the genus Zizania with four known species. Wild rice is an annual aquatic grass which grows in shallow lakes, marshes and in sluggish streams in various parts of the world. The grain of wild rice has been harvested by the Indians of the United States and Canada for many centuries. Explorers entering the territories of the Northern Lake States of America a few centuries ago described wild rice as a spontaneous crop which does not require plowing or sowing providing an abundant harvest of palatable and nourishing grain. Natural propagation assured the Indians of a yearly crop. As time passed, wild rice lost its importance as a staple for the Indian population, but it became a white man’s delicacy because of its unique color and flavor characteristics. Today, most of the wild rice in the world is harvested as a cultivated crop from paddies in the state of Minnesota. Smaller amounts are produced in Wisconsin and in southern Canada.

There are four species of wild rice, including Zizania aquatica L., Zizania palustris L. and Zizania texana Hitche, are native to North America, and only one [Zizania latifolia (Griseb) Turcz] is native to China, Japan and Vietnam.

Wild rice is not directly related to Asian rice (Oryza sativa), whose wild progenitors are Oryza rufipogon and Oryza nivara, although they are close cousins, sharing the tribe Oryzeae. Wild rice grows in shallow water in small lakes and slow-flowing streams; often, only the flowering head of wild rice rises above the water. The wild rice grain is eaten by dabbling ducks and other aquatic wildlife, as well as by humans.

Wild-rice grains are naturally gluten free and have a chewy outer sheath with a tender inner grain that has a slightly vegetal taste. According to the international American Association of Cereal Chemists’ (AACC) definition, the US Food and Drug Administration published a Draft Guidance on Whole-grain Label Statements in 2006 ¹ – wild rice belongs to whole-grain cereals. In recent years, there has been increasing consumer awareness of wild rice, but it has not attained regular use as a staple food. More than 3000 years ago, the grain was used in Chinese herbal medicine to treat a variety of ailments associated with nutrition ² and Japan also had a similar record. The distribution of wild rice was extensive in China, but its use as a grain has completely disappeared. North American wild rice, which is commercialized and considered as a health food, has been widely available in supermarkets and restaurants today ³. Composition analysis of wild rice reveals that it is rich in plant protein, dietary fiber, the amino acid lysine and low in fat ⁴. Little is known about the underlying biological function of wild rice in improving chronic metabolic disorders. Recent series of rat studies have demonstrated that consuming wild can drastically improve blood lipid profiles and suppress oxidative stress ⁵, ⁶. In those rat studies where wild rice was added to a high fat, high cholesterol diet found significant improvement of serum free fatty acids, total cholesterol, and triglyceride levels while maintaining higher high-density (HDL “good”) lipoprotein levels compared with a control diet ⁵. The exact explanation of the protective mechanism of wild rice is uncertain, but the dietary fiber, phytosterol, or antioxidant capacity of wild rice may be the reason for it. The findings suggest that wild rice may be used instead of white rice and processed wheat starch as a staple food in the human health diet and might serve as a potential food source for preventing nutrition-related chronic metabolic diseases. Current interest in whole grains and gluten-free diets, as well as antioxidants and phytochemicals, makes wild rice an attractive grain addition to the diet ⁶. However before we can recommend people start eating wild rice, well designed human studies are now needed to confirm the positive animal study findings.

Figure 1. Wild rice

Wild rice nutrition facts

Typically sold as a dried whole grain, wild rice is high in protein, the amino acid lysine and dietary fiber, and low in fat. Wild rice is classified as a whole grain and typically contains 75% carbohydrate, 6.2% dietary fiber, 14.7% protein, and 1.1% lipids. Wild rice is a good source of dietary fiber and has nearly double the amount of protein of white rice. Wild rice lipid content is low; however, most of the lipids are essential omega-6 (35.0–37.8%) and omega-3 (20.0–31.5%) fatty acids ¹. In addition to macronutrient content, wild rice contains phytosterol levels several times higher than white rice. Furthermore, the antioxidant activity of wild rice is 10–15 times higher than white rice.

Wild rice protein content is relatively high compared to other cereal grains. Nutritional analysis shows wild rice to be second only to oats in protein content per 100 calories. Wild rice is a good source of the B vitamins, thiamin, riboflavin and niacin and contains common mineral elements in amounts comparable to those in oats, wheat and corn ⁷. One cup of cooked wild rice provides 5% or more of the daily value of thiamin, riboflavin, iron, and potassium; 10% or more of the daily value of niacin, b6, folate, magnesium, phosphorus; 15% of zinc; and over 20% of manganese ⁸.

Table 1. Wild rice (raw) nutrition facts

[Source ⁹]

Table 2. Wild rice (cooked) nutrition facts

[Source ⁹] References

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5. Zhang H., Cao P., Agellon L.B., Zhai C.K. Wild rice (Zizania latifolia (Griseb) Turcz) improves the serum lipid profile and antioxidant status of rats fed with a high fat/cholesterol diet. Br. J. Nutr. 2009;102:1723–1727. doi: 10.1017/S0007114509991036. https://www.ncbi.nlm.nih.gov/pubmed/19631021
6. Han S, Zhang H, Qin L, Zhai C. Effects of Dietary Carbohydrate Replaced with Wild Rice (Zizania latifolia (Griseb) Turcz) on Insulin Resistance in Rats Fed with a High-Fat/Cholesterol Diet. Nutrients. 2013;5(2):552-564. doi:10.3390/nu5020552. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635212/
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