0 Food safety - chemicals
 1 Food-borne diseases
 2 Polycyclic aromatic hydrocarbons (PAHs)
 3 Sausage, Salami, Hot dog, cold cuts, pre-cooked meats
 4 Meat processing
 5 poultry processing
 6 Food poisoning
 7 precautions
 8 Food Allergy and Intolerances
 9 Fat, Body
 10 fatty food

\0 Food Safety

Not so long ago, concerns about food poisoning focused mainly on trichinosis from undercooked pork and salmonella from foods like potato salad at picnics. In years past, I had no qualms about eating and serving steak tartar, homemade eggnog and Caesar salad dressing made with raw eggs, rare burgers, scallop ceviche (the fish "cooks" in acid) and even raw oysters and clams. Nor did my guests hesitate to indulge in such foods.

But times - and dangerous food poisoning organisms - have changed. Today, almost no food is exempt from possibly harboring a micro-organism or microbial toxin that can make people sick and, in some cases, kill them. While millions of consumers worry about pesticide residues and additives in foods, the real hazards lie in microbial contamination and improper food handling, especially in the home.

Having paid close attention to recent warnings about cooking temperatures, cutting boards and the consumption of raw and undercooked foods, I thought I knew everything I needed to know about safe food handling and consumption. For example, I am a fanatic about handling raw poultry: everything it touches, including the kitchen sink, gets scrubbed immediately after use with hot, soapy water. And when I go grocery shopping in the summer, I bring a cooler along to keep cold foods cold during the half-hour drive home.

But in researching this column, I learned several valuable new lessons about food safety and have made adjustments accordingly in how I handle food, cooking utensils and cleanup. I also learned that the organisms that spoil food and make it look, smell or taste bad are not the same as those that cause food poisoning, which produce no obvious change in the food but can make a consumer very sick.

The Basics

Washing hands often and thoroughly, and not just after using the toilet, could eliminate nearly half the cases of food-borne illness, experts estimate. Before and after every food preparation task and between tasks like handling raw meat and then cutting vegetables, wash your hands with warm, soapy water for 20 seconds, then dry them with a disposable towel or clean cloth towel. Wash under rings and fingernails; use a nail brush if necessary.

Keep hot foods hot (above 140 degrees Fahrenheit) and cold foods cold (below 40 degrees). Microbes thrive between 40 and 140 degrees, and subsequent cooking or reheating may not destroy toxins.

Refrigerate or freeze both raw and cooked meats, poultry, fish and eggs as soon as possible after purchase. Do the same with leftovers and with foods you prepare in advance. It is best to chill cooked foods as quickly as possible; use shallow containers to speed cooling, and do not wait for them to reach room temperature before refrigerating them.

Wash all produce, even packaged salad mixes and vegetables, those that say "prewashed" or "triple washed" and those that will be peeled, like bananas, oranges, melons and avocados, especially if they are not going to be eaten right away. The skin could be contaminated and when the fruit is cut, food-poisoning organisms could spread to the flesh.

Do not drink "raw" (unpasteurized) milk or apple cider. If you buy unpasteurized cider, heat it to 160 degrees, then chill it before you drink it.

Have at least two cutting boards. Dedicate one (preferably not wood) to raw meats, poultry and fish. Immediately after use, wash it in hot soapy water or in the dishwasher. Periodically sanitize it with a solution of chlorine bleach and replace it when it develops significant grooves. Use a second board (this can be wood) only for cutting bread, vegetables, fruits and other foods that are not cooked.

Avoid cross-contamination. Keep raw meats, poultry and fish in their original packages and place them on platters on the bottom shelf of the refrigerator to prevent their juices from dripping on other foods. Wash scissors and knives used to open the packages. Never handle cooked food with utensils or platters that held raw food unless they have been thoroughly washed. Also, boil marinades for one minute if they are to be used for basting.

Thaw meats, poultry and fish in the refrigerator — never on the counter — or in the microwave oven or in a sealed package in cold water that is changed every half hour. Read and follow the "safe handling instructions" now required by the United States Department of Agriculture on all packages of raw poultry and meat. Also, marinate raw foods in the refrigerator.

Kitchen cloths and sponges can harbor all sorts of organisms. Wash dishcloths and towels in hot water often. Disinfect sponges in a chlorine bleach solution or by microwaving them on high for one minute, and replace them when worn.

Buy a refrigerator thermometer. The refrigerator should always be below 40 degrees, and the freezer at or below 0 degrees. Do not put highly perishable foods on the door. Milk and eggs are best kept in the body of the refrigerator.

Cooking for Safety

The rules for safe cooking depend on the food. The wise cook will buy — and always use — a food thermometer, either the kind that is inserted before cooking or the instant-read variety.

EGGS Check the contents of the carton in the store and do not buy it if any egg is cracked or if the shells look dirty. Store both raw and cooked eggs in the refrigerator. Use only pasteurized eggs (available in some supermarkets or by calling (800) 447-3447), never ordinary raw eggs, in foods that will not be cooked. Cook all egg-rich dishes to an internal temperature of 160 degrees.

POULTRY Insert a food thermometer into the thickest part away from bone and gristle. Cook ground chicken and turkey to an internal temperature of 165 degrees, boneless roasts and breast meat to 170 degrees, and whole birds, thighs and drumsticks to 180 degrees. Poultry should be stuffed just before it is cooked, and the stuffing should reach 165 degrees (if the bird is done first, remove the stuffing and finish cooking it separately). For frozen poultry, allow one and a half times the normal cooking time. Carve whole birds fully when done and refrigerate the extra meat and the carcass immediately.

MEATS All cuts of pork should be cooked to 160 degrees, although a fully cooked ham can be reheated to 140 degrees. Ground meat (as in hamburgers, meatloaf and meatballs) must be cooked to 160 degrees to kill the dangerous type of E. coli bacteria. Do not rely on color; even if brown all the way through, the internal temperature may not have reached 160. Roasts and steaks are less of a worry, since any dangerous organisms will be on the surface and killed by the time the internal temperature reaches 145 degrees. One exception, however, is meat that has been tenderized by pricking; it should be treated like ground meat.

CANCER-CAUSING DANGEROUS CHEMICALS IN FOOD

Pesticides PCB, DDT, 245T, Dildrin etc cause cancer. if possible buy organic produce. always wash/peel fruit

\1 Food-borne diseases

Investigating a Food Supply Gone Haywire
 With the writing of her ]997 book, Spoiled: The Dangerous Truth About a Food Chain Gone Haywire (Penguin), Fox answered her questions about E. coli, but she also looked at other frightening pathogens that have invaded our food supply. These include Salmonella and Campylobacter, both of which have become almost omnipresent in poultry; and "mad cow" disease, which has invaded British beef and killed a dozen people in England (see the cover story, this issue). Fox is convinced that we can get these dangerous contaminants out of our food supply, and that Sweden's model programs of scrupulous cleaning and disinfecting show how it can be done. "Over here we're trying to deal with the problem through meat irradiation and other solutions. instead of attacking it at its source," says Fox. "We know what factors in chicken rearing. for instance, are responsible for Salmonella outbreaks. Some reforms have been made but, unfortunately, the U.S. Department of Agriculture (USDA) doesn't have the authority to order sweeping changes." Fox, who lives in rural Maine, is working on a new hook, It Was Probably Something You Ate: A Practical Guide to Avoiding nnd Surviving Food-Borne Disease. E. Spoiled is a very scary book about . the ways in which modern agricultural and factory farming methods have left us with a food system that is dangerously contaminated. Maybe you could start with an overview of what you found. FOX: First of all, I found that it was really very complicated. Why are we having all of these cases of food-borne illness? The answer lies in modern processing and factory farming. They both contribute, but the consumer also has a hand in it as well. There are many factors. We have changed our entire relationship to food. We've changed how we produce it, how we process it, how we distribute it. We've also changed what we cook, how we cook it, and how we buy it. For instance, consumers want fresh fruits and vegetables all year-round. That means the produce has to come from all over the world, and it does. If you go to your local supermarket, the fruits and vegetables may come from 26 different countries. Every time we consume that produce, we are actually consuming the environment in which those foods were produced. We are consuming the quality of the water and the soil, and the sanitary conditions of the people who pick and pack them. One of the things that scared me most was what you wrote about meat. You describe an incredible amount of contamination in, for instance, poultry. You say that 99 percent of chickens were found by the USDA in a sample to be contaminated with generic E. coli bacteria, indicating fecal contamination. And one E. coli O[sub 157]:H[sub 7]-infected cow can contaminate 16 tons of hamburger. Also, 72 percent of chickens in one study were found to be contaminated with Salmonella. If 99 percent of chicken are contaminated with generic E. coli, and 72 percent infected with Salmonella, how dangerous is that to people, assuming they buy chicken at the supermarket and they cook it properly? It puts an incredible onus on the cooking process. It certainly does. Cooking can kill these microbes and render the food safe for you to eat, but there's also a danger that you will cross-contaminate other things in the kitchen. lake chicken, for instance. Virtually all of the chickens we buy are contaminated with something called Campylobacter, which you may have never eeard of. Yet it is the most frequent cause of diarrhea disease in most parts of this country. If we are cooking our chicken thoroughly, why are so many people getting sick? Some studies have shown that the person most likely to become sick is the person preparing the chicken, because it's on their hands--it may also get on the counters, on the cutting boards, etcetera. You have to be very careful not to transfer the bacteria that are on these products into things that you are going to eat without cooking, like salad ingredients. You note that when cooking hamburgers on the grill, you have to be careful not to put the cooked hamburgers on the planer that also held the uncooked hamburgers. You can re-contaminate the meat that way. That's exactly right. Anything that you have touched with that uncooked meat product should be washed before it touches a cooked meat product, and that would be something like a spatula. People don't even think of that. There are actually cases where people have become seriously ill because of the spatula that was used to transfer an uncooked, then a cooked burger. To me it is really asking the consumer to operate a kind of biohazard lab, and that's too complicated for me. I just stopped bringing meat into the kitchen. You're what you call a "reluctant" vegetarian. I'm sad to say that really I've always enjoyed meat in my diet. The first thing I gave up was hamburger. I think I wouldn't have been so concerned about it if it were something I'd ground myself. But hamburger now is mass produced in places like Iowa or Nebraska from all the scraps left over from cutting meat. As you've already pointed out, one contaminated cow can contaminate a significant amount of meat, because hamburger may contain a hundred different animals from four different countries. Some of these animals may be dairy cattle carrying infections.

You're essentially saying what Oprah Winfrey said. Would you go so far as to recommend that people not eat hamburger? I think everyone has to make their own decision. If you really are a hamburger fanatic and are so unwise as to want to eat it rare, then you probably ought to go to the grocery store, buy a chuck steak and bring it home. Grind it up yourself in your own clean grinder, which you make sure to wash thoroughly afterwards. I know that's a lot of trouble. but when I say that. I'm surprised at the number of people who say. `My grandmother used to do that.' I think that we've become very complacent about our food we don't want to give it any time or attention, and we put it so low on our really become no more than a refueling process. One of the implications of what you're saving is that you are not necessarily safe if you're vegetarian. Vegetables and fruits are easily contaminated. If you buy, say, a commercial supermarket salad packaged in a bag, I imagine it is very easy for that salad to become contaminated. Well, yes. We have to ask, what was this lettuce washed in? Who cut it up for us? I think it's ironic that we turned a lot of food safety activity over to the lowest-paid workers in our entire economy. Some of those salad bags come labeled "triple-washed" and the implication is clearly that these foods are ready for the salad bowl. And yet, I took a bag of that "triple-washed" lettuce, washed it and found about a tablespoon of dirt in the bottom of the pan. Not enough consumers are aware that just about everything you eat needs to be washed, and even that's not a guarantee. But I have to go back and say that you are more likely to confront these disease-causing microorganisms on animal products, which are contaminated by animal waste. Fecal matter gets onto the meat during slaughter, and there are various things that occur in processing that can exacerbate it. Vegetables are less likely to be contaminated with animal waste, but it can happen. Let's talk about Salmonella and eggs a little bit. You wrote that cooking eggs the ways millions of Americans like them, sunny side up, for instance, doesn't necessarily kill Salmonella. That's right. These were tests carried out in England. What has happened to the egg is nothing less than a tragedy, because the egg is such a versatile food. I was looking in my master French cook book and found 123 main course dishes that contained egg. If you cooked them the way we are now directed to cook them, there would only be 23 of those dishes left, an 83 percent decline. In these English tests, they inoculated eggs with Salmonella and then checked to see how hard they had to be before the Salmonella died. And they found that only scrambling them quickly at a very high heat, boiling them for nine minutes or longer, or frying them until the yolk solidified was enough. When the Minnesota Public Health Department did a survey of people who had Salmonella infections, the great majority of them had eaten undercokked eggs, just in the ordinary way many of us had: Sunny side up, poached or something like that. How could we effectively rid ourselves of Salmonella contamination? I eat organic eggs from a small producer in Massachusetts. They are fed grain, not the kind of chicken feed that may contain ground-u chickens and animal protein which may contain bacteria. The chickens go outside. And they don't get antibiotics, which is another factor in stressing these birds. Most importantly, though, these birds are tested three times in their life for Salmonella and the tests have come up negative. Most eggs in the United States are raised in factory operations where you have some thing like 70,000 birds in a huge hen house. How do we mainstream the kind conditions you're talking about? We'd have to change the way we're producing eggs, because all of the factors in intensive production have contributed in one way or another. For instance, we breed chickens for producing eggs on a very regular basis--we select for the best producers. So if you go into a commercial hen house, all the chickens are actually like clones, as close as you can get without actually cloning them. This means that they're all identically susceptible to disease. The feed that they get may well be contaminated; it often is. They are fed antiobiotics, which not only selects for certain bacterial strains, it seems to lead to antibiotic resistance in these strains. Rats and mice may get in the house and run on the conveyer belts that feed these birds and then take away their eggs. They may run from house to house so that disease may spread between the houses. The water may be dirty. All of these factors are going to contribute to the birds being susceptible to certain diseases, and in one way or another, they can pass them on to us. Unfortunately, what I see facing the world is an imperative to produce food intensively because of population increases. The U.S. is likely to double its population by 2100. Many countries have doubled or tripled their populations very recently. Just to keep up with feeding people, some observers say we more or less have to go with intensive crop management, using a lot of pesticides and intensive animal agriculture. That's operating on the assumption that the only way we can produce this amount of food is through intensive farming, and I don't believe that is necessarily true. Organic farmers are finding that it is not as difficult as it originally was thought to produce high-quality, high-yield food in a competitive situation.

I think we a]so need to look closely at the things that are making disease worse. For instance, we might have more of a variety in chickens in these houses. We might have smaller houses, and more of them. We might not have them connected with conveyer belts, which can spread disease. The houses should certainly be kept clean, and the animals need clean food and water--that's only common sense. We in the US have the cheapest food in the world, and that's been a matter of USDA policy. We need to look again at that policy and see whether it is truly helpful to us as a nation. It may be resulting in more food-borne disease, which just shifts the true cost elsewhere. That's not to say that more expensive food is always safer, because it certainly isn't. Look at the people who got sick from expensive imported raspberries. There are many factors creating this increase in food-borne disease. We just need to take a saner approach.

CONTACT: Center for Science in the Public Interest, 1875 Connecticut Avenue NW, Suite 300, Washington, DC 20009 (202)332-9110; Consumers United for Food Safety, PO Box 22928, Seattle, WA 98122/(425)747-2659. INTERVIEWED BY JIM MOTAVALLI By Jim Motavalli E Magazine: The Environmental, May/June 1998 CONVERSATIONS NICOLS FOX


\2 Polycyclic aromatic hydrocarbons (PAHs) and sensitivity to cooking method

Polycyclic aromatic hydrocarbons are produced when any incomplete combustion occurs [Lijinsky 1991]. Thus, they are found in polluted air, cooking oil fumes, tobacco smoke, smoked foods [Gomaa 1993], and foods cooked at high temperature. Let's note here that comparisons between cooked food and smoking are of limited value, not only because PAHs are absorbed through the digestive tract in one case and through the lungs in the other, but also because it is thought that the main carcinogen in tobacco smoke is the presence of nitrosamines. Moreover, cooked food (in general) doesn't contain tar or nicotine.

Air pollution usually contains many fewer PAHs than what a smoker breathes, and in fact much less than the average level of PAHs in food. (Even raw food can contain PAHs, due to air pollution [Lodovici 1995, Wickstrom 1986].)

Most PAHs are not carcinogenic, although a few are (such as benzo(a)pyrene). They appear mainly in meats cooked at high temperature--grilling, for example. Microwaving doesn't produce PAHs, and foods other than meats contain negligible amounts of PAHs. Foods low in fat, or cooked beneath the source of heat, contain many fewer PAHs, so the type of food cooked and the method of cooking are important.

More quantitatively, the table below shows the amounts of pyrene and benzo(a)pyrene, two PAHs known to be carcinogenic, expressed in micrograms per kilogram of food. There are of course other carcinogenic PAHs, and many more noncarcinogenic ones, but the point here is just to get an idea:

AMOUNTS OF POLYCYCLIC AROMATIC HYDROCARBONS (PAHs) IN SELECTED COOKED MEATS

Figures are expressed in mcg per kg of food. Food Source / Cooking Method Amount of: Pyrene Benzo(a)pyrene Frankfurter sausage, log fire 20-450 6-212 Frankfurter sausage, cone fire 21-84 2-31 Frankfurter sausage, fried, oven-baked 1-3 < 1 Barbecued pork ribs 42 11 Pork, charcoal-broiled 24 8 Steak, flame-cooked 20 4 Beef patties, charcoal-broiled 7-8 3-11 Smoked haddock 1 < 1 As we see above, the ranges are quite wide, probably due to extreme sensitivity to the cooking method. Oven baking produces minimal amounts of PAHs, even in the most fatty meats like frankfurter sausages.

Natural toxic constituents in food, and effect (or absence of effect) of cooking

Here, we will only investigate a few examples, since the list of all natural toxic constituents would be extremely long [Ames 1983], besides which not all have been studied yet. It will appear that heating does not destroy all of these constituents, and that some (but not all) of the toxins listed below are found in foods that are commonly eaten cooked, but that are inedible raw, except perhaps in small quantities (like potatoes). Thus a good argument in favor of eating raw is that you reduce your exposure to many natural toxins.

"Avoiding toxins" does not solve the nutritional cost/benefit trade-off. On the other hand, as we shall see in Part 3, there is a trade-off between toxicity and deficiencies, in that if one tries to avoid as many toxins as absolutely possible, they would have to avoid so many foods that deficiencies would likely ensue from the severe dietary restriction. Also, from the examples that will be presented below, trying to eliminate toxins completely is a hopeless task in any event (for raw as well as cooked-food eaters).

"Alien" proteins vs. cooked forms of proteins. Finally, we notice that with the Paleolithic diet, which is not an all-raw diet, foods that are not edible raw are avoided but for different reasons than toxicity per se. From the Paleolithic diet point of view, it is more important to avoid "alien" proteins that cause problems via molecular mimicry (i.e., autoimmune reactions) than to avoid cooked forms of proteins we are adapted to. In this view, it is more a consideration that foods requiring processing were ones that were introduced relatively late in human history, so that genetic adaptation to them is not yet complete, irrespective of any cooking/toxicity concerns, which are seen as more minor issues.

Considering the practicalities. Remark: We do not recommend worrying excessively about completely avoiding (all of) the foods listed below, first of all because the list is not exhaustive and toxins are quite widespread in nature. And secondly because our body has many detoxification mechanisms which are specifically designed to allow it to handle moderate, relatively normal amounts of toxins without deleterious consequences. Our goal, rather, is to show that one needn't be excessively concerned about potential harmful effects of the chemical constituents created by cooking, since all living animals are naturally exposed to quite a variety of toxins in the foods they eat anyway.

Mycotoxins

From Marth [1990], mycotoxins (toxins produced by molds) are completely destroyed at their melting point, which is generally at high temperatures: 164°C (327°F) for Zearalenone, 170°C (338°F) for Rubratoxia. When roasting peanuts, the toxicity of aflatoxin B1 is reduced by 70%, and that of aflatoxin B2 by 45%. Thus, heat treatment cannot be considered as a satisfactory means to eliminate mycotoxins.

Beans

Raw kidney beans at a level as low as 1% of diet can cause death in rats in two weeks. Beans cooked at 100°C (212°F) for 30 minutes, and incorporated at a level as high as 20% of diet, do not retard growth when tested against casein. (Feeding rats with casein instead of beans doesn't affect their growth rate, and can therefore be used as a baseline for comparison.) However, when beans which have been cooked at the lesser temperature of 70°C (158°F) for 30 minutes are incorporated, growth retardation is almost as great as that which occurs when raw beans are fed. The small amount of lectin presett in beans cooked at 70°C might be responsible for this effect [McPherson 1990]. However, cooking kidney beans doesn't destroy all antinutrients [Grant et al. 1982].

Fava beans. The well-known disease "favism" is caused by consumption of fava beans in genetically susceptible individuals. Such individuals carry a polymorphism of a gene (present in some regions where malaria is prevalent) that is thought to protect against malaria but also results in severe deficiency of glucose-6-phosphate dehydrogenase (G6PD) [Golenser 1983].

Soybeans. From Liener [1994], soybeans contain some heat-labile protease inhibitors and hemagglutinins. ("Heat-labile" means those susceptible to changes by heat; a hemagglutinin is something that causes red blood cells to clump together.) Soy also contains factors that are relatively heat-stable, though of lesser significance, such as:

Goitrogens: substances that cause goiters, i.e., an enlargement of the thyroid gland.

Tannins: complex plant compounds that are often bitter or astringent.

Phytoestrogens: plant analogues of the hormone estrogen.

Flatus-producing oligosaccharides: carbohydrates of small molecular weight that cause flatulence (gas).

Phytates: which bind minerals preventing absorption.

Saponins.

Antivitamins.

From Faldet [1992], heat treatment of soybeans destroys or reduces heat-labile antinutritional factors, improves digestibility and availability of sulfur amino acids, and increases fat digestibility by non-ruminants, but excessive cooking will reduce protein availability. (Note: Ruminants are hoofed, cud-chewing animals such as cattle, sheep, goats, deer, and giraffes, having multiple stomach chambers that are specially adapted for digesting tough cellulose raw.) Thus, there is an optimal heat treatment, which was found to be 120 minutes at 140°C (284°F), or 30 minutes at 160°C (320°F).

Grains - The antinutrients here (anti-amylases, phytates) are affected by heating, but phytates require other processing (such as fermentation) for further neutralization, which is still only partial. Also, soaking/germination (sprouting) reduces phytates [Hurrell 1997]. Soaking under optimal conditions (55°C, pH 4.5-5.0) can eliminate phytates [Sandberg and Svanberg 1991].

Egg Whites - Raw egg white contains a protein called "conalbumin" which binds to iron. Additionally, raw egg white contains avidin, which binds to biotin and can impair metabolism of other B-vitamins. Note however that raw egg toxicity should not be overstated: 20 raw eggs per day for several weeks would be necessary to create a biotin deficiency.

Mushrooms - The most common commercial mushroom, Agaricus bisporus, causes cancer in mice [Toth 1986]. The dosages required were almost half of their total food intake.

Concerning poisonous mushrooms, obviously cooking amanitas (an extremely poisonous variety of mushroom) won't make them edible, but there are examples of mushrooms which become edible after cooking. Since these varieties are very special and can't be found at the grocery, we won't expand further.

Potatoes - Potatoes contain solanine and chaconine, which are not hazardous unless large quantities are eaten. They don't accumulate in the body, and are not destroyed by heat.

Spinach and Rhubarb - These contain oxalates, which among other effects inhibit calcium absorption. Again, they are not hazardous unless large quantities are eaten. They don't accumulate in the body, and are not destroyed by heat.

Cyanogenic Glycosides - These are found in lima beans, cassava, and many fruit pits [Beier et al. 1994]. Processing techniques partially destroy cyanogenic glycosides, but some poisonings caused by the consumption of large amounts of cassava or fruit pits have been reported, including apricot kernels. When in contact with stomach acids, the cyanogenic glycosides release cyanide, which is the active component in Zyklon B (used by the Nazis in death camps). So indeed cyanide is toxic in large amounts, but obviously a few apricot kernels will not do much harm.

Taro - Contains some trypsin inhibitors and lectins, which are destroyed by heat [Seo 1990].

Parsnips - These contain toxic psoralens, which are potent light-activated carcinogens and mutagens not destroyed by cooking [Ivie 1981]. Parsnips contain psoralens at a concentration of 40 ppm, and Ivie [1981, p. 910] reports:

[C]onsumption of moderate quantities of this vegetable by man can result in the intake of appreciable amounts of psoralens. Consumption of 0.1 kg of parsnip root could expose an individual to 4 to 5 mg of total psoralens, an amount that might be expected to cause some physiological effects under certain circumstances...

Flavonoids - Flavonoids are a broad class of compounds common in plants and in the human diet. The basic characteristic of flavonoids is that their chemical structure includes what is known as the flavonoid skeleton, that is, a skeleton (core) of diphenylpyrans, i.e., C6-C3-C6, where the C stands for carbon, and C6 is a benzene ring [Hertog and Katan 1998]. Over 4,000 flavonoids are known, and new ones are being researched and described [Hollman 1997]. In plants, flavonoids serve a number of functions: as pigments (the color of fruits and flowers is due to flavonoids), antioxidants, sunscreens, etc. Because of the large number of compounds in this class, generalizations about the function of flavonoids are difficult [McClure 1975]. However, the following can be said about certain flavonoids:

Quercetin, a very common flavonoid in the human diet, is known to be mutagenic [Nagao 1981]. However, it is not carcinogenic, and has been shown to have anticarcinogenic properties in tests in vitro; see Hertog and Katan [1998], and Chung et al. [1998].

Flavonoids can inhibit enzyme systems in mammals [Hollman 1997].

The flavonoid phloridzin (and its breakdown products) can inhibit respiration in animal tissues [McClure 1975].

Certain flavonoids can function as antioxidants and help preserve vitamin C [McClure 1975].

Some flavonoids protect against the mutagenic effect of other substances. (Refer to the previous section on Mutagenicity and Carcinogenicity, subtopic "Other Factors Influencing Carcinogenesis.")

Alfalfa Sprouts - Alfalfa sprouts contain approximately 1.5% canavanine, a substance which, when fed to monkeys, causes a severe lupus erythematosus-like syndrome. (In humans, lupus is an autoimmune disease.) Canavanine is an analog for the amino acid arginine, and takes its place when incorporated into proteins. However, alfalfa that is cooked by autoclaving (i.e., subjected to pressure-cooking) doesn't induce this effect [Malinow 1982, Malinow 1984].

Note here that the monkeys were fed semi-purified diets, with a canavanine content of 1-2%, versus a typical canavanine content of 1.5% (dry weight--that is, when completely dehydrated) for alfalfa sprouts [Malinow 1982]. Thus, although it would be very difficult for a human to eat enough fresh alfalfa sprouts to ingest even 1% canavanine, individuals should be aware of the potential risks, and consume (or not consume) alfalfa sprouts accordingly. (In particular, those rawists who juice sprouts should probably strictly limit or avoid the consumption of alfalfa sprout juice, due to the concentration effect that results from juicing.)

Other Examples - Let's mention quickly a few other examples: pyrrolizidine alkaloids, present in herbal teas, are carcinogenic, mutagenic, and teratogenic (cause birth defects); gossypol in cottonseed causes abnormal sperm and male sterility, and is a carcinogen; piperine in black pepper causes tumors in mice; capsaicin in hot pepper is a mutagen; allyl iosthiocyanate, in oil of mustard and horseradish, is a carcinogen in rats; quinones and their phenol precursors (in many different plants) have mutagenic and antimutagenic properties.

Other toxic effects of cooking

Heated Milk Protein

It is possible that heated milk protein may be a factor in atherosclerosis [Annand 1971, 1972, 1986].

Heated Fats

Oxidized fats, oils, and cholesterol. Research reveals that in animal models, oxidized fats, oils, and cholesterol induce higher levels of arterial plaque (i.e., atherogenesis) than do the corresponding non-oxidized fats, oils, and cholesterol [Taylor et al. 1979, Kummerow 1993, Kubow 1993, O'Keefe et al. 1995]. The biochemical processes that make oxidized fats atherogenic are the subject of scientific controversy; however, one suggestion is that the heating of fats, oils, and cholesterol increases the levels of lipid peroxide products. The idea is that the peroxides (in combination with lipids) promote an atherogenic response [Kubow 1993].

In tests feeding high-cholesterol diets to rabbits, the consumption of scrambled or baked eggs produced increases in serum cholesterol of 6-7 times the pre-existing levels, while fried or hard-boiled eggs raised levels by 10-14 times [Pollack 1958]. Cordain [in a posting to the Paleodiet list of 10/9/1997] also reports that his research group routinely induces atherogenesis in test animals (miniature swine) by feeding oxidized fats/cholesterol.

Role of oxidized LDL cholesterol in atherogenesis. O'Keefe et al. [1995, pp. 70, 72] explain the role of oxidized cholesterol in atherogenesis as follows:

LDL cholesterol must be oxidized or glycosylated (or both) before it becomes atherogenic.(8,9) Oxidative modification of cholesterol occurs by means of oxygen free radical processes. Only after the LDL has been modified (through oxidation or glycosylation) does it activate differentiation and migration of macrophages. The scavenger receptors on the macrophages recognize oxidized LDL (but not unmodified LDL) and allow for subsequent phagocytosis. When the macrophage becomes filled with oxidized LDL cholesterol, it becomes the foam cell that is typically observed in early atherosclerotic lesions... The oxidative modification of LDL cholesterol seems to be the final common pathway in the process of atherosclerosis.

Steinberg et al. [1989] also report that oxidized LDL cholesterol, at high levels, is atherogenic. For a good summary of the atherogenic properties of oxidized LDL cholesterol, see Table 2 in O'Keefe et al. [1995, p. 72], and Table 1 in Steinberg et al. [1989, p. 917]. Here it should be noted that some aspects of the effects of oxidized cholesterol are controversial in the sense that a scientific consensus has not yet been reached. Readers are encouraged to consult O'Keefe et al. [1995] and Steinberg et al. [1989] for a detailed overview of current knowledge in this field.

The paradox of relatively high cholesterol intake and cooked meats vs. rarity of heart disease in hunter-gatherer groups. It is also worth remarking that many other factors than lipid peroxides influence the development and/or prevention of atherogenesis, such as the amount of saturated fat, amount of mono- or polyunsaturated fat, amount of carbohydrates and insulin response, etc. Of particular note here is the example of hunter-gatherer societies, where the incidence of heart disease is extremely low (perhaps the lowest that has been seen among human groups), despite the fact that relatively large amounts of cooked meat are consumed. (See Part 3's discussion of hunter-gatherers for a look at some of their food preparation practices; as well as another site link, Hunter-Gatherers: Examples of Healthy Omnivores, for a look at disease incidence.) This is in marked contrast to the high levels of atherosclerosis in Western diets containing cooked meat.

This divergence may be due to the differences between the type of meat (wild game) in hunter-gatherer diets--which in general is quite lean--compared to modern domesticated meats (five times less fat, and one-fifth to one-sixth as saturated [Eaton 1996]), and/or the difference may be due to a range of other factors. Of specific interest regarding the subject of oxidized cholesterol is that while hunter-gatherers eat roughly the same amount of cholesterol (480 mg) as in the modern Western diet [Eaton 1992] (from meat, presumably cooked), their serum cholesterol levels, as measured in five modern hunter-gatherer groups, avtraged a very low 123.2 mg/dL [Eaton 1992].

Viewing single factors out of context can be misleading. Thus if cholesterol and/or oxidized cholesterol are in fact atherosclerotic in effect, then the implication is that there must be something else in the diets/lifestyles of hunter-gatherer groups mitigating or negating this effect. (A good overview of the large divergences between hunter-gatherer diets and the modern Western diet can be found in Eaton [1996]. Major differences are to be found in consumption levels of saturated and polyunsaturated fats, preformed long-chain fatty acids, protein, carbohydrate, phytochemicals, etc., as well as in exercise levels.)

The general point here is to keep in mind that, before attempting to form conclusions that might be premature, it is important to view the role of any one factor in the equation of health in the context of the overall diet rather than in isolation. Depending on the situation, the benefits of a food or class of foods may mean more for the health of the body than whatever associated negatives there may be--or vice versa. That nutritional benefits from foods, whether raw or cooked, unavoidably come at the expense of costs and tradeoffs is a central issue that we will return to more than once, in different forms, as this paper proceeds.


\3 Sausage, Hot dog

Meat product made of finely chopped and seasoned meat, which may be fresh, smoked, or pickled and which is then usually stuffed into a casing. Sausages of fish or poultry are also made. The word sausage, from the Latin salsus ("salted"), refers to a food-processing method that had been used for centuries. Various forms of sausages were known in ancient Babylonia, Greece, and Rome; and early North American Indians made pemmican, a compressed dried meat-and-berry cake. From the Middle Ages, various European cities became known for the local sausage, with such types as the frankfurter (Frankfurt am Main), bologna (Bologna, Italy), and romano (Rome) being named for their places of origin. Salami (named for the salting process, salare, Italian: "to salt") is a popular sausage with many varieties. In modern food processing, the meat content, frequently beef or pork, may also include other meats, meat mixtures, and added meat-packing by-products. Other additives may include water, cereals, vegetable starch, soy flour, preservatives, and artificial colourings. The wide variety of spices and condiments used in sausage making includes salt and, depending on the ethnic or regional origin of the recipe, coriander, nutmeg, cloves, garlic, vinegar, mace, pepper, chili peppers, or pistachio nuts. Casings may be the internal organs of meat animals, paraffin-treated fabric bags, or modern synthetic casings of plastic or reconstituted collagen (insoluble animal protein). Skinless sausages are produced by stuffing the ingredients into cellulose casing, then immersing the sausage in hot followed by cold water, forming a thin protein film allowing removal of the original cellulose. Dry sausages developed mainly in warm areas where preservation was difficult; fresh and cooked sausages developed in cooler climates. Because they are processed to reduce moisture content, dry sausages offer proteins, B vitamins, and minerals in highly concentrated form. Sausage-processing methods include cooking, curing (by application of salt solution), and smoking (exposure to smoke, often following curing). The last two methods, originally employed for preservation, are now used mainly for their contribution to flavour. According to the processing method employed, sausages are classified as fresh (not cooked or cured); uncooked smoked; cooked smoked; cooked; cooked meat specialties, including luncheon meats and sandwich spreads, usually in loaf form and without casings; and dry sausages. All but dry sausages require refrigerated storage; under cool storage conditions, dry types have long shelf life. Both fresh and uncooked smoked sausages must be cooked prior to serving; cooked smoked sausage is usually warmed before serving. Cooked sausages, cooked meat specialties, and dry sausages are ready to eat.

COUNTRY COOKING SAUSAGES TO SAVOR Savor today's low-fat, high-flavor sausages in six satisfying one-dish meals BROWSE THE FRESH MEATS SECTION OF YOUR SUPERMARKET and you'll discover a world of new sausages. Chicken, turkey, seafood, game, fruits, and vegetables seasoned with spices and aromatic herbs appear among old favorites, multiplying your options for savory one-pot meals. SAUSAGES WERE INVENTED AS A THRIFTY way to transform meat scraps into something good-tasting. In countries around the world, farmwives, home cooks, and local butchers ground pork, beef, and game (and sometimes a high percentage of fat) to produce links whose flavors were enhanced by the spices needed for preservation. In time, savory creations evolved into veritable icons of ethnic or regional identity--with kielbasa becoming a standby on Polish menus, chorizo standard Mexican fare, and "hot" and "sweet" Italian sausages essentials in countless pasta sauces and sandwiches. Only during the past decade has sausage making changed in a big way Joining the familiar choices in today's meat department cases are a variety of new poultry, seafood, and game sausages flavored with fruits, vegetables, fresh herbs, and spices. Aidells, one of the first American food companies to market innovative sausages nationally, now features more than 25 varieties, with additions appearing each season. Many of these "new sausages" contain far less fat than traditional links, a fact that--combined with some exciting flavors--has brought notice from consumers who had given up eating sausages. Six tasty new types of sausage appear in the hearty one-dish meals that follow--with all the choices, though, we could have gone on cooking meals inspired by sausages forever. J.L.H. Italian-Seasoned Turkey Sausage with Pasta and Vegetables For a light winter supper, serve this savory pasta, a tossed green salad, and crisp Italian bread. MAKES 6 SERVINGS 2 tablespoons olive oil 1 pound Italian-seasoned turkey sausages, casings removed 1 medium-size onion, thinly sliced 2 medium-size (3/4 pound) zucchini, quartered lengthwise and cut into 1/2 chunks 4 cloves garlic, chopped 2 teaspoons dried oregano leaves 3 cups water 1/4 teaspoon salt 2 1/2 cups rotelle or spiral-shaped pasta 3 cups firmly packed fresh spinach leaves 2 plum tomatoes, seeded and diced 1 In 4-quart saucepan, heat oil over medium heat. Add sausages and onion; cook 5 to 7 minutes or until lightly browned, stirring to break up sausages. Add zucchini, garlic, and oregano; cook 5 minutes. Transfer sausage mixture to medium-size bowl. 2 In same saucepan, heat water and salt to boiling over high heat. Add pasta and cook 10 to 12 minutes or until cooked through and most liquid is absorbed. Reduce heat to low; return sausage mixture to saucepan and mix well. Stir in spinach and tomatoes. Transfer to serving bowl. Nutrition information per serving--protein; 26 g: fat: 17 g; carbohydrate: 50 g; fiber: 5g; sodium: 626 mg: cholesterol: 61 mg; calories: 457. Chicken-and-Apple Sausage Curry Coriander, cloves, curry powder, and thyme contribute a warm fragrance to this Middle Eastern-inspired meal. MAKES 4 SERVINGS 1 teaspoon olive oil 4 5-inch (10 to 12 ounces) chicken-and-applesausages, quartered crosswise 1 large (1/4 pound) sweet yellow pepper,seeded and cut into 1-inch pieces 1 medium-size onion, chopped 2 teaspoons curry powder 1 1/2 teaspoons fresh or 1/2 teaspoon dried thyme leaves 1 teaspoon ground coriander 1/4 teaspoon salt 1/8 teaspoon ground cloves 1/8 teaspoon ground red pepper (optional) 3 medium-size (1 pound) sweet potatoes, peeled andcut-crosswise into 1-inch-thick slices 2 1/2 cups water pound green beans, trimmed and halved 1 tablespoon all-purpose flour 4 sprigs fresh thyme (optional) Naan or pita bread (optional) 1 In heavy 4-quart Dutch oven or deep skillet, heat oil over medium heat. Add sausages, sweet pepper, and onion; saute until browned--about 4 minutes. 2 Add curry powder, thyme, coriander, salt, cloves, and, if desired, red pepper; cook, stirring until spices have warmed--about 1 minute. Add sweet potatoes and 2 cups water; cover and heat to boiling. Reduce heat to low and cook 8 minutes. 3 Add green beans; cover and cook vegetables just until tender--5 to 8 minutes. 4 In small bowl, stir remaining 1/2 cup water into flour until smooth. Stir into sausage mixture; heat to boiling, stirring constantly, until thickened. 5 To serve, spoon into 4 soup plates. Garnish each with a thyme sprig and accompany with naan, if desired. Nutrition information per serving with 2 1/2-ounce sausage and without thyme sprig or naan--protein: 13 g; fat: 9 g; carbohydrate: 35 g; fiber: 8 g;sodium: 522 mg; cholesterol: 55 mg; calories: 268 Mexican Rice, Beans, and Sausage With the help of Mexican-flavored sausage and a pantry stocked with rice, beans, and corn, this hearty medley can be ready to serve in less than an hour. MAKES 6 SERVINGS 1/2 cups long-grain white rice 1 small onion chopped 1 13-ounce package Mexican-flavored smoked turkey-andchicken sausages, cut crosswise diagonally into1/4-inch-thick slices 1 tablespoon olive oil 1 14 1/2-ounce can reduced-sodium chicken broth 1 1/4 cups water 1 15-ounce can black beans, drained and rinsed 1 7-ounce can whole-kernel corn, drained 2 tablespoons chopped fresh cilantro leaves 1 Heat oven to 375 Degrees Fahrenheit In 2 1/2-quart casserole or Dutch oven, combine rice, onion, sausages, and oil, mixing to coat rice completely with oil. 2 In 1-quart microwave-safe measuring cup in microwave oven or in saucepan over medium heat, heat broth and water to boiling. Pour broth mixture into casserole and cover. 3 Bake rice mixture 30 minutes. Stir in black beans, corn, and cilantro. Cover and bake 15 to 20 minutes longer or until all liquid is absorbed. Nutrition information per serving--protein: 20 g; fat: 12 g; carbohydrate: 61 g; fiber: 7 g; sodium: 746 mg: cholesterol: 44 mg; calories: 430. Barbecued Smoked Sausage and Lima Beans A spicy- -sweet sauce stands up to the smoky flavor of the turkey-and duck sausages used to make this old-fashioned supper. MAKES 4 SERVINGS 2 teaspoons olive oil 4 5-inch (10 to 12 ounces) smoked turkey-and-duck sausages 1 medium-size onion, chopped 2 10-ounce packages frozen Fordhook lima beans 1 14 1/2-ounce can stewed tomatoes 1/4 cup firmly packed light brown sugar 1/4 cup cider vinegar 1 teaspoon dry mustard 1 teaspoon chili powder 1/2 teaspoon ground ginger 1/4 teaspoon salt 1 In heavy 9-inch skillet, heat oil over medium heat. With fork, pierce sausages all over several times. Add sausages and onion; cook, turning sausages and stirring onion occasionally, until lightly browned--about 4 minutes. 2 Add limes, tomatoes, brown sugar, vinegar, mustard, chili powder, ginger, and salt; cover and heat to boiling. Reduce heat to low and cook, stirring occasionally, until limes are tender--10 to 12 minutes. 3 To serve, with tongs, lift sausages and arrange on top of beans; serve from skillet. Nutrition information per serving with 2 1/2-ounce sausage--protein: 21 g; fat: 8 g.; carbohydrate: 53 g; fiber: 15 g; sodium: 971 mg: cholesterol: 55 mg: calories: 357. Turkey Kielbasa with Warm Potato Salad Our version of this favorite salad substitutes low-fat turkey kielbasa for the traditional ham or bacon. MAKES 6 SERVINGS 2 pounds potatoes, peeled 2 tablespoons vegetable oil 1 small onion, chopped 1 pound turkey kielbasa, sliced 1 tablespoon all-purpose flour 1/2 cup water 3 tablespoons cider vinegar 1 tablespoon sugar 1/4 teaspoon ground black pepper 3/4 cup frozen green peas, thawed 1 Cut potatoes crosswise into 1/4-inch-thick slices. In 3-quart saucepan, heat potatoes and water to cover to boiling over high heat. Reduce heat to low; cover and cook potatoes just until tender--about 3-5 minutes. Drain potatoes in colander. 2 In same saucepan, heat oil over medium heat. Add onion and kielbasa; cook 3 to 5 minutes or until onion softens. Stir in flour until well mixed, then stir in water, vinegar, sugar, and pepper. Heat until thickened and bubbly. Reduce heat to low. Gently stir in cooked potatoes and peas; simmer minutes. Remove from heat and serve. Nutrition information per serving--protein: 17 g; fat: 15 g; carbohydrate: 46 g; fiber: 5 g; sodium: 596 mg; cholesterol: 50 mg; calories: 385. Chicken-and-Spinach Sausage Boiled Dinner In this lighter version of the classic New England one-pot meal, low-fat chicken-and-spinach sausage stands in for bacon or ham and a whole chicken. MAKES 4 SERVINGS 2 teaspoons butter 8 small (3/4 pound) onions, peeled 4 5-inch (10 to 12 ounces) low-fat chicken-and-spinach sausages 1 quart water 4 medium-size (1/2 pound) carrots, peeled and halved 4 medium-size (1/2 pound) turnips,peeled and halved 1/4 teaspoon salt 1 small (1 pound) cabbage, quartered 1 tablespoon chopped fresh parsley leaves 1 In heavy 4-quart saucepan or Dutch oven, melt butter over medium heat. Add onions and sausages; cook, turning sausages and onions occasionally, until lightly browned--about 4 minutes. Transfer sausages to plate, leaving onions in saucepan. 2 Add water, carrots, turnips, and salt; cover and heat to boiling. Reduce heat to low and cook 10 minutes. 3 Add cabbage and cook until vegetables are just tender--5 to 8 minutes. 4 Return sausages to saucepan, making sure they are covered by broth. Cook, uncovered, just until sausages are heated through (they will start to expand)--about 5 minutes. Do not overcook or sausages will split. 5 To serve, with slotted spoon, transfer,sausages and vegetables to serving platter and ladle broth into soup tureen, or divide sausages, vegetables, and broth among 4 soup plates. Sprinkle with chopped parsley. Nutrition information per serving with 2 1/2-ounce sausage--protein: 15 g; fat: 6 g; carbohydrate: 24 g; fiber: 8 g; sodium: 554 ma; cholesterol: 55 ma; calories: 197. What to Pour SYRAH--OR SHIRAZ, AS AUSTRALIAN and South African vintners call it--features the bold flavors of black fruits and peppery, smoky undertones, making this deep-red wine a good match for our spicy sausage suppers. For our milder dishes, consider a crisp white wine like viognier, which shows citrus accents and restrained fruit flavors. A few suggested pairings follow. Italian-Seasoned Turkey Sausage with Pasta and Vegetables Alexander Valley Vineyards' Wetzel Family Select Syrah 1995 (Sonoma; $15) Mexican Rice, Beans, and Sausage Rosemount Estate's Diamond Shiraz-Cabernet 1996 (Upper Hunter Valley, Australia; $10) Barbecued Smoked Sausage and Lima Beans J. Lohr Winery's South Ridge Syrah 1994 (Santa Clara Valley; $12) Turkey Kielbasa with Warm Potato Salad Lindemans' Shiraz 7996 (Lower Hunter Valley, Australia; $15) Chicken-and-Apple Sausage Curry Bonterra Vineyards Viognier 1996 (Mendocino; $23) Chicken-and-Spinach Sausage Boiled Dinner Renwood Winery's Viognier 1996 (Shenandoah Valley; $22) L.M. All prices are suggested retail and may vary.

Sausages by Mail
 If you don't find the sausages you want in local supermarkets and gourmet stores, try these sources: Aidells Sausage Co., Mail-Order Dept., 1625 Alvarado St., San Leandro, CA 94577; (800) 546-5795. Bilinski's Gourmet Sausages are available from Walnut Acres Organic Farms, Penns Creek, PA 178620800; (800) 433-3998. McKenzie of Vermont, 160 Flynn Ave., Burlington, VT 05401; (800) 480-8850 or (802) 864-4585. PHOTO (COLOR): ITALIAN-SEASONED TURKEY SAUSAGE WITH PASTA AND VEGETABLES derives its lively flavor from garlic, oregano, zucchini, fresh spinach, tomatoes, and morsels of sausage. Green bowl: Wolfman-Gold & Good Co. Wine decanter: Tudor Rose Antiques. Serving pieces: Takashimaya. For resources, see Address Index. PHOTO (COLOR): Fragrant with spices and fresh thyme, CHICKEN AND-APPLE-SAUSAGE CURRY is ready to serve in less than half an hour. Plate, charger, and wineglass: Wolfman-Gold & Good Co. Bread Tudor Rose Antiques. Mosaic flatware: Takashimaya. PHOTO (COLOR): Spicy MEXICAN RICE, BEANS, AND SAUSAGE turns winter staples into a hearty and satisfying oven meal. Dutch oven: Le Creuset of America. Serving spoon: Pierre Deux. Bowls: William-Wayne & Co. Fork: Bernardaud. Napkin: Wolfman-Gold & Good Co. PHOTO (COLOR): An easy-to-make supper in a skillet. BARBECUED SMOKED SAUSAGE AND LIMA BEANS captures the big flavor of slow-simmered bean dishes. Tortoiseshell flatware: Takashimaya. Plates: Bernardaud. Beer glasses and napkins: Wolfman-Gold & Good Co.

Frankfurter also called WIENER, or (in the United States) Hot Dog, highly seasoned sausage, traditionally of mixed pork and beef. Frankfurters are named for Frankfurt am Main, Ger., the city of their origin, where they were sold and eaten at beer gardens. Frankfurters were introduced in the United States in about 1900 and quickly came to be considered an archetypal American food. The first so-called hot-dog stand, selling the sausages as a sandwich on what was to become the standard long hot-dog bun, was opened at Coney Island, New York, in 1916. The hot dog remained popular in the United States throughout the 20th century, being especially associated with barbecues, picnics, and athletic events. Frankfurters are sold ready-cooked and lightly smoked, either loose, vacuum-packed, or canned, to be heated by grilling, steaming, or gentle, brief boiling (frying makes them tough). The German and Austrian frankfurter also is known as a würstchen, or "little sausage," and many varieties of these sausages exist. In Germany and Austria, frankfurters are eaten warm with sauerkraut and cold, if lightly smoked, with potato salad. Nutritionally, the typical American frankfurter is about 55 percent water, 28-30 percent fat, and 12-15 percent protein. All-beef or turkey frankfurters are also produced, as are versions with reduced fat content. Most commercially marketed frankfurters contain nitrates or nitrites of sodium or potassium, which prevent the growth of the botulism-causing bacterium, Clostridium botulinum, and preserve the meat's characteristic reddish colour, which would otherwise be lost in processing.

These are precooked sausages or meat loaves that are usually served cold in sandwiches or on party trays. You can buy them already sliced in vacuum packs, or have them sliced to order at a deli counter. Most cold cuts are high in fat and sodium. Synonyms: lunch meats, luncheon meats, sandwich meats, cooked meats, sliced meats, cold meats. Varieties: Alpino salami .. This is an Italian-style salami. Substitutes: salami

basturma = bastirma = pastirma = basterma = pasterma .. This Armenian specialty consists of beef that's marinated in spices and air-dried.

bierwurst = beerwurst = beer salami Pronunciation: BEER-wurst OR BEER-vurscht .. This is a chunky, tubular German sausage that's usually sliced and served cold in sandwiches. It's made with pork and beef. Substitutes: krakauer OR bierwurst OR jagdwurst OR bologna

blockwurst .. This is a spicy German pork sausage that's usually served in sandwiches. It comes ready-to- eat. Substitutes: cervelat (very similar) OR bierwurst.

bologna = baloney = balogna Pronunciation: buh-LONE-uh OR buh-LONE-ee OR buh-LONE-yuh .. This soft, mild sausage is a sandwich staple. It's made from beef and/or pork and usually smoked. It's usually sold sliced and ready-to-eat. Substitutes: mortadella.

Calabrese sausage .. This spicy dry Italian salami is made out of pork and hot chile peppers. Substitutes: salami OR pepperoni.

coppa salami = coppa .. This has bits of ham in it.

corned beef .. This is cut from a beef brisket that's been cured with salt and spices and then simmered in water. It's traditionally served hot on rye bread. Substitutes: pastrami (more tender, and very similar) csabai Pronunciation: chah-BUY .. This is a Hungarian smoked sausage that's heavily seasoned with paprika. Rings of it are sold in German delis. finocchiona

foie gras entier Pronunciation: fwah grah ahnt-YAY .. This pricey French delicacy is simply goose or duck liver that's been lightly cooked. When aged, it becomes very rich and flavorful. Goose livers are tastier and more expensive than duck livers. Some people refuse to eat foie gras because the animals are force-fed to enlarge their livers. Substitutes: pate de foie gras

galantina .. This is cold cut resembles a chunky mortadella. Substitutes: mortadella OR bologna

gelbwurst .. This pork and veal sausage is very mild and fine-grained. Name means "yellow sausage" in German, but refers to the color of the casing rather than cream- colored sausage itself. You can put it into sand- wiches or pan-fry it. It's called "diet bologna" in Germany since it's relatively low in fat. Substitutes: bologna

headcheese .. Made from parts of the hog's head, that is boiled together with spices and gelatin, then cooled and sliced. Result is a mosaic of meat chunks. Good in sandwiches. Substitutes: sulze OR zungenwurst jagdwurst .. This is a coarse, mild German cold cut that's often served on sandwiches with mustard. It's made of pork, beef, and sometimes garlic. Substitutes: krakauer OR bierwurst krakauer .. Like bologna, only it's studded with chucks of ham. You can serve it cold in sandwiches, or fry it for breakfast. Substitutes: jagdwurst OR bierwurst

Lebanon bologna .. This is a highly seasoned smoked beef sausage based on a Pennsylvania Dutch recipe. Substitutes: salami OR summer sausage leberkäse = leberkase Pronunciation: LAY-ber-ka-suh .. Despite its name ("liver cheese" in German), this Bavarian specialty contains neither liver nor cheese. It's a pork, beef, and veal meatloaf with the color and consistency of bologna. Germans like to fry thick slices of it and serve them with potatoes. Substitutes: bologna

liverwurst = liver sausage = leberwurst .. This is a family of pork liver sausages that are creamy enough to spread. One variety is braunschweiger, which is smoked liverwurst. Substitutes: pâté OR teewurst OR mettwurst (the spreadable kind) OR gelbwurst

mortadella = mortadella bologna Pronunce: more-tuh-DELL- uh.. This exquisite smoked pork sausage is similar to bologna, only it's flavored with garlic and has bits of fat and sometimes pistachios in it. It's a key ingredient in a muffaletta sandwich. Always serve it cold. Substitutes: bologna OR olive loaf olive loaf .. This is like bologna, only with bits of stuffed olives embedded in it. Substitutes: mortadella OR bologna

pastrami .. Beef brisket that's been seasoned and dry-cured. It's often served hot on rye bread. Substitutes: corned beef (not as tender, but similar)

pate = liver paste Pronunced: pah-TAY.. Leave it to the French to come up with this buttery rich delicacy. Goose pâté is pricier and more subtle than duck pate, and is the best choice if you plan to serve the pâté cold. Duck pâté works best in warm dishes. Some people refuse to eat pâté de foie gras from France because the animals are force-fed to enlarge their livers. Substitutes: liverwurst OR foie gras entier OR monkfish liver
 pepper loaf = pepper loaf .. This is a pork and beef loaf that's liberally seasoned with cracked peppercorns.
 plockwurst
 rauchfleisch .. A German specialty, this is smoked beef that's normally sliced thin. ringwurst = ring bologna = fleischwurst .. This pork and beef sausage looks and tastes like bologna. Germans like to heat it up and serve it with potato salad or bread. Substitutes: bologna salami = salame .. This is a family of ready-to-eat sausages that are made with beef and/or pork and heavily seasoned with garlic and spices. They're often used in sandwiches or antipasto plates. Many salami, like the popular Genoa salami, are air-dried and somewhat hard. Others, like cotto salami, are cooked, which makes them softer and more perishable. Most salami are made of pork, but all-beef kosher salami are also available.

In Italian, salame is the singular form and salami the plural, but Americans often talk of one salami and many salamis. Substitutes: Lebanon bologna OR summer sausage OR pepperoni schinkenwurst = bier schinken = ham bologna .. This German cold cut consists of ham suspended in a bologna-like emulsion. It's usually served cold on sandwiches. Substitutes: krakauer OR bierwurst OR jagdwurst soppressata = soppresata = soprassata = finocchiona.. This is a fatty Italian pork salami that's seasoned with peppercorns. Substitutes: Another Italian salami sulze = sulz = sülze Pronunced: SOOL-zuh .. This is made from a mixture of calves' feet or pig snouts, eggs, and other meats that's been cooked and then allowed to gel. There's no need to cook it further; the cold slices are usually served as appetizers. Substitutes: headcheese

summer sausage = cervelat = cervelas Pronunciation: SUR-vuh-lat .. This is a family of spicy, somewhat dry pork and/or beef sausages that are great for sandwiches. They don't need to be cooked. Varieties include landjaeger and thuringer. Substitutes: blockwurst

teewurst = teawurst .. Germans like to spread this smoky "tea sausage" on crackers or bread at teatime. Substitutes: mettwurst (the spreadable kind) OR liverwurst textured sausages .. These have chunks of meat suspended in them that form a mosaic pattern when sliced. Varieties include schinkenwurst, jagdwurst, tyroler, Ansbacher pressack, tongue sausage, and zungenwurst.

thuringer = thueringer Pronunciation: THUR-in-jure .. This is a mild summer sausage that's made of pork and sometimes beef. Substitutes: cotto salami tongue loaf = tongue sausage .. Delis often stock loaves of pork, lamb, veal, or beef tongues that have been cooked, pressed, jellied, and/or smoked. Substitutes: zungenwurst

touristenwurst .. This is a pork and beef soft salami ring. Substitutes: salami

wunderwuurst .. This is liverwurst dotted with pistachios. Substitutes: liverwurst

zungenwurst = blut zungenwurst = blood tongue sausage Pronunciation: ZUNG-en-wurst OR ZUNG-en-vurscht .. This German blood sausage includes pieces of pickled tongue. It comes ready to eat, but it's often heated before serving. Substitutes: blood sausage

SALAMI AND COLD CUTS - There are various Sardinian salami and cold pork meats. In fact pork is not only roasted but also used to make excellent salami. There is capocollo, which is a salted and cured product that is eaten raw, made from the muscles of the brain area of the pig. Bacon where the fat of the pig's stomach is cured following the same procedure used for ham. Raw ham, which is made from the pig's leg and shoulder. There is also Sardinian sausage, which used to be home made but nowadays is produced on an industrial level and it is sold fresh, seasoned or smoked. The ingredients utilised to manufacture Sardinian sausage are: pork meat cut into pieces, lard, salt, pepper, aniseed or fennel, cloves and parsley. Wild boar ham, which is a local delicacy is in great demand by gourmets.

Cold Cuts All Beef Sausage Blood Tongue Boiled Beef Tongue Corned Beef Dutch Loaf Garlic Minced Ham Ham Sausage Hard Salami Head Cheese Leona Liverwurst - smoked & regular Minced Ham

Smoked Sausages All Beef Metts Andouille (Cajun) Frankfurters Hamilton Metts (natural casing or skinless) Hot Metts Knockwurst (garlic) Polish Kiabasa Smoked Chorizo Smoked Italian Weiners (natural casing or skinless)

Smoked or Roasted Meats Boiled Beef Tongue Canadian Bacon Cottage Hams Double Smoked Bacon Dried Beef Pickled Hocks - seasonal Roast Beef Smoked Beef Tongue Smoked Chops Smoked Hocks

Deli/Cold Cuts - In my personal experience, the items on these lists may well be gluten-free but in your average deli, the residue left behind on the machines they slice the meats and cheeses on certainly are not. My preference is always to ask them to cut me a nice broad hunk and then take it home, trim the front and back slices off and discard them or give them to a non-celiac in the family, and then I feel better about using the remaining slices myself.

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\4 Meat processing

Heavily browned meats increase the risks of colon and rectal cancer. Food poisoning can take up to three days to develop. The last thing eaten may not be the cause of stomach upset. Curing and smoking Meat curing and smoking are two of the oldest methods of meat preservation. They not only improve the safety and shelf life of meat products but also enhance the colour and flavour. Smoking of meat decreases the available moisture on the surface of meat products, preventing microbial growth and spoilage. Meat curing, as commonly performed in products such as ham or sausage, involves the addition of mixtures containing salt, nitrite, and other preservatives. Salt decreases the moisture in meats available to spoilage microorganisms. Nitrite prevents microorganisms from growing and retards rancidity in meats. Nitrite also produces the pink colour associated with cured products by binding (as nitric oxide) to myoglobin. However, the use of nitrite in meat products is controversial owing to its potential cancer-causing activity. Sodium erythorbate or ascorbate is another common curing additive. It not only decreases the risks associated with the use of nitrite but also improves cured meat colour development. Other common additives include alkaline phosphates, which improve the juiciness of meat products by increasing their water-holding ability.

Food Preservation

Spray washing of harvested tomatoes prior to processing. any of a number of methods by which food is kept from spoilage after harvest or slaughter. Such practices date to prehistoric times. Among the oldest methods of preservation are drying, refrigeration, and fermentation. Modern methods include canning, pasteurization, freezing, irradiation, and the addition of chemicals. Advances in packaging materials have played an important role in modern food preservation. Spoilage mechanisms Food spoilage may be defined as any change that renders food unfit for human consumption. These changes may be caused by various factors, including contamination by microorganisms, infestation by insects, or degradation by endogenous enzymes (those present naturally in the food). In addition, physical and chemical changes, such as the tearing of plant or animal tissues or the oxidation of certain constituents of food, may promote food spoilage. Foods obtained from plant or animal sources begin to spoil soon after harvest or slaughter. The enzymes contained in the cells of plant and animal tissues may be released as a result of any mechanical damage inflicted during postharvest handling. These enzymes begin to break down the cellular material. The chemical reactions catalyzed by the enzymes result in the degradation of food quality, such as the development of off-flavours, the deterioration of texture, and the loss of nutrients. The typical microorganisms that cause food spoilage are bacteria (e.g., Lactobacillus), yeasts (e.g., Saccharomyces), and molds (e.g., Rhizopus).

\5 poultry processing Birds bred for poultry production are generally grown for a particular amount of time or until they reach a specific weight. Rock Cornish hens, narrowly defined, are a hybrid cross specifically bred to produce small roasters; in the marketplace, however, the term is used to denote a small bird, five to six weeks old, that is often served whole and stuffed. Seven-week-old chickens are classified as broilers or fryers, and those that are 14 weeks old as roasters. Fat content The fat content of poultry differs in several ways from that found in red meat. Poultry has a higher proportion of unsaturated fatty acids compared with saturated fatty acids. Both turkey and chicken contain about 30 percent saturated, 43 percent monounsaturated, and 22 percent polyunsaturated fatty acids. The high levels of unsaturated fatty acids make poultry more susceptible to rancidity through the oxidation of the double bonds in the unsaturated fatty acids. Saturated fatty acids, on the other hand, do not contain double bonds in their hydrocarbon chains and are resistant to oxidation. However, this fatty acid ratio has led to the suggestion that poultry may be a more healthful alternative to red meat. In birds fat is primarily deposited under the skin or in the abdominal cavity. Therefore, a significant amount of the fat can be removed from poultry by removing the skin before eating. Microbial contamination Poultry provides an excellent medium for the growth of microorganisms. The principal spoilage bacteria found on poultry include Pseudomonas, Staphylococcus, Micrococcus, Acinetobacter, and Moraxella. In addition, poultry often supports the growth of certain pathogenic (disease-causing) bacteria, such as Salmonella.

Potential causes of contamination of poultry during the slaughtering and processing procedures include contact of the carcass with body parts that contain a high microbial load (e.g., feathers, feet, intestinal contents), use of contaminated equipment, and physical manipulation of the meat (e.g., deboning, grinding). Prevention of microbial contamination involves careful regulation and monitoring of the slaughtering and processing plants, proper handling and storage, and adequate cooking of raw and processed poultry products.

\6 Food poisoning

This usually refers to the often violent vomiting and diarrhea that can occur when a bacterial germ, often Staphylococcus, secrets a toxin while growing in your food. You ingest the toxin, which irritates your gastrointestinal tract, and you develop a violent gastroenteritis, typically lasting a few hours to a day or so, until the toxin is cleared from your system. Treatment is generally supportive, which is to say you mainly just wait it out. The body knows just what to do - get that toxin out of the system - which it does by violently purging everything from both ends of the GI tract. Other forms of food poisoning involve infection of the bowel with gastroenteritis-producing bacteria or the ingestion of toxins with other effects, chiefly on the nervous system.

Nausea, vomiting, and diarrhea - gastroenteritis - occurring less than 6 hours after eating indicate ingestion of a toxin, most commonly Staphylococcus aureus. Only toxin-related disease causes symptoms this rapidly, and almost never with fever. Common sources of the sudden, explosive gastroenteritis due to S. aureus might be described as "church picnic food poisoning," caused by dairy products, poultry, or meat left out in the sun or at room temperature for too long. Patients recover in 24-48 hours with symptomatic support for dehydration.

Gastroenteritis with paresthesias - nerve tingling - are the hallmarks of toxin-related seafood poisoning which also occurs without fever. Scombroid fish poisoning can be caused by tuna (including canned tuna), mackerel, bonito, skipjack, or mahi mahi. It is an explosive illness with flushing, headache, dizziness, nausea, cramps, and severe diarrhea. Symptoms usually resolve within 4 hours. Severe cases are treated with antihistamines or bronchodilators for wheezing or asthmatic patients.

Paralytic or neurotoxic poisoning from shellfish causes paresthesias of the mouth, tongue, and face, and often a feeling of floating. Weakness sets in rapidly, including cranial nerve paralysis. Most cases resolve within 24 hours with symptomatic care, but consuming a lot of tainted shellfish can produce respiratory failure.

Ciguatera poisoning from fish such as red snapper, barracuda, grouper, or amberjack -- all bottom feeders -- can cause sudden cramps, nausea, vomiting, and diarrhea with paresthesias of the lips, tongue, and extremities. Patients may complain of a metallic taste in the mouth, shooting limb pains, or reversed temperature perception. This is the most common form of food poisoning in Florida. With activated charcoal, a cathartic, and symptomatic therapy, acute symptoms may subside in 2-8 days, but weakness and sensory findings can last for months.

Cramps and profuse watery diarrhea within 6-16 hours of eating suggest "holiday food poisoning." This is most commonly caused by eating bacteria-containing turkey or other food left at room temperature for hours on end. The bacteria (Clostridium perfringens or Bacillus cereus) produce a toxin in the gut, causing delayed toxin-related symptoms that resolve in 20-36 hours.

Fever, cramps, and diarrhea within 12-72 hours suggest an infection of the gut. Illnesses associated with egg consumption, especially Salmonella, Shigella, or Campylobacter jejuni infection, have become much more common. Treatment depends on the severity of symptoms, because in general, antibiotic treatment prolongs the period that the patient sheds the germ in his or her stool. If the patient has bloody stools or fever, however, treatment with ampicillin or trimethoprim-sulfamethoxazole (Septra®, Bactrim®) will shorten the illness due to Salmonella or Shigella. Campylobacter responds to erythromycin-class antibiotics, but usually by the time the diagnosis can be made, it's too late to actually shorten the illness.  Children with fever and diarrhea 16-48 hours after eating in whom appendicitis is suspected could be having cramps due to Yersinia enterocolitica infection.

Acute and often bloody diarrhea 3-5 days after consuming undercooked hamburger or unpasteurized juices could be due to enterotoxigenic Escherichia coli. This produces fever and chills about half the time. Most cases resolve in 3-5 days with supportive care, but 10% develop severe hemorrhagic colitis, and this organism can rarely produce the very dangerous hemolytic-uremic syndrome. Order your hamburger well-done.

Of course, botulism (not infant botulism, discussed elsewhere in the Encyclopedia) in older children and adults is the extreme case of food poisoning - often fatal. It is the result of ingestion of the nerve-paralysing botulinum toxin secreted by the bacterium Clostridium botulinum in contaminated canned food. Again, that toxin is deactivated by thorough cooking. If any canned good ever smells funny, throw it away and do not taste it even in the slightest - you could die from just that little taste.

Thaw poultry in the refrig, never at room temperature. Salmonella is killed in marketing process but can be reintroduced by improper handling, storage, or cooking methods. Food poisoning can take up to three days to develop. The last thing eaten may not be the cause of stomach upset

\7 precautions

Wash hands well before handling food. Beware of using cross contaminated utensils and work areas. Wash dishes and utensils with soap after using them. We are the final food inspectors of the shit we eat.

Cooked food can become contaminated and spoiled if left out in open. Cooking spoiled food will not make them safe. Once food spoils, disease causing bacteria or toxins have multiplied so much that reheating even to 165 degrees won't destroy them.

Do Not take any herbs, supplements, or medication without the advice of a physican for any reason.

The diet should contain foods with adequate amounts of dietary fibre and all the nutrients; carbohydrates, fats, proteins, minerals, and vitamins.

Freezer: When freezing food, the worst enemy is air which causes freezer burn, ergo wrap all food in air tight (zip lock) bags and don't use containers larger than the food or air and frost will collect which also cause freezer burn. Food expands when frozen.

\8 Food Allergy and Intolerances
 (National Institute of Allergy and Infectious Diseases)
Food allergies or food intolerances affect nearly everyone at some point. People often have an unpleasant reaction to something they ate and wonder if they have a food allergy. One out of three people either say that they have a food allergy or that they modify the family diet because a family member is suspected of having a food allergy. But only about three percent of children have clinically proven allergic reactions to foods. In adults, the prevalence of food allergy drops to about one percent of the total population. This difference between the clinically proven prevalence of food allergy and the public perception of the problem is in part due to reactions called "food intolerances" rather than food allergies. A food allergy, or hypersensitivity, is an abnormal response to a food that is triggered by the immune system. The immune system is not responsible for the symptoms of a food intolerance, even though these symptoms can resemble those of a food allergy. It is extremely important for people who have true food allergies to identify them and prevent allergic reactions to food because these reactions can cause devastating illness and, in some cases, be fatal. How Allergic Reactions Work An allergic reaction involves two features of the human immune response. One is the production of immunoglobulin E (IgE), a type of protein called an antibody that circulates through the blood. The other is the mast cell, a specific cell that occurs in all body tissues but is especially common in areas of the body that are typical sites of allergic reactions, including the nose and throat, lungs, skin, and gastrointestinal tract. The ability of a given individual to form IgE against something as benign as food is an inherited predisposition. Generally, such people come from families in which allergies are common -- not necessarily food allergies but perhaps hay fever, asthma, or hives. Someone with two allergic parents is more likely to develop food allergies than someone with one allergic parent. Before an allergic reaction can occur, a person who is predisposed to form IgE to foods first has to be exposed to the food. As this food is digested, it triggers certain cells to produce specific IgE in large amounts. The IgE is then released and attaches to the surface of mast cells. The next time the person eats that food, it interacts with specific IgE on the surface of the mast cells and triggers the cells to release chemicals such as histamine. Depending upon the tissue in which they are released, these chemicals will cause a person to have various symptoms of food allergy. If the mast cells release chemicals in the ears, nose, and throat, a personmmay feel an itching in the mouth and may have trouble breathing or swallowing. If the affected mast cells are in the gastrointestinal tract, the person may have abdominal pain or diarrhea. The chemicals released by skin mast cells, in contrast, can prompt hives. Food allergens (the food fragments responsible for an allergic reaction) are proteins within the food that usually are not broken down by the heat of cooking or by stomach acids or enzymes that digest food. As a result, they survive to cross the gastrointestinal lining, enter the bloodstream, and go to target organs, causing allergic reactions throughout the body. The complex process of digestion affects the timing and the location of a reaction. If people are allergic to a particular food, for example, they may first experience itching in the mouth as they start to eat the food. After the food is digested in the stomach, abdominal symptoms such as vomiting, diarrhea, or pain may start. When the food allergens enter and travel through the bloodstream, they can cause a drop in blood pressure. As the allergens reach the skin, they can induce hives or eczema, or when they reach the lungs, they may cause asthma. All of this takes place within a few minutes to an hour. Common Food Allergies In adults, the most common foods to cause allergic reactions include: shellfish such as shrimp, crayfish, lobster, and crab; peanuts, a legume that is one of the chief foods to cause severe anaphylaxis, a sudden drop in blood pressure that can be fatal if not treated quickly; tree nuts such as walnuts; fish; and eggs. In children, the pattern is somewhat different. The most common food allergens that cause problems in children are eggs, milk, and peanuts. Adults usually do not lose their allergies, but children can sometimes outgrow them. Children are more likely to outgrow allergies to milk or soy than allergies to peanuts, fish, or shrimp. The foods that adults or children react to are those foods they eat often. In Japan, for example, rice allergy is more frequent. In Scandinavia, codfish allergy is more common. Cross Reactivity If someone has a life-threatening reaction to a certain food, the doctor will counsel the patient to avoid similar foods that might trigger this reaction. For example, if someone has a history of allergy to shrimp, testing will usually show that the person is not only allergic to shrimp but also to crab, lobster, and crayfish as well. This is called cross-reactivity. Another interesting example of cross-reactivity occurs in people who are highly sensitive to ragweed. During ragweed pollination season, these people sometimes find that when they try to eat melons, particularly cantaloupe, they have itching in their mouth and they simply cannot eat the melon. Similarly, people who have severe birch pollen allergy also may react to the peel of apples. This is called the "oral allergy syndrome." Differential Diagnoses A differential diagnosis means distinguishing food allergy from food intolerance or other illnesses. If a patient goes to the doctor's office and says, "I think I have a food allergy," the doctor has to consider the list of other possibilities that may lead to symptoms that could be confused with food allergy. One possibility is the contamination of foods with microorganisms, such as bacteria, and their products, such as toxins. Contaminated meat sometimes mimics a food reaction when it is really a type of food poisoning. There are also natural substances, such as histamine, that can occur in foods and stimulate a reaction similar to an allergic reaction. For example, histamine can reach high levels in cheese, some wines, and in certain kinds of fish, particularly tuna and mackerel. In fish, histamine is believed to stem from bacterial contamination, particularly in fish that hasn't been refrigerated properly. If someone eats one of these foods with a high level of histamine, that person may have a reaction that strongly resembles an allergic reaction to food. This reaction is called histamine toxicity. Another cause of food intolerance that is often confused with a food allergy is lactase deficiency. This most common food intolerance affects at least one out of ten people. Lactase is an enzyme that is in the lining of the gut. This enzyme degrades lactose, which is in milk. If a person does not have enough lactase, the bod  cannot digest the lactose in most milk products. Instead, the lactose is used by bacteria, gas is formed, and the person experiences bloating, abdominal pain, and sometimes diarrhea. There are a couple of diagnostic tests in which the patient ingests a specific amount of lactose and then the doctor measures the body's response by analyzing a blood sample. Another type of food intolerance is an adverse reaction to certain products that are added to food to enhance taste, provide color, or protect against the growth of microorganisms. Compounds that are most frequently tied to adverse reactions that can be confused with food allergy are yellow dye number 5, monosodium glutamate, and sulfites. Yellow dye number 5 can cause hives, although rarely. Monosodium glutamate (MSG) is a flavor enhancer, and, when consumed in large amounts, can cause flushing, sensations of warmth, headache, facial pressure, chest pain, or feelings of detachment in some people. These transient reactions occur rapidly after eating large amounts of food to which MSG has been added. Sulfites can occur naturally in foods or are added to enhance crispness or prevent mold growth. Sulfites in high concentrations sometimes pose problems for people with severe asthma. Sulfites can give off a gas called sulfur dioxide, which the asthmatic inhales while eating the sulfited food. This irritates the lungs and can send an asthmatic into severe bronchospasm, a constriction of the lungs. Such reactions led the U.S. Food and Drug Administration (FDA) to ban sulfites as spray-on preservatives in fresh fruits and vegetables. But they are still used in some foods and are made naturally during the fermentation of wine, for example. There are several other diseases that share symptoms with food allergies including ulcers and cancers of the gastrointestinal tract. These disorders can be associated with vomiting, diarrhea, or cramping abdominal pain exacerbated by eating. Gluten intolerance is associated with the disease called gluten-sensitive enteropathy or celiac disease. It is caused by an abnormal immune response to gluten, which is a component of wheat and some other grains. Some people may have a food intolerance that has a psychological trigger. In selected cases, a careful psychiatric evaluation may identify an unpleasant event in that person's life, often during childhood, tied to eating a particular food. The eating of that food years later, even as an adult, is associated with a rush of unpleasant sensations that can resemble an allergic reaction to food. Diagnosis To diagnose food allergy a doctor must first determine if the patient is having an adverse reaction to specific foods. This assessment is made with the help of a detailed patient history, the patient's diet diary, or an elimination diet. The first of these techniques is the most valuable. The physician sits down with the person suspected of having a food allergy and takes a history to determine if the facts are consistent with a food allergy. The doctor asks such questions as: What was the timing of the reaction? Did the reaction come on quickly, usually within an hour after eating the food? •Was allergy treatment successful? (Antihistamines should relieve hives, for example, if they stem from a food allergy.) •Is the reaction always associated with a certain food? •Did anyone else get sick? For example, if the person has eaten fish contaminated with histamine, everyone who ate the fish should be sick. In an allergic reaction, however, only the person allergic to the fish becomes ill. •How much did the patient eat before experiencing a reaction? The severity of the patient's reaction is sometimes related to the amount of food the patient ate. •How was the food prepared? Some people will have a violent allergic reaction only to raw or undercooked fish. Complete cooking of the fish destroys those allergens in the fish to which they react. If the fish is cooked thoroughly, they can eat it with no allergic reaction. •Were other foods ingested at the same time of the allergic reaction? Some foods may delay digestion and thus delay the onset of the allergic reaction. Sometimes a diagnosis cannot be made solely on the basis of history. In that case, the doctor may ask the patient to go back and keep a record of the contents of each meal and whether he or she had a reaction. This gives more detail from which the doctor and the patient can determine if there is consistency in the reactions. The next step some doctors use is an elimination diet. Under the doctor's direction, the patient does not eat a food suspected of causing the allergy, like eggs, and substitutes another food, in this case, another source of protein. If the patient removes the food and the symptoms go away, the doctor can almost always make a diagnosis. If the patient then eats the food (under the doctor's direction) and the symptoms come back, then the diagnosis is confirmed. This technique cannot be used, however, if the reactions are severe (in which case the patient should not rssume eating the food) or infrequent. If the patient's history, diet diary, or elimination diet suggests a specific food allergy is likely, the doctor will then use tests that can more objectively measure an allergic response to food. One of these is a scratch skin test, during which a dilute extract of the food is placed on the skin of the forearm or back. This portion of the skin is then scratched with a needle and observed for swelling or redness that would indicate a local allergic reaction. If the scratch test is positive, the patient has IgE on the skin's mast cells that is specific to the food being tested. Skin tests are rapid, simple, and relatively safe. But a patient can have a positive skin test to a food allergen without experiencing allergic reactions to that food. A doctor diagnoses a food allergy only when a patient has a positive skin test to a specific allergen and the history of these reactions suggests an allergy to the same food. In some extremely allergic patients who have severe anaphylactic reactions, skin testing cannot be used because it could evoke a dangerous reaction. Skin testing also cannot be done on patients with extensive eczema. For these patients a doctor may use blood tests such as the RAST and the ELISA. These tests measure the presence of food-specific IgE in the blood of patients. These tests may cost more than skin tests, and results are not available immediately. As with skin testing, positive tests do not necessarily make the diagnosis. The final method used to objectively diagnose food allergy is double-blind food challenge. This testing has come to be the "gold standard" of allergy testing. Various foods, some of which are suspected of inducing an allergic reaction, are each placed in individual opaque capsules. The patient is asked to swallow a capsule and is then watched to see if a reaction occurs. This process is repeated until all the capsules have been swallowed. In a true double-blind test, the doctor is also "blinded" (the capsules having been made up by some other medical person) so that neither the patient nor the doctor knows which capsule contains the allergen. The advantage of such a challenge is that if the patient has a reaction only to suspected foods and not to other foods tested, it confirms the diagnosis. Someone with a history of severe reactions, however, cannot be tested this way. In addition, this testing is expensive because it takes a lot of time to perform and multiple food allergies are difficult to evaluate with this procedure. Consequently, double-blind food challenges are done infrequently. This type of testing is most commonly used when the doctor believes that the reaction a person is describing is not due to a specific food and the doctor wishes to obtain evidence to support this judgment so that additional efforts may be directed at finding the real cause of the reaction. Exercise-Induced Food Allergy At least one situation may require more than the simple ingestion of a food allergen to provoke a reaction: exercise-induced food allergy. People who experience this reaction eat a specific food before exercising. As they exercise and their body temperature goes up, they begin to itch, get light-headed, and soon have allergic reactions such as hives or even anaphylaxis. The cure for exercised-induced food allergy is simple -- not eating for a couple of hours before exercising. Treatment Food allergy is treated by dietary avoidance. Once a patient and the patient's doctor have identified the food to which the patient is sensitive, the food must be removed from the patient's diet. To do this, patients must read lengthy, detailed ingredient lists on each food they are considering eating. Many allergy-producing foods such as peanuts, eggs, and milk, appear in foods one normally would not associate them with. Peanuts, for example, are often used as a protein source and eggs are used in some salad dressings. The FDA requires ingredients in a food to appear on its label. People can avoid most of the things to which they are sensitive if they read food labels carefully and avoid restaurant-prepared foods that might have ingredients to which they are allergic. In highly allergic people even minuscule amounts of a food allergen (for example, 1/44,000 of a peanut kernel) can prompt an allergic reaction. Other less sensitive people may be able to tolerate small amounts of a food to which they are allergic. Patients with severe food allergies must be prepared to treat an inadvertent exposure. Even people who know a lot about what they are sensitive to occasionally make a mistake. To protect themselves, people who have had anaphylactic reactions to a food should wear medical alert bracelets or necklaces stating that they have a food allergy and that they are subject to severe reactions. Such people should always carry a syringe of adrenaline (epinephrine), obtained by prescription from their doctors, and be prepared to self-administer it if they think they are getting a food allergic reaction. They should then immediately seek medical help by either calling the rescue squad or by having themselves transported to an emergency room. Anaphylactic allergic reactions can be fatal even when they start off with mild symptoms such as a tingling in the mouth and throat or gastrointestinal discomfort. Special precautions are warranted with children. Parents and caregivers must know how to protect children from foods to which the children are allergic and how to manage the children if they consume a food to which they are allergic, including the administration of epinephrine. Schools must have plans in place to address any emergency. There are several medications that a patient can take to relieve food allergy symptoms that are not part of an anaphylactic reaction. These include antihistamines to relieve gastrointestinal symptoms, hives, or sneezing and a runny nose. Bronchodilators can relieve asthma symptoms. These medications are taken after people have inadvertently ingested a food to which they are allergic but are not effective in preventing an allergic reaction when taken prior to eating the food. No medication in any form can be taken before eating a certain food that will reliably prevent an allergic reaction to that food. There are a few non-approved treatments for food allergies. One involves injections containing small quantities of the food extracts to which the patient is allergic. These shots are given on a regular basis for a long period of time with the aim of "desensitizing" the patient to the food allergen. Researchers have not yet proven that allergy shots relieve food allergies. Infants and Children Milk and soy allergies are particularly common in infants and young children. These allergies sometimes do not involve hives and asthma, but rather lead to colic, and perhaps blood in the stool or poor growth. Infants and children are thought to be particularly susceptible to this allergic syndrome because of the immaturity of their immune and digestive systems. Milk or soy allergies in infants can develop within days to months of birth. Sometimes there is a family history of allergies or feeding problems. The clinical picture is one of a very unhappy colicky child who may not sleep well at night. The doctor diagnoses food allergy partly by changing the child's diet. Rarely, food challenge is used. If the baby is on cow's milk, the doctor may suggest a change to soy formula or exclusive breast milk, if possible. If soy formula causes an allergic reaction, the baby may be placed on an elemental formula. These formulas are processed proteins (basically sugars and amino acids). There are few if any allergens within these materials. The doctor will sometimes prescribe corticosteroids to treat infants with severe food allergies. Fortunately, time usually heals this particular gastrointestinal disease. It tends to resolve within the first few years of life. Exclusive breast feeding (excluding all other foods) of infants for the first 6 to 12 months of life is often suggested to avoid milk or soy allergies from developing within that time frame. Such breast feeding often allows parents to avoid infant-feeding problems, especially if the parents are allergic (and the infant therefore is likely to be allergic). There are some children who are so sensitive to a certain food, however, that if the food is eaten by the mother, uufficient quantities enter the breast milk to cause a food reaction in the child. Mothers sometimes must themselves avoid eating those foods to which the baby is allergic. There is no conclusive evidence that breast feeding prevents the development of allergies later in life. It does, however, delay the onset of food allergies by delaying the infant's exposure to those foods that can prompt allergies, and it may avoid altogether those feeding problems seen in infants. By delaying the introduction of solid foods until the infant is 6 months old or older, parents can also prolong the child's allergy-free period. Controversial Issues There are several disorders thought by some to be caused by food allergies, but the evidence is currently insufficient or contrary to such claims. It is controversial, for example, whether migraine headaches can be caused by food allergies. There are studies showing that people who are prone to migraines can have their headaches brought on by histamines and other substances in foods. The more difficult issue is whether food allergies actually cause migraines in such people. There is virtually no evidence that most rheumatoid arthritis or osteoarthritis can be made worse by foods, despite claims to the contrary. There is also no evidence that food allergies can cause a disorder called the allergic tension fatigue syndrome, in which people are tired, nervous, and may have problems concentrating, or have headaches. Cerebral allergy is a term that has been applied to people who have trouble concentrating and have headaches as well as other complaints. This is sometimes attributed to mast cells degranulating in the brain but no other place in the body. There is no evidence that such a scenario can happen, and most doctors do not currently recognize cerebral allergy as a disorder. Another controversial topic is environmental illness. In a seemingly pristine environment, some people have many non-specific complaints such as problems concentrating or depression. Sometimes this is attributed to small amounts of allergens or toxins in the environment. There is no evidence that such problems are due to food allergies. Some people believe hyperactivity in children is caused by food allergies. But researchers have found that this behavioral disorder in children is only occasionally associated with food additives, and then only when such additives are consumed in large amounts. There is no evidence that a true food allergy can affect a child's activity except for the proviso that if a child itches and sneezes and wheezes a lot, the child may be miserable and therefore more difficult to guide. Also, children who are on anti-allergy medicines that can cause drowsiness may get sleepy in school or at home. Controversial Diagnostic Techniques One controversial diagnostic technique is cytotoxicity testing, in which a food allergen is added to a patient's blood sample. A technician then examines the sample under the microscope to see if white cells in the blood "die." Scientists have evaluated this technique in several studies and have not been found it to effectively diagnose food allergy. Another controversial approach is called sublingual or, if it is injected under the skin, subcutaneous provocative challenge. In this procedure, dilute food allergen is administered under the tongue of the person who may feel that his or her arthritis, for instance, is due to foods. The technician then asks the patient if the food allergen has aggravated the arthritis symptoms. In clinical studies, researchers have not shown that this procedure can effectively diagnose food allergies. An immune complex assay is sometimes done on patients suspected of having food allergies to see if there are complexes of certain antibodies bound to the food allergen in the bloodstream. It is said that these immune complexes correlate with food allergies. But the formation of such immune complexes is a normal offshoot of food digestion, and everyone, if tested with a sensitive enough measurement, has them. To date, no one has conclusively shown that this test correlates with allergies to foods. Another test is the IgG subclass assay, which looks specifically for certain kinds of IgG antibody. Again, there is no evidence that this diagnoses food allergy. Controversial Treatments Controversial treatments include putting a dilute solution of a particular food under the tongue about a half hour before the patient eats that food. This is an attempt to "neutralize" the subsequent exposure to the food that the patient believes is harmful. As the results of a carefully conducted clinical study show, this procedure is not effective in preventing an allergic reaction. Summary Food allergies are caused by immunologic reactions to foods. There actually are several discrete diseases under this category, and a number of foods that can cause these problems. After one suspects a food allergy, a medical evaluation is the key to proper management. Treatment is basically avoiding the food(s) after it is identified. People with food allergies should become knowledgeable about allergies and how they are treated, and should work with their physicians. U.S. Food and Drug Administration Center for Biologics Evaluation and Research 800-835-4709 http://www.fda.gov/cber/index.html

Food Allergies, Rare but Risky By FDA Consumer

Do you start itching whenever you eat peanuts? Does seafood cause your stomach to churn? Symptoms like these cause millions of Americans to suspect they have a food allergy. But true food allergies affect a relatively small percentage of people. Experts estimate that only 2 percent of adults, and from 2 to 8 percent of children, are truly allergic to certain foods. Food allergy is different from food intolerance, and the term is sometimes used in a vague, all-encompassing way, muddying the waters for people who want to understand what a real food allergy is. "Many people who have a complaint, an illness, or some discomfort attribute it to something they have eaten. Because in this country we eat almost all the time, people tend to draw false associations (between food and illness)," says Dean Metcalfe, M.D., head of the Mast Cell and Physiology Section at the National Institute of Allergy and Infectious Diseases. Allergy and Intolerance -- Different Problems The difference between an allergy and an intolerance is how the body handles the offending food. In a true food allergy, the body's immune system recognizes a reaction-provoking substance, or allergen, in the food -- usually a protein -- as foreign and produces antibodies to halt the "invasion." As the battle rages, symptoms appear throughout the body. The most common sites are the mouth (swelling of the lips), digestive tract (stomach cramps, vomiting, diarrhea), skin (hives, rashes or eczema), and the airways (wheezing or breathing problems). People with allergies must avoid the offending foods altogether. Cow's milk, eggs, wheat, and soy are the most common sources of food allergies in children. Allergists believe that infant allergies are the result of immunologic immaturity and, to some extent, intestinal immaturity. Children sometimes outgrow the allergies they had as infants, but an early peanut allergy may be lifelong. Adults are usually most affected by tree nuts, fish, shellfish, and peanuts. Food intolerance is a much more common problem than allergy. Here, the problem is not with the body's immune system, but, rather, with its metabolism. The body cannot adequately digest a portion of the offending food, usually because of some chemical deficiency. For example, persons who have difficulty digesting milk (lactose intolerance) often are deficient in the intestinal enzyme lactase, which is needed to digest milk sugar (lactose). The deficiency can cause cramps and diarrhea if milk is consumed. Estimates are that about 80 percent of African-Americans have lactose intolerance, as do many people of Mediterranean or Hispanic origin. It is quite different from the true allergic reaction some have to the proteins in milk. Unlike allergies, intolerances generally intensify with age. Dangerous Dishes For people with true food allergies, the simple pleasure of eating can turn into an uncomfortable -- and sometimes even dangerous -- situation. For some, food allergies cause only hives or an upset stomach; for others, one bite of the wrong food can lead to serious illness or even death. Food intolerance may produce symptoms similar to food allergies, such as abdominal cramping. But while people with true food allergies must avoid offending foods altogether, people with food intolerance can often eat some of the offending food without suffering symptoms. The amount that may be eaten before symptoms appear is usually very small and varies with each individual. Common Sites for Allergic Reactions •mouth (swelling of the lips or tongue, itching lips) •airways (wheezing or breathing problems) •digestive tract (stomach cramps, vomiting, diarrhea) •skin (hives, rashes or eczema) When Food Additives Are a Problem Over the years, people have reported to FDA adverse reactions to certain food additives, including aspartame (a sweetener), monosodium glutamate (a flavor enhancer), sulfur-based preservatives, and tartrazine, also known as FD&C Yellow No. 5 (a food color). The federal Food, Drug, and Cosmetic Act requires that FDA ensure the safety of all substances added to foods, but individual health conditions sometimes cause problems with certain additives. Aspartame After reviewing scientific studies, FDA determined in 1981 that aspartame was safe for use in foods. In 1987, the General Accounting Office investigated the process surrounding FDA's approval of aspartame and confirmed the agency had acted properly. However, FDA has continued to review complaints alleging adverse reactions to products containing aspartame. To date, FDA has not determined any consistent pattern of symptoms that can be attributed to the use of aspartame, nor is the agency aware of any recent studies that clearly show safety problems. Carefully controlled clinical studies show that aspartame is not an allergen. However, certain people with the genetic disease phenylketonuria (PKU), those with advanced liver disease, and pregnant women with hyperphenylalanine (high levels of phenylalanine in the blood) have a problem with aspartame because they do not effectively metabolize the amino acid phenylalanine, one of aspartame's components. High levels of this amino acid in body fluids can cause brain damage. Therefore, FDA has ruled that all products containing aspartame must include a warning to phenylketonurics that the sweetener contains phenylalanine. Monosodium Glutamate Monosodium glutamate (MSG) has been used for many years in home and restaurant foods, and in processed foods. People sensitive to MSG may have mild and transitory reactions when they eat foods that contain large amounts of MSG (such as would be found in heavily flavor-enhanced foods). Because MSG is commonly used in Chinese cuisine, these reactions were initially referred to as "Chinese restaurant syndrome." FDA believes that MSG is a safe food ingredient for the general population. It is regarded by the agency as among food ingredients that are "generally recognized as safe." FDA has studied adverse reaction reports and other data concerning MSG's safety. The agency also has an ongoing contract with the Federation of American Societies for Experimental Biology to reexamine the scientific data on possible adverse reactions to glutamate in general. MSG must be declared on the label of any food to which it is added. Sulfites Of all the food additives for which FDA has received adverse reaction reports, the ones that most closely resemble true allergens are sulfur-based preservatives. Sulfites are used primarily as antioxidants to prevent or reduce discoloration of light colored fruits and vegetables, such as dried apples and potatoes, and to inhibit the growth of microorganisms in fermented foods such as wine. Though most people don't have a problem with sulfites, they are a hazard of unpredictable severity to people, particularly asthmatics, who are sensitive to these substances. FDA uses the term "allergic-type responses" to describe the range of symptoms suffered by these individuals after eating sulfite-treated foods. Responses range from mild to life-threatening. FDA's sulfite specialists say scientists, at this time, are not sure how the body reacts to sulfites. To help sulfite-sensitive people avoid problems, FDA requires the presence of sulfites in processed foods to be declared on the label, and prohibits the use of sulfites on fresh produce intended to be sold or served raw to consumers. FD&C Yellow No. 5 Color additives must go through the same safety approval process as food additives. But one color, FD&C Yellow No. 5 (listed as tartrazine on medicine labels), may prompt itching or hives in a small number of people. Since 1980 (for drugs taken orally) and 1981 (for foods), FDA has required all products containing Yellow No. 5 to list it on the labels so sensitive consumers could avoid it. (As of May 8, 1993, food labels must list all certified colors as part of the requirements of the Nutrition Labeling and Education Act of 1990)

True Allergies
 Heredity may cause a predisposition to have allergies of any type, and repeated exposure to allergens starts sensitizing those who are susceptible. Some experts believe that, rarely, a specific allergy can be passed on from parent to child. Several studies have indicated that exclusive breast-feeding, especially with maternal avoidance of major food allergens, may deter some food allergies in infants and young children. (Smoking during pregnancy can also result in the increased possibility that the baby will have allergies.) Most patients who have true food allergies have other types of allergies, such as dust or pollen, and children with both food allergies and asthma are at increased risk for more severe reactions. Life-Threatening Reactions The greatest danger in food allergy comes from anaphylaxis, a violent allergic reaction involving a number of parts of the body simultaneously. Like less serious allergic reactions, anaphylaxis usually occurs after a person is exposed to an allergen to which he or she was sensitized by previous exposure (that is, it does not usually occur the first time a person eats a particular food). Although any food can trigger anaphylaxis (also known as anaphylactic shock), peanuts, tree nuts, shellfish, milk, eggs, and fish are the most common culprits. As little as one-fifth to one-five-thousandth of a teaspoon of the offending food has caused death. Anaphylaxis can produce severe symptoms in as little as 5 to 15 minutes, although life-threatening reactions may progress over hours. Signs of such a reaction include: difficulty breathing, feeling of impending doom, swelling of the mouth and throat, a drop in blood pressure, and loss of consciousness. The sooner that anaphylaxis is treated, the greater the person's chance of surviving. The person should be taken to a hospital emergency room, even if symptoms seem to subside on their own. There is no specific test to predict the likelihood of anaphylaxis, although allergy testing may help determine what a person may be allergic to and provide some guidance as to the severity of the allergy. Experts advise people who are susceptible to anaphylaxis to carry medication, such as injectable epinephrine, with them at all times, and to check the medicines's expiration date regularly. Doctors can instruct patients with allergies on how to self-administer epinephrine. Such prompt treatment can be crucial to survival. Injectable epinephrine is a synthetic version of a naturally occurring hormone also known as adrenaline. For treatment of an anaphylactic reaction, it is injected directly into a thigh muscle or vein. It works directly on the cardiovascular and respiratory systems, causing rapid constriction of blood vessels, reversing throat swelling, relaxing lung muscles to improve breathing, and stimulating the heartbeat. Epinephrine designed for emergency home use comes in two forms: a traditional needle and syringe kit known as Ana-Kit, or an automatic injector system known as Epi-Pen. Epi-Pen's automatic injector design, originally developed for use by military personnel to deliver antidotes for nerve gas, is described by some as "a fat pen." The patient removes the safety cap and pushes the automatic injector tip against the outer thigh until the unit activates. The patient holds the "pen" in place for several seconds, then throws it away. While Epi-Pen delivers one premeasured dosage, the Ana-Kit provides two doses. Which system a patient uses is a decision to be made by the doctor and patient, taking into account the doctor's assessment of the patient's individual needs. Advice from Study Hugh A. Sampson, M.D., and colleagues at Johns Hopkins University School of Medicine in Baltimore, Md., published a study of anaphylactic reactions in children in the Aug. 6, 1992, issue of The New England Journal of Medicine. The study involved 13 children who had severe allergic reactions to food: Six died, and seven nearly died. Among the study's conclusions: Asthma, a disease with allergic underpinnings, was common to all children in the study. •Epinephrine should be prescribed and kept available for those with severe food allergies. •Children who have an allergic reaction should be observed for three to four hours after a reaction in a medical center capable of dealing with anaphylaxis. Anne Munoz-Furlong, who founded The Food Allergy Network for people with food allergies in 1991 after struggling to deal with her own child's allergies, comments: "My youngest daughter was diagnosed with milk and egg allergies when she was 9 months old, nine years ago. We tried to lead a life around her restricted diet. For example, we had Jell-O mold for her first birthday because I didn't know it was possible to create a cake without milk or eggs. I knew there must be other families struggling with the same issues." Finding the Forbidden Because there is no "cure" for food allergies other than strict avoidance of an offending food, one of the biggest problems those with food allergies face is verifying whether a forbidden product is contained in a particular food. For example, in Sampson's study, all six deaths occurred because either the child or the parent was unaware the food contained a substance to which the child was allergic. Munoz-Furlong says the Nutrition Labeling and Education Act, which requires more complete food labeling, should greatly help people with food allergies to avoid dangerous foods. The new labeling changes will make it easier for the consumer to readily identify things they could be allergic to," says Linda Tollefson, D.V.M., chief of the epidemiology branch at FDA's Center for Food Safety and Applied Nutrition. "Before this law was passed, true allergens were required to be on the label, but the exceptions were standardized foods, which will now have to list all ingredients." According to Elizabeth J. Campbell, director of the center's division of programs and enforcement policy, the principle underlying standardized foods originally was that people basically knew what was in various foods. "Originally food standards were adopted to ensure uniformity. If you saw a product labeled mayonnaise, food standardization meant it had to be mayonnaise. People used to know what was in mayonnaise; nowadays they have to be told that mayonnaise contains both eggs and oil," Campbell says. "Years ago, when the law was first written to provide for standards of identify for certain foods, it only required that optional ingredients be declared. The new law stipulates that all ingredients in standardized foods must be declared." Campbell believes that once the labeling is in place, consumers will have the information they need to make correct food choices. "In most cases, ingredients have to be labeled simply because they are ingredients, not because they are unsafe," she stresses. "For those with food allergies, I think it is more of a patient education problem." Food additives, such as sulfites and certain colors, can also cause problems for people sensitive to them. "If you have a food allergy, you really have to alter your life," Tollefson says. "You have to really read labels, and really be careful about what you eat." Steve Taylor, Ph.D., a professor and head of the Department of Food Science and Technology at the University of Nebraska in Lincoln, says the biggest problem for people with food allergies is restaurant food. Historically, restaurants have been regulated by local health departments and have not had to label foods. "For many restaurants, labeling of food products they serve would cause horrendous problems...what about chalkboard menus? How would you include all the ingredients? Enforcement would be a nightmare," he admits. But steps are being taken to better educate restaurant employees. The Food Allergy Network and The American Academy of Allergy and Immunology, along with The National Restaurant Association, recently produced a pamphlet on food allergies which has been distributed to 30,000 members of the association. The brochure explains what restaurants can do to help customers who need to avoid certain foods, defines anaphylaxis, and advises employees on what to do if food allergy incidents occur. John A. Anderson, M.D., director of the Allergy and Immunology Training Program at Henry Ford Hospital in Detroit, says changes in food habits may be responsible for the feeling some physicians have that food allergies may be on the rise. "You could make a case for the fact that we are introducing peanuts, in the form of peanut butter, to people at a very young age, which would affect the prevalence rate for people who are sensitive to that allergen," he notes. "In Japan, where they use more soy, there is a higher prevalence of soy allergy. My feeling is that as soy, a cheap protein supplement, is put in a lot of commercial foods you will see an increase in the rate of sensitivity worldwide." Metcalfe says that if food allergies are rising, it is due to more common use of foods that tend to be allergenic. He cites milk as a source of protein supplement in many prepared foods, and points out that people are eating more exotic seafood and more fish. "But it's important to remember that the majority of people with true food allergies are allergic to three or fewer foods," Metcalfe says. Other than advising anyone with a known or suspected severe food allergy to carry and know how to self-administer epinephrine, there is no treatment for food allergy other than to eliminate the offending food. But Metcalfe is optimistic about the future. "I don't think it is likely a drug will be found to prevent food allergies. But I do think within 10 years we will see allergy shots available for some of the more common food allergies, because we are learning to identify and purify food allergens. I think we will see some development of immunotherapy for food allergies," he says. Experts estimate that only 2 percent of adults, and from 2 to 8 percent of children, are truly allergic to certain foods. Food Allergies and Biotechnology People with food allergies have expressed the concern that new varieties of food, developed through the new techniques of biotechnology (such as gene splicing), may introduce allergens not found in the food before it was altered. FDA addressed this concern in its 1992 biotechnology policy statement and said it will regulate whole foods developed through biotechnology by applying the same rigorous safety standards as for all other foods. The agency is taking steps to ensure that foods developed through biotechnology do not pose any new risks for consumers. Under the new policy guidelines, a protein copied by genetic engineering from a food commonly known to cause an allergic reaction is presumed to be allergenic unless clearly proven otherwise. Any food product of biotechnology that contains such proteins must list the allergen on the label. Labeling would not be required if the manufacturer could demonstrate that the allergen was not transferred. For example, if a food company were to breed potatoes containing a genetically engineered soy protein (to which some people might be allergic), the labeling on the potatoes would have to disclose the presence of the soy protein. But labeling would not be required if scientific data clearly showed that the protein had been changed and no longer contained the soy allergen. To ensure that FDA has state-of-the-art information for its food biotechnology policy, the agency will sponsor a scientific conference in the spring of 1994 to discuss what makes a substance a food allergen. How to Cope What should you do if you suspect you have a food allergy? The Food Allergy Network's Anne Munoz-Furlong suggests keeping a food diary as a first step, writing down everything you eat or drink for a one- or two-week period. Note any symptoms and how long it took for such symptoms to develop. But Furlong and other experts agree that those who suspect food allergies also need to be evaluated by a physician with intensive specialty training in allergy and immunology. Be sure to discuss what diagnostic and treatment plan is anticipated and the costs. Ask if the tests have been proven effective by accepted standards of scientific evaluation. "Go to a board-certified physician who is an allergy expert," advises Paul C. Turkeltaub, M.D., associate director of the division of allergenic products and parasitology at FDA's Center for Biologics Evaluation and Research. "Be very wary of claims of food allergy to explain chronic, common complaints." The diagnosis of food allergy requires a careful history, physical exam, appropriate exclusion diet, and diagnostic tests to rule out other conditions. Tests can include direct allergy skin tests, blood tests, or "elimination and challenge" tests for suspected foods. The most accurate kind of test is a controlled challenge test, often done in "blind" or "double-blind" fashion to eliminate psychological factors. In a blind challenge, the patient is given either a sample of the food, without being told what it is, or a placebo, an inert substance used as a control in the test. The observer (a doctor or assistant), however, knows what the substance is. Both patient and observer record any symptoms of allergic reaction. In a double-blind challenge, neither the patient nor the observer knows if the patient is given the food (allergen) or the placebo. In recent years, unproven tests such as "food cytotoxic blood tests" and "sublingual provocation food testing" have been promoted as supposed "diagnosic" tools to detect food allergies. FDA believes that food cytotoxic blood tests are not supported by well-controlled studies and clinical trials. In food cytotoxic testing, a test tube of blood is taken from the patient. The white cells (leukocytes) are mixed with plasma and sterile water and placed on microscope slides coated with dried extracts of a particular food. The reaction of the cells is then examined under a microscope; if they change shape, disintegrate, or collapse-or the person examining them says they do-the patient is supposedly allergic to that particular food. Test results may be interpreted by a "nutritional counselor" working on commission, who recommends vitamins and minerals (often available on site) that the patient needs to correct his or her "allergic condition." But FDA and other experts emphasize there is no evidence that such tests are valid in diagnosing food allergies. Sublingual provocation food testing dates back to 1944. The tests consists of placing three drops of an allergenic extract under a patient's tongue and waiting 10 minutes for any symptoms to appear. When the doctor is satisfied he has determined the cause of the symptoms, he administers a "neutralizing" dose, which is usually three drops of a diluted solution of the same allergenic extract. The symptoms are then expected to disappear in the same sequence in which they appeared. Advocates claim that if the neutralizing dose is given before a challenge test (for instance, eating a meal containing the offending food), the person will not have symptoms. But after careful study of existing data, The American Academy of Allergy and Immunology says no controlled clinical studies demonstrate either diagnostic or therapeutic effects of sublingual provocation food testing. The academy concludes that use of the tests should be reserved for experiments in well-designed trials. If you are diagnosed with a food allergy, scrutinize food labels to detect potential sources of food allergens. When eating out, ask about ingredients if you are unsure about a particular food; ask to talk to the manager of the restaurant about ingredients in specific dishes. Keep epinephrine with you and know how to administer it. If you do experience a reaction, seek medical attention immediately, even if the symptoms are mild or seem to subside. Mild symptoms may be followed 10 to 60 minutes later by the onset of severe problems.

Do you, or someone you know, shun certain foods because you are "allergic?" Surveys show that nearly 1/3 of all adults believe they have a food allergy. The foll seeks to shed light on such FAQs as: What is a food allergy? How do you know if you have one? What should you do if you have a food allergy? And, if it is not a food allergy, what might it be?

Myth: Lots of people have food allergies. Reality: "From talking with the public, you might think almost everyone has a food allergy," said Daryl Altman, MD, at the Amer Coll of Allergy, Asthma and Immunology and researcher at the Allergy Info Svcs in Long Island, NY. "In surveys, nearly one-in-three American adults indicated he or she was allergic to some food." But in reality, the most conservative estimates indicate two% of the pop in the US are food allergic. Children are more susceptible than adults to food allergy-up to five% have some type of food allergy. However, common allergens such as eggs and milk are typically outgrown by age five.

The eight most common food allergens in people are: Peanuts, tree nuts (for example, almonds, pecans and walnuts), dairy, soy, wheat, eggs, fish and shellfish (for example, shrimp and crab). Nevertheless, allergies to nearly 175 different types of food have been doc. "These foods are responsible for over 90% of serious allergic reactions to food," stated Susan L.Hefle, PhD, co-director of the Food Allergy Research and Resource Pgm at the Univ of Nebraska-Lincoln.

Myth: A food allergy means I'll just get a runny nose, right? Reality: No -- although food allergy is rare, it is a serious condition and should be diagnosed by a board-certified allergist. Food allergy is a reaction of the body's immune system to a certain component, usually a protein, in a food or ingredient. The reactions can be uncomfortable and mild including vomiting, diarrhea, skin rashes or runny nose, sneezing, coughing and wheezing, and may occur within hours or days after eating. However, anaphylaxis, a more serious and life-threatening reaction, may occur. Anaphylaxis is a rapidly occurring reaction that often involves hives and swelling, enlarging of the larynx with a choking sensation, wheezing, severe vomiting, diarrhea and even shock. These symptoms can also occur within minutes, hours or days. "Food allergic patients should have an anaphy-laxis reaction plan worked out ahead of time with their allergist," according to Anne Mu-oz-Furlong, president and founder of The Food Allergy Network. "The plan should be practiced with family and friends in case of an emergency."

What is an Allergic Reaction? An allergic reaction occurs when a susceptible person is exposed to a specific protein. Because the body perceives this protein (an allergen) as being a threat, it produces a special material-a substance that recognizes allergens-known as Immunoglobulin E (IgE) antibody. A person who has a tendency to develop allergies tends to produce increased amounts of IgE. After the initial exposure to a specific allergen (such as "cat" or "dog" protein) the body reacts to future exposures by creating millions of IgE antibodies. These newly produced IgE antibodies then connect to special blood cells called basophils, and special tissue cells called mast cells. These cells are then "stimulated" to release histamine which causes the allergy symptoms: Itchy watery eyes and nose, scratchy throat, rashes, hives, eczema and even life-threatening anaphylaxis.

Myth: Any negative reaction to a food is a food allergy. Reality: Adverse reactions to food can have many causes. If something does not "agree with you," it does not necessarily mean you are allergic to it. Food allergy is a very specific reaction involving the immune system of the body, and it is important to distinguish food allergy from other food sensitivities. Whereas food allergies are rare, food intolerances, which are the other classification of food sensitivities, are more common. Intolerances are reactions to foods or ingredients that do not involve the body's immune system. Intolerance reactions are generally localized, transient and rarely life threatening with one possible exception-sulfite sensitivity. "A good example of a food intolerance is lactose intolerance. And, it is extremely important to know the difference between it and a milk allergy," said Robert K. Bush, M.D., University of Wisconsin. He emphasized that, "Whereas lactose intolerance may result in a bloated feeling or flatulence after consuming milk or dairy products, milk allergy can have life-threatening consequences. The milk allergic patient must avoid all milk proteins."

Myth: I think I'm allergic to a food -- I just won't eat it, so I don't need to be seen by a doctor. Reality: Just thinking you are allergic to a food does not mean you have an allergy. To properly diagnose a food allergy or sensitivity the offending substance must be accurately identified. Avoiding a food may deprive you of food choices and important nutrients, and could be dangerous if the allergen is actually different. Diagnosis of a food allergy can be complex, with three major components. The first and most important is involving a board-certified allergist, preferably a food allergy specialist. Second, a history of a specific food causing an allergic reaction is necessary; a food diary can help. Third, an IgE antibodies test, is only useful when combined with the former components, but it does not always pinpoint a food allergy (see sidebar). Hugh Sampson, M.D., director, Food Allergy Clinic, Mt. Sinai Medical Center, and chair of the American Academy of Allergy, Asthma and Immunology's Adverse Reactions to Foods Committee, emphasized an examination by a board-certified allergist: "Due to many people claiming to have food allergies, many physicians have become "desensitized" to taking their symptoms seriously."

The Double-Blind Placebo-Controlled Food Challenge This test, considered the "gold standard" for food allergy testing, is performed by a board-certified allergist. The suspected allergen is placed in a capsule or hidden in food, and fed to the patient under strict supervision. Neither the allergist, nor the patient, is aware of which capsule, or food, contains the suspected allergen-hence the name "double-blind." In order for the test to be effective, the patient must also be fed capsules or food which do not contain the allergen to make sure the reaction, if any, being observed is to the allergen and not some other factor-hence the name "placebo-controlled." It is tests of this kind that have enabled allergists to identify the most common allergens, and also to determine what foods, ingredients and additives do not cause allergic reactions.

Myth: I don't frequently eat food I'm allergic to, so I can eat a little bit for a special occasion. Reality: Because food allergy can be life threatening, the allergen must be completely avoided-even the most minute amounts. Although an extreme case, a man allergic to shellfish died of anaphylaxis shock after encountering simply the steam from shrimp. It can be fatal to assume a given food environment is safe and not be cautious. A board-certified allergist can help the food allergic patient manage diet issues without sacrificing nutrition or pleasure when eating at and away from home. Since most life threatening, and sometimes fatal, allergic reactions to foods occur when eating away from home, it's impera- tive that the food allergic individual or responsible guardian clearly explain the risks of exposure to a certain food or ingredient to food service workers, family and friends-and always ask before eating.

Myth: With all the ingredients in processed food I can never completely avoid my allergen. Reality: When purchasing groceries, labels should be read for every product purchased-every time. Although food and beverage manufacturers are often improving and changing their products, changes in ingredients must be listed on ingredient labels.

According to Fred Shank, PhD, dir of the Ctr for Food Safety and Applied Nutrition FDA, "Foods which contain allergenic substances must be properly labeled or be subject to recall. The FDA supports the activities of independent orgs to inform consumers of these recall activities." The FDA includes on its list of recall substances all eight of the major allergens, so if these substances are present in a food, but not listed on the label, they must be recalled. Additionally, substances which cause non-allergic-based reactions, such as the additives sulfites and tartrazine (FD&AMPC Yellow #5), are on this list. Some individuals have unique sensitivities to these food components which are not allergenic or allergy-causing in nature, but may cause comparably severe reactions.

What is Sulfite Sensitivity? Sulfiting agents are commonly used to preserve the color of foods, such as dried fruits and vegetables, and to inhibit the growth of microorganisms in fermented foods, like wine. Sulfites can also be found in beer, some fruit drinks, shrimp and some prepared foods. Although sulfites are safe for the majority of people, for some, they have been found to cause a reaction. For this reason, the FDA requires that when sulfites are added to foods in greater than 10 parts/million (or, 10 sulfite molecules per million molecules) they must be indicated on the label.

Myth: Since I'm allergic to peanuts, I can't eat anything with peanut oil. Reality: There are many misunder- standings regarding exactly what might stimulate the food allergic reaction. "Virtually all food allergens are proteins," explained Steve L. Taylor, Ph.D., co-director of the Food Allergy Research and Resource Pgm at the Univ of Nebraska-Lincoln. "And, the process of refining oil removes the protein which would trigger an allergic reaction." Oils used in processed foods and in cosmetics are highly refined and should pose no problem for the food allergic individual. Yet, caution should be taken with natural, cold pressed or flavored oils. These oils, as well as oil that has been used to cook peanuts (or another food to which an individual might have an allergy), might contain the protein of the allergen and should be avoided. For example, an individual with a fish allergy should ensure that the oil used to cook his or her food was not first used to fry fish.

Myth: I'm allergic to food additives. Reality: Other common misconceptions regarding food allergy are additives and preservatives. Although some - sulfites and tartrazine - have been shown to trigger asthma or hives in certain people, these reactions do not follow the same pathway observed with food. There are other food additives that have historically been associated with adverse reactions, but because they do not contain proteins or involve the immune system, true allergic pathways cannot be used to explain the reported reactions. In addition, many of these additives, including monosodium glutamate, aspartame and most food dyes have been studied extensively, and the results show little scientific evidence exists to suggest they cause any reaction at all.

Avoid Cross Contact! Cross contact of foods with those that may present a food allergy problem is poorly understood and not well communicated. Although food processors are well aware of the dangers of cross contact and manage them appropriately, such caution is not always taken in the home, school cafeteria or restaurant. Although unintentional, the effects can be devastating. For some food allergic individuals, the most minute particle of the allergen can be fatal. Some examples of mishaps that can induce a food allergic reaction include: Plain chocolate brownies are served using the same spatula that was used to serve peanut-containing brownies. French fries are prepared in the same oil used to deep-fry fish.

Myth: "Tell me about my corn allergy." Reality: There are those suspected food allergies that are so rare that their existence is questioned. The most common of these are corn and chocolate "allergy," and there are several probable explanations for adverse reactions. Even though many people claim to be allergic to them, allergists can rarely demonstrate allergy to corn or chocolate in double-blind, placebo-controlled food challenges (see sidebar).

Corn "allergy" is often associated with a reaction to another allergenic substance. In some cases soy allergic individuals may react to products containing corn. Occasionally corn is carried, handled or stored in the same containers used for soy. Although only minute residues of soy may remain, this can be enough to cause an allergic reaction in highly sensitive people.

Chocolate "allergy" is also thought to be extremely rare, and though some are truly chocolate-allergic, most who complain of symptoms have irreproducible reactions. Possibly the reactions are due to another ingredient found in the chocolate product being consumed.

Food allergy is certainly nothing to be taken lightly. Although its prevalence appears to be increasing, overreaction, self-diagnosis and incorrect assumptions only lead to skepticism of physicians and food service workers - obviously, a less-than-ideal situation for the truly allergic individual. It is vitally important to leave the diagnosis of a food allergy to a board- certified allergist.

The foll orgs can help you more fully understand food allergy: The Amer Acad of Allergy, Asthma and Immunology (1-800-822-2762; www.aaaai.org) and the Food Allergy Network (1-800-929-4040; www.foodallergy.org). The Intl Food Info Council Foundation (http://ificinfo.health.org) can provide further info on food allergy and food and asthma. Also avail is a food allergy poster designed for food service workers.


\9 Fat, Body

Belly and Thigh Fat Losing male belly fat is easy compared to stubborn female thigh fat. Q. I'm puzzled. I'm an athletic 39-year-old female. I recently started serious weight training after biking and running for a number of years. I've run two marathons. I also watch my diet, especially fat.

Here's the problem. Since I've been weight training, my weight has gone up about 10 pounds! My diet hasn't changed and my activity level has probably increased. I'm definitely stronger and more defined, but my clothes don't fit any more. This bothers me a lot. My legs are a special problem. They're beefier, rather than leaner looking and more cut. I have fat deposits on my thighs and even though they're more solid, the fat still shows. I'd like to be able to wear a mini-skirt, but I have mixed emotions. Frankly, I'm so disturbed that I am thinking about giving up weight training. Any suggestions?

A. Hold on. This is no time to give up. The fact that you've gained weight after taking up weight training - even though your diet and activity level have not changed - indicates that weight training is doing its job well. Obviously, your body is quite responsive to strength training. You're gaining muscle and that's good. The problem you have is more related to gender, and with patience and persistence it can usually be overcome.

Male And Female Fat Deposits are Different As I'm sure you've noticed, men gain weight on their bellies and women tend to accumulate fat on their hips and thighs. Researchers have recognized this since the 1940s, according to Physiology of Sports and Exercise, the excellent textbook by Jack W. Wilmore, Ph.D.,and David L. Costill, Ph.D.(Human Kinetics, 1994). My thighs are always cut, even when I put on a few pounds. Where the extra weight shows is on my waist. Happily, I can lose the weight on my belly almost as easily as I gain it. That's the way it is for most men. Unfortunately, women are not so lucky, Their hip and thigh fat is much more stubborn. This is a basic difference between these male and female fat deposits.

"Love handle" fat that men accumulate on their sides is different. It's just under the skin and called subcutaneous fat. As the name suggests, you can grab it and shake it. Like female thigh fat, it's hard to get rid of. However, men's potbelly fat, the kind I'm referring to, is located deep within the abdominal area, around the internal organs; exercise physiologists call it visceral fat. That's why potbellied men often have relatively hard abdomens. When I was in high school, a big bellied classmate like to demonstrate his "rock hard stomach" by having us punch him as hard as we could. I remember being impressed at the time, but now I know that his abdominal muscles were simply stretched tight over a lot of deep abdominal fat. That's where men pack on fat readily. Good Fat, Bad Fat This is a good-news, bad-news situation for both men and women, but for different reasons. Deep fat, that men have in their abdominal region, according to Big Fat Lies, (Fawcett Columbine, 1996) the book by Glenn A. Gaesser, Ph.D., which was recently featured in a Newsweek magazine cover story (August 21, 1997), is "metabolically hyperactive," both in storing and releasing fat at "a breakneck pace." That's both good and bad. Bad because the fat released into the blood stream often ends up clogging the coronary arteries and can lead to hypertension, diabetes and other metabolic problems. Good because, as I've already suggested, exercise and diet are quite effective in reducing visceral fat.

A study described by Dr. Gaesser in Big Fat Lies shows the effect of exercise on male belly fat. Researchers at Osaka University Medical School studied fifteen young professional Sumo wrestlers. Despite their obvious obesity, the Sumo wrestlers had relatively little visceral fat, as assessed by CAT scans. They also had low levels of blood cholesterol (160 mg/dl), and normal levels of triglycerides (105 mg/dl) and blood sugar (95 mg/dl), all levels generally associated with modest amounts of visceral fat. Quips Dr. Gaesser, "The moral seems to be: If you're going to eat a lot, then exercise a lot too."

For men it's easy on - with possible serious health consequences - and easy off. But for women it's almost the reverse. Women have the edge healthwise, but it comes with a price. Female hip and thigh fat present substantially less health risk than male abdominal fat, say Robert A. Robergs, Ph.D., and Scott O. Roberts, Ph.D. in their new textbook EXERCISE PHYSIOLOGY: Exercise, Performance, and Clinical Applications (Mosby, 1997). Dr. Gaesser explains why. He says it's because the female fa  tissue takes potentially harmful fat out of the blood stream. Female lower-body fat cells contain an abundance of an enzyme called lipoprotein lipase, which says Dr. Gaesser: "causes them to store fat easily," and as you can verify, "give it up very begrudgingly."

Don't Despair So the good news is that you are an unlikely candidate for heart disease and other serious ailments. Unfortunately, the bad news is that most women will always have more fat on their thighs than a man. That seems to be Mother Nature's plan. (Covert Bailey, author of Smart Exercise (Houghton Mifflin, 1994) and many other bestsellers, believes it is related to the child bearing function; he says breast feeding activates release of fat from the thighs.) Still, there's no need for despair; the situation is far from hopeless. Through a combination of exercise (weights and aerobics) and a sensible, low-fat diet, most women can develop shapely legs. According to Covert Bailey, who has personally measured the body fat of hundreds of women, thighs usually slim down when total fat gets to about 18%

Recommendations My recommendation is that you keep doing what you're doing now. Continue biking and running in moderation - excessive endurance exercise destroys muscle tissue - eat a balanced, low-fat diet (don't starve yourself) and, by all means, keep lifting. The muscle that weight training builds not only puts curves on your quads, it burns fat around the clock. Muscle is what keeps your metabolic fires burning brightly. Slowly, but surely, the unsightly fat on your thighs will moderate, and maybe even disappear.

For specific details on combining weights, aerobics and diet, read my book Lean For Life, which you'll find in the products section of this site. Finally, whenever you feel discouraged - and you will occasionally - check out the fitness competitors in the bodybuilding magazines you'll find on any newsstands - Muscle & Fitness, Muscular Development, Ironman and MuscleMag are the old standbys - for evidence of what consistent, intelligent weight training and aerobics will do for a women's thighs. Good luck.

Ripped Enterprises, 528 Chama, N.E., Albuquerque, New Mexico 87108, Office Hours, 8-5 (M-F, Mountain Time). Phone (505) 266-5858, FAX (505) 266-9123, e-mail:

Diet & Training Philosophy, In Brief by Clarence Bass

First, I believe every person is conducting an experiment of one. We all have different backgrounds, needs, goals and abilities. I would never blindly follow anyone else's diet or training regimen, and I don't expect anyone to blindly follow mine. That's why I always try to explain not only "how" I eat or train, but "why" as well. That's so readers can understand and evaluate my methods, weigh my advice. I expect you to take what rings true, makes sense - most of it, hopefully - and adapt it to your special situation. Leave the rest.

Diet The word "diet" has a negative connotation. It conjures up thoughts of hunger and deprivation. Diets don't work very well, because they make people unhappy. That's why I never diet. I follow an eating style. I believe the key to permanent body fat control is eating satisfaction. There's no need to eat foods you don't like - I never do - and there's no need to ever leave the table feeling hungry. That doesn't mean there's no discipline involved. There is. It takes effort and planning to eat the sensible, no-hunger way. Still, master my style of eating, and you can look forward to a lifetime of eating satisfaction - and leanness. The secret lies not in how much you eat, but what you eat. If you eat the right things you can almost eat as much as you want and still lose fat; it's actually hard to overeat. What happens is you become full and satisfied before you take in more calories than you burn. The details are in my books. But here's a brief summary: my eating style is low in fat (not too low), high in natural carbohydrates (carbs, the right kind, are not fattening) and near vegetarian (small amounts of meat and fish). Still there's plenty of good quality protein for the hardest training athlete. All the macro- and micro-nutrients are there. It's healthy, balanced - and satisfying. Finally, I almost never count calories. You won't have to either, once you master the "Ripped" style of eating. Exercise I started exercising regularly when I was about 13 - and never stopped. So, it should come as no surprise that, as in the case of diet, I look on exercise as a lifestyle. I believe your body tends to mirror your lifestyle. That's nature's way. The body seems to sense that an active person needs to be lean and, conversely, that a sedentary person does not. In the same vein, I am convinced that exercise gets more important, rather than less, as you get older. Therefore, I take a long-term approach to exercise, an approach designed to keep you training - and improving - year after year.

I admit to being a "muscle head." Weight training has always been my first love. But I recognize that one cannot be totally fit without aerobic exercise. As a result I follow a balanced exercise program: strength and endurance. A dual approach, weights and aerobics, is not only the route to total fitness, it's also the best way to become lean and stay lean. In my books, you'll find all the details - they're fascinating, I believe - on the specific and distinct roles weights and aerobics play in becoming lean and totally fit.

Enjoyment, believe it or not, is the key ingredient in any really successful exercise plan. That doesn't mean the program must be easy. To the contrary, productive exercise is often brutally hard. What it does mean is that the regimen must be satisfying. In my view exercise satisfaction comes mainly from two things: variety and goals. Both the body and the mind respond best to a varied exercise approach. You'll find plenty of variety, change, in the workouts I recommend. You'll never be bored. What's more, variation is essential to long-term progress.

Goals, realistic goals, are equally important, because they keep you motivated. Nothing is more satisfying than to set an exercise goal or target, work hard, and then achieve that goal. But a goal achieved is a goal lost, so you must continually challenge yourself with new goals. That's why I recommend - and follow - a goal-oriented training approach.

Finally, I don't have all day to spend in the gym. I have a life outside the gym, and I know my readers do as well. Fortunately, that's never been a problem, because in my opinion best results come from short, hard and infrequent training. Believe it or not, that applies to both weights and aerobics.

\10 fatty food

A Reason to Eat Fat. Norine Dworkin. Score one for fatty food: Eating standard American fare may be bad for the body, but it's good for the brain. Surprising as it seems, new research suggests that the Western diet's high levels of fat and protein protect against stroke-related memory loss. What's more, they offer better protection than the Asian diet, generally held up as a model for health precisely because it contains less fat and protein. Webster Ross, M.D., of the Department of Veterans Affairs in Honolulu, followed Japanese-American subjects who migrated to the United States in 1965. Those who started eating mostly Western food were far less likely to suffer memory loss after stroke than those who stuck to Asian fare. "Something about the Asian diet's low protein, low fat and high complex carbohydrates that speeds up the process seems to lead to certain kinds of strokes," says Ross.

A caveat: Ross believes that men in his study who eat American fare still consume less fat than other Americans. "We're not talking about the average suburbanite who goes to McDonald's three nights a week," he says. "We're talking about Japanese immigrants who had no fat in their diet when they moved here. A piece of bacon or a hamburger every two weeks was a tremendous increase for them. We probably need some animal fat and protein for healthy blood vessels, but I don't think that fat should be 40% of our diet, which is what's in the Western diet." Meanwhile, another new study casts cholesterol, a staple of the American diet, against type--not as the heart-disease villain, but as a heroic defender against depression and anxiety. Edward Suarez, Ph.D., a psychologist at Duke University Medical Center, found that young women with low levels of total cholesterol (below 160 mg/dl) are at greater risk for developing depression than those with normal or elevated cholesterol (180mg/dl and above), even if they have no history of the mood disorder. But, like Ross, Suarez is quick to state that his research is no license for a blues-busting diet of Big Macs. Better, he says, are cold water fish like salmon and tuna, fish oils or flaxseed oil, rich sources of omega-3 fatty acids, an essential form of fat that is good for the heart. According to Suarez, low cholesterol levels reflect a more critical shortage of omega-3s, shown in other studies to play a key role in mood disorders. When levels of omega-3s dip, less cholesterol circulates in the body, hampering brain cells from using the mood-regulating neurotransmitter serotonin, which in turn may lead to depression or anxiety.

"In countries like China and Japan, where fish is a staple, depression rates are lower than in the United States," Suarez says. "Since they also have lower rates of cholesterol, people may be eating enough essential fatty acids" but skipping less nutritious forms of cholesterol like french fries and brownies. Psychology Today, Nov 1999 Personal Health: Yet Another Reason to Fight the Fat PERSONAL HEALTH Yet Another Reason to Fight the Fat By JANE E. BRODY o you know your triglyceride level? New evidence strongly suggests that it is time to add triglycerides to the substances in the blood that influence your chances of developing heart disease. Triglycerides are basic particles of fat carried through the bloodstream by various molecules. They are derived from fats eaten in food or made in the body from other energy sources like carbohydrates. The new evidence indicates that blood levels of triglycerides that have long been considered "normal" -- 200 milligrams in 100 milliliters of blood serum -- are actually too high and should be monitored and controlled along with other coronary risk factors. Researchers at the University of Maryland Medical Center in Baltimore have found significant cardiac risks above 100 milligrams. They say long-standing uncertainties about the importance of triglycerides arose in part from mistaken assumptions about where to draw the line between safe and hazardous levels. The new studies also call into question the way triglyceride levels are measured, after a 12-hour fast. Dr. Michael Miller, who directed the Baltimore study, said the level achieved after a fatty meal might tell more about a person's chances of developing clogged arteries. New Limits of Safety The National Cholesterol Education Program lists 200 milligrams as a normal blood level of triglycerides. Levels of 200 milligrams to 400 milligrams are considered borderline, warranting changes in diet to bring them down. Drug therapy to lower triglycerides, according to the national guidelines, should be reserved for those with levels higher than 400 milligrams as well as those with levels of 200 to 400 who have other coronary risk factors like smoking, diabetes and high cholesterol. However, the Baltimore study found that those with triglyceride levels at or above 100 milligrams (as measured after a 12-hour fast) were 50 percent more likely than those with levels below 100 to suffer heart attacks, need bypass surgery or angioplasty or die from heart disease. This study, which followed 350 men and women for 18 years, was published in May in The Journal of the American College of Cardiology. Dr. Miller, director of preventive cardiology at the University of Maryland, said his was just one of several recent studies "suggesting that we may have been missing the big picture" regarding triglycerides, because clinicians and medical researchers had failed to look low enough when they assessed the contribution of triglycerides to coronary risk. Furthermore, researchers had assumed that if high triglyceride levels were hazardous, the higher the level the greater the risk would be. But this is not always the case. In fact, some people with very high triglyceride levels -- 1,000 milligrams or more -- are no worse off than those with levels of 200. Further complicating the picture, when triglyceride levels go up, blood levels of protective HDL-cholesterol go down, suggesting that low HDL's, not high triglycerides, are really responsible for any increased coronary risk found in people with high triglycerides. "We showed that a fasting triglyceride level above 100 milligrams is an important risk factor independent of the level of HDL's," Dr. Miller said. An earlier finding from the decades-long Framingham Heart Study had also shown that in women and in people over 65, rising triglyceride levels increased coronary risk independent of any cholesterol measurements. And a Danish study of 3,000 initially healthy middle-agedaand elderly men found that the risk of suffering a first heart attack rose substantially when triglyceride levels were above 140, regardless of HDL levels. In a report in March in the journal Circulation, the team from Copenhagen University Hospital reported that the Danish men with the highest triglyceride levels were more than twice as likely to suffer a heart attack as those with the lowest levels. Finally, in an analysis published last year in the Journal of Cardiovascular Risk that combined the results of 17 triglyceride studies among a total of 46,413 men and 10,864 women who had been followed for years, Dr. John E. Hokanson and Dr. Melissa A. Austin of the University of Washington in Seattle reported, "Triglyceride is a risk factor for cardiovascular disease for both men and women in the general population, independent of HDL." Missing from this impressive set of data is a large long-term study showing that reducing triglyceride levels that are above 100 or even 200 milligrams can prevent serious heart problems. It took studies like this to convince physicians and the public that it was worth the money and effort to lower cholesterol levels. Small studies indicate that lowering high triglycerides may be as effective in preventing coronary artery disease as lowering the level of heart-damaging cholesterol. In the Meantime . . . Some people with extremely high triglyceride levels do not get heart disease because their triglyceride complexes are too large to damage arterial cells, whereas others with much lower levels are in danger because their triglyceride complexes are small. Triglyceride levels in the blood reach their peak about four hours after a meal; the more caloric the meal, the higher the peak and the longer it takes the body to clear excess triglycerides from the blood. And, since triglycerides raise the risk of clotting, having too much in the blood for too long could precipitate a heart attack. Diets high in saturated fats (from meats and dairy foods), sugars (including natural sugars in fruit), alcohol and refined carbohydrates (white bread, white rice, etc.) can raise blood levels of triglycerides. If people on a very low-fat diet replace fats with sugars and refined starches, triglyceride levels may rise and protective HDL's fall. Some experts say that if weight is not a problem, it may be better to replace artery-clogging saturated fats with heart-healthy olive and canola oils and to eat more fish rich in omega-3 fatty acids like mackerel, sardines, herring, bluefish and salmon. Being overweight (particularly fat around the middle) and sedentary also contribute to high levels of triglycerides. The treatment here is obvious: eat fewer calories and burn more through exercise. It is also better both for reducing triglyceride levels and weight to consume many small nutritious meals a day instead of a few large ones. Triglyceride levels may also rise somewhat in postmenopausal women who take estrogen by mouth and in people who take bile acid sequestrants, a common medication for lowering cholesterol. If changes in diet, weight loss and exercise fail to bring elevated triglycerides down to a safe level, effective drug treatment is available.

PERSONAL HEALTH New Guide Puts Most Americans on the Fat Side By JANE E. BRODY ith bathing suit season approaching (and already here in some parts of the country), it seems as if nearly every popular magazine in the last month or two has touted one scheme or another for shedding that winter padding and achieving a movie-star figure in eight weeks or less. Even without the beach as an incentive, millions of Americans are perpetually struggling to lose pounds, an effort that has spawned a $33 billion diet industry. The Body Mass Index Federal health authorities are using this index to determine who is overweight. Under new guidelines, a body mass of 25 or more is considered overweight. Previous guidelines set the mark at about 27. On the chart below, your body mass index is at the intersection of your height and weight. Body mass is generally calculated in kilograms and meters, but for those accustomed to pounds and feet, this formula works: 1. Multiply weight by 703. 2. Multiply height in inches by height in inches. 3. Divide the answer in Step 1 by the answer in Step 2 for your body mass index.
 Sources: Shape Up America, National Institutes of Health

Last week, the National Institutes of Health gave Americans a far better reason to be self-conscious about their bodies and to increase their efforts to lose weight, not just for summer but forever. Based on an evaluation of many big studies linking excess body fat to a long list of chronic and potentially fatal diseases, an expert panel convened by the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Disease announced a new definition of overweight, a definition that brings to 55 percent the proportion of the adult population that should become more diligent weight watchers. In other words, according to the revised guidelines, more than half the population is too heavily larded, which makes us by far the fattest people on earth. The point at which an American would be considered overweight has been shifted downward, from a body mass index of 27 to one of 25. Those with an index of 30 or more are classified as obese. It is a guideline already established by the World Health Organization for people everywhere. If approved by the 115 health experts reviewing the guidelines, the new definition would add another 25 million adults to the 72 million who were previously considered overweight. The National Association to Advance Fat Acceptance objected to the new guidelines, saying that changes in diet and exercise habits can improve a person's health risks even if no weight is lost. The association is concerned that the increased attention to weight will prompt even more people to try diets doomed to fail and add to the number of people who avoid going to doctors for fear of being harassed about their weight. While the association may be correct in its belief that some people would be better off staying fat than spending their lives struggling to get their weight down to a level they simply cannot maintain, for the vast majority of overweight Americans, the problem is not genetic and not incurable. It is a consequence of eating too much, especially too much of calorically dense foods like fats and sweets, and exercising too little.

Who Is Overweight? The body mass index, or B.M.I., is considered a better measure of the amount of fat on a person's body than would be indicated by the traditional height-weight charts. Ck out a copy.

Waist size remains a key indicator of the right weight.

However, even the B.M.I. is not a perfect measure of fatness. A person who is very muscular but who has a low percentage of body fat could end up with the same B.M.I. as someone who is truly fat. Therefore, the new guidelines, which will be issued to medical professionals next week, also call upon physicians to measure their patients' waistlines. Fat that collects around the belly is the most serious health threat, and the guidelines say that among those with a B.M.I. of 25 to 35, men with waists of more than 40 inches and women whose waists exceed 35 inches face an increased risk of developing serious health problems. In fact, even if your B.M.I. falls into the low-risk range of 21 to 25, if you carry too much weight around the middle you're at greater risk than someone whose weight sits on the hips or thighs. Likewise, people with an acceptable B.M.I. who gained 10 or more pounds as adults (say, after age 21) are at greater risk than those who have maintained their college weight.

Why Worry About Weight? The main impetus for changing the weight guidelines is the growing realization that just about any amount of excess body fat is a potential health risk. Although there is some evidence that being a little overweight when you're old is actually beneficial, this is still being debated. The most recent analysis of data from the National Health and Nutrition Examination Survey revealed that as B.M.I. rises above 25, average levels of blood pressure and artery-damaging blood cholesterol rise, average levels of protective HDL cholesterol fall and it becomes more difficult to maintain normal levels of blood sugar.

Thus, as the B.M.I. rises, the risk of developing a long list of ailments rises, too. They include coronary artery disease and resulting heart attacks, hypertension, stroke type 2 diabetes, gallbladder disease, osteoarth- ritis, sleep apnea and accompanying respiratory problems and certain cancers, including cancer of the breast and endometrium. The National Inst of Health estimates that obesity-related disease costs the nation about $100 billion a year. Along with causing disease, obesity can shorten life. In fact, the Institutes' statement on the new guidelines noted that obesity is the second leading cause (after smoking) of preventable death in the US today.

In calculating someone's risk, the new guidelines state that more than the B.M.I. should be considered for many people in the lower ranges of overweight. Physicians will be told to look at risk factors for disease before deciding whether to urge patients to lose weight or merely avoid gaining any more.

Thus, if your B.M.I. exceeds 25, before urging you to lose weight your doctor should take into account your blood cholesterol, blood sugar and blood pressure, evidence of arthritis in your knees or hips and any respiratory problems, as well as your family medical history and your own risky behaviors, like smoking, eating poorly and not exercising.

Finally, the 24-member expert panel that formulated the new guidelines recommended that normal-weight people should also remain vigilant and have their B.M.I.'s reassessed every two years. It is easier to stop encroaching weight problems early than to have to shed scores of excess pounds that have hung around your frame for years.

PERSONAL HEALTH In a Fat-Filled World
 Some Sound Advice By JANE E.BRODY

Are you confused about dietary fats? Well, you're not alone. Judging from the sometimes conflicting reports recently presented at a scientific conference, experts in the field seem to be having the devil's own time sorting out which fats and oils and how much of them are likely to be most beneficial to health and at the same time acceptable to consumers and food producers.

The conference was organized by the American Heart Association, American Cancer Society and Oldways Preservation and Exchange Trust. Research into the fat issue is unlikely to come to definitive conclusions any time soon. But since you do have to continue to eat, and since fat is part of a normal diet that adds flavor to food, promotes satiation and carries in essential vitamins, you would be wise to follow the advice provided by some of the world's leading experts on the subject.

Dr. Frank Sacks, a cardiac researcher from the Harvard School of Public Health, said it best: "After looking at the whole picture, it makes sense to follow a diet moderate in fat that derives between 30% and 35% of its calories from fat, but that is low in saturated fat and contains a mixture of natural liquid vegetable oils and fish oil from foods."

There is no perfect fat or oil. As Dr. Sacks noted, "For almost any fat, there will be something not good about it." Although some fats (for example, fish oil and pure vegetable oils) are clearly better for your heart than others (for example, dairy fat, meat fat and hydrogenated vegetable oils), it is not possible to say which of the better oils is best.

Nor is there a hard and fast rule about the amount of fat appropriate in a healthful diet. Looking, for example, at heart-healthy diets in various parts of the world as well as those tested in clinical studies, there is a wide range -- from 10 percent to more than 40 percent of calories from fat -- to be found in wholesome diets.

"No matter what anyone thinks, one size does not fit all," said K. Dun Gifford, founder and president of Oldways, a nonprofit organization that identifies and promotes healthful diets from different countries. "We're driven to find a common denominator -- to simplify, simplify, simplify -- but that's a dangerous thing to do in a culturally diverse society such as ours." Dr. Sacks made a plea for "the dietary pattern approach that considers foods in the context of the whole diet, not in isolation, since the biological effects of the pattern may differ from the individual effects of component foods."

For example, the Mediterranean diet, which is rich in olive oil yet associated with low rates of heart disease and several common cancers, contains very little meat but is loaded with other health-promoting ingredients, including plentiful vegetables and fruits and dried beans and peas. The traditional Asian diet, on the other hand, is very low in all fats, but also rich in vegetables as well as fish and carbohydrates. "We've made some mistakes with the low-fat message," Dr. Sacks said. He explained that it led some people to adopt a poor dietary pattern, a diet loaded with calories from refined carbohydrates like white bread, simple carbohydrates like sugar and a slew of convenience foods but with little or no increase in fruits, vegetables or whole grains.

The result has been poor nutrition, widespread weight gain, a precipitous rise in diabetes and little or no benefit to the health of the heart or any other organ. A study in Lyon, France, may be the best evidence yet for adopting a wholesome dietary pattern. Participants were men known to have heart disease. Among those who ate more fruits, vegetables, bread, beans, fiber, cheese, poultry, fish and canola oil and less meats, butter and cream, total mortality was reduced by 56 percent, cardiac deaths by 65 percent, nonfatal heart attacks by 70 percent and cancer by 61 percent compared with participants who continued to eat a typical Lyon diet.

Without changing total fat intake for the experimental group, saturated fats in the Lyon diet were replaced by monounsaturated and polyunsaturated vegetable oils and fish oils. However, Americans have not yet reached the most important goal for fat consumption: a reduction in saturated fats (from meats, poultry, dairy products and solid vegetable fats that are hard at room temp) to less than 10% of calories. Saturated fats, along with trans fats formed when vegetable oil is hydrogenated, raise blood levels of cholesterol and are strongly linked to high rates of heart disease.

The average intake of saturates is now at about 12 or 13 percent, and some people are consuming more than 15% of their calories as saturated fat. All fats and oils are mixtures of fatty acids: saturated, monounsaturated and polyunsaturated. And within each of these categories, there are many different fatty acids, each of which has its own pattern of activity in the body.

For example, one kind of saturated fatty acid, stearic acid found in meats and chocolate, does not raise harmful LDL cholesterol levels. Unfortunately, most of the saturated fat in meats is palmitic, which does raise LDL cholesterol and which accounts for about two-thirds of the saturated fat in the American diet. Another saturated fatty acid, myristic, found in dairy fat, raises LDL cholesterol even more than palmitic, which is a good reason for choosing only nonfat or low-fat dairy foods. Now let's look at the more healthful fats, the monounsaturated and polyunsaturated oils found in plants and fish.

The American Heart Association suggests that up to 15 percent of calories can come from monounsaturates, prominent in olive and canola oils, avocados and many nuts. Monounsaturates make up an average of 10 percent of calories, with about two-thirds of them coming from animal fats that are rich in undesirable saturated fatty acids. Monounsaturated fatty acids lower harmful LDL cholesterol but have no adverse effect on heart-protective HDL cholesterol, which acts like arterial Drano, helping to keep blood vessels clear of fatty deposits.

According to one conference report, olive oil (but not canola oil) temporarily impairs the ability of blood vessels to dilate, but the health significance of this finding is unknown. Polyunsaturated fatty acids, prominent in corn, soybean, safflower and sunflower oils, lower blood cholesterol even more than monounsaturates, but they do so by lowering the LDL's and to some extent the HDL's.

The heart association suggests that polyunsaturates make up no more than 10 percent of calories, a level above which no population naturally consumes. In studies in animals and tens of thousands of people, diets that favor polyunsaturates lower the rate of heart attacks. Also helpful are the omega-3 fatty acids, polyunsaturates prominent in fish and a few rarely eaten greens like purslane, as well as canola and soybean oils.

Several studies have linked fish-eating to reduced rates of sudden death from heart disease, and the more fish the better. In a study in the Netherlands, the risk of cardiac death was 60% lower among frequent fish-eaters than among people who ate little or no fish. However, while fish oil reduces cardiac deaths, it does not prevent cardiac events like heart attacks, suggesting that it works mainly by preventing abnormal heart rhythms rather than atherosclerosis. Defining Saturated, Poly, Mono and Trans Unsaturated Fats by Lisa Hark, Ph.D., R.D.

(4/7/98 HeartInfo) - In the sophisticated world we live in, even the fat we eat is complicated, with various types existing in nature depending on their chemical makeup. Understanding the composition of the different fats and their food sources is important, as is learning the scientific evidence known about the effects of fats on heart disease. This knowledge helps us understand and implement the latest dietary recommendations for heart disease prevention. For example, the National Cholesterol Education Program nutrition guidelines advocate reducing fat intake to less than 30 percent of total calories, with less than 10 percent of those as saturated fat. Polyunsaturated fats should not exceed 10 percent of calories and monounsaturated fat should account for up to 15 percent of total calories. Here is an explanation of these fats, as a way to help you understand the basis for these guidelines and how they can be translated into real life.

Polyunsaturated fatty acids (PUFA) are primarily found in vegetable oils and fish sources. Omega-6 PUFA are derived from vegetable oils and are liquid at room temperature. They include corn, sunflower, safflower, soybean, and sesame oils. Salad dressing, margarine, and mayonnaise having these oils are therefore high in polyunsaturated fat. Omega-3 PUFA are found primarily in fish.

Monounsaturated fats are derived from plant sources. High amounts are found in olive, canola (rapeseed), and peanut oil as well as avocados, and certain nuts. Monounsatu- rated and polyunsaturated fats do not increase serum cholesterol or LDL levels and are associated with a reduced risk of heart disease.

Saturated fats are derived from both plant and animal sources and have been shown to promote plaque formation by raising blood cholesterol in animals and humans. Saturated fats are solid at room temperature and can also be formed from vegetable oil by the chemical process know as hydrogenation. According to the National Health and Nutrition Examination Survey (NHANES III), the American diet contains between 14 to 18 percent saturated fat. Specific foods which contain a significant amount of saturated fat include chicken fat (30 percent), vegetable shortening (31 percent), lard (40 percent), beef fat (50%), butter (62 percent), palm kernel oil (81 percent), and coconut oil (86 percent).

Trans unsaturated fats are also formed from hydrogenation, or the addition of hydrogen atoms to an unsaturated fat and have been shown to increase the risk of heart disease. Hydrogenation gives foods, such as crackers, cookies, potato chips, French fries, and doughnuts, a longer shelf-life by making them less likely to turn rancid. There is presently no way to determine the amount of trans unsaturated fats Americans are consuming since the revised food labels do not specify the amount contained in the product.

- Tell a Friend HeartInfo Home Help About Us Membership Resources Risks Specialists Search Nutrition News Ask Us Products/Svcs. Physicians FAQs Q&A Library Patients Patient Awards Glossary What's New SCIENCE REPORTER - CLICK HERE A Four Part Series: IS 30 PERCENT LOW ENOUGH? Does limiting fat intake to 30 percent of daily calories protect the heart? by Tina Adler

INTRODUCTION - PART ONE - 30 percent is low enough - 3/4/98 PART TWO - 30 percent is not low enough - 3/11/98 PART THREE - Risks to cutting out the fat - 3/19/98 PART FOUR - How to cut the fat - 3/26/97

INTRODUCTION: (3/4/98) - Back in 1957 the American Heart Association first advised the public that eating less fat could decrease a person’s risk of coronary heart disease. By 1973, the group issued what has become a dietary golden rule: keep fat to 30 percent or less of total calories and saturated fat to 10 percent or less.

But this is a general guideline for the public; it’s not necessarily the best diet for an individual to follow. Indeed, it’s a compromise between the ideal and the practical, acknowledge the AHA and other health groups. Even as far back as 1989, a government report on diet and health noted that the public was unlikely to go along with a stricter-yet more effective-regimen.

Most of us could reach the recommended goal without dramatically changing our eating habits, but would it have much of an effect on our risk of heart disease? Or do we need to go lower? Starting today, we’ll begin a four-part series answering those questions.

PART ONE: 30 percent is low enough:

(3/4/98) - What would happen to death rates if Americans took to heart the dietary golden rule to keep fat to 30 percent or less of total calories and saturated fat to 10 percent or less? The country’s rate of heart disease would certainly decline. On average, Americans derive at least 34 percent of their daily calories from fat, including 12 to 14 percent from saturated fat. The American Heart Association predicts that a 2 to 4 percent drop in the average consumption of saturated fat alone would lower the population’s risk of coronary heart disease by 3 to 5 percent. That would translate into roughly 17,000 fewer deaths each year.

Those figures impress many health experts who say that the 30/10 rule represents an attainable and effective goal for most Americans. Only people suffering from or at risk of heart disease need to make deeper cuts, they argue. As Dr. Mason Freeman of Harvard Medical School in Boston explains, going lower would produce modest benefits yet require major changes. In fact, if someone’s level of the "bad" LDL cholesterol was low (below 130 mg/dl), Freeman wouldn’t recommend changing his or her diet.

Other doctors and nutritionists take a yet more liberal view. They argue that even if you need to lower your blood cholesterol levels, going above the 30 percent limit may be fine - if you watch the type of fat you eat. While a strict cutoff for saturated fat - the main cause of high LDL scores - makes sense, one on total fat does not, they say. Instead of counting total fat calories, people should substitute monounsaturated and polyunsaturated oils for saturated fat and for trans fat, a chemically altered substance found in margarine, packaged foods, and fast foods.

When it comes to monounsaturated fats in particular, "the more the better," says Dr. Walter Willett of Harvard School of Public Health in Boston. Willett and others who support lifting restrictions on total fat cite research that found low rates of heart disease among people who ate a traditional Mediterranean diet. Fat, often in the form of olive oil, provided 40 percent of the Mediterranean residents’ total calories. Only about 8 percent of their calories came from saturated fat and almost none came from trans fat.

Mediterranean menus include plenty of monounsaturated and polyunsaturated oils. In addition to fruits, vegetables, and grains, the diet also includes fish, which is rich in omega-3 fat. This valuable nutrient helps the heart by inhibiting blood clotting. It is also found in walnuts, canola oil, and soybean oil. Other health experts argue that it’s unclear what elements in the Mediterranean menus protect against heart disease and that it’s still a good idea to get less than 30 percent of your calories from fat. More from them in part two of the series.

PART TWO: 30 percent is not low enough

(3/11/98) - Many health groups recommend deriving 30 percent or less of your calories from fat; 10 percent from saturated fat. Some health experts, however, call for tougher guidelines.

Making a big dent in your saturated fat intake can lower levels of the "bad" LDL cholesterol significantly. Decreasing saturated fat from 12 to 13 percent of calories to below 7 percent can produce a 10 to 15 percent drop in LDL, for example. Following the 30/10 rule, however, would do little for the average American with a high LDL. It would drop by only 4.5 percent - say from 160 mg/dl to 153 mg/dl - far from the desirable level of 130 mg/dl or below.

Heart-disease patients who cut their fat intake to the bare bone, such as participants in Dr. Dean Ornish’s programs, make a good case for going below the 30 percent rule. They often see dramatic changes in their heart condition.

Patients in such programs also exercise and practice relaxation strategies, which helps their heart. One of the main reasons for reducing total fat to below 30 percent is to cut back on calories, notes Dr. John LaRosa of Tulane University Medical Center in New Orleans. Fat supplies more calories per gram than any other component of our meals. Cutting calories can help improve a person’s cholesterol scores, as being overweight causes LDL levels to climb and the "good" HDL cholesterol to decline.

So can you rest easy if you’re doing even better than the golden rule dictates and getting less than 30 percent of your calories from fat? Maybe not. Next week: Risks to cutting out the fat

PART THREE: Risks to cutting out the fat

(3/19/98) - Despite their benefits, very low-fat diets that go well below the common recommendation to derive a maximum of 30 percent of calories from fat can prove risky for some people.

For one, dieters tend to substitute carbohydrates for fat and that can lower levels of the "good" HDL cholesterol. In a 1997 study, researchers compared the effects of low-fat and very low-fat regimens on HDL. They found that HDL decreased more in dieters who got only 10 percent of their calories from fat and substituted carbohydrates for fat than it did in dieters deriving 26 percent of their calories from fat, primarily olive oil. Levels of the "bad" LDL cholesterol dropped a similar amount in both groups.

High-carbohydrate diets are also a risk for diabetics, whereas using monounsaturated fats can help reduce diabetics' blood sugar and triglyceride levels.

The amount of fat a person needs changes over the years. Low-fat meals are unsuitable for children under age 2, who need calorie-dense food. The benefits of cutting blood cholesterol levels wane by age 65 to 70 and may disappear by age 80.

Before you and your family choose the 30/10 plan or something stricter, check with a doctor. You'll want to rule out any existing health problems, such as diabetes or low HDL, that would influence your menu planning.

"As is often the case with most health interventions, recommendations on fat intake must be tailored to the individual," says Dr. J. Michael Gaziano of Brigham and Women's Hospital in Boston.

Next week learn how others have limited the fat in their diet.

PART FOUR: How to cut the fat (3/26/98) - In general, reducing unhealthy fats in the diet requires substitution rather than elimination: using polyunsaturated and monounsaturated oils instead of butter or lard; choosing low-fat foods instead of high-fat. Most nutritionists and public health agencies also recommend eating more fruits, vegetables, and whole grains.

A recent study of successful dieters may give you some ideas to get started. The researchers looked at the diets of 145 middle-aged people who had successfully decreased their fat consumption over a period of 5 years and maintained a healthful diet for at least 5 months.

First off, the participants altered their diet in many—not just a few—ways. Those who made the greatest number of different changes also reduced their fat intake the most. Of all the changes made, forgoing fat as a flavoring, such as not buttering bread or vegetables, cut out the most fat.

Their other strategies included using less meat, cooking fat, and fewer snack foods and eating more fruits, vegetables, and low-fat products. Some dieters cut back on chocolate, but that wasn't the first food to go.

Those who ate less meat usually beefed up their beans and rice consumption. Many participants also revised their breakfast menus by reducing breakfast meats and eggs and adding a banana.

The study included 122 women and 23 men, so it reflects changes that women find useful. And those may be the most important. In the United States, women handle most of the shopping and cooking. Men, studies show, are often happy to abide by women's dietary dictates.

People's bodies respond differently to dietary fat. So if a regimen that brought your neighbor's cholesterol levels under control fails to make a dent in yours, don't give up. Curse your genes and try another plan.

Trans Fatty Acids By Lynn Grieger, RD, CD, CDE (7/22/99 HeartInfo) - While saturated fats raise blood cholesterol levels, monounsaturated fats lower blood cholesterol levels. But what about trans fatty acids?

WHAT ARE TRANS FATTY ACIDS? Trans fatty acids were virtually unknown until the mid-1980’s, when the food industry started to use less saturated fats, primarily from animal and tropical oils, in processed foods. Because saturated fats cause increased levels of blood cholesterol, consumers pressured the food industry to replace harmful saturated fats with the more beneficial unsaturated fats.

Trans fatty acids are formed when liquid fats are hydrogenated, or partially hydrogenated, to become more solid at room temperature. Saturated fats have a higher melting point and less potential to become rancid. These properties are beneficial in many crackers, baked goods, and fried foods. To replace saturated fats, the food industry chose to use hydrogenated oils, creating trans fatty acids in the process.

HEALTH IMPLICATIONS OF TRANS FATTY ACIDS Although less harmful to our cardiovascular system than saturated fats, trans fatty acids raise blood cholesterol levels, therefore contributing to heart disease. Effects of trans fatty acids on HDL and LDL cholesterol levels are still unknown. The American Heart Association recommends that daily total fat intake be limited to no more than 30 percent of total calorie intake, and that trans fatty acids be limited as much as possible.

TRANS FATTY ACID CONTENT OF FOODS Trans fatty acids occur naturally in our food supply in meat and milk from ruminant animals such as cows and sheep. Recent research suggests that 20-25 percent of the trans fatty acids consumed are from these naturally occurring sources. The bulk of trans fatty acids in the typical American diet are found in:

hydrogenated oils, used in crackers, baked goods, cereals, and breads

fast foods such as French fries, fried fish, and onion rings

margarine, especially stick margarine

According to a report in the Journal of the American Dietetic Association, the average American consumes 5.3 grams of trans fatty acids per day. This translates into approximately 7.4 percent of total daily fat consumed. Since consumers can easily avoid products that contain the majority of trans fatty acids found in the United States diet, it makes sense to take this additional step in reducing risk of cardiovascular disease.

REDUCING TRANS FATTY ACIDS Trans fatty acids are not listed separately on current food nutrient labels. To determine if a food might be high in trans fatty acids, look at the ingredient list. If the first ingredient is a hydrogenated or partially-hydrogenated oil, then the product contains trans fatty acids.

To limit trans fatty acids and follow current guidelines that promote cardiovascular health, follow these steps:

Use the softest margarine you can find. The first ingredient should be water (in diet margarine products) or a liquid fat. Some types of margarine contain no trans fatty acids.

Read cracker, cereal, and baked goods labels for hydrogenated or partially-hydrogenated fats.

Use these products sparingly to limit trans fatty acid intake.

When choosing fast food, avoid fried foods as these contain higher amounts of trans fatty acids.

Researchers are learning more about the health effects of individual types of fat, such as saturated, monounsaturated, and trans fatty acids. Although the total amount of fat in the diet is still important, wise consumers will limit saturated fat and trans fatty acids. Remember that fruit, vegetables, and whole grains contain little or no saturated fat or trans fatty acids, and should be the mainstay of a heart-healthy diet.

What Matters Most, Calories or Fat? by Lynn Grieger, R.D., C.D.E.

Fat Percentages on Labels: Don't Be Misled! Doctors Debate Low-Fat High-Carbohydrate Diet vs. Reduction in Saturated Fats A Grocery List and Meal Plan Helps With Weight Loss

(8/26/98 HeartInfo) - What matters most, calories or fat? The answer to this question used to be easy. Traditional wisdom has been that it is the amount of fat consumed, not the total calories, that matters most in a heart-healthy diet. Based on that advice, we've evolved into a nation of fat-avoiders, focusing on a single nutrient in our quest for the perfect diet.

In Jan 1998, The International Conference on the Mediterranean Diet, co-sponsored by the Harvard School of Public Health and The Oldways Preservation & Exchange, brought together leading scientists from around the world to discuss "fat phobia" and the widespread use of high-carbohydrate, low-fat foods. Their conclusion? Calories, not fat, matter most in a healthy diet.

Many food manufacturers and nutrition authors seem to believe that as long as foods are low in fat, the rest of the diet is insignificant. They suggest that when people decrease their fat intake, consumption of foods inherently low in fat such as fruits, vegetables, legumes and whole grains will rise. This made sense until the proliferation of reduced fat foods hit the supermarket shelves. With the availability of many reduced-fat products, there is more freedom of choice. Be sure to make intelligent choices that will result in a well-rounded diet.

While eating a low-fat diet is extremely important for individuals concerned about their heart health, there is more to consider than fat content. Instead of looking only for the grams of fat per serving on a nutrition label, look further. Follow these simple steps on the road to a healthy diet:

1. Read the list of ingredients. Look for the word "whole" in the first ingredient, indicating that this product contains more of the natural grain and its important nutrients. 2. Avoid foods containing hydrogenated fats. A byproduct of the hydrogenation of liquid vegetable oils is trans-fatty acids, which appear to lower HDL and raise LDL levels, the opposite direction we want to take. 3. For individuals who are not satisfied eating a small portion of fat-free or low-fat foods, eat less of the higher fat product. For example, instead of purchasing a low-fat cookie, buy the real thing and consume it sparingly. You'll see more heart-healthy benefits by consuming fewer total calories, even if the fat content is slightly higher in these foods. For some reason, many people equate "low-fat" with "eat as much as you want", an undesirable and false conclusion. 4. Stock your refrigerator with produce. Spend more time in the produce section of the grocery store, and less time in the snack and packaged food aisles. Fruits and vegetables purchased in season are great buys, and you don't have to worry about reading the nutrition labels!

Remember balance. Current dietary guidelines often recommend balance and moderation in eating habits, meaning that we should be careful to consume a wide variety of foods, and moderate our portion sizes according to energy needs. Unfortunately, most Americans do not seem to be listening, since as a nation we are gaining weight at an alarming rate. Scale down portion sizes, increase daily activity, and follow the above suggestions on your road to a heart-healthy lifestyle.

Fats are concentrated sources of energy for the body and also carry vitamins A, D, E, and K. It is necessary in the diet. Two kinds of fat cause coronary disease and heart problems, not its total. Polyunsaturated: Containing much fatty acid and lacking hydrogen atoms. It is liquid at room temperature. Saturated: A lipid containing high hydrogen content. Predominant in meat and dairy products. It is solid at room temperature and bad for health.

Trans fatty acids: Artificially hydrogenated vegetable oils to resist rancidity, solid at room temp. Found in margarines, baked stuff, and deep fried junk foods.

Mono and polyunsaturated are less troublesome and best.

Saturated fats usually come from land animals or tropical oils like palm kernel and coconut oil. These fats are easy to recognize because they are solid at room temperature. The major foods with this: cheese, meats. The body needs a small amount of this fat to function well. It is the main contributor of lipoproteins (LDL).

Polyunsaturated fat comes from vegetables, nuts, seeds, and fish. At room temperature these fats remain liquid. Safflower and corn oils are the best of this group.

Monounsaturated fats like olive oil, canola, and peanut oil are probably the healthiest. They too remain liquid at room temperature. These fats lower LDLs without affecting HDLs, but they are still fat.

Hydrogenated fats are processed vegetable oils in food products as margarine, shortenings, and peanut butter.

Chicken fat (9%) is tasty and not too bad in moderate doses compared to butter (22%). Fat is okay if balanced with carbohydrates and protein.

Think all vegetable fats are the same? Think again. Hydrogenated and partially hydrogenated vegetable oils, both trans fats, may be the worst fats of all.

When liquid vegetable oils are put through the process of hydrogenation to become solids--like margarine--they also become what are known as trans fats. Researchers have recently discovered that trans fats, found in hundreds of foods, may increase artery-clogging LDL cholesterol even more than saturated fats.

NB: These trans fats are not itemized in the nutrition facts box, so check ingredients lists carefully. If you see the words "hydrogenated" or "partially hydrogenated" steer clear for the sake of your arteries and heart.

-- Nonfat Food Failure. If you're trying to lose weight, add a little fat to your diet. This surprising diet hint may be a more effective strategy than eating nonfat foods.

Australian researchers studied the effects of fat and carbohydrate consumption on subsequent eating behavior. Participants who received fat ate significantly less at the following meal than those who received carbohydrates. Researchers hypothesize that dietary fat acts on intestinal receptors to make you feel full.

FATS & CHOLESTEROL Diet plus exercise cuts abdominal fat Novel protein controls fat absorption diet and fat; lipids; monounsaturated fat; polyunsaturated fat; saturated fat Definition: Fats are organic compounds that are made up of carbon, hydrogen, and oxygen; they are the most concentrated source of energy in foods. Fats belong to a group of substances called lipids. Fats come in liquid or solid form. All fats are combinations of saturated and unsaturated fatty acids. Fats can be called very saturated or very unsaturated depending on their proportions.

Functions: Fat is one of the three nutrients (along with protein and carbohydrates) that supply calories to the body. Fat provides 9 Calories per gram, more than twice the number provided by carbohydrates or protein.

Fat is essential for the proper functioning of the body. Fats provide the "essential" fatty acids, which are not made by the body and must be obtained from food. Linoleic acid is the most important essential fatty acid, especially for the growth and development of infants. Fatty acids provide the raw materials that help in the control of blood pressure, blood clotting, inflammation, and other body functions.

Fat serves as the storage substance for the body's extra calories. It fills the fat cells (adipose tissue) that help insulate the body. Fats are also an important energy source. When the body has used up the calories from carbohydrate, which occurs after the first 20 minutes of exercise, it begins to depend on the calories from fat.

Healthy skin and hair are maintained by fat. Fat helps in the absorption, and transport through the bloodstream of the fat-soluble vitamins A, D, E, and K.

- Defining Saturated, Poly, Mono and Trans Unsaturated Fats by Lisa Hark, Ph.D., R.D.

(4/7/98 HeartInfo) - In the sophisticated world we live in, even the fat we eat is complicated, with various types existing in nature depending on their chemical makeup. Understanding the composition of the different fats and their food sources is important, as is learning the scientific evidence known about the effects of fats on heart disease. This knowledge helps us understand and implement the latest dietary recommendations for heart disease prevention. For example, the National Cholesterol Education Programnutrition guidelines advocate reducing fat intake to less than 30 percent of total calories, with less than 10 percent of those as saturated fat. Polyunsaturated fats should not exceed 10 percent of calories and monounsaturated fat should account for up to 15 percent of total calories. Here is an explanation of these fats, as a way to help you understand the basis for these guidelines and how they can be translated into real life.

Polyunsaturated fatty acids (PUFA) are primarily found in vegetable oils and fish sources. Omega-6 PUFA are derived from vegetable oils and are liquid at room temperature. They include corn, sunflower, safflower, soybean, and sesame oils. Salad dressing, margarine, and mayonnaise containing these oils are therefore high in polyunsaturated fat. Omega-3 PUFA are found primarily in fish. Monounsaturated fats are derived from plant sources. High amounts are found in olive, canola (rapeseed), and peanut oil as well as avocados, and certain nuts. Monounsaturated and polyunsaturated fats do not increase serum cholesterol or LDL levels and are associated with a reduced risk of heart disease.

Saturated fats are derived from both plant and animal sources and have been shown to promote plaque formation by raising blood cholesterol in animals and humans. Saturated fats are solid at room temperature and can also be formed from vegetable oil by the chemical process know as hydrogenation. According to the National Health and Nutrition Examination Survey (NHANES III), the American diet contains between 14 to 18 percent saturated fat. Specific foods which contain a significant amount of saturated fat include chicken fat (30 percent), vegetable shortening (31 percent), lard (40 percent), beef fat (50 percent), butter (62 percent), palm kernel oil (81 percent), and coconut oil (86 percent).

Trans unsaturated fats are also formed from hydrogenation, or the addition of hydrogen atoms to an unsaturated fat and have been shown to increase the risk of heart disease. Hydrogenation gives foods, such as crackers, cookies, potato chips, French fries, and doughnuts, a longer shelf-life by making them less likely to turn rancid. There is presently no way to determine the amount of trans unsaturated fats Americans are consuming since the revised food labels do not specify the amount contained in the product.


WHAT MATTERS MOST, CALORIES OR FAT? by Lynn Grieger, R.D., C.D.E.

Fat Percentages on Labels: Don't Be Misled!Doctors Debate Low-Fat High-Carbohydrate Diet vs. Reduction in Saturated Fats A Grocery List and Meal Plan Helps With Weight Loss

(8/26/98 HeartInfo) - What matters most, calories or fat? The answer to this question used to be easy. Traditional wisdom has been that it is the amount of fat consumed, not the total calories, that matters most in a heart-healthy diet. Based on that advice, we've evolved into a nation of fat-avoiders, focusing on a single nutrient in our quest for the perfect diet.

In Jan 1998, The International Conference on the Mediterranean Diet, co-sponsored by the Harvard School of Public Health and The Oldways Preservation & Exchange, brought together leading scientists from around the world to discuss "fat phobia" and the widespread use of high-carbohydrate, low-fat foods. Their conclusion? Calories, not fat, matter most in a healthy diet.

Many food manufacturers and nutrition authors seem to believe that as long as foods are low in fat, the rest of the diet is insignificant. They suggest that when people decrease their fat intake, consumption of foods inherently low in fat such as fruits, vegetables, legumes and whole grains will rise.This made sense until the proliferation of reduced fat foods hit the supermarket shelves. With the availability of many reduced-fat products, there is more freedom of choice.Be sure to make intelligent choices that will result in a well-rounded diet.

While eating a low-fat diet is extremely important for individuals concerned about their heart health, there is more to consider than fat content. Instead of looking only for the grams of fat per serving on a nutrition label, look further. Follow these simple steps on the road to a healthy diet:

1. Read the list of ingredients. Look for the word "whole" in the first ingredient, indicating that this product contains more of the natural grain and its important nutrients. 2. Avoid foods containing hydrogenated fats. A byproduct of the hydrogenation of liquid vegetable oils is trans-fatty acids, which appear to lower HDL and raise LDL levels, the opposite direction we want to take. 3. For individuals who are not satisfied eating a small portion of fat-free or low-fat foods, eat less of the higher fat product. For example, instead of purchasing a low-fat cookie, buy the real thing and consume it sparingly. You'll see more heart-healthy benefits by consuming fewer total calories, even if the fat content is slightly higher in these foods. For some reason, many people equate "low-fat" with "eat as much as you want", an undesirable and false conclusion. 4. Stock your refrigerator with produce. Spend more time in the produce section of the grocery store, and less time in the snack and packaged food aisles. Fruits and vegetables purchased in season are great buys, and you don't have to worry about reading the nutrition labels!

Remember balance. Current dietary guidelines often recommend balance and moderation in eating habits, meaning that we should be careful to consume a wide variety of foods, and moderate our portion sizes according to energy needs. Unfortunately, most Americans do not seem to be listening, since as a nation we are gaining weight at an alarming rate. Scale down portion sizes, increase daily activity, and follow the above suggestions on your road to a heart-healthy lifestyle.