The Lo-Co…Vegan…Thanksgiving

Last year I hosted Thanksgiving, so this year I’m not cooking: we’re going to my brother-in-law’s for the family get together. But I realized a few years ago that not cooking Thanksgiving has a huge, huge downside — I don’t have leftovers for several days of “hot lunch” (as my husband likes to call my preferred leftovers for lunch choice.)

So now, on the years I don’t host the actual Thanksgiving feast, I cook ‘Thanksgiving Friday” for local friends and family.

The beauty is: it’s not the ‘real deal’ so I can experiment a bit.  The downside: I’ve found that as we get older, more of my Thanksgiving Friday guests have dietary restrictions. So this year I’ve been searching for new recipes that meet a bunch of requirements.  First, some kind of low fat, low-cholesterol recipes for me.  Second, vegan side dishes for my niece.  And lastly, garlic & onion free options for one of my sisters.

It’s not easy.

But I love a challenge.

From a lo-co perspective, I refuse to give up gravy and mashed potatoes – so my lo-co choice for Thanksgiving is mostly just to limit portion size of non-lo-co foods. But I am adding one new thing: a healthier, homemade cranberry sauce. The recipe I like is Cooking Light’s Classic Cranberry Sauce which has a lot of sugar but is quite tasty.  Plus you can make it ahead (key) and it at least has the nutrients and calcium of fresh, tart cranberries. So in my view, it’s a decent lo-co choice.  (And hey, it’s easy to have the canned stuff available for those who refuse to vary from tradition.)

For my niece and sister, I am giving Lemon-Garlic Kale Salad from Melissa Clark / Julia Moskin (sorry, can’t tell whose recipe this is!) a whirl this Friday.  By separating out a bit of  lemon juice/salt/olive oil mixture and keeping it garlic-free for my sister, this recipe should work for EVERYONE at my table. Well, everyone except my son who wouldn’t touch kale if I paid him.  He’ll stick with the traditional Campbell’s Soup/Durkee Fried Onion-drenched green bean casserole.  Oh , who am I kidding – he’ll have nothing green. It’s Thanksgiving. He gets a pass.

For other great Thanksgiving ideas, read Julia Moskin and Melissa Clark’s excellent Essential Thanksgiving NYT article and accompanying recipes. I’m trying the turkey leg cooking method (no, not for me – I’m sticking to white meat!) and the mashed potato ideas listed in this well-done, instructional piece.

So my niece has something else to eat besides plain turkey and lemon-garlic kale salad, I’m investigating gluten free recipes.  There is a veritable treasure trove of recipes and ideas for gluten free thanksgiving at Gluten Free Girl’s Grain Free Thanksgiving. And Cooking Light offers a Gluten Free Holiday Menu.  I haven’t worked out yet which gluten free sides I’ll be making – but I better hop to it since it’s already Tuesday!

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Why You Should Use the New Cholesterol Guideline Calculator

The new cholesterol treatment guidelines were unveiled on November 12, 2013 and controversy flared almost immediately.

The issue?

A duo of doctors are concerned that the new calculator used in one part of the guidelines seriously over-estimates heart disease risk (the calculator delivers a person’s 10-year risk of heart disease: the new guidelines state those with a risk above 7.5% should take a statin). If they are right, the result would be millions of new people taking a statin — who maybe don’t need this drug.

A serious concern, indeed.

Am about to go into a bit of detail about why it might be over-calculating: if you know already/have been following in the news (or don’t care for the details) skip down to BOLD below!

Harvard professors Dr. Paul M. Ridker and Dr. Nancy Cook tested the risk calculator using THREE studies they chose, of thousands of people over the last decade — and found the calculator over-predicted risk by 75-150 percent. One possible reason for the (alleged) over-prediction is that the new guidelines were based on MANY studies (usually a GOOD thing) but in this case, that means that some of these studies included people from more than a decade ago (a time when far more people smoked than currently do, and thus had more heart attacks.)

The AHA’s response?

As reported by the Boston Globe, “the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that patients and doctors should discuss treatment options rather than blindly following a calculator.”

The article goes on to state that according to Dr. Sidney Smith, executive chairman of the guideline committee, “the concerns “merit attention.” But, he continued, “a lot of people put a lot of thought into how can we identify people who can benefit from therapy.” Further, said Smith, a professor of medicine at the University of North Carolina, “What we have come forward with represents the best efforts of people who have been working for five years.”

So, what’s the deal? Should you use the calculator or not?

I vote YES, emphatically!

Of course, I’m not a doctor (and you shouldn’t believe everything you read on the internet)… but here’s let me tell you why I say YES, you should use the calculator.

As stated in my last post, The New Guidelines, the RATIONALE behind these new guidelines makes all the sense in the world.  The new guidelines no longer tie statin medication to achieving a particular cholesterol number.

Said differently, the new guidelines recommend statins only for those AT RISK of heart disease. For those who have high cholesterol but low heart disease risk, statins are NOT recommended.

This makes more sense conceptually (to me) than the prior mandate of hitting a certain cholesterol goal number – especially since those ‘goal numbers’ were not, apparently, tied to anything scientific!

To illustrate, I’ll use, um, me.  Yes, I totally get that an n=1 is not useful for anything other than as an example, but I’ll make an example nonetheless.

Under the old guidelines, statin medication was possibly warranted for me simply because my cholesterol numbers were near certain figures — even though I eat well, exercise a lot, and don’t have ANY OTHER risk factors. Net, under the old guidelines my doctor actually TALKED to me about taking a statin, even though I’m healthy and don’t have any heart disease risk factors EXCEPT for “high” cholesterol.

I decided no. But it wasn’t necessarily an easy thing to do.

Under the new guidelines?

Shocker –  I am nowhere near that 7.5% heart disease risk cutoff.

That’s because the new guidelines take into account the fact that:

  • My LDL (bad) cholesterol is far, far lower than 190
  • I’m a female (here’s another huge shock – the original guidelines were created using mostly data from white men.  Sigh.)
  • My blood pressure is low/normal, and I do not take blood pressure medication
  • I’m not diabetic
  • I do not smoke.

To me, even just reading this list of inputs into the heart disease risk calculator “proves” this is a significantly better way to estimate heart disease risk than the old guidelines, (which put me as at risk simply because “my cholesterol is above 200.”)  The new guidelines just make FAR more sense: they endeavor to predict risk, not get to a cholesterol goal.

So download the calculator (and do it soon in case the AHA gets under so much pressure they take it down) – just click the red button that says, “Download CV Risk Calculator” and save it to your desktop. USE IT!  (And if the above link doesn’t work, check my RESOURCES page for latest link.)

Yes, OK, there could be a problem with the calculator…

But don’t decide not to use it because of the potential issue.  Instead, use it wisely!

If your result is at or near that 7.5%, take that as a clue to talk to your doctor.  Don’t blindly decide you need to start a statin with that result — but do talk to your doctor. Maybe he or she will decide to run some further tests (like C-reactive protein, ApoB and LDL-P – read more here) to really understand your risk.

But do download the calculator and get a sense of your 10-year risk.

  • It could save your life. You could truly need a statin and not know it.
  • Or you could find out you are at/near the 7.5% risk – and if you do, you can decide what to do about it, with your doctor.
  • Or you could be like me and find out statins aren’t indicated – even if the calculator is over-estimating risk.

But now, at least, the calculator means your discussion with your doctor will be focused on the right thing – what, truly, is your individual level of heart disease risk. And you can form a plan based on that, rather than a (seemingly somewhat arbitrary) cholesterol goal number.

So even if the calculator is over-estimating, the most likely result will NOT be millions taking statins unnecessarily. The most likely result will be millions ASKING their doctors about their level of heart disease risk.  So they can create a plan together.

Which is the point, no?

To read more about the new guidelines – and why using the new online calculator makes sense – I found these articles particularly insightful:

And just a quick reminder: to use the calculator, you need three pieces of info: your total cholesterol, your HDL (good) cholesterol, and your systolic blood pressure (the first number in the blood pressure measurement).

And last but not least, the calculator cannot be used if you already have heart disease or if you currently take statins: if that’s you, best bet is to talk with your doctor about what the new guidelines mean for you.

 

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The NEW guidelines for cholesterol-lowering statin meds

It was another big week for cholesterol news.

Last week the FDA declared that partially hydrogenated oils (PHOs), a very common processed food ingredient, are now not safe. As explained in FDA: Trans Fats are not GRAS, if PHOs are indeed declared not GRAS (generally regarded as safe), FDA will have found a way to significantly reduce unhealthy trans fats from the American food supply. Which is huge.

Then this week, more enormous cholesterol news.  On November 12, 2013, the American Heart Association and the America College of Cardiology released new guidelines for the treatment of high blood cholesterol. The new guidelines will very likely result in a dramatic increase in the number of Americans taking statin medications to lower cholesterol and heart disease risk.

Both in the span of just one week

And it wasn’t even National Cholesterol Education Month.  (That was September.)

What gives? Why these two huge announcements now, within days of each other?

While I have no idea if the timing was coordinated (or not), I do know that both moves have the potential to significantly reduce cholesterol and heart disease risk. And that one move (banning PHOs) is a no-brainer while the other (the new statin guidelines) has many up in arms.

As you know, I am not statin-girl (unless clearly warranted) so it’s potentially troubling that the new guidelines will prompt millions of new statin prescriptions. So I empathize with those who are unhappy with the new guidelines. That said, I am all for the RATIONALE behind these new guidelines — which focus on heart disease risk, not on reducing a particular cholesterol number in an otherwise healthy, low-risk individual.

This makes sense to me.

And OK, so I’m not a doctor, so who cares that it makes sense to me? On the other hand, I do think a great deal about medical issues… and to me, these new guidelines are logical. And logical=good, right? In effect, the new guidelines recommend statins only for those AT RISK of heart disease. For those who have high cholesterol but low heart disease risk, statins are NOT recommended.

So, what exactly are the new guidelines? Broadly… if you are in one of the following four groups, you have elevated heart disease risk and should take statins:

  1. those who already have cardiovascular disease
  2. anyone with LDL (bad) cholesterol of 190 mg/dL or higher
  3. anyone between 40 and 75 years of age who has Type 2 diabetes
  4. people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher. (And there’s a calculator available online ** so you can figure out if this applies to you. It’s an Excel spreadsheet download – click the red ‘Download CV Risk Calculator’ box and save it to your computer. Do it soon because they may take it down…)** NOTE – the ‘risk calculator’ is occasionally taken down, edited, etc.  If the above link doesn’t work, check my RESOURCES page as I’ll try to keep that one current.

That’s it in a nutshell (well, that and the elimination of the old guideline to get LDL to an ‘as-low-as-possible’ level — in the new guidelines, there is no set LDL goal level).

Is that all? Of course not – there was a ton of media coverage last week, and there’s a lot more in-depth understanding of the guidelines that can be had. As it’s an important (and can be confusing topic), I wanted to provide what I found to be the best primary sources in case you want to dive in and read more.

(If, on the other hand, you prefer to read one piece providing an overview of the new guidelines, how they are different from the old guidelines, and how to calculate your personal heart disease risk, you might find this article I just published on Answers.com more useful: “New Cholesterol Statin Drug Guidelines.”)

But if you want more in-depth information, here are some sources:

Perhaps the new guidelines will result in millions more Americans taking statin drugs – but perhaps, if they are the RIGHT people to take statins, that will be a good thing.  If you are wondering if you should take a statin, read up on the new guidelines, calculate your heart disease risk online, and talk to your doctor.

If you already take statins (or have heart disease already) the online calculator won’t work for you — in that case, talk to your doctor about what the new guidelines mean for you.  Maybe your doctor will recommend going off statins for a bit to see what your baseline cholesterol level is now. Or maybe your doc will want you to stay on statins, but will switch you to a different one.

Either way, the times have changed. Read up on the new guidelines and talk to your doctor about how they apply to your situation.

I know I will.

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FDA: Trans Fats Are Not GRAS

On Thursday, November 7, the FDA proposed a new law which would effectively eliminate partially hydrogenated oils (PHOs) or artificial trans fats.

Why does this matter?

Because PHOs are in a LOT of the processed food we Americans eat. According to the FDA, PHOs are “the major dietary source of trans fat in processed food.” In fact, PHOs are a key ingredient in many popular snack foods. The NYT article, FDA Ruling Would All But Eliminate Trans Fats, explains that artificial trans fats “still lurk in many popular products, like frostings, microwave popcorn, packaged pies, frozen pizzas, margarines and coffee creamers.”

And I’m betting you (and I) eat plenty of these items — even as we try to watch our cholesterol.

I mean, all of us trying to lower heart disease risk by keeping our cholesterol in check know to avoid red meat and processed food in general. But frozen pizzas? And the occasional bag of microwave popcorn? These seemed to me (until I read about PHOs this week) fairly innocuous.

Apparently not so much.

Which is why the FDA acted. And it was a BIG play they made — the FDA has declared PHOs as “Not GRAS.”  Or, in regular-person-speak, if the FDA proposal passes, partially hydrogentated oils would now be known to be NOT ‘Generally Recognized As Safe.’

This is a radical shift.  HUGE.  The FDA is now saying that this common food additive IS NOT SAFE.

If, after the 60 day comment period, this proposal passes, food companies will not be able to use trans fats – AT ALL.

Which, frankly, is amazing.

It’s been a long time coming.  According to the FDA Targets Trans Fat in Processed Foods article on the FDA website, the FDA proposed all the way back in 1999 that food manufacturers had to specify the amount of trans fat per serving on Nutrition Labels. And it took until 2006 for trans fats to appear by law on nutrition labels.

So it took 7 years to require food labels show trans fats. And 7 years later the FDA wants to ban the use of trans fats.

Why?

According to the FDA site, it will save thousands of lives:

“… there are still many processed foods made with partially hydrogenated oils (PHOs), the major dietary source of trans fat in processed food. Trans fat has been linked to an increased risk of coronary heart disease, in which plaque builds up inside the arteries and may cause a heart attack.

The Centers for Disease Control and Prevention estimates that a further reduction of trans fat in the food supply can prevent an additional 7,000 deaths from heart disease each year and up to 20,000 heart attacks each year.”

Let’s hope it doesn’t take 7 more years for the FDA proposal to take hold and for PHOs to be declared unsafe.

We’ll see what happens after the 60 day period for public comments.

 

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How To Bake Boneless, Skinless Chicken Breasts

It was a two-chicken week this week.

First, there was the baked chicken with great flavor, that was sadly ruined because the chicken was dry and overdone.  That sent me to the internet where I did a lot of research. That led to chicken number 2: a different recipe (but still baked) and the result was delicious chicken: not overdone or dry at all.

Woot.

This chicken foray all started began because my mom was planning to make pot roast for out-of-town guests.

Yes, pot roast.

She was throwing a casual dinner party for out of town guests, and pot roast is just perfect casual dinner party fare.  Just set it up, let it rip and it’s always delicious (though not so lo-co, but that was not the point.) She had purchased a lovely pot roast and was all set to go when she had to punt because other friends had the same out-of-town couple over for dinner the night before.  And guess what was on the menu?

Yup, pot roast.

So my poor Mom had to race to the store. And ended up with 3 pounds of boneless, skinless chicken breast.

Which frankly, might not have been my choice because chicken breasts are hard to cook – meaning, usually they get over-cooked and dried out.

But she had the chicken in hand, so we had to find a solution. I suggested The Silver Palate’s Chicken Marbella recipe. It’s fabulous: though filled with ingredients I don’t like, somehow it works. And it’s a great choice for a dinner party: it’s always delicious and almost as easy as a pot roast – as long as you get it marinading the night before.

The only trouble is, the Chicken Marbella recipe is for whole chicken or bone-in chicken pieces; if you cooked boneless, skinless for the same amount of time, they’d definitely dry out. And I’d never done it.

So I suggested my mom cook the chicken for no more than 40 minutes (rather than the 50-60 minutes in the original recipe.)  And yet – I steered her wrong.  Her chicken had great flavor but was very dry. (And yes, I know, never try out a new recipe for company – totally insane of me to suggest this. But that’s another story.)

My guess, as Mom and I were discussing it, was the dry chicken was caused by two issues: a) the 40 minutes I suggested was just much too long, and b) I didn’t realize that my mom cut the breasts in half – probably necessitating an even shorter cook time.

I felt so badly I’d led my mom astray for a dinner party (sorry again, Mom!)

With that on my mind, I was determined to figure out what should have been the right cook time for baked chicken breasts. What was interesting is that my research pointed to 2 issues: both cook time AND temperature. Several sources recommended that the proper way to get moist baked chicken is to cook the boneless, skinless chicken breasts at a slightly higher temperature — 400 degrees — for 20-30 minutes depending on the thickness of the breasts.

I was all set to try it out, when I opened the New York Times Dining section and found Chicken Offered To The Green Goddess, by Melissa Clark, one of my favorite NYT chef authors. I had to try this recipe – both because it looked delicious AND because I needed to test out baking chicken to see if I could do it without them drying out.

But I chickened out (sorry for terrible pun).  I bought split chicken breasts rather than skinless, boneless because I really wanted to try this Green Goddess sauce – and worried I’d ruin it my first time out.

So I followed Melissa Clark’s Green Goddess Roasted Chicken recipe (500 degrees for about 40 minutes) and the skin was gorgeously browned and the chicken was moist moist moist!

And no, I did NOT eat the skin.  But it looked pretty!

This is a great recipe to try – either as Melissa Clark wrote it, or with boneless, skinless breasts.  If you go boneless, skinless, go with 400 degrees for 20-30 minutes (test the chicken at 20 minutes to see if it’s done: no red or pink and it should be 160-165 degrees). And do watch Ms. Clark’s video, I found it very helpful.

And because it drives me insane that the NYT recipes never include nutritional info, I took the time to enter it into My Fitness Pal.

Then I wrote an article about this revised recipe and published it on Answers.com: A Low Cholesterol Take On Melissa Clark’s Green Goddess Chicken Recipe. Follow my version of the recipe if you want to go with boneless, skinless breasts rather than whole chicken or split breasts.  And bonus, my article includes the nutritional value of the recipe.

Give it a whirl.  Either the original (which is far more impressive than chicken breasts – so choose Ms. Clark’s original if you are cooking for company) or my revised boneless, skinless version. And if there are ingredients you don’t care for in the Green Goddess dressing, the recipe’s very flexible – Ms. Clark even tells you what you can substitute.

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