Jalapeño Popper Chicken Salad

In my last post (from over a month ago, yes), I mentioned that I planned to make Paleomg’s jalapeño popper chicken salad. It was so good, and SUPER spicy (I’m too lazy to take out seeds, and usually I like a lot of spice)! Definitely very different from the other chicken salad I re-made (non-Whole30 version)that week.

It seems to me like that last post was pretty recent, but it was over four weeks ago! Four weeks from now I will be a) 37 weeks pregnant, and b) moving into my new house! It feels like both of those things are really far in the future, but it will come before I know it! Hopefully kiddo keeps cooking until well after that to allow us time to get a bit settled before his arrival, but we’ll figure it out if that’s not the case. Other than that, the timing will work out pretty well. We’re awaiting the delivery of two furniture items (a couch from Crate & Barrel and a custom-made sideboard from Sandtown Millworks), both of which should be ready and delivered between our settlement date (a Tuesday) and the day we’ve hired movers (a Saturday). We’re also getting a chance to get blinds quotes (which means getting to go into our house a few extra times!) and should be able to get those installed in that same time period before we move in, also.

I packed my first three boxes today, of books. I plan to get rid of several broken items (an old, paint-peeling, wood-rotting adirondack chair; a Target bookshelf that is no longer all in one piece; a side table that is broken) in the next few weeks. Dan is ambitiously trying to sell our current couch and a few other items on Craigs list. The couch might end up being a dump item. It’s so old and gross. Blah, I can’t wait to be rid of it. And I’ll keep packing here and there, but the big push will probably be the last week of April and first week of May.

I haven’t been cooking a ton as it is, but it’ll definitely dwindle further over the next few weeks til we move. I AM hoping to cook up a ton of meals to freeze and make snack balls/bars ahead of kiddo’s arrival, but won’t start til we’re in the new house. Then I think the freezer will be the limiting factor. Or time. Eek!

Anyway – back to the jalapeño popper chicken salad. It was pretty easy, though there were a lot of steps and component parts. Unlike Juli Bauer in her nice and professional-looking cooking video, my jalapeños did not stay on the burner very well, so I kept having to fish them out of the flame with tongs. I also didn’t leave any bacon or jalapeño aside to sprinkle on at the end, as Juli suggests. I just threw it all in. As I said, it was quite spicy, but really tasty. And rich – a little goes a long way.

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This Week’s Meal Plan

A quickie to report on what I plan to make and eat this week. Hopefully I’ll get a few other posts up this week, but we’ll see!

This week’s plan features a lot of chicken. I’m not sure I have this much chicken in the house, so I might have to buy some. I’d generally prefer to vary it some more, but these are what I want to make, so… here’s what I’m making! Other things I will eat because I have them: broccoli, Brussels sprouts, portobello mushrooms, arugula, sweet potatoes, red new potatoes, and avocados.

Sunday

Make:

  • Chicken salad salads (non-Whole30 version, so using dried cranberries and Greek yogurt from the original recipe)

Eat:

  • Whatever’s around! Plus, dinner at Woodberry Kitchen with Dan to celebrate my birthday. Can’t wait!

Monday (go to work day)

Eat:

  • Breakfast: Yogurt (maybe with almond butter and/or fruit), chicken sausage
  • Lunch: Chicken salad salad
  • Dinner: TBD
  • Snacks: Probably yogurt, maybe fruit, maybe some bars (Lara, RxBar, Epic)

Tuesday (telework day)

Make:

Eat:

  • Breakfast: Chicken sausage and maybe eggs (I’ll be taking my glucose challenge screening test, so I was advised to have a protein-heavy breakfast if I ate)
  • Lunch: TBD. Probably chicken salad salad
  • Dinner: Slow cooker buffalo chicken chili
  • Snacks: TBD

Wednesday (go to work day)

Eat:

  • Breakfast: Yogurt (maybe with almond butter and/or fruit), chicken sausage
  • Lunch: Chicken salad salad
  • Dinner: Pizza (I believe homemade by my book club hostess). Also some sort of dessert because it’s my birthday!
  • Snacks: Probably yogurt, maybe fruit, maybe some bars (Lara, RxBar, Epic)

Thursday (telework day)

Eat:

  • Breakfast: Egg sandwich: 1-2 fried eggs in butter with spinach between two pieces of toast, probably with cheese, hot sauce, and avocado
  • Lunch: Maybe leftover chili?
  • Dinner: TBD. Maybe salmon?
  • Snacks: TBD

Friday (go to work day)

Eat:

  • Breakfast: Yogurt (maybe with almond butter and/or fruit), chicken sausage
  • Lunch: Probably sweetgreen or Taylor Gourmet salad
  • Dinner: TBD
  • Snacks: Probably yogurt, maybe fruit, maybe some bars (Lara, RxBar, Epic)

Saturday

Make:

  • Jalapeno popper chicken salad from paleomg (yes, chicken salad twice in one week, but I’ve been wanting to re-make the one above for a while, and make this one. So that’s what I’ll do!)

Eat:

  • Oh who knows. But surely some of that jalapeño chicken salad.

Workouts

I’m only doing CrossFit anymore. And Barre3 classes. My prenatal yoga class ended and my birth class will now take the time of the prenatal yoga class, so I can’t sign up for the next session. Running is too uncomfortable. Other yoga is too lay-on-your-back or core or twist-intensive for my comfort. So, I’ll go to CrossFit at least 3x before work during the week, probably 4x, and will probably do at least one Barre3 workout.

Paleo Quiche

I’m kind of sort of back in the groove of weekly meal planning and prepping. I really lost it during my first trimester, and it just wasn’t happening with holidays, travel, etc. I’ve been mostly feeling a lot better since entering the second trimester, although I have felt a little more tired these past few weeks. And I’ve had a head cold for a WEEK at this point. I’ve never had a cold this long. I’m starting to feel like I’m never going to get better.

Anyway, I saw this recipe for paleo quiche from Paleo Running Momma recently, and I was excited to have every single ingredient on hand except for the breakfast sausage. So I bought some the next time I went to the store, as well as an extra butternut squash just so I’d still have one on hand. Which was a good call because it turned out that the one I already had had gone bad and squishy :-(. I hate wasting food.

I wouldn’t say this was a quick dish to throw together, but it wasn’t terrible. Like any real food meal, it had a fair amount of chopping and steps. But the end result is super tasty, and the butternut squash crust seemed to work out pretty well.

I only needed about 1/2 to 2/3 of my butternut squash to make the crust, so I chopped up the rest into chunks and roasted it with some beets and leftover red onion I had lying around, so I have that in the fridge. Also, the recipe called for 3/4 lb. of sausage, but I used the whole 1 lb. package. I had about 1-2 cups more filling leftover than would fit in the dish, so I saved that and ate it separately the next day (yum!). Also, as you can see from the photo, I used frozen Trader Joe’s brussels sprouts instead of fresh. I first microwaved them for several minutes (5?), then cut them in half, then roasted them per the recipe. They were still a little soggier than fresh ones would have been after roasting, but in the end, I don’t think you can tell the texture in the final dish.

I cut it into 6 slices instead of 8 (the recipe said it’s 8 servings), and I’ll eat this as a pre-made breakfast on days I don’t telework for the next couple weeks. (I didn’t go into work yesterday because GOVERNMENT SHUTDOWN… so one more day of pre-made breakfast still in the freezer!)

For this week, I also have made (or planned to make):

  • Sizzing pork Greek salad from Melissa Hartwig’s new Fast and Easy Whole30 cookbook. I subbed ground beef instead of pork because I didn’t have any ground pork, and I added artichokes and tomatoes. This made more meat than necessary, so I have that leftover in the fridge for this week.
  • Mustard- and almond-flour- glazed flounder (the recipe called for salmon, which I though I had frozen, but it turned out I only had two tiny flounder filets in the freezer instead) and roasted potatoes and broccoli. The fish and roasted potatoes recipes were from RealPlans (which I signed up for again for three months).
  • Spinach Artichoke Chicken Bake, also from RealPlans (plan to make Thursday)
  • Deviled eggs and breakfast sausage (plan to make Saturday)

I continued to work out last week despite being sick, but this really has just dragged on and gotten worse. I didn’t work out yesterday, and today I won’t go to CrossFit, though I will go to my super relaxing prenatal yoga class that I started a few weeks ago. Hopefully I can get back to it tomorrow. I’m not feeling any better today, but I’m feeling… different. Less constantly runny nose, more coughing and pressure in my head and ears. So maybe that means things are progressing? We’ll see how I feel in the morning! In the meantime, I’ll keep drinking lots of fluids (including orange juice mixed with seltzer that has been a new craving of mine that I’m indulging… a lot).

Baby Food

This is not what you might think, from the title.

First, let me just acknowledge and move on from the fact that I haven’t posted since August. Clearly, other things have been my priority. That’s okay.

Moving on. In October, a colleague of my husband’s and close friend gave birth to a beautiful baby girl. This friend and her husband also have a dog that we often temporarily adopt when they are out of town, and they do the same for us and our dog. Their dog, Stark, has made an appearance in at least one previous post. I’ve never done this for friends before, but I decided to make several freezable meals for them so they would have easy food after the birth of their child. (So, not baby food – but food-for-parents-that-just-had-a-baby doesn’t roll off the tongue as well.)

I selected four recipes that I thought would freeze well and that would provide some variety. For them, I made four servings each, so 16 individually packaged meals in total. The recipes usually made more, so this was also my meal prep for the week! They were all recipes I’d made before, except one. I chose most from the Fed&Fit cookbook, because most of those package and freeze well, and I like them!

  • Lemony Kale and Sausage soup from Fed&Fit. I believe I added some potatoes and used both sausage and ground turkey (because I had it on hand).
  • Lagered Turkey Chili from Ali Larter’s Kitchen Revelry. I’d made this recently for myself (see photos below), and it was delicious.
  • BBQ Chicken Casserole from Fed&Fit. This was the one I’d never made before, but I thought it turned out great! Dan and I had 4 servings of our own from the recipe to enjoy, so it was great.
  • Tomato and Sausage Frittata from Fed&Fit. Easy and good. I made with chorizo.

Now, I don’t eat frequently with these friends. My husband spends more time with them (as I mentioned, the wife is a colleague of my husband’s). I’ve been to their house for a meal of grilled fish and another for a barbecue with hot dogs and hamburgers. I wasn’t aware of any major food preferences. However, after I was most of the way through making the meals, my husband informed me that he wasn’t “sure they ate much meat.” Hm. Well.

So, I wrote a note that I sent along with the meals when I gave them to them explaining what the meals were and that I mostly eat paleo-ish (lots of vegetables and meat) so that’s the way I cook, and that all of the meat was as high quality as we’re able to get. They did indeed eat them, but the wife told me later that she’d become vegetarian several months before. I’m not sure if she ate any or just let her husband, even though I think he’s eating mostly vegetarian also. Alas. I respect their decisions but also don’t feel bad about providing them super nutrient-dense meals (made more-so by the presence of high quality animal products). Lesson learned for next time though.

I didn’t take photos while cooking, but have some images of other times I’ve made a few of these meals.

Lagered Turkey Chili

 

Tomato & Sausage Frittata

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Eating In Japan (Japan: Part 3 of 3)

I’ve been thinking about how to structure this post. A day by day accounting of each meal? I sort of already did that in my Japan itinerary post, though without pictures of the food. Just highlighting my favorite meals? But even the not-so-favorite meals are still interesting and memorable. So you’ll get a mix.

First, a few thoughts on my personal approach to eating in Japan.

  1. Eat whatever is put in front of me. Why not? I’m probably not going to be able to ask what it is or ask for something different, so just go for it. This led me to eat a few things that I had never eaten before (raw horse meat, sea urchin), things I typically detest (shrimp), and things I don’t necessarily detest but just don’t… choose to eat because I like almost everything else better (squid, octopus).

2. Don’t be too precious or indecisive. By this I mean, I wasn’t concerned about finding the most authentic Japanese meal/experience or the best sushi or ramen. From everything I’d heard about Japan, it was all going to be good. Quality and service are very important and food is respected. I didn’t want to spend time perseverating over this option or that option. Plus, I don’t speak Japanese, and I wasn’t prepared to get uncomfortable enough to put myself in situations that might have been required in order to find the most authentic experience. So did we end up at a lot of safe, guidebook-recommended, English- and tourist-friendly places? Yes. Was it delicious? Yes. Was it the most authentic experience and the best food I could have had there? Probably not, but I was 100% okay with that.

3. Must haves. These included very fresh sushi (Daiwa sushi, check); conveyor belt sushi (place in Ueno, Tokyo, check); wagyu beef (Otsuko Steak in Kyoto, check); and ramen (multiple checks).

4. Try new things. I ate a lot of things I’d never had before, including the items listed above and most of the street food in Osaka. It also included:

  • Takoyaki: fried dough balls with octopus in them
  • Okonomayaki: savory pancakes containing almost anything – noodles, eggs, meat, sauce, green onion, cabbage, etc.
  • Japanese yam… paste? I don’t know what this stuff is called. We had it the first night in Tokyo at the Shinsuke izakaya with raw tuna. It was at the breakfast buffets in the Matsumoto and Yakushima hotels. And it was in this cold soba noodle dish at the cold soba and tempura restaurant in Matsumoto. It’s white (under the egg here) and had a sticky, pasty consistency and not a ton of flavor. I enjoyed it.fullsizeoutput_ae2d

So, we ate well. We didn’t fuss about it too much. My most memorable food experiences include (in chronological order):

  • Our first meal in Japan at Shinsuke Izakaya, obviously. It was our first meal! We each got a beer and we shared a sake. I don’t remember everything we got, but it included sashimi, the Japanese yam stuff I mentioned above, some pickled things. All in small dishes.
  • Daiwa Sushi. We didn’t have a super fancy sushi dinner in Tokyo, which we debated. But this was damn good sushi, worth the wait.
  • The izakaya, Soan Zama, in Matsumoto. As I mentioned in my first Japan post, we were the only customers, and the woman working did not know any English. There must have been at least one other employee cooking, but we never saw that person. We again each had a beer and shared a sake. We asked for something local. Dan ordered cold soba noodles and something else (I don’t remember). I ordered a set chicken dish, which I believe also came with rice, miso soup, and pickled vegetables. The woman watched us eat the whole time, essentially. Occasionally she would busy herself with something else, but mostly just watched us. We tried to just talk to each other normally, but it was tough. Still, the woman was adorable and the service and food so wonderful.
  • Dinner and breakfast at our ryokan, Shirouma-so, in Hakuba. Both were set course meals like I’ll show below for kawa doko. Both included whole fried fish, only one of which I ate the whole thing (head and all). Dinner also included a pot thing for cooking meat. It was clay maybe, and the meat cooked in liquid in a tray over a candle. When the candle was done burning, the meat was ready. We were told, if we wanted, to crack an egg into a bowl we had and dunk the meat in the raw egg before eating it. It was delicious. The meals also had miso soup, rice, and various pickled vegetables. Dinner had tempura vegetables and shrimp also. Breakfast had yogurt and melon and a crepe with a cooked but egg in it.
  • Eating in Osaka. I’ve already talked about takoyaki and okonomayaki, both of which we ate in restaurants in between strolling along the Dotombori canal and Dotombori street at night. The next morning, we went to Kuromon market and saw and ate a ton. There was so much food. The first thing I ate was a sort of meat and egg on a stick (pictured below). Then we got this cucumber salad with octopus in it (I mostly at the cucumber, Dan ate the octopus, but I did have a bite). Dan got this enormous scallop, which was cooked for him in butter over charcoal in its own shell. We ate eel, we ate eel over egg, we ate takoyaki, we ate a peach smoothie. And I’m pretty sure there were a few more things on sticks in there.
  • Kawa doko, eating on platforms above the flowing river, in Kibune. This was a set course meal. Dan and I were starving and both ordered the option with the most things. And beer. The meal included fish, sashimi, pickled vegetables, rice, miso soup, tempura, noodles, and probably other things I am forgetting. So many of our meals were like this in that they involve so many little, beautiful dishes – for the soup, for the rice, for the pickled vegetables, etc. It’s a lovely way to eat.
  • Lunch at the Kagoshima Toppy Hydrofoil port restaurant. Like a few other places we’d eaten (breakfast in the Shinjuku train station in Kyoto, lunch at Subaru Fifth Station on Mt. Fuji before hiking), we ordered via a machine that spits out a ticket, which you then hand to the hostess. In this case, the machine had no English nor pictures. But a poster next to it had pictures and prices, so we were able to figure out which button to push by finding the only one with the specific price of what we wanted. This place is memorable to me because it felt truly diner-like. Not run down, but sort of divey feeling. I loved it. Our ramen was sort of greasy and wonderful. Some of the other patrons were clearly also on their way to Yakushima (where we were departing on the hydrofoil from Kagoshima to) and were sort of hippy hiker-seeming. It just sticks out.

Finally, just a few other food/drink experiences worth mentioning, because I have the pictures:

  • Drink vending machines are everywhere. They have a lot of sugary sodas and coffee. And pocari sweat, a Gatorade-type drink that was really refreshing when we were walking around Kyoto!
  • Our first breakfast in Japan was at a fast food French cafe breakfast place. We got pastries with ham and cheese maybe, in rice flour dough. They were actually kind of delicious. (See above where I talk about not insisting on the most authentic experience.)
  • I did a tiny bit of research to find good coffee in Tokyo and found Nozy Coffee Roastery. I think these lattes were like $7 or $8 each. They were good, though, and much needed after walking a ton (this was the day of 33,000+ steps).
  • We shopped at 7-Eleven a few times (including for fruit and salad when I was really struggling! which they had! they have everything in Japan!), and they must have been running some sort of promotion. Twice, they motioned for Dan to stick his hand in this box and pull out a piece of paper. I forget what he ‘won’ the second time, but the first time was a bag of shrimp-flavored puffed starchy things. Dan ate the bag for breakfast the morning we left Tokyo.
  • Dan got green tea ice cream before we started on the Path of Philosophy in Kyoto when his blood sugar was dipping dangerously low and he was feeling hungry.
  • The food sold by vendors at the Gion festival celebrations in Kyoto was similar to the street food in Osaka. Lots of fried things on sticks. The lines were crazy.
  • Our lunch in Hiroshima. I need to go look up that name and I’ll update this. I had a nice meal of pork, rice, miso soup. The place was really cute and cozy.
  • For breakfast or lunch (timing was weird) in the Kagoshima airport on our way from Yakushima back to Tokyo back to Baltimore, I ordered something without having really ANY IDEA what I was getting. Turns out, it was this ground beef with egg ribbons. That looks like cheddar cheese, but it’s egg. And miso and rice and pickled vegetables of course. And, of course, our on-mountain ‘dinner’ at the Mt. Fuji hut at 3,400 meters. Not the tastiest meal ever, but it was food. Japanese curry (which was a thing), a sausage? patty, sausage links, rice, and pickled vegetables.

Hooray!

Chicken Salad Salad

Guys. I am so excited about the jar salads I made this week. They were so good.

We got home from Japan late Friday, so I had all weekend to meal plan and prepare food for the week. (Side fact: I’m doing another Whole30! My third. I started Monday, so this is only day 3. The last I did was a year ago. I’d pretty much decided to do it post-Japan even before I left for the trip. I’d been eating crap just because it’s there and not feeling great and not being mindful and just wanted to take time to be more intentional about my food choices. Actually, it’s about habits. I like to reset and reform good habits. Then eventually they wear away, and I come back to reset them. Anyway, and then, when I was in Japan, I was craving vegetables. I usually eat so many vegetables and could not find enough vegetables. I loved the food there, but I was very excited to come home and do a Whole30. We’ll see how long that enthusiasm lasts. :-). Anyway.) Instead of falling back on my default salads, I googled for some inspiration. I found this Chicken, Apple, and Pecan Salad from Damn Delicious, and it is damn delicious.

Chicken salad is still sort of a new thing for me. I had never liked mayo until I started eating frites several years ago (they were sort of a thing for a while, right?) and realized that aioli is mayo. So I started making my own. Store-bought mayo still just seemed unappetizing, but homemade was yummy. I used to make it with canola or vegetable oil, you know, before I knew better. Now that I limit those oils, I haven’t found a good way to make it anymore. I tried avocado oil once and really didn’t like it. However, I do like the Primal Kitchen mayo from Thrive Market made with avocado oil. I still don’t use it a lot, so it’s been sitting in my fridge for a while, and it was nice to find an excuse to use it.

To Whole30-ify the recipe, I did not use dried cranberries nor Greek yogurt. Instead, I used a little bit more mayonnaise and a lot more freshly squeezed lemon. Also, my experience with kale in jar salads is that it smells terrible after even a day in a jar (tastes okay, but coworkers give you funny faces), so I used spinach instead.

Ohmygod, so good. I took the picture below after my first bite while sitting at my desk at work because I was so excited.

For better or worse, it takes a while to eat. Not sure why – so many chopped up parts maybe. I was trying to eat really quickly at my desk in between two meetings yesterday. My coworkers were waiting for me to walk with them to the second meeting in another building. I finally had to give up and put some of it back in the jar to eat later. Probably better to not force eating so quickly anyway.

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Fat

The paleo/real-food sphere had a mini freakout a few weeks ago when headlines started popping up that coconut oil is bad for you (for example: here). These headlines were precipitated by (trying not to use words like ‘the result of’ or ’caused by’ given what’s coming below) an American Heart Association (AHA) presidential advisory that was published in Circulation (an AHA publication). The article reviewed the literature on effects of reducing saturated fat and replacing it with unsaturated fat on cardiovascular disease. It had one short section on coconut oil, but coconut oil specifically was not a main point of consideration in the literature reviewed. The article ultimately concluded that reducing saturated fat and replacing it with polyunsaturated and monounsaturated fats reduces cardiovascular disease (heart attacks, strokes). Since coconut oil is high in saturated fat (and the specific studies related to coconut oil the article cited indicated that coconut oil increases LDL cholesterol, which the article cites as being a cause of cardiovascular disease), the AHA advises against using coconut oil.

Polyunsaturated and monounsaturated fats, which the AHA recommends, include canola oil, corn oil, soybean oil, peanut oil, safflower oil, olive oil, and walnut oil, among others.

Ok.

My initial reaction, like that of many others who eat the way I do (or the way I try to), was to sort of roll my eyes and wonder how they’re manipulating or selectively interpreting the evidence this time. But. Right there with my initial reaction was the thought, “But what does the article actually say? What evidence does it cite? Are there methodological flaws to that evidence, or is it pretty strong?” The truth is that I don’t really know. I assume there must be something wrong with it, because I feel pretty confident in these two things:

  1. Naturally occurring, real food is good for you. This includes naturally occurring, saturated fat, like that found in coconut oil, lard, and butter, which humans have had access to and subsisted on forever and ever, amen.
  2. Industrially-produced ‘vegetable’ and seed oils, like canola oil and soybean oil, are bad for you.

And part of me feels like I don’t care what the evidence says, for the following reasons:

  • The two points above make sense. It makes sense that what humans ate up until 50-100  years ago and what occurs naturally in nature is good for you. And it makes sense, especially considering the rise in chronic disease over the past 50 years, that the industrial production of food generally is not good for you.
  • I am becoming increasingly skeptical of the body of scientific literature that exists, at least around food and nutrition. Corporate interests and funding are so intermingled with so much research. In this case, big agriculture, like corn and soybean growers.

That said, I am a generally rationale person who wants evidence. I have a masters of public health – not a science degree, but I’m trained in epidemiology and evidence-based thinking. I insist on others having data and evidence to back up their claims.

And, I’m married to a very critical-thinking evidence-based medicine-supporting physician who cares about knowing the evidence.

I’ve never been good or comfortable at making strong arguments off the cuff, especially without really knowing what I’m talking about. So – new personal research question:

  • What does the evidence say regarding health outcomes of eating different types of fats, from different sources? What are the strengths and weaknesses of the evidence?

So, I’m going to embark on a little personal journey to really try to understand the AHA’s article, the evidence it cites, the other evidence that’s out there that it doesn’t cite, and really try to wrap my arms around this. Some people (like the authors of AHA’s paper, presumably) conduct literature reviews as part of their full time jobs, and I’m not sure how much time and energy I’ll really be able to put into this. Because I know I’m going to want to go deep. But we’ll see. I’m going to start by reading the article closely, summarizing what it says, and determining what additional questions it raises for me that I might want to look into. Starting now.

Summary of Article:

Okay, as it turns out, I’ll need to do this in chunks. Below is a summary of the first 6 pages, with the additional questions I have (in italics). I’m not answering them now – just taking note of where I want to look into things more.

Introduction:

  • Purpose: Review and discuss the scientific evidence on the effects on CVD of dietary saturated fat and its replacement by other types of fats and carbohydrates
  • Rationale for decreasing saturated fat:
    • Saturated fat raises LDL cholesterol.
      • How well-established is this?
    • LDL cholesterol causes atherosclerosis (plaque buildup in arteries).
      • How well-established is this?
    • Populations with low saturated fat have low rates of CVD.
      • I can believe that this is well-established, but it doesn’t necessarily mean that populations with high saturated fat have high rates of CVD.
  • Current AHA guidelines:
    • Keep saturated fat to 5-6% of daily calories if you have elevated LDL and under 10% for the general population.
    • Replace saturated fats with poly and monounsaturated fats (I’ll use PUFA and MUFA from here on).
  • Summary of evidence: Randomized controlled trials and observational studies both have come to different conclusions regarding the effects of reducing saturated fat on CVD. However, RCTs and prospective observational studies in which saturated fats were replaced by PUFAs rather than carbohydrates (usually refined carbs) show reductions in the incidence of CVD whereas studies that replace saturated fat with carbohydrates do not.

Then the article discusses RCTs that looked at replacing saturated fat with PUFAs.

  • First, AHA looked at 3 meta-analyses looking at this question. It seems that within those 3 meta-analyses, 10 studies were identified. AHA chose four of those ten that it deemed to be the highest quality, having met the following criteria:
    • Compared high saturated fat with high PUFA intake
    • Did not include transf fat as a major component
    • At least 2 years of sustained intake of diets
    • Controlled dietary intake of the intervention and control groups
      • How did they do this? Is this reliable?
    • Proved adherence by objective biomarkers such as serum cholesterol or blood or tissue levels of PUFAs.
      • I’ll say right here that I am super confused about using serum cholesterol as a biomarker demonstrating adherence to a low saturated fat diet. It must be pretty well-established that replacing saturated fat with PUFA reduced serum cholesterol. Is it? Above, they said that high saturated fats increase LDL cholesterol. Is this the same thing? If saturated fats increase it then PUFAs decrease it? They use this biomarker a lot… sometimes seeming to use it as a result, sometimes as evidence that the control group actually adhered to a high PUFA diet. I’m just confused.
    • Collected and validated info on cardiovascular or coronary disease events
      •  So, a general question I have is how important are these qualities? If a study didn’t have them, is it right to not consider as high-quality evidence?
  • Study 1: Wadsworth Hospital and Veterans Administration Center in LA.
    • Date of published study: 1969
    • Double-blind.
      • Need to look up how this was done double-blind. They don’t explain.
    • N=846 men. 30% had CVD.
    • Diet:
      • The two groups were served meals in separate dining rooms at the center.
      • Control – usual diet (I assume, it doesn’t specify).
      • Experimental – Replaced saturated fat with PUFAs: corn, soybean, safflower, and cottonseed oils
      • Adherence measures\d by ‘enrichment with linoleic acid in blood, adipose tissue, and atherosclerosis specimens.’
        • I assume these are good biomarkers…. I don’t know.
    • Duration: 8 years
      • Were all the same people in it for 8 years? What was the average duration of individuals in the study?
    • Results:
      • Serum cholesterol reduced by 13%.
        • Is this a result or a biomarker that the experimental diet was adhered to?
      • Statistically significant 34% reduction in CVD, myocardial infarction (MI aka heart attack), sudden death, or stroke.
        • I believe this is measuring whether ANY of these outcomes happened. Looked at individually…:
      • 20% fewer MI or sudden death events, but not statistically significant
      • 41% fewer men with strokes (p=0.055)
        • This is on the edge of being ‘statistically significant’ if you’re going for a p-value of <5, but it’s close, so I think this is reasonable.
      • 31% reduction in CVD events, statistically significant.
        • So, this seems to be the main driver of the 34% reduction in any of these events above.
        • Also, how are ‘CVD events’ defined? What is a CVD event that is different from the other ones being measured?
  • Study 2: Oslo Diet Heart Study
    • Date of published study: 1970
    • N=412. Men that had had a myocardial infarction (heart attack)
    •  Diet
      • Control – their ‘usual high-saturated fat diet.’
        • Was this confirmed? Did they indeed have high saturated fat diets?
      • Experimental – participants and wives taught how to select and prepare foods low in saturated fat and high in PUFA vegetable oils.
        • Again, was this monitored? Was it confirmed that it was a) lower than the control group and/or b) lower than what they were eating before the study?
        • PUFA diet lowered serum cholesterol by 14%, confirming adherence
          • Here’s where I’m still confused. I think this is not a result. It’s meant to demonstrate that the low saturated fat diet was adhered to.
      • Duration: 5-year trial.
        • Again, were the same participants in it for all five years?
      • Results:
        • 29% reduction in recurrent MI and new cases of angina pectoris or sudden death (p=0.011)
          • MI reduced by 37% (statistically significant)
          • Angina pectoris reduced by 66% (statistically significant)
          • Sudden death the same in both groups
        • 25% reduction in MI or sudden death (p=0.05).
          • Are these just different ways of grouping all the potential outcomes?
        • 27% fewer cardiovascular deaths (p=0.09)
      • Study 3: British Medical Research Council
        • Date of published study: 1968
        • N=393, men that had had an MI.
        • Diet:
          • Control – ? Not specified in article.
            • Presumably their normal diet?
          • Experimental – participants told to drink soybean oil with fruit juice and also use it in cooking. Participants also counseled on reducing saturated fat.
            • Did they actually reduce saturated fat? Did they adhere to the protocol? Is a reduction of serum cholesterol evidence of this?? Clearly this is something I need to get figured out first.
          • Reduced serum cholesterol by 16%.
        • Results
          • 18% reduction in a recurrent coronary event (MI, angina, sudden death), but not statistically significant.
        • Study 4: Finnish Mental Health Study
          • Date of published study: 1972-1983 (three different publications)
          • N=1222 patients at 2 psychiatric hospitals
            • Also, two cohorts studied. One cohort had some participants that had evidence of coronary heart disease (arterial blockage starting) and some participants that did not. The other cohort only had participants that did not have evidence of coronary heart disease.
          • Diet:
            • In one hospital, high PUFA (mainly soybean oil) diet given first, followed by the sat fat diet. Each diet period lasted 6 years.
            • In other hospital, reverse.
              • But not all people were there the whole 6 or 12 years, right??
            • Serum cholesterol 14% lower in high PUFA diet groups.
            • Adherence also demonstrated by 3-fold enrichment of linoleic acid in adipose tissue.
          • Results
            • Coronary heart disease death reduced by 41%.
              • I’m confused. This is within the 95% confidence interval, but the accompanying chart has a p-value of 0.19. I’ll need to look up this result.
  • AHA Meta-Analysis of these four studies: AHA “performed a fixed-effects met-analysis of these 4 core trials.”
    • Result: Lowering saturated fat and replacing it with PUFA-rich vegetable oil lowed coronary heart disease by 29%.
      • I have to say, I do not understand their analysis at all. Especially from looking at the chart they provided. I’m not familiar with ‘inverse-variance fixed-effects meta-analysis,’ and I do not know how to interpret the chart. And do not see how the chart translates to their finding (29% reduction in CHD).

______

Initial thoughts

I have a lot of questions to answer, for which I’ll need to go look at the original studies. And do some additional background research probably.

Some of the criticisms I’ve seen to this include:

  • AHA ‘cherry-picked’ the studies. Well. AHA (presumably) identified criteria and then identified which studies met those criteria. To determine whether I think this is cherry-picking, I need to better understand the criteria and their value, and I also need to review the other studies and confirm that I agree they didn’t meet the criteria. For me to agree that AHA cherry-picked these studies, I would need some evidence or rationale that indicated that AHA chose the studies first and then chose criteria that matched those studies, rather than the reverse. We’ll see.
  • The studies are old. Well. So what? Good science is good science (and bad science is bad science). If something was done really well, why re-do it? This doesn’t necessarily mean the studies aren’t valuable – unless something else has changed since then that would invalidate these findings. I’m not sure if there is.

Generally, it seems like there are some meaningful, valid results. But I especially want to understand the implication of the durations more. These sound like long study durations… but if the same individuals weren’t in them for the full length, is that still as valid? And I’m also not convinced that the participants actually adhered to their assigned diets! Maybe I should be – maybe reduction in serum cholesterol is evidence of this. I just don’t know yet.

This might be the last you hear me talk about this, or it might not. Next steps are to continue summarizing the article and start to answer my own questions. Cheers.