What Healthy People Do

Happy New Year! 2009 is gone, and I've decided that this blog should come to an end as well. I hope you've found some useful wellness information and tips along the way.

Thank you. Stay well.

Dr. Bob

"Julie and Julia" is a wonderful film, filled with high praise for great food and strong women. Everyone should see it. And everyone should cook and eat like Julie and Julia. The food does not have to be French, but it does have to be cooked at home with fresh ingredients.

America would be a much healthier place if everyone cooked and ate as Julie and Julia do. Buying fresh and cooking at home gives you complete control of what you feed your family.

Cooking at home does not mean buying a frozen pizza and cooking does not mean heating the darn thing in the microwave. Buying fresh means buying from the “perimeter of the grocery store” ( from Michael Pollan’s book “In Defense of Food”), the areas where ingredients such as broccoli do not have a marketing department or a bar code.

Buying fresh means you know what you are eating. Buying fresh or fresh frozen (e.g., frozen green beans with no added sauces) means one ingredient that a farmer grew. Buying frozen prepared foods means that the ingredients were shipped to the factory in a truck. Buying a prepackaged frozen dinner almost certainly guarantees that you do not have a clue what you are really eating.

Cooking at home does not necessarily mean hours in the kitchen or butter in everything. From scratch cooking can be done simply and in a way that is good for your heart. I was trained to cook by a Cordon Bleu graduate, and for the past 34 years, have cooked virtually all of our dinners while working 50 hours a week. (I am proud to say that I bought my now taped-together, and tattered two-volume “Mastering the Art of French Cooking” in 1977.)

First, always start with fresh or unprocessed ingredients. As above, I agree, frozen green beans are still just green beans, and almost as good as fresh. Second, find recipes that do not stress you. Third, plan a meal that gives you some healthy protein, two or three veggies, a good carb like yams, and cook the food in good oils.

Just to get you started, here is a wonderful, Julia-like, from-scratch dinner that can be done in a legit 30 minutes.

Tonight we are doing a simple salad with scratch dressing, pork medallions (you can use chicken breasts but they take longer to cook), oven roasted veggie (almost any will do, tonight it is asparagus), and, for dessert, sautéed apricots with yogurt and mint.

First, the asparagus. Turn oven to 350. Chop off the bottom third of the asparagus and discard. Place asparagus on a baking sheet and lightly toss in a tablespoon plus of olive oil, salt and pepper. Pop this into the oven for a full 30 minutes. If your asparagus is thin enough, the asparagus will turn into a delightfully sweet, almost candy-like crunch.

Next, the pork medallions. Heat your skillet (medium high heat) and add a couple of tablespoons of olive oil. Cut a pork tenderloin into ½ to ¾ inch thick slices and toss in flour. Cook the medallions about 3 or 4 minutes per side and remove to a serving plate. You may need to cook the pork in two batches. Deglaze (pour liquid in and scrape up the bits and let thicken for a few minutes) the pan with dry white wine (vermouth works well) or water. Flavor the deglazed liquid still in the pan with lemon juice or tarragon or capers or nothing (your choice), and slide the medallions back in to absorb the flavors over low heat.

Now a salad. Either quickly chop a head of good lettuce (remembering that iceberg lettuce is a nutritional desert) or open a back of mixed baby greens. Make a salad dressing by mixing a third of a cup of olive or canola oil with ¼ cup of vinegar (yes, you can guess at the portions here), add a dollop of Dijon mustard and whisk with a fork.

Dessert. Halve the apricots and remove the pits. After dinner as the dishes are being cleared, warm another sauté pan, add a bit of oil, and quickly sauté the apricots (cook until they start to turn color on the bottom). Flip another minute or two to warm through and put on plate with a dollop of quality, non-flavored yogurt. You may top with mint or a drizzle of honey. Serve.

You cooked, your significant other cleans the kitchen and dishes.

And that is how you eat a healthy meal quickly. You know exactly what you ate. And you ate some good protein cooked in good oil, two or three veggies (depending on size of the salad), and a fruit. The American Heart Association and both Julie and Julia would approve.

Eat well to stay well.

Dr. Bob Gleeson

The “Mediterranean Diet” is widely, and scientifically, associated with excellent health. But dunking your bread in olive oil before eating a humongous plate of double-sausage, double-cheese lasagna is not a Mediterranean Diet.

The idea for the Mediterranean Diet started with the Seven Countries Study. In the 1950s, Dr. Ancel Keys traveled the world looking for populations that had varying risks of heart disease and then studied their diets, exercise habits, and cholesterol levels.

Crete was among the countries with the best health, greatest longevity, and best risk markers. So, when you think Mediterranean Diet, think of the diet eaten on the island of Crete some 60 years ago. Fish, olives, whole grains, fruits and vegetables from the garden. Not too much, eaten preferably with family and friends, and certainly without a television blaring in the background.

The best diet markers of excellent health in the 100,000 strong Nurses’ Health Study and the 100,000 strong Physicians Health Study help us identify a modern “Mediterranean Diet."

So when I say, “Eat a Mediterranean Diet,” I mean you should eat:

1. At least five colorful fruits and vegetables every day. OJ for breakfast and berries on your cereal, a salad at lunch is usually two, an apple for snack, veggie with dinner is six. Have a piece of blueberry pie for dessert and you are at seven—just eat the berries and leave the crust.
   
   
2. One or two whole grains every day. Oatmeal, wheaties, shredded wheat, Cherrios, whole wheat bread for your sandwich, quinoa for dinner.
   
   
3. Nuts. Yes nuts. A handful or two every day. Lowers heart disease by 30 percent.
   
   
4. Ocean fish a couple of times a week. Salmon, tuna, sardines. Tilapia and cat fish just don’t have much omega-3.
   
   
5. Use olive and canola oil and avoid saturated fats (e.g., the white fat on a steak). The healthiest diets get about a third of their calories from fat. (Stay tuned, I’ll blog about the evils of the low fat diets soon.)
   
   
6. And some, but not too much, alcohol. This means a glass of wine or two.

A Mediterranean Diet does not require perfection. In my opinion (not scientifically studied that I know of), the best diet includes the above foods because their provide a marvelous package of health-promoting nutrients. And once you eat all the good stuff, you can indulge moderately without much guilt.

Stay well.

Dr. Bob

Over the last week or so, I've given you links to some good health-assessment Web sites. Now I'm going to share with you where your numbers should be. It's important to know your numbers.

You know how much money is in your checking account, don’t you? Your savings account? Your 401K ? Your mortgage? Your net worth (total assets minus total liabilities)?

Knowing your health numbers is a lot like knowing your financial numbers. Both are important.

Great health is pretty simple. Don’t smoke; don’t be fat; eat a diet of lots of fruits and veggies with good proteins, good carbs, and good fats; and be active all day long.

Sometimes people who do all of these good and healthful things, yet still have funky blood pressure or lipids. Then it is time for medical therapy because maintaining good health numbers can keep you healthy for a long time.

I am not trying to give everyone a medical diagnosis to perpetuate the medical-industrial complex. I am trying to define optimal health. So here are your target health numbers for great health, even if you do everything else right.

1. Your body mass index should be between 20 and 27.9. If your BMI is above 35 or even near 40, your weight carries the same risk as smoking a pack of cigarettes a day.
   
   
2. Your blood pressure should be near 120/80. If it is 130/85, you should start to think about adopting a healthier diet and exercise plan (more exercise, less alcohol, less salt, less prepared, frozen or fast food), and if above 140/90, it is time to consider seeing your primary care provider for some medical treatment.
   
   
3. Your fasting blood sugar should be below 100. Diabetes starts at 125 and prediabetes is the area between 100 and 125. Trust me, you don’t want to be diabetic. Next week I’ll blog about what you should do if you are prediabetic.
   
   
4. Your total cholesterol should be below 200.
   
   
5. Your HDL cholesterol should be above 40 if you are a man and above 50 if you are a women. No exceptions here — low HDLs are a huge marker of increased cardiac risk.
   
   
6. Your LDL cholesterol should vary by your risk. Go to heartdecision.org to get your cardiac risk scores. If you are low risk, then your LDL goal is less than 160; if moderate risk, your goal is less than 130; if high risk, your goal is less than 100; and if very high risk, your goal is less than 70.
   
   
7. Your triglycerides should be less than 150 by national guidelines. I think this number is way too high and would like them to be below 100.

So by now, you probably want to know where I keep my own numbers; do I live up to my own standards? Well, I try (aside from eating ice cream out the carton). I have a BMI of 24.5, a BP around 120/80 on medication for the past 25 years; a fasting blood sugar of 88; and on low dose statin, a total cholesterol of 180, an HDL of 55, an LDL of 113, and triglycerides of 60.

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The following is feedback received for this blog: Dr. Bob -- Thanks for writing these articles -- very helpful to someone like me trying to keep healthy. I just got my blood numbers back and I'm very frustrated. I try to do what you say with eating and exercise, yet my total cholesterol is still high. I have a total of 211, but my LDL is 124 and my HDL is 69. Can HDL be too high? Is my high HDL, which I thought was a good thing, making my total too high? BTW, my BMI is about 25 and I'm otherwise healthy. - Don