Anyone have any experience using krill oil, and how does it compare to fish oil?

As for other forms of omega-3s, isn't flax considered dangerous for men, due to ALA content? There are conflicting studies, but I recall at least one that said ALA caused a rise in the rate or prostate cancer.

Is there any way for a vegetarian to replace fish oil and get the same benefits?

I am definitely down with the fact that Fish Oil is vastly superior to Flax Oil. I've seen quite a few people touting flax oil lately so I'm glad you put that to bed.

Question: You mention recommended doses of EPA and DHA for those with elevated triglycerides. Can you offer any guidance for supplement levels when triglycerides aren't an issue? IE a level for good preventative nutrition? I've looked around and recommendations are all over the shop.

Thanks.

I've read a few other articles about the differences between fish oil omega-3s and other sources, but this article spells it out very clearly about how those differences apply directly to heart disease. I'll be printing this one for my family. Thanks!

S

Vegetarian DHA is available. It is cultured from algae. That's where the fish get. EPA may be available now too.

zubin:

There are vegetarian DHA/EPA supplements made from algae.

Zubin, when I followed a vegetarian diet I was able to find DHA supplements derived from algae, but EPA is harder to come by.  V-Pure is the only one I found that contained both EPA and DHA.  The capsules are costly, but might be a good option for you if you aren't comfortable taking krill or fish oil.

Thanks all, I will look into the algae supplements!

As a newcomer to your blog please forgive me if this topic has been brought up before.
There is a scathing attack in an article by Ray Peat,a noted Biology professor, on the damaging effects of fish oil.
A few people have stopped taking fish oil after reading the article.
Can you please comment?
http://raypeat.com/articles/articles/fishoil.shtml

http://www.westonaprice.org/knowyourfats/essentialfattyaciddef.html
A Reply to Ray Peat
on Essential Fatty Acid Deficiency

By Mary G. Enig, PhD

Ray Peat, PhD, is an influential health writer who claims that there is no such thing as essential fatty acid (EFA) deficiency. According to Peat, the body can make its own EFAs; furthermore, he claims that EFAs in the body become rancid and therefore cause cancer.

Unfortunately, Peat does not understand the use of EFA by the human body. He is trained in hormone therapy and his training in fats and oils has been limited to misinformation as far as the polyunsaturated fats and oils are concerned.

Research on EFAs is voluminous and consistent: EFAs are types of fatty acids that the body cannot make, but must obtain from food. We do not make them because they exist in virtually all foods, and the body needs them only in small amounts. The body does make saturated and monounsaturated fatty acids because it needs these in large amounts and cannot count on getting all it needs from food.

There are two types of EFAs, those of the omega-6 family and those of the omega-3 family. The basic omega-6 fatty acid is called linoleic acid and it contains two double bonds. It is found in virtually all foods, but especially in nuts and seeds. The basic omega-3 fatty acid is called linolenic acid and it contains three double bonds. It is found in some grains (such as wheat) and nuts (such as walnuts) as well as in eggs, organ meats and fish if these animals are raised naturally, and in green vegetables if the plants are raised organically.

Essential fatty acids have two principal roles. The first is as a constituent of the cell membrane. Each cell in the body is surrounded by a membrane composed of billions of fatty acids. About half of these fatty acids are saturated or monounsaturated to provide stability to the membrane. The other half are polyunsaturated, mostly EFAs , which provide flexibility and participate in a number of biochemical processes. The other vital role for EFAs is as a precursor for prostaglandins or local tissue hormones, which control different physiological functions including inflammation and blood clotting.

Scientists have induced EFA deficiency in animals by feeding them fully hydrogenated coconut oil as their only fat. (Full hydrogenation gets rid of all the EFAs; coconut oil is used because it is the only fat that can be fully hydrogenated and still be soft enough to eat.) The animals developed dry coats and skin and slowly declined in health, dying prematurely. (Interestingly, representatives of the vegetable oil industry blame the health problems on coconut oil, not on fatty acid deficiency!)

In a situation of fatty acid deficiency, the body tries to compensate by producing a fatty acid called Mead acid out of the monounsaturated oleic acid. It is a 20-carbon fatty acid with three double bonds named after James Mead, a lipids researcher at the University of California at Los Angeles who first identified it. An elevated level of Mead acid in the body is a marker of EFA deficiency.

According to Peat, elevated levels of Mead acid constitute proof that your body can make EFAs. However, the Mead acid acts as a "filler" fatty acid that cannot serve the functions that the original EFA are needed for. Peat claims that Mead acid has a full spectrum of protective anti-inflammatory effects; however, the body cannot convert Mead acid into the elongated fatty acids that the body needs for making the various anti-inflammatory prostaglandins.

Peat also asserts that polyunsaturated fatty acids become rancid in our bodies. This is not true; the polyunsaturated fatty acids in our cell membranes go through different stages of controlled oxidation. To say that these fatty acids become "rancid" is misleading. Of course, EFAs can become rancid through high temperature processing and it is not healthy to consume these types of fats. But the EFAs that we take in through fresh, unprocessed food are not rancid and do not become rancid in the body. In small amounts, they are essential for good health. In large amounts, they can pose health problems which is why we need to avoid all the commercial vegetable oils containing high levels of polyunsaturates.

Peat’s reasoning has led him to claim that cod liver oil causes cancer because cod liver oil contains polyunsaturated fatty acids. Actually, the main fatty acid in cod liver oil is a monounsaturated fatty acid. The two main polyunsaturated fatty acids in cod liver oil are the elongated omega-3 fatty acids called EPA and DHA, which play many vital roles in the body and actually can help protect against cancer. Furthermore, cod liver oil is our best dietary source of vitamins A and D, which also protect us against cancer.

Actually, Peat’s argument that polyunsaturated fatty acids become harmful in the body and hence cause cancer simply does not make sense. It is impossible to avoid polyunsaturated fatty acids because they are in all foods.

EFAs are, however, harmful in large amounts and the many research papers cited by Peat showing immune problems, increased cancer and premature aging from feeding of polyunsaturates simply corroborate this fact. But Peat has taken studies indicating that large amounts of EFAs are bad for us (a now well-established fact) and used them to argue that we don’t need any at all.

Finally, it should be stressed that certain components of the diet actually reduce (but do not eliminate) our requirements for EFAs. The main one is saturated fatty acids which help us conserve EFAs and put them in the tissues where they belong. Some studies indicate that vitamin B6 can ameliorate the problems caused by EFA deficiency, possibly by helping us use them more efficiently.

About the Author
Mary G. Enig, PhDMary G. Enig, PhD is an expert of international renown in the field of lipid biochemistry. She has headed a number of studies on the content and effects of trans fatty acids in America and Israel, and has successfully challenged government assertions that dietary animal fat causes cancer and heart disease. Recent scientific and media attention on the possible adverse health effects of trans fatty acids has brought increased attention to her work. She is a licensed nutritionist, certified by the Certification Board for Nutrition Specialists, a qualified expert witness, nutrition consultant to individuals, industry and state and federal governments, contributing editor to a number of scientific publications, Fellow of the American College of Nutrition and President of the Maryland Nutritionists Association. She is the author of over 60 technical papers and presentations, as well as a popular lecturer. Dr. Enig is currently working on the exploratory development of an adjunct therapy for AIDS using complete medium chain saturated fatty acids from whole foods. She is Vice-President of the Weston A Price Foundation and Scientific Editor of Wise Traditions as well as the author of Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol, Bethesda Press, May 2000. She is the mother of three healthy children brought up on whole foods including butter, cream, eggs and meat.

IMPORTANT CORRECTION

In the Winter 2004 "Know Your Fats" column we stated that Siberian pinenut oil was a good source of gamma-linolenic acid (GLA). This was indicated from fatty acid analyses performed in Siberia. We have since performed further tests on the oil and found that it does not contain significant amounts of GLA but rather a fatty acid called pinoleic acid, an 18-carbon fatty acid with three double bonds but with the first double bond on the fifth carbon, not the sixth, as in GLA. We are sorry for any inconvenience this may have caused.

http://www.westonaprice.org/knowyourfats/essentialfattyaciddef.html

I'm a 57 year old grandma and have been vegan for over 6 years. I've run 3 marathons since turning 50, but took at 18 month hiatus to care for a grandson.  I was slowly trying to get back into running by starting out with 20 min. jogs and 3 minutes of jumping rope. Last October I developed painful tendinitis in my knee...my M.D. encouraged me to try O.T.C. painkillers (aspirin, acetaminophen, and ibuprofen) and take glucosamine all to no avail...he sent me to a physical therapist who gave me a few exercises said I shouldn't run at all, ever...that he quit running at age 30 and advises walking only. At that point my doctor wanted to prescribe some NSAID and give me a 2nd prescription for something that would allow my stomach to handle the prescription NSAID.   Without my M.D.'s recommendation I went to an acupuncturist for 3 months...no luck there.  Then a few months ago, again without my M.D.'s referral, I went to a chiropractor.  Since I was vegan, he prescribed flax oil, which seemed to help only a little, although the chiropractor said he really thought I would benefit the most from fish liver oil. Yesterday, in desperation, I took fish oil and felt much better.  I'm not pain free yet...but the improvement was quite dramatic.  I'll have to see how it goes.  I was vegan for personal, ethical reasons as opposed to health concerns...so even though this is a bit of a disappointment for me and my veganism...I think I will continue to use the fish oil and see if I benefit further.  By the way I had been taking vegan DHA for years from either "Omega Zen" or "Deva". Many, many years ago I heard that the playwright George Bernard Shaw had to take liver for a B-12 deficiency.  As the story goes someone said to him, "Is that liver you're eating...I thought you were a vegetarian."  Shaw replied "I am, this is my medicine."

Ah, This is exactly what I was looking for! Clears up
a few misnomers I've read

Dr. Goldstrich has proven especially adept at understanding how to incorporate new findings from clinical studies in our framework of coronary atherosclerotic plaque management strategies.

I have heard about acai berries and acai berry supplements containing sufficient Omega 3. I found out about this while I was looking for great alternatives for kids. Because for sure, they don't like fish oil supplements as they are huge and smelly, but I also believe they need the Omega 3 and all the good it brings. I found out about acai berry powder with Omega 3. I admit I am almost convinced.

I had a friend that recently went for a heart scan. He said his score was zero. Is that possible?

I hope the USA can see its way to some sort of national standards for State run medicare. As recent events show, if you have the will, the money will be found.

I live in Ontario, Canada and only had to ask my primary care physician in order to get a CT angiogram (did not know about the Calcium score at the time) It's cost is covered under our social medicine program OHIP.

A new study shows 30% drop in mortality from CD

http://www.theheart.org/article/980589.do

Sure it is.  My score was 0.  That's despite doing quite a bit in direct opposition to the AHA recommended dietary advice:

-no wheat/gluten at all (whole or refined)
-very few, if any grains (whole or refined)
-very low sugar and starch consumption (low carb)
-pastured red meat several times a week (bison, beef, or pork)  with normal ferritin level
-high saturated fat consumption (grassfed butter, coconut oil, home-render lard)
-whole fat dairy (incl raw whole milk and raw milk aged cheese)
-no attempt to artificially increase fiber, though there's probably a fair amount of fiber in the ample fresh non-starchy veggies I consume
-2 to 3 "backyard" eggs cooked in ample butter nearly daily for breakfast

i am 72 years old my calcium score is zero.2 yrs ago i was diagnosed with angina.i took the linus pauling protocol and cured my heart disease.on march 20th 2009 i had a calcium score scan and astounded my cardiologist as my arteries were completely cleared.vitamin c and amino acid is cheap and available. no money in it for doctors.discredited by medical profession.

"Why the "push" towards CT coronary angiograms and not "just" a CT heart scan? Well, I know it's shocking but it's . . . money!"

No, surely not.

Rogers experience brought back an unpleasant near miss CT Angiogram memory of an episode that I had while being in the hospital 5 years ago. I was  brought in with congestive heart failure-EF 20/25,  Now Don't think you are soon to lose a faithful reader, my EF is now 45/50, due to Aranesp injections, that I am doing exceptionally well on.  My anemia is now under fabulous control.
But, I digress, one day while in the hospital a beautiful young lady with long flowing hair wearing a white coat and stethoscope came in to see me and identified her self as the cardiologist assistant. She quickly started to promote me to have an angiogram.  I refused. The hospital cardiologist came to see me and I told him not to send me any more sales reps. (he must have learned this technique from big Pharma with all their beautiful drug sales reps). I never did have that apparently unnecessary needless invasive procedure done.  Guess what?, I lived to tell the story.

One morning last year, I drank way too much strong tea. A few hours later, I had chest pains and tachycardia. I had forgotten about the tea, which with hindsight  was the obvious cause, and I went to an emergency room.

By the time I got there, the pain had gone, and I should never have stepped into the ER waiting room.

As soon as they got their hands on me, they wouldn't let me go, claiming that insurance wouldn't pay if I left against doctors' orders. They quickly ran up any thousands of dollars of expensive tests, all of which came back fine.

They were very unhappy that I refused a coronary artery stent.

My ejection fraction was 65.

Anonymous in Canada,

"A new study shows 30% drop in mortality from CD"

Yes, modern medicine "saves" more people all the time.  

But is the *incidence" of CD dropping? or is medicine just getting better at treatment.  I want to avoid CD, not just be saved from it.

I used to be a strong believer that the US needed a universal medical care system similar to Canada and the UK.  Now that I have had a closer look at the UK's system over the last 14 years (in-laws are there) and have experienced the profound lack of primary prevention under a US HMO system (healthcare rationing), I'm not-so-sure.  

Sure, we are a rich nation and we should be able to afford decent healthcare for everyone.  The current system is for haves and have-nots with the in-betweens really getting pinched.  And furthermore, the haves don't get nearly the quality of care that they pay through the nose for anyway (though many don't realize it).  

But I can't see how turning over the decisions to government is going to be any better than it has been to turn over decisions to HMP insurance companies and accountants.  In fact, it could get worse.  Especially since government has turned into the handmaiden for special interests.  As much as I think it should happen, I have a hard time getting behind the proposals.  Be careful what you wish for, you might get it.

ok fred88, you almost got me excited....until I saw the oral EDTA chelation.... I'm calling BS by association

Fred,

I've heard a mixture of reports on the Pauling protocol with varied success. Can you give a little more detail as to how much vitaming C, L-Lysine, etc. you took per day at what intervals, and the time duration you believe it took for the protocol to do it's job?

Thanks,
Kent

Pauling Protocol in PDF format
take note of this section
The half-life of vitamin C in the bloodstream is 30 minutes.  
Linus Pauling advised taking vitamin C throughout the day in divided doses. The Hickey/Roberts Dynamic Flow theory predicts that taking vitamin C  every four hours will produce the highest sustained blood concentrations. Take more before bedtime.
I use a time release formulation

Heart Disease, Ascorbate, Lysine and Linus Pauling by Jeffrey Dach MD A useful summary here

CT coronary angiograms yield around $1800-$4000 per test. CT heart scans yield somewhere around $200. Though the scan center support staff might not care too much about the money themselves, their administrators likely make the cost distinctions clear to them.

The video link doesn't work. [You've got an "o" at the end instead of a "0".]
Here's the right one:
http://www.youtube.com/watch?feature=player_embedded&v=y1RXvBveht0

Dear Dr. Davis,
Thank you for providing such life-saving info.  
My husband's uncle is 69 and has already had one bypass and also suffers from advanced renal carcinoma.  In the past, his docs suggested the typical zero fat, very low protein diet.  His heart disease advanced.  Now he is able to eat more protein because he is on dialysis.  His cancer is under control and his doc have informed him that his greaterst health threat is heart disease.  He wants to reverse his placque but conventional medicine and wrong diet advice have failed him.  He is the type who is extremely motivated and will absolutely comply with a big diet overhaul plus exercise (he currently walks half a mile per day but was extremely athletic into his 50s until kidney cancer struck -- then heart disease) and I would like to suggest that he sign up for your Track Your Plaque program and refer him to your blog as well as that of Nephropal.  He lives in Boston and I am wondering if you have  any collegues there who could help him implement and oversee the Track Your Plaque strategies given his grave situation.  He understands that there are no guarantees but what he's done in the past has failed miserably so is ready to try a new approach and is able to eat decent amounts of protein now.  Any suggestions you may have would be most appreciated.

Thanks for catching that John.

Dr. Davis,

I don't have Type 1, but I have to use insulin to cover anything more than a trivial amount of carbs.

The problem with Mexican food is the beans, rice and tortillas.

In fact, most supposedly "low glycemic" foods like beans raise my blood sugar a lot, just a bit later than does white bread.  A person with an intact 2nd phase insulin release would not see a spike from these low glycemic foods, though they would need to secrete a LOT of insulin to cover them.

The people who create the GI lists only test at an hour or two after eating. So if a food spikes someone high at 3 or 4 hours, they miss it.

That's why if you are looking for a diet that really keeps native insulin secretion low you want to count absolute carbs, NOT look at the glycemic index.

I have heard other diabetics mention that chinese food is the worst when it comes to their blood sugar. Rice/noodles/sweet sauces/corn starch thickener = too many carbs. I wonder what else is used?

There are some big surprises when checking ingredients. An example would be the McDonald's hamburger and grilled chicken. The hamburger is beef, salt and pepper. If you think the grilled chicken is only chicken, you are wrong. Take a look. There are about 20 ingredients. Some are polysorbate 80, corn gluten, wheat gluten, sodium benzoate...and the list goes on and on. http://www.mcdonalds.com/app_controller.nutrition.categories.ingredients.index.html

Living gluten free and needing to check all labels and ingredients has been a real eye opener for me.
Anne

the key ingredient (my Shanghai cooking teacher taught me) in wok cooking cabbage was sugar and caramelise it with the cabbage.

Diabetes occurs because the body can't use glucose properly, either owing to a lack of the hormone insulin, or because the insulin available doesn't work effectively.
only way That control your diet.

I second Anne's comments about gluten. My spouse was recently Dx as gluten intolerant. We'd been eating low carb, and had successfully controlled his blood sugar, but now that we are asking for the gluten free menus I can see lots of carbs on the menu in places I would not have imagined!

Did your friend say whether his dosage requirements were the same for a particular kind of food whether it was made at home from scratch, or prepared at a restaurant, or from a grocery store ready-to-make box/bag?

"Personally, though I love the taste of Americanized Chinese food, I've always been suspicious of what exactly goes into these dishes. But I was unaware of the blood sugar implications."
Type 2 diabetic with relatively low insulin resistance:
I can go to a Chinese buffet and select what expect to be proteins (meats) and vegetables.  After so many attempts with spikes I have about given up on Chinese foods.

Frank Roy

The problem with Chinese eaten out is it's mostly noodles and rice - just starch.  Even those dishes that look like it's just meat and veggies comes swimming in a sauce full of sugar and corn starch.

Chinese food is OK when I make it myself.  I stirfry meats and veggies in avocado oil and season with some fresh ginger, garlic and tamari.  Without rice to soak up the flavorings, you don't have to use piles of tamari, so don't have to thicken the sauce particularly and don't need corn starch.  It's very yummy, actually more flavorful than what you can get when eating out, and a minimal impact on bg.  

And cabbage carmelizes just fine without sugar.  A stirfry of just hamburger, shredded cabbage, ginger, garlic and tamari is a favorite around here.  It's one of the favorite meals of my husband who does not low-carb.

This is the thing wrt to dosing insulin, you *can't* dose for a high carb diet (though what is high carb may vary from person to person).  

If I eat "normally" (which is pretty low-carb), I dose my insulin according to rules I have figured out for myself.  With these rules, my blood glucose *never* goes too high.  Of course it rises some with the meal (usually into the 120-140 range), but then settles back down before the next meal (to 80-110 or so).

If I eat a "cheat" meal, there's no right amount of insulin to take.  If I use the same rules to dose, my blood glucose goes up over 200, sometimes WAY over.  But it still returns to normal, it just takes a bit longer.  

The amount of insulin it would take to keep my bg low after a meal would be *huge* - enough to cause me to go hypoglyemic after the peak.  And hypoglycemia is a *lot* more dangerous than running a bit high.  

So what's the answer for a diabetic?  You just don't cheat very often.  High bg causes damage, you can't afford to do it much.  You cheat just often enough to keep yourself eating normally the rest of the time without building up  cravings that lead to binges.  

The other thing is... what happens to a diabetic injecting insulin *also* happens to non-diabetics!  You just don't see it cause you're not filling a syringe.  But your body is pumping out piles of insulin to handle the carbs you eat, so if you indulge in carby foods, your insulin levels rise.  

This causes a host of problems... including increasing the risk of heart disease and other problems associated with inflammation.  

Even if your body *does* handle glucose properly, keep raising your insulin levels and eventually your cells start to become resistant.  Increasing insulin resistance therefore increases the chances you'll become frankly diabetic.  

In short, while most folks can eat way more carbs than I can, no one needs to eat gobs of carby foods.

There's LOTS of good food to eat that isn't full of sugar and starch, which are really pretty bland foods anyways.

The secret ingredient in restaurant cooking is transfats.  Our favorite restaurant Long Life Veggie House in Berkeley (next door to the campus) uses it.  My husband loves that place! Every dish is DELICIOUS. They don't use MSG but they deepfry in hydrogenated veggie oils. *Deep fried* broccoli sure tastes much better than non-deep fried    Even if non hydrogenated veggie oils are used, the high amount of oil combined with really high carbs can really cause some severe metabolic changes.

The other ingredient is cornstarch and sugar -- it's not a lot but anyone insulin resistant may experience glucose excursions quickly.  Cornstarch makes food more tender b/c it coats the meat as it's stir fried (or deep-fried) which seals in flavor and moisture.

Pre marinating in sugar is like brining -- it also enhances flavor and moisture.  Have you ever had a brined Thanksgiving turkey??  WOW, it's awesome.  And you can't mess it up (ie, overroast or over bake)!

MSG -- this makes the food even more tasty -- and hard to resist! My mom's old Chinese cookbooks list MSG 1 tsp in almost EVERY recipe!

Homemade Chinese food is a lot more healthier but the rice portions can get pretty outrageously excessive in terms of carb/glycemic load and glycemic index.  

-G

The secret ingredient in restaurant cooking is transfats.  Our favorite restaurant Long Life Veggie House in Berkeley (next door to the campus) uses it.  My husband loves that place! Every dish is DELICIOUS. They don't use MSG but they deepfry in hydrogenated veggie oils. *Deep fried* broccoli sure tastes much better than non-deep fried    Even if non hydrogenated veggie oils are used, the high amount of oil combined with really high carbs can really cause some severe metabolic changes.

The other ingredient is cornstarch and sugar -- it's not a lot but anyone insulin resistant may experience glucose excursions quickly.  Cornstarch makes food more tender b/c it coats the meat as it's stir fried (or deep-fried) which seals in flavor and moisture.

Pre marinating in sugar is like brining -- it also enhances flavor and moisture.  Have you ever had a brined Thanksgiving turkey??  WOW, it's awesome.  And you can't mess it up (ie, overroast or over bake)!

MSG -- this makes the food even more tasty -- and hard to resist! My mom's old Chinese cookbooks list MSG 1 tsp in almost EVERY recipe!

Homemade Chinese food is a lot more healthier but the rice portions can get pretty outrageously excessive in terms of carb/glycemic load and glycemic index.  

-G

I just returned from a two week stay in Italy, doing a bit of my own "Mediterranean Diet" experiments.  When practical, we sought out food sources and places to eat that were typical for the local area, and tried as much as possible/practical to stay away from establishments that mostly catered to tourist tastes.  I was really curious to see how the mythical "Mediterranean Diet" we Americans are urged to follow compared to the foods really consumed in Italy.

The first week, we stayed in a rural Tuscan farmhouse apartment (agriturismo), so many, if not most of our meals were prepared by me with ingredients I bought at the local grocery store (Coop) or the outdoor market in Siena.  In addition, I purchased really  fantastic free range eggs from the farm where we were staying (between some language issues and seasonality, eggs and wine were what we could buy from them - though I was tantalized by the not-quite-ripe figs heavy on many trees).  Mostly, our meals consisted of simple and easily prepared fresh fruits and vegetables, rustic cured meats (salami, proscuitto, pancetta, etc.) hand-sliced at the deli down the road, fresh sausages, various Italian cheeses, plus plenty of espresso.    It was a bit disappointing to find underripe fruit & tomatoes as well as old green beans in the grocery stores, not to mention too many low fat and highly processed foods, but all over Europe the food supply is becoming more industrialized, more centralized, and homogenous, so I'm not too surprised that it happens even in Italy.  But even with the smaller grocery store size, the amount of in-season produce was abundant, yet one still was better off shipping from the perimeter of the store, venturing into the aisles only for spices, olive oil, vinegar, coffee, etc.  Without the knowledge of where to go and the language to really talk in depth about food with people, I wasn't able to find truly direct and local sources for as many foods as I would have liked, but still, we ate well enough!

The first week I maintained blood sugar levels very similar to those I get at home, because except for the Italian specialties, we ate much like we always do.  A few rare exceptions to my normal BG tests were after indulging in locally made gelato or a evening limoncello cordial, but even then, the BG rise was relatively modest and to me, acceptable under the circumstance.  Even with the gelato indulgences, it felt like I might have even lost a few pounds by the end of the first week and my FBG didn't rise much over 100.

The second week we stayed in two cities (Florence & Rome), and I didn't prepare any of my own food because I didn't have a kitchen/fridge.  I found it impossible to get eggs anywhere for breakfast, and the tickets our hotels provided for a "continental" breakfast at a nearby café/bar was always for a coffee  or hot chocolate drink and some sort of bread or roll (croissant, brioche, danish, etc.).  At first I just paid extra for a plate of salami and cheese if that was available - or went to a small grocery store for some plain yogurt), but then I decided to go off LC and conduct a short term experiment, though I didn't consume nearly as many carbs as a typical Italian or tourist would.

So I breakfasted with a broiche roll or plain croissant for breakfast with my cappuccino, but unfortunately no additional butter was available.  I didn't feel "full" enough with such a breakfast and I was usually starving an hour or two later.  Additionally, when I ate the "continental" breakfast, I noticed immediate water retention - my ankles,  lower legs, and knees looked like someone else's at the end of a day walking and sightseeing, swollen heavy.  Exercising my feet and lower legs while waiting in lines or sitting didn't seem to help.

Food is much more expensive in Europe than in the US, and the declining US$ made everything especially expensive (not to mention the higher cost of dining out rather than cooking at home), so we tried to manage food costs by eating simple lunches at local take-away places, avoiding the corporate fast food chains.  I was getting tired of salami/proscuitto & cheese plates, but the typical "quick" option was usually a panini (sandwich).  At first I tried to find alternatives to paninis, but the available salads were designed for side dishes, not main meals and rarely had any protein, and the fillings of the expensive sandwiches were too skimpy to just eat without the bread.  So I started to eat panini, although I sometimes removed as much as half of the bread (though it was nearly always very excellent quality pan toasted flatbreads or crusty baguette rolls, not sliced America bread).  So of course, my post prandial BGs rose, as did my FBG.  I also found my hunger tended to come back much too soon and I think overall I ate more than usual in terms of volume.

Then we deviated from the "Italian" lunch foods and found a better midday meal option (quick, cheaper, and easier to customize for LC) - stopping at one of the numerous kebab shops and ordering a kebab plate with salad, hold the bread (not Italian, but still Mediterranean, I guess).  I felt much better fueled on kebab plates (more filling and enough protein) than paninis, though I must say I still appreciated the taste of caprese paninis (slices of fresh mozzerella and tomato, basil leaves, mustard dressing on crusty, pan-toasted flat bread).  If I followed my appetite, I could have eaten two caprese paninis.

We had some great evening dinners, at places also frequented by locals.  This often was a fixed price dinner of several courses ("we feed you what we want you to eat").  Multi-course meals included house wine, and invariably consisted of antipasta (usually LC, such as a cold meat and cheese plate), pasta course (much smaller servings than typical US pasta dishes), main course plus some side vegetables, and dessert/coffee.   These were often the best meals we experienced, full of local flavor and tradition (sometimes with a grandmotherly type doing the cooking), and definitely of very good quality, though we noticed the saltiness overall tended to be on the high side.  I ate from every course, including some of the excellent bread (dipped in plenty of olive oil) and usually about half of the pasta served (2 oz dry?), plus about half of the dessert.   After these meals I always ran BGs higher than usual, varying from moderately high (120-160 - at home I would consider this very high for me) to very high (over 180).  By late in the week, my FBG was into the 115 range every morning (usually I can keep it 90-100 on LC food).  Nearly everything that week was delicious, well-prepared food, but the high carb items definitely were not good for my BG control in the long run.  

And most days I was doing plenty of walking, sprinting for the Metro subway trains, stair climbing (4th and 5/6th floor hotel rooms!), etc. but since I didn't have my usual housework to do, it probably wasn't too different from my usual exertion level.

So it was very interesting to experience the "Mediterranean Diet" first hand.  Meats and cheeses were plentiful, fruits and vegetables played a much more minor role (main courses didn't come with vegetables other than what was in the sauce, but had to be ordered as additional items), but the overall carbs were decidedly too many.  As I expected, it wasn't nearly as pasta-heavy as is portrayed in the US media/health press, but it is still full of too much grain and sugar, IMO.  Low fat has become the norm in many dairy products, sadly, and if the grocery stores are any indication, modern families are gravitating towards highly processed, industrial foods.  Sugar seems to be in everything (I quickly learned to order my caffe freddo con panno or latte sensa zuccero - iced coffee with cream or milk without sugar) after realizing that adding lots of sugar was the norm).  

And, after several days of breakfasting at the café near our Rome hotel (where carbs were the only option in the morning), I learned that our very buff, muscular, very flat-stomached, café owner doesn't eat pasta (said as he proudly patted his 6 pack abs).   I probably could have stuck closer to the carb intake I know works better for my BG control, but I figured if I was going to go off my LC way of eating and experiment, this was the time and place.

And yes, there were far fewer really obese people than in the US and lots of very slender people, but I could still see there were *plenty* of overweight, probably pre-diabetic and diabetic Italians (very visible problems with lower extremities, ranging from what looked like diabetic skin issues, walking problems, acanthosis nigricans, etc.).  Older people do seem to be generally more fit than in the US (fit from everyday life, not exercise regimes), but there were plenty of "wheat bellies" on men old and young, even more young women with "muffin tops", and simply too many overweight children (very worrisome trend).  So it may well be more the relaxed Italian way of living life (or a combination of other factors such as less air conditioning, strong family bonds, lots of sun, etc?) that keeps Italian CVD rates lower than the American rates, more than the mythical "Mediterranean diet".

Hi, Anna--

Your story is so well told that I'd like to post it in a future blog post.

Anna,

You R-O-C-K Girl!!  

I love reading all your insightful thoughts and stories ... and now I know how to order high octane caffeine in italian (in addition (!!) to how to feed my feline friend ground whole bones + meat (ie vit D + protein, respectively) to prevent deficiencies.

-BG

Anna,

You R-O-C-K Girl!!  

I love reading all your insightful thoughts and stories ... and now I know how to order high octane caffeine in italian (in addition (!!) to how to feed my feline friend ground whole bones + meat (ie vit D + protein, respectively) to prevent deficiencies.

-BG

BG,

I  R-O-C-K?  Wow - tell my son, but I doubt he'll believe you.  He was so tired of hearing me say what/who/where Rick Steves' travel book recommends...

Are you ready to try some Coratella?  I suggest you  look it up before you order .  I sought out a recommended restaurant near the old South Roma stockyards in Testaccio, known for their special "fifth quarter" dishes, you know, for the "trippa of a lifetime".  The waiter wouldn't let me order the Animelle a sale e pepe.  Maybe next time...