My Take On Korean Food

After spending 2 weeks in Korea, I became quite familiar with the Korean diet. The food of Korea might be the world’s most flavorful.  While calling it the best would clearly be a matter of individual discretion, it is tough to deny the absolute magnitude and intensity of taste: packed as it is with loads of salt, garlic and hot pepper which form the basis of most dishes.   I was absolutely amazed at the food that I had in the countryside (a spicy soft-tofu stew and a steamed-chicken stew in a sweet, non-spicy sauce were the highlights for me), although the foods was pretty good in Seoul as well – just without the same freshness.  In this blog I intend to discuss the benefits and drawbacks of the Korean diet.

What’s Good In Korean Food?

1. Pro-Biotics: Long touted for the boosting the immune system and preventing disease several staples of Korean food contain probiotics, none more popular than Kimchi (a fermented cabbage dish served with EVERY meal, including breakfast,) The quality of kimchi and its nutritional content vary from place to place (even Asiana airlines served tolerable kimchi on the flight over), but we would probably all benefit from the combination of the nutrition packed cruciferous vegetables (usually cabbage) and the probiotics generated through the fermentation process.
2. Total Calorie Consumption/Limited Snacking: In America people tend to get fixated on the notion of eating many times per day to keep metabolism boosted.  And I do mention to my patients that while total calories matter, too much in any one sitting can undo some of that benefit.  Nonetheless, the lack of snacking and customary snacking habits on junk/fast food items, sugar drinks, sodas, etc. keeps total calorie consumption down.  Consequently, even with fewer gyms the obesity rates don’t even come close to America’s.
3. Lack of Sweets/Refined Sugar The food generally reflects this.  Outside of a few starchy staples, the typical western high-glycemic foods, or typical desserts just don’t exist or are, at least, not frequently consumed. The major exception, of course, is sticky white rice.
4. Relatively Healthy Side Dishes (Panchan): Korean side dishes are scattered across the table during most meals.  Usually consisting of tasty vegetables, often fermented or doused in hot pepper.  The consumption of these dishes decreases the proportion  you eat from what we in America would call the feature items of (meat and starch)
5. Chop Sticks: can lead to slower eating.  This one might be a bit of a stretch.  It is much tougher to grab large amounts of food at one time, even for the most experienced users, as you would with a fork and knife.  This slowing down of the eating process allows your satiety hormones to kick in earlier in meals.

What’s Unhealthy in the Korean Diet?

1. White Rice: Along with kimchi, sticky, white rice is the most common feature of a Korean meal. You very well might get spared white rice if you are eating noodles.  In healthier establishments with a dedication to “wellbeing” you might get a combination of rice with a small amount of beans and sesame seeds that creates a more nutritious balance.  Nonetheless, conversion to a whole grain version (like brown rice) would result in a lower-glycemic load, more nutritional content (thiamine in particular) and more fiber.
2. SALT!!!: While sodium is a necessary part of one’s diet, virtually every taste consumed in Korea is overwhelmingly salty.  If you have normal blood pressure and normal functioning kidneys, it should not make a big difference if you eat low to moderately heavy salt loads.  Once things are off in the least, though, sodium loads raise blood pressure (and can cause a pronounced amount of fluid retention).  This culturally-expected sodium content has two main effects: One, it trains taste buds to expect things to be saltier (otherwise they are difficult to taste compared to other items).  More importantly as people age and are still used to this food they will have a difficult time controlling blood pressure putting themselves at greater risk for strokes.
3. Increased Availability of Western Junk Food: Unfortunately,  the accessibility to western style junk is increasing In Korea, and while firm data is hard to come by, my perception was that the population segment that had the greatest weight issues were early adolescents.  The more western eating habits creep in, the bigger the western problems ultimately will be.

Image courtesy of adactio on Flickr

Binge Drinking, High Blood Pressure and Death

Here is an interesting article from health.com about binge drinking and hypertension.  A study published in the journal Stroke of 6100 South Koreans age 55 and up were studied for two decades demonstrated that the risk of death from a heart attack or stroke was double for those with high blood pressure who consumed 6 drinks in one sitting.  For those who had up to 12 drinks in one sitting or more, the risk was five-fold.  Not surprisingly each of these risks increased as hypertension became more severe.

Many of my hypertensive patients are surprised when I explain to them that alcohol consumption can raise blood pressure.  It is the rare patient who has only one glass of wine per night.  But for those who drink 2-3 or more units of alcohol per night, quitting or cutting back can significantly lower blood pressure, decrease calorie consumption – aiding weight loss, and reduce the severity of sleep apnea.  The results can be quite dramatic.  What this study shows, though, is that even people who do not drink on a daily basis still are at risk for alcohol related health complications.  It might not be easy to convince college students – a notorious binge drinking population - of this, but adults should know of the potential harms of these routine behaviors if further studies confirm these findings.

To read the full article from Health.com, click here.

Image courtesy of nomegusta on flickr.com

What Supplements Do I Take?

I get asked by many of my patients what supplements, if any, I take.  I preface any conversation with the classic parental advice of “do as I say not as I do,” and let my patients know that each individual has needs that are dictated by their circumstances.  I generally take supplements to be exactly that.  I feel that I am not getting enough of what I need of something to suit the lifestyle that I lead.  Generally speaking, if I lived in an area with fresh produce, grains and livestock, abundant fish and sunlight and if I took perfect care of body without any excesses, I would not take any supplements.  In the real world, here is my list:

1. Vitamin D₃ – The bulk of vitamin D gets created as pre-vitamin D through absorption of UV rays from the sun by the skin.  People at risk for vitamin D deficiency include those with minimal sun exposure, those who are obese or losing weight and people with issues of malabsorption.  In an ideal world I would live on an island with warm weather and plenty of sun exposure by spending much of my time outdoors throughout the year.  The reality is that I live in a northern city and spend most of my time indoors giving me minimal exposure to the sun for long stretches throughout the year.  There are clear links between vitamin D deficiency and multiple disease processes ranging from various forms or cancer to cardiovascular disease, metabolic bone disease and diseases involving the immune system.   A reminder: vitamin D is fat soluble, so take it with a fat-containing meal.

2. Omega-3/Fish Oil – These popular fatty acids have a healthy effect on brain function (particularly mood) and inflammation.  At high enough doses they can have powerful effects on depression and bipolar disorder that are comparable to traditional psychiatric medications.   Omega-3-fatty-acids also have an anti-inflammatory effect and can significantly lower triglyceride levels.  In an ideal world (on that island) my diet would consist of plenty of fish and would be low in unhealthy oils so this would not be necessary. 

3. Ginger – I take capsules of the whole root (not just isolated substances from within ginger that might have the wanted effect).  I take ginger for its anti-inflammatory effect.  This is not something that I recommend for all patients, but is useful for me in staying off of stronger, prescription strength anti-inflammatory medications that can be toxic to the kidneys particularly when taken frequently.  Without the chronic wear-and-tear of competitive sports, I probably would not bother with ginger.  Ginger tea, though, can be useful for nausea.  Cut up a bunch of fresh ginger root and boil it in water for 5 minutes.  Drinking a glass or two can have a relatively quick effect.

4. Tumeric – Again, I take the whole root in capsule form.   I am fearful of “anti-cancer” agents that are taken out of their natural environment.  While reported to have strong cancer-fighting properties, I take this herb (the primary ingredient in curry) for its anti-inflammatory effect. There appears to be an effect on the same enzyme as with the ginger.  Cultures that eat large amounts of turmeric in their diet also have low levels of certain types of cancer. 

5. Co-Q-10 – This enzyme (also known as Coenzyme Q) is produced by the body.  There is possibly some use for co-Q-10 in the management of heart failure patients.  Additionally, a recent meta-analysis suggested that blood pressure can be lowered by as much as 10 points when taking Co-Q-10 supplements, in addition to already reported positive effects on insulin resistance.   I originally took it to help with stamina in athletics.  I have not found a tremendous amount of data to back that up, but it is something that I continue to take given the personal response that I have other positive benefits associated with it including.  It should be noted that, since this is a natural substance produced in the body, the body might not produce as much when on it.  I have found that I feel a little shaky the first day after stopping it, so I tell my patients that either you are on it daily or not.  Some of my patients also find that they have a little bit of insomnia if they take it too late, so I recommend they take it in the morning. 

Sugar Again Linked to Cancer

A study discussed by MSNBC.COM and originally published in Cancer Research demonstrated that pancreatic cancer cells fed on different types of sugar have different reactions.  These cells were given both sucrose (table sugar made up of glucose and fructose) and fructose alone.  Each sugar had a different effect with fructose being directly responsible for cancer cell proliferation.  These fast-burning sugars seem to be feeding cancer cells – as opposed to starving them and letting your immune system naturally fend them off. 

Over the past couple of years I have had multiple patients who have come to me after being advised by oncologists or the nutritionists they recommend to keep up their caloric intake by any means necessary so that they do not lose too much weight while undergoing cancer treatment.  Two of them, including one with stomach cancer, were advised to consume ice cream regularly to achieve this goal.  I hope over time studies like these become commonplace enough that causative and curative aspects of nutrition and behavior are ultimately taken more seriously. For a while high-fructose corn syrup has been thought to cause harm in terms of obesity, diabetes and even cardiac disease.  This adds fuel to the fire by linking it even more closely with cancer.  Its continued inclusion in commercially processed foods, particularly those consumed by children, is largely a political issue that goes beyond basic health and nutrition. 

While long-term studies would have to be analyzed for the preventive effects of avoiding sugar (and certain types of sugar) consumption, there are certainly direct implications for cancer patients as they are given dietary recommendations during and after treatment.  This does not mean that going in the opposite direction of dietary harm – a bacon cheese burger without the bun – is any better for you.  Rather this study should be a friendly reminder to stay away from sugar, animal fats and all those things we are pretty sure are cause harm.  The bottom line at this point a balanced diet high in fiber, low in refined sugars and processed carbohydrates and unhealthy fats (particularly those found in animals) is still recommended.

To read the full MSNBC.com article, click here.

Can Calcium Supplements Cause Heart Attacks?

The British Medical Journal presented a meta-analysis conducted by a research group in New Zealand of 15 studies on calcium supplementation without vitamin D.  Calcium supplements are widely prescribed for the prevention and management of osteoporosis and have been shown to modestly reduce fracture risk in high risk populations.  This analysis, however, found an increase risk of heart attacks, vascular events and death with lone calcium supplementation.  The possible mechanism lies in the increased amount of calcium in the blood that might be adhering to arterial walls. 

The scariest findings?  While for every 1000 patients treated with calcium 26 fractures were prevented, 14 additional patients had heart attacks, 10 had strokes and 13 died.  Not exactly the type of trade-off many would make.  Combine these numbers with an association of increased prostate cancer risk in men with higher calcium intake and the concept of calcium supplementation might ultimately be overhauled. 

It should be noted, however, that these findings are not necessarily directly applicable to all patients.  First, the study excluded the use of vitamin D, which is generally given along with calcium.  Additionally many patients with osteoporosis who take calcium also take bisphosphonates that would effectively lower the amount of circulating calcium that would be available for deposition into blood vessels.  The bottom line is that if you are a man, you probably should avoid calcium supplements altogether and if you are a woman, you should take them if at high risk, but not without vitamin D and or bisphosphonates.

To read the full British Medical Journal report, click here.