P2. P 125-135

Design: Cluster randomized study of 56 Spanish family doctors P: 4317 physically inactive patients I: a) Provided brief advice & educational materials to all pts & offered an additional 15 min appt to prescribe an individualized physical activity plan. b) Prescription (for those who came): Negotiated a goal, addressed potential barriers, designed a 3 month plan, printed a specific prescription (with a self-monitoring log) & gave a brief printed guide C: Usual care O: At 6 mos: a) Rx Gp did 18 min more mod/vigorous physical activity (28% more)(P<0.05). Effect limited to those > 50 yrs old. b) Rx Gp had 3.9% more meeting physical activity recommendations at 6 mos (control had 15.0%)(P<0.05) c) No change in V02 or QOL (SF-36) At 2 years a) Rx group did 7.3 min more mod/vigorous physical activity (28% more)(P<0.05) b) Rx Gp had 2.4% more meeting physical activity recommendations at 6 mos (control had 15.0%)(P<0.05) c) No change in V02 or QOL (SF-36) d) Comment (by SCG): Note that in BOTH groups there was a HUGE increase in the proportion meeting minimal exercise requirements (30% !!) and time exercising (140 minutes/wk) which the authors don’t comment on. I think this is an example of the Hawthorne effect - ie the effect of being in a study and knowing that your activity is being tracked.

1&2) Lauric acid, a saturated fat, makes up 47% of coconut oil and is the #1 oil in it. 3) Lauric acid increases Chol-T, LDL, and HDL 4) Harvard recommends AGAINST coconut oil. 4) Net effect is to increase heart disease

1) Daily recommended fiber: Women: 25 g/day, greater benefits if > 40 g/d Men 38 g/day, greater benefits if > 45 g/d 2) Average US intake is 18 grams/d 3) Less than 3% of US popultation meets the recommended intake. BR 132.

Micronutrients are chemical elements or substances that are essential in small or minute amounts for growth and health. Two main classes: vitamins + minerals

Beneficial non-nutrients are valuable to health, but not proven to be essential for life. 1) Anti-oxidants 2) Anti-inflammatory molecules 3) Phytochemicals 4) Polyphenols 5) Phytosterols 6) Glucosinolates 7) Carotenoids

Anti-oxidant foods are anti-inflammatory foods

1) Cruciferous vegetables - contain sufloraphane & indole-3-carbinols eg Broccoli, cauliflower, Brussels sroups, bok choy, kale 2) Dark berries & fruits - contain polyphenols, such as ellagic acid, anthcyanidins, anthcyanins. eg blueberries, raspberries, strawberries, cranberries, pomegranates 3) Allium vegetables - rich in organosulfurs eg garlic, onions, leeks 4) Orange, yellow & dark green vegetables/fruits - contain carotenoids that stimulate natural killer celss which fight foreign inflammation eg carrots, yams, mango 5) Dark green leafy vegetables - high in potassium, calcium, and magnesium eg spinach, collard, Swiss chard, dark lettuces, matard & turnip greens

• AGE are oxidative stress inducers & result in inflammation • Disease: diabetes (1&2), atherosclerosis, kidney disease, slow wound healing • Fomed by an amino acid (protein) + monosaccharide (simple sugar such as glucose) • cause cell damage esp to cells with a long life (nerve & brain), collagen proteins in kidney, blood vessels & eye cells.

Increased with dry heat (10-100x uncooked) - esp BBQing, grilling, roasting, baking, frying, sauteing, searing, toasting High [AGE] in meat (esp red meat), certain cheeses, fried eggs, butter, cream cheese, margarine, mayo, oils & nuts Food preparation 1) Increase consumption of unprocessed foods (vegetables, fruits, legumes, whole grains) 2) Decrease intake of fatty meats, solid fats, full dairy products, processed foods 3) Don’t prepare foods with dry heat, cooking, grilling, baking, frying 4) DO use moist heat: boiling, stewing, poaching, steaming. If cooking meat, add acidic ingredients (vinegar, tomato or lemon juice- see page 10).

1: Cheese Sources of saturated fat in US diet:

As a result they are increasing the amount of saturated fats like coconut oil, palm oil, and lard.

1) Partially hydrogenated oils (shortenings, margarines) 2) Fried foods - french fries, doughnuts 3) Commercially baked goods - crackers, cookies, microwave popcorn 4) Coffee creamers 5) Refridgerated doughs 6) Naturally found in meat & dairy products

Going from most to least toxic: Trans fats > saturated fats > omega 6 fatty acids.

1 & 2) Bad: • Saturated fats in general raise cholesterol (see here) • Trans fat - increases MI & strokes Good (should replace above): • polyunsaturated - Omega 3s, omega 6 (bad = arachadonic acid, good = linolenic) • Monounsaturated - help lower LDL - Canola, Olive, Peanut (C.O.P.) 3) Saturated fats • Lauric - coconuts, palm oil, meat - ^ Chol-T, ^ LDL, ^ HDL • Stearic - cheese, dairy, meat, poultry - may lower LDL • Palmitic - palm oil, dairy, meats - ^ Chol-T, ^LDL, ^ HDL

In trans fats, there are two carbons joined by a double bond. If the hydrogens are on OPPOSITE sides, it is called ‘trans’; if they are on the same side, it is called ‘CIS’. • Cis are more flexible and thus liquid at room temp; trans are less flexible, leading to oils which are solida at room temp and have longer shelf life. • natural trans fats occur in the body fat & milk of ruminant animals, mainly cows & sheep - not harmful • commercial trans fats raise LDL-C & lower HDL • a 2% increase in energy intake from bad trans fat (vs carbohydrates) is assoc with riks of CAD of 1.93 (P<0.001)

Saturated fats are probably risk factors for CAD • according to one study (in women) an increase in 5% of energy intake from saturated fats (vs carbohydrates) was assoc with a 17% increase in risk of CAD. However this did not reach statistical signficance (P=0.10). • in this study, they estimated that replacing 5% of energy from saturated fat with energy from unsaturated fats would reduce risk of CAD by 42% (P<0.001).