GUT CUT SCUTTLEBUTT
Obesity Surgery Riskier Than Thought

Severely obese individuals hoping to take a short cut – literally – to losing pounds may be biting off more than they can chew by opting for gastric bypass surgery. Three new studies appearing in last month's Journal of the American Medical Association (JAMA) called the safety – and supposed cost savings – of obesity surgery into question.  

The most disturbing of these contradicted previous statistics which reported death rates well under 1% for middle-aged patients. The new data suggests that 5% of men and 3% of women aged 35-44 died within a year of the surgery. Among patients 65-74 years old, 13% of men and 6% of women died – and among those over 74 years old, half of the men and 40% of the women died. "The risk of death is much higher than has been reported," said lead author Dr. David Flum of the University of Washington.  "It's a reality check for those considering these operations."

Whether the sobering news will deter those 150,000 patients predicted to undergo obesity surgery in the U.S. this year is hard to say. The popularity of such surgeries has grown ten times in the past seven years according to a second JAMA study. This explosion reflects the ballooning proportion of Americans who are more than 100 pounds overweight, from 1 in 200 a decade ago to 1 in 50 today.  

Gastric bypass is the most common type of obesity surgery and involves attaching a section of the upper stomach to the lower intestine, effectively preventing patients from eating their usual amount of food.  Post-surgery complications can include infection, malnutrition, bowel and gallbladder problems. Of course, the list of obesity-related ailments is even longer – with heart disease, diabetes, and sleep apnea among the best documented.  

It was such widely recognized health concerns that led the federal government to extend Medicare coverage to obesity surgery – but the third JAMA study cast doubt on whether the procedure actually reduces health care costs. Following patients for three years, researchers found that while an average of 8% were hospitalized before surgery, a full 20% had been hospitalized a year afterward, primarily for complications relating to their surgery.

Bottom line: The risks of obesity surgery are higher than previously believed.  A healthier path to lasting weight-loss begins with a healthy diet filled with high-fiber, low-calorie fruit and vegetables, and daily exercise.

STRETCH KVETCH
Pre-Stretching Impairs Exercise Performance

Conventional wisdom holds that stretching before working out can help protect you from injury.  But evidence has been building for some time that pre-exercise stretching offers little insurance against injury. What's more, it may even take a toll on athletic performance.

CDC researchers, who conducted a systematic review of the scientific literature, found that stretching was not significantly associated with a reduction in total injuries. While it does increase a person’s range of motion, the effect is not necessarily protective. “Theoretically, a hypermobile [very flexible] person increasing their range of motion through stretching could result in a less stable joint...and a higher risk of injury,” according to Duane Knudson, Ph.D. Associate Professor at California State University, Chico.

Super jocks inclined to discount injury risk and stretch anyway as part of their preparation for running a marathon or riding epic surf may want to think again.

Studies have found that stretching impairs different aspects of athletic performance:  decreasing running speed, limiting high jumps, even hindering heavy lifting. In fact, a recent study from Louisiana State University found that static stretching (where a stretch is held in a specific position for a certain time) before working out reduced muscle strength endurance by 28%. The mechanism?  It may be that stretching affects the muscle's ability to contract.

So, what should you do? Warm up with a few low-intensity repetitions of the movement you will be doing. If you're bench pressing, for example, do a few repetitions with the bar before adding on the weights. This may increase blood flow to and help oxygenate key muscles. Stretching after exercise also remains essential to maintaining flexibility – a leading predictor of longevity, as mentioned in a previous DNN. If you want to focus specifically on flexibility, try yoga for a wealth of health benefits (fight fat, bust stress, and sleep better).

Bottom Line: Stretching offers little anti-injury benefit and may reduce muscle performance. Warm up instead with a few low-intensity reps and save stretches for after the workout.

Bonus: Want to know which foods can cut down on your body's recovery time and get you back to the gym faster?  Click here to learn dietary tips to speed healing.

SQUASH, BY GOSH
Butternut Bursts with Immune Benefits

Fall markets are awash with squash – and butternut's one of the best at boosting immune function in anticipation of winter colds. What makes butternut squash a Superfood for your immune system is its unique nutrient combination of vitamins A, C and E.  

One cup of cooked butternut squash provides over 450% of your Daily Value of vitamin A – commonly known as the “anti-infective” vitamin for its role in developing immune and mucosal cells – cells that line the airways, urinary and digestive tracts – thus forming the body’s first line of immune defense. The same serving supplies over 50% of your Daily Value of vitamin C (helps inactivate viruses and may reduce the severity and duration of colds) and 13% of your Daily Value of vitamin E (shields immune cells from free radicals and may boost the production of bacteria-busting white blood cells).  That 13% of daily vitamin E is nothing to sneeze at – especially when you consider it's one of the highest fruit (yes, butternut's a fruit, not vegetable) sources, while even "top" E sources (like sunflower seeds) only supply roughly 30%.

More reasons to go nuts for butternut: One serving provides plenty of potassium, magnesium, fiber, manganese, vitamin B6, thiamin, niacin, and folate – all for just 82 calories. This gourmet gourd also supplies a top source of the antioxidant phytonutrients, beta-carotene (more than pumpkins), alpha-carotene (more than carrots), and beta-cryptoxanthin (best food source bar none). As mentioned in the last DNN, beta-cryptoxanthin may reduce the risk of polyarthritis (inflammation that affects at least two or more joint groups) as well as lung and prostate cancers. For breaking news on the other two butternut squash carotenoids, alpha- and beta-carotene, read on.

BETA-CAROTENE CONUNDRUM
Does it Lower, or Raise, Lung Cancer Risk?

With November being Lung Cancer Awareness Month, we thought it time to look at the link between lung health and beta-carotene (the phytonutrient responsible for the bright orange color of sweet potatoes and cantaloupe for example). 

Numerous studies have demonstrated beta-carotene's bounty of health benefits, ranging from enhancing sun protection, to promoting eye health and protecting the heart. However, some research has raised nagging questions regarding the relationship between beta-carotene consumption and lung cancer. Two new studies deepen the complexities of this debate.
 
In one, French researchers examined data from 60,000 women to see if there was a link between beta-carotene supplements and lung cancer. Among women who were smokers at some point in their lives, the risk of developing tobacco-related cancers (e.g. lung, head and neck) more than doubled with supplemental beta-carotene intake.  But among women who'd never smoked, the complete opposite was true: Those with the highest intake of beta-carotene supplements had the lowest risk of developing such cancers. Although dietary intake (i.e. from the kind of foods mentioned above) followed similar trends among both groups, the effects were far less pronounced.

What's more, dietary (vs. supplemental) intake of beta-carotene was found to reduce mortality from any cause – including cancer, in a new Dutch study. Researchers analyzed health data from over 1,100 elderly men and women and found that those who had the highest plasma concentrations of alpha- and beta-carotene (again, that includes butternut squash, carrots, and pumpkin) had a lower risk of dying from cancer, even after adjusting for past smoking.

So, should you back off beta-carotene? If you've ever smoked, I would shelve the supplements for sure. Even if you haven’t smoked, you're better off turning to the produce aisle than the pharmacy section. As previously reported in the DNN, The Lancet's large-scale review of 14 randomized trials found that antioxidant pills, like beta-carotene, increased overall mortality. Given the mountain of research on the many benefits – and, thus far, mixed findings on the possible risks – of dietary beta-carotene consumption, plus the fact that most Americans fail to get enough of this key nutrient, previous smokers need not cut back on carrots and cantaloupe. Just aim for a variety of nutrient-dense, fiber-rich fruits and vegetables – so that orange is one of the many colors of the rainbow on your plate.

MAKE THAT A BEAN BURGER
Veg Protein Healthier for Heart

Yet another reason to minimize meat – and make more room for plant-based protein on your plate. A recent Mayo Clinic analysis of data from nearly 30,000 postmenopausal women found a 30% lower risk of death from heart disease among those who ate the most vegetable protein from legumes, beans, and nuts in place of either carbohydrates or animal protein. 

"All proteins aren't equal in their health effects," notes lead researcher Linda E. Kelemen, R.D., Sc.D., Assistant Professor of Epidemiology. "Vegetable proteins may deliver minerals and antioxidants that the body benefits from, or contain substances that affect our hormones in healthier ways.” While researchers continue to investigate the mechanism responsible for these effects, we hope that such findings help dissuade those few deluded dieters who continue to adhere to the tattered grail of Atkins and other unhealthy "low-carb" regimens. 

Minimizing meat intake and making more room for veg protein has benefits beyond heart health. As reported in previous DNNs, vegetarian women weigh less than their carnivorous peers, while men who had the highest fruit and vegetable (and lowest meat and dairy) consumption dramatically reduced their risk of prostate cancer. Another study correlated low meat consumption with a 30-40% reduction in colorectal cancer risk. Processed meats are particularly unhealthy, possibly increasing pancreatic cancer risk.

If you've got the will but are confused about the way to include more vegetable protein in your diet, consult the chart below for top sources.  Unsure about how much protein you need? Multiply your body weight by 0.37 – so a 150 lb. person would need 56 grams of protein a day (more if they're engaged in strenuous, muscle-building exercise).

*If you obtain the majority of your protein from plant-based food sources other than soy, it may be necessary to combine certain foods, such as corn or other grains, with beans and other legumes to provide all of the essential amino acids required to build muscle and other body tissues.

Bottom line: Choosing vegetable protein sources in place of animal protein may significantly reduce your risk of dying from heart disease.

NUTRITION ZEROES?  TRY HEROES!
Five Foods that Don't Get the Credit They Deserve

In virtually every issue of the Dole Nutrition News we feature a Superfood – a fruit or veggie so packed with powerful nutrients offering targeted health benefits that it belongs in a class all its own. While some of these healthy headliners have achieved the nutrition-equivalent of celebrity status (who hasn't heard of blueberries' brain benefits, for example?), most are at least widely recognized as good-for-you-foods.  

While most Superfoods invite general applause, what about those fruits and vegetables that elicit little more than a yawn? We took a second glance at foods that, at first, generate little excitement – or even confusion – and found that some so-called "nutrition zeroes" actually turned out to be "nutrition heroes."  Here's our list of five under-appreciated – and even misunderstood – fruits and veggies that it's time for you to re-evaluate:

Avocados: Some of the smartest folks I know avoid avocados as "high fat" – but it's precisely the monounsaturated fat that make the velvety-textured fruit so good for your heart. Avocados' monounsaturated fat has been shown to lower LDL “bad” cholesterol, while raising HDL “good” cholesterol. Avocados' fiber and phytonutrient beta-sitosterol also help control cholesterol, while its lutein promotes eye health.

If, like us, you're avoiding iffy vitamin E supplements and looking for a food source, guess what fruit has the highest gram-per-gram content of this powerful antioxidant?  Avocado!  Finally, if we'd created a "Superfood for your liver" category, avocados just might qualify. In fact, in one Japanese study, avocado beat out 22 other fruits as the best defense against liver damage.

Celery: A dieter's standby, celery is often dismissed as a nutrition nonentity. But it turns out two medium-sized stalks (110g) of celery provide an excellent source of vitamin K (a chief nutrient for bone health) and a good source of vitamin C (promotes collagen formation), folate (for heart health and lower risk of birth defects) and potassium (helps maintain healthy blood pressure levels) – all for just 20 calories. Celery is also loaded with phytonutrients such as quercetin (promotes prostate and brain health) and 3-n-butyl phthalide (helps lower blood pressure levels). A new study from Case Western Reserve University found that another celery phytonutrient, apigenin, may slow prostate tumor growth.

Lime: Although not usually eaten raw because of the sour taste, one medium lime (67g) has only 20 calories and provides an excellent source of vitamin C (for healthy skin, teeth, and immune function). Limes are also loaded with antioxidant phytonutrients, such as eriodictyol and naringenin, which several studies have shown may reduce the risk of heart disease by fighting free radicals and lowering blood lipid levels. In addition, researchers from the University of Costa Rica found that lime juice may prevent cholera infections.

Parsley: Regarded as little more than a garnish, parsley actually packs a powerful nutrition punch. Just Ό cup (15g) of parsley provides over 300% of the Daily Value of vitamin K (promotes bone health) and contains an excellent source of vitamins A and C. Parsley is also a top source of the antioxidant flavonoid apigenin, which in addition to protecting the prostate (see celery), may also help reduce the risk of breast, colon, skin and thyroid cancers. Parsley's abundance of eye-healthy phytonutrients – beta-carotene, lutein, and zeaxanthin – can help safeguard your sight, while chewing on a sprig after a meal can help freshen your breath.

Potatoes: The fact that the potato is the most widely consumed vegetable in America wouldn't be so bad if it weren't consumed primarily deep-fried, massively processed, and drowning in saturated fat. In fact, a medium baked potato with skin (173g) has 163 calories, no fat, and provides an excellent source of potassium and vitamin C. This same serving contains a good source of fiber, magnesium, copper, manganese, niacin, vitamin B6, and folate. Potatoes also supply chlorogenic acid – a phytonutrient, which research shows may block the formation of carcinogenic nitrosamines and reduce the risk of liver and colon cancers. A recent British study discovered compounds in potatoes called kukoamines, which may lower blood pressure levels. When eating a potato, leave the skin on for added fiber and nutrients.
 
So, if you've been "dissing" some of these nutrition "heroes" as "zeroes," try making room for them on your plate, and discover they're far more yum-yum than ho-hum.

CURRIED BUTTERNUT SQUASH/APPLE SOUP

Prep: 25 min.
Cook: 30 min.
Servings: 4

4 teaspoons olive oil, divided
1 1/2 cups chopped DOLE Onions, divided
1/3 cup sliced DOLE Peeled Mini Carrots
1/3 cup chopped DOLE Celery
2 cups peeled and diced butternut squash
2 1/2 cups fat-free, reduced-sodium chicken broth
4 teaspoons chopped DOLE Cilantro, divided
1 small DOLE Apple, peeled and diced
1 to 1 1/2 teaspoons curry powder
4 dollops low-fat plain yogurt

HEAT 3 teaspoons oil in large pot over medium heat. Add 3/4 cup onions, carrots and celery; cook until vegetables are tender, about 7 minutes. Add squash; cook 4 minutes. Add broth and 2 teaspoons cilantro; bring to a boil; reduce heat. Cover; simmer until vegetables are tender, about 10 to 12 minutes.

HEAT remaining 1 teaspoon oil in medium nonstick skillet over medium heat. Add remaining 3/4 cup onions and cook until golden, about 3 minutes. Add apple; cook 2 minutes. Add curry powder; cook and stir 30 seconds. Remove from heat and set mixture aside.

POUR half of the soup into the blender or food processor. Cover; blend until smooth. Repeat with remaining soup.

POUR blended soup into large pot; stir in curry-apple mixture. Heat soup over low heat until heated through. Garnish soup with yogurt and remaining cilantro.

Per Serving: 138 calories, 5 g fat (1 g sat.), 1 mg cholesterol, 69 mg sodium, 22 g carbohydrate
(4 g dietary fiber, 9 g sugars), 4 g protein, 177% vitamin A, 37% vitamin C, 9% calcium, 6% iron, 14% potassium, 10% folate

BUFF – OR BLUFF?
Cosmetic Enzyme Claims Dissolve Under Scrutiny

We're not immune to the seduction of products that promise a more beautiful complexion via natural fruit enzymes.  If anything, our familiarity with the powerful proteolytic activity (digestion of dead protein cells) of pineapple and  papaya makes us all the more intrigued...so intrigued that we decided to take a couple of famous name brand products into our DNI laboratories to check out the enzymatic action.

Unfortunately for consumers who buy high priced pineapple and papaya enzyme masques and scrubs – it turns out that there's more bluffing than buffing going on. Sure, the skin care manufacturers might be putting pineapple or papaya into their peels and potions, but the active enzymes don't survive the processing that makes these products shelf stable. 

Bromelain (the active enzyme in pineapple) and papain (in papaya) are found only in fresh or frozen whole fruit – not in jars and tubes. 

If you're interested in letting these awesome enzymes invigorate your complexion, you're better off trying one of our do-it-yourself treatments made from the real thing.

As featured in previous Dole Spa sections, our Lana'i Pineapple Body Scrub works wonderfully at smoothing rough, calloused or flaky skin. Another natural recipe for dealing with imperfect skin, our tingling Papaya Peel will help you put your best face forward.

SUPERFOODS

Learn which foods have targeted health benefits to K.O. disease.