Take it or leave it.

Tuesday, June 18, 2013


I remember the day as if it were yesterday. I was living in Colorado, where I was an intern in family medicine. I had just worked a 30-hour shift, beginning at 6 the previous morning and going till noon the following day. Starved and sleep-deprived, I decided to stay at clinic an extra hour and sit in on the lunch lecture. I wanted free food and intended to doze.

The talk was given by a pharmaceutical rep. He was discussing the benefits of a new antihypertensive drug. These drugs lower the blood pressure and reduce the risk of stroke and cardiovascular disease. I already knew about several classes of such medications. Beta blockers, ACE inhibitors, angiotensin receptor blockers (ARBS), calcium channel blockers, and going back to medical school had for each class memorized the the mechanisms of action, side effect profiles, pharmachokinetics and dynamics of several medications, some 20 or more in all. My brain was near bursting with this information and ways of conveying it to patients so that their heads wouldn't burst. Medical training was filled with lessons (didactics) on drugs and their treatments. Never mind that many drugs don't work all that well, in many cases being hardly more effective than placebo.

Needless to say, I fell asleep before the lecture was over.

On my way home from work, I walked into the grocery store in a zombie-like trance. I can't remember what I was looking for. After call shifts I usually made a bee-line to the beer section for a trusty six-pack of some foreign beer or microbrew. On my way to the cold drinks I happened to look to my left, where I noticed the produce section. And there they were. All these different types of leafy green vegetables. More than I had ever seen in one place. Maybe they had just gotten a shipment in, or relocated the section. I don't know, but I had never noticed such a cornucopia. I mean, I knew spinach and lettuce, but there were half a dozen more.

I took a closer look. Spritzed with water, the produce glistened, and fresh scents wafted my way. I read the names of the items. Swiss chard, collard greens, mustard greens, dandelion greens, parsley, oregano, basil and other herbs. All for under a dollar each (2008 prices; now they're closer to $2 or $2.50 per bunch, still relatively cheap). And I thought, why don't I know anything about these foods? Surely they must beneficially impact health, perhaps even prevent some or many of the diseases I am learning how to treat with drugs.

And so I made it my aim to learn about these foods, and to eat them, and if things went well, to recommend them to others.

I ditched the beer idea and filled up my shopping cart with greens, deciding to start with chard.

Swiss chard. A leafy green vegetable similar to spinach. Chard has many health benefits. A one-hundred calorie serving of cooked chard (3 cups) provides 25% or more of 12 essential vitamins, minerals, and fiber, including over 600% of the RDA for vitamin A. Clearly, chard is a nutritional powerhouse.

But let's explore one of the lesser known benefits which pertains to blood pressure and may be of particular interest to the athlete.

Chard is high in nitrates. These compounds are converted to nitric oxide in the body. Nitric oxide (NO) is a powerful vasodilator. This means it enlarges blood vessels, lowering blood pressure while increasing blood flow to the organs. This is particularly important when engaged in exercise. Studies have been conducted using beet juice, a nitrate source. In one study, cyclists were given 16 oz of beetroot juice for six days before an event and increased power output and time trail performance. In another study, beet juice was shown to improve oxygen utilization, meaning cyclists required less oxygen to cycle just as fast.

Chard has a higher nitrate content than beets. In fact, leafy greens have more nitrates than any other vegetables. Don't be dissuaded by the bad press nitrates have received. While it is true that processed meats (cured and smoked beef and pork) are preserved with nitrates, the health risks (particularly the cancer risks) associated with these foods are due to the foods themselves more than the preservatives used; for this reason the American Institute for Cancer Research recommends avoiding all processed meats like the plague they are. This includes bacon and ham. Because of the health benefits of eating vegetables, and the relatively high levels of nitrates in many vegetables, experts are calling into question the low values of nitrate consumption traditionally recommended. The nitrates in whole plant foods should not be avoided but rather emphasized in the diet.

So eat chard. But remember, many nutrients including nitrates are heat sensitive and are destroyed with cooking. Chard is not generally eaten raw, but luckily it requires a very short cooking time, and you will love the silky texture. Simply boil chard for 3 minutes (after removing the stems), mix in some lemon, spices, and maybe some coconut butter, top with fresh tomato and beans, and you have yourself a blood vessel expanding meal that will fuel you to victory in your next event.

By emphasizing chard and other leafy green vegetables you naturally reduce your risk of stroke and cardiovascular disease, lower your blood pressure, and render anti-hypertensives unnecessary, proving once again that your food is your best medicine and farmer's markets are the pharmacies of the future.

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