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01/28/2004
Pyramids and Loco Stuff
The other day my wife and I spotted tracks in our snow-covered
backyard. I followed the tracks up to our rhododendron bush
under our breakfast room window. Sure enough, the deer had
feasted on all but one of the buds that would have bloomed this
spring. Needless to say, we were not happy with the dietary
choice of this intruder. Last week, we talked about how another
intruder, a small frog, has invaded Hawaii, causing sleepless
nights for many of its residents. Could it be the sleepless nights
that have driven many Hawaiians to embrace as their “comfort
food” a dish known as the “loco-moco”? Loco in Spanish is, of
course, the word for “crazy”. My friend Dan in Honolulu called
my attention to the loco-moco and described it as being a bowl of
rice topped with a hamburger and a fried egg and an “ono” gravy
(a good gravy).
At first, I questioned the loco-moco as an acceptable choice from
the standpoint of a healthy diet. However, with the choice of a
healthy diet so controversial these days, who’s to know? We’re
besieged with testimonials of people who have lost weight by
following the cabbage soup diet, the Scarsdale diet, the Weight
Watchers program, etc., etc. The list goes on and on. Even Bill
Clinton exposed a flattened tummy recently, attributing it as I
recall to the South Beach diet. Diets range from the super low-
fat, near-vegetarian regimen of nutritionist Dean Ornish to the
high-fat, meat-rich diet of Robert Atkins, whose widow is now
engaged in a feud with New York’s Mayor Bloomberg over a
joke he told involving her late husband.
Ornish’s diet has been shown to be beneficial in stopping and
even clearing coronary blockages in heart patients, while the
Atkins diet, in recent reputable studies, has been associated with
weight loss and improved cholesterol profiles. Confused by the
extremes of apparently healthy diets, I welcomed the article titled
“What Does Science Say You Should Eat?” by Brad Lemley in
the February 2004 issue of Discover magazine. The article deals
primarily with the work of the chairman of the department of
nutrition at the Harvard School of Public Health, Walter Willett.
Willett’s proposed “Healthy Eating Pyramid” has attracted
considerable media attention but I hadn’t realized until I read the
Discover article that my wife has played and is playing a key role
in Willett’s work.
To tell the truth, it’s unlikely that Willett knows my wife’s name.
However, she is one of the 121,700 nurses in Harvard’s Nurses’
Health Study initiated in 1976. Every year, she gets a lengthy
questionnaire to elicit details about her health, diet, smoking,
alcohol intake, etc. In 1980, Willett took charge of assessing the
dietary data provided by the nurses. Willett also launched two
more studies: the Health Professionals Follow-Up Study that
includes 50,000 men and a study of 116,000 younger women, the
Nurses’ Health Study II. With a quarter of a million participants,
these studies contrast sharply with dietary studies on animals or
on small groups of people.
Back in the 1980s, there was a growing consensus that fat, which
constituted about 40 percent of the typical American diet, was
responsible for the blockages of blood vessels leading to heart
attacks. Following a National Institutes of Health conference,
the word went out that Americans should lower their fat intake
from 40 to 30 percent. In 1992, the U. S. Department of
Agriculture (USDA) took up this doctrine and incorporated it in
its “Food Guide Pyramid”. At the base of this pyramid are the
bread, cereal, rice and pasta group, with suggested consumption
of 6 -11 servings a day. At the top, pointy part of the pyramid
are the fats, oils and sweets group, to be eaten “only sparingly”.
In between, are the vegetable (including potatoes) and fruit
groups (3-5 and 2-4 servings, respectively), the milk, yogurt and
cheese group (2-3 servings) and the meat, poultry, fish, dry beans
and nuts group (2-3 servings).
Enter Willett, who characterizes the USDA pyramid as offering
scientifically unfounded advice that has contributed to the
obesity problem and has led to unnecessary deaths. He points to
the appearance of all sorts of low-fat foods and the soaring of
carbohydrate consumption as leading to the current obesity
epidemic. Strong criticism of the USDA guidelines! Willett
backs up his view with data published in the December 2002
issue of The American Journal of Clinical Nutrition. Men who
followed diets most closely aligned with Willett’s Healthy Eating
Pyramid reduced their risk of major chronic disease by 20
percent compared to 11 percent for men following most closely
the USDA Pyramid. For women, the figures were 11 and 3
percent, respectively.
Willett’s quarrel with the USDA pyramid is multifold. To form
his Healthy Eating Pyramid, he takes white bread, white rice and
pasta from the USDA pyramid’s base group and moves them to
the top pointy “use sparingly” category. Here they join sweets
and potatoes, the latter no longer considered as a vegetable. Red
meat and butter share the “use sparingly” tip of the pyramid. The
potato-less vegetables are in the “use in abundance” category in
Willett’s pyramid, just above the base, which now consists of
plant oils and whole grain foods to be consumed “at most
meals”. Why the promotion of oils from the tip to the base of the
pyramid? It’s Willett’s separation of “good’ fats and oils from
the “bad” ones. Willett credits Atkins with having the right idea
in his low-carb approach but faults him in not making the good
fat-bat fat distinction. The Discover article summarizes Willett’s
regime as the “good carb, good fat” approach.
Actually, the real base of Willett’s pyramid is not a food group;
it’s daily exercise, which Willett thinks is essential and confirms
that walking is the best choice for many people. My wife
certainly must have contributed via the Nurses’ Health Study to
that conclusion. She walks and exercises religiously and the
study indicates that women who walked an average of three
hours a week were 35 percent less likely to have a heart attack in
an 8-year period than women who walked less than that.
The medical basis of Willett’s pyramid involves those
carbohydrates such as potatoes, rice and pasta being converted to
glucose by the enzyme amylase. The glucose in turn causes the
pancreas to put out insulin to conduct the glucose into our cells.
Too much glucose is bad and over a period of time the cells
become insulin resistant and the glucose levels stay high. The
pancreas is prodded to produce more insulin to try to get the
glucose into the cells. All this can lead to type 2 diabetes and, in
Willett’s opinion, other health risks. He is joined by Stanford
endocrinologist Gerald Reaven, who coined the term “Syndrome
X” to represent the host of diseases ranging from coronary heart
disease to various forms of cancer that he claims result from
insulin resistance.
There’s much more in the Discover article about Willett’s
conclusions on the optimal choices for a healthy diet. Some of
his ideas were greeted with skepticism initially but are now
gospel. I may continue with more on Willett and other diet-
related topics in the near future, perhaps next week, but I must
get back to the loco-moco.
It turns out that my friend Dan’s loco-moco was a relatively
primitive version of the Hawaiian comfort food. The loco-moco
has not remained a static dish, but has evolved over the years. I
found on the Web mention that “the place” to experience the true
loco-moco is the Cafe 100 restaurant in Hilo on the Big Island of
Hawaii. I was horrified to find that the restaurant’s Kilauea
Loco-Moco is comprised not only of the rice, hamburger, fried
eggs (two, not one!) and gravy but also has a slice of Spam (not
the electronic kind), 4 links of Portuguese sausage, a side of
Korean kim chee, a scoop of chili over the rice and some
macaroni salad! Dan tells me kim chee is made with cabbage or
won bock with plenty of chili pepper in it and that it will “blow
the hair right off your head”! I’ll leave it to you to figure out
how the Kilauea Loco-Moco fits into any food pyramid!
What is truly frightening is that the loco-moco, like the coqui,
may find its way from its native soil to foreign territory. It has
evolved from its original form in 1949 as just rice, hamburger
and gravy to the Kilauea. Should it reach mainland USA, just
imagine what will happen. The loco-moco will evolve even
further, becoming super sized in fast food establishments and
French fries will be added! We will be doomed!
OK, I admit that, if I ever get to Hilo again, I will probably
search out the Cafe 100 and try its version of the ultimate loco-
moco. And I’m thinking that maybe, if we put out a loco-moco
next year, the deer would eat it and leave our rhododendron buds
alone.
Allen F. Bortrum
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