The EALM Blog Shelf

While Laura Cipullo and the Laura Cipullo Whole Nutrition Team work on some new and exciting projects, you may notice less posts on the Eating and Living Moderately Blog. We have created a “blog shelf” below to keep you entertained and educated. Get caught up on the latest nutrition education by clicking on each year below. We will send you nutrition updates, but we will not be inundating your mailboxes on a weekly basis. If you want weekly “love” and inspiration, subscribe to our Mom Dishes It Out blog for weekly posts and recipes. Mom Dishes It Out provides expert advice from mom Registered Dietitians and mom Speech Pathologists on the “how to” of health promotion!

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The EALM Blog Shelf

Please feel free to peruse our posts organized by year below. Or take a look at the categories listed at the bottom of the page to find a post in the desired.

2015

2014

2013

2012

2011

2010

I Scream, You Scream, We All Scream For Lycopene!

I Scream, You Scream, We All Scream For Lycopene!
By Alyssa Mitola, RD and the Laura Cipullo Whole Nutrition Services Team

Photo Credit: jacki-dee via Compfight cc
Photo Credit: jacki-dee via Compfight cc

What is Lycopene? Lycopene is a powerful antioxidant. Although chemically related to vitamin A, lycopene does not function in our bodies like the vitamin. Rather lycopene serves as the most powerful antioxidant of the >600 carotenoids, riding our body of harmful free radicals and oxidizing species. Lycopene is a red pigment found in fruits and vegetables. You may already know that tomatoes are a rich source of lycopene, but lycopene is also found in guava, papaya, watermelon, grapefruit, and apricots.

Photo Credit: EJP Photo via Compfight cc
Photo Credit: EJP Photo via Compfight cc

Lycopene is constantly being researched for its potential health benefits, most notably in relation to cancer and cardiovascular disease. The strongest research comes from lycopene’s role in preventing prostate cancer. Many studies have found that people with higher intakes of lycopene have reduced rates of prostate cancer (Giovannuci et. al 1995; Zu et. al 2011). In addition, a 2013 study published in the British Journal of Medicine showed people consuming higher amounts of lycopene had less incidences of cardiovascular disease. Researchers are also currently investigating lycopene’s role in sunburn, gingivitis, osteoporosis, asthma, and mental disorders.

 

The health benefits of lycopene are numerous and we should try to include sources of lycopene daily. However, this does not mean lycopene should be taken as a supplement. Rather lycopene should come from a diet rich in fruits and vegetables. Lycopene is actually more bioavailable (available to our bodies) when it is heated. Therefore foods like tomato puree, tomato sauce, tomato paste, and tomato juice are even richer sources of lycopene. When purchasing tomato-based products, be sure to look out for no sodium or low sodium products. Eating lycopene with a healthy, fat like olive oil, will also increase your body’s ability to absorb the lycopene. With tomatoes in season get your fill of lycopene. Serve your tomatoes with some olive oil or make some homemade salsa, a tomato salad, or a fresh pot of tomato sauce!

  

 

References:

1) Giovannucci E, Ascherio A, Rimm EB, Stampfer MJ, Colditz GA, Willett WC. Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst. 1995;87(23):1767-1776.

2) Fielding JM, Rowley KG, Cooper P, et al.: Increases in plasma lycopene concentration after consumption of tomatoes cooked with olive oil. Asia Pac J Clin Nutr 14 (2): 131-6, 20.

3) Holzapfel NP, Holzapfel BM, Champ S, Feldthusen J, Clements J, Hutmacher W. The Potential Role of Lycopene for the Prevention and Therapy of Prostate Cancer: From Molecular Mechanisms to Clinical Evidence. Int J Mol Sci. 2013;14(7): 14620-14646.

4) Zu K, Rosner BA, Clinton SK, Loda M, Stampfer MJ, Giovannuci E. Dietary Lycopene, Angiogenesis, and Prostate Cancer: A Prospective Study in the Prostate-Specific Antigen Era. JNCI J Natl Cancer Inst (2014) 106 (2).

5) Jacques P, Lyass A, Massaro JM, D’Agastino B.  Relationship of lycopene intake and consumption of tomato products to incident CVD. British Journal of Nutrition (2013), 110, 545-551.

6) Story E, Kopec RE, Schwartz SJ, Harris GK. An Update on the Health Effects of Tomato Lycopene. National Institute of Health Annu Rev Food Sci Technol. 2010; 1: 1-24.

 

Don’t “Defriend” Fat

Don’t “Defriend” Fat
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

 

In the 70’s, we banned fat. In the 90’s we banned carbs – and neither really worked to improve our lifestyles and relationships with food. As new research comes out regarding the best ways to eat for a healthy body, heart health, brain health – you name it – our food industry adjusts accordingly to provide these foods for us to eat. But what if we simply had a neutral relationship with food and a positive relationship with eating? It seems we would be more likely to eat exactly what our bodies need and avoid the foods our bodies can do without.

Photo Credit: misterbisson via Compfight cc
Photo Credit: misterbisson via Compfight cc

Recently, an article was published in TIME Magazine with the title “EAT BUTTER.” There’s something that will catch the reader’s eye, but what is behind the cover? For over 40 years, Americans have been on a low-fat craze because it was believed to be the best way to preserve our hearts from heart disease. Turns out, the research was misleading and the way we interpreted the research was not any better for our bodies. According to Marion Nestle, professor of Nutrition, Food Studies and Public Health at New York University, ideally we thought “that if people reduced saturated fat, they would replace it with healthy fruits and vegetables.” What really happened was people replaced those calories with processed foods and snacks like low-fat cookies, cakes, crackers and more.

We started regaling fats as “good” fats and “bad” fats, and we did the same with cholesterol. Giving these positive and negative titles to foods can lead to overeating and or food avoidance. It is important to understand that fats, like all foods, are neutral. They are essential in our diet for brain health, blood sugar regulation and for keeping us feeling full. Carbs (sugar, fruits, vegetables, grains, dairy) are also essential in our diet for energy, fiber, vitamins and minerals. Avoiding one or the other can lead to undernourishment and side effects like fatigue and mood swings.

Photo Credit: Pauline Mak via Compfight cc
Photo Credit: Pauline Mak via Compfight cc

In 1996, Dr. Walter Willet published research concluding that removing fat from our diets and replacing that void with carbohydrates does not reduce our risk for heart disease. It just so happens that around the time this study was published, the Mediterranean diet started gaining popularity. All fats are important. All carbs are important. All proteins are important. There is actually research supporting Mediterranean diets with 40% fat. But the fat source is mainly monounsaturated fats. Remember, when you eat fats like dairy, oils, nuts, and so on, you are typically getting a bit of saturated and unsaturated fat. So while the jury is still out, stick with moderation and try to eat more wholesome nutrition the majority of the time.

Ultimately, the TIME article is not saying Americans should drop everything and start eating butter or loading up on saturated fat. The message seems to be implying that we should no longer be afraid of fat, and we can start incorporating all types of fat in moderation. It’s time we changed our thinking from exile to acceptance. Allowing ourselves to have access to all foods will decrease the desire to resist any particular nutrient or food group. We will all be healthier for it.

Fish Oil Linked to Prostate Cancer?

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Prostate cancer is the second leading cause of cancer death for men in the United States. In fact, according to the American Cancer Society, 1 in 6 men will be diagnosed with prostate cancer at some point in their lifetime. Some studies suggest that omega-3 fatty acids may reduce the risk of certain cancers and have anti-inflammatory properties but the ACS reports that such studies are still inconclusive.  But with so much talk about the Mediterranean diet and omega-3 fatty acids lowering the risk of heart disease, chances are that you or someone you know is probably consuming more fish oil supplements or eating more fatty fish like salmon, herring, or mackerel. Despite the health benefits of omega-3 fatty acids, a recent study found that fish oil may increase the risk of high-grade prostate cancer.

The latest study on the association between prostate cancer and omega-3 fatty acids, “Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial,” was published in the Journal of the National Cancer Institute, and was funded by National Cancer Institute and the National Center for Complementary and Alternative Medicine. The study analyzed levels of omega-3 fatty acids in the blood of 834 men who had been diagnosed with cancer, and 156 of them were diagnosed with high-grade cancer. (In the study, researchers defined omega-3 fatty acids as EPA, DPA and DHA.) They then compared the results with blood samples from 1,393 cancer-free men. Men with the highest level of omega-3 had a 43% increase in risk for prostate cancer and a 71% increased in risk for high-grade cancer (the most fatal) (Brasky, JNCI 2013).

It’s important to note that the study shows that there is an association between increased omega-3 fatty acid plasma levels and prostate cancer but does not demonstrate that the intake of omega-3 fatty acids causes prostate cancer. The study measured blood levels in the participants but did not include information on their eating habits. Thus, the effect between fatty acids from a fish source or supplements is not differentiated. As of now, the cause and effect relationship of the two is still unknown and much more research is needed. The study concludes that men with a history of prostate cancer should discuss with a health professional if fish oil supplements are safe for them. Since fish oil supplements are a concentrated form of omega-3 fatty acids, it can add up to a lot.

While the study sends a conflicting message to many who follow the Mediterranean diet or taking supplements, it’s simply important to remember that consuming any food in excess is not healthy. Men would benefit from consulting their doctor while continuing to read relevant research on this topic before taking fish oil supplements.

To learn more, check out the American Cancer Society for more information.

Love Your Heart with 8 Heart-Healthy Foods

February isn’t just the month of flowers, chocolates or spending time with the ones you love..but as heart health month, it’s also about loving your heart! Heart disease remains one of the leading causes of death for both men and women1. Lifestyle choices play a major role in preventing heart disease as well as controlling it. With this in mind, it’s never too early to start focusing on overall heart health. Show your heart how much you appreciate it by incorporating these heart healthy foods!

Berries – Please your heart with antioxidant rich berries like strawberries, goji berries and blackberries, which are an antioxidant powerhouse! Blueberries for example, house high amounts of phytonutrients like anthocyanidins, which aid in the process of neutralizing free radical damage in our cells. Consuming 1-2 portions of berries daily may help reduce cardiovascular disease risk2.

Brussel Sprouts – Tender, crunchy and just a little bit nutty, brussel sprouts have more to offer than just flavor. This cruciferous veggie contains vitamin C and vitamin A which help fight against heart disease, and vitamin Its high fiber content aids in digestion, helps lower cholesterol and reduces the risk for developing heart disease, stroke and hypertension3.

Chia Seeds – Chia seeds contain a high level of soluble fiber, which helps slow down digestion and regulates blood sugar levels. Soluble fiber can help lower LDL cholesterol, reduce risk for cancer and cardiovascular diseases. Just three tablespoons of these seeds can provide 37-44% of the American Heart Association’s recommended amount of fiber per day. Two tablespoons of chia seeds provide a 3:1 ratio of omega-3:omega-6 FA. With 3x more omega-3 than omega-6, adding chia seeds to a diet can help an individual reach optimal health by balancing out the ratio of fatty-acid intake in one’s daily nutrition. To learn more about chia seeds, click here.

Collard Greens – This cruciferous veggie is high in vitamins A,C, K and folate. It contains antioxidants and provides us with anti-inflammatory benefits.

Greek Yogurt – Low in saturated fat and cholesterol, Greek yogurt makes for a heart-healthy snack. It’s high in protein and calcium, which can help you stay fuller longer, while strengthening your bones.

Olives – Monounsaturated fats in moderation are heart-healthy fats that help lower blood cholesterol levels4. A rich source of monounsaturated fats is olives, which have been shown to lower LDL (“bad cholesterol”) and increase or maintain HDL (“good cholesterol”).

Salmon – High in omega-3 fatty acid, DHA and protein, salmon helps lower blood pressure and reduces inflammation5.

Wheat germ – Packed with B vitamins, the nutrients found in the grain play a vital role in maintaining heart-healthy bodily functions. In addition to lowering the risk of heart disease, B vitamins like folate are especially for women of childbearing age as well as any woman eating too little veggies or fruits. As an excellent source of fiber, wheat germ helps control cholesterol.

Omega-3 and Omega-6 Fatty Acids: The Scoop You Didn’t Know

Over the past few years, omega-3 fatty acids have received a lot of attention and promotion. Yet when you pick up your supplements at the local pharmacy or health food store, the label includes omega-3’s, omega-6’s omega-9’s and oh my mega confusion! What is the difference between these essential fatty acids and what is this talk about keeping a ratio? This blog will help demystify the omega-3 fatty acids versus omega-6 fatty acids confusion. Find out if you need to add omegas to your nutritional intake and which omega.

The Difference Between Omega-3 and Omega-6

Both omega-3 and omega-6 are termed ‘essential fatty acids’ (EFA), since our bodies cannot readily produce these, we must obtain them through foods or supplements.

While there are many types, the three most common omega-3 fatty acids are Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), and Alpha Linolenic Acid (ALA). DHA and EPA are mainly found in cold-water fish like tuna, salmon, and sardines, while ALA is found in plant sources like canola oil, walnuts, flaxseed, and soybeans. Unlike DHA or EPA, which can be readily absorbed by our bodies, ALA from plant sources like seeds, nuts or vegetable oils are only partially converted (about ten percent) by our bodies into the beneficial forms EPA and then DHA. Studies have shown that the health benefits of EPA and DHA are greater than ALA. Therefore, the goal is to try to get Omega 3 FA’s in the form of DHA and EPA.

Unlike omega-3‘s, omega-6‘s consists of only one type of fatty acid, Linoleic Acid (LA), which is later converted into Gamma-Linolenic Acid (GLA). As opposed to omega-3‘s, getting omega-6‘s from the foods we eat daily, is rather simple. LA is commonly found in seed oils like corn, canola, sunflower and soy — ingredients found in many of the processed foods Americans typically consume in abundance. The better sources of omega-6’s include raw nuts, like pistachios and seeds like chia. Since Americans typically consume much more of the fatty acid omega-6, it is more important for one to focus on including omega-3 fatty acids in their diet or through their supplement. However, for an individual following a low processed food lifestyle such as a paleo, vegan or vegetarian diet, omega-6’s must be included. A great source of an omega-6 fatty acid is the seed known as chia.

Helpful Hint: Two tablespoons of chia seeds provide a 3:1 ratio of omega-3:omega-6 FA. With 3x more omega-3 than omega-6, adding chia seeds to a diet can help an individual reach optimal health by balancing out the ratio of fatty-acid intake in one’s daily nutrition.

Both Are Beneficial

Omega-3’s have been found to lower the risk factors for heart disease and cancer, as well as have anti-inflammatory properties (whereas some omega-6 can contribute to inflammation). This fatty acid is necessary for brain function, healthy development of nerves and eyesight. Omega-3’s have been linked to the prevention and treatment of several other conditions like arthritis, ADHD, Alzheimer’s, depression, diabetes, high cholesterol and blood pressure, diabetes, stroke and osteoporosis to name a few.

Omega-6’s provide a defense against and can aid in reducing symptoms in diabetic neuropathy, rheumatoid arthritis, eczema, allergies and high blood pressure. Studies also show that consuming 5-10 percent of energy from omega-6’s may help decrease the risk of CHD and cardiovascular disease.

Together, omega-3 and omega-6 fatty acids produce many of the health benefits described above. The catch? Eating them in the right amounts.

As In Most Things, Balance Is Key

In today’s society, the convenience of fast-food and heavily processed snacks makes for a not-so convenient way for us to maintain a balanced consumption of both omega-3 and omega-6 fatty acids. Most processed foods contain a high amount of omega-6 and data shows that a Western diet may contain too much omega-6 fatty acids. If we recall, some omega-6’s may promote inflammatory properties but too much can result in inflammation. Recent research suggests that this imbalance may contribute to health conditions like heart disease, diabetes, and more. One such study shows that while the dietary intake of omega-3:omega-6 ratio should range from 1:1-4 for optimal health, the evolutionary changes in the Western diet has led to an increase in consumption range of 1:10-20. To reach a healthier balance between the two, experts suggest that a lower ratio of omega-3/omega-6 fatty acids is more desirable for reducing the risk of many chronic diseases.

However, just as important as it is to consume a healthy ratio of the two, it is equally important especially for vegetarians and vegans, to consume enough essential fatty acids as to prevent deficiencies. Remember, as remarkable as omega-3 and omega-6 fatty acids exhibit in aiding our brain development, immune system function and blood pressure regulation, sources should be consumed in healthy moderation!

Take Home Message:
Aim for a dietary intake with a ratio of 1 omega-3 FA : 1-4 omega-6 FA.

The Epidemic of Diabetes

Hydrate with water, not soda

Regardless of weight and age, America is heading towards a Diabetes epidemic. Americans must change their lifestyles by moving more, and eating less.

Diabetes does not discriminate based on overall weight. America needs to focus on decreasing belly fat, specifically, eating less processed food and moving more.

 

Based on the study reported in the Journal of Pediatrics, Diabetes is increasing in our teen population. There was a 14% increase in prediabetes and diabetes in a ten year period. In 1999 – 2000, there was a 9% incidence of prediabetes and diabetes in teenagers between ages 12- 19. In 2007- 2008, there was a 23 % incidence of prediabetes and diabetes. This is more than two fold. However, the study also revealed this was regardless of weight. Across the weight spectrum, all teens had an increase in the incidence of Diabetes. In my mind, this is a Diabetes Epidemic not an obesity epidemic.

Obesity did not increase in our youth during this ten year period from 1999 – to 2008. One study from the NHANES reports an actual decrease in teen obesity, despite an increase in prediabetes and diabetes. Also, half of the participants in the study had at least one risk factor for cardiovascular disease, which means everyone needs intervention.

So what is the intervention? It depends on who you ask but the many agree America must move more, eat less processed food, and practice stress relief. America is eating too much and not moving enough. We are a culture of convenience. People need to eat because they are hungry rather than bored. We need to eliminate highly processed food such as chips and soda. We need to feel full with fiber and drink for hydration. Simple solutions are to replace chips with fiber rich berries and soda with bubbly water like Perrier. Ideally, we need to decrease insulin resistance and belly bulge (aka abdominal obesity).

The study admits to flaws. One of the flaws is the tool BMI – Body Mass Index. This measurement tool uses overall weight and height, not accounting for muscle mass and frame. Football players are considered obese when using BMI. A better tool to assess for obesity, belly fat, insulin resistance and or risk for diabetes would be the waist to height ratio. This tool would not qualify the typical football player as obese.

On Tuesday, I had the opportunity to share some of these thoughts with the HLN audience. Click here to see the clip.

 

May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999−2008. Pediatrics. 2012;peds.2011-1082.

The Truth Behind Coffee

The Truth Behind Coffee

For many, there’s nothing like a cup of coffee to start the day. As one of the most widely consumed
beverages in the world, it has long been debated that consuming coffee can lead to health problems.
These misconceptions can often lead to confusion about whether one can enjoy coffee as part of
a healthy diet. As an avid coffee drinker myself, with all the misconceptions about coffee, it is
necessary to dispel the misconceptions, and discover the truth behind coffee.

What are 3 of the most common misconceptions about coffee and health?

There is a misconception that coffee causes heart disease, should be omitted during pregnancy
and may influence the development of breast cancer. However, recent research reveals that
despite coffee consumption being associated with increased blood pressure and plasma
homocysteine levels, it is not directly related to heart disease. As for omitting coffee during
pregnancy, although women are often advised to follow this by their obstetrician or gynecologist,
studies show that coffee intake equal to 3 cups or 300 mg coffee daily does not increase risk for
impaired fetal growth. Moreover, according to the National Institutes of Health-AARP Diet and
Health Study, there is no correlation between coffee intake and increased breast cancer risk. In
fact, coffee may even help to prevent breast cancer. While there may be minimal associations and
even benefits to drinking coffee, it is not recommended to start drinking coffee, if you don’t
already.

Can drinking too much coffee cause heart problems?

Recent research reports coffee drinkers are not at a greater risk for heart disease. While a mild
stimulant in coffee, caffeine, has been shown to increase heart rate, blood pressure, homocysteine
levels, and cholesterol levels, most people do not experience heart problems from drinking coffee—
even if they consume up to 6 cups daily. If you have heart disease or heart problems, it is best to
consult your doctor about drinking coffee.

In addition, it is important to pay attention to what is being added to the coffee; whether it is
whole milk, sugar or even whip cream. Remember, in this day and age specialty coffee drinks are
extremely popular and research studies black coffee, not Frappuccino’s.

What are the top 5 benefits of drinking coffee?

An increase in coffee consumption is typically associated with a lowered risk of Diabetes Type II,
but does not prevent Diabetes Type II. Research also suggests coffee consumption may help prevent
Parkinson’s disease, liver disease (cirrhosis and hepatocellular carcinoma), reduce the risk of
Alzheimer’s disease, and improve endurance performance in physical activities such as cycling and
running.

Is there such a thing as drinking too much coffee?

Typically, I educate my clients to keep their intake at 2 or less cups a day. More than 2 cups of coffee
can be counter-productive during a fitness workout. Recent studies indicate that there have been
no harmful effects with intakes at 4 cups equivalent. For adults consuming moderate amounts
of coffee (3-4 cups/d providing 300-400 mg/d of caffeine), there is little evidence of health risks
and some evidence of health benefits. In addition, currently available evidence suggests that it
may be prudent for pregnant women to limit coffee to 3 cups/day ( prevent any increased probability of spontaneous abortion or impaired fetal growth. People with
hypertension, children, adolescents, and the elderly, may be more vulnerable to the adverse effects
of caffeine.

Do the benefits differ between decaf and regular coffee?

In terms of Diabetes, other than the difference of 2-4 mg caffeine between regular and decaf,
there are no beneficial differences between the two. Surprisingly however, decaf coffee has been
associated with acid reflux and gastric ulcers.

Bariatric Surgery and Diabetes

Bariatric surgery can reverse Diabetes, but The Endocrine Society recommends people take caution before taking extreme actions.

 

Two points I found interesting include:

Remission in diabetes may be a result of the hormonal changes in the intestines after bariatric surgery.

“Observational studies have suggested that weight loss surgery can rapidly improve glycemic control and even produce remission of diabetes in severely obese patients with type 2 diabetes. This improvement and/or remission of diabetes is noted before meaningful weight loss occurs, and is thought to be due to a weight-loss independent change in the incretin hormone milieu as a result of the alteration in intestinal anatomy.  Complete remission is defined as a fasting glucose level below 101 mg per deciliter and a glycated hemoglobin level of less than 6.0% for at least 1 year without active pharmacologic therapy. Until now, however, there has been a paucity of randomized controlled trials showing greater efficacy for surgical versus medical therapy, and for the variety of weight loss procedures available.”

 

Bariatric surgery should involve decision making regarding the ability to make long term lifestyle changes and be supported by a multidisciplinary team.

“The Endocrine Society recommends that practitioners consider several factors in recommending surgery for their obese patients with type 2 diabetes. These include the patient’s BMI and age, the number of years of diabetes, and an assessment of the ability to comply with the long-term lifestyle changes that are required to maximize success of surgery and minimize complications. Importantly, shared decision-making is critical in making a decision about bariatric surgery. The success of weight loss surgery in patients with obesity and diabetes ultimately depends on the partnership of patient, endocrinologist, surgeon, and a support team in the continuum of the long-term care of the patient.”

 

Read the article at http://www.endo-society.org/advocacy/policy/upload/Bariatric-Surgery-and-Diabetes.pdf.

Love Your Heart With Oats

Love Your Heart With Oats

The oats found in oatmeal are a rich source of beta-glucans which provide a source of dietary fiber to the body. The beta-glucans found in oats and other grains such as barley and rye contain soluble and insoluble fiber. Soluble fiber has been shown to lower cholesterol levels and can also regulate blood glucose levels due to the way it is digested in the body. The insoluble fiber helps keep your bowel movements regular! Beta-glucans have also been claimed to boost immunity.

 

5 Tips for Getting the Grains:

Add oats to a cookie or muffin recipe.

Include barely in soups and stews.

Swap sprouted barely bread for other sandwich breads.

Hide oats in your turkey meatloaf.

Start your day with hot oat bran cereal and slivered almonds.

Recipes to Rave About:

American Heart Association’s Oat Recipes – http://bit.ly/y8KOq9

Heart Healthy Living has a list of 21 oat and oatmeal recipes so you can have a nutritious breakfast that never gets boring. (Oatmeal also makes a great snack!)

http://www.hearthealthyonline.com/cholesterol/lower-cholesterol/healthy-oatmeal-oat-recipes_ss1.html

Picture: <p><a href=”http://www.freedigitalphotos.net/images/view_photog.php?photogid=901″>Image: Michelle Meiklejohn / FreeDigitalPhotos.net</a></p>