Monthly Archives: July 2014

Which grain is the best source for protein, essential amino acids, BCAA and arginine?

Listed below are total protein, essential amino acids, branched chain amino acids, and arginine content for quinoa, oats, corn, millet, barley, brown rice and potato. The values provided are for 100 calories, for each respective grain.

Let’s ask some questions:

1. Is there a difference in protein content among these 7 grains?

Yes, there is a difference. Per 100 calories, oats are king, containing more than 2x the amount of protein in barley, the lowest ranking grain on this list. In fact, oats, quinoa and corn each have approximately 2x more total protein than each of the lowest ranking grains, potato, brown rice and barley. Millet is intermediate, at 2.95 grams of protein per 100 calories.

Table 1 Grains

2. Can these grains be considered as “complete protein”?

A “complete protein” is defined as containing all of the 10 essential amino acids (EAA). As shown in the table below, each of the 7 grains contains all of the 10 essential amino acids. Oats contain the greatest amount of essential amino acids (Total EAA), followed by corn and quinoa.

Table 2 Grains

3. Which grain contains the highest amount of branched chain amino acids (leucine, isoleucine and valine)?

The branched chain amino acids (BCAA) leucine, isoleucine and valine are well documented to stimulate muscle protein synthesis (Blomstrand et al. 2006). Oats, corn and millet contain the highest amounts of total BCAA, followed by quinoa, brown rice, potato and barley.

Table 3 Grains

4. Which grain is highest in arginine?

Arginine is the required precursor for the production of nitric oxide (NO), which has been claimed to promote vasodilation in active muscle during exercise, thereby improving strength, power and recovery (Alvares et al. 2011). As shown in the table below, once again, oats contain the highest amount of arginine, followed by quinoa and brown rice.

Table 4 Grains


1) Oats contain the highest amount of total protein, relative to the other grains on this list.

2) All of the 7 grains on this list contain milligram amount of all of the 10 essential amino acids, making each of them a complete protein. Oats contain the highest total amount of essential amino acids, relative to the other grains on this list.

3) Oats also contain the highest amount of branched chain amino acids and arginine, when compared with all the other grains on this list.


Álvares TS, Meirelles CM, Bhambhani YN, Paschoalin VM, Gomes PS. L-Arginine as a potential ergogenic aid in healthy subjects. Sports Med. 2011 Mar 1;41(3):233-48.

Blomstrand E, Eliasson J, Karlsson HK,Köhnke R. Branched-chain amino acids activate key enzymes in protein synthesis after physical exercise. J Nutr. 2006 Jan;136(1 Suppl):269S-73S.

Nutritional data provided by

Grapes vs. Raisins: A Nutritional Analysis

If your goal is optimal nutrition, would you choose grapes or raisins? To most, the obvious answer would be grapes, because they’re less calorie dense than raisins. Grapes contain 20 calories per ounce, whereas raisins contain 85 calories/ounce. But, what if I asked the same question, and you had 100 calories to spend on either grapes or raisins? Although they’re the same fruit-raisins are dehydrated grapes-is there a difference in nutrition, when normalized to calories?

Before delving into the nutritional comparison it is important to briefly discuss what happens during the dehydration process. The grape obtains energy through photosynthesis occurring in the green stem. Once the grape is removed from its stem, it still has an energy requirement that needs to be met. Since the stem is no longer providing this energy, the grape begins to use its own chemical processes to maintain energy demand. At the core of the difference between the raisin and the grape is that once the grape leaves the stem, it starts to break down its own energy stores (ATP) to maintain the cellular energy demand, a process that consumes water.

Are there nutritional differences between the grapes and raisins?

grapes raisins

In the table we see that when normalized to 100 calories, there isn’t a difference in protein, fat or carbohydrate, when comparing grapes and raisins.

grapes raisins2

Among the minerals, Copper content is reduced by more than 40% in raisins when compared with grapes. Copper is a cofactor for the antioxidant enzyme, Copper-Zinc Superoxide Dismutase. That its content reduced in raisins indicates a diminished antioxidant response.

grapes raisins3

Antioxidant depletion in raisins is also evident when looking at the vitamin list. Vitamin C (95% reduced), β-Carotene (100%), Vitamin A (100%), Leutein + Zeaxanthin (100%), Vitamin E: α-Tocopherol (86%), and Vitamin E: γ-Tocopherol (90%) are all dramatically reduced in raisins, when compared with grapes. That raisins are depleted in antioxidants, when compared with grapes is confirmed by looking at their respective ORAC (Oxygen Radical Absorbance Capacity) values: 261 for grapes vs. 113 for raisins.

The B-vitamins riboflavin (59%), pantothenate (56%), and Vitamin B6 (54%), each of which are required for efficient energy metabolism are reduced in raisins.

Finally, both Vitamin K (94%) and choline (neurotransmitter, 54%) are also reduced in raisins, when compared with grapes.

So, if your interest is optimal nutrition, eat grapes, not raisins!


Reference values for raisins and grapes obtained from

ORAC values for raisins and grapes obtained from w…/Data/ORAC/ORAC_R2.pdf

Acrylamide is in Chocolate!

The media often tells us that dark chocolate is “healthier” than milk chocolate because of its high antioxidant content. Yes, this is true: dark chocolate contains more than four times the amount of antioxidants than milk chocolate (~200 Units/gram vs. ~45 Units/gram; Miller et al. 2006).

However, as shown below, what they neglect to tell us is that cocoa powder beats both dark and milk chocolate, with ~800 antioxidant Units/gram! That translates into 4-fold more antioxidants than dark chocolate, and approximately 18-fold more antioxidants than milk chocolate! So, make your own chocolate at home, with cocoa powder, right?

choco aos

Maybe not. To make cocoa powder, cacao beans are first roasted at a high temperature. Roasted cocoa beans are processed to remove its cocoa butter, leaving behind the cocoa solids which are then ground, forming cocoa powder. One could argue that the remaining cocoa powder, when used in chocolate is better for health than using raw (non-roasted), ground cacao beans because cocoa powder has less saturated and total fat. Although this is true, roasting the cocoa bean (or any grain, nut, or seed) produces acrylamide, a compound that has been shown to be both neurotoxic and carcinogenic (Burek et al. 1980; Johnson et al. 1986; Friedman et al. 1995). Raw cacao beans, because they have not been roasted, do not contain acrylamide.

How much acrylamide is in a Hershey’s dark chocolate bar? One 43 gram bar contains approximately 30 grams of cocoa powder (70% cocoa solids). Hershey’s cocoa powder contains 909 µg/kg of acrylamide, and when multiplied by 0.03 kg (30 grams), this yields 27.3 µg total acrylamide. The lowest risk for dietary acrylamide-induced toxicity has been recommended to be less than 1.5µg/kg body weight/day (Shipp et al. 2006). This value translates into 75 µg/day for a 50 kg woman, or 112.5 µg/day for a 75 kg man. So, if you eat one Hershey’s dark chocolate bar, you will have ingested a significant amount towards the 75 or 112.5 µg/day upper limit. It’s important to note that there is indeed difference in acrylamide content when comparing Hershey’s and Ghiradelli cocoa powder: Hershey’s contains 3-fold more acrylamide than Ghiradelli (909 µg/kg vs. 316 µg/kg). Therefore, to minimize acrylamide-related risk, if you’re making your own chocolate at home the best thing to do would be to grind your own raw cacao beans, as I do (

Another food that is thought of as “healthy” are baked potato chips, but they’re not healthy in terms of acrylamide content! Baked! Lay’s Original Naturally Baked Potato Crisps have 31 µg of acrylamide per 1 ounce bag. Listed below are other notable sources of dietary acrylamide, including one unhealthy (Pringles), and others commonly thought to be “healthy”.

1 oz. (16 crisps), Pringles Sweet Mesquite BBQ Flavored Potato Crisps: 70 µg of acrylamide

1 oz. (6 crackers), Health Valley Original Oat Bran Graham Crackers: 43 µg of acrylamide

1 serving (2 oz.), Nature’s Path Organic Optimum Power Breakfast, Flax, Soy, Blueberry: 22 µg of acrylamide

1 oz., Blue Diamond Roasted Salted Almonds: 6.7 µg of acrylamide

2 slices, Arnold Bakery Light 100% Whole Wheat Bread: 5.7 µg of acrylamide


Acrylamide list:

Burek JD, Albee RR, Beyer JE, Bell TJ, Carreon RM, Morden DC, Wade CE, Hermann EA, Gorzinski SJ, 1980. Subchronic toxicity of acrylamide administered to rats in the drinking water followed by up to 144 days of recovery. J. Environ. Pathol. Toxicol. 4,157-182.

Friedman MA, Dulak LH, Stedham MA, 1995. A lifetime oncogenicity study in rats with acrylamide. Fundam. Appl. Toxicol. 27, 95-105.

Johnson KA, Gorzinski SJ, Bodner KM, Campbell RA, Wolf CH, Friedman MA, Mast RW, 1986. Chronic toxicity and oncogenicity study on acrylamide incorporated in the drinking water of Fischer 344 rats. Toxicol. Appl. Pharmacol. 85, 154-168.

Miller KB, Stuart DA, Smith NL, Lee CY, McHale NL, Flanagan JA, Ou B, Hurst WJ, 2006. Antioxidant activity and polyphenol and procyanidin contents of selected commercially available cocoa-containing and chocolate products in the United States. J Agric Food Chem. 31;54(11), 4062-8.

Shipp A, Lawrence G, Gentry R, McDonald T, Bartow H, Bounds J, Macdonald N, Clewell H, Allen B, Van Landingham C, 2006. Acrylamide: review of toxicity data and dose-response analyses for cancer and noncancer effects. Crit. Rev. Toxicol. 36, 481-608.

High Fructose Corn Syrup, Fruit and Health: A Perspective

Consumption of high fructose corn syrup (HFCS) has been linked to a variety of adverse health conditions, including non-alcoholic fatty liver disease, type II diabetes, increased blood pressure, dislipidemia (i.e. decreased good cholesterol, HDL), and obesity (Nseir et al. 2010).

So, consumption HFCS is not good for health. But, I’d like to add a bit of perspective: the main sugar found in fruit is fructose! Is it possible to suffer from the same adverse metabolic effects by eating too much fruit? How much fruit would one have to consume to reach the levels of fructose found in soda?

One 20 oz. soda contains 240 calories and 65 g sugar. All of this sugar comes from HFCS, which is 55% fructose. To determine the amount of fructose in soda, we multiply 65 grams by 0.55, to obtain 35.75 grams of fructose.

How much fructose is contained within fruit? When normalized to the same amount of calories as a 20 oz. soda, bananas contain 16.4 g of fructose; strawberries, 20.1 g; cherries, 20.8 g; blueberries, 21.2 g; oranges (navels), 21.6 g; peaches, 24.0 g; raisins, 24.0 g; pears 27.4 g; grapes, 28.6 g; apples, 32.0 g. So, we see that most fruits, with the exception of apples contain about 10 grams less fructose than that found in a 20 oz. soda.

If you’re worried about the adverse metabolic effects from eating too much fructose, I suggest, upon your next visit to the doctor to pay close attention to your blood test results. If your triglycerides are higher than 60 mg/dL, if your HDL is low (~40 µM), and if you have liver enzyme (ALT and AST) readings higher than 20 U/L, cutting down fructose containing foods would be a good idea.


Fructose values determined via

Nseir W, Nassar F, Assy N. Soft drinks consumption and nonalcoholic fatty liver disease. World J Gastroenterol. 2010 Jun 7;16(21):2579-88.

Raw Vegan vs. Vegan: Which Diet is Best for Optimal for Health?

In a previous article I wrote about how vegans have been shown to have decreased risk of heart disease, cancer, and all-cause mortality. In addition, in 3 separate articles I’ve written about how cooking food at high temperature (above boiling, 212ºF), whether it is roasting, baking, frying or grilling produces molecules that have been shown to shorten lifespan (AGE products), and, that cause cancer in rodents (both acrylamide and furan). Collectively these data indicate that a vegan diet without cooking any of the food at high temperature is optimal for health. However, within the confines of a vegan diet, which is best for health, raw, or raw plus boiled? In this article, I will discuss why a purely raw food diet is not optimal for health.

In short, the reason is because of fructose. Fructose isn’t only found in HFCS, it’s also the main sugar found in fruit. Raw food diets consist of nuts, seeds, fruit and vegetables. However, on a 80-10-10 diet, in which nuts are rarely used, almost all of the calories will come from fruit. For example, bananas contain 27% fructose ( In other words, if you eat nothing but bananas in a single day, this would be equivalent to a 27% fructose diet. And, on the fructose scale, bananas are relatively low in fructose. For example, strawberries, cherries, blueberries, oranges, peaches, pears, grapes, watermelon and apples contain 34%, 35%, 35%, 36%, 40%, 46%, 48%, 53%, 53% fructose, respectively. If you ate nothing but watermelon all day you would be on a 46% fructose diet. So, are there any adverse health effects of this amount of dietary fructose?

The answer is yes: both high and low fructose diets have been shown to elevate blood levels of triglycerides, which are a well documented risk factor for cardiovascular disease (Austin et al. 1998). On a 20% fructose diet for 5 weeks, triglycerides (20%), LDL (12%) and total cholesterol (10%) each increased (Reiser et al. 1989). In contrast, although triglycerides were not found to elevated after 4 weeks of a 20% fructose diet (compared with 3% fructose in the controls) in a separate study, both LDL and total cholesterol were significantly elevated (Swanson et. al  1992). However, evidence from 2 additional studies in humans clearly show the positive association between increased fructose intake and elevated triglycerides. Le et. al (2006) found that fructose supplemented at 1.5g/kg body weight for only 1 month was sufficient to raise blood levels of triglycerides by 36% and VLDL-triglycerides by 72%. The amount of fructose supplemented is the Le study is equivalent to 75g and 105g fructose for a 50kg and 70 kg woman and man, respectively, and can easily be obtained by eating 11-15 bananas. In addition, Faeh et. al (2005) showed that fructose supplemented at 3 grams/kg body weight increased triglycerides by 79%. This amount of supplemented fructose is equivalent to eating 22-30 bananas. In addition, these are relatively low-fructose containing diets.

In contrast, rats fed a 67% fructose diet (the control diet contained only starch) more than doubled plasma triglycerides, increased the concentration of triglycerides in liver, increased liver size, and, decreased liver copper content. The importance of copper depletion is illustrated by its role as a cofactor in the enzyme Copper-Zinc superoxide dismutase (CuZnSOD), the first line of defense against superoxide radicals located in the cytosol of all cells. Depletion of liver copper would be expected to reduce CuZnSOD activity, thereby increasing liver oxidative stress. Indeed, the concentration of lipid peroxidation products was shown to be higher in plasma, heart and urine in rats fed the high fructose diet (Busserolles et al. 2003). The good news is that an all fruit diet would never reach the 67% fructose diet found in the Busserolle study, but evidence from relatively low fructose diets (20%) still show elevations in triglycerides.

If on a raw food diet the answer is to not to eat only fruit, what should be substituted? As mentioned earlier, there is no risk of forming AGE products, acrylamide or furan when boiling food. Therefore, substitution of some amount of fruit on a raw food diet, perhaps one third to half of the total calories should come from whole grains. Boiled whole grains (with vegetables, for the added flavor) is a great way to keep your total fructose intake relatively low. To ensure no loss of nutrients during the boiling process, don’t dump the soup, drink it, it’s delicious! The tocotrienols found almost exclusively in whole grains have been shown to reduce cholesterol (Zaiden et. al 2010), to reduce inflammation (Wu et al. 2008), to reduce DNA damage (Chin et al. 2008), to reduce cancer progression (Wada et al. 2005), and are neuroprotective (Khana et al. 2003). Therefore, when substituting fruit for whole grains, you won’t be sacrificing nutrition!

From a personal experience, in 2011 I switched from a Mediterranean diet to almost exclusively raw vegan. However, my triglycerides, which have never been higher than 60 mg/dL jumped from 40 mg/dL in 2011 to 90 in 2012! Nothing else changed in my routine-the supplements that I take, or how often I exercise, my body weight/composition was the same-only my diet changed. Based on this, it seems like raw plus boiled may be the path to optimal health!

Austin MA, Holkanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 1998;81:7B-12B.

Busserolles J, Gueux E, Rock E, Demigné C, Mazur A, Rayssiguier Y. Oligofructose protects against the hypertriglyceridemic and pro-oxidative effects of a high fructose diet in rats.
J Nutr. 2003 Jun;133(6):1903-8.

Chin SF, Hamid NA, Latiff AA, Zakaria Z, Mazlan M, Yusof YA, Karim AA, Ibahim J, Hamid Z, Ngah WZ. Reduction of DNA damage in older healthy adults by Tri E Tocotrienol supplementation. Nutrition. 2008 Jan;24(1):1-10.

Faeh D, Minehira K, Schwarz J, Periasami R, Seongus P, Tappy L. Effect of fructose overfeeding and fish oil administration on hepatic de novo lipogenesis and insulin sensitivity in healthy males. Diabetes 2005;54: 1907-13.

Khanna S, Roy S, Ryu H, Bahadduri P, Swaan PW, Ratan RR, Sen CK. Molecular basis of vitamin E action: tocotrienol modulates 12-lipoxygenase, a key mediator of glutamate-induced neurodegeneration J Biol Chem. 2003 Oct 31;278(44):43508-15.

Lê KA, Faeh D, Stettler R, Ith M, Kreis R, Vermathen P, Boesch C, Ravussin E, Tappy L. A 4-wk high-fructose diet alters lipid metabolism without affecting insulin sensitivity or ectopic lipids in healthy humans. Am J Clin Nutr. 2006 Dec;84(6):1374-9.

Fructose data in foods provided by

Reiser S, Powell AS, Scholfield DJ, Panda P, Ellwood KC, Canary JJ. Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch. Am J Clin Nutr. 1989 May;49(5):832-9.

Swanson JE, Laine DC, Thomas W, Bantle JP. Metabolic effects of dietary fructose in healthy subjects. Am J Clin Nutr. 1992 Apr;55(4):851-6.

Wada S, Satomi Y, Murakoshi M, Noguchi N, Yoshikawa T, Nishino H. Tumor suppressive effects of tocotrienol in vivo and in vitro. Cancer Lett. 2005;229:181-91.

Wu SJ, Liu PL, Ng LT. Tocotrienol-rich fraction of palm oil exhibits anti-inflammatory property by suppressing the expression of inflammatory mediators in human monocytic cells. Mol Nutr Food Res. 2008 Aug;52(8):921-9.

Zaiden N, Yap WN, Ong S, Xu CH, Teo VH, Chang CP, Zhang XW, Nesaretnam K, Shiba S, Yap YL. Gamma delta tocotrienols reduce hepatic triglyceride synthesis and VLDL secretion. J Atheroscler Thromb. 2010 Oct 27;17(10):1019-32.

War on drugs? Where is the government war on obesity?

War on drugs? Where is the government war on obesity?

The government sponsored war on drugs, at a cost $15.5 billion/year has as its goal to reduce drug use and its consequences in the US (Ref. 1, 2011 FY Budget Summary). Sadly, in 2007 (the most recent year for which data were available), the economic impact of illicit drug use on American society totaled more than $193 billion (Ref. 1).

But, where is the war on obesity? In 2009, the consequences of being overweight or obese cost a combined $270 billion (overweight, $72 billion; obesity, $198 billion; Ref. 2) in excess medical costs, mortality, and disability. The Society of Actuaries in 2010 (Ref. 2) reviewed almost 500 research articles published between 1980-2009 on obesity and its relation to mortality, and found that being overweight or obese is associated with increased prevalence of diabetes, cardiovascular disease, hypertension, cancer, kidney disease, stroke, osteoarthritis and sleep apnea. In addition, being obese significantly increases the risk of death and morbidity (Ref. 2). Although the government has sponsored a “let’s move” program, and, has invested $750 million in research with the goal of preventing tobacco use, obesity and heart disease (Ref. 4), these are minor moves when compared with the $270 billion economic burden of being overweight or obese.

The number of Americans that are overweight (BMI between 25.0–29.9) or obese (BMI of more than 30) is continuing to rise, and, it has been projected that by the year 2030, half of all US citizens will be obese, resulting in an additional cost of ~$60 billion/year (Ref. 5).

What’s the solution to this health crisis? In my opinion, taxes on all prepared and junk food. In other words, fruits, vegetables, raw nuts, meat, fish, eggs and dairy would not be taxed. There would be no taxes on farmed items, but, additional taxes on everything else. And, I believe this will work for the same reason that cigarette taxes have reduced the amount of smokers in the state of NY.

In 2008, NY increased its state cigarette excise tax by $1.25 to a total of $2.75 per pack, making it the highest state cigarette tax in the nation at the time. One year later, adult smoking in the state was at its lowest rate ever recorded, 16.7% of all New Yorkers. This was a 12% decrease, or nearly 310,000 fewer adult smokers than in 2008 (Ref. 3).

Furthermore, when reading the upcoming quote, the same argument can be made for reducing both childhood and adult obesity: “Cigarette taxes and are the most effective way to reduce smoking because higher prices drive people to quit, and, prevent young people from starting smoking. The Campaign for Tobacco Free Kids estimated that New York’s $1.25 cigarette tax increase would prevent more than 243,000 New York children alive today from smoking and motivate 140,000 more New York smokers to quit for good” (Ref. 3).

In an attempt to further reduce cigarette smoking in NY, the cigarette tax was raised an additional $1.60 in 2010.

Isn’t it about time that city, state and the federal government start a war against obesity?



1) (2011 FY Budget Summary)

2) Society of Actuaries, “Obesity and its Relation to Mortality and Morbidity Costs” 2010.


4), “HHS Announces $750 million Investment in Prevention”

5) Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011 Aug 27;378(9793):815-25.



Vegans, Vegetarians, Fish and Meat eaters: Which diet is best for minimizing risk of disease and death?

To answer the question proposed in the title, today I’ll look at the results of the Oxford Vegetarian study, in which risk for all-cause mortality, ischemic heart disease and malignant neoplasms was determined (Appelby et al.  1999). 6000 vegetarians and 5000 non-vegetarians were recruited, and, all participants were further divided into 4 groups: vegans, defined as those who never ate animal products; vegetarians, who never ate meat or fish but did eat dairy products, eggs, or both; fish eaters, who ate fish but no meat; and meat eaters (who ate meat more than once per week).

All groups consumed the same amount of total calories. However, when comparing individual macronutrients, vegans had the lowest protein (3.3% of total calories less than meat eaters) and fat intake (4.6 % less), but they made up for this difference by having a higher carbohydrate intake (9.5%), relative to all other groups. A similar dietary pattern was found in vegetarians, when compared with both fish and meat eaters.

A decreased total cholesterol/HDL ratio (TC/HDL) was found in vegans, when compared with vegetarians, fish and meat eaters  The TC/HDL ratio has been shown to be a strong independent predictor for the development of peripheral arterial disease (PAD, Ridker et al.  2001), a disease in which plaque builds up in the arteries that carry blood to the head, organs, and limbs. In vegans, TC/HDL = 2.88; in vegetarians, 3.25; fish eaters, 3.21; meat eaters 3.56. Based on these results, the incidence of ischemic heart disease was predicted to be 57% lower in lifelong vegans and 24% in lifelong vegetarians than in meat eaters.

When considered as a whole group (11,000 subjects), significant associations between individual dietary components and mortality risk for ischemic heart disease were determined. For example, eating up to 5 eggs per week did not significantly increase mortality risk, but eating 6+ eggs per week increased risk by 270%. Eating cheese (excluding cottage) up to 4 times per week did not increase mortality risk, but eating cheese more than 5 times per week increased mortality risk by 247%.  Relative to the lowest intake of animal and saturated fat, mortality risk was increased by 329% and 277%, in the highest intake, respectively. Similarly, those that ate the most cholesterol had a 353% increased mortality risk, relative to the lowest intake. In other words, high amounts of eggs cheese, animal and saturated fat were found to be associated with increased risk for ischemic heart disease.

Death rates, risk of ischemic heart disease and the risk of malignant cancer were 20%, 28% and 39% reduced in in non-meat-eaters when compared with meat eaters.Cumulatively, these results provide yet another reason to reduce meat consumption! (Also see



Appleby PN, Thorogood M, Mann JI, Key TJ. The Oxford Vegetarian Study: an overview. Am J Clin Nutr. 1999 Sep;70(3 Suppl):525S-531S.

Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 2001 May 16;285(19):2481-5