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Don't vacillate, vaccinate instead!

Wednesday, March 21st, 2012

Could she have measles?

The Wall Street Journal this morning had an article titled, "Where Could The Next Outbreak Of Measles Be?" A secondary heading on a later page said, "Low Vaccination Rates Trigger Fears," and there was a US map showing problem areas. Boulder, Colorado was one of those hot spots.

The article led me back to the concept of "herd immunity," very well illustrated on a webpage from the National Institute of Allergy and Infectious Diseases. Basically it says we need a relatively high percentage of a given population to be vaccinated (AKA immunized) against a given disease in order to prevent epidemics.

The particular viral disease I'm writing about is measles, sometimes called "red measles" or, technically, rubeola. The National Library of Medicine has an excellent, brief description of this ailment and notes that before widespread vaccination became common, most people had a case of measles before age 20.

Then the MMR vaccine was developed by a Merck scientist in the 1960s. Measles incidence went from being, as a 1954 quote termed it, "as inevitable as death and taxes," to an uncommon to rare disease in developed countries. In the US for the twenty years after the vaccine was licensed, an estimated 52 million overall cases, 17,400 leading to mental retardation and 5,200 deaths were prevented.

In 2000 the WHO estimated that there were still ~45 million cases of measles worldwide yearly causing 800,000 deaths. While mortality in developed countries was ~1/1000, in sub-Saharan Africa, mortality was 10%. In cases with complications, the rate could rise to 20–30%. On average, ~450 children died every day from measles. By 2007 immunizations had cut the yearly global death rate by 75%.

But in 1998 an article in The Lancet had caused a stir that has continued to this day. A British gastroenterologist reported a series of 12 young patients who were referred to his practice with bowel complaints. Their average age was six and 8 of them developed symptoms of autism within a month after they got their MMR injection.

Should I believe what I just read?

Many parents hearing about this report stopped their children's immunizations. This was in spite of numerous much larger studies showing no connection between MMR and autism. In 2005 a Japanese group showed an increase in autism diagnoses in children who got their childhood immunizations after the country's particular MMR vaccine was withdrawn from use because of a suspected side effect of the mumps component. In 2009 a review of multiple large studies was published examining three linkages that had been proposed: MMR and autism, thiomerosal (a mercury-based preservative chemical used in some vaccines, but not in MMR) and autism, multiple vaccinations and autism.

The accumulated data from these large groups in a number of countries showed no association between any of these factors and autism. Finally in 2010 The Lancet published a rather wishy-washy retraction of the Wakefield article.  His license had been revoked by the UK General Medical Council and the British Medical Journal's editorial staff published a much stronger condemnation of Wakefield's work in 2011, calling it fraudulent.

And yet today's WSJ article note parts of the US, especially in the northwest, have relatively poor compliance rates with vaccination guidelines. Parents can opt out because of medical, religious or even philosophical concerns. Low-income kids can receive free immunizations under a federally-funded programs, but one physician interviewed said the parents in his practice who don't want their kids vaccinated are wealthy and well-educated.

We've seen some minor outbreaks in the past few years. If we don't overcome parental misinformation and fears, we may have a major epidemic.

 

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The "sex life" of a virus

Saturday, March 10th, 2012

The double helix

Most of us who are adults (and many who are not) have personal knowledge of human sexual reproduction, the process by which a man and a woman each contribute genetic material that contains DNA (deoxyribonucleic acid), the chemical basis of new life. DNA is an incredibly long twisted molecule. Its structure is a double helix with two strands composed of a sugar-phosphate backbone linked by four specific chemicals: adenine (A), thymine (T), cytosine (C) and guanine (G). These are called bases and match up in specific pairs, A always with T and G with C.

DNA has an amazing ability to replicate itself; the strands separate and each becomes the pattern for a duplicate to be constructed. Occasional mistakes are made, but we have a cleanup chemical, DNA polymerase, a kind of automatic spellchecker, that makes corrections.

Our human DNA has about 3 billion pairs of these bases; yours and mine and Cousin Flo's will be 99% identical. The remaining 1% is what makes the difference between an Einstein, a sports hero, a jazz musician and you and me. Our DNA is 98% the same as a chimpanzees and 85% the same as a mouse, but these comparisons clearly understate the importance a single base pair difference can make.

Viral "reproduction" is quite different. Influenza viruses don't have DNA; instead they contain RNA and have to replicate in living cells. Once they are inside one, the process results in many viral "offspring." These eventually leave to infect other cells in the organism and in doing so kill the one they replicated in. RNA (ribonucleic acid) is somewhat like DNA, but has one different base and a slightly different sugar in its "backbone." It's usually found as single strands shorter than those of DNA or, in the case of the flu virus, in seven or eight pieces. It lacks a proofreading enzyme so most of the new influenza virus copies are actually mutants.

Most of these changes, called antigenic drift, are minor. So the flu shot I get every year, which is an educated best guess as to what this years flu virus will be, offers considerable, but not total protection.

flu shots make sense

Sometimes the mutations are more significant; the process is called antigenic shift. That may occur when a host is infected with two different influenza viruses at the same time. The swine flu, for example, contained genes from pigs, humans and birds. When this happens, pandemics may occur.

Influenza is spread in several different ways: an infected person coughs or sneezes and you inhale the aerosolized virus; humans may come into direct contact with bird droppings or nasal secretions; various surfaces may become contaminated (viral particles in mucous may survive several weeks on banknotes).

Modern techniques for producing new flu vaccines rapidly may prevent millions of deaths and steps toward a "universal flu vaccine" are being researched. In the meantime logical precautions and yearly flu shots can save lives.

 

 

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Posted in DNA, flu vaccination, Governmental Efforts, immunizations, influenza, medically-oriented background info, pandemics, RNA, spread of diseases | No Comments »

Viral Diseases: Influenza, Part 2

Thursday, March 8th, 2012

Homo Habilis, the first member of the genus Homo

I realized, as I wrote my last post, that I was using medical jargon that might make no sense to most readers. So I want to examine how the influenza virus is described by doctors, specialists in epidemics (AKA epidemiologists) and other scientifically-trained groups.

First of all let's briefly talk about how we classify everything that is alive. There's a complex system called taxonomy which is conventionally used to group separate different  groups of dissimilar and similar organisms. It has seven major layers, or taxa. Humans, for example,  belong to the kingdom Animalia, the phylum Chordata, the class Mammalia, the order Primata, the family Hominidae, the genus Homo and the species Homo sapiens. 

Flu viruses fall into three genuses, and those logically enough are called A, B and C.  The A type has only one species, lives in nature in wild aquatic birds (but can infect other animals), and causes the most severe diseases in humans. Subtypes of flu A can be identified by a variety of laboratory tests that determine which kind of two glycoproteins (complex chemicals that contain both carbohydrate and protein constituents) are found on the surface of the virus.

One of those is called hemagglutinin (H for short) and the other neauraminidase (N). There are 16 H types and 9 Ns; Hs bind the virus to a cell and help it insert its genetic information into that cell. Ns get involved later in the infection and help the virus release its "offspring" from the cells they were produced in.

Laboratory tests can show which H and N are present.  Both are antigens, substances that can cause an immune reaction if taken into your body by one route or another (e.g., breathing them in) and cause your body to produce antibodies, chemicals that are produced to combine with and counter the effects of the antigen. Some important influenza viruses are H1N1 which caused the 1918 Spanish Flu and the 2009 Swine flu, H2N2 (Asian flu of 1957), H3N2 (Hong Kong Flu 1968) and H5N1 (Bird Flu in 2004).

The CDC's short article on types of influenza viruses mentions there are seasonal epidemics nearly every winter in the United States; those are caused by type A or B, not by type C. All of the terrible flu pandemics have been caused by type A flu viruses. The B virus types are normally found only in humans (seals and ferrets are the only other animals that can be infected by flu B).

We get ours every year

Why is type A the killer? It mutates much more rapidly than B, usually by minor changes in the H and N  surface proteins, occasionally by sudden major changes. The first kind of change may alter the antigens you can be exposed to so the antibodies you've developed to fight off a flu infection don't work. That's also why the vaccine you get, which contains two A subtypes and one B strain, may not fully protect you. That's not a reason to skip your flu shot.

The other kind of mutation is more serious and I'll write about it next.

 

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Arsenic: it's in juices too, along with lead

Tuesday, February 28th, 2012

Any arsenic or lead here?

In September of 2011 Dr. Oz, the Columbia University cardiothoracic surgeon turned TV personality, reported on a problem with apple juice. His show is often on one of the six screens in front of our health club's exercise bikes. I didn't know much about him and routinely read a book on the recumbent bike I ride for an hour, so I paid little attention...then.

His comments applied only to apple juice. He had commissioned an independent lab to check the arsenic level in five brands of  juice. They  found 10 of the 36 samples had arsenic levels higher than the EPA's drinking water standard of 10 parts per billion (ppb).

The FDA called his publicizing the results of his study "irresponsible and misleading," saying drinking all brands of apple juice is safe. What he hadn't asked the lab to do was to determine if that toxin was in its inorganic form, felt to be dangerous, or in the less dangerous organic form. The FDA said they retested the same batches of juice and found the levels of the more toxic form to be well within safe limits, "almost zero."

Their standard for combined organic and inorganic arsenic is 23 ppb; foods or beverages measuring above that level get retested to determine how much inorganic arsenic is present.

Let's think about that cutoff level; drinking water, to be "safe" used to have less than 50 ppb, more recently 10 ppb has been set as the upper limit. As I've mentioned before, the state of New Jersey now has a standard of 5 ppb.

But in at the end of November, 2011, the website, MedPage Today briefly noted the results of a confirmatory study. Consumer Reports decided to measure both arsenic and lead in apple juice and grape juice. Nine of the 88 samples they had checked exceeded the "safe" limit.

This is supposed to be safe

Then in January, 2012, Consumer Reports.org published their full report online. That article mentioned that 25% of their samples had lead levels over the FDA's bottled-water limit of 5 ppb. And of the 10% of the samples with elevated arsenic amounts, most was the highly toxic inorganic variety.

That report is well worth reading. The Consumers Union group, an advocacy offshoot of Consumer Reports urged that new limits be set for these toxins in juice: 5 ppb for lead and 3 ppb for arsenic. Groundwater contamination with those toxins was implicated in the elevated amounts found in fruit juices. Human activities release three times as much arsenic into our environment as do natural sources

Then in early February two senior members of Congress, one from New Jersey and one from Connecticut, introduced the "Arsenic Prevention and Protection from Lead Exposure in Juice Act of 2012," AKA the "APPLE Juice Act of 2012." If it passes, the FDA would be required to establish standards for arsenic and lead in fruit juices in two years time.

The other issue, of course, is how much juice kids actually drink. The American Academy of Pediatrics recommends no juice until age 6 months, and no more than 6 ounces a day until age six. The reality is over a third of a sample of 555 children, 25% of those age two and under and 45% of kids aged from 3 to 5, exceeded those limits.

We've got a long ways to go, but at least we're hearing about these threats to the health of our kids and grandkids.

 

 

 

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Exercise counts most for kids

Saturday, February 18th, 2012

thumbs up on this activity

In a previous post I mentioned former neighbors whose two boys had to run around outside for an hour a day (and they did spend most of that hour literally running), before they got any "screen time." I thought that was admirable and noted both kids were slender.

Now I found an article in the February 15, 2102 issue of JAMA that confirms the wisdom of the approach my friends took toward this issue. A sextet of authors from the UK, Norway, Sweden and Canada published results for the International Children's Accelerometry Database Collaborators (ICAD).

First I had to make sure what accelerometry meant in this context. The dictionary definition was only somewhat useful. It obviously refers to a gadget for measuring acceleration, but when I returned to a prior study  of 1,862 British children aged 9 or 10 published in 2009 in the American Journal of Clinical Nutrition, I learned it's a very expensive and sophisticated gadget. My wife has a step counter that our local hospital seniors' organization, the Aspen Club, gave her free. The device used in the large-scale research project, sold by a Florida firm, does lots more than just count steps. Among other thing it also monitors how much energy you expend and what your activity intensity has been. Of course the current model I found online costs $1,249, but there is a volume discount.

That earlier study concluded we need to get our youngsters really moving in order to "curb the growing obesity epidemic."

The current paper offers a more nuanced viewpoint. It has a daunting title: "Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents."  The study looked at exercise levels and screen time in over 20,000 kids ages 4 to 18. Overall those who got more exercise improved all the risk factors measured: waist size, blood pressure, insulin levels, triglycerides and HDL cholesterol.

thumbs down on this one

Once levels of physical activity were factored in, sedentary time seemed relatively unimportant. But a smaller group, 6413 kids, was followed  for a little over two years and neither screen time nor exercise seemed important in changes in waist size, while kids who, at the start of the various studies, had bigger bellies, also had them later. I'd bet most of those were quite TV-addicted, since the paper warns that activity (or lack of activity actually) is often a clue to snacking and soft drinks.

I may show the short form of this paper to the principal of the nearby grade school I've mentioned previously. All those kids, starting in kindergarden, have a one-hour exercise period mostly spent running. I think it's a school-district-wide program and just confirms what to me is common sense.

Lots of our youngsters are spending their days sitting in front of a screen of some sort instead of playing active games outdoors. Even in the age group followed in the recent article, a quarter of the kids were at least overweight; 7% were already obese. The average time for active play was a half an hour a day and the average for screen time was close to six hours a day.

I doubt we can totally reverse those numbers, but it's a good idea.

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Posted in body mass index (BMI), Cardiometabolic Risk factors, coronary artery disease, medically-oriented background info, our kids and their weight issues, Publications | No Comments »

End of Life Care

Wednesday, February 15th, 2012

Hospice care nurses can make you smile

We've had a relative and a friend who each had Hospice care, one in another state and one locally. Both their spouses thought that Hospice was wonderful and wondered why they had to wait so long before their loved one was eligible for it. So when the Annals of Internal Medicine for February arrived, I decided to read an article titled "End-of-Life Care Discussions Among Patients with Advanced Cancer" and the section called "In the Clinic" which this month was on Palliative Care.

I knew that Hospice is for patents in their last six months of life. More than three quarters of them have at least one of four diagnoses: congestive heart failure, kidney failure, dementia or chronic obstructive pulmonary disease (emphysema). They have no life-saving avenues left and are normally not in a hospital setting. Some prefer to die at home and some are in long-term care facilities. We have a local organization, Pathways Hospice which supplies care for patents in several Northern Colorado communities; they offer on-call nursing care 24/7, spiritual care, appropriate medical equipment and counseling services. Their care is overseen by physicians trained in Palliative Medicine.

I thought the two overlapped, but didn't know as much as I wanted to much about Palliative Care itself. It's now a subspecialty recognized by the American Board of Medical Specialties and its physicians usually work with a team that may include social workers, chaplains, physical therapists and pharmacists. The patents they care for have severe illness and are usually in a hospital setting, although some may be seen in outpatient clinics.

There are no treatment limitations for this group of patients, but for some the article said, "You would not be surprised if the patent died within 12 months." Other have had recurrent hospital admissions or complex care needs. They may have limited family support or chronic mental illness.

Management of their symptoms: pain, shortness of breath, nausea, agitation and distress, delirium and "failure to thrive" are crucial avenues for the Palliative Care team to address. Those teams have quadrupled in the last ten years.

The link I supplied led me to a directory of hospitals which offer Palliative Care teams. Physicians trained in Palliative Medicine supervise both those teams and Hospice activities.

But it's best to have that talk while you're still able to.

The problem I noted reading the Annals articles was that many patents don't ask their docs about EOL care and, somewhat surprisingly, many physicians don't have any discussion with their patients about this crucial area until the very last moment, if that. Frequently people in the final month of their lives finally have that EOL talk; often they're an inpatient by then and being cared for by someone other than their long-term physician.

My wife and I have discussed what we do and don't want, but I think it's time for me to let my primary care physician know what I've decided. At present I'm basically healthy, but I'm also about to turn seventy-one and you never know.

 

 

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Posted in End-of-Life care, Hospice, medically-oriented background info, mental health issues, Palliative Care, Publications | No Comments »

Adults, obese and otherwise

Sunday, February 12th, 2012

PIck well and cut back your waste/waist

In my last post I explained the concept and the math behind the body mass index (BMI) approach to evaluating if your weight was normal or not (your BMI is very  well in synch with the most scientific methods of determining body fat percentages). Now I want to expand on that a bit  with some recent statistics and some thoughts on how we can lose weight if we need to. Unfortunately, some of us have lots of extra pounds we should shed if we want to have our best shot at leading long, healthy lives.

The Feb 1, 2012 issue of JAMA had a number of interesting articles on obesity. I've previously mentioned several on childhood and adolescent obesity; today I'd like to zero in on two whose focus is American adults.

Four CDC staffers, led by Katherine Flegal, PhD, published the most recent statistics from a recurring national survey with the daunting acronym NHANES. This national health and nutrition survey (the E stands for examination) started in 1971, but from 1999 on has been released results in two-year cycles. The current article from the National Center for Health Statistics, looking at the 2009-2010 NHANES data had a little good news and lots of bad news.

After 1980, until the turn of the 21st century, the prevalence (scientific term for percentage) of obesity in our population kept zooming up. Now it appears to have leveled off. I guess that's something we should be happy about, except now over 35% of adults in this country are obese. Men and women have about equally high rates of obesity and men have caught up to women in this regard over the last twelve years. Some subsets, by sex and racial groups, are even more likely to be obese or very obese.

The worst news from this article was that no group--men, women, non-Hispanic whites, Hispanics or non-Hispanic blacks--had a decrease in the prevalence of obesity in this most recent data set.

So which exercise and diet should we try?

getting enough exercise is difficult when your joints hurt

Many adults report "No Leisure-Time Physical activity." Overall, more of us are exercising, but the data vary from state to state. Those who have arthritis, fifty million in the US, need special attention or are even more likely to get no exercise. The CDC has worked with the Arthritis Foundation to develop ideas for this huge group. Going back to my review of articles on youngsters, I think for the rest of us, we could begin with simple steps, parking at the far end of the parking lot and substituting some walking for part of our screen time as two examples.

Harvard Medical School's free online HEALTHbeat publication had a review of pros and cons of various diets in its Feb 7, 2012 edition. The bottom line still is if you want to lose weight, you must cut down on your calories. The Mediterranean-style emphasis on fruits and vegetables, unrefined carbohydrates, nuts, seeds and fish may be the most effective in reducing cardiovascular and diabetic risks.

My New Year's Resolution is to keep my weight under 150 pounds. I have to work at it as I like to eat, but most of the time I've stayed away from splurges.

How about you?

 

JAMA

 

 

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Posted in body mass index (BMI), Centers for Disease Control and Prevention (CDC), Complications of Obesity, coronary artery disease, diabetes type 2, Life Expectancy, Life extension, medically-oriented background info, Metabolic Syndrome, Obesity, Publications, Weight Loss | No Comments »

Adulthood: when your BMI is more important than your IBM (stock)

Thursday, February 9th, 2012

I do this at home, without clothes

In my last post I wrote about our upcoming generations and their obesity issues. Unfortunately, as you might have easily been able to predict, that carries over into adulthood. The same issue  (Feb 1, 2012)  of the Journal of the American Medical Association (usually called JAMA) had several articles on adults also. To begin with the National Health and Nutrition Survey (NHANES) looked at the body mass index (BMI) of men and women from 1999 through 2010.

"AARRGGHH" you say, "Why the hell should I care about whatever BMI is enough to try to understand it?"

Well, that's a tough question, I admit. But BMI is the standard way of deciding if a person is too thin, normal, overweight or obese. So let's give it a try.

Your BMI is a number calculated using your height and weight.  If you weight 250 pounds and you're a seven-foot tall basketball professional center player, you're unlikely to be obese. But if you're five foot, six inches tall, and don't exercise at all, like the adolescent I was reading about recently, you're far too heavy. In the first case, the athlete has a lot of muscle, whereas the youngster is almost certain to be carrying around a lot of excess fat.

For a long time physicians just weighed their patients. That plus eyeballing their bodies in an exam room works for most people. Then along came the BMI as one way of getting a little more scientific. I looked online for the history of the use of body mass index as I suspected it was "invented" by a European (it was). It certainly seems to me to favor the metric system. There it's easy to figure out your BMI; you divide your weight in kilos by your height in meters. It's much more complicated using pounds and inches (BMI = weight in pounds divided by height in inches squared and that number is multiplied by 703) The CDC explanation of BMI is helpful and also supplies a "widget" you can download and a calculator if you just want to bookmark the website.

height counts, for adults too

So now you've (hopefully) figured out your own BMI; What does it mean and how reliable is it?

First the numbers: most people with a BMI under 18.5 are skinny, underweight. That probably excludes a whole passle of long-distance runners. Most people with a BMI over 18.5 and under 25 are in the "normal" weight category. I used the CDC calculator and my number is 20.5. Most whose magic number is 25+ and less than 30 are overweight and almost anyone whose BMI is over 30 is obese. The teenager I mentioned above has a BMI of 40.

Okay, you say. Now what do I need to do once I know what category I'm in.

I'd start with the eyeball test. Do you have a roll around the middle? In early 2009, weighing only three pounds more than I had for twenty years, I clearly did. I made up my mind to do something about that excess flab, knowing that fat in the belly also implies arteries that are narrowing down.

After losing thirty pounds and keeping it off, I bounced up after the Superbowl and went back on my diet, i.e., consuming fewer calories. I went to a meeting last evening; there were lots of goodies, but I ate only carrots and cucumbers. This morning I'm at 148.2 pounds, smack dab in the middle of the three-pound "ideal weight" range I decided on.

Harvard Medical School just published a piece titled "Choosing the diet that will work for you." The central theme is cutting calories.

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Posted in balanced diets, body mass index (BMI), Complications of Obesity, JAMA, medically-oriented background info | No Comments »

The very high-priced spread

Saturday, February 4th, 2012

This obese teenager could be headed for trouble

I've been concerned about our burgeoning problem of excessive weight, so when the Journal of the American Medical Association for February 1, 2012 arrived, I was intrigued by the variety of articles touching on the subject. Let me start with a disclaimer: I have no clear-cut special competence, no magic bullet for preventing or treating obesity in our children. I do think it's a major threat to the upcoming generations here and elsewhere in the world. I am also very aware that its opposite numbers, hunger and even starvation, threaten whole populations around the globe.

But my own background, both as a physician and as someone who has successfully fought weight issues (I weighed 218 in 1969 and 148 this morning), has made me concentrate on the American epidemic of eating to excess as a major area of my interest.

The first article dealt with kids and adolescents. A group of CDC researchers reported an update on obesity in American kids, giving data from 199 to 2010. The newest statistics show nearly ten percent of our infants and toddlers are obese and close to 17% of our kids ages two to nineteen. As the kids got older, more boys than girls were obese in this survey with over 4,000 participants.

Then there was an article titled "Weight Loss Stratagies for Adolescents," based on a Boston Children's Hospital Conference roughly a year ago. The MD, PhD Harvard Professor of pediatrics who discussed the issue began with the case history of a particular obese girl, a fourteen-year-old who was five foot six and weighed nearly 250 pounds (giving her a body mass index,BMI, of 40). Her adoptive parents were overweight themselves, but had to learn to "back off" in their attempts to control her diet. There is some early data that suggests that parents can help by providing health food choices in the home and facilitating enjoyable physical activity throughout the day (versus a fixed "exercise time).

I had seen an example of that with some former neighbors whose boys, in order to have their one hour of "screen time," had to be outside playing for several hours at a time. Both youngsters were lean.

One critical point to be made is avoiding focusing on obese kids only. A large Danish study, published in the New England Journal of Medicine in December, 2007,  followed over a quarter million children born in the 1930 to 1976 time period. Denmark established a national civil register of "vital statistics" in 1968 and enrolled everyone in the country, giving them a unique number, ironically termed their CPR number. Although that had nothing to do, I gather, with cardiopulmonary resuscitation, which is what I think CPR means, the study did look at risk factors for coronary heart disease.

When your heart's on fire, it may not be from love

The results are impressive and threatening: every one point increase in BMI across the spectrum was associated with an increased risk of coronary artery disease. A child didn't have to be fat to be at risk later on. One calculation estimated that a 13-year-old boy weighing 25 pounds more than the average had a one-third increase in the likelihood of having a heart attack before the age of sixty.

It's time to start helping our kids live leaner and longer, healthier lives.

 

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Posted in balanced diets, coronary artery disease, Exercise possibilities, Food Choices, Healthly lifestyle, Healthy eating, Healthy food shopping, JAMA, Life Expectancy, medically-oriented background info, Obesity, our kids and their weight issues, Publications, weight gain | No Comments »

What sweetener do you use: Part 6; the fake sugars

Wednesday, February 1st, 2012

Nearly a month ago I started to write a post on the "Fake sugars," I had read an article on them in the Personal Journal section of The Wall Street Journal, but got distracted when I realized I needed to think about (and write about) table sugar and high fructose corn syrup.

they're all sweeter than sugar

So now I'm finally going to start on the artificial sweeteners. There are four major ones that WSJ reviewed (they even had a panel of tasters): Sweet'N Low, Equal, Splenda and Truvia. They came on the market, respectively, in the 1970s, 1980s, 2000 and 2008. All have zero calories per packet, whereas table sugar has 15 or 16, depending on who you read, per teaspoon. They cost much more than sugar and are considerably sweeter. A Mayo Clinic article online reviews the general subject and terms these chemicals as intense sweeteners.

The National Cancer Institute mentions that they are regulated by the FDA and, in an August 2009 online paper, states there is "no clear evidence that the artificial sweeteners available commercially in the United States are associated with cancer risk in humans."

The most recent addition to this mix, called Truvia when it's made by Coca-Cola and Cargill, or PureVia when it's parents are PepsiCo and Merisant, comes from a plant called Stevia, found in South America. Stevia has a curious history in the United States; it was added to teas by Hain Celestial until the FDA got an anonymous letter questioning its safety in late 2007. At  that point the FDA banned its use in foods, but in 2009, faced with major industry interest, Stevia by-products were approved as food additives (but not Stevia itself).

Stevia, saccharin and the real sugar

Now Truvia and PureVia are being used in a wide range of processed food and beverages. A cousin to the chemical they contain has been extensively used in Japan for over twenty years without major side effects being noted and Stevia, the parent plant, has not only been used for centuries in South America, but also touted for its supposed health benefits.

So why do I have some lingering doubts, in fact some major concerns about all of these chemical food additives, not excluding Truvia and PureVia?

As best I can tell the vast majority of the research on them has been sponsored by the same companies that profit from them. I fail to see independent, carefully performed, double-blind controlled studies especially on the "new two." Some research has been done on their chemical components, including one four-month study on type 2 diabetics that did not show either high blood pressure or high blood sugar as a result of consuming the active agent in Truvia.

But it's not just diabetics who are being exposed to the chemicals in these sweeteners. Most of us are, if we consume a diet drink or anything labeled "light." And medical history informs us that untoward effects may show up in relatively small number (or perhaps even large numbers), years later.

So I'm going to avoid "fake sugars" whenever I can. And perhaps, just perhaps, someday I'll find out I was being smart in doing so.

 

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Posted in additives, blood sugar, chemistry, Fake sugars, Food Additives, Food and Drug Administration (FDA), Food Choices, Food safety, medically-oriented background info | No Comments »

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