Archive for the ‘Healthy food shopping’ Category

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.


Vindication? Part 1

Thursday, January 5th, 2012

One way to get lots of protein

Since the late 1990s when I invented a diet, or perhaps I should say an eating pattern, I've relied on one principal concept: Eat Less; Do More. I came upon this simple idea after listening to a group of medical professionals who were discussing which diet they should go on while they were simultaneously consuming huge portions at our hospital cafeteria.

One of them, I recalled, had tried a high-carb, low-protein diet the past year; losing nearly twenty pounds, then regained it all and more in a few months. Now she was going to attempt  to lose twenty-five pounds with a different approach, this one with an emphasis on protein. I had seen weight-loss plans come and go and didn't believe any of them were the answer, at least not for everyone. I remember coming home and saying to my wife, "Lynn, I've invented a new diet"

I explained it was simply, "Never finish anything; No snacks between (meals); Nothing after eight." I added, "Get lots of exercise."

I lost the seven pounds I had gained on a two-week vacation and didn't need my strategy again until early in 2009. Then I weighed 177 one morning, up three pounds from my normal weight since 1991. I attributed that to eating out four times in the prior week. But when I tried on a pair of good suit slacks, I realized the weight hadn't changed much, but the distribution sure had.

I went back to my eating plan, lost five pounds easily, then coasted a while before resuming the diet. Lynn bought me a digital scale and I weighed myself daily. I also started going to our gym six days a week. Eventually I shed thirty pounds and five inches off my waistline. At 147 pounds I was twenty-five under my usual high school weight. This morning, nearly two years later, I weighed 148.

I allow myself a three-pound zone of weight fluctuation, thinking that would account for fluid shifts and the occasional big splurge. Whenever I exceed 150 pounds I go back on my plan.

Then I read a Wall Street Journal article titled "New Ways Calories Can Add Up to Weight Gain: Study Challenges Idea That Varying Amounts Of Fat, Protein and Carbohydrates Are Key to Weight Loss." It quoted the Journal of the American Medical Association, AKA: JAMA. I went online and found the JAMA article and an accompanying editorial.

I read both pieces in detail, even finding a wild typo, "...their diets were returned to baseline energy levels and diet compositions (15% from protein, 35% from fat and 60% from carbohydrate)." I called the AMA and suggested they correct the numbers since they added to 110%.

Is a high-carb, low-protein diet safer?

But the basic premise of the study's data intrigued me. It's something I've believed for years, calories count, as opposed to what form those calories come in. But there's one extra facet: low-protein diets can be dangerous.

I'll analyze that in detail in my next post.



Do I need to eat my words?

Wednesday, October 19th, 2011

Different choices for different ages

An old friend forwarded an article on vitamins yesterday, one that I read with special interest. It came from MedPage Today, an online medical news service for healthcare professionals that partners with the University of Pennsylvania School of Medicine to offer physicians continuing medical education credit (CME) for reading articles and then answering a few questions.

The article was titled "Vitamin Studies Spell Confusion for Patients" and extensively quoted Dr. David Katz fromYale's prevention research center. He is an adjunct Associate Professor at Yale's School of Medicine and an internationally renowned authority on nutrition. He comments that, based on the recent study I mentioned several posts ago, many clinicians say they've written off supplements for good.

Yet 50% of Americans take supplements; many take more than just a multivitamin.

Then Dr. Katz offers some caveats as I did, stating the Iowa study is "merely observational and can't prove cause and effect." He still recommends omega-3 fatty acids (AKA "fish oil") and vitamin D for most of his patients and adds calcium for women and prenatal vitamins and folic acid for pregnant women. otherwise he only uses vitamins when there are deficiencies.

A recent pole of clinicians found that 70% favor annual screening of specific vitamin levels to treat deficiencies. Which vitamins (and minerals) might be measured as part of an annual focused screening examination and whether medical insurance plans would cover such laboratory tests has not been delineated, as best I can find.

But I'm seventy, and articles from 2005 to 2010 in authoritative sources, talk about seniors needing much more B12, having multiple minor, but significant, vitamin deficiencies, and not eating well-balanced, healthy diets, even here in the United States, much less in other spots around the world. I'm lactase deficient and small-boned; do I need a calcium supplement?

clearly the best way to get your vitamins

I agree with Dr. Katz that eating a balanced diet would be a better answer, at least for those who are younger. The concept of "eating your colors," i.e., having multiple suit and vegetable dishes over the day which contain different phytochemicals as represented by the color of the food itself, makes great sense.

How many Americans do that at present or are likely to do that even if medical figures recommend such?

I regard this as an ongoing discussion. Dr. Katz is certainly correct in saying that vitamins have been shown to treat disease states, but not to prevent chronic disease. The surmise in the article in MedPage seems sound to me: vitamin isolates are less effective on their own and a full blend of antioxidants and phytochemicals (again, best found in those whole fresh fruits and vegetables, may be the key to obtaining maximum benefits.

This discussion is likely to go on and on, so I'll supply two URLs that may help you, in consultation with your own physician, make choices that are relevant to your nutritional status, age and degree of health.

Let us eat lettuce...and more

Wednesday, July 27th, 2011

I want more to a salad than just iceberg lettuce

Some years back I told my wife, "I'm tired of the same old salad; could you make a different one?"

We both cook, though she does more of of daily cooking than I do, but salad making is my least favorite part of cooking.

Over the next six weeks she never made a salad I had tasted before; her mix and match approach led to some surprises, but I'm always happy to try new dishes and almost all of them were successes. She added edamame, sunflower seeds, unusual greens; I ate them all. I finally told her, "I didn't mean an entirely new salad every time, just less of the iceberg lettuce, store-bought tomatoes and cucumber with familiar dressing.

We still eat salads at least once a day, sometimes as our main dish with chicken or fish added for protein. Sometimes we'll have a brand new mixture; sometimes I can recognize we've had this blend before and put it on the "keeper list."

Today I read about food companies attempts to get more Americans on the same dietary pathway. The Wall Street Journal had an article titled "The Salad Is in the Bag." I was amazed to read that the typical US adult eats salad with a meal only 36 times a years, roughly once every ten days. Less than half of Americans eat even one "leaf salad" in meals they serve at home in a two-week period.

The two of us are clearly on the far end of that scale when it comes to salad making. Our share of this weeks' vegetables from Grant Family Farms, our CSA, included summer squash, English peas, cabbage, carrots, kohlrabi, cilantro, parsley, green onions, a little broccoli, cylindra beets (new to us) and romaine lettuce. All of those veggies will find their way into salad

I've even gotten more enthusiastic about preparing some of the new salad combinations myself.

So what's going on with the "store-bought" salad concept?

A market research group reported the biggest issue is making salads. Apparently people don't want to take the time to wash produce, inspect it, cut it and come up with mixtures the family will eat (we won't even get into those who abhor greenery).

So some of the major food companies are responding by making salad preparation easier. One concept being explored is adding more kinds of vegetables to bagged lettuce or spinach. That way all you have to do is buy a bag, bring it home, open it before a meal and pour the contents into a salad bowl.

Well that sounds easy, but it turns out to be a bit more complicated than the simple version. One company found wheatberries absorbed moisture; their research director spent six months resolving that issue. Then there's the price issue; bagged salads cost more. Past history and the view of CPSI says there's more risk of pathogen growth and therefore of food-bourne illness.

But pre-washing with newer chemical mixtures, eliminating the need for a second wash at home, may help.

A new and improved version

Salad, anyone?


E. coli and you

Saturday, June 4th, 2011

This is a "bug" you don't want

I've seen several articles in The New York Times and the Wall Street Journal in the past few days about diseases caused by an extremely toxic new strain of the common bowel bacteria, E. coli. More then 1,800 people in Europe have been infected with this food-bourne illness and some have died from an unusual kidney complication it can lead to.

The "bug" itself appears to be highly resistant to antibiotics and experts in the United States feel the wrong approach is being taken in Europe. One professor from Washington University is quoted as saying, "If you give antibiotics and the strain is (already) resistant, then you give that bacteria a competitive advantage..."

Here the recommended strategy is not to treat E coli infections with antibiotics at all. American doctors give IV fluids to help keep the kidneys functioning. They dialyze patients who develop acute kidney failure. On both side of the Atlantic physicians agree that people who develop bloody stools should be admitted to a hospital in an isolation room/ward. Otherwise a person who has an E. coli-caused diarrheal illness can easily infect others.

But dialysis can save your life

The rare, but deadly kidney disease that these food-bourne bacteria can cause is called hemolytic-uremic syndrome (HUS). The NIH PubMed website defines it as a disorder that usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury.

Hemolytic-uremic syndrome (HUS) often occurs after a severe gastrointestinal infection with E. coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections, including shigella and salmonella, as well as infections outside the GI system.

In America HUS is most often seen in children and is the commonest cause of acute kidney failure in them. Several large outbreaks in 1992 and 1993 were linked to undercooked hamburger meat contaminated with E. coli.

But in this case we're not talking about meat, but rather vegetables. In the past American outbreaks have been associated with contaminated tomatoes, lettuce and cucumbers.

So should we be worried? Thus far there have been only four cases identified in the US. Those people had traveled to the northern part of Germany recently and that's been identified as the epicenter of this E. coli outbreak. Germany has had 1,733 cases in the most recent count I could find. Initially Spanish cucumbers were blamed, but now it appears clear that Germany is the source.

The FDA is closely monitoring lettuce, cucumbers and tomatoes imported from Germany and Spain, but those countries account for <0.2% of our imported produce.

My family is about to start our 26-week season eating locally produced organic vegetables from Grant Family Farms, the CSA we joined last year. That improves my comfort zone enormously. I think the rest of you should consider farmers' markets, CSAs and other sources for vegetables that are grown relatively near your homes.

I've been saying that for a while; this outbreak just reinforces my thoughts on the subject.

Fish, fish and more fish

Tuesday, March 15th, 2011

Sardines by the dozen

I've been looking at three articles  on which fish we should be eating. One came from a newspaper, one from a website and the third from the Environmental Defense Fund website.

One of the dietary changes we've heard repeatedly over the last few years, besides eating more fruits and veggies and less red met, is to eat more fish. We're fortunate to have a wonderful restaurant here that's simply titled "Fish." We eat there fairly frequently, especially before attending plays (but that's another story). We also cook fish at home at least once and usually twice a week.

So which kind of fish should we be eating? That leads to the questions of sustainability, heart health and contaminants. To those, based on a recent experience, I'd add the risk of toxins (I'll write a blog post about that some other time).

The article from the Wall Street Journal (March 2, 2011) focused on salmon, talking about Wild Alaskan, Wild Pacific, Farmed Atlantic and Closed Tank-Framed varieties. The Farmed Atlantic salmon raised many enivronmental concerns and both Seafood Watch and Greenpeace decry salmon farming, stating it takes three pounds of  wild-caught fish to produce one pound of salmon.

The Wild Alaskan salmon got kudos from Seafood Watch, although another group noted that 40% of "wild" salmon caught in the state's waters were actually raised in hatcheries. Wild Pacific slamon raised sustainability concerns from some groups, but not all.

Confusing, huh? Well then I turned to the online piece. This had three distinct sections: the AHA wants us to consume more omega-3s and recommends mackerel, lake trout, herring, sardines, albacore tuna and salmon as good sources. Yet in the contaminant section it's noted that albacore tuna, high on the food chain, carry the risk of mercury and PCBs.  There's debate as to the risk for most adults, but pregnant women (or those who are at risk of pregnancy) should clearly avoid this fish choice.

And farmed salmon, high up on the list of omega-3s, is tough to raise in a sustainable fashion.

The Environmental Defense Fund suggests we eat wild salmon from Alaska, pink shrimp from Oregon, talapia from the US, farmed rainbow trout, alabacore tuna from the US or Canada, yellowfin from the US. The EWG website led me to a Mark Bittman article (New York Times November 16, 2008) where Mark lauds wild-caught fish; he finds the flavor better and the environmental concerns lessened.

So what are we to do? I'd suggest eating more fish, trying to eat some fatty fish, eating less farmed fish and reading more about the issues involved. I may try more sardines.

The real question is whether there will be enough wild fish for all.

More Beef or Zorba's diet?

Wednesday, March 9th, 2011

eat half the steak and ask for more veggies

I read dueling articles in the Wall Street Journal, one appeared yesterday with the title "Beef Industry Carves a Course" and the other today titled "Why to Eat Like a Greek." So I wanted to go through the pros and cons of both.

Apparently the National Cattlemen's Beef Association came up with a new kind of MBA two years ago. This one isn't the traditional MBA, but instead stands for Masters of Beef Advocacy. Roughly 2,000 people have finished the program thus far, but that's only 10% of what the beef producer's group hopes to train.

This is not a 2+ year Master's degree, like some of our graduate students got; it's a six-session, one hour at a time online course on beef safety, beef nutrition, animal care, environmental stewardship, modern beef production and something called the beef checkoff. The last of those is a program started way back in 1985 where $1 a head is assessed on sales of live cattle and the states get half and the Cattleman's Beef Promotion and Research Board gets the other half.

Note the term "promotion." The WSJ article says the MBA program helps train beef-associated folk (chefs, butchers, feedlot operators and ranchers) in promoting and defending red meat.

The per capita consumption of beef and veal has fallen from a peak of  94 pounds in the 1976 to 62 pounds in 2009 and the new USDA guidelines suggest we replace some of the red meat in our diets with fish and other seafood. Many schools have instituted a "Meatless Monday" policy

One thing I hadn't heard about was that PETA (People for Ethical treatment of Animals) has a new program where models wearing only strategically placed lettuce leaves stand on street corners in towns across the country and hand out tofu hot dogs. Now that's a new approach.

I'm a long way from a vegan; we do eat beef and have a quarter cow in our freezer. The cow was raised with a small number of companions, grass-fed and grass-finished, so is lean meat.

In our case we also eat vegetarian meals on occasion and will spend four days with our other set of adult children, our former graduate students from India who are lacto-ovo vegetarians, next week.

Most of the time we eat what amounts to a Mediterranean diet with whole grain cereals, lots of fruits and vegetables, fish and relatively small amounts of animal fat. The other WSJ article mentioned a meta-analysis done by an Athens university on studies involving more than a half million people; they claim  nearly a one third reduction in the risk of developing the metabolic syndrome (high BP, large waist circumference, high blood sugar, low levels of good cholesterol (HDL) and high triglycerides).

Okay, what are the cons I said I'd mention? Well to begin with I'm not sure the beef industry has changed much other than trying to increase their PR efforts. And the Mediterranian diet isn't much different from the increase fruits and veggies, eat less red meat. Same old, same old. I agree with the overall premises, but I'm not convinced that olive oil is an essential component.

So neither article changed my diet at all.

Walmart weighs in on local produce

Friday, October 15th, 2010

Let me start with a disclaimer. I don't have any personal connection with Walmart and I'm aware of the issues that unions, small locally-owned stores and others have had with the corporation. We rarely even set foot in our local Walmart mega-store.  We do have a Sam's Club card and occasionally buy something there, but do most of our non-CSA grocery shopping at another chain entirely.

We've continued to get the majority of our veggies and fruits from our CSA, Grant Family Farms. The organic produce, mostly grown locally, or in the case of apples, regionally has been wonderful. On the other hand, I've been fully aware we're in a minority. There are lots of people who could afford the extra price, but have never tried farmers' markets. Others don't have access to a CSA organization. Many more wouldn't be able to afford the prices even if they wanted to purchase these kinds of groceries. I've seen articles implying governmental support would be needed before this happened.

I doubted that was likely to occur, but wondered if one of the huge grocery chains could start the process of giving making healthier choices available for almost anyone. Now that seems to have started.

A article in the October 14, 2010 edition of the New York Times gave me some measure of optimism in this arena  and some background information that I was unaware of.

Walmart is the world's largest grocer. What it does can influence markets and manufacturers across the  globe. That being said, up until now I hadn't heard much that linked the chain with sustainable agriculture.

Apparently Walmart has been edging toward sustainability goals for five years and set a series of these targets. Now they're turning their sights toward food with a goal of doubling the percentage of produce grown in a given area, actaully the same state a given store is located in.

Still they are only aiming at a 9% local foods goal in the United States. That's a sliver, a nice sliver to be sure, but they're already set much higher targets in Canada (30% by the end of 2013 according to the article).

They're also planning to spend a billion dollars on food from farms much smaller than the enormous ones most of their groceries come from now, cut down on food waste by improving their farm to market shipping patterns, and query their large-scale producers on their use of water, fertilizer and chemicals. There's even a beef-purchase clause in their new plan that is aimed at prevention of further loss of the Amazon forest.

All this will result in more money in the Walmart coffers, but I don't care. They have such incredible clout, on such a wide scale that their new goals will influence agricultural and marketing practices in a major fashion.

It's a good start.

Slow Food, farmer's markets and more

Wednesday, August 18th, 2010

I had heard of the "Slow Food" movement, begun in the late 60s after McDonald's got to Rome. I didn't know much about it until I read Michael Pollan's June 10, 2010 online article in "The New York Review of Books." His six-page piece is exceptionally well worth reading; I just got back to it via Google without any difficulty. Now I'll attempt to articulate some of its points and add a few of my own views.

Pollan covers some far-flung aspects of the recent history and current trends of "food in America" (and elsewhere). Early on he mentions that our citizens now spend less of their money and time preparing and cleaning up from meals than any other group in history. There has, however, been a secondary, but crucial cost, the decline of meals eaten together as a family. The impact of this is visible: our kids are growing up with meals eaten in front of the TV with an absence of family conversations; our food industry has had an enormous sway in what we eat and where, e.g., "Fast Food;" our diet with all its emphasis on ease and speed of preparation has led to the epidemic of obesity and its related diseases.

Pollan notes the variegated segments of the food movement, distinct as they have been over the past thirty years or so, have now appeared to have a common focus on high-level problems: we cannot sustain our present food/farming patterns longterm without major environmental and economic consequences. Climate change issues are at the heart of this shift, as is the realization that cheap fossil fuel enabled the huge post WW II increases in farm/food system productivity via the pesticides and fertilizers they spawned. In order to solve our global warming and water issues, we will almost certainly have to alter our farming/food patterns.

Our current diet, centered for many on meat-eating, consumes huge amounts of our increasingly valuable water supply. Our habits of wanting produce grown around the globe to be available on our tables year-round consumes fuel in enormous quantities.

The new health care reform legislation, Pollan feels, may lead to health insurance firms having a keen interest in the prevention of chronic diseases. We appear to be at a cusp where food-related businesses, locovores, food movement organizations, health insurers and even our government may agree on the need for change.

I'm tentatively hopeful that the next twenty years will see progressive shifts in our dietary patterns, our food sources, our use of fossil fuels and the longterm health of our kids and grandkids. Maybe that's asking for a lot, but the alternative is truly frightening. It's time and past time for a whole series of interlocking changes.

More on "What to Eat"

Friday, July 23rd, 2010

I finished Dr. Marion Nestle's book, "What to Eat" some time ago, but got distracted by several other books and articles in various publications I read. Now I'd like to return to her superb volume and make a blanket statement to begin with. I've been concentrating on books, articles and online sources, in the wide field of food, nutrition and dieting for well over a year now and have found and read a number of excellent publications . If you were limited to reading only one book in the area, I'd strongly suggest this one.

That being said, I'd like to devote a few posts to the book and my reactions to it.

Nestle expanded my concept of who benefits from our having an overabundance of food available, and eating much more of it then we should (remember two thirds of Americans are overweight. and half of that group, one third of our total population is obese). So of course the food industry, in all its manifestations, food production, sit-down restaurants and the plethora of fast-food outlets, benefits directly from our overeating.

What I hadn't thought of as collateral beneficiaries were the whole diet industry, our expanding number of health clubs, our pharmaceutical firms and even my colleagues in medicine.

Then there's the stock market angle. A number of those entities I've listed (a list I've obtained from reading Nestle's book) are actually publicly owned and have shares traded on the stock market. As such, my take is they need to demonstrate constant growth, or at least a pattern of growth, to maintain share value.

Nestle also emphasizes changes, over the last thirty years or so, in our eating patterns. We are encouraged to snack from an early age and most of those snacks, unlike my occasional piece of fruit, are empty calories. More calories ingested equals more weight, unless you're also burning more calories.

I'm now six and a half weeks out from back surgery and won't be able to return to our own health club for another ten days. So for now I'm walking, and going a little further each day. Today I walked for seventy-five minutes. I wasn't moving very rapidly and I didn't calculate how many calories I burned. I didn't care really; it was a beautiful morning (I started at 7:45 AM) and I enjoyed the walk. I chose a different route than I've taken in past days and saw some different scenery.

A major part of losing weight is to think about what you're doing when you shop, when you eat and when you chose how to spend your time. I may watch a TV show from time to time, but I'd rather spend the same amount of time exercising.

How about you? What choices do you make in these areas?