Archive for the ‘weight gain’ 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.

 

What sweeteners do you use? Part 4: HFCS and mercury

Tuesday, January 24th, 2012

A safer place for mercury

In my last post I mentioned that fructose metabolism appears to be more complex than I learned in medical school. Of course that was in 1962-1966 and a lot has changed in medical knowledge in the forty-five plus years since then. We all know that fructose, in the form of high-fructose corn syrup (HFCS) is added to many processed foods and sweetened drinks; the question being debated is, “Is that bad for us?”

I’ve been reading a variety of articles from the medical literature and some popular websites on the subject and not all scientists, physicians and dietitians agree on the answer. I previously mentioned a Mayo Clinic online article that stresses the need to cut our added-sugar intake, both table sugar and HFCS, and mentions that research on HFCS isn’t yet at the point to implicate it as worse for you than other added sweeteners.

There’s also an article by Jennifer Goldstein from Prevention magazine that I found on the msnbc website. I’m not sure of her science background (she’s now the Beauty Director for the magazine). Nonetheless, her article is reasonably well-balanced, if you read between the lines. The over-all conclusion is that anti-HFCS evidence is slim. She quotes an NYC-based nutritionist as saying the calories in HFCS and table sugar, gram for gram, are equal, but mentions several reports that have shown HFCS samples may contain mercury… in small amounts.

But you don't want it here, or in your food

Mercury is a neurotoxin, a substance which can damage the brain, especially the developing brain of a fetus or infant. Even “small amounts” are considered dangerous for babies in the womb. We have all heard of its presence in fish, but mercury in HFCS was new to me. I’m about three years behind, it appears. I found a Washington Post article from January, 2009 which mentioned two studies examining this issue.

At that time, in spite of industry denials, nearly half of HFCS samples tested contained mercury as did almost a third of processed food and beverage products. The researchers writing on this  enormously significant problem noted that HFCS had been made using chemicals produced in industrial plants clinging to an outmoded, 19th century method

A now-retired FDA scientist, Renee Dufault, headed a study in 2009 showing low levels of mercury in all the processed foods she and colleagues tested (and none in organic foods) and then had their results verified by two independent labs. She then says the FDA’s head of their Food Additives section told her to quit her HFCS studies. She quit the FDA instead and published her results. A physician-headed team at the Institute for Agriculture and Trade Policy, a non-profit watchdog, repeated her studies using commercial beverages and foods. Their twenty-plus-page paper is worth reading.

By the middle of December, 2010, the HFCS industry had gotten the message. But until all HFCS made in the United States is mercury-free I’m going to avoid it.

What sweeteners do you use: Part 3. Fructose & HFCS

Friday, January 20th, 2012

It's time to dissect out the science behind sugars

I knew that sugars are found naturally in milk, fruits, vegetables and honey. MedlinePlus, from the NIH’s National Library of Medicine has a brief discussion of those natural sugars. I also knew that glucose was absorbed in the small intestine and leads to the pancreas putting out insulin. It’s eventually converted to energy, though some may be stored in another form in the liver and muscles until needed.

But before I get to the artificial sweeteners, I needed to read more about fructose, the other half of table sugar.  My first source, a Mayo Clinic article, didn’t make it to be much of a villain, but then I started to put the whole picture together. To start with, table sugar is half glucose and half fructose. The two “simple sugars,” called monosaccharides by chemists, have the same chemical formula with six carbon atoms, twelve hydrogens and six oxygens, but the way those are arranged is quite different. They each supply four Kilocalories per gram or fifteen per teaspoonful (That’s technically correct, but most of us just use the term “calories.”).

If you taste table sugar and call it a “one” in terms of how sweet it is, glucose is about three-fourths as sweet and fructose is nearly one and three-fourths as sweet.  Both are considerably sweeter than lactose, the kind of sugar found in milk. Fructose is also easier to dissolve in water and hangs on to water better; that’s apparently how it can lengthen the shelf life of baked goods.

That’s not why I think high-fructose corn syrup (HFCS) became ever-present in sodas, other sweetened beverages and processed goods. In a blog post I wrote many  months ago, I mentioned that after WWII our government wanted to find a way to use two kinds of war-time chemicals; they eventually became pesticides and fertilizers. Corn turned out to be an extremely efficient plant in turning sunlight to stored energy, so it was subsidized. Eventually that led to “monoculture, huge farms raising nothing but corn.

What's the motive: health or profit?

Like any other industry, the corn producers needed to make a profit and have their stock prices increase. That resulted in HFCS being produced and added to lots and lots of food and beverage items.

So what? A 2208 article in Science Daily gave me a clue. The way our bodies handle fructose is considerably more complex than that of glucose. The two simple sugars are separated from each other in the small bowel and glucose quickly passes through the liver on its way to all the other spots in the body where it can become energy. Fructose, according to scientists, makes the liver work harder and there’s some data pointing toward its triggering the production of fat.

And we don’t just get straight fructose in our diets: HFCS, according to the USDA, is about one fourth water and the rest dissolved sugars. HFCS42  (with 42% fructose) is added to many products, especially processed foods. HFCS55 (with 55% fructose) is added to soft drinks. It’s roughly comparable in sweetness to table sugar; the issue is why do you need to ingest any more sugar?

There’s been more research in this area and I’ll cover that in my next post.

 

 

 

What Sweeteners Do You Use? Part 2

Monday, January 16th, 2012

Sugarcane grows in the tropics

In my last post I said I’d dig more fully into the background and safety record of the artificial sweeteners. Then I got diverted; one question was what kind of sugars were there before the artificial sort? I ended up at a website called Lab Cat which, in a brief verbal and visual format, described the sugars we commonly might ingest. Table sugar usually comes from either sugarcane or beets; it’s a combination of two other sugars, glucose and fructose, the former found, typically in grapes and corn; the latter in honey, fruits and vegetables.

When a physician measures your blood sugar level; he or she is checking for glucose. The WebMD site has a nice discussion of blood sugar, mainly focused on those who have too much of it, namely diabetics. Another brief discussion, this one by a Harvard Medical School professor, can be found in an abcNEWS piece online. Normal fasting blood sugar levels are in the 70 to 99 milligrams per deciliter (mg/dl) range.  A deciliter is one-tenth of a liter, a little over three and a third ounces or six and two-thirds tablespoons. A liter is 1.05 quarts and a liter of water has 33.81 ounces of water. Even after eating, a non-diabetic person doesn’t usually  have a blood sugar level over 135 to 140 mg/dl.

Diabetics may have considerably higher blood sugar levels, enough so their urine contains sugar. Up to levels of 180-200 mg/dl your kidneys can reabsorb sugar; above those levels a urine dipstick test will be positive (briefly immersing a plastic strip into the urine; the chemicals on the strip will cause a color change if glucose is present in the urine).

If your blood sugar is low, below the low 70 mg/dl level, either from missing meals or overdosing with insulin or oral drugs used for diabetes (there are a host of other causes), you usually will feel shaky, hungry and perhaps have other symptoms. Most of us who are otherwise healthy  are unlikely to have our blood sugar level fall to really low levels, but those can be extremely dangerous.

If you get an IV with sugar, it’s really glucose under its pseudonym, dextrose. A common IV solution is D5W; that means the composition of the fluid is 5% dextrose (glucose) dissolved in water. another is D5NS, meaning the sugar is dissolved in a salt solution. That is usually given to patients who are dehydrated and need volume; the sugar, in the form of dextrose, is added to make the sterile intravenous fluid “isotonic,” An isotonic solution has the same salt concentration as the normal cells of the body and the blood.(using only salt enough to approximately match what your normal blood level of sodium should be and not adding the dextrose would result in a fluid too dilute for safety).

Fructose can be added to foods, drinks, or, eventually, your waistline

When I read what I had written thus far I realized I wasn’t sure anymore what exactly happens to the fructose part of table sugar, or for that matter the high-fructose corn syrup added to so many processed foods. That turns out to be more complicated than I remembered so I’ll save that discussion for my next post.

 

 

 

What sweetener do you use? Part 1

Wednesday, January 11th, 2012

real sugar has some calories

I have a confession to make. On the rare occasions when I do use a sweetener, I actually use sugar or occasionally honey.

Now that doesn’t happen very often; I don’t have all that much of a “sweet tooth” and usually add a few Crasins to my unsweetened cereal in the morning and drink a non-coffee called Cafix (now that’s a clever name; I suppose it’s implying “Caffeine Fix”) with a small amount of vanilla soy milk, but no sugar.

On Wednesday, January 4th of this year, The Wall Street Journal had a big spread in their “Personal Journal” section with an eye-catching title, Bracing for the Fake Sugar Rush.” In the article four artificial sweeteners, Truvia, Splenda, Equal and Sweet”n Low’ were compared to sugar. Prices were listed, tastes and aftertastes were compared, the sweetening agents were mentioned and the calories noted (0 for the articial sweeteners and 15 calories per teaspoon for the good old fashioned stuff).

Then I started thinking. I knew that adding 3,500 calories to my food intake theoretically would result in a weight gain of a pound. Since I enjoy math I wanted to figure out how much sugar that is. That translates into 233 and 1/3 teaspoons full or 1.167 kilograms of sugar (about two and a half pounds). So I’d have to eat two and a half pounds of sugar to, in theory, gain a pound of weight?

These three don't; but do they have any risks?

I went back to the article I just mentioned: my real reason for not using artificial sweeteners is two-fold. The WSJ admittedly “unscientific taste test” confirmed one of those; all four of the fake sugars had strange aftertastes according to their samplers: one was “Tab-like,” one was compared to soap water, another termed metallic and the fourth said to leave a taste “like a copper pipe.”

The other is safety; consumers often hear much later of concerns about new chemicals, whether they be sweeteners or medications. The managing director of a “brand-consulting firm” says one worry is “Did they test it on enough rats over a long enough period of time?”

Well, I’ve done basic lab research with rodents (three and a half years in medical school) and I’d really like to be able to say those experiments directly apply to humans, but I can’t be sure that’s a true statement. I did later work with dogs and when my boss (an associate professor at UCLA) was getting ready to present some of our results at an international conference, he came up with a great idea.

“Peter,” he said, “when I show the slides with our data, someone in the back of the room is going to get up and ask if humans react the same way. So let’s replicate our experiment in at least a few people.”

Guess who was the first of those “people?” I was poked and prodded and infused with the same materials as our dogs.

In our case the data was essentially the same and when that inevitable heckler at the back of the room said his piece, my boss replied, “Let’s have the first large slide.”

But how much safety testing has been done with humans for these sweeteners? I’ll try to find out if there are any long-term data on those of us who use non-caloric alternatives to sugar and write about that next.