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The "tippling" point

Tuesday, February 8th, 2011

one too many

My wife clipped an article from The Wall Street Journal last week and stuck in my "read this, Peter" stack she keeps. I got around to it yesterday and was impressed enough to do the background research. The writer had looked at the 2010 Dietary Guidelines for Americans and focused on the beneficial effects of moderate alcohol consumption.

Well that caught my attention; I drink a glass of wine two or three nights a week, rarely drink two and never more than that

The author of the short article, Stanton Peele, is a psychologist, attorney and writer on addiction recovery. He is a PhD, JD who has written nine books on addiction and has a different view than the "Disease Model" that many of us were taught in our medical training. His take is  the "Life Process Model"in which addicts use their drug of choice to cope wih life. I did note that eleven years back some of his research was sponsored by the Distilled Spirits Council and the Wine Institute  (their support of his work ended in 2000).

Okay that made me a sceptic, but I decided to read the section on alcohol in the recently released 2010 DGAC. It begins by emphasizing the hazards of heavy EtOH intake, quoting a 2009 study attributing 90,000 deaths a years to alcohol "misuse" in the United States. It also estimates that 26,000 deaths were averted (I like that term better than prevented since eventually we all die) by moderate EtOH consumption.

The traditional definition of moderate is one or two drinks per day for males and one per day for females. A lot of people exceed those levels with 2009 and 2010 studies showing estimates of 9% of men and 4% of women drinking heavily.

So what's the good stuff assuming you're an adult, not pregnant, don't have a drinking problem and don't have disease that are exacerbated by alcohol? it appears from extensive reviews of the medical literature that moderate drinking isn't associated with weight gain (remembering that EtOH is "empty calories and you still have to eat a balanced diet). Also moderate evidence supports less cognitive decline with age in moderate drinkers and strong evidence "consistently demonstrates" a lower risk of coronary heart disease in moderate drinkers. Bone health as shown by the incidence of hip fractures appears to be improved by moderate drinking.

MVAs and drowning as well as falls are more likley with heavy drinking, but the risk for these is less well estbalished with moderate drinking.

There's even a section on lactation and breastfeeding; Alcohol reduces milk production and decreases infant milk consumption for three to four hours after alcohol is consumed, but the DGAC concluded that after age two to three months, an infant's exposure would be negligable if the mother waited three to hour hours after consuming a single drink before breastfeeding.

And of course nobody is urging you to start drinking if you don't already.

So I'm going out to dinner with my wife and a friend tonight and will order a glass of wine.

But she's going to drive home.

Posted in beverages, Governmental Efforts, Healthly lifestyle, Life extension | No Comments »

Hooray for Mark Bittman

Friday, February 4th, 2011

The New York Times

A while back we purchased a huge cookbook by Mark Bittman who writes columns in The New York Times. That was a gift for our Indian children (formerly  graduate students at CSU where we were their "local parents) and had the title How to Cook Everything Vegetarian. We liked the cookbook so much that we purchased a copy for ourselves (we're not vegetarian, but eat that way perhaps 25% of the time and certainly eat more fruits and veggies than meat the rest of the time).

The bookstore had a used copy of his 1998 book How to Cook Everything and I bought that also and then received as a gift from friends on the Times staff his 2008 update of that book. They became two of our favorites, especially since Bittman gives 10-20 options for preparing most items, a real chance to variegate your menu. We later purchased a copy of Bittman's 2009 slender volume Kitchen Express: 404 Inspired Seasonal Dishes You Can Make in 20 Minutes or Less. That's written in a looser style and should appeal to my wife Lynnette, but thus far we haven't used it as often.

So we've become Bittman fans and when I noticed in my online NYT offering for Feb 1st a column by Mark  I hurried to read it. The title of that Opinionator piece was "A Food Manifesto for the Future." The coulmn was trenchant, to say the least, and Mark ended by saying he'd expand on its topics in later coulumns.

I think you should try to retrieve it for thorough reading, but I'll summarize his points. They are: end our current huge goverment subsidies that end up supporting the "processed food"industry and shift that money (or at last some portion of it to farmers and even markets that grow and sell "real" food." Get rid of the USDA's conflicting double duty assignment to simultaneously increase sales of corn and soy (among other farm products, but especially those two) and serve as the source for advice on good nutrition (the latter job could potentially go to the FDA).

The issues also include: outlawing CAFOs (concentrated animal feeding opereations), while aiming toward more sustainable metohos that don't pollute our envionoment; help us all to do more of our cooking at home; use govenments taxing powers to decrease the sales of the all-mighty cheeseburger and similar foods; increase recycling while reducing waste (he cites an enormous fertilizer-caused dead zone in the Gulf of Mexico); strenghten truth in labeling laws and put lots of oomph (dollars) behind sustaiable agricuture>

There it is, paraphrased mildly as it's all the things I agree with.

Our American diet isn't what it should be, not by a long ways. One of the most obvious manifestations of that is how many of us are overweight or obese. That's fairly obvious just walking around. What I don't see every day are CAFOs and, since I don't eat fast food, the lines at the chain food outlets. Or, for that matter, the hidden costs of our US subsidies to Big Agriculture.

Thanks for the first in what promises to be a series of columns well worth reading, Mr. Bittman.

Posted in Governmental Efforts, Healthy eating | No Comments »

They're finally here!

Tuesday, February 1st, 2011

I woke up at 6:30 AM this morning and weighed myself: 149.6 pounds, right in the middle of my goal weight.  I've been working on my life style changes, more exercise and less food, since May 2009 and, although I bounce up and down 2-3 pounds, I'm basically lean.

Breakfast was a quart of "lime water" (I squeeze fresh limes three times a day), a cup of regular coffee for Lynnette and of Cafix for me (a blend of barley, rye, chicory and sugar beets; I avoid caffeine), a banana and a home-made oatmeal dish with millet, brown sugar, sunflower seeds, walnuts, and ground flaxseed to complement the commercial oatmeal. There's no salt in any of the above and we added fat-free milk (Lynnette) or soy milk (Peter) to our oatmeal. We'll eat our big meal of the day at noon and at home.

The Wall Street Journal's Personal Journal section had an article titled "New Dietary Guidelines: Less Food, Less TV." The June 2010 DGAC version from the advisory committee of sceintists and nutrition experts had gone through the expected round of commentary, largely from food indusrty sources and the final products, as always is considerably watered down. You can find it online at www.dietaryguidelines.gov if you want to read the entire document, or skim through portions.

So here's a section of what it says:

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Limit the consumption of foods that contain refined grains, especiallyrefined grain foods that contain solid fats, added sugars, and sodium.

How do we translate that into simple English? More than 1/2 your plateful should be vegetables and fruits, buy lower salt products and don't add any when you cook or at the table; eat less red meat. Eat real food, not food products; read labels carefully when you shop. I'd add: eat out less and exercise more.

I read Dr, David Katz's column, "New Dietary Guidelines: A Physician's Perspective" on the Huffingtonpst.com website (Katz is the Director of Yale's Prevention Research Center). He agrees that the feedback gave a politicized spin to the final document, but liked the new emphasis on obesity and chronic disease prevention (roughly 1/6 of our kids and 1/3 of our adults are obese). He didn't care as much for the continued emphasis on dairy and meat consumption with less attention paid to plant-based diets.

So this version of the Dietary Guidelines isn't all that much different from prior versions, unless you read carefully and, in some cases, between the lines. I found a section (Chapter one, page 3) on "The Heavy Toll of Diet-related Chronic Diseases that I'll comment on at another time.

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Posted in Food-related disease, Governmental Efforts, Healthly lifestyle, Healthy eating, medically-oriented background info, Obesity, our kids and their weight issues | No Comments »

What's Good for General Bullmoose...

Thursday, January 20th, 2011

A Bull Moose has some clout

Several major concerns in Americans' diets have apparently taken another step to resolution. I've written how the dietary salt (sodium really) recommendation has recently been lowered so that about 70% of us (all but the young, white and quite healthy) should be ingesting only 1,300 to 1,500 mg. of sodium per day. That's tough enough to do. I saw a recipe yesterday in a "Light Cooking" magazine my wife gets that was interesting: a steak hash. But per portion it had 1,000 mg. of sodium.  That's over two thirds of what I should eat in a whole day. I didn't bookmark that recipe.

Then there's the relatively high cost of fresh fruits and vegetables compared to some other choices, so called "prepared foods" one can buy in the supermarket. Those mixtures are often filled with sodium, fats and sugars, but they're comparatively cheaper in many instances.

We're fortunate enough, as a pair of USAF retirees,  to be able to buy our fruits at the Air Force Base Commissary closest to us as we did when we drove to Cheyenne to see our Dermatologist today. And in the summer, of course, we've again purchased a veggie share and a fruit share from the local CSA, Grant Family Farms. Next summer two sets of friends will join us in that, so the variety will go up and the price per item down as we purchase larger shares. Then we got a quarter of a "hand-raised" cow this year at a wonderful per pound price. That came through friends whose neighbor has a very small herd and sells a few each year.

So what if you're on a tighter budget and don't live where friends and their neighbors have livestock?

Today in The New York Times appeared an article titled "Promote Healthy Foods."  It details how Wal-Mart (since 2008 I think it's actually Walmart), now the biggest retail concern in the country has a new plan, one that over the next five years will cut down on packaged foots content of the sodium, fat and sugars. That gradual approach doesn't ring well with some; I saw some negative quotes, but other countries have followed the same pattern with success. it's hard to go from high-salt to low-salt diets in one urgent push. I know since I tried that when my own blood pressure first went up in the early 1980s.

I tried some "no-salt" foods and hated them. Yet now, some 25+ years later, I'm quite comfortable adding pepper and other spices and using no table salt and no cooking salt.  We cook with a little salt when we have company, using less than the recipe calls for, and I frequently see our guests adding salt at the table. When we eat alone there's no salt shaker there.

Wal-Mart is also planning to offer fruits and vegetables at lower prices. And the article said they plan to build some more stores in rural and "underserved" areas. The company has been discussing healthy eating and our epidemic of childhood obesity with the First Lady and she apparently endorsed their efforts. Why is this significant? Well it's because they can pressure their suppliers to follow along with the concept. They are the Bull Moose herd leader and others tend to tag after them.

We don't do much shopping with them, but in this case I say, "Hooray for Wal-Mart."

Posted in cooking: new ideas, Corporations and healthy foods, Food Additives, Food producers and less-healthy foods, Governmental Efforts, medically-oriented background info, our kids and their weight issues | No Comments »

When even the experts disagree

Friday, January 14th, 2011

A good source of calcium

I saw two interesting articles this week that made me pause and chuckle a bit. One came from the American College of Physicians' publication, "ACPInternist:" the other from medscape.com as A "Best Evidence Review," and compared and contrasted recent US and Canadian authoritative recommendations." The topics were calcium intake/supplements and Vitamin D optimal dosage and the suggestions varied considerably.. I doubt it's because Canada is further north, but that thought crossed my mind.

So let's talk about calcium first.

In July 2010 an article appeared in the British Medical Journal which made many physicians change their recommendations on calcium supplements. There was nearly 1/3 more heart attacks in a group of patients taking calcium pills as opposed to another group who weren't. At a later revelation at an American medical society meeting, the same group of research scientists showed a data from the Woman's Health Initiative (WHI) that also found a heart risk from calcium supplements, this time both in heart attacks and calcification of coronary arteries.

We quit taking our calcium pills, but continued to drink and eat milk and milk products.

Now other medical researchers have cast doubts on the significance of the data saying the overall WHI statistics showed what is a small heart risk at most. There's still a debate as to whether calcium supplements do or do not decrease hip fractures (a major problem, especially in older women).

Then the Institute of Medicine report issued in November as a joint US-Canadian dictum said most Americans, except possibly for teenage girls and some of the elderly, get enough Vitamin D and calcium without using any supplements and that the major risk of too much calcium intake was really kidney stones. There was a specific caveat that postmenopausal women taking supplements may be getting too much calcium.

High-dose Vitamin D

Now the January 5th, 2011 Medscape review looked at Vitamin D recommendations in Canada versus those in the United States. Both came from authoritative sources: The Osteoporosis Canada study concluded that many of us are low in Vitamin D and that more is good, mostly in promoting bone health, but possibly in colon cancer prevention and also in decreasing older adult falls. They suggest taking larger doses than the US Institute of Medicine does.

SO...how do I parse these varying studies and what do we plan to do. First, we will continue to get our calcium from food sources, mostly milk, soy milk (with its added calcium), cheese and yogurt. Secondly we'll continue to take a larger dose of Vitamin D in pill form, but perhaps slightly less than we are now, and I may get a little more sun exposure.

One comment in the Medscape article was a "young white person needs approximately 4 minutes of direct exposure to sunlight on the arms and legs to generate approximately 1,000 IU of vitamin D3." There's debate as to using sunscreen or not with a small, but randomized Australian study showing a similar increase in blood levels of Vitamin D, measured as 25-hydroxyvitamin D3 (25-OH-D) whether actual sunscreen was used or a placebo sunscreen. Notice, please, that nobody is suggesting prolonged or facial sun exposure.

Sun and Clouds

I may try some arm and leg skin exposure to sunlight; my wife who has had one skin lesion removed won't. We'll continue taking Vitamin D and she needs a follow-up blood level test as her first one was low. We're now on 5,000 IU per day and that may be too much; the Canadian study suggests 800 to 2,000 IU per day; the US recommendations, while lower (800 IU per day for those 71 and older; we're just shy of that), say risks from too much Vitamin D don't increase until doses are over 4,000 IU per day.

Confusing, isn't it; I suggest you ask your own personal physician as to what you should be doing and also ask them if they've seen the most recent recommendations.

Posted in Governmental Efforts, medically-oriented background info, supplements | No Comments »

Fats and fatty acids and our health: chemistry and politics

Thursday, December 23rd, 2010

Butter on a dish

I wrote about omega-3 fatty acids the last time, but, until I read Professor Robert L. Wolke's wonderful book, What Einstein Told His Cook, I didn't understand the name or remember much of the chemistry behind the fatty acids or fats themselves for that matter.

So let's start with a little chemistry, thanks to Wolke who is an emeritus  professor of that discipline and wrote a Food 101 column for the Washington Post for a number of years.

Fats, also called triglycerides, are chemical substances whose molecules are made up of three fatty acid, long chains of carbon atoms hooked onto a connector called glycerol. The carbon atoms themselves usually have two hydrogen atoms and if every carbon in the fatty acid chain has both its soul-mate hydrogens then we call it a saturated fatty acid.

When one carbon hydrogen is lacking its pair of hydrogens, the fatty acid is termed monounsaturated; if two (or three or more) carbons find themselves without their hydrogens, the fatty acid is polyunsaturated.

And then there's olive oil

The last carbon on a fatty acid's chain is termed the omega carbon from the final letter in the Greek alphabet. Omega-3 fatty acids, the good kind I've mentioned before, are missing hydrogens three carbons from the end of their chain.

So Omega-6 fatty acids, the much less healthful kind, lack hydrogens six places away from the omega end of the carbon line. And so on for Omega-9 fatty acids.

And while we're at it, if we're talking about a mostly saturated fat, it's likely to be a solid and from  an animal source (or a chemistry lab). Those that are mostly unsaturated are usually from vegetable sources and are much more commonly liquids.

Two more chemistry concepts for today, then I'll quit. If you look at the composition of a particular vegetable oil, part may be saturated, part monounsaturated and part polyunsaturated. The proportions count in deciding if the veggie oil is good for you or not, as saturated fats aren't healthy.

When food manufacturers want to stack the deck and sell you solids, not liquids (think margarine versus canola oil), they can add hydrogens in a technical process. On the other hand, partially unsaturated fats are easier to spread than totally solid ones.

That process, hydrogenation, can produce molecules rarely found in nature and one of the consequences of doing so led to trans fats, where the hydrogens added end up on opposite sides of a carbon. Those trans fats turned out to be nasty beasts (this was suggested in the medical literature as early as 1988), causing heart disease, with one estimate of 20,000 additional deaths per year in the United States. That number was published in  The American Journal of Public Health in 1995.

Thirteen years later, in January 2008, the state of California passed a law to minimize restaurants use of trans fats to less than half a gram per serving and in 2010 started to enforce that law. Apparently the state didn't think the restaurants would be able to comply with the new rules immediately and gave them two years to make changes. During all that time they could serve more than the limit of trans fats. Bakeries will have to comply with a similar law beginning on January 1, 2011.

I'll come back to the various kinds of fatty acids next time as there's more to add.

In the meantime, especially over the holidays, be aware of what you choose to eat.

Have a Merry (and healthy) Christmas.

Posted in Food producers and less-healthy foods, Governmental Efforts, medically-oriented background info, Unhealthy eating | No Comments »

Guidelines for diagnosing food allergies in flux

Wednesday, December 15th, 2010

I've been tracking down some changes in the diagnosis of food allergies, especially in kids. I started with a Wall Street Journal article, dated Tuesday, December 7, 2010 and titled "New Rules for Food Allergies." That mentioned the National Institute of Allergy and Infectious Diseases, a segment of the NIH under the US Department of Health and Human Services, had recently convened an expert panel on the subject.

The resultant guidelines were published in the "Journal of Allergy and Clinical Immunology." I found a review in WebMD (webmd.com) and then the lengthy report itself online at the NIAID website. I realized it was so voluminous there was a separate 29-page summary for clinicians and a much shorter set of guidelines for patients with a more thorough patient guideline to be published in 2011.

An Epi-Pen for severe allergic reactions

So what's the short version? Well to start with about 5% of kids and 4% of adults have food allergies. If they eat specific foods they may have reactions varying from mild to life-threatening.

The most freguent food allergies are to eggs, milk, peanuts and tree nuts, soy (that surprised me), wheat and some shellfish. Kids often outgrown an allergy to milk, eggs, soy and wheat, but not those to peanuts and tree nuts.

There are no cures to these allergies and having a mild reaction to a food once doesn't mean you won't have a severe reaction on another exposure.

Allergies often are seen in people who have some other diseases, asthma for one example and eczema (a skin disease) for another. Those plus a family history of food allergy may alert you and should alert your physician to your having a greater risk of food allergies.

Neither of the usual office tests used to diagnose food allergies, is definitive. Those include a blood test looking for antibodies to specific food and skin-prick test where a tiny amount of a suspected allergen is paced on a forearm then pricked to see if a wheal result.

The only test that proves you have a food allergy is a food challenge. That must be done, for safety reasons, under the careful direction of an experienced healthcare professional.

Yet all is not as dire as the above sounds. One study published in the Journal of Pediatrics this fall looked carefully at the medical records and testing of 125 children who had been sent to the National Jewish Hospital in Denver for evaluation of eczema and food allergies.

After careful food challenge tests were evaluated, over 90% could go back to eating foods they had been avoiding.

A few other tidbits caught my eye: peanut allergies are especially severe and, fortunately, I'm seeing more and more labels that specify this product is (or is not) produced in a peanut-free environment. Wheat protein allergies are not synonymous with celiac disease, so those having such allergies may not react to gluten in oats, rye and barley. And fish allergies, which tend to start after childhood, can be another very severe problem.

I give my wife her allergy shots at home, so I keep Benadryl and an Epi-Pen handy. Food allergies are nothing to sneeze at (no pun intended), so if there is a family history of them or you or your child have eczema or asthma, make sure you get a thorough evaluation by a qualified physician.

Posted in Governmental Efforts, medically-oriented background info, our kids and their weight issues, Unhealthy eating | 1 Comment »

When all else fails

Tuesday, December 7th, 2010

Most of my posts are written for those of us who are of normal weight and want to stay there or those who are overweight and would like to lose a few pounds or twenty or forty. As of this morning, for example, I'm twenty-four pounds under my May 2009 peak and sixty-five under my obese 1970 lifetime maximum.

It's the holiday season with Thanksgiving and Hanukkah and Christmas thrown in to a jumble of other parties, gourmet club dinners, symphony events and theatre events. I'm at my upper limit of 153 pounds and have to really watch carefully to avoid all the temptations.

Many of you are in the same mode, I bet, but overall doing okay with your weight.

Then there's an entirely different group. I saw an article on Lap-Band surgery for those people who are obese and haven't managed with diets, counselling, support groups and perhaps even medication to lose the pounds they desperately need to shed.

Does this man need Lap-Band surgery?

Now I'm an Internal Medicine doc and a retired one at that, so I looked at the Mayo Clinic website, an Australian website, one for a nearby hospital and MedlinePlus, an online information source sponsored by the NIH and the National Library of Medicine. I wanted to know more about this surgical strategy for the obese.

First off it's not cheap with prices varying from $13,000 to $25,000 in the United States. Some people go south to Mexico where the prices are lower, but I wouldn't be likely to do that if I were seeking out this procedure.

It's done under general anesthesia using a laparoscopic approach. That means several small incisions are made in the abdominal wall and a small camera in inserted to allow the surgeon to see what he or she is doing. A band is then positioned around the stomach so that the upper portion of that organ forms a small pouch with a narrow opening to the rest of the stomach.

It doesn't require internal staples or cutting and, if the surgeon is experienced may take only 30 to 60 minutes. The 2,700-person Australian series I read about reported no deaths.

Lap-Band surgery has been restricted to the very obese with a Body Mass Index over 40 (mine is 20.5), or the fairly obese who have complicating diseases such as diabetes, heart disease or sleep apnea.

But, after the surgery people have to stick to a diet and should exercise. Plus there are complications with half the patients in one large series reporting nausea and vomiting, a third having reflux, a quarter of the bands slipping and requiring repositioning and perhaps 10% experiencing some blockage near the band.

The band is adjustable; the physician can tighten or loosen the stricture by adding or removing saline.

And this is the least invasive surgery for severe obesity. I also read where some proponents (and the company that makes the device) want to loosen restrictions on its use. They'd like it to be approved for use in people with a BMI over 35 or over 30 with complicating diseases. That would include over 25 million Americans.

I'll certainly stay out of that debate and stick to my diet and exercise concepts.

Posted in Complications of Obesity, Dieting, Governmental Efforts, medically-oriented background info, Obesity | 2 Comments »

Even more fat for our taste buds

Wednesday, November 17th, 2010

A new and expensive burger

I picked up my copy of The Wall Street Journal this morning, opened it to "Personal Journal," the section I usually read first, and gasped. The lead article was titled  "Bring On the Fat, Bring On the Taste."

That certainly caught my attention... negatively. Then I started reading the rest of the article and got even more upset. The subtitle was "Celebrity Chefs Join Burger Wars, Baste Beef Patties in Butter." The text went on to describe how some of the top chefs in America are now getting into the burger business. Some say they are using only the best kinds of beef and specialty ingredients, but a number of food specialists, among them university professors, say what they're chef really doing is serving high-fat burgers.

Another new burger

They're also charging much more than the fast food restaurants. One of the burgers, made from Japanese Kobe beef and served with foie gras and truffles, costs $39. And that's not the most expensive pattie. Another has truffles, foie gras and Madeira sauce and goes for $60.

Why would anyone eat these cardiovascular time bombs? Well they presumably taste good and perhaps they are status symbols. But they also use beef that has up to 30% fat content, or is basted in butter or, in one iteration, has a double layer of beef with potato chips in between to increase the crunchiness.

As for the chefs, they've realized the high-profits creating the monster burgers can bring. Hubert Keller, a French-trained, high-levl chef, makes 9 to 12% margins from his haute cruisine restaurants. His marginal profit on his first burger unit is 37.5%, so he's opened his second and third and has four more in the planning stage.

So let's go back to why this might be a problem, to our bodies even more than to our wallets. The 2010 Dietary Guidelines for Americans (DGAC) hasn't been released  in its final form yet, but the expert panel's preliminary report, available online, wants us to cut our intake of staurated fats to less than 7% of our total calories.

That makes enormous sense; saturated fats are associated with cardiovascular disease (CVD) risk and people who either have this problem or are at high risk for it need to minimize their intake of these lipids.

We're in the midst of an epidemic of obesity, hypertension, type 2 diabetes (T2D) and 50 million Americans are said to have the metabolic syndrome (a combination of abdominal fat, high blood pressure, insulin resistance (T2D), abnormal blood lipids and several other blood factors making one prone to CVD).

My opinion is the last thing we need is these expensive new high-fat burgers.

But I'd bet they sell well and make the chefs a bundle of money. When it comes to following the DGAC, we don't have a good track record.

Posted in cooking: new ideas, Governmental Efforts, Unhealthy eating | No Comments »

I changed topics in mid-post; now it's on iodine

Wednesday, November 3rd, 2010
Salt pig with kosher salt

salt pig with kosher salt

I read an article from the Harvard Heart Letter on beating high blood pressure with food. I wanted to trace back the source data, a study published in The New England Journal of Medicine (NEJM) in June 2010, especially after reading a number of NEJM letters to the editor in an October edition of the journal.

Then I got sidetracked by the iodine aspects of the diet, noting that one of the letters suggested a low salt intake could result in iodine deficiency.

I'm on a no-added-salt diet myself (for high blood pressure). I've been on one for thirty years and my BP is excellent, especially now that I'm lean (151.6 pounds this morning, about what I weighed in 8th grade). So I probably meet the new, lower United States salt intake recommendations, about 1,200 mg of sodium for those of us who are over 50, are African Americans, have hypertension or diabetes; that's 70% of all Americans.

My wife and I frequently use kosher salt when we cook. It contains no iodine, whereas common table salt is iodized. So do I need to switch to using regular salt? My calculations said iodized salt, added at 1/2 tsp. per day would contribute 1190 milligrams of sodium and about 100 micrograms of iodine.

Iodized salt

So where should we get our 150 micrograms a day of iodine (that's the suggested intake for adult men and women, although pregnant women should get 220 micrograms and lactating women 270 micrograms). Those seem to be standard recommendations, although I've read some that vary a little from those figures.

I found a stark reference in another NEJM letter saying iodine deficiency affects more than 1/3 of the world's population, an estimated 2.2 billion people. It is the foremost cause of preventable mental retardation worldwide and even in its mild forms can affect the brain function of  kids.

My wife and I take a senior multivitamin daily; my reading indicates that almost all of those contain 150 micrograms of iodine. But a Boston University Medical Center study of prenatal vitamins, found considerable variance from the listed iodine content in many brands, both OTC and prescription. They suggested pregnant women should take prenatals that contain potassium iodide and urged the drug companies to make sure their products contain enough iodine as potssium iodide, since the amount of iodine in kelp varies considerably.

Then there's the question of dietary iodine. Another study, reported at the April 2010 meeting of the American Association of Clinical Endocrinologists (AACE) was titled "Iodine Content of Fast Foods Contributes Little to Iodine Levels in the Body." That study noted only one fast food chain consistently used iodized salt and that milkshakes and one chain's chicken sandwiches had the most iodine (the primarily latter from constituents other than the chicken).

Over the years since the 1971 National Health and Nutrition Examination Survey (NHANES), to the 2000-2001 NHANES, mean urine iodine levels fell by over 50%. We haven't got a widespread iodine deficiency problem in this country...yet.

The AACE president said, "The way to protect the general public from iodine deficiency is to make sure there is more regular use of multivitamins containing  potassium iodide,"

So with all that as background, and reading that we can tolerate iodine intakes of 1,000 to 1,1000 micrograms a day if we're over age 4, I'm not going to increase my salt intake, but I will continue my varied diet, perhaps eat more seafood, and take my senior vitamin daily.

Posted in Food Additives, Governmental Efforts, medically-oriented background info | 1 Comment »

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