Archive for the ‘Food producers and less-healthy foods’ Category


Friday, October 14th, 2011

The culprits, this time.

Reading "USA Today" online, I found an article detailing the repercussions of the recent/ongoing outbreak of disease linked to cantaloupes coming from one specific farm in Colorado. That operation, Jensen Farms, re-called its fruit in mid-September. The Food and Drug Administration and the Seattle-based Institute for Environmental Health have not yet found the root cause of the outbreak. Since the normal shelf life for cantaloupe is ~two weeks, none of the Jensen Farm product should still be in stores. And no other sources have been implicated. Nonetheless, cantaloupe producers in California and Arizona, the two states with the largest crops of this fruit, are seeing sales plummet 80% or more.

That probably shouldn't surprise us. Spinach sales, devastated by the 2006 E. coli outbreak, are still down nearly a third in one California county.

As of October 12, the current outbreak had led to 116 illnesses and 23 deaths, making it the deadliest in more than a quarter century. There was another outbreak in Texas in October of 2010; that one was related to celery and resulted in 10 total illnesses and five deaths.

I went to several online medical sites to refresh my memory on Listeriosis. When I dealt with infections from this bacteria it was in immuno-compromised patients. Listeria is found worldwide, often in association with farm animals, many of which are otherwise healthy carriers of the bacterium. People can also be carriers and perhaps five to ten percent of us have Listeria in our bowel flora.

There are roughly 2,500 US cases of Listeria infections yearly and about a fifth of those infected die. Most are isolated cases, not major outbreaks The bacteria isn't transferred from person to person with the exception of pregnant women and their fetuses or newborn babies.

This is a foodborne illness, most commonly associated with improperly processed deli meats or unpasteurized milk products.

About 30% of all reported US cases occur in pregnant women. As opposed to the majority of us, who may have nonspecific symptoms, or none at all, pregnant women can transmit the infection to their fetuses or to their newborn infants. They also may have minor symptoms, if they are otherwise healthy, but Listeria can lead to miscarriages, stillbirth, premature birth or, potentially, to serious disease or death of newborn babies.

Others at higher risk for serious disease when infected with this bacterium include the elderly, diabetics, cancer patient, AIDS patient, those with significant kidney disease and anyone on immunosuppressive drugs.

It's tough to diagnose Listeria infections: the most common signs and symptoms include fever, muscle aches, nausea and/or diarrhea. There are no reliable tests for the bacteria, so the diagnosis is difficult in the absence of a history of exposure to a potentially contaminated food source during an outbreak.

Most of us clear the infection without any treatment; those at higher risk should be considered for immediate IV antibiotics and consultation with an Infectious Disease specialist is recommended (and if a pregnant woman has the inception, an Ob-Gyn specialist and a Pediatrician should be involved.

Antibiotics for Food-Producing Animals, Part Two

Tuesday, August 16th, 2011

This turkey could end up as ground meat

The August 13th edition of The Wall Street Journal contained an article extending the discussion of the recent ground-turkey-related disease outbreak and the routine use of antibiotics in animals raised as food. It noted that the FDA has been reviewing the subject for 40+ years without issuing firm restrictions, supposedly because of a lack of data on resultant health risks in people.

There's a long, long pattern of recommendations coming from scientific panels without any conclusive followup by the FDA or the USDA. The history of these committees and advisory groups is well documented in a Health and Human Services paper I found online and will briefly summarize. I'll provide a link for your own perusal if you get interested in reading more on the subject.

In 1968 the UK started a Joint Committee on the Use of Antibiotics in Animal Husbandry and Veterinary Medicine . The "Swann report" presented to Parliament the following year concluded "that the administration of antimicrobials to food-producing animals, particularly at sub-therapeutic levels, poses a hazard to human and animal health."

That seemed clear-cut to me. The report said that the increase in antibiotic-resistant enteric (intestinal) bacteria of animal origin resulted from the use of those drugs for growth promotion of farm animals.

enteric bacteria in their home turf

Since then, there have been a number of "expert panels" and task forces, both in the United States and elsewhere that have reached essentially the same conclusions. What's lacking is any large study (preferably more than one)  showing a direct connection between antibiotics being given to entire herds and resultant human illness. There has been a lot of "indirect evidence" implicating the widespread use of these drugs in animals as a potential human health hazard.

The animals in question, typically turkeys, chickens, cattle or pigs, are  not being treated for specific diseases. They are, en masse, given antibiotics in their feed or water, primarily to increase their weight gain (and thus their profitability for the companies raising them).

A spokeswoman for the National Turkey Federation was quoted as saying, "Antibiotics have been safely used on farms...for half a century to treat and control disease in animals and to improve the animal's (sic) overall health, allowing for greater productivity."

The article in The Wall Street Journal said, "Industry groups are cautious about regulation." They feel human health may actually be improved by the longstanding practice of antibiotics being added to feed and that meat prices are lower becuase the animals use less energy fighting disease and therefore grow faster.

Now six members of Congress asked the FDA to actually implement the proposed rules. After all, it's only been 40+ years and a number of outbreaks since the concept has first been proposed. There was another recall in April 2011, this one of ~55,000 pounds of ground turkey.

It's about time to tighten up the rules.

An Entire Pillar of Salt?

Saturday, July 23rd, 2011

Not a pillar, but too much anyway

I remember a Biblical reference (Genesis 9:26 in my copy) to Lot's wife looking back at Sodom and Gomorrah and turning into a pillar of salt. Today I'd like to talk about much smaller amounts than a whole pillar and salts in the pleural, not just sodium chloride, ordinary table salt, but potassium as well.

I am aware there's been considerable discussion of our dietary salt/sodium intake in the past few years. A July 12, 2011 article in The Wall Street Journal titled "Neutralizing Sodium's Heart Impact" led me back into this literature.

We've been urged time and again to lessen our sodium intake. The 2011 Dietary Guidelines, as I've mentioned before, suggested the average American cut their sodium intake from our average of  3,400 milligrams down to 2,300, roughly a teaspoon a day.

But a large group of us, all at risk for hypertension: everyone over 51, African-Americans, anyone with pre-existing high blood pressure and those with diabetes or chronic kidney disease (i.e., over half our population) were told we should go further, cut to roughly a half teaspoon of salt a day, with various sources suggesting 1,200 to 1,500 milligrams per day total sodium intake.

The most recent study appeared in the Archives of Internal Medicine on July 11th and had a slightly different take on the subject. A prospective cohort study of 12,00+ US adults, followed nearly 15 years, showed that both lower sodium intake and higher potassium intake were associated with a lower risk of death.

The numbers appear significant with the quartile i.e., quarter of the group, ingesting the highest sodium to potassium ratio having almost one and a half times the death risk of those who ate the lowest ratio. That held true for all-cause mortality and the death risk for ischemic heart disease was over two-fold in the group who ate more sodium and less potassium-containing foods.

So how do we get more potassium in our diets and just how much should we be ingesting? I found a lovely illustrated guide on the website and another good discussion on MedlinePlus, the NIH website. The former guideline has both potassium and calorie data.

Adults with normal kidney function should be getting 4.7 grams a day from the foods they eat (if you have reduced kidney function, ask your own physician how much you should ingest). Some medicines affect your ability to excrete potassium; for the rest of us 19 and older the Food and Nutrition Center of the Institute of Medicine says the 4.7 gram amount is reasonable. Nursing moms need 5.1 grams a day.

Here' a good potassium source

A large baked potato with skin has 845 milligrams of potassium and 160 calories while 1/2 of a medium sized cantaloupe has 680 milligrams and only 60 calories. A medium banana has 451 milligrams with 105 calories.

Red meats, chicken, salmon, cod, flounder and sardines are all good sources of potassium and a cup of low-fat plain yogurt has 530 milligrams with 150 calories.

Many of us have eaten far too much sodium (in processed foods) and too little potassium.

It's time for a change.



But now they're adding sugar?

Friday, July 8th, 2011

We've removed the HFCS

A few days ago I re-read Taubes's July 2002 article in The New York Times and the November 2002 "Nutrition Action Health Letter" article from CSPI that looked at his claims that refined carbohydrates are the problem and contradicted many of them. I have 40+ years of personal experience of reading articles critically. I fully understand that all one sees in print may not tell the entire story or may be slanted toward a particular view of the truth.

But I was still surprised to see a Wall Street Journal article ("Personal Journal, Wednesday July 7, 2011 pp. D1-2) titled "Sweet Revenge, Chefs Pour on the Sugar."

The story of high-fructose corn syrup dates back to the aftermath of WWII. Two major war-time industries needed to continue employing large numbers of workers, especially with all the GIs returning. So toxic chemicals became pesticides and gunpowder morphed into fertilizer. Corn was felt to be the most efficient crop in converting sunlight to food energy, so it became the most favored crop. Soon there was the question of new uses for all that corn.

High-fructose corn syrup (HFCS) was first introduced by Richard O. Marshall and Earl R. Kooi in 1957.  The industrial production process was developed by Dr. Y. Takasaki in Japan from 1965 to 1970 and Takasaki is known to many as the creator of HFCS. HFCS was rapidly introduced to many processed foods and soft drinks in the U.S. from about 1975 to 1985.

High-fructose corn syrup is produced by milling corn to produce corn starch, then processing that starch to yield corn syrup, which is almost entirely glucose, and then adding enzymes that change some of the glucose into fructose.

The problem of course, is the rapid absorption of both HFCS and table sugar leading to a surge of insulin levels, resultant lowering of elevated blood sugar levels and, perhaps to hunger and subsequent over-eating. Taubes may have that part correct.

Now however, many high-level chefs are turning away from HFCS and substituting sugar. That's also been true for food-producing companies; you can now purchase Wheat Thins or Pepsi sweetened with sugar instead of HFCS.

But these are better for you

But my copy of Harvard's School of Public Health "Nutrition Source Update," led me to their new Healthy Eating Pyramid (link below) which puts sugary drinks and sweets at the small end with a comment to use them sparingly.

The chef's in the "Sweet Revenge" article have it wrong; they think HFCS is worse for you than sugar (many scientists think both have negative effects on health) and are surprised to find it in so many commercial foods, e.g., oyster crackers.

The American Medical Association and the American Dietetic Association both urge all of us to restrict our intake of all caloric sweeteners. The research director of the University of Cincinnati's Diabetes and Obesity Center says HFCS and table sugar are biochemically identical.

So I believe it's time to cut down on HFCS, table sugar, honey, brown sugar, golden syrup (made from cane sugar) and even agave nectar.

Your dentist will be happy and in the long run I think you'll have better overall health.

E. coli here as well as there

Friday, June 10th, 2011

You may not need to be quite this careful

On June 7th CDC officials were quoted as saying an unusual strain of E. coli, similar to that that has caused the on-going epidemic in Germany, had also, in the US in 2010, caused even more illness than the more common form of the bacteria. In this country, however, the national tracking and monitoring system for food-bourne diseases, revealed considerably less serious problems, with fewer of those affected requiring hospitalization.

So what actually happened here vs. in Europe? Let's start with what E. coli is and how we determine its variants (or strains as they are usually termed). In 1885 a German physician/bacteriologist discovered the most common bowel bacterium. His name was Theodor Escherich and the organism was found in the colon, so its name became Escherichia coli, E. coli for short. Several types of E. coli are part of the normal flora of the human gut, are not a threat to our health, help keep more dangerous bacteria from colonizing the bowel and can actually produce, in some instances, forms of vitamin K.

Laboratories test for E. coli strains by determining which form of the bacterium's antigens are found in its various structural components layer. The ones that form the major surface antigens are the O antigens, and the H and K antigens. The O157:H7 variety is more virulent than most others and causes diarrheal disease by producing a toxin harmful to the lining of the intestine.

Even that nasty "bug," which can be found in undercooked beef, but also other foods, is not lethal to most affected by it. Most healthy adults recover from a O157:H7 infection  in 5 to 7 days. Roughly 6% of those affected, usually young children, elderly adults and people of all ages with weakened immune systems, can develop much more serious complications such as hemolytic uremic syndrome  (HUS) in which red blood cells break down (hemolysis), blood platelets (responsible for clotting) clump up in small blood vessels in the kidneys and acute kidney failure occurs.

The most common problem bacterium, E. coli O157:H7, has for some time been a focal point for eradication from food products. The others, commonly called the "non-O157s" haven't routinely been tested for. Now the debate is whether US meat packers will be forced to check for rarer forms of E. coli making the selling of ground beef that contains it illegal.

Why is ground beef the focus?

It often contains meat from a number of cows (sometimes a large number) and has to be thoroughly cooked to break down the toxin. The day of the safe rare hamburger (I used to love them) may well be over. Other cuts of beef would come from just one animal and cooking the surface is usually felt to be relatively safe.

Meanwhile in Europe the number affected by the epidemic is up to almost 3,000 in 12 countries with over 700 developing HUS and 30 deaths. The lab tests on sprout samples were negative, but people who ate bean sprouts were nine times more likely to become infected than those who hadn't.



More on the E. coli front

Tuesday, June 7th, 2011

This week the focus appears to have shifted. I saw a photo in The Wall Street Journal of the German Health Minister and the local Hamburg Health Minister donning surgical gloves and wearing masks and gowns while they plan to visit an isolation ward.

Are these the culprits?

Now the most likely culprit appears to be bean sprouts in the food-borne illness that has affected well over 1,500 in Germany alone with 627 developing Hemolytic Uremic Syndrome (HUS). The article I read said that's an abnormally high percentage for this dire complication which has killed 22 people thus far.

Hamburg was the epicenter of the epidemic, i.e., most cases of the illness and of HUS-related complications have occurred relatively close to that city. There's lots more epidemiological work to be done, but a farm in the German state of Lower Saxony has been implicated, closed, and its produce is under a general recall.

The World Health Organization (WHO) has an online fact sheet that mentions people in 12 other countries have developed the disease termed hemorrhagic colitis (so you may see the unusual strain of E. coli called EHEC for Enterohemorrhagic E. coli). All but one person in that cohort had travel links to, or residence in, Germany.

The E. coli strain, called O104:H4, is rare, but has been seen in humans before. This is the first time its been linked to an EHEC outbreaks, this time with more than 2,200 people affected. There have been EHEC outbreaks every year, in varying parts of the globe, but almost always those have been small (the largest was in Japan in 1996 and affected more than 10,000 people).

The most recent update I found said that the first 23 samples (of 40) from the farm in question, tested negative, but more tests and more samples are pending.

Of course the economic impact on farmers has already been huge with estimates of $44 million in loses per week in Germany alone. Spain, whose cucumbers were initially blamed for the EHEC outbreak, is thinking of suing.

As of May 7th the European agriculture commissioner proposed paying farmers 30%of the cost of the vegetables they've been unable to sell, 150 million Euros. The source is still unclear and may never be known, but bean sprouts are still felt the most likely culprit, even if the ongoing tests come back negative. They've been implicated in previous US and Japanese outbreaks and are grown in heated water setting up an ideal culture media.

US scientists suggest that children, the elderly and those with weakened immune systems should not consume them raw.

This is what I'm buying

And it may be unfair, but yesterday when I shopped for groceries, I looked for "grown in the US" labels.

Lies, damn lies and misleading labels

Friday, May 20th, 2011

Caveat emptor (let the buyer beware)

A while back I mentioned the Nutrition Action Healthletter that the Center for Science in the Public Interest puts out. The April edition has a fascinating article titled "10 Common Food Goofs" written by CSPI's PhD house nutritionist, Bonnie Liebman. I knew some of the concepts she mentioned, but certainly not all of them and her specific examples are superb.

The main thrust is we need to read labels and read them carefully. Yet even if we do so the food industry with the "help" of the FDA frequently misleads us. One examples had to do with portion size.  My wife, an extremely successful lifetime member of Weight Watchers (she's five foot nine and weighs 130 pounds), taught me this concept a while back. Her idea of an appropriate serving of meat is the size of a deck of cards.

I started from there and looked at what I ate. Twenty-six pounds ago my typical meat serving was 12-16 ounces, now it's six to eight ounces (I'm five foot eleven and now weigh 150 pounds). But Liebman takes the concept and moves it into areas I never thought my way through before.

One example is Fat Free Coffee-mate. Nestle's Original variety has a label that states it's free of cholesterol, lactose, gluten and trans fat and the Nutrition Facts label claims 10 calories, and zero cholesterol, sugar or salt.

There's a catch though and that's serving size. The FDA and the food manufacturers have decided to round down if you use just one absolutely level teaspoon as the serving size. That's not what most of us do when we use a coffee creamer.

If I do have a cup of coffee I almost always add a creamer and I don't measure out a level teaspoon. I usually don't pour the Coffee-mate, but I certainly use more than the "serving size." Liebman says if you drink a 12-ounce mug of coffee and pour in two tablespoons of Coffee-mate, you've actually added 50 calories and 1.6 grams of saturated fat, more calories and nearly as much saturated fat as if you'd added a similar amount of half and half.

There are nine other examples in her article, but the drift is the same. Serving sizes of a variety of foods, e.g., ice cream, aren't what the label may lead you to think. Contents may include only tiny amounts of what the label raves about (added fruits and veggies) or may have added vitamins that are best obtained from foods, e.g., not from expensive water that also contains added sugar and therefore calories.

On the other hand there are code words, "natural" and "made with real fruit" are two that Leibman mentions. We either don't know the code or need a magnifying glass to read the micro-print that explains it. The word "Natural," except for meats and poultry, is one of the vaguest terms in advertising. And Organic doesn't mean calorie-free.

Bottom line: read labels with extreme care. Better still, stick to unprocessed foods without labels.



The great potato war

Tuesday, May 17th, 2011

Time for a switch?

I was reading The Wall Street Journal this morning, starting as usual with the "Personal Journal section which headlined the story of a successful prolonged cardiac resuscitation: "96 minutes without a heartbeat."But then the front page caught my eye with an article titled "Spuds, on the Verge of Being Expelled, Start a Food Fight in the Cafeteria."

Searching back-files, I found recent discussions at the US Senate Agriculture's Appropriations Subcommittee hearings. The Department of Agriculture plans to not allow money in the WIC program budget to be spent on white potatoes and not surprisingly senators from Maine and Idaho protested.

Medical articles I found stated that potatoes dominate our vegetable consumption, especially among adolescents who favor them fried. Another study, this one among young preschoolers, showed 70% of 2 to 3 year old kids eating some form of vegetables daily, with french fries and other fried potatoes being the most commonly consumed vegetables. An article in Nutrition Research from April 2011 stated that white potatoes, including French fries, did contribute "shortfall nutrients' and, when consumed in moderate amounts, could form part of a healthful diet.

So what's the rub? Well to begin with if you're only eating French fries, or worse still baked potatoes with lots of cheese, butter and other toppings, you may not be eating any other vegetables and you're getting a lot of "unhealthy diet" items.

Then there's the question of which potato is better. The "Tufts University Health&Nutrition Letter" recommends trying sweet potatoes instead of white potatoes, saying they have huge amounts of beta-carotene  (if you eat them, as I do, with the skin) and larger quantities of vitamin C, folate, calcium and manganese than their pale cousins.

The article in the WSJ that I started with mentions "Maine Potato Candy," mashed white potatoes rolled in coconut and dipped in chocolate and even potato doughnuts, One school food-service director is quoted as regularly serving hash browns , mashed potatoes, "Maine fries," a baked potato bar and even potato puffs for various school meals.

The proposed USDA guidelines, on the other hand, would limit starchy vegetables (not just white potatoes, but also corn, peas and lima beans) to no more than one cup per week. As expected the potato industry and their elected representatives launched a campaign to defend their product, even calling the white potato a "gateway vegetable" that can introduce kids to other vegetables.

The fracas apparently started when the Institute of Medicine, part of the National Academy of Science, recommended that WIC money shouldn't be used to buy white potatoes. One food-service director, up in Caribou, Maine, said she tried serving sweet-potato fries, but her students "just don't like them." She'said to have noted they cost more and most of it goes in the trash.

I love sweet potatoes, but I started eating them early in life and I think that's the key. If those two and three year-old kids get introduced to sweet potatoes, in whatever form, and then after a few years get baked sweet potatoes (without all the toppings...we use salsa), by the time they are teenagers they'll eat them without any qualms.

Or so I think.

Colorful foods, natural & un-

Tuesday, March 29th, 2011

Any food dyes here?

I've always been suspicious of food dyes. Reading labels and seeing Red 40 and Yellow 6 made me wonder if they added any benefit, other than allowing the food companies to sell more of their product. Then we were in Maryland, near the end of an eleven day trip to visit kids and grandkids and old friends and I spotted an article in the Washington Post titled "Eye-catching foods to get closer look from regulators." Today the Wall Street Journal and The New York Times had similar articles.

So I went back to an online 2007 British article published by professional staff from two medical schools which, in a randomized, double-blinded, placebo-controlled trial showed adverse effects (hyperactivity) from one mxture of artifical food color and additives. In 2008 the non-profit Center for Science in the Public Interest, calling those dyes the "Secret Shame" of food industry and regulators, petitioned the FDA to ban them, noting several of them were already being phased out in the United Kingdom.

CSPI noted that a 2004 meta-analysis had shown that those dyes can affect children's behavior and quoted two more recent British government-funded studies of kids in a general population that had also concluded that the dyes and a preservative (sodium benzoate) had adverse effects on behavior.

So what happened? You got it. The FDA didn't ban the dyes.

In June of 2010 CSPI published another article that raised issues beyond hyperactivity, namely cancer and allergic reactions. They commented that our public is exposed by the food manufacturers to roughly fifteen million pounds per year of eight synthetic dyes. Three of those dyes are contaminated with known carcinogens, CSPI said, and a fourth, Red 3, was already acknowledged to be a carcinogen by the FDA itself.

Three of the four plus Blue 1 can cause allergic reactions in some people; this is not new knowledge according to CSPI.

Why do the food companies use the dyes? They're eye-catching and kids look for bright colors. CSPI urged the FDA to ban the dyes since there is evidence in human and animal studies of potential harm from them, but none of helpful effect, except to the wallets of the food producers.

That article came out in late June of 2010. Now in late March of 2011 the FDA is convening a panel of experts with the comment that artificial food dye is an issue "for certain susceptible children with ADHD and other problem behaviors."

I'm not betting on the outcome of the panel's recommendations, at least not from the FDA. On the other hand the food industry may be catching on. Some may try natural colors and I saw a mention of a new Koolaid product, Koolaid Invisible.

In the meantime, maybe it's time to wean your kids off of M&Ms.

Good fish, bad fish: a cautionary tale

Monday, March 21st, 2011

This fish is in trouble

I've learned something about fish food poisoning these past few weeks. Perhaps I knew about it  in medical school, but that was a long time ago. We love fish, consider it a treat, eat it several times a week and, once in a while, partake of other marine creatures. I like mussels as long as they're cooked,  and will eat sushi, but never raw oysters.

So four people we know have had apparent fish-related food poisoning recently. They didn't eat at the same place or the same fish. That got me curious and I started to hunt down types of food poisoning related to eating fish and other marine critters. I found two that aren't the usual bacterial- or viral-caused forms (I'll write about those another time).

So what happened in the first instance was at a play when a close friend got suddenly and violently ill. He collapsed, was "out of it" for perhaps thirty seconds (I thought cardiac arrest or major stroke), then sat up and vomited copiously over himself and his spouse. Then he seemed weak, but otherwise normal. I went with hin to the ER where he was monitored for cardiac rhythm changes for four hours, got blood work and had a brain scan. All those were essentially normal, but he vomited four more times in the ER and once more as I was driving him home.

Over the next two weeks he had a cardiac workup with an echocardiogram, a stress test and a 24-hour Holter monitor for rhythm disturbances. All those were negative. He was previously reasonably healthy for his age of 72 and had no history of any seizure disorder.

A few other tests are pending, but then I spoke to a friend who had suffered a similar illness and heard of two others in the community. I went hunting for odd forms of food poisoning as none of these folk had diarrhea and none had sequelae of their short-term illness.

I finally heard the term scromboid fish food poisoning. All four had eaten fish and several had eaten shellfish.

Scromboid turns out to fit better than other diagnoses. It's typically associated with the consumption of fish, especially Scombridae fish like tuna or mackerel. It has a rapid onset, is marked by abdominal symptoms and or prostration, headache, palpitations, or flushing., sometimes tachycardia (rapid heart beat) and low or high BP and usually is self limited. It is caused by a toxin which is not inactivated by cooking and may be associated with spoiled meat.

The CDC says it's the most common chemically-related food poisoning in the United States., but at that only causes 5% of the food-related illness reported. It's much less nasty than ciguatera, the other fish related illlness I found. That one is also toxin-related, heat-resistent, can cause somewhat similar symptoms, but can lead to months ort even years of problems.

After reading of these I'll still go back to our favorite fish restaurant; they had no other patrons with similar symptoms. Scromboid seems to be relatively uncommon & mild in retrospect. On the other hand some speculate that ciguatera caused the migration of the Polynesians between 1,000 and 1,400 CE.