Archive for the ‘Life Expectancy’ Category

New proposed food advertisement rules with hedging language

Friday, April 29th, 2011

And here we go again

In response to the hue and cry about childhood obesity, an Interagency Working Group was set up, under the direction of our Congress, between the FTC, the FDA, the CDC and the Department of Agriculture . Their tasking was to "develop a set of principles to guide (note that word) industry efforts to improve the nutritional profile of foods marketed directly to children ages 2-17" and also to support healthful food choices.

After I read a short Wall Street Journal article on this proposal this morning, I found the original government release from yesterday online and a commentary in The Atlantic online written today by Dr. Marion Nestle, a named chair professor in the Department of Nutrition, Food Studies and Public Health at NYU and a visiting professor at Cornell. I have her 2006 book, What To Eat and consider her a trusted and knowledgeable figure in the field.

Let's start with the Interagency proposal, titled "Food for Thought." It mentions the major sources of calories for youngsters are cookies and cakes, pizza and various sugary drinks. When and if they eat veggies, half of those are chips and fries. Their parents are becoming concerned about childhood obesity as well they should be; one in three kids is overweight and headed toward an increased risk of all the diseases associated with obesity, hypertension, asthma and diabetes among them. They won't, on average, live as long as their folks do.

So, given that issue and the fact that the food industry spends huge amounts to markets these unhealthy food choices to kids, what does this august group come up with?

A voluntary program that should (note the word choice) be followed by the year 2016. Strange I think that's five years from now.

The recommendations, now subject to public comment (read that as efforts to soften them by the food industry) appear reasonable on first glance. They include foods that "provide a meaningful contribution to a healthful diet" and note those food components that should (same word again) be limited (added sugars, sodium, saturated fats and trans fats).

Marion Nestle's comment notes a prior attempt that never saw the final "rules" being implemented, and voices concern that the principles are still voluntary with no agency set up to track compliance and that five years seems far too long to institute these kind of changes. She thought the 2010 proposals weren't strict enough and noted the sodium level mentioned in the 2011 version was actually slightly increased, presumably to allow inclusion of more junk foods. She does congratulate the FTC for its courage.

Well I'll be a little blunter. I'm not holding my breath that these changes will happen short of massive public protest.

Even though 17 major companies are making some changes by reformulating foods and decreasing their markets efforts to kids, I think those will be glacially slower than they should be if we're going to help and even save the upcoming generations.

So it's time for all of us to weigh in on this issue. Start a campaign, talk to friends, write a something.



Which came first: the diabetic chicken, the obese egg or the depressed farmer?

Saturday, February 26th, 2011

The chicken and the egg

My wife is a Mental Health therapist, attended a conference recently & then got an email from the presenter which referred to a study linking diabetes and depression. I got the synopsis from the Web and then went to our local hospital library where I could get a copy of the article. I'll come back to it later, since it was a new twist on the familiar entity .

the depressed farmer

Firstly, in spite of my post's title, this is no joking matter. I found a World Health Organization (WHO) fact sheet dated January 2011 on diabetes: It's a worldwide epidemic with more than 220 million suffering from the disorder and its consequences including an estimated 3.4 million deaths a year. If you're diabetic your chance of dying at a given age is twice that of your peers. If you are diabetic for fifteen years, you have a 2% chance of being blind and a 10% possibility of having severe visual impairment. Ten to twenty percent of diabetics die of kidney failure and then, of course, there's heart disease and stroke and amputations from diabetic vascular disease.

Next I found a medical article with stark  statistics: in 2007 about 2.6% of the US population aged 20-39 had diabetes, 10.8% of those aged 40 to 59 and 23.1% of those over 60. Diabetes and its complications consume 14% of the US health dollar and we're fairly high up there in the list of countries having a significant prevalence of the disease. Lowest on the WHO list was Iceland at 2% and highest was Saudi Arabia with 13+% of those who are 20 to 79 years old being diabetic.

There is a strong correlation between diabetes type 2 & excess weight, especially among women. That association is 80% or higher in Europe, Latin America and North America according to still another article.

And, as you might expect, eating a healthy diet, getting regular physical activity, maintaining a normal body weight and not smoking are the basic of diabetes prevention. By the way, 90% of diabetics around the world have type 2 disease, resulting from the body's ineffective use of insulin.

So what's the new angle? I already knew that half of all diabetics die from cardiovascular diseases, incluing heart attacks and stroke. I didn't know the odds were considerably worse for women with both diabetes and depression. The article I had printed off followed over 55,000 women for ten years (1996-2006) as part of the Nurses' Health Study. There were strong correlations between diabetes and depression in this study performed by researchers from Harvard, the University of Singapore and two English medical schools. Another professor, this one from Indiana, stated that over the past twenty years they'd learned that people with diabetes are twice as likely to suffer from depression as those who don't have the disease.

The Harvard group, in another article, state that death risk is three times as great if a person has both diabetes and depression. The two diseases appear to be linked; the question of antidepressant drugs being associated with an increased risk of diabetes was raised, but causation is unclear at present.

So once more, eat well, stay slim, exercise and be happy; it's good for your health.

Dietary fiber: The latest from the NIH-AARP study

Tuesday, February 15th, 2011

brown rice and couscous

Okay, I confess; I didn't know there was such a thing as the NIH-AARP study either. Today I was reading the Wall Street Journal and saw an article titled "Fiber-Rich Diet Linked to Longevity." It mentioned the large ongoing study that I subsequently found online. Back in 1995-96 three and a half million questionnaires were mailed out to AARP members aged 50 to 71 who lived in one of six states (CA, FL, PA, NJ, NC, or LA) or two metropolitan areas (Detroit and Atlanta). Why these particular states and cities were chosen wasn't immediately clear to me.

Roughly one out of seven returned the questionaires, still that's over half a million people and an large number of medical articles have been generated from following this group over the past fifteen years. The stats on the subjects of the study interested me; 60% were male, 90%+ were white, non-Hispanic, only 11 of the men and 15% of the women were current smokers. Body mass index and education levels varied widely.

I read the newspaper article about dietary fiber, tried to get the online article from the Archives of Internal Medicine (they wanted $30 for 24 hour usage of the paper) and then found the (free) NIH release on their MedlinePlus web page.

The report says eating a fiber-rich diet could cut your risk of dying from heart disease, respiratory disease or "other causes" by 22%. The lead author works at the National Cancer Institute and mentions that the 2010 Dietary Guidelines push whole grains, vegetables and fruits. But the study, with over a third of a million participants, said that the fiber from fruits wasn't a factor in the reduced death rates. That doesn't mean we shouldn't eat fresh fruit though.

Fiber has already been linked to lower risks of diabetes, reduced rates of some cancers (liver, bladder, esophagus, kidney, head & neck) and less tendency toward obesity; here it's also associated with a lower mortality rate from heart disease or respiratory disease.

Now a real question, and one asked directly by a dietician/exercise physiologist who commented on the study, is whether those who choose high fiber diets also lead healthier lifestyles (e.g., more exercise, no smoking). That may well be the case, but why not add more whole grains to your own diet? That seemed to be a nugget of nutritional advice that could benefit everyone.

The recommended fiber intake for adults over 50 is 30 grams for men and 21 for women. That's a lot of whole grains and where can we get them? I found a Harvard Medical School list online and copied and pasted it into this post.

  • Amaranth
  • Barley
  • Brown rice
  • Bulgur (cracked wheat)
  • Whole-wheat pasta or couscous
  • Flaxseed
  • Millet
  • Oats
  • Quinoa
  • Rye
  • Spelt
  • Wheat berries
  • Wild rice

We cook with some of these (e.g., barley was in the bison, potato, carrot and turnip stew we had this week). We eat brown rice, millet seeds, wild rice, oats and flax seeds on a regular basis (we had a dish of steel-cut oats at breakfast today; most of the rest we've tried at one time or another.

More fiber, especially from whole grains, makes sense. Give it a try.

Bill Clinton meets The China Study

Friday, September 24th, 2010

Back in July I wrote about The China Study, a book written by a PhD named T. Colin Campbell who advocates our switching to a plant-based diet. Both Dr. Dean Ornish and Dr. Caldwell Esselstyn have extended Campbell's work into the clinical arena. Their diet and lifestyle programs are being followed by many who've wished to reverse deleterious effects of the typical Western diet they'd followed for years.

Yesterday I got an email from a friend asking if I'd write a blog post on the subject and mentioning that former President Bill Clinton was now on the plan. This afternoon I Googled "Bill Clinton's Diet" and found articles and a video interview of Mr. Clinton with Wolf Blitzer. Clinton had coronary artery surgery and his stent had begun to clog up with new deposits of lipid-rich material. He wants to live to see grandchildren, so he's adopted the plant-based diet fully.

Mr. Clinton is eating veggies and fruit, drinking almond milk instead of anything dairy. He occasionally eats fish, but no other meat; he does add a protein powder to a fruit shake daily. Thus far he's lost twenty-four pounds and his image on the video I watched was clearly that of a much slimmer man than before.

I have to admit I'm impressed. Mr. Clinton stated that 82% of those who've followed a similar diet have "begun to heal." Those figures go as far back as 1986.

I think if I had coronary artery disease I'd be tempted to change my eating habits completely, as has the former President. At the moment I'm about 80 to 90% of the way there. I drink soy milk (in my  case because of lactose intolerance) and eat a lot more veggies and fruit and much less meat than I did up to May of 2009 when I went back on the diet and lifestyle plan I came up with in 1996. I did so primarily to lose more weight and I'm roughly 25 pounds lighter today.

But, in the absence of any clinical atherosclerotic artery disease, I haven't gone the next step. I still occasionally eat red meat, though much smaller portions than in past years (a quarter the size of the steaks I used to love). I had some Swiss cheese at lunchtime (about 2 ounces) and I do eat chicken and fish.

As more evidence turns up I may further alter my dietary pattern. For now, since I'm lean with a Body Mass Index (BMI )of 20.5 and haven't been pushed by chest pain or any other signs of blood vessels being clogged, I'll settle for my part-way-there status.

I do think all of us in the US and much of Europe, plus some in other parts of the world, need to move away from the Western Diet and need to get our BMIs down below 25. Now two-thirds of us in America are above this figure which marks the boundary of being overweight (anyone with a BMI over 30 is obese).

Thanks, Mr. President, for setting an example for us to follow.

Even the experts don't agree

Friday, September 17th, 2010

Reading the September issue of the scholarly journal, Annals of Internal Medicine, a monthly publication of the American College of Physicians, I came across a marvelously detailed article on low-carb diets. It was a joint effort by the Harvard School of Public Health and the National University of Singapore and examined the results of two huge, long-term projects. It was followed by an editorial review as major articles frequently are in the Annals; the groups reviewing the article were from Duke and the Durham VA Medical Center (staffed by Duke professors in my day there).

The Nurses Health Study prospectively followed 85,168 women, aged from mid-30s to just under 60 initially, for twenty-six years. The Health Porfessional's Follow-up Study did the same for a group of 44,548 men (podiatrists, optometrists, pharmacists, dentists and veterinarians, but not physicians), aged 40 to 75 years initially, for twenty years.

The researchers conclusions were that eating a low carb diet from animal sources led to a higher mortality risk whereas the opposite was true for eating a low carb diet based on vegetable sources.

So far, things seemed reasonable to me, but then the reviewers analyzed the article and tore it apart in many respects. It was the best of times; it was the worst of times, or to paraphrase, it wasn't the best of studies; it wasn't the worst of studies.

The first problem was this wasn't a controlled clinical trial, but just an enormous observational study. Then there were caveats about extra risk factors: sure the men who ate the most animal-based fat were at greater risk for heart-disease deaths, but they also smoked more and exercised less. And low-carb wasn't exactly really low carb; the group eating the least carbs per day really ate a fair amount (nearly 40% of their calories as carbs). And the participants in these studies aren't exactly representative of the broader (no pun intended) US population and weren't put on specific diets at all.

So what did I end up with? Just what I've been saying all along. Eating more veggies and less red meat, exercising more, not smoking...all those make sense. Moderate carb, low carb, this diet, that diet...none of those ideas has been convincingly proven. Actually low-fat hasn't been shown to reduce health outcomes either.

So eat sensibly, try cutting back on red meats and processed meats and be sure to eat your veggies (and fruits). Didn't Mom always say that?

Living to 100; I tried some of Harvard Medical School's ideas

Monday, August 30th, 2010

We've purchased a number of Harvard Medical School's short publications; as expected they're excellent. I just was re-reading on on "living to 100." Most of the concepts, e.g., don't smoke, exercise regularly and eat a healthy diet, are well known to almost all of us but less commonly followed than I'd like to see. Some of the others, like take care of your teeth, establish a social network that lasts and kept your brain working hard, are also fairly obvious, but less well-publicized.
But then there was an idea that I really liked: keep an optimistic viewpoint on life. I tend to be cheerful, like puns (that's a "two-fer," optimism and brain play) and view the cup as mostly full, rather than partially empty.

My wife isn't hiking this summer as one knee has been bothering her; she goes to the gym for Pilates and/or yoga two or three times a week and is still in her "Strong Women, Strong Bones" class twice a week. She has a group of friends who attend one class and sit and converse afterwards; she has a close friend in the Strong,Stong class and has a snack with her afterwards.

I've noticed her social network and thought I needed one myself. So this past weekend I went for a hike in the mountains with a close friend of ours. I'm ten weeks out from back surgery and have been walking, but not going to the gym. In the week before the hike I walked further, three and a half hours without pause one day (actually I stopped to pet a dog for a moment) and two hours up and down hills another day.

My legs weren't as strong as usual going up the mountain to 11,440 feet and I had to stop twice, but made it to the summit. Then, on the way down, something extraordinary happened. We had seen a couple hiking up and later heard the man had stopped with Acute Mountain Sickness. Someone called 911 when they got to a point where they had cellphone reception and ten of us gathered around the couple and, in one way or another, contributed to getting the man down the slope.

The National Park medics arrived with oxygen and another group brought a stretcher with a single huge wheel. When my friend and I got to the trail-head I thought, "What a great day; exercise, a superb group effort and lots of positive approaches to solving a problem."

Then to top thing off, our friend came back with me, and joined my wife and I in celebrating our anniversary. With days like that I may live to 100.

The China Study; time to change my diet?

Wednesday, July 21st, 2010

We were on a trip recently and stopped for three days to visit some relatives we seldom get to see. He's a physician, past department chair at a highly regarded clinic/academic center and is working on a major research project in four countries, one of which is China. They've altered their dietary pattern in a very significant manner since we last saw them, four years ago. I asked for the background data on their new diet and purchased two books, the first of which is "The China Study," by T. Colin Campbell, PhD and his youngest son, Thomas M. Campbell II.

Dr. Campbell, an emeritus named-chair professor at Cornell, has been a long-term major figure in the area of nutrition and was involved in a large-scale research project involving scientists from China, the US and England. They did blood-work and gave out questionnaires to 6,500 adults in rural and semi-rural areas of China as well as performing urine tests, three-day dietary measurements and analysis of food samples.

The resultant book emphasizes health differences between people in China on a mostly to exclusively vegetarian diet and those of us who eat what has been termed the Western Diet, one rich in meat and dairy products, relatively low in vegetables and fruit. Dr. Campbell strongly advocates our switching to an exclusively plant-based diet and details how the "Diseases of Affluence," especially heart attacks, diabetes Type 2, some cancers, and obesity are related to nutrition.

I also looked at Dr. Campbell's impressive bio and, as well, read some of the critiques of his conclusions. I think the book is well worth reading and enjoyed Dr. Campbell's article in "The Huffington Post," published today (7-21-2010). In it he calls for an NIH Institute of Nutrition. I would agree that our Western Diet, rich in fats, sugar and salt, is a major cause of overweight and many assocated diseases. I would disagree that some of the specific conclusions in "The China Study" have been conclusively proven. I'd love to see a new NIH branch which could fund studies to prove or disprove those conclusions.

I'd recommend you read the book and judge for yourself.

More Fish, Less Chips

Saturday, June 12th, 2010

I'm four days out from back surgery and can sit up long enough to post on my blog tonight. I've been reading more about the omega-3 fatty acids and especially about DHA, otherwise known as docosahexanoic acid. DHA was discussed in great detail at a recent meeting of the Royal Society of Medicine (RSM) and the article in the May 29, 2010 issue of "The Economist" led me to a book, "The Omega-3 Connection" written by a Harvard medical School professor and an online medical article on "Fish Oil: Getting to the Heart of It."

There's an amazing amount of new information coming out about the importance of the Omega 3s and maybe DHA in particular (The other Omega 3 of interest is EPA, eicosapentanoic acid). This may take three or four posts to cover, but let's start with some general statements. DHA, according to one researcher who presented at the May RSM meeting, may explain why dolphins, which weigh about the same as zebras, have brains nearly five times as large. It seems to play a role in a number of significant mental health diseases and low levels of DHA appear to be associated with a higher risk of suicide. The Department of Defense in the United States is paying attention to that last factor and plans to supplement the diets of its troops with Omega 3s.

The problem links to our current diets, high in omega 6s, low in omega 3s. It's time for a change, both in diet and in supplements. More later on the topic.

Salt Intake and Stomach Cancer in Young U.S. Adults

Saturday, May 8th, 2010

An interesting article appeared in last Wednesday's Journal of the American Medical Association. It reported a National Cancer Institute surveillance program which covered a large segment of the American population (about 25% of us) and reviewed over 39,000 cases of stomach cancer. The rates of new cases of this frequently fatal disease declined in almost all age groups except for while adults age 25 to 39 where it climbed almost 70%.

Now this could be just a statistical issue and the overall rates were still quite low (1 in 200,000). But, on the other hand, the one major association found was to diets, especially those high in salt and foods preserved with salt and low in fresh fruits and vegetables.

The study was looking at cancer in the "lower stomach," sometimes felt to be caused by chronic infections with H. Pylori, the same bacteria that's associated with ulcers. This is as opposed to disease in the cancer in the "upper stomach" associated with reflux disease.

Most other adults in the age range studied (25 to 80) had a clearcut decrease in rates of developing stomach cancer and black adults shared in this decrease. The authors noted that historically the incidence of this form of cancer has been higher in parts of the world where foods are often preserved with salt. Those rates have declined in many countries along with decreased rates of H. Pylori infection and the overall decrease in U.S. rates was certainly not unexpected.

We're left with an actual increase in one group. It will be further investigated, but the authors noted that salt intake has been going up in Americans in general and wondered if altered eating patterns were the culprit in the young adults in the study.

Hmm.. I've written before about our excess salt intake (for some of us it's more than twice what is recommended)  and suggested we could lower high blood pressure incidence with all of its potential for devastating consequences if we were to cut down on the salt, both by adding less and by eating less of those prepared foods that are high in sodium content.

Now we have one more reason to spurn the salt shaker and shop wisely for more fresh fruits and vegetables.

A book on food and human history

Tuesday, May 4th, 2010

I read The Economist regularly, but was unaware, until I purchased the book, An Edible History of Humanity, that Tom Standage, listed as the magazine's business affairs editor, was also an author. I've just started leafing through his 2009 book, having finished reading one of the two book club selections I needed to get through by next week. But even perusing the book over a few minutes, I've already seen it connects to a number of topics I'm interested in.

One of those is the ongoing controversy about genetically modified food. Early in Standage's book, he discusses the progression of teosinte, an ancestral form of maize, to modern corn. It seems clear to me that human selection of which crops had their seeds spread was responsible for this. The author notes that a cave in Mexico has a series of ancient cobs that vary from half an inch to eight inches in length and talks of the high likelihood that farmers of the past would have deliberately chosen those mutated maize varieties that produced larger ears.

So we've been fiddling with our food crops for a long time. Well and good in many or even most instances; basically I have no problem with the concept . But Standage also discusses the 1845 Irish potato famine where an over-dependence on a single food and a devestating crop failure caused by a fungus infection, led to a million deaths.

So on the one hand I often approve of our modifying our food sources, but, as I've mentioned in previous posts, I personally think some of the heirloom varieties of vegetables which are available in our local farmers markets just plain taste better than their super-market cousins. They also may protect us in a fashion by their being different.

I don't want us to become reliant on a single variety, a solitary kind of almost any food crop. The need to produce more corn, more tomatoes, more potatoes, may have been one factor leading to the highly productive mega-farm concept of agriculture, but I worry that it also exposes us as a country, or even as a species, to the risk of famines if a new vegetable disease and/or climate change wipes out a particular strain of a crop or multiple crops.

Is this at all a realistic issue? We now have highly developed, well-connected sources of production and shipping of food items, but we also have a burgeoning human population and the threat of global warming, derided by some, but strongly concurred with by many.

I'm in favor of keeping multiple food sources and expanding our choices whenever possible.

That's enough for today; I realize I've tried to connect some dots that may seem isolated from each other, but I think they're well worth cogitating over.