Archive for November, 2010

Water, water everywhere and how much should we drink?

Monday, November 29th, 2010

My wife was really looking out for me yesterday. She read and clipped out an article from USA Weekend's HealthSmart section with the title "4 crucial tips for managing

A standard eight-ounce glass of water

your weight." They came from THE DOCTORS, a daytime TV show I've never seen (I don't watch much TV anyway).  The show apparently has four physicians, a pediatrician, an Ob-Gyn doc, an ER doc and a plastic surgeon.

The tips seemed reasonable: drink water; stay consistent; get good sleep and log on to keep pounds off. I've written a post on sleep and weight, believe in consistency (but it's my one sore spot, especially on vacations ), keep a record of my weight on a regular basis (but not online) and drink lots of water.

Now that one caught my eye; I drink three very large glasses (30 oz each) of lime water a day and often drink water before starting to eat. I've read that some think that even the standard recommendation of eight glasses a day is excessive, but my habit started when I had vocal cord issues and a senor speech therapist suggested I drink a large quantity lime-flavored water every day.

my 30-ounce glass next to the standard one

Now there's some data to support my idiosyncrasy of having some water at the start of a meal. A study done by researchers at Virginia Tech and reported at a recent national meeting compared two groups of subjects aged 55 to 70. Both groups were on a low-fat, low calorie diet. The research subjects in one group drank two cups of water before each meal; those in the other group didn't.

This was a twelve week study and the water drinkers lost more weight. Then the scientists followed their progress for a year. Not only did they keep weight off, they even lost a little more.

There's a catch; this doesn't work for young dieters. The speculation is that older people's stomachs empty slower and I'd tie that in with feeling full and choosing not to eat more.

Several other university groups commented on the subject. One said that those who drink water don't drink sugar-filled beverages and, on the average, consume 75 to 90 calories less a day. That adds up over the course of a year; 100 calories less a day would equal a little over ten pounds of weight loss. The other wondered if people who aren't on an actual diet would keep up their water-drinking pattern longterm.

So far I have, for twelve years, but for different reasons. I think I'll be more deliberate in my pre-meal water drinking and see how that helps.

Don't overdo this if you try the idea; too much water intake can be dangerous. Two cups before meals sounds reasonable, but my large water intake isn't for everyone.

Too much cheer for the holidays and other times

Friday, November 26th, 2010

We had a family Thanksgiving dinner for nineteen people yesterday and served beer, wine, non-alcoholic punch with fresh fruits and some sparkling fruit drinks. I had a glass of Riesling and later tried some of the fruit punch, I didn't pay much attention to what others were drinking, all but four were adults ranging in age from early twenties to mid-seventies.

Fat Tire beer, my favorite

When we cleaned up later, it seemed there were a lot of beer bottles, but I realized at least five adult men drank beer and nobody had more than two bottles. I don't usually drink beer myself (although I'll make an exception for Fat Tire, a superb locally-brewed beverage) and normally have one glass of wine with a meal three times a week. Once in a great while, if we're at home, I'll have a second glassful.

I realize we don't drink much compared to some of our friends, but haven't seen anyone drink to excess or appear drunk at any of the parties we've been to in years.

Then I read the December issue of the Harvard Heart Letter and saw that a South Korean study had revealed the hazards of binge drinking. I'd thought of that as primarily a problem for college students; we live in a university town and over the years have read of several binge drinking tragedies.

I found the original article online in a publication called Science News and then followed a link to another article, this one an Irish study. Both were sobering, to say the least.

I've read a number of articles that say drinking in moderation may be heart-healthy. The key word is moderation and we're talking about one drink a day for women and two for men. Binge drinking implies much more alcohol consumption, four to five or more drinks a day or six at any time.

It's not just an issue for teens and college students; a CDC study said one in seven adults admitted to binge drinking.

The Korean study focused on men with poorly controlled hypertension and said their risk of cardiovascular death or  stroke was markedly increased, more so if they drank very heavily. It followed over six thousand people for twenty-one years.

The Irish study compared middle-aged men's drinking patterns in Belfast and France, with the Irish men drinking two to three times as much. Those who were binge drinkers had almost twice the risk of a heart attack or death from heart disease over a ten-year followup period.

The French more typically drink wine with meals; The Irish drink more beer and spirits and I would think they do so in pubs without much food being consumed.

So I personally think it's okay for most adults to drink in moderation (that's assuming they don't have a personal or family alcohol problem and understand what moderation means).

But drinking to excess, especially binge drinking, is a totally different matter. These new studies show yet another hazard for those who overly imbibe.

So if you plan to have a glass of holiday cheer, keep it at a minimum and, of course, don't drive if you drink.

Vitamins in general

Tuesday, November 23rd, 2010

Vitamins for seniors

I've written several posts on calcium intake and, in reviewing them for the book I'm working on, noted I had mentioned, but not detailed, my thoughts about vitamin D. So I've been researching source material on the subject and wanted to bring you up to date on my take on the new recommendations for how much we should be getting.

Let's begin with vitamins in general. A reasonable starting definition of  a vitamin is an organic compound that is required in tiny amounts and can't be synthesized by the body. So until the 1930s, when vitamin C was first made by chemical means, all our vitamins came from our diet.

Vitamins are divided into water-soluble and fat-soluble varieties. The former include vitamin C and the B vitamins, B1, 2, 3, 5, 6, 7, 9, and 12; the latter include vitamins A, D, E and K. Various others have been proposed and later found to be capable of synthesis by humans, thus accounting for the missing letters and numbers.

Water-soluble vitamins are not well-stored by the body and must be regularly replenished. Vitamin C, for instance, in studies conducted on conscientious objectors in Britain during WW II and in Iowa on prisoners in the 1960s, is depleted in a few weeks to as long as six to eight months depending on the degree of "pre-loading". The British Navy started giving lime juice to its sailors in 1795 to prevent them from developing scurvy on long voyages.

On the other hand excess intake of these is less likely to have toxic effects.

Fat-soluble vitamins are stored in the liver and various fatty tissues, need not to be taken quite as regularly  and conversely are more likely to be toxic when taken in excess.

Those are, of course, sweeping general statements.

So let's go back to how we get our vitamins and a few controversies. The famous chemist and two-time Nobel pre winner Linus Pauling, proposed in 1970 that taking larger doses of vitamin C could reduce the incidence of the common cold. He later expanded his claims to include mega-dose vitamin C as beneficial for a variety of ailments, including cancer.

A large series of well-designed and double-blind studies disproved the former claim and the Mayo Clinic conducted three controlled studies from 1979 to 1985 that showed patients with advanced cancer who were given 10,000 milligrams of vitamin C a day had no improvement when compared to pateints given a placebo.

So we take 500 milligrams of vitamin C a day. Can you get enough of the 13 vitamins from your diet? Sure if you work at it. Does the requirement for various vitamins change with age? I think the answer if clearly yes and, for instance, we're now taking a large dose of B12 daily as recent data suggests seniors may malabsorb this crucial vitamin.

And B12 is water soluble, so if I take a little bit more than I need I'm not going to worry about it.

But then there are the fat-soluble vitamins and I'll write more about them and especially about vitamin D in my next post.

I'd never heard of the ketogenic diet

Friday, November 19th, 2010

Reading the New York Times breaking news on my Kindle this afternoon, I came across a diet that was new to me, one that most of us will never go on. But for a small group of kids it can have an incredible impact.

The story was about a nine-year-old boy who has severe epilepsy. In his case his seizures were resistant to all the major drugs that might usually have been effective. He was having them as frequently as 150 times a day.

His parents were desperate until they finally found Dr, Elizabeth Thiele at the Massachusetts General Hospital for Children. She's a specialist in pediatric neurology, an Asoociate Professor at Harvard Medical School and heads up a program for pediatric epilepsy.

One of her interests is keto as the diet is called. When children have drug-resistent seizures, keto can be effective in a significant percentage of cases.

The diet is high-fat, quite the opposite from many of those used by adults for weight loss. The kids on it start in the hospital, starving for a relatively brief period. But our bodies only have enough glucose, our primary source of energy, to last about 24 hours.

After that we burn fat reserves and our livers convert those fats into fatty acids and ketones. The latter pass into the central nervous system and become the brain's source of energy. Somehow, it's not exactly known how, that can reduce how often epileptic seizures occur.

The diet has been around for over eighty years, but when anti-seizure medications were developed and shown to e efective in most kids, keto fell by the wayside.

In the mid 1990s a Holywood producer brought it back. His son had severe epilepsy and drugs weren't helping. Keto did and the producer started a foundation to promote the use of the diet. He got his friend Meryl Streep to star in a film called First Do No Harm and the foundation sponsored a scientific study of the diet.

Since then it's been offered by over 100 hospitals for kids with drug-resistant epilepsy and two randomized, controlled studies showed it can be effective.

The boy in the article eats four times as much fat as protein or carbohydates. He's on a tightly controlled program and even his snack are calcualted. One of those snacks included two slices of bacon, seven macadamia nuts and less than one eighth of an apple. His urine would be checked for ketones as in the slide.

There are diets to lose weight and gain health; there are also diets to help with specific medical problems. I'll never try keto and hopefully, like many kids, the boy in the article will outgrow his need for it.  For now it's been an wonderful asset for his health.

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.

Miscellaneous ramblings, centered on portion size and vacations

Tuesday, November 16th, 2010

Today I read a book on "Mindless Eating" and eventually I'll write more about it. But first off it rang a cord for me with a section from a Harvard Health Publication on cutting down on salt. We eat too much salt, too much sugar and too much fat. One of the simplest ways to cut down on those is to diminish your portion sizes.

I don't weigh in on any of the fad diets except to say they won't solve the long-term problem that two out of every three of us have in the United States. I think eliminating something you like won't work very well over the years. So instead, I diet by cutting off a portion of everything on my plate. I can still have a small amount of almost anything; I just don't overeat..except on vacations.

We spend six days on a trip to Texas recently. Our surrogate dad had turned 90 and we wanted to visit him. So part of that trip was with an elderly couple living in a retirement community. Part of it was visiting other friends. Everyone wanted to make sure we were well fed.

We went to restaurants, clubs and dining facilities in the retirement village. There were abundant choices and generally quite good food (though I did miss our fresh fruits and vegetables from our CSA). The problem was my lack of the ability to say NO.

I left home at 150.6 pounds, well within my comfort zone. I returned at 157 pounds and have had to play catch up ever since. I'm almost back to where I started at. I do fine at home; I even mamage local parties and restaurants without a problem. So what happens with a trip?

Ah, I think I have figured out some of the issue; we were with good friends who wanted to treat us to their favorites places to eat. Or, in the case of our older friends, we were eating buffet style. Both situations are diet traps. They require some extra punch in my diet resolve.

So one of my coping mechanisms, one that I have to strengthen for vacations, is portion control. I really didn't eat anything on this trip that I wouldn't otherwise; I just ate more. I have a four by six card that says "Don't overeat." It may appear a little silly, but it's saved me countless times at home or in our area. Even that simple device makes me pause, eliminate the extra scoop of frozen yogurt or the second piece of bread with butter and jam. it's time for the card to be on my packlist.

The pause is the real necessity. In the book I was reading today, just moving a dish of food a distance away, or as we do serving everything in the kitchen so seconds require a trip back from the dining room can help.

Dieting or, in my case, maintaining a weight you've worked to get at, requires some thinking. The pause can let you move away from the mindless eating trap.

The Fifth Taste

Friday, November 12th, 2010

Glutamic acid

I was reading an article in the Harvard's HEALTHbeat, one titled "An assault on salt?" and saw a reference to something I knew next to nothing about, umami--"the so-called fifth taste." That lead me to an April, 2010 publication crafted jointly by Harvard's Department of Nutrition and the other CIA, the Culinary Institute of America. That latter publication, "Strategies for cutting back on salt" is something I'll write about another time. In the meantime I decided to look up  more about umami.

I knew about the other four tastes: sweet, sour, salty and bitter, but had only heard the term umami used in context, not what it meant or how long it's been around. Apparently sweet, sour and salty were the original three recognized tastes, then a Greek philospher, Democritus deduced, probably after eating something he didn't like, that some foods are bitter. And things stayed that way, with four basic tastes (some would add spicy and astringent) until the late ninetenth centurywhen the famous French chef Escoffier invented veal stock.

About the same time a Japanese chemist, Kikunae Ikeda, while trying a seawees soup called dashi, sensed there was another taste. He wrote that it was the component that produced the flavor of meat, seaweed and tomatoes. Eventually, in 1908, he isolated a single chemical, a glutamate and later patented MSG. He used the Japanese word for delicious as the name for this new flavor and synthesized it; perhaps adversely affecting the seaweed industry in doing so. I got some of this from an online extract I found from a book titled Bozo Sapiens: why to err is human by Michael and Ellen Kaplan. I really enjoyed the short piece I read and ordered a copy of the book.

Subsequently scientists have found a receptor for umami; these cells don't have nerve synapses to other nerves, but instead secrete a neurotransmitter, ATP, that excites the sensory fibers which convey taste stimuli to the brain.

So like salt and sugars, food chemists can add umami to fats and induce us to want more and more. David Kessler, MD, JD, the former FDA head, is quoted as saying the standard joke in the restaurant chain business is, "When in doubt, throw cheese and bacon on it." Aged cheese has umami and bacon is said to have six different kinds of umami.

We just ate daikon and beets for dinner, both from our CSA, Grant Family Farms; we'll have grapes for dessert. If umami is a road to obesity and staying away from prepared foods the road to weight control, we were on the mark tonight.

Dietary therapy in hypertension

Friday, November 5th, 2010

High blood pressure, commonly called hypertension by physicians and other medical professionals, is a major problem in the united Sates, Canada and Europe. The numbers are staggering; roughly 30% of the adult population in the US and Canada, over 405 in a survey done in six European countries.

Why is this connected to diet? The incidence figures have gone up over the past twenty years and are most likely closely tied to the increased weight in members of our Western civilization. The consequences of poorly controlled hypertension are dire: strokes, kidney disease, cognitive impairment and heart problems are all more likely in the hypertensive group.

So what came first, the high blood pressure or the increased weight? And what can we do about hypertension?

I read an article in thew June 3rd, 2010 edition of The New England Journal of Medicine (NEJM 362:2102-2112) and then read a host of comments to the editor that were published in October 2010.

The article itself was something I saw mentioned in the "Harvard heart letter." It seemed fairly straight-forward at first. The two authors, Dr. Frank M. Sacks and Hannia Campos have published lots of research articles together; one is a physician and a senior Harvard professor; the other a PhD and a member of the Department of Nutrition at Harvard. This time they focused on hypertension, beginning with a breif case study, then telling us the astounding figures about high blood pressure and it's consequences.

It isn't just a BP of 140 over 90 and above; any blood pressure over 115 is associated with all those medical problems. Worldwide, according to Sacks and Campos, that level of blood pressure, 115 and above, is the most important determinant of the risk of death. In the cardiovascular arena alone it's a major factor in over seven and a half million deaths a year.

So Sacks and Campos looked at three major factors in this problem: eating a healthy diet, cutting body fat and decreasing salt intake. Once again a diet rich in fruits and veggies, along with low-fat dairy, fish, nuts and poultry were their answer. They looked at the DASH study (Dietary Approaches to Stop Hypertension)  and subsequent diet-therpay studies, mostly those with reduced salt being a major component.

Their conclusions were along the lines I had suspected: people with high blood pressure should reduce their salt intake, eat fish, nuts and legumes instead of red meat, consume more fruits and veggies insated of desserts, eat whole grain products, use healthy oils (olive, canola, soybean etc.) and stay away from juices as substitues for whole friuts.

Well, we do that now, I thought. Then I read the letters to the editor. I've already written a post on iodized salt, but another letter wanted Sacks and Campos to mention the benefits of more potassium in the diet, quoting a study that showed a 50% reduction in the need for BP meds with increased dietary potassium. That one I'd leave up to your own doc; I agree with the general long as you don't have significant kidney disease.

One of the other letters focused on dietary sugar and sugar-sweetened beverages, with a recent, but not randomized and controlled study, saying that cutting sugar intake lowers blood pressure. And one group of docs didn't seem to have the time for all that; they'd just start the patient on BP meds.

Whew! That was a bit of information overload. I think what I carried away was a lesson learned over and over; we're too fat as a civilization and eat the wrong things. That's unhealthy in many ways. It's time to make a change in both spheres.

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.