Archive for April, 2011

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.



Obese kids, a growing problem

Tuesday, April 26th, 2011

eating too much of the wrong things

There is a very interesting article in the Wall Street Journal today about how Portland, Maine, concerning about the growing number of obese kids in the community, developed a city-wide plan to combat the issue. Their concept has now spread elsewhere in the state.

Well that caught my attention and I started looking for background medical and non-medical data. Many of the websites I visited initially were poorly written, causing me to move on, but I found one for the 6th Biennial Childhood Obesity Conference to be held in San Diego starting 0n June 27th ( The underlying dire fact is the percentage of kids in the US who are overweight or frankly obese has nearly tripled in the last thirty years.

The conference offers youth scholarships for travel, hotel accommodations, meals (presumably healthy ones) and registration/materials fees. This way kids ages 14 to 18 can meet with medical experts, teachers, policy makers and other kids to hear the evidence-based best approaches to combating obesity.

some start off the wrong way

Former President Bill Clinton's foundation's web page said we've got ~25 million kids in the overweight and obese danger zones and the medical therapy for obese kids costs us three times that of normal weight kids. Twenty-five percent of our children don't engage in any kind of free-time physical activity.

So is it genetics or food or activity that's causing the problem. I think the answer is "yes," but I'd certainly put more emphasis on the latter two factors. Less than 25% of our high school kids take PE on a daily basis; instead they spend an average of four to five hours a day doing non-exertional "techy" activities including video games, computer use and even plain old television watching.

So back to Portland's plan. They developed a 5-2-1-0 concept: five servings of fruits and veggies, 2 hours or less of "screen time," at least one hour of exercise a day and zero sugar-filled drinks. They've already reversed the upward trend in obesity, but at considerable cost ($3.7 million) and with some difficulty in measuring the results. Now the CDC has recently given over a quarter of a billion dollars to 39 US communities in an effort to both start programs and follow their outcome.

I Googled the name of Dr. Victoria Rogers, a pediatrician mentioned in the article. She works as Director of the Kids Co-op at the Barbara Bush Children's Hospital at Maine Medical Center and is involved in the 5-2-1-0 Goes to School program, another  Portland-based program called "Let's Go!," and the state-wide Maine Youth Overweight Collaborative.

In Maine alone, Let's GO is now active in nearly 350 schools and the local business men and women who funded the original project are able to see some preliminary results already. One phone survey found increasing (but still relatively low) percentages of kids adopting healthier eating and exercise habits. Dr. Rogers and her cohorts want to follow 1,500 kids who are in the Let's Go! study long term to see if they change their eating and exercise habits for a lifetime.

So what's happening in your town or city and your state. It's our kids; we have to make a difference in their lives and this is a great way to do so.



exercise and eating as you get older

Friday, April 22nd, 2011

you may not want to try this much weight

I was reading a food and exercise article this morning in a Nutrition Action Healthletter, a publication from the Center for Science in the Public Interest, a group whose watchdog goals I often support. CSPI has been around for forty years and when I looked at its board member list I saw the familiar name of David A. Kessler, MD, JD, the former FDA head and ex-dean of two medical school.

The April 2011 article my wife showed me was titled "Staying Strong: How exercise and diet can help preserve your muscles." Well I'm two days shy of my 70th birthday and a gym rat, there six days a week. And I eat well or so I thought. What's there for me to learn from this article?

I agreed with the opening quote from Dr. Miriam Nelson, the director of Tuft's Center on Physical Activity, Nutrition and Obesity Prevention, "Muscle is the absolute centerpiece for being healthy, vital and independent as we grow older." Of course, having a functioning brain helps. But I wasn't about to quibble with a distinguished figure like Dr. Nelson, who is a Fellow of the American College of Sports Medicine, an Assocatiate Professor at Tufts and founder of the Strong Women program.

The Healthletter said most of us lose muscle mass starting in our late 30s and early 40s. I had certainly noticed that a few years back, in spite of being physically active. To reverse the process, or at least keep a decent amount of muscle, resistance training is advocated, I've been doing lower body exercise mostly (an hour+ on a recumbent bike), but recently added back some weight training for both upper and lower body.  Ben Hurley, a PhD Exercise Physiologist at the University of Alabama, feels muscle power is the key to fall prevention, a critical factor in the elderly.

Even if you fall and break a bone, like the oldest member of my wife's Strong Women, Strong Bones class, did, your chances of having a rapid recovery are considerably increased. Her docs were amazed at how she bounced back. Strength training, in several studies, has been shown to increase bone density.

What else did I need to do? The new information in this Healthletter was of the amount of protein we need as we age. I read the article and added a hunk (~4 ounces) of leftover beef to my cereal, milk and fruit breakfast. That advice came from researchers at UT Galveston (and numerous other universities), especially a PhD Associate professor, Dr. Douglas Paddon-Jones, who's worked with NASA on usingartificial gravity and amino acids to preserve muscle mass in astronauts.

Is leucine the key?

The bottom line was to eat more protein and to add some to your breakfasts and lunches as you age. One particular amino acid, leucine, appears to be most crucial. it's found in whey (in milk and cheese) and in fish, poultry, eggs and meat. I'll write more about timing of amino acid intake another time.


grass-fed (and grass-finished) vs. grain-finished beef

Wednesday, April 20th, 2011

What's your beef?

We've been buying meat (a bison we split four ways, a young sheep we shared with another couple and, most recent a quarter beef) that's been grass-fed and grass-finished. I always thought it was a healthier way to eat red meat, even though overall we're eating smaller meat portions, more fish and chicken, lots more fruit and veggies all the time and an occasional meat-free main meal.

Now I found a very well done (no pun intended) examination of the issue at the website. CNN discussed the Cooking Light Test Kitchen. We have a subscription to that magazine and enjoy its recipes, but I didn't know much about its test kitchen. They had a complete article on the grass-finished vs. grain finished beef controversy. I say grass-finished since essentially all cows eat grass to start with, but some eat only grass and perhaps some hay for six months to a year. Others, those who end up in those huge feedlots like the ones we see when we drive east in Colorado, eat corn mixed with soy and other edibles and are given hormones and lots of antibiotics, whether they are ill or not.

I won't even get into the subject of drug-resistent bacteria in this post, but instead I'll stick to the question of "Can a grass-finished ruminant taste good and can I afford to buy grass-finished beef?" I should mention bison as well, but that meat wasn't tested in CNN's study.

In short, the answer is going to be yes for almost all of us. I know the meat will be less fatty (there's always going to be some fat, of course), but cooked properly, anyone other than those who are specially "trained to evaluate sensory characteristics in beef" won't know the difference. I have a friend who raised beef cattle in Nebraska and disagrees with me on the subject, but the Nutrition Journal article I just quoted (I printed the entire journal article that was mentioned in passing in the CNN piece), basically said it's what you grew up eating. Consumer "sensory panels", that represent the vast majority of us, they felt, were more of an art than a science.

So what are the advanatges and disadvantages of grass-finished beef. It's got fewer calories, roughly four and a half pounds worth per year if you eat as much beef as the average American. Its fat is yellower than the grass-finished cow's, representing more beta-carotene, a significant antioxidant. And it contains more omega-3s as well as more Vitamin A & E.

Disadvantages? It may cost more, if you buy it at the supermarket, but try your area's CSA or look for a local farmer who raises beef and buy it in bulk. CNN got 243 pounds of meat for $5.32 per pound, just a tad higher than they would have paid in supermarkets. We paid <$3 per pound for the quarter cow we bought recently. I'll finish the Chico State article + one from Tufts in another post.

Saving $1T by losing pounds

Saturday, April 16th, 2011

whole-grain cereal and a banana

Mark Bittman's "Opinionator" column in the New York TImes April 12, 2011, was right on. He called the $36B that Congress has been haggling over (like two small boys) small potatoes compared to what could be saved if we ate less overall and ate more of the right things. He quoted a number of medical resources, so I went back to look at the originals.

In the January 24, 2011 online edition of the American Heart Association's journal Circulation, a panel headed by a Stanford Associate Professor, Paul Heidenreich, stated that cardiovascular disease (CVD) currently accounts for more than one sixth of all US health dollars spent. They went on to predict that by 2030 the direct costs of care for all forms of CVD would triple from a 2010 estimate of $273B to $818B .

CVD includes stroke, heart attacks, congestive heart failure and hypertension among other entities and they are often highly correlated. In fact the INTERHEART study which Bittman quotes (and I found in a seven-year-old copy of the journal Lancet), says lifestyle-related risk factors such as obesity, smoking and hypertension account for roughly 90+% of heart disease.

We haven't even started on Type 2 diabetes (DM) yet and Bittman noted that problem will cost roughly $500B per year  by 2020. And almost all of the cases of Type 2 DM are preventable.

If we want to reduce the deficit, one way would be to reduce our weights and trim our waistlines. Sure, we wouldn't get rid of all CVD and Type 2 DM, but a large share of the $1.3T per year we will be spending on them by 2020-2030 could be avoided.

We're spending over $2T a year now on healthcare and those costs are going up and up.

So how can we save a major chunk of that huge sum? How about Dr. David Ludwig's ideas? He's a Harvard doc who has worked with Marion Nestle, the PhD dietitian I've mentioned before. He published a very recent article in JAMA (the Journal of the American Medical Association) with both straightforward and complex/innovate modalities to improve our American diet.

I read something about Dr. Ludwig and his earlier concepts in his Harvard bio and a WebMD interview. He's a pediatric endocrinologist working at Children's Hospital in Boston, founding director of its Optimal Weight for Life (OWL) program and author of Ending the Food Fight:Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World.

In the JAMA article he talks about better funding for school lunch programs, making breads with whole grains (non-refined) and research needed to improve food preservatives that are healthier than the current ones. His own studies appear to show a correlation between lower calorie intake and eating whole grain products.

I see two difficult issues: getting people to make healthy foods choices and avoiding bureaucratic costs as the British experienced from their NHS shift toward paying physicians for preventive measures (NB. WSJ article from 4-16-2011 p. C3).

But what a great way to save us money that Congress might even agree on.





Updated link

Thursday, April 14th, 2011

I had a link to a Mayo Clinic article in my last post that needs correcting.

It should be

Snacking: fried has to goeth before a small (size)

Wednesday, April 13th, 2011

Healthy snacks

To snack or not to snack, now that is the question. I read two articles on the subject, one in the Wall Street Journal and the other in the Mayo Clinic's online comments. Then I thought about Wednesday evenings, my own downfall.

The newspaper article was titled "The Battle of the Office Candy Jar" and detailed the travails of people whose bosses and office mates think that the workplace should always be stocked with a dish of candy bars. Then there are the tempters who are forever bringing cookies and birthday cakes in to work or selling candy bars for their kid's baseball teams or school fundraisers.

The WSJ calculated the effects of eating two pieces of candy a day, five days a week, assuming one didn't cut down other foood intake or decide they needed to increase their exercise regime. Wow, it's over seven pounds added a year. It's even worse when the candy is presented in a clear jar, rather than a covered and opaque dish.

I immediately thought, 'It's Wednesday!' That's when I go to a three-hour evening writers' critique group. My cohorts bring in stories to be read aloud and commented on (I have one for tonight on the Festival of Holi that our former graduate students from Mumbai brought us to recently). They also bring in cakes and cookies and I used to bring biscotti. Our leader always has a jar with Tootsie Pops and I invariably eat more than I intend.

The Mayo Clinic piece says snacks aren't always bad and their diet plan includes snacks that can help obviate hunger pangs and keep you from binge eating. But their choice of snacks is quite different: fruits and veggies make much more sense than doughnuts and candy.

Their website: can lead you to a healthy snack site which suggests 100-calorie snacks, e.g, 2 cups of carrots or, one of my favorites, air-popped popcorn.

I'd prefer to avoid snacking whenever possible, but I'm aware I need help in avoiding the tempting items I encounter on wednesdays or at parties. I've switched from bringing biscotti to fetching a sack of almonds. Mayo's cautions that even though nuts contain protein and thus can help you feel full for a longer time, they also contain calories, largely in the form of monosaturated fat (which is certainly a better variety than the polyunsaturated kind).

So I've made a game of it: I eat four almonds. No particular reason that I chose that number, but it works.

I also have a four by six card that says

My home-made snack barrier

So let's talk about supplements

Tuesday, April 12th, 2011

You don't need supplements to build muscles

I'm in the gym at least six times a week when we're in town and I've noticed the establishment sells very large containers of protein powders and other muscle building supplements. Well, unlike some of the young men who are constantly working on free weights building up their upper body musculature, I spend at least an hour on a recumbent bike and then do stretches and five machines at moderate weights. What I don't do is lift free weights or gulp down large quantities of strange looking liquids that supposedly help to make you look like Charles Atlas or some Olympic weight lifter.

But both The Redbook article I mentioned in my last post and the Tufts Health&Nutrition Letter (sic) I got in the mail and eventually subscribed to mentioned other supplements in some detail. Redbook, after discussing four newish diet pills and their pros and cons, moved on to "natural" weight-loss pills, powders and liquids. They quoted studies and experts from Harvard and UC San Diego and referred readers to, which appears to be a reasonable public-access website for medical information (though it also carries lots of advertisements).

One caution from Dr. Michael Steelman (I Googled him and he's the only weight loss specialist to receive the national society's Bariatrician of the Year award twice and is now the editor of a peer review journal in the field) is that "Dietary-supplement companies aren't required to show clinical data on the safety and efficacy to the FDA, which means we have no idea whether they work or if they're safe."

The Tufts article mentions a "voluntary recall" in 2009  of 14 diet-aid products sold as Hydrocut. This is a combination of several active components including caffeine and green tea plus at least three other ingredients. When I traced the history of the product I found the manufacturer had been reported by the New York Times in 2003 as burying studies showing it was ineffective and covering up evidence of cardiac side effects.

Later on there were 23 reports of major side effects with one person ending up with a liver transplant (and at least 17 cases of liver damage reported in the American Journal of Gastroenterology).

Yet when I Googled the drug I found ads for it online today. The company just reformulated the product and put it back on the market.

I went back to the Redbook which next mentioned bitter orange extract. I found university physician comments and reviews saying it doesn't help dieters lose weight and has significant side effects. But you can find lots of ads for the drug.

Brew tea leaves or drink milk; don't take supplement pills

The only two substances that may be effective and reasonably safe are green tea extract and CLA, conjugated linoleic acid (found in dairy products). But a Harvard medical school obesity specialist recommends that the best way to use them for weight loss is to drink some green tea and some skim milk, not to buy the unregulated and often costly supplements you can find advertised online or in magazines.

"Caveat emptor," the Romans used to say; let the buyer beware.

Diet pills and supplements, part one

Saturday, April 9th, 2011

Take two and call me in the morning

I've never used diet pills and have avoided supplements that are supposed to help you lose weight, but there's a great new article on them. It's in a distinctly non-medical source, but was as useful as the medical sites I found and the medical newsletters I received, so let's start there.

The article is in Redbook which I can state categorically I normally don't read. But I got in the mail yesterday, unsolicited, a health-related newsletter from a major university and saw an article in it on diet supplements and weight loss. That started my online search that circuitously led me to the Redbook article, also available online  at

The piece says it will update you on five of the newest diet pills (I counted four, but who's counting?). They walk through the pros and cons of orlistat, available OTC as Alli, which prevents digestion of a share of any fat you consume. The manufacturer of this drug did a study (I prefer totally independent sources) and found increased weight loss in subjects who took the med. What's the con? Well if you consume more fat than ~15 grams per meal, you can develop diarrhea and you may not absorb your daily vitamin intake as well (A, D, E, and K are fat-soluble).

The next drug is Merida (Silbutramine) which acts centrally, i.e., in the brain, altering two chemicals that tell you when you're full. It also can raise your blood pressure and has been assocaiated with strokes and heart attacks. This one is only for the obese or those seriously overweight with other rick factors (e.g., diabetes), is expensive and your healthcare insurance may not cover its cost.

Then there's a duo, Glucophage (metformin) and Byetta (exenatide) that are mostly used for diabetics with weight control problems. Therefore they are usually covered by insurance plans. They also can cause nausea and diarrhea, but have been effective in some fairly long-term studies.

I won't even start on the supplements in this post. What I do want to mention is that most of the medical specialists that Redbook consulted emphasize these drugs are not for the person who wants to lose five or ten pounds so they look good in party clothes or a swim suit. They're for the seriously overweight who preferably are under a doctor's care. And one medical expert said they only work if you are willing to make lifestyle changes.

Guess what? That means dieting and exercising.



Eating Disorders, Part one

Wednesday, April 6th, 2011

Drugs as food

I was reading the Wall Street Journal yesterday and saw an article titled "Food may be addicting for some." Thus far I've been able to find the Archives of General Psychiatry online and ran across a synopsis of the article that was perhaps more erudite, but less helpful than the newspaper article. I then read a "" review of the study.

Let's start with the newspaper. It describes a study on a small number of subjects, 39 women, who had MRI brain scans after completing a short food addiction test that was originally designed to detect people with eating disorders. Fifteen of the women had high scores indicative of potential addictive eating problems; those same women had markedly different brain scan results than the lean subjects.

Okay, let's go back a ways. Last year in the journal Nature Neuroscience, Scripps researchers found that obese rats had brain alterations as compared with lean rats. The changes in the rats' brains were similar to those reported in people who are drug addicts. In short we normally get neural (brain-mediated) rewards for "pleasurable" activities. Similar rewards occur in response to addicting drugs.

The current study started with 48 healthy young women, some of whom were thin and some fat (or as, in our world of political correctness, we now term "obese."). They were enrolled in a "healthy weight maintenance' study.  Thirty-nine MRI results are reported, after the women were show pictures of chocolate milkshakes or a less enticing solution and some actually got either the milk shake or a tasteless control surrogate.

Then they had brain scans and the pattern of neural activation was much like those seen in drug addicts. Either food intake (or even viewing a photo of food) or drug use can stimulate the brains release of chemicals we find pleasurable.

"It ain't easy" for some to lose the extra weight

So what does this mean for society? Number one: not everyone can lose weight by following a deciding to diet. Number two: the omnipresent visual food ads can be detrimental to a segment of our population. Number three: I think organizations similar to Alcoholics Anonymous may be one aid to that group of the obese.

The lead author, Ashley N. Gearhardt, a doctoral student at Yale, who help devise the 26-question Food Addiction Scale, was quoted as sayying, "Some of them actually stop socializing because it gets in the way of their eating."

We've got a major problem here folks. I gained a few pounds on a 11-day trip to see old friends all of whom wanted to feed me wonderful meals. When I got home I went back to my usual eating pattern and the extra weight dropped off rapidly.

That's not going to be as easy for some and darn near impossible for others.