Archive for May, 2011

Hypertension: some good news

Tuesday, May 31st, 2011

Let's check your BP

I was reading a blog post from May 2010 written by an unidentified cardiologist. Some of the underlying issues were worth following to better sources. The blog stated that high blood pressure is our most common chronic disease. It went on to mention the connection between BP and weight, saying, as a nation, America is one million tons overweight. It claimed that ten pounds of weight loss could normalize the BP of many Americans.

I initially got into today's data search because of a Wall Street Journal article (Personal Journal; May 31, 2010; pp.D1-2) titled "A Long-Awaited Advance in the War on Blood Pressure." I Googled the author, Ron Winslow and he is the deputy editor for health and science and a senior medical and health care writer for WSJ with over a thousand articles written.

He reported that the American Society for Hypertension (ASH) met in New York last week (May 21-24,2011) and Dr. Brent Eagan, the vice president of ASH, and Professor of Medicine at the University of South Carolina reported some real progress on the multi-state Hypertension Initiative he heads. It's working with ~500 primary care practitioners and over 110,000 hypertensive patients in the Southeast. Nearly 70% of their patient have controlled BPs now (vs. 40% a decade ago).

About as far away as you can get in the U.S., Kaiser Permanente's northern California branch follows >600,000 patients with hypertension and reported at the same ASH meeting that 80% of that group have controlled BP readings compared to 44% ten years back.

One of the Kaiser patients had a regular checkup in 2007 and had mildly elevated BPs then (145/74). Her own comment was, "Here in northern California, we believe in exercise and good nutrition and we're not into pills."

Yet her doctors started her on two medications for hypertension and early this year her BP was 117/74. She's walking three miles three times a week, eating fruits and vegetables and going to a strength-training class at a gym. I don't know if she lost weight also, but I wouldn't be surprised. I mentioned in an earlier post, that my own BP fell markedly after I lost ~25 pounds, and the dosage of the anti-hypertensive drug I've been on for years had to be cut in half.

Guess who's at higher risk for CV disease

So why am I writing about this in a blog devoted mostly to weight/diet/exercise?  First, there's an increased awareness of the association between excess weight, high BP and cardiovascular risk at all ages. An article in the Feb 3, 2009 edition of Circulation looked at the issue in children and adolescents. Concentrating on the Metabolic Syndrome (obesity, diabetes, hypertension, abnormal blood lipids), there was, even in these young people, a definite correlation between the degree of obesity and cardiovascular risk. They stated that strong evidence places obesity as the most significant risk factor

Can I tie all this together? Well I'd say bluntly that obesity is our major enemy, it's a major causal factor in hypertension which is being treated pharmacologically at earlier stages and that diet and exercise are extremely useful ways to combat both entities.

Sodium and Iodine intake

Friday, May 27th, 2011

You can get iodine from salt and from food

My wife subscribes to a healthy cooking magazine and I sometimes read parts. Last week I was puzzled by their piece regarding appropriate dietary sodium intake. There were three column, one for younger adult women, one for "older" women (starting at 51) and one for all adult men.

The levels were 2,300 mg per day for young women and all men and 1,500 mg a day for men. Yet sodium recommendations (in various publications) for older adults of both genders as well as African Americans of any adult age, and those of us with high blood pressure, diabetes or kidney disease (a total of perhaps 70% of our total population) range from 1,300 to 1,500 mg per day . The American Heart Association now recommends all of us limit our sodium intake to 1,500 mg/day.

I decided to write an email to the magazine and mentioned that they were behind the power curve. I got a prompt answer from their senior dietitian; in their June edition they'll be listing a lower figure for older men. I thought. 'It's a start, at least."

Then I received the June 2011 edition of the Harvard Heart Letter. One question that arises when we're told to cut back on salt, is will we stinting on iodine? The title of the lead article gave a direct answer: "Cut salt--it won't affect your iodine intake." The subtitle continued in the same theme: "Iodized salt provides only a small fraction of daily iodine intake."

Those of us over the age of 19 should get 150 micrograms of iodine per day (The senior vitamin/mineral supplement we take contains 150 micrograms/tablet). The recommendations are higher for women who are pregnant or breast-feeding (220 and 290 micrograms respectively).

We also get iodine from dairy products including cheese and yogurt, eggs, marine fish and vegetables that come from regions where the soil contains lots of iodine. Essentially all iodine ingested in food and liquids is absorbed and bio-available (This is not true for iodine in thyroid hormones taken for therapeutic purposes). So I searched to see if we might be getting too much iodine. The data is vague, but an old World Health Organization recommendation I found stated that 1,000 micrograms/day was felt to be safe.

Thyroid check in pregnant woman

We need iodine to enable our thyroid glands to synthesize thyroid hormone. Too little iodine intake leads to hypothyroidism and enlargement of the thyroid gland (goiter). That's bad enough for adults, but worse for fetuses, infants and children where too little iodine can seriously affect brain development.

Most Americans, especially those who eat lots of processed food, take in excess sodium. But the majority of the food-producing companies in adding salt to their products, don't use iodized salt.

You can get all your needed iodine from the AHA-recommended sodium intake (NB. not all salt is iodized) and from "natural" foods Processed foods just add sodium you don't need.

But if you're pregnant (or might be), ask your own doctor.



Brian Wansink's "Mindless Eating" concept

Tuesday, May 24th, 2011

Don't fill your plate this way

I just read Brian Wansink's book, Mindless Eating: Why We Eat More Than We Think. Wansink got a PhD in Consumer Behavior from Stanford and from 2007 to 2009 was the USDA's Executive Director for Nutrition Policy and Promotion. He's currently in an Endowed Chair at Cornell and won the humorous Ig Nobel Prize in 2007.

If you've never heard of the Ig Nobel Prizes, Google the term. They started in 1991 and were originally given for discoveries "that cannot, or should not be, reproduced." They are presented by Nobel laureates in a ceremony  sponsored by three Harvard groups, broadcast on NPR, on the Internet and on Science Friday the day after Thanksgiving. Some are thinly veiled criticism (BP was a co-winner in 2010 for disproving the old belief that oil and water don't mix). Most are for serious work that has a humorous slant (malaria-carrying mosquitoes are equally attracted to the smell of Camembert cheese and human feet; this led to insect traps in Africa being baited with that cheese).

In Wansink's case, his award was given in the Nutrition category for studying people's appetite for mindless eating by secretly feeding them a self-refilling bowl of soup.

His work has focused on how our environment influences our eating habits. Wansink says we all make well over 200 food choices a day (what to eat, what to drink, how much of each) and we rarely know why we make those decisions or if they are helpful/healthy choices.

For instance, one of his experiments showed using smaller plates can help you serve and eat less. Another concerned fat-free foods, which may have nearly as many calories (and sometimes more) than the standard version of the same food item. In one of his studies, normal-weight subjects given low-fat foods actually consumer one-sixth more calories and overweight subjects took in nearly 50% more calories.

Wansink says low-fat foods have a "health halo;" we think they're better for us and therefore, in a sense, give ourselves permission to eat more of them.

Container size is another of his "food trap" areas. When presented with a larger package, a larger bottle of a soda or a short, fat glass to pour a drink into, we end up eating or drinking more.

He suggests a series of food trade-offs and food policies (if I want that doughnut, I need to spend an hour walking; I'll only eat snacks when I'm sitting at the table).

Try eating with these instead of a knife and fork

I liked Wansink's books, already had been using many of his strategies, but found others I can adopt. I think his studies and concepts are valid and his ~300-page publication well worth reading.If you do so, you may find yourself using chopsticks the next time you eat Chinese food. You'll likely eat less per bite and eat slower.

I may try them for American food.


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.

What should I eat today? It depends who you trust.

Friday, May 13th, 2011

I ate out last evening and splurged a bit (I had one glass of Riesling, split an calamari appetizer, ate two-thirds of a Thai entree and split a favorite dessert, sticky rice with mango). So today my weight is up a little, but still within my allowable range.

Watch out for scam artists

But that sent me to my stack of recent articles on healthy and unhealthy eating and in particular to one from the April 2011 edition of the Nutrition Action Healthletter put out by the Center for Science in the Public Interest (CSPI). I have four of their articles sitting on my work desk amidst others I found on the internet or in a medical journal.

The one that caught my eye was titled "10 Common Food Goofs: "Fool me once..." and written by Bonnie Liebman. She is the Director of Nutrition for CSPI, got an MS degree from Cornell and has worked since 1977 for the CSPI almost from its inception.

I was going to ping off her article, but then got caught up after Googling Liebman, in following the Web trail back to a harsh critique of CSPI coming from an organization called The Center for Consumer Freedom (TCFCF)

I personally respect CSPI, but my intellectual curiosity kicked in and I wanted to know if the criticisms, calling CSPI the "undisputed leader among America's 'food police,'" came from a valid source. It took a bit of hunting, but what I found was interesting.

The non-paper trail for TCFCF leads to an interesting character, Richard Berman, a high-paid lobbyist for the restaurant and beverage industry. I don't know his actual salary, but he traded in one very fancy house for another even fancier one in the past decade and a half. One ABC article said his business got $1.5 million back in 2004 from TCFCF.

His internet overview of CSPI slams its director, Michael Jacobson, an MIT-trained PhD microbiologist. But when I followed up on Jacobson's reputation, I found the Center for Disease Control (CDC) had given him its 2010 Foundation Hero's Award.

Berman, on the other hand, was noted in the 2006 ABC article I found online, as one of a growing group of lobbyists who've set up non-profit front groups to push their corporate messages. The Center for Media and Democracy was quoted as saying groups have filed complaints with the IRS against such smear tactics. A former IRS division director was quoted as saying, "If someone sets up a website claiming the moon is made of green cheese and they go through some elaborate proof of that, the IRS isn't going to say that's too absurd. It's a form of free speech."

So I'm going to stick with CSPI's publications and ignore Berman's industry-favoring slant. I found it interesting that one of the websites I found in tracing Berman's roots is titled

I think my bottom message is don't believe all that you read. Check up even on sites and publications you normally have confidence in.

That was a divergence from my usual blog posts, but I thought it was worth my time and hopefully yours too.


correction on web address

Wednesday, May 11th, 2011

I tried the web address on my most recent post and had to add nih to get to the actual site I mentioned. This one should work.

Katz Redux

Tuesday, May 10th, 2011

I went back to Dr. David Katz's classic article published in the Harvard  Health Policy Review in 2006. His example of the Pima Indian tribe had caught my eye the first time through the piece and serves as a cautionary note for the rest of us. I decided to explore the subject further.

mesquite tree

The Pimas, who live not far from us, in the four corners region where Arizona, Colorado, New Mexico and Utah meet, used to be outdoors men and women, taking long-distance walks on a regular basis and eating a diet that fits all the modern parameters for healthy eating. it included two unusual items one of which was mesquite,  which I think of as a tree. I've now found that mesquite has bean pods that can be dried and ground into a sweet,nutty flour high in calcium, magnesium, potassium, iron and zinc, and rich in the amino acid lysine.

The other native foodstuff was a drought-resistant bean, tepary, which has recently been introduced into African agriculture . All in all they exercised much more than many of us and ate a high-fiber, low-fat low-sugar diet without an abundance of calories.

Then civilization happened to the Pimas. Now they own casinos and don't walk anywhere as far as their forebears (their per capita income is still on the low side). They also eat a less healthy "American diet" similar to the rest of us.

The consequences were those you'd expect. obesity and diabetes. Fifty percent of the adult Pimas are obese and of those 95% have diabetes. The tribe is now part of a major NIH research project (the website is at and then add /pathfind/pthfind.htm or /obesity/obesity.htm), which over the past 30 years has shown that before gaining weight, overweight people have a slower metabolic rate.

This so-called "thrifty gene" theory originally suggested in 1962, looked at populations, like the Pimas, who over thousands of years would have alternating period of famine and feast. When there was little to eat, they stored fat. Now that they don't need to do this in the same fashion, the gene has led them toward the diseases associated with obesity, especially diabetes.

less healthy than mesquite flour

An update from the Harvard School of Public Health mentioned the mayor of Boston having banned sale and advertising of "sugar-loaded drinks" from city-owned buildings and city-sponsored events. The chair of HSPH's Department of Nutrition was quoted as saying, "There is abundant evidence that the huge increase in soda consumption in the past 40 years is the most important single factor behind America's obesity epidemic."

So not all of us have thrifty genes to blame for weight gain. But we can start by abandoning those sodas and other sugar-laden drinks.  And perhaps, to whatever extent we can, returning to a diet similar to our own ancestors, with more locally grown fruits and veggies leading the way to better health.



Leave it to we Beaver's

Thursday, May 5th, 2011

a tree, post-beaver

The May 4, 2011 edition of the Wall Street Journal had an article that quickly send me to my computer. The title was "Why Wood Pulp Makes Ice Cream Creamier." Well, until I read the article and then hunted down background information, I certainly didn't know I could be chewing on logs (or derivatives thereof) in my daily diet

The Center for Science in the Public Interest, an organization I generally trust, has a website on food additives. There's a couple of pages on the good, the semi-bad and the ugly (as I would phrase it) and then 25+ pages on specific additives. I'll drop in a link to that fascinating section of the CSPI's web content if you want to learn more and perhaps return to the general topic in a later post.

In the meantime back to the May 4th article and its cousins. I say that since Googling "wood pulp in food" yields links to a considerable number of articles, blogs and other Internet-accessible items on the subject. I just printed out a page from a blog from India, a 2006 Dow Chemical Company's attorney's letter (the first page of 68) requesting an exemption to for considering wood pulp as a food additive and an FDA paper on the subject.


The bottom line is CPSI in their extensive listing of food additives rates carboxymethylcellulose (CMC) in their group "Cut Back: Not toxic, but large amounts may be unsafe or promote bad nutrition."

Yet processed food manufacturers are using more CMC and other cellulose (read this as wood pulp) deriviatives to increase fiber content of white bread (I don't eat white bread), allow hurried/lazy cooks to add pre-shredded cheese (we shred our own) and enhance something called "mouth feel" in ice cream.

To make the powdered form of cellulose, wood is cooked in chemicals to separate the constituent and then, in some cases, processed further with acid to break down the fiber.

If made properly, (ah, there's that word "if" again), cellulose is a). supposed to be harmless in small amounts and b). isn't absorbed by the body, thus adding bulk to foods without adding calories. It also adds fiber to foods that otherwise are low in this component.

The WSJ article quotes Michael Jacobson, the CSPI's executive director, as saying, "Cellulose is cellulose." He then apparently said that no research points to health problems secondary to eating cellulose.

The FDA limits the percentage of cellulose in some foods (e.g., cheese spread and jams) and sets an upper ceiling (usually 1 to 4 %) for how much cellulose can be added to meat products.

Well I know we need fiber in our diet and it appears that this additive isn't bad for you. But I prefer not to eat processed foods and to get my fiber in natural forms.

So I Googled "Food high in fiber" and found a Mayo Clinic website that listed, amoung other foods: raspberries, unpeeled pears and apples, whole-wheat spaghetti, bran flakes, cooked split peas and lentils and artichokes.

It's your choice; Processed foods with added wood pulp or plain old fruits and veggies.

Chew on!


Today's trail led back nearly five years

Tuesday, May 3rd, 2011

It's time to eat less and do more

There was an interesting article in the Wall Street Journal this morning titled "The Bigger the Belly, the Bigger the Risk." It cited an article published online yesterday in the Journal of the American College of Cardiology with the lead author being a Mayo Clinic (Rochester branch) physician named Francisco Lopez-Jimenez.

I followed the paper trail (that's not exactly correct since it's an online publication) and read the abstract, then another of Dr. Lopez-Jimenez's articles, then a commentary and followed those concepts back to a long article written in 2006 by a Yale staffer, Dr. David L. Katz.

Dr. Katz's article in the Harvard Health Policy Review (Vol. 7, No. 2, Fall 2006, pp.135-151) is one of the best I've ever read and I'll concentrate on it today and then move up to 2011.

Katz gives statistics (remember these are almost five years old) showing at least 15% of kids ages 6 to 19 are overweight with higher percentages for Hispanic and Black children. Then he notes that more than two thirds of kids over 10 who are obese will turn out to be obese as adults. They will then be subject to the big three obesity-relayed diseases, diabetes, heart disease and cancer. And while they are children, their quality of life is less, for many reasons.

What I didn't realize was even those who lose weight as adults, but were obese as kids, are at increased risk.

Not the right choice for weight loss

He goes on to explain that as a species, we ate, historically, when we could, stored fat for times when food was scarce, and exercised a lot. All that has changed, but we still tend to eat more than we should, given the fact that for many of us food is abundant. And our modern labor-saving devices mean we usually exercise far less than we should. We also eat the wrong things. The end result is weight gain, to the point of frank obesity for many.

Today's article said where you carry excess weight is more important than the sheer fact of being overweight. I read several of Dr. Lopez-Jimenez' publications, and their main thrust is that central obesity, i.e., having a large roll around your waistline, is much more detrimental than simply having a higher than usual weight or BMI.

Lopez-Jimenez and his co-authors looked at studies following patients with heart disease, but other papers support their basic theme. The NIH's director of cardiovascular sciences, Dr. Michael Laurer, who wasn't involved in the Lopez-Jimenez study, is quoted as saying, "Fat is not created equal and where fat is located makes a difference."

The other comment that was somewhat new also came from Dr. Laurer who said, "Fat isn't an inert substance." Apparently scientists have found a number of toxic chemicals can be released from fat.

I'm heading to the gym next where I'll see a number of men in the locker room who have built up their upper body muscles, but have a considerable roll around their mid-section. They need to adopt a new exercise, pushing away from the dinner table.