Archive for June, 2011

Great tomatoes: memories or not?

Wednesday, June 29th, 2011

Here's what they look like in the supermarket

When I was a kid in Wisconsin, we used to have "beefsteak tomatoes" several times a week. Then I went off to college and medical school, then residency and fellowships and, eventually, the Air Force. At some point I realized I wasn't eating tomatoes as often and, when I did, they just weren't the same.

We raised our own back in large pots on the back patio two years ago, bought a few at farmers' markets and some vine-ripened tomatoes at a supermarket. The taste, in all cases was much, much better than the standard grocery-store tomato, but I hadn't thought much about the reasons.

Than a friend, knowing about my blog, suggested I buy a book called Tomatoland, written by Barry Estabrook. The back cover advance comments included one by Ruth Reichel who was Editor in Chief for Gourmet Magazine for ten years (it went out of business in 2009) and has been restaurant critic for the New York Times and the Los Angeles Times. She felt the original Gourmet article, "The Price of Tomatoes," (which was expanded to become the book) was the one she was most proud to have published during her tenure.

There are two basic themes to Tomatoland: one is that the "industrial tomato," grown in Florida and accounting for a third of all the fresh tomatoes grown in this country (and a much greater percentage of those available in the supermarkets from October to June) is bred for almost everything except taste. His detailed exploration of the Florida tomato, whose attributes are tightly controlled by a state tomato committee, explained what I had known for some time. They add little to salads except for color.

But here's what they look like when they're picked

That especially excludes taste and nutritional benefits. The one thing the modern industrial tomato has over its 1960-era predecessors is sodium; it has considerably less vitamin content and less calcium, according to Estabrook. He has won two James Beard awards, one for his blog I went to that website and read a recent post which brought me back to the second theme of Tomatoland: the abhorent conditons endured by our migrant farm workers.

There are, according to that post, 400,000 of those low-paid laborers, 70% of whom are estimated to be undocumented. Florida had virtual slavery with crew bosses picking out and often holding workers in dismal settings (locked in a truck, for instance). That situation, has gradually improved in some aspects at least, in  large part due to the efforts of a worker coalition. But Estabrook's recent post said many of the migrant farm hands/pickers skipped working in Georgia this year after a new law mirroring Arizona's harsh legislation was put into place.

So Georgia was short 11,000 farm workers and the farmers were in danger of losing $300,000,000 worth of produce. The governor, who pushed for the new law a few months ago, is now offering those vacant farm jobs to unemployed probationers. The problem is the work is tough and often reuires experience, so the newly employed group is quitting in droves.

Read the book; it's an eye-opener.



So what should I eat?

Friday, June 24th, 2011

Medical research comes through for us

I was reading my morning papers yesterday, The Wall Street Journal (hard-copy edition) and the New York Times breaking news (on my Kindle). I came across a June 23, 2011, WSJ article titled "You Say Potato, Scale Says Uh-Oh." It detailed a recent research study online in a prominent medical journal. The premise was what you choose to eat will determine what happens to your weight over a four-year period.

The overall conclusion, once again, is picking healthier items for your diet leads to less weight gain. Most American adults gain a pound a year, but if they add a serving of French Fries on a daily basis, they'll gain more (3.35 pounds). The NEJM said the participants in three huge studies (a total of 120,877 U.S. men and women who were free of chronic diseases and non-obese at the start of the studies), gained most if the extra item was potato chips, and lost weight if it was yogurt. The list, after chips, in deceasing correlation to weight gain included potatoes, sugar-sweetened beverages and unprocessed red meat or processed meat.

Negative numbers were noted for the addition of vegetables, whole grains, fruits, nuts and then yogurt. Other lifestyle influences were examined. If one of the subjects exercised regularly, they lost weight; if they watched much TV, they gained pounds.

So what's new here? Huge studies over lengthy time periods + a few different conclusions.

The study's co-author, Dr. Walter Willet, the chairman of Epidemiology and Nutrition at Harvard's School of Public Health was interviewed on NPR New's program "All Things Considered." He commented that highly refined foods-sugar-added beverages and potatoes, white rice and white bread-were related to greater weight gain. The presumption is these foods are rapidly broken down into sugar, absorbed and then quickly removed by the action of insulin. So if you eat these things, in a short while you're hungry again.

high-protein Greek-style yogurt

Nuts have fat, but keep us satiated for a prolonged time. Yogurt was a surprise to the research group (we're talking about natural yogurt without added sugar) and the mechanism for its influence on weight is unclear, but may relate to the healthy bacteria included.

The bottom line may be just because some foods contain fat, doesn't necessarily mean they'll be fattening. On the other hand, foods that keep us satisfied for a longer time may help us control our overall calorie intake over the long haul.




Vitamins & supplements: part 1

Tuesday, June 21st, 2011

The amazing mangosteen

I started reading the New York Times breaking news on my Kindle this morning and ran across a story titled "Support is Mutual for Senator and Utah Industry." The photo below the byline showed US Senator Orin Hatch at the HQ of one of his state's firms; this one puts out a $40 bottle of fruit juice. Well, that's a lot more than I usually pay (and I almost always buy fruit, not juice, anyway). But my interest was piqued, so I read the story and then did background research.

The fruit involved in the mangosteen, a name I vaguely remembered from my Air Force tour in the Philippines. It's been used in medicinal products in India and China for many years, but much more recently sold in mixed juice form in the United States with fairly incredible health claims (improves immunity, fights cancer, has anti-aging properties).

The Memorial Sloan-Kettering Cancer Center website says, "Despite claims by several marketers, the efficacy and safety of mangosteen products for cancer treatment in humans has not been established." They do mention that several small studies suggest it may be beneficial for halitosis, but also note at least one person who suffered a major side effect after prolonged use of mangosteen juice.

I was able to find a single randomized, double-blind, placebo-controlled trial that demonstrated some laboratory evidence of changes in immune function in a small group of 40 to 60-year-old  who took a mangosteen product that also contained multivitamins and "essential minerals" over a 30-day period. The study participants who got the combination product also felt their health improved.

So is this another expensive scam or will further study find we should all consider drinking mangosteen juice? Frankly I don't know, but I'd bet it's going to be hard to find out.

In March of this year, a Board Certified Family Practice physician who is now on the "mangosteen circuit" apparently spoke at the central Utah headquarters of the firm producing the miracle juice and claimed it had "anti-tumor," "anti-obesity," "anti-aging," "anti-fatigue," "antiviral," "antibiotic," and "anti-depressant" properties.

When asked how he knew the juice wasn't snake oil, he replied, "A company that is selling snake oil is not going to stay in business for 11 years and grow as fast as this company is growing."

That's strange. If I were asked a similar question I'd want to be able to show solid, evidence-based data generated by researchers who have no financial interest in the company.

sell very expensive juice with extensive but unproven health benefit claims

But the senator has apparently been the focal point for legislation that says nutritional supplement companies can bring out new products without FDA approval and make lots of general health claims without studies of safety or effectiveness.

Oh, and by the way, the New York Times mentioned that the doctor making all those sweeping statements has had his license to practice revoked on two occasions, for charges including prescribing excessive amounts of narcotics and for giving a weight-loss clinic signed, blank prescription forms.

He's not my idea of an ideal spokesperson.

Post-exercise protein choices, part 1

Friday, June 17th, 2011

Maybe a few more pounds than this

I received a comment recently on one of my April 2011 posts asking if I still had the April edition of the Nutrition Action Health Letter (NAHL) published by the Center for Science in the Public Interest. My reader had lost her copy and wanted to know what protein supplement CSPI thought was reasonable. I found the info (it was creatine monohydrate with background research done by an associate professor at the University of Regina in Saskatchewan), emailed it to her and decided to review the whole topic in more depth.

I'm in the gym six or seven days a week for ~two hours or a tad more. I'm not trying to bulk up and never attempt the weights I see some of the really husky guys lifting.

As I walk in, I pass a lineup off supplements and see men especially, mixing up powders from large containers. I've never even considered the idea. I told my reader that the professor's credentials seemed reasonable, but she should ask her own physician before starting any supplements from a bottle. I also mentioned that I hard boil eggs, compost the yolks and eat the whites at meals that are otherwise low in protein.

But I reread the article in the April NAHL "Staying Strong: How exercise & diet can help preserve your muscles." The opening quote caught my eye. Miriam Nelson, the director of Tuft's Center on Physical Activity, Nutrition and Obesity Prevention said, "Muscle is the absolute centerpiece for being healthy, vital and independent as we grow older."

I turned seventy in April, so it made sense to pay attention to her. I'm already active and doing some "resistance training" as was recommended later in the article. I saw also quotes from Ben Hurley, a professor of kinesiology at the University of Maryland (and husband to Jane Hurley, an RD on the NAHL staff).

Hurley has been a longtime student of strength training AKA resitance or weight training and feels it is the mode of choice for preventing muscle loss.

Notice I said preventing loss of muscles, not muscle building. I see men in our gym who are only a few years younger than me and are still bulking up deliberately. The sixteen to twenty-year-old youngsters are presumably doing so to impress the young women or because their friends do so, but why do that at age sixty plus?

I actually bought Stonyfield Organic Oikos yogurt

But back to protein intake; experts like the woman who holds the Distinguished Chair in Geriatric Medicine at the University of Texas Medical Branch, Galveston, say we should consume 30 grams of protein soon after exercising and that smaller amounts won't work in older adults.

So that's four ounces of skinned chicken breast (170 calories) or my egg white plus some Greek yogurt (with twice the protein of regular yogurt). I'll try that a while and then comment on the idea.

Have an apple or maybe some cilantro?

Tuesday, June 14th, 2011

Snow White, you may wish to reconsider!

I was reading the Wall Street Journal a few days ago and found an article with the jolting title "Pesticide Residue Taints Apples." The US Department of Agriculture (USDA) tests a variety of foods for pesticides and this year 98% of the apples they screened tested positive. Most of us eat apples; they are the second-most widely consumed fruit in this country (bananas are first).

I next found the USDA website and information on their testing program. It's been going on yearly since 1991, tests over 85 "commodities" including foods that may be fresh, canned or frozen, poultry, beef and catfish. They also test water (bottled, private and school wells, municipal water sources). The Pesticide Data Program (PDP) tests for more than 450 distinct pesticides of a variety of types (herbicides, fungicides, growth regulators, insecticides). The most recent PDP statement I could find (2009) said samples were obtained from 11 states representing ~50% of US population and all regions of the country and analyzed in thirteen central laboratories.

Have some cilantro, my dear

This year samples were washed under cold water for ten seconds to emulate typical consumer actions and yet over 90% of those from grapes, strawberries, cilantro, potatoes, oranges and spinach (plus apples of course) had pesticide residue. Cilantro was tested for the first time and the data was frightening; 44% of cilantro samples not only positive tested for pesticides, but also for unapproved pesticides.

According to a number of online sources, we have in recent years shipped to other countries huge amounts of pesticides that are not allowed to be used in the US. Then, of course, we may import foods from those countries. The good news, limited as it was, came from the USDA; only 3% of 2009 samples from produce, beef and rice contained either unapproved pesticides or excess amounts of pesticides.

The US Apple Association, burned by a "60 Minutes" program in 1989 which linked the pesticide Alar to health risks, has long complained about the Environmental Working Group's Dirty Dozen & Clean Fifteen lists. Yet the EWG's 2011 Shopper's Guide (I'll paste in the URL below), says if consumers chose from the good list they can reduce their daily pesticide intake by more than 90%.

So if you can, choose from the "Clean Fifteen" and otherwise buy organic; if not shop wisely and that's especially true for those of you who are purchasing food for youngsters. An EPA senior staffer, Devon Payne-Sturgis,PhD, Assistant Director of the National Center for Environmental Research, authored a prize-winning 2009 publication showing 40% of US children have levels of one type of pesticide well above what is considered to be the safe limit.

I'm going to see if we can buy organic cilantro and in another hour or so I'll go pick up our first shipment of this year's CSA veggies.



E. coli here as well as there

Friday, June 10th, 2011

You may not need to be quite this careful

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

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

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

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

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

Why is ground beef the focus?

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

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



More on the E. coli front

Tuesday, June 7th, 2011

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

Are these the culprits?

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

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

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

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

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

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

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

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

This is what I'm buying

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

E. coli and you

Saturday, June 4th, 2011

This is a "bug" you don't want

I've seen several articles in The New York Times and the Wall Street Journal in the past few days about diseases caused by an extremely toxic new strain of the common bowel bacteria, E. coli. More then 1,800 people in Europe have been infected with this food-bourne illness and some have died from an unusual kidney complication it can lead to.

The "bug" itself appears to be highly resistant to antibiotics and experts in the United States feel the wrong approach is being taken in Europe. One professor from Washington University is quoted as saying, "If you give antibiotics and the strain is (already) resistant, then you give that bacteria a competitive advantage..."

Here the recommended strategy is not to treat E coli infections with antibiotics at all. American doctors give IV fluids to help keep the kidneys functioning. They dialyze patients who develop acute kidney failure. On both side of the Atlantic physicians agree that people who develop bloody stools should be admitted to a hospital in an isolation room/ward. Otherwise a person who has an E. coli-caused diarrheal illness can easily infect others.

But dialysis can save your life

The rare, but deadly kidney disease that these food-bourne bacteria can cause is called hemolytic-uremic syndrome (HUS). The NIH PubMed website defines it as a disorder that usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury.

Hemolytic-uremic syndrome (HUS) often occurs after a severe gastrointestinal infection with E. coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections, including shigella and salmonella, as well as infections outside the GI system.

In America HUS is most often seen in children and is the commonest cause of acute kidney failure in them. Several large outbreaks in 1992 and 1993 were linked to undercooked hamburger meat contaminated with E. coli.

But in this case we're not talking about meat, but rather vegetables. In the past American outbreaks have been associated with contaminated tomatoes, lettuce and cucumbers.

So should we be worried? Thus far there have been only four cases identified in the US. Those people had traveled to the northern part of Germany recently and that's been identified as the epicenter of this E. coli outbreak. Germany has had 1,733 cases in the most recent count I could find. Initially Spanish cucumbers were blamed, but now it appears clear that Germany is the source.

The FDA is closely monitoring lettuce, cucumbers and tomatoes imported from Germany and Spain, but those countries account for <0.2% of our imported produce.

My family is about to start our 26-week season eating locally produced organic vegetables from Grant Family Farms, the CSA we joined last year. That improves my comfort zone enormously. I think the rest of you should consider farmers' markets, CSAs and other sources for vegetables that are grown relatively near your homes.

I've been saying that for a while; this outbreak just reinforces my thoughts on the subject.