Archive for July, 2011

Should you take multivitamins?

Friday, July 29th, 2011

The best choice is on the right

Eight days ago The Wall Street Journal had an article with an intriguing title, "Multivitamins: Lots of Types, Lots of Label Confusion. The question was "do you really need a multivitamin?" and the answer was, "probably not, although much depends on your age, gender, diet and health.

I take a senior vitamin (I'm 70), 5,000 IU of vitamin D every other day, 500 milligrams of vitamin C and 2,500 micrograms of B12 a day. I also take another vitamin-containing capsule suggested by an ophthalmologist (as my Dad had macular degeneration and there's some data suggesting taking these vitamins plus zinc, selenium, copper, lutein and zeaxanthin can help prevent this disease).

The last two chemicals I mentioned are probably unfamiliar to most of you; but they're found naturally in your eyes, especially in the retina/macula. Zeaxanthin is the pigment that gives paprika  (made from bell peppers), corn, saffron, and many other plants their characteristic color.

The questions I asked myself for these vitamins today were firstly: what are the recommended daily allowances RDAs), the amount from food (and maybe added pills) that are sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals in a group. And secondly: what are the tolerable upper intake (TUL) levels for these same vitamins.

Both these querys can be answered by looking at tables supplied by the Institute of Medicine (look at The IOM is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. It's been the health arm since 1970 of the National Academy of Science which itself was established by President Lincoln in 1863.

I'll just mention a few of the RDAs and TULs and stick to my age and gender. Remember B vitamins are water soluble, so for most of these there is no upper determined limit. Excess amounts should be excreted in the urine. That doesn't mean you can or should gulp an endless amount of these; to me it just means there is no data on adverse effects.

Vitamins that are fat soluble (A, D, E, and K for most of of us, CoQ10 for those who take this supplement {disclaimer: I know little about CoQ10 and have never taken it myself}), are different. Excess amounts may remain in the body and cause toxicity.

Vitmain C megadoses were advocated years ago by Linus Pauling (who won two Nobel prizes), but large, randomized clinical trials on the effects of high doses on the general population have never taken place and toxicity in some individuals taking high doses has been shown. The RDA for me is 75 mg/d and the TUL is 2,000.

I wondered if I were possibly pushing the upper limits of vitamin A intake, with 2,500 IU (international units) in my senior vitamin and 2,500 IU in the other multi I take, so I looked for the TUL and found it in IU format in the NIH's MedlinePlus website as 25,000 IUs.

Multivitamins are a $4.9 biilion/year industry, so I'd consult your own physician if you want to take them or any supplements.


Let us eat lettuce...and more

Wednesday, July 27th, 2011

I want more to a salad than just iceberg lettuce

Some years back I told my wife, "I'm tired of the same old salad; could you make a different one?"

We both cook, though she does more of of daily cooking than I do, but salad making is my least favorite part of cooking.

Over the next six weeks she never made a salad I had tasted before; her mix and match approach led to some surprises, but I'm always happy to try new dishes and almost all of them were successes. She added edamame, sunflower seeds, unusual greens; I ate them all. I finally told her, "I didn't mean an entirely new salad every time, just less of the iceberg lettuce, store-bought tomatoes and cucumber with familiar dressing.

We still eat salads at least once a day, sometimes as our main dish with chicken or fish added for protein. Sometimes we'll have a brand new mixture; sometimes I can recognize we've had this blend before and put it on the "keeper list."

Today I read about food companies attempts to get more Americans on the same dietary pathway. The Wall Street Journal had an article titled "The Salad Is in the Bag." I was amazed to read that the typical US adult eats salad with a meal only 36 times a years, roughly once every ten days. Less than half of Americans eat even one "leaf salad" in meals they serve at home in a two-week period.

The two of us are clearly on the far end of that scale when it comes to salad making. Our share of this weeks' vegetables from Grant Family Farms, our CSA, included summer squash, English peas, cabbage, carrots, kohlrabi, cilantro, parsley, green onions, a little broccoli, cylindra beets (new to us) and romaine lettuce. All of those veggies will find their way into salad

I've even gotten more enthusiastic about preparing some of the new salad combinations myself.

So what's going on with the "store-bought" salad concept?

A market research group reported the biggest issue is making salads. Apparently people don't want to take the time to wash produce, inspect it, cut it and come up with mixtures the family will eat (we won't even get into those who abhor greenery).

So some of the major food companies are responding by making salad preparation easier. One concept being explored is adding more kinds of vegetables to bagged lettuce or spinach. That way all you have to do is buy a bag, bring it home, open it before a meal and pour the contents into a salad bowl.

Well that sounds easy, but it turns out to be a bit more complicated than the simple version. One company found wheatberries absorbed moisture; their research director spent six months resolving that issue. Then there's the price issue; bagged salads cost more. Past history and the view of CPSI says there's more risk of pathogen growth and therefore of food-bourne illness.

But pre-washing with newer chemical mixtures, eliminating the need for a second wash at home, may help.

A new and improved version

Salad, anyone?


An Entire Pillar of Salt?

Saturday, July 23rd, 2011

Not a pillar, but too much anyway

I remember a Biblical reference (Genesis 9:26 in my copy) to Lot's wife looking back at Sodom and Gomorrah and turning into a pillar of salt. Today I'd like to talk about much smaller amounts than a whole pillar and salts in the pleural, not just sodium chloride, ordinary table salt, but potassium as well.

I am aware there's been considerable discussion of our dietary salt/sodium intake in the past few years. A July 12, 2011 article in The Wall Street Journal titled "Neutralizing Sodium's Heart Impact" led me back into this literature.

We've been urged time and again to lessen our sodium intake. The 2011 Dietary Guidelines, as I've mentioned before, suggested the average American cut their sodium intake from our average of  3,400 milligrams down to 2,300, roughly a teaspoon a day.

But a large group of us, all at risk for hypertension: everyone over 51, African-Americans, anyone with pre-existing high blood pressure and those with diabetes or chronic kidney disease (i.e., over half our population) were told we should go further, cut to roughly a half teaspoon of salt a day, with various sources suggesting 1,200 to 1,500 milligrams per day total sodium intake.

The most recent study appeared in the Archives of Internal Medicine on July 11th and had a slightly different take on the subject. A prospective cohort study of 12,00+ US adults, followed nearly 15 years, showed that both lower sodium intake and higher potassium intake were associated with a lower risk of death.

The numbers appear significant with the quartile i.e., quarter of the group, ingesting the highest sodium to potassium ratio having almost one and a half times the death risk of those who ate the lowest ratio. That held true for all-cause mortality and the death risk for ischemic heart disease was over two-fold in the group who ate more sodium and less potassium-containing foods.

So how do we get more potassium in our diets and just how much should we be ingesting? I found a lovely illustrated guide on the website and another good discussion on MedlinePlus, the NIH website. The former guideline has both potassium and calorie data.

Adults with normal kidney function should be getting 4.7 grams a day from the foods they eat (if you have reduced kidney function, ask your own physician how much you should ingest). Some medicines affect your ability to excrete potassium; for the rest of us 19 and older the Food and Nutrition Center of the Institute of Medicine says the 4.7 gram amount is reasonable. Nursing moms need 5.1 grams a day.

Here' a good potassium source

A large baked potato with skin has 845 milligrams of potassium and 160 calories while 1/2 of a medium sized cantaloupe has 680 milligrams and only 60 calories. A medium banana has 451 milligrams with 105 calories.

Red meats, chicken, salmon, cod, flounder and sardines are all good sources of potassium and a cup of low-fat plain yogurt has 530 milligrams with 150 calories.

Many of us have eaten far too much sodium (in processed foods) and too little potassium.

It's time for a change.



Food Allergies: part two

Wednesday, July 20th, 2011

These may cause hives or much more serious reactions

I was intrigued by the comments on Food Allergy that I mentioned in my last post.I printed off a nine-page discussion, but then went back to check on the background of the article's editor and author. The chief editor, who helped found this website fifteen years ago, is a rheumatologist with what appear to be impeccable credentials. The author is a pathologist, not an allergist, but also seems to have a very solid background.

She mentions that roughly 6-8% of kids have food allergies and 3% of adults. Her discussion is detailed, but crucial in it is the fact that true food allergies involve the immune system and may be life-threatening. Many who develop food allergies have relatives who are allergic to pollens or other non-food items (feathers or medicines, for instance). If both your parents have those kinds of allergic problems, you're more likely to develop food allergies than someone from an allergy-free family.

True food allergic reactions happen soon after ingestion of the nuts or shellfish or whatever causes the problem in a particular person. They may cause mild symptoms (such as oral itching), skin reactions such as hives, gastrointestinal reactions (pain, nausea, vomiting, diarrhea) or led to an asthmatic attack).

I'll copy in the Mayo Clinic website's take on the most severe reaction, anaphylaxis.

"Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you're allergic to, such as the venom from a bee sting or a peanut.

The flood of chemicals released by your immune system during anaphylaxis can cause you to go into shock; your blood pressure drops suddenly and your airways narrow, blocking normal breathing. Signs and symptoms of anaphylaxis include a rapid, weak pulse, a skin rash, and nausea and vomiting. Common triggers of anaphylaxis include certain foods, some medications, insect venom and latex.

Anaphylaxis requires an immediate trip to the emergency department and an injection of epinephrine. If anaphylaxis isn't treated right away, it can lead to unconsciousness or even death."

Here's another Epi-pen; it can keep you alive

I mentioned an Epi-pen in my previous post on this subject. We keep one in the house since I give my wife her allergy shots; If you've had food reactions that appear to be true food allergy your doctor may want you to have one available.

Adults and kids are more likely to react to those foods commonly served in their particular culture, e.g., rice in Japan, fish in Scandinavia.

And to add to the mix, there are several types of cross-reactivity, e.g., allergic reactions from a food similar to one a person has had a severe reaction to or allergies to fruits (especially melons and apples) during the "hay-fever season"  The latter is caused by uncooked foods and may occur in half of those affected by pollens. Typically they are mild, but a tenth of those affected may have more severe problems and 1 or 2% can even have anaphylaxis.

Similarly, some people, usually teens or young adults, can eat a particular food, then exercise and then develop an allergic reaction. Eating two or more hours before exercising seems to prevent this form of food allergy.

There's lots more information, but suffice it to say food allergy should be taken seriously.

A sneeze, a wheeze or worse: part one

Friday, July 15th, 2011

a common food allergen

I've been reading about food allergies recently beginning with a Wall Street Journal article entitled "An 'Allergy Girl' Comes Out of Her Bubble." Sandra Beasley, author of that short piece, is in her early thirties, has major food allergies and has written a memoir, Don't Kill the Birthday Girl: Tales fom an Allergic Life.

I found two medical websites dealing with the issue, one from the Mayo Clinic. and the other on We have to sort out food allergy from food intolerance, which is considerably more prevalent. I have mild food intolerance to milk and dairy products, presumably from a low level of the enzyme, lactase, which helps break down the lactose in those foods, but can drink a small glass of milk without any problems resulting. I have a relative who has fairly severe lactose intolerance and strictly avoids milk; if he drinks even a small glass, he's going to, at the very least, have lots of gas.

We have a local friend who is allergic to a protein in milk; she'll have bloody diarrhea if she drinks any quantity of it. She can drink coconut milk and, when she joins us at our favorite Thai restaurant, will order Thai ice tea with that substitution.

Mayo's website says the FDA requires food producers to provide a list of the big eight, the most common ingredients that cause around 80% of food allergies. The list includes milk, eggs, peanuts, so-called "tree nuts," including almonds, walnuts and cashews, fish including bass, cod and flounder, shellfish (e.g., crab, shrimp and lobster), soy and wheat.

Fresh meat, fresh produce and some oils don't require labeling, but packaged foods do. That holds true even when the allegen is in a flavoring, coloring or other ingredient. The manufacturers are required to list even small amounts of the allergens if and only if, they're actually contained in an ingredient.

But there's another issue or two or three. Some food allergens can be introduced via cross contamination, so many food producers will add statements like, "Manufactured in a factory that also processes peanuts." This is voluntary on the part of the food company and the FDA is working to make the format of these warning labels more consistent.

But the article from "allergy girl" describes an episode where she asked for a dairy-free menu in a restaurant, then ordered a drink. The cocktail came with a milky liquid bottom layer. Upon inquiry she found the garnish contained pine nuts.

The waiter said, "You didn't ask for the nut-free menu."

If you have severe food allergies and eat these, you may need the Epi-pen

In her case, as in the situation for many adults with major food allergies, multiple foods can cause life-threatening reactions.

We ask friends who are coming to our house for a meal what food intolerances and food allergies they have and plan accordingly. But two years ago, one man was about to reach for a dish that had a pine nut topping when his wife grabbed his hand.

"Did you forget to mention the last time you ate pine nuts, we had to visit the emergency room? she asked.

I was happy I had an Epi-pen in the nearby bathroom.



A gastronomic slant on invasive species

Tuesday, July 12th, 2011

So that's a lionfish

I normally think of invasive species as plants that are non-indigenous, kudzu comes to mind. Actually, in our Colorado garden areas, a plant called bindweed invades and takes over unless we are diligent about weeding. When I Googled it, I found it did indeed meet the definition more commonly used, a plant or animal imported from another country or continent (in bindweed's case Eurasia), sometimes for seemingly logical reasons (e.g., as an ornamental or to control another species regarded as a pest).

But let's switch gears. There was an article in The New York Times on July 10, 2011 that caught my attention. Its title was "Answer for Invasive Species: Put It on a Plate and Eat It," and it began with a photo of a flamboyant fish, the lionfish. That led me to the website for Food and Water Watch, a non-profit, independent organization with an impressive and eclectic Board of Directors and a mission to ensure the food, water and fish we consume are safe, accessible and sustainably produced.

Their 2011 Smart Seafood Guide now has "Recommended Invasive Species" Many of these, once introduced into a new habitat, have no natural predators, so the suggestion is that we fill that niche. For instance we could eat the lionfish, which, according to the NYT article, is devastating reef fish, both in the Caribbean and coastally, off Florida. But caught by spearfishing and braised in brown butter sauce, lionfish tastes wonderful.

The Nature Conservancy sponsored a lionfish food fair a year ago, paying local fisherfolk $11 a pound for the pesty fish. The fritters made from this invasive species went over well with the crowd. There was concern with lionfish, as with many other species, about the possibility of toxins from microbes, so selective fishing from "clean" areas was necessary.

The Smart Seafood Guide I downloaded from Food and Water Watch lists eight other species as potential menu items. Asian carp, which are not bottom feeders, are caught with nets of several kinds or even on hook and line. They've spread from the Southeast through floods and are moving toward the great Lakes. They eat plankton in amounts out of proportion to their size and thus compete with native fishes. They're a bony fish and a NYC chef, the James Beard Foundation and Food and Water Watch have combined in an effort to develop recipes for these and others of the unwanted species.

The Beard Foundation's VP noted that we've gone from weeding out some plant species to regarding them as delicacies; perhaps we can do the same with our Asian crabs, Asian carp, lionfish, Asian swamp eels, Chinese mitten crabs, European green crabs, rusty crayfish, walking catfish (able to live out of water for short periods and move short distances on land), and two species of tilapia.

spearfishing is the way to catch lionfish

There are a number of other avenues being explored to control these critters and we'll also need to prevent their deliberate further spread once the profit motivation comes into play.

But to me, it sounds like it's time for a fish dinner

But now they're adding sugar?

Friday, July 8th, 2011

We've removed the HFCS

A few days ago I re-read Taubes's July 2002 article in The New York Times and the November 2002 "Nutrition Action Health Letter" article from CSPI that looked at his claims that refined carbohydrates are the problem and contradicted many of them. I have 40+ years of personal experience of reading articles critically. I fully understand that all one sees in print may not tell the entire story or may be slanted toward a particular view of the truth.

But I was still surprised to see a Wall Street Journal article ("Personal Journal, Wednesday July 7, 2011 pp. D1-2) titled "Sweet Revenge, Chefs Pour on the Sugar."

The story of high-fructose corn syrup dates back to the aftermath of WWII. Two major war-time industries needed to continue employing large numbers of workers, especially with all the GIs returning. So toxic chemicals became pesticides and gunpowder morphed into fertilizer. Corn was felt to be the most efficient crop in converting sunlight to food energy, so it became the most favored crop. Soon there was the question of new uses for all that corn.

High-fructose corn syrup (HFCS) was first introduced by Richard O. Marshall and Earl R. Kooi in 1957.  The industrial production process was developed by Dr. Y. Takasaki in Japan from 1965 to 1970 and Takasaki is known to many as the creator of HFCS. HFCS was rapidly introduced to many processed foods and soft drinks in the U.S. from about 1975 to 1985.

High-fructose corn syrup is produced by milling corn to produce corn starch, then processing that starch to yield corn syrup, which is almost entirely glucose, and then adding enzymes that change some of the glucose into fructose.

The problem of course, is the rapid absorption of both HFCS and table sugar leading to a surge of insulin levels, resultant lowering of elevated blood sugar levels and, perhaps to hunger and subsequent over-eating. Taubes may have that part correct.

Now however, many high-level chefs are turning away from HFCS and substituting sugar. That's also been true for food-producing companies; you can now purchase Wheat Thins or Pepsi sweetened with sugar instead of HFCS.

But these are better for you

But my copy of Harvard's School of Public Health "Nutrition Source Update," led me to their new Healthy Eating Pyramid (link below) which puts sugary drinks and sweets at the small end with a comment to use them sparingly.

The chef's in the "Sweet Revenge" article have it wrong; they think HFCS is worse for you than sugar (many scientists think both have negative effects on health) and are surprised to find it in so many commercial foods, e.g., oyster crackers.

The American Medical Association and the American Dietetic Association both urge all of us to restrict our intake of all caloric sweeteners. The research director of the University of Cincinnati's Diabetes and Obesity Center says HFCS and table sugar are biochemically identical.

So I believe it's time to cut down on HFCS, table sugar, honey, brown sugar, golden syrup (made from cane sugar) and even agave nectar.

Your dentist will be happy and in the long run I think you'll have better overall health.

Spellcheck failed again

Wednesday, July 6th, 2011

You just got a post "Will this work and is it safe?" that I thought I had read carefully and spellchecked. But, once again, there's another step, does-this-make-sense checking.

My wife got her copy on email and said, "I think you meant 1995, not 1195" for the Barker hypothesis."


Will this work and is it safe?

Tuesday, July 5th, 2011

The ultrasound said 9 pounds

I'm still digesting Taubes's work with mixed feelings, but his concept that insulin is central in the obesity epidemic took on a new meaning today. I was reading the "Health & Wellness" section of The Wall Street Journal and came across an article titled "Programming a Fetus for a Healthier Life." I was intrigued and read further, finding the U.K. government is backing a research effort in the realm of "fetal programming," changing the uterine environment during pregnancy in an attempt to better a child's health for the better in later years.

This is new turf for me and normally not an area I would have written about; in this case, however, the experiment, thus far only in its early stages, hopes to prevent obesity.

The underlying concept is the work of Dr. David J. P. Barker, who published a theory in 1997 termed the "thrifty phenotype," saying that in poor nutritional conditions, a pregnant woman can modify the development of her unborn child such that it will be prepared to survive in a resource-limited environment. The extension of this says reduced fetal growth is associated with a number of later-life chronic conditions.

Barker is now both Professor of Epidemiology at an English university and Professor in the Department of Cardiovascular Medicine at the Oregon Health and Science University. In 1995 his theory was renamed as the Barker hypothesis by the British Medical Journal. Now it's being applied in a very different setting.

a model of human insulin

The study is attempting to enroll obese pregnant women, 400 of them, in a trial of an oral agent called Metformin, normally utilized to treat type-2 diabetes, to lower their blood sugars, which tend to run higher than normal. The thought is that glucose is passed on to babies in utero and they then end up larger than normal birth weights and elevated insulin levels, setting the stage for lifelong obesity.

Dr. Jane Norman, a maternal-fetal health specialist at the University of Edinburgh is a lead investigator. A prominent US specialist, on the board of the 2,000-member Maternal-Fetal Medicine Society and not involved in the study, says he'd have no qualms about his patients joining the Metformin-taking moms-to-be.

I searched the literature and found the following

"Does metformin cause birth defects? Is it safe to take it during the first trimester?

Most studies suggest that metformin is not associated with an increased risk of birth defects. Some early trials suggested that the use of metformin during the first trimester was associated with an increased risk of birth defects. However, it is not clear whether these were caused by metformin or poor control of the mothers’ diabetes. More recent trials studying the safety of metformin during pregnancy, mostly when used to treat insulin resistance in women with PCOS (polycystic ovary syndrome), did not show an increased rate of birth defects or complications at birth."

So the concept appears to be a reasonable test of whether the uterine environment can be safely altered with a drug to prevent obesity.


Reading Taubes: part one

Saturday, July 2nd, 2011

Avoid white bread

A while back one of my blog readers asked if I had ever read Taubes. I wasn't sure if that was a book title, a diet plan or an author, so I Googled the word and eventually purchased two books written by a veteran science writer, Gary Taubes.

Taubes studied applied physics at Harvard and areospace engineering at Stanford, then wrote articles for Discover and Science plus four books. He looks for scientific controversises and wades into them. In July 2002 he published an article in the New York Times Magazine titled "What if it's All Been a Big Fat Lie,"

The article takes us back to the Adkins diet craze. Dr. Atkins, trained in cardiology, was significantly overweight and used a JAMA study as a basis for his own personal diet plan. He then published two books urging dieters to severely limit carbohydrate consumption. At one point it was estimated that one out of eleven North American adults were on his diet. His company made over $100 million, but filed for Chapter 11 bankruptcy in 2005, two years after he died.

Taubes explores some of the same turf, saying it's refined carbohydrates that make us fat. His initial plunge into the field was the NYT piece, followed by a 2007 book, Good Calories, Bad Calories and now a 2011 book, Why We get Fat: and What to do About It.

Taubes has hefty credentials as a science writer; he is the only print journalist to have received the Science in Society Journalism Award three times. Currently he's a Robert Woods Johnson Foundation investigator in Health Policy Research at UC Berkeley's School of Public Health. But his initial article ignited a firestorm. In the piece Taubes mentions that the common veiwpoint links the kickoff of the obesity epidemic  (in the early 1980s), to cheap fatty foods, large portion servings (at commercial establishments presumably), an increase in food advertisements and a sedentary lifestyle.

He would beg to differ, invoking what he terms "Endocrinology 101," an explanation that says human evolution was not designed for a high-sugar, high-starch diet. Until a comparatively recent era (roughly 10,000 years ago) we were not agriculturists, but hunter-gatherers. So Taubes thinks the problem is our increased consumption of sugar, high fructose corn syrup, white bread, pasta &  white rice.

Others think he picks and chooses his facts. I don't think he's wrong in his basic premise, but he also disagrees with the ideas of "calories in; calories out," avoiding saturated fats and exercising being important in weight control (He seems to think people who exercise then hurry off to eat more).

more than one way to "thin a cat"

I'm down thirty pounds since early in 2009, have easily kept the weight off by exercising six days a week, avoiding sugar & HFCS foods and eating lots  more veggies and fruits while cutting back on portion size of meat dishes.

I'll read more on Taubes and his detractors and let you know what I agree with and what I don't.