We’ve stopped taking supplemental Calcium

August 3rd, 2010

For some years now, as we’ve gotten older and my wife’s bone density studies moved into the borderline arena (osteopenia but not frank osteoporosis), we’ve been taking calcium tablets. We settled on a mix of calcium citrate (supposedly better absorbed than calcium carbonate) and Vitamin D. I took two of the caplets in the morning and two in the evening, giving me 1,260 mg of calcium and 1000 IU of Vitamin D. She took two in the morning and three in the evening.

This week we stopped taking that supplement and I bought some dried figs instead.

What’s going on here? Well, the British Medical Journal (29 July 2010) published a very well-done meta-analysis (a review of a number of medical research studies) of 12,000 patients over the age of forty who were given calcium supplements in randomized, placebo-controlled research studies. The study’s goal was to look at the risk of heart attacks in patients given at least 500 mg of calcium per day. The article concluded there was an increased incidence of heart attacks, about 30% more than in the control subjects and therefore the management of osteoporosis through by the use of non-food calcium should be re-evaluated.

There are a number of caveats here. The supplements used didn’t contain Vitamin D, which in the accompanying editorial, is said to possibly reduce fall risk and even help cardiovascular function. And the mechanism for the increase in heart attacks in unclear, so the finding may even prove to be “incidental.”

Today I read my copy of the ACP Internist, a publication from the American College of Physicians (I’m a Fellow of the ACP, an association of academically inclined Internal Medicine doctors). They reviewed the BMJ article, noted that its results didn’t extend to supplements that include Vitamin D. They also mentioned that the editorial noted that positive effects of taking calcium supplements, a supposed health benefit for those having osteoporosis or at risk for developing it, aren’t proven anyway, so why take the risk.

I crossed of my Ca++s from the mini-calendar I keep to record meds taken and events upcoming. We’ll wait for this controversy to resolve, if it does. In the meantime I noted that figs were the top non-dairy source of calcium in a list compiled by a physician posting on a CBS News website (the others were sardines with bones, soybeans, salmon with bones and sesame seeds). Four figs contain 506 mg of calcium (but about 130 calories).

The figs were relatively expensive, but hospital stays for heart attacks are certainly more so, in a number of ways. I may get some sardines when I go buy a lemon and thyme to make pea pod soup later today. I normally drink soy milk, but had an eight ounce glass of non-fat regular milk this morning. Some studies I’ve been reviewing would have us not consuming any dairy either, but for now I’ll continue having small amounts of non-fat milk, along with our usual generous helpings of fruits and vegetables..

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High Fructose Corn Syrup: June 2004 Am. J. Clinical Nutrition article, 2008 editorial

July 31st, 2010

I was reading an article in “the Wall Street Journal,” (WSJ) in their Health and Wellness section for July 13th, 2010. The article discussed findings from two major medical conferences on obesity. The title of the piece was “Eating to Live or Living to Eat” with a subtitle “Why Some People Can Resist Dessert While Others Can’t.”

There was a lot of good material in the article, but as usual, I wanted to read the source material for myself. I’ve learned over the years that articles, books and presentations can often be written to fit the biases of the writer. So I’ll almost always try to track down the original publications. One of the comments in the WSJ had to do with leptin, a hormone that normally helps you know when you’re full.

That thread took me to an 2004 article published in the “American Journal of Clinical Nutrition.” I view this as a seminal research study, one we’re just catching up to. The authors, researchers at Loiusina State University and the University of North Carolina gave data showing the consumption of High Fructose Corn Syrup increased, in the U.S. population, ten-fold in a twenty-year period, forming 40% of caloric sweeteners added to foods and beverages.

Why is that important. Well, let’s once more go back to the decision of our government to support the pesticide and fertilizer industries after WW II (I’ve mentioned this in prior posts) and therefore to support corn and soybean growers. That eventually led to the push for more HFCS use.

Why is that bad? The 2004 study shows the parallel increase in obesity, with a lag time of course, and discusses the problem of fructose, which is metabolized differently than ordinary sugar and therefore doesn’t, via several mechanisms, including that of leptin, give you the “I’ve eaten enough signal.”

More than that, HFCS is added to lots of foods, but especially to soft drinks. Some of the “food items” it’s added to, and sodas are among those, are just “empty calories,” with no real nutrient value.

The leader author of the 2004 study, Professor George A. Bray, published or co-published nine books on the subject in the last twenty years and a 2008 editiorial, in the same journal, on, “How bad is fructose?”. He’s also been attacked, in an online publication I just read, as someone who is paid by the pharmaceutical industry to help promote anti-obesity medications. My bet is the writer of this piece works for an non-academic concern and likely for the food industry. Dr. Bray’s 2008 editorial on fructose in the same journal had the statement, “The author has no personal or financial conflict of interest.”

My own take is the conclusions in his 2004 study, that HFCS is overused by our foods industries, that we should get soda machines out of our schools and reduce the portion size of sodas offered in other venues, made sense. As a nation, we’re just now following some of those recommendations.

These days my wife and I read labels when we do buy processed foods and avoids foods that have HFCS. We’re doing much less of this anyways, since we get farmers’ market and CSA produce regularly and have our milk and eggs delivered from a local organic dairy.

What are your thoughts on this issue?

Posted in Healthy eating, Obesity, medically-oriented background info | 2 Comments »

More on “What to Eat”

July 23rd, 2010

I finished Dr. Marion Nestle’s book, “What to Eat” some time ago, but got distracted by several other books and articles in various publications I read. Now I’d like to return to her superb volume and make a blanket statement to begin with. I’ve been concentrating on books, articles and online sources, in the wide field of food, nutrition and dieting for well over a year now and have found and read a number of excellent publications . If you were limited to reading only one book in the area, I’d strongly suggest this one.

That being said, I’d like to devote a few posts to the book and my reactions to it.

Nestle expanded my concept of who benefits from our having an overabundance of food available, and eating much more of it then we should (remember two thirds of Americans are overweight. and half of that group, one third of our total population is obese). So of course the food industry, in all its manifestations, food production, sit-down restaurants and the plethora of fast-food outlets, benefits directly from our overeating.

What I hadn’t thought of as collateral beneficiaries were the whole diet industry, our expanding number of health clubs, our pharmaceutical firms and even my colleagues in medicine.

Then there’s the stock market angle. A number of those entities I’ve listed (a list I’ve obtained from reading Nestle’s book) are actually publicly owned and have shares traded on the stock market. As such, my take is they need to demonstrate constant growth, or at least a pattern of growth, to maintain share value.

Nestle also emphasizes changes, over the last thirty years or so, in our eating patterns. We are encouraged to snack from an early age and most of those snacks, unlike my occasional piece of fruit, are empty calories. More calories ingested equals more weight, unless you’re also burning more calories.

I’m now six and a half weeks out from back surgery and won’t be able to return to our own health club for another ten days. So for now I’m walking, and going a little further each day. Today I walked for seventy-five minutes. I wasn’t moving very rapidly and I didn’t calculate how many calories I burned. I didn’t care really; it was a beautiful morning (I started at 7:45 AM) and I enjoyed the walk. I chose a different route than I’ve taken in past days and saw some different scenery.

A major part of losing weight is to think about what you’re doing when you shop, when you eat and when you chose how to spend your time. I may watch a TV show from time to time, but I’d rather spend the same amount of time exercising.

How about you? What choices do you make in these areas?

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The China Study; time to change my diet?

July 21st, 2010

We were on a trip recently and stopped for three days to visit some relatives we seldom get to see. He’s a physician, past department chair at a highly regarded clinic/academic center and is working on a major research project in four countries, one of which is China. They’ve altered their dietary pattern in a very significant manner since we last saw them, four years ago. I asked for the background data on their new diet and purchased two books, the first of which is “The China Study,” by T. Colin Campbell, PhD and his youngest son, Thomas M. Campbell II.

Dr. Campbell, an emeritus named-chair professor at Cornell, has been a long-term major figure in the area of nutrition and was involved in a large-scale research project involving scientists from China, the US and England. They did blood-work and gave out questionnaires to 6,500 adults in rural and semi-rural areas of China as well as performing urine tests, three-day dietary measurements and analysis of food samples.

The resultant book emphasizes health differences between people in China on a mostly to exclusively vegetarian diet and those of us who eat what has been termed the Western Diet, one rich in meat and dairy products, relatively low in vegetables and fruit. Dr. Campbell strongly advocates our switching to an exclusively plant-based diet and details how the “Diseases of Affluence,” especially heart attacks, diabetes Type 2, some cancers, and obesity are related to nutrition.

I also looked at Dr. Campbell’s impressive bio and, as well, read some of the critiques of his conclusions. I think the book is well worth reading and enjoyed Dr. Campbell’s article in “The Huffington Post,” published today (7-21-2010). In it he calls for an NIH Institute of Nutrition. I would agree that our Western Diet, rich in fats, sugar and salt, is a major cause of overweight and many assocated diseases. I would disagree that some of the specific conclusions in “The China Study” have been conclusively proven. I’d love to see a new NIH branch which could fund studies to prove or disprove those conclusions.

I’d recommend you read the book and judge for yourself.

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Harvard Medical School Weighs In

July 16th, 2010

I recently received an email from Harvard Medical School (HMS) about their series of medically-related Special Health Reports. I purchased one on Women’s Health Fifty and Forward for my wife and then saw another in their list titled “Lose Weight and Keep it Off.” That one arrived just after we got home from a two-week vacation. On the morning we departed I weighed 149 pounds, the bottom edge of my goal weight of 149-150. I knew before we left that I wouldn’t be sticking to my usual diet, but hadn’t realized that I’d gain six and a half pounds on the trip.

I went back to the strict version of my diet as soon as we got home and three and a half of those extra pounds are gone already. This morning I weighed 152.2, within my acceptable range. Having started my dieting in May of 2009 at 177, I’m not too upset, but I wanted to look at the HMS take on dieting and especially on maintaining your weight goal once you’ve achieved it. I’d like to do better on vacations.

I had lots of excuses for my temporary weight gain: I was recovering from b ack surgery and couldn’t exercise like I usually do six or seven days a week;we had visited relatives on the first leg of our trip and they fed us very well; the week-long Chautauqua stay was at a lovely hotel with abundant meals included and the final three days were spent visiting friends, one of whom is on the New York Times staff as a deputy food editor and took us to his favorite restaurants. I wasn’t happy with my excuses.

The last chapter of the HMS report cites the statistic that 95% of people who lose weight will regain it in a few years. Well I’m interested in being in the 5% who can keep their weight off, so I read that chapter with great interest. It turns out there’s a project, the National Weight Control Registry, that has been following over 5,000 long-term dieting successes. Of course, those people, in general, stick to diets that are healthy and don’t have excess calories. They also exercise regularly.

That made sense, but it turns out that they differ considerably in their diets and what they do for exercise. What they do share is the ability to pick out an approach to eating and exercise that fits their own long-term goals. Then they adhere to that plan, get an hour of exercise a day, eat lots of fiber and less fat, weigh themselves at least weekly and don’t watch much TV.

Okay, I do all of that and, having read the HMS publication, I realize watch TV is a double-edged sword. By that I mean you’re stationary and you’re exposed to lots of food commercials.

That’s great stuff, but didn’t tell me what to do on vacations. I think what I have to incorporate into my travel plans, maybe on my computerized pack lists, is a statement. “You’re going on a trip, Peter. You’re also going on your own diet plan, especially the part about portion control.”

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The Dirty Dozen and the Clean Fifteen redux

July 13th, 2010

I had seen an article on foods that are more often contaminated with pesticides and other chemicals and wrote a blog post on it (“Protect your kids, buy organic”) on May 21st. Now I’ve got a follow-up to that post. To begin with, as I briefly alluded to in the May post, there’s an Environmental Working Group (EWG) that makes recommendations to the public on a number of health-related issues. It’s a 501(c)3 non-profit that was originally formed in 1993 and includes people from a variety of disciplines (e.g., scientists, engineers, lawyers). It also, since 2002, advocates Congress on health-protection and subsidy-shifting policies and publishes a variety of reports through its website www.ewg.org. I just signed up for several of its newsletters and read a study that may lead to my changing which cellphone I use.

“Prevention” magazine, in its August 2010 edition just published an article reviewing the recent version of the Dirty Dozen and the Clean Fifteen. I usually don’t read this publication, but my spouse has a subscription and said I’d be interested in this particular article. When I originally found those lists in May, I clipped them from a newspaper, researched the background of the EWG, then made multiple copies of the lists and we started buying more organic foods than we had previously. Subsequently our 26-week Grant Family Farms (local CSA) Veggie Couples Share began and, as of yesterday, our 22-week Fruit Share began. But we’re still buying some produce that doesn’t come from our CSA. So I read the article in my wife’s copy of “Prevention” with interest.

The writer went through the lists fruit and vegetable by fruit and vegetable and gave a cogent rationale for why each was on each list. For instance, take celery, which ranked number one on the Dirty Dozen list. When I first read that I wasn’t at all sure why celery would be in the “These you really should buy in the Organic foods section.” But the comment in the article made sense. Three quarters of our celery crop is grown in the fall and winter when weather conditions make contamination by bacteria and fungi more likely to occur. That added to the fact that we consume all of the celery stalk (I do cut of those leafy bits and the large end of the stalk), leads to repetitive spraying of the crop with pesticides. So buying organic celery now does make logical sense to me.

Try the EWG website and see if their work interests you as much as it does me.

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Marion Nestle’s book, “What to Eat”

July 9th, 2010

On one of my previous posts I mentioned Marion Nestle as a professor of nutrition who had commented on the 2010 Dietary Guidelines. I read two of her columns in the Atlantic Monthly and a blog post she had written and was struck by her intimate and detailed knowledge of the process by which the Dietary Guidelines, initially put together by an committee of experts, get subtly altered before they reach their final form.

Subsequently I purchased two of her books and have been reading my way through her absolutely superb book, “What to Eat.” I’ve been stunned by her depth of knowledge and have learned many new facts. Today I looked at her bio and realized she’s been directly involved with the Dietary Guidelines in the past, has both a Masters’ degree in public health nutrition and a Ph.D in molecular biology.

The book itself is stellar and won the James beard Foundation award for best food reference in 2007. Dr. Nestle examines the trillion dollar/year US food industry and walks you through the sections of a supermarket commenting as she goes. I’ll mention a few of the more striking areas today, but will try to pick out more over the next few posts I do. I think you should read this book yourself.

When you enter an average supermarket in this country, you’re confrounded with an enormous array of choices. She estimates you have 30,000 plus to pick from. So how do you get to the items on your shopping list? Well first you have to pass artfully, probably a better term is cunningly, arranged shelves and more shelves with food items you didn’t plan to buy.

The placement of those food choices is far from random. If your goal, like mine, is to shop the periphery, mostly purchasing fresh fruits and vegetables and a few dairy items, you’ll still pass through a gauntlet of deliberately placed, often highly processed, foods, many of which have lengthy ingredient lists. And you’ll likely find the things you do wish to buy have less carefully been arranged.

Why is this? Well to start with the government subsidizes the production of a few items: corn, soybeans, sugar beets and sugarcane, but not that of other fruits and vegetables. And the major food companies (that includes a much smaller number of them than I had once thought), don’t make as much money from the items on my shopping list, but lots more from foods that have been augmented, processed and made to appear appetizing to adults and, in some cases to children.

So the next time you’re in a supermarket, go there with your own shopping list and try to stick to it. Look at ingredient lists if you do buy processed foods; check out the fat, sugars (sic) and salt contents of anything you buy. And start to look at what is placed where in the store. Decide what’s been put there to catch your attention and to tempt you to buy.

Happy shopping.

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The Brits weigh in on salt; my last post until the 8th

June 23rd, 2010

We’re heading out on a two+ week trip and, since I had back surgery 15 days ago, I can’t carry much. So I’m leaving my laptop at home, bringing my Kindle to get the news (it also has eight books I could read) and will only take one paperback book. That one is by Marion Nestle, a named-chair nutrition professor at NYU, and is her take on how the food industry tries and largely succeeds in influencing nutrition and health, usually not for our benefit. More on that subject later.

In the meantime I found an article on a branch of the United Kingdom’s health system, their National Institute for Health and Clinical Excellence (That leads to a great acronym: NICE), wants the U.K. government to help further restrict salt intake.

As I’ve noted before, most of the salt in the American diet, and apparently most in the U.K population’s diet, comes from salt added to “prepared foods.” So the NICE group wants the government to get the food industry, via new laws or taxes or restricting some TV ads, to stop pushing salt (and fat and sugar) at the consumers.

The average daily salt intake in the U.K is about 8.5 grams, which is the equivalent of 3.34 grams of sodium. The current recommendation there is 6 grams of sat or 2.36 grams of sodium. The goal espoused by NICE is to gradually lower the salt intake to 3 grams (1.18 grams of sodium) by 2025.

They think such diminution of sodium content of foods (and fat content also) could help prevent about 40,000 premature deaths from heart attacks, strokes and other cardiovascular disease. Of course the U.K. food industry, through a lobbying group, is protesting, saying NICE is out of touch with what’s been happening for years and that the steps recommended are totally unnecessary.

NICE has come up with some great new concepts, including restricting permits for fast food outlets in some areas (presumably near schools), barring some food ads during hours when kids may be watching TV and a “traffic light” system for color codes on foots that would reveal their level of salt, fat and sugar.

If I have to say so myself these are very NICE ideas.

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More on salt intake

June 19th, 2010

I’ve written several posts on sodium intake (table salt, of course, is sodium chloride, but I tend to think in terms of the sodium itself). I printed our most of the sodium, potassium and water section in the new Dietary Guidelines Advisory Committee’s (DGAC) 2010 draft which I had barely touched on in my last post. The entire DGAC report is huge; there was a nine-page Executive Summary and the section on salt and water is more than thirty pages in length. I also went to another section, one on high potassium foods.

The bottom line isn’t new at all, probably little changed from the 2005 Guidelines. But the data behind the recommendation is more and more solid. So here’s the short version and some background.

We get way too much sodium in our American diet and way too little potassium.

Most of the sodium comes from processed foods: yeast breads, chicken, pizza, pasta, cold cuts, condiments, cheese, grain-based desserts, soups and beef. The natural sodium contnet of foods gives us about 10% of our total intake and table and cooking salt another 5 to 10%. So roughly 75% comes from salt added in the manufacture of foods. It’s associated with high blood pressure (AKA hypertension), strongly felt to be a highly significant contributor to that disease. More than 90% of us will develop hypertension in our lifetime.

Eating a diet lower in sodium makes great sense, especially for anyone with pre-existing hypertension, middle-aged and older adults, Blacks (who have a higher risk of hypertension-related complications, e.g., stroke and kidney failure) and diabetics. We ingest more than twice the 1,500 milligrams per day the DGAC thinks we should.

For people who have normal kidney function and aren’t on meds that cause potassium to go up or be retained, more dietary potassium helps reduce blood pressure. Somewhat absurdly, most of us get our potassium from reduced fat milk, coffee, chicken and beef, OJ or grapefruit juice, fries and chips. We get roughly 3,000 milligrams (less for women) of the recommended 4,700 the DGAC thinks we should be eating/ingesting. There’s a list of high-potassium foods that starts with baked potatoes and their skins and includes lots of fresh (or canned) foods: beet green, carrot juice, nonfat plain yogurt, some fishes, and of course, bananas and other fruits.

I’m going to rad more of the DGAC report and will be eager to find out how many of the recommendations make it into the final 2010 Dietary Guidelines. It sure makes sense to me, but a lot of folk would have to gradually adapt to less sodium and some countries are going that route.

Then there’s the issues of affording a healthy diet and of food companies going along with with what the Advisory Committee recommends.

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The 2010 Dietary Guidelines

June 16th, 2010

I was reading the papers this morning (our local newspaper + “The Wall Street Journal” + the New York Times breaking news) and saw an interesting article in the local paper titled “Four Steps to Fighting Obesity.” It even had a box titled “Putting limits on sodium.” Well that certainly got my attention and led me to a great website: www.dietaryguidelines.gov.

It seems a 13-member advisory committee (called the DGAC) of health and nutrition experts was set up by the two relevant government agencies, the Department of Agriculture (USDA) and Health and Human Services (HHS). They’ve been working a couple of years and their charge was to update, if necessary (and I’m sure it is) the 2005 Dietary Guidelines.

The website led me to a very large document and thus far I’ve read the nine-page Executive Summary and printed off another thirty-two pages on “Sodium, Potassium and Water.” I’ll read that section later, but the overview made me decide to pause in my posts on Omega-3s and point you toward the 2010 guidelines. At this stage the public has thirty days to comment on them before it’s made final. I doubted it will change much, but a professor of nutrition posted on “The Atlantic” website some comments that made me wonder.

First this set of dietary guidelines has to be reviewed every five years, by Congressional fiat. Then the professor, Marion Nestle, has written a book titled “Food Politics: How the Food Industry Influences Nutrition and Health.” I just ordered a paperback copy of her revised edition and also a copy of her book, “What to Eat.” She doesn’t think the guidelines change much from version to version

I’ll await the final version of the 2010 DGAC Report, but in a nutshell they’re recommending we get our dietary sodium intake way down (70% of us need to go to 1,500 mg/day), eat less saturated fat. exercise more, avoid junk food, and follow Michael Pollan’s advice: “Eat food. Mostly plants. Not too much.”

I’m doing that already; we got our first “Couple Veggie Share” delivery Monday from our local CSA
and will soon be starting on our “fruit share.” What I want to see is the final ideas on how the vast majority of us can also eat healthy, affordable fresh fruits and vegetables. Now if the committee can solve that quandary and convince Americans to follow the Dietary Guidelines, we may get somewhere.

So here’s the problem (and perhaps the answer): We’ve got to do something and soon. The issue starts with kids and what they eat; if we don’t find a way to change that, we’re not doing our primary job as parents and grandparents and citizens.

The

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