Odds and Ends

Adverse Outcomes in Pregnancy - There is an increase in the  risk of having a stroke during pregnancy and within a few months of giving birth.  This information comes from a study that is not yet published, but is described in this link from Heartwire.  Risk factors for cardiovascular disease include diabetes and obesity.  Because we have more risk factors of heart disease in our children and young adults, it makes sense that these adverse outcomes would be on the rise for young mothers.  This is another example of how obesity and being overweight must be viewed as disease conditions and targeted for prevention.

Tylenol Changes - In July of 2009 when I wrote this post Acetaminophen, an FDA panel had recommended that the maximum dose of Tylenol be lowered.  Two years later, the drug maker has decided to change its label so that that maximum amount of extra strength Tylenol one should take in a day is 3000mg.  Other changes are expected in the future.  I won't go back over the why of this, but you can refresh your memory by visiting the past post.

AQI  - I have had more than a couple of days this month where I did not feel well - two of them occurring this week.  Part of it is due to  becoming dehydrated because I AM one of the people who exercises out side in the heat and would need to replenish my electrolytes.  But Thursday was especially bad and I had been taking care to hydrate.  Oddly, I was speaking with a friend that morning and pondering my malaise without ever thinking of the air quality.  The oddity refers to irony really, because I was speaking to the friend who inspired my posting about Air Quality Indexes some years ago.  Indeed, in this east coast heat wave, we are also having code orange days - which are not bad for everyone - but they are not ideal exercise days.  And just now, I found this AWESOME link that you can visit to see the forecast of Air Quality across the country and a day ahead of time.  It is quite a find - take a look

Salad Bars - I occasionally receive updates from Let's Move - the US Government's obesity prevention program but do not spend a lot of time with the newsletter.  This week however, I was intrigued by an announcement that there is funding available to help schools get salad bars into their lunchrooms.  The grant program is available to any K-12 school that participates in the National School Lunch Program.  If you are a parent (aunt, uncle, grandparent) and your "child's" school does not have a salad bar, I would tell them about this program.  Here is the website - and this time, I AM impressed.

SNPs - Guess what a SNP is?  It is pronounced SNIP and has to do with DNA and genetic codes?  OK - Single Nucleotide Polymorphism.  It means that a mistake is made when a cell is reproducing.  The body can sometimes catch and repair these mistakes and at other times, changes occur which could make one susceptible to a disease or condition or vice versa.  I read an article about SNPs and muscle strength and endurance this week.  There is some interesting research about predispositions - but GREAT  caution was made against using gene testing to determine athletic prowess or prescription.  I want you to hear that - if you read advertisements about a test that can determine if you or your child could be a sprinter, jumper or Olympic marathoner - do NOT buy into that hype.  I am looking forward to the next article in the series, because it promises to tell us how to change the things that we CAN change.  Brace yourself, I expect it will take some effort.   (article by Dr. Maria Urso in the ACSM Certified News Vol. 21[2])

GST - Once again my International Public Health hero, Boyd Swinburn has a quotable moment. He was actually in two stories this week. He is from Australia and has an important position with the World Health Organization.  He is also a professor at Deakin University.  The reference to GST is about a tax that is used in Australia.  A recent study showed that if the GST is not applied to fruits and vegetables sales of them go up significantly.  That is a great idea and one that we could use in the US.  Since everyone gets their panties all in a wad when we talk about increased taxes on junk food, let us just decrease taxes on healthy food!

Dr. Swinburn also gave a speech about obesity recently and likened the problem and the solution to measures taken in Australia with regard to tobacco (cigarettes).  In this speech is a quote to note - it is in direct alignment with what I plan to write my dissertation on: 

"Clearly we have not had a global (obesity)epidemic because people have suddenly lost willpower or mothers don't know how to parent any more.''

And thus - the rise in obesity has a great deal to do with the availability of very high calorie food that is mercilessly marketed to everyone and more readily available to the poor.

Motivation

Have to give my walking friend credit for two things - one is the opportunity to get in a 2 a day and the other - blog fodder.  

She switched our walk to the afternoon today, so I rode my bicycle this morning.  I really start the day best when I exercise before breakfast and we usually walk at 9am so when she had to reschedule I thought - oh good, there is that eighth day I was trying to find (to cycle).

This is the friend who has as her only exercise, our one hour walk on Saturdays.  You may recall the post regarding her agreeing to get up 15 minutes earlier (she wanted to do 30) and using her tread climber in the morning before she went to work.

Monday was the first and ONLY day that she attempted this.  Of course, she did not listen, she got up 30 minutes earlier and was so exhausted she could not function - or something to that effect so said her email (:)

She also started working some over time hours and that - which is sedentary brain numbing work, leaves her exhausted at the end of the day.  Ironically, it is medical coding work and often has to do with billing for treatment of cancer - lung and breast cancer cases filled her day today...

But we talked as we walked this evening and regrouped.  She is ready to go again on Monday.  She says she will get up only 15 minutes earlier and she will have a spot of caffeine, half cup coffee or the equivalent and get on her tread climber.  As I told her, if she only ends up exercising for 5 minutes, it is 5 more minutes that she has been doing.


My friend is important and she is a good example of all that I discuss for health promotion and policy.  [She  knows that I am talking about her.]  She has had gastric bypass surgery - and as I told her today, she risked her life doing that and is not taking care of herself.  She is much like the population in general - it is easier (should they choose to do it) to eat 100 calories less than to burn 100 calories more.  However - that is a weight loss issue.  For optimal health and prevention of disease, daily exercise is vital - it is the ONLY answer.


She knows all of these things - she does not have the intrinsic motivation to do it - but we are working on that.

Calorie Labeling - Does it Work?

Dumanovsky, T., Huang, C. Y., Nonas, C. A., Matte, T. D., Bassett, M. T., & Silver, L. D. (2011). Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys. BMJ, 343.


The study referenced above occurred over two time periods, one in 2007 before NYC adopted its labeling laws and the other in 2009 about a year after the law.  It takes a while for research to be analyzed, written up and accepted for publication.  I would love for them to do the whole thing again and of course, people will because the laws are being taken to scale - (nationalized).
The bottom line for this short study is that people who chose to USE the calorie information at the restaurants did have a significantly lower average of calories per meal than those who did not.  In other words, if you USE it - it works.  
The restaurants were all fast food chains and at the time of the 2009 part of the study 16% of the people who were surveyed used the calorie information. (there were over 8000 people at time two- 2009)

Hot Dogs and Oxymorons

It is hard to point out faults or contradictions when people are doing their best and have a noble cause.  But I write a blog and some things people say or do are blog worthy...

So the first - at a planning meeting for a gathering where mini health screenings will take place refreshments were being discussed.   Hot dogs will be served.  In addressing this, the person who will be conducting the health screens explained that all the buns could not be whole wheat.  In fact, she said, some of the buns were to be whole grain and others white.  The person put great effort into explaining this issue.  I sat quietly, as this was not my show, and thought to myself "It really doesn't matter what you put it in, it is a HOT DOG!"

I am conflicted about the second part of this post because I really wouldn't want someone to read it and know I was talking about them.  Suffice it to say, calling yourself one of the "healthy obese" is using an oxymoron.  The two conditions are mutually exclusive (they cannot occur at the same time).  I know I alot of people will argue this fact, but arthritis (or wear and tear of our joints and discs) is caused by only a few things and being overweight is one of them.  

TLC and all the Cs

I have been reading a little lighter fare today - an article in the ACSM Certified News.  The article is about cholesterol factors that are related to coronary heart disease and risk of a cardiovascular event - such as a stroke or heart attack.

Most of us are familiar with the Cs that are tested in annual blood work and the article gives a great overview and glossary of them.  This includes the values associated with the tests.  Sometimes we aim for a higher value and other times a lower one.  In either case, they are a risk factor for disease. 

The tests include:
TC = total cholesterol
HDL-C = high density lipoprotein cholesterol
LDL-C = low density lipoprotein cholesterol
TG = Triglycerides (another blood fat)
VLDL - C = very low density lipoprotein cholesterol

Each of the above tests has a target value and usually a person is trying to get below that number - i.e. below 200 for the TC.  But the HDL value is one where we want to be high.  If that value is above 60 it actually can protect a person from a heart event.  You can read more about specific target values here.

The article describes a newer test as well.  It is not at this time recommended as part of the adult cholesterol panel, but  is used with persons who have very high TG - diabetics often have high TG even when they can control their LDL.
The new value is called Non-HDL and is the difference between TC and HDL.  Literally - take the total cholesterol value and subtract away the high density lipoprotein value and that is your NON-HDL value - if you do not have heart disease and have less than 2 risk factors for heart disease (i.e. your other values are normal) than your Non HDL should be < 190. 

All of our cardiovascular risk factors can be addressed with TLC - that stands for therapeutic lifestyle changes.  TLCs that you may be familiar with include exercise, changes in what you eat (i.e. less red meat and more fish) and weight loss. Learn more about ways to improve your health and prevent heart disease at the American Heart Association website.
Here is the info on the article I referenced today:
Title: LIPIDS AND HEALTH; A GUIDE FOR THE FITNESS PROFESSIONAL
BY: WILLIAM SNYDER; CHANG CHAU; AND SARAH MAKOSH;
AND JAMES R. CHURILLA, PH.D., MPH, M.S., RCEP, CSCS
IN: ACSM’S CERTIFIED NEWS • APRIL—JUNE 2011 • VOLUME 21: ISSUE 2

The Brain

Neuroscientist   David Eagleman  was a guest on the Colbert Report the other night.  The link under his name should take you to the video.  He is a very interesting and handsome scientist, in my always ready opinion.

I am exhausted from a day of PowerPoint "creating" and data clean up and analysis - so the link is the best I can give ya!

Two A Days

Perhaps you were not familiar with the term two a days before the NFL strike of 2011, but one of the concessions that the owners made to the players was that they would not have to participate in any more two a days.
I am a huge fan of two a days, sometime I call them splits - but that is really a different sports term altogether.  The reason I used the term was to explain that I was splitting my workout into two parts, a morning and an evening session.

Somewhere in the growing "past blog" files, is one where I tried to impress upon everyone the rationale for working out twice in one day.  I said something like, "it feels so good why wouldn't you want to do it twice!"

However, I four mile run twice a day, or a run in the morning and a bicycle ride in the evening are far less taxing than two football workouts.  I think that the players were right to ask for the end of two a days.  Hearing about it however, made me miss the ones I used to do.

Odds and Ends

RACCs -  A few weeks ago, my Mom bought something that seemed to be the lowest in calories, but in fact was not.  Last week I bought something that I thought was a low calorie food that did not in fact qualify as one.  What is going on?  Serving sizes in both cases, and the Reference Amount Customarily Consumed in the latter.  
The incident with my M0m involves egg substitutes.  She went to the store on my behalf and instead of just buying the brand "Egg Beaters" she looked for the egg substitute with the least calories (she loves me so much!).  Now I had searched the brands long ago and already knew which was the lowest.  She returned home with egg whites which had less calories.  It took me some time to figure it out until I remembered what I am always complaining about...inconsistent serving sizes.  What she bought was labeled as 3 Tbsp and what I buy is 1/4 cup.  I later learned that the 3 Tbsp is about 46 grams and the 1/4 cup is 61 grams.  
The second example is similar but what confused me was that a 60 calorie dessert cup (mousse) had a label statement, "not considered a low calorie food."  I pondered on that for about a week.  I recall that the reports I have recently read indicated that a small RACC was considered low in calories if it had 40 per serving.  This indeed was a small RACC (an especially small one).  I realized it mostly when I opened the package.   It was VERY light and had no substance.  I went back and compared it to the PUDDING cups that have 60 calories and boy buddy - was there a difference.  The mousse, which I won't buy again, weighs 71 grams and the pudding weighs 106 grams.

Chocolate Chips - Ah, one of my You Tube subscribers asked me to make chocolate chip cookies.  I actually did.  You can see the recipe here.  Funny thing.  Sugar free chocolate chips have the same amount of calories as regular ones.  I bought the regular - but goodness, those things are LOADED.  A third of a cup has about 220 calories!

Fortification - I noticed a milk this week that had flax added to it.  Really?  Recall what the Dietary Guidelines and the IOM Front of Pack reports say - the nutrient that we need is best found in its natural source.  Milk does not naturally contain flax!

Qualifiers- Though I have said this before, I feel compelled to reiterate. With regard to foods that are labeled all natural, natural or organic... There are either no standards, vague standards, lax standards and or no evidence to show that consuming foods with those labels is beneficial to your health.  With regard to weight, there is absolutely no difference.  It makes far more sense to review the labels for the amount of the short fall nutrients or foods/nutrients to limit as indicated by the Dietary Guidelines.  Short fall meaning we need more - like fruits and vegetables and whole grains and well, limit is self explanatory but refers to saturated fat, sodium, calories and the like.




(LA - where ARE you?)

Exercise Goal follow up

Today is Saturday - the day of the week that I committed to an hour walk with my friend.  As we were walking, I told her about my weekly exercise routine and asked what she did on her other days.

As I feared, she said, "this is it."  Oh no!

She said that she had been thinking about getting up earlier and doing something before work.  Of course, I asked when she would start this and what she might do.

As we talked it out - I actually encouraged her to start smaller than she had said - 15 minutes instead of 30.  So she is going to start Monday by getting up 15 minutes sooner and doing 15 minutes on her tread climber before she goes to work.  YEAH!

PS, I also suggested that she start getting up earlier before she tried going to bed earlier.  That way, when she began the earlier to bed piece, she would actually be tired and ready to sleep.  (yes?)

Whole Grain Quiz

In the national health and diet survey that was last administered for the FDA - one of the questions asked of the respondent is if the foods mentioned by the interviewer are whole grain foods.  There are six items on the list. I am reviewing the survey results now and can tell you the % of the persons who got each item correctly (for 2005).  After you guess, I will tell you which are whole grains and the percent of the sample who correctly answered.

First I will let you guess.  Is the following food item a whole grain food?

Whole Wheat Bread

Corn Flakes

Popcorn

French Bread

Rye Bread
Oatmeal

The survey was conducted in 2004 and 2005 and results released in 2008

United States Department of Health & Human Services

Office of Disease Prevention and Health Promotion

Food and Drug Administration

Whole Wheat Bread (y/90%)

Corn Flakes (n/53%)

Popcorn (y/29%)That is right it IS - and I eat it daily :)

French Bread (n/78%)

Rye Bread* (n/28%)
Oatmeal (y/90%)


*I do not know why they included rye bread in the survey - it is totally a trick question.  Some rye breads ARE whole grains, but most are a blend.

Birth Control VS STD Control

Today the Institute of Medicine recommended that birth control (prescription types) be made available without a copay.
I can understand why many people support this.

I do not use prescription birth control - in my whole adult life, I may have used the pill for a week.  I do not like drugs - really.
That being said, I am in no way against birth control.  When I heard this on the news today,  I had a aha moment.

With the exception of condoms, women are fully responsible for the purchase of birth control and if they do not have the money - they must rely on the man to accept wearing a condom or use the rhythm method, to prevent pregnancy.

So this is good news BUT:

 There is a very important point that needs to be made - birth control does not protect against sexually transmitted diseases.  Condoms are not 100% effective for birth control  OR disease prevention, but they are certainly the way to engage in Safer Sex - 

Exercise Challenge

I do not talk about the physical activity guidelines very often, but there were released in 2008 and call for no less than 30 minutes of moderate to vigorous exercise five days a week.  More is better and it applies to all adults, even those with disability and those who are over age 65.  
The recommendations for children are higher, 60 minutes every day.
If persons are questioned about their physical activity and they report NO strength training - even if they exercise 5-7 days a week, they are categorized as NOT meeting the PA guidelines.  Cardiovascular exercise (elevating your heart rate) and  muscle conditioning are the two most important aspects of the recommendations.  After which comes balance and core work for preventing falls as we age.  (A reduction or stabilization in the number of falls in persons over age 65 is one of the goals of the National Prevention Strategy).


I am going to tell you what my plan for the next month is with regards to a regular exercise routine.  I will re-evaluate in September and adjust based on the availability of the pool (open swim times) and my teaching and course work schedule.  What is not included in this plan are the many short walks that I take, cycling to and from campus and the ten minute segments of yoga or pilates that I do in the evening (after dinner).  Those are just extra little things, and I do not count them towards my daily or weekly activity goals.


My plan is to run four days a week, swim on two days, lift weights on the swim days (or two other days if there is a conflict - but two days every week [as I already do]) and to walk (1hr with a friend who is less athletic than I) one day and to cycle for fitness one day.  Oh wait!  that is eight days, well - I will figure it out.
It might look like this:
Monday - lift weights and swim laps
Tuesday - run , four miles and adding up to six/eight
Wednesday - run
Thursday - lift weights and swim laps
Friday - run
Saturday - walk with friend and or cycle
Sunday - run


I do a full body weight training session - all muscle groups - low reps heavier weights (and don't give me any excuses about "oh, I don't want to bulk up", because bulking up is HARD people - and it takes hours and hours in the gym)- but I wait at least 48 hours between my workouts so that my muscles can recover and build.  The time after the workout is as important in strength training as the time during the workout.


So what is your plan for the next month??

The Hidden Message

I was telling my dinner companion about the Dietary Guidelines recommendation that we avoid solid fats and added sugars.  This was discussed in a past blog post here.  I was telling her because I asked the server about the fresh vegetables.  The medley was awesome, all nutrient dense non starchy produce.  I told him that it sounded great and I would like to have this side with my dinner. Steamed.  Then I clarified, "steamed, without oil, fat or butter".  He said, "Well, they are steamed and they are in the steaming tray for easy serving, but they are sitting in butter."  
REALLY!
People take home message:  You should ask your servers if the steamed veggies have fat added to them.

 I then tell my friend that the DGAs say we should increase the amount of fruits and vegetables in our diet but that we should eat them without adding certain things.  The DGA has a group of items that we should "limit", like salt, solid fats, starches etc.  
The things to limit are abbreviated as SoFAS  Oh my gosh - how did I miss that... sofas!  HA :) The hidden message or the twofer message, avoid fatty foods and sedentary behavior :)

Patient Choice?

My mother does not know how to post comments on the blog website because I have not shown her yet.  Today she told me something about a recent blog post that would have made a good comment - so I will share it with you myself.

My mother was referring to the post about my friend who had heart surgery and was then served a hospital breakfast which included bacon.  Mom is right.  Patients are often given a menu from which to select an entree and sides, beverage, dessert etc.  Her point being that my friend must of chosen the bacon himself.

She may be completely correct or partially correct.  I did work in a hospital for seven years and most patients do get a menu to select from but there are several menus.  For instance, there are special options for people with high blood pressure, with diabetes, and with heart disease.  My friend should have gotten the "heart prudent" menu and bacon should not have been on it.  According to the Dietary Guidelines, bacon should not be on any of the menus.  

Lastly, I think my friend might not have chosen that first meal because he was still waking up from the anesthesia. When I visited him a few days later, he had ordered a salad with turkey breast and some vegetables.  It had some kind of processed yellow cheese as well. It looked just dreadful.

Still, it was a very good call on my Mom's part - and sadly, most people do not know what the DGAs recommend as far as foods to limit and foods to increase (i.e. fruits and vegetables, whole grains, good fats). 

I may be in for a busy week - but do not think I have forgotten you in my absence.  I hope to talk about the most recent report from the Trust for America's Health - F as in Fat, soon.

Odds and Ends

Latisse is the eye cream that is supposed to thicken eye lashes without the use of mascara.  The commercial plays a lot during one of the shows that I watch on line and it always amazes me that someone might risk the side effects of discolored and I would guess unattractive eyes, in order to possibly have fuller lashes.  The website offers the warning below which begs another thought.  Is the language used in the warned something that the average consumer can understand?
Possible side effects.

The most common side effects after using LATISSE^® are an itching sensation in the eyes and/or eye redness, which were reported in approximately 4% of clinical trial patients. LATISSE^® solution may cause other less common side effects which typically occur close to where LATISSE^® is applied. These include skin darkening, eye irritation, dryness of the eyes and redness of the eyelids.

If you develop a new ocular condition (e.g., trauma or infection), experience a sudden decrease in visual acuity, have ocular surgery, or develop any ocular reactions, particularly conjunctivitis and eyelid reactions, you should immediately seek your physician’s advice concerning the continued use of LATISSE^® solution.

Texting  while driving is considered to be very dangerous and against the law in some states.  The other day I saw persons texting while driving while I was engaged in three different modes of transportation.  This happened within five hours.   The first occurred while I was riding my bike and waiting to cross the rode (a driver went by me looking into his phone and not the lane), second while I was driving to a meeting and third, while I was walking across the street at campus (that driver was turning left and pushing buttons on his phone).  The one that I saw while I was driving was a girl that was coming to a four way stop.  She looked up from her phone to check the intersection and then went forward and back to her phone tasks.

Aggression - I read the below referenced research article a few days ago and to be honest, the statistical analysis was  complex enough to leave me with only a partial understanding of the process by which the authors came to their conclusions.  It was very interesting however which is why it ended up on the O&E list.  Basically then, researchers looked at students in grades 3-5 interviewing (survey) them twice a year until they were in 7th grade.  Students were measured on group membership (and whether the persons in that had an average level of aggression or a higher or lower than average level of aggression. The scientists used that group to predict the students adaptation with these measures; self worth, victimization, social preference and aggression.  What was very cool was how the researchers looked at this outcome based on the students typical group membership, past group membership or current group membership.  The most interesting finding was the difference between boys and girls.  Girls who were associated with more aggressive groups, at any time, were less well adjusted (more victimization, less social preference) and boys who were associated with more aggressive groups at any time, had better adjustment - were more popular, less victimized, etc.

Rulison, K. L., Gest, S.D., Loken, E., & Welsh, J.A. (2010). Rejection, feeling bad, and being
hurt: Using multilevel modeling to clarify the link between peer group aggression and
adjustment Journal of Adolescence.

OPRAH is an mnemonic or a word whose letters come from other words that will help us to remember things.  You are probably more familiar with the one that we learned in school in the US in order to remember the names of the Great Lakes, HOMES.  But OPRAH is to help people remember the correct way to use a condom :)  It stands for Open, Pinch, Roll, Action, Hold.

For the Doctors

In 2008, the National Heart Disease and Stroke Prevention (NHDSP) program began to emphasize the ABCS to address these chronic diseases.  I read about the ABCS in the National Prevention Strategy document which I recently mentioned in the blog.  

Here is the general basis of the ABCS.  They are measures that health care professionals should address with all of their patients, including YOU.

A is for aspirin (reduces heart attack risk for many people)

B is for controlling blood pressure or hypertension

C is for keeping LDL cholesterol levels normal - prevention or medication

S is for smoking - quitting or never starting

Here is an interactive map that shows the number of cases of heart disease and stroke per state and by county within states.  It is a publication of the CDC.

Who DOES listen to the guidelines?

Some one that I care about is in the hospital recuperating from heart surgery.  In his own words, this is why he had the surgery:

"The surgery is to repair my mitral valve which is leaking severely and stressing my heart.  The surgery is long and requires being on a heart-lung machine. Mitral valve prolapse was one of the underlying conditions contributing to"    

... his brothers sudden death from arrhythmia (my dad's heart attack death was also related to an unstable arrhythmia).  My friend also told us that his arteries were clean and clear and this allowed for a laproscopic surgery which is less invasive though heart surgery is always invasive.  

The surgery is over and I have followed my friends progress on line and I visited him today. 

He let us know what his first meal was - a "lovely" tray of scrambled eggs, bacon, oatmeal, fruit, biscuit and bagel with juice and milk. 
We (you and I ) recently reviewed the Dietary Guidelines for Americans and I recall mentioning that there  was no harm in eggs for most persons, and this is true, but BACON!!  The man just had heart surgery!  Here is the paragraph from the DGA 2010 -

In addition to being a major contributor of solid fats, moderate evidence suggests an association between the increased intake of processed meats (e.g., franks, sausage, and bacon) and increased risk of colorectal cancer and cardiovascular disease.

I told my friend to get out of there as soon as possible because his arteries were NOT going to stay clear under those conditions.

The Great Monetary Effect of Calorie Reductions

I recently reviewed this research article and as it supports the things that I believe to be true - I like it!

The reference is:

Dall, T. M., Fulgoni, V. L., Zhang, Y., Reimers, K. J., Packard, P. T., & Astwood, J. D. (2009). Potential Health Benefits and Medical Cost Savings From Calorie, Sodium, and Saturated Fat Reductions in the American Diet. American Journal of Health Promotion, 23(6), 412-422

In this study, the scientists used modeling or simulation to estimate the impact of certain dietary changes on health and how those changes would impact spending on treatment for specific conditions.  The data on the population was gathered through existing sources, such as national survey and examination databases that track our behavior and health over decades (which is why we know things like how much more we weigh, how much less we do, how rates of hypertension and diabetes have risen, etc etc).

As I continue to read articles that refer to TEI and TEE (total energy intake and expenditure) the formulas  become more familiar to me.  Many of the researchers refer to "the" doubly labeled water technique.  This appears to be gold standard research which captures the absolute total energy burned and consumed by persons under laboratory controlled conditions.  The results only involve small groups of people, because the technique is costly and intricate but are the basis for most equations. The formulas begin with some baseline numbers that are tweaked with factors (mathematical) related to age, gender and activity level.  

This study included a formula for estimated energy requirement or EER.  I like this one.  It was used to compute one of the findings that I embrace.  I will now share both with you. 

With their formulas and modeling the researchers looked at the impact of reducing sodium intake in persons with uncontrolled hypertension (high blood pressure), lowering saturated fat intake for those with high LDL (bad cholesterol) and lowering caloric intake to address overweight and obesity.  These three things did save billions of dollar each year over a simulated four year period, HOWEVER, the strategy that saved the most money - 58 billion dollars a YEAR, was reducing calories just by 100 - per person.  The researchers isolated this to model a population at a certain physical activity level at 100 cals a day less than usual without changing anything else.  So, many people eat 2000 cals a day (or much more) and instead they were projected to eat 1900 - every day.  This strategy reduced the number of overweight and obese Americans by 71million (58 billion dollars saved).  The sodium and fat calculations only reduced medical expenditures by  2.3 and 2 billion dollars, respectively (per year).  Thus it was concluded that the focus should be on getting people to eat less calories.   When the research model calculated a 500 calorie decrease, perhaps 1500 calories a day - the model predicted that nearly all of US adults would be in the normal weight category in four years!  
That brings us back to Swinburn's article which suggested that Americans are consuming and extra 500 calories since the 1980s and that the extra is equal to a fast food burger (intake) or two hours of extra walking (expenditure)!   

Now here is the formula for estimated energy requirement - male and female - though you have to plug in some of your own values and you MUST do the math according to the rules of operations or whatever it is called when you have to do it in a very specific order to get the right answer (Melanie - you can ALWAYS comment on these posts on the website :)) 

EER=
[662-(9.53 x age)] + [PAL x (15.91 X weightkg)] + (539.6 x heightm )  
for males 


[354-(6.91 x age)] +[PAL x (9.36 X weightkg)]+ (726 x heightm ) for females


choose a PAL here

sedentary 1- 1.4
low active 1.4-1.6
active 1.6-1.9
very active 1.9 - 2.5
or
low 1.4 - 1.69
moderate 1.7-1.99
high 2-2.4

You can use this link to convert your weight and height to kg and meters. 

When I did it for myself it came to just over 1800 calories - I usually eat 1600-1800 depending on my activity levels - so I think it was pretty accurate. 

An Attempt to Limit the Calories of Cheap Foods

News out today reporting that 19 chain restaurants have joined with the Healthy Dining group and the National Restaurant Association to participate in an initiative titled, Kids LiveWell.
The restaurants agree to certain nutritional criteria for a percentage of their kids meals and side dishes.  They are then able to get promoted on the Healthy Dining group's website.  
I am not that thrilled with the criteria.  It is in some ways connected to the latest nutritional guidelines (DGA 2010), but does not  go as far as the proposed rule for the National School Lunch Program.  For instance the meal can have up to 600 calories and that seems high since the children who would be young enough for the kids menu need (roughly speaking) no more and usually much less than 1800 calories a day.  (recall most kids menus are up to age 10 or 12).  I see that the 600 calories includes one side item and a beverage - so that is better.  
One of the restaurants that signed up is Cracker Barrel and that is what caught my attention when I heard the news story. I went to their website just now and I do not see anything as of yet.  Today was to be the kick off.  By the way, check out their kids menu as it stands now (the link just above)- CRAZY high in fat...  check out the other links I have included in this post to learn more.


The criteria in the Kids LiveWell program is higher than is recommended for calories, total fat, trans fats and sugars - just so you know.

the high cost of cheap foods

I was in the grocery store with my Mom the other day and we were behind a man and his son (it seemed that they were father and son).  The little boy was in the front of the grocery basket, dirty feet hanging down, messy blond hair, and the cutest smile ever.  He might have been a teeny bit chubby, but really he was cherubic.  

The man with him was quite overweight - but attentive to the boy and really seeming to be doing his best.  In the main part of the shopping cart were about twenty or so frozen dinners - pot pies and dessert pies and sodas.  Oh and a half gallon of whole milk.  I don't remember any other things.  I told Mom, "That boy doesn't stand a chance."  Meaning that he was likely to add to the 16% of obesity in American children and later to the 32% of adult obesity.  She said, as she usually does, "you can't do anything about it though - even if it is true."  To which I replied, "But I can, I absolutely can and that is why I am in school."  Not to change that father or to "save" that child , but to impact population health through population strategy.

Just for curiosity, I positioned myself near to the register display and watched as the order of that duo was scanned. Every one of the frozen entrees cost less than a dollar.  In fact, they all cost less than 75 cents!  The sodas were also under a dollar except the two Mt. Dew brand ones, which were 1.25.  The only thing that cost more than two dollars was the whole milk and just barely.  

Then I watched as they scanned my Mother's groceries and the inverse was true.  We might have had ONE thing that was less than a dollar and our skim milk was a dollar MORE than the whole milk.

I absolutely believe that the price of food that is filling, nutritious and low in calories and fat must be adjusted with a policy or a strategy (free market possibilities exist!).  Remember there are little p policies and big P policies, so don't get upset about government intervention. (I favor big P but not everyone does)

I realize that there are some people that will choose the high calorie, fat, and sugar foods over the healthier ones no matter the cost, but I sincerely believe that if an affordable  option was there, more people would eat better.  I would like my future work to be finding out if what I think is in fact true.  Again, population effects are what I am after, not individual level change - I don't have the stomach for that business!!

Living Longer - but still terminal

NLST 

The published study is available by clicking the above link

My concern and or contention with using imaging to screen for lung cancer in high risk groups (i.e. smokers) is complex.  First, whether it be a chest x ray with minimal radiation exposure, low dose CT or a max dose diagnostic spiral CT - the screen itself can be carcinogenic, and second, it takes the focus off other smoking related lung diseases which impact a greater number and at lower dose of smoking.  Both COPD and Lung Cancer are irreversible, fatal conditions.  Lastly, more smokers die of heart disease than either of the above - when the death certificate is completed, anyways.

In an article regarding the recent results of the National Lung Cancer Screening Trial - a medical doctor (i.e. I am NOT a doctor) notes that lung cancer seems to be the cancer that gets the least respect.  He noted that mammograms are never questioned (except that these days they are), and maybe he has a point about lung cancer not being given respect.  When I read the article and the study results - which I will get to in a moment, I thought of my dearest Aunt Jay who did die of lung cancer after years of hardcore smoking.  If she had been the recipient of these screenings would that have saved her life, extended her life, extended it in a productive way that was free of pain?  Would it have made a difference?  Surely, if it would have, then I must rethink my stance.  I do not know the answer and I don’t think the scientists do either.  Lung cancer, specifically the small cell lung cancer that is most related to cigarette smoking - is nearly always fatal and fatal quickly.  That “quickly” is within years of diagnosis.  If we now diagnose it late and a person dies within five years, does earlier detection mean anything more than one will die within ten years instead of five?  Or perhaps, with an earlier diagnosis one could quit smoking and ease the suffering or intensity of what would surely come in any case?   I do not know.  I know this however - more persons who smoke have emphysema and chronic bronchitis and spirometry is a cheap and non invasive procedure that can detect it in order to treat it.  No one seems outraged about its lack of use in high risk groups.  Indeed, COPD seems to be the lung illness that gets no respect.  Is it a financial thing?  Certainly the spirometry industry isn’t going to make a lot of money if we make sure all smokers get THAT test.

As a public health educator/health promoter (and not a health care professional) I do not at this time have any positive thought on CT screening for lung cancer in smokers as a preventative measure. The only preventative measure that I endorse for lung cancer is quitting smoking or never starting.

From the now published results of the NLST I offer a few points that I consider important.  Usually when reviewing a research article the first things review are what they did and what they found

That gives you a heads-up on the subject matter - to see if it is of interest to you.  But to see if the findings are of any real value it is better to look at HOW they did what they did and WHO they did it with.

This study has some good qualities in that in took a large group of volunteers who met certain criteria and with their consent, randomly assigned them to two groups.  The follow up that occurred for the next six to seven years included a once a year screen (CT or  X ray) for three years.  The people were followed to see who among them was diagnosed with lung cancer (who lived, who died) in that seven years and if the CT found more of those cancers sooner than the Xray.  It did, but it also found a whole lot of lung cancers that were NOT lung cancers.  Those false positives would have to be ruled out with additional diagnostic examinations, including more imaging.  In the CT group there were more positive findings for each of the three years in which screens were conducted.  However, the rate of false positives was high for BOTH the Xray and the CT - 94 to 96 % respectively.

As mentioned above, it is important to know who the study involved.  In this case, there were over 53,000 persons.  The persons enrolled had to be considered heavy smokers or smokers who had been heavy smokers and quit in the last 15 years or less.  That is important.  They chose the people that they thought were most at risk for getting lung cancer during the study period of less than ten years.  To be considered a heavy smoker the person had to have a 30 pack-years history.  That means that they had to smoke one pack a day for 30 years or two packs a day for 15, etc.  A plurality of participants were between 55 and 59 years of age (42%) and another between 60 and 64 (30%).  Six of the people were under age 55 and 4 were over age 75.  A majority of the participants were male (60%), white (90%) and 48% were current smokers.

Looking over the study again - I read this sentence …“Small-cell lung cancers were, in general, not detected at early stages by either low-dose CT or radiography.”  Well - that is something that is not talked about so much in the news reports of the study. 

The published article also has a figure with two graphs comparing the screenings.  In the top graph are the number of lung cancer cases found (y axis).  There is a line for the CT and a line for the X ray.  In the bottom graph is the number of lung cancer deaths and again, a line for CT and a line for X ray.  The horizontal axis is the years since the participants were in the study 0 to 8.  In the lung cancer cases the CT line is on top (finding more) and in the lung cancer deaths, the Xray line is on top. In other words, during the study period of less than 8 years, there were more deaths in the x ray screened lung cancer cases than the CT screened cases.  This only convinces me that the CT group is living longer with a diagnosis - not that they are living longer than they would have without the CT scan.

NLST

This post from November of 2010 discusses the National Lung Cancer Sreening Trial (NLST).  It was a study that enrolled a large group of smokers and former smokers.  It split them into two groups by random assignment.  Some of the smokers were given low dose CT and others Xrays.  You may recall that I am not fond of using either as a screening method, but the CT has substantially more radiation than the x ray.

Preliminary reports had just came out when I wrote the November post and the final results have now been published.  I have been reading about them and getting my notes together so that I can share some things with you.  I don't feel quite prepared to do it tonight, and I am sort of on vacation... so just to let you know - I am working on this.

Tomorrow I may also skip the O&E post as it is my Mom's Bday and I am going to take her out to hear music at the beach - over beers.  All 83 year old Mom's should have beer on their bday - unless of course they want hard liquor :)

Every BLT Matters

I am surrounded by clever people and this blog post was inspired by one of them.  I have from time to time mentioned my sister who is a maintenance, life time member of Weight Watchers.  This sister has enlightened me on the Weight Watchers program of today - the smart program that encourages not diets, but forever choices in eating that enable people to maintain weights that are healthy - while consuming the right portions of the right foods, cooked in delicious, volumizing ways.  All the things that I say are important are in the program and because it absolutely is not a short term strategy to lose a few pounds or a lot for that matter, I fully endorse it.

But I don't think I ever mentioned that my sister has gone to weight watchers with her good friend and neighbor.   I am also incredibly fond of this neighbor.  Today I was speaking to my sister, who bragged about her friends progress - more steady now than it has been at times over the years.  Her friend has a new term or saying that she uses when she buckles down and tracks her calories. [The National Weight Control Registry shows that persons who keep track of their calories while losing weight and who monitor them later, are much more successful than those who do not do so.]  Our dear friend Micky uses the  BLT mantra when she gets serious.  That means she keeps track of every single Bite, Lick and Taste.  The thing is, she is 100% correct because it IS those BLTs that add up into hundreds of calories and it only takes 50 more a day to put on the pounds.

Now you know why I often say I am not sure my recipes are okay until the very end - I do not sample my  cooking (well, with very rare exceptions) while it is in progress.

Bottom Line:  Calories count and calories live in every bite, lick and taste of foods AND beverages.

Plane Ponderings

In the air again - I have these two things to share from my travel to Florida today..

I was able to get the aisle seat on both flights and on the first flight, I shared the row with two men. The man in the middle was overweight and he was telling the man at the window about the seats being "skinny" now a days. In fact, people are bigger, but anyways that is the conversation they had.

As the flight progressed, I was editing a paper that I have been working on 'for months'.  It is nearly complete and I was reviewing the latest version.  The paper gives an overview of the new labeling law and the IOMs work on front of pack labeling.  It also explains the importance of dietary factors in obesity prevention and the need for us to limit calories.  The same things that you guys know I have been researching and summarizing for most of the summer.

The gentleman that had complained about the seats not being big enough asked me if I were a teacher - and was I grading papers.  I said no, that I was a student and this was my paper.  He said, "do you mind if I ask what it's about?"  DEAR ME - ha. I gave the briefest overview and then he went on to tell me about not getting enough exercise since he retired and gaining so much weight (I would not expect that he was much over age 50 - so I am not sure why he retired).  The irony is that this and most of my papers are about the need to actually EAT LESS not move more.... but I didn't go there with my row mate.  Later he told the window seat guy that he was going to eat buckets full of crawdads and such when he got to New Orleans.

On the second leg of my journey, I read a letter to the editor in USA Today.  The writer of the letter was upset that service men (military) were not given priority boarding for air travel. He stated feeling horrible about walking past the men or women in uniform while he went on to his first class or whatever special seat he had.  If you recall, I opt to wait until the last zone is called and then get at the back of the line.  I think that service persons should fly free, first class, and without any fees whatsoever - but I think they should be given the privilege to board at the absolute last minute and get off at the very first!   


Wasn't it just this past weekend that another study came out that indicated an increased risk of deadly blood clots from too much time spent sitting?