Quantifying the healthiness of YOUR diet

   This past June, I used several blog posts to talk about how researchers measure the healthiness of a meal pattern.  I discussed the Healthy Eating Index which is associated with the Dietary Guidelines for Americans, the Alternative HEI which was created by nutrition scientists at Harvard, and the diet component of a cardiovascular health measure from the American Heart Association.
   In one post, I offered the criteria below which is from the AHEI.  I bring this back to your attention today because I found a legitimate website that offers a 'test' on the healthiness of YOUR meal pattern (or diet).  I took the quiz and I liked it because it seemed to follow the recommendations of the AHEI.  I scored an A but it was not a perfect A.  Even I can improve my dietary health by consuming more fruits and veggies.
   Here is the link to take the quiz and again, the AHEI info is explained below.

That blog post can be reread by clicking here.

Remember you can get a score between 0 and 10, I am giving you the extremes in these examples.

1. Vegetables (not counting potatoes)  You get ten points for having at least 5 servings a day.  A serving is a half cup or one cup if it is a green leafy vegetable (1 c = 236 .59 g).  If you consume no veggies or just potatoes, you get a score of zero.  Vegetables are associated with decrease risk of  CVD and some cancers.  Green leafy veggies are associated with decreased risk of diabetes.  Potatoes are not associated with either and may increase the risk of diabetes.
2. Whole Fruits (only) Ten points for 4 or more servings a day (NOT fruit juice) and a serving is one medium fruit or a half cup berries.  If you do not eat fruit on any day you get a 0.  Fruits decrease the risk of CVD and some cancers.  Fruit juice does not and can increase the risk of diabetes.
3. Whole Grains This is calculated in grams - you may eat a food, like oat meal that has 15g of whole grains in it.  To get a ten, women need 75g and men 90g per day.  Read your labels - only whole grains count, so looking at total grains can be confusing. Whole grains reduce the risk of CVD, colorectal cancer and diabetes.  Refined grains (the white stuff) increases these risks - avoid them.
4. Sugar Sweetened Beverages & Fruit Juice - (you know this includes soda and fruit drinks/ades).  You have to not drink any of this stuff to get your 10 points.  IF you drink one or more a day you get zero.  A serving is 8 ounces (226 g). The drinks are associated with weight gain and obesity, CVD, and diabetes.  See the note above re fruit juice.
5. Nuts, Beans (legumes), Vegetable Protein (tofu)  The constituents or make-up of these foods is very healthful - monounsaturated fats, micronutrients, etc. These lean proteins decrease the risk of CVD (esp when eating them instead of read meat).  Nuts reduce diabetes and weight gain (but watch them for calories).  To get 10 points consume one or more servings a day (serving size is small- 1 oz (28.35g) or 1 TBSP of peanut butter (not the crappy kind).  One serving a day will get you your 10 points.  Only go for 3 or 4 servings if it is in place of bad calories - like lunch meat.
6. Red and Processed Meats  Best scenario - 10 pts for less than one serving a MONTH.  If you have greater than or equal to 1.5 servings per day, you get 0 points.  A serving is 4 ounces of meat (steak, etc) or 1.5 ounces of processed meats (lunch meat, bacon).  Why?  Consuming red and processed meats increases the risk of CVD, CVA, diabetes, colorectol and other cancers. 
7. Trans fats -They increase the risk of CHD and diabetes and the scores are calculated as a % of total energy intake.  The best (10 points) is .5 or less a day -  if you consume 4 or greater - 0 points.  This is the equivalent of about ten calories in a 1800 calorie diet per day.  Trans fats have no health promoting properties, but do occur naturally in small amounts - making total elimination impossible.  Certainly it is better to choose prepared foods that are 100% trans free.
8. Fish - or long chain fatty acids (EPA+DHA)  Fish is associated with a decreased risk of cardiac arrhythmia - or irregular heartbeat and sudden cardiac death.  My father died from this. The goal is 250mg/d or two 4 ounce servings of fish per week (10 points). If you do not eat any fish you get 0 points.
9. PUFA  Instead of having a saturated fat item as the original HEI does, this index encourages poly unsaturated fat intake in place of saturated fats.  This is very important and ties into the concern that people misunderstand the fat problem and consume an overall low fat diet.  That is not healthy! Please read more here. (esp paragraph 3) Healthy oils are associated with decreased CHD and diabetes.  We should get 10 % of our total calories from these fats (10 points).  You cannot count your fish twice though.  You can count mono unsaturated fats, like olive oil.  This would be 180 calories in a 1800 calorie day.
10. Sodium/Salt  Too much sodium increases blood pressure, CVD, stomach cancer and all death.  The recommendations of 1500mg a day - no more - should get you your 10 points.
11. Alcohol  No alcohol = 2.5 points, Too much (greater than or equal to 2.5/d (women) 3.5/d men), = 0 points and Moderate = 10 points.  To get your ten points women have one half to one and a half drinks per day and men have 1.5 to 2 drinks a day.  Remember these few things - 1) alcohol HAS calories, 2) not everyone should drink - no matter what this says - and 3) a drink is 4 ounces of wine, or 12 ounces of beer or 1.5 ounces of booze.  So two drinks a day = 8 ounces of wine (possibly one glass at some bars!).  I drink two measured drinks a week, sometimes 3 so I guess I would get 5 to 8 points.

Some abbreviations used:
CVD - cardiovascular disease (includes all types of heart disease)
CHD - coronary heart disease (one type of heart disease)
CVA  - cerebrovascular accident (stroke)

Overweight and Military Service

I am certain that soda has a lot to do with this problem, as does the increasing portion size and energy density of foods at home and restaurants.  I am certain we have a problem.

Currently, about 25 percent of 17- to 24-year-olds are too overweight for military service. Also, the Department of Defense spends an estimated $1 billion per year on medical care for weight-related health problems.

Mission: Readiness is the nonprofit, nonpartisan national security organization of senior retired military leaders calling for smart investments in America's children. It operates under the umbrella nonprofit Council for a Strong America.

Read their recently released report, Still Too Fat to Fight - HERE

Soda and Obesity

   I should change that title to sugar sweetened beverages and obesity.
   Soda that does not contain calories is not driving the obesity epidemic.  Beverages that are high in sugar, like soda, fruit drinks, sports drinks, iced tea, creamy coffees etc add calories which add pounds.
   You may be interested in reading the research and the expert opinions as presented - not by Mayor Bloomberg  - but scientists and physicians.
Click here to do so.

Fit and Active (fit facts) The Right Front of Pack system?

   One of my classmates was eating a snack the other day and the package caught my attention.  I noticed that it had a front of pack label and that the back of the pack contained an explanation of the label system.  I did not recognize the brand of mini rice cakes.  I thought that the Quaker iced/frosted mini rice cake snacks had a new package and label.  I asked my friend if I could have her empty package.  I know, I am that weird.
   Turns out, the snack cakes were a store brand and the store has implemented this labeling across all its products.  It is from ALDI.  They refer to their scheme or system as Fit Facts.
   I am 100% in favor of a front of pack system or label that highlights nutrients that are important to consider in our diets.  Nutrients that we get too much of and should limit.  The problem is a lack of standardization over which nutrients should be highlighted.  The Institute of Medicine has given us some guidelines but the recommendations have not translated into rules - YET.  I wrote about them here, almost a year ago.
   The ALDI labeling, which you can see below does not make things clear for the shopper.  For example, the rice cakes package I 'borrowed' shows the amount in grams or milligrams(sodium) of four items.  I disagree with the inclusion of total fat because saturated fat is the item to limit and though three of the four show a percent daily value (which is suspect but helpful) the fourth SUGAR has no percent daily value because it has no daily value.  If the FOP system used was the multiple traffic light, the criteria would have each of those items as either red, amber or green. In the rice cake case, the sugar grams are 6.  That seems low right?  It's not.  The total weight of the package is 20grams.  That means that the product is 30% sugar.  The multiple traffic light (MTL) uses red to warn that a product is high in sugar if it contains as little as14% ! It is okay to eat this 90 calories and 6 grams of sugar, just don't tell yourself it is a low sugar product.
   The front of pack systems are needed and they can be helpful but  this label does not make it easy for you to know if something is "healthy."  We should not have to get out our calculators and divide 6 by 20 to get our percent of sugar!

The picture on the bottom left is the Front of Pack system.

 

NonDairy - Good Fat - No Sugar - Low Calories

   In my blog, I am more likely to make food 'group' recommendations than product recommendations - my most well known product rec being  Smuckers All Natural Peanut Butter. 
   Today I will share the labels of two products - two brands, in one category that I do highly recommend.  Almond Milk. There is a continuing controversy over dairy products, esp. milk and if you are not allergic to nuts, this is a fantastic alternative.  It is better for several reasons.
   The reasons are calories, sugar and fat.  Taste may not be among the plus factors, because I am  suggesting the unsweetened versions ONLY.  Please don't go for the sweetened as those just add sugar. However, using the almond milks in recipes, cereal and coffee as opposed to drinking it straight is what I have in mind.  It is really best not to drink our calories anyways.
   Below are two labels.  One brand doesn't break down their fat content but both of them have fat without saturated fat.  Therefore,  the grams are all GOOD fat.  Please understand, there IS good fat and you need it.  These products give you healthy fat with calcium and without sugar.  The calorie content is very low.  The calories are half that of the same serving size of skim milk (90c).  The serving size is NOT small - it is one cup.   BTW, whole milk has ~140 cals, 2% ~ 130s, 1% ~110s.  Full disclosure - almond milk pales in comparison to skim milk with regard to protein.  Still, protein is not one of the nutrients that Americans lack so you'll be fine.

This is Almond Breeze.  It has better amounts of Good Fat. 

This is  Silk Pure Almond - More Expensive but better Calcium Percentage

I use almond milk in my oat bran, my cake and cereal bar recipes, and when I make sugar free instant pudding.

Kohls - Good for the Environment?

    Kohls deserves a kudos for its efforts to go paperless.  I don't think that their decision is entirely altruistic as there are several winners and at least one loser from this venture.
    In my last statement from the department store, I was enticed to switch to paperless billing because 1) it was good for the environment - it would reduce waste and conserve resources and 2) it was good for my wallet -  a 10 dollar credit to my account for making the switch.  So good for the planet and good for me.
   Kohls of course will save time and money by not having to print and mail paper statements.  Good for Kohls.
   The US Postal Service, which needs the business, is the loser here.  I guess this also discriminates against persons who do not have access to the Internet or who fear sharing account information via the Internet.  
    Certainly Kohls  reviewed information in its customer database before doing this.  I expect that they found  a high percentage of them do have Internet access and probably use Internet banking.
    Now I have to go sign up because my wallet and my planet are counting on me!
   BTW - this comes just in time. Maybe Kohls can offset the destruction of trees  that occurred in order for us to have the space shuttle on display.


 

When Fear Makes Us Fat

   In the past week, the Rudd Center released a report on the affects of childhood anti obesity campaigns including the one that is running in Georgia. I believe that I have already discussed it here.
   That campaign includes print, radio and TV spots that highlight obese children.  During the TV or radio spots, children are seen or heard in various situations that include dramatic music. The child may talk about being left out of activities, being unable to participate in activities, or having high blood pressure and diabetes.  Sometimes words are introduced in bold and dramatic manner on the screen.
   The point of the ads is to scare people.  Scare people into doing something about obesity.  They only succeed on the scare not the action. The main reason they fail is that they do not give suggestions for maintaining a healthy weight or for losing weight.  
   This is something I have talked about before - in regards to using fear appeals or fear messages.  They do have a place in health promotion and behavior change but ONLY if the intended audience (in this case the parents) is given a strategy and a means to access and apply it.  [think about smoking. You can scare people but you also have to tell them that quitting is possible, nicotine therapy helps, nicotine therapy (medications) can be obtained, where to get it and then provide it at no or low costs.]
   The Rudd study found that the obesity messages made things worse and for the very reasons I just explained.
   We do not need to tell parents or children that they are fat - we need to make it so they do not "passively" consume too many calories in the first place.
Please read the published Rudd study  HERE. 
   BTW, in the story I read, Rudd staff noted that menu labeling was one of the successful strategies that should be promoted.

EU Reccomendations on HPV Vaccines

   Cervical cancer is most commonly, if not entirely, caused by the human papillomavirus (HPV). Forty of the 100 strains are transmitted through sexual contact, including oral, vaginal and anal intercourse.  Of those strains, some cause genital warts (unsightly and uncomfortable but minor) and others are associated with cervical cancer.  Having the human papillomavirus may increase the risk of penile cancer for men.  There are other causes of penile cancer which itself is very rare.  Conversely, cervical cancer is the second most common cancer for women.  Breast breast cancer being the most common.  There were just over 12,000 cases of cervical cancer in the US in 2008.  Cervical cancer deaths are not common as the PAP smear is able to detect abnormalities and prevent the cancer.
   It is estimated that at least 50 percent of all adults have been exposed to HPV at one time or another.  The virus is usually cleared by the body's immune system, but can be a chronic condition in rarer cases.  One can transmit the virus to others through sexual contact in the acute state and if they do not clear the virus they will continue to risk transmission through sexual activity.  The lingering virus is a serious matter and transmission rates are very high.  For this reason, the two vaccines that are available have an important role (only for those not previously exposed).  Because so many sexually active people have been in contact with a person carrying the virus, the target of the vaccine is girls (maybe boys too) who have not yet begun sexual activity.
   The two vaccines, Gardasil and Cervarix, only target the most important strains of the 100.  Gardasil covers two that cause warts and two that cause HPV.  Cerarix only covers the HPV strains, however, Cervarix has also been shown to have an impact on oral cancer and this is important.  Most people think of smokeless tobacco as the main cause of oral cancer - actually it is smoking BUT the rise in new oral cancer cases is associated with HPV NOT tobacco at all.
   Earlier this month, European health officials with information from the European Centers for Disease Control, made a recommendation that ALL girls in Europe (ages?) be vaccinated.  Some countries in Europe have coverage rates as low as 17% while Portugal and Brazil had coverage rates as high as 80%.  The recommendations include more promotion of the vaccines and steps to make vaccination easier (logistics).  The article that I read did not indicate if the coverage rates 17-80% were for the full series (3 shots) or for any vaccination level.
    In the USA, the issue of HPV vaccines became a political firestorm when a presidential candidate made some erroneous statements regarding side effects. 
    According to the US CDC, all girls AND boys ages 11-12 should be started on the series of shots.  The coverage is low and more info about this can be found here.

Your Doctor's Food Environment

   My research and public health interest is in changing the food environment in order to support diet quality.  Our diets will improve if we eat more whole foods (fruits and veggies), lean proteins, healthy oils and whole grains while limiting saturated(trans) fats, sugar, calories and as a country, salt. 
    In the current issue of JAMA, 3 doctors authored a commentary regarding the eating habits of the medical profession.  In the piece, Drs. Lesser, Cohen and Brook note that overweight and obesity is common in physicians. Overweight doctors are less likely to tell their overweight patients to lose weight.  
   The authors of the letter suggest healthy eating environments in hospitals, doctors' offices and at medical conferences.  They suggest a standard which foods to be served or catered should meet and they recommend calorie disclosure on meals.  They believe that the labels should indicate if the meal is higher in calories than is appropriate.  They call for portion restriction of desserts and snacks (100 calorie sizes) and a ban on sugar sweetened  beverages.
   The point, the authors say, is that doctors and medical institutions should set the stage for the rest of us.  As with tobacco, when doctors stopped smoking, so did their patients.  IF doctors (and nurses) take better care of themselves through dietary improvements, they will be more likely to encourage their patients to do the same.  If institutions start to limit the serving of calorically dense, nutrient poor foods so will other employers.
  

Do Menu Labels Matter?

   I am certain that you have heard the news that starting next week all of McDonald's indoor and drive through menu boards will show calorie content of all foods. Recently I shared a study by Christina Roberto regarding the percent of customers who actually use the drive through lane.  Her study informed the decision to include both menus.
   There are a few things in the news that are wrong or otherwise worth noting.  First of all, McDonald's IS doing something that it will have to do anyway.  The National Menu Labeling law has been passed.  A reporter from USA Today said that the law had merely been proposed.  That is untrue.  What is pending is the final rule.  I have also seen some negative response to McDonald's.  I feel that is inappropriate.  I am not fooled into thinking that they will become a healthy eating establishment, and I think that they are mostly interested in sales.  But why make an enemy out of a restaurant that I assure you is NOT going to disappear.  
   I love that McDonald's made a decision to post early.  They made preparations when the law was passed.  The law has been supported by the National Restaurant Association.   Others will follow their lead, to move forward now.  This gets the conversation back into the public where it needs to be and may get the FDA moving on that final rule.
   McDonald's will respond to its costumers.  They are planning on introducing more fruits and vegetables.  They were the first to rid their oils of trans fats and to offer fruit in the happy meal.  I only hope that people will buy the new items.  Most of us do not go to McDonald's for their salads and such.
   Which brings me to another issue that needs to be cleared up.  Some have said, in response to McDonald's actions, that menu labeling does not have an impact on purchases.  That is not true.  We do have a number of studies that show no effect, but the ones that show a change in behavior help us to understand why the others do not.  Most people who see the information, understand the information, and know the relevancy of calories to a their daily diet will choose the lower calorie items.  However, there are also those who decide to go to McDonald's or Burger King to get that Bic Mac or Whopper and they do not look at anything... they order what they came to order.  There is nothing wrong with that.  
   We do have evidence that the public wants the information and will use the information when the conditions are conducive to this use.  Remember too that anybody can do a study and share their result with reporters, but not every study meets scientific rigor.  If you hear a news report that says the labeling does not work, ask yourself a few questions.  How do they know that?  Did they go to a restaurant and watch people?  Did they survey people?  Did they compare a restaurant's sales before and after labeling went into affect?  Did they call people on the phone?  Who did they call?  Did the people they called or watched or had fill out a form understand how calories impact their weight and health?  How many establishments or people were in their study?  1?  30?
   Check out this fact sheet for some evidence and this website for a list of research studies.

Plate or Pill? Fish Oil Revisited.

   I feel a personal responsibility to respond on the results from the omega 3 fatty acids study that is published this week in the peer reviewed journal of the American Medical Association or JAMA.
   You may have already heard the 'news'  that there is a lack of evidence to suggest a health benefit from the use of fish oil supplements.  That would be an accurate headline that does align with the study results.
    My need to address the study here comes from my post in 2009 after I returned from an truly enjoyable and educational week at the Cooper Institute in Dallas Texas.  Dr. Kenneth Cooper is a strong advocate for fish oil supplementation and after hearing him speak, and share research, I was convinced of the positive effect.  If you are familiar with my blog you know that I strongly and emphatically endorse nutrient intake in the form of food not pills.  It was a departure for me to share his recommendation on supplementation. 
   So what happened to change the consensus?  Past research did  show a positive benefit from fish oil. (and Dr. Cooper made his assessment based on the research that was available at the time) Some of the studies used fish oil capsules,  others tracked dietary omega 3s,  and a few studied fish oil supplementation in animals.  
   The current research is a review.  It began with a screening of over 3600 study records.  Of those, the scientists used only 20 which met strict inclusion criteria.  The ones included were considered sound research studies.  They had to be randomized and include control groups.  People who were different only by random chance and not in any systematic way were given pills or not given pills.  The studies that were included had to last more than one year.  Most of them were blinded - people did not know what they were being given in order to reduce the chance of a placebo effect.  The scientists considered the design of the study, the actual robustness of the data collected and how the data was analyzed.  All of this is spelled out in their research article allowing other scientists to challenge or confirm their conclusions.  The outcomes that were studied include, death from any cause, sudden death, cardiac mortality, heart attack and stroke.  
   Of these 20 studies, two of them were a comparison of dietary intake not pills.  Those 2 studies cancelled themselves out and were not discussed further in the article. 
   On a separate note, the Mediterranean diet has been the subject of much research and eating fish has been associated with positive health outcomes.  It was this association that led to supplementation in the first place.  
    The authors conclude that there is no evidence to support the  use of fish oil supplements in clinical practice.  In other words, doctors should not prescribe it to  prevent first heart attacks or to treat heart disease.  
    The pills are very expensive and this is a sad dollar day for the supplement industry.  The pills are out, but the salmon benefit is still very real.
     At the end of the day, in my role as public health professional, that leaves one nutrient/vitamin to consider for supplementation - Vitamin D.  There just isn't any way to get sunshine onto a plate and the best source of Vitamin D is the sun.  Talk to your doctor before starting on any medications or supplements.

The study abstract is available:

Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: A Systematic Review and Meta-analysis

Evangelos C. Rizos, MD, PhD; Evangelia E. Ntzani, MD, PhD; Eftychia Bika, MD; Michael S. Kostapanos, MD; Moses S. Elisaf, MD, PhD, FASA, FRSH
  

A Billion Dollar Disease

   A couple of weeks ago, I read a post by Cris Frangold.  Cris pronounces a love for investing and writing about it.  I would consider him or her a financial blogger, with a  focus on medical services and the health sector.
   The piece that I read in Seeking Alpha regarded the value of Merck and purchasing its stock.  One reason offered to invest in the company was its drug Januvia.  Januvia is meant to treat the symptoms of type 2 diabetes.  Cris noted that 2012 Q2 sales of the drug were over 1billion dollars. Then he or she said:

Januvia has a potential to be a real moneymaker because the American Diabetes Association estimates that 25.8 Americans, or 8.3% of the population have Type 1 and Type 2 diabetes - the majority are Type 2.

   Type 2 diabetes in adults and children is related to diet - diet as it produces obesity.  It appears that excess body fat leads to metabolic dysfunction or disregulation so that blood sugar, blood pressure, and cholesterol irregularities follow.   Our diabetes rates have doubled in the past 30 years in tandem with our increase in obesity.  The 30 year trend of rising weights has been attributed to an increase in availability and consumption of high calorie, nutrient poor foods and beverages.
   Sure we can make billions on treatment and millions investing in those treatment options, but isn't there a better response?  I suggest that there is.  Investing in a diabetes drug means counting on a disease to continue, needing it to continue in order to enhance a portfolio or fund a retirement account.  That seems to be a good example of maleficence.    
   What of the better good?  I say the noble thing to do is invest in the food environment so that meals and drinks contain reasonable amounts of sat fat, sugar and calories.  And yes - sometimes that takes a mandate.

 American Diabetic Association
National Diabetes Information Clearinghouse.  Program of the National Institutes of Health

Let's Make Prevention the Priority

   At the end of August, the World Cancer Congress 2012 was held in Canada.  The congress is a meeting of professionals - research and practice - that occurs every two years.  The purpose is to share experience and knowledge to impact change in cancer occurrence and outcomes (death). 
   Once again, but with growing unity and urgency, people who study cancer in labs, communities and patients and those who treat patients, tell us that at the very least 50% of cancer can be prevented.  
   Prevented by what we do, what we are exposed to, whether or not we are immune to viruses (HPV, HCV, HBV) and the screenings we complete (PAP, sigmoidoscopy). 
   Graham Colditz, PhD, DrPH was one of the presenters.  He notes smoking as the cause of 30% of all cancer and said that reducing smoking rates to 11% (like in Utah) would reduce smoking related cancers by 75%.  He also noted that being overweight accounts for about 20% of cancers (and that to prevent cancer the BMI range should be between 21 to 23).  Physical inactivity and poor diet ( defined as a diet that does not include the better foods in adequate amounts and does not limit others (salt, trans fat, sat fat, sugar) each cause about 5% of cancer and if improved would reduce the new cases of cancer substantially.
   I have no doubt that this is true.  Therefore, I have strong reservations on spending my money (donations) or the governments money to explore treatment/cures when we are doing nothing to stop the cases from coming.  It is like this familiar health care story.  Do we keep training EMTs, buying ambulances and expanding hospital ER rooms to treat drowning victims - or do we fix the hole in the bridge. Public health folks, like me, want to fix the bridge. {some people would do neither and just educate people to stop falling into the hole!}
    I would like money to be spent on improving our environment so that eating well, moving more, consuming the right amount of calories, getting appropriate and evidence based health screenings and vaccinations is EASY.  (even if this means some kind of regulation)
   We are fools to keep treating things that we can prevent.  (I in no way place blame on cancer or heart disease patients and I am not suggesting that we not treat their illnesses. [the pharmaceutical industry would never have that!] I just want to point out the futility on a population level.   I see the environment and health care system as places to intervene, and when situations are truly conducive to good health, then I view personal responsibility as a possible nationwide focus.) 

 See more about the World Cancer Congress and the UICC here.
{note when looking at studies or speeches like this - there are two sets of numbers to explore - the percent of cancer that is accounted for by a factor and the amount that can be prevented if that factor is addressed}

Corn is for Cows and other secrets from Italy

   I stopped eating canned corn and corn on the cob along with peas and potatoes sometime early in the 2000s.  I made this decision because they are starchy vegetables.  Starchy vegetables are higher in calories than non starchy ones (e.g. green beans, summer squash, kale) and have a higher active sugar content (carbohydrates). This starch content makes them have a higher glycemic index and glycemic load.  The glycemic issue regards how the body responds to the food.  These vegetables break down very quickly, spiking the body's blood sugar.  This does not happen with other complex carbs like whole grains and non-starchy vegetables.  Foods that turn to sugar quickly  require an insulin response - the body needs to get the sugar out of the blood.  Foods that turn to sugar and are digested quickly are the ones that we should avoid, according to the HSPH Nutritionsource, as they have been linked to diabetes and other diseases.  This includes ALL of the refined carbs (e.g. sugar, pastries, etc) and some complex carbs (peas, corn and potatoes).  The MayoClinic offers a nice list of non starchy vegetables.
Read more from nutritionists and Harvard scientists Here.
   You may recall from the posts about the revisions to the National School Lunch Program that the IOM suggested that children also limit starchy vegetables.  
   Because corn has been in the news a lot lately, I recalled something that happened back in 1983 that looking back,  I should have paid more attention too.  First, in case you missed it, the price of corn is much higher this year because of severe drought conditions leading to crop loss.  In the US, corn is used to feed cattle, make sugary syrups and to create ethanol.  I believe it was intended for only one of those uses and I certainly blame the second one for the influx of super calorically dense foods and drinks.  Now let me tell you what happened in 1983....
   I was in high school and my parents participated in the foreign exchange student program.  The young lady who came to stay with us, and who is my dear friend to this very day, is from Italy.  On one of her first nights in our home, before she came to know us, we served corn as part of our dinner.  Our guest sat aghast, painfully stricken and at a loss for what to do.  It was many weeks later before she admitted to us that she could not understand why we would serve her corn. "Corn is what we feed cows."
    Now it is time to consider her wisdom.  The diabetes rates in Italy are half that of the US and the heart disease rates are about a third less.  Add that to the longevity and the healthy cholesterol levels of Italians and I think we can start to make some connections.

(Ah the days of mashed potatoes, peas, corn and gravy.  We would make a place in the middle of the potatoes and fill it with another starchy vegetable and cover it in gravy. All role modeled by dear old dad.  Perhaps this explains all the heart disease and diabetes in my  family.)  PS - I do enjoy Asian baby corn.

Diet Quality Not Based on Organic

   I have written for at least three years that science does not support a health benefit from organic foods or one that are labeled as all natural.  Organic produce may contain less pesticide residue (but you still need to wash what you buy). 
   I cannot locate the post, but I remember recently pointing out that none of the three healthy eating indexes I shared with you (the HEI from the Dietary Guidelines, the AHEI from Harvard and the heart healthy diet defined by AHA)  mention the word organic when making recommendations on what to include in a diet pattern.
   In case you missed it, the networks are abuzz with results of a recent study that confirmed these already known facts.  A new  finding was that non organic meats were more likely to be contaminated from bacteria because of non-medicinal antibiotic use in livestock (creating resistance).  This finding supports the argument for some kind of regulation on the use of antibiotics in animals that are not sick (which I thought we already had).
   Watch the video embedded here or click this link instead. 

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Safe Doses Depend on Exposure Frequency

   Today I am going to share a document that was created by the Center for Health, Environment and Justice.  I have been holding on to it for a few days and do not remember how I came to find it.  It may have been a link in a news story.
   The handout was prepared for parents.  The issue it addresses is chemicals in products that children use for school.  The message and the handout are important for all people - of any age.
   Understanding that we have more hazardous, toxic, and carcinogenic chemicals in our environment (land, water, air, products) than we can count and classify, protecting ourselves from them is a concern.  Those that we have identified as having a harmful effect at any level, such as lead, are regulated and products that contain it (lead paint, leaded gasoline) are banned.   We also have substances that are harmful but a certain amount can be found in the human body before any health risk occurs.  Think of methylmercury found in fish.  It is measured in parts per million and we can eat a certain fish many times because it is low level (tilapia = .013PPM) or just a few times, if ever, because it is high (tuna, swordfish = .99PPM).  The mercury released from coal fired power plants is the main source of fish contamination.  The EPA could impose regulations (as mandated in the Clean Air and Clean Skies Acts) on those power plants but is stymied by the tremendous push back and power from the energy industry.
    Sometimes the amount of exposure to a chemical doesn't matter as much because the likelihood of that exposure is so rare.  This was once the idea with radiation from medical imaging.  The radiation amounts were moderately high in CT scans, but hardly anyone got them and if they did, maybe it would be one in a lifetime.  That has changed and efforts are being made to lower the dose and limit the frequency.  Remember the many posts on this issue and ask your doctor why you need the scans.  
  Within a similar context, consider the chemicals that are leaching out of our plastics. BPA, phthalates, polyvinyl chloride.... It is not that these chemicals are high in any one place but that they are in EVERYTHING -  EVERYWHERE.  This means we are under constant exposure.  If a substance is toxic, any level is too high if you are being exposed to it repeatedly every day.  So read this handout and consider the environment and your health a little more seriously.  In fact, it makes the banning of certain chemicals for use in plastics make a lot more sense.
 Here is the handout.
   And since so many of us want more info on fats in food, we can think of artificial trans fats as another of those toxic substances.   If you have something with 4 grams of trans fat on one holiday a year - than a dose of 4 grams is a safe dose.  If you have something with 4 grams of trans fat every day - you are substantially increasing your odds of a heart incident (stroke, infarction, death)  In that way, the dose is too high.  A dose of less than .5 grams a day is still a risk.  Less than 1 gram a month is a better level.

Did we become overweight on purpose?

   In the September 2012 issue of the American Journal of Public Health, Mary T Bassett, MD MPH, discusses the role of government in "leveling the playing field" so that consumers have a real choice when choosing a food item.  A level playing field could increase consumption of higher quality foods.
   This statement, her article and my own studies lead to the same conclusion.  Most of us make food choices based on taste, cost, marketing shaped preferences, availability and convenience.  Healthiness comes in last - after these attributes have been considered - by us or for us.
   Dr. Bassett made mention of the food industry's support for initiatives that encourage physical activity as a strategy to reduce obesity.  This is clear by the placement of actual exercise icons on some food packages.  
   Here is a sad truth.  Exercise is not a popular way to spend leisure time.  Two hundred years ago that didn't really matter, we moved for sustenance and survival.  In the more recent past, our physical activity levels during work and non work hours has decreased.  We have become sedentary and for that reason alone need to exercise.      
   Both of these energy expenditure issues play a role in our obesity (over fatness) epidemic, but a much smaller one than you'd expect.  Trends of weight status in the US and similar countries show a steady and sharp rise beginning in 1970 and continuing to this date.  It has occurred in every age group - infants included.
   Certainly, the entire country did not have a sudden cellular shift  that made us ALL genetically predisposed to gain weight.  And with regard to burning less calories from work and travel, the best estimates from scientific studies suggest at most a decrease in 100 calories expended.
   Could it be then, that the entire country made a conscious and deliberate decision to gain weight?  Even before we learned of the connection between fat and disease, we knew that being too large for our bones was uncomfortable and stigmatizing.  Few of us would invite those things. So I say NO, we did not seek out calorically dense, nutrient poor, portion inappropriate foods. They came to us.
   Sure, our changing culture had us looking for convenience and increased the number of meals we purchase away from home.  We did not however, know that our 200 calorie meal had doubled into a 400 calorie one- before adding the super sized sized milk, juice or soda.
    Today, we find ourselves in need of a few less calories (compared to 1970) but consuming a WHOLE lot more - often passively.  Calorically dense foods are what the food industry offers  - at a price we can't refuse.
   Our environment changed around us, we got fat, our heart disease, diabetes, cancer and stroke risk went up.  Indeed the playing field from which we make our choices became leveled against us.

The article referenced in the opening paragraph : Mary T. Bassett.  Of Personal Choice and Level Playing Fields: Why We Need Government Policies on Food Content. American Journal of Public Health: September 2012, Vol. 102, No. 9, pp. 1624-1624.