Tuesday, November 13, 2012

A Blog Decision

   On Thursday I will take the oral component of my comprehensive exams.  I am enrolled in a Public Health doctorate program.  As you might have deduced, my area of interest is public health law and reducing obesity by changing the food environment.
   I am interested in conducting research on laws and strategies that are meant to reduce the availability and consumption of foods that are calorically dense and nutrient poor - aka junk foods.  I am not out to BAN them or tell anyone that they cannot eat them.  My hope is that through policy, we can make nutritious foods the majority preference.  I think that this would happen if better for you foods were less expensive, more convenient, tasted better, were universally available, were what you saw advertised on TV and were what your friends and family were eating.
     This post - the one I don't want to write - should be my last for a while.  Here is why.
   First I should study hard for my exams.  If I do not pass my exams that would indicate that writing the blog was probably not a good use of my time!
    If I do pass them, the next part of my program involves 1) writing a proposal for my dissertation (research experiment)- 2) defending my ideas and getting my professors to approve my plan and then 3)conducting my research, analyzing my data, writing two papers about the study, and 4) defending my study and the results in front of faculty, family and friends.
   So if I don't pass - I have to study hard and retake my exams and if I do pass, I will have a whole lot of work to do!
   No matter what happens on Thursday, I have several end of the semester projects to complete- but they are all very interesting.
   Of course, I am leaving off the part where I work with faculty in order to have my tuition paid covered.
  The last consideration for continuing the blog is a rather disappointing review of the blog analytics.  With one or two fantastic exceptions, my readership for the blog is quite low.  I understand.  There are millions of Bloggers competing for readers. 
 My You Tube channel is faring much better.  I have over 240 subscribers from all over the world.  As my cooking and physical activity videos are relatively popular, I will continue to create and post them.
 You can visit my You Tube Channel here.
I have tried to stop blogging before - it is hard because I enjoy it so much and some of my readers are loyal and especially important to me.  It just makes sense to stop now....for a while.

Monday, November 12, 2012

When Serving Sizes Are Wrong

   I have shared that a low energy diet is endorsed by the Dietary Guidelines for Americans and is the cornerstone to Volumetrics and  Weight Watchers.  Energy density of a food or meal is determined by dividing the total calories by the weight of the food(s) in grams.
   Sometimes the serving size of a food is provided in ounces not grams.  This is usually not a problem as ounces are easily converted to grams.  If you are choosing between two products and they are both given in ounces, you can just divide calories by ounces to see which is the least caloric.  Sometimes the serving size is given in ounces AND grams.  But be careful....
   I was choosing ice cream today - ice cream always gets me.  When it is a tub of ice cream the serving size is 1/2 cup - which is not useful for two reasons.  First it is unrealistic.  We tend to eat more than one half.  And Second, it isn't calories per half of cup that we need to be aware of but calories by weight - in grams.  I have pointed out before that the 1/2 c serving sizes have unequal weights across products and flavors (the grams are always provided so you can do your own math).
   When buying ice cream bars, (I choose from Weight Watchers and Skinny Cow).  I read the grams per bar to know which one is REALLY the lower calorie option. The front of the box might say that they are 100 calorie bars, but that does not mean that you get the same amount of ice cream.  I always want more ice cream for my calorie - more bang for my buck.  Usually Skinny Cow wins the calories per gram contest.  The Weight Watchers Fudge Bar is the exception.
   But today something caught my eye in the small print on the front of the package.  This led me to check those grams again.  On all the packages (excluding the fudge), all flavors of both brands said 6- 2.65 fl ounce bars per package.  How can they all be the same fluid ounces if they are NOT the same weight in grams?    The 2.65 ounce bar in the Weight Watcher group weighs about 52 grams and the Skinny Cow ones weigh  63 or slightly more grams.  
   But wait... fluid ounces?  Ice cream is not a liquid.
Either way the ounce to gram conversion doesn't equal what the product says.  When using fluid ounces the conversion from 2.65 = 78g, when using the more appropriate ounce to gram conversion the 2.65 ounces = 75 grams.  None of the conversions were true to the label grams.  
   When in doubt, ALWAYS refer to the grams..Actually, doubt or no doubt - its calories/gram so use the grams.
Now - time for some ice cream. 

Saturday, November 10, 2012


    As a woman living in the USA, I have many advantages.  I experience more freedom, power, agency, and equity than women in many non Western countries.  I have greater privilege than my American ancestors from as little as 50 to 100 years ago.  Yet as far as women have come, it is not perfect.
   Women's education, work and political experiences are inferior to men's and this difference is more pronounced for women of color.  But it is the sexual disparity that I focus on today.
   It starts with the terms that we use.  For women we refer to reproductive health and for men, sexual healthPrimary care for women is meant to address fertility, maternal health, and to prevent cancer of the reproductive organs (breast, cervix, uterus, etc).  For men, primary care is more than fertility and cancer prevention.  One of the goals if not the main goal is the ability to engage in sex.  To have fun. 
   Long after a man is expected to procreate, it is important for him to have sex.  Why is that?  Why is it important for the MAN particularly.
  I am not one, but with few exceptions (e.g., pain with ejaculation) I expect that having sex = enjoyment for men.
  A fantastic post by Dr. Jane Brody was published in the NY Times blog on August 6th.  I want you to read it (man or woman).  She brings attention to the problem of painful intercourse for a growing number of women.  The discomfort is associated with a lack of estrogen which occurs for many reasons that are explained in the article.  Women can "have sex" without experiencing pleasure. In fact, some medical conditions make sex extremely unpleasant.
   As Dr. Brody explains, this leads many women to become asbstinant (to avoid sex) and it has a negative effect on relationships and mental health.
   But there are NOT any commercials about this. If this were a man problem, we would be forced to watch ads about a pill that would fix it.
   I doubt insurance covers estrogen creams.  That is NOT ok.  Read the blog.  Talk to your doctor. You can even print the post and bring it with you to an appointment!  

Wednesday, November 7, 2012

Tilapia Study Revisited

   In 2008, I wrote two posts related to the Wake Forest University School of Medicine study that questioned the place of tilapia in a heart healthy diet.  The issue of concern was the ratio of Omega 3 to Omega 6 fatty acids.  Some health care professionals and researchers suggested that because the ratio of 3 to 6 was low, tilapia could actually cause inflammation instead of reduce it (like omega 3 fatty acids in salmon are said to do).
   I noted in those posts 4 years ago that tilapia was a popular fish that was mild in taste, low in calories, saturated fat, and mercury and high in protein.  In other words, it was a really great food. Right before starting this post, I had tilapia for dinner! (with roasted Brussels sprouts and baby corn).
   In a special section of this month's Nutrition Action Health Letter several myths, scams and claims are challenged.  The tilapia "caution" is one of them.  The WFU study was summarized and the tilapia naysayer was identified as Dr. Andrew WeilI have found him to be a little extreme with his nutrition advice at other times as well.  This article doesn't say that tilapia has a higher ratio than was suggested by the WFU researchers, it just clarifies that the low ratio has NOT been conclusively linked to any adverse health outcome.     
   The American Heart Association considers tilapia to be a good choice and since we are talking about inflammation and its relation to heart disease, that is a good enough endorsement for me.  To be clear - salmon is the better fish for heart health.

Sunday, November 4, 2012

Aspartame Limits

   I have done much reading and writing about studies on the safety of artificial sweeteners over the years.  I have shared my opinion that the scientific studies are robust and that the FDA and the European equivalent EFSA were justified in approving saccharin, aspartame and sucralose for use in humans - adults and children.  
   I stand by my opinion.  I know that some people are allergic to specific compounds in these substances.  I know that aspartame is not heat stable (so don't bake with it).  Those two issues do not make the chemical unsafe  for the average person consuming reasonable amounts.
   There are at least two things that I did not know - or hadn't given thought to until I read the article by Schernhammer et. al discussed in my last post.  I hadn't considered the consequences of  long term use of any of the sweeteners.  It's true. We do not know what will happen if someone uses a particular amount of any of the sweeteners for 40 or more years.  We just expect that our short term studies in people extrapolate into years of safety.  
    With regard to aspartame in particular which is in all three of the diet sodas I prefer, as well as the packets I use to sweeten my cappuccino and oatmeal, I learned something new.  
   The FDA and the EFSA have determined that the ADI  - or acceptable daily intake of aspartame from all sources- is 40 or 50 mg/kg of body weight.  It depends on which country you live in!  The USA has the higher limit of 50mg/kg. To calculate what is safe for YOU and you live in America, you first have to convert your weight to kg.  That is approximately  your weight in pounds x 2.2.  
   That was one thing I wanted to bring to your attention.  Before we leave it, lets get an idea of what that upper limit means for people.  Some one who weighs 100 pounds ( I know who is that?!?) can ingest 40*43kg = 1720mg of aspartame in a day.  A person who weighs 150 pounds can ingest 40*68kg = 2720mg of aspartame in a day.  Recall that the sweetener is in many sugar free products and can be added with packets.  I do not know the limits on the other two sweeteners.
   The second thing I wanted to share and learned from the article is that a 20 ounce soda that is sweetened with aspartame contains about 350mg of it.  Therefore, those insane 64 ounce big gulp drinks that the Mayor of NYC is trying to restrict - if they were diet - would contain 1120 mg of aspartame.  So maybe he DOES need to add diet sodas to the regulation.
   I am comfortable using my aspartame and sucralose (for baking) but I think it is smart to keep track of how much you consume and to be mindful of any new science that becomes available. 

Friday, November 2, 2012

Diet Soda and Cancer

    Within the last week, an article was published on diet soda and cners which received a lot of attention.  The attention was for being inaccurate or misleading.  Several peer reviewed journals had rejected the article before it was finally accepted by the American Journal of Clinical Nutrition.  The issue was over whether or not the conclusion of the authors, that there was an association between diet soda consumption and certain cancers, was supported by the evidenceThe main outcomes of interest were non-hodgkins lymphoma and multiple myeloma.  The researchers found a slightly elevated risk for NHL in men onlyThis was not an experiment so there is no statement of cause.  NO one - not even the scientists who did the research - is saying that diet soda causes anything.
   One of the issues that author's of this study brought up was the rare occurrence of the cancers in any of the people in the study  I read the article and found some problems as well. My point of writing the post tonight was to let you know two things - but as I read the article a second time, something else stood out to me which I will share at the end.
First - I agree - this study is weak.  As I was reading I thought this study felt familiar and that is because this spring the same authors published research on soda consumption and heart disease. In fact, I  blogged about it ~  here. They are using the same data to answer several research questionsThat is okay, but its where the data is coming from that caught my attention.  In this study, the authors  point out that the majority of survey respondents (they collected the info through mail surveys every two years starting in 1976 and 1986) did not drink a lot of soda.  WHAT?!  Who doesn't drink soda in America?! This made me go back to the page that described the research. The information used in this study came from two groups of people enrolled in different studies.  One group was women who were nurses.  They started the study in 1976 when they were between the ages of 30 and 55.  The second group was male health care professionals (doctors, etc).  They completed their first survey in 1986 when they were between the ages of 40 and 75. 
    Every two years from the start, both groups were re interviewed, or completed follow up surveys.  Every other time, or every four years, they completed a food frequency questionnaire.  For the FFQ, they were asked to report on the frequency of consumption of around 130 items, including soda.  The last survey took place in 2006.  The people were between age 60 and 95 at the last time point. Some had died and some had been diagnosed with cancer.  Those cases were counted and then the researchers looked to see if there was any association between the amount of soda, diet or regular, consumed and the rate of cancer in the groups.  As I said,  a small increased risk was found in the men, but it was also found for regular soda.  The risk for these particular cancers was rare overall.

   Here are three very important things to consider about the people who were in this study.  They were all born between 1911 and 1946 (so yes, now I can see why they were not soda drinkers)(I failed to make this point in the blog post last March). They were all in health care professions. They were mostly white people.

Here is something very important to consider about their food and soda intake. They were asked to report the frequency of food and beverage consumption over the past YEAR.  Can you remember what you had last week?

Therefore, the people for whom these results were calculated do not represent average Americans.  The information they provided on their own behavior was probably inaccurate due to recall bias (forgetting or not wanting to tell the truth are two type of bias - or errors).

Does this study suggest that there is a link between diet soda and cancer - specifically aspartame sweetened diet soda - NO.
Is there something more to say about aspartame?  YES.  
I will share that in my next post.  Here's a teaser... maybe its the diet soda Mayor Bloomberg should limit.  This comes from the girl who has about 9 diet sodas a week.  

study citation: Schernhammer, E. S., Bertrand, K. A., Birmann, B. M., Sampson, L., Willett, W. W., & Feskanich, D. (2012). Consumption of artificial sweetener– and sugar-containing soda and risk of lymphoma and leukemia in men and women. The American Journal of Clinical Nutrition.

Thursday, November 1, 2012

Food Pushers

    I went to a barber shop to get my hair trimmed today. I had never been to this place before and I don't think I have ever gone to a barber before - but it was close to my apartment and I thought it would be less expensive than a hair salon. 
   The man who cut my hair was very nice - he was older.  I know this because he talked about cutting hair in the 1960s when men let their hair grow long.  He told me that because I asked if cutting women's hair was different than cutting men's.
    When he was finished and I asked the price, he told me it was on the house.  Wow - right!  To which I replied with much thanks and gratitude - (and shock) "how, wonderful",  "I am a poor college student, thank you SO much."  He then asked me what I was studying.  I told him that my program was Public Health, but I was specifically interested in food policy and obesity.  "You know",  I said, "trying to make it a little harder to eat food that is not good for us and easier to eat the good stuff.  In other words, I am a big fan of Mayor Bloomberg."
   I expected to get some grief.  Most people get nervous about policy and regulation. Instead the wise barber said, "You know I think that the food companies have had a big part in this."  "Yes," I said, "that is exactly what I mean."  He said, that it seemed they were always pushing food at us, always pusing food that was not good for us.  He agreed that someone should make it harder for them to do that and that maybe someone should push the better food!  We agreed that advertising two for one burgers should be replaced by ads for one dollar salads.
    All in all - a good day - a good conversation - and wow - a free hair cut, too.