Tuesday, January 29, 2013


   There was a time when diverticulosis, a condition under which tiny sacs grow on the wall of the colon, and diverticulitis, when those sacs become painfully inflamed, were treated with diet restriction.  The way to prevent those painful flair ups, it was thought, was to avoid eating foods or meals that had seeds, kernels etc (tomatoes, popcorn, nuts) in them. I know this to be true because I live it - vicariously.  A loved one of mine was diagnosed with the disease (via the emergency room) and we (his family) were put on high alert to make sure no seedy foods landed on his plate.  As it turns out, diverticulosis has more to do with ones overall lifestyle and diet patterns and not seeds or nuts.  In fact, the risks for diverticulosis are similar to those of colon cancer, and include eating a lot of red and processed meats (some say more than once a week is a lot), consuming a diet high in refined grains (white breads, pasta, baked goods) and not getting enough fiber (from food)- while also being overweight and exercising too little.  Gee - this sounds familiar!  Those same things are related to many different diseases.
   I remembered this story from my past after reading about the seed myth in the current issue of the Nutrition Action Newsletter.  I have to mention the article because there is something I want to quote from it - which is quite funny, in that sad but true way.
   If you have read my blog for any length of time, you've seen my posts about colon cancer and colonoscopy as a preventative measure.  I have talked about fecal occult tests used to detect abnormalities as well.  Anyways, in the CSPI Newsletter, it was  pointed out that colon cleansing - tonics and such that are sold direct to consumers, are not necessary and could be harmful.  A physician with Georgetown University Medical center, Ranit Mishori was interviewed for the story.  She said a few things worth repeating.  
   One is that the ads suggest that using a colon cleanser will reduce ones stress.  She advises that "yoga, exercise, walking, talking, and even having a glass of wine" will do the same thing and are safe.  She doesn't understand why people think that they need to "detoxify and get the gunk out."  But her best point was made when she compared the preparation for a colonoscopy to the aftermath of a cleansing drink or suppository.  Recall this blog post where I shared my friends story of her first colonoscopy.
   Dr. Mishori said, "in either case you are sitting on the toilet for two days and its uncomfortable."  She said she was puzzled by peoples eagerness to do it for some hyped up claim on a commercial and unwillingness to do it so that they can have a cancer screening exam.  Good point.

(the article I quoted from was the cover story for the Nutrition Action Newsletter Jan/Feb 2013, but there was no author listed)

Sunday, January 27, 2013

A reasonable weight does a body good

   A week or so ago, I saw a professor who had taught a class I attended in 1999 or 2000.  I believe it was a seminar in aging.  I was completing my post baccalaureate certificate in Gerontology at the time.  In fact, the courses that I took in order to receive that 'degree' are ones that changed my personal approach to health.  I learned that what one does in their 20s and 30s has everything to do with what they will be able to do in their 80sI changed my lifestyle then and have never once faltered.  No periods of time without daily exercise and no yo yo dieting or weight fluctuations.  Prior to 1999, I had been pretty much like everyone else.  I went on a "diet" to lose the ten or twenty pounds I put on by eating just whatever the hell was in front of me.  I often ate enough to give myself a belly ache.  I exercised only in spurts.  I like who I am today so much better.
   Anyways, this professor was overweight 13 years ago - perhaps she was obese.  I do not remember her having any physical limitations, she was just over fat.  When I saw her recently, now in her 50s or 60s, it was as she was entering a room.  She walked in hunched over and leaning heavily upon a very large walking stick.  She was taking small, hesitant, heavy steps.  
  My reason for sharing this it to make the point that even if a person does not show evidence of metabolic syndrome due to obesity,  being overweight is unhealthy.   This woman was clearly disabled.  [of course, her difficulty ambulating could be caused by something else, but being overweight surely exacerbates it] 

Friday, January 25, 2013

Must READ - Weight Watchers vs Volumetrics

    After a few words, I will attach a link to an article I just read.  It is an announcement related to a US News and World Report evaluation of popular meal patterns.  Researchers and nutrition experts evaluated the quality of  several meal patterns or diets in regards to their overall nutrition value, their use in weight control or loss, their impact on health and how easy it is to adopt the particular style of eating/cooking in the short and long terms. 
   I am partial to the Mediterranean pattern which is plant/fish and healthy oil based.  It scored well in regards to improving ones health.  I am also a constant promoter of Volumetrics which was only noted for weight loss, which is not why I endorse it.  I do so because it focuses on low energy density which is a recommendation of the Dietary Guidelines for Americans.  You will see below that Volumterics is dinged for requiring extra preparation time.  I remind you that I dedicate a You Tube channel to debunking that myth!  The reporter should have interviewed me.  
   Lastly, I have consistently stated that the tenets of Weight Watchers and the results of the program participants are to be lauded.  And today it sits on the top of the list of best diets!
Weight Watchers (3.8 stars) -- The diet plan uses a points system to help people lose weight and keep it off. Weight Watchers beat other diet plans for both short-term and long-term weight loss in experts’ ratings.

 Volumetrics (3.4 stars) -- The diet is based on eating foods that are low in calories and high in volume to help people feel full while losing weight. It got high marks for nutrition, but the diet requires lengthy meal preparation.   
 The above is quoted directly from this article - READ MORE

Wednesday, January 23, 2013

Orange Juice Is a SSB!

   The commercial calls Florida OJ 100% healthy.  That is an incorrect or inaccurate statement.  Let me tell you why (and it is NOT because its from Florida).
   Orange juice is not a fruit - it is classified as a juice and more importantly as a sugar sweetened beverage.  When researchers or nutritionists are conducting dietary assessments and the person they are interviewing says that they had a glass of orange juice, the reviewer puts a check in the box next to sugar sweetened beverage.  If the same person says that they had an orange, the reviewer would check the box for a serving of fruitWe are encouraged to have 3-5 servings of fruit a day and less than one serving of SSB a WEEK.
   So whether its Florida sunshine (oj) or a juice that claims to have 50 less calories, it is still classified as a sugar sweetened beverage.  It gets counted just like a sugary soda.  Fruit juice is unnecessary. (and unhealthy with a possible exception for tomato juice)
  Eat your nutrients and drink water (or alcohol - ha ha, in moderation of course and only if you are a person without alcohol risks factors). 

Monday, January 21, 2013

Which of these three things made us fat?

   I recently read an article by Duffey and Popkin (2013) published in the American Journal of Preventive Medicine.  The researchers attempted to quantify the effects of three suspected causes of the rise of obesity in children and adolescents.  They did a similar study in 2007 on adults.  The results are not definitive, but the three    factors are worth noting.  
   Duffey and Popkin looked at changes in 1) the number of eating occasions (meals+snacks) per day, 2) the energy density of foods and beverages in those meals, and 3) the portion size of each item.  My immediate reaction to their expectation that increases in portion size and number of times people eat would explain the rise in obesity was, "not necessarily."  
   A person might not gain weight under those conditions if they applied the concept of Volumetrics (B. Rolls) or chose foods low in energy density as the Dietary Guidelines advise.  In the thirty years that were studied, portion sizes and number of eating occasions did rise (and sometimes fall).  The energy density of the meals did not show a clear pattern of increase or decrease. 
   In the past 13 years, my number of eating occasions and portion size also increased, but my weight did not. That is because I have strictly adopted the low energy density concept.  I was able to increase the size of my meals because I reduced the calories per gram in each of them.  (I also eat no less than 8 times a day)
   What the researchers did find when studying adults was that in the past 30 years, the change in total energy intake that is associated with the rise in obesity, has involved all three.  More of the change is explained by portion size and an increase in number of meals eaten.  In the last five or more years, portion sizes have begun to decrease.    
   You can review the abstract (a summary of what they did and what they found) by clicking here.

Friday, January 18, 2013

Cancer - Know the Numbers

This information in this post was gathered from the most recent version of Cancer Facts and Figures 2013, published by the American Cancer Society.
    New cases of cancer projected for 2013 are primarily of the lung, breast, colon/rectum and prostate. The biggest killers, based on my quick scanning of the number projected to occur and the number projected to cause death, are lung, colon and pancreas.  The number of new cases of pancreatic cancer are a quarter that of lung cancer, and 13% them will die.  Half the lung cancer patients will also die (slightly more men than women).  Tobacco is expected to contribute to 174,100  of the 2013 cancer deaths (most will be from lung cancer).  In the American Cancer Society report, a chart showing the trends for cancer death rates  is remarkable in its depiction of lung cancer.  It trends up for both men and women, hitting a peak for men about ten years earlier - and has been declining in men from about 1990 and more recently for women.  A review of the research on smoking suggests that these trends are related to when men and woman started to smoke (different era) and when they started to quit.  It is the kind of graph that smoking friendly countries need to consider.  The incidence of cancer comes some ten to twenty years after smoking rates pick up.
   We lack effective treatments for pancreatic, lung and colon cancers.  However, colon cancer is one that can be prevented, like cervical cancer, by regular screenings which identify pre cancerous lesions that can be removed.  (Breast cancer is one that continues to occur but kills less people because of treatment options)
   What is most important from my position in public health is that as much as 33% of the projected new cancer cases could be prevented because they are associated with poor diet, overweight/obesity and lack of physical activity.  
   Cancers that are caused by infections, such as HPV, HBV, and HCV may be avoided with vaccines.  HIV related cancer can be reduced by preventing the transmission of HIV through safer sexual contact.
   Other risks for cancer include genetic and environmental.  Usually a series of events occur before cells mutate into cancer.  We are getting better at finding cancer sooner, but it can be as many as ten years from an exposure to a diagnosis (think smoking, suntanning, CT scans, phthalates in plastic, etc).
   There is so much more to tell you, and I regret not having the time to really dive into this report - as I have in years previous. Instead, I strongly encourage you to open this document.  The introduction alone is worth its length in gold.  It explains what cancer is, what may lead to it,  how it is diagnosed and staged and what certain terms like life time risk and relative risk mean.  
   Briefly, the life time risk of developing any type of cancer is about 44% for men and 38% of women.  This is in general and does not take into account any of your individual risks or protective factors (i.e., it could be higher or lower for you).  The life time risk for a certain cancer maybe higher or lower than those numbers as well.  Relative risk, as explained in the document, is when you compare a persons risk to someone elses - someone who may be different.  For example, the relative risk of lung cancer between smokers and non smokers, or colon cancer between those who eat a plant based diet and those who eat a meat based diet.
   Please take the time to look at the document.  I know you have heard about this on the news lately - or seen newspaper articles, but its not the same as "being there".

Wednesday, January 16, 2013

More on labels and calorie disclosures

   Packaged food labeling is one of my research interests and my research interests are informed by my personal dietary goals. 
I believe that in order for the population (and me) to apply the nutrition recommendations offered by our government, we need to assess the foods available to us.  In order to assess them and choose the best, we need information.  We don't need a lot of information, but we need some.  We need enough to make an informed, but quick decision among many options.  
   I prefer the multiple traffic light system for any item, but at this time that isn't likely to occur.  The multiple traffic light (MTL) grades a food on imprortant attributes, e.g., saturated fat, salt and sugar.  A food gets either a red, yellow or green light in each category.  To eat well, you choose more foods that are green from all categories.
   The Institute of Medicine (IOM) has given the FDA a proposal that will make assessing the nutrient value of packaged food easier than our current Nutrition Facts Panel. I have discussed this at length in the past, so this is a bottom line refresher.  Instead of a MTL, the IOM suggests that each food item - if it first meets an overall eligibility criteria - be given one, two or three stars for each nutrient (saturated fat, sugar and sodium/salt). An example of something that wouldn't meet the eligibility criteria is candy.  Otherwise, a food item could have 1 to 3 stars.  ALL products, per the recommendation MUST list the calories per usual(practical) serving.  Whether or not something meets the eligibility criteria for stars, the calories per serving must be placed in eye catching text on the front of the package.
   It was that part of the recommendation I was thinking of as I shopped for groceries over the weekend.  You see, one of the main reasons for the IOM report is to address the confusion caused by food makers and grocers using their own front of package labels.  It is amazing how many do not include calories, and instead tell us things we can't intrepret or do not need to know.  For example, a grocery store shelf tag in Florida said, "20 carbs per serving".  SO WHAT??  That is not enough information to help me.   Another example, "contains 10 grams of fat".  SO WHAT?  Is it the kind of fat that is good for my heart?  If so, I want to buy it.  But no matter what it is, if it is energy dense (high in calories) I will probably avoid it (unless it is loaded with good fat, like salmon). We need our standardized, scientifically governed front of pack labels and we need them NOW.

  My other nutrition information interest is meals away from home  -  you need to see this new report from CSPI for some jaw dropping belly popping calorie counts.

 (If you are curious, my overall field of study is best explained this way - Public Health Law Research specific to Food Policy, specific to Policy that makes unhealthy (nutrient poor) foods less attractive > such as, information, price increases, zoning laws on fast food places, taxes, display bans/restriction, advertising limits.)

Monday, January 14, 2013

Why Exercise is Essential

  Here is the most important thing that you need to know about exercise – and it applies to either weight loss or weight gain.  Exercise matters because it has an impact on body weight; specifically, body weight ratio.  Most basically, our body weight is composed of fat mass and fat free mass (sometimes referred to as lean body mass).  Fat free mass involves several components, including, bones, muscles and water.  When you change your body weight, it is essential for good health and calorie expenditure that you increase your fat free mass and/or preserve your fat free mass.            
   Exercise helps you to do so because it builds muscle.  Muscle where most energy is burned.   If you lose lean body mass you may weigh less but have a higher ratio of body fat and this is not good.
   A person can be overweight and not have metabolic disturbance if they exercise and keep up their fat free mass (they may still have joint problems though).  A person can be thin and have metabolic dysfunction because they have a higher proportion of fat mass.
   Cardio exercise can certainly keep you toned, but to build muscle I recommend that you consider strength training (resistance or weight lifting) at least twice a week (as the PGA suggest.)
   I also want to share with you this sentence from the recently released report U.S. Health in International Perspective: Shorter Lives, Poorer Health from the Institute of Medicine and the National Research Council (2012).

[D]ecades of research suggest that avoiding sedentary behavior and engaging in regular physical activity (independent of body weight, body mass index, and dietary habits) exerts its own protective effect on the risk of heart disease and stroke and possibly other conditions, including cancer, depression, and dementia (Lee et al., 2012; U.S. Department of Health and Human Services, 2008a).

   As the sometimes controversial Robert Lustig, MD says, “exercise is the anecdote for anything that is wrong.”  I agree – and you know that I do.  He also thinks fructose is the root of all evil and that foods that cause the release of insulin are the culprit for our obesity epidemic or the diseases that accompany it.  I am not sure – but he has a new book out that you might like to search for if you are interested.  I agree with him 85% of the time, somewhat less than I agree with Walter Willett (90+%) and a lot more than I agree with that Dr. Oz fellow.  

Interested in the full report regarding the poor health of Americans compared to similar countries... click here.

Friday, January 11, 2013

Infection, bugs, antibiotics and YOU

   After coming down with an unexpected illness - unexpected because I just don't get sick -  I have a 'lesson learned' story to share with you.  First a few details about what ailed me.
   One evening, a few days before Christmas, I noticed that my elbow, right on the bone, hurt if I touched it. Within a few hours of noticing that pain, I had swelling around the elbow and about two inches up the back of my arm in the tricep area.  The next day I treated what I thought was a spider bite, and it could have been, with ice and ibuprofen.  I was treating the inflammation.  The area was pink and hot - which in retrospect, is a sign of infection.
   About one and a half days later - on Christmas day in fact, I realized this was something I could not fix myself.  I also felt chilled and feverish.  At the emergency room, I was diagnosed with cellulitis AND bursitis of the elbow.
   Cellulitis  is a bacterial infection of "loose connective tissue just under the skin" and the bacteria that usually causes it is a strep or staph type.  Bursitis is a condition in which a small sac that protects a joint, like a knee, hip or elbow, becomes irritated (possibly from swelling caused by an infection elsewhere!) and the sac fills with fluid.  The cellulitis is treated with antibiotics and the area of bursitis is usually aspirated (i.e., the fluid is drained with a needle).
   Because I had an infection, or because it was Christmas, there was no mention of aspiration.  I was given an intramuscular injection of a strong antibiotic, rocephin and a 14 days supply of an oral version of the same drug family (cephalosporin),  Intra muscular means into the muscle.   I learned the other nifty antibiotic facts from a chart I found on line and you can view it here.
   Turns out I was moderately sick and it took almost a week for me to feel myself again - but I only missed two exercise days :)  I finished my oral antibiotics this week and should be seeing a sports medicine doctor next week re the bursitis.  My elbow still hurts just on the knob, and it appears to still have excess fluid.  I would let it go, but I am concerned about my ability to return to swimming.  The pool opens next week! And yoga is a little painful still.
   But here is what I really wanted to share with you so I hope you are still reading.  When I saw the nurse practitioner at student health for my follow up (the incident occurred when I was out of town), I told her that I could not remember the last time I took an antibiotic.  I bragged that it had possibly been ten years, and therefore, I was pretty confident that I would clear this infection in no time.  I  - I told her - am NOT resistant to antibiotics.
  Here is the problem - and now that she said it and I'm writing it - it feels like I should have known this.  It is not ME that we need to worry about - its the bacteria - the bugs, germs etc they are resistant to the antibiotics .  I am sure that it matters that I am healthy and have a good immune system, but I still have to worry about the bugs that have become strong due to other peoples over use of antibiotics (part of that is doctors faults and part of that is patients faults, or parents faults).  It is rather the opposite of Herd Immunity - I'll let you look that up.
   So that is my Christmas Story... boo , huh.
 PS - as I researched these issues after the fact, it is likely that the germ got through my skin (skin is a defense shield) not from a spider bite, but from a pretty severe exacerbation of eczema that I had at the end of the fall semester. There were openings in my skin from the rash. It worsens under stress.  And though I can't say for sure where I was exposed to the bacteria - there is a good chance it was one of the three airports I passed through on the way to my Mom's in Florida.