Monday, November 25, 2013

The new trans fat? Acrylamide 11 Years Later.

My blog site search engine is currently broken.  This is unfortunate because several years ago,  I wrote a post about a chemical found in french fries that was linked to cancer or which actually caused cancer in experimental studies involving mice.  Of course the mice were fed foods with much more of the chemical than most of us would be exposed to, but anytime a substance is considered a carcinogen or in the case of acrylamide a "probable cancer causing substance," I tend to steer as clear of it as possible. 
When I wrote about acrylamide years ago, it did not pose much of a threat to me as I don't eat french fries, chips or any white potato foods.  But the latest report regarding acrylamide includes cereal based foods (which includes cookies, crackers, whole grains and cold cereal) and COFFEE!   This is a sad day.  (To be fair, the first report may have said the same thing and I glossed over it).
Acrylamide is not a naturally occurring substance, but one that is created during some cooking processes.  For example, using really high heats in frying, baking and roasting (coffee beans are roasted and that is how coffee becomes tainted with acrylamide).  In this way, acrylamide reminds me of the harmful chemicals that are created when red meat is grilled and for that matter, the cancer causing chemicals in cigarette smoke (which among other things, also has acrylamide) - the chemicals aren't there until you or someone else does something to the product. 
The FDA has issued some guidance to food manufacturers and growers to help them reduce the amount of the chemical that is 'created' when the foods are processed.  With regard to chips and fries, the sugar in the potato seems to interact with the heat causes acrylamide to develop, so farmers are encouraged to grow low sugar potatoes. For coffee lovers, it is good to know that some types of coffee bean have less acrylamide after roasting than others - the FDA report notes that one lower acrylamide coffee bean is the arabica type (my sister had long ago convinced me it was the better tasting roast and I agree).  
The cereal foods category has me a little perplexed and concerned both personally and professionally. Acrylamide is created from an amino acid in the grains, called asparagine.  When the grains are heated at high temperatures, this amino acid is effected. According to a report I read and link below, the major culprit is whole grain, yes ~ the kind we are supposed to eat more often. I wonder if this means my cereal bars, made from All Bran, oat bran and Kashi Go Lean, or my mini cakes, made from whole wheat and soy flour are sources of acrylamide in my diet. Not cool. This will be a challenge for the FDA because they encourage us to follow the dietary recommendations from the USDA/DHHS  which focus on a plant based diet high in whole grains and fiber.  
The FDA is currently studying the impact of acrylamide in levels Americans are likely to consume (i.e., less than the mice did) in order to determine if more serious measures need to be taken.
For now they recommended avoiding french fries and chips and dark or burnt toast. 
Here are some FDA links that offer more information. 
FDA Q and A 
Food sources and cooking 
This next link is the report to industry and it is very telling, e.g., it discusses growing, transporting, storing and prepping potatoes in a way to reduce the amount of acrylamide that will be produced when those specific potatoes are fried.   The report has a section on cereals and coffee as well. When I was reading this I began to feel the general public's frustration with nutrition science and guidance.  
Lastly, a public health statement from the CDCs Agency for Toxic Substances and Disease Registry from 2012.

Wednesday, November 20, 2013

What does it mean to be metabolically healthy obese?

     Over the past weekend, I read a summary statement for a research study by Camhi and Katzmarzyk, 2013.  I was intrigued because the exercise and health scientists explored the differences in body composition (e.g., % lean mass, fat mass, bone density, central fat tissue) between two groups of obese people. The people in the study were classified as metabolically healthy obese or abnormal obese. The summary statement did not indicate if obesity was determined by BMI, waist to hip ratio, waist circumference or some other measure.  It did say how the determination of healthy vs unhealthy (metabolically speaking) was made, and I thought this a teaching point.  (FYI: Simply put, metabolic refers to under the skin - cellular processes. So the researchers were not looking at whether or not there were mental health issues, or physical conditions like arthritis, in this group of obese persons.)  I also do not know why the researchers chose the criteria listed below to determine metabolic health, but each has been independently associated with poor health outcomes, like heart disease, in other studies.  Of the following measures, an obese person in the study who had 1 or less of them was considered metabolically healthy, and an obese person in the study who had 2 or more was considered metabolically abnormal.  

The measures were:
  1. a blood pressure reading higher than 130/85 mm/Hg
  2. a fasting glucose level greater than 100 mg/dl
  3. a waist circumference greater than 102 cm men, 88 cm women (click here to convert to inches) 
  4. triglyceride level (blood fats) higher than 150 mg/dl
  5. hdl (good) cholesterol less than 40 mg/dl men, 50 mg/dl women
     I noticed that they did not use total cholesterol levels or LDL levels. 

     The aim of the study was to see if something about body composition was different between the two groups (could this difference explain the accumulating risk factors).  The researchers did find differences, which were specific to gender.  For most of the body composition measures they assessed(not described here), the metabolically healthy obese had lower values.  For example, both metabolically healthy men and women had lower fat mass and less stomach or trunk fat.  Most every measure was related to a type of adipose(fat) tissue, such that the more fat one had on their body, and in specific places, the more likely they were to have more than 2 of the risk factors and thus be metabolically unhealthy.
     Take home point.  Your absolute weight is not as important as your body composition and the 5 measures listed here are numbers you might want to pay attention to at your doctor's visits.

Saturday, November 16, 2013

Reducing purchases of sugar sweetened beverages

   I am posting about a study that was discussed in the popular press this week (if I remember correctly, it was an on-line article from a Boston newspaper).  I have not reviewed the research though I did contact the lead author/scientist, Dr. Jason Block to see if a publication is pending.  That being acknowledged, I will summarize the news story and add a few thoughts.
   At the very least, this study on sugar sweetened beverages (SSBs), like soda, juice, sports drinks, flavored whole milk and coffee drinks, offers promising results.  Dr. Block and his research associates tested whether raising the price of SSBs that contain 150 or more calories, would lead to a decrease in purchase of said drinks.  There was a 16% decrease in sales after the price change (1 cent per ounce, so $.20 increase in price).  Without seeing the research article, if there is one, I can't tell you the absolute change in number of beverages sold.  I also don't know what, if anything, the people spent their saved 'soda' money on.  They might have spent the money they did not spend on soda on foods that might be high in sugar or calories, on sugar free drinks, or on nothing. That is an important outcome to assess in these types of studies.
    In a second study, the same team labeled the SSBs with their calorie content and organized the display of drinks by amount of calories.  I assume that the first columns were sugar free items, then low calorie, then high calorie.  In this experiment, sales of low calorie drinks increased by about 11%.
   The results of this work support both the use of calorie labeling and taxation (price manipulation) to change behavior and thus, improve health.  However, I do not know the details of the study, so I make that assertion with some caution.  I would like to know more about any unintended consequences (substituting soda for chips, eg) and whether or not the changes that were seen were able to be sustained over time.  Lastly, this study took place at one work site and the results might be different elsewhere.  
    If/when I hear back about the study itself, I will write a follow up post.  I am very interested in this type of population level intervention.  In other words, putting effort toward changing the environment instead of changing people in one on one interventions (like a diet class).

Tuesday, November 12, 2013

Cholesterol Lowering Drugs

   To my knowledge, there is little evidence to support broad use of statins - or medicines that lower cholesterol.  The goal for treating high cholesterol is to decrease risk of heart attack and early death.  The research I have reviewed only showed this benefit for statin users who have been diagnosed with heart disease or who have had a heart attack.  It is that group that benefits from use. The new recommendations are to give statin medications based on factors (like having diabetes) other than a persons blood cholesterol level.  In a way, this removes the argument of how high the LDL level has to be before medicine is prescribed and at what dose should the statin be started, based on that LDL number.  The cut off number was always arbitrary.  How could there be more risk at 120 and not 119, for example.  But I don't know that this is any better, because it still places an emphasis on pills over lifestyle.
   I share the concerns of CNNs Dr. Sanjay Gupta who equates this shift to medication over changes in diet (and exercise) as a sign of defeat against the prevention of diseases associated with obesity.  Medication is not the solution here and we shouldn't give up on prevention.
    I understand that efforts to nudge people into better lifestyles has not been successful.  I don't think encouraging people to rely on medicine to fix problems is better than changing the environment to provide people better options (i.e.,  options to be physically active and to eat in moderation).  It does seem that nutrition information and nutrition guidelines are consistently and broadly misunderstood by a majority of persons.  This is in large part due to the complicated and ever changing information out there.  It is confusing and most people don't know what to look for when assessing a food's nutritional content and 'healthiness.'
    Just recently, I walked by a man and woman at the grocery store as the man was reading the back of package nutrition label.  (YAY!)  I heard him say, "Oh no, this is loaded with carbohydrates."  I wanted to stop, go back and ask him,"And what exactly does that mean to you?  Why is that a good or bad thing?"   Because if all someone told me was "its loaded in carbohydrates," I could not make an informed decision.  Sugar is a carbohydrate, so are vegetables and grains!  
   Our education and health promotion efforts must be constant, but simplified. Americans consume diets that are high in calories and items that might lead to high cholesterol, diabetes, obesity, heart disease, etc.  The main objective to improve health should be changing the diet (and increasing activity) not medicating the entire country.  Using medication in this way is as foolish as providing more rescue workers to collect the drowning from the river instead of putting a rail on the bridge to keep people from falling in the river.

Saturday, November 9, 2013

Will the new trans fat law start a Peanut Butter war?

   I sure hope so! It is no secret - I am a fan of 'truly' all natural peanut butter.  When I say truly, I mean that the ingredients written on the label, if you didn't churn it yourself at a whole foods store, are simply: peanuts, and sometimes salt.  It is also no secret that Smuckers All Natural peanut butter is my favorite.  I have blogged about it numerous times and even made a You Tube video showing the world how to stir it.
    The reason a truly natural peanut butter needs to be stirred is that at room temperature, the oil will separate.  Peanut oil is NOT a solid fat.  In order to make it solid, it has to be hydrogenated, or in some cases, a solid fat is added to the peanut butter  - like palm or coconut oil (called oil only because they are plant based).  Palm, coconut and palm kernel oil is the same type of fat as beef or butter fat - it is almost 100% solid (saturated) fat.
   Trans fats are bad fats - not in excess, but period - in any amount (according to research reviewed by the FDA).  A trace amount of trans fat occurs naturally, but most trans fats are created in the process used to make unsaturated fats stay solid at room temperature and to make them last longer. [an example of when this process has been applied is when peanut butter is on a store shelf and the peanut oil has not separated - it isn't floating on the top.]
   The FDA is now banning all trans fats because they have been found to lower good cholesterol (HDL), raise bad cholesterol(LDL) - both of which are linked to heart disease, and to independently (whether you have high LDL cholesterol, low HDL cholesterol or normal cholesterol) increase the risk of heart disease.
   So begins the peanut butter war - I predict.  Currently, trans fats are allowed in products, except that nice ban in NYC restaurant foods.  And under current law, if a product contains less than .5 grams of trans fat, the label can say 0 trans fat per serving.  WELL.  The FDA says no amount of trans fat is considered safe.  There is no safe dose.  Just like there is no safe dose of lead. (Besides that - those little .4 grams of trans fat we consume unknowingly from multiple products can add up in a day!)  
   Therefore, when the law takes effect (and no I am not holding my breath), food companies will not be able to claim zero trans fat when they are providing nearly half a gram because they can't sell a product that contains ANY synthetic trans fats.  Hence, I bet those "all natural" but surprising solid at room temperature "no need to stir!" brands of peanut butter, are going to disappear.  I say, 'good riddance.'
    And in the meantime, keep reading those ingredients labels.  Your peanut butter does not need added oils, peanuts have their OWN oil and that is what makes all natural peanut butter natural - the peanuts - and just the peanuts.

If you missed those past posts on the different brands of peanut butter and how the labels can be misleading, click here. If you only have time for one of those posts, I recommend this one, which explains why you have to stir the peanut butter and why that is a good thing.
I am not going to share the You Tube link, though you can find it easily enough.  Some people got into a comments free- for- all about my stirring the peanut butter and said some things I wouldn't want my mother to see!  Still, people should be able to say what they feel (even smart asses) - so I left the posts up.

Monday, November 4, 2013

Future Self-Control

    I am 100% in favor of mandatory nutrition information at the point of purchase for ready to eat foods at all places where they can be purchased (e.g., restaurant, vending machine, movie theater, bowling alley).  I believe that an interpretive system, like the multiple traffic light (red for high in a nutrient, amber for moderate and green for low), is crucial, but I understand that nutrition labeling as a means to change behavior will always be less effective than other strategies, like zoning laws and taxes.
    The provision of nutrition information, even with a color code or star rating system, leaves individuals free to make an informed choice.  Unfortunately, choosing food isn't the same as choosing a dishwasher (which also comes with content info and a rating system).  
   There are many things that influence a food choice.  One of my favorite theories or frames which addresses these nuances is behavioral economics.  
READ THIS GREAT ARTICLE, by Liu, Wisdom, Roberto, and Liu (2013).  
  The reason I think the traffic light labels are crucial is two fold.  First, most people do not have awareness of dietary guidelines or the nutrition knowledge that allows them to determine if a food is high or low in items that are best limited (e.g., saturated fat, sugar, salt, calories).  Second, many people are present biased in their (food) decision making. In other words, the desire for the taste or the happy memory associated with a certain food, is first and foremost in a present biased persons mind.  The needs of  'here and now' trump any consequences (weight gain, ill health) that might occur sometime in the future.
   There is another factor (noted in the article I linked earlier) that I wanted to share.  I think you will go "oh my gosh, that is so true!" just like I did.  This is the belief or confidence we have in the self-control of our future selves.  For example, on a certain day of the week, you know that you should skip dessert.  You are full and can't afford the extra calories.  But it is someone's birthday so you just have to have some, and you'll do better next time or the next day.  Then someone brings cookies to the office and you really shouldn't have any, but everyone else is having them, and they really taste good, so you eat the cookies and promise yourself that tomorrow you will have dinner with out bread.  Oh, but tomorrow comes and the waitress served bread so you have to eat it, right? etc.....