Wednesday, April 30, 2014

Quitting smoking and E cig update

Let me be clear from the onset, this post is not about quitting smoking by using e cigs!  I am merely planning to share two items with you.  This first is a story about quitting that someone told me today and the second, in case you missed it, is the FDA and the Center for Tobacco Products announcement on e cigs.

I have come to know the bike mechanic at a large sports store near my home (because I buy old bicycles with numerous problems).  One day, maybe last year, I saw the bike mechanic smoking outside the store and this made me sad.  Another day, also last year, he told me that he was considering going to college to study a health profession (pharmacotherapy) - this was after I told him about my work in Public Health.  I was very happy to hear his plans and encouraged him to go for it, while adding, something, I can't remember exactly what, about smoking.  A long discussion on quitting ensued, because in the past I officially helped people to quit smoking, and he seemed interested in hearing about it.

Today I saw him again and he immediately and enthusiastically told me that he had quit smoking.  Not one puff in the last month.  He said that he had been thinking about it for some time and finally it hit him, 'I'm done.'  

I quit in the same fashion, but its rather uncommon (successful cold turkey).  He spoke about the first week or two after he quit, all the junk/gunk he coughed up.  I know why that happened; his cilia (protective, hair like filters at the back of the throat) were coming back to life and doing their job, but most people (smokers) who experience this intense coughing, think that they were better off smoking and go back to it.  Unfortunately, a drag off a cigarette may stop the coughing (because the cilia are killed by tobacco smoke).  My friend, the bike mechanic, did not fall for that!  He saw the coughing for what it was - healing, detox and stayed with the quitting.  Next he noticed that fruits and vegetables actually taste GOOD - so he is also eating better.  I am glad because the antioxidants in fruits and vegetables will help clear up some of the smoking damage.  Plus, he is young.  Quitting while under the age of 30 may allow the smoker's body to become like that of a nonsmoker (over time).  So kudos to him and anyone else - regardless of age - who quits.  There is only one thing better than quitting smoking and that is not starting in the first place.  To see the benefits of quitting smoking time line from the American Lung Association click here.

E Cigs
The Center for Tobacco Products will be regulating e cigs in the same manner as cigarettes, smokeless tobacco and the like.  This means, for starters, e cigs cannot be sold or marketed to children, flavors might be forbidden (flavored tobacco, with the exception of menthol, has been outlawed by the Family Smoking Prevention and Tobacco Control Act of 2009), and the companies selling/marketing e cigs cannot imply health benefits or cessation efficacy without providing  scientific evidence to back such claims.  In addition, makers of the products will have to file reports which disclose the smoke or vapor constituents(chemicals) and quantities from their product.  WHEN this will happen or when the info will be available to you, is not yet known.  Read the press release here.

Monday, April 21, 2014

The Sunshine Study: Does it do your weight good?

A couple of weeks ago I heard a news story which referenced the power of sunshine.  Readers who have met me know that my favorite thing in life is sunshine.  I was delighted to hear that science supports something I knew anecdotally (i.e., by my personal experiences); the sun does a mind good.  It follows that what does the mind good will do the body good (tanning excluded!).

The headlines were even better – tantalizing even… early morning sun aids in weight control… or those who spent time in the sun between  8 and 11 a.m. weigh less (smaller BMI) than those who do not get out in the early sun. REALLY?!  I exercise outside almost every morning (walk, bike, run) after 8am but before 12.  Yay!

I do have a low BMI, but I know it is because of my dietary intake and physical activity (it certainly isn’t my genes), I am not inclined to believe that the sun I adore is keeping me thin.  Still, I wanted to learn more about this study so I could give my favorite ‘element’ the kudos and promotion it deserved.

I located the referenced study – referenced in the popular press and linked for you below – and read every single word.  I read and read, paragraph after paragraph, I read and searched and waited… until I got to the very end, past the introduction, the methods, results, discussion, limitations, acknowledgement and the references.  I even used ‘word find’ for goodness sakes FIND: Sunlight or Sunshine.  Nada, nil, zilch.  Sunshine is not mentioned once in the study.

Below I offer a little information from the study, and then the email response from the corresponding author, because of course I emailed her.  I had to be doubly sure I didn’t overlook the part where the people talked about the time they spent in the sunlight.

Participants (54 people) agreed to wear a special light and activity sensor on their wrist (on the outside of their clothing) for 7 days.  This device generated data that the researchers could review, i.e., when the person fell asleep, how long they slept, when they were exposed to light – background, ambient light – and the level of intensity of that light.  The unit of measure for light is LUX.  The participants also completed a 7 day food intake diary and gave their heights and weights (for BMI calculation).  The goal was to see if timing and intensity of light was associated with sleep, eating, or BMI. 

The only finding that was considered ‘real’ was that people exposed to higher levels of light i.e., > 500 lux had lower BMI numbers than people not exposed to light above 500 lux.  This correlation only held if the exposure occurred in the early morning hours. 

It is probable that the light at > 500 lux was from the sun, but there is absolutely no way to confirm this.  Researcher Phyllis Zee kindly responded to my email inquiry and said that with a lux over 200 it is expected that sunlight was ‘involved,’ but the source of light was indeed unknown. Also, I think it is important to note that a BMI even if accurately representing excess adipose tissue is not something associated with the last 7 days!  One BMI point = 6 pounds and well, my BMI is about my last 7 years, not 7 days.

All that being said, Sunshine Makes Me Happy and that is all I need to know.

Friday, April 11, 2014

Cocoa and Weight: What do mice have to do with it?

I regularly consume cakes and cookies made with pure cocoa powder.  I choose cocoa powder because I understand that it contains substances (e.g., antioxidants, polyphenols, flavanols) that promote health similar to the way fruits and vegetables do.  I also choose it because it adds great flavor - a wonderfully rich chocolate taste - acts like a leavening agent (and therefore must be one, because my cakes and cookies with cocoa are fluffier than those without it), and adds only a small amount of calories.

I do not add cocoa to my foods because I think it will allow me to eat a calorically dense high fat diet without consequence.  In other words, I would never read the headline Eating Chocolate Keeps You Thin and 1) believe it, or 2) start eating a lot of chocolate. So when I saw this actual headline: “Eat Chocolate to Get Thin? Study Touts Cocoa for Weight Loss,” in Forbes magazine, I decided to find and read the actual research. The study was published in the Journal of Agricultural and Food Chemistry.  The study subjects in were not people and they were not given cocoa in the sense that you and I know cocoa.

I have just finished reading – really reading – my first scientific study in which the subjects were animals, mice in this case.  The details on the mice were fascinating: where the mice came from, how they were kept (i.e., the type of cage, the number of mice to a cage, the air temperature, the humidity, and the cage cleaning schedule), how their body composition was measured, how they were fed, tested for glucose and insulin tolerance, and finally euthanized and autopsied.  Well ok, the killing of the mice was not at all fascinating; it sort of broke my heart a little.

As I said, the study was published in a chemistry journal, so I am trying to simplify something I can only begin to grasp.  The scientists in this study (Dorenkott, et al 2014) began by explaining that the chemical properties of cocoa have shown health promoting effects in previous animal studies, but the exact mechanism of effect is not fully understood (e.g., if mice who consumed cocoa had less heart attacks than mice who did not consume cocoa is it because the cocoa reduced plaque buildup? lowered LDL cholesterol? raised HDL?).  In addition, researchers have not identified the specific part of cocoa that is creating the positive outcome.

Cocoa is rich in a compound called flavanol, which researchers believe drives its health promoting or disease inhibiting effects. Flavanol breaks down into several other components and in this study, the researchers wanted to compare cocoa extract and three fractions from the extract: polymer rich, oligomer rich, and monomer rich fractions. The researchers were specifically testing how these 4 substances influenced weight and body fat (i.e., obesity markers); and glucose/insulin tolerance (i.e., diabetes markers).  

This was a feeding study, not a weight loss study and the mice were NOT put on diets.

In order to compare the 4 substances, the researchers fed a group of mice one of six diets.  Each cage of mice was randomly assigned to one of six diets: a low fat diet with no cocoa ‘parts,’ a high fat diet with no cocoa ‘parts,’ a high fat diet with cocoa extract, a high fat diet with a monomer rich fraction, a high fat diet with a polymer rich fraction or a high fat diet with an oligomer rich fraction. Staff prepared and weighed the food before providing it to the mice. At the end of each of 12 weeks, the food was removed (if left over) and weighed again – similar to a plate waste analysis – and fresh food was provided.  The researchers placed the exact same amount of calories in each cage, but the mice on the low fat diets consumed more total grams of food.  I expect this is because the number of calories per gram is higher in a high fat diet. 

What I described sounds like the ideal controlled experiment. The mice could NOT cheat on their diet and were not aware of which study condition they were in.  All the mice lived in the same ‘neighborhood.’  The mice did not self-report their food intake or weight and every mouse was tested with the same calibrated device.  The study lasted 3 months, which is enough time to get an idea of an effect; and because it was an experiment, we can be confident that any difference in the outcomes was due to diet type.

Still, even in this near perfect situation there was an issue regarding the dietary intake.  As already noted, there was more food intake (by weight) in the low fat diet.  In addition, the texture of the diets was different.  Texture can influence diet likability and accuracy of the plate waste measurement.  The low fat diet was a powder-based diet; calories were in the powder and the powder was hard to clean from the feeders.  Some of the powdered feed could have dispensed into the cage uneaten and unnoticed by staff.  So, as a consumer of research, keep in mind this limitation.  It is possible that the low fat mice did eat fewer calories than the high fat mice even though the study was set up so that the calories would be the same. 

The high fat diet mice all ate the same amount of food – across the 5 high fat diets.  This is important because in other studies, one concern has been that the cocoa extract/fraction was making the food less enjoyable, leading the mice to eat less food and therefore gain less weight because they were consuming fewer calories (not because cocoa was limiting their weight gain).  In this study, the researchers are confident that the calorie intake was the same, so any differences in actual body weight, body fat and diabetic markers is attributed to whichever supplemented diet (if any) showed such differences.

I may have a limited understanding of the chemistry of cocoa, but the graphs showed a clear difference in outcomes between any high fat diet and the low fat diet. The mice on the high fat diets gained more weight and increased their body fat more under any of the cocoa conditions than the low fat diet mice.  There were a few subtle differences between the diets on the diabetic markers.  The low fat mice always had the best outcomes (e.g., lower fasting blood glucose), but in some cases one or more of the high fat diets with supplementation was equal to the low fat diet or one of the high fat supplement conditions was better than the high fat diet without any cocoa substance.   The high fat diet without any cocoa substances was always worse than the low fat diet.  Remember when I say diet, I mean meal plan; the mice were fed a high number of calories in order to cause weight gain they were not ‘dieting.’  

The researchers will be following up on the oligomer rich cocoa fraction as it showed the most promise in this study.

An important side that I want to point out is that the researchers justified the study by stating as fact that high fat diets are detrimental to health because they lead to obesity and metabolic dysfunction.  This leaves me wondering why we still debate the pros and cons of a high fat diet and why we are using our resources to find fixes for things we could change.  Is the goal of the research to give people a cocoa extract pill that allows them to eat a high fat diet without jeopardizing their health?  I suppose that makes sense if the high fat diet refuses to die; we will need alternative measures to improve health outcomes. 

The researchers killed and autopsied the mice at the end of the 12 weeks.  I find that the most disturbing part of this study – the headline should be, “Mice die so you can keep eating a high fat diet.’

Thursday, April 3, 2014

It's what you eat, not what you call the diet.

David Katz and Stephanie Meller co-authored a systematic (careful, organized, detailed) review of research related to 7 popular dietary patterns (e.g., low carbohydrate, low fat, Mediterranean, paleolithic, vegan).  You can access their work, including a table that lists the diet categories and the features of that diet here.  For example, the paleolithic diet is based on - or tries to emulate - what we believe our Stone Age ancestors ate, therefore people consuming a paleolithic diet avoid processed foods and eat a lot of vegetables and fruits. The rationale for why each diet pattern is included in the review, or why we should care, is also listed in the table.  For example the low glycemic diet is included because a lot of research is devoted to studying how the body handles foods of different glycemic values (I have blogged about this) and glycemic index and glycemic load could matter for diabetes control.

The actual research article is about 13 pages long.  It is thorough.  It is NOT hard to read - if you have ever asked yourself (or me!), "which is the better diet?" - take the time to read the article for yourself.  Heck, start with the discussion section at the end if you like and if intrigued, go back and read the information about the diets themselves. The authors do not throw statistics at you.  They tell you why they chose to include certain studies, for example, because they were experiments that included a representative sample.  We, the readers, take it on faith that the study authors' (Katz and Meller) interpretation is correct and that they have done due diligence.  I want you to know that I feel confident in the conclusions made by these two authors. 

Here is the take away.  With regard to weight, it is still about calories and some diet patterns make it easier for a person to consume the right amount of calories for themselves.  That is not universal; the pattern that is right for me might be a disaster for you.  If you're curious, I am a blend between Mediterranean and vegetarian as these diet patterns are described in the article.  [That is an important point.  Any of these diet patterns can be trouble if the substitution one makes is to a food containing a high amount of a nutrient of concern, e.g., stop eating cheeseburgers start eating cake.]

But Drs. Katz and Meller were writing about diet patterns and health not weight loss.  Is it healthier to avoid meat altogether or to eat a low carbohydrate diet, for example?  At the conclusion of their study of the studies, Katz and Meller emphasize that we already know the answer and no matter how we actively or passively distract ourselves with the 'diet of the day,' the truth is the same.  A plant based diet, which is minimally processed and contains select carbohydrates (my new favorite way of distinguishing them), and meats that when eaten come from animals who themselves had a natural, plant based diet is health promoting.  The review also debunks the myth that grains make you fat and instead supports a dietary pattern that includes whole grains which are high in fiber because they are associated with lower rates of disease and better weight control.  My Mediterranean diet is high in whole grains and fiber.

Just an FYI, another way that Katz and Meller address the oft misunderstood carbohydrate is to suggest limiting "the objectionable carbohydrate sources—namely, starches and added sugars."
Amen to that.

Here is the proper citation and a link to the article.
Katz, D. L., & Meller, S. (2014). Can We Say What Diet Is Best for Health?. Annual Review of Public Health, 35(1).