Eating for the 'wrong' reasons and important links

Even though I don’t have time to maintain my blog, I am reluctant to shut it down. So today I am writing for two reasons. The first is to remind readers about the danger of eating when you aren’t hungry and the second is to share a couple of health news sources. These news sources will be of particular interest to those who have enjoyed my blog topics, and I will share the links at the end. The sources have free email subscriptions and I believe they are two of the best (i.e., credible, relevant, current) out there.

As I thought about writing (my posts often percolate in my head a few days), I remembered that I started my blog as a newsletter back in 2004 (approximately) when I was working at a hospital and taking classes to earn my Master’s in Public Health. Many readers followed my journey from that point (i.e., to Florida as a Tobacco Treatment Specialist, to UNCG for more graduate studies in Public Health, to Beasley School of Law to complete a post doc in Public Health Law Research) to now – 13 years later.

Today, I am an Assistant Professor at Temple University in the Department of Social and Behavioral Sciences. My teaching responsibilities include a course about substance use disorders and addiction (that should make sense if you’ve read the blog over the years) and a course on nutrition as it relates to the health of populations (i.e., I am still not a registered dietician and do not give individual diet advice). I teach additional courses and conduct research/program evaluations, but this blog has foremost been about behaviors that impact our health and the laws that make those behaviors harder or easier to accomplish (e.g., that darn national menu labeling law that can’t seem to be implemented, soda taxes, new food labels). 

Dietary intake and health status (including obesity) has probably been of most interest to my readers, and to me. So, I want to talk about a specific area of risk regarding dietary intake. Eating for non-hunger reasons. It is often when we eat for the ‘wrong’ reasons that we gain weight. I think what sets me apart from a lot of people is that I don’t do that. I primarily eat to fuel my body when I am hungry. Or better put: I do not eat to socialize. I do not eat because I am bored. I do not eat because I am sad. I do not eat because I am high (haha, just kidding – bc I don’t get high). I do not eat just because everybody else is eating or to be polite. To be clear, I LIKE food, and enjoy meals and snacks and alcoholic beverages, but I don’t respond to social (including work meetings) or familial pressure to eat for the sake of fitting in.

Now that I think about it, I did blog about this many years ago – about how to eat in a social context without gaining weight. I suggested that when you are going to an event (family traditions included) where it is expected that you ‘eat to be social,’ or you know your favorite foods will be available, you plan it so that the food you eat at the event is part of your daily intake (and if its occasional, maybe it’s a little more than your daily intake). But eating when you are sad, bored, or unexpectedly confronted with someone’s ‘oh I had to get these out of my house, please have some’ cookies is a sure path to over consumption/excess calories. This over consumption is especially likely because the food associated with those ‘eating but not for hunger’ reasons are usually high in sugar, saturated fat, salt and calories. So, just think about that – and decide how you want to handle it.

That’s all I have for you on diet and health today. Most importantly are the links I promised you at the start of this post. Here they are:

STAT News Morning Rounds

ConscienHealth blog   (the subscribe option is on the top right of the page)

Seen about town, ads pushing calorie dense items and calorie disclosures, etc

It was really challenging to come up with a title for this blog post, which is a good sign that I am trying to say too much in one post. Nonetheless, I am stubborn and have been holding on to these photos and these thoughts for at least a month.

First, calorie disclosures are coming, they will be the law of the land, but probably not fully so until 2016. In other words, the congress persons representing businesses will get the law delayed, but they will not get it appealed (I understand from my sources).

Second, it is becoming clear that 'a calorie is a calorie' is not quite true - even for weight. You may recall a post from me some years ago that implied that as far as weight was concerned 1800 calories of twinkie are the same as 1800 calories of vegetables. I went on to say, and this part remains true, that a person will be a lot healthier and feel much better if they refrain from eating 1800 calories of twinkie. I think we've all known that the body handles macronutrients differently, i.e., refined carbs are metabolized differently than fats or fibers - but more recently science has established that the number of calories might be the same in say a twinkie and a piece of salmon, but once our body digests and metabolizes these foods, the calorie end point is not the same.

Some people have suggested that calorie monitoring may be less necessary, and to that point I strongly disagree.  Many people who have lost weight and kept if off do eat better and maintain high levels of exercise but they also remain vigilant to consuming a sensible range of calories.

I am not abandoning calorie monitoring. However, I am not involved in research on metabolism - nor am I a nutritionist-  so I will stick to watching what happens when calorie disclosure laws go into effect. For example, I anticipate changes in availability of lower calorie options and changes in purchasing behavior. I am not going to keep trying to describe the science on the relationship between calories and weight gain. Instead, I assure you that we cannot eat with reckless abandon and many of our away from home meal purchases are ridiculously high in those wrong kind of calories.

Now my pictures and why I chose to take and share these in particular.

This ad was presented to me while I was listening to Pandora Radio - not so targeted considering I am a calorie controlled vegetarian!

I was 'exposed' to this ad on the Philly transit bus;  a bargain for two high calorie items. PLUS I am a NYG fan :)

You may have heard that grocery stores do not want to put calorie labels on their prepared food; that is unfair to restaurants and leaves customers lacking important information for food choices. 

Manufacturers update their labels from time to time, they may reformulate a product which changes the calorie amount, they may change the serving size which would change the calorie amount or they may fear scrutiny and revisit the accuracy of their label. These side by side boxes are both Jacobsens Blueberry Snack Toasts, but the calories INCREASED from 40 each to 45 each. Everything else appears to be the same. When I find older version with less calories listed, I buy them, but I am just fooling myself!

This is my favorite!  This restaurant is in Philadelphia where a calorie disclosure law has been in place for several years. The menus also have to display sodium/salt content. This is one positive outcome of calorie disclosures! 

The proliferation of calorie disclosures

In one of my recent posts, I mentioned that calorie declarations for restaurant items were beginning to show up on TV and in web based ads. It appears that the industry is gearing up for the calorie disclosure mandate that goes into effect this December (see the Final Rules for ACA sect 4205[1]).  I have noticed that up-front calorie disclosures are becoming more prevalent in grocery stores as well.

The grocery store calorie proliferation is likely due to several factors, including the Affordable Care Act’s wide reaching mandate. Food manufacturers began adding front of pack labels some years ago (with declarations THEY are comfortable with, i.e., not every manufacturer includes calories or sugar amounts on the front of every one of their products), but one voluntary version Facts Up Front does provide info on calories and select nutrients, and it has potential.  If you click on the link above, you can scroll through some of the examples. As an example, I have noticed that most sliced bread brands have Facts Up Front labels now - with the calories displayed - but BE CAREFUL sometimes its calories per 2 slices and sometimes per 1 slice. The Institute of Medicine has recommended a standardized, mandatory front of pack label with an interpretive design, for example, 3 stars vs 1 star (I wrote about this recommendation a few years ago).  I believe that the more customers see calorie disclosures, the more they will demand them - up-front.  (The new calorie disclosure law is about ready-to-eat foods at grocery stores, restaurants and similar establishments, not packaged foods. But again, people are now expecting to see calories more easily because of laws like this.)

One of the issues in labeling, especially for packaged or self-serving foods (e.g., ice cream), is a push to present easily, or commonly, understood serving sizes.  The serving sizes (usually) accompany the calorie counts on front labels, e.g., half a cup, 2 tablespoons. I think it would be a disservice to customers, however, not to also include the weight in grams or number of ounces of that particular ½-cup or tablespoon; a ½- cup of one item may not be commensurate with ½ a cup of another item.  Recently, I was choosing between cookie brands. For each brand, the calorie amount per 3-cookie serving was 130, but the serving for one brand had 20 grams and the other had 30 grams, so in essence, I would get to eat MORE food for the same calories if I chose the heavier product. I owe my ‘per unit’ calorie comparisons to lessons I have gleaned from using UPC shelf labels, price per ounce, as I’ve mentioned in the past. 

I think that emphasizing serving size can also be context specific.  One place it makes sense for the majority of people to see calories per serving ‘size’ instead of serving ‘weight’ is the vending machine.  I say this because, the usual serving size of a snack purchased from a vending machine, or the amount customarily consumed, is the whole package. The package is the serving size.  Most people intend to eat all the M&MS, Fritos, or Lays, so by scanning across all products and knowing how many cals per pack, a person can, if they choose, pick the lowest calorie package and be done with it.  (In time, I suspect, savvy customers will figure out that even here, they can get more or less calories per package based on weight/volume.)

So that is very cool.  Calories are showing up more (this is good for people who are trying to limit calories or who simply want to choose items with fewer calories - can’t do it if you don’t know the numbers!).  The national law (again see ACA section 4205) covers more than foods – restaurant chains under the laws jurisdiction will also have to display calories for their alcoholic beverages!  Not the gin and tonic you order at the bar, but the Bahama Mama or Margarita from places like Red Lobster and Chili’s.  This is one place that the restaurant industry in general, is not giving us a prelude with its on line menus.  I went to the websites of more than 10 restaurant chains while writing this blog, and only one, Red Lobster, had its alcoholic beverage calories posted. Some of these drinks have more calories than my meals; I expect many drinks will be reformulated when the law goes into effect.  If you want to get an idea, check out Red Lobster’s menu – see page 2. Else, stick with lighter beers and wine or traditional drinks, gin and tonic should have about 100 calories as does my favorite Dee Dee Sour (Seagram’s seven and Fresca).  BTW, the Red Lobster  Caramel appletini has 160 cals and the chocolate martini has 330 – how could anyone know this without a calorie disclosure on the menu, when you are ordering?  Unless of course, it’s that ONE day a year when none of this matters (smile face!)

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[1] https://www.federalregister.gov/regulations/0910-AG57/food-labeling-nutrition-labeling-of-standard-menu-items-in-restaurants-and-similar-retail-food-estab

https://www.federalregister.gov/articles/2014/12/01/2014-27834/food-labeling-calorie-labeling-of-articles-of-food-in-vending-machines

Fiber rich plates and smaller stomachs?

Okay, the title is sensational.  I wanted to get people's attention.  Fiber rich plates might actually bloat your stomach, and yet, still be good for you.  My blog post is not about using fiber to lose weight, its just about fiber. 
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My diet is naturally high in fiber.  By naturally, I mean that my daily plate is plant based and contains many vegetables and whole grains, foods that are high in both soluble and insoluble fibers.  I started increasing my fiber intake after learning from nutritionist/researcher Barbara Rolls, PhD that one could have a full plate of food, feel satiated and stay nourished, by choosing foods (and creating meals) low in energy density (~ 2001).  

Energy density, the calories per gram of food, has been the subject of many of my past posts and I have a You Tube channel primarily dedicated to demonstrating how to prepare low energy dense meals.  

Many foods that are low in energy density are also high in fiber.  A body of literature suggests that eating fibrous foods is health promoting and disease preventing.  For an overview of these benefits and the studies that support them, see the Dietary Guidelines for Americans, and the Nutrition Source at Harvard’s School of Public Health.

One of the benefits associated with diets high in fiber is weight control.  It makes sense that a diet high in fiber would lead us to eat less if we feel full sooner, or with fewer overall calories.  I think, based on my personal experience, that being able to eat more food per calorie is a main mechanism of effect for weight control (aesthetically, emotionally and digestively, we are more satisfied with a fuller plate).  Experimental studies show that certain digestive actions, including the release of certain hormones, are what cause a person to feel full and eat less (see e.g., Pereira and Ludwig, 2001).  A recent study on mice found that hormones are not just acting in the gut, but in the brain as well. The study:  Frost, G., Sleeth, M. L., Sahuri-Arisoylu, M., Lizarbe, B., Cerdan, S., Brody, L., & Bell, J. D. (2014). The short-chain fatty acid acetate reduces appetite via a central homeostatic mechanism. Nature Communications, 5, can be viewed for free here.

In the Frost et al study, researchers fed some mice a high fiber diet while feeding other mice normally.  The mice on the higher fiber diet did end up weighing less than the other mice (on average). A scientist who did not participate in this study, but who also does this kind of work was interviewed by blogger/reporter Brian Owens.  He, the other scientist, made some interesting comments that I wanted to share with you.  To paraphrase William Colmers (in Brian Owens article), in order for the researchers to track the fiber and its metabolites through the mice bodies, the mice were fed a lot of fiber.  Dr. Colmers said that it is possible that the appetite regulation seen in the lab study was not a chemical reaction in the brain - but a consequence of the mice feeling “uncomfortable.”  Dr. Colmers also pointed out that the lab was likely filled with “mouse farts.”  I will let you consider the same scenario for a lab experiment with people.

In fact, the next step is to do a fiber feed in human volunteers, but in order to get the level high enough, they will probably be given some form of fiber in a pill.  I understand that as a first step, it makes sense to see what is happening by using something artificial or modified, but what we really want to know is what happens when people eat foods that are high in fiber. I don’t know how a study using an extracted form of fiber is going to answer that question.

Here is a link to the piece Brian Owens wrote for Nature.

Nutrition Labels: Chaos, Confusion and Coercion

As it turns out, the FDA didn't publish those final rules for menu labeling last month and the IOM didn't persuade the government to mandate new front of pack labels for packaged foods. Instead, there is a mix match of existing individual state and city menu labeling laws and states continue to send more bills on labeling to their legislatures.  Even the US Congress has a new restaurant menu labeling bill, which is attempting to rewrite the current law (the one not yet implemented or enforced).  In the new bill, lobbyists for convenience stores, entertainment venues and grocery retailers are trying to get their constituents or companies excluded from mandatory labeling.  I disagree with the entertainment venue exclusion, or any exclusion for an establishment selling foods without a label, e.g., a steam table at a grocery store or 7-Eleven.

With regard to packaged foods, I expected that the recommended update to the nutrition facts label would see years of delay, but I did not expect that a group would form to scare us into believing that being told the amount of calories and sugar in our food was a threat to our independence!  Seriously.  The group is called Keep Food Legal, because apparently full disclosure on the ingredients in the products we purchase is somehow paternalistic and threatens our individual liberties.

BTW, in more sugar news, the World Health Organization has updated its stance on limiting sugar intake (to reduce obesity and oral disease); they recommend no more than 5% of total daily calories from added sugar.  This is a little less than is recommended by the American Heart Association.  If you missed the blogpost where I introduced the sugar concerns generated from recent research, you can read it here.

Lastly, the Grocery Manufacturers Association is going full steam ahead with its Facts Up Front labels (and spending lots of money to do it).  The problem with industry front of pack labels and the individual city and state menu laws is that they are not standardized across products or states and do not necessarily have the information that is most important to us (e.g., some list total carbohydrates instead of grams of added sugar).  

That being said, I am starting to warm up to the industry sponsored front of pack food labels because I think they are the best we're going to get for a while. And the Facts Up Front labels list sugar grams and calories, which matter.  

That's my update on labels. The next blog will be about sedentary activity and why you and I should avoid it.

If you want more info on the food industry and labeling, I recommend a ConscienHealth blog post - access it here.

Eating to Please... the Slippery Slope

No matter where you live in the world, society has certain norms about food.  In addition, your family or church culture might have traditions or customs about food.
Some things are easy.  If you are going to a function where food is to be served, whether its an official party, or just a visit to your Auntie's house where food is not to be refused! - go hungry (go to the event hungry).  In other words, don't add to the days calories, include what you eat or drink there as part of your day's total intake.

But what about the social norms that you can't prepare for?  What if someone bakes a cake and brings it in to work?  Or you just drop by a friends house and he or she brings out cookies?  Is it right to eat just to please someone else?  Is it right (smart) to eat just because 'everyone else is'?   I say no.  I think we are on a slippery slope when we start eating to give other people pleasure.  Consistently eating for reasons that are far removed from the main purpose which is to fuel our bodies and brains is dangerous.

To be absolutely 100% clear, food is to be enjoyed!  Tasted, savored, shared - I always enjoy eating but I do not eat to feel enjoyment.  Does that make sense?
Eating to feel good is a very dangerous habit to get into and eating just because someone suggests it, or you are bored, or you want to celebrate.. when you are really not hungry.. that is risky.  It can condition the brain to use food as a crutch or as a feel good medicine.. food should not be used as a security blanket.

It is okay to tell someone that you are too full to try their cake, or heck, that you have allergies, or that you are fasting for religious purposes, tell them anything you want..you do not have to eat to please someone else. But if you know a food event is coming, it makes more sense to go there hungry or to bring a low calorie item to share rather than offend your host.

Please give this post some thought.  One of the reasons - and there are many - that a majority of people weigh more than is healthy for them (70% of US adults), is because they consume more calories than they need, and that is sometimes because they eat for the wrong reasons. (sometimes they eat too many calories by accident, but that is related to food labeling)

Is the Food Industry Promoting Obesity?

The US population has a high rate of obesity, perhaps the highest in the world (see the WHO and CDC obesity websites for the numbers).  The simplest explanation, the one without nuance, is that people are eating more calories than they need. The nuanced explanation involves all the reasons why we are consuming too many calories.  For example, one reason is that we don't know how many calories we need.  Another is that, even those who know their caloric needs, cannot reasonably (or accurately) estimate the amount of calories in the food and beverages available to them.  Still another, the food and beverages most readily available and heavily promoted are (ridiculously) high in calories.
So is the food industry a culprit?
I give you three reasons why I think the answer is yes, but note, I said a culprit not the culprit.  They are:

1. The french fry burger
2. Endless bowls of pasta
3. And the Bacon Pepperoni pizza burger

 There are many factors that promote an over consumption of calories.  The cause will always involve an interaction between the person and his or her environment.  But really, does the environment have to be this over the top?  Cheap, calorically- dense, nutrient-poor food is much easier to access than it is to avoid.  That's a problem, but its one we CAN address.

Odds and Ends

HPV and Herd Immunity  I believe I've mentioned herd immunity when discussing seasonal flu.  Basically, it means that if enough people in your group are immune to an illness, your chances of getting sick decrease even if you are not immune.  The disease gets blocked before reaching you.  I mention it today because there is a suggestion that herd immunity may working to protect some people from HPV.  Public health advocates hope that young men and women will NOT depend on herd immunity.  I am sure that Merck and GSK also hope that you don't skip the vaccines.

Pretentious Grocers  I frequent stores such as Whole Foods and Earth Fare as rarely as possible as I cannot afford to shop at them. I only go if I cannot find a product somewhere else.  In the last week or so I have had to visit both stores.  As usual, the visits led me to gasp at the prices.  Prices on items that I buy at other grocers were priced, not a few cents more, but dollars more.  That is nuts.  The items come from the same place!  These stores promote themselves with offerings of all natural, organic, people and environmentally friendly products, but exclude a great number of people with their prices.  It must be noted that none of the healthy eating indexes (HEI, AHEI and the AHA version) or the DGA, explained here in the last month, mention all natural or organic items in terms of reducing the risk of overweight or disease.  This is because science has yet to make such a link.

Physical Activity When I first presented my exercise tracker, I noted that I did not include general physical activity.  Instead, I focused on what would be considered exercise, by definition.  I did not include all the activity breaks that I take in a day.  Many of those are walks around the block which I have had to limit with my calf injury. So I noticed that in the last 7+ days, I've done more physical chores than usual.  I have cleaned my bathroom and kitchen, using an old fashioned sponge mop instead of my 'swifter,' and getting better results.  I went to the local coin car wash and washed my own car.  Again, it was cleaner by my own hand.  I spent extra time at the community garden, watering, harvesting and pruning.  These are activities that people do much less these days - meaning we are sedentary in general and specifically.

Hyatt Menus The company press release included a statement on the increase in overweight and obese children, but the menu description does not mention any SoFAS or calorie moderation.  It does note choosing food suppliers whose agricultural practices involve sustainability which I value as an environmentally focused person.  However, the rest of the focus is on organic foods.  Intuitively, organic foods should be better for us if they contain less contaminants or additives, but there is nothing to suggest that using them leads to less calorically dense meals.  So if the hotel chain wants to address obesity they are going to have to do it by lowering calories.  If they want to cater to the deep pockets that shop at Whole Foods and Earth Fare, well, they have that covered then.

Aerosol I learned today that aerosol cans are recyclable.  I thought that disposing of the 'contents under pressure' cans was problematic and checked my city's recycling website to see what I could do.  Indeed, I can recycle as long as the can is completely empty and the nozzle is removed.  Pretty cool.

New Zealand Nutrition Conference

I thought if I just wrote obesity conference as the title, you might skip this read due to obesity burnout. I will keep it short for you.

Tomorrow in New Zealand - Wellington to be exact, nutrition experts from across the country are meeting with tobacco control experts in an attempt to revitalize the campaign against obesity. The rates of overweight and obese are similar in New Zealand to USA and other western countries. About 33% of adults are overweight and 25% are obese. They may have more obese adults than the USA.

In a press release about the up coming conference the Cancer Society Health Promotion Manager, Dr. J. Pearson shared some of her thoughts or concerns and here I will share those that resonated with me.

She said that they (the country) needed to tackle this problem the way New Zealand and other countries have dealt with tobacco. Many countries have successfully reduced their national smoking rates, some, like the USA have cut them in half. You know how it was done - ongoing campaigns about the dangers, increase in cost, limited access and promotion, esp. to children, and medications or programs to assist in quitting.

When Dr. Pearson mentioned the advertising of unhealthy and fast foods I had a thought. Remember when tobacco ads were more prominent? Do you ever remember seeing a person who looked sick (or dry skinned and wrinkly) smoking a cigarette? No. Do you see many obese people doing commercials for Twinkies, Fritos, sodas and McDonald's?

I understand that eating is pleasureful but for some it is a pleasure substitute or a lack of understanding. Even if food makes you happy I am near certain that being overweight does not bring you contentment. When we first started to crack down on smoking people - addicts, became upset that the government was trying to control them and tell them what to do. That is mostly because the tobacco companies were minimizing the health effects and glamorizing smoking. Now that the majority of the population DOES believe that tobacco kills, having limited access to tobacco and being protected from tobacco smoke is seen as a GOOD thing.

So think of a person who is hearing that obesity, even moderate overweight(ness) , can lead to heart disease, diabetes, and arthritis but seeing healthy, slim, active people eating high fat high calorie foods? Or the person wants to eat the lower calorie plant based or Mediterranean diet but cannot find those foods or afford them?

As Dr. Pearson said, "It is like telling a smoker not to smoke, then putting them in a room full of smokers and handing them a cartoon of cigarettes!"

On a final note, there is also concern in New Zealand that many of the schools healthy lunch programs have lost funding and that the Government seems to think that increasing physical activity is going to solve the problem. As I have learned and Dr. Pearson notes "strong international evidence" is telling us that this problem cannot be solved if people do not start eating LESS calories. Physical Activity is a must for good health and disease prevention but it is NOT a first line weight loss strategy, calorie control, is.

Now stay tuned tomorrow for news on the problem of obesity in our PETS :)

Hold Everything..

Okay, maybe not everything, but you could hold the stuffing or at least hold your weight - steady, until the New Year.

Hold the Stuffing is a contest that is played in some form or another at many businesses at this time of year. The point of the "challenge" is to support people who have made strides in obtaining a healthy weight, even if they are not at their goal weight yet. Health Promotions staff encourage people to just keep things even and enjoy the holidays.

This means that the person is not to try to lose weight over the next six or seven weeks, but it ALSO means that they are not to gain any either. The threshold is 2 pounds. The "contestants" cannot go up OR down more than two pounds from their start weight. The weight needs to be taken before Thursday November 26th.

You can play with teams and go by a group weight or you can do it individually. We are doing it individually at my small office and I created a tracking tool for each person to use. I will link it here and you will be able to play too if you like. Just print the form, get your weight and be mindful of your eating.

That being said and Thanksgiving a mere few days away - let me share some things my sister has learned from her Weight Watchers class. (everyone knows that if they tell me something they risk seeing it in a future blog post)

One thing that the program has its members do is think of all the things they would like to eat on the day and to portion them out on a paper plate. Actually take a plate and write in the things you are going to eat. Hopefully, you will make the lower calorie items take up more space than the high calorie ones. My sister shared something else which I REALLY like and that I include on the tracking sheet. That is to "control what you eat, how much you eat and when you eat." I have been doing this for years and years and I highly recommend it.

Do taste lots of things on your holiday, just don't eat so much of them! Also, be careful because some items have more calories than you can possibly imagine!

Diet Drugs

How well do you know your blog writer? Here is a test question. Does Deirdre believe in diet drugs? Answer. NO



It has been a little while since our grocery stores held prominent displays of the latest OTC weight loss drug, Alli. Long too, since Wynona Judd did her print and TV ads endorsing the product. I of course, had my say in these pages
http://yourhealtheducator.blogspot.com/2009/03/wellness-weekly-with-video.html

This drug was intended to enhance weight loss by blocking some fat absorption, probably because eating less fat would be too inconvenient for some people. I railed against it, I still rail against it and now the FDA has made a cautionary statement in its regard.

FDA notified healthcare professionals and patients that it is reviewing new safety information regarding reports of liver-related adverse events in patients taking orlistat. Orlistat is marketed in the United States as a prescription product, Xenical, and as an over-the-counter (OTC) product, Alli. Between 1999 and October 2008, 32 reports of serious liver injury, including 6 cases of liver failure, in patients using orlistat were submitted to FDA’s Adverse Event Reporting System. The most commonly reported adverse events described in the 32 reports of serious liver injury were jaundice, weakness, and abdominal pain. FDA is reviewing other data on suspected cases of liver injury submitted by the manufacturers of orlistat, analysis of these data is ongoing and no definite association between liver injury and orlistat has been established at this time. FDA is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed and those using over-the-counter Alli should continue to use the product as directed.

Scientifically speaking the safest and most effective way to lose weight is to take in less calories that you burn.

Odds and Ends

Ah, another week has passed and a few items should be noted, saving the best for last, let me begin:

Compressed Morbidity: I thought of this again this week, having first heard the term at the Cooper Institute in May. The idea is to compress disease into the last years of a long life instead of spreading it out over many years. In other words, as Dr. Cooper had said, right now we are dying longer not living longer and that needs to change. I think of this with lifestyle related illnesses.. illnesses associated with obesity and tobacco. Yes, for many illnesses there are medications, but rarely a cure and some illnesses will significantly impair the quality of life a person experiences. It is time to leave disease for old age.

Weighing: This past week someone asked how often I weighed myself, following that question with another before I could answer, "Every day?" In fact, I do not weigh everyday and told my new friend that I tend to weigh two or three times a YEAR. I thought afterwords that the reason I have no need to weigh more than that is because I am consistent. I eat and exercise according to recommendations, well, okay, I do perhaps exercise more and eat a little less, but I have been this same weight plus or minus two or four pounds for almost nine years. I am NOT on a diet.

Heart Rates and Cool Downs: I was pleasantly surprised when the instructor of a spin class reminded everyone to slow down and not stop right away as the heart would be better conditioned if one eased off the intensity. I have always hypothesized that the reason for heart attacks at racing finish lines could be strongly associated with someone going full throttle and then coming to a complete stop. Many times I see runners bend over or sit down. I think that is crazy! I imagine blood backing up into the heart.. no medical training tells me that is so, but just think, PUMP PUMP PUMP run run run.. okay screeching halt.......STOP.. scary to me.



Calorie Awareness: I thought this would be a good thing to share with you. I have in my head a baseline calorie amount that I like to stay around and plan around. If I do no exercise that is what I eat, if I do moderate exercise I add a little more, if I am running my very long runs I add even more. So the message to myself is I eat LESS when I do not exercise. This is an exercise motivator. I do not eat EXTRA when I exercise.. that can be a fools game.. I eat LESS when I do not and I do not want to eat less, so I exercise!

KUDOS KUDOS KUDOS: This week I happened to stumble upon two incredibly inspiring people. Both are women and both were once obese and unhappy. I am inspired by them and I want YOU to be inspired by them because they lost their weight and have maintained their new weights with lifestyle change concentrating on energy in and energy out. They have both cut their calories and increased their exercise. I cannot do their stories the justice they deserve but you can read them on line. I will post links for you to find them. I read about Miss Rosie Coates in Runner's World and her story had me saying YES YES YES a few times. And Miss Raquel Barragan who goes by Rocky, is a partner in the cooking video world and has also lost a significant amount of weight and has done so with the new Weight Watchers program (not diet, program). Both ladies have my utmost respect and admiration.

Rosie's story: http://sportydiva.com/

Rocky's YouTube Channel: http://www.youtube.com/user/rockybarragan

Oh, yes, I think it was Rosie who said this.. but you know how I say eat less move more.. she said eat less, sweat more :)

Label Tricks

I become increasingly frustrated with producers of supplements and meal replacements as well as producers or manufacturers in general as they tout their wares as health promoting and essential when they can be anything but…

There are dozens of reasons why vitamins and minerals added to products, liquid or otherwise, can be a waste of money. Here are a few:

1) Research often doesn’t support the health claim in THAT form
2) Products don’t have enough of the said ingredient to make a difference
3) The product may have fillers that counteract the positive health effect
4) The label is misleading
5) The product is contaminated or has unclaimed ingredients that cause harm

In many ways, all we get for our dollar is expensive pee.

More so, I want to educate consumers. Labels on our foods can be misleading. Recently I discussed why buying foods with omega three fatty acids was misguided, but many other health claims or label facts can trip you up as well.

Fat free, trans fat free, sugar free, calorie free – most of the time means that there is a trace amount of the item per serving size.. depending on how the nutrient is measured it could be .49 grams of 4 calories.

Serving size is another issue. Recall my ice cream dessert video on you tube… ½ c is the serving size on the box and not only do most of us have a cup.. the weights are different on almost every box.. it is calorie per gram that the consumer would be best to consider.

Recently I wrote that the FDA/USDA did not define the term “natural” and I was mistaken. They do, only in the sense of a policy, not a regulation. Both FDA regulated products and USDA regulated meats and poultry labled "natural" are encouraged to be minimally processed and not contain artificial flavorings, colorings or preservatives.

Many times a product will claim itself to be hormone free when the law prohibits hormones in the first place, i.e. poultry and hog products.

My favorite was when all sorts of things that never ever had carbs began to have labels claiming they were carbohydrate free… like WATER.

Added fiber? Try getting it the old fashioned way.. the way research says is helpful.. in a food that contains it from the beginning.

It will nearly always behoove the consumer to read the ingredient list of baked goods, like bread, to be sure, no matter what the label implies, or screams at you, “multi grain”… that the word before the grain is WHOLE. Did you know that there was something called the Whole Grain Council and that they have a label for whole grain products.. indeed… if the package has their black and yellow stamp you CAN be assured that the serving size has at least 8 grams of whole grains.

Another label to be trusted is the USDAs certified organic. Unfortunately, a recent research study found no health benefit to eating organic foods. I myself do not eat them. BTW, the organic label does NOT apply to any USA raised or caught seafood and according to an article in Runner’s World this month, that label on food sold here would be from another country and may lack any clear and consistent definition or practice. In fact, one would be better off eating wild Alaskan salmon which is apparently regulated here and farmed arctic char which is also supposed to be healthy and safe.

Another trick noted from the same Runner’s World article was putting 100% juice on a label under the drinks name, like pomegranate, but only 20% of the juice is of that type. Anyways, fruit juice is not the best beverage to spend your money on whether it is 100% or not.

Lastly I want to say that you do not have to shop at Whole Foods to eat whole foods and eating whole foods; fruit, vegetables and grains is health promoting.

the Perils of Fructose

My goal today is to list some of the main points from two lectures I attended today. The speaker was an MD researcher who has linked, through his research, fructose with cardiovascular disease in that he believes it causes metabolic syndrome which is a precursor for heart disease and diabetes. I want to share any points that might be relevant in our real lives, so here they are:

Fructose itself appears to increase uric acid and uric acid increase can lead to a nitric oxide decrease. Fructose also seems to effect the hormone leptin which is supposed to suppress appetite when we have had enough to eat. Scientifically over my head, but I believe these are the actions that lead to a syndrome which has the following adverse health components:
Hypertension
Increased weight, abdominal fat
Insulin resistance
High levels of triglycerides
Inflammation
Oxidative stress
Endothelial dysfunction

Limiting fructose is advised. Table sugar is a molecule of fructose bound to a molecule of glucose. High Fructose Corn Syrup contains the same two molecules in an unbound or free form. Both fructose sources cause the increase in uric acid, but the free form is more potent.

Fructose is also found in fruits, however, there is some neutralizing of the effects because of the fiber, antioxidants and polyphenols found in many fruits. Watch out though, not all fruit has the protective chemicals. For instance and sadly, watermelon is one of the most high fructose fruits with little antioxidant balancing. Also watch dried fruit because of the high sugar and calorie content involved. People eat it too freely.

Dr. Johnson advises that we eat 2-3 fruits a day, because there is 4-8 g of fructose in each. He strongly encourages limited fruit juices and avoiding soft drinks.

I learned some odds and ends as well.

In white persons under 40 who have high blood pressure, salt restriction doesn’t seem to help.

Olive oil is best purchased in the can, to preserve its health promoting properties.

Heart disease or vascular disease has two distinct pathways. I understood Dr. Johnson to differentiate between atherosclerosis and arteriosclerosis. Whether I have the terms right or not, he was explaining that one type of artery disease was related more to saturated fats and cholesterol while the other was more likely due to the inflammation and cell damage from the hypertension related to fructose consumption. He was responding to my question regarding whether or not he was trying to minimize the effects of a high fat diet on heart disease and he said NO , not at all.. but that the high fat diet caused one type of problem and the high fructose diet caused another.

He estimates that we consume upwards of 50gs of fructose a day and would be better off at 25gs a day.


a little more tomorrow in regards to a fructose index, fructose sources, and a soda tax...

Let the Comparison Begin

I am actually torn about tonight's post. Yesterday I received an article in the mail from a dear friend in Maine. I did not read it closely until just now.
Last night the first news stories were published about the cost of treating obesity (147 billion a year) and out of curiosity I looked up the cost per year that Tobacco Free Kids estimates is spent on tobacco related illnesses (96 billion a year). Obesity has indeed passed tobacco, I expected it would.
And this morning, I read an article about reducing hospital re admissions and got rather frustrated at a lack of personal responsibility in the patients. So all that is on my mind!

The article, ironically, compares Big Tobacco with Big Food and was written by Ellen Goodman. She notes a new film and a new book regarding the food industry's tactics to get us to eat more cheap, fast and harmful food and wonders if the mood of America isn't about to change and say, "Enough." She does note a concern that always frustrates me and that is the controversy over accepting ones weight or size and rallying against obesity. Well, the fact that it is considered a controversy is the problem. I actually had the thought today that maybe our Armageddon is going to be related to our total lack of responsibility in taking care of the body that the creator(s) gave us. Many times it seems a total disregard for health and wellness. An abuse of our very essence... we wouldn't treat our cars or motorcycles this way and expect them to keep running, would we?

I am not without empathy and I do feel that addictions exist and are not something that can be willed away.. however, one has the personal responsibility to adopt a treatment or follow a plan to change what is wrong. In the article I read this morning, a woman with chronic heart failure was dismissed from the hospital after an exacerbation of her illness. She was advised not to eat hot dogs, as the July 4th Holiday was approaching. The patient is quoted as saying that she went to the picnic and said, I am not supposed to have a hot dog, but give me one anyway. She further commented that if she was dead in the morning she would never know. Well, ha ha, isn't that funny. Instead, she was back in the ER and admitted to the hospital because she did NOT do what the doctor's said. Perhaps people need to understand that not taking care of themselves has a ripple effect. Her family would have been worried and strained by this readmission, doctors and nurses would have to care for her and somebody did not get a bed at that hospital because she was in it. Oh, and she is a Medicare patient so premiums for everyone can be effected.

I suppose everyone has a right to go to hell in a hand basket at their whim.. as my friend Tom Brown used to say.. but only if they can do so without wasting the rest of our valuable resources to get there.

So yes, I feel incensed by some of the recent news...

Quitting Smoking and Weight Gain

Today's post isn't only about quitting smoking and weight gain, but also about how people (and doctors are people too) think to manage weight gain. The post is inspired by a statement made in one of my quit smoking classes. Many people are concerned that when they quit smoking they will gain weight and for both medical and aesthetic reasons, that is often a deal breaker. Unfortunately, literature does support that people who quit smoking will gain ten or so pounds, some will gain much more and some will not gain at all. What the literature doesn't get into, is WHY the person gains weight.. I mean the REAL why.

My "student" is very motivated to quit and has the support of her primary care physician. In fact, he told her that if she gained weight to come back to him and he would assist her. She joked and asked if he was going to send her to a psychiatrist.. I offered my guess, a nutritionist? thinking this doctor was really on top of his ballgame when the "student" said, "No, he said he'd give me something for it." Ah... a pill. I told her not to worry because my health education would cover the weight gain issue and hence, this blog post was born.

[All readers know that I consider medication to be a last resort treatment or certainly a second or third approach , but never a first response to a non emergent situation.]

With regard to tobacco... Some will say that nicotine effects metabolism.. well, it may, but not by much. Seriously, if it increased metabolism enough to affect weight we would bottle it up and use it to treat obesity. More say that nicotine is an appetite suppressant. I agree, it is similar to coffee in that regard.

A person who quits tobacco has to get reacquainted with their appetite. There is also the psychological piece of being bored and eating when one would have smoked, being nervous and eating, being angry and eating.. etc. the classic emotional eating pattern that people who have disordered eating experience everyday.

I smoked myself for about 17 years and through it all I have pictures of life events. Sometimes I am thin and sometimes I am quite overweight (ranging 100 to 149 lbs). Many times, I have a cigarette in my hand or a pack of Winstons on the table near to me. I am fat or thin NOT because of cigarettes but because of FOOD. If you eat too much you will gain weight.. it is energy in and energy out, truly that simple for 95% of the population.

So a former smoker or an emotional eater has to learn two or three things. First, when am I hungry and when am I emotional.. Two, how to cope with emotions in health promoting ways.. journaling, exercising, talking, music, aromatherapy, massage, eating nutritious food! and Third, how does weight control work i.e, what food is healthy, how many calories do I need , how many am I currently eating, how do I keep a healthy low calorie food healthy and low calorie when I prepare it and so on.

When I work with people I encourage the Volumetrics concept. It is important because it is NOT a diet, it is NOT temporary and it IS safe, effective and health promoting.

I really frown on my quitters getting all those toxins out of their system just to put more chemicals in. Lifestyle change first and risky drug therapy and surgery as last resorts.. got that?

Do You Have Cankles?

Well, I cannot believe that I am doing this post, but alas I am. Cankles are ankles that lack definition. They are firstly caused by obesity, but other causes can include a genetic inclination to store fat in the lower leg, chronic achilles tendinitis and other less common situations. According to an article I read in the WSJ, the average circumference of an ankle is 11 inches. Women have become increasingly concerned about the look of their legs as clothing styles can accent the calf and ankle. (you can Google the word in case you don't know the look)

In fact, there are exercise programs designed to target that area so that the ankles can be slimmed. And you know, I am not sure that I have mentioned this in the last year or two, but you cannot control where exactly you will gain or lose your weight. It just doesn't work that way. I would suggest that one way, perhaps the best way, to prevent fat ankles is to not be fat. Albeit, there are exceptions as there always are...sometimes things just happen.

Funny thing, I HAVE tendinitis right now. When the doctor was looking at my achilles and ankle area yesterday and recommending ultrasound for healing, he actually said that he thought the treatment would work well as I did not have much adipose tissue there. I measured just now, having read the article, and my ankle is 8 inches around.

I also read in the same article, by Amy Chozick , that some counselors were worried that focusing on "cankles" would lead more girls to develop eating disorders. Really.. are you kidding me? Here is an issue to worry about...

childhood obesity

Indeed, I saw a boy at the Farmer's Market today with his Mum... he was very overweight, drinking a soda. Sweating in the sun. He was swollen everywhere, no doubt his ankles too but I didn't look.. instead I was looking at this 8 to 10 year old boy with BOOBS and thinking that really ought to count as child neglect.

Teaching Moments

We have a new employee where I work and she is only now getting to know me. I say this because what she said was so funny being said to ME. Her story was priceless and a wonderful teaching moment, then and now.

And do let me say.. I am NOT making fun of my coworker, nor judging her nor overtly trying to change her. I am subtle but open while at work. I eat the way I eat and when people ask me about my food or lifestyle I share information, ideas, recipes, and products. I LOVE doing that. I recall saying this before but it is worth repeating. People won't eat junk food if it isn't around, and people WILL eat good food if it is.

So not really knowing me that well, Sally (not her real name :)) began her story this way,
"This morning when I stopped at McDonald's..." Before she could finish her sentence, I said, "McDonald's???!!" and she continued, "Yeah, I always get a steak bagel (500+ cals)." To which I think I said, "Oh my." I believed she acquiesced that it wasn't so healthy and then added, "But today I decided to get the combo (with hash browns and coffee) because it is cheaper." I was very animated and dramatic while she talked, telling her she was killing me.. that my arteries were clogging as she spoke.... I was joking and educating at the same time. She did ask me when I last went to McDonald's and it was in the early 2000s when they released the Go Active meal with the water and pedometer. Anyway, the point Sally was trying to make, though I hardly let her finish, was that the coffee spilt in the bag and when she got out of the car the bag broke and her food fell on the ground... see, she was not meant to eat all that fat!

Seriously though, we have real life example of two things I have said recently. One is that it is significantly easier and cheaper to eat too much than to eat the right amount.
And the other, an example of someone who doesn't know which foods are health promoting and which are not. She often brings a microwave meal for lunch and eats all of what is meant to be three servings, but she may not even know that. I believe that her eating and her health will improve because her coworkers are great role models.... I being just one.

the high cost of eating well

Every blog post does not have to be a research paper and so tonight I will just express opinion and grave concern about the state of disease prevention.
Health care reform is happening and within the congressional debates and presidential meetings are many nods to the importantance of prevention. Specifically, prevention of disease can be tied to three things of which we have control, and a fourth of which we don't, genetics. We do have control over our weight for the most part, for what we eat, again for the most part and for the amount of exercise we do.
With regard to what we eat, when legislating change, I implore the powers that be to confront the issue of how our food has changed and how readily available and cheap the worst types of food have become.
I say this as in the last day or two I have seen the 1 dollar double cheeseburger promotion, the 25 cent hot dog and the 1.50 dollar discrepency between a snack that is full of sugar and one that is sugar free. What IS THAT>?!
We have a crisis and it is because people cannot afford to eat nutritious low calorie food. Furthermore, they don't know exactly which food is healthy and low calorie nor how to prepare that food so it remains so.
I feel frustrated because I could absolutely educate society with a public health grant.. I could take the information that I have on my blog and You Tube to people who do not access the web. I cannot however, change the price of food.
Even today at the beach, I saw a family where the mother and perhaps her sister were substantially overweight.. they came from the snack bar with french fries, which they shared with the children who were not YET overweight. Was there another option at the snack bar? I do not know. Was it as cheap as the french fries? Likely not.
It is so hard for me to know the right thing and witness the wrong thing. Many people, regardless of circumstance, are naive when it comes to how food and exercise affect their health but pointing it out individually is not the right technique. It will backfire. Community education and policy change is less threatening and more cost effective and physically effective than pointing out individual misgivings and mistakes.
There are people who are in my inner circle who do not do the right things even though they are pretty well informed. I get that. I DO get that. It is like smoking. Smokers know that it is killing them, but not smoking is a completely different lifestyle for them. Same with ME and running. Running all the time is not the best thing to do, I often have over use injury, I KNOW that but I love running.
So my job, my quest.. it is two fold. Food has to be affordable and people have to know how to prepare it and eat it. We joke about backing away from the table, but seriously, we HAVE to back away from the table.
An example, I found these awesome 100 calorie snacks today... on my Mom's counter!! They are Newton's Fruit Crisps, pretty expensive so I probably won't buy them.. but there are two "crisps" in the package and the package has 100 calories. When I tried them it was like I finally found my low calorie Pop Tart.... very very yummy. I ate a pack today and thought, I can see that people would eat several packs at once, exactly how NOT to moderate calories. If people would retrain themselves to eat every few hours and to have a general idea of what those foods are going to be, they will STOP eating (when the meal is over) as they remind themselves that they will eat again very soon.
So today I just wanted to express my frustration I suppose. I am frustrated that healthy food is not affordable. I am frustrated that many people do not know which foods are healthy and how to keep them that way when preparing them. And I am frustrated that people do not do what works even when they know what it is. Many of these things are not the fault of the individual, except in the end, you decide whether or not you will do the "treatment".

wellness weekly

Okay back to the regular news and a video meal:

The News:

Prescription Drugs: I believe that anyone who has read at least three of my blog entrees, even ones from the early 00s, knows that I have a very strong inclination against prescription drugs. It is also true that when a disease can be controlled or cured and quality life years added, I support pharmacotherapy. That is my little disclaimer I guess. I don’t want people to think that I never advocate for meds. I am not doing so today however. This past week has been a disturbing one in several ways. One big pharma is reported to have paid less taxes than one would expect due to a certain way that they closed a deal, and another kept worrisome clinical trial results hidden from people taking a certain antipsychotic drug. By the way, this is NOT the first case like that. Another company is in trouble for over charging Medicaid. All are being investigated. I also spoke to a man this week who listed six or seven prescription meds he has to take, though he couldn’t name any chronic disease that he had. Another woman told me that the doctor keeps putting her adult daughter on more and more meds and is stymied because she isn’t losing weight. The mother said to me, “He doesn’t understand. She eats like a pig.” Another woman told me how when she was first diagnosed with emphysema, she continued to smoke and could not make her inhaler last for the whole month. On a positive note, she told me that she has quit smoking and hardly needs to use the inhaler. That is EXACTLY why it is never too late to quit smoking. If you have a disease and are in treatment for it, that treatment will be more effective if you stop the activity that is causing the disease. I know, I am so smart. Back to the drug companies, one of them markets an inhaler for COPD in TV commercials and actually says during the commercial that the medicine can be used by current smokers. WHAT?!?!?! Too many meds, too many side effects, and too little personal responsibility. Remember, at least four of the ten leading causes of death and disability CAN and should be prevented.

Omega 3s: I want to say more about this today. First I advise that you read a little more from a trusted source, i.e, a non profit volunteer agency that does not also sell supplements! The American Heart Association. Here is a direct link: Fish and Omega-3 Fatty Acids. I want to revisit this for two reasons. First, last week I reported that Dr. K Cooper said in his lecture that everyone needs to take Omega 3s in supplement form and that the dose is 1g per day. I know he said 1 gram and that it should be 60% DHA/EPA, both of those statements are supported in other literature but the AHA has different dosage recommendations based on an individuals health. According to the AHA for example, I do not need to take the supplement but someone wanting to reduce their LDL or with existing heart disease should. Also they recommend even higher doses for some people, with physician supervision. You must make your own educated decisions. But here is the second thing I want to emphasize. The amount and type of Omega 3 that these companies are adding to your bread, eggs, milk and whatnot, are both WRONG. I checked out a milk carton today that very boastfully claimed 36 mg of Omega 3, well, great, where are you going to get the other 964 mg you need to get 1 GRAM. One place is in salmon, but oh my gosh, there is another awesome link on the AHA, it lists mercury content in one column and omega 3 in the other (by gram). This is wonderful and the kind of info I need to bring out to the community. Fish, Levels of Mercury and Omega-3 Fatty Acids
Device Recall Hits ‘em Where it Hurts: Drugs and devices, both types of companies can get seedy with their direct to consumer advertising and their doctor pandering. More reason to eat your fish and not your chips! We have had recalls of pacemaker batteries, wires that misfire, defibrillators, stents that reclog and more, but this time Medtronic got in trouble with a bone graft device that doctors recommended and used for off label conditions. They can do that, but the concern is that they may have been paid consulting or speaking fees and indirectly marketed the device for a treatment for which it was not FDA approved. Things have gotten bad because a lot of adverse health outcomes were reported for the off label use. Seriously, the FDA didn’t seem that keen on the device for the regular use either. This off label stuff is serious business, I myself had to sign a disclaimer before talking to docs about tobacco addiction treatment. Anyway, according to the WSJ this week, there has been a near 70% profit drop for Medtronic and jobs are being cut.
Fitness: Just a short bit to remind you that physical fitness is measured by muscle strength and endurance as well as flexibility and cardiovascular conditioning. It is important and imperative to good health to exercise your heart. Cardiovascular activity, what we often think of as aerobic, includes activities that get your heart rate up. A weight bearing exercise is not necessarily cardio and cardio is not necessarily weight bearing. What does weight bearing have to do with it? Weigh bearing exercises help men and women prevent bone loss. So running is an example of both cardio and weight bearing while swimming and cycling are just cardio. Of course walking can really get your heart rate up and you can cycle without increasing your heart rate much. Effort counts! Weight training for fitness is not the same as weight training for a competition. Ladies, relax, really, you won’t bulk up unless you spend hours and hours and hours in the gym weekly. Flexibility can be gained through simple stretches, yoga, pilates, etc. Whatever You are willing to do. You can work your core also without doing crunches, by doing the plank for example.

Okay then what are you doing? Don’t just sit there you have diseases to prevent…


Live Well
Deirdre

the following video is a dinner I put together after work one day. enjoy