Fiber and Whole Grains

Last week as I wrote about ways to increase servings of whole grains (16g per serving x 3 per day - at least),  I noted that increasing whole grains and increasing fiber were two different things.
So I will give a very brief description of the difference between the two and then link you to a more expansive explanation from the American Heart Association.

• Whole Grains have varying amounts of fiber
• Whole Grains have specific nutrients that we don't get in this same combination from other foods; B vitamins, magnesium, selenium, iron
• To qualify as whole grain, all 3 parts must be included - the bran, germ and endosperm
• Refined grains remove the bran and endosperm.  Many times refined grains will be enriched with the vitamins that are already in whole grains.  Enriched means that they add them back in.  Scientists are finding that naturally occurring vitamins and minerals are much more effective at improving health than supplements are - and fortification is similar to supplementation.
• All whole grains have some fiber, as noted, but not all fiber is a whole grain.  Fruits, vegetables, nuts and beans are all sources of fiber.  Fiber is not a food group so the DGAs recommend foods that have fiber - not fiber itself.
• Fiber improves digestive health, blood cholesterol and satiety - we feel full longer. 
• Fiber can be soluble and insoluble - we need both and they do different things.
• Both whole grains and fiber have been shown to improve health and prevent disease.  This includes some types of cancer, diabetes and most convincingly, heart disease.

On that note - learn more from the American Heart Association by clicking here..

USG - Unhealthy for Sensitive Groups

   A good portion of the United States (1/3) is under a weather advisory for severe heat and high UV Index.  Under these conditions, the particulate matter aka air pollution hovers around us - it does not dissipate.  The Weather Channel advises that everyone limit exposure during these 100+ degree days with UVIs of 10.  As the scale only goes to 10, I think it is much higher in relative terms.
   Air Quality which is impacted by the weather, is tracked by the government.  There are metropolitan centers that can provide you with local data.  The national website is here.  Today's map includes a lot of orange and red.  In fact, my town is colored red and my entire state is orange.  I am happy to see that where my family lives in the Northeast and Florida, it is merely yellow (which of course is not good  - green is good - ONLY green is good, but yellow is less bad than orange or red). 
   If you click on the link that I embedded above, you can find your own state and check the air quality.  This morning my area was in code orange and the radio announcers were warning that it was unsafe for sensitive groups to be outside.  I take issue with the USG days vs the UNH (unhealthy) for two reasons.  One is that the cut off between orange and red is arbitrary - 150 is orange and 151 is red.  But more importantly, there is no safe level of air pollution.  There is a level where harm begins to be seen.  One may see harmful effects, like difficulty breathing, sooner in people who are compromised (asthma, young, old) but that does NOT mean that the air is safe for someone who doesn't immediately show symptoms.
   Toxic air is toxic for anyone that breathes it. No one has immunity to pollution.  We may be at different levels of risk or susceptibility for the immediate effects, but the particulates damage the tiny air sacs in everyone's lungs and the pollutants (chemicals in the air) get in our blood stream raising the risk for heart attack.  Reminds me of when people say that they are allergic to tobacco smoke.  EVERYONE is allergic to tobacco smoke... it is poison.
   If you click on this link and scroll down a little, you can see the numbers that make up the air quality categories.

The Benefits of Menu Labeling

   I am hopeful that today's Supreme Court decision will help to move the National Menu and Vending Label Laws forward.  You may recall that the Patient Protection and Affordable Care Act (PPACA) mandates, at the very least, calorie disclosure at the point of purchase.
    Many cities, states and restaurant chains have already begun to provide this information.  It is exciting to me because the policy can change the food environment.
   People will always get to choose what they purchase and eat, but those choices depend on money, time, convenience (what is available where you are), and selection.  Early findings show that restaurants and vending machine owners increase the number of healthy options when forced to disclose calorie content.  By healthy  I mean, lower in saturated fat and added sugar as well as energy density.  This is a good thing.

 

The Low Fat Diet Headlines

    A study by Ebbeling, Ludwig et al was published in JAMA today, but began making headlines yesterday.  I want to give you a one or two (i.e 4) paragraph summary and a take home message.  I do this because I found the headlines and the stories behind them to be misleading and at times inaccurate.  I emailed one reporter directly in this regard.
    A controlled study of 21 people who were overweight or obese (average BMI was 37), found that the composition of diet patterns had an affect on resting and total energy expenditure.  REE/TEE = calories burned.  This diet comparison occurred after the participants had succeeded in losing 10% of their beginning weights.  During weight loss and weight maintenance, the people remained in a hospital setting and ate the food provided to them.  Each person consumed each type of study diet. I am not sure how long they were on them, but they were given them in random orders.  The 3 diets had different amounts of carbs and fat, but the same amount of protein.  The important factor seems to be the glycemic load.
    The study suggests and adds evidence to the research that calories are not equal.  When compared side by side there was no evidence to support a difference in REE/TEE between the three diets. However, each diet pattern had a different glycemic load, and the researchers did provide evidence that as the load went down, the REE/TEE went up.  We want our expenditure to be as high as possible after weight loss in order to maintain it.
    Take home message:  Choosing foods with  a lower glycemic load (GL) seems like a good idea.  Fat intake can lower the glycemic load of a total meal, but be careful there and choose healthy fats more often than saturated ones.  ALSO- sometimes a foods glycemic index and glycemic load contradict each other.  It is the GL that you want to focus on if that is the case - choose lower.  A low GL food is 10 or less and you can see more about that here. Both the GI and GL refer to carbohydrates.  
    In this study, whatever diet pattern the subject was on (1,2 or 3), the overall calorie intake was the same.  There fore, calorie type is important but overall calories still count.
 

Getting Your Whole Grains

Obtaining the recommended 3- 6 servings a day of whole grains in order to improve health and prevent disease, does not have to be hard.  Using the back of pack food label to determine the portion of that recommended amount provided by a serving of that food is nearly impossible.  Currently, the FDA does not require the back of pack nutrition label to list the amount of whole grains per serving.  Apparently, the Whole Grain Council is not as powerful as the Dairy Council.

Most of our products contain a blend of whole and refined grains, and that presents a problem.  If the product is not 100% Whole Grain (note : containing 100% whole wheat or other grain is not the same as the entire product being 100% whole grain), you have some proportional math to do - and you don't have the information you need to do it.

For example, I make my own cakes with 100% whole grain flours (soy and wheat).  I know the weight of the flours, 232 grams total and that each cake makes eight servings.  This means that my dessert contains nearly 2 servings of whole grains (29g).  If I also used white flour in my batter, I would need to know what percent of that serving size was made up of the refined flour and thus NOT contributing to my whole grain allotment.  (aaack)

Lucky for us, nutritionists have figured out some foods that provide a complete serving of whole grains. Additionally, if you  see a product with the Whole Grain Stamp you can know that 100% means it meets or exceeds a serving, Excellent means it meets the 16 gram serving size and Good means it contains half a serving.  

Foods that contain one full (16g) serving are:
3 cups of popped popcorn (no BUTTER)
1 piece of 100% whole grain bread
1/2 c cooked brown rice
1/2 c cooked whole wheat pasta 
1 cup cold whole grain cereal
1/2 cooked whole grain (oatmeal) cereal

There are things that fool us or can be confusing such as,
all bran does not mean 100% whole grain, but it is a great source of fiber.  As I said above, having whole grains as ingredients can mean very little if the majority of the product is refined.

I want to talk more about the differences in benefits from fiber and whole grains - in another post.
 I leave you with this link from the CSPI which clarifies the health benefits of whole grains and the research to support them.  It ends with things to look out for when you are shopping.

Try for at least 48gs of whole grains a day!  Need help?  My cake recipe is available on You Tube - as are my muffin recipes.

City Buses

Here is an idea.  
Most cities and counties in the US are concerned because a growing number of their residents are overweight or obese.  The cost to society in lost productivity and medical care is sometimes staggering. A growing body of evidence suggests that the biggest contributor to this national rise in obesity is the abundance of energy dense, cheap, nutrient poor, high fat, high sugar, processed foods.  Another factor is the heavy marketing and promotion of these foods.
SO - maybe we should stop advertising them or the places where they are sold on our county and city buses! 
(Today I saw an ad for a $4.99 Steak and Shake special on the back of the bus that passed me as I rode my bicycle home from school.)

Odds and Ends

Kale (in a bag)  Yesterday I bought kale in a bag.  The price was $2.78 for a pound that was already rinsed and trimmed.  It appears to be the small leaf variety that I prefer and I cooked it all today.  I do not live near a Farmer's Market (which is why I am a fan of mobile markets) and am unwilling and uninterested in traveling past four or five grocery stores to get to one.  I am also someone who believes that the produce in my local grocery store is healthy and fresh.  Truthfully, it is also less expensive when sold at a big retail store.  I did notice on the bag that my kale came from a NC farm about 2 hours away. The only issue I have with the product is the suggested cooking ideas on the back.  They are to add 1 lb of country ham or chicken stock or 2 tbsp of olive oil.  Though the oil is the healthy variety of fat, that suggestion adds 60 calories to each of the four servings.

Commodities  It is probably obvious to you that I have been studying our food supply and food system lately.  Mostly I am learning about how it has changed over the years.  From this, I have learned what the 9 major food or agricultural commodities are and wanted to share that with you.  I wrote this list on an index card, but I did not write the source!  I think it might have been in an article I read.

• Milk and Milk Products
• Meat, Poultry and Fish
• Eggs
• Legumes(beans), Nuts and Seeds 
• Grain Products
• Fruits
• Vegetables
• Fats, Oils and Dressings
• Sugar, Sweets and Sugar Sweetened  Beverages 

Fish The  3 dietary indices we've reviewed recently all make reference to the importance of fish in a meal pattern.  However, most suggest that the 2+ servings a week be from oily fish.  So, besides salmon, what are the choices and within those choices, which are not also high in mercury?  An unlikely source, the Skin Cancer Foundation, provides an answer to both questions.  Of course, they had an additional parameter in mind when they put their list together - Vitamin D.  Salmon is the only non white-flaky fish that I like.   Most of my favorites are not oily - and thus not on the list.  The worst is that my second favorite that provides Omega 3s is canned tuna fish.  I know that tuna steak and albacore canned tuna are high in mercury, but consumer reports cautions me that canned light tuna, though better - should also be restricted. 
Gluten = Calories?  Several companies make meatless "chicken" nuggets.  My favorite variety comes from the brand Health is Wealth.  I buy the vegan ones which are usually available at Whole Foods or Earth Fare stores.  I have been having trouble finding them lately.  I like this particular variety because they are nutrient dense and calorie dilute with 120 calories for 85 grams.  Quorn and Boca both have similar products, but Quorn is 210c/85g.  The other day I saw something similar to what I like from Health is Wealth- the only difference was that it had "gluten free." on the box.  I snatched them right up and only when I got home did I realize that they had 170 calories per serving - 40 more than the usual brand.  No big deal - but WHY?  I checked the website and compared the breading ingredients.  In place of the whole wheat flour (where the gluten is) they used rice flour and corn meal - YUK.

Cure Cancer  I noticed that someone had a picture of all these different colored ribbons on their Facebook page with the caption, Cure Cancer.  Sure.  But how about we do what we can to prevent the many cases, if not all, that have some origins in lifestyle.  A healthier food environment would be a good place to start.

Food Safety I read a great commentary by Drs. Silver and Bassett who were employed by the NYC Department of Health at the time the article was published.  They refer to our food as being "too salty, too fatty, too sugary and too rich in calories."  Thus it is unsafe.  They note that when salt, sugar, saturated fat and even calories are taken in excess - they cause bodily harm.  The best line was,  "Simply waiting for the food industry to self-regulate while telling the public to "just say no" to the ubiquitous supply of unhealthy food is clearly a failed strategy."  Ubiquitous means that something is everywhere or used all the time.  (So - see the cancer note on making a healthier environment)

Graphic Exercise

Ha ha - not graphic that way!  I was playing with the Microsoft Excel Program because there is a way to type in numbers and make charts.  I have to do that with one of my research 'jobs' and I didn't know how - so I practiced with my exercise schedule.

I want to note that the walking times in my routine are extra.  They are not part of my fitness plan but days I added because friends asked me to walk with them.  I consider them social time.  I also take occasional bike rides that I consider recreation as opposed to exercise.  The chart does not include my bike riding for transportation. 
The weird thing is, I add the walks and rides to accommodate my friends and when they cancel - oh and they do - I feel compelled to go on without them because it was ON MY SCHEDULE!  Isn't that nuts.  I have the opposite problem of the majority of Americans, I'd say. 

BTW, recent cancellation excuses from my friends include; it's too hot, I'm stuck in traffic, I have my period, someone died.  So okay - sure, someone dying is acceptable

This chart was made for fun.  It is pretty accurate but likely not spot on!

Eating for Your Heart

Heart disease is the number one killer of Americans and the American Heart Association wants to address that by improving the country’s cardiovascular health by 20% w/in the next 8 years.  In other words, they have established goals for 2020.  You can read about the goals and how the measures to meet them were established in a link below.

I read about them in a research article by Huffman, et al and in that article, I learned of the factors that are associated with cardiovascular or heart health.  Four of them are behavior related and three are under the skin indicators which can be measured medically. 

The full 7 factors of cardiovascular health as determined by AHA physicians and scientists are:

·         Smoking status

·         Diet quality

·         Weight

·         Amount of physical activity

·         Blood glucose levels

·         Cholesterol readings

·         Blood pressure numbers

I was posting about different healthy eating indexes when I found this research study. You may recall the AHEI 2010 criteria.  Here is how the AHA defined a healthy diet.

Primary Dietary Factors:

• Fruits and vegetables:>4.5 cups per day
• Fish: >two 3.5-oz servings per week (preferably oily fish)
• Fiber-rich whole grains:>three 1-oz-equivalent servings per day
• Sodium:<1500 mg per day
• Sugar-sweetened beverages:<450 kcal (36 oz) 3 12 oz cans per week.

 Secondary Dietary Factors:

• Nuts, legumes, and seeds:>4 servings per week
• Processed meats: none or <2 servings per week
• Saturated fat: <7% of total energy intake

The symbols mean greater than or equal to (>) or less than or equal to (<)

Many of us will need less than the amounts stated above because they were based on a 2000 calorie diet.

In the research study by Huffman, only the primary dietary factors were used and for each condition that the person achieved, they received one point.  Therefore, the total diet score could be 0 to 5.  People who scored 4 or 5 were considered to have an ideal diet.  The study results suggest that less than 1 % of Americans have an ideal diet.  This is disturbing and helps us to understand why so many are at risk for heart disease.  I have been thinking about my own diet pattern since reading this and I think I could be a 4 – but I have to work on that – including more fruit!  I am glad I have that booklet that tells me which fruits are best!

I would recommend that you read  this free article about  establishing the AHA criteria and goals. At the very least the information on pages 11 and 12, because it provides more information on diet factors and the research to support their importance.

If you are interested in the study by Huffman, Capewell, Ning,et al , it can be viewed here.

Status of Leading Health Indicators

Today I will present some highlights on the status of a few of the 15 Leading Health Indicators as assessed in the current CDC early release reports of National Health Interview Survey data.

There are 15 individual updates on the CDC website and if you scroll down a bit (after the initial list of 15), you will get reports for each one separately.  If you click on the link for each indicator on the website, you can see the graphs and tables. The text below the name tells you what you'll learn from each figure.

Here is an update on 3 indicators that make sense for this blog, obesity, physical activity and cigarette smoking

Remember that this information was put together from a sample of adults who answered questions during a household interview in 2011.  The comparison - % change - refers to household interviews from 1997.  This pertains only to adults and the sample is supposed to be representative of all Americans - not individually but as groups.  It does not mean that any of this applies directly to you.  

Here is a snap shot of our big numbers.

Obesity - When putting all race/ethnicity and gender together - 28.7%  of American adults have a BMI 30 or greater.  In 1997 that number was 19.4%.
If we look at all males, the percent with 30 or higher BMI is 29 and only females it is 28% - not a real difference between genders.  There are differences between age groups and between blacks and whites.  The fattest age group is MINE - age 40-59 and the worst disparity is between black and white women with a 19% difference in current BMI status.

Physical Activity - Here the comparisons on physical activity were related to the percent of adults who achieve the minimal requirements of the 2008 Physical Activity Guidelines - remember all those posts?  Me either, here is a link.  Anyways, just looking at the recommended aerobic activity, less than 50% of the population is currently meeting the target amount - since 1997 we have achieved between 40 and 50% of the recommended amount.  The least active group are those over the age of 75, but again, this is where individuals can really be different - like my Mother... she is more active than many 20 year olds.  When the question involves a combination of both the aerobic (raise your heart rate) and the muscle training components, the country is doing horrible!  Well, that's my opinion - but the rate of attainment is about 30% - Today I went swimming and lifted weights - so I am on target.

Cigarette Smoking - Ah - the biggest controllable risk factor for heart disease, lung problems and cancer.  In 2011, 18.9% of US adults smoked cigarettes.  That is a great improvement from 1997 when it was 24.7% (hey that is when I quit :)) but it is not much different from last year.  The age of smokers breaks out prettily evenly between ages 18-64.  The best news is that this study suggests that 60% of adults have NEVER smoked.

Status of LHIs

Tomorrow I hope to give you some updates on the status of America's Leading Health Indicators as reports were released today from the 2011 National Health Interview Survey.

The NHIS is a nationally representative survey of US Households. It randomly samples from all persons not living in institutions, therefore, nursing home or long term care residents, oversees military personal, citizens living abroad and prisoners are excluded. Within the randomly selected household from every state and DC, questions are asked about the household makeup and a joint interview of the family is conducted.  In that part, anyone who is aged 17 or older can contribute in answering the questions.  Separately, one adult is interviewed to answer questions about themselves and a randomly selected child..  All interviews take place in person with computer assisted technology.  There is no paper survey.  There is also no lab component and the dietary and activity questions are broad in nature.  I often refer to NHANES, which has a different method of  data collection.

The NHIS has been required by law since 1957 and was updated in 1997.  Supplements are added to the core components when new findings about health or disease require additional questions.  This is a voluntary survey.  It is expected that in 2011, 35,000 households and 87,500 people participated.

The main reason to collect the information is to monitor trends in illnesses and disability, to track the progress of LHIs, to explore the extent of and barriers to health care access and to evaluate federal  programs and policies.

I need a little more time to review the reports that were just released.  I only looked at the obesity numbers today (still high).  

I thought  that for now I would  give you the link to the webpage that identifies the LHIs.  It explains their purpose and notes the current goals for each one. e.g. X% of Americans should have a normal weight by the year 2020..

Click on this link to learn more.  The LHIs are in a column on the left.

Measuring Toxins - Making Sense of Big Numbers

** make sure you read to the end - its the whole point!
Some years ago - maybe six - I wrote about mercury in fish - methylmercury - and shared a PPT and maybe even a paper I had written called, Good Fish Bad Fish.  The good is that when we eat fish in place of meat, we lower our levels of saturated fat.  Fish also is the best source for PUFAs and Omega 3s.  It can be bad because our waters are polluted, mostly from coal fired power plants (and other human causes of mercury emissions).  Our fish can be toxic.  For instance, swordfish and shark - even tuna steaks - are too high in methyl-mercury  to be consumed in any more than the rarest of circumstances.  (the bio-degradation process changes the mercury to methyl mercury)

Still many fish types - or the waters where the fish are found - do not have toxic levels.  The EPA among others, tests fish and water and a list is kept of the amount of mercury found in both.  There are many measures of this and that prompted today's post - in a way.  See them below.  Plenty of fish, including salmon and tilapia are very low in  mercury as measured in PPM,  parts per million.  It is recommended that we choose fish with less than .5 PPM of mercury. 
Check the list from the FDA  here. By the way, the NRDC now has a calculator with which you can estimate your mercury exposure by the type, amount and frequency of your fish consumption.  Here is the calculator.

Terms:
rFd - Reference Dose - the amount set by the EPA that is safe in humans (safe and effective if its a drug)
NOEL - with human or animal subjects-  this is the level at which there are no observable effects
NOAEL - with human or animals - the level at which there are no observable adverse(bad) effects
PPM/PPB - how they measure toxins (here mercury) in fish and water.  Fish safety 1PPM and water is 2PPB (FDA and EPA)
MRL - Minimal Risk Level -this regards the amount of daily exposure that a human can endure without risk of adverse health
AL - Action Level - higher than MRL, signals that something must be done to correct the situation or harm may occur, i.e. the amount may be close to surpassing the rFd

Here is the point for today:When we look at our fish advisories and charts - what does PPM really mean?  Hard to wrap you mind around one part in a million isn't it?  Well - just last week I received my annual report from the city on the quality of my drinking water [yes!  people open and read those things sometimes]
That brochure provided 2  great examples of what PPB means  - yes that is billion, so I took that info to the internet and confirmed the translation into parts per million examples:
 One part per million is the same things as approx:
1 penny out of 10,000
1 inch out of 16 miles
1 minute in two years

Getting the Most from Your Servings Per Day

I joined the organization, The Center for Science in the Public Interest.  This is a good fit for me as I have the desire to share research(science) with others.  I do this here in the hopes that people will apply the best evidence to decisions they make about their health. My membership was only 10$ and I recently received a fact book on healthy foods from them as part of my signing up.   I do study nutrition matters on a daily basis, so I feel confident in my ability to wade through the junk and sensationalism - this book is neither.  It was created by nutritionists and the criteria used to determine a foods healthiness is clearly stated and scientifically supported.

The booklet has 2 charts that are of particular interest and relevant to our recent discussions.  In these charts, fruits and vegetables are given scores based on their ability to provide the nutrients we most need within the standard serving size ( RACC - 1 piece of fruit or 1/2 cup etc).  This includes vitamins and minerals; carotenoids, vitamin C, potassium, calcium, iron and fiber... with vitamin k and lutein included for vegetables.  Along with the score and some symbols for the amount of nutrient provided (i.e 20% of DV) the rows contain the calorie amount.  This is perfect as it allows me to iterate on an important point I continue to make.  Calories count!  A diet(meal pattern) that is considered healthy includes a certain amount of servings a day from select food groups.  These recommended servings are intended to be consumed at an individually based caloric level.  We can average that to 1800 calories a day for minimally active persons (perhaps).

The food groups from which to choose are fruits and vegetables, whole grains, protein and healthy oils.  If you choose your 4 fruits and 5 vegetables from among the most caloric ones, e.g bananas and potatoes - that is 900 calories worth!! 
Better yet, the booklet shows that the fruits and the vegetables with the absolute highest nutrient scores are often also the lowest in calories.  The low energy density high nutrient combination is well represented here.  (volumetrics)

For instance, the top 12 fruits include 10 with less than 100 calories per serving.  The lowest calorie highest scoring fruits include cantelope (1/4), watermelon (2 cups diced) strawberries (8 berries), grapefruit (1/2) and an orange.  Note that honeydew melons and bananas are much further down the list.  The highest score is 575 for 3 pieces of guava (watermelon is second at 314) and the score for the banana is 045. 

The vegetables are awesome.  So many nutrient dense low calorie choices exist.  This is so important because we should eat 5 servings of veggies and if they are high in calories, we won't be able to have that glass of wine at the end of the day - or small cup of ice cream! [note that if  10 percent of the 1800 calories can go to SOFas - that is just 180 calories for desserts] 
The number one vegetable with a phenomenal score of 1389 points - yes that is thousands... is KALE.  A 3/4 c of cooked kale only has 20 calories.  Another powerhouse is canned pumpkin (specifically canned) 1/2 c has 40 calories and 570 points.  I use canned pumpkin often. Brocolli rabe is low in cals and has a high score of 386. A medium sweet potato which has a good score (485), has 100 calories.  That is not a lot of calories but remember you have 4 more vegetables servings to get in the same day.  Some vegetables with low scores AND high calories are avocado, lima beans and white potatoes.  All of these have a score below 075.  [I am using the leading zero so you don't think I made a mistake on the potato and banana - I know that they are loved - but their overall nutrient content is not so great]

I think that a list like this is very helpful.  The book does the same thing for meats and for protein sources.

Odds and Ends

Morbidity In the USA and similar nations, the average life expectancy is greater than age 75, but the years of life spent with a chronic disease have also risen. Some people have heart disease for 30 years, being diagnosed when they are in their 40s.  The better goal would be to extend healthy life expectancy.  This is a concept called compressed morbidity.  It can be great to live till the age of 90 - especially if we could compress the disease or morbidity into the last ten years of that life.

Shiritaki Recalling 2 past posts or maybe 4 - calcium is a short fall mineral according to the DGA.  We need it.  Dairy products are not the only source of calcium and may not be the best source.  When using the DV or daily value numbers on a food label, we consider 5% to be a low amount and 20% to be high.  In this way, we know that the calcium number we are aiming for is 20%.  If a food has 20% of calcium it is considered a good source of it. WELL, my shiritaki noodles - made of tofu -  have only 20 calories per serving, compared to 100+ for a serving of pasta, and they contain 10% of my daily calcium needs!  More actually because I do not have a 2000 calorie diet.  That is very cool and unexpected. 

Cervical Cancer The men responsible for the vaginal smear - scraping cells from the cervix and viewing them under a microscope for abnormality- Dr George Papanicolaou and Dr Herbert Traut- are credited for reducing cervical cancer death by 80% in the USA.  The HPV vaccine may help us stop spreading the virus that causes cell abnormalities, but the Pap smear detects the cancer and saves lives.  It appears we need both.

CAGR  Ah those pharmaceutical companies and the financial analysts who track them - you can learn so much!  I read another recommendation regarding a diabetes drug recently and it was noted that because of the world wide rise in cases of this disease (thank you obesity epidemic) the CAGR is expected to be over 7%.  In other words, companies that have diabetes drugs are good stocks to hold.  The CAGR stands for compound annual growth rate.  Not sure what that means?  Click here.

The problem with fake sugar

Several artificial 'no' calorie sweeteners have been approved for use by national governmental bodies in various countries.  This post will not delve into their safety - I have done this on more than one occasion (you can search the blog) and have concluded for myself that the products are safe if used as intended.  (i.e. some are not heat stable and you should not bake with them) Regarding sensational stories associated with them, I refer you to snopes.com which regularly debunks such myths.
And as I am known to say, if it turns out that these sweeteners do kill us - I will be dead twice.  
Of the products available for purchase, the most popular appear to be Nutrasweet (aspartame), Splenda (sucralose) and SweetnLow (saccharin).  I regularly use the first two, but not brand names.

So what is the worry with them?  Some research suggests that people who use artificial sweeteners or drink diet drinks actually gain weight.  Now don't panic.  First of all, the research is not the kind that can make a causal determination.  No study has ever said, diet soda's cause weight gain.  There are studies that show a correlation - or a coincidence - between diet soda consumption and increased BMI for one example.

I am not saying that people who use sweeteners won't gain weight.   I am saying that it is not because of the sweeteners themselves.  Some interesting research suggests two explanations for what is happening.  First, since we have all this fancy imaging equipment that we tend to over use, scientists have put people into  fMRI or PET scans to look at their brains after the subjects consumed sugar or an artificial sweetener.  Turns out - sugar taps into the reward center of the brain (yippee!) and sweeteners do not.  This means our bodies get different messages and respond in kind - you know different neurotransmitter action and all that.  Secondly, sugar has calories - empty as they are- sugar is still a source of energy.  Aspartame and the like do not have calories(energy).  Here is the key.  If you drink a diet soda or use a sweetener to cut back on say 100 calories, but you consume that 100 calories, and more later - then YOU WILL GAIN WEIGHT.  There are many reasons why we over consume and some of them happen by accident - we don't expect the meal at the restaurant to have 1200 calories - but either way - too many is too many and that's what happens.
If you can use sweeteners and regulate your intake - as I most certainly do - then this should not be a problem for you.

I suppose there is still more we have to learn about artificial sweeteners and I absolutely do not consider them a healthy product - but I hear sugar is itself toxic so- well - we have to limit it. 

** I am not making an endorsement, you must engage in your own informed decision making regarding the use of sweeteners.
** I will absolutely offer an opinion about the brands that fortify their products, you know with fiber and or vitamins.... THAT is NUTS - save you money.  Get your nutrition from FOOD - because that is where science says it works.  There is NO evidence to suggest that fiber in an artificial sweetener improves health the way it does in an orange or oat bran.

Exercise Psychology

I have a few things on the agenda for the days to come - for instance, the AHA has its own criteria for a healthy diet and diet is included in the risk markers for heart disease.  I am anxious to share these with you.  I want to tell you what you should really worry about with artificial sweeteners (I use them) and I'd like to highlight the greatest advance to preventing cervical cancer (not Gardasil!).

However, my last few posts have been pretty heavy for you and me - so today I will simply share this exchange that occurred at my  university pool.

A man who has become my side by side 'lane mate' friend does a pretty heft workout that involves a lot more than swimming.  He goes off to a corner first and does pushups, he uses the ladder for triceps dips and the diving board for pullups.  He has special gloves he puts on his hands for his laps, uses some type of flotation gadget that goes between his legs for something, employs the kickboard, a jog belt and more.  
I go to the pool twice a week, and often see him on at least one of those days - Thursday - mostly, that is the day I started using the kick board too (he encourages my pitiful progress).  I did not see him for a week or so around the Memorial Day holiday and the day he came back he had even MORE gadgets for his workout.  He had  barbells made out of Styrofoam.  I said, "Wow, pulling out the big guns today."  And he explained that he was trying to make up for his lost days.  I asked him how many days a week he worked out at the pool and he really struggled to answer.  He was stumbling over the words, "3 days".  I laughed and said, "What's that matter?  You know if you say it out loud, then you have to do it?"
To which he replied, "Oh,  you're a psychology professor aren't you?"  Ha Ha!  NO.  Hardly. 

 

Calcium - Get It HERE!

Recently, we went over the Alternate Healthy Eating Index (AHEI) and the recommendations on what to include in a food pattern as stated by Harvard School of Public Health (HSPH).  There were some differences from the national dietary guidelines.  

Today I would like to address one of them in as briefly a manner as I am capable.

Calcium.  This mineral is vital for bone health and the most usable source appears to come from dairy products.  The Dietary Guidelines for Americans includes 2-3 servings of dairy in its sample food plans.  The nutritionists at HSPH remind us that milk/dairy is not the only source of calcium and may not even be the best.  Two reasons against it are the high saturated fat content and the digestive difficulties some people have with lactose.  With regard to the fat component, to reduce consumption of saturated fats, which all the guidelines suggest, one must choose the 1% or less version of dairy across all the products.  This means your milk, yogurt, ice cream and cheese!

There is good news.  Green leafy vegetables are a very low calorie, no fat, exceptional source of calcium AND vitamin K.  These are two of the three bone health factors.  The other is vitamin D which is very hard to find in food sources (salmon is one, mushrooms another).  You will find kale, collards, brocolli raab, and many other similar vegetables (spinach, mustard and turnip greens) loaded with calcium and K. Less leafy vegetables and legumes are options too.  For instance, broccoli, Brussels sprouts, white beans,  okra, soy beans and some forms of tofu.  (here you could have one cup of dairy a day (milk or yogurt or cheese) and then two of these others as one option in meeting recommendations.

Every one of these veggies is a low calorie food with the exception of the white beans - which have more calories but are a superb source of protein. 
Here are some numbers for you:
(1 cup of leafy greans, 1/2  cup otherwise)
Calories are below 50 per serving of each item listed.
Collards - 266 mg of calcium and 836 mcg of K (the winner)
Kale - 94 mg of calcium and 1062 mcg of K
Broccoli raab (rabi) - 100 mg calcium and 217 mcg K
Brussel Sprouts - 28mg calcium and 109 mcg K

What to learn more?  You can look up a particular food and assess its macronutrient, vitamin and mineral content.  When you are scrolling through, don't stop at potassium which has a k by it.  Actual vitamin K is lower in the list. Access the nutrient data base by clicking here.
My knowledge comes from reading the information available from the Nutritionsource website of HSPH - You can read it yourself by clicking here.

mSv - how much radiation for you?

From many past posts - you may remember that the mSv is a millisievert - a measurement of radiation.  People can be exposed to radiation through a multitude of medical imaging procedures and the mSv is one way to track that exposure .

I won't go over the issue again - suffice it to say - there is a risk of cellular damage from the radiation and that can increase risk of cancer.  The machines themselves deliver different doses of radiation and are often not calibrated to make sure that the least radiation needed is what is being used.  The types of imaging (CT, Xray, MRA) transfer different doses as well.  I have previously posted charts on this. If you go to the Cancer Panel Report HERE, the chart is in chapter four.

Today an excellent study is published in JAMA and I think you can access the entire study, but definitely the summary paragraph (abstract) is enough to be helpful.

Briefly, this is what the researchers did and their overall findings.

They reviewed data from 5 different big health care systems.  For example, you may belong to an insurance program where everyone uses the same health care system (like Cone Health).  The researchers reviewed the records in 5 of these big programs and tracked the type and amount of imaging the patients received over the years (they signed release forms - don't panic).  The scientists estimated the dose of radiation through a detailed, multilevel process that is described in the article.  Certainly, there is room for error but the averages and trends are important. They categorized the radiation, in mSv, as an effective dose, a high dose and a very high dose.  The very high dose is >50mSv.   Their overall conclusion - covering the years 1996 to 2010 - and pertaining to the millions of people in those systems - is that all types of imaging increased and so did radiation.  As the CT scan is the target of most of my rants, I will tell you that in 1996, 52 of every 1000 patients had a CT scan which increased to 149 of every 1000 by 2010.  That is a 7.8% per year increase.  The researchers also conclude that each dose class, effective, high and very high was increased.  More people being scanned, and more people getting more radiation at all levels.  

If you go to this link and only read the section in the abstract under results - you will gain a lot of insight into this problem.  Of course, you can read as much as you like (I think).

Recall my recent post regarding the Consumer Reports collaboration with physicians groups which is meant to protect patients from overuse of this technology.  You can view that again here.

What We Ate in 1999

There is a way to review the food supply for the amounts of food by type that we consume each year.  This is done with surveillance data from the USDA.  It is called US  Food Supply Data.  Researchers do a good job estimating what actually ends up in our homes.  For example, they account for parts that are not edible and what might get lost along the way (spoilage/waste). Of course, they can not be certain of how much we eat or toss out within our own homes.

I am reading an article now that was published in Food Review in 2000.  Unfortunately, it is comparing our estimated intakes to the recommendations of an older set of Dietary Guidelines.  In the article there is data from 1970 thru 1999.  It compares a few sets of years, but I am most interested in the changes between 1970 and 1999 when the obesity epidemic took off.

Here are a few highlights from the article.

We have reduced some of our full fat milk consumption but increased cheese consumption which is high in saturated fat.
The vegetables we were eating in 1999 were far from ideal. If you consider the AHEI - it is horrible.  Fifty two percent of vegetable consumption involved five foods and three of them were potatoes.  The same bad news for fruits.  The main fruits consumed were bananas and orange JUICE - not oranges.

Based on the old guidelines, we were to aim for no more than 30% of our calories from total fat.  That has changed to a recommendation to limit saturated fats and increase healthy ones.  The newest guidelines recommend strict limitation of solid fats and added sugars, SoFAS. From 1970 to 1999 we increased our consumption of added fats by 32% (or 64 grams) but what's worse is that it makes up 87% of the total.  This leaves very little room for the fats that occur naturally in meats.  (the added ones are from  baked goods, dairy creamers, butter and salad dressings).  We have increased our added sugar consumption by 29% .  This comes from desserts (refined grains) and sodas.  In fact, the average person (if things were really evened out) consumed 34 tsp of sugar a day in 1999.  That is almost 4 cans of soda!
I was particularly interested in the meat, poultry and fish section - considering the recent posts on a healthy eating index.  In 1999, we were consuming three 4 oz servings of red meat a day.  Recall that the ten point score was for less than one red meat serving a month!  Also, that is an underestimate because they are averaging it across all of us, including vegetarians who consume 0 red meat.

This type of study does not allow for causal conclusions, however - with what we know about diet and disease it certainly shows that our increase in added fats, sugars, refined carbs (and the 15% increase in overall calories) matches our rise in obesity, heart disease and diabetes.  In 1970, 46% of adults were overweight or obese and now it is about 67%.  In 1970, 15% were obese and now that is over 30%.  
We did not change the foods we eat near as much as the foods we ate CHANGED.  It is time to alter our food supply back to the way it used to be.  We can get rid of all this extra fat and sugar that most of us have no idea is even there.  A person shouldn't need a college degree to navigate the food environment!

Putnam, J., Kantor, L. S., & Allshouse, J. (2000). Per capita food supply trends: progress toward dietary guidelines. Food review, 23(3), 2-14.

BMI is a measure of fatness.  
We the measures of fatness overweight, obese and morbidly obese and use numbers from BMI- body mass index- to categorize people.  We are essentially referring to risk associated with percent body fatness, not weight.  BMI is a proxy measure of fatness - excess adipose tissue.  This excess relates to risk for disease. The BMI is helpful for researchers more than individuals because when you have 100s and 1000s of people with BMIs at a certain level grouped together, MOST of them will meet the criteria for overfat by their BMI number and those who do not won't really change the analysis.

My BMI does not declare my health status, but if I had a high one, over 25, I would want to ask my doctor if my fat levels were of  concern.  This is an individual issue.

The risk for disease in an "overweight" person is not as great as that in an "obese" or "morbidly obese person."  Generally speaking.  If I am overweight I may have a certain risk of high blood pressure, let us just say 10%, but if I am obese, that rises to 20%.  My BMI doesn't really tell me enough though- even if I look at a chart or use a calculator to determine it.  I might find myself in the >25<30 cat or the >30 cat or the >40.  Certainly - all of us are at great risk when it is 30 or higher, but those 20s can be a little more nuanced.

This difference is not always small enough to be ignored in data analysis either, I am learning.
In reviewing numerous articles within the topic of obesity and chronic disease, I have started to see that the amount of fatness (better measured with waist circumference, skin calipers or other techniques beyond BMI) that increases risk for disease is 1) not the same for each disease (e.g. heart disease or diabetes) and 2) is not the same overall or specifically by race or ethnicity.

I will have to read a lot more to fully grasp the numbers and explanations (some of them as yet unknown) but I can say a few words now and keep this issue in mind.  [It seems the more precise our measuring, the less generalizations we can make!]

For example, current wisdom is that a BMI over 25 is an indicator for disease risk in a population of people (as a group).  It turns out that Asian Americans may have disease risks with a BMI at 24 and black Americans are fine up to 26.  Thus, the number of whites in the samples used to determine these things may have skewed the numbers.  At the same time, a white American may have a higher risk of heart disease at BMI 25 than a black American, but a black American a higher diabetes risk at a lower BMI.  Gender differences are there as well and these numbers were just for demonstration purposes!

I suppose the 'bottom line take home' points are these:
Body fat, especially visceral fat, is linked to disease.  One way that we try to measure it is BMI but it is very inaccurate at the individual level.  For an individual, WC or WHR ratio might be better. You can click here to review that information.
Most of the time, if you have extra body fat, you know it. :)  You may not want to know it - because then you have to do something about it - but you know. 
Lastly, we each have our own tipping point where our weight makes us sick and it can be higher or lower depending on many things. Additionally, we have a physical and psychological weight preference, but it is less important with regard to disease causation.

Odds and Ends

Sweating and Heart Rate  I saw a woman who appeared to be over 'fat' today.  She was walking in the warm mid morning sun, on a fitness path so I assume she was exercising.  She had on a long sleeve sweat shirt/jacket and long pants that looked elastic or plastic.  She was not carrying any water.  I guess she was trying to make herself sweat more.  I really wanted to talk to her about this.  Instead I express myself here.  Sweating can increase fluid loss and dehydration.  Sure that might equal a pound or two at the end of the day - as well as a headache, risk of dehydration and tachycardia - or rapid heart beat.  This is NOT the increase in heart rate that comes from moderate to vigorous exercise which burns calories and fat!  Instead it is an increase that puts one at risk for serious adverse health outcomes.

Atherosclerosis v Arteriosclerosis  These words are often used interchangeably but that isn't really appropriate because they mean different things.  The first regards narrowing of the arteries - from plaque build up and can also be considered thickening.  The second specifically refers to hardening.  It seems to me that the first could cause the second.  They are both indications of cardiovascular disease and can cause clots/blockages/reduced blood flow(ischemia) and heart attacks.


Sleep  There is an association between sleep duration and quality and weight.  Read more here - HSPH obesity prevention source.

Exercise and Weight  To the extent that exercise is related to what a person weighs, the bigger issue isn't whether or not you burned calories - you did, its whether or not you overcompensated for it by consuming too many afterwards!  I was talking to some one at the pool last week and realized that I exercise 9 days a week - ha ha.  He mentioned that my exercise routine explained why "you look so good."  But it doesn't completely.  Sure, exercise has a lot to do with my composition and tone, but my refraining from eating with the same intensity is what reduces my body fatness.

Food Donations  We are fortunate to have a music in the park series in my town.  At today's event there was also a food drive.  I brought 'my' peanut butter, canned light tuna, lentils and baby corn.  When I set my bag down, I noticed that someone had given macaroni and cheese - in a box.  This is something that has come up at the community meetings I have been attending regarding food insecurity.  People who are forced by circumstance to receive their groceries from food pantries (and our donations) are already at the mercy of  cheap, calorically dense, nutrient poor foods..  So - Really - can't we do better in what we offer them?  Also - donations that require mixing with 'other ingredients' only work if the person has the other ingredients!  (BTW - some pantries  and community kitchens take fresh produce and THAT is awesome)

Healthy Eating Initiative  Question.  Why is the United State's national initiative to improve dietary intake and reduce obesity called, Lets Move?  Answer. Because it is politically safer to encourage exercise than to limit foods.