Trans fats - beyond the nutrition facts panel

   A recent post regarding trans fats and how to read the Nutrition Facts Panel has become quite popular.  The purpose of using the NFP in that example was to identify if a food was high or low in trans fats.  The reasons why this is important is detailed there. 
   An important point that I failed to mention was that a company can legally list a product as having 0 grams of trans fat per serving if that serving size (determined by the manufacturer) has less than 0.5 grams of trans fat.  
   Let me explain why this matters.  If in your day you choose several food products which you think have no trans fat, but which have 0.4 grams each, then you can consume more than 1 gram of trans fat without even realizing it.  Health and nutrition experts tell us to avoid trans fat altogether if possible, but to keep it under 1 gram per WEEK.  Another way that the less than 0.5 per grams can add up is if the posted serving size is e.g 1/2 a cup (and has 0.3 grams) and you actually eat 1 cup - which would have nearly a full gram.  Remember, unlike saturated fat, trans fat has no level that is considered safe.
   In order to protect yourself from this trickery, an extra label step is required of you.  I am including another picture below to demonstrate.  You will see that the ingredients listed include hydrogenated oils.  If you see partially hydrogenated vegetable oils (PHVO) or hydrogenated vegetable oils, you are consuming a product which DOES have trans fat.  The terms are used interchangeably.  [to be clear, fully hydrogenated oils do NOT have trans fat but do not mistake hydrogenated for fully hydrogenated].
   In a Medscape article written by a physician for physicians, doctors were urged to counsel their patients (you guys) on both saturated and trans fats.  It was suggested that patients replace most of their saturated fat (red meat, butter, full fat dairy) with mono unsaturated and poly unsaturated fats/oils.  We have already discussed this previously. Doctors were told to have the patients stay clear of trans fats.  The reasons for this are that they have a role in promoting heart disease, stroke risk and diabetes.
   Now my label is very important and covers two important points.  The first is the hidden trans fats, but the second is the misleading promotion of the product.  Planters is calling this line of products, Nut-trition.  I have only reviewed the peanut butter, but as you will see it has added sugar, salt and oil (not the healthy product they are "selling").  Again, an all natural peanut butter contains only one thing, Peanuts (and somtimes salt).

    Notice the hydrogenated vegetable oil as well as the addition of numerous other oils.  Peanut butter contains one of the healthiest oils we have - it is NOT solid at room temperature (peanut oil).  There is absolutely nothing to gain by adding more oils. Notice also that the sugar listed isn't naturally occurring sugar.  There is sugar from the fruit, but in addition the words sugar and syrup indicate added sugars.  This product has some amount of trans fats even though the NFP says 0g.

If you ever have a doubt about a product - go to Whole Foods and see if you can find it there.  They do not sell any items with artificial trans fats.

The Medscape article I referred to was written by Jonathan Berz, MD

For those of you in the US, have a nice Labor Day weekend - I am toiling over my studies and will be back in a few days.

Sharing a Healthy Plate

   Last night I attended a small gathering of doctorate students in Public Health at my university.  We had a pot luck appetizer theme and I took that as an opportunity to get out my tulip platter and wow people with nutrient dense, calorie light treats.  I took a picture and post it below so that you might consider bringing a healthy tray to your next social event.
   Tonight I met a different set of friends.  We are planning our high school reunion.  Our meeting was at a restaurant and someone had preordered a few appetizers.  They were all calorically dense and I chose to just have a beer (:)). So on occasion, I DO drink my calories, but for some, alcohol is health promoting.  This is never true about sugar sweetened beverages!
   Tying these two evenings together is another true thing about me.  I do not eat food to make other people feel comfortable.  I eat when  it suits me to eat (which is related to what the food is and whether or not I am hungry). As you might also know, I don't take kindly to 'food pushers'. {food pushers are those that seem to feel uncomfortable by other people's not eating, or not eating "more"} And yet I am as much a food pusher as any body else and have to restrain my own impulses.[It's a phenomenon of our broader culture - of many cultures]  Last night, if someone had not made a plate of food at our buffet table, I found myself wanting to ask, "Aren't you going to eat something?"  And I did offer to make a plate for one guest in particular -(her hands were full with her twins!).  It's funny isn't it.  In my defense, I never push things that are not part of a quality diet :)
   Here is the tray - which has Wasa crackers and two flavors of Light Laughing Cow cheese wedges (they do not come that way, I bought two and mixed them), grapes in personal sized bunches (I cut them that way), vegetarian eggrolls cut into 50 calorie servings, and my own blueberry cake squares.

Beneath those goodies is a great picture of a tulip - I love tulips.

 

Does a BMI number cause Breast Cancer Death?

   The headlines read that obesity increases the risk of cancer recurrence and death in women who are diagnosed with breast cancer.  The actual study involved an evaluation of several groups of women who had stage 1, 2 or 3 breast cancer and were themselves enrolled in clinical research trails.  The purpose of those research trials was not to determine if weight impacted recurrence or mortality, but to evaluate the efficacy of new chemotherapy drugs.  This is important.  Who were the women in the sample, how much are you like them, and how much are other breast cancer patients like them?
    The women who were studied all received chemotherapy and had operable cancers (I do not know if they had surgery, only that they had operable tumors and received chemotherapy).  A consideration to make is whether or not the people who chose to enroll in the study are different from people who did not enroll.  Also, only certain types of people were allowed to participate.  Usually, and it is true here, the people in drug studies have the condition the drug is trying to treat, but are usually otherwise healthy.  This study left out people with "significant" co-morbidities (other diseases occurring at the same time), but I do not know what 'significant' includes.
   The headlines refer to BMI as the risk factor, but having a BMI of 30 or higher isn't the problem.  What that number might reflect is the problem.  For most people BMI mirrors waist circumference (WC) - they mean the same thing.  However, in some people the BMI does not reflect their weight status well.  Waist circumference over 35 inches or higher is a very good indicator that a person also has insulin resistance, high triglycerides and high blood pressure.  It is those issues - collectively called 'metabolic dysfunction', that puts people at greater risk of disease and death.  Consider that those conditions; high blood pressure, trouble with sugar, high blood fats,  make the body less robust, less able to fight off infection, less able to rebound from injury and disease.  Metabolic dysfunction is deconditioning and a person with these conditions (including a WC 35+ and a high BMI) is at a disadvantage before treatment for cancer ever begins.
   This way, obesity and smoking are similar - both increase the risk of disease and death from any disease - just know that BMI and obesity are not the cause - it is the metabolic dysfunction.  Maybe they are the cause of the cause.
    Here is a link to the study regarding the outcomes of the 3 drug trials that were used for the headline making stories.

Study reference:
 Sparano, J. A., Wang, M., Zhao, F., Stearns, V., Martino, S., Ligibel, J. A., Perez, E. A., Saphner, T., Wolff, A. C., Sledge, G. W., Wood, W. C., Fetting, J. and Davidson, N. E. (2012), Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer.


 

Circumsicing Babies

   The focus of this blog has included the application of research to real life and evaluating headlines that are in response to research.  In other words, the "truthiness" of those headlines.
   The American Academy of Pediatrics confirmed its stance and recommendation for male infant circumcision today.  The rationale behind the recommendation is that there are lower rates of certain infections amongst males who have had the procedure.  The outcome that shows a greater difference between circumcised and uncircumcised boys is urinary tract infections.  UTI rate also seems to have the most evidence behind it- it has been studied the longest. Other outcomes that researchers associate with lack of circumcision are HIV, HPV, cancer, and sexually transmitted infections in general.  (associated  meaning the outcomes are higher in one group than the other)
   If I had a male child I would have him circumcised, but not because I believe that it prevents sexually transmitted diseases.  I believe that it may reduce infections in general and to tell you the honest truth - my decision is also aesthetic.
   This morning I heard someone make an argument for circumcision as an HIV prevention strategy using the results of the change in HIV rates in African men, living in African countries who are circumcised as adults.  The person who was using this evidence to support circumcision in infant American boys was challenged.  Can you see why?  How are these two groups similar?  They are not.  The results from the adult study in another country does not translate to these boys.  Even if it makes biological sense, you can't extrapolate to such a different context.
   Another point made in the discussion was that the rate of circumcision in the UK is much lower than that in the USA and UK men HIV is lower in the UK.  This was countered by another who said that the number of new cases was much higher in the UK - or the rate vs the prevalence (chronically ill vs newly ill).  Again - the two groups are not the same and a comparison is suspect. (what else protects against HIV?  Maybe UK men have less sex?  Maybe many are HIV and undiagnosed?  Who knows, but you can't show cause and effect either way.)
  My biggest issue however, is when any of them try to say that circumcision prevents the "disease in question" or that not being circumcised causes it.  The only way to claim that direct link is to have some boys circumsized and others not and then make sure that they are exposed to the same conditions and risks throughout their lives and see if one groups gets more diseases than the others.  That has not been done and it will not be done.
   I imagine that instead, most of these studies are looking at the characteristics of men with a disease.  To determine what those characteristics are, they have to ask questions - either of the men, their physicians or their partners. Or some combination. Whether or not they have been circumcised is observable but the number of sexual partners, the use of condoms with partners, consistent or occasional use of condoms, the risk behaviors of the people the men have sex with... all of those things have to be considered and all of those things have certain biases.  For example, a person might not remember, might not know, or might not want to say.  But, what if boys who are not circumcised have different kinds of sexual partners/experiences on average than the circumcised boys/men do? With all of these things impacting the risk of getting sick, how can one say that circumcision is the determinant?  Maybe a question to ask is whether or not condoms are more or less protective based on circumcision status.
    I am not at all speaking out against the procedure - just the use of studies to make a link between the penis status and the diseases.  I am especially suspect of the circumcision - HPV link.  
   Today I heard someone say that HPV causes penile cancer (they were claiming that circumcision prevents HPV and thus can prevent penile cancer).   That got a reaction from me! I feel certain that if HPV caused a cancer in men Merck (drug company with the HPV vaccine) would be all over it.  Unless of course,  the association is real but the actual cancer incidence is extremely low. 
   I have not reviewed any of the studies, my main point is that there is a great deal to consider and just because someone says it on the radio, doesn't make it true.
   Here is a link to the actual statement from the pediatric organization as published in their leading journal.

Odds and Ends

   I think the Odds and Ends post may be retiring. This pains me because at least two of my dearest friends seem to like them most of all.  I am contemplating this change because I have been reviewing the analytics - who reads which blog posts - and not many people who don't know me are reading the odds and ends.  I think that  main theme posts are more popular.  Also, my school work and Mon/Tues class prep are demanding a bit more of my time (of course this should be so - it is a doctorate program after all!).
      I do a few tidbits for today
Shirataki Shout Out  In the current nutrition action newsletter from CSPI, my favorite non flour noodles are highlighted.  Shirataki noodles are made from tofu and are calorically dilute.  They meet the definition for a very low calorie food.  You can use them in stir fry meals - hot or cold - and make them into Italian dishes.  You can search for shirataki recipes on my You Tube channel.   I did spell it wrong on the channel so click here to find the recipes.
Bojangles on Campus - The students at my University say that there should not be a fast food restaurant on the first floor of one of the residence dorms.  Still - the restaurant does occupy such a space and as I cycled by today at around 1 pm, I noticed a crowd of people waiting to be served. Money Talks!  That restaurant isn't going anywhere.
Tree Tents and Global Warming What an interesting research project.  Trees that would be subject to the effects of global warming are being exposed to those conditions by scientists.  I heard about this on an NPR show this morning.  I learned that when trees such as these die, they release carbon into the atmosphere.  Carbon emissions are one of the factors implicated in global warming.  Thus as the trees (in groves) die, the very thing that caused their death is perpetuated and strengthened. The story refers to the tents as a torture lab.  I hope that you care enough about the planet to want to hear the story and am including the link here.
Diet Quality and Meals Away from Home My research interests include the impact that meals away from home have on the diet quality of Americans.  I will talk more about this in another post.
Cycling Injuries - As a runner who has been cycling more because of a running injury - and not my first or last, I had a thought.  "Do cyclists ever have over use injuries?" It seems like cyclists don't have to stop cycling to heal from an injury like runners often do. So I did a little, informal research.  I was surprised to find that the most common and frequent problem from cycling is knee related.  KNEE - the joint that people always (incorrectly) assume is damaged by running.  The other issue with cycling is related to pressure and lack of blood flow to the perineum and genitalia.  Both of these issues can be corrected or prevented with proper bike adjustment, seat alignment and seat construction. I read an article that suggested that to prevent overuse injuries in cycling a person should start slowly - and slowly was defined as one or two hours a day.  Are you kidding me?  BTW - I have ridden three times this week - all over 2 hours.  I am training for an event, I guess.  But I will be glad to get back to the old me.  Cycling involves too much sitting.  (NOTE:  Runners and Cyclists have falls - but the most serious injuries from falls/crashes are amongst cyclists - and indeed those types of injuries require significant recuperation times)
One for Tobacco - Sadly, a federal appeals court in the US struck down the graphic warning label requirement of the FSPTCA of 2008.  I am quite disappointed.  Last week Australia won a round and this week the Tobacco Industry won one.  Personally, I think the entire world should be a smoke free zone (but tobacco itself - unlit or unheated (without fumes) - is ok with me).

North Carolina Education Lottery and Obesity

   North Carolina, like many states with soaring obesity rates, has a statewide obesity prevention program.  It is called Eat Smart Move More NC.  I am a naive optimist, but I like to think that when a state has such an initiative, all its departments, agencies, forms of government - etc - will work together.  At the very least they would not work against each other.
   So how does the Lottery system play into this?  It's rather bizarre actually and of course, I would be the one to hear the commercial and scratch my head.  Here it goes.
   Full disclosure, I didn't hear the whole commercial.  I missed the beginning. It seems like the narrator was asking people to define what "LUCKY" meant to them.  I heard the last person say, "when I circle around the parking lot for ten minutes and then find a space up front, 'I feel lucky.'"  The narrator then summed up the other responses (the ones I missed).  He said, something like, "If you get the last cookie in the break room cookie jar, or find the prize in your french fries, or get to park close to the store - you are LUCKY."  People who are having this kind of good luck, should "buy a lottery ticket.'
  I was thinking, REALLY?! People who think cookies, french fries and limited physical activity are things to strive for - ought to spend their money on a good health insurance plan.
   Myself - I feel damn lucky that I do not NEED to park close to a building.  I am ever grateful to have full use of my body in order to walk a few steps.

Product Line - Label Alert

   I wish this post were an update on national menu labeling or standardized front of pack product labeling, but it is not.  I am still unaware of an expected date for action on either of these.  
   What I want to draw your attention to today is a potential "trick" label.  I have noted for your education that the words "all natural" or "natural" on a food label do not guarantee anything more than this: "minimally processed."  If you have a definition for minimally processed, its as good as any because the entire issue is cloaked in vagueness.  If you really want something that has limited processing (and you probably should) then buy fresh fruits and vegetables.  Hopefully, your chicken, fish and meat would not be processed, but don't take that for granted.  Read the label (e.g. chicken is often 'plumped' with salt).
   But those are not the tricks of which I speak today.  I refer to a product line.  Just because a group of products is named Wholesome Goodness does not mean that any of the items are good for you or healthy.  There are several criteria by which to measure, but you might consider the amounts of added sugar, sodium, Trans fats and saturated fat, as well as calories per gram (or serving size).    
   If you are buying tomato sauce for example, you may have Del Monte, Hunts, a value brand and Wholesome Goodness.  The trick is that consumers see Goodness and think it is the healthiest one.  That may or may not be true.  Don't be sold by names or label disclosures, read the ingredients and nutrition facts panel to make a better decision. 
   This is all we can do unless or until the FDA/USDA come up with a standardized symbol and criteria. I would not trust individual food manufacturers as their goal is to sell a product not to improve the quality of your diet.

This is just a product line, not an accredited line of healthy or low calorie products.

GSK and Alli Lose - YOU Don't

   And that is the problem.  People who use the over the counter weight loss pill, Alli, do not lose weight. 
   I often take a look at pharmaceutical industry news - even the stock values and projected earnings of companies.  I think that we learn a lot about our health care system by doing so.  I wasn't surprised by what I read the other evening, but I do think I missed a piece when I wrote this three years ago... edited excerpt from post:

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.

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

   That FDA statement focused on liver related side effects.  The drug had additional and more common side effects, in fact, it was recommended by the maker that initial use begin on a weekend - when you would not be around other people so much (gas, leakage, etc).
   I understood that Alli was the OTC version of Xenical/Orlistat, but did not realize that GlaxoSmithKline bought Xenical from Roche with the goal of modifying it (to make it safe enough to put on a shelf without a prescription) and profiting from its expected super sales.  GSK was the one behind all the commercials, Wal-Mart displays and celebrity endorsements.  It was an extensive and expensive marketing campaign.  Surely it made sense - we all want a pill that lets us eat whatever we desire and still lose weight (except that is NEVER what the fine print says).
   The current value of the product is - well NIL.  GSK is trying to sell and has no buyers.  The reasons the drug flopped are the very reasons I gave for hating it in 2008.
   Its efficacy was based on the person consuming foods low in fat and remaining calorie conscious - in other words, the pill was not the instigator of the weight loss the lower calorie intake was (it always is).  But people don't take pills because they are interested in changing their diet.  They do it instead of changing their diet (why I hate all obesity drugs).  A majority of people on Alli  did not lower their fat intake which led to substantial and embarrassing gas and diarrhea while on the pills. 
   Upshot with Alli: No weight loss, plenty of inconvenience and embarrassment.

 Thanks to the Motley Fool bloggers for their great post on this issue!

Why I Keep Loving Weight Watchers

    The first page of the search results below will link you to 4 previous posts that address the importance of moving your body (being active) throughout every day.
   I am very passionate about this health behavior.  The upshot is that sitting for more than one hour at a time, no matter how active you are otherwise, no matter what you weigh, is linked to higher rates of several diseases (e.g. heart disease, diabetes), disease risk factors (e.g. abnormal blood sugars, high blood pressure) and all causes of death (all cause mortality).  The amount of increased risk is different based on your general health, weight and exercise level but extended periods of sitting are bad for everyone. 
    Remember when I taught my first college under grad course last fall?  On the first day of class (they were 3 hour classes) I explained this sitting/disease risk to the students.  Then I made sure that we always took two stand up and move breaks every class - even when we had guest speakers. {traditionally three hour classes contain one 15 minute break}  If the only thing my students took away from class was the need to limit sitting time - I have done them a very big favor.
   That brings me to Weight Watchers.  The program is also doing their customers a very big favor.  My sister, who is a successful loser/maintainer (almost 5 years now) attends Weight Watchers - more to support others than herself, I think.  Today she told me that her meeting leader gave a great, graphical presentation on this very topic.  And as is true, the leader emphasized that the "not sitting" is important for HEALTH above and beyond anything it might do for calorie burn or weight.  To be clear, sitting doesn't make you fat.  Eating more food than your body needs is the cause of weight gain.  Sitting DOES make you unhealthy if you do a lot of it.  We are learning that a lot doesn't mean the number of hours you sit in a day, but the number of minutes you go without standing.
  Search Results on Sitting from this blog, with research links.  HERE

Boston Market a Plus and a Minus

   The restaurant chain, Boston Market, has committed to reducing sodium availability at their stores.  Literally.  They will not put salt shakers on the tables.  Recall, Argentina - the country - did the same thing about a year ago in all the restaurants in its capital.
    Table shakers are not the only Boston Market strategy.  They are also reducing sodium/salt in some of their menu items.  The news story I read made a point to mention a salt reduction in mashed potatoes and macaroni and cheese.  So yes, that is the minus. Not that they are reducing salt, but that they serve mashed potatoes and macaroni and cheese!  Both are items that are not part of the quality diets we have been discussing throughout the summer.  They are very starchy and as made at Boston Market, high in calories and moderate in saturated fat.  
   So YES!  Reduce the salt.  Salt is related to hypertension for many people.  Salt does not have calories however.  It would be nice if the restaurant chain would modify the recipes for lower energy density as well.
    Here is their menu - so you can see the nutrient information.

The Unskinny Truth

   You may have heard of a line of cocktails referred to as Skinnygirl.  Well there is nothing skinny about the drinks and treats that are described in this USA Today story.
   The reporter highlights some alcohol infused frozen treats that have become popular in our heat wave summer.  They include ice cream sandwiches, wine milkshakes and beer pops.
   I want to be very clear that the science supporting the benefits of moderate alcohol consumption do NOT apply to these drinks or desserts.  In fact, we can safely assume that adding cream to the alcohol negates its positive properties.  The health promoting components of alcohol do not include sugar and saturated fat - two things that reduce the quality of ones diet.  
   These ice cream/alcohol combos add both plus a lot of calories  - a LOT of calories. In its pure forms, one and a half ounces (a jigger) of distilled liquor (gin, whisky, scotch, vodka, rum etc), 4 ounces of wine and 12 ounces of light beer all have approximately 100 calories,  zero fat, and only trace amounts of sugar.  These cream laden beverages have ranges of calories between 400 and 1000 calories.
   You can still have them - but don't fool yourself into thinking that you are doing something good for your body.  Once it gets past your mouth - the goodness is over.
   

Odds and Ends

F as in Fat The 2012 report from RWJF and the Trust for America's Health will be released soon.  This week a press update offered news on disappointing and compelling trends.  The majority of states have an adult obesity rate of 25% or higher.  Twelve states have rates of 30% or higher and when rank ordered, the 30 heaviest states include 7 from the South.  This speaks to regional food norms.  In the South one can expect foods to be deep fried, rich, sweet and salty (maybe not all at once!).  It is also custom in the South to eat what you are offered and for those offerings to be generous.  The pending report form TFAH and RWJF will offer suggestions on curbing the obesity epidemic and the benefits that we can expect from certain strategies.  
We're # 1 I passed a billboard that proclaimed hospital X to be number one in heart surgery. I considered this to be evidence that hospitals are competing for customers.  There must be a significant number of them (or why advertise on a billboard).  A great many Americans have or will have heart disease - in fact, the odds of dieing from it are pretty high.  It is the number one cause of death here.  The hospitals know this and can profit from it.  They must - billboards are not cheap.  Incidentally, the current HSPH newsletter has a link to a blog post by one of their esteemed staff on the topic of hospital ratings.  The blogger discusses how a hospital can be scored differently by 3 credible sources. It is a great, MUST read.  Click HERE.
MCR (medicare)  Not to be political but to acknowledge a topic that has become political.  I have been listening to the public discourse and in the interest of full disclosure, I support the Affordable Care Act.  The ACA has benefited Medicare recipients that I know personally.  Still, there may be a future where persons over the age of 67 are seeking health care coverage as primary payers of that coverage.  Perhaps they will have vouchers.  In order for such a person to find the best coverage for the least amount of money (premium, copay, deductible) they will need to be healthy and not smoke.  The insurance companies will probably SEEK out healthy active seniors in order to reduce losses related to costs of covering non healthy older adults.  The majority of older adults are currently and will continue to be unhealthy.  Half of all adults now suffer from at least one chronic disease associated with being inactive and or overweight.  (increasingly adults have more than one disease, i.e arthritis and diabetes)
     You won't be able to change your past, but you have some control over your future. Get some amount of exercise every single day, always be aware of the foods you are consuming - aim for quality in the proper quantity, avoid all cigarette smoke.

The Cooper Institute

  The Cooper Institute in Dallas Texas is many things.  In fact, its name has been expanded to include Cancer Prevention and Research.  This makes sense.  The institute provided the very first evidence on the benefits of physical activity.  Now we know that being physically active is one of the three most important things a person can do to prevent cancer.  The others are consuming a quality diet that meets your energy needs and not smoking.
   The scientists, physicians, exercise specialists and health promotion experts affiliated with the Cooper Institute concentrate on individual level factors and programs.  They have determined  the most successful strategies for losing weight, maintaining weight loss, becoming physically active and staying physically active.  Not only do they have programs and tools to help people achieve their goals, they also train the people who will assist you.
   In fact, I received a Wellness Promotion Director certification from them several years ago. My attendance at the week long training is among my top 10 best experiences.
   I introduced the Institute so that I could let you know that they have updated their website.  It provides many tools - and the research to support them - for the public and for professionals.  
    Please click here and explore their new website if you have any struggles with eating well, maintaining a healthy weight or exercising.  In order to have the best chance of a healthy, active, long life - you need to do all three - and not smoke.
   Of note - I do not agree with every thing on their website.  To be fair, my area of interest is policy and not individual behavior change, which is their specialty.  For instance, I noticed that they made a very low daily calorie recommendation for weight loss and I think that is inappropriate.  On the positive side, they have information on realistic calorie expenditures for persons who weigh around 150 pounds.  Also they have a calorie needs estimator which appears to be accurate.  It said that I need just over 1600 calories a day to maintain my weight at my high activity level.  So play around with the site, use what you like, leave the rest but ALWAYS think things through and make informed choices.

Another Choice for Smokers

   With Australia on the books and the UK likely to follow, smokers now have label options among their choices.  Actually, it is not going to be a choice but lets pretend that it is for my post.  When buying cigarettes smokers can choose from:

• reg(shorts) or 100s
• menthol or non-menthol
• mild or full flavored (aka light vs not light)
• graphic or Logo package

and now

• graphic or brand(logo) or plain package

   Why the fuss about a pack label?  Tobacco companies use them for branding.  If I asked you to name a cigarette brand - even if you have never smoked, I bet you could name at least two.  Some that come to mind for me are Camel, Kool, Pall Mall, Marlboro, Virginia Slims... etc.  There is an image tied to those brands.  Virginia Slims  associates w/ successful, thin, liberated women.  Marlboro is the rugged, tough, male.  People start smoking, it is suggested, to become that image or have what those people have.  Tobacco companies spend billions of dollars every year to make that so.  Probably they spend more on branding than ever before because the Master Tobacco Settlement of 1998 severely restricted their advertising options and prevent sponsorship of sporting events.
    Health experts use labels to dissuade people from smoking or to encourage them to quit.  Warning labels were expanded with the Family Smoking Prevention and Tobacco Control Act of 2008 (they had to take up more space on the labels), but graphic pictures are due in 2014.  Other countries have been using them for some time.  The USA used the evidence from Australia and the UK to make a case for graphic messages in the 2008 law.  The current CDC print and television ads are also graphic in nature.  
   Graphic labels are effective - but there are not  VERY effective.  
People who smoke have difficulty quitting due to the nature of nicotine addiction.  But why do people even start?  Why do thousands of adolescents try cigarettes every day and many become life long smokers.  Currently 18% of high school students smoke.  Read more statistics about youth smoking at the Tobacco Free Kids website here.
   People start smoking when they are young - usually under the age of 18.  Very few current smokers started after the age of 21.  (I started when I was 15 and smoked 17 years.  I have been quit 15)
   Who is most susceptible to the promise of glamor, sophistication, popularity, success??? Youth.  It is hoped that by making the cigarette packs plain there will be less of a branding effect.  This change may lead to a true reduction in the prevalence of smoking.
   We will have to wait a few years to test the effect of the Australia law - but it sure sounds reasonable in theory!
   

Hepatitis C - A test worth taking?

    In this recent post, I introduced the concern raised by the CDC and other health officials regarding possible undiagnosed cases of hepatitis C in those born between 1945 and 1964.  This group of 'baby boomers' may have engaged in high risk behavior in their twenties but spent much of the rest of their lives in low risk situations.  Both the person and their primary care physician (if they have one) are not connecting the earlier risk behavior with possible current hepatitis C status.  People of this age range, 47-67 may have contracted the disease years ago.  It is likely that many who were exposed to the virus have not cleared it from their systems.  I expect the number to be smaller (the amount exposed), but the CDC is worried.  They want everyone, with and without risk factors, to be tested.
   My thoughts on this have not changed since my blog post in May but the recommendation for testing has grown louder and stronger, with the CDC presenting more urgency today.  This was shared on tonight's Nightly News with Brian Williams. 
    {please note that I have NO expertise in this area and am only expressing my opinion on the suggestion that everyone be tested.  Those who have engaged in IV drug use or had a blood transfusion during that time period should strongly consider the personal value of a test.}
If you do not see the video here - try this link.

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The Physical Limits You Create

 There are a few people in my family who are active and of healthy weights.  But I suspect that about 70% of my extended family is as overweight and inactive as the overall populations of the USA and similar countries.
  There are consequences to not caring for ones body.  I define 'caring for' as eating the right amounts of the best foods (lean protein, fish, fruits and vegetables, whole grains, healthy oils), being active everyday and limiting the time spent sitting.
  I got a glimpse of the consequences when I was going out the other afternoon.  In the parking lot of my apartment, I noticed a neighbor (the one who appears to be watching TV all the day long) standing by her car.  A gentlemen bent down and then got back up and they seemed to be a bit stumped.  
   I asked the two older than me adults (60 to 70ish), if I might be of some help to them.  The cover of the fuse box along the side of the wall near to the floorboard had been kicked off.  The woman could not bend down and the man said he wasn't small enough to get in there to see where it went.  They may have both been overweight, but I believe his problem was agility more than size.
   I got on my knees, looked into the car, found the fuse box and snapped on the cover.  The woman said, "Oh I never would have been able to get up."  Then they said something about the advantage I have for being little.
   Not being able to bend down is NOT a normal part of aging.  It is a sign of doing something wrong when you were younger.  Period. 
   Go back and read the part where I defined 'caring for' and do those things.  Start yesterday.

Your Numbers - Your Risks

   Before we move on to another topic, I want to assure myself that the information I shared with you yesterday made some kind of impact.

from the American Heart Association website

   Did you view any food labels today?  Were the trans fat grams high or low?  If they were not 0 to 0.5  then they were high.
   Do you have any existing health condition that makes avoiding trans fat especially important?  (heart disease, high blood pressure, diabetes)
   Is there any reason to avoid trans fats if you do not have those conditions?  YES.  Do normal weight people need to avoid trans fats? YES.  Do people who exercise every day? YES.
   Not sure what I am talking about?  Maybe you missed yesterday's post. You can review it here.



 

Trans fats, food labels and your health

   In 2008, Howlett et al published the results of a study that described several problems with regard to the public's understanding of trans fat or trans fatty acids (TFAs). A type of fat found in foods.
   The Nutrient Facts Panel (NFP) on food products begain listing trans fats, under the total fat heading, in 2006.  At about the same time, the city of NY and Philadelphia placed bans on TFAs in restaurant foods.
    Because of the restrictions, people may know that trans fats are bad, but not exactly why or in what amounts.  This is what the researchers determined in 2008.  Considering that knowledge levels may not have changed since then, I want to take a few minutes to enlighten you.
   Trans fats are created in a process called partial hydrogenation (phvo).  (They also occur naturally, but infrequently and in small amounts in certain foods).  Trans fats are similar to saturated fats, but there is NO safe level.  They are a created fat and have no nutritive value.  In fact, their only dietary impact is one of harm -  they are often referred to as a negative nutrient.
   Trans fat is responsible for increased low density lipoprotein and decreased high density lipoprotein.  That would be your LDL and HDL in a blood test. In this way, trans fats are associated with the development of heart disease and heart attacks.  Everyone should keep their intake of Trans fat as low as possible.  Zero is a nice goal.  This is especially important for people with high blood pressure, diagnosed heart disease or diabetes.  Yes, diabetes.  We often think of that illness as a sugar problem, but most diabetics die from heart disease.
   So Trans fats are bad and you should avoid them.  How do you know if a food product is high or low in them?  If the NFP does not say zero, can you look at the % DV and decide?  Recall that if something is 5% or less it is considered low.  

Ah this must be my Smuckers Label - what a great source of GOOD fats!

   Take a look at the label.  As you can see, there is no % value given for Trans fat, only the amount of grams.  That is because the FDA has not provided us with a daily value.  This is very important...
***** Any amount of Trans Fat is too much.  Therefore, if it 'only' has four or five grams of Trans fat - that is still a HIGH amount.  It is confusing because when you look at fat and saturated fat grams - 5 can be considered moderate and 3 considered low, but in Trans fat 3 is NOT LOW.
  

Howlett, E., Burton, S., & Kozup, J. (2008). How modification of the nutrition facts panel influences consumers at risk for heart disease: the case of trans fat. Journal of Public Policy & Marketing, 27(1), 83-97

Odds and Ends

Water Conservation - Beverage Heroes?  A story from the Associated Press (AP) caught my attention yesterday.  It was published in many papers so you might have caught it.  The largest beverage companies are spending millions of dollars to assure that certain land areas are NOT developed and that the proper care of watersheds is administered.  The conservation efforts are intended to protect the companies bottom lines - the products they sell.  Beverages are predominately water.  I understand that their motive is self satisfying but the outcome is beneficial to everyone and I applaud the efforts.  Here is a link to the story from one of many sources.
Weight Control Success You are probably aware that individual research experiments and the National Weight Control Registry support the assertion that people who are successful at maintaining weight loss use self monitoring techniques.  They keep track of their intake of calories.  The level of monitoring (every calorie or just general daily calories) is not as important as the awareness of what one is eating. Because we spend almost 50% of our food budgets on away from home meals and calorie monitoring is a successful weight control technique, it is vital that we have calorie content available on menus and menu boards.  Lets get the final rule written and the numbers on our menus!  (FDA delay)
Eye Drop Application Here is another thing you may know, but just in case you don't I will share it.  Actually there are two things. As noted previously, I have sun damage to my eyes.  The condition is called pinquela.  My whites are discolored (this makes me sad).  The eye doctor suggests that I use drops every day.  He told me this two years ago, so I got some Visine.  When I saw him in July he said "NO!  That is the opposite of what you need."  Ooops.  So for dry, damaged, scratchy eyes, lubricant drops are helpful.  I bought the store brand after I used up the sample he gave me. (But only after I compared the ingredients labels).  Anyways, I also told him that I had trouble administering the drops.  I would blink before the drop reached my eye.  So - here is the technique.  With your eye closed, squeeze a drop in the corner (where your tear ducts are) then tilt back and open your eye, lean sideways, and the drop rolls right in!
NFL and Disease Prevention Somewhere along the line, I signed up to receive occasional emails from the NFL.  This would be precipitated by my love of the NYG - whom I shall see play in person next month!  In July,  I received one of the emails and it was announcing a new Wellness Initiative for current and former players, coaches, team members and families.  The main focus appears to be mental health.  This may be a response to suicides and family conflict that plagues some of the players.  Though it includes physical health - that may be related more to injuries (including concussions) that can turn in to disabilities than chronic disease prevention.  The program includes a 24 hour hot line for members in crisis.  You can learn about it by clicking here.  I can't imagine this being a bad thing.  I hope that it helps.

Lastly my weekly exercise chart.  I didn't share it last week, but I add it today to highlight the near absence of any red columns!  That is running.  I did manage 15 minutes, but clearly I am not healed so I stopped. I hope for more red next time.  BTW, for those who have followed my swimming trials and tribulations.. just once a week, okay just this semester, Oh, if the pool is closed, its not my fault, YAY!, okay twice a week, okay three times a week.. Well, the whole Rec Center is closed this week and I am thinking of paying to swim at the Y.  Clearly I made it past the six months (now two years) time that makes something a habit.

Food Preferences

   As I read a particular section from the article referenced below, I was reminded of something that I observed over 20 years ago.  I thought it was a mistake then and know that it was now.  I was barely 20 years old and attending a local community college (studying child development).  For spending money,  I cared for a little girl - like a nanny. I was with her from age 9 mos to age 3.  We were very close. Yes, I looked after her during the time of two major milestones.  The establishment of food preferences and toileting.
   One day during her potty training, I remember arriving at the house and hearing that she had JUST "pooped" in the toilet.  She was rewarded for this big girl activity with an M&M cookie.  
   In the article I read today, the section on food preferences (p S53) notes that children do not really need to learn to like high fat/high sugar foods because there seems to be a universal preference -taste wise - for fat, sugar and salt.  They don't have to learn to like the taste, but their preferring foods that are high in fat and sugar is shaped by their experiences.
   When these tasty foods are paired with experiences that are also pleasant, children learn that they are special foods.  They think that the foods made them happy (instead of the people or situation)!  Obviously, the cookie story is an example of a food reward.  Other conditioning factors include celebrations and holidays which center around energy dense foods.  Seeing the people that you love (parents) eat these types of foods is also normative. The article offers this caution...

In situations where foods high in sugar, fat and salt serve as rewards, the functions of food can become confused.

Though I had considered all of the above I had not thought of this additional concern noted by the authors...

Foods eaten in order to obtain rewards can often become disliked.

   It took a long time for me to add spinach and mushrooms back into my diet.  I remember sitting at the table - the reward being leaving the table or dessert - but only after eating THAT food.  
    These things are  worth bearing in mind as a parent OR grandparent but also in considering your own food preferences.  
    Today's examples were on the individual level, but I assure you, the food industry is doing everything it can and spending billions to ensure that you prefer the foods that it sells.  Those foods are most often energy dense - high (sat) fat and sugar.   

Nestle, M., Wing, R., Birch, L., DiSogra, L., Drewnowski, A., Middleton, S., Economos, C. (1998). Behavioral and social influences on food choice. Nutrition Reviews, 56(5), 50-64.

 

The Calories You Burn

Part Two
   Here is a way to get a (very) rough estimate of the amount of calories you are burning in a day.  This is for people who have been weight stable for at least a year.  If you are currently at a steady weight,  write down everything (remember the Micky Mantra - every bite, lick and taste) you ate yesterday and the day before.  Write down everything for today and do the same thing tomorrow.  That should give you four days to average.  Do NOT change your normal behavior - this includes eating out. If you usually eat out, then you need to capture those meals in your average.
   There are many tools available on line (and perhaps in print) that can help you determine the calorie amounts for all of the foods on your list, if you have the serving sizes.  [You might have to go four days forward instead of two days backwards for accuracy.  The reason I suggested that you start with past days (even though you may forget something) is so you won't change your pattern because you are thinking about it.]
   If you purchase foods away from home, you can usually get calorie information from the restaurant's website, but it may be slightly or largely inaccurate.  If you prepare your own meals, you can get info on the ingredients from the USDA website.  When you feel pretty confident that you have the four days individual totals, add them together, divide by four and that is your average.  Remember this is only going to work if you are tracking what you normally eat.
  If you are stable, the number you came up with should be the same number that you burn.  TEI total energy intake = TEE total energy expenditure in weight stable people.  
   I will tell you that this type of estimate is closer than any you can get by trying to track your energy burn, outside of a clinical, laboratory setting.  The machines at your gym are NOT accurate.  Your GPS systems and sports watches are not either (but they are a good measure of consistency and changes - in other words they are reliable even if they are not valid)
  I want to be very clear that what I just told you is offered as a way for you to assess in general terms, the amount of energy you use in a day.  It is not meant to suggest how many calories you need to maintain or lose weight.  The only qualified nutrition guidance that applies to individuals is provided by licensed/registered dieticians.  Remember that even if you forget everything else you read.  Your personal trainer at the gym is NOT qualified to give you diet advice, unless of course, he or she is an RD.  
  Nutritional science continues to grow and to challenge our  assumptions about food and weight.  We are learning that a calorie is not a calorie. What you eat can have an impact on your metabolic processes.  Again, that is a discussion to have with a nutrition expert.
   Ah, but let me get back to the conversation started with the Lowe article.  We will use me as an example.  I am very confident that my calorie intake varies from 1600 to 1680 calories a day (higher if I am running more).  This keeps me, a very active person who is short and thin, at a stable weight.  If I shift that range by even 70 calories, to between 1750 and 1830 a day, I will gain several pounds in a year.  Seems like nothing, but of course, we have shifted our normal calorie intake by as many as 300 calories a day and gained many pounds.  This can be reversed, in general and at the population level, by a 500 calorie reduction (some say).   Sounds like a lot, but if you are one of the people eating 3000 calories a day  and switch to low energy dense foods, its a piece of ......... its not that hard.
 

Food Supply and Weight (part one)

Part One  
   Continuing from yesterday, here are observations regarding the food industry.  This post is related to information in an article by Tillotson which is referenced below.  Something to consider on an individual level (with regard to energy balance) will be noted tomorrow. 
   The U.S has created a phenomenal food system based on the exceptional work of our agricultural industry.  Less than two hundred years ago, the US began its investment in agriculture.  The goal was to provide Americans with a food supply adequate to prevent (or reverse) nutritional deficiency. The government invested in farmers and land, in Universities, technology and research.  The efforts were hugely successful and continue today.  We can feed our people and much of the world.  The agricultural industry is responsible for supplying food makers with cheap commodities; beef, dairy, grains, sugar, etc and the food industry....Well they too are an American (business) success story.  
   We forget that in the late 1800s a shift occurred in our relationship with food.  We went from growing our own food or working to earn food to paying money for food.  This inspired entrepreneurs to create and sell a product (with substantial backing from investors), but it also meant we weren't working as hard in general or doing any physical work to obtain our food.
   In the 21st century, NOW, we have the least active population that has ever existed and the most abundant food supply.  We don't just eat to stay alive - we eat because its the social thing to do and because it brings us pleasure.  The food industry is happy to keep oversupplying.  Food companies work hard to shape our preferences and to earn our loyalty.  Any time, any where, tasty and cheap.
   So that's a problem.  Two systems working remarkably well and a population that (as we discussed yesterday) is unable to regulate its intake.  The same population that is quite disinterested in exercise.
   There are a number of ways to regulate the supply and the demand side, but what about regulating or restricting what an individual consumes?
   At the end of the day, the amount of regulation or limiting a person needs is based on energy expenditure.  If a person does not want to exercise, then the amount of calories they burn in a day and thus need, is going to be low.  There may come a point where the amount needed is too low to be reasonably regulated.  That is hard to explain.  It means that we need a certain amount of calories - even if that need is psychological and our limiting has limits.
   Clearly we cannot go on eating all the food that is available to us.  By doing so, we become a nation of unhealthy people.  The food supply allows over 3000 calories a day for every person.  Not everyone consumes 3000 calories a day, but it can easily be done.
   More about energy balance in a food heavy society, tomorrow.
 

Tillotson, J.  (2004). America's obesity: conflicting public policies, industrial economic development, and unintended human consequences. Annu. Rev. Nutr., 24, 617-643.

Unlimited Food Supply and Biscuits

   Last night I made myself a note to write about Red Lobster's cheddar cheese biscuits because the restaurant is currently running its Four Course Seafood Feast special. I believe I broke that down last year (calorie wise), so you can search the blog for the details.  However, I heard the commercial yesterday and this time I was struck by this... "served with unlimited cheddar cheese biscuits".
   Today I read an article about the need for people to regulate their eating because of the abundance of food in our environment.  Food is available in unlimited supply.  Our brains are wired to eat when we see food, even if we are not hungry.  This was a survival mechanism 100 and more years ago (but is now contributing to disease and disability).  In our evolutionary history, it was unlikely that we'd ever become sedentary.  Another part of our brain is "turned on" by energy dense foods that are high in sugar and fat. Again - that was not a problem for our ancestors but it is a big problem for us.  
   Biological drives are not the only thing we have to contend with today.  We also have the social influences and a change in consumption norms.  (It now seems normal to eat hamburgers that are three times the size they were in 1950 and our office mates are constantly encouraging us to "try some" of the latest baked good).
   Nutrition/Public Health advocates generally fall into two groups. I am of the group that wants to manipulate the environment ( a little) so that we are not constantly bombarded with these foods and the pressure to eat them (i.e. $ 14.99 for a gluttonous feast).  If we change the environment, there will be less need for individuals to override their urges and other pressures. (less need for the elusive will power)
   Our inability to lose weight and keep that weight off (achieved by a rare few), is well documented.  We know that we should not eat something just because its there - and yet we do.
   I was going to talk about the article I read in tomorrow's post and I expect that I still will.  But for now, here are some comments on the food environment and efforts to control/regulate intake on a personal level. It starts with a statement on low energy dense foods as one solution (article citation is at the end of the blog) :

 ....if people try to avoid weight gain by limiting themselves to smaller portions of foods that are relatively high in energy density, they will have to restrict their food intake and cope with resulting feelings of hunger and deprivation. The virtue of a low energy dense diet is that it allows people to eat a satisfying amount of food while limiting energy intake (AKA Volumetrics, see my You Tube Channel for how to do this)

The mere presence of a food is often sufficient to elicit a drive to eat it.

...the fact that some people demonstrate such tight and prolonged control over their food intake, physical activity and body weight does not mean that weight control professionals are able to instill this ability among those that do not naturally possess it. (and I will add, those who do not posses this should NOT beat themselves up about it)

(with regard to the risk of dieting leading to eating disorders).... it may be even more important to determine why so many people are not more restrained eaters than it is to determine why a small percentage become so restrained that they develop disordered eating.

 I have to say that when I went to the Red Lobster website today - I saw a picture of some of the options in their feast and it looked like grilled fish and steamed vegetables were available (skip the 150 calorie, 2.5 g saturated fat biscuits).

Lowe, M. (2003). Self-Regulation of Energy Intake in the Prevention and Treatment of Obesity: Is It Feasible? Obesity, 11(10S), 44S-59S. 

Food Labels and Fats

   The picture I am including today is a great example for assessing the value of a product in regard to dietary fat.  Confusion over fat intake has persisted over the years.  Fat is essential – hence the term essential fatty acids.  A significant body of evidence now suggests that it is saturated and trans fat that we should limit in our daily diets (not total fat).  An even stronger body of evidence supports the addition of unsaturated fats and omega three fatty acids (within in your personal calorie requirements). 

   In the past, health educators and nutritionists as well as governmental agencies, have encouraged us to cut fat and focused on total fat.  This was a mistake.  Unfortunately, we did a really good job and it is hard to get people to let go of the notion that all fat is bad.

   Policy impacts more people than education and is easier, but education is what you are going to get today. 

  If you review the label on the right, you will see that the saturated fat amount is minimal.  More importantly this item (and serving size) is a good source of poly and mono unsaturated fats.  It  meets the definition of being low in saturated fat.  The omega 3 fatty acids are not listed here, but this is for a salmon burger.  I highlighted the protein line, but not because Americans or most Westerners are lacking in protein.  This is a source of lean protein.  In perspective, a cheeseburger at McDonalds has 15 g of protein but 6 additional grams of saturated fat.

   Of note, I chose this product because the salmon fillets that I had recently purchased were too lean.  Crazy I know, the label should have been a clue – but the cooking sure was (no grease drippings and very dry).  Salmon is a fatty fish – it is the type of fatty fish we are encouraged to eat.  The label indicated that the 3 oz serving had 0 grams of fat – how so?   You may recall my confusion when my salmon and tilapia labels had the same nutrient content listed…. Apparently, those salmon had been on some kind of diet.  

    This product is better.  Not all salmon fillets are low in fat.  That was a fluke.  Most are higher in fat and calories even than the label I show you here.  However, as long as you are not buying the pre seasoned ones with butter (why do they DO that?), your salmon should be low in saturated fat and moderate in the good fats.

Misrepresenting the Facts

   I have no fondness for the product 5 Hour Energy.  I don't like that it is a caffeine supplement, that it is marketed mercilessly, and that its ads are misleading and deceptive.
   To be clear and repetitive, I understand that there are benefits to caffeine intake and I regularly consume two or more cups of coffee a day.  The research that supports the benefits of caffeine do so with regard to coffee with a dose response and an upper limit.  There is no scientific evidence to support a health benefit of energy drinks or caffeine supplements.  There is concern over misuse of these 'supplements,' especially in our youth.  It is possible that they cause harm in excess and in combination with other substances and activities..
Now back to this specific product.
   There is a commercial currently airing that suggests an endorsement from a great number of doctors.  The spokesperson (in a white coat) is standing near a desk with a huge stack of papers.  She says and the on screen text emphasizes that they contacted 3000 physicians.  They say that doctors recommend their product.  Here is what the obtuse, fine print says... obtuse because it is not easy to understand.. maybe on purpose.  
   It appears that they sent a survey to some doctors and received 503 responses - but it is not clear if they only sent it to 503 or 503 out of XX number responded.  That is a very important missing piece of information (as is where the doctors are practicing medicine (i.e. in the world); if they are seeing patients, how long they have been doing so; what the average age of the doctor who responded,  etc).  The fine print also says that 2500 docs (or their offices) were approached by sales staff and asked to read some information.  The text implies that 2500 people responded to the request which would be a nearly unheard of 100% response rate.  Again, who WERE those people and WHERE are they located.  Maybe they are all in one small part of the world, for example - or one state in the US or one region.  The ad claims a total sample of 3000 - so lets go with that as the actual resonses.
    It then says (the fine print not the voice over), 73% of the doctors 'would recommend a low calorie energy supplement to healthy patients ALREADY taking an energy supplement.' Being gracious, that means 2190 docs said this.  Of those, 1200 would specifically recommend low calorie 5 Hour Energy to their patients who ALREADY take a supplement and are healthy.  All told, less than 50%  of the doctors would actually recommend the product.  
   OF course I emailed them and asked for information on their actual sample of doctors... we should not hold our breath on that one.  However, I reminded them that if they were going to present this as if it were a valid survey then it was customary to share these details.

Odds and Ends

Bigger than Brand X One of the explanations for an increase rate in obesity in any country is the change in portion sizes of meals away from home, drinks and individual food items.  Research suggests that when we have more food in front of us, we will eat more.  A bigger serving means more calories (unless they just add water).  So increased portion size = more calories = weight gain.  (of course, we could have all started to be more physically active when the food portions got bigger but we know THAT didn't happen).  My dismay should be easy to understand then.  This week I noticed a new veggie burger.  A company that sells other frozen meals has joined the veggie burger fray.  The package said something like, "10% more pattie than the leading brand."  I flipped the package over because there was no front of pack nutrient information and noted that it also has 70 more calories per serving.  We have got to stop this.  More food, whether you are a customer or the food provider is NOT what we need right now.

Mammograms and 5 Year Survival For some time, the utility of regular breast cancer screenings with mammogram have been questioned.  The mammogram can detect smaller lumps than a self breast exam, but the lumps are often (not always) harmless. The harmlessness of the lump is not known until subsequent invasive tests and months of  increased stress are endured.  Furthermore, the mammogram does not appear to reduce the risk of breast cancer death. An observation piece written in the online version of the British Medical Journal is quite informative.  When considering the effectiveness of a test or treatment, we often use 5 year survivability as a measure.  The five years begin at the time of diagnosis.  Drs. Woloshin and Schwartz provide a great example in the article.  If a group of women are all diagnosed at the age of 65 and die before they are 70 than the 5 year survival rate is 0.  If those same women were diagnosed at age 63, the survival rate will be increased if they die after age 68.  HOWEVER, they will all still be dead at age 70.  It is a matter of how long one is living with a diagnosis more than whether or not an early diagnosis changed thins.   The important part is what happens AFTER the diagnosis.  The treatment.  You have to make an informed decision about mammograms but I will tell you this - examining your breasts  (feeling them) and looking for lumps IS an effective screening tool. 

McDonalds - Look Here

P&G Snacks Save the Day -  The consumer products company reported a 45% increase in sales from Q4 2011 to Q4 2012 and gives all the credit to its snacking business.  (dratz)

Fruit V Fruit Juice  Dr. Robert Lustig continues to educate people on the problems with fructose as found in sucrose and HFCS.  In a radio interview, he closed his presentation by addressing the issue of fruit.  "YES" he said, People should absolutely eat fruit but just as certainly, avoid fruit juice.  He said that the most important thing that fruit offers us is fiber. He noted that most people will not over consume oranges.  They will eat one.  But think of how easy it is to drink 2-3 glasses of orange juice which has many more calories minus the fiber.

Shower Scene As I was going from the pool area to the locker room one day last week, a younger student(20s) was behind me.  She asked, out of nowhere "How do you stay so thin?"  OF course this turned into a long conversation (I exercise a lot and do not eat too many calories) and a referral to my You Tube channel where she could learn about Volumetrics.  But I also shared some personal info with my young enquirer.  At one time I weighed much much more than I do now, and I have weighed the same lower weight for over ten years. During our conversation I was either in a swim suit or a towel - so yeah - no hiding under clothes.  And she said, "But your skin looks so young."  Awesome right?.  What I think that she meant was that it had elasticity and tone.  Nice. (exercise, use lotion, don't smoke).