Monthly Archives: February 2013

Where are those calories are coming from?

Posted by on February 28, 2013 Comments Off on Where are those calories are coming from?

Hint: it’s fast food. A recent Centers for Disease Control and Prevention (CDC) study found that over a 3-year period 11.3 percent of calories came from fast food.

That surprises no one. There were, however, two interesting points made:

First, while adults have decreased their intake of fast food, consumption by youth has increased. As consumption of fast food declines with age, it is not clear to me whether the decline is true progress or related to the aging of the population.

The second takeaway from the study is more intriguing, as shown in the following summary of study findings:

CDC_NatHealthSurveyNutrition_201302

I have highlighted the finding at the bottom of the graphic.

When it comes to fast food: the more you eat, the more you gain; the more you gain, the more you eat.

If someone told you that the more heroin, opium, etc. you consume the more you want, you would not be surprised.

Are you as surprised as I am to find a study that shows the same is true of fast food?

Since we regulate addictive drugs, there is an argument to be made that addictive substances consumed as food could be regulated as well. I do not know what that regulation should consist of, only that we have a tradition of regulating addictive substances, assuming that the individual is incapable of self-regulation in the face of addiction.

As is frequently the case, the questions that arise are more intriguing and clear than the answers.

Source: NCHS Data Brief ■ No. 114 ■ February 2013

If soft drink consumption is dropping, why are we getting fatter?

Posted by on February 25, 2013 Comments Off on If soft drink consumption is dropping, why are we getting fatter?

I saw an article from Reuters by Silvia Antonioli, and the subject excited me: Analysis: Health-conscious Americans hurt aluminum can market.

Wow–consumption of sugary drinks in aluminum cans is declining as Americans switch to bottle water and iced tea. The article is well-written, but it is a news article not a scholarly study.

So, I thought: Maybe it is absolutely correct, but:

  1. Americans might have health concerns about aluminum cans and be switching to larger (16.9 oz and 20 oz) soft drink bottles.
  2. Consumption of aluminum cans may have declined because of recession and economic uncertainty, not health concerns.
  3. The decline in consumption of aluminum cans might be diet sodas or beer or even juice not soft drinks

    4. The Can Manufacturers Institute (CMI) publishes data on production of cans, but the latest data are proprietary, sold, and probably more available to a Reuters reporter. The following graphic confirms the decline in cans for carbonated soft drinks and increase in alcoholic beverage cans 2008-2010.

    MetalCans 2008_2010

    Source: CMI 2010 Annual Report

    Looking at a longer period (1970-2005), aluminum can production for soft drinks peaked in 1998 and for beer in 1990.

    Can Production 1970-2005

    An excerpt from a white paper by Ibis World confirms the points in the Reuters article:

    IBISWorld on Canned Soft Drinks

    I came to the thesis of the Reuters article as a skeptic, but now tend to be more accepting. That conversion leaves a more pressing mystery: if soft drink consumption is really dropping, why are we not dropping pounds as well?

Sugar and spice, and salt is not very nice Part II

Posted by on February 21, 2013 Comments Off on Sugar and spice, and salt is not very nice Part II

Last time we looked at the danger of dietary sodium, likely to shorten the lives of a million Americans. If knowledge is power, then here is some power for you:

Let’s start simple, with the major sources of dietary sodium from the CDC.
CDC Sources of Sodium

Unless we make our own bread (a fun thing to do with a bread maker, not as much fun by hand), we have little control over the amount of salt in bread. We can look for low-sodium alternatives or we can wait for government action. By the way, the government has been regulating bread for a long time, in Europe before the founding of this country and since the 17th century by colonies/states such as Massachusetts. Since 1941 the US government has been mandating nutritional additives to bread, including folic acid, iron, and other nutrients. Regulating sodium content is not even a stretch.

Take a look at this graphic from the CDC–sodium can be reduced by half in nearly identical sandwiches with a bit of care in choosing ingredients:

Low Sodium Sandwich

Reducing sodium in our diets is one of those simple things we can do to improve our health. Doing the easy thing is sometimes better than the difficult. 2 Kings 5:13

Here is some further reading on dietary sodium:

UCSF Low Sodium Guidelines
CDC Sodium Tip Sheet
Medline Plus: Dietary Sodium

Sugar and spice, and salt is not very nice Part I

Posted by on February 19, 2013 Comments Off on Sugar and spice, and salt is not very nice Part I

“No matter how we look at it, the story is the same – there will be huge benefits in reducing sodium,” said Pam Coxson, PhD, a UCSF mathematician and the lead author on the paper who performed one of the three analyses published in Hypertension.

The quotation is an understatement–the studies claim that hundreds of thousands of lives can be saved by less salt. What are the facts?

Let’s start with the Centers for Disease Control and Prevention (CDC):

About 90% of Americans eat more sodium than is recommended for a healthy diet. Too much sodium increases a person’s risk for high blood pressure. High blood pressure often leads to heart disease and stroke. More than 800,000 people die each year from heart disease, stroke and other vascular diseases, costing the nation $273 billion health care dollars in 2010.

The key point is the relationship of sodium to hypertension and cardiovascular events:

About 45 percent of these cardiovascular deaths are attributable to high blood pressure, and numerous medical studies have already demonstrated how reducing dietary salt – the primary source of sodium – can lower blood pressure and reduce the risk of a heart attack or stroke.

The study’s three analyses came up with varying numbers of saved lives, ranging from 250,000 to 1,200,000 over the next decade by reduced sodium intake–they averaged 280,000 to 500,000. We have long known that certain populations are more salt-sensitive and should radically reduce intake. The CDC list below tells that story, but we all should reduce sodium, not merely by not picking up the salt shaker, but by eating more fresh foods and looking at the labels on the processed foods we eat. Salt-sensitive populations

We can all benefit by a reduction in sodium, long before we become part of a vulnerable population. Next time, let’s look at some strategies we can use while waiting for food companies to offer lower sodium alternatives and government action in this domain.

Helpful links for more information about dietary sodium

It’s the children–stupid!!

Posted by on February 14, 2013 Comments Off on It’s the children–stupid!!

If poet William Wordsworth was correct that “The child is father of the man,” then we can expect some really fat men in the coming generation.

Based on data from high school students, the problem is, well, looming large.

Note that even where the trend is not statistically increasing, it is still increasing.

If lifetime habits are formed when we are young, then the target of our efforts should be clear.

Common wisdom is that the schools, from which these data come, are part of the problem and the solution. Because they are often under-funded, they accept money from food companies for placement of vending machines. There is widespread belief that snacks and sugary drinks in those machines are part of the problem of obesity. Some districts have put restrictions on what can be in those machines.

For example, here is a 2005 National Conference of State Legislatures (NCSL) summary

Whether those restrictions are sufficient to mitigate the harm is beyond the scope of this posting.

Then, there is the more basic question of whether the impact of vending machines is real or merely plausible. A study by Penn State researchers found no link between vending machines and obesity, contrary to the expectations of the researchers.

The scope of the problem and the accompanying political debate is well-described in the February 20, 2012 New York Times.

The challenge to our society, shown below, is clear even if the solution remains illusory.

us_obesity_trend_yrbs_91_11

The Role of Obesity in US Mortality

Posted by on February 11, 2013 Comments Off on The Role of Obesity in US Mortality

Recently there was a public debate between a physician and the Governor of New Jersey on the subject of weight. The Governor, pictured below, famously ate a donut on the David Letterman Show, eliciting this: “I’m worried he may have a heart attack. I’m worried he may have a stroke,” former White House physician Connie Mariano, M.D. said in an interview with CNN.
Christie

The media event continued with a press conference at which Governor Christie told the doctor to shut up, and a follow-up phone call in which he put the point more strongly. Nonetheless, he admitted that: “I have been remarkably healthy. My doctor continues to warn me my luck is going to run out relatively soon. So, believe me, it is something that I am very conscious of,”

There were suggestions that the doctor was diagnosing him long-distance, which is generally a breach of medical ethics if not common sense. I take that as political spin–the doctor was simply citing well-known demographic facts. For example, you only need to look at a recent study of the impact of obesity on longevity on 50-year-olds. (Governor Christie is 50 years old)

Researchers at the University of Pennsylvania applying statistical analysis to mortality figures were able to tease out the role of obesity.

In the United States, they concluded, obesity contributes to a loss of 1.5-2.0 years of life to men and women at age 50.

Mortality by country attributable to obesity 2011

That conclusion is even more astounding when you consider that it is an average: many people lose considerably more than 2 years of life because they weigh too much: eating too much and exercising too little.

I confess that I do not like having a President who smokes. I also do not want a President who is morbidly obese. If Governor Christie represents everyman, then everyman needs to exercise more and eat less, beginning with less donuts.

The Casualties Do Not End With The War

Posted by on February 7, 2013 Comments Off on The Casualties Do Not End With The War

We know that casualties do not end with a war, but we don’t often think about it. Unless we are directly affected, the symptoms are invisible to us.

Among the casualties are those who suffer from CMI (Chronic Multisymptom Illness). During the 1991 Gulf War there were 700,000 military personnel in the war theater. About 25-35 percent of them have reported symptoms consistent with CMI.

CMI_IOM_20130201

A Congressionally-mandated, consensus report by the Institute of Medicine Committee on Gulf War and Health lists some of the symptoms, based upon the following working definition:

CMI_Definition_IOM_20130201

Reported symptoms are:

CMI_symptons 20130201

As treatments, the reporting committee considered:

  1. Pharmacological interventions (medications)
  2. Other Biological Interventions (such as electrical brain stimulation)
  3. Cognitive Behavioral Therapy (Individual and Group)
  4. Brief Psychodynamic Therapy (Individual and Group)
  5. Biofeedback
  6. Cognitive Rehabilitation Therapy
  7. Complementary and Alternative Therapies
  8. Exercise

My observation is that the Committee recommendations are guarded and limited because of the absence of unbiased, unambiguous research studies. Use of antidepressants along with cognitive behavioral therapy, as well as symptomatic treatment, such as NSAIDs for pain.

Many of the report recommendations deals with programmatic approaches to the problem by the Veterans Administration as well as teaching clinicians how to deal with patients who have a chronic illness, to be managed not fixed.

As citizens we are obligated to pay the full costs of the wars that we support, not just the military hardware and the salaries of military personnel, but the care of those with casualties. Those casualties may be invisible to us, may be difficult to treat, but the distress they cause is real, and the risks their victims have taken on our behalf are just as real. We are without honor as a people if we do not provide them with treatment for all their wounds, visible and invisible.

The Verdict on US Health: Shorter Lives, Poorer Health Part II

Posted by on February 4, 2013 Comments Off on The Verdict on US Health: Shorter Lives, Poorer Health Part II

Last time we looked at the findings of the consensus report of the Institute of Medicine that concludes that we face shorter lives and poorer health compared to other advanced countries.

The report includes a comparison of deaths among both men and women under 50. I included the chart for men last time, but overlooked the chart for women. My bad.

US-Health-in-Intl-Perspective_women

The top three causes of mortality for men were 1. Non-intentional injuries, 2. Non-communicable diseases, excluding cardio-vascular, and 3. Intentional injuries.

The top three causes of mortality for women were 1. Non-communicable diseases, excluding cardiovascular, 2. Non-intentional injuries, and 3. Perinatal conditions.

Since there is a separate category of maternal conditions for women, the perinatal conditions, which appears for both men and women, obviously refers to risks while being born rather than giving birth.

But the report goes beyond those findings to suggest possible sources of the problem and recommendations for further study.

It is not a simple discussion but a complicated one, filled with the kind of nuance and qualification common to academic work, and conspicuously missing in public discussion.

The Table of Contents gives a taste of the complexity, which suggests that remediation will be equally complex and multi-modal–not as simple as the public and their political representatives might prefer:

4 Public Health and Medical Care Systems, 106
Defining Systems of Care, 107

  1. Question 1: Do Public Health and Medical Care Systems
    Affect Health Outcomes?, 109
  2. Question 2: Are U.S. Health Systems Worse Than
    Those in Other High-Income Countries?, 110
  3. Question 3: Do U.S. Health Systems Explain the
    U.S. Health Disadvantage?, 132
  4. What U.S. Health Systems Cannot Explain, 133
  5. Conclusions, 135

5 Individual Behaviors 138

  1. Tobacco Use, 140
  2. Diet, 144
  3. Physical Inactivity, 147
  4. Alcohol and Other Drug Use, 149
  5. Sexual Practices, 152
  6. Injurious Behaviors, 154
  7. Conclusions, 159

6 Social Factors 161

  1. Question 1: Do Social Factors Matter to Health?, 163
  2. Question 2: Are Adverse Social Factors More
    Prevalent in the United States Than in Other High-Income
    Countries?, 170
  3. Question 3: Do Differences in Social Factors Explain the
    U.S. Health Disadvantage?, 185
  4. Conclusions, 190

7 Physical and Social Environmental Factors 192

  1. Question 1: Do Environmental Factors Matter to Health?, 193
  2. Question 2: Are Environmental Factors Worse in the
    United States Than in Other High-Income Countries?, 199
  3. Question 3: Do Environmental Factors Explain the
    U.S. Health Disadvantage?, 203
  4. Conclusions, 205

8 Policies and Social Values 207

  1. The Role of Public- and Private-Sector Policies, 209
  2. The Role of Institutional Arrangements on
    Policies and Programs, 211
  3. Societal Values, 219
  4. Policies for Children and Families, 225
  5. Spending Priorities, 233
  6. Conclusions, 236

The report notes:
It will also be important for Americans to engage in a thoughtful discussion about what investments and compromises they are willing to make to keep pace with health advances other countries are achieving. Before this can occur, the public must first be informed about the country’s growing health disadvantage, a problem that may come as a surprise to many Americans.

The report summarizes the costs of inaction:

20130108 Costs of Inaction from IOM report