Tag Archives: Food

Disease and National Defense

Posted by on July 29, 2013 Comments Off on Disease and National Defense

In Biblical times, where historical accounts and historical myth sometimes mingle, there are accounts of great armies being destroyed by disease. Conflicting accounts of the siege of Jerusalem circa 701 BCE by the Assyrian king Sennacherib are of that nature.

Fast forward two thousand years. Evans, Kleinman, and Pagano write:

In 1334 an epidemic struck the northeastern Chinese province of Hopei. This “Black Death” claimed up to 90% of the population, nearly five million people. The epidemic eventually reached and decimated Tartar forces that had been attacking Kaffa, a Genoese colony on the Crimean Peninsula. In 1347, the departing Tartars catapulted plagueinfested bodies into Kaffa. The Genoese quickly dumped these bodies into the sea, however it was too late. Four ships escaped back to Italy carrying the plague that in just two years killed one-third of the European population.

The relationship between disease and national defense is not a new one in the US. Just a simple web search revealed this 72-year-old article from the American Journal of Public Health on the dangers of venereal disease to military preparedness. Another article in the Journal of the American Medical Association (JAMA) of the same year reports that venereal disease has been a concern of the US Army and Navy since 1778.

There is continued concern about the impact of infectious disease on national defense, for example, the emergence of antibiotic-resistant pathogens and the threat from tick-borne diseases, and from influenza.

Indeed, with anthrax and ricin scares, preventing and managing bio-terrorism is a major part of contemporary national preparedness.

In addition, the Department of Defense is participating in prevention initiatives. As Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs in the Department of Defense, put it:

At the Department of Defense, we’ve moved from a concept of health care to health, meaning that we understand health really is a much more involved concept other than just freedom from disease. It relates to healthy communities and healthy and active lifestyles and also addresses mental wellness and spiritual wellness as well. For us to create a fit and ready force, we need to make sure that we’re paying attention to all these dimensions of health and wellness.

All of these efforts center upon a single premise: national defense depends upon maintaining the health of the civilian and military populations.

That raises an important question: does it matter whether the threat to our health is a foreign enemy, a small band of domestic terrorists, or what we do to ourselves?

As we eat too much, as we eat too much of the wrong foods, as those foods provide biological encouragement to continue those habits, as we exercise too little, and as we create our own national health epidemic, is that not more than what any adversary could do to us?

Or as Walt Kelly’s cartoon Pogo once famously stated: We is met the enemy, and he is us.

The things we already know–but don’t often do

Posted by on July 15, 2013 Comments Off on The things we already know–but don’t often do

There is the old Middle Eastern story of the one who journeyed East in search of wisdom. He came upon a stone where he read, “Turn me over.”
He picked up the stone and read on the underside: Why do you seek new knowledge when you do not use that which you already have?

A recently reported Swedish study that followed 71,000 individuals over a 13-year period found that consuming less than five daily servings of fruits and vegetables was associated with higher mortality and shorter survival periods. Those eating one serving of fruit daily lived 19 months longer on average, while those eating 3 servings of vegetables lived 32 months longer.

Now by itself, this is not very surprising. We know that heavy meat consumption is linked to colorectal cancer, particularly in combination with genetic mutations, as described in a recent issue of Smithsonian Magazine. So, the possibility that a different diet would be protective, even by contrast, makes some sense.

Fornaciari subsequently analyzed bone collagen of King Ferrante and other Aragonese nobles, revealing a diet extremely reliant on red meat; this finding may correlate with Ferrante’s cancer. Red meat is widely recognized as an agent that increases risk for mutation of the K-ras gene and subsequent colorectal cancer. (As an example of Ferrante’s carnivorous preferences, a wedding banquet held at his court in 1487 featured, among 15 courses, beef and veal heads covered in their skins, roast ram in a sour cherry broth, roast piglet in vinegar broth and a range of salami, hams, livers, giblets and offal.)

In a similar vein, one out of three Americans suffers from hypertension (high blood pressure), a major risk factor for serious cardiovascular events such as stroke and heart attack. A recent study in JAMA showed that 18 months after the beginning of a study in which the experimental group did home blood pressure monitoring along with pharmacist case management, 71.8 percent had controlled blood pressure compared to the control group with usual care at 57.1 percent.

It would be easier if we had pills that would lower our body weight or a vaccination against high blood pressure. We don’t. But we have knowledge that we are not using: walk more, eat less processed foods and more whole grains, vegetables, and fruits, monitor blood pressure and pulse regularly. No, it is not magic–just the best that we can do.

Two things that might help

Posted by on July 8, 2013 Comments Off on Two things that might help

Two recent studies have yielded two tips that might help make your weight loss program work. They are not magic nor pharmaceutical. I confess that they confirm my own biases and experience, which does not make the findings any more valid.

The first study, which appears in the June 26, 2013 American Journal of Clinical Nutrition (AJCN), is a survey of eleven studies on water consumption and weight reduction.

This review found that increased water consumption was associated with greater weight loss. The reviewers conjectured that either the water satisfied hunger cravings, or that the water substituted non-caloric fluid intake for equivalents that might contribute 400-500 calories per day.

The second study, published online June 3, 2013 in the International Journal of Obesity showed a decreased appetite for food following strenuous exercise. The findings from this study are more limited and guarded: it only studied 17 individuals, and ran counter to other studies that showed no relationship.

We need to hope that something will work to help us reverse the trend toward greater obesity. A Rand study by Sturm and Hattori, published online in September 2012 by the International Journal on Obesity showed the accelerated trend toward obesity in the United States beginning in 1987.

Obesity Change 1987-2010

For example, there is a 13-fold increase of BMI > 50 shown by 1200 on the index above.

While the trend in the following table slowed slightly after 2005, there was still an increase of 70 percent increase in those with BMI > 40 so that 15.5 million Americans or 6.6 percent exceeded that BMI.
Obesity 2000_2010

Something has to give–and it better not be more waistlines.

Illusion and Health

Posted by on June 24, 2013 Comments Off on Illusion and Health

A recent University of Texas study about the gap between perception of adequate exercise and optimal diet and the reality of an individual’s regime sent me googling.

I remembered a similar meme about body image. My memory was that men do not see how fat they are, and women imagine themselves fat when they are not, leading to anorexia.

Here are a few of them, and there are no doubt more:

Those studies raised an important question: how do reality and perception diverge when it comes to health?

So, let’s look at the University of Texas study from the Journal of Women’s Health, entitled Lifestyle and Cancer Prevention in Women: Knowledge, Perceptions, and Compliance with Recommended Guidelines.

Among those who believed that good diet and physical activity prevented cancer, the study found discrepancies (I have color-coded them) between what they believed they were doing and were actually doing as shown in the following table:

Women's Perceptions JWH 20130610

It can be seen that while 85 percent believe they are consuming a healthy diet, only 8.5 percent are eating an adequate amount of fruits and vegetables. While 73.1 percent reported engaging in physical activity to prevent cancer, only 31.5 percent were active enough to have a positive impact.

The study found that the significant predictors of the discrepancy were education, and to a lesser extent race-ethnicity independent of education. While the authors speculate about the reasons for those findings, they are clear and unambiguous about the implications, which I quote at length with the footnotes removed:

This finding has important public health implications. The first implication is that women in the current study reported understanding that engaging in regular physical activity and eating a healthy diet are important behaviors for cancer prevention. Thus, media campaigns and targeted public health messages should focus on the importance of specific frequencies and durations of recommended behaviors (i.e., 5 a Day for Better Health), and place less emphasis on the general importance of health behaviors. This may help attenuate the “underdosing” observed in the current study. Current public health efforts are focusing on making community-wide changes to reduce obesity and improve health.19 These efforts may be enhanced by promoting awareness of potential discrepancies between perceptions of behavior and actual behavior and by highlighting practical ways to integrate specific cancer prevention behaviors into daily life at adequate levels. Furthermore, they should consider the imbalance between educational resources for healthy eating and physical activity and barriers to these behaviors (i.e., society encourages the overconsumption of unhealthy food; low access to fresh produce and places to exercise safely sometimes exists). Given that women often serve as “gatekeepers” of health behavior within their families, efforts to address these discrepancies among women may ultimately have a positive downstream effect on men and children. Because dietary habits are often solidified in childhood, the discrepancies observed in this study could potentially set children up for a lifetime of poor health behaviors. These findings add to the body of existing literature indicating that although health-relevant knowledge and attitudes are generally positively associated with the practice health behaviors, the associations are only modest.

Results further indicated that the observed discrepancies for diet and physical activity were significantly more common among women with less education and among members of racial/ethnic minority groups. This is consistent with a large body of research supporting a social gradient in health (i.e., lower socioeconomic position and minority status are associated with poorer health behaviors and poorer health outcomes). One explanation for this is differential exposure to obesogenic environments. That is, individuals with low socioeconomic status and racial/ethnic minorities have less access to healthier foods such as fruits and vegetables due to higher cost and lower access to grocery stores that carry fresh produce. They also have fewer safe places to engage in physical activity. These women may be particularly vulnerable to perceiving that they are engaging in specific diet and physical activity behaviors to help prevent cancer. However, they may lack the opportunity to fully engage in preventive behaviors, thus failing to engage in such behaviors with sufficient frequency and duration to reduce their cancer risk. Such women may need to be specifically targeted for intervention and may benefit from tailored messages and interventions regarding diet and physical activity.

Do we not all know friends and family and clients who believe they are eating well and exercising adequately, but do not understand why their weight keeps rising, with the attendant complications? Our challenge as a society is not only to find ways of addressing the health problems that are undermining our economy and personal functioning that underpin our nation, but to communicate those findings in a way that is unambiguous and specific. The challenge of communicating the findings of a solution to the public health issues may be even more daunting than isolating those causes.

Fast food and slow death

Posted by on June 3, 2013 Comments Off on Fast food and slow death

My father returned from a business trip with great enthusiasm for a new food product he had experienced. A company had found the best meat available and mass produced hamburgers, with the mustard, ketchup, and pickle already on the bun. Dad had eaten his first McDonald’s hamburger, more than a half century ago.

He died at age 45 of a massive heart attack, a product not only of McDonald’s and other fast food, but of a sedentary lifestyle, poor heredity, and a 1950’s diet, in which it wasn’t a meal without meat.

He and others who lived through the Second World War had experienced the deprivation of rationing following not long after the Great Depression. Having enough to eat, enough protein to eat, and then seeing opulent food as a sign of material success were all very real to that generation.

The success of feminism led to changes in America’s eating habits. Instead of one partner packing the lunch pail and preparing dinner, both were in the work force, too hurried and harried to spend as much time on meals. Quick meals, whether processed from the grocery store or from a fast food chain, became the norm. In the not too distant future we will learn what the impact has been on gut bacteria that process nutrients and play a role in regulating our weight.

In October 2011 researchers from the University of Michigan, Warsaw School of Social Science and Humanities, and the University of Texas published a study showing significant correlation between national rates of obesity and the density of Subway restaurants in 28 developed nations. Their study ‘Globesization’:
ecological evidence on the relationship between fast food outlets and obesity among 26 advanced
economies found high rates of obesity in countries such as the United States and Canada with high density of Subway restaurants compared to low rates of obesity in countries such as Japan and Norway with low rates.

We can safely assume that it is not Subway alone, but a propensity to support fast food restaurants that is related to obesity. In the study graphic below, the clustering of values along a rising trend line from lower right to upper left, demonstrates the correlation between obesity on the vertical and subways on the horizontal:

Subway_Obesity

Source: Roberto De Vogli , Anne Kouvonen & David Gimeno (2011): ‘Globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies, Critical Public Health, 21:4, 395-402

My father’s generation died sooner, from fatty diets, cigarettes, and a sedentary lifestyle. If anything, computers have made our lifestyles more sedentary, but we know the dangers of cigarettes and saturated fats. We have statin drugs to stave off early death. Now we live longer, die slower, and endure chronic illnesses, such as cardiovascular disease and diabetes.

One of the singular distinctions between children and adults is the ability of adults to postpone pleasure and even endure discomfort in pursuit of a greater good. That may mean planning healthier meals, lighter meals, walking more and driving less. It means, in short, all the things we know we should do but sometimes do not. A long life need not be accompanied by a slow death–if we are willing to act on the knowledge we already have.

What’s a woman to do? Or a man? Dairy and weight and bones and stuff.

Posted by on March 18, 2013 Comments Off on What’s a woman to do? Or a man? Dairy and weight and bones and stuff.

In many ways women’s health is more challenging than men’s.

Women over age 50 are much more likely to get breast cancer, or its precursors, such as fibrocystic breast disease.

Women get cervical and ovarian cancer–men don’t need pap smears or the equivalent.

Women are five times more prone to osteoporosis.

Many medical studies have disproportionately targeted men, although that is changing.

But let’s just consider osteoporosis for a moment. Some risk factors are:

  1. Unchangeable
    • Sex
    • Age
    • Race
    • Family History
    • Frame Size
  2. Hormone Levels
    • Sex Hormones
    • Thyroid
    • Other Glands
  3. Dietary
    • Low Calcium Intake
    • Eating Disorders
    • Weight Loss Surgery
  4. Steroid Prescriptions and Others
  5. Lifestyle
    • Sedentary Lifestyle
    • Excessive Alcohol Consumption
    • Tobacco Use
  6. Too little estrogen

This is but one ailment, but threading the needle is difficult. Consider that sedentary lifestyle and inadequate weight are opposites. If someone exercises and loses weight, the risk is increased. If someone does not exercise, the risk is increased. And the task is even more complicated. A recent study found that consumption of high-fat dairy is associated with increased mortality from breast cancer–so your doctor will probably tell you to stick to low-fat dairy to get additional calcium–be sure to ask.

Very often we hear that someone fell and broke their hip; less often we realize that someone’s hip broke, and they fell.

The International Osteoporosis Foundation estimates that 1 in 3 women and 1 in 5 men will experience a fracture from osteoporosis.

Osteoporosis affects more than 10 million Americans, accounting for 1.5 million fractures annually.

Salt: Connecting the Dots

Posted by on March 11, 2013 Comments Off on Salt: Connecting the Dots

Some number of millenia ago our evolutionary forebears crawled out of the sea, carrying its salt flowing through their veins to ours. In the right amount, salt is not only good for us but essential to life.

That is not the same, however, as dumping salt on our food before tasting it or eating processed dinners, from the supermarket or from the nearest fast food franchise.

Most of us have long known that salt increases hypertension among salt-sensitive individuals.

Two sets of studies have come out, one widely publicized, the other well below the radar, that add concerns about excess salt consumption.

Researchers publishing in a recent issue of Nature have linked salt consumption to auto-immune disorders such as multiple sclerosis, psoriasis, ankylosing spondylitis, and rheumatoid arthritis. Unless you have a $200 annual subscription to Nature, you may wish to google “salt autoimmune” to read descriptions of the studies. Or, you may wish to simply click on these links to Medical News Today or The Huffington Post.

So, what are the dots to be connected? That’s where the second study comes in, the one with little publicity.

A presentation at the 2013 American Academy of Dermatology annual meeting in March found that individuals with psoriasis were more likely to have metabolic syndrome. They found that 30 percent of the psoriasis children had metabolic syndrome symptoms compared to the non-psoriasis group. There were not significant differences in Body-Mass Index (BMI), c-reactive protein, or endothelial cells

A 2012 study in South India found a higher incidence of metabolic syndrome among those with psoriasis. In this case:

Patients were diagnosed with MetS for having three or more South Asian Modified National Cholesterol Education Program Adult Treatment Panel III criteria: abdominal obesity (waist circumference ≥90 cm for men, ≥80 cm for women); blood pressure, >130/85 mm Hg; fasting blood glucose, ≥100 mg/dL; hypertriglyceridemia, >150 mg/dL; or low HDL (<40 mg/dL for men, <50 mg/dL for women).

Calcium: Friend or foe? Part II

Posted by on March 7, 2013 Comments Off on Calcium: Friend or foe? Part II

Last time we looked at calcium supplements and cardiovascular risk. The indicators are strong that men should not be taking calcium supplements in the absence of a very clear, unambiguous reason to do so. Women at risk for osteoporosis, for example, need to discuss the relative risks and benefits with their physician. No treatment is without potential risks, so we need to make decisions based on likely outcomes and known risks.

Susanna C. Larsson PhD puts the issue of calcium in perspective:

Larsson_JAMA_Calcium_2013

In addition to the cardiovascular risks we have considered, there are elevated risks of kidney stones (renal calculi). Calcium is intimately related to the development of kidney stones, also called “calcium stones.

The U.S.Preventive Services Task Force has issued recommendations.

Annals of Medicine Calcium 2013

Here is what those recommendations ( I Statement and Grade: D) mean:

UPSTF grades

The best, meaning safest, sources of calcium are not supplements but diet. The Office of Dietary Supplements at NIH has issued a helpful Calcium Fact Sheet/a>

The recommended daily allowances for calcium are:

CalciumRDAs

And some of the best sources to attain that level of daily calcium consumption are:
NIHCalciumsources

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?