Tuesday, June 19, 2007
Only the Finest Propaganda will Solve Childhood Obesity
Yes, life sometimes gets in the way of my blog posts; rather than keep you waiting for a fully referenced article I was hoping to post as follow up to the new recommendations to address childhood obesity, issued jointly from the AMA, CDC and HHRS, I'm going to keep this short and point first to a massive, 400+ page, document - Preventing Childhood Obesity: Health in the Balance - published in 2005 by the Food & Nutrition Board (FNB) of the Institute of Medicine (IOM) that painstakingly reviewed the evidence published regarding childhood obesity.
When you take some time to read it, you'll notice some critically important statements thoughout:
"Empirical data is lacking..."
"...problem exists, causes less clear..."
"...little clarity about the relative importance of possible causitive factors..."
"...a robust evidence base is not yet available."
"In reviewing the available evidence to inform this report, there was an abundance of scientific studies on the causes and correlates of obesity, but few studies testing potential solutions with diverse and complex social and environmental contexts, and no proven effective population-based solutions."
But that's okay, let's press forward without hard data; the latest AMA recommendations seem to have ignored the above lack of data and even ignored that the IOM document specifically states that within their publication there is "limited literature upon which to base these recommendations..." and chose instead to concentrate on "...parallel evidence from other public health issues..." to side-step empirical data and move forward to modify public opinion anyway.
"Now that the nation has begun to realize the significant health, psychological and societal costs of an unhealthy weight, it is time to re-examine its way of thinking and revise the social norms that are now accepted."
"In the absence of precise understanding of the eitology of the problem, it may be useful to look at the lessons learned from other public health campaigns and to try and determine if these lessons have any relevance for the prevention of childhood obesity."
Their playbook to resolve childhood obesity? Lessons learned from tobacco control, seat belt enforcement, underage drinking, childhood vaccination, and regulation of speed limits; with the most notable precedent examples throughout the section on Lessons Learned from Public Health Efforts and their Relevance to Preventing Childhood Obesity being the stunning success of tobacco control initiatives, that now leave smoking, in the minds of the majority of society, "nearly considered, if not deviant behavior, at least one in private;" and they note the magnitude of the change in public perception of smoking over the years of gradual change, from a time when smoking was viewed as a private matter, to now when smoking is viewed as a moral failing and deviant behavior.
They note, "Culture is not a static set of values and practices," and that programs to prevent and reverse obesity need to balance "the role of coersion versus the individual."
Coersion?
How they fail to see the under-current of shame and moralizing a behavior like smoking is scary. We're going to now do this with children, kids who happen to weigh too much for their age and height? Have we lost our minds?
Oh, it just gets better though.
The 'best practices' to be employed in a national campaign to address childhood obesity:
When you take some time to read it, you'll notice some critically important statements thoughout:
"Empirical data is lacking..."
"...problem exists, causes less clear..."
"...little clarity about the relative importance of possible causitive factors..."
"...a robust evidence base is not yet available."
"In reviewing the available evidence to inform this report, there was an abundance of scientific studies on the causes and correlates of obesity, but few studies testing potential solutions with diverse and complex social and environmental contexts, and no proven effective population-based solutions."
But that's okay, let's press forward without hard data; the latest AMA recommendations seem to have ignored the above lack of data and even ignored that the IOM document specifically states that within their publication there is "limited literature upon which to base these recommendations..." and chose instead to concentrate on "...parallel evidence from other public health issues..." to side-step empirical data and move forward to modify public opinion anyway.
"Now that the nation has begun to realize the significant health, psychological and societal costs of an unhealthy weight, it is time to re-examine its way of thinking and revise the social norms that are now accepted."
"In the absence of precise understanding of the eitology of the problem, it may be useful to look at the lessons learned from other public health campaigns and to try and determine if these lessons have any relevance for the prevention of childhood obesity."
Their playbook to resolve childhood obesity? Lessons learned from tobacco control, seat belt enforcement, underage drinking, childhood vaccination, and regulation of speed limits; with the most notable precedent examples throughout the section on Lessons Learned from Public Health Efforts and their Relevance to Preventing Childhood Obesity being the stunning success of tobacco control initiatives, that now leave smoking, in the minds of the majority of society, "nearly considered, if not deviant behavior, at least one in private;" and they note the magnitude of the change in public perception of smoking over the years of gradual change, from a time when smoking was viewed as a private matter, to now when smoking is viewed as a moral failing and deviant behavior.
They note, "Culture is not a static set of values and practices," and that programs to prevent and reverse obesity need to balance "the role of coersion versus the individual."
Coersion?
How they fail to see the under-current of shame and moralizing a behavior like smoking is scary. We're going to now do this with children, kids who happen to weigh too much for their age and height? Have we lost our minds?
Oh, it just gets better though.
The 'best practices' to be employed in a national campaign to address childhood obesity:
- Community-wide campaigns
- School-based initiatives
- Mass media strategies
- Laws and regulations
- Provider reminder systems
- Reduce costs to patients
- Home visits
The list includes elements of both formal planned interventions and recognized cultural and social factors. Detailed too are the necessary elements to convince the population at large there is a problem that requires drastic measures:
- A persuasive science base documenting a socially and scientifically credible threat
- A supportive partnership with the media
- Strategic leadership and a prominent champion
- A diverse constituency of highly effective advocates
- Enabling and reinforcing laws, regulations and policies
Notice above, the critically important factors are not solid evidence, but persuation, packaging the message for the media to propogate to the public, repeat the message through advocates and champions, and regulating laws and policies to conform to the pursuasive messages.
That's not science, that's carefully orchestrated propaganda.
"Propaganda is the deliberate, systematic attempt to shape perceptions, manipulate cognitions, and direct behavior to achieve a response that furthers the desired intent of the propagandist." Source: Garth S. Jowett and Victoria O'Donnell, Propaganda And Persuasion, 4th edition, 2006
This is what public health experts intend to do to our children.
In stunning clarity, the document provides insights into what we can expect in the coming years:
"Tough choices will have to be made at all levels of society. There will be trade-offs in convenience, in cost, in what's 'easy', in pushing oneself and one's organization, in choosing between priorities, in devising new laws and regulations, and in setting limits on individuals and industries."
The second document I'd like to direct your attention to is from the US Preventative Task Force, published in 2006, Screening and Interventions for Overweight in Children and Adolescents: Recommendation Statement.
It states, "There is insufficient evidence to ascertain the magnitude of the potential harms of screening or prevention and treatment interventions. The USPSTF was, therefore, unable to determine the balance between potential benefits and harms for the routine screening of children and adolescents for overweight."
Now, in 2007 - with no new science and still no compelling evidence, no empirical data, absolutely nothing more than "hope" this will work, the AMA, CDC, and HHRS is jumping in with both feet, and expects all of us to do the same; expects we'll all get on board, full steam ahead with little more than our fear that if we do nothing, our kids are going to die prematurely; anything is better than nothing.
Except that anything is may wind up destroying our children in the long-term.
But hey, they won't be fat, right?
The direction we're now heading in stubbornly and without evidence, reminds me of something Aldous Huxley said in a speech at the California Medical School in San Francisco, 1961:
"There will be in the next generation or so a pharmacological method of making people love their servitude and producing dictatorship without tears, so to speak, producing a kind of painless concentration camp for entire societies so that people will in fact have their liberties taken away from them but will rather enjoy it ... [through] brainwashing enhanced by pharmacological methods."
In the 1953 publication of The Impact of Science on Society, Bertrand Russel penned the following:
"Scientific societies are as yet in their infancy. . . . It is to be expected that advances in physiology and psychology will give governments much more control over individual mentality than they now have even in totalitarian countries. Fitche laid it down that education should aim at destroying free will, so that, after pupils have left school, they shall be incapable, throughout the rest of their lives, of thinking or acting otherwise than as their schoolmasters would have wished." "Diet, injections, and injunctions will combine, from a very early age, to produce the sort of character and the sort of beliefs that the authorities consider desirable, and any serious criticism of the powers that be will become psychologically impossible."
Tuesday, June 12, 2007
Oh, Yeah, That'll Work
An article in Sunday's Independent (UK) paints an ominous picture of what may be coming down the pike as a way to solve the epidemic of childhood obesity; simply take these children from their families and place them in care of the state.
"Doctors are calling for the parents of obese children under the age of 12 to be targeted under child protection laws and for their offspring to be taken into care."
Next month a motion will be presented at the British Medical Association (BMA) conference that will include provision for social workers to "treat childhood obesity as neglect" and allow state intervention, including removal from the home.
"Dr Matt Capehorn, who will present the motion on obesity in Torquay, said: "No healthcare professional would want to break up a family unit but this has to be considered if the child's health is being put at risk." Dr Capehorn, a GP, runs an obesity clinic in Rotherham, South Yorkshire."
The motion comes on the heels of our own American Medical Association releasing its latest Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity document on June 6, 2007. Noticably absent - media coverage to highlight its release!
Take some time to read it, I'll be writing more in depth about what appears to be in the works for us here in the United States! I'll note where the evidence stands for the recommendations in the document and point out data that's obviously being ignored in the efforts to reduce the prevalence of obesity in children.
Keep in mind as you read the document, this is from the same organization led by Dr. William Plested III, president of the American Medical Association, who was quoted as saying at a recent Rotary Club meeting in Jacksonville, Florida, “We’re going to pay for this with a generation of ‘fatsos’ with every disease you can imagine.”
Nice, huh?
"Doctors are calling for the parents of obese children under the age of 12 to be targeted under child protection laws and for their offspring to be taken into care."
Next month a motion will be presented at the British Medical Association (BMA) conference that will include provision for social workers to "treat childhood obesity as neglect" and allow state intervention, including removal from the home.
"Dr Matt Capehorn, who will present the motion on obesity in Torquay, said: "No healthcare professional would want to break up a family unit but this has to be considered if the child's health is being put at risk." Dr Capehorn, a GP, runs an obesity clinic in Rotherham, South Yorkshire."
The motion comes on the heels of our own American Medical Association releasing its latest Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity document on June 6, 2007. Noticably absent - media coverage to highlight its release!
Take some time to read it, I'll be writing more in depth about what appears to be in the works for us here in the United States! I'll note where the evidence stands for the recommendations in the document and point out data that's obviously being ignored in the efforts to reduce the prevalence of obesity in children.
Keep in mind as you read the document, this is from the same organization led by Dr. William Plested III, president of the American Medical Association, who was quoted as saying at a recent Rotary Club meeting in Jacksonville, Florida, “We’re going to pay for this with a generation of ‘fatsos’ with every disease you can imagine.”
Nice, huh?
Friday, June 08, 2007
Summer Reading Picks
For months now, I keep wanting to write up book reviews for a number of books I've read that are worthwhile reads; for one reason or another, such posts fall to the back of the list and don't seem to get written. So, rather than try to catch up with an individual review for each book, I'm going to consolidate them into one post and leave it to you to pick and choose those books you may want to add to your reading list!
Of the few dozen books I've finished since January of this year, these make my cut to recommend reading when you have time:
The Omnivore's Dilemma, Michael Pollan
While I didn't agree with his "meat as a condiment" contention in a recent article, his book is a compelling look at four uniquely different food supplies in the United States; from factory farmed to hunting and gathering (between the two lie industrial organic and traditional polyculture rotational farming - which may or may not be "certified"organic) Once you read how much corn and soybeans make up the typical diet in the United States, you'll never look at a chicken nugget the same again!
The Great Cholesterol Con, Anthony Colpo
Rich with research and data references to support his review of the scientific literature and conclude that elevated cholesterol and dietary saturated fats are not the cause of heart disease. His meticulous attention to detail leads to his conclusion (p 254), "There is every reason in the world to encourage people to exercise frequently, stop smoking, eat minimally processed foods, and find ways to get a handle on the stresses of modern life. The evidence for low-fat diets, on the other hand, is based on a mixture of erroneous assumptions, half-truths and downright lies." Colpo spends a lot of time detailing the data from well-referenced studies, those often quoted to support the lipid-hypothesis, and uncovers some compelling arguements that the data does not support the theory. I would have liked a better quality printing, but cannot deny the incredible list of references included that makes this one a top pick for me to recommend. Colpo backs his assertions with hard data - truly valuable in today's strange mix of evidence-based talk, followed by the same dogma in the face of contradiction!
The 150 Healthiest Foods on Earth, Jonny Bowden, PhD
The editorial review on Amazon.com asks, "Why get your nutrients from expensive supplements when you can enjoy delicious, nourishing foods instead?" Dr. Bowden answers with a refreshing departure from the dogma, by assessing a food's value by nutrient-density and culling out dietitian favorites that are not really our best options. Noticably absent are many foods we're repeatedly told optimize our diet, namely a large number of grains; included are many foods that would make any dietitian start the incessant scolding - whole eggs, grass-fed beef, and even butter (from grass-fed cows). It's an easy read with fantastic photographs, but most importantly, great information and lots of interesting sidebar tidbits to keep you reading! [In the interest of full disclosure, I am quoted in the book and did help with profiling some of the foods that made the final cut; however, I hold no financial interest in the sales of the book]
The Great Cholesterol Con, Malcolm Kendrick, MD
Yes, same title as Colpo's book and subject matter, but that's where the similarities end. Dr. Kendrick is a practicing physician and his writing style is an easy-going, step-by-step, reader oriented approach; one I imagine parallels discussions with his patients to ensure they understand well what he is saying. He takes readers through a thoughtful explaination and examine scientific data in an understandable manner, beginnning first with what heart disease and cholesterol are, why the current treatments are what they are, why they're not necessarily the "fix" we think they are, and then explains what he believes underlies the development of heart disease - stress; more importantly, he connects the dots and explains why he's come to this conclusion with evidence to support his position. I would have liked a bibliography at the end - one that provided all references within the book. But, even with a noticably absent bibliography (or indec), Kendrick does provide enough identifying information about studies he cites, so they are easily found when searched for in PubMed.com.
The End of Food, Thomas Pawlick
I picked this book up on a whim while on vacation last month - it was paperback and fit easily into my bag for reading during our trip. What an eye-opener it turned out to be! What started for Pawlick as disgust over his repeated experience buying beautiful red tomatoes that appeared ripe, but never seemed to taste good or actually be ripe, turned into a quest to understand what is happening in our food supply today and led to his book that details a number of things being done that are impacting not only appearance and taste, but actual nutrient levels in foods like tomatoes.
Survival of the Sickest, Sharon Moalem, PhD
Of all the books I've read in the last few months, this is, without a doubt, my favorite! It too was an "on a whim" purchase - the back cover asked intriguing questions, "Can a person rust to death? Can sunglasses cause sunburn? Who gets drunk faster - Europeans or Asians? And why?" What I thought might just be another whack book, but bought anyway, turned out to be an intriguing look at our genetics and why we have some interesting mutations in some, but not others, in our population of humans; and why some of these mutations aren't necessarily "disease" as we know it, but the result of evolutionary pressure that provided protection that was once critical in survival, but not so much today. This was not only a fun read, but packed with useful information that flips many things we think about our understanding of genetics on its head, and in the process makes you really start to think about things like pharmaceuticals that block particular signals and genes in a whole new way.
Currently on my pile of books to read this summer (no reviews, I haven't read them yet), with similar subject matter:
Rethinking Thin, Gina Kolata
Real Food, Nina Planck
What we Believe, But Cannot Prove, John Brockamn, editor
Animal, Vegetable, Miracle: A Year of Food, Barbara Kingsolver et al
Death to Diabetes, DeWayne McCulley
The Hundred Year Lie, Randall Fitzgerald
Of the few dozen books I've finished since January of this year, these make my cut to recommend reading when you have time:
The Omnivore's Dilemma, Michael Pollan
While I didn't agree with his "meat as a condiment" contention in a recent article, his book is a compelling look at four uniquely different food supplies in the United States; from factory farmed to hunting and gathering (between the two lie industrial organic and traditional polyculture rotational farming - which may or may not be "certified"organic) Once you read how much corn and soybeans make up the typical diet in the United States, you'll never look at a chicken nugget the same again!
The Great Cholesterol Con, Anthony Colpo
Rich with research and data references to support his review of the scientific literature and conclude that elevated cholesterol and dietary saturated fats are not the cause of heart disease. His meticulous attention to detail leads to his conclusion (p 254), "There is every reason in the world to encourage people to exercise frequently, stop smoking, eat minimally processed foods, and find ways to get a handle on the stresses of modern life. The evidence for low-fat diets, on the other hand, is based on a mixture of erroneous assumptions, half-truths and downright lies." Colpo spends a lot of time detailing the data from well-referenced studies, those often quoted to support the lipid-hypothesis, and uncovers some compelling arguements that the data does not support the theory. I would have liked a better quality printing, but cannot deny the incredible list of references included that makes this one a top pick for me to recommend. Colpo backs his assertions with hard data - truly valuable in today's strange mix of evidence-based talk, followed by the same dogma in the face of contradiction!
The 150 Healthiest Foods on Earth, Jonny Bowden, PhD
The editorial review on Amazon.com asks, "Why get your nutrients from expensive supplements when you can enjoy delicious, nourishing foods instead?" Dr. Bowden answers with a refreshing departure from the dogma, by assessing a food's value by nutrient-density and culling out dietitian favorites that are not really our best options. Noticably absent are many foods we're repeatedly told optimize our diet, namely a large number of grains; included are many foods that would make any dietitian start the incessant scolding - whole eggs, grass-fed beef, and even butter (from grass-fed cows). It's an easy read with fantastic photographs, but most importantly, great information and lots of interesting sidebar tidbits to keep you reading! [In the interest of full disclosure, I am quoted in the book and did help with profiling some of the foods that made the final cut; however, I hold no financial interest in the sales of the book]
The Great Cholesterol Con, Malcolm Kendrick, MD
Yes, same title as Colpo's book and subject matter, but that's where the similarities end. Dr. Kendrick is a practicing physician and his writing style is an easy-going, step-by-step, reader oriented approach; one I imagine parallels discussions with his patients to ensure they understand well what he is saying. He takes readers through a thoughtful explaination and examine scientific data in an understandable manner, beginnning first with what heart disease and cholesterol are, why the current treatments are what they are, why they're not necessarily the "fix" we think they are, and then explains what he believes underlies the development of heart disease - stress; more importantly, he connects the dots and explains why he's come to this conclusion with evidence to support his position. I would have liked a bibliography at the end - one that provided all references within the book. But, even with a noticably absent bibliography (or indec), Kendrick does provide enough identifying information about studies he cites, so they are easily found when searched for in PubMed.com.
The End of Food, Thomas Pawlick
I picked this book up on a whim while on vacation last month - it was paperback and fit easily into my bag for reading during our trip. What an eye-opener it turned out to be! What started for Pawlick as disgust over his repeated experience buying beautiful red tomatoes that appeared ripe, but never seemed to taste good or actually be ripe, turned into a quest to understand what is happening in our food supply today and led to his book that details a number of things being done that are impacting not only appearance and taste, but actual nutrient levels in foods like tomatoes.
Survival of the Sickest, Sharon Moalem, PhD
Of all the books I've read in the last few months, this is, without a doubt, my favorite! It too was an "on a whim" purchase - the back cover asked intriguing questions, "Can a person rust to death? Can sunglasses cause sunburn? Who gets drunk faster - Europeans or Asians? And why?" What I thought might just be another whack book, but bought anyway, turned out to be an intriguing look at our genetics and why we have some interesting mutations in some, but not others, in our population of humans; and why some of these mutations aren't necessarily "disease" as we know it, but the result of evolutionary pressure that provided protection that was once critical in survival, but not so much today. This was not only a fun read, but packed with useful information that flips many things we think about our understanding of genetics on its head, and in the process makes you really start to think about things like pharmaceuticals that block particular signals and genes in a whole new way.
Currently on my pile of books to read this summer (no reviews, I haven't read them yet), with similar subject matter:
Rethinking Thin, Gina Kolata
Real Food, Nina Planck
What we Believe, But Cannot Prove, John Brockamn, editor
Animal, Vegetable, Miracle: A Year of Food, Barbara Kingsolver et al
Death to Diabetes, DeWayne McCulley
The Hundred Year Lie, Randall Fitzgerald
Thursday, June 07, 2007
Back to Our Regularly Scheduled Program
You may recall the alarming headlines reported here that suggested a high-fat meal was very risky to endothelial function; one went so far as to suggest just one bite of a burger might kill you!
Seems some researchers thought maybe it's a good idea to see what effect a high-protein (low-carb) and low-fat (high-carb) habitual diet might have on endothelial function over a longer period of time - say, maybe a year?
Wonder why you haven't seen any headlines on the latest study - Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin - published in the British Journal of Nutrition?
Might be because the researchers found nothing significantly different between the two diets, and noted "weight loss does not improve FMD [flow mediated dialation]."
Paper gets published, media sees it, notes noting to see here, no sexy headlines....not quite juicy enough to waste readers time with (even though it contradicts those one-meal experiements), so let's just move on.
But wait!
Just because the study objective was to see effect (benefit or risk) on FMD, adhesion molecules and adiponectin, was there anything else they measured that did have significance and is worthy of our time to look at?
How about we take a look?
Two groups of subjects were randomized into two different dietary protocols - the first included 13 people assigned a low-carbohydrate diet (40% protein, 27% carbohydrate and 33% fat; 26g fiber daily); the second included 12 people assigned the high-carb diet (20% protein, 60% carbohydrate, 20% fat; 40g fiber daily).
Both groups were weighed, measured, poked and prodded and followed up with a 6-weeks, 12-weeks and 52-weeks. Measurements and testing included weight, BMI, blood pressure, cholesterol, glucose, insulin, CRP, VCAM1, sICAM1, E-selectin, P-selectin, and total adiponectin. In addition, vascular measurements were taken for blood pressure analysis and endothelium-dependent FMD, along with an assortment of other tests.
The various measurements were duly recorded for baseline and re-measured during follow-ups, and were included in the final paper. Some critically important measures were statistically significant, but not the focus of the study design; thus not highlighted in the abstract conclusions.
We hear a lot about how low-carb diets are bad for cholesterol.
In this study, like others, total cholesterol, LDL and triglycerides were lowered over the course of the year and HDL rose while following the low-carb diet.
Total Cholesterol:
Baseline = 5.3
52-weeks = 4.62
[low-fat group went from 5.7 to 4.94]
LDL:
Baseline = 3.5
52-weeks = 2.69
[low-fat group went from 3.8 to 3.07]
HDL:
Baseline = 1.3
52-weeks = 1.44
[low-fat group went from 1.3 to 1.34]
Triglycerides:
Baseline = 1.7
52-weeks = 1.07
[low-fat group went from 1.4 to 1.34]
Intriguing too was the improvements with glucose and insulin following the low-carb diet:
Glucose (fasting):
Baseline = 5.9
52-weeks = 5.19
[low-fat group went from 5.8 to 5.5]
Insulin (fasting):
Baseline = 16.9
52-weeks = 7.28
[low-fat group went from 12.1 to 5.22]
An interesting finding was that adiponectin, a hormone involved in a number of metabolic processes, including glucose regulation and fatty acid catabolism, "did not change significantly after 12 weeks of weight loss" (p=0.10), but increased (good) at the last measurement, 52-weeks, at the end of the study (p=0.05).
Blood pressure (not high at baseline) improved, from 122/75 at baseline to 115/68 at the 52-week measure; for those on the low-fat diet, blood pressure increased from 122/75 at baseline to 130/74 at 52-weeks.
It's clear in the data that both dietary approaches offered improvements with weight loss in the above measures of risk factors. Something though wasn't "right" to help with, improve, endothelial-dependent FMD. We'll explore potentials in a moment.
Somethign troubling that seems glossed over - the higher blood pressure in those following the low-fat diet - where at baseline their blood pressure averaged 122/75, at 6-weeks it improved to 115/72 and again improved at 12-weeks was similar at 118/70. What happened between the 12-week measure and the blood pressure reading at week 52, when blood pressure was now averaging 130/74?
This is something I would consider worthy of noting, even maybe point out and suggesting additional questions and investigation as to why!
In the discussion section, the researchers stated that "The main finding of the present study was that weight loss on a low-carbohydrate diet which brought about reductions in glucose, insulin and LDL-C did not improve FMD either after short-term weight loss or long-term weight maintenance. Irrespective of diet composition weight loss had beneficial effects in the short term on adhesion molecules and blood pressure and in the longer term on adiponectin and P-selectin. There appears to be a delay in improvement in both adiponectina nd P-selection as these molecules did not improve until weight loss had been maintained for a year."
They went on to add, "Lack of change in FMD in the present study confirms our previous finding that weight loss does not improve FMD...One of our goals with the dietary intervetion was a reduction in LDL-C which we achieves, 18% at 6-weeks and nearly 30% at the end of the study with no effect on FMD."
The researchers also noted that "The present study was also designed to achive a reduction in glucose in a 6-week weight loss intervention on a more moderate diet of 6000kJ and we achieved this but with no effect on FMD."
And, "A complex physiological response such as FMD may be related to LDL and glucose cross-sectionally and in post hoc analyses but these may not be casually related but correlate in some circumstances with the real unmeasured mediator of change. For instance, oxidative stress may be a major factor in reducing NO bioactivity but reducing LDL levels may have no effect on this even though the endothielial cell is clearly heathier as judged by a reduced adhesion molecules."
In the end, they concluded that "weight loss on a low-carbohydrate, low-saturated fat diet, does not improve FMD despite improvement in cardiovascular risk factors. The improvement in adiponectin was delayed."
So what was their error of omission?
Well, for one they failed to note the problematic rise in blood pressure observed in the subjects following the low-fat diet. But, let's set that aside for a moment.
They also failed to note that the above failure to improve FMD was also observed in subjects following the low-fat diet; one that happened to be designed well enough to match the American Heart Association recommendations!
Yet even that low-fat diet (20% of calories from fat) didn't help improve FMD, despite their weight loss, improvement in glucose, insulin and cholesterol; but this was left unsaid.
I'm not surprised.
So, what we're left with is the stated null finding of those on the low-carb diet, with no real statement that neither dietary approach did much for FMD.
I hate to say it, but there was also a lack of curiosity as to why this was.
It's pretty much accepted dogma that a low-fat diet improves the cardiovascular system, thus would exert a postive - significant - effect on endothelial-dependent FMD. It didn't, yet the researchers didn't say "hey, wait, this low-fat diet didn't help either" and instead highlighted that the low-carb diet didn't improve FMD in their conclusions.
Some questions really do need to be asked.
First, how did the low-carb diet look compared with the habitual diet?
We know subjects were consuming, on average, 11.4mJ each day (2725-calories) as their habitual diet. The weight loss diet was 6000kJ each day (1430-calories). They followed the weight loss phase of the diet for six weeks and lost 5.8kg, or 12.75-pounds.
Let's do math!
Each day, we're to believe, the subjects were in a calorie deficit of 1295-calories. Six weeks is 42-days, so over the period, a calorie deficit of 54,390 calories - enough to theoretically lose 15.5-pounds. Hmmm....Okay, so it's pretty clear they did not really follow the diet as planned, since it's clear they consumed more calories than was reported. Happens all the time, no biggie.
Except, we have no idea what the excess calories were, so we have a confounding variable here. Did they eat pie? Did they eat broccoli? Did they eat fatty meat instead of lean meat? Did they skip the oatmeal and eat eggs? Who knows?
It's also noteworthy that the low-fat dieters ate a habitual diet of 10.8mJ daily (2581-calories) and were placed on the same weight loss calorie level. So they were in a calorie deficit of 1150-calories each day, or a six week deficit of 48,342-calories. This theoretically would result in a weight loss of 13.8-pounds; they lost 5.9kg (13-pounds). Did they cheat less? Did they stick to the diet more carefully? Who knows?
But, we can be sure we have a confounding variable here - something doesn't add up, and it looks like that something is calorie intake. It appears it was higher than the dietary protocol called for; and an increased calorie intake we have no idea what foods/macronutrients it came from.
So then, is there anything else? Let's see how macronutrient intake changed on the low-carb diet.
At baseline, their habitual diet - 2725-calories - was from 39.6% carbohydrate (270g), 19.6% protein (133.5g) and 36.5% fat (110.5g). We do not know the baseline intake for fatty acids, but do know the dietary protocol was strict - saturated fat 7%, PUFA 6% and MUFA 13% of calories.So, while following the weight loss diet, the macronutrient profile changed to provide 1430-calories each day, of which 33% were carbohydrate (118g), 40% protein (143g) and 27% fat (43g) with 7% from saturated fat (11.1g), 6% from polyunsaturated fat (9.5g) and 13% from monounsaturated fat (20.7g).
The first glaring disparity is the protein-to-fat intake, for every 1g of fat, they were expected to consume 3.3g of protein; this is a highly unusual pattern, heavy with protein and too lean - if you review other studies on "low-carb" diets, the fat intake is usually higher than the level in this protocol and protein typically lower; of note, this intake ratio is next to impossible without some funky planning. I'd like to know how much soy was a part of this diet? How much of the diet was comprised of non-fat dairy? How much fish was allowed, and what type was it? Were protein shakes or supplements part of the protocol? If so, which type of isolate dominated?
Without this specific data, it's difficult to say one way or another if the foods included may have contributed to the null finding or not.
So here, we have a potential confounding variable that is unexplored.
Anything else?
Well, from the data we do know, it seems we find an inadequate level of polyunsaturated fats - with just 9.5g each day; a level at which the subjects are unable to meet essential requirements for omega-6 or omega-3 fatty acids!
I am really starting to wonder why researchers designing diet protocols that are inadequate for known essential nutrients?
The Institute of Medicine (IOM) clearly states in the Daily Recommended Intake documentation, the MINIMUM required each day from omega-6 is 5% to 10% of calories and the MINIMUM requirement each day from omega-3 is 0.5% to 1% - when calories are adequate to maintain weight. In absolute terms - absolute gram minimums - the IOM states that adequate intake of omega-6 fatty acid is 14g-17g for men (depending on age) and 11g-12g for women (depending on age); and that adequate intake of omega-3 fatty acids is 1.6g for men and 1.1g for women.
Combined, the absolute minimum intake for essential fatty acids is between 15.6g-17.6g for men and 12.1g-13.1g for women.
In this study, even if every last gram of polyunsaturated fat was an omega-3 or omega-6, these subjects were deficient for essential fatty acids with only 9.5g of polyunsaturated fats as part of the diet.
So, again, confounding variable - huge confounding variable!
And the researchers question why the diet didn't have an effect on FMD?
Perhaps the researchers haven't read the data showing improvement in cardiovascular health when essential fatty acid intake is optimized to meet or exceed current recommendations?
Recent evidence of the role of omega-3 polyunsaturated fatty acids on blood pressure control and hypertension-related complications
Omega-3 Fatty Acids: Role in Cardiovascular Health and Disease
Fish Oil and Endothelial Function
I can't say it enough - I love good data, but studies like this, with macronutrient intakes, as percentage of calories, is highly confounded data. Designing a dietary approach to lose weight or maintain weight, macronutrient percentages are often inefficient and do not meet essential nutrient requirements.
I'd really like to see some researchers start designing studies to ensure adequate intake of essential nutrients within the calorie deficits - until we start to look at the nutrient-quality of weight loss diets, I'm afraid we're not going to make much progress to provide the public with sound, scientifically supported recommendations.
Seems some researchers thought maybe it's a good idea to see what effect a high-protein (low-carb) and low-fat (high-carb) habitual diet might have on endothelial function over a longer period of time - say, maybe a year?
Wonder why you haven't seen any headlines on the latest study - Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin - published in the British Journal of Nutrition?
Might be because the researchers found nothing significantly different between the two diets, and noted "weight loss does not improve FMD [flow mediated dialation]."
Paper gets published, media sees it, notes noting to see here, no sexy headlines....not quite juicy enough to waste readers time with (even though it contradicts those one-meal experiements), so let's just move on.
But wait!
Just because the study objective was to see effect (benefit or risk) on FMD, adhesion molecules and adiponectin, was there anything else they measured that did have significance and is worthy of our time to look at?
How about we take a look?
Two groups of subjects were randomized into two different dietary protocols - the first included 13 people assigned a low-carbohydrate diet (40% protein, 27% carbohydrate and 33% fat; 26g fiber daily); the second included 12 people assigned the high-carb diet (20% protein, 60% carbohydrate, 20% fat; 40g fiber daily).
Both groups were weighed, measured, poked and prodded and followed up with a 6-weeks, 12-weeks and 52-weeks. Measurements and testing included weight, BMI, blood pressure, cholesterol, glucose, insulin, CRP, VCAM1, sICAM1, E-selectin, P-selectin, and total adiponectin. In addition, vascular measurements were taken for blood pressure analysis and endothelium-dependent FMD, along with an assortment of other tests.
The various measurements were duly recorded for baseline and re-measured during follow-ups, and were included in the final paper. Some critically important measures were statistically significant, but not the focus of the study design; thus not highlighted in the abstract conclusions.
We hear a lot about how low-carb diets are bad for cholesterol.
In this study, like others, total cholesterol, LDL and triglycerides were lowered over the course of the year and HDL rose while following the low-carb diet.
Total Cholesterol:
Baseline = 5.3
52-weeks = 4.62
[low-fat group went from 5.7 to 4.94]
LDL:
Baseline = 3.5
52-weeks = 2.69
[low-fat group went from 3.8 to 3.07]
HDL:
Baseline = 1.3
52-weeks = 1.44
[low-fat group went from 1.3 to 1.34]
Triglycerides:
Baseline = 1.7
52-weeks = 1.07
[low-fat group went from 1.4 to 1.34]
Intriguing too was the improvements with glucose and insulin following the low-carb diet:
Glucose (fasting):
Baseline = 5.9
52-weeks = 5.19
[low-fat group went from 5.8 to 5.5]
Insulin (fasting):
Baseline = 16.9
52-weeks = 7.28
[low-fat group went from 12.1 to 5.22]
An interesting finding was that adiponectin, a hormone involved in a number of metabolic processes, including glucose regulation and fatty acid catabolism, "did not change significantly after 12 weeks of weight loss" (p=0.10), but increased (good) at the last measurement, 52-weeks, at the end of the study (p=0.05).
Blood pressure (not high at baseline) improved, from 122/75 at baseline to 115/68 at the 52-week measure; for those on the low-fat diet, blood pressure increased from 122/75 at baseline to 130/74 at 52-weeks.
It's clear in the data that both dietary approaches offered improvements with weight loss in the above measures of risk factors. Something though wasn't "right" to help with, improve, endothelial-dependent FMD. We'll explore potentials in a moment.
Somethign troubling that seems glossed over - the higher blood pressure in those following the low-fat diet - where at baseline their blood pressure averaged 122/75, at 6-weeks it improved to 115/72 and again improved at 12-weeks was similar at 118/70. What happened between the 12-week measure and the blood pressure reading at week 52, when blood pressure was now averaging 130/74?
This is something I would consider worthy of noting, even maybe point out and suggesting additional questions and investigation as to why!
In the discussion section, the researchers stated that "The main finding of the present study was that weight loss on a low-carbohydrate diet which brought about reductions in glucose, insulin and LDL-C did not improve FMD either after short-term weight loss or long-term weight maintenance. Irrespective of diet composition weight loss had beneficial effects in the short term on adhesion molecules and blood pressure and in the longer term on adiponectin and P-selectin. There appears to be a delay in improvement in both adiponectina nd P-selection as these molecules did not improve until weight loss had been maintained for a year."
They went on to add, "Lack of change in FMD in the present study confirms our previous finding that weight loss does not improve FMD...One of our goals with the dietary intervetion was a reduction in LDL-C which we achieves, 18% at 6-weeks and nearly 30% at the end of the study with no effect on FMD."
The researchers also noted that "The present study was also designed to achive a reduction in glucose in a 6-week weight loss intervention on a more moderate diet of 6000kJ and we achieved this but with no effect on FMD."
And, "A complex physiological response such as FMD may be related to LDL and glucose cross-sectionally and in post hoc analyses but these may not be casually related but correlate in some circumstances with the real unmeasured mediator of change. For instance, oxidative stress may be a major factor in reducing NO bioactivity but reducing LDL levels may have no effect on this even though the endothielial cell is clearly heathier as judged by a reduced adhesion molecules."
In the end, they concluded that "weight loss on a low-carbohydrate, low-saturated fat diet, does not improve FMD despite improvement in cardiovascular risk factors. The improvement in adiponectin was delayed."
So what was their error of omission?
Well, for one they failed to note the problematic rise in blood pressure observed in the subjects following the low-fat diet. But, let's set that aside for a moment.
They also failed to note that the above failure to improve FMD was also observed in subjects following the low-fat diet; one that happened to be designed well enough to match the American Heart Association recommendations!
Yet even that low-fat diet (20% of calories from fat) didn't help improve FMD, despite their weight loss, improvement in glucose, insulin and cholesterol; but this was left unsaid.
I'm not surprised.
So, what we're left with is the stated null finding of those on the low-carb diet, with no real statement that neither dietary approach did much for FMD.
I hate to say it, but there was also a lack of curiosity as to why this was.
It's pretty much accepted dogma that a low-fat diet improves the cardiovascular system, thus would exert a postive - significant - effect on endothelial-dependent FMD. It didn't, yet the researchers didn't say "hey, wait, this low-fat diet didn't help either" and instead highlighted that the low-carb diet didn't improve FMD in their conclusions.
Some questions really do need to be asked.
First, how did the low-carb diet look compared with the habitual diet?
We know subjects were consuming, on average, 11.4mJ each day (2725-calories) as their habitual diet. The weight loss diet was 6000kJ each day (1430-calories). They followed the weight loss phase of the diet for six weeks and lost 5.8kg, or 12.75-pounds.
Let's do math!
Each day, we're to believe, the subjects were in a calorie deficit of 1295-calories. Six weeks is 42-days, so over the period, a calorie deficit of 54,390 calories - enough to theoretically lose 15.5-pounds. Hmmm....Okay, so it's pretty clear they did not really follow the diet as planned, since it's clear they consumed more calories than was reported. Happens all the time, no biggie.
Except, we have no idea what the excess calories were, so we have a confounding variable here. Did they eat pie? Did they eat broccoli? Did they eat fatty meat instead of lean meat? Did they skip the oatmeal and eat eggs? Who knows?
It's also noteworthy that the low-fat dieters ate a habitual diet of 10.8mJ daily (2581-calories) and were placed on the same weight loss calorie level. So they were in a calorie deficit of 1150-calories each day, or a six week deficit of 48,342-calories. This theoretically would result in a weight loss of 13.8-pounds; they lost 5.9kg (13-pounds). Did they cheat less? Did they stick to the diet more carefully? Who knows?
But, we can be sure we have a confounding variable here - something doesn't add up, and it looks like that something is calorie intake. It appears it was higher than the dietary protocol called for; and an increased calorie intake we have no idea what foods/macronutrients it came from.
So then, is there anything else? Let's see how macronutrient intake changed on the low-carb diet.
At baseline, their habitual diet - 2725-calories - was from 39.6% carbohydrate (270g), 19.6% protein (133.5g) and 36.5% fat (110.5g). We do not know the baseline intake for fatty acids, but do know the dietary protocol was strict - saturated fat 7%, PUFA 6% and MUFA 13% of calories.So, while following the weight loss diet, the macronutrient profile changed to provide 1430-calories each day, of which 33% were carbohydrate (118g), 40% protein (143g) and 27% fat (43g) with 7% from saturated fat (11.1g), 6% from polyunsaturated fat (9.5g) and 13% from monounsaturated fat (20.7g).
The first glaring disparity is the protein-to-fat intake, for every 1g of fat, they were expected to consume 3.3g of protein; this is a highly unusual pattern, heavy with protein and too lean - if you review other studies on "low-carb" diets, the fat intake is usually higher than the level in this protocol and protein typically lower; of note, this intake ratio is next to impossible without some funky planning. I'd like to know how much soy was a part of this diet? How much of the diet was comprised of non-fat dairy? How much fish was allowed, and what type was it? Were protein shakes or supplements part of the protocol? If so, which type of isolate dominated?
Without this specific data, it's difficult to say one way or another if the foods included may have contributed to the null finding or not.
So here, we have a potential confounding variable that is unexplored.
Anything else?
Well, from the data we do know, it seems we find an inadequate level of polyunsaturated fats - with just 9.5g each day; a level at which the subjects are unable to meet essential requirements for omega-6 or omega-3 fatty acids!
I am really starting to wonder why researchers designing diet protocols that are inadequate for known essential nutrients?
The Institute of Medicine (IOM) clearly states in the Daily Recommended Intake documentation, the MINIMUM required each day from omega-6 is 5% to 10% of calories and the MINIMUM requirement each day from omega-3 is 0.5% to 1% - when calories are adequate to maintain weight. In absolute terms - absolute gram minimums - the IOM states that adequate intake of omega-6 fatty acid is 14g-17g for men (depending on age) and 11g-12g for women (depending on age); and that adequate intake of omega-3 fatty acids is 1.6g for men and 1.1g for women.
Combined, the absolute minimum intake for essential fatty acids is between 15.6g-17.6g for men and 12.1g-13.1g for women.
In this study, even if every last gram of polyunsaturated fat was an omega-3 or omega-6, these subjects were deficient for essential fatty acids with only 9.5g of polyunsaturated fats as part of the diet.
So, again, confounding variable - huge confounding variable!
And the researchers question why the diet didn't have an effect on FMD?
Perhaps the researchers haven't read the data showing improvement in cardiovascular health when essential fatty acid intake is optimized to meet or exceed current recommendations?
Recent evidence of the role of omega-3 polyunsaturated fatty acids on blood pressure control and hypertension-related complications
Omega-3 Fatty Acids: Role in Cardiovascular Health and Disease
Fish Oil and Endothelial Function
I can't say it enough - I love good data, but studies like this, with macronutrient intakes, as percentage of calories, is highly confounded data. Designing a dietary approach to lose weight or maintain weight, macronutrient percentages are often inefficient and do not meet essential nutrient requirements.
I'd really like to see some researchers start designing studies to ensure adequate intake of essential nutrients within the calorie deficits - until we start to look at the nutrient-quality of weight loss diets, I'm afraid we're not going to make much progress to provide the public with sound, scientifically supported recommendations.
Tuesday, June 05, 2007
You Asked for It...
After receiving a number of emails yesterday and this morning, asking for some context to where we spent money on our food budget, here is the list:
- Beef - 200-pounds @ $3.40= $680
[two split-half orders; a split-half is half a cow divided by two families] - Pork tenderloin 15-pounds @ $5.50 - 20% = $66
- Slab Bacon (uncured) - 16-pounds @ $5.00 - 20% = $64
- Sausage (bulk) - 16-pounds @ $3.50 - 20% = $45
- Brats/Sausage (link) - 20-pounds @ $4.50 - 20% = $72
- Ham Steak - 12-pounds @ $4.25 - 20% = $41
- Spare ribs - 20-pounds @ $2.10 - 20% = $34
- Turkey (2 Heritage birds/year) = $120
- Chicken (26 birds/year) = $234
- Eggs - 78 Dozen @ $2.50 = $195
- Lamb - 20-pounds @ $4.00 - 20% = $64
- Wild Fish & Shellfish = $200
- Other meats (bison, venison, etc.) = $60
- Milk, Half & Half, Yogurt, Cheese = $980
- Butter = $185
- CSA (local, organic produce, April - Nov) = $600
- Farmer's Market & retail (mid-April - mid-Nov) = $100
- Retail Produce, including frozen (mid-Nov - mid-April) = $250
- Oils, Spices, Condiments, Nuts/Seeds/Nut Butters = $247
- Miscellaneous = $75
Total = $4,312; $82.92 each week; $27.64 per person each week.
Had this been any other point in time, compiling the list might have been impossible; last year when we moved here, I started to keep track since our food purchasing habits changed as we joined a CSA and started ordering meat, poultry, eggs and such directly from local ranchers. While we lived in northern VA, I was easily spending $150 a week, but wouldn't be able to break down where the money went by food type. Sorry, I'm just not that obsessive!
Here, living in mid-Missouri, tracking my spending by food type is rote, it's how I order much of what we consume, so understanding where I spend on food is much easier here than in Virginia.
Something that I do need to note: what this does not include: our meals in restaurants or take-out eaten at home (we average once a week, one meal out/take-in); and meals while on vacation or attending conferences.
This, I think, is important to point out because, if this is considered into the above figure, our total cost for food is truly higher, almost double, since we average $25 a week for meals prepared outside our home, and budget $75-100 a day when traveling for meals (with an average 28-days a year on vacation and attending conferences).
If I include that $1300 for meals out/take-in [25 * 52] and $2100 for meals while traveling [28 * 75], we're looking at $7,712 for food each year; $642.66 per month; $148.30 each week; $49.43 per person each week. And, no, I really don't want to do the math to see how much I really spent while we lived in VA - it's too frightening to think about since I know it's significantly more than we're spending here in mid-MO.
So how to reconcile the budget if I did prepare each meal, at home or while traveling, from purchases throughout the year - that is no meals from restaurants or take out, and no need for vacation/conference eating out since all meals are from what we purchase; a more realistic budget of $4920 is needed to maintain our almost exclusive organic/pastured dietary habits throughout the year here in mid-MO.
I arrived at this figure by taking a year - 365-days - and subtracting our current average of 28-days traveling to arrive at 337-days; then took 52-days, divided it by 3 (meals each day) to arrive at 17-days; then subtracted that from 337 to arrive at 320 days - the days of meals provided in my budget above. I then divided the budget [$4312] by 320-days = $13.48 per day for meals we eat from the above budget. I then multiplied that sum by 365-days (in a year) to arrive at what we'd need to spend if we consumed all meals prepared by ourselves without any from restaurants.
So if $4,920 is truly more representative of what it would take to eat all meals, then we're looking at $94.61 each week, or $31.54 per person...to eat an almost exclusively organic/pastured diet; here in mid-MO.
Now granted, the way I do save considerable money requires first, a good, big upright freezer; next bulk purchase of meats/poultry/game (30-100+ pounds at a time) and then enough money on-hand to purchase major quantity when something expensive is on sale (like butter or oils - for example, right now I have close to 25-pounds of butter in the freezer).
Add to this, a membership in a CSA, while over time saving money, requires an up-front payment for the season (or you pay more if you pay with the payment plan; and out here there is no weekly or monthly payment plan - when you use the payment plan of three payments, it increases the total cost for the season by $50).
So, each of my "large sum required" ways to save a lot of money in the long-term makes it next to impossible for someone who is receiving assistance to do the same thing. I think this is one flaw in the current system that can and should be addressed - to me it makes sense to make funds available to allow recipients to utilize local sources, like a CSA or Farmer's Market or rancher, if it's saving more to do so than force the purchase at retail prices each month.
I don't think any of the CSA's in this area are equiped to accept EBT payments; even if they were, the up-front cost for membership would be prohibitive since those receiving assistance cannot "borrow" from future assistance to pay for an on-going source of fresh produce. So while a CSA membership costs about $18.75 each week (32-weeks) for a family of four, and would be a very cost effective way to ensure weekly fresh, local produce to recipients, it's not possible with how the system is structured today.
The Farmer's Markets in and around our area aren't equipped to accept EBT payments either; so while local produce (both conventional and organic) is available in the Farmer's Markets, often at significantly less than retail prices, it too remains a resource that cannot be utilized by those receiving assistance. (Some Farmer's Markets across the country are equipped for EBT payment)
Forget about trying to purchase meat or poultry in a large enough quantity to have a discount extended for bulk purchase; and totally forget about the significant savings when someone is able to buy a split-quarter or half, which makes meats and poultry cheap, cheap, cheap when compared to retail. Again, it's too much money up-front for someone receiving assistance to manage, even though long-term it saves significant sums of money.
Those receiving assistance, even when they have the room for one, cannot use their budget to purchase a freezer - which would enable them to purchase larger quantity at a lower price! The way money is currently made available also makes it next to impossible to stock-up on non-perishable foods (like canned vegetables & fruits, canned tuna/fish, peanut butter, etc.) when sales are favorable to a large quantity purchase, that over time saves money.
Anyway, for those of you who wanted to know how I manage to spend what we do each month on a mostly organic/pastured diet, there you have it.
Monday, June 04, 2007
Final Thoughts on the Food Stamp Challenge
With the weekend to gather my thoughts about our experience last week doing the Food Stamp Challenge, I'm left with more questions than answers, and no solutions that seem realistic to improve the situation where millions are struggling to feed themselves on what seems like a paltry sum - an average $3.00 a day per person.
As I learned, it is possible to feed a family within the budget a varied, nutrient-dense diet and even have food left at the end of the week. When I started to put together a menu and shopping list from the area stores' sale circulars, I thought it was going to be next to impossible to get everything we'd need for the week - I was surprised with the ease with which I did put together a menu, list of things on sale and the rest needed as 'fill-in-the-gap' items not advertised, and was able to buy everything for the week without much fuss. We even had food left at the end of the week - enough to more than start the next week and ease the stress of staying within the budget.
As some have noted in comments and email - I'm at a distinct advantage, I know which foods are nutrient dense and how to plan a menu, so it's not realistic, let alone reasonable, to expect someone without my specific background to be able to replicate my success in meeting the challenge. Some even emailed me links to show how pitiful some did when they tried to do the challenge.
I hate to say it, but posturing politicians aren't a great example of failure to succeed in the challenge. Their success is likely tied to their position on the issue - those who are in favor of increasing the assistance more likely to fail miserably than one interested in maintaining the status quo or reducing the budget. What I found when I poked around the blogosphere is that those without a vested interest either way, like me, were able to stay within the budget constraints during the week and seemed to do well with a little planning. Those who are strongly in favor of increasing the money provided did poorly. Coincidence? Who knows; but had congressman Ryan been trying to live on the DC budget - $31.30 average - and really planned better, he could have fared better than he did. But, that wouldn't have made headlines and would have been counter-productive to increasing the budget to provide more money to families needing assistance.
That's not to say that the assistance currently provided is great; it's not. It definitely does not allow a family (or individual) to buy whatever, whenever they'd like. Heck, without some planning you won't get through the month - plain and simple.
Even with planning you still won't have lots of goodies or all the convenience more money does provide one with.
While I was able to stay within budget, there were no ready-to-eat snacks, beverages (other than calcium enriched V-8), or packaged, quick to grab-and-go foods.
The budget forced planning, creativity and cooking each day - something no amount of money will inspire someone to do unless they see the value of their time as fundamental in managing on their budget.
While it's infinitely easier to grab a bag of pre-cut and washed lettuce than to wash and chop it yourself, the convenience comes at a steep premium - an average bag of lettuce (romaine) weighs 8-ounces and is often on sale for 2-for-$5.00....reality check - that's $5.00 per pound; head lettuce (romaine) goes for anywhere from $0.99 a head to $2.49 a head. Last week I weighed the two heads I purchased - one was about 1.75-pounds, the other 1.25 (green and red leaf respectively), so I had 3-pounds of lettuce that cost me $1.39 a head (total $2.78, or 0.92/pound).
If I purchased the amount of lettuce we ate throughout the week, already washed and chopped for me, I would have needed 6-bags to have 3-pounds of lettuce - at 2/$5 that's $15 - or, put another way, 47.6% of the budget for the week for a family of three.
Doing the washing and chopping myself left $12.22 in the budget for other foods.
So, I'm left wondering, if $21 per person each week isn't enough, how much is? Is it $25? $30? 40? More...? How much is enough?
When I poked around various state websites, detailing program funding in different locations, it's clear where you live matters in how much is provided. For example, here in Missouri and in neighboring Kansas, the average assistance is about $21 per person per week; but in areas that have higher cost-of-living, the amount can be as high as $38.75 per person each week.
What I did find shocking was that, according to Harvesters website, "Harvesters clients who receive Food Stamp benefits indicate that their monthly allotment lasts just 2 ½ weeks."
So, if my math is correct, a family of four - who receives an average of $21 per person per week - receives an average of $364 a month for a family of four.
[The math here = 21 * 4 = 84 * 52 = 4368/12 months = 364]
Based on the Harvesters finding that this amount provided for only 2.5 weeks in a month - are we to believe a family of four needs an average assistance with $582.40 a month instead of the current $364 each month?
[The math here = $336/2.5 = $134.40 per week when it's all spent in just 2.5 weeks; 134.40 * 52-weeks = $6988.80 per year/12 months = $582.40/month]
Do those needing assistance need 60% more each month to feed their families?
I don't know about you, but even we don't spend that much on average over the year, and I'm not exactly what you'd call thrifty when it comes to grocery shopping. In fact, I've heard many, many times from my much-more-cost-aware husband that I'm spending way too much on groceries!
So, I sat and calculated out our food costs, based on actual buying through the year, and between May 2006 and May 2007 we spent $4300 on food, including almost exclusive purchase of grass-fed pastured beef, chickens, turkey, pork, lamb and eggs; dairy from milk of pastured animals (including goat milk products); milk, fresh produce, oils, butter, and miscellaneous purchases at various grocery stores and produce when the CSA and Farmer's Market isn't providing fresh local vegetables and fruits.
That's an average of $82.69 a week for the three of us - $27.56 each per week - $3.93 per day per person. And we eat almost everything organic and grass-fed/pastured - and for less per person per week than the person needing additional help through Harvesters each month! [update 6/5: math error: annual, weekly and individual food budget updated to reflect correction]
Why are we not asking how we can help folks learn to budget better? When the same folks are coming through for additional help each month, maybe it's worth our time and effort to sit and listen, help them learn where they can make changes to their current buying practices to stay within their budget next month? It's easy to call the problem "not enough money" and just give them more money - but seriously, after doing it for a week, I'm not surprised we managed well - what I spent isn't that much less than I normally do on a weekly average!
So, I'm not convinced more money given to those who do need help is going to change much for them, or be the panacea that fixes the very real problems inherent in the existing system.
More money won't solve transportation problems.
More money won't relieve predatory pricing - it may even provide incentive to not only continue predatory pricing, but increase prices to eat up the additional dollars provided just as quickly.
More money won't buy access that isn't already there for fresh fruits and vegetables.
More money won't solve poor dietary habits.
More money won't solve time management issues.
More money won't incline people to cook more from scratch.
And, I hate to say it like this, but more money won't make people better planners - if someone today isn't thinking far enough ahead to budget for meals for a month, more money isn't going to change short-sightedness and failure to plan ahead when it's not in practice now.
After years as an IT professional, I can say with certainty, the saying "throwing more money at system problems makes them worse" is true.
I hate the idea that people are hungry and malnourished in the United States.
We can do better. We need to do better.
But I'm left without any good solutions....
All I have after a week of staying within the budget is questions - lots of questions...
As I learned, it is possible to feed a family within the budget a varied, nutrient-dense diet and even have food left at the end of the week. When I started to put together a menu and shopping list from the area stores' sale circulars, I thought it was going to be next to impossible to get everything we'd need for the week - I was surprised with the ease with which I did put together a menu, list of things on sale and the rest needed as 'fill-in-the-gap' items not advertised, and was able to buy everything for the week without much fuss. We even had food left at the end of the week - enough to more than start the next week and ease the stress of staying within the budget.
As some have noted in comments and email - I'm at a distinct advantage, I know which foods are nutrient dense and how to plan a menu, so it's not realistic, let alone reasonable, to expect someone without my specific background to be able to replicate my success in meeting the challenge. Some even emailed me links to show how pitiful some did when they tried to do the challenge.
I hate to say it, but posturing politicians aren't a great example of failure to succeed in the challenge. Their success is likely tied to their position on the issue - those who are in favor of increasing the assistance more likely to fail miserably than one interested in maintaining the status quo or reducing the budget. What I found when I poked around the blogosphere is that those without a vested interest either way, like me, were able to stay within the budget constraints during the week and seemed to do well with a little planning. Those who are strongly in favor of increasing the money provided did poorly. Coincidence? Who knows; but had congressman Ryan been trying to live on the DC budget - $31.30 average - and really planned better, he could have fared better than he did. But, that wouldn't have made headlines and would have been counter-productive to increasing the budget to provide more money to families needing assistance.
That's not to say that the assistance currently provided is great; it's not. It definitely does not allow a family (or individual) to buy whatever, whenever they'd like. Heck, without some planning you won't get through the month - plain and simple.
Even with planning you still won't have lots of goodies or all the convenience more money does provide one with.
While I was able to stay within budget, there were no ready-to-eat snacks, beverages (other than calcium enriched V-8), or packaged, quick to grab-and-go foods.
The budget forced planning, creativity and cooking each day - something no amount of money will inspire someone to do unless they see the value of their time as fundamental in managing on their budget.
While it's infinitely easier to grab a bag of pre-cut and washed lettuce than to wash and chop it yourself, the convenience comes at a steep premium - an average bag of lettuce (romaine) weighs 8-ounces and is often on sale for 2-for-$5.00....reality check - that's $5.00 per pound; head lettuce (romaine) goes for anywhere from $0.99 a head to $2.49 a head. Last week I weighed the two heads I purchased - one was about 1.75-pounds, the other 1.25 (green and red leaf respectively), so I had 3-pounds of lettuce that cost me $1.39 a head (total $2.78, or 0.92/pound).
If I purchased the amount of lettuce we ate throughout the week, already washed and chopped for me, I would have needed 6-bags to have 3-pounds of lettuce - at 2/$5 that's $15 - or, put another way, 47.6% of the budget for the week for a family of three.
Doing the washing and chopping myself left $12.22 in the budget for other foods.
So, I'm left wondering, if $21 per person each week isn't enough, how much is? Is it $25? $30? 40? More...? How much is enough?
When I poked around various state websites, detailing program funding in different locations, it's clear where you live matters in how much is provided. For example, here in Missouri and in neighboring Kansas, the average assistance is about $21 per person per week; but in areas that have higher cost-of-living, the amount can be as high as $38.75 per person each week.
What I did find shocking was that, according to Harvesters website, "Harvesters clients who receive Food Stamp benefits indicate that their monthly allotment lasts just 2 ½ weeks."
So, if my math is correct, a family of four - who receives an average of $21 per person per week - receives an average of $364 a month for a family of four.
[The math here = 21 * 4 = 84 * 52 = 4368/12 months = 364]
Based on the Harvesters finding that this amount provided for only 2.5 weeks in a month - are we to believe a family of four needs an average assistance with $582.40 a month instead of the current $364 each month?
[The math here = $336/2.5 = $134.40 per week when it's all spent in just 2.5 weeks; 134.40 * 52-weeks = $6988.80 per year/12 months = $582.40/month]
Do those needing assistance need 60% more each month to feed their families?
I don't know about you, but even we don't spend that much on average over the year, and I'm not exactly what you'd call thrifty when it comes to grocery shopping. In fact, I've heard many, many times from my much-more-cost-aware husband that I'm spending way too much on groceries!
So, I sat and calculated out our food costs, based on actual buying through the year, and between May 2006 and May 2007 we spent $4300 on food, including almost exclusive purchase of grass-fed pastured beef, chickens, turkey, pork, lamb and eggs; dairy from milk of pastured animals (including goat milk products); milk, fresh produce, oils, butter, and miscellaneous purchases at various grocery stores and produce when the CSA and Farmer's Market isn't providing fresh local vegetables and fruits.
That's an average of $82.69 a week for the three of us - $27.56 each per week - $3.93 per day per person. And we eat almost everything organic and grass-fed/pastured - and for less per person per week than the person needing additional help through Harvesters each month! [update 6/5: math error: annual, weekly and individual food budget updated to reflect correction]
Why are we not asking how we can help folks learn to budget better? When the same folks are coming through for additional help each month, maybe it's worth our time and effort to sit and listen, help them learn where they can make changes to their current buying practices to stay within their budget next month? It's easy to call the problem "not enough money" and just give them more money - but seriously, after doing it for a week, I'm not surprised we managed well - what I spent isn't that much less than I normally do on a weekly average!
So, I'm not convinced more money given to those who do need help is going to change much for them, or be the panacea that fixes the very real problems inherent in the existing system.
More money won't solve transportation problems.
More money won't relieve predatory pricing - it may even provide incentive to not only continue predatory pricing, but increase prices to eat up the additional dollars provided just as quickly.
More money won't buy access that isn't already there for fresh fruits and vegetables.
More money won't solve poor dietary habits.
More money won't solve time management issues.
More money won't incline people to cook more from scratch.
And, I hate to say it like this, but more money won't make people better planners - if someone today isn't thinking far enough ahead to budget for meals for a month, more money isn't going to change short-sightedness and failure to plan ahead when it's not in practice now.
After years as an IT professional, I can say with certainty, the saying "throwing more money at system problems makes them worse" is true.
I hate the idea that people are hungry and malnourished in the United States.
We can do better. We need to do better.
But I'm left without any good solutions....
All I have after a week of staying within the budget is questions - lots of questions...
Friday, June 01, 2007
Hunger in America, Are You Up to the Challenge?
Hunger Awareness Week begins tomorrow, June 2-10, and my home state, Missouri, and neighbor Kansas, through the organization Harvesters, are encouraging citizens to take the Food Stamp Challenge for a week.
The challenge includes a budget $38.75 per person each week - guidelines are available online to determine your food budget if you participate, and are based on the maximum benefits available across the nation.
The guidelines note that in Missouri and Kansas the average is approximately $20/week per person; so the budget I worked with last week is closer to the reality here than the higher budget allowed in the challenge they're hosting.
But, that's OK - I think it's a good experience for anyone interested in working within a budget to feed your family, especially when that budget is less than you'd normally spend each week. What I'm not convinced of is that more money each week/month is the solution - but that I'll get to in a later post.
The challenge includes a budget $38.75 per person each week - guidelines are available online to determine your food budget if you participate, and are based on the maximum benefits available across the nation.
The guidelines note that in Missouri and Kansas the average is approximately $20/week per person; so the budget I worked with last week is closer to the reality here than the higher budget allowed in the challenge they're hosting.
But, that's OK - I think it's a good experience for anyone interested in working within a budget to feed your family, especially when that budget is less than you'd normally spend each week. What I'm not convinced of is that more money each week/month is the solution - but that I'll get to in a later post.
The Week in Review
First, a correction - when starting the week and shopping, I didn't know that those receiving assistance do not pay tax on food purchases. So my going over budget wasn't actually $4.93 as I originally thought, but was $1.99 - that I'm now sure was due mostly to my purchase of spices and condiments it's been argued elsewhere most would have some of on hand, since it's rare someone is starting with absolutely nothing in the pantry.
So, then, the next question is, after a week, do we have anything left to start off next week and not start again from scratch? Let's take a look:
So, then, the next question is, after a week, do we have anything left to start off next week and not start again from scratch? Let's take a look:
- 1/2 jar sweet relish
- 3 cans Van Camp Pork & Beans
- Baby spinach (enough for one small dinner salad)
- 1 can chunk light tuna
- Mustard (almost full)
- Mayonnaise (about half full)
- Ketchup (almost full)
- Spices (all ginger, some garlic, pepper, sesame seeds)
- Salt (box almost full)
- 5 carrots (from 2-pound bag)
- 2 celery stalks (from one bunch)
- 1/2 bag sunflower seed kernels (from 1-pound bag)
- Mixed together, a handful of walnuts and almonds
- 1 can black olives
- Tea bags (about half the box remains)
- 1 can red kidney beans
- 1-pound ground beef
- 12-oz package frozen sole
- 1/2 bag frozen cut green beans
- V-8 juice - about 1-cup remains in bottle
- Salad, about enough for two small side salads
- Unopened 1-lb package chicken/pork franks
Bigger question - did the food eaten during the week meet nutrient requirements?
You can see from the FitDay tracking, that with the exception of Vitamin D, I met all nutrient requirement RDA's. This time of the year, for most Americans getting out into the sunshine sans sunscreen, vitamin D isn't an issue - we make it in our skin from exposure to ultraviolet rays from the sun.
I did lose three pounds during the week, yet wasn't hungry!
In reviewing my macronutrient intake I found my calories were lower than usual - I ate an average of 2,330-calories each day, when I need about 2,600 a day to maintain my weight.
The calorie deficit of 270-calories each day explains about a half-pound of the weight loss (1890-calories over seven days) and I'd speculate the remaining 2.5-pounds was the dual effect of water loss and a higher than usual intake of protein, with the protein boosting the thermic effect of food consumed. Whatever the reason, three pounds? I'll take it!
Carbohydrate intake each day averaged 97g carbohydrate, with 24g fiber, so 73g net carbohydrate; and my protein was higher than usual, averaging 142g protein each day. I usually eat about 100-125g of protein each day, so the higher protein intake is also likely to be a contributor to my satiety with less calories.
Low-Carb Increases CRP?
Last month the Journal of the American College of Nutrition published a study, Low Carbohydrate, High Fat Diet Increases C-Reactive Protein during Weight Loss, that I'd set aside to write about when time permits.
I'm also a strong believer in not re-inventing the wheel, so when someone else writes a good analysis, I'm inclined to point you in that direction rather than repeat what's been already said.
Cassandra Forsythe is a PhD Fellow at the University of Connecticut, Storrs, and works with Dr. Jeff Volek; her studies include exercise and nutrition.
Her blog is Female Fitness and Nutrition Scientist, and yesterday she posted her analysis of the study and its findings.
I'm also a strong believer in not re-inventing the wheel, so when someone else writes a good analysis, I'm inclined to point you in that direction rather than repeat what's been already said.
Cassandra Forsythe is a PhD Fellow at the University of Connecticut, Storrs, and works with Dr. Jeff Volek; her studies include exercise and nutrition.
Her blog is Female Fitness and Nutrition Scientist, and yesterday she posted her analysis of the study and its findings.
Into the Home Stretch
Well, we're into the home stretch - vegetable omelets for breakfast with bacon; tuna salad (celery, onion, mayo) on a bed of lettuce, cucumber, shredded carrots, walnuts and dressing; with dinner to end our day - a dinner salad (baby spinach, romaine, shredded carrots, cucumber, tomato, dressing) and chicken chili, topped with a dallop of sour cream and shredded cheddar cheese. And yes, in the picture, my son's hand is reaching for his additional item on the side - some cantaloupe.
My use of chicken for chili started a few years ago, when a dinner out included a cup of chicken chili - a medley of vegetables, spices, beans and chicken - unlike any chili I'd had before...it was insanely delicious!
I don't have any particular set recipe to make it - it's just basics that I start with and is a great way to use up leftover vegetables that sometimes collect in the refrigerator throughout the week.
You know what I'm talking about - the two tablespoons of spinach, the half-cup of broccoli, the scant onions and peppers, etc. - the veggies you won't bring yourself to toss while clearing the table from dinner (and shouldn't), but the amount isn't really enough for a side at another meal.
I use these leftover vegetables often, in omelets, but even that doesn't always get them eaten fast enough. So, chicken chili (or other "stew-like" dish) is a great place to add them and boost nutritional value of a meal without much fuss.
When I make dishes like this, I usually start with more fresh ingredients, but since I was working with what was on hand for the week, here is what I wound up doing to make the meal.
The small 3-pound chicken went into a pot of water to cook slowly. This provided not only the meat for our chili, but also provided a rich stock for future use.
When the chicken was done, I simply removed it from the water and let it cool while I started another pot (the stock was also set aside and cooling).
The burner was on medium heat and into the pot went a can of diced tomatoes, a jar of picante sauce, 1/2 packet of taco seasoning, 1/2 onion chopped chunky, 1 carrot diced really tiny, the green pepper tops I'd saved from when I made the stuffed peppers - chopped medium/chunky, 1-cup V-8, the leftover zucchini, tomatoes and onions from the night before, and 2-cups frozen green beans.
After stirring that all together to simmer and cook, I took all the meat off the chicken and diced it up. After I waited about 15-minutes for the vegetable mix to simmer and cook, I added about 2/3 of the chicken meat to the mix, along with one can of drained, well-rinsed red kidney beans and left it to simmer and cook.
When it was ready, it was served with grated cheddar cheese and sour cream for topping.
What's great about this recipe is that it's not dependent on any particular vegetables, other than the tomato base - whatever vegetables are on hand are used and you can let your imagination go - it's all good!
Today's breakfast is eggs and bacon with a side of strawberries (the last we have for all of these foods), and lunch is going to be leftover chicken chili.
So that wraps up the week, and we do have food left. I'll follow-up with some thoughts later.
My use of chicken for chili started a few years ago, when a dinner out included a cup of chicken chili - a medley of vegetables, spices, beans and chicken - unlike any chili I'd had before...it was insanely delicious!
I don't have any particular set recipe to make it - it's just basics that I start with and is a great way to use up leftover vegetables that sometimes collect in the refrigerator throughout the week.
You know what I'm talking about - the two tablespoons of spinach, the half-cup of broccoli, the scant onions and peppers, etc. - the veggies you won't bring yourself to toss while clearing the table from dinner (and shouldn't), but the amount isn't really enough for a side at another meal.
I use these leftover vegetables often, in omelets, but even that doesn't always get them eaten fast enough. So, chicken chili (or other "stew-like" dish) is a great place to add them and boost nutritional value of a meal without much fuss.
When I make dishes like this, I usually start with more fresh ingredients, but since I was working with what was on hand for the week, here is what I wound up doing to make the meal.
The small 3-pound chicken went into a pot of water to cook slowly. This provided not only the meat for our chili, but also provided a rich stock for future use.
When the chicken was done, I simply removed it from the water and let it cool while I started another pot (the stock was also set aside and cooling).
The burner was on medium heat and into the pot went a can of diced tomatoes, a jar of picante sauce, 1/2 packet of taco seasoning, 1/2 onion chopped chunky, 1 carrot diced really tiny, the green pepper tops I'd saved from when I made the stuffed peppers - chopped medium/chunky, 1-cup V-8, the leftover zucchini, tomatoes and onions from the night before, and 2-cups frozen green beans.
After stirring that all together to simmer and cook, I took all the meat off the chicken and diced it up. After I waited about 15-minutes for the vegetable mix to simmer and cook, I added about 2/3 of the chicken meat to the mix, along with one can of drained, well-rinsed red kidney beans and left it to simmer and cook.
When it was ready, it was served with grated cheddar cheese and sour cream for topping.
What's great about this recipe is that it's not dependent on any particular vegetables, other than the tomato base - whatever vegetables are on hand are used and you can let your imagination go - it's all good!
Today's breakfast is eggs and bacon with a side of strawberries (the last we have for all of these foods), and lunch is going to be leftover chicken chili.
So that wraps up the week, and we do have food left. I'll follow-up with some thoughts later.
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