A Question of Government Surveillance

In September, the New York City Board of Health may vote on a proposal to require city labs to report results of A1c blood tests to track blood sugar control of diabetics. As CNN reported, this type of surveillance by the governement is raising a number of questions.

A century after New York became the first American city to track people with infectious diseases as a way to halt epidemics, officials here propose a similar system to monitor people with diabetes, a non-contagious foe.

"There will be some people who will say, 'What business of the government is it to know that my diabetes is not in control?"' said Dr. Thomas R. Frieden, the city's health commissioner.
The answer, he said, is that diabetes costs an estimated $5 billion a year to treat in New York and was the fourth leading cause of death in the city in 2003, killing 1,891.

The proposed system requires no consent from the patient, which begs the question, does the government have the right to your medical records without your consent?

There are those who argue, as Dr. Frieden does above, that in the interest of containing costs the government must intervene. Also included in the arguements for surveillance that are supported by the American Diabetes Association:

• it would allow doctors better access to medical information especially among patients who frequently switch doctors
• it would allow the city Department of Health or individual physicians to follow up with patients who miss appointments
• it would save the city millions by preventing complications of the disease

Over time, doctors could receive letters, telling them whether their patients have been getting adequate care. People who skip checkups might get a note from their doctors, reminding them of the dangers of untreated diabetes.

First of all, I highly doubt doctors are going to appreciate letters in the mail suggesting their patients are not receiving adequate care. What exactly is going to happen to a doctor who has too many patients who are not controlling their blood sugars well enough? Will the city revoke their license? Will they be criminally negligent?

Before this type of plan can be even considered, one must know the consequences of non-compliance of a patient for the doctor treating them. Let's not forget that doctors cannot make a patient follow a treatment plan. Ethically they are bound to communiate to the patient the effects of the disease, the treatment available and do their best to motivate the patient to move forward with treatment to control the disease. They cannot, however, make a patient follow a treatment plan. And, taking that to the next step, a letter to the lax patient? Does the city think that doctors are not already aggressively communicating the importance of blood sugar control to diabetics? Do they really think pestering a diabetic to control their blood sugars is going to be effective?

What is to become of the lax patient who simply will not do what it takes to get their blood sugars under control? What exactly does the city have in mind for them? Does the city recognize the potential for such a plan to be counter-productive in that doctors may simply decide the risk to their practice is not worth accepting new diabetic patients in the future? What then?

Do patients have the right to refuse treatment, not comply with treatment plans and/or simply ignore their doctors' advice?

Dr. Amy Fairchild, an expert on public health ethics at Columbia University, said disease monitoring programs have historically been able to overcome privacy worries if the health threat is sufficiently frightening.

"We respond with surveillance when we believe something has reached epidemic proportions," Fairchild said. "And this may fit the profile. Have we become a nation of obese people who are all going to get diabetes?"

The program's success, she said, may depend partly on how patients respond. "It's not necessarily that someone has that information. It's that they're pestering you. 'The next thing I know, you'll be telling me what I can and can't eat,"' she said.

Which brings me to my last concern about such a government surveillance program - what's next?

Will the government decide to monitor what we eat? How much we weigh? What our cholesterol is? How often we engage in active exercise?

Splenda Ads Deceptive - New Zealand Advertising Standards Authority

The New Zealand Advertising Standards Authority (ASA) has upheld a complaint against Johnson & Johnson for misleading marketing practices in advertisements for the chlorinated artificial sweetener Splenda. "This complaint is on the basis that Splenda is being compared directly to sugar and misleading and confusing consumers into thinking it's as natural as sugar because it's 'made from sugar and tastes like sugar,'" according to the upheld complaint.

The Authority's Advertising Standards Complaints Board, made up of representatives from New Zealand's advertising and marketing agencies, reviewed 15 second and 30 second versions of an ad for the artificial sweetener along with focus group input. The Board determined that the ad deceived consumers into thinking Splenda is all natural like sugar, when it is actually a chemical compound. "The (Splenda) advertisement...gave rise to a likelihood of a consumer being confused and mislead as a result of the comparison in the advertisement," the Board decided. According to the ASA, when the Board upholds a complaint, they ask the company not to run the ad again. Read more...

Fat Man Walking

I came across an interesting story yesterday. It seems a 39-year-old man, Steve Vaught, is unhappy about his weight and has decided to take measures into his own hands to lose the weight. His solution is rather novel - he's walking across the United States!

He writes on his site, The Fat Man Walking, that I am going to walk across the United states from San Diego to NYC to lose weight and regain my life!

I hope to remind people like me, that we each have the strength and ability to do anything we want. Losing weight is a choice the same as continuing to exist in this terrible condition is a choice. I have decided to live! It really is a simple decision when you think about it.

His wife is keeping his website updated as he makes his way across the country with a map detailing his route, pictures from his travels and information about how his journey is progressing. He started his walk on April 10th from Oceanside and as of today is almost to Winslow, Arizona.

Food for Thought

In this month's Journal of the American Medical Association [JAMA] researchers from Tuft's University question the use of supplements for vitamins, minerals and nutrients, Essential Nutrients: Food or Supplements?

The consumption of adequate levels and proper balance of essential nutrients is critical for maintaining health. The identification, isolation, and purification of nutrients in the early 20th century raised the possibility that optimal health outcomes could be realized through nutrient supplementation. Recent attempts using this approach for cardiovascular disease and lung cancer have been disappointing, as demonstrated with vitamin E and beta carotene. Moreover, previously unrecognized risks caused by nutrient toxicity and nutrient interactions have surfaced during intervention studies. The most promising data in the area of nutrition and positive health outcomes relate to dietary patterns, not nutrient supplements. These data suggest that other factors in food or the relative presence of some foods and the absence of other foods are more important than the level of individual nutrients consumed. Finally, unknown are the implications on public health behavior of shifting the emphasis away from food toward nutrient supplements. Notwithstanding the justification for targeting recommendations for nutrient supplements to certain segments of the population (eg, the elderly), there are insufficient data to justify an alteration in public health policy from one that emphasizes food and diet to one that emphasizes nutrient supplements.

Bravo!

While we have a good understanding of the various essential vitamins, minerals and elements required for optimal health, we still do not fully understand how various co-factors in food work in concert with each other. Based on this most recent data, other factors in food are more important than the level of individual nutrients consumed. Almost all of the science on various nutrients is in "isolation" - that is, investigating a particular nutrient by itself or with a limited spectrum of other nutrients.

It is only in the last 100-or-so years we've had the technology to isolate vitmains, minerals and elements and actually create supplements. Prior to this "advancement" eating a nutrient-dense diet was the key to optimal health. Even with our technological advancement, this remains true today also - you are better off eating a nutrient-dense diet than relying on supplements to meet your nutrient requirements.

Eating a nutrient-dense diet, however, means making some radical changes to your diet if you're currently eating the standard American diet which is calorie-dense and nutritionally bankrupt - supplements will do little to improve your health if you are consuming a poor diet.

A nutrient-dense diet starts with real, whole foods that includes natural fats and oils, high quality proteins and a selection of vegetables, fruits, legumes, nuts, seeds and perhaps some whole grains.

Enough - Enough - Enough Already!

Hey, I'm guilty of it - each day I write about how I think we should eat for maintaining weight and good health. But, it seems, Americans are not only fed up with the constant barrage of "healthy eating" messages, but we're also totally confused! Well, some of us are...

Porter Novelli just released the findings from a recent survey of Americans they conducted. The results of their survey were presented at the IFT Annual Meeting [Institute of Food Technologists] and found:

• 20% of Americans are totally confused about how they should eat
• 25% are tired of others telling them what to eat
• 80% believe that within the next 5-years the dietary advice will change radically

Wow!

I can understand the confusion and frustration though - as the "experts" bicker about the various dietary approaches available that are supported by evidence, 2 out 3 Americans remain overweight or obese and the conflict within the medical and scientific communities over which approach is best is based on a "one-size-fits-all" (doomed to fail) mentality.

Don't think for a moment that the stakes in the debate aren't high - they are skyhigh - whole careers and industry product lines have been built on a single belief - that dietary fat is the cause of our weight and health problems. To abandon such a belief is to abandon everything you think you know and believe.

Let me tell you a story. A true story.

Back in 1969 there was a doctor. A Dr. Kilmer McCully. While researching the cause of pre-puberty deaths in children with atherosclerosis, he discovered the damaging potential of homocysteine. He found a genetic defect that allowed extremely high levels of homocysteine to accumulate in their blood which seemed to cause massive plaque build up. He published his findings and, believe it or not, promptly lost his job. He'd found himself on the wrong side of the "conventional wisdom" about the role of cholesterol in heart disease.

Mind you, he wasn’t saying that homocysteine was the only cause of heart disease. He was saying, and continued saying for 30 years, that cholesterol by itself is not the only cause of heart problems. His findings were again published in JAMA in 1998 - after three decades of toiling away in ignored obscurity due to an irrational resistance to his findings.

As with many breakthroughs, Dr. McCully’s data was first ignored, then ridiculed, then persecuted, and finally accepted as the establishment’s own. Yes, today the experts do accept the role that homocysteine plays in the development of heart disease.

Some real food for thought in this story - think of the amount of evidence that has been potentially smothered over the years by this "status quo" approach that is part daily life in the scientific community. More to the point, think of the people who died needlessly from heart disease simply because physicians did not have the latest information on homocysteine and other risk factors.

Now think about the debate over dietary recommendations and our obesity epidemic. Do you believe the overwhelming weight of the evidence suggests that dietary fat is the cause of our woes? Or, would you prefer the truth?

While the American public is left confused, frustrated and at their wits end over the whole issue, the experts cling to the belief that it's the dietary fat that is the root cause of our problems. Oh, and of course, it's also too many calories and not enough exercise...but at the end of the day, it's still the fat in our diet.

If only the truth was so simple.

Today there is so much evidence that suggests our blind acceptance that it's the dietary fat is wrong. Yet, the discussion about fat isn't a discussion, it's a debate, fueled by an irrational need to maintain the "status quo." As this debate continues at a fever-pitch, the real problems of our dietary habits are ignored.

The truth is we've thrown the baby out with the bath water in this obsession with dietary fat intake. We've missed the point - eating a diet that is rich with nutrients and provides for good health in the long-term is the key.

I'm afraid, things aren't going to get better any time soon. Until enough researchers and doctors and other healthcare professionals stand up and say "enough is enough" and step back from the "conventional wisdom" to ask the hard questions, little is going to change.

That doesn't mean you can't do something about it now!

For me that has meant discarding everything I once thought was true about nutrition - educating myself about essential nutrients and which foods provide the most "bang for the buck" and making nutrient-density the priority.

I don't count calories, fats, carbohydrates or anything else - what counts is how nutrient-dense my days are. I eat real, whole foods with little added-sugar. I shop for and prepare meals that are nutrient-dense and look not for convenience today, but value the convenience of good health in the long-term. And, I keep up with the science.

You can too! There is no reason to be confused or frustrated by the idea of good eating habits - it comes down to common sense, and that I am confident my readers have plenty of. Take the time to read, educate yourself and understand how real, whole foods are the cornerstone of health - once you do that, it's much easier to tune out the debate and enjoy your life and your food!

No Power to Feast

It's hurricane season again and that means preparations for those who live along the eastern seaboard and gulf states region of the United States. Richmond.com had An Eye on the Storm today that included preparedness advice for readers from the Red Cross and NOAA. Anyone living in the areas effected by hurricanes might want to read through the article to make sure they and their family are prepared.

Within the list of items to have on hand in the Disaster Supply Kit is [a] three-day supply of water (one gallon per person per day), and ready-to-eat canned, non-perishable food—make sure you have a manual can opener.

I'm taking the time this morning to provide information about how you can ensure you and your family not only have something to eat, but eat well during an emergency. When an emergency hits, you're not only in need of safe, clean drinking water and basic food - you need nutrient-dense foods to counter the stress you're under also. Stress causes you to release stress hormones and increases your requirements for essential nutrients to counter the effects of stress on the body and mind.

With that said, let's take a look at the potential foods you can have on-hand that offer the best nutritional quality when you have no electricity to cook. Not only is nutrient-density important, calorie density is also key since storing large quantities of food is impractical. And, don't forget, have a manual can opener too!

• Proteins
  Canned Tuna in oil (preferably olive oil)
  Canned Alaska Salmon (preferably with bones)
  Canned Clams
  Natural Nut Butters (peanut, macadamia, almond, walnut, etc.)
  Canned Turkey or Chicken
  Nuts and Seeds to snack on - peanuts, almonds, walnuts, pecans, macadamia nuts, sunflower kernels and pumpkin seeds
  Small wheels of Hard Cheese in Wax - keep refrigerated until emergency
• Fats and Oils
  Small Jars of Real Mayonnaise (once open mayo goes bad quickly)
  Packets of Real Mayonnaise that do not require refrigeration
  Cold Pressed Oils - Extra-Virgin Olive Oil, Macadamia Nut Oil, Walnut Oil, etc.
  Butter (store in freezer, once thawed it will keep up to one week without refrigeration)
• Fruits
  Apples, Pears and Oranges all keep well without refrigeration
  Lemons, Limes and Grapefruit all keep well without refrigeration
  Other fresh fruits you have on hand will keep, depending on variety, up to a week
  Canned Fruits in natural juice or light syrup
  Small jars of 100% fruit jams
  Dried Fruits
• Vegetables
  Canned green vegetables - green beans, asparagus, spinach, etc.
  Canned roots - yams, beets, potatoes, etc.
  Fresh vegetables that you have on hand will keep, depending on variety, up to a week
• Grains
  Grains require cooking and therefore are more difficult to have available, however, freeze a loaf or two of a 100% whole grain bread - after thawing it will keep up to a week without refrigeration
  Cold Cereals made from Whole Grains
• Water and Beverages
  Bottled Water - 1 Gallon per person per day
  Sports Drinks with electrolytes
  Boxed Fluid Milk - the smaller boxes are better to avoid waste and spoiling
  Boxed, Canned or Bottled 100% Vegetable Juice
  Boxed, Canned or Bottled 100% Fruit Juice
  Tea Bags or instant tea
  Instant Coffee
  Red Wine
• Legumes
  Canned Beans and Lentils that are cooked and ready-to-eat
• Condiments & Spices
  Iodized Salt
  Black Pepper
  Dried, ground spices like onion powder, celery salt, garlic powder
  Ketchup
  Mustard
  Sugar or Artificial Sweeteners
  Vinegar
• Combination Foods or Snacks
  Ready-to-Eat, Just Add Water Meals (camping stores sell these)
  Trail Mix
  Dark Chocolate Bars
  Jerky - Beef, Turkey, Chicken, Fish
• Vitamins
  High Quality Full Spectrum Multi-vitamin for adults
  High Quality Full Spectrum Multi-vitamin for children
  Combination EFA Supplement with omega-3 and omega-6 EFA's

Before heading to the store and aimlessly shopping for this and that, take a few moments to plan meals for a week for you and your family. Plan nutrient-dense meals and determine how much each person needs for each meal and snack and build a shopping list based on your actual needs for up to a week of eating without electricity or ability to cook. While you might not be able to cook, you still want to nourish your body and eat as well as you can during a stressful event! It's a good idea to purchase only foods you will eat even if there is no emergency, which is, of course, what we all hope for! In the event you find yourself with foods not eaten and they're nearing expiration, consider donating them to a food bank if you won't be able to eat them!

Keep any foods that do not require refrigeration stored in an accessible place and consider keeping a day or two worth of food and water in the trunk of your car in case you must evacuate quickly. Lastly, keep your car filled with gas since gas pumps do not work without electricity!

Food Police Issuing Citations

The media was all over the news that the Center for Science in the Public Interest [CSPI] petitioned the FDA to place warning labels on sweetened beverages. In their petition, CSPI calls for warning labels on all beverages, carbonated and non-carbonated, that have 13g or more of added sugars.

At first glance many may think this is an idea worthy of consideration, afterall there is evidence to support the notion that soft drinks are linked to obesity.

The Growing Up Today Study, research out of Brigham and Women's Hospital and Harvard Medical School in Boston, looked at the habits of 12,000 children and found that greater consumption of sugar-added beverages was associated with increases in weight over a two-year period. Additionally, researchers at Children's Hospital in Boston studied 548 children and found that for each additional serving of sugary drink, the risk of obesity increased significantly.

However, even I must admit, these finding did not prove that sweetened beverages cause obesity - they do suggest that sugary beverages play a contributing role but causation is not established firmly in the science here. The link is most likely because sweetened beverages provide "empty calories" - too many excess calories at the end of the day. This is more easily seen when you consider that other studies suggest our bodies don't register the calories we drink as well as the calories we chew. In additional studies, when study participants are given additional calories from a sugary drink, they don't compensate by reducing their calorie intake from foods. From this type of evidence, it seems that liquid calories add on to, rather than displace, food calories.

Contrary findings are also within the available data. Researchers from Queen's University in Ontario examined 137,593 youth from 34 countries to identify relationships between dietary and physical activity patterns and incidence of overweight. In the study, overweight was not tied to soft drink intake but was linked to lower physical activity level and more time spent watching television.

As much as I would prefer a clearer correlation on this issue, the jury is still out in the scientific evidence. Hey, I think my readers deserve an honest evaluation of the evidence that is available!

That said, I think the CSPI petition has the potential to lead us down a path toward a "nanny state" approach to diet and nutrition. Do we want or need the government - remember those public policy makers who gave us the Food Pyramid - to subjectively decide what food or beverage is healthy and what is not and then craft warning labels for those foods deemed unhealthy? What will be next on the "hit list" of potential foods some believe should carry a warning label? Butter? Eggs? Beef?

I think you, my readers, know by now I am all about eating a healthful diet and restricting or eliminating foods and ingedients that offer little in the way of nutrition. Such a dietary modification is however is a personal choice one makes to better their overall health through better nutrition. The CSPI petition offers nothing toward educating the public about good nutrition or healthy eating. In fact, the recommended warning label wording includes suggestions to consume diet soft drinks instead of sugary ones. The government, in my opinion, has no business promoting the use of artificial sweeteners. What consumers need is objective nutrition information to make informed choices, not arbitrary warning labels.

Tight Jeans? Blame your Genes?

The BBC reported on Sunday that [s]cientists say they have discovered a gene linked to diabetes and obesity, offering hope for a diagnostic test in the article "DNA test for diabetes and obesity."

Faulty versions of the gene ENPP1 disrupt the way the body stores energy and handles sugar by blocking the hormone insulin. Children with faulty versions were obese at as young as five years old. The French and UK team told Nature Genetics that spotting the problem early and intervening could save lives.

Interesting, huh?

While inactivity and poor diets are much to blame for obesity and the metabolic problems that can lead to full-blown diabetes, the authors of the latest study say some people are genetically prone as well.

I don't know about you, but I think this may well turn out to be a "chicken versus egg" issue in the long-term. The reason - is the defect congenital (you're born with the defect) or is the defect from damage to the DNA later?

For one thing, the research cannot determine when or how the gene became defective at this point in time - just that those who are obese and/or have diabetes share similar defects in the gene (there wasn't one defect but eleven potential variations of defect on the same gene). This type of research holds much promise though - IF researchers investigate why there is a defect on this gene in the obese or diabetic.

While the media has been quick to offer this data up as evidence that a defective gene is potentially responsible for obesity and/or diabetes, I'd advise caution here before you throw up your hands and accept the idea that there is little you can do, it's in your genes.

Why?

We know from various other research of the genetic basis of disease and disorders that in many instances the defect found in the DNA is caused by something that has a cumulative effect on the body's ability to repair the damage. For example, as this article points out, [a]n accumulation of genetic damage to the DNA is how overexposure to sunlight can cause skin cancer and an overdose of radiation from X-rays can cause cancer in internal tissues like the thyroid gland. When oxidative damage occurs in genes that determine cell growth and when the mechanism that normally repairs such damage fails to work properly, the cell is no longer able to keep its growth in check and a malignant tumor results. There are already several other cancers that have been linked to genes that have lost their ability to repair defective DNA.

Also, given the narrow range of shared genes across the human genome, it appears unlikely that only particular populations are suddenly being born with a genetic defect while entire populations remain free of or have such small incidence of such a mutation. In the United States, Australia and Britain, obesity is skyrocketing while France, Italy and Spain remain relatively steady with obesity rates hovering for decades in the 6-10% range. Very similar environments, very different eating habits - very big reason to question how this genetic defect occurs and not assume it's congential.

Let's find the reason why this defect is happening in individuals who are obese and/or diabetic and work toward preventing this genetic defect from ever happening in the first place! Here are some things I'd love to see future research explore:

• What is similar and different in the diets of those with the defective gene when compared with those that do not have it?
• Do those with the defect have nutritional deficiencies in their diet?
• Are there any environmental toxins those with the defect are exposed to that those without it are not?
• Are there any dietary toxins those with the defect are exposed to that those without it are not?
• Can a woman with the defect pass it on to her unborn child?
• Can the damage be reversed by eliminating the cause (if one is found)?
• Do those with the gene have an over abundance of any particular nutrient?
• Do other markers exist that hint at damage occuring before it is evident on the gene?
• Why are different defects found on the same gene in different people?
• What percentage of obese and/or diabetic people have a normal gene?

Squires Does it Again!

As those of you who read my blog know, I find it disheartening when a syndicated columnist writes about research or nutrition and fails to do so accurately. I've previously pointed to errors in the column, The Lean Plate Club, penned by Sally Squires in the Washington Post. Today, again, she gives me one more reason to write about her misinformation and inaccuracies.

Her column today is titled "The Protein Solution" and opens with surprisingly positive sentences about eating more protein - To reach a healthier weight with fewer hunger pangs, consider eating more lean protein. A new study adds to a growing body of research that points to protein's power to satisfy hunger better than either fat or carbohydrates.

From there it's downhill as she tries to make the data fit her opinion, that low-fat is the only healthy option. And, hey, she is entitled to her opinion - my problem is with her ommissions and dismissal and/or ignoring fact.

Problem One

The findings could also help explain the recent but short-lived enthusiasm for low-carb diets, which happen to be high in protein.

What is her definition of "high protein" and exactly which low-carb diets is she writing about?

The low-carb diets all include advice to eat more protein foods, and yet, none that I've crunched menus for exceed the 35% of calories from protein the Institute of Medicine [IOM] feels is the upper limit of Adequate Intake. In fact, most fall within 20-30% of calories from protein and are better described as "high fat" since restricting calories from carbohydrate typically requires higher amounts of fat, often exceeding the upper limit of 35% of calories from fat, a level the IOM believes is the upper limit for fat intake.

And this "short-lived enthusiasm" for low-carb diets - is it true?

A just released survey from the Harvard School of Public Health found that in 2004 36% of respondents were keeping track of their carbohydrate intake and in 2005 the same percentage, 36% still kept track of their carbohydrate intake. Where there has been a significant waning in interest is in the use of products touted as "low-carb" - sales for such products has been declining for well over a year now.

However, two noteworthy indicators provide more insight. One - sales of whole foods those following a low-carb diet rely on - eggs, cheese, edible oils, meat, poultry, nuts, seeds, fresh produce, fish, etc. - remain strong or continue to rise for sales. Two - research funding continues to be strong in the area of low-carb nutrition - the data is compelling and scientists continue to investigate the low-carb dietary approach for weight loss, diabetes and other health issues.

Let's not mistake product failure with declining interest in the low-carb dietary approach - whole foods remain strong as does the interest from the scientific community...two indicators that are more important than the sale of processed foods touted as low-carb.

Problem Two

Ms. Squires relies on a quote from a "biased" source, Arne Astrup.

"It's telling us that one of the reasons why the low-carbohydrate diets seemed to work is not because of low carbohydrates, but because of high protein," said Arne Astrup, head of the department of human nutrition at the Royal Veterinary and Agricultural University in Copenhagen. "Look at Atkins, South Beach and the Zone," said Astrup, who wrote an editorial accompanying the protein study, which appears in this month's American Journal of Clinical Nutrition. "They're all characterized as having 30 to 40 percent of calories from protein."

Now you may be wondering why I consider Dr. Astrup to be biased. Well, Ms. Squires fails to disclose that Dr. Astrup is medical advisor to Weight Watchers in Denmark. His department at the university has also received funding from over 50 Danish and international food companies.

I think her readers deserve to know any potential conflict-of-interest from whom she is quoting, don't you?

Problem Three

Thirty percent of daily calories as protein -- about twice what most Americans eat, and the upper limit recommended by the Institute of Medicine -- is the amount that University of Washington researchers gave to 19 participants in the latest study.

Ms. Squires incorrectly states the upper limit for protein as 30% of calories from protein. The Institute of Medicine website provides access to their macronutrient distribution recommendation documents which are found here: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids

The correct upper limit is 35% of calories from protein as determined by the IOM. It is noteworthy that even at this level, the IOM documentation states that, "no defined intake level at which potential adverse effects of protein was identified." It continues with the explanation that the range of protein advised is to "complement" the percentages from carbohydrate and fat!

So, quite frankly, even that 35% upper limit intake is not an evidence-based recommendation, it was designed to fit the low-fat recommendations.

Problem Four

Ms. Squires continues to put forth the myth that higher protein in the diet is dangerous to those with normal kidney function.

Even so, Weigle and others caution that boosting protein to 30 percent of daily calories may not be safe for everyone, since it could overtax kidneys in those with kidney problems, diabetes or glucose intolerance.

While those who have existing kidney problems should understand the potential risk of high protein diets and work closely with their physician to determine if increasing protein is appropriate, those who have normal kidney function - including diabetics and those with glucose intolerance - are at no increased risk for degradation of their kidney function. This is based on decades of research data which has shown that increased protein does not cause kidney disease.

Problem Five

A broad, sweeping generalization that, in fact, may prove disasterous in terms of health.

For others trying to reach a healthier weight, Astrup said that the latest findings show "that there's no reason to cut down on carbohydrates or that much on fat. Simply increase your protein. That can be done as part of a very healthy diet, including eating all kinds of fruit, vegetables and whole grains."

No reason to cut down on carbohydrate?

Oh really?

While Dr. Astrup includes eating fruits, vegetable and whole grain as part of the diet, he fails to adequately address the carbohydrates one needs to seriously consider limiting - refined sugar, refined grains, high fructose corn syrup, and processed foods that often are not only high in added sugars but also contain trans-fats!

Without stating the types of carbohydrate foods that are potentially nutritionally bankrupt, he and Ms. Squires leave the reader with the impression that anything they want to eat that's carbohydrate is A-Okay. A steady diet of processed, sugar laden foods, high in carbohydrate offer little in the way of nutrient density and are best viewed as "empty calories" that displace calories from better nutrient-dense foods.

This should have been clearly stated for readers to understand that in the study in question, participants ate nutrient-dense carbohydrates - fruits, vegetables, whole grains and legumes - and did not eat just any carbohydrates they wanted to in their diet!

Problem Six

The continued perpetration of fat-phobic recommendations for weight loss.

Ms. Squires wraps up her column with a number of recommendations to keep the level of fat calories low while increasing protein intake. In doing so, she ignores the evidence that finds that increased fat intake while reducing carbohydrate intake works for weight loss while also improving health risk factors.

I personally have no problem with anyone wanting to eat a diet that is lower in fat, but to continue to put forth opinions that imply an increased fat intake is harmful in the context of a low-carb diet, is, in my opinion, irresponsible. The data clearly shows that when carbohydrate is restricted, protein is adequate and fat is inevitably increased, calorie reduction is spontaneous (no calorie counting is required), weight is lost (with a sparing effect on lean body mass) and risk factors such as cholesterol, triglycerides, CRP and glucose tolerance all improve.

Now while this particular study was low in fat and calorie reduction was also spontaneous, the researchers DID NOT analyze the effect such a dietary approach had on cholesterol, triglycerides or CRP in the blood. Without this data we simply do not know if a diet higher in protein, stable with carbohydrate and lower in fat has the same positive effect on these risk factors.

Just the Facts...

Today I am giving my readers a "just the facts" entry to provide information about recent research out of Italy on the artificial sweetner, aspartame - better known in the US as NutraSweet and Equal.

The "results call for urgent re-examination of permissible exposure levels of APM (aspartame) in both food and beverages, especially to protect children," read the final sentence of the recently published research paper, "Aspartame induces lymphomas and leukeamias in rats."

The paper, published in the European Journal of Oncology, details the findings of researchers from the Ramazzini Institute in Italy who investigated the effects of various doses of aspartame on the health of 1,800 rats for their full life span.

The study included a group of rats designated as the "control" group who recived no aspartame in their diet and six groups fed various levels of aspartame in their diet each day. The findings are disturbing - so disturbing that the European Food Safety Authority is already investigating the study to establish whether there are any implications for human health.

The researchers found:

• Female rats ingesting aspartame had a statistically significant increase in lymphoma and leukeamia
• Male rats fed the highest dose also had an increase in the incidence of lymphoma and leukeamia
• Even at the lowest dose of aspartame, there was a 62% increase in lymphoma and leukemia in the aspartame fed rats when compared with the control rats
• While not statistically significant, brain tumors were reported in the experimental rats while no tumors were found in the control group
• Even though the aspartame groups ate less calories each day, both the control rats and the experimental groups had similar body weight
• The experimental rats fed the highest doses of aspartame had noticable changes in the color of their fur

All levels of aspartame fed to the experimental rats - from the lowest doses to the highest - were within levels comparable to potential levels of human intake.

Aspartame is found in over 6,000 foods, beverages and pharmaceuticals in the United States, many which are specifically designed for use by children.

Before publication, the journal had seven experts review the data in anticipation of a storm of controversy. The Ramazzini Institute sent its first results to the European Food Safety Authority. EFSA, as reported by the BBC, confirmed that it would be asking its expert scientific panel on food additives to review the results "as a matter of high priority, in the context of the previous extensive safety data available on aspartame".

You're Going to Diet!

MSNBC.com today ran the article, "Keep pounds from piling on in middle age" - highlighting the annual trend toward gaining weight as we age. Researchers predict that the average adult American will gain 10-20 pounds in the next ten years! In research studies, adult weight gain correlates with:

• Higher risk of Diabetes (Type II)
• Obesity
• Joint damage and osteoarthritis
• Higher risk of several cancers, including colon cancer and breast cancer

Specifically, for each two pounds gained, a man's risk for developing diabetes rose by 7%. A one inch increase in waist circumferance over ten years increased risk by 20%. Overweight adults have a three-fold higher risk of developing osteoarthritis of the knees that will require surgery.

As the article points out, [a]lthough adult weight gain is common, you shouldn’t consider it normal or healthy.

Without missing a beat, the article continues by promoting the idea that following the 2005 Dietary Guidelines for Americans will reduce your risk of gaining weight if you reduce your calorie intake and increase your activity.

So just how many extra calories are we talking about?

According to the article, it's as simple as reducing calorie intake by 100-calories each day and increasing activity.

Hmmm, does the math add up? If a two-pound gain each year is "average" that's less than 20-calories per day if we're to believe the "calorie theory." To be more precise, it's 19.2 calorie per day (3500-calories per pound x 2 pounds = 7000/365 days = 19.178).

I have no idea how they decided the recommendation to reduce calorie intake by 100-calories per day. With that decrease in calories, with no significant change in activity, one should lose almost 8.5-pounds in a year after accounting for and deducting the 20-calories per day one must eat to gain 2-pounds in a year.

Which brings me to an interesting article I read recently about the 2005 Dietary Guidelines and Food Guidance Pyramid(s) for Americans by Sandy Szwarc, "MyPyramid Scheme" at TechCentralStation.com. It may help explain the calorie deficit recommended in the MSNBC.com article.

Ms. Szwarc contends that "the new pyramid, MyPyramid, ...puts the nation on a diet. In fact, its calorie recommendations are so restrictive, they endanger the health of Americans. "

"MyPyramid involuntarily subjects Americans, especially figure-conscious females, to the very same risks of dieting and dietary restrictions: dysfunctional eating, food fears and eating disorders; nutritional shortfalls; and health problems such as doubling long-term risks for high blood pressure, heart disease and type 2 diabetes to name a few."

Are we really being subjected to stealth messages designed to have us perpetually on a diet?

I'm starting to think so. When I visited MyPyramid.gov, the calculator on the homepage recommended I consume 1800-calories per day to maintain my weight and was based on my age, gender and activity level.

If I didn't already know my Basal Metabolic Rate [BMR] and Active Metabolic Rate [AMR], I wouldn't know that the 1800-calories recommended is, in fact, a calorie-deficit of over 850-calories per day for my height and weight. I would also not know that such a calorie intake was barely enough calories to meet my BMR. Such a calorie-deficit would cause an 88-pound weight loss in one year and wreck havoc on my health!

Yes, we have an obesity epidemic in the United States. I do not think a solution is going to be found by recommending sustained calorie deficits, calorie counting, perpetrating fat-phobia while ignoring the very real issues - we eat too much sugar, too many processed foods, too many refined grains, too many damaged fats, too many man-made trans-fats and too many liquid calories.

Simply reducing calories without addressing the problematic foods will not improve our weight or health. The current recommendations are just more of the same recommendations we're been fed a steady diet of for the last 30-years - and still without one study designed to specifically investigate how compliance with the guidelines prevents weight-gain or improves risk factors!

The answer to the obesity epidemic does not lie in counting calories, fat grams or stealthy messages designed to place you unwittingly on a calorie-restricted diet! The solution is one many will not speak of, will not admit, will not dare to go out on the limb of truth with - real food.

False Dichotomy & Red Herrings

Philosopher and author Ayn Rand had a keen eye for the "false dichotomy"- that is, an argument with the "missing middle."

This is best understood as an argument that offers two choices and requires that you pick one of them. This happens when there may be other alternatives left unsaid which would undermine the original argument. In the false dichotomy the alternatives are strictly limited to black-and-white so that when one choice is discredited, the reader is forced to accept the other choice.

For example, in the article "How Sweet it Is" [StLouis.com], a false dichotomy is presented to readers about sugar consumption - by allowing yourself a little bit of sugar, you can keep your cravings at bay and keep your diet from backfiring.

When trying to lose weight, no one wants to fail and, let's admit it, it's difficult to restrict the foods you enjoy most - sweets. The author presents a dilemma to any dieter - all or nothing when it comes to sugar in your diet - and clearly seeks to convince the reader that eliminating sugar is the wrong choice.

To convince the reader that restricting sugar dooms you to failure, the author continues by including an "expert" opinion in the mix - Rachel Brandeis, an Atlanta dietitian and spokeswoman for the American Dietetic Association, agrees. "I wouldn't say sugar is something we should avoid," she says. "We shouldn't be on a hunt to eliminate sugar altogether. ... Low-carb fad diets have played a role in this phobic fear of carbohydrates. And that's not healthy."

In one sentence, readers are presented with authoritative information from an "expert" who says that:

• Sugar is not something to avoid
• We shouldn't eliminate sugar altogether
• Low-Carb diets are a fad
• Low-Carb diets create a phobia about sugar
• Low-Carb diets are unhealthy

Now that's pretty convincing!

But this is not an adequate argument, the choice favored - in this instance, including added sugars in your diet - must be supported by evidence.

Alas, no evidence exists that suggests anyone will be harmed by eliminating added sugar! So, instead of facts, we are presented with a false dichotomy supported by red herrings and opinions. All in an effort to convince you that eliminating added sugar from your daily diet is not only unwise, but is unhealthy and will lead to weight-loss failure in the long-term!

Here are the facts:

Need and want are two different things in life:

• No one needs added sugar in their diet
• No one needs high fructose corn syrup [HFCS] in their diet

Facts about added sugars:

• Added sugar is "empty calories" - calories that bring no essential nutrients that your body needs with them
• Added "empty calorie" sugars crowd out nutrient-dense calories in the diet
• Nations with the lowest consumption of added sugar have the lowest rates of obesity
• Consumption of high fructose corn syrup raises triglycerides in the blood
• Research studies show that those who consume the most added sugar in their diet are at the greatest risk for overweight and obesity

Reasons to consider restricting or eliminating added sugars in your diet include:

• Within one to two weeks of eliminating added sugars in the diet, cravings for added sugars are significantly diminished or completely gone
• Sugar casues an increase in blood sugar which stimulates insulin release, which in turn inhibits fat burning hormones
• High insulin levels promote fat storage in the body
• A diet that includes added sugars stimulates the appetite for more food and increases the risk one will eat too many calories

The unstated alternatives to added sugars in your diet include:

• Many vegetables are naturally sweet and include essential nutrients
• Most fruits are naturally sweet and include essential nutrients
• Artificial sweeteners provide an alternative to sugar for those who choose to use them
• Some choose natural sugars instead of artificial sweeteners - honey, blackstrap molasses, unrefined brown evaporated cane - all provide some essential nutrients with sweetness
• Stevia is a natural herb that is sweet and used in many countries as a sweetener in foods
• Supplementation with L-Glutamine has been shown in studies to diminish or eliminate cravings for sugar

I encourage you to develop a keen eye for the "false dichotomy" used in the diet debates and use your critical thinking skills to uncover the alternatives that are always left unsaid - they're often your best choice!

Evaluating the Weight of Evidence

How reliable are the findings of a research study?

Scientists generally agree that data is reliable when it's replicated - that is repeated by a different group of researchers using the same or more rigorous investigational protocols and the findings of the additional study confirm the original findings.

This month's JAMA reported the findings of Dr. John Ioannidis, a researcher at the University of Ioannina in Greece, who reviewed major studies published in three influential medical journals between 1990 and 2003 - including 45 highly publicized studies that initially claimed a drug or other treatment worked.

As RedNova.com reported on the review, [s]ubsequent research contradicted results of seven studies - 16 percent - and reported weaker results for seven others, an additional 16 percent. That means nearly one-third of the original results did not hold up.

"Contradicted and potentially exaggerated findings are not uncommon in the most visible and most influential original clinical research," said study author Dr. John Ioannidis.

Examples of data originally touted as beneficial and later refuted or watered down by subsequent research:

• Hormone pills protect menopausal women from heart disease. A larger, more rigorous Women's Health Initiative study later found the pills increase actually heart disease risks.
• Vitamin E pills protect against heart disease. A more rigorous study found no such protection.
• Antibody treatment targeting a bacterial poison improves patients' chances of surviving sepsis, a potentially deadly bloodstream infection. A much larger study found no protection.
• Inhaling nitric oxide helps patients with respiratory failure. Larger studies found no benefit.
• Antioxidant substances contained in tea, wine and many fruits and vegetables substantially reduce the risk of heart disease. A later study said the benefit was more modest.
• An operation that clears fat from neck arteries reduces stroke risks in patients without symptoms. A subsequent analysis found more modest benefits.

Ioannidis acknowledged an important but not very reassuring caveat: "There's no proof that the subsequent studies ... were necessarily correct." But he noted that in all 14 cases in which results were contradicted or softened, the subsequent studies were either larger or better designed. Also, none of the contradicted treatments is currently recommended by medical guidelines.

So what does this mean for you?

It's a reminder that you should not put too much stock in a single study and understand that treatments often become obsolete with medical advances. This isn't to say that emerging data is wrong - just that before you jump at a new treatment based on new evidence, weigh the possibility that it may not be your best option until later studies confirm the data. In this review, in about one-third of studies the data from later results found the original findings did not hold up or were weak.

Ioannidis said scientists and editors should avoid "giving selective attention only to the most promising or exciting results" and should make the public more aware of the limitations of science.

"The general public should not panic" about refuted studies, he said. "We all need to start thinking more critically."

Cholesterol: Is It in the Genes?

For decades a diet that is higher in fat than recommended - that is more than 30% of calories from fat and more than 10% from saturated fat - has been implicated as a "cause" of high cholesterol, which in turn has been implicated as a "cause" of cardiovascular disease.

Remember in school the equation problem "A=B, B=C, so A=C?"

When it comes to cholesterol the equation is fairly simple and straight-forward:

• More than 30% of calories from fat = risk of high cholesterol
• High cholesterol = risk of cardiovascular disease
• More than 30% of calories from fat = risk of cardiovascular disease

But, it is true?

For years research data has continued to find contradictory results when extrapolating data on diet and cholesterol and heart disease. When data supports the idea, the media is all over it...when the findings are weak or in contradiction to the idea, the findings are often ignored, discredited, or some flaw is found in the design to explain the contradiction. Then, there is the "paradox" explanation - namely the "French Paradox" and the "Spanish Paradox" - advanced when nothing else can explain away findings.

New findings, reported today by Reuters Health in the article, "Genes key in how diet affects cholesterol levels" challenge the conventional wisdom of "diet = high cholesterol."

The study of 28 pairs of male twins -- one a lean athletic type, the other a bit rounder and sedentary -- found that brothers tended to show the same cholesterol response to high-fat and low-fat diets, even though their exercise habits were starkly different.

Because identical twins share the same genetic makeup, the findings point to the importance of genes in determining how a person's cholesterol levels respond to diet and lifestyle changes, according to the study authors.

The study followed 28-pairs of identical twins (male) and used cross-over diets containing different amounts of fat. One diet had 40% of calories from fat, the second had 20% of calories from fat.

The study found a high degree of similarity in how brothers' LDL cholesterol (the "bad" form of cholesterol) responded to the switch from the high-fat diet to the low-fat one. On average, the men's LDL declined on the low-fat diet, but any individual's response seemed to depend largely on genes.

In general, low-fat diets tend to lower LDL concentrations, but can also decrease "good" HDL cholesterol and raise triglycerides, another type of blood fat. So cutting dietary fat may not have a net benefit, depending on the individual.

What the article didn't state was that some of the twins followed did better with a higher fat diet than a lower fat diet. Add to that the finding that HDL may decrease while triglycerides increase on a low-fat diet - those observations are noteworthy and future research must explore why. HDL is basically the "garbage collector" of cholesterol. The evidence to date supports the contention that high triglycerides are a risk factor. When a dietary change impacts both negatively, this should be a red flag!

For those who fail to better their cholesterol profile with diet, genes -- rather than a lack of will -- could be the reason, said Paul T. Williams, a researcher at the Lawrence Berkeley National Laboratory in California and the study's lead author.

Controlled-carb diets have been shown to markedly improve cholesterol levels in people following them in controlled-studies. This is not to say everyone benefited - there is a population whose cholesterol responds negatively to a higher-fat, low-carb diet. Some studies suggest this population could be as high as 30% of the general population.

For this reason, it is critical that you have your cholesterol profile followed by a physician if you modify your diet to be low-carb or, with these findings that show HDL and triglycerides may be negatively impacted by a low-fat diet if you go that route.

Until, or unless cholesterol levels are ruled out of the equation as a risk factor, it is important to have your cholesterol checked with any dietary change. If you're not seeing a positive result in your cholesterol profile work with your doctor to adjust your macronutrient intake to see if a different one works better.

The Cost of Convenience

If you're spending more than $0.46 for your daily cup of coffee at the local coffee shop, convenience store or cafe each morning on the way to work, you're spending too much.

The cost to brew your own coffee daily, including the cost of the coffee pot, daily filters, coffee, half-and-half, sugar-free syrup and two travel mugs (one to use while the other is getting washed) is just $0.46 per day for 12-ounces of brewed coffee, 2-ounces of half-and-half, with 1-ounce of sugar-free syrup of your choice.

If you stop locally to get your morning joe, you'll spend $0.99 to $4.99 for that same cup each morning on the way to work. Five mornings each week and at the end of the year you could have saved $138.33 to $1182.33 just on your morning coffee!

*****

Think that prepared roast chicken at the supermarket is a great deal for just $4.99? Think again. Not only might it have questionable ingredients, you paid more than twice what it would cost you to make it yourself and know what ingredients you used.

Most prepared chickens are 2-3 pounds, so that $4.99 chicken is costing you $1.66 to $2.49 a pound. On sale, whole chicken is often as cheap as $0.49 per pound with a three-pound chicken costing you about $1.50. Add in the spices and cost to heat your oven and that home-prepared bird costs about $2.00 for you to make yourself. If you are currently eating a prepared chicken twice a month from the grocery store, at the end of the year you've spent over $70 for convenience.

*****

Those bags of lettuce in the supermarket are convenient, but how much are you really paying for that lettuce?

A 5-ounce bag of pre-washed spring mix averages $3.49 - that's $11.16 per pound.

If each week you're using two 5-ounce bags of lettuce you're spending $6.98 each week, or $362.96 per year just for lettuce.

Try this - for $1.69 each, buy a head of leafy green romaine and a head of red leaf, wash it yourself, chop it and save yourself $187.20 a year.

*****

Pre-cut carrots are convenient, but an 8-ounce bag of pre-cut carrot sticks is $1.99, whereas plain old regular carrots are $0.99 per pound. If you're eating, on average, just 1/2 pound a week, you'll save yourself $77.74 over the year if you peel and cut the carrots yourself.

*****

While cleaning, peeling, chopping, cooking, etc. do take some time, at the end of the year you can save yourself thousands of dollars for a small committment of time. The few examples above alone could save you over $1500 a year!

Cheap Food or Health - It's Your Choice

Did you know that we, in the United States, spend less money from our disposable income on our food than any other country in the world? The Living section of the Wichita Eagle yesterday asked, Food is cheap, but are we getting our money's worth?

Americans spend 10 percent of our disposable income on food. It's no surprise that residents of poorer countries spend much more -- 33 percent in Mexico, for instance. But the residents of several relatively prosperous nations spend quite a bit more as well -- such as Japan, at 26 percent, and Italy, 23 percent.

From the report, Money Income in the United States, for a family of four, this works out to about $4225 a year for food, $81.25 per week, $11.60 a day, or just $2.90 per person per day.

Now I know some reading this spend more and some spend less - these numbers are just "averages" based on data from the Census Bureau for an average family of four in the United States.

Regardless of how much you spend on food, the question must be asked - Is the food you are buying cheap today going to cost you more later?

Forget about "later" it's already costing you, me, us - a lot more today!

Think about this - today we spend $4,631 per person for healthcare expenditures in the United States - for a family of four that is $18,524 - more than 4-times what a family spends on food.

Want to know where the United States ranks first in the world? (NationMaster.com)

• Grain consumption
• Soft Drink Consumption
• Banana imports
• Healthcare expenditure per person
• Overweight and Obesity
• Mortality/Death - to name just a few - Acute myocardial infarction, Acute renal failure, Chronic ischaemic heart disease, Deficiency of other B group vitamins, Folate deficiency anaemia, Hypertensive heart and renal disease, Hypertensive heart disease, Hypertensive renal disease, Insulin-dependent diabetes mellitus, Intestinal malabsorption, Malignant immunoproliferative diseases, Obesity, Stroke, not specified as haemorrhage or infarction, Vitamin B12 deficiency anaemia
• Prescription drug use, with an estimated 50% of the population taking one or more prescription drugs

And, where do we rank second?

• Corn Consumption
• Added Sugar Consumption
• Mortality/Death - to name just a few - Deficiency of other nutrient elements, Dietary selenium deficiency, Heart failure, Iron deficiency anaemia, Non-insulin-dependent diabetes mellitus

Even more startling - while the life expectancy of a woman in the United States is currently 80-years, she will enjoy "good health" for only 68.8 of those years; men with a life expectancy of 74.3-years will enjoy "good health" for only 67.6 of those years. In other words, on average, women will endure 11.2-years of "ill health" and men will endure 6.7-years of "ill-health."

How do you want to spend your golden years - in good health or years in a state of ill-health?

You have a powerful influence on your long-term health - the food you buy and eat each day - you really are what you eat! What you spend today on your food may have a significant impact on what you have to spend later on healthcare costs while suffering years of "ill-health" that may have been averted by four things:

• Eliminating sodas and anything else sweetened with High Fructose Corn Syrup (HFCS) from your diet
• Eliminating as many processed foods from your diet as possible
• Eliminating all man-made trans-fat from your diet (anything with "partially hydrogenated" or "fractionated" oils in the ingredients, even if the package claims "no trans-fats")
• Learning to cook to prepare most of your meals

You don't necessarily have to spend more money on food to do this, although initally you will have to spend more time reading labels for ingredients and getting adept in the kitchen!

When you're not buying soda, chips, cakes, candy, baked goods, french fries, white bread, processed cheese food, imitation creamer, margarine, shortening, etc., you have that money to spend on fresh, seasonal vegetables and fruits, fish, poultry, natural cheese, legumes, meat, natural fats and oils, nuts and seeds, and a wide-range of other real, whole foods.

This does not mean you can never have a brownie again - make them from scratch with real ingredients - butter, pecans/walnuts, brown sugar, baking powder and unbromated, whole wheat flour is all that you need for homemade brownies...that and 30 minutes.

This does not mean you can never have french fries again - make them from scratch - a couple of white potatoes and unrefined peanut oil that you use once and toss and a dash of salt is all you need...that and 15 minutes. I do not, however, recommend making french fries a staple in your diet.

You may be thinking, I don't have time to cook! Well, you can take the time now, or use those 6.7 to 11.2 years in ill-health wishing you made the time, wishing you'd had the foresight to see long-term good health as "convenient" instead of that frozen pizza you microwaved for dinner on July 7, 2005.

Atkins Low-Carb Quandry Update

You may recall that I recently wrote about a European television series, Diet Trials, that followed dieters on four diets - Atkins, Weight Watchers, Rosemary Conley and Slim Fast - for six months. The show was followed with great interest by viewers who watched, week after week, as those following Atkins lost more weight while their triglycerides plummeted (a good thing) significantly more than those on other diets.

The very public demonstration that an Atkins diet can help one lose weight and lower cardiovascular risk factors left the medical establishment in Europe in a quandry - without solid long-term safety questions answered, how can they recommend low-carb diets for weight loss?

As I said in my previous article, it is short-sighted to limit options to those who are overweight and obese today while waiting for research data that both clinical case studies and anecdotal evidence suggests is safe and effective for at least six months. Barring any major metabolic issues, the vast majority of individuals will not need to remain at very limited carbohydrate levels for the long-term.

Who in Europe listens to me though?

I was not surprised at all by the follow-up Op/Ed letter in IC-Wales today - Healthy diet, lifestyle change and more exercise key to losing weight - from Dr. Nadim Haboubi, a consultant physician and Sian Jones, a specialist dietitian.

Without missing a beat or departing from the low-fat dogma, they make it clear they are alarmed about the article...regarding the safety and the efficacy of Atkins diet.

Their first issue with the Atkins diet is that [t]he principal aim of weight management is...to introduce a negative energy balance to reduce body weight.

I whole-heartedly agree!

And what the research shows is that those who are placed on a low-carb diet - both in controlled settings and in "free living" conditions - eat less calories without having to count calories. So, what's the problem when even they admit the low carbohydrate diet is quite popular currently as it achieves a short-term weight loss mainly through reducing appetite. (emphasis mine)

Well, they continue onto their second issue, that one has to maintain a lower body weight over the longer-term.

Imagine that, I agree again!

I do find it amusing that they felt they had to state the obvious. What we know, again from the research, is that regardless of diet used to lose weight, people have a hard time keeping weight off for the long-term. Why, you might ask. It's simple - they too often return to the very eating habits that caused the weight gain in the first place. The ONLY surefire way to assure weight maintenance is to make a permanent change in your eating habits for the long-term.

This is something that, when reviewed from Induction to Maintenance, Atkins (and other low-carb diets) try to do for the long-term. This is also where I believe many are missing the "big picture" of low-carb diets. I'll get to that in a moment though since there was another issue they felt necessary to include in their letter.

In the long-term, they contend that it is important to ensure that people who are obese are following a healthy balanced diet that is low in saturated fats and high in complex carbohydrates.

Ready for a "really big" problem now?

To date, research has never exclusively followed two controlled-groups, over the long-term, to determine if only a diet low in saturated fats compared with a diet "higher" in saturated fats is 1) safe, 2) healthy, 3) cardio-protective, 4) reduces risk of cancer, 5) lowers cholesterol, 6) reduces incidence of degenerative disease, 7) enables better weight management long-term or 8) improves quality of life and/or life expectancy long-term.

But wait you say - everyone points out research over the years that shows that those who follow a diet that is lower in saturated fats are healthier!

Here's what I say...The research used as evidence does indeed make that correlation.

Keep in mind though, correlation is not causation.

When you look at the evidence, something important keeps returning to make the data hard to use as "proof" - confounding factors.

So, what are "confounding factors?"

They're things in a study that impact the results, for better or worse, and make determining exactly what caused the results difficult to tease out of the data with certainty.

For example, much of the data used as "proof" are from lifestyle intervention studies where multiple "lifestyle problems" are addressed and remedied all at once - change diet, add medication to lower cholesterol and/or blood pressure, require smoking cessation, include an exercise program and even teach relaxation techniques.

So the question begs, at the end of such a study, what exactly caused the results?

Anywhere you have multiple interventions, you have confounding factors - unless, at the start, a way to account for each is established and each is accounted for in the final results. And while some studies have sought to address the above confounding factors, there are still other confounding factors to consider too.

Other confounding factors - and ones that I think are more important - what types of foods are included in the diet change versus the control group? What level of trans-fats are in both diets? What about fried foods and the potential HNE's? How much "junk food" is in each diet?

All of these things impact health and they have not been adequately tracked in the studies used as "proof" that low-fat diets are healthy because they are lower in saturated fats.

In fact, at the end of the day, it may just be that it's the lower trans-fats, HNE's and junk food that results in better health and the level of saturated fat may have nothing to do with it. We simply do not know or can state with certainty that it's lower saturated fat because no one has actually looked at these other confounding factors when determining results for different dietary interventions.

You may be thinking, that's outrageous, she's nuts, no one debates the issue of saturated fats or thinks they're even healthy!

To such doubt I ask you remember that I look at evidence...and here are some eye-opening numbers for you.

As of this year, 2005, the United States once again experienced an uptick in life expectancy, now reported to be 77.7 years on average, up from 77.4 years in 2002. Impressive, huh?

During that same period, the United States fell in its worldwide ranking for life expectancy, when compared with other countries, from 28th to 48th. We barely remain in the top-50 countries in the world for life expectancy. [CIA World FactBook]

Just some food for thought to start with as I present some more interesting numbers.

In countries often cited as the "picture of health" with low rates of obesity, cardiovascular disease and other degenerative diseases, who live longer than we do - here is the level of saturated fat they eat as part of their daily calories (these statistics are from the British Journal of Medicine, WHO and CIA World FactBook):

• France
  Total Fat: Men 37.7%; Women 40%
  Saturated Fat: more than 15%
  Obesity rate = 11%
  Life Expectancy Rank = 16th, 79.28 years
• Spain
  Total Fat: Men 39.2%; Women 38.9%
  Saturated Fat: 13%
  Obesity Rate = 8.6%
  Life Expectancy Rank = 19th, 79.23 years
• Italy
  Total Fat: 34.7%
  Saturated Fat: 12%
  Obesity Rate = 6.7%
  Life Expectancy Rank = 14th, 79.4 years

I've made a point to look at three countries often highlighted as examples of the "Mediterranean Diet" lifestyle. While the media tries hard to convince us those in these countries are eating a low-fat diet, the statistics point to another reality.

Not only do people in these countries outlive us and suffer less from a variety of degenerative diseases, their diets are markedly different than ours - the majority of their meals prepared at home from fresh, whole foods; there is significantly less reliance on packaged processed foods; they liberally use natural fats and oils in cooking with significantly less trans-fats in their diet; and they consume much lower levels of added sugars in their diet.

So tell me again, without any doubt, it's the saturated fat that's deadly and must be kept low in the diet if one wants to be healthy long-term...and then go tell those who are living longer, healthier lives in a true Mediterranean diet that they're eating too much saturated fat. Convince them that our recommendations in the US are better for long-term health and longevity.

Which now brings me back to the editorial...where yet another additional assertion was made.

It is important to note that those who are on the Atkins diets do restrict their intake from protective foods (such as fruits and wholegrain cereals). This is of concern as research has shown a clear association between poor fruit and vegetable intake and bowel cancer.

The point often lost in the whole debate - restriction is not elimination.

The fact is that even during the most restrictive period on Atkins, some fruits are included.

Yes, tomatoes, pumpkin, avocado, lemons, limes, squash and even macadamia nuts are all really fruits and all are allowed during the first two weeks of Induction. After the first two weeks all berries (strawberries, blueberries, raspberries, blackberries, etc.), along with honeydew melon, cantelope and other low glycemic-index fruits are not only allowed, but encouraged.

Ahhh, but what about grains - surely we need those, don't we?

Need to eat and like to eat are two different things. While it is true that grains and grain products are restricted initially - and fiber intake really is the issue for including them - I often wonder why no one points out the fact that non-starchy vegetables are higher in fiber and more nutrient-dense?

Throughout both Induction and Ongoing Weight Loss, the volume of non-starchy vegetables is high, and one is expected to maintain that level of intake for the long-term as they add more carbohydrate selections, including whole grains.

Let me be clear here - the foundation of low-carb is non-starchy vegetables and that remains the foundation as one moves along and modifies their diet to be controlled-carb long-term.

This is something that those stuck in the low-fat dogma fail to acknowledge in their quick dismissal of low-carb and controlled-carb diets. Many also lose sight of the fact that in the long-term, whole grains are allowed and re-introducing them is encouraged as one is still losing weight. Are you starting to see how, over time, low-carb diets are trying to teach new eating habits long-term? You don't just diet and then try to maintain a diet. Instead you start by restricting particular foods and slowly but surely adapt your diet along the way so that by the time you've lost the weight you now have a lifestyle pattern of eating you can continue with long-term.

But of course there is the issue of foods that are higher in saturated fats, right?

Keep in mind that allowing a food is not requiring a food.

While Atkins and other low-carb diets often include foods typically banished in low-fat diets, like beef, lamb, natural cheese, cream and eggs, there is no requirement one eat them or ever eat them in excess.

In fact, eating anything in excess is strongly discouraged because one goal in low-carb weight-loss diets is to learn new eating habits while one is losing weight and learning to listen to satiety signals the body sends when you eat. By allowing selections often deemed "unhealthy" by low-fat doctrine, one is given an opportunity to actually learn how to eat the very foods that tempt them later after they lose weight and are now trying to maintain weight!

How anyone misses this is beyond me.

How anyone can say, with a straight face, that eliminating trans-fats, avoiding refined carbohydrates and junk food and significantly reducing added sugars is unhealthy long-term is beyond me. Oh, yeah, those aren't things that the critics often ignore too.

Anyone who can think that a diet of mostly whole foods - non-starchy vegetables, legumes, whole grains, meats, eggs, cheese, poultry, fish, natural fats and oils, fruits, nuts and seeds, herbs and spices, and even moderate amounts of starchy vegetables - is unhealthy needs to rethink the connection between diet and health.

In the United States we have a crisis on our hands and to summarily dismiss low-carb diets is missing an opportunity to help those who are obese now.

By remaining focused on the first few weeks of restriction in low-carb diets, we're missing the point of long-term lifestyle modification, long-term changes in eating habits and the potential for better long-term health by ignoring the fact that long-term, low-carb diets are modified slowly, as one continues to lose weight, to reduce fat intake while increasing carbohydrate intake.

One only needs to open Dr. Atkins' New Diet Revolution or Atkins for Life to see that, plain as day, in black and white - as carbohydrate intake increases, fat intake decreases.

At maintenance, controlled-carb diets, like Atkins for Life, are not "low-fat," but they're certainly not excessive in fat calories either. In fact, controlled-carb starts to look very similar to the real life eating habits in France, Italy and Spain for macronutrient mix and foods encouraged in the long-term.

Tell me again that's not healthy!

Opinion Versus Evidence

One thing that bugs me is when "medical writers" or "science editors" write things without backing up their statements with references to studies or data.

Case in point - in today's Toledo Blade, science editor Michael Woods ends his article, "How to adopt anti-inflammatory way of living" with this sentence: Nobody is certain about those popular low-carb/high protein diets, but some evidence suggests that they increase invisible inflammation.

Invisible inflammation is what the American Heart Association calls "low grade inflammation" and the marker for it is C-Reactive Protein (CRP) in the blood. The AHA website provides us with information about how important a marker the CRP may be in our risk for a heart attack - Most studies show that the higher the hs-CRP levels, the higher the risk of developing heart attack. In fact, scientific studies have found that the risk for heart attack in people in the upper third of hs-CRP levels is twice that of those whose hs-CRP is in the lower third.

So, elevated CRP is an important risk factor we should consider for our long-term health. Many believe that certain foods help the body reduce inflammation. Mr. Woods includes a list in his article:

• Fatty fish like salmon, mackerel, and sardines
• garlic
• onions
• almost all green vegetables
• nuts (especially walnuts and almonds) and beans
• fruits and berries (especially deeply colored items like blueberries, oranges, tomatoes, and cantaloupe)
• herbs (especially rosemary, oregano, and parsley)
• spices (especially ginger, turmeric, clove, and cinnamon)
• certain beverages (especially green, white, and black tea and red wine)
• olive and canola oil
• cocoa

So far so good, except, last time I looked, all of the above foods are not only allowed on a low-carb diet to lose weight (except oranges) and a controlled-carb approach to maintaining weight, they're strongly encouraged! (and yes, oranges are fine later in a low-carb diet and controlled-carb approaches)

So, what's this assertion that low-carb may increase infalmmation coming from? Here are the foods that he lists that increase inflammation:

• fatty meats
• high-fat dairy products
• foods cooked at high temperatures, including many fried foods, fast foods, and snack foods such as French fries, hamburgers, and potato chips

I hear you saying hmmm.

Here is where I say, let's take a look at the evidence rather than take his word for it, OK? To do so requires that we find dietary comparisons where a low-carb diet versus a low-fat diet were investigated and researchers actually measured CRP as part of the study.

Do such studies exist? Yes.

Last September, in the American Journal of Medicine, researchers from the University of Pennsylvania compared a low-fat diet to a low-carb diet for six months. They assessed weight loss and compared changes in lipoprotein subfractions and C-reactive protein levels.

Their finding? C-reactive protein levels decreased modestly in both diet groups. However, patients with a high-risk baseline level (>3 mg/dL, n = 48) experienced a greater decrease in C-reactive protein levels on a low-carbohydrate diet (adjusted difference = -2.0 mg/dL, P = 0.005), independent of weight loss.

So, a low-carb diet had a better result on CRP in those following a low-carb diet who had the greatest risk at the start of the study - regardless of how much weight they lost.

Are there any other studies that find similar improvements?

In May 2004 the International Journal of Obesity published a study from Australian researchers that compared a conventional, low-fat diet (30% or less fat) with a low-carb diet and included CRP levels are part of the analysis of the two dietary approaches.

Their finding? Both diets significantly increased HDL cholesterol concentrations and decreased fasting insulin, insulin resistance, sICAM-1 and CRP levels.

So again, we find evidence that suggests that low-carb diets can decrease markers for inflammation.

The AHA maintains that [n]o one knows for sure what causes the low-grade inflammation that seems to put otherwise healthy people at risk. However, the new findings are consistent with the hypothesis that an infection -- possibly one caused by a bacteria or a virus -- might contribute to or even cause atherosclerosis.

Can your diet affect the CRP levels in your blood? Sure they can, and eating the foods on the list he included to help reduce inflammation are all good bets, not only because they may help reduce inflammation, but because they're all nutrient-dense....you just can't go wrong with fresh blueberries, olive oil or wild salmon!

Will eating fatty meats and regular dairy product increase CRP markers? They might, they might not - low-carb diets do not require you to eat either, but if you do include some occassionally, remember, the evidence shows that an overall low-carb dietary approach does not increase CRP - and that's from the evidence.

I highly doubt an occassional burger is going to do such harm that you can't enjoy one now and then - and heck, what's a burger without a nice slice of natural cheddar? Use common sense in your food choices - eat a varied, nutrient-dense selection of foods and work with your physician to ensure your blood tests are on track for good health!

Happy 4th of July! I'm off to enjoy a cheeseburger and a big salad for lunch myself!

AHA Includes Trans-Fats in "Heart Healthy" No-Fad Diet

The Early Show [CBS] recently featured the American Heart Association's "No Fad Diet," a newly released book praised for promoting a healthy lifestyle to gradually and permanently lose weight. On their website, the article, Why 'No-Fad Diet' Really Works, promotes the book as the diet is for all those who are tired of trying to lose weight and failing.

Dr. Robert Eckel, the president of the American Heart Association [AHA] says, "We now have the science to say if you lose weight quickly, you really have to adapt a lifestyle to keep it off long term. Fad diets work, but not long term better than any other diet."

What caught my attention was the sentence, [t]he American Heart Association has stood by its dietary guidelines for four decades and the book is just a reflection of its desire to educate people about the heart-healthy way to eat and live and maintain a healthy weight, Dr. Eckle explains.

There are virtually no details provided about the diet online, so one is left with taking it on faith that the plan is really "heart healthy" and spending $24.95 to learn more by purchasing the book. I'm not one to take things on faith when it comes to nutrition, so I had to see for myself just what they're recommending and what falls within the definition of "heart healthy." A quick trip to Border Books and I had my very own copy of the book.

The back cover assures a reader that "The weight-loss strategies in this book are based on reliable scientific research and are backed by respected medical professionals. The American Heart Association has the information you can trust." [And, yes, the AHA is larger in the sentence on the back cover too!]

The implication is clear - the AHA is trustworthy, their professionals are the ones who are "respected" and they're able to wade through the mounds of research data and cull out only that which is "reliable." Got it?

My first stop within the pages are the sample menus. Why start anywhere else - the menus tell the story best about what they're recommending since they provide a very clear picture of what they're encouraging you to eat day after day.

The sample menus were an eye-opener!

This is not a trick question - Are trans-fats "heart healthy?"

Of course they're not - in fact, the National Academy of Sciences-Institute of Medicine [NAS-IOM] concluded in July 2002 that "trans fat promotes heart disease" and "the only safe intake of trans fat is ‘zero.’" They stated that this was an ingredient that has no safe level for human consumption. Trans-fats are found in foods listing "partially hydrogenated" oils and/or "shortening" and/or "margarine" and/or "fractionated" oil in the ingredients list - a result of chemically altering the oil through a process of adding hydrogen with a nickle catalyst to render it solid at room temperature.

So why then is the AHA including foods that have trans-fats in their sample menus and having the audacity to call them "heart healthy?"

Here are just a few shining examples from the sample menus:

• Page 87 - 6" fast food ham submarine sandwich (290 calories)
• Page 118 - 2 large rectangle low-fat graham crackers (108 calories)
• Page 103 - 4 slices Melba Toast (78 calories)
• Page 100 - 3 cups light microwave popcorn (63 calories)
• Page 94 - 1 whole wheat english muffin (134 calories)
• Page 109 - 1 glazed doughnut (fast food) (160 calories)
• Page 114 - 4 reduced fat vanilla-flavored wafer-type cookies (60 calories)
• Page 122 - 1 biscuit with bacon (fast food) (360 calories)

As pointed out in Shape last September, "Laboratory testing by CSPI and other consumer organizations has also detected the fats in places you might not expect: Breakfast cereals, microwave popcorn, frozen waffles, packaged pudding snacks--all contain partially hydrogenated oils, albeit in smaller amounts than a bucket of fried chicken. Even lowfat foods such as Kellogg's Low Fat Granola aren't trans-fat-free. "It's truly a stealth fat--it's everywhere," Severson says, noting that some seemingly healthful foods like peanut butter, breakfast bars, flour tortillas, bean dips and even baby foods contain trans fats.""

Remember, the NAS-IOM has stated that there is no safe consumption level of trans-fats for humans. So why are glazed doughnuts, fast food biscuits with bacon and microwave popcorn even on the AHA menus? Color me confused, but how are these foods "heart healthy" when the respected scientists at the NAS-IOM have concluded the only safe level of intake is ZERO?

Why did the AHA not have the guts to use the "reliable scientific evidence" and tell consumers straight out that trans-fats are deadly and then provide menus that show how to eat without them?

On page 35 they provide a bullet point with "Avoid trans fats" and then include foods notorious for their trans-fat content in their sample menus, giving a greenlight to eating them when following their "No Fad Diet."

On page 421 they provide recommendations on how to eat fast food with no warning about trans-fats from buns, spreads, cooking oils, french fries or battered fried foods on the fast food menus.

On page 422 they provide a list of foods that may "derail" your diet, and include the biscuit with bacon that they recommend in the sample menu on page 122 - and still no warning about trans-fats.

In fact, their one and only real attempt to provide useful information about trans-fats is found on page 432 and is incomplete - "Commercial products containing hydrogenated or partially hydrogenated vegetable oils include vegetable shortenings, stick margarines and backed good such as cookies and crackers."

While the marketing machine is in full swing to have the media promote this book as healthy, in my view this "diet" is unhealthy and has the potential to wreck havoc on your health in the long-term. It may have been written by "respected medical professionals" at the AHA, who claim they've used "reliable scientific evidence," but at the end of the day, this is one unhealthy way to eat based just on their menus encouraging foods with trans-fats.

And, don't get me started on "Heart Healthy Check" Logo!

Is a Low-Fat Diet Better Long-term?

Only if you're willing to keep your calories restricted - to about 1400 a day!

According to an article at ABC-News detailing the results from the National Weight Control Registry, a database of people who have lost atleast 30-pounds and maintained their weight-loss for at least one year, that's how many calories they eat on average to maintain their weight.

This most recent look at a sampling of 2,700 people in the database, most of whom were women, found that all reported eating about 1,400 calories per day. The number of registrants following a low-carb diet (<90g carbs) rose between 1995 to 2003, from 6% to 17%, and the percentage of calories from fat also rose from 24% to 29%.

What is troubling, at least to me, is the severely restricted calorie load eaten to maintain the weight loss.

A calorie intake of just 1,400-calories per day is starvation. Such a low intake of calories will not provide adequate levels of essential nutrients for the long-term. If you recall, I wrote recently about a study that showed an increased risk of death following weight loss, [Can Losing Weight Kill You?] and pondered about what could be the reasons for the increased risk.

Since the researchers did not track the type of diet used to lose weight, the nutrient-density of the weight-loss diet or the quality of the maintenance diet in that study, it is impossible to conclude that weight-loss, in and of itself, increases risk of early death. However, as I pointed out, loss of lean body mass may be a risky problem with losing weight - and some dietary approaches actually rob the body of high amounts of lean body mass along with fat loss, namely low-fat, very low calorie diets.

For years the National Weight Control Registry has been used to highlight how a low-fat diet and exercise helps one maintain their weight loss. It is often touted as the "proof" that a low-fat diet works in the long-term. But, and this is where the problem is, the focus is on the percentage of fat in the diet and the amount of exercise, not the nutritional quality or quality of life and health of those being followed. Until we shift our focus, and look at the quality of the diet in terms other than calories (hint, hint - nutrient-density) in the short and long-term, we are not going to solve the obesity trends in the US.

As the ABC-News article painfully shows, no one seems worried about the effect of what is chronic starvation for these people - they're concerned over a rise in the percentage of fat in the diets of those in the registry!

You may remember when I wrote about Basal Metabolic Rate in my previous commentary - very few adults have a basal metabolism of just 1,400 calories, and if they're exercising [that is "active"], 1,400 calories is most definitely not enough calories to meet Active Metabolic Rate [the amount of calories to maintain weight].

With that low an intake of calories, the body is fighting for survival, making all sorts of metabolic compromises through homeostasis, to just survive. Long-term that cannot be viewed as a "good" way to lose weight or proof of "success" for maintaining weight loss.

No one should be expected to starve themselves to reach a healthy weight and no one should be expected to become chronically deficient in essential nutrients because they're not eating enough calories each day to maintain that weight loss.

If you're considering a weight-loss plan, think long and hard about what is expected in the long-term....think about how you'll have to eat once you reach your goal weight....think about the importance of meeting or exceeding your nutrient requirements, even in the weight loss period.

And then consider a controlled-carbohydrate approach - an approach that, when done properly, allows adequate calories, is nutrient-dense, spares lean-body mass and allows you to eat well once you're at your goal weight to maintain not only your new weight, but also your long-term health.