The Doctor Weighs In

By Dov Michaeli MD, Ph.D

Every Sunday morning we have a family ritual: 8-9 in the morning it’s “Meet the Press”, 9-9:30—the Chris Matthews Show. And while the TV is blaring and we OD on politics, we walk on the treadmill or step on the elliptical, do abdominals and pushups, do Yoga and lift weights—in short: we indulge our political and fitness addictions simultaneously, and feel self-righteous and quite superior to the flabby unwashed masses.

I love to watch Chris at his best: benignly opinionated, urging his guests to express their opinion on a political subject before pronouncing the Matthews ‘truth’ (“Tell me something I don’t know… here is what I think”), full of lively energy; the man is manifestly enjoying exposing hypocrisy, mendacity, stupidity and other ills of our political leading lights.

So guess how surprised I was when I found out that Chris Matthews makes stupid mistakes, like any one of us. As I sorted through today’s mail my eyes fell on the cover of the latest issue of Diabetes Forecast. There he is on the cover, smiling his heart-melting Irish smile, over the title: “Chris Matthews: the Hardball host goes head-to-head with type 2”. I guess for the readership of this magazine there is only one sort of “type 2”— diabetes. Chris was interviewed by Dan Gilgoff, the politics editor of Beliefnet.com and author of The Jesus Machine: How James Dobson, Focus on the Family, and Evangelical America are Winning the Culture War. (I can’t resist a digression here. Dan, don’t fret: Dobson, Focus on the Family, and Evangelical America are losing the cultural war!).

The interview was an eye-opener for me. I have to admit, I used to attribute much of the American people’s lack of sophistication in health matters to poor education. No more; here is a highly educated individual, possessing an uncanny capacity to ferret out ignorance, stupidity, and dishonesty who betrays an incredible degree of ignorance when it comes to his own health.

Here are some excerpts from the interview, along with some gratutitous comments.

Q. You knew for years that you had diabetes but did very little about it.

A. … I had malaria after coming back from a trip to South Africa in 2001, but what I kept [hearing about] from my doctor was my high blood sugar levels. And I said, “What does that have to do with anything?”

Comment: Chris, with your sharp ear to nuance and encrypted messages—what did you think your doctor was trying to tell you? And you, doctor, were you too pressed for time to press your point home? By the way, going to South Africa without taking the Malaria pills? Did you think you were beyond the reach of lowly creatures such as mosquitoes?

Q. But you more or less ignored your diabetes until even more recently, right?

A… I also wasn’t doing any kind of dieting. I was aware of a general need to skip some things. The toughest habit is going to an airport in the morning when you haven’t had breakfast and seeing the pastries there. Hunger is the best chef—you see a couple pastries and have that and a cup of coffee for breakfast. There was a time when I’d have a hamburger and French fries for lunch with a beer or white wine, and I’d have cheesecake for dessert. It was pretty outrageous.

Comment: I agree. Many a time did I find myself struggling to walk past the Peet’s and Starbuck’s Coffee stands at the SF airport, without succumbing to the temptation of the pastries. But where was your doctor? How come you weren’t warned about pastries, hamburgers, French fries, beer or white wine for lunch? This is inexcusable.

Q. Did you consider reforming your diet after learning about your high blood sugar levels?

A…. I didn’t say, “Wait a minute, this is something I can reasonably deal with.” I didn’t understand the importance of it or the doability of it—that I could solve this problem, that it would be over, and I would be just like everybody else….

Comment: That he didn’t understand the importance of it is in part his doctor’s fault, and in part Matthews’ own dismissive attitude when confronted with inconvenient facts.

Q. You stayed in the hospital a few days. How scary was it?

A. When you have three doses of morphine and it still hurts, you begin to worry.

Comment: And I am sure you went back to your TV show, blasting any and all comers for their lack of clear solutions to our health care problem. Chris, it is people like you who are part of the problem.

Q. You’ve certainly lost a good bit of weight in the past year.

A. On my scale at home I’ve gone from around 235 to about 205, and I think I can lose some more if I do a little more exercise. I really haven’t done any exercise to lose all this weight, just changing what I eat.

Comment: Chris, I watch you every Sunday on TV. You need to lose a minimum of 20 more lbs. You may rid yourself of the daily insulin injections, and as a bonus, you’ll wow the beautiful female political commentators on your show if you lost 40 lbs, and exercised!

Q. Why your aversion to exercise?

A. Don’t have any time. When am I going to do it?

Comment: What a lame excuse. There are people who run multi-billion dollar enterprises who find time to exercise. You make time, Chris. Get up one hour before you normally do, and just do it. It is going to grow on you, it will energize you to go after the bad guys, and you’ll feel sick on days that you skip—I guarantee it.

Q. As a public figure, do you feel obligated to send a message about diabetes?

A. What people ought to be told about diabetes is that if they have it in the family or sense that they’re on the road to it, they should go to their doctor and ask him what he thinks and actually listen to the doctor like they would use [their] financial advisor.

Maybe it’s an Irish thing—we like to think we can talk our way out of things or that we can avoid them. But I’ve come to respect doctors a whole lot through this whole thing because they know what they’re talking about and they’re telling you to do something for your own good.

Comment: You are right, Chris; people ought to listen, even more than to their financial advisor. It is a matter of their health and life—pretty existential stuff.

But you are wrong about it being an “Irish thing”. I have had Russian patients come in with a list of medications and treatments they had decided they needed, and all attempts at telling them otherwise were a waste of time. My own father would go to the doctor only to tear up the prescriptions he was given and treat himself with his grandmother’s nostrums. And my Rabbi told me that when your Celtic forefathers had no idea that the emerald island even existed, the Jews of Ireland already suffered from diabetes. And why did they have diabetes? Because they didn’t listen to their (Jewish) doctors.

See you next Sunday on TV.

Dov Michaeli MD, Ph.D is in the biotech industry

by Pat Salber

AGEs stands for “advanced glycation end products.” AGEs are promoters of high oxidative stress and, as such, they are known to play an important role in the development of cardiovascular disease in diabetics.

AGEs are produced by our bodies internally under certain conditions, such as hyperglycemia. They are also present in fairly high amounts in the typical Western diet. Research published in the Journal of the American Diet Association (Goldberg et al 2004) and in Critical Review of Food Science and Nutrition (O’Brien and Morrissey 1989), show that AGEs are present in high levels in dietary mixtures of proteins, lipids, and sugars processed under elevated temperatures, such as broiling, roasting, or grilling.

According to an recent article in Diabetes Care (October 2007), a single ingestion of a drink high in AGEs results in an immediate impairment of a normal blood vessel function – known as “flow-mediated dilation” or FMD. FMD is the expected dilation of arteries that occurs as a response to decreased blood flow (aka ischemia).

Impairment of FMD is widely accepted as an early indication of endothelial dysfunction, a precursor to atherosclerosis. It is postulated that repeated disturbances of endothelial function over time may lead to cardiovascular disease both in diabetics and non-diabetics.

The authors of the study, Jaime Uribarri and colleagues, had previously demonstrated that a diet rich in AGEs impaired FMD, however, because that diet also contained other substances that can cause the vasodilatory defect, they wanted to repeat the study using a “food” that was “free of carbohydrates or lipids or other known vasoactive substances.”

The researchers created the high AGEs food by combining caffeine-free Coca-Cola light with glucose and concentrating it by a rotary evaporation process. The article states that the resultant beverage is AGE-rich, but free of glucose or lipids (it’s not clear to me what happened to the glucose they added to the diet Coke—but heck, I am not a chemist so I just have to take the researchers word for this.)

Anyway, 44 diabetic subjects and 10 non-diabetic subjects got to drink this concoction to see what it did to their FMD. It turns out both diabetics and non-diabetics had a reduction of FMD after drinking the AGE-rich drink. There was no change in FMD when the subjects were asked to drink water.

The authors speculate that ingestion of diets rich in high-AGE foods could, over time, cause multiple insults to the body’s blood vessels and, eventually result in permanent endothelial dysfunction and overt vascular disease.

An accompanying editorial by Dandona et al, in the same journal point out that a reduction in FMD has been associated with an increase in cardiovascular risk. And that multiple studies over the past 10 decade have shown associations between diet and alterations in FMD. One study cited in the editorial (Plotnik et al, JAMA, 1997) documented a predictable reduction in FMD related to eating high-fat, high-carbohydrate fast food. This was prevented by pretreatment with antioxidants.

We are just beginning to scratch the surface of the relationship between ingestion of certain macronutrients and the relationship to insults to the vascular system. Although we know certain foodstuffs, such as saturated and trans-fats, are bad for us, this new line of research on AGEs opens up a whole new avenue to explore – the relationship between how we combine foods, process and cook foods and their impact on our vascular (and thus our entire body’s) health and well-being.

I look forward to exploring more research on this fascinating and important topic.

by Pat Salber

Perhaps the folks over at Hardee's fast food haven't heard the country is in the midst of an obesity epidemic.  They have just unveiled a new breakfast offering, the Country Breakfast burrito.  It consists of a two egg omelet filled with bacon, sausage, diced ham, cheddar cheese, hash browns and sausage gravy.  Surrounding this protein load is a flour tortilla.  The burrito weighs in at 920 calories.  That's right, 920 calories, about half of what you should ingest in a day.  This little baby also has 60 grams of fat.  All those calories and all that fat will only set you back $2.69.

According to a story by the Associated Press, Brad Haley, Hardees' marketing chief, says that the burrito offers the sort of big breakfast item normally found in sit-down restaurants with an added advantage.  "It makes this big country breakfast portable," he said.

Other Hardee offerings include the Monster Thickburger, a 1,420-calorie sandwich that contains two 1/3-pound slabs of beef, four strips of bacon, three slices of cheese and mayonnaise!  Want a healthy alternative?  Try the Hardees' chicken salad --it is only 1,100 calories and 83 grams of fat.  Supposedly, the chain does offer some low-calorie options, including roast beef and chicken sandwiches.

AP reports that the Center for Science in the Public Interest, a Washington-based advocate for nutrition and health, has called the Hardee's line of Thickburgers "food porn." I love it, food porn!

Jayne Hurley, senior nutritionist at the Center, said the burrito is "another lousy invention by a fast-food company."  The "country breakfast bomb," as she called it, represents half a day's calories and a full day's worth of saturated fat and salt, to say nothing of cholesterol.  "That's all before 10 o'clock in the morning," she said.

Hardees' Haley makes no apologies:  "We don't try to hide what these are," he said. "When consumers go to other fast-food places they feel like they've got to buy two of their breakfast sandwiches or burritos to fill up. This is really designed to fill you up."

Way to go, Hardees.  Keep on fillin' us up.

by Pat Salber, MD

A small story in the business section of USA Today is good news (I hope). It says eleven major food companies, including giants Coca-Cola, Pepsi, and McDonalds will announce changes in how they advertise their products to kids. The Council of Better Business Bureaus (CBBB), in an effort to respond to the epidemic of childhood obesity, has organized the Childrens Food and Beverage Advertising Initiative to get food companies to “pledge” to stop advertising unhealthy products to children. These voluntary measures are supposed to go into effect by the end of 2008.

Evidently each company is making its own pledge. McDonalds, the article notes, will only promote meals with “no more than 600 calories, no more than 35% of calories from fat, 10% of calories from saturated fat and 35% total sugar by weight.” Is that dinner they are talking about? Or a mid-afternoon snack. When it comes to healthy eating, the devil is always in the details.  Products in Kraft Foods' Sensible Solutions line, which has less fat and calories than their other foods, will be the only types of products advertised to kids.

Although, the USA article was pretty positive about the Initiative, it did close with a quote from Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. Brownell says that the food companies’ voluntary guidelines for advertising to kids “are a good move in the right direction, the risk is that it stops here.” We’ve all seen that happen before, right? It is the rare industry that voluntarily reigns in bad practices that are highly profitable.

Digging Deeper

This article motivated me to dig a bit deeper. According to a press release found on the CBBB’s website, the eleven companies* participating in its Childrens Food and Beverage Advertising Initiative, have

“pledged to focus essentially all of their advertising primarily directed to children under 12 on products meeting better-for-you standards or refrain from advertising to that age group.” (Better-for you, compared to what?? … the high sugar, high fat they were advertising to kids before?). Steven J Cole, President and CEO of the CBBB goes on to day, “These expansive commitments significantly exceed the Initiative’s baseline requirements.”

The Pledges

Here are some of the pledges:

McDonalds:

All advertising primarily directed to children under 12 will be for meals that meet “specified calorie, fat, saturated fat, and sugar limitations consistent with the Dietary Guidelines for Americans 2005 and other government standards. They will restrict their advertising to the “Advertised Meal” that must provide no more than 600 calories; and no more than 35% of calories from fat, 10% of calories from saturated fat, and 35% total sugar by weight

The “Advertised Meal” will either be a 4 piece Chicken McNuggets® Happy Meal with low fat white milk and apple dippers with low-fat caramel dip or a Hamburger Happy Meal with low fat white milk and apple dippers with low-fat caramel dip. Scroll down to Appendix A of the pledge to see the details of what’s actually in the “Advertised Meals”

Kraft Foods

Kraft has pledged to only advertise products to children that meet its Sensible Solution nutrition criteria. Cool Whip Lite, Honey Maid Bees, Oscar Mayer Fat Free Wieners, and Lunchables Pizza are some of Kraft’s Sensible Solution products.  (Want to see the rest?  Here's the link to Krafts' Sensible Solutions products.)

General Mills

General Mills will no longer advertise to children foods with more than 12 grams per serving. (Be careful with this one, serving sizes are usually a fraction of what actually gets poured into the bowl or put on the plate). They also pledge to advertise only Healthy Dietary Choices to children under 12.

In fact, according to information on the CBBB website, General Mills has partnered with Nickelodeon (scroll down to page 4 of the pledge) to bring the popular Nickelodeon characters SpongeBob SquarePants, Dora the Explorer and Diego to frozen and canned vegetables. The goal is to make eating vegetables fun for kids. Each package of frozen vegetables will also include stickers featuring the characters that parents can use to reward children for eating their vegetables.

Note, these are frozen and canned vegetables – not the fresh kind that you can get for a fraction of the cost in the veggie section of your local market. And, it is of interest, that the brands touted in the pledge are frozen beans and frozen broccoli with butter sauce!

Never good enough.

I could go on and on, but you are probably thinking. What a crab…nothing is ever good enough. Well, in the midst of an obesity epidemic that threatens the world’s children with early onset chronic diseases and a shortened lifespan, then, heck yeah, promoting frozen buttered broccoli instead of the fresh kind and “apple dippers with low-fat caramel dip” instead of real low fat, fresh apples is not really good enough.

Let’s keep on pushing and pushing until the industry really gets it right. But, we have to do more than blab about it. We have to buy better, cook better, eat better and, in this way, fundamentally change the market for food.

Big job? You bet? But it can be done. Just the fact that these eleven companies are now trying to figure out how to market healthier foods indicates that they will respond to consumer demand (and regulatory threats). When more and more of us choose to shop in the outer perimeters of supermarkets (where the fresh foods are) or in local farmers’ markets, you can bet that industry will be watching.

Pat Salber, MD

by Brian Klepper

I routinely hear well-intentioned people say that, if Americans, and most particularly kids, would just become more responsible for their own health and start eating right, then our obesity and diabetes epidemics would turn around.

I don't think this is going to happen, at least not anytime soon. The blunt truth is that, to a large degree, we have an obesity epidemic because Congress ensures that the food industry has free rein with their marketing practices.

Late last year, Pat Salber wrote a post – she had a corresponding video commentary on Medscape – on advergaming. An important study had been released on the Kaiser Family Foundation website that detailed how food companies were using the Web to influence kids' eating behaviors, building on their TV advertising tactics. Here's a quote from the press release:

The report, “It’s Child’s Play: Advergaming and the Online Marketing of Food to Children,” found that more than eight out of ten (85%) of the top food brands that target children through TV advertising also use branded websites to market to children online. Unlike traditional TV advertising, these corporate-sponsored websites offer extensive opportunities for visitors to spend an unlimited amount of time interacting with specific food brands in more personal and detailed ways. For instance, the study documents the broad use of “advergames” (online games in which a company’s product or brand characters are featured, found on 73% of the websites) and viral marketing (encouraging children to contact their peers about a specific product or brand, found on 64% of sites). In addition, a variety of other advertising and marketing tactics are employed on these sites, including sweepstakes and promotions (65%), memberships (25%), on-demand access to TV ads (53%), and incentives for product purchase (38%).

In 2005, Consumers Union issued a report on the food industry's advertising campaigns. That press release headline read:

Certainly, the data say we're losing the war on obesity. Data from two National Health and Nutrition Examination Surveys show that the prevalence of obesity in adults (aged 20–74) more than doubled between the end of the 1970s to the early 2000s (from 15.0% in the 1976–1980 survey to 32.9% in the 2003–2004 survey).

Children and teens also grew significantly plumper. The prevalence of obesity in children 2–5 years rose 2.5 times, from 5.0% to 13.9%; for those aged 6–11 years it nearly tripled, from 6.5% to 18.8%; and for the 12–19 year olds, it more than tripled, from 5.0% to 17.4%.

It's worth noting that, while obesity has intensified throughout the country over the last several decades, certain areas, like the South, are consistently worse than elsewhere. This is traceable in part to regional dietary habits that, of course, long predate the food industry's influence, as well as to the role of poverty.

Percentage of Obese Americans - 2005

BMI > 30, or ~ 30 lbs. overweight for 5'4" person

Source: Centers for Disease Control, Behavioral Risk Factor Surveillance System, 20006 

(If you're interested in seeing the CDC's 20 year (1985-2005) annual trend data on overweight by state, go to http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm, and look for the link that says "Download the Obesity Trends Map." Play the slides in quick sequence. It's very alarming to watch as the entire country lights up, reflecting how quickly we're getting fatter.)

The reality is that most of us are susceptible to the marketing, and can't withstand the barrage of enticements. And they're everywhere. Every day, Americans are bombarded by come-ons for fast, prepared and junk foods. This diet has become part of many people's regular routine. The industry now vies to subsidize school districts in exchange for the unrestricted ability to advertise, put in vending machines and have their products available in cafeterias. They have developed books for very young children with appealing characters to create brand loyalty early on,

And except for the unhealthy part, what's not to like? These foods are cheap, readily available and, lets face it, all that salt and fat taste really good. Only the most optimistic among us can imagine that, unless something dramatic changes, we'll be able to reverse our love affair with bad food. Nor will any of the other developed and developing countries that all have the same problem.

The food industry has virtually unrestrained promotional access because Congress has willfully ignored their role in the obesity problem, preferring instead to argue that if people were just more responsible as individuals, they'd get this under control. (A quick glimpse of our Congressional representatives shows that, when they preach restraint and self-control, they're talking about us, not themselves.)

 The threats are to the national health and the national pocketbook. At the moment, for example, diabetes and related conditions alone cost Americans about $165 billion a year, about 8 percent of the national health care spend. And we're just getting going. As the population gets fatter, this is going to be a blockbuster national health care problem. Nobody will be able to afford what, in today's terms, we'll be expected to pay to keep all these people alive, semi-well, and consuming.

Congress has good reason to advocate for the food industry, in the form of millions of dollars in lobbying funds that go to buy influence. Skeptical? Go to www.opensecrets.org, the site of the Center for Responsive Politics, a non-partisan group dedicated to accountability in government, and do some checking yourself. Big dollars from the food, beverage, candy and restaurant industries to Congress, part of the larger $2,5 billion dollars that were distributed in 2006 to our 535 representatives. This is the way it is with virtually all special interests. Most effective groups lobby. Why? Because it works!

There are, of course, precedents for change. Congress decided that the tobacco and alcohol industries would be limited in where and how they could advertise, actions that have had profound impacts on America.

It's absolutely in the national interest to turn this problem around. But unless we have dramatic change from elsewhere – chemical concoctions that make junk food taste as good but have no ill effects, or some miraculous national consciousness-raising (Not impossible. Check out the teen fitness program Dance Dance Revolution or consider how the green movement is sweeping across the globe.) – we won't change our obesity and chronic disease problem. To fix that, we'll need a change in how the food industry behaves. And to get that, we'll have to change how our government works.

(The same is true, by the way, for health care reform, but that's another post.)

Brian Klepper is a health care analyst based in Atlantic Beach, Florida. You can reach him at bklepper@gmail.com.

Thanks heavens, the Farm Bill is finally getting the attention of the healthcare community. In case you can’t make the link here are some equations:

Cheap corn = cheap high fructose corn syrup = fat = diabesity.

Pesticides + chemical fertilizers = toxic soil and toxic water

I could go on and on, but you get the point.

Michael Pollan, journalist and author of the best-selling book, "The Omnivore’s Dilemma," summed it up nicely in his April 22, 2007  NY Times opinion piece, "You Are What You Grow":

“Compared with a bunch of carrots, a package of Twinkies, to take one iconic processed foodlike substance as an example, is a highly complicated, high-tech piece of manufacture, involving no fewer than 39 ingredients, many themselves elaborately manufactured, as well as the packaging and a hefty marketing budget. So how can the supermarket possibly sell a pair of these synthetic cream-filled pseudocakes for less than a bunch of roots? For the answer, you need look no farther than the farm bill. This resolutely unglamorous and head-hurtingly complicated piece of legislation, which comes around roughly every five years and is about to do so again, sets the rules for the American food system — indeed, to a considerable extent, for the world’s food system. Among other things, it determines which crops will be subsidized and which will not, and in the case of the carrot and the Twinkie, the farm bill as currently written offers a lot more support to the cake than to the root. Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat — three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades — indeed, for about as long as the American waistline has been ballooning — U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy.”

Now, according to a press release from American Public Health Association and other organizations:

“Over 300 health professionals from around the country- physicians, nurses, dietitians and public health practitioners - sent Congressional leaders a letter today calling for the 2007 Farm Bill to be a "Healthy Food Bill," to better combat childhood obesity and other illnesses by making healthy food more affordable and accessible.

'The Farm Bill is fundamentally a public health bill,' said Dr. Benjamin of APHA. "Its long reach affects the food security of our nation and, in turn, our health." The letter, sent to Chairs and Ranking Minority Members on the House and Senate Agriculture Committees, targets policies in previous Farm Bills that have helped make the calorie-dense foods Americans already over-consume - namely cheap starches and highly processed foods made from added sweeteners and oils derived from corn and soybeans - some of the cheapest to buy.

Obesity and unhealthy eating constitutes a national crisis, with $117 billion per year in estimated treatment and indirect costs. The epidemic of childhood obesity promises that these children will have more heart
disease, diabetes, cancer and stroke, in some cases not long after they become adults.

'Our communities are flooded with cheap, unhealthy foods that ultimately are helping drive healthcare costs through the roof,' said Dr. David Wallinga, director of the Food and Health Program at the Institute for Agriculture and Trade Policy. 'None of us can afford the status quo. Our Farm Bill should support greater access to healthier foods for children, and support farmers growing healthier foods. It's an investment everyone will benefit from.'

From 1985 to 2000, the real consumer cost of fresh fruits and vegetables rose nearly 40 percent while that of sugars and fats actually dropped 7-14 percent. Soda pop prices dropped most of all, by 24 percent in real dollars. By encouraging the over-production of a few raw commodity grain crops, Farm Bill policies have worked at cross-purposes with healthy eating recommendations, such as those in the USDA's own Dietary Guidelines for Americans.

The letter also singles out the industrial-scale production of food animals raised on grain and routinely fed human antibiotics as growth promoters, which increases antibiotic resistance. Impacts on the health of consumers, communities and the planet from the intensive use of pesticides and fossil fuels in agriculture are highlighted as well.

The health professionals called for a new Farm Bill that will improve access to healthy foods (fresh fruits and vegetables, whole rather than refined grains, and better fats), help ensure better school access to healthy foods, and help to build the infrastructure to get healthy foods to low-income communities.

'This letter reflects our professions' understanding that the obesity crisis has links to a food system that is seriously out of balance,' said Dr. Robert Lawrence, Director of Johns Hopkins' Center for a Livable Future, and Professor of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. 'The Farm Bill has to be part of the prescription for improving our health."

To read the full letter, go to: http://www.healthobservatory.org/
<http://www.healthobservatory.org/> , or
http://www.farmandfoodproject.org/
<http://www.farmandfoodproject.org/> "

Pat Salber, MD

Would you believe it? I found this report on a three-decade study of wine drinkers on Wine Spectator Online. The study itself was published in a respected peer-reviewed medical journal, the Journal of Gerontology. The results are the stuff wine-marketers (and wine lovers) dream about: Wine drinkers had a lower mortality rate compared to drinkers of other alcoholic beverages.

No, the study was not performed in California's Napa Valley nor in the Loire Valley in France. Rather it was done in Finland (there's wine in Finland?) by Timo Strandberg and colleagues, researchers at the University of Oulu. At the start of the study in 1974, 2,468 businessmen and male executives, ages 40-55, were assessed at the Institute of Occupational Health in Helsinki for cardiovascular risk factors and alcoholic beverage preferences.  Only 131 of these men did not use alcohol, 455 did not report a single beverage preference, and 694, 251, and 937 preferred beer, wine, and spirits, respectively.

 The researchers tracked these men down for a re-assessment in 1985 and again in the year 2000. As you can imagine, some of these guys were a bit “long in the tooth” by the end of the study. Others had died or just dropped out (of the study).  Study subjects were included in the final calculations only if they were constant in their preference for one type of alcohol (e.g., wine, beer, or spirits) over the others.  By the time of the second stage of the study, in 1985, only 1,369 men were available to be reassessed. Some dropped out of the study, some changed alcohol habits and 93 of the men had died. By the time of the final calculations, in 2002, there were 1,127 men left in the study who drank three or less drinks per day and had not changed their drinking preferences over the course of the study.

Here are the results:

The men remained pretty constant in their choice of alcoholic beverage and there was not a significant difference in the amount they drank between the different beverage groups.

 Men with wine preference had the lowest total mortality of the three groups due to lower cardiovascular mortality. Compared to the spirits drinkers, wine drinkers had a 34% lower total mortality.  Beer drinkers had a 9% lower mortality than spirits imbibers.  Should we break out a bottle of pinot to celebrate the good health of wine drinkers? 

Best keep the cork in the bottle for now. There are some confounding variables. It turns out wine drinkers had healthier habits than beer and spirits guzzlers. They exercised more and smoked less, both factors associated with better health and lower mortality.   In other words, it may not have been the wine that led to a good long life, rather wine drinkers might be more health conscious.

Here's how the Strandberg, the lead researcher, sums it up:

"Is it the drinker rather than drink characteristics, as healthier men preferred wine?" It could also be that "spirit preferrers may lead a more dangerous life, with more risk factors, and all hidden aspects may not be culled in an epidemiologic study." What he is pointing out, rightfully so, is that care has to be taken in interpreting the results of this type of study.

Oh well. It did sound too good to be completely true -- kind of like reading that dark chocolate lowers blood pressure, but only if you don't eat so much that you get weight-related hypertension. 

Back to the fruits and veggies.

Pat Salber, MD

Here is the translation for calories on food packaging:

Calorie free:   Fewer than 5 calories per serving

Low calorie:  40 calories or less per serving.  If a serving is 30 grams or less or 2 tablespoons or less, it signifies 40 calories per 50 g of the food

Reduced or fewer calories:  At least 25 percent fewer calories per serving than the reference food

That means you can say something is "reduced in calories" if there are 25% fewer calories, but the food can still be very high calories.  75% of a big amount is still a big amount

Did you know that 10 percent of the energy consumed in this country (~100 billion gallons of oil per year) is used to grow our foods? And 14% of that astounding number is related to transporting foods from where it is grown to where it is eaten? Another 1/3 of the energy related to producing food is related to the manufacture of fertilizers. 

The SF Chronicle, in a supplement to celebrate Earth Day, published an article to help readers Eat Green.  Entitled, "Are You Gorging on Fossil Fuels?" the article , written by Carol Ness, provides some, well, food for thought...and hopefully it will spur you to action.  Here are some of the tips from that article:

• Eat local.  You can save tons of energy by eating foods grown within 100 to 150 miles of where you live.  A study by Iowa State University shows that if Iowans bought just 10% more locally grown produce, annual carbon dioxide emissions would be reduced by up to 8 million pounds.
• Eat organic....organic farmers don't use those energy-gobbling fertilizers used to "normal" produce.
• Eat whole foods.  These are the types of foods found on the perimetry of our grocery stores or in farmer's markets (fresh vegetables, fruits, eggs, and dairy products).  The whole inner part of the average grocery store is dedicated to highly processed  foods.   These foods require more energy to produce them than they provide when consumed. 
• If you eat meat, eat locally-raised, pasture-fed animals.  These animals eat local grass, as opposed to fertilizer-fueled corn and they do not require lots of gasoline to get them to where you can buy them.
• "EnerWize" your kitchen.  Replace old energy inefficient appliances.
• Bottled water or tap water?  No question, drink local tap water.  Filter it if you like, but don't preferentially buy water shipped from Europe or Fiji or other exotic locales.  It tastes the same, it is just as good, and it doesn't burn energy getting from the spring-fed stream to your mouth.
• When you eat out, eat green.  Patronize restaurants that buy local.  Google "eat local" for recommendations.

Getting green, going green, staying green, requires attention to the details of your energy consumption, but it need not be onerous and the rewards are palpable.  My meals taste better when I buy local,  my neighbors do better when I buy local and I feel better when I buy local.

 Thanks to the SF Chronicle for providing this guidance.

Pat Salber, MD

Click here to read other TDWI posts on this topic

There are a bunch of little things I have wanted to share…but they are all pretty brief, really not enough to justify a “whole post.” So, I am now inaugurating a new, occasional TDWI post (you get to do that when you are “in charge”). This post will give me a chance to capture some great, but brief, unrelated ditties, for your reading pleasure. Many of these postlets have been sent to TDWI by readers who will be credited for enriching our collective reading experience.

These posts will be called “This and That” or T&T, for short.

Here is the first TDWI T&T post (enjoy):

· Email from Skip McGinty: Why Ellen DeGeneris says she can’t quite get around to exercise:

“I gotta work out. I keep saying it all the time. I keep saying I gotta start working out. It's been about two months since I've worked out. And I just don't have the time. Which uh..is odd. Because I have the time to go out to dinner. And uh..and watch tv. And get a bone density test. And uh.. try to figure out what my phone number spells in words.” Ellen DeGeneres

· Snack tips from Fitness magazine (my plane reading Houston to SF):

Cracker snacks, how do they stack up:

Ritz crackers Serving size = 5 crackers Calories/serving = 80

Wheatables Serving size = 17 crackers Calories/serving = 140

Multi-grain Wheat Thins Serving size = 17 crackers Calories/serving = 130

Triscuits (I love ‘em) Serving size =6 crackers Calories/serving =120*

Kavli Thin Crispbread Serving size =3 “sheets” Calories/serving= 60

Wasa Fiber Rye Crispbread Serving size = 1 sheet Calories/serving = 30**

*120 calories and I only get to eat six small Triscuit crackers…this is why I don’t eat them anymore

**Wasa Fiber Rye crackers are the perfect snack food. You can eat two (comparatively gigantic crackers) and only ingest 60 calories. Try dipping them in Haig’s hummous. Now there is a snack that is satisfying, filling, and modest in term of calorie contribution

· Are you a runner or walker? Got lots of old running shoes lying around?

Of course you do. If you are never going to use them again, here’s how you can put them to good use. Box them up and send them to Ana Weir at www.oneworldrunning.com. She will wash them, spiff them up, and then send them to folks in the developing world so that they can run, hike,or just plain get around in shoes. Thanks, Ana.

· Finally, Barry Messersmith sent this to TDWI to help readers recognize and respond to stroke-in-progress (Thanks, Barry!):

“A stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. This test is recommended by physicians. Ask the person these 4 things:
1. Ask the individual to SMILE.
2. Ask the person to SPEAK A SIMPLE SENTENCE
(Coherently, i.e. . . It is sunny out today)
3. Ask him or her to RAISE BOTH ARMS.
4. Ask the person to 'STICK' OUT THEIR TONGUE.
If the tongue is 'crooked', if it goes to one side or the other,
this is another sign of a stroke.
If he or she has trouble with ANY ONE of these tasks, call 911 immediately and describe the symptoms to the dispatcher.”

OK, a bit of a disjointed post, but fun, huh? Let me know if you like this new feature. If so, T&T will be a keeper…if not, this could be the first and last This and That.

If you like the idea of sharing short, but substantiated, health tips, email them to me @ psalber@comcast.net. You could find your name in the bright lights of TDWI, cool huh?

Pat Salber, MD

Yes, I know. We’ve all read these articles ad nauseam. And we all are in agreement, so what’s more to say? As Chris Matthews would say: tell me something I don’t know. Try this, Chris. Today on NPR was this news item:

· If current trends continue, over 50% of the population (that’s everybody, adults and children) would be obese or morbidly obese by the middle of the century.

· Babies as young as 2 years old are now being seen in hospitals and clinics with severe obesity and diabetes type 2.

· An 880 lbs (that’s not a typo) man had to be taken to the hospital. It required 16 men (and I don’t mean girlie-men) to move him, a part of the house had to be demolished, and a specially constructed vehicle/ambulance had to be used.

Question: where in the world can something like that happen? The answer is posted at the bottom of this column.

The battle between profit and portions .

In today’s New York Times Sunday Business section (NYT, Sunday, March 25, 2007 ) there is a new look at the obesity problem—from the business perspective (“Will diners still swallow this?” by Andrew Martin). There is actually a profit incentive for restaurants to stuff us with ever bigger portions. How could that be? Simple, the cost of food is only about 30% of the total; the rest is fixed expenses: labor, rent, utilities, taxes, etc. This is from research soon to be published by Marion Nestle, professor of Nutrition, and Lisa R. Young, a dietician and adjunct professor, both at NYU. So now the calculus is quite straightforward; Starbuck’s, a uniquely American phenomenon of marketing genius, offers a 12-ounce “tall” for $1.70, while the 16-ounce “grande” (how did they come up with those names?) will set you back by $1.89. Now consider that the extra 2 ounces costs Starbuck’s about 5 cents. Labor and other fixed costs are, well, fixed. Multiply the 14 cents extra profit per cup by the millions of cups sold every day, and enormously grande profits can fill you with a new appreciation of the power of large portions.

The same math applies to Super Size hamburgers (McDonald’s), Colossal hamburgers (Ruby Tuesday), Thickburgers (Hardee’s), Megabreakfast (Denny’s), to name a few. Ruby Tuesday’s actually tried to reduce the portion size and charge less for the smaller portions, but customers voted with their feet. They soon had to re-join the portion-size arms race.

It is not only consumers who force the restaurants into this dance macabre; Wall Street, with its quarterly profit obsession, will crush the shares of restaurants who even try to reverse course--next quarter same store sales and profit margins will not look good. It took a privately held company, T.G.I. Friday’s, and a gutsy CEO with a well-developed sense of morality (and Super Size prefrontal and frontal cortexes?) to announce a Right Size policy, and reduced prices to match.

What’s to be done?

It’s tough. Consumers were brainwashed that they get better value with large portions. A typical argument of the‘free-choice, market-forces’ crowd is that if we consumers didn’t want to eat those gigantic portions- we would simply leave some on the plate. Right…In reality, most people will eat whatever quantity is put in front of them. This is well documented in the literature. I, for one, have to clean up my plate; my mother used to say, in Yiddish, that it was a sin to leave food on the plate. And if I didn’t ask for seconds, it was a sign that I didn’t like her cooking…Restaurant chains LOVE such mothers.

Professor Rolls of Penn State U., who did research on the behavior of consumers when offered large portions, suggested that restaurants may start a small, almost surreptitious, downsizing of food portions. I suspect that in our competitive, no prisoner taken economy, competitors will quickly spread the word.

I favor a sustained, widespread education campaign, not much different from the anti tobacco campaign. I believe that in the last analysis an educated citizenry will force a return to sanity and sanité.

So what country was it?

AUSTRALIA ! I couldn’t believe it. My icon of outdoorsmen, frontiers people, the epitome of healthy lifestyle. Say it isn’t true mate, please.

Dov Michaeli MD, Ph.D.

When it comes to absorbing nutrients, it makes a difference how you prepare a food (cooked or raw) and what foods you eat with it. The science of understanding nutrient absorption is an area called “bioavailability.”

BBC NEWS online has an interesting, easy to read article, titled "Getting the Best Out of Your Food," that will help you understand the best ways to eat certain foods to maximize their nutritional value to you. Here are a few hints from the article.

Eat your spinach with a glass of orange juice.

We all know spinach is a good source of iron. It is an important source if you are a vegetarian. But did you know that the iron in spinach is in a form that is not readily absorbed? By drinking orange juice along with your spinach, you change the iron in spinach from an oxidized state to a more readily absorbed non-oxidized state.

You absorb more beta-carotene, an antioxidant, from cooked carrots than raw carrots. Cooking breaks down the carrot’s cell walls, allowing easier absorption of this important nutrient.

Canned tomatoes or cooked tomatoes are better than raw tomatoes when it comes to lycopene. Lycopene is another antioxidant. It is thought to halt cell damage. It is turned into a more readily absorbed form when tomatoes are cooked or canned.

Iron fortified cereals may not be the best way to get your daily dose of iron. Whole grain cereals contain phytates which inhibit the absorption of iron. Calcium in milk also inhibits iron absorption. And that cup of coffee you drink with your cereal…well, it contains phenols that inhibit iron absorption as well.

So it all gets pretty complicated. As scientists continue to study how nutrients are absorbed and how foods interact with each other, we are likely to get even more confused. For now, it is probably best to follow a diet that is varied in nutrient sources and varied in the ways the food is prepared. If you eat a diet that is rich in fruits and veggies and includes good sources of protein and fiber, you can feel confidant that you have optimized your chances of getting all the vitamins and minerals you need.

In most of the Western world, salad is not a traditional breakfast food. Most of us wouldn’t touch the green stuff until lunchtime as least, preferring instead to start the day with cold cereal, an egg dish, or a pastry.

Once you start having breakfast salads, however, it will become a habit you won’t want to break. Besides substituting for more caloric options, such as bacon or butter croissant or sugar coated cereals, salad fills you up. When made with fresh, high quality ingredients, it is a great source of vitamins and fiber. Add some cheese and a little extra virgin olive oil and you have a wonderful Mediterranean style breakfast treat.

To get you started, here is my recipe for what I call, " Pat's Great Big Breakfast Salad."  Here’s the recipe:

Place in a bowl the following ingredients:

2 cups of torn leaves of a crispy lettuce (like Romaine)

Slice or chop ¼ cup of fresh tomatoes

Chop 2 scallions (green onions)

Fresh herbs (basil, parsley, oregano – all easy to grow)

1 ounce Feta cheese, crumbled

Toss with

2 teaspoons of extra virgin olive oil

Freshly cracked black pepper.

Be sure you weigh and measure the cheese and olive oil as this is where the calories come from. If you are careless here, you can add a lot of calories and it really won’t taste any better. This large, satisfying breakfast salad has only 188 calories (107 from the fat in the cheese and olive oil).

If possible, buy your produce from a Farmer’s market or from a local grower at your supermarket. It is likely to be fresher because it doesn’t have to be transported long distances. And, it often tastes better because it was allowed to stay in the ground or on the vine longer than veggies that are shipped to distant parts.

Serve with

A Wasa light rye cracker, 2 or 3 olives or a handful of radishes. Add a good cup of coffee and a large glass of ice water with sliced lemon and, voila, a perfect breakfast.

If you don’t have time to make this in the am. Prepare it the night before (minus the cheese and olive oil). Put the cheese in a separate plastic bag and buy a small container of olive oil that you can keep at work. When everyone else is chowing down of a 1,000 calorie pastry, you’ll be filling up on vegetables.

PS: If you are a PEERtrainer (www.peertrainer) participant, you can download this item into your food log by going to the PEERtrainer calorie wiki. Search for Pat’s great big breakfast salad and click on download to “breakfast.

Want a healthy breakfast?  Try a salad.

Thanks to Barry Messersmith for sending this link:  Good Foods, Gone Bad.

Christopher Winjek, the author of The Top 10 Good Foods Gone Bad describes his hit list of bad foods, all of which were formerly known as good foods, but are now corrupted by over- processing and under-investment in things that make good foods "good." 

 The list has few surprises:  #10 is fish sticks..."good for you" fish is covered in breading and associated preservatives to help it survive in your freezer forever.  Because it is so tasteless, we compound the problem by smothering it in tartar sauce or other high calorie condiments (the calories we forget to count).

#9 is yogurt.  That's right, the food we think is intrinsically healthy is loaded with sugar.  Check out "Yogurt - health food or dessert?

Canned soup is 8th on the list.  According to the author, canned soup "is a miserable concoction of salt, fat, artificial additives, preservatives, water and maybe part of a carrot." One serving typically contains 1000 mg of sodium, about half of the recommended daily allowance.

Green tea drinks are number 7.  We are not talking about pure green tea from Asia, but the green tea drinks you find in the grocery store that have been made "tastier" with sweeteners and other stuff. 

Russett potatoes win the 6th slot for two reasons:  (1) they have a high glycemic index and so raise your blood sugar
"Fully loaded" baked potatoes more quickly than foods with a lower glycemic index and (2) they usually require something high fat, high calorie -- like butter or sour cream -- to make them tasty. 

Popcorn (#5) used to be a health food, but not anymore.  Read the ingredients on the package before you pop up your next batch.  Sliced bread and breakfast cereals are numbers 4 and 3--think white bread and fruit loops.  Need I say more?

The second place award goes to organics that really aren't. Here's what Winjek has to say about commercial organics:

"Big players such as Wal-Mart and Kraft want part of the profits, and their demand for cheaper production methods undermines what it means to be organic. And so we now have organic milk from caged cows force-fed organic grain. And we have organic junk food with organic ingredients flown in from around the globe, disguised as health food by virtue of the organic label."   Cage a cow and feed it organic grain?  Come on now!

Pepperoni pizza (meat n' cheese)And, the winner is pizza.  Number one on the hit parade of good foods, gone bad.  The typical fast food pizza is topped with high fat meats, oily toppings, practically no fresh ingredients.  Years ago, I went to Italy and had real pizza.  Fresh peas, homegrown onions, recently picked tomatoes, and wonderful homemade sauces....ah, that's amore.

Scientist Robert Bohannon drinks coffee and talks on the phone Friday in his Environostics offices in Durham, N.C. Bohannon has developed caffeine so it can be baked in doughnuts and bagels Geez, Louise, I spend alot of time writing about healthy eating.  Donuts are not high on my list of healthy foods.

So, now, a scientist, Dr. Robert Bohannon , has come up with the concept of Buzz Donuts.  You take a high carb, high fat food and add caffeine.   Give it a snazzy name:  Buzz Donuts.  There you go...the perfect food for the modern age.  It should keep cardiologists in business for a good long time!