Archive for March, 2011

Gluten appears to cause more problems than we thought

Thursday, March 31st, 2011

Ah, that wheat beckons or does it?

My wife handed me an article the other day that she had clipped from the March 15, 2011 edition of The Wall Street Journal. The title was "Clues to Gluten Sensitivity." We've got several friends who have adopted gluten-free diets. When I went through medical school, in the Dark Ages, I only learned about celiac disease (CD), an autoimmune response to gluten. I hadn't thought about CD in years, but after finding a number of articles in the web-based medical literature, I realized there was an analogy between CD and severe lactose intolerance.

Some people lack the enzyme necessary to successfully drink cow's milk. They have bloating, pass gas and may have diarhea after drinking milk. Others, like me, can drink some milk, but have symptoms if they drink it in quantity. Still others may have a normal level of lactase, the enyzyme that allows digestion of lactose (the main sugar in cow's milk), but have an allergy to a protein in milk.

Similarly, about 1% of our population has CD as a genetic disease which causes severe symptoms after ingestion of gluten, a protein found in wheat, rye and barley. They can be diagnosed (while on a normal diet) with blood tests and a biopsy of the small bowel. The blood tests show the presence of certain antibodies and the biopsy shows the flattening of the usual villi, tiny finger-like projections that are crucial for the absorption of foods. CD doesn't go away, but a gluten-free diet can allow them to lead a normal, healthy life. The incidence of CD appears to have risen markedly over the last half century, perhaps because of alterations in modern wheat that increase the amount of gluten.

Now physicians at the University of Maryland Center for Celiac Research, Johns Hopkins and several Italian medical schools have found a much more common gluten sensitivity (GS) disorder. Those people don't have damaged villi or positive blood tests and may have a host of symptoms that relent when gluten is removed from their diet.

Whole wheat bread, my favorite, but not for everyone

The estimates I've read range from 6 to 10% of our population as having GS. They don't appear to be reacting in the same way as those with CD. At present there's no definitive test for GS, but a gluten-free diet relieves the multitude of symptms that may be associated with this disorder.

Then, just to complicate things a bit further, there is also wheat allergy, a condition that is relatively rare (less than 1% of kids and some adults after exercise). That can cause severe problems with hives, nasal congestion or even anaphylactic shock.

The new disorder, GS, raise lots of questions with few answers, so stay tuned in and think about your own tolerance for gluten.


Colorful foods, natural & un-

Tuesday, March 29th, 2011

Any food dyes here?

I've always been suspicious of food dyes. Reading labels and seeing Red 40 and Yellow 6 made me wonder if they added any benefit, other than allowing the food companies to sell more of their product. Then we were in Maryland, near the end of an eleven day trip to visit kids and grandkids and old friends and I spotted an article in the Washington Post titled "Eye-catching foods to get closer look from regulators." Today the Wall Street Journal and The New York Times had similar articles.

So I went back to an online 2007 British article published by professional staff from two medical schools which, in a randomized, double-blinded, placebo-controlled trial showed adverse effects (hyperactivity) from one mxture of artifical food color and additives. In 2008 the non-profit Center for Science in the Public Interest, calling those dyes the "Secret Shame" of food industry and regulators, petitioned the FDA to ban them, noting several of them were already being phased out in the United Kingdom.

CSPI noted that a 2004 meta-analysis had shown that those dyes can affect children's behavior and quoted two more recent British government-funded studies of kids in a general population that had also concluded that the dyes and a preservative (sodium benzoate) had adverse effects on behavior.

So what happened? You got it. The FDA didn't ban the dyes.

In June of 2010 CSPI published another article that raised issues beyond hyperactivity, namely cancer and allergic reactions. They commented that our public is exposed by the food manufacturers to roughly fifteen million pounds per year of eight synthetic dyes. Three of those dyes are contaminated with known carcinogens, CSPI said, and a fourth, Red 3, was already acknowledged to be a carcinogen by the FDA itself.

Three of the four plus Blue 1 can cause allergic reactions in some people; this is not new knowledge according to CSPI.

Why do the food companies use the dyes? They're eye-catching and kids look for bright colors. CSPI urged the FDA to ban the dyes since there is evidence in human and animal studies of potential harm from them, but none of helpful effect, except to the wallets of the food producers.

That article came out in late June of 2010. Now in late March of 2011 the FDA is convening a panel of experts with the comment that artificial food dye is an issue "for certain susceptible children with ADHD and other problem behaviors."

I'm not betting on the outcome of the panel's recommendations, at least not from the FDA. On the other hand the food industry may be catching on. Some may try natural colors and I saw a mention of a new Koolaid product, Koolaid Invisible.

In the meantime, maybe it's time to wean your kids off of M&Ms.

Good fish, bad fish: a cautionary tale

Monday, March 21st, 2011

This fish is in trouble

I've learned something about fish food poisoning these past few weeks. Perhaps I knew about it  in medical school, but that was a long time ago. We love fish, consider it a treat, eat it several times a week and, once in a while, partake of other marine creatures. I like mussels as long as they're cooked,  and will eat sushi, but never raw oysters.

So four people we know have had apparent fish-related food poisoning recently. They didn't eat at the same place or the same fish. That got me curious and I started to hunt down types of food poisoning related to eating fish and other marine critters. I found two that aren't the usual bacterial- or viral-caused forms (I'll write about those another time).

So what happened in the first instance was at a play when a close friend got suddenly and violently ill. He collapsed, was "out of it" for perhaps thirty seconds (I thought cardiac arrest or major stroke), then sat up and vomited copiously over himself and his spouse. Then he seemed weak, but otherwise normal. I went with hin to the ER where he was monitored for cardiac rhythm changes for four hours, got blood work and had a brain scan. All those were essentially normal, but he vomited four more times in the ER and once more as I was driving him home.

Over the next two weeks he had a cardiac workup with an echocardiogram, a stress test and a 24-hour Holter monitor for rhythm disturbances. All those were negative. He was previously reasonably healthy for his age of 72 and had no history of any seizure disorder.

A few other tests are pending, but then I spoke to a friend who had suffered a similar illness and heard of two others in the community. I went hunting for odd forms of food poisoning as none of these folk had diarrhea and none had sequelae of their short-term illness.

I finally heard the term scromboid fish food poisoning. All four had eaten fish and several had eaten shellfish.

Scromboid turns out to fit better than other diagnoses. It's typically associated with the consumption of fish, especially Scombridae fish like tuna or mackerel. It has a rapid onset, is marked by abdominal symptoms and or prostration, headache, palpitations, or flushing., sometimes tachycardia (rapid heart beat) and low or high BP and usually is self limited. It is caused by a toxin which is not inactivated by cooking and may be associated with spoiled meat.

The CDC says it's the most common chemically-related food poisoning in the United States., but at that only causes 5% of the food-related illness reported. It's much less nasty than ciguatera, the other fish related illlness I found. That one is also toxin-related, heat-resistent, can cause somewhat similar symptoms, but can lead to months ort even years of problems.

After reading of these I'll still go back to our favorite fish restaurant; they had no other patrons with similar symptoms. Scromboid seems to be relatively uncommon & mild in retrospect. On the other hand some speculate that ciguatera caused the migration of the Polynesians between 1,000 and 1,400 CE.

If you do eat fast food, you may want to buy this book

Wednesday, March 16th, 2011

My writing mentor, Teresa Funke, sent me an email after reading one of my posts recently. She mentioned that her family has a book titled Eat This Not That! Her three kids love reading the book and pointing out choices, especially wrong ones, that she and her husband make. They've purchased several editions of the book over the past few years.

Well I had to buy the book and easily found it in our favorite locally owned bookstore, Old Firehouse Books (that's right; it's in an old fire station). This is the 2011 edition and costs $19.99.

The authors (major and minor) are David Zinczenko, the editor-in-chief of Men's Health and a co-writer, Matt Goulding, who's said to be a New York Times best-selling food author and has cooked and eaten his way around the world. I Googled the second author and found he also has a book called Cook This Not That! Since we already do lots of healthy heart cooking I won't buy that other book.

But let's go back to the book that I did purchase.

So what does this book do? Remember, I rarely eat fast food at all and if I do it's because we're on a trip and didn't bring sandwiches (we almost always do for shorter road trips, but the second or third day out, we may have to find a place to eat). My favorite choice then is Subway since I can pick a simple "sub" and not goop it up. Plus I know what the calories are in the sandwich since they're listed.

But the book is interesting. It lists the "20 Worst Foods in America,' for instance. It tells what's really in a "Chicken McNugget" (seven ingredients in the meat and twenty more in the breading). It has a Top Swaps section telling which burger, wings, pasta, ribs, fajitas, chicken, fries, salad, pizza and ice cream is better than its competitor. It focues on some specific food choices (bad ones, according to the book) and tells why (e.g., a Taco Bell Mexican Pizza has 64 different ingredients; Skittles have more sugar per package than two twin-wrapped packages of Peanut Butter Twix and a whole range of additives that help bring about all those colors; many of those were apparently linked in a Lancet article to hyperactivity and behavioral problems in children).

The bulk of the book fits the title, side by side comparisons of food choices from different fast food restaurants. They're interesting and may be quite useful to those of you who partake on a regular basis of such fare.

I have some real caveats however. Many of their "Eat This' selections still have way too much salt and sometimes more fat than I'd be interested in eating. The book touts losing weight without exercising or dieting. That's not my style at all. Nonetheless it's both a good read, and according to Teresa, a nice way to introduce kids to making food choices. The book rates and, in some areas, grades a wide variety of foods.

Overall I'd give it a C+, but you may rate it higher, even if you only eat fast food occasionally.



Fish, fish and more fish

Tuesday, March 15th, 2011

Sardines by the dozen

I've been looking at three articles  on which fish we should be eating. One came from a newspaper, one from a website and the third from the Environmental Defense Fund website.

One of the dietary changes we've heard repeatedly over the last few years, besides eating more fruits and veggies and less red met, is to eat more fish. We're fortunate to have a wonderful restaurant here that's simply titled "Fish." We eat there fairly frequently, especially before attending plays (but that's another story). We also cook fish at home at least once and usually twice a week.

So which kind of fish should we be eating? That leads to the questions of sustainability, heart health and contaminants. To those, based on a recent experience, I'd add the risk of toxins (I'll write a blog post about that some other time).

The article from the Wall Street Journal (March 2, 2011) focused on salmon, talking about Wild Alaskan, Wild Pacific, Farmed Atlantic and Closed Tank-Framed varieties. The Farmed Atlantic salmon raised many enivronmental concerns and both Seafood Watch and Greenpeace decry salmon farming, stating it takes three pounds of  wild-caught fish to produce one pound of salmon.

The Wild Alaskan salmon got kudos from Seafood Watch, although another group noted that 40% of "wild" salmon caught in the state's waters were actually raised in hatcheries. Wild Pacific slamon raised sustainability concerns from some groups, but not all.

Confusing, huh? Well then I turned to the online piece. This had three distinct sections: the AHA wants us to consume more omega-3s and recommends mackerel, lake trout, herring, sardines, albacore tuna and salmon as good sources. Yet in the contaminant section it's noted that albacore tuna, high on the food chain, carry the risk of mercury and PCBs.  There's debate as to the risk for most adults, but pregnant women (or those who are at risk of pregnancy) should clearly avoid this fish choice.

And farmed salmon, high up on the list of omega-3s, is tough to raise in a sustainable fashion.

The Environmental Defense Fund suggests we eat wild salmon from Alaska, pink shrimp from Oregon, talapia from the US, farmed rainbow trout, alabacore tuna from the US or Canada, yellowfin from the US. The EWG website led me to a Mark Bittman article (New York Times November 16, 2008) where Mark lauds wild-caught fish; he finds the flavor better and the environmental concerns lessened.

So what are we to do? I'd suggest eating more fish, trying to eat some fatty fish, eating less farmed fish and reading more about the issues involved. I may try more sardines.

The real question is whether there will be enough wild fish for all.

Doonesbury adds up the calories

Sunday, March 13th, 2011

Don't eat here

I was reading the Sunday comics in our local paper and did a double take at the message in "Doonesbury," always one of my favorite cartoons. Zonker is working at "McFriendly's" and there's an emergency staff meeting. Their boss, termed Mr. Big, is there and talks about the chain falling behind their competition.

What's going on is their appetizer special isn't offering enough calories compared to Applebee's appetizer sampler (@2,590 calories) and Chili's Texas Cheese Fries (@2,100 calories) with the latter offering a full day's worth of calories "packed into an appetizer {bolding taken directly from the cartoon}).

We don't eat fast food (once in a while while on a trip we'll stop at Subway which has nutrition info listed), but I decided to check into these incredible numbers.

Guess what; they're real. A variety of fast food chains (Applebees, Chilis, On the Border) and restaurants (Outback Steakhouse) offer appetizers that boggle my mind. Remember, these are appetizers, and even if one presumes they're shared with one to three others, if you follow them with a meal, you'll be so far over the dietary guidelines you might as well be on a spaceship.

I found a website titled "The 20 Worst Foods in America" and looked at a few items. Applebee's apparently offers (or, to be charitable, offered at sometime in the recent past), an onion appetizer called the "Awesome Blossom." This one had 2,710 calories, 168 grams of fat and 6,360 mg. of sodium (my goal is 1,500 mg of sodium a day or less).

No wonder we're tipping the scales at higher and higher numbers; no wonder two thirds of our population is overweight and/or obese.

Don't eat these things. Best of all, don't eat in these places, at least until they clean up their act.

Yet we're at fault, at least partially. We've allowed ourselves to be gulled by the big corporations' propaganda and find it easier to eat out than to cook from scratch.

Our kids learn from our example, even when they appear to resist what we say, they often do what we do.

It's time and past time to walk (or drive) away.

Thanks, Garry Trudeau. You were right on target.



More Beef or Zorba's diet?

Wednesday, March 9th, 2011

eat half the steak and ask for more veggies

I read dueling articles in the Wall Street Journal, one appeared yesterday with the title "Beef Industry Carves a Course" and the other today titled "Why to Eat Like a Greek." So I wanted to go through the pros and cons of both.

Apparently the National Cattlemen's Beef Association came up with a new kind of MBA two years ago. This one isn't the traditional MBA, but instead stands for Masters of Beef Advocacy. Roughly 2,000 people have finished the program thus far, but that's only 10% of what the beef producer's group hopes to train.

This is not a 2+ year Master's degree, like some of our graduate students got; it's a six-session, one hour at a time online course on beef safety, beef nutrition, animal care, environmental stewardship, modern beef production and something called the beef checkoff. The last of those is a program started way back in 1985 where $1 a head is assessed on sales of live cattle and the states get half and the Cattleman's Beef Promotion and Research Board gets the other half.

Note the term "promotion." The WSJ article says the MBA program helps train beef-associated folk (chefs, butchers, feedlot operators and ranchers) in promoting and defending red meat.

The per capita consumption of beef and veal has fallen from a peak of  94 pounds in the 1976 to 62 pounds in 2009 and the new USDA guidelines suggest we replace some of the red meat in our diets with fish and other seafood. Many schools have instituted a "Meatless Monday" policy

One thing I hadn't heard about was that PETA (People for Ethical treatment of Animals) has a new program where models wearing only strategically placed lettuce leaves stand on street corners in towns across the country and hand out tofu hot dogs. Now that's a new approach.

I'm a long way from a vegan; we do eat beef and have a quarter cow in our freezer. The cow was raised with a small number of companions, grass-fed and grass-finished, so is lean meat.

In our case we also eat vegetarian meals on occasion and will spend four days with our other set of adult children, our former graduate students from India who are lacto-ovo vegetarians, next week.

Most of the time we eat what amounts to a Mediterranean diet with whole grain cereals, lots of fruits and vegetables, fish and relatively small amounts of animal fat. The other WSJ article mentioned a meta-analysis done by an Athens university on studies involving more than a half million people; they claim  nearly a one third reduction in the risk of developing the metabolic syndrome (high BP, large waist circumference, high blood sugar, low levels of good cholesterol (HDL) and high triglycerides).

Okay, what are the cons I said I'd mention? Well to begin with I'm not sure the beef industry has changed much other than trying to increase their PR efforts. And the Mediterranian diet isn't much different from the increase fruits and veggies, eat less red meat. Same old, same old. I agree with the overall premises, but I'm not convinced that olive oil is an essential component.

So neither article changed my diet at all.

Eggs, eggs and more eggs

Friday, March 4th, 2011

Eggs from Morning Fresh Dairy

I recently started eating egg whites on a regular basis.  We get our eggs from the Morning Fresh Dairy, the same organic dairy that delivers milk to our front door once a week. Lynnette gets a half gallon of fat-free, locally produced milk every week and I  buy a half gallon of their whole milk every other week. The herd resides about eight miles from us and we enjoy purchasing local products whenever we can. Since I'm moderately lactose intolerant, I also buy vanilla soy milk.

We get eggs from the same dairy, and usually go through a dozen a week. I worried about the cholesterol in the eggs yolks although I love to make omelets. So more recently I've started hard-boiling six eggs at a time, keeping the resultant cooked eggs in the refrigerator and eating just the whites. I felt good about getting egg protein, but hadn't done my due diligence so today I started looking at various comments on eggs.

The eggs come from Platteville, Colorado, a small community about 35 miles southeast of Fort Collins where we live. They're produced under the United Egg Producer Animal Husbandry (UEP) standards and, having Googled those, I'm reasonably content. For instance those chickens get no hormones in their food. The UEP standards started with an independent scientific advisory committee in 1999 and came out as a voluntary program in 2002. The USDA and an independent firm called Validus audit farms seeking UEP certification annually and look at cage space, clean water and nutritious food issues.

a better chicken coop

On the other hand, The Humane Society issued a statement against the UEP in 2009, saying their standards were misleading and the so-called battery cages were abusive. In response the UEP issued their own statement in January 2010 discussing revisions in the guidelines. I haven't been to the Plateville facility, so I can't comment on their "hen-friendly" environment.

The other issue is eating eggs. There has been a recent downplay of the role of dietary cholesterol as a risk factor as compared to saturated and especially trans fats. The Harvard nurses' longitudinal study found that consuming an egg a day wasn't associated with a higher risk of heart disease.

Chicken eggs have been termed the "perfect protein" and supply all essential amino acids needed for humans. The yolk is the question I haven't totally resolved: it contains all the egg's vitamin A, D, and E, but rougly four times the calories of the egg white and a large yolk has greater than two-thirds of the recommended daily intake of 300 mg. of cholesterol. There is debate as to whether the egg yolk presents a significant health risk with a variety of research studies showing differing results. On the other hand, one amino acid, choline, is found only in the yolk. Pregnant and nursing women need choline (from some source), as it's needed for fetal brain development.

So for now I'm going to continue eating my hard-boiled egg whites and I'll try to go to Plateville and do my own inspection of the chicken farm one of these days.



Fish or fish oil or neither?

Tuesday, March 1st, 2011

I read the Harvard Health Letter for March 2011 and then found a series of related medical articles and an interesting editorial. Let's start with the Harvard publication.It mentions four trials of fish oil supplements in people with pre-existing heart disease. None of those showed a positive effect in patients who are also on modern drug therapies.

Above the brief summary box was an longer commentary quoting Dr. Robert Eckel, the former president of the American Heart Association. He said "If you have heart disease, taking fish oil doesn't seem to replace eating fish." He also wrote the editorial I read in the journal Circulation. Dr. Eckel, who is on the staff of the Department of Medicine in the University of Colorado's medical school (down the road about 65 miles from me), carefully analyzed the four studies and concludes that prior evidence showing diets that include fish make sense, but taking fish oil supplements after you've had a heart attack doesn't.

A Mayo Clinic position paper I found online recommends eating one to two servings of fish a week and notes that fatty fishes, like salmon, herring and even tuna, are higher in the omega-3 fatty acids that may help. Talapia (which I've eaten twice this week) and catfish, are less likely to be heart healthy and any fish that's deep-fat fried may be bad for you.

What about those of us who haven't had clinical heart disease (yet)? Even the Harvard letter says fish oil may be okay for preventive therapy. But I'm not able to find good solid data to support this.

It seems true that populations that eat more fish, like the Inuit and some of the long-term participants in the Nurses' Health Study, were less likely to have a variety of severe heart disease issues (heart attacks, sudden death, heart rhythm problems). The unresolved question is whether they also had better health habits or genetics or other reasons for their diminished risk.

So from my point of view I'll continue taking my twice-a-day fish oil capsule. It's one that is third-party tested for heavy metals, PCBs and dioxins and the relative low dose of omega-3s (270 mg of EPA, 180 mg of DHA, 115 mg of other omega-3s) plus the addition of small doses of omega-9s and 6s seems more likely to help than harm

But I'm going to keep on eating fish, try some fatty fishes and watch the literature.