Hot Chocolate + Blizzard = Happy

Ah, there's nothing better than a rich cup of hot chocolate on a cold winter's night...when there's approximately a foot of snow outside...and more to come!

I steer clear of powdered hot chocolate mixes. Most have dismally small amounts of protein (about 2g) and calcium (43mg), are full of added sugar and, well, they're just not chocolatey enough for me! I usually make my own hot chocolate, which is just quick and convenient as a mix - and much more nutrient-dense.

Here's my favorite recipe for hot chocolate:

Rouge Tomate: Nutritious and Delicious!

Yesterday, I took my mom out for lunch at Rouge Tomate for her birthday. What an exquisite dining experience! My interest in Rouge Tomate was first piqued by a nutrition career panel I attended last winter. One member of the panel was Natalia Hancock, RD, culinary nutritionist for Rouge Tomate. A restaurant with a nutritionist on staff? Yes, it's true! Check out Rouge Tomate's philosophy to learn more.

First, the setting:

Looking down to the lower level.

Main level.

Lower level.

Alpha-Carotene, Beta's not-so-little sister?

Just before Thanksgiving, I came across this article published in the Archives of Internal Medicine. In short, the authors analyzed data from 15,318  adults who participated in NHANES, and followed them over a 14-year period.  Carotenes are antioxidants, and it has been hypothesized that they may lower risk for cancer and cardiovascular disease. In this case, the authors discovered that those adults with the highest blood concentration of alpha-carotene had the lowest risk of death from all causes - yes, this includes cancer and CVD.

Now, while this is quite intriguing, please note that it is an association, which does not establish cause and effect. Still, this article highlights something I often explain: that nutrients cannot replace food.

The Food Safety Modernization Act

Congress is voting tonight on the The Food Safety Modernization Act. Among other things, the bill would actually give the FDA the power to issue food recalls (did you know that although the FDA is responsible for 80% of the nation's food supply, it cannot issue mandatory recalls of contaminated food?)

Here's an interesting NY Times opinion piece by Eric Schlosser and Michael Pollan on the bill. I am very curious to see what new tomorrow brings!

Probiotics in Ice Cream?

I just came across an article in the Journal of Dairy Science about the formulation of probiotic, prebiotic and synbiotic ice cream. Apparently the bacteria remained viable after storage and met the "minimum required to achieve probiotic effects."  More information may be found here. This article disturbs me, but before I continue, some definitions:

Probiotic refers to live microorganisms thought to be healthy for the host organism (in this case, humans).
Prebiotic refers to substances that support the growth or activity of probiotics.
Synbiotic refers to substances or foods containing both probiotics and prebiotics.

I'm a contributing editor at SuperKidsNutrition.com!

I just joined SuperKidsNutrition.com as a contributing editor! Check out my bio and the other editors here. Some info about the site below:

"SuperKids Nutrition Inc. was founded in August 2006 by Melissa Halas-Liang, MA, RD, CDE to save the world one healthy food at a time^TM.  The SuperKids Nutrition team represents a diverse, nationally recognized group of Registered Dietitians and nutrition professionals who specialize in childhood, school and family nutrition.  SuperKids Nutrition is recognized and listed by the USDA and state board educational sites as a credible nutrition education resource providing nutrition content, parent Q and A and resources on over 10,000 school websites across 23 states.  The SuperKids Nutrition website, books and other educational resources are available to parents, teachers, and healthcare professionals looking for tools and information on eating healthfully and raising a healthy family. To learn more, "visit http://www.superkidsnutrition.com/

Last chance to support my walk to fight Diabetes!

 On October 24th - this Sunday! - I am walking and raising funds for the American Diabetes Association's signature fundraising walk, Step Out: Walk to Fight Diabetes. Every step I take and every dollar I raise will make a difference in the lives of 23.6 million Americans living with diabetes. By making a donation on my behalf, you will be helping the Association provide community-based education programs, protect the rights of people with diabetes and fund critical research for a cure.

No matter how small or large, your donation will help us Stop Diabetes.

Visit my page to make a donation today! 

What's Missing in Soy Cheese?

Today at work, soy cheese came up in two different conversations. I soon realized that I'm not sure how it measures up nutritionally to low-fat milk cheese. It's not something I would usually compare side-by-side, but in this case my patient was asking simply because she likes the taste of soy cheese (not because she couldn't eat dairy cheese). Soy milk is full of high-quality protein, so surely the same is true of soy cheese, right? Read on...

Here's what a quick search turned up.

Tofutti Soy Cheese Slices
Partially hydrogenated soybean oil is the 2nd ingredient (trans-fat alert!!) And that's quite a dollop of sodium for one measly slice. Steer clear of this for sure.

• 1 slice (0.67oz) = 70 calories, 2g protein, 4g total fat, 2g saturated fat, 290mg sodium
• http://www.tofutti.com/cheese-amer-lable.html
• http://www.tofutti.com/cheese-mozz-lable.html

Vegan Gourmet
A bit better, but that's not a lot of protein. Hmm. 

• 1 oz = 50 calories, 2g protein, 4g total fat, 0.5g saturated fat, 200mg sodium (no trans fats in ingredients list) 
• http://www.followyourheart.com/products.php?id=24 
• http://www.imearthkind.com/

Together we can Stop Diabetes. One step at a time.

 On October 24th, I am walking and raising funds for the American Diabetes Association's signature fundraising walk, Step Out: Walk to Fight Diabetes. Every step I take and every dollar I raise will make a difference in the lives of 23.6 million Americans living with diabetes. By making a donation on my behalf, you will be helping the Association provide community-based education programs, protect the rights of people with diabetes and fund critical research for a cure.

No matter how small or large, your donation will help us Stop Diabetes.

Visit my page to make a donation today! 

Burger with a side of Statins?

Someone please tell me this is a joke: http://www.ncbi.nlm.nih.gov/pubmed/20691321

"Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments."

Um, right, not to mention that statins have side effects and may cause liver problems - everyone taking them must have their liver enzymes monitored to be sure they are safe...and what about varying levels of medication from day to day?

The Hundred Year Diet: The Interview

Check out my book review and interview with Susan Yager, author of The Hundred Year Diet: America's Voracious Appetite for Losing Weight.

Need some tasty lunch ideas?

YUM! Tasty and healthy lunch ideas Toby Amidor and I created:  Back to School: Packing a Healthy Lunch 

...and don't forget to keep them safe to avoid foodborne illness! 

Here's how: Food Safety 101: Keeping Bagged Lunches Safe

Worried about calcium supplements?

Yipes  - a recent study linked calcium supplements to increased risk for heart attack in older women. I don't think a single study is enough to change the world or anything, but it is somewhat disturbing - what with me and virtually every woman I know taking calcium supplements! I'm not in the same age group as the study participants, but still...I've been meaning to look up the actual research to see just how worried I should be.

In the meantime, the NutritionData Blog has some good points in this post:
Calcium Supplements: Too much too late?

 

Ask: Do we need 100% of nutrients every day?

As humans, we've evolved with cycles of food availability. For example, you couldn't eat bread until the grain had been harvested and milled. If you wanted strawberries you had to wait until they ripened. Today, we hear about recommended daily allowances of vitamins and minerals constantly. We take daily vitamins to be sure we're getting 100%. But do our bodies need 100% every day? Do we, for example, need more vitamin C just when the summer fruits come in season? Do our bodies need more protein in the winter, when fresh fruits and veggies weren't available but meat could be caught? I'm wondering if our bodies need a cycle, and not a daily dose.


This is a multi-part question, and I will do my best to address all of it - some ventures outside the realm of my expertise, and some parts are simply opinion or do not have clear cut answers at this point.

Garden Update

Not much time to write lately, but at the very least I can take some garden photos! We pulled up the lettuce and have started some Kentucky Wonder Bean seeds. They really are wondrous, as they grew almost 10 inches tall in like 4 days...beanstalk, anyone?

Anyway, here's the latest. Cucumbers in the front, eggplant is the tallest. Very back row is broccoli, then cabbage and collards.

News This Week

There's been so much in the news this week! I feel like I could write a post about each one. Here's a sampling of what caught my eye:

• Obesity increased in 28 states, according to this report by the Robert Wood Johnson Foundation.
• Kellogg determined it was tainted packaging making people sick, not actually their cereal. (Well, that's great and all, but practically speaking, it doesn't make a difference!)
• The Center for Science in the Public Interest launched a report about the risks of artificial colors in foods.
• The Journal of Public Health published an analysis of the sodium and sugar content of baby and toddler foods (all the more reason to make your own!) 
• Promising research published regarding the treatment of major depression with omega-3 fatty acids (although omega-3s did not appear to be effective when anxiety was also present).  

Garden Update

Hmm, there's some holes in the collards. I think when the lettuce is finished we might plant kale and bush beans.

Well, I just took another look and the lettuce has definitely bolted...

Healthy Traveling with Kids: It's Possible!

Check out the article Toby Amidor and I wrote on SuperKidsNutrition.com: Healthy Traveling with Kids: It's Possible!

Ask: When to see a dietitian?

How does a person decide if he/she needs to see a nutritionist or a dietician?

Before I answer this question, I want to mention the differences between a dietitian and a nutritionist. "Nutritionist" is a blanket term. There is no regulation regarding its use (unfortunate, because I happen to like the word better). As such, anyone may call his/herself a nutritionist, whether knowledgeable about nutrition or not.

In contrast, a registered dietitians (RDs) have spent years studying biology, chemistry, clinical nutrition and food science, and are required to pass a national exam administered by the American Dietetic Association. Throughout their careers, RDs are required to accrue continuing education credits in order to keep up to date with the latest nutrition advancements. Someone with a Masters degree in nutrition has likely received additional training in clinical nutrition, research interpretation/evaluation and behavioral theory. 

Ok, on to the question: there are many reasons to visit a dietitian/nutritionist! It is, of course, a personal decision involving not only health, but convenience and cost as well. More and more dietitians are venturing into teledietetics (nutrition counseling by phone/internet), which is a great option for folks in rural areas or with limited mobility. In any event, I am focusing on health reasons. Let's see how many I can come up with:

• Prevention of Disease. Visit a dietitian for a general nutrition check-in. Are you eating as well as you think you are? Are you bored with your food? Can't decipher nutrition labels and health claims? A dietitian can help you sort fact from fiction and identify ways to improve (and inspire) your diet and lifestyle. You can't change your genetic susceptibility to illnesses such as diabetes, heart disease and cancer, but you can give yourself a better chance at beating the odds.
  
  
• Support during Disease. Visit a dietitian if you are diagnosed with a medical condition, especially:
• Diabetes or insulin resistance (may be called "prediabetes")
• High Cholesterol or Heart Disease
• Kidney disease
• Liver disease
• Food Allergies
• Any Gastrointestinal-related disorder, including GERD, gastritis, ulcerative colitis, Crohn's disease, irritable bowel syndrome and many more.
  
  
• Pregnancy (before, during and after).
  
  
• Weight Loss. Sure, you might know generally what you need to do, but meeting with a dietitian, having s/he perform a diet analysis can be very helpful. Continuing to meet occasionally will help keep you on the right track. This is true of any medical condition requiring nutrition and lifestyle changes.
  
  
• Family Nutrition. There are dietitians who specialize in pediatric and family nutrition. Everyone's heard the stories about kids who only eat beige foods...
  
  
• Disordered Eating. Ideally, treatment of eating disorders should take a multidisciplinary approach and include - at a minimum - a physician, a dietitian and a mental health professional (psychiatrist or psychologist).
  
  
• Sports and Fitness. A sports dietitian will help you maximize the benefits from your fitness training. Ensure that your physical efforts are supported by the appropriate nutrition strategies.
  
  
• Supplement Confusion. Unlike drugs, there is little regulation of supplements. What is safe? What really works? What the heck do those claims mean, like "supports healthy cholesterol levels"? A dietitian has the knowledge and resources to help you sort it through.

Hope this is of some help, and thanks for the question!

P.S. Either spelling (dietitian or dietician) is correct, but dietitian is most commonly used, and is the choice of the American Dietetic Association.

Ask: Meal Replacement Protein Shakes

I have been drinking protein shakes sometimes for breakfast and sometimes for both breakfast and dinner. The drinks I have been using are called Isagenix and I add a scoop of the Isagenix whey protein in the shakes as well. I was wondering what your thoughts are on meal replacement protein shakes and what I should be looking for in a shake if I was to continue to use them. I don't mind if you specifically speak to the Isagenix products and give your thoughts on them. Just curious. 

Thanks for the great question. Meal replacements, be it protein shakes, powders or bars are very popular and often used in weight loss strategies. How well meal replacements work for this purpose really depends on the person: some folks are happy knowing exactly what and how much to eat. It's easy, eliminates guesswork and they can stick to it. Other people find this too restrictive and end up "rebelling" by eating a meal and the meal replacement!

In the short term, meal replacement shakes can be a useful tool to control portion sizes, jump start a diet and lead to weight loss. However, there is not great deal of research regarding long term use [1] and I would not recommend them for other than occasional or convenience use. Here are some of my concerns:

Will NYC Restaurants Make the Grade?

New York City Passes Restaurant Grading 

Statement of CSPI Food Safety Attorney Sarah Klein 

"Congratulations to the New York City Department of Health and Mental Hygiene for enacting restaurant food-safety grading.  Beginning in July, consumers will finally be able to see how a restaurant fared on its most recent health inspection, simply by glancing at the letter grade in the front window or vestibule.  Foodborne illness sickens 76 million Americans each year, and 40 percent of those illnesses are linked to restaurant food.  With a greater emphasis on food safety in restaurant kitchens, we hope to see a lot fewer sick consumers in the New York City.
 
Los Angeles has been doing restaurant grading for over 10 years with great results—including a documented 20 percent decrease in hospitalizations due to foodborne illness.  With cities on both coasts now providing this import food safety information to consumers, the only question remaining is:   Why aren’t all cities doing restaurant grading?"

Ask me!

I'm starting something new on here. I love getting questions from friends about nutrition trends. I love reading and researching. So...

Have a nutrition-related question? Wondering whether those product health claims are really legit? Confused about supplements?

Ask me!

Email me at jjznutrition@gmail.com

I'll research your question and post about it. Your question may help other readers and vice versa. No names will be disclosed to ensure your privacy. 

Interning, Butchering and Hope

The final step in becoming a registered dietitian (RD) - aside from passing the RD exam - involves completing an 11-month internship. I like to describe the internship as a 'residency for dietitians.' I suppose it's an apt comparison; we rotate our way through a variety of practice areas: clinical nutrition, community nutrition education, food service and an elective of our choosing.

Since September 2009, I've interned at seven locations:

• NY State Psychiatric Institute
• City Dialysis Center
• Naomi Berrie Diabetes Center
• Cornell University Cooperative Extension
• FreshDirect
• Food Bank for NYC
• The Cleaver Company and The Green Table

I'm in the final days of my food service rotation at The Cleaver Company, a locally-sourced, sustainably-focused catering company located in NYC's Chelsea Market. As a supplement to our experience in Mary Cleaver's kitchen, my classmate and I spent some time two doors down at Dickson's Farmstand Meats helping to vacuum package the locally-raised, feedlot-free meat carved by Adam Tiberio, Dickson's butcher. Sounds ok, right?

Wrong. It was absolutely, totally, completely fascinating. We watched silently as Adam carried out an entire hindquarter of a cow, hung it on a hook and proceeded to carve it so quickly and precisely it took all the concentration I had to keep moving - following his packaging instructions - and not dumbly stare (in veneration mostly, but with a drop of horror too). I'll never say, "I butchered the job" to refer to a mistake again.

Good thing I'm not at all squeamish. As the first hindquarter was hooked, we noticed an organ hanging down. "What's that?" we asked. "Oh, a kidney..." My grandfather was a USDA meat inspector in the 1940s and 50s, and then a meat salesman in NYC's Meat Packing District through the early 1970s. Dickson's gave me a morsel of family history as well.

The NY Times recently mentioned Dickson's in this story on local meat. 

Yesterday (my second time at Dickson's), I got to vacuum package goat while The Boston Beer Company (aka Sam Adams) filmed Adam carving beef (too bad I didn't get to see the goat carving, for comparison's sake). Apparently there is a partnership-to-be between Dickson's and Sam Adams. I signed a release since they filmed me packaging, though I think my back was mostly to the camera. My identifying feature? A Christmasy combination of a light green headscarf and red clogs.

All of the above is a dreadfully superficial description of what is really going on here.  The food system is changing. The resurgence of butchering, the staring customers, the filming - it all gives me hope. In the future, maybe we won't give 70% of our antibiotics to animals in feedlots. Maybe we'll have fewer strains of antibiotic-resistant bacteria and fewer cases of foodborne illnesses. Maybe the Mississippi River won't be so polluted by CAFO* runoff and maybe the deoygenated "dead zone" in the Gulf of Mexico will shrink (if the oil spill is ever contained). Maybe our great-grandkids won't know what the global warming fuss was all about.

That's what's going on.

*CAFO = Concentrated Animal Feeding Operation

Garden Update

Approximately 2 weeks later, things have certainly grown. Please ignore the half-done leaf mulching job - it's on the list to finish! Think I might pick some of the romaine for dinner.

FTC Cracks Down on Kellogg's Health Claims

Yesterday, the FTC took some of the 'snap, crackle and pop' out of Rice Krispies. As part of a settlement between Kellogg and the FTC, no longer will boxes of Rice Krispies proclaim: “Now helps support your child’s immunity,” with “25 percent Daily Value of Antioxidants and Nutrients – Vitamins A, B, C, and E.” and “Kellogg’s Rice Krispies has been improved to include antioxidants and nutrients that your family needs to help them stay healthy.”

Read the release here, and a NY Times article covering the topic here.  

Kellogg has been in the hot seat with the FTC since last year's dispute over the claim that Frosted-Mini Wheat cereal was, "clinically shown to improve kids’ attentiveness by nearly 20%.” (Remember the TV ad with the talking Frosted Mini-Wheat square helping the kid with schoolwork? You won't see those anymore either.)

Ok, so Rice Krispies isn't exactly high on my health-offender list, which is why this is such a good example. Who really thinks of Rice Krispies as unhealthy? In truth, without the vitamin-fortification, Rice Krispies is an exceedingly average source of simple carbohydrates with a dollop of sodium (299mg in 1 1/4 cup).  That's it. All it needs is a little vitamin-fortification here, some antioxidants there, some health claims and ta-da! Healthy food! 

Health claims exist to get people to buy stuff. They annoy me for many reasons. In this case, it's because they are especially effective on something as benign as Rice Krispies. (I hope that most people have a clue about some other products...how about 7 Up with Antioxidants?)

With that said, I'll leave off with the words of FTC Chairman Jon Leibowitz:

“We expect more from a great American company than making dubious claims – not once, but twice – that its cereals improve children’s health. Next time, Kellogg needs to stop and think twice about the claims it’s making before rolling out a new ad campaign, so parents can make the best choices for their children.”

Garden, Take 1

This year we decided to forgo the CSA we have belonged to for the past two years. The reason? We've finally gone as local as local can get and planted our own vegetable garden! My husband and I have been wanting to grow something more than tomatoes for quite a while, but the summer always seemed to slip away. And with our CSA, we always had plenty of local, organic vegetables. However, this year we were determined to make it on our own.

[Don't get me wrong: I loved our CSA. But it was a bit far for us to travel (opposite side of the county) and I felt that now that I have an honest-to-goodness yard, it should be used for more than growing patchy grass.]

In our garden we planted: broccoli, cabbage, collards, eggplant, cucumbers, romaine and red leaf lettuce, bell peppers and tomatoes. I'm looking forward to eating my first salad completely from the garden! I'm already planning for next year. I'd love to include some squash and potatoes...mmm.

CSA stands for Community Supported Agriculture. Basically, a farmer will sell shares of his or her crops to consumers for the growing season. Instead of grocery shopping, you receive distributions of crops once a week or so, depending on your CSA arrangement. By doing this, the consumer shares in the risks inherent to farming - there are no guarantees.  Farmers feed us, after all - why should they be the only ones taking on the risk? This arrangement benefits both consumer and farmer alike. The farmer has a steady income and can plan for future seasons. The consumer receives a greater quantity of vegetables when the crop prospers and a lesser quantity when it doesn't.  For example, last year's late blight decimated the tomato crop, and we received virtually no tomatoes. In contrast, the year before had us nearly sick of tomatoes they were so plentiful. (Sick of tomatoes? I know, it sounds impossible...but trust me, I couldn't use them fast enough!)

In closing, let me say how great our CSA was/is. We belonged to Restoration Farm located in Old Bethpage, NY. The farm is beautiful and the growers, Caroline and Dan, are amazing. I highly recommend it if you live in Nassau County or even western Suffolk County. The farm is on the grounds of Old Bethpage Village Restoration, a recreation of a mid-19th-century American village. The majority of the buildings are genuine - they were moved to the site from their previous locations and arranged to represent a typical rural Long Island farm village of that time period. Each season the village holds Civil War reenactments, the Long Island agricultural fair and other events. Both the farm and the village are fantastic places to visit if you are in the area.

Have we Traded Trans Fat for Saturated Fat?

According to an article published this week in the New England Journal of Medicine, the answer is no. Read the article here.  The investigation was conducted by a researcher from Harvard Medical School and the Center for Science in the Public Interest (CSPI), one of my favorite organizations and publisher of the Nutrition Action Healthletter.

Trans fats have similar characteristics to saturated fats. With the trans fat labeling requirement in effect since 2006, and the NYC ban on trans fats, many were concerned that manufacturers and chefs would simply replace the trans fat in their products and recipes with saturated fat. If this were the case, would we really be accomplishing anything to improve our overall health?

The researchers conducted two evaluations of 83 reformulated supermarket and restaurant foods (from 1993-2006 and 2008-2009) and discovered that the majority of reformulated foods had less than 0.5g trans fat per serving (the level at which a manufacturer can claim "0g trans fat") and the average amount of saturated fat was " lower, unchanged, or only slightly higher (<0.5 g per serving) than before reformulation."

Keep in mind there are thousands and thousands of products out there and this analysis only closely examined 83 reformulated products...but I still hope this is an indicator of things moving in the right direction - or at least not a wrong one.

Gluten Intolerance?

Here is a question I recently received from FOODPICKER.org:

Jan A. asks: I have type 2 diabetes and just found out I have gluten intolerance.  I haven’t been able to figure out what I can eat.  I have been leaving grains out of my diet.  What should I do?

Answer:  I am so glad to answer this question, as gluten has become a hot issue lately! First, I would like to explain that gluten is not inherently a poison. Gluten is a protein found in wheat. Gluten is strong and stringy, and is responsible for bread's ability to rise without breaking apart and collapsing. You cannot make yeast-rising bread with flour that does not contain gluten.

Gluten contains two fractions, gliadin and glutenin, both of which evoke an autoimmune response in people with Celiac disease. Celiac is an autoimmune disease resulting in an inflammatory condition in the small intestine. The protein fractions of barley and rye (hordeins and secalins, respectively) are closely related to those in gluten, and will also initiate autoimmune activity (although oats are gluten free, they have been suspect in the past due to contamination during processing). People with Celiac disease must eliminate all sources of wheat, barley and rye - and their derivatives - completely from their diets or risk serious damage to their GI tract and a host of other issues.  There is no established threshold for immune response initiation, so complete elimination is paramount.

It is possible that a larger number of people than previously thought are sensitive to gluten. Type 1 diabetes (another autoimmune condition) has been linked to Celiac disease with increasing frequency. However, while there are specific antibody and biopsy tests to help diagnose Celiac disease, tests for gluten sensitivity are generally unreliable. The easiest thing to do is to try a gluten-elimination diet and see if whatever symptoms you are experiencing improve.

Avoiding gluten sounds simple but is actually quite tricky, as gluten is ubiquitous in the average American diet. Keep in mind that "wheat-free" does not mean "gluten-free" and there are many non-food products that must be avoided.

For example, sources of gluten include:

• Bread, pasta and any products made from barley, rye, wheat and any of their derivatives, including  kamut, triticale, spelt, graham, semolina and durum.
• Vinegars made from fermented wheat, rye or barley (malt vinegar)
• Beer, made from fermented barley 
• Soy sauce, made from fermented wheat or barley 
• Gravies, sauces, jellies thickened with flour or starch
• Emulsifiers in some toothpastes contain gluten
• Modified food starch, found in many packaged foods and processed cheeses (and even Twizzlers!)
• Hydrolyzed or Texturized vegetable protein, may use wheat, rye or barley proteins
• Dextrin 
• Malt syrup and malt flavoring (derived from barley; found in some soy and rice milk products)
• Vegetable gum
• Glue on envelopes 
• Prescription and OTC medications may contain wheat starch as a filler
• Lipstick may also contain wheat starch as a dispersing agent/filler
• Natural and artificial flavorings - may contain gluten.

Here is an even more comprehensive list of gluten-containing foods and ingredients.

Ok, so at this point you are probably wondering: “is there anything I can eat?” The answer is yes! 

Naturally gluten-free foods include:

• Fruits
• Vegetables
• Meat, poultry, seafood
• Beans and legumes
• Gluten-Free Grains  (corn, quinoa, rice, oats, millet, amaranth, teff, buckwheat, soybeans, arrowroot)
• Dairy (milk, yogurt and most cheeses)
• Oils and fats 
• Alcohol, except beer

Quinoa is a favorite of mine – it cooks in half the time it takes to make brown rice and is the highest grain source of protein. A gluten-free diet requires you to ‘think outside the box,’ especially in terms of breakfast foods. Why not have a scrambled egg with some quinoa and a piece of fruit?  For lunch, you can create delicious and hearty salads with lettuce, veggies and beans. Top it off with a dressing of olive oil and lemon juice (instead of vinegar). When dining out, be sure to ask your server about dishes with sauces, breading and cream soups (may be roux-based and contain flour). When in doubt, stick to simple, fresh foods and ask for dishes without sauces or gravies.

At home, be aware of possible cross-contamination with foods containing gluten. Wash cutting boards and utensils thoroughly. Use squeeze bottles of condiments whenever possible to avoid contaminating the condiment jar by inserting a utensil that previously contacted gluten-containing foods. Bread crumbs may stick to the insides of toasters (or the toaster oven rack) and may contaminate gluten-free items. Of course, always read the ingredients list when buying packaged food!

There are many gluten-free products out there (breads, cookies, snack bars, etc.). These products may come in handy at times, but are not necessary. Focus on naturally gluten-free foods, especially since many gluten-free products are highly processed and have a higher fat content.

At this point, you may notice that following a gluten-free diet also eliminates many sources of whole grains. For this reason, I do no generally advise anyone to follow a gluten-free diet unless there is a particular reason for doing so – i.e. symptoms related to suspected gluten sensitivity, wheat allergy or a diagnosis of Celiac disease. "Gluten-free" does not automatically mean "healthy." But with some experimentation and practice, it is possible to eat a delicious and healthful gluten-free diet. 

Good luck!

Tolerable Upper Limit for Fructose?

Couldn't have said it better:
http://blog.nutritiondata.com/ndblog/2010/04/fructose-poison-or-nutrient-or-both.html

Sugarless Candy (and sugar alcohols)

Here is this week's question I received from FOODPICKER.org:

Jeff W. asks:  My doctor recently diagnosed me with type 2 diabetes.  I know it is important to watch my sugar intake.  Is sugarless candy really sugarless?

Answer:  While sugarless candy will not contain sugar, be aware that it may contain other sources of carbohydrate. All carbohydrates will affect blood sugar, be it candy, potatoes or bread.  (Really, all food will affect blood sugar, but carbohydrates have the greatest effect.) In the past, people diagnosed with diabetes were told they were not allowed to eat sugar. This is no longer true. People with diabetes can eat any foods but must pay closer attention to portion sizes and combination of foods.

Candy sweetened with sugar is a source of concentrated carbohydrate. You may choose to substitute with sugarless candy, but be sure to read the label and note the amount of carbohydrate in each serving - and the serving size! I would also suggest reading the ingredients listing and noting which artificial sweetener is used in the product.

Sugarless candy is often sweetened with sugar alcohols. The names of sugar alcohols usually end in -ol; some common ones are sorbitol, maltitol, xylitol, mannitol and lactitol. Sugar alcohols are metabolized differently than sugar, so they will not raise you blood glucose quite as much as sugar and they have slightly fewer calories. However, ingestion of large amounts of sugar alcohols may cause diarrhea. This occurs because sugar alcohols are usually not fully digested. The presence of undigested carbohydrate in the intestine alters the osmotic pressure, thus causing water to be drawn into the intestine, resulting in diarrhea. This reaction to sugar alcohols varies from person to person, so keep this in mind when trying out sugarless candy made with sugar alcohols.

Everyone is different -  sugarless candy may affect your blood glucose differently than someone else with type 2 diabetes. As with incorporating any new food into your diet, the only way to know for sure is to try a small amount and test your blood glucose.

Reversing diabetes?

Here is this week's question from FOODPICKER.org:

Tammy S. asks: My 45 year-old husband was diagnosed with type 2 diabetes a few months ago.  Is it true that you can reverse diabetes?

Answer:  Confusion abounds regarding whether or not type 2 diabetes can be reversed! The short answer is no. Diabetes is a chronic condition that cannot be cured - it can, however, be managed. There is a distinct difference.

Type 2 diabetes occurs when the pancreas either does not produce enough insulin, or the body's cells do not respond to insulin properly (insulin resistance). In either case, the not enough glucose is moved from the bloodstream into the body's tissues, and you are left with high blood glucose levels.

Let's look at an example: 2 hours after a meal, blood glucose should be below 140 mg/dl. When your blood glucose is over 140 for longer than 2 hours, other constituents of blood are skewed: triglyceride levels increase, fibrinogen (used in clotting) decreases. Over time (in terms of years) this will increase your chances of damaging the tiny blood vessels in eyes, kidneys and nerves - leading to a host of other problems.

A person without diabetes can eat chocolate cake or a salad for lunch - in either case, 2 hours after a meal his/her blood glucose will be below 140 (probably more like 120). The pancreas will compensate depending on what is eaten. In a person with type 2 diabetes, like your husband, eating chocolate cake for lunch (and nothing else) puts a huge glucose load on his bloodstream. His pancreas kicks into overdrive to compensate, but it just can't keep up. Two hours later his pancreas is still trying to clear all the blood of the sugar from lunch. It's like using a spork to eat soup - it sort of works, but is not totally efficient! Now, if your husband had eaten a salad and maybe some broiled fish or chicken followed by a smaller portion of chocolate cake, his blood glucose might be within a normal range 2 hours later.

Does that mean his diabetes is cured? No! If he goes back to eating cake for lunch, his diabetes manifests again.

However, diabetes complications should not be considered manifest destiny! This does not mean that you cannot live a healthy, long life with diabetes. Treatment of type 2 diabetes includes a healthful diet, physical activity, blood sugar monitoring and medication. 

The most successful person with type 2 diabetes takes control of their treatment by:

• testing blood sugar as recommended
• following a meal plan to control blood sugar
• exercising on a regular basis
• taking medications as prescribed
• maintaining a healthy body weight (or losing weight, if needed)
• visiting healthcare providers on a regular basis - endocrinologist, dietitian, CDE, etc.)

Possible diabetes? Fasting glucose question

Below is a question I recently received from FOODPICKER.org

Susan D. asks: My fasting glucose number was 127.  Does this sound like pre-diabetes or diabetes?  What should I do to control by blood sugar?

Answer:  Diabetes is usually diagnosed if your blood glucose level exceeds 125 mg/dL during a fasting plasma glucose test. This test is usually conducted on more than one occasion to confirm the diagnosis. Three types of blood tests are to diagnose diabetes: 

• A Fasting plasma glucose test measures your blood glucose after fasting (not eating anything) for at least 8 hours. 
  
  
• An oral glucose tolerance test also starts with you in the fasted state, then you drink a glucose-containing beverage and your blood glucose levels are monitored for 2 hours afterwards.
  
  
• A random (or casual) plasma glucose test measures blood glucose at any point in time, without regard to when you last ate. 

Here is some more information regarding diabetes diagnosis from the NIH's National Diabetes Informational Clearinghouse. Since a blood glucose of 127 mg/dL is just above the cutoff, your doctor will likely repeat the fasting test or have you complete an oral glucose tolerance test before officially diagnosing you.

If your diagnosis of diabetes is confirmed, you should speak to your doctor regarding treatment. Generally, this involves blood glucose monitoring, oral medications, exercise and diet changes. Most notably, you will need to take care to spread carbohydrates evenly throughout the day. This may seem overwhelming, but there is a lot of help available! Often the best way to get started is by attending a diabetes education class or making an appointment with a Certified Diabetes Educator or Registered Dietitian. Check out this post from a few weeks ago for some more ideas in finding help. 

Send your questions to diabetes@foodpicker.org or directly to me at jjznutrition@gmail.com

Prediabetes, weight loss and fruits & vegetables

Here is a question I recently received from FOODPICKER.org:

Bob R.: I have pre-diabetes and am trying to lose weight.  How many servings of fruit and veggies should I have each day?

Answer: Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. It's great that you have already decided to take the first step to better health! According to the American Diabetes Association losing as little as 5-10% of your body weight (approximately 10-15lbs), along with engaging in regular activity, may help you delay or prevent the development of type 2 diabetes.

In general, adults should consume about 3 cups of vegetables and 2 cups of fruit everyday.  But what counts as a cup? This may be confusing. In general, 1 cup of raw or cooked vegetables or 2 cups of raw leafy greens should be considered 1 cup of vegetables. For fruits, 1 cup of chopped fruit or ½ cup of dried fruit can be considered 1 cup. Here is a handy vegetable chart and a handy fruit chart from MyPyramid.gov that should help clear things up a bit.

You'll notice that both vegetable juices and fruit juices are also on the MyPyramid charts. In terms of watching your blood glucose levels, juices have two major strikes against them: they contain little to no fiber, and are a concentrated source of sugars. Drink juices in moderation! Also be sure to look out for starchy vegetables like potatoes, corn and peas. Starchy vegetables are much higher in carbohydrate than their non-starchy or cruciferous counterparts. Go for vegetables like broccoli, kale, lettuce, cabbage, cauliflower, chard, bok choy and bell peppers. Check out http://www.choosemyplate.gov/  for menu planning tips and to track and assess your food intake. Also visit FruitsandVeggiesMoreMatters.org for recipe ideas.

Don't forget that regular, moderate exercise is an important part of a healthy lifestyle. You don't have to join a gym - try walking for 30 minutes, 5 days a week. It will make a difference.

New Type 2? Think there's nothing to eat?

Question of the week from FOODPICKER.org:

Susan A.: I was diagnosed with type 2 diabetes last month.  I’m having difficulty understanding how many carbs and sugar I can have each day.  I’m finding that nearly everything contains carbs and sugar!  Can you help me with this?
 
Answer: Asking for help is the first step in learning diabetes self-management. You might start by asking your endocrinologist or primary care doctor to refer you any classes in your area. Also please refer to last week's question & answer for help in finding a Certified Diabetes Educator (CDE) or Registered Dietitian (RD) to work with you. For newly diagnosed persons, I highly recommend personalized sessions with a CDE or RD. It will be very helpful in starting you off on the right track to great diabetes self-care and good long-term health.

There are 2 main meal planning methods taught to people with diabetes: carbohydrate counting and the exchange system.  I find carb counting a much easier method to learn and teach, but you may find you like exchanges better. Be sure to ask about these two methods so you can discover which will work better for you.

In general, the body needs a minimum of 130 grams of carbohydrate each day. Carbohydrates are not the enemy here - your body runs on carbohydrate and needs adequate amounts to survive! For someone with diabetes, the issue is that the body cannot handle a large amount of carbohydrate at one time. It is important for you to spread carbohydrates throughout the day. You will find it easier to do this (and easier to maintain blood glucose control) if you eat several smaller meals and snacks instead of only 2 or 3 meals per day.

For example, say you are aiming for approximately 150 - 160g of carbohydrate per day. You could divide as follows:

• Breakfast: 25 -30g
• Snack: 15 - 20g
• Lunch: 30 - 45g
• Snack: 15 - 20g
• Dinner: 30 - 45g
• Snack: 15g

This type of breakdown of grams/carb per meal is typical in the carb counting method of meal planning.

When reading food labels, the "Total Carbohydrate" amount is the most important one to consider (sugar is included in the "Total Carbohydrate" amount). For foods without labels (the best type to eat!), you can try searching the USDA's nutrient database or FOODPICKER.org. You can also track and assess your diet for free with USDA's SuperTracker.

In general, the faster your blood glucose rises, the higher it is likely go. You'll want to concentrate on carbohydrates that take longer to digest. This includes carbohydrate choices with lots of naturally-occurring fiber: whole grains (brown rice, quinoa), whole fruits (not fruit juices) and non-starchy vegetables (broccoli, lettuce, spinach, green beans, peppers, tomatoes, etc.).

There are a few common starchy vegetables to look out for: corn, peas, white potatoes and sweet potatoes. While nutritious, these veggies are more concentrated sources of carbohydrates. Enjoy them in smaller portions than you would non-starchy vegetables. Low-fat dairy products (milk & yogurt) are also nutritious carbohydrate choices, but be sure to check the "Total Carbohydrate" amount, especially on fruit-flavored yogurts. Some are loaded with added sugars, which will drastically increase the amount of total carbohydrate. 

Do you know someone with diabetes?  They can send their questions to: diabetes@foodpicker.org

Diabetes Education Help

Question of the week from FOODPICKER.org

Nancy M. asks: "I am trying to find a class for our grandson. He is 19 and has a part-time job but no insurance. He just found out last week that he is a type 1 diabetes after losing a lot of weight and his blood sugar was 523. He is on insulin but needs to go to a class to manage his diabetes without going hungry. Where do we start? Any suggestions would help us a lot."

Answer: Learning you or someone you love has diabetes can turn your world upside-down, but know that help is available and you are not alone! There are many resources to check, even without medical insurance. Diabetes cannot be cured, but it can be managed. People with diabetes can enjoy healthy, long life filled with delicious foods - but education is the first step. It is extremely important for your grandson to start taking an active role in his health right away.

First, where was your grandson diagnosed? I would check with the doctor, healthcare provider or clinic that actually made the diagnosis. Also check with other other local hospitals and clinics. It is very likely they have many resources already in place for people just like your grandson.

Second, your best bet would be to find a certified diabetes educator in your area. You can locate a diabetes educator through the American Association of Diabetes Educators. A certified diabetes educator (CDE) is a healthcare professional with additional training and specialized knowledge in diabetes self-management education. A variety of healthcare professionals may also be CDEs - doctors, nurses, registered dietitians, pharmacists, etc.

Another resource is the American Dietetic Association, through which you can find a registered dietitian (RD) in your area. Registered dietitians are food and nutrition experts. An RD will assess your grandson's nutritional needs, work with him to provide knowledge and facilitate lifestyle changes that fit within his current work schedule and activity level.

Note that both websites above will generate a list of providers, from there you can contact the individual diabetes educator or registered dietitan to see what s/he offers in terms of classes, one-on-one education sessions, and find out about cost. Some RDs and CDEs work alone, some are part of a larger healthcare facility or network of facilities.

Also, be sure to check out the American Diabetes Association for more resources and information on diabetes basics, lifestyle and events.  Finally, you might also want to tell your grandson to check your state Department of Health's website. For example, New York State DOH has a diabetes page filled with information and available resources.

Good luck!

Snacking and Diabetes

Question of the Week from FOODPICKER.org:

Tom R. asks: "I have been diagnosed with type 2 diabetes. During the day at work I eat very little, but in the evenings and weekends, I can't seem to stay out of the kitchen. Do you have any suggestions to control my snacking in the evenings and weekends?"

Answer: Before I offer some snacking tips, we should take a step back to examine your food pattern. Not eating much during the day sets yourself up for two problems: 1) unstable blood glucose levels and 2) excessive eating/snacking later in the day. Unfortunately, many popular snack foods are loaded with carbohydrates and fat, and contain very few nutrients and fiber, e.g. potato chips, corn chips, pretzels, etc.

It is especially important for people with diabetes to eat small meals throughout the day to keep blood glucose and energy levels stable. If you are not used to eating breakfast or lunch, I would suggest starting with something small, like a piece of whole grain bread with natural peanut butter. Plan to bring some healthy snacks with you to work. Some examples include:

• Almonds, walnuts or other nuts - plain or lightly salted
  
• Low-fat string cheese
• Hard boiled egg
• Apple or piece of fruit
• Hummus with carrot and celery sticks
• Greek yogurt - much lower in sugar and higher in protein than regular yogurt!
  
• Light or plain microwave popped corn

I think you'll find that slowing altering your eating pattern to include several small meals spread throughout the day will help with both issues I mentioned.

However, I do have some suggestions for snacking at home. First, when you find yourself hankering for a snack, take a few minutes to decide if you are really hungry or if you just "want" something - there may be a difference. If you aren't sure, start with some unsweetened, flavored seltzer water, sugar-free gum or herbal tea and then see how you feel.

I also suggest altering the availability of snack foods in your home - get rid of it or don't buy it! As I mentioned, most typical snack foods have few nutrients and they are designed to be tasty and leave you wanting more. They are hard for anyone to resist. Until you establish new habits, it is easiest to simply not have it available. Unless you live alone, this may take some family negotiations - see if you can limit the amount available if not everyone is on board.

Instead of chips or candy, have low-calorie, high fiber items around such as popped corn (you can make it and flavor it yourself on the stovetop or in the microwave) and fresh crunchy veggies (carrots, celery, broccoli), which are satisfying to chew. If you absolutely need to have something sweet, frozen grapes make a great treat, or you can try some sugar-free jello or a piece of high-quality dark chocolate (70% cocoa) - you'd be surprised at how satisfying a small piece can be. Good luck!

Question of the Week: Sugar Substitutes and Diabetes

Here is this week's question from FOODPICKER.org:

Q: What is the best sugar substitute to use for baking and daily use for diabetics?

A: These days, you have a choice of many sugar substitutes, unlike years ago when people with diabetes were stuck with saccharin. There are many more available today: Aspartame (NutraSweet or Equal), acesulfame potassium (Sunett and Sweet One), saccharin (Sweet'n Low), sucralose (Splenda), rebaudioside A (also called rebiana or reb-A, which is derived from the stevia plant) and various sugar alcohols (maltitol, xylitol, erythritol and many more). Truvia, a new sweetener on the market, is a combination of erythritol and rebiana.

If by "daily use" you mean for use in coffee or tea, the choice is really up to your tastebuds. However, please know that some artificial sweeteners do contain a small amount of carbohydrate. When used in moderation, these sweeteners should not hugely impact your blood glucose - but only you will know how it affects you when you check your blood glucose levels. Please be aware that sugar alcohols are not absorbed in the small intestine, and may cause gas or diarrhea - proceed with caution until you know how they affect you.

Since most sugar substitutes are many times sweeter than sugar, this creates volume and texture problems when making baked goods. However, there are some good options out there: Splenda and Truvia make a crystalline product which measures out the same as sugar, cup-for-cup. I would check each manufacturer's website for information on use in baking and recipe ideas.

While you may lower the carbohydrate content of baked goods by using a sugar substitute instead of sugar, be aware that flour is itself a source of carbohydrate. Just keep this in mind when planning your meals, and you can find a way to have some treats while also managing your blood glucose levels.

A final, personal note:

It is a myth that people with diabetes must buy special "diabetic" food (or supplements) and cannot have sweets. People with diabetes can eat a healthful diet of real foods - yes, treats too - just like everyone else should! The difference is in the planning and combination of foods, which is why it is essential for people with diabetes to meet with a Registered Dietitian (RD) or Certified Diabetes Educator (CDE) to formulate a meal plan.

Artificial sweeteners are often a hot-button issue. I respect the choice to use them, but I am not a huge fan of any of them. Our palates are quite malleable and, given the opportunity, will adjust to varying levels of tastes. Artificial sweeteners undermine this process by keeping the palate used to a heightened level of sweetness. I usually advise slowly cutting back on sugar and/or sugar substitutes bit by bit - try it, you might be surprised at what you can adapt to!

Ever wonder why you don't see those 'drink milk/eat dairy to lose weight' ads anymore?

Yeah, me too. I recently discovered why: it is no longer legal to make this claim. Oh, there are ways around it, sure - now the message is only implied in advertisements, not explicitly stated. In class last week, we examined what used to be the most oft-cited research to support the claim that dairy foods aid weight loss. Let's take a look at:

Zemel MB, Thompson W, Milstead A, Morris K, Campbell, P. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obesity Research 2004;12:582-590

This was a randomized, placebo-controlled trial (a very strong study design) that sought to determine the effects of increasing dietary calcium (read: dairy products) during caloric restriction in humans. In other words, does dairy or calcium help weight loss? The trial lasted 24 weeks. The subjects were healthy, obese men and women between the ages of 18 and 60. 34 women and 7 men started the trial (n=41), and 27 women and 5 men actually completed the trial (n=32).

Subjects were randomized into 3 diet groups: high dairy diet (providing 1200-1300mg calcium), calcium-supplemented diet (approx 500mg calcium from food + 800mg from a supplement), and control diet (identical diet to calcium-supplemented diet, except with a placebo supplement). All 3 diets were designed to create a 500kcal/day deficit.

Main outcomes included overall change in body weight, total fat loss (as measured by a DXA scan), fat loss from trunk region (measured by waist circumference and DXA scan). All of this seems well and good. Strong study design, monitoring with reliable tests...the authors even state on p. 584 that "all subjects maintained complete daily diet diaries throughout the study, and compliance was assessed by weekly subject interview, review of the diet diary, and pill counts." Impressive! Too bad they don't report this data. We have no idea what the subjects were actually doing.

Now, for the results: As expected, all subjects lost some weight. For overall body weight (which is the only outcome I will discuss here, for the sake of time and space, and the space-time continuum): the control group lost 6.4 +/- 2.5% of their body weight. The calcium-supplemented group lost 8.6 +/- 1.1%, and the high-dairy group lost 10.9 +/- 1.6% of their body weight. Ok, the high dairy group lost the most weight. Seems like the end of the story, right? I'll get back to that in a minute.

I shouldn't forget to mention some limitations of this study: small sample size (only 32 completers), mostly women, we have no idea exactly what they were consuming during the study because even though it was assessed, those data were not reported.

Now, the lead author of this research wrote a diet book, The Calcium Key, in which he states that study after study has "proven" that low-fat dairy foods work wonders for weight loss, and that you can "increase the amount of weight lost by 70%."

Hmm...

Sure, the control group lost 6.4% of their body weight compared to the 10.9% lost by people on the high-dairy diet. This is an increase of 70%, but what does it actually mean? The control group lost 6.6 kg (14.5 lbs) during the 24 weeks, the calcium-supplemented group lost 8.6kg (18.9 lbs) and the high-dairy group lost approximately 11 kg (24.2 lbs) in 24 weeks. Wow! 1 pound per week!

Remember that all subjects were supposedly eating a diet with a 500kcal/day deficit - this should promote a healthy weight loss of 1 lb per week, no matter how much dairy or calcium one consumes (3500 kcal = 1 lb; 500 kcal x 7 days = 3500 kcal). Perhaps the high-dairy group subjects were simply more compliant with the diet? Again, data not reported, so we don't know.

I hardly think this one study showing us that we can increase weight loss from 2/3 lb per week to a 1 lb per week is grounds for the dairy council plastering posters everywhere (well, they used to be everywhere). Oh, and this research was supported by the National Dairy Council. Not surprising.

What is surprising are the economics and conflicts of interest in this research (i.e. the lead author's employer holds a patent on the claim that dairy consumption improves weight loss!) check out this post from Parke Wilde, who teaches U.S. Food Policy at the Friedman School of Nutrition Science and Policy at Tufts University.

Question of the Week from FOODPICKER.org

Here is a question I received from FOODPICKER.org:

"I have type 2 diabetes and high blood pressure. Someone suggested I try “Original No Salt” which is Sodium-free instead of salt. Is it a safe alternative for my use?"

A: "Original No Salt" does not contain sodium, and thus is safe to use if you have hypertension, also known as high blood pressure. There is a direct link between sodium intake and an increase in blood pressure, which is why you are told to lower the sodium in your diet.

Products such as "Original No Salt" are good alternatives to table salt, but there are many other ways to flavor your food. You might try herbs (fresh herbs are particularly flavorful), spices, pepper, lemon and lime juice. Mrs Dash is a brand of salt-free herb flavor mixes, but you can easily create your own herb mix at home for a fraction of the cost - just buy your favorite herbs and mix together in a jar. Here are some other seasoning ideas from the American Heart Association.

You should also be aware that the majority of sodium in our diet comes from processed foods - NOT from salt added during cooking or at the table. Processed foods are loaded with sodium! Be sure to check both the serving size and the sodium content of any food you buy with a Nutrition Facts label. Foods particularly high in sodium include anything canned (soups, beans and vegetables), lunch meats, sausage, salami and cheese. Sodium content will vary from brand-to-brand, so be sure to do some comparing.

By making simple substitutions, you can dramatically reduce the sodium you eat: buy frozen or fresh vegetables instead of canned. Buy dehydrated beans (in bags) and cook your own, or rinse canned beans before eating.

You may also be interested in learning about the DASH (Dietary Approaches to Stop Hypertension) diet plan which has been shown to lower blood pressure. The DASH diet focuses on plenty of fresh vegetables, fruits, low fat dairy, whole grains, nuts and lean meats. This diet would also be appropriate for someone with type 2 diabetes. You can learn more about the DASH diet here and here is a brochure (pdf)

Do you know someone with diabetes? They can send their questions to: diabetes@foodpicker.org

Check out: www.FoodPicker.org for Diabetes Nutrition Education

I just became a nutrition editor at www.foodpicker.org - a website designed to help people with diabetes make better food choices.

I became particularly interested in counseling people with diabetes while I was a dietetic intern at the fabulous Naomi Berrie Diabetes Center in Manhattan.

In the United States, 24 million people have diabetes and an estimate 57 million have pre-diabetes. There is a direct correlation between what a person with diabetes eats and their blood glucose levels. The risk for health complications increases the longer blood glucose remains uncontrolled. Do you know what well-controlled diabetes is a risk factor for?

Nothing!

My hope in joining this project at www.foodpicker.org is to provide a credible discussion of nutrition and diabetes-related topics. I will be posting about these, in addition to my usual favorite: how health and nutrition research is distorted by the media.

---

Senior Women, Cognitive Decline and Exercise

Before continuing with my favorite topic - media misinterpretation of health news - I would like to acknowledge something that came up in my class last week: the journalists writing about this stuff do not have it easy. Often they must take something exceedingly complex, decipher it, then translate it into the language of a much lower reading level - all without exceeding a certain word count. Yipes!

The purpose of these comparisons - media vs. scientific journal - is not simply to diss the media. The point is to demonstrate why health professionals should not consider the media a reliable source of health research news. Even when the information reported by the media is accurate, it is often not complete. Simple as that. Sometimes what is left out can make a big difference. I am sure I won't cover everything either - there's nothing like reading the original work!

Anyway, on with the comparison:

NY Times blurb - Exercise: In Women, Training for a Sharper Mind
vs.
Liu-Ambrose, T. et al. (2010) Resistance Training and Executive Functions, A 12-Month Randomized Controlled Trial. Archives of Internal Medicine, 170(2):170-178

This was a randomized, controlled, single-blinded, prospective study. 155 women between the ages of 65-75 were randomly assigned to one of 3 groups: resistance training once per week (RTx1), resistance training twice per week (RTx2) and a balance and toning group (BAT). This was reported accurately in the NY Times, except for missing the frequency of the BAT group (they met twice a week).

Details not included: the trial was completed form May 1, 2007 through April 30, 2008. The women were free living (i.e. not institutionalized) individuals from Vancouver, average height, weight, education level, score on visual acuity tests ( > 20/40) and score on the MiniMental State Exam ( > 24). [We debated the meaning of this last score. One classmate said that a score below 30 indicates cognitive decline - so are we to assume that the women in this study may be experiencing some (but not severe) cognitive decline? This would make sense, but is not clear - more info is needed.]

On 3 occasions, the women were put through a series of tests designed to assess executive function: beginning of the trial, midpoint (6 months) and trial completion (12 months). This included the Stroop test (assessment of selective attention and conflict resolution) as well as tests of set shifting and working memory. The tests were described in detail and are quite interesting (i wonder how i would score if someone asked me to name the color of the word "blue" printed in red ink, etc.)

The NY Times states, "improvements in the strength training group included an enhanced ability to make decisions, resolve conflicts and focus on subjects without being distracted by competing stimuli."Ok, well at least the last two were correct ("resolve conflicts" = conflict resolution; "focus on subjects without being distracted by competing stimuli" = selective attention), but the ability to make decisions was not tested. I am not sure where that came from. Also tested (but not reported in the Times) were: gait speed, muscular function and whole-brain volume.

Some other important findings not reported in the Times: after 6 months (at the midpoint evaluation), there were no differences between any of the groups. At the end of 1 year, significant between-group differences were found for selective attention, conflict resolution and muscular function only - no differences were found at any point for set shifting, working memory or gait speed. The Times reports the numbers correctly for the improved cognitive measures (improvement of 10.9% for the RTx2 group and 12.6% RTx1 group; decline of .5% for BAT group) but leaves out which functions showed no differences. Also not reported: peak muscle power increased by 13.4% in the RTx2 group but decreased by 8.4% in the RTx1 group and by 16.3% in the BAT group. I thought this was very interesting - does this indicate that weight training once a week was not enough to halt loss of muscle power? I supposed it helped slow the decline, but still...I'm not exactly sure how to interpret these results, but it seems that if you are a woman between the ages of 65-75 and you want to improve or maintain muscle strength, once a week resistance training is not enough. Also interesting: improvement in selective attention & conflict resolution was significantly associated with improvement in gait speed (but keep in mind that there were still no significant differences between the groups for gait speed).

One final (and striking) finding that took the authors by surprise: whole brain volume decreased a small but significant amount in the two RT groups! Yes, in the two groups that showed improvement in executive function. I can hear the jokes about weight-lifters already starting to fly...but keep in mind these results may not generalize to men, women outside the tested age group (65-75) or even to those in the age group outside of the Vancouver area. The authors could only speculate as to the implications of this paradoxical finding. And nope, you will not read about that in the NY Times.

Obesity Plateaus in US (Really?) - Media Misinterpretation of the Week

Last week, I read this article in the Jan 14, 2010 NY Times:  Obesity Rates Hit Plateau in U.S., Data Suggest (http://www.nytimes.com/2010/01/14/health/14obese.html) I found this hard to believe, but hey, it supposedly came straight from the CDC - hard to argue with. 

We examined this further in my class tonight. I must give credit to Joyce Vergili, EdD, RD, CDE for doing the breakdown for us in class. Some of the highlights are below. I was a bit surprised at this: The NY Times usually does an OK job, but they really did misinterpret this study, which only serves to propagate confusion.

The NY Times states that, "Americans, at least as a group, may have reached their peak of obesity, according to data the Centers for Disease Control and Prevention released Wednesday." This sounds like big news! Yet, go to the CDC website, and there is nary a mention of this mysterious data. Turns out, the numbers were actually published in the Journal of the American Medical Association (JAMA) using data from the ongoing NHANES (National Health and Nutrition Examination Surveys).  It was not "just released" data. It was NHANES data from 1999 - 2008. NHANES data is actually available to the public, if you care to learn how to manipulate the database.

Here is the link to the entire JAMA article, published online: http://jama.ama-assn.org/cgi/content/full/303/3/235

Anyway, where the NY Times really screws up is the following: "The numbers indicate that obesity rates have remained constant for at least five years among men and for closer to 10 years among women and children — long enough for experts to say the percentage of very overweight people has leveled off."

What the authors, Flegal et al., actually state regarding this is: "In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women. The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men."

Let's be clear here. Did the authors say we have plateaued? No! They simply state the prevalence has changed. Has it slowed? Maybe. Seems likely. But stopped? No. Take a look back at the first sentence of the NY Times piece, when it states Americans "may have reached their peak of obesity." One classmate pointed out this sentence makes it sound as if rates are declining. I'm not exactly sure how Dr. Deitz (interviewed for the Times piece) can say we've "halted the progress of the obesity epidemic" based on these data. At the very best, it appear it might be slowing - very different than halting altogether. 

The NY Times also fails to point out the weaknesses of the study, as noted by the authors (possible sampling error, reliance on BMI and that they limited statistical power: "The power of this study is limited to detect small changes in prevalence, particularly among subgroups defined by sex, age, and racial and ethnic group."

How many people reading the NY Times piece think we have now stopped obesity in its tracks?