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Archive for March, 2010

http://www.nytimes.com/2010/03/31/business/31statins.html

A friend sent me this article which details the new way that AstraZeneca, with the approval of the FDA, is helping Americans avoid heart attacks….to encourage Americans to start taking Crestor for prevention.  Crestor is a statin drug that, up until now, was prescribed for those with high cholesterol, not those that might be at risk.  Crestor has potential side effects that include headache, muscle aches, joint pain, nausea, constipation, and abdominal pain, not to mention that pesky risk for liver damage. 

I can just see the billboards and commercials now….for only $3.50 a day, you can reduce your risk for heart attacks without treadmills or vegetables.  That works out to $105 per month, or $1260 per year.  And, this medication will be intended to be taken for years, which is definitely good for AstraZeneca.  I suppose this is also good news for insurance companies, a once daily pill is much cheaper than a 5-day hospital stay for a heart attack along with the bypass graft or stent placement surgery that will likely follow.  I don’t fault AstraZeneca, or the insurance companies, for this; some may even applaud their efforts.  They are in the business of making money just like food companies, fast food giants, soda retailers, and the producers of the latest diet gimmick.     

Really?  This is where we have turned?  We have resorted to popping a pill every day to prevent heart attacks?  I guess there are pills to prevent pregnancy, but that is a little different.  I can’t really get the same results with eating vegetables and getting more exercise.   And, babies aren’t anything like heart attacks, very close, but I suppose even that’s debatable. 

I was under the impression that preventing heart attacks had something to do with regular exercise, eating a variety of fruits, vegetables and whole grains, and balancing stress?  But, that certainly is a lot more work than popping a pill.  News like this leaves me feeling very defeated as a professional and in what I aim to promote to people.  Will we ever learn that the consumption of whole foods, exercise, and stress reduction are what keep us healthy?  The food and pharmaceutical companies certainly don’t want you to believe this, and today, I feel like they’re winning.  Eve 2-AstraZeneca 1000.  Scores updated weekly.

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Okay, so this is really just an add-on to my previous post regarding the new health care reform bill and having calories posted on all menu boards.  I believe that the makers of the new health bill believe that having calorie information in everyone’s face in every restaurant venue will insight people to choose differently, and hopefully, healthier.   I understand their good intentions.  But, hasn’t this information been around a long time?  Now, I realize that not having knowledge about food puts one at a disadvantage for making the best choices, but having that knowledge does not necessarily mean that one will make a alternative choice, or better one, for that matter.  This is the case in many areas of our lives, but food is what I am here to discuss today.

Let’s look at Oprah, for instance.  I don’t like to pick on people, well only in private, but we have all witnessed her enormous fluctuations in weight over the years.  And, those that watch her show, probably heard all about her current diet choices and exercise regimes.    She is the epitome of a yo-yo dieter, or what my department likes to call a “dieting casualty.”  Oprah is one of the wealthiest women in the world, has a great deal of power, and an educated woman….she did graduate from college, I had to check.  But, somehow, with all this education, wealth and power, even Oprah cannot seem to get it together when it comes to weight and health. Now, I think she has learned some things over the years and just like anyone is figuring out what is right for her.  But, even someone that can pay a personal chef, a private trainer, and a private food purchaser, she can’t maintain a consistent and healthy weight.  I am not in any way making fun of Oprah here, it is a struggle than many share.  I am just making the point that even with all the knowledge and resources, people don’t necessarily make the best decisions.

I am a dietitian and have struggled with weight over the years, not quite as wildly as Oprah considering my highest weight ever was 135lbs, but that is not a good look for me, and I have tons of knowledge about nutrition and diet.  I have seen and worked with numerous dietitians that were obese.  I even did crazy diets in hopes of losing weight and even resorted to bulimia for years.  I “knew” this was very bad for me, but I always thought I would stop after just 5 more pounds….apparently, eating disorders don’t work that way.  We, dietitians, are just like everyone else, knowledge does not mean action.

Obesity is not discriminatory, it preys on all humans, and some pets.  It is sitting there waiting for us to overeat the French fries dipped in garlic aioli, chicken wings, and M&M’s.  It doesn’t care who we are.  White or Black.  Low income or high income.  Educated or uneducated.  Rural or urban.  It doesn’t seem to matter.  Obesity doesn’t seem to be a disease that we can blank out with more education, although we are certainly trying, aren’t we?

So, will putting calorie amounts on menus really help our nation get healthier?  I suppose it will help some make better choices, but still they have a choice, which if there wasn’t a choice, it wouldn’t be America.  People need to take personal responsibility for their behaviors and I suppose being more educated will enable them to do this, but again, that doesn’t necessarily mean they will.

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With the new health care bill, restaurants that have 20 or more outlets will be required to post the calorie content of standard menu items along with suggested daily intake of calories. I am not saying that this part of the health care bill isn’t a good idea, but I have some reservations. Full details can be found at: http://http://healthcarebillindex.com/HR3962/DIVISION_C/TITLE_V/SUBTITLE_C/PART_1/SEC_2572/#HC039386C50B448BBB3B7CFBEBC156536

THE GOOD
I will talk about my positive reactions first. I do believe that restaurants should be obligated to provide calories, fat, carbohydrates, etc for those that are interested in such information. For some, this is vital information. For instance, a child with Type 1 diabetes who uses an insulin pump needs to input an accurate amount of carbohydrates into their pump in order to receive the correct amount of insulin for that meal. An error in guessing can result in blood sugars being too high or too low.

And, I also think this may enlighten some to the high amount of calories found in items that most consider “healthy” such as entrée salads, which I’ve seen top 2000 calories, which for most is a average daily intake. Certainly, change begins with knowledge, I will not deny that. So there will certainly be some that will benefit from this.

And, to add one more good point, this may ignite restaurants to start making reasonably-sized portions, although, I am sure most of the patrons would be disappointed, especially when the cost of the meal doesn’t fall as well. I don’t think those that are super-sizing and visiting buffets necessarily want their portions smaller anyway. These restaurants are in the business of customer service and have provided what most Americans demand, extra-large portions. You’d think we all had grown up in a third world country the way we heap food on our plates and keep heaping.

THE BAD
I am not trying to throw stones here. I am fairly certain that the proponents of this section of the bill have very good intentions. I imagine that they believe that having this information at restaurants and vending machines would somehow make Americans choose better, and thus, be healthier and we would spend less money on healthcare. I get it. The theory is sound; just not sure that’s what happens in reality, though. Fast Food restaurants have been providing this information, now even on the wrappers, for years. This information has not stopped people from super-sizing their meals nor has it stopped 50,000,000 Americans from eating at Fast Food restaurants daily. I am pretty sure Americans did not get skinnier in the last 10+ years of this information being available.

Another not so great thing is that the suggested daily intake of calories will also be listed on the menus. Did I miss something? From my education, calorie needs are dependent on a combination of factors including weight, lean muscle mass, gender, age, and activity level of an individual. I am not under the impression that Americans are actually going to abide by this “calorie law” since the nutrition facts label has had this for years, however, if someone did want to follow it, they may be getting too few or too many calories for their needs.

THE UGLY
I suppose you could classify these next two points as “The Bad,” but they have more to do with emotions, and emotions can sometimes be ugly. I am learned to be okay with eating whatever I want and not feeling guilty about it, however, I didn’t used to be and know a quite a few of my friends and coworkers that still cling to this guilt after eating cake, cookies, French fries, bread, etc. Should I, or anyone, be made to feel guilty or feel as if they aren’t healthy because they want to order the 1500 calorie meal? I imagine I order this amount of calories often, I probably don’t finish it, but sometimes I would especially after running a 20-mile training run. So, now can I expect the restaurant staff to be peering at me over their soft-drink station after they find out that “she’s the one that ordered the 1500 calorie meal?” It’s not just the makers of this bill that are pointing fingers, but now the restaurants and possibly our dinner-mates? In my own experience and of those of my patients, I have witnessed this guilt back-firing with binging. I know I’ve done it, for more reasons than just feeling guilty, and I’ve heard my patients talk about how guilty they felt after having 1 or 2 pieces of cake, that they then decided to just eat the whole thing. I suppose some would argue that this guilt might stop some from indulging and for some, I am sure it will. Significant enough to make an impact on America’s health? Probably not.

The last issue I want to address is similar to above, but it has to do with well-intentioned parents and their kids. As a dietitian, who typically works with adults, I probably can’t look at a kid and determine their calorie needs. But, now parents are going to be the keepers of their kids’ calorie intake. Yes, I understand that parents make all, well most, of the purchasing decisions. But, imagine a child ordering a grilled cheese and fries and mom chimes in: “no honey, that is too many calories for you” or “you’re too big to be eating that.” But, how can I expect parents to trust their kids to internally know when to stop eating when they, themselves, don’t know when to stop. I do believe that comments such as these, good intentions or not, can lead to eating disorders, low self-esteem, closet-eating, food hoarding, and lack of trust for one’s own regulation of hunger and satiety.  I realize these may sound like extremes, but I am an ex-bulimic and work with chronic dieters, this stuff happens.  How have we gotten so far away from our natural instincts that we have to have calories listed on everything in order to know how much we should eat?  Have we lost all of our hunger and satiety sensation?

And, finally, do we really think the obesity epidemic is going to be solved by mandating that restaurants include calories on the menu and fat taxes? I suppose it might help, but considering much of this information has been around for a long time and Americans keep getting fatter, probably not.  I guess only time will tell.

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I don’t feel like I am writing anything new here, but I continue to overhear and receive comments about foods being “fattening”, the extreme avoidance of any food containing fat, and the fact that people continue to purchase fat-free and reduced-fat products, so I feel I need to put this fear of fat to rest. If this were true, we would all have gotten skinny eating Snackwells, Wow chips, and Reduced-fat Oreos, but obesity reigns on. It’s not fat that makes us fat, its any calories in excess whether they come from fat, carbohydrate or protein. Any of these in excess will be stored as fat in the body. So, can any one food be called “fattening?” I guess if eaten in excess of needed calories, but you can’t blame any particular food for our obesity epidemic.
And, it’s not only my clients I hear this from, but seemingly well-educated people, too. For instance, there is a doctor, who shall remain nameless, that I work with that continues to put this fear of fat into patients telling them that peanut butter, nuts, avocadoes, and dairy will make them fat. He might as well just tell them that these foods come straight from the devil and should be included among the Commandments: Thou Shall Not Eat Fat. He’ll surely be surprised to know that I didn’t blow up like the blueberry girl from Willa Wonka when I ate that entire avocado for lunch, yep 300 calories and 27 grams of fat. And, shockingly, I even had about 400 calories in almonds that same day. It’s a wonder I didn’t have to buy new pair of pants or get someone to roll me out to my car.
I understand the reasons that fat gets a bad reputation; it has 9 calories per gram as compared to carbohydrate or protein, which have 4 calories per gram. So, in the minds of the diet “gurus”, you can eat more food if you eat less “fatty” foods, which is certainly true. The problem with the low-fat craze was not the promotion of eating less fat and more fruits, vegetables, and lean meats. No, the problem started when companies wanted to get a piece of the diet cash. Big companies, and the diet companies themselves, started producing low-fat and fat-free foods, and might I add low-taste and taste-free, not necessarily void of calories, just less calories from fat and typically more calories from carbohydrate, usually sugar. When you’re at the supermarket sometime, take a look at the calorie difference between the original vs. low-fat vs. fat-free products, typically it’s not a whole lot. And, what I’ve witnessed with these foods is that people just end up eating more, maybe because they’re less satisfying or maybe it just feels right to eat more since you are eating “healthy.” Either way, the low-fat craze, nor the low-carb craze, has reduced our waistlines; in fact, we are heavier than ever here in America.
Fat is not the enemy. Fat is essential to our bodies. There are a host of reasons that fats are needed, just as there are for proteins and carbohydrates. Fats are needed to absorb certain vitamins, to insulate our bodies for temperature regulation, to protect vital organs, which is very useful when one plays roller derby, assist in immune function, and to make our skin and hair pretty to name just a few. I could go on and on about this, but it can be found in any basic nutrition or physiology book. All of these macronutrients are needed by the human body, but, alas, in balance.
Balance is a challenging thing, but I will try to make it simple. Eat whole foods; skip the refined foods that have added fats and sugars. The fat in whole foods such as nuts, seeds, avocadoes, olives, grass-fed beef, wild caught fish, and organic dairy are of the “good” variety. The vegetable fats typically have high amounts of mono-unsaturated fats while the animals raised with natural diets will have high amounts of omega-3 fatty acids. These are the fats that we end up short on when we eat only refined foods and meat from factory farms. I stand by Michael Pollan’s statement: “Eat food. Not too much. Mostly plants.”

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Steroid usage by baseball players and other athletes has been all the media rage in the last few years. Jose Canseco released his book entitled “Juiced,” where he told his story of anabolic steroid use and other players that he personally witnessed being injected with steroids and human growth hormone. Americans were up in arms about the messages that it sends to today’s youth who are looking to become professional athletes. Baseball and other sports were thrown for a loop on records and titles that were given to individuals and teams that used steroids, should they be taken away? is it fair? what to do for the future of the sport?, etc. Personally, it’s a no brainer issue….steroids are illegal in sports, users should be ejected from the league, no pay out, blah, blah, blah, but it is never this simple and I am really not interested in debating the issue of steroids in sports.
What does intrigue me is the media attention that this got and yet, everyday, our food supply is injected with hormones, which then we eat if we are not careful about our purchasing decisions. Estradiol, progesterone, testosterone, zeranol, trenbolone acetate, and melengestrol acetate are the six hormones that are legal for use in food production in the United States. Where was Canseco on that one? Now, I realize, there are multiple books that detail the hormone usage in our food supply, however, Americans average a 3rd grade reading level. I am not sure they could read, let alone comprehend, the “Omnivore’s Dilemma” by Michael Pollan, which is a highly recommended read, but above the average Americans’ reading level. I am aware that this issue is all over the internet, some wacky sources and some reliable scholarly sites, but it is absent from the everyday media. I rarely see nightly news coverage on the hormone usage in our food supply, a newspaper or People magazine article entailing such. Now, I have theories on why this might be, but I won’t voice them here as I am now probably being watched by the likes of Monsanto and Phillip Morris.
I am not going to go over all these “legal” hormones that are used in food production, injected into cows to produce more milk, injected into chickens to produce more eggs, injected into chickens, pigs, and cattle to gain weight and produce more meat. I don’t need to. Most people can do the math…inject hormones into animals and that means the meat, eggs, and milk will also contain those hormones…it’s not rocket science. The first three hormones listed, estradiol, progesterone, and testosterone, are all sex hormones. Could this be the reason that females are reaching puberty at a younger age? I don’t know for certain, but kind of makes sense, doesn’t it? Could our obesity epidemic have a little to do with this? Maybe, but I am not certain. Could this be the reason for increase in cancers over the years? Maybe, but again, I am not certain. These hormones probably are not the only reason for such phenomena, but could be a likely attribute.
Now, what to do? Well, I am definite that Major League Baseball is not going to do much about the hormones used in our food supply. And, I am pretty sure the government isn’t either, and if they even thought about it, there would be protesters in the streets with signs that America is turning “socialist” and “I have a right to have hormones in my food”, “don’t kill corporate America”, and other ridiculous responses. And, honestly, we don’t have to wait for anyone to regulate this. We, as consumers, have purchasing power. But, unfortunately, these hormone laden foods’ prices are kept low by our tax dollars. But, isn’t your health more important? You have a vote with every dollar you spend on food. I don’t expect that everyone has enough income to buy all organic, but when you can, use your purchasing power to buy organic eggs, milk, and meat, and better yet, buy them from local sources. Most of our local farmers may not be “certified organic,” but that isn’t because they don’t use organic methods, it’s more likely because its costs a lot to have this certification. Ask your local farmers how they produce the food and they will probably invite you to their farm. So, the way I see it is that we have two options:  We can either wait for “America’s War on Hormones” or start using our purchasing power to tell these big companies that we do not want hormones in our foods by buying organic, and better yet, local.

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Size bias is certainly routine in everyday life and definitely in the world of roller derby. Many outside of the derby world might naturally assume that the smaller girls would be jammers and the bigger girls would do the hard hitting as blockers. My derby sisters are probably chuckling at this as they know this isn’t necessarily the case. I have seen some “bigger” jammers that are truly amazing with their speed, agility and they are impossible to knock down and like myself, there are some “small” girls that will knock a girl out of her skates…I have yet to do this, but it’s not from lack of trying.
And, just like roller derby, I find size bias as a dietitian. I am intrigued by the comments I receive from clients regarding MY size. I am 5’4” and weigh in at 120lbs; body fat percentage is around 20%. I am not overweight, but I am certainly not the skinniest person you’ve ever seen, I used to weigh 95 pounds….more on that another time. I always think “What does it matter to them? Isn’t this supposed to be about what they’re doing or not doing? Aren’t they coming to me for my knowledge? Are they playing mind games with me?” I don’t have the answers, but I have some theories and I’m pretty sure it really has nothing to do with me or my size, and more to do with my clients’ perceptions of what it means to be thin or overweight. Typically, I just brush off such comments and get back to the reasons that brought them to me. And, another thing, it’s really none of their business. Ah, but here I share with all that care to read this.
I have some clients that would prefer to see a thin dietitian, such as myself; I think they believe that thin dietitians have all the answers, or I am hiding my magic wand somewhere. Well, I must, right? I’m thin, I must eat all the right foods in the right combinations and the right amounts and never indulge in chocolate or alcohol or chicken wings, right? In the words of Dwight Schrute: “False!” Now don’t get me wrong, 85% of the time I choose whole grains, vegetables, fruits, nuts/seeds, lean meats, etc, but I believe in balance and enjoy the occasional brownie, beer, chocolate, Keystone Review wings, and my recent weekly favorite, a pretzel from Taste of Philly. So, if these clients are correct in their thinking, instead of getting a 4 year degree, 1 year internship, and taking an exam to become a registered dietitian, I should have just been weighed???
And, funny enough, there are some clients who would prefer not to see a thin dietitian. Why you might ask? Well, over the years I have heard rumors from clients that thin dietitians know nothing about the struggles that one might encounter with a “weight” problem. NEWS FLASH: I am not thin because I thrice tapped by ruby red slippers and said “let me be thin, let me be thin.” Ironically, I have had to work at this as well. Huh, who knew? I have had my “struggles” with weight over the years from starving myself to binging/purging, and every diet in between those two extremes. I started dieting in middle school about the time I hit puberty. I won’t go into all the gory details in this post as I want to keep them short, but I’ve done it all.
I don’t know everything, but I have learned some things in the last 10 years of being a dietitian and 20 years of pursuing thinness. First, don’t judge a dietitian or roller girl by their size or lack of tattoos. A thin person is not necessarily “healthy” or fast and an overweight person isn’t necessarily “unhealthy” or good at hitting. Second, I have yet to witness strict dieting being successful . I promote being mindful while eating real foods, which means more fruits, vegetables, whole grains, lean meats, nuts/seeds, and organic dairy products. And, finally, BALANCE. Take rest days; eat pretzels, chocolate, and wings occasionally; it’s good for the soul.

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In my opinion, the egg is one of the most wonderful foods from omelets, scrambled eggs, over-easy, quiche, casseroles, deviled, soufflé, and my everyday favorite, the hard-boiled egg. There isn’t an egg I don’t enjoy. And just to clarify, I am talking about eggs from chickens, not ostriches, not alligators, not parrots, not snakes, chickens and more specifically, hens. I have purchased quail eggs to my dismay, just really tiny and a lot of work, but they were very delicious none the less.
Eggs have been eaten since the beginning of time. In many cultures, eggs have much symbolism. Some view eggs as a sign of life, resurrection (think Easter), fertility, spring, rebirth, and even immortality. Americans, the excellent consumers that we are, eat a lot of eggs. About 240 million hens produce50 billion eggs each year. White shelled eggs are produced by hens with white feathers and ear lobes. Brown shelled eggs are produced by hens with red feathers and red ear lobes.
Ah, but there is much controversy surrounding the egg. Much like Humpty Dumpty, he’s been king, and then has fallen, and I am here to put him back together again. You may refer to me today as “The Egg Defendant.”
So, why the controversy you may ask? Well, eggs, since they are an animal product, do contain cholesterol, 213mg per egg to be exact, most of which is found in the delicious yellow yolk. Many experts suggest limiting dietary cholesterol to 300mg per day for someone without high cholesterol levels and 200mg per day for someone with elevated cholesterol levels. So, this must mean that eggs are bad, right? They must raise our cholesterol levels; they are loaded with it, right? From the mouth of Dwight Schrute: “False.”
Now, the physiology behind this is pretty involved, so I am going to try to make it as simple as possible. Our liver produces cholesterol, which is necessary for the daily operations of all the cells in the body. However, for most people, if more dietary cholesterol is consumed, the liver will produce less, and vice versa. For various reasons, not all humans function at 100% capacity. So, for some, eating more dietary cholesterol can increase blood cholesterol levels that can start to wreak havoc on the artery walls. But, should we be blaming this on 1 specific food, the egg? I think not.
Let’s talk about all the positive aspects of the egg. Eggs contain roughly 70 calories, about 7 grams protein, and 5 grams of fat, most of which is found in the egg yolk. OMG, fat, NO! Yes, that is why there are “egg beaters” out there, egg whites with yellow food coloring. Ah, but some fat is good for us and can help raise those HDL cholesterol levels, which some call the “good cholesterol.” I like to say “healthy” cholesterol ‘cause it goes with the “H” and patients remember it better that way. And, the yolk contains Vitamin D, one of the only food sources of Vitamin D, as it is a fat-soluble vitamin. Also, eggs are a cheap source of protein, which can be great for those with low incomes.
With all that said, eggs are not created equal. This is where the hens’ diet matters. The natural diet of hens includes grass, plants, worms, bugs, and other things found in pastures. With a natural diet, the eggs of hens will be full of Omega-3 fatty acids, which can help raise that healthy type of cholesterol, HDL. Unfortunately, the money-making machine that is human has altered the diet of these hens in order to produce more eggs and thus, make more money. Obviously, producing more eggs won’t make you the most money. If you could house them and thus, go lean on land, and feed them cheap corn and soybean meal, the money could just roll in. Well, I guess that is correct, but with some consequences. These corn fed hens produce eggs that don’t have much omega-3 fatty acids or Vitamin D. Also, they are housed in such close proximity, so they require hormones and antibiotics to prevent illness. I could go on about this, but this post is getting rather long now so that can be addressed at another time. For simplicity, what the hen eats or has injected into them is passed on to the consumer through meat and eggs.
In my assessment, eggs are an excellent source of protein, omega-3 fatty acids, vitamin d, but, only if they come from eggs that are free-range or cage-free. Better yet, purchase eggs from a local farmer. They will even let you visit to see where the hens feed. I belong to an egg co-op through Brown Family Farms (www.brownfamilyfarm.com) and have the option of getting 1 or 2 dozen eggs every other week. These are delicious eggs and the yolks are so golden, nothing like I have ever seen from super market eggs. They may be a bit more expensive, but so worth it.

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