It has been estimated that small decreases in salt intake can lead to decreases in systolic blood pressure. Population-wide, such a reduction would theoretically lead to reduced prevalence of heart attack and stroke, saving thousands of lives per year.

If all goes as planned, it will be interesting to compare blood pressure levels and the incidence of heart attack and stroke in New York City before and after the 25% reduction…

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Dietitians and nutritionists are lied to quite regularly (I’m feeling negative today, can you tell?). When we ask what our patient ate for lunch yesterday, while they actually had a quarter pounder with cheese and a large order of fries, they will respond in one of three ways: (a) The truth; (b) “Half a hamburger with a few french fries” ; or (c) “A grilled tofu salad with veggies from my garden and oil and vinegar dressing.” Person (b) is probably the most common. Person (b) isn’t really lying, they either don’t remember exactly how much they ate or they’ve fooled themselves into thinking they ate less.

Persons (b) and (c) are the reason why we can’t seem to gather accurate nutrition information for clinical studies, which poses a problem for our results. Well, now there’s a foolproof way for the researchers among us to learn exactly what you’re eating. Step 1: Get consent to spy on you from human subjects. Step 2: Attach a small video camera to your body. Step 3: Promise you we won’t use the footage for reality television. Step 4: Edit out the bathroom scenes before presenting data to large audiences.

The new technology won’t be available for widespread use for some time now, so no need to worry just yet…

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In light of this information, it is not surprising that most of these people are gaining most or all of the weight back once they leave the show. In the real world, doctors and nutritionists typically recommend about two pounds of weight loss per week to acheive steady, sustainable weight loss. However in the rhealm of reality television, fast results certainly make for better drama.

Drama is one thing when you’re vying for the attention of a washed up hip hop star, airing your dirty laundry, eating bugs, or repelling down skyscrapers, but it is entirely different ethically when health risks are involved. Weight loss that is too rapid is associated with heart complications and is not sustainable. So, if you’re thinking of wearing a garbage bag while sweating it out, or going on a serious calorie restriction for weeks or months, do yourself a favor and do it the right way – slowly.

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Food Security is defined as “having access to sufficient, safe, nutritious food to maintain a healthy and active life” by the World Health Organization. The main difference between food security and hunger is the nutrition piece. Food can provide sustenance without necessarily being nutritious (this versus this), possibly leading to long term nutrient deficiencies but calorie surpluses.

According to the US Department of Agriculture’s report (summary of findings here), one in seven households in the US were classified as food insecure in 2008. Fifteen percent of American households either going hungry or sacrificing nutritious foods for calorie dense, nutrient poor ones to fill their bellies is certainly cause for concern.

I empathize. Last year, I made the move from Georgia to New York immediately after graduation, without a job lined up for my arrival or much in the way of savings. During the first few weeks of my three month unemployment, I found myself snacking on whatever I could get my hands on – free or insanely cheap, and admittedly sometimes not the most healthful food (I know what you’re thinking. Don’t judge me. I don’t come to your blog and judge you, do I?). Recognizing the irony of searching for a job as a nutritionist and engaging in such hypocrisy, I got smart.

I cooked all my meals at home and froze the leftovers in individual portioned containers. I didn’t waste anything. I started buying low sodium canned vegetables, soups, and beans, and frozen fruit. I discovered dried beans, and online coupons (I actually became very excited about online coupons). I ate oatmeal for breakfast instead of the expensive cereals I was used to. I switched to the generic store brand of everything. I bought large bags of brown rice and made a lot of my dinners based around that. I drank nothing but water and the occasional green tea.

I realize that many Americans who have lost their jobs or are food insecure for a different reason have not only themselves, but also their children to care for. Sometimes even doing everything you can to prevent waste and save money at the store doesn’t go far enough. There is a ton of support available to people who find themselves in this incredibly tough situation.

First of all, locate a community food bank close to you. I’ve volunteered with many of these and most give out weekly grocery bags with staples that keep well. They try and include food from all the food groups, and from my experience they do a very good job. Also, those who financially qualify can apply for the Supplemental Nutrition Assistance Program (SNAP, or the food assistance program formerly known as the Food Stamp Program) or the Women, Infants, and Children (WIC) program if you are pregnant or have a child under the age of 5.

To end on a happier note, or at least a silver lining, President Obama has proposed increasing spending on food assistance programs such as the ones listed above for the 2010 budget (see page 45 if interested).

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The FDA announced on Friday that they are giving nearly 30 manufacturers of caffeinated alcoholic beverages 30 days to prove the safety of their products. Per the FDA’s press release:

“Under the Federal Food, Drug, and Cosmetic Act, a substance added intentionally to food (such as caffeine in alcoholic beverages) is deemed “unsafe” and is unlawful unless its particular use has been approved by FDA regulation, the substance is subject to a prior sanction, or the substance is Generally Recognized As Safe (GRAS).”

I attempted to find the caffeine content of Sparks and another alcoholic energy drink called Joose (Hint: if you don’t want the FDA to target your company, maybe don’t call your product Joose) out of curiosity. My attempt was unsuccessful as that information isn’t listed on the company’s website. I imagine the caffeine content is similar to that of a cup of coffee, but as the information was unavailable it could feasibly be much higher.

In a brief, informal poll involving friends of mine, I asked them the following question: “Do you think it is safe to combine alcohol with caffeine?” The response was a resounding “no.” If you have any background in physiology, without having to do any double blind placebo-controlled studies, you know intuitively that combining a depressant with a stimulant simultaneously probably doesn’t do pretty things to your insides.

In fact, there is science to back this up, though the studies are primarily behavioral rather than physiological. (There might be a slight ethical quandary with a study involving intentional intoxication to study physiological outcomes.) Not surprisingly, people found that although intoxicated, they had more energy and were more likely to stay out partying later and to engage in risky health behaviors. The following is an excerpt from Drug and Alcohol Dependence:

“The combined use of caffeine and alcohol is increasing sharply, and studies suggest that such combined use may increase the rate of alcohol-related injury. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence.”

On another anecdotal note, in college I lived next door to two women who consistently consumed the alcoholic energy drink, Sparks. They had concocted a drink by the name of “ghetto predator” which consisted of half Sparks and half Miller High Life. With regularity, they would return home in a whirlwind of jackassery. At times, there were injuries and poor decisions, which I would catch gossip of at some later date.

So, for the next 30 days, and thereafter if these things aren’t pulled off the market, you should probably avoid them for a number of reasons. (1) We don’t know the physiological effects; (2) Avoid the empty calories; (3) Don’t be a part of the jackassery whirlwind; and (4) You could get hurt or make an incredibly poor decision (according to science and both of our mothers). If you do drink caffeinated alcoholic beverages, you should definitely do so in moderation and with a buddy you trust.

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Dr. Jason Newsom, of Bay County, Florida, did not spare the fast food industry’s feelings as he tried to wage a local war on overeating and obesity. In his position as the head of the Bay County, Florida Health Department, he supported an agenda dedicated to improving local public health.

One way he decided to execute this agenda was to call attention to certain high fat, nutrient poor foods using an electronic sign outside the Health Department. Various messages were splashed across the digitized board, including: “French fries = thunder thighs,” and the message that ultimately cost him his job, “America Dies on Dunkin’.”

Checkmate. At long last, Dr. Newsom – a man known for serving in Iraq as an Army physician, a passion for health and medicine, publicly hating on doughnuts, and unknown for displaying social restraint – had called out a specific brand, giving local Dunkin’ Donuts owners grounds to involve higher governmental powers. Mike Thomas, the County Commissioner, called for his dismissal from his position, calling him a “zealot.”

In an unrelated story, Mike Thomas is the owner of a Doughnut shop. Oh… wait…

Soon thereafter, Dr. Newsom resigned from his position.

Doughnuts, in all their gooey, sprinkled, chocolaty, jelly-filled glory, have a history of polarizing communities. Back in ’07, a group of three enraged older Americans demonstrated against a doughnut ban outside their local senior center. They wielded signs stating, “I’m old enough to choose” and, “They’re carbs, not contraband.”

Alright, that last paragraph was just for fun. In all seriousness, the issue with Dr. Newsom brings up a recurring theme: public health vs. corporations, and a microcosm of that theme: nutrition vs. the food industry. (Hmph. Could this be why The Faster Times has a sub-section dedicated to food politics?) Should a doctor be forced to resign his position for attacking food that is a known contributor to the overall poor diet quality of Americans, even if he is going after a specific brand? This woman says no.

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Do you have high cholesterol? Are you middle aged? If you answered yes, you may be at increased risk of developing dementia later in life, according to a new study in Dementia and Geriatric Cognitive Disorders (original study).

Nine thousand people from age 40 to 45 were followed for 30 years, until they reached late adulthood. The findings were surprising: borderline high and high cholesterol levels in the participants’ forties were associated with a 50% and 26% increase in risk for developing dementia, respectively.

Previous studies of this relationship did not find a connection, but one former study found that the presence of several cardiovascular risk factors, including high cholesterol, did influence the risk for Alzheimer’s disease.

This study demonstrates one more reason you should take the necessary steps to control your cholesterol throughout your lifetime.

The post Link Between High Cholesterol at Midlife and Dementia Later in Life appeared first on The Faster Times.

High cholesterol can contribute to atherosclerotic build-up in the blood vessels, which can lead to a heart attack or a stroke. The first line of defense against high cholesterol in most cases is lifestyle change.

Even a moderate amount of intentional exercise has cholesterol-lowering potential (This recent study highlights the effects in women, specifically). Diet interventions have also been effective cholesterol-lowering therapies. Increasing soluble fiber, decreasing saturated and trans fats, and including plant stanols or sterols in your diet can all help lower cholesterol.

Soluble fiber lowers cholesterol by binding bile acids, which contain cholesterol from your body. Beans, grains such as oats, and whole fruits and vegetables are sources of soluble fiber.

Saturated fats are found in animal products and palm and coconut oils. To decrease your saturated fat intake, eat mostly plant foods, choose low-fat dairy foods, remove the skin from poultry, and choose leaner cuts of beef when you do eat it (those marked “lean” or “extra lean”).

Trans fatty acids are in hydrogenated oils used in some margarines and processed foods. Check food labels at the grocery store before buying these products.

Plant sterols and stanols are naturally occurring in plant-based foods, but in quantities that are too small to effect cholesterol levels. Some foods (look for margarines, spreads, and fruit drinks) are fortified with therapeutic doses of sterols and stanols that have been shown to reduce LDL cholesterol up to 10%.

With all of these options at our disposal, some people are still unable to achieve a desirable cholesterol level with lifestyle change alone. If you have maintained these changes in your life for 3 months and your cholesterol remains over 200 mg/dL, you should discuss potentially adding a cholesterol lowering medication with your doctor.

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The post Before You Resort to Cholesterol-Lowering Drugs… Try Making a Few Changes in Your Life appeared first on The Faster Times.

“Is it true I have a higher chance of dying if I lose weight?” my patient asked me. Why would she ask such a question? Does she really think it’s healthier to be overweight? No, she simply read the morning news headlines. The baffling headline in question was referencing a study that concluded that people who are overweight were less likely to die than those who were normal weight or underweight (as determined by body mass index, or BMI). Also of note, people who were severely obese were much more likely to die when compared to those other groups. Here it is, all your problems solved: You are actually healthier if you’re overweight!

News on obesity never ceases to capture the attention of Americans. Why are we overweight? What can we do about it, what can our government do? How can our tax dollars work to shrink this obesity epidemic? (What can help us lose our weight as easily as we’ve lost our 401Ks?) These are good questions to be asking. And we ask them a lot.

We discuss this with our peers and our co-workers to no end. We are deeply concerned about this, whether for our health, our looks, our self esteem, or our concern for the health of our country. Unless you’ve been living under a rock, you know that obesity is, in short, really freaking bad for your health.

So why, knowing this, does the study my patient was reading about conclude that being overweight protects against death, the ultimate finality? Well, we do know that unintentional weight loss in older adults is predictive of mortality – perhaps a bit of excess weight is protective for this reason. The authors of the study are also careful to note that they are not discussing co-morbidities, i.e., any other disease or condition that could affect quality of life while we’re still here, roaming the Earth.

Okay, so far, all this information is well and good. What kills me (pun intended) is the type of media coverage such a study generates. Take this headline, brought to you by Newsday, for example: “It Wouldn’t Kill You to Lose a Few Pounds – Or Would It?” Way to take harmless information and turn it into a public health issue. My guess is that this is the headline my patient happened across, right before our meeting about weight loss.

The New York Times initial coverage of this article was rather clear that being too obese was not a good thing. A subsequent article regarding the same study was not as clear, and what I would consider potentially damaging. The second article in question is essentially urging people to throw out their diets (bad idea: just ask these monkeys) and scales and embrace themselves as is. It gets a few brownie points for urging people to engage in regular exercise, but this information is placed in context of the overweight and mortality study, which is, after all, not the best motivator for people struggling with weight loss.

Psychologists who specialize in health are very familiar with what’s called the Health Belief Model. Basically, this theory states that people ask themselves a few questions before deciding to engage in a preventive behavior, a sort of risk-benefit analysis. They ask themselves if they are susceptible to a serious condition, about barriers to engaging in healthy behavior, and about how beneficial they perceive the behavior to be. It is easy to see why overweight people who engage in this very logical line of thinking would throw out the possibility of changing their diet or physical activity habits when presented with the limited information discussed in the articles above.

A protective association between obesity and tuberculosis (TB) was also recently reported on. (Previous link brought to you by the New York Times; click here for an example of less responsible reporting.) The study results are quite interesting, suggesting a connection between fatty tissue and immunity in some people, but I can already hear my patients’ thoughts (riddled with my own sarcastic undertones): “Sure, I’m at risk for diabetes, heart disease, cancer, and sleep apnea, but what the hell? No TB!”

Certainly, these protective associations may exist between different variables and being overweight on occasion, and this is interesting from a scientific standpoint. The thing that concerns me is that the lay reader is less likely to be a scientist, and more likely to be a person who has read or clicked on X headline because they themselves are overweight or obese, and thus have a personal interest in excess weight not killing them (“You mean it won’t kill me? Hallelujah! Let’s go to our favorite Brazilian steakhouse every night this year!”).

To be fair, these articles are not really attempting to communicate my ridiculous quotations. However it is my fear as a clinician that coverage of this type, geared toward the lay public, is one more contributory factor to an overweight, weight-obsessed society that is showing no signs of improvement. I know from experience that it is incredibly hard to sway people to change their daily behavior for the betterment of their health. My patients know from experience that it is incredibly difficult to lose weight, and their daily struggle with this can be compromised by unclear and inconsistent messages regarding overweight, obesity, and health. Considering the fact that obesity, still on the rise, is one of the largest health crises our nation faces today, I think we need to get on the same team here.

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The post Dear Media: No More Irresponsible Obesity Headlines, Please. Love, Jennifer appeared first on The Faster Times.

A large multi-site global study recently found that eating fish was associated with a reduced risk of developing dementia. The more frequent fish eaters (those that ate fish daily) experienced a greater protective effect over less frequent fish eaters (those that ate fish a few times per week). Eating fish infrequently (a few times per week) was still more protective against dementia than not eating fish at all.

Omega-3 fatty acids are credited with this protective effect, but since this study was looking at fish consumption, not omega-3 supplementation, it is unclear whether you would see the same risk reduction by simply taking a fish oil supplement.

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