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    Copyright 2008-2015Slow Food Fast. All writing and images on this blog unless otherwise attributed or set in quotes are the sole property of Slow Food Fast. Please contact DebbieN via the comments form for permissions before reprinting or reproducing any of the material on this blog.

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    SlowFoodFast sometimes addresses general public health topics related to nutrition, heart disease, blood pressure, and diabetes. Because this is a blog with a personal point of view, my health and food politics entries often include my opinions on the trends I see, and I try to be as blatant as possible about that. None of these articles should be construed as specific medical advice for an individual case. I do try to keep to findings from well-vetted research sources and large, well-controlled studies, and I try not to sensationalize the science (though if they actually come up with a real cure for Type I diabetes in the next couple of years, I'm gonna be dancing in the streets with a hat that would put Carmen Miranda to shame. Consider yourself warned).

Diabetes meets ethnic foodways in new ADA series

Just in at my library are two new cookbooks from the American Diabetes Association. Indian Cuisine Diabetes Cookbook by May Abraham Fridel (©2017, ADA, Inc.)  and The Italian Diabetes Cookbook by Amy Riolo (©2016, ADA, Inc.)  are written by two food authorities in their respective home cuisines. The books are bright, they’re attractive, the food looks decent and authentic.

But what makes them “diabetes cookbooks”? What have they changed–or not–about the recipes and what was the ADA’s role other than simply publishing them? Above all, how helpful are they to an average diabetes or prediabetes patient?

Both books start out with an explanation of their food traditions and what’s generally healthy about them. Both include a variety of food categories for different meals, from appetizers or chaats to mostly-protein “main” dishes to mixed casserole-type dishes to salads, breads, soups, cooked vegetables, fruits, baked sweets and drinks. The Indian cookbook also includes some useful spice mixes and tips on how to handle them, and the Italian one includes some traditional menu choices and tips on choosing wine.

The recipes are generally very DASH Diet-able with an emphasis on a variety of vegetables, beans, whole grains, low-fat dairy, whole fruits and nuts, along with smaller portions of meat and cheese and less added sugar for desserts.

On a closer read, the adaptations to recipes mainly look like sane portion sizing for starches and sweets, reducing or substituting poly- and monounsaturated fats for some of the saturated fats, cutting down excess sugars in sweets and desserts, adding fruit and vegetables, and substituting almond flour and dried fruits for standard flour and sweeteners. The recipes are adjusted just enough to be low in sodium and saturated fat, reasonable on calories, total carbohydrates and added sugars. The portion sizes listed are smaller than what you’d get at an American restaurant or see on a magazine cover these days but they’re close to the amounts people traditionally serve.

So the nutrition stats are a general improvement compared with most current cookbook-style recipes for equivalent dishes, and it looks like the nutrition guides at the bottom of each recipe are relatively accurate given the ingredients. So far so good. If this was the ADA’s doing, I’m all for it.  But it seems obvious to me that it would be better to trust the ADA reviewers’ understanding of diabetes nutrition than either cookbook author’s.

I was surprised to find that the ADA let each of the authors go her own way on the introductions, and that the health explanations tend to be vague and cultural rather than practical. In the Indian cookbook, Fridel describes ayurvedic dietary principles rather than talking about nutrients. Riolo also veers off into a discussion of which appetizer traditionally goes with which first course and how to choose Italian wines in a way that doesn’t really have anything to do with target carb counts or  exchanges for a meal either.

You can discount or admire these things as you please, but you can’t really learn a lot from them diabetes-wise. They’re not really directed toward helping patients put together balanced, carb-controlled meals from the nutrition stats given with the recipes.

Moreover, the ADA’s particular nutrition stats system lists “carbohydrate exchanges” separately from “starch,” “fruit” “vegetable” and “dairy” exchanges, even though most of the ingredients that fall into those categories contain significant carbohydrates. All of them have to be counted for diabetes management.

It’s not clear why their system differs so much in this regard from the Academy of Nutrition and Dietetics’ standard “Choose Your Foods” exchanges system for carb count approximations. It works okay for figuring out standard servings definitions for the major food groups if you’re following the DASH Diet or USDA/HHS MyPlate plans, but it’s not really in keeping with the way endocrinologists and certified diabetes educators train Type I diabetes patients. It makes carb counting and carb planning for meals more complicated than it has to be. That can’t be a good thing.

Also, simply giving the nutrition and exchanges stats for each recipe as it shows up in the book is not the same as teaching a new patient how to carb count or set up a balanced plate. Most of the dishes are mixtures of carb-containing and noncarb-containing ingredients–casseroles, soups with beans, meat and vegetables, biryanis, meatballs containing breadcrumbs, and so on. Those are some of the most difficult foods to estimate carbs for by eye, and it’s not visually obvious–or discussed in any detail–what the authors and their nutrition consultants at the ADA did to adjust these specific recipes.  In this regard the ADA books are no worse than most “diabetes diet” cookbooks and magazine recipe collections, but they’re also not much clearer.

Beginners really would do better to start with the carb and noncarb foods separated on the plate, at least until they get a feel for what to count and how much food to serve.

What both of these books–and any others in the ADA series–could use is a short, clear explanation for how to work through the nutrition stats they give in each recipe and how to plan a nutritionally balanced meal around that dish to reach a target total amount of carbohydrate. A two-page standard ADA primer with a basic diabetes meal plan diagram, some suggested per-meal carb counts or carb exchanges, a balanced-nutrition plate à la ChooseMyPlate.gov,  examples of where to look in the recipes for serving sizes and how to create a full meal from them, how to add things up for a meal’s total carb, etc., would help a lot. It might also be helpful to point out how to rework the meal plan if someone wants more than the standard serving amount or takes second helpings.

All in all, these two cookbooks aren’t terrible as cookbooks, but they’re not nearly as helpful as they could be as diabetes guides.

“Healthy” breakfast muffins? Miscalculated.

Julia Moskin’s latest “Recipe Lab” in the New York Times food section revisits one of my (cranky, irascible) pet peeves: the “healthy” muffin. She claims her version, filled with an expensive and lengthy list of the latest buzzword ingredients and yet supposedly lighter-textured than most bakery offerings, is healthy, always a warning sign, especially when paired with the instruction to make sure it’s well-leavened and to use “unprocessed” oils. These are code words for a heavy dose of baking soda and baking powder on the one hand and coconut oil, the newest darling of the hipster food world, on the other.

But–benefit of the doubt–I looked at the recipe and scrolled down to mouse over the nutrition stats. They’re provided in a popup link you can’t copy, with a very faint “i-in-a-circle” watermarked icon below the ingredient list. Not a good sign, generally: hiding the nutrition stats signals that they’re kinda suspish, or at least unflattering. But okay, at least they’re posted here.

Edamam provides the analysis–and per average muffin, 20 to the batch, claims the following stats:

318 cal, 16 g total fat, 1 g saturated fat, 0 trans, 9 g monounsaturated, 4 g polyunsaturated, 39 g carbohydrate, 2 g fiber, 19 g sugars, 4 g protein, 38 mg cholesterol,260 mg sodium

Something didn’t sit quite right with that. I looked up at the ingredient list.

Sure enough, the fat was provided by 1 1/3 cup of coconut oil. Yick. But never mind. The point here is that Edamam lists the saturated fat at a very improbable 1 gram per muffin.

There is–being kind about it–no way this is correct. The only thing I can think of is that Edamam used the soybean or canola oil option for the calculation, but why would that be? Coconut oil is listed as the much-preferred fat. And it’s got more saturated fat per gram than lard. About 82% saturated fat by weight, if you check the most reliable lab analysis at the USDA National Agricultural Library’s nutrient database. And actually, the mono and poly stats suggest something closer to olive oil than soybean or canola.

The correct calculation for 315 ml of coconut oil is 260 grams of saturated fat for the recipe. For 20 muffins, that’s almost 14 grams of saturated fat per muffin, not 1. And 14 grams is pushing the recommended daily max of 20 grams of sat fat for a 2000 calorie-per-day diet. Just for a muffin.

Given the nice way the New York Times provided the grams as well as cups and spoons measures in the recipe, here’s what I came up with, direct from the USDA NAL database and averaging a bit for the different options between apples and carrots and between walnuts and pecans.

  • Total calories for the recipe: 7213, per 1/20th (1 muffin): 361
  • Total saturated fat: 273 g,  per muffin: 13.7 g
  • Total monounsaturated fat: ~50 g, per muffin: 2.5 g
  • Total polyunsaturated fat: ~50 g, per muffin: 2.5 g
  • Total cholesterol: 744 mg, per muffin: 37 mg
  • Total carb for the recipe: 699 g, per muffin: 35 g
  • Total sugars: 390 g, per muffin: 19.5 g
  • Total fiber: 49 g, per muffin, 2.5 g
  • Total sodium: ~4670 mg, per muffin, 234 mg.

And yes, it’s kind of a pain to navigate all the USDA data chart by chart, ingredient by ingredient, put in the actual amounts in grams, have it recalculate the whole chart, add the totals up nutrient by nutrient, and then divide by 20. It would be so nice to find an accurate and complete free recipe-style app to pull all the relevant data and stick it in a single spreadsheet. The myfitnesspal.com recipe calculator is about the best I’ve found so far, but it’s not as complete, and neither unfortunately is the USDA’s Supertracker calculator, as far as I can tell.

How did Edamam and the New York Times Food Section do? The sodium, though a bit much for a single bready item (4 t. baking powder, 1 t baking soda and half a teaspoon of salt on top of that, plus whatever’s in the buttermilk), came out about right at 260 mg (I got 234 per muffin). The carbs are about right too, if kind of a lot. Sugar at 19 grams is about half the total carb and makes it no great bargain (not to mention, brown sugar plus maple syrup? cha-ching, and the maple flavor probably disappears with all the other stuff. Kind of a waste.). This is still a pretty cakey item, despite Moskin’s protestations to the contrary and all the grated carrot and blueberries and multigrain ethos. Edamam’s calorie estimate is a bit low by 40 cal per muffin. You could probably live with that.

But you shouldn’t. Because with the trendy, expensive coconut oil option, the published saturated fat estimate is way, way, way off. Way off. Bizarrely off.

I visited Edamam’s web site to see if I could figure out how they calculated this–whether their own calculator would give me the right result if I input “315 ml. coconut oil,” or whether their API, which features natural language processing, somehow makes  errors this big when it parses a recipe and does the lookup in the USDA database. Did it pull the wrong ingredient, or did the NY Times staff type the wrong thing into their recipe submission? Or what? Continue reading

BMI criticized again…by psychologists?

The International Journal of Obesity has just released a short article by Janet Tomiyama (UCLA) and Jeffrey Hunger (UC-Santa Barbara) et al–a team of psychologists. They analyzed NHANES data from 2005-2012 for about 75,000 individuals, and concluded that BMI status doesn’t correlate well with six concrete markers of cardiovascular and metabolic health–blood pressure, blood triglycerides and cholesterol, blood glucose, insulin resistance, and C-reactive protein. Extrapolating a bit from the NHANES study participant numbers, they conclude that millions of Americans–54 million–have been misclassified as unhealthy due solely to their BMI numbers.

According to their analysis, 47% of the overweight people in the study had healthy status (0-1 of 6 markers) other than their weight. About 30% of obese and even 16% of morbidly obese people had healthy status according to their protocol, whereas about 30% of those in the healthy BMI range had more than one actual cardiovascular or metabolic disease marker that would be ignored if only BMI is considered.

Is this really the death-knell for public concern over weight? Should it be?

Here’s how the UCLA press release puts it (with my emphases in italics):

But a new study led by UCLA psychologists has found that using BMI to gauge health incorrectly labels more than 54 million Americans as “unhealthy,” even though they are not.  […]

“Many people see obesity as a death sentence,” said A. Janet Tomiyama, an assistant professor of psychology in the UCLA College and the study’s lead author. “But the data show there are tens of millions of people who are overweight and obese and are perfectly healthy.”

Incorrectly labels? Perfectly healthy?

The definition for “healthy” used in this study is 0 to 1 known risk factor for CVD and diabetes. But clinically, one risk factor is often enough to be of acute concern, especially if it’s untreated high blood pressure or blood glucose. Those generally need treatment sooner rather than later.

Furthermore, the study as posted on Hunger’s web page excludes obesity and overweight a priori from that count of risk factors for CVD and diabetes. I don’t know the absolute latest research consensus, other than what was in the Dietary Guidelines for Americans Advisory Committee’s report last February, but my general understanding is that weight does show some statistically independent influence on CVD at least. That picture may be changing as we learn more about its interactions with other risk factors, but if it’s still valid, weight should have been counted as one of the existing “known risk factors” along with the other markers and that would have skewed Tomiyama and Hunger’s analysis considerably.

Even without those considerations, the different weight groups classified by BMI cutpoints do in fact show a significant increase in health risk from one category to the next. Turn Hunger and Tomiyama’s percentages around and you see that 70% of people in the 18.5-24.9 healthy BMI range have 0-1 risk marker other than weight; 53% in the 24.9-29.9 overweight range have more than 1 marker, 70% in the 30-35 range have more than 1 marker, and 84% in the 35 and over BMI range have more than one marker other than weight.

Plot those crude percentages and you’ll see a very sharp rise in risk incidence between the healthy and overweight categories, a reversal of fortune from “most people healthy” to “more than half at risk,” with further solidification of “most people at risk” as you venture further into obese and morbidly obese. There’s really no debating that trend, even given the narrow way this team has defined “healthy.” To say nothing of “perfectly healthy.”

Researchers in biomedicine (i.e., physical as opposed to psychological medicine) have recently reexamined whether the current BMI cutpoints defining healthy, overweight, obese and morbidly obese are in the right places to describe most people’s 10-year risk of overt CVD events (heart attacks and stroke), diabetes, or all-causes mortality, or whether BMI is just a continuous gradient of increased risk without definable cutpoints. At last count, the conclusion was that the current statistical best-fit cutpoints are pretty much correct, even though the data for individuals have a pretty big spread (and that each BMI step or number still has incrementally higher risk than the one below).

The upshot: BMI categories are still a pretty good marker of the overall health status of Americans when you’re talking about trends. Crude, yes. Exceptions for athletes with much more muscle than fat, yes. But the numbers are still strongly in favor of using BMI as a general warning flag to check for more specific cardiovascular and metabolic disease markers in individuals.

It’s very odd to see a paper like this coming from a team of behavioral psychologists, which Tomiyama and Hunger are. They’re at least nominally outside their field here, doing a statistical analysis on physical health data, and the paper’s methodology and definitions (along with some of their position statements in the American Journal of Public Health and elsewhere) show a specific agenda toward deconsecrating BMI and downplaying overweight and Continue reading

“The Dorito Effect”: Fervor over Flavor

So, the party’s over, the halftime show’s over, Denver won, a variety of pop stars are brushing off media criticism over what they wore, and a nation is figuring out how to deal with the caloric aftermath of buffalo wings and a variety of dips and chips. (My biggest excitement: locating the owner of a red Corvette with a leaking gas tank in time to deal with it and avoid a more dramatic spectacle. Luckily it was mid-afternoon and the owner was alert, sober, and not smoking. She  also wasn’t whining about having to go out to look at the car. As some of the male guests might have been, Corvette or no.)

Mark Schatzker’s recent book, The Dorito Effect, is an energizing read for those of us who aren’t really into the classics of Superbowl Sunday.

Kroger Superbowl recipe booklet

I’ll spare you the inside pages, but the closest to nutritious was Kroger’s own recipe for double-coated baked cauliflower “hot wings”–ingredients: a head of cauliflower, a little flour and water, garlic powder, Kroger’s store-brand hot sauce, and some melted butter to doll up the cauliflower florets before dipping in…ranch dressing. 

Not that it’s really so much about Doritos, but rather that it takes the 1960s invention of Doritos–a “taco-flavored” taco chip without any actual meat, cheese or salsa, just what has become known to all as orange cheez dust–as the first serious divorce between food and intrinsic flavor.

It isn’t really the first, of course, and Schatzker traces the history of post-WWII mass agriculture as the story of more food, grown quicker, with less and less flavor. Everything from tomatoes to chickens to broccoli to wheat comes under the microscope lens here. Yes, it’s another Michael Pollan-style examination of some familiar complaints about how and why nothing tastes the same anymore.

He collects reactions from champion kvetchers as diverse as Julia Child (she did it first, he claims, calling modern–1960s–American chicken tasteless and with the texture of “teddy bear stuffing”) to the Slow Food Movement (no relation, ahem!) to Michael Pollan himself, to a variety of old bickering couples who remember the flavor of old long-legged breeds of chickens now relegated to the remote gourmet sidelines of the vast factory-farming chicken industry…

Schatzker tells a fairly entertaining version of this tale–how Big Food and Big Agro convened with flavor chemists to alter the course of human gastronomy in the wake of WWII. As we breed livestock and produce to grow more, bigger, faster, he discovers, we lose not only flavor but nutrients and replace them with water and carbohydrate filler even in things like broccoli and tomatoes. And then we try to make up for that by dousing them in ranch dressing and orange cheez dust and artificial flavorings; hence the title of his book.

Coatings, dressings, artificial flavorings, salt, sugar and oils–these, he says, have become the substitute for intrinsic flavor in real foods, and a mainstay of the unsubstantial snack foods–starting with Doritos–that have pushed out bulk produce and unprocessed ingredients in the American diet.

Schatzker takes it a couple of steps further, though, presenting his theory that the loss of flavor in real foods is the key factor to blame for American overconsumption of calories, and that flavor is one criterion we should work to restore at a national level.

Yes, we’ve read much of this before elsewhere, but his interviews are still eye-opening. He interviews flavor chemists at McCormick, which does a lot more of its work behind the scenes of the restaurant and processed food world than you might think. Those little bottles of herbs and spices on supermarket shelves are just the tip of the iceberg.

Schatzker also profiles one of the original breeders of today’s heavy-breasted, fast-grown, efficient-feeding mass market chickens–though the man is still proud of that early work given the economic pressures on postwar America. He gets the inside story on the decline of flavor and nutrition in broccoli, kale, tomatoes, strawberries and other common produce, and learns why some top agriculture researchers eventually quit the corporate world to try and restore some of the diversity and quality that had been lost during the peak years of their careers. Continue reading

Thanks

I want to give a quick thanks to Dr. Marion Nestle, who took the time to let her readers and colleagues know about Sunday’s Dietary Guidelines post in her Twitter feed and on her blog, foodpolitics.com, which I’ve read with interest ever since starting this blog. The response has been overwhelmingly positive and I appreciate it very much.

USDA Dietary Guidelines released…a full year later

The Dietary Guidelines Advisory Committee’s scientific report, essentially the major draft of the USDA “Dietary Guidelines for Americans” guidelines, was finished last February. The Dietary Guidelines for Americans, 2015-2020 has finally been released in its official form to the public–but it’s only available online at health.gov as of this week, with promises of an eventual PDF.

To that end, because the Health.gov site doesn’t yet have a downloadable version, I’ve pulled the text and images of the final “Dietary Guidelines for Americans 2015-2020” into a quick-and-dirty two PDFs you can download below for free. It’s not perfect–the pages don’t all flow with gorgeous layout and some of the graphics were so oversized I had to kind of select-cut-and-paste them in sections to get the charts to fit. I think I’ve got it all in there, though, including most of the helpful nutrition and diet charts in the appendices (with notes where I didn’t catch on that there was more to a chart than first appeared).

What can I say–“Enjoy.” Ummm….well, anyhow, here they are:

Dietary Guidelines for Americans, 2015-2020–this includes the Table of Contents, Intro, Executive Summary, and body of the report (Chapters 1-3).

USDA DGA 2015-20 Final-IntroandChapters (PDF, 3.4 MB)

Appendices (14 of them) for the Dietary Guidelines –I couldn’t get Adobe to stick this on the end of the document nicely, so it’s separate but useful.

USDA DGA 2015-20 Final Appendices (PDF, 263 KB)

The original Dietary Guidelines Advisory Committee Scientific Report from last February is available here.

What was the holdup? What are the differences from the health-basis-only recommendations of the DG Advisory Committee’s version last year?

Given the shoddy job major media gave the advisory committee’s scientific report last winter and spring, perhaps the best thing to do this time around is skip the media coverage hyperbole and compare the two reports directly and see what gives.

Professor Marion Nestle digs in with dissatisfaction as to some of the likely buyoffs this time around–she deems that the big meat, egg, sugar, etc. producing industries have won some victories in what wasn’t said. She also complains, as I do, that the online version is full of stupid bells and whistles. It’s hard to navigate, there are a lot of windows and figures that are actually slide shows and you have to know to click on them to get the rest of the information. Hopefully the PDFs above will be more readable.

Nestle’s take is more political than mine (for a change? not really). She notices more of the inconsistencies with naming food categories only when they’re favorable, and using nutrient names (sugar, saturated fat, sodium) as substitutes for the big-business food categories that are poor nutritionally.

I’m less incensed about most of that– and ironically a little more optimistic about what was included. Continue reading

Another reason to avoid processed and fast food

In the past five or ten years, obesity and diabetes researchers have started taking a closer look at environmental factors that have unexpectedly strong disruptive effects on our appetite, food consumption levels and metabolism, even at levels currently deemed safe by the Food and Drug Administration. The potential of artificial sweeteners to lower glucose tolerance in less than a week by shifting the balance of gut bacteria is only one unnerving example.

Environmental chemicals like fungicides, pesticides and plasticizers (BPA and the like) have long been of concern for cancer, endocrine disruption and infertility. Some extensive and carefully conducted studies now reveal that some of these chemicals can also increase fat cell development and storage as well as insulin resistance. Low levels of exposure directly increase the rate of obesity in rats, and  population studies, though not as extensive, show that exposure also tracks with obesity in humans.

These common chemicals are now being considered obesogens–chemicals that cause obesity or at least make people more prone to it. And these are effects that may end up being passed down.

In the rat studies, the effects lasted for several generations, and that also seems to tally with earlier findings on environmental endocrine disruptors and male infertility. Some of the tests that were conducted on rats in the obesogen study were too invasive to perform on human subjects, and a human generation is a lot longer than a rat generation–20+ years vs. 6 weeks–so it may be hard to trace inheritance in humans just yet.

Well–so what does it mean for us while we wait for the perfect definitive human study to come along?

To my mind, it means taking a harder look at how we choose the food we eat. We can’t remove all pesticide residues from the environment but we can probably eat fewer things wrapped pristinely in plastic and cut down our reliance on plastic utensils and disposable containers.

As I look around my kitchen, I realize just how often I reach for plastic sandwich bags–daily for lunches, but also for leftovers, herbs, halves of onions or lemons, cheese, vegetables. Stacking plastic storage containers keep soup, salad, rice or beans–or this week, an overload of stuffed shells, since I finally got my cook-once-eat-six-times-or-so batch cooking mojo figured out. And almost everything else in my fridge and on my shelves is in contact with plastic at one time or another.

Plastic wrappings pervade most of the supermarket offerings–overwraps on plastic-coated juice boxes, plastic see-through windows on cardboard pasta boxes, sacks of dried beans and rice, loaves of bread, plastic inner bags for boxed cereals and snacks, and plastic linings on the insides of tin cans. Also, of course, all those bottles of soda and energy drinks and vitamin waters and juices and milk. And yogurt. To say nothing of fast food, vending machine food, and so on.

Plastic is everywhere because it’s cheap, light, flexible, avoids breakage in shipping, and it helps you keep your food dry if you want it dry or moist if you want to keep it from drying out. You can keep everything separate and clean and airtight even when stored side by side. You can store it in the freezer and take some types of plastic containers right to the microwave. If you want to give up plastic, either for health reasons or environmental ones, you have to give up some of those advantages too.

Your next best bets are glass, which is heavy and breakable and no longer reliably tempered borosilicate, at least not in the US. Or perhaps stainless steel, at least for cold containers–maybe a stainless steel kit for lunches? I don’t know–if you don’t take strict care of it, or if it’s in contact with wet or acidic foods for long periods, it may rust. Storing salads or tomato-based items might be a problem. Ceramic bowls and containers–also heavy and breakable, and some of the food-approved glazes still leach measurable amounts of copper and other metals.

I do occasionally see someone from the homesteading and health food store generation, or else in Amish or Mennonite-style dress, loading up on bulk buy drygoods at Whole Foods with their own glass jars and cotton drawstring bags. And I always admire them for it, but I also think that’s an awful lot of stuff to trundle around to the store and get the clerks to okay. It is not easy to do and it’s obvious they’ve saved up for a monthly trip to stock up because you wouldn’t want to have to do it more than that often, especially when you have young children in tow, even very well behaved young children as they often do (another thing to admire them for; my daughter used to go and play hide-and-seek in the corner grocery when she was that young. At least she knew not to take anything).

But back to plastics and food storage. The obesogen phenomenon is intriguing but probably not the main source of the current obesity epidemic. Common sense says people might have slightly more propensity for developing fat cells but they’d still be small cells if people weren’t overfeeding them by eating more calories than they used to. That’s the major trend, by far. It’s still the food itself that matters most.

Processed and fast food still dominate as popular items of diet, and they’re very high-calorie-density compared with most nonstarchy bulk vegetables, which never seem to be recommended first on any popular weight loss and fitness show anymore (cough–Dr. Continue reading

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