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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).

Fish Tale: Omega-3s and Greenland’s shores

Well…another shining example of “magic bean” and “superfoods” wishful thinking has bitten the dust, thanks to more careful research. It may be a good thing.

In recent years, several reassessments of the heart health benefits of popular fish oil supplements have failed to find a significant protective effect from omega-3 fatty acids. A new genetic study of the Inuit in Greenland revisits the old 1970s finding that started the whole fish oil phenomenon (and salmon farming) and explains a lot of that failure. The researchers found a specific gene variant in almost all the participants but not in other populations.

The gene in question helps package fatty acids from the Inuits’ traditional all-fish-whale-and-seal-meat diet more efficiently to keep blood lipid levels down. Researchers noted another striking effect: participants who have two copies of this particular gene variant are also significantly shorter and ten pounds lighter on average than those without it. And although this gene variant is very common among people of mostly-Inuit descent (today a lot of Greenlanders have mixed Inuit and Danish heritage), the ethnic and racial group with the next highest concentration of this gene variant, as far as it’s been tested, appears to be the Chinese, but only about 25 percent of them have it. People of European descent mostly don’t have this variant.

What does this mean for omega-3s and fish oil supplements in North American popular culture? The New York Times article didn’t go that far, but the implication should be clear: Unless you’re Inuit, you probably don’t have the specific gene variant that helps your body deal with omega-3s, so for you, omega-3s are like most other animal-derived fatty acids–adding more to your diet is just adding more to your blood lipid burden. Rich fish like salmon may taste nice, but lipids are lipids, and calories are calories. Given the likelihood that they’re really not cardioprotective after all, overeating them doesn’t make sense, especially for a population as overweight as ours has become.

Fish oil supplements are probably even less of a good idea, and they don’t even taste good. They won’t really protect your health as claimed, not for omega-3s, anyway (cod liver oil is still probably good for vitamin D, if you can still find it, but most people would probably prefer a mercifully flavorless vitamin pill).  So save your shekels, buy actual salmon once in a while, and enjoy it–but sparingly.

Media misread on the new USDA dietary guidelines

The new USDA public nutrition guidelines are being updated again, as scheduled, and the Dietary Guidelines Advisory Committee’s version now says some egg yolks are okay and to limit carbs and sugar instead. A variety of media commentators have jumped all over that, even though it’s not very different from what the guidelines have been emphasizing for years. Now, if anything, I would have hoped that most of the commentaries in the newspapers of record would be critical of the industry influence on the USDA’s nutrition guidelines for the general public each time, but no.

The most prominent commentators, notably Nina Teicholz, whose op-ed in last Sunday’s New York Times really bothered me, are well-educated and should know how to “read a french fry” as it were. But instead of looking at the likely effect of loosened USDA dietary limitations on a public that has gone so seriously overboard on calorie-dense food, they’ve taken the opposite tack. Mostly to declare self-righteously that the new relaxation of standards really means all the previous recommendations to limit saturated fat and cholesterol were bunk and a waste of time based on “uncertain” and “weak” or even “junk” science.

Which is untrue. Epidemiologic research–large observation studies and surveys, like the NHANES diet and cardiovascular health survey series from the 1970s onward, and the big Framingham Heart Study of the 1950s onward, are not junk science. They do what clinical feeding trials can’t: they look for the contribution of individual dietary risk factors to chronic and complex-origin health conditions like heart disease and stroke across very large population groups. Both the processed food industry and people like Teicholz claim that clinical feeding trials are the only legitimate way to provide “proof” of cause and effect, but the cost of conducting them carefully long enough and with a big enough participant pool for meaningful results would bankrupt the nation halfway through.

Epidemiologic findings matter on the large public scale. Not every specific applies absolutely and equally to every single person, but that’s not what population-wide studies are for. The big studies, loose as they might seem compared with DNA fingerprinting and perfectly demonstrated cause-and-effect kinds of lab workups for individual cases, give best-bet recommendations for most people to reduce their risk.

Your genetics determine how well that works for you specifically, but most of us don’t have access to DNA testing on that level, and the “big six” lifestyle risk factors (high sat fat, high blood cholesterol and blood pressure, overweight, lack of exercise and smoking) are a lot easier to change and get some control over. After all, you can’t change your genetics much (and yes, my daughter is quite disgruntled that she can’t pick cooler parents. But tough. We couldn’t pick ours either).

So anyway, I know I’m unusually irritated with any news about USDA dietary guidelines–I used to work at NIH, and some of my colleagues had attempted to serve on the dietary guidelines committee and ended up completely frustrated at how “bought” the process became. The USDA has always had a conflict of interest when it comes to public health recommendations because its main mission is support of US agriculture, and public health always comes a distant second to big business. The committees have repeatedly subverted and weakened the scientific nutrition panelists’ best-finding recommendations by including food industry participants and weighting toward industry priorities in the consensus mix. There’s no great reason to expect the food industry isn’t still playing and winning the same game on the same committee this time around. [Update: the meat industry has just asked for an additional 75 day comment period].

But the main problem I see at this point is how poorly mainstream journalists and editors have handled the announced overhaul. None really seem to have dug into the comparison between current and previous issues of the guidelines, much less compared the USDA’s final takes with dietary guidelines from the DGAC, a combined group of more purely biomed/scientific research experts representing HHS (including NIH) and the FDA, or those of the major health advocacy organizations such as the American Heart Association.

And declaring that it’s now fine for anyone to eat all fats without limitation is nonsense and a misread. The USDA guidelines don’t say that–the DGAC draft guidelines certainly don’t say that. And if the USDA does attempt to drift in that direction for the final release, as some of the director’s announcements suggest, given the participation of Big Food and Big Agriculture hoping to sell the public more meat, eggs, and cheese, along with more profitable processed goods, would you necessarily believe them?

Is it really the fault of the scientists on the panels over the years, as Teicholz claims (“How did they get it so wrong?”), that the epidemiology findings they relied on for previous rounds of recommendations weren’t borne out by much smaller and less conclusive clinical studies?

Maybe the role of saturated fat is less apparent in a clinical study. I don’t doubt that. But as noted above, the statistical power of the comparatively short-term clinical trials for cardiovascular disease effects is bound to be a lot lower than in a long-term population-wide study, even if the controls are tighter. There are so many interfering factors–other dietary and lifestyle factors, and so many varieties of genetic risk factors within and among different population groups, genders, and age groups, that you need the big numbers and the large timescale to see effects above the noise. Meta-analysis of a lot of limited clinical studies with iffy results doesn’t make up for that. If anything, it compounds their individual uncertainties.

[And in fact it turns out that much of Teicholz’s assumption on that point is based on a very poorly conducted, much criticized meta-analysis of studies on saturated fat and cardiovascular disease published last spring. Most inclusive meta-analyses performed using standard stats analysis best practices actually show reductions of between 14 and 26% in CV events and deaths when subjects cut their saturated fat intake below 10% of calories and ate more vegetables instead of carbs, or else substituted polyunsaturated fats for them.]

Teicholz’s op-ed had carefully modulated but still overt indignation at the imperfect scientific basis behind previous recommendations to cut saturated fat and limit egg yolks and other high-cholesterol foods. What should be there and isn’t is the acknowledgement that when those recommendations were first announced to the public–by the AHA, the CDC and the USDA in the late 1960s, population trend studies over the next 10 years showed a stark drop in the rate of heart attacks–about a 30 percent drop. In other words, it worked. Big time.

And the broad peak of the population curve for a first heart attack shifted to the right by 10 years–that is, the average age for men went from about 50 to about 60, and for women from about 60 to 70. These were huge improvements in public health overall, and they were achieved partly because the public believed and paid attention, and partly because the nutrition and health experts hadn’t given up and abdicated responsibility in the face of industry pushback.

Clearly these results didn’t last; but is that the fault of the studies that identified saturated fat and cholesterol as things to reduce (note: not eliminate completely, just reduce)? The 1980s ushered in a long Republican-led era of unfettered, uncritical support of corporate priorities over public health, Reagan’s “ketchup is a vegetable” quip and the conversion of school lunches to chain restaurant concession contracts, a popular nose-thumbing at so-called “food police” health recommendations, the rise of high-fat-and-sugar-and-oversized-portion “comfort” and “indulgent” foods in restaurants and food magazines, and an entrenched anti-science bias in Congress that still haunts us today.

Not that much has changed from Reagan’s time in office–including the sad observable fact that most Americans for the past decade or so clearly aren’t paying serious attention to or even attempting to follow those modest earlier USDA recommendations, particularly the recommendations to eat more vegetables rather than more boxed, labeled namebrand processed foods, whether Big Macs or Ding Dongs or Froot Loops…

So few Americans today eat any vegetables at all compared with people of the same ages in the 1970s. As I’ve mentioned before, a shocking number of my friends, in their 40s and 50s already, do not cook at all. They have advanced degrees, if mostly in the humanities. They nervously repeat but don’t understand how to  read between the lines of whatever diet and health claims are in the news, and they’ve come to think cooking is too hard. They have a lot of takeout menus on their iPhones.

There is just one more factor to mention here: the profit motive. Teicholz, a former contributor to NPR, Gourmet and Men’s Health, wrote that op-ed in part to promote her new book, The Big Fat Surprise, which claims that diets high in meat, butter, Continue reading

Testing salt reduction on a really large scale

Microwaved platter of low-sodium tofu with snow peas

This tofu dish with snow peas and shiitake mushrooms uses low-sodium dipping sauce ingredients as its base rather than soy sauce or oyster sauce. It’s also microwaveable from start to finish and takes about 10 minutes total.

If you have a big enough–and motivated–study population, even modest reductions in daily sodium intake can make a big difference in preventing strokes and heart attacks. Last month, cardiovascular researchers from Beijing and Sydney announced a new 5-year diet trial in Science to do just that (see the general overview article, “China tries to kick its salt habit”).

China’s northern rural poor eat an estimated 12 grams of salt a day on average, considerably more than Americans’ 9 grams a day (which is still over the top) and more than twice the WHO’s recommended 5 grams or less. An estimated 54%, more than half, of Chinese adults over 45 have high blood pressure these days, and the Chinese government is taking practical steps to provide antihypertensive medications and shift the tide back–but that’s an awful lot of prescriptions.

Given the cost of antihypertensive drugs for such a huge population, and the cost of dealing with side effects and consequences of untreated or undertreated high blood pressure, prevention seems the better way to go. The researchers project that reducing the national average by even 1 gram of salt a day would save 125,000 lives a year in China. So they’ve recruited 21,000 villagers so far in China and Tibet, and plan to provide test groups with nutrition counseling plus a lower-sodium salt substitute for cooking, then compare their sodium intakes and rates of heart attack and stroke with those for a control group.

Most Chinese still do their own cooking at home, especially outside the big cities.  If lowering the sodium content of the salt they use works, it has the potential to get an awful lot of people off daily hypertension medication and reverse a major health threat. But will people do it if they’re not in the trial, or once it ends? Will it catch on? And is it the right answer in the long run?

Salt substitutes, with potassium chloride replacing some of the usual sodium chloride, have been tried by heart patients in the US since the 1970s or so. They’re a little more expensive than table salt or kosher flake salt, at least in the US, but they’re not all that expensive. But they’ve never really caught on here with most consumers.

Similarly, a few decades ago, a big public health campaign in Japan to reduce the high rate of stroke led to the introduction of low-sodium soy sauces, with about half the sodium content per tablespoon of traditional ones.

Not much market research is available on how many people have been buying low-sodium vs. regular soy sauce in Japan since its introduction. From the few current market reports I could find–one of them an executive report from Kikkoman–it looks like low-sodium is still a smaller if steady fraction of their business in Japan, and that it’s more popular in Europe and the US than at home.

It’s important to have a low-sodium line for reasons of corporate responsibility and even prestige, but there was no mention of its percentage of total domestic or worldwide sales. Traditional soy sauces, which can range from 14-18% sodium concentration w/v, are still apparently preferred for taste, and the Kikkoman executives attribute much of their expected taste appeal to salt rather than the other flavors in each one’s profile.

That’s kind of discouraging to me. The Japanese are known for more refined and sensitive palates on average than Americans, and their range of soy sauces and tamaris for specific food combinations is much broader and more sophisticated. The higher-quality low-sodium soy sauces are produced by ion filtration to get sodium out rather than simply diluting them with water, so most of the flavor that’s actually flavor remains. I would have hoped the key flavor signature of each match was the actual flavor of the brewed soy sauces, not the saltiness.

It’s likely, though, that the Japanese are just as susceptible as the rest of the world to the sodium tolerance phenomenon–the more sodium you eat habitually each day, the more you expect and consider normal in your food, and you almost stop even noticing it as a separate flavor.

The overall Chinese market for soy sauce is currently estimated at $20 billion and grew about 23.4 percent over the past 5 years, mostly due to population growth. The stakes are pretty high for China, but the government has tighter control of its salt and soy sauce producers than other countries do, and the will to make a broad change seems to be present, at least at a government level, and if the new study is anything to go by, among ordinary villagers as well. So maybe this time it will catch on once the study’s over.

But obviously, if you’re starting out at a 12-gram-a-day salt habit, the best way to reduce sodium in home-cooked food would be to cut back hard on salt and salted items altogether. That takes time, practice, awareness and deciding that it’s worth going through that first couple of weeks until your palate readjusts to a lower-sodium diet (which it will, but it takes a couple of weeks and a little patience).

Can cutting the salt be done with Chinese food? Not American souped-up chain restaurant caricatures of Chinese dishes, which are hideously over-the-top and greasy as well, but actual home cooking? I’ve done low-sodium Continue reading

Questionable sodium study, even more questionable comments

A new European study that purportedly shows low-sodium diets to be ineffective in preventing high blood pressure, and even more unlikely, that they increase the risk of death from heart attack or stroke, is being published in the May 4 issue of JAMA, and predictably it’s already excited a variety of comments in Gina Kolata’s current New York Times article from the CDC and from…Dr. Michael Alderman.

Predictably, because the CDC researchers think too few people were studied for too short a time with unreliable methods (24-hour urine collection to measure sodium intake indirectly, after the fact as it were.)

Alderman’s reaction was also predictable: he’s still insisting that only a nation-wide feeding study sort of clinical trial that follows its subjects until they die is sufficient to prove a true link between sodium intake and cardiovascular disease. Something so expensive and unwieldy it couldn’t be completed even if it were started, and we’d still be waiting around 30 years later wondering if salt had anything to do with heart attacks or strokes. Very convenient for the processed food industry, but pretty useless for public health. And also conveniently, Gina Kolata found more than one expert to say so.

What she didn’t find, but could have, is that a number of large-scale feeding studies have already been done and shown that eating a balanced lower-sodium diet helps reduce blood pressure and prevent blood pressure increases. DASH-Sodium is one of them. And no one had to wait until the study subjects died to figure it out.

Age, salt and the new USDA dietary guidelines

Last Monday the USDA released its latest version of the Dietary Guidelines for Americans (nominally dated “2010”). I was driving home and NPR carried USDA Secretary Tom Vilsack’s speech, in which he listed a few of the new highlights: eat less, eat less food with solid fats, eat less processed food, eat more vegetables and fruits, eat less sodium.

How much less sodium? About 2300 mg or 6 grams (1 teaspoon) of table salt per day, he said, is the recommended maximum for healthy adults, in line with the long-standing National High Blood Pressure Education Program’s guidelines, which are shared by the American Heart Association and many other professional medical groups.

There’s a second lower-sodium recommendation for anyone overweight, African-American, with heart or kidney disease or high blood pressure or diabetes, and anyone middle-aged or older. This year, as the more specifically heart-health-oriented professional organizations already recommend, the USDA guidelines set the lower maximum at 1500 mg per day, or about 3 grams of table salt.

And you’d think that was great, and I do, that the USDA guidelines have finally caught up with what the medical associations have been demanding based on the overwhelming weight of studies on dietary sodium intake as it affects blood pressure, cardiovascular disease including stroke, and kidney disease.

But there are two catches hidden in the midst of all this, and I’m not even sure Vilsack was aware of it. Smaller one first: Middle-aged? How old is middle-aged?

“Fifty-one and older,” Vilsack said. Whew, I thought. Four more years before I have to start thinking of myself as middle-aged. By the time I get there, I’m hoping the standard will have gotten fudged upward by at least another decade or so.

Because, you know, if you’re not 50 yet, 51 sounds reasonable–and comfortably remote for a lot of younger adults. Which I am, thank you very much. Don’t look at me like that.

So here’s Catch-51: When I was working at the National Heart, Lung and Blood Institute back in the mid-’90s, the general working recommendation for lowering sodium to 1500 mg/day was all the other high-risk groups Vilsack mentioned…and healthy adults 40 and up. Not 51 and up.

The choice of a cutpoint at age 40 for otherwise healthy people was based on the risk data from the first three National Health and Nutrition Education Surveys, which began collecting data across the nation starting in the 1970s. The latest version collected data around 2006 and its findings were just released last spring by the Centers for Disease Control. All the NHANES studies correlate  in-depth interviews about diet, exercise and lifestyle patterns, and cardiovascular history along with clinical health measurements (height and weight, blood pressure, cholesterol, urinary sodium excretion, blood iron, etc.) from thousands of ordinary Americans. Even early on, there appeared to be an independent higher risk and a greater need to lower sodium at 40 and older, all other health risk factors being equal.

But of course 40 seems too young to be middle-aged. And the USDA, which issues the Dietary Guidelines for Americans, tends to downplay certain elements of the risk statements so that no one, or at least not the agency’s chief constituents, gets upset. The no one in this case might easily be the Continue reading

FDA Regulation–Too Slow on Salt?

The Washington Post carried a story today that the FDA is finally getting a move on and planning how to regulate salt in processed foods–after numerous and repeated failures of laissez-faire voluntary self-regulation attempts. It’s been a long time coming; the FDA has been petitioned repeatedly by the American Heart Association, the Center for Science in the Public Interest, and many other organizations, both private and governmental, and has always maintained up to this administration that salt was a “generally recognized as safe” ingredient.

So I’m glad that the FDA is finally making some effort to regulate sodium in food and drop the “generally recognized as safe” status. I’m unfortunately not amazed at all that they’re trying to drag it out to a 10-year process. People’s taste for salt can be downshifted significantly in two or three weeks on average, so there’s really no excuse for such a gradual decrease except for the manufacturer’s cost of reformulation. They seem to be pacifying the processed food manufacturers–all the classic  prechewed food industry claims about reduced customer satisfaction appear to be overtaking discussion and usurping the issue of health risk.

But what really gets me is the last quote in the article:

“Historically, consumers have found low-sodium products haven’t been of the quality that’s expected,” said Todd Abraham, senior vice president of research and nutrition for Kraft Foods. “We’re all trying to maintain the delicious quality of the product but one that consumers recognize as healthier.”

Tell the truth: Those foods aren’t really all that delicious now. It’s like admitting that heavy salt is the predominant flavoring (the other being cardboard).

Salt reduction vs. hypertension meds–which would you choose?

One of the big complaints processed food companies, physicians in clinical practice, and the great gourmet media all have in common is that cutting back on salt would make food taste flat, and you as an individual wouldn’t necessarily get a big drop in your personal blood pressure from doing it. They argue that only “salt-sensitive” people have to worry about their intake, and anyway, a few points lower, they all say, isn’t really impressive enough to give up your 300-mg serving of sodium in a bowl of Kellogg’s raisin bran or 390 in a slice of La Brea sourdough. And don’t, for g-d’s sake, ask your favorite name brand celebrity chefs to stop salting early and often in each dish!

A big statistical modeling study in the New England Journal of Medicine this week knocks all this wishful thinking on the head, and does it very nicely. The study looked not at individual blood pressure drops but the health and cost benefit of dropping average salt intake by 3 grams a day over the entire U.S. population.

The researchers found that if everyone drops their salt intake back down, the benefits start to look like the ones from quitting smoking, cutting cholesterol and saturated fat, and losing weight to get to a normal BMI.

That’s because even when individual blood pressures drop by only a few points, they’re not going up (as they are today), and when a small average drop happens in a very large group, the big bell curve of disease shifts toward lower risk of consequences and later starts for developing heart disease and high blood pressure. After the first national cholesterol lowering guidelines were issued in the late 1960s, the nation’s heart disease and stroke risk dropped by about a third, and at least until obesity and blood pressure started to cause a back-reaction, the average age for a first heart attack went from 50 to 60 in men. That’s a huge kind of benefit.

The combined drop in heart disease and stroke deaths from cutting salt would be something like 200-400,000 people per year, a lot more than can be saved by simply putting everyone on blood pressure medications–the study made that comparison directly.

Altogether, a solid recommendation for dropping sodium levels in processed and restaurant foods, which make up about 80% of today’s sodium intake. And for not imitating processed food and chain restaurant thinking in your professional or home cooking, as Francis Lam seems to in his Salon.com commentary on the new NYC Department of Health initiative. And if there was any doubt that the Culinary Institute of America has been training Continue reading

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