In 2004, two 14-year-old New Zealand girls found that a blackcurrant drink made by GlaxoSmithKline, the giant company, contained almost no Vitamin C — contrary to advertising that boasted of its Vitamin C content. Today the company was fined about $150,000 (US).
Category: nutrition
Omega-3 and Mood Disorders
I subscribe to the Arbor Clinical Nutrition Updates. It is a nice way to slowly learn more about recent nutrition research. A partial subscription is free. Last week’s topic was omega-3 and mood disorders. The update summarized three articles:
1. Appleton KM. et al. Effects of n–3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials. Am J Clin Nutr 2006;84:1308 –16. This meta-analysis of 12 clinical trials found that omega-3 fats significantly reduced depression.
2. Frangou S. et al. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry. 2006 Jan;188:46-50. This experiment found that an omega-3 fat helped persons with bipolar disorder.
3. Hallahan B. et al. Omega-3 fatty acid supplementation in patients with recurrent self-harm: Single-centre double-blind randomised controlled trial. Br J Psychiatry. 2007 Feb;190:118-122. This experiment found that omega-3 fats reduced a depression score.
I recently reviewed an article for the American Journal of Clinical Nutrition that found that omega-3 fats did not reduce depression scores. Unfortunately the article was not accepted for publication. I hope it gets published somewhere else.
The Berkeley School Lunch Program: Correction
After I mentioned that the Berkeley lunch program was in poor shape, Ann Cooper, the chef in charge, invited me to visit — to set the record straight. It was quite an opportunity; the Berkeley lunch program, some hope, will become a model for the whole country. This is why there was a long New Yorker article recently about what Cooper is doing.
Spending about $1/day more per student, Cooper has shifted the lunch menu far away from the heavily-processed and factory-made food of most school lunches. Far more of the food is cooked in the district kitchens, albeit days in advance in some cases. I took Cooper’s word for it that the students actually eat the new food. This is a great improvement, in my opinion. The big questions are whether these changes are sustainable and what effect they will have.
The single best thing you can do for your health is to eat healthy food (the exact nature of which has yet to be determined, but you get the idea). Obesity, diabetes, heart disease, cancer, stroke — all the big American health problems are made much worse by the crummy diet of most Americans. Will Cooper’s improved lunches cause her lucky diners to eat better as adults? If so, $1/day is a great bargain compared to health care costs. (She estimated these changes will cost $2/day across the country.) Will Cooper’s improvements reduce obesity and diabetes? That is obviously the hope.
I wouldn’t say the Berkeley school lunch program is in trouble or in poor shape; I would say it is in limbo. Four things are big question marks:
1. Cooper seemed to be working very hard and not quite enjoying it. Even after a year on the job. This is not a good sign. Her salary is being paid by the Chez Panisse Foundation — not a good sign. She struck me as incredibly dedicated but how much failure and frustration can she and the Chez Panisse Foundation bear? This sort of thing is often much harder than anyone imagines in the beginning.
2. Obesity is a big big issue. Whether the new food will help is unknown. Cooper seems to take it on faith that her food will be less fattening. I am less sure. As anyone who has read The Shangri-La Diet knows, I believe that American food became really fattening not because it was processed or “unhealthy” but because of the increasing popularity of foods that tasted exactly the same each time (e.g., microwave entrees). If she cooks the same recipes again and again, the hoped-for weight loss may not happen. If it doesn’t, will the program continue? Or will $1/day be seen as better spent on something that hasn’t yet failed, such as more physical ed?
3. The effects of Cooper’s changes are going to be measured by UC Berkeley School of Public Health researchers. As far as I could make out, the comparison will be between Berkeley students and students in another school district. You have n = 1 (1 school district) in the experimental group and n = 1 (1 school district) in the control group. This is better than nothing but, given the importance of the question — can better school lunches improve health for the rest of a student’s life — and our great ignorance as to its answer, it is scary bad. It will be so easy to reach the wrong answer. Researchers with this sort of design often act as if they have hundreds of subjects in each group — each student is treated as a different and randomly-assigned subject. This isn’t just false, it’s misleading.
4. While I am sure the researchers can measure obesity, I am less sure they will do a decent job of measuring changes in attitudes toward food. It is not a typical public health question.
I am very optimistic about the future of food — and therefore health — in America, but it’s because of (a) the Food Network, (b) the growth of farmers’ markets, and (c) the success of Whole Foods and similar stores. Not to mention Rachael Ray. Americans are becoming food connoisseurs, starting to catch up with a large chunk of the rest of the world, such as China. The American increase in connoisseurship is trickle-down — from rich people to everyone else. Like cell phones, like TVs, like literacy, like many things. Whereas Ann Cooper is working in a school district that has lots of poor people. Not a good place to start this sort of revolution.
Addendum: This article in New York magazine reminded me that Ann Cooper’s previous job was at an expensive private school. So maybe it is another case of trickle-down after all.
Is Sugar Fattening?
In 1987, Dr. Israel Ramirez, a researcher at the Monell Chemical Senses Institute, whose research led to the theory behind the Shangri-La Diet, questioned the prevailing assumption that sugar causes obesity in humans. Rat experiments did not support such a simple idea, he pointed out.
The most recent issue of the American Journal of Clinical Nutrition has a review article that agrees with Ramirez (but, alas, does not cite him). Now there is clinical evidence that Ramirez was right. From the abstract:
Numerous clinical studies have shown that sugar-containing liquids, when consumed in place of usual meals, can lead to a significant and sustained weight loss
Maybe the Shangri-La Diet isn’t so crazy.
How Good is the Atkins Diet?
A new study, just published in JAMA, compares several popular diets: Atkins, Zone, Ornish, and LEARN (a conventional-wisdom-type diet based on “national guidelines,” according to the paper). The Atkins diet did much better than the other three. The results were quite a bit more positive for Atkins than an earlier comparative study where compliance was poor, weight loss was minimal, and no diet was clearly better than the rest. The Atkins Company, not surprisingly, is pleased with the new study; they have put it in their research library.
Here is what the researchers concluded from their data: “A low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss” (from the abstract — the meaning of “alternative” is not explained).
However, a graph in the paper (Figure 2 for those of you with access) makes a very important point that the researchers don’t mention: Persons on the Atkins diet weighed more after 12 months on the diet than after 6 months. After 6 months, in other words, the lost weight was coming back. The regain is not small: From Month 6 to Month 12 the Atkins dieters regained about one-quarter of the weight they had lost. At the end of the study (Month 12), they had lost about 10 pounds.
My interpretation is that the Atkins Diet works for two reasons: 1. The food is new. The flavors of the new food are not yet associated with calories. The novelty wears off, of course. This is why some of the lost weight was regained. 2. High-glycemic-index foods (such as bread and potatoes) are eliminated. This produces permanent weight loss, but not a lot. When I started to eat low-glycemic-index foods I lost 6 pounds, which I never regained. A 6-pound loss is not terribly different from the 10 pounds (average) lost by study participants.
In a newspaper article, the study’s lead author mentioned the regain:
As the study progressed, [Christopher Gardner, an assistant professor of medicine at the Stanford Prevention Research Center] said, some dieters put back on some of the weight they had lost early in the year.
That’s misleading. It wasn’t “some dieters” — it was a trend shown by the whole group. But at least he (kinda) mentioned it.
Jane Jacobs on the Food Industry
According to Paul Goldberger in the NY Sun,
[Jane Jacobs] regretted the construction of more and bigger buildings, and the enormous power held by the real estate industry, Mr. Goldberger said. “But she was also a realist,” he said. “She was not Utopian, and I think that was the thing that distinguished her from many other intellectual and urban thinkers. She believed that the world we had was actually pretty good, if only we would learn to understand it, appreciate it, and handle it right.”
Exactly. That is what I was saying in my comments on Michael Pollan (here and here). Our food world — which is mainly a processed food world, very little food is unprocessed — is actually pretty good. Some food processing is done according to wrong theories — the wrong theory that fat per se is fattening, for example. The newest food processing gets the most attention because it is still noteworthy (e.g., low-fat foods) but it is new theories that are most likely to be wrong. This is why “processed food” gets a bad rap. Most food processing, which is no longer advertised and we no longer notice because it is so common, is done according to correct theories — the main examples being cooking, refrigeration, freezing, and other forms of germ reduction. The germ theory of disease is correct. The poor health of many Americans reveals plenty of room for better understanding; I think the theory behind the Shangri-La diet is an example of better understanding. That theory suggests new types of food processing, as I explain in the last chapter of the book.
Omega-3 Facts of the Day
1. In the 1960s, Greenland Eskimos ate a diet very high in omega-3s.
2. In the 1960s, Greenland Eskimos had very low rates of psoriasis. The Danish rate of psoriasis was 20 times the Eskimo rate.
3. High omega-3 intake reduces inflammatory intercellular signals.
4. Psoriasis is beginning to be considered an autoimmune disease.
It’s not the same type of fact but on the SLD forums spacehoppa reported her rheumatoid arthritis was in remission, apparently from omega-3s, for the first time in the 18 years since it was diagnosed. Her balance was also better.
Eating Less
Emily Yoffe has a fascinating piece in Slate about going on a “CRON” (calorie-restricted optimal nutrition) plan. She eats 1500 calories/day. I was struck by three things: 1. Roy Wolford, apparently the first person to try something like this for a long time, did not live to be unusually old. He was 79 when he died. This is very helpful self-experimentation: CRON didn’t work, at least for life expectancy. One data point is much better than none. 2. Hunger is a huge problem. 3. In spite of the hunger, Yoffe is continuing the plan after the allotted 2 months have finished. Her sleep is still poor, etc., but she likes being thinner.
Yoffe mentions the UpDayDownDay regime studied by NIH researcher Mark Mattson. There is now a website for an associated book and diet. (My earlier comments.) A few weeks ago I asked Donald Laub, a Stanford professor of medicine who is doing this regime, if he was still taking olive oil to make the low-calorie days easier to endure. He said he was.
More about Pollan and Processed Food
A reader named Shawn made an interesting comment on Michael Pollan vs. Processed Food:
I’d like to point out that your example of fortifying flour (white flour, actually) is not really that great, since in this case they are simply adding back some (but not all) of the nutrients that were destroyed in processing. Whole wheat flour does not have to be fortified because it has those nutrients to begin with — which actually supports Pollan’s arguments against food processing.
That’s true, it does support Pollan’s argument against food processing. More detail will help make my underlying logic clearer. Flour is milled for several reasons, the details of which don’t matter; let me just say that white flour is more profitable than whole wheat flour, thus can be sold at a lower price. In terms of price, milling is win-win: the supplier makes more profit and the customer gets cheaper flour. But when you consider nutrition — milled flour less nutritious than unmilled — it is not clear at all that milling is win-win. B vitamin supplementation, by cheaply replacing what the milling took out, moves us back to win-win. Not milling is not win-win: It is nothing-nothing.
When you process food based on a correct theory — an accurate understanding of how our bodies work — the result is often win-win. When you process food based on a wrong theory, it is much harder to reach that result. This is what Pollan didn’t understand. As usual, Jane Jacobs said it best. In response to people who said that Problem X or Problem Y was due to overpopulation — just as Pollan is anti-food-processing — Jacobs said the problem is not too many people, the problem is the undone work. In the case of food, the problem is not too much processing, the problem is the undone work — the undone work of coming up with good theories to guide the processing.
Science in Action: Omega-3 (methodological improvements)
I realized (in both senses) several ways to improve my omega-3 self-experimentation:
1. Simpler treatment. I had been drinking both walnut oil and flaxseed oil. For the sake of simplicity, I stopped the walnut oil. I continued to drink 2 tablespoons/day of flaxseed oil. I will vary the amount of flaxseed oil.
2. More controlled measurement. Instead of balancing on any part of my right foot, I started balancing on only the balls of my right foot.
3. More measurement. I measure my balance once/day. During that one session I had been measuring my balance 20 times (measuring how long I could stand on a platform before falling off — 20 durations). The first 5 durations were warm-up, leaving 15 durations that counted. I increased the total number of trials to 30. It was still easy; the whole thing takes about 10 minutes.
4. A new measure. Anything that affects balance is likely to affect other mental abilities, I believe. To test this belief, I will start measuring my brain in a new way: a pencil-and-paper version of Saul Sternberg’s memory-scanning task. It will take about 5 minutes.
I started #1-3 about a week ago and will start #4 today.