Nutrition Education: The Best Solution

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The scientific paper about nutrition education programs from South America was an opinion piece derived from a student’s dissertation defense. It addressed nutrition labels in Brazil: the labels were too focused on the caloric content instead of the ingredient information.

The paper gives an example of two foods that have 97 calories but are vastly different in nutritional value. Chewy fruit-flavored candy had 21 grams of carbs, no protein, 1.5 grams of saturated fat, and no fiber; 14 almonds had 3.6 grams of carbohydrate, 3.5 grams of protein, 8.4 grams of healthy fat, and 2.1 grams of fiber. The almonds also had several vitamins and minerals while the chewy fruit candy had none.

The question is whether labels alone can change the nutritional health of a nation. Hard to say. Brazil came up with a simple public health approach using three recommendations:

  1. Choose whole, minimally processed foods
  2. Cook those foods yourself
  3. Eat those foods with other people

I think that’s an excellent approach. It means that people may have to shop a little more often and spend more time preparing food. But when you consider travel to get take-out or fast food, or the expense of food delivery, we can get better and fresher quality foods with fewer preservatives and more nutrition for around the same price.

Eating those foods with other people, at a minimum, means that families eat at least one meal together daily, possibly two if we include breakfast. The other possibility is to invite neighbors, friends, or other family members. We don’t have to fix feasts; just fresh, healthier foods that are simple to cook and share.

The Bottom Line

I think the Brazilian approach could work in the U.S. If we were to use the public health nutrition education program from WWII with an emphasis on the benefits of the foods for our health along with videos people could use to prepare the foods simply, and even scale that down to individual communities where small groups could learn how to shop and cook, we can change the health of the nation.

I also think it begins with parents: they’ll have to lead the way if they expect children to eat better. When we visited Paula’s cousin, who has three children under two (a toddler girl and identical twin baby boys), we remarked at the variety of food their daughter was willing to eat. Her dad said that she may be the only kid in preschool asking, “Excuse me, where is the hummus?” It may mean that parents will have to learn more about healthier foods and how to prepare them. I think it’s a small price to pay to improve their kids’ potential for better health.

What are you prepared to do today?

        Dr. Chet

Reference: Adv. Nutr. 2019;10:549–556.

Improving Nutrition in South America

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One of the problems today with public nutrition education programs is that there’s an important element that would prefer it not be done. In fact, food manufacturers are doing all they can to avoid any approach that may impact sales of high-fat, high-sodium, high-sugar, and highly processed food. I get it—they want to sell as much as they can. But to suggest that ketchup is a vegetable in the school lunch program doesn’t make any sense. I’m not going to comment further because that could take a month of Memos.

Instead let’s look at what some countries in South America have done to address nutrition as their obesity and related disease rates rise. One of the most controversial steps was taken by Mexico: the government put a 10% tax on high-sugar drinks, snacks, and sugary cereals that have limited nutritional benefit compared to total calories. It was not easy because the people of Mexico, much like the U.S., are against paying any more in taxes. But as of 2019, consumption of sugary sodas has dropped 12% in the poorest segment of the population and 5% in more affluent segments.

One of the most innovative approaches is used in Chile: foods high in added sugar, saturated fats, sodium, and high in calories have to place black stop signs on the front of package labels, and those foods can’t be sold or promoted in schools or promoted on television. Children have been educated about the meaning of the label changes and are steering their parents away from foods with black stop signs on the labels.

These radical approaches had to fight the food industry all the way, but the good of the people outweighed the profits of the industry. There may be a better way yet, and that’s what I’ll talk about Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.washingtonpost.com/business/2019/07/16/latin-americas-war-obesity-could-be-model-us/

How Can We Improve Nutrition and Public Health?

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I recently read a couple of articles, one from a newspaper and another from a journal, that talked about South American countries and how their governments should deal with the obesity epidemic and how some are approaching this issue. There may be lessons we can use here for us in the U.S. and other parts of the world.

Some historical perspective: the last public health initiative that actually worked well in the U.S. was during WWII. To direct more meat to the people fighting the war, the government enlisted any and all means to convince the public that organ meats were actually delicacies. Instead of a simple call to support the war movement, the pitch was to help consumers understand how organ meats such as brains, intestines, liver, and kidneys were nutritious. Along with that, they provided recipes for how to prepare these special parts of cows and pigs. It worked and those cuts were really considered delicacies. After the war ended, the special nature of these parts gradually drifted away.

In my opinion, that was the most successful public health education program ever done. When you consider all that’s been done related to educating the public about cholesterol, fat, trans fat, and sugar, nothing has ever gotten people to change their habits; the nutrition facts label is often more confusing that helpful. It’s obvious we need help, but what and how? We’ll take a look at what these countries in South America have tried on Thursday.

What are you prepared to do today?

        Dr. Chet

The Bottom Line on Sugary Drinks and Cancer

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The question is simple: do we avoid all sugary drinks, including fruit juices? The best I can come up with is to withhold judgment and don’t get excited about it for now. Let’s take a look at what the concerns of the researchers were and then my concerns.

Researchers’ Concerns

The first is that the NutriNet-Santé study was not a randomized sample. That means that only those people who were interested in participating for whatever reason did so. The sample was predominantly women at 78.7% of the cohort with a mean age of 42 years. The researchers accounted for age and gender in the statistical analyses, but that doesn’t account for the lack of randomization.

Researchers also stated that the rate of cancer was much lower: 620 of the 100,000 people in the study compared with 972 per 100,000 people in all of France. They adjusted the numbers to reflect the age and gender distribution in France, but I used the numbers actually given in the study. They also said the diagnosis of cancer was self-reported. I can’t believe anyone would say they have cancer if they don’t, but it would have been better if it were verified.

Related to that, some cancers were limited, thus affecting the statistics. If you don’t have enough of any type of cancer, it’s difficult and scientifically shaky to calculate a relationship.

Younger subjects consumed higher amounts of sugary drinks than older subjects. There were other factors as well, but these also were taken care of statistically. Further, they acknowledge what I alluded to: when people self-report, they can over- and under-estimate their intake. They also chose only the subjects that had at least two diet records completed in the first two years; the potential was 10 if all records were completed by all subjects. That seems low to me—there’s too much missing data.

Finally, this was an observational study and thus cause and effect can’t be attributed to the results. But it does raise questions.

My Questions

I think they could have gone a long way to answering the question about sugar intake if they had compared the fruit intake with the juice intake: take the fruit intake, calculate the sugar content, then match it with juice intake with the same sugar content. What was the rate of cancer in each group? Doing the direct comparison could go a long way to suggest whether it’s the sugar alone or if the effects were ameliorated with the fiber and phytonutrients of whole fruit with the same amount of sugar. That’s an obvious question; this is an ongoing study so maybe they’ll do that in the future.

I also think that running a comparison of total carbohydrate intake could also give us insight. If someone had a high carbohydrate intake, especially if it were high in refined carbohydrates, that might be meaningful as well.

The Bottom Line

The question I was left with was this: how could less than a half-cup per day of any type of added sugary drink that contained fewer than 50 sugar calories cause an increase in cancer? It just doesn’t make any kind of sense when you consider the total mean average calorie intake of the subjects was 1,850 calories. If the total sugar intake from solid foods of the individuals was high, or it was highly refined carbohydrates, that could make a difference. That analysis wasn’t done.

At this point, I wouldn’t stop drinking a glass of fruit juice or adding some juice to a smoothie. Don’t go out of your way to drink more fruit juice, but don’t avoid it either; certainly you should choose fruit juice from whole fruit over soda with sugar. If you have an artificial sweetener you like, use that instead of sugar. As for other drinks that contain sugar, they’re highly refined carbohydrates so you should be keeping those under control anyway. While this was an interesting and controversial report, nutrition is still about balance. Keep that in mind as you choose what you eat and drink every day.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408.

Finding the Cancer Risk in Sugary Drinks

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In Tuesday’s Memo, I reviewed the methodology of the NutriNet-Santé study in France. As I suggested, it was solid. The sugary drink choices included fruit juices, sodas, sugar-sweetened hot and milk beverages, sports drinks, and energy drinks. In terms of the data collection, I can’t think of anything they could have done better.

Turning to the statistical analysis, it was complicated to say the least. The use of high-speed computers allows for many statistical analyses to be done in short order, even with over 100,000 subjects. My only concern is that, as they did the trend for hazard ratios, they adjusted for many variables including age, gender, energy intake, and family history. How many variables? About 24 in all by my count. That’s not necessarily wrong, but there are some that would seem obvious such as total carbohydrate intake from all foods, and percentage of calories from carbohydrates other than vegetables and fruit.

Another way of analyzing the data was something I’ve done before, and that’s compare the rate of cancer to the national cancer statistics in France. In this case, the rate of cancer in France is 0.95% while it was 0.87% in the unadjusted data from the study. That’s very close and a bit lower than the national average.

Must we avoid even a half-cup of fruit juice per day? Is the sugar in your coffee or sweet tea causing a significant increase in your risk of getting cancer? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408.

Is There a Link Between Sugar and Cancer?

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Sugar has been in the news with the publishing of the latest results from the NutriNet-Santé study from France. The headlines of press releases suggest that drinking as little as four ounces of a sugary drink, including fruit juice, per day was related to an increased risk of getting cancer. Sugary drinks of all types except fruit juice were associated with an increased risk of getting breast cancer. These were all hazard ratio trend analyses; as the consumption increased, so did the risk of cancer.

If you read the Memos regularly, you know my approach is to always check how the data were collected. In this study, they used three 24-hour dietary records that included two weekdays and one weekend day. The diet records were done every six months throughout the duration of the follow-up, about five years. They subjects entered their data online; with over 100,000 subjects, that’s the only way this study could be done.

Of all the types of diet assessments, this is as close to the gold standard as I’ve seen. They had 97 different sugary drinks and 12 artificially sweetened drinks that were possible choices with very detailed descriptions and photos of drinks to help assess portion size. The only step they didn’t take was to have the records checked by a dietician before the subjects entered their data online. The methods in this study were solid compared to just about every other study I’ve talked about.

Should we avoid all sugary drinks at this point? More on Thursday. Tomorrow is the July Insider Conference call; this is your chance to learn more about nutrition and get your questions answers. You can still be included, so check out memberships right now.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408.

MSG Is Safe, But Be Wary

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The controversy regarding MSG certainly won’t end with this Memo, but I want you to know what the research says so you can make an informed decision. There’s no question that some people have sensitivities to certain food additives, and I’m not diminishing that response in any way. My point in doing this series of Memos was to dispel myths that have grown around some food additives such as MSG.

Why was the early research wrong? The Chinese Restaurant Syndrome grew from a single physician who described how he felt after eating Chinese food. More case studies were published, then small trials that seemed to support the observation. As time went on, trials with better controls over subjects and their reactions were done to test those responses attributed to MSG.

Regarding the excitotoxic brain damage, for the most part, that research injected glutamate (and not MSG) directly under the skin or directly into the digestive system. Because of its importance in so many chemical reactions, glutamate is tightly regulated and does not cross the blood-brain barrier. In other words, the research could have been done better. When it was, the results of those studies could not be duplicated.

Where does that leave you? Reading labels, I hope. I just checked the label of smoked ham: no MSG but there were at least three different sources of sodium. Same was true for beef jerky. That contributes to the high sodium intake we all have if we eat those foods.

You can’t really get away from MSG anyway; it’s naturally found in so many foods such as meats, cheeses, and even in tomatoes. There could be a benefit to using MSG: it may lower your overall sodium intake because it takes a lot less MSG to give the umami flavor than salt does.

But be wary. Umami flavor can become addictive. You know those chips I like so much? Some have MSG added, and they’re tough to eat in reasonable amounts. It may be best to avoid them altogether unless you can control the quantity you eat. That was why MSG was thought to cause weight gain; by itself, it doesn’t but it can cause a person to overeat, and that for sure will increase body weight.

Like anything else, unless you’re allergic, MSG can be a part of a reasonable diet to add flavor to food. If it helps make people want to eat broccoli and cabbage, I’m all for that because the benefits of the vegetables far outweigh any harm from the sodium.

Don’t forget to let me know if you’ve ever had a negative reaction to MSG. I’ll give the results next week.

What are you prepared to do today?

        Dr. Chet

References:
1. Questions and Answers about MSGhttp://bit.ly/32tvELS.
2. N Engl J Med 1968; 278:796.
3. Science. 1969 May 9;164(3880):719-21.

Early Research on MSG

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People have been ranting against MSG for decades, but I never paid attention until I read a study on a group of subjects who said they had a negative response to eating Asian foods. The subjects were tested under four scenarios consecutively, dependent on their response to the prior test results. The study demonstrated that when exposed to massive amounts of MSG versus a placebo, there were no consistent responses from this sensitive group of subjects. That’s meaningful because it challenged common knowledge.

That common knowledge began with a letter to the New England Journal of Medicine by a physician after reporting symptoms he felt after eating a meal of Asian foods; it wasn’t research, just a personal anecdote. At the same time, a researcher from Washington University in St. Louis began a series of studies on glutamate and other protein precursors that demonstrated the excitotoxicity affects on brain tissue; excitotoxicity (ex-SIGHT-o-tox-ISS-i-ty) refers to nerve cells being damaged or killed by excessive stimulation by the neurotransmitter glutamate. That was when the bulk of the negative research on MSG drew attention. However, over a period of years, other researchers attempted to duplicate those studies with unsuccessful results.

Where does that leave us? Other than a variety of conspiracy theories, MSG doesn’t seem to have the negative impact that has been attributed to it. I’ll finish this up on Saturday but my original question still stands: if you feel you respond negatively to MSG, reply to this email and I’ll let you know the results next week.

What are you prepared to do today?

        Dr. Chet

References:
1. N Engl J Med 1968; 278:796.
2. Science. 1969 May 9;164(3880):719-21.

A Closer Look at Monosodium Glutamate

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People these days love salty, and as I’ve said before many times, I especially love salty: nuts, chips of any kind, cured meats such as ham. I believe if bacon weren’t salty, it wouldn’t be as popular as it is. Mix salt with amino acids, especially glutamine, and it creates a taste called umami. It’s an almost irresistible flavor that some people, if not most, can’t stop eating.

Now what if I told you that monosodium glutamate (MSG) had been added to those specific foods to give it that umami taste? (It hasn’t, so don’t throw out the bacon or jerky just yet.) What would you think then? You might not be so enamored with those foods because MSG has been linked to headaches and brain dysfunctions. Some people attribute symptoms of allergic reactions to MSG that include breathing issues, the aforementioned headaches, and many other neurological-type issues.

Would you believe that MSG probably doesn’t cause those symptoms in most people? That the “research” showing that MSG is bad was poorly done, and to some degree, wasn’t even really research? For sure, you don’t want to miss Thursday’s Memo. Until then, let me know if you’ve responded negatively to MSG by replying to this Memo.

What are you prepared to do today?

        Dr. Chet

Reference: Questions and Answers about MSG http://bit.ly/32tvELS.

That Sugar Film: A Fantasy

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Let me clear up a few things right away. I’m not a fan of overeating sugar, whether pure cane sugar or high fructose corn syrup. But glucose is the perfect fuel because it burns completely with only carbon dioxide and water as the by-products. I think what everyone should do is respect glucose for what it can do and what overconsumption can do: make us fat—but no more than the other carbohydrates we over consume. With that in mind, let’s take a look at the filmmaker’s weight gain.

He claims to have eaten the equivalent of 40 teaspoons of sugar a day, keeping his calories the same as his regular diet, and gaining almost 20 pounds. My simple opinion is: bull. People in the movie spent some time suggesting that a calorie is not just a calorie, that somehow you can get more from sugar. I’ll address that in a moment. The real problem is that while he thinks he didn’t over eat, he absolutely must have to gain close to 20 pounds in two months. Period. I’m not suggesting he intentionally lied, but I watched him eat and he was not measuring much of anything. Unless you weigh or measure, you can’t say that you ate what you claimed you ate.

But let’s say that he was correct, that he ate 2,300 calories per day with 800 calories coming from sugar. What that would require was somehow more calories are extracted from sugar. My question is how? To go molecular for a second, the energy we get from food is the energy stored in the chemical bonds of the food; if we take in more fuel than we need, the body stores the extra energy as fat. If sugar has only so much energy stored in the chemical bonds, how can it release more? Glucose or fructose, doesn’t matter. That would require some form of unknown chemical reaction that could create energy. That doesn’t happen in any biochemistry of food I’ve ever studied. If it could, it would come at a cost, an energy cost somewhere.

The idea that a calorie is not a calorie has always been a foolish argument because there’s no chemistry to support it. We cannot make more energy than we begin with. The only way he gains 20 pounds is he overate. A lot.

He spends a lot of the movie talking about sugar spikes and falls that made him “addicted” to sugar. I’ve never seen anyone drink that much fruit juice, to the extent that it wasn’t reasonable. I asked on Facebook how sugar affects people who drink juice or any other form of sugar, but not sodas. The results were 1:3 against a sugar rush of any kind. I also included physicians and other healthcare professionals. Was it a formal study? No. And neither was what the author did to himself in this film.

To me, his film was a real work of fiction. Add it to your collection of fantasy films.

If you reduce the amount of sugar in your diet after watching this film, that’s great. You really can’t go wrong getting your calories from better nutritional choices. But don’t base your decision on this pretend research.

What are you prepared to do today?

        Dr. Chet