Timi Gustafson, R.D.
Helping people to live healthy and fulfilling lives.
For a generation of American school children, parents and consumers it was supposed to be the instantly recognizable icon for healthy eating: “The Food Guide Pyramid.” No more. Today, the government has unveiled a new symbol. Unlike the familiar triangular shape, the new graphic consists of a circular plate, divided in four colored segments for fruits, vegetables, grains and proteins. In addition, there is a smaller circle for dairy products, suggesting that a glass of low-fat milk or a cup of yogurt has also a place in a health-promoting diet.
The goal of the “MyPlate,” as the new guidelines are called, is to help consumers balance calories, increase consumption of healthy foods and reduce lesser healthy ones.
The central message is kept as simple and straightforward as possible to avoid further confusion of an already confused public: Enjoy food but eat less of it; avoid oversized portion sizes; eat lots of fruits and vegetables as well as whole grains; switch to low-fat or fat-free dairy products; cut back on sodium intake and drink water instead of sugary drinks.
Out with the old, in with the new
Why do we need a new symbol to communicate the government’s dietary recommendations? “The pyramid really does not capture the public’s attention anymore,” said Robert C. Post, Deputy Director of the Department of Agriculture’s Center for Nutrition Policy and Promotion in a recent interview with WebMD.com (5/26/2011). “What we learned is not just giving information… [but to] give people the tools and the opportunities to take action.”
Few nutrition experts will miss the current emblem called “Mypyramid.” “Good riddance” is also the prevailing sentiment among consumer advocates. From the time of its release, it was criticized as too confusing and deeply flawed for its lack of specific information. “It’s going to be hard not to do better than the current pyramid, which basically conveys no useful information,” said Walter C. Willett, MD of Harvard School of Public Health in the New York Times (5/28/2011).
With the new circular design, the government wants to provide today’s consumers with fast, easy to grasp information about the basics of healthy eating. “We need to get consumers’ attention,” said Mr. Post. He stressed that the new icon can only serve as a “visual cue” to help people make better dietary choices.
The idea of illustrating nutritional guidelines in form of a pyramid-shaped graphic goes back to the Swedish cookbook author, Anna Britt Agnsäter, whose work was publicized by the Swedish government in 1974. The concept was adopted with slight modifications by the U.S.D.A. in 1992 and renamed as the “American Food Guide Pyramid.”
Like the Swedish original, the American version was meant to represent a hierarchical order of foods in terms of recommended daily intake. Foods to be consumed in larger quantities were placed closest to the wider base of the pyramid, while those to be eaten in smaller amounts were placed closer to the tapering top.
Since its inception, several updates have been made to the pyramid, both by the government and private researchers. The MyPyramid, released in 2005, was widely seen as a departure from the original concept. In essence, only the triangular shape survived. The familiar structure was turned on its side, with vertical, brightly colored strips symbolizing different food groups. To emphasize the importance of physical exercise, a graphic symbolizing a person running up a staircase was added.
A more detailed approach to structuring dietary guidelines was taken by Dr. Willett with his “Healthy Eating Pyramid.” Essentially, he tried to break up the different food groups by nutritional quality and also with regards to sources of protein, carbohydrate and fat content. Whole grains, vegetables, fruit and plant oils are at the base of his hierarchy, while red meat, refined grains, animal fats and sweets are at the top, meaning to be eaten only sparingly.
By contrast, the “Atkins Lifestyle Food Guide Pyramid” by Dr. Robert C. Atkins, MD favors protein sources, such as poultry, fish, beef and pork as the dominant food group, ahead of vegetables, fruits, dairy products and grain foods, the latter of which he considers among the least desirable food items.
A favorite of many nutrition experts, myself included, is the “Mediterranean Diet,” which is not commonly depicted in form of a pyramid. Still, the preferences are clearly distinguishable. At the base are pasta, breads, rice, whole grains and potatoes. One layer up are vegetables, fruits, beans, legumes and nuts. Olive oil is used deliberately and for a number of purposes. Less so are dairy products, eggs, poultry and fish. Desserts and sweets are rare treats. Beef and pork are only served occasionally and in small portions.
The bottom line
Whether the new icon combined with the recently updated guidelines will be effective in the ongoing struggle against America’s obesity crisis remains to be seen. What matters most is that people understand the causal connections between their eating habits and their overall health prospects. The essential information has been available for many years, but the message hasn’t caught up with our prevailing lifestyles. Not yet. Lets give this latest initiative a chance.
If you enjoyed this article, you may also want to read “The New Government Guidelines for Healthy Nutrition.”
Timi Gustafson R.D. is a clinical dietitian and author of “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com
Remember the line in the movie Forrest Gump? “Life is like a box of chocolate – you never know what you’re going to get.” According to a recently released report by Oceana, an international advocacy group for the protection of the world’s oceans, that is exactly what happens every time you go to the fish market. Food scientists are discovering rampant labeling fraud of seafood among retailers and restaurants, leaving consumers uncertain about their purchases.
The researchers involved in the Oceana study, “Bait and Switch: How Seafood Hurts our Oceans, our Wallets and our Health,” suspect that fish and shellfish is mislabeled up to 70 percent of the time. They say that consumers are routinely given little or no information about where and when seafood is harvested. And worse, the information that is provided is frequently misleading or intentionally false.
This is a problem that affects millions of seafood lovers in America and around the world. While the U.S. government stresses the dietary health benefits of fish, it doesn’t make the necessary efforts to effectively regulate the fishing industry or even to enforce already existing laws.
Most of the seafood consumed in America is imported. With hundreds of different fish- and shellfish species for sale, it is unrealistic to expect Americans to make informed choices on their own. Consumers have to rely blindly on the information they are given. Yet, according to the report, only two percent of the imports get inspected in terms of origin and health safety.
Even sporadic DNA testing has confirmed that false labeling is widespread. The Food and Drug Administration (F.D.A.) found during only one year of random port inspections that at least a third of fish imports were mislabeled.
Certain fish species are more easily misidentified than others. For instance, the label “Red Snapper” may stand for Catfish, Rockfish, Tilapia, Nile Perch, Mahi Mahi or Atlantic Cod (among others). “Grouper” may also be Catfish, Hake, Tilapia, Pollock or Nile Perch. “Bluefin Tuna” can include Bigeye Tuna or Yellowfin Tuna. “Salmon” may come from a fish farm, although it explicitly says “wild-caught” on the label.
Especially the wild and farmed varieties of salmon are not always visually distinguishable. Salmon from aquaculture would normally look somewhat grayish but is often given dietary supplements and artificial dyes to match the typical pink color of the wild cousins. The considerable price differences between the wild and the farmed versions can make it very tempting to commit labeling fraud.
Fish fillets are even harder to identify. Many look alike without the unique features and markings of skin, head and tail. Processing also masks the identity of shellfish. Clams and mussels get easily mixed up when sold without their shells.
Most imported seafood is processed before it’s shipped. Only about one fifth arrives whole or gutted. Whether it is sold in cans or served in small cuts in sushi bars, it is impossible to tell what exactly you are eating simply by looking at it.
Seafood is traded internationally more than any other food. In fact, most of it is transported around the globe, crossing numerous borders before reaching the end-consumer. This makes it complicated if not impossible to keep track of its journey from the water to the plate. “The increasing complexity and globalization of seafood markets have exacerbated fraud, both deliberate and unintentional,” says the report.
Illegal fishing operations have many ways to exploit the complexity of the international seafood trade and are able to effectively “launder” unlawful catches in the regular processing and distribution channels. “In addition to mislabeling and smuggling of illegally caught fish, other forms of seafood fraud include falsifying documentation, bribery and corruption,” according to the report.
Illegal practices cannot easily be stopped. Most fish caught in the open seas is processed right away on board of giant processing vessels before it comes ashore for further processing and packaging. At the time of labeling, the true origin and often the identity of the catch may have been obscured long before it reaches the market. The report concludes that “seafood fraud can happen at each step of the supply chain. Mislabeled fish found in restaurants may have been mislabeled by the restaurant, but the restaurant may rely on the distributors, who may change the label and the price to increase their profits. Mislabeling is driven in part by economic incentives to imitate a more expensive product or avoid tariffs on particular species.”
Seafood fraud can threaten human health
Seafood is extremely perishable. Proper handling and refrigeration are essential for quality and safety. Improper procedures can result in serious health risks for consumers. Looks, smells and tastes are not necessarily sufficient to determine quality because fish may contain toxins or allergens and still show no signs of spoilage.
Industrial pollutants like mercury, lead, PCBs and dioxin are even harder to detect. Unfortunately, nearly all fish and shellfish available on the market today contain traces of these toxins, with some species showing enough concentration to be harmful to humans, especially pregnant women and young children.
Farmed fish can carry antibiotics and dyes that are not present in the wild. Excessive use of antibiotics in aquaculture can lead to the spread of drug-resistant bacteria.
Allergens in seafood pose a serious and sometimes life-threatening risk. Fish and shellfish are among the most common food allergies in America. Failure to detect these potentially fatal health hazards is part of the many dangers resulting from labeling fraud.
Conservation measures are seriously harmed by seafood fraud
Overfishing and capture of species already threatened by extinction hurt all conservation efforts. Widespread concealment of illegally caught fish through multiple transfers, falsified documentation and underreporting makes responsible oversight and management of fishing industries around the world nearly impossible. It is estimated that as much as one fifth of reported catches worldwide come from illegal fishing. The U.S. is especially vulnerable to become “an easy target for dumping illegal, poor quality and unpopular seafood because controls are few and far between,” says the report.
One of the main obstacles in the fight against seafood fraud is that the U.S. government does not require complete traceability of fish imports. By contrast, the European Union has a system of catch certification in place to eliminate illegal imports and exports to and from the continent.
Insufficient inspections and enforcement of existing laws
To date, no single federal agency is in charge of combating seafood fraud. What makes matters worse is that federal agencies don’t even exercise the legal powers they have. The few regulatory efforts in place remain “uncoordinated and ineffectual,” according to the report. Instead of taking a concerted approach, agencies operate within a “patchwork of overlapping and outdated laws.” For instance, the Food and Drug Administration (F.D.A.) is responsible for ensuring the safety and proper labeling of all seafood sold in the U.S. Misinformation and false advertising, however, can only be addressed by the Federal Trade Commission (F.T.C.). The inspecting and policing of seafood imports is left to the U.S. Customs and Border Protection Agency (C.B.P.). Only the U.S. Department of Agriculture (U.S.D.A.) has the authority to force seafood companies to list all countries of origin on seafood labels, which is still not happening today despite of regulations that were put into law years ago. In other words, it’s a maze of bureaucracy that gets in the way of meaningful reform.
The Oceana report is especially damning with regards to the F.D.A.’s performance or lack thereof. “Current efforts […] to combat seafood fraud are wholly inadequate. There is no comprehensive inspection system comparable to even the most basic requirements for meat and poultry. […] The F.D.A. publicly acknowledges that it devotes ‘minimal resources to detecting and preventing fraud.’ Even more concerning, enforcement efforts are virtually nonexistent.”
Only two percent of imported seafood is inspected for health and safety risks and much less for the purpose of fraud investigation. Despite the fact that the F.D.A. has the legal authority to prevent any and all illegal food items from entering the country, shady import businesses can feel quite confident that fraudulent practices will remain undetected for a long time to come.
There are a few other inspection- and safety programs, some initiated or endorsed by the seafood industry. However, most of these are voluntary and unlikely to be followed by those engaging in fraudulent practices.
The technology for testing is already here
Genetic testing of seafood is available and relatively cheap. Commercial laboratories charge up to 20 dollars per DNA analysis, but the actual costs per test are much lower. The F.D.A. has recently purchased gene sequencing equipment for five field labs and hopes to increase testing by the end of the year. Still, most of the current work is being done by individual scientists and advocacy groups like Oceana, not by regulators and law enforcement. To date, there is still no national study on the scope and the implications of seafood fraud and that is a serious public health concern.
If you enjoyed this article, you may also want to read “What You Should Know About Seafood” and “Genetically Altered Salmon and Other Engineered Food.”
Timi Gustafson R.D. is a clinical dietitian and author of “The Healthy Diner – How to Eat Right and Still Have Fun™,” is available on her blog http://www.timigustafson.com and at Amazon. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format at www.amazon.com
A just released study on the benefits of HDL (the “good”) cholesterol-raising drugs has shown disappointing results. While lowering LDL (bad) cholesterol levels plays an important role in the treatment of heart disease, doctors have long believed that taking active measures to increase HDL levels as well would yield additional benefits.
As widely reported in the press, these expectations now seem unwarranted. The interim analysis of the study shows that a high dose of niacin, a B vitamin credited with the ability to increase high-density lipoprotein (HDL) in the bloodstream, taken in combination with statins does little if anything more to prevent heart attacks and strokes.
Sponsorship for the study, called AIM-HIGH trial, was shared by the U.S. government and Abbot Laboratories, a pharmaceutical company that makes Niaspan, a drug widely prescribed to heart disease patients as an HDL booster. During the trial that was originally scheduled to last 32 months, 3414 participants with heart- and vascular disease were treated with Zocor, a low-density lipoprotein (LDL) lowering statin.
While all participants were given the statin, one group received also Niaspan and another one a placebo. The study was concluded 18 month early when it became clear that Niaspan did not provide the significant advantages it was supposed to. Although the drug raised HDL levels as expected, the effects did not translate into measurable improvements of heart problems.
The effectiveness of Zocor was not called into question. The researchers emphasized that patients who were using Niaspan should not stop taking the drug without consulting with their physicians first.
Abbot Laboratories says it remains confident about the effectiveness of its product even after the study, insisting that “Based on its long history of clinical evidence, Niaspan remains an important agent for patients with blood lipid problems.”
The Food and Drug Administration (F.D.A.) has announced it will review the study but has not yet revised its former findings and recommendations.
Still, the new results will probably change the ways physicians treat their heart disease patients from hereon in. And not all patients are unhappy about being taken off the drug either. Niacin, the active ingredient in Niaspan, can cause a number of unpleasant side effects, including flushing and headaches. But because it was widely seen as a potentially life-saving medicine, the downsides were deemed acceptable.
In 2006, another pharmaceutical company, Pfizer, reportedly halted the development of its own HDL-raising drug “after studies showed that the medicine increased the risk of death.” (New York Times 5/27/2011)
The fact that HDL (“good”) cholesterol helps to “sweep up” LDL (“bad”) cholesterol in the bloodstream remains unchanged, of course. The importance of keeping both LDL levels down and HDL levels up is not in dispute.
Less known in the public arena is that niacin is not only present in HDL-raising drugs but also in many foods we all consume every day, including dairy products, lean meats, poultry, fish, nuts, eggs and enriched breads and cereals.
What this means is that diet- and lifestyle changes can significantly help increase HDL levels “naturally.” For instance, drinking three cups of orange juice a day can increase HDL by over 20 percent, according to one British study. Replacing saturated with monounsaturated fats and eliminating trans fats can not only reduce LDL but also boost HDL. So does drinking alcohol in moderation, especially red wine. Two to three servings per day of soluble fiber, found in oats, rice, dried beans and many fruits and vegetables can offer similar benefits. And, of course, regular physical exercise, in particular aerobics, not smoking and consistent weight management are among the best measures you can take to keep your cholesterol in check both ways.
Some foods containing niacin:
White-meat chicken, 3.5 oz, cooked: 13.4 mg of niacin
Mackerel, 3.5 oz, cooked: 10.7 mg
Trout, 3.5 oz, cooked: 8.8 mg
Salmon, 3.5 oz, cooked: 8 mg
Veal, 3.5 oz, cooked: 8 mg
Chicken, dark meat, 3.5 oz, cooked: 7.1 mg
Lamb, 3.5 oz, cooked: 6.6 mg
Turkey, white meat, 3.5 oz, cooked: 6.2 mg
Ground beef, 3.5 oz, cooked: 5.3 mg
Peanuts, ¼ cup: 5.3 mg
Pork, 3.5 oz, cooked: 4.8 mg
Peanut butter, 2 tablespoons: 4.4 mg
Beef steak, 3.5 oz, cooked: 4.1 mg
Timi Gustafson R.D. is a clinical dietitian and author of “The Healthy Diner – How to Eat Right and Still Have Fun™,” is available on her blog http://www.timigustafson.com and at Amazon. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format at www.amazon.com
Watching TV and playing video games has long been named as one of the culprits for our national obesity crisis. Our sedentary lifestyle habits certainly deserve some of the blame and there is no shortage of advice on how to wean us from our most beloved pastime.
The average American stays glued to the tube between four to six hours daily. Parents may complain about the almost addictive attitude their kids have towards video games, but, of course, adults surfing channels for hours on end are no different.
The fact that so many of us spend excessive amounts of time in front of the screen suggests that the experience is different from other activities that hold our attention to a far lesser degree.
Clinical studies have suggested that there are behavioral and neurological connections between the events we see on the screen and our ability to pay attention. “The kind of concentration that [especially] children bring to video games and television… is sustained with frequent intermittent rewards,” says Dr. Christopher Lucas, professor of child psychiatry at New York University School of Medicine.
In other words, watching TV shows and playing video games may be so popular because they offer more frequent rewards than other activities. The neurological explanation is that the brain releases dopamine, a neurotransmitter in charge of pleasure experience. Our attention span is prolonged by the constant gratification we receive from suspenseful movies, funny sitcoms or challenging contest games. Watching or interacting with any of these might serve as a kind of dopamine-enhancing self-medication.
Encouraging people to push the switch-off button and do something else may be the obvious answer but perhaps not the only one. Trying to deny ourselves what gives us pleasure rarely works over time. Sometimes, indulging in what comes naturally can be a smarter solution.
For me, a recent visit to a computer store was a real eye-opener in this regard. The place was packed with kids and teenagers who were not there to buy laptops and tablets but to play – not video games where you just use your thumbs but athletic games that require full body action. Of course, I am talking about the highly popular Kinect game series that runs on the Xbox 360 player from Microsoft.
For all those who are new at this, like myself, here is a brief description of how it works: Kinect uses motion sensors that track the movements of every part of a person’s body –arms, legs, knees, head, hips and so on. The collected data allow a computer to produce a kind of “digital skeleton,” which is then fed into a video game environment. Players can view their actions in real time on screen in form of an avatar, an electronic image that corresponds to the players’ performance.
Some of the scenarios are highly imaginative. As a health care professional and fitness buff, I was immediately drawn to a game titled “Your Shape,” which promises calorie burn-off while having nothing but fun. It comes with a “personal trainer” and a dynamic exercise program for every health- and fitness level.
For the specific purpose of weight loss, Kinect offers another workout program called “The Biggest Loser,” which features trainer-guided exercise- and nutrition tips based on the popular TV show on NBC.
If that doesn’t sound especially appealing, there is a large selection of athletic sports to choose from, and also less strenuous activities, like dancing, golf or bowling.
Do I think that this is the solution to ending America’s notoriously sedentary lifestyle? No, of course not. But it can be a helpful tool.
There are countless reasons why both adults and kids spend too many hours on the couch every day. In many families there is not enough time and energy left for much else after a grueling workday and long commutes. Playing outside the house or on a nearby playground may not always be safe for kids who are on their own.
As they become more affordable, these new technologies may indeed provide some alternative outlet. Isn’t it better to do something for our health in the virtual world if it helps us to avoid getting sick in the real one?
Timi Gustafson R.D. is a clinical dietitian and author of “The Healthy Diner – How to Eat Right and Still Have Fun™,” is available on her blog http://www.timigustafson.com and at Amazon. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format at www.amazon.com
Most Americans are concerned with their weight and are changing their food choices. Although losing weight remains a key priority for most adults, a surprising number of consumers are now less concerned about the amount of food they eat than they were a few years ago. If these statements sound contradictory to you, it is because they are. Both food manufacturers and health care industry try hard to make sense of America’s eating habits. Not a week goes by without another survey reporting the discovery of new trends in consumers’ behavior. The picture is anything but clear.
It is true that many more Americans have become interested in healthy eating. Concerns about food safety have definitely increased, and for good reasons. In response to several outbreaks of food-related illnesses in recent years, there is now greater demand for organic food products, even if it means paying higher prices. But for most of the population, nutritional quality is still not a priority when it comes to food choices.
Most Americans don’t eat enough fresh fruits and vegetables according to the United States Department of Agriculture (USDA), which recommends five servings of each in its dietary guidelines. Milk and eggs are being consumed in lesser amounts, but cheese is more popular than ever. Meat, poultry and fish consumption continues to rise. The overall fat content in the average American diet is undiminished.
Americans love their snacks. According to USDA studies, almost 20 percent of daily calorie supply comes from snack food in this country. Half of younger adults skip breakfast on most days, a quarter goes without lunch, and home-cooked dinners are becoming the exception rather than the rule even among families with young children. Especially kids suffer in growing numbers from malnutrition and weight problems due to unhealthy eating patterns.
Working men and women eat on average 25 percent of their meals away from home. That doesn’t mean the other 75 percent are being made from scratch. Fast food, pizza, take-outs and frozen dinners are the preferred choices of those with busy lifestyles. Pre-packaged meals, so-called “convenience foods,” became available in the 1950s when women started to enter the work force in large numbers and being a full-time “homemaker” was no longer attractive or financially feasible. The invention of the microwave, the omnipresence of fast food chains and a growing appetite for cheap food to go all fed into these trends and continue to do so.
While many aspects of these lifestyle changes are positive, the downsides are quite devastating. We are in the midst of a national obesity epidemic that has reached crisis level. Childhood obesity has become by far the greatest health threat to the country’s future.
And yet, there is growing evidence that Americans are getting fed up with dieting and weight loss. Finding themselves ceaselessly barraged with often contradictory information and expert advice, people become less enlightened and instead more confused and helpless. Others feel increasingly resentful about being lectured on what they see as their private business. As important as good health may be to them, many Americans find it too arduous and time-consuming to follow suit in their diet.
The number of people who say they watch their food intake at least occasionally for weight management and fitness purposes is stagnant, according to reports by three leading weight loss companies. “People are just saying: The hell with it. I’m going to eat whatever I feel like,” said one spokesperson for Marketdata Enterprises, a research firm specializing in data gathering for the weight loss market.
According to a survey conducted by the American Dietetic Association (A.D.A.), over 80 percent of Americans now rate nutrition as “only moderately important” to them. Most experts agree that people are clearly moving away from being obsessed with being thin. Some have suggested that the aging Baby Boomers are at least one of the reasons. When folks get older, they are more set in their ways, which is also reflected in their eating habits.
“I think there is some cultural backlash to our societal urge to live forever,” said John Lyons, a psychologist at Northwestern University. “It’s like a realization of one’s limits and an acceptance, something you see in the 40s to 50s age group. Maybe you just accept your lot and do the best you can.”
Not surprisingly, support groups for overweight people are emerging all over the country. Demand for better protection of the rights of the obese is getting louder and keeps gathering followers. Obesity has been stigmatized for far too long in our society, they say, and it’s time to question what counts as the ideal body image. Of course, this is a valid point. Many people with serious weight problems suffer from low self-esteem and other emotional distresses, which often complicate their efforts to lose weight in the first place.
Still, it is plain to see that the continuing obesity crisis is not a sustainable situation. Throwing our hands up and walking away in resignation is not an option. Too much is at stake here. There is no way that we will ever be able to provide affordable health care for everyone if the health of vast parts of the population continues to deteriorate at this pace. We won’t be able to dig ourselves out of this crisis, no matter what health care model we try to follow.
The necessary lifestyle changes will not happen without awareness and recognition of the consequences we will face if we continue on the current path. Unfortunately, the immediate forecast is not hopeful.
Last year, I had the opportunity to visit Bhutan, a remote and isolated country in the eastern region of the Himalayas. There are few places left in the world where the cultural heritage is still as intact as here, although this is changing fast due to rapid modernization and development. The government, a monarchy, is keenly aware of the potential problems this poses to the nation and its people. For a number of years now, it has been making sincere efforts to strike a workable balance between greater openness toward the modern age and the protection of the kingdom’s unique identity.
For this purpose, a national program has been established to allow only socioeconomic developments that serve Bhutan’s particular social and cultural needs. It’s named “Gross National Happiness” (GNH), a term obviously chosen in contrast to the Gross National Product (GDP), which is a purely economic indicator.
The GNH considers four major factors as essential for a well-functioning society: Sustainable development, the preservation and promotion of cultural values, conservation of the environment and natural resources and the maintenance of good governance. All of these policies are applicable at the communal as well as at the individual level. Personal happiness and wellbeing is to be measured in terms of physical-, mental- and spiritual health. This includes issues of health care, education, standard of living, practice of religion and community vitality.
The idea of measuring a highly subjective concept like personal happiness on a national scale is not as unique as one might think. In Great Britain, a similar happiness survey is in the works and the French government is also looking into the emotional state of its average citizen. Canada has already undertaken a number of Bhutan-style GNH surveys in the past.
The latest attempt to take the public’s pulse in terms of happiness has just been completed in the United States, albeit only in one town, Somerville in Massachusetts.
For the first time in its history, the city hall issued a local census form that included a somewhat blunt question: “How happy do you feel right now?” This new addition to the traditional surveys about income, education, race, etc. was aimed at people’s satisfaction with life in general. Reportedly, like the question itself, many of the responses were a bit surprising, ranging from overly vague to excessively detailed. Unlike the Bhutanese, the folks of Somerville may need a little more time to get used to this level of inquisitiveness by their government.
Still, the operation helped to shed some extra light on the subject of happiness. Most respondents addressed matters important to their individual well-being, but ideas to improve the quality of public life were also placed high on the list.
Which brings me to one of the most influential experts on the subject of happiness and a favorite author of mine, the psychologist Abraham H. Maslow. In his signature work, Maslow developed a theory he called “Hierarchy of Needs,” which he depicted in form of a pyramid. The most basic requirements for well-being are placed at the bottom, while the lesser essential ones go to the top. The lowest levels include physiological needs, like air, water, food, shelter, etc. After that come personal safety and financial security. Further up are relationships with family and friends. Only when these basic needs are fulfilled, more complex needs like self-esteem, status, creativity and a sense of purpose come into play. The highest achievable level is called “self-actualization,” an almost mystical state of harmony and understanding.
Of course, not everyone has the same needs or requires their fulfillment in the same order. Still, there are some universal patterns. Good health, loving companionship, basic material security and so forth are essential ingredients in everybody’s life. If these are amiss, we can’t function well. Fear and stress may overcome us. We may suffer from boredom or lack of inspiration. Or we find ourselves left out and isolated with no one to turn to for help. We may not be able to clearly define what constitutes happiness, but we know for certain that persistent unhappiness will eventually become a health issue.
While it is impossible to make plans or build structures that promote happiness on a personal level for everyone, there are things we can put in place to improve the quality of life for all our citizens. Access to health care, affordable education, reasonable job security, environmental protection – these are issues we all are constantly dealing with. Of course, there is considerable disagreement how to go about each and every one of these, but there is no dispute that certain basic needs must be met for us to function as a society. Surely you don’t have to go to Bhutan to understand that.
According to the Centers for Disease Control and Prevention (CDC), more Americans suffer from Asthma than ever before. Almost 10 percent of the general population is now affected. Based on a recently published study, the CDC found that the disease has spread almost equally among all demographic groups, although young children in low-income areas showed the largest increase. Almost a fifth of African-American children has been diagnosed, compared to just over 10 percent a decade ago.
The researchers involved in the study have stopped short of giving specific reasons for the sharp increase. They also did not comment on recent budgetary proposals by Congress to reduce funding for the National Asthma Control Program.
Asthma – the Greek word for “panting” – is a chronic inflammatory disease of the airways. Common symptoms include wheezing, coughing, chest tightness and shortness of breath. Besides environmental causes, there can also be genetic factors involved. If left untreated, chronic inflammation of the lungs can result in irreversible damage.
Several potential causes for asthma have long been identified. They include exposure to allergens in nature as well as man-made pollutants, like traffic exhaust fumes, household chemicals, pesticides, cigarette smoke (including second-hand smoking) and the likes.
People, especially children, living in poor housing conditions are at higher risk of developing asthma. Common indoor pollutants are dust, house mites, animal dander (dog- and cat hair), cockroaches and molds. Toiletries like perfumes and hair sprays can have detrimental effects as well.
Equally widespread is what is called “occupational asthma,” which stems from long-term exposure to hazardous work environments. The American Thoracic Society estimates that 15 to 23 percent of asthma cases occurring during adulthood are work-related. The highest percentage of these is reportedly associated with manufacturing jobs.
There is also the possibility of “exercise-induced asthma,” which is not uncommon among top athletes. Apparently, there is a high incidence rate of the disease among cyclists and long-distance runners.
Obesity and asthma seem to show strong correlations. Several factors may play a role, including decreased respiratory function due to build up of fat tissue and elevated risk of inflammation in connection with poor eating habits.
Chronic stress is suspected to have a potential trigger effect for asthma as well. While undergoing stressful situations per se may not have a direct causal effect, it is clear that long-term exposure to stress can compromise the immune system and thereby aggravate airway inflammation among other responses.
Asthma resembles in many ways other airway diseases, like bronchitis, emphysema and other respiratory infections. People who have asthma also suffer from allergies, however, not everyone who is affected by allergies has asthma. For this reason it can be difficult to diagnose asthma.
Most asthma cases can be controlled if managed effectively. Unfortunately, to this point in time, there is not much more available than a one-fits-all approach to treatment since asthma is diagnosed only in terms of severity of symptoms without consideration for different variations of the disease. The severest symptoms are called “acute asthma exacerbation,” also know as “asthma attack,” which typically includes extreme shortness of breath, heavy wheezing and chest tightness.
The most effective form of treatment is the prevention of exacerbation by maintaining normal pulmonary function as well as a healthy weight range, optimal nutrition, regular exercise and lots of fresh air.
Asthma and food allergies
In addition to adverse reactions to allergens and pollutants, there can be allergies to certain foods involved. Sometimes, asthma attacks can be triggered by foods and ingredients added in the manufacturing process. For some patients certain diet restrictions may be required to avoid these reactions. Food hypersensitivity is an overreaction of the immune system in response to specific foods, like peanuts or strawberries, to name two of the most common. Other food items known for their propensity to trigger asthma attacks are milk, eggs, tree nuts, soy, wheat, shellfish, tartrazine and sulfites. In extreme cases of multiple food allergies steps must be taken to avoid nutritional deficiencies.
Food allergies can be treated non-medically by eating smaller meals more frequently throughout the day; eliminating spicy, fatty, acidic and caffeine containing foods and beverages; avoiding food intake within 3 hours of bedtime; maintaining a healthy weight range.
As with any respiratory infection, asthma potentially compromises the body’s ability to receive enough nutrients. Because the symptoms can be quite debilitating, decrease of appetite is not uncommon, which means that fewer calories and important nutrients are being provided when they are most needed. A high-quality diet plan can help avoid serious deficiencies.
Most people eat whatever you put in front of them. This at least is the quintessence of a best-selling book, titled “Mindless Eating – Why We Eat More Than We Think” (Bantam Books, 2006), by Brian Wansink. The author is not a medical doctor, dietitian, psychologist or a chef for that matter. Wansink is a professor for marketing in the Applied Economics and Management Department at Cornell University. His subject of interest is not what we should eat or stay away from. He wants to know why we eat what we eat and why we eat so much of it.
“Everyone – every single one of us – eats how much we eat largely because of what’s around us,” he says. “We overeat not because of hunger but because of family and friends, packages and plates, names and numbers, labels and lights, colors and candles, shapes and smells, distractions and distances, cupboards and containers. The list is almost as endless and it’s invisible.”
In Wansink’s opinion, dietitians and other health practitioners focus too much on what they know best, which is the ins and outs of the nutritional properties of our foods. Their concerns are focused on calories, fat content, cholesterol levels and so forth. By contrast, Wansink is more interested in the psychological aspects of food consumption, more like marketing experts in the food industry approach the subject. Instead of questioning the nutritional quality of the food people eat every day, we should rather ask what makes these foods so attractive to consumers that they just can’t get enough of them.
This is why traditional diets and weight loss programs often don’t work in the long run. They don’t understand or don’t take sufficiently into account what motivates people to reach for food in the first place.
In a series of experiments, Wansink and a team of researchers tried to demonstrate how our eating habits are heavily influenced by outside cues that have little or nothing to do with food. For instance, there is significant evidence that eating is strongly connected to emotional states, like stress, anxiety, boredom, depression and so on. Actual hunger or the seductive power of smells and tastes play in fact a much smaller role when it comes to food choices. In one particular experiment, participants were given five days old stale popcorn that was definitely not very palatable. Still, most of them ate considerable amounts of the tasteless popcorn when it came in supersized buckets instead of small or medium-sized bags. Serving sizes have apparently an enormous influence on our food intake – even to the point where quantity trumps quality. A tasty but smaller meal seems to be less valuable to many people than an overflowing plate at an “all-you-can-eat” joint. More bang for the buck.
The desire to take advantage of a good deal is not the only motivator, as the Wansink tests found out. Presentation, ambiance, lighting, background music, social interactions, service, prestige and other perceived values all play a role in our eating behavior. Not all of these influences affect us consciously, of course. They surround us, but we don’t necessarily realize the power they have over us.
When asked about the reasons for their choices, almost all test participants were able to give plausible answers. The researchers observed that especially intelligent and educated people had the capacity to rationalize their behavior, even when their actions bordered on the absurd. “I just wanted to celebrate tonight,” or, “It was a Friday night,” or “I deserve a little fun once in a while.” Some of these were statements made by students after a night of binge drinking and eating to the point of physical sickness and exhaustion. Wansink calls this the “intelligence trap,” by which he means our ability to rationalize even some of our most unreasonable behavior. Apparently, education does not always make us smarter, certainly not when it comes to basic issues like eating and drinking.
The logical question is, what would then work for us to break bad habits and adopt better ones? Wansink suggests that we probably will have to trick ourselves into better behavior, or as he calls it, into “mindful eating.” “This whole idea that you can prevent mindless eating with the power of your mind is a tremendous fallacy,” he said in a recent interview. “When I talk about mindless eating, some people erroneously say, then the secret to solving mindless eating is to eat mindfully.”
Wansink, however, does not think that’s a workable proposition. “For most Americans, our lives are way too chaotic to accommodate that.” Indeed, living every day in a state of constant mindfulness seems not only exhausting but also not very desirable. If anything, it would add another layer of stress to our already overburdened lifestyles.
So what else could we normal mortals do? Wansink proposes to take small steps that don’t require a lot of effort and attention. For instance, you can serve all your meals on smaller plates, which would automatically lead to portion size reduction. If you buy food items in bulk for economical reasons, split them up in smaller containers and store them in different places in your fridge and pantry. If you feel the need for a mid-morning or afternoon snack, go ahead, but don’t keep snack food or candy in your sight or in your desk drawer where you can easily reach for more. Tests have shown that most people eat less when the munchies are not within immediate reach. The same works the other way around as well: Keep bowls of appetizing fruits on display in your home or office, instead of sweets and pastries, and your snacking habits will do you some good for a change.
The bottom line is that most of us can’t simply count on willpower to control our cravings and urges. Maintaining discipline and self-control may be a deserving goal, but without some reprieve once in a while it can lead to paranoid and dysfunctional behavior. Becoming over-scrupulous with food choices can very well result in additional eating disorders.
People need to understand their weaknesses and learn to avoid the pitfalls. Like recovering alcoholics or drug addicts, some individuals living with eating disorders may never be able to let their guard down completely. Weight management can be a battle that lasts a lifetime. Still, we all have the ability to learn from our mistakes and correct them by better recognizing the causes behind our actions.
This article is based on a recent interview with Brian Wansink, PhD, published in Nutrition Action (5/2011), the “Health Letter“ of the Center for Science in the Public Interest.
That high sugar consumption contributes to weight gain has widely become accepted as a fact, but the possibility that eating the sweet stuff could make us actually sick is another matter. Questions about potentially devastating health effects of sugar are the subject of a recent article by Gary Taubes in The New York Times Magazine (4/17/2011).
While Taube’s investigation stops short of passing final judgment, he does in fact make a persuasive argument that sugar may be a dangerous toxin or poison on par with tobacco and alcohol – “something that’s killing us.”
The latter are not Taube’s words but those of Robert Lustig, a specialist on pediatric hormone disorders and a renowned expert in childhood obesity at the School of Medicine of the University of California in San Francisco. Lustig has long been convinced that sugar is not only bad for our health because it offers too many empty calories without much nutritional value. “It’s not about the calories,” he insists. “It’s a poison.”
By sugar, he does not single out the white granulated variety that you pour in your tea or coffee or on top of your breakfast cereal, which is known as sucrose. He also (and especially) includes high-fructose corn syrup (HFCS), which is almost omnipresent in processed foods and soda drinks. In fact, over the last 30 years, HFCS has become the sweetener of choice for manufacturers of processed foods and sodas, primarily because it’s cheaper than refined sugar. Only now the tide seems to be turning back in favor of old-fashioned sugar, as HFCS is becoming increasingly unpopular with health-conscious consumers.
Lustig agrees with the assessment of the majority of nutrition experts that the high sugar content in the typical American diet plays a major role in the current obesity- and diabetes epidemic, but he goes much further than many of his colleagues. He believes that sugar is also a likely dietary cause of several other chronic ailments and diseases of Western lifestyles – like heart disease, hypertension and some types of cancer. Consequently, he demands that sugar should be classified as a toxic substance.
From the start, Taubes does not hide his belief that the professor has a point: “ Lustig, who has genuine expertise, has accumulated and synthesized a mass of evidence… compelling enough to convict sugar,” he writes.
Lustig’s general (some say “loose”) use of the term “sugar” has made him vulnerable to his critics. By “sugar,” he says, he means both sucrose (e.g. beet- and cane sugar) as well as HFCS. Sucrose consists of carbohydrate glucose and carbohydrate fructose as a 50-50 mixture. By contrast, HFCS contains 55 percent fructose and 45 percent glucose. Since fructose tastes much sweeter than glucose, the desired sweetening effect is higher in HFCS than in refined sugar. Still, both forms of sugar end up as a glucose-fructose combination in our bodies, or as Taubes puts it: “The question, then, isn’t whether high-fructose corn syrup is worse than sugar; it’s what do they do to us.”
That is also Lustig’s argument. It’s not about what kind of sugar we should use and what kind we should avoid. It’s not even about the empty calories many of our food products are overloaded with. Rather, it is about the “unique characteristics” of sugar and the ways our bodies metabolize the fructose in it “that may make it singularly harmful, at least if consumed in sufficient quantities.”
And this is where Lustig makes his case most compelling: The fructose component of both sugar and HFCS is primarily metabolized by the liver, while glucose is metabolized by every cell in the body. The more fructose you consume, the harder the liver has to work. And if you take high amounts of fructose in liquid form, e.g. through sodas and fruit juices, the liver will have to struggle even more to handle the onslaught. Eventually, the poor organ won’t be able to keep up metabolizing and will eventually convert much of the fructose to fat. This also can induce a condition known as insulin resistance, which is well known as a causal factor of type 2 diabetes.
A growing number of physicians and medical authorities now agree that high sugar consumption is harmful in a number of ways. For instance, “metabolic syndrome,” which includes significant risk factors for heart disease and diabetes, is dramatically on the rise. The Centers for Disease Control and Prevention (CDC) estimates that currently 75 million Americans suffer from metabolic syndrome.
Insulin resistance and metabolic syndrome in connection with high fructose intake have been studied in clinical laboratories for some time. When test animals are given lots of sugar, their livers eventually turn “fatty.” As one scientist involved in such studies put it: “If you want to cause insulin resistance in laboratory rats, feeding them diets that are mostly fructose is an easy way to do it.”
Chronically elevated insulin often leads to unhealthy increases in cholesterol as well. Higher triglyceride levels can lower HDL (“good”) cholesterol, further worsening insulin resistance and also the risk of heart disease.
Taubes waits almost until the end of his article to make his own, perhaps most devastating argument against sugar. “What are the chances,” he asks, “that sugar is actually worse than Lustig says it is?”
One of the diseases that routinely coincide with obesity, diabetes and metabolic syndrome is – cancer. The World Health Organization (WHO) through its International Agency for Research on Cancer concluded after a large population study in 2004 that there are clearly identifiable connections between these various diseases. “You are more likely to get cancer if you are obese or diabetic than if you’re not, and you are more likely to get cancer if you have metabolic syndrome than if you don’t.”
Does this mean that a large percentage of cancers may be caused by our dietary and lifestyle choices? The World Cancer Research Fund and the American Institute for Cancer Research seem to back up such thinking. But how so?
Taubes cites clinical research that has connected insulin resistance to the growth of tumors. “Some cancers develop mutations that serve the purpose of increasing the influence of insulin on the cell; others take advantage of the elevated insulin levels that are common to metabolic syndrome, obesity and type 2 diabetes. Some do both.” Researchers believe that many precancerous cells would not mutate into malignant ones “if they weren’t being driven by insulin to take up more and more blood sugar and metabolize it.”
In other words, while we still may not know enough about the dietary causes of cancers, there are strong indications that insulin resistance caused by high sugar intake plays a role in the formation of at least some types of cancer – and that should be enough to set off the alarm bells.
Taubes himself is reluctant to do just that, and so the article ends not with a call to arms but rather with a shrug. “Officially,” he writes, “I’m not supposed to worry because the evidence isn’t conclusive, but I do.” – Me too…
To read the article, “Is Sugar Toxic?” by Gary Taubes, go to www.nytimes.com
For the longest time, Amy’s mother didn’t think there was anything wrong with her daughter needing to go to the bathroom every time right after meals. Her youngest had trouble with a “nervous stomach,” as she called it, for as long as she could remember. Eventually, though, she became concerned with her child’s weight. At the age of 11, Amy was five feet tall but weighed less than 60 pounds.
“All the popular kids in her class are super thin,” she told me when we first met for a consultation at my practice. “It’s the look they see and adore on TV and the Internet.”
Dieting for looks is not unusual among young girls. The message that “you can’t be too thin” is conveyed to all of us by the media. But because children are far more impressionable than adults, they tend to take these beliefs much more to heart and act accordingly. Peer pressure, the desire to live up to certain fashion standards as well as body changes during the early stages of puberty are all well-known factors that can contribute to the development of eating disorders at a young age.
Of course, weight-consciousness does not automatically result in eating disorders. The issue of dieting during childhood has only come to the forefront with the ever-growing childhood obesity epidemic. Still, clinical studies have found that children who diet for weight loss are much more likely to develop dysfunctional eating habits later in life.
What are eating disorders?
Eating disorders are foremost psychological disturbances. People who suffer from eating disorders have a dysfunctional relationship to food. Fear of becoming overweight – and therefore unattractive – is only one of many possible causes, although a common one. This state of mind is clinically called “anorexia nervosa” (AN), which is derived from the Greek words an, meaning “without,” and orexis, meaning appetite. Taken literally, however, the term is somewhat misleading. Anorexics don’t starve themselves because of lack of appetite. Rather, they are afraid of what eating even small amounts of food can do to their body image. Especially girls and young women who work (or aspire to work) as photo models in the fashion industry or have athletic ambitions are at risk of developing anorexia.
Another frequently occurring form of eating disorder is called “bulimia nervosa” (BN), which can include regular bouts of overeating or binge eating followed by self-induced vomiting or use of laxative to prevent weight gain. Like anorexics, bulimics are deeply concerned about their body image, but because their eating patterns are inconsistent, they resort to extreme measures to undo the perceived damage.
On the other end of the spectrum, there is a behavior called “binge eating disorder” (BED), which results in compulsive overeating without subsequent countermeasures to avoid weight gain. Those suffering from BED are likely to face weight problems eventually.
All eating disorders carry great health risks, especially when they start early in life. Potentially serious harm is not only caused to the physical- but also the mental health and well-being of those who engage in this kind of dysfunctional behavior.
How does one recognize and treat eating disorders?
Regrettably, eating disorders among children are not yet sufficiently understood both by science and the public. Parents are often not equipped to deal appropriately with the phenomenon. Sometimes, it can be hard to even recognize the symptoms of unhealthy behavior when kids go through different phases of growing up.
But if there are any indications that something is amiss, parents should look for a number of potential warning signs, such as rapid changes in eating patterns, self-imposed dieting, skipping meals or refusing to eat in the presence of other family members. Parents who find their kids taking diet pills or laxatives on their own and without supervision should definitely be alarmed. Other possible indicators are changes in physical appearance, like swelling of the cheeks or jaw or stained teeth and bad breath from self-induced vomiting.
When parents become aware of this kind of behavior, they must take action at once and get professional help for their kids if necessary. Effective treatment of eating disorders may require consultations with several health care specialists besides your family doctor, possibly a pediatrician, psychiatrist and nutrition therapist.
Parents may have to participate in the therapeutic process as well. Eating disorders do normally not develop in a vacuum. Older siblings, friends, classmates, even the parents themselves can contribute to a child’s disturbed relationship to food.
There are a number of proactive measures concerned parents can take. For starters, it is important to maintain a healthy “food culture” at home. Children should learn from early on to appreciate the value of good nutrition. Food-oriented family activities, like grocery shopping and farmers market visits, growing a vegetable garden or preparing meals together can help promote healthy eating habits. Food should never be used as means of reward or punishment.
It is up to the adults to be good role models. That includes open discussions about issues of physical beauty and self-esteem. If parents deal with negative body images themselves and convey these by, let’s say, obsessive dieting or fitness training, they are likely to pass their sentiments on to their kids as well. As it is often the case, leading by good example may be the best approach to get everybody back on track.
If you enjoyed this article, you may also be interested in reading “Exercise at a Young Age Has Many Benefits Besides Physical Fitness” and “Helping Your Child With Weight Problems.”