Chews Wise

Doctors Rx at AMA: Eat Local and Organic

A couple of weeks ago, the New Yorker had a fascinating article on McAllen, Texas, a  county that ranks among the highest in the nation in health-care costs. Funny thing is, the outcomes of the patients in the system weren't any better than places that spent far less. The moral of the story, by physician and writer Atul Gawande, was that you must control the culture of spending (and earning) to contain out-of-control health care costs.

What he spent less time on was the make-up of the county, which ranks high in alcohol consumption, diabetes and heart disease. The per capita income, he noted, was $12,000 a year and the Tex-Mex diet contributed to a 38% obesity rate (the national average is 34%). While acknowledging these social causes of illness, Gawande didn't take the next step and consider diet as a cost-efficient way to rein in health costs. Obviously, costs have to be contained in the system, especially one that rewards doctors for every test, procedure and visit. But why not include or integrate factors outside the health-care system that breed disease in the first place? Why not change the playing field so there are, in effect, fewer patients for doctors to over treat?

If Gawande didn't consider this argument, I was surprised that the American Medical Association did this week. In a fairly remarkable development, the AMA voted at its convention to support "practices and policies within health care systems that promote and model a healthy and ecologically sustainable food system."

"Preventing disease is paramount in the provision of health care. Hospitals, physicians and nurses are ideal leaders and advocates for creating food environments that promote health. This policy is an important contribution to a prevention-based health-care delivery system," said Jamie Harvie, director of the Health Care Without Harm Sustainable Food Work Group.

This statement wasn't just your usual "eat your fruits and vegetables, cut down on fatty food and exercise" type of recommendation. It was a blanket endorsement of organic and local foods, recognizing that the way food is produced effects health, the environment, even the conditions of workers. The resolution, in turn, was based on a report by its Council on Science and Public Health, which presents an informed view of the current nutritionally deficient food system. The report (pdf) states:

The current US food system is highly industrialized, focusing on the production of animal products and federally subsidized commodity crops, such as corn and soybeans. This has resulted in a highly processed, calorie-dense food supply, instead of one rich in a variety of fruits vegetables, and whole grains ... The poor quality diets supported by this system contributes to four of the six leading causes of death in the United States: heart disease, stroke, diabetes and some cancers.

The report then describes the way industrialized food production has actually threatened health. "These methods have contributed to the development of antibiotic resistance; air and water pollution; contamination of food and water with animal waste, pesticides, hormones and other toxins; increased dependence on nonrenewable fossil fuels (including fertilizers)," the doctors' report says.

It also adds the clincher that I wish Gawande had considered: "Clinical approaches to addressing diet-related health concerns are costly and not sustainable."

The resolution passed this week states:

• That our AMA support practices and policies in medical schools, hospitals, and other health care facilities that support and model a healthy and ecologically sustainable food system, which provides food and beverages of naturally high nutritional quality.
• That our AMA encourage the development of a healthier food system through the US Farm Bill and other federal legislation.
• That our AMA consider working with other health care and public health organizations to educate the health care community and the public about the importance of healthy and ecologically sustainable food systems.

Industrial food producers are already in a tizzy over the documentary Food Inc., but I bet they didn't expect to be facing the nation's doctors.

I would note a last bit of irony to this resolution. For years -- back in the 1950s and 1960s -- the AMA did battle with one of the earliest proponents of organic farming, J.I. Rodale. They investigated him, and brought complaints to the Federal Trade Commission (over Rodale's over-zealous promotion of vitamins). It took a few more years -- OK decades -- for the AMA to change its position and at least endorse one point that Rodale got right: That the way food is produced effects health. He realized this in the 1940s. The AMA acknowledges it today.
- Samuel Fromartz

 

Kenya Diet: Leave U.S., Stop Stressing, Eat Veggies, Lose 100 pounds

The WaPo had an interesting item yesterday about an African immigrant leaving the U.S. and going home because of the recession. But the thing that caught my eye was that James Odhiambo weighed 300 pounds when he was living in Dallas, and then lost 100 pounds after he went home. His wife went down four dress sizes. And it didn't seem like they were dieting. They just began living in a different country.

He wanted a healthier lifestyle for his family, less anxiety, fewer 14-hour days. So he recently traded his deluxe apartment, the pickup truck, the dishwasher and $4.99 McDonald's combos for life in a place he considers relatively better: sub-Saharan Africa.

"Right now I'm no stress, no anxiety," said Odhiambo, 34, relaxing in his family home in this western Kenyan city along the shores of Lake Victoria. "Think of it this way: When I was in the U.S., I was close to 300 pounds. Now, I'm like 200. The biggest thing for me was quality of life."

Why? No more fast food. His wife started buying veggies.

Instead of shopping for groceries at Wal-Mart, Odhiambo's wife heads to the local market and bargains for fresh tomatoes, onions and the Kenyan equivalent of collard greens, sukuma wiki. She has dropped four dress sizes.

Which is curious, considering this recent study highlighted by Marion Nestle that wealthier people eat better. That may be true, but what people buy is also influenced by availability, culture and geography. The Kenya couple, with their two kids, now live on about $5 a day.

But, okay, maybe you don't want to move to Kenya. Well Jane Black of WaPo reports on another encouraging development: doubling the value of food coupons at farmers' markets under a program developed by Wholesome Wave Foundation.

"The idea of doubling your money really resonates," said Daniel Ross, executive director of Nuestras Raices, a grass-roots community development group that helped administer the Holyoke matching program. "We've found in all our research that low-income people know what healthy food is, but because of price, they can't afford it. This helps them get the food they really want for their families."

Quick Bites - Alaska Quits MSC?

(Updated) Alaska Quitting MSC? -  The state of Alaska wants another party to arrange sustainable fish certification for its salmon fisheries with the Marine Stewardship Council, Sustainable Food News reports ($-sub). The state Department of Fish and Game has been the client which arranged for this service -- a rare role for a government body. Now,it is hoping another group, such as a fisheries industry body, takes over the role. Alaska is the largest certified sustainable fishery in US waters, if not the world. Fisheries pay fees to get certified by the MSC, which independently reviews fish populations, catches, management and fishing methods. But the state feels it has a higher standard than even MSC. More on this item over at seafoodnews.com.

You Can Go Home Again - Vancouver celebrated the first return of a sockeye salmon to a lake in 100 years. "Seeing that first fish, it almost made us cry," George Chaffee, a councillor with the Kwikwetlem band, said.

Holy Jalapeno! - Turns out tomatoes weren't the culprit in the recent outbreak of salmonella. Instead the FDA has turned its attentions to jalapeno peppers. Tomato growers predictably were angry. "They will never say that tomatoes were not implicated, because to do so would [imply] they caused hundreds of millions of dollars of damages for nothing," Tom Nassif, president of Western Growers, told the WSJ. The salmonella outbreak sickened 1,200 people across 42 states.

unHappy Meals - The WSJ also has an item on Los Angeles city council member's attempt to ban junk food in an area of the city with high obesity rates. The 32-square-mile chunk of the city is home to some 400 fast-food restaurants, where 30% of adults are obese, compared with about 21% in the rest of the city.

Japanese Women Don't Get Fat

A couple of years ago, Mireille Guiliano, in French Women Don’t Get Fat, explained just how French women manage to enjoy food without gaining weight. Needless to say, it was a runaway bestseller.  Well, French women are not alone. Just take a walk through Tokyo.

I have not seen one obese person in Japan. I have seen very few overweight people. And the Japanese are not jogging down the streets, or pumping iron. They also do not eschew sweets, carbs, ice cream, fried foods, cheese, alcohol or meat. There are also copious amounts of snack foods, most of them sweet and salty, and outrageous versions of western desserts, often piled with gobs of cream-like substances.

But these foods are eaten sparingly. When we sit down to a meal, there are a minimum of two veggie dishes, usually greens. Often these dishes are accompanied by two or three types of pickles - again vegetables. Often soup. Then, of course, rice, served up with nearly every meal. And a bit of protein, though not necessarily meat. More likely grilled fish, or a bit of fresh tofu, served up in bowls, with a bit of ginger, scallions and shoyu. The meat or fish portions are also quite small -  a serving the size of your palm would be on the large side. And that’s pretty much it.

Here's a picture of a quick lunch I got at a department store, as an example, with miso soup, barley rice, sweet fried chicken, a tofu veggie burger with sauce, salad and pickles.

So, am I, at nearly 6 feet, not going hungry? No. I definitely eat more than my Japanese cousins but I’m not going hungry. All I really do miss here are whole grain breads, since the Japanese spin on bread is exceedingly light, airy, and white.

Breakfast in Kyoto

At our hotel in Kyoto, they served up the usual eggs and bacon on the buffet, but also miso soup, hot tofu, three salads, some fish salad, grilled fish (the serving the size of a credit card cut in half), some danish and croissants, and yogurt -- a mishmash of options. OK, fish for breakfast is a bit much, though the salads were fresh and delicious. I looked over to what two Japanese women were eating. A bit of egg, salad, two type of pickled vegetables, miso soup and fruit. That was it.

Made me think of Pollan’s dictum: Eat Food. Not too much. Mostly plants. That’s the diet here. It’s not something you think about. It’s just the way you eat.

- Samuel Fromartz

Is Organic Better?

Well, researchers on a four-year European Community-funded study think so.

Preliminary results of the $26 million study, conducted at Newcastle University in the UK, found that organic fruit and vegetables contained up to 40 percent more antioxidants. These compounds are thought to play a role in warding off cancer and heart disease. Organic milk contained up to 60 to 80 percent more antioxidants than conventionally produced milk in the summer, and 50 to 60 percent higher levels in the winter. Organic milk also was found to contain higher levels of vitamin E.

The primary researcher, professor Carlo Leifert, said the figures were so dramatic that they would the equivalent of eating an extra portion of fruit and vegetables every day.

The study is in line with others at the University of California Davis, which found higher levels of antioxidents in organic tomatoes. Harold McGee explains that organic crops rely on these substances to ward off pests and diseases in the absence of chemical treatments.

In the Newcastle study, the crops and livestock are raised at a research farm. Details on the work, including several videos, can be found at the researchers' web site.

- Samuel Fromartz

Bean There, Done That

When I was working on Organic Inc., I marveled at the passions the prolific soybean fueled, from vegans dishing up tofu, tempe and soy milk; to raw milk proponents who view the bean as little more than a nasty toxin; to agribusiness giants who process it into soy protein isolate and then add it, like corn, to everything; to Asian cuisine, where the most sublime soy foods are found. Rarely has a bean meant so much to so many.

I knew there was more here than meets the digestive tract, so was pleasantly surprised to see a new book on the subject, Beans: A History by Ken Albala. The passions I encountered while researching soybeans were by no means unique. A “social stigma” against most beans, Albala writes, “remains firmly in place from the time of the ancient Greeks up to the 20th century.”

"The matter is not only gas but class," the Times review points out. "Because beans are cheap to raise and offer a protein payoff that is comparable to meat’s, poor people have traditionally eaten them. The plants that bear beans don’t appeal to the aspirational bourgeoisie. Beans are, in the developed world, markers of a hand-to-mouth lifestyle best left behind. 'In any culture where a proportion of people can obtain protein from animal sources,' Albala observes, 'beans will be reviled as food fit only for peasants.'”

A pity, since the lowly legumes are high in protein and fiber and low in fat. But as history shows, as incomes rise, people want meat.

- Samuel Fromartz

Image: soybeans, Wikipedia

Embargo, Weight Loss and the Cuban Sandwich

The Slow Cook has a provocative post on what the collapse of the Soviet Union did to Cuba: it improved the diet, according to a study in the American Journal of Epidemiology.

The Cuban economy had become highly dependent on the financial support as well as fuel, fertilizers and pesticides provided by the Soviet regime. When that ended in 1989, Cubans had to reinvent the way they feed themselves. Nationwide, Cubans consumed one-third fewer calories and most were forced to walk or bike to work. The average Cuban lost 20 pounds, and over a period of years the country reverted to an organic system of agriculture and planted every available green space for food crops.

During the decade-long period of adjustment, the prevalence of obesity in Cuban declined from 14 percent to 7 percent. Deaths from diabetes dropped 51 percent. Deaths from heart disease declined 35 percent. Overall, Cuba's death rate was reduced by 18 percent.

Sounds like the post-Peak Oil diet... One major casualty - the beloved Cubano sandwich.

- Samuel Fromartz

With My Re-Entry, A Fat Post

By Samuel Fromartz

Whew! What a nice break.

I did the unthinkable and went on vacation for 2 weeks without a laptop. I checked email a couple of times  at a public library, but truth be told, I didn’t miss it. Not a bit. Without pending deadlines, I had very few emails that demanded attention. And as for all those pesky email lists and alerts, I just scanned and tossed them once I got back.

What I realized was something I already knew but found hard to accept - that email and the web are an incredible time suck, with a plethora of minutia sapping your attention and brain power. It’s the intellectual equivalent of eating too many corn chips in front of the tube. You wonder where all the time went and what you got out of it. (Perhaps I’d even include this post in that -- actually, I will. Take it or leave it).

But now that I am back in this unnatural position, in front of a screen, consuming my metaphorical brain corn chips, a couple of items have grabbed my attention. Like fat. It’s been on my mind this summer. In the summer lull, I happened to catch Shaq’s Big Challenge on ABC in which the giant basketball star corralled a group of morbidly obese kids from the Sunshine state for months, trying to get them to lose weight and get in shape.

The show itself had its moments, leaving me teary-eyed and bleary-eyed. The challenge these kids faced was truly heartbreaking at times, but it was also difficult to dramatize what was a months-long slog of weight loss, exercise and diet change. Shaq helped. He’s actually entertaining. The kids were also heroic. But it’s a crime that they got to such an extreme stage before there was any sort of intervention. Indeed, the public school, with its lack of a physical ed requirement and its fast-food lunches, was an enabler of the epidemic. The parents didn’t help either. In fact, they were part of the problem, which shows how love, spoiling, and nutritional ignorance are a recipe for disaster.

The key, though, was you couldn’t finger anyone for the blame: The clueless school, trying to offer food kids would actually eat (for $1 a meal); the parents, who obviously had their own food issues; the kids, who bellyed up to the trough of candy, soda, burgers, pizza and fries at any opportunity and the culture at large, which provides this smorgasbord and offers absolutely zilch in the way of accessible healthy food alternatives or education. Yes, the critics will claim, these kids and their parents were just exercising free choice to eat what the hell they wanted. But frankly, that’s like saying they were choosing to stick a very slow acting gun in their mouths and pulling the trigger. The bullets were edible and called food. We know the result - an epidemic of obesity that is only getting worse.

As everyone knows, the only way to lose weight is to eat less and move more. Both are difficult. Even with a personal trainer in the mold of Attila the Hun, Shaq’s personal counseling sessions, an obesity doctor, a nutritionist, a receptive school principal and a chef re-engineering the school lunches, it was difficult. And people without resources are expected to do this on their own? No wonder dieting is a $35 billion business which people perennially fail at. (It’s kind of an ideal business model for it ensures repeat customers). All of these kids, however, lost weight, some dramatically. But the big winners were clearly in the minority, which shows you how difficult it is -- even with the most extreme sort of intervention -- to succeed.

There have been several TV shows along these lines (ABC seems to be flogging the genre with its current Fat March in which several obese adults walk from Boston to D.C. to lose weight). Why the interest? There’s a growing audience for these shows -- literally. We are now told that we are getting fatter, according to a widely reported study this week. Not a single state has shown a drop in obesity rates in the past year. People in 31 states have gotten fatter. So there's a entertainment genre for couch potatoes worried about  being couch potatoes. (Now if TVs were powered by treadmills rather than enjoyed with potato chips we might actually get somewhere...)

Forget for a moment the impact on heart disease, diabetes, and other illnesses. (Obesity-related hospital costs for children ages 6 to 17 more than tripled from 1979 to 1999, rising from $35 million to $127 million, according to the report.) Just consider the quality of life issue. The overweight kids in Shaq’s show were unhappy, depressed, with extremely low self-esteem. Their parents, schools and society had failed them. Everyone recognized the train wreck but no one knew what to do. Even the Superstar was flummoxed.

But at least he (even at the behest of a prime time ABC show) tried. The Washington Post mentioned a couple of other examples in its report on the latest statistics, like a "Shape Up" program in Somerville, Mass., that added school crossing guards to previously unattended corners and alerted parents to the change. That boosted by 5 percent the number of kids who walked to school.

But here’s the kicker quote to the Post story, which we should all keep in mind. “Interventions are important to put in place," said Jeffrey Koplan, who directs the Global Health Institute at Emory University in Atlanta. "But none of this is going to turn around [the obesity epidemic] in a year or two, or three and maybe not even in five. We have got to be in this for the long haul."

Kind of sounds like, well, exercising.

Consumers Hate HFCS, Survey Says

The Hartman Group market research firm announced a shift among consumers who are veering away from processed foods, sugar and specifically high fructose corn syrup, which it calls "the whipping boy of their frustration."

...When consumers do venture into the (increasingly) quiet depths of the center store for packaged or processed foods, they are choosing to focus their attention on those foods with the fewest ingredients, additives or preservatives. Likewise, their chief concern when reading package labels has shifted from nutrients and health claims to sugar content, where they demonstrate two complementary goals (a) reducing overall sugar intake and (b) avoiding anything with HFCS.

Choosing to re-formulate your cookie line with whole grain options is absolutely meaningless if your product still contains HFCS. Ditto for fortified juices, crackers, soups or any other packaged food category. We can guarantee you that 7UP's recent decision to market itself as "natural" to consumers fell on deaf ears when the ingredient label read "high fructose corn syrup."

In a survey, Hartman reported that 71 percent agreed with the statement, "processed foods are not good for my health." (Thirteen percent disagreed). And 89 percent agreed that "the key to long-term health is through eating more fresh foods." (Six percent disagreed). It also reported that 38 percent were swayed by  the chapter on corn in Michael Pollan's Omnivore's Dilemma. Gotcha! Just kidding on that last one.

Dovetailing with the boom in demand for corn ethanol, dare we suggest that HFCS will find itself in a death spiral? Now lets not get ahead of ourselves...

- Samuel Fromartz

A More Nutritious Organic Tomato?

A recent study comparing organic and conventional tomatoes found that the organic tomatoes have higher levels of flavonoids - an antioxident - but does this mean the tomatoes are "healthier"?

The researcher at the University of California Davis behind the study said the results were intriguing but not definitive. "There's a lot of confusion," said Alyson Mitchell, a professor of food chemistry and toxicology at the University of California, Davis, in this Sacramento Bee article. "For every study that shows there's a difference, there's another that shows there isn't."

Interestingly, this study took a long-term look at two particular flavonoids - quercetin and kaempferol - and found on average they were 79% and 97% higher, respectively, in organic tomatoes than conventional ones. 

Scientists theorize that "flavonoids are produced as a defense mechanism that can be triggered by nutrient deficiency, such as a lack of nitrogen in the soil," the BBC reports. Organic farms add compost to the soil to build fertility, rather than fast-acting synthetic nitrogen.

A previous study by Mitchell et al in 2003 found that organic berries contain higher levels of phenolics, which include vitamin C and antioxidents. They theorized then that plants developed these compounds in the absence of chemical fertilizers as a way to combat pests, diseases and natural stresses that may be present at higher levels on organic farms.

This new study may also support findings by the University of Texas, which found a long-term decline in certain nutritious elements in conventionally grown fruit and vegetables. The researchers theorized that this too reflected the increasing use of synthetic chemical fertilizers over a half-century - a theory that researchers around the world are pursuing, according to a San Francisco Chronicle report last year.

What's less clear is whether these nutritional differences are significant to human health. They should also not obscure a bigger point: that consuming a healthy amount of fruits and veggies each day is more important than eating too little or none at all.

- Samuel Fromartz