High Intake of Red and Processed Meats Increases Mortality Risk

A recent research supported by the National Institutes of Health, published in the Archives of Internal Medicine has shown that daily intake of red and processed meats (examples: beef and pork) is associated with increased risk for death in older adults, while white meat (examples: chicken, turkey and fish) may have a small protective effect. This is the largest study ever, including more than a half million adults aged 50 to 71, who were followed for 10 years. After adjustment for BMI and smoking, those who had the highest red meat intake had significantly higher risk of dying overall, and of dying from cancer and cardiovascular disease. Same applied to processed meat (examples: sausage, cold cuts or hot dogs). As the authors pointed out in the discussion of the article, meat is a source of several carcinogens (substances that can cause cancer) which are formed during high-temperature cooking of meat. Iron in red meat may increase oxidative damage increasing the formation of N-nitroso compounds. While red meat is a major source of saturated fat (not good), fish is rich in omega-3 fatty acids (good). In 2004, the FDA Announced a Qualified Health Claim supporting that consumption of omega-3 fatty acids reduces the risk of heart disease (coronary artery disease).

Reference article:

Meat intake and mortality: a prospective study of over half a million people. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Arch Intern Med. 2009 Mar 23;169(6):562-71. [PMID: 19307518] (Free Full Article)

Washington Post coverage

Super Size Me - the Swedish Experiment

A research from Linkoping University, Sweden, published in the medical journal "Gut", showed that regular indulging in fast food caused, in less than 4 weeks, a pathologic rise in the level of a liver enzyme, alanine aminotransferase (ALT) in the blood. The fast food experiment subjects aimed for a body weight increase of 5-15% by eating at least two fast food-based meals a day with the goal to double the regular caloric intake in combination with adoption of a sedentary lifestyle for four weeks. They limited their daily exercise to less than 5000 steps for 4 weeks. The authors suggested that an increased flow of monosaccharides to the liver could induce the production of the enzyme in the liver cells. The authors, therefore, recommended that physicians should include not only questions about alcohol intake, but also recent excessive food intake, when evaluating reasons for a new elevation of ALT.

An article in the Guardian gave a little history how the Dr. Fredrik H Nystrom's Swedish experiment design was influenced by Morgan Spurlock's 2004 documentary "Super Size Me", in which Spurlock ate nothing but McDonald's food for a month. You may remember that doctors urged him to abandon his experiment after getting the results of blood tests which show that his liver is so badly damaged it looks as though it is the result of heavy drinking. The results of the Swedish study did document liver enzyme test abnormalities, but those were not as dramatic as Spurlock's.

It is actually not necessarily a matter of whether the food is consumed from McDonald's, a family restaurant, or cooked at home. It is not entirely a matter of whether the food is "fast food" or a fully served multi-course meal in a fancy restaurant. The central issue is all about choices. How many calories, how many of those are proteins, how many are from carbs, and how many are from fat. Wherever you eat, you have to make the best choices regarding the portions and the quality of food. Stay healthy!

Reference:

Fast food based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects. Stergios Kechagias, Åsa Ernersson, Olof Dahlqvist, Peter Lundberg, Torbjörn Lindström, and Fredrik H Nystrom. Gut 2008 Feb 14; [Epub ahead of print] PMID: 18276725

Roundup - What's the Problem?

"... as an adult, we understand even if you ruin an appetite, there's another appetite coming right behind it. There's no danger in running out of appetites. I've got millions of them." --Jerry Seinfeld. The "Heart Attack" episode.


Fact: When food is in short supply, obesity as a public health problem does not exist. As a matter of fact, being obese under those circumstances signifies being wealthy or of higher economic status than the average population. Look at countries where some are living in poverty, and others are more affluent. Which segment of that society has a problem with obesity?

Fact: When food is made available and affordable, in the presence of abundance, the average person will eat more. Much more. Bigger portions. It is surprising to see people who immigrated as adults from less affluent countries continuing to eat the portions and at the times that they were used to, and stay slim. They have already developed the habits and controls and they stay satisfied with the portions and types of food that they used to consume. Their first generation kids, however, who were not raised in such a controlled environment, may become overweight or obese.

Fact: When food is not only made available in abundance 24 hours a day, but is also advertised all day long, people tend to consume even more. And branding does affect their choices.

Fact: Social networks can strongly enhance the spread of obesity.

One conclusion I can draw here is that: External influences tend to have a stronger effect on controlling how much we eat than spontaneous internal influences, in the average person. It takes a conscious effort and proper habit building and modifications to overcome those external influences. That we are victims of an environment and a culture that facilitates (or may even encourage) habits that will make us unhealthy, the only true refuge is our own ability to change habits and behaviors that developed under those circumstances. Although I stress on over-eating as a deadly habit, it is important to notice that serious under-eating as in anorexia nervosa is at least as deadly, if not more.

Remember, weight control is achieved through three elements:

1. Diet (portion acontrol and quality control)

2. Exercise or physical activity

3. Behavioral change towards healthy habits

Everything else (a diet program, a trainer, a pill, a surgical operation) is a tool that helps you control your energy storage (and, consequently, the weight of fat) through one or more of the above mechanisms.

Stay healthy! Happy Holidays!

Excess Fat, Red Meat, Alcohol, and Cancer

"Food, Nutrition and the Prevention of Cancer: a global perspective", a report produced by the World Cancer Research Fund together with the American Institute for Cancer Research , has been the most authoritative source on food, nutrition, and cancer prevention for 10 years. In October 2007, the updated Report was released in Washington, DC. The Report is the result of a five-year process that included examination of the world's literature by a panel of the world's leading scientists, supported by observers from United Nations and other international organisations

The Report found out that carrying excess body fat increases the risk for cancer of the colon, kidney, esophagus, pancreas, and endometrium, as well as breast cancer in post-menopausal women. Their first recommendation is: Be as lean as possible within the normal range of body weight.

The Report also indicated that there is convincing evidence linking consumption of red meats like beef, pork and lamb to colorectal cancer. The recommendation is: Limit intake of red meat and avoid processed meat. People who eat red meat to consume less than 500 g (18 oz) a week, very little if any to be processed. ‘Red meat’ refers to beef, pork, lamb, and goat from domesticated animals including that contained in processed foods. "Processed meat" refers to meat preserved by smoking, curing or salting, oraddition of chemical preservatives, including that contained in processed foods.

Another recommendation: Limit alcoholic drinks. The evidence on cancer justified a recommendation not to drink alcoholic drinks. The report specified that, based solely on the evidence on cancer, even small amounts of alcoholic drinks should be avoided. But, because other evidence shows that modest amounts of alcoholic drinks are likely to reduce the risk of coronary heart disease, the Report recommended limiting rather than avoiding, alcohol consumption.

The strongest evidence on methods of food preservation, processing, and preparation showed that salt and salt-preserved foods are probably a cause of stomach cancer.

The World Cancer Research Fund global network consists of the following charitable organisations: The American Institute for Cancer Research (AICR); World Cancer Research Fund (WCRF UK); Wereld Kanker Onderzoek Fonds (WCRF NL); World Cancer Research Fund Hong Kong (WCRF HK);Fonds Mondial de Recherche contre le Cancer (FMRC FR) and the umbrella association, World Cancer Research Fund International (WCRF International)
The World Cancer Research Fund global network funds research on the relationship of nutrition, physical activity and weight management to cancer risk, interprets the accumulated scientific literature in the field, and educates people about choices they can make to reduce their chances of developing cancer.

Source:
An abbreviated version of the full Report http://www.dietandcancerreport.org/downloads/summary/english.pdf

For a summary of the recommendations:
http://www.wcrf.org/home/recommendations.lasso

The Paradox

Restaurant (A) presents food items that are advertised as being healthy choices, and has even caused some people to lose serious weight. Restaurant (B) was the topic of an entire movie (Supersize Me) which focused on unhealthy eating. Could someone possibly think that eating huge portions at restaurant (A), and picking up choices that were not advertised in their health menu, would still be healthier than eating anything at Restaurant B? Aha, it is the branding thing, again. You remember, we touched on that once before. And here is a very elegant study, actually four studies in one report, that is an eye opener. The article title is “The Biasing Health Halos of Fast-Food Restaurant Health Claims: Lower Calorie Estimates and Higher Side-Dish Consumption Intentions”, that appeared in the October issue of the Journal of Consumer Research.

Study 1: “Calorie Estimations by Subway and McDonald’s Diners” concluded that branding Subway as the healthier choice leads people to believe that Subway meals contain 21.3% fewer calories than same-calorie McDonald’s meals.

Study 2: found that even consumers who are "familiar" with both restaurants estimate that Subway sandwiches contain much less calories than McDonald’s sandwiches containing the “same” number of calories.

Study 3 is the real kicker. Participants were given Subway sandwiches that contained 50% “more” calories than the “unhealthy” Big Mac. In addition to a serious underestimate of the calories in the Subway sandwich, participants who ate the Subway sandwiches ended up ordering higher-calorie drinks and cookies. It is as if those who thought that they ate healthier main-dishes, tended to reward themselves by eating higher calorie side-dishes or drinking more calorie-rich drinks. As you can imagine, they consumed many more calories because of the double mistake (underestimating the main meal calories, and taking richer side orders)

Study 4 actually proved the influence of marketing and branding. When consumers were presented with arguments contradicting the health claims, the “halo effects” mentioned above tended to disappear.

What a fascinating research, and no doubt one that will become a classic. The series of studies were designed to help finding an answer to a question, as stated by the authors: Why is America a land of low-calorie food claims, yet high-calorie food intake?

Source:

Chandon P, Wansink P. The Biasing Health Halos of Fast-Food Restaurant Health Claims: Lower Calorie Estimates and Higher Side-Dish Consumption Intentions. Journal of Consumer Research. Vol. 34 · October 2007

Pierre Chandon, Ph.D. is Associate Professor of marketing at INSEAD, France. Brian Wansink, Ph.D. is the Chair of Marketing and of Nutritional Science in the Applied Economics and Management Department, Cornell University, NY. The data in these studies were collected at the expense of the authors, and the studies were not sponsored by any outside source.

Alcohol after Gastric Bypass

A glass of wine or two. A beer. A little mixed drink. Would that be OK after a gastric bypass? Well, early after the surgery, while the stomach is healing, you really want to avoid the irritant effect of alcohol. You want your pouch to heal well. So, the answer, as far as we know, is "no". But, what about drinking, let's say 6 months, a year, or more after the surgery? A very interesting study confirmed the previous opinion, that is, alcohol levels go higher after gastric bypass than people who had no such surgery. In a study published in the September issue of the journal "Surgery for Obesity and Related Diseases" (SOARD), researchers from Stanford School of Medicine, Stanford, California, concluded that the gastric bypass patients had a greater peak alcohol level and a longer time for the alcohol level to come back down to zero than the individuals who did not have gastric bypass. A particularly interesting finding was that the gastric bypass patients did not feel that alcohol influenced them any more than the no-surgery group. Could that explain why there are reports of post-gastric bypass patients who were cited for driving under the influence (DUI) after a small social alcoholic drink? Maybe. But also remember that there are other complications related to alcohol intake. Liver disease from alcohol is well-known. To develop alcoholic liver disease on top of the known obesity-related liver disease can be particularly dangerous. Alcohol is not good for peptic ulcers, either. Alcohol calories are empty calories, which is not what gastric bypass patients want to ingest. Also alcohol drinking has been linked to vitamin B1 deficiency. Severe vitamin B1 deficiency can lead to serious nerve damage, that is, Wernicke’s encephalopathy. So far, we do not have a perfectly scientific answer to the question: Is it OK to drink, in moderation, if you are not driving, several months or years after gastric bypass? We just do not have the final answer, and prefer to err on the cautious side. Better be safe than sorry.

References:
Klockhoff H, Naslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery.Br J Clin Pharmacol. 2002 Dec;54(6):587-91.

Hagedorn JC, Encarnacion B, Brat GA, Morton JM. Does gastric bypass alter alcohol metabolism? SOARD. 2007 Sept;3(5):543-8. (Note: This is the study quoted above)

Can TV ads influence our kids' taste buds?

This is not exactly a bariatric surgery topic, but, nevertheless, a very interesting one. Does advertising/branding affect children's taste? Well, we know that TV ads do influence kids, who, as a consequence, keep begging and nagging for an advertised product. The pressuring will intensify, once other parents provided your kids friends with the product. What standing do you have when you stick to the hated "No", while the attractive TV ads say "yes", and peers' parents have given the sign of approval?

A very interesting study came from Stanford Prevention Research Center and Stanford University School of Medicine. It was published in the August, 2007, issue of the "Archives of Pediatrics & Adolescent Medicine." (1) Kids aged 3-5 years (yes, that young!) were entered into a food tasting game, where they were given 2 identical food items, one wrapped in a McDonald's typical wrapping, and the other wrapped in a plane white wrapping. Items included not only hamburgers, fries and chicken McNugget's, but also baby carrots, which are not even sold at McDonald's, but were placed on top of a McDonald's french fries bag and on top of a matched plain white bag. McDonald's was chosen because it is a good example of a well-branded and heavily marketed source. Guess what? There was a statistically significant higher taste preference for the foods associated with the branded wrappings. This study is remarkable for its hypothesis, and the results that came out of it.

The authors concluded that branding of foods and beverages influences young children's taste perceptions. The authors also suggested that branding may be a useful strategy for improving young children's eating behaviors.

No wonder, a report of a joint "WHO/FAO Expert Consultation" indicated that: "Heavy marketing of fast-food outlets and energy-dense, micronutrient-poor foods and beverages" is a "probable" cause of excess weight gain and obesity. There has been strong evidence of a relationships between television viewing and obesity in children. Could that be, at least partially, due to the food advertising to which they are exposed? You bet.

(1) Robinson TN, Borzekowski DL, Matheson DM, Kraemer HC. Effects of fast food branding on young children's taste preferences. Arch Pediatr Adolesc Med. 2007 Aug;161(8):792-7. PMID: 17679662