And Speaking of Sugar

Last Friday I flashed back to an entry from February 2012 where I showed how eager the media is to help us blame sugar for the obesity and the diabetes epidemics instead of the taking responsibility for our own choices.

Shortly after deciding to feature those comments I came across this related news report. “The Sugar Association is asking the Food and Drug Administration to require more detailed information about artificial sweeteners on packaging.”

The problem as they see it is that, because sweeteners do not provide nutrition or calories, they are not required to be listed on nutrition facts labels. Instead they are listed under ingredients in smaller print on the side of the package.

The industry argument is, “Consumers deserve to know what is in their food so they can make informed decisions for themselves and their families.” By making these changes, the FDA “will bring the complete transparency in sweetener labeling that we know consumers want, deserve and should expect.” 

They innocently portray themselves as merely calling for transparency by putting the information on food labels as “sweetener,” followed by the name. This is similar to the tactics of the anti-GMO crowd. By forcing producers to list an ingredient on the package, they hope that past misinformation will give shoppers the impression that a safe ingredient, because it is highlighted, is really dangerous. It’s a subtle scare tactic dressed up as transparency that they have pulled off elsewhere*, but it’s not based on science!

I referred to information sources I trust like WebMD and the Mayo Clinic rather than believing folks like Global Healing, Nutralegacy or Doctors Jocker and Axe. Here is what the real doctors at Mayo Clinic have to say. 

Under the heading of possible health benefits, they state, “Artificial sweeteners don't contribute to tooth decay and cavities. Artificial sweeteners may also help with: Weight Loss and Diabetes.”

As far as concerns: “according to the National Cancer Institute and other health agencies, there's no sound scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer or other serious health problems. Numerous studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women.”

So they are safe and sometimes beneficial, but the Sugar Association has for a long time believed, “Consumers Are Confused: Decoding Artificial Sweeteners,” as that headline from ten years ago stated. The article goes on to say, “August marks the five-year anniversary of the Food and Drug Administration’s (FDA) receipt of a petition to help clear up some of the confusion...." So this has been going on for 15 years, and they are taking another run at it. Why? Before you start feeling bad for the Sugar Association, follow the money.

“The U.S. Sugar program is the federal commodity support program that maintains a minimum price for sugar, authorized by the 2002 farm bill....” It was designed to “protect the incomes of the sugar industry-growers of sugarcane and sugar beets, and firms that process each crop into sugar.”

This Reason Magazine article from last year calls it welfare for the rich, saying that it costs Americans as taxpayers and consumers about $4 billion per year. It does this in several ways: 

1. “Subsidies when sugar prices fall below a certain level;
2. Protection from foreign competition (a limit on imports); and
3. A guarantee that prices stay high (the sugar program imposes quotas on how much sugar may be produced in America).”

They are willing to spend a lot of money lobbying to maintain this sweet deal.

This Market Watch story from 2018 confirms the $4 billion cost while pointing out, “On average, U.S. sugar prices are about twice as high as world prices.” 

So, Big Sugar is trying to subtly frighten more people into buying their product at twice the price, based on a false (but popular) notion that the alternatives cause cancer and other problems, while downplaying the truth about the health concerns around sugar itself. They are counting on only a tiny minority of critical thinkers to figure it out.

*Note how successful they have been in giving high fructose corn syrup an undeserved bad rap.

Flashback - Food Label Funny Business – Part 2

[Last Friday’s flashback related to serving size, like the “single serve pizza” or the chicken pot pie that each contains two servings. Trust me, it’s easier to cut a small pizza in half than the soupy-centered pie.

This week I flash back to early last year in another example of how important it is to pay attention and to “Read the Label.”  It’s not about serving size this time but about a surprising comparison, finding out an energy drink is about as unhealthy as a gooey donut. Here are the details I shared in January 2019.]

Every gardening class on the use of pesticides repeats the mantra, “Read the Label.” Even a bottle of Lysol brand cleaner has the statement, “It is a violation of Federal law to use this product in a manner inconsistent with its labeling.” This is true of many other household cleaners, even though most people do not think of them as pesticides (killing bacteria) or otherwise hazardous.

But this little bit of wisdom applies not only to household cleaning and garden chores, but also to what we eat. I found a rather surprising example recently.

Since about 60 years ago Americans began worrying about the amount and types of fat contained in their foods. Eating fat was believed to clog the arteries, and many assumed that the fat in food turned into fat in the body. Government guidelines picked up the message, and most of the funding from about 1970 on went to scientists trying to prove the dangers of fat. 

More recent research shows that we should be more concerned with sugar than with fat. Experts now blame the obesity epidemic on sugar, as cities try to tax or ban sugary soft drinks and experts try to discourage sugar consumption in general. (Sugar moderation is especially important to avoid developing adult-onset diabetes.)

Here is the example that surprised me. Below are pictured two products: a 32-ounce bottle of Gatorade and a container of Boston Cream Donuts from the bakery at my local grocery store. Which would the average person guess contains more sugar? 

 

The Gatorade, as does its rival PowerAde, contains 21 grams of sugar per serving with a little more than 2.5 servings per bottle. That’s 56 grams of sugar as pictured here.

The package of donuts contains 10 grams per serving with 4 servings total. That’s about 28% less sugar in the four donuts pictured compared to a single bottle of sports drink, and the donuts contain less than half the sugar per serving!

How many other surprises are lining the grocery store aisles? We never know unless we read the label.

Failure of many people to do so is how the foodies and other self-proclaimed health experts get away with their absolute rules – never eat prepackaged foods, never eat anything you can’t pronounce, avoid GMOs and gluten. These stances are easy to remember but extreme and often nonsensical. If we just take a minute or two to read the label, we can make good choices without going overboard.

Flashback – Food Label Funny Business

[Over the years I have warned about the importance of reading labels on food packages. Today I will flash back to one of these and next Friday to another. The first emphasizes the importance of paying attention to serving size before taking the package information at face value.

Here, from December 2015 is “Brownie Mix Tricks.”]

This is not about some fancy recipes to make or decorate brownies. It’s  how the information on the box can easily be misleading or deceptive.

On the front of this box of brownie mix the label says, “110 calories.” This looks very reasonable for a dessert.  It is less than two graham crackers, little more than a single chocolate chip cookie.  But let’s look at the fine print.

Trick number one: the serving size is 1/20 of a package. That seems like a very small brownie. When I made them, I cut the finished brownies in an 8x8 pan first in half, then cut each of those slices in half. Then I turned it and cut again in the same way. I had 16 small, square brownies about 2 inches on a side.  Now 1/16 is not 1/20; it’s actually 25 percent larger. So 110 calories becomes almost 140 calories.  But wait!

Trick number two: the front of the package refers us to the nutrition facts label on the side of the package. There it says again 110 calories (with 20 servings per package), but that is for the contents of the package only, the powdery stuff. When you stir in the water, oil and eggs a serving size has 160 calories, which becomes 200 calories for the size brownie I cut, and the calories from fat have increased from 9% to 38%.

So we have a package that honestly and legally reads 110 calories, but the brownie I put in my mouth has 200 calories, nearly double that amount. This seems a little bit tricky, at best. We are expecting one amount and getting nearly twice as much.

The government’s solution to this problem is to make the nutritional labels larger. The behavioral model’s solution to this problem is to promote critical thinking. The government’s solution is the same problem with a bigger font size, but we still have to figure it out for ourselves. At least the behavioral model gives us a chance to be better consumers, as this somewhat trivial case shows. And it also gives us a chance to be more successful in many of life’s more complex challenges (where the government can't solve it for us - we still have to figure it out for ourselves).

P.S.  The brownies were delicious!

Why FDA Approval?

With the desperate search for a coronavirus vaccine and medicines to reduce the seriousness of the disease comes a lot of discussion about FDA approval. One side argues that speed is of the essence and we need to accelerate the process. The other side argues that we can never be sure of a drug’s effectiveness without proper testing. (This will reflect some of the information from last week’s entry, “Understanding Experiments.”) 

The FDA admits, “It takes on average 12 years and over US$350 million to get a new drug from the laboratory onto the pharmacy shelf.” The first step requires about three years of laboratory testing before testing on humans. “Only one in 1000 of the compounds that enter laboratory testing will ever make it to human testing.” 

Next comes a three-phase process. First they must test for safety. Next they need 100 to 300 volunteers to test for basic effectiveness. Finally 1000 to 3000 patients in clinics and hospitals are monitored for effectiveness and to identify adverse reactions. Each phase can easily take years to complete. (And some people wonder why drugs cost so much and why the companies fight and scheme to protect their patents.)

In the interim some drugs that have been previously approved for other diseases are being tested on coronavirus patients. This practice of prescribing drugs off-label is really quite common in the US. WebMD writes, “Off-label prescribing isn't necessarily bad. It can be beneficial, especially when patients have exhausted all other approved options.”

This is why FDA approval is so valuable and why makers of so many pills, salves, ointments and medical devices are so eager to try to take credit for having cleared this hurdle. Otherwise the law requires them to post the familiar disclaimer: “The statements made regarding these products have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.” (But the disclaimer is familiar only to those who bother to read the fine print.)

If companies fail to do this, it’s not the FDA but the Federal Trade Commission (FTC) that comes after them for misrepresentation, as they did in this case – one of many that show up almost weekly.

“Under a settlement with the Federal Trade Commission, the marketers of an electrical nerve stimulation device called Quell have agreed to pay at least $4 million and stop making deceptive claims that the device treats pain throughout the body when placed below the knee and is clinically proven and cleared by the Food and Drug Administration (FDA) to do so.” (From an FTC press release.)

I checked their website and found that they no longer show the device as FDA approved (to treat or cure), but still do try to give that impression through endorsements and research posters. They continue to mention the FDA at least twice on the site, referring only to registration, not approval – big difference. In summary, the “FTC alleged that the defendants lack scientific evidence to support widespread chronic pain relief claims…” but the site lists no such disclaimer. It’s big business and a $4 million fine pales in comparison to a $350 million development cost.

That it is “100% drug free and non-surgical” while it “stimulates sensory nerves with safe and precise electrical pulses to trigger a natural pain relief response” appeals to people with chronic pain trying to avoid addictive drugs. It’s understandable how such a device would tempt people, and if placebo does the trick it might be worth $300 plus an on-going expense for fresh electrodes.

Like so many other health and medical decisions, avoiding such questionable products is all about a little research and critical thinking.

Appropriately Skeptical

From time to time I see an ad from a local doctor promoting stem cell therapy for pain. It includes one endorsement telling how the office was so easy to work with and how the pain went away. For some time now I have been skeptical about the validity of this promotion. I thought stem cell research was not yet in the mainstream of medical practice, and I know that endorsements are not reliable evidence. It seemed suspicious, so I decided to look into it.

The promotional material on line states in part: “Stem cell therapy uses your body’s most powerful and flexible cells to promote natural regeneration in damaged joints.” It claims to be effective for a list of conditions: surgical wounds, tendon damage, severe muscle strain, arthritis, damaged cartilage, torn meniscus and many other joint and soft tissue injuries and conditions.

“The stem cells … come from your own body … a small quantity of bone marrow from your large hip bone.” (Using the recipient’s own stem cells avoids the need for FDA approval.) The on-site lab processes the harvested cells. The doctor then can “precisely inject your stem cell mixture where you need it … where they morph into new cell types” and provide “long-lasting relief” for “many [but not all] patients.”

My first stop was WebMD with a sub-headline reading: “Unproven, Risky Treatments Mislead Patients to Seek Cutting-Edge Therapy.” International Society for Stem Cell Research (ISSCR) “advises patients to seek only stem cell treatments being tested in clinical trials approved by the FDA”… or some approved smaller studies.

There is a lot of information on the site but it is summarized like this: “Every treatment has some risks. So the question comes down to whether the benefits outweigh the risks. And those studies haven't been done yet.” 

This Healthline report from about 18 months ago says that stem cell therapies are being promoted for a wide variety of conditions, but “very few of these applications have any scientific backing, [however] stem cell therapy for knees has been the subject of quite a few promising studies.” It would be a big improvement over knee replacement, but promising studies hardly qualify a procedure for routine outpatient application. They list the cost of this treatment at “approximately $3,000 to $5,000 per knee, depending largely on geographical location.” 

The FDA gives much of the same information. “Stem cell products have the potential to treat many medical conditions and diseases. But for almost all of these products, it is not yet known whether the product has any benefit—or if the product is safe to use.”

Consumer Reports chimes in with a sub-headline: “A new industry is booming. But critics worry that the treatments are ineffective and dangerous.” Here is a very brief summary: “Stem cells are special cells with the potential to repair damaged tissue and organs.” But “not all of them are possessed of equal power.” According to the current scientific consensus, the therapeutic potential of stem cells taken from fully developed tissues, adult cells, is believed to be much more limited. (Does this include marrow from hipbones? I wonder.)

That Consumer Reports piece is a long article with many warnings about the confusion in the field and the inability of regulators to keep up with the proliferation of clinics, both legitimate and otherwise.

Another reason I am skeptical is that the same doctor offers many other questionable services including platelet-rich plasma (PRP), calling it “one of the most powerful natural healing methods available today.” Some conditions include dry eyes, hair loss and erectile dysfunction.

The Pain Science website opinion published earlier this year describes it this way: “injections bathe troubled cells in a concentrated mixture made from your own blood. Hopefully this stimulates healing where it is otherwise failing … but no one really knows for sure yet.” Regardless, it’s not hard to find someone willing to do it for you, but it’s not cheap. “Without any clear evidence of benefit beyond placebo, PRP is now being marketed aggressively as a cure-all for sports injuries.”

I did this research not because I would consider going to a pain specialist unless I was referred by my primary care doctor. I did it just to show how careful we need to be to avoid spending a lot of money on dubious treatments. 

I didn't name this doctor because I'm sure there are similar ads running all over the country. I am not demonizing any doctor who may truly believe in such treatments, but it is a warning to patients everywhere. 

It is nearly always better and safer to be appropriately skeptical.

Can You Trust Your Pharmacy?

A recurring comment in the script of an episode of an old TV Western (Maverick, 1958) was the line, “If you can’t trust your banker, who can you trust?” The modern day equivalent of that could well be, “If you can’t trust your pharmacy?” This is nothing against the pharmacists, who studied hard to be licensed. There is no evidence of them not giving accurate advice. The displays in the store itself along with some other corporate and industry practices, on the other hand, can and do imply things that aren’t true. Two recent news items act as a good reminder.

The first is about an on-line survey of 1000 Americans published in August, sponsored by the Center for Inquiry (CFI) and conducted by Lake Research Partners. The survey centered on people’s general trust in their pharmacy at Wal-Mart and CVS, and more specifically their feelings regarding homeopathic medicines at those pharmacies.

They chose these pharmacies because both corporations face a lawsuit over their practice of selling homeopathic medicine side by side with science-based remedies. CFI believes it is deceptive to imply that they are as effective as regular OTC cough, cold and other remedies, when they have “no medical benefits beyond that of a placebo.”

There is, in fact, broad agreement on this point. “After a thorough and extensive review of over 200 research papers on the subject, the National Health and Medical Research Council (NHMRC) [of Australia concluded in 2015]:  “There are no health conditions for which there is reliable evidence that homeopathy is effective.” (For a thorough explanation of homeopathic medicines click the link.)

That survey of Wal-Mart and CVS customers asked them about how they make their purchasing decisions for cough, cold, and flu remedies at the two stores “and about their general knowledge of the basic principles of homeopathy, an 18th-century pseudoscience that has been utterly disproven.” The survey showed that exposure to this new information about the failures of homeopathy in so many independent studies led consumers to have to negative feelings about the products and the companies selling them. More than 4 in 10, “described their feelings about the purchase of a homeopathic remedy in deeply negative” terms.

Remember, one of the companies, CVS, still talks about how proud they are of the decision to discontinue tobacco products five years ago and believe it shows their concern about the health of their customers. Tobacco sales were profitable, but ultimately stood in the way of them being considered “a trusted health care provider.” According to their CEO, they strive to be in the same class of business values as TOMS shoes (which donates shoes to African countries providing unfair competition to African small businesses trying to survive by selling shoes – but that kind of unintended consequence is a topic for a different time). If they value their reputation for being a healthcare resource, one would think they would be as concerned about the accurate representation of their products.

But if you can’t trust your pharmacy about the product displays, what about the prices?

That leads to the second news item. A lawsuit filed in August by PharmacyChecker.com accuses “The National Association of Boards of Pharmacy (NABP), LegitScript, and three Pharma front groups [of] operating a coordinated campaign to suppress market competition, artificially inflate the price of prescription drugs, and spread misinformation to scare consumers away from international online pharmacies.” 

PharmacyChecker.com verifies the reliability of international online pharmacies and compares their drug prices to allow consumers to be confident about their on-line purchases and to inject competition into the prescription drug market. They allege in the lawsuit that those organizations have conspired with Google, Microsoft and others to lower their page on search results and in some cases to display a warning box when the page is opened.

Companies and industries do many things to protect their business and to make a profit. Consumers have to do many things to protect themselves. Mostly it involves research and critical thinking, especially when health and healthcare costs are concerned.

Rewards for Not Paying Attention

Should people be rewarded for not paying attention or for pretending they didn’t know about dangers that have been well publicized to the point that they are common knowledge? 

First, a less dire example of well-known information: a study hitting the Internet and the airways recently revealed that “Washing your hands under running water may be a better way to stop the spread of infections than using a hand sanitizer.” The hand sanitizer can be nearly as effective as washing hands for removing flu viruses, provided both are done properly. It just takes longer.

In laboratory experiments “it took about 30 seconds for the sanitizer to eliminate all the flu virus in the saline samples, but more than 4 minutes for the sanitizer to get rid of flu in the mucus samples.” From the lab tests they moved to a more real-life situation by putting mucus directly on people’s fingertips. When it was given time to dry (for 40 minutes), the hand sanitizer killed the flu virus within 30 seconds. But in a more realistic situation where the mucus was still moist, it took about 4 minutes of rubbing for the flu virus to be completely eliminated.

Proper hand washing removed traces of the virus in both cases in about 30 seconds, whether the participants used soap or not. The benefit is not from the soap, but from the rubbing under running water. 

No one is likely to rub the hand sanitizer for 4 minutes or alternatively to let their hands dry after sneezing for 40 minutes, but neither do many people spend half a minute scrubbing under running water. When a sink is not available the alcohol is a good option. 

That’s what we know today, but we had substantially the same information 10 years ago. From Live Science in October 2009: “Hand washing with ordinary soap and water is the most effective way to remove germs. But when you're on the go, alcohol-based hand sanitizers are tremendously effective in preventing the spread of the seasonal flu.” They gave 20 seconds for washing and 15 for the sanitizer, so the latest study just worked a little on the details. It wasn’t really news.

This is just one everyday example of how the media likes to present old news as some brand new revelation wrapped in the cloak of the latest study.

In light of that consider the opioid epidemic. Within the last two weeks, “OxyContin maker Purdue Pharma LP filed for bankruptcy protection…succumbing to pressure from more than 2,600 lawsuits alleging the company helped fuel the deadly U.S. opioid epidemic.” Nearly every state, numerous cities and counties and many others insist that the company “aggressively marketed prescription painkillers while misleading doctors and patients about their addiction and overdose risks.”

Any money awarded will not bring back even one of the 400,000 lives lost between 1999 and 2017, but the various levels of government hope to be able to confiscate money from drug company profits to remedy the situation rather than taking from tax payers.

My question is: what are they going to do with this money? Treatment is no doubt an option. Perhaps they will fund stocks of Naloxone (sometimes sold under the brand name Narcan). 

Of course, awareness will surely be part of the plan. But with the opioid epidemic in the news daily, with current Public Service Announcements and with the subject sure to come up in the upcoming presidential campaigns, what more can they do to get the word out? The company may have been playing fast and loose with the truth in the past, but now their website clearly states, “OXYCONTIN® exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death.” 

With so much information available, should compensation be available to everyone who becomes addicted from now on? At what point does society expect people to recognize and deal with the danger? In the case of cigarettes it has taken decades – people are still suing tobacco companies over risks that have been widely known for 50 years or more, but they claim to be victims. 

If risky or irresponsible behavior continues to be rewarded even well after the risks are known, problems will never be solved.

GMO Green Beans?

On a weekly shopping trip we picked up some whole green beans, a favorite at our house. As she opened them later, my wife commented that they were labeled as Non-GMO. The GMO labeling is a subject of mockery in the family – as is gluten-free, natural, organic and a number of other scientifically meaningless qualifications when it comes to healthy eating for most people.

The first thing I wondered was whether anyone was selling genetically modified green beans. This was not an idle thought. I have previously written about orange juice and tomatoes labeled as non-GMO when, in fact, it is impossible to buy the modified version of either.

I looked up “GMO green beans” and discovered this website which answers the question directly saying, “To date, no GMO green beans have been commercialized.” They go on to say that researchers in Brazil are trying to get approval to work on it. Until then, “breeders of green beans in many world areas are also applying traditional plant breeding methodologies to develop new varieties with better combinations of characteristics…to improve yield, eating quality, and resistance to fungal, bacterial and viral diseases…to enhance the green beans grown and eaten by people, as a component of nutritious and healthful diets.” They are using the slow, old-fashioned method of modification that no one is afraid of.

Because that site seemed to be in favor of GMO technology, I continue to look for more evidence from a source on the other side. The Seattle Organic Restaurants site lists the “Top 20 Foods and Products that have been Genetically Modified.” Green beans are not on the list.

A site called superfoodly asks: "Are Canned Beans Healthy? Here’s The Biggest Safety Danger.” GMOs are not mentioned. The biggest danger according to them is BPA in the packaging. But as they report on it, they admit, “what the science suggests about it doesn’t appear to match the risk perceived by the public.” What is believed to be the number one danger turns out to be a case of ignorance. “Even when rats were fed up to 70,000 times the concentration of BPA that the typical American eats, they didn’t experience a change in hormone levels, weight, or reproductive orders.”

How does Delmonte respond to the challenge? Their website states, “The FDA, USDA, World Health Organization, and the American Medical Association have concluded that products containing genetically engineered ingredients are safe. Even though there are no health risks (allergens or negative nutrients) associated with GMOs, we decided to provide information about GMOs in our products to consumers so that they can make informed choices.” Apparently the informed choice is whether or not to avoid something that has been deemed safe. That makes no sense except by understanding that the job of Delmonte is to sell beans and other food, not to educate the public; and they can certainly sell more by appealing to unwarranted fears of GMOs stirred up by rumors and other misinformation, some of which is purposely disseminated by parties with a financial interest.

That explains why they take a similar stance on BPA. “Cans are lined with epoxy resins, of which BPA is a component…to make the plastic flexible so it completely covers the inside of the can. Based on extensive research, the U.S. Food and Drug Administration and many other regulatory agencies around the world have concluded that BPA is safe to use in packaging.” But Delmonte goes on to proudly announce that they don’t use it anyway.

It doesn’t end there. The other side of the label at the top says, “With Natural Sea Salt,” just another phrase with implied (but not real) health benefits targeting superstitious food shoppers. 

The real motive for all these enticing myths displayed on the packaging may be to distract shoppers from the writing on the bottom of the label – 14.5 oz. on a can that used to be 16 oz. That’s the real deception – shrinking packaging with or without BPA raises the price.

This is not intended to pick on Delmonte, everyone does it. It’s easy selling fake benefits to the ignorant public, and it will persist as long as Americans continue to get their health and science information from celebrities, charlatans and social media.

Latest (?) Alzheimer’s News

Isn’t it interesting how the number of Alzheimer’s stories and articles picks up every July? Actually, it’s not a coincidence at all. The annual meeting of the Alzheimer’s Association International Conference® is scheduled for the middle of July. This year it ran from the 14^th to the 18^th in Los Angeles. Naturally, the news media eagerly awaits the latest studies coming out of the conference because the subject of Alzheimer’s Disease or dementia is an emotional draw for so much of their audience.

Since there is still no drug treatment to prevent or cure dementia, the emphasis lately has been on other prevention practices. Is there anything we can do? Yes, there is, and it’s announced as a new breakthrough regularly. But in reality, it differs from year to year by only a few minor tweaks and looks very much like other familiar health advice.

In 2017 a new study, “published in The Lancet and conducted by the first Lancet Commission on Dementia Prevention and Care, brought together 24 international experts to review existing dementia research and provide recommendations for treating and preventing the devastating condition.” They concluded that a third of dementia cases “worldwide could potentially be prevented through better management of lifestyle factors such as smoking, hypertension, depression, and hearing loss over the course of a lifetime.” It was presented as a new report. Although the report was new, these recommendations look very familiar. 

For example, in 2015 World Dementia Council (WDC) asked the Alzheimer's Association to evaluate and report on modifiable risk factors, that is, possible prevention steps for cognitive decline and dementia. They concluded that there was “sufficiently strong evidence” that “regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension)” along with “a healthy diet and lifelong learning/cognitive training" could have a positive effect.

 And last July similar news came out of their annual meeting, which was held in Chicago. One of the experts announced the results of a large multi-year study: “Lowering blood pressure more than usually recommended not only helps prevent heart problems, it also cuts the risk of mental decline that often leads to Alzheimer's disease.” Getting the top number down to around 120 was shown to lower risk of mild cognitive impairment by 19 percent. (That’s three references to hypertension in four years.)

At that time they reminded readers that the American Heart Association recommends the following lifestyle changes to help manage high blood pressure: balanced diet, alcohol in moderation, regular exercise, weight and stress management, no smoking and taking medications as directed. (It all sounds familiar.)

Not to be deterred by the fact that this is getting a bit repetitious, last week the BBC (and many others) reported on the latest findings revealed at this year's conference with the headline: “Dementia: Lifestyle changes that could lower your risk.” The report outlined the factors associated with a healthy lifestyle: no smoking, eating a healthy diet, getting regular exercise and drinking only in moderation.

I didn’t investigate these studies to mock the findings. I agree with the findings. In fact, it is totally aligned with something I published over 5 years ago, pointing out that there are really no secrets to good health, just the same old advice.

 Rather my intention was to show how the media repeat news stories, rarely questioning whether or not it’s really new. I also discovered, without a hint of surprise, that they will adjust any news story to fit their agenda. In this case as reported by Kaiser Health News (KHN), the Washington Post reported that the study advised, “Ditch the red meat,” and KHN wrote, “Give up red meat.” When I looked at the study details and dug into the (footnote) source they used to define a healthy diet, the wording was “fewer red meats,” not to ditch it or give it up.

That leaves us again with a need for discipline to stick to that common-sense healthy lifestyle and critical thinking to take the news with a large helping of skepticism.

Walk Faster, Live Longer?

A very interesting article in JAMA a number of years ago requires the application of critical thinking to avoid making a misinterpretation.

 A team of scientists put together a summary of nine studies over the years totaling almost 35,000 subjects over the age of 65, residents of various nursing facilities . Each study was trying to find out whether measuring a person’s walking speed could help predict how much longer they would live.

The data came from the various researchers measuring how fast people walked over a short measured course, between 8 and 20 feet long, using a stopwatch and converting the speed to feet or meters per second. They then followed up years later to see how well the measured speed at the time of the test correlated with how much longer the individuals lived. (The authors refer to it as “gait speed.”)

The published conclusion, when they put the information from all the studies together: “In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.” The graphs accompanying the article show this quite clearly, and the findings held true for both men and women and for people of different races. The top group walked the course at 1.6 meters per second, which converts to about 3.6 miles per hour. (For a longer distance this would mean a pace at which someone could walk a mile in about 17 minutes.)

How is this useful? “First, gait speed might help identify older adults with a high probability of living for 5 or 10 more years, who may be appropriate targets for preventive interventions that require years for benefit.” It could help assess whether a particular medical procedure would be worth the risk – there is always a risk, especially for older people. “Second, gait speed might be used to identify older adults with increased risk of early mortality, perhaps those with gait speeds slower than 0.6 m/s.” It is a simple and informative way for “assessing expected survival to contribute to tailoring goals of care in older adults.” Furthermore, it is a simple measurement that can be easily done in a nursing home corridor by non-professionals.

How is this not useful? Correlation is not causation. Someone seeing this article and not using critical thinking might conclude that beginning to walk faster was a way to guarantee longer life. After all, the graphs on the page clearly show that those who walked faster lived longer. Except for the fact that exercise is good for anyone, this conclusion is not necessarily so; it’s not what the analysis shows.

The authors theorize that the correlation exists because, walking “requires energy, movement control, and support and places demands on multiple organ systems, including the heart, lungs, circulatory, nervous, and musculoskeletal systems.” A slower walking speed could indicate some damage or a larger than normal energy requirement for other reasons. Both could be a general indicator of lessened vitality. It makes sense that those who were going to live longer were just capable of walking faster, and did so.

Unfortunately, scientists did not prove that increasing our walking speed will increase our life expectancy. (In fact, people walking faster while texting could easily decrease their life expectancies.) Getting more exercise, including walking, and generally taking care of ourselves will. There is rarely one easy answer. The real secret to good health appeared in this space over five years ago and, unfortunately requires some degree of discipline.

Super Foods

Critical thinking leads me to believe that all the talk about super foods is crazy. People read about some newly christened super food, adopt it in the hope of improving their lives, convince themselves that they feel so much better, and spread the word. This is particularly dangerous in the case of celebrities. 

Here is a sample I pulled from a Gannett article over four years ago.

Alas, for 2015 we find out that quinoa is out and kaniwa, “sourced primarily from the Andes Mountain region of South America,” is this year’s super-food, “high in protein, fiber, iron and calcium” and gluten-free!  In the search for a better sweetener, “coconut sugar is making its way onto the scene.” Actually, all things coconut are in fashion as part of the Paleo food trend.  Almonds are out and pistachios are in along with Nduja and spreadable salami.

Just last year I commented on a TV ad for beet powder as a circulation super food, with the power to support increased energy without stimulants, promote heart health and support healthy blood pressure levels. (Notice how these products sold as supplements always support and promote without really promising to do anything definite.)

Finally, here is one from this year that sounds extremely confident and enthusiastic. It begins: “Move over kale, quinoa, and coconut water! …There are some new superfoods on the block, packed with powerful nutritional benefits and exotic tastes.” To reduce the shock of finding yet another new super food, they remind us how the super-food trends of today would seem “rather bizarre” just a few years ago – now that’s comforting!

It continues: “These are the superfood trends you should not only watch out for, but get excited about.” Included in the list are nut oil, chaga mushrooms, cassava flour, watermelon seeds and tiger nuts; and try maqui berries, instead of the so-passé goji and acai. Wash it all down with some probiotic water. When making your heart-healthy smoothy, try substituting moringa for your matcha, maca or spirulina. (Who does this stuff?)

That’s why I was so pleased to find this article. Although when I saw the headline, “The Definitive Superfood Ranking,” I expected more of the same, the picture showed apples and broccoli, so there was hope that some sanity would prevail. 

The piece begins: “It seems like everything in the grocery store is labeled ‘super’…[but] which foods are actually proven, by science, to be good for you and which ones are all hype.” They go on to say that many dietitians think the term super foods should be eliminated because it is so misleading, sometimes intentionally so by food marketers. Such labeling raises the price and promises to do what no single food can do alone, make you healthy.

The article begins by exposing the gluten-free myth. “Unless you have celiac disease or suffer from a true gluten intolerance (example: you are doubled over and running for the bathroom post-pizza), there are no proven physical benefits from going gluten-free.” Then it explains how orange juice is not the best source of Vitamin C and adds that the benefits of coconut oil, chia seed, kimchi, sweet potatoes, almonds, acai and beets are more hype than reality.

At this point in the story, the emphasis changes to address truly healthy foods: eggs, cherry juice, broccoli, coffee, apples, green tea, black beans, dark chocolate, red wine, salmon, turmeric and blueberries. Each are backed by some valid scientific research and their prices are not inflated by fads and hype. (I also noticed that not a single one of them caused problems with my spell-check, unlike about half of the so-called super foods in the lists above.)

Wow! Are real foods eaten in moderation the answer? Despite that, the odds are good that in 2020 someone will discover another new super food in some remote jungle, and the masses will jump on board. (Excluding those who were mauled to death trying to harvest tiger nuts!)

How Sweet It Is!

A couple of things came together over the last few weeks that brought up some interesting questions. The first was this video from John Stossel using the sugar industry as an example of crony capitalism or corporate welfare. The second was the bold print on the side of a bread package announcing that the product contained no high fructose corn syrup (HFCS).

Most of the Stossel video, “Sugar’s Sweetheart Deal,” is about how the industry advertises that they are not subsidized, but government bailouts (using our tax dollars) when the price falls, keep them rich and happy. The government also helps keep the price up with artificial quotas on domestic production and imports. So much of our food costs more, because sugar costs more, and it’s in so many products. 

When I looked at the ingredients on that bread package, the one proudly proclaiming that it contained no HFCS, I was not surprised to see sugar near the top of the list. Perhaps the sugar industry also is behind the bad reputation that most people associate with the cheaper substitute. Is there something behind the halo-effect of “No High Fructose Corn Syrup” or is this another case of hype?

This source gave me a clue: “There isn't enough evidence to say that HFCS is less safe to eat than table sugar, according to the American Medical Association, which has stated that HFSC does not appear to be more harmful than other caloric sweeteners.”

The HealthLine site goes into more detail. “There are only tiny differences between HFCS 55. – the most common type of high-fructose corn syrup – and regular sugar. A major difference is that high-fructose corn syrup is liquid – containing 24% water – whereas table sugar is dry and granulated.” The differences in chemical structure between the fructose and glucose in HFCS and the sucrose in sugar is not significant and “do not affect nutritional value or health properties.” After they are broken down in the digestive system, they end up looking exactly the same.

In a discussion of recipes on howstuffworks.com, they point out that there is a small difference. The HFCS has slightly higher levels of fructose, but the difference is very small and not particularly relevant from a health perspective.

So the package posting no HFCS is not really a reassurance; it only means they used sugar instead. It’s just another advertising trick. Both are about the same thing, neither is particularly good for us, and both should be consumed in moderation.

But what of the packages that say “no sugar” or “sugar-free.” Therein lies another can of worms. Most of the time those products don’t contain HFCS either; they contain artificial sweeteners. But wait! Aren’t artificial sweeteners a kind of slow-acting poison? Some will tell you exactly that.

It turned into another research project. This time I went to Mayo Clinic's site. “Artificial sweeteners are synthetic sugar substitutes. But they may be derived from naturally occurring substances, such as herbs or sugar itself.” They can be “attractive alternatives to sugar” because they contain virtually no calories and do not contribute to dental problems. Artificial sweeteners may also help with weight control and diabetes.

They go on to say: “Artificial sweeteners have been scrutinized intensely for decades.”  Studies from the 1970s “that linked the artificial sweetener saccharin to bladder cancer in laboratory rats” led critics to claim that they are unhealthy and carcinogenic. “But according to the National Cancer Institute and other health agencies, there's no sound scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer or other serious health problems. Numerous studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women.” 

The sole choices left are the so-called natural sweeteners, such as honey, maple syrup, and molasses. These are popular among the health-conscious crowd, some even calling honey a miracle food. Back to Mayo for this information: "Natural sugar substitutes may seem healthier than sugar. But their vitamin and mineral content isn't significantly different. For example, honey and sugar are nutritionally similar, and your body processes both into glucose and fructose.”

Will all that information change minds? Probably not! Will “No High Fructose Corn Syrup” continue to sell, while people continue to warn their neighbors about the dangers of artificial sweeteners? Most likely! Will foodies be attracted to honey in recipes thinking it contains some health secret? That, too! Critical thinking and simple, solid research where are you?

Short Subjects

Gluten-free dog food: There are a couple of bad reasons for buying gluten-free dog food and only one good one. But first a little background.

“Gluten is the term for proteins found in wheat, rye, barley and oats. It has glue-like properties, allowing food to stay together. Celiac disease occurs in people with a genetic predisposition and results in damage to the small intestine because of gluten sensitivity. It makes digestion difficult for the affected population.”

The first bad reason is the same one explaining why people buy gluten-free food for themselves. The same website that supplied that explanation above goes on to say, “If you purchase a grain-free dog food, that generally means it’s also gluten-free. A manufacturer might label a grain-free food as also being gluten-free, but that’s marketing for the uninformed.” The only reason they would do that is to sell more product by driving an imaginary competitive advantage. (It might allow them to charge more, too.)

The second bad reason is to assume a gluten-free diet would benefit the pet. “Most dogs do not suffer from celiac disease, so a gluten-free diet is not necessary.” The sole exception is Irish setters that may have inherited a gluten intolerance, but this includes just a few Irish setters. 

The only good reason would be if a dog had celiac disease, confirmed by a vet with blood tests and a biopsy of the intestine. This would be a rare situation even if Irish setters were very common. To make sure I checked for the 10 most popular dog breeds according to the American Kennel Club. Irish setters didn’t make the list.

Then why do we see so many ads and associated material for gluten-free dog food? – The same reason we see gluten-free posted on so much people food – “marketing for the uninformed.”

Workplace Wellness Programs: These became all the rage over the past decade or so, especially within large companies. This website echoes the universal sentiment:

“Considering the improvement to the well-being and productivity of a healthy workplace, and the amount of time we spend at our workplaces, it makes sense to foster workplace wellness programs. Not only does it affect the output of team members, but it makes them feel good in all areas of life—including work.”

Having a suite of such programs makes an employer appear to be progressive and caring while making a wise investment. “One of the signs of a top-notch employer will be a workplace wellness program.”

Top-notch or not, a program that doesn’t work is not a good use of time and money, and according to this NPR health report, that might be the case. Workplace wellness programs, now an $8 billion industry, have received conflicting marks over the years from various studies, but none have been carefully designed enough to rely on – until now. 

Researchers from the University of Chicago and Harvard conducted the first large-scale, peer-reviewed study with a randomized controlled trial design. “They published their findings [last] Tuesday in the medical journal JAMA.” Details of the study can be found by following the link.

In the end, participants self-reported healthier behavior than those not enrolled, such as exercising more or managing their weight better. “But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels, how much employers spent on health care or how often employees missed work. Their job performance and how long they stuck around in their jobs also seemed unaffected, the researchers say.”

Since a benefit given is nearly impossible to take back, the large number of companies that have them will be forced to assume some hidden return on investment, but the latest scientific data does not really back that up.

Death Threats: Now that the Internet allows people to make death threats without leaving the comfort of their homes or even on the go from their phones, there seem to be more of them – and for more and more trivial reasons. Just last week an Atlanta meteorologist received death threats and other “inappropriate messages” for interrupting the Masters golf tournament to update viewers on tornado watches in the area. Of course a watch is not as serious as a warning, but it’s far more serious than watching golf on TV – except to some who accused the meteorologist of being pretentious and wasting their time. Perspective, anyone?

Stoking the Fear (Continued)

This is a brief follow-up to last Friday’s comments on how news and advertising use fear, especially the fear of death and illness, to sell products and capture viewers' attention. (When a study can point out that toasters and air purifiers cause indoor air pollution, eyebrows shoot up.)

Now comes another story highlighting how companies use the same tactics to sell products and services to fight aging.

“A company that charged patients thousands of dollars for infusions of blood plasma from younger donors said [recently] that it had stopped treating patients after the Food and Drug Administration warned consumers against such treatments, purported to prevent aging and memory loss.” That’s right, a company called Ambrosia, cleverly named after “the food or drink of the Greek gods, often depicted as conferring longevity or immortality upon whoever consumed it,” offered customers over the age of 35 an infusion of one liter of blood donated by 16- to 25-year-olds, all for only $8,000.

The FDA said that there was “no proof that plasma from young donors can be used as a treatment for dementia, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease or post-traumatic stress disorder, as some companies have claimed.” Plasma infusions are only approved for treating blood-clotting deficiencies in patients who are bleeding and in a few other very specialized cases. (Only one small study showed a slight benefit to Alzheimer's patients.)

Furthermore, the FDA warns that no matter how well screened they may be such treatments can result in: infections; serious allergic reactions, including anaphylaxis, which can manifest as hives and airway obstruction; transfusion-related acute lung injury; overload of the circulatory system leading to swelling of the body and difficult breathing.

This company and others are operating outside of FDA guidelines and are charging big bucks for an unproven technology. These companies are capitalizing on that fear of aging and dying to prey on unwitting customers.

This one is just a single example. So many ads and news stories use the same tactics. Our only defense, as I wrote last time is to use critical thinking and perspective. If it seems too good to be true… 

It’s also odd that when people get outraged at corporations, they typically attack big companies such as banks, food conglomerates, Wal-Mart or McDonalds. At least these companies deliver a product that has some benefit. Companies like the ones above that offer products of zero or questionable value get little pushback, and it takes a government agency to warn everyone of potential dangers and about how they are wasting their money. Despite the lack of evidence and possible dangers, many still continue to patronize these and so many others like them. (See, for more evidence, all my previous blogs on dietary supplements.)

People, People, People...

And now back to one of my favorite topics, Americans being duped by celebrities or celebrity endorsements into buying things they don’t need, things of little value or things that are potentially dangerous. On an individual basis it’s sad, and on a societal one it’s very discouraging.

If your car broke down, would you have it towed to the local TV station for the news anchor to look at – even if his or her hobby happened to be car repair? Probably not.

If your toilet backed up would you invite the local golf pro over to fix it – even if he had an engineering degree and an interest in plumbing? I don’t think so.

If you had a health question, would you seek advice from a Hollywood star instead of a health professional? The answer should be the same, but then how does Gwyneth Paltrow get away with it?

She holds health summits for her Goop brand charging $1500 per person, “despite repeated debunkings of her brand’s health claims, and piece after piece arguing the nonsense she sells is nothing more than snake oil.” This article comments on a new partnership with Netflix to push her products. In addition to her original lifestyle-and-wellness business, she owns a clothing manufacturer, a beauty company, an advertising hub, a publishing house, a podcast producer and several others. According to the New York Times, her brand is worth $250 million!

By playing on her celebrity status, Ms. Paltrow is reeling in customers by the boatload pedaling what many sources refer to at pseudoscience and misinformation. Errors in fashion may be OK; customers risk nothing more than possible derision. But when it comes to someone’s health, outcomes can reach beyond a waste of time and money to become dangerous or even fatal. 

Take for example one of the ten most read entries on the Goop site. “In consultation with Dr. Alejandro Junger, we created a week-long detox menu to recover from post-holiday indulgence.” Likely no one ever looked up the doctor’s credentials or questioned the efficacy of his advice before venturing into this experiment in self-medication. Unfortunately, as I’ve often written before in detail, detox plans are both unnecessary and dangerous. 

In other examples related to health, Goop continues a war on science with claims that are so outlandish that the whole thing could be mistaken for satire. But it’s not, and it’s very problematic. Dr. Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, is a frequent critic. “Assuming this isn’t performance art, the increasing popularity of companies like Goop is a cause for legitimate concern. Despite the best efforts of journalists and doctors, the debunkers are not winning the wellness war. Indeed, there is evidence that the trust people place in traditional sources of science is eroding.”

 Or as Vox put it just last summer, “Goop has been called out for bullshit over and over. But the brand seems to be stronger than ever.” Many agree that such opposition has just strengthened the brand among those already made suspicious of traditional medicine by so many other snake oil enterprises – basically appealing to those people who have sent their critical thinking on a long vacation.

It’s ironic that science brings us smart phones and the Internet so celebrities can use them to profit from the ignorance of people by selling and/or endorsing junk-science treatments and fake cures. It demonstrates the truth of what Isaac Asimov said many years ago: “The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.”

Being Careful About What You Eat

It looks like a number of essays recently have been about food, but since I steer away from politics to show more everyday behavior, the healthy food stories tend to jump out. I found a number of fairly recent stories about whether being picky about our food is worth the effort. 

The marketing departments of food companies go out of their way to make us feel guilty about eating the wrong things and to reassure us that we are making wise food decisions. But how much is true and how much is hype?

Many packages are labeled as healthy. Does that have any real meaning? 

The FDA is in the process of redefining their guidance on this subject, updating it from the 2016 version that read in part: “this guidance is intended to advise food manufacturers of our intent to exercise enforcement discretion relative to foods that use the implied nutrient content claim 'healthy' on their labels which:

(1) Are not low in total fat, but have a fat profile makeup of predominantly mono and polyunsaturated fats; or
(2) contain at least ten percent of the Daily Value (DV) per reference amount customarily consumed (RACC) of potassium or vitamin D.”

They conclude “guidances describe our current thinking on a topic and should be viewed only as recommendations.” All that seems as clear as mud! So we keep seeing "healthy" on all sorts of packages.

What about organic? The government does have strict guidelines about what can be considered organic, but still there is no guarantee. As this article from last October shows: “Three Nebraska farmers will plead guilty to knowingly marketing non-organic corn and soybeans as certified organic as part of a lengthy, multi-million-dollar fraud scheme.” This had been going on for many years.

A few months earlier, this news came from the Genetic Literacy Project. “The U.S. Department of Agriculture fails at regulation of organic food as fraudulent products overwhelm the agency’s conflicted, compromised system.”

Furthermore, as I discussed in detail last May, the USDA organic program allows some pesticides not classified as synthetic, and tests only for those pesticides disallowed by the program. Organic pesticides are not necessarily safer and all products – organic or synthetic – have the potential to be toxic. The careful approach is not in the food supply but in food preparation, as in washing all fruit and vegetables thoroughly.

 The use of natural is even foggier.

The FDA has asked for pubic comment “on the use of this term in the labeling of human food products” as a result of three citizen petitions asking for a clear definition, another one asking that the term be prohibited on labels and several court cases requested clarification.

 It leaves us asking whether these terms are really helpful or just the usual advertising jargon. It shouldn’t surprise us when, just last month there was a nationwide recall of more than 68,000 pounds of “gluten free Organics Breaded Chicken Breast Nuggets.” But they sounded so healthy and natural!

It takes some critical thinking to get to the bottom of all this, but what is really called for here is a dose of perspective. There was a time when everyone didn’t worry so much about the credentials of their food. Many were just happy to have it. And that went for everything we put in our mouths. Consider the study a couple of years ago that cleaner surroundings were not necessarily healthier for infants, making them more prone to developing allergies. And books like Let Them Eat Dirt, warned about the dangers an over-sanitized world posed for children.

Yet advertisers find that these words, and others like green and sustainable, can have an almost hypnotic effect, causing consumers to turn off their critical thinking and just trust the labels.