Conflict on the Menu

New York City’s new rules for menu labels at chain restaurants have set off a food fight among the nation’s obesity experts.

French fries at a McDonald’s. A new rule would force many New York restaurants to post calorie information in noticeable places.

Most support the theory of the city’s health commissioner that forcing chain restaurants to list the calories alongside menu items — flagging that a Double Whopper With Cheese has 990 calories, for example — will make patrons think twice about ordering one. The rules are set to take effect at the end of March.

There is a countertheory, however, set forth by Dr. David B. Allison, the incoming president of the Obesity Society, a leading organization of obesity doctors and scientists. An affidavit he recently submitted to the United States District Court for the Southern District of New York has ignited a controversy within his organization.

In the filing, Dr. Allison argues that the new rules could backfire — whether by adding to the forbidden-fruit allure of high-calorie foods or by sending patrons away hungry enough that they will later gorge themselves even more.

“What harms (if any) might result” from the new rules? Dr. Allison wrote in the court filing. “That is difficult to predict.”

It might be only a scientific debate among nutrition experts, except for the fact that Dr. Allison was paid to write the document on behalf of the New York State Restaurant Association, which is suing to block the new rules.

Dr. Allison’s role in the debate has angered some members of the Obesity Society, setting off an e-mail fury since word of his court filing began to circulate. Some have pointed to Dr. Allison’s other industry ties, which have included advisory roles for Coca-Cola, Kraft Foods and Frito-Lay.

Many of the group’s 1,800 members are “completely mad that a president-elect of the Obesity Society, an organization that cares about obesity and cares about healthy eating, wants to hold back information from people that helps them make healthy choices,” said Dr. Barry M. Popkin, a member of the organization, who is director of the Interdisciplinary Obesity Center at the University of North Carolina, Chapel Hill.

Dr. Popkin has filed his own affidavit in the lawsuit, defending the city’s menu labeling plan.

The controversy highlights unresolved issues in the obesity field about industry ties and conflicts of interest, said Dr. Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. “The field is incapable of policing itself,” Dr. Brownell said.

Spurred by Dr. Allison’s affidavit, the obesity group released a statement on Tuesday supporting calorie labeling on menus. “The Obesity Society believes that more information on the caloric content of restaurant servings, not less, is in the interests of consumers,” said the statement by the society, which is based in Silver Spring, Md.

Dr. Allison, a professor of biostatistics and nutrition at the University of Alabama, Birmingham, is scheduled to start a one-year term as president of the Obesity Society in October. He has defended his affidavit. In a telephone interview, he said he did not take a position for or against menu labeling in the document but merely presented the scientific evidence that the labeling might deter over-eating but might not and, in fact, might be harmful.

He also defended his work for the restaurant industry, but would not disclose how much he was paid for his efforts.

“I’m happy to be involved in the pursuit for truth,” Dr. Allison said. “Sometimes, when I’m involved in the pursuit for truth, I’m hired by the Federal Trade Commission. Sometimes I help them. Sometimes I help a group like the restaurant industry. I’m honored that people think my opinion is sufficiently valued and expert.”

The executive vice president for the restaurant association’s metropolitan New York chapters, E. Charles Hunt, said that Dr. Allison was retained by the association’s lawyers. “Obviously, a lot of it was in favor of our position,” Mr. Hunt said, “although he didn’t come right out and say that.”

Dr. Allison’s 33-page affidavit cites a study that found that dieters who were distracted while eating and presented with information that food was high in calories were more likely to overeat.

“To the extent that many NY diners consume food from restaurants while in a state of distraction or performing distracting tasks,” he writes, “we might hypothesize that the belief that the food is especially high in calories would trigger disinhibited increased consumption.”

He also says that for some people, the deterrent of a high-calorie label might be short-lived and end up making them even hungrier and likely to eat even more later — “inadvertently encouraging patrons to consume lower-calorie foods that subsequently lead to greater total caloric intake because of poor satiating efficiency of the smaller calorie loads.”

Dr. Allison was quoted advancing similar arguments in 2006 during a breakfast meeting sponsored by Coca-Cola at an international conference of obesity experts in Sydney.

Dr. Allison, who disclosed at the meeting that he was a consultant to Coca-Cola on obesity issues, warned that policies to restrict certain foods might backfire, citing research showing that birds put on weight when food is scarce, according to a newsletter article about the conference.

The new labeling rules by New York City’s Board of Health have support from a cross section of organizations, including consumer groups like Public Citizen and the Center for Science in the Public Interest, as well as doctor groups like the American Medical Association, the American Academy of Pediatrics, the American Diabetes Association and the American Heart Association.

While some chains already post calorie information on posters, fliers or on the Internet, public health officials argue that people may change their ordering habits or restaurants might change their menus if calorie labeling is more conspicuous.

The New York rule would require that chains with 15 or more restaurants nationally, including fast-food restaurants, put the information on their menus or menu boards.

This is the city’s second attempt to adopt such regulations. A judge struck down a menu-labeling plan last year, saying the law needed to be reworded. It has since been revised to comply with the judge’s order.

Similar requirements have been adopted in King County, Wash., which includes Seattle, and are under consideration by 21 other state and local governments.

New York’s health commissioner, Dr. Thomas R. Frieden, likened Dr. Allison’s claims to an argument that the world is flat.

“We don’t have 100 percent proof that it’s going to work, but we have a reasonable expectation it will be successful,” Dr. Frieden said.

“When places have to put ‘2,700 calories’ next to an appetizer,” Dr. Frieden said, “they might not have a 2,700-calorie appetizer anymore.”

*This article written by STEPHANIE SAUL, published at newyorktimes.com

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Cutting Cholesterol, an Uphill Battle

The HDLs, the so-called good cholesterol that protects against heart disease, were also high at 69, so that was good. My triglycerides, at 95, were well within the normal range of zero to 149. The VLDLs, also a potentially harmful form, measured 19, again within the normal range of 5 to 49.

But the LDLs, the bad guys that deposit plaque on artery walls, were 134 — “high” since they should be under 100 if I want to maintain a healthy cardiovascular system.

My doctor wasn’t too concerned because my blood pressure is low, I eat a healthful diet and I exercise every day for 60 to 90 minutes and run up and down scores of steps. Still, I decided to cut out cheese, lose a few pounds and return in three months for another test, this time after an all-night fast.

So in early March, three pounds lighter and taking a daily supplement of plant stanols, which are supposed to lower cholesterol, I had a second test. But now my total cholesterol had risen to 236 and the LDLs were up to 159.

Still, my doctor was not as alarmed as I was. My father and his father and his father’s brother had heart attacks in their 50s, and my father and grandfather died of their second attacks at 71. I was 65. Were my days going to be numbered by a surprise coronary or stroke? Not if I could help it.

Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements. But the latest test, in early June, was even more of a shock: total cholesterol, 248, and LDLs, 171.

My doctor’s conclusion: “Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.” I was not inclined to become a total vegetarian to see if that would help. The time had come to try a statin, one of the miraculously effective cholesterol-lowering drugs.

By studying the effects of statins in thousands of people who already had heart disease or were likely to develop it, researchers finally proved that lowering total and LDL cholesterol in people at risk was both health-saving and life-saving. I’ll know by fall if the low-dose statin I now take nightly will do the trick, or if I’ll need a higher dose. [See Fall Update, below.]

Lifestyle Changes

Americans tend to turn far too quickly to drugs to solve their health problems. Drugs should be the last resort, if there are reasonable measures people can take first to control a problem. And there are dozens of such measures that, individually or together, can help to lower LDLs.

High LDL cholesterol is an independent risk factor for coronary heart disease, and lowering it by 60 milligrams can reduce coronary events like heart attacks, angina and sudden death by 50 percent after only two years, experts from Oregon Health and Sciences University wrote recently in The Journal of Family Practice.

The Oregon specialists, Dr. Elizabeth Powers, Dr. John Saultz and Andrew Hamilton, recommended that doctors start with lifestyle modifications when a patient has high LDLs. And Dr. Vincent Lo of French Camp, Calif., suggested that the patient’s culture, preferences and practical issues like cost and availability be considered. Not everyone can afford to join a gym, and a traveling salesman may have a hard time sticking to a low-fat, calorie-controlled diet.

These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.

Alcohol. Consuming one or two drinks a day can lower LDLs by 4 to 10 milligrams. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.

Exercise. Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3 to 16 milligrams and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.

Weight loss. When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42 milligrams. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31 milligrams.

Yoga and tai chi. These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20 to 26 milligrams when done for 12 to 14 weeks.

Smoking. An analysis of several studies found that LDL cholesterol was 1.7 percent higher in smokers, but two smoking cessation studies found little or no difference. In any case, smoking is a strong independent risk factor for heart disease and sudden coronary death, so it is best avoided.

Modifying Your Diet

About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240 to 160 milligrams.

There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I’m taking.

Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.

For protein, choose fish and shellfish, poultry without the skin and lean meats, all prepared with low-fat recipes. Eat more dried beans and peas (cooked, of course), soy products like tofu, and nuts like walnuts and almonds. Grains should be mostly or entirely whole — 100 percent whole wheat bread and cereals made from whole wheat or oats, brown rice, bulgur and the like. Oats and oatmeal are rich in soluble fiber, which lowers cholesterol.

Pile on the vegetables and fruits. Especially helpful are those high in fiber like Brussels sprouts, cabbage, spinach, carrots, blueberries, oranges and apples.

Cook with canola or olive oil, and use margarine made from plant stanols.

And enjoy a glass of wine with dinner.

Equally important are the foods to limit or avoid: organ meats like liver, egg yolks, most fried and fast foods, doughnuts and pastries, full-fat cheeses and ice cream, processed meats like salami, bacon and other fatty cuts of pork, and untrimmed red meats.

Fall Update

The low-dose statin I’d been taking did the trick. After four months of taking 10 mg a day of Lipitor, my total cholesterol went from 248 to 159. The bad cholesterol, or LDL, went from 171 to 84. My good cholesterol also went up slightly. My ratio of total cholesterol to good cholesterol has me living forever!

This article written by By JANE E. BRODY, published at newyorktimes.com

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Surgical Treatment for Diabetes

Evidence is accumulating that the best treatment for Type 2 diabetes related to obesity may well be the most drastic: stomach-shrinking surgery, perhaps accompanied by intestinal rearrangements. That such extreme remedies would even be considered is a measure of how intractable the intertwined epidemics of obesity and diabetes have become in the United States.

Diabetes of all types is a vicious disease that kills some 73,000 Americans each year, making it the fifth-leading cause of death in this country. It is characterized by an inability to produce or use insulin, with the result that blood glucose levels soar, damaging the kidneys, blood vessels in the eyes and nerves in the feet.

There is no cure, only the hope that it can be controlled by strict dieting, drugs and a lifetime of careful living. Unfortunately, many patients are unable to comply with the onerous regimen, pounds lost are ultimately regained and legions of patients suffer heart attacks, blindness, kidney failure or foot amputations.

Against that discouraging backdrop, a new study by Australian researchers, published in the Journal of the American Medical Association, seems to promise extraordinary results, albeit with many caveats about the preliminary nature of the findings in a relatively small group of patients who had mild cases of the disease.

The study involved 60 patients who were obese and had recently developed Type 2 diabetes, by far the most prevalent kind. Half were given conventional treatments, including diet, exercise and medicines. The rest got conventional treatment plus surgery in which a band is placed around the stomach to constrict its size and limit eating.

In almost three-quarters of those who had surgery, all signs of diabetes disappeared. Only 13 percent of those given conventional therapy had complete remissions. The difference was because of weight loss. Patients in the medically treated group lost only 1.7 percent of their weight, on average. Those in the surgically treated group lost 20.7 percent. There were no serious complications from the minimally invasive procedure.

Other studies have shown that gastric bypass surgery, a riskier operation in which the stomach is stapled and the intestinal tract rearranged, is even more effective, achieving remission in a matter of days or weeks, well before substantial weight loss has occurred. This is apparently because the operation causes metabolic changes that lower blood glucose levels beyond what weight loss alone can accomplish.

Some experts predict that surgery will become a common treatment for diabetes in coming years. Before that happens, it will be essential to see how patients fare over an extended period and get a better fix on which patients are most likely to benefit from costly surgeries that always bear some risk.

Source: nytimes

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Do Cellphones Affect Fertility?

I wanted to ask a question I asked my science teacher today. Is it true that for boys who carry their phones in the pocket, it can cause problems with their sperm?

It sounds like an urban myth, but there is some limited data to suggest that cellphones can affect male fertility. In fact, last month a study in the medical journal Fertility & Sterility examined the cellphone use of 361 men at a fertility clinic. The results showed that the more men used cellphones, the lower the count, quality and motility of their sperm.

In October, the same medical journal reported on an animal study from Milwaukee researchers who found that rats exposed to six hours of daily cellular phone emissions for 18 weeks had a significantly higher incidence of sperm cell death than rats not exposed to such emissions. The study authors said the results suggest that carrying cellphones near reproductive organs could negatively affect male fertility.

However, as a review last fall in Reproductive Biomedicine Online points out, there simply isn’t enough quality research to know whether the effects seen in animal studies or observational data are meaningful. Even if cellphones do affect sperm quality and motility, is it enough to have a meaningful impact on a man’s fertility?

There are some global concerns about declining male fertility in industrialized countries, but issues like pollutants, exposure to chemicals and smoking are likely far more worrisome culprits than cellphones. If I had a teenage son, I think I would try to limit his cellphone use for broader reasons than worries about his future fertility. I would hope my teenager would be active enough in sports and school that his time spent on the phone would be minimal.

Source: nytimes

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Stem Cell Therapy Controls Diabetes in Mice

Scientists reported Wednesday that they were able to control diabetes in mice by harnessing human embryonic stem cells. The work raised the prospect that the embryonic cells might one day be used to provide insulin-producing replacement cells to treat the disease in people.

The scientists, at the biotechnology company Novocell, turned the stem cells into cells that produced insulin in the mice. Those cells kept blood sugar in check after the mice’s own insulin-producing cells were destroyed.

“For those who say there is not much evidence that embryonic stem cells can cure diabetes, there you go,” said Dr. Camillo Ricordi, director of the diabetes research institute at the University of Miami, who was not involved in the research.

Still, a small number of the mice developed tumors, and some experts said the cells might not be well characterized enough for use in people. In any event, Novocell said it would be several years before any human tests could begin.

Doctors are already experimenting with transplants of insulin-producing islet cells from cadavers for patients with type 1 diabetes, a disease which destroys a person’s own islet cells. In some cases, the transplant recipients have not needed daily injections of insulin, at least for a while.

But there are too few donors to provide cell replacement to more than a small percentage of diabetics. Embryonic stem cells, which can potentially be turned into any type of cell in the body, could potentially be a source of islet cells.

Novocell, which is based in San Diego, reported in 2006 that they had turned human embryonic stem cells into insulin-producing cells in culture dishes, something others have also reported doing. But Novocell’s cells did not vary insulin production in response to glucose, a key requirement for implantation.

In the latest work, published online Wednesday by Nature Biotechnology, the researchers got assistance from the mice themselves. Instead of implanting the insulin-producing cells into mice, they implanted precursor cells that were one step short of developing into insulin-producing cells.

The mice’s bodies apparently provided the proper signals to turn the implanted cells into functioning insulin-producing cells in about 90 days.

When the scientists used a toxin to destroy the mice’s own islet cells, the animals that had received the human cells continued to produce insulin and control their blood sugar while mice without the implants quickly became diabetic. After about 100 days, the scientists then removed the implanted cells from the mice that had them, and blood sugar levels shot up.

“This for the first time validates that you can use human embryonic stem cells to produce fully functional human islets,” said Emmanuel E. Baetge, the chief scientific officer of Novocell and senior author of the report.

But Dr. Mark A Magnuson, a professor at Vanderbilt University and director of its stem cell biology center, said the Food and Drug Administration might not allow the transplant into people of cellular material that would have to “mature” in the body.

“Would this happen reproducibly in different people, and would it be the same in all transplant sites?” Dr. Magnuson said in an e-mail message. “If it wasn’t totally predictable, could there be adverse effects, such as tumors?”

Indeed, in the Novocell experiment, 7 of the 105 mice with the implants developed teratomas, a sort of tumor. Dr. Baetje said Novocell probably could have reduced or eliminated the teratomas if it had purified the cells before implanting them.

Dr. Ricordi of the University of Miami said he was somewhat concerned by signs that the implanted cells cut glucose levels too much, which itself can be dangerous.


This article written by Andrew Pollack, published at nytimes

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Medical Career Training

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