Problem Identified, How Is It Fixed?

I’m going to provide a lot of details here, not to bore you, but to let you see just how frustrating a problem a CO leak can be to resolve when there is no clear-cut, quick to test and identify leak present that can be fixed without much fuss.

When my carboxyhemoglobin (COHb) blood test showed my level was 12.9% I had no idea if that level was harmful, nor did I know if it indicated continued exposure or if it just was taking time to decline after exposure. 

Like most people, I hadn’t ever heard of a carboxyhemoglibin test, let alone have an understanding of what it meant to have a COHb of 12.9%! 

Since I wasn’t sure what the COHb was telling me, I sought out experts that might give me information – someone, anyone, whom could tell me if I needed to be patient, it takes time for COHb to normalize, or tell me I was still being exposed to CO.

Enter Dr. David Penney, PhD – Professor of Physiology & Adjunct Professor of Occupational and Environmental Health in the School of Medicine, Wayne State University AND Director of General Surgical Research at Providence Hospital, Southfield, MI.  A researcher with decades experience, more than 110 published research papers, a dozen review articles, and books published on the subject of carbon monoxide exposure and poisoning, he was the man with the expertise about carbon monoxide poisoning that I had to contact.

I emailed him to ask what a COHb of 12.9% meant in terms of my exposure and was it a likely suspect causing so many of the health issues I experienced for the last couple of years.  He kindly replied within an hour or so that he’d like me to call him.  I did, and in the almost two hour conversation, I learned we had a problem and was given lots to read and follow-up on – namely things related to my short and long-term health and approaches to investigating the source of the CO that was definitely still present and poisoning me.

After speaking with Dr. Penney, I called our HVAC service provider, they returned to our home, conducted a bunch of tests, but found no CO, not even very low levels, emitting from the furnace.  The HVAC technician wasn’t all that helpful with information about how to resolve the issue; no ideas about what to do or whom to call to continue investigating the source – in fact, he basically thought we didn’t have a problem and pretty much dismissed my concern, saying I was worrying myself over nothing.

At that point, I was frustrated, I had a COHb of 12.9% – Dr. Penney had been clear, a COHb of 12.9% translated to either a fairly high level of acute exposure for a limited time – or – a longer-term, chronic exposure to lower levels.  With no alarms sounding a warning to alert us to the presence of higher levels, my exposure was almost certainly low-level and chronic, which explained my progressively worsening health symptoms. 

Yet here was our service contactor saying not to worry if we had no alarms going off. 

Who was right? 

I was putting my bet on Dr. Penney.

From my conversation with him, I understood that in our home we have five potential sources of carbon monoxide – in our utility room there are the furnance and hot water heater systems; in the kitchen, the gas stove top; between our family room and living room, the fireplace; and lastly, the attached garage. 

So, me being me, I sought more information.  Dr. Penney was so helpful, but he wasn’t an engineer – I needed to know how combustion systems worked and where they fail in relation to carbon monoxide.  I knew nothing about is combustion systems, so I shot off an email to another researcher I’d read about online – Tom Greiner, Associate Professor, Agricultural & Biosystems Engineering at Iowa State University, explaining the situation, my discussion with Dr. Penney, and asking if he had any information he might share about how to diagnose a carbon monoxide leak. 

While I waited to hopefully get a reply back, I turned the furnace off; despite the chilly temperature outside, I didn’t want to take any chances.

Like Dr. Penney, Tom Greiner was quick to return an email, asking that I call him. 

I did, and again, I was given a wealth of information, in what was again a conversation lasting well over two hours – information and insight that proved critically important in our step-by-step process of elimination to identify the source.  In addition to needed information, Mr. Greiner suggested I contact a top industry expert – Bob Dwyer, who is presently the Director of Training at the CO Safety Association; formerly Director of Training at Bacharach;  his resume, when I searched online was impressive and included fascilitation of Carbon Monoxide & Combustion Safety Programs to over 100,000 people thorughout North America!   He was the expert, on-the-ground, about carbon monoxide and combustion systems!

Before contacting Mr. Dwyer, I felt I needed to somehow test our furnace, so I waited two days, keeping it off.  When we turned it back on, within 45-minutes the CO alarm in the room read 39ppm – no alarm sounded, but we had a reading and we now knew we had a problem. 

We turned the furnance back off and I contacted Bob Dwyer, hoping he might have some insights and advice on how to proceed since I wasn’t sure my HVAC contractor was necessarily up to the task.  Bob Dwyer has some serious experience with carbon monoxide – he too spent a couple of hours on the phone with me, going through various information I needed to know, from a much more technical prespective, and explained how simple, or complicated, it might be to resolve the problem. 

More importantly, he armed me with very specific information about the types of tests we could do ourselves to eliminate suspects to hone in on, and identify the source of the CO so we could contact the right person/company in to fix the problem.  He also gave very specific information about the types of testing that we’d want done, based on what we learned doing our own process of elimination, and called someone in to resolve the problem.  This information was invaluable!

First up, we moved monitors around and placed one within fifteen feet of our stove top and one within ten feet of the door to the garage; we left one monitor in the utility room and moved one into our bedroom, since that’s where we slept and needed overnight readings.  We checked daily and started a routine of testing different sources under different conditions since we needed to start to understand when carbon monoxide was present since many things can come into play and cause it to remain in, get sucked in, or re-enter your home. 

Things like air pressure, wind, gas pressure, pipe seals, etc. were all potential issues since each had the potential to change the dynamic of combustion of fuel and oxygen.

Who knew something so potentially deadly could be so complicated?

The gas stove top quickly eliminated itself – with no standing pilot and a nice blue flame, it never registered CO, not even a blip when first lit, not after 30-minutes of continuous use, not even any hint of CO after a solid hour of use.  Heck, we couldn’t even get a reading when we moved the monitor to within a foot of the stove top!  We were actually quite pleasantly surprised by this, since gas cooktops have very high allowances for CO emissions in homes.  Ours apparently was sealed well and not emitting CO even when on.  Yippie!

The garage was fairly easy to eliminate, so we were left with just two possibilities – the furnace, which we were told didn’t have a problem or the new hot water heater, which was just installed with a new ventilation system that included a power-vent. 

You’d think figuring which one was the problem would be pretty easy – the problem was, as we monitored, both seemed to have a problem…..sometimes.  Sometimes not. 

We were confident the problem was in the ultility room – when the monitors upstairs had readings, the utility room always had the highest reading.  But still didn’t know why since there was no consistency to when CO would rise in the room.  Sometimes it registered on the monitor with just the furnace on, sometimes with just the new hot water heater running, sometimes with both running, and sometimes not at all. 

Was the monitor wrong?  Were we just getting abberant readings that weren’t really there?  One way to answer that was to re-test my blood.  Two weeks had passed since my COHb level was 12.9% – if I was still being exposed, thus indicating the monitors were accurate when they registered low levels of CO, my blood would still have an elevated COHb level.

Two days later, the test results came back and my COHb had declined, but remained elevated above normal, it was now 6%.  I was still being exposed – not as often or with levels as high as before, probably because we were keeping the furnace off except to test now and then, but I was still exposed, confirming that our monitors, reading various levels and sometimes nothing, were indeed functioning.  My c-reactive protein (CRP) was also declining – where before it was 30, it was now 12…..inflammation still present, but diminishing to some degree; still way too high, but at least I now knew what was causing it to elevate and wasn’t petrified I was going to die any minute!

With the additional blood work and our intermittent, but persistent, readings of CO peaks on the monitors throughout the house, we called both the HVAC contractor and the plumbing contractor that installed the new hot water system. 

We felt they needed to work together to determine how the systems were working alone and in combination when both were on, and figure out how to resolve the problem.  Last Wednesday they both arrived early and surprise – the newly installed hot water heater ventilation pipe had a leak! 

They determined that because their was no seal at the point where the PCV pipe joined the vent cap, CO was escaping at very low levels into the utility room.  Depending on the air pressure in the room, the CO leaking in from this unsealed connection rose within the room, and with the furnace on, it was traveling throughout the house. 

Did my plumber forgot this critical step – sealing the pipe connection inside the vent cap – in the installation?

Apparently not.  The step-by-step installation instructions didn’t include this step, nor did the hands-on training he’d received directly from the manufacturer.  So now we were faced with the realization that not only did we have a problem, but this installation step may be critical….others might have a problem with their installation and not know it.

The manufacturer at that point was contacted, so they’re aware of the problem we had and what was done to hopefully eliminate the CO in my house.  The big question now was did sealing the pipe eliminate the problem?  We’d need to continue monitoring and hopefully have a windy day to challenge the systems to air pressure changes in the room and throughout the house.

We are now almost a week out since sealing the connection between the pipe and the vent cap – thus far we’ve had no CO registering on any monitor in the house, even when we’ve turned the furnace on for heat or air conditioning while the hot water heater is running.  We’re still waiting for the weather to cooperate and give us high wind conditions to potentially present significant changes in air pressure in the room and house. 

We watch and wait, hope we’ll have a windy day sooner than later, and have follow-up blood tests for my CRP and COHb scheduled for next Monday.

If a windy day causes yet another rise in the CO, then we’ll need to take a step back and have a back-draft analysis of our entire home.  If a strong windy day doesn’t change CO levels in the room or house, then we can be fairly confident that the leak happened because the pipe wasn’t sealed when the system was installed.

I really have to thank Bob Dwyer for putting the bug in my ear that a newly installed system was no guarantee we were free from a problem – that in his experience he had seen not only installation of a new system turn out to be unnecessary (that it wasn’t really the problem to begin with), but also had seen a new system installed that truly resolved an existing problem, but also created a new problem.

We know for sure, with no doubt, that our old hot water heaters were a chronic source of varying levels of carbon monoxide spilling into our house – their ventilation was inadequate (not only too long in length out of the house, but it had too many right angles and right angle equivalents to properly vent CO out of the house, most likely since the day it was installed in 1995), they were badly sooted inside and out, at the top and bottom, and they had a vent pipe reading of 1600ppm inside the utility room the day the alarm sounded.  They were a problem that plauged my health for years.

My health, getting progressively worse each year since moving into the house, was due what I now understand is occult carbon monoxide poisoning – a chronic exposure to low levels of carbon monoxide, that in time can, and too often are as lethal and deadly as an acute high level exposure to CO.  Because the symptoms parallel so many other potential health problems, it’s almost always missed – misdiagnosed as something else, with the victim returned to the source that’s poisoning them. 

Doctors are taught not to chase “zebras” because they’re too few and far between in their day to day practice of medicine.  For the average doctor, a “zebra” walking into his or her office is a once in a lifetime occurance, if ever. 

But I’m left wondering, is occult carbon monoxide poisoning really a zebra or is it something a lot more common than we think?

I didn’t have the flu, chronic fatigue syndrome, depression, polycythemia vera, heart disease, or any number of other diseases my symptoms mimicked.  I was chronically being exposed to low levels of carbon monoxide, slowly being poisoned – and this winter, I now know, I’d entered what I’ve been told is the “death window” – the period in year three to five of chronic low level CO exposure, where my symptoms accelerated, placing me at high risk for death. 

I’m lucky – others aren’t and their deaths from eventual heart failure may or may not even be identified at autopsy.

I’m also angry – since we got married, we’ve always had carbon monoxide alarms in our home, yet they only sounded twice – once in 2007 and again in March of this year – this despite carbon monoxide being present persistently.  I wanted to know why they failed to alert us that we had an ongoing, persistent problem with carbon monoxide in our house.

What I learned still leaves me numb. 

I’ll follow-up on why later in the week, but will leave you with a few lines included within the instruction packet for each of the UL compliant carbon monoxide alarms in my home. 

WARNING: This device is designed to protect individuals from acute effects of
carbon monoxide exposure. It will not fully safeguard individuals with specific medical conditions. If in doubt, consult a medical practitioner. Individuals with medical problems may consider using warning devices, which provide audible and visual signals for carbon monoxide concentrations under 30 ppm.

[...]

If the alarm is exposed to 70ppm of CO, IT MUST ALARM BETWEEN 60 AND 240 MINUTES.

[...]

The unit is designed not to alarm when exposed to a constant level of 30ppm for 30days.

——————

Translation when you include additional information contained within the instructions - your house can have anywhere between zero and 29ppm and you will never know it.  Your house can have between 30ppm and 69ppm all the time, and you will not know it unless you push the peak level button to see if any CO between 30ppm and 69ppm was recorded. ***

More to come in my follow-up!

***Some older models that are still within their expected shelf-life will record levels as low as 10ppm; some newer models may also record peak levels between 10ppm and 15ppm.  You must read the package insert to know what is the minimum level of carbon monoxide your monitor will record, whether it will sound an alarm or not!

Mystery Solved

At my age, when an estradiol level comes back elevated on Day 3 of a cycle, one almost automatically thinks it’s simply age, you’ve enetered that period of perimenopause and it is what it is.  You can’t change the passing of time on biology.

So in March, when my estradiol level came back at 120 (normal range 30 to 100), Gil wasn’t pleased to see it elevated on day 3, but wasn’t surprised given my age.  I, on the other hand, wasn’t surprised and didn’t think he should be either, since my cycle has always been short (23 days; sorry if TMI) and highly predictable (still is), so I thought it sounded reasonable that my estrogen levels would elevate earlier in the cycle! 

For well over a year, I was convinced something was drastically wrong with my thyroid – yet test after test found nothing wrong.  In fact, my numbers kept showing that my thryoid wasn’t just functioning as it should, but that its function was well within the optimal range you want to see for TSH and Free T4, and I was free from thyroid antibodies. 

You can only test so many times before you have to accept there is nothing wrong with your thyroid.

In my March bloodwork, we evaluated pretty much everything possible, including thyroid again, from the perspective of hormones; and all the tests were normal except my estrogen level.  That really nagged at me.  Hey, call it denial, but I’m not convinced my days are over for having another baby…my days may be numbered, but given the laundry list of things going wrong with me, age alone didn’t explain to me the vast majority of them. 

So with my protests, we scanned and confirmed the presence of a lead follicle already dominating the cycle, and it was sized appropriately for the level of estrogen.  So while the estradiol level was elevated, it could potentially be explained by the lead follicle.  Still though, it nagged at me – it wasn’t just that I had elevated estrogen early in the cycle, but also my CRP was beyond skyhigh, it was scary high (30) and a CBC again found elevated white blood cells with the elevation only with neutrophils. 

Something was radically wrong and it was causing inflammation and a strong immune response – maybe estrogen dominance wasn’t the only thing impairing my fertility, but maybe it held a clue to what was happening with my health?

I hit Google and PubMed.  It’s at this point where Google and PubMed could be friend or foe – searching causes of estrogen dominance online returned, literally, tens of thousands of suspects – some way out there, some well within believable, and some established, known offenders in our environment. 

Weeding through the results seemed overwhelming but I got lucky when I entered a bunch of keywords – estrogen, c-reactive protein, neutrophils, inflammation, infertility – and hit the jackpot. 

Into the fifth link I was reading described the relationship between nitric oxide and its impact not only on estrogen levels, but on inflammatory markers and white blood cell production, namely neutrophils. 

I wondered, how did nitric oxide possibly play into this with me? 

Was it really a possibility?

I changed my search parameters a bit and B-I-N-G-O, there it was, carbon monoxide poisoning….and I knew what the problem was and had been for quite some time. 

Apparently nitric oxide levels increase in the body when you’re exposed to carbon monoxide, that increase in turn elevates estrogen, over time causing estrogen dominance…..the longer one is hypoxic, the more NO circulating, the higher the estrogen is elevated…..it’s a viscous cycle.

I didn’t include exposure to carbon monoxide in my previous post because it didn’t register on my radar to communicate to any doctor I’ve seen in the last two years.  In fact, in my mind, it was an unrelated-to-health  issue that was resolved at each of two occurances in the past; therefore not something to include in my attempts at resolving the health issues that were plauging me.  It was only now, with this newfound potential lead, that suddenly, in hindsight, I realized it was highly possible I was suffering carbon monoxide poisoning.

Now for the history:

Two years ago, in May 2007, we had a carbon monoxide alarm sound in our house, so I called the fire department and they confirmed the levels in the house were dangerously high, we should keep the windows open to maintain lower levels while getting our plumber and HVAC contractors in to investigate.  We did that and it was determined that the hot water heaters were the cause of the carbon monoxide in the house and the problem was fixed (so we thought) - all was well before we retired for bed the same evening that our alarm sounded in the morning. 

The next day, on the advice of our HVAC contractor, we installed a CO alarm in our utility room downstairs, so that if carbon monoxide was an issue in the future, we’d have an alarm sooner than we did with only one on our main level.  We also installed an additional alarm on our main floor level and one upstairs so all levels of the house were monitored for high levels of carbon monoxide.

Fast forward to March 10, 2009 – the CO alarm in our utility room downstairs is screaming and wakes me in the pre-dawn hours. 

Same routine – fire department in, carbon monoxide present and needs to be investigated;  HVAC and plumbers called, and it’s determined that our hot water heaters are shot, the problem can’t be fixed, we’ll need to replace them. 

In my mind that’s reasonable considering that the hot water heaters are those originally installed in 1995 when the house was built, so they’re 14 years old and should be replaced, they’re past their shelf-life…..but our plumbing contractor determines too that our ventilation system for the hot water heater exhaust is terribly inadequate, so in addition to replacing the hot water heaters, we’ll also need to install a new exit route for the exhaust. 

From what I’ve read about carbon monoxide, I want to do what I can to keep us safe….so we decide we’ll even go with a power-vent system to be sure we don’t have another carbon monoxide problem in the future….and while we’re at it, let’s go with a tankless model to eliminate the issue of needing to constantly heat water in reserve;  such a system is a bit more expensive, but doesn’t need replacement as often as a storage tank hot water heater. 

As far as we were concerned, our problem was solved when the new hot water system was installed on March 16th.  Problem is, when my bloodwork was drawn on March 24th, CBC revealed elevated white blood cells, my CRP was skyhigh and my estrogen was elevated – and now, staring me in the face from online keyword searches was carbon monoxide poisoning. 

Given the half-life of CO, it was a full two weeks since the CO alarm sounded and the hot water heaters were turned off, and one week since the new system was installed, including a new ventilation route out of the house.  Carbon monoxide shouldn’t be the problem, but all leads at that moment were pointing to it.

I seriously wanted to know my carboxyhemoglobin levels, and on March 28th, eighteen days after the carbon monoxide issue was thought resolved we drew blood to measure my COHb.

The call came after midnight on Monday, March 30th,  since my COHb was critically high at 12.9% and that level wasn’t something the lab could wait until morning to report.

The finding confirmed I was poisoned by carbon monoxide, and the next day as I started reading through the literature, I was shocked by how many of the things going wrong with me were directly related to chronic low level exposure to carbon monoxide.  I knew an acute, high level exposure was dangerous, could even be lethal – but what was this ‘low level exposure’ potential on health?

I now had a culprit to eliminate, but still no peace since we thought our problem was resolved when the hot water heater was replaced and a whole new ventilation system installed.  Where was this still coming from? 

More importantly, why didn’t our alarms go off it is was such a persistent problem?

The revelation that I was suffering from chronic carbon monoxide poisoning started an incredibly informative and frustrating journey to get to the bottom of the source. 

And that I’ll explain in my next post, where I’ll also thank three very helpful people,  experts that without whom I’m not sure we’d be as far along as we are in resolving this and am grateful to for their time and expertise in helping us figure out this mystery!

Mystery Diagnosis

Have you ever watched the television show, Mystery Diagnosis?

It’s one of the few shows I enjoy and it is often amazing how often misdiagnosis or a total inability to find a diagnosis leads ordinary people on a quest to just understand what is wrong with them.  Often they reach a point where it’s not simply a matter of finding treatment, they just want to know what it is that is making them sick, whether there is available treatment or not, they just want a name for what’s wrong.

I haven’t posted since December, but before I post the reason why, I’m going to share some things that have been going on and getting progressively worse to see how many of my readers can figure out what’s been wrong! 

Let’s call this Regina’s Mystery Diagnosis.  Those of you whom already know what was going on can’t comment!

Here are the many symptoms I’ve experienced over the last three years, which provide clues:

• Progressive fatigue
• Progressive lethargy
• Dry skin & dull hair
• Aquagenic urticaria (hives after exposure to warm water or humidity)
• Secondary infertility
• Recurrent pregnancy loss
• Progressively persistent mild cough (like having to clear throat more often than normal)
• Sinus congestion; need to blow my nose when I wake up each morning
• Numbness around left hip bone area [progressive worsening]
• Cold hands all the time
• Cold feet all the time
• Slowing growth of hair on legs and under arms [by February 2009, I could go a full month without shaving it had gotten so slow, and even then it wasn't like I had to absolutely shave or braid, it was just enough to want to shave!]
• Forgetfulness [progressive for two years and getting much worse by the day in 2009]
• Progressive Moodiness & Irritability
• Premature Ventricular Contractions (PVC) [May 2008]
• Arrhythmia [May 2008]
• Pounding heart beat [intermittent, but persistenet since May 2008]
• Cramps in legs & feet at night, wakes me up at night [started Fall 2007, progressive]
• Lightheadedness
• Feeling like I might faint when standing up from lyng down or sitting position [started February 2009 after return from Colorado]
• Mild elevation of blood pressure [once, May 2008]
• Weight gain without drastic change to eating habits [November 2008 - March 2009]
• Difficulty losing weight despite reducing carbohydrate to 40g or less each day
• Bloating & retaining water
• Muscle & joint aches
• Numbness in fingers/hands upon waking [started February 2008]
• Numbness in lower arms upon waking [started October 2008]
• Intermittent insomnia
• Tingling lips [intermittent, started sometime in the Fall 2008]
• Palpitations [on and off since May 2008]
• Generalized muscle weakness
• Exercise intolerance & intermittent shortness of breath
• Mild headaches (occasional)
• Mild GI issues (occasional)
• Complete inability to focus attention [November 2008 to April 2009]
• Declining ability to do math sequences
• Hard to find the right word more often
• Low to no tolerance for stress, physical or emotional [progressively getting worse]
• Deep crevice wrinkles developing around my mouth when I smile [progressive]
• Developing wrinkles around eyes
• Puffy inflammed bloated appearance
• Water retention with tightening of rings on fingers
• Ruddiness on cheeks, almost like rosea but not rosea

Lab Bloodwork Values with more clues:

May 2008
During cardiac workup for palpitations, PVC’s and arrhythmia, blood pressure was mildly elevated (130/90 – I’m usually 110/70) and lab tests showed:
Elevated Red Blood Cells
Elevated White Blood Cells (notably neutrophils)
Elevated Hemaglobin
Elevated Hematocrit

Updated to add: non-fasting glucose, 89 (taken two hours after breakfast)

August 2008
Maternal chromosome karyotyping – normal
Clotting factors – normal
TSH & Free T4 – normal
Pituitary hormones – normal
Adrenal hormones – normal
Antibody testing – negative
Autoimmune tests – negative
Infections – negative
Allioimmune tests – negative
Genetic tests – all normal except for one copy (heterozygous) for MTHFR C677T
Blood pressure 110/70

C-Reactive Protein = 9

October 2008
TSH & Free T4 – normal

C-Reactive Protein = 12

March 2009
TSH & Free T4 – normal
Red blood cells – high normal
White Blood cells – highly elevated (notably neutrophils)
Elevated hemoglobin
Elevated hematocrit

Updated to add (Day 3 Hormone Tests) in March 2009

Estrogen – elevated
FSH – low normal (expected, estrogen elevated)
LH – low normal (expected, estrogen elevated)
Progesterone – normal
Prolactin – normal
Testosterone – normal
DHEA – normal
AM Cortisol – normal
IGF-1 – normal
FBG 82
Any other tests I’m forgetting were also normal

C-Reactive Protein = 30 (yes, it was really 30)

Add to this all an interesting observation made in hindsight – in our trips to Colorado in January and March 2008 and again in February 2009, I was able to go to altitude with no ill effects – no headaches, nausea or shortness of breath upon physical exertion.  For both trips in 2008 we’d taken a 2-day period to go from our altitude in Columbia of less than 700 feet above sea level to 10,000+ feet above sea level by staying in Denver to adjust before going to Keystone and Vail.  This year, however, our plans meant I had to go, same day, from where we live to 10,000+ feet in less than 12-hours.  While Gil and Hunter were both queasy and had headaches, I had no problems going to altitude that quickly.  In fact, during that vacation, my energy levels again started to increase, despite being at altitude with lower oxygen levels.

My CRP level at 30 prompted me to ask for one more test before panicking, and that one test dropped the bombshell that told us exactly what was the problem that plauged me for almost three years.  What was that one test and what was the problem?

Feel free to leave comments and I’ll post a follow-up in the days to come to explain what was wrong and why it remained elusive to diagnosis!

New Yorkers Brace for Double Tax on Sugared Beverages

Commentary from Governor David Patterson, New York on CNN.com:

Today, we find ourselves in the midst of a new public health epidemic: childhood obesity.

What smoking was to my parents’ generation, obesity is to my children’s generation. Nearly one out of every four New Yorkers under the age of 18 is obese. In many high-poverty areas, the rate is closer to one out of three.

That is why, in the state budget I presented last Tuesday, I proposed a tax on sugared beverages like soda. Research has demonstrated that soft-drink consumption is one of the main drivers of childhood obesity.

These days I’m no longer surprised when something like an “obesity tax” is foisted upon the masses without so much as a whimper – afterall it is your fault if you’re fat, right?  You should pay more, right?

Several commentators in the media applauded the move by Governor Patterson – Nicolas Kristof opined the hope that other states will follow suit because “if other states follow, [it] could help make us healthier.”

He even ties it up neatly with a bow, repeating Patterson’s parallel to smoking and cigarettes, “These days, sugary drinks are to American health roughly what tobacco was a generation ago. A tax would shift some consumers, especially kids, to diet drinks or water.”

No one likes taxes, but by golly, we must do this for the children!  We must save ourselves from ourselves with this tax – save the children, save the world, reduce consumption of sugared beverages and all will be well.

What’s maddening isn’t so much the propsed tax on sugared beverages, it is what government does if they can get away with it….what’s maddening is that no one seems to notice that we are already paying taxes that enable the flood of cheap soda, fruit drinks and sugared beverages into our markets.  It’s paid by our taxes in the Farm Bill, with corn being king amongst the crops subsidized by our tax dollars.

This new tax represents a double taxation to New Yorkers – taxed first from their income to subsidize corn in the Farm Bill; and now to add insult to injury, when they dare to consume products made from the corn products their tax dollars helped make cheap at the consumer level – namely high-fructose corn syrup….beverages produced that are artificially low in price at the consumer level and often cheaper than buying a bottle of water!

If the government truly wants to tackle the obesity epidemic, perhaps it’s time to revisit the Farm Bill and how it is directly creating a market flooded with cheap corn calories at the consumer level for things like high-fructose corn syrup which is used in thousands of food products in our markets!

Banning Bottled Water?

They say the road to hell is paved by good intentions.

The Toronto Star recently noted the political battlelines drawn around the debate to ban bottled water in Toronto, “Environmentalists claim bottled water commercializes a public resource, undermines faith in Canadian water systems, and sends plastic bottles to the landfills. The bottled water industry counters that environmental groups rig recycling rate numbers and vilify a product that helps combat obesity.”

Last week the vote was cast and the Toronto city council voted to immediately ban the sale and/or distribution of bottled water in City Hall and the city’s civic centres where contracts permit, and ban the sale and/or distribution of bottled water in other city-owned facilities such as arenas and theatres by the end of 2011.

While it’s now illegal to not only sell bottled water, but also illegal to distribute bottled water in city-owned facilities in Toronto, it’s still perfectly legal and acceptable to sell and distribute sweetened waters (translation – soda and fruit drinks).

Afterall, isn’t that really what soda and fruit drinks are – simply sweetened water?

Let me see if I understand this.

Bottled water = bad-illegal

Bottled soda & fruit drinks = good-legal

This vote after Statistics Canada released data that found Canadians consumed more than 95 litres of soft drinks in 2007!

How much more soda and fruit drinks do you think folks will drink now that bottled water is banned?

And So We Begin the Food Stamp Challenge

When I posted about this year’s Food Stamp Challenge yesterday, underway in various locations in the US, I assumed it was going to be much harder this year to stay within the allotted budget despite an almost double amount of money last year. My regular readers may recall, last year I reviewed the sales circulars online to get the best bargains, planned the week of meals before I went shopping, had to include a fairly high level of canned goods (especially beans) and barely made the budget.  We did well nutritionally – with the exception of Vitamin D, we met all nutrient requirement RDA’s and managed to keep carbohydrate intake at an average 97g per day for the week; 73g net if you deduct fiber.  But, as I noted, it wasn’t easy to do on a budget of just $3.00 per person per day, or $63 for the week for my family.

 

This year, with a nearly double budget – $123.27 for the week ($5.87 per person per day) – I changed the rules I’d follow in response to comments last year.  Unlike last year, this year I’d shop in only one store, no pre-planning; instead I’d grab a sales circular on my way into the closest grocery store to my home and do my shopping for the week without any menus planned ahead of time.

 

Now I don’t shop for many routine items at the grocery store – most meats for us are usually ordered from a local farm, I buy a lot of produce at the local Farmer’s Market, and some things, like cheese, I usually buy at a specialty shop in town.  But I do shop enough in the grocery stores to note that prices have definitely risen over the last year, with some items nearly double what I remember from last year.

 

When I did our grocery shopping yesterday, at HyVee (closest to my house) I was surprised that I wasn’t just within budget, but that I didn’t spend the entire budget.  And, I included a number of items that were “maybe” items, held back until I could see the running total for the “must have” foods; “maybe” things like crumbled blue cheese, roasted red pepper hummus, name-brand coffee, a small container of heavy cream, a fancy brand of fajita wraps and a small pumpkin my son asked for that we aren’t going to actually eat.

 

That isn’t to say I didn’t make any compromises – I did buy canned green beans over the fresh, they were much less expensive in the can; I chose frozen whole strawberries over the fresh for the same reason; and frozen broccoli won over the fresh too.  My cuts of meat, poultry and fish were all selected by price rather than higher priced selections. For the most part, organic foods were out….one compromise I would not make was the organic, grass-fed, VAT pasturized, non-homogenized milk for my son; that was one thing that would be included no matter how much it cost.  Luck had it though that it was on sale this week!

 

I also decided once I saw the sale circular for the week, that I’d see if I could do a week with low-carb – basically keep carbohydrate (for my husband and I only) at or below 60g a day on average and not have to include much in the way of beans or starchy foods, although I did buy two bread items (wraps and pita) when I saw they were possible within the budget.  My goal again this year is that in the week we are able to eat well and meet our nutrient requirements.  I think I did fairly well too!

When all was totaled, I spent $115.55 before tax, $120.91 with tax.

 

What did I get for my money? 

 

 

 *Items with a star were “maybe” items included when I saw the total was still within budget, listed in order placed into the final order. 

1-pound butter
3-quarts half & half
2 dozen large eggs
1/2 gallon organic whole milk
1 8-ounce brick store-brand mozzarella
1 8-ounce brick store-brand cheddar
1 container sour cream
1 container cottage cheese
1 package cream cheese
10 8-ounce containers assorted store-brand yogurt (including plain)

 

1-pound deli ham (it was a steal at $1.99 a pound!)

 

1-pound bag frozen broccoli
1-pound bag frozen spinach
1-pound bag frozen whole strawberries

 

Box of tea bags
1 can bean sprouts
2 cans green beans
Small Hellmann’s mayonnaise
2 Bottles store-brand salad dressing
1 small bottle soy sauce
2 cans mandarin oranges
1 bag dried split peas
1 packet taco seasoning
1 can tomato paste
1 can diced tomatoes

1 bag sauerkraut

5 bananas bunch
2 pears
1 head cauliflower
2 cucumbers
2 bags of store-brand mixed salad
1 head iceberg lettuce
2 kiwi fruit
1 yellow pepper
2 red peppers
2 green peppers
Yellow and green squash
1 spaghetti squash
2.5-pounds carrots
1 package Wholly guacamole
4 lemons
5 onions
1/2 cantaloupe
5 apples
2 plums

 

1 package Johnsonville sausage patties
1 package Oscar Mayer bacon
1 whole chicken
1 package chicken leg/thigh quarters
1 package split chicken breasts
2 pounds ground beef
1 large pork roast
1 package coconut crusted fish filets (store made; raw; frozen)
1 package eye-of-round steak

Folgers coffee* (I had a smaller, less expensive container, but added this instead) 

1 package boneless skinless chicken breasts*
1/2 pint heavy cream*
1 small bottle olive oil*
1 small jar minced garlic*
Assorted bags, very small amounts, open/loose spices sold by the ounce*
1 container blue cheese crumbles*
3 small sample size cheese (butterkase, gouda, gruyere)*
1 container roasted red pepper hummus*
1 5-pack Toufayan tomato wraps*
1 package pita*
1 small pumpkin*

You’ll notice that above I don’t have any tomatoes or tomato sauce.  That’s because we have a garden and right now, an excess of tomatoes that have to be eaten or made into sauce, so I’ll be using those tomatoes in some dishes this week.

As you can see, I wasn’t left with little choice – I didn’t have to buy boxes of macaroni & cheese or ramen noodles.  In fact, with the higher budget this year, I was able to buy much more fresh produce and meat, along with some “goodies” to enhance the meals I’ll make, like blue cheese to top salads, assorted cheeses for snacks, and decent coffee for our morning brew.

Last night we kicked off our week with a delicious chicken & beef fajitas, complete with tomato wraps, sour cream, guacamole and cheddar cheese that I shredded from the block of cheese.  Since our son isn’t too keen on spicy food, I made him some plain chicken and onion sautéed in a little butter, and with that he had some broccoli and a blueberry yogurt, and then a plum for dessert. 

 

Food Stamp Challenge 2008

In May 2007, I decided to step up to a challenge getting a lot of press as the Congress was readying to pass a new farm bill – it was to feed my family with a budget those recieving food stamps must stay within each week.

At that time, the average per day was just $3.00 per person each day, which translated to $21 per week per person, or $63 total for all three of us to eat for one week. I chronicled my shopping, meals and my thoughts afterward between May 25 and June 5, which are still available on my blog.

Making the news this week is a new challenge as we near the holiday season and more individuals and families find themselves in need of assistance. Yesterday kicked-off the Grand Rapids for the Michigan Food Stamp Challenge where those participating try to live on $5.87 per day per person (the new, higher maximum level provided to recipients).

From news reports, “300 state and local leaders who have pledged to live on the equivalent of food stamps for five days.”

Apparently the governor of Michigan, Jennifer Granholm, is participating in the challenge. As reported by mlive.com, “The governor says she took her son shopping Sunday at a Meijer grocery store. They could only spend $5.87 per day per person. She says she bought a lot of macaroni and cheese.”

Like last year, I’m not surprised by the belief perpetuated in the media that one must eat poor quality, high carbohydrate, cheap foods to survive on a limited budget. Last year I showed that was untrue as I fed my family a high-quality, nutrient dense diet for the week on just $3.00 a day per person. This year recipients receive even more money and I have to wonder, given the current economic situation, is the increase enough or not?

So this year, once again, I’m going to see what a food stamp budget, $5.87 per person per day, buys us since food prices have steadily increased in the last year.

Can we eat as well as we did last year?

Will I need to make compromises?

Will we eat better?

Last year a number of comments criticized that I shopped in three different stores, had access to the internet to review sales circulars and plan based on sales, and had time to plan our meals before I shopped. For this challenge, I will shop in the closest grocery store to our house, will pick-up the circular when I enter the store and do my best without pre-planning the week since it was pretty clear that time and ability to plan ahead are both issues for many.

Like last year, I invite readers to step up to the challenge too and share your experience in the comments as we move forward for the week, starting tomorrow.

Here’s our rules for the October 2008 Food Stamp Challenge:

1. Maximum per person is $5.87 per person per day. For us, a family of three, this means I have to feed us with just $123.27 in the coming week. Your total budget does not include any sales tax since recipient purchases are not subject to sales tax.

2. Salt and pepper are considered in your pantry, so you do not need to buy either. But any other spices, condiments or cooking fats/oils do need to be purchased or you need to deduct a portion of your cost when you did buy the item that is in your pantry since it’s difficult to have a stocked pantry when you’re on food stamps. For example, if you do have chopped garlic in your house, you don’t have to buy another jar for the week, but should – if you use some – deduct a part of the cost. If the jar cost $5.00 and you use one serving from a 10-serving jar, take 50-cents off your budget to account for the garlic you used.

3. It’s best to plan ahead, so if you have mailed or newspaper ad circulars, review what’s on sale and make a list before you shop. This time around, I’ll personally not plan ahead like I did last year and I’ll shop in only one grocery store. You don’t have to unless you want to also.

4. If you have a child in school and they receive or buy lunch, do not deduct this from your budget. Any foods you pack for lunch or snacks does have to be part of your budget however.

5. The budget does not include paper products, cleaning supplies, over-the-counter medicines, prescription medication, or non-food items not covered by food stamps. If you do need to buy these while you’re shopping, just make them a separate order, paid for separately, so you can accurately add up what you’re spending on food only.

6. We can shop for, prepare and cook whatever we want to eat, and can eat free food at business functions, meetings, work, or other places just like anyone else; in addition we can sample from tasting stations in grocery stores, and eat at parties we attend, hosted by friends or family. We cannot take home leftovers to stretch our budget though.

7. We can also eat out – but do need to include any meals we pay for and include the tax and tip since food stamp recipients cannot pay for meals out with their debit card, but also do have the expectation that the food stamps are assistance, not their sole source of buying food…we’ll include any meals out in our total budget.

Basically, the challenge includes preparing and eating what you are able to purchase throughout the coming week, and any meals eaten out, since it’s one thing to have to shop with a limited budget and another to live with it for a week.

Who will join me this week?

Again this year, those participating in the challenge are encouraged to email me photos of their groceries for the week, along with recipes and meal ideas and insights about your experiences during the week. I’ll highlight them here on my blog next week and open discussion about the various challenges we all faced, and the things we learned along the way! As always your comments are welcome as the challenge gets underway!

Investigate the Alternate Hypothesis

Ever since the publication of Gary’s Taubes’ Good Calories, Bad Calories, folks within the low-carb community have suggested and discussed various study designs to investigate the alternate hypothesis, the “Carbohydrate Hypothesis”, explored in the book.  The biggest issue isn’t so much designing a study, but funding a study large enough and controlled enough to reach valid conclusions.

 

With obesity considered one of the most pressing health issues of our time, wouldn’t it be great if we could find the resources necessary to investigate, in a really well done trial, that alternate hypothesis?

 

Enter Project 10¹⁰⁰  -  a call for ideas to change the world by helping as many people as possible.

 

Project 10¹⁰⁰ is accepting submissions of ideas for projects until October 20, 2008.  One hundred ideas will be selected for public review and voting to narrow the field to twenty semi-finalists.  An advisory board will then select five projects to fund from a commitment by Google of $10-million dollars.

 

One category is “Health” and the critera provided to help those submitting ideas includes:

 

Criteria:

• Reach: How many people would this idea affect?
• Depth: How deeply are people impacted? How urgent is the need?
• Attainability: Can this idea be implemented within a year or two?
• Efficiency: How simple and cost-effective is your idea?
• Longevity: How long will the idea’s impact last?

Project 10¹⁰⁰ may be a way to fund a study to investigate the Carbohydrate Hypothesis!

 

If you’d like to submit your ideas, you can go to the Project 10¹⁰⁰ website, or directly to the submission page.

A Picture Worth 1000-Words

Gary Taubes – Columbia, MO – November 2008

Gary Taubes, author of Good Calories, Bad Calories and three time winner of the National Association of Science Writers’ Science in Society award, is scheduled to present his lecture, The Quality of Calories: Big Fat Lies: The Truth About Diet, Exercise and Obesity, on November 13, 2008 in Columbia, Missouri.

The event is sponsored by the Boone County Medical Society and the Department of Nutritional Sciences at the University of Missouri.  It is free and open to the public.  Registration is strongly recommended as seating is limited.

The presenation will take place at the Monsanto Auditorium (University of Missouri) at 2:30pm and will be followed by a reception in the McQuinn Atrium.  More details are on the flyer below.  To register online, click here.

Public Comments Open for USDA School Lunch Program

Daily school lunch offered in Columbia, MO

Last week, in the Atlanta Journal Constitution, an article revealed some
shocking school breakfast and lunch options: “Pop-Tarts and doughnuts
for breakfast for 2-year-olds. Rolls, chicken nuggets and French fries for
school lunches. Brownies given the same nutritional value as a slice of
whole-wheat bread.”

This struck a chord with me since I recently posted here about the dismal lunches served in the Columbia Public Schools in Missouri. One particularly disturbing lunch option – Smucker’s PBJ Uncrustable, Pepperidge Farms Goldfish Pretzels, Rice Krispie Treat, 1% cholocate milk, baby carrots and a fruit – is offered daily to students throughout the district!With 789-calories, the school’s website highlights that the lunch contains 23g of protein (92-calories) and just 24% fat (189-calories; 21g); no mention that this means the lunch also contains 508-calories from carbohydrate (127g), or the equivalent of 32-teaspoons of sugar in a child’s metabolism…not to mention if a parent packed such a lunch for their child each day, they’d be branded as irresponsible and lending a hand to the epidemic of childhood obesity!

With school back in session across many states, it seems we have a pattern that shows school lunches are not as healthful as we’re led to believe!

Senatobia, Mississippi: Chicken Nuggets or BBQ Rib Sandwich, Mashed Potatoes w/Gravy, Cheesy Broccoli, Hot Cinnamon Apples, Fruit Juice, Yeast Roll, Gelatin. (assorted milk)

Randolph, Massachusetts: Nachos with cheese, beef, onion, tomato and sour cream and fruit. (assorted milk)

Roff, Oklahoma: Corndog, tator tots, black-eyed peas, chocolate pudding and milk.

Whittier, Massachusetts: Choice of Domino’s of french bread pizza, small salad, pretzel, assorted fruit. (assorted milk)

Folsom, New Jersey: Nachos with cheese or Smucker’s PB&J, vegetable, fruit and milk.

Ada, Oklahoma: Frito chili pie with cheese, green beans, garden salad, rosy applesauce, salad bar and milk.

Benton, Arkansas: Pizza, corn, salad, half an orange, milk. Nachos, pizza, chicken nuggets, corndogs, frito chili pie….what is frito chili pie anyway? And why are we not disturbed by these school lunches offered to our kids each day?

Continue reading…

Low-Carb Health Examiner

With so much already on my plate, you’d think I was nuts for taking on one more thing!

But I have – I’m now posting columns Examiner.com as the national Low-Carb Health Examiner!

My first post there is a reprint, from 2005: Food for Thought

I’m still working out the kinks, but will still be writing and posting here too…!

Jamie VanEaton, whom many will recognize as “Cleochatra“, is the national Low-Carb Examiner and Amy Dugan, whom many will recognize as “Sparky’s Girl” is the St. Louis Low-Carb Examiner.

Feeding Infants Fructose

Discussion:  Consuming fructose during suckling may result in lifelong changes in body weight, insulin secretion, and fatty acid transport involving CD36 in muscle and ultimately promote insulin resistance.

That was the conclusion reached by researchers who published Dietary Fructose During the Suckling Period Increases Body Weight and Fatty Acid Uptake Into Skeletal Muscle in Adult Rats, in the journal Obesity.

While the study was on rats, it’s interesting to look at the ingredients in baby formula sold in the United States (all of the below are the first few ingredients listed from peapod.com and do not include the brand name):

INGREDIENTS:  Nonfat Milk, Whey Protein Concentrate, Corn Syrup Solids…

 

INGREDIENTS:  Corn Syrup Solids, Partially Hydrolyzed Nonfat Milk and Whey Protein Concentrate Solids, Vegetable Oil…

 

INGREDIENTS:  Corn Syrup Solids, Vegetable Oil (Palm Olein, Soy, Coconut, and High Oleic Sunflower Oils), Casein Hydrolysate …

 

INGREDIENTS:  Corn Syrup Solids (43.2%), Soy Protein Isolate (11.5%), High-Oleic Safflower Oil (10.3%), Sugar (Sucrose) (8.4%), Soy Oil (7.7%), Coconut Oil (7.7%)….

Is there a connection with rising prevalence of childhood obesity and feeding infants corn syrup solids?  Things that make you go ‘hmmmm’

My New Blog Home

Well, I decided to migrate my blog, Weight of the Evidence, to WordPress.  This was due to Blogger locking my blog under the mistaken belief it was a “spam blog”.  I have some minor work to do on the posts that migrated to get them properly tagged – but should have that complete by the end of next week.

For anyone who has my old blog address in their links (weightoftheevidence.blogspot.com) – please change the link to www.WeightoftheEvidence.com – Thank you!

Chew on this…

The Cochrane Database of Systematic Reviews recently withdrew a document within its collection – Advice on low-fat diets for obesity.

As we learn on The Cochrane Collection website, the editorial group responsible for this previously published document have withdrawn it from publication.

The reason cited for the withdrawal?

This review is withdrawn because it is very much out of date, as authors stated. None of the authors has any plans to update it.

Happy Trails to you….

http://www.youtube.com/watch?v=4IGtDPG4UfI

Two Year Dietary Trial Results: Low-Carb Better than Low-Fat

The study just published in the New England Journal of Medicine, Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet (free full-text), is quite a read, with lots of data and lots of findings to explore and look at!

First things first – the objective of the study was to compare the effectiveness and safety of weight loss diets over a two year period.

The dietary approaches included in the study:

• a low-carb diet, loosely based upon the Atkins diet, no calorie restriction
• a Mediterranean diet, calorie restricted, based on the recommendations of Dr. Willett & Dr. Skerrett (Eat, Drink & Be Healthy)
• a low-fat diet, calorie restricted, based on the American Heart Association guidelines

In addition to weighing participants each month and measuring waist circumference, the researchers measured at reporting invervals (6-months, 12-months and 24-months) total cholesterol, LDL, HDL, triglycerides, fasting blood glucose, fasting insulin, HbA1C, blood pressure, HOMA-IR, C-reactive protein, leptin, adiponectin, bilirubin, alkaline phosphatase, alanine aminotransferase and urinary ketones.

Enrolled in the study were 322 volunteers; they were provided their largest meal each day (lunch) at work, and given support and guideance about their diet throughout the study period. Of the 322 who started the trial, 95.4% completed one year, and 84.6% (272 participants) completed the 24-months – making this perhaps, the best adherence level in a dietary trial lasting two years!

So what happened? Let’s look at the various outcome measures to see.

Weight Loss

The mean weight changes among the 272 participants who completed 24 months of intervention were:

–3.3 ±4.1 kg in the low-fat group (7.3-pounds)
–4.6 ±6.0 kg in the Mediterranean-diet group (10.1-pounds)
–5.5 ±7.0 kg in the low-carbohydrate group (12.1-pounds)
(p=0.03)

Overall, in the intent to treat data (which includes even those subjects that did not complete the study) the weight loss was reported as:

–2.9 ±4.2 kg for the low-fat group (6.4-pounds)
–4.4 ±6.0 kg for the Mediterranean-diet group (9.7-pounds)
–4.7 ±6.5 kg for the low-carbohydrate group (10.3-pounds)

The reason I note the two findings is that in the media reports, the trend appears they’re reporting the intent-to-treat numbers, which are lower because they include the 50 subjects that dropped out. Those who actually completed the study are the data I prefer to look at for weight loss since it accurately presents how effective the dietary approaches are when continued for two years!

Waist Circumference

-2.8 ±4.3 cm in the low-fat group
-3.5 ±5.1 cm in the Mediterranean-diet group
-3.8 ±5.2 cm in the low-carbohydrate group

Lipid Profiles

The graph itself speaks volumes:

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein decreased significantly only in the Mediterranean-diet group (21%) and the low-carbohydrate group (29%), during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

During both the weight-loss and the maintenance phases, the level of high-molecular-weight adiponectin increased significantly in all diet groups, with no significant differences among the groups in the amount of increase.

Circulating leptin, which reflects body-fat mass, decreased significantly in all diet groups, with no significant differences among the groups in the amount of decrease; the decrease in leptin paralleled the decrease in body weight during the two phases.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Among the 36 participants with diabetes, only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly different from the increase in plasma glucose levels among participants with diabetes in the low-fat group.

This is critically important to note – the low-fat group experienced a rise in fasting blood glucose over the course of the two years; this despite a greater calorie deficit than the other two diets, and a greater increase in physical activity! Yet, this type of diet is exactly how the ADA recommends people at risk for or diagnosed with diabetes eat, while expecting ever increasing doses of medication to cover their progressive decline in glycemic control.

It is also noteworthy that, “there was no significant change in plasma glucose level among the participants without diabetes.” Basically those who did not have diabetes did not experience any change in their values over the period of the study.

What the researchers did not note in their written text of the results was this – the low-carb dieters had similar declines in their fasting blood glucose levels through month 12, followed by a progressive decline through month 24.

If we look at the data provided, we can see something important changed – the quality of the carbohydrate they consumed seems to have declined. If you look at the table providing details of the dietary intakes, one major change in the low-carb group between moth 12 and month 24 pops out – as the study progressed, the consumed less and less fiber on average, compared with their baseline intake. Now early on, that’s to be expected. Later, as carbohydrate is increased – if quality whole foods are the choice – fiber typically increases!

In contrast, insulin levels decreased significantly in participants with diabetes and in those without diabetes in all diet groups, with no significant differences among groups in the amount of decrease.

Among the participants with diabetes, the decrease in HOMA-IR at 24 months was significantly greater in those assigned to the Mediterranean diet than in those assigned to the low-fat diet.

Again, in the text, the researchers do not note if there were changes in HOMA-IR in the low-carb group. There was – over the 24-month period, the HOMA-IR in those with diabetes, following the low-carb diet, declined by 1.0; in those with diabetes following the low-fat diet the decline was 0.3; and in those with diabetes following the Mediterranean diet the decline was 2.3.

The last item reported in the section was the HbA1C levels. Among the participants with diabetes, the proportion of glycated hemoglobin at 24 months decreased by:

0.4 ±1.3% in the low-fat group
0.5 ±1.1% in the Mediterranean-diet group
0.9 ±0.8% in the low-carbohydrate group

The changes were significant only in the low-carbohydrate group.

The lower HbA1C is perhaps one of the most important outcomes of this study. The diabetics, in the low-carb group, were able to lower their levels by 0.9 over the 24 months and this was significantly greater than those in the two other diets. Unfortunately the researchers did not include the baseline HbA1C for participants, so we do not know what the reduction really means.

Liver-Function

Tests Changes in bilirubin, alkaline phosphatase, and alanine aminotransferase levels were similar among the diet groups

Alanine aminotransferase levels were significantly reduced from baseline to 24 months in the Mediterranean-diet and the low-carbohydrate groups.

The Good, Bad, and Why oh Why?

Overall, most reporting on the study today, feel the research team did a good job designing the study and executing it, many applauding the high rate of retention in the study for two years. I too am impressed that the participants remained committed to the trial, their assigned diets, and the longer-term outcome measures!

I personally would have liked more information than was published.

Key information regarding the baseline diet was not included in the data – not published items include how many calories were consumed, on average, at baseline; nor do we know how much protein, carbohydrate, fat or fiber was in the baseline dietary habits of those participating. While obviously not critical, it is ‘nice to know’ data.

I also would have liked to see the researchers have the courage to actually follow the Atkins dietary approach, and not make changes based on a number of assumptions.

We do not, for example, know what the outcome would be if the participants on the low-carb dietary arm had not been told to specifically choose vegetable based fats over animal fats. Atkins does not specifically state you must eat butter, but the diet allows butter. In addition, encouraging the consumption of plant-based proteins over animal proteins is another tweak that may not have had any effect, or may have had a positive or negative one. We simply do not know because the researchers encouraged plant-based protein consumption rather than leave the dietary recommendations as they are – meats, eggs, poultry, fish, tofu and such are allowed, ad libitum. [please see update below!]

The reporting in the media, as my earlier post highlights, has been quite an eye-opener. I’m not sure if those quoted realize it or not, but their reaction to the study is quite telling, especially those with the strongest vested-interests in maintaining the status quo.

In the Wall Street Journal, Robert Eckle, the past president of the American Heart Association and a professor of medicine at the University of Colorado Health Sciences Center, said he was not ready to recommend an Atkins-type low-carb diet based on the results. People on a low-carb diet increased their consumption of saturated fat, he said, which could not be good for them in the long run.

Did he even bother to read the findings?

Or maybe he was just disappointed the AHA’s recommended diet – the diet recommendations the low-fat group were instructed to follow – did so poorly compared to the other two?

Did he know that the study author, Dr. Meir Stampfer of Harvard Medical School, in the same article, said “It is time to reconsider the low-fat diet as the first choice for weight loss and for cardiovascular health, it is not the best.”

I think tomorrow, we’ll take a fun ride through many of the quotes and opinions offered on this study!

In the meantime, what are your thoughts? Feel free to leave comments!

UPDATE 7/18/08

I received an email today from a friend who asked one of the researchers about the reference to plant-based (vegetable) fats and proteins. Dr. Shai assured him that the low carbohydrate group was not advised to consume a vegetarian low-carb diet, nor were they specifically restricted from eggs, cheese, red meat, poultry or fish. Due to dietary restriction (religious) the group would not, for instance have a cheeseburger or butter on top of their steak. Olive oil featured prominently. The participants did read the Atkins diet book. And the examples provided of the types of meals was “For example, a plate could include : fish or fried/not bread coated chicken/or red meet, broccoli and mushrooms coated with eggs, roasted eggplants, vegetable salad (peppers, cucumber, green leaves, notlettuce) with olive oil dressing.

One Study, A Myriad of Opinions

The buzz across the internet today is the findings from the paper, Weight loss with a Low Carbohydrate, Mediterranean, or low fat diet, published in the New England Journal of Medicine.

The headlines are all over the place regarding what the results mean:

Low-Carb and Low-Fat Diets Face Off

Dr. Meir Stampfer, the study’s senior author and professor of epidemiology and
nutrition at Harvard School of Public Health, told ABC News: “The low-carb diet
was the clear winner in providing the most weight loss.”

The Never-Ending Diet Wars: Why Atkins Still Doesn’t Beat Low-Fat Diet

“An optimal diet is one that is low in fat (because fat, whatever the type, has
9 calories per gram versus only 4 calories per gram for protein and
carbohydrates). When you eat less fat, you consume fewer calories without
having to eat less food, because the food is less dense in calories, as well as
low in refined carbohydrates.”

Healthy Diets Shown to Have Benefit Despite Modest Weight Losses

In a tightly controlled dieting experiment, obese people lost an average of just
6 to 10 pounds over two years. The study, published Thursday in The New
England Journal of Medicine, was supposed to determine which of three types of
diets works best. Instead, the results highlight the difficulty of weight loss
and the fact that most diets do not work well.

More Evidence that Diets Don’t Work

After two years of effort the dieters lost, on average, 6 to 10 pounds. The
study, funded in part by the Atkins Research Foundation, seemed designed to
prove that low-carb diets trump low-fat diets. But in the end, all it really
showed is that dieters can put forth tremendous effort and reap very little
benefit.

Diet Study: Hold the Carbs, Not the Fats

Low-carbohydrate and so-called Mediterranean diets may be more effective than
low-fat diets, according to a major new study published in tomorrow’s New
England Journal of Medicine.

Against the Grains

Carbohydrates have taken another hit. A new study finds that a low-carb diet
results in greater weight loss and better cholesterol readings than a low-fat
regimen that promotes a lot of grains and fruits.

Diet Plans Produce Similar Results

New research shows that Mediterranean and low-carb diets are just as good and
just as safe as the low-fat diet often prescribed by doctors, a revelation that
should give people more choices in eating well.

Unrestricted Low-Carb Diet Wins Hands Down

The similar caloric deficit achieved in all diet groups suggests that a
low-carbohydrate, non–restricted-calorie diet may be optimal for those who will
not follow a restricted-calorie dietary regimen.

Atkins Diet is Safe and Far More Effective Than a Low-Fat One, Study Says

The controversial Atkins diet is just as effective and safe as a conventional
low-fat diet, a two-year study has found. Researchers found that
overweight volunteers shed more pounds on the low carbohydrate regime than they
did on an orthodox calorie-controlled diet.

Low-Carb and Mediterranean Diets May Equal Watching Fat Intake

Explain to interested patients that the study suggested low-carbohydrate and
Mediterranean diets could be as effective as the traditionally recommended
low-fat diet for weight loss.

It’s amusing that each of the above headlines are all reporting on the same study!

Later today, in another post, we’ll set aside the headlines and simply look at the study itself and the results.

Shame on Missouri!

Yes this is going to be a rant!

Yesterday I was alerted to the newly proposed changes, open for public comment, in the Missouri Eat Smart Guidelines – standards for school lunches (and breakfast) in my state. When I first opened the document, I was not surprised by the incremental reduction of dietary fat and the push for more fiber, especially with whole grains.

What did surprise me was the absolute lack of attention to nutrient-density at each category level. Oh, there is a minimum which applies to each category – the minimums established by the USDA that establish minimum calories, fat not to exceed 30%, acceptable levels of protein, cholesterol, sodium and fiber, along with target minimums for calcium, iron, and vitamins A and C.

So the committee drafting the newly proposed “expemplary” category didn’t think it wise to perhaps set the bar higher – ya know, establish benchmark minimum for other micronutrients…maybe the same ones identified as deficient in our children in Missouri?

Hey, the starting document to consider this could be the Missouri Department of Health & Senior Services (DHSS) recently published Dietary Intake Summary Report for school year 2000-2001 – in it the DHSS reported finding the vast majority (greater than 50%) of all children in the state fail to meet RDA requirements for vitamin A, iron, calcium, folate and zinc, and 25% fail to meet requirements for protein, vitamin B6 and vitamin C.

HELLO!

We have a serious problem with malnutrition and the best the Missouri Eat Smart Guidelines committee can come up with is stricter limits on dietary fat and increasing fiber?

Has the committee that drafted this guideline even looked at what is being served in our schools?

Columbia public schools offer this delight each day:
Smucker’s PBJ Uncrustable, Pepperidge Farms Goldfish Pretzels, Rice Krispie Treat, 1% cholocate milk, baby carrots and a fruit.

Can you imagine what would be said to a parent packing such a lunch for their child?

But guess what? That lunch conforms to the standards for low-fat with just 21g of dietary fat (24% of calories) – just ignore the fact that once protein is tallied, carbohydrate accounts for 508 of the 789 calories – that’s 127g of carbohydrate, or the equivalent of 32-teaspoons of sugar in a child’s metabolism in one meal!

But hey, it provides 6g of fiber – above the target 5g standard, right?

The public schools have the audacity to call that abomination a nutritious lunch?

Oh, and don’t get me started on the soy-based products being used in meals and that fact not being disclosed to parents, unless of course, they poke around to read the allergen lists.

Beef Tacos on the menu?

I’d expect they’re made with beef, wouldn’t you? Nope…they’re based on an “enriched” product schools purchase – made with some beef and an ingredient listed as “VPP” – vegetable protein product – better known as soy protein.

Chicken Nuggets on the menu?

I’d expect they’re breaded chicken pieces, wouldn’t you? Nope…they’re also based on an “enriched” product schools purchase, already prepared – made with some chicken and an ingredient listed as ISP – isolated soya protein.

Think it can’t get worse?

I don’t think schools do much more than open a can, heat and serve these days – just reading through the spreadsheets available online makes that pretty clear – almost everything sold in school breakfast and lunches are convenience foods, from various vendors, that are nutritionally bankrupt, but easy to heat and serve.

If a parent were to habitually feed their child that crap, at the very least they’d be chastized as irresponsible – yet this is how the schools operate each day, serving what can only be called food-garbage each day and they have audacity to label them “healthful” and nutritious.

When you have a chance, read through the proposed Missouri Eat Smart Guidelines, then let the committee know what you think in the open public comments!

If people don’t start speaking up, and demanding truly nutrient-dense meals for their children, it’s only going to get worse!

Caution: Childhood Obesity

In the last month, two major media sources (Washington Post and Time magazine) have devoted page upon page to the epidemic of childhood obesity.

Washington Post: Young Lives at Risk: Our Overweight Children

Time: Our Super-Sized Kids

There is no doubt in my mind that there are, indeed, more children who are much heavier today than there were when I was growing up, and that parents of obese children should have access to resources to help them help their child.

What I find disturbing is that the current level of alarm, hysteria and obsession with children’s growing waistlines hasn’t caused any to pause, step back, and examine the facts. Instead, it seems, the drum beats on to reduce calories, reduce fat, add mroe fruits and vegetables, lots of whole grains and increase activity.

The message is part of a perpetual campaign to convince our population that we must do it “for the children,” with an indictment against parents who are said to not see nor do anything about their fat children; that the community, doctors, schools, health organizations, the food industry and the government must lead these wayward parents to understand how to improve both diet and activity levels for their children.

We see and read about extreme cases of childhood obesity, extreme examples of poor eating habits, and extreme lifestyle habits; we’re reminded that is how it happens – too much food and not enough activity, the recipe for growing fat children in America today.

But excess accumulation of fat isn’t the only problem – we’re also hit with the sobering reality that, in addition to heavier children, our children are also growing sick sooner; we’re told of children with type II diabetes (once called “adult onset” diabetes since it was virtually unheard of in children or teens), dyslipidemia, PCOS, metabolic syndrome, precocious puberty, high blood pressure, heart disease and more. The statistics are frightening and we’re constantly reminded that today’s children will likely die earlier than their parents if we don’t do something!

The mind-numbing statistics, experts expressing grave concerns, fine examples of poor eating habits, and images of the most extreme cases of obesity in children all work to create a strong sense that we all must do something, that all of our children are at risk, that the future is at stake if we don’t do the right thing and do it now!

Is the hype really helping?

Are the solutions on the table going to work not only to prevent childhood obesity, but reverse it in those children whom are already obese?

Considering the solutions presented today is identical to the solutions offered throughout the past three decades, I can only conclude things will get worse not better; the longer it goes on, the stronger the pressure on parents will grow to ‘get with the program’ and follow the direction of the expert recommendations.

As parents, we have an obligation to protect our children, keep them safe, nurture them and do the best we can as we raise them.

My previous post provided an example of how the current guidelines to use BMI as the gold standard measure of overweight and obesity in children is problematic. The fact that a child can be a normal healthy weight in one month and then overweight or obese in another without any change in weight or height tells us the charts are inaccurate. The fact that the hypothetical child would have dropped from 59th to 52nd percentile for weight on the traditional chart, but went from normal to overweight on the BMI chart, speaks volumes about its deep flaws.

What’s telling is that almost all the comments left in the hypothetical ’set-up’ of the situation post were the belief the child gained weight. That is understandable, given the repeated message we all hear that overeating and inactivity make you gain weight. If the child now had a BMI indicating she was overweight, she must have gained weight if her BMI just two months ago said she was normal-healthy weight. Too bad it wasn’t true.

If we, as parents and a nation, truly wish to resolve the issue of childhood obesity, we must begin to re-examine our assumptions and how we’ve arrived where we are today. Our children are not only growing fatter, they’re growing sicker, and doing the same thing with only the volume turned up on the message isn’t going to change this. Throwing medication at the problem isn’t going to make it go away. Surgical intervention isn’t going to reverse it, and certainly can’t prevent it before the fact.

We have the answer, yet we ignore it.

We’ll explore that in another post coming soon!

In the meantime, feel free to leave your comments about the issue of childhood obesity, its causes and its solution.