November 11th, 2008 by Dr. Val Jones in Health Tips
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Several people have asked me if corn syrup is the root of all evil. This cheap, high calorie sweetener is adding hidden calories to everything from spaghetti sauce to condiments to peanut butter. But is it actually worse for you than “regular” cane sugar? Is there something special about corn syrup that makes it worthy of national vilification?
The truth is that corn syrup isn’t any “worse” than any other highly refined sugar – there’s nothing special about corn that makes it harmful to consume (unless maybe if you’re allergic to corn, but that’s another story). The real issue is that we humans love sweet things, and that food product manufacturers are simply adding sweetener to their products to cater to our taste buds. In so doing, hidden calories add up… and waist lines expand in response.
Folks with diabetes understand how difficult it is to find unsweetened products these days, and they have to work extra hard to avoid the high fructose corn syrup in so many foods. For those of us who don’t have diabetes (yet?) we’d probably do well to follow their example and consciously cut down on our sugar intake if not to manage our insulin levels, but at least to avoid unnecessary calorie consumption.
I myself am a bit of a sugar addict by nature – I resolved to cut down on carbs a few months ago and have dropped 10 pounds already. I have learned to like unsweetened almond milk, unsweetened organic ketchup, and I make my own sauces and avoid refined flour products.
In my next post I’ll speak with Penny M. Kris-Etherton, Ph.D., R.D., Distinguished Professor of Nutrition, Penn State University about what she learned at the recent American Dietetic Association Food & Nutrition Conference & Expo (FNCE) in Chicago. She’ll explain why all the fear mongering about corn is a bit exaggerated.
June 19th, 2008 by Dr. Val Jones in Expert Interviews
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I recently discussed the emerging black market for raw (unpasteurized) milk and the FDA’s crackdown on California farmers. Soon after I posted my comments, a reader asked some detailed questions about heat, enzymes, and milk’s nutritional value. At the same time I received an email from the Vice President of Nutrition Affairs-Health Partnerships at the National Dairy Council, offering to connect me with a dairy product scientist to further the discussion. Isn’t it nice when all the stars align correctly?
I just interviewed Gary Rogers, Ph.D., the Editor-In-Chief of the Journal of Dairy Science and Professor of Animal Science and Dairy Extension Leader at the University of Tennessee in Knoxville. You may listen to the podcast, or enjoy my synopsis below:
Dr. Val: What is pasteurization?
Dr. Rogers: Pasteurization is the heating of milk to a specific temperature for a specified period of time to kill harmful bacteria that may be living in the milk.
Dr. Val: Raw milk enthusiasts argue that pasteurization decreases the health benefits of milk. What exactly is lost when milk is pasteurized?
Dr. Rogers: There are really no important changes that occur (from a nutritional standpoint) to milk when it’s pastuerized. Heat treatment is simply used to kill the bacteria that may present a health risk to those of us who consume milk. Research over the years has shown that there are no significant nutritional benefits to raw milk, but there are risks associated with exposure to bacteria.
Dr. Val: Some people say that raw milk is easier to digest than pasteurized milk. Is that primarily a myth?
Dr. Rogers: Yes, that’s a myth. There is no scientific evidence to suggest that raw milk is easier to digest than pasteurized milk. In fact, many people who have digestive difficulty with fluid milk can eat cheese and yogurt without any difficulty.
Dr. Val: I’ve heard some people claim that there are certain beneficial enzymes in raw milk that are destroyed in the pasteurization process. Is there any truth to that?
Dr. Rogers: There are dozens of enzymes in milk, but most of them are proteases that are involved in the break down of milk proteins and fats. While it’s true that heating can destroy some of these enzymes, they really have no role in human digestion. The enzymes are responsible for milk spoilage, so removing them extends the shelf life of the milk.
Dr. Val: Tell me about UHT milk (the boxed milk that is stored at room temperature) – does it differ -nutritionally and chemically – from pasteurized milk?
Dr. Rogers: UHT (or “ultra-high temperature”) milk undergoes a pasteurization process at a much higher temperature than regular milk. This increases its shelf life, but nutritionally and chemically it’s no different from regular pasteurized milk. It contains all the calcium, phosphorus, and protein of regular milk. However, UHT milk does have a different flavor that some Americans don’t like. In Europe, though, they really enjoy the flavor of UHT milk and often prefer to drink it over pasteurized milk. In the U.S. we use it for flavored milk products, and for military personnel who can’t keep their milk refrigerated as easily.
Dr. Val: I think the key confusion that people have here is that they think of heating milk like heating vegetables. We all know that when we boil vegetables for a long time the nutritional value decreases because their vitamins are removed in the water. However, with milk we’re essentially heating it without removing the “water” part.
Dr. Rogers: That’s exactly right. Pasteurization doesn’t add or subtract anything from milk nutritionally, it’s just a heat treatment to destroy bacteria like listeria and salmonella.
Dr. Val: Are US cows exposed to antibiotics and hormones that could find their way into milk?
Dr. Rogers: I know that consumers are very concerned about these issues, but they need to know that every milk tanker is required by law to be tested for antibiotics. There’s a huge incentive for milk producers not to include milk from cows that may have been sick and treated with antibiotics because any tanker that’s found to have any trace of antibiotic in the milk will have its milk discarded. Not only that, but since tankers usually carry milk from multiple producers, one small contribution of contaminated milk will cause all the neigboring farms’ milk to be destroyed. So there’s a lot of peer pressure to keep the milk supply clean. Farmers who contribute milk from cows on antibiotics are fined for the losses of other producers’ milk as well.
As far as “hormones” are concerned, you’re talking about RBST (recombinant bovine growth hormone) to enhance milk production in cows. Although no lab test was ever able to distinguish milk from RBST treated cows from non-treated cows, consumers expressed such concerns about the practice that few milk producers use RBST anymore. I’d say that maybe 10-15% of dairy producers use it, and then it’s not for fluid milk sale, but rather cheese and other dairy products. Those numbers are continuing to decline.
Dr. Val: What does it mean when milk is labeled “organic?” Given the high price of groceries, are there advantages to purchasing organic milk?
Dr. Rogers: I work with both conventional dairy producers and organic dairy producers in my “day job” so I have friends on both sides. As far as nutrition and healthfulness is concerned, organic and conventional milk are equal. The “organic” label has to do with the production practices on the farms that produce the milk, not the properties of the milk itself. On organic farms, they do not use chemical fertilizers or pesticides to raise the crops that they feed to their cows. Some people like the idea of supporting organic farmers and consumers have every right to do that. But both organic milk and conventional milk are safe and equivalent nutritionally.
Milk is heavily regulated and controlled so that even on conventional farms, the pesticides do not get into the milk. All milk is tested for pesticides, and in my experience it has always contained far lower levels than the standard set for safety by the FDA.
Dr. Val: But isn’t it possible that the organic milk might have an even lower level of pesticides in it than conventional milk?
Dr. Rogers: Actually the tests that I’ve seen have not been able to distinguish organic from conventional milk as far as pesticide levels are concerned. However, I haven’t received results from all the organic farms in the U.S. But keep in mind that pesticides exist in such small quantities in milk that usually we can’t even detect them with the most sensitive instruments that we have in the laboratory.
Dr. Val: Is soy milk a good substitute for cow’s milk?
Dr. Rogers: It’s really hard to replicate the nutrition that comes from traditional milk sources. The calcium absorption, amino acids, vitamin, and mineral contents of milk provide a distinct advantage over soy milk, unless you have a specific dairy allergy. In a large recent study on baby formula, for example, there was no advantage to using soy based formulas over cow’s milk. People may prefer to use soy milk for its flavor, or because they support vegetarian food sources. But most soy milk is processed by dairy farms anyway.
*Listen to the interview with Gary Rogers*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 12th, 2008 by Dr. Val Jones in Opinion
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I’ve written about raw milk before, but here again we find it making front page news. There has been a recent FDA raw milk crack down in California, and I believe that’s a good thing for public health reasons. Although raw milk enthusiasts ascribe mystical powers to the product (some say its natural microbial flora can cure everything from asthma to autism), I don’t see anything mystical about the pathogens that can grow in room temperature milk: e. coli, salmonella, listeria and even tuberculosis. If you like the taste of raw milk and don’t mind the risks associated with imbibing warm body fluids of manure-encrusted bovines… then go right ahead. But please, don’t put your children at risk.
The New York Times exposed the raw milk counter-culture phenomenon last year. Grocery store milk has been heated and packaged in a nearly sterile fashion so that no harmful bacteria are in it. Farmers collect raw milk from cows, then send it to a processing plant where it’s pasteurized (a heat treatment) and homogenized (blending the creamy part with the skim part) it before packaging the milk for human consumption. This process has virtually eliminated milk borne illness in this country, but now certain farmers are threatening to reverse that progress.
So why are people fascinated with raw milk and seeking out farmers who will sell them milk prior to heat treatment? Raw milk does taste very good, and there’s no doubt that the creamy layer that floats on the top is delicious. In New York City raw milk has a black market, cult following. Should you jump on the bandwagon?
As my regular readers know, I grew up on an organic dairy farm, and had the pleasure of handling cows up close and personal for at least a decade. In fact, their sweet-smelling grass breath, and not so sweet-smelling cow patties are etched permanently in my mind. Cows are curious, somewhat dim witted, and generally oblivious to the terrain upon which they tread.
Cows will stand in manure for hours without a moment’s regret, should you present them with fresh hay to eat or some nice shortfeed. They drop patties on the ground, in their troughs, and occasionally on one other. Their flicking tails often get caked with manure as they swish flies away and they scratch their udders with dirty hooves as well.
This is why when it comes time to milk them, farmers need to wipe their udders carefully with a disinfectant scrub before applying the milk machine. Mastitis (or infection of the udder teets) is not uncommon, and is a reason for ceasing to milk a cow until the infection has cleared.
And so, the cleanliness of raw milk depends upon whether or not the farmer removes all the excrement carefully, scrubs the teets well, and remembers not to milk the cows with mastitits. It also matters whether or not the cows are harboring certain strains of bacteria – which often don’t harm the cow, but cause very serious problems for humans.
Did I drink raw milk as a kid? Occasionally, yes. Were my parents super-careful about the cleanliness of the milk? Yes. Did I ever get sick from raw milk? No. Would I give raw milk to my kids? No.
I appreciate that epicures want to experience the flavor of raw foods, but for me, the risks are simply not worth it when it comes to milk. There is no appreciable nutritional benefit to drinking raw milk (in fact, store bought milk is fortified with Vitamin D, which is critical for healthy bones), and it caries a small risk of serious infection. I agree with the FDA’s ban on interstate sales of unpasteurized milk, and would not want to see raw milk available widely for general consumption. Of course, to get around this ban, some companies are selling raw milk and cheese under the label “pet food.”
It’s a crazy country we live in – anti-bacterial hand wipes, soaps, gels, plastics and an insatiable appetite for raw milk. As a doctor, I throw up my hands. Is raw milk getting a raw deal? Some farmers may feel that way – but this former farmer is pleased to have access to safe, clean milk. What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 28th, 2008 by Dr. Val Jones in Expert Interviews
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Dr. Val: Dr. Carmona, I recently met you at the Partnership to Fight Chronic Disease conference in Washington, D.C., and now you’re here with the STOP Obesity Alliance. You are certainly one busy guy. What are you doing with your life these days?
Dr. Carmona: My life is certainly very full and very fulfilling. After completing my four-year term as surgeon general, many good people in the private sector offered me opportunities to continue my life’s work. All of my endeavors are geared toward improving the public’s health —that is, the health, safety and security of a person, a population, a nation —and sometimes even globally through partners that we work with.
As I surveyed the various opportunities to engage in public health service, I wanted to choose initiatives that gave me the biggest bang for my buck. In other words, I wanted to support programs that would have maximal impact in improving the lives of Americans. The chronic disease burden caused by a preventable condition —obesity — seemed like a really logical place to start.
We have to figure out how to reverse obesity in more than 9 million children, and we need to help the two out of three adults who are overweight or obese. Obesity has a huge impact on diseases across the board —asthma, cardiovascular disease, diabetes, cancers and a whole host of chronic diseases. Obesity either causes or is a comorbid [simultaneous and independent] factor in each of these.
In addition to my involvement in the Partnership to Fight Chronic Disease and in the STOP Obesity Alliance, I am involved in the National Foundation for Infectious Diseases, where I chair the Childhood Influenza Immunization Coalition — which endeavors to ensure that our children get their full complement of vaccines.
In a country where we spend more on health care than any other nation in the world, our metrics put us somewhere between 25th and 40th in terms of life expectancy, childhood vaccinations, maternal child mortality and things like that. We have to step back and ask: “Where are we missing the boat here?” I think part of the answer is that many of our children don’t complete their immunization series. In Arizona just recently, we had a measles outbreak. That shouldn’t happen in this country.
When I was a child, every mom worried about her son or daughter getting polio. We don’t have to worry about that any more because of vaccines. In a global economy where people move freely across geopolitical borders, vaccination has never been more important —both here in the U.S. and internationally.
Dr. Val: Tell me a little bit about what you’re doing at Canyon Ranch. People may have some misperceptions about the population that Canyon Ranch exists to serve (i.e., wealthy spa-goers). But I know there’s a lot more to it than that.
Dr. Carmona: I’m the vice chairman and CEO of Canyon Ranch [resorts in Arizona, Massachusetts and Florida], and I am always looking for opportunities for the organization to contribute to health policy issues. Our goal is to help the people who come to us to find a path to optimal health and wellness through prevention strategies based on a true integration of the mind, body and spirit.
The Canyon Ranch Institute is the nonprofit arm of our organization that takes our best practices at Canyon Ranch and translates them to underserved populations around the country. So we serve the upper echelons of society, but we also have a strong social responsibility to “give back” to underserved communities and to help eliminate health disparities. Through the institute, we partner with [for example] the Urban Health Plan in the South Bronx [in New York City] — which is in one of the poorest congressional districts in the United States. We’ve committed to helping some of the poorest Hispanic people in America because they struggle with disproportionate disease burden as a group.
Essentially, we’re building a Canyon Ranch Institute Life Enhancement Program in a federally qualified community health center to change the health metrics of that population. And we’re going to focus on disease prevention and an integrative approach to health and wellness. We’re going to measure our impact scientifically. We do everything in peer partnership in a way that honors the culture of the community, and we respect what they’re already doing to serve their population. With everything we do, we plan and act as consultants to the local community leaders. In this case, we took the local community physician and other health leaders and brought them to Canyon Ranch on a scholarship program. We trained them and then sent them back to the Bronx with a small team of staff to help them put together a life enhancement program. And now, we’re building a curriculum with them.
Dr. David Satcher and I are discussing a new initiative in Atlanta, perhaps through his institute — the Satcher Health Leadership Institute. We also have a partnership with the Lance Armstrong Foundation, in which we’ve come together with other surgeons general to bring forth a collective call to action on cancer prevention and survivorship — which we’ll announce this summer here at the National Press Club. This is the first initiative to include all the past surgeons general, so it’s really exciting.
We’re doing many innovative and entrepreneurial things that we can initiate quickly with a lot of smart and willing people. You can move a little more nimbly in the private sector than you can in the federal government, so it’s a joy to be able to pull all these people together to address the unmet needs of various populations at all levels of society.
Dr. Val: How do you incorporate the “mind, body, and spirit” approach to health without getting too far afield from science?
Dr. Carmona: At Canyon Ranch and the Canyon Ranch Institute, we believe that achieving optimal wellness involves taking an integrative and holistic approach to the many dimensions of health and well-being —enhancing the physical, mental, emotional, social, spiritual and environmental aspects. We’re also helping to translate this integrative approach to underserved communities through the Canyon Ranch Institute.
I have a small group of integrative health doctors and other health professionals who meet on a regular basis at Canyon Ranch. Their job is to read their scientific literature and meet periodically with me to present the new and emerging science in health and wellness. Then we review the science together and ask ourselves if there’s anything applicable that we could use as a product to improve the health of those we serve at Canyon Ranch or through the Canyon Ranch Institute’s nonprofit efforts.
So, for example, we’ve been taking a close look at the brain fitness movement in order to see what we could apply to older adults. When you and I went to medical school, we were taught that when you hit 60 or 70, you couldn’t really learn anything new and you need to be put out to pasture. The fact of the matter is that the science is now very clear that not only can you learn, but you can grow your knowledge and ability in many areas — even when you’re into your 90s and 100s. So at Canyon Ranch, we combine physical fitness with brain fitness, and we have holistic programs to develop cognitive skills through nutrition and mind exercises to increase intellectual capacity.
We have also been investigating whether or not touch can be healing. I believe it’s a gray area — some of it may be hocus-pocus, but some may also have scientific merit. So we’re working with Gary Schwartz, Ph.D., an expert in energy medicine, to take a closer look at this and to conduct some trials to see what works. I know this is pushing the envelope, but it’s not implausible that the comfort and stress reduction one experiences from gentle touch might improve immunity.
I recognize that holistic medicine is a very dynamic and challenging field to be in, but we vet everything and make sure that we have some scientific validity before we move forward with anything as a product. We try to stay open-minded as we study these so-called complementary and alternative medicine practices to see what works. And if we find a benefit, we incorporate it. If not, we reject it and move on.
Dr. Val: And do you practice what you preach? How are you taking care of yourself?
Dr. Carmona: I get about an hour to an hour and 15 minutes of exercise five to six times a week. I even have staff meetings while working out at the gym sometimes. I’ll say: “I have 24 hours a day, and you guys get 23. But I need one for exercise. If it’s so important that you need to see me during that hour, then you have to work out with me. We can swim or walk, and you can debrief me while we’re doing that.” Sometimes they’ll take me up on it, but not always. Last night we didn’t finish our business dinner until 11 pm. Everybody went to bed, but I went to the gym.
I do a lot of cross-training. I don’t run that much anymore because my knees are getting sore. I use elliptical machines and the StairMaster. I swim, and then I do a weight training circuit every other day.
Just keep moving. I think that’s the important thing.
Dr. Val: And what do you do nutritionally?
Dr. Carmona: I’m careful about what I eat. I eat a little bit of beef, but not much. I do eat a lot of chicken. I have fish allergies so, unfortunately, I can’t eat seafood. I eat a lot of whole grains, nuts and fruits, and I control my portions. My typical breakfast is oatmeal, fruit and a glass of skim milk. For lunch, I have a sandwich and some salad, and then I have a full but portion-controlled dinner. I allow myself some vices. I used to joke with my staff all the time about not being able to pass a Baskin-Robbins without stopping in to get a vanilla ice-cream cone.
Dr. Val: Baskin-Robbins has 31 flavors … and you pick vanilla?
Dr. Carmona: That’s right. I told them they’re wasting their time on the other 30. There’s only one flavor that I need: vanilla. Every once in a while, I’m really risqué and I’ll try French vanilla.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 27th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I attended the STOP Obesity Alliance press conference on May 22, 2008, in Washington, D.C. During the conference a new strategy to reduce obesity rates was announced — which provides employers with an obesity management benefit for their employees. I asked Carl Graziano, the vice president of communications for DMAA: The Care Continuum Alliance, to explain what this new benefit is and how it works. (DMAA was formerly known as the Disease Management Association of America.)
Dr. Val: How does the DMAA “prototype obesity benefit” work?
Graziano: The prototype is just that — a suggested approach based on the best available evidence on effective obesity interventions. While we provide a template for possible covered services and suggested pricing, it will be up to individual end users to tailor this benefit to their particular budgets, corporate cultures and values. Generally, we recommend three tiers of coverage, starting with enhanced primary care services, nutritional counseling and pharmaceuticals. A second tier would add treatment by an obesity specialist, and a third level would provide coverage for bariatric surgery and associated supporting services. Plan participants could be subject to an additional premium and co-payments for these services, as with other “riders,” such as vision and dental benefits.
Dr. Val: Which employers are planning to offer this benefit?
Graziano: We’re pleased to have the support of the Service Employees International Union (SEIU), which will consider our benefit approach as it develops coverage for its members. We expect that as experience with the benefit design and awareness grows, other employers will tailor it to their specific needs. As the STOP Obesity Alliance survey shows, while most employers believe in the appropriateness of obesity-related services, less than half say their companies devote enough attention to the problem of obesity. We believe this reflects a lack of guidance on how to provide obesity benefits, and that’s why we developed our suggested approach.
Dr. Val: What can people do to make sure that their employer offers this benefit or something similar?
Graziano: Because this benefit prototype will be freely available from and promoted by DMAA, we expect growing awareness of it among benefits managers over the next year — both through their own efforts to stay current on benefit design trends and recommendations from employees and others.
Dr. Val: How do we know that this program works? What outcomes have you demonstrated so far?
Graziano: Designing a formal approach to obesity benefits is largely uncharted territory, which is precisely the reason why DMAA saw a need to initiate research in this area. That said, our benefit design is strongly rooted in the best available evidence that interventions deliver high-value, positive outcomes. We are breaking new ground here, but we believe the benefit’s value-based approach offers the best chance of positive clinical and financial outcomes in a real-world setting.
Dr. Val: What’s the most important aspect that the public should know about the DMAA obesity benefit?
Graziano: It’s important that the public understand that personal behavior — eating healthfully, exercising and making other lifestyle changes — is essential to the success of any overweight or obesity intervention. While our benefit approach may ultimately contribute to new and expanded care options for the overweight and obese — a change that’s much needed in the face of a growing obesity epidemic — the commitment of plan participants to these interventions will play a large part in reversing the overweight and obesity trend.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
