Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Could A Low-Salt Diet Be Bad For Your Heart?

A spilled salt shaker

A paper in a recent edition of  Journal of the American Medical Association (JAMA) offers the contradictory conclusion that taking in less salt—a key goal of U.S. health and dietary recommendations—is bad for you. But before you roll your eyes and groan about flip-flops in science, know that this study isn’t the kind of work on which you or anyone should base dietary decisions.

In this study of 3,681 men and women from Belgium, Bulgaria, Italy, Poland, Romania and Russia whose health was followed for eight years, participants with the lowest sodium excretion (which is a good measure of sodium intake) were 56% more likely to have died from cardiovascular disease than those with the highest sodium excretion. Among the nearly 2,100 participants with normal blood pressure at the study’s start, sodium excretion (sodium intake) had no effect on the development of high blood pressure.

These are startling findings. If true, they would undercut major programs by the U.S. government to reduce Americans’ intake of salt—the main source of sodium—from prepared and processed foods and at home. Read more »

*This blog post was originally published at Harvard Health Blog*

Beer Bellies Anyone? Waist Measurement Can Determine Risk For Heart Disease

Beer-mug-with-tape-measure

Extra fat that accumulates around the abdomen goes by many names: beer belly, spare tire, love handles, apple shape, middle-age spread, and the more technical “abdominal obesity.” No matter what the name, it is the shape of risk.

Abdominal obesity increases the risk of heart attack, stroke, diabetes, erectile dysfunction, and other woes. The danger zone is a waist size above 40 inches for men and 35 inches for women.

As I describe in the April 2011 issue of the Harvard Men’s Health Watch, beer is not specifically responsible for a beer belly. What, then, is to blame? Calories. Take in more calories with food and drink than you burn up with exercise, and you’ll store the excess energy in fat cells.

Many studies indicate that people who store their extra fat around the midsection (apple shape) are at greater risk for heart and other problems than people who carry it around their thighs (pear shape). An analysis of 58 earlier studies covering over 220,000 men and women suggests that excess fat is harmful no matter where it ends up. This work was published in The Lancet. Read more »

*This blog post was originally published at Harvard Health Blog*

Avoid Weight Gain By Using Brain Tricks To Master Portion Control

When I was growing up, my parents had a simple rule when it came to food: “Finish everything on your plate.” We had to sit at the table until we did.

They meant well. They wanted us to understand that food should not go to waste. The problem with this advice — and I’m sure I’m not the only American who grew up with it — is that we learned early on to eat everything put in front of us when we sat down to meals. Then the size of the plates grew — and so did the amount of food we consumed.

Portion inflationIt’s called portion inflation. Take a look at the illustration at left. It’s based on an analysis published in the Journal of the American Dietetic Association which found that typical restaurant portion sizes today are two to eight times as large as those in 1955. Back then, people who consumed a typical American meal (a hamburger, French fries, and a soda) had only one portion size to pick from. Today we can choose from multiple portion sizes: reasonable, big, bigger, and ridiculous (as I’ve come to think of the sizes listed in that last column).

Portion size matters. The bigger the portion, the more calories you can consume. An example using a table of calorie information available online in the nutrition section at McDonald’s: By choosing the largest size in each category, you’ll end up consuming nearly triple the number of calories in a meal as you would if you chose the smallest portions.

Food Smallest size/calories Largest size/calories
Hamburger 3.5 oz/250 calories 11.1 oz/750 calories
French fries 2.5 oz/230 calories 5.4 oz/500 calories
Coca Cola 12 oz/110 calories 32 oz/310 calories
Total calories 590 calories 1,560 calories

Partly as a result of portion inflation, we’re eating more. Dietary surveys indicate that, on a per capita basis, Americans consumed 200 calories more per day in the 1990s than they did in the 1970s. That may not sound like a lot, but over time extra calories translate into extra pounds. Some experts calculate that people who add 150 calories a day to their diets, without increasing physical activity to burn those calories off, will gain as many as 15 pounds in a year. Read more »

*This blog post was originally published at Harvard Health Blog*

New Dietary Guidelines Give Little New Guidance

There isn’t much new in the latest iteration of the “Dietary Guidelines for Americans.” Three years in the making, the 2010 guidelines (released a tad late, on January 31, 2011) offer the usual advice about eating less of the bad stuff (salt; saturated fat, trans fats, and cholesterol; and refined grains) and more of the good stuff (fruits and vegetables; whole grains; seafood, beans, and other lean protein; and unsaturated fats). I’ve listed the 23 main recommendations below. You can also find them on the “Dietary Guidelines” website.

The guidelines do break some new ground. They state loudly and clearly that overweight and obesity are a leading nutrition problem in the United States, and that a healthy diet can help people achieve a healthy weight. They also ratchet down sodium intake to 1,500 milligrams per day (about two-thirds of a teaspoon of salt) for African Americans and people with high blood pressure or risk factors for it, such as kidney disease or diabetes. But the guidelines also leave the recommendation for sodium at 2,300 milligrams a day for everyone else, a move that the American Heart Association and others call “a step backward.”

Vague language spoils the message

One big problem with the guidelines is that they continue to use the same nebulous language that has made previous versions poor road maps for the average person wanting to adopt a healthier diet.

Here’s an example: The new guidelines urge Americans to eat less “solid fat.” What, exactly, does that mean — stop spooning up lard or Crisco? No. Solid fat is a catchphrase for red meat, butter, cheese, ice cream, and other full-fat dairy foods. But the guidelines can’t say that, since they are partly created by the U.S. Department of Agriculture USDA), the agency charged with promoting the products of American farmers and ranchers, which includes red meat and dairy products. “Added sugars” is another circumlocution, a stand-in for sugar-sweetened sodas, many breakfast cereals, and other foods that provide huge doses of sugar and few, or no, nutrients. Read more »

*This blog post was originally published at Harvard Health Blog*

Do Artificial Sweeteners Actually Promote Weight Gain?

When sugar-free beverages first became available, I was skeptical that they could really taste as good as “the real thing.” I quickly changed my mind. In fact, it seemed to me that the sugar-free versions actually tasted better than “the real thing.”

It seemed like a no-brainer. Sugar-free beverages had no calories and tasted better—maybe there is such a thing as a free lunch. Obviously, many people who also wanted to lose weight made the same switch. Were we right about artificial sweeteners?

Although short-term studies suggest that switching from sugar to no-calorie sweeteners can help, other research suggests it may actually promote weight gain. Writing in the December 2011 Harvard Health Letter, noted obesity researcher Dr. David Ludwig explores the possible connection between sugar substitutes and weight gain.

The FDA has approved six calorie-free sweeteners: acesulfame, aspartame, neotame, saccharin, Stevia, and sucralose. They are Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »