Archive for June, 2011

The marketing campaign a few years ago from the Corn Refiners Association annoyed me. Have you seen it? Two mothers are chatting at a party; the hostess mother is pouring a purple liquid out of a gallon jug and the guest mother makes a comment about health problems with high fructose corn syrup (HFCS). The hostess mother doesn’t hesitate a moment but fires back with the assertion that HFCS is natural, it comes from corn, and it is absolutely healthy “just like sugar” when it is used in moderation. (As a matter of fact, recent commercials are pushing to change the name of HFCS to “corn sugar”.)

Of course I had to go to their website and read their claims for myself. (I was hopeful that my own sugar addiction would be condoned and I could have carte blanche with chocolate!) Here is what I learned:

The American Medical Association stated in June 2008 “HFCS does not appear to contribute to obesity more than other caloric sweeteners…” And the American Dietetic Association concluded in December 2008 “No persuasive evidence supports the claim that HFCS is a unique contributor to obesity.” Ok. Carte blanche with the chocolate cravings, right?

So let’s back up a moment and look at this debate carefully. (And hopefully by the end of the article you’ll have a more articulate answer than the hapless woman at the party when her hostess defended HFCS.) No one argues that obesity has risen in our country. Some 65% to 80% of adults in the United States are overweight or obese. The rate of childhood obesity has tripled in the past two decades and roughly 20% of children in the general population are overweight. The percentage is closer to 50% for children in some ethnic groups. There is no doubt that obesity contributes to the increased incidence of diabetes, cancer, heart disease and stroke. The global trends are also ominous. The rates of obesity are already high and rising in most developed countries and they are rising the fastest in countries that are undergoing a cultural transition in their nutrition habits. At the 10th International Congress on Obesity held in Sydney, Australia, in September 2006, World Health Organization data were reported indicating that for the first time in history, there are more overweight than hungry people on the planet. (I’m quoting David Katz’s book “Nutrition in Clinical Practice” for most of these statistics.)

The unifying reason my ancestors came to America from Germany, Ireland and England was to build a better life for their families. They bought land and worked to clear it, till it and produce food. My maternal grandfather was born in 1885 and died in 1979. He grew up on a farm in northern Ohio and this is an excerpt from a book my mother wrote:

“Life on the farm was hard work for parents and children. Jay was required to keep wood in the woodbox by the stove in the kitchen. He would pump and carry the water needed for the laundry, which his mother washed in big tubs scrubbing on a washboard, then hung clothes on lines out of doors. The bitter winter would “freeze-dry” the clothes, but made a horrendous task of hanging and retrieving them.”

Of course, this morning I cooked indoors at my stove with food I purchased at my local store. My washing machine and dryer are purring along at the moment and I’m sitting at a desk under the air conditioning vent occasionally looking outside. Not only have modern conveniences decreased my personal energy expenditure significantly, but the relative ease with which I can purchase food and drink allows me to consume calories well beyond those necessary for my survival. And I am not alone. According to James Howenstein, only 2.8 persons out of every 100,000 had diabetes in 1880. He notes “In countries where people eat a diet low in fat and sugar and high in whole foods such as unrefined grains and fresh fruits and vegetables, diabetes is almost nonexistent. When they move to the USA, their diabetes risk skyrockets.”  It’s not difficult to figure out that the biggest culprit in this pandemic of obesity and diabetes is concentrated calories combined with a decrease in physical activity.

Table sugar or sucrose is a disaccharide (literally means “two sugars”) composed of one glucose and one fructose molecule. Glucose is the cellular energy fuel of the body. It’s stored as glycogen in our liver and triglycerides in our fat cells. Fructose is naturally found in honey and fruit. (and corn!) It is metabolized by the liver and recycled as a component of triglycerides. HFCS is a mixture of fructose and glucose – with a higher proportion of fructose than table sugar. Its use has risen 250 percent in the last fifteen years and it has permeated processed foods. Check labels on your store-bought foods like ketchup, spaghetti sauce, mayonnaise etc and you’ll find it has been added everywhere. The name can be disguised, though, so look for sugar, white sugar, brown sugar, confectioner’s sugar, corn syrup, dextrin, honey, maple syrup, raw sugar, beet sugar, cane sugar, corn sweetners, evaporated cane juice, malt, and molasses. Thanks to farmer’s corn subsidies HFCS is cheap to make. It is relatively stable to store and dissolves easily.

So in the future, if someone claims that HFCS is natural and from corn like the earnest mother in the commercial, now you’ll know to say: “but my children and I don’t need a bolus of calories from ANY source. Gee, those oranges look great – Want to split one with me? And let’s go for a walk after dinner!”

 

The LA Times article yesterday quoted an epidemiologist Rebecca Schmidt of the UC Davis MIND Institute saying that women who reported that they had not taken prenatal vitamins immediately before and during a pregnancy were twice as likely to have a child with autism. The researchers asked 700 women retrospectively if they were taking vitamins – a strategy that has been shown to be less than reliable. (Do YOU remember what you did six months or five years ago?) These women had children who were 2 to 5 years old and were diagnosed with autism. An interesting twist to the research was an attempt to stratify the women and screen them for two gene variants that are affected by taking supplemental folic acid and that have been linked to autism in prior research. The two gene variants were MTHFR and COMT. We’ve known that MTHFR (methylene tetrahydrofolate reductase) is a key enzyme in folic acid metabolism and that if a woman has a variant in this gene that she is at increased risk for giving birth to a child with neural tube defects. We also know that folic acid, vitamin B6 and vitamin B12 supplementation can “over ride” this gene uniqueness. COMT (catechol-o-methyl transferase) is a key enzyme involved in the metabolism of compounds such as catecholamines (epinephrine and norepinephrine), estrogens, and other pharmaceutical drugs and environmental toxins. B vitamins also may help negate the effect of this gene variant, but the situation is more complex than just adding vitamins.

So the LA Times article was helpful and reiterated what we’ve known for many years: prior to conception women (and probably also men) should supplement their diet with folic acid and other B vitamins. But claiming that autism rates were up to seven times higher in women with one of the gene variants was perhaps a little bit of a leap. (and attention-grabbing…because of course it got MY attention, right?!)

About the same time that the article was published I read an article in the Atlantic Monthly by David Freeman which chronicled the work of Dr. John Ioannidis. He is known for his mathematical models that show that most of today’s medical research is questionable. Quoting Freeman:

“In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time….His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25% of supposedly gold-standard randomized trials, and as much as 10% of large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using th peer-review process to suppress opposing views.”

So, the upshot? I recommend prenatal vitamins prior to conception. I recommend a pre-conception visit to review health history, medications, supplements and screen a pap smear, a rubella titer and possibly genetic counseling depending on the prospective parents’ ages, ethnic backgrounds and family histories. A pre-conception visit is an excellent time to look at stress-management tools, work schedule adjustments, and possibly bring up parenting styles and beliefs for consideration. A thoughtful, planned pregnancy is ideal. Since upwards of two thirds of pregnancies are unplanned, however, I encourage daily vitamin use for all people who are sexually active.