UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 24, No. 1
Jan/Feb 1999
TABLE OF CONTENTS
FTC Will Pay Closer Attention to the Dietary Supplement Industry's Ads
Supplement Claims Prohibited
Alternative Medicine Use Increasing
DHEA May Increase Cancer Risk
Folate in Multivitamins May Cut Risk for Colon Cancer
Ginkgo and Mental Function
A Good Source for Antioxidants
New Database of Scientific Literature on Dietary Supplements
The FDA Warns About Products Containing Gamma Butyrolactone (GBL) and
Asks Companies to Issue a Recall
First Estimate of Lifetime Risk for Developing Coronary Heart Disease
Ultrasonography Predicts Heart Attack/ Stroke Risk
Cholesterol Levels Decline Among U.S. Adolescents
How Do You Get Kids to Eat Fresh Fruits and Vegetables?
Early Detection and Treatment of Hemochromatosis
Health Statements Approved for Wine Labels
Science Panel Seeks to Calm Concerns About Well-Cooked Meats
Quit Monkeying Around
Questions Keep Sprouting About Sprouts
Upcoming Events:
Women and Obesity: From the Bench to the Bedside and Beyond
"Helping Children Connect: The Role of Physical Activity,
Nutrition, and Emotional Health in
Growing up Fit" Offered By UCLA Extension, Saturday, March 20
Televideo Conference: "Emerging Issues in Food Safety"
Resources:
Farmer's Markets
Preventing Neural Tube Defects
New Food Safety Website is Established
Subscription for NUTRITION PERSPECTIVES
Sheri Zidenberg-Cherr, PhD, Editor
University of California
Department of Nutrition
One Shields Ave.
Davis, CA 95616
NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist,
and staff. It is designed to provide research-based information on ongoing nutrition and
food-related programs. It is published bimonthly (six times annually) as a service of the
University of California Cooperative Extension and the United States Department of
Agriculture. Subscription to NUTRITION PERSPECTIVES is available from UC Cooperative
Extension, Department of Nutrition, University of California, Davis, California. Cost is
ten dollars ($10.00) for a one-year subscription. Subscriptions and questions or comments
on articles may be addressed to: NUTRITION PERSPECTIVES, University of California,
Department of Nutrition, One Shields Ave., Davis, CA 95616-5270. Phone (530) 752-3387; Fax
(530) 752-8905.
FTC WILL PAY CLOSER ATTENTION TO THE DIETARY SUPPLEMENT
INDUSTRY'S ADS
The Federal Trade Commission (FTC) recently warned the dietary supplement
industry this week to be more careful in its advertisements, on both outright claims, and
what is implied to consumers. The agency issued a comprehensive business guide to help the
companies that make vitamin, mineral, and herbal supplements avoid making misleading and
dangerous advertising claims about their products.
The dietary supplement industry has exploded in recent years flooding the market with
products that often carry deceptive advertising. Supplements claim to help consumers do
everything from losing weight to improving memory recall. "Consumer use of dietary
supplements has increased dramatically in the last few years," said Jodie Bernstein,
director of the FTC's Bureau of Consumer Protection. "This business guide will go a
long way to ensure that consumers are getting information that is truthful and adequately
substantiated. Good players in the industry will have the guidance they need. Others will
continue to face vigorous enforcement by the FTC."
While the Food and Drug Administration has jurisdiction over dietary supplement labeling,
and any health claims stated on the product, the FTC regulates their advertising
practices. In the guide, the FTC points out several examples of deceptive advertising. One
ad for a weight-loss supplement shows pictures of a woman who says she lost 20 pounds in
eight weeks while using the supplement. An asterisk next to her statement references a
disclaimer in fine print at the bottom of the ad that reads, "Results may vary."
The placement and size of the disclaimer is insufficiently prominent to effectively
qualify the claim, according to the FTC.
"To ensure that disclosures are effective, marketers should use clear language, avoid
small type, place any qualifying information close to the claim being qualified, and avoid
making inconsistent statements that could undercut or contradict the disclosure," the
guide says.
But some consumer groups say the guide will have little, if any, impact upon advertising
practices. "It is really much ado about nothing," said Bruce Silverglade of the
Center for Science in the Public Interest. "The FTC has essentially restated the
current law in plain English for small companies." The big question," said
Silverglade, "is whether or not the law will actually be enforced. Thus far, the FTC
has a poor enforcement record, having only brought seven cases against dietary supplement
makers this year."
And the agency's enforcement stands to get only weaker with proposed legislation in
Congress that would require the FTC to permit preliminary health claims in dietary
supplement ads. Preliminary health claims could include the results of rat studies, said
Silverglade.
Source: Nutrition Week 28(44):1, November 20, 1998.
SUPPLEMENT CLAIMS PROHIBITED
The FDA has rejected the first set of health claims submitted by a dietary
supplement manufacturer (Weider Nutrition International) under provisions of the FDA
Modernization Act of 1997. According to the Natural Foods Merchandiser, the prohibited
claims were:
(1) Vitamin A and beta-carotene may reduce the risk in adults of atherosclerosis, coronary
heart disease, and certain skin cancers;
(2) Vitamins C and E may reduce the risk in adults of atherosclerosis, coronary heart
disease, certain cancers, and cataracts;
(3) B-complex vitamins may reduce the risk in adults of cardiovascular disease by lowering
elevated cholesterol levels;
(4) Chromium in adults may reduce the risk of hyperglycemia (high blood sugar) and the
effects of glucose intolerance;
(5) Omega-3 fatty acids in adults may reduce the risk of cardiovascular disease;
(6) Zinc in adults may increase the body's ability to fight infection and heal wounds;
(7) Garlic in adults may reduce serum cholesterol and the risk of cardiovascular disease;
and
(8) Calcium consumption by adults and adolescents increases bone density and may decrease
the risk of fractures.
Although some of these nutrients may help prevent disease, the proposed claims were
either false, simplistic, or too broad. The FDA Modernization Act requires that health
claims be based on authoritative government agency statements and enable the public to
understand the nutrient's significance in the context of a total daily diet. The FDA
apparently concluded that the claims lacked sufficient authoritative support because they
were based on research that was preliminary rather than conclusive.
Source: Nutrition Forum 15(6): 41, 46, November/December 1998.
ALTERNATIVE MEDICINE USE INCREASING
Five years ago, data from a 1991 survey of US households revealed that more
than a third of respondents had used alternative therapies during the previous year. The
same investigators repeated the survey in 1997, and the new data demonstrate that use of
these therapies had increased. The information was obtained by telephone interviews of
2,055 randomly selected US adults.
Forty-two percent of the respondents reported using at least 1 of 16 different alternative
medicine therapies during the previous 12 months which shows an increase from 34 percent
in the earlier survey. The percentage of respondents who had seen an alternative medicine
practitioner in the previous year increased from 36 percent to 46 percent. Alternative
therapies were more common among women than men (49 percent vs. 38 percent) and among
those aged 35 to 49 years (50 percent) than older (39 percent) or younger (42 percent)
people. Therapies with the largest increase in use were herbal medicine, massage,
megavitamins, self-help groups, folk remedies, energy healing, and homeopathy.
Alternative medicine continues to grow in popularity despite the limited evidence of
efficacy from rigorously controlled studies. While some of this growth may reflect
failings of the traditional health care system, many patients clearly find value in both
traditional and alternative therapies.
Source: Journal Watch 18(24): 192, December 15, 1998
DHEA MAY INCREASE CANCER RISK
Marshall Goldberg, MD, an endocrinologist and medical researcher at Jefferson
Medical College in Philadelphia, says that the popular hormone supplement
dehydroepiandrosterone may increase the risk of prostate cancer. Researchers at McGill
University in Montreal reported earlier this year that men with elevated levels of IGF-1
were 4.5 times more likely to develop prostate cancer than men with lower levels. (IGF is
a growth factor that helps to regulate cell turnover.) Dr. Goldberg has studied the
effects of DHEA on his patients for nearly 10 years and says that doses as small as 25 mg
per day can raise IGF-1 levels significantly.
Source: Nutrition Forum 15(6): 46, November/December 1998.
FOLATE IN MULTIVITAMINS MAY CUT RISK FOR COLON CANCER
Prospective studies in men have identified low folate intake as a risk factor
for colon cancer. Boston investigators have reported an inverse association between folate
intake and colon cancer in a prospective cohort study of 88,756 female nurses.
Over the years, 655 new cases of colorectal cancer were identified. In a multivariate
analysis adjusting for age, activity, body-mass index, smoking, family history, and intake
of aspirin, alcohol, methionine, fiber, and meat, a daily folate intake of more than 400
µg was associated with a 31 percent lower risk for colorectal cancer than an intake of
200 µg or less. The protective effect of high folate intake, usually through a
multivitamin, became statistically significant after 15 years. Dietary folate (usually 400
µg or less) was protective, but not significantly so. Intake of calcium and vitamins A,
E, C, and D, was not protective.
Long-term daily use of a folate-containing multivitamin may reduce the risk of colorectal
cancer in women. But as in all observational studies of a preventive therapy, the results
could also be due to other factors (vitamins, minerals, or health habits not adequately
accounted for). Randomized studies are needed to confirm a causal relation.
Source: Journal Watch 18(21): 166 November 1998.
GINKGO AND MENTAL FUNCTION
The Medical Letter has concluded: Extracts of ginkgo biloba might improve mental function
with some patients with dementia, but available data suggest that the benefits, if any,
are modest. In a German post marketing surveillance study, the drug appeared to be safe,
but serious bleeding has been reported. The purity and potency of ginkgo extracts sold in
the USA are unknown (1).
Reference:
1. Medical Letter 40:63-64, 1998
Source: Nutrition Forum 15(6): November/December 1998, p. 46.
A GOOD SOURCE FOR ANTIOXIDANTS
High intakes of fruits and vegetables provide a good source of antioxidants.
Researchers from Johns Hopkins University studied 123 healthy men and women for 11 weeks
to measure the effect of fruits and vegetable consumption on the oxidation of lipids in
the bloodstream. Antioxidants protect against the oxidation of blood lipids, hindering the
development of atherosclerosis and reducing the risk of stroke. For the first three weeks,
individuals ate a control diet low in fruits, vegetables, and dairy products.
After three weeks, one group continued with the control diet, while the other two groups
were assigned a low-fat diet consisting of nine or ten daily servings of fruits and
vegetables. Scientists then measured the level of breath ethane, a substance released when
polyunsaturated fatty acids in the bloodstream are oxidized. The groups that consumed
greater amounts of fruits and vegetables had significantly lower levels of breath ethane,
indicating less oxidative damage to blood lipids. The findings support the idea that high
intakes of fruits and vegetables provides the body with antioxidants which can lower the
incidence of atherosclerosis(1).
Reference:
1. Circulation; 98(22):2390-2395, December 11,1998.
Adapted from: Nutrition Week 28(47): December 11, 1998, p. 7.
NEW DATABASE OF SCIENTIFIC LITERATURE ON DIETARY SUPPLEMENTS
The Office of Dietary Supplements (ODS) at the National Institutes of Health
announced the launch of its new International Bibliographic Information on Dietary
Supplements (IBIDS) database at a news media event in January at the National Press Club
in Washington, DC. IBIDS is a database of published, international, scientific literature
on dietary supplements that is available to the public free of charge through the ODS
Internet home page (http://dietary-supplements.info.nih.gov).
The purpose of this database is to assist both scientists and the general public in
locating credible, scientific literature on dietary supplements. The computer interface
was designed to be user-friendly so individuals with all levels of expertise may use it
easily. For those unfamiliar with dietary supplement terminology, a drop-down list of
standard keywords is available. "This database is one of the specific mandates for
the ODS designated in the original Dietary Supplement Health and Education Act of 1994
that created the office," said Dr. Bernadette M. Marriott, Director of the ODS.
"We have viewed its development as a key effort of the office that will be useful to
the scientific community and to the public for identifying scientific information on
dietary supplements."
Keeping with their commitment to work together with other agencies, the ODS staff
initiated an interagency cooperative agreement with the Food and Nutrition Information
Center (FNIC), the National Agricultural Library (NAL), Agricultural Research Service, and
the US Department of Agriculture to develop and maintain the IBIDS database. The NAL has
extensive prior experience in developing research databases. IBIDS is driven by a
sophisticated search strategy that simultaneously and transparently searches numerous
existing medical, botanical, agricultural, chemical, and pharmaceutical databases. This
presented a technical challenge because each of the existing databases uses a different
format and set of key words.
Source: Press Release National Institutes of Health December 31, 1998.
THE FDA WARNS ABOUT PRODUCTS CONTAINING GAMMA BUTYROLACTONE (GBL)
AND ASKS COMPANIES TO ISSUE A RECALL
The Food and Drug Administration is alerting consumers not to purchase or
consume products, some of which are labeled as dietary supplements, that contain
gammabutyrolactone (GBL). The FDA has also asked the companies that manufacture these
products to voluntarily recall them. The agency has received reports of serious health
problems, some that are potentially life-threatening, associated with the use of these
products.
Although labeled as dietary supplements, these products are illegally marketed unapproved
new drugs. Products containing GBL are marketed under various brand names including
Renewtrient, Revivarant or Revivarant G, Blue Nitro or Blue Nitro Vitality, GH
Revitalizer, Gamma G, and Remforce. They are promoted with claims to build muscles,
improve physical performance, enhance sex, reduce stress, and induce sleep. GBL is also
known by the chemical names: 2(3H)-furanone dihydro; butyrolactone; gamma-butyrolactone;
4-butyrolactone; dihydro-2(3H)-furanone; 4-butanolide;2(3H)-furanone, dihydro;
tetrahydro-2-furanone; and butyrolactone gamma.
GBL-related products have been associated with reports of at least 55 adverse health
effects, including one death. In 19 of those cases, the consumers became unconscious or
comatose and several required intubation for assisted breathing. Other reported effects
included seizures, vomiting, slow breathing, and slow heart rate. There are reports of at
least 5 children under 18 years of age who have been injured or who have suffered these
kinds of effects.
When taken orally, GBL is converted in the body to gamma hydroxybutyrate (GHB). GHB is a
very potent unapproved drug. It is currently being investigated under the supervision of
doctors for the treatment of narcolepsy. [ecause of its serious side effects, GHB should
not be taken. The FDA and the Justice Department have ongoing criminal enforcement actions
against GHB.
Products containing GBL are sold in liquid and powder form. They are sold via the
Internet, in some health food stores, and in some gymnasiums and fitness centers.
Consumers are advised to dispose of any products of this type in their possession. If they
have experienced adverse health problems from use of these products, they should promptly
contact a physician. The FDA requests consumers and physicians to report adverse events to
the FDA's MEDWATCH, 1-800-332-1088. The Trimfast Group, Inc. has agreed to recall the
product Revivarant, (32 ounces of liquid in a plastic bottle), and Revivarant G, (200
grams of powder in a pill bottle). Other companies manufacturing products containing GBL
are being asked by the FDA to voluntarily recall them. The FDA is considering all
potential regulatory actions at its disposal if products containing GBL are not recalled.
The agency will act expeditiously to protect the public health.
Source: Press Release, FDA Talk Paper, January 22, 1999.
FIRST ESTIMATE OF LIFETIME RISK FOR DEVELOPING CORONARY HEART
DISEASE
The lifetime risk for developing coronary heart disease (CHD) has been
estimated for the first time by researchers at the National Heart, Lung, and Blood
Institutes Framingham Heart Study. The risk is high: one out of every two men and one out
of every three women aged 40 and under will develop CHD. At age 70, the risk is still
high: one out of every three men and one out of every four women will develop CHD in their
remaining years of life (1).
"This study shows why it is so important for adults of all ages to take steps to
prevent heart disease," says Claude Lenfant, MD, NHLBIDirector. "Even young
adults should know their cholesterol and blood pressure numbers, eat in a heart-healthy
way, be physically activel, and watch their weight to reduce their lifetime risk of the
disease."
Heart disease is the number one killer of Americans. The most common form of heart disease
is CHD. It affects 12 to 13 million Americans. It occurs when the coronary arteries become
narrowed or clogged and cannot supply enough oxygen-rich blood to the heart. CHD can lead
to chest pain, called angina, and heart attacks. People are more likely to die from heart
disease than cancer, stroke, lung diseases or accidents. Each year, almost 500, 000
Americans die from CHD.
The lifetime risk estimate for CHD is an average value for the general population, but
individuals may have higher or lower absolute lifetime risks depending on whether or not
they smoke, have high blood pressure, high blood cholesterol, or diabetes, or are
sedentary or overweight.
"When it comes to health, average isn't always good," says Daniel Levy, MD,
the study's principal investigator. "The fact that the average 50-year-old woman is
three times more likely to get CHD than breast cancer during her lifetime has important
implications for public health." Dr. Levy says the study will help policy makers
assess the risks and burdens for various diseases and help the public understand why heart
disease prevention is so important.
The study also has implications for older Americans, and the physicians caring for them,
who may have believed that persons who survive to an older age without CHD are no longer
susceptible to developing it. Since even at age 70 the average person remains at high
risk, greater emphasis should be placed on control of risk factors in older men and women,
says Dr. Levy.
The Framingham Heart Study began 50 years ago in Framingham, Massachusetts. To study more
recent trends in the risk of coronary disease, new cases of heart disease occurring
between 1970 and 1996 were identified by NHLBI researchers working in collaboration with
scientists from Boston University. The 7,733 volunteers, aged 40-94, provided a
well-described population with long-term follow-up and carefully documented CHD events and
causes of death. The researchers calculated lifetime risks for CHD for ages 40, 50, 60,
and 70. In all categories, men had a higher lifetime risk than women. Other estimates of
CHD lifetime risk have been limited by reliance on death certificate data or short-term
follow up, according to Dr.Levy.
Reference:
1. Lloyd-Jones, DM; Larson, MG; Beiser, A; Levy, D. Lifetime risk of developing coronary
heart disease. Lancet, January 9, 1999, 353(N9147):89-92.
Source: Press Release National Heart, Lung, and Blood Institute January 7, 1999.
ULTRASONOGRAPHY PREDICTS HEART ATTACK/STROKE RISK
The National Heart, Lung, and Blood Institute (NHLBI)-supported scientists
report that ultrasonography, a non-invasive test, predicts the risk of heart attack and
stroke in older persons with no cardiovascular disease symptoms (1). The test was used to
measure the thickness of the walls of two arteries in the neck. The result gave vital
information beyond that available from an assessment of the standard cardiovascular
disease risk factors, such as high blood pressure and high blood cholesterol. "This
study shows that ultrasonography has great potential in the prevention of heart attack and
stroke," said NHLBI Director Dr. Claude Lenfant. "By identifying high risk
patients, ultrasonography would allow doctors to provide aggressive treatment early. Such
treatment includes control of high blood pressure and high blood cholesterol, weight loss,
increased physical activity, and aspirin and other drug therapies," he added.
Ultrasonography is a relatively inexpensive, painless test in which sound waves above the
range of human hearing are sent into the neck. Echoes bounce off the moving blood and the
tissue in the artery and are then formed into an image. The test is currently used in
stroke prevention to diagnose advanced disease in the carotid arteries. The new study
found that the test detects disease much earlier and identifies those at risk of heart
attack as well as stroke. The study involved 4,476 men and women, aged 65 and older, drawn
from the NHLBI-supported Cardiovascular Health Study (CHS), a multi-center investigation
of older Americans. The CHS centers are in California, Maryland, North Carolina, and
Pennsylvania. About 40 percent of the ultrasound studys participants were men and 60
percent women. Blacks comprised about 15 percent of the participants; the rest were white.
Participants were followed for an average of 6.2 years.
The NHLBI press releases, fact sheets, and other materials are available online at the
following Web site: http://www.nhlbi.nih.gov
Reference:
1. The finding appears in the January 7 issue of The New England Journal of Medicine.
Source: Press Release National Heart, Lung, and Blood Institute January 6, 1999.
CHOLESTEROL LEVELS DECLINE AMONG US ADOLESCENTS
Total cholesterol levels among US adolescents declined 7 mg/dL between the
late 1960s and the early 1990s, according to a new analysis of cholesterol trends and
levels (1). This decline is similar to the somewhat larger decrease in cholesterol levels
among adults during the same time period. The overall downward trend in cholesterol levels
accompanies a simultaneous decline in saturated fat and cholesterol intake among both
adolescents and adults in the US. This impressive drop in cholesterol levels among US
adolescents gives us hope for their future heart-health. Today's children with high
cholesterol tend to be tomorrows adults with raised levels, and the higher the
cholesterol, the greater the risk of atherosclerosis and heart disease, said Dr. Claude
Lenfant, Director of the National Heart, Lung, and Blood Institute(NHLBI) of the National
Institutes of Health.
The new analysis is based on data from the third National Health and Nutrition Examination
Survey (NHANES) conducted by the National Center for Health Statistics (NCHS), Centers for
Disease Control and Prevention, between 1988 and 1994. Trend information was based on
NHANES III and earlier versions of the survey. In the period 1966-1970, the average total
cholesterol level in adolescents was 167 mg/dL. By 1988-1994, the level had dropped to 160
mg/dL. The average total cholesterol level in adults declined by 10 mg/dL (from 213 to 203
mg/dL) from 1976-1980 to 1988-1994, and by 17 mg/dL (from 220 to 203 mg/dL) from 1960-1962
to 1988-1994. The reason for the greater drop in adults is unclear, according to the
authors of the study, but may be partially due to the fact that adolescents start at lower
total cholesterol levels and experience changes in HDL (good) cholesterol and other lipids
in conjunction with puberty. At the same time as the decline in cholesterol levels,
adolescents were improving their diet. Average saturated fat consumption of 12-to-17 year
olds declined from 14 percent of calories in 1971-1974 to 12 percent of calories in
1988-1994. During the same years, total fat intake dropped from 37 to 34 percent of
calories and daily cholesterol intake fell from 350 mg to 265 mg.
Adults have also reduced their consumption of saturated fat, total fat, and cholesterol.
This improvement in diet, and the resulting drop in cholesterol levels, have been
important contributors to the decline in deaths from heart disease. Since 1972, deaths
from coronary heart disease have fallen by nearly 53 percent. The prevention of heart
disease begins in childhood so the importance of dietary changes in young people is clear,
said Dr. James Cleeman, coordinator of the National Cholesterol Education program (NCEP),
which is administered by the NHLBI. "If these children can maintain lower cholesterol
levels into adulthood, they will postpone or prevent the onset of coronary disease, an
important health achievement," he said. However, Dr. Cleeman, who is a co-author of
the latest study, noted that more progress is needed. Only one in six children and
adolescents are fully meeting dietary recommendations for fat and cholesterol, he added.
The NCEP's recommendations call for all healthy Americans over age 2 to limit:
¨ saturated fat intake to less than 10 percent of calories;
¨ total fat intake to 30 percent of total calories or less; and
¨ cholesterol to less than 300 mg per day.
Todays youth also need to be more physically active because only about half of today's
adolescents are getting enough exercise, said Dr. Cleeman. This ties into the increase in
overweight among children and adolescents in the US and the need for better weight
control, he said. Dr. Edward J. Sondik, Director of the National Center for Health
Statistics, said, It is essential to have this array of data to track positive change,
identify remaining problems, and better understand the complex relationship between diet,
exercise and health. For example," he noted, "the next NHANES survey to start
soon will continue to report on dietary behaviors and health measures but will also tell
us how much time kids spend before the TV and on the computer and will include new tests
of cardiovascular fitness."
Although the new analysis found that total cholesterol levels decreased in all race/sex
groups studied, black adolescents experienced a smaller decline compared to whites (8
mg/dL in white adolescents and 5 mg/dL in black adolescents.) In general, total
cholesterol levels were about 5 to 7 mg/dL higher in non-Hispanic black adolescents
compared to non-Hispanic whites and Mexican Americans. Of all the groups, black females
continued to have the highest total cholesterol (168 mg/dL) and experienced the smallest
decrease over time (4 mg/dL). The finding of higher total cholesterol levels in black
adolescents differs from the pattern in adults, in whom blacks have lower total
cholesterol than whites. The authors did not speculate about the racial differences in
adolescents, but they noted the higher prevalence of overweight among non-Hispanic black
adolescents compared with non-Hispanic white and Mexican-American children and
adolescents. For more information on cholesterol, visit the NHLBI's website at http://www.nhlbi.nih.gov
Reference:
1. November/December issue of Preventive Medicine
Source: Press Release the National Heart, Lung, and Blood Institute (NHLBI):Monday,
December 7, 1998
HOW DO YOU GET KIDS TO EAT FRESH FRUITS AND VEGETABLES?
The Occidental Community Food Security (CFS) Project discovered one way to
get kids to eat fresh fruits and vegetables: a Farmers' Market Fruit and Salad Bar.
During the 1997-98 school year, the CFS Project launched a pilot program at McKinley
Elementary in partnership with the Santa Monica-Malibu Unified School District (SMMUSD),
the City of Santa Monica, school staff, parents, and students. The pilot was designed to
evaluate the barriers and opportunities for purchasing produce for school lunches directly
from farmers while increasing childrens access to healthy meals. At the pilot site,
McKinley Elementary, half of the school population is eligible for free or reduced meals.
The program works as follows:
¨ Fresh fruits and vegetables are ordered from farmers who sell at local farmers' markets
twice a week;
¨ Growers provide a discount to make the program economically feasible;
¨ Produce is delivered from the market to the school by the City of Santa Monica (the
market manager);
¨ Parent volunteers and staff select the salad bar items, prepare fruits and vegetables
on a daily basis, and monitor for USDA guidelines;
¨ Students choose between a hot meal and a salad bar meal which includes protein, dairy,
and bread items.
Designed as an integrated approach, project staff helped make the program a success by:
¨ Highlighting crops grown by students in the school garden when possible;
¨ Using salad bar scraps in the compost for the garden;
¨ Taking students on tours of the farmers' market;
¨ Arranging for farmers to visit the school cafeteria during lunch;
¨ Working to link nutrition education to the cafeteria ;
¨ Purchasing from organic farmers whenever possible;
¨ Making the program culturally appropriate.
The overall program results were successful:
¨ An average of 70 children each day chose a salad bar meal which emphasized fresh fruits
and vegetables.
¨ The program was expanded to a second school by the end of the school year.
¨ Local farmers who sold at the farmers' market increased their revenues while taking
part in a program they enthusiastically support.
¨ The school food service programs did not bear additional costs.
This year, the school district has hired a Food and Nutrition Coordinator to oversee the
program and its expansion to an additional five elementary schools. For more information,
contact Lucia Sanchez, Program Director, at (323) 259-2633 or luchasan@aol.com.
Source: Community Food Security News : Fall 1998, pp.11, 16.
EARLY DETECTION AND TREATMENT OF HEMOCHROMATOSIS
The Centers for Disease Control and Prevention (CDC), issued a press
announcement of conference proceedings examining the detection and treatment of
hemochromatosis. The articles in the supplement, based on presentations made at a 1997
international conference sponsored by the CDC, highlight the need to increase awareness
and enhance early detection of hemochromatosis, a condition in which the body accumulates
excess amounts of iron.
The supplement is available on the Internet from the American College of
Physicians-American Society of Internal Medicine at www.acponline.org
.
Some Facts About Hemochromatosis
¨ It occurs in approximately 1 in 200-500 persons in the United States.
¨ It can cause a wide variety of conditions, including liver disease, diabetes mellitus,
heart failure, thyroid disorders, sexual dysfunction, weakness, extreme fatigue, and joint
pain and deformity. Deaths from hemochromatosis are most commonly associated with liver
neoplasms, liver disease and cardiomyopathy.
¨ Complications of iron overload from hemochromatosis can be avoided by early diagnosis
and appropriate management.
Diagnosis and Management
¨ Persons with a repeated elevation of the transferrin saturation (TS) test (55 percent)
may have hemochromatosis and should be evaluated for excessive iron stores and organ
damage.
¨ Hemochromatosis is treated by removal of blood (phlebotomy therapy). Usually, this
means removal of one unit of blood every week or every other week until levels of stored
iron are depleted.
¨ Phlebotomy therapy helps prevent the medical complications of hemochromatosis; in
persons who already have complications, it can reduce their severity.
¨ Dietary restrictions may aid, but not replace, phlebotomy therapy to prevent
complications. Persons diagnosed with hemochromatosis should avoid iron supplements, use
alcohol only in moderation, and avoid raw shellfish.
Early Detection
¨ Testing for hemochromatosis is recommended for immediate family members of persons with
hemochromatosis and persons with early signs and symptoms compatible with hemochromatosis
(such as elevated iron measures, severe weakness or fatigue, signs of liver disease, type
2 diabetes, and brady arrhythmias).
¨ The use of a DNA test for hemochromatosis is not recommended except in the context of
ongoing research.
¨ Other important challenges for early detection include:
1) standardization of case definitions for hemochromatosis,
2) laboratory standardization of iron measures,
3) physician education, and
4) alleviating concerns about medical and insurance discrimination.
Challenges and Opportunities
Two pieces of information are needed to better inform strategies to control and prevent
unnecessary illness and death from hemochromatosis:
¨ Determine the likelihood of ill health among people predisposed to over-accumulate
iron.
¨ Determine the amount of existing disease attributed to hemochromatosis in the general
population.
HEALTH STATEMENTS APPROVED FOR WINE LABELS
The Treasury Department and its Bureau of Alcohol, Tobacco and Firearms (ATF)
recently announced three specific actions concerning the labeling of alcoholic beverages.
They were as follows:
¨ Treasury and ATF are launching an effort to develop legislation to strengthen its
authority over alcohol labels as a way of deterring alcohol beverage marketing directed to
underage persons and to prevent alcohol abuse. In doing so, it will consult closely with
the department of Health and Human Services (HHS), industry, and health groups.
¨ The ATF is publishing in the Federal Register a notice of proposed rule making
prohibiting alcohol beverage containers that mislead consumers about the alcohol character
of the product particularly those that appear to be marketed to underage persons.
¨ The ATF approved two new statements for wine labels that had been requested by wine
producers, but only after modifications.
The two statements that were approved are:
"The proud people who made this wine encourage you to consult your family doctor
about the health effects of wine consumption."
"To learn the health effects of wine consumption, send for the Federal Governments
Dietary Guidelines for Americans, Center for Nutrition Policy and Promotion, USDA, 1120
20th Street, NW, Washington, DC 20036 or visit its website."
Alcohol beverage labels are approved by the ATF to make sure they do not contain
statements or representations that are likely to mislead consumers about the product. The
ATF worked with industry to modify their proposed statements to meet these criteria.
"Under existing law, the ATF can only deny labeling statements if they are false or
misleading," said Treasury General Counsel Ed Knight. He said "The ATF
determined that the labeling statements approved today met the factual standards as not
being false or misleading because these statements do not make any health claim, but
simply direct consumers to sources for information about the health effects of alcohol
consumption." In an effort to determine consumers' perceptions of the two statements,
the ATF relied on a survey of current wine drinkers conducted by the Substance Abuse and
Mental Health Service Administration's Center for Substance Abuse Prevention, an office
within the US Department of Health and Human Services. The findings indicate that for most
of those who participated in the study, drinking patterns would not be influenced by the
message on the label.
"The Treasury department is continuing its efforts to combat underage drinking and
will work to strengthen its authority to ensure that products are neither targeted at nor
provided to minors," said the Treasury Under-Secretary for Enforcement, James E.
Johnson. With regard to the legislation, the Treasury will consider a number of options,
including whether to require the Government Warning Statement on alcohol beverage products
be rotated among different messages, and whether to require all alcohol advertisements to
carry a Government Warning Statement. The Treasury department will also look at other
legislative proposals to strengthen its authority over alcohol marketing practices
targeted at underage consumers or that encourage alcohol abuse. The ATF is immediately
seeking comment on a rule to stop the misleading packaging of alcohol products, especially
those that would be attractive to children. Examples of this would be products that
resemble frozen flavored ice products, gelatin products, and non-alcoholic fruit sodas and
drinks.
Source: Press Release from the Bureau of Alcohol, Tobacco and Firearms Public Affairs
Department, February 5, 1999 RR-2937.
SCIENCE PANEL SEEKS TO CALM CONCERNS ABOUT WELL-COOKED MEATS
Consumers should use caution when interpreting a new study on the possible hazards of
eating well-cooked meats, say scientists from the American Council on Science and Health
(ACSH). This study, published in the Journal of the National Cancer Institute, compared
the preparation and consumption of meats by women who did and did not have breast cancer
(1). Women who regularly ate well-done red meats were shown to have a higher risk of
breast cancer than those who consistently preferred their meats cooked rare or medium. The
authors of the study point to heterocyclic amines, which are compounds formed in meats
cooked at high temperatures (by broiling or grilling, for example) until well-done, as the
likely culprits. But scientists from ACSH warn consumers to put the results of this new
study into perspective. "First of all," stated ACSH President Dr. Elizabeth
Whalen, "a single study does not prove anything. Scientists do not consider a
hypothesis supported until the results have been replicated by independent
researchers."
An editorial accompanying the report makes that very point; the journals editors note that
this study alone is not sufficient to establish a causal link between eating well-done
meat and developing breast cancer. Dr. Whelan also notes that while some heterocyclic
amines are known animal carcinogens, that does not necessarily mean that they are human
carcinogens as well.
"Consumers would be best advised to follow well-substantiated lifestyle guidelines
for optimizing their health and preventing breast cancer," says ACSH Director of
Nutrition Dr. Ruth Kava. In other words: "Don't smoke; avoid obesity; stay physically
active; eat a varied, balanced diet that includes fruits and vegetables; consume all foods
in moderation; and follow protocols for breast self-examination and mammography." As
far as dangers from consuming meats or any other foods are concerned, consumers should
keep in mind that the risk of bacterial illness is considerably higher than risk posed by
heterocyclic amines or traces of animal carcinogens formed in cooking. Consumers should
therefore be sure to handle, store and cook all foods properly.
The American Council on Science and Health is a consortium of over 250 leading scientists
and physicians. For more information, contact Dr. Ruth Kava or Dr. Elizabeth Whalen,
American Council on Science and Health, 1995 Broadway 2nd Floor, New York 10023, Phone:
(212)362-7044, Fax: (212)362-4919, URL: www.acsh.org.
Reference:
1. Zheng, W; Gustafson, DR; Sinha, R; Cerhan, JR; Moore, D; Hong, CP; Anderson, KE; Kushi,
LH; Sellers, TA; Folsom, AR. Well-done meat intake and the risk of breast cancer. Journal
of the National Cancer Institute, 90(N22):1724-1729 November 18, 1998.
Source: Press Release American Council on Science and Health, November 19,1998.
QUIT MONKEYING AROUND
Would you eat ice cream flavored with large pieces of primates? Unfortunately
for Ben & Jerry's, that's how the Japanese interpreted the ice cream makers'
"Chunky Monkey" flavor-literally. The company was forced to come up with another
name for the banana-flavored dessert, the New York Times reports. Imagine the
interpretation problems foreigners could have with other Ben & Jerry's flavors.
"Phish Food"--pellets or flakes? "Chubby Hubby"-chunks of overweight
men? It's a good thing they've retired their "Tennessee Mud" flavor.
Source: Nutrition Week 28(47):1, December 11, 1998.
QUESTIONS KEEP SPROUTING ABOUT SPROUTS
Sprouts, those crunchy, healthy newborn plants often associateed with the
hippie days of the 1960s, have in this decade become regulars in salad bars and produce
departments across the country. But along with their presence has come an increasing
frequency of sprout-related food-borne illness. The federal government has linked the most
common kind, alfalfa sprouts, to a number of food-borne disease outbreaks, most occurring
since 1995. The disease culprits included the bacteria Salmonella and Escherichia coli
O157:H7, a particularly dangerous pathogen. These outbreaks led the Food and Drug
Administration in August 1998 to issue a health advisory for high-risk groups warning them
not to eat raw alfalfa sprouts and in September to conduct a public health hearing to
determine what further steps, if any, are needed to ensure the safety of sprouts.
"There are some interesting questions raised about sprouts," says Karen Hulebak,
a science policy analyst in the FDA's Office of Policy. "What do we know about the
source of sprout contamination? What should consumers do? There are a lot of
uncerainties." Following are some answers to those questions.
What are Sprouts?
Sprouts, the germinating form of seeds and beans, are easy to produce. They require no
soil, only water and cool temperatures. They emerge in two to seven days, depending on the
type of seed or bean. In addition to raw alfalfa sprouts, other varieties include clover,
sunflower, broccoli, mustard, radish, garlic, dill, and pumpkin, as well as various beans,
such as mung, kidney, pinto, navy and soy, and wheat berries. Many are sold individually,
and some are sold in mixtures. Potomac Glen Farms in Potomac, MD, sells a wide array. Each
offers a distinct flavor, suggesting, as sprout growers like to point out, that sprouts
indeed work well in a variety of dishes, such as soups, salads, sandwiches, and stir-frys.
While versatile, sprouts also are favored for their nutritional value. Like other fresh
produce, sprouts are low in calories and fat and provide substantial amounts of key
nutrients, such as vitamin C, folate and fiber. A 1997 Johns Hopkins University study
suggested raw broccoli sprouts may be particularly rich in sulforaphane, a compoound that
may mobilize the body's natural cancer-fighting resources and reduce the risk of
developing cancer (1).
How do they cause illness?
Though popular in this country in only the past few decades, sprouts have actually been
around for thousands of years. Mung beans have been used in Chinese foods for years,
though usually in cooked dishes. Today, sprouts in the United States are a $250 million
market. Some 475 US sprout growers produce 300,000 tons of sprouts every year, according
to the International Sprout Growers association. As many as 10 percent of Americans eat
sprouts regularly. Sprouts have only recently emerged as a recognized source of food-borne
illness. Since 1995, health officials have attributed 13 food-borne disease outbreaks
worldwide to sprouts. Ten of these outbreaks occurred in the United States, resulting in
illnesses in at least 956 Americans and at least one death. Four of the outbreaks were
caused by E. coli bacteria, and three of those involved the most dangerous strain, E. coli
O157:H7. The biggest outbreak occurred in Japan in 1996 where 9,000 people were sickened
and 17 died after eating radish sprouts contaminated with E. coli O157:H7. The O157:H7
strain produces a toxin in the human gut that damages cells of the intestinal lining. This
allows blood to pass into the stool. Other symptoms of O157:H7 infection are stomach ache,
nausea, and vomiting. Infection can lead to hemolytic uremic syndrome (HUS), a major cause
of acute kidney failure in children in this country. HUS is fatal in about 3 to 5 percent
of cases.
Many of the outbreaks have involved raw alfalfa sprouts or mixed sprouts containing raw
alfalfa sprouts contaminated with Salmonella. In people, Salmonella can cause
salmonellosis, an illness characterized by fever, stomach cramps, and diarrhea. The
illness can last as long as seven days, and severe cases may require hospitalization. In
some people, it can cause death. A small number of illnesses may develop into recurring
joint pain and arthritis.
How does the contamination occur?
It is believed that the seeds from which sprouts are derived are often the source. Some of
the seeds may become contaminated by animals in the field or during post-harvest storage,
for example. Also, the use of animal manure in the fields of alfalfa intended for nonhuman
use may be a problem if seed is used for sprouting. The ideal conditions provided by
germinating seeds and beans, namely abundant nutritients in this phase of plant growth,
high levels of moisture needed to produce sprouts, and heat generated form the sprouting
process, help ensure the survival and growth of bacteria. "In the sprouting
environment, bacteria can grow quickly," says Robert Wick, PhD, a plant pathologist
with the University of Massachusettes and one of the presenters at the FDA's September
1998 public hearing on sprouts. So far, mishandling of sprouts during production, packing,
or distribution has not been implicated as the source of sprout contamination. However,
bacteria already present in the sprouting seed can continue to thrive in conditions in
which poor food handling techniques are practiced, for example, lack of refrigeration,
infected workers, and dirty and unsanitary sprouting facilities.
What preventive measures can be taken to avoid or eliminate contamination?
Following three food-borne disease outbreaks involving raw alfalfa sprouts in August 1998,
the FDA reaffimed a warning that had been issued by the National Centers for Disease
Control and Prevention in 1997. The advisory urged people at high risk for severe
food-borne disease, children and the elderly, and people with compromised immune systems,
to avoid raw alfalfa sprouts until methods to improve the safety of sprouts can be
identified and put in place.
Possible preventive measures to ensure safe sprouts may include decomtamination of sprout
seeds and/or the chemical treatment of the seeds with calcium hypochlorite which is
already in use in California on an emergency basis as approved by the state's
Environmental Protection Agency. Irradiation appears to work well in decontaminating
sprout seeds also, especially when used in conjunction with calcium hypochlorite.
Irradiation of sprout seeds would reqiure the FDA's approval. Heat treatment, (the same as
pasteurization), has limited appeal because there is such a fine threshold at which
bacteria can be killed and germination not destroyed.
According to the International Sprout Growers Association (ISGA) president Snider, the
industry is involved with the FDA's Center for Food Safety and Applied Nutrition, the
National Advisory Committee on Microbiological Criteria for food, and the National Center
for Food Safety and Technology, in an effort reduce any hazards associated with sprouts.
"This is a difficult time for us," she acknowledges. "But out of
difficulties, something good can come. We expect these concerns over sprout safety to turn
out to be our best friend. We want our products to carry zero risk."
How to Eat Sprouts Safely
If you belong to one of the groups at high risk for food-borne disease (children, the
elderly, and people with compromised immune systems), avoid raw alfalfa sprouts. If you
are a healthy adult, follow these tips:
1. Buy only sprouts kept at refrigerator temperature. Select crisp-looking sprouts with
the buds attached. Avoid musty-smelling, dark, or slimy-looking sprouts.
2. Refrigerate sprouts at home. The refrigerator should be set at no higher than 40°
Fahrenheit (4° Celsius).
3. Wash hands with warm water and soap for at least 20 seconds before and after handling
raw foods.
4. Rinse sprouts thoroughly with water before use. Rinsing can help remove surface dirt.
Do not use soap or other detergents.
Reference:
1. Nestle, M. Broccoli sprouts as inducers of carcinogen-detoxifying enzyme systems:
clinical, dietary, and policy implications. Proceedings of the National Academy of
Sciences of the United States of America, 1997 Oct 14, 94(21):11149-51. (UI: 97470931)
Source: USFDA, FDA Consumer
WOMEN AND OBESITY: FROM THE BENCH TO THE BEDSIDE AND BEYOND
The UCSF National Center of Excellence in Womens Health is sponsoring a forum dealing
with women and obesity on April 22, 1999. This event will feature six speakers presenting
on the following topics:
¨ health implications and definitions of obesity, behavioral/lifestyle modification,
medical and surgical treatments,
¨ impacts of ethnicity and SES on obesity, and
¨ womens body image/size acceptance.
Participants will learn about the recent controversies surrounding obesity and women,
discuss and debate research relating to obesity and women, help develop a
multidisciplinary understanding of all aspects of this topic, participate in a provocative
and stimulating roundtable discussion, and learn of funding opportunities for research on
obesity. Speakers include Dr. Judith Stern, UC Davis; Laurel Mellin, RD, UCSF; Dr Marco
Patti, MD, UCSF; Dr. Gina Moreno John, MD, UCSF; Michaela Kiernan, Stanford; and Joanne P.
Ikeda, RD, UC Berkeley.
For more information or to register for this event, phone (415)885-7273 or email:
ucsfcoe@itsa.ucsf.edu.
"HELPING CHILDREN CONNECT: THE ROLE OF PHYSICAL ACTIVITY,
NUTRITION, AND EMOTIONAL HEALTH IN GROWING UP FIT" OFFERED BY UCLA EXTENSION,
SATURDAY, MARCH 20
UCLA extension is offering a new one-day, fitness program "Helping Children Connect:
The Role of Physical Activity, Nutrition, and Emotional Health In Growing Up Fit"
Saturday, March 20. This course will address why inactivity and childhood obesity have
increased to disturbing levels in our society and how this trend can be reversed.
Health habits and attitudes are formed early in childhood. Parents, teachers, physical
educators and allied health professionals are charged with helping children develop the
eating, exercise, and coping skills that will provide them with a healthy start in
building fit bodies. Issues to be discussed in this program include the connections
between television watching, food, choices, stress, misinformation, and organized physical
activity, and their impact on childhood health.
The course meets Saturday March 20, 9 am-3:30 pm, at UCLA; 5200 Math Sciences, Tuition for
noncredit course # P3643 is $70 and for the credit course # P3641 is $125. Registration
may be made in advance or at the door. For complete details call, (310) 825-7093 or write
UCLA Extension Sciences, 10995 Le Conte Ave., Ste. 714, Los Angeles, Ca 90024. To register
for courses, call (310) 825-9971 or (818) 784-7006.
TELEVIDEO CONFERENCE: "EMERGING ISSUES IN FOOD SAFETY"
Presented by the Institute of Food Technologists (IFT) and sponsored by the
Northern California Regional Section (NCIFT) and the San Joaquin Valley Sub-Section
(SJIFT). The conference will be held on Tuesday, April 6, 1999 at the Edison Ag-Tac
Center, 4175 South Laspina Street, Tulare, CA beginning at 5:00 pm.
The speakers are as follows:
Bruce Stillings, IFT President, Host
Dr. Michael P. Doyle, Director of the Center for Food Safety and Quality Enhancement,
"A technical perspective on emerging food safety issues."
Dr. Morris E. Potter, newly named Director of the FDA's Food Safety Initiative, "The
regulatory issues."
Keynote Speakers are:
Dr. Janet McDonald, Public Affairs Specialist, FDA, San Francisco District Office
Dr. Linda Harris, Food Safety/Microbiology Specialist, UC Davis
Who should attend: All professionals involved in food handling, especially food
processors, regulators, nutritionists, foodservice operators, educators, and dietitians
are encouraged to attend.
For information or forms contact Bernadine Ferguson at (559)255-1625, or Bruce Ferree,
(209)948-0129 or visit the website at http://www.ift.org/sections/ncift/video.htm
Registrations Due by Friday, April 2.
RESOURCES:
FARMER'S MARKETS
The number of farmers' markets in the US is steadily increasing, up 37
percent from 1994. Today there are 2,746 farmers' markets. The US Department of
Agriculture has now published the National Directory of Farmers' Markets. The directory
lists the location, hours of operation, contact numbers of farmers' markets, and also
notes if they participate in the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) or other food security programs. The directory is available on
the web at www.ams.usda.gov/farmersmarkets or can be ordered by calling (202) 720-8317.
Source: Nutrition Week 28(47): December 11, 1998, p. 8.
PREVENTING NEURAL TUBE DEFECTS
The CDC-produced manual, Preventing Neural Tube Defects: A Prevention Model
and Resource Guide, for folic acid campaigns is now available on the web. The address is:
http://www.cdc.gov/nceh/programs/infants/brthdfct/prevent/folcamp.html
In addition to the scientific background on neural tube birth defects, the manual
outlines a plan for preventive action including: Mobilizing your community; Planning a
prevention campaign; Using health communications materials; and tracking and evaluating a
community program.
NEW FOOD SAFETY WEBSITE IS ESTABLISHED
The website www. FoodSafety.gov is a "gateway" web site designed to
help the public find government food safety information more readily on the web. The site
provides links to food safety-related web sites from federal, state, and local government
agencies. www. FoodSafety. gov is one of the initiatives of the May 1997 National Food
Safety Initiative Report to the President. This site was developed by the FDAs Center for
Food Safety and Applied Nutrition (CFSAN) in consultation with USDAs Food Safety
Inspection Service (FSIS). http://www.foodsafety.gov/
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