UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 26, No. 2
March/April 2001
UC Davis News: Judith Stern Receives Charles A. Black Award
Safety Alert: Metabolife Recalls Its Metabolife Diet &
Energy Bars
Herbs and Warfarin: A Potentially Dangerous Combination
Media Discourages Breastfeeding
Value Marketing Is Making Americans Fat
The Government's New Cholesterol Guidelines
Focus on Food, Not Fat, in New American Heart Association
Guidelines
The Use and Misuse of Fruit Juice In Pediatrics
N-3 Fatty Acids: New Trials Confirm Cardio-protective Activity
Dietary Supplements May Do More Harm than Good
Does Diet influence Hyperactivity?
Resources:
Six "Quick Clicks" for Quality Nutrition Education
An Internet Guide to Evidence-Based Medicine
New Book: Children and Teens Afraid to Eat
Exercise with Disabilities Resource
Calcium-Related Websites
Subscription for NUTRITION PERSPECTIVES
Sheri Zidenberg-Cherr, PhD, Editor Department of Nutrition University of California Davis, CA 95616
NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Cristy Hathaway, 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, Department of Nutrition, University of California, Davis, CA 95616-5270. Phone (916)752-3387; FAX, (916) 752-8905.
UC DAVIS NEWS: JUDITH STERN RECEIVES CHARLES A. BLACK AWARD
Professor Judith Stern, PhD, Department of Nutrition, was selected recipient of the 2001 Charles A. Black Award by the Council for Agricultural Science and Technology (CAST). The award recognizes her work in translating science to the media. She was honored at a reception and banquet in Alexandria, Virginia, in March.
Stern is also in Internal Medicine/Division of Clinical Nutrition and Metabolism,
director of the UC Davis Food Intake Laboratory Group, and co-director of a
NIH-funded Alternative Medicine Center for Research in Asthma, Allergy and Immunology.
An expert on diet and nutrition, she has published extensively on nutrition,
the effect of exercise on appetite and metabolism and obesity. CAST assembles,
interprets and communicates science-based information on food, fiber, agricultural,
natural resource and related societal and environmental issues to legislators,
regulators, policymakers, media, the private sector and the public.
Source: CA&ES Currents; December 2000.
SAFETY ALERT: METABOLIFE RECALLS ITS METABOLIFE DIET
& ENERGY BARS
Metabolife International has issued a voluntary recall of all of its Metabolife
Diet & Energy Bars manufactured through May 4, 2001, because the products
contain a significantly higher-than-labeled level of vitamin A (approximately
32,500 IU per bar). The problem was reportedly due to an error by the contract
manufacturer, MLO Products, Inc. Excessive amounts of vitamin A can cause severe
health problems. Specifically, large amounts of vitamin A (more than 25,000
International Units or IU) can cause severe liver damage (including cirrhosis),
bone and cartilage abnormalities, increased pressure in the brain, and birth
defects in infants whose mothers consumed vitamin A during pregnancy. Those
especially vulnerable to vitamin A toxicity are children, including those breast
fed by mothers consuming excessive amounts of vitamin A, pregnant women, and
those with liver disease caused by alcohol, viral hepatitis, and severe protein-calorie
deficiency, according to a statement by the company.
The Metabolife Diet & Energy Bars were distributed from December 25, 2000,
to May 4, 2001, to retail stores nationwide. The two-ounce dietary supplement
bars have a red label that reads, in part, "Metabolife Diet & Energy
Bar." These products come in Outrageous Oatmeal Raisin, Perfectly Peanut,
Downright Chocolate and Lemony Lemon flavors. All lots produced to date are
subject to this recall.
No illnesses from this product have been reported to date. No other Metabolife
products are affected by this recall. "Metabolife discovered the excessive
vitamin A amounts during Metabolife's own quality assurance sampling audit,
which was confirmed by independent testing by the manufacturer," stated
Metabolife's CEO, David Brown. "We are voluntarily recalling this 4-month-old
product as a responsible company."
Consumers who purchased a Metabolife Diet and Energy Bar should return it to
the place of purchase for full refund, or destroy the product. Consumers with
questions may call (800) 540-7099. Again, no other Metabolife products are affected
by this recall.
Source: SafetyAlerts [Online] Press Release; May 8, 2001.
National health objectives for 2010 to increase the proportion of pregnancies
begun with optimum folic acid levels have already been met, according to a survey
conducted by the Centers for Disease Control and Prevention (CDC) (1).
The US Public Health Service recommended in 1992 that women of childbearing
age increase their consumption of folic acid, based on data that low folic acid
levels are associated with an increased incidence of spina bifida and anencephaly.
The Food and Drug Administration (FDA) followed with a mandate in 1996 that
all enriched cereal grain products be fortified with folic acid.
Serum levels of folate in women aged 15 to 44 years who participated in the
National Health and Nutrition Examination Survey (NHANES) 1999 were compared
with those obtained during the NHANES III survey of 1988-1994. The folate level
among women of childbearing age has increased from 4.7 µg/mL during the
NHANES III survey to 12.6 µg/mL in NHANES 1999 for those without supplementation
and from 8.4 to 20.0 µg/mL for those who took supplemental vitamins. Similar
increases in folate levels occurred in all populations. Pediatricians can anticipate
treating fewer patients with spina bifida and anencephaly.
Reference:
1. Folate Status in Women of Childbearing Age-United States, 1999. MMWR; October
27, 2000; 49:42; pp. 962-965.
Source: AAP News; 18(2); February 2001; p. 53
HERBS AND WARFARIN: A POTENTIALLY DANGEROUS COMBINATION
It appears that many physicians and their patients have adopted a "don't
ask, don't tell" policy when it comes to the use of so-called "unconventional"
therapies (e.g. herbs, vitamins, or chiropractic, among others). A recent survey
of 232 arthritis sufferers found that most of those interviewed used some form
of unconventional therapy, but that fewer than half had discussed the issue
with their physician (1). The reason patients most frequently cited for not
disclosing their use of unconventional therapies? Their physician never asked.
It is becoming increasingly apparent that health professionals must do a better
job of initiating a dialog on this topic. A case in point involves the growing
evidence that herbal remedies can produce potentially dangerous interactions
with the commonly prescribed anticoagulant warfarin. A survey of the literature
identified three herbs that present a danger when used with warfarin.
Danshen
A case report from Cheuk M. Yu and colleagues describes a 48-year-old Hong
Kong woman with rheumatic heart disease who underwent valvuloplasty (surgical
reconstruction of a deformed cardiac valve) (2). Before discharge, warfarin
1 mg daily was prescribed, with subsequent increases to a final dosage of 4
mg daily to maintain the international normalized ratio (INR) between 1.5 and
3. The patient was also an intermittent user of herbal medicines prescribed
by an herbalist, with the main component of one of the herbs being "danshen,"
which is the root of Salvia miltiorrhiza.
Approximately one month after she received a new prescription for herbal medicine
to treat symptoms of headache and general malaise, the patient presented in
the emergency department with fever, atrial fibrillation, and other symptoms.
The clotting profile was found to be extremely abnormal, with the INR > 5.62.
The patient was found to be over-anticoagulated, most likely the result of an
interaction between warfarin and danshen. This aberrant clotting profile persisted
for at least five days after warfarin and danshen were stopped.
Tsung O. Cheng describes danshen as a drug commonly used by herbalists to treat
a variety of symptoms of heart disease, including angina, myocardial infarction,
and congestive heart failure (3). In addition to inducing vasodilation, danshen
also suppresses thromboxane, reduces platelet adhesion, and may decrease warfarin
clearance. Thus, it potentiates the anticoagulant activity of warfarin.
Although its use appears to be most popular in Asia, Cheng warns that an increasing
number of patients in the West are likely to gain access to danshen. "Because
both Coumadin and coronary artery disease are common, physicians should be aware
of the possibility of the interaction between Coumadin and danshen when excessive
bleeding or unexpected prolongation of the prothrombin time [PT] is encountered
in any patient … who has otherwise been under good anticoagulant control."
Of additional interest is the fact that danshen sometimes is added to Chinese
cigarettes.
Dong Quai
Another traditional Chinese herb, dong quai (also known as tang-kuie, dang
gui, and Chinese angelica), is actively marketed in the United States for numerous
gynecologic problems, including menstrual cramps and menopausal symptoms. Analyses
of dong quai have identified several coumarin derivatives that could produce
antithrombotic effects, results that were observed clinically by Robert Lee
Page II and Julie D. Lawrence (4).
In their case report, the authors describe a 46-year-old African American woman
with a history of heart disease, stroke, and atrial fibrillation who was stabilized
for two years on 5 mg warfarin daily. In the course of a routine follow-up examination,
testing revealed an unexpected and profound alteration in the patient's clotting
profiles. Her PT and INR increased from around 16.2 seconds and 1.89 to 27.0
seconds and 4.9, respectively. At first the authors were unable to identify
the case of this sudden change, and it was only when the patient recalled that
she had started taking dong quai (one 565-mg tablet one or two times daily)
for perimenopausal symptoms on the advice of an herbalist that they were able
to diagnose the problem. Four weeks after discontinuing dong quai her clotting
values had returned to the therapeutic range.
St. John's Wort
Gaining popularity as a remedy for mild depression, in part because of its
reported near-complete lack of appreciable side effects, St. John's Wort has
nonetheless received some scrutiny in Sweden because of its suspected interaction
with warfarin. In seven cases documented by the Swedish Medical Products Agency,
physicians have reported clinically significant reductions in the anticoagulant
activity of warfarin (i.e. decreased INR values) associated with patient use
of St. John's Wort (5).
None of the cases resulted in thromboembolic complications, but in each instance either an increase in warfarin dosage or cessation of St. John's Wort therapy was necessary in order to maintain appropriate clotting profiles. Although the mechanism of activity is unknown, the authors speculate that the effect may be the result of induction of the cytochrome P450 2C9 enzymes.
Caution Advised
What these reports demonstrate is that health professionals need to find out
about patient use of unconventional therapies, both to anticipate known drug
interactions and to be alert for undocumented but potentially harmful combinations.
The Food and Drug Administration estimated that one out of 10 people who try
the products experiences some type of harmful side effect (4). As noted by Page
and Lawrence, the "naturalness" of many unconventional therapies is
not a guarantee of their "harmlessness," and the distinction may not
be evident to many consumers.
References:
1. Jaya K. Rao, MD, MHS; Kimberly Mihaliak, BS; Kurt Kroenke, MD; Use of Complementary
Therapies for Arthritis among Patients of. Ann Intern Med; Issue 131; September
21, 1999; pp, 409-416.
2. Yu CM, Chan JCN, & Sanderson JE. Chinese herbs and warfarin potentiation
by 'Danshen.' J Int Med; 241(4); April 1997; p. 337.
3. Cheng TO. Interaction of herbal medicine with Coumadin. J Emerg Med; 18(1);
January 2000; p. 122.
4. Page RL 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy;
19(7); July 1999; 870-6.
5. Yue QY, Bergquist C, and Gerden B. Safety of St John's wort (Hypericum perforatum).
Lancet; 12(355); February 2000; pp. 576-7.
Source: Nutrition & the MD; 26(10); October 2000; p. 7.
MEDIA DISCOURAGES BREASTFEEDING
Women may be getting negative messages about breastfeeding from the mass media,
according to an analysis of references to infant feeding on British TV and in
the press (1).
Authors Lesley Henderson, senior research fellow, Jenny Kitzinger, reader,
and Josephine Green, senior lecturer, Centre for Media and Communications Research,
Department of Human Sciences, Brunel University, London, reviewed 13 national
newspapers, all regular health and parenting TV shows, and all programs from
a sampling of news bulletins, soap operas, medical drama series and daytime
nonfiction programs during March 1999.
There were 235 infant feeding references in 1,396 television episodes. Of those,
in just one scene a baby was breastfed; a breast pump was shown in nine scenes.
The preparation of formula milk or bottle-feeding, however, was shown in 170
scenes. Most of the references to breastfeeding were verbal, occurred in fictional
stories and provided a source of humor and embarrassment. In contrast, most
of the references to bottle-feeding were visual, occurred in all types of TV
programs, provided background to the scene and in specific advertisements, supported
the role of fathers in parenting. There were 27 references to problems related
to breastfeeding, including the difficulty of leaving the infant. The only problem
mentioned in association with bottle-feeding was the time involved in sterilizing
bottles.
Breastfeeding was presented in the press as a middle class or celebrity activity.
Only three of 38 references were positive. Problems associated with breastfeeding
were identified in 15 articles, including sore nipples, weight gain, disrupted
sleep, saggy breasts, the transfer of drugs through breast milk and the death
from starvation of a breast-fed baby whose mother had breast milk insufficiency
syndrome. Health risks associated with formula milk were mentioned only once.
The authors suggested that the lack of a positive image in mass media may reinforce
the idea that bottle-feeding is normal and that breastfeeding is difficult,
likely to fail and appropriate only for wealthy or celebrity women and may affect
how women choose whether to breastfeed their babies.
Reference:
1. Henderson L, Kitzinger J, and Green J. Representing infant feeding: content
analysis of British media portrayals of bottle-feeding and breast feeding. BMJ
2000; 321: 1196-1198.
Source: AAP News; 18(2); February 2001; p. 52.
VALUE MARKETING IS MAKING AMERICANS FAT
Foreign visitors to this country always comment on two things: portion sizes
in our restaurants are huge, and too many Americans are overweight. Is there
a connection between the two? Health experts think so, and think we could remedy
the problem.
You know what value marketing is. It's selling people more of something for
less money. In the food industry, it's when the server says, "For only
a quarter more you can have the larger size." Value marketing is referred
to as "value meals," "super sizes," and "oversized"
packaging.
Value marketing makes sense for the food industry. Restaurateurs, for instance,
can give customers value either by cutting prices or putting more food on the
plate. "When it comes to a choice between cutting prices by a dollar or
giving people about thirty cents extra food, it's pretty much a no-brainer,"
says marketing expert Dr. John L. Stanton.
But more food for less money has an inescapable downside: It shifts the
pressure from our wallets to our waistbands.
The problem is devouring all that extra food. The US Department of Agriculture
figures show that we are eating an additional 148 calories per day, on average,
than we were twenty years ago. That increase may seem insignificant at first,
but it could work out to an extra 15 pounds per year.
Today 55 percent of American adults are clinically overweight, and one in every
four adults is obese (severely overweight). For the first time in history, most
of the American population is at increased risk for obesity related diseases
like certain cancers, coronary heart disease, stroke, diabetes, high blood pressure,
gall bladder disease, and osteoarthritis.
What Can You Do?
As long as American rate "value" over "health," the food
industry will continue to spend billions of dollars on value marketing. It won't
stop until the customer speaks up.
"In supermarkets, restaurants, and coffee shops, tell them you don't want
more for less, less food for even less money. You want a meal you can finish
without feeling stuffed," says the American Institute of Cancer Research
(AICR) Director of Nutrition Education Melanie Polk, RD.
When given the option, customers can always order the small size. "Make
it a rule to ask for the smallest portion available. Always say small, say half
or share," Polk suggests. Choosing the regular burger instead of the quarter-pound
size saves about 160 calories. Ordering a cup of cream of mushroom soup instead
of a bowl could eliminate a whopping 180 calories, cutting the total by half.
Pushing your plate away after just one cup of pasta on a three-cup platter saves
almost 300 calories.
"At table service restaurants, divide the meal with a knife before you
start eating and ask the waiter for a doggie bag," Polk says. If you're
the kind of person who doesn't like to make a fuss, send for AICR's new Customer
Cards. They read, "Your food is excellent, but your servings are too large.
I would prefer a reasonable portion size." Use the card to send your compliments
to the chef.
Bucking the "Bigger Is Better" Trend
Value marketing has confused Americans about what a normal portion of food
looks like. With every super-sized fast food meal or 64-ounce soft drink, we
lose perspective.
According to AICR's brochure, The New American Plate, you can regain perspective
on potion size by spending a few minutes with a measuring cup. Look on the Nutrition
Facts label of your favorite food and find the standard serving and empty it
onto a clean plate (or in a bowl). Make a mental note of what that standard
serving looks like.
Ask yourself how many standard servings go into the portion you usually eat.
Are you eating three servings of potatoes when you are full after only two?
Are you pouring two servings of cereal when your activity level requires only
one? If the answer is yes, gradually reduce the size of your typical portion.
One caveat: Most of us don't eat nearly enough vegetables and fruit. They are
low in calories and important for cancer prevention, so help yourself to more
as you cut back on other foods.
Adapted from: AICR Newsletter; Issue 71; Spring 2001; pp. 1-3.
THE GOVERNMENT'S NEW CHOLESTEROL GUIDELINES
On May 15, the National Heart, Lung and Blood Institute issued major new clinical
practice guidelines on the prevention and management of high cholesterol in
adults. The guidelines are the first major update in nearly a decade. Below
is a summary of the guidelines, also known as the Adult Treatment Panel (ATP)
III, and their implications for consumers and dietetics professionals.
The new guidelines were developed over 20 months by 27 panel members and consultants,
including from ADA, who are leading experts in heart disease, lipid measurement
and management, primary care medicine, nutrition, epidemiology, health economics
and other areas.
Key new guidelines are:
· more aggressive cholesterol-lowering treatment and better identification of those at high risk for a heart attack;
· use of a lipoprotein profile as the first test for high cholesterol; a new level at which low HDL (high-density lipoprotein) becomes a major heart disease risk factor;
· a new set of "Therapeutic Lifestyle Changes," with more power to improve cholesterol levels;
· a sharper focus on a cluster of heart disease risk factors known as "the metabolic syndrome" and
· increased attention to the treatment of hightriglycerides.
The new guidelines are expected to substantially expand the number of Americans
being treated for high cholesterol, including raising the number on dietary
treatment from about 52 million to about 65 million and increasing the number
of people receiving prescribed cholesterol-lowering drugs from about 13 million
to about 36 million.
ADA and its members are uniquely trained and qualified to help Americans make
the long-term dietary and lifestyle changes that can lower cholesterol, reduce
risk of heart disease and achieve and maintain good health.
The guidelines recommend a new "Therapeutic Lifestyle Changes" treatment
plan for high cholesterol that reflects changes inn Americans' eating habits.
The "TLC" plan includes daily intakes of less than 7 percent of calories
from saturated fat and less than 200 milligrams daily of dietary cholesterol.
And the guidelines allow up to 35 percent of daily calories from total fat,
as long as most is from unsaturated fat, which does not raise cholesterol levels.
The dietary modifications that are called for in these guidelines, such as
limiting saturated fats and increasing intakes of soluble fiber and plant stanol
esters, can be met with planning and with the help of a dietetics professional.
Plant stanols and sterols are included in certain margarines and salad dressings;
foods high in soluble fiber include cereal grains, beans, peas, legumes and
many fruits and vegetables.
The guidelines specifically emphasize the importance of medical nutrition therapy,
the comprehensive services of a dietetics professional, in facilitating the
behavior changes that people will need to make in order to follow the recommended
diet and lifestyle changes. The guidelines recommend evaluating patients to
see if a diet- and lifestyle-based approach to clinical treatment will be effective
prior to-or with, cholesterol-lowering drugs.
People should check with their doctors to learn their overall risk for a heart
attack, and what, if any, treatment is needed. Patients should seek referrals
from their physicians to registered dietitians.
Specific changes in the new guidelines include:
· Treating high cholesterol more aggressively for those with diabetes. Besides their very high short-term risk for having a coronary event, persons with Type 2 diabetes also have a particularly high risk of dying from a heart attack. Type 2 diabetes or non-insulin- dependent diabetes mellitus, is the most common form of the disease and affects more than 14 million Americans.
· A lipoprotein profile as the first test for high cholesterol. A lipoprotein profile measures levels of LDL, total cholesterol, HDL and triglycerides, another fatty substance in the blood. The prior recommendation called for initial screening with a test for only total cholesterol and HDL. The guidelines advise healthy adults to have a lipoprotein analysis once every 5 years.
· A new level at which low HDL becomes a major risk factor for heart disease. ATP III defines a low HDL as being less than 40 mg/dL. Previously, a low HDL was less than 35 mg/dL. The change reflects new findings about the significance of a low HDL and the strong link between a low HDL and an increased risk of heart disease. An HDL level of 60 mg/dL or more is considered protective against heart disease.
· Additionally, the guidelines stress the need for weight control and physical activity, both of which improve various heart disease risk factors.
· Identifying a "metabolic syndrome" of risk factors linked to insulin resistance, which often occur together and dramatically increase the risk for coronary events. The syndrome includes factors such as too much abdominal fat (indicated by too large a waist measurement), elevated blood pressure, elevated triglycerides and low HDL. Therapy for the syndrome emphasizes TLC, especially weight control and physical activity. Insulin controls the body's metabolism of carbohydrates, fats and protein. In insulin resistance, its normal actions are impaired.
· More aggressive treatment for elevated triglycerides. Recent studies indicate that an elevated triglyceride level is significantly linked to the degree of heart disease risk. The new guidelines recommend treating even borderline-high triglyceride levels. Therapy includes weight control and physical activity and sometimes, for higher triglyceride levels, medication.
· Advising against the use of hormone replacement therapy (HRT) as an alternative to cholesterol-lowering drugs. According to ATP III, studies have not shown that HRT reduces the risk for major coronary events or deaths among postmenopausal women who have heart disease. HRT also increases the risk for thromboembolism and gallbladder disease. In contrast, cholesterol-lowering drugs have been found to reduce coronary events in women with or without heart disease.
An executive summary of the new guidelines, the "Third Report of the NCEP
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol
in Adults," also known as Adult Treatment Panel (ATP) III, appears in the
May 16, 2001, issue of the Journal of the American Medical Association.
Adapted from: The American Dietetic Association Press Release; May 21, 2001.
Eating more whole grain foods? Good decision. Whole grains are higher in dietary
fiber and nutrients than refined grains, and can play an important role in lowering
cancer risk and improving health. Sometimes, however, some detective work is
needed to actually find those whole grain products. Take whole wheat bread,
for example. Consumers consider brown breads to be more healthful. But you will
find brown breads on the supermarket shelves that are not actually whole grain.
Some bread is brown because caramel coloring or molasses is added during production,
but they are actually made mostly of refined flour or "enriched" flour.
The same goes for "seven-grain" bread.
To find bread that is truly made with whole-grain wheat, read the ingredient
list. The words "whole wheat flour" or "100 percent whole wheat
flour" should be listed first. Even if some refined flour is used, there
is more whole grain flour in this product than in any other type. You can find
whole grain cereals in much the same way. The ingredient list begins with a
"whole" grain, such as whole wheat, whole oats, whole barley, etc.
Impressed by banners across packages proclaiming "made with whole grain?"
Again, look at that list of ingredients. Is "whole wheat flour" listed
first? The manufacturer may have added some whole grains to make this claim
for the product, but the amounts are so small that there will be minimal difference
in nutritional value.
Looking for some whole grains to serve for dinner instead of basic white rice
or pasta? Try bulgur, quick-cooking brown rice, barley, kasha, millet, or quinoa.
They are available in supermarkets or at whole foods stores. Many grain products
are mistakenly thought to be whole grain, such as couscous and spinach pasta.
Finally, remember that whole grains can boost the nutritional value of many
recipes. You can add oatmeal to cookie recipes, substitute whole-wheat flour
for some of the refined flour in muffins and quick breads, and stir barley into
soups and stews.
Adapted from: AICR Newsletter; Issue 71; Spring 2001; p. 9.
FOCUS ON FOOD, NOT FAT, IN NEW AMERICAN HEART ASSOCIATION
GUIIDELINES
Acknowledging that previous versions of the American Heart Association's (AHA)
dietary guidelines have failed to communicate certain key nutrition concepts
effectively, Ronald M. Krauss, MD, principal author of the AHA guidelines for
2000, said that the new recommendations take a philosophically different approach
to helping consumers reduce their risk of heart disease and maintain optimum
health.
"The 2000 guidelines focus on overall dietary patterns and what foods
people should eat, not quantitative criteria as we have in the past," Krauss
told the audience of nutrition professionals that assembled to hear about the
new recommendations. He said that the AHA previously has emphasized reducing
fat as a percentage of calories and limiting amounts of cholesterol, a strategy
that many consumers have found difficult to implement. By instead encouraging
consumers to eat a varied diet that includes more plant-based foods, the new
guidelines make it unnecessary for most people to perform the calculations previously
needed and should, hopefully, improve compliance.
Core Elements
The framework of the new guidelines consists of four objectives that the AHA
identifies as essential to good health:
· A healthy eating pattern including foods from all major food groups;
· A healthy body weight;
· A desirable blood cholesterol and lipoprotein profile; and
· A desirable blood pressure.
Krauss said that many of the specific strategies the AHA recommends to attain
these objectives remain the same as in years past. A diet rich in fruits, vegetables,
legumes, whole grains, low-fat dairy products, fish, lean meats, and poultry
is still the basis for sound nutrition across the lifespan. However, a wealth
of new research has made it possible for the AHA to make some new recommendations
that are supported by peer-reviewed evidence.
For example, recent studies have linked consumption of fatty fish and omega-3
fatty acids to reduced sudden death from coronary heart disease, reduced arrhythmias,
increased anti-platelet effects, and lower rates of morbidity and mortality
from coronary heart disease. For these reasons, the AHA now suggests that individuals
consume two servings of fatty fish per week. Also, in recognition of data that
show the incidence of overweight and obesity increasing at an alarming rate,
for the first time the AHA guidelines stress the importance of preventing obesity
and maintaining a healthy body weight.
The guidelines' new emphasis on overall healthy dietary patterns, as opposed
to reducing fat intake as a percentage of calories, should help consumers achieve
their body weight goals, Krauss said. "We recognize that 'low-fat' is not
necessarily the best message for weight loss, because we've seen how people
can get the wrong message and go overboard looking for reduced fat, without
a significant impact on overall energy intake or body weight."
Other changes include new, more individualized approaches to management of
high-risk subgroups of patients, such as those with diabetes, high blood pressure,
and pre-existing cardiovascular disease. One such revision highlighted by Krauss
is the special consideration now given to individuals with a cluster of metabolic
risk factors for heart disease or stroke, such as excessive abdominal fat, glucose
intolerance or diabetes, and fasting triglyceride levels above 200 mg/dL. Studies
show that risk factors, collectively known as " Syndrome X," can best
be reduced by replacing dietary saturated fat with unsaturated fat instead of
with carbohydrates. Very-low-fat diets that are high in carbohydrates, although
they are appropriate for many who wish to reduce their risk of heart disease,
can decrease HDL cholesterol and increase triglycerides, a response that can
be problematic in the Syndrome X patient population.
The new AHA guidelines are available in the October 31, 2000, issue of Circulation
and on the World Wide Web at www.americanheart.org/dietaryguidelines/index.html.
Source: Nutrition & the MD; December 2000 Supplement; pp. 4-5.
THE USE AND MISUSE OF FRUIT JUICE IN PEDIATRICS
Historically, fruit juice was recommended by pediatricians as a source of vitamin
C, and an extra source of water for healthy infants and young children as their
diets expanded to include solid foods with higher renal solute. Fruit juice
is marketed as a healthy, natural source of vitamins and, in some instances,
calcium. Because juice tastes good, children readily accept it. Although juice
consumption has some benefits, it also has potential detrimental effects.
Recommendations:
· Juice should not be introduced into the diet of infants before 6 months of age.
· Infants should not be given juice from bottles or easily transportable covered cups that allow them to consume juice easily throughout the day. Infants should not be given juice at bedtime.
· Intake of fruit juice should be limited to 4 to 6 oz/d for children 1 to 6years old. For children 7 to 18 years old, juice intake should be limited to 8 to 12 oz or 2 servings per day.
· Children should be encouraged to eat whole fruits to meet their recommended daily fruit intake.
· Infants, children, and adolescents should not consume un-pasteurized juice.
· In the evaluation of children with malnutrition (over nutrition and under nutrition), the health care provider should determine the amount of juice being consumed.
· In the evaluation of children with chronic diarrhea, excessive flatulence, abdominal pain, and bloating, the health care provider should determine the amount of juice being consumed.
· In the evaluation of dental caries, the amount and means of juice consumption should be determined.
· Pediatricians should routinely discuss the use of fruit juice and fruit drinks and should educate parents about differences between the two.
Beverages of all sorts are gaining increased attention from nutrition and health
experts. Juices are not always bad for children, but studies show that many
young children are getting "too much of a good thing." For example,
10 percent of 2-3-year-olds consume more than 12 ounces of juice per day.
In recommending that whole fruits be encouraged, remember that some whole fruits
like grapes or large apple chunks present a choking hazard to very young children.
Strictly speaking, juices are not totally devoid of dietary fiber, (this is
confusing if not wrong in the statement that says that there's not fiber unless
the juice has pulp in it) but the fiber content is less than the whole fruit
would provide.
Many of the concerns over excess juice consumption apply to other beverages,
especially sodas and fruit "drinks." The above recommendations represent
approximately half of the daily fruit servings recommendations of the Food Guide
Pyramid. In other words, your child can get half his/her daily fruit in the
form of juice, but routinely going beyond that amount may be excessive. Excessive
juice consumption may be associated with diarrhea, flatulence, abdominal distention,
and tooth decay.
Adapted from: AAP Press Release; May 8, 2001.
N-3 FATTY ACIDS: NEW TRIALS CONFIRM CARDIO-PROTECTIVE ACTIVITY
Since researchers first documented the low rates of coronary artery disease
in Eskimos who consumed diets high in fat, cholesterol, and n-3 polyunsaturated
fatty acids (n-3 PUFAs), there has been a steady stream of reports confirming
that n-3 PUFAs can indeed help prevent cardiovascular disease. But most of these
reports have been based on epidemiological studies; there have been few prospective,
randomized clinical trials in humans.
Recently, however, several clinical intervention trials have begun to bridge this gap in the long-postulated relationship between n-3 PUFAs and prevention of cardiovascular disease. According to a recent review "recent developments in research confirm and extend the probability that n-3 PUFA beneficially influence cardiovascular disease. Large randomized clinical trials in which patients with coronary heart disease were treated with marine n-3 PUFA demonstrated a decreasedrisk of cardiovascular and all-cause mortality, which was achieved independent of vitamin E supplementation or LDL cholesterol lowering" (1).
SCIMO Trial
The most recent results come from Germany, where investigators in the Study
on Prevention of Coronary Atherosclerosis by Intervention with Marine Omega-3
Fatty Acids (SCIMO) enrolled 223 patients in a placebo-controlled trial that
assessed the progression of coronary atherosclerosis after long-term intervention
with a fish oil concentrate consisting of 55 percent eicosapentanoic and docosahexanoic
acids (EPA and DHA) (2).
Patients with angiographically proven coronary artery disease at baseline were
randomized to receive either 1.65 g EPA/DHA daily or a placebo reflecting the
average fatty acid composition of the European diet. Angiograghy was repeated
at two years, with the extent of progression or regression of disease judged
by a panel of experts. Of the 48 patients who showed change in the placebo group,
36 showed mild progression, 5 showed moderate progresstion, and 7 showed mild
regression.
By contrast, among the 55 patients in the fish oil group who showed change,
35 showed mild progress-sion, 4 showed moderate progression, 14 showed mild
regression, and 2 showed moderate regression. The authors also reported that
patients who took fish oil showed a trend for fewer cardiovascular events (p<
0.1) (7 for placebo vs. 2 for fish oil). However, LDL cholesterol levels tended
to be higher in the fish oil-supplemented group.
GISSI-Prevenzione
The SCIMO results corroborate findings from the much larger open-label Italian
study GISSI-P, which enrolled 11,324 patients who had suffered a myocardial
infarction within the preceding three months (3). Participants were randomized
to one of four groups receiving either highly purified fish oil (containing
850 mg EPA/DHA), 300 mg vitamin E, both fish oil and vitamin E, or no supplement
(control group) for three and a half years. Results, measured in terms of all-cause
mortality, non-fatal myocardial infarctions, and non-fatal strokes (the combined
primary endpoint), were then compared with those of patients who received no
supplement.
There was a 10 percent relative reduction in risk for the combined primary
endpoint in patients who received fish oil vs. all other patients, and a 15
percent reduction in those who received only fish oil vs. those who received
neither fish oil nor vitamin E. The vitamin E group did not show a statistically
significant benefit, and the fish oil/vitamin E combination group showed a benefit
similar to that of fish oil alone.
The vitamin E findings in the GISSI came as somewhat of a surprise, given the
mounting observational data suggesting that vitamin E is effective in the secondary
prevention of cardiovascular disease. However, these negative data for vitamin
E were recently confirmed in the Heart Outcomes Prevention Evaluation Study,
which found that treatment with vitamin E for a mean of 4.5 years had no apparent
effect in 9541 patients at high risk for cardiovascular events (4). In this
randomized controlled trial, the 4761 patients treated with 400 IU of vitamin
E did not differ significantly from the 4780 controls taking a placebo in terms
of deaths from cardiovascular causes, numbers of myocardial infarctions, or
strokes.
Other Outcomes
Given recent findings, which build upon a strong base of previous evidence
suggesting a cardiovascular benefit to taking fish oil, Angerer and von Schacky
conclude that a moderate daily dose of 0.5 to 2.0 g of EPA and DHA is likely
to be safe and effective in the secondary prevention of cardiovascular disease.
Still, they caution that n-3 PUFAs have not proven to be effective in certain
treatment situations, and more information is needed to confirm a benefit in
others. Specifically, the hope that n-3 PUFAs could reduce the incidence of
restenosis after angioplasty has thus far proven to be unfounded: a double-blind
trial that evaluated treatment with 2.7 g EPA and 2.3 g DHA two weeks before
and six months after angioplasty showed no benefit (5).
In addition, use of n-3 PUFAs in the primary prevention of heart disease, treatment
of peripheral artery disease, and for cardiac transplantation appears promising.
Large-scale clinical trials will be needed, however, to confirm benefits with
respect to morbidity and mortality.
References:
1. Angerer P, von Schacky C. n-3 polyunsaturated fatty acids and the cardiovascular
system.
Current Opinion in Lipidology; February 2000; 11: 1; pp. 57-63.
2. von Schacky C, Angerer P, Kothny W , Theisen K, and Mudra H. The Effect
of Dietary n-3 Fatty Acids on Coronary Atherosclerosis. A Randomized, Double-Blind,
Placebo-Controlled Trial. Ann Intern Med; 130:554; 1999.
3. Valagussa F, Franzosi M G, Geraci E, et al. Dietary supplementation with
n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results
of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza
nell'Infarto miocardico. Lancet, Aug 7, 1999, 354(9177): pp. 447-55.
4. Jialal I, Devaraj S, Yusuf S. Vitamin E supplementation and cardiovascular
events in high-risk patients. N Engl J Med; 2000; 342(25); p. 1917.
5. Odd Johansen, Magne Brekke, Ingebjørg Seljeflot, Michael Abdelnoor,
Harald Arnesen. n-3 fatty acids do not prevent restenosis after coronary angioplasty:
results from the CART study. Journal of the American College of Cardiology;
1999; 33:(6): pp. 1619-1626.
Source: Nutrition & the MD; 26(10); October 2000; pp. 4-5.
DIETARY SUPPLEMENTS MAY DO MORE HARM THAN GOOD
Parents who give their children dietary supplements may believe they are providing
natural, healthy alternatives to prescription drugs. But experts agree parents
need to be cautious. There were 704 reports of harmful effects with dietary
supplements involving children ages 6 to 18 years in 1998, according to American
Association of Poison Control Centers. As the definition of supplements expands
to encompass vitamins, minerals, botanical products, enzymes, and animal extracts,
the potential dangers increase.
Parents of children with chronic disorders such as attention-deficit/hyperactivity
disorder (ADHD) and adolescents wanting to lose weight or gain muscle are particularly
more likely to use supplements. The Washington Post reported creatine, a performance-enhancer,
was banned at University of Tennessee after 14 football players had cramping
episodes during one game. During a 33-month period, the Food and Drug Administration
linked 134 cases of serious illness, including death, to Ephedra, a supplement
used for weight loss and ADHD. For additional information regarding Ephedra,
see Nutrition Perspectives; 25:4; Jul/Aug 2000; pp. 2-3.
Some 50 percent of parents who use alternative medicine do not inform their
doctors, according to a report by Linda Spigelblatt, MD, associate professor
of pediatrics at the University of Montreal, Quebec (1). To minimize risks,
parents should read ingredient lists and confer with a physician about potentially
dangerous substances. Parents also can call the American Dietetic Association's
consumer hotline at (800) 366-1655 or visit the Physicians' Desk Reference Web
site at www.pdr.net for more information on
a particular dietary supplement.
Before giving children supplements, the Federal Trade Commission recommends
parents be aware of the following:
· Since dietary supplements have not been tested for their safety or effectiveness, the long-and short-term effects are not known.
· No federal standards for the quality or purity of supplements exist.
· "Natural" supplements may not be safe.
· The best adviser is the child's pediatrician. Consult a physician for beginning or continuing use of a supplement.
· Deceptive advertising tactics include impressive medical terms, money-back guarantees and words like "scientific breakthrough," "miraculous cure," or "ancient remedy."
Reference:
1. Spigelblatt L, Laîné-Ammara G, Pless IB, Guyver A. The use
of alternative medicine by children. Pediatrics; Issue 94; 1994; p. 811.
Adapted from: AAP News; 17(5); November 2000; p. 231.
DOES DIET INFLUENCE HYPERACTIVITY?
A lengthy list of dietary substances has been proposed as triggers for hyperactivity
in children, including sugar, additives, dyes, preservatives, and natural salicylates
found in vitamin C-rich foods. After their literature review, Susan E. Levy,
M.D., FAAP, section chief of the division of child development and rehabilitation
of Children's Seashore House, Children's Hospital, Philadelphia, and Susan Hyman,
M.D., FAAP, assistant professor of pediatrics at the University of Rochester
School of Medicine and Children's Hospital at Strong, concluded there may be
a small, poorly defined subgroup of children who show behavioral changes in
response to food additives or other dietary components, with the exception of
sugar, for which no convincing link has been shown.
"The scientific literature has largely laid the matter of sugar and hyperactivity
to rest. But it has taken a life of its own outside of the medical community.
It is not at all uncommon for parents to say, 'I don't know why he's still hyperactive.
I took sugar out of his diet,'" commented Dr. Hyman.
Parents can be remarkably difficult to convince. Mark Wolraich, M.D., FAAP,
professor of pediatrics and director of the Child Development Center at Vanderbilt
University, Nashville, has conducted four double-blind studies of sugar and
hyperactivity, all negative, both for the study group as a whole and for individual
children in crossover studies who received different diets at different study
points. After the investigators analyzed the results and discussed them with
the families, he said, some parents still insisted their child was affected
by sugar.
Dr. Wolraich points out that there are other good rationales for controlling
the sugar content in a child's diet, such as the risks of cavities and excessive
calorie intake. "It's important to maintain a good relationship with the
family. If the parents have strong beliefs, I won't necessarily try to convince
them otherwise, unless I think a diet is doing some harm."
Adapted from: AAP News; 17(4); October 2000, p. 133.
RESOURCES:
SIX "QUICK CLICKS" FOR QUALITY NUTRITION EDUCATION
Nutrition professionals need to cast a critical eye toward nutrition information
found on the web, both for their own sake and for that of their patients. One
strategy is to develop a list of quality sites that can be trusted to deliver
accurate information. The question is, which sites fulfill this all-important
criterion, while also providing the features and functionality that patients
will find useful? Nutrition & the MD has provided a list of "quick
clicks" that provide rapid access to a wide variety of excellent nutrition
education resources.
Where to Start
The best place to begin any search for nutrition information may well be Click
1, the Tufts University Nutrition Navigator (www.navigator.tufts.edu).
Although the site doesn't itself publish nutrition information or answer questions,
it does, much like Yahoo! and other search engines, serve up links to third-party
sites that do. The difference is that all sites featured on the Nutrition Navigator
has been reviewed by Tufts nutritionists, who rate each site for accuracy, depth
of information, timeliness, and overall usability. (They also categorize sites
appropriate for health professionals vs. consumers, although many are listed
in more than one area.) Only those sites that receive a certain minimum score
for these quality criteria are eligible for inclusion in the Tufts database.
This helps users quickly locate the information they need without having to
wade through a pile of useless or misleading links.
General Nutrition
Click 2, The Mayo Health Oasis (www.mayohealth.org),
is the only site to receive a perfect 25 out of 25 score on the Nutrition Navigator
rating scale. Thus, the site and its Nutrition Center make for an excellent
all-purpose nutrition resource where consumers can find reference articles on
a number of nutrition topics, as well as a Mayo dietitian's answers to frequently
asked nutrition questions.
Another excellent site that deserves special mention for its diverse and very
deep database of nutrition resources is Click 3, the USDA Food and Nutrition
Information Center (FNIC; available at www.nal.usda.gov/fnic/).
Serving the needs of professionals and consumers alike, the FNIC features an
A-to-Z list of links to major nutrition topics, plus special resource centers
for dietary supplements, dietary guidelines, and the USDA Food Guide Pyramid.
Parents and Children
Parents (especially new ones) are often particularly motivated to learn about
nutrition, so they can be sure they're doing right by their children. To feed
this information craving, nutrition professionals should send parents or those
about to become parents to Click 4, the Children's Nutrition Research
Center at the Baylor College of Medicine website (www.bcm.tmc.edu/cnrc/index.htm).
In addition to current and back issues of their quarterly newsletter, Nutrition
& Your Child, visitors will also find a very comprehensive and helpful "Facts
and Answers" index of frequently asked questions and responses available
on the site.
Vegetarians
With the health benefits of a plant-based diet becoming more and more evident,
a growing number of consumers are considering becoming vegetarians. But this
decision raises many questions, for example, how to maintain adequate intake
of nutrients such as iron and calcium. An excellent informational site geared
for consumers, but which may be of interest to professionals as well, is found
at Click 5, The Vegetarian Resource Group Website (www.vrg.org).
Besides numerous vegetarian recipes and tips, visitors can also find a deep
archive of articles on many aspects of vegetarian nutrition.
Non-English Speakers
The language barrier is a significant problem that nutrition professionals
may encounter when trying to deliver basic nutrition information to their patients.
To overcome this obstacle, check out Click 6, the Nutrition Education
for New Americans website (monarch.gsu.edu/nutrition/index.htm).
Here you'll find downloadable sets of nutrition handouts, including the Food
Guide Pyramid, plus fact sheets for healthy adults, mothers and babies, seniors,
and children, available without copyright in 37 different languages.
Source: Nutrition & the MD; 27(2); February 2001; pp. 6-7.
AN INTERNET GUIDE TO EVIDENCE-BASED MEDICINE
Most nutrition professionals are probably aware of the term "evidence-based
medicine" (EBM) and know that its definition involves, as most of the literature
generally phrases it, "evaluating the validity of research in clinical
medicine and applying the results to the care of individual patients."
(See Evidence-based Medicine Resource Center; available at www.ebmny.org;
accessed on January 8, 2001). But how exactly does this differ from the decision-making
process that health care professionals have been following all along? And, more
importantly, how can nutrition professionals use EBM to deliver more effective
patient care?
While it is somewhat beyond the scope of this article to present a full discussion
of EBM and its application in today's health care system, it is nonetheless
possible, to identify and describe some excellent websites where nutrition professionals
can learn more about EBM and how it can be used to improve patient care.
EMB Basics Online
The primer, "Evidence-Based Medicine: What It Is and What It Isn't,"
available at the UK's Center for Evidence-Based Medicine (cebm.jr2.ox.ac.uk/ebmisisnt.html),
is a great place to get grounded in the basics of EBM. To those skeptical that
EBM entails anything different from the practices at most modern health care
facilities, the authors argue that medical interventions for similar patients
have been shown to vary widely and inexplicably across institutions. This fact
calls into serious doubt the notion that uniform evidence-based practice already
exists, they say. They also claim that the reading tie needed to stay abreast
of the latest evidence from research far outstrips the time most busy professionals
can devote to such study. If health care professionals can't spare the time
to review the latest evidence, they can't possibly be bringing that evidence
into their everyday decision-making.
Cochrane Collaboration
Is it then true, as some critics argue, that only those in ivory towers have
enough time to practice EBM properly? Proponents of the philosophy say no, and
that the key is to utilize information tools that allow for efficient incorporation
of relevant patient-oriented evidence into clinical practice. One such tool
is the Cochrane Collaboration Database of Systematic Reviews, a continuously
updated archive of critical review articles that assess health care interventions
based on evidence from randomized controlled trials.
The idea for this database took shape in the late 1980s with an initial review
by Archie Cochrane, who observed that the varying standards of evidence used
in most traditional review articles made for clinical confusion and waste of
precious health care resources. From this modest start, the Collaboration has
grown to include more than 50 international review groups comprised of more
than 6000 members. These members hand-search journals in 19 countries, produce
and update systematic Cochrane reviews in most major areas of health care, and
oversee a system for receiving and incorporate feedback into the review process.
The database is noteworthy for the wealth of information it includes on nutrition
and related issues. Although the full text of the database is available only
by subscription, abstracts can be accessed free of charge at www.cochrane.org/cochrane/revabstr/mainindex.htm.
Many institutional libraries license the database on behalf of their patrons.
Guideline Guidance
Another phenomenon that has developed partly as a result of the EBM movement
is the production of guidelines which, when combined with personal experience,
are designed to help clinicians provide the best possible patient care. While
some guidelines have been criticized for focusing more on cost containment than
concern for the patient, there are online resources that can help identify quality
guidelines that are evidence-based.
Perhaps the most useful of these sites is the National Guideline Clearinghouse
www.ngc.org/indes.asp, which has
compiled a database of hundreds of guidelines (including 57 for nutrition and
metabolic diseases) that can be searched or browsed by disease, treatment/intervention,
or sponsoring organization. In addition to providing structured abstracts describing
each set of guidelines (and, in many cases, the full text of the guidelines
themselves), the Clearinghouse also features a helpful utility that compares
attributes of two or more guidelines side by side.
If the Clearinghouse fails to turn up the requested information, consider expanding
the search to other useful guideline-oriented sites, including the University
of California at San Francisco's Primary Care Clinical Practice Guidelines page
(medicine.ucsf.edu/resources/guidelines),
which aggregates guidelines from a number of sources, or the CPG Infobase
(www.cma.ca/cpgs/index.asp),
a guidelines database from the Canadian Medical Association.
Source: Nutrition & the MD; 27(2); February 2001; pp. 7-8.
NEW BOOK: CHILDREN AND TEENS AFRAID TO EAT
The newly revised 2001 book "Children and Teens Afraid to Eat: Helping
Youth in Today's Weight-Obsessed World" is now finished and on the market.
It is re-titled, with 32 new pages, new research, new insights, and new ways
to help kids. Both Amazon.com and Barnes & Noble online keep this book in
stock and give it a 5-Star rating.
It joins the companion book "Women Afraid to Eat: Breaking Free in Today's
Weight-Obsessed World" in challenging America's obsession with extreme
thinness, documenting the tragic effects, and giving clear guidelines for healthy
change. The message is a revolutionary idea to some: We can be healthy at the
size we are.
Health at Any Size for Kids Guidelines for parents:
· Be active together with your children. Have fun in a variety of activities.
· Promote communication and sharing of feelings.
· Teach positive self-talk. Praise and support each other.
· Promote self-acceptance, self-respect, respect for others, and appreciation of diversity.
· Promote normal eating. Avoid dieting.
· Eat family meals together at least once each day, if possible, and with the television off.
· Be a role model of: Health at Any Size for kids, healthy eating, and lifestyle.
· Avoid focusing on weight or shape, or talking about it in a negative way, every body is a good body.
· Help children develop interests and skills that lead to success, pleasure and fulfillment, apart from appearance.
· Encourage friendships with caring neighbors and other adults.
Children and Teens Afraid to Eat challenges today's obsession with thinness.
Young people today are growing up with a deep fear of fat. It's a fear that
consumes them, shatters lives, and even kills. They live in a culture that tells
them their bodies are wrong and promotes destructive values through media, advertising
and entertainment industries.
Children and Teens Afraid to Eat: Helping Youth in Today's Weight-Obsessed
World offers the nutrition profession's strongest challenge to date to America's
obsession with thinness, laying bare its tragic results. In this book Frances
M. Berg, a licensed nutritionist and adjunct professor at the University of
North Dakota School of Medicine, extensively documents the harm done in children's
lives. Berg says it is a serious health crisis when more than two-thirds of
high school girls are dieting, less than half are fully nourished, one-third
are smoking, and one-fifth take diet pills, all in their desperate drive to
be thinner. Teenage boys mirror these problems to a lesser extent.
Now in its third, completely revised 2001 edition, re-titled, with new research
and 32 new pages, this book shines the spotlight even more clearly than before
on the six major problems driving this crisis, dysfunctional eating, undernourishment
of teenage girls, hazardous weight loss, eating disorders, size prejudice and
overweight. All are increasing and striking at ever-younger ages.
In the second half, Children and Teens Afraid to Eat gives clear guidelines
in how to deal with this crisis in health-centered ways. Thus, it offers more
than a penetrating analysis of a major public health problem, it is also a how-to
book of practical solutions, with action steps that parents, teachers, counselors,
and health providers can take now to promote health and well-being. The earlier
edition is being used extensively in schools, health clinics and in-service
training programs across the United States and Canada.
Berg's companion book Women Afraid to Eat: Breaking Free in Today's Weight-Obsessed
World documents the same problems for women. Both books show how the medical
profession's insistence on ideal weight as a national priority has reinforced
and validated the obsession with size and shape. But instead of improved health,
the efforts to help people manage their weight have backfired, failing at weight
loss and contributing to an epidemic of body dissatisfaction.
Berg who is editor of Healthy Weight Journal advocates a health at any size
approach in which people of all sizes receive consistent messages to "eat
well, live actively and feel good about yourself and others," based on
the Canadian Vitality program. To normalize eating, parents are urged to first
end their own dieting, and then teach children regular eating habits and to
tune in to hunger and fullness signals.
Together the Afraid to Eat books offer a treasure trove of new information,
charts, resource lists, tips and how-to suggestions. They provide a wealth of
research and insight for speakers, writers and students at all levels. Both
are highly recommended by health, nutrition and library sources for both consumers
and professionals. To read excerpts or order online visit the website: www.healthyweight.net.
Children and Teens Afraid to Eat
Helping Youth in Today's Weight-Obsessed World
by Frances M. Berg, 2001 (3rd edition), 352 pages, 1997
ISBN 0-918532-55-8 soft cover $19.95
ISBN 0-918532-56-6 hardcover $27.95
Women Afraid to Eat
Breaking Free in Today's Weight-Obsessed World
by Frances M. Berg, 2001, 2000, 384 pages
ISBN 0-918532-62-0 soft cover $19.95
ISBN 0-918532-63-9 hardcover $27.95
Source: Press Release; Healthy Weight Network; January 25, 2001.
EXERCISE WITH DISABILITIES RESOURCE
The National Center on Physical Activity and Disability (NCPAD) is funded through
a four-year grant from the Centers for Disease Control and Prevention (CDC).
Their mission was created from the consensus that physical activity is a key
to optimal health, that inactivity is a serious health concern for people with
disabilities, and that people with disabilities are at greater risk than the
general population for developing secondary health conditions due to sedentary
lifestyles. A major constraint to creating specific exercise guidelines for
persons with disabilities is the lack of available information. The information
that does exist is poorly organized and spread over a wide range of venues.
As a result, researchers, practitioners, and consumers seeking this information
have great difficulty finding the resources they require.
The NCPAD website, http://www.ncpad.org, features NCPAD's Research Citation
Database, which contains references for journal articles, newsletters, book
excerpts, and hyperlinks to websites as well as NCPAD's Fact Sheets and Bibliographies
on topics relating to specific activities and disabilities. NCPAD's website
also provides a national resource directories of facilities, programs, and events
concerned with physical activity and disability.
The National Center on Physical Activity and Disability can be contacted at:
(800) 900-8086 or at: http://www.ncpad.org/ncpad@uic.edu.
Source: NCPAD Press Release, January 10, 2001.
· Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin
D, and Fluoride (www.nap.edu/books/0309063507/html/index.html):
Offers free access to the full text of the 1999 Dietary Reference Intakes form
the Institute of Medicine. Hard copy can also be purchased online.
· National Institute of Health (NIH) Consensus Statement on Osteoporosis
Prevention, Diagnosis, and Therapy (odp.od.nih.gov/consensus/cons/111/111_intro.htm):
From here you can access the full text of the statement form this NIH consensus-development
conference held in March 2000. A conference bibliography and recorded video
cast of the conference are also available.
· Clinical Essentials of Calcium and Skeletal Disorders (primarycare.medscape.com/PCI/calcium/public/calcium-about.html):
Provides full text of this clinically oriented handbook by Leonard J. Deftos,
MD, JD. Access is free but registration at Medscape (www.medscape.com) is required.
· The Calcium Information Resource (www.calciuminfo.com):
Well-designed consumer-oriented site that provides a mix of basic and relatively
in-depth information about calcium and how to achieve recommended daily intakes.
Produced by Smith Kline Beecham, with a strong emphasis on the use of Tums as
a source of calcium.
Source: Nutrition & the MD; 26(9); September 2000; p. 8.
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