UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 26, No. 5
September/October 2001
TABLE OF CONTENTS
Governor Has Signed SB 19 (Escutia): School Nutrition
Life Expectancy Hits New High in 2000; Mortality Declines For
Several Leading Causes of Death
Diet, Exercise Delay Type 2 Diabetes
As Diabetes Epidemic Surges, HHS and ADA Join Forces to
Fight Heart Disease,
the Leading Cause of Death for People with Diabetes
Obesity and Diabetes Still On the Rise in US
Healthful Weight, Proper Diet, and Exercise Could Prevent
Diabetes
Use of Weight Loss Products by Adults
Physicians Influence Fitness
Obesity Linked To Early Puberty in Young Girls
'Miracle' Health Claims: Add a Dose of Skepticism
Folic Acid Reminder
Is Folic Acid Fortification Preventing Neural Tube Defects?
Alternative Medicine Is No Fad
Soy Foods: Should You or Shouldn't You?
Prenatal & Infant Nutrition for Teens
Nutrition/Physical Resources on the Web
HHS Media Advisory
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.
GOVERNOR HAS SIGNED SB 19 (ESCUTIA): SCHOOL NUTRITION
The bill establishes specific nutrition standards for food and beverages sold
in elementary schools, prohibits the sale of sodas until after the last lunch
period in middle schools, and increases the State's reimbursement for school
meals by 10 cents. Below is a summary of the final bill.
Summary of provisions:
1. Sets nutritional standards for foods sold in elementary schools:
Any snacks sold outside the federal meal program must
· Have no more than 35 percent of its calories from fat
· Have no more than 10 percent of its calories from saturated fat
· Be no more than 35 percent sugar by weight
The only beverages that may be sold to students are milk, water or juice that
is at least 50 percent fruit juice with no added sweeteners.
2. In middle schools carbonated beverages may be sold only after the end of
the last lunch period.
3. High schools and middle schools may elect to take part in a pilot program
that implements the nutritional standards for all foods and beverages sold outside
the federal meal program.
· They will be eligible for the increased reimbursement rate stated below
in number 4, and a planning grant stated below in number 5.
4. The bill increases the reimbursement rate for free- and reduced-price meals
in elementary and middle schools by 10 cents from the current 13 cents to 23
cents. Meals purchased at full price by children will be reimbursable at a rate
of 10 cents per meal.
5. Districts with elementary schools, middle schools or high schools participating
in the pilot program may apply for planning grants to be used for developing
other policies related to nutrition and physical activity.
· Funds may be used for costs associated with developing and adopting
these policies, including paid release time for teachers and school employees,
publication costs, costs associated with holding a public hearing, etc.
Costs:
· Year 1: $5 million (grants and technical support)
· Year 2: $5 million (grants and technical support)
· Year 3: $30 million (one-half year of increased reimbursement rates)
· Year 4 and ongoing: $60 million for increased reimbursement rates.
Note:
· SB 19 does NOT restrict food services on high schools, unless they
volunteer for the pilot.
· SB 19 does NOT restrict the sale of candy for fundraisers when those
sales take place at home or in the community.
· SB 19 does NOT prohibit the sale of sodas in middle schools. It allows
such sales after the end of the last lunch period.
Source: Online at: http://democrats.sen.ca.gov/senator/escutia/; October 5,
2001
LIFE EXPECTANCY HITS NEW HIGH IN 2000; MORTALITY DECLINES
FOR
SEVERAL LEADING CAUSES OF DEATH
Life expectancy for the US population reached a record high of 76.9 years in
2000 as mortality declined for several leading causes of death, according to
preliminary figures from a report released by HHS' Centers for Disease Control
and Prevention (CDC).
"Americans on average are living longer than ever before, and much of
this is due to the progress we've made in fighting diseases that account for
a majority of deaths in the country," HHS Secretary Tommy G. Thompson said.
"But we can do even more by eating right, exercising regularly and taking
other simple steps to promote good health and prevent serious illness and disease."
The estimates are featured in a new CDC report, "Deaths: Preliminary Data
for 2000," an analysis of over 85 percent of the death certificates recorded
in the United States for 2000.
The report shows that age-adjusted death rates continued to fall for heart
disease and cancer, the two leading causes of death in the US that account for
more than half of all deaths in the country each year. Mortality from heart
disease has declined steadily since 1950, while cancer mortality has been on
the decline since 1990.
Age-adjusted death rates also fell for other leading causes of death, including:
homicide, suicide, accidents or "unintentional injuries," stroke,
diabetes, chronic lower respiratory diseases, and chronic liver disease and
cirrhosis.
In addition, the preliminary infant mortality rate in the US fell to its lowest
level ever in 2000, 6.9 infant deaths per 1,000 live births, down from a rate
of 7.1 in 1999.
"A healthy pregnancy is a major factor in reducing the risk of infant death,"
said CDC Director Jeffrey Koplan. "Timely prenatal care and avoiding harmful
behavior like smoking are two examples of how pregnant mothers can protect the
health of their infants."
The report also shows that mortality decreased by 3.7 percent for HIV infection
in 2000, the fifth straight year of decline. After increasing every year between
1987 and 1994 at an average of 16 percent annually, HIV mortality leveled off
in 1995, dropped 29 percent in 1996, 48 percent in 1997, and 21 percent in 1998,
before slowing to a 3.6 percent decline in 1999.
Meanwhile, mortality increased for certain leading causes of death, including
Alzheimer's disease, influenza and pneumonia, kidney disease, hypertension,
septicemia, and pneumonitis due to solids and liquids, a condition that disproportionately
affects the aging population and which emerged for the first time as one of
the 15 leading causes of death.
"Information is often the most effective weapon we have against many of
these problems, and having timely data gives us better information," said
Dr. Edward Sondik, director of CDC's National Center for Health Statistics,
which prepared the report.
Information on causes of death is recorded on death certificates by physicians,
medical examiners and coroners, and reported to the state vital statistics offices.
Demographic information is provided by funeral directors, based on information
from informants, who are usually family members.
The report can be found online at the CDC Web site: http://www.cdc.gov/nchs.
Note: All HHS press releases, fact sheets and other press materials are available
at www.hhs.gov/news.
Source: HHS Press Release; October 10, 2001.
DIET, EXERCISE DELAY TYPE 2 DIABETES
At least 10 million Americans at high risk for Type 2 diabetes can sharply
lower their chances of getting the disease with diet and exercise, a major clinical
trial indicates (1).
"In view of the rapidly rising rates of obesity and diabetes in America,
this good news couldn't come at a better time," said Health and Human Services
Secretary Tommy G. Thompson in announcing the findings August 9 at the National
Institutes of Health (NIH). "So many of our health problems can be avoided
through diet, exercise and making sure we take care of ourselves."
The study also found that treatment with the oral diabetes drug Glucophage
(metformin) reduces diabetes risk, though less dramatically, in people at high
risk for Type 2 diabetes.
Participants who were randomly assigned to intensive lifestyle intervention
reduced their risk of getting Type 2 diabetes by 58 percent. On average, this
group maintained their physical activity at 30 minutes a day, usually with walking
or other moderate-intensity exercise, and lost 5 percent to 7 percent of their
body weight. Participants picked randomly to receive treatment with Glucophage
reduced their risk of getting Type 2 diabetes by 31 percent.
The study, called the Diabetes Prevention Program (DPP), compared diet and
exercise to treatment with Glucophage in 3,234 people with impaired glucose
tolerance (IGT), a condition that often precedes diabetes. The trial clearly
answered the main research questions.
The DPP, conducted at 27 centers nationwide, is sponsored by the NIH. It is
the first major trial to show that diet and exercise can effectively delay diabetes
in a diverse American population of overweight people with IGT, a condition
in which blood glucose levels are higher than normal but the individual is not
yet considered to have diabetes.
Forty-five percent of the participants enrolled in the DPP were from minority
groups that suffer disproportionately from Type 2 diabetes: African Americans,
Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians.
The trial also recruited other groups known to be at higher risk for Type 2
diabetes, including people age 60 and older, women with a history of gestational
diabetes, and people with a first-degree relative with Type 2 diabetes.
Lifestyle intervention worked as well in men and women and in all the ethnic
groups, according to the study's chairman, David Nathan, MD, of Massachusetts
General Hospital in Boston. It also worked well in people age 60 and older,
reducing the development of diabetes in this group by 71 percent. Glucophage
was effective in men and women and in all the ethnic groups, but was relatively
ineffective in the older volunteers and in those who were less overweight.
DPP volunteers were randomly assigned to one of the following groups:
· Intensive lifestyle changes with the aim of reducing weight by 7 percent
through a low-fat diet and exercising for 150 minutes a week;
· Treatment with Glucophage (850 mg twice a day), a drug approved in
1995 to treat Type 2 diabetes; or
· A standard group taking placebo pills in place of Glucophage.
The later two groups also received information on diet and exercise. DPP participants
ranged form age 25 to 85, with an average age of 51. Upon entry to the study,
all had impaired glucose tolerance as measured by an oral glucose tolerance,
and all were overweight, with an average body mass index (BMI) of 34. (A BMI
of 25 or more, or 27 after age 35, indicates obesity.) About 29 percent of the
DPP standard group developed diabetes during the average follow-up period of
three years. In contrast, 14 percent of diet and exercise group and 22 percent
of the Glucophage group developed diabetes.
Volunteers in the diet and exercise group achieved the study goal, on average
a 7 percent, or 15-pound, weight loss, in the first year and generally sustained
a 5 percent total loss for the study's duration. Participants in this lifestyle
intervention group received training in diet, exercise (most chose walking),
and behavior modification skills.
Can the interventions prevent diabetes altogether? "We simply don't know
how long, beyond the 3-year period studied, diabetes can be delayed," says
Nathan. "We hope to follow the DPP population to learn how long the interventions
are effective." The researchers will analyze the data to determine whether
the interventions reduced cardiovascular disease and atherosclerosis, major
causes of death in people with diabetes.
Reference:
1. The Diabetes Prevention Program. Design and methods for a clinical trial
in the prevention of type 2 diabetes. Diabetes Care. 1999 Apr;22(4):623-34.
Source: FDA Consumer; 35(5); September-October 2001; pp. 10-11.
AS DIABETES EPIDEMIC SURGES, HHS AND ADA JOIN FORCES
TO FIGHT HEART DISEASE, THE LEADING CAUSE OF DEATH FOR PEOPLE WITH DIABETES
A new emphasis on treating diabetes comprehensively, that is, managing not
only blood glucose, but also blood pressure, and cholesterol, could save lives,
according to the U.S. Department of Health and Human Services (HHS), the National
Diabetes Education Program (NDEP) and the American Diabetes Association (ADA).
NDEP is co-sponsored by the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) and the Centers for Disease Control and Prevention.
Marking November as national diabetes month, HHS and its partners are joining
forces to inform the public that good diabetes management is more than lowering
blood glucose. Control of blood pressure and cholesterol is crucial to help
prevent heart disease and stroke, the leading killers of people with diabetes.
New guidelines for blood pressure and LDL cholesterol in people with diabetes
are lower than for the general population and similar to those for people with
known heart disease. This new public awareness campaign comes in response to
new studies that show a dramatic link between diabetes and heart disease. Research
now shows that people with diabetes can live longer and healthier lives with
relatively small decreases in blood glucose, blood pressure and cholesterol.
"With 16 million people and counting, diabetes is growing at an alarming
rate in America," said HHS Secretary Tommy G. Thompson. "Diabetes
has increased 49 percent from 1990 to 2000 and projections indicate a 165 percent
increase by the year 2050. If you have diabetes, you are at a very high risk
for heart attack and stroke. But you can take control and lower your risk with
this new treatment approach."
To communicate the importance of comprehensive care in simple language, the
"ABCs of diabetes" have been developed. The A stands for the A1C (a-one-see),
or hemoglobin A1C test, which measures average blood glucose (sugar) over the
previous 3 months. B is for blood pressure, and C is for cholesterol. This approach
was developed because the vast majority of people with diabetes don't know that
they are at very high risk of cardiovascular disease and that this risk can
be greatly reduced with appropriate treatment. Research shows that 75 percent
of people with diabetes die from heart disease and stroke, and they die younger
than the general population.
"The American Diabetes Association is delighted to support NDEP in getting
the word out about the 'ABCs of Diabetes,'" said Dr. John Buse, Chair of
the Association's Cardiovascular Initiative, entitled "Make the Link."
"The ABCs of Diabetes is a clear message for both patients and healthcare
providers that it's not just glucose that matters if you want to help prevent
heart disease and stroke."
"People with diabetes know how important it is to control their blood
glucose, but too little attention is paid to the role of cholesterol and blood
pressure," said Allen M. Spiegel, MD, NDEP spokesperson and director of
the NIDDK at the National Institutes of Health (NIH). "Research shows that
this new approach, aggressively treating these three risk factors, can save
lives."
Recommended Targets:
· A1C less than 7 percent. Check at least twice a year.
· Blood pressure below 130/80. Check at every doctor's visit.
· Cholesterol (LDL) below 100. Check at least once a year.
Questions to Ask
· What are my A1C, blood pressure, and cholesterol numbers?
· What are my treatment goals?
· What do I need to do to reach and maintain my goals?
The same steps needed to control blood glucose work for controlling blood pressure
and cholesterol: stay at a healthy weight; follow a healthy diet; get daily
physical activity; don't smoke; and take prescribed medications.
NDEP and ADA have developed a new tool: a new brochure for people with diabetes
that provides essential information and has a wallet card to help them track
their ABC numbers. It's free, and part of a new, national public education campaign,
Be Smart about Your Heart: Control the ABCS of Diabetes. To get the new brochure
and the free wallet card and to learn more about diabetes, call 1-800-438-5383
or visit NDEP's Web site at http://ndep.nih.gov
or contact the ADA at 1-800-DIABETES or visit www.diabetes.org/makethelink.
The National Diabetes Education Program is jointly sponsored by NIH and the
Centers for Disease Control and Prevention (CDC) and 200 public and private
partners. The American Diabetes Association is the nation's leading voluntary
health organization supporting diabetes research, information and advocacy.
Founded in 1940, the ADA has offices in every region of the country, providing
services to more than 800 communities.
Source: HHS Press Release; November 1, 2001.
OBESITY AND DIABETES STILL ON THE RISE IN US
The prevalence of obesity in the United States increased 61 percent from 1991
to 2000, according to a current study (1). Diabetes also increased in that same
time period by 49 percent. In 2000, 19.8 percent of adults were obese, 56.4
percent were overweight, and more than 7 percent had diabetes. The results were
taken from the CDCs Behavioral Risk Factor Surveillance System, a random-digit
telephone survey of 184,450 people. Weight, height, and diagnosis of diabetes
were self-reported by the survey respondents. The authors concluded that obesity
and diabetes will likely continue to increase unless effective interventions
are implemented. To read the study, go to www.jama.com.
Reference:
1. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing
epidemics of obesity and diabetes in the United States. JAMA; September 2001;
12;286(10):1195-200.
Source: Nutrition Week; XXXI(34); September 17, 2001; p. 6.
HEALTHFUL WEIGHT, PROPER DIET, AND EXERCISE
COULD PREVENT DIABETES
Women who aren't overweight, exercise at least half an hour a day, and eat
a diet high in fiber reduce their risk of type 2 diabetes by 90 percent, according
to a recent study (1). These women also ate a diet low in glycemic index and
trans fat. Researchers form the Harvard School of Public Health followed 84,941
women as part of the Nurses Health Study form 1980-1996. During that time, overweight
or obesity was the single most important predictor of diabetes, contributing
to 61 percent of the cases of type 2 diabetes in the study. Lack of exercise,
a poor diet, smoking, and abstinence from alcohol were also associated with
a significant increased risk for diabetes. To read an abstract of the study,
go to www.nejm.org
Reference:
1. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC.
Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J
Med; September 2001; 13;345(11):790-7.
Source: Nutrition Week; XXXI(34); September 17, 2001; p. 6.
USE OF WEIGHT LOSS PRODUCTS BY ADULTS
Nearly 7 percent of surveyed adults, 30 percent of which included young obese
women, use non-prescription weight loss products, according to a recent study
(1). In a survey of 14,679 adults aged 18 of older, women and younger adults
were the most frequent users of non-prescription weight loss products, including
ephedra, which has been linking to adverse health effects. Almost 8 percent
of normal-weight women also used non-prescription weight loss products. In their
report, Blanck and colleagues state that they believe that the use of these
products will only increase obesity rates in the United States. To read the
article abstract, go to http://jama.amaassn.org/issues/v286n8/abs/joc10285.html.
Reference:
1. Blanck HM, Khan LK, Serdula MK. Use of nonprescription weight loss products:
results from a multistate survey. JAMA; August 2001; 22-29;286(8):930-5.
Source: Nutrition Week; XXXI(34); September 3, 2001; p. 7.
As few as 3 hours of counseling by health care workers over 2 years can boost
sedentary adults' physical fitness, according to a study form the National Heart,
Lung, and Blood Institute (NHLBI) (1). At the beginning of the trial, only 1
percent of volunteers met federal recommendations for physical activity. Two
years later, about 20 percent did. Director Claude Lefant said the results mean
that time-crunched physicians and their staff can still have an important effect
on patients' health.
The study of 874 adults compared three types of education and counseling, ranging
from 4-minute "advice sessions" to regular telephone counseling and
weekly support classes. For women, the more intense intervention led to more
activity. However, for men the short sessions were just as effective as the
long.
Fitness was measured by oxygen uptake during a treadmill test, while physical
activity was self-reported. The NHLBI said the study is the first controlled
trial to compare the effects of various methods of education and counseling
on long-term physical fitness.
Reference:
1. Simons-Morton DG, Hogan P, Dunn AL, Pruitt L, King AC, Levine BD, Miller
ST. Characteristics of inactive primary care patients: baseline data from the
activity counseling trial. For the Activity Counseling Trial Research Group.
Prev Med; November 2000; 31(5):513-21.
Source: JAMA; 286(11); September 19, 2001; p. 1306.
OBESITY LINKED TO EARLY PUBERTY IN YOUNG GIRLS
Obesity is related to early puberty in girls, according to a study from the
American Academy of Pediatrics' 1,600-member national practice-based research
network, Pediatric Research in Office Settings (PROS) (1).
The study found that 6- to 9-year-old girls who had started developing breasts
or pubic hair were significantly more overweight than girls of the same age
who had not. The study also found that this association was stronger for white
girls than for black girls, but it could not account for the finding that black
girls started puberty, on average, one year earlier than white girls.
Virginia Commonwealth University School of Medicine pediatric endocrinologist
Paul Kaplowitz, MD, FAAP, collaborated with the authors of a 1997 PROS study
to re-examine puberty data on 17,000 girls between the ages of 3 and 12 years
old, after accounting for the girls' body mass indexes.
The original PROS study of secondary sexual characteristics was conducted in
the mid-1990s. Findings from this study suggest that girls in the United States,
particularly black girls, are beginning puberty at younger ages than studies
found several decades ago, but the reasons are not clear. However, because nutritional
status affects the timing of puberty and knowing that there is a trend for increasing
obesity in US children, the authors of the recently published article sought
to better define the relationship between obesity and early puberty in girls.
Based on these findings, physicians should anticipate that overweight girls
are more likely to show signs of early puberty and physicians should take obesity
and racial status into account when deciding how to manage early-maturing 6-
to 9-year-old girls.
Practitioners seeking more information about joining PROS should contact PROS
Central at (800) 433-9016, ext. 7623; e-mail PROS at pros@aap.org.
The PROS Secondary Sexual Characteristics study was supported by the Health
Resources and Services Administration Maternal and Child Health Bureau, and
Genentech Inc.
Reference:
1. Kaplowitz PB, Slora EJ, Wasserman RC, Pedlow SE, Herman-Giddens ME. Earlier
onset of puberty in girls: relation to increased body mass index and race. Pediatrics;
August 2001; 108(2):347-53.
Source: AAP News; 19(3); September 2001; p. 107.
'MIRACLE' HEALTH CLAIMS: ADD A DOSE OF SKEPTICISM
Whether they're looking for a short cut to losing weight or a cure for a serious
ailment, consumers may be spending billions of dollars a year on unproven, fraudulently
marketed, often useless health-related products, devices and treatments. Why?
Because health fraud trades on false hope. It promises quick cures and easy
solutions to a variety of problems, from obesity to cancer and AIDS. But consumers
who fall for fraudulent "cure-all" products don't find help or better
health. Instead, they find themselves cheated out of their money, their time,
and maybe even their health. Fraudulently marketed health products can keep
people from seeking and getting treatment from their own healthcare professional.
Some products can cause serious harm, and many are expensive because health
insurance rarely covers unapproved treatments.
To avoid becoming victims of health fraud, it's important for consumers to
learn how to assess health claims and seek the advice of a health professional.
Common Health Fraud Targets
Officials at the Federal Trade Commission (FTC) and the Food and Drug Administration
(FDA) say health fraud promoters often target people who are overweight or have
serious conditions for which there are no cures, including multiple sclerosis,
diabetes, Alzheimer's disease, cancer, HIV and AIDS, and arthritis.
Cancer
A diagnosis of cancer can bring feelings of fear and hopelessness. Many people
may be tempted to turn to unproven remedies promoted as cancer cures. But they
and their loved ones should be skeptical of "miracle" claims because
no single device, remedy or treatment can treat all types of cancer. Cancer
is a name given to a wide range of diseases; each requires different forms of
treatment that are best determined with the advice of a health professional.
Cancer patients who want to try an experimental treatment should enroll in
a legitimate clinical study. The FDA reviews clinical study designs to help
ensure that patients are not subjected to unreasonable risks.
For more information about cancer treatments, contact the American Cancer Society; the nearest local chapter will be listed in the yellow pages of your phone book.
For free publications on cancer research and treatment, call the National Cancer
Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or
log on to http://cancernet.nci.nih.gov/.
HIV and AIDS
Although legitimate treatments can extend life and improve the quality of life
for people with AIDS, there is, so far, no cure for the disease. People diagnosed
with HIV, the virus that causes AIDS, may want to try untested drugs or treatments.
But trying unproven products or treatments, such as electrical and magnetic
devices and so-called herbal cures, can be dangerous and may cause HIV-positive
individuals to delay seeking medical care.
An example is the herb St. John's Wort, which has been promoted as a safe treatment
for HIV. There is no evidence that this herb is effective in treating HIV, and
in fact, studies have shown that it interferes with medicines prescribed for
HIV.
People who think they may be HIV-positive may turn to home test kits. But claims
for these products may be misleading and possibly harmful. Safe, reliable HIV
testing can be done only through a medical professional or a clinic, or through
the Home Access Express HIV-1 Test System; it is the only system approved for
home use by the FDA.
The US government has a toll-free HIV-AIDS Treatment Information Service, 1-800-HIV-0440
(1-800-448-0440), which is staffed by English- and Spanish-speaking health information
specialists. Information also is available at www.hivatis.org.
Arthritis
Consumers spend an estimated $2 billion a year on unproven arthritis remedies - thousands of dietary and so-called natural cures, like mussel extract, desiccated liver pills, shark cartilage, CMO (cetylmyristoleate), honey and vinegar mixtures, and magnets and copper bracelets. But these remedies are not backed by adequate science to show that they offer long-term relief. For current, accurate information on arthritis treatments and alternative therapies, call the Arthritis Foundation at 1-800-283-7000 or visit its website at www.arthritis.org.
Assessing Claims for Dietary Supplements
The array of dietary supplements, vitamins and minerals, amino acids, enzymes,
herbs, animal extracts and others, has grown tremendously over the years. Although
the benefits of some of these products have been documented, the advantages
of others are unproven.
For example, claims that a supplement allows you to eat all you want and lose
weight effortlessly are false. To lose weight, you must lower your calorie intake
or burn more calories, for example, by increasing exercise. Most medical experts
recommend doing both.
Similarly, no supplement can cure arthritis or cancer in five days. Such claims
are false. Consumers should be wary of any claims for a dietary supplement that
say it can shrink tumors, cure insomnia, cure impotency, treat Alzheimer's disease,
or prevent severe memory loss. These kinds of claims deal with the treatment
of diseases, and companies that want to make such claims must follow the FDA's
pre-market testing and review process required for new drugs.
FDA Regulation of Health Claims
Federal law allows for certain claims to be made in the labeling of food and
supplements. These include claims approved by the Food and Drug Administration
that show a strong link, based on scientific evidence, between a food substance
and a disease or health condition. These approved claims can state only that
a food substance reduces the risk of certain health problems, not that it can
treat or cure a disease. Two examples of approved claims are: "The vitamin
folic acid may reduce the risk of neural tube defect-affected pregnancies,"
and "Calcium may reduce the risk of the bone disease osteoporosis."
Dietary supplements also may carry claims in their labeling that describe the
effect of a substance in maintaining the body's normal structure or function,
as long as the claims don't imply the product treats or cures a disease. The
FDA does not review or authorize these claims. An example of such a claim is,
"Product B promotes healthy joints and bones." When a dietary supplement
is promoted with a claim like this, the claim must be accompanied with the disclaimer,
"This statement has not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure or prevent disease."
To learn more about the kinds of labeling claims that can be made for foods
and dietary supplements, see www.cfsan.fda.gov/~dms/hclaims.html.
Safety Concerns
Prescription drugs must undergo clinical testing and receive the FDA's full
review for safety and effectiveness before they are sold. Over-the-counter medicines
are subject to the OTC drug review process, which determines safety and effectiveness
of the products. Dietary supplements are not required to undergo government
testing or review before they are marketed. Yet, supplements may have drug-like
effects that could present risks for people on certain medicines or with certain
medical conditions. This is true, even if the product is marketed as "natural."
For example, St. John's Wort can have potentially dangerous interactions with
a number of prescription drugs, including anticoagulants, oral contraceptives,
antidepressants, anti-seizure medicines, drugs for HIV, and drugs to prevent
transplant rejection.
If you take a prescription medicine, always consult your healthcare professional
before starting a dietary supplement.
Some dietary supplement substances require further scrutiny and study before
they can be considered safe for all people. Though many supplements have a history
of use, that history does not necessarily guarantee safety in every circumstance.
Some substances for which safety concerns have been raised are comfrey, chaparral,
lobelia, germander, aristolochia, ephedra (ma huang), L-tryptophan, germanium,
magnolia-stephania, and stimulant laxative ingredients, such as those found
in dieter's teas. The herb comfrey, for example, contains certain alkaloids
that can cause serious liver damage. Consumers should not take any product containing
comfrey either orally or as a suppository and should not apply comfrey products
to broken skin.
Even some vitamins and minerals, when consumed in excessive quantities, can
cause problems. For example, high intakes of vitamin A over a long period can
reduce bone mineral density, cause birth defects and lead to liver damage, according
to the National Academy of Sciences.
To ensure the safe use of any healthcare product, read the labels and package inserts, follow product directions and check with your healthcare professional.
How to Spot False Claims
When evaluating health-related claims, be skeptical. If something sounds too
good to be true, it usually is. Here are some signs of a fraudulent claim:
· Statements that the product is a quick and effective cure-all or diagnostic
tool for a wide variety of ailments. For example: "Extremely beneficial
in the treatment of rheumatism, arthritis, infections, prostate problems, ulcers,
cancer, heart trouble, hardening of the arteries and more."
· Statements that suggest the product can treat or cure diseases. For
example: "shrinks tumors" or "cures impotency."
· Promotions that use words like "scientific breakthrough,"
"miraculous cure," "exclusive product," "secret ingredient"
or "ancient remedy." For example: "A revolutionary innovation
formulated by using proven principles of natural health-based medical science."
· Text that uses impressive-sounding terms like these for a weight-loss
product: "hunger stimulation point" and "thermogenesis."
· Undocumented case histories or personal testimonials by consumers or
doctors claiming amazing results. For example: "My husband has Alzheimer['s
disease]. He began eating a teaspoonful of this product each day. And now in
just 22 days he mowed the grass, cleaned out the garage, weeded the flower beds
and we take our morning walk again."
· Limited availability and advance payment requirements. For example:
"Hurry. This offer will not last. Send us a check now to reserve your supply."
· Promises of no-risk "money-back guarantees." For example:
"If after 30 days you have not lost at least 4 pounds each week, your un-cashed
check will be returned to you."
Avoiding Unscrupulous Dealers
It's easy to see why some people can be taken in by promoters' promises, especially
when successful treatments have been elusive. But resist pressure to decide
"on the spot" about trying an untested product or treatment. Ask for
more information and consult a knowledgeable doctor, pharmacist or other healthcare
professional. Promoters of legitimate healthcare products do not object to your
seeking additional information.
To learn whether the FDA or the FTC have taken action against the promoter
of a product you may be considering, visit www.fda.gov/oc/enforcement.html
or www.ftc.gov. Visit www.cfsan.fda.gov/~dms/ds-warn.html
for a list of the dietary supplement ingredients for which the FDA has issued
warnings.
In addition, if you're considering a clinic that requires you to travel and
stay far from home for treatment, check it out with your doctor. Although some
clinics offer effective treatments, others prescribe untested, unapproved, ineffective,
and possibly dangerous "cures." In addition, the healthcare providers
who work in these clinics may be unlicensed or lack other appropriate credentials.
For information about a particular hospital, clinic or treatment center, contact
the state or local health authorities where the facility is located. If the
facility is in a foreign country, contact that government's health authority
to see that the facility is properly licensed and equipped to handle the procedures
involved. For information about facilities in Mexico, contact the Secretary
of Health (Secretaria De Salud) in the Mexican state where the facility is located.
Online resources:
· Virtual Health "Treatments" (http://www.ftc.gov/bcp/conline/edcams/miracle/index.html)
Offers tips on avoiding health fraud online.
· Dietary Supplements (http://www.cfsan.fda.gov/~dms/supplmnt.html)
Offers an overview of dietary supplement regulation, including safety and warning
information.
· Buying Medicines and Medical Products Online (http://www.fda.gov/oc/buyonline/default.htm)
Offers tips and precautions for buying medical products online.
How to Report a Potential Problem
To report a health product that you believe is being advertised falsely, contact:
· The FTC by phone, toll-free, at 1-877-FTC-HELP (1-877-382-4357); TDD:
202-326-2502; by mail to Consumer Response Center, Federal Trade Commission,
Washington, DC 20580; or online at www.ftc.gov. Click
on "File a Complaint Online."
· Your state Attorney General's office, state department of health, or
local consumer protection agency. These offices are listed in the blue pages
of your telephone book.
To report a product that you believe is fraudulently labeled, call your local
FDA office. The number is listed in the blue pages of the telephone book.
To report an adverse reaction or illness that you think is related to the use
of a supplement or other healthcare product, call a doctor or other healthcare
provider immediately. You also may want to report your reaction or illness to
FDA MedWatch. Call 1-800-FDA-1088 (1-800-332-1088) to request a report form,
or file a complaint online at www.fda.gov/medwatch/report/hcp.htm.
Patients' names are kept confidential. For more information on how to report
a problem to FDA, see www.fda.gov/opacom/backgrounders/problem.html.
Food and Drug Administration
The FDA regulates over $1 trillion worth of products, which account for 25
cents of every dollar spent annually by American consumers. It is part of FDA's
job to see that the food we eat is safe and wholesome and that the medicines
and medical devices we use are safe and effective. For more information, call
toll-free, 1-888-INFO-FDA (1-888-463-6332), or visit the FDA website, www.fda.gov.
Federal Trade Commission
The FTC works for the consumer to prevent fraudulent, deceptive and unfair
business practices in the marketplace and to provide information to help consumers
spot, stop, and avoid them. To file a complaint, or to get free information
on any of 150 consumer topics, call toll-free, 1-877-FTC-HELP (1-877-382-4357),
or use the online complaint form. The FTC enters Internet, telemarketing, identity
theft and other fraud-related complaints into Consumer Sentinel, a secure, online
database available to hundreds of civil and criminal law enforcement agencies
US and abroad.
Source: Online at: http://www.ftc.gov/bcp/conline/pubs/health/frdheal.htm;
September 2001.
Many physicians are missing a key opportunity to prevent birth defects by not
telling their female patients to take a daily multivitamin containing folic
acid, says the March of Dimes.
The voluntary health agency made its comments following the September 5th release
of a survey of 2001 women aged 18 to 45 conducted by the Gallup Organization
under a grant from the Centers for Disease Control and Prevention.
In the survey, 76 percent of the women said their physicians did not discuss
the benefits of folic acid to prevent neural tube defects. Less than one-third
of US women of childbearing age, not pregnant, take a daily multivitamin containing
folic acid. But 20 percent of women asked said that they would be more likely
to do so if physician or other health care professional said to.
The March of Dimes recommends that all women capable of becoming pregnant should
take a multivitamin containing 400 µg of folic acid daily beginning before
conception and continuing into the early months of pregnancy.
Copies of the survey, "Folic Acid and the Prevention of Birth Defects:
A National Survey of Pre-Pregnancy Awareness and Behavior Among Women of Childbearing
Age, 1995-2001," item 31-1596-01, may be obtained by calling (800) 367-6630.
Source: JAMA; 286(12); September 26, 2001; p. 1443.
IS FOLIC ACID FORTIFICATION PREVENTING NEURAL TUBE DEFECTS?
Neural tube defects (NTDs) are among the most common birth defects worldwide,
resulting in nerve damage or death of the fetus due to spina bifida and anencephaly.
Researchers have long known that folic acid supplementation of pregnant women
can help reduce the incidence of NTDs, perhaps by as much as 50 percent to 70
percent, but translating this knowledge into effective public health policy
has been problematic.
To prevent the first occurrence of a NTD, the U.S. Institute of Medicine recommends
that women capable of becoming pregnant consume an extra 400 µg/d of synthetic
folate, in addition to usual folate intake from foods. This approach recognizes
that NTDs occur very early in a pregnancy, about the fourth week post-conception,
and that women planning to become pregnant need extra folate at this very critical
juncture. However, because an estimated 50 percent of pregnancies are not planned,
and unplanned pregnancies usually have not been confirmed by the fourth week
of gestation, in many cases a NTD will already have occurred by the time the
pregnant woman thinks to begin folic acid supplementation(1). Therefore, pregnancy
cannot be used as the trigger to initiate supplementation.
Focus on Fortification
The solution to this problem, according to many experts, is population-wide
folic acid supplementation through food fortification. In 1998, the U.S. Food
and Drug Administration endorsed this view by mandating folic acid fortification
of all enriched grain products at a level of 140 µg per 100 g of product.
This quantity is not sufficient to produce the full 400 µg/d of supplementation
that is recommended for pregnant women, but this reduced level of fortification
was deliberately chosen to prevent over consumption of folic acid by those who
eat large quantities of fortified products. Of particular concern is that widespread
fortification could mask pernicious anemia in the elderly, thereby delaying
treatment of vitamin B12 deficiency.
Although it is understandable that the FDA would want to err on the conservative
side, there has been some question as to whether fortification at these levels
will help prevent NTDs. A national panel from the UK recently recommended that
flour be fortified with folic acid at 240 µg per 100 g of product, nearly
twice the level now mandated in the United States (2). It concluded that fortification
at these levels could produce a significant reduction in NTDs without resulting
in over consumption by any population segment.
Birth Certificate Data Show NTD Reductions
So, is the more cautious United States' approach to fortification working?
According to two recent studies, the answer appears to be yes.
In a poster presented at the American College of Obstetricians and Gynecologists
meeting in May 2001, Mark Evans and colleagues from Hahnemann University reported
on their assessment of maternal serum alpha-fetoprotein (MSAFP) values in a
total of 61,119 pregnant women in 1997 (before the U.S. fortification program
began) and again in 2000 (3). Results show a 42 percent decrease in the number
of patients with a multiple of median MSAFP value of 3.00 of higher. Given that
higher MSAFP values are associated with increased likelihood of NTDs, Evans
et al. concluded that this profound decrease would likely reflect a reduction
in the number of actual births affected by NTDs.
This conclusion now appears to be confirmed by outcomes data from live births.
Using birth certificate reports of NTDs from 45 states and Washington DC, Honein
and colleagues compared the prevalence of spina bifida and anencephaly before
mandatory folic acid fortification began (October 1995 through December 1996)
to that after the program was in place (October 1998 through December 1999).
Their findings indicate that NTDs decreased from 37.8 per 100,000 live births
to 30.5 per 100,000 births, a decline of 19 percent (4).
The authors note that the quality of data obtained from birth certificates is limited, both because of known reporting inaccuracies and because many women with NTD-affected pregnancies choose to terminate their pregnancies. Still, according to other expert investigators, the data are robust enough to allow for some critical conclusions to be made. "The study by Honein et al. provides important information, food fortification works," write Mills and England in an accompanying editorial. "Birth certificates data can, however, provide only imprecise estimates of how well it works. Much hard work lies ahead to determine how many cases of NTD are actually being prevented" (5). They say that additional studies will be needed to decided whether folic acid fortification should continue at present levels, or if it should be increased, as some suggest, to reap even greater public health benefits.
Why Do Supplements Work?
Although these results appear to indicate significant progress in preventing
NTDs, it can be argued that we have made little headway in the past decade in
understanding why folic acid supplementation reduces NTD risk. Researchers agree
that clinical folate deficiency is not a major cause of NTDs. There is some
evidence to suggest that folate absorption is impaired in pregnancies affected
by NTD, but these studies have been difficult to interpret because of differing
methodologies.
Recently, using a new a more precise stable isotope tracer technique, Boddie
and colleagues assessed whether 11 women with a history of NTD had reduced ability
compared with 11 control group women to absorb polyglutamyl folate (the form
of folate found naturally in foods) and monoglutamyl folate (synthetic folic
acid found in supplements or fortified foods) (6). They found no significant
difference in the ability of either group to absorb (estimated by urinary excretion)
food folate vs. folic acid. However, the women with previous NTD-affected pregnancies
showed a trend toward lower absorption of both forms of folate compared to control
women. According to the authors, "The magnitude of this potential difference
appears to be in the range of 20-25 percent, which may result in a physiologically
significant difference in folate status in situations in which intake is limited."
Larger studies using the same technique are needed to confirm these findings.
References:
1. McKinley MC, McNulty H, McPartlin J, Strain JJ, Pentieva K, Ward M, Weir
DG, Scott JM. Response of red blood cell folate to intervention: implications
for folate recommendations for the prevention of neural tube defects. Am J Clin
Nutr; May 2000;71 (5 Suppl):1308S-11S. Review.
2. Kirby RS. Fortification of foods with folic acid. N Engl J Med; September
28, 2000;343(13):971; discussion 972.
3. Evans MI, Wapner RJ, O'Brien JE, Dvorin E, Huang X, Harrison H. Impact of
folic acid supplementation in the United States: markedly diminished high maternal
serum AFPs. Obstet Gynecol; April 2001;97(4 Suppl 1):S42.
4. Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LY. Impact of folic
acid fortification of the US food supply on the occurrence of neural tube defects.
JAMA; 2001 Jun 20;285(23):2981-6.
5. Mills JL, England L. Food fortification to prevent neural tube defects: is
it working? JAMA; June 2001 20;285(23):3022-3..
6. Boddie AM, Dedlow ER, Nackashi JA, Opalko FJ, Kauwell GP, Gregory JF 3rd,
Bailey LB. Folate absorption in women with a history of neural tube defect-affected
pregnancy. Am J Clin Nutr; July 2000; 72(1): 154-8.
Source: Nutrition & the MD; 27(8); August 2001; pp.4-5.
ALTERNATIVE MEDICINE IS NO FAD
Complementary and alternative medicine (CAM) is not a passing fad and will
be around for the foreseeable future, said Harvard Medical School researchers
in a study published in the August 21 Annals of Internal Medicine (1).
The study used data compiled from more than 2000 interviews and examined trends
in the use of 20 different types of CAM from acupuncture to yoga.
The use of alternative treatments was independent of gender, ethnicity, and
education level. Regional trends and urban vs rural differences were also absent.
The researchers said most of the 20 therapies have steadily increased in popularity
since the 1960s, with the largest overall growth rate occurring in the late
1960s and early 1970s.
The researchers noted the timing of societal adoption of particular therapies.
In the 1960s, commercial diet programs, lifestyle diet therapy, megavitamin
therapy, and self-help groups increased markedly. The 1970s saw growth in biofeedback,
energy healing, herbal medicine, and imagery. In the 1980s, massage and naturopathy
increased while yoga decreased in popularity. The 1990s brought increased use
of aromatherapy, energy healing, herbal medicine, massage, and yoga.
Reference:
1. Goldman P. Herbal medicines today and the roots of modern pharmacology.
Ann Intern Med. 2001 Oct 16;135(8 Pt 1):594-600.
Source: JAMA; 286(12); September 26, 2001; p. 1443.
SOY FOODS: SHOULD YOU OR SHOULDN'T YOU?
For years now, research has suggested that soy may be an effective cancer-fighter.
But some recent studies suggest that women at high risk for breast cancer should
moderate their soy intake. The current consensus is that you don't have to give
up your tofu stir-fry or soy shake, but you may want to hold off on taking soy
supplements.
It's been a long, strange trip for the humble soybean. A central part of Asian
diets for millennia, this pale brown legume spent many years dismissed by meat-loving
Americans as a strange "hippie" food. Gradually, however, soy has
assumed a place in the scientific spotlight. In just the last few years, a realistic
picture has emerged of soy's proper place in healthy, disease-fighting diets.
The Early Days of Soy Research
Cancer researchers began studying soy in an effort to explain why women in
Asian countries had far fewer cases of breast cancer than American women. Interestingly,
when Asian women moved to countries that consume more "Western" diets,
higher in fat, lower in vegetables, and particularly low in soy foods like tofu
and miso, their rates of breast cancer increased within one generation.
Before long, laboratory work began to support soy's potential for fighting
cancers of the breast, prostate and colon. In some early trials, soy showed
the ability to inhibit biological activities associated with these cancers in
human subjects as well. Scientists soon came to focus on specific substances
in soy called isoflavones. Recent research on soy isoflavones, however, has
shown mixed results.
Are Soy Isoflavones Helpful or Harmful?
According to current theories, isoflavones are natural substances in soy that
(among other functions) seem to act as weak forms of estrogen. That's important
because some forms of breast cancer use estrogen to "feed" the formation
of tumors. When soy isoflavones "stand in" for estrogen, breast cells
obtain less of this powerful hormone, and are less likely to produce tumors.
So far so good, but a few recent studies have signaled that isoflavones may
produce some negative effects as well. In one much-discussed clinical trial,
supplements of soy isoflavones were found to increase the rate at which breast
cells reproduce. That's worrisome because if a mutation should occur while cells
are quickly growing and dividing, the cancer process could theoretically get
off to a rapid start.
Researchers are quick to point out, however, that the results of any individual
study need to be viewed in their proper context. This particular trial involved
isoflavone supplements, not soy foods, and it lasted only two weeks. In addition,
increased cell growth is just one of several indicators for breast cancer risk.
The Bottom Line
Since there aren't yet any dietary recommendations for soy intake and cancer
prevention, what can we conclude? Dr. Mark Messina, a prominent soy foods expert
at Loma Linda University in California, acknowledges that recent studies raise
important questions. He believes that common sense and moderation offer the
best answers.
Dr. Messina urges people to start by considering the Asian example. Most Japanese,
for instance, consume no more than a single serving of soy food a day. "Loading
up on any one food, including soy, is not advisable," he says. "A
balanced diet that includes soy is a good idea, as long as it also includes
plenty of vegetables, fruits, whole grains and beans. After all, many different
plant foods appear to provide health benefits. The best way to take advantage
of that fact is to eat a wide variety, all the time."
Many soy researchers believe that, for healthy women, even two of three servings
of soy foods a day should be fine as one part of a mostly plant-based diet.
Women at high risk for breast cancer, women who are taking tamoxifen, and women
who have of have had hormone-dependent (estrogen-positive of ER+) breast cancer
may want to limit themselves to no more than a few servings a week.
As for soy supplements, watch out. Soy pills and powders can contain amounts
of isoflavones (usually daidzein and genistein) far in excess of the amounts
possible to get through diet. Very little research has been done on the effects
of such "mega-doses." The research that has been done raises enough
doubt to conclude that, for the time being, it's probably best to leave the
soy supplements on the store shelf.
Source: AICR Newsletter; Fall 2001; 73:1-3.
PRENATAL & INFANT NUTRITION FOR TEENS
"Building for the Future" is a nutrition education program curriculum designed to help teach the basics of prenatal and infant/young child nutrition to pregnant and parenting teens. The CD-ROM contains PowerPoint slide shows, Microsoft Word pre-tests, handouts, worksheets and post-tests for classroom instruction. It is produced by Outreach & Extension at the University of Missouri Lincoln University. For more information call 1-800-292-0969 or order at: http://www.muextension.missouri.edu/xplor/order.htm
Source: University of Missouri Press Release; August 01, 2001.
NUTRITION/PHYSICAL RESOURCES ON THE WEB
Knowledge Path: Childhood Nutrition
The National Center for Education in Maternal and Child Health (NCEMCH) has
updated the knowledge path on childhood nutrition. This electronic document
offers a guide to the Center's Web site on the topic and selected electronic
and print resources found elsewhere. Identified in the knowledge path are downloadable
electronic publications, databases, project descriptions, electronic discussion
lists, and Web sites. Betsy Haughton at University of Tennessee and Jan Dodds
at University of North Carolina at Chapel Hill assisted in the development process
and provided content review.
Go to http://www.ncemch.org/RefDes/kpchildnutr.html
Bright Futures in Practice: Physical Activity
The NCEMCH posted an electronic version of Bright Futures in Practice: Physical
Activity on the Bright Futures Web site. The guide provides current information
on screening, assessment, and counseling to promote physical activity and to
meet the needs of health professionals, families, and communities. The project
was co-chaired by Kevin Patrick at San Diego State University and Bonnie Spear
at University of Alabama at Birmingham and supported by MCHB/HRSA. Go to http://www.brightfutures.org/physicalactivity
The NCEMCH's nutrition and physical activity projects are supported by the
Maternal and Child Health Bureau of the Health Resources and Services Administration
through a cooperative agreement.
Source: NCEMCH Press Release; September 07, 2001.
HHS Deputy Secretary Claude Allen unveiled Healthfinder Espanol, a new, Spanish-language
gateway to reliable health information, at the Mary's Center for Maternal and
Child Care, on September 28.
Healthfinder Espanol will help Spanish-speaking individuals easily find the
answers to their health-related questions. Healthfinder is the award-winning,
federal consumer health portal Web site managed by the US Department of Health
and Human Services (HHS).
The HHS Office of Disease Prevention and Health Promotion, which leads the
Healthfinder project, has worked with patients, staff, and local community members
at Mary's Center, teaching citizens how to use the Internet as well as the Healthfinder
Web site. Input received from the Mary's Center community was vital in the creation
of Healthfinder Espanol. All HHS press releases, fact sheets and other press
materials are available at www.hhs.gov/news.
Source: HHS Press Release; September 25, 2001.
SUBSCRIPTION FOR NUTRITION PERSPECTIVES NEWSLETTER
NOTE: The top line of the mailing label shows the expiration date for your
subscription.
Please renew before that date to avoid a break in service.
______ Renew my subscription _____Start a new subscription
Enclosed is a payment of $10.00 for a one year subscription (6 issues). Checks should be payable to the Regents of the University of California.
PLEASE PRINT INFORMATION TO ENSURE ACCURACY
Name_______________________________________________________________________________________
Address_____________________________________________________________________________________
City____________________________State_____________Zip____________County_______________________
Professional Affiliation (optional)__________________________________________________________________
_____The above is a change of address
Mail this form and payment to: NUTRITION PERSPECTIVES, Department of Nutrition,
University of California, Davis, California, 95616-8669.
The University of California, in compliance with the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and the Rehabilitation Act of 1973, does not discriminate on the basis of race, creed, religion, color, national origin, sex, or mental or physical handicap in any of its programs or activities, or with respect to any of its employment policies, practices, or procedures. The University of California does not discriminate on the basis of age, ancestry, sexual orientation, marital status, citizenship, medical condition (as defined in section 12926 of the California Government Code), nor because individuals are disabled or Vietnam era veterans. Inquiries regarding this policy may be directed to the Director, Office of Affirmative Action, Division of Agriculture and Natural Resources, 300 Lakeside Drive, Oakland, CA 94612-3550, (510) 987-0097.
NUTRITION PERSPECTIVES
Department of Nutrition
University of California
Davis, CA 95616-5270