A Cure for Celiac???

New hope for celiac disease sufferers?
By Cathryn Delude, posted December 21, 2009

In a sense, the 2 million plus Americans with celiac disease are lucky. No other autoimmune disease has such a safe and effective treatment.

Purging the diet of gluten -- the protein in wheat, rye and barley that triggers an immune reaction in the gut -- can reverse the disease and reduce intestinal inflammation. That's important, because studies now show that the consequences of untreated celiac disease are graver than previously thought, causing anemia, arthritis, osteoporosis, hepatitis, neurological problems and even malignancies, as well as increased general mortality.

Still, it is very difficult to eliminate gluten entirely. It lurks in disparate sources such as vinegars, soy sauce, medications, lip balm and Play-Doh (which some children consider edible); and even gluten-free foods, which are expensive, may contain enough traces to cause symptoms. "When we study celiac patients who have been doing their best to follow a gluten-free diet, even after five years we see lots of damage in the small intestines in about half of them," said Dr. Robert Anderson, a gastroenterologist in Melbourne, Australia, who is working on a vaccine to prevent or switch off the reaction to gluten.

His is one of many efforts underway to develop new, non-dietary treatments for celiac disease. Ultimately, celiac patients may be able to take a pill before a meal so they could, for example, have stuffing with their holiday turkey. Or, as is Anderson's goal, they could go for a series of treatments similar to allergy shots that would teach their immune systems to tolerate gluten.

"It's very exciting that the pathophysiology of celiac disease is understood to such a degree that we can design potential therapies," said Dr. Peter Green, director of the Celiac Disease Center at Columbia University College of Physicians and Surgeons in New York.

There are two categories of treatments being developed. One would supplement a gluten-free diet and protect patients from occasional gluten exposure; the other would train the immune system to tolerate gluten and allow patients to eat a regular diet.

Enzyme therapy

Within the first category, one approach uses oral enzymes that target gluten. We cannot completely digest gluten because humans lack digestive enzymes that can break it down, but researchers at Stanford University combined enzymes from bacteria and barley that finish what our own digestive juices cannot. They showed in rats that when gluten is broken down into smaller fragments, it no longer causes inflammation in the intestines. Alvine Pharmaceuticals, based in San Carlos, Calif., has developed this "glutenase" therapy and is now recruiting patients for a Phase II clinical trial.

In this trial, as with the others, participants have had a diagnosis of celiac disease confirmed by a biopsy but have had it under control on a gluten-free diet. They are given either a drug or placebo, along with a gluten challenge, often the equivalent of one or two slices of bread.

"From the early data it looks like the oral enzymes break down enough gluten to be useful," said Dr. Daniel Leffler, director of clinical research for the Celiac Center at Beth Israel Deaconess Medical Center in Boston. Leffler was not involved in the enzyme trial but is an investigator in a nearly completed Phase II trial testing a different drug, larazotide, developed by Alba Therapeutics in Maryland.

The larazotide approach leaves the gluten peptides, or small fragments of proteins,intact but aims to prevent them from penetrating beneath the lining of the gut into the mucous layer where the immune reaction occurs. In celiac disease, as in many autoimmune diseases, including Type 1 diabetes, this intestinal barrier is "leaky" or permeable.

Larazotide is a bioengineered drug designed to close those leaks to keep out gluten and prevent or reverse the disease. In preliminary results from about 300 patients in Phase I and II trials, the drug did seem to benefit patients, who had fewer adverse symptoms after eating gluten. It also reduced the levels of the antibody that serves as a blood marker for the immune response to gluten. But interestingly, the drug did not seem to reduce intestinal permeability.

"So the drug works, but maybe through a different mechanism that we don't understand yet," said Green, who is on the clinical advisory board for both Alba and Alvine. He predicts that, if ultimately found effective, the oral enzymes and larazotide would be marketed as supplements to a gluten-free diet but that many patients would want them to actually replace the restrictive diet. It's unclear not only whether such a use would be possible but also whether it would be a daily regimen or followed only when dining out or traveling, for instance.

Immunotherapy

The second category of treatment, known as immunotherapy, is more investigational but also more exciting, Leffler said. It would allow patients to eat a regular diet by quelling immune response in the gut. This response is driven by immune cells known as T cells, which react when other immune cells display gluten fragments on their surface.

In Australia, a company founded by Anderson, called Nexpep, is packaging the gluten peptides that trigger this immune response into a vaccine that will desensitize the immune reaction. The theory, which he says works in animals, is that by introducing these peptides through injections under the skin rather than through the gut, the immune cells learn to tolerate them and no longer display them to the T cells. That can theoretically prevent or turn off the reaction that damages the intestines

Anderson expects Phase I safety trials of this vaccine, Nexvax2, to be completed in mid-2010. He anticipates that patients would receive a series of injections of the vaccine, followed by occasional maintenance doses.

"If we can figure out how to give the drug, how frequently and when we need maintenance therapy," he added, "then we can use the same principle to explore treatments for other autoimmune diseases." Several other groups are also developing vaccines for celiac disease, but this one is furthest along.

A low-tech immunotherapy approach might require just one inoculation -- of hookworm. It is known that a non-pathogenic hookworm introduced to the gut can relieve asthma symptoms. Researchers suspect that it is because we evolved with intestinal parasites that trained our immune system to tolerate environmental irritants, but our hygienic modern living has deprived us of this beneficial symbiosis.

Researchers at the Brisbane Princess Alexandra Hospital in Queensland, Australia, tested the effects of hookworm inoculation on 20 patients with celiac disease to see if it would blunt the immune response to gluten. In addition to hoping to provide relief for celiac patients, the researchers want to learn if this could be an effective therapy for inflammatory bowel disease and Crohn's disease.

The results have not been published, but when the Phase II trial was over and the patients were offered a medication that would kill the parasites, they all opted to keep their hookworms.

health@latimes.com
Copyright © 2009, The Los Angeles Times
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Extending the Honeymoon in Type 1 Diabetes - New Use for an Old Drug

FDA-approved drug may slow beta cell destruction in type 1 diabetes patients

DALLAS — Dec. 4, 2009 — New findings by UT Southwestern researchers suggest that a drug already used to treat autoimmune disorders might also help slow the destruction of insulin-producing cells in patients recently diagnosed with insulin-dependent (type 1) diabetes.

In type 1 diabetes, formerly known as juvenile diabetes, cells in the pancreas called beta cells, which produce insulin, are destroyed by an autoimmune process.

Researchers at UT Southwestern and 14 other centers worldwide found that injections of the drug rituximab slowed beta cell destruction in the pancreas of those newly diagnosed with type 1 diabetes for at least a year, suggesting a potential treatment option that might improve management and reduce long-term complications of the disease.

“Our findings in no way suggest that rituximab should be used as a treatment or that it will eliminate the need for daily insulin injections,” said Dr. Raskin, principal investigator of the trial’s local effort. “This is not a cure for type 1 diabetes.

“The results do, however, provide evidence that B cells play a significant role in type 1 diabetes and that selective suppression of these B cells may deter the destruction of the body’s beta cells.”

Prior research has shown that two types of immune cells — B cells and T cells — help trigger type 1 diabetes. T cells attack and destroy the insulin-producing beta cells. The B cells, however, don’t directly attack insulin-producing cells, but researchers have speculated that they trigger the T cells to attack. Rituximab directly attacks and destroys the beta cells.

For the current study, researchers conducted a randomized, double-blind study in which 81 participants received infusions of either rituximab or a placebo once a week for four weeks. The participants, who ranged in age from 8 to 40 years and had been diagnosed with type 1 diabetes within 100 days of enrollment in the study, returned approximately every three months for two years to undergo blood tests and meet with a physician. Two-thirds of the 81 participants received the drug.

The scientists found that after one year, the participants who received rituximab needed lower doses of insulin and were able to produce more of their own insulin than those who received the placebo. They also had better control of their blood sugar.

Dr. Raskin said researchers do not think rituximab could ever be used to completely reverse type 1 diabetes because the pancreas typically is too damaged by the time diabetes is diagnosed.

He also said that while the exact mechanism of how rituximab affects type 1 diabetes remains unclear, the study clearly shows that a therapy that targets B cells may improve beta-cell function in early type 1 diabetes.

The next step, Dr. Raskin said, is to evaluate the potential effects of rituximab in diabetes.

Other UT Southwestern researchers involved in the study include Dr. Perrin White, professor of pediatrics; Dr. Bryan Dickson, associate professor of pediatrics; Dr. Soumya Adhikari, assistant professor of pediatrics; Dr. Mark Siegelman, associate professor of pathology; Marilyn Alford, senior advanced practice nurse in internal medicine; Tauri Harden, a former advanced practice nurse in internal medicine; Erica Cordova, registered nurse at Parkland Memorial Hospital; and Nenita Torres and Maria Lourdes Pruneda, senior research nurses in internal medicine.

The study is supported by the Juvenile Diabetes Research Foundation International, the American Diabetes Association and the Type 1 Diabetes TrialNet Study Group, a clinical trials network funded by the National Institutes of Health.

Visit www.utsouthwestern.org/endocrinology to learn more about UT Southwestern’s clinical services in endocrinology, including diabetes.

BUZZ: Movie Popcorn is Bad For You (Duh!)

I love reading headlines related to food and nutrition. This is what showed up on my Yahoo BUZZ today:

Horror at the Movies: Popcorn
by Claudine Zap (posted 21 Nov 2009)

We would want to be the last ones to ruin movie night, but this just in from Center for Science in the Public Interest: Chowing down on a medium popcorn and soda is the calorie equivalent to three McDonald's quarter-pounders and 12 — yes 12 — pats of butter. And it gets worse: About 90% of this 1,600 calorie bomb comes from fat.

‘Two Thumbs Down’ for Movie Theater Popcorn
(posted 18 Nov 2009)

New Lab Tests of Movie Theater Popcorn Show It’s Still the Godzilla of Snacks

WASHINGTON—It's hard to picture someone mindlessly ingesting three McDonald's Quarter Pounders with 12 pats of butter while watching a movie. But according to new laboratory analyses commissioned by the nonprofit Center for Science in the Public Interest, that food is nutritionally comparable to what you’d find in a medium popcorn and soda combo at Regal, the country’s biggest movie theater chain: 1,610 calories and three days’ worth—60 grams—of saturated fat. (Nutrition aside, that combo costs $12—for raw ingredients that must cost Regal pennies.)

The study, published as the cover story in the December issue of Nutrition Action Healthletter, updates a famous exposé the group conducted 15 years ago. For Regal and AMC, CSPI tested samples from theaters in the Washington, D.C., area. For Cinemark, samples came from Texas, Illinois, and Maryland.

The oversized boxes and bags (four to five ounces) of candy sold at movie chains are universally high in calories. A 5-ounce bag of Twizzlers has 460 calories and 15 teaspoons of sugar. A 7-ounce box of Nerds has 790 calories and 46 teaspoons of sugar. Chocolate candies like Butterfinger Minis, Raisinets, Sno-Caps, or M&M's have between 400 and 500 calories and at least a half day’s worth of saturated fat. An 8-ounce bag of Reese's Pieces is just a cup of candy. But with 1,160 calories and 35 grams of saturated fat, it's like eating a 16-ounce T-bone steak plus a buttered baked potato.
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Another interesting thing about popcorn, is that eating it while watching a movie leads us into mindless eating. Tons of it. For some real interesting insights into portion size influencing our eating habits, take a read of this:

Big portions influence overeating as much as taste, even when the food tastes lousy, Cornell study finds
By Susan S. Lang (posted 5 Nov 2005)

Large portions push people to overeat -- even to overeat foods they don't like.

According to a new Cornell University study, when moviegoers were served stale popcorn in big buckets, they ate 34 percent more than those given the same stale popcorn in medium-sized containers. Tasty food created even larger appetites: Fresh popcorn in large tubs resulted in people eating 45 percent more than those given fresh popcorn in medium-sized containers.

"We're finding that portion size can influence intake as much as taste," said Brian Wansink, the John S. Dyson Professor of Marketing and of Applied Economics at Cornell. "Large packages and containers can lead to overeating foods we do not even find appealing."

Wansink and Junong Kim, assistant professor of marketing at the University of Central Florida, gave 158 moviegoers either medium (4.2 oz) or large (8.4 oz) tubs of free popcorn that was either fresh or 14 days old. The researchers asked the moviegoers to describe the popcorn after the movie, and they weighed how much popcorn was left in the containers. As expected, the 14-day-old popcorn was described with such remarks as "stale" and "it was terrible."

When the moviegoers were asked if they thought they ate more because of the size of the container, 77 percent of those given the large tubs said they would have eaten the same amount if given a medium container. "This means that the moviegoers were unaware that the exceptional amount they ate was due to the size of the container," said Wansink, who also is the author of the new book, "Marketing Nutrition: Soy, Functional Foods, Biotechnology, and Obesity," and director of the Cornell Food and Brand Lab, made up of a group of interdisciplinary researchers who have conducted more than 200 studies on the psychology behind what people eat and how often they eat it.

Several of Wansink's previous studies show that larger portions prompt people to eat more not because of a clean-your-plate mentality, but because large packages and portions suggest larger consumption norms. "They implicitly suggest what might be construed as a 'normal' or 'appropriate' amount to consume," said Wansink, who tested this concept in 1996 with volunteers given different-sized bags of M&Ms that were too large to be finished while watching a videotape; those given larger bags ate twice as much as those with smaller bags.
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For some interesting reading, I highly recommend his book Mindless Eating – Why We Eat More Than We Think, by Brian Wansink. Published by Bantam-Dell (2006).

So what do I eat at the movies? Sometimes I brought in my own snacks (grapes or raisins; one evening I even packed an entire dinner in to-go containers and used a big purse). But lately I just don't get anything to eat or drink. It's not like we're going to starve during the 2 hr show. It's one way to break that behavior change of tv & movies connected to food & eating. And think of all the money you save by skipping the snack bar.

Positive Placebo Power

Experts: Placebo power behind many natural cures
By MARILYNN MARCHIONE, AP Medical Writer Marilynn Marchione, Ap Medical Writer – Tue Nov 10, 3:16 pm ET

EDITOR'S NOTE: Ten years and $2.5 billion in research have found no cures from alternative medicine. Yet these mostly unproven treatments are now mainstream and used by more than a third of all Americans. This is one in an occasional Associated Press series on their use and potential risks.

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People looking for natural cures will be happy to know there is one. Two words explain how it works: "I believe."

It's the placebo effect — the ability of a dummy pill or a faked treatment to make people feel better, just because they expect that it will. It's the mind's ability to alter physical symptoms, such as pain, anxiety and fatigue.

In just the past few weeks, the placebo effect has demonstrated its healing powers. In tests of a new drug to relieve lupus symptoms, about a third of patients felt better when they got dummy pills instead of the drug.

The placebo effect looms large in alternative medicine, which has many therapies and herbal remedies based on beliefs versus science. Often the problems they seek to relieve, such as pain, are subjective.

"It has a pejorative implication — that it's not real, that it has no medicinal value," said Dr. Robert Ader, a psychologist at the University of Rochester in New York who has researched the phenomenon.

But placebos can have real and beneficial effects, he said.

"Much of the results of certain alternative procedures are largely placebo effects, unless you believe there are people who exert magical powers so they can hold their hands over your body and cure you of disease," Ader said. "Make you feel better? That's entirely possible, especially if you believe it."

The placebo effect accounts for about a third of the benefits of any treatment — even carefully tested medicines, scientists say. This dates to a landmark report in 1955 called The Powerful Placebo. Viewed as groundbreaking, the analysis of dozens of studies by H.K. Beecher found that 32 percent of patients responded to a placebo.

Later studies found that dummy pills could raise pulse rates, blood pressure and reaction speed when people were told they had taken a stimulant; the opposite occurred when people were told that a drug would make them drowsy.

How does it work? Scientists do not always know, but there are many possible ways. Brain imaging shows that beliefs ("I know these pills will help") can cause biological changes and affect levels of chemical messengers and stress hormones that signal pain or pleasure.

Emotions, too, can trigger physical changes. Take the case of a child with croup. Crying tightens the airways and makes it tougher to breathe. Many people believe that cool mist is helpful, but when it has been tested in hospital studies with croup tents, it has not been found to help, said Dr. Owen Hendley, a pediatrician at the University of Virginia.

Try it at home, though, and you may get a different result.

"The child sits in the lap of the mother and the mother holds the mist maker close to the child. The child settles down, the mother settles down. The setting, and the mother feeling that it is helping, makes everybody calmer," and the child actually is able to breathe better, Hendley explained.

If it were not for the placebo effect, "physicians would not be nearly as successful as we are," said Dr. Thomas Schnitzer, a Northwestern University arthritis specialist. He helped lead a big study that found glucosamine and chondroitin supplements were no better than dummy pills for arthritic knee pain.

Doctors sometimes exploit the placebo effect to help patients. One survey found that many doctors admitted sometimes giving patients sugar pills or drugs or vitamins that would not really help their condition, in an effort to trigger a placebo effect.

In Baltimore, the University of Maryland Medical Center's shock trauma center is offering some patients Reiki therapy, which claims to heal through invisible energy fields manipulated by a special "master." The hospital's anesthesia chief, Dr. Richard Dutton, says it is self-hypnosis and compares it to Lamaze classes that teach pregnant women breathing exercises to take their minds off the pain of labor.

Roy A. Armstrong's family agreed to it after he was injured in a motorcycle crash last year. The 39-year-old suffered cardiac arrest and had many broken bones. As he lay tethered to a breathing machine, nurse Donna Audia and a partner circled his bed, waving their arms through the air and touching his head while humming and making tunes by rubbing a crystal bowl with a wand.

Armstrong was too sedated to remember anything, but "I think in some way it helped him to get better," his wife said. He is still recovering through physical therapy.

Dutton said: "You can call it a placebo effect, you can call it a chicken soup effect. It's all about creating the right mental state in the person. The patients tell us they seem to like it. And in pain management, that's the whole goal. If 30 percent of your patients get better on placebo, why not give it to them?"

Swear-by-it stories and anecdotal reports of benefit are one thing. Proving a treatment helps is quite another. Many alternative medicine studies have not included a placebo group — people who unknowingly get a dummy treatment so its effect can be compared.

Acupuncture is especially hard to research. Positive studies tend to lack comparison groups that have been given a sham treatment. Or they are often done in China, where the treatment is an established part of health care.

One U.S. study found that true acupuncture relieved knee arthritis pain better than fake acupuncture, in which guide tubes were placed but no needles were inserted. But a European study involving twice as many patients and using a more realistic sham procedure found the fake treatment to be just as good. The conclusion: Pain relief was due to the placebo effect.

Advertisements and testimonials from product users can encourage a placebo effect. The Federal Trade Commission last summer reached a settlement over advertising claims for Airborne, a product "invented by a teacher" that was supposed to ward off germs spread through the air.

"Products like Airborne are what we call `credence products.' That's a fancy word for saying it's difficult or impossible for consumers to determine if the product has done anything for them," said commission lawyer Rich Cleland. "Part of that is because of the placebo effect. Part of that is because people don't want to believe they've been ripped off."

Barbara Domen, a former kindergarten teacher in Caswell Beach, N.C., said she was prone to colds and used Airborne six or seven times a year when she flew on planes.

"It worked for me," although it could be because since she retired, "I'm away from all the germs," she said. She skipped it on one flight and caught a terrible cold.

"Maybe it's psychological, but I think I'll continue to use it," she said.

Some placebo effects are due to conditioning, or ascribing benefits to something you did that may in fact have played no role in your improvement. Insomnia is an example, said Michael Perlis, a psychologist and neuroscientist at the University of Pennsylvania.

If you have trouble sleeping one night, your body's need for sleep makes it very likely you'll sleep well the next night. If you take a sleeping pill, you think you slept well because of the pill, he said.

Do any herbal remedies work for insomnia? "Not that I know of," Perlis said. "But all of them have potential to be useful with time. It has nothing to do with them — it has everything to do with conditioning."

FDA article on placebos (2000)
American Cancer Society article on placebos (2009)

Food and Health Communications Food Blog » Get the Nutrition Right Game

Food and Health Communications Food Blog » Get the Nutrition Right Game

Chewing Gum May Help People Lose Weight

Study finds chewing gum can help lower calorie intake and increase energy expenditure

WHAT: New research from University of Rhode Island presented at The Obesity Society's 2009 Annual Scientific Meeting shows the role of chewing sugar-free gum, such as Wrigley's Extra®, in helping to reduce calorie intake at lunchi and increase energy expenditure among individuals in a laboratory setting.ii Primary outcomes include:

•After subjects chewed gum in the morning, their calorie intake at lunch was decreased by 68 calories.

◦Despite consuming fewer calories at lunch, participants did not report greater hunger and did not compensate by increasing their calorie intake later in the day.

◦When participants chewed gum, they reported feeling less hungry, as compared to when they did not chew gum.

•When subjects chewed gum with a relaxed, natural pace before and after eating, their energy expenditure increased.

◦When participants chewed gum before eating, their energy expenditure was higher by approximately 5%, as compared to when they did not chew gum.

◦When participants chewed gum after eating, their energy expenditure was also higher by approximately 5%, as compared to when they did not chew gum.

◦Furthermore, with gum chewing, subjects reported reduced weariness and less perceived effort to do things, as compared to when they did not chew gum.


Overall, this study demonstrates the effects of chewing sugar-free gum on meal intake and energy expenditure, such that over a half-day about 62 kilocalories could be 'saved' by a total of one hour of relaxed gum chewing compared to not chewing gum. It also contributes to a growing body of evidence in these two areas. Three previous studies have reported that chewing gum before snacking can help reduce hunger, diminish cravings and decrease snack intake.iii,iv,v And, nutritionists report that even small changes in caloric intake can have a significant impact in the long term. In addition, a previous study has demonstrated increased energy expenditure when chewing gum.vi

A research summary with additional information on methodology is available upon request.

WHO: Kathleen J. Melanson, Ph.D., R.D., Associate Professor of Nutrition and Food Sciences, University of Rhode Island, led the research study and is available for interviews to discuss the potential role of chewing gum on appetite control, meal intake and calorie expenditure.

Gilbert Leveille, Ph.D., Executive Director, Wrigley Science Institute™, will also be available to discuss study findings and research on the Benefits of Chewing™ gum related to weight management and other areas including oral health, stress relief, and focus, alertness and concentration.

WHEN: Research will be presented at The Obesity Society's 2009 Annual Scientific Meeting from noon—1:00 p.m. EST and 5:30—6:30 p.m. EST on Monday, October 26 and Tuesday, October 27; Washington Marriott Wardman Park, Washington, D.C.


###
WRIGLEY SCIENCE INSTITUTE™:
Wrigley is committed to advancing and sharing scientific research that explores the benefits of chewing gum. The Wrigley Science Institute works with independent researchers at leading institutions around the world to learn more about the potential health and wellness benefits of chewing gum. The current work of the Wrigley Science Institute is focused on exploring the impact of chewing gum in four key scientific areas: oral health; stress relief; focus, alertness and concentration; and weight management. More information may be found at www.wrigley.com.

The study was supported by an unrestricted research grant from the Wrigley Science Institute™ presented during the 2007 Annual Meeting of The Obesity Society.

© 2009 Wm. Wrigley Jr. Company. All Rights Reserved. Extra, Benefits of Chewing and Wrigley Science Institute are registered trademarks of the Wm. Wrigley Jr. Company.

i Kathleen J. Melanson, Kaitlyn E. Reti, and Daniel L. Kresge. Impact of chewing gum on appetite, meal intake, and mood under controlled conditions. Obesity 2009. Washington, D.C. October 2009.

ii Daniel L. Kresge, Kaitlyn E. Reti and Kathleen J. Melanson. Relationships between gum chewing, energy expenditure and RQ before and after controlled breakfasts. Obesity 2009. Washington, D.C. October 2009.

iii Hetherington MM, Boyland E. "Short term effects of chewing gum on snack intake and appetite." Appetite. 2007; 48(3):397-401.

iv Hetherington MM, Regan MF. "Effect of chewing gum on short-term appetite control and reduced snack intake in moderately restrained eaters." Obesity. 2007; 15: 510-P.

v Paula J. Geiselman, Corby Martin, Sandra Coulon, Donna Ryan, and Megan Apperson. Effects of chewing gum on specific macronutrient and total caloric intake in an afternoon snack. FASEB J. 2009 23:101.3.

vi Levine J, Baukol P, Pavlidis I. "The energy expended in chewing gum." New England Journal of Medicine. 1999; l 341(27): 2100.

You Don't Need Extra Protein to Build Muscle

I've been working with folks trying to lose weight (but not muscle) for most of my dietetic career. And this includes a lot of gym rats who continue to insist that protein is king and post workout protein shakes are the magic bullet.

Here's another research study supporting my philosophy of protein with every meal, but not more than your palm (or a deck of cards) and that most people DON'T need protein shakes/supplements.




Moderate amounts of protein per meal found best for building muscle
Study: 1 ounce per meal is muscle synthesis improvement 'ceiling'

Contact: Jim Kelly
jpkelly@utmb.edu
409-772-8791
University of Texas Medical Branch at Galveston

GALVESTON, Texas — For thousands of years, people have believed that eating large amounts of protein made it easier to build bigger, stronger muscles. Take Milo of Croton, the winner of five consecutive Olympic wrestling championships in the sixth century BC: If ancient writers are to be believed, he built his crushing strength in part by consuming 20 pounds of meat every day.

No modern athlete would go to such extremes, but Milo's legacy survives in the high-protein diets of bodybuilders and the meat-heavy training tables of today's college football teams. A recent study by University of Texas Medical Branch at Galveston metabolism researchers, however, provides evidence that strongly contradicts this ancient tradition. It also suggests practical ways to both improve normal American eating patterns and reduce muscle loss in the elderly.

The study's results, obtained by measuring muscle synthesis rates in volunteers who consumed different amounts of lean beef, show that only about the first 30 grams (just over one ounce) of dietary protein consumed in a meal actually produce muscle.

"We knew from previous work that consuming 30 grams of protein — or the equivalent of approximately 4 ounces of chicken, fish, dairy, soy, or, in this case, lean beef — increased the rate of muscle protein synthesis by 50 percent in young and older adults," said associate professor Douglas Paddon-Jones, senior author of a paper on the study published in the September issue of the Journal of the American Dietetic Association. "We asked if 4 ounces of beef gives you a 50 percent increase, would 12 ounces, containing 90 grams of protein, give you a further increase?"

The UTMB researchers tested this possibility by feeding 17 young and 17 elderly volunteers identical 4- or 12-ounce portions of lean beef. Using blood samples and thigh muscle biopsies, they then determined the subjects' muscle protein synthesis rates following each of the meals.

"In young and old adults, we saw that 12 ounces gave exactly the same increase in muscle protein synthesis as 4 ounces," Paddon-Jones says. "This suggests that at around 30 grams of protein per meal, maybe a little less, muscle protein synthesis hits an upper ceiling. I think this has a lot of application for how we design meals and make menu recommendations for both young and older adults."

The results of the study, Paddon-Jones points out, seem to show that a more effective pattern of protein consumption is likely to differ dramatically from most Americans' daily eating habits.

"Usually, we eat very little protein at breakfast, eat a bit more at lunch and then consume a large amount at night. When was the last time you had just 4 ounces of anything during dinner at a restaurant?" Paddon-Jones said. "So we're not taking enough protein on board for efficient muscle-building during the day, and at night we're taking in more than we can use. Most of the excess is oxidized and could end up as glucose or fat."

A more efficient eating strategy for making muscle and controlling total caloric intake would be to shift some of extra protein consumed at dinner to lunch and breakfast.

"You don't have to eat massive amounts of protein to maximize muscle synthesis, you just have to be a little more clever with how you apportion it," Paddon-Jones said. "For breakfast consider including additional high quality proteins. Throw in an egg, a glass of milk, yogurt or add a handful of nuts to get to 30 grams of protein, do something similar to get to 30 for lunch, and then eat a smaller amount of protein for dinner. Do this, and over the course of the day you likely spend much more time synthesizing muscle protein."

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Other authors of the paper ("A Moderate Serving of High-Quality Protein Maximally Stimulates Skeletal Muscle Protein Synthesis in Young and Elderly Subjects") include postdoctoral fellow T. Brock Symons, associate professor Melinda Sheffield Moore and University of Arkansas professor Robert R. Wolfe. The study was supported by funding from the National Cattlemen's Beef Association Checkoff Program and UTMB's National Institutes of Health Claude D. Pepper Older Americans Independence Center.

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Here is the actual article in the Journal of the American Dietetic Association:
A Moderate Serving of High-Quality Protein Maximally Stimulates Skeletal Muscle Protein Synthesis in Young and Elderly Subjects

Are Artificial Sweeteners Really That Bad for You?

Are Artificial Sweeteners Really That Bad for You?

By Claire Suddath Tuesday, Oct. 20, 2009 on Time.com

Too much sugar will make you fat, but too much artificial sweetener will ... do what exactly? Kill you? Make you thinner? Or have absolutely no effect at all? This week marks the 40th anniversary of the Food and Drug Administration's decision to ban cyclamate, the first artificial sweetener prohibited in the U.S., and yet scientists still haven't reached a consensus about how safe (or harmful) artificial sweeteners may be. Shouldn't we have figured this out by now?

The first artificial sweetener, saccharin, was discovered in 1879 when Constantin Fahlberg, a Johns Hopkins University scientist working on coal-tar derivatives, noticed a substance on his hands and arms that tasted sweet. No one knows why Fahlberg decided to lick an unknown substance off his body, but it's a good thing he did. Despite an early attempt to ban the substance in 1911 — skeptical scientists said it was an "adulterant" that changed the makeup of food — saccharin grew in popularity, and was used to sweeten foods during sugar rationings in World Wars I and II. Though it is about 300 times sweeter than sugar and has zero calories, saccharin leaves an unpleasant metallic aftertaste. So when cyclamate came on the market in 1951, food and beverage companies jumped at the chance to sweeten their products with something that tasted more natural. By 1968, Americans were consuming more than 17 million pounds of the calorie-free substance a year in snack foods, canned fruit and soft drinks like Tab and Diet Pepsi.

But in the late 1960s, studies began linking cyclamate to cancer. One noted that chicken embryos injected with the chemical developed extreme deformities, leading scientists to wonder if unborn humans could be similarly damaged by their cola-drinking mothers. Another study linked the sweetener to malignant bladder tumors in rats. Because a 1958 congressional amendment required the FDA to ban any food additive shown to cause cancer in humans or animals, on Oct. 18, 1969, the government ordered cyclamate removed from all food products.

Saccharin became mired in controversy in 1977, when a study indicated that the substance might contribute to cancer in rats. An FDA move to ban the chemical failed, though products containing saccharin were required to carry warning labels. In 2000, the chemical was officially removed from the Federal Government's list of suspected carcinogens.
(Read TIME's 1974 article on cyclamate and saccharin.)

In 1981, the synthetic compound aspartame was approved for use, and it capitalized on saccharin's bad publicity by becoming the leading additive in diet colas. In 1995 and 1996, misinformation about aspartame that linked the chemical to everything from multiple sclerosis to Gulf War syndrome was widely disseminated on the Internet. While aspartame does adversely effect some people — including those who are unable to metabolize the amino acid phenylalanine — it has been tested more than 200 times, and each test has confirmed that your Diet Coke is safe to drink. Nor have any health risks been detected in more than 100 clinical tests of sucralose, a chemically altered sugar molecule found in food, drinks, chewing gum and Splenda.

The fear-mongering and misinformation plaguing the faux-sweetener market seems to be rooted in a common misconception. No evidence indicates that sweeteners cause obesity; people with weight problems simply tend to eat more of it. While recent studies have suggested a possible link between artificial sweeteners and obesity, a direct link between additives and weight gain has yet to be found. The general consensus in the scientific community is that saccharin, aspartame and sucralose are harmless when consumed in moderation. And while cyclamate is still banned in the U.S., many other countries still allow it; it can even be found in the Canadian version of Sweet'n Low. Low-calorie additives won't make you thinner or curb your appetite. But they help unsweetened food taste better without harming you. And that's sweet enough.

Breakfast Cereal Recommendations from RealSimple.com

This article showed up on Yahoo.com this morning and, as always, I checked out the "who" that is touting this "best" list. Real Simple is a Time Inc. magazine that started in 2000, has expanded to a TV show on TLC and involves Registered Dietitians in food and health articles. Glancing through their offerings I can see how this could be another resource for folks looking for information, recipies and great home ideas to improve eating choices.

The Best Breakfast Cereals

The Classics

Many breakfast-cereal concoctions come and go (R.I.P., Donkey Kong Crunch; adios, Urkel-O's). Then there are the beloved stalwarts-raisin bran, corn flakes, crispy rice-that will be breakfast staples forever. But which brands in these traditional categories are best? Real Simple testers ate their way through 42 boxes to find out. (Note: All cereals tested in this story were free of high-fructose corn syrup and hydrogenated oils.)

The Best O's: Cheerios

The pure oaty flavor and the hearty crunch of these whole-grain rings, which contain just one gram of sugar per serving, easily won over testers. “No wonder my toddler can’t get enough of them,” one enthused.

To buy: $4 for 14 ounces.

The Best Crispy Rice: Erewhon Organic Original Crispy Brown Rice

Made with brown rice (a nice twist on the traditional white), these delicate puffs have “a pleasing nutty flavor,” a staffer raved. “Topped with strawberries, they would make a great light breakfast.”

To buy: $4 for 10 ounces.

The Best Shredded Oats: Life

Mikey liked it back in the 1970s, and Real Simple testers feel the same way today. The thin oat squares strike a tasty balance of salty and sweet.

To buy: $4 for 15 ounces.

The Best Raisin Bran: Cascadian Farm Organic Raisin Bran

“The plump, juicy raisins aren’t overwhelmed by the number of flakes,” said a fan. “Plus, the fruit is free of that awful coating of sugar so many companies use.”

To buy: $4 for 14 ounces.

The Best Corn Flakes: Trader Joe’s Organic Corn Flakes

“These large, sturdy flakes hold their shape, have a strong corn flavor even when drowned in milk, and don’t develop a slimy film like some other versions,” said one appreciative tester.

To buy: $2.50 for 12 ounces.

The Best Frosted Wheat: Three Sisters Sweet Wheat

These bites have a dusting of icing on one side that adds a touch of sweetness to the milk. Bonus: The resealable plastic bag cuts down on wasteful packaging.

To buy: $3.40 for 15.5 ounces, Whole Foods Market.


The Best High-Fiber, Low-Fat

Cereals touted for their nutritional profile can’t always make the same claim for taste. Real Simple staffers sampled 77 options―all containing at least 3 grams of fiber, no more than 10 grams of sugar, and less than 2 grams of fat, as recommended by Marilyn Tanner-Blasiar, a registered dietitian and an American Dietetic Association spokesperson. Here are the breakfast champions.

The Best High Fiber: Kashi Go Lean

A medley of bran twigs, honey whole-grain puffs, and mini soy graham crackers, this won praise for being hearty and delicious. One of the healthiest of all the winners, it packs 13 grams of protein and 10 grams of fiber into a single serving.

To buy: $4 for 14.1 ounces.

The Best Shredded Wheat: Kashi Autumn Wheat

Passionate shredded-wheat devotees raved about how the squares “absorb the milk just enough, without soaking it up like a sponge.” Said one of them, “It’s tightly woven and yet has a lovely, airy crunch.”

To buy: $4.20 for 17.5 ounces.

The Best Crispy Whole Grain: Multi-Bran Chex

Molasses perks up the flavors of corn, wheat, and rice in these woven brown crisps. “Forget toast in the morning. This reminds me of my favorite wheat bread, but with a more robust, nutty flavor,” a panelist said.

To buy: $3.30 for 14 ounces.

The Best Whole Wheat Flakes: Organic Weetabix Crispy Flakes

This flake version of a popular English cereal has a pleasant, grainy texture and a slight sweetness, thanks to cane juice and a touch of sea salt.

To buy: $4.50 for 12 ounces.

The Best High-Fiber Twigs: Fiber One Original

Many twigs are thin and brittle, said a taster. “This sturdy example stands up well to milk and fruit.” For an afternoon snack, try the cereal solo or sprinkled on yogurt. Half a cup contains a whopping 14 grams of fiber.

To buy: $4.20 for 16.2 ounces.

The Best Flax: Nature’s Path Organic Flax Plus Multibran

It’s easy to get more heart-healthy omega-3s in your diet with these golden flakes. “They have a cute, cuplike shape that holds the milk,” commented a fan.

To buy: $4.60 for 13.25 ounces.

The Best Kids'

Remember when you loved visiting Susie Schumacher’s house because her mom bought “sugar” cereal? It’s still a special treat today. A panel of 32 elementary-school testers munched their way through 93 contenders, none exceeding 15 grams of sugar (the limit for registered dietitian Tanner-Blasiar). These picks hit the sweet spot.

The Best Puffs: EnviroKidz Organic Gorilla Munch

“Super crunchy!” one youngster said of this gluten-free corn cereal with 8 grams of sugar (the lowest per serving of the bunch). “I’d eat them during recess as a snack,” another noted.

To buy: $4.60 for 10 ounces.

The Best Cinnamon Squares: Total Cinnamon Crunch

The “fresh cinnamon-stick taste” of these small, ultra-crispy squares enticed many panelists to go back for seconds.

To buy: $3.90 for 15.4 ounces.

The Best Marshmallow: Three Sisters Marshmallow Oaties

Testers liked that the white, pink, and purple marshmallows in this addictive cereal didn’t dissolve. “They keep their shape until the very end,” one noted.

To buy: $3.40 for 12.5 ounces, Whole Foods Market.

The Best Honey-Nut O's: Honey Nut Cheerios

“Drinking the flavored milk is the best part,” one tester proclaimed after sampling this honey-and-almond classic made with whole-grain oats.

To buy: $3.80 for 12.25 ounces.

The Best Fruity: Apple Jacks

Red flecks of dried apple cover these frosty-hued O’s. Made of corn, wheat, and oats, this cereal gets extra sweetness from apple juice and cinnamon.

To buy: $3.80 for 12.2 ounces.

The Best Cocoa: Erewhon Organic Cocoa Crispy Brown Rice

“I could eat these all day,” said one 10-year-old panelist of the airy rice pebbles. “They stay crisp in the milk but seem to melt in your mouth. And they taste like hot chocolate.” (For a fourth grader, that’s a good thing.)

To buy: $4 for 10.5 ounces.

Food Safety?

Dangerous foods list includes leafy greens, eggs, tuna

By Aaron Smith, CNNMoney.com staff writer
On Tuesday October 6, 2009, 2:07 pm EDT

Leafy greens -- including lettuce and spinach -- top the list of the 10 riskiest foods, according to a study from a nutrition advocacy group released Tuesday.

The Center for Science in the Public Interest listed the following foods, in descending order, as the most risky in terms of outbreaks: leafy greens, eggs, tuna, oysters, potatoes, cheese, ice cream, tomatoes, sprouts and berries.

The scientists rated these foods, all of them regulated by the Food and Drug Administration, by the number of outbreaks associated with them since 1990, and also provided the number of recorded illnesses.

The severity of the illnesses ranged from minor stomach aches to death, the center said. With leafy greens such as lettuce, the top cause of illness were pathogens like E. coli, Norovirus and Salmonella in foods that were not properly washed.

Over the past 20 years, leafy greens caused 363 outbreaks, resulting in 13,568 reported illnesses, the center said. That's compared to berries, No. 10 on the list, which were associated with 25 outbreaks totaling 3,397 reported illnesses.

"Leafy greens are a healthy home run, but unfortunately they're associated with food-borne illness," said Sarah Klein, a staff lawyer with the center who helped prepared the study.

In all, the Top 10 resulted in more than 1,500 outbreaks, totaling nearly 50,000 reported illnesses, according to the center, which added that most food-related illnesses don't get treated or reported, so the real total is likely much larger.

"Millions of consumers are being made ill, hundreds of thousands hospitalized and thousands are dying each year from preventable foodborne illnesses," the study said. "Unfortunately, the FDA is saddled with outdated laws, and lacks the authority, tools and resources to fight unsafe food."

Food producers, including the Western Growers Association, released statements criticizing the report.

"Farmers are consumers, too," the association said, in a release from spokesman Paul Simonds. "They eat the fresh produce they grow as do the members of their families, and have invested millions of dollars enhancing food safety practices in the last few years. Scaring people away from eating some of the healthiest foods on the planet, like fresh produce, does not serve consumers."

Salmonella was also a chief culprit in egg, cheese and tomato-related illnesses, the study said, in cases when eggs are undercooked and when cheese is not processed properly.

Salmonella can be difficult to remove from raw tomatoes without cooking, according to the study.
The study also associated Salmonella and E. coli with potatoes. Klein said this generally happens when cold-prepared potato items, such as potato salad, are mixed with other contaminated ingredients.

Unrefrigerated fresh tuna deteriorates quickly, the study said, releasing harmful toxins, and canned tuna gets dragged into the picture because of mixed-in ingredients such as mayonnaise. Improperly washed oysters are at risk of Norovirus.

Rich Ruais, executive director of the Blue Water Fisherman Association and the American Blue Fin Tuna Association in Salem, N.H., disagreed with the study's "bad rap" on tuna.

"Tuna? I beg to differ," he said. "Tuna is one of the healthiest foods on the Earth. It's life sustaining; it's life prolonging."

Ruais said the tuna-based diet of Japanese citizens plays a big part in their high average longevity. He also said the FDA strictly mandates that tuna is gutted and stuffed with ice immediately after it's caught by commercial fisherman, and submerged in slush once it gets to shore, to prevent risk of pathogens.

More surprisingly, bacteria can also survive in ice cream, primarily from the Salmonella contamination of eggs, an important ingredient that is sometimes undercooked, the study said. Much of the study's blame goes to a 1994 outbreak that sickened thousands of ice cream lovers in 41 states.

The National Milk Producers Federation released a statement criticizing the report as "based on outdated information."

"Cheese and ice cream products are among the safest, most stringently regulated foods in this country," said the federation, in its release. "The cheese examples in this report mostly concern consumption of raw milk products, which neither [the] FDA nor the dairy industry recommends. The ice cream example is 15 years old and was an isolated incident."
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This article can raise a few red flags for any consumer, but also has some "Chicken Little running around screaming about a falling sky" in it. And some possible misunderstanding if someone only looks at the list itself and not at the true risk factors associated with food borne illnesses.

Wash your fruits & vegetables (as I stated in an earlier blog post a few years ago)!!!

Potatoes are not the dangerous food - it's the recipes used for potato salad and then improper refrigeration that causes increased risk food borne illnesses.

For proper food handling and safety, check out "Fight BAC" (from the Partnership for Food Safety Education).

Restrict or Not to Restrict; Candy & Kids Experiment

What would happen if you gave a toddler/pre-school child unlimited access to candy & sweets? Would the child eat junk all day and fill up on non-nutritional foods? Or would she/he get bored and realize that if it's there all the time, it's not so special anymore.

Annie Sasseville RD, CNSD, a Pediatric Dietitian at Mile High Climbers, LLC wondered the same thing. And having access to an adorable 2 1/2 yo daughter, was able to test this hypothesis. She posted the first week results of her unique experiment HERE and a month later, the final outcome HERE.

What do you think of her tips for parents? Would this work for adults?

Can Wheat Cause Type 1 Diabetes?

You might think so after reading this headline:

Type 1 diabetes linked to immune response to wheat

Press release headlines are designed to elicit a response, a desire to read the actual article. But most people never get passed the press release because the actual science is boring or difficult to understand in the manner it is published.

Here is the press release as published:
Scientists at the Ottawa Hospital Research Institute and the University of Ottawa have discovered what may be an important clue to the cause of type 1 diabetes. Dr. Fraser Scott and his team tested 42 people with type 1 diabetes and found that nearly half had an abnormal immune response to wheat proteins. The study is published in the August 2009 issue of the journal Diabetes.

Early in life, the immune system is supposed to learn to attack foreign invaders such as viruses and bacteria, while leaving the body's own tissues and harmless molecules in the environment alone (including food in the gut). When this process goes awry, autoimmune diseases and allergies can develop. Type 1 diabetes is an autoimmune disease that occurs when the immune system mistakenly attacks the pancreas, the organ that regulates blood sugar. Dr. Scott's research is the first to clearly show that immune cells called T cells from people with type 1 diabetes are also more likely to over-react to wheat. His research also shows that the over-reaction is linked to genes associated with type 1 diabetes.

"The immune system has to find the perfect balance to defend the body against foreign invaders without hurting itself or over-reacting to the environment and this can be particularly challenging in the gut, where there is an abundance of food and bacteria," said Dr. Scott, a Senior Scientist at the Ottawa Hospital Research Institute and Professor of Medicine at the University of Ottawa. "Our research suggests that people with certain genes may be more likely to develop an over-reaction to wheat and possibly other foods in the gut and this may tip the balance with the immune system and make the body more likely to develop other immune problems, such as type 1 diabetes."

In a commentary accompanying the paper, diabetes expert Dr. Mikael Knip of Finland said "These observations add to the accumulating concept that the gut is an active player in the diabetes disease process."

Dr. Scott's previous research has shown that a wheat-free diet can reduce the risk of developing diabetes in animal models, but he notes that more research will be required to confirm the link and determine possible effects of diet changes in humans. Research is also needed to investigate links with celiac disease, another autoimmune disease that has been linked to wheat.
###
This research was funded by the Juvenile Diabetes Research Foundation and the Canadian Institutes of Health Research. The authors include Dr. Majid Mojibian, Dr. Habiba Chakir, Dr. David E. Lefebvre, Jennifer A. Crookshank, Brigitte Sonier and Dr. Erin Keely, as well as Dr. Scott. Patients were enrolled at The Ottawa Hospital and the Children's Hospital of Eastern Ontario.

An estimated 246 million people have diabetes worldwide. Type 1 diabetes is the most severe form, representing about 10 per cent of all cases. Insulin injections can help control blood sugar levels in those affected but there is no cure.

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Celiac is another autoimmune disorder. It has long been known if you have 1 autoimmune problem, your risk for another is much higher. In Type 1 diabetics about 5% or more have also been diagnosed with Celiac (I worked with one family who's daughter was diagnosed with BOTH at the same time). This study noted that the genetic subset for Celiac was not present in the tested patients (by the way, a very small number of test subjects) and this immune response was not the same as that for Celiac.

Here is an abstract of the actual article in the Journal of Diabetes (published by the American Diabetes Association). I'm a member of ADA but I was unable to access the full text of the article online.

Diabetes-Specific HLA-DR–Restricted Proinflammatory T-Cell Response to Wheat Polypeptides in Tissue Transglutaminase Antibody–Negative Patients With Type 1 Diabetes
Majid Mojibian, Habiba Chakir, David E. Lefebvre1, Jennifer A. Crookshank, Brigitte Sonier, Erin Keely and Fraser W. Scott

Abstract
OBJECTIVE There is evidence of gut barrier and immune system dysfunction in some patients with type 1 diabetes, possibly linked with exposure to dietary wheat polypeptides (WP). However, questions arise regarding the frequency of abnormal immune responses to wheat and their nature, and it remains unclear whether such responses are diabetes specific.

RESEARCH DESIGN AND METHODS In type 1 diabetic patients and healthy control subjects, the immune response of peripheral CD3+ T-cells to WPs, ovalbumin, gliadin, α-gliadin 33-mer peptide, tetanus toxoid, and phytohemagglutinin was measured using a carboxyfluorescein diacetate succinimidyl ester (CFSE) proliferation assay. T–helper cell type 1 (Th1), Th2, and Th17 cytokines were analyzed in WP-stimulated peripheral blood mononuclear cell (PBMNC) supernatants, and HLA was analyzed by PCR.

RESULTS Of 42 patients, 20 displayed increased CD3+ T-cell proliferation to WPs and were classified as responders; proliferative responses to other dietary antigens were less pronounced. WP-stimulated PBMNCs from patients showed a mixed proinflammatory cytokine response with large amounts of IFN-γ, IL-17A, and increased TNF. HLA-DQ2, the major celiac disease risk gene, was not significantly different. Nearly all responders carried the diabetes risk gene HLA-DR4. Anti-DR antibodies blocked the WP response and inhibited secretion of Th1 and Th17 cytokines. High amounts of WP-stimulated IL-6 were not blocked.

CONCLUSIONS T-cell reactivity to WPs was frequently present in type 1 diabetic patients and associated with HLA-DR4 but not HLA-DQ2. The presence of an HLA-DR–restricted Th1 and Th17 response to WPs in a subset of patients indicates a diabetes-related inflammatory state in the gut immune tissues associated with defective oral tolerance and possibly gut barrier dysfunction.

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What does that mean for regular people? There is a possibility that people with Type 1 diabetes show a autoimmune response to wheat that is NOT Celiac. But this is a correlation result, NOT cause & effect. The headlines could easily be misconstrued to suggest eating wheat causes Type 1 diabetes. Nothing could be further from the truth. While this might be one potential trigger in someone who is genetically susceptable, there are many folks with genetic potential who eat wheat and never develop Type 1 diabetes. I'd like to see what happens if they open up this screening to a larger number of people with Type 1 diabetes and include first degree relatives who do NOT have Type 1 diabetes.

Living With Celiac

I do not have Celiac, but as a Registered Dietitian I have worked with many families newly diagnosed. So I have an interest in related news and internet postings. Here is one that caught my eye today.

The Expense of Eating With Celiac Disease

By LESLEY ALDERMAN, NY Times. Posted Aug 15, 2009

YOU would think that after Kelly Oram broke more than 10 bones and experienced chronic stomach problems for most of his life, someone (a nurse? a doctor?) might have wondered if something fundamental was wrong with his health. But it wasn’t until Mr. Oram was in his early 40s that a doctor who was treating him for a neck injury became suspicious and ordered tests, including a bone scan.

It turned out that Mr. Oram, a music teacher who lives in White Plains, had celiac disease, an underdiagnosed immune disorder set off by eating foods containing gluten, a protein found in wheat, rye and barley.

Celiac disease damages the lining of the small intestine, making it difficult for the body to absorb nutrients. Victims may suffer from mild to serious malnutrition and a host of health problems, including anemia, low bone density and infertility. Celiac affects one out of 100 people in the United States, but a majority of those don’t know they have the disease, said Dr. Joseph A. Murray, a gastroenterologist at the Mayo Clinic in Minnesota who has been studying the disease for two decades. The disease can be detected by a simple blood test, followed by an endoscopy to check for damage to the small intestine.

Seven years after receiving his diagnosis, Mr. Oram, who is married and has one daughter, is symptom-free, but the cost of staying that way is high. That’s because the treatment for celiac does not come in the form of a pill that will be reimbursed or subsidized by an insurer. The treatment is to avoid eating products containing gluten. And gluten-free versions of products like bread, pizza and crackers are nearly three times as expensive as regular products, according to a study conducted by the Celiac Disease Center at Columbia University.

Unfortunately for celiac patients, the extra cost of a special diet is not reimbursed by health care plans. Nor do most policies pay for trips to a dietitian to receive nutritional guidance.

In Britain, by contrast, patients found to have celiac disease are prescribed gluten-free products. In Italy, sufferers are given a stipend to spend on gluten-free food.

Some doctors blame drug makers, in part, for the lack of awareness and the lack of support. “The drug makers have not been interested in celiac because, until very recently, there have been no medications to treat it,” said Dr. Peter Green, director of the Celiac Disease Center at Columbia University. “And since drug makers are responsible for so much of the education that doctors receive, the medical community is largely unaware of the disease.”

As awareness grows and the market expands, perhaps the prices of gluten-free products will come down. Meanwhile, if you suffer from the disease, here are some ways to keep your costs down.

When people first learn they have celiac disease, they tend to stock up on gluten-free versions of breads, crackers and pizza made from grains other than wheat, like rice, corn and buckwheat. But that can be expensive and might not even be that healthy, since most gluten-free products are not fortified with vitamins.

“The most important thing to do after being diagnosed is to get a dietary consultation,” Dr. Murray said. With planning, you can learn to base your diet on fruits, vegetables, rice and potatoes. “I have some patients who rarely use those special gluten-free products,” he said.

Get in the habit of reading labels, advises Elaine Monarch, executive director of the Celiac Disease Foundation, a nonprofit organization in Studio City, Calif. Soy sauce, for instance, often has wheat protein as a filler. But Ms. Monarch found a brand of light soy sauce at her local grocery with no wheat that cost much less than one specifically marked as gluten-free. “There are often alternatives to specialty products, but you have to look,” she said.

Gluten-free bread is more expensive than traditional bread and often less palatable. And that holds for many gluten-free items. Some people, including Mr. Oram, end up buying a bread machine and making their own loaves. Nicole Hunn, who cooks gluten-free meals for her family of five and just started the Web site glutenfreeonashoestring.com, avoids mixes, which she says are expensive and not that tasty, and instead bakes with an all-purpose gluten-free flour from a company called Bob’s Red Mill, which can be used in place of wheat flour in standard recipes.

If you’re too busy to cook, look for well-priced gluten-free food at large chains like Whole Foods Market and Trader Joe’s. “Trader Joe’s now carries fantastic brown rice pasta that is reasonably priced and brown rice flour tortillas that can sub for bread with a variety of things,” says Kelly Courson, co-founder of the advice site CeliacChicks.com. Ms. Courson put out a Twitter message to her followers and learned that many were fans of DeBoles gluten-free pastas, which can be bought in bulk on Amazon, and puffed brown rice cereal by Alf’s Natural Nutrition, just $1 a bag at Wal-Mart.

Finally, it may be worthwhile to join a celiac support group. You can swap cost-cutting tips, share recipes and learn about new products. Many groups invite vendors to bring gluten-free products to meetings for members to sample — members can buy items they like at a discount and skip the shipping charges. Support groups typically have meetings, as well as newsletters and Web sites where you can post questions. Groups to check out include the Celiac Disease Foundation and the Gluten Intolerance Group of North America.

Finally, if you itemize your tax return and your total medical expenses for the year exceed 7.5 percent of your adjusted gross income, you can write off certain expenses associated with celiac disease. You can deduct the excess cost of a gluten-free product over a comparable gluten-containing product.

Let’s say you spend $6.50 on a loaf of gluten-free bread, and a regular loaf costs $4; you can deduct $2.50. In addition, you can deduct the cost of products necessary to maintain a gluten-free diet, like xanthan gum for baking. If you mail order gluten-free products, the shipping costs may be deductible, too. If you have to travel extra miles to buy gluten-free goods, the mileage is also deductible. You’ll need a doctor’s letter to confirm your diagnosis and your need for a gluten-free diet, and you should save receipts in case of a tax audit.

Do you have a flexible spending account at work? Ask the plan administrator if you can use those flex spending dollars on the excess cost of gluten-free goods — many plans let you do this. For more on tax deductions, go to the tax section of the Celiac Disease Foundation’s Web site.

Yes, managing the disease is a hassle. But untreated celiac disease can wreak havoc with your health. A study published in the July issue of the journal Gastroenterology found that subjects who had undiagnosed celiac were nearly four times as likely to have died over a 45-year period than subjects who were celiac-free.

“Sometimes I resent how time-consuming it is to cook from scratch,” Ms. Courson of CeliacChicks.com said. “But I remind myself that my restrictions actually help keep me in line, more than the next person with unhealthy foods readily available.”
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Yes, if you are diagnosed with Celiac, the most important thing you can do is take the time to sit down with a Registered Dietitian (RD) to really learn about Gluten-free (GF) living. Make sure the RD is experienced and comfortable working with the GF diet and he/she will direct you to the proper books and websites for additional help. Physicians who just hand you a piece of paper or tell you to look it up on the internet are doing you a disservice. While there is a slew of good information available for self-motivators/self-studiers, there is also potential for misinformation.

The other issue I have noticed is a increase of 'self-diagnosed' folks beliving they are wheat-intolerant or that GF diet will change behavior. Wheat allergy is not the same thing as Celiac (although sometimes it's easier to explain the diet restriction to a layperson by using the term "food allergy"). Living GF isn't always easy, make sure you are properly diagnosed before you embark on the GF diet. Because once you are Celiac, you will always be Celiac and the GF diet is a lifetime (no cheating) committment to your health.

Some additional links:
University of Maryland Center for Celiac Research
Celiac Sprue Association
Gluten Free Living Magazine
Living Without Magazine
Whole Foods Market Gluten-Free Information
Trader Joe's Labels & Lists
The Gluten-Free Diet, by Shelley Case, RD

Should Someone Be Fired for Promoting Healthy Eating?

Fla. doc fired over 'doughnuts equal death' sign

By MELISSA NELSON, Associated Press Writer Melissa Nelson, Associated Press Writer Thu Aug 13, 4:41 pm ET
PENSACOLA, Fla. – Dr. Jason Newsom railed against burgers, french fries, fried chicken and sweet tea in his campaign to promote better eating in a part of the country known as the Redneck Riviera. He might still be leading the charge if he had only left the doughnuts alone.

A 38-year-old former Army doctor who served in Iraq, Newsom returned home to Panama City a few years ago to run the Bay County Health Department and launched a one-man war on obesity by posting sardonic warnings on an electronic sign outside:

"Sweet Tea (equals) Liquid Sugar."
"Hamburger (equals) Spare Tire."
"French Fries (equals) Thunder Thighs."

He also called out KFC by name to make people think twice about fried chicken.

Then he parodied "America Runs on Dunkin'," the doughnut chain's slogan, with: "America Dies on Dunkin'."

Some power players in the Gulf Coast tourist town decided they had had their fill.

A county commissioner who owns a doughnut shop and two lawyers who own a new Dunkin' Donuts on Panama City Beach turned against him, along with some of his own employees, Newsom says. After the lawyers threatened to sue, his bosses at the Florida Health Department made him remove the anti-fried dough rants and eventually forced him to resign, he says.

"I picked on doughnuts because those things are ubiquitous in this county. Everywhere I went, there were two dozen doughnuts on the back table. At church, there were always doughnuts on the back table at Sunday school. It is social expectation thing," says Newsom, a lean 6-foot, 167-pounder in a county where 39 percent of all adults were overweight in 2007 and one in four was considered obese.

Newsom was hired by the state Health Department to direct the county agency. His $140,000-a-year salary is paid jointly by the state and the county. His job primarily involves educating the public about health issues — swine flu, AIDS and the like — but he also decided to address the dangers of glazed, sprinkled and jelly-filled treats.

He angered staff members by barring doughnuts from department meetings and announcing he would throw the fat-laden sweets away if he saw them in the break room. He also banned candy bars in the vending machines, putting in peanuts instead.

In May, lawyers Bo Rivard and Michael Duncan, co-owners of a new Dunkin' Donuts, asked Newsom to take down the "America Dies on Dunkin'" message. Newsom already had run other anti-doughnut warnings, including "Doughnuts (equals) Diabetes," and "Dunkin' Donuts (equals) Death."

The businessmen had the backing of County Commissioner Mike Thomas, who owns a diner and a doughnut shop. Thomas called for Newsom's ouster, saying the doctor shouldn't have named businesses on the message board.

"I think he was somewhat of a zealot," Thomas says. "I don't have a problem with him pushing an agenda, it's the way he did it. People borrowed money to go into business and they are being attacked by the government."

A short time after Newsom's meeting with Rivard and Duncan, Newsom says, his bosses at the state Health Department told him that his leadership wasn't wanted and that he could be fired or resign. He chose to resign May 8 but has reapplied for the job.

"I have never been known for my subtlety. I don't have a knack for it. I speak the truth to people and just assume that that my data and purpose are so real and true that everyone will see the value of what I'm doing," says Newsom, who now works at a prison, doing exams of inmates.

Rivard and Duncan did not return numerous calls to their offices.

"Dunkin' Donuts is pleased that the signs have been removed," Andrew Mastrangelo, a spokesman for Canton, Mass.-based Dunkin' Donuts said in an e-mail.

The Florida Health Department has refused to talk about Newsom since he is considered a job applicant. "We will be happy to talk to you after the position has been filled," department spokeswoman Susan Smith said in an e-mail.

Newsom is hoping to get his job back so that he can resume his campaign against overeating.

"My method was a little provocative and controversial," he says, "but there wasn't a person in Bay County who wasn't talking about health and healthy eating."

___

I guess if he had kept his signs 'generic' instead of mentioning brands by name, he wouldn't be in such hot water.

It's sad that health promotion is not supported. Instead, society/lawyers/insurance companies are so focused on disease treatment instead of prevention.

Healthy lifestyles saves health care dollars. Department of Defense and other entities have proven that. Worksite wellness programs save companies money with decreased sick days and insurance premiums. But there is still very little reimbursement or insurance coverage for wellness services (i.e. office visits with a Registered Dietitian to provide a personalized approach to healthier eating within the patient's lifestyle/preferences).

How Bad is a High Fat Diet?

High-Fat Diet May Make You Stupid and Lazy

Short-term memory getting worse? Exercise getting harder? Examine your diet. New research published online in The FASEB Journal (http://www.fasebj.org) showed that in less than 10 days of eating a high-fat diet, rats had a decreased ability to exercise and experienced significant short-term memory loss. These results show an important link between what we eat, how we think, and how our bodies perform.

"Western diets are typically high in fat and are associated with long-term complications, such as obesity, diabetes, and heart failure, yet the short-term consequences of such diets have been given relatively little attention," said Andrew Murray, co-author of the study and currently at the University of Cambridge in the United Kingdom. "We hope that the findings of our study will help people to think seriously about reducing the fat content of their daily food intake to the immediate benefit of their general health, well-being, and alertness."

Rodents are thought to be good analogues to humans for studies like this, but research in humans would be needed to confirm that the effects cross over. Also, because rats live much shorter lives, study effects may play out on significantly shorter time scales than in humans.

Murray and colleagues studied rats fed a low-fat diet (7.5 percent of calories as fat) and rats fed a high-fat diet (55 percent of calories as fat). Muscles of rats eating the high-fat diet for four days were less able to use oxygen to make the energy needed to exercise, causing their hearts to worker harder - and increase in size.

After nine days on a high-fat diet, the rats took longer to complete a maze and made more mistakes in the process than their low-fat-diet counterparts.

In the fat-laden rats the researchers found increased levels of a protein called uncoupling protein 3, which made them less efficient at using oxygen needed to make the energy required for running.

"It's nothing short of a high-fat hangover," said Dr. Gerald Weissmann, editor-in-chief of journal. "A long weekend spent eating hotdogs, French fries, and pizza in Orlando might be a great treat for our taste buds, but they might send our muscles and brains out to lunch."
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Andrew J. Murray, Nicholas S. Knight, Lowri E. Cochlin, Sara McAleese, Robert M. J. Deacon, J. Nicholas P. Rawlins, and Kieran Clarke
Deterioration of physical performance and cognitive function in rats with short-term high-fat feeding
FASEB J. first published on August 10, 2009 as doi:10.1096/fj.09-139691 Abstract

The full article is available online but only for FASEB members (which I am not).

Humor

Nutrition for the Athlete

Adapted from the Health & Lifestyle lecture I have been providing at Joint Base Balad, Iraq during my deployment with the 332d Expeditionary Medical Group.


The first priority for athletes is meeting energy requirements. Energy balance is key to maintaining lean tissue mass, immune and reproductive function, and optimum athletic performance.

To have calories in = calories out means you will have a balance effect on the scale. If you have more energy coming in then going out then your weight will start increasing. If you have less energy coming in and more energy going out then you will have a wt loss.

With limited energy intake the body will then use fat and lean body tissue for fuel. Not maintaining enough energy for fuel compromises the benefits of training.

You will most likely not achieve your best physical performance while restricting calories. (Keep in mind that it is certainly possible for an over-fat, way out of shape individual to both lose weight and improve their physical performance at the same time) However, for a normal weight, relatively “in-shape” individual…caloric restriction will be detrimental to performance.

Low-energy intakes can result in loss of muscle mass, menstrual dysfunction, loss or failure to gain bone density, and increased risk of fatigue, injury, and illness.

To help optimize training and prevent illness, athletes should consume a daily diet rich in nutrient-dense carbohydrates and high-quality protein in order to provide adequate energy for muscular activity and maintenance of optimal immune system functions.

Carbohydrates are the body’s main source of energy. The body converts Carbs you eat into glucose. Glycogen is the main storage form of glucose and it is stored primarily in muscle and liver.

Continuous exercise uses up the body’s glycogen stores. It is important to ensure adequate Carb intake pre, during, and post intense physical activity. Repetitive training/competition reduces glycogen storage leading to impaired performance.
Athletes (and very active military members) need adequate Carb intake to keep glycogen stores high, therefore allowing for optimal physical performance.

Approximate protein intake guidelines are based on the type of athlete. Requirements include the need to repair exercise-induced microdamage to muscle fibers, use of small amounts of protein as an energy source during exercise, and the need for additional protein to support gains in lean tissue mass. However, repeated research has shown that protein intake in excess of 2 g/kg simply results in the excess amino acids being converted to fat and stored appropriately.

Turns out that most Americans (even non-athletes) easily achieve these protein intakes as part of their regular diet, therefore it is rare that an athlete would need to deliberately add a protein supplement to their diet. Except when people are limiting their total caloric intake for weight loss.

For optimal benefit, spread protein evenly throughout the day.

Fat is important in the diets of athletes as it provides energy, fat-soluble vitamins, and essential fatty acids. Additionally, there is no scientific basis on which to recommend high-fat diets to athletes. There are no ergogenic effects from fat intake (i.e. eating more will not improve athletic performance, but not eating enought total calories may hurt your progress). Be sure to limit saturated fats since that is the type of fat that can raise blood cholesterol.



How much energy do you need? Even when you are trying to lose weight, there is a minimal amount of calories you need to prevent loss of muscle mass. You need to support your Resting Metabolic Rate (RMR).



Once you calculate what your body needs to support stable weight at your activity level, you can reduce the intake, increase the activity, or best - combination of both, to help promote weight loss. But never eat less than your RMR if you want to keep your metabolically active muscles - see "Maximizing Metabolism" Lecture (coming soon).

Want to gain weight (muscle)? You have to support the proper exercise (higher resistence, fewer repetitions to fatigue) with adequate rest for repair and building. And you need enough extra CALORIES (not extra protein). Remember the protein needs even when in anabolic mode (muscle building) are maximum 2 g/kg (or ~1 g/lb body weight).

Look at your hands; your two hands are a good representation of the total amount of protein you can use in a day for support of muscle building. Magazines advertising protein powders and bars and supplements are owned by the companies selling these products. High protein diets tend to increase blood acidity, phosphorus load (thus pulling calcium out of your bones and then it is lost in your urine), and nitrogen released when protein is used for energy (fortunately healthy kidneys can remove the excess nitrogen from our blood).

To get extra calories between meals try dried fruit & nuts, peanut butter sandwich, high fiber snack bars.




Hydration (Fluid) is very important. And being deployed in the desert (Iraq) makes it a prime concern even if you are not exercising. Water is the best rehydration for most people. Electrolyte-replacement Sport drinks (i.e. Gatorde or Powerade) are useful when your workout is over 60 min or you are drinking a lot of water and not eating (don't want to dilute the sodium in your blood).

Water helps cool your body. When you are active your body heats up. Sweating brings water to the surface of your skin where evaporation pulls this heat away from your body. If you don't have enough water to sweat, or you cover up all your skin so you sweat but it cannot evaporate, you will overheat. If your body temperature gets too hot, you are "cooking" yourself into a severe illness.

Some ways to tell if you are drinking enough. Weigh yourself before and after your workout. Drink at least 2 cups of water for every pound lost. Check your urine; if it's darker than pale yellow straw you need to be drinking more. Here in Iraq I've been drinking about 4L per day.



For more information:
sportsmedicine.about.com/Sports_Nutrition.htm
www.dietitian.com/sportnut.html
Food and Nutrition Information Center (USDA)
Nancy Clark, MS RD “Sports Nutrition Guidebook”

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Sleeping is Good for Weight Control

Public release date: 8-Jun-2009
http://www.eurekalert.org/pub_releases/2009-06/aaos-srr060209.php

Sleep restriction results in weight gain despite decreases in appetite
and consumption

WESTCHESTER, Ill. – According to a research abstract that will be
presented on Monday, June 8 at SLEEP 2009, the 23rd Annual Meeting of
the Associated Professional Sleep Societies, in the presence of free
access to food, sleep restricted subjects reported decrease in appetite,
food cravings and food consumption; however, they gained weight over the
course of the study. Thus, the finding suggests that energy intake
exceeded energy expenditure during the sleep restriction

Results indicate that people whose sleep was restricted experienced an
average weight gain of 1.31 kilograms over the 11 days of the study. Of
the subjects with restricted sleep who reported a change in their
appetite and food consumption, more than 70 percent said that it
decreased by day 5 of the study. A group of well rested control subjects
did not experience the weight gain.

According to lead investigator Siobhan Banks, PhD, a research fellow at
the University of South Australia and former assistant research
professor at the University of Pennsylvania School of Medicine, it was
surprising that participants did not crave foods rich in carbohydrates
after sleep restriction, as previous research suggested they might.
Results indicate that even though physiologically the desire to eat was
not increased by sleep loss in participants, other factors such as the
sedentary environment of the laboratory and the ability to snack for
longer due to reduction in time spent asleep might have influenced the
weight gain.

"During real-world periods of sleep restriction (say during shift work),
people should plan their calorie intake over the time they will be
awake, eating small, healthy meals," said Banks. "Additionally, healthy
low fat/sugar snacks should be available so the temptation to eat
comfort foods is reduced. Finally, keeping up regular exercise is just
as important as what food you eat, so even though people may feel tried,
exercising will help regulate energy intake balance."

The study involved 92 healthy individuals (52 male) between the ages of
22 and 45 years who participated in laboratory controlled sleep
restriction. Subjects underwent two nights of baseline sleep (10 hours
in bed per night), five nights of sleep restriction and varying recovery
for four nights. Nine well rested participants served as controls. Food
consumption was ad libitum (subjects had three regular meals per day and
access to healthy snacks, and during nights of sleep restriction
subjects were given a small sandwich at one a.m.).