The Food Environment

Acorns affect our health!

TheDairyShow — Wed, 14 Dec 2011 09:00:00 -0500

By Michael Crupain, MD, MPH

I think most of us probably think that as humans we are pretty removed from what happens in “nature.” And certainly in medical school we didn’t have any classes on how human health is dependent on the health of the ecosystem. Despite this sentiment though, human beings are still linked to the environment and what effects nature also affects our health. This is true whether we are talking about something as big as climate change or apparently something as small as acorns.

Last week’s New York Times reminded us of this link in the article, After Lean Acorn Crop in Northeast, Even People May Feel the Effects. It turns out that this year is a very bad year for acorn production. While we don’t have much direct use for acorns, field mice, deer, and birds do. Without these acorns the deer will wander further out of the cover of the forest and be more likely to be hit by cars. This results in not only dead Deer, but also serious injuries for drivers.

Acorn abundance also has an effect of the risk of humans acquiring Lyme disease and the article states that 2012 may be “the worst year for Lyme disease ever.” The reason for this has to do with the effect of acorns on the population of both mice and deer.

The acorn is one of the primary foodstuffs of the field mouse. The field mouse, in turn, is one of the main sources of food for the tick that spreads Lyme disease and one of the primary reservoirs for the bacteria responsible for the disease. In years of high acorn production the mouse population grows, which provides more opportunities for the tick population that carries the Lyme disease causing bacteria.

But wait, the article said that there were less acorns this year, so shouldn’t the risk of Lyme disease decrease with the decreasing mouse population? This is where is gets a little confusing, but hopefully I can clear it up for you.

It turns out that the lifecycle a tick is two years long from Egg to Larva to Nymph to Adult. Most ticks get “infected” with the Lyme causing bacteria in the larval stage when they feed on the blood of a field mouse. Development from Larva to Nymph, the stage when a tick is most likely to infect humans, takes one year.

With that in mind lets get back to acorns. Unlike this year, the fall of 2010 saw a bumper crop of acorns. This excess of food led to an explosion in the population of field mice in the summer of 2011. This increase in mice means that tick Larva were more likely to be exposed to the Lyme bacteria during this time. Remember though, that it takes one year for the ticks to reach the Nymph stage when they are most likely to effect humans. So now in the summer of 2012, when the Larva becomes Nymphs, there will likely be many more of them than usual in the forest to attach to humans passing by. In addition because of the lean acorn crop in the fall of 2011, the deer we discussed earlier that will wander out of the woods to find food will also spread the infected ticks further from the forest floor. It feels a long way off, but it will be important to be extra vigilant for ticks this coming summer. The good news is though, that because of the low acorn yield this year, the summer of 2013 should see less Lyme disease.

Secrets of the Processed Food Industry Revealed

TheDairyShow — Sat, 03 Dec 2011 14:49:02 -0500

On a recent of episode of 60 Minutes, reporter Morley Safer visits a company you’ve probably never heard. The company called Givaudan it turns out is the world’s largest flavoring company.

Flavoring is an incredibly important component of creating processed foods, because it allows the industry to create products with the flavors of delicious high-quality ingredients, despite none being present. The better a product tastes, the more likely we will be to buy it, so it’s no wonder that creating these flavors is a big business.

As the 60 Minutes story reveals companies use sugar, fat, salt, and other flavors created in chemistry labs, that human biology craves, to create pleasurable experiences for eaters. Employees of the company, out on a trip to look for the next new flavor for soda, admit to Safer that they are trying to create flavors that are irresistible and addictive.

For this reason many in public health argue that the processed foods industry is a big part of the reason for our world’s obesity epidemic. Processed food companies make more money by selling more products and they do this by designing these items to be irresistible. Consuming more processed foods of course means more calories and that leads to weight gain. This is why many public health advocates would like to place limits on companies’ abilities to use sugars, fats, and salt in their foods.

I doubt however, that many would argue that food companies want consumer to be overweight. Weight gain instead, is simply an unintended consequence of maximizing sales through the creation of cheap, high calorie, hyper-palatable addictive foods. Safer asks Givaudan VP of Global Strategy and Business Development, Bob Pellegrino, about this issue. Referring to obesity, Safer asks if the food industry wants his company to create flavors so that people want more. Pellegrino answered, “I don’t think it’s creating a desire for moreness, as well as it’s a desire for memorability, so that people will repeat the purchase of the product and enjoy them.” Do you see the difference? I don’t either.

I recently had the opportunity to visit the McCormick Company. When you hear the name McCormick, you probably think about the small jars of powdered spices that are permanent residents in your kitchen cabinets. You might be surprised to learn though, as I was, that spices make up only half of McCormick’s business, the other half is devoted to developing flavors for the processed food industry. Our guide was sensitive to criticism of her companies business-after all did we want them to be making foods that taste bad. She was also very upset about rules that were limiting companies’ abilities to use trans-fats and plans for regulations on salts, because they would make her job so much more difficult. We were told that the company also works on creating healthy processed foods and would love to be doing more, but despite what people say they want, they just don’t want to buy them.

Understanding how our biology works and how food companies use this knowledge to create processed foods is an important first step to becoming healthier. By cooking our own foods using real whole ingredients, we can develop flavors and make delicious healthy dishes that can’t be rivaled by all of the food technology in the world. Despite this our society relies heavily on these processed products that are a major contributor to the risk for disease. Unhealthy processed foods are highly prevalent in the food environment and cooking and eating healthy is decidedly more difficult. Certainly companies have the right to make processed fodos taste good, but when they purposefully make unhealthy foods addictive do we need to draw a line? What do you think?

Watch The 60 Minutes Story Below:

This Thanksgiving make the Turkey a Side

TheDairyShow — Mon, 07 Nov 2011 09:47:00 -0500

By Michael Crupain, MD, MPH

(Note: This Article was originally published in the American College of Preventive Medicine Resident Physician Newsletter)

There is nothing that better symbolizes a Thanksgiving meal than turkey. According to the Turkey industry, between 80% and 95% of Americans consume this bird on the fourth Thursday of November each year. While we can’t be sure if Turkey was really eaten at the first Thanksgiving, it has certainly been an important part of the tradition and American culture for at least 200 years.

The modern Turkey however, is a far different bird than the Turkey Benjamin Franklin told his daughter would be a better symbol for America than the Bald Eagle. Today the majority of Turkey’s represent a single breed, the Broad Breasted White, which has been bred to have a small frame and large breasts. These birds grow very fast, reaching slaughter weight after only 14-18 weeks and have a taste that can best be described by the word bland.

99% of Turkeys produced in this country never see the light of day, because they are raised in an industrial system. After their birth in a lab (due to their anatomical proportions, this breed can only reproduce by artificial insemination), the animals have their beaks and toes clipped and are transferred to a brooding house where they will live for about 6 to 8 weeks. From here they will go to one or two more similar houses where they will be fattened quickly on a diet of grains and medications. Their homes are long barns without windows, where there is a continuous flow of food, water, air, and artificial light. The birds stand all day on piles of litter and are packed tightly together. Like other industrial food animal production facilities, Turkey farms represent a potential problem not only for the Turkeys, but also for public health. The pollution and antibiotic resistant bacteria that may be produced on these farms can cause issues for the health of works, neighbors, and the environment.

Fortunately due to increasing awareness of the public about the practices of industrial agriculture, small farmers are starting to grow what are known as Heritage Breed Turkeys. These breeds, which have names like Bourbon Red and Narragansett, also have much more natural proportions and a much more interesting flavor than industrial birds. Typically heritage birds are raised outdoors in large fields where they can engage in more natural turkey behaviors like foraging. Heritage breed may take up to twice a long as factory birds to reach slaughter weight and cost more. Industrially produced Turkey’s however, are artificially cheap, because the costs to human health and animal welfare are externalized.

There are a number of websites that you can order heritage breeds birds from, but your best bet is to find a farmer at your local farmers market who is raising them. This way you can find out more about how the birds are raised and help support the local economy. Its best to start looking early though, because these birds are often in limited supply.

While Turkey is healthy lean meat filled with protein and important vitamins and minerals, due to the cost of heritage birds, its better to make the vegetables the focus of your Thanksgiving meal and make the turkey a side. Focusing on dishes with super foods like mashed sweet potatoes (instead of mashed white potatoes), roasted cauliflower, raw tuscan kale salad, and roasted carrots will ensure a delicious and healthy meal.

When cooking the heritage turkey, I recommend separating the legs and thighs from the breast. These different muscles cook at different rates and cooking them together almost certainly leads to dry white meat. Instead try roasting the breast separately in a 400F oven until it reaches 165F (about 1 hour). Because heritage Turkey’s have more flavor, you won’t need to brine the bird, but feel free to add some herbs to the skin and other aromatics to the cavity. For the legs and thighs, I recommend a braise. One of my favorite recipes is this one from famed chef Daniel Boulud.

Wasting Antibiotics

TheDairyShow — Mon, 03 Oct 2011 08:08:00 -0400

By Michael Crupain, MD, MPH

Antibiotics are valuable medications that have made treating what were once life-threatening infections with bacteria, relatively easy. A growing threat to public health however, is the development of bacteria that are resistant to our current antibiotics. An infection with one of these resistant bacteria can increase costs, suffering, and even cause death. Each year fewer and fewer new antibiotics are being developed and we may find ourselves someday soon faced with bacteria that are resistant to all of our current defenses.

Resistant bacteria are a normal part of evolution, but they proliferate more quickly when exposed to antibiotics, especially low doses of antibiotics given for prolonged periods of time. Unfortunately in Industrial Food Animal Production (aka Factory Farms, aka Feedlots, aka IFAP), the long term feeding of low doses of antibiotics to food animals is commonplace. Instead of using these valuable drugs to treat disease as we do in human medicines, IFAP uses them at low doses in order to promote growth. In the US, according to the FDA, about 80% of antibiotics are given to animals and, according to the Union of Concerned Scientists, about 80% of these are for non-therapeutic uses such as growth promotion. The inappropriate use of antibiotics in IFAP is a major threat to public health and is finally being recognized by the government agencies responsible for protecting it.

Despite recognizing the problem, little has been done about it. One of the most important functions of public health agencies is measuring the magnitude of the problem. Unfortunately when it comes to the problem of the use of antibiotics in IFAP and the development of resistant bacteria the USDA and FDA have not been able to make any significant changes. This is the subject of a new report from the Government Accountability Office (GAO) that came out in September.

According to the report the FDA has finally begun collecting data on antibiotics sold for use in food animals (that’s were the numbers above come from), however the resolution of the data is low. The FDA does not collect data on either the species of animal the drugs are used in or the indication for use.

Also according to the GAO report the FDA has implemented stronger standards for the approval of new antibiotics for use in food animal production to prevent the development of resistant bacteria, however, due to funding limitations it is unable to apply these standards to previously approved drugs. Instead the FDA is relying on companies and veterinarians to voluntarily limit the use of antibiotics in food animals. Considering that IFAP and veterinary organizations strongly support the use of non-therapeutic antibiotics, it seems unlikely that this program will be very effective. In addition since poor data about antibiotic use is collected, it will be impossible to determine any interventions level of effectiveness.

The report also comments on Denmark’s policies for the use of antibiotics in IFAP. Denmark banned the use of antibiotics for growth promotion in IFAP many years ago. In addition they have an incredible monitoring system that allows them to track the types, indications, and amounts of antibiotics administered to animals. The system even allows the monitoring agencies to determine if one veterinarian is prescribing antibiotics in a way that is not consistent with other veterinarians in their same region. This allows them to intervene incase there is inappropriate use.

The FDA has recognized the dangerous use non-therapeutic doses of antibiotics in animal agriculture as a serious problem, but has not yet been able to do anything signficant to curb it. The agency needs more funding and support from the public to take this issue on. We need to implement a monitoring system more like Denmark’s so that we can understand the full magnitude of the problem and monitor the effect of interventions. There is currently both legislation as well as FDA guidance pending that would help limit the use of medically important antibiotics for irresponsible uses in animals. These policies both represent a step in the right direction, but do not go far enough. The EU banned the use of antibiotics as growth promoters in IFAP in 2006 in order to protect the public from the dangerous of antibiotic resistant bacteria developed in IFAP and its time we do the same here.

This Week's Food News

TheDairyShow — Mon, 26 Sep 2011 08:08:00 -0400

By Young-Rok Shin, MD, MPH

In case you missed it here are some news highlights from last week.

This week, we had two articles about the Federal government’s role in food policy. Jennifer Huget at the Washington Post covered the Harvard School of Public Health’s release of their own version of the USDA’s MyPlate dietary guide in “Dishing up a different healthful-eating plate.” While similar to the USDA’s guide (which is the new replacement for the old Food Pyramid), it replaces the cup of dairy with water and adds a flask of healthy oils. It also tweaks the plate components by emphasizing that the grains and protein should be from healthful sources.

In the New York Times, we had an article by Fernanda Santos titled, “Public Schools Face the Rising Costs of Serving Lunch” about the Federal government’s recent requirement that schools start raising their prices to better reflect the cost of providing school meals. This was done to eliminate the large differences in prices that exists between some school districts. New York City, for example, only charges $1.50 for lunch, compared with Fairfax County, Va, which charges $2.65. Critics of the measure claim that the price increase will drive parents away from the school lunch program altogether by making them too expensive to afford for struggling families that are just above the cutoff for subsidized lunch, and that the new prices will still not realistically cover the actual cost of lunch anyway.

An End to Unlimited Breadsticks?

TheDairyShow — Sun, 25 Sep 2011 15:40:25 -0400

By Michael Crupain, MD, MPH

Recently Michelle Obama held a press conference at an Olive Garden restaurant in Maryland. She was there to announce that Darden Restaurant Inc, which owns the Olive Garden, Red Lobster, as well as other chains, had signed on to make their menus healthier as part of the Let’s Move Campaign.

The group will adopt a number of strategies to improve the health of the food they serve; they will reduce calories and sodium by 10% in the next 5 years and reduce it by another 10% in the preceding five years; make fruits and vegetables the default option for sides in kids meals; and make low fat milk the default option for kids beverages. In addition, they state that soda will not be promoted, menus will promote healthy choices, and the nutritional values of children’s menus will be improved.

According to the First Lady this pledge represents a “breakthrough moment in the restaurant industry” and for the most part I would agree. According to ObamaFoodorama.com, the Darden group serves about 400,000,000 meals per year, so this company does truly have the opportunity to help change the food environment.

The most meaningful part of the plan is probably the change of default options for kids meal sides, to fruits and vegetables and eliminating any push for sodas. While parents will still be able to order less healthy items for their kids, studies show that people tend to stick with their default choices.

Changing default options in the food environment is a great way to increase healthy eating. If it becomes easier and more automatic for people to eat a salad for lunch rather than a burger or a piece of fruit for a snack rather than a bag of chips than health will improve. This concept of the power of changing defaults is well illustrated by the prevalence of people consenting to organ donation in different countries depending on whether people have to “opt-in” or “opt-out” to donate. In those countries where one has to “opt-in” participation rates are very low. However in those countries where one has to “opt-out” participation nears 100%. So if people automatically get broccoli instead of fries, they are going to be more likely to eat the broccoli.

Another important way to change defaults is to offer smaller/lower calorie portions. The Darden group has also signed onto this; however, their pledge in this area is less impressive. First of all 5-10 years is a long time. While I am sure it not easy for a restaurant group of this size to make menu changes quickly, its hard to believe they can’t do it faster than they have pledged to.

Also, if you review the menu at the Olive Garden, you will quickly discover that it is easy to have a meal there in which you would consume of 3000 calories, which is about 1000 more calories than is required for the entire day for the average person. A 10 or 20 percent reduction in calories, would therefore still mean that people would be likely to consume over an entire day’s work of calories in a single sitting. And just one serving from the available unlimited salad and breadsticks offer has 500 calories.

Overall this move by Darden Restaurants represents a step in the right direction. Changes in such a large chain have the ability to make an impact on the population and hopefully this move will encourage other businesses to follow suit and improve our food environment.

This Week's Food News

TheDairyShow — Sun, 18 Sep 2011 23:30:04 -0400

By Young-Rok Shin, MD, MPH

It was quite a busy week for food news.

In “’Corn sugar’ is false advertising, FDA warns” Thomas Watkins of the Associated Press wrote about the Corn Refiners Association’s attempt to circumvent the bad publicity that high fructose corn syrup has been receiving lately by renaming it as “corn sugar.” The FDA has issued a warning about this, however, as it oversees all food labeling and has not approved this name change. While no labels on actual food products have used the “corn sugar” label, the Corn Refiners Association is using the name in TV commercials and on at least some of its websites and the FDA has raised concerns that the new label may be misleading and confusing for consumers.

The New York Times had two articles related to food this week. Jane Brody wrote about the findings of a new series of reports published in The Lancet about fighting the obesity epidemic by approaching the problem from multiple angles. She described her own experience of what had changed from her childhood to modern times with regards to the much greater availability of cheap, convenient, and tasty processed foods and the decline in physical activity resulting from the design of suburban neighborhoods and the rise of modern conveniences like television. She then went on to go over some of the recommendations from the reports from The Lancet, which advised approaching the problem similar to the way tobacco smoking was handled with advertising controls, increases in tobacco taxes, greater availability of treatments such as the nicotine patch, and banning public smoking.

Joe Nocera wrote a column titled “Killing Jobs and Making Us Sick,” in which he laments the Republican Party’s opposition to funding proposals for the Food Safety Modernization Act and the FDA. Despite significant industry and bipartisan House support for an industry fee that would have raised $300 million to help fund the new food safety act, Republican Senators killed the fee because they viewed it as a tax in disguise. House Republicans then cut the FDA’s own budget by $87 million instead of increasing it by $120 million as requested by President Obama. Although the Senate just recently approved a $40 million increase in the budget, it is still not believed to be enough to cover the new inspections that the FDA has been mandated to carry out, and it also remains to be seen what the final 2012 budget will look like.

In the Baltimore Sun this week, Candus Thomson covered Maryland’s efforts to receive a seal of approval from the Marine Stewardship Council for locally caught striped bass. With consumers increasingly choosing products that are labeled as eco-friendly and sustainable, supporters of the effort believe that it will provide a boost for local watermen by allowing them to charge a premium price for their fish while providing a safeguard against state budget cuts on research and protection programs for Maryland’s fisheries. However, not everyone is onboard, with opponents questioning the validity of the Marine Stewardship Council’s approval process and Maryland’s ability to properly maintain its striped bass fisheries in a sustainable manner against the many water quality challenges that face the Chesapeake Bay.

Finally, The Nation magazine has a whole issue on food issues this week, covering Michael Pollan’s thoughts on how to effect change to the food system, food as a human right, Walmart’s new plan to open stores in food deserts all over the country, and much more. Some of the articles are available only to subscribers, but the ones linked here and many others are available for free (although reading more than a couple of articles at a time may require a free signup).

Redefining Health Education

TheDairyShow — Wed, 14 Sep 2011 08:00:00 -0400

By Michael Crupain, MD, MPH

Last week there was an interesting Op-Ed in the NY Times calling for the resurrection of Home Economics classes in schools. The article, by Professor Helen Zoe Veit, makes many good points about many Americans not knowing how to cook and therefore relying on processed and prepared foods for nourishment. She suggests that Home Ec is a great venue to teach America’s youth about healthy cooking and that by doing so we could combat the epidemic of obesity and chronic disease that we face.

I really enjoy cooking, but when I think back to my Home Ec cooking class, I do not have many pleasant memories nor do I remember doing any healthy cooking. I do remember making apple pie, coffee cake, cheese steaks. I also remember that if the person measuring out the ingredients for the day made any mistakes then our whole group failed for that day! This class clearly was focused on recipes, but it would have been better to focus on the techniques of cooking. While we learned the technique of measuring ingredients (to be fair, as a result of this strict measuring policy, I learned the difference between a wet and dry measuring cup), we did not learn many other cooking techniques that we could apply to multiple foods or throughout our lives. If we are going to combat obesity by bringing back Home Ec, there are going to have to be some major changes in the curriculum.

This brings me to a meeting I recently attended on childhood obesity, at which, a number of different stakeholders were present, including both dieticians and schoolteachers. Much of the conversation focused on the idea that increasing nutrition education could decrease obesity rates.

Nutrition education as you may know is focused on teaching nutrition science. Students are taught about fats, carbohydrates, proteins, vitamins, calories and the dietary guidelines, but do not learn anything about how to actually cook nutritious foods. Nutrition science is very important to understand, but just knowing what is best to eat, is probably not enough. It is more important to actually be able to eat healthy foods and the best way to do this is to be able to cook it your self.

So, I could not agree more with Professor Veit’s assertion that healthy cooking needs to be taught in school, but instead of reviving Home Economics, I believe that we need to rethink the way Health Education is done. Lets shift the focus of nutrition education in school in a more practical direction and put teaching student how to cook under the purview of health education. After all, we eat three meals a day and there is probably not a single more important health skill that a person can learn than how to cook (washing your hands is part of cooking!). These classes could integrate knowledge about nutrition and cooking techniques and thereby arm students with the both the knowledge and the ability to prepare meals that maintain a healthy weight and prevent chronic disease.

This Week's Food News

TheDairyShow — Sun, 11 Sep 2011 14:00:00 -0400

By Young-Rok Shin, MD, MPH

In Vegetable Gardens Are Booming in a Fallow Economy, Sabrina Tavernise of the New York Times wrote about the boom in backyard and community vegetable gardening that started after the 2008 financial crisis. Taking place primarily in rural areas, this movement has been about cutting grocery bills, with people growing or purchasing in bulk and then canning, pickling, or otherwise preserving their food for long-term use in order to reduce their overall food costs. Some of the backyard growers are also selling their excess crops at local farmers’ markets to supplement their incomes.

USA Today had a piece called Restaurants want a piece of food stamp pie covering the efforts of restaurants to expand food stamp benefits (now known as the Supplemental Nutrition Assistance Program, or SNAP) to allow their use in restaurants, including fast food chains. Although federal regulations generally do not allow SNAP to be used to buy prepared foods, there is an exception for the disabled, elderly, and homeless. The lobbying efforts have the support of anti-hunger advocates but are opposed by public health advocates and current SNAP vendors.

A Northern California School District’s Cafeteria is having a tough time competing with food trucks selling unhealthy foods during lunchtime. According to the NY Times, Novato High School is preparing healthy meals for students, but students don’t like them and buy ice cream and other junk food from trucks parked outside. The question the article fails to answer is; is the food really any good or are students critiques justified?

This Week's Food News

TheDairyShow — Sun, 04 Sep 2011 11:09:22 -0400

By Young-Rok Shin, MD, MPH & Michael Crupain, MD, MPH

On the opinion pages of the New York Times, Mark Bittman expressed his disappointment with the Obama administration in a piece titled, “Profits Before Environment.” He criticized the administration’s actions on environmental issues such as genetically modified crops and a new proposed oil pipeline that would cut across the Midwest between Canada and the Gulf coast. He cited numerous concerns about both issues, and called on President Obama to stop protecting corporate interests at the expense of the environment.

Fox Business News interviewed Slow Food USA President Josh Viertel about the Farm Bill and subsidies for unhealthy foods. Josh and Fox’s Neil Cavuto talk about how the government has created a toxic food environment with its financial support for unhealthy foods. The clip is below.

The website Gilt Taste posted on a well-done video about food environments in the South Bronx, one of NYC’s most unhealthy. The video put together by students from the New Settlements Bronx Helpers with the Center for Urban Pedagogy. In the 28 minute piece the students talk with bodega owners, wholesalers, distributors, community leaders, and public health experts about why the food environment in the South Bronx is the way it is. While the video may be a little long, it is definitely informative and worth a watch. If you don’t want to watch the whole thing, it starts to get really good at around the 10 minute mark.

Bodega Down Bronx from the Center for Urban Pedagogy on Vimeo.