Choose Respect National Initiative

During May 2006, the Centers for Disease Control and Prevention (CDC) is launching Choose Respect, a US national initiative designed to prevent dating violence and encourage persons aged 11--14 years to have healthy, respectful relationships. Findings from the 2003 Youth Risk Behavior Survey indicated that approximately one in 11 high school students reported being victims of physical dating violence during the 12 months preceding the survey, equating to nearly 1.5 million high school students nationwide (1). Those victimized by a dating partner were more likely to engage in episodic heavy drinking, suicide attempts, physical fighting, and current sexual activity (1).

Dating violence in adolescents also has been linked to lifelong patterns of violence that carry over into other relationships (2). Healthy relationship skills can have a beneficial effect on the ability of adolescents to prevent dating violence (2).

Choose Respect encourages the early development of healthy attitudes, behaviors, and skills (e.g., negotiation or compromise) to help youth interact positively and treat others with respect. The initiative tools are designed to complement other community prevention strategies to change social norms and encourage healthy relationships. Additional information is available at http://www.chooserespect.org/.

Throughout summer 2006, CDC will work with community agencies in 10 cities to create awareness of the initiative's themes and resources among youths aged 11--14 years. In each city, activities and materials, including online games, videos, posters, and public service announcements, will be used to increase awareness of the importance of respecting friends and peers and to teach skills that help form healthy relationships.

References

1. CDC. Physical dating violence among high school students---United States, 2003. MMWR 2006;55:532--5.
2. Wekerle C, Wolfe DA. Dating violence in mid-adolescence: theory, significance, and emerging prevention initiatives. Clin Psychol Rev 1999;19:435--56.

Celiacs: Beware of FDA's Latest Errors on Barley

The Food and Drug Administration (FDA) has again fallen far short of public expectations. It has released the final and full report regarding "Qualified Health Claims Associating Barley Products with Reduction of Risk of Coronary Heart Disease." As far as it goes it is the usual fare of bureaucratic discourse that effectively serves the marketing needs of the manufacturers who requested the approvals for health claims relating to barley products.

The barley manufacturers will doubtless be thoroughly delighted. The FDA delivered exactly what they sought. Good for them, not so good for consumers though. Why? Well, let's just see what the FDA has said first and the consider that question.

The Food and Drug Administration announced that it has finalized a rule that allows foods containing whole grain barley to claim that they reduce the risk of coronary heart disease. Specifically, whole barley and dry milled barley products such as flakes, grits, flour, meal and barley meal, which provide at least 0.75 grams of soluble fiber per serving, may bear the following claim:

"Soluble fiber from foods such as [name of food], as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. A serving of [name of food] supplies [x] grams of the soluble fiber necessary per day to have this effect."

Coronary heart disease claims nearly half a million lives a year. High total cholesterol levels and high levels of low density lipoprotein (LDL) cholesterol are known to increase one's risk for heart disease, so consumers are encouraged to keep these levels as low as possible. Scientific evidence indicates that including barley in a healthy diet can help reduce the risk of coronary heart disease by lowering LDL and total cholesterol levels.

"FDA is pursuing new initiatives to help consumers improve the choices they have for healthy and nutritious diets," said FDA Deputy Commissioner Scott Gottlieb, M.D. "We firmly believe that one of the best ways to encourage healthier eating habits is to help consumers get truthful, up-to-date, science-based information about food products so that they can make choices that are based on a better understanding of the health consequences of their diets."

FDA began allowing the claim in December 2005 under an interim final rule, while at the same time accepting public comments on the rule for 75 days. During this time no comments were received that warranted changes to the interim final rule.

Yes, that's a great shame. Comments should certainly have been submitted. I completely missed the opportunity as I somehow was completely unaware of the request for comments? How about you, did you know about this issue? Well, anyway, let's answer my question from above. Why is this bad news for consumers?

There are a few reasons actually. Let's just keep them brief. They are:

1. Dr Gottlieb is using standard rhetorric when he uses phrases such as "truthful, up-to-date, science-based information about food products" because the statements the FDA makes are always colored by multiple forces endemic to FDA and even wider Americam culture that render such comments mere make-believe. These include commercial and economic interests and political realities which operate at multiple levels.
2. The claims perpetuate an approach to food that is fundamentally flawed. It encourages the continuing consumption of highly refined and manufactured foods whch undermines health. Whole foods are much better for health and wellbeing. Highly refined flours, from whatever grain, didturb the digestion, toxify the body and tend to have a higher glycemic index, contributing to development of diabetes.
3. The claims, however qualified, make consumption of barley containing products appear to be healthy to the average consumer. This enhanced health credibility is precisely what the manufacturers want and the FDA has delivered but narrow and selective reviews of questionable "science" relating barley to heart disease makes no reference to the other diseases that the products will worsen, such as bowel cancer, diabetes, and importantly, food sensitivities and worse (see next point).
4. Very importantly, this favorable review and endorsement by an FDA with tunnel vision completely ignores the substantial number of peoplle with celiac disease. All celiacs must avoid wheat, rye, oats and barley as these grains contain the gluten that damages their small intestines. Every single product containing barley, now endorsed as healthy by the FDA, is dangerous to people with celiac disease.

In my view the FDA's endorsement of barley is little more than a commercially contrived marketing device. More people will become more diseased thanks to their efforts.

If you would like to read the full transcript of the FDA's Interim final rule online, it is available at: http://www.cfsan.fda.gov/~lrd/fr051223.html

Help With Detecting Caffeine

Chemists at Washington University School of Medicine in St. Louis are developing a quick, "dipstick" test they say could represent the first home testing kit to detect caffeine. Interest in detecting this common stimulant is high and growing as consumers increasingly try to avoid caffeine due to its unwanted health effects.

Caffeine is a common cause of insomnia, irritability and anxiety disorders and contributes to several known diseases. Several studies have linked caffeine consumption with a higher risk of miscarriage among pregnant women prompting the US Food and Drug Administration to specifically advise that pregnant women avoid or limit their intake of caffeine.

The test may lead to a reduction in demand for products containing caffeine and that can only benefit health. I have previously criticized people who promote increased caffeine consumption or support those who do. A search on The Health Gazette site will reveal several articles on the theme because caffeine is a widely abused drug that too many people know very little about.

To develop the new immunoassay test, lead developer Ladenson, a chemist at the university, and his associates, obtained an antibody derived from the blood of llamas. The researchers obtained the antibodies by repeatedly injecting the animals with caffeine to illicit an immune response to the drug. They then cloned the caffeine-specific antibody and combined it with other chemicals to enable caffeine detection. The study will appear in the 1 June edition of the American Chemical Societys Analytical Chemistry.

Caffeine is placed in many products that people don't normally assume contain the substance. The amount found in coffee labeled as decaffeinated can actually be quite high. Having a reliable, quick indicator could prove very important for many people, especially those who are very sensitive to caffeine and those with problems such as anxiety, where caffiene avoidance is particularly beneficial.

Existing methods of caffeine detection are slow, unsuited to consumer use and expensive. The new test solves all these problems. It indicates qualitatively whether or not caffeine is present, but does not quantify the amount. For those who wish to avoid caffeine, that's certainly what is needed.

Obesity and Smoking a Double Whammy

According to new research from the American Legacy Foundation as many as nine million adults in the United States are affected by both obesity and smoking, two of the nation's top public health epidemics. Indeed, these problems face all Western nations.

The research also suggests that though this figure might appear low compared to the millions of Americans affected by smoking and obesity independently, smoking and obesity in combination greatly impact America's most disadvantaged populations i.e. those who are the least educated and those in the lowest income bracket.

The research shows that more than 2.3 million Americans with income levels of less than $20,000 both smoke and are obese. It is widely acknowledged that smoking and obesity are two of the major causes of death and illness in the Unites States, but until now the overlap between the two conditions has never been measured.

The American Legacy Foundation examined data from the 2000 National Health Interview Survey.The foundation which focuses on helping smokers who want to quit and preventing youth from starting to smoke wanted to estimate the number of adults in the U.S. who both smoke and are obese.

According to the report 81 million Americans were smokers, obese, or both in 2000, and an estimated nine million Americans were obese and smoked.

The two conditions, independently, are particularly high among people from lower socio-economic levels and it is of concern that those who are affected by both smoking and obesity, also come from disadvantaged populations, those with lower income (2.3 million) as well as African Americans (1.6 million).

According to recent figures over 400,000 Americans die each year from tobacco- related illness, including cancers, heart disease and stroke; overweight and obese individuals are at increased risk for many of those same diseases and health conditions.

The American Legacy Foundation says these factors pose a public health problem and demonstrate the dire need for resources, from quit smoking clinics, to consumer call lines, to effective education campaigns, to be made available for anyone who wants to quit smoking.

The report is available online at http://bmj.bmjjournals.com and will be published in the British Medical Journal in it's June edition.

Smoking and obesity are both killers. They each cause considerable morbidity and mortality. But before we make these labels out to be monsters let's remember this: they are both self-inflicted harms. They represent repeated choices and behavioral patterns.

Yes, there is a need for better health education, particularly amongst the less educated. However, I regularly observe plenty of quite sufficiently educated people who smoke and who are obese or at least overweight. The risks to their health are extremely high but the reality is they must accept responsibility for the state they are in and the consequences that will inexorably follow.

The truth is such people often are quite comfortable with the suggestion that they have some sort of disease. Increasingly people are justifying obesity by calling it a disease, as if it is something one passively catches rather than a condition one must actively work at developing. Smokers too, like to be let off or excuse themselves for their behavior by claims they are "addicted," as if this means they can't help smoking.

But this is nonsense. Such significant self-inflicted harm should perhaps be called what it is. If it is any type of disease, it is mental illness.

If you are a smoker I have one word for you: stop. If you are obese or overweight then take action to reduce your weight and improve your health. The method for losing weight is astonishingly easy and very inexpensive and does not require enriching the largely fraudulant multi-billion dollar "weight loss" industry. What you do need however, is motivation. If you don't have that then perhaps you do genuinely need to seek psychological help.

Weightloss is addressed almost as an aside in my soon-to-be-released book. Losing weight simply isn't the near impossibility that people have been mislead into believing it to be. The so-called weightloss industry has a vested interest in people continuing or repeatedly needing their services and products and that is clearly how things seem to work out. But if you are genuinely motivated to lose weight and significantly improve your health and wellbeing, I can certainly show you how. If you lack the motivation and willingness to accept responsibility I can still show you, but it would be a waste of time wouldn't it. It's your call.

Eat Less -- Age Less

When nutrition is discussed as a means of slowing, stopping or reversing the aging processes the talk is usually about the foods and supplements to consume and the anti-nutrients to avoid. These things are certainly important. However, a recent study in the Journal of the American Medical Association (JAMA) identified not eating as significant in reducing the indicators of aging.

The study (JAMA 2006;295:1539–48) on calorie restriction in humans was not large and confined itself to already overweight adults. Forty-eight individuals were randomly divided into four groups, each assigned to a diet for six months: a normal weight-maintenance diet; a diet with 25% fewer calories than needed to maintain weight; a diet with 12.5% fewer calories than needed to maintain weight, plus a 12.5% increase in energy output through exercise; and a very-low-calorie diet providing 890 calories per day (generally, on average, adult eats about 2,000 calories per day). Essentially as a safety measure, the study was designed so that if dieters lost 15% of their body weight they would be switched to a diet that maintained that weight.

The people in all of the groups eating calorie-restricted diets lost weight, as one would expect. A number of other metabolic changes were also observed in the dieters, but not in the people who ate normally. These included a drop in fasting insulin levels in all of the dieters, and a decrease in core body temperature in the low-calorie and low-calorie-plus-exercise groups, but not in the very-low-calorie group.

Previous research evidence suggests these changes are signs that the aging process has slowed down. Resting energy output also decreased in the dieters, as did measures of cellular damage, adding to the evidence that during the study period the dieters aged less than the nondieters.

Of course the study was very small and the effects on people who are not already overweight were not studied. Nor are any possible long or longer term outcomes known. However, we can hope that the findings may find their way into some encouragement for people who are currently overweight (and there are certainly plenty of those). What a motivator - on top of feeling better, looking better and moving towards health restoration and reduced risk of disease, they also get measurably younger!

Excellent Rebuff to Prof Gilcrest on Sun Exposure

The Health Gazette recently published a press release from the American Academy of Dermatology. In it Professor Gilcrest, a dermatologist and academic at Boston University, expressed the view that people should essentially avoid sunshine exposure. This is a position with which I do not agree, for many reasons, though I do encourage people to carefully avoid overexposure, especially any severe enough to cause sunburn.

I have expressed my views about the appropriate source of vitamin D being reduced to diet and supplements elsewhere already. It is important to obtain plenty of vitamin D in dietary forms, to supplement effectively when necessary and to obtain regular direct sunshine exposure to the skin, where an important amount of vitamin D should be made by the body.

Dr Gilcrest's position (and that of the Academy for which she speaks) was thoroughly addressed by John Cannell, MD, of The Vitamin D Council. His detailed discussion can be found along with Gilcrest's statement on the Gazette. It makes good reading and given both the importance of Vitamin D for good health and the significantly erroneous information being promoted by many dermatologists, I recommed you take a few minutes from your busy schedule to read it.

High Folate Levels on IVF Increases Twins Rate

Women undergoing IVF fertility treatment have a higher chance of having twins if their folate intake is above the recommended dose according to a new prospective cohort study, published in the latest issue of The Lancet (vol.367, pp. 1513-1519). Given the issue of folic acid fortification this finding is quite topical. The USA is reported to have seen a 12 per cent increase in twin births for fertility treated mothers since the introduction of mandatory folic acid fortification in 1998.

In the UK pregnant women are currently prescribed and recommended to take folate supplements to reduce the risk of neural tube defects. However, studies suggest that a lack of compliance is undermining these recommendations, and calls are growing for the introduction of fortification of flour with folic acid. In 1998 the US introduced fortification measures; a move that has seen the number of birth defects fall by 25 per cent. Similar strategies in Canada have seen the instance of birth defects cut in half.

The importance of increasing the intake of folic acid to reduce the incidence of neural tube defects is not something I have a problem with. However, I do not agree with fortification as currently practiced and planned for two important reasons. The first is that it is far too indiscriminant and uncontrolled, resulting in totally unknown dosage levels. The second is that it currently uses refined flours as a delivery vehicle, making them appear to be a health food when in fact refined flours are highly destructive to health and should be avoided.

The issue of unknown dosage is highlighted by this current research, at least in so far as it relates to women who become pregnant using IVF. Multiple births are themselves a significant health risk factor. In addition, it should be noted that the US fortification program has not been regarded as a total success story, with a commentary published in the journal Pediatrics (Sept. 2005, Vol. 116, pp.753-755) claiming fortification levels need to be increased. This further highlights the unknown and uncontrollable dosage levels achieved when relying on fortification. Increasing the level is not the answer.

Scandalous Promotion of VitaCig - Cigarettes with Vitamin C

Evidently cigarettes injected with Vitamin C that "don't stain smokers' teeth" have been developed by a Canadian researcher. The new cigarettes, named VitaCig, have been developed by non-smoker Roger Ouellette, according to the online edition of Daily Mail. Canadian company Vita-C Tobacco is distributing the cigarettes.

The misnamed "healthy" cigarettes will be available in about 2,000 outlets in Quebec and, if they prove successful, could be sold across the world, the company claimed. VitaCig is less likely to stain the teeth and creates less odor too, its creator claimed. It was more "beneficial" to health than regular brands because of the vitamin dose, he said.

Vitamin C contributes to reducing the harmful effects of smoking. "We give you all the vitamins you lose, plus some to help you," Ouellette claimed. It could also help keep your teeth white, he said.

Some anti-smoking campaigners have expressed disapproval. "I find it hard to believe anyone would take the claims seriously, but some people might be fooled," said Amanda Sandford of Action on Smoking and Health, an anti-smoking charity. "It is quite a disgraceful form of marketing because it could lure innocent or naive people into thinking they can smoke to get the vitamins they need" she added.

Smoking cigarettes leads to several health problems, especially lung cancer, emphysema, cardiovascular disease and other disorders. The single sensible health related behavior a smoker perform do is to quit smoking.

I have a zero tolerance for smoking. Anyone who consults me for health related advice, recommendations, treatment or personal instruction who smokes is told that the single most substantial improvement they can make in their health is to stop smoking immediately. This advice is free. If a smoker won't act on that advice (or give a credible assurance that they will) then the consultation or lesson is terminated and I explain that I am not available for smokers unless they are specifically seeking help with quitting.

I know that some smokers need substantial assistance to kick the disgusting habbit but I gave up all techniques that involve any tolerance for the smoking behaviors long ago. Frankly, too many people are too soft on smokers and more punitive sanctions should be employed, especially when smokers cause harm to others by their smoking.

As for this gimmick by Vita-C Tobacco, it is nothing more than an astonishingly shameless attempt to cash in on current health-awareness trends. I would gladly see them put out of business, with their assets seized to pay health reparations. Them, that is, along with all the other tobacco companies. Like I said: zero tolerance.