The "Arthritis Diet"

Volume 8 / Number 5

May 2005

Weill Medical College of Cornell University

Food & Fitness Advisor

®

Helping Women Live Healthier, More Active Lives TM

ALSO IN THIS ISSUE IN THE NEWS

The “Arthritis Diet” Foods that help ease arthritis—what’s real and what’s myth?

• Vitamin E does not prevent cardiovascular events or cancer • More muscle mass, less osteoarthritis • Vegetable protein is heart healtheir than red meat • American Heart Association urges caution in using Celebrex and Bextra, after the FDA recommends they remain on the market Page 2

There’s no doubt that good nutrition can help prevent and combat many chronic illnesses, including arthritis. But what does “good nutrition” really mean? How do you know exactly what foods are effective for specifically easing arthritis? Is there such a thing as an “arthritis diet”?

Solutions

Fighting inflammation

Lifestyle changes that help tame heartburn Page 3

Living Fit Strength-training with resistance bands Page 4

Supermarket Sleuth Avoiding convenience store food traps Page 6

Beastly Bites Why they call them “loaded” baked potatoes Page 9

BodyWorks Knee repair with microfracture Page 10

Moves of the Month Isometric vs. isotonic exercises Page 11

Ask Dr. Etingin • Are all whole grain cereals high in fiber?

• How safe are fish oils?

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Many experts now agree there are ways to eat that positively affect arthritis. That’s especially true of rheumatoid arthritis (RA), says Miriam E. Nelson, PhD, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University in Boston.

“Nothing’s been shown to prevent RA, but the right diet can reduce the symptoms, the pain,” says Nelson, coauthor of Strong Men and Women Beat Arthritis (2002 Three Rivers Press).

The “right” diet emphasizes PUFAs— polyunsaturated fatty acids—instead of saturated fats. That’s why low carbohydrate/high-protein diets such as Atkins are not good for people with arthritis. Even if eating more meat and fewer carbs helps you lose weight, (which is critical when you have osteoarthritis, OA), too much saturated fat is counterproductive for fighting arthritis. Experts particularly recommend a specific type of PUFA, omega-3 fatty acids. They’ve been shown to have positive benefits on a number of conditions (including RA) but they must be obtained from our diet; humans can’t manufacture them.

There are currently no official daily recommendations for omega-3 fatty acids; the range seems to be between 2-4 grams a day. Fatty fish, such as salmon and sardines, are rich in omega-3s, especially EPA (eicosapentaenoic

acid) and DHA (docosahexaenoic acid). Four ounces of salmon provide a little over a gram of EPA and DHA. Strict vegetarians can rely on another omega-3 fat: linolenic acid. It’s found in plant-derived sources, including tofu, nuts, and flaxseed oil. However, flaxseed oil is not a cooking oil; it’s best used in salad dressings or drizzled over steamed vegetables.

Since OA is not caused by inflammation (although studies suggest there is an inflammatory component), there’s no evidence that increasing omega-3s will directly help OA. However, every arthritis expert agrees that a diet rich in fish (and fruits and vegetables) helps you lose weight, which is critical to controlling OA. “Every 10 pounds you put on increases your risk for OA,” says Patience White, MD, chief public health officer of the Arthritis Foundation. OA develops with wear and tear on cartilage as we go through midlife. At the same time, metabolism slows, making it harder to lose weight. The only real solution? “Eat less, and exercise more,” White says.

Nelson points out that there are relatively painless ways to work the necessary nutrients into your diet. “Go from eating no fish at all to having one serving a week. Sprinkle a few seeds or nuts onto your salad,” she suggests. When cooking, use canola oil.

The omega balance

In their desire to get away from “bad” saturated fats (which help promote heart problems) Americans have turned more to a different PUFA: omega-6s. Unlike the antiinflammatory omega-3s, however, some omega-6 fats contain substances that actually Continued on page 8 FOOD & FITNESS ADVISOR

MAY 2005

IN THE NEWS No benefits seen for vitamin E

Food & Fitness Advisor

®

EDITOR-IN-CHIEF ORLI R. ETINGIN, M.D. Director, Iris Cantor Women’s Health Center; Vice Chairman, Dept. of Medicine; Professor of Clinical Medicine, Weill Medical College of Cornell University

EDITOR RITA BARON-FAUST COPY EDITOR BARBARA MERCHANT CONTRIBUTORS SHARON PALMER, R.D., MARILYNN LARKIN, WENDY MEYEROFF EDITORIAL SUPPORT WEILL CORNELL PUBLIC AFFAIRS GROUP DIRECTOR DAVID ELTZ ADVISORY BOARD CARDIOLOGY ERICA JONES, M.D. ENDOCRINOLOGY CAROL LEVY, M.D. GASTROENTEROLOGY CHRISTINE L. FRISSORA, M.D. ELLEN SCHERL, M.D. GYNECOLOGY MARGARET POLANECZKY, M.D. INTERNAL MEDICINE SHARI MIDONECK, M.D. NUTRITION LOUIS ARONNE, M.D. KATHY ISOLDI, R.D. ONCOLOGY ANNE MOORE, M.D. LINDA VAHDAT, M.D. PHYSIATRY ELISABETH LACHMANN, M.D. PHYSICAL THERAPY AMY SHAPSES, P.T. PSYCHOLOGY DEBORAH LEVITT, PH.D. RHEUMATOLOGY LISA SAMMARITANO, M.D. SPORTS MEDICINE LISA CALLAHAN, M.D.

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Vitamin E does not help prevent cancer or heart disease., say two new studies A large-scale study from Canada found that people who took vitamin E supplements for seven years had no significant risk reduction for cardiovascular events, cancer, or dying from cancer, compared to those taking a placebo. Some of the more than 700 people taking vitamin E in the Heart Outcomes Prevention Evaluation (HOPE) trial and its extension (HOPE-TOO), had an increased risk of congestive heart failure, according to the report in the March 16 issue of the Journal of the American Medical Association ( JAMA). This comes on the heels of data from the Women’s Health Study (WHS), a 10-year randomized clinical trial involving almost 40,000 women, that found neither aspirin nor vitamin E reduced cardiovascular risk.

That report was presented at the annual meeting of the American College of Cardiology in March and published in the New England Journal of Medicine. A major study last year concluded vitamin E supplements might even be harmful for some people.

More muscle mass, less osteoarthritis

People with greater muscle mass have thicker cartilage in their knees, which may help protect them against osteoarthritis (OA). A study of 86 middle-aged men and women in Australia found that over a two-year period those who lost muscle mass also lost cartilage volume in their knees. The participants’ knees were imaged with magnetic resonance imaging at the start of the study and two years later to assess cartilage volume at the top of the leg bone (tibia); dual x-ray absorptiometry was used to evaluate body composition.

Even though obesity is associated with OA, in this study measures of body fat were not independently associated with changes in knee cartilage volume. Writing in the February issue of Arthritis and Rheumatism, the researchers at Monash University in Australia say further studies are needed to see if interventions to increase muscle mass may protect against osteoarthritis.

Vegetable protein heart healthier than red meat

The type of protein you eat can affect your chances of dying of heart disease, according to a new study. Investigators at the Mayo Clinic followed 29,017 postmenopausal women for 15 years, and found those who often ate vegetable protein in place of carbohydrates and animal protein were 30 percent less likely to die of heart disease than women who substituted red meat and dairy products for carbs. In contrast, women who ate two servings of red meat every day instead of obtaining the same amount of calories from carbohydrates had a 44 percent higher risk of dying from heart disease. A similar pattern emerged for dairy foods, including milk, cream, ice cream, yogurt, and cheese. The women were free of cancer, heart disease, and diabetes at the beginning of the study when they were questioned about their eating and lifestyle habits. Overall, choosing a high-protein, low-carb diet had no significant influence on the risk of dying from any cause, the researchers wrote in the February 1 issue of the American Journal of Epidemiology.

Celebrex & Bextra to remain on the market—with cautions

A scientific advisory from the American Association (AHA) recommends that the use of COX-2 inhibitor drugs such as Celebrex and Bextra be avoided in people who have cardiovascular disease or are at high risk, and physicians should weigh the benefits and risks before prescribing such drugs to healthy people. The AHA statement supports recommendations issued by an advisory committee to the U.S. Food and Drug Administration (FDA) in February. The FDA committee said Celebrex and Bextra should be alllowed to remain on the market, but carry a “black box” warning that states use of the drugs can increase the risk of blood clots and high blood pressure. The panel also recommended Vioxx be allowed back on the market. It was withdrawn in September 2004 after clinical trials showed patients who took high doses had 2-3 times the risk of heart attacks and strokes compared to placebo. The committee also said naproxen (Aleve, Naprosyn) appeared to be the safest of the conventional nonsteroidal antiinflammatory drugs (NSAIDs), and recommended naproxen as a first-line therapy for arthritis pain when taken with a proton pump inhibitor drug to prevent gastric bleeding. The AHA advisory, published in the March 21 issue of Circulation, also warned that all-over-the counter NSAIDs should be used in strict accordance with label directions, and if patients need such a drug for more than 10 days, they should consult a physician.

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WOMEN’S HEALTHCARE

SOLUTIONS WHAT YOU CAN DO

Healing Heartburn

To avoid or ease heartburn:

Medications can help reflux, but so can lifestyle changes

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Quit smoking.

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Lose weight if you’re overweight.

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Avoid peppermints, acidic, fatty, or spicy foods.

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Cut portion size; eat slowly.

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Eat smaller, more frequent meals.

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Don’t eat within 3 hours of bedtime.

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Sleep with the head of your bed elevated 6 inches. Use bed blocks under the bed; extra pillows don’t work.

There are many reasons for transient Heartburn strikes nearly half of all American adults at least once a month. LES relaxation. “Anything that increases the pressure in the abdominal cavity But for many people the burning pain can cause it. For example, belching, caused by gastrointestinal reflux disease tight clothing, eating a very large (GERD), the backflow of stomach meal, and lying down right after eatacid into the esophagus, is an almost ing,” remarks Dr. Harris. Eating too everyday occurrence. fast may cause stomach distention (due There are more treatment options to large amounts of swallowed air) than ever for GERD, including effecand can promote reflux, according to a tive medications and procedures to study last September in the American decrease acid reflux, and prevent esophageal damage that could lead to Journal of Gastroenterology. cancer. However, lifestyle factors also Obesity contributes to reflux by putcontribute to reflux, and making these ting increased pressure on the stomach. changes can go a long way in easing Another contributor is an hiatal hernia, in heartburn, a fact people often forget in which part of the stomach protrudes their rush to grab an antacid. into the chest through an opening in the diaphragm, interfering with proper functioning of the LES. Doing a slow burn Certain foods can relax the LES, such Stomach acid is normally kept where it as peppermint, citrus belongs by a valve juices, tomato sauce, made of muscle at the THE ANATOMY OF GERD chocolate, and alcobottom of the esophaEsophagus hol. Smoking also gus, called the lower Leaky triggers LES relaxesophageal sphincter esophageal Acid sphincter ation. A report in the (LES). “Reflux occurs reflux November 2004 issue either because the LES of Gut found the is too loose, allowing acid to leak into the odds of developing esophagus, or the reflux were 70 perstomach isn’t emptycent greater in longing properly,” says time smokers and Christine Frissora, people who conStomach MD, assistant professumed a lot of sodisor of medicine at the um. Estrogen therapy Weill Medical College may also increase risk. of Cornell University.

In some cases, the LES becomes weakSorting out symptoms ened or the stomach muscle doesn’t Indigestion does not mean you have contract normally, interfering with its GERD. “Dyspepsia is a general term normal emptying process. that refers to abdominal pain or dis“The most common reason for reflux comfort after eating, as well as belchis what we call transient LES relaxation. ing, or feeling bloated and uncomfortable,” says Dr. Frissora. “Belching after Normally, when you swallow, the LES eating could also be related to acid opens up as food comes down the esophagus, and then closes. But in tran- reflux in some patients.”

The classic symptom of GERD is sient LES relaxation, the valve opens heartburn, felt as a burning sensation without a swallow,” explains Arthur D. (felt behind the breastbone), most often Harris, MD, assistant professor of medafter meals and worsening when lying icine at the Weill Medical College and director of the Gastrointestinal Motility down or bending over. “Some people feel reflux as chest pain and confuse it Laboratory at the NY-Presbyterian with a heart attack. GERD can also Weill Cornell Medical Center.

FOOD & FITNESS ADVISOR

MAY 2005

cause food regurgitation and difficulty swallowing,” adds Dr. Frissora.

Some patients may experience extra esophageal symptoms that come to the attention of an ear, nose, and throat specialist, notes Dr. Harris. Such symptoms can include chronic throat-clearing, hoarseness, cough, and new-onset asthma. “There is also an association between reflux disease and sleep apnea, a condition where you literally stop breathing while you are sleeping,” says Dr. Harris. “Whether or not reflux contributes to sleep apnea or sleep apnea contributes to the reflux has not been clearly sorted out. But it’s a very common association.”

Only 10-20 percent of people see their doctor for help with heartburn.

But chronic exposure to stomach acid can damage the esophagus, leading to irritation, erosions, scarring and narrowing (strictures). Around 10 percent of GERD patients develop precancerous cell changes called Barrett’s esophagus, that require monitoring Proper diagnosis includes a thorough medical history and one or more tests to determine if the problem is serious and whether the eso[hagus has been damaged.

Dousing the fire

Many people automatically assume Continued on page 11 3

LIVING FIT

Can You Resist?

WHAT YOU CAN DO

Resistance bands make for a versatile workout that helps strengthen and tone muscles without weighty gear At a time when high-tech exercise machines and gadgets like balance boards are all the rage, it’s easy to overlook exercise bands. But to do so is a mistake, especially if you don’t get to the gym often enough or want to stay fit while traveling. “Many people look at bands and say, ‘oh, that’s what they use in physical therapy.’ But bands are versatile and inexpensive, and you can use them virtually anywhere.

People don’t give them enough credit for being a valuable piece of workout equipment,” says Robyn M. Stuhr, MA, an exercise physiologist at the Women’s Sports Medicine Center at the Weill Cornell-affiliated Hospital for

Special Surgery in New York.

Using a resistance band is a great way to vary your workout and decrease boredom, adds Amy Shapses, PT, director of physical therapy at the Weill Cornell Iris Cantor Center for Women’s Health Care. “‘Shocking’ the muscles occasionally by doing an exercise differently can also lead to better conditioning,” says Shapses. During rehabilitation, for example, after doing hip abduction and extension work in the physical therapist’s office, “patients can simulate the exercise at home by tying the band

To use resistance bands safely: ●

Try out bands in the store to make sure the amount of resistance is right for you.

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Start out with simple exercises that do not involve attaching the band to a door or other object.

As with any type of weight-training, start out slow and gradually progress to greater resistance and more reps.

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around the leg of a table. They like the challenge of doing the exercise themselves, and it’s important that they

SAMPLE RESISTANCE BAND EXERCISES Here are exercises you can do standing with bands alone (no need to attach to a chair or door). They cover the major muscle groups and can be done in workout gear, street clothes, or business attire. Do three sets each of six to 10 repetitions, depending on your fitness level. To increase resistance, wrap more of the end of the band around your hand(s), or fold the band in half, doubling its thickness. You can also use the next level band, which generally is thicker, and a different color.

Squat This exercise strengthens the thighs and buttocks muscles. Stand on the band with both feet and hold the ends of the band in your hands at waist level. Slowly squat, keeping your back straight; try not to let your knees go forward past your toes.

Straighten by pressing your feet into the floor, and repeat.

Good morning This exercise strengthens the hamstrings and buttocks muscles, and is particularly effective when done in combination with the squat. Stand on the band with both feet, bringing the ends of the band over your shoulders. Come forward, leading with the chest and bending the knees. Come back up, leading with the back, and squeezing the buttocks muscles. Repeat.

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Bent-over row The bent-over row targets the muscles in your midback. Stand on the band, and hold the ends at waist level, but keep your arms perpendicular to the floor. Now raise your arms back and slightly out to the side, keeping the forearms parallel to the floor. You will feel your shoulder blades contract.

Rotator cuff/external rotation Extend one leg and stand on the band. Hold one end of the band in each hand, keeping hands together at waist level. Raise the arm opposite the extended leg up to the side, making a 90-degree angle at the elbow. Bring the hand back to starting position, keeping the elbow bent, then raise the arm up again.

Repeat.

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WOMEN’S HEALTHCARE

do so because coming to me twice a week isn’t enough,” says Shapses.

You can easily incorporate resistance bands into a total workout program, notes Stuhr. “If you have some dumbbells, a couple of bands, a mat for floor work, and a stability ball, you can train your muscles in different ways, using different movement patterns. This is especially important when you’re exercising at home and don’t have access to the huge array of equipment at a club.”

Tips and cautions

Bands come in different colors, each representing a different level of resistance ranging from 1-25 pounds.

Generally, lighter colors mean less resistance; however, color coding varies from manufacturer to manufacturer, so check the package before you

buy. They generally cost around $12 (see Resources). You can also increase the resistance—and the intensity of your workout—by making the band shorter or longer (wrapping more or less of the band around your hands, for example), or by folding a band in half, thereby doubling its thickness.

Handles are also available to make gripping the bands easier. More advanced exercises call for using the bands with an exercise ball.

Try the bands out in a sporting goods store to determine the degree of resistance that may be right for you.

“The main thing is not to waste your time,” remarks Shapses. “If you’re not fatigued by the eighth repetition, then the resistance is probably too light. By contrast, if you can’t do more than a few repetitions, then it’s too much for you.” Pay attention to your form, and

be sure you are isolating the muscle you are trying to work.

Remember, too, that bands don’t last forever, adds Stuhr. “They can get old and dry, causing them to snap, so replace them more or less frequently, depending on how often you use them, and how.”

RESOURCES The TheraBands brand can be purchased in packages of three in varying degrees of resistance (or in rolls you can cut yourself) from www.optp.com, and with accessories such as handles and anchors for use with door frames, from TheraBands at http://www.theraband.com/resistive.html Latex-free and natural rubber bands are also available.

Seated curls (on page 4, upper right) Chest press From a seated position, anchor the band under the side of a chair. Wrap Stand up straight the ends of the band around your left hand, holding the band so it is with feet hiptaut with your palm up. Keeping your elbows close to your torso, bend width apart and your elbow to bring your hand toward your shoulder, using a slow and knees slightly steady motion. Then slowly lower your arm again. Repeat with the other bent. Wrap the arm. This exercise strengthens the biceps. elastic band around your shoulder blades; hold your elbows Flyes up, and press Wrap the band around your midback, and lie on your arms straight the floor, holding the ends of the bands in each out until they are hand. Push both arms straight up over the chest. fully extended. At Open the arms towards the floor, keeping elbows the same time, feel slightly bent so arms have a rounded look. Push your chest muscles both hands towards each other, keeping your squeezing togetharms in an arc over the chest; feel as though you er. Bring your arms are making a hugging motion. Open the arms back to a 90 towards the floor, and degree angle repeat. to the body, Single-lat pulldown and repeat, This exercise strengthens the holding band latissimus dorsi, the largest musoverhead. cle in the back. Stand with your feet hip-width apart, knees slightly bent. Hold the band overhead, stretched to about shoulder width. Pull with one arm until the arm is next to the torso; the other arm will naturally move up and slightly forward of your head.

Marina Terletsky; Exercises courtesy Marilynn Larkin, Posturecize Slowly return to the extended position (holding band overhead), and repeat.

FOOD & FITNESS ADVISOR

MAY 2005

5

THE SUPERMARKET SLEUTH

Convenience Store Food Traps Fat, sodium, and calories can do you in when you grab a snack at the local quick-mart Weighing choices

“Convenience stores are worse than fast foodplaces; there aren’t as many choices,” says Marilyn Gammarino, RD, LD, CDE, clinical nutritionist in Rockville, Maryland. Gammarino expresses particular concern over the way convenience stores have altered diet behaviors. “While people are filling up on gas...they see the convenience store and feel compelled to grab something to eat.” Which may explain why managers display candy bars next to the cash register (just as in supermarkets).

“Convenience food stores are convenient, but they can have unhealthy food items. A consumer can buy a snack or a drink and not realize how

SUPERMARKET SLEUTH SURVEY: CONVENIENCE STORE SNACKS Product & Serving Size 7-Eleven Big Gulp soda (1/4 ice) 32 oz 7-Eleven Double Gulp soda (1/4 ice) 64 oz 7-Eleven Chimichunga (bean & cheese) 7 oz 7-Eleven Green Burrito (microwaveable) 7 oz 7-Eleven Italian sausage 5.3 oz 7-Eleven tuna salad sandwich 7.5 oz Bon Appetit banana bread 1 slice Cheetos, Asteroids (tube) 3/4 cup Dannon Light n Fit Yogurt 6 oz Dolly Madison Brownie 3 oz Dolly Madison Cherry Pie Doritos Mega Grab 1 oz French’s Potato Sticks 3/4 cup Goldfish Crackers 1.5 oz Hostess Cupcake 1 Hostess Ding Dong 2 pieces Hostess Donettes w/powdered sugar 3 donuts Hostess Double Chocolate Muffin 1/2 muffin Keebler Club & Cheddar Crackers 1.3 oz Lunchables Crackers Stackers 1 Mini Chips Ahoy 35 g Nabisco Nutter Butters 54 g Nabisco Oreos 6 cookies Orville Redenbacker’s Smart Pop Popcorn 3 3/4 cups Planter’s Dry Roasted Peanuts 1 oz Planter’s Trail Mix 1 oz Pringles Original 1 oz Slim Jim Smoked Meat Stick 2 sticks Sunshine Cheez-It crackers 1.25 oz Tollhouse Chocolate Chip Cookie Ice Cream Sandwich 1

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Serv/Pkg Calories 1 1 1 1 1 1 1 2.5 1 1 1 4 6 1 2 1 2 2 1 1 1 1 1 2 12 6 1 1 1 1

304 608 469 710 425 546 450 160 90 333 470 140 170 210 180 360 180 345 200 420 170 260 270 110 173 130 160 190 180 520

Fat/Sat Fat Carbs/Sugar Sodium 0 g/0 g 0 g/0 g 17 g/6 g 26 g/9 g 38 g/15 g 22 g/3 g 25 g/5 g 10 g/2 g 0 g/0 g 11 g/4 g 22 g/11 g 7 g/1 g 12 g/3 g 9 g/2 g 6 g/3 g 19 g/12 g 9 g/3 g 18 g/4 g 12 g/3 g 15 g/7 g 8 g/2 g 11 g/2 g 12 g/3 g 2 g/0 g 13 g/2 g 7 g/2 g 11 g/3 g 17 g/7 g 9 g/3 g 23 g/9 g

76 g/NA 152 g/NA 62 g/6 g 93 g/5 g 2 g/1 g 56 g/3 g 49 g/29 g 15 g/1 g 16 g/12 g 54 g/11 g 65 g/35 g 17 g/1 g 14 g/<1 g 27 g/<1 g 30 g/17 g 44 g/32 g 23 g/11 g 44 g/29 g 23 g/5 g 60 g/48 g 24 g/10 g 37 g/16 g 41 g/23 g 26 g/0 g 8 g/4 g 14 g/10 g 15 g/0 g 3 g/0 g 21 g/1 g 72 g/44 g

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30 mg 60 mg 920 mg 1,600 mg 1,500 mg 960 mg 350 mg 320 mg 95 mg 190 mg 470 mg 200 mg 200 mg 360 mg 290 mg 240 mg 200 mg 255 mg 470 mg 1,100 mg 115 mg 190 mg 290 mg 360 mg 95 mg 10 mg 170 mg 550 mg 300 mg 350 mg

WOMEN’S HEALTHCARE

Marina Terletsky

Convenience stores are lying in wait for you at gas stations, airports, and street corners, offering foods to grab and go when you’re hungry and in a hurry. Whether it’s coffee and donuts while you fill up your gas tank in the morning or a late afternoon pick-meup of soda and chips on the way home from work, convenience stores can be a trap for the health-conscious.

Quick marts are being singled out by health experts as major purveyors of junk food, contributing to America’s growing obesity problem. According to the Center for the Advancement of Health, researchers find some neighborhoods, especially poor neighborhoods, have more convenience stores than supermarkets and this encourages poor nutritional habits.

many calories and fat they are consuming,” says Ann Northam, RD, CD, and clinical dietitian at the New York-Presbyterian Weill Cornell Medical Center.

Once inside a convenience store, it may often be difficult to find something healthy to eat.

What are your choices? Packages of chips, crackers, cookies, and donuts, microwavable sausage sandwiches, quart sized, refillable cups of sugary sodas and slushies, and freezers stocked with ice cream sandwiches and other caloric frozen treats.

Some foods appear fairly innocent.

Who could imagine a healthy-looking bran muffin could pack in 700 calories? Northam cautions people to watch out for food labels that read “healthy,” “low-fat,” or “low-carb.”

Some low-fat foods may be full of sugar, and low-carb products may be heavy on fat, adding up to hundreds of calories. The nutrition label should be required reading in a convenience store, she says.

Size matters

“An important thing to remember when reading a food label is serving size. A lot of packages for foods and drinks are large, but the serving size is small,” notes Northam. Those “individual serving” packages keep getting bigger. But the nutrition information on the package is often calculated for a “suggested” serving, which is usually much smaller than the contents of the bag. The “big grab” bag of chips has now morphed into the “mega grab,” which may contain 4-5 servings in just one bag. Even individual snack cups may contain 2.5 servings. Most people who buy an individual package are probably going to eat every last bite. That “mega grab” bag of Doritos is going to set you back 560 calories.

The suggested serving of a small package of mini-donuts is often half the package; nutritional information on that large muffin may be for half the muffin. If a bag of trail mix suggests a serving size of 3 tablespoons and you down 1 cup, it’s going to net you 720 calories.

The big gulp trap

Many beverages contain two to four 8-ounce servings per bottle. Liter size bottles of soda provide about 400 calories in a bottle. 7-Eleven proudly reports that they sold 33 million gallons of fountain drinks last year— enough to fill 75 Olympic size swimming pools. The 32-ounce Big Gulp wasn’t big enough for customers, so 7Eleven introduced the 64-ounce Double Gulp container, which holds 2 quarts—a whopping 608 calories if filled with regular soda. Even 100 percent orange juice in a 16-ounce bottle can add up to 220 calories when the whole drink is consumed.

Bottom line: Do the math. It may cost you hundreds of calories just for a quick snack with little nutritional gain.

FOOD & FITNESS ADVISOR

MAY 2005

Healthy foods are hidden

If you look hard, you may find some healthy food choices in stores.

Northam suggests looking for fresh fruit (which may be displayed in a basket near the register), single serve packs of nuts, low-fat yogurt, water, diet soda, or 100 percent fruit drinks instead of regular soda, pretzels, and low-fat popcorn instead of potato chips. Gammarino recommends graham crackers, a bagel, dried fruit, selected trail mixes and low-fat energy bars. You may even be able to find baked chips, skim milk, string cheese, rice cakes, fruit juice frozen bars, low sugar cereals, microwavable fat-free

popcorn, and microwavable turkey sandwiches without the mayonnaise or butter.

Instead of a Tollhouse Chocolate Chip Cookie ice cream sandwich, pick a Dreyer’s frozen whole fruit bar and save your self 440 calories. Crunch on a couple of Rye Krisps instead of a 1.5 ounce pouch of Goldfish, and cut your calorie intake by 71 percent.

Search for smaller packages, such as Nabisco’s new “100 Calorie Packs.”

When it comes to snacks, bigger is not usually better.

NEXT: MEAL REPLACEMENTS

EXERCISE AFTER MENOPAUSE: THE BIG BOUNCE Keep exercising after menopause and you’ll reap big benefits—including a lowered cardiovascular risk, better bones, and even fewer migraines, say two studies from Germany and Canada published in the February issue of Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine.

The German study involved 78 early menopausal women (1-8 years after the start of menopause, with an average age of 55) who had signs of mild bone loss in the spine or hip, who were taking part in the ongoing Erlangen Fitness Osteoporosis Prevention Study. The women were assigned either to an exercise training program or (as a control group) to continue their normal lifestyle. The training group had four 65-70 minute exercise sessions a week (two supervised and two at home), which included low- and high-impact aerobics and rope skipping for endurance, as well as jumping, dynamic, and isometric exercises for strength. All of the women kept food diaries, and took vitamin D and calcium supplements.

After three years, the training group had stabilized bone mineral density (BMD) compared to a severe decline in the control group. The exercisers also lowered their total cholesterol and triglycerides (both increased in the control group), reduced their waist size (the control group stayed the same), and made gains in isometric and dynamic muscle strength, and in endurance and aerobic capacity (all of which declined in the controls). An added benefit for the exercisers: modest reductions in menopausal symptoms such as insomnia, migraines, and mood swings; no effect was seen on hot flashes.

The Canadian study of 118 postmenopausal women (aged 46-68) who were not on hormone therapy, showed higher levels of daily physical activity were associated with having less abdominal fat and an improved risk profile for metabolic syndrome. The women kept 3-day activity and food diaries that were representative of their lifestyle. The women detailed how much time and energy they devoted to physical activity and exercise three days of the week (two weekdays and one weekend day), rating each activity on a scale from 1-9, depending on its intensity. The diaries were then compared to measurements of abdominal fat, body mass index (BMI), blood pressure, and cholesterol tests, as well as fasting glucose levels. Those women who spent at least 30 minutes a day doing moderate- (such as light housework) to high-intensity activities (such as running) had the best risk profile, say researchers from Laval University. Women who exercised the most at a higher intensity had a lower percentage of visceral fat, a smaller BMI and waist size, as well as lower blood pressure, cholesterol, triglycerides, and better insulin sensitivity, compared to low-activity women. Even those women with insulin resistance or type 2 diabetes had a better metabolic profile if they exercised, says lead researcher Simone Lemieux, PhD, of the department of food science and nutrition at Laval.

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ARTHRITIS DIET Continued from page 1 promote inflammation. One of the worst culprits is corn oil. Even when you think you’re avoiding omega-6 fats, processed foods such as desserts, white bread, and more, are loaded with them.

Experts agree it’s critical to bring the two omegas back into balance.

“We eat something like a 14:1 ratio of omega-6 to omega-3 fats,” says sports nutritionist Ellen Coleman, RD, of Riverside, California. While there’s still debate over exactly what is the “right” ratio, most experts, including Coleman and Nelson, agree that it probably should be closer to 3:1.

The calcium connection

One nutrient that belongs in the diets of both OA and RA patients is calcium, especially calcium with vitamin D. It’s important for the OA patient, since that’s a disease in which bone loss occurs due to erosion, and calcium is critical to maintaining bones. Many RA patients are on corticosteroids like prednisone that also promote bone loss.

Melanie Harrison, MD, MS, assistant professor of medicine and public health at the Weill Medical College of Cornell University and a rheumatologist at the Cornell-affiliated Hospital for Special Surgery, says RA patients should be taking in extra calcium. The current recommendation is 1,2001,500 mg of calcium daily for women.

That doesn’t mean you should go overboard, Dr. Harrison warns. “There’s such a thing as getting too much calcium and vitamin D.” So before you add those elements into your diet through a tablet, she says, “Check out your multivitamin, making sure it doesn’t already have those nutrients.” Since calcium is a mineral, some vitamin supplements may not contain it. Your best bet is to get your daily allowance of both calcium and vitamin D from milk and food. (Milk is fortified with vitamin D.) If you can’t eat dairy foods containing lactose, try tofu for calcium and soy milk fortified with vitamin D.

vitamin C, is beneficial? Yes and no. contains antioxidants known as Vitamin C does seem to have a posiflavonoids, which help inhibit the protive effect on RA; studies at Harvard duction of chemicals in the body have found that lower intakes of fruits called prostaglandins, which promote and vegetables and vitamin C “are pain and inflammation. A few prelimiassociated with an increased risk of nary studies suggest drinking tea may inflammatory polyarthritis or rheumadampen inflammation and slow cartitoid arthritis.” lage breakdown. But more studies are However that same nutrient may needed. not be as beneficial for OA. Virginia B. Kraus, MD, PhD, associate professor of Food myths medicine at Duke University, has been Myths abound about foods which supstudying osteoarthritis and dietary posedly aggravate or ease arthritis. changes for years. She and her colOne of the most persistent is that eatleagues studied an increased vitamin C ing tomatoes, eggplant, and green intake on OA. Why this vitamin? peppers (which all belong to the same “Vitamin C is involved with collagen family of plants known as nightshades) synthesis, which is the major conmakes arthritis worse. The theory is stituent of cartilage. It’s also an that nightshade vegetables lead to a antioxidant…and oxidative stress is a buildup of toxins that exacerbate component of the arthritic process. So arthritis. One uncontrolled study had we went in thinking we’d show some arthritis patients avoid these vegetakind of benefit,” with a vitamin C bles, and their symptoms improved. increase, Dr. Kraus says.

But there was no control group, so the The study involved guinea pigs study is not considered scientifically (which like humans can’t synthesize valid (and arthritis symptoms can wax their own vitamin C) given low, medi- and wane on their own). um, or high doses of vitamin C. The Another myth is that drinking nothmedium dose of 30 mg equaled the ing but vegetable juice for a week can 200 mg humans would get from eatimprove arthritis. Ditto for the notion ing the recommended five servings of that drinking cider vinegar can help fruits and vegetables daily. The high gout (a form of arthritis). Neither have dose was five times higher. Much to been proven true in clinical studies. their surprise, Dr. Kraus and colleagues found animals on the higher Stick to Good Eating dose of vitamin C had a worsening of Ultimately all the expert advice for osteoarthritis, with severe cartilage degeneration. Dr. THE ARTHRITIS FOOD GUIDE PYRAMID Kraus speculates whether Vegetable oils something else that “keeps Include oils rich in Omega 3; Sweets company” with the vitamin use others use sparingly sparingly C in food that might actuMeat, poultry & Milk, cheese & ually be the protective yogurt 2-3 servings eggs, 2 servings agent. But that’s supposition Beans, legumes for now, she stresses.

Fish & shellfish & nuts at least 1 serving at least 1 So what does Kraus tell serving her patients? “Don’t think Bread, pasta, rice, couscous, polenta, other whole grains & potatoes 4-9 servings, that vitamin C can substitute at least half from whole grains for five fruits and veggies a day. It’s fine if they take a Vegetables Fruits supplement with the RDA; 3+ servings 3+ servings it’ll give them what they need, but not to excess.”

8 Glasses of Water

“C”-ing equals believing?

A spot of tea?

Surely that stalwart of good nutrition,

Tea, whether green or black,

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Adapted from Strong Men and Women Beat Arthritis (2002, Three Rivers Press)

THE CENTER

FOR

WOMEN’S HEALTHCARE

BEASTLY BITES

WHAT YOU CAN DO

“Loaded” Baked Potatoes They’re overloaded with calories and fat

To ease your arthritis: ●

Exercise regularly and strengthen muscles around affected joints.

●

Include more omega-3 fats in your diet, either from fatty fish or plant-based foods.

●

Strike a balance of 3:1 omega-3 to omega-6 fats.

●

Get 1,200-1,500 mg of calcium daily, and at least 600-800 IU of vitamin D.

●

Eat more vegetables and fruits, and less red meat.

●

Include tea in your diet; it may help fight inflammation.

●

Drink plenty of water to keep hydrated.

diet and arthritis comes down to a diet heavy on fish, fruits, vegetables, and certain nuts and seeds, as Nelson and her colleagues at Tufts have outlined in an “arthritis food guide pyramid.”

“Focus less on processed foods and more on whole foods,” advises.

Nelson. She also puts eight glasses of water at the base of the pyramid.

That’s because water literally lubricates the joints; it carries nutrients, and flushes away waste in our system.

In the end, no single nutrient is going to banish arthritis, says Coleman. “You can’t, for example, just extract the vitamin C from an orange and say, ‘This is what’s good for you.’

That orange also contains fiber and other elements. The effects of diet on health are multifactoral. It’s not just individual components.”

What happened to the plain old potato, long-time staple of Western diets?

It’s bad enough that potatoes have been bashed by the low carbohydrate fad, but restaurants are further tarnishing the potato’s nutrition reputation by layering on toppings packed with calories, fat, and sodium. You name a topping, it’s probably been piled onto a potato, including chicken, cheese, bacon, sausage, chili, guacamole, sliced steak, broccoli in cheese sauce, and seafood Alfredo.

There are now restaurants that specialize in these big, bad spuds. And chefs are ordering the largest potatoes on the farm to serve stuffed. Some loaded potatoes weigh in at 20 oz, compared to 6 oz for a medium potato.

When you’re contemplating the stuffed potato (as an appetizer or side dish) and think some toppings sound healthy (such as broccoli, sliced vegetables, or chicken), keep in mind that they’re usually doused in a rich, fatladen sauce. A Chicken Cesar Broccoli Stuffed Baked Potato at the restaurant

chain 1 Potato 2 contains a hefty 710 calories, 51 g fat, 10 g saturated fat, and 1,375 mg sodium per serving. If you have a choice of toppings, opt for salsa or just a dollop of sour cream or guacamole. If you must give in to the gooey temptation of a potato blanketed with cheese sauce, share it or eat just half.

Don’t forget that potatoes are an excellent source of fiber, vitamin C, niacin, vitamin B6, iron, magnesium, thiamin, and pantothenic acid. At Wendy’s, a plain baked potato provides 272 calories, 0 fat, and 50 g sodium, a much lighter alternative to a biggie order of Wendy’s fries, which wallops a punch of 440 calories, 19 g fat, 3 g saturated fat, and 381 mg sodium. Some baked potato restaurants, such as 1 Potato 2, are featuring “lite” versions of the overstuffed spud that are significantly lower in fat and calories, providing a healthful alternative to beat the burger blues.

WHAT’S IN THOSE BEASTLY BITES? Loaded Potatoes/1 serving

Cal

Fat /Sat Fat Sodium

1 Potato 2 BBQ Chix/Ched/Bacon Stuffed Potato

685

43g/17g 1,765 mg

1 Potato 2 Mexican Stuffed Potato

670

46g/17g

1 Potato 2 Philly Steak & Cheese Stuffed Potato

675

40g/15g 1,410 mg

1 Potato 2 Lite Chicken Cesar/Broccoli

375

12g/3g

845 mg

1 Potato 2 Ultralite Veg/Herb/Cheese Stuffed Potato 240

2g/1g

425 mg

34g/20g

750 mg

Arby’s Baked Potato Deluxe

578

1,070 mg

Arby’s Plain Baked Potato w/butter & sour cream

423

23g/14g

160 mg

Ranch 1 Baked Potato w/Broccoli

521

1g/0g

50 mg

Wendy’s Bacon and Cheese Baked Potato

557

25g/7g

910 mg

Lonestar Steakhouse Loaded Baked Potato

663

18g/6g

1,623 mg

RESOURCES Your best source for information on diet and arthritis is the Arthritis Foundation web site at www.arthritis.org

FOOD & FITNESS ADVISOR

MAY 2005

Ruby Tuesday Baked Potato w/butter & sour cream 460

19g/12g

n/a

Source: Restaurant Nutrition Information, USDA National Nutrient Database for Standard Reference.

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BODY WORKS

Mending with Microfracture A technique that heals knee injuries by literally tapping into bone to release cartilage-forming cells that cushions the bones and allows the joint to move without friction. Knee injuries produce defects in the cartilage which cause friction, pain, and restricted mobility; eventually the cartilage breaks down, leading to OA. Articular cartilage doesn’t have its own blood supply, so it doesn’t heal well after injuries, says Dr. Williams. Bone marrow not only contains red blood cells, but also stem cells (called mesenchymal cells) that aid cartilage formation. “Microfracture uses the blood and stem cells to help repair the defect, preserving the function of the joint,” explains Dr. Williams.

The damaged tissue is first cut away using arthroscopic surgical techniques, and the underlying bone Tapping into repair is uncovered. “We then use a surgical Microfracture is not a new or highawl, which is like a tiny ice pick, to tech procedure, but it’s actually the create a series of very small holes, or most popular method for repairing microfractures, in the bone deep small articular cartilage injuries, says enough to reach the marrow,” says Riley J. Williams, MD, an assistant Dr. Williams. Around a dozen 2-4 professor at the Weill Medical College mm deep (0.078-0.157 of an inch) of Cornell University and an attending orthopedic surgeon at the Cornell- holes are made by gently tapping the awl in the exposed subchondral bone, affiliated Hospital for Special Surgery. allowing a mixture of blood and Articular cartilage forms a rubbery coating on the bones of the knee joint stem cells to migrate to the surface.

“The mesenchymal cells and blood form HOW MICROFRACTURE IS DONE a fibrin clot in the During microfracture, the surgeon removes damaged area, and over 4-8 cartilage and scrapes away calcified cartilage to expose months the clot turns a small area of into cartilage called underlying bone. A fibrocartilage.”

Knee injuries that damage cartilage are very common among active women, and are a common cause of osteoarthritis (OA). But a treatment technique for certain injuries can help cartilage heal itself. The procedure, called microfracture, literally taps into the bone underlying the damaged cartilage to release cartilage-forming cells from bone marrow to form a biological “patch” over the injured area. The procedure is recommended mostly for active individuals with a small defect in the articular cartilage, who have minimal or no arthritis, who are not overweight, and who are willing to undergo a lengthy rehab program.

surgical awl is then used to create a series of holes a fraction of an inch deep to reach the bone marrow. The holes allow blood and stem cells to seep to the surface, forming a clot that forms a fibrocartilage patch over the injury site within 4-8 months.

Marina Terletsky

10

Protecting the patch

The growing fibrocartilage patch must be protected from weight-bearing stress while it forms, requiring a special rehabilitation program that strengthens muscles but doesn’t stress the knee. Rehab starts right in the recovery

room, using a continuous passive motion (CPM) machine. CPM allows you to gently bend and straighten your knee while lying down.

The range of motion is set by a physical therapist and gradually increased over a period of 6 weeks until your knee regains its full natural range, says Dr. Williams. CPM rehab is intense; you exercise for six hours a day and also do limited strength training with a stationary bike. Once the fibrocartilage forms, you’ll move on to partial weight-bearing activity with crutches for another 8-12 weeks.

You’ll be able to return to normal activities within 6-8 months after the procedure.

A study of 48 microfracture patients by Dr. Williams and colleagues presented at the annual meeting of the American Academy of Orthopedic Surgeons in Washington, D.C. in March, reported 66 percent of patients had good to excellent improvement in knee function after three years, as well as reductions in pain. Magnetic resonance imaging revealed most injury sites filled in well with fibrocartilage. “Patients with a body mass index over 30, which is the cut-off for obesity, did not do as well with this procedure, and the repair fill was not as good,” he notes.

Candidates for microfracture must have a small injury (no larger than 2 cm, less than a third of an inch), since fibrocartilage is not as strong as normal cartilage. You must also be a nonsmoker (smoking inhibits healing), have little or no arthritis, a body mass index under 30, and have normal bone alignment (neither knock-kneed nor bow-legged). If you don’t qualify, other options include cartilage grafting, implants of your own cartilage cells grown in the lab, or total knee replacement.

Microfracture repair lasts at least 5 years in active individuals, says Dr. Williams. “We have had clinical success in over 90 percent of our patients.

They are able to return to their normal activities, as long as they don’t put undue stress on the joint with highimpact sports.”

THE CENTER

FOR

WOMEN’S HEALTHCARE

HEARTBURN Continued from page 3 they have too much stomach acid and reach for antacids before making lifestyle changes. “The vast majority of people who have heartburn do not make too much acid. The problem is the acid is in the wrong place, namely your esophagus,” remarks Dr. Harris.

“Gravity is probably the strongest force that helps to keep things in the stomach so one of the worst things you can do is to lie down right after you eat, because you lose the effect of gravity.” Avoiding trigger foods and heavy meals, stopping smoking, losing weight, and sleeping with the head of your bed elevated can all help you avoid heartburn.

It’s also important to avoid eating before bedtime. “Acid secretion is greatest right after you eat, which is why reflux worsens in the evening.

You are also not swallowing with the frequency that you do during the day,

so the esophagus’ ability to clear injurious acid is reduced,” he adds.

Always drink medications with plenty of water. “Certain medications, especially if taken at night, can harm the esophagus. Over-the-counter drugs such as aspirin, ibuprofen, and acetaminophen can also damage the esophagus if they are not taken with enough water and remain in the esophagus too long,” notes Dr. Harris.

For occasional heartburn, antacids (such as Tums, Mylanta, and Rolaids) or acid-reducing drugs called H2 blockers, such as cimetidine (Tagamet), can quickly relieve symptoms.

People with chronic reflux are typically given proton pump inhibitors (PPIs), which block acid secretion by turning off mini-pumps in the stomach lining that produce acid. These include Prilosec OTC and the prescription drugs omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and

esomeprazole (Nexium). All PPI’s, taken properly, can heal esophageal irritation and erosions. PPIs are taken before a meal (usually breakfast) and take a few days to reach maximum effectiveness.

Side effects can include headache, nausea, abdominal pain, and diarrhea.

Prilosec OTC is identical to prescription strength Prilosec (20 mg), but it’s approved for short-term treatment of occasional heartburn (less than 14 consecutive days) no more than three times a year. If heartburn keeps recurring it may indicate a more severe form of GERD and you need to see your doctor. In severe cases, surgery or other interventions may be needed to tighten the LES. “I can’t stress enough about the importance of lifestyle modifications,” emphasizes Dr. Harris. “We have wonderful drugs for reflux disease, so lifestyle changes have sort of fallen by the wayside. But they should still be a major part of managing reflux.”

MOVES OF THE MONTH ISOMETRIC OR ISOTONIC? Isometric exercises involve tightening a muscle for 5-10 seconds, without moving other body parts, to condition that specific muscle. Isotonic exercises involve resistance using objects, such as free weights, to strengthen muscles. Both types of exercise bolster the supports around a joint, and can benefit the knees and shoulders—two joints commonly affected by arthritis.

Isometric or isotonic moves can both strengthen the quadriceps muscles that support the knee, and the rotator cuff muscles that help stabilize the shoulder. Isometric exercises have the advantage of allowing you to strengthen muscles without moving a sore joint. Here are four sample moves.

Isometric for the shoulder Isometric for the knee Lie on your back with your right elbow flexed to 90 degrees and held close to your body. Grasp the outside of the right wrist Lie flat on your back with your heels on the with your left hand, and try to ground and toes pointed to the ceiling. Tighten move the right hand outward, the muscles on the front of the thigh. Hold for a resisting the motion with your count of 10. Do 3 sets of 15 repetitions every left hand. Do not allow your other day. right arm to move. Hold for 6 seconds. Relax for 10 seconds. Do 2-3 sets of 15-20 repetitions. Repeat by grasping the inside of the right wrist with the left hand and resisting an inward motion for the same amount of Isotonic for the knee time, sets, and repetitions. Do this exercise every other day.

Sit on a firm chair with a folded towel under your thigh. Prop your Isotonic for the shoulder foot on a stool so that your Stand with your feet shoulder-width apart. Grasp a light knee is slightly bent. Place weight (1-2 pounds), and bend your elbow 90 degrees so a light weight (1-2 the weight is waist-high. Rotate your arm outward pounds) around the away from your body. Keep your elbow at your ankle and lift your foot to side and forearm parallel to the floor. Do 2-3 sets straighten the knee. Then of 15-20 repetitions. Repeat by rotating your arm slowly lower your foot inward across your body for the same number of sets and back down. Do two sets of repetitions. Do this exercise 2-3 times a week.

20 repetitions 2-3 times a week.

Marina Terletsky FOOD & FITNESS ADVISOR

MAY 2005

11

ASK DR. ETINGIN DID YOU KNOW?

I’ve noticed recently that many breakfast cereals have big banners saying they contain whole grains. In your “Quick Bites” column on fiber and whole grains in the April issue, you stated that the FDA requires products to have 51 percent whole grain ingredients to have a “whole grain” label. But some of these cereals seem to have very little fiber. Wouldn’t it follow that cereals with lots of whole grain are high in fiber?

Whole grain does not always mean high fiber, as a quick scan of the supermarket shelves reveals. For example, Post Cereals’ “Honey Bunches of Oats” has a whole grain banner, but we found that it has only 2 g of fiber in a one cup serving. If you look at the ingredients, you’ll see it contains corn, whole wheat, and rolled oats, so it meets the FDA whole grain criteria.

General Mills’ “Cheerio’s” has 3 g of fiber in a serving, with whole grain, oats, and bran among its primary ingredients. In comparison, bran cereal, such as Kellogg’s “All-Bran,” has around 20 g of fiber in a cup. Kashi “Good Friends” has 10 g of fiber in one cup serving (1 g of soluble fiber), with its main ingredients being wheat bran, corn and whole wheat. Kellogg’s “Frosted Mini-Wheats” has 6 g of fiber and “Raisin Bran” has 7 g in a serving, both listing whole wheat as the first ingredient.

(Just about all of these cereals contain sugar and added sweeteners.) These cereals are all good sources of whole grain, but if you’re looking to boost your fiber intake, pick those products highest in fiber. As always, you need to read labels carefully; some cereals may seem lower in fiber until you notice a serving is a half a cup.

In the February 2005 article on omega-3s does the recommendation to consume up to 1,000 mg of EPA and DHA mean 1,000 mg of each, or 1,000 mg combined? Is anyone testing fish oil capsules with regard to mercury toxicity? And is there a special supplement for improving mood?

Fish oil capsules contain EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), so the recommendation is for both fats combined. Contamination is a concern, because fish can accumulate toxins such as mercury, PCBs, and dioxins. However, most of the contaminants are found in the fish meat and not in the oil. At a recent meeting sponsored by the Institute of Medicine, fish oil capsules were given a clean bill of health.

Consumerlab.com, an independent laboratory, recently tested 41 omega-3 fish oil products and found no detectable levels of mercury (considered to be over 10 parts per billion, ppb), PCBs, or dioxins. In contrast, Consumerlab says some fish contain 10-1,000 ppb of mercury, depending on the type of fish.

COMING SOON (You can read the test results at www.ConsumerLab.com). There is a prescripSmart Foods: Which foods pack tion-only product called Animi-3, which contains the most nutritional punch?

EPA and DHA, as well as folic acid, vitamins B6, and B12, designed to reduce cardiovascular The best ways to firm your risk. However, its manufacturers suggest it may abdomen also benefit mood. We suggest you discuss the use of fish oil with your doctor, since it has Cervical disk disease—a real blood-thinning and other side effects. pain in the neck EDITORIAL SUBSCRIPTIONS CORRESPONDENCE $39 per year (U.S.) The Editor $49 per year (Canada) Food & Fitness Advisor P.O. Box 5656, Single copies of back Norwalk, CT 06856issues are available for 5656 $5.00 each. Call 203857-3143 CornellEditor@aol.com

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In the not too distant future, getting a dose of vaccine may be as easy as munching on a potato.

Scientists from Arizona State University in Tempe recently reported they successfully delivered a hepatitis B vaccine via a genetically engineered potato.

The scientists randomly assigned 42 previously vaccinated volunteers to consume two or three “doses” of potatoes engineered to produce a hepatitis B antigen (HBsAg) or regular potatoes. Among the 16 volunteers who got the vaccine in a potato, 10 (or 63 percent) showed an increase in antibodies against hepatitis (measured by HBsAg titers), over half of the 17 people given two doses of the potato vaccine had increased antibodies, but no antibodies were detected in any of the 9 people given a placebo potato.

“We are greatly encouraged that this prototype study of human immunization against (hepatitis B) gave a strong and sustained systemic antibody response in about 60 percent of the volunteers who ate transgenic potatoes,” the researchers noted in the February 14 Proceedings of the National Academy of Sciences.

This is just one of a number of ongoing experiments aimed at creating genetically modified plants to produce medicines, and the Arizona State researchers say their study results “provide compelling evidence” that such forms of oral vaccines could be a useful component of programs aimed at preventing intestinal and non-intestinal diseases.

DISCLAIMER Food & Fitness Advisor is intended to provide readers with accurate and timely medical news and information.

It is not intended to give personal medical advice, which should be obtained directly from a physician.

Acting on any information provided without first consulting a physician is solely at the reader’s risk. We regret that we cannot respond to individual inquiries about personal health matters.

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FOOD & FITNESS ADVISOR

MAY 2005