News to Empower You!

By Dace Trence , MD, FACE

Are you watching your calorie intake, trying to lose weight? But running late and while driving see the neighborhood burger drive-through, and your stomach rumbles and tells you did not have lunch? Oh, well, just this once…twice…three times…sound familiar?

Well, you may be hurting yourself more than you know! A recent study from Boston (Block et al, British Medical Journal 2013 May 23;346:f2907) reports on results from a survey of about 1,800 adults and 300 school age children visiting 89 fast-food restaurants in New England. The restaurants included McDonald’s, Burger King, Subway, Wendy’s KFC and Dunkin’ Donuts. People were asked to estimate the calorie content of the meals they purchased, and then this was compared to actual calorie content.

For adults, dinnertime was targeted; for adolescents, lunchtime and early afternoon (after school) was targeted. And what were the results? Almost 25 percent of both adults and children underestimated the calorie content by 500 or more calories!! Overall, two-thirds of the surveyed individuals underestimated their meal calorie content. And the higher the actual calorie content, the greater the underestimation.

Adults ate an average of 836 calories, but estimated that their intake was 661 calories, while adolescents ate 749 average calories, but estimated their meal content at 490. Even if nutritional information was posted (and this study was done before routine posting of meal content was mandated), this information did not improve a person’s ability to estimate the calorie content of the meal (okay, let’s admit it…how many of us really look at that information?). Even more interesting, if a label of health was associated with a particular meal choice, it was more likely that additional side dishes would be ordered and calorie content of the actual meal even more underestimated (ouch!).

How to EmPower yourself? Look at the posted calorie content of what you are thinking of ordering. If you do not see this, ask for it or look up this information. This information can be readily found on web sites and on apps for tablets and smartphones. Learn what would be better choices at a restaurant for you and your family, and stick to them when ordering. At the very least, chose the smallest portion size, if still unsure of a meal’s calories. And do not assume that a label of heart healthy or best choice is necessarily that — look at the facts, do your research, be EmPowered!

Have you heard about the Mediterranean diet? You probably know already that this diet, rich in vegetables and fruits, low in meats and dairy products and, yes, moderate in fish and alcohol content, has been linked to lower heart disease risk, lower stroke risk, even longer life span. But what about its effect, if any, on the prevention of loss of cognitive (thinking) function, on the prevention of Alzheimer’s or dementia?

Another study from Boston (Journal of Nutrition 2013; 143:493-499) looked at associations between long-term Mediterranean diet eaters and cognitive function and/or decline. The researchers specifically looked at 16,058 female nurses in the Nurses Health Study who had been asked to complete questionnaires about lifestyle, initially every two years and then every four years, who were additionally evaluated by phone interview, through validated tests of memory, recall of given words and numbers, and attention. Dietary intake was assessed through the serial questionnaires on file, with a point system used for quantity of vegetables, fruits, nuts, grains, etc., including an assessment of intake of monosaturated fat (such as olive oil) to saturated fat (such as butter) ratio. Physical activity was assessed as an additional variable, as well as a number of other possible variables, to remove them from the evaluation of diet alone.

The results showed that women following a Mediterranean diet tended to have lower weight and also be more physically active. They had fewer heart attacks and were less likely to develop diabetes — something you are probably not at all surprised to hear. Memory and thinking skills did decrease as everyone aged, but the good news was that the more the women stuck with the Mediterranean diet, the more likely that memory and thinking loss were slowed! In particular, the more vegetables the women ate and the more monounsaturated fatty acids (such as olive oil) taken, the more impact on slowing loss of function. In general, more vegetables, more fish and more nut intake was associated with an overall higher level of cognitive function in later life.

How to EmPower yourself? Please pass the carrots… and broccoli…and corn…and maybe a little baked fish and salad greens with olive oil dressing!

To salt or not to salt, that is my question! And indeed that is a question many experts are asking in view of the confusion about salt (specifically sodium) daily intake recommendations being made almost monthly. Some organizations are strong opponents of salt intake, some are saying that restrictions should be eased up. Who do you believe? EmPower Magazine featured information about salt in the 2013 spring issue, subsequent to which the respected Institute of Medicine came out with its report. The average sodium consumption in the United States, and around the world, is estimated at 3,400 milligrams a day (about 1 ½ teaspoons), an amount that has not changed in decades.

In 2005, the Institute of Medicine recommended a sodium intake of 1,500 to 2,300 milligrams a day because those levels were not likely to raise blood pressure. But studies subsequently published challenged the association of low sodium intake as protective against disease. As example, a very small study reported on 232 randomly assigned Italian patients with aggressively treated moderate to severe heart failure asked to take in either 2,760 or 1,840 milligrams of sodium a day, but otherwise to not change their diets. Those taking in the lower level of sodium had more than three times the number of hospital readmissions — 30 as compared with 9 in the higher-salt group — and more than twice as many deaths — 15 as compared with 6 in the higher-salt group.

In a report in 2011, 28,800 people with high blood pressure, at least 55 years old (and older), were tracked for 4.7 years and their sodium intake checked through urinalysis. The researchers reported that the risks of heart attacks, strokes, heart failure and death from heart disease increased significantly for those taking in more than 7,000 milligrams of sodium a day as well as for those taking in fewer than 3,000 milligrams of sodium a day! Both low and high intakers did less well than those in the middle range of salt intake. Dr. Brian L. Strom, chairman of the committee and a professor of public health at the University of Pennsylvania, has suggested that as you go below the daily intake of 2,300 milligrams of sodium, there is an absence of data in terms of benefit, but there begin to be suggestions about potential harms.

How to EmPower yourself? 2300 mg may sound like a lot, but it is just under a teaspoon of salt, so put away that big bag of chips, refuse the Polish sausage and skip the soy sauce!