The Fallacy of Moderation



What does moderation really mean?

 Moderation is a word that has been used quite often when describing healthy eating and drinking patterns. Webster's Collegiate Dictionary defines moderation as avoidance of extremes or tending toward average. What does this really mean when we are talking about food? Does it mean one cookie a day or one less cookie than we usually eat? Perhaps it means that we don't eat the whole cookie jar? Does it mean once a day, once a week, once a month or once a year? The problem is that it can mean anything that we want it to mean. This isn't good enough when we are talking about promoting healthy eating behaviors. To say "all things in moderation" to me seems like an excuse to maintain the status quo, which arguably is average.

Paula Deen announced this week that she has had type 2 diabetes for the past three years. Her announcement mentioned very little about following healthy dietary habits. Rather, she stated that she has always been a advocate for moderation (there's that word again). Deen's recipes are not known for being healthy and it must be extremely embarrassing for her to have developed a disease that has a strong tie to dietary factors. Regardless of the cause of diabetes, diet and exercise are integral for its management. They are much too important to be passed off by the use of a non-specific word such as moderation. Deen's announcement this week motivated me to write this blog post, but this post is not about her.

The food industry loves the term moderation for the very reason that it is non-specific. Hershey's has created the Moderation Nation to help consumers find balance in their lives. Part of their message is that 100 calories a day of chocolate can fit into your balanced diet. That's fine, if you do not need to lose weight, but about one third of American adults are obese. George Blackburn, MD, PhD, Chief of the Nutritional/Metabolism Laboratory, and Director of the Center for the Study of Nutrition Medicine, which are affiliated with the Beth Israel Deaconess Medical Center in Boston, Massachusetts, reports that for a vast majority of obese Americans, as little as 200 calories a day prevents them from losing the 20-30 pounds necessary to gain significant health benefits(1). That is less than a small package of M&M's (240 calories). Often, that 100 calorie treat becomes a 200 or 300 calorie "nibble" especially when the whole package contains more than 100 calories. The concept of moderation keeps consumers buying products, which is the primary concern of major food manufacturers and restaurants. In the case of Deen's Savannah, GA restaurant, it keeps the line of patrons circling the block waiting to be seated. Moderation promotes sales and keeps the customers coming through the door.

Last month the marketing research group NPD discovered that Americans are following MyPlate guidelines only 2% of the time. That translates to seven days out of the year! That surely is not moderation and I would argue that the message of moderation is not working. MyPlate promotes such a simple concept and advises Americans to consume half of their plate from fruits and vegetables. It doesn't get much easier than that!

So what can we do that is better? The National Heart, Lung and Blood Institute in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases developed the WeCan Program to teach children and families how to choose healthier diets and exercise more. This program uses the Stoplight Approach to teach which foods should be eaten every day (green light), which foods should be eaten in smaller quantities and less often (yellow light) and which foods should rarely be eaten (red light). Another way to define this approach uses the words "Go, Slow, and Whoa." These three simple words convey more meaning than the word moderation and help to underscore that not all foods can be eaten regularly in moderation if you are trying to lose weight. This approach can be used to teach adults how to better control their food intake too and shows great promise in some area weight management programs.

Stoplight symbols have been added to packaged foods in some European countries to help consumers choose healthier diets. It's doubtful that food manufacturers would allow such a system in the United States because many food products would be labeled yellow or red which could potentially negatively impact sales. You can understand why manufacturers prefer the use of the term "moderation" when it comes to promoting healthier diet habits.

Smart phone users can benefit from using the Fooducate application which independently grades thousands of grocery food items and provides a stoplight color code and letter grade to help consumers make appropriate food choices. The app also discusses the reason for the grade so that you can better understand what makes a food more or less healthy.

I encourage you to make a pertinent comment on this post. I will send a copy of The Little Black Book of Foodspiration by Yvette Quantz, RD, CSSD, LD to the first 20 people who leave a comment. If you are one of the twenty, please email me at info@rochesternutrition with you name and address.

Resource:
1. Blackburn, GL and Waltman, GA. Expanding the Limits of Treatment-New Strategic Initiatives. J Am Diet Assoc. 2005;105:S131-S135.

Resistant Starch: The New Carb on the Block

Resistant starch is the next hot topic that you’ll be hearing about in the news, and I’m not talking about the laundry. This is nutrition science discovering new things about how foods impact our health. In the early 1980’s it was discovered that a component of starch could not be absorbed by the small intestine and passed into the large intestine where it was digested by bacteria, releasing beneficial compounds for the cells of the colon. It was identified as resistant starch (RS). RS is different from dietary fiber because it is bound along with other starchy carbohydrates, not the bran or the germ.




RS can be found naturally in legumes, seeds, whole grains, under-ripe bananas, raw potatoes, and (to a lesser extent) processed starchy foods that have been cooked and cooled, such as breads, cereals, potatoes, rice and pasta. A brand of corn has been engineered to contain a large amount of RS for use in food manufacturing; it is called high-amylose corn (Hi-Maize). This isn’t the corn that you eat at your dinner table. High-amylose corn is processed into flour and added to baked goods to decrease the overall absorbable carbohydrate and increase the RS of a product.



There has been a surge of recent research looking at the health properties of RS. Much of the research uses processed products such as Hi-Maize. Some benefits are improved glycemic control, decreased insulin secretion, decreased cholesterol levels, increased fat burning and improved colonic health. Negative effects have been discovered too, especially with highly purified RS diets that do not include the other components of dietary fiber. There is a concern for increased risk of colon cancer in this situation.



The consumption of RS in the US is currently estimated to be about 3-6 grams per day. In developing countries where unprocessed starch consumption is high the intake ranges from 30-40 grams per day. RS intake in China is about 18 grams per day. Research has identified the beneficial intake of resistant starch to be between 10-20 grams per day. With RS, more is not necessarily better, and a healthful intake can be as little as 5% of total carbohydrates.



Over-processing of foods diminishes RS content along with many other nutrients. This is one plague of industrialized food production. Our goal for healthy eating should be to include whole grains, legumes, and seeds while decreasing processed baked goods. Processed and engineered foods are no match for the panoply of nutrients that whole foods provide.



Engineered RS has been developed to be a functional food, a food or dietary component that may provide a health benefit beyond basic nutrition. I wonder if eating high-amylose corn muffins, pasta, or bread will benefit the consumer as much as the manufacturer. Only time, and more research will tell.

The Enigma of Blood Sugar Control

My son has type 1 diabetes. I've blogged about our struggles with this disease before. My son would love for me avoid sharing our personal experiences with respect to him, but I'm on a mission to better understand how diabetes is controlled and to help other diabetics in the process.

To me, the expression "blood sugar control" seems like an oxymoron. It is elusive at times and often we are left scratching our heads as to why our son's blood sugar becomes high or low (even though I'm a dietitian and my husband is a physician). Diabetics, especially teenagers, can take these values personally and may feel like they have failed in managing their health. There are so many factors that affect blood sugar. Understanding why blood sugar becomes high or low is very complicated. Lately, I feel like we've been chasing our tails and I need to know more about diabetes to help my son understand more and manage his disease without excessive emotion.

As I educate myself, the nuiances of blood sugar control are becoming more apparent. I have decided to post a "pearl of wisdom" on my Facebook page daily to reinforce the concepts that I am learning and to share that knowledge with other diabetics or those responsible for caring for a person with diabetes. I invite your comments, experiences, and knowledge on this topic here on my blog as well as on Facebook and Twitter. I'm hoping to impact hundreds of people and create an online comminuty of diabetics sharing their experiences and wisdom. Please pass this on to your diabetic family, friends, and coworkers. To your Health!

Diabetes From a Personal Point of View

The dates of some experiences can be imprinted on one’s memory for a long time. I don’t think I’ll ever forget the day that my son was diagnosed with type 1 diabetes at 8 years of age. He had been excessively thirsty for a few days, and was drinking a lot of water. A couple days prior to his diagnosis, I remember him coming home from school and telling me in amazement that he went to the bathroom twenty times that day! My husband and I scoured the internet looking for any other explanation than the one that we knew was most obvious. In medicine, they have a saying: If you hear hoof beats it’s probably a horse, not a zebra. This means that what is most obvious is most likely. In our case it was a horse, type 1 diabetes.




When I was a nutrition student learning about diabetes, I struggled to get my mind around all that was necessary to manage the disease. Diet, medication and physical activity are all very important in controlling diabetes, and none of it is simple. I am still learning how complex diabetes management is every day. My son is now a 15 year old athlete. He has risen to the challenges of diabetes better than many adults would have. He knows how important physical activity is for his blood sugar management, and after trying several different sports he found a sport that he loves, rowing. Diabetics used to be discouraged from participating in sports because of the risk of low blood sugar. Now, we view physical activity and athletics as an important part of keeping a diabetic person healthy throughout life. The advent of the insulin pump has allowed us to fine tune the delivery of insulin such that athletics is not considered as dangerous as it used to be.



Since my son has been diagnosed with diabetes on March 16, 2004 he has had several seizures related to low blood sugar, all of them occurring during sleep. He’s always recovered relatively quickly from them, and was alert enough to drink juice to bring his blood sugar back up. His most recent seizure on July 7, 2010 was different. By now, my other children are well versed in their brother’s diabetes management. My 13 year old daughter has helped me administer juice to her brother and witnessed the multiple daily finger pricks to check blood sugar and injections of insulin. On this warm day in July, she frantically called us at work to let us know that our son was having a seizure. I left for home grateful that she would be there to give him juice. While I was en route she tested his blood sugar and administered glucagon, a quick acting sugar to help raise blood sugar in unresponsive diabetics. When I arrived the situation had not improved. Another injection of glucagon failed to bring him around. I was relieved when my husband, a physician, arrived home to help, but nothing that we did brought our son back to his normal mental status. We called 911.



I’m happy to say that my son has made a full recovery and the only lasing effect from this day was his inability to train athletically for about a week due to headaches from a lumbar puncture that was part of his hospital evaluation. We replay the events leading up to this day and try to figure out what contributed to it. I never expected my son to have a seizure that we couldn’t bring him out of. I now wonder if we should have been better prepared to understand how different the needs of a diabetic athlete are compare to other athletes and other non-athlete diabetics. I’ve since learned that to correct for a low blood sugar, a diabetic athlete can require twice as much carbohydrate as a non-athlete diabetic. I’ve also learned that dehydration can impact a diabetic athlete differently than a non-diabetic athlete. I never wanted to understand as much about diabetes as I do now. My experiences with my son have motivated me to learn as much as I can about this disease to help him and other diabetics, athlete and non-athlete alike, to take control of their lives!