Friday, July 29, 2011

Saving Health Care by taxing junk food?

IHOP Bacon ‘N Beef Cheeseburger has 1,250 calories, plus 620 for onion rings. The Cheesecake Factory Farmhouse Cheeseburger has 1,530 calories, 1900 with fries. A PB&C milkshake at Cold Stone has 2010 calories; it contains peanut butter, chocolate ice cream and milk, with 68 grams of saturated fat and 153 grams of sugar. Since the new health-care law mandates calorie count information on menus, starting in 2011, will this make a difference? Most fast-food chains now offer lower calorie choices – whether this is helping people make wiser choices is not yet clear.

As readers know, the ‘standard American diet’ (SAD) of fast food laden with sugar, fat and salt, is causing an epidemic of obesity, with resultant high rates of diabetes and its many complications. Mark Bittman, a well known food writer and New York Times columnist, analyzes the impact of taxing junk food on our health and health care costs in the July 24th edition of the NYTimes. His premise is that the food industry is interested in profits, not the public health, and that the federal government should establish a bold, national fix. Much of this column is based on Bittman’s ideas. I should add that I agree with him.

The Rudd Center for Food Policy and Obesity at Yale says that taxes become a significant force in changing buying habits for soda at about a penny an ounce. The average American consumes 44.7 gallons of sweetened sodas a year, and another 17 gallons of non-carbonated sweetened drinks. With a 20% tax in the price of sugary drinks, there would be an estimated 20% decrease in consumption, resulting in the prevention of obesity of 1,500,000 Americans (over 10 years) and 400,000 fewer cases of diabetes, saving about $30 billion dollars in health care costs. The money gained in taxes could be used to subsidize the purchase of staple foods like vegetables, whole grains, dried legumes and fruit. This is an essential part of the plan: making healthy foods available and affordable, bringing grocery stores into ‘food deserts’, teaching children and adults how to shop and cook, and supporting farmers markets and community gardens.

Soda taxes have been proposed in Philadelphia, San Francisco, and New York. France and Hungary are also proposing a tax on junk food, while Brazil is subsidizing produce for the poor in its ‘Zero Hunger ‘ program. The idea is gaining ground.

Currently, instead of taxing junk food, we are paying – with tax dollars - to support corn farmers whose corn is made into high-fructose corn syrup – used to sweeten soda! So far, efforts to change what Americans eat through education and persuasion have failed, partly due to the 4 billion spent annually on advertising by the fast-food industry. Bittman says that 86% of food ads seen by children are for foods high in sugar, fat and sodium. The percentage of obese children has tripled in the last 30 years, and of obese adults has more than doubled.

Efforts to tax certain foods will be opposed by those decrying the ’nanny -state’. However, we are faced with a health crisis with serious budgetary implications. Public health regulations have been very successful in other areas.
We now tax cigarettes over $2 per pack – a combination of state and federal excise taxes – and the US smoking rate has fallen from 40% to 20%. Although over 400,000 people still die each year from tobacco, the toll was twice as high before taxation. We have government mandates for seat belts and children’s safety car seats in most states, which are estimated to save over 15,000 lives each year. Government regulation of drinking water and food safety, driving speeds, and building codes have saved countless lives and reduced health care costs.

Here in West Marin we are tremendously lucky to have organic farmers, farmers’ markets and healthy produce. We also have great tasting water. We should all thank our farmers, eat more produce and drink fewer calories, whether it’s soda, sweetened bottled tea, or beer. OK, beer drinkers, I said less, not none! And – support a tax on sweetened soda if it comes around, as it will reduce your health care costs.
Sadja Greenwood, MD, MPH back issues on this blog

Saturday, July 2, 2011

Turmeric - an ancient spice with exciting modern research

Turmeric has been gathered and cultivated in India for over 2500 years, used as an orange dye, a medicinal plant and a spice in curry. Today there is renewed interest in turmeric and its main ingredient curcumin for their potential activity against cancer, Alzheimer’s disease, arthritis and many other health problems.

At the University of Texas MD Anderson Cancer Center, Dr. Bharat Aggarwal is studying curcumin. Aggarwal, a biochemist and molecular biologist, considers turmeric to offer great promise for health. He says that the combined rate of the four most common cancers in the United States—lung, prostate, breast, and colon—is much lower in India, where turmeric (in curry) is a staple in the diet. Aggarwal is studying the ability of curcumin to shut down nuclear factor kappa B (NF-kB), which is involved in the regulation of inflammation and many other processes. By blocking the activity of this ‘master switch’, curcumin appears to interfere with the cancer process at an early point, impeding multiple routes of growth: reducing the inflammatory response, inhibiting the proliferation of tumor cells, inducing their self-destruction, and discouraging the growth of blood vessels feeding tumors. These effects can shrink tumors and inhibit metastasis. Also, shutting down NF-kB can enable chemotherapy drugs to destroy cancer cells more effectively. Research on curcumin and various cancer types is still preliminary, and laboratory based; there have been few human trials. It would be unwise to stop cancer chemotherapy to take curcumin, however some oncologists are interested in curcumin as a supplement. People under treatment for cancer should confer with their oncologist, as curcumin may alter the efficacy of chemotherapy drugs. A detailed discussion of curcumin used in cancer can be found at Dr. Aggarwal’s website

Alzheimer’s Disease: Based on the finding that there is 4 times less Alzheimer’s disease in India than in the US (turmeric is used as a daily spice in Indian curries), researchers at UCLA are studying the ability of synthetic curcumin and Vitamin D to clear the amyloid plaques found in the brains of people with Alzheimer’s. Laboratory experiments have shown that blood cells called macrophages are able to destroy amyloid plaque when incubated with Vitamin D and a form of synthetic curcumin. Studies using Vitamin D and curcumin in human patients are underway at UCLA, USC and various universities in India. At present, there is no recommended dose of curcumin for treatment or prevention.

Since curcumin is anti-inflammatory, it is being tried in the treatment of rheumatoid arthritis, with trials at UCLA. Osteoarthritis may also be helped, according to a trial at Western Ontario and McMaster Universities, where researchers used a mixture of curcumin and soy phospholipids, called Meriva. At the University of Arizona, there is a study on curcumin’s ability to prevent bone loss in mid-life women.

Inflammatory Bowel Disease: Both Crohn’s Disease and ulcerative colitis can result in abdominal pain, diarrhea, weight loss and fatigue, and often strike children or young adults. At the U. of Arizona there are studies showing that daily curcumin pills were able to decrease intestinal damage and cut the number of relapses by 50%. The researchers stressed that curcumin should not replace standard therapies.

Cautions: Curcumin is safe, but should not be used in pregnancy or in people with gall bladder disease because it stimulates bile secretion and gallbladder contractions. Most people, however, can try curcumin supplements, which are better absorbed if combined with pepperine (black pepper). If you look at the recent book by Dr. Aggarwal, Healing Spices, you will find more information on turmeric as well as ways to make your own curries.
Sadja Greenwood MD, MPH –back issues on this blog