Consumer Alert: Aspartame

Aspartame (also known to you as Nutrasweet and little blue packets of Equal) is an artificial sweetener used in a variety of products. Most people associate it with diet soft drinks and the little packets for coffee and tea. In fact, it's in a lot of products you might not even think about (certain cereals, yogurt, etc.).

Depending on who you ask, aspartame is either perfectly safe or very dangerous. I will be upfront (as I sit here and type this while drinking a Diet Coke) and say that I don't think it is dangerous per se, although probably there are people who are sensitive to it and may react. And it's probably not good in excess, like pretty much anything else. There's even some evidence that using artificial sweeteners can actually lead to weight gain. But that's not what I'm blogging about today.

A producer of aspartame, Ajinomoto, has rebranded its product as AminoSweet. According to the website, "AminoSweet is made from two amino acids, the building blocks of protein found in many of the foods and drinks we eat every day, such as fish, meat, eggs, cheese and cereals."

I have a problem with the marketing approach here. It's misleading to imply that AminoSweet is somehow a "natural" sweetener because it's "made from two building blocks of protein just like those found naturally in many everyday foods." Is Ajinomoto trying to pull the wool over our eyes? Or do they think we are stupid? We've known for years that aspartame (or Nutrasweet or Equal) is an artificial sweetener. Key word: Artificial. As in, not found in nature.

If you avoid artificial sweeteners for any reason, be sure to read labels carefully. Shady marketing practices like this are sure to multiply as the trend of "natural" products increases.

Congenital Heart Defect Awareness Week: Feb. 7-14

Did you know that heart abnormalities are the most common birth defect? I didn't, until a few weeks ago. A Facebook friend posted a link to the Cora's Story blog and I casually clicked over to see what it was about. Cora died suddenly in her mama's arms at just 5 days old from an undetected congenital heart defect (CHD). I can't imagine suffering such a devastating loss, and I thank my lucky stars for my kids' healthy hearts. But Cora's mother Kristine has turned her pain into a wonderful mission in her daughter's name: to raise awareness about CHD and how easily it can be detected. With Kristine and Cora's help, hopefully more CHDs will be caught and treated early, saving babies' and children's lives.

Another fact I learned from Cora is how easily many CHDs can be detected. A simple pulse oximetry test (aka "pulse ox") done 24-48 hours after birth in conjunction with a newborn exam can detect a large proportion of CHDs, with a low false-positive rate. A pulse ox test is noninvasive and very simple: the reader is typically attached to the baby's toe and determines the oxygen saturation of the blood. An abnormal reading (typically below 95) is indicative of a problem. The research on pulse ox screening bears out the effectiveness of pulse ox screening tests for newborns.*

So why hasn't pulse ox testing become routine for all newborns? As I mentioned, the test is completely non-invasive and hospitals already have the equipment. Portable pulse ox readers are also available, which means both birth center and homebirth midwives could also easily carry them. Kristine is working on Cora's behalf to get laws passed nationwide mandating a pulse ox to be done on every newborn. I applaud her efforts and admire her strength at turning her pain into an effort to save lives.

What can YOU do? Request this test for your own babies and tell the pregnant moms in your life to request it when their babies are born. Pass this information on, and tell others to pass it on too. Write your Congressman and your state representatives and tell them you want pulse ox testing to be mandatory for all newborns. You might just save a baby's life.

*More information and research:
Medscape Medical News
British Medical Journal
University of Michigan
Medical News Today
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What Happened to Informed Consent?

I guess for some people this is old news, but this morning I read this article about medical students doing pelvic and rectal exams on patients who are under general anesthesia for surgery. These patients, in many cases, did not consent to such exams, and may not ever even know it was done to them. Apparently this issue has come up a few times over the years (see the references section of this article) without ever really being resolved. And men, this includes you too... Imagine going in for a routine knee surgery and having 4 or 5 med students practice rectal exams on you while you're out cold.

If a woman goes out to a bar and a man spikes her drink with roofies and then has sex with her while she's unconscious, is it not rape if she can't remember it? Of course it is. How is this significantly different?

Any procedure performed on a patient requires informed consent. It is a legal right and an ethical obligation. The fact that this continues to go on is abhorrent. Of course med students need to learn somehow, but this is not the way.

Studies and surveys have shown that people will, when asked, consent to med students performing such exams. There are also some programs in place that pay volunteers for undergoing examinations in order to teach med students. Both are better alternatives than simply probing people's orifices without their knowledge or consent. More importantly, performing pelvic and rectal exams with a conscious patient have the advantage of allowing the patient to give feedback (as in, "Hey that HURTS!"). The student can better learn to conduct such exams so as not to hurt the patient.

If you are having surgery or any other treatment at a university or teaching hospital, ASK if they have med students learning pelvic and rectal exams on anesthetized patients. If you are ok with simply knowing in advance, you can feel free to consent at that time. Or you can tell your attending physician you do not consent, as well as write it on your consent form that you specifically do not consent to such exams.

If you are a student doctor or nurse, please refuse to check your ethics at the hospital door. Just because "this is the way it's always been done" doesn't mean it has to continue to be done that way. Tell your resident, your attending, your supervisor, or your preceptor that you won't participate in exams of anyone who hasn't given explicit consent.


Hat tip to The Unnecesarean for the topic of this post.
Further reading here

Resolution Time

For a lot of people, the new year is a time to pledge change. Some people try to break old habits and some try to create new (healthier) habits. One of the most common resolutions is to get in better shape, whether that means losing weight, exercising more, or both. Maybe you've made that resolution in the past. Maybe you made it this year.

It should come as no surprise then, that January is the busiest month of the year at gyms and health clubs. (Second is September- when kids go back to school and routines that petered out over the summer start anew.) I've watched each January as the gym fills with "New Year's Resolution People" who are gone by the time Valentine's Day rolls around. And you should know, that we as instructors and trainers, are talking about you. We love to see new faces in class, really we do. But when you start out during the month of January, we are skeptical. And truthfully, though I can't speak for all instructors, there are some of us guilty of complaining about our gym regulars getting shut out of classes by overexuberant newbies during the month of January. Sorry.

Here is where I have seen a lot of people go wrong. Let's take a hypothetical woman named Jane. Jane has made a resolution to lose weight through diet and exercise. So on January 2, she signs up at the gym and vows to go every day. I would bet my last dollar that Jane will fail.

Why?

Well, for a couple of reasons. First, Jane is likely to burn herself out quickly. I see this more with men, but women do it too. Jane literally hits the ground running, going 4, 5, 6 days in a row to the gym and pushing herself hard. And then she is overtaken by fatigue and muscle soreness... And then she thinks, "Ugh, this is why working out sucks. It makes me tired and sore." And pretty soon that gym membership is nothing more than an automatic monthly charge on her credit card. Second, Jane set herself up for failure before she even began by setting a vague goal of "losing weight" through diet and exercise.

But Jane doesn't have to be one of the New Year's Resolution People that instructors and trainers sigh about. She can do one simple thing to help herself succeed. She can set a SMART goal. SMART stands for Specific, Measurable, Attainable, Relevant, and Time-bound.

Specific- "Losing weight" or "getting in shape" are not specific goals. Losing 20 lbs. or being able to run for 30 minutes without stopping is specific.
Measurable- There should be no doubt about whether a goal has been achieved. Progress towards a goal can be measured- losing 5 lbs. out of 20, or running 10 out of 30 minutes without stopping.
Attainable- Losing 20 lbs. or training for a marathon in 2 weeks is not attainable (and even if it were, it certainly wouldn't be healthy). Be realistic when setting a goal.
Relevant- It may seem obvious, but it doesn't make sense to train for a 5k run by riding a bike. And "training" for a competitive eating event is probably not a good method of weight loss. (That's a joke people!)
Time-bound- Assigning a deadline keeps goals on track. Set both short-term or interim goals to mark progress towards a long-term goal.

For Jane, a SMART goal might be: Fit into her size 6 jeans (specific) by losing 20 lbs. (measurable) in the next 4 months (time-bound). To do this she will count calories and go to the gym 3 days a week (attainable and relevant).

Finally, my personal opinion for people who haven't been working out regularly is to start off slow. Yes, we should all work out about 5 days a week, but for those just starting out, 2-3 days a week is enough. Carve out that time and cement it into a weekly schedule, the same way meetings or appointments are scheduled. Once those couple of days become a habit, add another day, and eventually another. Trying to do it all at once can be too overwhelming and discouraging, and I think that's why a lot of people can't stick with a routine for more than a few weeks.

Have you made a resolution to get in better shape in the past? How did it work out for you? Are you resolving that this is the year you'll get fit?

A Bit of History That Gives Me Chills

Yesterday one of my favorite bloggers, The Unnecesarean, posted an excerpt from a history text about birth in the early 20th century. The excerpt presents the practice of putting women under "twilight sleep" for labor and delivery as a way to convince WASP women to have more babies because "modern" birth practices render it painless-- or at least without the memory of pain. I had never heard of this racist/classist perspective of twilight sleep before. But it got me thinking, especially since I recently read that the tv show Mad Men featured a character giving birth within the haze of twilight sleep.

I can't remember the first time I heard about women being "put under" to have their babies- it was probably as a child or teen. Until a few years ago, I guess I thought it was a benign but clumsy attempt to spare women the pain of birth. No big deal. But then I happened to see "The Business of Being Born, " a documentary by Ricki Lake that covers a little bit of the history of birth in the US. The historical aspect was eye-opening, to say the least. When you start to think about the fact that this is the way many of our parents came into the world (and maybe even some of us, considering twilight sleep was prevalent well into the 60s and even the 70s in some hospitals), it can be downright scary.

Beginning in the 1900s, a combination of scopolamine and morphine was administered to all women entering the hospital for birth. Women had no recollection of the birth, and certainly no recollection of any pain. Feminists heralded this as a fantastic medical breakthrough, and demanded its widespread availability for birthing women. As word spread of this wonderful new pain-free way to give birth, women across the country chose to deliver in hospitals offering twilight sleep. In fact, there are reports of women being put under for delivery whether they wanted it or not, even against their own explicit refusal. But since women had no recollection what actually happened during their births, and husbands at that time were not part of the birth process, it was years before the true horror of twilight sleep was exposed.

Since the women were not fully sedated, and not fully relieved of the pain of labor, they had to be placed in restraints in their hospital beds so as not to thrash themselves onto the floor. When husbands started questioning the marks on their wives' wrists and ankles left behind by the leather restraints, the practice of restraining was not abandoned. Instead new restraints made of lambswool were designed so as not to leave any marks. Women were left, tied down, to writhe through their labors until the doctor arrived with forceps to extract the baby. (See photo at top.)

When the effects of the medicine wore off, women were presented with a freshly bathed, blanketed bundle of baby. Some women complained of feeling detached from their babies, like they weren't even sure it was their own child. The drugs also crossed the placenta and often sedated the baby, resulting in breathing problems. Over time the method was eventually abandoned, as a result of the negative side effects and the second wave of feminism. As women reclaimed control of their reproductive lives, including access to birth control pills, they also began increasingly demanding unmedicated births and fathers' involvement in births. The development of epidural anesthesia also played a role in the demise of twilight sleep.

Maybe it's my own personal bias against hospitals, but the thought of literally being dropped at the door of the maternity ward by my husband and literally having no recollection of anything else until being handed a baby two days later utterly horrifies me. I don't think the method would have taken off if husbands had been allowed in- I cannot imagine any man permitting such barbaric practices to be visited upon his wife. But they didn't know, so they couldn't help.

There was (and I think there still is) a certain mystique around birth: We don't know exactly how labor starts, and can't predict when it will happen. Regardless of a mother's weight gain or belly size, we don't know the size of the baby until it's born-- even ultrasound measurement can be off by a pound or more in either direction. This mystique allowed generations past, and still allows many people today, to maintain a certain degree of ignorance about birth. It's very easy to assume that the doctor has all the knowledge, the hospital has all the equipment, so all the expectant parents need to do is show up when it's time. I think that is a dangerous attitude. The same people who wouldn't hesitate to seek a second opinion from a doctor who said they need a heart transplant... the same people who would consult with three different orthopedic surgeons about a knee replacement... don't think twice about their choice of care provider, birth place, or pain management options. I could write a whole other post on the topic of informed birth choices... But suffice to say for now, If you don't know your options, you don't have any.

Vitamin D Confusion

Until recently, I'd never given vitamin D much thought. I mean, rickets? Isn't that a disease that pirates and other seafarers got, along with scurvy and beriberi? It seems like every time I turn on the news lately, vitamin D deficiency is linked with other health conditions, such as cardiovascular disease, prostate cancer, diabetes, depression, even H1N1 influenza. The problem isn't limited to adults, either. New research has indicated that children are vitamin D deficient as well.

It's possible we've taken the "safe sun" message too much to heart. We've become so accustomed to slathering on sunscreen every time we step outside that we're blocking our bodies' natural vitamin D production from the UV light of the sun. Ironic that by trying to prevent one disease, skin cancer, we've potentially put ourselves in the path of other diseases.

The NIH recommends 400 IU of vitamin D supplementation for adults, assuming an individual is not synthesizing any vitamin D from sunlight. But is that enough? Recent evidence makes the case for higher amounts, up to 5000 IU per day. There is also a case for modest sun exposure, 5-10 minutes of full sun (without sunscreen) on the arms/legs/face, 2-3 times per week. But the amount each individual needs varies based on age, race, time of year, and latitude. So how to know if you're getting enough?

I was surprised to learn recently that a simple blood test can tell you if you're getting enough vitamin D. (And with my annual physical coming up in a couple of weeks, I'm definitely asking for my D to be tested as part of my labs.) If you'd like to ask for it too, it's the 25-hydroxyvitamin D test, also known as the 25(OH)D test. Note: This is different from the 1,25-dihydroxyvitamin D test [1,25(OH)2 D], which will not give an accurate portrayal of vitamin D status. According to the Vitamin D Council, a healthy level is 50-80 ng/ml, which should be maintained year-round.

Another bit of information of note: Athletes may need more vitamin D than the general population. This is an area of research that needs more study, but initial recommendations are on the upper end of the intake range. One writer chronicled her experience with D deficiency and its effects on her athletic performance. If your performance has been lagging for no apparent reason, it might be time to check your D level.

I think this is as good a reason as any for me to pack it in and move to the Caribbean. "Sunshine Vitamin" anyone?

NYTimes Article: Froot Loops Are Health Food

Link to article

You may soon be seeing the new "Smart Choices" labels on products at your grocery store. Several manufacturers- such as Kellogg's, Kraft, and PepsiCo- have banded together to label certain products as "better for you" options. They formed a committee, including the dean of Tufts University school of nutrition and representatives of each the cooperating corporations, in order to decide which foods would meet their criteria to receive the Smart Choices green checkmark logo.

Now here's the problem. Can we honestly think that giant processed-food manufacturing companies are going to put consumers' best interests ahead of their own financial interests? I'm going to go with, "Uh, no."

So what foods have made the list? You can do a search online for products by brand or by category. It's rather amusing to look at the contradictions. All-Bran and Corn Pops are both Smart Choices? Or as the article points out, both regular AND "light" mayonnaise are Smart Choices too? So, according to the Smart Choices program, it seems there is no substantial nutritional difference between those products. Also included as a Smart Choice: Fruit Roll-Ups. Never mind that in a 14g serving, 7g is pure sugar. A Smart Choice can be made of 50% sugar? Seriously, did a group of 7 year olds put this list together?

By artificially enhancing a food with little to no nutritional value, manufacturers can slap a Smart Choice label on a product. (Coming soon to a store near you: Bacon! Now with added calcium!) And by doing this, they can still claim they are following federal nutrition guidelines. This is a complete scam on the American public and an insult to our intelligence. There's hope though: The FDA has written a letter to the Smart Choices program to put the committee on notice that they'll be facing regulatory scrutiny. Let's hope they're willing to put some muscle behind the criticism. No, it's not easy to altogether avoid processed foods. But as consumers we can learn to read nutrition labels and make better choices without some silly checkmark contrivance.

What Color Is Your Pee?

Yes, that's right, I just asked you the color of your pee. Go ahead to the bathroom and check. I'll wait right here.

Done? Ok.

Urine color is a great indicator of your hydration, which is important even if your most strenuous activity is couch surfing. The U.S. Navy has a helpful chart to help you determine if you are sufficiently hydrated based on the color of your urine. How did you fare? As the chart notes, sometimes vitamin supplements can affect the color of your urine, particularly B vitamins, which tend to temporarily turn it neon yellow. If that's the case, you can check again in a couple of hours.

Severe dehydration is, of course, a serious condition, and can be fatal. Even mild dehydration can cause symptoms that many people would not associate with fluid loss, such as fatigue, headache, or irritability. Ever just feel "blah"? It could be mild dehydration!

How much fluid do we actually need? Well, the bad news is that it's probably more than you usually drink. The good news is that any liquid, not just water, counts towards your daily intake. Yes, even coffee. Even wine! In general, we need about two quarts of fluid a day- that's the legendary eight 8-0z. glasses of water. But that's just for starters. If you are spending time outside in hot weather, spending time at high altitude, ill, pregnant, or breastfeeding, you'll need to drink two to six cups more per day. And you'll definitely need to drink more during exercise.

The American College of Sports Medicine recommends a fluid replacement approach to hydration during exercise. If you weigh yourself before and after a workout, you can determine how much fluid you've lost. An ounce of water weighs 1 oz., so one pound of weight loss would be 16 oz. of fluid lost. Aim to consume at least that replacement amount during exercise, as well as taking in extra fluids before and after a workout. Unless you are exercising for upwards of an hour, plain water is sufficient for hydration. If you are training for more than an hour at a time, you should consider a sports drink for electrolyte and carbohydrate replacement.

It can be a PITA to make sure you're drinking enough each day. Hence the question, what color is your pee? If it is clear or pale yellow, you can be sure you are getting enough fluids. If not, think about carrying a water bottle with you or keeping a big cup on your desk at work. And the next time you're feeling "blah," reach for some water before you reach for some coffee or a snack-- You might just be dehydrated. Drink up and then go get your pee on!

Current Thoughts on H1N1 Influenza: "Swine Flu"

I've been following the news about the swine flu since it first started making headlines last spring. The media have repeatedly drawn our attention to the fact that the 1918 flu pandemic began much the same as the current one: With a mild version of the virus in spring and summer. And we all well know, by the fall of 1918, that strain turned suddenly deadly. It's difficult to escape drawing a very frightening parallel to the H1N1 strain making the rounds.

Although the government has been cautious about predicting the impact of swine flu this fall, the FDA is nonetheless putting the H1N1 vaccine on a fast track to approval. The call for the population to immunize may well happen before human clinical trials of the vaccine have been completed. And that, for me, is where things get very scary. Do I want to be in the position of being a guinea pig for a brand new vaccine? Do I want my children to be guinea pigs too?

The other concern I have with the H1N1 vaccine (aside from it being untested) is that it will be the first influenza vaccine to contain an adjuvant. A few other FDA-approved vaccines contain adjuvants, which help boost immune system response and allow less antigen to be included in the vaccine. That means the amount of antigen can be stretched to allow for more doses of the vaccine to be produced. And if you recall the flu vaccine shortage of 2004, this is a potentially fantastic development. But! The adjuvant in Glaxo's swine flu vaccine is not FDA approved, and while some clinical data exist from its use in Europe, it has not been studied here. More alarming: The government has made vaccinating pregnant women a priority, but the vaccine will go untested in pregnant women.

I am not anti-vaccination. I understand that vaccines are one of the most important medical developments of the modern era. My kids are fully vaccinated, with the exception of seasonal flu vaccines, mostly because those vaccines tend not to be highly effective due to strain mismatch. And (knock on wood) my kids have never had the flu despite being in daycare/preschool with dozens of other nose-picking little petri dishes like themselves. To my knowledge, I've only had the flu once, an unconfirmed case in 1999. I spent two days in bed, using copious amounts of NyQuil to maintain a semi-vegetative state until the worst had passed.

At present, H1N1 has not demonstrated itself to be any more virulent than any other strain of seasonal influenza. If the virus does not mutate into something more deadly, I have no plans to take part in what amounts to a mass clinical trial. If people start kicking the bucket left and right, however, I may be persuaded to get the vaccine. Let's not engage in mass hysteria and allow safety to fall by the wayside.