I saw this story from BBC NEWS and it's very good news for those folks who think that it's too late to start. It's never too late to start feeling good!!
Healthy living 'can add 14 years'
Taking exercise, drinking moderately, eating sufficient fruit and vegetables and not smoking can add as much as 14 years to your life, a study has found.
Research involving 20,000 people over a decade found those who failed on all criteria were four times more likely to have died than those who succeeded.
The findings held true regardless of how overweight or poor they were.
The Public Library of Science Medicine study suggests many could increase their lifespan through simple changes.
The research was carried out by the University of Cambridge and the Medical Research Council in the English county of Norfolk between 1993 and 2006.
Participants were aged between 45 and 79. They were socially mixed although overwhelmingly white, and as far as they were aware at the time, did not have cancer or any heart problems.
Taking off the years
A point was awarded for each of the following: not currently smoking, consuming between one and 14 units of alcohol per week (the equivalent of between half a glass and seven glasses of wine), eating five servings of fruit and vegetables each day and not being inactive.
This last category was defined as either having a sedentary occupation and taking half an hour of exercise a day, or simply having a non-sedentary job like a nurse or plumber.
Not only did the team find that those with four points were significantly less likely to have died over the period than those with none, they also found that a 60-year-old person with a score of zero had the same risk of dying as a 74-year-old with the full four points.
"We've know that individually, measures such as not smoking and exercising can have an impact upon longevity, but this is the first time we have looked at them altogether," said Professor Kay-Tee Khaw, who led the research.
"And we also found that social class and BMI - body mass index - really did not have a role to play.
"It means a large proportion of the population really could feel health benefits through moderate changes."
Everyone gains
It was in the reduction of deaths attributed to cardiovascular disease where the findings were most pronounced, with those scoring zero five times more likely to succumb than those scoring four.
But there was also a relationship between score and cancer deaths.
While the main analysis excluded people with known disease, the researchers found that those with serious conditions fared better the higher they scored than those who scored lower.
Health campaigners welcomed the study.
"This is good news and shows that by living a healthy life, people can reduce their risk of dying from heart and circulatory disease," said Judy O'Sullivan of the British Heart Foundation.
"By not smoking, drinking alcohol in moderation, taking regular physical activity and eating a diet rich in fruit and vegetables, people can improve their chances of living longer."
A Department of Health spokesperson said: "Everyone has responsibility for their own health, which was highlighted last year when we kickstarted the Small Change, Big Difference initiative to show people that there are simple changes they can make in their lives that will have a direct impact on their health."
© BBC MMVIII
Showing posts with label news. Show all posts
Showing posts with label news. Show all posts
Monday, January 07, 2008
Wednesday, October 17, 2007
From the New York Times website
We actually do this all the time!
October 17, 2007
The Minimalist
Serving Pasta? Forget What You Learned
By MARK BITTMAN
LET me propose that you start cooking pasta in a way that might make you the laughingstock of your foodie friends: make more sauce, and serve it on top of less pasta. Do exactly what you’ve learned not to do.
Instead of a pound of pasta for two to four people, make a half, or even a third of a pound. Instead of a cup or two of sauce, make it four cups, or more. Turn the proportions around.
What do you wind up with? Pasta more or less overwhelmed by sauce, which you can view as a cardinal sin or as a moist, flavorful one-dish meal of vegetables with the distinctive, lovable chewiness of pasta. (There is, of course, a tradition of this kind of pasta dish in Italy, but it falls more under the category of minestre, which is closer to soup.) It’s also an easy way to significantly increase your intake of vegetables without adding too many refined carbohydrates, and may, if you’ve abandoned it, get you back into pasta again.
Obviously this won’t work with every sauce — you don’t want to pull this trick with creamy or cheesy ones, or those based on meat — but it works with just about every vegetable you can think of, and with many fish preparations as well.
To understand why this may get you branded as a heretic, think back to the 1970s, when Americans needed even more help cooking than we do now.
Thanks to Marcella Hazan, Giuliano Bugialli and others, we discovered how to cook Italian food at home. And for the first time, many of us were venturing to Italy in search not only of Renaissance art and medieval villages but of the incredible cuisine.
What we found was exactly what Ms. Hazan had been telling us: Americans, even Italian-Americans, drowned their pasta. We poured on ladlefuls of thick tomato sauce and tossed two or three quarter-pound meatballs on top for good measure. We made the pasta itself irrelevant.
We also learned we overcooked it, undersalted the water and often used the wrong shape. But as much as I owe Ms. Hazan and her peers, for the first 20 years that I cooked pasta, I always felt as if I was about to be arrested for violating some canonical law.
In the old country, the sauce was used to barely moisten and flavor the pasta. There are a couple of possible explanations for this. One is that Italians were neat. “For centuries, most people ate pasta with their hands,” said Kevin Wells, who translated and annotated the 1570 cookbook “Opera dell’arte del cucinare” by Bartolomeo Scappi. Little or no sauce, he said, was “a matter of decorum.”
Another is that there were not always other options. “Poor people dressed pasta with little or nothing,” said Andrea Graziosi, a University of Naples professor. “The legend says they used to hang a herring, and each member of the family would rub his or her slices of bread on it to get flavor.”
When some of those Italians immigrated to the United States they found a continent that was producing food like no continent before. And, said Mr. Graziosi, “they overused what they found both because they felt richer and could not use what they had at home.”
“The consequences are the incredible distortions — to the Italian eye — of Italian-American cuisine,” he said. You want meat sauce, with meat on top? You’ve got it, in spades.
As the years went by, though, a kind of “if it’s Italian, it must be good” mentality developed here, and home cooks began enjoying pasta with a minimum of sauce. (We also began undercooking it, just to show that we could take al dente one ridiculous step further.)
But today, barely moistened pasta often doesn’t make sense. Even setting aside the extreme recommendations of the Atkins diet, it’s widely agreed that highly refined grains — a group that includes the semolina flour from which the best-tasting dry pasta is made — do us little nutritional good. From the point of view of the body, there’s little difference between pasta and white bread (and, for that matter, biscotti); neither has much in the way of protein, vitamins, micronutrients or fiber, and all are digested quickly and may ultimately be stored as fat.
I am not suggesting that we return to oversauced baked ziti with sausages, mozzarella-laden lasagna or spaghetti under three handball-size meatballs. Rather, I’m recommending that we exploit our astonishing supply of vegetables (still evident at this time of year), augmented if you like with a bit of meat for seasoning.
There are recipes here, but many people won’t need them. The other day, I arrived at a friend’s house in time to cook lunch. We had chickpeas, broccoli rabe and garden tomatoes. I parboiled the broccoli rabe, just until it became bright green; I then chopped and sautéed it in olive oil with garlic, dried chili flakes and a couple of cups of chickpeas. I added two or three chopped tomatoes. Meanwhile, I half-cooked about a third of a box of farfalle (undoubtedly a more legitimate cook would tell me I was using the “wrong” shape) in the water I had used for the greens.
When the tomatoes broke down and the broccoli rabe was tender, I dumped in the drained pasta, after saving some cooking water. I added a little of the liquid and simmered the mixture until the pasta was done. I garnished it with basil and a little more olive oil. Although it was not soupy, we used spoons because the broth was so good. Total working time was about half an hour, and a better one-dish lunch I could not imagine.
I’ve been playing with this style of pasta for months: a load of briefly sautéed spinach with garlic, raisins, pine nuts and a bit of stock; well-roasted mixed vegetables, mashed or puréed, with lots of olive oil; braised endive and onion; bok choy with black beans and soy sauce (with fresh Chinese egg noodles, naturally). The list is long.
Give it a shot. There is no downside — except maybe a bit of mockery from the pasta police (who I’m sure will arrive, in my case, later this morning).
October 17, 2007
The Minimalist
Serving Pasta? Forget What You Learned
By MARK BITTMAN
LET me propose that you start cooking pasta in a way that might make you the laughingstock of your foodie friends: make more sauce, and serve it on top of less pasta. Do exactly what you’ve learned not to do.
Instead of a pound of pasta for two to four people, make a half, or even a third of a pound. Instead of a cup or two of sauce, make it four cups, or more. Turn the proportions around.
What do you wind up with? Pasta more or less overwhelmed by sauce, which you can view as a cardinal sin or as a moist, flavorful one-dish meal of vegetables with the distinctive, lovable chewiness of pasta. (There is, of course, a tradition of this kind of pasta dish in Italy, but it falls more under the category of minestre, which is closer to soup.) It’s also an easy way to significantly increase your intake of vegetables without adding too many refined carbohydrates, and may, if you’ve abandoned it, get you back into pasta again.
Obviously this won’t work with every sauce — you don’t want to pull this trick with creamy or cheesy ones, or those based on meat — but it works with just about every vegetable you can think of, and with many fish preparations as well.
To understand why this may get you branded as a heretic, think back to the 1970s, when Americans needed even more help cooking than we do now.
Thanks to Marcella Hazan, Giuliano Bugialli and others, we discovered how to cook Italian food at home. And for the first time, many of us were venturing to Italy in search not only of Renaissance art and medieval villages but of the incredible cuisine.
What we found was exactly what Ms. Hazan had been telling us: Americans, even Italian-Americans, drowned their pasta. We poured on ladlefuls of thick tomato sauce and tossed two or three quarter-pound meatballs on top for good measure. We made the pasta itself irrelevant.
We also learned we overcooked it, undersalted the water and often used the wrong shape. But as much as I owe Ms. Hazan and her peers, for the first 20 years that I cooked pasta, I always felt as if I was about to be arrested for violating some canonical law.
In the old country, the sauce was used to barely moisten and flavor the pasta. There are a couple of possible explanations for this. One is that Italians were neat. “For centuries, most people ate pasta with their hands,” said Kevin Wells, who translated and annotated the 1570 cookbook “Opera dell’arte del cucinare” by Bartolomeo Scappi. Little or no sauce, he said, was “a matter of decorum.”
Another is that there were not always other options. “Poor people dressed pasta with little or nothing,” said Andrea Graziosi, a University of Naples professor. “The legend says they used to hang a herring, and each member of the family would rub his or her slices of bread on it to get flavor.”
When some of those Italians immigrated to the United States they found a continent that was producing food like no continent before. And, said Mr. Graziosi, “they overused what they found both because they felt richer and could not use what they had at home.”
“The consequences are the incredible distortions — to the Italian eye — of Italian-American cuisine,” he said. You want meat sauce, with meat on top? You’ve got it, in spades.
As the years went by, though, a kind of “if it’s Italian, it must be good” mentality developed here, and home cooks began enjoying pasta with a minimum of sauce. (We also began undercooking it, just to show that we could take al dente one ridiculous step further.)
But today, barely moistened pasta often doesn’t make sense. Even setting aside the extreme recommendations of the Atkins diet, it’s widely agreed that highly refined grains — a group that includes the semolina flour from which the best-tasting dry pasta is made — do us little nutritional good. From the point of view of the body, there’s little difference between pasta and white bread (and, for that matter, biscotti); neither has much in the way of protein, vitamins, micronutrients or fiber, and all are digested quickly and may ultimately be stored as fat.
I am not suggesting that we return to oversauced baked ziti with sausages, mozzarella-laden lasagna or spaghetti under three handball-size meatballs. Rather, I’m recommending that we exploit our astonishing supply of vegetables (still evident at this time of year), augmented if you like with a bit of meat for seasoning.
There are recipes here, but many people won’t need them. The other day, I arrived at a friend’s house in time to cook lunch. We had chickpeas, broccoli rabe and garden tomatoes. I parboiled the broccoli rabe, just until it became bright green; I then chopped and sautéed it in olive oil with garlic, dried chili flakes and a couple of cups of chickpeas. I added two or three chopped tomatoes. Meanwhile, I half-cooked about a third of a box of farfalle (undoubtedly a more legitimate cook would tell me I was using the “wrong” shape) in the water I had used for the greens.
When the tomatoes broke down and the broccoli rabe was tender, I dumped in the drained pasta, after saving some cooking water. I added a little of the liquid and simmered the mixture until the pasta was done. I garnished it with basil and a little more olive oil. Although it was not soupy, we used spoons because the broth was so good. Total working time was about half an hour, and a better one-dish lunch I could not imagine.
I’ve been playing with this style of pasta for months: a load of briefly sautéed spinach with garlic, raisins, pine nuts and a bit of stock; well-roasted mixed vegetables, mashed or puréed, with lots of olive oil; braised endive and onion; bok choy with black beans and soy sauce (with fresh Chinese egg noodles, naturally). The list is long.
Give it a shot. There is no downside — except maybe a bit of mockery from the pasta police (who I’m sure will arrive, in my case, later this morning).
Wednesday, August 22, 2007
diabetes and heart disease
Reading this, I'm really happy that my hunny (who was diagnosed with type 2 diabetes in July 2006) has a doctor who is watching his blood pressure and cholesterol levels as closely (if not more so) as his sugar.
August 20, 2007
Six Killers | Diabetes
Looking Past Blood Sugar to Survive With Diabetes
By GINA KOLATA
Dave Smith found out he had Type 2 diabetes by accident, after a urine test.
“Whoa, look at the sugar in here,” his doctor told him. Mr. Smith’s blood sugar level was sky high and glucose was spilling into his urine.
That was about nine years ago, and from then on Mr. Smith, like so many with diabetes, became fixated on his blood sugar. His doctor warned him to control it or the consequences could be dire — he could end up blind or lose a leg. His kidneys could fail.
Mr. Smith, a 43-year-old pastor in Fairmont, Minn., tried hard. When dieting did not work, he began counting carbohydrates, taking pills to lower his blood sugar and pricking his finger several times a day to measure his sugar levels. They remained high, so he agreed to add insulin to his already complicated regimen. Blood sugar was always on his mind.
But in focusing entirely on blood sugar, Mr. Smith ended up neglecting the most important treatment for saving lives — lowering the cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes.
He also was missing a second treatment that protects diabetes patients from heart attacks — controlling blood pressure. Mr. Smith assumed everything would be taken care of if he could just lower his blood sugar level.
Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure. But controlling blood sugar is not enough.
Nearly 73,000 Americans die from diabetes annually, more than from any disease except heart disease, cancer, stroke and pulmonary disease.
Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves. In fact, according to the federal Centers for Disease Control and Prevention, just 7 percent are getting all the treatments they need.
“That, to me, is mind-boggling,” said Dr. Michael Brownlee, director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York. “It makes me ask, What is going on? I can only conclude that people are not aware of their risks and what could be done about them.”
In part, the fault for the missed opportunities to prevent complications and deaths lies with the medical system. Most people who have diabetes are treated by primary care doctors who had just a few hours of instruction on diabetes, while they were in medical school. Then the doctors typically spend just 10 minutes with diabetes patients, far too little for such a complex disease, specialists say.
In part it is the fault of proliferating advertisements for diabetes drugs that emphasize blood sugar control, which is difficult and expensive and has not been proven to save lives.
And in part it is the fault of public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight.
Most diabetes patients try hard but are unable to control their disease in this way, and most of the time it progresses as years go by, no matter what patients do.
Mr. Smith, like 90 percent of diabetes patients, has Type 2 diabetes, the form that usually arises in adulthood when the insulin-secreting cells of the pancreas cannot keep up with the body’s demand for the hormone. The other form of diabetes, Type 1, is far less common and usually arises in childhood or adolescence when insulin-secreting pancreas cells die.
And, like many diabetes patients, Mr. Smith ended up paying the price for his misconceptions about diabetes. Last year, he had a life-threatening heart attack.
The Heart Disease
Just after returning from church last October, Mr. Smith had a discomforting sensation. Deciding to focus on something else, he went to a local newspaper office where he was weekend editor. But the strange feeling persisted and intensified.
“I felt a pain in my chest,” Mr. Smith recalled. “It wasn’t sharp — it was more of a kind of pressure, a feeling like something is contracting.”
The pain spread, to his neck, along his shoulder, down to his biceps. Mr. Smith, alone and frightened, looked up heart attack symptoms on the American Heart Association’s Web site. They were exactly what he was experiencing.
An hour later, Mr. Smith was at the Mayo Clinic in Rochester, Minn., in the throes of a major heart attack, transported by helicopter while his wife and two young sons frantically drove two and a half hours to be with him. A main artery to his heart was 90 percent blocked. If he had waited to seek help or if his local hospital and doctor had not acted quickly and sent him to the Mayo Clinic, he probably would have died.
Mr. Smith thought his biggest risk from diabetes was blindness or amputations. He never thought about heart disease and had no idea how important it was to control cholesterol levels and blood pressure. He said his doctor had not advised him to take a cholesterol-lowering or blood pressure drug and he did not think he needed them.
Most people with diabetes are equally unaware of the danger that heart disease poses for them.
A recent survey by the American Diabetes Association conducted by RoperASW found that only 18 percent of people with diabetes believed that they were at increased risk for cardiovascular disease.
Yet, said Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital, “when you think about it, it’s not the diabetes that kills you, it’s the diabetes causing cardiovascular disease that kills you.”
Dr. Brownlee said he was stunned by the results of the diabetes association poll. “If you are one of those 82 percent who don’t think you are at increased risk,” he said, “finding out that you are and that you can decrease that risk substantially could literally change your life.”
The science is clear on the huge benefits for people with diabetes of lowering cholesterol and controlling blood pressure. After multiple studies, costing hundreds of millions of dollars and involving tens of thousands of subjects, national guidelines were rewritten to reflect the new data, and professional organizations issued recommendations for diabetes care.
With cholesterol, the guidelines say that levels of LDL cholesterol, the form that increases heart disease risk, should be below 100 milligrams per deciliter and, if possible, 70 to 80. Yet, Dr. Brownlee said, diabetes patients with LDL cholesterol levels of 100 to 139 often are told that their levels — ideal for a healthy person without diabetes — are terrific.
“Many practicing doctors just don’t know that an LDL cholesterol number that is normal for someone without diabetes is not normal for someone with diabetes,” he said.
Mr. Smith found all that out too late. The heart attack, he said, “really blindsided me.”
He also did not know the other measures proven to prevent complications in diabetes. He was correct that high blood sugar is dangerous. It can damage the small blood vessels in the eyes, leading to blindness; the nerves in the feet, leading to amputations; and the kidneys, leading to kidney failure.
But no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation. So while controlling blood sugar can be important, other measures also are needed to prevent blindness, amputations, kidney failure and stroke. Mr. Smith was doing none of them.
He also made the common assumption that Type 2 diabetes is simply a consequence of being fat. And that losing weight will help cure it.
Obesity does increase the risk of developing diabetes, but the disease involves more than being obese. Only 5 percent to 10 percent of obese people have diabetes, and many with diabetes are not obese. To a large extent, Type 2 diabetes is genetically determined — if one identical twin has it, the other has an 80 percent chance of having it too. In many cases, weight loss can help, but, as Mr. Smith has learned, most who lose weight are not cured of the disease. He lost 40 pounds but still has diabetes.
“Everybody in the act of losing weight will have a pretty dramatic improvement pretty quickly,” said Dr. C. Ronald Kahn, a diabetes researcher and professor of medicine at Harvard Medical School. Blood sugar levels drop precipitously and the disease seems to be under control. But that is because the metabolic process of weight loss lessens diabetes. Once weight is lost, he added, and people stabilize at a lower weight, their diabetes may remain.
When it comes to weight loss, Dr. Kahn said, “there is a range of susceptibilities in how people react.”
Complex Regimens
Before he left the hospital, Mr. Smith’s doctors told him about his new diabetes regimen: a statin to drive his cholesterol level very low, two drugs to lower his blood pressure, an aspirin, insulin and two drugs to reduce his blood sugar levels. That new list of drugs was what he should have been taking all along.
Mr. Smith is taking them now, terrified that his heart disease will progress.
“I’ll never be out of the woods,” he said. “I’ve got to face that.”
Diabetes researchers say stories like Mr. Smith’s are all too familiar.
The statistics are grim: A quarter to a third of all heart attack patients have diabetes, even though diabetes patients constitute just 9.3 percent of the population. Another 25 percent of heart attack patients are verging on diabetes with abnormally high blood sugar levels.
Most worrisome are diabetes patients who already have symptoms of heart disease, like chest pains or a previous heart attack. “That is a terrible situation,” said Dr. James Cleeman, coordinator of the National Cholesterol Education Program at the National Institutes of Health. Those patients, Dr. Cleeman said, are set up for a fatal heart attack and should be stringently controlling their cholesterol and blood pressure.
And it is not just that many diabetes patients are overweight, as people with Type 1 diabetes, who often are thin, also have a high risk of heart disease. There is something about diabetes itself, researchers say, that leads to high levels of LDL cholesterol and a form of LDL cholesterol particles that is particularly dangerous. Diabetes also leads to increased levels of triglycerides, which are fats in the blood that increase heart disease risk, and in diabetes is linked to high blood pressure.
Being obese or overweight, in contrast, are “weak contributors to heart attack risk,” Dr. Nathan said.
Type 2 diabetes “does not exist in isolation,” Dr. Nathan said. “Underlying diabetes are all these cardiovascular risk factors.”
Somehow, though, it has taken quite a while for the alarm bells to go off.
One reason might be that it was heart disease researchers, not diabetes researchers, who conducted the seminal studies.
The key to saving lives is to reduce levels of LDL cholesterol to below 100 and also control other risk factors like blood pressure and smoking. The cholesterol reduction alone can reduce the very high risk of heart attacks and death from cardiovascular disease in people with diabetes by 30 percent to 40 percent, Dr. Cleeman said. And clinical trials have found that LDL levels of 70 to 80 are even better for people with diabetes who already have overt heart disease.
Studies of blood sugar control have been more problematic than those of cholesterol lowering.
In Type 2 diabetes, the most ambitious effort was a huge study in Britain. It found that rigorous blood sugar control could lower the risk of complications that involved damage to small blood vessels, a list that includes blindness, nerve damage and kidney damage. But there was no effect on the overall death rate. There was a small decrease in the number of heart attacks but it was not statistically significant, meaning it could have occurred by chance.
The National Institutes of Health is trying again, with a larger study of blood sugar control that includes enough patients to detect more subtle effects on the heart attack rate if they exist. For now, though, the answer simply is not known.
In Type 1 diabetes, a large federal study did find evidence that rigorous blood sugar control could reduce heart disease risk. But the effect emerged 12 years after the study ended and most of the patients, in those years, had not been able to sustain the blood sugar control that they had had during the study. Did the short period of rigorous control exert a delayed effect on heart disease or was the effect caused by some other factor during the study or afterward, some asked? While most think it was caused by blood sugar control, it is impossible to know for sure.
The result, notes Dr. John Buse, president-elect for science and medicine at the American Diabetes Association, is that for people with Type 1 and, especially, for those with Type 2 diabetes, there are still questions about whether and to what extent blood sugar control protects against heart disease and saves lives.
That leaves cholesterol lowering, for patients with Type 1 and Type 2 diabetes, as the most effective and easiest way by far to reduce the risk of heart disease and the only treatment proven to save lives. But doctors say achieving the recommended cholesterol levels usually means taking a statin. Some patients resist, wary of intense drug company marketing to patients and afraid of side effects like muscle or liver damage which, although extremely rare, have frightened many away from the drugs, Dr. Brownlee and other diabetes specialists said. (Dr. Brownlee said he had no financial ties to statin makers.)
Others point to drug company advertising itself.
Statin advertising, said Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington, is all about heart disease, and the advertisements do not mention diabetes. The diabetes advertisements are all about blood sugar. Dr. Hirsch has seen few that put the two together.
Yet lowering cholesterol with statins, Dr. Hirsch and others said, is much simpler than anything else diabetes patients are asked to do. And, he added, the drugs are among the best studied and the safest on the market. (Dr. Hirsch said he had no financial ties to statin makers.)
Dr. Hirsch has a message for diabetes patients: If he had to rate the different regimens for a typical middle-age person with Type 2 diabetes, the first priority would be to take a statin and lower the LDL cholesterol level.
Dr. Brownlee agreed, but added that the two other measures to protect against heart disease, blood pressure control and taking an aspirin to prevent blood clots, should not be neglected.
“Right now, without waiting for lots of exciting things that are almost in the pipeline or in the pipeline, starting tomorrow, if everyone did these things — taking a statin, taking a blood pressure medication, and maybe taking an aspirin — you would reduce the heart attack rate by half.”
The Burnout
Even when patients do take the right steps to control diabetes, the grueling process can simply wear them down.
Virgil Umbarger learned that he had Type 2 diabetes when he was 39 and had a medical exam for a life insurance policy.
That was 25 years ago, and the start of a journey that diabetes specialists say ends up fundamentally changing a person’s world. Unlike Mr. Smith, who has just awakened to the danger he is in, Mr. Umbarger, a funeral director in Yakima, Wash., has lived with diabetes and its increasingly complex regimen for decades. And, as happens with most diabetes patients eventually, he feels he is reaching a point where he just cannot continue to do all that he should to protect his health.
In a sense, Mr. Umbarger said, he was not completely surprised when he learned he had diabetes, because it runs in his family. But he never thought it would happen to him. At 6 feet tall and 195 pounds, he was not heavy.
Still, Mr. Umbarger’s first thought was to lose weight. “I starved myself,” he said, and lost 15 pounds. But he still had diabetes and the pounds crept back on.
Dr. Buse said his patients knew how important it was to diet and exercise, but most could not do it enough to make a difference, and some were also thwarted by medications to control blood sugar that make patients gain weight.
In the end, Mr. Umbarger decided to seek care from a diabetes specialist. He chose Dr. Hirsch, even though it meant driving nearly three hours each way for an office visit. There was no one nearby with that kind of expertise, Mr. Umbarger said.
On his first visit, Dr. Hirsch gave him a fistful of prescriptions, including a statin, blood pressure medications and one for the drug Mr. Umbarger dreaded — insulin. He also told Mr. Umbarger to have regular checks for eye, nerve and kidney damage. And he has to watch what he eats and count carbohydrates.
Dr. Hirsch and other diabetes specialists say they are well aware of how daunting the program can be.
“Many come here once or twice and walk away saying, ‘I don’t want to do this,’ ” Dr. Hirsch said.
Not Mr. Umbarger. For years, he tried to do all that was required. He can cope with the medications and the long drives to see Dr. Hirsch. The problem for him, as for most diabetes patients eventually, is the blood sugar monitoring. He is supposed to prick his finger six or more times a day to measure his glucose levels and adjust his insulin dose accordingly.
Every time he checks his blood sugar is like getting a report card — was he eating too many carbohydrates? Did he get the insulin dose right?
“I don’t want to look,” he said.
“Pricking your finger, seeing that number day after day, it wears on you,” Mr. Umbarger said. “It’s like a ball and chain.” He confesses that he has only been checking his blood sugar once or twice a day, guessing at many of his insulin doses. His blood sugar levels have been rising and guilt hangs over him.
Meanwhile, no matter what they do, most people with Type 2 diabetes get worse as the years go by. Patients make less and less insulin and their cells become less and less able to use the insulin they do produce.
“That is why it is not uncommon to start initially with diet therapy, then after a few years we need to add a drug that improves insulin sensitivity,” Dr. Kahn said. “Then when that drug isn’t enough, we add a second drug that improves insulin sensitivity by a different mechanism. Then we add a drug that stimulates that pancreas to make more insulin.”
Then, he added, patients with Type 2 diabetes may need insulin itself, but when that happens they have to take even more than a person with Type 1 diabetes — two or even three times as much — because their cells no longer respond adequately to the hormone.
While it is not easy to re-energize burned-out patients, Dr. Hirsch said, at the very least, doctors and patients should know what is important.
“We already have the miracle pills” — statins and blood pressure medications, he said. And they are available for pennies a day, as generics.
“We need patient education and physician training that this stuff is out there and this is what we should be focusing on to make a difference in lives.”
August 20, 2007
Six Killers | Diabetes
Looking Past Blood Sugar to Survive With Diabetes
By GINA KOLATA
Dave Smith found out he had Type 2 diabetes by accident, after a urine test.
“Whoa, look at the sugar in here,” his doctor told him. Mr. Smith’s blood sugar level was sky high and glucose was spilling into his urine.
That was about nine years ago, and from then on Mr. Smith, like so many with diabetes, became fixated on his blood sugar. His doctor warned him to control it or the consequences could be dire — he could end up blind or lose a leg. His kidneys could fail.
Mr. Smith, a 43-year-old pastor in Fairmont, Minn., tried hard. When dieting did not work, he began counting carbohydrates, taking pills to lower his blood sugar and pricking his finger several times a day to measure his sugar levels. They remained high, so he agreed to add insulin to his already complicated regimen. Blood sugar was always on his mind.
But in focusing entirely on blood sugar, Mr. Smith ended up neglecting the most important treatment for saving lives — lowering the cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes.
He also was missing a second treatment that protects diabetes patients from heart attacks — controlling blood pressure. Mr. Smith assumed everything would be taken care of if he could just lower his blood sugar level.
Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure. But controlling blood sugar is not enough.
Nearly 73,000 Americans die from diabetes annually, more than from any disease except heart disease, cancer, stroke and pulmonary disease.
Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves. In fact, according to the federal Centers for Disease Control and Prevention, just 7 percent are getting all the treatments they need.
“That, to me, is mind-boggling,” said Dr. Michael Brownlee, director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York. “It makes me ask, What is going on? I can only conclude that people are not aware of their risks and what could be done about them.”
In part, the fault for the missed opportunities to prevent complications and deaths lies with the medical system. Most people who have diabetes are treated by primary care doctors who had just a few hours of instruction on diabetes, while they were in medical school. Then the doctors typically spend just 10 minutes with diabetes patients, far too little for such a complex disease, specialists say.
In part it is the fault of proliferating advertisements for diabetes drugs that emphasize blood sugar control, which is difficult and expensive and has not been proven to save lives.
And in part it is the fault of public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight.
Most diabetes patients try hard but are unable to control their disease in this way, and most of the time it progresses as years go by, no matter what patients do.
Mr. Smith, like 90 percent of diabetes patients, has Type 2 diabetes, the form that usually arises in adulthood when the insulin-secreting cells of the pancreas cannot keep up with the body’s demand for the hormone. The other form of diabetes, Type 1, is far less common and usually arises in childhood or adolescence when insulin-secreting pancreas cells die.
And, like many diabetes patients, Mr. Smith ended up paying the price for his misconceptions about diabetes. Last year, he had a life-threatening heart attack.
The Heart Disease
Just after returning from church last October, Mr. Smith had a discomforting sensation. Deciding to focus on something else, he went to a local newspaper office where he was weekend editor. But the strange feeling persisted and intensified.
“I felt a pain in my chest,” Mr. Smith recalled. “It wasn’t sharp — it was more of a kind of pressure, a feeling like something is contracting.”
The pain spread, to his neck, along his shoulder, down to his biceps. Mr. Smith, alone and frightened, looked up heart attack symptoms on the American Heart Association’s Web site. They were exactly what he was experiencing.
An hour later, Mr. Smith was at the Mayo Clinic in Rochester, Minn., in the throes of a major heart attack, transported by helicopter while his wife and two young sons frantically drove two and a half hours to be with him. A main artery to his heart was 90 percent blocked. If he had waited to seek help or if his local hospital and doctor had not acted quickly and sent him to the Mayo Clinic, he probably would have died.
Mr. Smith thought his biggest risk from diabetes was blindness or amputations. He never thought about heart disease and had no idea how important it was to control cholesterol levels and blood pressure. He said his doctor had not advised him to take a cholesterol-lowering or blood pressure drug and he did not think he needed them.
Most people with diabetes are equally unaware of the danger that heart disease poses for them.
A recent survey by the American Diabetes Association conducted by RoperASW found that only 18 percent of people with diabetes believed that they were at increased risk for cardiovascular disease.
Yet, said Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital, “when you think about it, it’s not the diabetes that kills you, it’s the diabetes causing cardiovascular disease that kills you.”
Dr. Brownlee said he was stunned by the results of the diabetes association poll. “If you are one of those 82 percent who don’t think you are at increased risk,” he said, “finding out that you are and that you can decrease that risk substantially could literally change your life.”
The science is clear on the huge benefits for people with diabetes of lowering cholesterol and controlling blood pressure. After multiple studies, costing hundreds of millions of dollars and involving tens of thousands of subjects, national guidelines were rewritten to reflect the new data, and professional organizations issued recommendations for diabetes care.
With cholesterol, the guidelines say that levels of LDL cholesterol, the form that increases heart disease risk, should be below 100 milligrams per deciliter and, if possible, 70 to 80. Yet, Dr. Brownlee said, diabetes patients with LDL cholesterol levels of 100 to 139 often are told that their levels — ideal for a healthy person without diabetes — are terrific.
“Many practicing doctors just don’t know that an LDL cholesterol number that is normal for someone without diabetes is not normal for someone with diabetes,” he said.
Mr. Smith found all that out too late. The heart attack, he said, “really blindsided me.”
He also did not know the other measures proven to prevent complications in diabetes. He was correct that high blood sugar is dangerous. It can damage the small blood vessels in the eyes, leading to blindness; the nerves in the feet, leading to amputations; and the kidneys, leading to kidney failure.
But no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation. So while controlling blood sugar can be important, other measures also are needed to prevent blindness, amputations, kidney failure and stroke. Mr. Smith was doing none of them.
He also made the common assumption that Type 2 diabetes is simply a consequence of being fat. And that losing weight will help cure it.
Obesity does increase the risk of developing diabetes, but the disease involves more than being obese. Only 5 percent to 10 percent of obese people have diabetes, and many with diabetes are not obese. To a large extent, Type 2 diabetes is genetically determined — if one identical twin has it, the other has an 80 percent chance of having it too. In many cases, weight loss can help, but, as Mr. Smith has learned, most who lose weight are not cured of the disease. He lost 40 pounds but still has diabetes.
“Everybody in the act of losing weight will have a pretty dramatic improvement pretty quickly,” said Dr. C. Ronald Kahn, a diabetes researcher and professor of medicine at Harvard Medical School. Blood sugar levels drop precipitously and the disease seems to be under control. But that is because the metabolic process of weight loss lessens diabetes. Once weight is lost, he added, and people stabilize at a lower weight, their diabetes may remain.
When it comes to weight loss, Dr. Kahn said, “there is a range of susceptibilities in how people react.”
Complex Regimens
Before he left the hospital, Mr. Smith’s doctors told him about his new diabetes regimen: a statin to drive his cholesterol level very low, two drugs to lower his blood pressure, an aspirin, insulin and two drugs to reduce his blood sugar levels. That new list of drugs was what he should have been taking all along.
Mr. Smith is taking them now, terrified that his heart disease will progress.
“I’ll never be out of the woods,” he said. “I’ve got to face that.”
Diabetes researchers say stories like Mr. Smith’s are all too familiar.
The statistics are grim: A quarter to a third of all heart attack patients have diabetes, even though diabetes patients constitute just 9.3 percent of the population. Another 25 percent of heart attack patients are verging on diabetes with abnormally high blood sugar levels.
Most worrisome are diabetes patients who already have symptoms of heart disease, like chest pains or a previous heart attack. “That is a terrible situation,” said Dr. James Cleeman, coordinator of the National Cholesterol Education Program at the National Institutes of Health. Those patients, Dr. Cleeman said, are set up for a fatal heart attack and should be stringently controlling their cholesterol and blood pressure.
And it is not just that many diabetes patients are overweight, as people with Type 1 diabetes, who often are thin, also have a high risk of heart disease. There is something about diabetes itself, researchers say, that leads to high levels of LDL cholesterol and a form of LDL cholesterol particles that is particularly dangerous. Diabetes also leads to increased levels of triglycerides, which are fats in the blood that increase heart disease risk, and in diabetes is linked to high blood pressure.
Being obese or overweight, in contrast, are “weak contributors to heart attack risk,” Dr. Nathan said.
Type 2 diabetes “does not exist in isolation,” Dr. Nathan said. “Underlying diabetes are all these cardiovascular risk factors.”
Somehow, though, it has taken quite a while for the alarm bells to go off.
One reason might be that it was heart disease researchers, not diabetes researchers, who conducted the seminal studies.
The key to saving lives is to reduce levels of LDL cholesterol to below 100 and also control other risk factors like blood pressure and smoking. The cholesterol reduction alone can reduce the very high risk of heart attacks and death from cardiovascular disease in people with diabetes by 30 percent to 40 percent, Dr. Cleeman said. And clinical trials have found that LDL levels of 70 to 80 are even better for people with diabetes who already have overt heart disease.
Studies of blood sugar control have been more problematic than those of cholesterol lowering.
In Type 2 diabetes, the most ambitious effort was a huge study in Britain. It found that rigorous blood sugar control could lower the risk of complications that involved damage to small blood vessels, a list that includes blindness, nerve damage and kidney damage. But there was no effect on the overall death rate. There was a small decrease in the number of heart attacks but it was not statistically significant, meaning it could have occurred by chance.
The National Institutes of Health is trying again, with a larger study of blood sugar control that includes enough patients to detect more subtle effects on the heart attack rate if they exist. For now, though, the answer simply is not known.
In Type 1 diabetes, a large federal study did find evidence that rigorous blood sugar control could reduce heart disease risk. But the effect emerged 12 years after the study ended and most of the patients, in those years, had not been able to sustain the blood sugar control that they had had during the study. Did the short period of rigorous control exert a delayed effect on heart disease or was the effect caused by some other factor during the study or afterward, some asked? While most think it was caused by blood sugar control, it is impossible to know for sure.
The result, notes Dr. John Buse, president-elect for science and medicine at the American Diabetes Association, is that for people with Type 1 and, especially, for those with Type 2 diabetes, there are still questions about whether and to what extent blood sugar control protects against heart disease and saves lives.
That leaves cholesterol lowering, for patients with Type 1 and Type 2 diabetes, as the most effective and easiest way by far to reduce the risk of heart disease and the only treatment proven to save lives. But doctors say achieving the recommended cholesterol levels usually means taking a statin. Some patients resist, wary of intense drug company marketing to patients and afraid of side effects like muscle or liver damage which, although extremely rare, have frightened many away from the drugs, Dr. Brownlee and other diabetes specialists said. (Dr. Brownlee said he had no financial ties to statin makers.)
Others point to drug company advertising itself.
Statin advertising, said Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington, is all about heart disease, and the advertisements do not mention diabetes. The diabetes advertisements are all about blood sugar. Dr. Hirsch has seen few that put the two together.
Yet lowering cholesterol with statins, Dr. Hirsch and others said, is much simpler than anything else diabetes patients are asked to do. And, he added, the drugs are among the best studied and the safest on the market. (Dr. Hirsch said he had no financial ties to statin makers.)
Dr. Hirsch has a message for diabetes patients: If he had to rate the different regimens for a typical middle-age person with Type 2 diabetes, the first priority would be to take a statin and lower the LDL cholesterol level.
Dr. Brownlee agreed, but added that the two other measures to protect against heart disease, blood pressure control and taking an aspirin to prevent blood clots, should not be neglected.
“Right now, without waiting for lots of exciting things that are almost in the pipeline or in the pipeline, starting tomorrow, if everyone did these things — taking a statin, taking a blood pressure medication, and maybe taking an aspirin — you would reduce the heart attack rate by half.”
The Burnout
Even when patients do take the right steps to control diabetes, the grueling process can simply wear them down.
Virgil Umbarger learned that he had Type 2 diabetes when he was 39 and had a medical exam for a life insurance policy.
That was 25 years ago, and the start of a journey that diabetes specialists say ends up fundamentally changing a person’s world. Unlike Mr. Smith, who has just awakened to the danger he is in, Mr. Umbarger, a funeral director in Yakima, Wash., has lived with diabetes and its increasingly complex regimen for decades. And, as happens with most diabetes patients eventually, he feels he is reaching a point where he just cannot continue to do all that he should to protect his health.
In a sense, Mr. Umbarger said, he was not completely surprised when he learned he had diabetes, because it runs in his family. But he never thought it would happen to him. At 6 feet tall and 195 pounds, he was not heavy.
Still, Mr. Umbarger’s first thought was to lose weight. “I starved myself,” he said, and lost 15 pounds. But he still had diabetes and the pounds crept back on.
Dr. Buse said his patients knew how important it was to diet and exercise, but most could not do it enough to make a difference, and some were also thwarted by medications to control blood sugar that make patients gain weight.
In the end, Mr. Umbarger decided to seek care from a diabetes specialist. He chose Dr. Hirsch, even though it meant driving nearly three hours each way for an office visit. There was no one nearby with that kind of expertise, Mr. Umbarger said.
On his first visit, Dr. Hirsch gave him a fistful of prescriptions, including a statin, blood pressure medications and one for the drug Mr. Umbarger dreaded — insulin. He also told Mr. Umbarger to have regular checks for eye, nerve and kidney damage. And he has to watch what he eats and count carbohydrates.
Dr. Hirsch and other diabetes specialists say they are well aware of how daunting the program can be.
“Many come here once or twice and walk away saying, ‘I don’t want to do this,’ ” Dr. Hirsch said.
Not Mr. Umbarger. For years, he tried to do all that was required. He can cope with the medications and the long drives to see Dr. Hirsch. The problem for him, as for most diabetes patients eventually, is the blood sugar monitoring. He is supposed to prick his finger six or more times a day to measure his glucose levels and adjust his insulin dose accordingly.
Every time he checks his blood sugar is like getting a report card — was he eating too many carbohydrates? Did he get the insulin dose right?
“I don’t want to look,” he said.
“Pricking your finger, seeing that number day after day, it wears on you,” Mr. Umbarger said. “It’s like a ball and chain.” He confesses that he has only been checking his blood sugar once or twice a day, guessing at many of his insulin doses. His blood sugar levels have been rising and guilt hangs over him.
Meanwhile, no matter what they do, most people with Type 2 diabetes get worse as the years go by. Patients make less and less insulin and their cells become less and less able to use the insulin they do produce.
“That is why it is not uncommon to start initially with diet therapy, then after a few years we need to add a drug that improves insulin sensitivity,” Dr. Kahn said. “Then when that drug isn’t enough, we add a second drug that improves insulin sensitivity by a different mechanism. Then we add a drug that stimulates that pancreas to make more insulin.”
Then, he added, patients with Type 2 diabetes may need insulin itself, but when that happens they have to take even more than a person with Type 1 diabetes — two or even three times as much — because their cells no longer respond adequately to the hormone.
While it is not easy to re-energize burned-out patients, Dr. Hirsch said, at the very least, doctors and patients should know what is important.
“We already have the miracle pills” — statins and blood pressure medications, he said. And they are available for pennies a day, as generics.
“We need patient education and physician training that this stuff is out there and this is what we should be focusing on to make a difference in lives.”
Tuesday, August 21, 2007
a step in the right direction, I guess
Yes, Deep-Fried Oreos, but Not in Trans Fats
By MONICA DAVEY
INDIANAPOLIS, Aug. 17 — The deep-fried Combo Plate may be a little more healthful this year at the Great Indiana State Fair. So say the fair’s leaders, who, taking a step rarely seen in the realm of corn dogs and fried pickles, have banned oils with trans fats from all the fryers that line the grounds here.
The change is only the latest in a string of bans on artificial trans fats. Tied to health problems including heart disease, they have been banished by national restaurant chains, snack brands and New York City, which forbids restaurants to use them in food preparation.
But this is perhaps the most unlikely locale yet: the nation’s classic summer fair, long seen as one final safe haven from the health police.
Along the steamy thoroughfare here, where only sensitive palates can distinguish among the various cuts of potato (curly fries, ribbon fries and the old standby, French), fairgoers seemed pleased with the switch. The food tasted the same, they said happily. And if this meant they could indulge without guilt or have one more helping, so much the better.
“This is a slice of heaven,” said Ryan Howell, 31, as he cradled his Combo Plate, which, for the record, consists of one battered Snickers bar, two battered Oreos and a battered Reese’s Peanut Butter Cup — all deep-fried in oil that is trans-fat free, thank goodness.
“This was an issue we wanted to tackle,” said Cindy Hoye, executive director of the fair, which spent the winter months testing various oils and, despite the fears of some concessionaires about possible changes to taste or costs or tradition, concluded that trans-fat-free oils created what Ms. Hoye called a better product.
National fair officials say Indiana and at least one other fair, the Western Washington, have led the way on a health issue that is only now creating a buzz in the fair industry. During a national convention of fair officials in Las Vegas this November, Indiana representatives are to offer a workshop, “Going Trans-Fat Free,” which, the convention program promises, will answer the question “What is all the craze about?”
Some concessionaires here said trans-fat-free oils seemed to leave “less of a varnish buildup” on their French fry baskets and corn dog equipment. But Chris Coffman, who helps his brother, Sam, operate a stand that sells the fried-dough snack called elephant ears, was none too pleased with the new ways.
The oil they are now using has to be changed more often, Mr. Coffman said (although some other concessionaires said their new oils in fact required less changing). And he worried, briefly, that the ban might also apply to the margarine that the Coffmans use to make cinnamon sugar stick to their doughy confections; it does not, fair officials ruled.
And that, Mr. Coffman said, is the silly part of the whole ban: it will barely skim the surface of fair food’s inherently — and proudly — unhealthful nature, he said.
“It’s craziness,” said Mr. Coffman, 45, who says he eats fair food every day but who appears surprisingly trim. “They’re using this for a marketing ploy. It’s a way to convince people that they can eat more — that somehow all of this is safe now and you can eat all you want — when we all know that’s not true.”
The calorie count? The state fair does not require vendors to provide those numbers, and no one here would venture any guesses. But figures from the Web site Calorie King.com suggest that a Combo Plate, for instance, comes to well over 700 calories. That is more than a third of the entire daily caloric intake recommended by the Department of Agriculture for a 30-year-old woman who is 5-foot-6 and 130 pounds and who exercises less than 30 minutes a day.
Ms. Hoye, the fair’s executive director, pointed out some healthful (if, judging from the customer lines, less popular) offerings of salads and tomato juice here. But she was quick to acknowledge that trans-fat-free oils will not turn standard state fair cuisine into health food.
“When you are having fair food, you are having fun,” she said. “You’re probably still going to use some calories out here. Look, we can’t control what goes in an Oreo, but we can say what goes in our fryers out here.”
Jeremy Orme, who runs Fried Creations, the home of the Combo Plate, introduced a new item at this year’s fair: deep-fried Pepsi. He rolls out his Pepsi-based dough, dips it in a batter made with Pepsi and deep-fries it for 90 seconds. His oil, made of soybeans, is trans-fat free as required, and on the front of his booth he has posted a local newspaper’s account about the fair’s trans-fat ban.
But inside the booth, where the air is dense with oil, workers chuckle about the whole concept. And Mr. Orme himself rarely eats what he cooks here.
“I stay away from fried foods,” he said.
By MONICA DAVEY
INDIANAPOLIS, Aug. 17 — The deep-fried Combo Plate may be a little more healthful this year at the Great Indiana State Fair. So say the fair’s leaders, who, taking a step rarely seen in the realm of corn dogs and fried pickles, have banned oils with trans fats from all the fryers that line the grounds here.
The change is only the latest in a string of bans on artificial trans fats. Tied to health problems including heart disease, they have been banished by national restaurant chains, snack brands and New York City, which forbids restaurants to use them in food preparation.
But this is perhaps the most unlikely locale yet: the nation’s classic summer fair, long seen as one final safe haven from the health police.
Along the steamy thoroughfare here, where only sensitive palates can distinguish among the various cuts of potato (curly fries, ribbon fries and the old standby, French), fairgoers seemed pleased with the switch. The food tasted the same, they said happily. And if this meant they could indulge without guilt or have one more helping, so much the better.
“This is a slice of heaven,” said Ryan Howell, 31, as he cradled his Combo Plate, which, for the record, consists of one battered Snickers bar, two battered Oreos and a battered Reese’s Peanut Butter Cup — all deep-fried in oil that is trans-fat free, thank goodness.
“This was an issue we wanted to tackle,” said Cindy Hoye, executive director of the fair, which spent the winter months testing various oils and, despite the fears of some concessionaires about possible changes to taste or costs or tradition, concluded that trans-fat-free oils created what Ms. Hoye called a better product.
National fair officials say Indiana and at least one other fair, the Western Washington, have led the way on a health issue that is only now creating a buzz in the fair industry. During a national convention of fair officials in Las Vegas this November, Indiana representatives are to offer a workshop, “Going Trans-Fat Free,” which, the convention program promises, will answer the question “What is all the craze about?”
Some concessionaires here said trans-fat-free oils seemed to leave “less of a varnish buildup” on their French fry baskets and corn dog equipment. But Chris Coffman, who helps his brother, Sam, operate a stand that sells the fried-dough snack called elephant ears, was none too pleased with the new ways.
The oil they are now using has to be changed more often, Mr. Coffman said (although some other concessionaires said their new oils in fact required less changing). And he worried, briefly, that the ban might also apply to the margarine that the Coffmans use to make cinnamon sugar stick to their doughy confections; it does not, fair officials ruled.
And that, Mr. Coffman said, is the silly part of the whole ban: it will barely skim the surface of fair food’s inherently — and proudly — unhealthful nature, he said.
“It’s craziness,” said Mr. Coffman, 45, who says he eats fair food every day but who appears surprisingly trim. “They’re using this for a marketing ploy. It’s a way to convince people that they can eat more — that somehow all of this is safe now and you can eat all you want — when we all know that’s not true.”
The calorie count? The state fair does not require vendors to provide those numbers, and no one here would venture any guesses. But figures from the Web site Calorie King.com suggest that a Combo Plate, for instance, comes to well over 700 calories. That is more than a third of the entire daily caloric intake recommended by the Department of Agriculture for a 30-year-old woman who is 5-foot-6 and 130 pounds and who exercises less than 30 minutes a day.
Ms. Hoye, the fair’s executive director, pointed out some healthful (if, judging from the customer lines, less popular) offerings of salads and tomato juice here. But she was quick to acknowledge that trans-fat-free oils will not turn standard state fair cuisine into health food.
“When you are having fair food, you are having fun,” she said. “You’re probably still going to use some calories out here. Look, we can’t control what goes in an Oreo, but we can say what goes in our fryers out here.”
Jeremy Orme, who runs Fried Creations, the home of the Combo Plate, introduced a new item at this year’s fair: deep-fried Pepsi. He rolls out his Pepsi-based dough, dips it in a batter made with Pepsi and deep-fries it for 90 seconds. His oil, made of soybeans, is trans-fat free as required, and on the front of his booth he has posted a local newspaper’s account about the fair’s trans-fat ban.
But inside the booth, where the air is dense with oil, workers chuckle about the whole concept. And Mr. Orme himself rarely eats what he cooks here.
“I stay away from fried foods,” he said.
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