Sugary colas linked to gestational diabetes

Women planning on becoming pregnant may want to curb the cola habit. A study published today shows that drinking more than five servings of sugar-sweetened cola in the week prior to becoming pregnant raises the risk of developing gestational diabetes. This is the first study to find such an association.

Researchers from Louisiana State University examined data from 13,475 women in the Nurses' Health Study II. During 10 years of follow-up, they identified 860 cases of gestational diabetes. The women's dietary patterns were analyzed and showed that, compared with women who consumed less than one sugar-sweetened cola beverage per month, those who drank more than five servings a week had a 22% greater risk of gestational diabetes. No association was found for other sugar-sweetened beverages or diet beverages.

Gestational diabetes is a complication of pregnancy that can lead to premature birth and also raises the risk of later development of diabetes in the mother. Children whose mothers have gestational diabetes are at higher risk for obesity and diabetes.

"We don't know why significant association was only found in sugar-sweetened cola, but not other types of sugar-sweetened beverages -- fruit drinks, other soft drinks, etc," the lead author of the paper, Dr. Liwei Chen, said in a news release. "One of the explanations could be the tremendous popularity of cola in the United States."

It's possible that sugary colas increase the risk of gestational diabetes because the drinks contribute to a high glycemic load. Higher sugar intake by itself may lead to impaired function of the pancreas, where insulin is produced. The study is published in the journal Diabetes Care.

-- Shari Roan

Photo credit: Daniel Barry / Blooomberg News

Florida Department of Citrus seeks to 'educate' scientists about the value of orange juice

Apparently, the Florida citrus industry has a thin skin. When we reported earlier this month that many scientists have come to the conclusion that 100% fruit juice isn’t much healthier than soda, growers took notice.

To recap, here are some of the eerie similarities between fruit juice and soda:

A glass of juice concentrates all the sugar from several pieces of fruit. Ounce per ounce, it contains more calories than soda, though it tends to be consumed in smaller servings. A cup of orange juice has 112 calories, apple juice has 114, and grape juice packs 152, according to the U.S. Department of Agriculture. The same amount of Coke has 97 calories, and Pepsi has 100. And just like soft drinks, juice is rich in fructose -- the simple sugar that does the most to make food sweet.

Of course, fruit juice has many vitamins and minerals, but these are generally not lacking in the modern American diet. Besides, the healthier way to get them is to eat the fruit itself instead of drinking juice.

These facts have left many experts wondering why campaigns to impose taxes on soda and other sugar-sweetened beverages in the name of fighting obesity have neglected to target juice as well. As Dr. Charles Billington, an appetite researcher at the University of Minnesota, put it, juice “is pretty much the same as sugar water.”

That’s not how orange growers in Florida see things. To make their views known, the Florida Department of Citrus enlisted dietitian Gail Rampersaud to inform the experts quoted in our story about the virtues of orange juice. Several copies were delivered Tuesday.

Written on letterhead from the University of Florida College of Agricultural and Life Science’s Food Science and Human Nutrition department, where Rampersaud is a nutrition research and education assistant, the letter points out that:

•  One hundred percent orange juice is a natural source of essential vitamins, minerals and phytonutrients needed for a lifetime of good health. In fact, one 8-ounce glass counts as a fruit serving and can contribute to almost 25 percent of your USDA-recommended daily fruit and vegetable servings, based on a 2,000-calorie diet.

•  An 8-ounce serving of orange juice is an excellent source of vitamin C and provides at least 100% of the Daily Value for this important antioxidant. A recent analysis of NHANES data reports that 60 percent of adult men and 53 percent of adult women had dietary vitamin C intakes less than the Estimated Average Requirement (EAR) established by the Institute of Medicine and over 22 percent of adults had plasma vitamin C concentrations that put them at moderate risk of developing vitamin C deficiency. In addition to being rich in vitamin C, an 8-ounce serving of 100 percent orange juice is a good source of thiamin, potassium and folate and delivers other important nutrients such as vitamin B6 and magnesium.

•  Citrus juices are nutrient-dense and provide a high ratio of nutrients relative to their calorie content. A study that I conducted and published in the Journal of Food Science reported that 100 percent orange juice was more nutrient-dense than many commonly consumed 100 percent fruit juices, such as apple, grape, pineapple and prune.

•  Citrus fruit and juices, including 100 percent orange juice, are free of added sugars and contain only the natural sugars found in whole fruit. A comprehensive review of studies regarding 100% fruit juice intake and increased weight in children and adolescents reported that the preponderance of evidence does not support such an association. In fact, this review suggested that consuming 100% fruit juice in moderate amounts “may be an important strategy to help children meet the current recommendations for fruit.”

•  A recent analysis of NHANES 1999-2002 data reported that 50% of children age 2-5, 74% of children age 6-11, and 81% of adolescents age 12-18 are not meeting MyPyramid fruit intake recommendations based on a single day’s dietary intake. An evaluation of the same NHANES data reported that 100% fruit juice intake was associated with higher daily intakes of whole fruit in children age 2-11 years. The American Academy of Pediatrics’ guidelines include moderate intakes of 100 percent fruit juice (i.e., 4-6 ounces per day for children age 1-6 years and 8-12 ounces per day for older children). One hundred percent fruit juice can help children get the nutrients they need and help meet fruit intake recommendations.

•  While it is true that the 2005 Dietary Guidelines for Americans recommends that the majority of fruit choices should be whole fruit, the Dietary Guidelines Advisory Committee did recognize the nutritional value of including 100% fruit juice in the diet for providing nutrients such as vitamin C, folate, and potassium. The Committee concluded that the “recommended intake of fruits and juices achieve an optimal balance” with regard to meeting nutrient intake recommendations.

The letter failed to impress at least one researcher, who forwarded it on to us. (We posted it with Rampersaud’s permission.)

Dr. Robert Lustig, a pediatric endocrinologist at UC San Francisco, was quoted in the story saying, “The upside of juice consumption is so infinitesimal compared to the downside that we shouldn't even be having this discussion." Here is his response to Rampersaud (also posted with his permission):

Thank you for your letter. As it is stated in the Kaplan article, I am not against fruit. As far as I am concerned, the most important nutrient contained in fruit (not just citrus, but any fruit) is fiber. "The juice is Nature's way of getting you to eat your fiber." Thus, I am not against fruit; indeed I am for it. So the Florida Department of Citrus can rest easy in terms of the citrus crop.

Unfortunately, juice has no fiber. Just calories, of which half are fructose. I am attaching an article I wrote on the Fructose Epidemic demonstrating the difficulties in hepatic metabolism from fructose, and another article I co-wrote with the American Heart Association remanding the American public to reduce its consumption of fructose. As you can see, I am not the only one who thinks this is a problem.

The problem is not with fruit, but with juice. Juice is merely a method of decreasing depreciation and increasing profits for the food industry. For if you take the most important nutrient and throw it in the garbage, what person does that benefit?

So, if you are a representative of the citrus growers, you should be in my camp, and should applaud my research and my stance. Fruit affords all the micronutrients you highlight, affords you fiber, and reduces your consumption of fructose (1 orange has one fourth the calories of a cup of orange juice). If, on the other hand, you are merely a shill for the food processing industry, then I will be happy to battle you and your entire industry in an open forum. I welcome the challenge.

-- Karen Kaplan

Photo: Why drink juice when you can eat fruit? Credit: Francine Orr/Los Angeles Times

Better living through chemistry, Thanksgiving style

Listen up, all you science geeks: Do you want to be the star of Thanksgiving dinner? Then watch this video.

Taped a few days ago at the Catholic University of America in Washington, D.C., the video features a lecture and demonstration given by chemistry professor Diane Bunce. Bunce is also associate editor for chemical education research for the American Chemical Society's Journal of Chemical Education. She dons a pilgrim-esque bonnet and apron -- and then a lab coat -- to explain how chemistry and Thanksgiving intersect. Watch it and you'll amaze and possibly annoy friends and family with your newfound knowledge!

We won't provide any spoilers, but topics include how a pop-up turkey timer works (hint: it doesn't exactly have to do with the turkey) and why we eat mashed potatoes instead of paper towels (hint: it has to do with the molecular makeup of carbohydrates and cellulose). But wait -- there's more! Ever wonder what makes muffins rise? The answers are here. And don't miss the part about which antacids neutralize the most stomach acid. That could be key on Thursday. The video is also available on the Bytesize Science website, sponsored by the ACS.

We were riveted throughout the 23-minute video, and watching it we realized that had we had a professor like Bunce, no doubt chemistry would have been a lot more fun.

— Jeannine Stein

Folic acid and cancer: New data might add to suspicion or, better, to discussion

We're not trying to pick on folic acid, honest. As food additives go, the synthetic version of vitamin B9, aka folate, is one of the more noble ones, widely credited -- heralded even -- for reducing the rate of neural tube birth defects. But we are trying to point out, again, that if a little is good, a lot is not necessarily better. 

Several months ago we offered up this story in the Health section: 

Folic acid might be losing its sheen

It said: "New studies suggest that getting too much folic acid might fuel certain cancers in some people. And with the vitamin showing up in ready-to-eat cereals, bread, snack bars, multivitamins and more, some health experts fear that it's easy to far exceed the recommended daily intake of 400 micrograms. There is now an urgent need, experts say, to figure out how much folate is enough but not too much for different segments of the population."

That urgent need isn't going away. Now we have a study, published today in the Journal of the American Medical Assn., that might cause another eyebrow or two to be raised at this miracle of fortification.

Researchers in Norway analyzed data from 6,837 people with ischemic heart disease treated with folic acid, B6 and B12; folic acid and B12; just B6 or a placebo. Those treated with folic acid and B12 had higher rates of cancer, cancer deaths and deaths in general over the course of several years. Lung cancer contributed significantly to the cancer numbers.
 
Of note, Norway doesn't fortify its foods with folic acid, as does the U.S., meaning baseline blood levels were lower to start with than they would be here. Also of note, the researchers point out: Although the folic acid doses in the study were higher than what the typical American would consume through fortification alone, they were below the limits set by our Institute of Medicine.

Just as a lot of folic acid isn't necessarily a good thing, fortification isn't necessarily a bad thing. The researchers conclude:

"Our results need confirmation in other populations and underline the call for safety monitoring following the widespread consumption of folic acid from dietary supplements and fortified foods."

Here's that abstract  and more on folic acid from Medline Plus.

-- Tami Dennis

Photo: Would you like a folic-acid boost with that? You might as well.

Credit: Los Angeles Times

More tips from the Pantry Raid

Our nutritional makeover series "Pantry Raid" most recently took us to the home of Mission Viejo resident Kristy Noble and her sons, Scott, 14, and Robert, 17. The Nobles face time and money limitations familiar to lots of families that want to eat more healthfully but don't have a lot of time to cook.

Registered dietitian Lisa Gibson offers advice to the family, but she also recommended these resources for more information on diet and nutrition:

Books with nutritional information and/or recipes:

"American Dietetic Association Complete Food and Nutrition Guide" by Roberta Larson Duyff and the American Dietetic Assn. (Wiley, 2006): This book offers tips on eating more healthfully, incorporating more fruits and vegetables, navigating restaurant menus and devising safe ways to diet.

"Eating on the Run" by Evelyn Tribole (Human Kinetics, 2003): No time to cook? The author makes suggestions for healthful snacks on the go, gives advice on losing weight and emphasizes eating from all food groups.

"Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook" by the Cleveland Clinic, Bonnie Sanders Polin, Frances Towner Giedt and Dr. Steven Nissen (Broadway, 2007): Heart-healthy recipes fill this book, which also features advice on making lifestyle changes that last.

Magazines and newsletters on cooking and nutrition:

Cooking Light magazine and website: The magazine offers tasty, healthful recipes usually low in fat and calories, plus general health tips; the website also has recipes, plus information on health and entertaining.

UC Berkeley Wellness Letter: This ad-free newsletter from Berkeley's School of Public Health and other university researchers offers the latest in health research, translated for the layman. In addition to information on food and nutrition, it also includes wellness tips, plus information on exercise and preventive medicine.

Mayo Clinic Health Letter online: This widely read newsletter contains a plethora of health information on diseases, chronic conditions, exercise and more. It also features a recipe of the month.

Websites with information on nutrition and food:

American Dietetic Assn.: This site is packed with information on food and nutrition, and it links to MyPyramid, the customizable food and menu planner.

Healthy Dining Finder: Going out to dinner but not sure what you'll be faced with on the menu? Visit this site first, and find neighborhood restaurants featuring dietitian-recommended healthful items.

The lentil stew Kristy Noble prepared for dinner the night we were there was made with...

The McRib is (almost) back! Now, let's read the fine print

Hey, Southern Californians, if you're in the mood for a patty made from pork, water, salt, sugar (dextrose to be exact) and a few preservatives -- a.k.a. a McRib sandwich from your local Golden Arches outlet -- you're in luck. Or soon will be. This just in:

"Featuring a boneless pork rib patty topped with pickles, onions and tangy BBQ sauce served on a fresh bakery roll, the legendary sandwich, which has not been available to customers in Southern California since 2006, will be offered on the menu for a limited time at participating McDonald’s restaurants. ..."

This was too good to resist. We had to check out the nutritional information. The upshot: 500 calories per sandwhich, 26 grams of fat and 980 milligrams of sodium. To be fair, it's a better bet in some ways than the Premium Crispy Chicken Club Sandwich, with 630 calories, 28 grams of fat, and 1,360 milligrams of salt.

That's not to say healthful food can't be had. It can. So, please, choose wisely. The Southwest Salad With Grilled Chicken seems like a fairly smart choice -- unless you're watching your sodium. And you should be. (More on sodium as it relates to blood pressure, food, labels, etc.) And salads are less likely to be ordered with a honking huge side of fries. A large size has 500 calories of its own. (We will not discuss the McFlurry.)

For help in making smart choices when eating fast food, here's some basic advice from helpguide.org.

And for the nitty-gritty on menu options at chain restaurants, fast-food and otherwise (all conveniently compiled in one place), there's CalorieCount.com. It's fascinating stuff. ...

Still, we're left wondering ...

"Legendary sandwich"?

-- Tami Dennis

Photo: Make good choices. They're available.

Credit: Christine Cotter / Los Angeles Times
 

High-fat, high-sugar diet alters bacteria in the gut, making it easier to gain weight

A high-fat, high-sugar diet does more than just pump calories into your body. It also alters the composition of bacteria in your intestines, increasing the proportion of the little buggers that make it easier for you gain weight and harder to lose it, research in mice suggests. And the changeover can happen in as little as 24 hours, much faster than researchers had suspected, according to a report today in the new journal Science Translational Medicine.

Many different factors play a role in the propensity to gain weight, including genetics, physical activity and the environment, as well as food choices. But a growing body of evidence, much of it accumulated by Dr. Jeffrey I. Gordon of Washington University in St. Louis, shows that bacteria in the gut also play a key role. His findings could eventually lead to new ways to induce weight loss or to prevent weight gain in the first place.

Humans need bacteria in their gut to help convert otherwise indigestible foods into a form that is digestible. Human intestines contain trillions of bacteria, perhaps 10 of them for every cell in the body. Although hundreds of different types of bacteria are present, 90% of them fall into two major divisions, or phyla: the Firmicutes and the Bacteroidetes. Previous research had shown that obese mice had higher levels of Firmicutes, while their lean littermates had more Bacteroidetes. Analyzing the genomes of the bacteria, Gordon and graduate student Peter Turnbaugh concluded that the Firmicutes were more efficient at digesting food that the body can't, such as the complex sugars in grains, fruits and vegetables, breaking them down into simple sugars that can be used by the body.  Because these bacteria are more efficient, animals that have a higher proportion of Firmicutes in their guts convert a higher proportion of ingested food into calories that can be absorbed by the body, making it easier to gain weight. Over the course of a year, for example, a small increase in absorbed calories could lead to significant weight gain, Gordon said.

When the researchers transferred bacteria from the guts of obese mice into so-called gnotobiotic mice, which were raised in a sterile environment and had no bacteia in their guts, the mice gained more weight than did those receiving a similar amount of bacteria from lean mice, even though they were fed the same diet. But that was in mice. The question remained whether bacteria in the human gut could do the same thing.

In the new research reported today, Gordon, Turnbaugh and their colleagues found that they could transfer bacteria from human intestines into gnotobiotic mice, creating "humanized" mice that in themselves may prove to be a valauble research tool. The bacteria would colonize the mouse intestines even if they had been frozen and stored for long periods.

The gnotobiotic mice were fed a low-fat, plant-rich diet in the weeks before the bacteria were transplanted and for a month afterward. Analyzing the genomes of the bacteria, the team concluded that the bacterial colony in the mice was virtually identical to that of the human donor. After the bacteria were transplanted from a lean human donor, the colonies in the mice had a high proportion of Bacteroidetes and a low proportion of Firmicutes. But within 24 hours after the mice were switched to a high-sugar, high-fat diet, the proportions of the two phyla were reversed. With time, the mice also grew fatter than their littermates who did not receive the human bacteria. Furthermore, when the bacteria from these obese mice was transplanted into other gnotobiotic mice, those animals gained weight, even though they were kept on a low-fat diet. These findings suggest that the bacterial colonies can be passed from generation to generation, providing an explanation beyond genetics for why obesity runs in families.

The team is now studying bacterial colonies from malnourished children to see if the bacterial population can be altered to increase the children's ability to use food.

— Thomas H. Maugh II

 

Would you drink Coke or Pepsi for breakfast?

It appears that L.A. Times readers love their juice. Dozens of you wrote in to sound off about Sunday’s story “Nutrition Experts See Juice Glass as Half Empty.” The bottom line – that 100% fruit juice can be as unhealthy as soda – was not welcome news to many readers.

To recap, the story points out that fruit juice has comparable amounts of calories and sugar as soda on an ounce-per-ounce basis. Drinking excess soda will make you gain weight, and the same is true of juice. Health experts scratch their heads when schools remove soda from their vending machines and substitute juice instead. Though juice comes from fruit, it is not nutritionally comparable because it has more sugar and less fiber. As Dr. Charles Billington, an appetite researcher and endocrinologist at the University of Minnesota, put it: “It’s pretty much the same as sugar water.”

Juice drinkers wrote in with their complaints. Among them:

If [your butt] is super-glued to the couch, you can become obese eating celery. (I doubt it – that would mean eating a LOT of celery – but in principle, you could become obese if all you ate were apples and oranges.)

And:

My Dad lived to be 96 and drank more than one glass of orange juice, squeezed fresh every day. He hooked me, but I am only 80.

One reader pointed the finger at the way juice is packaged:

Just as with soda, having a big old half gallon in the fridge leads to pouring big old glasses of it any old time -- and a whole lot of calories.

But he added:

My father in his 60's was thinking that he was so healthy drinking his Tropicana orange juice every day -- a whole quart. Then suddenly, wham!! Diabetes hit him and he almost died. This is a Yale Medical School grad very aware of medical issues. In hindsight, he realized that he had been in sugar denial.

Several readers also wrote in to say that they’ve been on to juice for some time now. For instance:

I stopped drinking fruit juice several years ago when I realized I had high triglycerides, which can be a symptom of the body having trouble processing sugar and other carbohydrates. The large amount of sugar in orange juice even makes my teeth hurt now when I try some.

A researcher from the Harvard-affiliated Joslin Diabetes Center commented:

The "healthy halo" around juice has been in great need of a reevaluation.

He pointed to this study, published last week in the journal Cell Metabolism, that found that sugar consumption reduced the lifespan of worms. (I know, people are not worms, but they are useful models for studying aspects of human health.)

If you’d like to add your two cents, please feel free to post a comment here.

The problem of excess sugar consumption certainly raises the question (asked by one reader) of how much sugar one can consume each day without getting into trouble. The answer depends on how many total calories you’re shooting for each day. A helpful guide is available from LifeClinic.com. For instance, a 2,200-calorie diet can include up to 12 teaspoons (or 44 grams) of sugar each day.

I also got questions from many readers asking whether their beverage of choice (pomegranate juice, cranberry juice) was any healthier than orange or apple juice. You can look up almost anything at this website from the Agricultural Research Service’s Nutrient Data Laboratory, part of the U.S. Department of Agriculture. Be sure to check the 1-cup option to get an accurate read on calories, sugar and other components of an actual serving size (the program defaults to “100 grams”).

-- Karen Kaplan

Photo: Though it comes from real fruit, this glass of orange juice might was well be a Coke or Pepsi. Credit: Francine Orr / Los Angeles Times

High-carb diets may put dieters in better moods

The high-protein versus high-carb diet debate continues with the release of a new study that looked at something usually left out of the weight loss equation: mood.

Most studies on these two popular weight loss methods -- and on diets in general -- typically focus on pounds lost, pounds kept off and cardio-vascular function. But in a study published today in the Archives of Internal Medicine, Australian researchers took a more holistic approach. In addition to weight they also measured mood, discovering that those who stayed on a high-carbohydrate, low-fat diet for a year had better moods than those who were on a low-carbohydrate, high-fat diet, although the two groups lost about the same amount of weight.

The researchers randomly assigned 106 overweight and obese men and women to either a low-carb, high-fat diet or a high-carb, low-fat diet for a year. The groups were somewhat restricted in their calorie intake -- women were allowed 1,400 calories, and men about 1,700. On the low-carb plan, diets consisted of 4% carbohydrates, 35% protein and 61% fat, while the high-carb was composed of 46% carbohydrates, 24% protein and 30% fat.

The participants' weight was noted at weeks eight, 24, 40, and 52, and their mood was evaluated via three questionnaires that measured various aspects of mood, including tension-anxiety, depression-dejction and anger-hostility.

Both groups lost a significant amount of weight -- about 30 pounds. In the early weeks of the study both groups showed an improvement in mood. However, over time that changed. Mood improvements remained in the high-carb group but went back to original levels for the low-carb group.

Researchers speculate that the results could be evidence that it's tough sticking with a low-carb diet over a longer period of time, especially in cultures that favor carbohydrates. "Over the long term, trying to maintain that dietary pattern may mean coming across a lot of challenges," said Grant Brinkworth, lead author of the study and a research scientist at the Commonwealth Scientific and Industrial Research Organisation -- Food and Nutritional Sciences in Adelaide. "That may cause cause a negative mood impact, even though you’re getting a good weight loss." That bad mood might eventually affect adherence to the diet down the road as well, he added.

Another theory is that in a low-carb diet, lower levels of serotinin may be produced. Serotonin is a neurotransmitter responsible for lending a feeling of happiness and well-being, and eating carbs can increase its release.

-- Jeannine Stein

Photo credit: Krista Simmons / Los Angeles Times

Tsk, Kellogg. Did you think no one would notice?

-- First came the bold statement.

On boxes of Rice Crispies and Cocoa Crispies was the claim: "Now helps support your child's immunity." (The whole thing was in a bright yellow banner, with "immunity" rivaling the size of the product name.)

-- Then came the criticism and, of course, the media attention.

Here's Sunday's USA Today story: Critics blast Kellogg's claim that cereals can boost immunity. Said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity, in that story: "By their logic, you can spray vitamins on a pile of leaves, and it will boost immunity."

And said the Boston Globe in an editorial today:  "Even if Cocoa Krispies and Rice Krispies were helpful against the flu, the side effects would be unacceptable in a nation where obesity is epidemic among children. Kellogg’s deserves no immunity from public scorn."

Apparently, the San Francisco city attorney got the ball rolling with a letter demanding some explanation. Here's "City takes aim at Kellogg's advertising," from the San Francisco Examiner.

-- Now comes the pullback.

Says today's press release: "Kellogg Company today announced its decision to discontinue the immunity statements on Kellogg's Rice Krispies cereals. ... While science shows that these antioxidants help support the immune system, given the public attention on H1N1, the Company decided to make this change. The communication will be on pack for the next few months as packaging flows through store shelves. We will, however, continue to provide the increased amounts of vitamins A, B, C and E (25% Daily Value) that the cereal offers."

Perhaps smaller companies can get away with such things.

-- Tami Dennis

Photo: All that's missing is the immune-boosting breakfast cereal. Credit: Los Angeles Times