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My High Calorie Intake Could Make Me Forgetful?

Lori Lieberman, RD, CDE, MPH, LDN — Wed, 22 Feb 2012 19:41:23 +0000

On February 13, 2012, the Mayo Clinic issued the press release “Overeating May Double The Risk Of Memory Loss,” and I’m pretty worked up about it right now. It could be because the media is suggesting I should eat less, and I don’t like it when I’m told to eat less—particularly for no good reason. And maybe it’s because I take my mental function seriously, particularly living with Multiple Sclerosis, which can impact cognitive function. So best not to make unsubstantiated claims about what’s going to impact things like my memory unless it comes from good, solid science.

I’m perplexed. Could I really be the only one who sees the great irony in the opening statement of this Mayo Clinic press release stating that higher calorie intake, as self-reported by those with memory loss, ages 70-89, is associated with greater mild cognitive impairment (MCI)? The authors conclude, “Cutting calories … may … prevent memory loss as we age.” The study suggests that eating “too much” (more than 2,143 calories) may double the risk of memory loss.

Yes, the very people assessed to have the worse cognitive function reported the highest, sometimes extremely and unbelievably high calorie intakes. And as the press release’s video reveals, we’re talking significant impairment (as in “Oh my, I’ve forgotten I was supposed to fly to New York yesterday— oops!”).

It’s well established that self reported dietary intake is full of errors—generally, the underweight err on the side of over-representing food intake, while the overweight do just the opposite. But self-reporting by the cognitively impaired? Is this some sort of joke, an April Fool’s prank come early?

Even self-reported food intake using a validated assessment tool has its faults. (As in the Harvard study.) Being validated does not mean that the findings are real, that they reflect what was truly eaten. It merely addresses reproducibility. In this Mayo Clinic study, the only thing that was truly confirmed (as reported in the press release) is the degree of impairment, as assessed by more than one source. So we know the participants are truly cognitively impaired, but we don’t know with certainty how much they really calorically ate in the preceding year they were reporting on. Quite the population for accurately reporting, retrospectively, the amount they ate!

Maybe, given their MCI, the participants had forgotten how many portions they really consumed? Or perhaps they forgot that we typically don’t report these things honestly.

The Joke Is on Us

So here’s my beef. The Mayo Clinic’s press release, and subsequently the media outlets that picked it up, misled us. Even if my reasoning is off and all of the potential places where the science seems shabby were fully explained in the full study (which has yet to be released) there remains this problem: the media’s conclusions suggest causation when at best we have an unexplained association.

The research summary states that higher caloric intake is associated with more cognitive loss (but does not necessarily cause it). So to then conclude, as most every article has, that we should be reducing our food intake, “cut out the chips” even, limiting our calories to prevent memory loss couldn’t be more absurd! How unreasonable to manipulate us with these faulty one-liners, these irresponsible conclusions.

The Real Answer May Lie with BMI

The study controls for variables that might otherwise have confounded or confused the results. The researchers appropriately ensured that the finding, the increase in MCI with higher caloric intake, was not the result of such variables as diabetes, stroke, and, important to this argument, BMI. In other words, if I understand the press release and study abstract correctly, the increase in MCI associated with increased caloric intake at the highest intake levels was not due to BMI. So BMI would not have been similarly increasing along with the cognitive impairment. Or, for that matter, with caloric intake.

So here’s where I run into some difficulty. The study is stating that some—many individuals ages 70-89 years—are consuming more than 2,000 to 6,000 calories daily, if we believe what they self-reported. And this is not linked with increasing BMI? If it isn’t, that means people eating a rather extraordinary amount of food have no higher BMIs than those at lower intakes. Soooo, if they are eating so much but don’t have higher BMIs, then how do we explain this?

There are several possible explanations. They could be expending more calories from exercise. Yet from the abstract, there was no mention of activity level—a major omission if we are assessing intake and making claims regarding the effects of intake without exploring output. Maybe it’s exercise that’s linked with MCI, for goodness sake, as exercisers would need to be eating at higher calorie levels. “Exercise Causes Cognitive Impairment.” Wouldn’t that make for a headline!

Or, maybe there is some other medical explanation for such high intakes without resultant higher BMIs. Are they malabsorbing—as in such conditions as celiac disease? This would result in nutrient deficiencies, which certainly may be responsible for cognitive losses.

Or maybe they have some thyroid condition or cancer not yet diagnosed, which may account for greater expenditure of calories and may also impact cognitive function. I am no expert on memory loss—that I can say with certainty. But it appears the researchers have not done due diligence regarding their study and its conclusions.

In fairness, all the answers may be in the full research paper, yet to be published. I requested it but was only presented with the abstract and the press release; my questions regarding exercise were ignored.

Even referring to the higher caloric intake as “excessive” or “overeating” leaves me scratching my head—on what grounds? If you are more active than your peers at 75 years old—still playing tennis, walking regularly, golfing in your retirement years, even hiking as I’ve seen many a 70 and 80 year old do—wouldn’t you need to be consuming more calories? Why should they be labeling this higher intake excessive unless it is resulting in an undesirable weight increase outside of their normal range? I didn’t see this addressed in either the abstract or the press release.

And Why Should You Care?

Most of the people reading the Mayo Clinic’s press release do not match the profile of the study participants in terms of age. But they are being irresponsibly told that lower caloric intake may prevent cognitive failure. And when it comes from a reputable establishment such as the Mayo Clinic and sealed as a reality in the written word of such media outlets as the Wall Street Journal, Time Online, and others, people will believe it.

People will believe that higher caloric intake is detrimental—regardless of caloric need. And then another study may arise (like the Harvard study) drawing similarly inappropriate conclusions, and people will buy into those senseless conclusions, too. And soon everyone will be so inundated with all this “science” that they’ll be overwhelmed about what they can eat and what they should avoid and how much. See the problem?

What can you do? Don’t be too quick to accept the written word as fact. Await a follow-up study that might confirm findings. And be careful about where you get your information. Sure, reputable resources are better than sites promoting and selling something that have a financial interest in convincing you of the value of their words. But even seemingly solid institutions and individuals can draw the wrong conclusions. When in doubt, discuss such articles with those capable of shedding some light on the findings.

The unfortunate end result of early publication of scientific studies is a loss of trust. Studies that haven’t yet been published in peer-reviewed journals have no place in the hands of the public. Misinformation runs rampant; as consumers of this information, we are left overwhelmed and confused. And it’s a bad state of things when we can’t trust reputable medical institutions.

Religious Zealots Try to Impose Their Views on Women

Amy Tuteur, MD — Tue, 21 Feb 2012 19:46:58 +0000

Since when is bald-faced lying an acceptable religious practice?

In an amazing coincidence two groups of religious zealots have waded into the public fray. Both have done so ostensibly to promote American values. Both are attempting to control women’s bodies. And both groups are lying.

Catholic bishops claim that they are fighting for that quintessential American value, freedom of religion, in opposing a government mandate to include contraception in health insurance plans. Protestant zealots (joined in some cases by Catholic zealots) are blustering that proposed laws to mandate ultrasounds before abortion are nothing more than efforts to provide women with information needed to make the medical decision to terminate a pregnancy.

Both groups are lying. Both groups are attempting to violate that quintessential American value, freedom of religion. Indeed they are attempting to impose THEIR religion on people of other religions or no religion at all. And they are doing it in exactly the same way. They are committed to “rationing by inconvenience.”

Make no mistake; this is about Catholic zealots imposing their belief that birth control is immoral and this is about Protestant zealots imposing their belief that abortion is immoral. There has been no attempt to restrict their religious freedom. No one is attempting to force the Catholic bishops to use birth control and no one is attempting to force the Protestant zealots to have abortions. No one in either group is being forced to violate his or her religious convictions by engaging in a practice that he or she deems immoral.

So why are the Catholic bishops and Protestant zealots upset? Because they don’t want OTHER PEOPLE to use birth control and they don’t want OTHER PEOPLE to have abortions. Oops, let me amend that. They don’t want WOMEN to use birth control and they don’t want WOMEN to have access to abortion. What a coincidence. Both are trying to impose their religious convictions on WOMEN’S bodies.

Both the Catholic bishops and the Protestant zealots are trying to use the same method to accomplish their religious objectives: rationing by inconvenience.

Rationing by inconvenience is used by health insurance companies to deprive members of covered services. By making it difficult to access those services (mandating pre-approvals, denying payments, forcing members into complaint resolution and arbitration) insurance companies attempt to reduce use of expensive services or force members to pay out-of-pocket for those services in order to access them in a timely fashion. Rationing by inconvenience is used by religious zealots in precisely the same way. By refusing to pay for the health service of contraception, the Catholic bishops hope to discourage women, particularly poor women, from using birth control. Protestant and Catholic zealots hope to prevent women from accessing legal abortion by interposing inconvenience, whether it is waiting periods or mandate ultrasound exams that are both medically unnecessary and physically invasive. For example, religious zealots in the Virginia legislature are hoping that by mandating an invasive vaginal ultrasound, they can discourage women from having abortions.

That’s bad enough. What’s worse is that they are lying about it. Catholic bishops are trying to discourage the USE of birth control. Refusing to pay for it is just a tactic in preventing the use of contraception. It has nothing to do with the bishops’ religious freedom. Mandating medically unnecessary, inconvenient and uncomfortable procedures as requirement before accessing abortion has nothing to do with providing women with information.

These religious zealots should not be allowed to control women’s bodies by limiting their access to safe, legal medical TREATMENTS. They are attempting to impose THEIR religious values on women who don’t share them. These tactics should be rejected as fundamentally un-American attempts at religious coercion.

Cross posted on The Skeptical OB

Dystopia And Margaret Atwood’s A Handmaid’s Tale: 1986 – 2012

Kylie Sturgess — Mon, 20 Feb 2012 19:25:26 +0000

“OfFred was a normal everyday woman with a career, a name, a life like all women have come to expect and take for granted in this age. When the Religious Right came into power, they began to put into practice their insane beliefs which strip women of their identity, their rights, their body, their very name. Women are to be called Of (whatever asshat they belong to), instead of, say Beatrix. Reproduction is an issue because all the toxins in the environment have rendered many women infertile. But if you are fertile, woe to you, you get to be a baby factory against your will, get promised to some jerk you don’t love or even like because someone deemed him important enough to breed. Oh, come on!

This book was written in 1986…” - Review by Stephanie on GoodReads, February 10th, 2012.

While the genre of the book is open to debate (Valerie Martin in the introduction of the 2006 Everyman’s Library edition, suggests political satire, allegory, and even “reconstructed post-print novel”), I would argue that The Handmaid’s Tale by Margaret Atwood can be seen to firmly fit within the genre of science fiction, often called “speculative fiction”. This is an attempt by writers using their imagination to project themselves into a possible future.

Corporations and zygotes are not conceptually related, but, nonetheless, the extension of personhood rights to corporations may pave the way for the extension of personhood rights to zygotes. The latter action would, of course, limit the autonomy and reproductive rights of real persons, namely women. - Protect Zygotes and Corporations; Piss on Women, CFI, by Ronald A. Lindsay.

Within science fiction, you can see different kinds of novels: technology based, space, novels that explore society on earth as it might be in the future, and so on. Some of the more famous examples of speculative fiction include Huxley’s Brave New World, or Orwell’s Nineteen Eighty-Four. Sociologically speculative stories usually propose an argument about what are contemporary (not fictional) issues. The Handmaid’s Tale is one of these kinds of stories; it’s the author’s creation of an imagined society which grows out of our own, and represents potential events in the world as we know it.

Appearing of MSNBC with Andrea Mitchell today, Foster Friess, the main donor to the Super PAC backing Rick Santorum’s presidential bid, dismissed the controversy surrounding President Obama’s new birth control rule by suggesting that women should just keep their legs shut. - Santorum Sugar Daddy Foster Friess Gives ‘Gals’ Contraception Advice: Put An Aspirin Between Your Knees, Alex Seitz-Wald, Think Progress.org, Feb 16, 2012.

Her fault, her fault, her fault, we chant in unison.
Who led them on? Aunt Helena beams, pleased with us.
She did. She did. She did.
Why did God allow such a terrible thing to happen?
Teach her a lesson. Teach her a lesson. Teach her a lesson.
- The Handmaid’s Tale, p. 82.

The Handmaid’s Tale also falls into a sub-genre within speculative fiction, one with philosophical and literary antecedents. It is a dystopian novel: fiction that sets up for our contemplation an imagined world, not an ideal one – one in which the worst things that could happen have come to pass. Atwood does something similar to what Orwell and Huxley have done: demonstrating through her work how human society can go wrong.

The influence of earlier dystopian works like those of Swift’s Gulliver’s Travels or Butler’s Erehwon, or even Huxley’s Brave New World is open to discussion (I could point out comparisons between the segregation in Gilead and Brave New World’s World State) – but it can be said that Atwood is consciously working within a generic tradition.

It’s not necessary to have read More, Huxley or Orwell to engage with The Handmaid’s Tale, but a knowledge of dystopian texts does enrich the debate of which this book is a part.

The ultrasound legislation would constitute an unprecedented government mandate to insert vaginal ultrasonic probes into women as part of a state-ordered effort to dissuade them from terminating pregnancies, legislative opponents noted.

…”We hear the same song over there. The very tragic human notes that are often touched upon involve extreme examples,” said [Todd] Gilbert, R-Shenandoah. “But in the vast majority of these cases, these are matters of lifestyle convenience.” - Virginia House getting all up in your vagina, Daily Kos, February 15th, 2012.

Religious discourse is used within the novel as a form of social conformity – marginalising women’s place in society in both subtle and overt ways – and naturalises the patriarchy. Women can also act in collusion with men against other non-privileged women, to benefit their own standing in society; Serena Joy, who worked as an Evangelical singer, promoted the very same system that eventually resulted in her being house-bound, complicit and resentful.

Offred’s atittudes reflect a woman who “had it all”, who looked complacently at the groups that represented women’s rights and sees her mother as an aging women’s rights activist whose efforts were “over the top”. The Republic of Gilead is a clear warning for complacency of such women in society to accept their independence and equality without question – as predicted by Offred’s mother and by Moira, who eventually succumbed to the Republic of Gilead as a member of the Jezabel’s club (“…What I hear in her voice is indifference, a lack of volition.” p.284)

Set in Cambridge, Massachusetts (the Wall that is used for hanging executed bodies is in Harvard University), this is the story of a destabilised country, dying from radiation poisoning, which takes drastic steps to secure the population of male genes. Women’s biological function is privileged, but as a result, women become marginalised as individuals – as the prime aim is to find healthy, fertile women who can produce children for those ruling class of men in position of power and influence.

To me, The Handmaid’s Tale is indeed a dystopian novel, a warning – if society refuses to “act upon” changes enacted by dominant groups with strong ideologies, a totalitarian state like Gilead could be the devastating result.

As all historians know, the past is a great darkness, and filled with echoes. Voices may reach us from it; but what they say to us is imbued with the obscurity of the matrix out of which they come; and try as we may, we cannot always decipher them precisely in the clearer light of our own day.
Are there any questions?
– From the partial transcript of Problems of Authentication in Reference To The Handmaid’s Tale – Professor James Darcy Pieixoto (The Handmaid’s Tale, p.324).

Michele Baldwin, HPV Awareness Activist, Succumbs to Cervical Cancer but Leaves Legacy

Julia Lavarnway — Wed, 15 Feb 2012 18:25:20 +0000

Michele Baldwin (1966–2012)

Michele Baldwin, a passionate HPV and cervical cancer awareness activist, succumbed to the disease she fought so long and hard against on February 5, 2012, at the age of forty-five. Her father, Skeptical Inquirer editor Ken Frazier, wrote a beautiful obituary for Michele in the Albuquerque Journal.

Michele had already gone through two extensive rounds of treatment, one in the fall of 2009 and another one year later in the fall of 2010. Both rounds included a surgery—one of which was experimental. In the summer of 2011, the cancer once again returned, and this time the news was worse than ever: it was inoperable, and Michele had run out of treatment options. She was given less than a year to live.

Michele on the Ganges River in India (credit: http://www.starryganga.com)

Michele, a lover of water sports, threw herself into being a kayak guide. She realized that during her long hours on the water she was able to go for long stretches without thinking about cancer. It was then that she had the idea that would become her life’s work and legacy: she would stand-up paddleboard, a sport she had only just taken up in August 2011, seven hundred miles down the Ganges River in India for HPV and cervical cancer awareness. The journey began on October 18 in the Himalayan rapids of Rishikesh and ended on November 24 in the city of Varanasi. Michele set a world record for greatest distance ever paddleboarded by a woman and earned international press for HPV/cervical cancer awareness with her project, the Starry Ganga Expedition. She did it to save the lives of others; to make sure that other women wouldn’t have to suffer her same fate.

In a world in which we have politicians like Michelle Bachmann spreading misinformation about a vaccine that can literally save lives by preventing certain forms of cervical cancer, we need more people like Michele Baldwin who are willing to advocate for the HPV vaccine’s use. Michele made it her final mission in life to help the fight to stop this horrible disease. Her battle underscores the importance of getting this vaccine to women worldwide regardless of religiously based moral convictions.

Michele’s legacy will continue to bring awareness to the importance of HPV vaccination. Her entire journey down the Ganges was filmed by biographer Nat Stone and will be turned into a documentary by director/producer Mahmoud Salimi. Her’s is also the central story in Frederic Lumiere’s forthcoming television documentary, Anyone’s Daughter: The HPV Epidemic. Michele set up a living memorial to raise funds for cervical cancer/HPV awareness. Donations can be made through the Global Initiative Against HPV and Cervical Cancer.

Lessons From Cupid: Where BMI Goes Wrong

Lori Lieberman, RD, CDE, MPH, LDN — Tue, 14 Feb 2012 22:14:15 +0000

Today is Valentine’s Day and no, I’m not going to flash any food porn involving chocolates. But with Cupid hovering around lately, I couldn’t help but address the subject of BMI, Body Mass Index.

What if Cupid and his parents showed up in my office concerned about obesity? What would I say? Let’s assume for a moment, from the various images of him, that his BMI would be in fact high. For the record, BMI is simply a calculation of weight divided by height squared, used as a marker for obesity. It is not, as you have been lead to believe, a measure of body fatness or percent body fat.

If historically, as evidenced by Hallmark’s greeting cards, Cupid has always been husky from his youngest years, here’s what I’d say: Assuming he has paralleled the BMI chart, he is gaining as much annually as any other normal healthy child. It’s just that he started larger—simply genetics, most likely. I would still explore his intake and eating behaviors, recommending modifications to ensure health and prevent disease (just as I would do if an average weight individual presented for, let’s say, food allergies). But if all looked well, I would not create a problem where there was none.

If, however, I discovered he was hoarding the chocolates he planned to deliver, binge eating or emotionally overeating (perhaps because of unrequited love), these patterns would need to be addressed—with me and with a therapist.

Okay, maybe a LITTLE bit of food porn...

Like chocolates, we come in all shapes and sizes. And if your size, like Cupid’s, has always leaned toward the larger end of the spectrum, it is likely that is a healthy and normal place—for you. If, however, you have never listened to your hunger and fullness, tending to regularly use food for comfort or to manage stress and emotions, there’s room for changing your relationship with food—and as a result, your weight.

Maybe as an adult your BMI is out of range, placing you in the “obese” category. That puts you in good company with top paid professional athletes such as Vince Wilfork and Charles Barkley. BMI is hardly the best way to gauge your size, or your risk of disease. Many with high BMI’s are quite healthy and fit, often at the top of their games. BMI may be high simply from a high muscle mass. Remember, body mass index does not distinguish where that mass comes from—muscle or fat (or bone, for that matter).

Years ago a woman who did body building recreationally came in for assistance with weight loss. It was winter, and quite frankly I could never have visually guessed what her risk was. By the charts, she was obese with a high weight for her height. But when I assessed her eating, I could only conclude that she wasn’t eating enough, regardless of her weight concerns. Weeks later, following a half marathon, she reported that she was hospitalized with internal bleeding. Apparently, her percent body fat was so low that there was damage to her internal organs, resulting in the bleed. Yes, body fat does have a function, and cushioning our internal organs is just one example.

But if your weight has been climbing out of a healthy range, and you have not dramatically increased your muscle mass, it may be time to take a closer look at your activity as well as your food intake and eating behaviors.

And we should be most focused on an individual’s pattern, as opposed to their absolute weight or BMI. I had a teen patient not long ago who presented at the 50th percentile BMI for age. Great, no? His doctor thought so and was quite pleased with his healthy place on the chart. But a look at his BMI chart revealed that he had plummeted in a very short period from a high BMI to “normal”. Unfortunately, this drop resulted from anything but normal thoughts and behaviors around food; it was rather the consequence of a full-blown anorexia. Reinforcing how “healthy” his recent BMI was only added flames to the fire.

As for the adult Cupid, waist circumference, or waist to hip ratio, would likely tell me more, being suggestive of abdominal fat and its associated risk with chronic diseases, including Type 2 diabetes. A waist circumference above 35 inches (women) and 40 inches (men) is considered a predictor of increased risk. The waist-to-hip ratio—literally, your waist measurement divided by your widest hip measurement—is also a good predictor of risk. 1.0 or above is greater risk, and desirable is 0.8 for women and 0.9 for men.

But perhaps the best measure to use would be percent body fat (most accurately determined by underwater weighing but indirectly measured with calipers or more high tech devices). And yet I rarely recommend it. Why? Because we really don’t need another measure, another number to fixate on. If your weight is climbing out of range, you’ll know it. Take a look at your eating patterns and activity. Focus on eating mindfully and separating physical hunger from all the other reasons you eat.

And if your weight is above a “desirable” BMI, but has been stable for years and you have normal blood pressure, cholesterol, and blood sugar, let it go. As long as you can comfortably engage in activity to keep you strong and fit for years to come.