Americans may be heeding warnings to avoid sugary drinks, but many are still consuming way too much “added sugar” in their food, a new government report shows. 

And most of those sugary foods are being consumed at home rather than at restaurants, said study co-author Bethene Ervin, a nutritional epidemiologist at the Centers for Disease Control and Prevention.

Current government guidelines suggest that Americans limit total discretionary calories, including added sugars and solid fats, to 5 to 15 percent of food consumed per day. Ervin and her co-author Cynthia Ogden found that added sugars make up approximately 13 percent of the average American adult’s total intake.

Ervin and Ogden found that adult consumption of added sugars declined with increasing income. So, while women in the lowest income category were consuming 15.7 percent of their calories as added sugars, those in the highest income category were consuming 11.6 percent of their calories as added sugars. The researchers found a similar trend for men.

What surprised Ervin and Ogden was the lack of an income effect on kids. No matter what income bracket the kid came from, the consumption of added sugars was the same.

“Income is often considered a proxy for education,” Ervin said. “So adults with more income and education may be making healthier lifestyle choices. But that may not be translating over for their children.

”One culprit is sugary sodas. Although other research has shown that soda consumption has been declining, if you look at individual foods and beverages, these drinks still lead the pack, Ervin said.

Many Americans may not know how much total sugar they’re consuming because the sweeteners are often hidden in prepared foods, like ketchup, experts say.

“I think people are interested in making changes and they’re heeding the warnings about sugary beverages,” said Sara Bleich, an associate professor of health policy at the Johns Hopkins School of Public Health. “But when it comes to food it’s much more complicated. Cereal, for example, has a tremendous amount of added sugar. And not everyone understands that breakfast foods like muffins and pastry, things that people don’t consider to be a desert or an indulgence, pack a lot of sugar.”

Beyond that, there’s the issue of the tricky labeling found on food packages. “It takes 4 to 5 servings to fill a normal sized bowl,” Bleich said. “And that’s an enormous amount of sugar.”

Sometimes it just comes down to convenience over health, Bleich said. “I don’t think that moms want to be buying a KFC meal every night, but there’s also no time for them to cook a three course meal,” she added.

And then there’s the issue of dealing with kids who have absorbed all the marketing of sugary products. “It’s a two-way street,” Bleich said. “When it comes to kids, the whine factor does play a role.”

If you’re wondering why all there’s all this fuss about sugar, Dr. David Heber is happy to explain.

Too much added sugar, especially fructose, can lead to a multitude of chronic illnesses, said Heber, a professor of medicine at the University of California, Los Angeles, and director of the UCLA Center for Human Nutrition.

We’re genetically engineered to consume fats and sweets because we evolved on the savannah where food was scarce, so you ate as much as you could when you could, Heber explained. But in times of plenty, we can wreak havoc on our bodies, he added.

Fructose can convert to fat, which can not only make us heavier, but can also lead to a fatty liver – which is one of the leading causes of liver transplants, Heber said. Too much sugar can also lead to inflammation, which can raise the risk of heart disease.

Part of the problem is the ubiquity of added sugars. “Breads, for example, have a lot of sugar,” Heber said. “It’s in all kinds of places you’re not expecting to find it, even foods like ketchup.”

Heber suggests steering clear of processed foods. “You want a diet that his high in protein and low in fat with two thirds of your plate taken up by fruits and vegetables,” he said. 

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A Mediterranean diet rich in fruits, vegetables, olive oil and a little wine can cut the risk of heart attacks and strokes by 30 percent, researchers reported on Monday in a study that shows the real-life benefits of a diet long encouraged by doctors.

The results were so startling that the study was cut short after less than five years, and the results rushed to publication in the New England Journal of Medicine.

“A Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events,” the researchers, led by Dr. Ramon Estruch of the Carlos III Health Institute in Barcelona, wrote.

The study was done in Spain, where people already supposedly eat the Mediterranean diet -- which is characterized by lots of salad, fruit, vegetables, nuts, a little fish, a little lean meat, a small amount of cheese and olive oil.  Wine is also served at meals. But the 7,400 volunteers in the trial got extra counseling, and either a weekly supply of extra-virgin olive oil or mixed nuts.

Many studies have shown that people who eat a Mediterranean diet are less likely to die of heart disease. This one was powerful because it randomly assigned people to eat such a diet as part of their normal lives over several years.

The 7,400 patients aged 55 to 80 were all high risk of heart disease because of diabetes, a family history of heart disease, high blood pressure, unhealthy cholesterol levels or they were overweight or smokers.

They were randomly assigned to one of three groups: a Mediterranean diet with extra-virgin olive oil added; the same diet but with mixed nuts; or just a standard diet with advice to cut fat. They were given either a liter of olive oil per week (for the olive oil group), 30 grams of walnuts, hazelnuts and almonds (for the nut group), or little non-food presents for the control group.

They all got individual and group counseling.

After nearly five years, 58 people who simply followed a low-fat diet had strokes, but just 32 people did if they ate a Mediterranean diet with nuts, and 49 who followed the Mediterranean diet with extra olive oil. The Mediterranean diet also cut the risk of heart attack.

Thirty people died from heart disease in the control group, compared to 31 who ate the Mediterranean diet with nuts and 26 who at the Mediterranean diet with olive oil.

But the people who ate a Mediterranean diet were less likely to die overall in the five years, compared to those in the control group. Overall, the Mediterranean diets cut the risk of heart disease death, heart attacks and strokes by 30 percent, the researchers calculated.

"This is another piece of evidence for the benefits of diets containing 'good' fats such as those in olive oil and nuts," said nutrition expert Marion Nestle of New York University. 

"I wonder whether they plan to continue the trial for a longer time—I didn’t see any comment on that—because a few more years might give greater clarity," Nestle added in an e-mail.

There are lots of reasons why a Mediterranean-style diet might reduce heart disease. Researchers had noticed that people in Northern Europe, who eat butter and lard more than olive oil, were more likely to die of heart disease than their Southern European neighbors, even if they were just as overweight and exercised the same amount.  A study of the diet’s benefits published back in the 1960s showed the diet cut the rate of strokes and heart attacks, probably because it lowered cholesterol levels.

Olive oil and nuts contain monounsaturated fats, which are better for artery health than the saturated fats found in butter, meat and lard. The diet is also high in fiber and vitamins such as A, C and E, as well as minerals.  Walnuts and fish are rich in omega-3 fatty acids, which have been shown to benefit heart health. And reducing meat has been shown to cut the risk of both heart disease and cancer.

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Courtesy of Robin Herman

Robin Herman, 60, says it's harder to keep weight off after menopause. But some simple, subtle changes may help.

Robin Herman has always been slender. She eats right, exercises regularly and keeps an eye on her weight. But middle age and menopause have hit her right in the waistband, and she’s frustrated.

“What is this? I used to be able to look straight down at my feet and now there’s this rounded tummy in the way,” Herman says. While she’s still not overweight, Herman, 60, has gained 11 pounds that she just can’t seem to shake. Her problem illustrates what many women are finding in mid-life -- they are putting on pounds despite their best efforts.

“At first I cut back about a quarter of what I was eating. And then I was just eating about half of what I had been eating. Now I don’t take seconds. I don’t eat a lot of bread. I don’t eat potatoes. I don’t eat empty calories. I don’t drink sodas,” said Herman, who recently retired from the Harvard School of Public Health in Boston.

She joined Weight Watchers, a program that’s been clinically proven to work in helping people lose weight. “I kept a food diary. You could eat as many fruits and vegetables as you wanted. I put in a little more exercise,” she says.

“I got nowhere. It just wasn’t doing anything. And it was making me crazy about following every spoonful I ate.”

Herman sounds like thousands of women across the country who are slowly tipping over the point from being normal weight to overweight, or from being overweight to obese. A study published on Tuesday sheds a little light on what may work and why some approaches that help women shed a few pounds in the short term aren’t helping them keep the weight off long-term.

Bethany Barone Gibbs of the University of Pittsburgh Medical Center and colleagues analyzed data from a study of more than 500 overweight women in their 50s and 60s to see what made a difference. They had been randomly assigned to either intensive nutritional and exercise counseling, or to a more general, less weight-loss-focused program. The woman also reported what and where they ate, for four years.

As expected, more of the women who got specific diet and nutrition counseling lost weight. But Gibbs and colleagues wanted to know what worked for any of the women who managed to lose weight, regardless of which group they were in.

Early on, some of the more obvious diet strategies worked -- eating less fried food, staying away from restaurants, avoiding sweets and eating more fish. But these approaches didn’t work for the women in the long term, Gibbs reported in the Journal of the Academy of Nutrition and Dietetics.

 “What we found at four years is that the women who changed their eating behaviors to eat more fruits and vegetables, who ate less desserts, less sugar-sweetened beverages and less meats and cheeses were more likely to have greater weight loss or less weight gain long term,” says Gibbs, an assistant professor in the Department of Health and Physical Activity.

“But on the other hand, something like eating more fruits and vegetables did not predict weight change at six months but was one of the most important predictors for long-term weight change.”

Avoiding restaurants didn’t seem to make a difference long-term, either, she said. Gibbs said the key to keeping weight off long-term may be a little counter-intuitive. “Short term, people are still motivated when they start a weight loss program,” she said. “They are never going to eat another French fry, eat another piece of pie, so you see the pounds coming off.”

But hardly anyone can keep this kind of abstinent behavior up forever. The women who added fruits and vegetable to their diets, using them to replace higher-calorie meats and cheeses, lost more weight over the long-term. “That small change can give you a big, long-term result,” Gibbs said.

How could something so subtle work better than going for the big effect? In part, it’s because weight gain is often subtle and sneaky, too, says Katherine Tallmadge, a personalized nutrition counselor and speaker and immediate past president of the DC Metro Area Dietetic Association. “When people gain weight, it’s usually a pound or a pound and a half a year,” she says. “It is a very small and creeping kind of weight gain.”

The study also illustrates what many middle-aged women complain about. “I recall at age 25 if I wanted to lose five pounds I could do it in a week.  Now, it takes far longer to lose weight,” says Karen Giblin, president of menopause support organization Red Hot Mamas North America, Inc.   

This doesn’t surprise Dr . Domenica Rubino, an endocrinologist who runs the Washington Center for Weight Management and Research. “As we age, the average person has a tendency to gain weight and to gain more fat than muscle,” Rubino says. On top of this, women are undergoing hormonal changes that can disrupt sleep, stress them out and make them tired, three things also associated with weight gain. “Women are getting early morning awakening  and even though they are exhausted, they are not getting back to sleep,” she says.

Giblin can vouch for what happens next. “My willpower goes down the tube when I'm stressed and I will not do all the good things I should do be doing like eating properly and exercising,” Giblin says.

It all can add up to the muffin top effect: that shift of weight to the abdomen that makes clothes fit poorly, if at all, and that stresses out a woman every time she gets dressed.

“It’s so hard counting calories and keeping food diaries for years and years and years,” Gibbs agreed. “We have a population-sized problem here.” With two-thirds of Americans overweight or obese, she says, people need some simple solutions.  

“I've had to make exercise a lifestyle choice,” says Giblin, who co-authored "Eat to Defeat Menopause" with Dr. Mache Seibel last year. “Never skip a meal,” she advises. “And if you are prone to snacking, grab a piece of fruit or six  to eight almonds.”

Rubino says hormone replacement therapy can help, too, if it helps cut hot flashes and anxiety. “You are sleeping better and not having the hot flashes and your mood is better,” she says.

STOP Obesity Alliance Director Dr. Scott Kahan says managing stress can really help people control weight. “If things are very stressful, things are going on in your life, often stress management techniques can help,” he says.

Kahan and others admit this can be easier said than done. “I think we live in a very difficult time, a toxically busy world,” Tallmadge says. “What really upsets me is when people call themselves lazy or undisciplined when in fact they are running themselves ragged.”

But it’s not exercise.  Many women are busy getting their families ready for the day and then commuting during the very morning hours when they would have been otherwise most likely to exercise.

“It’s a real balancing act.”

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FDA

The Food and Drug Administration has approved two new diet drugs, but both have restrictions about who can -- or should -- take them.

The Food and Drug Administration has approved two new diet pills in a week -- the first new obesity drugs to be approved in 13 years. The agency, usually dry about its approvals, practically gushed about the pent-up demand for new obesity treatments in a country where more than two-thirds of the population is overweight or obese and steadily getting fatter.

“These prescription medications would be taken for the rest of a person’s life,” the FDA says on its website. 

“For many people, obesity is a life-long condition, but we don’t always think of it -- or treat it -- as such,” said Dr. Amy Egan, deputy director for safety in FDA’s Division of Metabolism and Endocrinology Products

But don’t expect to be able to get either drug easily. Each of the new drugs -- Belviq and Qsymia -- is being restricted in a different way. And consumer advocates say dieters should think twice about taking either.

The FDA was so worried about Belviq, approved last week, that it has asked for the Drug Enforcement Administration to control its use, like it does opiate painkillers. The DEA must now decide what restrictions to put on the pills, a process Belviq’s maker, Arena, says could take several months.

Qsymia, approved on Tuesday, won’t have these restrictions. But the FDA and drugmaker Vivus have worked out a plan to try to ensure that doctors don’t start running diet pill-mills.

“The only way the doctors will be able to prescribe Qsymia is through a certified pharmacy,” Vivus vice president Dr. Barbara Troupin said in an interview. That means they won’t be able to stock it themselves -- and they’ll be barraged with educational materials, Troupin said.

Vivus will track which doctors are prescribing the drug, and which ones undergo training. “If a prescriber wants to write for (prescribe) the drug, they can write for the drug. But we will have their information and continue to inform them about the risks and who the appropriate patients are,” Troupin said. “Hopefully, they won’t view it as being tormented.”

But the FDA and Vivus understand that people are likely to be clamoring for the drug, and there are clear guidelines on who should take it. Women who might get pregnant shouldn’t, for one -- the drug causes birth defects including cleft palates. Nor should people with overactive thyroids or who have heart disease risks such as an irregular heartbeat.

Approved patients should be obese, meaning they have a body mass index -- a measure of height to weight -- of 30 or greater. The National Institutes of Health has a BMI calculator here. A person 5 feet 5 inches tall is considered overweight at 150 pounds and obese at 180 pounds. People with BMIs of 27 may be eligible if they have a weight-related condition such as high cholesterol.

Doctors will be asked to monitor patients closely, watching heart function and looking for signs that a patient may become suicidal --a side effect of drugs related to topiramate, the seizure drug included in the two-drug Qsymia cocktail.

These precautions do not satisfy Dr. Sid Wolfe of Public Citizen, who has campaigned against Qsymia and Belviq.

“I would be very surprised if either of these drugs stays on the market very long,” Wolfe said in an interview.

Food and Drug Administration officials approved the diet drug Qysmia this week.

He points to the long list of withdrawn diet drugs, from Dexatrim, which caused fatal strokes, to fenfluramine, withdrawn in 1997 because it could damage heart valves, and ephedra, banned in 2004 after it was found to cause deadly heart attacks, strokes and other ills. Wolfe was disappointed when Qsymia won approval.

“There are a bunch of problems with it,” he said. “One is there is not remotely any kind of failsafe way to keep pregnant women from using this drug.”

Americans and drug companies are looking for an easy way out, but study after study shows good, old-fashioned careful eating and exercise works better than any diet pill, Wolfe says. And healthy eating and exercise have the added bonus of lowering the risk of heart disease, cancer, diabetes, arthritis and even Alzheimer’s disease. Wolfe's group approves of carefully designed programs that help people do that.

“People are just so desperate to approve something because they haven’t done anything for 13 years,” Wolfe said. One of Qsymia’s components, phentermine, is on the market as a diet drug. The only other diet drug on the market is orlistat, which stops the body from absorbing fat. A low-dose version, Alli, is even available without a prescription. But that’s it. The only other option for severely obese people, besides diet and exercise, is surgery to limit how much they can eat.

It is possible to get a home-made version of Qsymia. Any licensed doctor can prescribe phentermine together with certain versions of topiramate, the epilepsy drug, although the FDA doesn’t recommend it.

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The U.S. Food and Drug Administration approved the new weight loss pill Qsymia on Tuesday, adding to a very skimpy arsenal of drugs Americans can take to battle severe obesity -- and adding a last-minute name change after two years of wrangling over whether to approve the drug.

Qsymia  (pronounced kew-SIM-ee-ah) pairs an old stimulant drug with an epilepsy drug to try and bring some options to the two-thirds of Americans who are overweight or obese -- and who have higher rates of heart disease, diabetes, stroke and cancer as a result.

“Obesity threatens the overall wellbeing of patients and is a major public health concern,” Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, said in a statement. “Qsymia, used responsibly in combination with a healthy lifestyle that includes a reduced-calorie diet and exercise, provides another treatment option for chronic weight management in Americans who are obese or are overweight and have at least one weight-related comorbid condition.”

It’s the second obesity drug to win FDA approval this summer. Last month, the agency OK'd Belviq, the first new weight loss drug approved in 13 years. Qsymia combines phentermine, a stimulant, with the anti-seizure drug topiramate.

The FDA took its time in reviewing Qsymia, formerly known as Qnexa, because of fears about the side-effects, which can include a fast heart rate and metabolic acidosis, a condition marked by highly acidic blood that can, in severe cases, put people into a coma and even kill them. Metabolic acidosis can also cause kidney stones and damage bones. There’s been a growing debate over whether it’s worth the risk of taking drugs that could damage the heart to battle the growing obesity epidemic.

Diet drugs have a sketchy history in the U.S. and the FDA worries about irresponsible doctors who dispense pills from their offices to just about all comers, whether they’re in the group that’s supposed to get the drug or not. The FDA approves drugs for certain uses in certain people, but once a drug is approved, a licensed doctor may prescribe it as he or she sees fit.

Vivus, the company that makes the drug, has said it’s aware of this and has said it would restrict who can prescribe Qsymia and how. The once-a-day pill will be available only through mail order so that doctors cannot dispense it from their offices. The company also plans to educate doctors about the drug's risks, which include birth defects, and to carefully watch users for any signs of heart damage.

The agency asked for a last-minute name change from Qnexa, however. "The FDA indicated concern about potential confusion regarding the name Qnexa and worked with Vivus during the final steps of the review process to identify Qsymia as an acceptable brand name," Vivus's Dr. Barbara Troupin said in a statement.

Qsymia is approved for use in obese adults, those with a body mass index of 30 or greater, and overweight adults, those with BMI of 27 or greater, who have at least one weight-related condition such as high-blood pressure, type 2 diabetes or high cholesterol. 

This doesn’t calm the fears of Dr. Michael Lauer, a cardiologist at the National Institutes of Health who was on the panel of experts that advised the FDA about the drug.  Lauer and one other panelist voted against approval, but 20 panelists endorsed the drug in February.

"I believe that if the public were to 'buy' (Qsymia) after FDA approval, it would run the risk of severe, even fatal, consequences from another diet lemon," Lauer writes in Tuesday's issue of the Annals of Internal Medicine.

“If we think about the history of obesity medications, we've seen plenty of lemons. Ephedra, fen-phen, phenylpropanolamine, and sibutramine had to be withdrawn from the market because of cardiovascular toxicity. Rimonabant was approved for sale in Europe, but was never approved in the United States because of severe psychiatric side effects,” he added.

Lauer is not the only opponent. Public Citizen, a consumer group, has been campaigning against the drug, too.

"As was the case for the diet drug lorcaserin (Belviq), approved last month despite concerns about heart valve damage, it was also reckless of the Food and Drug Administration to approve Qnexa. Research shows the medication increases heart rate, and four patients on the diet pill had non-fatal heart attacks during the clinical trials, while none of those on the placebo had heart attacks," Public Citizen's Dr. Sidney Wolfe said in a statement.

"It is magical and delusional thinking for anyone to believe that a drug will turn off hunger without hitting other targets where it will do harm, usually to the cardiovascular system."

Vivus hopes it will be a safer successor to the notorious and now banned “fen-phen” diet cocktail. Fen-phen combined fenfluramine and phentermine -- one of the two drugs in Qsymia -- but it damaged the heart in some cases and caused a condition in some patients called pulmonary hypertension, which causes fluid to build up in the chest, bringing a feeling of breathlessness.

Reviewers say the amount of the drug phentermine in Qsymia is safer. The two drugs together seem to lower appetite while keeping patients perky. Lauer said he would have liked to see more tests to specifically look for heart problems before the FDA approves the drug.

Doctors tested the pill in more than 4,430 overweight and obese patients. About half lost 10 percent  of their weight -- enough to lower cholesterol and blood pressure, reduce the risk of diabetes and early death.

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By MyHealthNewsDaily.com staff

For some men, weight loss plays an important role in raising low testosterone levels, a new study finds.

In the study of overweight, middle-aged men with prediabetes, about half of those with low testosterone levels who attempted to lose weight by changing their lifestyle experienced an increase in their testosterone levels.

The findings suggest "doctors should first encourage overweight men with low testosterone levels to try to lose weight through diet and exercise, before resorting to testosterone therapy to raise their hormone levels," said study researcher Dr. Frances Hayes, a professor at St. Vincent’s University Hospital, Dublin.

Hayes and colleagues analyzed information from nearly 900 men with prediabetes — a condition in which blood sugar levels are abnormally high, but not high enough to be classified as Type 2 diabetes. The men's average age was 54.

The men were randomly assigned to receive one of three treatments: the diabetes drug metformin, an inactive placebo pill or lifestyle modifications, which consisted of exercising for 150 minutes a week and eating less fat and fewer calories. The researchers said they considered men to have low testosterone if their levels were below 300 nanograms per deciliter of blood.

Among the men assigned to change their lifestyle, about 20 percent had low testosterone levels at the study's start. After one year, that number fell to 11 percent.

Among those taking metformin, 24.8 percent had low testosterone at the beginning of the study, and 23.8 percent still had the condition a year later. For the placebo group, the rate fell from 25.6 percent to 24.6 percent during the study.

Men in the lifestyle modification group lost an average of about 17 pounds over the one-year study, and testosterone levels among men in this group increased 15 percent on average, the researchers said. (Men in the metformin group lost about 6 pounds.)

"Losing weight not only reduces the risk of prediabetic men progressing to diabetes but also appears to increase their body's production of testosterone," Hayes said.

The study was presented this week at the Endocrine Society’s annual Meeting in Houston.

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By MyHealthNewsDaily Staff

Americans may not eat the healthiest diets, but most get adequate levels of essential vitamins and nutrients, according to a new report from the Centers for Disease Control and Prevention.

For most nutrients, less than 10 percent of the population is deficient, the report showed.

However, deficiency rates vary by age, gender and ethnicity, and close to a third of African-Americans were deficient in vitamin D, the report said.

These higher deficiency rates are a concern and need more attention, said study researcher Christine Pfeiffer, of the CDC’s National Center for Environmental Health.

The report gave the results of an analysis of blood and urine samples collected from people between 2003 and 2006, measuring levels of 58 nutrient markers.

For the U.S. as a whole, 10.5 percent of people were deficient in vitamin B6, 8.1 percent were deficient in vitamin D, 6.7 percent were deficient in iron, 6 percent were deficient in vitamin C, 2 percent were deficient in Vitamin B12, and less than 1 percent were deficient in vitamin A, E and folate.

Vitamin D deficiency was 31 percent among African-Americans, 12 percent among Mexican-Americans and 3 percent among whites. Further research is needed to explain why non-Hispanic blacks have better bone health but yet have a higher rate of vitamin D deficiency, the report noted.

Iodine levels among women ages 20 to 39 years may need improvement. This age group had iodine levels that were, on average, just above iodine insufficiency, the report said.

Iodine is an essential component of thyroid hormones, which regulate growth and development. Iodine is especially important in women during childbearing years to ensure proper brain development of the fetus during pregnancy.

The report found higher rates of iron deficiency among Mexican-American children ages 1 to 5 (11 percent), blacks (16 percent), and Mexican-American women of childbearing age (13 percent) when compared with other race/ethnic groups.

One particular public health success story has been increases in folate levels in recent years. Blood folate levels in are 50 percent higher in all ethnic groups since the country began fortifying cereal-grain products with folic acid in 1998, the report said.

The CDC plans to further analyze the data to identify the influence of socioeconomic and lifestyle factors on levels of nutrient levels, the agency said.

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