Paul Chinn / The Chronicle

Olya Dalrymple scoops Nutella-flavored ice cream for a customer at iScream in Berkeley, where sugar is plentiful.

Thursday, February 2, 2012

Like alcohol and tobacco, sugar is a toxic, addictive substance that should be highly regulated with taxes, laws on where and to whom it can be advertised, and even age-restricted sales, says a team of UCSF scientists.

In a paper published in Nature on Wednesday, they argue that increased global consumption of sugar is primarily responsible for a whole range of chronic diseases that are reaching epidemic levels around the world.

Sugar is so heavily entrenched in the food culture in the United States and other countries that getting people to kick the habit will require much more than simple education and awareness campaigns, the UCSF scientists said.

It’s going to require public policy that gently guides people toward healthier choices and uses brute force to remove sugar from so many of the processed foods we eat every day, said Dr. Robert Lustig, a pediatric endocrinologist at UCSF.

“The only method for dealing with this is a public health intervention,” Lustig said in an interview. “Everyone talks about personal responsibility, and that won’t work here, as it won’t for any addictive substance. These are things that have to be done at a governmental level, and government has to get off its ass.”

In response to the study, the food and beverage industries said in statements that sugar cannot be blamed for high rates of chronic disease in the United States and elsewhere.

Comparing sugar to alcohol and tobacco is “simply without scientific merit,” the American Beverage Association said. “There is no evidence that focusing solely on reducing sugar intake would have any meaningful public health impact.”

Altering biochemistry

Lustig has written and talked extensively about the role he believes sugar has played in driving up rates of chronic illness such as heart disease and diabetes. Excessive sugar, he argues, alters people’s biochemistry, making them more vulnerable to metabolic conditions that lead to illness, while at the same time making people crave sweets even more.

It’s sugar, not obesity, that is the real health threat, Lustig and his co-authors – public health experts Laura Schmidt and Claire Brindis – say in their paper. They note that studies show 20 percent of obese people have normal metabolism and no ill health effects resulting from their weight, while 40 percent of normal-weight people have metabolic problems that can lead to diabetes and heart disease. They contend that sugar consumption is the cause.

In other words, not everyone gains a lot of weight from over-indulging in sugar, but a large proportion of the U.S. population is eating enough of it that it’s having devastating health effects, they say.

“The gestalt shift is maybe obesity is just a marker for the rise in chronic disease worldwide, and in fact metabolic syndrome, caused by excessive sugar consumption, is the real culprit,” said Schmidt, a health policy professor who focuses on alcohol and addiction research.

22 teaspoons a day

Americans eat and drink roughly 22 teaspoons of sugar every day – triple what they consumed three decades ago – and most people aren’t even aware of the various ways sugars sneak into their diets, often via breads and cereals and processed foods. Terms that identify sugars on labels include sucrose, glucose, fructose, maltose, hydrolysed starch and invert sugar, corn syrup and honey.

Ultimately, getting those sugars out of the American food culture is going to require a massive shift in how foods and beverages are made in the United States, the authors say. In the paper, they say that the Food and Drug Administration needs to remove sugar from the list of foods “generally regarded as safe,” meaning they can be used in unlimited quantities.

But the food and beverage industries have repeatedly denied that sugar is the main villain behind rising rates of obesity, or the increases in diabetes and heart disease. Instead, industry representatives say that a complex cultural shift – toward a more inactive lifestyle and increased calories overall – is to blame.

And not all scientists agree that sugar should shoulder the entire burden for the chronic diseases afflicting modern Americans.

“When you get into this argument about sugar in the diet, you also have to look at the type of food that has a high sugar content,” said Jo Ann Hattner, a San Francisco registered dietitian who teaches nutrition courses at Stanford. “Those foods have few nutrients and little fiber, and that’s not good for you. So is it sugar itself that’s harmful?”

Good advice: Eat less

That said, Hattner added, there’s no doubt that people in general consume too much sugar and that everyone could benefit from eating less – and especially looking out for “hidden” sugars in their diets. Those sugars are often found in processed foods like sodas, cereals and breads. Even cookies contain much more sugar than they did a decade or two ago, nutritionists say.

But while individuals certainly can make small changes to their diets to eat more nutritiously, that alone is not going to effect major public health improvements, Lustig and his co-authors said.

In their paper, they argue for taxes on heavily sweetened foods and beverages, restricting advertising to children and teenagers, and removing sugar-ladened products from schools, or even from being sold near schools. They suggest banning the sale of sugary beverages to children.

Schmidt noted that those policies could nudge people toward healthier choices – but only if, at the same time, healthier choices are made widely available. Such policies have worked in reducing alcohol consumption and smoking rates, she said. There’s no reason they can’t work with sugar too.

Lustig said he realizes that there will likely be heavy resistance to the idea of largely removing sugar from American diets – and resistance not just from the food and beverage industries, but from the public at large.

“Everybody yells, ‘Nanny state, this guy is trying to control our food,’ ” Lustig said. “But it’s already being controlled. It limits consumer choice when so much of our food is controlled by these industries. I’m actually trying to undo the nanny state.”

E-mail Erin Allday at eallday@sfchronicle.com.

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2012/02/02/MN891N1PQS.DTL

This article appeared on page A – 1 of the San Francisco Chronicle

Robert H. Lustig, MD, UC San Francisco Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin.

Among the helpful resources for parents and teachers with the same question is http://teenagebrain.blogspot.com which compiles interviews with many specialists on the topic.

Some quotations from these interviews sum up the current knowledge:

The greatest changes to the parts of the brain that are responsible for impulse-control, judgement, decision-making, planning, organization, and involved in other functions like emotion, occur in adolescence. This area of the brain (prefrontal cortex) does not reach full maturity until around age 25!

Dr. Cohen’s summary: Don’t explain things to teenagers the same way you would an adult. Make sure their diet is as balanced as possible. If they are not getting healthy fats (particularly omega 3 fish oils) to help  with brain development and  and healthy proteins (crucial for neurotransmitter formation) their brains are not going to function as well as they could.

http://www.guardian.co.uk/politics/2006/oct/17/prisonsandprobation.ukcrime I know your teenager isn’t a criminal; this points out how important fish oil is for mood stabilization and how omega 3′s have been shown to help with depression and bipolar disorder.

Most people take six to twelve thousand steps each day. If you’re a runner or taking Bart or Muni, you’re taking more than that.

Balancing your feet is one of the easiest steps you can take to stay out of the doctors office, including mine. If your feet aren’t balanced, your body is going to overwork with all those steps. Custom orthotics help support your three foot arches (yes, there is more than one arch) which in turn help to reduce the load on the low back. See more on the latest study below.

If you aren’t sure your feet are supporting you as best they can, come in for a complimentary foot scan at ProActive Chiropractic in San Francisco.

Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Pilot Study

ABSTRACT
Objectives: The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain.

Methods: The study recruited 50 patients with chronic low back pain through media advertising in a midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After 6 weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of 6 weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment.

Results: This study showed changes in back pain and disability with the use of shoe orthotics for 6 weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time.

Conclusions: This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after 6 weeks of use is feasible. A larger clinical trial is needed to verify these results. (J Manipulative Physiol Ther 2011;34:254-260)

Full study »

Most people take 6-12 thousand steps a day. If you’re a runner or taking Bart or Muni you’re taking more than that.

Balancing your feet is one of the easiest things you can do to stay out of the doctors office, including mine. If your feet aren’t balanced your body is going to overwork with all those steps. Custom orthotics helps support your 3 foot arches (yes there is more than one arch) which then in turn helps reduce the load on the low back as this study demonstrates.

If you aren’t sure if your feet are supporting you come in for a complementary foot scan at ProActive Chiropractic in San Francisco.

Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Pilot Study

ABSTRACT
Objectives: The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain.

Methods: The study recruited 50 patients with chronic low back pain through media advertising in a midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After 6 weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of 6 weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment.

Results: This study showed changes in back pain and disability with the use of shoe orthotics for 6 weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time.

Conclusions: This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after 6 weeks of use is feasible. A larger clinical trial is needed to verify these results. (J Manipulative Physiol Ther 2011;34:254-260)

Full study »

Crosby hasn’t played since Dec. 5 following a recurrence of the symptoms that sidelined him for more than 10 months last year. The team says Crosby will work with chiropractic neurologist Dr. Ted Carrick, who treated Crosby for similar symptoms last summer.

The 24-year-old star skated with his teammates for the first time in more than a month last Friday, a first step in what could be another long comeback. He continues to deal with dizziness and headaches and doctors have not cleared him to exert himself at a high level.

“The motion stuff is still a little bit iffy,” Crosby said last Friday. “I want to make sure I give it a fair shot, but at the same time I know it’s something I can improve.”

VIDEO:Describing Crosby’s symptoms

Carrick worked closely with Crosby last summer after Crosby’s progress slowed. Carrick said in September that Crosby would have a “very good outcome” following his rehab.

Crosby vowed to return this season, and he was spectacular in his season debut on Nov. 21, scoring two goals against the New York Islanders and had 12 points in eight games.

Yet all the good feeling faded after getting jostled around in a loss to Boston on Dec. 5.

There is no timetable for Crosby’s return and though he called the chance to join his teammates on the ice a “positive step” it was also largely symbolic.

The 2009 NHL MVP is still uncertain when he’ll be able to practice, let alone suit up for a game.

“Sidney has made a lot of progress but he is still having some symptoms, so this is the next step in his recovery,” Penguins general manager Ray Shero said. “Obviously he won’t be back in the lineup until he is symptom-free.”

Unlike last January, when Crosby took an obvious shot to the head in successive games, there was no single play that led to the issues reappearing.

“It’s a tough injury,” Crosby said. “It’s not always clear-cut all of the time. Now I feel like I know a lot more about what I’m feeling and how to improve it. I think being more familiar helps a bit.”

SI VAULT:Inside Sidney Crosby’s head

The Penguins have struggled without their captain. A Stanley Cup contender with Crosby in the lineup, Pittsburgh has slipped to eighth in the Eastern Conference, though the team did sweep games in Florida and Tampa Bay over the weekend.

The victories came after Crosby’s teammates made a very public display of support, taping a “C” on their jerseys as he joined them for a relatively informal game day skate.

Crosby’s silence during his current rehab — he hadn’t spoken publicly in more than a month since being injured — led some to question coach Dan Byslma about the mystery surrounding Crosby’s status.

“I’ve been doing this long enough to know that if there’s information to give, it’s part of my role and responsibility that comes with what I do to provide that and I’ve always been willing to do that,” Crosby said. “But if there’s no information to be given, then I’m not going to give any or make something up.”

Copyright 2012 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

I have written many articles about the risk of long-term medication use to treat pain. The risks, side effects, and limited efficacy seem unreasonable when typically our patients find we can get to the root cause of the pain with chiropractic, applied kinesiology, muscle work, and home exercises,” says Andrew Cohen, DC, a chiropractor in downtown San Francisco. “There are certainly times when medications should be used in conjunction with active care, but, as this study demonstrates, to achieve lasting relief, patients need to restore normal movement and strength.”

Call ProActive Chiropractic to set up an appointment. You’ll be happy; we guarantee it.

Notes from Dr. Cohen: I find this video insightful, educational and entertaining. Enjoy!

Caviar and Sturgeon* (Imported Wild-caught) Caviar, Paddlefish (Wild-caught from U.S.)		Caviar (U.S. Farmed) Sturgeon (U.S. Farmed) Sturgeon: White (Wild-caught from OR and WA)
Chilean Seabass/Patagonian Toothfish*	Cobia (U.S. Farmed) Sablefish/Black Cod/Butterfish (AK, BC)	Sablefish/Black Cod/Butterfish (CA, OR, WA)
Cod: Atlantic (Trawl-caught from Canadian and U.S. Atlantic) Cod: Pacific (Imported)	Cod: Pacific (U.S. Bottom Longline, Jig and Trap) Cod: Atlantic (Hook-and-Line from Iceland and Northeast Arctic) Haddock (U.S. Atlantic Hook-and-Line)	Cod: Atlantic (Bottom Gillnet, Bottom Longline, Bottom Trawl and Danish Seine from Iceland and Northeast Arctic) Cod: Atlantic (U.S. Gulf of Maine Hook-and-Line) Cod: Pacific (U.S. Trawl) Haddock (Iceland Atlantic and U.S. Atlantic Trawl)
Crab: King (Imported)	Crab: Dungeness; Kona (Australia); Stone	Crab: Blue* (U.S.); Jonah; King (U.S.), Kona (HI); Snow (AK, Canada)
Crayfish (Imported Farmed)	Crayfish (U.S. Farmed) Prawn: Spot (BC)	Prawn: Spot (BC)
Flounders or Soles (Atlantic Wild-caught, Except Summer Flounder)	Halibut: Pacific (U.S.)	Flounder, Sanddab, Sole (Wild-caught from U.S. Pacific) Flounder: Summer (Wild-caught from U.S. Atlantic)* Turbot, Greenland*
Groupers (HI and U.S. Atlantic*) Grouper: Gag; Snowy; Warsaw; Yellowedge (U.S. Gulf of Mexico)*	Mahi Mahi (Troll/Pole from the U.S. Atlantic) Striped Bass (Farmed or Wild-caught*)	Black Sea Bass Grouper Black and Red (U.S. Gulf of Mexico)* Mahi Mahi (Imported Troll/Pole and U.S.)
Hake: White	Tilapia (U.S. Farmed)	Hake: Offshore, Red and Silver Tilapia (Farmed in Brazil, Costa Rica, Ecuador and Honduras)
Halibut: Atlantic or California* (Set Gillnet)	Cobia (U.S. Farmed) Halibut: Pacific (U.S.) Tilapia (U.S. Farmed)	Flounder, Sanddab, Sole (Wild-caught from U.S. Pacific) Summer Flounder (Wild-caught from U.S. Atlantic) Turbot, Greenland*
Lobster: Caribbean Spiny (Brazil)	Lobster: Caribbean Spiny (FL) Lobster: Spiny (Baja California, Mexico, CA)	Lobster: American/Maine (Trap-caught) Lobster: Caribbean Spiny (Bahamas)
Mahi Mahi (Imported Longline)	Mahi Mahi (Troll/Pole from the U.S. Atlantic)	Mahi Mahi (Imported Troll/Pole and U.S.)
Marlin: Blue* or Striped* (Imported)	Swordfish (Harpoon and Handline-caught from Canada, the U.S., North Atlantic and East Pacific)*	Marlin: Blue (HI)* Swordfish (Drift Gillnet from CA)* Swordfish (Longline from HI and U.S. Atlantic)*
Monkfish	Mahi Mahi (Troll/Pole from the U.S. Atlantic) Sablefish/Black Cod/Butterfish (AK, BC)	Mahi Mahi (Imported Troll/Pole and U.S.) Sablefish/Black Cod/Butterfish (CA, OR, WA)
Orange Roughy*	Halibut: Pacific (U.S.) Tilapia (U.S. Farmed)	Flounder, Sanddab, Sole (Wild-caught from U.S. Pacific) Summer Flounder (Wild-caught from U.S. Atlantic)* Turbot, Greenland*
Pompano: Florida	Striped Bass (U.S. Farmed or Wild-caught*)	Black Sea Bass
Rockfish: Pacific (Trawl)	Halibut: Pacific (U.S.) Rockfish: Black (U.S. Hook-and-Line) Sablefish/Black Cod/Butterfish (AK, BC) Striped Bass (U.S. Farmed or Wild-caught*)	Flounder, Sanddab, Sole (Wild-caught from U.S. Pacific) Rockfish (Hook-and-Line or Jig from the Pacific) Sablefish/Black Cod/Butterfish (CA, OR, WA)
Salmon (Farmed, including Atlantic)*	Arctic Char (Farmed in Recirculating Systems) Salmon (AK Drift Gillnet, Purse Seine and Troll) Salmon, Freshwater Coho (U.S. Farmed in Tank Systems)	Salmon (Drift Gillnet, Purse Seine and Troll from CA, OR, WA) Salmon, Coho (BC, Wild-caught)
Sharks* and Spiny Dogfish*	Cobia (U.S. Farmed) Halibut: Pacific (U.S.)	Dogfish: Spiny (BC)* Sturgeon (U.S. Farmed) Sturgeon: White (Wild-caught from OR and WA)
Shrimp (Imported Except Canada and Thailand from Fully Recirculating Farms)	Prawn: Spot (BC) Shrimp (U.S. Farmed in Fully Recirculating Systems or Inland Ponds) Shrimp: Pink (OR)	Prawn: Spot (U.S. Pacific) Shrimp (Wild-caught from Canada and U.S.) Shrimp (U.S. Farmed in Open Systems) Shrimp (Thailand from Fully Recirculating Farms)
Snapper: Red or Vermilion (U.S.)	Tilapia (U.S. Farmed)	Snapper: Gray; Lane*; Mutton*; Yellowtail (Wild-caught from U.S. Atlantic and U.S. Gulf of Mexico) Snapper, Silk (Wild-caught from U.S. Caribbean, U.S. Gulf of Mexico and U.S. South Atlantic) Tilapia (Farmed in Brazil, Costa Rica, Ecuador and Honduras)
Swordfish (Imported)*	Mahi Mahi (Troll/Pole from the U.S. Atlantic) Swordfish (Harpoon or Handline from Canada, U.S., North Atlantic and East Pacific)*	Mahi Mahi (Imported Troll/Pole and U.S.) Swordfish (Drift Gillnet from CA)* Swordfish (Longline from HI and U.S. Atlantic)*
Tilapia (Farmed from China and Taiwan)	Tilapia (U.S. Farmed)	Tilapia (Farmed in Brazil, Costa Rica, Ecuador and Honduras)
Tilefish: Blueline and Golden (U.S. Gulf of Mexico and U.S. South Atlantic)*	Mahi Mahi (Troll/Pole from the U.S. Atlantic) Striped Bass (U.S. Farmed or Wild-caught*)	Mahi Mahi (Imported Troll/Pole and U.S.) Tilefish, Golden (U.S. Mid-Atlantic)*
Tuna: Canned (All Except Troll/Pole)	Tuna: “White” Canned Albacore (Troll/Pole from the Canadian and U.S. Pacific) Tuna: “Light” Canned Skipjack (Troll/Pole)	Tuna: “White” Canned Albacore (Troll/Pole Except Canadian and U.S. Pacific)
Tuna: Albacore (North Atlantic and All Longline Except HI)* Tuna: Bigeye (All Longline Except U.S. Atlantic)* Tuna: Blackfin (All Longline and Purse Seine)* Tuna: Bluefin (Wild or Ranched)* Tuna: Skipjack (Purse Seine and All Imported Longline) Tuna: Tongol (All Gillnet and Purse Seine Except Malaysia) Tuna: Yellowfin (All Purse Seine and Longline Except HI and U.S. Atlantic)*	Tuna: Albacore (Troll/Pole from the Canadian and U.S. Pacific) Tuna: Bigeye (Troll/Pole from the U.S. Atlantic) Tuna: Skipjack (Troll/Pole) Tuna: Yellowfin (Troll/Pole from the Pacific and U.S. Atlantic)	Tuna: Albacore (HI Longline and South Atlantic Troll/Pole)* Tuna, Bigeye (Troll/Pole and U.S. Atlantic Longline) Tuna: Blackfin (Troll/Pole)* Tuna: Skipjack (Longline from HI and the U.S. Atlantic) Tuna, Tongol (Troll/Pole or from Malaysia) Tuna, Yellowfin (Troll/Pole Except Pacific and U.S. Atlantic) Tuna, Yellowfin (Longline from HI and the U.S. Atlantic)

Best Choices: Seafood in this category is abundant, well-managed and caught or farmed in environmentally friendly ways.

Good Alternatives: These items are an option, but there are concerns with how they’re caught or farmed-or with the health of their habitat due to other human impacts.

Avoid: Take a pass on these items for now. They are caught or farmed in ways that harm other marine life or the environment.

The Super Green List: A list of wild and farmed seafood that’s healthy for people and the oceans.

	Key AK BC CA FL HI OR WA Mid-Atlantic Northeast Southeast / Alaska British Columbia California Florida Hawaii Oregon Washington New York to North Carolina Connecticut to Maine South Carolina to Texas A slash is used to separate different market names for the same fish.