Is the 10,000-Steps Goal a Myth?

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One of the things many people do for fitness is try to get 10,000 steps per day. Researchers recently wanted to know whether that many steps really gives a person any health advantage, because the concept of 10,000 steps per day wasn’t based on any real science—it came from a Japanese company who invented a wearable step counter in 1965 and just made up a number that sounds good.

Researchers analyzed data from 16,741 older women who agreed to wear a step counter at least 10 hours per day for at least four days a week during waking hours. They divided the subjects into quartiles based on the number of steps per day. After four years of follow-up, they discovered that hazard ratios declined as the number of steps per day increased. No real surprise there. What was surprising was that there were no additional benefits after 7,500 steps per day; in fact, the mortality began to decline with as little as 4,400 steps per day.

Is the goal of 10,000 steps per day a myth? Not in my opinion; most of us are too sedentary most of the time. The mean age of the subjects in this study was 72. It may be that younger women need more steps to impact mortality because they have potentially more years to live; then maybe after reaching 72, they can scale back. Hard to say. But they looked at mortality only; 10,000 steps per day may have benefits they didn’t examine.

I would have thought walking intensity might have had an impact, but it didn’t in this study. However, another recently published study may provide more insight, especially as it relates to obesity. We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.

Readers Report on MSG

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Of the dozens of responses to the Memos on MSG, most readers reported the types of symptoms commonly attributed to MSG along with some interesting physical responses. Several people responded that they had always heard to avoid MSG, so they have. I thought one particular comment was interesting: upon looking at the foods that contain MSG, especially snack food, he wouldn’t eat them anyway so it was never an issue for him.

Many people get a true allergic response within minutes of ingesting MSG. This is the list of reactions: swelling, hives, itching, redness, headache, migraines, coughing, palpitations, shortness of breath, numbness around the mouth and cheeks, joint stiffness, pain in the arms, sleepiness, stupor, trouble sleeping, vomiting, and diarrhea. If they avoid MSG, they don’t have the symptoms.

There were a couple of unusual reactions I have to mention. One individual found that if he has MSG in food for dinner, he has vivid dreams, usually involving someone chasing him around or being in a struggle situation. He never gets them otherwise, so he avoids MSG.

Another person said when he eats food with MSG, he craves chocolate.

The common theme was that everyone used trial and error to find the culprit. Here’s your challenge, even if you’ve never attributed a problem to MSG: if you get some of the symptoms on the list, examine the content of the foods you eat. Can you narrow down a suspect for your symptoms? The goal is know yourself and the way to do that is to pay attention.

What are you prepared to do today?

        Dr. Chet

Sports for Kids: A Better Way

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I hope you took the time to read the Norwegian Children’s Rights in Sport document; if not, please do, especially the Plan for Development. The focus is on making sure the child is safe and secure no matter their abilities. The goal is for all kids to develop the joy of learning sports by having fun and gaining lifetime skills.

The kids also have the right to master a variety of skills in many sports. The ages 6 through 12 are not for specialization, they’re for generalization. Kids have the right to decide how much or how little they want to participate in sports and much they want to train. That doesn’t mean that this is all willy-nilly; it’s very organized with progressions from skill to skill and sport to sport.

Let me use the illustration from the last Memo about dodgeball. If kids are put into groups with similar abilities, they can still play dodgeball. They can develop their eye-hand coordination much better than if they avoid that game altogether. They can be given drills that allow them to focus on the ball release, to anticipate which direction to move, and how to catch the ball. The progression may be different and slower than more talented kids of the same age, but they will progress. They may never play dodgeball again, but they can develop skills that help them become a goalie in soccer. If they grow into their teenage and young adult bodies with better skills, who knows where that may lead? The most important point is for kids to learn to associate sports with having fun.

There are two elements that are the antithesis of American youth sports. Travel teams are prohibited, and no scores are kept for any game up to the age of 12. Local communities can have competitions within a reasonable distance and that’s encouraged, but nothing like the travel teams we see in the U.S.

No keeping score? It’s prohibited and if caught, coaches and parents are subject to penalties. They’re also not allowed to keep statistics: no leading scorers, no saves in hockey. The emphasis is on learning a variety of skills in many sports to encourage life-long activities.

I haven’t seen documentation of long-term effects, but it would be reasonable to anticipate a reduction in obesity and a less sedentary lifestyle than we have in the U.S. today, and that could reduce healthcare costs. We might even find a smaller carbon footprint if people are more inclined to walk or bike or ski to their destinations.

Where’s the Competitive Spirit?

Don’t be deceived—competition is encouraged at the right time. Once children over 13 decide they want to become competitive athletes, the training escalates with more info on nutrition, practice of sport-specific skills, and higher levels of competition. Once they’re in, they go all in. Remember this: the first kids who went through this change in the approach to sports for kids are the young adults who won all those medals in the last Winter Olympics. Now they’re turning their attention to the sports in the Summer Olympics.

Competitive? Of course they are. They just want to end up with a population of adults who have a life-long appreciation for movement and a commitment to keep going. So far, it seems to be working.

The Bottom Line

I think anything that helps kids develop an appreciation for movement is a good thing. Could the Norwegian way work in the U.S.? Most likely not because the current system of an exclusionary approach to sports is so entrenched, but it could work within a community or a school district. If the focus is on playing, having fun, and getting good coaching in sports skills all year round for young kids, that could translate to benefits for all ages. Maybe it would prevent the burnout student athletes experience who start competing at six years old. By the time they finish high school, too many are done. For life. That costs the child and it also costs society.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.aspeninstitute.org/blog-posts/norway-won-winter-olympics/

An Alternative Path for Athletic Kids

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At the last Winter Olympic Games, which country won more medals than any other? The U.S.? China? Russia? No, it was Norway—a record 39 medals. How does a country with about five million people outperform countries such as Germany with 80 million, Canada with 35 million, or the U.S. with 325 million? As you might expect, there isn’t one simple answer, but it may be related to their approach to sports for kids.

In 2007, the government of Norway adopted a set of rules called Children’s Rights in Sport; you can read the document by clicking on the link in the references. Their approach begins with the premise that kids should play sports because they enjoy it and that what they learn with their friends will last a lifetime. So the very first idea is that sports will be a life-long activity. Contrast that with the approach to sports in the U.S. As we proceed through elementary, high school, and college, fewer and fewer people participate in sports on a regular basis. The emphasis is on competition, not life-long skills, so the kids with an average amount of skill learn that if they’re not a star, sports isn’t for them. They become sedentary adults.

Ever play dodgeball in phys ed class? You probably remember kids with rocket arms mixed with kids a foot shorter and poor reaction times. How well does that work out most of the time? The entire Norwegian approach focuses on developing sports skills consistent with the abilities of the child, not on the kids who perform best. The approach involves community sports clubs. The approach takes whatever skills a child has and helps them improve with children of similar abilities, including children with physical disabilities.

How does this approach lead to better performance in the Winter Olympic Games? We’ll continue on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Children’s Rights in Sport

Kids and Sports in America

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In my travels, I stay in a lot of hotels and speak in many venues from convention centers to hotel ballrooms. No matter the season, I can count on there being a team of kids staying in the hotel. I don’t mean professional teams; I mean kids’ teams from baseball and softball, gymnastics, volleyball, and of course the number one sport, soccer. Pick an age group and there’s a team tournament being held somewhere. I don’t mean local community events; I mean that the kids participate in travel teams, which means the entire family travels.

I recently saw a segment on youth sports on a national sports show. One of the scenes that stood out to me was a parent using profanities toward the umpire or referee. I used to be a football official and took my share of abuse. No one used profanities at games, but that was 20 years ago and things are much different today. Kids with some talent who show an interest in a sport can get moved along rapidly to higher levels of competition. It seems that failure is not an option once they get there.

What does this focus on competition at early ages do to kids? Is it healthy? Does it create champions? Hard to say for sure, but there may be another way, one that leads to lifetime participation in sports and activity. We’ll take a look on Thursday.

What are you prepared to do today?

        Dr. Chet

Nutrition Education: The Best Solution

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The scientific paper about nutrition education programs from South America was an opinion piece derived from a student’s dissertation defense. It addressed nutrition labels in Brazil: the labels were too focused on the caloric content instead of the ingredient information.

The paper gives an example of two foods that have 97 calories but are vastly different in nutritional value. Chewy fruit-flavored candy had 21 grams of carbs, no protein, 1.5 grams of saturated fat, and no fiber; 14 almonds had 3.6 grams of carbohydrate, 3.5 grams of protein, 8.4 grams of healthy fat, and 2.1 grams of fiber. The almonds also had several vitamins and minerals while the chewy fruit candy had none.

The question is whether labels alone can change the nutritional health of a nation. Hard to say. Brazil came up with a simple public health approach using three recommendations:

  1. Choose whole, minimally processed foods
  2. Cook those foods yourself
  3. Eat those foods with other people

I think that’s an excellent approach. It means that people may have to shop a little more often and spend more time preparing food. But when you consider travel to get take-out or fast food, or the expense of food delivery, we can get better and fresher quality foods with fewer preservatives and more nutrition for around the same price.

Eating those foods with other people, at a minimum, means that families eat at least one meal together daily, possibly two if we include breakfast. The other possibility is to invite neighbors, friends, or other family members. We don’t have to fix feasts; just fresh, healthier foods that are simple to cook and share.

The Bottom Line

I think the Brazilian approach could work in the U.S. If we were to use the public health nutrition education program from WWII with an emphasis on the benefits of the foods for our health along with videos people could use to prepare the foods simply, and even scale that down to individual communities where small groups could learn how to shop and cook, we can change the health of the nation.

I also think it begins with parents: they’ll have to lead the way if they expect children to eat better. When we visited Paula’s cousin, who has three children under two (a toddler girl and identical twin baby boys), we remarked at the variety of food their daughter was willing to eat. Her dad said that she may be the only kid in preschool asking, “Excuse me, where is the hummus?” It may mean that parents will have to learn more about healthier foods and how to prepare them. I think it’s a small price to pay to improve their kids’ potential for better health.

What are you prepared to do today?

        Dr. Chet

Reference: Adv. Nutr. 2019;10:549–556.

Improving Nutrition in South America

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One of the problems today with public nutrition education programs is that there’s an important element that would prefer it not be done. In fact, food manufacturers are doing all they can to avoid any approach that may impact sales of high-fat, high-sodium, high-sugar, and highly processed food. I get it—they want to sell as much as they can. But to suggest that ketchup is a vegetable in the school lunch program doesn’t make any sense. I’m not going to comment further because that could take a month of Memos.

Instead let’s look at what some countries in South America have done to address nutrition as their obesity and related disease rates rise. One of the most controversial steps was taken by Mexico: the government put a 10% tax on high-sugar drinks, snacks, and sugary cereals that have limited nutritional benefit compared to total calories. It was not easy because the people of Mexico, much like the U.S., are against paying any more in taxes. But as of 2019, consumption of sugary sodas has dropped 12% in the poorest segment of the population and 5% in more affluent segments.

One of the most innovative approaches is used in Chile: foods high in added sugar, saturated fats, sodium, and high in calories have to place black stop signs on the front of package labels, and those foods can’t be sold or promoted in schools or promoted on television. Children have been educated about the meaning of the label changes and are steering their parents away from foods with black stop signs on the labels.

These radical approaches had to fight the food industry all the way, but the good of the people outweighed the profits of the industry. There may be a better way yet, and that’s what I’ll talk about Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.washingtonpost.com/business/2019/07/16/latin-americas-war-obesity-could-be-model-us/

How Can We Improve Nutrition and Public Health?

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I recently read a couple of articles, one from a newspaper and another from a journal, that talked about South American countries and how their governments should deal with the obesity epidemic and how some are approaching this issue. There may be lessons we can use here for us in the U.S. and other parts of the world.

Some historical perspective: the last public health initiative that actually worked well in the U.S. was during WWII. To direct more meat to the people fighting the war, the government enlisted any and all means to convince the public that organ meats were actually delicacies. Instead of a simple call to support the war movement, the pitch was to help consumers understand how organ meats such as brains, intestines, liver, and kidneys were nutritious. Along with that, they provided recipes for how to prepare these special parts of cows and pigs. It worked and those cuts were really considered delicacies. After the war ended, the special nature of these parts gradually drifted away.

In my opinion, that was the most successful public health education program ever done. When you consider all that’s been done related to educating the public about cholesterol, fat, trans fat, and sugar, nothing has ever gotten people to change their habits; the nutrition facts label is often more confusing that helpful. It’s obvious we need help, but what and how? We’ll take a look at what these countries in South America have tried on Thursday.

What are you prepared to do today?

        Dr. Chet

The Bottom Line on Sugary Drinks and Cancer

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The question is simple: do we avoid all sugary drinks, including fruit juices? The best I can come up with is to withhold judgment and don’t get excited about it for now. Let’s take a look at what the concerns of the researchers were and then my concerns.

Researchers’ Concerns

The first is that the NutriNet-Santé study was not a randomized sample. That means that only those people who were interested in participating for whatever reason did so. The sample was predominantly women at 78.7% of the cohort with a mean age of 42 years. The researchers accounted for age and gender in the statistical analyses, but that doesn’t account for the lack of randomization.

Researchers also stated that the rate of cancer was much lower: 620 of the 100,000 people in the study compared with 972 per 100,000 people in all of France. They adjusted the numbers to reflect the age and gender distribution in France, but I used the numbers actually given in the study. They also said the diagnosis of cancer was self-reported. I can’t believe anyone would say they have cancer if they don’t, but it would have been better if it were verified.

Related to that, some cancers were limited, thus affecting the statistics. If you don’t have enough of any type of cancer, it’s difficult and scientifically shaky to calculate a relationship.

Younger subjects consumed higher amounts of sugary drinks than older subjects. There were other factors as well, but these also were taken care of statistically. Further, they acknowledge what I alluded to: when people self-report, they can over- and under-estimate their intake. They also chose only the subjects that had at least two diet records completed in the first two years; the potential was 10 if all records were completed by all subjects. That seems low to me—there’s too much missing data.

Finally, this was an observational study and thus cause and effect can’t be attributed to the results. But it does raise questions.

My Questions

I think they could have gone a long way to answering the question about sugar intake if they had compared the fruit intake with the juice intake: take the fruit intake, calculate the sugar content, then match it with juice intake with the same sugar content. What was the rate of cancer in each group? Doing the direct comparison could go a long way to suggest whether it’s the sugar alone or if the effects were ameliorated with the fiber and phytonutrients of whole fruit with the same amount of sugar. That’s an obvious question; this is an ongoing study so maybe they’ll do that in the future.

I also think that running a comparison of total carbohydrate intake could also give us insight. If someone had a high carbohydrate intake, especially if it were high in refined carbohydrates, that might be meaningful as well.

The Bottom Line

The question I was left with was this: how could less than a half-cup per day of any type of added sugary drink that contained fewer than 50 sugar calories cause an increase in cancer? It just doesn’t make any kind of sense when you consider the total mean average calorie intake of the subjects was 1,850 calories. If the total sugar intake from solid foods of the individuals was high, or it was highly refined carbohydrates, that could make a difference. That analysis wasn’t done.

At this point, I wouldn’t stop drinking a glass of fruit juice or adding some juice to a smoothie. Don’t go out of your way to drink more fruit juice, but don’t avoid it either; certainly you should choose fruit juice from whole fruit over soda with sugar. If you have an artificial sweetener you like, use that instead of sugar. As for other drinks that contain sugar, they’re highly refined carbohydrates so you should be keeping those under control anyway. While this was an interesting and controversial report, nutrition is still about balance. Keep that in mind as you choose what you eat and drink every day.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408.

Finding the Cancer Risk in Sugary Drinks

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In Tuesday’s Memo, I reviewed the methodology of the NutriNet-Santé study in France. As I suggested, it was solid. The sugary drink choices included fruit juices, sodas, sugar-sweetened hot and milk beverages, sports drinks, and energy drinks. In terms of the data collection, I can’t think of anything they could have done better.

Turning to the statistical analysis, it was complicated to say the least. The use of high-speed computers allows for many statistical analyses to be done in short order, even with over 100,000 subjects. My only concern is that, as they did the trend for hazard ratios, they adjusted for many variables including age, gender, energy intake, and family history. How many variables? About 24 in all by my count. That’s not necessarily wrong, but there are some that would seem obvious such as total carbohydrate intake from all foods, and percentage of calories from carbohydrates other than vegetables and fruit.

Another way of analyzing the data was something I’ve done before, and that’s compare the rate of cancer to the national cancer statistics in France. In this case, the rate of cancer in France is 0.95% while it was 0.87% in the unadjusted data from the study. That’s very close and a bit lower than the national average.

Must we avoid even a half-cup of fruit juice per day? Is the sugar in your coffee or sweet tea causing a significant increase in your risk of getting cancer? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408.