Diabetes Drugs On The Hot Seat

Even if you don't have diabetes, you may find this post useful. One in three of us is walking around with a condition (insulin resistance) that is setting the stage for diabetes later.

Drugs can extend lives. Drugs can improve the quality of a life. Drugs can also make people feel miserable and carve out a nice chunk of their income. Sometimes, drugs can shorten lives. When it comes to pharmaceutical drugs, the longer you can hold off taking them, the better.

Enter the diabetes drugs Avandia (rosiglitazone) and Actos (pioglitazone). I've been following this class of drugs since the demise of one of their sisters, Rezulin (troglitazone) in 2000. Likewise with these, it's best to delay the time when you are hard-pressed to fill a prescription. That can be accomplished with lifestyle changes. (I feel this way about statin drugs too.) But there's a certain something about these new diabetes drugs that warrants this post.

Preserve The Beta

By the time people are diagnosed with type 2 diabetes, they may have lost up to half of their beta-cell function. (Beta cells are found in the pancreas. They make insulin. We can't live without insulin.) This loss is often unrecoverable, and progressive. No amount of exercise, healthful diet, or drug therapy (until recently) seems to halt it, let alone reverse it, once it has reached a certain point.

This loss of beta-cell function is depicted by the dotted line in the graph below. Notice that no type of drug, including injections of insulin, changed the downward slope of that line.



Catch Insulin Resistance Before It Progresses to Diabetes

Some beta-cell function can be recovered if lifestyle changes such as weight loss are instituted early.¹

This is why I harp about getting your blood sugar tested - long before you notice symptoms. No matter what your age, if you are overweight and relatively inactive (or if you are a healthy weight but you smoke²), there's a good chance your cells are becoming insulin resistant. To compensate for this resistance, those precious beta cells pump out more insulin. After a while, they lose the ability to respond. Once that happens, you won't be able to avoid taking drugs - for the rest of your life.

Get your blood sugar tested. If it's over 100 mg/dl after an overnight fast, you are insulin resistant. If it's over 126 mg/dl, you may very well have type 2 diabetes.^{3, 4} (See my post "Are You Insulin Resistant? Get Pricked" for a photo of what blood sugar testing entails.)

The Promise Of TZDs

Many diabetes drugs until recently worked either by inducing the pancreatic beta cells to pump out more insulin (you can see this might reduce beta-cell function even faster) or by reducing glucose output from the liver (e.g. metformin). Avandia and Actos are different. They belong to a new class of drugs called thiazolidinediones (I still have difficulty pronouncing that word) or TZDs which act upon cells to decrease their insulin resistance. Bingo. Beta cell function (somewhat) preserved.

TZDs do many other things, some beneficial, some not so good. One undesirable side effect is fluid retention or edema. Recently, in June, the New England Journal of Medicine published what has become a controversial study that linked Avandia to an increased risk of heart attack. That spurred an FDA safety alert. Thus, Avandia's hot seat.

How To Avoid Filling A TZD Prescription

The very best thing you can do to avoid taking diabetes drugs is to avoid insulin resistance. You can do that by maintaining a healthy weight, remaining active, not smoking, and eating a diet that does not put incessant demands on your insulin-producing cells. Sugar and starches, especially highly processed carbohydrates (of the type at the bottom of this post), consumed with abandon, put demands on your insulin-producing cells.
________¹ Diet-Induced Weight Loss Is Associated with an Improvement in ß-Cell Function in Older Men
² A few studies that link smoking to insulin resistance:
Smoking Induces Insulin Resistance - A Potential Link with the Insulin Resistance Syndrome
Insulin Resistance and Cigarette Smoking
The Insulin Resistance Syndrome in Smokers is Related to Smoking Habits
³ The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
⁴ The single number cutoff point (100 mg/dl) exists in an imaginary world, but is useful for diagnostic purposes. In reality, ideal blood glucose exists within a range. That range differs among people. It can also vary within a person at different life stages and different physiological conditions. However, wellness or good health is partially defined by homeostasis, that is, the maintenance of limits for optimum functioning. Thus, the blood glucose range within a healthy person should be small.

A fasting blood glucose value of 100 mg/dl to 125 mg/dl is considered, diagnostically, as Impaired Fasting Glucose (IFG) and is derived from a test of plasma (syringe to a vein), not capillary (finger stick) blood. Fortunately, newer meters are plasma-calibrated so these two numbers should coincide. If a meter is not calibrated, its result may be 10% to 15% lower than a result from a venous test. For example, if your finger stick test result from a non-plasma-calibrated meter is 100 mg/dl, this may equate to a venous result of 110 to 115 mg/dl, which still falls well within the range for IFG.

________

Time Out

I've been busy in my diabetes work. There's a lot going on there, not least of which is the future of two fairly new but risky diabetes drugs, Avandia (GlaxoSmithKline reports $3 billion in 2006 sales) and Actos (Takeda). An FDA advisory panel is holding a meeting on Avandia today. I'll post about them, and a few other related items, when I can carve out a bit of time ... soon!
________

Chinese Flip Flops

There are so many unfortunate aspects to this story, I don't know which one to focus on.

The story (not my story) starts with these...


And progresses to this (Warning: Graphic Photographs):
One Lady's Foot Story________

Chianti With Pizza?

A few weeks ago, there was an exchange in comments under my Thin Crust Pizza post. The discussion centered around whether wine was a suitable beverage to accompany pizza.

Bill said:

"Please don't show a bottle of chianti with pizza. Italians do the sensible thing and drink either beer (not the American watery kind) or coke with their pizzas because eveyone knows that pizza and wine is a perfect heartburn recipe."

To which Ronald replied:

"I drink wine with pizza. I occasionally will have beer but I prefer wine, with no heartburn. How can anyone espouse soda as a viable beverage for anything?"

To which Bill replied:

"I'm just telling you what Italians drink with pizza. Wine is not considered a suitable drink with pizza there."

Nick added:

"I rather like a light wine, like the Chianti pictured, with a good pizza."

________Coincidentally, I received an email from Natalie MacLean, of Nat Decants, last night. Natalie writes about wine. Boy, does she write about wine.

Natalie weighs in:

"You really can drink wine with just about anything."

Not only does she defend a wine & pizza pairing, she itemizes her go-with-pizza picks on her Wine & Food Matcher:

The following wines go best with pizza:

Red Wine

• Barbaresco
  
• Cabernet Franc Full-Bodied
  
• Chianti
  
• Dolcetto
  
• Montepulciano D'abruzzo

Rose

• Dry Rose

Not the last word. Just another data point.
________

Litigation: A Blunt Instrument For Change

I enjoy reading Bill Marler's blog. If you want to know about the latest food safety outbreaks, his is the site to visit. A comparable government site might be FoodSafety.gov but it lacks coordination (and timely updating). Today is July 17, and their latest Selected Highlight is the June 9th E. coli Expanded Recall story. Nothing up top about the salmonella in Veggie Booty. You have to wade though the various agencies' sites to find it.

One reason I (along with Senators Durbin, Schumer, Casey, and Clinton) support the Safe Food Act 2007 is because it would establish this coordination.

Back to Bill. He's a Seattle attorney who specializes in food poisoning cases. This afternoon I caught an interview with him on a radio program that airs from Boston called Here and Now. The topic was, not surprisingly, food safety. A quote of his that stood out for me:

"We do have a broken food safety system in America. Having a lawyer in Seattle be the blunt instrument of change isn't necessarily the right way to approach food safety in America."

I agree with him. Litigation does seem, in this country at least, to provide comparable if not better public health protection than legislation. He said it better than I did though.

You can listen to the whole 4-minute interview here:
Here and Now: Bad Meat
________

Saturated Fat

Autumn asks:

"What do you think of Dr. Mary Enig's research on fats and her suggestion that saturated fat is not the devil we've been lead to believe?"

That's a hot potato, Autumn.

First, I'll admit I don't know much about Enig's research. I haven't read her book, Know Your Fats.

But, superficially at least, I agree. I don't think saturated fat should be as maligned as it is.

I don't feel comfortable promoting that fact because:

1. If you remove the red flag from saturated fat, some people will take that as a license to consume more whole milk, cream, high butterfat cheese, fatty steaks ... which aren't inherently bad foods, but they're more caloric than their low-fat alternatives and can promote weight gain. (Studies provide isocaloric diets. That is, they adjust amounts of macronutrients: fats/carbohydrates/proteins, but keep the same number of calories. In reality, people will eat a serving of, say, yogurt and not adjust the amount depending on the fat, thus calorie, content. That's my experience.)
   
   
2. Consumption of foods that contain saturated fat supports the livestock factory farming industry. These foods may also come packaged with undesirable substances (antibiotics, growth hormone, prions, E. coli, etc.).
   
   
3. Regarding our evolutionary past, the selection of genes in meat-eating hunter-gatherers millions of years ago was influenced by environmental pressures distinct from pressures of modern man. For example, infection (which serum fats aid in protection against) may have been a greater health risk then than cardiovascular disease is today. Hunting and gathering are also heart-pumping, calorie-expending activities.

There's a lot to know about saturated fatty acids (SFAs), and I can't say I know a ton. As you know, there isn't one type of SFA; they differ by their chain length. And different SFAs translate into different functions ... more than just providing calories or stuffing lipoproteins. Different SFAs also have different affects on serum lipids, an area of ongoing research.

There do appear to be benefits associated with saturated fat consumption:

1. SFAs increase HDL (Delta Study). MUFAs¹ and PUFAs² do this too, when substituted for carbs, but SFAs do it best.
   
   
2. Although SFAs are associated with increases in LDL, they may decrease Lp(a), a type of lipoprotein derived from LDL thought to be an independent risk factor for heart disease. (The saturated fat used in this 2003 study came from coconut oil.)
   
   
3. One oft-cited study suggested SFAs are the preferred fuel for the heart, at least the rat heart.
   
   
4. Reduction of saturated fat in the diet is often accompanied by increases in carbohydrate, a macronutrient adjustment that has been shown (example) to increase triglycerides and lower HDL.

That said, people differ in their response to fat in the diet. That's a really important piece of the puzzle, individual response. Some people respond better (weight loss, better serum lipids) with a low-fat diet, others with a low-carb/higher fat diet. (For example, the latter may be beneficial for a person with insulin resistance, low HDL and low LDL.) Broad recommendations are risky.

So, I'm back to where I started. Some amount of saturated fat in the diet appears to be beneficial. But I don't want to take responsibility for someone construing that to mean I endorse a diet of double bacon cheeseburgers and Ben & Jerry's.
________¹ Monounsaturated Fatty Acids (olive oil, canola oil)
² Polyunsaturated Fatty Acids (corn oil, safflower oil)
Photo of New York Strip Steak by Nicole Weston via Slashfood.com. Link includes recipe.

Cholesterol Production Via Carbohydrate Intake

Winthrop, and others, have asked me to explain how foods such as carbohydrates that don't contain cholesterol can affect cholesterol levels in the body. His question was prompted by my previous post, How To Avoid Filling A Statin Prescription, where I recommended reducing intake of processed carbohydrates.

Here's a bare-bones reply:

1. Cholesterol is a type of fat. It is a major component of fatty streaks or plaques that develop in arteries (see photo).
   
   
2. Most of the cholesterol in our body, 80-90%, is manufactured within cells in our body. Little comes from food we eat. If you stopped eating cholesterol entirely, you could still have high cholesterol levels.
   
   
3. The more cholesterol you eat, the less your body makes. The less cholesterol you eat, the more your body makes. (This is called a feedback mechanism.)
   
   
4. Cholesterol is made inside our cells from certain raw materials, and is instructed to be made by certain signaling molecules.
   
   
5. The raw material for cholesterol production (and triglyceride production) inside our cells is a 2-carbon molecule (Acetyl-CoA). That 2-carbon molecule can come from the breakdown of carbohydrate, fat, or protein.
   
   
6. Carbohydrates are built from a basic unit called a monosaccharide, which usually provides 6 carbons.
   
   • 1 monosaccharide = glucose, fructose, etc.
     
   • 2 monosaccharides bound together = sucrose (table sugar), lactose (milk sugar), etc.
     
   • 1000s of monosaccharides bound together = starch (found in plants), glycogen (found inside our body), cellulose, etc.
   
   You can get a mother lode of 2-carbon fragments, the raw material for making cholesterol (and triglycerides), from the breakdown of starch.
   
   
7. When we eat carbohydrate, our body secretes the hormone insulin. When we eat a processed carbohydrate (whose glucose units are freed faster than those from a minimally processed carb, i.e. has a higher glycemic index) our body secretes proportionately more insulin.
   
   
8. Insulin is an anabolic or building hormone. Along with other signaling molecules, insulin controls the production of fats such as cholesterol and triglycerides (mostly increasing them). It also controls the packaging of cholesterol and triglycerides into LDL, VLDL, HDL, and other lipoproteins.

The combination of lots of raw material (carbohydrate, especially highly processed carb), and lots of insulin may result in higher levels of circulating cholesterol and triglycerides over time. That's one thought anyway.

The above mechanism is extremely basic. I'm humbled by my growing knowledge of these metabolic pathways - the number of feedback mechanisms, types of signaling molecules, influence of other health factors such as insulin resistance, metabolic syndrome, obesity, diabetes, as well as age, gender, genetics etc. - that I almost didn't post this. But I wanted to give an answer to a question I'm often asked. Consider this a very basic explanation. Cutting and pasting it into your take-home essay on cholesterol is a fool's risk.
________Photo of a human coronary artery with cholesterol-ridden plaque from the University of Pennsylvania School of Medicine.

How To Avoid Filling A Statin Prescription

In my previous post, I wrote about a possible link between statins and nerve disease. The link hasn't been substantiated, but a warning flag has been raised. Some large, long-term clinical trials will have to be conducted before the FDA will issue a caution on statin use. In the meantime, if you'd like to avoid taking statins to manage your cholesterol, try the following. They work.

Four lifestyle changes you can make today:

1. Don't smoke. Avoid second-hand smoke. (Smoke lowers HDL, the good cholesterol, the one you want to be high.)
   
2. Exercise. At the minimum, take a daily walk.
   
3. Reduce saturated fat. (e.g. full-fat dairy products, marbled red meat. Some amount satured fat is beneficial.)
   
4. Eliminate processed carbohydrates. If it dissolves in your mouth, toss it. If it's made from wheat (flour), choose something else to eat.

Number 4 is difficult. But if you're determined to avoid obesity, diabetes, heart disease, etc., and the costs to your health and wallet that accompany them, you'll attempt it, truly and doggedly. Unfortunately, our economy, our society, our culture, even well-meaning health institutions, are wrapped up in processed carbs. So it may be difficult, but it can be done. What do you eat instead? Vegetables, fruits, nuts, seeds, beans, lean meats and seafood, low-fat dairy products, healthful oils, and 6.3 grams of dark chocolate daily.

Here's a list. It's for people who ask, "Like what?", when I recite Number 4.

Severely limit the following, even if it says "Made with whole grain":

Breads
Rolls
Biscuits
Bagels
English muffins
Hot dog buns
Hamburger buns
Pizza
Focaccia
Pita
Tortillas
Waffles
Pancakes
Crepes
Muffins
Cake
Pie
Cookies
Pastries
Donuts
Pretzels
Popcorn
Crackers
Cheese curls
Corn chips
Taco shells
Snack chips
Rice cakes
Breakfast cereals
Pasta
Spaghetti
Noodles
Couscous
Stuffings (bread)

What did I leave off?

Note: For an explanation of how intake of highly processed carbohydrates can lead to increased cholesterol and triglycerides, see my post, "Cholesterol Production Via Carbohydrate Intake".
________

Statins Implicated in Nerve Disease

The following is not a result of a clinical trial - yet. It's not getting much attention from the medical community. But if you're considering taking a statin (Crestor, Lipitor, Zocor, Vytorin, etc.) to manage your cholesterol, you may find this story of interest.

Last Tuesday, July 3rd, the Wall Street Journal ran a front-page story about statins and their link to amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease:

A Risk in Cholesterol Drugs Is Detected, but Is It Real?

The story was based on an interview with Dr. Ralph Edwards, director of the World Health Organization's drug monitoring center, and on a paper he and his colleagues published in the journal Drug Safety last month.¹

Dr. Edwards sifts through reports of adverse events experienced by consumers of a drug after that drug has gone to market - millions of reports. Last year, he noticed something:

"Of 172 people in his database who developed Lou Gehrig's disease or something similar while taking prescription medicines, 40 had been on statins."
- WSJ story

Also:

"Of a total of 5534 safety reports of peripheral neuropathy, 547 were on statins."
- Drug Safety study

Even the FDA noticed a statin-ALS link - half a year before Dr. Edwards and using a different data base:

"The FDA says that through the end of last year, about one-third of the ALS adverse-event reports in its database - 99 of 298 - involved people on statins."
- WSJ Story

Many people who take statins experience muscle pain or weakness. I've seen studies recently that link statin use to reversible peripheral neuropathy - numbness, tingling, burning in hands or feet that goes away when the drug is stopped. However, that a statin might be linked to development of an irreversible degenerative nerve disease such as Lou Gehrig's or other ALS-like disorder is troubling.

Why A Statin-ALS Link Isn't Getting Much Attention

One reason this study isn't getting much attention is that it's a result of data-mining, not of a controlled clinical trial - the gold standard of research. In a clinical trial, adverse events that occur in the people taking the drug can be compared to a fairly similar group of people not taking the drug, which increases the belief that the drug is causing the problem.

Also, participants of a clinical trial are well screened, so that confounders can either be eliminated up front (via exclusion criteria) or adjusted statistically. For example, what if many of the people taking a statin who developed ALS were also smokers? Could smoking, and not statin-taking, be the real cause of the adverse event? In this case, smoking is considered to be a confounder, and in a clinical trial, can be taken into account.

Another reason it's not getting much attention is that ALS is rare (for now), while heart disease (the disease statins are most often used to treat) is not. However, it is exactly because it is rare that it is unlikely to show up in a clinical trial. As Dr. Edwards points out, "[The trials are] relatively short term. Because ALS is a progressive disease, its onset might be rather slow."

So even though cases that arise via data-mining can be complicated by confounders, the technology is useful in detecting problems that take a while to develop (since it's employed after-market). And in the case of a less common disease, data-mining can pick up vagaries where a clinical trial is hampered by its smaller population size.

A third reason might be that as the second most prescribed drug in the US (antidepressants top them), statins serve to generate enormous profits for their manufacturers. There were 203 million prescriptions written for them in 2006, at a cost to consumers of $16.5 billion.² Statins are also very good at what they do, reducing cholesterol.
________
The lesson I take away from this is that it's foolish not to employ lifestyle changes to reduce cholesterol - changes that have been documented to work - before going the statin route.³ Not only will they save you money (statins are a long-term and expensive therapy), but they provide advantages that statins don't.

See my next post, How To Avoid Filling A Statin Prescription, for four lifestyle changes that can help manage cholesterol and reduce risk for heart disease.
________¹ Statins, Neuromuscular Degenerative Disease And An Amyotrophic Lateral Sclerosis-Like Syndrome: An Analysis Of Individual Case Safety Reports From Vigibase
² The Statin Drugs, Prescription and Price Trends, Consumers Union, February 2007, and IMS Health Inc.
³ It's important to consult with your physician before halting or foregoing statin therapy. As Eric noted in comments, not all cases of high cholesterol respond to lifestyle measures.

A Small Daily Dose of Dark Chocolate Lowers Blood Pressure

Finally, a study about chocolate with results I can apply. See those two small chunks of dark chocolate in FRE's hand? That amount was just found to be effective at reducing blood pressure if eaten daily.¹

I'm very excited.

This is the first study to report this benefit using such a small intake of chocolate. Previous studies had us eating about a quarter pound (100 grams) of chocolate daily. Daily is an operative word here. Slack off eating that 500-calorie-bar daily and no effect on blood pressure would be seen. I don't know anyone who could fit 500 extra calories into their diet - Every Single Day - and not gain weight or displace other needed nutrients. That's why this study is so exciting to me. I've seen lots of chocolate studies but never one I allowed to significantly change my eating behavior, or one that I felt responsible in recommending to others.

Study Basics

• Randomized, controlled, investigator-blinded (you can't blind the chocolate eaters).
  
• Participants were 44 white, older (56 to 73 years of age), mildly hypertensive adults recruited from a primary care clinic in Germany.
  
• Intervention was daily consumption of 6.3 grams (30 calories) of dark chocolate; control group received white chocolate (which had no BP-lowering effect).
  
• After 18 weeks, dark chocolate eaters reduced their systolic BP by an average of 2.9 mm Hg, their diastolic by 1.9 mm Hg. (This is no pittance.²)

Why This Study Excites Me

• After 18 weeks, everyone (100%) who consumed dark chocolate experienced a reduction in blood pressure.
  
• Retention was 100%. No participants dropped out. That's something for an 18-week intervention. Perhaps the pill was easy to swallow.
  
• Participants kept daily food diaries. This helps rule out effect from other dietary components, or a change in eating habits during the study. This level of food intake assessment is unusual and expensive, but it adds credence to the results.
  
• The daily chocolate dose did not result in weight gain.
  
• The study documented the likely mechanism: Some ingredients in dark chocolate, possibly cocoa polyphenols, increase circulating levels of a compound called S-nitrosoglutathione. This chemical is a vasodilator, it can widen blood vessels allowing increased blood flow.

How to Apply Their Results

• Eat dark chocolate. Not white chocolate, not milk chocolate, not chocolate with a low cocoa content. Aim for a 70% cocoa content or higher.
  
• Eat no more than about 6.3 grams (the amount shown in the photo), unless you can afford the calories.
  
• Eat the chocolate daily. This is important; think of it as a pill. The BP-lowering effects in this study were progressive: No effect was seen for the first 6 weeks, the strongest effect was measured at the end of the study (18 weeks). So you'll need a daily dose to reach and maintain the BP-lowering effect.

________¹ Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide
The authors of this study are the same, mostly, as those who conducted the one on chocolate and blood pressure that I discussed here back in April.
²According to these researchers, this reduction would reduce stroke mortality in the population by 8% and cardiovascular disease mortality by 5%.
It's also equivalent to the BP reduction (3 to 4 mm Hg systolic, 1 to 2 mm Hg diastolic) seen in the HOPE (Heart Outcomes Prevention Evaluation) Study which was achieved using an ACE inhibitor, and which reduction, although modest, was thought to contribute to the reduction in heart attacks seen in this group of over 9500.
Lastly, as Mike prompted in comments, there may be a dose-response mechanism working, meaning the more cocoa you eat, the greater your BP reduction. Previous studies that used more than the 6.3 grams in this study found greater reductions. This is not a consumption license.

Photo: Homegrown. The chocolate is Green&Black's, 70% cocoa.

No Pesto For You

________Photos: Homegrown

Former FDA Associate Commissioner Sounds Alarm on Imported Food

In keeping with the topic of tainted food, here's a June 8th, PBS interview with William Hubbard, a former associate commissioner of the FDA. He served in that position for 14 years, retiring in 2005.

Extended Interview: Former FDA Official Discusses Food Safety


I was shocked at his frankness. Here are a few excerpts:

WILLIAM HUBBARD: Well for example, here's a cereal that has small freeze-dried strawberries in it. They almost always come from China.

BETTY ANN BOWSER: The strawberries do?

WH: The strawberries do. And FDA has found some contamination issues with those strawberries. The cereal of course, the final product is made here in the United States, but it uses foreign ingredients.

BB: So they make the cereal here, but the strawberries in the cereal come from China.

WH: That's correct. But the FDA finds tremendous problems from Asian countries in what they call filth.
________
WH: Well, let's look at, this is apple juice. Now, you think apple juice is as American as apple pie. But in fact, much of our apple juice comes from China. And what FDA has been finding is they would water down the apple juice, add a chemical called inulin.

BB: The Chinese?

WH: Yeah, and inulin would make it taste just like real apple juice and even FDA's own labs were having trouble finding a chemical in there. It was really an economic fraud to water down real apple juice and only use a small amount of real apple juice. And that was a very common problem and goes on today.

BB: Wait a minute. Let's see what this label says.

WH: You won't see anything on it. It just says apple juice.

BB: It says 100 percent juice from concentrate.

WH: Well they lie.

BB: But the label says 100 percent...

WH: It should be. ... But they have developed such nefarious techniques for disguising their watering down of the real apple juice that even the FDA laboratories are having difficulty finding this compound inulin, which mimics the chemical composition of apple juice.

BB: So how do I know when I'm getting a jar of real apple juice at the store?

WH: You don't.
________
WH: This is an interesting example, Betty Ann. This is applesauce, baby applesauce. And it has ascorbic acid as a vitamin C to help prevent spoilage. It's known as an antioxidant. So you might think, well, if I don't want to buy this. If I'm worried about ascorbic acid being there because most ascorbic acid comes from China, I would buy organic applesauce which is this.

BB: Right.

WH: But if you notice on the label it says it's made from organic apples, but it still contains ascorbic acid. So you're still getting a foreign imported chemical even though this is technically an organic product.

BB: That doesn't seem right. I mean that's almost like lying about what's in the product. How can it be organic if it's got chemicals in it?

WH: Certainly the apples would likely have been organic, but ascorbic acid is an important ingredient to prevent spoilage in these commodities. It's a good thing. It's not unsafe. It's just if it's coming from a place where no one is checking it out, then there could be some potential concern.
________
BB: I hate to ask this question, but I have to because it's part of my job. If bad guys wanted to poison, people always worry about the food, about the food system in America being subject to terrorists. I mean if terrorists really wanted to, how easy would it be for bad guys to make hundreds of thousands of people sick?

WH: Well on his last day in office, Secretary of Health and Human Services, Tommy Thompson, said he worried about the food supply from imported food because he thought it was too darned easy to do just that.

BB: What do you think as a former FDA employee?

WH: I'd rather not say.

BB: Do you have concerns about it?

WH: Secretary Thompson was echoing concerns among many knowledgeable food safety officials.

BB: Okay, so you wouldn't disagree with him?

WH: I wouldn't disagree with Secretary Thompson.
________

Tainted Livestock

Doug asked:

(1.) 'Kay, Bix, here's the $64,000 question: do you believe that "melamine fed to livestock destined for the consumer food supply poses no threat to human health"?

(2.) I'm also wondering if our livestock are STILL being fed melamine-contaminated food. (3.) If not, how long before we can safely go back to eating supermarket chicken, pork, etc.?

Short answers:

(1.) No. (2.) Not knowingly. (3.) I don't know.

________
Take that quote: "melamine fed to livestock destined for the consumer food supply poses no threat to human health" and replace the word "no" with "low".

The FDA admits to a low threat, not an absent threat. My Senator should know better.

When a CNN reporter asked:

"Now that the risk assessment for melamine in feed for livestock is low, does that mean that you will then allow the pet food companies to sell all their recalled food to livestock companies as long as it's used in a small amount?"

The FDA responded:

"The answer is no - that we consider any of the tests positive to be adulterated and could not be used to further process into feed."

(What standard of health defines a food as adulterated, yet allows its continued sale and consumption?... the standard of health that has business interests in mind. That CNN reporter should get a medal for asking that question.)

The risk is not so much in feeding a tainted chicken breast to a healthy 30-year-old. It's in feeding it to someone with kidney problems (many diabetics), or others with metabolic disorders, over and over again.

No one has adequately addressed the risk of chronic, low-level ingestion of melamine, which might be had from various sources, not just contaminated pet food. (800 hogs' urine tested positive for melamine, yet these hogs were never fed the contaminated feed.)

There's also the question of toxicity when melamine is combined with other chemicals in vivo, chemicals that should also not be in our food (e.g. cyanuric acid). This last question may be difficult to answer since it doesn't look like we're fully cognizant of what those chemicals are.

Speaking of chemicals that shouldn't be in our food ... the Chinese seafood that was detained at port contained chemicals that, according to the FDA, "have been shown to be carcinogenic with long-term exposure in lab animals." How long have we been eating them?

I want to see more inspections.
________Photo of chicken by the Italian photographer Pascal Oliver Marolla. Here's his gallery.