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Your Heart Month action plan

Heart disease, sometimes called coronary artery disease, is the leading cause of death in the United States. Despite improvements in prevention, diagnosis, and treatment, it is still responsible for nearly 600,000 deaths each year, mostly from heart attacks. Millions more are at increased risk because of certain biological and behavioral risk factors. Some of these risk factors cannot be changed, such as age, sex, and family history, while others can be altered to reduce risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity. You can learn much more about heart disease from the American Heart Association.

Since February is Heart Month, this is an ideal time to assess your own risk of heart disease and take steps to improve your heart health. If you aren’t sure where to begin, my Health & Fitness column in the Aiken Standard this week includes four simple steps you can take to assess and lower your risk for heart disease. If you aren’t sure where to begin, these four steps should be a good start to prevent and treat heart disease.

Heart

 

 

 

 

 

 

 

 

 


Here is your Heart Month action plan:

  1. Assess your risk. If you haven’t done so recently, you should see your doctor to have your risk factors evaluated. This includes tests for blood glucose and blood lipids (including total, LDL, and HDL cholesterol and triglycerides), measurement of your blood pressure and body weight, and an assessment of other health factors such as your family history, whether you smoke, and your level of physical activity. You may be able to find a health fair or other event in the community at which you can have many of these measurements made, but only your doctor can help you determine the best course of treatment given your personal risk profile.
  1. Be active everyday. The benefits of as little as 30 minutes per day physical activity are well-established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, that can have such a broad impact on reducing heart disease risk!
  1. Improve your diet. If you are like most Americans, your diet is too high in unhealthy fats, salt, and added sugar and lacking adequate whole grains, fruits and vegetables, and fiber. This type of diet is associated with obesity, high blood pressure, high cholesterol, and diabetes. All of these conditions are risk factors for heart disease, so you may literally be eating your way to a heart attack. Changing what you eat to include more whole grains, fruits, vegetables, and low-fat meat and dairy and minimizing added sugars, fat, and processed foods can help you lose weight and prevent or treat high cholesterol, diabetes, and high blood pressure.
  1. Quit smoking. There is no way around this one—quit! Ask your doctor about prescription medications that can make quitting easier. Nicotine replacement therapy in the form of patches, gum, and lozenges can help manage cravings and are available over the counter. Ultimately, though, quitting smoking is a behavior change that takes motivation, willpower, and time. But it is worth it—your risk of heart attack goes down within days and can drop 50–70% within five years after quitting.

The potential impact of these steps is great. Knowing which risk factors are most concerning can help you and your doctor make the most effective treatment decisions. Even modest changes in diet and activity can lead to improvements in risk factors and reduced heart attack risk. The best news is that you can start today by putting down your next cigarette, going for a walk, and eating a healthier dinner. Your heart will be glad you did.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

 

Planning to join a gym? Here’s what to expect from a fitness test.

Getting in shape is a common goal for the New Year. Before you start an exercise or weight loss program you may want to have a fitness test to determine your current status and to assess improvement as you progress through the program. If you join a gym, a fitness assessment may be required. This is smart, since a fitness test is important for determining a safe and effective exercise recommendation. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Personal_Training_at_a_Gym_-_Pushups


A good fitness test should include measurements of muscular strength, aerobic fitness, flexibility, and body composition. While the specific test procedures may vary, here is a description of what you might expect during your fitness test.

Muscular strength is measured using a one-repetition max (1-RM) test in which the heaviest weight you can lift is determined, typically for the bench press and the leg press. Sometimes alternative tests are used, such as the number of push-ups or sit-ups you can do. Handgrip strength can also be used as a rough estimate of overall muscular strength.

Cardiorespiratory or aerobic fitness is the ability of your heart and lungs to supply oxygen to your exercising muscles. The “gold standard” is to actually measure the amount of oxygen you breathe during vigorous exercise, called maximal oxygen uptake or VO2 max. This test requires specialized equipment that is typically only available in exercise labs, so most fitness tests estimate VO2 max.

Your aerobic fitness test will probably be a submaximal test in which your heart rate is measured as you exercise at several intensities on a treadmill or stationary cycle. The change in your heart rate is used to estimate your VO2 max.

Flexibility is an important, but often overlooked, component of fitness. Flexibility is usually measured using the sit-and-reach test which assesses low back and hamstring flexibility.

Body composition refers to your percent fat, which is of interest to people who want to lose weight or build muscle. The most common method of measuring percent fat is skinfolds, in which the thickness of your skin and subcutaneous fat is measured at several sites on your body. The most important criteria for accuracy of skinfolds is the skill of the tester, so look for someone who has years of experience to measure your skinfolds. There are more accurate methods of measuring percent fat but they are limited to research and clinical purposes.

Simpler methods of assessing your body weight and fatness include body mass index and circumferences. Body mass index can be calculated from your height and weight (look online for a BMI calculator) and is widely used to assess body weight and health. Waist and hip circumferences are determined using a measuring tape and provide more information about where fat is stored. Upper body fat (high waist circumference) is associated with higher health risk than lower body fat (low waist measurement).

There are two additional points to remember before you have a fitness test or start an exercise program. First, you should see your doctor if you are new to exercise or have had changes in your health. Second, a fitness test should be conducted by a qualified professional. Make sure the personal trainer or fitness professional you work with is certified and has experience with fitness testing.

Finally, and most importantly, use the results of your fitness test to motivate you so you can see improvements as you get more fit in 2016!

 


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
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 drbrianparr@gmail.com | http://twitter.com/drbrianparr

What’s trending in 2016?

This is the time of year where you might be thinking about your New Year’s Resolutions. If getting in shape, either to lose weight or to improve your strength or endurance, is your goal you are not alone. According to one report, getting fit is the most common resolution. Since 2007, the American College of Sports Medicine (ACSM) has surveyed health and fitness professionals to identify exercise trends for the upcoming year. Here are a few of the top fitness trends  to look for in 2016:

The biggest fitness trend for 2016 is wearable fitness technology. From activity trackers like the Fitbit to heart rate rate monitors, the newest “wearables” are sophisticated tools for recording your steps per day, distance you run, and calories you burn. Some, like the new Apple Watch, have multiple functions while others, like GPS watches, provide specific information. Make sure to pick the device that meets your needs… and your budget, as they can get expensive!

Next on the list is body weight training. Popular for building strength and endurance with minimal equipment, body weight training goes far beyond the push-ups and pull-ups you may remember doing in PE class. This type of training can be done almost anywhere, which is good news for people who are on a budget or want to train at home.

Following that is high-intensity interval training (HIIT), which uses repeated cycles of short, maximal or near-maximal exercise alternated with short rest periods. These HIIT sessions last less than 30 minutes but lead to fitness improvements that exceed those of traditional longer-duration training. Beginning exercisers should note that HIIT training is intense, so starting slow is recommended.

Strength training still ranks highly, and for good reason. In addition to building or toning muscles, strength training can make everyday activities easier, help maintain bone mass, and promote weight loss. Strength training is often incorporated into other types of exercise, so you don’t necessarily need to “pump iron” to build strength.

Fifth on the list is educated and experienced fitness professionals. You should look for a facility that requires the staff to have fitness certifications that involve both education and experience. This may include personal training, which is number six on the list. Personal trainers are excellent resources for people just starting out as well as experienced exercisers. Finding a trainer who has experience working with people like you is important, so ask for recommendations and references to get the best match.

Next is functional fitness, using strength training to enhance the ability to perform a wide range of physical activities. For example, athletes have long used functional fitness training to target the movements they utilize in their sport, but the same principle holds true for occupational demands and activities of daily living.

Rounding out the top ten are fitness for older adults, exercise and weight loss, and yoga, which have been on the list for some time. While this list does not include every popular or “trendy” type of exercise, it does capture the components of most types of training. CrossFit, for example, is a combination of body weight, strength, and functional training involving high-intensity intervals in a group setting.

Even if you don’t plan to join a gym or aren’t interested in the latest fitness trends, keep in mind that even something as untrendy as walking for 30 minutes each day can have substantial health and fitness benefits. And if you haven’t been exercising, this can be a great way to get started on a happy and healthy New Year!


 

 

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

Forget about low-carb, go smart carb.

Nutrition advice tends to be complicated and contradictory, making simple answers to the question, “What should I eat?” anything but simple (but you still need to do it!). This is particularly true when it comes to carbohydrates. On one hand, current recommendations call for carbohydrates to be the major part of your diet. On the other hand, low-carbohydrate diets are at odds with these recommendations but are still very popular.

For example, the Atkins diet restricts all carbohydrates, including refined grains and sugars. The Paleolithic diet emphasizes minimally processed foods that may have been consumed by our ancient ancestors including lean meat, eggs, fruit, and vegetables while restricting the consumption of grains and added sugars. Both have been shown to promote weight loss better than traditional low-fat diets.

Proponents of low-carbohydrate diets claim that restricting carbohydrates promotes fat loss and eating carbohydrates leads to fat storage and weight gain. It is also likely that people who follow low-carbohydrate diets find them easier to stick to than other diets, so they may actually end up eating fewer calories.

But the problem may not be carbohydrates in general, it might be eating too few of the right carbohydrates. Given that September is Whole Grains Month, this seems like a good time to explore the benefits of going smart-carb instead of low-carb. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Food grains


Sources of carbohydrates include whole grains (such as whole wheat bread), refined grains (white bread), and sugars. Both refined grains and sugars tend to raise blood glucose rapidly, called the glycemic index, which leads to an increase in certain hormones, including insulin. Insulin stimulates the uptake of nutrients into cells, including the storage of fat in adipose tissue. This is one reason why carbohydrates are linked to fat gain and why restricting carbohydrates leads to fat loss.

But carbohydrates from whole grains don’t raise either blood glucose or insulin as much. This “low and slow” response has several benefits, including improved blood glucose regulation, lower triglycerides, and, potentially, reduced fat storage. For these reasons, complex carbohydrates from whole grains are called “good carbs,” in contrast to refined grains and sugars, known as “bad carbs.”

Considering that the typical American diet contains too much carbohydrate from sugars and refined grains and not enough whole grains, restricting carbohydrates may have some benefits. But there is another approach: be smart about your carbohydrate choices. Instead of cutting out all carbohydrates, focus on reducing refined grains and sugars and emphasizing whole grains.

You can meet this goal by limiting your intake of sugars, especially added sugars, and refined grains while increasing your consumption of whole grains, fruits, and vegetables that are high in fiber. When comparing food labels, look for foods that contain whole grains (the first ingredient should be something like “whole wheat flour”) and higher levels of fiber. But be aware that some foods, like many breakfast cereals, contain whole grains but are also high in added sugar. The best advice is to get the majority of your carbohydrates from real food, including vegetables, fruits, whole grains, and legumes, rather than from processed foods.

Something to keep in mind is that although low-carbohydrate diets are associated with weight loss and good health, they are not the only way to achieve these benefits. Indeed, people who are considered to be fit and healthy have a wide range of eating patterns, from vegetarian and low-fat diets to extreme low-carbohydrate diets and everything in between. The one factor they have in common is that they are active. It may be that regular exercise is just as important as what you eat when it comes to promoting health.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

It’s not your fault, but it is your responsibility.

Eating well and being physically active are two of the most important things you can do to promote good health. But knowing you should do these things does not always mean it is easy to actually do them.

Despite the simplicity of the message “eat healthy and exercise,” many people struggle with knowing exactly what to do and how to do it. This is largely due to the complicated and ever-changing nature of nutrition and exercise information and the fact that most people receive no education in these areas.

You may even feel like the information you read and hear is designed to confuse you. That may be true, considering that much of the nutrition information we get comes from food companies that are trying to convince us to buy their products. Even scientific research can yield conflicting results, challenging even the most knowledgeable professionals, myself included, to make sense of it. And even if you do decide to make eating or activity changes, the “best” diet or exercise program claims may make you wonder if you made the right choice.

Given this, it’s not your fault if you struggle to understand basic health information and recommendations. But it is your responsibility to learn as much as you can to make the best choices for you and your family.

This is the topic of my Health & Fitness column in the Aiken Standard this week

Man shopping in supermarket

This won’t be easy, of course. The popular media, as well as social media, promote confusion and false promises about nutrition by making claims that some foods are “toxic” while others are “superfoods.” The old good carb, bad carb or good fat, bad fat arguments have been given a new life as eat this, not that lists. The problem is that many of these claims are not supported by science. The research that is done often yields complicated or conflicting results that aren’t explained in a way that actually helps people make good decisions.

The same is true for exercise. No one doubts that exercise and physical activity are essential for good health, but there are conflicting claims about specific benefits of exercise and what the best form of exercise really is. This can lead to the idea that if you aren’t doing the right exercise, it doesn’t count. Nothing could be further from the truth! While there are reasons why some athletes might want specific types of training, the majority of people can benefit from simply spending less time sitting and going for a walk each day.

So, what can you do? Given the confusing and changing nutrition recommendations it’s best to focus on what hasn’t changed. That is, to focus on eating real food rather than processed, prepackaged foods. Planning meals and snacks to include fruits, vegetables, whole grains, nuts, legumes, lean meat, eggs, and dairy should give you plenty of healthy fats, carbohydrates, and proteins.

Instead of worrying about the “perfect” exercise, make it your goal to do something active for at least 30 minutes every day.  Beyond that, dedicating time for aerobic, strength, and flexibility exercise will bring greater benefits. Remember, the best exercise for you is the one you will do! Seek advice from people you trust and credible professionals, but remember that if it sounds too good to be true, it probably is.

Your responsibility isn’t to understand all of the nutrition, exercise, and health information you hear. It’s to make an effort to make a few simple, healthy choices despite that confusing information: Sit less, move more, and eat real food.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

Sometimes kids do get good activity and nutrition education in school. Here are two examples.

Earlier this week I wrote about the fact that most children will miss any meaningful education about nutrition, activity, and health when they head back to school. But this isn’t always the case. Some schools include health education in the curriculum, but most don’t. But others do promote healthy eating and exercise elsewhere in the curriculum (daily PE, for example), opportunities for activity throughout the day (recess, letting kids move around in the classroom), and providing healthy meals and snacks.

This is critically important, since good nutrition and physical activity are necessary prerequisites for children to learn and grow.

kids playing


Sometimes I hear about schools that have implemented robust health education programs and individual teachers who make an effort to add activity and nutrition to the “testable” subjects they teach. I am also familiar with two educators who have made nutrition and physical activity a priority both inside on outside the classroom.

One is my brother (@mrkevinparr), a fourth grade teacher in Washington state. Several years ago he decided to address the childhood obesity problem he saw among his students by teaching about healthy eating. Since there was no room in the curriculum for this topic, he created a way to do it while teaching math. This inspired the students to think beyond their class and organize a community health fair.

The other is a longtime friend who was a principal of an elementary school (now district superintendent) in Michigan. He made physical activity a priority through several initiatives including implementing a walking school bus, installing a track around the playground, and encouraging teachers and students to exercise before, during, and after school. (Check out this video!)

So…it can be done, even in the context of an environment that doesn’t support teaching healthy habits. This isn’t to say that parents don’t play an important role in teaching their children healthy habits. But many parents don’t (or don’t know how). Considering the importance of healthy eating and activity for achievement in school and in life in general, schools are a natural place to address these topics.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

School gets out, weight goes up. Why now is the time to focus on preventing childhood obesity.

Obesity is a major concern for adults, linked to several leading causes of death and numerous other health problems. What you may not know is that obesity is also a serious health issue for children. It is troubling to note that nearly one-third of school-aged children and teenagers are over a healthy body weight and nearly 20% are considered obese. Remarkably, 10% of infants, toddlers, and preschoolers, are also considered obese.

This is important because the common combination of poor nutrition, physical inactivity, and obesity has physical, psychological, and social consequences for children that frequently persist into adulthood. There are many reasons why childhood obesity occurs and much that can be done to prevent it. Now that school is almost out for the summer, this is a critical time of year to focus on good nutrition and activity to help prevent unhealthy weight gain in kids. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Childhood obesity cartoon


Overweight and obese children are at increased risk for type 2 diabetes, high blood pressure, heart disease and even stroke – conditions usually associated with adulthood. Even if an overweight child does not have these conditions now, he or she is likely on that path. Many experts predict that children born today will be the first generation in history to have a shorter lifespan than their parents due to obesity-related diseases that begin in childhood.

Children who are overweight are also more likely to suffer other consequences including lower self-esteem, social functioning, and academic performance. Overweight children are also less likely to play sports or participate in other forms of physical activity. Considering that the consequences of obesity are made worse by low levels of activity, this creates a cycle leading to poorer and poorer health.

There are numerous potential causes of obesity in children, but the most likely suspects are too little activity and excessive calorie intake, largely because of added sugars. Fewer than half of all kids meet the minimum recommendation of 60 minutes of activity each day and many children spend as much time watching television or playing video games as they do in school. We shouldn’t be surprised that we have a childhood obesity problem!

While poor nutrition and a lack of activity in schools is thought to contribute to the problem, many children get more activity and eat better at school than they do at home. A recent report suggests that children gain more weight over the summer than during the rest of the year. Furthermore, for many kids, fitness gains made during the school year are frequently lost over the summer. Since summer vacation is rapidly approaching, this is a critical time to help our children stay fit and healthy.

The good new is there is much we can do. Ensuring that children get plenty of healthy foods such as fruits and vegetables, reducing the consumption of added sugars, and eating appropriate portion sizes will go a long way to addressing the diet aspect of obesity. Making sure that kids of all ages have opportunities to be active while limiting time spent sitting, especially in front of a screen, are equally important.

Since children don’t make most of the decisions about their activity and diet, it is important to recognize the role that parents, grandparents, and other caregivers play. More often than not, obesity is a family issue. This means that  solving the problem is a family issue, too. Adults should model healthy behaviors by making diet and activity changes themselves. A good place to start is by turning off the TV and going outside to play or for a walk. It’s something all of us—adults and children—will benefit from.

Losing weight is easy, not finding it again is the hard part.

Earlier this week I wrote about tips and tricks from people who are successful losing weight. While some people may make it look easy, losing weight is challenging, to be sure. But maintaining weight loss can be even more challenging.

Many people think that they are finished once their diet or weight loss program ends. The truth is that the end of the diet marks the beginning of the next phase: keeping the weight off. In fact, many people have successfully met their weight loss goal only to gain the weight back later. In fact, some people do it every year, losing and regaining the same 10 (or more) pounds over and over.

There is a practical reason why this happens. In order to lose weight and keep it off people need to learn a whole new lifestyle involving what, when, why, and how they eat as well as daily exercise. These lifestyle changes are difficult to make and can take months or years to fully adopt. In many cases, the weight loss program ends before people make lasting behavior changes. This makes it all too easy to revert to old habits.

While there are literally hundreds of diets and weight loss programs to choose from, “weight maintenance” programs are far less common. The good news is that following the advice of people who are successful at losing weight and keeping it off can help you maintain your weight loss.

The members of the National Weight Control Registry (NWCR) — the “successful losers” have lost an average of 66 pounds and kept it off for over five years the — provide insight into how they keep the weight off. Most report continuing to maintain a low-calorie, low-fat diet and doing high levels of activity. Almost 80% eat breakfast every day, 75% weigh themselves at least once a week, over 60% watch less than 10 hours of TV per week, and 90% exercise, on average, about 1 hour per day.

Many people worry whether they are following the “best” diet or weight loss program. The specific diet may not be as important as what you do when it ends. Notice that the majority of successful losers still control what they eat and nearly all exercise each day. This suggests that going back to the way you ate before you lost weight is unrealistic. And if you aren’t exercising, at least walking, every day already, now is a good time to start.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

Exercise, like all prescriptions, only works if you use it as directed.

Earlier this week  I wrote about the Exercise is Medicine initiative and why physicians should prescribe exercise to all of their patients.

Despite the widely-known benefits of exercise, many physicians—and people in general—believe that chronic health conditions should be managed using medications, not  proper nutrition and physical activity. This is a misguided approach considering that weight gain and health conditions related to weight gain  accumulate over a period of years, resulting from eating too much combined with low levels of activity.

One reason that physicians are hesitant to prescribe exercise (and, similarly, good nutrition) is that in their experience, it doesn’t work. What they mean is that the results they see after recommending lifestyle modifications are typically not sufficient. So the assumption made by doctors and patients is that lifestyle modifications don’t work. But this is not necessarily the case

This debate comparing lifestyle modification with medical management of chronic diseases is familiar. Consider statins, the popular lipid-lowering medications that are currently among the most-prescribed drugs (examples include Lipitor, Zocor, Crestor and Vytorin). The effect of statin drugs on lowering blood lipids is significant in most patients. This, together with clever marketing to both patients and physicians, explains why they are so widely used.

It is possible to lower blood lipids as much as statins by carefully controlling diet and regular exercise, but it is difficult. How difficult depends on the individual, but everyone would agree that successful lifestyle modification takes more effort and dedication than taking a pill. In order for any treatment to work, it has to be followed. A patient who doesn’t follow their diet or exercise program is no different from a patient who doesn’t take their medication as directed. In both cases, the response to the treatment will fall short of expectations.

If someone didn’t take their statin medication and their blood cholesterol didn’t go down, no one would label the drug a failure. The medication may well have worked if the patient took it. But people routinely claim that diet and exercise don’t work, when the real problem is that these treatments aren’t followed. This could be because the patients weren’t provided with appropriate and actionable information or because they didn’t faithfully follow the instructions they were given.

The problem isn’t that lifestyle modification isn’t effective, it’s that people don’t implement healthy changes for the long-term. Whereas a statin drug results in rapid changes, the benefits of behavior change are realized more slowly. This can lead to the incorrect conclusion that diet and exercise aren’t working, even though they are.

In reality, medication can be part of a treatment plan, but should not be the only prescription.  Long-term health benefits come from changing eating and activity patterns. Medications should be used as a  “jump start” to treating a condition, with a goal of developing a new way of eating and regular activity as the long-term treatment.

For example, medications like statins can lower cholesterol quickly. Then, lifestyle changes can keep the cholesterol down, reducing the need for the drug. Since side effects depend on the dose and duration of treatment, this approach would reduce the risk of potentially dangerous side effects.

For many patients, lifestyle changes are effective on their own, meaning the medication isn’t necessary. And consider this: maintaining a healthy body weight, proper nutrition, and regular exercise has been proven to be the best—and at this point, only—way to prevent most of the health problems most of us will face. Good nutrition and physical activity really are the best medicine!

More confusing food labeling, from people who should know better!

Since I am thinking about the topic of confusing food labeling this week, I wanted to share another example that I read about recently.

The Academy of Nutrition and Dietetics, formerly the American Dietetic Association, announced the first food to bear their “Kids Eat Right” label. This is a big deal, because the label is a sort of endorsement from the professional organization that represents nutritionists and dietitians. It follows that these foods would be among the healthiest choices for kids.

Unless they aren’t.

It turns out that the first food to bear this label is Kraft American Singles cheese “product.” It’s not even real cheese. Or even real food for that matter. Obviously, there is more going on here than helping consumers identify healthy foods for their kids. Hint: it involves money!

Nutritionist, professor, and author Marion Nestle provides some excellent commentary about this on her blog, Food Politics. Check it out…she is an excellent resource for all things nutrition.