Warning: Reading This May Upset Fast Food Industries

Can the Food Industry Play a Constructive Role in the Obesity Epidemic? That is both the title of an article and the question posed in the October '08 issue of the Journal of the American Medical Association (JAMA). David Ludwig, MD and Marion Nestle, PhD survey the so-called "responsible policies" food companies are taking on to promote healthy eating and living. They note how companies such as Pepsi Co, McDonalds, Kraft and Coca-Cola state they are trying to educate the public about energy expenditure (calories consumed v calories burned in physical activity), nutrition and encouraging physical activity.

What, you mean you haven't seen a McDonald's marathon (there are actually McDonald's Marathons)? And of course they are trying to educate us on nutrition why wouldn't they?  I mean, they are in the business of selling nutritious foods. They understand the human body and its physiology so well that they've pioneered techniques to pack as much fuel as possible in their foods - a.k.a refined starch, concentrated sugars and low quality fats - in order to make our bodies work and feel better.

My diatribe brings up an interesting question: do major food companies in fact have a duty to try and curb their malignant effects on society? And can we rightfully place blame on these institutions for adverse health outcomes the world faces? That is to say who should be acting more responsibly consumers or the food industry?

The authors of the JAMA article point out what Michele Simon, professor of health policy at University of California Hasting's, argued in her 2006 paper Can Food Companies Be Trusted to Self-Regulate?

"The food industries lobby vociferously against policies to improve children's health, make misleading statements and misrepresent their policies at government meetings and in other public venues; and make public promises of corporate responsibility that sound good, but in reality amount to no more than public relations"

Thus we have major food industries not only promoting unhealthy foods, but also obfuscating any policies or regulation aimed at safeguarding the public from their products. So these industries are allowed to flood the market advocating the purchase of unhealthy foods and advertise them in virtually (literally virtually) all avenues of life, and consumers are to bear, what, the total responsibility for sound choice and good decision making? Let's put it this way, as Zoë Robert stated in her article Junk Food Advertising: Are Children the Biggest Losers?, "for every $1 USD [the World Health Organization] spends on trying to improve nutrition around the world, $500 USD is spent by the food industry promoting processed foods".

Therefore back to one of my questions I brought up, does the food industry bear a significant part of the blame and responsibility of the ill-health effects associated with their foods. I think that their lack of discretion says it all: from carefully calculated advertising placements in schools to their enlistment of "lifetime customers" - as Eric Schlosser warned inFast Food Nation - with products such as McDonald's happy meals.

Do these food industries have a duty to try and curb their malignant effects on society? Maybe not - sarcastic tone can be interpreted here. Maybe they aren't obligated to do anything but sell their products. Maybe they don't have to promote healthy alternatives if they don't want to. But maybe they should have to oblige to regulation limiting their scope of marketing. Or regulation that rightfully warns people how misleading their products are. 

It wasn't long ago that cigarette makers were fighting the research that linked cigarette smoking to lung cancer and birth defects. It wasn't long ago that they fought tooth and nail to oppose warning labels on cigarette packets. Should that be the fate of the fast food industry? Maybe; Maybe not.  But it does have a nice ring to it: Quarter Pounder with Cheese comes with fries, a drink and an increased risk of diabetes, heart attack, stroke and cancer if consumed regularly.

- m.tsang

TB Island

Pop quiz: Which disease do you have a 30% chance of having, and is the second leading cause of death by infectious disease in the world? Well, that was sort of a trick question - but I probably have your attention. Tuberculosis is the second leading cause of infectious disease in the world, according to the CDC, with about one third of the world's population (2 billion) having non-active or latent Mycobacterium Tuberculosis (LTB).

However there is no true 30% percent chance of having the disease - some more than others and vice versa. As Clifton E. Barry III and Maija S. Cheung mention in this month's Scientific American article New Tactics in the Fight against Tuberculosis 90% of those who have LTB live in third world countries. This reminds me of my father's response to a Doctor's inquiry of his history of LTB, "Of course I have [LTB], I grew up in Hong Kong; back then they call it TB Island". The Doctor just kind smirked and said "ok, ok, never the active form though correct?" To which my Dad smugly replied "no".

Barry and Cheung note that "ninety percent of people infected with [LTB] never develop active TB disease". However, that still leaves us with a large number of people around the world with active TB. The disease itself is caused by the bacteria Mycobacterium Tuberculosis which primarily takes home in the lungs. This is a good place for the bacteria to camp out since they work most efficiently in an oxygen rich environment (aerobic). The bacteria invade and exploit the lung tissue which kills it - this is why TB patients often cough up blood. Moisture droplets containing the bacteria can spread to non-infected persons through spit, coughing or sneezing.

TB can be cured if the patient sticks to a tedious six to nine month antibiotic regimene. In the first half of the twentieth century developed nations employed antibiotics with alacrity, and along with other improved public health measures diseases like TB were all but extirpated in places like the US. In fact, as Randolph Nesse M.D. and George Williams PhD write in their book Why We Get Sick, "In 1969 the US Surgeon General felt justified in announcing that it was 'time to close the book on infectious diseases'."

Well the book has not only been re-opened since then, but it has been re-written. Now, some of the bacteria causing TB has evolved to withstand the first-line antibiotics, so-called multidrug resistant TB (MDR TB). Barry and Cheung say to effectively fight off the defiant MDR TB "requires therapy for up to two years with second-line anti-TB drugs that produce severe side effects". Even worse, there are cases of Extreme Drug Resistant TB (XDR TB) that can go virtually unscathed by all lines of defense put against it. "People with tuberculosis resistant to multiple drugs have about a 50% chance of survival, note Nesse and Williams. "That is about the same as before antibiotics were invented!" they warn.

Antibiotic-resistant strains of TB can occur when patients don't complete their entire six to nine month regimen of pills. Prematurely stopping the medication will leave some bacteria in the body. Then ultimately certain bacteria are selected which are better suited for that antibiotic environment.

As Laurie Barclay points out, "nearly all regions of the world, including the United States, now have reported cases of XDR TB". The resurgence hasn't been matched with an equally mounted response. Incidence rates of TB in developed countries is low. In the US, since the last major TB outbreak between 1985-1992, TB rates have been declining. However, rates of decline have been slowing ever since 2000. Much more research into XDR and MDR TB strains is needed to effectively address the problem.

Moreover, "with the overwhelming majority of TB patients concentrated in some of the world’s poorest countries, large pharmaceutical companies have had little incentive since then to invest heavily in research and development for new drugs" note Barry and Cheung. And in places like the US, mainly minorities are inflicted with the burden of TB. Facts like these make it easier for TB to stay under the health radar. Yet if we don't get on it soon we could be faced with strains that are completely resistant to drugs and our only defense will be opening the doors and letting the sun shine in as the WHO has advocated.

- m.tsang

Cutting Through the Fat

Usually I am not so cynical, but my initial reaction to this new piece of research was less than exciting. I began to imagine sedentary life deepening its roots into an abyss of malnutrition - although the people end up skinnier! Droves of people lined up outside of an Olive Garden tormented my brain as they forgot about all the other nutrients, vitamins and minerals bottom-less baskets of pasta and bread lack.

The research led by Hei Sook Sul PhD. of UC Berkeley showed that mice without the gene DNA-PK acquired less body fat than regular mice do. The gene works by inhibiting the liver's capacity to convert glucose into fatty acids which themselves are stored as adipose tissue (fat).

Now, I admit, I am less optimistic about the potential this research possesses. Not that because I think the research won't be ready and usable in the future, but that it will be: that by stymieing the action of an enzyme people can eat all the junk they want and not see any outward consequence a.k.a. fat. My pessimism stems from the immediate gratifying diets and weight loss programs that so plague our culture. I mean we already have diets that exclaim they can help you lose you ten pounds in ten days, but at what cost and how healthy of a diet is it? We even already have pills on the market claiming to burn off your fat for you without any actual effort.

However, maybe I am being a little too negative. Let me take a step back and conclude that this would be beneficial to certain people as a short term treatment. As I said in a past article of mine "Casual or Causal" conditions such as elevated body fat increase your risk of cardiovascular disease, stroke, diabetes and even some types of cancer. Thus, eliminating that risk factor could have an enormously positive effect on mortality rates, quality of life and controlling health care costs across our country. People at greatest risk of a heart attack might be able to forgo that experience. Obese patients who can't walk unassisted might be able to shed enough weight to engage in extensive physical activity.

One individual who was interviewed in the video-report exclaimed "I would still have to watch what I eat". So yes, people know that they have to watch what they eat, but will they? Do they? Even without a "miraculous" fat-saving pill we are plagued by escalating obesity and diabetes rates which is roughly 32% and 13% respectively of adults aged twenty or older. Would we expect people to watch what they eat when a super-pill is available if they don't already?

The overall message that is being overshadowed is eating healthy: balanced, diverse and nutritious. The world doesn't necessarily need a super-pill; we don't need miracle-diets. Eating nutritious and balanced will inevitably lead to reductions in obesity and diabetes. Eating fruits, vegetables, whole grains, and meat. Eating the least amount of processed foods. Eating foods low in excess sugar and fats. That is the diet plan we should follow - the one that evolved over millions of years of human lineage. It is the one our bodies respond to best. Unfortunately, it is the one many of us utilize the least.

- m.tsang

Beneficial Bugs

Last week some friends and I took a trip to the local Chinese grocery store. We were on a mission: to grill out. Our intent was to get some food we usually wouldn't otherwise obtain at the local Ralph's or Vons supermarkets. Long story short, what we ended up purchasing was one whole salmon (head to tail) and a packet of larvae. Yes, larvae! As in the intermediate stage of the insect lifecycle that takes on a elongated mushy capsule shape.

After they were cooked it didn't seem like it was going to be so bad. They were just crispy little morsels at this point. Similar to the look of a little oval pretzel. Similarities stop there however. Its not so much that they tasted absolutely horrible - I mean, there was a musty dirt like after taste. It was more of the fact that they were bugs. Once, mushy slimy wiggly little masses. Now dried, fried and caught in-between my teeth.

Why were we all - five of us brave souls - so turned off by this? It was our preconceptions. All negative and making it impossible to enjoy each crunchy bite. Yet some of us eat this kind of stuff everyday - but we don't know it! Take for example Carmine, this compound, according to wikipedia, "may be prepared from [cochineal, a bug], by boiling the dried insects in water to extract the carminic acid. Carmine is most commonly used in food coloring. Manufacturers who use this product in their foods have come under fire for not letting their vegetarian consumers know they were eating animal products. Now the FDA requires these products to be labeled as carrying Carmine. (How someone is supposed to know carmine is a bug derivative is beyond me).

Something you might also not be aware of is this: some manufacturers are chalking their products full of bacteria (probiotics). This is more or less a good thing though. A recent CNN report noted that "Scientists have known for decades that probiotics can boost your health. That's why yogurt's "active cultures," or good bugs, are touted so often. And now these bugs can be found in cereal, cheese, energy bars, soup, and a wealth of other products filling up grocery and pharmacy shelves.

This isn't as crazy as an idea as it sounds. There are well over ten trillion micro-organisms that take shelter along your intestinal tract. 500 - 1000 different species. Outnumbering human cells by ten to one. They perform a myriad of functions such as digesting undigested parts of plant matter, signaling the endothelium to absorb certain chemicals, and creating essential vitamins and nutrients such as Vitamin K and B12. Others will even do your laundry*.

In fact the majority of the cells in the human body are actually foreign "invaders". As Richard Dawkins notes in his book the Ancestor's Tale, "most animal cells house communities of bacteria so comprehensively integrated into the smooth working of the cell that their bacterial origins have only recently become understood". Case in point are mitochondria. Dawkins points out that "they were once free-living bacteria." Without mitochondria we wouldn't have the energy to sustain such a large body style or the active lives we seek out.

However, not all bacteria are beneficial. E. Coli is a well-known example. Whereas the gut is normally inhabited by certain strains of E.Coli, Escherica coli 0157:H7 is the one that can wreak havoc causing severe diarrhea and even kidney failure leading to death. Cholera, a condition that also leads to severe cases of diarrhea and sometimes death, is propagated by Vibrio Cholerae, a bacteria that signals the gut to secrete chloride. Water naturally follows by osmosis which causes the diarrhea. Ironically, probiotics were first experimented with in the early 20th century to cure bowel irritations and conditions such as cholera.

Major steps in eradicating such diseases didn't come from using probiotics, instead they were effects of increased sanitation, clean water and refuse removal in the developing world. Antibiotics have also helped to the body to get rid of these pernicious bacteria. Interestingly, as the CNN article points out, use of antibiotics can kill off the beneficial bacteria in your body too leaving ill-effects. According to that article, supplementation with probiotics can help re-colonize the gut biota population. However, overall beneficial effects have not been shown to be conclusive. There are interesting trends that show slight benefits, but more research needs to be done as this Reuters article points out. 

Also, a research team out of Northwestern University is shedding new light on vaccine efficacy via probiotics. They argue that by ingesting probiotics you can get the bacteria to produce a vaccine naturally in the gut. "Nature isn't used to seeing antigens injected into a muscle," said Terrence Barrrett, M.D, of Northwestern University. "The place where your immune system is designed to encounter and mount a defense against antigens is your gut." This is one clear example where probiotics can be seen to have a realistically beneficial effect. I just want to know which yogurt I have to eat to get my laundry cleaned.

- m.tsang

[*If you are reading this because you were unsure if I was joking, then I feel bad for you]

Pestilencia Mental

Last week an extensive Gallup Poll disclosed the state of emotional health in the U.S. The poll surveyed people's responses to questions about depression, anxiety, stress, hopefulness, optimism and other similar states of mind. The responses were translated into a so-called Emotional Health Index (EHI). And I'll let you in on a little secret: the EHI...not so good.

Taken over almost every day of 2008, the survey was able to track changes in the overall mood of the nation in what was an incredible year indeed. There were a multitude of salient events that occurred creating many ups and downs. Most notably the election of our first black President ever created a sense of pride and optimism amongst a majority of people in the US. And we saw the last days of former President Bush to boot - although some sadly misinformed citizens didn't see that as a laudable affair.

Unfortunately that Yang didn't occur without its Yin*. 2008 was also a year of recession which we are still experiencing. The burst of the housing bubble and failing of all the dubious mortgage-backed securities brought a sense of insecurity across not only the nation, but also the world. Bear Sterns collapsed. Lehman Brothers went bankrupt. And tax payers found themselves giving bonuses to CEO's who needed a bailout in order to offset their profligate ways. Even Botox procedures took a hit of -8.5% last year.

According to USA Today, these latter developments had more of an impression on our moods than anything else. (Latter as in the failing economy, although a lack of Botox might definitely make some "appear" to have taken a turn for the worse!)

Stress shot up over 2008, peaking in the fall and winter as the economic crisis deepened, then continuing high through February. The 10 least happy days of 2008 all were in the last quarter.

The report also noted that mental wellbeing was worse for Latinos than any other group.

There were few racial differences, but Hispanics, the nation's largest and fastest growing minority, had the worst emotional health all year long.

This fact isn't particularly surprising to me. Latinos are often hit worse by some of the major infectious diseases and ailments our nation is faced with. For example, if you are Latino you are twice as likely to have diabetes and Latina women have five times the rate of HIV/AIDS compared to non-Latina whites. Moreover, the emotional downturn impacted the poorest individuals the most which constitute a large body of Latinos.

Tough and ardent times like these take their toll on individual stamina and hopefulness. Most of us are aware that unemployment often means health might take a stab or two due to being uninsured, but mental health seems to be overlooked in many ways. In the USA Today article, Lanny Berman, executive director of the American Association of Suicidology, notes that unemployed adults have two to four times the suicide rates of employed people.

And in terms of California's large Latino population the situation could perplexingly become worse. According to a recent study by Guilherme Borges, ScD, et al, the rate of those who seriously consider and actually attempt suicide is higher for Latinos that were born in the U.S. and those who moved to the U.S. before age thirteen.

As the largest home for Latinos in the US, this has serious public health implications for California. In fact, California ranked 30th among all the other states in terms of their EHI. With California's unemployment rate inching above the national average towards 10% we ought to take notice not only to the lack of health coverage our citizens will be seeing but also the mental health we will be experiencing. 

- m.tsang

[*As an artifact of my article presintation I was forced to write Yang without Yin which sounds considerably less casual as Yin without Yang. Yang is associated with sunny; Yin with dark.]

Stem-Cells: Another Religious Soapbox

Seven years. Seven years and seven months, to be precise, is the amount of time former-President Bush squandered. I am referring to stem-cell research (however, I could have been talking about any number of issues!). Thankfully President Obama has the prudence not to commit the same mistake. On Monday President Obama rescinded the ban that stymied federal funding towards stem-cell research.

Although, this now allows federal funding to be allocated towards research involving stem-cells, under the Dickey-Wicker Amendment it is still illegal to use federal funds that involves creation or destruction of an embryo.  So there are only two ways to extract new stem-cells from an embryo: through private funding or state funding (if your state has a law in accordance with that type of research).

Scientists have long touted the potential stem-cells as a cure-all. They are able to take on the characteristics a myriad of cell types within the body. These cells could then create tissue types to cure diseases and injury such as: Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis.

It's no secret that support for such bans arises from religious and pro-life ideology. The same support base which wants to also ban the cloning of embryos whose stem-cells could be used for therapeutic purposes. Without cloning researchers have to rely on in-vitro fertilization patients to donate their left over embryos for research. Whatever the source, proponents of such bans argue they are savings lives because the embryo has the potential to develop into a fully formed fetus.

The subject becomes extremely torpid with so many stipulations as to what constitutes life. What pro-lifers consider life is really a blastocyst - the two to five day old embryo in the shape of a hollow ball (from which stem-cells are taken). It has no nervous system. It can't think. It's a ball of cells. Men's sperm looks more alive then a blastocyst does! At least those can swim. When a man masturbates he releases a plethora of potential cells that could turn into a fetus. Are these pro-life groups worried about us masturbating? (It wouldn't put it past me if they were). What about each egg that sheds during menstruation? What about having sex with a condom on? I mean, conception is so close you can almost hear the little semen yelling "let me out!" But let's be honest, you’re really not giving life a chance with jr's raincoat on. How non pro-life of you to do that.

I can't even begin to point out all the other hypocrisies when stem-cell opponents exclaim embryos are real humans with the same entitled rights as you and me - well, unless your a gay embryo.Yet for all pragmatic purposes, there is one very ironic part to this whole issue. According to a USA Today report approximately one half-million embryos lie frozen in US fertility clinics. Frozen! So instead of using these cells to promote and expand great research to save actual lives, proponents of the ban would rather the embryos stay frozen. How non pro-life of them to do that.

These issues disclose an important fact: science has been stymied by a major impetus. That force is religion: an unscientific force that has been allowed to impede the progression of science. Why? Why in Texas was there recently a 7-7 tie as to whether creationism should be taught in schools? Why should we allow religious groups to falsely discredit and disparage factual, tangible scientific work? Just because the fossil record isn't completely intact? Because a book says the earth is at the center of the universe?

Science is in the business of understanding the beautiful complexities of life. There is no room for perversions. There is no room for putting a man on house arrest for the remainder of his life because he advocates the sun is at the center of the galaxy - which the Vatican did to Galileo. There is no room for putting a teacher on trial for teaching the principles of descent with modification - which is what happened to high school teacher John Scopes in 1926. And there is no room for holding scientists hostage because they want to use blastocysts to cure disease and save lives. Especially when opponents to stem-cell research exclaim their reason it is to save a life.

- m.tsang

No Walk in The Park

Let me ask you this, how many reasons can you come up with for not exercising?  How about for exercising?  Now which are more important? Well, to answer that you would have to know the effects of exercise, and unless you are: a) in denial or b) in denial, you should know it is best to exercise! The most well known effects of regular exercise are obvious: more muscle, less fat, toner body, and weight loss.

Mere physical appearance isn't the only effect exercise has on the body. A superfluous of studies over the past several decades have shown regular exercise creates a stronger heart, clearer lungs and reduces your chance pathologies such as atherosclerosis, diabetes, hypertension, stroke and heart attacks. Moreover, a number of new studies have found that those who exercise regularly have less chances of developing cancer, cataracts and age-related macular degeneration (in the eyes).

So far we've got exercise at: effectively reducing your chance of succumbing to the top three killers in the U.S. - Heart Attack, Cancer, Stroke (In that order). And some of you still be at: denial. Ok, exercise takes time and planning to fit into the daily grind. Completely understandable. But can you find 15 minutes out of every other day to reduce diabetes? Researchers at Heriot-Watt University of Edinburgh, Scotland hope you can. Their research found that 15 minutes of high intensity workout (i.e. running) every other day for two weeks significantly reduced individual’s blood-glucose levels.

Great! You now have your 15 minutes set aside. Maybe you can find just 15 more? The American College of Sports Medicine argues that 30 minutes a day five times a week is the best way to go. That’s to keep the weight off and body healthy. "More recent evidence has supported this recommendation and has indicated that more physical activity may be necessary to prevent weight regain after weight loss", states the ACSM. Keeping the weight off keeps the blood-glucose low, your blood-pressure down and dampens your the risk of stroke and heart attack.

Hopefully I didn't create complete aversion by telling you about the 30 minute recommendation! Yet that seems to be a normal reaction to exercise. Instead you often get people who either skip exercise all together or try some kind of diet, especially "hollywood" diets. Take for instance the "Master Cleanse" diet: the detox diet to clean out your GI while losing weight. I know what you’re thinking, but hold on a second. It is completely normal to supplant millions of years of evolution that created organs such as your liver and kidneys with: squeezed lemons, maple syrup, and cayenne pepper several times a day for 10 days! Wow! I can skip over the physiological implications this has on your body by simply bringing attention that this diet lacks: calcium and protein - among a plethora of other nutrients.

The lesson that science has taught us is this: exercise is good for you - for your bones, heart, body and mind. Let me put all salubrious reasons aside for the moment and just reiterate one of the seven reasons the Mayo Clinic encourages people to exercise: because it can be fun! So join a team, a pick-up game, go hiking, take up kung-fu, hoola-hoop your way to number one on Wii Fit, chase squirrels out of your yard, or go to yoga to pick up girls (or guys). Just do it?

- m.tsang

[The title comes from the quote "People say that losing weight is no walk in the park.  When I hear that I think, yeah, that's the problem." I found it online and it is attributed to Chris Adams who was a former world class wrestler.  He once died on an overdose of GHB, but was brought back to life in the emergency room.  A few years later he was shot and killed during a drunken brawl.]

Where's the Pain?

Perusing through some back-logged evolution news stories I came across one titled "Painful Labor: A Modern Thing". The author went on to say how in 2001 the remains of a pelvis were found from the fossils of a Homo Erectus female. The 1.2 million-year-old pelvis demonstrates how the birth canal of Homo Erectus is considerably larger - about 30% - than the average women's you would find today. Anthropolgists previously estimated the last batch of large canals occurred around 2.4 million-years-ago. 

It was interesting because the author exclaimed that this demonstrates that birthing pains are more of a recent adaptation - only within 1.4 million years have female pelvises narrowed as opposed to 2.4 mya. The author even went as far to state that a few million years ago babies might have just slid right out - rolling of eyes appropriate here.

Although, as one observant commenter pointed out, this article had it all wrong. Labor pains aren't normally derived from the pelvis, they are born from muscle contractions of the cervix. So besides being a tepid article at best, the author was also misguided in her importance of the find. The importance of the find is that it helps connect the dots to our distant past. That's about it.

However, there is a terribly painful thing about labor that came to mind and is very apparent in the US: infant mortality rates. Among industrialized first-world nations the Centers for Disease Control ranked "the United States 29th globally in infant mortality in 2004, the latest year such data were available for all countries", according to a MedScape article commenting on the subject.

The average US infant mortality rate is close to 7 out of every 1000 births. Thats down from nearly 20:1000 in 1970. African-American women have the highest rate at almost 14:1000 births. Next sits Native Americans and Puerto Ricans at just over 8:1000. Whites at over 5:1000 and Cubans at the lowest with just over 4:1000. 

So where's the pain? Although overall rates have gone down these facts still reveal some of the major troubles facing our health care system.  Why as the country who spends the most money per person on health care are we still ranked 29th in terms of infant mortality? Why does there exist such prominent gaps in health-access and disease between people of different race, ethnicity, socioeconomic status, etc?  Why are there over 46 million U.S. citizens without health care? However complicated they may be, these are problems we can fix. Aren't they? 

- m.tsang

Casual or Causal?

A little over a week ago, right here in San Diego, a paper at the International Stroke Conference reported that having more fast food restaurants in a neighborhood is linked to a higher likelihood of having a stroke. Areas...with an average of 33 [fast-food restaurants] per neighborhood had a 23% higher relative stroke risk than areas...with an average of 12, reports Crystal Phend at MedPage Today. Although, a debate continues as to whether the relationship is causal or not.

Some like Beth Johnson a spokeswoman for the National Restaurant Associated said "there is no correlation between dining at chain restaurants and the incidence of stroke". Ok. Way to go. Great observation. Pat on the back. The study didn't necessarily test for whether communities were actually eating at the fast-food diners and that the food itself caused the strokes - the restaurants just happen to stay in business at such a high density because no one is eating there.

Current research does, however, demonstrate that where you live will determine your access to healthier foods. Late last week researchers at the John Hopkins Bloomberg School of Public Heath reported "46 percent of lower-income neighborhoods had a low availability of healthy foods". Maybe the same communities with an average 33 fast-food restaurants per neighborhood? The report also noted how those with "low healthy food availability are at an increased risk of consuming a lower quality diet". A low quality diet. Similar to the kind of food served at a fast-food restaurant?

Well let’s take a look. Fast food characteristically contains high levels of carbs, fats, cholesterol and sodium. Looking at McDonald's website I found that one Quarter Pounder with Cheese contained 90mg cholesterol, 26g fat, 1190mg sodium, and 40g carbs. A conservative value meal - large fries and diet coke - ups the ante to 51 g fat, 1590 sodium, and 103g carbs. The American Heart Association recommends that individuals should curb their cholesterol intake to less than 300mg per day. The also argue to curb fat intake to less than 65g and sodium intake to 2300mg a day. So in just one meal, an individual is pushing the limits on how much they should be consuming.

Eating such meals consistently can lead to high levels of cholesterol (hypertriglyceridemia), glucose (hyperglycemia) and fat in the blood, and high blood pressure (hypertension). Studies repeatedly demonstrate that these factors are always associated with increased chances of having a stroke.

Hypertriglyceridemia, hyperglycemia, elevated triglyceride (fat) levels, and hypertension all can damage the lining of blood vessels. The body responds by repairing the damaged area with plaque and platelets. The plaque and platelets can eventually break off. These rogue elements permeate their way into the smaller arteries of the heart and brain suffocating them of oxygen. This leads to things such as - dah dah dunnnnn - Heart Attacks and Stroke.

I understand the caveat of those that say we can not be so precipitous and blame strokes on fast food. It couldn't be the only explanation otherwise everyone eating fast-food would be having strokes. Other factors such as lack of physical activity play an important role. However, the poor nutritional content characteristic of fast-food and its relationship to strokes in the study leave me with no doubt that the relationship is causal. Take it to the bank...or McDonald's whatever you prefer.

- m.tsang