Bait & Switch?
This article appeared in the NY Times
Tests Reveal Mislabeling of Fish
Scientists aiming their gene sequencers at commercial seafood are discovering rampant labeling fraud in supermarket coolers and restaurant tables: cheap fish is often substituted for expensive fillets, and overfished species are passed off as fish whose numbers are plentiful.
Yellowtail stands in for mahi-mahi.
Nile perch is labeled as shark and tilapia may be the Meryl Streep of seafood, capable of playing almost any role.
Recent studies by researchers in North America and Europe harnessing the new techniques have consistently found that 20-25% of the seafood products they check are fraudulently identified, fish geneticists say.
Labeling regulation means little if the “grouper” is really catfish or if gulf shrimp were spawned on a farm in Thailand.
Environmentalists, scientists and foodies are complaining that regulators are lax in policing seafood, and have been slow to adopt the latest scientific tools even though they are now readily available and easy to use.
“Customers buying fish have a right to know what the heck it is and where it’s from, but agencies like the F.D.A. are not taking this as seriously as they should,” said Michael Hirshfield, chief scientist of the nonprofit group Oceana, referring to the Food and Drug Administration.
On Wednesday, Oceana released a new report titled “Bait and Switch: How Seafood Fraud Hurts Our Oceans, Our Wallets and Our Health.” With rates of fraud in some species found to run as high as 70%, the report concluded, the United States needs to “increase the frequency and scope” of its inspections.
DNA bar coding, as it is called, looks at gene sequences in the fish’s flesh. “The genetics have been revolutionary,” said Stefano Mariani, a marine researcher at University College Dublin, who has published research on the topic. “The DNA bar coding technique is now routine, like processing blood or urine. And we should be doing frequent, random spot checks on seafood like we do on athletes.”
Policing the seafood industry has historically been challenging because even the most experienced fishmongers are hard pressed to distinguish certain steaks or fillets without the benefit of scales or fins. And many arrive in supermarkets frozen and topped with an obscuring sauce.
Older laboratory techniques to identify fish meat looked at the mix of proteins in flesh samples, but were unreliable, expensive and cumbersome. Investigators often relied instead on laborious legwork, tracking inconsistent fish names on paperwork as seafood moved across international borders. Eighty-four percent of seafood consumed in the United States is now imported, often passing through a multistep global supply chain.
With the new genetic techniques, the gene sequence found in a fish sample is compared with an electronic reference library like that maintained by the International Barcode of Life Project, which now covers 8,000 varieties of fish compiled by biologists over the last five years. The testing is now relatively cheap: commercial labs charge about $2,000 for analyzing 100 fish samples, for an average of $20 apiece, but the cost is under $1 per sample for labs that own the equipment.
Douglas Karas, a spokesman for the F.D.A., said in an e-mail that the agency had been working with scientists to “validate” DNA testing for several years. It recently purchased gene sequencing equipment for five F.D.A. field laboratories and hoped to use it “on a routine basis” by the end of this year.
This new type of scrutiny could allow hundreds of thousands of samples to be tested each year, rather than the hundreds that are now rigorously analyzed, said Dr. Paul Hebert, scientific director of the Barcode of Life project, based in Guelph, Ontario. In March, the F.D.A. issued an alert to inspectors about mislabeled fish. It had already used bar coding as irrefutable evidence to prosecute sellers or issue warnings involving seafood “misbranding,” Mr. Karas said, much as prosecutors use DNA evidence in sex crime cases.
But it will take time to clamp down on a lucrative and, apparently, widespread practice. Dale Sims, chief fishmonger for Cleanfish, a San Francisco-based supplier of high-end sustainable seafood, said he’d seen thresher shark labeled as shark, swordfish and mahi-mahi all in the same market, as well as many other obvious substitutions.
“It infuriates me but it’s hard to correct,” he said. “I’m embarrassed to say that there’s been a lot of fragmentation in this industry. So if someone is unscrupulous, it’s been easy to get away with it.”
For consumers, the issue is about dollars and cents — wanting to get the quality and type of fish they paid for. “If you’re ordering steak, you would never be served horse meat,” said Dr. Hirshfield of Oceana. “But you can easily be ordering snapper and get tilapia or Vietnamese catfish.”
USDA TO UNVEIL NEW DIETARY GUIDELINES 6/2/11
USDA WILL DUMP FOOD PYRAMID
A US Department of Agriculture (USDA) communique indicates that in response to longstanding criticisms, the USDA will replace the controversial 19-years-old Food Pyramid on June 2, 2011 with a clearer Food Plate.
The Food Plate will be divided to clarify relative portions of different food groups.
A small circle might appear next to the plate representing dairy, such as milk or yogurt.
The 1992 pyramid was meant to suggest smaller portions for foods at the smaller peak of the pyramid, but many people viewed peak items as most important; also, many criticized the pyramid for ignoring the insulin impact of some high carbohydrate foods. Delayed change resulted in alternative pyramids.
The nonprofit group Oldways developed separate pyramids for the Vegetarian Diet, Mediterranean Diet, Asian Diet, and Latino Diet, available at http://bit.ly/iGEUN4, http://bit.ly/kAKRGO, http://bit.ly/m6V96x, and http://bit.ly/m3TDSk, respectively.
Harvard University released its Healthy Eating Pyramid, which includes vitamin supplements and exercise, online at http://hvrd.me/iurrj3.
The Healing Foods Pyramid 2010 was released by University of Michigan Integrative Medicine at http://bit.ly/lu6wqe.
The Food Plate will likely appear June 2 on the USDA site, which is at http://www.cnpp.usda.gov/.
Can You Guess the Average Number of Prescription Drug Side Effects?
?
The list of side effect of prescription drugs currently averages 70 reactions per drug, overwhelming physicians and patients alike, U.S. researchers say.
Lead author Dr. Jon Duke, a Regenstrief Institute investigator and assistant professor at Indiana University School of Medicine, and colleagues says the study involved more than 5,600 drug labels and more than half a million labeled effects. The study, published in the Archives of Internal Medicine, found that the average label contains 70 different side effects, with more commonly prescribed drugs averaging around 100 side effects. The list of side effect of prescription drugs currently averages 70 reactions per drug, overwhelming physicians and patients alike, U.S. researchers say.
Lead author Dr. Jon Duke, a Regenstrief Institute investigator and assistant professor at Indiana University School of Medicine, and colleagues says the study involved more than 5,600 drug labels and more than half a million labeled effects.
The study, published in the Archives of Internal Medicine, found that the average label contains 70 different side effects, with more commonly prescribed drugs averaging around 100 side effects. A single label contained as many as 525 possible reactions.
Overall, the greatest number of side effects was found in antidepressants, anti-viral medication and newer treatments for Restless Legs Syndrome and Parkinson’s disease, the study says.
Generally medications prescribed by psychiatrists and neurologists had the most complex labels, while drugs used by dermatologists and ophthalmologists had the least, Duke says.
“Having a high number of side effects on a drug’s label should not suggest that the drug is unsafe. In fact, much of this labeling has less to do with true toxicity than with protecting manufacturers from potential lawsuits,” Duke says in a statement. “But having all these labeled side effects can overwhelm doctors who must weigh the risks and benefits when prescribing a medication.”
Another Reason Tomatoes Are Good For You
Did you know? . . .
A substance found in cooked or processed tomatoes blocks artery-clogging LDL, or bad, cholesterol.
This appears to reduce the harmful oxidation of fats in the blood to almost zero within eight weeks, potentially reducing the risk of heart attack or stroke.
This conclusion was presented to a meeting of the British Cardiovascular Society in June, 2009.
Researchers Suggest One Way to Reduce Autism Risk
WELL-TIMED PRENATAL VITAMINS MAY REDUCE RISK OF AUTISM
Researchers have concluded that taking prenatal vitamins for three months before becoming pregnant and one month after getting pregnant lowers the risk of having a child with autism, especially for genetically susceptible mothers and children. (Prenatal vitamins are supplements that are recognized by health organizations, such as the American Dietetic Association, as increasing the likelihood of a healthy newborn.)
Mothers of autistic children were 4.5 times more likely both to have genotypes linked to greater risk of having autistic children, and to report not having taken prenatal vitamins during the three months prior to, and the first month of, pregnancy.
Taking prenatal supplements after the first month of pregnancy had no effect on the risk of having an autistic child. Researchers suggested that folic acid, which is synthetic vitamin B9, and other B vitamins in prenatal vitamins might help protect against deficits in early fetal brain development, even among the genetically susceptible.
Due to possible inaccuracies involved in interviewing women years after giving birth, the team stressed the need for further research. This just-released study will be published in the July, 2011 issue of the journal Epidemiology and is available online now at http://bit.ly/jAVqh9.
Ways to Prepare Fish That Could Reduce Risk of Heart Failure
BAKED OR BROILED FISH LINKED TO LOWER HEART FAILURE RISK?
A study found that consumption of 5 or more weekly servings of broiled or baked fish may lower heart failure risk by 30%, while one weekly serving or more of fried fish may increase heart failure risk by 48%.
Researchers found heart failure risk was reduced further when the fish was dark, such as salmon or mackerel, compared to when the fish was tuna, or light fish such as sole or cod.
Despite earlier studies, the team did not find any lower heart failure risk with increased intake of omega-3 fatty acids, or alpha-linolenic acid (ALA); and while frying increases trans fatty acid (TFA) content, no link was found between TFA intake and heart failure risk.
The finding may not be one of cause and effect because those eating more baked or broiled fish were more likely to be older, heavier, less active, diabetic, and smokers, and who eat fewer fruits and vegetables.
All participants were women.
This study was released May 24, 2011 but will not be published until a future issue of Circulation: Heart Failure. It is available online now at http://bit.ly/kFgKgh without charge.
80% of Seafood We Eat is Imported. What Percentage of US Food Imports Are FDA-Inspected?
GLOBALIZATION OF FOOD SUPPLY RAISES DISEASE RISK
How safe do you feel eating food treated with raw human sewage?
Did you know that 80% of all fish and seafood we eat in the US is imported?
…and only 1% is FDA inspected.
So what does that mean for you and your family?
Researchers have found that the increasing importation of food from developing nations is raising foodborne illness risks due to much lower standards in these countries for sanitary food production.
Importing foods can move diseases from areas in which they are indigenous to areas where they have never existed. In a number of developing countries, raw human and animal sewage is routinely used to treat soils and aquaculture ponds. Contaminants, many linked to fecal matter, are frequently found in imported foods. However, due to mushrooming imports, only1% of imported food is FDA-inspected.
Eighty percent of fish and seafood consumed in the US is imported, much of it from Asia where fish are fed raw sewage.
In Thailand, chicken coops – containing up to 20,000 birds – are suspended over ponds so that farmed shrimp and fish can feed directly off the bird droppings.
Crops are often grown on tiny lots where farmers are under pressure to use unapproved chemicals or misrepresent their methods, suggested the report.
Presented May 23, 2011 in New Orleans at the general meeting of the American Society for Microbiology, this study has not yet been published or posted online.
How Can Dark Chocolate Help You?
Dark chocolate may combat exercise-induced oxidative stress
Consuming flavonoid-rich dark chocolate prior to exercise may decrease the potential muscle damaging effects of oxidative stress, suggests a new study.
Dark chocolate containing 70% cocoa was associated with blunting oxidative stress after exercise, measured as a reduction in levels of a compound called F2-isoprostane, according to findings published in European Journal of Nutrition.
“We believe that the small effects observed here could be physiologically important, but arise from cocoa-induced metabolic changes leading to modulation of the major plasma constituents,” wrote scientists led by Glen Davison from Aberystwyth University in Wales.
“In addition, dark chocolate was effective at blunting the exercise-induced increase in plasma total antioxidant status observed in the other trials, providing support for the idea that the elevated total antioxidant status on the dark chocolate trial has physiological significance.”
Stress
Oxygen-breathing organisms naturally produce reactive oxygen species (ROS), which play an important role in a range of functions, including cell signalling. However, over production of these ROS from smoking, pollution, sunlight, high intensity exercise, or simply ageing, may overwhelm the body’s antioxidant defences and lead to oxidative stress.
Oxidative stress has been linked to an increased risk of various diseases including cancer, Alzheimer’s, and cardiovascular disease.
The researchers also noted that extended periods of exercise are also often used to model physical stress, and that this may be eased by consumption of a polyphenol-rich dark chocolate.
Choc-full of benefits?
According to their new findings, the effects were seen after only one 100 grams serving of the dark chocolate.
“It is possible, therefore, that greater blunting of oxidative stress responses would be observed with a different timing and/or quantity of dark chocolate ingestion, although this will require further investigation,” wrote the researchers.
The health benefits of polyphenols from cocoa have been gathering increasing column inches in the national media. To date studies have reported potential benefits for cardiovascular health, skin health, and even brain health.
The majority of science into the potential benefits of cocoa have revolved around cardiovascular benefits of the flavanols (also known as flavan-3-ols or catechins), and particularly the monomeric flavanol (-)epicatechin.
Study details
Davison and his co-workers recruited 14 healthy men to participate in their study. Volunteers were asked to consume 100 grams of dark chocolate, a control bar, or nothing. Two hours later they were required to cycle for 2.5 hours at 60 percent of the maximal oxygen uptake level.
Results showed that intake of the dark chocolate resulted in an increase in antioxidant status before the cycling, and reduced levels of F2-isoprostane one hour after the cycling had finished, compared with the control bar.
Insulin levels were also increased before the trial and after cycling for men who consumed the dark chocolate and this was associated with a “better maintenance of plasma glucose concentration”, added the scientists.
On the other hand, there were no changes in markers of immune response, which is known to be affected by rigorous exercise.
“These results with acute dark chocolate consumption are similar to those observed following 2 weeks of daily dark chocolate ingestion,” wrote the researchers.
The other scientists were affiliated with Loughborough University and the University of Newcastle in the UK, and the Nestle Research Center in Lausanne, Switzerland. The study was funded by the Nestle Research Center.
Source: European Journal of Nutrition
“The effect of acute pre-exercise dark chocolate consumption on plasma antioxidant status, oxidative stress and immunoendocrine responses to prolonged exercise”
Authors: G. Davison, R. Callister, G. Williamson, K.A. Cooper, M. Gleeson
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Cutting Fat Just A Little Has Big Benefits Long-Term
SLIGHTLY LOWER FAT INTAKE MAY REDUCE DIABETES RISK
Researchers have found that, even without any resulting weight loss, a modest reduction in dietary fat alone may significantly increase insulin secretion, increase glucose tolerance, and increase insulin sensitivity – indicators of a decreased risk of diabetes type two.
Participants were placed on one of two diets with only minor differences in the content of fat and carbohydrates. These diets were eucaloric, meaning their calories were tightly controlled so that body weight would not change during the eight-week study.
In addition, during analysis, the team took into account even minor, short-term fluctuations in body weight. One diet was 55 percent carbohydrate and 27 percent fat and the other was 43 percent carbohydrate and 39 percent fat.
The lower-fat diet produced better insulin sensitivity even without weight loss. Further study is needed to determine the exact mechanism involved, but these results suggest that an upper limit of dietary fat of about 27 percent might lower the long-term risk of diabetes type two. This just-released study will be published in a future issue of the American Journal of Clinical Nutrition but is available online now at http://bit.ly/jUN0Wd with subscription or fee.
Why Eat Your Crucifers?
CRUCIFEROUS VEGETABLES REDUCE RISK OF CARDIOVASCULAR MORTALITY
Scientists have found that, for both men and women, a greater consumption of fruits and vegetables may reduce both the overall risk of dying and the risk of dying from cardiovascular disease; and they found that a greater consumption of cruciferous vegetables in particular may reduce these risks even further and by as much as 22 percent.
The crucifer, or brassica, family of vegetables includes cabbage, broccoli, cress, cauliflower, Brussels sprouts, and others.
However, increased fruit and vegetable intake was not found to have any significant effect on the risk of death from cancer.
While those with highest cruciferous intake levels showed the greatest reductions in mortality risk, even those at the lowest intake level consumed a lot of crucifers; this is because the study used information on 134,796 Chinese adults in Shanghai, a population that regularly consumes a large amount of crucifers.
The team suggested that increased intake of crucifers and other vegetables may promote longevity and cardiovascular health.
This study was released May 18, 2011 and will be published in a future issue of the American Journal of Clinical Nutrition. It is available online now at http://bit.ly/kuajMF with subscription or fee.
Untreated OSA May Pose Significant Public Health Risk
SLEEP APNEA LINKED TO FASTER CANCER GROWTH
Researchers have found evidence that the intermittent interruption in breathing that occurs in patients with obstructive sleep apnea (OSA) may cause greater proliferation of cancer cells, increased tumor growth, and more aggressive cancers.
OSA is a disorder in which patients regularly stop breathing for short periods during sleep, and it may affect as many as five percent of Americans, raising the risk of cardiovascular disease and lung problems.
Previous research had shown an association between continuous hypoxia, or shortness of oxygen, and cancer growth, but it was not known until now whether the intermittent hypoxia of OSA had the same effect. It is worth noting that the research focused only on melanoma cancer. The team suggested that if further research confirms these results or worse, finds that the interruption in breathing can actually cause cancer in OSA patients in the first place, it will mean that the public health impact of untreated OSA may be far greater than ever suspected.
This study was presented today, May 18, 2011 in Denver at the international conference of the American Thoracic Society. It has not yet been published or posted online.
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Study: Poor Childhood Diet Linked to Low IQ – Vitamins Can Help
A diet high in fats, sugars, and processed foods in early childhood may result in lower IQ scores, while a diet rich in healthy foods packed with vitamins and nutrients may work in reverse, suggests new research.
The study, published in BMJ’s Journal of Epidemiology and Community Health, reports a “weak but novel” association between dietary patterns in early childhood, and general intelligence assessed at eight and a half years of age.
The results of the study suggest that the eating habits in early childhood – particularly up until the age of three – may play a role in shaping the development of the brain, and thus affect behaviour, learning performance and IQ in later life.
“In this population of contemporary British children, a poor diet, associated with increased intake of processed foods, fat and sugar, in early childhood may be associated with lower IQ at the age of 8.5 years. In addition, a concurrent healthy diet may be associated with higher IQ,” said the researchers, led by Dr Kate Northstone from the Department of Social Medicine at the University of Bristol, UK.
The importance of healthy diets
Commenting on the new study, Barbara Gallani director of food safety and science at the UK’s Food and Drink Federation told FoodNavigator that it would not be surprising if a healthy, balanced diet is important in IQ development, “just like it is generally for children’s health and growth.”
She added that it is important for everyone, not just children, to eat a wide variety of foods, noting that it is possible eat a healthy diet and still include some ‘treat’ foods.
Gallani said that food manufacturers are leading the way when it comes to providing clear labelling on foods, as well as changing recipes to make old favourites healthier, which “makes it even easier for parents to choose a balanced diet that’s right for their families.”
An intelligent diet
Northstone and her colleagues noted that previous research investigating possible associations between nutrition and IQ in children have tended to focus on the use of dietary supplements or on intakes of specific nutrients.
For example, several studies have examined the effects of vitamin supplementation on IQ in children, with mixed results.
However, the authors said that studies investigating the long-term effects of nutrition on intelligence are sparse and conflicting. “In particular …there appears to be little known about the effects of the diet in early childhood on general intelligence later in life,” they said.
“We do not eat foods in isolation, rather consuming combinations of foods in meals and snacks,” explained the authors.
“Assessing dietary patterns as opposed to individual foods or nutrients allows to us take into account these intercorrelations, which may otherwise be overlooked,” they said.
The new cross sectional study, based on the Avon Longitudinal Study of Parents and Children (ALSPAC), examined the links between dietary patterns through early and mid-childhood (3 to 8.5 years) and IQ assessed at 8.5 years of age.
Study details
The researchers measured dietary patterns using principal-components analysis (PCA), which provide overall summaries of dietary intake. The diet data, measured at the ages of 3, 4, 7 and 8.5 was then examined for any associations between diet and IQ in nearly 4,000 children.
Three consistent dietary patterns were found from PCA at each time point: a ‘processed’, ‘traditional’ and ‘health conscious’ pattern.
The ‘processed’ pattern was illustrated by foods containing high fat and sugar content and by higher intakes of processed and convenience foods. The ‘traditional’ pattern was associated with consumption of generally home cooked meat, poultry, potato and vegetables, whilst the ‘health-conscious’ pattern was predominantly made up from high intakes of salads, fruit, vegetables, fish, pasta and rice.
“On minimal adjustment, all dietary pattern scores were associated with IQ with the exception of the ‘traditional’ pattern,” said the authors.
Before adjustment for confounding factors (such as parental influence, social and economic status, and other environmental factors) the researchers observed that the ‘processed’ food pattern was negatively associated with IQ at all ages, while the ‘health-conscious’ pattern at all ages were positively associated with IQ.
However, after adjustment for a wide variety of potential confounding factors, they reported that many associations between IQ and dietary pattern were lost, and those that remained (‘processed’ pattern at three years and ‘health-conscious’ patterns at 8.5 years) “were markedly attenuated”, according to the authors.
For the remaining relationships (after full adjustment) the ‘processed’ food pattern at 3 years was found to be such that a one point increase in the PCA score resulted in an almost two-point decrease in IQ at 8.5 years. Whilst the ‘health-conscious’ pattern was associated with an increased in IQ of 1.20 points per one point increase in PCA pattern score.
Interpretation
Northstone and colleagues said that the results of the study suggest a more “long-term effect of diet on the child’s ability to ‘learn’,” they noted that this could be in part be explained by favourable growth of the brain in early childhood – They noted that it is known that the brain grows at its fastest rate during the first 3 years of life.
“Studies have shown that head growth during this time is associated with cognitive outcome, and it is possible that good nutrition during this early period may encourage optimal brain growth,” said the authors.
However, they added that given the levels of attenuation seen in the effect sizes when adjusted for confounding factors, “we cannot exclude the possibility of residual confounding.”
Source: Journal of Epidemiology and Community Health
Published online ahead of print, doi: 10.1136/jech.2010.111955
“Are dietary patterns in childhood associated with IQ at 8 years of age? A population-based cohort study”
K. Northstone, C. Joinson, P. Emmett, A. Ness, T. Paus
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The Unexpected Amount of Vitamin D Required to Help COPD Rehabilitation
VITAMIN D SUPPLEMENTS BOOST COPD REHABILITATION BENEFIT
A study has found that, among chronic obstructive pulmonary disease (COPD) patients who participated in a three-month respiratory rehabilitation exercise program, those who simultaneously received large-dose vitamin D supplementation experienced a significant boost in exercise capacity and respiratory muscle strength, compared to those who received placebos. (COPD is a progressive lung disease that includes chronic bronchitis and emphysema, and can involve chronic coughing or shortness of breath; it is exacerbated by a lack of exercise, which is common among sufferers, and rehabilitation programs aim to increase lung muscle strength and exercise capacity.)
Although the US recommended daily allowance for vitamin D is 600 international units (IU) for those up to age 70, and 800 IU for those older, the researchers gave some COPD rehabilitation patients 100,000 IU daily. Within three months, those patients significantly surpassed the others in lung strength and exercise capacity.
Researchers suggested vitamin D supplements could boost the regular benefits of rehabilitation programs. Further study is needed to determine how vitamin D effects this benefit. This study was presented today, May 16, 2011 at the international conference of the American Thoracic Society in Denver. It is not yet available online.
Can You Guess How Much Sugar You Eat Daily?
Did you know…?
Th
e average American eats his or her weight in sugar every year.
Typically, an individual consumes 50 teaspoons of sugar a day, often without realizing it.
Most dietary sugar is hidden in processed and packaged foods.
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Sugar lurks in a variety of food, drinks, supplements and even in kids vitamins!
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- No Sugar or Sucrose
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- No Egg
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- No Caffeine
- No Herbal Stimulants
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Possible Link Between Digestive Problems & Depression/Anxiety?
DIGESTIVE IRRITATION IN NEWBORNS MAY CAUSE LIFELONG DEPRESSION
A new study has found that short-term gastrointestinal irritation in the first days of life can permanently re-set the brain to a state of depression or anxiety, suggesting that digestive problems may actually be the cause of certain psychological disorders, and not the result of them as is commonly assumed.
Because not all stomach upsets result in lifelong depressive or psychological disorders, the researchers speculate that the impact of gastric irritation may depend on when it occurs during the development of the genetic makeup of the affected person. Past research shows that individuals who suffer from functional dyspepsia (persistent or recurring pain in the upper abdomen), a group making up about 15-20 percent of the population, are also more likely than others to be depressed or anxious.
Conventional wisdom has held that stress hormones associated with altered mood cause digestive disturbances; however, the gut and brain are actually hard-wired together by the vagus nerve, which sends signals in both directions from the brain to the internal organs.
This just-released study will not be published until a future issue of the journal PLoS One. It is available online now at http://bit.ly/iPmy4w without charge.
Study: How Omega-3 in Pregnancy is Linked to Childhood Obesity
Adequate intake of omega-3 fatty acids during pregnancy may lower the risk of childhood obesity by 32%, according to new research from Harvard Medical School.
The study, published in American Journal of Clinical Nutrition, examined the relationship between the type of fat a mother consumed at mid-pregnancy and whether her child was obese at age 3 – determined by body mass index (BMI) and skinfold measurements.
The researchers, led by Dr. Emily Oken, associate professor in the department of population medicine, reported that enhanced maternal-fetal omega-3 status was associated with lower childhood obesity.
“We examined the extent to which prenatal omega-3 and omega-6 PUFA concentrations were associated with childhood adiposity,” wrote Onken and her colleagues.
“A higher ratio of cord plasma omega-6 to omega-3 polyunsaturated fatty acids (PUFAs) was associated with higher subscapular and triceps [skinfold thicknesses] and odds of obesity,” they said.
Omega-3 and obesity
The consumption of omega-3 fatty acids, most notably EPA and DHA, is associated with several health benefits, including improving of lipid metabolism, preventing coronary heart diseases, and reducing inflammatory responses. In addition, omega-3s have been suggested to reduce fat levels in animals fed a high-fat diet.
Onken and her colleagues explained that a low intake of omega-3 fatty acids, found mainly in fish and seafood, in addition to a presence of large amounts of omega-6s has been suggested to be a risk factor in the development of obesity.
Previous research in animals found that such imbalances in the types of fatty acids in the diet, promotes the development of fat tissue. However, the authors noted that very few studies have investigated these effects in human populations.
Study details
Onken and her colleagues reported that around one fifth expectant mothers ate more than 2 fish meals per week at mid-pregnancy, however only about half of these women achieved the recommend intake of DHA of 200 mg per day.
The authors said that such an observation suggests although pregnant women ate fish, they did not consume enough of the species known to contain high amounts of DHA, such as salmon, tuna, and mackerel.
Only 3% of pregnant women in the study were found to consume the recommended intake of 200 mg/day of DHA in the last month of pregnancy. Onken and her team noted that this is the time when large amounts of DHA are transferred from the mother to the infant to support brain development.
The research team then calculated the odds for obesity in the offspring at age 3 according to the mother’s omega-3 fatty acid intake and the level of omega-6s and omega-3s in cord blood at delivery.
Onken and her co-workers reported the odds of obesity in 3-year-olds were between 2 and 4 times higher when cord blood had a high ratio of omega-6 to omega-3 fatty acids.
In contrast, the odds of obesity were 32% lower when maternal consumption of omega-3s was high or if the ratio of omega-3 to omega-6 was at close to recommended levels.
The Harvard research team noted that the study is the first indications from human data that low intakes of omega-3s in the presence of large amounts of omega-6s during pregnancy might affect the chance of obesity in the offspring.
“These findings need to be confirmed by others. It will also be important to demonstrate that making deliberate changes to a woman’s fat intake during pregnancy has desirable effects on weight and fatness in children,” they added.
Source: American Journal of Clinical Nutrition
Volume 93, Issue 4, Pages 780-788, doi: 10.3945/?ajcn.110.005801
“Prenatal fatty acid status and child adiposity at age 3 y: results from a US pregnancy cohort”
Authors: S. M Donahue, S.L Rifas-Shiman, D.R. Gold, Z.E Jouni, M.W Gillman, E. Oken.
Obesity & Nutrient Deficiency
OVERWEIGHT PEOPLE AT GREATER RISK OF NUTRITIONAL DEFICIENCIES
Researchers conclude that obese or overweight people appear to have a greater risk of experiencing suboptimal levels of vitamins and minerals – especially vitamin B12, carotenoids, folate, vitamin C and iron. Whether currently dieting or not, overweight individuals may be able to prevent nutritional deficiencies by taking a multi-nutrient supplement and eating nutrient-rich foods in an effort to reduce the risks of obesity-related chronic diseases.
Suboptimal nutrient levels among the overweight people may be due to a poor diet, higher nutrient requirements (due to larger size), obesity-caused changes in absorption, excretion, or metabolism of nutrients, or a combination of these factors.
Additionally, fat-soluble vitamins become isolated within fat tissues and therefore unavailable to the body.
Dieting practices, bariatric surgery and anti-obesity drugs may compound the risks of nutrient deficiency.
Evidence exists that people with a higher body mass index (BMI) more commonly consume energy-dense, processed foods.
Supplements among the overweight can improve blood fat profiles and insulin resistance.
This study was released late on May 12, 2011 but will not be published until the June 2011 issue of the journal, Nutrition Bulletin. It is available online now at http://bit.ly/jq8Eau.
Heavy Coffee Consumption May Decrease Risk of Breast Cancer in Some
Among postmenopausal women, heavy coffee consumption is associated with a lower incidence of estrogen receptor (ER)-negative breast cancer, according to a study published online May 11 in Breast Cancer Research.
Coffee contains a wide array of chemicals that may have carcinogenic, chemopreventive, antioxidative, and weakly estrogenic properties. For example, it contains the phytoestrogen trigonelline, which may activate ER through an estrogen-independent mechanism, explain the authors led by Jingmei Li, PhD, from the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
That complexity has led to uncertainty regarding whether coffee has a net positive or negative effect on breast cancer risk, although a significant body of evidence suggests a modest decrease in risk.
Breast cancer can be broadly separated into hormone-responsive (ER-positive) and non-hormone-responsive (ER-negative) subtypes. Previous research has suggested that coffee intake may have heterogeneous effects on the risk of developing the 2 subtypes.
The researchers looked at the association between coffee consumption and postmenopausal breast cancer risk in a large, population-based study (2818 cases and 3111 control patients). They determined the odds ratios (OR) for cancer overall and for each ER tumor subtype, using multivariate logistic regression models in a stratified case-control analysis.
There was a small decrease in overall breast cancer risk associated with coffee consumption (OR for more than 5 cups/day compared with 1 or fewer cups/day, 0.80; 95% confidence interval, 0.64 – 0.99; P = .028). Among heavy coffee drinkers (>5 cups a day), there was a strong reduction in risk for ER-negative breast cancer (OR for more than 5 cups/day compared with 1 or fewer cups/day, 0.43; 95% CI, 0.25 – 0.72; P = .0003) in a multivariate-adjusted model.
The effect of coffee consumption on breast cancer risk reduction was higher for ER-negative tumors than for ER-positive tumors (P heterogeneity [age-adjusted] = .004).
Two study limitations include the use of self-reported food recall surveys and the fact that receptor data were only available for 65.4% of the population studied.
“We found no evidence that coffee consumption increases the overall risk of postmenopausal breast cancer,” the authors conclude. “However, a high daily intake of coffee was found to be associated with a significant decrease in ER-negative breast cancer among postmenopausal women. Future studies are needed to confirm the effects of coffee consumption in the light of breast cancer subtypes.”
The study was supported by the National Institutes of Health and by the Märit and Hans Rausing’s Initiative against Breast Cancer. The authors have disclosed no relevant financial relationships.
Breast Cancer Res. Published online May 11, 2011. Full text
Alcohol Marketing & Impact on Adolescents
Alcohol marketing is effective.
Although profitable for the manufacturers, the detrimental results seen in American adolescents — who are not the target audience — are increased frequencies of drinking and binge drinking, which could be a prelude to alcohol-related behavioral and health problems in later life.
The findings from a pair of studies were presented by Susanne Tanski, MD, from Dartmouth-Hitchcock Medical Center of Pediatrics, Lebanon, New Hampshire, here at the Pediatric Academic Societies and Asian Society for Pediatric Research 2011 Annual Meeting.
In any given month, approximately 40% of American high-school students drink alcohol. Of these, nearly 25% will binge drink, consuming 5 or more drinks in succession.
“The alcohol industry works hard to get our money, with $17 billion spent on ads in 2009 [in the United States]. The goal is to create brand loyalty, and alcohol ads link drinking with partying and having fun,” Dr. Tanski told Medscape Medical News.
Surprisingly little is known about whether alcohol marketing is a risk factor for alcohol abuse in adolescents, Dr. Tanski noted.
In the first study, of the 328 adolescents (18 to 23 years of age; 164 males, 164 females) who participated, 58% had drunk in the previous month and 62% had binged. The anonymous Web survey was a “cue-based” recall of television ads, in which still images from 39 alcohol ads and 15 fast food ads with the identifying brand name/logo digitally obscured were viewed. A 4-point scale was used to determine whether participants had seen the ad and whether they could identify the brand.
The ad responses were linked to responses concerning drinking intensity (recall of the number of times drinking and the number of times binge drinking in the previous 30 days), glass size of a typical drink corresponding to photos of various beverage glasses, and abuse of alcohol in the previous year. The latter category included the number of episodes of vomiting (54% of respondents), passing out (23%), and memory loss (38%) after drinking.
When age, sex, ownership of alcohol-branded clothes/other merchandise, professed preference in alcohol brand, and food ad recognition/recall were controlled for in a regression analysis, increased alcohol ad recognition/recall was associated with higher drinking intensity and increased alcohol abuse.
“Something striking is going on here. Controlling for recall of fast food marketing, the results suggest that alcohol ad targeting is related to alcohol abuse in adolescents,” Dr. Tanski told Medscape Medical News.
“Every day in the United States, approximately 4750 people under age 16 start drinking. Work documenting the role of alcohol marketing in young people’s drinking is important because alcohol is the leading drug problem among young people, responsible for approximately 5000 deaths per year among persons under 21,” David Jernigan, PhD, associate professor at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and director of the Center on Alcohol Marketing and Youth, told Medscape Medical News.
Television networks are awash in alcohol ads, and although voluntary restrictions in the age of the target audience exist, how adolescents respond to alcohol ads targeted at an older audience has been unclear.
To specifically address this, the second study focused on the influence of television advertising of alcohol products on the brand preference and frequency of alcohol use in 2699 adolescents, aged 16 to 20 years, as part of a longitudinal study of media use by American youth. Every state in the country was represented.
About 64% of respondents had tried alcohol, and nearly 21% had binged in the preceding month. Of those who ever drank, 68.1% had a favorite brand. Of the list of 158 brands, distilled spirits were the choice of 53.2% (typically girls, whose preference was Smirnoff); beers were the choice of 42.4% (typically males, who preferred Budweiser).
Annual ad expenditures for 95 alcohol brands correlated with the selection of a brand; Spearman’s correlation coefficient for this “brand signature” was 0.64 (P < .0001). Moreover, binge drinking in those who had a favorite brand ranged from 28% to 74% (by sex, 25.1% for females and 38.8% for males), compared with 11% in those with no professed brand preference.
“Our data suggest that alcohol ad campaigns influence the consumption of alcohol by adolescents at levels that are a risk to their present and future health,” Dr. Tanski told Medscape Medical News.
“Other federally funded long-term studies have found that the more young people are exposed to alcohol marketing of various kinds, the more likely they are to drink or, if already drinking, to drink more. However, there has been very little published on the relationship between youth brand preference and drinking behavior. Since marketing is done by brand, this kind of work is crucial to understanding the role of marketing in youth drinking behavior,” Dr. Jernigan told Medscape Medical News.
“There are no nationally representative long-term data on youth brand preference. Our center monitors youth exposure to alcohol marketing, and repeatedly identifies a small group of brands (between 5% and 8%) that are responsible for the majority of youth exposure. We (as well as the Institute of Medicine and, last week, a bipartisan group of 24 state attorneys general) have argued for stronger industry self-regulation to shield young people from the marketing. This youth brand preference data could make the case for more meaningful action stronger,” Dr. Jernigan told Medscape Medical News.
Dr. Tanski and Dr. Jernigan have disclosed no relevant financial relationships.
Pediatric Academic Societies (PAS) and Asian Society for Pediatric Research 2011 Annual Meeting: Abstracts 2155.1 and 2155.2. Presented April 30, 2011.
Liver Failure & Ignorance About OTC Meds
Over the Counter Medication Ingredients
Ignorance about ingredients found in more than 600 over-the-counter and prescription drugs could account for increasing liver failure, U.S. researchers say. Senior author Michael Wolf of Northwestern University Feinberg School of Medicine in Chicago says his study found only 31% of participants knew Tylenol contained acetaminophen; 75% of participants knew Bayer contained aspirin; 47% knew Motrin contained ibuprofen; 19% knew Aleve contained naproxen sodium and 19% knew Advil contained ibuprofen. The study, published in the American Journal of Preventive Medicine, finds 41% of participants read the ingredients on drug labels. Ignorance about ingredients found in more than 600 over-the-counter and prescription drugs could account for increasing liver failure, U.S. researchers say.
“It’s incredibly alarming,” Wolf says in a statement. “People may unintentionally misuse these medicines to a point where they cause severe liver damage. It’s easy to exceed the safe limit if people don’t realize how much acetaminophen they are taking. Unlike prescription products, there is no gatekeeper, no one monitoring how you take it.”
“When you have pain, you aren’t paying attention to what’s in a medicine, you just want relief,” lead author Jennifer King says in a statement. “People think ‘if I can buy it without a prescription, it can’t be harmful.’ They don’t realize exceeding the maximum dose can cause liver damage and people don’t understand they may be taking the drug simultaneously in multiple medications.”
In addition, acetaminophen is found not only in over-the-counter medications like Tylenol, it is called APAP on prescription medications, King said.
Despite Overweight Status, Dieters Don’t Count Calories
REPORT FINDS PEOPLE BELIEVE CALORIE COUNTING IS TOO DIFFICULT
A study found that although 43% of Americans are trying to lose weight and a further 26% are trying to maintain their weight, only 9% keep track of calories consumed on a daily basis.
Past research suggests that people who pay attention to how many calories they eat lose more weight than those who do not.
The study found that 30% cited calorie counting as being too difficult and only 5% consistently try to balance the calories they consume with the calories they expend.
Only 9% could accurately estimate the correct calorie intake for their height, weight and level of physical activity.
87% listed TASTE as a main consideration for food purchases; while 79% pointed to price as a key consideration (an increase of 6% over last year).
A substantial 43% reported their physical activity level as sedentary, an increase from 37% a year ago.
This study was released by International Food Information Council (IFIC), and the full report is available online now at http://bit.ly/lRmjI6 without cost.
Recurrent Abdominal Pain in Children May Be Migraine
May 5, 2011 — Up to 15% of recurrent abdominal pain in children meets criteria for abdominal migraine (AM), a new study suggests.
The findings underline the importance of recognizing AM in children with recurrent abdominal pain because there are now a wide range of treatments available, researchers say.
“The message is that this is out there,” said Donald Lewis, MD, professor of pediatrics and neurology at Children’s Hospital of the King’s Daughters and Eastern Virginia Medical School in Norfolk. “US physicians just aren’t thinking about it, aren’t recognizing it, and there are kids with recurrent abdominal pain who might benefit from the interventions we have for migraine.”
The study appears in the May issue of the journal Headache.
Surprising Results: Tracking Milk from Cow to Cup
Localizing food supply isn’t a simple matter. Cutting the journey of a carton of fresh milk from cow to cup would end up increasing the food miles of other dairy products, while also pushing up prices and greenhouse-gas emissions.
That’s according to Miguel Gomez of Cornell University in Ithaca, New York, who modelled the dairy supply chain in the US. He found that dairy products travel an average of 515 kilometers (~320 miles) from cow to shop via the various processing factories.
Gomez then showed that if the existing network were fine-tuned to make milk deliveries as local as possible, other dairy products would have to travel further: a 10% decrease in milk miles produced a 31% increase in food miles for dairy products overall (Food Policy, DOI: 10.1016/j.foodpol.2010.11.028). Gomez says dairy is likely to be typical of food industries.
This means “locavores” should lobby for the industry to change, with more companies and processing plants sited closer to cows and consumers. The other option is to change their diet, which Gomez says is a more efficient way to reduce emissions than localizing food chains.
12 Superfoods You Really Must Try
Super Foods Pack a Powerful Lunch
When it comes to diet and nutrition, there are so many trends from which to choose.
Wish you could get rid of some restrictions and go by simpler guidelines instead?
Then here you have it – some of the prettiest, tastiest and easiest to eat items on the planet, which is probably Martha Stewart’s Whole Living magazine decided to produce Power Foods: 150 Delicious Recipes with the 38 Healthiest Ingredients (available at bookstores and Amazon.com), highlighting these super foods.
Nature provides clues to help us find the healthiest and most nourishing foods. Many are plants, blooming with bright colors and artistic shapes that beckon to be picked and eaten—earthy stalks of asparagus looks like architecture for woodland fairies, and the violet-red juice of beets is so vibrant it was used as crimson dye by our ancestors.
There are only three species of fish on the Power Foods cookbook’s list, and no other meat at all. That leaves beans and nuts as sources of protein. They might not look like much, but it seems Mother Nature tucked them in to sturdy protective shells for good reason: their power is precious. Legumes and tree nuts pack an incredible health punch with fiber and essential fatty acids like Omega 3.
Twelve Top Power Foods You Really Must Try:
- Artichokes
- Beets
- Kale
- Swiss Chard
- Apricots
- Papayas
- Flaxseed
- Pumpkin Seeds
- Quinoa
- Sablefish (Black Cod)
- Lake Trout
- Wild Alaskan Salmon
So for a true power lunch, forget the two martinis and the fancy reservation. Instead, stock your pantry for power and take a few tips from one of the country’s favorite cookbook producers:
- Roast beets & bell peppers. They’ll keep for a long time in the fridge so you can add them at will to salads, sandwiches, stews and pastas.
- Carrots are extra good-for-you because of the beta-carotene, but it’s fat-soluble. So, cook carrots with olive oil or toss them with an oil-dressed salad.
- White asparagus might seem like high-class cuisine, but next to its more common green cousin, its nutrition pales in comparison. Try marinating green asparagus in balsamic vinegar & extra virgin olive oil, grilling it and sprinkling it with shaved Parmesan for delicious, nutritious side dish.
- Quinoa is not a grain, but cooks up like one. It offers a complete source of protein, and once cooked, it can be eaten warm or cold, savory or sweet. Try treating it like you would oatmeal – with cinnamon, raisins & dried cherries.
- Sablefish is an environmentally sound choice. Because of its healthy fat content, you can dress it lightly and cook it at high heat—grilled is great.
How Dads Influence Childhood Eating Patterns & Rituals
DADS’ HABITS ESTABLISH KIDS’ DINING OUT PATTERN
Children ranging from ages 9 – 15 more frequently use and and spend time at fast-food and full-service restaurants if their fathers frequently visit and spend time in these restaurants, according to a new study.
About half of the food budget of Americans is currently spent in restaurants.
Food prepared away from home is strongly associated with food that is higher in calories, saturated fat and sodium.
Researchers also found that greater time spent in restaurants was linked to more time spent in cars and to both parents maintaining regular daytime working schedules. The study suggests that parents and especially fathers, should consider setting better eating examples for their children by making better food choices and by more often eating at home, making dinner at home a family ritual. Dietary behaviors, such as eating away from home, have been shown to remain fairly stable from childhood into young adulthood.
This study was published in the May-June 2011 issue of the Journal of Nutrition Education and Behavior. It is available online at http://bit.ly/mOegnV with subscription or fee.
Ban Chocolate Milk in the Cafeteria?
Did you know? . . .
Seventy percent of the sugar found in chocolate milk was already there before the chocolate flavoring was added!
An eight-ounce serving of the unflavored white stuff holds 14 grams of sugar, while the same amount of chocolate flavored milk holds 20 grams of sugar.
So the net increase is 6gm of sugar, which is a little more than 1 teaspoon.
That doesn’t mean it is the best choice. There are other healthful options available.
Some schools are contemplating banning chocolate milk from the lunch menu, but just how does its nutritional profile compare to other choices?
- Orange Soda – 32 gm sugar (according to USDA)
- Orange Juice Drink (5% juice) – 29 gm sugar (according to USDA)
- Coca-Cola – 27 grams of sugar (or more than 5 teaspoons).
- 100% Orange Juice – 22 gm of sugar (according to USDA)
- Chocolate Almond Milk (Almond Breeze) – 20 gm sugar
- Vanilla Enriched Rice Milk (Rice Dream) – 12 gm sugar
- Unsweetened Chocolate Almond Milk – 0 gm sugar
Is There a Link Between Forgiveness & Immune Health?
Could forgiveness lead to enough beneficial physiological change to improve immune function in people whose immune status is already compromised?
A new study conducted in people living with HIV shows individuals who truly forgave someone who had hurt them in the past showed positive changes in their immune status.
The study was presented here at the Society of Behavioral Medicine 32nd Annual Meeting and Scientific Sessions.
Amy Owen, PhD, Duke University Medical Center, Durham, North Carolina, found that greater forgiveness significantly correlated with higher CD4 cell percentages (P = .042). Unlike the CD4 cell count, which is a measure of how many functional CD4 T cells are circulating in the blood, the CD4 cell percentage represents the percentage of total lymphocytes that are CD4 cells.
In regression analyses, the relationship of forgiveness and CD4 cell percentages remained significant even when controlling for variables that could affect CD4 cell counts, including age, race, sex, level of education, years with HIV, adherence, substance use, and viral load (P = .034).
“We hypothesized that higher levels of forgiveness would be associated with higher CD4 cell percentages controlled for demographic and behavioral variables as well as viral load,” Dr. Owen told Medscape Medical News. “And none of these variables accounted for the relationship between forgiveness and CD4 cell percentages. So there is something special going on between forgiveness and CD4 cell counts.”
Beneficial Effect
The study involved 78 individuals living with HIV and receiving antiretroviral medications. Subjects had been taking anti-HIV medications for at least 1 year, and 67% of them had undetectable viral loads. Eighty-one percent were nonwhite. Medication adherence was assessed by calculating the mean number of missed doses during the past 4 days. Subjects were also asked about tobacco, alcohol, marijuana, and cocaine use.
Forgiveness was measured by the Enright Forgiveness Inventory, a tool that assesses positive and negative feelings, thoughts, behaviors, or imagined behaviors toward an individual who caused the subject hurt.
Dr. Owen also defined forgiveness strictly as being a freely made choice to move away from negative cognitive, emotional, and behavioral responses toward a person who caused a hurt and work towards developing positive cognitive emotional and behavioral responses toward that person.
“For my study, I compared the relationship of forgiveness of another person and CD4 cell percentages both without controlling for any other factors (using a bivariate correlation), and then I tested whether this relationship would hold up when I controlled for other possible factors linked to CD4 percentage levels that could account for an observed relationship between forgiveness and CD4 percentages (using a hierarchical linear regression).”
In bivariate correlations, results showed that greater forgiveness was significantly associated with higher CD4 percentages, whereas linear regression analyses found that this relationship remained significant after controlling for the potential influence of other factors.
“Results support our hypothesis and reflect previous findings on relationships of psychosocial factors with immune makers in people living with HIV/AIDS, and findings indicate that forgiveness of another person may be beneficial for their health,” said Dr. Owen.
Understanding Forgiveness is Key
She also noted that helping people who have been violated in the past come to a place of peace can be done, but it has to be done well.
“If psychiatrists want to counsel patients about forgiveness, they first need to understand very deeply what forgiveness is and what it is not,” she said. “If there isn’t a good therapeutic relationship between a physician and the patient, “what patients can hear from you when you are suggesting forgiveness is, ‘I don’t want to hear about it anymore and what’s wrong with you that you are not just fine with it.’ But that can be extremely violating and potentially retraumatize the person who has already been deeply hurt.”
It’s also very important to respect a patient’s anger, she added, because sometimes that is all a person has.
“If you threaten that by suggesting that the patient shouldn’t be so angry, it can be disrespectful, so if a psychiatrist wants to engage with a patient on the topic of forgiveness, it’s essential they understand the definitions of forgiveness and be willing to journey with that person over time. Patients will struggle with it; it’s not a linear process, but it is very transformative.”
Emotional Pain Common
Reverend Michael Barry, PhD, Cancer Treatment Centers of America, Philadelphia, Pennsylvania, told Medscape Medical News that unforgiveness is a state where a person retains negative emotions, including anger and hatred, for a perpetrator of harm.
“This creates a state of chronic anxiety, and chronic anxiety has a predictable impact on a wide range of bodily functions, including the reproductive system, the digestive system, and the immune system,” he said.
For example, stress hormones, including cortisol and adrenalin, have been shown to reduce the production of natural killer cells — the “foot soldiers” in the fight against cancer, he noted.
Dr. Barry’s own research has shown that almost two-thirds of cancer patients identified forgiveness as a personal issue for them, and 1 in 3 of them indicated they had severe forgiveness issues, “so we are aware of the emotional pain that many of our patients are in.
“There is a direct correlation between unforgiveness and our immune system, which directly affects our healing processes. We teach people what we have learned about the process of forgiveness in a short-term forgiveness intervention program that works,” he added.
Dr. Owen has disclosed no relevant financial relationships. Dr. Barry is the author of The Forgiveness Project. He also developed a forgiveness program, entitled Release! The Healing Power of Forgiveness.
Society of Behavioral Medicine (SBM) 32nd Annual Meeting and Scientific Sessions: Abstract 4010. Presented April 30, 2011.