Is there something fishy about fish oil?

To be sure, there's plenty of misinformation out there about fish oil. Take a look at the swill that passes for health information on Woman's Day: On Call with Dr. Sandy: Fish Oil and Mercury:



Reader Question: My doctor recommended that I take a fish oil supplement, but I'm concerned about mercury. Is there any way to tell which brands are lowest in mercury content?



On Call Response: When it comes to OTC supplements, the answer is no. Though most fish oil supplements sold by major brands are probably safe, there's really no way to tell what's in the bottle or how much mercury it might contain.




Perhaps Dr. Sandy should read the many independent analyses performed on nutritional supplement fish oil, including those at Consumer Lab and Consumer Report before she offers her blind criticisms.

Lovaza vs fish oil supplements?

Lovaza is the FDA-approved form of fish oil that is available only by prescription. It contains 842 mg of the omega-3 fatty acids, EPA and DHA, per capsule.

The FDA application for Lovaza is viewable here on the FDA website. Interestingly, while there is plenty of the usual regulatory gobbledy-gook about toxicology, dose escalation, and efficacy in the extensive documentation, there is little said about the issue of contamination.

In other words, critics of nutritional supplement fish oil harp on the possibility of contamination with mercury and pesticide residues, like dioxin and PCBs (polychlorinated biphenyls). Yet there is virtually nothing about these same issues in the FDA application for Lovaza.

Let's take a look at a sample over-the-counter fish oil product. Our friends at PharmaNutrients (a new Track Your Plaque partner for nutritional supplements) have a fish oil product called PharmaNutrients" Cardio. Here's an independent analysis of the Cardio product (per 1000 mg fish oil capsule):

EPA content: 566.1 mg
DHA content: 216.6 mg
(Total EPA + DHA 782.7 mg)

Cardio passed all tests for peroxides, PCBs, dioxin, furans, dioxin-like PCBs, and heavy metals (arsenic, cadmium, lead, mercury) using criteria at least 60% more stringent than European Commission (EC) standards (EC standard <2 picograms/gm for dioxins and furans, PharmaNutrients <1 picograms/gm; EC standard <10 picograms/gm for dioxin-like PCBs, PharmaNutrients <3 picograms/gm). PCBs levels in particular are less than 0.009 ppm, 90% below the industry-wide purity standard of 0.09 ppm. Likewise, mercury is >90% lower than European Commission standards.

In other words, this over-the-counter "pharmaceutical grade" fish oil has virtually nothing but omega-3 fatty acids.

Interestingly, the PharmaNutrients fish oil capsule also contains the third omega-3 fatty acid, docosapentaenoic acid (DPA), a neglected form that some authorities have proposed has superior cardiovascular protective properties over eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). If DPA is included in the analysis, PharmaNutrient's Cardio contains a total of 900 mg omega-3 fatty acids per capsule.

At some point, I'd like to see a head-to-head comparison not just on purity grounds, since I am convinced that high-quality products like Cardio can match or exceed the purity of prescription fish oil, but on efficacy in raising omega-3 blood levels, the omega-3 index. (The omega-3 index is a predictor of heart attack and sudden cardiac death--the higher, the better.) My prediction: High-quality fish oil supplements will match or exceed prescription fish oil.

More on blood sugar

Take any of the following foods:

One chicken breast
Quarter-pound ground beef
6 oz salmon steak
½ cup raw almonds
3 eggs scrambled in olive oil

How much is blood sugar increased by any item in the above list?

If you said virtually zero, you’re correct. Eat any of these foods, regardless of portion size, and blood sugar won’t change substantially. If you started with a blood sugar of, say, 90 mg/dl, 1-2 hours later it would be 90 mg/dl. It might go up or even down a few milligrams, but for all practical purposes it remains substantially unchanged.

How much is blood sugar increased by the foods in this list:

2 slices multigrain bread
1 whole wheat bagel
4 oz high-fiber breakfast cereal
2 whole grain pancakes, 2 oz maple syrup

The foods in this list are a different story from the first. Depending on your body weight, exercise habits, and other factors, a typical blood sugar response in an otherwise healthy non-diabetic person would be 120 mg/dl to 160 mg/dl. In someone with diabetes, it could easily exceed 200 mg/dl.

That isn’t good. Large blood sugar excursions to 140 mg/dl have been clearly associated with greater risk for heart attack, progression to diabetes, inflammatory responses, and other adverse health effects. In fact, blood sugars as low as 100 mg/dl after eating have been associated with increased cardiovascular risk.

Then why are the USDA, American Heart Association, the American Dietetic Association, and the American Diabetes Association telling us to eat more of the foods that shoot blood sugar up to such high levels? “Eat more healthy whole grains”?

To see how much the issue of exaggerated blood sugars after eating applies to you, a simple blood sugar check 1-2 hours after eating can show you. Either your doctor can have the test drawn or you can purchase your own inexpensive glucose meter (e.g., Walmart, Wagreens).

My prediction: You will be very surprised at blood sugar responses after common foods, including “healthy whole grains.” And, by the way, keeping blood sugar excursions to a minimum will facilitate weight loss.

Postprandial blood sugar: Almonds vs. whole wheat bread

Here's my postprandial (after-eating) blood glucose demonstration.



I tested raw almonds vs. 100% whole wheat bread, matched for calories. (Full nutritional composition below.)



Blood sugars:

Raw almonds

Start:

One-hour after eating:





2 slices 100% whole wheat bread

Start:

One-hour after eating:





100% whole wheat bread, 2 large slices

Water (g) 24.69

Energy (kcal) 158

Protein (g) 8.29

Fat, total (g) 2.14

Carbohydrate (g) 26.43

Sugars, total (g) 3.56

Fiber, total dietary (g) 4.4

Cholesterol (mg) 0

Saturated fatty acids, total (g) 0.478

Monounsaturated fatty acids, total (g) 1.022

Polyunsaturated fatty acids, total (g) 0.384





23 almonds, raw



Energy (kcal) 159

Protein (g) 5.86

Fat, total (g) 13.64

Carbohydrate (g) 5.98

Sugars, total (g) 1.07

Fiber, total dietary (g) 3.4

Cholesterol (mg) 0

Saturated fatty acids, total (g) 1.03

Monounsaturated fatty acids, total (g) 8.525

Polyunsaturated fatty acids, total (g) 3.331



To get low-carb right, you need to check blood sugars

Reducing your carbohydrate exposure, particularly to wheat, cornstarch, and sucrose (table sugar), helps with weight loss; reduction of triglycerides, small LDL, and c-reactive protein; increases HDL; reduces blood pressure. There should be no remaining doubt on these effects.

However, I am going to propose that you cannot truly get your low-carb diet right without checking blood sugars. Let me explain.

Carbohydrates are the dominant driver of blood sugar (glucose) after eating. But it's clear that we also obtain some wonderfully healthy nutrients from carbohydrate sources: Think anthocyanins from blueberries and pomegranates, vitamin C from citrus, and soluble fiber from beans. There are many good things in carbohydrate foods.

How do we weigh the need to reduce carbohydrates with their benefits?

Blood sugar after eating ("postprandial") is the best index of carbohydrate metabolism we have (not fasting blood sugar). It also provides an indirect gauge of small LDL. Checking your blood sugar (glucose) has become an easy and relatively inexpensive tool that just about anybody can incorporate into health habits. More often than not, it can also provide you with some unexpected insights about your response to diet.

If you’re not a diabetic, why bother checking blood sugar? New studies have documented the increased likelihood of cardiovascular events with increased postprandial blood sugars well below the ranges regarded as diabetic. A blood sugar level of 140 mg/dl after a meal carries 30-60% increased (relative) risk for heart attack and other events. The increase in risk begins at even lower levels, perhaps 110 mg/dl or lower after-eating.

We use a one-hour after eating blood sugar to gauge the effects of a meal. If, for instance, your dinner of baked chicken, asparagus brushed with olive oil, sauteed mushrooms, mashed potatoes, and a piece of Italian bread yields a one-hour blood sugar of 155 mg/dl, you know that something is wrong. (This is far more common than most people think.)

Doing this myself, I have been shocked at the times I've had an unexpectedly high blood sugar from seemingly "safe' foods, or when a store- or restaurant-bought meal had some concealed source of sugar or carbohydrate. (I recently had a restaurant meal of a turkey burger with cheese, mixed salad with balsamic vinegar dressing, along with a few bites of my wife's veggie omelet. Blood sugar one hour later: 127 mg/dl. I believe sugar added to the salad dressing was the culprit.)

You can now purchase your own blood glucose monitor at stores like Walmart and Walgreens for $10-20. You will also need to purchase the fingerstick lancets and test strips; the test strips are the most costly part of the picture, usually running $0.50 to $1.00 per test strip. But since people without diabetes check their blood sugar only occasionally, the cost of the test strips is, over time, modest. I've had several devices over the years, but my current favorite for ease-of-use is the LifeScan OneTouch UltraMini that cost me $18.99 at Walgreens.

Checking after-meal blood sugars is, in my view, a powerful means of managing diet when reducing carbohydrate exposure is your goal. It provides immediate feedback on the carbohydrate aspect of your diet, allowing you to adjust and tweak carbohydrate intake to your individual metabolism.

Food sources of vitamin K2: Reprint

For some reason, my December, 2007, Heart Scan Blog post, Food sources of vitamin K2, has been receiving a lot of traffic.

I therefore reprint the vitamin K2 post below.





Vitamin K2 is emerging as an exciting player in the control and possible regression of coronary atherosclerotic plaque. Only about 10% of dietary vitamin K intake is in the K2 form, the other 90% being the more common K1.

The ideal source of K2 is natto, the unpalatable, gooey, slimy mass of fermented soybeans that Japanese eat and has been held responsible for substantial decreases in osteoporosis and bone fractures of aging. Natto has an ammonia-like bouquet, in addition to its phlegmy consistency that makes it virtually inedible to anyone but native Japanese.

I say that the conversation on vitamin K2 is emerging because of a number of uncertainties: What form of vitamin K2 is best (so-called MK-4 vs. MK7 vs. MK-9, all of which vary in structure and duration of action in human blood)? What dose is required for bone benefits vs. other benefits outside of bone health? Why would humans have developed a need for a nutrient that is created through fermentation with only small quantities in meats and other non-fermented foods?

Much of the developing research on vit K2 is coming from the laboratories of Drs. Vermeer, Geleijnse, and Schurgers at the University of Maastricht in the Netherlands, along with several laboratories in Japan, the champions of K2.

MK-7 and MK-8,9,10 come from bacterial fermentation, whether in natto, cheese, or in your intestinal tract; MK-4 is naturally synthesized by animals from vitamin K1. While natto is the richest source of the MK-7 form, egg yolks and fermented cheeses are the richest sources of the MK-4 form.

Chicken contains about 8 mcg MK-4 per 3 1/2 oz serving; beef contains about 1 mcg. Egg yolks contain 31 mcg MK-4 per 3 1/2 oz serving (app. 6 raw yolks). Hard cheeses contain about 5 mcg MK-4 per 3 1/2 oz serving, about 70 mcg of MK-8,9; soft cheeses contain about 30% less. Natto contains about 1000 mcg of MK-7, 84 mcg MK-8, and no MK-4 per 3 1/2 oz serving.















Feta cheese

Thanks to the research efforts of the Dutch and Japanese groups, several phenomena surrounding vitamin K2 are clear, even well-established fact:

--Vitamin K2 supplementation (via frequent natto consumption or pharmaceutical doses of K2) substantially improves bone health. While K2 by itself exerts significant bone density/strength increasing properties in dozens of studies, when combined with other bone health-promoting agents (e.g., vitamin D3, prescription drugs like Fosamax and calcitonin), an exaggerated synergy of bone health-promoting effects develop.



--The MK-4 form of vitamin K2 is short-lived, lasting only 3-4 hours in the body. The MK-7 form, in contrast, the form in natto, lasts several days. MK-7 and MK-8-10 are extremely well absorbed, virtually complete.

--Bone health benefits have been shown for both the MK-7 and MK-4 forms.

--Coumadin (warfarin) blocks all forms of vitamin K.





Interestingly, farm-raised meats and eggs do not differ from factory farm-raised foods in K2 content. (But please do not regard this as an endorsement of factory farm foods.)

Another interesting fact: Since mammals synthesize a small quantity of Vit K2 forms from vitamin K1, then eating lots of green vegetables should provide substrate for some quantity of K2 conversion. However, work by Schurgers et al have shown that K1 absorption is poor, no more than 10%, but increases significantly when vegetables are eaten in the presence of oils. (Thus arguing that oils are meant to be part of the human diet. Does your olive oil or oil-based salad dressing represent fulfillment of some subconscious biologic imperative?)

If we believe the data of the Rotterdam Heart Study, then a threshold of 32.7 micrograms of K2 from cheese yields the reduction in cardiovascular events and aortic calcification.

It's all very, very interesting. My prediction is that abnormal (pathologic) calcium deposition will prove to be a basic process that parallels atherosclerotic plaque growth, and that manipulation of phenomena that impact on calcium depostion also impact on atherosclerotic plaque growth. Vitamins D3 and K2 provide potential potent means of at least partially normalizing these processes.

As the data matures, I am going to enjoy my gouda, Emmenthaler, Gruyere, and feta cheeses, along with a few egg yolks. I'm going to be certain to include healthy oils like olive and canola with my vegetables.


All images courtesy Wikipedia.

Copyright 2007 William Davis, MD

Family lessons

Lou was recovering from his 3rd bypass operation. This third go-round left him weaker, slower, less quick on the rebound. In fact, he was lucky to have survived.

At 71 years old, Lou went a good 15 years since his second bypass, another 10 years prior to his first bypass at age 46.

In the days immediately following Lou's bypass, I had a chance to talk to his son, who stayed at his Dad's bedside while Lou struggled through post-op recovery.

"Did your Dad tell you about why this has happened, what caused his heart disease?" I asked.

"Sort of. He just said I should get checked," Lou's son, Aaron, replied.

"Did he mention the lipoprotein(a) pattern he has?"

"No. He never mentioned anything like that. He just said to get checked."

That's how it gets played out more often than not: Mom or Dad has a heart attack, stents, or (3rd) bypass, the children are told to get checked. Getting "checked" assumes that the doctor knows what to check for.

In Lou's case, the reason why he was in the hospital getting his 3rd (and final) bypass was lipoprotein(a), along with genetically-determined small LDL particles, low HDL, a postprandial (after-eating) disorder, hypertension, and borderline diabetes, not to mention vitamin D deficiency, omega-3 fatty acid deficiency, and marginal thyroid function. (Lou, a retired city employee, had showed only marginal interest in correcting these patterns. While he accepted medications, he proved unwilling to engage in the diet and nutritional supplement strategies required to correct his patterns.)

So Lou's 3rd bypass operation provided a moment of reflection for Aaron to ask: "Could I share the fate of my Dad?" With Lou's combination of genetic patterns, there was at least a 75% likelihood that he did. Sadly, going to his doctor would likely yield little more than a cholesterol panel, a question about smoking, and a prescription for Lipitor.

Just getting "checked" would be, more than likely, a recipe for disaster for Aaron: heart disease in his 40s or 50s. That's why you need to take control over this sad state of affairs and ask--no, insist--that an effort be made to determine whether you might share your parents' fate.

Look like Jimmy Stewart


"This diet works great," Don declared. "But I think I've lost too much weight."

At 67 years old and 5 ft. 11 inches, Don began the program weighing 228 lbs (BMI 31.9). Because of high triglycerides, high blood sugar, high c-reactive protein, and excessive small LDL, I instructed Don to eliminate all wheat products from his diet, along with cornstarch and sweets. His intake of lean meats, eggs, vegetables, oils, raw nuts, etc. was unlimited.

Don now weighed 194 lbs, down 34 lbs over 6 months (BMI 27.1). Triglycerides, blood sugar, blood pressure, and well-being had improved dramatically; small LDL, however, had dropped only 30%--still room for improvement.

"My friends say I'm too skinny. They ask if I have cancer!"

I've heard this many times: Someone loses weight in a relatively short period of time and friends and family tell you you're too skinny. "It must be cancer. Nobody loses weight like that."

Unfortunately, many Americans have forgotten what normal looks like. Normal is certainly not a 190-lb, 5 ft 4 in woman, nor is it a 228 lb, 5 ft 11 inch man. But Americans have put on so much weight that the prevailing view of what constitutes "normal" weight has been revised upward. Normal is closer to what we see in old movies from the 1940s and '50s with people like Jimmy Stewart and Donna Reed. That's what we are supposed to look like.

So Don actually remains mildly overweight but is judged as "too skinny," or even cancer-ridden, by friends and family.

Ignore such comments. As you lose pounds and approach a truly desirable weight, realize that you are returning to the normal state, not the vision of "normal" now held by most Americans.

Getting vitamin D right

Vitamin D is, without a doubt, the most incredible "vitamin"/prohormone/neurosteroid I have ever encountered. Frankly, I don't know how we got anything accomplished in health pre-D.

Unfortunately, people I meet rarely take their vitamin D in a way that accomplishes full restoration of vitamin D blood levels. It really isn't that tough.

Here's a list of common tripping points with vitamin D:

"I take vitamin D: 1000 units a day."
This is probably the most common mistake I see: Taking a dose that is unlikely to yield a desirable blood level. (We use 60-70 ng/ml of 25-hydroxy vitamin D as our target.) Most men and women require 6000 units per day to achieve this level. There is substantial individual variation, however, with an occasional person needing much more, a rare person requiring as little as 1000 units.


"I bought some vitamin D on sale. They were white tablets."
Time and again, patients in my office who initially have had successful vitamin D replacement, despite being reminded that only oil-based forms should be taken, switch to tablets. While they initially showed a 25-hydroxy vitamin D blood level, for instance, of 67 ng/ml on 8000 units per day with an oil-based capsule, they switch to a tablet form and the next blood level is 25 ng/ml. In other words, tablets are very poorly or erratically absorbed.

I have had people use tablets successfully, however, by taking their vitamin D tablets with a teaspoon of oil, e.g., olive oil. Oil is necessary for full absorption.


"I'm going to Florida. I'll stop my vitamin D because I'm going to lay in the sun."
Wrong. 90% of adults over 40 years old have lost the majority of their ability to activate vitamin D in the skin. A typical response might be an increase in blood level from 25 to 35 ng/ml--a 10 ng increase with a dark brown tan.

There is an occasional person who, with sun exposure, increases blood levels substantially. This can occur in both fair-skinned and dark-skinned people, though I've never seen it happen in an African-American person. The occasional person who maintains the ability to convert vitamin D with sun exposure, or young people, should seasonally adjust their vitamin D dose, e.g., 6000 units winter, 3000 units summer, or some other regimen that maintains desirable blood levels. You can see that monitoring blood levels (we check levels every 6 months for the first 2 years) is crucial: You cannot know what your vitamin D needs are unless you assess 25-hydroxy vitamin D levels.


"I drink plenty of milk. I don't think I need to take vitamin D."
Oh, boy. This is so wrong on so many levels.

First of all, no adult should be drinking plenty of cow's milk. (A discussion for another day.) Second of all, cow's milk averages 70 units of vitamin D, often the D2 form (ergocalciferol), per 8 oz. Even if the FDA-mandated 100 units per day were present, an average adult dose of 6000 units would require 60 glasses of milk per day. Can you say "diarrhea"?

Likewise, other food sources of vitamin D, such as fish (300-400 units per serving) and egg yolks (20 units per yolk), are inadequate. This makes sense: Humans are not meant to obtain vitamin D from food, but from sun exposure over a large body surface area. And this is a phenomenon that is meant to occur only in the youthful, ensuring that nature takes its course and us older folks get old and make way for the young (i.e., unless we intervene by taking vitamin D supplements).


"My doctor said that my vitamin D blood level was fine. It was 32 ng/ml."

Let's face it: By necessity, your overworked primary care physician, who manages gout, hip arthritis, migraine headaches, stomach aches, prostate enlargement, H1N1, depression, etc., is an amateur at nearly everything, expert in nothing. Nobody can do it all and get it right. Likewise vitamin D. The uncertain primary care physician will simply follow the dictates of the laboratory form that specifies "30-100 ng/ml" as the "normal" or "reference range." Unfortunately, the laboratory often quotes population distributions of a lab measure, not an ideal or desirable level.

To illustrate the folly of population distributions of a measure, imagine you and I want to know what women weigh. We go to a local mall and weigh several thousand women. We tally up the results and find that women weigh 172 lbs +/- 25 lbs (the mean +/- 2 standard deviations). (That's true, by the way.) Is that desirable? Of course it isn't. Population average or population distribution does not necessarily mean ideal or desirable.


"My husband's doctor said he should take 4000 units per day. So I just take the same dose."
That would be fine if all adults required the same dose. However, individual needs can vary enormously. A dose that is grossly insufficient for one person may be excessive for another. Once again, vitamin D dose needs can be individualized by assessing 25-hydroxy vitamin levels in the blood.


"I don't need to take vitamin D. I already take fish oil."
I suspect this mistaken belief occurs either because people confuse fish oil with cod liver oil, which does contain some vitamin D. (Cod liver oil is not the best source of vitamin D, mostly because of the vitamin A content; also a discussion for another time), or because they've heard that eating fish provides vitamin D. However, fish oil capsules do not contain vitamin D unless it is added, in which case it should be prominently and explicitly stated on the label.


"I don't have to take vitamin D. It's summer."

For most people I know, if it's a bright, sunny July day, where are they likely to be? In an office, store, or home--NOT lying in the sun with a large body surface area exposed. Also, most people expose no more than 5-10% of surface area in public. I doubt you cut the grass in a bathing suit. Because of modern indoor lifestyles and fashion, the majority of adults need vitamin D supplementation year-round.


I advise everyone that gelcap vitamin D is preferable. Some, though not all, liquid drop forms have also worked. Take a dose that yields desirable blood levels. And blood levels of 25-hydroxy vitamin D are ideally checked every 6 months: in summer and in winter to provide feedback on how much sun activation of D you obtain.

If your doctor is unwilling or unable to perform vitamin D testing, fingerstick vitamin D test kits can be obtained from Track Your Plaque.

Jimmy Moore's thyroid adventure

My friend, Jimmy Moore of Living La Vida Low Carb, describes his thyroid experience here.

As Jimmy points out, he was looking for a way to jump-start a 50-lb weight loss. In my experience, low thyroid hormone levels ("hypothyroidism") are an exceptionally common cause for weight gain. Correcting even marginal hypothyroidism can facilitate weight loss, often resulting in 10 or more pounds of weight loss within the first month.

Unfortunately, Jimmy's thyroid hormone panel proved normal: TSH 1.3, thyroid hormones free T3 and free T4 in the mid- to upper-half of the reference range.

I say "unfortunately" because it is really an easy, inexpensive, and benign solution for losing weight. (I don't, of course, wish that Jimmy or anyone else develops a thyroid condition. But it really can provide gratifying weight loss results when thyroid function is low.) Jimmy might consider taking his oral temperature first thing in the morning as another means of assessing the adequacy of thyroid function.

Perhaps you will be luckier than Jimmy and have thyroid dysfunction that can be corrected and jump-start your weight loss program. Fingerstick thyroid test kits like the one Jimmy used are available here from Track Your Plaque.
Supermarkets and buggy whips

Supermarkets and buggy whips

Will supermarkets eventually phase out, joining the history books as a phenomenon of the past? Or are supermarkets here to stay, an emblem of the industrialization of our food--easy access to foods that are convenient, suit the undiscriminating masses, stripped of nutritional value despite the prominent health claim on the package front?

Anna left an insightful comment on the last Heart Scan Blog post, Sterols should be outlawed, along with some useful advice on how to avoid this trap for poor health called a supermarket:


I rarely shop in regular supermarkets anymore (farm subscription for veggies, meat bought in bulk for the freezer, eggs from a local individual, fish from a fish market, freshly roasted coffee from a local coffee place, etc.). What little else I need comes from quirky Trader Joe's (dark chocolate!), the fish market, farmer's markets, a small natural foods store, or mail order.

When I do need to go into one of the many huge supermarkets near me, not being a regular shopper there, I never know where anything is, so I have to ramble a bit around the aisles before I find what I'm looking for (and I almost always can grab a hand basket, instead of a trolley cart).

It's almost like being on another planet! There's always so many new products (most of them I hesitate to even call food). It's really a shock to the senses now to see how much stuff supermarkets sell that I wouldn't even pick up to read the label, let alone put in a cart or want to taste. I'm not even tempted by 99% of the tasting samples handed out by the sweet senior ladies in at Costco anymore (only thing I remember tasting at Costco in at least 6 mos was the Kerrygold Irish cheese, because I know their cows have pasture access and it's real food).

What's really shocking to me is how large some sections of the markets have become in recent years. While Americans got larger, so did some sections of the supermarket (hint - good idea to limit the consumption of products from those areas). Meat and seafood counters have shrunk, though. Produce areas seem to be about the same size as always (but more of it is pre-prepped and RTE in packaging.

But the chilled juice section is h-u-g-e! And no, I don't think there is a Florida orange grove behind the cases. Come on, how much juice do people need? Juice glasses used to be teeny tiny, for a good reason. To me it looks like a long wall stocked full of sugar water. Avoiding that section will put a nice dent in the grocery expenses.

The yogurt case is also e-n-o-r-m-o-u-s! Your 115 yo Bulgarian "grandmother" wouldn't know what to make of all these "pseudo-yogurts"! Chock full of every possible variety, but very little fit to eat. The only yogurts I'll look at are made with plain whole milk, without added gums, emulsifiers, or non-fat milk solids, and live cultures (I mostly buy yogurt now and then to refresh my starter culture at home). I can flavor them at home if needed. The sterols are showing up in processed yogurts, too, along with patented new strains of probiotic cultures (I'll stick to my old fashioned, but time-proven homemade lacto-cultured veggies and yogurt instead).

I found the same "cooler spread" in the butter & "spread" section. The spread options were just grotesque sounding. Actually, the butter options weren't much better, as many were blended with other ingredients to increase spreadability, reduce calories or cholesterol/saturated fat, etc. A few plain butters were enhanced with "butter flavor" - say what? And on no package could it be determined if the butter came from cows that were naturally fed on pasture or on grain in confined pens.



Well said, Anna.

There's a huge supermarket about 1 mile away from my house similar to the one Anna describes with aisle after aisle of eye-catching cellophane-wrapped foods. I go there about every 3 or 4 months, and then I only go to get something I need in a pinch. Every time I go, I too am reminded just how many products there are that look more like junk food than real food.

But there's no real money in real food. Who gets rich off of selling green peppers, tomatoes, and eggs?

Supermarkets sell these modern industrial foods because people buy it: Look around you. You don't get to be a 250 lb 5 ft 2 inch-woman by eating too many cucumbers.

Like Anna, I drive an additional several miles to Trader Joes', buy at farmers' markets whenever possible, buy some odds and ends like wine and cheese and raw nuts at specialty stores. I grow my own basil in a big pot I keep in the kitchen and we are just about to start turning over the soil in the back yard for our vegetable garden. I don't need nor do I miss having the choice among 40 different chips, 25 brands of ready-made microwavable dinners, an entire aisle of breakfast cereasl (all of which are virtually the same with different names and labels), or 75 varieties of salad dressing.

The supermarket for me--and I hope for many of you--has become a place rarely frequented, and only for the odd forgotten item. Oh, I forgot the dog chewies the grocery does have--my dogs love them. So perhaps they are good for something after all.

Comments (17) -

  • Anonymous

    3/17/2009 1:15:00 PM |

    A nice thought, to demodernize and go back to the days of a different shop and source for every grocery item, but even when trying to live clean, supermarkets can still win out budget-wise during these troubled times.  I'm mostly living off of frozen vegetables and lots of canned salmon etc.  The food *ideal*?  No.  But it's not trash, either.

    Don't throw out the baby with the bath water!

  • Brock Cusick

    3/17/2009 1:56:00 PM |

    The first and most important problem with grocery stores is that they're allowed to take bribes from the food vendors. That means they really work for the food vendors with the greatest degree of vertical integration, organization & bargaining leverage (e.g., Coca-Cola, Kellogs, the Florida Orange Growers Association, etc.) and not for the customers that shop the aisles.  This perverse incentive explains almost everything that's wrong with supermarkets today.

    The second biggest problem is that those same parties I mentioned above have taken control of the political process that governs nutritional disclosure, creating barriers of ignorance between "customers" at the grocery stores and truly useful information.

  • JPB

    3/17/2009 4:07:00 PM |

    Comment to Brock:  Your comment could also apply directly to the medical profession with a little editing!

  • Anonymous

    3/17/2009 5:37:00 PM |

    Anna is lucky to be able to find all these natural, organic, pasture raised produce, but some of us are not lucky enough to afford or find space for large freezers in our tiny apartment sized fridges. It's still winter here so no markets with fresh produce, no free range hens grazing in the snow and below zero temperatures. However, I do frequent the halal and polish meat markets whenever possible. We don't have a trader joe's and the 2 organic markets here may as well post a sign on the door "only millionaires can afford to shop here." Supermarkets are ok if you know what sections to shop in and what to buy. They are also starting to stock organic products like cheese made with raw milk (which is banned in Canada btw).

    Sorry about the rant but not everyone is as fortunate as others.

  • Lola

    3/17/2009 10:00:00 PM |

    Supermarkets will exist as long as there are people who are simply too busy or don't have the energy to get to all those different stores. In the old days when "main street" could still be counted on, you could go to the grocer, butcher, fishmonger, baker etc all within a short distance of each other. Now you often have to drive, bus, walk all over town to get to them.  For most low income people, this is not an option. Working two minimum wage jobs doesn't leave much time or energy except to get in and out of a supermarket as quickly as possible. A disabled person may not even have good access to some of these places. [When my hypothyroidism was at the height of its untreated awfulness, going to more than one store in a day was unthinkable.] Bear in mind also that many low-income people live in areas where the only food stores are a crappy supermarket and fast food outlets and no other places will open because they know nobody can afford it.

    If we *really* want to improve peoples' health, then we need to work on eradicating the causes and effects of poverty. It's no good if we get an organic market to open in the ghetto or rural town if people can't afford to go there or aren't able to get there. Perhaps instead of all the food subsidies going to Big Farming, we could subsidise business owners that wanted to open in low-income areas. But somehow when the government uses money that will help the poor it's Evil Pinko Commie Welfare but when giving the same money to big business it's fine and dandy. That's why I don't think the government (and it doesn't matter whether Democrat or Republican) doesn't actually care about health despite all the bleating about obeeeeeesity.

  • baldsue

    3/17/2009 10:53:00 PM |

    Nope, I didn't slim down from size 14 to size 2 by walking the aisles of my local supermarket.  Instead I rode my bike to the farm down yonder for my fruits and veggies and I hopped into my car to drive to Trader Joes and Whole Foods for the rest of my nutrients.  And that's the way it's going to stay for me.

  • vin

    3/18/2009 10:55:00 AM |

    I buy all my fresh greens, fruits, fish and nuts from my supermarket. Frozen and canned foods are useful in the winter months.

    Rest of the food asiles are simply not interesting.

    Local green grocer's shop has usually little choice and very often unripe food.

    Just look around in the supermarket and you can find almost everything you need to stay healthy.

  • Kipper

    3/18/2009 11:35:00 AM |

    Supermarkets are to some extent what you make of them. I end up at Safeway fairly often due to my schedule, but I couldn't tell you what was in most of the interior aisles or freezer cases.

  • Anne

    3/18/2009 1:08:00 PM |

    There's no fishmongers or butchers which sell organic produce near me, and no greengrocers which sell organic produce either, nor farmer's markets, but I hardly ever set foot in a supermarket ! Instead I shop online in the comfort of my living room from them ! I buy organic meat, fish, fruit and veggies, tea and coffee, and household items, from my supermarket, but because I buy online I don't have to pass shelves and shelves of junk food and get a headache from the bad atmosphere there. The prices are the same whether online or in store and there's no delivery charge because I get my shopping mid week - it's a fantastic deal which saves stress, time and money Smile

    Anne

  • Anonymous

    3/18/2009 2:37:00 PM |

    Good points made in the above comments!

    I would LOVE a Trader Joe's or a farmers market, or even a Whole Foods market in my area... they aren't here in the suburbs where I live... all are 20 miles away in the city, or simply non-existent here.

    It just doesn't make sense to drive that far for my food (utilizing some of the outlets quoted by Dr. Davis in his blog post), and only patronizing some of these type outlets frankly sounds a bit elitist... and quite expensive, too.

    Rather, the commitment to good health requires some resourcefulness... I'm into figuring out what I CAN healthfully eat from Randall's (Safeway), Kroger, H*E*B, and Costco... stores reasonably close.  I'm into planting my own fresh herbs, and a small "victory" garden of vegetables we enjoy... it's fun, challenging, and good exercise, too.

    But I am fortunate... I have a generous food budget, I live in a reasonably populated area, with excellent weather and growing conditions most of the year, and access to fresh produce and quality supermarket foods year round.  Just mostly stay away from the center of the supermarket, be knowledgeable and selective while there, and you will be fine... that's my advice... oh, and if people don't continue to buy junk, the "supers" won't be stocking it for very long.

    madcook

  • Gretchen

    3/18/2009 3:24:00 PM |

    I agree with some others that not everyone can afford to shop at upscale organic markets. Not everyone has access to locally produced farm produce.

    We have to work with what's available, and unfortunately, the people who need the most help nutritionally are the ones who can't afford fresh food.

    We need to educate people about how to find better food at a supermarket.

  • scall0way

    3/18/2009 3:47:00 PM |

    OK, I shop at a supermarket! But I'm mostly a "perimeter shopper" - produce, dairy, meats, etc. But it's convenient because I can buy things like paper goods, detergents, light bulbs, all those other non-food items that supermarkets carry. The place is only a little over a mile from my house. I save on gas and energy. I do love the local farmer's market - but it's only open June-November. I do love Trader Joe's - but there are none nearby. It's a haul to get to one, so I limit my trips. I love Whole Foods, but it's too expensive other than for certain special items.

    But I would not even give my *dogs* food or treats from a supermarket. We get our food and treats from a pet store whose philosophy gibes pretty well with my own. Founded to: "provide our customers with the healthiest foods, best products and highest quality of pet-animals ever assembled in one store...We believe that animals should eat what nature intended them to eat, along with a variety of natural supplements."

    LOL, not only is my own health better these days, but so is the health of my pets. Smile

  • Monica

    3/19/2009 8:44:00 PM |

    Pet snacks from the supermarket?!  Smile

    OK, I have to admit that made my eyebrows go up.  I happened upon healthy eating for myself by first figuring out what was healthy for my pets when the pet food scare happened a few years ago.  I doubt dog chewies contain melamine, and perhaps they aren't a routine in many households, but they're not an evolutionarily appropriate food for dogs.  The only pet snacks I get at the supermarket are the big chunks of raw meat that get thrown to my dog and cats daily... the food they were designed to eat.  (I can almost hear people exclaim how expensive this is but it's way cheaper because the meals themselves are treats because they take 15-30 minutes to eat.)

    90% of the stuff in the grocery store isn't fit for human consumption, that's true.  However, it's still very handy for many things.  You can completely avoid the unhealthy stuff with a little effort.  That's not even remotely possible in the pet aisle in which every single product is a derivative piece of frankenfood.  

    Throw your dog or cat a raw meaty bone and some organ meats now and then.  They will thank you with good health once they have been getting real food long enough.  You will never need a $300 tooth cleaning at the vet, that is for sure.

  • Rob

    3/19/2009 9:30:00 PM |

    From what I have seen of TJ's and Whole Foods, you can do yourself a lot of the same harm in the center of these stores as the local MegaMart.   Stick to the outsides no matter which store you shop in.  Although! I will say that I recognize most of the ingredients in JT's inner aisle food, not so true of the supermarket! And I like the sardines at TJ's.

  • Anna

    3/21/2009 7:48:00 AM |

    Great comments, everyone.  Yes, it's true, we all have different circumstances, different locations and climates, different food budgets, and different ways of coping with our food sourcing options.   The most important thing is to find what works best with the resources/options one has (assuming one knows all the resources).  But so many don't even ever consider looking "outside the box" or think about how to do it without relying on a supermarket.  I am continually amazed at how many terrific resources are out there, not just here in So Cal, but in many communities, practically in people's own backyards, but they don't know about it or take advantage.

    Even the 99 cents store has some good options, if one can avoid the minefields of cheap sugars, starches and processed foods.  That's were I go to shop for  my donations to the local food pantry, where they mainly want non-perishables in unbreakable packaging.  I buy canned and pouched salmon, sardines, and tuna there, because I know so few complete protein foods are donated.  

    I do think it's possible to eat pretty well from a supermarket *if* one is disciplined, truly informed and willing to forgo convenience for real food, but there are so many hazards at the supermarket that many can't easily avoid or don't know to avoid (especially if they are paying attention to mass media nutrition advice).  I'm sure it didn't save me any time to shop there way back when and it certainly wasn't very enjoyable.  I know I spent more money there for food that wasn't as good for us (I was too easily tempted and distracted too often), despite ironically trying very hard to pinch pennies with coupons, sale circulars, buyer's cards, and shopping around.  

    We *are* fortunate with our mild local climate and long growing season, but I know people in Madison, WI and upstate NY who have great produce from their CSAs, too, just in a shorter time frame (though many practice traditional food storage methods, like root cellaring and lacto-fermentation to extend the harvest).  Some CSAs allow for a trade of labor instead of payment, too.  My neighbor and I take turns on pickups for our biweekly CSA boxes, so I only have to make a 14 minute (round trip) drive once a month for most of my produce, a huge timesaver (I do understand there are transport issues for some people and I know I'm fortunate to have a car, but I *could* (but don't very often) ride a bike to get my food at stores or the CSA spot, too - I have two shopping baskets that easily detach from the rear rack).  My CSA pickup point is in the other direction of the stores, but only a tiny bit farther and in a somewhat rural, natural part of town, far more pleasant than the long cashier lines, parking lots,  and stop-& go traffic hazards near the stores.

    I'm probably going to host a new pickup point next quarter at my house, so now our community will then have east, west, *and* a central pickup location, making this CSA even more convenient for more people who want to join (there's a waiting list).  The CSA can to expand from 1500 to 2000 members if they add some new pickup spots.  New CSAs with slightly different membership models have started up in recent years offering even more choices for people, too.

    But is it more expensive?  My CSA's large biweekly box costs $30 (there are two sizes, with weekly or biweekly options and any number of boxes can be canceled in advance before the start of a quarter, with 2 allowed cancelations with notice during the quarter - so it's quite flexible).  Members pay for their boxes in advance for a quarter year (though if I host a weekly pickup spot in the future, I'll get a box for free); I think $15 a week for the generous amount of high quality, just picked produce is *very* competitive with any store of any caliber in my area (except maybe the super low prices at the 99 cent store are less, but even then it would be close in cost; the variety and quality of the 99 cent store produce doesn't even come close).  I know people who spend that much or more on a delivery pizza or takeout for one meal for their family (or dvd rentals for the weekend).  I think I could only do better if I grew it all myself (instead, I put my edible gardening efforts into "special" crops or lazy things like bananas, fig and citrus trees).

    We love eggs and consume a lot each week in many varied dishes.   The eggs I buy via my neighbor's co-worker are $1 cheaper per doz than the eggs I would buy in the store(thankfully my neighbor doesn't mind transporting several doz eggs once a week to me).   Prior to that, I had a "backyard" egg source that was even cheaper (half the store price), *and*  (maybe this is the elitist aspect) they delivered them to a cooler on my front porch because they were already delivering meat, eggs, and goat milk to a local alternative health institute (until the couple split up and ended their "backyard" farm business).  

    One of the few places I do get take-out now and then is the local, family owned (non-franchise) rotisserie chicken place.  I make salad and veggie sides at home, though.  Great chicken using marinade  ingredients I might use at home if I were roasting the chicken;  5 quarters (an extra leg) when you buy a whole chicken for $10 (it's the only thing I buy there, our family of three can eat off it for at least 2 meals, plus soup, and it doesn't have the chemical injections that the cheaper grocery store rotisserie chickens contain).   I watch other families spend $20-30 for a single meal every time I go there.  I often ask for 5 pieces to be legs because I know they always have lots legs (and they have more flavor and moisture), since nearly everyone else requests the "healthy" chicken breast combos.  Sometimes they have extra cooked whole chickens in their cooler for $4 (from earlier in the day or the night before), so I always get one or two extra when available.  And the old guy at the counter is always happy to make up a huge container of wings, backs, and meaty scraps for me, for my chicken broth; it makes really great mineral-rich flavorful broth.   So I have a cheap streak that wants to eke out everything but the cluck Wink.  I know families that throw away more food than my family eats.

    So clearly, I don't think putting a priority on wholesome unconventionally sourced food is necessarily really expensive, nor is it "elitist" at all  - we don't drive fancy cars and make other decisions that allow eating good food easier (both my husband and I grew up in families where money was quite scarce for significant periods of time, but both our mothers were extremely resourceful when it came to nourishing, economical food - so we are *very* mindful of how fortunate we are).  The  "elitism" charge that often comes up in food issue discussions distracts from the real issues.  I'm not suggesting there aren't considerable barriers to eating well for some people, there are, and some are very hard to overcome.  I donate regularly to the local food pantry and am very aware of local "food insecurity" issues, which of course have worsened  lately.  I'm also aware of how difficult it is to get fresh, nutrient dense food into the hands of those most needing it.

    But not everyone is in that sort of position, and some non-supermarket options can sometimes actually work better for people with difficulties sourcing good food, though of course, that will vary to situation to situation.  I'm just suggesting that it can be worth looking for alternatives; there *are* other options "outside the box" in many, if not most places; it sometimes just takes the desire and creativity to find and access them.  And sometimes it requires shifting priorities, which can be hard to do (especially if lacking support from significant others).  Believe me, my husband and I have shifted some of our priorities (financial as well as lifestyle considerations) to accommodate good food (and sitting down to meals together most nights) being high on our list of priorities.  We want to eat well, but that doesn't necessarily mean extravagantly.

  • Dr. William Davis

    3/21/2009 5:55:00 PM |

    Thanks for the well-thought out description of your experience, Anna.

  • Trinkwasser

    3/21/2009 7:50:00 PM |

    A big AMEN!!! from over here. I treat most of the supermarket as a toxic waste dump. Mother likes it because it's cheap and the floor is level. The rest of the town is on a hill and she has difficulty with hills so I get the rest of the stuff from the local shops.

    Mind you, the Organic Shop is something of a toxic waste dump too if you're trying to avoid carbs. And the supermarket is better than many others I've used in the past (Co-Op), they have Fairtrade stuff and the veggies aren't that bad. When I worked full time it was nearly as good as shopping around, you traded quality for convenience to a degree but you need discipline to work one properly.

    Can't beat locally grown meat, fish and veggies for quality though and sometimes they're not that much more expensive and occasionally cheaper, plus the money goes to local businesses rather than to anonymous shareholders: don't forget that supermarkets get their low prices by screwing their suppliers.

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