On mammograms and politics

When I started this blog, I wanted to keep politics out of it. Mostly because talking about politics always leads to arguments, and as much as I can enjoy a good debate, I usually end up feeling stressed out and frustrated. The people who argue about politics feel very strongly about their convictions and typically seek out information that confirms their opinion while dismissing anything that supports the contrary view. It's called confirmation bias. Because of this phenomenon, I know that I will not be able to convince anyone on the opposing side to change their minds any more than they could convince me to change mine. So I usually prefer to not talk about politics unless provoked. But I am so struck by some recent developments in public opinion on a couple of health care issues that I feel the need to break my own rule. I might not sway people on the other side, but maybe I can help push some people who are on the fence closer toward the right side: my side. Okay, just kidding about that.. sort of.

If you haven't heard about the new recommendations about mammography screenings that have been released by a panel of experts to advise the Department of Health and Human Services, you must be living under a rock. In a nutshell: a review of evidence has led the panel to conclude that routine mammography screenings are not necessary for women under 50.

This recommendation has not surprisingly been met with downright furor from the American public, and especially women. Young breast cancer survivors are standing up saying, "A mammogram saved my life" and critics are calling it a step towards "rationed health care." I can understand these points of view.. to a point. Being a believer in evidence-based life (as the title of my blog suggests), I support the new recommendations, and I'll tell you why in a minute.

First, I have a question for those who think the panel is wrong. It occurred to me after reading a letter to the editor in my local newspaper this morning. In it, the writer says "Shame on this panel. We want to save lives no matter what the cost." My question for this writer and others like her is: Do you also support saving the lives of Americans who are currently uninsured, no matter what the cost? Or is it only the lives of people like you (the "us" in the world) that you want to save, while the rest ("them")are left to get sick and die?

At this time in this country, I am hearing two arguments that, to me, seem contradictory. On one hand, it is morally imperative that we perform 19,000 unnecessary mammograms in order to save one woman's life (NY Times) "no matter what the cost"; and on the other hand, health care reform designed to expand access to health insurance is simply too expensive. I would hope that these arguments are coming from two discrete groups of people, but I suspect there is some overlap; some people who are making both arguments at the same time. This doesn't make sense to me. The only explanation I can think of is that some people will justify any expense to save the lives of the people they can relate to: middle-class or wealthy Americans who already have health insurance, but are simply unwilling to pay to save the lives of those who are below them on the socio-economic totem pole: the poor and uninsured. Now that, to me, is morally reprehensible.

I could go on about that, but I have other things to do with my day so I will leave it at that. Now, to explain why I agree with the mammography recommendation:

1. Although there is the rare virulent cancer that is detected by early mammography screening, there are also other, slowly-growing and innocuous cancers that are detected and treated unnecessarily by risky procedures like surgery, chemotherapy, etc.

2. The recommendation only advises against routine screening, not screening in general. So, for women who are at high risk and would receive the most benefit from early screening, that will always be an option. Even if insurers were to use this recommendation to change their reimbursement policies (which they are NOT doing anyway, so relax), it would only mean that a mammogram would have to be prescribed by a physician after assessing an individual patient's risk, similar to the way that blood tests are ordered and covered by insurers now. My insurance company doesn't cover "routine" blood tests (i.e. blood tests for no good reason), but as long as my physician signs off on it because she feels it is necessary for diagnosis, it is all paid for. Women are not being told not to get screened, they are only being told to make the decision with their physicians on an individual basis rather than automatically being screened every year. I don't see what is so horrible about this.

3. If routine screening for women in their 40's is worth the cost because it saves a handful of lives, then why wouldn't we expand the screening to women in their 30's? Or 20's even? There are women who develop breast cancer and die from it in those age groups as well, so if we are unable to accept any level of risk, shouldn't all women who could possibly develop breast cancer be screened? And for that matter, although it is rare, breast cancer can occur in men, so should all men be receiving regular mammograms, too?

This "save every life at any cost" mentality, though understandable, could lead to a slippery slope of more and more unnecessary screenings for more people, and subsequently higher health care costs. Furthermore, it may backfire by leading to excess disease and deaths in other segments of the population. The uniquely American unwillingness to look at disease from a public health perspective rather than an individual perspective is one of the reasons that the United States spends so much more on health care than other countries, without receiving the dividends of better health outcomes. Although it is difficult, sometimes it is necessary to think with our heads rather than our hearts. The cost of excessive procedures will be paid not only in dollars and cents, but in lives as well. It might save the lives of a few, but those savings will ultimately be paid by those for whom the resulting higher costs of health care become prohibitive. If the cost of health care is increased, access will be decreased, which will lead to greater morbidity and mortality for those who don't have it.

And just think about this: there are already women who can't afford to get mammograms at any age and regardless of their risk because they don't have health insurance. Maybe our first concern should be to get them covered. But then the question is, are they worth saving "at any cost"?

Deceptive Advertising: Nutella

There's a new commercial I keep seeing for Nutella that is really pissing me off (View it at Nutella's website here). Now, I have to admit, I love me some Nutella. I might not eat it very often, but it's seriously good stuff. But my affection for the product does not mitigate my disgust with the company's marketing practices.

The commercial, for those of you who can't be bothered to click the link, features a mom talking about all of the reasons why she likes to give her kids Nutella. She says Nutella is "a delicious hazelnut spread I use to get my kids to eat healthy foods. I spread a little on all kinds of healthy things, like multigrain toast. Every jar has wholesome, quality ingredients like hazelnuts, skim milk, and a hint of delicious cocoa. And Nutella has no artificial colors or preservatives." Sounds pretty good, right? Let's look at each of these claims separately shall we?

1. Nutella can get kids to eat healthy foods. Notice, she doesn't say that Nutella IS a healthy food. That's your first clue. If the best thing that can be said about the product is that it helps kids eat OTHER foods that are healthy, chances are the product itself is not.

2. It contains wholesome ingredients. What the hell does that even mean??? Does anyone know? Let me give you a tip: "wholesome" is the word food manufacturers use to describe foods that have no nutritional benefits worth mentioning. The dictionary definition of wholesome is "promoting health," but the professor of my food science class defined it differently. He said "wholesome" refers to foods that contain everything you would expect them to contain and nothing else. In other words, they have not been contaminated by substances you wouldn't want in your food (like chemicals, insects, etc.) "Wholesome" CAN refer to healthy foods such as fruits and vegetables, but it can just as easily be used to describe butter, bacon, and french fries. When you hear this word, just ignore it.

3. Nutella contains hazelnuts, skim milk, and a "touch" of cocoa. Maybe so. They're probably not making this up, but let's look at what else is in it. According to the label, the first ingredient is not hazelnuts, skim milk, or cocoa. It's sugar; 21 grams of it per serving to be exact. Why don't they mention that in the commercial? Oh and there's also some modified palm oil, a saturated fat (i.e. artery-clogging fat). And the skim milk? It's down at the bottom of the list. You can't tell how much skim milk you'd actually get in one serving, but judging by the 4% daily value of calcium each serving contains, you can bet it's not much. An 8 ounce glass of skim milk provides 30% of the daily value for calcium, so if you do the math, that's about 2 tablespoons, or .13 servings of dairy.

4. Nutella has no artificial colors or preservatives. My short answer to this is: so what?! There is no convincing evidence that either of these things has any negative effect on health. But there is plenty of evidence that sugar, saturated fat, and excess calories contribute to all kinds of health problems.

This kind of advertising (and I've seen it done many many times before) makes me think that we really need more regulation of food advertising. If a product has an overall poor nutritional profile and is likely to promote disease rather than health, a company should not be allowed to suggest that it is nutritious. It is deceptive and unethical. These companies are exploiting the public's lack of nutrition knowledge and profiting while their customers suffer the consequences.

Like it or not, calories count

I think by now most people have heard about the theory that calorie restriction leads to a longer life. But in case you haven't, I'll sum it up for you. There have been some animal studies that suggest that eating a low-calorie diet can slow down the aging process, preventing a myriad of diseases and extending the lifespan. Interestingly, it seems that it is calorie restriction specifically and not just leanness or weight control that provides the benefit. Physical activity, while helpful, did not slow down aging the way that calorie restriction did in the animal studies.

An article in the New York Times discusses the concept and a new study that seeks to evaluate the hypothesis in humans. It seems very likely that the results will be positive. Participants interviewed for the Times article have lost weight and have greatly improved their blood pressure and cholesterol levels.

I have to say, I'm not sure why people seem to think this approach is so severe, when the people in this study are eating 1600-2500 calories a day. It's hardly a starvation diet. And if it can help us live a lot longer and healthier, isn't it worth it?

No one made you eat it

An interesting article from Newsweek, "America's War on the Overweight," tries to answer the question, "Why does an overweight country hate people who are overweight?" It is a bit of paradox that in a country where the majority of people are overweight and one in three is obese, there still seems to be a lot of anti-fat sentiment, especially in the media. Much of this sentiment stems from the perception that weight is controllable, and therefore people who are overweight lack self-control and must be lazy and self-indulgent. Although I tend to agree with the first part of this (weight is controllable), I don't think that the latter conclusion follows necessarily from it. But that tirade is for another post...

What is so bizarre about Americans' disdain for the overweight is that so many Americans are in that category. How can we berate others for doing what we ourselves do? The writers of this article hit the nail on the head:

Some of it has to do with the psychological phenomenon known as the fundamental attribution error, a basic belief that whatever problems befall us personally are the result of difficult circumstances, while the same problems in other people are the result of their bad choices. Miss a goal at work? It's because the vendor was unreliable, and because your manager isn't giving you enough support, and because the power outage last week cut into premium sales time. That jerk next to you? He blew his quota because he's a bad planner, and because he spent too much time taking personal calls.

Sadly, very few people recognize this inherent bias in our judgment of others and ourselves. Of course, I think when it comes to weight control, probably the majority of people DO blame themselves and their own choices. I think they are wrong about that, too. They think that if they just had enough will power or if they weren't so lazy, they wouldn't be where they are. Unfortunately for them, it isn't as simple as that and instead of providing motivation, this self-guilt-tripping only promotes more failure.

Those who doubt that other forces outside the individual are at work in creating the obesity epidemic, I ask you this: What has caused the rapid increase in obesity in our country and around the world in just the last few decades?? Have we all just gotten lazier and lost our self-control? That seems unlikely to me. And what would explain the difference in obesity rates between states? For example, Alabama has an obesity rate of 31.4% while Colorado's rate is a "mere" 18.5%. So are people in Alabama less virtuous than people in Colorado? It just doesn't make sense to me. I believe, as I've said before, that we should be pointing the finger at changes in the environment and in culture and lifestyles, rather than at individuals.

My favorite salad dressing

Okay, so I've been slacking on the blog posts. I think it's because all of my posts end up being these long, drawn-out diatribes that require a lot of thought and research to write. It's a little daunting to try to keep that up on a regular basis. So, I think I'll give shorter, less-intense posts a try. For today, I'd like to share with the world (or my 6 readers at least), a recipe for the best low-fat salad dressing I've tasted. It is based loosely on a dressing I tried at a local vegetarian restaurant, Claire's Cornercopia. Unfortunately, I don't really measure things, so it's not so much a recipe as a list of ingredients, which you can adjust to your own taste:

nonfat plain yogurt (Greek or regular)
salt, pepper
lime juice (or lemon juice, alternatively)
fresh or dried herbs - I recommend dill and/or chives

I prefer my dressing to be simple, as above, but feel free to add as many additional flavors as you like.

The best thing about this dressing is that it has only 22.5 calories per 1/4 cup and 0g fat. This is compared to the typical commercial dressing which has 290 calories and 31g of fat!! So you can feel free to drench your salad in this dressing with NO guilt whatsoever.

Creatures of Habit

I am currently reading a phenomenal book: The end of overeating, by David A. Kessler, MD. In it, Kessler talks about the way that many of us have been conditioned to overeat, as a result of food industry practices and marketing and our brain circuitry.

The better half of the book explains the many factors that drive eating behavior and the ways in which certain stimuli (such as food ingredients or cues in the environment) can lead people to eat too much and eat the wrong things, typically over and over again. But toward the end of the book he finally gets to the most important issue: how do we use this information to stop the pattern of overeating?

One thing Kessler discusses is the importance of rules. According to him, if you want to lose weight, you must establish specific rules about how you will behave in situations where your are tempted by food. For example, you could make a rule for yourself that you will not visit fast food restaurants or that you will not eat fried foods. Then, you must practice adhering to this rule. The more times that you drive by the fast food restaurant or turn down the fries, the easier it will get. The conditioned response that you developed to that food will weaken.

I think this approach is somewhat contrary to popular opinion that "everything in moderation" is okay or that depriving yourself of indulgent foods will only make you crave them more. Dr. Kessler and the research he cites as support for his theory suggests that the opposite is true: the less you eat something, the less you give in to your desires, the less you will want them. I have to agree with him. I am still trying to figure out what "the answer" to long-term sustainable weight loss is, but I think this comes pretty close.

My own personal experience is explained well by this notion that abiding by consciously-made rules can essentially de-condition the subconscious mind, and thereby change behavior. About 6 1/2 years ago, I decided to get serious about losing weight (I had about 10 lbs to lose). I made strict rules about what I would eat, and followed them. As time went by, I found that it was easier and easier to resist the foods I used to find irresistable. Now, I have reached the point where I need to GAIN weight and am struggling to do so because eating small, low-calorie, and low-fat meals has become such a deeply entrenched habit. It takes much more mental effort for me to choose to eat an ice cream sundae than it does for me to choose to eat a bowl of broccoli.

I think that if others can adopt this same practice of setting rules and sticking to them, no exceptions, no moderation, they would reach the point where the rules are no longer needed; declining dessert is effortless and eating vegetables is an almost unbreakable habit.

Overeating, not lack of physical activity, blamed for obesity

While most experts agree that diet and physical activity are BOTH important when it comes to the etiology of obesity, there is a definite dichotomy between the diet-pushers and the exercise-pushers. It seems to me that everyone takes a side, believing that one or the other is just a little more significant. I have made no secret of the fact that I am firmly in the diet camp; I think that overeating leads to obesity far more frequently and with more certainty than being sedentary does. My evidence: I rarely exercise with any vigor (a horrible thing, I know), yet my low-calorie and mostly healthful diet keeps my weight consistently low. I also know many individuals who are very active and still can't seem to lose weight.

Now, it appears there is some research to back up my claim. A recent study found that an increase in calorie consumption is more likely the main cause of the increase in obesity rates seen in recent years. I have to admit, I question the researchers' methodology here, but because their results affirm my own bias, I'll look past it.

Regardless of what studies show, it is simply common sense that eating well should be the top priority for anyone trying to lose weight. It's a lot harder to exercise away a few hundred calories than it is to just not eat them in the first place!

Mistakes people make

I'm not sure why I'm thinking about this today, but I felt compelled to explain why one of the most common eating habits that people have is ALL WRONG. I am referring to the tendency to eat tiny little meals for breakfast and lunch and then eat a big, multi-course dinner at 8:00 at night and then go to bed 2 hours later.

When you think about it, it just doesn't make any sense. When you wake up in the morning, you've been fasting for at least 8-10 hours and you're getting ready to start a whole day's worth of activity. Why would you think that what your body needs is just a cup of coffee? Even if you eat breakfast, you're probably eating something like a yogurt, a granola bar, bowl of cereal, bagel, donut, or some other carbolicious 3-bites-and-it's-gone food. For one thing, most of these popular breakfast items are not enough calories. Yup, you read that correctly. NOT ENOUGH. Secondly, they also happen to be high in carbohydrates and/or refined sugar but low in protein, healthy fats, and often fiber. These are the things that give you lasting energy and make you feel full.

For many people, this starvation continues through lunch, where typical choices include salad, soup, sandwiches and other "light" fare. After all, we don't want to blow all of our calories by mid-day do we?

Then 3:00 hits. And the munchies start to set in. The next thing you know, you're grabbing whatever junky snack you can out of the vending machine and wondering how you'll ever stick to a diet when they all make you so hungry!

When dinner rolls around, the only "real" meal most people eat all day, it's a big production: big portions of meat, starch, and sometimes a veggie (like a salad drowned in a few hundred calories' worth of dressing. And of course, you have to save room for dessert. Now having eaten all of those calories, you do the only reasonable thing: go to sleep.

Does this seem backwards to anyone else but me??? Your body needs the most energy in the morning, not in the evening. Accordingly, breakfast should be the biggest meal of the day. Lunch should be moderate in size but still pretty hearty and dinner should bear closer resemblance to a snack than a holiday feast. I realize this is a difficult concept for people to grasp. Most of us have grown up eating this way and it has become part of our culture. But starving all day and binging at night is a recipe for weight gain. And if you try to lose weight while maintaining this habit, you will set yourself up for struggle and failure.

Yippee!! Another good blog for healthy food for kids!

I was so disappointed when the Lunch Nugget blogger stopped posting, as I thought this blog was a great resource for parents. But it has been brought to my attention that there is a new kid in the blogosphere posting healthy meals for babies, toddlers, and kids. It's called Weelicious (it's even got a cute name!). I couldn't agree more with the philosphy of the talented mom who writes this blog. She ssays of her son, Kenya: "Kenya only knows what I feed him. If I gave him McDonalds, he’d love it, but if I give him pesto chicken, that’s what he’ll crave." BINGO! I say this all the time. Unfortunately, I don't have any real-life experience with parenting to back it up, but this woman does!

Foods we eat too much of- Part I

I just read this great article on MSN.com about portion distortion. It names 8 foods that Americans tend to overeat: pizza, salad dressing, ice cream, burgers, white rice, potato chips, soda, and orange juice. I would have to agree that the typical portion sizes for these items are often 2-4 times the recommended "serving sizes," which are as follows:
pizza- 1 small slice
salad dressing- 2 tbs.
ice cream- 1/2 cup
burger- 3 oz.
white rice- 1/2 cup
potato chips- 1 oz. (about a handful)
orange juice and soda- 8 fl oz.

I would add a few more items to this list of foods that people eat way too much of. In fact, after some thought, I would add lots of items to this list! In this first installment, I'll discuss three:

Cheese. A serving size is one ounce, which is the equivalent of one slice or 1/4 cup shredded. However, most foods that contain cheese have at least twice this amount. Cheese is often portrayed as being a good source of protein and calcium, and therefore relatively healthy. I disagree. While small amounts of cheese can be incorporated into a healthy diet, one serving per day is more than enough. Cheese may have some redeeming qualities, but it also contains a lot of saturated fat. Plus, there are better ways to get protein and calcium: low fat yogurt and milk are prime examples.

Bread. A serving of bread is equal to one slice of store-bought pre-sliced bread (think Wonder). So, when MyPyramid recommends 6 servings per day, that doesn't mean 6 6" grinder rolls or 6 Dunkin Donuts-sized bagels. Actually, a Dunkin Donuts bagel would provide 3 servings and about 300 calories. This New York Times article rounds up the caloric content of bagels from various eateries, some of which provide up to 7 bread servings. Other ways people eat too much bread: mindlessly noshing on bread before dinner and devouring sandwiches on oversized hard rolls or foot long grinders. I don't care who you are, no one needs a 12 inch sandwich!

Pasta. Do I even need to explain this one? A food guide pyramid serving is 1/2 cup, about the size of half a baseball. Even the serving size on the box (which provides 220 calories)is only one cup. It would barely fill a typical coffee mug. Does anyone eat that much?? Not even close. And here's a bit of news for you: whole wheat pasta has the same number of calories. It is more healthful, ounce for ounce, but it has the same potential to lead to weight gain if eaten in the quantities that people tend to serve themselves.

More to come in a future post! In case you're wondering, there ARE some foods that we don't eat enough of. Among them, vegetables, fruit,whole grains, and unsaturated fats.

Toss this salad out and enjoy something else!

I'm not sure how, but in the minds of most people, salads have become synonymous with health food. Determined dieters proudly resist the tempting burgers and fries on restaurant menus and order the guilt-free salad instead. They often bring homemade salads to work with them for lunch, or order a salad from the office cafeteria, assured that they are making the best possible choice from a nutritional standpoint.

Sadly, the salad is just as likely to be the dieter's downfall as it is to be her road to success. With the wide array of high-calorie toppings that are likely to adorn otherwise innocent salad greens and the globs of dressing that smother them, it is not surprising that salads can often put even the heartiest of meals to shame when it comes to calorie and fat content.

Of course most people know by now that the chicken caesar salad and taco salad aren't as healthful as once thought. But even the truly healthy-sounding salads can pack a caloric punch. A perfect example of this is a salad featured in the Food section of the New Haven Register today: the Signature Salad at Eli's on Whitney in Hamden, CT.

The menu describes the salad's components: "Mesclun greens, candied walnuts, craisins, gorgonzola cheese and Granny Smith apples with a balsamic vinaigrette." Sounds harmless enough. But an analysis of the recipe outlined in the Register's article reveals that this salad, most likely ordered as an appetizer or part of a larger meal, contains 1130 calories, 99 grams of fat, 21 grams of saturated fat, and 45 grams of sugar. For the record, that's more than half the calories most people need to eat in a whole day and more than 100% of the daily recommendation for saturated fat. This salad also has as much sugar as 15 Starburst candies! It has twice as many calories and more than 2 1/2 times the amount of saturated fat as a Big Mac.

The main culprit here and in most salads is the dressing. The recipe calls for 1/2 cup per serving. HALF A CUP! The serving size for most salad dressings is 2 tablespoons. And most dressings, even the seemingly "light" vinaigrettes, have 70-100calories per tablespoon. But even without the dressing, this salad is still higher in calories than most fast food burgers. This is because Eli's uses large portions of three high-calorie toppings: blue cheese, candied walnuts, and dried cranberries.

My advice to anyone watching their weight: unless you really know what's in it, skip the salad and get something more satisfying instead. It will likely be better for you, too.

New Pepsi line? Throw it back!

So PepsiCo is launching a new line of sodas that are made with sugar instead of high fructose corn syrup (HFCS). Should we celebrate the company's newfound health consciousness? Hardly! The new sodas are still full of empty calories from sugar. Sugar is not health food, natural or not. Lard is natural, too, but I don't see people extolling its virtues and buying it in bulk.


People have gotten the idea that HFCS is worse than sugar, because it is allegedly metabolized differently by the body and leads to weight gain. HFCS has been partially blamed for the obesity epidemic, and rightly so, but it is not because it is inherently different from sugar, but because of the way it changed the food supply when it came on the market. HFCS is much less expensive than sugar. When HFCS became available, it enabled food manufacturers to sell sugary foods and drinks at much lower prices than they used to. This likely led people to start consuming a lot more calories from HFCS-sweetened products. As nutrition expert Dr. David Katz has explained, its cost-effectiveness also led to its widespread use in processed foods, even those that are not supposed to be sweet. The result is that we end up consuming more sugar overall. So, HFCS may have played a role in the rising prevalence of obesity and diabetes in the U.S., but sugar could have had the same effect if it were used in the same way ("Sweet and Corny").


There is no empirical evidence that HFCS is any worse than sugar or that it has any different effects on appetite, weight, or other metabolic factors. The abstract from a review of studies on HFCS published in the American Journal of Clinical Nutrition had this to say:


"High-fructose corn syrup (HFCS) has been implicated in excess weight gain through mechanisms seen in some acute feeding studies and by virtue of its abundance in the food supply during years of increasing obesity. Compared with pure glucose, fructose is thought to be associated with insufficient secretion of insulin and leptin and suppression of ghrelin. However, when HFCS is compared with sucrose, the more commonly consumed sweetener, such differences are not apparent, and appetite and energy intake do not differ in the short-term. Longer-term studies on connections between HFCS, potential mechanisms, and body weight have not been conducted. The main objective of this review was to examine collective data on associations between consumption of HFCS and energy balance, with particular focus on energy intake and its regulation" (Melanson et al., 2008).


Bottom line: Stick to diet soda or no soda at all! What? Afraid of artificial sweeteners? See the post below.

My take on artificial sweeteners

Among the many misconceptions that people seem to have about nutrition and food safety is the notion that artificial sweeteners are essentially poison and must be avoided in order to be healthy. This one really gets my goat because despite the fact that it is not backed up by any credible science, a large proportion of the population readily believes it. This behavior strikes me as incredibly hypocritical, given how arbitrarily Americans seem to decide which products they are going to be wary of and demand the highest level of proof of safety and
which they will accept and use regardless of the
harm they are likely to cause.

For example, we have an abundance of evidence about the dangers of the typical American diet: one that is high in calories, saturated fat, sodium, and refined carbohydrates and low in fiber. Yet, this is not enough to convince anyone to abandon their typical American eating habits, save for the first week of January. On the other hand, a few unsubstantiated rumors about artificial sweeteners show up on some conspiracy-theory websites and everyone immediately swears them off!

All of the artificial sweeteners currently on the market have been approved by the FDA. Obtaining this approval is a long and rigorous process, entailing the meticulous conduct of numerous safety studies. But this is apparently not enough to convince the American public, who believes that the research demanded by the FDA is not sufficient. On the other hand, diet pills, vitamin and mineral supplements, and herbs, including the natural sweetener Stevia, are happily embraced despite the fact that they have not received FDA approval and are largely unregulated. (A product containing Stevia has recently received FDA approval, but it has been used by many for decades prior to this).

Another thing I think many people don't realize is that artificial sweeteners have been approved for use by adults, children, and pregnant women. If you use artificial sweeteners normally, there is no need to stop using them when you become pregnant or to prohibit your children from having any foods or drinks containing them. There is simply no scientific reason to ban them from your diet ever.

Even the Center for Science in the Public Interest, a well-known "whistle-blowing" organization often referred to as the "nutrition police" because of their rigid approach to consumer safety standards, has given sucralose (Splenda) its seal of approval, describing it as "safe." CSPI is not so kind to other sweeteners, but it does call aspartame and acesulfame potassium, two of the most commonly used sweeteners, "probably safe." Read their assessment of all sweeteners here.

Some studies have suggested that drinking diet beverages may actually lead to weight gain. I believe this to be a gross misinterpretation of research findings. The studies that have found an association between overweight and diet drink consumption were cross-sectional, non-experimental designs. In other words, they just looked at one group of people and compared those who drink diet beverages to those who don't. One can never determine causation with this type of study design. There are too many other factors at work. Researchers have theorized that artificial sweeteners may increase one's desire for sweets, leading to excess consumption of sugar later. It has also been postulated that the perception of sweetness actually triggers a hormonal response similar to what would occur if actual sugar were consumed.

I have read a number of experimental studies on artificial sweeteners (the ones that never make it to mainstream media because their results are not controversial enough), and these have found no difference in weight or in hormonal response (e.g. glucose and insulin levels, among others) when people were given a sugar-sweetened beverage compared to an artificially-sweetened beverage. Therefore, I have different theories about why people who drink diet beverages seem to be more likely to be overweight:

1. People who are overweight are simply more likely to drink diet beverages. Think about it, if you've never been overweight, it might not occur to you to buy diet anything. Whereas, if you are overweight, switching from regular to diet soda might be the first thing you do.

2. When people drink diet beverages, they feel free to eat more food. Be honest, how many times have you justified eating a larger portion of something or indulging in something high in calories because you a.) had a light lunch, b.) skipped breakfast, c.) ate really healthy yesterday, etc. ? When you eliminate calories you might otherwise be drinking, it's easy to think you can "afford" calories from something else (like that extra scoop of ice cream or the larger sized order of fries).

The easy way to avoid gaining weight when using artificial sweeteners is to make sure that your total calorie intake is within the range it should be for weight loss. If you write down what you eat and don't exceed your daily allotment, you will not have trouble losing weight even if you drink a gallon of diet soda daily. If any doubt remains in your mind, I use anywhere from 25-40 packets of Splenda a day (no, I'm not exaggerating) and I drink at least one 12-oz. can of diet soda, and I am underweight. If artificial sweeteners truly caused weight gain, this would not be possible.

The bottom line is that artificial sweeteners are probably going to do much less damage, if any, to your health than regular sugar would, especially if you are prone to drinking a lot of sweetened beverages or eating a lot of desserts.