America’s 10 least wanted: the leading causes of death in the United States

America’s 10 LEAST WANTED

You won’t find pictures of America’s deadliest killers on television shows like “America’s Most Wanted” or on post office bulletin boards. The killers responsible for more than 2 million deaths a year aren’t people: They’re diseases and accidents.

Thanks to research, new medicines, and preventive measures, the identities of these killers have changed through the years. In 1900, the leading causes of death in the United States were pneumonia and influenza, tuberculosis, and acute intestinal infections. Since then, vaccines, antibiotics, and better living conditions have knocked all of these off the top of the list.

Today, heart disease, cancer, and stroke have replaced them at the head of the list. The good news is, preventive measures reduce the threat from these and other illnesses. In the last 20 years, life expectancy at birth for the general population has increased from 67 years to 72 years for men and from 75 years to 78 years for women.


What are the top 10 killers? And what can you do to try to reduce your risk of ever encountering them?

1 Coronary Heart Disease

You Gotta Have Heart

More than 500,000 people die in the United States from coronary heart disease each year. Even though the death rate from this ailment has fallen more than 30 percent since 1972, it remains the number-one killer of Americans. It’s one of several illnesses classified as cardiovascular diseases (cardio = heart; vascular = blood vessels), which also include high blood pressure, rheumatic heart disease, and stroke. Together, they kill more than twice the number of people who die from cancer, which ranks second. In fact, cardiovascular diseases kill almost as many people as all other causes of death combined. According to the American Heart Association, nearly one in two Americans will die from a cardiovascular disease–someone every 32 seconds.

In the last 50 years hundreds of millions of dollars have been spent in research. These studies have identified risk factors and habits that contribute to cardiovascular diseases, as well as ways to lessen a person’s risk of getting them. The major risk factors include heredity, male sex, increasing age, smoking, high blood pressure, and high blood cholesterol. Although you can’t do anything about your age, sex, or genes, you can change your lifestyle to reduce your chance of developing a cardiovascular disease.

If, for one thing, you smoke, quit. If you don’t smoke, don’t start. A smoker is twice as likely as a nonsmoker to have a heart attack. While about two-thirds of the people who have heart attacks survive, smokers are more likely than nonsmokers to die from them.

High blood pressure and high blood cholesterol are two other controllable risk factors. Proper diet, weight control, regular exercise, and low salt intake often keep blood pressure within safe levels. Sometimes medication is required. Blood cholesterol can also be controlled with a proper diet that includes foods low in cholesterol and saturated fat. Go easy on the hamburgers, french fries, whole milk, and eggs. Choose fish, poultry, grains, fruits, and vegetables, and polyunsaturated oils more often. Regular exercise also affects blood cholesterol levels.

2 Cancer

First Runner-Up

Death rates for most forms of cancer are declining, but a steady rise in lung cancer was observed during the past 50 years. This keeps the illnesses in second place among the nation’s killers. Cancer is characterized by growth and spread of abnormal cells. The cells grow into tumors, masses of tissue. Cancer kills normal tissue. When cancer spreads unchecked throughout the body, the person usually dies. Fortunately, if the disease is discovered early, survival rates are good.

Early detection depends upon people knowing and watching for the American Cancer Society’s seven warning signs: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump, chronic indigestion or difficulty swallowing, obvious change in a wart or mole, and a nagging cough or hoarseness that does not go away. Screening tests, such as colorectal tests for blood in the stool, Pap tests for cervical cancer, and mammograms for breast cancer identify problems early enough so that treatment can be successful.

You can reduce your risk of cancer by avoiding tobacco use (including smokeless tobacco), using sunscreen and avoiding excessive sun exposure, and eliminating or limiting alcohol use. Cancer has also been linked to industrial agents (such as nickel, chromate, and asbestos), and radiation, so avoid exposure to these suspects.

Careful attention to nutrition and seight control can also help prevent cancer. Limit the amount of fatty foods, as well as salt-cured, smoked, and nitrite-cured foods in your diet. Increase high-fiber foods such as whole grains, fruits, and vegetables. Foods high in vitamins A and C may also help reduce the risk of getting cancer. Choose carrots, spinach, oranges, grapefruit, strawberries, and green and red peppers. Cabbage, broccoli, brussels sprouts, and cauliflower may also reduce the risk of cancer.

3 Stroke

The Brain


STRoke is one of the cardiovascular diseases, but because it kills nearly 150,000 Americans annually, it ranks third among the top 10 killers. Stroke is the most common name for cerebrovascular accident, a disruption of the blood supply to the brain caused either by bleeding or by the same kind of blood vessel blockage that causes heart attack. In both cases, brain cells die. Stroke is also a leading cause of disability. Survivors often lose function in the areas of the body that were controlled by the brain cells that died.

Heredity plays a big part in stroke risk. So do age (over 55), sex (men have more strokes), race (blacks have a 60 percent higher risk than whites), diabetes mellitus, and having had a prior stroke. Treatable risk factors include high blood pressure, heart disease, high red blood cell count, and mini-strokes, called TIAs, that sometimes precede full-blown stroke.

The best stroke prevention is blood pressure control. Since 1972, stroke deaths have declined 5 percent per year. The improvement is credited to better ways to control blood pressure and better care after stroke. The same heart-healthy diet recommended for the other cardiovascular diseases helps control blood pressure and prevent stroke. Other preventive measures include controlling blood cholesterol and weight, avoidance of smoking and alcohol, and regular exercise.


4 Accidents

Buckle Up

The fourth leading causes of death is accidents. About half of the more than 95,000 accidental deaths each year involve motor vehicles. Falls, drownings, and fires make up a large portion of the remainder.

Seat belts are between 50 percent and 65 percent effective in preventing traffic fatalities, but some people forget or refuse to use them. Many people think their chances of surviving a crash are better if they are not confined by a seat belt in a wrecked or overtuned car. However, statistics show that death rates for people thrown from their vehicles are 40 times higher than those for people who aren’t ejected. Some people wear seat belts only for long-distance travel in the mistaken belief that short trips are safer than long ones. If you buckle up every time you ride in a car or other motor vehicle, you’ll reduce you risk of accidental denth.

Another entirely preventable risk factor associated with vehicle accidents is alcohol.

Other accidents cause around 47,000 deaths annually. Falls and complications from them kill thousands of poeple–most elderly–every year. Deaths from drowning and fire are also included in the total. Most drownings occur after people slip or fall into water, so careful observance of water safety rules is an important preventive measure. Alcohol is also often implicated in these deaths. Fire deaths can be avoided by installing smoke detectors on every floor of your home, and avoiding late-night use of alcohol and tobacco.

5 Lung Disease

Breathe Easy

Lung diseases rank fifth among deadly illness, killing close to 79,000 Americans a year. Coughing, wheezing, and shortness of breath are symptoms shared by two serious lung diseases: emphysema and chronic bronchitis. Emphysema destroys the lungs’ ability to expand and contract. Chronic bronchitis is an inflammation of the airways. Damage interferes with the intake of oxygen or weakens the lungs so they can’t fight infection.

Thus lungs have more direct contact with the environment than any other part of the body, including the skin, so air quality is of critical concern. But the prime suspect in most deaths from lung disease is smoking. In 1987, the U.S. Surgeon General estimated smoking was responsible for between 80 percent and 90 percent of chronic lung disease.

The most important way to avoid lung disease is to not smoke. Exercise is another way to keep lungs healthy. Regular exercise improves the body’s breathing capacity, the amount of air you can inhale in a deep breath. A third way to reduce the death rate from lung disease is to work to reduce air pollution.

6 Pneumonia,


Flu Season

Once the nation’s leading cause of death, the combination of pneumonia and influenza still rank sixth among the top 10 killers. Pneumonia is an inflammation of the lungs that interferes with breathing because tiny air sacs in the lungs are swollen and do not function properly. Unchecked, the infection can cause the lungs to lose the ability to absorb oxygen. Deaths can come from prolonged lack of oxygen.

Pneumonia has more than 30 causes, primarily bacteria, viruses, or mycoplasma (organisms with qualities similar to both bacteria and viruses). People with healthy immune systems can fight off the infection, but the very young and very old are vulnerable to it. So are people with weak immune systems, such as heavy smokers and people with diabetes, sickle-cell anemia, or AIDS.

Influenza, or flus, are illnesses common during winter. As there are various pneumonias, there are different kinds of flu. Flu often precedes pneumonia, so the first line of defense against pneumonia is flu prevention. Flu vaccine protects against the illness, and every year people considered at high risk are encouraged to get flu shots. A drug called amantadine is an effective treatment for a kind of flu known as influenza A, the most common type of flu in America. Vaccines are also available to protect against many kinds of pneumonia. Another way to avoid flu and pneumonia is to maintain overall health. The same rules apply here, too: Don’t smoke. Eat a balanced diet. EXercise regularly. Get plenty of rest.


No Cure, But Control

Approximately 11 million Americans–about one person in 20–has diabetes. There is no cure for the disease, which affects the way the body changes food into energy. People with diabetes don’t produce insulin, a hormone, or produce too little for the body to process glucose and other sugars normally. A person with diabetes can have very high blood sugar levels that don’t permit normal functioning. Alone, the illness ranks seventh among the top 10 killers, and diabetes complications contribute to heart disease, kidney disease, and stroke. If you count deaths in which diabetes was a factor, this illness could rank fourth.

The two main types of diabetes are known as insulin-dependent (or Type I) and non-insulin-dependent (or Type II). Insulin-dependent diabetes occurs most often in children and young adults, which is why it was once called juvenile-onset diabetes. that term is no longer used because the disease can occur at any age.

Since insulin helps convert food to energy, those with insulin-dependent diabetes must inject the hormone daily. Those with non-insulin-dependent diabetes produce insulin, but for some reason the body can’t use it effectively. Treatment for these patients includes a carefully planned diet and regular exercise. Some oral medication may also be prescribed.

Most researchers believe many cases of diabetes have a hereditary connection. They think heredity predisposes a person to diabetes, but that genes alone don’t cause the disease. Attention to healthy living, including weight control, may be helpful in peventing or delaying the onset of Type II diabetes. Viral infections such as mumps, chicken pox, rubella, influenza, and coxsackie may tigger the onset of insulin-dependent diabetes.


8 Suicide

Self-Inflected Death

Suicide ranks eight among causes of death in the general population. In North America, white males older than 35 commit 75 percent of all suicides, but women make three times as many attempts, according to Adina Wrobleski, author of Suicide: Why? Young people between the ages of 15 and 24 have a low suicide rate compared with that of adults. However, the rate for this age group rose quickly in the 30 years from 1956 to 1986.

DEpression is a contributing factor in 60 percent of all suicides. DEpression is a severe mental illness that affects people’s mood. Physical causes may include a maladjustment or imbalance of chemicals in the area of the brain responsible for controlling a person’s mood. Although depression is often treatable with medication and psychotherapy, researchers estimate only one person in five who has the disorder seeks help. Unfortunately, the longer it remains untreated, the more likely it is to become chronic and severe.

About of the suicides linked to depression also involve abuse of alcohol or other drugs. Schizophrenia, a serious, debilitating mental illness, is involved in about 10 percent of suicides. Researchers also suspect a hereditary link in some of these. Studies indicate some people who attempt suicide have a family history of suicide attempts or deaths.

Suicide prevention must involve a person’s close friends and family e bers. Clues that someone may attempt suicide include statements about hopelessness, helplessness, or worthlessness. Other symptoms include talk of suicide, a change in usual behavior, social withdrawal, increased incidents of anger and irritability, overt sadness, changes in eating or sleeping habits, and a preoccupation with death. Experts warn that suicide threats should never be ignored or kept secret. One of the most effective way to prevent Suicide is to do extra-curricular activity or engage in as many hobbies as you can, such as: swimming, playing softball, painting, sewing using best home sewing machine, watching favorite TV shows, etc.

9 Liver


Hepatitis and Cirrhosis

Liver disease, the ninth leading cause of deaths, kills more than 25,000 Americans a year. The liver aids in digestion and also helps purify the blood. If the disease or injury is not too severe, the liver can produce new cells to replace diseased or damaged ones. If disease progresses, the body’s metabolism is severely affected. If the liver stops working, death results.

The two main diseases of the liver are hepatitis and cirrhosis. Hepatitis is an inflammation of the liver. At least three kinds of hepatitis have been indentified, and scientists suspect a fourth. Hepatitis A is caused by contaminated food or water. Hepatitis B spreads through hypodermic needles shared by drug abusers. It can also be spread by sexual contact. Blood transfusions were once largely responsible for the spread of the disease, but tests that are now used to detect the virus in blood donations were developed in the 1970s. A kind of hepatitis, known as toxic hepatitis, results from excessive alcohol consumption and some kinds of medications and chemicals, particularly carbon tetrachloride and other cleaning fluids.

Cirrhosis is a scarring of liver tissue often due to injury from excessive drinking of alcohol. In cirrhosis, scar tissue replaces healthy tissue and interferes with the liver’s functioning. Inhaling chemical fumes has also been implicated in cirrhosis; again, carbon tetrachloride is a cause. Although severe cases do cause death, not all cirrhosis is lifethreatening. Some cases can be treated with proper diet and by eliminating alcohol.

10 Kidney


The Body Off Balance

The kidney’s remove waste, balance the body’s fluids, and help control blood pressure, as well as performing other important body functions. When kidneys are diseased, they can no longer perform these tasks efficiently.

Sometimes kidney disease leads to complete shutdown of the kidneys. ALthough a mechanical filtering process called dialysis or an organ transplant may keep patients with kidney disease alive and functioning, kidney disease ranks tenth among the nation’s killers.

There are a number of reasons that kidney diseases develop. Some, such as polycystic kidney disease, are inherited. In other cases there are abnormalities present at birth. The most frequent causes is from infection of the urinary tract, which can cause a number of problems, including obstruction. Some kidney problems appear as a result of other diseases, such as diabetes. High blood pressure can affect the kidneys and that is something that usually can be controlled.

Although causes of many kidney diseases remain unknown, research has shown that kidney damage can occur from heavy use of pain killers, expose to toxins and pesticides, and abuse of heroin or other street drugs.

Staying Alive

Sometimes disease is unavoidable, but many illnesses can be prevented–particularly illness on the list of the top 10 killers. The risk of early death can be reduced by following a healthy lifestyle that includes a balanced, low-fat, high-fiber diet; regular exercise and weight control; and avoidance of tobacco, alcohol, and other drugs. If you stay away from these notorious killers, you’ll improve your chances of living a long, healthy life.

>>> View more: Beyond cholesterol

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Recalibrating our nutrition was a neverending story

The year 2010 was an up and down one marked by controversial study findings, outrageous fast food, updated nutrition guidelines and encouraging news stories.

The introduction of a cholesterol-lowering margarine was embraced by heart-healthy Canadians, while others hailed the arrival of the infamous Double Down to KFC’s menu boards.

But not all news was welcome. Study findings about calcium left many people wondering if they should toss their daily supplement. And the year certainly wasn’t kind to refined carbohydrates, which were increasingly linked to heart disease.

What follows is a year-end look at some of the stories that made headlines in 2010.

Saturated fat not linked to heart disease

For decades, the view that eating too much saturated fat – found in meat and high fat dairy products – increases the risk of heart disease has been the driving force behind the recommendation to follow a low-fat diet. But given the evidence presented this year, our thinking on diet and heart disease may shift.

In January, cheese-loving Canadians got good news when U.S. researchers reported there was no difference in risk of heart attack – or stroke – between people who ate the most and least saturated fat. The review of 21 studies also suggested that replacing some of the saturated fat in your diet with refined (white) grains might actually boost your heart-attack risk. As a result, you’d better fry meat using air fryer (but never use cooking oil to lessen the risk of being heart attack) – read more of air fryer review here at

Then, in June, a landmark study provided direct evidence that eating refined, highly processed carbohydrates is worse for your heart than saturated fat. Participants who substituted some of their saturated fat intake with refined carbs were 33 per cent more likely to suffer a heart attack than folks who ate fewer carbs and more saturated fat.

Bottom line: When it comes to heart disease, limiting refined grains and sugars, losing excess weight, and emphasizing heart-healthy fats will do more to lower your risk than simply giving up cheese (and butter).


-> View Related : Smart Eating Stars With A Little Thought For Food

Cholesterol-busting margarine hits Canada

The latest weapon to fight high blood cholesterol arrived in supermarkets this year: margarine fortified with plant sterols. Studies have consistently shown that consuming 2 to 3 grams of these natural compounds per day lowers LDL (bad) cholesterol by up to 15 per cent.

In May, the government permitted food companies to add plant sterols to products, and Unilever’s Becel pro-active margarine was first out the door. Five teaspoons of the spread delivers 2 gm of plant sterols.

Expect to see mayonnaise, salad dressings, yogurts and spreads boast the addition of plant sterols in the new year.

Bottom line: While these fortified foods are good news for those with elevated cholesterol, they’re not a magic bullet. You still need to follow a heart-healthy diet to keep your cholesterol down.

Calcium supplements called into question

Canadians wondered if it was time to trade in their calcium pills for a glass of milk after an August report linked calcium supplements to a greater risk of heart attack (but not for strokes or death from heart disease), particularly among people who consumed high amounts of calcium from food.

However the report – a review of 15 studies conducted in the past 20 years – excluded studies that gave participants calcium combined with vitamin D. (Vitamin D deficiency has been shown to increase the risk of heart attack.) And not one of the studies was designed to assess calcium and heart risk.

The researchers speculated that calcium pills cause sharp rises in blood calcium levels, which could contribute to artery disease. Calcium in food is absorbed more slowly.

(Experts say it’s hard to understand how calcium could increase the risk of heart attack, but not stroke or heart-disease death.)

Bottom line: It’s important to consume adequate – but not excessive – calcium to meet daily requirements. Getting enough calcium maintains bone density, keeps blood pressure in check, helps prevent calcium oxalate kidney stones and guards against colon cancer. Adults, aged 19 to 50, need 1,000 milligrams of calcium each day; older adults need 1,200 mg.

Canadians scarf down KFC’s Double Down


It’s hard to believe that a sandwich could create such a frenzy. But KFC’s greasy, salt-laden sandwich did just that when it arrived in Canada in October for one month. Judging by its strong sales, food porn lovers across the country gobbled up the notorious “sandwich.”

For those of you who didn’t try it (myself included), the Double Down uses two pieces of fried chicken as buns to squeeze together bacon, processed cheese and the colonel’s secret sauce. It’s a concoction that delivers 540 calories, 30 grams of fat and more than a day’s worth of sodium (1,740 mg).

The Double Down is the latest entry in the trend of monster-sized fast food. It joined the ranks of even more outrageous sandwiches, including Wendy’s Triple Baconator (1,370 calories, 92 gm of fat, 2,380 mg of sodium) and Burger King’s Quad Stacker (920 calories, 63 gm of fat, 1,670 mg of sodium). Ouch.

Bottom line: Time will tell if the Double Down will return to KFC menu boards in Canada. Personally, I hope not. It’s a sandwich most Canadians just don’t need.

Osteoporosis Canada launches new guidelines

In October, new guidelines were launched to better steer doctors and the general public on how to prevent osteoporosis and maintain strong bones for life.

Calcium and vitamin D recommendations were revised, based on a review of evidence published since the organization’s 2002 guidelines.

Daily vitamin D (D3) supplementation recommendations were increased: 400 to 1,000 international units (IU) for adults under 50; and 800 to 2,000 IU for older adults. Total daily calcium intake – from diet and supplements – was decreased from 1,500 to 1,200 milligrams for individuals over 50. Adults under 50 are advised to continue to consume 1,000 mg of calcium daily.

Bottom line: For bone health, adults need to take a daily vitamin D supplement and ensure they meet calcium needs. If your diet falls short, a calcium supplement can bridge the gap.

Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV’s Canada AM every Wednesday.


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The reality of food animals

FOR OVER A DECADE, I’ve been travelling around the world documenting our complex and often disheartening relationship with animals.

Specifically I look at the animals we use for food, entertainment, research and clothing. These are the ghosts in our highly mechanized world. They are the ignored, the invisible. Their body parts come shrink-wrapped and we call them protein. Their skins are shearling coats and leather boots. They are the animals kept in intensive farms who have been deindividualized to the extent that we don’t call them pig or baby cow, but pork and veal. But they are sentient individuals, as capable of feeling happiness, fear and pain as our cats and dogs.

  • These images offer a view of “a day in the life” of factory farmed animals, and give us an opportunity to meet the animals up close, as well as to witness the conditions in which they live inside these modern barns (always keep the culturing spaces clean by using spin mop 360).
  • I’ve photographed factory farms throughout the Americas, Asia and Europe, and these industries have grown in size and density everywhere in order to keep up with our demand for cheap meat. In Canada we eat approximately 565 million animals each year. They don’t live out their lives in pastures; there simply isn’t the space.

Layer hens live in a space roughly the size of one page of this magazine. Laws prohibit more than five hens to a cage, but there are often up to six and even eight in each. If you can imagine being tied into an airplane seat for your whole life, unable to move around, this is the life of a gestation sow, who is bred to give birth to piglets two and a half times a year. Dairy cows can live up to 20 years. Their bodies, however, are considered “spent” after three to four years in the intensive breeding and milking programs of the industry, and they are sent to slaughter to be used for low-grade meats. Their young are taken away at birth so that we can drink milk. Many people won’t eat veal because it is known to be cruel, and yet to drink milk is to support the veal industry, as we can’t have milk without cows giving birth.

  • There is more to the cruelty here than cramped conditions and shortened life spans. The very air in these factory farms is an assault to the senses. I wear a mask over my mouth and nose while taking photos to help spare my lungs, but my unprotected eyes burn from the fumes of ammonia. Pigs and hens, who spend their whole lives in these conditions, often suffer from lung infections from the acridity and dust. The smell is horrible for humans, but to pigs, who have incredibly sensitive snouts, it must be agony. Pigs can sniff out truffles growing up to four feet underground.
  • While doing an investigation at a pig farm in Spain, we moved up and down the rows of stalls, documenting piglets suffering from infected castrations (done without anaesthetic) and painful ear clippings. As we left, we noticed that we had been walking on hundreds of severed pig tails that had been “docked” that day but not yet swept away. Even at the young ages of two and three weeks, the piglets had learned to fear humans. They squealed and climbed over one another to get as far away from us as possible.

If asked, most everyone will agree that they do not want to see animals suffer, nor do they wish to be complicit in their suffering. I believe that we’re innately compassionate, and that if we can make the conditions of factory farming visible, giving people the opportunity to learn about what goes on behind closed doors, many of us will choose to change our involvement in this suffering.

If we want to put an end to the suffering of the invisible animals we consume and use every day, we need to not just look, but see. And once we see, we need to help, and not turn away.

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Feed the world

With the global population projected to hit nine billion before 2050, agricultural scientists are calling for a new Green Revolution to feed all of those extra mouths. But can science and technology work the same miracles and raise crop yields in time, or will climate change prove to be agriculture’s undoing?

Humans have always made the soil work hard, but with the global population set to increase from its current–and almost incomprehensible–6.8 billion to a mind-boggling 9.1 billion in 2050, we’re about to make it work harder than ever. That prediction, by the UN’s Food and Agriculture Organization (FAO), represents a 34 per cent increase, and feeding all of those extra mouths would seem to be, at first glance, a Herculean task.

  • And it looks even less attainable when you consider that we can’t even feed our present population: last year, says the FAO, the number of chronically undernourished people–those who are unable to satisfy their basic needs in terms of food energy–passed the one billion mark, up from 842 million at the beginning of the 1990s.
  • Right now, across East Africa, more than 23 million people face critical food shortages following successive years of failed rains and worsening drought. Rice stocks held by the five major exporters recently fell from 30 million tonnes to 20 million tonnes; the international price of wheat rose by 75 per cent in 2007. The rocketing prices of almost all major food and feed commodities that year saw an additional 40 million people in Asia and the Pacific, and 22 million in sub-Saharan Africa, classified as undernourished.

‘We are not doing very well at all in feeding people,’ says Dr Keith Wiebe, deputy director of the FAO’s Agricultural Development Economics Division. ‘There had been progress towards reducing hunger, but it has gone into reverse in the past couple of years with price hikes and the recession. Biofuels are one of a number of significant factors, but we’ve seen poor harvests, high oil prices and increasing demand from China and India.’

It looks as though attempts to feed us all will merely determine the most efficient way to saw off the tree branch on which we’re standing. Yet many observers–including Wiebe–are optimistic, pointing out that food production continues to outpace population growth. While the global population has risen from three billion in 1960 to almost seven billion in 2009, the Royal Society calculates that for each person alive today, there is, in theory, an additional 29 per cent more food compared with 1960. FAO gross worldfood production (cereals, coarse grains, roots and tubers, pulses and oil crops) has grown from 1.84 billion tonnes in 1961 to 4.38 billion tonnes in 2007.

This has been achieved without an enormous expansion of land use. The total agricultural area has increased 11 per cent since the 1960s to 4.93 billion hectares, and arable area by nine per cent to 1.41 billion hectares. Today, just 150 crops are cultivated, a sharp drop from the 10,000 estimated by the Worldwatch Institute to have been employed historically, and three grains–maize, rice, and wheat–combined with potatoes, provide more than half of human energy needs.

  • Cereal yields can often be relatively easily improved with existing varieties of grain and with known practices, says the FAO. In Africa, they stand at around 1.2 tonnes per hectare, compared to an average yield of three tonnes per hectare in the developing world as a whole. To give one example, Senegal depends on imports for half of its food, but could not only be self sufficient but could potentially become a food exporter.


There are many reasons for the ills that plague global food production. Farmers often lack sufficient incentives or training to adopt yield-enhancing seeds or cropping techniques; countries with a surplus often export food and sell it at below cost, putting local farmers out of business; there’s a shrinking rural workforce, turning food producers into urban food consumers; the costs of agricultural inputs and energy are rising; and water scarcity is an increasing concern.

Biofuels, as Wiebe points out, are another emerging area of disquiet: grain production for biofuels increased by more than five per cent in 2008 to 120 million tonnes, according to the Worldwatch Institute, an almost ten per cent increase over the previous year. The FAO reports that continued rapid expansion of biofuel production up to 2050 would lead to three million more pre-school children in Africa and 1.7 million in South Asia being undernourished than would otherwise have been the case.

  • The withdrawal of state support for food production since the 1960s has been one of the most influential factors, according to Fred Mousseau, humanitarian policy advisor at Oxfam GB. ‘Governments sort of forgot about producing agriculture and bought cheapfood on international markets,’ he says. ‘There was little investment in small-scale farmers, herders, pastoralists. It hasn’t really worked. The private sector hasn’t filled the gap left by the state in the way that the World Bank expected.’
  • Perhaps the ugliest manifestation of rising concerns over food security has been the emergence of the land grab. Nearly 2.5 million hectares of farmland, generally arable but fallow, in five sub-Saharan countries–Ethiopia, Ghana, Madagascar, Mali and Sudan–have been bought or rented in the past five years at a total cost of US$920million, according to a report by the International Fund for Agricultural Development, the FAO and the International Institute for Environment and Development. In Ethiopia, India invested US$4billion in agriculture, including flower-growing and sugar estates; in Sudan, Saudi Arabia leased 10,000 hectares for wheat, vegetables, and livestock. Meanwhile, China acquired the rights to grow palm oil on 2.8 million hectares of Congolese land, and in Kenya, Qatar leased 20,000 hectares for fruit and vegetable cultivation in exchange for funding a US$2.3billion port.


So how much more food and land will we need in 2050? The FAO says that overall food production will need to increase by 70 per cent; annual cereal production will need to rise to about three billion tonnes from 2.1 billion tonnes today; and annual meat production will need to increase by more than 200 million tonnes to 470 million tonnes.

According to the FAO, the world has considerable land reserves that could, in theory, be converted to arable land. Currently, about 15 million square kilometres, roughly ten per cent the total land surface, is covered by cropland. The FAO projects that by 2050, the area of arable land will be expanded by 70 million hectares, or about five per cent, with land in developing countries expanding by 120 million hectares and arable land in developed nations contracting by 50 million hectares.

These figures are likely to rise as more people become better off and eat more meat, and land is set aside for biofuels. These changing consumption patterns, the impacts of climate change and the growing scarcity of water and land led John Beddington, the UK government’s chief scientific advisor, to describe the future global confluence of food, water and energy insecurity as a ‘perfect storm’.

  • Most scenarios of how climate change will affect our efforts to feed ourselves appear grim: salt water from rising sea levels affecting paddy fields; unpredictable climate with unreliable rainfall patterns harming seasonal farming practices; extreme weather damaging crops; and an increase in pests and disease. The FAO also reports that sub-Saharan Africa’s share of the world’s hungry people could rise from 24 per cent to up to 50 per cent. ‘The detrimental effects of climate change could reduce global crop production by almost ten per cent by 2050,’ says Stefanie Rost of the Potsdam Institute for Climate Impact Research (PIK).

  • Yet the picture is, perhaps unexpectedly, more mixed: the International Panel on Climate Change projects that global foodproduction could rise if local average temperatures increase by up to 3[degrees]C; any warmer and it could decrease. There may also be beneficial effects on plant growth from the rising levels of atmospheric carbon dioxide. And a report published late last year by the International Livestock Research Institute (ILRI) suggested that in East Africa, the effects of climate change on maize and bean harvests would see moderate declines across the region, but some agricultural areas would do better than others. In the mixed crop-livestock systems of the tropical highlands, the study suggested that rising temperatures may actually favour foodcrops, helping to boost output of maize by about half in highland ‘breadbasket’ areas of Kenya and beans in similar parts of Tanzania. However, harvests of maize and beans could decrease in more humid areas, and across the entire region, production of both crops is projected to decline significantly in dry lands.

Carlos Sere, director general of the ILRI, has an optimistic interpretation. ‘The emerging scenario of climate-change winners and losers isn’t inevitable,’ he says. ‘Despite an expected threefold increase in food demand by 2050, East Africa can still deliver foodsecurity for all through a smart approach that carefully matches policies and technologies to the needs and opportunities of particular areas.’


But if we get it wrong, hunger won’t be the only consequence. In 2007, food riots broke out in Mexico as corn prices rose after the USA began to divert the crop to produce ethanol. Dissatisfaction at the way in which global food production is organised has crystallised into the Via Campesina, an international peasant movement that originated in the 1990s but has gained impetus from recent rises in food prices. Today, it represents farmers in 56 countries, including an organisation of Scottish crofters. The movement talks of food sovereignty rather than food security, by which its leaders seek to organise food production and consumption according to the needs of local communities, giving priority to production for local consumption.

A fundamental tenet of Via Campesina is that peasant or family-farm agriculture is based on sustainable production with local resources and in harmony with local culture and traditions. This approach has increasing sympathy and support among manyfood scientists, who endorse what is described as an agro-ecological approach to food production. This involves mixing varieties of crops, polycultures and crop-livestock combinations whose sustainability is underpinned by the use of local energy, material and labour resources, and species diversity.

  • ‘The same key principles underlie the sustainability of these farms,’ says Professor Miguel Altieri, an agro-ecologist at the University of California, Berkeley. ‘Farmers who live in rural communities near cities and towns, and are linked to local markets, avoid the energy wasted and gas emissions associated with transporting food hundreds and even thousands of kilometres.’
  • Altieri argues that the world already has enough land and food to feed nine billion people, but that the present top-down approach to agriculture prevents this from happening. ‘The problem is political,’ he says. ‘If you want to solve the problem, you instigate land reform, giving land to small farms. The trouble is that research organisations are supporters of genetic selection because they are all plant breeders. In the 1960s, the food movement was driven by a pesticides treadmill; today it’s being driven by a transgenics treadmill.’

But Altieri stresses that he’s no Luddite. ‘We have a dialogue between science and the traditional knowledge of farmers who have been farming for thousands of years,’ he says. ‘Diversity is the key. It’s an agricultural model that decouples us from a dependence on pesticides and provides resilience to climate change.’

The view is endorsed by the UK-based Food Ethics Council (FEC), which argues that too much emphasis is placed on growingfood, as opposed to how it’s distributed and consumed. ‘Instead of asking, “How can science and technology help secure globalfood supplies?”, we need to ask, “What can be done–by scientists but also by others–to help the world’s hungry?”,’ says Dr Tom MacMillan, the council’s executive director.

  • The FEC isn’t alone. The International Assessment of Agricultural Knowledge, Science and Technology for Development (IAASTD), a UN-backed study written by 400 scientists and approved by 60 governments, including that of the UK, cites the failure of many developed nations to consider social and environmental needs when trying to meet agricultural production goals. Instead, IAASTD argues that the key is to combine science and technology research with traditional knowledge to provide local solutions.
  • The FAO’s Wiebe also favours this approach. ‘It’s unfortunate the debate between agro-ecology and science has become so polarised,’ he says. ‘Neither by themselves will be sufficient. There’s going to be a mix of solutions, most of them site-specific. The important thing is to be open to both knowledge of farmers and modern science.’

DFID, the UK government’s international aid department, has begun to make funding for some projects conditional on scientists consulting local communities, and Britain’s Royal Society believes crop researchers should undergo placements in developing nations. ‘You need to link scientists to the ultimate end users,’ says Dr James Smith, co-director of the Centre of African Studies and ESRC Innogen Centre at the University of Edinburgh. ‘You get everybody involved and think how it will translate from the field lab into farming.’

‘A lot of the debate about technology shouldn’t be about the technologies themselves but about their application,’ says Oxfam GB’s Mousseau. ‘How do we save water, protect the fertility of the land? [Answering these questions] doesn’t require research institutes, it requires training of farmers on the ground.’ Mousseau points to the example of Ethiopian corn farmers. Thanks to government loans, in 2002, Ethiopia enjoyed its highest corn production for a decade. But with no system to help the farmers market the corn, there was no price control, the market collapsed and farmers sold at a loss. Many went bankrupt and ended up being recipients of UN food aid.


It’s clear, however, that new technologies will be needed to make up for shortfalls in land and farming skills, and many experts believe that new varieties of food staples, either developed by genetic modification or through plant breeding, are essential. Examples include salt-tolerant rice, drought-tolerant maize and heat-tolerant varieties of climbing beans.

Last autumn, the Royal Society published Reaping the Benefits, a report that called for 2billion [pounds sterling] to be invested in new technologies to address global food security. The society said that agro-ecology had a role to play, but that in the medium term, genetic modification and breeding of new varieties of crops that are resistant to disease, drought, salinity, heat and toxic heavy metals was essential. The longer term aim, the society said, is the development of nitrogen-fixing cereals, which would require less fertiliser, and perennial crops.

Yet some observers are concerned that those seeking to alleviate hunger can become too hamstrung by technology–and that technology risks becoming one-dimensional. Many of the innovations that will emerge are likely to come from the Consultative Group for International Agricultural Research, which has sought to centralise expertise and research into regional hubs to be disseminated around the world.

  • Technology is crucial, but is frequently not practically applied to local conditions, according to Smith, who feels that scientific research needs to become ore practical and tap into local knowledge more than it has done in the past. ‘We have a situation where centres are focusing on high-risk, high-gain programmes, rather than spreading risk and expertise around. It needs to be more subtle,’ he says. ‘It’s not clear to me that biofuels or GM crops will answer the problems.’
  • A reduction of water use will undoubtedly be central to many solutions. Irrigated agriculture covers one fifth of arable land and contributes nearly half of crop production, says the FAO. According to the PIK, without substantial improvements in water productivity or other measures to increase yields on present cropland, an expansion by about ten million square kilometres would be required to feed a population of ten billion. This would require an extra 4,500 cubic kilometres of water every year on top of the current 8,800 cubic kilometres used. ‘In many regions of the world that already face limits of water availability, that isn’t an option. We need to think of better ways to use the water that’s there,’ says Dieter Gerten, a hydrologist at the PIK.

Studies by the PIK looking at harvesting rainwater for use during dry spells and reducing soil evaporation found that such behaviour could increase global crop production by about 20 per cent, with the highest potential mainly in semi-arid regions such as the US Midwest, the Sahel, southern Africa, and central Asia.

WWF has pioneered a system of rice intensification that appears to increase yields and use less water–a potentially crucial development since half of the world depends on rice as a food staple, source of income, or both. Traditional farming requires up to 5,000 litres of water to produce one kilogram of rice; the WWF technique plants young, single seedlings around 25 centimetres apart, providing better airflow and access to sunlight than in conventional systems. Pilot projects in India show crop yields up from three tonnes to five tonnes per hectare, using 40 per cent less water.


Yet that finishing line, with the daunting target of feeding 9.1 billion people by 2050, looms ever larger. Smith feels that, unless significantly altered, the present system of crop research could fail to deliver. ‘The Green Revolution created new varieties of grains that worked in optimal conditions. With climate change, there may well not be optimal conditions,’ he says. ‘The reality is, we can’t feed everyone properly now. I suspect that there will always be one billion people or more who are malnourished or have insufficient calories.’

But Oxfam GB’s Mousseau argues that the goal is achievable–just. ‘It will require an increase in political will compared with what we’ve seen,’ he says. ‘It’s possible, but there has to be a recognition that this is about people’s right to food, rather than the interests of a few large corporations who are trying to guide the international agenda. There are successful examples: Indonesia and Brazil have both reversed the tide through proactive programmes in food and agriculture.’

Wiebe also believes the target is attainable. ‘I’m cautiously optimistic,’ he says. ‘That it’s a difficult challenge is illustrated by the fact that we’re nowhere near feeding everyone today. But it’s more a question of access to food than production. The resources are there. It requires policy choices and appropriate investment. These are big challenges, but the FAO thinks they can be met.’

The Green Revolution

The Green Revolution began in the 1960s, transforming agricultural practices and using technological innovation to breed hybrid varieties of cereal crops and significantly increase crop yields. Early examples included high-yielding hybrid Wheat in Mexico and hybrid varieties of rice in the Philippines.

The increases have been substantial. According to the FAO, between 1961 and 1985, yields of cereal crops such as wheat, rice and maize doubled in developing countries. But there were drawbacks. For the most part, food wasn’t grown where the need for it was most pressing. The Green Revolution was generally unable to significantly increase yields in more marginal areas and demanded that farmers engage in new and more intensive forms of agricultural production, in some cases dramatically altering their livelihoods and the risks they were obliged to take.

Where crop improvements were accompanied by investment in infrastructure, such as in parts of Asia and Latin America, there were widespread benefits. But the poorest farmers in Asia, and more particularly in Africa, lacked the resources to adopt the entire package of technologies. Yield increases varied, and were more successful in environments that most closely mirrored those of the research centres where the seeds were first developed.

The Green Revolution also concentrated investment in a series of international agricultural research centres, the Consultative Group for International Agricultural Research. ‘There’s a brain drain, where you see the local agricultural research programmes in developing countries being stripped of the best people,’ says Dr James Smith, co-director of the Centre of African Studies and ESRC Innogen Centre at the University of Edinburgh. ‘The big institutions take up the funds and local centres can’t compete.’

Technology meets tradition

The answers to improving yields don’t always–or even, perhaps, often–require multi-million-pound technological investment. In Kenya, the use of a so-called push-pull system of pest management devised by the International Centre for Insect Physiology and Ecology has increased maize yields by more than 100 per cent, and has now been adopted by more than 10,000 farmers there and in Uganda and Tanzania.

Maize is an important food and cash crop in East Africa, but it’s plagued by two moths: the spotted stem borer (below) and the maize stalk borer (bottom). The larvae of these moths can cause yield losses of up to 40 per cent.

The low-cost system removes the need for pesticides through the use of plant species that either ‘push’ away the pests or ‘pull’ them into ‘trap’ crops. First, the maize field is surrounded by a border of Napier grass, which is more attractive to the moths than maize (the ‘pull’ part of the system). The forage legume silverleaf is then planted within the maize. This releases semiochemicals that repel the stem borer moths (the ‘push’ element). Silverleaf also fixes atmospheric nitrogen, contributing to crop nutrition.

The Royal Society cites the push-pull system as a classic example of the combination of local knowledge with agro-ecology. Researchers are now looking to develop push-pull strategies for crops other than maize.

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Food for thought

IN MICHIGAN, where I grew up, my family observed a classic Midwest tradition. With every major life event, we aimed to nourish relatives, friends and neighbors. A birth in the family? Let them eat German chocolate cake. A death? Please accept our condolences and this vegetable lasagna with heating instructions taped to the plastic wrap. That was just what you did.


We also cooked to heal ourselves. Every Saturday for 22 years, my Grandpa Charles made a massive vat of chili for the kids in the neighborhood. The children waited with chipped, mismatched bowls in hand until he took a final taste and declared it perfect. As a kid, I thought his chili was simple generosity. Now I know that making it offered him something valuable, too. Grandpa spent his life as a manual laborer, hauling iron and sweating away in hot boiler rooms. Cooking his weekend chili helped him forget the pain of his week and show off talents beyond his brute strength. All those chili bowls licked clean probably felt like the equivalent of applause.

  • I started cooking to compensate for challenging days on the job, too. As a young reporter in Florida, if I left the newsroom haunted by a particularly gruesome crime, as if cued by genetic instinct, I would drive straight to a supermarket and then spend two hours carefully crafting a vat of braised lamb shanks and biscuits scented with rosemary–one of my grandfather’s recipes. I’d sip wine and shift mental gears as I traced the recipe’s familiar steps: Brown the meat; don’t overwork the dough; add the salt. Then I’d notice the volume of food I’d inadvertently made and round up neighbors I barely knew for an impromptu dinner party. By the end of the night, my worries would have been forgotten.


  • Since then, I’ve held many such supper parties. I’ve also had those diners drop by with crocks of food in return–culinary karma at work, as with all those cakes and casseroles from my Midwest youth. I appreciate the tradition more than ever.

Sometimes the simple act of cooking can offer a way to do something to ease the feeling of helplessness or of being overwhelmed. It’s easy to say, “If there’s anything I can do…,” but the phrase can feel empty.


Not long ago, a friend was diagnosed with a rare form of brain cancer. At that point, there was nothing anyone could do–except that I could make a big pot of coq au vin, one of her favorites. Cooking was a comfort, and it gave me an excuse to see my friend and discuss something other than her illness. “This looks great!” she said when I brought over the dish.


As we sat down at her table, I realized that sharing this food provided something essential–something we needed. This felt normal.

With that, we ate.

Kathleen Flinn’s latest book, Burnt Toast Makes You Sing Good, was published in August.

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Cookbooks and their authors

Forty years ago, when I sat down at the reference desk as a virgin librarian and awaited my deflowering from the public, I was pretty cocky. No one could possibly be more prepared for what was to come than I was. No one knew more about reference and readers’-advisory work than I did. I was ready for anything that a patron could possibly desire.


As an undergraduate, I had studied the classics of Greece and Rome, the literature of the Middle Ages, the poetry of Victorian England, the essays of the New England transcendentalists, the tragedies of Shakespeare, and the comedies of Aristophanes. Then, in graduate school, I covered the entire spectrum of children’s and young-adult literature, the classic works of reference, and even genre fiction. I knew books–everything from Dante to Danielle Steel.

  • So … what was my “first time” like at the reference desk? A rather rotund woman approached me and asked, “Can you put me on the waiting list for that new watermelon diet book?” What a disappointment! Why not a question on the relationship of abstract expressionism to Dada? How about an analysis of the symbolism in Moby-Dick?
  • I told myself that things would get better. But they didn’t. By the end of the day, I had received five more requests for diet and cooking books. I soon learned that the single biggest informational need that people have centers on food. By the end of the week, the number was tip to 40. By the end of the month, I had stopped counting. My mantra soon became food is life.

Unfortunately, food books were the one area of the collection I knew nothing about. I was brought up in the era when boys took shop and girls took home economics. My problem was exacerbated by the fact that the food section was the single biggest area in our nonfiction collection.

How would I become proficient in this area? No way I was going to actually read these books and cook the recipes, and there were no Cliff’s Notes for cookbooks back then. How would I master the art of recommending food books? My solution was to rely on the dust-jacket photos of the authors.

  • This was a methodology that I had explored in library school. I had a theory that different readers are attracted to different author pictures and that if a reader has a negative feeling about an author based upon the dust-jacket photo, nothing (not even a great review) will motivate that reader to surrender a sense of intimacy to the book. What I did to test my theory was take a series of eight photographs of various everyday noncelebrities and show them to 150 randomly selected library patrons. I asked each patron four questions about each photograph: Would you read (1) a cookbook, (2) a mystery, (3) a romance, and (4) a general nonfiction book by the person in the photograph. What did I find? These patrons preferred to read cookbooks by fat people, mysteries by skinny people, and nonfiction books by people with a scholarly, elitist look about them–pipes, bow ties, and wire-framed glasses … that sort of thing. The romance results came back inconclusive so I did some follow-up research and found that older women preferred romances written by dignified, white-haired ladies wearing furs, and younger women preferred romances written by younger, sexier women wearing plunging blouses and short skirts.


  • So, drawing upon my graduate-school research, I began pushing cookbooks by fat authors to the many patrons who wanted foodbooks. James Beard was the great fat cookbook author of that era. Beard was not only fat but he always looked happy and satisfied, a kind of modern-day Falstaff. I have always believed that food has two basic purposes: nourishment and pleasure. Of today’s many cookbook authors, Paula Dean and Rachael Ray seem best to radiate those two qualities. They both appear happy and a tad chunky in their dust-jacket photos. That, I am sure, is the secret to their best-selling success. One senses that their recipes provide the comfort level we seek in a meal. Martha Stewart used to put me into that comfort zone, but her recent dust-jacket photos re veal a certain world weariness, almost like she’s trying to appear happy. Martha never used to have to try.

Today, things have changed a bit in the food-book industry. As our population ages, more and more people are becoming vegetarians. It’s the health-wise way to eat. That presents a real problem for readers’-advisory librarians. The photos for the vegan authors tend to radiate more intensity than joy. The look seems to be a bit smug, as if the authors were saying, “We’re holier than the rest of you, and we are the ones saving the planet.” May I recommend Madhur Jaffrey’s book World Vegetarian? Of all the dust-jacket photos on vegetarian cookbooks, hers resonates with the most joy. She is positively radiant. I’m betting two-to-one that her recipes pack more happiness than what you will find in the average vegan cookbook.

Finally, there is the issue of the always-expanding world of diet books. As our population gets fatter and fatter, so, too, have our diet-book collections bulked up. Always look for a skinny diet author. Remember The James Coco Diet (1984)? Well, Coco looked downright rotund on his dust jacket. And two years later, he was dead.

Will Manley has been writing the Manley Arts since 1991. Visit Will at

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Beyond cholesterol


Coronary artery disease prevention has not been convincingly linked to any specific anti-dietary cholesterol regimen. A healthy balanced diet, with plenty of whole grains, fruits and vegetables, is analyzed, and is better than adding any dietary supplements or dropping any specific foods.

Full Text:

A great deal of attention has been given in the past three decades to fat and cholesterol in our diets. These nutrients have been linked in numerous studies to heart disease through mechanisms usually involving blood levels of the potent risk factor, low density lipoprotein (LDL) cholesterol concentrations. The overall importance of saturated fat as a cholesterol-raising nutrient is clear. Controversy continues, however, concerning the importance of dietary cholesterol.

In addition, questions about specific types of fat have been raised and must be addressed. In particular: Are margarines containing trans-fatty acids worse than butter? Should omega-3 fatty-acids supplements be recommended to lower blood cholesterol? Uncertainty about other nutrients and vitamins exists as well. Is the type of protein consumed important in controlling blood cholesterol? Are vitamins, including vitamin C, beta-carotene, vitamin E, folic acid, vitamins [B.sub.12] and [B.sub.6], flavonoids, and carotenoids protective against heart diseases? What about organic compounds in plants classified as phytochemicals? These may act like estrogen, the main female hormone, which is being prescribed increasingly. And how strong are the studies implicating iron and homocysteine in the development of coronary disease?

Research findings from various studies presented to the American public by the media have left them wondering about the adequacy of the current recommendations and confused about what is left to eat! What nutrients are most important? What can vitamins really do beyond treating vitamin deficiencies? What should an average person do about managing his or her diet to prevent coronary heart disease? In this article we will summarize the information that has become available recently, and provide you with guidelines.


Dietary fat and fatty acids

The link between dietary saturated fat and heart disease is clear. The National Cholesterol Education Program recommends that American people lower their fat intake from the current level of 34 percent of total calories to less than 30 percent of total calories and reduce saturated fat in the diet. Indeed, people who have heart disease may benefit significantly by lowering their fat even further. Dr. Dean Ornish showed that when diets with less than 10 percent of calories were consumed, regression of coronary arteriosclerosis occurred.

Bottom Line: Lower your fat intake as much as you can and still keep your diet varied as well as tasty. However, reaching and maintaining a healthy body weight is important, and calories from nonfat foods do count!

Dietary cholesterol

Recent studies showing only “modest” increases in blood cholesterol with the daily feeding of eggs to young healthy men and women have raised the question” Can I eat one egg daily instead of sticking to the American Heart Association’s recommendation of no more than four per week?”

Bottom Line: Although those studies showed only a modest (yet significant) rise in blood cholesterol with the daily consumption of eggs, the effect of dietary cholesterol on blood cholesterol can vary from person to person: some individuals are more sensitive to dietary cholesterol than others, and there is no simple test to identify them. In addition, for most Americans even the small blood-cholesterol-raising effects of dietary cholesterol can contribute to higher overall risk of coronary heart disease. So stick to the recommendation of no more than four eggs a week for now.

Trans-fatty acids

Trans-fatty acids are partially hydrogenated fats found in margarine and shortenings, in baked products made with partially hydrogenated fats and (in small amounts) in meats and dairy products. They have been shown to raise LDL cholesterol. Trans-fatty acids may also increase the risk of heart disease by raising Lp(a), a form of LDL that may interfere with the normal breakdown of blood clots. Trans-fatty acids behave like saturated fats although, on the food label, they are included with the unsaturated fats. Trans-fatty acids in the American diet range between 2 and 8 percent of calories consumed.

Bottom Line: Lower your total fat intake and saturated fat intake. Use small amounts of unsaturated liquid oil, e.g., olive oil, canola or corn oil, if needed in cooking and baking, in place of butter, margarine or shortening. If you need a spread for your bread, use jam or jelly or the low-fat or nonfat margarine. Select low-fat or nonfat dairy and baked products.

Omega-3 fatty acids


Omega-3 fatty acids are polyunsaturated fats from plant (linolenic acid) and marine sources (eicosapentaenoic, docosaheaenoic fatty acids) found in fish oil capsules and in salmon, bluefish, mackerel and (in smaller amounts) in other seafood. Eating fish rich in omega-3 fatty acids can cause significant reductions in serum triglycerides (blood fat) in individuals who start out with very high blood levels (>500 mg/d). In addition, omega-3 fatty acids may slow the process of blood clotting. These fatty acids are not, however, helpful in lowering blood cholesterol levels.

Bottom Line: Include fish within the allowance of 5 oz.-6 oz. per day of lean meat or poultry without skin. Do not take fish oil capsules unless prescribed by your doctor. Concentrated levels of omega-3 fatty acids in fish oil capsules can have bad effects when taken with certain drugs like coumadin or in patients with diabetes.

Soy protein

There have been a number of studies in which soy protein has been shown to lower serum cholesterol levels in hypercholesterolemic individuals when compared to protein from dairy products (casein) or beef protein. Soy has isoflavones called daidzein and genistein (plant estrogens) that may play a role in cholesterol metabolism or it may be the amino acid pattern of the protein itself. The protein quality of soybean is close to that of animal proteins. Some Asian populations include soybean daily as tofu, soy milk and tempeh. These foods have been consumed safely for centuries. All soybean products, including soy protein isolate, do, not have the same amounts of isoflavones. Tofu is the best source. Soybean products do contain fat-4 ounces of tofu has 5 grams of fat (which is mainly unsaturated) and 9.4 grams of protein.

Bottom Line: Soybeans can be included in the meal plan in place of animal products and could be a very useful adjunct to the low-saturated-fat, low-cholesterol diet.

Antioxidant vitamins


It has been suggested that large doses of antioxidant vitamins can retard the “oxidation” of LDL cholesterol. Oxidized LDL is more damaging to the arterial wall. In animal studies it has been shown that supplementing the diet with antioxidants inhibits the progression of arteriosclerosis. The nutrients studied in these experiments have been ascorbic acid (vitamin C), alpha-toco-pherol (vitamin E) and beta-carotene.

The animal studies are supported by studies comprising populations in different countries where high levels of blood vitamin C, vitamin E and vitamin A (a product of beta-carotene) are associated with lower rates of heart disease. However, there have been no clinical trials in humans that have used these vitamins to prevent or retard arteriosclerosis.

Bottom Line. More data is needed before antioxidant vitamin supplements are recommended to the general public. Individuals can, however, consult their physicians on antioxidant use.

Food sources of antioxidant vitamins


  • wheat germ
  • whole-grain bread and cereals
  • nuts
  • green leafy vegetables


  • citrus fruits and juices
  • cabbage
  • broccoli
  • cantaloupe


  • carrots
  • dark green leafy vegetables
  • sweet potatoes
  • winter squash
  • apricots
  • mangoes
  • papaya
  • cantaloupe


Fruits and vegetables are powerhouses of phytochemicals which may help in the prevention of chronic degenerative diseases like heart disease, hypertension and diabetes. Each food is loaded with several phytochemicals. For instance, carrots have more than 500 carotenoids; beta-carotene is one of them. In order to get the full potential benefits of these substances, it has been suggested that we eat several servings of vegetables and fruits dairy.

The phytochemicals may be a natural way to increase estrogen levels (or estrogen-like activity). A large body of data suggests that estrogen replacement prevents heart disease and death in postmenopausal women. Estrogen treatment can lower LDL and raise HDL cholesterol levels. Clinical trials are under way to test directly if estrogen can protect postmenopausal women. It should be used only under the supervision of a physician.

Bottom Line: We should all eat several servings of fruits and vegetables each day.


Niacin, or nicotinic acid, is a member of the B vitamin family. The recommended dietary allowance for this vitamin is 15 mg/day, while the doses used to lower LDL cholesterol and raise HDL cholesterol range from 1,000 to 4,000 mg(day. At these very high doses, there is the potential for serious adverse effects: this is particularly so with the slow-release niacin preparations that do not cause flushing and itching, but are more likely to adversely affect the liver.

Bottom Line: Niacin, when used to lower LDL and raise HDL cholesterol, should only be taken under a physician’s supervision.


High iron stores have been associated with heart attacks in a study done in Finland. However, only a small proportion of the population–those with high serum ferritin and high serum LDL–had higher risk of heart disease. Furthermore, separate studies of U.S. physicians and of Icelandic men and women showed no association between serum level of ferritin or iron and the risk for heart attacks.

Bottom Line: The data presently available for a link between iron and heart disease are inconsistent, and do not justify changes in food fortification policy or dietary recommendations.


Elevated levels of hombcysteine (a nonessential amino acid) has been found to be an independent risk factor for heart attack and stroke. High homocysteine levels may reflect reduced availability of folic acid, vitamin [B.sub.6] or vitamin [B.sub.12] Adequacy of these vitamins in the diet, particularly folic acid, may normalize plasma homocysteine levels.

Bottom Line: Building your meals with grains, beans, vegetables and fruits will help increase your folic acid intake. You should however, check with your doctor to make sure you do not have vitamin [B.sub.12] deficiency. Too much folic acid (from foods or supplements) can mask vitamin [B.sub.12] deficiency. Supplementation with vitamin [B.sub.6] for long periods can also cause neurological problems. Aim to get more than 400 micrograms of folate in the diet from food sources and discuss measurement of your homocysteine level with your doctor.

Folic acid in Foods

Food (1 cup) Folic acid
cooked/ ready-to-eat (mcg)

Total cereal 466
Product 19 cereal 400
Lentils 357
Lima beans 273
Asparagus 242
Red kidney beans 229
Spinach 204
Split peas 127
Orange juice (diluted
from concentrate) 109
Artichoke (1 medium) 53
Orange(1) 39


There is no argument concerning the need to reduce dietary saturated fat, achieve a healthy body weight, exercise regularly and avoid cigarettes when you undertake a program to lower your risk for developing coronary artery disease. In addition, a diet rich in fruits, vegetables and whole grains will contain many vitamins and other micro-nutrients that may add further protection against arteriosclerosis. The use of supplements to increase consumption of these vitamins and micro-nutrients is not recommended at this time. Finally: Before you accept any recommendation, you should know:

  1. that any one study you read about is not the last word on how you should eat.
  2. that removing or adding one food or supplement to the diet does not guarantee that you will then be eating a healthful diet. A healthful diet is about the foods you can eat and not about the ones you are told to avoid.
  3. that nutritional science is evolutionary and not revolutionary. A story about nutrition gets media attention because it is unusual and because it proposes a new theory. The new information should remain theory until it is tested further and confirmed.
  4. how the study upon which a new recommendation is based was conducted. A randomized clinical trial is the best design for clinical research. Data from studies on animals, or from observational studies, are not the final prescription.

Dr. Ginsberg is the director of the Irving Center for Clinical Research and the Irving Professor of Medicine, College of Physicians and Surgeons at Columbia University.

Ms. Karmally is the director of Nutrition, Irving Center for Clinical Research, Columbia-Presbyterian Medical Center, N.Y.C., spokesperson for the American Directors Association and on the board of directors for the N. Y. Affiliate of the American Heart Association.

=> Read: The year in nutrition: salt wars to E shock

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Standards for Staple Foods Revised

Nov 02, 2010 (Cameroon Tribune/All Africa Global Media via COMTEX) — Revision of standards for wheat flour and refined vegetable oils took place in Douala over the week end. Members of the Standards and Quality Agency, known by its French acronym as ANOR (it’s similar to SEKA, an organization with respect to sewing industry – source from, the best sewing machines reviewing website – began a nation-wide revision of the quality standards of refined vegetable oils and wheat flour in the country.

This was during a workshop last Friday at the Douala SAWA Hotel. Stakeholders from the Littoral and South West Regions sought common standards for the food staple.


The agency expects to make a tour of the markets during which these basic products will be collected and analysed for Vitamin A and minerals like iron. Producers, and the business public as well as consumers will be sensitised on what food quality is good for their health.

The Deputy Director General of ANOR, Andely Chantal, said despite abundant food production, the country suffers from insufficient nutrients especially Vitamine A and minerals.

“The consequences of these nutrients deficit are not always visible externally and so victims do not realise the negative effects of their absence. To fight this situation, government has partnered with UNICEF and Helen Keller International to improve on the vitamins and mineral contents of foods in the country,” she explained.


Of the four most important staple foods – sugar, magi cube, oils and flour – in the country, refined vegetable oils and flour from wheat were tackled for quality improvement during this pilot phase of the quality control programme.

For example, vitamin A and iron are often wanting in their right proportions in these foods widely and intensively consumed in Cameroon. Such quality concerns made necessary the need to carry out studies on the food staples, the results of which were being revised over the week end in Douala. ANOR is a public administration created by Presidential decree of No. 2009/296/ of September 17, 2009.

Copyright Cameroon Tribune. Distributed by AllAfrica Global Media (
>>> View more: Hunger has a profile

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The year in nutrition: salt wars to E shock

Whole grains, broccoli, omega-3s and soy continued to grab positive headlines this year, but other stories surprised, even worried, us.

While Canadians’ intake of fruit and vegetables declined for the first time in a decade, south of the border Americans were told they could count pizza as a vegetable serving.

The fact that pizza is high in sodium seemed to be less of a worry as research findings questioned the government’s advice to slash sodium in the North American diet. Meanwhile, Campbell Soup Co. (U.S.) added salt back to soups in an effort to boost flagging sales.

Yet it was the news about vitamin supplements that shocked us the most. The safety of calcium supplements was questioned, and vitamin E supplements took a blow. Here’s a roundup of 2011 newsmakers:


Canadians’ diet lacks fruit and vegetables

We’ve long been told to eat more fruit and vegetables. A produce-rich diet helps lower the risk of certain cancers, heart attack, stroke, high blood pressure, cataract and macular degeneration.

That’s why Health Canada advises we consume at least seven servings

(combined) each day.

One serving is a medium-sized fruit, 1/4 cup dried fruit, 1/2 cup of cooked vegetables, 1 cup of salad greens or 1/2 cup 100-per-cent vegetable or fruit juice.

It became clear this year we haven’t been heeding this advice. In June, Statistics Canada’s latest analysis of the nation’s health revealed that our intake of fruit and vegetables had declined for the first time in a decade.

According to the data only 43 per cent of Canadians, aged 12 and older, manage to eat more than five servings per day.

My advice: In 2012, resolve to incorporate fruit and vegetables into all of your meals and snacks.


Perhaps Canadians would have scored higher on the fruit and vegetable front had pizza been counted as a vegetable serving as it is south of the border.

In November, the U.S. Congress released a spending bill to keep pizza on school lunch menus in a fight against an Obama administration proposal to make school lunches healthier.

The bill allows pizza to qualify as a serving of vegetables because it contains two tablespoons of tomato paste. The U.S. Department of Agriculture had proposed that a half cup of tomato paste – too much to put on a pizza – be considered a vegetable, but was ignored.

Advocates of healthy school lunches have criticized the bill, saying it will prevent schools from offering a wider variety of vegetables.

The controversial ruling was even mocked by Kermit the Frog, on an episode of Saturday Night Live.

The idea that pizza is a vegetable is pretty ridiculous. With minimal fibre, vitamin C and folate – not to mention added sodium – two tablespoons of tomato paste hardly comes close to a serving of broccoli or carrots.

Bottom line: You still need to serve your pizza with a side of vegetables.


=> Related Posts: Smart eating starts with a little thought for food


A number of studies questioned the science behind the drive to reduce sodium in our national diet.

In July, a review of seven randomized controlled trials found no strong evidence that cutting sodium protected from heart attack, stroke or dying from heart disease. In fact, it reported a greater risk of premature death among people with a history of heart failure who followed a low-sodium diet.

Last month, a report from Canadian researchers who reviewed data from nearly 29,000 adults found that while a very high sodium intake – 7,000 to 8,000 milligrams per day – was harmful to heart health, so was a low-salt diet.

People who consumed the lowest sodium levels – less than 3,000 milligrams per day – also had higher rates of cardiovascular death and hospitalization for heart failure. (However, fewer heart problems occurred at the lower end of sodium consumption than the higher end.)

Meanwhile, after trumpeting its efforts to reduce unhealthy amounts of salt from its products, Campbell added salt back to its Select Harvest canned soups sold in the U.S. to combat slow sales.

Canadians consume on average 3,400 milligrams of sodium per day, more than double the daily requirement. Health Canada is pursuing a voluntary program to reduce our average daily sodium intake to 2,300 milligrams by 2016.

Despite this year’s backlash against the anti-salt agenda, most experts feel the scientific argument for cutting sodium in processed foods is strong. Expect the war on salt to continue in 2012.


It’s fair to say it was a bad year for calcium supplements. In April, New Zealand researchers linked calcium supplements – taken by many women to protect bones – to heart attack.

The conclusion was drawn from a re-analysis of the Women’s Health Initiative (WHI), a seven-year trial which assigned women to calcium and vitamin D supplements or placebo to assess risk of hip fracture.

Women who were not taking calcium supplements on their own before the study began had a greater risk of heart attack while those who were already using calcium supplements did not.

The authors speculate that a sudden change in the level of blood calcium could damage coronary arteries and lead to heart attack. Women who already had calcium in their blood due to personal calcium use may have been immune to this spike.

(Interestingly, another arm of the WHI that looked at coronary artery calcium levels found no evidence of increased heart risks among women assigned to calcium plus vitamin D.)

Should women toss their calcium supplements to protect their heart? This study certainly isn’t the final answer.

Women should focus on meeting calcium requirements through food first. Dietary calcium has not been shown to increase heart risk.

Women, aged 19 to 50, need 1,000 milligrams of calcium each day and older women require 1,200 milligrams. The safe upper limit for older women (and men) is 2,000 milligrams per day.


Vitamin E supplements also got bad news. A study published in the Journal of the American Medical Association, known as the SELECT trial, found that vitamin E – once thought to guard against prostate cancer – actually increased the risk slightly.

The report noted that the rate of prostate cancer was 17-per-cent greater in the vitamin E group, a finding that was statistically significant. There was no increased risk when vitamin E and selenium were taken together, suggesting that selenium somehow dampens the harm caused by vitamin E.

This study added to the growing concern of many scientists that high-dose vitamin supplements are harmful in certain people.

Take-away message: If you’re a male taking vitamin E, pitch your supplement.

Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV’s Canada AM every Wednesday. Her website is


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Breaking the heart: heart disease starts early, studies show but it doesn’t have to

The bodies in the labs belonged to teenagers who had died suddenly in car accidents, had been killed, or had committed suicide. Upon examining the bodies, researchers noticed that a surprising number of the teens carried a biological time bomb set to detonate later in life: fatty deposits in blood vessel walls. Those deposits can lead to deadly heart disease, the biggest single killer of Americans. One-third of all teenagers will eventually die from heart disease, according to the American Heart Association.

Although symptoms of heart disease rarely occur until age 50 or later, the hundreds of subjects examined in the “Pathological Determinants of Atherosclerosis in Youth” (PDAY) study mentioned previously show that the buildup of fatty deposits is already happening in many young people’s cardiovascular systems. “The process begins in childhood and progresses throughout life,” says Dr. Rae-Ellen W. Kavey, a pediatric cardiologist at the National Heart, Lung, and Blood Institute in Bethesda, Md. Luckily, heart disease can be slowed and even reversed.

Clogged Pipes

A quick tour of the circulatory system is important for understanding how heart disease strikes. The heart is a muscular pump about the size of your fist. It pumps blood through an intricate network of rubbery tubes (blood vessels) that wind their way to every body part. The blood flowing through large vessels called arteries is laden with the oxygen and nutrients that body tissues need. The blood drops off this vital cargo and flows back to the heart through veins. Blood draining from tissues also carries waste products, which are filtered through other organs and removed from the body. All of the body’s blood vessels, along with the heart, make up the circulatory system.


For the blood to circulate, the tubes that carry it need to be open. In a process called atherosclerosis, a fatty material called plaque builds up on artery walls and narrows the lumen, or empty space, of the vessels (as seen in the subjects of the PDAY study on page 28). The arteries that supply blood to the heart, called the coronary arteries, are especially crucial. They are narrow, so even a small amount of plaque buildup can dramatically constrict the channel. A clot can form, completely blocking the narrowed artery. After just a few minutes without blood flow, the affected heart muscle cells can die, producing a heart attack. The attack may kill or disable a person, depending on the extent of injury to the heart muscle.

Controlling the Risk

Almost all teenagers in the United States have fatty streaks in their arteries that signal the beginnings of atherosclerosis, the PDAY study demonstrated. But the severity of the damage to the coronary arteries depends on certain risk factors, says Dr. Henry McGill, a pathologist at the Southwest Foundation for Biomedical Research in San Antonio, Texas. The important risk factors that you can control are high blood pressure (hypertension), diabetes, obesity, high blood cholesterol, physical inactivity, and cigarette smoking.

Blood pressure is the force that blood exerts as it pushes against artery walls. Blood pressure is measured in millimeters of mercury and includes two numbers. The first is the systolic blood pressure, taken when the heart beats; the second is the diastolic pressure, the pressure when the heart relaxes between beats. Hypertension occurs when either number is higher than normal–that is, higher than 120/80 for an adult. (The cutoff is lower for teenagers because blood pressure generally rises with age.) If the blood’s force is too great, the heart has to work overly hard. Hypertension can also stimulate the development of plaque, although scientists are not yet sure how.

Hypertension, not common in teens before the 1990s, is now appearing more often in young people, primarily those who are overweight. More young teens are also developing diabetes, a disease in which levels of blood sugar are high. That can harm the heart, Kavey says; again, diabetes is often associated with excess weight. As a result of those trends, today’s teens may start having heart attacks in their 30s or 40s, a decade earlier than today’s adults usually do. “That’s terrifying to me,” Kavey told Current Health.

Besides its association with high blood pressure and diabetes, being overweight is risky for the heart for other reasons, in the PDAY study, the subjects who were obese (significantly overweight) had almost twice as much plaque in their coronary arteries as did the teens who were not overweight.

Another type of fat can be a problem for the heart: cholesterol, a soft, waxy substance found in the blood and in all body cells. The body makes its own cholesterol and gets some from animal-derived foods such as meats, eggs, and high-fat dairy products. Too much high-fat food intake can raise cholesterol levels and contribute to plaque development.

Stop Heart Disease Before It Starts

Eating heart-healthy foods and becoming more active can greatly reduce the chances of developing heart disease. In a 2004 study, researchers from Hong Kong and Australia put 82 overweight children ages 9 to 12 on either a low-fat diet alone or a low-fat diet plus weekly exercise for a year. In the children who stuck with the diet and exercise program, researchers saw reductions in the thickness of the walls of the carotid arteries, the chief arteries in the neck. (Thicker walls mean more fatty buildup.)

Looking once more at the PDAY study, the risk factor associated with the most plaque buildup was smoking. Avoiding cigarettes is probably the single most important thing a young person can do to preserve healthy arteries for a lifetime.

Most teens don’t know what the insides of their arteries look like, but they would be wise to learn from those who’ve had their time bombs exposed. It’s possible to add decades to the timer, research shows. “If you control these risk factors for life, just a modest reduction [in risk] will dramatically affect the development of coronary heart disease,” McGill says. The time to start is now.

Change Your Life Make your heart healthier by changing the way you live.

Get moving.

Aim to work out for 30 minutes to an hour most days of the week.

Try walking, dancing, cycling, swimming, shooting baskets. or raking leaves. Exercise can make your heart stronger and your circulatory system more efficient. It can also lower the amount of cholesterol in your blood, help you lose weight, and keep your blood-sugar levels down.

Improve your diet.

Eat foods low in cholesterol and saturated fat. (See “Chewing the Fat.” page 19, for more information on fats.) Eat more wholegrain breads, pastas, and cereals and fresh fruits and vegetables.

Don’t smoke.

Smokers are two to four times as likely to die of heart disease as nonsmokers, according to the American Heart Association. Nicotine narrows the arteries, and other chemicals in cigarette and tobacco smoke promote plaque buildup and the formation of blood clots that can block an artery, leading to a heart attack.

Monitor your weight.

Shedding excess pounds can normalize high blood pressure and reduce the risk of diabetes. Maintaining a healthy weight directly protects the heart.

JAMMED UP Keep these images in mind the next time you think about ordering that super-crispy fried chicken and double-fudge sundae! The image on the left shows a healthy heart artery, with plenty of space in the lumen for blood to flow. On the right, however, this teen’s artery was so plugged up with plaque, blood had almost no room to squeeze through.



* Which of the body’s systems do the heart and blood vessels form? (the circulatory system)

* How does a heart attack happen? (Cholesterol forms plaque along the walls of blood vessels in a process called atherosclerosis; when plaque clogs the coronary arteries, heart tissue dies, causing a heart attack.)

* Look at the image of the 18-year-old’s artery on page 28. If the subject had not died young of unrelated causes, what could you infer about his future health? (With the lumen barely wide enough to let blood pass through, the subject would probably have developed heart disease or suffered a heart attack in the decades ahead.)


Have the class find definitions for some heart- and heart disease-related terms that weren’t in the article. Examples might be capillaries, cardiac arrest, congestive heart failure, coronary heart disease, hypercholesterolemia, myocardial infarction, and stroke. Students can then create a puzzle or quiz using those terms and others from the article.


The University of Texas Health Science Center at San Antonio, which conducted the study of atherosclerosis in deceased teens that is mentioned in the article, has a full curriculum for teachers. Visit, and click on Cardiovascular System.

Even if your students can’t visit “The Giant Heart” at the Franklin Institute Science Museum in Philadelphia, they can still learn a lot of facts and trivia from the accompanying teacher’s guide:

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