The Checkup

The nutrition world is all atwitter over First Lady Michelle Obama's new campaign to combat child obesity. It's a major effort and her pet topic. But it's always hard to judge whether ambitious programs such as the one she spelled out today will seep sufficiently into Americans' day-to-day lives to make a dent in the obesity epidemic.

The new "Let's Move" initiative aims to improve school nutrition programs, help parents get a better handle on choosing healthful foods for their families, bolster school- and community-based opportunities for physical activity, and eliminate "food deserts", areas where people lack access to decent grocery stores. Some of what's included was already in the works -- revamping the Food Pyramid, for instance, is a logical extension of the ongoing revision of the Dietary Guidelines for Americans. The FDA had already said it was going to push for a universal front-of-package food labeling system and Congress has had reauthorizing the Child Nutrition Act on its to-do list since the act expired last fall.

Perhaps the most encouraging aspect of the initiative is the support of the new Partnership for a Healthier America, also announced today, and the broader collaboration Obama has in mind. Rather than having government dictate all the specifics, her program calls for bringing together players from the public and private, for-profit and non-profit worlds to come up with solutions. And so far, so good: Since this morning's announcement, I've received a number of press notices from organizations saying they've proudly joined the cause.

It's great to see the American Academy of Pediatrics and American Medical Association's on board. But it's better still to see that Nickelodeon has pledged to lend a hand.

Let the doctors and politicians do what they will to curb childhood obesity in this generation, the campaign's goal. But if you want kids to buy into that effort, it's good to have the likes of Nick in your corner.

For more on Michelle Obama's plan to fight childhood obesity, see the Post's Special Report.

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U.S. Rep. John Murtha's death yesterday from complications following gallbladder surgery he had in January was a very rare occurrence. According to the American College of Surgeons, among generally healthy people undergoing such surgery, deaths occur in only 0 to 1 per 1,000 patients.

Murtha, 77, reportedly was readmitted to the hospital Jan. 31 after his earlier surgery; it turned out his large intestine had been damaged during the removal of his gallbladder. Murtha's surgery was said to be laparoscopic, a minimally invasive approach that's become the standard of care in most hospitals, rather than the more invasive "open" surgery.

Hartford, Conn. surgeon Peter Bloom, who removed my own stone-ridden gallbladder 13 years ago, says no randomized, clinical trial has ever pitted the two approaches against one another, so it's really not known whether one is safer than the other. Still, the risks each poses are pretty much the same.

First are the general risks associated with any surgery, Bloom explains. Problems such as stroke, heart attack, blot clots traveling to the lungs and causing a pulmonary embolism, infection and problems with anesthesia are common to both procedures. These complications "might do someone in in a day," Bloom says. A patient's age and overall health can affect the risk of complications from gallbladder removal or any other surgery, he adds.

Other complications specific to gallbladder surgery often take longer to make themselves apparent, Bloom says. These include injury to the bile duct, intestine or liver.

When I told Dr. Bloom that I don't remember hearing about any of those risks before my surgery, he laughed and said nobody ever remembers. But he says he sits down with every patient before scheduling surgery and goes over a booklet that includes the full list of potential complications. "It's frightening, and part of it is in unfamiliar language," Bloom says, noting that he doesn't recall being told the risks of surgery he himself has received, so eager was he just to get on with the procedure.

"Most people just want to get better," Bloom says. And, thankfully, most do.

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Last week the British medical journal The Lancet formally, and finally, retracted a study it had published in 1998 that loosely linked the measles/mumps/rubella vaccine to the development of autism.

The science behind that study was found to be shoddy, and the researcher has been accused of ethical breaches. Moreover, it planted a fear of vaccination in parents in both Great Britain and the United States. That fear is unlikely to be erased by the retraction of the study.

As I write in this week's "Eat, Drink and Be Healthy" column, the study also planted the notion that autism may be linked to gastrointestinal disorders. It promoted a theory that kids with autism may have what's known as "leaky gut," a condition that allows food proteins that normally are too big to pass through the intestinal wall to enter the bloodstream and eventually the brain.

That notion has encouraged many parents of autistic children to believe their children's condition may be managed, treated or even cured through diet. Specifically, many believe that a gluten-free, casein-free diet protects autistic children against food proteins (gluten, found in wheat, barley and rye, and casein, found in dairy products) that may trigger symptoms or worsen the severity of their autism.

This approach has famously been adopted by actor Jenny McCarthy, who claims a special diet has virtually reversed her son's autism.

The problem is, reputable, solid science hasn't established a connection between diet and autism. In January, the journal Pediatrics published a paper noting just that -- but also allows that many kids with autism, just like those without, may have gastrointestinal disorders that can be diagnosed and treated. It is possible that attending to those underlying ills could make a child feel much better, so much so that his or her autism might appear to have improved.

Parents of children with autism are understandably eager to do whatever they can to help their kids lead happy, healthy lives. If adjusting a child's diet has the effect of achieving that end, that's wonderful.

But those who put all their eggs in the diet basket may risk distracting themselves from the pursuit of autism's true cause.

I'd like to hear from parents of children with autism. Do you believe diet plays a direct role in your child's condition? Or do you believe that's a red herring?

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A study published today in the journal Cancer Epidemiology, Biomarkers & Prevention finds that people who drink two caloric soft drinks a week have nearly double the risk of developing pancreatic cancer when compared to those who drink less.

The research tracked 60,524 men and women in the Singapore Chinese Health Study for 14 years and found that the soft-drinkers increased their risk of contracting the deadly cancer by 87 percent. The relationship held up even when smoking and a handful of other habits were taken into account. The study did not look at consumption of diet soda; soft drinks were defined as "sugar-sweetened carbonated beverages."

The study, funded by the National Cancer Institute, notes that lifestyles in Singapore have much in common with those in the U.S. and that the findings should apply to Caucasians as well as to the Asians who were tracked.

Lead author Mark Pereira, an associate professor in the School of Public Health at the University of Minnesota, suggests that the high level of sugar in sodas may boost insulin levels in the body, which in turn might spur the development of pancreatic cancer cells.

But no such connection was found between drinking fruit juices, whose sugar content often matches that of soft drinks.

The findings, while provocative and frightening, could use some perspective. First, the total number of pancreatic cancer cases found over the 14 years of the study was just 140. Of those, 18 occurred among people who'd reported consuming two or more sodas per week, and 12 among those who drank less than two; 110 occurred in people who'd reported drinking no soda.

The study acknowledges that those small numbers might make the association a little more tenuous, "limiting the power" of the data and "giving potential to a chance association." It also cites four earlier studies that examined the soda-pancreatic cancer link that came to varying conclusions, including finding no link at all to finding an association for women but not for men.

Speaking on behalf of the American Beverage Association, consultant Richard H. Adamson said, "The study is, in my opinion, a weak study." Adamson, former vice president for science and technical affairs for the beverage association and, before that, a researcher at the National Cancer Institute, says that the study was "very small with regard to number of cases" of pancreatic cancer for major conclusions to be drawn from its data.

Further, Adamson says, the researchers didn't correct for other known pancreatic-cancer risk factors such as chronic pancreatitis, high-fat diet, workplace exposure to chemicals or gender (males are much more likely to get this cancer than females). The fact that the association didn't hold for juice raises questions, he said, as the sucrose in Singapore soft drinks "breaks down into the same thing that's in juice."

In the end, Adamson said, "The study doesn't scare me. I continue to drink soft drinks."

I'm not a soda drinker, and this study doesn't inspire me to start sipping. But while many public-health advocates believe we'd all be better off without soda in our lives, I'm not sure that if I did enjoy soda I'd stop drinking on the basis of this study alone. Because pancreatic cancer is relatively rare, even doubling your risk leaves your individual risk pretty low.

On the other hand, given the grim prospects for surviving pancreatic cancer (fewer than 5 percent of those diagnosed are alive after five years), and that fact that there's no screening test and very few treatment options, anything we can do to reduce our risk might be worth considering.

How about you? Are you a soda drinker? Does this study make you inclined to cut back?

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Like everyone else in the D.C. area, Pam Peeke is focused on riding out Snowmaggedon. Speaking to me by cell phone from her frigid, power-lacking home in Bethesda, Peeke, a health and fitness expert, author of Fit to Live and host of Discovery health TV's series Could You Survive?, was headed out to a hotel, but before she went she shared some tips for staying safe and healthy in these cold, snowy conditions.

• In the house: Bundle up, wear layer upon layer, and don't forget gloves and extra socks. Do not set up an outdoor grill inside; area hospitals are already treating people for carbon monoxide poisoning, which can quickly become deadly. If you're using a fireplace, make sure the flue is fully open and the screen fully closed -- and make sure someone is tending the fire at all times. Ditto for candles; if you're using them for light or to warm your hands, be sure to keep an eye on them always.
• If you need to get out: Unless you are quite physically fit, leave the shoveling to others. Keep an eye out for young, healthy people who might be willing to shovel your driveway and sidewalk. Even if you are fit, don't take the snow lightly. Try to wait until the sun is out and high in the sky so it's a bit warmer when you work. Bend from the knees, not your back, to prevent back injury, and be sure not to overload your shovel; take it slow and easy. Avoid getting wet, especially if you don't have a way to heat up when you get back indoors. Being damp increases your odds of dangerous hypothermia.



• Watch your step: If all you have are what Peeke calls "silly boots" -- those that lack adequate tread and aren't waterproof -- stay inside. To avoid slipping, make yourself walk very slowly, and whenever possible step on snow, not shiny patches of ice. Most of all, don't fool yourself: this snow is serious business, Peeke says, and "some people are fooled into thinking they can do things they can't." This isn't the time to embark on a long walk for the sake of exercise, she says.



• Mind your heart: The cold causes blood vessels and bronchial tubes to constrict, placing extra stress on your heart, making you more vulnerable to angina (chest pain caused by the coronary arteries' inability to deliver appropriate oxygen to your muscles -- including your heart muscle). Worse yet: Myocardial infarction may occur if the heart is damaged and unable to pump at full volume. The severe pain and shortness of breath you'll experience signal an emergency. It's simply not worth taking a risk, Peeke says, and until tertiary roads are cleared, ambulances and other emergency vehicles might have trouble getting to you.

As for all that food languishing in your fridge and freezer, it needn't go to waste. "Stick stuff in giant garbage bags and stick it in the snow," she suggests. The temperature's low enough to keep frozen food frozen. "Don't leave it in the fridge to rot!"

Do you have any snow-safety tips to share with fellow readers? Please post them in the Comments section. And please be careful out there (and in there, too)!

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