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  • Can We Safely Use Melamine Dishes and Polyamide Plastic Utensils? | NutritionFacts.org

    Can We Safely Use Melamine Dishes and Polyamide Plastic Utensils? | NutritionFacts.org

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    I recommend glass, ceramic, porcelain, or stainless steel tableware and wooden or stainless steel cooking utensils.

    Melamine is used to make a variety of hard plastic “food contact items such as cups, plates, bowls, and utensils because they are dishwasher safe, inexpensive, and durable.” If that word sounds familiar, it may be because melamine has also been added illegally to protein products to game the system to make it appear that “food commodities” like pet food contain more protein than they actually do. By 2007, more than a thousand potentially contaminatedpet food products were recalled after “the chemical was found to be a contaminant in wheat gluten used in those products,” but not before it caused disease and death in pets throughout North America. 

    “It is presumed that melamine was intentionally added by suppliers in China to falsely elevate the measured protein content and, hence, the monetary value of these products.” The pet food scandal was just the writing on the wall. The following year, “melamine was discovered to be the cause of an outbreak of urinary tract stones and renal failure” (kidney stones and kidney failure), affecting hundreds of thousands of infants and young children throughout China. “Investigations revealed that the compound was added illegally to powdered milk and baby formulas to falsify protein content.” 

    As I discuss in my video Are Melamine Dishes and Polyamide Plastic Utensils Safe?, in the United States, you can find it in food packaging and sneaking its way into animal feed. However, those using melamine dishware can be exposed directly, as it migrates straight into the food upon exposure to heat. In fact, “cooking spoons and crockery made of melamine resin are not suited for microwaves and cooking,” according to food safety authorities. Okay, but what if you never cook with it, fry with it, or microwave it? What if you just use melamine to eat out of? 

    In “A Crossover Study of Noodle Soup Consumption in Melamine Bowls and Total Melamine Excretion in Urine,” researchers measured the amount of melamine flowing through the study subjects’ bodies compared to eating the same soup out of ceramic bowls. Their findings? “Melamine tableware may release large amounts of melamine when used to serve high-temperature foods”—and not even hot foods. “Melamine migration can be detectable from daily-use melamine-made tableware, even in the low temperatures,” like just warm water. Why do we care? Because the level of melamine you’re exposed to “is significantly associated with kidney function deterioration in patients with early-stage CKD,” chronic kidney disease, in which even relatively “low melamine levels may cause a rapid decline in kidney function.” So, I would suggest glass, ceramic, porcelain, or stainless steel tableware instead. 

    What about polyamide utensils, common black plastic spoons, spatulas, and the like? All sorts of different plastic materials are used in kitchen utensils. Polyamide is “typically used for turners [spatulas] or ladles due to their high heat and oil resistance.” “However, components of this plastic can migrate from the utensils into the food and consequently be ingested by consumers.” Out of 33 utensils tested, nearly 1 in 3 exceeded the upper safety limit. The German Federal Institute for Risk Assessment “recommends that consumers keep contact with food as brief as possible when using PA [polyamide] kitchen gadgets, especially at high temperatures,” such as above the temperature at which we may drink hot tea or coffee. 

    A different survey of black plastic kitchen utensils found about a third contaminated with flame retardant chemicals. Why? Because it may be made from plastic recycled from electronic equipment that was impregnated with the stuff. Then, should you dip the polyamide utensil into oil, the chemicals can trickle out, suggesting that using such “utensils for frying may lead to considerable dietary exposure.”

    The black dye itself in some polyamide utensils can leach out, too. Eventually, with enough use, the levels drop, but it may take the equivalent of boiling the utensils for about a hundred hours before the dye leaking approaches safety levels. It’s probably just easier to use utensils that are wooden or stainless steel.

    This is the last in a three-part series of cookware videos. If you missed the others, check out Are Aluminum Pots, Bottles, and Foil Safe? and Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe?.

    It may not be safe to microwave melamine, but what about microwaving in general? See Are Microwaves Safe? and The Effects of Radiation Leaking from Microwave Ovens. 

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    Michael Greger M.D. FACLM

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  • Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

    Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

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    Ketogenic diets have been found to undermine exercise efforts and lead to muscle shrinkage and bone loss. 
     
    An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic effect” of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means performance-impairing. 
     
    For nonathletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of “perceived exercise effort” and “also significantly correlated to feelings of ‘fatigue’ and to ‘total mood disturbance,’” during physical activity. “Together, these data suggest that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.” 
     
    You may recall that I’ve previously discussed that shrinkage of measured muscle mass among CrossFit trainees has been reported. So, a ketogenic diet may not just blunt the performance of endurance athletes, but their strength training as well. As I discuss in my video Keto Diets: Muscle Growth and Bone Density, study participants performed eight weeks of the battery of standard upper and lower body training protocols, like bench presses, pull-ups, squats, and deadlifts, and there was no surprise. You boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to a non-ketogenic diet added about three pounds of muscle mass, whereas the same amount of weight lifting on the keto diet tended to subtract muscle mass by about 3.5 ounces on average. How else could you do eight weeks of weight training and not gain a single ounce of muscle on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.” 
     
    What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plague children placed on ketogenic diets, along with slowed growth and kidney stones. Ketogenic diets may cause a steady rate of bone loss as measured in the spine, presumed to be because ketones are acidic, so keto diets can put people in what’s called a “chronic acidotic state.” 
     
    Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all, including osteoporosis, bone fractures, and kidney stones, then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. As you can see in the graph below and at 2:48 in my video, a single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas.  

    The young girl had a rare genetic disorder called glucose transporter deficiency syndrome. She was born with a defect in ferrying blood sugar into her brain. That can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into the brain, which makes a keto diet a godsend for the 1 in 90,000 families stricken with this disorder.

    As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs. Unfortunately, the alternatives aren’t pretty and can include brain surgery that implants deep electrodes through the skull or even removes a lobe of your brain. This can obviously lead to serious side effects, but so can having seizures every day. If a ketogenic diet can help with seizures, the pros can far outweigh the cons. For those just choosing a diet to lose weight, though, the cost-benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet, as I discussed in my video Flashback Friday: The Weight Loss Program That Got Better with Time.
     
    Remember the study that showed the weight loss was nearly identical in those who had been told to eat the low-carb Atkins diet for a year and those told to eat the low-fat Ornish diet, as seen below and at 4:18 in my video? The authors concluded, “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. 

    There are regimens out there like “The Last Chance Diet which consisted of a low-calorie liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths from cardiovascular-related events.” An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for those who produce deadly diet books. 

    It’s possible to construct a healthy low-carb diet or an unhealthy low-fat one—a diet of cotton candy would be zero fat—but the health effects of a typical low-carb ketogenic diet like Atkins are vastly different from a low-fat plant-based diet like Ornish’s. As you can see in the graph below and at 5:26 in my video, they would have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans. 

    And when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet and diminished on a low-carb one, as shown below and at 5:44 in my video. Heart disease tends to progress on typical weight-loss diets and actively worsens on low-carb diets, but it may be reversed by an Ornish-style diet. Given that heart disease is the number one killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss, too, as can tuberculosis and a meth habit. The goal of weight loss is not to lighten the load for your pallbearers. 

     
    For more on keto diets, see my videos on the topic. Interested in enhancing athletic performance? Check out the related videos below. 

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    Michael Greger M.D. FACLM

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  • Why You Should Never, Ever Take Too Much Vitamin C

    Why You Should Never, Ever Take Too Much Vitamin C

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    If you take vitamin C supplements, you may want to take a closer look at your dosage. Some people are overdoing it thanks to sketchy advice they’re seeing online, and developing uncomfortable side effects like nausea, headaches or heartburn — and, in extreme cases, painful kidney stones.

    Last week, a TikTok influencer battling colon cancer shared that she developed kidney stones after she’d been taking very high doses of vitamin C in an effort to boost her immunity and combat the cancer. She said she had been ingesting 50 g of vitamin C every day, she said, which equals a whopping 50,000 mg. The recommended daily intake for women is 75 mg.

    After seeing the video on TikTok, Dr. Ashley Winter, a board-certified urologist and chief medical officer at Odela Health, posted to X, formerly known as Twitter, to break down why taking too much vitamin C isn’t only unhelpful — it can also be dangerous.

    “Excess vitamin C in your diet doesn’t DO anything for your immune system because you just pee it out. And in your pee, the vitamin C becomes Oxalate, which is one of the major causes of KIDNEY STONES! YOU ARE LITERALLY FOLLOWING A DAMN KIDNEY STONE RECIPE,” Winter wrote.

    Supplement needs can vary, so it’s best to talk with a doctor to figure out what is best for you instead of going off the assumption that you need more of a vitamin for your health. And in the case of vitamin C, there can be such a thing as overdoing it.

    Vitamin C is a water-soluble vitamin that’s found in citrus fruits (think: oranges and grapefruit), cruciferous vegetables (such as cauliflower and kale) and potatoes. It plays an important role in the growth of our skin, bones and connective tissue. It’s also a powerful antioxidant, meaning it protects our cells from free radical damage. At a normal dose, which is 75 mg a day for women and 90 mg a day for men, vitamin C supports healthy immune function.

    You don’t want to have low levels of vitamin C, but the vast majority of people don’t. Too little vitamin C can cause issues like easy bruising and dry, splitting hair. Serious vitamin C deficiencies cause scurvy, a disease that can lead to fatigue, anemia and joint pain along with bleeding gums and loosened teeth. However, it’s not common — in the United States, about 7.1% of the population may develop any kind of vitamin C deficiency according to the Cleveland Clinic, and the incidence of extreme deficiency that leads to scurvy is rare.

    On the flip side, boosting vitamin C levels too high also brings issues. Because it’s water-soluble, vitamin C is not stored in your body. Your kidney processes it and you pee it out, Winter said. This means two things. One: High amounts of vitamin C won’t do anything for your health because it’ll just get excreted in your urine. Two: It can be risky. As your kidneys process an overflow of vitamin C, oxalate, one of the main causes of kidney stones, forms and accumulates. Over time, that oxalate can crystallize and turn into kidney stones, said Winter. Your kidneys will essentially have to work overtime and there are going to be health consequences, she added.

    Some of the milder signs you may be ingesting too much vitamin C include gastrointestinal problems like nausea, diarrhea, heartburn and vomiting. Plus, the higher your dose, the greater your risk of kidney stones. Kidney stones can block urine flow out of your kidneys and be incredibly painful. While some people can pass kidney stones naturally, others will need surgery to recover. In severe cases, too much vitamin C can even lead to kidney failure.

    “High doses of vitamin C don’t really ‘help’ that much,” said Dana Ellis Hunnes, a clinical dietitian, assistant professor at UCLA Fielding School of Public Health, and author of “Recipe for Survival.”

    Vitamin C supplements probably don’t boost your immune system, anyway.

    Hunnes said people are often looking to be healthy or healthier in general, and supplements are typically marketed as a relatively cheap way to achieve that. While vitamins and minerals are essential for several body functions, it’s important not to get carried away.

    “Just because a little bit of something is good doesn’t mean a lot of something is better,” she said.

    Winter said she started to see an uptick in patients taking extreme quantities of supplements like vitamin C during the pandemic, when many people were looking for natural ways to boost their immune system. (Data shows vitamin C sales soared during 2020.) It doesn’t help that you can find vitamin C products everywhere, with many claiming to enhance your health or boost your immune system.

    Despite the widespread popularity and accessibility of such products, there’s really no convincing evidence to support the belief that high doses of vitamin C do anything for your immune system, said Winter. “There’s this conflation between taking normal vitamin C, correcting scurvy, and using excess quantities of vitamin C for this quote-unquote immune boost,” she said.

    So, how much vitamin C should you take?

    As mentioned above, the recommended daily intake of vitamin C in adults is 75 mg for women and 90 mg for men. Most people get more than enough vitamin C by consuming fruits and vegetables or by taking a multivitamin and don’t need to take any vitamin C supplements, Winter said. Eating fruits and vegetables like oranges, strawberries, Brussels sprouts and broccoli, is the best way to get your daily dose of vitamin C. Not only are these foods a good source of the vitamin, but the calcium in them helps to inhibit the production of kidney stones, according to Harvard Health.

    That said, vitamin C supplements are recommended for certain health conditions that cause intestinal malabsorption problems or to counteract the side effects from some medications, like methenamine. Even in these situations, which should be closely monitored by a health care provider, a person probably wouldn’t need more than a 500 mg supplement, Winters said.

    If you do have a concern about the right amount of vitamin C for your needs, reach out to your physician. The upper limit for adults is 2,000 mg a day, but that doesn’t mean it’s worth getting close to the limit. Anything more than the recommended daily allowance or perhaps even up to two or three times that amount doesn’t really do you any good anyway, said Hunnes. “You’re best to get the daily requirement, maybe slightly more, and call it a day,” she said.

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