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THE PHYSICIAN AND SPORTSMEDICINE - VOL 33 - NO. 6 - JUNE 2022


Food Pyramid Goes Interactive
What's New for Patients?

The United States Department of Agriculture (USDA) recently unveiled MyPyramid, a new series of nutrition recommendations that replaces the previous food guide pyramid. The USDA hopes the new version will motivate consumers to make healthier food choices and increase their daily physical activity. According to the USDA, MyPyramid reflects the latest nutritional science and parallels the 2005 Dietary Guidelines for Americans, released in January of 2005. The recommendations are available at https://www.MyPyramid.gov.

The new food guide pyramid has been turned on its side and streamlined. A staircase up the side is designed to remind people to make small "Steps to a Healthier You." Bands of color represent the various food groups (orange for grains, green for vegetables, red for fruit, yellow for fats and oils, blue for milk, and purple for meats). Foods that should be eaten often (eg, grains, fruits, vegetables) have a wider color band than foods that should be eaten sparingly (eg, oils). Each color stripe is wider at the bottom to represent that unrefined foods (eg, whole grains, raw fruits and vegetables) should be eaten more often. The amount of processing with added sugars and fats increases as the stripe narrows toward the top, suggesting that fewer of these foods be eaten. All this is implied—but not specifically stated—in the graphic.

The familiar one-size-fits-all food pyramid has been replaced by 12 food patterns. Consumers who visit the Web site are asked to input their age, sex, and activity level. They are then guided to one of 12 food patterns based on daily nutrition needs ranging from 1,000 to 3,200 calories. Worksheets can be printed from the MyTracker page to help consumers monitor their food choices and activity level. Doctors and nutritionists can select "For Professionals" from the menu on the home page for access to educational tools.

Nancy Clark, MS, RD, a sports nutritionist in Chestnut Hill, Massachusetts, calls the pyramid a "missed opportunity." For example, she says the graphic loses its educational value when photocopied in black and white. She also notes that although the Web site has merit, not everyone has access to a computer. The Web site doesn't ask for height or weight, just age, when calculating calorie needs. "Although the pyramid validates that exercise is important, the calorie calculations for athletes tend to be on the low side," she says. Clark thinks a calorie range, rather than a single number, would be more appropriate.

Phillip Zinni III, DO, ATC/L, corporate medical director for E&J Gallo Winery in Modesto, California, says the new interactive Web site is useful. Two of his patients began using the site after he referred them to it. Zinni says the graphic, however, is confusing, because it doesn't tell you if the base is good or bad, how wide a band has to be before it's considered "bad," or which bands clinicians should emphasize to their patients.

Susan Kleiner, PhD, RD, a nutrition authority and author in Mercer Island, Washington, says the concept is a good one, but the material isn't really ready for public use yet. "There are many errors and inconsistencies as you move around through the site and input information," she says. One problem she notes is possible confusion about carbohydrate sources. "Starchy vegetables are listed under vegetables, but nutritionally the carb contents make them more similar to breads. A bread/starch category would be helpful so that people really understand what they are eating," Kleiner says. She says that people may still want more help with menu planning, but this is a good start. Kleiner cautions users not to take the recommendations as gospel, and to wait until the bugs are worked out of the program.

Donald M. Christie, Jr, MD, an internist and sports medicine physician in Lewiston, Maine, says he recommends the new food pyramid Web site to all his patients who have Internet access, a knack for spending time on-line, and enough patience to click through all the steps. He sees one benefit in that the Web site lists amounts of actual foods, which helps patients translate theoretical needs into "real food," and that helps them decide what to buy at the grocery store. He adds that the graphic might better be called a "technicolor dreamcoat" or a "food rainbow" rather than a pyramid and reminds patients to shop for the colors of "real food," rather than artificially colored, prepared foods.

Patricia D. Mees
Minneapolis


Update on Congressional Efforts to Strengthen Anti-Doping Laws

Dual bipartisan efforts are underway in Congress to pass federal laws that would standardize drug testing and sanctions for professional athletes.

In late April, Rep Cliff Stearns, a Republican from Florida, and cosponsors proposed the Drug Free Sports Act (HR 1862), which would authorize the US Commerce Secretary to oversee drug testing rules for sports. The law would subject professional athletes who test positive for performance-enhancing drugs to the same sanctions that are applied among Olympic competitors who test positive: a 2-year suspension for a first offense and a lifetime ban for a second offense. According to a draft of the bill, professional leagues that don't comply would be fined at least $5 million.

Stearns and his colleagues on the House Commerce, Trade, and Consumer Protection subcommittee have held a series of hearings on Capitol Hill to learn more about sports league drug testing policies. Their counterparts on the House Government Reform Committee, headed by Rep Tom Davis, a Republican from Virginia, have held similar hearings and introduced their own legislation that would include and go beyond the Drug Free Sports Act. The Clean Sports Act of 2005 (HR 2565) would impose multiple random tests for performance enhancing drugs during the season and off-season.

The legislation guarantees that players who test positive receive due process. It also gives the Office of National Drug Control Policy the authority to require additional sports leagues and National Collegiate Athletic Association Divisions 1 and 2 to comply with the more stringent rules, and it establishes a commission that would report on performance enhancing drug use in high school and college and provide recommendations for reducing their use. Sen John McCain, a Republican from Arizona, is expected to introduce a companion bill in the Senate.

Hearings Draw Headlines

Legislators' interest in performance-enhancing drugs in professional sports appears to have been sparked by a book that alleges baseball's biggest stars had used steroids. Also, President George W. Bush focused attention to the problem of performance-enhancing drug use in his 2004 State of the Union address. High-profile deaths of two professional athletes—Korey Stringer and Steve Bechler—have also fueled concern about the safety of performance-enhancing substances.

The list of witnesses on Capitol Hill have included professional athletes, commissioners of sports leagues, drug testing experts, and sports medicine professionals. Those from the sports medicine community have included:

• Doping experts Gary I. Wadler, MD, associate professor of clinical medicine at New York University School of Medicine in Manhasset, New York, and Charles Yesalis, MPH, ScD, professor of health and human development at The Pennsylvania State University in University Park;
• Sports medicine physician John Lombardo, MD, a drug adviser to the National Football League (NFL) and medical director for sports medicine at The Ohio State University in Columbus;
• Researcher Linn Goldberg, MD, professor of Medicine, Oregon Health Sciences University; and
• Houston Rockets athletic trainer Keith Jones, ATC, and Sandra Worth, ATC, head athletic trainer for the University of Maryland.

Some of the hearing sessions can be viewed at the C-Span Web site.

What's Ahead?

Debate is expected to continue as the two laws progress through Congress. Most professional sports leagues have taken the stance that they already have adequate drug policies in place, and that the leagues are best equipped to police their own players. Players unions have also spoken out against federal oversight of drug testing.

Major League Baseball, which was the first group to appear before Congressional hearings, recently announced new, tougher drug testing policies and penalties. Baseball commissioner Bud Selig, in a break from other sports officials, has said that he is open to the idea of federal intervention if the drug-testing policies of professional prove to be inadequate.

Lisa Schnirring
Minneapolis


Field Notes

CDC Recommends Two New Repellents

The US Centers for Disease Control and Prevention (CDC) recently updated its recommendations about insect repellents to include two new active ingredients that have shown long-lasting protection against mosquitoes: picaridin and oil of lemon eucalyptus. The guidance was released in late April in advance of the 2005 West Nile virus season.

According to an April 28 CDC news teleconference, one product containing 7% picaridin (Cutter Advanced, Spectrum Brands, Inc, Atlanta) is being distributed in the United States this year. The CDC says that picaridin is similar in efficacy to N, N-diethyl-3-methylbenzamide (DEET). The other repellent, oil of lemon eucalyptus, provides protection similar to low-concentration DEET products and is available in several formulations throughout the United States.

The CDC said though DEET has been used for many years and has a good safety record, many consumers are suspicious of it or don't like its smell. Lyle Petersen, MD, MPH, director of the CDC's Division of Vector Borne Infectious Diseases, said the agency expects to see West Nile virus activity continue to spread into the Northwest; in 2004, the virus entered new areas of California and Oregon. Last year the virus was present in all continental states except for Washington state.

Emily Zielinski-Gutierrez, DrPH, a behavioral scientist for the CDC Division of Vector Borne Infectious Diseases, says that people older than 50 have significantly lower rates of repellent use than younger people, but the same group is at a higher risk for getting severely ill if they become infected with the virus. She advised consumers to keep repellent products close at hand, for example, near the back door, next to gardening tools, and alongside golfing equipment.

Zielinski-Gutierrez also noted that the CDC is trying to address lower insect-repellent usage rates in the Latino population.


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