Make the Smart Switch to Low-Fat Milk - by Karen Walters, Bariatric Educator, B.Sc. Nutrition and Food
Posted by: sean in Diet and Nutrition on February 8th, 2010
Most people know that milk is a good source of calcium but it is also a good source of protein, vitamin D, and vitamin A. It also contains vitamin B-2 (riboflavin) and vitamin B-12, which play a role in cardiovascular health. Calcium is a mineral that helps us maintain strong bones and teeth, as well as helping muscles and nerves work properly. The calcium in milk has a high bioavailability, which means it is easily absorbed by the body. Vitamin D has been added to milk, which helps in the absorption of calcium and since we don’t get as much vitamin D from the sun as we used to it’s a much needed addition.
According to Health Canada, the recommended daily calcium goals are:
Most people know that milk is a good source of calcium but it is also a good source of protein, vitamin D, and vitamin A. It also contains vitamin B-2 (riboflavin) and vitamin B-12, which play a role in cardiovascular health. Calcium is a mineral that helps us maintain strong bones and teeth, as well as helping muscles and nerves work properly. The calcium in milk has a high bioavailability, which means it is easily absorbed by the body. Vitamin D has been added to milk, which helps in the absorption of calcium and since we don’t get as much vitamin D from the sun as we used to it’s a much needed addition.According to Health Canada, the recommended daily calcium goals are:
1300mg for healthy adolescents (ages 9-18 years)
1000mg for healthy adults (ages 19-50 years)
1200 mg of calcium for over the age of 50 years.
If you’re at risk for osteoporosis, your doctor may tell you to take in 1500 mg of calcium per day from foods and supplements combined.
A 250 ml (1cup) glass of milk contains 300mg of calcium, so if you’re not planning on drinking 3 to 4 glasses of milk per day you need to consume other foods that contain sources of calcium, such as 175 ml of yogurt or 50 g of hard cheese, which contain about the same amount of calcium as a glass of milk. Other non-dairy sources of protein include broccoli, almonds and canned salmon with bones.
Health Canada recommends that everyone from one to age 50 intake 200 IU of vitamin D per day, which can be accomplished by drinking 2 glasses of milk per day; ages 50-70 should be intaking 400 IU and ages 71 and up need 600 IU of vitamin D per day. Vitamin D is known for it’s immune boosting properties so it has been suggested that you may want to increase your vitamin D intake to 1000 IU. Fish, liver, and egg yolk are the only foods that naturally contain vitamin D, so if you’re not drinking any beverages that are fortified with vitamin D you should be taking a vitamin D supplement.
If you’re one of those people who cut milk from their diet because you view it as too fattening you may want to rethink your decision. By switching from 2% to skim milk you can eliminate some of the fat and calories without sacrificing any of the vitamin and mineral content of milk. If you were to drink one glass of skim milk as opposed to one glass of 2% milk, you would decrease the calorie content by 40 and the fat by 5g. This means that if you were to drink one glass of skim milk each day for one year you would decrease your calories by 14,600 which amounts to 4 lbs of body fat. If you currently drink homogenized milk you would save yourself 6 lbs of body fat by making the switch to skim milk. If you make the change gradual you won’t even notice the difference. Try first switching to 2%, then 1% and then skim.
So if you’re looking for an alterative for your Protein First on your meal plan, choose a nice cold glass of low-fat milk, it satisfies your protein need and contributes to healthy teeth and strong bones.
References Used:
www.dietitians.ca/
Got Protein? - By Emily Kielbeski, B.A.Sc., Bariatric Educator
Posted by: sean in Uncategorized on February 3rd, 2010
Protein plays a role in increasing your metabolism and aiding in weight loss. Including more protein in your diet is something that we suggest to nearly everyone. There are many foods that naturally contain protein (such as yogurt, cottage cheese, milk, lean meats, nuts, eggs, soy products, etc) that can contribute to your healthy diet. Sometimes, however, people look to protein supplements to enhance their protein intake. Supplements are just that; they are there to “supplement” your everyday diet, not to replace all your food selections.
Here is some information on what to look for when purchasing a protein supplement such as a protein powder or a protein bar.
First of all, remember your homework from your first visit? How we ask you to calculate the protein percent of the different food items? Protein percent means how much of the product is made of protein. This knowledge can be put to good use, and the equation is quite easy. When looking for “good” protein bars or protein powders, keep this equation in mind:
% Protein = grams of protein X 4 (there are 4 calories in each gram of protein), then divide by the total calories in the product x 100 to get the %.
The higher the % protein, the better the particular protein supplement! This will mean that the majority of the product is made of protein, and not carbs and fat which can inhibit weight loss efforts.
For example, a protein bar by Bariatrix Nutrition is around 150 calories and 15grams of protein. Doing the math, 15 x 4 = 60. 60 divided by 150 x 100 = 40%. This is great! There are also protein drinks, for example the Nutri15 drink packets, which are 70 calories and 15 grams of protein (15 x 4=60. 60 divided by 70=85%)
You can keep in mind this equation when looking at protein powders as well. You want the majority of calories to come from protein, not carbs and fat. There are different types of protein powders - whey protein isolate is the most pure and concentrated form of whey protein available. The one pictured here has around 20grams of protein per serving and around 120calories. That works out to be 67% protein.
You can incorporate protein powder into a variety of items – try mixing it into yogurt, sprinkling it on your oatmeal, or blending it with skim milk, fruit, and flaxseed for a delicious protein shake!
Overall, when looking at protein supplements, check out the total calories and where they are coming from. Is the product full of carbohydrates? Don’t confuse energy bars for protein bars – energy bars are much higher in carbohydrates.
Protein supplements have their place in weight management, but remember they are there to supplement a healthy diet that is also rich in natural protein from foods.
The Unsweetened Truth about Juice - By Janelle Ryan, BSc., Bariatric Educator
Posted by: sean in Uncategorized on February 2nd, 2010
Many of our patients are curious as to why we recommend to avoid or limit drinking fruit juice. Most people think that drinking juice is beneficial for them since they are getting vitamins and nutrients that they need. I always tell patients that I would recommend that they eat the actual fruit rather than drink the juice. It is very important to recognize that one fruit does not equal one glass of juice. It would take a lot more than just one fruit to make enough juice for someone to drink. The juice is also lacking in fibre as fruits tend to have fibre in their skin and this is not included in the juice. Below is a table showing the unsweetened fruit juice compared to fruit:
|
|
Calories |
Carbohydrates(g) |
Sugar(g) |
Fibre(g) |
|
McIntosh Apple (1 medium) |
80 |
19 |
14 |
3 |
|
Apple juice (1 cup) |
114 |
28 |
24 |
0 |
|
Cranberry (1 cup whole) |
44 |
12 |
4 |
4 |
|
Cranberry juice (1 cup) |
116 |
31 |
31 |
0 |
|
Orange (1 medium) |
62 |
15 |
12 |
3 |
|
Orange juice (1 cup) |
112 |
27 |
21 |
0 |
As you can see there is a big difference not only between the calories, but also the total carbohydrate values. Juice is made up of mostly sugars and contains no fibre.
If you find drinking water is too boring for you, there are many low calorie alternatives that you can use without turning to fruit juice. Drink tea, herbal teas or coffee with either low amounts of sugar or artificial sweeteners. Also there are many new products that are being made now such as flavoured water or Crystal light which are much lower in calories than juice. Adding some slices of lemon or lime gives water a refreshing twist. By avoiding fruit juices, achieving meal plan goals can become a lot easier.
References:
http://www.nutritiondata.com/facts/fruits-and-fruit-juices/1975/2
http://www.www.thedailyplate.com/nutrition-calories/food/compliments/mcintosh-apple-mac
Young Adults at Risk of Heart Disease due to Obesity - findings of the Heart and Stroke Foundation
Posted by: sean in Dr. Wharton's Blog on January 27th, 2010
Hamilton is in the eye of a perfect storm for an impending crisis of heart disease in Ontario.
The city has the seventh highest percentage of overweight and obese residents among the province’s 36 health units and the eighth highest for high blood pressure, according to the Heart and Stroke Foundation, which used data from Statistics Canada’s Canadian Community Health Survey.
Physical inactivity and being overweight create the conditions for diabetes, high blood pressure and high cholesterol, says Dr. Sean Wharton, an obesity expert with 7,000 patients in Hamilton and Halton.
The Heart and Stroke Foundation’s latest report, released yesterday, says the situation is so severe right across Canada, 50 years of progress “is being erased by an explosion of unhealthy habits.” It warns a “perfect storm” of risk factors and demographics are converging to create an unprecedented burden on heart care.
A person with a body mass index of 25 to 30 is overweight, and someone with an index of more than 30 is obese. The index is based on a person’s weight in kilograms divided by height in metres squared.
Also alarming is the increase in obesity, high blood pressure and diabetes among young adults — 30 to 40 per cent of Wharton’s patients are under 40.
The number of Canadians in their 20s and 30s with high blood pressure has almost doubled in 15 years to 250,000, says the report. Of those 20 to 34 years old, three million are inactive, 2.5 million are overweight or obese, two million smoke and 164,000 have high blood pressure.
The problem is that young adults don’t know what they are subjecting themselves to, Wharton says.
“And it’s not just them. I don’t think the community is aware their young people are sick.”
An inactive 22-year-old who weighs 250 pounds is not healthy, he says: “We have to help them understand what’s going on and what to do.”
The report says 20-year-olds are still Canada’s heaviest smokers.
“The young have increased their risk (of heart disease) incredibly,” Wharton says. “Young Hamiltonians are developing multiple risk factors or are already having early heart disease. We’re now seeing people develop high blood pressure in their late 20s.”
But baby boomers are also helping defy the progress made in heart disease. One in five adults aged 50 to 64 has two or more major risk factors — high blood pressure, diabetes, smoking or obesity — much of it due to overeating, poor eating habits and physical inactivity.
The report also warns boomers will “put great strain on the health-care system and turn back the clock on the gains we have made.”
Wharton said many don’t know what to do about their weight and how to restructure their lives to control it. The problem is not just stress, but not knowing simple things, he says — such as, always eating breakfast increases your metabolism, or that a bagel has 300 to 400 calories.
Burlington and Halton residents fare much better. Halton has the sixth lowest percentage of overweight residents and smokers and the eighth lowest in Ontario with high blood pressure. Halton also ranks in the top three communities where residents eat the recommended number of servings of fruits and vegetables per day.
Wharton believes the dramatic contrast between Hamilton and Halton is due to Hamilton’s poverty rates and Halton’s greater wealth.
The Heart and Stroke report calls on the Canadian government to implement a comprehensive heart health strategy.
Ontario ranks third highest of the provinces and territories for best heart health behaviours, after B.C. and Alberta. Nunavut is the worst.
905-526-3392
Water for Healthy Weight Loss - By Amanda Steel, Bariatric Educator
Posted by: sean in Diet and Nutrition on January 18th, 2010

We often forget that water makes up about 70% of the body. Muscles are 75% water; blood is 82% water; lungs that provide oxygen are 90% water; the brain is 76% water; even bones are 25% water. Therefore it only stands to reason that we should be drinking ample water in order for the body to function optimally.
Below are several reasons to add more water to your diet.
1. Water can help to naturally suppress the appetite. Sometimes the body confuses the signs of hunger and thirst. If you feel hungry, it might actually be that the body needs water. Try drinking a glass of water before you eat, this can make you feel fuller before meals and can help to curb overeating.
2. A person who is overweight needs more water. Water is needed in order for the body to properly metabolize body fat, so someone with excess fat tissue needs extra water. We need to drink about eight - 8 oz. glasses of water per day. An overweight person needs about 1 additional glass for every 25 pounds of excess weight.
3. Water is essential in relieving constipation. When you are dehydrated, the body siphons water from the colon, resulting in hard and dry stools. Fibre also absorbs water in the body, so when adding more fibre to the diet (from foods or supplements), it is imperative to drink more water. When you consume more water, it helps to promote normal bowel function and relief from constipation.
Thirst is often the final sign of dehydration, so if you feel thirsty, your body is telling you that you are probably dehydrated. Another good way to judge hydration is by the colour of your urine – generally it should be almost colourless or very light yellow. Dark colored urine may indicate dehydration.
Prevent dehydration by sipping on water throughout the day. Try hot, warm or cold water, herbal or green tea, or adding a slice of lemon or lime for some flavour. Kick start your day by drinking a tall glass of water upon waking.
References:
1. Batmanghelidj, F. Your Body’s Many Cries for Water. Global Health Solutions Inc. Vienna, VA. c. 1995 www.watercure.com
2. Robertson, Donald. “Water: How 8 glasses a day keep fat away”.
http://www.weightlosshalloffame.com/Helpful%20Documents/Water.pdf
Tips for Making Food Diaries Easier - by Lisa Tsugios, Bariatric Educator, B.Sc.
Posted by: sean in Uncategorized on January 18th, 2010
Many weight management programs in the past have used food journaling as a key to success, and ours is no exception - the benefits of food diaries have been known for some time. The truth is that people who are most successful at weight loss will be very good at watching what they eat, and there is no better way of achieving this than completion of regular food diaries. Here are some tips and strategies to make filling out diaries a little less painless:
1. It is important to recognize that there are different strategies for
completing food dairies – some people find success using food logs
attached to calorie-counting websites (an easy solution for those who are on the internet often). Others might prefer to stick to pen and paper. Many people create Excel spreadsheets. Computer software and Apps for Blackberries and iPhones are also available. There are also small portable calorie-counters, such as the CalorieSmart device, that are able to produce printouts on your computer.
2. Location is key. Are you keeping your food diaries safely tucked
away? Out of sight, out of mind often proves to be true. Try to keep
your food diaries in a place where they’re not only easy to access,
but within view.
3. In the initial phases of meal planning, you may find eating some of
the same things each day to be helpful. Most of us are creatures of
habit - pick a breakfast and three snacks that work for you, write
them out and photocopy your meal plans. Filling in less fields
throughout the day makes them much less labour intensive, while
reducing choice tends to also reduce stress.
4. Many people find that meal planning ahead of time is their key to success. Combining filling out food diaries ahead of time with this
behaviour often results in eating a balanced diet throughout the day. Filling out diaries ahead of time also works well for determining
proper portion sizes of food items that will fit well with your meal plan size, and is an absolute must when you are introducing a new food into your diet.
There are many different methods of completing daily food diaries, but the best method by far is one that works for YOU.
Emotional Eating - by Soraya Kanjee, Bariatric Educator, BSc. Foods and Nutrition
Posted by: sean in Uncategorized on January 18th, 2010
For many people, stressful situations can become so overwhelming to deal with that food is the only thing that makes them feel better. This is the point where attempts at weight loss can begin to suffer and trying to keep a meal plan can be a difficult challenge. If you have ever eaten because you were angry, worried, stressed or just plain bored, you have experienced what is called “emotional eating”.
Emotional eating is defined as using food as a distraction to soothe or suppress unpleasant emotions in our daily lives. People tend to start focusing on comfort foods instead of dealing with the emotions and feelings at hand. However, there are methods to overcome the behaviours of emotional eating.
Manage your stress
1. Try stress management techniques such as yoga, meditation and relaxation. If you find yourself in a stressful situation, try taking a few deep breaths and reassess the situation after some time. You are likely to feel better after having a couple of minutes to cool down.
Get a hunger reality check
2. Are you really hungry or is the feeling a result of boredom? If you only ate a few hours ago and don’t feel any rumbling in your stomach, you are probably not really hungry. Give your body some time to let the cravings pass. Try chewing gum, drinking water or even herbal teas.
Use food diaries
3. Journaling is a proven method to help people lose weight. Write down what you ate, when you ate and how much you ate in your diary. In addition write down how you are feeling, whom you are eating with, and even rate your hunger. Writing these details down might not help right away, but after a couple weeks you might be able to recognize a trend in your eating patterns and distinguish where and why you are bingeing.
Find support
4. Family and friends are meant for you to lean on when you need them, so take full advantage of them! If you don’t feel comfortable letting your friends and family know, consider joining a support group or even attend some of the emotional eating classes available at the WMC. Professional help is also available to help deal with emotional eating, stress and anxiety. Talk to your health care provider if you feel this is an option for you. Many different resources are also available to help. The Cognitive Behavioral Workbook for Weight Management by by Michele Laliberte (Author), Randi E. McCabe (Author), Valerie Taylor (Author) is a workbook to help readers struggling with their weight how to use proven-effective cognitive behavioral strategies to manage emotional eating triggers, overcome body image issues, and make positive lifestyle changes.
Keep busy
5. If you’ve ever been sitting in front of the television with a bag of chips and suddenly realized that the whole bag is done, you’ve experienced unconscious eating. Try incorporating more active activities into your day to keep you busy and away from temptations. When trying to relax try your best to eliminate the food aspect and concentrate solely on the relaxing part. For example, watch movies without the popcorn and watch TV without the chips.
Fight temptations
6. Temptations are hard to escape from when they are hiding in your kitchen cupboards. If you know that chocolate is your weakness, don’t bring it home! When going to the grocery store have a shopping list prepared and stick to the list. Also, grocery stores usually have healthier options around the outside aisles of the store; only go into the inner aisles if you need something on your list.
Snack healthy
7. Enjoy the pre-planned snacks to help curb any cravings. Try choosing the lower calorie version of your favourite snacks or even purchase the children’s size version of your favourite snack/meal. Low fat, low calorie snacks such as fresh fruit, yogurt, and even vegetables and dips are a great healthy alternative to high calorie snacks. Eating small frequent snacks throughout the day can help you to curb your appetite and satisfy any cravings.
Remember that having a craving does not mean that you are hungry! Give your body a chance to learn and recognize the difference. Making a conscious effort at working through your emotional eating setbacks can help to prevent future health problems. Many people fall off track during their weight loss journeys, but the most successful people are the ones who keep trying.
References
Hadzipetros, Peter. “Binge eating.” CBC. CBC, 30 Aug. 2007. Web. 08 Dec. 2009. <http://www.cbc.ca/news/background/health/binge-eating.html>.
”Weight-loss help: Gain control of emotional eating.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 19 Mar. 2009. Web. 10 Dec. 2009. <http://http://www.mayoclinic.com/health/weight-loss/MH00025>.
Staying motivated in the Winter months- by Renee Woloch, Bariatric Educator, BASc Applied Human Nutrition
Posted by: sean in Diet and Nutrition, Uncategorized on January 12th, 2010
With temperatures plummeting this time of year, most of us end up hibernating in our homes. But hibernating is for bears. It is important for us to stay active during all seasons. Maintaining your health in the winter heightens your mood. If you regularly exercise, you’ll keep your endorphins circulating throughout your body.
Think of winter as the best time to get outside and experience the sun and fresh air while you get in shape. While enjoying your outdoor activities, you can take in the stunning scenery that many Canadians miss out on while they’re stuck inside on the couch.
On the Homemakers magazine website I found these 3 ways to help make your fitness resolutions a successful part of your daily life.
Here they are…
Doing what you think you should do rather than what you enjoy

When you are looking for stimulation it is easy to look at someone else’s success. But its now time to ask what it is YOU like to do. The only exercise you will stick to is the one that you yourself enjoy.
Taking on too much too fast:
Enthusiastic motivation is a wonderful addictive feeling but it can cause you to go a bit overboard. If your lazy mornings consisting of relaxing and lying around on the couch suddenly turn into cardio marathons followed by some serious weight training, your body is not going to like you. By doing this you can cause yourself a lot of muscle soreness and that’s a de-motivator. If your exercise regimen is too demanding, you’re more likely to give up because you can’t keep up with it. Make small changes to your exercise routine and build on those small changes at regular intervals. For example, use a pedometer and increase your daily steps by 250 steps per day. Make is simple and achievable to start.
Negative thinking
Remove “can’t” from your vocabulary. It’s not that you can’t do something; it’s just that you haven’t learned HOW to do it yet.
With the right mindset and by following your meal plans, you will have enough energy to maintain an exercise regimen. This could be the year those fitness resolutions not only stick, but become a healthy lifelong lifestyle.

Obese patients with no medical problems are still at risk of increased mortality
Posted by: sean in Dr. Wharton's Blog, New developments on January 10th, 2010
Jennifer Kuk and Chris Adern, researchers at York University, have recently published data demonstrating that obese individuals who have few medical problems, are still at risk of early death compared to normal weight patients.
The article appeared in Diabetes Care. http://care.diabetesjournals.org/content/32/12/2297.full.pdf+html?sid=3977826d-bbbc-4272-94db-273630990ece
Metabolic Syndrome is defined as: increased abdominal girth, plus 2 of the following: diabetes or insulin resistance, high lipids and increased blood pressure. All patients with this condition have a higher mortality (death rate), compared to patients without these conditions. Many obese patients have metabolic syndrome, and this is why they are considered to have a higher risk of mortality. Therefore if an obese patient does not have any of these conditions, technically, they should not have a hgih rate of mortality. But is that true? And this is question that Kuk and Adern looked at.
The article examined data from 6,011 men and women from the Third National Health and Nutrition Examination Survey (NHANES III) who were metabolically normal or metabolically abnormal: defined as having insulin resistance (IR) or two or more metabolic syndrome (MetS) criteria.
A total of 30% of obese subjects had IR, and 38.4% had two or more MetS factors, whereas only 6.0% (or 1.6% of the whole population) did not have IR and all MetSyn factors.
Based on the mortality data over 8 years, both the metabolically normal and metabolically abnormal obese individuals had the same risk of mortality, about 2.5 to 3-fold elevation in mortality risk compared to the metabolically normal normal-weight individuals (who were used as the baseline).
Kuk and Adern conclude that even if you do not have metabolic problems, obesity in itself, puts you at greater risk of mortality, compared to being normal weight.
Why? What results in the increase risk. The metabolically normal patients were younger and less obese than the metabolic abnormal patients. Adern and Kuk suggest that individuals may develop metabolic syndrome in time, and that early treatment may help. They may also be at more risk for cancers, traumatic accidents and health care bias resulting in poor medical treatment.
This is an impressive article and has been backed up by another recent article, to be published in circulation. Circulation 2010; 121:230-236. This gives us evidence to continue to treat obese patients regardless of comorbid conditions, as per the NIH obesity treatment algorithms.
Sean Wharton, MD
The Story on Whole Grains - by Hilary Dunn, Bariatric Educator
Posted by: sean in Diet and Nutrition on January 6th, 2010
Incorporating whole grains into the diet is encouraged at WMC, and there are many new products claiming to be made with them. This blog will help explain why whole grains are best, and how to find the best choices.
Why choose whole grains?
- whole grains help you feel full sooner, so fewer calories are consumed
- improves your bowel function
- helps to lower bad cholesterol (LDL)
- decreases your risk of heart disease (women eating atleast 1 serving per day had 30-36% lower risk of heart disease-Iowa’s Women’s Health Study)
- decreases risk of heart attack (in men consuming 42 grams per day 18% decreased risk compared to those consume 4g)
- decreases risk of stroke (by 36% in women who ate 3 servings per day according to the Nurses Health Study)
Whole grains have health benefits and can assist with weight loss. But what is a whole grain? There are many products on the market claiming to be made with whole grains or whole wheat- even when they look white.
What is a whole grain?
A whole grain means the entire seed is used, and the seed includes:
Bran- the outer shell of the seed, where fibre and B vitamins are found
Endosperm- inner section that provides energy, where carbohydrates and protein are stored
Germ- in the endosperm, houses nourishment for the seed, contains B vitamins, vitamin E and phytochemicals
Whole wheat flour is made from whole grains and contains more nutrients than white or refined flour. During the refining process the bran and germ are removed from the seed, and therefore the nutrients they contain are lost as well. For example, 93% of vitamin E, 80% of the B vitamins, and 78% of fibre is lost during the refining process. You will also see enriched flour in ingredient lists; it is simply refined (white) flour with a few, not all, of the nutrients added back in. Enriched flour is most commonly used, and most importantly, it still contains fewer nutrients and fibre than whole wheat flour, despite being ‘enriched’.
Read labels carefully
Many packages will have ‘Whole wheat!’ or ‘Multigrain!’ printed across the front. Multigrain means literally that multiple grains have been used, but those grains may be from refined flours. It does not mean you are getting whole grains. For example, Multigrain Vegetable Thins are made with multiple refined grains, not multiple whole grains. The ingredient list will be the best place for information, as it will tell you what flours are used in the product. Enriched wheat flour, enriched bleached flour, unbleached wheat flour, rice flour, and durum wheat semolina are all examples of refined flour.
You need to look for products that list whole grain flour, whole wheat flour, or whole grain wheat flour. It should be first or atleast near the top of the ingredient list, as ingredients are listed based on the amount in the product with the largest amounts listed first. If an ingredient list begins with enriched wheat flour (white flour) and lists whole grain flour later in the list, then the product contains more white flour than whole wheat.
So the bottom line, read the ingredient lists to find products with whole grains! It will help increase fibre in the diet and provide more nutrients than refined flours.
Young adults, boomers all show risk factors