Gut Microbiota and the Developing Child

by Ayten Salahi

Undernutrition poses a formidable threat to the health and life trajectory of children around the world. A new study examines the role of gut microbiota in modulating nutritional status and early life development, and sheds light on bacterial transplants as a potential new method to tackle this longstanding challenge.

The human gut microbiome is the bacterial ecosystem that lives predominantly in the digestive tract and plays a significant role in our immune response, neurological networks, and both our mental and physical development throughout life. The delicate balance of ‘good’ and ‘bad’ gut bacteria – or gut maturity – partially determines a developing child’s ability to absorb critical nutrients through food. Without that ability during early life, or without medical interventions to restore that ability, children are likely to manifest long-term health consequences associated with childhood undernourishment, including physical stunting, immune dysfunction, and neurodevelopmental issues. Childhood undernourishment has also been linked to permanent impairments to health and human capital, that impact both extant and future generations.

The ‘solution’ to childhood undernutrition is multivariate. As scientific understanding of microbiota continues to evolve, researchers and healthcare practitioners have begun to shift their focus towards examining how the microenvironments of our gut bacteria impact our macroenvironments, and whether these microenvironments could signal potential new treatment targets to alleviate the global burden of childhood undernutrition.

Bacterial transplants have been identified as one potential treatment. A study from Blanton et al. examined whether developmental outcomes could be inherited through microbiota – specifically, through fecal transplants. They tested what would happen if germ-free mice were transplanted with the gut bacteria of both ‘healthy’ and  ‘severely stunted’ infants and children, all of which were fed a traditional Malawian diet of cornmeal, peanuts, and kidney beans. The results showed that when germ-free mice were transplanted with fecal transplants from severely undernourished children, the mice manifested stunted growth, impaired bone morphology, and metabolic abnormalities in the muscle, liver, brain, and immune system. This study therefore suggests that gut bacteria play a role in the transference of developmental outcomes.

Findings from the same study also suggest that microbiota transplants from healthy donors could potentially prevent growth impairments and undernourished health outcomes in recipient animals, depending on the age of the donor and the type of bacteria. When researchers co-housed mice that had just received microbiota from either 6-month-old healthy donors or severely undernourished donors, microbiota from the healthy donor group overpowered and displaced the microbiota from the undernourished donor group, and prevented developmental impairments in both groups.  More research is needed to confer these findings in humans, but the results of this study present the interesting possibility that gut immaturity can be prevented and repaired through transplantation of microbiota from healthy donors. Future research must also be conducted to examine whether bacterial transplants play a role in preventing long-term mental, physical, and socioeconomic consequences of early life undernourishment, or constitute any reduction to the global burden of childhood undernutrition.

Study of microbiota in the developing child offers a compelling new lens with which to examine health inequity at the microscopic scale, with macroscopic implications for therapeutic interventions in community health. Adequate nutrition is the cornerstone of human development, and a growing body of evidence suggests that gut microbiota play an important role in promoting early life nutritional status. The potential therapeutic use of bacterial transplants could have significant implications for global nutrition programs seeking to identify new levers to improve childhood nutrition, particularly in resource-poor settings. However, gut microbiota therapeutics constitute only a small and largely theoretical part of the much bigger and more complex picture that is global nutrition. Pervasive issues around sanitation, hygiene practices, and access to potable water and nutritious food continue to constitute some of the greatest challenges to global health worldwide.

Ayten Salahi is a first-year FPAN MS and RD candidate, and is dedicated to the future of policy, programming, and clinical practice in sustainable diets. Ayten came to Friedman after working as a molecular and clinical researcher in neuropharmacology and diabetes management for nearly 8 years.

Advertisements

NewTrition Welcome Back 2017

by Kenny Westerman, Katherine Rancano, Jessica Ellis and Jennifer Huang

NewTrition_logo

NewTrition uses a platform of TED-style talks to generate excitement and discussion about the field of nutrition both within and outside of the Friedman community. Previously, NewTrition has invited students, professors and external speakers to deliver short presentations on topics that interest them (which are not necessarily related to their coursework or research!) Check out this vimeo to get a better idea.

If you are interested in helping us organize these events this year, giving a talk yourself, or nominating someone else who you think would be a great speaker, please email tuftsnewtrition@gmail.com! Also, feel free to contact Kenny, Katherine, Jessie, or Jennifer with any questions.

Contact:

Revival of the Student Research Conference

by Jennifer Huang

The 10th Future of Food and Nutrition Graduate Student Research Conference, known fondly within the Friedman community as the SRC, took place on April 7th and 8th. Jennifer Huang gives us a photo-filled recap of this student-led event, where she—and all who attended—were blown away by the amazing capabilities of student presenters and the Friedmanites who worked tirelessly since last November on planning this event.

This year the SRC had its first-ever Poster Slam, where presenters competed against one another to win the prize for the best three-minute talk about their research. A total of 13 presenters from various institutions participated at this Friday evening event where an anomaly at Friedman occurred: Free beer and wine! (And delicious veggies, of course). Some presenters transformed their talks into an entertaining rap or poem, while others presented theirs straight. Topics ranged from food insecurity during and after climate shocks, celebrity marketing to global food supply and demand. Overall, there was just the right amount of (wine-fueled) nerdiness!

On Saturday, Helena Bottemiller Evich, Senior Food and Agriculture Reporter at POLITICO, gave the keynote lecture. While Helena anticipates fewer advancements in agriculture and nutrition policy during the Trump presidency than during the Obama administration, she holds a bit of hope after browsing Ivanka Trump’s Instagram, finding pictures of healthy food and farming. Maybe having Ivanka as an adviser isn’t a terrible thing after all, she mused. Helena also noted that advocates for the National School Lunch Program and other nutrition programs seem to agree as they have already begun to target lobbying efforts in Ivanka’s direction. In addition to Ivanka, Helena also mentioned other key players to follow for agriculture and nutrition issues, such as Chairmen Roberts in the US Senate Committee on Agriculture, Nutrition and Forestry and Chairmen Conaway in the US House Committee on Agriculture.

Helena recounted how she got out of her urban “bubble” before the election and spoke to farmers around the country. As a result, she was one of the few in Washington, D.C. who correctly predicted Trump presidency. She ended her talk by encouraging us all to branch out of our personal networks and engage with others of different mindsets.

Helena Bottemiller Evich gave her keynote speech. Photo: Jeroen Eyckmans.

Helena Bottemiller Evich gave her keynote speech. Photo: Jeroen Eyckmans.

The panel discussion in the afternoon continued the conversation about the future of food and nutrition, and was equally inspiring. The panelists came from various sectors, including Dr. Julian Agyeman, a professor of Urban and Environmental Policy and Planning at Tufts University, Dr. Richard Black, Principal at Quadrant D Consulting who recently served as the VP of Global R&D Nutrition Sciences PepsiCo, Ms. Anne McHugh, the Director of Chronic Disease Prevention and Control Division at the Boston Public Health Commission, and Ms. Sylvia Rowe, President of SR Strategy. Our very own Dr. Parke Wilde moderated the panel.

When discussing the role of scientific evidence across sectors, Ms. Rowe clearly summarized the current social climate when she said, “There is not going to be science for the sake of science anymore, [as] public faith in science is questioned.” On the topic of private and public partnerships, there was consensus among the panelists that it will be critical to “find the synergy of goals,” as stated by Ms. McHugh.

The panel ended on a lighthearted note when a student asked a hypothetical question: Without time and monetary constraints, what questions (not necessarily about food) would the panelists want to ask and solve? The answers ranged from establishing public-private partnerships to combatting obesity, nudging behavioral changes for healthier lifestyle, discovering the role of microbiome in health and disease, to promoting public acceptance of diversity by understanding our personal genomics. Their diverse responses suggest the richness of this multidisciplinary discussion.

Panel discussion on the role of scientific evidence across sectors. Photo: Jeroen Eyckmans.

Panel discussion on the role of scientific evidence across sectors. Photo: Jeroen Eyckmans.

 

Of all the wonderful SRC activities, I personally enjoyed interacting with student presenters the most during the Saturday presentation sessions and poster session. I learned about my fellow classmates’ research, such as alfatoxin exposure in pregnant Nepalese and the minimum grocery delivery order requirement for elderly SNAP participants. I also met people from other institutions who are working on topics I have been learning about in class. When I chatted with an Emory student about her qualitative evaluation of food and nutrition security knowledge and practices in Guatemala and Honduras, I drew my learning from Dr. Jennifer Coates’ NUTR217: Monitoring and Evaluation. When a University of Delaware student presented his regional field experiment on nontraditional irrigation water, I saw how the concepts I have learned in Dr. Sean Cash’s NUTR341: Economics of Agriculture and the Environment are applied. I am excited to cross paths with those students again when we are professionals.

Faculty and student presenters at the poster session. Photo: Jeroen Eyckmans.

Faculty and student presenters at the poster session. Photo: Jeroen Eyckmans.

 

The 10th Future of Food and Nutrition Conference ended with a delightful networking reception at Trade, where conference presenters and participants continued their conversations and deepened their connections with mouthwatering appetizers and refreshing drinks.

Networking reception. Photo: Jeroen Eyckmans.

Networking reception. Photo: Jeroen Eyckmans.

The learning and the personal connections that this year’s SRC has facilitated for meand for all who attendedare invaluable. The coming together of creative and ingenious students from around the country who are working to make our food and nutrition future better is truly an event you need to see to believe. I am grateful for the SRC team, particularly the SRC chairs, Dianna Bartone and Delphine Van Roosebeke, for leading this wonderful event. I am already looking forward to the 11th Future of Food and Nutrition SRC!

The hardworking team of Friedmanites who made the 10th SRC possible! Photo: Jeroen Eyckmans.

The hardworking team of Friedmanites who made the 10th SRC possible! Photo: Jeroen Eyckmans. 

 

Jennifer Huang is a first-year Food Policy and Applied Nutrition MS student and a registered dietitian. She is interested in econometrics, agricultural trade, and food safety.

Evaluating the Pinnertest: The Importance of Scientific Evidence

by Erin Child

So, you think you have a food intolerance? What do you do? You could call your doctor and set-up an appointment that is inevitably months away. Then you have a 10-minute meeting in which they only look at their computer and refer you to a specialist, THEN go through more testing, and finally (hopefully!) get some answers. Or, you could order an at-home kit that takes 10 minutes to complete and promises results that will get you feeling better, sooner. Which one do you choose? Read on and decide.

In our current world of food intolerances and hypersensitivities in which the best path to treatment is often a conundrum, the Pinnertest promises an easy solution to any dietary woes.  A few months ago, I started noticing ads for this new test popping up on social media. The Pinnertest is an over-the-counter food intolerance testing kit that uses microarray technology to test for IgG (Immunoglobulin G) mediated sensitivities for 200 common foods.

The classic manifestations of true food allergies (hives, oral discomfort, trouble breathing, anaphylaxis, etc) are mediated by overproduction of IgE antibodies. Like IgE, IgG is a type of antibody. And IgG is the most common antibody in the human body. (The immune system releases five types of antibodies: IgA, IgE, IgG, IgD, and IgM.) Instead of testing IgE mediated allergies, the Pinnertest producers claim that the microarray technology allows them to test for IgG mediated intolerances to 200 different foods—including lettuce, quail, and baking powder—using only a few drops of blood. It sounds scientific, but also seemed too good to be true. Was it?

I started my research by reaching out to the Pinnertest folks directly. My goal? To score a pro-bono test to try it out myself and see the results first hand. I was thrilled when a friendly representative at Pinner immediately reached out to set up a phone interview (calendar evite and everything). When the day came, I called—and was sent to voicemail. Twenty minutes and five tries later, I knew I had been ghosted. My subsequent emails were ignored, and my quest to learn first-hand about the scientific evidence backing their product was squashed.

So, I began researching on my own. The Pinnertest website sports a cluttered page of medical study citations that cover work on food allergies, intolerances and Celiac Disease—but none of which provide any evidence of using IgG testing for food intolerances.  My own PubMed search [IgG + food intolerance; Immunoglobulin G + food intolerance] yielded little, but did include one recently retracted 2016 article linking IgG testing to food allergies. The rest of the Pinnertest website leads you down a rabbit-hole of B-list celebrity endorsements and every Friedman student’s favorite—Dr. Oz videos! Interestingly, nowhere on the site does it tell you the cost of the test. To find out pricing, you must first enter your information (“Hi, my name is Newt Trition”) before you discover that the test will run you a whopping $490.

To further explore if this test has any scientific merit, and is worth the hefty price tag, I reached out the Boston Food Allergy Center (BFAC). Dr. John Leung, MD, the founder and CEO of the BFAC, and the Director of the Food Allergy Center at Tufts Medical Center and Co-Director of the Food Allergy Center at Floating Hospital for Children, took some time out of his day to answer my questions. Dr. Leung said, “We have patients coming into our office on a weekly basis with that kind of report [IgG], who pay out of pocket no matter what insurance they have. [Insurance doesn’t cover the test] because there is a statement from both the American and European Societies for Allergy saying that this test has no clinical significance.”

This is something to consider in any area of medicine—if a test is not covered by insurance, it may be the first sign that clinical significance could be lacking.

My conversation with Dr. Leung was brisk, informative, and confirmed my gut reaction that this test was too good to be true. Furthermore, there is a body of literature providing evidence that IgG mediated reactions are a sign that a food intolerance does not exist, not the other way around. In a 2008 European Academy of Allergy and Clinical (EAACI) Task Force Report, the authors wrote, “food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components.” Simply put, IgG evidence can show that you’ve been eating that food, not that you are intolerant to it. The EAACI has been joined by their Canadian, American, and South African counterparts in clear statements that research does not support the use of IgG mediated testing for food intolerances at this time.

Having shadowed Dr. Leung at the BFAC, I know that he takes patients’ claims of food intolerances seriously, and is invested in using the best clinical practices and scientific evidence available to make the diagnosis. Concerning IgG mediated testing, he stated, “There is so little research, so from a clinical view it is not very useful, it doesn’t mean much. It is not diagnostic.” And yet, the Pinnertest website claims that the“Pinnertest is a common procedure in most European countries. In many cases, dietitians and nutritionists will ask for their client’s Pinnertest results before creating any kind of diet plan.” Since this approach directly contradicts the current EAACI recommendation, that’s highly unlikely.

I also had the opportunity to speak with Rachel Wilkinson, MS, RD, LDN, and Practice Manager of the BFAC. Rachel explained, “If patients come in concerned about food intolerances, we can do the hydrogen breath test for lactose, fructose or fructan [found in some vegetables, fruits and grains]. These are the three main ones [food intolerances] we can test for, because we actually have tests for those.” She went on to state, “What was interesting to me about the Pinnertest, was how they say they can specify one specific food–so not just a category. I honestly don’t understand how they would pinpoint a specific food. It makes more sense to me to listen to patient’s histories and to look at how their intestines are able to break down that particular group of sugars. So, I really would love to know how they [Pinnertest] are coming up with this.”

It is important to note that the Pinnertest is not just marketing itself as a food intolerance test. It is also presenting itself as a weight loss tool. Current Frances Stern Dietetic Intern and Masters Candidate Jocelyn Brault, interning at BFAC, indicated her concern: “I think this is also being marketed for weight loss, which you can see throughout their website. This is usually a good sign that we should dig deeper. Is this a proven weight loss method? This claim seemed out of nowhere to me.” Indeed, directly on the Pinnertest box it reads, “Discover which foods are making you sick or overweight.” If taken seriously, this test will result in unnecessary diet restrictions, and potential malnutrition if too many foods are unnecessarily eliminated. Rachel Wilkinson, RD noted, “if you’re going to be avoiding certain types of foods, you need to make sure your diet is still adequate. We do not want to see people over-restricting foods for no reason.”

Over the course of my research and conversations with Dr. Leung, Rachel, and Jocelyn, I confirmed that my initial gut reaction was correct: too good to be true. And here’s the kicker, so does The Pinnertest. In a tiny disclaimer at the bottom of their website, they write: “Quantification of specific IgE antibodies to foods and inhalants is an FDA-accepted diagnostic procedure for the assessment of allergies. However, the assessment of human IgG antibodies specific for individual food and inhalant antigens is not an FDA-recognized diagnostic indicator of allergy.”

It is a noble task to try to design an allergy test that does not require you to doctor hop, or wait months for an appointment, but the scientific evidence needed to back up the Pinnertest is lacking. Perhaps one day this will shift, and the body of evidence will improve. In the meantime, however, anyone who thinks they might have a food intolerance (or food allergy) is best served by going to their clinician (and then a dietitian). This at-home kit promises a quick fix, but is really just an expensive, dangerous distraction.

Erin Child is a second-semester NICBC student in the dual MS-DPD program. She is fascinated by the science of food allergy and intolerances, and will probably keep writing about them until someone tells her to stop.  With two weeks left in the semester, she would really like a nap. Like right now.

Nutrition in a Nutshell: Lessons Learned as a Dietetic Intern

by Katelyn Castro

I was one of those few teenagers who knew exactly what I wanted to be when I grew up. Now, after four years of college and two years of graduate school combined with a dietetic internship, a career as a registered dietitian is not far out of reach. While my passion for nutrition has never dwindled over these last six years, my approach nutrition has changed significantly.

Nutrition tips on the sidebar of Self magazine, an over-simplified nutrition lesson in a health class in middle school, and a quick nutrition lecture from my pediatrician, summed up my understanding of nutrition before entering college. Now­—six years of coursework and 2000+ hours of dietetic rotations later—I not only know the nitty-gritty details of nutrition science, but I also have learned some larger truths about nutrition that are not always talked about.

Beyond what you may read as you thumb through your social media feed, or even what you may learn from an introductory nutrition textbook, here are some of the lessons that I have acquired about nutrition along the way:

1- Nutrition is an evolving science.

First, let’s be clear that nutrition is a science that relies on concepts from biology, chemistry, anatomy, physiology, and epidemiology to study how nutrients impact health and disease outcomes. Understanding how diabetes alters carbohydrate metabolism allows people with diabetes to live without fear of dying from diabetic ketoacidosis or seizures due to unsafe blood glucose levels. Understanding how ulcerative colitis impacts mineral absorption and increases protein losses helps those with the condition manage nutrient deficiencies with adequate nutrition supplementation. These are only a few examples of the many ways our knowledge of nutrition science makes it possible to improve individuals’ health outcomes.

However, the more I learn about nutrition, the more I realize that the research still holds many unanswered questions. For example, previous nutrition guidelines, like when to introduce hypoallergenic food to children, are being disproven and questioned by more recent studies. On the other hand, research on the gut microbiota is just beginning to uncover how one’s diet interacts with their gut microbiota through hormonal and neural signaling. Staying up-to-date on the latest research and analyzing study results with a critical eye has been crucial as new scientific discoveries challenge our understanding of nutrition and physiology.

Who would have thought a career in nutrition would require so much detective work?

 2- Food is medicine, but it can’t cure everything.

The fact that half of the leading causes of death in the U.S. can be influenced by diet and physical activity highlights the importance of nutrition for long-term health. Using medical nutrition therapy for patients with variety of health problems, ranging from cancer and cardiovascular disease to cystic fibrosis and end-stage renal disease, has also allowed me to see nutrition powerfully impact the management and treatment of many health conditions. High cholesterol? Avoid trans fat and limit saturated fat in foods. Type 2 diabetes? Adjust the timing and type of carbohydrates eaten.

While making simple changes to eating habits can improve lab values and overall health, nutrition is often only one component of treatment accompanied by medication, surgery, therapy, sleep, and/or stress management. Interacting with patients of all ages and health problems, and working with health professionals from a range of disciplines has forced me to step out of my nutrition bubble and take a more comprehensive approach to patient care: Improving quality of life and overall health and wellbeing is always going to be more important than striving for a perfect nutrition plan.

3- Nutrition is political and nutrition messages can be misleading.

Back when the Academy of Nutrition and Dietetics was one of many health organizations sponsored by Coca-Cola and PepsiCo, I realized how much influence large food industries have on food advertising, marketing, and lobbying. With known health consequences of drinking too many sugary beverages, the concept of health organizations being sponsored by soda companies was perplexing to me. Learning more about the black box process of developing the government dietary guidelines has also made me more cognizant of government-related conflicts of interest with industries that can color the way nutrition recommendations are presented to the public.

Industry-funded nutrition research raises another issue with nutrition messaging. For example, only recently a study revealed that the sugar industry’s funded research 50 years ago downplayed the risks of sugar, influencing the debate over the relative risks of sugar in the years following. Unfortunately, industry-sponsored nutrition research continues to bias study results, highlighting positive outcomes, leaving out negative ones, or simply using poor study designs.  While sponsorships from big companies can provide a generous source of funding for research, as both a nutrition professional and a consumer, I’ve learned to take a closer look at the motives and potential bias of any industry-funded nutrition information.           

4- Nutrition is not as glamorous as it sounds, but it’s always exciting.

When the media is flooded with nutrition tips for healthy skin, food for a healthy gut, or nutrients to boost mood, the topic of nutrition can seem light and fluffy. With new diets and “superfoods” taking the spotlight in health magazines and websites, it’s easy to think of nutrition as nothing more than a trend.

However, any nutrition student or dietitian will prove you otherwise. In the words of one of my preceptors, “my job [as a dietitian nutritionist] is not as glamorous and sexy as it sounds.” Throughout my dietetic rotations, my conversations with patients and clients have gone into much more depth than just aesthetics and trendy nutrition topics. If I’m working with a patient with Irritable Bowel Syndrome, bowel movements (a.k.a poop) may dominate the conversation. If I’m counseling someone who has been yo-yo dieting, I may be crushing their expectations of fad diets while encouraging more realistic, sustainable healthy goals. If I’m speaking with a group of teenagers with eating disorders, I may not talk about nutrition at all and focus more on challenging unhealthy thoughts and behaviors about food. It is these conversations, discussing what really matters when it comes to food, nutrition, and overall health that make a career in nutrition ever-changing and always exciting.

Katelyn Castro is a second-year student graduating this May from the DI/MS Nutrition program at the Friedman School. She hopes to take advantage of her experiences at Tufts to make positive impact on individuals’ health and wellbeing through community nutrition outreach. You can follow on her journey as she blogs on all things relating to food and nutrition at nutritionservedsimply.com.

 

 

Finding Common Ground for Nutrition in a World of Alternative Facts

by Rachel Baer

Rachel Baer tackles the implications of the “post-truth” culture for the nutrition profession and poses 3 questions to consider about our response to the unending barrage of nutrition-related “alternative facts.”

As a registered dietitian, I can tell you this: Nutrition professionals know a thing or two about alternative facts. We spend our careers with textbooks and scientific journals in hand, waiting for the next misinformed food fad to go viral. We fight to defend the facts because we have always believed that if we could show people what is true, we could convince them that we have the best answers for their nutrition-related questions. But the concept of truth is losing popularity.

The Oxford English Dictionary declared the term “post-truth” to be the 2016 word-of-the-year. Post-truth is defined as “related to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.” Let that sink in for a moment: emotional appeals are more influential than objective facts. While this concept is alarming on many levels, I am particularly concerned about its implications for health professionals who rely on scientific truths as the basis of their credibility.

Don’t get me wrong. I understand the frustration people feel as they watch seemingly contradictory nutrition headlines emerge at the very hint of new research findings. One day people are told to limit egg consumption to 3 yolks per week, the next, the one-yolk-per-day allowance is back. However, as nutrition professionals, we have a certain appreciation for the fact that science is ever-evolving. We hold our recommendations lightly because we believe in a scientific community that is always growing, and that new discoveries only sharpen our understanding of nutrition and physiology. The public, on the other hand, does not always share this appreciation.

Confusion over wavering nutrition claims is exacerbated by the inundation of un-credentialed, unschooled voices clamoring for attention in popular media. Social media has provided a proverbial soapbox for anyone with a passionate message to share, regardless of qualifications. Simultaneously, dietitians tend to hold back on making bold retorts, often waiting for consensus to catch up with the fads so that our recommendations are supported with the latest research. This seeming imbalance of voices alongside the emergence of the post-truth culture only perpetuates the proliferation of unfounded claims, or “alternative facts,” as they have become popularly known.

I have no easy answers for this predicament, but here are 3 questions that we could benefit from exploring as nutrition professionals:

1. How do we remain experts while also being compelling?

Dietitians have long been referred to as the “food police.” While I resent this reputation, it highlights a worthy question: Do nutrition professionals present information in a way that is relatable, realistic, and winsome to the people whose respect we want to gain?

We can no longer depend solely on the letters after our names to gain an audience with the public, particularly when we are pitted against wayward blog and media influencers using sensationalized language to win over vast groups of people who blindly follow their passionate advice. The internet is full of examples of people preferring to follow the advice of a persuasive friend or influencer over the advice of a knowing professional. While this situation is endlessly frustrating to those of us who see through their hyperbolic messages, is there anything we can learn from these blog/media personalities that may help us reach the audience they seem to have hooked? How do we successfully build rapport with the public while maintaining good science?

2. How do we talk about fundamentals in a world that wants controversy?

Let’s face it. Fundamentals don’t make great headlines. For decades, consensus research has revealed that a diet full of minimally-processed fruits, vegetables, whole grains, nuts/seeds, lean proteins, and healthy fats is unequivocally and unanimously the best diet for human health. Yet, people still search elsewhere looking for the latest and greatest weight-loss, risk-reducing, and health-enhancing diets. Could it be that balance is more challenging than we thought? Perhaps avoiding certain food groups or food ingredients altogether is easier than the amorphous concept of moderation? Our greatest challenge is not getting more people to consume health information, it is finding new and compelling ways to deliver the information we’ve known for decades, and this is no small task.

3. How do we overcome differences within the nutrition profession to present a united front to people lost in the sea of alternative facts?

In 2014, David Katz and Walter Willet co-chaired a conference sponsored by the non-profit Oldways*, titled “Finding Common Ground.” Oldways and the co-chairs assembled what they referred to as “the dream team of nutrition experts,” including Friedman’s own, Dariush Mozaffarian, as well as Dean Ornish, creator of the Ornish Diet; David Jenkins, founder of the glycemic index; Boyd Eaton, originator of the Paleolithic diet; Collin Campbell, author of The China Study; and a myriad of others. Known most commonly for their differences, this group of scientists gathered together for the sole purpose of coming to a consensus on the basic tenants of a healthy diet. In the end, the group agreed on 11 common denominators of the widely differing philosophies they espouse. The topics ranged from fruit and vegetable consumption, to sustainability, to food literacy.

Following the conference, David Katz published an article in Forbes where he said “…it is the controversies at the edge of what we know that interest experts most, but ask [experts] about the fundamentals, and the vast expanse of common ground is suddenly revealed.” The Common Ground committee’s decision to gather around a table, invite open dialogue, and pursue unity is something we could all learn a lesson from. Alternative facts will always provide fodder for hucksters and peddlers of over-simplified nutrition information, but the scientific community has a vast body of research that unites us. As nutrition professionals, we cannot forget that our voices will always be more powerful together than they ever will apart.

Rachel Baer is a registered dietitian and a first-year in the NICBC program at Friedman. Her favorite foods are Brussels sprouts and brownies, and she loves nothing more than cooking great meals and gathering people around a table.

*Editor’s Note, 5/1/17  2:09 PM: An earlier version of this article incorrectly spelled the name of the organization, “OldWays.” The correct spelling is Oldways, and the change has been made above.

Balance, Variety, and Moderation: What Do They Really Mean?

by Katelyn Castro

Balance, variety, and moderation have been referenced in the Dietary Guidelines for Americans for decades. Yet overtime, the ambiguity of these terms has clouded their importance and left their meaning open for interpretation—often misinterpretation.

“Everything in moderation.”

“It’s all about balance.”

“I eat a variety of foods… well, a variety of ice-cream flavors!”

These words are often used to justify our food choices or to make us feel better when our diet is not 100% nutritious. Not anymore! Instead of using these words to rationalize our eating habits (which is completely unnecessary and counterproductive), let’s talk about how these nutrition concepts can be interpreted with a more intuitive approach to healthy eating.

Variety

Fruits and vegetables are usually the food groups that we focus on when we talk about variety in our diet. However, variety is encouraged within all the major food groups and among the food groups.

Besides making meals more colorful, eating a variety of fruits, vegetables, dairy, proteins, and grains provides a wider range of vitamins, minerals, antioxidants, prebiotics, and probiotics—keeping our heart, mind, skin, eyes, and gut functioning optimally. Varying protein with a combination of eggs, dairy, legumes, grains, and nuts is especially important for vegetarians to receive adequate amounts of all essential amino acids.

In addition to the benefits of variety at the biochemical level, a varied diet can also make eating more satisfying and flexible. While it can be easy to rely on your food staples for meals, introducing new ingredients can bring attention back to the flavor and enjoyment of eating, preventing you from eating on autopilot. Swap out an apple for a grapefruit or peach; have turkey or fish in place of chicken; substitute barley or quinoa for pasta. Choosing local and seasonal foods will also keep your diet varied diet throughout the year. Giving yourself permission to eat a variety of foods within all food groups can be freeing, helping to overcome rigid eating habits and food rules and appreciate the range of foods that satisfy your hunger and cravings.

Photo credit: https://stocksnap.io

Moderation

Sweets, fatty meats, fried food, fast food, soda… these are all foods recommended to “eat in moderation,” or limit, in some cases. Whether it is unwanted weight gain or increased risk of type 2 diabetes, the negative health effects of eating excess added sugars and solid fats have been identified in the literature. However, cutting out sugary and fatty foods completely can be just as damaging for our emotional health, leaving us disconnected from friends and family and preoccupied with thoughts about food. Food is a huge part of our culture; it’s social, celebratory, and meant to be enjoyed in good company. That’s why moderation—not restriction or overindulgence—is the secret to healthy, happy eating habits.

But, what does moderation really mean? Technically, the most recent dietary guidelines recommend limiting added sugars to less than 10% of total calories per day, saturated fat to less than 10% of total calories per day, and trans fat to as little as possible. Realistically, this may translate into having more added sugars one day (i.e. when you’re eating cake at a family birthday party), and having more saturated fat another day (i.e. when you eat pizza with friends on a weekend).

Moderation is about being open to day-to-day variations in your diet depending on your appetite, cravings, and activity level. Sometimes a big bowl of ice-cream is just want you need to satisfy your sweet tooth, other times a small square of chocolate may be enough to keep sweet cravings at bay. Savoring the flavor of sugary and fatty foods and becoming aware of how your body responds can help you determine what “eating in moderation” means for you.

Photo credit: https://stocksnap.io

Balance

Out of all three of these terms, balance probably has the most interpretations. A balanced diet is often defined as a balance of protein, carbohydrates, and fat within the Acceptable Macronutrient Distribution Ranges set by the Institute of Medicine. A balanced meal, on the other hand, refers to a balance of food groups consistent with MyPlate or Harvard’s Healthy Eating Plate: fill half your plate with fruits and vegetables, one fourth with lean protein, and one fourth with whole grains. Together, creating a balance of food groups and macronutrients can make meals and snacks more filling (from protein and fiber) and provide more sustained energy (from carbohydrates in whole grains, beans, fruits, and vegetables).

Beyond balance within our food choices, energy balance looks more broadly at the balance between energy intake (calories from food) and energy expenditure (calories used for exercise and metabolic processes). Energy balance is associated with weight maintenance, while energy imbalance can contribute to weight loss or weight gain. However, this concept is often oversimplified because energy expenditure cannot be precisely calculated since many factors like the stress, hormones, genetics, and gut microbiota (bacteria in our digestive tract) can alter our metabolism. For example, chronic stress can lead to high levels of cortisol, which signal the body to store fat, contributing to weight gain. In contrast, a diverse composition of gut microbiota may enhance metabolism and promote weight loss, according to preliminary research.

Considering the multiple factors influencing our metabolism, listening to our bodies’ hunger and fullness cues can often guide food intake better than relying on calculated formulas and food trackers. Creating balance, variety, and moderation in our diets can help us meet our nutritional needs and achieve energy balance, while preserving the joy and connection that food brings to our lives.

Photo credit: https://stocksnap.io

Katelyn Castro is a second-year student in the DI/MS Nutrition program at the Friedman School. She’s a foodie, runner, and part-time yogi on a mission to make healthy eating easy, sustainable, and enjoyable. You can find her thoughts on all things relating to food and nutrition at nutritionservedsimply.com