Coming Back to Common Sense

by Danièle Todorov and Delphine Van Roosebeke

Ever wish the question of what to eat could be, well, simple? In an interview with cardiologist Dr. Jacques Genest, we discuss themes in “common sense nutrition:” the research behind it, the barriers to adherence, and its evolving definition.

New trends in popular nutrition seem to pop up every day. This fervor for novelty has distracted us from what Dr. Jacques Genest simply calls “common sense nutrition.” Dr. Genest is a clinician in cardiovascular disease at The Research Institute of the McGill University Health Centre and a former researcher at the HNRCA. We had the pleasure of speaking with him last November during the 5th International Symposium on Chylomicrons in Disease. (For brevity and clarity, the questions from our original interview have been paraphrased.)

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From left to right: Delphine, Dr. Genest, & Danièle

Q: Supplements are immensely popular and it looks like they are here to stay. Is this frustrating to you as a practitioner?

I’m old enough to have given up. What I tell my patients is that I have no trouble with vitamin supplements, but nutrition will be far more imperative. I tell my patients to purchase [fish oils] in the original container. In other words: Eat fish. And to have a good diet as recommended by a food guide—fruits, vegetables, and no added salt. They are simple recommendations people love to forget.

Q: Such as?

Take a 46 year-old, blue-collar working male. He comes home and he will tell you that a nice piece of meat with a potato, brown gravy, and salt is like the elixir of the gods. If you put in front of him a regular salad with endives, he will not like that. So how do you change a mindset in which the palatability of food gives so much pleasure?

Q: As we have seen in the course Macronutrients [NUTR 370], there is a link between the carbohydrate intake and lipogenesis [the metabolic formation of fat]; however, there are still many people who put emphasis on minimizing dietary fat. Do you agree?

From a public health perspective, I think maybe it’s not as relevant as caloric intake. I have some patients that come back from France and they apologize because they’ve been eating some Camembert and some foie gras. I say, look, your lipids have never looked better. I think its portion size far more than anything else. Compare a steak that you would get in Europe—you’d get about a 3 oz. steak.  Here, you’d get basically a quarter of a brontosaurus. Now, I’m a huge believer in no saturated fat. I tell my patients, if you want to eat meat, eat meat that flies and that swims.

About thirty years ago, we went from a fat-diet to recommending a switch to carbohydrates. My personal impression is that this has been a huge mistake. The insulinemia you get with a high-carb diet is probably deleterious. Whereas a protein-rich, fat-rich diet is much more slowly absorbed, doesn’t produce hyperinsulinemia, and probably gives a better sense of satiety. I think we’ll look back and say that this might have been one of the biggest nutrition errors in the late 20th century.

We had forgotten about the covariates that come with a low-fat diet. Move to Japan where there is a relatively low-fat diet but you also have an incredibly good lifestyle. If you turn to more northern populations where you need the fat for some reason, you don’t necessarily correlate fat intake with cardiovascular disease. You don’t correlate caloric intake with cardiovascular disease.

Q: When you see patients, would you first talk about diet rather than prescribing medication?

My primary prevention patient—the 46-year-old man—I will often give up to two years to fix his bad habits. [If there is no lifestyle change in that time], then he is middle-aged, has high blood pressure, high cholesterol, and high blood glucose. He’ll need two pills for blood pressure, two pills for diabetes, a pill for cholesterol… Five pills when he’s 46; imagine how many pills he’s going to have when he’s really sick. And my success rate is probably less than 10%. The biggest threat [to long term health] is the insulin needle. It’s not having a heart attack, it’s going on the needle.

Q: What is the biggest gap in our knowledge that’s impairing how patients are treated?

You’re again a 46-year-old man. You have a bit of hypertension and your cholesterol is high. I put you on a statin and a blood pressure lower. At your next visit, your blood pressure is extremely normal and your cholesterol is extremely low. Why should you stay on an exercise program and a diet? The perverse effect of our outstanding medication may be that we’re not making the lifestyle effort to treat ourselves naturally.

Authors’ note: We can’t quite explain how we got onto this tangent about low-density lipoprotein (LDL), but it has been fascinating to think about and it would be a shame to exclude it.

What was your diet [50,000 years ago]? Tuberous vegetables, berries, and very little meat. Then something happens to you—you started domesticating animals. You got something you never had in your diet before, two things you rarely found in nature—cholesterol and saturated fats. It takes about a million years to change your genes through evolution. In 50,000 years, we haven’t had time to adapt to a huge influx of saturated fat and cholesterol.

How many animals do you think have LDL? Zero. Maybe the hamster if you feed it an extreme Western-style diet. But animals do not make LDL. In times of starvation, we developed the VLDL [very low-density lipoprotein] system. In my view, VLDL is unidirectional. [After removal of triglycerides by lipases], the particle should be completely taken up by the liver with no cholesterol on it. Where does the cholesterol go? It should go to HDL [high-density lipoprotein], which is the main source of cholesterol for most cells, rather than making or incorporating it. It might not be such a bad thing to say that we’re not meant to have LDL and that any technique to prevent it will be good, especially lifestyle nutrition.

Bottom Line

Surprisingly, there is a lot standing in the way of ‘common sense nutrition’. Adding a supplement or a medication is relatively easy compared to changing deep-rooted eating behaviors like food preferences and portion size. Recommendations around fat intake have changed dramatically and are still being hotly debated. The inclusion of animal products in these recommendations is even questionable from an evolutionary point of view. Dietitians and clinicians certainly have their work cut out for them.

A big thank you to Dr. Genest for taking the time to speak with us! It was a fascinating conversation and hopefully an equally enjoyable read.

Danièle Todorov is a first-year student in Nutritional Epidemiology with a focus on maternal nutrition and a minor obsession with lipid metabolism, a holdover from her biochemistry days.

Delphine Van Roosebeke is a master’s graduate in the Biochemical and Molecular Nutrition program with a background in biochemical engineering. Delphine has a crush on nutrients and the magic they perform in our body, and loves to share her knowledge with anyone who wants to hear it in a fun and approachable way! 

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The Dr. Oz Effect

by Julia Sementelli

With the beginning of the new year inevitably comes an onslaught of promotions and advertisements for miracle diets, detoxes, and supplements that vow to help you shed pounds, live longer, etc. And when you think of diets and supplements, most likely two words come to mind: “Dr. Oz.”  He is a doctor, but he is also a registered dietitian’s worst nightmare. While dietitians are out there teaching patients and clients that weight loss cannot be healthfully achieved in a pill or in a 2 week “cleanse,” Dr. Oz is preaching the opposite. Read on for the inside scoop of how Dr. Oz further complicates the already messy, ever-changing world of nutrition and health, including an interview with the man himself.

A recent client of mine, Mark (name changed for privacy), eats a fairly healthy diet: Greek yogurt and berries for breakfast, a salad with lean protein for lunch, and something from the Whole Foods salad bar for dinner (he doesn’t like to cook).  He says that his major downfalls are cookies and beer. Mark’s goal is to lose 30 pounds and improve his overall health given his family history of heart disease. “Give me a meal plan and I will follow it,” says Mark. I can work with that. He is actually a dietitian’s dream—someone who already doesn’t mind eating well and is motivated to lose weight. I thought his meal plan would be a breeze, until he said “Oh—I should tell you about my supplements.” I had expected a multivitamin and some daily vitamin D, but my hopes were dashed as Mark rattled off more than 15 supplements that he is currently taking, only one of them being a multivitamin. Among these supplements were resveratrol, an antioxidant found in red grape skins that he claims sheds years off of your life, and Conjugated Linoleic Acid (CLA), which apparently melts body fat. When I asked Mark where he learned about all of these supplements, he said “Dr. Oz.”

No two words can send angry chills up a dietitian’s spine quicker than Dr. Oz. While I am a fairly green registered dietitian, I have interacted with enough patients to see firsthand the power of Dr. Oz. Dr. Mehmet Oz started out as the resident expert on “The Oprah Winfrey Show” for five years before he was given his own spotlight, “The Dr. Oz Show.” He holds three degrees: a B.S. in biology from Harvard and an M.D. and M.B.A. from the University of Pennsylvania. He is vice-chairman of the department of surgery at the Columbia University College of Physicians and Surgeons in New York. He is also likeable. Consequently, he has become one of the most trusted doctors in the world and yet he uses words like “magical” and “miraculous” to promote supplements that promise to burn fat or prevent cancer. However, what the public may not understand is that a pill is not a miracle cure for anything. According to Stephanie Clarke, registered dietitian and co-owner of C&J Nutrition in New York City: “Most MDs get very little (or zero) nutrition education and background—so it’s a frustrating when they dole out nutrition advice or research without enough details or without thinking about how their messages will be interpreted by the public and related to real life eating.” But Americans continue to believe in the power of nutritional supplements recommended by a doctor that (most likely) has had minimal nutrition education and, more surprisingly, continue to buy them.  In fact, Americans spent more than $21 billion on vitamins and herbal supplements in 2015.  According to analyses, just the mention of a product on the Dr. Oz Show causes a surge in sales.

This phenomenon has been coined as “The Dr. Oz Effect.” Combine charismatic with a few letters after his name and you have someone who is more believable than the thousands of nutrition professionals that use science, not pseudoscience, to back up their recommendations. Even my own father, who has type 2 diabetes, an affinity for soy sauce (read: sodium), and meets my attempts to improve his diet with stubbornness, listens to Dr. Oz. Meanwhile, I have gone through four years of undergraduate education in nutrition, applying for competitive dietetic internships (50% acceptance rate), a one year unpaid dietetic internship, studying for and passing a comprehensive exam, and an additional two years of graduate work to get to where I am. And yet I still don’t have the influence that Dr. Oz does to change my father’s food behaviors.

As a dietitian, I strongly believe in balance. It is my goal to reduce the all-or-nothing thinking that surrounds eating and exercise. The media and people like Dr. Oz perpetuate this mindset, capitalizing on the public’s obsession with weight loss and diets by highlighting drastic regimens and alleged cure-all supplements. Diets do not work because they typically deprive a person of entire food groups, fats or carbohydrates, for example, and eventually the individual gives in and eats those food groups in excess since they have been denying themselves of them for so long.

The demonization of food, another spawn of the media, is the belief that particular foods are good or bad. It has resulted in mass confusion and further damage to peoples’ relationship with food. One of the most infuriating examples of this demonization is fruit. Yes, fruit. “I heard that the sugar in fruit is bad for you” or “I was told not to eat pineapple because it is high in sugar” are actual quotes that I have heard from clients. And not surprisingly, both clients attributed their beliefs to Dr. Oz. After some research, I discovered that, lo and behold, Dr. Oz did a segment titled “Can the Sugar in Fruit Make You Fat?” that most likely influenced these beliefs. Aside from vegetables, fruit is one of the most wholesome food groups, packed with fiber, antioxidants, vitamins, and minerals. Yet fruit cannot even avoid falling victim to the war on food. Conundrums like this exist for nearly every food: eggs, fish, coffee, potatoes…the list goes on. The only way to try to reverse the damage is to tell people that no food is off limits and remind them that there is no replacement for good eating and regular exercise. The only way that I have seen weight loss occur is with gradual and sustainable changes over time. And anyone that promises anything different is lying or worse, using pseudoscience to make outrageous claims.

Pseudoscience, the basis upon which Dr. Oz has constructed his lucrative empire, involves exaggerated and often contradictory claims that are not supported by reputable research. The media is also a culprit of using pseudoscience, composing articles and news stories from press releases of studies with small sample sizes or that use mice as their subjects. Just because it is effective or safe for mice, does not mean it will be safe for humans. Many writers for tabloids and mainstream magazines are stretched for time and are more concerned with quantity rather than quality given that their main goal is to make headlines that sell papers and magazines. Unfortunately, such writers and apparent health experts like Dr. Oz produce the majority of what the general public sees and uses to shape its food choices. However, according to a study published in the BMJ in 2014: “Consumers should be skeptical about any recommendations provided on television medical talk shows, as details are limited and only a third to one half of recommendations are based on believable or somewhat believable evidence.” That’s right—more than half of what Dr. Oz claims on his show regarding nutrition is not based on science. While the show has seen a dip in ratings, currently 1.8 million still tune into the Dr. Oz Show and are consequently exposed to information that is incorrect 50-67% of the time according to the 2014 study in the BMJ.

Dr. Oz has been criticized by a slew of medical professionals for his scam marketing, most notably in 2015 when ten physicians wrote a letter to the dean of health sciences at Columbia University requesting that Dr. Oz be removed as a faculty member due to his “egregious lack of integrity” on his TV show. Dr. Oz defends what he tells the public by claiming that “it’s not a medical show,” despite the fact that the show is titled The Dr. Oz show. Dr. Oz says that freedom of speech gives him the right to say what he wants to. But it is difficult to respect this freedom when he is a faculty member at a prestigious university that makes false claims on TV.

I reached out to the Dr. Oz team and received a response from Oz himself. When asked where he finds his nutrition information he said, “We obtain nutrition information from a wide variety of sources. We rely heavily on literature published in scientific journals as well as textbooks. In addition we consult a wide variety of experts including medical doctors and nutritionists. Our research staff is made up of myself a physician trained in preventive medicine as well as 3 medical students who take a year off to work with us. We evaluate all of the content on our show to ensure that viewers are getting accurate information. One of our researchers this year has a master’s degree in nutrition as well.” I am not sure which scientific journals Dr. Oz and his team are using, but when I researched “curcumin” and “oil of oregano,” two of the supplements that Dr. Oz has promoted on his show and that Mark, my client, is currently taking, the conclusion was that “the existing scientific evidence is insufficient to recommend their safe use.” In our interview, Dr. Oz said: “We also reach out to the Friedman school when we have difficult questions. I spent a day up at the school this summer meeting with a number of your faculty. Most recently I have spoken to an expert about fiber fortified foods and to your Dean about the current opinions on dietary fats.” He included a note that says that he and his team welcome interns to join them every month from September to June and students from Friedman are welcome to apply. *Insert eye roll*

When I asked about Dr. Oz and his team’s stance on nutritional supplements, he replied: “In general we believe that many have a place in people’s life to enhance nutrition. We always love to see more and better studies conducted on the utility of supplements in promoting health.” This is a nice response but when I begrudgingly watched a clip from the Dr. Oz show in which he says that Conjugated Linoleic Acid (CLA) can help to burn body fat, even without diet and exercise, I realized that what he says and what he does do not match. And aside from empty promises and putting people at risk with questionable pills, he is encouraging people to waste their money. This is what I told Mark in an effort curb his daily supplement cocktail. If the risk of taking his favorite “fat-melting” supplement won’t stop him, maybe the opportunity to save money will.

Dr. Oz is frustrating for many reasons, but for nutrition professionals it is the fact he uses his credentials as a physician to get away with promoting pseudoscience. Being a dietitian no longer involves simply telling people what to eat. It is trying to untangle the web of misinformation surrounding nutrition that clients have woven over the course of their lives and re-teach them what a healthy relationship with food should look like. While turning to supplements can seem like an easy fix, science shows that eating a diet based on whole foods like fruits, vegetables, whole grains, lean protein, and healthy fats, is the ideal diet. Science does not show that a pill is the secret to losing those last five pounds that keep hanging on. If scientists really found a cure for obesity, we would not be hearing about it at 4pm on a Tuesday afternoon. And unfortunately, the supplement industry is not going anywhere. The FDA and FTC regulate the supplement industry, but not very well. So it is up to trained and licensed nutritional professionals (i.e. registered dietitians) to educate the public about the dangers of supplements and listening to people who are simply “health experts.”

Julia Sementelli is a second-year Nutrition Communication & Behavior Change student and Boston-based registered dietitian who works in a local hospital and also counsels private clients.  You can find her on Instagram (@julia.the.rd.eats- Follow her!) where she strives to intercept confusing nutrition messages from self-proclaimed health experts with expert nutrition advice and tips (as well as some beautiful food photos if she does say so herself!).

 

 

Following our Food: A Northern California Supply Chain Adventure

by Christina Skonberg and Krissy Scommegna

How do people at different points of food production make decisions? As part of a directed study on Sustainable Supply Chain Management, Friedman students Krissy Scommegna and Christina Skonberg spoke with representatives at three different food and beverage businesses in California to learn how producers weigh costs and benefits to yield optimal results.

While the Obamas packed up the last of their belongings at the White House on January 19, 2017, we walked through the doors of Jaharis for our last first day of school ever (hats off to the indefatigable PhD students who may still have a few more to go). As we anticipate our transition away from Harrison Avenue in May, we reflect on this crossroads between academia and employment. The Agriculture, Food, and Environment curriculum has taught us to use sound data sources and unbiased modeling techniques to substantiate every claim we make, encouraged us to address how the food system disproportionately advantages some at the expense of others, helped us develop a systems approach to analyzing food production and consumption, and much, much more.

As we embark on one last semester of group study sessions and post-class beers, we return to a central question that drove many of us to attend graduate school in the first place:

How will we effectively apply these tools to real situations involving real people beyond the boundaries of academia? Do farmers in the Northern Plains actually develop quantitative models to determine which wheat varieties they should cultivate given climatic conditions, prices, and market demand? Do food and beverage packaging specialists conduct elaborate life cycle assessments to determine which materials have the lowest carbon footprint? Do retailers meticulously vet suppliers based on environmentally sound soil management practices? Or, do many of these producers forego elaborate methodologies to instead make decisions based on instinct and habit?

In our last four months at Friedman, we’re seeking to address some of these questions through a directed study on Sustainable Supply Chain Management. In speaking with over 20 food industry professionals who operate at different points of diverse supply chains around the country (read: Nebraskan cattle ranchers, Californian coffee procurement specialists, and Pennsylvanian butchers), we hope to explore how food producers optimize outcomes given their unique goals and constraints. In the classroom, we immerse ourselves in the minutiae of soil health, herbicide resistance, tillage techniques, and other important facets of on-farm production. Through site visits and interviews, we hope to deepen our understanding of decisions and tradeoffs beyond the farm gate and into the manufacturing, distribution, retail, and waste sectors of the wider food system.

Eager to escape the New England winter and set out on our supply chain quest, we ventured to Northern California over winter break to conduct our first few interviews. Below, we share stories from a handful of the inspiring producers we met.

Front Porch Farms: Healdsburg, California

Interviewee: Johnny Wilson, Farm Manager

Front Porch Farm in Healdsburg, California Photo from Front Porch Farm’s Official Website: https://fpfarm.com/

Front Porch Farm in Healdsburg, California
Photo from Front Porch Farm’s Official Website: https://fpfarm.com/

On a rare rainy day in Northern California, we trekked to bucolic Healdsburg to see how Front Porch Farm Manager Johnny Wilson cultivates the scenic 110 acre, 30+ crop farm. Perhaps most famous for their perennial cut flowers, wines, and Italian heritage polenta, Front Porch Farm is in many ways a paradigm of ecologically sound production. Drip irrigation systems line orchards, organic compost fertilizes fields, and their giant but gentle puppy Hilde assists in predator control. When asked about how the team determines which seeds to select from catalogs like Baker’s Creek and Seed Savers Exchange (yes, farmers still buy seeds from catalogs!), Johnny explained that while profitability is an undeniably important factor, the team also focuses on the ecological and cultural significance of crops. Enriching the agricultural diversity of Sonoma County (winegrape cultivation currently dominates the region), maintaining a polyculture system that fosters long term soil health and wildlife biodiversity, and experimenting with new varieties that excite the team are all considerations that go into the seed selection process. For Front Porch Farm, the generation of social and environmental value is inextricably linked to the success of their business. To see what diversified farming looks like at Front Porch, check out the map of their impressive agricultural mosaic in Healdsburg.

Blue Bottle Coffee: Oakland, California

Interviewees: Jen Flaxman, Learning and Development Manager & Melissa Tovin, Finance Operations Manager

Blue Bottle’s Roastery and Production Facility in Oakland, California Photo from the Washington Business Journal, December 2016

Blue Bottle’s Roastery and Production Facility in Oakland, California
Photo from the Washington Business Journal, December 2016

Jen Flaxman and Melissa Tovin of Blue Bottle Coffee in Oakland are intimately familiar with the complexity of international supply chains. As the Learning and Development Program Manager, Jen ensures that effective employee training and education programs help Blue Bottle employees in California, New York, and Japan thrive in their jobs. Melissa is Blue Bottle’s Finance Operations Manager and she spends much of her time forecasting appropriate procurement quantities for all Blue Bottle cafes (there are 33 globally). Among the many fascinating things we learned from Jen and Melissa was that much of the decision making around procurement quantities of green coffee (unroasted coffee beans) lies within the Finance department of Blue Bottle rather than in the Production department. Melissa—a veritable Excel whiz—explained that this improves accuracy in predicting and meeting demand, allowing the company’s green coffee buyers to focus their energy on developing supplier relationships in the field and upholding coffee quality standards. For Blue Bottle, technical tools like modeling are critical to supply chain decisions, and starting this summer you can taste the quality yourself in Boston. (Students in Chris Peters’ Food Systems Modeling course this semester may want to take note and highlight those analytical skills on their resumes!).

Three Thieves: Napa, California

Interviewee: Roger Scommegna, Thief

Left: Current Packaging for Bandit 1L Tetra Pak; Right: Roger Scommegna in his element Photos Courtesy of Roger Scommegna

Left: Current Packaging for Bandit 1L Tetra Pak; Right: Roger Scommegna in his element
Photos Courtesy of Roger Scommegna

Over a warm cup of non-Blue Bottle Coffee in Berkeley, we discussed the wine industry with beverage entrepreneur Roger Scommegna. Full disclosure, he may have been coerced into this interview due to family ties. As one of the founders of Three Thieves, Roger has spent the past 16 years working to bring high quality wines to the masses at low prices—a noble cause for grad students on a budget. Three Thieves achieved this model by initially packaging their wine in one-liter glass jugs and later establishing an offshoot brand, Bandit, available in half and one-liter Tetra Paks instead of traditional bottles.

Roger provided many insights into the beverage industry, but perhaps most interesting was his perspective on getting products into retail establishments. Roger discussed “gatekeepers” (wine buyers at different grocery chains like Safeway and Costco), and their authority in determining which products to purchase, in what quantity, and at what frequency. While one might expect grocery chains to use a reliable algorithm to determine which products will fare best on shelves, these gatekeepers often make decisions based on the crucial relationship forged between client and buyer. This camaraderie, the client’s ability to highlight differentiating features of their product, and even the restaurant where the business dinner takes place can all sway purchasing decisions. The gatekeeper is a powerful stakeholder in this context and can have a profound influence on a supplier’s brand. Roger recounted an instance when a purchaser told him that while his grocery chain had once regarded Three Thieves as a cutting edge brand, a lack of rebranding efforts had rendered their products outdated. In a successful response, Three Thieves conducted a branding overhaul and regained the favor of this key buyer.

At this early stage in our adventure, we’ve learned that—as is typically the case in science—the answer to our question about how producers make supply chain decisions depends. It depends on product, scale, metrics of success, and several other factors. Some decisions are based on models and economic analysis while others are more grounded in personal experience and preference. We look forward to speaking with the rest of our gracious interviewees over the course of the semester to learn more about the tools and motivations people use to make discerning production decisions. We’re indebted to the professors and faculty who’ve poured their energy into honing our technical skills and expanding our intellectual curiosities, and we hope that this opportunity helps bridge our academic lives with the professional endeavors we pursue after graduation.

Christina Skonberg is a 2nd year AFE student from Berkeley, CA who is trying to embrace the New England winter but couldn’t resist smuggling a suitcase full of Californian produce back to Boston in January. Krissy Scommegna is also a 2nd year AFE student who was happy to see her home in Boonville, CA in its rainy glory in January, even if it meant digging trenches against flooding and building fires in the wood stove to stay warm. Second-year AFE student Carrie DeWitt will also be participating in this directed study, but was unable to attend meetings in California in January. Stay tuned for more information about their end of semester presentation on Best Practices in Supply Chain Management, coming in May.

Alumna Interview: Elizabeth Whelan

by Sarah McClung

Sarah McClung interviews Elizabeth Whelan, a Friedman alumna, about her work with Save the Children in Myanmar and how her degree has helped her in the field.

Friedman alumna Elizabeth Whelan. Photo courtesy of Elizabeth Whelan.

Friedman alumna Elizabeth Whelan. Photo courtesy of Elizabeth Whelan.

I wish I could write that this interview took place over soup dumplings at Xi Yang Yang Xiao Long Bao Dumplings in Yangon, Myanmar. Sadly, that was not the case, but that is where I met Friedman alumna Elizabeth Whelan on a rainy day this summer. Last year, I was fortunate enough to receive support from the Dr. Elie J. Baghdady Memorial Fund, established by Friedman School alumna Georgette Baghdady in memory of her father to help students interested in humanitarian work gain experience overseas.  I learned that Whelan, currently working with Save the Children in Myanmar, was a recipient a few years back. She graciously agreed to an interview for The Sprout, in which we discussed where her degree has taken her, advice for current students, and some fond memories of the program and life in Boston.

For nearly two years, Whelan has been working for the international NGO Save the Children in Myanmar. She supports the Leveraging Essential Nutrition Actions to Reduce Malnutrition (LEARN) project with the goal of “increasing the capacity of local and international non-government organizations to deliver a more comprehensive approach to food security that includes all three food security pillars: availability, access, and utilization.” She loves living in Yangon and has found being in the midst of the country’s national transition fascinating. (Myanmar was formerly known as Burma until 1989.) She also expressed something I found to be true about Myanmar: the people are some of the warmest and most helpful you will ever meet.

I asked Whelan about how she ended up at Friedman and she shared an impactful experience from her days volunteering with Partners in Health in Haiti in which she was watching a nurse fit a child with severe acute malnutrition (SAM) with a nasal gastric tube. Knowing malnutrition is preventable, Whelan said that it was at that moment she realized that nutrition—in some form—was her calling. Whelan walked me back further in her superhero origin story and explained that her father was an agricultural economist and his work brought the family to Zambia where they lived for five years, during which time the country experienced a famine. As a result, her interest in nutrition and food security began at an early age.

“Friedman really seemed like an obvious decision,” said Whelan. She explained that in the seven years between completing of her undergraduate degree and starting graduate school, she considered other career paths, including nurse midwifery and photography. Whelan realized that all of her work was hunger-related and rather than dismiss the pattern as coincidence, she decided better to recognize it and find a place to pursue her passion more formally.

Some of Whelan’s fondest memories of Friedman include sharing her learning experience (and food!) with other students. “It was nice to be around people who like to cook,” she noted of casual interactions like the Wednesday seminars that made the Jaharis auditorium look like a tapas bar with people breaking out their mason jars and Tupperware full of delectable leftovers.

I am preparing to complete my MS in the FPAN program in December and had to ask Whelan about her last semester. “Plans came through towards the end,” she explained. She applied and was accepted into the Catholic Relief Services (CRS) International Fellows program, which ended up taking her to Ghana after a three-month consultancy with Action Against Hunger (ACF) in Paris, facilitated by Professor Jennie Coates. “Don’t stress about the future and trust that things will fall into place. Tufts has a fantastic reputation in the nutrition community. There’s brand recognition.” I asked if there was anything she wished someone had told her when she was a student and she talked about how graduating with a degree with nutrition in the title creates the expectation that you are a nutrition science expert.

When asked about coursework, Whelan explained that she could not think of a Friedman class that had not come up at some point in her professional life directly or indirectly. She specifically mentioned Professor Jennie Coates’ Monitoring and Evaluation class, Nutrition Science with Professor Diane McKay, Survey Research with Professor Bea Rogers, Professor Will Masters’ economics class, and even though Statistics with Professor Bob Houser was really “painful,” was very useful. Whelan also mentioned a directed study on determinants of sustainability under Professor Coates and Professor Rogers on Title II Food Aid Exit Strategies, which extended into her second year and allowed her to apply what she had learned in other classes in a more “real world” context.

“The thing about Friedman is that the professors are of such high caliber,” said Whelan explaining that she regularly comes across research published by Tufts professors.

I offered to relay messages back to Friedman professors and Whelan said the following:

  • Professor Coates: “I’m impressed by and grateful for the impact you and the food security tools you’ve developed have had on international development. My colleagues and I rely on them regularly.”
  • Professor Rogers: “I didn’t realize how much I learned in survey research, one of the most useful courses I took at Friedman.”
  • Professor Masters: “Your words from a lecture years ago stuck with me, something along the lines of ‘economics is walking back in the chain of causality until you would make the same decision as a farmer, or vendor, or some other person in a low income context. We don’t always understand why people make certain decisions but people are generally doing their best to survive and we need to understand their daily realities.’ These words have proven true and useful working in the field.”

And I of course had to ask Whelan about food. She found it difficult to name just one favorite, but some of her top picks include soup dumplings, fruits (particularly some of the exotic ones from Myanmar like mangosteen and pomelo), classic pecan pie, and—my favorite response—vanilla baked goods, including highly processed yellow cake from the grocery store – we’re talking sheet cake from Stop & Shop.

When asked to name her favorite things about Boston, Whelan mentioned fond memories of the walk from the T to the Medford campus, Prana Power Yoga, quintessential pubs and coffee shops, and living amongst so many students and feeling like a part of a larger academic community.

I knew after our soup dumpling lunch that Whelan was someone I wanted to keep up with. Work in international development can be disheartening, and I come across people who have become demoralized and cynical more often than individuals who have a positive outlook. Whelan obviously genuinely enjoys her work, and it was inspiring to speak with her about her efforts in the field as I prepare to leave Friedman. To learn more about LEARN or Save the Children, you can check out their websites. And should you find yourself in Yangon, do reach out to one very impressive alumna.

Sarah McClung is a second-year, second-semester FPAN student hoping to use her Friedman degree to help feed hungry people… but not like as a waitress. Please send any job leads. But like seriously.

Celebrating Nutrition Experts in the Community: National Registered Dietitian Nutritionist Day!

by Katelyn Castro

Dietitians, Nutritionists, Registered Dietitian Nutritionists: what’s the deal with all these titles? March 9th marks Registered Dietitian Nutritionist Day, a special day recognized by the Academy of Nutrition and Dietetics. Along with clarifying the confusing names used for nutrition experts, this day is meant to recognize the important role of registered dietitians in improving the health of patients and the community through food and nutrition. First let’s clear up the difference between a nutritionist and a registered dietitian nutritionist.

rdnday

What Is a Registered Dietitian Nutritionist?

The registered dietitian (RD) credential is a nationally recognized, legally protected title accredited by the Commission on Dietetic Registration (CDR) that can only be used by those who have met the following requirements:

  • Completed a bachelor’s degree in dietetics, nutrition, or nutrition science by an accredited university or met the current minimum academic requirements (Dietetic Program in Dietetics)
  • Completed an accredited dietetic internship program with 1200 supervised practice hours
  • Successfully completed the Registration Exam for Dietitians, administered by the CDR
  • Maintained certification by meeting continuing professional education requirements

While some dietitians may refer to themselves as “nutritionists,” anyone can call themselves “nutritionists” regardless of educational background or experience. According to the Academy of Nutrition and Dietetics, registered dietitians have the option of also identifying themselves as Registered Dietitians Nutritionists (RDN) in an effort to clarify that “every registered dietitian is nutritionist but not every nutritionist is a registered dietitian.”

Registered dietitians may also hold specialty certifications (e.g., Certified Specialist in Pediatric, Renal, Gerontological, or Oncology Nutrition) accredited by the CDR and other health organizations. While requirements vary by each specialty certification, they typically include a certain number of hours of experience within an area of specialty and successful completion of a specific board certification examination.

What Does a Registered Dietitian Do?

If it wasn’t clear enough already, RDs are the most credible source of research-based nutrition information for the public. RDs translate nutrition science into practical terms to help individuals and communities in a variety of settings: hospitals, health clinics, schools, nursing homes, food industries, fitness centers, private practice, universities, and research.

As a dietetic intern, I’ve had the opportunity to explore many of the diverse roles of registered dietitians. Seeing the profound, positive impact that dietitians have on individuals’ health and well-being is truly inspiring. But, what better way to explain the important role of RDs than to hear from dietitians themselves? Here is what four registered dietitians from our community shared about their personal experiences:

Helen Rasmussen, PhD, RD, FADA 

Helen has been a registered dietitian at the USDA-Human Nutrition Research Center on Aging (HNRCA) for 33 years. She is now the senior research dietitian in the Metabolic Research Unit at the HNRCA, which focuses on the effects of diet interventions on human aging. Helen is also a Fellow of the American Academy of Nutrition and Dietetics Association (FADA).

What do you do on a daily or weekly basis as a dietitian?

I have two hats in my position at the HNRCA: One is managing the Dietary Services kitchen laboratory, and the other is designing dietary interventions for research studies. HNRCA scientists come up with a research study/proposal, and we create the diet for the research study. We also screen potential research subjects for their eligibility to participate in a study.

What’s your favorite part about being a dietitian?

Two parts, really. I enjoy working with the Dietary Services staff who have to carry out the “food concoctions” that the other research dietitian (Jennie Galpern FS10) and I come up with, and also getting to know the volunteers we have selected to participate in the research studies.

What’s the most challenging part about being a dietitian?

Sometimes the diet that is needed for the particular research study feels like it is impossible to achieve, which makes the job interesting and fun. One example was that I was asked to come up with a low folate diet. Folate is now added to flour, so to include any kind of bread, cereal from commercially-made foods as well as foods we baked with store bought flour was not possible. I contacted a colleague who has done this kind of research, and she gave me the greatest suggestion: to work with a professor in the Midwest who teaches a class in milling. The students were going to learn how to mill wheat into flour. The professor had the students eliminate the folate when they got to the enrichment step. He shipped us a large barrel of the flour to be used in the low folate diet.

If you could only give one piece of nutrition advice, what would it be?

I have three pieces of advice. [First] A vitamin pill doesn’t substitute for a lousy diet. Introduce new fruits and vegetables of varied colors into your diet. [Second] Drink water. [Third] Become your own food and nutrition expert; the information is out there for you to read, and to digest.

What’s your favorite food?

Avocado.

Kelly Kane, MS, RD, CNSC

Kelly has been a registered dietitian for 20 years and holds a specialty credential as a Certified Nutrition Support Clinician (CNSC). Currently, Kelly has three roles as a dietitian at Tufts Medical Center: clinical manager, dietetic internship director, and inpatient clinical dietitian.

What do you do on a daily or weekly basis as a dietitian?

On the clinical side, I cover for other dietitians, and I see a wide variety of patients from children to adults from generally healthy patients to those that are critically ill. When I am seeing patients, I have to screen which patients would benefit most from a nutrition visit. Then, I review their medical record, check labs, talk with the medical team, and then visit the patient where I gather information, provide education, and make a nutrition plan. Then I communicate that plan to the patient and to the medical team.

What’s your favorite part about being a dietitian?

One of the best parts of being a dietitian is helping a patient understand his or her diet. When I educate families with children with diabetes, they are often extremely worried about how to feed their son or daughter. After meeting with them, their relief is visible and they are reassured that eating will remain an enjoyable experience since they now have the tools they need to manage the disease.

What’s the most challenging part about being a dietitian?

Without a doubt, the most challenging part is trying to educate a patient who has no interest in learning about his or her diet or no interest in making any changes.

If you could only give one piece of nutrition advice, what would it be?

Relax! People tend to overthink about food. Michael Pollan’s advice of “Eat food. Not too much. Mostly plants.” is great advice and reminds us that eating should be simple and enjoyable.

What’s your favorite food?

My favorite food is Thanksgiving stuffing, a recipe I learned from my mother made with milk crackers and lots of butter. It is a rare treat that I make once a year. It is absolutely delicious!

Annie Paquette, MS, RD, CSP

Annie has been a registered dietitian for nine-and-a-half years and is also a Certified Specialist in Pediatrics (CSP). She currently works as a pediatric clinical dietitian at the Frances Stern Nutrition Center, covering inpatient pediatric units at the Floating Hospital for Children.

What do you do on a daily or weekly basis as a dietitian?

I work daily in the pediatric hospital setting with children (aged newborn to adolescent) and their families/caregivers. I provide MNT [medical nutrition therapy] to children throughout their acute and chronic illnesses to support their overall healthy growth and development. This includes (but is not limited to) providing nutrition support regimens, modified formula recipes, and specialty diet educations.

What’s your favorite part about being a dietitian?

I love working as part of a multidisciplinary medical team each day with patients and their families. Nutrition, growth, and development are an integral part of the daily plan of care and I get to play an important role in a child’s care. It’s very rewarding to see children improve with the help of the nutrition we are providing.

What’s the most challenging part about being a dietitian?

Helping patients and families make sense of all the confusing nutrition messages they hear (from outside sources).

If you could only give one piece of nutrition advice, what would it be?

All foods can fit into a healthy diet.

What’s your favorite food?

Pizza!

Ally Gallop, RD, CDE

Ally has been a registered dietitian for three-and-a-half years and is also a Certified Diabetes Educator (CDE). Previously, Ally worked as an outpatient dietitian in areas of diabetes, cardiac, gastrointestinal surgery, and cystic fibrosis. She is currently a second-year Friedman student, studying nutrition communications, public relations, social media, and marketing.

What did you do on a daily or weekly basis as a dietitian?

As an outpatient diabetes dietitian, my day revolved around conversing with patients to design a care plan that incorporated a patient’s needs with the most healthful diet that supported their diabetes medical plan. Beyond individual counselling, I attended and participated in medical rounds with the interdisciplinary team, led group education classes for newly-diagnosed patients with type 2 diabetes, and was self-motivated to continue my own education on current research surrounding diabetes and nutrition care in diabetes.

What’s your favorite part about being a dietitian?

I love talking to people! But I become an avid listener when I put my dietitian hat on. Being a dietitian requires adept interviewing skills. You need to gain a person’s trust quickly, probe for information appropriately, and learn to only ask questions that lead to useful answers. Consultations with patients is challenging and exciting. The best part is when that patient has the “ah-hah!” moment; they finally understand and are motivated to become actionable about the topic at hand (or what you were trying to get across).

What’s the most challenging part about being a dietitian?

The most challenging factor is the lack of follow-up with patients in the clinical realm. Behavior change is difficult and frequent follow-up is imperative to progress, yet in the real world this rarely exists.

If you could only give one piece of nutrition advice, what would it be?

Focus on eating more fresh vegetables at meals.

What’s your favorite food?

Does wine count? If not, my favorite food is creamy peanut butter.

Katelyn Castro is in the process of becoming a registered dietitian as a first-year student at Friedman and a dietetic intern at the Frances Stern Nutrition Center. She is both overwhelmed and excited about all of the opportunities in the field of dietetics and cannot wait to follow in the footsteps of her dietitian mentors.

Why HIIT Workouts are a Total HIT!

by Skylar Morelli

High Intensity Interval Training (HIIT) is an effective, fat burning form of exercise that has been scientifically proven to lower risk for many diseases. HIIT involves different stations of exercises, with each movement done in short, intense durations with brief breaks in between. HIIT has become one of the most popular and successful methods of training.

HIIT involves short bursts of numerous intense exercises that raise your heart rate within seconds. Each exercise is performed for less than 1 minute, with a 5-10 second break in between sets. After 2-3 minutes, you move on to the next station until you have completed a circuit of 10-12 exercises. Though the durations are short, you’re encouraged to push yourself harder than you normally would; lifting the heaviest weight possible, planking until you tremble, and jump squatting until your legs turn into Jell-O. Many gyms offer HIIT classes that usually last 45 minutes to an hour. HIIT workouts are great since they are effective and involve less time commitment than normal workouts—perfect for grad students!

While all exercise improves mental and physical health, when compared to forms of continuous moderate exercise (CME), HIIT takes the cake. An example of CME is a more standard workout of 3 sets of 10-12 repetitions that you take your time to complete. HIIT is more effective at lowering BMI, improving insulin resistance, lowering risk of cardiovascular disease, lowering risk of hypertension, and lowering risk of diabetes. HIIT torches fat, increases muscle tone, and leaves you with an endorphin high that lasts for days.

The Club, a boxing gym in South Boston founded by George Foreman III, offers classes that incorporate HIIT. The workouts are tough but also fun! Enthusiastic trainers blast music and encourage you to push yourself to your limit. I sat down with Cassie Brown, a HIIT-certified personal trainer at The Club, who explained the science of HIIT.
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Q: What makes HIIT unique from other forms of training?

A: Scientific studies have shown that HIIT workouts 2-3 times per week can deliver results more quickly and dramatically than other approaches to training. HIIT trumps regular exercise regimes when it comes to gains in cardiovascular health and VO2 max, fat loss, and improved performance. VO2 max indicates a person’s cardiovascular and aerobic endurance by measuring the maximum amount of oxygen that a person can utilize during intense exercise – the more, the better. Another perk is that it speeds up your metabolism for up to 24 hours post workout, and up to 36 hours when heavy weightlifting is incorporated.

Q: What exercises are performed and for how long?

A: HIIT can include any form of exercise such as plyometrics (“explosive, powerful jumping”), kettlebells, running, battle ropes, TRX bands, weights, rowing, and cycling. Incorporating several movements into interval training allows you to switch muscle groups and still perform at a high level even with a short recovery period. The key is that “high intensity” should equal “short duration.” I find the days when I have the least time to get my workout in, I end up getting the best workouts. Working super hard in a short amount of time is what gives the best results to people who are looking to achieve general fitness and a lean physique. Most interval workouts are 20-45 seconds, with 10-15-second rests. Switching the movement and muscle groups is important so that you don’t get too fatigued or injured. A true HIIT workout should not last more than 45min.

Q: How does The Club capture the HIIT experience?

A: The Club best captures HIIT in our 45-minutes class, BOXFIIT 360. At The Club, George, a pro boxer, created his interpretation of HIIT, which he calls FIIT: Fight Intensity Interval Training. It’s a circuit with 10-12 stations, with 2 minutes at each station. Each exercise is performed for 20 seconds, followed by a 10 second rest. After repeating that cycle 4 times, you move to the next station. Stations involve boxing on different sized punching bags, moving battle ropes, suspension training (TRX), kettlebell and/or dumbbell exercises, and rowing. In less than an hour, you’ve done cardio, strength training, and boxing, and worked the hardest that you can.

Q: How long is the recovery, and what should one eat after?

A: For optimal fitness and a strong, healthy physique, HIIT workouts can be done 2-3 times a week, with 48 hours of rest in between. Recovery workouts like Yoga, Pilates, and Barre can help you recuperate properly; otherwise you will not see best results. Exercise is stress on your body, so if your refueling and recovery tactics are not sufficient, you will not see best results. After a HIIT workout, I’m always in the mood for salad with lots of greens, lean protein, or nuts, and squeezed citrus fruits like orange slices and lemon juice as the dressing. Any meal with a lot of vegetables is ideal. We all know we need protein post-workout, but that’s not all. For our body to properly refuel and digest the protein, we need the vitamins and minerals that allow our body to metabolize the food for recovery. Focus on veggies and fruits, and then eat your protein and complex carbs as a complement.

Q: How does one go about HIIT? With a trainer? Classes? And most importantly, can HIIT be performed on your own or at home? If so, can you please recommend some good websites or resources (especially for those on a college budget)?
A: HIIT can be done on your own! Download the free “Interval Timer” application, program your work and rest periods, set the number of rounds you’d like to work, and choose the sounds that cue your work and rest. It’s the same as having a trainer with a stopwatch yelling “stop!” and “go!” Of course, we all push ourselves harder when we are listening to someone else, so to bring real intensity (and safety) to your workout, working with a trainer is a great idea. HIIT is the best way to get an at-home workout that feels worthwhile and will totally kick your butt. Decide what movements you want to do and the number of rounds you’ll complete, set up your timer, and go for it!

Cassie did a wonderful job at covering everything there is to know about HIIT. If you’d like to try out a HIIT workout, your first class at The Club is free, and addictive! Check out http://everybodyfights.com for more info!

Skylar Morelli is a first-year Nutrition Communication student. Exercise and sunshine are her therapy.

New Year, New Trends, New Editors!

2015 is here and with it are our goals for the New Year. Whether you’ve made your New Year’s Resolution (or just a resolution not to make resolutions) the Sprout wants to help you make healthy decisions all year long!

For New Year’s inspiration, take a look at what Matt Moore hopes WON’T happen in 2015.

Interested in trying the controversial ketogenic diet? Mireille Najar explores the use of the high-fat diet for treating epilepsy and cancer and shares a few recipes.

If food is your interest, but you’d like more of a balanced plate, check out Amy Elvidge’s fascinating interview with The Boston Globe‘s food critic Devra First. Learn what it’s like to get paid to eat and where to eat in Chinatown when you’re starving during midterms.

Trying a new fitness routine? Katherine Pett details her first experience taking a class in…parkour! Check out what it’s like to be a newbie in the sport, and consider making an adventurous exercise decision of your own.

We are excited to have two new editors for the new year! Matt Moore, a first-year student in the Agriculture, Food, and Environment program and Katherine Pett, a first year in the Biochemical Molecular Nutrition program, are thrilled to get the ball rolling in 2015 and look forward to reading all your articles!

Finally, make a resolution this year to write for the Sprout! If you’re interested in contributing to a future issue, email us at friedmansprout@gmail.com to submit your ideas.

Here’s to a great start to your new year,

Katherine and Matt

In this Issue:

15 Food and Fitness Trends We Want to See in 2015

by Matt Moore
Fried-crickets-001As 2014 comes to an end, blogs, newspapers, magazines, and professional organizations have revealed their projected food and fitness trends for the following year. The following list joins in on the fun and is a very biased look at 2015 based on no research or evidence whatsoever and does not necessarily reflect the views of the Sprout.

 

The Basics of a Ketogenic Diet

by Mireille Najjar

The ketogenic diet remains one of the most extreme types of low carbohydrate diets, yet its potential role in tumor regression and pediatric epilepsy treatment has become an increasing topic of study among researchers and health professionals worldwide.

 

Devra First Getting Paid to Eat: An Interview with Devra First

by Amy Elvidge

A look into the life of the Globes restaurant critic. First shares the reality of her work and advice on how to live the dream as an aspiring gastronomer.

 

 

parkour1That Time I Tried Parkour

by Katherine Pett

If you’re still in the market for a New Year’s Resolution, consider trying a new type of exercise. Recently I tried out parkour and had a LOT of fun!