Friedman Goes to FNCE

by Hannah Meier, Sharmin Sampat and Anabelle Harari

Every year in October, dietitians from across America gather together at a convention for three days of learning, networking, and eating. The Academy of Nutrition and Dietetics organizes the national event, The Food and Nutrition Conference and Expo (or FNCE® for short), bringing together registered dietitians (RDs), dietetic technicians, registered (DTRs), students, interns, researchers, physicians, policy makers and industry leaders to talk about current practices, care guidelines, controversies, innovation and entrepreneurship in nutrition. Three current students from Friedman, Hannah Meier, Anabelle Harari and Sharmin Sampat share their highlights.

October 21-24, 2017 marked the 100-year centennial anniversary of the Academy of Nutrition and Dietetics’ organized advocacy and support for the profession. Highlights include not only interesting educational sessions put together by seasoned experts (including Friedman’s own Dr. Tim Griffin in a talk about Sustainability and Dietary Guidelines), but booth after booth in the expo hall of health foods, supplements, schools and services relevant to the practices of nutrition professionals. Attendees of the conference and expo can network with brands, media, and fellow professionals at sponsored events or practice group receptions before and after each organized day within the program. Each day also features special events like culinary demonstrations, book signings, and poster presentations of research conducted by dietitians across the country.

Photo: Hannah Meier

More details of the event and program can be found on the conference website: eatrightfnce.org.

Hannah Meier

Why did you choose to go to FNCE this year?

I knew I wanted to attend FNCE in Chicago after attending my first conference when it was in Boston last year. I learned so much at the sessions and enjoyed getting to know the people behind some of the popular and up-and-coming food and nutrition brands at the expo. This year, I was fortunate to be able to attend the conference on behalf of the food company I work with, 88 Acres. Instead of hosting an expo booth, we organized a get-together with two other New England brands, DrinkMaple and Biena, and were able to network with dietitians and media contacts more personally.

What was your favorite Education Session?

My favorite education session was actually a career panel about pursuing “hot” career paths in nutrition. We learned from dietitians who forged their way into roles that may not have existed previously, and it was inspiring to hear from them about how to balance confidence and work ethic while ensuring that you still love your career at the end of the day. Dawn Jackson-Blatner, the RD for the Chicago Cubs and one of the panelists has also been featured in top media outlets and on the reality show My Diet is Better than Your Diet (which she won!).

What was your favorite new product at the Expo?

As funny and unglamorous as this seems, my favorite product was from Starkist: Pouches of tuna with rice and beans in hot sauce. Since working with student athletes at Tufts in Medford, I’ve learned the importance of convenience when it comes to managing nutrition with a busy schedule, and it’s my goal to recommend whole foods as much as possible as opposed to convenient snack bars and shakes (though these can be great in a pinch and certainly better than nothing). The packs of tuna with rice and beans combine a high-quality source of protein with fiber-rich grains for carbohydrates, and make an excellent, portable post-workout or game snack—or something to bring with you during a busy day of back-to-back classes. The packs even contain a portable fork that can be reused!

Favorite quote of Anabelle, overheard at FNCE

Did you find any new food and nutrition trends that surprised you?

The rise of plant-based foods was prevalent on the expo floor, though it didn’t necessarily surprise me. The breadth of options featuring plant proteins from hemp seeds to pea protein included ice cream, milks, chips, and cereals. It is clear that there is a demand for more plant-focused alternatives to animal products and food companies are responding in creative ways!

What was the most controversial topic you saw?

I attended an educational session about weight bias in healthcare settings and felt an immediate divergence among RD’s in the audience about defining and treating obesity. The presenters reflected on the importance of ensuring that we do not use shameful, dehumanizing or assumptive approaches to treating and preventing obesity on the policy level, but argued that we cannot focus only on prevention and leave out those who still struggle with obesity as a disease. During the question and answer segment at the end of the talk, one dietitian presented the idea that obesity might not need to be approached as a disease and rather as a descriptor of size, and that we turn our focus away from managing “weight” and more to managing health behaviors. I have been personally interested in learning more about weight-neutral approaches to nutrition and adopting an evidence-based Health at Every Size framework for practice, looking at metabolic indicators as opposed to BMI as primary outcomes for health. As encouraging as it was to see medical professionals talking about reducing weight bias in health care, the debate goes on about the best way to “treat”, reduce, and prevent obesity in the long-term, and whether or not it should really be considered a disease whatsoever.

How has your understanding of food and nutrition changed since going to FNCE?

I am encouraged, yet a little overwhelmed with the potential we have as nutrition professionals to not only shape the health trajectory of our nation, but of the globe. I appreciated the wide array of niche areas in which dietitians across the country choose to specialize, and am reminded that this is a field that can benefit from all types of thinkers, movers and shakers. I think we are at a time where collaboration is critical, and changes need to be made both with small, individual steps on the ground and with large steps on the level of policy via food industry collaboration.

Hannah is a second-year Nutrition Communication student and registered dietitian. This was her second FNCE, and her first that she attended on behalf of 88 Acres. She enjoyed networking with other professionals and ironically ended up craving a lot of fruits and vegetables at the end of the conference after sampling protein bar after protein bar in the expo.

 

Favorite quote of Sharmin, overheard at FNCE

Anabelle Harari

Why did you choose to go to FNCE this year?

I was really interested in learning about the latest nutrition research, meet fellow nutrition students from around the country, and network with some brands that I love.

What was your favorite Education Session?

My favorite education session was a toss-up between a talk on Polycystic Ovarian Syndrome (PCOS) and navigating different career paths in nutrition. There were so many interesting and inspiring sessions, it was really difficult to choose which to attend! Luckily, all of the sessions were recorded and can be watched later.

What was your favorite new product at the Expo?

Love the new Triple Cream Chocolate Siggi’s yogurt and the Vital Protein Matcha Collagen that comes out in a few months. Both really delicious.

Did you find any new food and nutrition trends that surprised you?

There were a lot of bars, but that did not really surprise me. I saw a bunch of companies using sprouts, grains, and of course countless protein shakes.

What was the most controversial topic you saw?

Weight Stigma in Healthcare, Communities and Policy—this session challenged people to be careful with public health messaging around obesity, stigmatizing patients with obesity, and being considerate of the language we use as professionals.

How has your understanding of food and nutrition changed since going to FNCE?

I think there is a lot of exciting changes in biotech that will influence the food and nutrition profession. There were several DNA and microbiome testing companies at the Expo as well as a fascinating session on nutrigenomics. I think as the science advances, we’re seeing more personalized nutrition, people wanting to know very specific information, and also tailoring nutrition recommendations to each person based on their unique genetic information.

Anabelle is in her third year completing the MS-DPD program with a concentration in Nutrition Communications and Behavior Change. When she’s not in class, you can find her in the kitchen creating delicious and healthy recipes for her blog, Local Belle. Check her out on Instagram for inspiring recipes and nutrition tips: @localbelle 

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Favorite quote heard by Sharmin, originally attributed to Eleanor Roosevelt

Sharmin Sampat

Why did you choose to go to FNCE this year?

This was my first FNCE conference. I am glad and grateful I got a chance to attend as a student host volunteer, a position I had applied for early on. As a volunteer, I was stationed at the Silent Auction area and helped with registering items for the auction. It was a excellent opportunity to network and connect with people with various backgrounds in nutrition. I had heard a lot about FNCE during my internship at EatingWell Magazine and how amazing it is to attend the best annual event in the nutrition field. I also wanted to take the opportunity to go to the student internship fair and gain insights about the programs I plan to apply to for my Dietetic Internship next year.

What was your favorite Education Session?

My favorite session was Sport Supplement: Facts, Noise and Wishful-thinking. It talked about how the sport nutrition market accounts for $30 billion U.S. dollars and rising—but unfortunately, it’s a market backed with little scientific evidence. It also shed light on how athletes consume ineffective supplementation to improve their health/stamina. I was surprised to find out that 1 out of 10 supplements that are purchased over the internet contain substances that fail a drug test. The Speaker also briefly gave some cues for reducing risks associated with supplements. In addition, I noticed how social media was also a big part of the sessions at FNCE. As Anabelle noted, I too had a hard time deciding which sessions to attend.

What was your favorite new product at the Expo?

I thoroughly enjoyed the KIND fruit bites, which are bite-size snacks made of real fruit. They claim to have no juice, concentrate, or preservatives—just real fruit. I must admit I found them tasty and interesting.

Did you find any new food and nutrition trends that surprised you?

Though not surprising, I found a lot of focus on fiber, functional foods: foods that have positive effects on the body other than basic nutrition; like a company named Beneo introduced chicory root fibers, a digestible fiber, in their products to improve gut health. There were also sessions that focused on gut health and gut microbiota.

Favorite quote of Hannah, overheard at FNCE

What was the most controversial topic you saw?

I attended a session on agriculture and its links to healthy eating patterns. One topic that was discussed at length in this session was Genetically Modified Organisms (GMOs). The speaker addressed how different countries have varying viewpoints on GMOs, which influences their policy making. I think GMO, in general, is a very controversial topic and as noted by the speaker, Dr. John Erdman, an emotional one too!

How has your understanding of food and nutrition changed since going to FNCE?

I think FNCE has been a insightful experience and made me realise how nutrition and its related fields can make such a great impact, not only on an individual but also on governments and countries. There is immense and extensive research in the field of nutrition that is taking place right now. It was overwhelming and inspiring at the same time, and it makes me grateful to be a part of this field.

Sharmin is a 2nd year student at Friedman School of Nutrition, majoring in Nutrition Interventions, Communications, and Behavior Change. She is also completing her coursework at Simmons College to become a Registered Dietitian.

 

 

 

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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.

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.

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.

 

 

5 Reasons the Whole30 is Not the Anti-Diet It Claims to Be

by Hannah Meier, RD, LDN

How does the Whole30 Diet hold up from a dietitian’s perspective? Hannah Meier breaks it down.

I’m calling it: 2017 is the year of the non-diet.

As a dietitian who ardently discourages short-term dieting, I was thrilled to read many articles posted around the new year with titles like “Things to Add, Not Take Away in 2017,” and “Why I’m Resolving Not to Change This Year.” Taking a step more powerful than simply abstaining from resolution season, influencers like these authors resolved to embrace the positive, stay present, and not encourage the cycle of self-loathing that the “losing weight” resolutions tend to result in year after year.

Right alongside these posts, though, was an overwhelming amount of press exonerating the Whole30—a 30-day food and beverage “clean eating” diet.

The founders of the Whole30, however, adamantly claim it is not a diet. Even though participants are advised to “cut out all the psychologically unhealthy, hormone-unbalancing, gut-disrupting, inflammatory food groups for a full 30 days” (including legumes, dairy, all grains, sugar, MSG, and additives like carrageenan), followers are encouraged to avoid the scale and focus on learning how food makes them feel rather than how much weight they gain or lose.

But our culture is still hungry for weight loss. The possibility of losing weight ahead of her sister’s wedding was “the deciding factor” for my friend Lucy (name changed for privacy), who read the entire Whole30 book cover to cover, and fought her “sugar dragon” for 30 days in adherence to the Whole30 protocol (only to eat M&M’s on day 31, she admits).

“Whole30 focuses on foods in their whole forms which is positive for people who are learning how to incorporate more unprocessed foods in their diet,” Allison Knott, registered dietitian and Friedman alum (N12) explains. “However, the elimination of certain groups of foods like beans/legumes and grains may have negative health implications if continued over the long-term.”

Diets like these trick consumers into thinking they are forming a healthier relationship with food. Though weight loss is de-emphasized, a trio of restriction, fear, and control are in the driver’s seat and could potentially steer dieters toward a downward, disordered-eating spiral.

I still think 2017 is the year of the non-diet, but before we get there we need to unmask the Whole30 and call it what it is: an unsustainable, unhealthy, fad diet.

1: It is focused on “can” and “cannot”

The Whole30 targets perfectly nutritious foods for most people (grains, beans and legumes, and dairy) as foods to avoid entirely, relegating them to the same level of value as boxed mac and cheese, frozen pizza, and Kool-Aid. And most bodies are perfectly capable of handling these foods. They provide a convenient, affordable, and satisfying means of getting calcium, vitamin D, potassium, phosphorus, and nutrient-dense protein. The Whole30 eliminates almost all the plant-based protein options for vegans and vegetarians. While the point of eliminating these foods, creators Hartwig and Hartwig explain, is to reduce inflammation and improve gut health, nowhere in the book or website do they provide scientific studies that show removing grains, beans and dairy does this for most people. But we’ll get to that later.

The Whole30 also instructs that participants not eat any added sugar or sweeteners (real or artificial), MSG (monosodium glutamate, a flavor enhancer that has been weakly linked to brain and nervous system disruption), or carrageenan (a thickener derived from seaweed and is plentiful in the world of nut milks and frozen desserts; conflicting evidence has both suggested and refuted the possibility that it is associated with cancer and inflammatory diseases), sulfites (like those in wine), or alcohol. Not even a lick, as they are very clear to explain, or you must start the entire 30-day journey from the beginning once more.

“I couldn’t go longer than 30 days without a hit of chocolate,” Lucy told me, explaining why she was dedicated to following the program exactly.

Why take issue with focusing on “good” and “bad,” “can” and “cannot” foods? As soon as a moral value is assigned, the potential for establishing a normal relationship to food and eating is disrupted. “The diet encourages following the restrictive pattern for a solid 30 days. That means if there is a single slip-up, as in you eat peanut butter (for example), then you must start over. I consider this to be a punishment which does not lend itself to developing a healthy relationship with food and may backfire, especially for individuals struggling with underlying disordered eating patterns,” Knott argues.

How will a person feel on day 31, adding brown rice alongside their salmon and spinach salad after having restricted it for a month? Likely not neutral. Restrictive dietary patterns tend to lead to overconsumption down the road, and it is not uncommon for people to fall back in to old habits, like my friend Lucy. “People often do several Whole30 repetitions to reinforce healthier eating habits,” she explained.

Knott relates the diet to other time-bound, trendy cleanses. “There’s little science to support the need for a “cleansing diet,” she says. “Unless there is a food intolerance, allergy, or other medical reason for eliminating food groups then it’s best to learn how to incorporate a balance of foods in the diet in a sustainable, individualized way.”

While no one is arguing that consuming less sugar, MSG and alcohol are unsound health goals, making the message one of hard-and-fast, black-and-white, “absolutely don’t go near or even think about touching that” is an unsustainable, unhealthy, and inflexible way to relate to food for a lifetime.

2: It requires a lot of brainpower

After eight years of existence, the Whole30 now comes with a pretty widespread social-media support system. There is plenty of research to back up social support in any major lifestyle change as a major key to success. Thanks to this, more people than ever before (like my friend Lucy, who participated alongside her engaged sister) can make it through the 30 days without “failing.”

But the Whole30 turns the concept of moderation and balance on its head. Perfection is necessary and preparation is key. Having an endless supply of chopped vegetables, stocks for soups, meat, and eggs by the pound and meals planned and prepared for the week, if not longer, is pretty much required if you don’t want to make a mistake and start over. The Whole30 discourages between-meal snacking, (why?) and cutting out sugar, grains, and dairy eliminates many grab-and-go emergency options that come in handy on busy days. So, dieters better be ready when hunger hits.

Should the average Joe looking to improve his nutrition need to scour the internet for “compliant” recipes and plan every meal of every day in advance? While the Whole30 may help those unfamiliar with cooking wholesome, unprocessed meals at home jumpstart a healthy habit, learning about cooking, especially for beginners, should be flexible. It doesn’t have to come with a rule book. In fact, I think that’s inviting entirely too much brain power that could be used in so many other unique and fulfilling ways to be spent thinking, worrying, and obsessing about food. Food is important, but it is only one facet of wellness. The Whole30 seems to brush aside the intractable and significant influence of stress in favor of a “perfect” diet, which may or may not be nutritionally adequate, anyway.

The language used by Whole30 creators to rationalize the rigidity of the diet could make anyone feel like a chastised puppy in the corner. “It’s not hard,” they say, and then proceed to compare its difficulty to losing a child or a parent. Okay, sure, compared to a major life stressor, altering one’s diet is a walk in the park. But changing habits is hard work that requires mental energy every single day. Eating, and choosing what to eat, is a constant battle for many people and it doesn’t have to be. Life is hard enough without diet rules. The last thing anyone needs is to transform a natural and fulfilling component of it (read: food) into a mental war zone with contrived rules and harsh consequences.

3: It is elitist

When was the last time you overheard a stranger complain about healthy eating being expensive? Most likely, the protester was envisioning a diet akin to the Whole30. Grass-fed beef, free-range chicken, clarified butter, organic produce…no dry staples like beans, rice or peanut butter. Healthy eating does not exist on a pedestal. It does not have to be expensive, but it certainly can be depending on where you choose to (or can) shop. Let’s set a few things straight: You don’t need grass-fed gelatin powder in your smoothies to be healthy. You don’t need organic coconut oil to be healthy. You don’t need exotic fruits and free-range eggs to be healthy. Maybe these foods mean more than just nutrition, signifying important changes to be made within our food system. But it terms of nutrition, sometimes the best a person can do for himself and his family is buy conventional produce, whole grains in bulk, and Perdue chicken breast on sale because otherwise they would be running to the drive thru or microwaving a packet of ramen noodles for dinner. A diet like the Whole30, which emphasizes foods of the “highest quality,” does nothing more than shame and isolate those who can’t sustain the standard it imposes, further cementing their belief that healthy eating is unattainable.

4: It is socially isolating

Imagine with me: I am participating in the Whole30 and doing great for the first week eating fully compliant meals. Then comes the weekend, and “oh no” it’s a football weekend and all I want to do is relax with my friends like I love to do. For me, that typically involves a beer or two, shared appetizers (even some carrots and celery!) and lots of laughs. The Whole30 creators would likely laugh in my face and tell me to suck it up for my own good and just munch on the veggies and maybe some meatballs. (“But are those grass-fed and did you use jarred sauce to make them? I bet there’s a gram of sugar hiding in there somewhere.”)

But it is just a month—certainly anyone can abstain from these type of events for a mere 30 days (remember, “it’s not hard”)—but then what? Do you just return to your normal patterns? Or do you, more likely, go back to them feeling so cheated from a month of restraint that you drink and eat so much more than you might have if you’d maintained a sense of moderation?

Of course, there are people comfortable with declining the food-centric aspect of social life, for whom turning down a glass of wine with cheese in favor of seltzer and crudités is no big deal. And perhaps our social events have become a bit too food centric, anyway. Either way, using food rules to isolate one’s self from friends and family sounds an awful lot like the pathway to an eating disorder, and the sense of deprivation most people likely feel in these situations can snowball into chronic stress that overshadows any short-term, nutrition-related “win.”

Although, maybe we should get all our friends to drink seltzer water and eat crudités at football games.

5: It is not scientifically sound

Most of The Whole30’s success has come from word of mouth, stories, and endorsements from those who successfully made it through the program and felt “better” afterwards. The website, dismayingly, does not house a single citation or study referenced in creation of the diet.

It’s important to note that the Whole30 did not exist 20 years ago. The Whole30 is not a pattern of eating that is replicated in any society on earth, and it doesn’t seem to be based off any research suggesting that it is indeed a superior choice. At the end of the day, this is a business, created by Sports Nutritionists (a credential anyone can get by taking an online test, regardless of one’s background in nutrition—which neither of them has) part of the multi-billion-dollar diet industry. Pinpointing three major food groups as causing inflammation and hormonal imbalance is quite an extreme statement to make without any research to back it up.

What does the science actually show? Knott, who counsels clients in her Tennessee-based private practice reminds us that, “consuming a plant-based diet, including grains and beans/legumes, is known to contribute to a lower risk for chronic disease like heart disease, cancer, and diabetes. Grains and beans/legumes are a source of fiber, protein, and B vitamins such as folate. They’re also a source of phytochemicals which may play a role in cancer prevention.”

The Whole30 proposes eliminating grains because they contain phytates, plant chemicals that reduce the absorbability of nutrients like magnesium and zinc in our bodies. While it’s true that both grains and legumes contain phytates, so do certain nuts and some vegetables allowed on the diet, like almonds. It is possible to reduce the amount of phytates in an eaten food by soaking, sprouting, or fermenting grains and legumes, but research from within the last 20 years suggests that phytates may actually play a key role as antioxidants. In a diverse and balanced diet, phytates in foods like grains and legumes do not present a major micronutrient threat. Further, new findings from Tufts scientists provide more evidence that whole grains in particular improve immune and inflammatory markers related to the microbiome.

Legumes in the Whole30 are eliminated because some of their carbohydrates aren’t as well-digested and absorbed in the small intestine. Some people are highly sensitive to these types of carbohydrates, and may experience severe digestive irritation like excessive gas, bloating, constipation, etc. Strategies such as the FODMAP approach are used with these folks under professional supervision to ensure they continue to get high-quality, well-tolerated fiber in their diets, and only eliminate those foods which cause distress. For others, elimination of these types of carbohydrates is unsound. Undigested fibers like those in legumes are also known as prebiotics, and help to feed the healthy bacteria in our gut. Eliminating this beneficial food group to improve gut health goes directly against the growing base of scientific evidence surrounding the microbiota.

Dairy, for those without an allergy or intolerance, has been shown to provide many benefits when incorporated into a balanced and varied diet, including weight stabilization and blood sugar control. The diet also fails to recognize the important health benefits associated with fermented dairy products like yogurt.

In terms of the diet’s long-term sustainability, Knott adds, “There’s plenty of research to support that restrictive diets fail. Many who adopt this way of eating will likely lose weight only to see it return after the diet ends.”

Let’s not forget its few redeeming qualities

For everything wrong with the Whole30, there are a few aspects of the diet that should stick. The concept of getting more in touch with food beyond a label, reducing added sugars, and alcohol is a good one and something that everyone should be encouraged to do. Focusing on cooking more from scratch, relying less on processed foods, and learning about how food influences your mood and energy levels are habits everyone should work to incorporate into a healthy life.

Knott agrees, adding, “I do like that the diet emphasizes the importance of not weighing yourself. We know that weight is a minor piece to the puzzle and other metrics are more appropriate for measuring health such as fitness, lean muscle mass, and biometric screenings.”

Improving the nutritional quality of your diet should not eliminate whole food groups like dairy, grains, and legumes. It should not have a time stamp on its end date, and rather, should be a lifelong journey focusing on flexibility, moderation, and balance. Lower your intake of processed foods, sugars, and alcohol and increase the variety of whole foods. Et voilà! A healthy diet that won’t yell at you for screwing up.

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Thanks to Allison Knott MS, RDN, LDN for contributing expertise. Knott is a private practice dietitian and owner of ANEWtrition, LLC based in Tennessee. She graduated from the Nutrition Communications program at Friedman in 2012.

 

Hannah Meier is a second-year, part-time Nutrition Interventions, Communication & Behavior Change student and registered dietitian interested in learning more about non-diet approaches to wellness. She aspires to make proper nutrition a simple, accessible and fulfilling part of life for people in all walks of life. You can find her on Instagram documenting food, fitness and fun @abalancepaceRD, as well as on her (budding) blog of the same title: http://www.abalancedpace.wordpress.com

Putting a Pause on Peanut Butter Panic: New Guidelines Seek to Reduce Peanut Allergy Risk

by Erin Child

Do you like peanut butter? So do I. I’m kind of obsessed. Perhaps you add it to your smoothie bowl, drizzle it artfully on your Instagram worthy oatmeal, or, if you’re in grad school, it’s part of your PB&J. After all, that is the cheapest, easiest thing to make. But what if you had to take the PB out of the PB&J, and eliminate it from your diet and your life? This is a growing reality for many in the United States, with outdated, misinformed guidelines being blamed for the recent spike in peanut allergies. Read on to explore the revolutionary research that has spurred the creation of new guidelines, and why Americans need to change how we handle peanut exposure in childhood.

I recently stopped eating peanut butter in any way that could be deemed pretty or practical. Instead, you can find me in my room, with the door shut, maniacally shoveling peanut butter into my mouth with a plastic spoon.

This all started at the beginning of 2017. No, it is not some bizarre New Year’s resolution or diet trend. Rather, a new roommate moved in. She’s a great girl – kind, thoughtful, willing to learn how to properly load a dishwasher – and massively, catastrophically allergic to peanuts. She is also allergic to tree nuts and soy, but peanuts are THE BIG BAD. They are the reason why I spent the week before her arrival scrubbing my kitchen from top to bottom and running every dish and utensil (even the wooden ones, to my chagrin) through the dishwasher. And there is now an EpiPen® in our kitchen. Just as they are on some airlines, peanuts are now banned from the general living areas of my house, and thus I & my beloved jar of peanut butter have been sequestered to my room.

Many of you have probably dealt with peanut-free schools or day cares, or been informed to not consume any peanut products on your flight. Peanut allergy rates in children in the United States have quadrupled from the late 1990s (less than 0.5%) to about 2% today, and are the leading cause of anaphylaxis or death from food allergies. Thanks to my new-found awareness, I have become extremely self-conscious about eating peanut butter in public spaces. On the bus the other day some peanut butter dripped from my sandwich to the seat. I panicked, thinking “What is the chance this spill is going to wind up hurting some little kid?” (I hope they are not licking the seats on the bus, but still.)

Coupled with my new roommate’s arrival, I was fascinated to find that peanut allergies have been back in the news. On January 5th, 2017, the National Institute of Allergy and Infectious Disease (NIAID) published new guidelines for practitioners about when to introduce peanuts to high-risk, medium-risk, and low-risk infants. High-risk infants with severe eczema and/or an egg allergy should be introduced to peanuts between 4 to 6 months. Medium-risk infants with mild eczema should be introduced to peanuts by 6 months, and low-risk infants without eczema or other allergies can be introduced to peanuts any time after they have been introduced to solid foods.

These guidelines fit in with the dual-allergen exposure hypothesis. This suggests that children are first exposed to food particles through their skin as infants. This exposure primes their immune systems to treat the food proteins like invaders and build up defenses against it. If the food is eaten years later, the child has an acute allergic reaction because their immune system had ample time to prepare. Children with eczema have weakened skin barriers and are much more likely to experience repeated skin exposure to food allergens. This leads to an increased chance of an allergic reaction once they eat the food. Current research now supports this hypothesis, and also suggests that by shortening the time between skin exposure and ingestion, we will reduce the number of acute allergic reactions. The sooner an infant starts eating an allergen, the more likely the body will adjust to it without having time to bsuild up strong defenses against it.

These new guidelines on peanut exposure from NIAID seek to correct for guidelines set by the American Academy of Pediatrics in 2000. The 2000 guidelines were based on only a few tests done on hypoallergenic infant formula feeding, yet conclusively recommended that infants at high-risk for peanut allergies wait until 3 years of age to first try peanuts. Based on the newest findings, it appears that this advice was ill advised. My roommate, n=1, was born in the mid-1990s when delaying peanut exposure was coming into vogue. She had severe eczema an infant, and following doctors’ recommendations, wasn’t introduced to peanuts until somewhere between 18-24 months old. She is equally fascinated with the new research, and wishes there was some way to know if the outcome would have been different had she tried them at a younger age.

Peanut allergies are more common in the US, UK, and Australia, which are also the countries that have historically had the most stringent recommendations around peanut introduction. As doctors and researchers sought to figure out why peanut allergies were ballooning, they looked to countries with very low peanut allergy rates, like Israel, where infants are introduced to peanuts at early ages. In Israel, instead of Cheerios, infants are given a peanut based snack, called Bamba, as one of their first foods. In other developing countries, infants are exposed to peanuts early on—both in their environment and in their food. These other countries also have much lower allergy rates.

In 2015, NIAID funded the Learning Early About Peanut Allergy (LEAP) study to determine whether early exposure to peanuts would decrease the incidence of peanut allergies. The UK study was a randomized controlled trial including 640 infants between 4 and 11 months of age with severe eczema and/or egg allergy. The infants were split into two groups (based on skin prick test results for peanuts) and then randomized to either eat or avoid peanuts until 60 months old (5 years). For infants in the negative skin prick test group, 13.7% of those who avoided peanuts had developed an allergy and only 1.9% of those who ate peanuts developed an allergy (P<0.001). For infants in the positive skin prick test group, 35.3% who of those who avoided peanuts had developed an allergy and 10.6% of those who ate peanuts developed an allergy (P=0.004). These results were significant and stunning, prompting the formulation of the current NIAID guidelines.

So, should we all start slathering our babies in peanut butter? Maybe. (As always, talk to your pediatrician). Food allergy science is an evolving field, and what is true today may not hold true a decade down the line. But based on the significance of the current research and the lower peanut allergy rates in cultures and countries that do not limit peanut exposure, the evidence strongly indicates that parents in the United States should change their approach.

Only 20% of children diagnosed with peanut allergies will grow out of them. The vast majority, like my roommate, are allergic for life. For now, research on reducing peanut allergies in adults is limited, making it unlikely that we will be eliminating any allergies anytime soon. So for now, I will continue to eat my peanut butter in my room. Alone.

Erin Child is a second semester NICBC student in the dual MS-DPD program and this is her first article for the Sprout. She loves cooking (usually with Friends or Parks & Rec on in the background). She hates brownies. (Seriously.) As the Logistics Co-Chair for the Student Research Conference, she looks forward to seeing everyone there on April 8th!

WIC at the Crossroads of the Opioid Epidemic

by Danièle Todorov

The complexity and pervasiveness of the opioid epidemic has forced government agencies to be innovative with their resources. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in a prime position to care for pregnant women affected by the epidemic and has stepped up to the plate.

In January of 2016, then Secretary of Agriculture Tom Vilsack was appointed by President Obama to lead an interagency taskforce to address the opioid epidemic in rural America. Secretary Vilsack, who’s been outspoken about his own mother’s struggle with prescription drug addiction, knew that compassion and collaboration would be vital. His agency, the USDA, has unique resources and relationships in rural areas, putting it in a prime position to address the epidemic.

Addressing the epidemic is no simple task. According to the CDC, 91 Americans died daily from opioid overdose in 2015. Nearly half of these deaths involved a prescription opioid, used in the treatment of pain. In a town hall meeting in Missouri last July, Secretary Vilsack stated that due to “the devastating toll that opioid misuse has taken on our communities, and particularly rural areas, I have tasked USDA with creatively using all of the resources at our disposal to stem the tide of this epidemic” [1]. Interestingly, Secretary Vilsack highlighted WIC as a resource that could be creatively used. “For many women”, he stated, “WIC is their first point of entry into the healthcare system, and we have an opportunity to intercept and potentially prevent dangerous health outcomes for both the mother and the child” [1].

Pain management is an important part of pregnancy care. The prescription of opioids for pain in pregnancy is increasingly common; 1 in 5 Medicaid-enrolled women were prescribed an opioid at some point during their pregnancy in 2014 [2]. However, the effect of opioids on birth outcomes is understudied. In utero opioid exposure may be associated with preterm delivery and low birth weight [3]. Exposed neonates may develop withdrawal symptoms, a condition known as neonatal abstinence syndrome, which is associated with increased risk of seizures and breathing difficulties [3]. Similarly understudied are the rates of opioid abuse during pregnancy. We do know that pregnant women with substance abuse problems are particularly vulnerable to food and job insecurities and unstable housing, which exacerbate potential health complications [4].

The healthcare system often stigmatizes and underserves pregnant women with substance abuse problems. However, WIC is increasing its ability to engage them in care. WIC’s mission is to promote the health of low-income women and their children by providing nutritious food, health education, and referrals. Starting in 2014, WIC agencies have increased staff training surrounding substance abuse [1]. Staff are better equipped to notice potential substance abuse, to educate WIC participants about the dangers of substance abuse during pregnancy and breastfeeding, and to connect them with local resources. These expanded roles align with WIC’s mission, not only because they aim to protect the health of the women they serve, but because WIC “acknowledges that substance use is incompatible with good nutrition” [5].

WIC is forming relationships with women at a promising point in time in their lives. In their staff training guide, WIC cites a study showing that women are “more motivated to improve their lifestyle and health habits during periods when they make the transition from one life situation or role to another… WIC participants are a natural target audience for substance use information because they are, by definition, in the life transition stage of pregnancy and new motherhood” [5].

WIC is playing an important part in the collaborative response to the epidemic. As the director of the USDA, Secretary Vilsack understood that a holistic response was the only effective solution and embraced President Obama’s mandate. “This disease isn’t a personal choice,” says Secretary Vilsack, “and it can’t be cured by willpower alone. It requires responses from whole communities, access to medical treatment, and an incredible amount of support. To me, our mandate is clear: don’t judge, just help” [6]. Secretary Vilsack’s endorsement of his replacement as Secretary of Agriculture, nominee Sonny Perdue, gives hope that the USDA will continue this vital endeavor.

Sources

  1. Agriculture Secretary Vilsack Announces Substance Misuse Prevention Resources for Low Income Pregnant Women and Mothers In Order to Battle the Opioid Epidemic, U. Office of Communications, Editor. 2016.
  2. Desai, R.J., et al., Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstetrics and gynecology, 2014. 123(5): p. 997.
  3. Patrick, S.W., et al., Prescription opioid epidemic and infant outcomes. Pediatrics, 2015. 135(5): p. 842-850.
  4. Sutter, M.B., S. Gopman, and L. Leeman, Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence. Obstetrics and Gynecology Clinics of North America, 2017. 44(1): p. 95-107.
  5. Substance Use Prevention: Screening, Education, and Referral Resource Guide for Local WIC Agencies, F.a.N.S. U.S. Department of Agriculture, Editor. 2013.
  6. USDA. Addressing the Heroin and Prescription Opioid Epidemic. 2016 02/17/17].

Danièle Todorov is a first-year nutritional epidemiology student with a focus on pregnancy nutrition and birth outcomes.