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!).

 

 

Microalgae: Do They Have a Place in Your Diet or Should They Be Left in the Pond?

by Julia Sementelli

If you have an Instagram account, chances are you’ve seen a slew of blue-green smoothies pop up on your feed. That vibrant color comes from adding some form of powdered algae to the smoothie. High in antioxidants, healthy fats, and protein, microalgae are the latest superfood to take over the nutrition world. The most popular types of algae include chlorella, spirulina, Aphanizomenon flos-aquae (AFA), Blue Majik…the list goes on. Microalgae are claimed to boost your energy, decrease stress, and reduce your risk for diabetes and heart disease. The question, of course, is whether these microalgae have any science-based health benefits beyond the nutrients they provide. I’ve asked consumers, health food companies, and nutrition experts to weigh in on whether algae should be added to your daily regimen or if they’re better off as fish food.

What are algae?  And why are we eating them?

Microalgae are very small photosynthetic plants rich in chlorophyll, which is where the green comes from (hello flashbacks to high school biology class). According to research, algae types differ in the nutrients they provide but all share one characteristic: they are high in antioxidants.  (See “Get To Know Your Blue-Green Algae” in the sidebar to learn more about individual microalgae). While some microalgae have been on the market for years, they have just recently risen to fame in the nutrition world as social media, blogs, and magazines advertise the purported benefits. One microalga in particular, spirulina, has received a significant amount of attention.  Companies have jumped on the microalgae bandwagon by adding spirulina to their products and even selling it in pure form. Abby Schulman, vegan and nutrition enthusiast, says that her fascination with superfood culture generally led to hearing about microalgae, in particular spirulina.  “It is sort of billed as this amazing nutrient-dense secret pill,” she states. “I was actually concerned about my iron levels and nutrition generally when I first started using it, since it was right when I transitioned to veganism. It felt like a good way of packing in some vitamins was to try the spirulina.” As a vegan who eats a diet rich in fresh produce, Abby states that adding spirulina to her diet is “ a more shelf stable way of getting in greens at the level I eat them than having to buy huge tubs of greens all the time.”

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Photo credit: Julia Sementelli

Microalgae’s time in the sun

 Blue-green microalgae have become a nutritional celebrity thanks to their prevalence in popular health food spots across the United States. Juice Generation, a national juice and smoothie chain, has jumped on the algae bandwagon by selling products that tout its supposed benefits. Products range from “Holy Water,” which contains Blue Majik, tulsi, coconut water, and pineapple, to concentrated shots of E3Live. These products claim to boost energy, enhance focus, and balance blood sugar. However, research to support these claims is lacking.

Infographic credit: Julia Sementelli

Infographic credit: Julia Sementelli

Health food businesses that use social media and blogs to advertise their products have also played a significant role in making microalgae famous. Sun Potion, an online medicinal plants and superfoods company, sells a slew of supplements, including chlorella. Sky Serge, Sun Potion spokesperson, is a big proponent of the power of chlorella. “Sun Potion chlorella is a single-celled green algae that is different than others, and is grown indoors and processed using an advanced sound frequency technology to crack the cell wall, making its many nutrients available for us to enjoy,” she explains. She says that she enjoys consuming chlorella in a glass of spring water each morning. “I have personally felt its detoxification benefits and have noticed healthier skin, better digestion and overall, a better wellbeing. Whether I am drinking it in my water in the morning or adding it to a salad dressing, I try and want to consume it every day!”

To further bolster Sun Potion’s belief in the power of its chlorella, founder, Scott Linde claims that chlorella “contains all eight essential amino acids, which could allow a person to live solely on chlorella and clean drinking water.” Not surprisingly, he too consumes chlorella daily. “Upon waking in the morning, I enjoy an eight ounce glass of water with a teaspoon of chlorella mixed in,” he says. “This simple action can punctuate the start of a great day. The body is slightly dehydrated after sleep, meaning the nutrients from the chlorella are absorbed almost immediately into the blood stream.” When asked about the nutrition benefits of chlorella, Linde claims that drinking chlorella offers much more than just antioxidants. “It helps to oxygenate the blood, waking up the brain; nourish the organs; aid in healthy elimination; and assist the body in moving toxins out of the system.” Not only have Serge and Linde experienced excellent results, but their customers have as well. “At Sun Potion, we have actually had customers tell us that they have forgotten to make their coffee in the morning because they were feeling so good from their morning chlorella ritual. This is perfect example of potent nutrition and best quality plant materials helping to saturate the body with positive influence, leading to looking, feeling, and operating at one’s best.”

The good, the bad, and the blue-green

Although many health claims about microalgae, such as increasing energy and regulating blood sugar, are not supported by science, research has shown some promising, more realistic benefits. A 2013 study showed that adding 3600 milligrams per day of chlorella to the diets of 38 chronic smokers for six weeks helped to improve their antioxidant status and reduce their risk of developing cancer. Another study found that daily intake of 5 grams of chlorella reduced cholesterol and triglyceride levels in patients with high cholesterol. Research has even found that supplementing chlorella can improve the symptoms of depression, when used in conjunction with antidepressant therapy. Still, many of these studies are the first of their kind and more evidence is needed regarding the long-term effects on cholesterol, cancer prevention, and depression, in addition to other conditions microalgae are claimed to help to alleviate.

While the supposed benefits of microalgae typically receive all of the attention, microalgae also have their own list of caveats. According to New York City-based registered dietitian, Willow Jarosh, “Some people can have allergic reactions to both spirulina and chlorella, so take that into consideration when trying. In addition, spirulina can accumulate heavy metals from contaminated waters.” She also states that microalgae can actually be too high in certain nutrients. “If you have high iron levels, have gone through menopause, or are a man, be aware of the high iron levels in microalgae—especially if you use them regularly.”

So what’s the verdict?

While there is certainly a lot of hype surrounding microalgae in the media, from companies that sell products containing them to preliminary supporting research, when it comes to recommending adding chlorella to your daily diet, experts are hesitant.

According to Jarosh, “There are some really major health claims, with very little scientific evidence/research to back up the claims, for both chlorella and spirulina.” As the co-owner of a nutrition consulting business, C&J Nutrition, she finds that her clients are frequently asking her about her thoughts on microalgae. “We’re always reluctant to recommend taking something when the long-term safety is unknown,” Jarosh says. “And since there’s not much research in humans to provide strong reasons to take these supplements (yet!), and the long-term research is also lacking, we’d recommend not using either on a regular basis.”

Microalgae are packed with antioxidants and those are always a good addition to your daily eats. Although the colors of microalgae appear supernatural and their effects often advertised as having the ability to give you superpowers, research is currently inadequate to say whether microalgae have more benefits than other antioxidant-rich foods. If you do decide to try it based on its antioxidant content, make sure that it does not replace other fruits and vegetables in your diet. Remember: Whole foods are always better than a powder.

Julia Sementelli is a second-year Nutrition Communication & Behavior Change student and registered dietitian.  Follow her on Instagram at @julia.the.rd.eats

 

 

 

 

 

 

What’s the Deal with Vitamin D?

by Katelyn Castro

There is always one nutrient that seems to linger in the media for a while. Lately, vitamin D has been the lucky winner! Considering that over 40% of Americans are vitamin D deficient, according to the National Health and Nutrition Examination Survey (NHANES), it’s worth taking a closer look at vitamin D.

Depression, cancer, heart disease, and type 1 diabetes are some of the many health conditions that have been linked to vitamin D deficiency. While it is too soon to point to vitamin D as a cure-all, this vitamin may be more important for our health than previously thought—especially during the winter months in New England!

Why is Vitamin D Important?

Vitamin D is most often known for its role in bone health, increasing calcium absorption and helping with bone mineralization alongside calcium and phosphorus. Historically, rickets in children and osteoporosis and bone fractures in adults have been the most common signs of vitamin D deficiency.

As a fat-soluble vitamin and a hormone, vitamin D is also involved in many other important metabolic processes. Did you know vitamin D activates over one thousand genes in the human genome? For example, vitamin D is needed for protein transcription within skeletal muscle, which may explain why vitamin D deficiency is associated with poor athletic performance. Vitamin D also regulates blood pressure by suppressing renin gene expression, supporting the possible relationship between vitamin D deficiency and risk of heart disease. Additionally, vitamin D status may alter immunity due to its role in cytokine production. Studies have found that vitamin D deficiency is associated with upper respiratory tract infections. While more research is needed to explore these connections, these findings continue to suggest that vitamin D plays an integral role in bone, muscle, cardiac, and immune health.

Where Do You Get Vitamin D?

Only a few foods are natural sources of vitamin D, including eggs and fatty fish like salmon, mackerel, tuna, and sardines. Instead, vitamin D-fortified foods like dairy products, juices, and breakfast cereals make up the majority of Americans’ vitamin D intake.

Sun exposure, on the other hand, can be the greatest source of vitamin D for some people–hence vitamin D’s nickname, the “sunshine vitamin.” Unlike any other vitamin, vitamin D can be synthesized in the body when the sun’s ultraviolet B rays reach the skin and convert cholesterol into a Vitamin D3, the precursor for vitamin D. Then, Vitamin D3 diffuses through the skin into the blood, where it is transported to the liver and kidneys and converted into vitamin D’s active form, 25(OH)D.

Research has found that exposing arms, legs, and face to the sun for 15 to 30 minutes twice a week provides about 1000 international units of vitamin D (equal to about 10 cups of milk!). Despite this robust source of vitamin D, deficiency is surprisingly common in the U.S.

Who is at Risk of Vitamin D Deficiency?

Many circumstances can alter vitamin D synthesis and absorption, increasing risk of vitamin D deficiency. Some of the factors that have been found to impact vitamin D status include the following:

  • Season: According to research, during the months of November to February, people living more than 37 degrees latitude north or south produce little or no vitamin D from the sun due of the angle of ultraviolet B sunrays. While vitamin D is stored in fat tissue and can be released into the blood when needed, our stores typically only last one to two months.
  • Limited Sun Exposure: Vitamin D synthesis can also be blocked when sunscreen is applied correctly or when long robes or head coverings are worn for religious reasons. For example, sunscreen with a sun protection factor (SPF) of 8 decreased vitamin D synthesis in skin by about 95% in one study.
  • Skin Color: People with darker skin pigmentation have also been found in research to have lower levels of vitamin D due to decreased synthesis. This is supported by the high prevalence of vitamin D deficiency among certain ethnicities, with 82% African Americans and 69% Hispanics found to be vitamin D deficient according to NHANES.
  • Weight: Studies also suggest that overweight and obese people may have higher Vitamin D requirements. Since they have more body fat and since vitamin D is a fat-soluble vitamin, vitamin D is more widely distributed in fat tissue, making it less bioavailable. As a result, more vitamin D may be needed for it to reach the blood stream for distribution in the body.
  • Age: Older adults have been found to have lower levels of the vitamin D, likely due to both decreased sun exposure and inefficient synthesis. One study found that 70 year-olds had about 25% of the vitamin D precursor compared to young adults, which decreased vitamin D synthesis in the skin by 75%.
  • Fat Malabsorption: When any gastrointestinal disorder or other health condition impairs fat absorption (i.e. liver disease, cystic fibrosis, celiac disease, or Crohn’s disease), vitamin D is also poorly absorbed and utilized since Vitamin D is a fat-soluble vitamin.

 Vitamin D deficiency can be especially concerning because symptoms like bone pain and muscle weakness may go undetected in the early stages of deficiency. Although physicians do not routinely check vitamin D levels, those at risk of deficiency may benefit from a serum 25(OH)D test. This is a simple test used to measure the level of vitamin D circulating in blood, with levels less 20 nanograms per milliliter commonly used to diagnose deficiency. However, some organizations like the Endocrine Society argue that levels greater than 30 nanograms per milliliter should be recommended for optimal bone and muscle metabolism.

How Much Vitamin D Do You Need?

Similar to vitamin D serum levels, no ideal vitamin D intake has been well established since many factors contribute to vitamin D status. The U.S. Institute of Medicine recommends 600 to 800 international units (IU) of vitamin D daily for adults, assuming minimal sun exposure. On the other hand, the National Osteoporosis Foundation recommends larger doses of 1000 to 1200 IU daily for adults to support adequate bone health. Although vitamin D toxicity is rare, an upper level of 4000 IU has been set by the Institute of Medicine since extremely high levels can lead to calcium buildup, and could cause poor appetite, nausea, vomiting, weakness, and kidney problems.

With limited amounts of vitamin D provided from food, even fortified foods, diet alone is usually inadequate to meet vitamin D needs. For example, you would need to drink about 8 cups of milk every day to reach 800 IU of vitamin D from diet alone! While sun exposure can supplement food intake to meet vitamin D needs, many Americans still fall short of their needs due the factors outlined above.

For the 40% of Americans who have been found to be vitamin D deficient, vitamin D supplementation can be an effective and safe way to meet needs. Whether you’re an avid sunscreen-user or living here in New England during these fall and winter months, a daily vitamin D supplement can ensure that vitamin D stores are adequate. Multivitamins typically provide 400 IU of vitamin D, but a separate vitamin D supplement (D2 or D3) with 800 or 1000 IU may be needed to meet daily intake recommendations.

Katelyn Castro is a second-year student in the Dietetic Internship/MS Nutrition Program at the Friedman School. During the summer, she enjoys soaking up the sun if only for an excuse to get her daily dose of Vitamin D. During the winter, you can find her trekking through the snow, bundled up like the boy in A Christmas Story, and contemplating whether she needs a D supplement.

 

 

Timing of your Meals–Does it Matter?

by Yifan Xia

How would you feel if you were told to not have dinner for the rest of your life? Skipping dinner every day might sound shocking to most of us, but it was once a very common practice in ancient China in the Han Dynasty. In fact, even today Buddhism and Traditional Chinese Medicine (TCM) promote this practice as a healthier choice than eating three meals per day. But does this practice have roots in science? Of course, controversy exists around this topic, but one thing that we can be certain of today is that the timing of our meals can have a much greater impact on our health than we originally thought.

Researchers investigating the circadian system (internal biological clock) have started looking at the effects of mealtime on our health. Surprisingly, preliminary evidence seems to support the claims of Buddhism and TCM, indicating that eating meals earlier in the day might help promote weight loss and reduce the risk of chronic disease.

What are circadian rhythms and the circadian system?

Circadian rhythms are changes in the body that follow a roughly 24-hour cycle in response to external cues such as light and darkness. Our circadian system, or internal biological clock, drives circadian rhythms and prepares us to function according to a 24-hour daily cycle, both physically and mentally.

Why do they matter to our health?

Our internal biological clock is involved in almost every aspect of our daily lives: it influences our sleep-and-wake cycle, determines when we feel most energetic or calm, and when we want to eat.

These days people don’t always rely on their biological clocks to tell them when to eat, and there are many distractions in the environment that can influence mealtime. We typically think how many calories we eat—and what we eat—are the major contributors to our weight and health, but researchers have found that eating at inappropriate times can disrupt the internal biological clock, harm metabolism, and increase the risk of obesity and chronic disease.

What does the research say?

Although currently the body of research evidence for this area is relatively small, there are several human studies worth highlighting. One randomized, open-label, parallel-arm study, conducted by Jakubowicz, D., et al and published in 2013, compared effects of two isocaloric weight loss diets on 93 obese/overweight women with metabolic syndrome. After 12 weeks, the group with higher caloric intake during breakfast showed greater weight loss and waist circumference reduction, as well as significantly greater decrease in fasting glucose and insulin level, than the group with higher caloric intake during dinner. Another study published in the same year with 420 participants noted that a 20-week weight-loss treatment was significantly more effective for early lunch eaters than late lunch eaters. In 2015, a randomized, cross-over trial, conducted in 32 women and published in International Journal of Obesity, showed that late eating pattern resulted in a significant decrease in pre-meal resting-energy expenditure, lower pre-meal utilization of carbohydrates, and decreased glucose tolerance, confirming the differential effects of meal timing on metabolic health. However, few studies were identified reporting negative findings, probably due to the fact that this is an emerging field and more research is needed to establish a solid relationship.

 So when should we eat? Is there a perfect mealtime schedule for everyone?

“There are so many factors that influence which meal schedules may be suitable for an individual (including biological and environmental) that I cannot give a universal recommendation,” says Gregory Potter, a PhD candidate in the Leeds Institute for Genetics, Health and Therapeutics (LIGHT) laboratory at the University of Leeds in the United Kingdom and lead author on the lab’s recent paper reviewing evidence of nutrition and the circadian systems, published in The British Journal of Nutrition in 2016. Potter also comments that regular mealtime seems to be more important than sticking to the same schedule as everyone else: “There is evidence that consistent meal patterns are likely to be superior to variable ones and, with everything else kept constant, it does appear that consuming a higher proportion of daily energy intake earlier in the waking day may lead to a lower energy balance and therefore body mass.”

Aleix Ribas-Latre, a PhD candidate at the Center for Metabolic and Degenerative Diseases at the University of Texas Health Science Center and lead author on another review paper investigating the interdependence of nutrient metabolism and the circadian systems, published in Molecular Metabolism in 2016, also agrees: “To find the appropriate meal time has to be something totally personalized, although [it] should not present [too] much difference.” Aleix especially noted that people who are born with a tendency to rise late, eat late, and go to bed late (“night owls” versus “early birds”) are more likely to be at risk for metabolic disease.

Do we have to eat three meals a day?

How many meals do you usually have? In fact, how much food makes a meal and how much is a snack? There is no universal definition, which makes these difficult questions to answer.

“To maintain a healthy attitude towards food, I think it is important to avoid being too rigid with eating habits … I do think consistency is important as more variable eating patterns may have adverse effects on metabolism,” says Potter. “Although there is evidence that time-of-day-restricted feeding (where food availability is restricted to but a few hours each day) has many beneficial effects on health in other animals such as mice, it is as yet unclear if this is true in humans. I’d also add that periodic fasting (going for one 24 hour period each week without energy containing foods and drinks) can confer health benefits for many individuals,” Potter comments.

[See Hannah Meier’s recent article on intermittent fasting for more.]

Based on their research, Ribais-Latre and his lab have a different opinion. “We should eat something every 3-4 hours (without counting 8 hours at night). Many people complain about that but then consume a huge percentage of calories during lunch or even worse at night, because they are very hungry. Eating a healthy snack prevents us [from] eating too [many] calories at once.” He suggests what he considers a healthier mealtime schedule:

–          6:00 am  Breakfast (30% total calories)

–          9:30 am  Healthy snack (10%)

–          1:00 pm  Lunch (35%)

–          4:30 pm  Healthy snack (10%)

–          8:00 pm  Dinner (15%)

What if you are a shift worker or your work requires you to travel across time zones a lot? Ribais-Latre’s advice is “not to impair more their lifestyle… at least it would be great if they are able to do exercise, eat healthy, sleep a good amount of hours.”

What does Traditional Chinese Medicine say?

There are historical reasons behind the no-dinner practice in ancient China in the Han Dynasty. First, food was not always available. Second, electricity hadn’t been invented, so people usually rested after sunset and they didn’t need much energy at what we now consider “dinner time.”

However, there are also health reasons behind this practice. In TCM theory, our internal clock has an intimate relationship with our organs. Each organ has its “time” for optimal performance, and we can reap many health benefits by following this clock. For example, TCM considers 1:00 am – 3:00 am the time of “Liver”. The theory says that is when the body should be in deep sleep so that the liver can help to rid toxins from our body and make fresh blood. Disruption at this time, such as staying up until 2:00 am, might affect the liver’s ability to dispel toxins, leading to many health problems, according to the theory.

Many Western researchers do not seem to be familiar with the TCM theory. When asked about the practice of skipping dinner, Potter comments, “I think that skipping dinner can be a perfectly healthy practice in some circumstances; in others, however, it may be ill advised if, for example, the individual subsequently has difficulty achieving consolidated sleep.”

On the flip side, Ribais-Latre says that “skipping a meal is not good at all. We should not eat more calories than those we need to [live], and in addition, the quality of these calories should be high… If you can split those calories [to] 5 times a day instead of three, I think this is healthier.”

Even though there is no universal agreement on mealtime, the tradition of “skipping dinner” did come back into style several years ago in China as a healthier way of losing weight, and was quite popular among Chinese college women. Yan, a sophomore from Shanghai and a friend of mine, said that she tried the method for six months but is now back to the three-meal pattern. “The first couple of days were tough, but after that, it was much easier and I felt my body was cleaner and lighter… I did lose weight, but that’s not the main goal anymore… I got up early every day feeling energetic. Maybe it’s because I only ate some fruits in the afternoon, I usually felt sleepy early and went to bed early, which made it easier to get up early the next day with enough sleep… I’m eating three meals now, but only small portions at dinner, and I think I will continue this practice for my health.”

So what’s the take-away?

Mealtime does seem to matter. But exactly how, why, and what we can do to improve our health remains a mystery. Researchers are now looking into the concept of “chrono-nutritional therapy,” or using mealtime planning to help people with obesity or other chronic diseases. When we resolve this mystery, the question of “When do you eat?” will not just be small talk, but perhaps a key to better health.

Yifan Xia is a second-year student studying Nutrition Communication and Behavior Change. She loves reading, traveling, street dancing, trying out new restaurants with friends in Boston, and watching Japanese animations.

 

 

Can I Eat An Engineered Apple, Please?

by Delphine Van Roosebeke

The days of throwing your half-eaten apple away because it turned brown are over. Shiny non-browning apples are about to hit the consumer market in a few months. And this time, it’s not a fairy tale. Read on.

Cartoon from Pinterest

Cartoon from Pinterest

In 1812, the German Grimm Brothers created the shiny red apple in Snow White, featuring it as the symbol of evil given to Snow White by the witch on behalf of the jealous queen. The story was told to children to teach them not to trust strangers. Two hundred years later, it is the shiny green Arctic® Apple that brings people together to tell stories. This time, Okanagan Specialty Fruits Inc., a Canadian agriculture biotech company that creates new varieties of apples, has replaced the jealous queen. Don’t get me wrong, you won’t get poisoned as Snow White did, but you may be surprised by sliced apples that won’t brown for two weeks.

What are non-browning apples?

No matter how you slice, bruise or bite your apple, every apple turns brown eventually. When the apple’s flesh is cut, the oxygen in the air interacts with chemicals in the flesh of the apple. An enzyme called polyphenol oxidase, or PPO, makes melanin, an iron-containing compound that gives apple cells a brown tinge. The same type of ‘oxidative’ browning happens in the browning of tea, coffee and mushrooms. Within five minutes of slicing, browning can alter an apple’s taste and make it less aesthetically pleasing, but it doesn’t mean the apple is old or rotten.

To prevent this oxidative browning, Okanagan developed proprietary technologies to engineer genetically modified (GM) apples. The apples, called Arctic® Apples, produce reduced amounts of PPO. To achieve this, small gene fragments, called silencing RNAs, were injected into the apple seeds using bacteria. Such an insertion with gene fragments is a red flag for the apple cell, as it resembles the first step of viral attack. As a response, it chops up every sequence of DNA that looks like the suspicious fragment, and thus the PPO gene gets decimated. Because the PPO production is reduced to less than 10% compared to regular apples, the Arctic® Apple, even when sliced, will stay clear of browning for about two weeks. That’s roughly the same extended life span as apple slices from McDonald’s and Burger King, which use lemon juice and calcium ascorbate to prevent browning. Indeed, lemon juice and calcium ascorbate have a similar cosmetic effect to the silencing fragments inserted into the Arctic® Apples.

A regular apple, on the left, shows brown spots, while an Arctic® Apple has a clearer appearance. Photo by Okanagan Specialty Fruits

A regular apple, on the left, shows brown spots, while an Arctic® Apple has a clearer appearance. Photo by Okanagan Specialty Fruits

 Why do we need non-browning apples?

Is the world waiting for a non-browning apple or is this just another ‘we-can, so-we-do-it’ product that eventually may threaten the ecosystem or our bodies? Well, according to Okanagan, very few fresh-cut apples are available on fruit plates, in salads, in cafeterias, or on airplanes, primarily due to the browning issue. Anti-browning treatments are costly and often add an off-taste, the company says. But these treatments are not needed for Arctic® Apples, which is why Okanagan hopes to get their apples available in more places. Consumer research has suggested that apple products, such as bagged apple slices, are the number one produce item that customers would like to see more packaged versions of. Since apple slices are arguably easier to eat than whole fruits, this innovation could propel apple sales. Indeed, the simple convenience of baby carrots doubled carrot consumption, and Okanagan is endeavoring to achieve the same results with apples.

Another argument for bringing engineered non-browning apples to the consumer market is the reduction of food waste. According to the company, apples are among the most wasted foods on the planet, with around 30 to 40 percent of the apples produced never being consumed because of superficial bruising and browning. Given that 52 percent of fresh produce goes to waste in the U.S. alone, consumption of non-browning apples, such as the Artic® Apple, may be one small step in the right direction to shrink this enormous mountain of food waste.

When will you be able to eat them?
Cartoon from Pinterest

Cartoon from Pinterest

Non-browning apples have gotten the green light to get on the market, as both the USDA and FDA approved Arctic® Apples for consumption. According to Okanagan, the first commercial Arctic® Apple orchards were planted in 2015, but it takes a few years for newly-planted apple trees to produce much fruit. They expect small test market quantities from the 2016 harvest, followed by a gradual commercial launch starting in 2017 with increasing availability each year thereafter. The first two varieties that will be available to consumers will be the Arctic® Granny and the Arctic® Golden. Currently, Arctic® Fuji is next in line with others planned to follow!

Although Neil Carter, the president and founder of Okanagan Specialty Fruits, has expressed in the New York Times that the apples will be labeled as Arctic®, they will not explicitly label their apples as GMO. Unlike other genetically engineered crops, Arctic® Apples do not contain foreign DNA but silencing RNAs to reduce the expression of the PPO gene. Therefore, Arctic® Apples are not effectively captured by the current regulatory structure on GMO labeling. According to the company, the label Arctic® is sufficient to create transparency and let the consumers decide whether they want GM apples that don’t brown.

Food for thought on non-browning apples

Despite the millions of dollars and more than 20 years of research that went into the development of non-browning apples, not everyone welcomes the new shiny green Arctic® Apples from Canada. Since we already have hybrid ‘low browning’ varieties, such as the Cortland apple, and successful preservative treatments, some people wonder whether we really need a genetically engineered apple that doesn’t brown. In fact, with the advent of the non-browning apple, the food industry has departed from the premise that GM foods are meant to increase productivity. Indeed, the Arctic® Apple is one of the few GM products that is developed to improve the product cosmetically, to match the media-driven image of a perfect apple rather than improving the crop’s yield or nutritional performance. However, despite the maintenance of a fresher look, the preservability of non-browning apples is similar to conventional apples as Arctic® Apples will eventually still brown due to the rotting process by bacteria and fungi.

Given that PPO is involved in the plant’s defense mechanism, it has been speculated that the mutation in non-browning apples could make the plant more susceptible to insect and microbial pest damage, thus increasing farmers’ reliance on pesticides. Although more pesticides might be needed to maintain productivity of the crops, if non-browning apples actually do reduce food waste, growing fewer acres of non-browning apples may be adequate to meet the market demand. Also, the primary market of the Arctic® Apple is sliced apples, which is a subset of all apples consumed. However, as sliced non-browning apples find their way into more products, demand could increase from, say, parents wanting to use these apples as a convenient and healthy snack in their picky eater’s lunch box. This may eventually drive the need for increased production. Given these market dynamics, the cost-benefit of non-browning apples for the society is elusive and it remains to be seen to what extent the Arctic® Apple puts a burden on the natural environment.

Delphine Van Roosebeke is a rising Biochemical and Molecular Nutrition graduate with a background in biochemical engineering. When she is not thinking about dark Belgian chocolate, she’s eating it! 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! 

 

 

Lessons From the Anti-Fat Movement: Why Waging a War Against Sugar is Not the Answer

by Micaela Young

Blaming sugar for the obesity epidemic is tempting, but making it a target of public and policy concern may create unwarranted fear and an increased demand for sugar-free and sugar substitute products, steering us down an all too familiar—and perhaps even unhealthier—road.

Sugar Frankenstein JPG

It wasn’t too long ago that industry grabbed onto another contentious nutrition target during the anti-fat movement, profiting largely from a new host of fat-free and reduced-fat products, many of them packed with refined carbohydrates and sugar. In the 1980s, medical and nutrition science had not advanced enough to know that the link between total dietary fat and heart disease was far from clear. The first edition of the Dietary Guidelines for Americans in 1980 demonized fat and, as a consequence, sparked a wave of food industry innovation that grew to replace unwanted fats with refined carbohydrates and sugar. A probable catalyst for the U.S. obesity epidemic, this industry reformulation is a potential promoter of heart disease and diabetes, as suggested by several well-designed studies examining the consequences of a low-fat, highly-refined carbohydrate diet published over the last six years from top-tier journals: including the American Journal of Clinical Nutrition, Annals of Internal Medicine and Current Atherosclerosis Reports.

Earlier on, however, nutrition scientists had an inkling that not all dietary fat was created equal. Specifically, replacing trans fats and saturated fats with monounsatured and polyunsatured fats was more effective at reducing the risk of heart disease than reducing overall fat intake, as revealed in a 1997 study published in the New England Journal of Medicine. While there will always be debate and uncertainty, the health benefits of consuming certain dietary fats have gained a positive view in the scientific community, as reflected in the new 2015 Dietary Guidelines.

While this shift in thinking may be viewed as a gross misconception by the science community—having such a negative impact on public health—what is important to remember is that science is a dynamic, ever-revolving door. New evidence can change scientific thinking rapidly, calling important “facts” into question, but public opinion and consumer purchasing habits are much harder to change.

Today, history may be repeating itself, with a plethora of anti-sugar campaigns and policy movements following the flood of new research linking sugar consumption to obesity, diabetes prevalence, and heart disease. It turns out that sugar is a tricky beast to target, so public health advocates have gone after sugar-sweetened beverages. This is not a fool’s errand, however, because drinking your sugar seems to pile on the pounds, according to a randomized trial from the New England Journal of Medicine and a meta-analysis from the American Journal of Clinical Nutrition. In addition, added sugars are now thought to contribute to chronic disease risk and increased mortality, according to a 2015 study co-authored by Dr. Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy. Researchers estimated that sugar-sweetened beverages were responsible for 6,450 deaths from cancer, 45,000 deaths from cardiovascular disease, and 133,000 deaths from diabetes world-wide.

The public has caught on to this buzz around the negative effects of sugar consumption, and following suit are the usual suspects: the food industry (the wide-eyed consumer will notice new sugar-free and granulated sugar substitutes creeping onto grocery store shelves) and nutrition propaganda (anyone care to join me on Food Babe’s 7-day sugar detox?).

Policy makers have even jumped on the anti-sugar bandwagon, including former Mayor of New York City Michael Bloomberg, who in 2012 fought to ban the sale of sweetened drinks of more than 16 ounces. While Bloomberg’s proposal ended in a court decision denying his ban from going into effect, these types of efforts still continue.

Even though the concerns over added sugar consumption are warranted given current scientific consensus, the ambiguity around what these types of prohibitions on added sugars will do come from many factions: anti-hunger groups, scientists, and the soda-guzzling consumer who fears for his rights. One scientist against the banning and taxing of foods with high amounts of added sugars is Brian Wansink, the director of the Cornell University Food and Brand Lab, because he fears the unintended consequences. His reasons are just; in 2006, his lab conducted a study that linked low-fat labeled foods to misconceptions about the healthfulness of the products. On average, participants underestimated the calories in “low-fat” M&Ms and other foods by almost 50%, and, surprisingly, overweight individuals ate 60 more calories than normal-weight participants when presented with low-fat labeled foods.

In 2014, Wansink’s lab conducted a similar study on the implications of a soda tax after noticing more sugar-free foods on the market, and an increased effort to ban or tax sugar-sweetened beverages in certain locales. The results concluded consumers often made unhealthy substitutions for sodas. The main replacement? Beer and other high-calorie drinks. Not exactly the swap public health advocates were hoping for.

It is evident that something must be done to ease this public health concern, but the solution that will yield its intended results has not yet become apparent. The food industry uses current nutrition science to bring patchwork, processed foods to life, which can work monstrously against public health efforts. The important thing to remember is that, as stated in the 2015 Dietary Guidelines key recommendations, a healthy eating pattern limits added sugars (sorry, palm sugar) to 10% of calories per day—not including sugars from whole foods and fruits.

“It is clear that many Americans are consuming far too much sugar,” said Jeanne Goldberg, PhD, professor of nutrition and director of the graduate program in Nutrition Communication at the Friedman School. “But the best way to figure out if you are one of these people is to take a moment to figure out just how much you are getting, from your first bowl of frosted covered cereal in the morning to your last cup of tea. If this is over 12 teaspoons (about 50 grams) of added sugar—including the sugar in your frosted cupcake, not the sugar in your sugar snap peas—then you may need to cut back.”

Therefore, before we grab our torches and pitchforks and march toward Sugar’s house, let’s take a step back and think about the long-term implications of our well-intended actions. We would not want to steer the public towards an unhealthier eating pattern that, for example, includes more processed “sugar-free” foods with even more refined carbohydrates…

Micaela Young, CPT is a first year nutrition communication and behavior change student focusing in Agriculture, Food and Environment. She would trade you frosted cupcakes and breakfast cereal for chips and salsa any day.