How Nutrition in MassCare May Put The ‘Health’ Back in ‘Universal Health Coverage’

by Ayten Salahi & Hattie Brown

Including local incentives for food equity and nutritional status may boost momentum and potential of the MA Right to Health movement. Members of budding student group – the Friedman Food Policy Action Council (FFPAC) – met with Massachusetts State Senator Jamie Eldridge to discuss the need to include nutrition in a proposed cost analysis of a single payer health system (S.2202).

Pictured left to right: Ayten Salahi (MS/RD Candidate), Kurt Hager (MS/MPH Candidate), Senator Jamie Eldridge, Alana Davidson (MS Candidate). 22 NOV 2017

In thousands of American households, the prohibitive cost of healthcare has forced families into an impossible position: choose between financial ruin or the health decline and possible death of a loved one. In Massachusetts, this bleak reality has motivated both the state legislature and its constituents to revive a movement in favor of a single payer healthcare system. However, the degree to which nutrition interventions and food access will be covered in the proposed model remains largely unknown.

The central tenet of a single payer scheme under universal health coverage (UHC) is that health care is a human right. The proposed legislation in Massachusetts seeks to offer and protect healthcare for all residents through a publicly-financed program that provides comprehensive care and coverage under a single insurance plan. The single payer public option would serve as an alternative to employer-sponsored healthcare, in which premiums are paid through payroll deductions, coupled with co-pays and out-of-pocket deductibles. For middle- and lower-income beneficiaries, a single payer system means lower cost for better access to care.

In Massachusetts, the single-payer campaign has reached unprecedented support with 120 co-signers under a 2017 proposal colloquially called MassCare (H. 2987, S. 619). Though neither of the proposed legislation were passed this year, an amended bill (S. 2202) was passed with overwhelming support by the state Senate on November 10 by a 33-6 vote (all six Republicans in the chamber being against). S.2202 authorizes a cost analysis of a state-wide single payer system, and will be reviewed by the House in early 2018.

While MassCare holds promising potential to reduce healthcare spending for both the state and per capita, the proposed legislation does not explicitly or implicitly include nutrition interventions as a line item for consideration in the single payer costing analysis. Historically, UHC policy-makers have deemed nutrition-related services as non-essential, and therefore not covered by insurance. The World Bank refutes this trend, and reports that to accelerate progress towards affordability and access of care requires a “fundamental rethinking of how to keep people healthy.” The recommendations go on to cite regulatory measures targeted to improve diet-related behavior as seminal to the public health agenda. Just last year, the International Food Policy Research Institute (IFRI) further urged policy-makers to include access to adequate nutrients as an essential service in all UHC programs.

To learn more about how nutrition might fit into the proposed single payer costing analysis, three members of the nascent, student-run Friedman Food Policy Action Council (FFPAC) took to the Massachusetts State House in late November to meet with single payer champion and state Senator Jamie Eldridge. FFPAC emphasized that, as Massachusetts prepares to analyze the cost effectiveness of single payer models as outlined in S.2202, additional resources should be allocated to determine the efficacy of funding nutrition therapy programs within the model. To achieve this, FFPAC proposed that the MA single payer costing analysis include: 1) medical nutrition therapy coverage for patients with, or at risk for, hypertension, obesity and cardiovascular disease (CVD); 2) enteral nutrition coverage as outlined in MassHealth; 3) food insecurity screenings for all patients; and 4) tailored food prescriptions for low-income patients.

State Senator Jamie Eldridge, lead Senate sponsor of An Act Establishing Medicare For All in Massachusetts, said, “I was excited to meet with graduate students from the Friedman School of Nutrition, to discuss how preventative health, including nutrition interventions, would be a key component of single payer healthcare, and would help reduce healthcare costs in Massachusetts.”

As the proposed bill continues to undergo revision and review into 2018, FFPAC will continue to advocate that Massachusetts – home of the healthcare law that led to the Affordable Care Act –should again lead by investing in nutritional therapy programs in a single payer model as a method to improve the health of its citizens, lower healthcare costs, and lower the tax burdens of its residents.

The Friedman Food Policy Action Council (FFPAC) is a developing student-run organization of the Friedman School of Nutrition Science and Policy at Tufts University. The group will be formally established in December 2017, with a mission to advance evidence-based nutrition and agricultural policies in support of public and environmental health, by equipping students with the skills and relationships necessary to impact policy through advocacy. FFPAC will host its general interest meeting in the early 2018. For further information, please contact friedmanfpac@googlegroups.com. Stay tuned for opportunities to join us and amplify the voice of food advocates in 2018!

Ayten Salahi is a first-year FPAN MS/RD candidate, co-founder of the FFPAC, 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.

Hattie Brown is an MS candidate in the FPAN program, and a co-founder of FFPAC. Her interests at Friedman are in the economic implications of food systems, with a focus on the intersection of sustainable agriculture and access to nutritious food. Before coming to Friedman, Hattie worked as a researcher in various capacities, including legal, for a public finance firm, and clinical, for a study analyzing phytochemical compounds in cocoa and their impacts on satiety.

 

 

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You’ve Got to Love Your Tree

by Hannah Meier

“Love Your Tree.” It’s a directive inspired by Eve Ensler, the writer and activist behind the one-woman play, The Good Body (you may also know her as the playwright for the wildly popular Vagina Monologues). “Love Your Tree” is also the foundation of a creative arts eating disorder prevention campaign that started at the The Center for Eating Disorders at Sheppard Pratt in Maryland in 2006 and has since expanded nationally. Today, organizations across the country, including Massachusetts, are invited to participate in the 2018 campaign and submit artwork that illustrates body diversity, acceptance and positivity.

“Eve, look at that tree? Do you see that tree? Now, look at that tree (pointing to another one). Do you like that tree? Do you hate that tree ’cause it doesn’t look like that tree? Do you say that tree isn’t pretty ‘cause it doesn’t look like that tree? We’re all trees. You’re a tree. I’m a tree. You’ve got to love your body, Eve. You’ve got to love your tree.” (Excerpt from The Good Body, 2004 by Eve Ensler). 

In the Baltimore-based Center for Eating Disorders at Sheppard Pratt, art therapy is a main component of recovery—helping patients approach body image struggles in a non-threatening way. Friedman alum, Christine Diven (Nutrition Communication, ‘12), assists with communications for the center where Julia Anderson, a Certified Eating Disorder Art Therapist created the Love Your Tree (LYT) Campaign in 2006. LYT is inspired by the metaphor in Ensler’s play, and is designed to cultivate an appreciation for the natural diversity of body sizes and help young people fight against society’s narrow and marginalizing standard of beauty and worth.

Love Your Tree Like a tree…my body is similar to no other. Lily D. Sudbrook Magnet Middle School 2016

As someone who personally struggled with an eating disorder that stemmed from dysmorphic body image throughout my childhood and adolescence, I emphatically understand how important it is to build an acceptance and appreciation of all bodies—especially in childhood. With increased attention drawn to childhood obesity and even weight loss in youth, establishing a sense of body trust and acceptance in childhood is of the utmost importance for educators today to prevent the development of eating disorders for these kids down the road.

What We Know About Eating Disorders

Unfortunately, research on eating disorders is anything but well-funded. Current statistics estimate that between 0.5 to 3.7 percent of American women suffer from anorexia nervosa at some point in their lifetime, and about 1 percent of female adolescents currently have anorexia[i]. Bulimia nervosa affects an estimated 1.1 to 4.2 percent of women in their lifetime. Binge-Eating Disorder, one of the most recently codified eating disorders in the diagnostic manual for psychiatric illnesses, is the most common, affecting 3.5 percent % of women and 2 percent of men in the United States, according to the latest statistics[ii].

Clearly, these numbers are conservative, and they do not account for the millions of individuals who may suffer from disordered eating but do not meet one or more of the required criteria for a clinical diagnosis. These numbers also assume that those with eating disorders seek treatment, which is sadly not always the case. Also worth noting, most of our understanding of eating disorders comes from research conducted on women, since anorexia and bulimia are traditionally perceived to affect women more than men; however, men are no less likely to suffer from eating disorders[iii].

Dieting and disordered eating often come back to poor body image or a desire to alter one’s body to better fit societal norms, putting thinness above real physical health. Results from a  2008 Canadian study found that 40% of Canadian girls in tenth grade and 37% of girls in ninth grade thought of themselves as “too fat,” and 19% of those with a normal BMI considered themselves to be overweight. Twelve percent of those with a normal BMI admitted to trying to lose weight[iv].

All Different, All One
Like a tree, my body…is unique and part of a whole. Melissa B. Bel Air High School 2017

Body dissatisfaction has a lot of other negative effects on kids and teens beyond increasing the risk for developing eating disorders. Some studies have shown that when students feel badly about their bodies, their GPAs are likely to be lower than students who don’t feel badly about themselves. And while we might think these types of issues arise in adolescence, body dissatisfaction and body anxiety may begin as young as second grade across varying racial and ethnic backgrounds, in both boys and girls.

How does Love Your Tree fight back?

According to current program director Brianna Garrold, the LYT campaign is currently in its 12th year. It was originally structured for middle and high school students in the Baltimore and surrounding area, but now reaches outside the state with organizations in New Jersey, Massachusetts, and Connecticut. Schools and organizations that host programs invite students to submit artwork representing their response to the Tree metaphor.

The campaign is even expanding overseas and across age groups. “In 2014, an organization in Australia picked up the message and contacted the creator of the program for more information about LYT and tips for hosting their own show and awards ceremony,” Garrold explained. “Over the years, Love Your Tree has expanded to include college students, and as of 2016, kindergarten and elementary-aged students. LYT has also started branching out beyond school-based workshops and into community organizations as well.”

Just Beginning “Like a Tree…I am full of so much potential.” Katherine H (Dulaney Middle School) 2015 

For school participants and eating disorder patients alike, the metaphor of a tree helps to explore healthy body image and self-image in a non-threatening way. According to Garrold, art therapy often feels “easier and safer” for participants than other approaches.

What are the common risk factors we can focus on to prevent eating disorders?

Garrold points to the biopsychosocial model of development—an understanding that biological, psychological and social factors all can play key roles in determining whether someone will develop an eating disorder.

“Unfortunately, we live in a society that is comparative, image focused, and perfectionism driven—all things that fall under the ‘social’ part. Body dissatisfaction and body anxiety are beginning at younger ages due to exposure to these messages, and as our society becomes more connected and ‘plugged in,’ it is getting seemingly harder to ignore them,” she says. Frequently, comparison to peers and media influence are major factors that contribute to the development of low self-esteem and poor body image.

“It can feel like an uphill battle to help reach out and provide support for kids,” Garrold admits.  “Keeping an eye out for warning signs, like social withdrawal, critical or comparative comments about or related to peers or celebrities, fixation on being ‘the best’ or feeling the need to be perfect, [and] fixation with weight or food can offer insight into areas kids and teens might be struggling with.”

“Body of a Tree”
Like a tree…my body is as healthy as it can be.
Ethan S. (Pine Grove Middle School) 2015

What can we do in Massachusetts to get involved?

Garrold invites those of us outside of Maryland to participate as an out-of-state chapter, especially if we work with students or young adults. “Outreach programs like Love Your Tree are designed to combat negative messages by educating students about the effects of the media on self-esteem and body image. Allowing space and time for conversation around topics like body image can be empowering for students […] and providing education about media literacy (understanding some of the dynamics of advertising, [and] the use of photo alteration programs) is a great topic to include as well.”

Even if we can’t fully participate fully in LYT, the website offers resources and support, and Garrold stresses that the most important part is to help kids feel like they have someone to talk to and activities to engage in. She recommends the online gallery at www.loveyourtree.org to spark the conversation.

“Our culture seems to spend a lot of time discussing criticism and flaws and not enough time discussing successes and positive attributes. Encouraging kids and teens to get involved in activities they enjoy, engage with peers, feel comfortable and safe enough to explore their talents, and celebrate what makes each individual unique are all ways we can help foster healthier students, which in turn, fosters healthier communities. The hope is that starting on a small scale will snowball into larger messages of healthy self-esteem and body acceptance.”

Bringing it back to Friedman

As part of a school focused on nutrition science and policy, we are well aware of the health challenges our nation faces, and the role proper nutrition can play. Decades of research associating overweight and obesity with increased risk for disease and lower quality of life has called us to lead the crusade for health—to prevent or reduce overweight and obesity by empowering individuals and communities to prioritize nutrition and its downstream health benefits. We know that obesity and disease disparately affect those of low socioeconomic status, and understand that it takes a multi-pronged intervention to make a dent in reshaping a community.

“Love Every Tree, Love Every Body
Like a tree…my body is unique and beautiful.
Amelia R. (Patterson Mill High School) 2015

But have we been paying enough attention to weight stigma? The American Academy of Pediatrics very recently released a policy statement about weight stigma experienced by children and adolescents with obesity, which is a must-read for anyone working with this population (likely all of us, in some regard). In it, they point out that weight stigma is widely tolerated because our society believes it will motivate people to lose weight, despite its counterproductive contribution to behaviors such as binge eating, social isolation, avoidance of health care services decreased physical activity and ultimate accelerated weight gain over time[v].

Instead of focusing on reversing weight gain trends, perhaps we should focus on reversing the plague of weight stigma. Health behaviors exist outside of body mass index, and focusing wholeheartedly on weight has proven to be undeniably ineffective, and perhaps harmful, in cultivating healthy behavior change[vi],[vii],[viii].

As Garrold encourages, “helping establish a healthy (or healthier) self-image is essential to prevention of and recovery from eating disorders.” Everyone can benefit from feeling more connected to and proud of their body.

If you are interested in getting involved in the Love Your Tree campaign, visit www.loveyourtree.org for more information. The 2017-2018 campaign is NOW OPEN and accepting poster submissions from students of all ages. Visit the website to view past submissions and learn how to submit an entry.

Hannah Meier is a Registered Dietitian, second year Nutrition Communications student, aspiring eating disorder specialist and an advocate for healthcare that does not stigmatize based on weight. Her favorite ways to honor her body include twisting and balancing in yoga poses and wearing extra soft pajamas as often as possible.

Resources

[i] The Renfrew Center Foundation for Eating Disorders, Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources, 2003.

[ii] Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007) “The prevalence and correlates of eating disorders in the national comorbidity survey replication.” Biological Psychiatry, 61, 348–358.

[iii] Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eating Disorders, 20(5), 346–355. http://doi.org/10.1080/10640266.2012.715512

[iv] Boyce, W. F., King, M. A. & Roche, J. (2008). Healthy Living and Healthy Weight. In Healthy Settings for Young People in Canada.

[v] Pont, S. J., Puhl, R., Cook, S. R., & Slusser, W. (2017). Stigma Experienced by Children and Adolescents With Obesity. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/early/2017/11/16/peds.2017-3034.abstract

[vi] Thompson JK, Stice E. Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science. 2001;10(5):181-3.

[vii] Pelletier LG, Dion SC, Slovinec-D’Angelo M, Reid R. Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motivation and Emotion. 2004;28(3):245-77

[viii] Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association. 2005;105(6):929-36.

Who’s ready for pie?

November is an exciting time in the food, nutrition, and policy worlds. It officially marks the end of the harvest and the beginning of seasonal holiday eating! For Friedman students, it also marks a turning point in the semester – we have Thanksgiving break to look forward to, and the conclusion of the semester is a light at the end of the proverbial tunnel (at least until mid-January).

Several Friedman students are still coming down from the excitement of the Food and Nutrition Conference and Expo (FNCE) that just took place in Chicago. Anabelle Harari, Sharmin Sampat, and editor Hannah Meier recount what they learned, who they heard from, and products they tasted at FNCE.

Next up, Sara Scinto takes a critical look at all things pumpkin spice, and why fall’s most popular food flavor might not be exactly what consumers expect.

Looking forward to Thanksgiving, first-year student Sam Jones pauses to consider the complex relationships that often get left out of the telling of the traditional Thanksgiving story, and explains why, for some, it’s a day not so much about giving thanks but about mourning lives lost.

Speaking of Thanksgiving, if you’re gearing up for this year’s Turkey Trot, Megan Maisano has some tips for fueling your performance with four of her favorite seasonal foods.

To round out our November issue with some policy, Eliot Martin asks us to rethink approaches to food rescue, and Alana Davidson reports on Massachusetts’ first Farm to School Awareness Day at the State Capitol, along with an update on current Farm to School legislation.

Stay warm out there, folks! Happy reading,

Kathleen Nay & Hannah Meier

 

In this issue…

Friedman Goes to FNCE

by Hannah Meier, Anabelle Harari, and Sharmin Sampat

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.

 

Pumpkin Spice: Fad or Fallacy?

by Sara Scinto

Would you want a watery pumpkin pie? A savory pumpkin spice latte? How about a stringy pumpkin bread? Yeah, I wouldn’t either. I adore pumpkin spice everything as much as the next person (pumpkin is actually my favorite food), but are pumpkin and spices actually in these products?

 

Thanksgiving: A Misunderstood History

by Sam Jones

The holiday that many of us are looking forward to this month is actually based on a complicated history of conflict and controversy. As disease threatened the very existence of Native American tribes across New England, the Mayflower pilgrims were dying of starvation. Sam Jones recounts how the social history of Thanksgiving saved some and devastated others in order to give celebrators a new perspective on tradition.

 

 

Fueling Your Performance with Fall Flavors

by Megan Maisano

Gearing up for this year’s Turkey Trot? This month Megan Maisano shares seasonal foods and recipes that will fuel your best performance.

 

 

It’s Time We Rethink Food Rescue

by Eliot Martin

“Food rescue” seems to be a hot topic these days. Picking up wasted food from supermarkets and delivering it to low income communities has been extolled as a way to reduce waste and provide nourishment to those in need. This editorial explores why a more nuanced approach to food recovery is warranted to achieve the outcomes we want.

 

Friedman Policy Corner: Massachusetts’ First Farm to School Awareness Day at the State Capitol

by Alana Davidson

October is National Farm to School Month. To celebrate, Massachusetts Farm to School hosted the first Farm to School Awareness Day at the state Capitol on October 26th. Alana Davidson recounts what happened at the event, and details current legislation that is being considered on Farm to School and ways to get involved and support strong Farm to School programs.

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.

 

 

 

Pumpkin Spice: Fad or Fallacy?

by Sara Scinto

Would you want a watery pumpkin pie? A savory pumpkin spice latte? How about a stringy pumpkin bread? Yeah, I wouldn’t either. I adore pumpkin spice everything as much as the next person (pumpkin is actually my favorite food), but are pumpkin and spices actually in these products?

My mom and I enjoying real pumpkin whoopie pies

There has been an explosion of pumpkin spice products rolling out for fall in recent years and each season it starts sooner (apparently as soon as July in 2017). Fall flavors are creeping into summer because the consumer demand is there and food companies want in on the profits that have soared in the last 5 years. Tiffany Hsu from The New York Times article purports pumpkin spice sales “…surged 20 percent from 2012 to 2013, then 12 percent the next year, then 10 percent in 2015 and in 2016”.

Unfortunately, not all pumpkin spice products have either pumpkin or spice blends in them. Sugar is first on the ingredient list of both Pumpkin Spice Oreos® and Kraft’s Jet-Puffed® Pumpkin Spice Marshmallows; neither contain actual pumpkin NOR spices, unless they are hidden in the natural or artificial flavorings. However they do contain artificial colors to mimic that beautiful pumpkin orange. According to Wikipedia, pumpkin pie spice is usually “a blend of ground cinnamonnutmeggingercloves, and sometimes allspice”, but commercial pumpkin spice products typically include chemical compounds to simulate the taste of pumpkin pie. You are not only getting fooled by the absence of real pumpkin and spices, but you are not able to reap any of the nutritional benefits of these foods. Pumpkin is a rich source of carotenoids, vitamin C, and fiber; nutmeg contains multiple B vitamins; cinnamon is full of antioxidants; and ginger provides the essential minerals magnesium and copper. If you’d like to create your own pumpkin pie spice, here are the proportions recommended by Julie R. Thomson at the Huffington Post:

Natural pumpkin pie spice blend

  • 1 tablespoon cinnamon
  • 5 teaspoons ginger
  • 1 teaspoons nutmeg
  • 1 teaspoon allspice
  • 1 teaspoon cloves

 

 

 

Seemingly healthier stores like Trader Joe’s are no exception to the pumpkin spice fallacy. Their Pumpkin Shaped Frosted Sugar Cookies and Chocolate Mousse Pumpkins don’t include an ounce of pumpkin (they are just pumpkin shaped). And although Trader Joe’s Pumpkin Joe-Joe’s and Gluten Free Pumpkin Bread & Muffin Baking Mix do contain pumpkin and “spices” on their respective ingredient lists, sugar comes first. This is something to be cognizant of if your body doesn’t handle sugar well.

Pumpkin may not be as straightforward as it seems either. As it turns out, the canned pumpkin that is so heavily used in pumpkin pies and other fall goodies often contains one or more types of winter squash! For example, the company Libby’s uses a Dickinson pumpkin, which is more closely related to a butternut squash than a pumpkin you would find in your typical patch. Dickinson pumpkins and butternut squash are both part of the Cucurbita moschata species, while a traditional jack-o’-lantern pumpkin belongs to the Cucurbita pepo species.

Before you start a false advertising class lawsuit, a couple things should be clarified. Jack-o’-lantern pumpkins actually taste pretty bad and would make a terrible pumpkin pie. They’re stringy, watery, and not that sweet. This is why canned pumpkin companies use a variety of winter squashes that are more vibrant in color, “sweeter, fleshier and creamier” than a classic carving pumpkin. It just tastes and looks better. And these companies aren’t technically breaking any rules, since the FDA has a quite lenient definition of pumpkin, which includes any “firm-shelled, golden-fleshed, sweet squash”.

The reason pumpkin spice mania has taken America by storm is that sugary pumpkin spice products taste good! Food companies know this and give consumers what they want, which may not always be the best for the health of our bodies or our food system. But do not fear: we can still enjoy all the delicious pumpkin spice goodness by being more aware of ingredients and making our own treats.

Here are some of my all-time favorite recipes that have real pumpkin and/or spice blends in them:

1-Bowl Pumpkin Bread (V, GF)

1-Bowl Pumpkin Bread

DIY Pumpkin Spice Syrup (can substitute stevia for sugar or reduce sugar)

DIY Pumpkin Spice Syrup

Overnight, Slow Cooker, Pumpkin Pie Steel-Cut Oatmeal (GF, can be made V)

Slow Cooker Pumpkin Pie Oatmeal

Pumpkin Curry (GF)

Paleo Pumpkin Curry

Pumpkin Dream Cake (for very special occasions)

Pumpkin Dream Cake

Lastly, a pro tip for making your own pumpkin pancakes: substitute pumpkin puree for some liquid (whether oil or water) and shake some pumpkin pie spice into the batter. Play around with how much you substitute until it reaches a consistency that you like-there’s no wrong way to do it! The end product will be a dense and delicious pancake that pairs wonderfully with some maple syrup and/or berry topping.

Sara Scinto is a second-year NICBC student, avid coffee drinker, runner, triathlete, and yogi. She has a love for rainbows and all things food/nutrition related. During the fall, there is a 100% chance she has made some kind of pumpkin food within the last week. You can find her on Instagram @saras_colorfull_life.

 

Thanksgiving: A Misunderstood History

by Sam Jones

The holiday that many of us are looking forward to this month is actually based on a complicated history of conflict and controversy. As disease threatened the very existence of Native American tribes across New England, the Mayflower pilgrims were dying of starvation. Sam Jones recounts how the social history of Thanksgiving saved some and devastated others in order to give celebrators a new perspective on tradition.

As a kid, I was always taught that Thanksgiving is an American tradition based on a feast held a long time ago between the Native Americans and my European ancestors. As the tale goes, the pilgrims welcomed the Native Americans to their celebratory harvest feast and the two communities lived harmoniously for years. I was also taught that the Native Americans felt, or should have felt, grateful for the pilgrims’ generosity and help. Even today, this narrative is still presented in schools and households from the point of view of the pilgrims, portraying the Native Americans as dependent and voiceless. However, a closer look at the history of the first Thanksgiving reveals that the opposite may have been true—the European settlers could not have survived without the Wampanoag tribe of modern-day Massachusetts.

Photo: Sam Jones

The first Europeans to arrive on the eastern shores of what is now the United States of America were not the pilgrims who settled Plymouth in 1620. Europeans from France, England, Spain, Portugal, and Italy had all been travelling and trading along the eastern coast for over a century prior to colonization. Many of these travelers were trading more than just steel and jewelry. In fact, some travelers killed and captured indigenous people to sell in the slave trade.

One Native American captured by the Englishman Thomas Hunt was a young Wampanoag named Tisquantum. Historical records do not indicate how Tisquantum evaded slavery in Spain, but he managed to learn English on is journey back to Cape Cod. Upon his return, however, the thriving Native American community he had been taken from several years before was nothing more than a burial ground extending north and south along the entire coast of New England.

Photo: Sam Jones

Along with their goods, the European traders had brought various diseases, which decimated tribes along the coastline throughout the 1500s and early 1600s—90% of the region’s indigenous population died between 1616 and 1619 alone. The Wampanoag tribe was one such group that was considerably weakened by disease—their numbers were reduced from 20,000 to 1,000. When Tisquantum finally returned to what was left of his tribe, he was met with suspicion and treated as a servant to his own people.

The pilgrims arrived shortly after Tisquantum’s reunion with the Wampanoag, but nearly half of them died during their first winter in New England. Without food or a proper shelter, the pilgrims resorted to ransacking the graves and storehouses of the Native American tribes that had lived on Cape Cod prior to being wiped out by disease. In the spring of 1621, the pilgrims first interacted with the Wampanoag tribe with the help of Tisquantum who was able to use his English language skills to translate. An unprecedented treaty-like partnership was formulated between the pilgrims and the Wampanoag tribe because both parties viewed cooperation as mutually beneficial for several reasons.

The weakened Wampanoag tribe needed to bolster its strength and resilience to defend against a rival tribe known as the Narraganset, which remained untouched by the spreading disease. The Wampanoag tribe strategically garnered a trading partnership with the pilgrims as a means for their tribe to exert power in the region as middlemen between the Europeans and other tribes as well as to deter the Narraganset from implementing an attack.

In the fall of 1621, the pilgrims and 90 men from the Wampanoag tribe gathered for a feast to celebrate their first successful harvest. This occasion is now commonly referred to as the first thanksgiving. The partnership between the Wampanoag and the pilgrims continued in a similar fashion for the next 50 years. During that time, several ships arrived in Plymouth to settle the new colony. While the pilgrims’ numbers and territory exponentially increased, the Native American tribes throughout the region dwindled as death and disease remained rampant. In 1675 one of the sons of the Wampanoag leader, fed up with the colonists’ laws and encroaching settlements, launched an attack against the colonists. In the end, the European settlers won at the cost of over 5,000 lives. Not only was their manpower and weaponry far superior, but the diseases they brought from their homeland certainly played an active role in weakening the Native American people as well.

The history of Thanksgiving that I was taught as a kid is simplistic and revisionist as it does not acknowledge that the Native Americans had strict intentions in interacting with the pilgrims. They were not, as I was led to believe, a helplessly ignorant group of people. They did not foolishly welcome the white man onto their shores, nor did they gratefully accept help from their future oppressors. In their weakened state, the Wampanoag tribe orchestrated a mutually beneficial partnership with the pilgrims that lasted for roughly half of a century. They arguably saved the remaining pilgrims’ lives, only to be incrementally pushed off their land and killed by foreign pathogens and pistols.

It is unknowable who would have followed the Mayflower pilgrims and in what state the Wampanoag and other New England tribes would have been in had a partnership not been formed. Although in the end, the arrival of the pilgrims in 1620 eventually did lead to the death of tens of thousands of indigenous people at the hands of disease and warfare. This is the history upon which we base our most cherished of American holidays.

Photo: Sam Jones

This year, Thanksgiving will be commemorated as a Day of Mourning for those who died as a result of colonization and as recognition of the continued oppression and racism against their people. Every year since 1970 atop Cole’s Hill overlooking Plymouth Rock, indigenous and non-indigenous people have gathered at noon for a spiritual ceremony followed by select speeches about the history of their people as well as the issues facing indigenous populations across the country today. The ceremony is followed by a march through Plymouth and concludes with a feast.

For my Thanksgiving celebration this year, I will still sit with friends and family to a meal of ham and roasted vegetables, corn bread and pumpkin pie, stuffing and mashed potatoes. I will still express my gratitude for all that I have to be thankful for. But this year, I will also be adding a new tradition—a moment of silence for all of the people at whose expense my successes lie. Because I do not think that the purpose of engaging with the painful history of this country is to make those of us here today feel guilty and ashamed or angry and resentful. Instead, I believe it is to acknowledge the voices that have been silenced and the backs that have been walked on. It is also to impress the need for more tolerance, greater acceptance, and heightened awareness. As we begin another holiday season, our traditions may not change, but the intentions behind them just might.

Sam Jones is a first-year AFE student with a specialization in sustainable agricultural development. She loves to cook and frequently enjoys a brisk walk in the woods. Her goals include getting a dog, growing all of her own food, and eating her way around the world.

Fueling your Performance with Fall Flavors

by Megan Maisano

Gearing up for this year’s Turkey Trot? This month Megan Maisano shares seasonal foods and recipes that will fuel your best performance.

Photo: Megan Maisano

It’s the most wonderful time of the year! No, it’s not the winter holiday yet, but the season runners have patiently waited for over the last ten months: Fall.

After the heat and humidity of its summer, New England graces us with a pocket of blissful conditions before winter forces us back into the gym. Running just feels more effortless with crisp air, stunning foliage, crunchy leaves to step on, and trendy tights to rock.

The fall is also prime harvest season. So, when you swap your Mango Peach Salsa Yankee Candle with Apple Spice, be sure to do the same with your grocery list. Your palate and your legs will thank you.

Below are a few fall favorites you can count on to fuel your workouts, recover quickly, and perform your best.

Photo: Pixabay

Beets

Nitrates, baby. There is growing evidence on their performance-enhancing effects. While nitrates are found in nearly all vegetables, beetroots take the lead with more than 250 milligrams per 100-gram portion.1 Dietary nitrate is converted into nitric oxide, where it functions in blood flow regulation, muscle contraction, glucose and calcium homeostasis, and mitochondrial respiration. By increasing blood flow and decreasing oxygen needs during exercise, beets may improve your speed and stamina.1-4

This simple, yet hearty, Food Network salad balances the earthy taste of beets with creamy goat cheese and crunchy nuts. Add chicken or quinoa to make it a well-rounded meal.

Photo; Pixabay

Winter Squash

Pumpkins, butternut squash, and acorn squash are all in the same family of winter squash. Compared to their summer squash cousins, they have thick skins which means longer storage life and obligatory decoration on your kitchen counter.

Their bright orange color is a clear indicator that they’re packed with beta-carotene, an antioxidant that will keep our immune system in check and support our vision. But they’re also an excellent source of carbohydrates, potassium, fiber, and vitamin C. Eat before workouts to keep you energized and hydrated, or eat afterwards to replenish glycogen stores and repair muscle tissue.5-9

Don’t toss those pumpkin seeds either! They offer a tasty source of protein, iron, and magnesium – nutrients that must be replenished after strenuous exercise. Bonus — pumpkin seeds are also rich in tryptophan, an amino acid involved in the synthesis of serotonin and melatonin.10-12 Toss seeds on salads, roasted squash, or soup to reap benefits on mood and sleep.

Pumpkin or butternut? Can’t decide? Have both. Try this Food & Wine soup as an appetizer for your post-Turkey Trot meal.

 

Photo: Pixabay

Cabbage

A stomach can be a runner’s worst enemy, but cabbage is a stomach’s best friend. High in fiber, cabbage will keep you feeling full longer and keep your digestion system, ahem, on track. There’s also emerging research on the benefits of probiotics, like cabbage kimchi, on athletic performance via enhanced recovery from fatigue, immune function, and GI function maintenance.13

Still on that Oktoberfest kick? Try this German-inspired Eating Well dish that pairs pork chops with a sweet-and-sour cabbage side. Hefeweizen optional. Prost!

 

Photo: Pixabay

Clementines

When the days get shorter and darker, a fresh clementine can brighten up your day. Get your “Christmas-orange” while it’s in season from late October to early February. The citrus smell that the peel leaves on your hands will keep you feeling rejuvenated through afternoon class. Rich in vitamin C, magnesium, and potassium, these easy-to-peel snacks can help reduce exercise-related oxidative stress, support a healthy immune system, and keep you hydrated.14-17 Vitamin C also plays a role in the production of collagen, which is important for joint and tissue recovery after a workout.14,15

Combine citrus with cinnamon spice after your workout with this One Green Planet breakfast bowl. Bonus—cinnamon has anti-inflammatory effects that may decrease muscle soreness in response to cell damage.19 

Resources:

  1. Murphy, M et al. Whole Beetroot Consumption Acutely Improves Running Performance. Journal of the Academy of Nutrition and Dietetics. 2012;112(4):548-552.
  2. Coleman, Ellen. Reap the Benefits of Beetroot Juice — Evidence Suggests It Improves Heart Health and Athletic Performance. Today’s Dietitian. 2012;14(2):48.
  3. Shannon, Oliver et al. “Beet-ing” the Mountain: A Review of the Physiological and Performance Effects of Dietary Nitrate Supplementation at Simulated and Terrestrial Altitude. Sports Medicine. 2017;47(11):2155-2169.
  4. Peeling P, Cox GR, Bullock N, Burke LM. Beetroot Juice Improves On-Water 500 M Time-Trial Performance, and Laboratory-Based Paddling Economy in National and International-Level Kayak Athletes. Int J Sport Nutr Exerc Metab. 2015;25(3):278-84.
  5. Krustrup et al. Sodium bicarbonate intake improves high-intensity intermittent exercise performance in trained young men. Journal of the International Society of Sports Nutrition. 2015;12(25).
  6. Feldman, Donna. Why Sodium-Potassium Balance Is Critical for Better Hydration. com. <https://www.active.com/nutrition/articles/why-sodium-potassium-balance-is-critical-for-better-hydration&gt;. Accessed October 2017.
  7. Mansfield, Beth. Fall Nutrition means Winter Squash! Peak Performance. <http://peakperformance-ca.blogspot.com/2010/10/fall-nutrition-means-winter-squash.html&gt;. Accessed October 2017.
  8. Peternelj, T, Coombs, J. Antioxidant Supplementation during Exercise. Beneficial or Detrimental? Sports Medicine. 2011; 41(12): 10342-1069.
  9. LeBlanc K, Nelson, A. Beta-Carotene and Exercise Performance.: Effects on Race Performance. Medicine & Science in Sports & Exercise. 1999; 31(5):118.
  10. Brown, Mary. Top 11 Science-Based Health Benefits of Pumpkin Seeds. Authority Nutrition. June 2016. < https://www.healthline.com/nutrition/11-benefits-of-pumpkin-seeds#section1&gt;. Accessed October 2017.
  11. Ristić-Medić et al. Alpha-linolenic acid and cardiovascular diseases. Med Pregl.2003; 56(1):19-25.
  12. Chollet et al. Magnesium involvement in sleep: genetic and nutritional models. Behav Genet. 2001;31(5):413-25.
  13. Pyne et al. Probiotics supplementation for athletes – Clinical and physiological effects. European Journal of Sport Science. 2014; 15(1):63-72.
  14. Economos C, Clay W.D. Nutritional and health benefits of citrus fruits. FAO Corporate Document Repository. 1998. <http://www.fao.org/docrep/x2650T/x2650t03.htm#TopOfPage&gt;. Accessed October 2017.
  15. Shaw et al. Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis. American Society for Nutrition. 2017;105(1):136-143.
  16. Organic Facts.9 Best Benefits of Clementines. <https://www.organicfacts.net/health-benefits/fruit/clementines.html&gt;. Accessed October 2017.
  17. Adams AK, Best TM. The role of antioxidants in exercise and disease prevention. Phys Sportsmed. 2002;30(5):37-44.
  18. Baur, J. What fall produce should I eat? Runner’s World. 2017;10:p 36.
  19. Mashhadi et al. Influence of Ginger and Cinnamon Intake on Inflammation and Muscle Soreness Endued by Exercise in Iranian Female Athletes. Int J Prev Med. 2013; 4(1): S11–S15.

Megan Maisano, referred to as Megatron by family, is a second-year NICBC student and an RD-to-be. As a marathoner, triathlete, and military veteran, she’s interested in how nutritious food can best fuel endurance performance. She loves to plan and has a special place in her heart for mixed nuts and her pup, Nala.