Friedman Goes to FNCE

by Hannah Meier, Sharmin Sampat and Anabelle Harari

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

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

Photo: Hannah Meier

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

Hannah Meier

Why did you choose to go to FNCE this year?

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

What was your favorite Education Session?

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

What was your favorite new product at the Expo?

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

Favorite quote of Anabelle, overheard at FNCE

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

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

What was the most controversial topic you saw?

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

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

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

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

 

Favorite quote of Sharmin, overheard at FNCE

Anabelle Harari

Why did you choose to go to FNCE this year?

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

What was your favorite Education Session?

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

What was your favorite new product at the Expo?

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

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

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

What was the most controversial topic you saw?

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

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

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

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

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Favorite quote heard by Sharmin, originally attributed to Eleanor Roosevelt

Sharmin Sampat

Why did you choose to go to FNCE this year?

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

What was your favorite Education Session?

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

What was your favorite new product at the Expo?

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

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

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

Favorite quote of Hannah, overheard at FNCE

What was the most controversial topic you saw?

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

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

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

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

 

 

 

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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.

 

Candy-Ween

by Hannah Meier

Dressing up, carving pumpkins, ringing doorbells, staying up late, gorging on candy. Halloween traditions are well-beloved in the United States, and reminisced upon fondly by even the most educated nutrition students in the Boston area. But with sugar in the spotlight of contemporary public health interventions, is it time to reconsider our chocolate-coated hallows ‘eve habit?

Hannah and her younger brother Adam in matching, handmade leopard costumes

I liked to sort my candy by type, color, and preference. Each Halloween, I would make my rounds to every house with lights on in my suburban Minnesota neighborhood. I’d ring countless doorbells and gleefully chant, “trick or treat!” alongside my costumed friends, while grown-ups scooped candy by the handful into our open pillowcases. I would relish the end of the night, coming home and dumping the pounds of fresh candy onto a wide space of open floor, sorting the Milk Duds (a personal favorite) into their own pile and relegating Now & Laters, Licorice and Butterfingers into the pile of not-so-greats that I’d probably try to trade for more Milk Duds from my brother later.

The dumping and sorting of Halloween candy was a well-loved tradition

For me, candy was a given on Halloween. Sure, there were houses that we’d visit that would hand out fruit snacks or granola bars, and I usually ended up with at least one toothbrush. But these “treats” held hardly as much excitement. My parents allowed my brother and I to keep all our candy, but we were normally held to 2-3 pieces as treats per day, max.

Fast forward 20 or so years, and I not only survived 10 years of tick-or-treating in good health, I’m now in a position of relative influence in the world of nutrition. I’ve learned enough about food to know that candy provides little more to our bodies’ cells than some quick energy and easy calories. Some would argue there are properties within candy, like added sugar, that are harmful to our bodies. I would argue that most people have nothing to worry about if candy is left as a once-in-a-while food (even a once-a-day treat). Looking at the bigger picture of overall diet is more telling. Even though most candy contains negligible amounts of micronutrients, will our bodies really know whether we ate two Snickers® fun size® bars or a Chocolate Chip Cookie Dough Larabar®, give or take a few grams of fiber? I do not have an answer to that question, but I can tell you, without a doubt, that my mother would not have payed twice the price for pulverized cashews and dates.

used for comparison based on weight and likelihood of use as a Halloween candy

Now, I’m not anti-Larabar®, and recognize that if we were to compare ingredient lists, one would be a clear winner. Of course, I’m not comparing a Snickers® bar to an apple, a bag of trail mix, or popcorn—all options that would clearly be less-processed, more wholesome snacks. I’m comparing a Snickers® bar to a reasonable cousin—one that also provides the satisfaction of unwrapping a crinkly wrapper—yet happens to be expensive and out of reach for most. It’s worth taking a step back and considering whether the battle to promote “healthier” Halloween treats really holds up – we shouldn’t be relying on candy or snack bars like Larabar® for micronutrients, anyway.

Still, it’s hard to find the Halloween candy tradition benign when considering our current food environment, which makes eating large portions of highly processed foods in a fairly mindless way all too convenient and affordable every day. Holiday traditions put a spotlight on food industry favorites, and Halloween is the king of them all. Unlike food traditions surrounding holidays like Thanksgiving, Christmas, Hanukkah and Rosh Hashanah, Halloween is all about the candy.

Trick-or-treating and candy-giving on Halloween rolled out in the United States as a fully-fledged tradition in the 1950s, alongside Wonderbread® and CocaCola®. Packaged candy was cemented as a Halloween staple during the 70’s when folks feared razor blades in apples, Samira Kawash suggests in a 2010 article in The Atlantic. Since then, Americans have taken hold of the sugar habit, purchasing upwards of 600 million pounds of candy a year for Halloween, and 90 million pounds of chocolate during the week of Halloween alone according to a Neilsen report from 2009. That’s about one pound and 3.2 ounces of chocolate per child in the United States purchased in one week.

Talk about added sugar.

The most recent Dietary Guidelines for Americans, along with proposed updates to the FDA Nutrition Facts Panel, pinpoint 50 grams of added sugar as the suggested daily intake for an average adult based on a 2000 Calorie diet pattern. One pound and 3.2 ounces of milk chocolate contains about 543 grams of sugar, which averages out to over 75 grams of sugar per day if consumed in one week. And that’s just chocolate—add in sugar from other foods like yogurt, baked goods, sauces and dressings, and the scales are tipped firmly in the direction of “excess.”

So, what are we supposed to do about it?

According to an informal survey of Friedman students, a majority (64%) believe that handing out Halloween candy neither helps nor hurts public health nutrition policy, and only 55% do not believe it is our responsibility as nutrition professionals to shift our current candy-centric Halloween culture.

“Holidays are unique and have anticipated traditions that vary by family and culture,” one Friedman student responded. America just happens to have a love affair with sugar on Halloween.

But of course, Halloween candy is not the only thing contributing to chronic disease. Another student argued, “Blaming candy is like saying if we want to prevent house fires we should outlaw matches.”

Moderation was a signature theme of survey responses. “Every holiday doesn’t require candy and sweets, but it provides a good opportunity to discuss with children the importance of moderation and sharing,” one student suggested.

While I agree that moderation is a key message, and that foods like candy (or ice cream, or brownies) can indeed be incorporated into an overall health-promoting diet when approached without guilt or stress, does fixating on treats at holidays like Halloween (and Christmas, and Easter, and Valentine’s Day) really send that message? Would we be so obsessed with candy on Halloween if we weren’t constantly trying to avoid it the rest of the year?

To help make your decision—will you or won’t you participate in passing out candy to kids this Halloween?—let’s refer to my favorite decision-making tool: the Pros vs. Cons list.

 

PROS

CONS
Candy is cheap, usually on sale, and comes in many varieties Look at the ingredients list… if you dare
But chocolate has antioxidants, right? Have you ever babysat a kid who ate candy for dinner?
Dentists need more business, it’s good for the economy. Candy may be cheap, but fillings are expensive.
More likely to be viewed as a “cool house” for handing out candy. If no one comes to your door, you can wear pajamas and go to bed early.
Leftover candy

Leftover candy

 

While over 95% of Friedman students surveyed enjoy eating candy on Halloween, only 53% of them plan to hand out sweet treats to costumed kiddos this year. Most who aren’t participating in the tradition reported not having Trick-or-Treaters stepping up to their doors. Others said they would be handing out granola bars, nuts (allergies are a whole other topic worth considering on Halloween), or non-food items like stickers.

Most folks passing out candy are going with fun size bars or “whatever’s cheapest.” My building is one that will likely not be visited by young tricksters looking for treats, but if it were, I’d pick up a big bag of fun size pretzel M&Ms® (because they offer the best of both worlds) and ask every kid their name. Like one insightful second-year student added “Halloween is a great opportunity to get to know neighbors and give personal attention to your community.”

Thanks to all the Friedman students and alumni who filled out the unofficial survey and offered thoughtful and creative responses! It’s clear we can improve our Halloween traditions, but that doesn’t necessarily mean we need to do away with candy altogether.

*Statistics based on a voluntary Facebook-linked google survey of 45 Friedman students and alumni in September, 2107

Hannah Meier is a registered dietitian, second-year Nutrition Communications student, foodie, and festivity nerd. She believes in the power of food as both an instrument for health and community, and strives to make nourishing options as accessible and convenient as possible for all. You can find her on Instagram @abalancedpaceRD and Twitter @hannahrosemeier.

Evaluating the Pinnertest: The Importance of Scientific Evidence

by Erin Child

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nutrition in a Nutshell: Lessons Learned as a Dietetic Intern

by Katelyn Castro

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

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

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

1- Nutrition is an evolving science.

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

 

 

 

 

 

 

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.