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.

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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.

 

 

Food Techies Commence: Insights from Branchfood’s November Panel

by Micaela Young

Perkins + Will, an architecture firm in downtown Boston, was the unlikely gathering place of health and food innovators on Wednesday, November 16. The event? Friedman alum and Branchfood founder Lauren Abda hosted an evening entitled “Innovators in Food Tech & Health,” a panel discussion and product tasting event showcasing startups and companies creating new solutions to age old problems of behavior change. Discussed was everything from the potential for food tech as a tool in preventative health, to how innovative start-up apps are using new ways to promote healthy eating and exercising.

At networking events, I am usually the awkward person standing in the periphery, deeply enveloped in conversations that I am actually not a part of. (Sigh.) But that was not the case at Branchfood’s November event. Geeking out about food with innovators, including students at Harvard developing solutions to refugee access to fresh produce, and the founder of a small, New Hampshire based fermented food company, MicroMama’s, this Friedmanite fit right in.

These start-ups were all brought together by Lauren Abda, a Friedman alum who is herself an innovator. After graduating from the Food Policy and Applied Nutrition program in 2012, she worked at the World Trade Organization in Geneva for two years as a Fellow in the Agriculture and Commodities Division. Ready for a change of scenery, Lauren came back to Boston and worked for a tech company called Litmus. Noticing that food tech and start-ups were fragmented, that there was poor flow and knowledge sharing between entrepreneurs in Boston—a hub for innovation—and that new companies needed support, Lauren started a meet-up group that eventually became Branchfood, which now offers monthly events, panels, classes, newsletters, networking meet-ups, and office hours for people looking to launch ventures in a slightly more informed way. Branchfood also leases space in their downtown Boston office to budding creatives and companies in need of a place to plant their seeds.

Branchfood’s November 2016 panel discussion took place at Perkins + Will, a global architecture firm with a number of projects focused on health and wellness. David Dymecki, the Sports and Recreation Global Market Leader, explained in his kick-off welcome speech that not only is the firm seeing a growing trend in active design, but that food is an important part of office culture. “The next best thing about eating good food,” Dymecki noted, “is talking about good food.” I certainly can’t argue with that!

Janelle Nanos, an esteemed reporter at the Boston Globe who covers tech and innovation, as well as the business of food (she interviewed our own Tim Griffin for a story on hydroponics in November), began by having the panelists introduce themselves:

In the first seat was Jake Cacciapaglia, VP of Media at Runkeeper, a mobile running app that helps runners, from weekending warriors to seasoned marathoners. With over 50 million users, the app was recently acquired by Asics in March, presenting a new challenge for Cacciapaglia and his team in learning how to find balance between the app and its users, the marketing and selling of shoes and apparel, and helping Asics be more relevant in the digital world. The app incorporates nutrition guidance by partnering with apps like LoseIt! and MyFitnessPal.

Next up was Kyle Cahill, the Director of Sustainability and Environmental Health at Blue Cross Blue Shield of Massachusetts. Cahill’s biggest focus is on understanding how environmental factors influence society’s health.

The fourth panelist was Tara McCarthy, chief dietitian and co-founder of Kindrdfood, an app bringing focus to people who need to change their diet—for medical reasons—and bringing her expertise into their homes. McCarthy has also worked at Boston Children’s Hospital part-time since 2001.

Last but not least was Ian Brady, the Chief Executive of AVA, an app providing personalized nutritional guidance. Using their technology that is a combo plate of human intelligence (dietitians), plus robots, AVA is able to use client’s goals and food preferences to provide real-time recommendations that adapt “on the fly.” Oh—and AVA can tell you the macronutrient composition of a meal with just a photo! (Cue animated mind exploding clip.)

Nanos: What is your target audience? 

Cacciapaglia noted that most of their users are just trying to make running a part of the lifestyle, with a primary goal of weight loss. But the app isn’t just for helping weekend warriors form habits, or guiding experienced runners through harder training plans and race goals.  The ultimate target, Cacciapaglia says, are those who aren’t motivated, who aren’t likely to hit download in the first place.

Turns out this was a major theme of the night: amotivation.

Our health is multifactorial, noted Cahill, driven by our genes, our choices, and our environments, yet most of our resourceso to treating people once they are sick. “Food is cross cutting…the availability and quality of food, as well as where you live plays a significant role in food choices.” At Blue Cross Blue Shield, Cahill and colleagues bring an ecologic model to thinking about health, from individual choices to food system decisions.

Kindrdfood, McCarthy explained, targets anyone with health conditions, anyone who needs to change the way they eat. McCarthy then eloquently described the “care gap” between physician instructions (eat these foods; these foods are off limits) and what is actually put on the table, or taken to school in a lunchbox. Targeting all ages—although she admitted adults follow instructions better when the change is for their children—Kindrdfood attracts those who have just been diagnosed and are motivated to seek help. “The uphill battle,” said McCarthy, “is reaching those who do not think they need to change.”

Brady added that the common thread of why AVA users sign on is convenience, for real-time instant access (the “just tell me what to eat” folks). But the app also helps users manage conditions and link well-being with food. AVA targets those who want to change, but want help doing so.

Nanos: What do you see technology doing for your company?

Cahill took this question first, explaining that Blue Cross has an investment arm, called Zaffre, that is involved in helping local start-ups. One example in their portfolio is Zest Health, a platform for helping people access and navigate healthcare benefits, medical information and provider options more efficiently. But Zaffre’s investments are not just for linking patients to providers technologically, Cahill noted. They also prop up those who are using technology on the preventative side. For this, Cahill gave the example of Ovuline, a fertility trackernd health guidance app that follows women from preconception through child raising.

McCarthy then spoke of how telehealth, or video chatting with clients, is Kindrdfood’s only way of reaching clients. Why? Because it’s easy for families, McCarthy explained, and practitioners are able to be in their living rooms with them. “I get a lot more out of a visit when I am in their house. Being in their house, seeing how comfortable they are, seeing their actual food, seeing that they don’t have a table, seeing that the baby or child eats on the floor…that piece is huge.” McCarthy also explained that video chatting enables her to reach multiple caregivers, whereas in a traditional hospital or appointment setting you may not. And patients usually request more frequent visits than would normally be recommended. Telehealth adds an element of convenience inpatient appointments cannot come close to. However, the broken piece, she said, is connecting healthcare to use all of these technologies in sync.

Cacciapaglia echoed that telehealth is a great tool technology can offer, but noted that he has observed that maintaining app use and behavior change after these conversations was hard for clients even though the quality of time spent with the dietitian was great. But he was hopeful. “Having a nutritionist seems out of reach,” Cacciapaglia said. “It is expensive to have a one-on-one session and is hard to find the time, but it is now becoming more accessible.”

Because Brady and his team at AVA did not explicitly tell clients whether their recommendations and dietary information was coming from a person or a robot—keeping it vague—he has found that clients share more information than they might one-on-one with a dietitian. “People don’t have to look at someone through a video chat interface and share the bad thing they just did.” Instead, they can send it over text. This personal distance, whether good or bad, seems to be working for AVA, who sees the technology moving into forecasting, making proactive recommendations to clients to help them make the right choice—before they have to make it. How? Well, Brady explained that the technology uses natural language processing that attempts to tailor the response based on the question. The technical piece, however, is made up of a “backbone” of dietitians.

Nanos: What do you think the data you are pulling now could potentially do? What could we learn?

Cahill sees that the data he and his colleagues are pulling could be used on the population level. His vision is the creation of robust mapping tools that could integrate their data with public data sets around things that impact health, including where someone lives, the food environment, and access to medical clinics. Blue Cross Blue Shield could then zero-in to better work with employers on healthcare and interventions. Cahill explained that he would also like to use their data to promote a more holistic view in healthcare that includes nutrition habits, someone’s income, and other social issues that impact health. As an example, Cahill noted that he’s a vegetarian, “but my doctor’s never asked me that. May be nice to know—maybe not.”

AVA is looking for data to help fuel client’s motivation, to keep them accountable. Brady said that they leverage Myers-Briggs profiles, which he believes helps AVA take note of how an individual typically behaves and converses in order to best match responses, tailoring the conversation to the users’ level. Brady explained that if you speak formally, AVA wants to “speak” formally. And vice versa. “We often describe internally that we have ‘Ava’ who is sort-of middle of the road, then we have an ‘Emma’ version who is very supportive and will never yell at you for what you eat,” Brady said. “And then we have an ‘Olga’ version, who is very direct—you will not like the feedback you are going to get. I tried Olga, but I had to switch.”

Maybe Isaac Asimov was on to something…

Cacciapaglia sees the data as adding value to the customer experience, while making the app more relevant in runners’ lives. “Not only are we trying to figure out who is most valuable to us as a customer,” he said, “but we want to try and map out the journey of each of the members and be more relevant in that journey. For example, you can serve ads to someone on Facebook or in whatever app you are in, but if it’s not the right time or it doesn’t speak to you, we’re like ‘get out of my face’ with that stuff.”

Nanos: Where would you love to see the technology advance to?

McCarthy was eager to answer Nanos’ last question of the night. “I would love to see that we are not talking so much about medicine and talking more about prevention.” Her vision: “When you pull up someone’s e-medical records, a food button is there. We want that to be a focus, so it’s not an afterthought—it’s not skipped. A future where everyone is trained in food, everyone talks about food. I feel that it is a part that gets missed…these are big things.” To bring the point home, McCarthy recounts a time when a child’s healthcare team thought she was having a GI bleed. It turns out that the red fluid in the child’s tube was not blood at all, but beets that the child had eaten earlier in the day!

Then Brady took the floor. “Our ultimate goal is to help people fall in love with food again.” He aims for AVA to help clients be able to sit down and enjoy the experience—before, during, and after eating. “Our goal is to help people find that connection again.”

Cahill explained that he envisions technology helping to fix our broken food system, whether that means people’s appreciation of food, or if it means the process of getting food from field to table. “More money now goes into getting people to eat junk food that they shouldn’t eat than the other way around.”

In the last comment of the night, Cacciapaglia topped us off by reminding everyone that it is really hard to make healthy decisions all the time. (I hear you loud and clear, Jake!) “One thing that is really frustrating,” Cacciapaglia said, “is that I’m in my 30s and I still don’t understand what happens when I put something in my body and what my body is doing with that thing. Our education system doesn’t do a good job—unless you do a specific track to get that knowledge—we don’t really know.” He noted that we are left to discern media messages and advertisement intentions on our own. “Even with great effort on my part, I still have the question: ‘So what should I do?’ Technology can be powerful in making this journey a lot easier for an individual to take action, avoid temptation, and shape the environment in a way to do so.”

 

Branchfood’s November event was an interesting look into a side of the industry we don’t often talk about in classes at Friedman. Behavior change and motivation issues, however, are a constant topic of conversation. It seems that while technology can be a powerful tool to evoke change in those who are motivated, it is not yet the magic bullet of prevention. Only time will tell.

I encourage Sprout readers to check out Branchfood’s upcoming events HERE.

Micaela Young is a second-year Nutrition Communication student trying to soak up as much of Boston life as she can before graduation. First on her Boston bucket list is attending more Branchfood events!

 

Can I Eat An Engineered Apple, Please?

by Delphine Van Roosebeke

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

Cartoon from Pinterest

Cartoon from Pinterest

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

What are non-browning apples?

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

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

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

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

 Why do we need non-browning apples?

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

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

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

Cartoon from Pinterest

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

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

Food for thought on non-browning apples

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

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

Delphine Van Roosebeke is a rising Biochemical and Molecular Nutrition graduate with a background in biochemical engineering. When she is not thinking about dark Belgian chocolate, she’s eating it! Delphine has a crush on nutrients and the magic they perform in our body, and loves to share her knowledge with anyone who wants to hear it in a fun and approachable way! 

 

 

Lemon Preserve: Lemons + Salt + Patience

By Jennifer Huang

Have you ever seen “patience” listed as a recipe ingredient? No? Well you’ll need it, as this simple recipe promises a unique and versatile flavor burst that is well worth the wait.

I have seen lemon preserves in Middle Eastern grocery stores before—usually as unappealing lemons floating in questionable liquid—and never gave them a second thought. Thankfully, my brother recently enlightened me on what lemon preserves are after he saw a recipe posted by our favorite Taiwanese food blogger, Karen Hsu.

Lemon preserves aren’t new to the scene: The earliest reference to this ingredient was in an Arab Mediterranean recipe from the 11th century, according to the Encyclopedia of Kitchen History. Today, you will find lemon preserves in many Moroccan and Middle Eastern cuisines.

So what’s the hype? Well, many recipe bloggers describe how the fermenting process brings the flavor and fragrance of lemon to an unimaginable level. Used in recipes for salad dressing, couscous, chicken and many other dishes, lemon preserve is a versatile ingredient sure to liven up any dish. Another beautiful thing about lemon preserve—it is simple to make and requires few ingredients. However, one of them, as Serious Eats has put it, is patience.

Here is the recipe translated and adapted from Karen Hsu’s blog:

Lemon Preserve

Duration: 15 minutes

Ingredients:

  • 12 lemons
  • 200 g salt (approximately ¾ cup)
  • 3-4 whole pieces of bay leaves (optional)
  • Some black pepper (optional)
  • Patience

Lemon Preserve Picture (1)

Steps:

  • Sterilize glass jars. (My brother and I boiled mason jars in water for 10 minutes.)
  • Cut six lemons into ¼ inches slices.
  • Layer salt and lemon slices in the jar. Put some salt into the jar first, then a lemon slice, then salt, etc.
  • After layering, crush the bay leaves and sprinkle both the bay leaves and black pepper into the jar (optional).
  • Squeeze juice from the other six lemons into the jar.
  • Seal the jar and put it in the refrigerator.
  • Wait for a month. (Yes. A month, but it will transform your life after that month.)

Disclaimer: I have used this recipe, but have not tasted it myself (it won’t be ready until September 14, and is currently fermenting in Houston). However, after reading a myriad of articles about lemon preserve, I think it is a promising addition to anyone’ shelf.

But… since my patience is wearing thin, I have found Moroccan restaurants in Somerville and Charleston that have lemon preserve dishes I am dying to try. Join me if you are interested, because I shall be going there, very soon.

Jennifer Huang is a first-year FPAN student. She worked as a dietitian in Houston and is interested in the economics and trade of food and food safety at the international level.