Advances and Controversies in Clinical Nutrition is quickly approaching. If you haven't planned out your session strategy, check out some recommendations here.
One session of particular interest is Saturday's discussion on the gluten controversy. With the recent passing of the gluten-free labeling law by the FDA, which is designed to help consumers more easily identify gluten-free products, Douglas L Seidner, MD's talk is especially timely. Gluten-free diets may be a trend for some, but for approximately 3 million Americans with Celiac disease (gluten intolerance) avoiding gluten is a medical necessity. An additional 25-30 million Americans with gluten sensitivity may also benefit from the new labeling.
The FDA's regulations weren't passed without debate, some of which still remains. In order for a food to carry the gluten-free label, it must contain less than 20 parts per million (0.02 grams of gluten per 1 kg of food). According to the FDA, this is the lowest amount that can be reliably detected using current methods of testing. The FDA notes that most people with Celiac disease can tolerate this very small amount of gluten. However, while clinical symptoms may not occur, it's possible that even this small amount of gluten can still lead to damage of the mucosal lining of the gut. With that said, most would agree that this is a positive start, and should help those that need to avoid gluten navigate the grocery store aisle with a little more ease.
Though beneficial for many, some worry that this new labeling will only perpetuate the thought that eating gluten-free is healthier, even for those who have no difficulty digesting gluten. Food manufacturers have been taking advantage of this trend for years now by adding gluten-free claims to foods that are naturally gluten-free, and contributing to consumer's confusion about health foods. Books like Wheat Belly and celebrities like Miley Cyrus, who attributes her weight loss to avoiding gluten, add fuel to fire of the gluten-free diet debate.
As a dietitian, I find that interest in the gluten-conversation continues to grow among patients seeking nutrition therapy. Sometimes the topic arises as part of an effort to improve gastrointestinal symptoms, but more often patients are seeking a weight-loss plan. From understanding the benefits and medical necessity for those who don't tolerate gluten to helping consumers with the ability to digest gluten navigate through the media's misinformation, the gluten controversy spans a variety of nutrition and health professionals scope of practice. For a deeper dive, be sure to check out Dr. Seidner's session on Saturday, December 6th.
Advances and Controversies in Clinical Nutrition meeting is nearly here. This year's meeting, held Dec. 5 through Dec. 7 at the Capitol Hilton in Washington, D.C., provides a unique opportunity for nutrition researchers and clinicians to confer on the latest advancements and best practices in clinical nutrition.
These opportunities come via lectures, workshops, scientific posters, and satellite symposia. One of these satellite sessions, "The Controversial Role of Dietary Protein in Diabetes and Related Disorders," is sponsored and organized by the Egg Nutrition Center. This symposium, which will be held from 1:30 pm to 4:30 pm on Dec. 5, brings together Kevin Maki, PhD, Biofortis/Midwest Center for Metabolic and Cardiovascular Health; Theresa Nicklas, DrPH, Baylor College of Medicine; Barbara Gower, PhD, University of Alabama; and Amy Campbell, MS, RD, LDN, CDE, Joslin Diabetes Center. Campbell, who shares here her role in the session, has served as a diabetes and nutrition educator for over 20 years. Last year, she was awarded the 2012 Will Solimene Award for Excellence in Medical Communication for her article on probiotic and prebiotics for “Diabetes Self-Management.
The full interview is available here.
Thus far, 2013 has been another exciting year for the nutrition community. The base of scientific research has continued to expand; yet, nutrition still remains a developing science with many areas of uncertainty. The obesity epidemic remains a pressing issue, and the debate over the best way to solve this challenge is at the forefront of nutrition and health professionals' conversations. From gluten-free diets and technological advances in calorie tracking to bariatric surgery, it seems the number of ways to kick start weight loss grows just as fast as our country's waistline. That is why it's no surprise that several of the lectures at this year's Advances and Controversies in Clinical Nutrition conference will provide guidance for nutrition professionals working to improve our nation's health outcomes through weight management.
On the same note, the number of people with obesity-related chronic diseases grows. It has become more apparent that a multi-disciplinary approach to preventing and managing these conditions is the best method to address these health consequences. That's why the workshop on maximizing the impact of an inter-professional approach to nutrition conditions should be at the top of any health professional's list of sessions (Saturday, December 7 at 1:30 pm). For those working directly with patients, other top sessions include New Technologies for Monitoring Food Intake, and Translating Nutrition Science to Clinical Practice. Great research is only beneficial if we can communicate it effectively to patients.
While obesity and its related health conditions is such a hot topic, food and nutrition touches so many other parts of our lives. The growing body of research on organic foods and their connection to health is at the top of many consumers' minds. For years, it was thought that the reason to buy organic produce was to avoid pesticides and other chemicals that may be harmful. A study published last year questioned whether or not organic food offers more nutrients than its conventional counterpart, opening up a larger debate on the benefits of buying organic. For this reason, Dr. Roger Clemens' session on organic foods could be eye-opening for many attendees.
Gut health has recently taken center stage as a player in total body health. Emerging research suggests that one's gut health can be a predictor of (and maybe even play a role in) many other health conditions, from autoimmune disorders to obesity. Dr. Federico Rey, Assistant Professor of Bacteriology, will set out to differentiate between fact and fiction on this burgeoning topic.
There is no shortage of controversies in the nutrition profession. This year's conference line-up is an excellent reflection of the exciting advances happening in the field. Whether you are an academic, health care professional, student, or public health advocate, there is no question that you will walk away with a wealth of new knowledge after this weekend. You may even leave the conference with more new questions after getting so many answers.
View the full program for the conference and register today.
Poop, feces, kaka, and dung… what do these words have in common? For most people they bring on feelings of disgust but if you are like me, you might feel inclined to admit that human excrement is utterly fascinating. Now, before you start wondering whether I have lost my mind, let me explain.
I first learned of the novel uses of feces as an undergraduate when I applied to work on a summer research study called Camp Calcium. For six weeks of the summer break before my senior year, I processed fecal matter (and urine) from 30 teens so that we could measure how much dietary calcium was lost in their excreta, an important step in calculating how much calcium is absorbed in the intestine and sent to the skeleton. Long story short, I continued similar work in graduate school looking at how prebiotics altered the fecal microbial communities, a.k.a intestinal microbiota, to increase intestinal calcium absorption in teens who consumed less than recommended calcium intakes. Little did I know that poop would soon take the stage as the next cure-all for everything ranging from bacterial infections to metabolic diseases. Needless to say, I was hooked and hopefully you will be too after plunging through the rest of this post!
In a recent Science Magazine article titled The Promise of Poop author Jop de Vrieze outlines the unique influence that fecal transplants have on health. With all of the recent hype regarding the microbiome it is hard to believe that fecal transplants have actually been used since the 4th century to treat ailments like food poisoning and severe diarrhea. I guess our ancestors were on to something! Now positive effects of transplanting “good” fecal bacteria from health donors has been documented for a number of disorders and diseases (see infographic) but most notable is the evidence for treating Clostridium difficile, an infection that claims nearly 14,000 lives each year!
The article starts by introducing a unique C. difficile case that Dr. Max Nieuwdorp was treating during his residency. His patient was an 81-year-old woman who after antibiotic treatment for a urinary tract infection developed a horrible intestinal infection rendering her unable to eat and unlikely to survive. Not giving up, the doctor turned to the literature for alternative options and he found quite a doozy when he ran across Ben Eiseman's 1958 paper published in Surgery. The paper discussed the successful treatment of four cases of pseudomembranous enterocolitis which presents symptoms very similar to C. difficile. Dr. Nieuwdorp tried the procedure on the woman and after only three days she was well enough to leave the hospital.
Over recent years, support for fecal transplants has gained momentum. Now medical and scientific communities openly agree that this treatment cures C. difficile but many questions still remain. While clinicians do not yet know what qualities make up the perfect fecal donation, studies are pooping…I mean, popping up all over the world to identify the perfect fecal bacteria concoctions for different diseases. A recent research endeavor by Nieudorp has aimed to study the effects of fecal transplants on patients with metabolic syndrome because his team previously noticed that feces from lean donors led to improved insulin sensitivity in overweight individuals. Heck, if that isn't enough to make you a poop-lover, you may someday see Poop Pills next to your coveted probiotics at the pharmacy. A recent USA Today article highlighted the promise of a new bacteria concoction administered orally in a gelatin capsule in treating C. difficile. So, will fecal-derived bacterial treatments be at the forefront of functional food research in coming years? Only time will tell. But I will be there flushing through all of the exciting data to come!
website. Interested participants may register for the conference here. The Hotel reservation deadline is November 15.
For more information on ACCN, we spoke with one of this year's presenters, Dr. Dale A. Schoeller of the University of Wisconsin-Madison. Dr. Schoeller's presentation, “New Technologies for Monitoring Food Intake,” is scheduled for Saturday, December 7 at 8:00 am. In the following interview, he offers us a preview of his presentation and outlines the benefits of attending the conference. He points out, "This meeting provides an outstanding opportunity to get an educated review of the field that covers both years of research and some of the newest advances, allowing clinicians and investigators to get “caught up” quickly on these issues."
"When you're a hammer, everything looks like a nail." Nowhere is this statement more true than in medicine. A perfect example is in the treatment of type 2 diabetes.
If a doctor suspects his patient may be diabetic, he can run an oral glucose tolerance test (OGTT), in which the patient is given a glucose load, and subsequent blood response is measured to see how effectively the glucose is cleared from the bloodstream. In a non-diabetic patient, the blood sugar only rises a relatively small amount, as the intact and functional beta cells of the pancreas secrete just the right amount of insulin to reduce the blood sugar levels back to normal.
If a patient is given an OGTT and the blood sugar spikes more than expected, then by definition they are glucose intolerant. They have failed their OGTT, and cannot tolerate carbohydrates the way a non-diabetic can.
In medical school, we are taught that the primary goal in treating diabetics is to keep blood sugar levels low, and that hemoglobin A1c levels are predictors of further disease progression. There are two major ways to control this blood glucose level: with what we put into our bodies, as well how we mitigate the hyperglycemia once it has occurred.
Alpha-glucosidase inhibitors are a category of drug that work by decreasing the absorption of carbohydrates in your gut, resulting in a smaller rise in blood glucose. However, the unabsorbed carbohydrates need to go somewhere, causing the predicted unpleasant side effects of stomach discomfort and diarrhea.
Now instead of taking a drug that will reduce our absorption of carbohydrates, result in various side effects and cost additional money, why not just eat less of the very foods spiking the blood sugar in the first place? In other words, why would the American Diabetes Association (ADA) tell us that a diabetic diet should be 40-50% of the calories from carbohydrates, when by definition, these are the very foods they cannot tolerate? Visit the link to see how the ADA describes it on their meal-planning page: “How Much Carb?" It says: A place to start is at about 45-60 grams of carbohydrate at a meal.
It seems equivalent to a person with a peanut allergy slightly lowering their peanut intake and just injecting him or herself with an epinephrine pen after each meal. Why not just stop eating peanuts and avoid the side effects and discomfort of epi injections? Why don't they just eat less of the instigating carbohydrates in the first place? After all this was the treatment of diabetes in the pre-insulin era. Here is how Dr. Elliot Proctor Joslin described it in 1893:
Diabetic treatment is of the first importance. The carbohydrates taken in the food are of no use to the body and must be removed by the kidneys thereby entailing polydipsia, polyuria, pruritis and renal disease…The beneficial effects [of removing carbohydrates] were seen at once, and [Dr Joslin's patient] was advised to “eat all the cream, butter and fatty foods possible.
120 years later, the Joslin Diabetes Center, named after Dr. Joslin above, has a different message: Starchy foods, such as bread, pasta, rice and cereal, provide carbohydrate, the body's energy source. Fruit, milk, yogurt and desserts contain carbohydrate as well. Everyone needs some carbohydrate in their diet, even people with diabetes... [diabetics should consume] 40 percent [of calories] from carbohydrates.
Diabetes is diagnosed by demonstrating a glucose intolerance and therefore the first line of therapy should be a reduction in glucose. Why is this logic not the first, most obvious treatment? Of course if the patient refuses, or they reduce their carbohydrates and their blood glucose levels continue to remain elevated, then further therapy is in order.
Regardless of the etiology of each patient's food related disease, his or her treatment is seen as a constant, unchangeable variable given the label of "diet" or "lifestyle," which is invariably some variation of a low-fat, high carbohydrate diet. Just the fact that alpha-glucosidase inhibitors are used as a treatment for diabetes before a low carbohydrate diet confirms this.
Furthermore, if the patient is given a low-fat high carbohydrate diet (as is the standard of care today) to manage high blood sugar and he/she does comply with it meticulously, they will very likely need the insulin, alpha-glucosidase inhibitors, and/or metformin to control their daily dose of 180 grams of the very nutrient they cannot tolerate.
The Sugary Drink Portion Cap Rule adopted by the New York City Board of Health, which proposed limitations on the sale of sugary drinks to no more than 16 ounces, sparked much controversy and illuminated the classical struggle that exists between public health law and individual liberties. Individuals and establishments in fierce opposition to the proposed legislature professed a fear of uncontrolled federal paternalism that would be infringing on matters of individual choice. Their claims seemed validated when the New York Supreme Court struck down the bill in March, along with the New York Appeals Court coming to the same conclusion in July. However, a much closer look at the Court's decision reveals a more optimistic outlook than the one running across headlines.
First, let's consider the constitutionality of the proposed law. The Sugary Drink Portion Cap Rule was developed by Mayor Bloomberg and adopted by the New York City Board of Health. Under the separation of powers doctrine, the New York City Board of Health lacks the authority to create legislature, as it falls under the executive branch of the government. Alternatively, new laws should be made and proposed by the City Council, New York City's legislative branch. For this reason, the Sugary Drink Portion Cap Rule was deemed unconstitutional, but no judgments were made regarding the moral, ethical, or public health implications of the bill:
Before concluding, we must emphasize that nothing in this decision is intended to circumscribe DOHMH's legitimate powers. Nor is this decision intended to express an opinion on the wisdom of the soda consumption restrictions, provided that they are enacted by the government body with the authority to do so. Within the limits described above, health authorities may make rules and regulations for the protection of the public health and have great latitude and discretion in performing their duty to safeguard the public health (New York Appeals Court, July 30, 2013).
This ruling may seem like a significant setback in promoting public health, yet it provides open avenues to developing new strategies, while promoting greater public discussion. If legislature like the Sugary Drink Portion Cap Rule is rejected on more procedural terms, how can we learn from these events in developing policy driven strategies to combat obesity? We can look towards previous public health law as prime examples. For instance, the New York City Health Code Provision requiring the posting of calorie information on the menus of restaurants regulated by the New York City Health Department has done little to change people's food choices. Meanwhile, other evidence suggests that taxation, as in the case of a soda tax, may be more effective in changing individual behavior because it presents a major disincentive towards continuing consumption. A behavioral economics approach in which we alter the context in which individuals make decisions may provide the nudge that is needed to move individuals towards healthier choices. As we critically think about the environments in which we live, public health must employ strategies that change the landscape through effective policy.
"This has been a particularly interesting meeting. We always learn so much from the work done in other countries. As Treasurer of IUNS, I get to participate in the organization ahead of time which makes this meeting even more rewarding," said Dr. Murphy.
In her 15 years working at a cancer research center in Hawaii, Murphy has a bird's eye view of where nutrition is headed. "The concept of personalized nutrition is important, but at a population level, the intersection of genes and environment is really where the advances are going to be made. We already know certain genetic profiles have risk of cancer, and diet affects people differently. We have the tools now."
Murphy added: "In fact, we have just scratched the surface of nutrition. The public is so much more aware of the importance of diet, that the time is right for research. I am hopeful when I come to a meeting like this and see young investigators from abroad with so much energy. I think we could solve some of the world's problems, especially the double burden of malnutrition and obesity. It's meetings like this that generate ideas for the future of our field."
In addition, ASN recognized the following early career and student investigators (pictured below with their mentors) who received travel awards to attend the conference:
Robert Ackatia-Armah, University of California-Davis
Kristina Harris, Pennsylvania State University
Sarah Luna, Cornell University
Carmen Piernas Sanchez, University of North Carolina-Chapel Hill
Margarita Santiago, University Wisconsin-Madison
Towfida Siddiqua, University of California-Davis
Elaine Yu, Cornell University
International Congress of Nutrition in Granada, Spain, began on a festive note Sunday, with a lecture by WHO Director of Public Health and Environment, Maria Neira and a concert by the University of Granada Orchestra, featuring several opera songs. The mood was enhanced by an outdoor welcome reception featuring traditional Spanish music.
Starting on Tuesday, Executive Officer John Courtney, ASN President Gordon Jensen, Past President Teresa Davis, and other ASN staff were busy meeting with representatives from global nutrition societies, including delegates from Singapore, pictured here.
"This meeting is such a great opportunity to create new relationships with partners across the globe. We hope to see many of these attendees at our annual meeting in 2014 in San Diego," said Dr. Courtney.