By: Emma Partridge
American consumers are undoubtedly moving toward natural foods.
An analysis by Datassential of consumer foodservice issue
concerns may explain some factors in this overall trend;
consumers appeared most concerned with antibiotics and steroids
in animal proteins and/or dairy products, local food sources and
manufacturers surviving, and GMOs, among other issues.1 Fortune
magazine calls it “the war on big food” – but are consumers
benefitting from more than just those ‘left out' factors?2 I had
the chance to sit down with Dr. Mario Kratz, researcher at the
Fred Hutchinson Cancer Research Center, core faculty member of
the University of Washington (UW), and Associate Director of the
UW Diabetes Research Center, to discuss a few of these food
trends and what their intrinsic health benefits might be.
One trend of note is the move toward full-fat dairy products.
Whole milk sales rose 11% in the first half of 2015 alongside a
14% fall in skim milk purchases.3 While many speculate this shift
is in line with movement toward wholesome, unprocessed foods,
there are unrecognized benefits to full-fat dairy beyond its
less-processed nature. Full-fat dairy may increase satiety, or
lead a person to feel more full than if (s)he ate a low-fat dairy
product. In evaluations of 16 dairy fat studies, Dr. Kratz's team
found that, of studies comparing high-fat dairy to low-fat dairy,
high-fat dairy intake was actually associated with better weight
outcomes, and was not associated with higher weight. Further, 11
of the 16 studies revealed that people who ate more dairy fat or
high-fat dairy foods tended to be leaner and/or gain less weight
over time than those who ate less dairy fat.4 The results from
these analyses make a case for full-fat dairy as a protectant
against weight gain, potentially due to increased satiety
response. Additionally, there are other fatty acids present in
full-fat dairy that can act as hormones, and small amounts of
these fatty acids may be beneficial. The scientific reasoning
behind the presence of many fatty acids supports full-fat dairy
and, on the other side of that coin, there is no data supporting
healthful benefits from consuming non-fat, low-fat, or
isolated-fat dairy products in which many of the fatty acids have
Another food trend of note over the past few years is that of
coconut oil. While part of the trend may be attributable to its
non-cooking uses, coconut oil is also highly heat resistant, has
a long shelf life, and is rich in medium chain saturated fatty
acids (MCFAs). The heat-stability of coconut oil is beneficial to
reducing intake of harmful free radicals, but MCFAs may be the
most significant of coconut oil's intrinsic health benefits. In a
study comparing long chain fatty acids, generally purported to be
less-healthy fatty acids, to MCFAs, researchers found
MCFA-treated mice exhibited increased energy expenditure, reduced
adiposity, and improved insulin sensitivity.6 It is possible,
then, that consumers following the coconut oil trend may be
reaping such metabolic health benefits.
Perhaps the most significant trend to watch is that of developing
healthy, lifestyle-based eating patterns, which is recommended by
the 2015 Dietary Guidelines Advisory Committee in the
recently-released 2015-2020 Dietary Guidelines for Americans. In
a media-driven world of shoulds and should-nots, the Dietary
Guidelines Advisory Committee took a different approach with this
year's release: develop patterns of healthy eating and physical
activity within the environment around you. Dr. Kratz argues
something similar, that pattern matters and a varied eating
pattern may allow for small amounts of cravings and
diet-breakers, thusly providing a method to control them.5 In
short, his “number one” advice point is, “in spite of whatever
craze you may be following right now…if you find something new,
you should find a way to incorporate it into your overall diverse
1.Webster M. Changing Consumer Behaviors and Attitudes. Culinary
Institute of America; 2015.
2.Kowitt B. Special report: the war on big food. Fortune 2015.
3.O'Connor A. Consumers Are Embracing Full-Fat Foods. The New
York Times 2015.
4.bottomlinehealth.com. Why Whole Milk May Be Better Than Skim.
Bottom Line Health 2014.
5.Mario Kratz P, MS. In: Emma Partridge MC, ed2016.
6.Montgomery MK, Osborne B, Brown SHJ, et al. Contrasting
metabolic effects of medium- versus long-chain fatty acids in
skeletal muscle. Journal of Lipid Research.
By: Mary Scourboutakos
Presently in America breastfeeding rates are sub-par.
While the World Health Organization recommends exclusive
breastfeeding for up to six months of age, with continued
breastfeeding alongside complementary foods up to two years of
age or beyond—in the US 79% of mothers initiate breastfeeding,
but only 22% exclusively breastfeed to six months and only 27%
are still breastfeeding (non-exclusively) at two years
postpartum.1 Meanwhile in countries like Sri Lanka, 83.1% of
mothers are still breastfeeding their children two years
So the question is…how do we get women in America to breastfeed
Traditionally, when trying to promote breastfeeding, people have
focused on the benefits for infants, such as improved cognitive
development,3 fewer childhood infections,4 and decreased risk for
obesity and chronic disease later in life.5
But when you consider current rates of breastfeeding (see
above!), clearly this approach isn't working. Nevertheless, there
may be a presently unexplored way to promote breastfeeding...
Emerging research suggests that in fact, the benefits of
breastfeeding for the mother may surpass the benefits of
breastfeeding for the infant.6-8
In fact, research has shown that long-term breastfeeding is
associated with decreased maternal risk for breast cancer,9-11
ovarian cancer,12, 13 endometrial cancer,14 diabetes,15 heart
disease,16 as well as greater postpartum weight-loss,17, 18 and
mental health benefits.19, 20
But how long is long? And by how much does risk decrease? In
terms of breast cancer, research from China has shown that women
who breastfeed for more than 24 months per child cut their risk
for breast cancer in half, compared to women who breastfed for
only one to six months.10 Furthermore, dose-response curves for
risk of diabetes show an inverse relationship with lifetime
duration of breastfeeding, which suggests that the longer you
breastfeed for, the lower your risk is.15
So, my unsolicited piece of advice for public health agencies
is…if you're trying to improve rates of breastfeeding, never mind
touting the benefits for the baby, maybe try promoting the
benefits for the Mom!
3.Quigley MA, Hockley C, Carson C, Kelly Y, Renfrew MJ, and
Sacker A. Breastfeeding is associated with improved child
cognitive development: a population-based cohort study. J
Pediatr, 2012. 160(1):25-32.
4.Li R, Dee D, Li CM, Hoffman HJ, and Grummer-Strawn LM.
Breastfeeding and risk of infections at 6 years. Pediatrics,
2014. 134 Suppl 1:S13-20.
5.Yan J, Liu L, Zhu Y, Huang G, and Wang PP. The association
between breastfeeding and childhood obesity: a meta-analysis. BMC
Public Health, 2014. 14:1267.
6.Schwarz EB. Infant feeding in America: enough to break a
mother's heart? Breastfeed Med, 2013. 8(5):454-7.
7.Bartick MC, Stuebe AM, Schwarz EB, Luongo C, Reinhold AG, and
Foster EM. Cost analysis of maternal disease associated with
suboptimal breastfeeding. Obstet Gynecol, 2013. 122(1):111-9.
8.Bartick M and Reinhold A. The burden of suboptimal
breastfeeding in the United States: a pediatric cost analysis.
Pediatrics, 2010. 125(5):e1048-56.
9.Zhou Y, Chen J, Li Q, Huang W, Lan H, and Jiang H. Association
between breastfeeding and breast cancer risk: evidence from a
meta-analysis. Breastfeed Med, 2015. 10(3):175-82.
10.Zheng T, Duan L, Liu Y, Zhang B, Wang Y, Chen Y, et al.
Lactation reduces breast cancer risk in Shandong Province, China.
Am J Epidemiol, 2000. 152(12):1129-35.
11.De Silva M, Senarath U, Gunatilake M, and Lokuhetty D.
Prolonged breastfeeding reduces risk of breast cancer in Sri
Lankan women: a case-control study. Cancer Epidemiol, 2010.
12.Luan NN, Wu QJ, Gong TT, Vogtmann E, Wang YL, and Lin B.
Breastfeeding and ovarian cancer risk: a meta-analysis of
epidemiologic studies. Am J Clin Nutr, 2013. 98(4):1020-31.
13.Li DP, Du C, Zhang ZM, Li GX, Yu ZF, Wang X, et al.
Breastfeeding and ovarian cancer risk: a systematic review and
meta-analysis of 40 epidemiological studies. Asian Pac J Cancer
Prev, 2014. 15(12):4829-37.
14.Jordan SJ, Cushing-Haugen KL, Wicklund KG, Doherty JA, and
Rossing MA. Breast-feeding and risk of epithelial ovarian cancer.
Cancer Causes Control, 2012. 23(6):919-27.
15.Aune D, Norat T, Romundstad P, and Vatten LJ. Breastfeeding
and the maternal risk of type 2 diabetes: a systematic review and
dose-response meta-analysis of cohort studies. Nutr Metab
Cardiovasc Dis, 2014. 24(2):107-15.
16.Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg
MS, et al. Duration of lactation and risk factors for maternal
cardiovascular disease. Obstet Gynecol, 2009. 113(5):974-82.
17.Jarlenski MP, Bennett WL, Bleich SN, Barry CL, and Stuart EA.
Effects of breastfeeding on postpartum weight loss among U.S.
women. Prev Med, 2014. 69:146-50.
18.Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TI, and
Rasmussen KM. Breastfeeding reduces postpartum weight retention.
Am J Clin Nutr, 2008. 88(6):1543-51.
19.Groer MW. Differences between exclusive breastfeeders,
formula-feeders, and controls: a study of stress, mood, and
endocrine variables. Biol Res Nurs, 2005. 7(2):106-17.
20.Groer MW and Davis MW. Cytokines, infections, stress, and
dysphoric moods in breastfeeders and formula feeders. J Obstet
Gynecol Neonatal Nurs, 2006. 35(5):599-607.
By Chris Radlicz
Marion Nestle, PhD, MPH is Paulette Goddard Professor in the
Department of Nutrition, Food Studies, and Public Health at New
York University, which she has chaired from 1988-2003.
Additionally, she is Professor of Sociology at NYU and Visiting
Professor of Nutritional Sciences at Cornell. Dr. Nestle earned
her PhD in molecular biology and MPH from University of
California, Berkeley. Her research examines scientific and
socioeconomic influences on food choice, obesity, and food
safety, with an emphasis on the role of food marketing. She is
the author of several prize-winning books, and in her latest,
Soda Politics: Taking on Big Soda (and Winning), Dr. Nestle
provides insight on the soda industries tactics to gain
consumers and addresses what is now working in the fight
against ‘Big Soda'. I recently had the opportunity to ask Dr.
Nestle some questions relevant to her newest book.
1. How has your background in molecular biology lead you to
your career interest in public health, and particularly food
The direct story is that I was teaching undergraduate molecular
and cell biology in the Biology Department at Brandeis
University and was assigned a nutrition course to teach.
Undergraduate biology majors wanted a course in human biology
and it was my turn to take one on. From the first day I started
preparing that course, it was like falling in love. I've never
looked back. Politics was in the course from day one. It's not
possible to understand how people eat without understanding the
social, economic, and political environment of food marketing
and food choice.
2. What lead you to write your newest book, “Soda Politics:
Taking on Big Soda (and Winning)”?
I've been writing about soda marketing since the late 1990s
when I learned about "pouring rights" contracts--soda company
arrangements with educational institutions for exclusive sale
of their brand. These started with colleges but had just gotten
to elementary schools when I learned about them. Since
then, I've followed Coke and Pepsi marketing with great
interest. I teach food politics and food advocacy at NYU
and was well aware of all the advocacy groups working to reduce
soda intake as a public health measure. When my agent
suggested that I ought to write a book about sodas, it seemed
like a terrific idea to encourage readers to engage in advocacy
for healthier food systems. Sodas are a good example of
how to do this.
3. The title is provocative. Why do you say that those
taking on 'Big Soda' are in fact ‘winning'?
That's the best part. Soda sales are way down in the
United States. The soda industry thinks public health advocacy
is responsible, and who am I to argue?
4. What has influenced the slow but successful decline in
soda consumption seen today?
Excellent public health advocacy. Think of New York City's
poster campaigns over the last four or five years. These
illustrated the amount of sugar in sodas and how far you would
have to walk to work off the calories in one vending machine
5. The Coca-Cola funded non-profit, "Global Energy Balance
Network", recently shut its doors. Do you think this is
evidence of gaining momentum?
Reporters from the New York Times and the Associated Press were
shocked to discover that Coca-Cola was funding university
research to demonstrate that physical activity is more
effective than eating healthfully in preventing weight gain.
This idea is patently false. Investigations revealed that
the researchers worked closely with Coca-Cola executives to
craft the research, conduct it, interpret it, publish it, and
present it at meetings. This too seemed shocking. Now Coca-Cola
is scrutinizing who it supports and many organizations know
they need to be more careful to avoid such conflicts of
6. In what ways do you see parallels in tactics used by 'Big
Soda' and those previously used by cigarette companies in
defending their respective products?
Soda is not tobacco but the tactics sure look similar. The soda
industry follows the tobacco industry's playbook to the letter.
It too attacks inconvenient science, buys loyalty, funds front
groups, lobbies behind the scenes to get what it wants, and
spends fortunes to oppose public health measure that might
reduce soda intake.
7. Where can people follow your current work and get
involved in this fight against 'Big Soda'?
I write an (almost) daily blog at www.foodpolitics.com where I
cover such issues. Soda Politics has an Appendix that lists the
principal advocacy groups working on soda issues and provides
links to their websites. It's easy to get involved in
food advocacy and well worth the time.
By Caitlin Dow, PhD
The most recent data from the CDC indicates that approximately
35% of American adults have obesity (1). In order to reduce
obesity prevalence, a popular notion is that people with obesity
just need to “eat less and move more.” Indeed, many public health
programs use this concept as their primary approach for combating
obesity. While eating less and moving more may help
prevent obesity or result in successful, sustained weight
loss in individuals who are simply overweight (but not yet
obese), ongoing research indicates that these simple lifestyle
changes will do very little in the face of prolonged obesity (2).
If you look at any weight loss study, you will most assuredly
find the same results, regardless of study design. The first six
months are generally characterized by substantial weight loss,
followed by sustained weight regain, resulting in a final weight
that is negligibly lower and potentially higher than the starting
weight . This “checkmark effect” or weight loss recidivism that
has been reported nearly ubiquitously across diet and
exercise-based weight loss trials (3) indicates that lifestyle
interventions are generally not successful modalities for
Based on a rudimentary understanding of metabolism, the calories
in/out approach should work for weight loss and weight
loss maintenance. So why doesn't it work for so many people? The
answer lies in the complex network linking the environment,
genetic predisposition to obesity, as well as metabolic and
physiological changes. A large body of literature indicates that
the brain's reward systems are significantly dysregulated in
individuals with obesity (4). In an environment that supports
ease of access to highly palatable foods, the pleasurable effects
of consuming said foods can override homeostatic control of
intake. While some people are able to regulate intake despite the
high palatability of these foods, a number of genetic mutations
in the brain's reward systems may result in overeating and
obesity in many people. Furthermore, the hypersensitive reward
systems that often lead to obesity can become insensitive once a
state of obesity is attained. In effect, this leads to overeating
to receive the same pleasure from the same foods. These
dysregulated reward systems are coupled with preadipocyte
expansion into mature adipocytes, allowing for increased fat
storage. While this isn't the entire story, this should shed some
light on the complex interactions of dysregulated internal
systems that foster the metabolic abnormalities that result in
obesity. Importantly though, these impairments are typically only
demonstrated once obesity has been introduced and sustained (3).
As for weight loss, when caloric restriction is initiated, the
body triggers a number of systems to prevent starvation. From an
evolutionary perspective, this makes sense as food sources were
often unpredictable and the body adapted to conserve energy - the
“feast and famine” principle. However, for most of us living in
industrialized nations, famine is rare and feast is common,
limiting the need for this once very necessary adaptation (though
the body has not evolved to recognize the abundance of calories
in our modern food supply). When we try to induce weight loss via
caloric restriction, the body will reduce its resting metabolic
rate to counter these advances (5). This supports the “set point
theory” - the idea that the body will defend its
highest-sustained weight. In fact, as weight loss increases, the
drive to restore the highest bodyweight only increases (6). It's
like when you're pulling on your dog's leash to get him into the
vet and he plants his feet firmly and resists with all his might.
Ultimately his strength pulls him out of his collar and sends him
running in the opposite direction. Except here we're talking
about the human body and it's not nearly as comical.
All of these biological adaptations that introduce, sustain, and
defend obesity explain why weight loss and its maintenance is so
exhaustingly difficult for so many people. As Ochner and
colleagues suggest, most individuals who had obesity but lost
weight simply have “obesity in remission and are biologically
very different from individuals of the same age, sex, and body
weight who never had obesity.” As a hypothetical scenario,
imagine you are comparing two people: they weigh the same, but
person A had obesity and has lost weight whereas person B has
never lost weight. Person A will have to burn up to 300 calories
more (or consume 300 calories fewer) than person B to maintain
that weight (2). This underscores the idea that weight regain is
not simply an issue of willpower and weakness.
What we need more of are studies evaluating multiple approaches
to weight loss (surgeries, medications, likely in combination
with lifestyle changes). What we need less of is bias from people
without obesity, the media, and even healthcare providers.
Indeed, “the mere recommendation to avoid calorically dense foods
might be no more effective for the typical patient seeking weight
reduction than would be a recommendation to avoid sharp objects
for someone bleeding profusely” (2). We also need better obesity
prevention approaches because, clearly, it's biologically more
feasible to prevent weight gain than to lose weight and keep it
1.Ogden CL, Carroll MD, Kit BK, Flegal KM.
Prevalence of childhood and adults obesity in the United States,
2011-2012. JAMA. 2014;311(8):806-814.
2.Ochner CN, Tsai AG,
Kushner RF, Wadden TA. Treating obesity seriously: when
recommendations for lifestyle change confront biological
adaptations. Lancet Diabetes Endocrinol. 2015:
3.Ochner CN, Barrios DM,
Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight
regain following weight loss in obese humans. Physiol
Behav. 2013:120:106-13. doi:
4.Kenny JP. Reward
mechanisms in obesity: new insights and future directions.
Connolly-Schoonen J. Addressing Weight Loss Recidivism: A
Clinical Focus on Metabolic Rate and the Psychological Aspects of
Obesity. ISNR Obesity. 2012. doi:10.5402/2012/567530
6.Rosenbaum M, Leibel RL.
Adaptive thermogenesis in humans. Int J Obes.
By Allison Dostal, PhD
Gastrointestinal problems are one of the most common unpleasant
issues that we all experience at some time or another. But what
if your upset stomach wasn't just a passing discomfort? What if
severe abdominal pain, cramping, fatigue, and diarrhea became
more of your norm and less of a passing annoyance? For more than
1.4 million Americans, these symptoms typify their experience
with inflammatory bowel disease (IBD), a disorder characterized
by chronic inflammation of the gastrointestinal (GI) tract.
The specific cause (or causes) of IBD remain unknown, but
one leading hypothesis is that the bacteria that inhabit our GI
system – termed the gut microbiome – play a central role.
In this post, we'll take a closer look at this condition and
highlight research aimed at elucidating the impact of the
microbiome in IBD development, progression, and treatment.
Characteristics, Diagnosis, and Treatment of IBD
Inflammatory bowel disease is unique in that its symptoms vary
from person to person, and an individual's own experience with
their condition can differ markedly from another affected person.
Most people are diagnosed with one of the two most common types
of IBD, which are ulcerative colitis (UC) and Crohn's disease
(CD). The primary distinguishing factor between the subtypes is
that in UC, symptoms are limited to the colon. In contrast, any
part of the GI tract – from the mouth to the anus - can be
affected in CD. In addition, UC only involves the innermost layer
of the colon, while CD can extend deeper into the cell layers of
the GI tract. Lastly, in CD, the inflammation can “skip”, leaving
normal areas between patches of affected GI tract.
Making a clear IBD diagnosis isn't always as easy as meeting – or
not meeting – these criteria. There is no gold standard available
for a clear-cut diagnosis, and 5-15% of cases do not meet strict
criteria for either UC or CD. These patients fall into the “IBD
type unclassified” (IBDU) group. And in up to 14% of patients,
the diagnosis changes over time. Despite the difficulty in
specific diagnosis, all subtypes of IBD have one strong feature
in common: an abnormal response by the body's immune system. The
immune system is composed of various cells and proteins that
usually protect our bodies from infection. However, in people
suffering from IBD, the immune system reacts inappropriately, and
mistakes benign or beneficial cells and bacteria for harmful
foreign substances. When this happens, the immune system produces
an inflammatory response within the GI tract and produces the
symptoms of IBD. This adverse reaction is termed a “flare”, and
can result in symptoms such as abdominal pain and cramping,
diarrhea, fever, and blood in the stool. People with IBD often
have deficiencies in vitamins, minerals and macronutrients
stemming from loss of appetite, reduced food intake, and
malabsorption from the GI tract. The lack of nutrients can lead
to worsening of symptoms or development of new complications.
Treatment for IBD is centered around two goals: achievement of
remission and prevention of flares. Anti-inflammatory drugs such
as aminosalicylates and antibiotics are often the first line of
treatment, and can be followed by corticosteroids,
immunomodulators, and/or biologic agents. In severe cases,
removal of the affected part of the GI tract is needed if a
patient is not responsive to other treatments.
The Role of the Microbiome in IBD
In recent years, it has become clear that the microbes in our gut
have a key role in IBD, but the bacteria involved and their
associated functions remain largely unknown. An imbalance
of the normal gut bactera due to loss or overabundance of certain
species is important in the persistence of the inflammatory
responses seen in IBD. The role of the gut microbiota in IBD
pathogenesis has been demonstrated by studies showing that
antibiotic use can reduce or prevent inflammation – antibiotics
work by reducing the number and types of bacteria found in the
gut, therefore killing microbes that are causing IBD symptoms.
Also, results from studies with UC patients who underwent a
transfer of stool collected from healthy donors – called a fecal
microbiota transplant – had notable disease remission. However,
results have not been consistent between studies, due to
differences in populations studied, official diagnosis, treatment
methods and doses, and methods of assessing study endpoints.
Therefore, no consensus on the microbiome's relationship to IBD
has been reached.
As you can imagine, the combination of unpleasant,
potentially severe symptoms and an uncertain diagnosis or
treatment can result in significant stress on IBD sufferers,
their caregivers, and health care providers. The scientific
efforts dedicated to identifying causes and cures for IBD have
rapidly expanded in recent years due to advances in technology
that allow researchers to work toward refining a clear diagnosis,
map specific gut bacteria associated with disease development and
symptoms, and identify defined targets for therapy. One of these
initiatives is the Crohn's and Colitis Foundation of America
(CCFA) Microbiome Initiative, which is dedicated to understanding
the role of the gut microbes in IBD, IBD families, and disease
flares. Thus far, there are 7 active projects and 30 published
manuscripts stemming from the Initiative, which have determined
that different subsets of IBD are characterized by signature
bacterial compositions and that people carrying different IBD
genes have different microbiome compositions, among other
Other organizations are also supporting IBD research
endeavors, including the Kenneth Rainin Foundation, whose
Innovator Awards program provides $100,000 grants for one-year
research projects conducted at non-profit research institutions,
and the NIH's Human Microbiome Project, which has funded several
projects aimed at genetic and metabolomic elucidation of risk for
Crohn's disease. Several randomized trials are ongoing at this
time, and their results will inform future directions for
diagnosis, treatment, and eventual resolution of IBD.
Borody TJ, Warren EF, Leis SM,
Surace R, Ashman O, Siarakas S. Bacteriotherapy using fecal
flora: toying with human motions. J Clin Gastroenterol. 2004;38(6):475–483.
Bull MJ, Plummer NT. Part 1: The
Human Gut Microbiome in Health and Disease. Integr Med.
2014 Dec; 13(6):17-22.
Crohn's and Colitis Foundation of
Swidsinski A, Weber J,
Loening-Baucke V, Hale LP, Lochs H. Spatial organization and
composition of the mucosal flora in patients with inflammatory
bowel disease. J Clin
Tontini GE, Vecchi M, Pastorelli L,
Neurath MF, Neumann H. Differential diagnosis in inflammatory
bowel disease colitis: state of the art and future perspectives.
World J Gastroenterol. 2015 Jan 7;21(1):21-46.
By Emma Partridge
Dietary tracking applications (apps) have become quite
sophisticated over the years, moving from manual entering of a
food and portion to using barcode scanners to identify brand name
products and return nutritional content information based on an
entered portion. However refined these apps have become, their
most poignant issue may not lie in the accuracy of the
nutritional content information returned, but in the accuracy of
the user's portion estimation. An analysis of misreporting on
National Health and Nutrition Examination Surveys (NHANES)
between 2003 and 2012 published in the British Journal of
Nutrition found that under-reporting of energy intake was most
prevalent in US adults 20 years or older. Specifically likely to
under-report were women and overweight or obese subjects.1 The
reality that under-reporting, conscious or subconscious, can
happen in any subjective food recording process leads to
questioning whether these types of apps are actually successful
in their dietary tracking abilities, especially for overweight or
obese people tracking their diets in attempts to lose weight. In
a randomized control trial conducted at the Duke University
Medical Center and published in Obesity, researchers found that
overweight and obese young adults (18-35 years) were no more
likely to lose weight using a smartphone app than the control
group, who did not undergo any weight loss or health
intervention.2 If we can reasonably determine that smartphone
apps where one enters their food intake or receives social
support don't help the majority of overweight or obese people
lose the weight they're aiming to, how can this be improved? The
latest technologies coming into play are image-assisted apps that
allow users to submit photos of their meals then receive
nutritional content based on the food and the portion size. Apps
such as MealLogger allow the user to submit a photo of their
meal, choose their portion size, and post the photo for others to
view. While this form of social photo-sharing may skew users to
acceptable portioning by social pressure, the user's ability to
choose their portion size still introduces under-reporting bias.
Other apps rely on objective, but far broader, methods of
extrapolating nutritional content from a food photo. Apps like
MealSnap allow users to submit photos of their meal to have the
MealSnap system “auto-magically detect the nutritional breakdown”
of the meal, according to their Microsoft.com page. While this
calorie estimate is likely rougher than one where users choose
their portion, it is also objective and prevents under-reporting
bias. Apps with more user input may fall victim to inaccuracies
from under-reporting, while apps that avoid biased reporting may
sacrifice accuracy for objectivity. To correct this, future
technologies must undoubtedly continue to move toward a goal of
improved accuracy and usability. Likely, these technologies will
move toward advanced imaging, as imaging, finding ways to take in
the real food, rather than relying on the user's input. The
future of image-assisted food technology will determine how close
inventors and researchers can get to exact measurement of food
and portion while maintaining accurate extraction of nutritional
content. I, for one, am excited to see where it leads.
1.Murakami K, Livingstone MBE. Prevalence and characteristics of
misreporting of energy intake in US adults: NHANES 2003-2012.
British Journal of Nutrition. 2015;114(8):1294-1303.
2.Svetkey LP, Batch BC, Lin PH, et al. Cell phone intervention
for you (CITY): A randomized, controlled trial of behavioral
weight loss intervention for young adults using mobile
technology. Obesity. 2015;23(11):2133-2141.
By Emily Roberts
The Mediterranean Diet is based on the eating patterns in the
Mediterranean region and focuses on fruits, vegetables, fish,
whole grains and healthy fats (1). A diet not invented,
but discovered, is now recognized as one of the healthiest
dietary patterns (2). UNESO defines it as “a social practice
based on all the “savoir-faire”, knowledge, traditions ranging
from the landscape to the table and covering the Mediterranean
Basin, cultures, harvesting, fishing, conservation, processing,
preparation, cooking and in particular the way we consume” (3).
The Mediterranean region is considered the Mediterranean Basin
that borders the Mediterranean Sea and includes parts of seven
countries: France, Portugal, Italy, Spain, Greece, Malta and
Cyprus (4). There have been foreseen health benefits of
consuming this diet, classifying it as “heart healthy” due to
its likelihood to reduce the risk for heart disease (5,6).
Living on the southern coast of France, I not only experience
the Mediterranean lifestyle, but I have the opportunity to
consume a Mediterranean Diet.
The Mediterranean Diet was discovered to have particular health
benefits by Ancel Keys of the University of Minnesota in the
1950's. He happened upon this discovery while studying the
health of poor populations in Southern Italy in comparison to
the wealthy in New York. He found the Italian populations had
lower levels of cholesterol and a low rate of coronary heart
The diet is full of fresh foods including fruits, vegetables,
herbs, fish, olive oil, breads, nuts and pastas (1). There is a
very low consumption of red meats, poultry, butter, refined
grains and processed foods. The diet is rich in fiber,
monounsaturated fats and polyunsaturated fats, antioxidant
compounds, and essential vitamins and minerals; conversely, it
is very low in saturated fats. Given the diet's composition of
nutrient dense foods, strong adherence to this diet is
associated with improved nutritional adequacy (2).
A strong adherence to the Mediterranean Diet enhances the
chances of improving your health status. It has been found to
reduce the risk for mortality, especially due to cardiovascular
disease (7). There have been many cohort studies conducted in
the Mediterranean Basin often showing good adherence to the
diet and resulting in reduced incidence for cardiovascular
events (6). The benefits of the diet are likely to improve with
physical activity as well, such as decreased blood levels of
During my time in the south of France I have noticed the
influence the agriculture and natural resources of the
Mediterranean Basin has on the cuisine. This area is rich in
olive groves, offering a plentiful supply of fresh olive
products. The sea offers fresh fish, shellfish and other
seafood, while local markets sell fresh fruits and vegetables.
Cattle farms are not as populous in this area, so the
consumption of red meat and butter is not as high as other
European regions (such as Northern France). However,
considering I am still residing in France, pastries, baguettes,
and of course cheese are a typical part of the French dietary
meal pattern. This differentiates my diet somewhat from other
Mediterranean regions. Thankfully, walking as a means of
transport is very common if not necessary, offering an
efficient form of daily exercise. Fresh and homemade are the
two words that best describe home cooking near the
Mediterranean. While residing with a local French family,
I ate many freshly prepared meals. Everything made from scratch
from salad dressings to whole grain bread.
The Mediterranean Diet is not an effort, rather a daily
practice for many Europeans. As Americans, we may recommend it
as a diet intervention or integrate it into our own eating
habits for health reasons. This diet is seen to be successful
by offering significant health benefits. This encourages me to
try various diets from around the world that could potentially
provide various health benefits for Americans, as well as a
taste of a new culture.
3.La DiÈte MÉditerranÉenne 2010. Candidature transnationale en
vue de l'inscription sur la Liste ReprÉsentative du Patrimoine
Culturel ImmatÉriel de l'HumanitÉ. Espagne / GrÈce /
Italie/Maroc, Version Informations Additionnelles.
By Mary Scourboutakos
Living in Canada, I was never worried about recombinant bovine
somatotropin hormone, aka rBST. This synthetic hormone, which
mimics a natural hormone that causes cows to produce more milk,
was banned in Canada in the 1990s. So North of the
49th parallel, most people have never heard of it.
Meanwhile in the United States, the situation is a little
different. rBST is legal in the US because technically, there's
no evidence that it causes harm to humans. Meanwhile in Canada,
the rationale for its ban is that it may pose risks for the cows
that are treated with it.
With that in mind, whenever I visit the US, I always explore the
milk on grocery store shelves to see if it contains rBST. To my
surprise, on nearly every occasion, I've been hard pressed to
find a jug of milk that didn't say “from cows not treated with
This was reassuring. But then I noticed something…while every jug
of milk said “no rBST” I couldn't find a single block of cheese,
or container of yogurt declaring this.
This got me thinking…are they using the rBST-treated milk in
yogurt and cheese? Could it be that consumers are so far removed
from the food chain that they would think to look for “no rBST”
on their milk, but wouldn't think to look for it on their cheese?
It didn't make sense...were the labels missing? Or was the
industry using rBST milk in places where people would be less
likely to look for it? I wanted to get to the bottom of this, so
I started asking people about it. No one really knew the answer
until I spoke with a representative from the food industry who
told me that it takes so much effort to change labels, the
industry won't label something unless there is extremely consumer
demand. She predicted that the yogurts and cheese are probably
made with rBST-free milk, they're just not advertising it.
Lo and behold, after doing some reading I found that in fact,
many brands have removed rBST from ALL of their products, they're
just not stating it on their label, or they're doing so
haphazardly on some products but not others.
Perhaps I'm an over informed consumer who is paying attention to
details that nearly no one else even knows or cares about,
nevertheless, it's interesting to consider that a product could
in fact be potentially healthier—or at least kinder to the animal
it's coming from—than expected. I guess sometimes the food
industry doesn't show off everything it could.
By Celez Suratos, MS, RD, ACCN15 Blogger
It's no surprise that obesity was one of the many topics covered
at the recent Advances and Controversies in Clinical Nutrition
(ACCN) conference. At his presentation during ACCN, Dr. Scott I.
Kahan, MD, MPH, delved into the many obesity guidelines and
algorithms that exist today.
According to Dr. Kahan and the National Guidelines Clearinghouse,
there are over 400 guidelines on the topic of obesity (this
excludes the number of other various topics that may include
obesity as secondary information). With an ongoing and growing
list of information on obesity, how does a clinician sift through
it all to find a best strategy to put into practice? Luckily Dr.
Kahan summarized four recently published guidelines that can help
anyone interested in knowing more about how obesity should be
approached from a treatment standpoint. These guidelines were
derived from the (1) National Heart, Lung, and Blood Institute
(NHLBI); (2) Endocrine Society; (3) American Association of
Clinical Endocrinologists (AACE); and (4) American Society of
Bariatric Physicians (ASBP).
The information shared in this post will be from Dr. Kahan's
summary of the guidelines from the NHLBI. The recommendations
derived from this organization attempt to answer questions
regarding the benefits of weight loss, risk of being overweight,
the ideal diet an obese individual should follow, what lifestyle
interventions are relevant to assist obese patients achieve and
maintain weight loss, and the any benefits or risks of bariatric
surgery, if such an intervention is necessary. The five
recommendations a practitioner should follow when treating the
obese patient include:
- Use body mass index (BMI) as the primary screening tool to
identify patients who are obese (currently defined as BMI
greater than 30). One should also consider waist circumference
as a secondary screening tool to identify patients who may be
at increased risk for cardiovascular disease
- Advise on moderate weight loss, as defined by a three to
five percent reduction in weight, rather than a goal weight.
Three to five percent may sound like such a small amount, but
it can still have a great impact on various health outcomes in
an obese individual. And it may be a less daunting goal for the
- Just like a magic pill to make a person instantly lose
weight overnight does not exist, there is no such thing as the
perfect diet prescription to guarantee sustained weight loss.
The focus should be on an individualized meal plan that is
lower in calories, incorporates the patient's food preferences
(to encourage compliance), and is used in conjunction with
modified lifestyle behaviors
- A successful intervention requires a multidisciplinary
approach inclusive of professionals from the fields of
nutrition, physical activity, and behavior modification that
proceeds for at least six months. According to the data
included in Dr. Kahan's presentation, during this comprehensive
intervention period, patients with frequent on-site counseling
exhibited more weight loss than patients who relied on other
forms of counseling (i.e. electronic counseling, counseling
through more commercial weight loss programs)
- The last recommendation from the NHLBI guidelines involves
bariatric surgery when appropriate. At present time, patients
with BMI greater or equal to 40 kilograms (kg)/meter (m)2 or
greater or equal to 35 kg/m2 with co-morbidities, bariatric
surgery may be a more viable option than the other previously
Weight loss is not a “one size fits all” scenario; it is always
best practice to individualize, individualize, individualize!
Obesity is a complex issue that involves more than just number of
calories, or those seen on a weighing scale. It is a disease
state that constantly relies on a collaborative approach from
experts in multiple health-related disciples in order to ensure
the best results.
By Celez Suratos, MS, RD, ACCN15 Blogger
An individual only needs two things to easily access a myriad of
information: a device that has the ability to connect to the
internet, and an internet connection. Such information may be as
simple as finding nearby show times for a movie, or something
more complex, such as trying to self-diagnosis when exhibiting
symptoms of a particular disease. This concept is the same when
it comes to how the general public may be finding nutrition
information. Along with the ease of access of internet searches
however, is a high potential of inaccurate or incomplete
nutrition information that's widely distributed.
This can be further exhibited when it comes to myths surrounding
carbohydrate (CHO) intake in people with diabetes mellitus (DM).
DM is a complex disease in and of itself.Add the ever-evolving
nutrition recommendations, such as the diabetic exchange list,
glycemic index, and CHO counting into the mix, and one may be
more sympathetic as to why a patient may struggle with compliance
and management of his or her diabetes.
Alison Evert, MS, RD, CDE from the University of Washington
Medical Center approached some of the frequent concerns that
arise from patients and healthcare providers when it comes to DM
and CHO intake at the 2015 Advances and Controversies in Clinical
Nutrition conference. From the presentation and based on a 2005
Dietary Reference Intake report, individuals need to consume at
least approximately 139 gram (g) of CHO per day (this does not
include creating glucose through pathophysiological processes,
such as gluconeogenesis) in order to meet minimum obligatory
glucose needs. Ms. Evert reports recent data of median intake of
CHO as 220-330 g/day by men and 180-230 g/day by women. Moreover,
data from a 2014 National Health and Nutrition Examination Survey
(NHANES) reports that adults (20 years and older) without
diabetes consume 48 to 50 percent of their daily calories from
CHOs. This information tells consumers that intake of CHOs is a
necessity, whether or not he or she has DM. It also communicates
to nutrition educators that there may not be an ideal percentage
of calories that should be consumed from a single macronutrient.
This begs the question, is current and best practice to make
percentage recommendations of macronutrient intake based off of
total calories, or is this an archaic and irrelevant practice?
During her session, Ms. Evert reflected on her time as a dietetic
intern in which she made specific calculations on g of CHO a
diabetic should consume per day, and passed on a meal plan to
patients based on this information. Imagine trying to explain a
generic serving recommendation, such as “eat 13 to 17 servings of
CHO per day” to an ill and perhaps non-compliant, underserved, or
even under-educated patient.
The take-away message Ms. Evert's presentation is that patients
with DM need individualized nutrition recommendations/meals
plans, particularly as there are major differences in type 1
versus type 2 DM, the spectrum of type 2 DM progression among
patients, and medications that affect glycemic control. Her
suggestion – make it a point to discuss what our food sources of
CHO are and focus on lifestyle behavior change.