Stephen F. Austin State University

Student Blogs

Student Blogs

Dietetic Interns are required to write a blog in the graduate level advanced nutrition course about a topic that is of interest to their selected audience. These blogs are published on the website so that other people can see what interest our students have and the quality of their work.

Cardiovascular Disease

Grape Expectations: Is Red Wine Actually Cardio-Protective?
Wine Grape Expectations: Is Red Wine Actually Cardio-Protective?
Heather Rose Anderson
SFA Dietetic Intern

Introduction


Red wine's association with cardiovascular disease is a very popular topic. This is because cardiovascular disease is so prevalent in the world and not to mention, is the number one cause of death in the United States with 633,842 deaths in 2016 according to the Centers for Disease Control.1 This means that one in every four deaths is a cardiovascular event. Due to red wine's widely ranged consumption, there has been multiple studies supporting that it prevents cardiovascular disease. But, is that true? Health care and medical professionals are one of the primary people translating "overheard" and/or "small talk" information regarding nutrition to patients, so it is pertinent to deliver the correct advice to the right population. With not much time to do research themselves, here is up-to-date information for those in need of a quick answer that is easy to deliver to other medical professionals and patients who inquire. So, here we go! Let's get started with this:


The French Paradox


Have you ever heard friends or family say while they are topping off their cabernet, "Hey, wine is good for the heart?" Well, this impression of wine and heart health surfaced in the late 1980's due to the French Paradox. Although controversial, high intakes of saturated fat have been shown to be positively related to high mortality from coronary artery disease. However, the situation in France, shown by French epidemiologists, reveals much different data. The French Paradox refers to the idea that drinking wine might help explain the low rates of heart disease among the French, regardless of their high intake of dietary cholesterol and saturated fat. The epidemiological studies showed that consumption of alcohol at the level of intake in France, about 20-30 grams per day, can reduce risk of coronary artery disease by at least 40%.2,3 Therefore, this French Paradox may not be so "paradoxical" after all. Now that we've covered the background story of wine and cardiovascular health, we can move on to the gooey details.


What is in red wine that could make it cardio-protective?


Red wine contains polyphenols. Typically, a five-ounce glass of red wine contains around 100 mg of polyphenols.3 Polyphenols are secondary metabolites of plants and are usually involved in the defense against ultraviolet radiation or attack by pathogens, but recently research has consistently shown to offer protection against cardiovascular disease.4,5 Polyphenols contribute to the bitterness, astringency, color, flavor, odor and oxidative stability. If you've ever sipped a glass of red wine, you may have experienced the taste of bitterness and/or acidity - those are polyphenols! These polyphenols originate in the grape berry. If you didn't know, wine is made from grapes - specifically white wine is made from white grapes and red wine is made from red grapes. White wine, however, does not share the same properties with their red wine counterparts. White wines typically do not have polyphenols which are shown to be cardioprotective and those that do contain a very small amount - not enough to impact the health of someone's heart. Now let's dig a little deeper. To start, there are more than 8,000 polyphenolic compounds identified.5 In red wine, resveratrol is the existing polyphenol carrying out these cardioprotective effects.6,7 The health benefits of this polyphenol, resveratrol, as an antioxidant is continually emerging in research.


What does the research say?


It is suggested that a moderate intake of alcohol (1 drink for a woman and 2 drinks for a man) lowers your risk for developing cardiovascular disease.8 As you know, cardiovascular disease is when there is a buildup of sticky plaque in the arteries of the blood vessels or "the highways" in your heart. This build up is called atherosclerosis. Atherosclerosis is an inflammatory process.9 Due to alcohol's perceived positive effect on cardiovascular disease, it is theorized that alcohol consumption affects inflammation. There are labs that doctors can look at that tell if your body is in a state of inflammation, putting you at risk for developing cardiovascular disease - these labs are fibrinogen and C-reactive protein. If these labs are too high, then it could indicate inflammation. After three weeks of drinking 150 mL (a little over a half of a cup) of red wine a day, C-reactive protein stayed the same and fibrinogen improved significantly. To note, fibrinogen improvement also means there is an increase in blood clotting due to the platelet-to-platelet binding during platelet aggregation which could be something to watch in certain patient populations.10 Additionally, during these 3 weeks, there were also positive changes in total cholesterol and triglycerides, both indicative of a positive impact on your heart's health.11 Out of 136,382 people, a significant inverse association between light-to-moderate wine drinking and vascular risk was also shown in another study. This showed that with light-to-moderate wine drinking of around 1-2 drinks per day, your risk for vascular disease (arteries) decreased drastically.


But not so fast… with emerging genetic evidence, research from the University of Gothenburg showed that only about 15% of the human population with the specific form of the cholesteryl ester transfer protein (CETP) gene actually gain this positive cardiovascular benefit from moderate alcohol consumption.12 Genetics has been playing an underrated role in our health in the past. We now know not to discuss health in absolutes. If you think about it, how many of the "rules" we follow (e.g. don't eat red meat and/or don't eat fat because it makes you fat) are deterring on our genetic makeup?


What does drinking a glass of wine have to do with genetics anyways? Patients with the genotype (CETP) are known to reduce their risk of heart disease; however, two distinct groups were looked at based on whether they had the B1 or B2 version of this CETP gene in the Gothenburg study. The B2 version exhibited a lower risk of cardiovascular disease in patients who enjoyed moderate alcohol consumption. Out of the 618 patients, only 19% of them had this B2 version.


Genetic testing is increasingly becoming more and more common and could be pertinent to any mutations in a person's genes that may cause or progress illness or disease. But what if a patient or client does not have the funds or interest to get a genetic test? Well, there are other ways to tell that wine and/or alcohol consumption may not be right for your patient. According to the Mayo Clinic, signs such as flushing, hives, runny nose, migraines, low blood pressure, nausea, vomiting and/or diarrhea are signs of alcohol intolerance. Alcohol intolerance occurs when the body does not have the right enzymes to break down the toxins in alcohol - this is caused by inherited (genetic) traits. Any signs of alcohol intolerance are enough evidence to refrain from drinking because there may be a genetic predisposition to these toxins.


Conclusion


In conclusion, to say red wine is cardio-protective is one of those "absolute health" statements I mentioned above. First and foremost, listening to the body to determine alcohol tolerance is essential. Secondly, genetic testing to determine if one has the right version of the alcohol-related CETP gene which shows to be cardio-protective is the most proficient way of determining if wine is cardio-protective for an individual.


References

1. National Center for Health Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Published March 17, 2017. Accessed April 17, 2018.

2. Ferrieres J. The French paradox: lessons for other countries. Heart. 2004;90(1):107-111. doi:10.1136/heart.90.1.107.

3. Renaud S, Lorgeril MD. Wine, alcohol, platelets, and the French paradox for coronary heart disease. The Lancet. 1992;339(8808):1523-1526. doi:10.1016/0140-6736(92)91277-f.

4. Bonnefont-Rousselot D. Resveratrol and Cardiovascular Diseases. Nutrients. 2016;8(5):250. doi:10.3390/nu8050250

5. Pandey K.B., Rizvi SI. Plant Polyphenols as Dietary Antioxidants in Human Health and Disease. Oxidative Medicine and Cellular Longevity. 2009;2(5):270-278. doi:10.4161/oxim.2.5.9498.

6. D'Archivio M, Filesi C, Varì R, Scazzocchio B, Masella R. Bioavailability of the Polyphenols: Status and Controversies. International Journal of Molecular Sciences. 2010;11(4):1321-1342. doi:10.3390/ijms11041321.

7. Showing all foods in which the polyphenol Resveratrol is found Food Composition. (n.d.). Retrieved March 29, 2018, from http://phenol-explorer.eu/contents/polyphenol/592

8. Castelnuovo AD. Meta-Analysis of Wine and Beer Consumption in Relation to Vascular Risk. Circulation. 2002;105(24):2836-2844. doi:10.1161/01.cir.0000018653.19696.01.

9. Ross, R. (1999). Atherosclerosis--an inflammatory disease. The New England Journal of Medicine, 340(2), 115-126. https://doi.org/10.1056/NEJM199901143400207

10. Brunner, E. (2010). Fibrinogen and Clotting Factors. In Encyclopedia of Stress (pp. 51-55). https://doi.org/10.1016/B978-012373947-6.00159-8

11. Retterstol L, Berge KE, Braaten Ø, Eikvar L, Pedersen TR, Sandvik L. A Daily Glass Of Red Wine: Does It Affect Markers Of Inflammation? Alcohol and Alcoholism. 2005;40(2):102-105. doi:10.1093/alcalc/agh132.

12. Barter PJ. Cholesteryl ester transfer protein (CETP). AccessScience. January 2003. doi:10.1036/1097-8542.900195.

13. Alcohol Consumption and Genetics. Psych Central. https://psychcentral.com/lib/alcohol-consumption-and-genetics/. Published July 17, 2016. Accessed April 22, 2018.

14. Alcohol intolerance. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alcohol-intolerance/symptoms-causes/syc-20369211. Published March 26, 2015. Accessed April 22, 2018.

Special Diets

Can Food Fix COPD?
Veggies Can Food Fix COPD?
Leslie Rowe
SFA Dietetic Intern

Introduction


Everyone has experienced a conversation when the other person shares a new fact that sounds too good to be true, but your own lack of knowledge on the topic leaves you forced to nod and smile in curiosity. I'm not alone am I? I was stuck in this situation when visiting a patient in a hospital as he exposed me to a diet that cured chronic obstructive pulmonary disease, or COPD. I had never heard of any diet specifically for COPD, so I was intrigued to pick his brain for the details. He raved about eating a diet low in carbohydrates helped to reduce his respiratory issues, but also caused him to lose 36 pounds in 6 months. The book he found his information and diet tips from was titled, "Diet That Began My Mother's Recovery from COPD" by W.G. Miller. For those of you struggling with COPD or have a family member with this disease, I'm sure you are intrigued to read further into my findings after reading this book and digging into research about the possibility of a diet as a cure for COPD.


Overview of COPD


First, let's dive into a review of what COPD is, the symptoms that occur, and usual medical treatment. Chronic obstructive pulmonary disease (COPD) is a progressive diseaseof the lungs, ranging from mild to severe, that is the third leading cause of death in the United States.1It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke.2The disease includes chronic bronchitis and emphysema, and both are characterized by inflamed airway that decreases the amount of oxygen that flows to your body tissues. Long-term exposures to cigarette smoke, irritating gas, or mattercan cause one of the two conditions. The air sacs in the lungs lose the elastic quality and eventually destroy lung tissue in emphysema, and an inflammation and an excess of mucus obstructs airways, which causes shortness of breath in chronic bronchitis. This chronic shortness of breath will eventually limit one's ability to stay active and perform daily activities.Common symptoms with chronic bronchitis are a chronic cough with sputum, but other symptoms of emphysema will worsen over time as lung damage occurs. Common symptoms of COPD are fatigue, chronic cough, wheezing, chest tightness, unintended weight loss, and frequent respiratory infections. Living with this chronic disease can also affect mental health; it's not uncommon to feel fear, anxiety, depression or stress.3 Accurate diagnosis of COPD includes your doctor reviewing the symptoms, medical history, and environmental exposure as well as pulmonary function tests and X-rays.There is currently no cure for COPD, but it is considered preventable and treatable. Early detection of COPD is vital to maintenance and treatment; as well as smoking cessation.4 Effective therapies have been used to reduce symptoms and complications of COPD. Bronchodilators and inhaled steroids may be used in inhalers to relax muscles and reduce inflammation in the airways, or supplemental oxygen during daily activities may be needed. Vaccines and antibiotics are also widely used to treat associated infections in the lungs.


Miller's Book Review


Now that everyone is refreshed on COPD and how this disease affects the body, I want to share with you the contents of the book that first introduced me to a diet to cure COPD. The patient I referred to earlier read the book titled, "Diet That Began My Mother's Recovery from COPD" by W.G. Miller.5 Miller's mother had emphysema, and he was determined to find a way to not only slow the progression of the disease, but also cure it completely. As Miller watched her disease progress, he noticed her distending lungs eventually began crowding her stomach little by little as well as an increase in need oxygen required during mealtime, which resulted in decrease in meal sizes that caused weight loss.5After researching about COPD and current treatments, he believes opportunistic fungi that compromise the body's immune system cause this disease.He found evidence about how disease-like pathogens live off of sugar in the body, and hypothesized that if there were no sugar in the diet to provide pathogens a food supply, these pathogens would not be able to survive. Using this hypothesis, Miller developed a diet plan to eliminate simple sugars and grains. As his mother's primary caregiver who prepared all of her meals, he began a two-week transition of elimination of foods like bread, cereal, potatoes, and pasta without her knowledge. He described the subtle improvements just after two weeks, as his mother was no longer gasping for air when walking, her mood overall improved, she was sleeping more, and she was eating! After the diet was in full swing, the basic layout was three meals per day with a snack only occasionally and one 'cheat' meal per week. He includes many examples on well-balanced meals for breakfast, lunch, dinner, and snacks, so I included the an example of each below:


Breakfast Lunch Dinner Snack
Scrambled eggs with diced ham and green peppers; one half orange; coffee with powdered cream. Chicken soup with carrots, white onions and garlic; sliced tomatoes; romaine salad with cherry tomatoes, yellow squash, and white onions; Balsamic vinaigrette dressing. Garlic and chive marinated, baked pork steaks; steamed fresh peas and carrots with crushed garlic; spinach salad with hard-boiled egg, ham, and white onions; Balsamic vinaigrette dressing; fresh strawberries and cherries. Cashews

The diet Miller and his mother followed consisted mainly of uncontaminated protein and fresh vegetables, with plenty of water to drink, milk in moderation, and coffee in the morning. Miller includes many tips to preparing healthy meals, such as herb seasoning to meat and vegetables instead of using condiments, marinating meat before baking, grilling, stir-frying, or using the crock-pot, and consuming either raw orsteamed vegetables for variety at each meal. This diet worked long-term for his mother, as she showed great improvement from just implementation of this diet.5 Miller writes other books, one that details supplements that were able to complete his mother's recovery, and another that is a complete guide to her recovery journey with all details inside. I was amazed and glad a diet was able to improve the condition of emphysema in one person, but intrigued to find out if research supported this hypothesis by Miller.


Does Research Support The Book?


As I began my search for research on this topic, the main diet-related concern with COPD I noticed was unintentional weight loss and malnourishment. Malnutrition is common in those with COPD due to the combination of appetite loss, decreased physical activity, or depression, which result in decreased dietary intake.6After digging deeper, the general consensus is that the idea of a diet to cure COPD is a new concept that is not well researched at this point.Some research shows a correlation of a Mediterranean style diet with improved lung function, due to the antioxidant benefits extracted from the diet and defense against inflammation and oxidants.7Since Miller's diet resembles a paleo diet, one with alowamount of processed foods and refined sugars to reduce fungi in the lung microbiota, I focused my findings on these microorganisms. One study analyzed the variation of bacteria and fungi found in sputum of patients with COPD, with results showing the microbial communities continuously change during COPD exacerbations and are personalized to each individual. The lung microbiome of these COPD patients revealed to have varied types of fungi, such asCandida, Phialosimplex, and Aspergillus.8Since symptoms of severe asthma can resemble COPD symptoms, a clinical trial showed 29% of patients had sensitivities to at least 1 fungal allergen, such as Candida or Aspergillus, and multiple sensitizations were associated with poor asthma control.9With research to support that fungi, specifically Candida, can be present in lung microbiota, this study examined the association of a long-term and recent diets with fungal populations within the gut. "Candida [was] positively associated with diets high in carbohydrates, but negatively with diets high in amino acids, protein, and fatty acids."10Also, high abundance of Candida was most prevalent after recent consumption of carbohydrates.


These results give support to Miller's hypothesis and diet plan, but not without a few unanswered questions. Fungi in the gut and vaginalmicrobiome can be altered by the diet, but is this also true for fungi found in the lungs? One article suggests that since the gut microbiota helps shape the immune system, it does also affect the lung mucosa, but more research is needed.11 Also, I was unable to find research articles specifically looking at a diet high or low in carbohydrates and underlying effect on lung function in those with COPD. Has this theory been researched before or is Miller one of the first to try this diet for COPD? Until more evidence is published, Miller's diet approach remains a hypothesis.


Conclusion


I hope my small amount of research to get to the bottom of a nutrition claim has helped those of you who live with COPD. The diet that helped Miller's mother recover from COPD worked in his favor, but there are currently not enough studies to fully support this diet as a proven intervention. With this in mind, if I had the chance to interact again with the patient who brought this book to my attention, I would support him following the diet if he believed saw signs of improvement; however, I would ensure he was replacing the calories lost by removing simple carbohydrates from his diet with other nutritious foods and meets an adequate caloric goal each day. I am looking forward to monitoring this topic for further research in the future, as any possibility to treat a chronic disease with nutrition is exciting and important for the health of each generation.


References

1. O'Neil, Kevin M. Learn About Chronic Obstructive Pulmonary Disease (COPD). Chest Foundation. https://foundation.chestnet.org/patient-education-resources/copd/ Updated February 2018. Accessed April 15, 2018.

2. Mayo Clinic Staff. COPD. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679 Published August 11, 2017. Accessed April 15, 2018.

3. American Lung Association. Chronic Obstructive Pulmonary Disease (COPD).American Lung Association.http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/Published 2018. Accessed April 15, 2018.

4. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Chronic Obstructive Pulmonary Disease (COPD).Centers for Disease Control and Prevention.https://www.cdc.gov/copd/index.html Updated August 4, 2017. Accessed April 15, 2018.

5. Miller, W.G. Diet That Began My Mother's Recovery from COPD. 2012. Accessed April 1, 2018.

6. Seo, SeungHee, Medical Nutrition therapy based on Nutrition Intervention for a Patient with Chronic Obstructive Pulmonary Disease. ClinNutr Res. 2014; 3(2): 150-156. Doi: 10.7762/cnr.2014.3.2.150.

7. Yazdanpanah, Leila, Paknahad, Zamzam, Moosavi, Ali Javad, Maracy, Mohammad Reza, and Zaker, Mohammad Masoud. The relationship between different diet quality indices and severity of airflow obstruction among COPD patients.Med J Islam Repub Iran.2016; 30: 380.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972049/ Published May 31, 2016. Accessed April 15, 2018.

8. Su J, Liu H-y, Tan X-l, Ji Y, Jiang Y-x, Prabhakar M, et al. Sputum Bacterial and Fungal Dynamics during Exacerbations of Severe COPD. PLoS ONE 2015; 10(7): e0130736. https://doi.org/10.1371/journal.pone.0130736

9. Masaki K, Fukunaga K, Matsusaka M, Kabata H, Tanosaki T, Mochimaru T, Kamatani T, Ohtsuka K, Baba R, Ueda S, Suzuki Y, Sakamaki F, Oyamada Y, Inoue T, Oguma T, Sayama K, Koh H, Nakamura M, Umeda A, Kamei K, Izuhara K, Asano K, Betsuyaku T. Characteristics of severe asthma with fungal sensitization.Ann Allergy Asthma Immunol.2017; 119(3): 253-257.Doi: 10.1016/j.anai.2017.07.008

10. Hoffmann C, Dollive S, Grunberg S, Chen J, Li H, Wu GD, et al.Archaea and Fungi of the Human Gut Microbiome: Correlations with Diet and Bacterial Residents. PLoS ONE. 2013; 8(6): e66019. https://doi.org/10.1371/journal.pone.0066019

11. Segal, Leopoldo N., Blaser, Martin J. A Brave New World: The Lung Microbiota in an Era of Change. Ann AM Thorac Soc. 2014; 11(Suppl 1): S21-S27. Doi: 10.1513/AnnalsATS.201306-189MG

Your child's behavior versus your child's gut: is there a connection?
Gut Your child's behavior versus your child's gut: is there a connection?
Brandi Gouldthorpe
Dietetic Intern at Stephen F. Austin State University

French psychiatrist Phillipe Pinel, stated: "The primary seat of insanity generally is in the region of the stomach and intestines."


Every year further research studies are published trying to answer the question as to what the underlying causes and treatment options are for disorders and diseasesranging from Autistic Spectrum Disorders, Attention Deficit Hyperactivity Disorder (ADHD/ADD), depression, obsessive-compulsive disorder, schizophrenia and bipolar disorder which are becoming more common in children and young adults.


Having a child with a neurological or psychological disorder mentioned above can change your life in many ways. It can be overwhelming for a parent or family member who experience it 24/7 and can make some days harder than others. But what if your child's behavior or social problems could be managed by changing what they eat?


What is the GAPS diet?


Before I dive into the GAPS diet, it is important to know a little background regarding how this diet came about.


In the 1950s a doctor by the name of Sidney Haas developed a diet known as the Specific Carbohydrate Diet (SCD) after she found that eating only simple sugarsas your carbohydrate source significantly improved severe intestinal disorders in children. Years later Dr. Natasha Campbell-McBride took the SCD and further enhanced it by adding gut healing protocols in hopes of treating her daughter who had learning disabilities -which is where the GAPS diet or Gut and Psychology Syndrome diet was born. The diet is for psychological or neurological disorders said to be linked to intestinal barrier dysfunction.


What exactly do I mean by intestinal barrier dysfunction?


In recent years, many disorders and diseases have been studied in their connection to the gut. There are imbalances in the gut that usually imply dysbiosis. Gut dysbiosis is when there is a lack of healthy or "good" bacteria in your gastrointestinal track. The bacteria in the gut are needed for digesting food, synthesizing vitamins and fighting infections. The beneficial bacteria are essential to the body's ability to function. When dysbiosis in the gut occurs, the "bad" (or opportunist) bacteria breaks the balance and can cause inflammation.This prolonged inflammation from the overgrowth of bad bacteria and cause damage to the intestinal lining which can lead to increased intestinal permeability (leaky gut).1 So, what exactly is leaky gut? Well in the human body, our gut has over 4,000 square feet of surface area which controls what goes in and what gets absorbed into the bloodstream (when working properly). An unhealthy gut can have cracks or openings in the lining which causes partially digested food and toxins to enter the tissues beneath it which can trigger inflammation and change the healthy bacteria that live in our intestines. 2-4Everyone to some degree has leaky gut (that's normal), but people should not have a constant opening in the gut. Some leaky gut has been shown to be linked to genetics while other factors include modern lifestyles such as the American diet (low fiber and high sugar) has had emerging research. Recent research links the role this inflammation can play in the development of common autoimmune disorders (rheumatoid arthritis, type 1 diabetes, psoriasis) and developmental disorders (autism spectrum disorders and ADHD).


What does the GAPS diet have to do with intestinal barrier dysfunction?


The gut and the brain have bidirectional communication known as the gut-brain axis (the central nervous system and gut microbiota) and there is substantial evidence associated between this connection and gastrointestinal diseases.


Dr.Campbell-McBride has stated that clinical signs of abnormal gut flora have been shown to be present in almost 100% of mothers of children with neurological and psychiatric conditions.The belief is that when a child does not obtain normal balanced gut flora, food is not digested and absorbed properly and over a prolonged period can lead to developing multiple nutritional deficiencies. Common deficiencies recorded in these patients include magnesium, zinc, B vitamins, calcium, selenium, folic acid, omega 3 and 6 and amino acids - all nutrients important for proper development and function of the brain and immune system.


When a person has an unbalanced gut flora from either dysbiosis or leaky gut, the digestive system becomes a source of toxicity to the body. Abnormalities in cell groups and immunoglobulin are found in individuals. Common factors being candida species, the clostridia family, and gluteomorphins or opiates found in gluten and casein which leads to toxins entering the blood-brain barrier causing different neurological and psychiatric symptoms, showing the connection between the gut and the brain.


There is numerous anecdotal evidence of the GAPS diet's role innormalizing dysbiosis while also healing leaky gut.In order to heal the brain, the first step in the GAPS diet is to heal the gut.


Yes, I know that was a lot to take in, it can be overwhelming at first! The gut is just so fascinating though! So now that you have some background information, take a deep breath…now let's get back to the GAPS diet!


How does the GAPS diet work?

The GAPS diet is broken down into stages and works by restricting foods such as all grains, commercial dairy, starchy vegetables, all processed or refined grains, and focusing on easily digestible and nutrient dense foods that repair and heal the gut such as bone broth and fermented foods.The diet introduces foods that are easier for the body to digest and then to harder foods to digest as tolerated. Foods that the GAPS diet usually avoids is grains, cheese, sugar, and fake sweeteners.


The GAPS diet has an introductory diet for individuals with food allergies and intolerances that are designed to help heal and seal the gut lining. Stage one of the GAPS Diet limits you to broths, soups, and some probiotic-rich foods to slowly introduce the new diet. These foods are important in digestion and aid in healing the gut. In stage two the diet continues to add in foods like egg yolks and meat to add in vegetable stews and casseroles. In stage three, you continue with the foods from the previous two stages but now you can add avocados and sweet vegetables.Stage four focuses on grilled and roasted meats as well as adding cold pressed olive oil, juices, and almond bread (any nut or seed can be used). Stage five is the introduction of cooked apples and raw vegetables. More fruit juices are added at this stage. Stage six adds in raw fruit and honey and dried fruits.The supplementation part of the diet is tailored to each individual based on deficiencies in micronutrients or hormones found in lab and blood work.


The GAPS diet also encourages using all-natural cleaning products and personal care products to help lower any toxic loads or irritants.


The GAPS diet is restrictive and can be hard for a child or even an adult to follow. It is easier to begin when a child is younger, but it can still be done at any stage in life. While it may seem like a daunting task at first, there are many resources to help you along the way and may make a world of difference in your life! Here is a link to a GAPS diet support group. http://www.gapsdiet.com/support.html


Take Away


You can find so many success stories and blogs when searching the GAPS diet, but you can also find stories suggesting that the diet does not work - both can be true. There is not a fix-all one diet. If you have a child who suffers from GI problems and disorders mentioned above and has found that conventional use of medications and pills to treat your child does not work, then this diet might be the right fit! Just remember, it never hurts to try!


The father of modern medicine, Hippocrates, noted: "All diseases begin in the gut."


For the full diet and information visit: http://www.gapsdiet.com/


You can also find some recipe ideas in the recipe section of Gut and Psychology Syndrome, Internal Bliss cookbook, and the Heal Your Gut cookbook.


To learn about Gut and Psychology Syndrome, how it develops and how to treat it effectively with a sound nutritional protocol please read Dr. Campbell-McBride's book "Gut and Psychology Syndrome. Natural treatment for autism, ADHD/ADD, dyslexia, dyspraxia, depression, and schizophrenia"


1 Clapp M, Aurora N, Herrera L, Bhatia M, Wilen E, Wakefield S. Gut microbiota's effect on mental health: The gut-brain axis. Clinics and Practice. 2017;7(4):987. doi:10.4081/cp.2017.987[M1] .

2Conlon MA, Bird AR. The Impact of Diet and Lifestyle on Gut Microbiota and Human Health. Nutrients. 2015;7(1):17-44. doi:10.3390/nu7010017.

3Li Q, Han Y, Dy ABC, Hagerman RJ. The Gut Microbiota and Autism Spectrum Disorders. Frontiers in Cellular Neuroscience. 2017;11:120. doi:10.3389/fncel.2017.00120.

4Gillberg C. Disorders of empathy: autism and autism spectrum disorders (including childhood onset schizophrenia). Clinical child neuropsychiatry. February 1999:54-111. doi:10.1017/cbo9780511570094.007.

5Ferrari P et al. Immune status in infantile autism: Correlation between the immune status, autistic symptoms and levels of serotonin. Encephale 14:339-344, 1988.

6Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Frontiers in Immunology. 2017;8:598. doi:10.3389/fimmu.2017.00598.

7Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. Gastrointestinal flora and gastrointestinal status in children with autism - comparisons to typical children and correlation with autism severity. BMC Gastroenterology. 2011;11(1). doi:10.1186/1471-230x-11-22.

8Cryan JF, O'Mahony SM. The microbiome-gut-brain axis: from bowel to behavior. Neurogastroenterology & Motility. 2011;23(3):187-192. doi:10.1111/j.1365-2982.2010.01664.x.

9Huebner F, Lieberman K, Rubino R, Wall J. Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates. Peptides. 1984;5(6):1139-1147. doi:10.1016/0196-9781(84)90180-3.

10Campos M. Leaky gut: What is it, and what does it mean for you? Harvard Health Blog. https://www.health.harvard.edu/blog/leaky-gut-what-is-it-and-what-does-it-mean-for-you-2017092212451. Published September 21, 2017. Accessed April 2, 2018.

11Is the GAPS Diet the Cure for Autism and ADD? Institute for Integrative Nutrition. https://www.integrativenutrition.com/blog/2015/05/is-the-gaps-diet-the-cure-for-autism-and-add. Published May 6, 2016. Accessed April 2, 2018.

12Gut and Psychology Syndrome Nutritional Protocol. International Nutrition, Inc. http://www.gapsdiet.com/. Accessed April 2, 2018.


[M1]Put References at the beginning. See any article in the Academy Journal for formatting

My Journey with the Ketogenic Diet

My Journey with the Ketogenic Diet
Mara Ingersoll, Dietetic Intern


The Ketogenic diet is something that has been popping up on social media a lot lately, as most of my friends on social media have been posting about "starting the keto diet". The Ketogenic Diet has been studied for many different effects it has on the body including increased energy levels, elimination of brain fog, and what it's most commonly known for, weight loss.1The Ketogenic Diet has also been proven to improve the health in those with pathological conditions such as diabetes, cardiovascular disease, respiratory diseases, and neurological disorders. Of course, there are some drawbacks to every diet, so those will be briefly mentioned as well, but I am only going to go into detail on the ones that I noticed while on the diet.


If you have not already read my introductory blog post, (So You Want To Start a Diet) let me just summarize quickly:


I have dedicated the entire year of 2018 to trying a new diet each month. Not for weight loss necessarily, but to determine the effects each of them have on my body specifically. So again, the purpose of this is not to lose weight, instead it is to point out certain aspects of the diets that have been researched;each of the diets I am doing have been extensively researched and proven to have both beneficial effects and detrimental effects.


So, let's get back to keto, by the way I'm going to refer to the ketogenic diet as keto because it's just so much more convenient and let's be honest, it's kind of a cute word.


Keto focuses on consuming primarily fats, I know, you're probably thinking "how in the world can one lose weight by focusing on fats?" well, hold your horses, we're getting there. The body primarily uses carbohydrates as an energy source. Carbohydrates are on every nutrition label so it's super easy to know if a food contains carbohydrates if you just look at the label under "Nutrition Facts".I calculated my estimated calorie needs based on my height and weight and decided that I need around 1600 calories per day to participate in every day functions. Out of these 1600 calories, I chose to have 70% of them come from fat, 20% protein, and 10% carbohydrates. If you're considering trying this diet out and you do not know how to calculate your energy needs or how to read labels, just download a calorie counting app, because to be honest even though I know how to calculate it, it's so much easier with the app ??. The keto diet strictly limits carbohydrates, and here's why -when carbohydrates are limited in the diet, the body and brain turn to other sources for energy. Protein in the body can go through a process that turns protein into glucose, a carbohydrate, so protein is also pretty limited in the keto diet, as well. So why does it focus on fats? When the body lacks carbohydrates, it can turn fat into ketone bodies. The ultimate goal of the Keto diet is to go into ketosis, this is how your body can still work even without food because it goes into starvation mode and starts fueling your body with ketones rather than glucose due to a much larger supply of fat stores compared to stored glucose.


So enough of what the keto diet is, let's talk about what has happened so far in my experience with the diet.I will break down the arguable effects it has had and discuss what I've been going through.


Increased Energy Levels


Studies have proven that the Ketogenic diet increases energy levels and expenditure in mice and humans.6,7One study performed on high school Taekwondo students showed that after participating in the ketogenic diet, compared to a placebo group, there was an increase in aerobic capacity and fatigue resistance.8Honestly, I am used to drinking 2-3 cups of coffee every morning and then having an energy drink of some sort later during the day.


Coffee


Since being on Keto, I have 2 cups of coffee with 1 tablespoon of MCT oil (Medium Chain Triglycerides), 1 tablespoon of butter, 2 tablespoons of extra creamy whipped cream, and that's it - no energy drink! I noticed that my energy levels were high throughout the day without the extra energy drink after being on Keto for only 3 days! My MCT oil has 14g of fat, so that with the butter and whipped cream automatically start my morning with high fat content.


Reduced Brain Fog


Brain Fog


Like I previously mentioned, Keto has been researched and proven to reduce effects of brain fog, as well as increase mental clarity.9One study performed on 21 women showed that after 28 days on the ketogenic diet, compared to a nonketogenic diet, cognitive performance improved. Cognitive performance was tested with attention and mental flexibility, with a significant difference in performance in completing a task.10I have some pretty intense mood swings from time to time - probably stress related - but since starting Keto I went from having at least two mental breakdowns a week to only having one the three weeks I've been on the diet. Who knows if it really reduced my brain fog, but not having a mental breakdown has been niiiiiice.


Weight Loss


A study performed in 2012 on 60 adults showed that after 8 weeks on the Keto diet they had significant weight loss and increased exercise performance.11After starting this diet, I weighed 155lbs, which was primarily from weight gain while following the vegetarian diet during February. I now weigh 143lbs. When I began the Keto diet, I lost 7 pounds during the first week, which may be because I had gained weight during the vegetarian diet and maintained it during the low-carb high protein diet in March, but either way, I have shed some pounds in the last 3 weeks.


Drawbacks


Compliance. Compliance was actually super difficult with Keto. If you've done any research on the Keto diet, you've probably seen the term "Keto Flu", if you haven't, here it is: The "Keto Flu" is not an actual disease, but it apparently feels like you have the flu after the first few days while your body transitions to burning fat stores rather than carbohydrates. Well, that didn't really happen to me, but I definitely craved carbohydrate-heavy foods for the first 5 days, and yes, I cheated once or twice. Studies show that dieting can lead to guilt and shame, increasing stress responses on the body.12-14 Well, the few times I did cheat on Keto, I felt awful, mentally, which was wild because I ate stuff I would normally eat and love, but I quickly snapped back to the reality of "I'm only doing this for a month, and this is just extra information I can add to my blog", so the bad feeling did not last long. Below is a comparison of my "best" day and my "worst" day. As you can see, I got the hang of it a little better after two weeks.


I would consider the following to be Keto staples, trust me you'll use them all the time:


  • eggs (I went through 1 1/2 dozen per week)
  • butter - not margarine
  • cream cheese (like a lot, I used approximately 80oz the first 3 weeks)
  • almond or coconut flour (I used coconut flour... Most recipes call for either
  • MCT Oil (this is not necessary, but it provides straight fat)
  • Sweetner (most recipes call for Agave or Stevia)


A common error those following the Keto diet can include determining if you're in ketosis. Sure, there are test strips you can buy that you urinate on and it tells you if you're in ketosis, which is what I did, but how accurate are they? The truth is, not that accurate, you really need to have your blood tested to determine if you're in Ketosis, so that can be another issue you may face when starting this diet.


Another drawback can be the effect on cholesterol. There are several conflicting studies on whether or not the Ketogenic diet can increase "good" and "bad" cholesterol, there are also conflicting studies on if the Keto diet can increase particle size on the "bad" cholesterol.15,16 I would strongly encourage you to review some of the literature out there about the Keto diet and cholesterol, and of course have your cholesterol levels checked before beginning this diet to form your own personal opinion about Keto and cholesterol.


My Final Thoughts


I now have a different view of the Ketogenic diet, as I used to think it was silly. It can be difficult to remain compliant, and you know what, that's okay. The Ketogenic Diet has been proven to be beneficial in many circumstances, but also has its drawbacks, so be sure to always speak with your doctor about starting a new diet, and of course do your own research to see how it could affect your body.

References

1. Paoli A, Antonio. Ketogenic Diet for Obesity: Friend or Foe? Int J Environ Res Public Health. 2014;11(2):2092-2107. doi:10.3390/ijerph110202092.

2. Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7(6):500-506. doi:10.1016/S1474-4422(08)70092-9.

3. Stafstrom CE, Rho JM. The ketogenic diet as a treatment paradigm for diverse neurological disorders. Front Pharmacol. 2012;3 APR. doi:10.3389/fphar.2012.00059.

4. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789-796. doi:10.1038/ejcn.2013.116.

5. Vidali S, Aminzadeh S, Lambert B, et al. Mitochondria: The ketogenic diet - A metabolism-based therapy. Int J Biochem Cell Biol. 2015;63:55-59. doi:10.1016/j.biocel.2015.01.022.

6. Kennedy AR, Pissios P, Otu H, et al. A high-fat, ketogenic diet induces a unique metabolic state in mice. AJP Endocrinol Metab. 2007;292(6):E1724-E1739. doi:10.1152/ajpendo.00717.2006.

7. Bough KJ, Rho JM. Anticonvulsant mechanisms of the ketogenic diet. Epilepsia. 2007;48(1):43-58. doi:10.1111/j.1528-1167.2007.00915.x.

8. Rhyu H, Cho S-Y. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil. 2014;10(5):326-331. doi:10.12965/jer.140160.

9. Murphy P, Likhodii S, Nylen K, Burnham WM. The antidepressant properties of the ketogenic diet. Biol Psychiatry. 2004;56(12):981-983. doi:10.1016/j.biopsych.2004.09.019.

10. Wing RR, Vazquez JA, Ryan CM. Cognitive effects of ketogenic weight-reducing diets. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1995;19(11):811-816.

11. Brinkworth G, Noakes M, Clifton P, Buckley J. Effects of a Low Carbohydrate Weight Loss Diet on Exercise Capacity and Tolerance in Obese Subjects. Obesity. 2009;17(10):1916-1923. doi:10.1038/oby.2009.134.

12. Gruenewald TL, Kemeny ME, Aziz N, Fahey JL. Acute threat to the social self: Shame, social self-esteem, and cortisol activity. Psychosom Med. 2004;66(6):915-924. doi:10.1097/01.psy.0000143639.61693.ef.

13. Dickerson SS, Kemeny ME, Aziz N, Kim KH, Fahey JL. Immunological effects of induced shame and guilt. Psychosom Med. 2004;66(1):124-131. doi:10.1097/01.PSY.0000097338.75454.29.

14. Tangney JP, Stuewig J, Mashek DJ. Moral Emotions and Moral Behavior. Annu Rev Psychol. 2007;58(1):345-372. doi:10.1146/annurev.psych.56.091103.070145.

15. Ballaban-Gil K, Callahan C, O'Dell C, Pappo M, Moshé S, Shinnar S. Complications of the ketogenic diet. Epilepsia. 1998;39(7):744-748. doi:10.1111/j.1528-1157.1998.tb01160.x.

16. Dashti HM, Al-Zaid NS, Mathew TC, et al. Long term effects of ketogenic diet in obese subjects with high cholesterol level. Mol Cell Biochem. 2006;286(1-2):1-9. doi:10.1007/s11010-005-9001-x.

Are you interested in the Ketogenic diet? - Here's Why You Should Be
Are you interested in the Ketogenic diet? - Here's Why You Should Be.
Jamie Capin
SFA Dietetic Intern 2018
Keto Diet

A high-fat, low-carb diet. I know… it's a dream come true! Indulging in high amounts of butter, oil, nuts, and high-fat animal proteins seems to be the best tasting diet out there!The best part about this diet is its proven efficiency in weight loss and other medical conditions. Are you interested?... I know I am, andhere's why you should be as well.


What is the Ketogenic Diet?

The ClassicKetogenic Diet is a high-fat, low-carb, and moderate protein diet which shares similarities with Atkins and other low-carb diets.8 It has been around since the 1920s as an approach to treat epileptic seizures in children. Since the diets discovery, scientists have explored other avenues of how the Ketogenic Diet can impact healthy and medically ill individuals.Upon their research, they have found this diet to be beneficial for weight loss, Cancer, Alzheimer's, Diabetes Mellitus 2, Sports Performance, Multiple Sclerosis, and Acne. There are several forms of the Ketogenic Diet:


  • Classic Ketogenic Diet: This diet uses a ratio of 4:1 of fats to protein and carbohydrates consisting of 60-80% of fat, 10-20% protein, and 5-10% of carbs.
  • Cyclical Ketogenic Diet: The diet consists of higher-carb refeeds.
  • Example:Five days of keto followed by two high carb days. Or, two low carb days followed by one high carb day.
  • Targeted Ketogenic Diet: This alternative form is to add carbohydrates before and after workouts. The idea is to perform high intensity workouts without the side of effect of being kicked out of ketosis.
  • Most individuals should consume 25 - 30 grams of carbohydrates thirty minutes prior/after workouts.
  • High-protein Ketogenic Diet: Similar to the Classic Ketogenic Diet, however it allows more room for protein consisting of 60% fat, 35% protein, and 5% of carbs. This is because bodybuilders and athletes need more protein for muscle recovery to occur.


For the rest of this paper, we will only focus on the Classic Ketogenic Diet.


You're probably thinking what happens when you eat majority of your calories from fat. And indeed, there are a few things you should understand when consuming a high-fat diet.


Fuel Switching


For years, it has been known that ourpowerhouse for energy is glucose. However, while consuming a high-fat diet we have a shift in our fuel source.


Simply put, we store glucose as glycogen within liver and muscle cells. When consuming a very-low carb diet, the body will utilize all glucose and stored glycogen. Once glycogen is depleted, the body enters a starvation phase adapting to an alternate fuel source, ketones. Production ofketone bodies likeß-hydroxybutyrate is an important maker to measure while following the ketogenic diet.It assesses if the body is adapting to this alternate source of energy.Measurement of ketone bodiesare conducted by daily blood tests. Presence of theseketones allow the body to burn fat more efficiently whilereserving lean muscle mass.


Ketosis vs Ketoacidosis

You're probably wondering if ketosis is the same as ketoacidosis. I'm here to inform you that it is not. Ketoacidosis is a life-threatening condition which is caused by dangerously high levels of blood sugars and ketone bodies. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys.Ketosis differs from this as it has ketone bodies present but not enough cause harmful effects.An individual can fall into ketosis when following a low-carbohydrate diet, or fasting, as ketoacidosis can rapidly occur in type 1 diabetics whose bodies don't produce any insulin.


Metabolic Expense

Just because the body shifts to ketosis does not imply that you do not need glucose at all. Protein, which is supplied within the diet is converted through a process called gluconeogenesis. This is the production of glucose from a non-carbohydrate source.This is an excellent fuel source for the brain considering the brain prefers to utilize glucose than ketone bodies.


Satiety


Forget the consistent snacking because while consuming a high-fat diet it leaves a feeling of fullness. Research has found this diet to reduce hunger and drastically decline food intake.


Lifestyle


A high-fat diet means adios carbohydrate consumption! Forget the grains, fruit, and dairy products. This diet requires a strict dietary regimen which will test your compliance. Be prepared to alter your current dietary intake, as this diet may feel limited.


Who is it beneficial for?


As mentioned above, the Ketogenic Diet is beneficial for an array of individuals such as:


Weight loss


Are you ready to lose weight? If so, you may benefit from this high-fat diet. Since the 70's, the low fat, low-calorie diet was the recommended approach to weight loss, but now the Ketogenic Diet has been proven tosurpass this.


A meta-analysis compared a very-low-carb ketogenic diet to a low-fat diet for long-term weight loss. The study included thirteen studies consisting of 1,577 individuals. The results had found those who followed the very-low-carb Ketogenic Diet achieved greater reductions in body weight, TG, LDL, and HDL levels over aperiod for twelve months, as compared to those who consumed a low-fat diet.


A separate study compared weight loss in 322 obese individuals who were randomly assigned to either a low-carb, Mediterranean, or low-fat for two years. The study found weight loss to be remotely similar between the low-carb and Mediterranean group, but not enough to make a significant difference.11To conclude, the Ketogenic Diet should be individualized since many will not have the same outcomes.


Cardiovascular Disease


Do you have altered lab values such as LDL, HDL, TG, and cholesterol? If so, you should consider this high-fat diet. I understand many individuals are told not to followthe Ketogenic Diet when they are at risk for heart diseasedue to the dietary intake potentially causing anincrease in their lipid panel. However, consuming a high-fat diet has been beneficialas recent research has examined LDL particle size to have a stronger correlation with cardiovascular disease. Individuals with small dense LDL-P are at increased risk as compared to those with large buoyant LDL-P.


A study published in the Journal of Nutrition, found normal non-lipidemic men who had small dense LDL particles to have an increase in their particle size after consuming a high-fat diet for six weeks.


Acne


Do you suffer from acne? If so, there is emerging evidence which suggests a high-fat diet can be beneficial in treatment! Studies propose that a high sugar intake is implicated as the root cause of acne because it can stimulate insulin, androgen bioavailability (sex hormones) and insulin-like growth factor-1 activity.9High insulin levelsareknownto causeoily glands to stimulate.


For example, think of a typical American meal, such as a burger with French fries and a milkshake. A meal like this is high in carbohydrates causing an increase in blood sugar. Withhigh blood sugars,there is a high amount of insulin stimulated to bring these down. High insulin levels cause sebum oilto be released whichcauses blockage within our skin pores leading to acne to develop. As a nutritional intervention, it is suggested that the Ketogenic Diet to be beneficial as it does not cause high releases ofinsulin.


Cancer


Did you know cancer cells prefer glucose for growth, creation, energy production and transformation?Elevated glucose levels have been positively associated with poor prognosis in cancer patients.2 This is becausecancer cells use glucose and oxygen for fuel while producing lactic acid. This is problematic as normal cells undergo the same mechanism without the presence of oxygen. To combat this medical condition, it is suggested that this population should follow the Ketogenic Diet, as it forces the body to utilize ketones for energy instead of glucose. Elimination of carbohydrates will disable the opportunity for the virus to replicate.


Alzheimer's


Currently, there are 55 million Americans diagnosed with Alzheimer's disease.7 The ratehas been on the rise for several years, as research has suggested alink of withAmerican's adapting to more of a Westernized diet.Research has hypothesized that a high-fat and low-carbohydrate diet can reduceß-amyloid peptides, which isbelieved to be the etiology of Alzheimer's disease.


Diabetes Mellitus 2

For years, the best dietary regimen for diabetes has been carbohydrate counting or the diabetes exchange system.These dietary parameters are effective at reducing Hemoglobin A1c as well as blood glucose levels. However, for some people, the Ketogenic Diet can be more effective than these two nutrition interventions.


One study found that those who followed a very-low carbohydrate Ketogenic Diet for twelve months had greater reductions in HbA1c in addition to losing more weight and reducing medication as compared to those who followed a moderate carbohydrate, calorie-restricted, low fat diet.


Sports Performance


If you're an athlete, you've probably heard an athletic trainer emphasizing carbohydrates prior to and after workouts. However, what if you're interested in the Ketogenic Diet? Would this hurt your athletic performance...? Not so much. Research has compared high and low-carbohydrate diets and have observed no detrimental effects on aerobic exercise and resistance training. From studies thus far, they have observed a Ketogenic Diet to have more of a favorable effect on body composition when combined with resistance training.


Multiple Sclerosis


Are you someone, or do you know somebody who suffers from relapsing or remitting Multiple Sclerosis? If so, pay attention to emerging evidence regarding dietary treatment with the Ketogenic Diet. Although the evidence is new and has been limited on animal models, thus far scientists have suggested that this high-fat diet increases ATP production. ATP is a major function of the body whichpowers daily activities . Ever heard of these individuals fatiguing rather quickly… well the Ketogenic Diet can potentially improve these outcomes.


Overall thoughts


After reading the research,one would suggest the Ketogenic Diet to be impactful on multiple conditions. The diets proven efficacy is why its beneficial for you or someone you may know.Implementation of this diet should be individualized as this diet is NOT for everyone.


My Own Success


I myself have tried one of the forms of the ketogenic diet called carbohydrate cycling. I had two low carbohydrate days (under 20g) and one high refeed (150 g) day that followed. This method was maintainable and easy to follow as I did not feel limited with food choices. I also did not feel the need to supplement as I was still able to incorporate fruits, grains, and small dairy products when I had a those refeed days. With the diets proven efficacy,it is validated it can impactful on an array of individuals.So, go ahead, and give the diet a try if you believe this diet is the right fit for you.


References

1. AuweraIVder, Wera S, Leuven FV, Henderson ST. A ketogenic Diet reduces amyloid beta 40 and 42 in a mouse model of Alzheimer's disease. Nutrition and Metabolism. 2005;228(8):193-201. doi:10.1186/1743-7075-2-28.

2. Branco AF, Ferreira A, Simões RF, et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. http://onlinelibrary.wiley.com/doi/10.1111/eci.12591/abstract. Published February 15, 2016. Accessed April 6, 2018.

3. Bueno NB, Melo ISVD, Oliveira SLD, Ataide TDR. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 2013;110(07):1178-1187. doi:10.1017/s0007114513000548.

4. Butler N. Ketosis vs. Ketoacidosis: What's the Difference? https://www.healthline.com/health/ketosis-vs-ketoacidosis. Published February 15, 2018. Accessed May 2, 2018.

5. Jabekk PT, Moe IA, Meen HD, Tomten SE, Høstmark AT. Resistance training in overweight women on a ketogenic diet conserved lean body mass while reducing body fat. Nutrition & Metabolism. 2010;7(1):17. doi:10.1186/1743-7075-7-17.

6. Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. https://www.ncbi.nlm.nih.gov/pubmed/18175736. Published January 2008. Accessed April 4, 2018.

7. Latest Alzheimer's Facts and Figures. Latest Facts & Figures Report | Alzheimer's Association. https://www.alz.org/facts/. Published March 19, 2018.

8. Mawer R. The Ketogenic Diet 101: A Detailed Beginner's Guide. Healthline. https://www.healthline.com/nutrition/ketogenic-diet-101. Published June 17, 2017.

9. Paoli A, Rubini A, Volek JS, Grimaldi KA. Erratum: Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition. 2014;68(5):641-641. doi:10.1038/ejcn.2014.47.

10. Saslow LR, Daubenmier JJ, Moskowitz JT, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition & Diabetes. 2017;7(12). doi:10.1038/s41387-017-0006-9.

11. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. http://www.ncbi.nlm.nih.gov/pubmed/18635428. Published July 17, 2008. Accessed April 5, 2018.

12. Sharman MJ, Kraemer WJ, Love DM, et al. A Ketogenic Diet Favorably Affects Serum Biomarkers for Cardiovascular Disease in Normal-Weight Men. The Journal of Nutrition. 2002;132(7):1879-1885. doi:10.1093/jn/132.7.1879.

13. Storoni M, Plant GT. The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis. Multiple Sclerosis International. 2015;2015:1-9. doi:10.1155/2015/681289.

Autoimmune Diseases

PCOS: The Struggle is Real
PCOS PCOS: The Struggle is Real
Elizabeth Spies
SFA Dietetic Intern 2018

Despite the thousands of miraculous claims posted all over Facebook, weight loss is not easy. It's even harder if you have PCOS. PCOS, or polycystic ovarian syndrome is an extremely frustrating disorder that causes weight gain, hair growth, irregular periods and in many cases, infertility (9,11).


If you have recently been diagnosed with PCOS, it's likely that you might be finding yourself overwhelmed as you try to learn more about this disorder. Your doctor has probably told you, "lose weight, go on a diet, and get some exercise." They might have prescribed a new birth control for you to try, or they might have even given you a prescription for Metformin. It might seem easy enough at first, but you may find yourself wondering, "what kind of diet should I go on? What kind of exercise is best for me? How can I possibly lose weight when the pounds seem to just pile on?" If you are hoping to try for a baby soon, the thought of taking birth control might be frustrating. You might even discover that while effective, Metformin can have rather frustrating symptoms of its own.


After my own PCOS diagnoses, I spent a lot of time frustrated, and unsure of my next steps. I decided to compile research from reputable sources so that I could find the best way to treat my symptoms. After researching, I decided to create this blog to help other women with PCOS. In this blog, I have described specific diet approaches, safe and effective supplements and medications, and to discuss the unseen symptoms such as depression and infertility.


What diet should I follow?


There is probably no topic as hotly debated as nutrition. Some people will scream "no carbs! High fat! Keto!" others will cry, "Go vegan! No dairy!", and still others will recommend a variety of fad diets that have little to no scientific research. After studying the research done on a few diet approaches, there are three diets that really stand out. Remember, there is no one size fits all diet, and it is important to determine how each approach makes you feel.


KETO

The ketogenic diet has become wildly popular in recent years. So much so, that it's likely everyone from your doctor to your mailman has told you about it! Women with PCOS who follow the ketogenic diet (limiting carbohydrates to 20 grams or less per day) have been shown to see a body weight change as high as 12%. This diet has also been shown to improve blood insulin and testosterone levels, and even promote fertility (3). It is recommended that you start the keto diet at a low level of carbohydrates, and slowly add in more carbs until you find the level that works best for your body.


While this diet can be a powerful tool in treating PCOS symptoms, it is important to note that this approach requires a drastic lifestyle change , and ketone levels must be monitored to make sure you are staying in ketosis.


LOW CARB NON KETO


Elevated insulin levels in the body can worsen PCOS symptoms because testosterone synthesis is increased. Because of this, it has been thought that low carbohydrate diets can help to reduce circulating insulin levels. Studies have shown that a very modest reduction in carbohydrates can have a large impact on blood insulin and testosterone levels. The standard American diet suggests about 55% of our daily calories should come from carbohydrates, but dropping carbohydrates down to 41% has been shown to increase insulin sensitivity by 22% (5). It is important to note that every person is different, and even insulin resistant women with PCOS may tolerate varying amounts of carbohydrates.


DASH


The DASH diet was created to control blood pressure, but studies have shown that this diet can have a positive impact on insulin resistance. As insulin resistance plays a huge role in the symptoms of PCOS, treating this is very important. This diet focuses on fruits and vegetables, whole grains, low-fat dairy, fish, chicken and lean meats (1). The DASH diet will still require a rather large lifestyle change, but this approach is much less restrictive than diets such as the ketogenic diet, and might be easier to maintain.


A low carb non ketogenic diet would require you to consider your carbohydrate intake a bit more than the average person, but this diet would not be extremely hard to maintain.


What supplements should I take?


Vitamin D & Calcium


We all know that calcium and vitamin D are important for strong bones and healthy bodies, but there is actually a link between these nutrients and PCOS! When Vitamin D and Calcium are taken in conjunction with Metformin, a positive impact can be seen in both BMI and fertility. When compared to Metformin alone, there is a significant advantage in adding these nutrients to your daily regimen (6). As with any new supplement, be sure to consult your doctor if you are considering supplementing Vitamin D and Calcium.


Myoinositol


Myoinositol is a part of the vitamin B complex, and can be purchased at any pharmacy or health food store for a reasonable price. In women with PCOS, Myoinositol has been shown to increase insulin sensitivity. Myoinositol has also been shown to induce a regular menstrual cycle, improve fertility, reduce weight, and lower levels of hunger inducing hormones (7).


What's the deal with Metformin?


Metformin is a drug typically given to patients with diabetes, but it has been proven to be very effective in treating insulin resistance in women with PCOS. Metformin has been shown to promote ovulation and reduce insulin concentration (8).


Metformin is effective at what it does, but it is well known to cause nausea, vomiting and diarrhea. This can make it hard to adjust to this medication. It is recommended that Metformin be taken in conjunction with lifestyle changes, rather than as a long term solution to PCOS symptoms (8) . If you have been prescribed Metformin, be sure to discuss any symptoms or discomfort with your physician.

What kind of exercise should I do?


Being active is important for everyone, regardless of disorders or health status. Initially, just taking the first steps to get moving will be so beneficial. Aim for 30-45 minutes of activities like walking, swimming, or gardening a day, or about 150 minutes per week (4). Resistance training has also been shown to be very effective for women with PCOS. Seeking a personal trainer at your local gym is a great way to learn about lifting weights safely.

What about fertility?


When trying to conceive, PCOS can throw a serious wrench in your plans. PCOS can cause ovulation to be sporadic, or even nonexistent. Luckily as we discussed above, there are diets and supplements that can help improve fertility. A weight loss of about 5-10% of overall bodyweight can greatly improve your chances of getting pregnant (4).


If lifestyle changes and weight loss show no improvement, your doctor is likely to prescribe a fertility drug such as Clomiphene Citrate. This drug can help to encourage normal menstruation, and has a relatively low incidence of side effects (4).


Is there a connection with depression?


Women who are diagnosed with PCOS are more likely to experience depression. Whether this is due to hormonal imbalance, or to the negative state of health associated with the disorder, the symptoms of depression can be hard to manage. Studies show that even without any weight loss, following a PCOS diet plan and exercising can help to alleviate symptoms of depression (10).


The silver lining


Despite how frustrating, and hopeless you may feel after your PCOS diagnoses, it is important to know that you are not alone. Many women struggle with PCOS, and it is possible to manage your symptoms with some simple lifestyle modifications. Talk with your doctor, schedule a meeting with a dietitian, and always remember to love yourself every step of the way.

Allergy / Intolerances

Do You Have Histamine Intolerance?
Histamine Intolerance

Do You Have Histamine Intolerance?

By Heather Gallant

Dietetic Intern at Stephen F. Austin State University

Have you ever experienced headaches, flushing of the skin, or abnormally rapid heart rate when you eat certain foods? Did you get allergy tested and receive a negative result? If so, then you might have histamine intolerance. Most people have heard of intolerances to lactose and gluten, but did you know you can be intolerant to histamine? In fact, about 1% of the population has histamine intolerance.

What is Histamine?

Histamine is a type of biogenic amine that is made from the amino acid histidine. It is produced by mast cells, white blood cells, platelets, and histamine neurons and is stored in cells6. Histamine is released when stimulated and acts as a trigger for many mechanisms in the body. It can cause muscle contraction, dilatation of blood vessels, alterations of blood pressure, and irregular heartbeat6. In addition, histamine is known to play various roles in the release of neurotransmitters and gastric acid as well as can modify the functioning of the immune system6. There are two enzymes that play a role in the metabolism of histamine-diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT)6. DAO is responsible for breaking down histamine when the body releases it after histamine-rich food is consumed while HNMT inactivates histamine in cells6. For this blog post, we are going to focus on the DAO enzyme because of its role in metabolizing histamine in the body from food.

Histamine Formula

Histamine Intolerance

Histamine intolerance simply refers to an imbalance between the build up and breakdown of histamine. Histamine from food can be quickly eliminated from the body with the help of the DAO enzyme but when breakdown is impaired, the DAO enzyme activity decreases and insufficiently does its job of breaking down histamine. This causes histamine to excessively collect in the body and when this happens, a person can experience various symptoms, which we will discuss later on.

There are various possible mechanisms that can be the cause of histamine intolerance. It can develop through both increased accumulation of histamine and impaired histamine breakdown. Increased accumulation of histamine occurs by the overproduction of it caused by allergies, too many mast cells in your body, bacteria, gastrointestinal bleeding, or increased consumption of histamine by food. The main cause of histamine intolerance has to do with the breakdown of histamine. The DAO enzyme is responsible for breaking down histamine, but it can become impaired due to genetics and lack of enzyme production due to gastrointestinal diseases. Additionally, alcohol, medications and other biogenic amines can impair the breakdown of histamine by DAO.

Food Allergy and Food Intolerance

Before we get any further, I think it's important to explain the difference between food allergy and food intolerance. Food allergy causes a reaction in the immune system that affects various organs in the body. Food intolerance, also known as hypersensitivity, doesn't cause an immune response and is associated with the body's inability to digest a certain food. Food intolerance accounts for 15-20% of all reactions to food while the prevalence of a food allergy accounts for only 2-5% in adults and 5-10% in young children. Food allergies are classified as either immediate or delayed and cause an immune response. It is important to note that some food intolerances can be classified as a delayed food allergy.

Histamine intolerance is called a pseudoallergy, meaning it creates an allergic-like reaction but not because of activation of the immune system, but by impaired food digestion. Some people with symptoms of histamine intolerance might associate them to a food allergy when in fact, it's not because the immune system isn't involved. That is why people with this intolerance receive negative results from a food allergy test. It's tricky because food intolerance can cause some of the same signs and symptoms as a food allergy.

Symptoms of Histamine Intolerance

When people have reduced DAO activity, even small amounts of histamine can lead to symptoms, which can be expressed in multiple organs and systems of the body including skin, gastrointestinal tract, heart, lungs, and brain. Because of these common symptoms, the presence of histamine intolerance is frequently overlooked, or its symptoms are misinterpreted.

Common Symptoms of Histamine Intolerance

  • Hypotension
  • Wheezing
  • Headache
  • Irregular heartbeat
  • Diarrhea
  • Itchy rashes on skin
  • Nasal congestion
  • Dizziness
  • Nausea
  • Abnormally rapid heart beat

Histamine Intolerance and Food

Histamine is found in various amounts of different types of foods and their presence increases as the food ages. In addition to the amount of histamine in foods, the presence of other biogenic amines like tyramine and sulfites, the intake of alcohol, and DAO-blocking drugs are factors that increases reactions to the ingested food. Some release histamine from tissue mast cells. Listed below are foods that should be avoided if you have histamine intolerance.

Foods High in Histamine

  • Aged cheese
  • Vegetables: sauerkraut, spinach, eggplant, tomatoes
  • Fish: mackerel, herring, sardines, tuna
  • Cured and processed meats: salami, ham, sausage, hot dogs, bacon
  • Alcohol and especially fermented alcoholic drinks: red wine, champagne, fermented beers
  • Leftovers

Foods That Release Histamine When Eaten

  • Citrus fruits: papaya, strawberries, pineapple
  • Nuts and peanuts
  • Egg whites
  • Chocolate
  • Certain spices and additives

Testing and Treatment

You should first get allergy tested to rule out a food allergy. If the results come back negative, then you should test for histamine intolerance. The diagnosis is determined by the presence of at least two symptoms and an improvement of symptoms from a histamine-free diet. It is recommended to completely eliminate histamine from the diet for 4 weeks (about 30 days) and then reintroduce histamine foods one at a time to see how you react. I suggest keeping a food journal while you do this elimination diet to keep track of your symptoms as you slowly add in different foods. You may find that you tolerate some foods better than others. You can also get blood tested to determine your histamine and DAO levels.

The best thing you can do to treat histamine intolerance is to figure out the root cause of it. Talk to your doctor about the medications you are on and see if any of them are causing this intolerance. Work on healing your gut and look at other biogenic amines in the food as well that may be contributing to symptoms. Remove alcohol from your diet-most people know they have a problem with alcohol if they get a red, flushed face when consuming it. If you find that eliminating all histamine-rich foods works for you, then you can continue doing so. You can also take a DAO supplement that can help breakdown the histamine you do consume, but speak with your doctor first before taking it. Histamine intolerance is an individualized process of figuring out what foods your body can and can't tolerate.

References

1. Bieganski, T., Kusche, J., Lorenz, W., Hesterberg, R., Stahlknecht, C. D., & Feussner, K.D. (1983). Distribution and properties of human intestinal diamine oxidase and its relevance for the histamine catabolism. Biochimica et Biophysica Acta (BBA)- General Subjects, 756(2), 196-203.

2. Bodmer, S., Imark, C., & Kneubühl, M. (1999). Biogenic amines in foods: histamine and food processing. Inflammation Research, 48(6), 296-300.

3. De Martino, B. G. C., De Martino, S., & Tritto, G. (2000). Histamine plasma levels and elimination diet in chronic idiopathic urticaria. European Journal of Clinical Nutrition, 54(2), 155.

4. Krabbe, A. A., & Olesen, J. (1980). Headache provocation by continuous intravenous infusion of histamine: clinical results and receptor mechanisms. Pain, 8(2), 253-259.

5. Maintz, L., Bieber, T., & Novak, N. (2006). Histamine intolerance in clinical practice. Dtsch Arztebl, 103(51-52), 3477-83.

6. Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American Journal of Clinical Nutrition, 85(5), 1185-1196.

7. Mušic, E., Korošec, P., Šilar, M., Adamic, K., Košnik, M., & Rijavec, M. (2013). Serum diamine oxidase activity as a diagnostic test for histamine intolerance. Wiener klinische Wochenschrift, 125(9-10), 239-243.

8. Raithel, M., Küfner, M., Ulrich, P., & Hahn, E. G. (1999). The involvement of the histamine degradation pathway by diamine oxidase in manifest gastrointestinal allergies. Inflammation Research, 48(13), 75-76.

9. Sattler, J., Hesterberg, R., Lorenz, W., Schmidt, U., Crombach, M., & Stahlknecht, C. D. (1985). Inhibition of human and canine diamine oxidase by drugs used in an intensive care unit: relevance for clinical side effects?. Inflammation Research, 16(3), 91-94.

10. Wantke, F., Götz, M., & Jarisch, R. (1993). Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronical headaches. Clinical and Experimental Allergy, 23(12), 982-985.

11. Yan, L., Galinsky, R. E., Bernstein, J. A., Liggett, S. B., & Weinshilboum, R. M. (2000). Histamine N-methyltransferase pharmacogenetics: association of a common functional polymorphism with asthma. Pharmacogenetics and Genomics, 10(3), 261-266.

12. Zopf, Y., Hahn, E. G., Raithel, M., Baenkler, H. W., & Silbermann, A. (2009). The differential diagnosis of food intolerance. Deutsches Ärzteblatt International, 106(21), 359.

Beverages

Sparkling Water: Better Bubbly Beverage or Fizzy Fraud?
Sparkling Water Sparkling Water: Better Bubbly Beverage or Fizzy Fraud?
Courtney High
SFA Dietetic Intern 2018

So, you want to ditch your daily Dr. Peppers or Cokes, but love that fizzy, bubbly sensation. In an effort to have your cake (or fizz) and eat (or drink) it too, you've switched to sparkling water as a healthy alternative. I mean, all the cool kids are reaching for La Croix now, right? It's advertised as zero everything- zero sweeteners, zero calories, and zero sodium, so it's already got the sugary sodas beat. But are there any negative consequences to that carbonation you crave? Let's look at what sparkling water really is and what the science says about the effects of the carbonation on your health.


Background on the Bubbles

Where did carbonated water come from anyway? While natural sparkling mineral water from springs has been consumed for centuries and praised for its alleged capability of relieving gastrointestinal symptoms, the man-made version came about in the late 1700's by Joseph Priestley. The English scientist had suspended water above a vat of fermenting beer where the carbon dioxide produced from the fermentation process passively dissolved in the water.1 People found the effervescence pleasing; a man named J. Schweppe from Switzerland took the idea and ran with it, creating the first commercial production of the bottled beverage, which is the Schweepes beverage brand that is still around today.


So, what is it about that fizzy sensation in our mouths that we love so much? While many people think that it's caused by the physical property of the little gas bubbles popping in our mouths, the sensation is actually due to a chemical reaction where the carbon dioxide is converted to carbonic acid. This activates sensory receptors for pain that are in our mouths, which signals oral irritation, similar to what happens when we eat spicy foods.3 While it's still not completely understood what makes us crave the carbonation, some think that it's connected to our senses for detecting spoiling foods or even a desire to "live life on the edge."


It's important to recognize that there are different types of carbonated water, including:

  • Sparkling mineral water
  • Selter water, fizzy water, or bubbly water,
  • Club soda, and
  • Tonic water


Sparkling Mineral Water


The first, and probably the best option, is sparkling mineral water, which has minerals such as magnesium, potassium, and calcium that occur naturally from the source. It can be uncarbonated or contain gases that are present in the mineral spring water, which creates sparkling water. However, many mineral water companies add carbon dioxide to the water to increase the bubbles, as not all mineral water is naturally sparkling. Examples of sparkling mineral water would be San Pellegrino, Perrier, or Topo Chico.


Seltzer Water


The next-best option is man-made sparkling water, as known as seltzer water. It is a less expensive alternative to sparkling mineral water, as it is just water that has been injected with carbon dioxide. It may or may not have added minerals or flavors.6 This is where the famous La Croix drinks fit in, as well as many other bottled and canned sparkling waters that have only natural flavors in the ingredients along with the carbonated water. Often times, the fruity natural flavors that are added to these drinks are listed in the ingredients as simply "natural flavor." The La Croix company describes that their natural flavors are "derived from the natural essence oils extracted from the named fruit used in each of our LaCroix flavors."


Club Soda


The third option is club soda, which has more added to it compared to seltzer water. It usually contains mineral-like ingredients, such as sodium bicarbonate, sodium citrate, potassium sulfate and disodium phosphate. For those on a low-sodium diet, it is probably best to avoid club soda and opt for seltzer water, which is typically sodium-free.


Tonic Water


The last option that is often associated with sparkling water is tonic water. This is carbonated water that has a bitter compound called quinine added to it, as well as high-fructose corn syrup or sugar and other flavorings. While it is often lumped in with carbonated water, it is not the best option due to the added sweeteners and ingredients.


Bone Health

While bone health is a common concern with the topic of carbonated beverages, research suggests that the carbonation is not the culprit when considering the association of weak bones and carbonated drinks. One study looked at the effects of carbonation and bone mineral density, which is the strength of bones as determined by the amount of calcium and other minerals in the bones. A low bone mineral density is an indicator for increased risk of osteoporosis, which is when bones become brittle, fragile and break more easily. The study concluded that there is no negative link with bone mineral density and the consumption of non-cola carbonated beverages. Another study looking at the ability of bones to rebuild in older women found that after eight weeks of drinking one liter of carbonated mineral water each day, there was no difference in the continual bone rebuilding process in the women drinking the carbonated water compared to those drinking the uncarbonated version. So, while there is evidence that other ingredients10 in carbonated dark-colored sodas, such as phosphoric acid, are harmful for our bones, carbonation is off the hook, according to current research.


Dental Health


Tooth decay is another health concern with carbonated water. As previously mentioned, carbon dioxide dissolved in water does form carbonic acid, which makes the water slightly more acidic. Continued contact with foods or drinks that have higher acidity11 can be damaging for tooth enamel, resulting in tooth decay. However, a study looking at carbonated mineral water in relation to dental erosion found that while sparkling mineral water produces slightly more erosion than still mineral water, the level is still very low. The pH of the sparkling mineral waters used in the study were 5-6, compared to a pH of 7-8 for the still mineral water. It was concluded that carbonation in sparkling water is not an important factor in terms of risk for dental erosion, but rather other acids and ingredients such as sugar that are of greater importance when looking at a drink's potential for tooth decay.12 In contrast, another study looking at the effect of carbonation on etched or sealed enamel, which is common with dental or orthodontal work, concluded that carbonated water resulted in a decrease in the hardness of enamel that has been etched for adhesion of dental appliances. This is important to consider if you have temporary or permanent dental appliances, such as braces or a permanent retainer.13 With both of these studies, it is important to consider that they were both done by soaking teeth in solutions; therefore, the ability of the mouth's saliva to counteract the acidity of the carbonation by saliva buffering,14 which could decrease the effects of erosion, was not taken into account.


While these research conclusions are somewhat conflicting, carbonated water has significantly less effect on tooth erosion compared to flavored beverages or sodas. In fact, in the study that was first mentioned, it was found that carbonated water was 100 times less damaging than sugar-sweetened sodas or orange juice.12 The general consensus among dental professionals is that carbonated water is a far better alternative to these highly acidic and sweetened beverages; if dental damage is a concern, have the sparkling beverage with a meal or swish with regular water after drinking the bubbly version.


Digestive Health


How carbonated water affects digestive health is a topic with many claimed pros and cons. One study looked at how carbonated water affected gastric activity in healthy young women. The participants consumed either carbonated water, non-carbonated water, or no water just before eating a meal to investigate the effects on fullness and gastric activity. The conclusion was that carbonated water may cause a short-term increase in satiety.17 This could potentially be helpful for those looking to avoid overeating, as long as they are not filling up only on the beverage, which could lead to hunger and snacking soon after meals.


Another study looked at how carbonated water effected dyspepsia and constipation. Dyspepsia18 is commonly called indigestion and includes symptoms of nausea, bloating, and early fullness when eating. It was concluded that symptoms of dyspepsia and constipation were reduced in the participants after fifteen days of consuming carbonated water. There was an increase in belching but a decrease in early satiety, which is possibly related to decreased pressure in the stomach from air because of the belching.19 This could be helpful for those who are experiencing premature satiety at meals or uncomfortable fullness after meals due to indigestion. However, it should be noted that people with a history of acid reflux or other gastrointestinal issues were not included in this study. While acid reflux and/or heartburn are often associated with dyspepsia,18 it is a different issue and was not investigated in this research.


While it is often recommended to avoid carbonated beverages to help relieve symptoms of acid reflux or GERD (gastroesophageal reflux disease), there is little scientific evidence behind this advice. In a systematic review evaluating the effects of carbonated beverages on GERD, it was found that there are few studies specifically evaluating the relationship of carbonated beverages and acid reflux or GERD symptoms. It was concluded that existing research does not currently support a strong relationship between carbonated beverages and GERD.1 Despite this lack of scientific evidence, anecdotal and clinical evidence cannot be ignored- it is important that those suffering from GERD or other GI issues monitor their personal symptoms caused by carbonated water to determine if carbonated water is a trigger.


Final Thoughts - Where to go from here?


So, there you have it… a glimpse at the science behind the sparkle. Like many items, there's research supporting both sides of the story. What you make of it is up to you. In addition to considering the research, it's important to take into account how your body feels when you consume this beverage. If you have digestive issues, does it affect your symptoms? Do you notice any other unwanted symptoms when you sip this effervescent liquid? Overall, carbonated water is going to be a better option than sugar-sweetened beverages. Just like all things, consuming it in moderation will probably not lead to a negative downward spiral in your health. However, consuming it in excess (such as in place of regular water all the time) is probably not a good idea. I, for one, will continue to enjoy it here and there, such as a couple a week or so, unless further studies convince me otherwise. What you choose is up to you- are you a believer in these bubbly beverages or will you pass on this fizzy fad drink?


References

1. Johnson T, Gerson L, Hershcovici, T, Stave, C, Fass, R. Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2010;31(6):607-614. doi:10.1111/j.1365-2036.2010.04232.x. Accessed April 12, 2018.

2. Pouderoux P, Friedman N, Shirazi P, et al. Effect of Carbonated Water on Gastric Emptying and Intragastric Meal Distribution. Dig Dis Sci. 1997;42(1):34-39. doi:https://doi-org.steenproxy.sfasu.edu/10.1023/A:1018820718313. Accessed April 9, 2018.

3. Dessirier J-M, Simons CT, Carstens MI, O'Mahony M, Carstens E. Psychophysical and Neurobiological Evidence that the Oral Sensation Elicited by Carbonated Water is of Chemogenic Origin. Chem Senses. 2000;25(3):277-284. doi:10.1093/chemse/25.3.277. Accessed April 10, 2018.

4. Lecher C. FYI: Why Do Humans Like Fizzy Drinks? popscience.com. https://www.popsci.com/science/article/2013-07/fyi-carbonated-water-addictive.Accessed April 2018.

5. Spritzler F. Carbonated (Sparkling) Water: Good or Bad? healthline.com. https://www.healthline.com/nutrition/carbonated-water-good-or-bad. Published June 18, 2016. Accessed April 2018.

6. Axe J. Is Sparkling Water Good for You? Benefits and Dangers of Carbonated Water. draxe.com. https://draxe.com/sparkling-water/. Accessed April 2018.

7. LaCroix Nutritional FAQs. lacroixwater.com. http://www.lacroixwater.com/nutritional-faqs/.Accessed April 2018.

8. Tucker KL, Morita K, Qiao N, Hannan MT, Cupples A, Kiel DP. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr. 2006;84(4):936-942. doi:10.1093/ajcn/84.4.936. Accessed April 10, 2018.

9. Schoppen S, Pérez-Granados AM, Carbajal N, De La Piedra C, Pilar Vaquero M. Bone remodelling is not affected by consumption of a sodium-rich carbonated mineral water in healthy postmenopausal women. Br J Nutr. 2018;93(3):339-344. doi:10.1079/BJN20041332. Accessed April 10, 2018.

10. Brown S. Say "so long" to soda for better bone health. betterbones.com. https://www.betterbones.com/bone-nutrition/so-long-to-soda/. Published July 18, 2011. Accessed April 2018.

11. Foods and Drinks That Cause Acid Erosion. pronamel.us. https://www.pronamel.us/tooth-erosion/causes-of-acid-erosion/. Accessed April 2018.

12. Parry J, Shaw L, Arnaud M, Smith AJ. Investigation of mineral waters and soft drinks in relation to dental erosion. J Oral Rehabil. 2001;28:766-772. https://sfasu-illiad-oclc-org.steenproxy.sfasu.edu/illiad/illiad.dll?Action=10&Form=75&Value=149341. Accessed April 10, 2018.

13. Ryu H-K, Kim Y, Heo S-S, Kim S-C. Effect of carbonated water manufactured by a soda carbonator on etched or sealed enamel. Korean J Orthod. 2018;48(1):48-56. doi:10.4041/kjod.2018.48.1.48. Accessed April 11, 2018.

14. How Saliva Buffers Acids. dentalacademyofce.com. https://www.dentalacademyofce.com/courses/1417/HTML/pwd10_section_7.htm. Accessed April 2018.

15. Hammond C. Is Sparkling Water Really Bad for You? bbc.com. http://www.bbc.com/future/story/20150911-is-sparkling-water-really-bad-for-you. Published September 14, 2015. Accessed April 2018.

16. Khazan O. The Sad Truth About Seltzer. theatlantic.com. https://www.theatlantic.com/health/archive/2016/02/the-sad-truth-about-seltzer/433947/. Published February 1, 2016. Accessed April 2018.

17. Wakisaka S, Nagai H, Mura E, Matsumoto T, Moritani T, Nagai N. The Effects of Carbonated Water upon Gastric and Cardiac Activities and Fullness in Healthy Young Women. J Nutr Sci Vitaminol. 2012;58:333-338. doi:https://doi.org/10.3177/jnsv.58.333. Accessed April 10, 2018.

18. Axe J. Dyspepsia Signs & Symptoms + 8 Natural Remedies. draxe.com. https://draxe.com/dyspepsia/. Accessed April 2018.

19. Cuomo R, Grasso R, Sarnelli G, et al. Effects of carbonated water on functional dyspepsia and constipation. Eur J Gastroenterol Hepatol. 2002;14(9):991-999. https://sfasu-illiad-oclc-org.steenproxy.sfasu.edu/illiad/illiad.dll?Action=10&Form=75&Value=149342. Accessed April 10, 2018.


Is Your Coffee Obsession Healthy? Maybe.
Coffee Blog

Is Your Coffee Obsession Healthy? Maybe.

By Author Name

Dietetic Intern at Stephen F. Austin State University

Most Americans start the day with a cup of coffee, and we aren't alone! In fact, roughly 80% of the adult population worldwide consumes coffee on a regular basis (Komes & Busic, 2014). For most of us, coffee is our major source of caffeine to help us power through the day. However, lately I have heard several of my friends on social media and in conversation mention that they are trying to stop drinking coffee. Some of my friends have even tried replacing their morning cup of joe with warm, lemon water. But, why? Any time I ask for a reason, they always just simply say, "because I've always heard coffee isn't good for you." As an avid coffee drinker, I have decided to make it a personal mission to debunk the myths and spread knowledge I have learned through my own obsessive research about the true nature of coffee and its perceived health effects.

Coffee has been recognized for its various health benefits for over 1000 years! As early as fourth century BC, coffee was used as a mood stabilizer and often even given as a prescription for various illnesses (Bizzo, Farah, Kemp, Scancetti, 2015). Coffee is a blend of many different bioactive compounds that have varying effects on the body.

What are these bioactive compounds?

First and foremost, caffeine. Caffeine is the most well-known compound found in coffee, and is also the reason most of us drink this delicious brew in the first place. Caffeine is a heat-stable alkaloid that stimulates the central nervous system, acting as an adenosine-receptor antagonist (Bae, Park, Im, Song, 2014). In simple terms, this means that caffeine binds to certain receptors in the brain, blocking the effects of adenosine. Adenosine is a compound that signals to our brain that it is time for sleep. When caffeine binds instead of adenosine, we feel energized and ready to take on the day! Caffeine also functions to enhance mood, improve exercise performance, and has even shown to decrease tremors in individuals with Parkinson's disease (Esquivel & Jimenez, 2012).

You might also be surprised to find that coffee is actually full of antioxidants! In some countries, coffee is actually the major source of antioxidants for the general population (Komes & Busic, 2014). A class of phenolic compounds called chlorogenic acids are the main bioactive components responsible for coffee's abundant antioxidant activity. Several studies have reported that chlorogenic acids found in coffee are greatly associated with a decreased risk of diabetes, Parkinson's, Alzheimer's Disease, and even liver cancer (Komes & Busic, 2014). Over the years, researchers have also found that brewed coffee demonstrates a significant oxygen scavenging ability. However, longer roasting periods can result in a total loss of chlorogenic acid, and overall antioxidant activity. Therefore, medium-roasted coffee tends to have the highest oxygen scavenging ability, or the highest concentration of antioxidants (Komes & Busic, 2014).

Trigonelline is an alkaloid compound found in coffee and is largely responsible for coffee's bitter taste. Trigonelline has been shown to regenerate dendrites and axons in the brain, which may help to improve memory (Farah, 2012). Through the brewing process, trigonelline is converted to nicotinic acid, or a B-vitamin known as Niacin. Essentially, niacin helps the body to utilize the energy in our food (Komes & Busic, 2014).

Cafestol and Kahweol are also major bioactive compounds in coffee. Both compounds are diterpenes, which have shown to be help protect against liver damage as well as prevent premature cell death resulting from neurotoxins produced from Parkinson's disease (Bae, et al. 2014; Kim & Lee, 2015)

Coffee has also shown to be neuroprotective. Researchers believe that this is due partly to caffeine and caffeic acid. Certain studies have found that caffeic acid protects against amyloid ß induced neurotoxicity and tau phosphorylation, which means that coffee can possibly decrease the risk of Alzheimer's disease and help to support cognition through old age (Kim & Lee, 2015).

All of these health benefits sound amazing, right? Does all of this prove that coffee is in fact good for everyone? Well, no. Of course not. That would be too simple. Whether or not you experience positive effects from coffee all depends on how your body processes it!

The caffeine in coffee is metabolized by an enzyme in the liver, resulting from the gene CYP1A. Variations in the CYP1A gene affect how quickly you metabolize caffeine. Do you ever wonder why some people are anxious and jittery after just one cup of coffee, while others still struggle to keep their eyes open after 3 or 4 cups? Well, the answer lies in your genetics! Variations in the CYP1A gene place each of us in one of two groups: "fast" metabolizers vs "slow" metabolizers. Individuals with the "fast" CYP1A gene metabolize coffee roughly 4 times faster than individuals with the "slow" metabolizing variant (O'Connor, 2016). So how does that affect the health benefits mentioned previously? Well, several research studies have found that for "slow" metabolizers, many of the perceived health benefits of coffee consumption seem to actually have an opposite effect. Moderate to high coffee consumption among "slow" metabolizers has been associated with a higher risk of heart attack, heart disease, hypertension, and a lack of "protective" effects against some cancers when compared to those with the "fast" metabolizing variation of CYP1A (Cornelis, et al. 2006; Kressor, 2016).

Approximately 50% of the population has the genotype to be considered "slow" metabolizers. With a country divided, this could definitely explain the immense amount of conflicting data surrounding coffee consumption related to overall health. Obviously, not all of us are able to be tested for which CYP1A genotype we have. My best advice? Listen to your body! If you think you are a "fast" metabolizer, go ahead and stumble out of bed each morning to pour yourself a big cup of warm, delicious coffee. If you aren't sure which group you fall into, just be sure to listen to your body! If you don't feel like you tolerate coffee very well, then it might be better to err on the side of caution and minimize your caffeine intake.

References:

1. Bae, J., Park, J., Im, S., & Song, D. (2014). Coffee and health. Integrative Medicine Research, 3(4), 189-191. https://doi.org/10.1016/j.imr.2014.08.002

2. Cornelis, M. C., El-Sohemy, A., Kabagambe, E. K., & Campos, H. (2006). Coffee, CYP1A2 Genotype, and Risk of Myocardial Infarction. Jama,295(10), 1135. doi:10.1001/jama.295.10.1135

3. Esquivel, P., & Jiménez, V. M. (2012). Functional properties of coffee and coffee by-products ?. FRIN, 46(2), 488-495. https://doi.org/10.1016/j.foodres.2011.05.028

4. Farah, A. (2012). Coffee: Emerging Health Effects and Disease Prevention, First Edition. Y.F. Chu (Ed.) Blackwell Publishing Ltd.

5. Kim, J., & Lee, K. W. (2015). Neuroprotective, 423-427. https://doi.org/10.1016/B978-0-12-409517-5.00046-2

6. Komes, D., & Busic, A. (2014). Antioxidants in Coffee, 25-32. https://doi.org/10.1016/B978-0-12-404738-9.00003-9

7. Kresser, C. (2016, December 15). Coffee is good for you-unless it's not! Retrieved April 21, 2017, from https://chriskresser.com/coffee-is-good-for-you-unless-its-not/

8. Letícia, M., Bizzo, G., Farah, A., & Kemp, J. A. (2015). Highlights in the History of Coffee Science Related to Health. Coffee in Health and Disease Prevention. Elsevier Inc. https://doi.org/10.1016/B978-0-12-409517-5.00002-4

9. O'Connor, A. (2016, July 12). For Coffee Drinkers, the Buzz May Be in Your Genes. Retrieved April 21, 2017, from https://well.blogs.nytimes.com/2016/07/12/for-coffee-drinkers-the-buzz-may-be-in-your-genes/?_r=0

Diabetes

Apple Cider Vinegar, Friend or Foe for Diabetes? - Lindsay Hetzel
Apple Cider Vinegar

Apple Cider Vinegar, Friend or Foe for Diabetes?

By Lindsay Hetzel
April 23, 2017

Dietetic Intern at Stephen F. Austin State University

Introduction

Apple cider vinegar has been on the forefront of discussion; everywhere we look there is chatter about how to take apple cider vinegar, what the benefits are, and who benefits from taking it. Researchers have discovered that the acetic acid in apple cider vinegar has been found to suppress body fat accumulation, leading scientists to find out what the other benefits the vinegar could provide (Kondo et al., 2009). From diving in to research to find these answers I have found that people with type II diabetes, obese individuals wanting to lose weight, and individuals with high cholesterol appear to benefit the most from ingesting apple cider vinegar. For the purpose of this article, individuals with diabetes will be the focus.


Vinegar has a long history, dating back to Babylonia 5,000 BC (Kondo et al., 2009). There are various types of vinegar consumed today, apple cider vinegar, rice wine vinegar, red and white wine vinegar, and balsamic vinegar used for seasoning and preserving food. The main component of vinegar is acetic acid derived from fermentation giving vinegar its distinctive taste and pungent smell (Budak et al., 2014).

Individuals with type II diabetes mellitus (T2DM) are growing in population due to rising obesity, diet choices, and genetics. There are an estimated 171 million people worldwide suffering with T2DM, and that number is expected to increase to 366 million by 2030 (Hlebowicz et al., 2007). Insulin resistance is a condition where the cells in our body do not accept the insulin our pancreas creates for us to utilize the glucose in our bloodstream, thus our cells become insulin resistant.


Experts conducting research have agreed on the dose on 30 ml of apple cider vinegar to be sufficient to see results (White et al., 2007) (Kondo et al., 2009) (Mitrou et al., 2015). A study of obese Japanese individuals were split in to 3 groups consuming 30 ml, 15 ml, or 0 ml of apple cider vinegar to identify if the effects of vinegar intake on the reduction of body fat (Kondo et al., 2009). After 12 weeks, both of the vinegar groups lowered their body weight, BMI, abdominal fat, waist circumference, and decreased serum triglyceride levels compared to the 0 ml group (Kondo et al., 2009). While both groups had success, the 30 ml group lost more weight than the low dose group, and maintained their weight loss better than the 15 ml group (Kondo et al., 2009).


Apple cider vinegar has positive effects on insulin sensitivity and natural honey has been shown to have positive effects on cardiovascular disease risk factors (Beheshti et al., 2012) (Derakhshandeh-Rishehri et al., 2014). Honey and vinegar are often combined to be able to tolerate the mixture. Iran has a traditional syrup composed of 1 kg honey, 1500 ml water, and 300 g of vinegar, and a few mint sprigs, known as Sekanjabin, one of the oldest Iranian drinks that was studied to evaluate the effects in healthy individuals measuring cardiovascular disease risk factors (Derakhshandeh-Rishehri et al., 2014). The group consuming the syrup had a negative result of increased fasting insulin levels, but decreased their total cholesterol (Derakhshandeh-Rishehri et al., 2014). Concluding, consuming this amount of honey and vinegar did not enhance, but did not worsen each other's effects.


Advantages for Type II Diabetes

Ingesting apple cider vinegar has been shown to raise insulin sensitivity when taken at mealtime and at bedtime (Johnston et al., 2004) (White et al., 2007). Research has shown in insulin-resistant study participants that consuming apple cider vinegar (20 grams) before a high carbohydrate meal such as a bagel with butter and orange juice, resulted in raising the whole-body insulin sensitivity after 1 hour in the participants by 34%, and increased satiety (Johnston et al., 2004) (Ostman et al., 2005).


Individuals with T2DM are aware of the "dawn-phenomenon" known as an abnormal rise in blood glucose in the early-morning hours (White, et al., 2007). Consuming 2 tablespoons (30 ml) of apple cider vinegar and 1 ounce of cheese before bedtime improved the blood glucose levels in the morning in individuals with T2DM (White et al., 2007). Acetic acid has an antiglycemic effect, reducing starch digestion and/or delaying gastric emptying (White et al., 2007).


Disadvantages for Type II Diabetes

Individuals with gastroparesis, or delayed gastric emptying resulting from type I or II diabetes typically suffer with nausea, bloating, and vomiting (Hlebowicz, 2007). Individuals with gastroparesis were found to be negatively effected after consuming vinegar, exasperating their delayed emptying even further, making it difficult to control their blood sugar (Hlebowicz, 2007).


Conclusion

Overall, apple cider vinegar is helpful and cost-effective for people with T2DM, wanting to lose weight, and decrease their cardiovascular disease risk factors. Consuming 30 ml of apple cider vinegar daily has been proven to improve health. Individuals with gastroparesis may want to skip the vinegar, due to worsening symptoms.


Disclosure: As always, consult your physician before beginning any new regimen.


Easy Apple Cider Vinegar Drink

1-2 tablespoons water
2 (30 ml) tablespoons apple cider vinegar
1/4 teaspoon honey


Combine and mix all ingredients. Optional add-ins: dash of cinnamon, few drops of lemon juice.

References

Beheshti, Z., Chan, Y., Sharif Nia, H., Hajihosseini, F., Nazari, R., Shaabani, M., & Omran, M. (2012). Influence of apple cider vinegar on blood lipids. Life Science Journal, 9(4). Retrieved from https://www.researchgate.net/profile/Hamid_Sharif_Nia/publication/260311324_Influence_of_apple_cider_vinegar_on_blood_lipids/links/00b7d530bb6f074e4b000000.pdf

Budak, N., Aykin, E., Seydim, A., Greene, A., & Guzel-Seydim, Z. (2014). Functional properties of vinegar. Journal of Food Science, 79(5). Retrieved from http://doi.org/10.1111/1750-3841.12434

Derakhshandeh-Rishehri, S., Heidari-Beni, M., Feizi, A., Askari, G., & Entezari, M. (2014). Effect of honey vinegar syrup on blood sugar and lipid profile in healthy subjects. International Journal of Preventative Medicine, 5(12), 1608-1615. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336993/?report=printable

Hlebowicz, J., Darwiche, G., Bjorgell, O., & Almer, L. (2007). Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC Gastroenterology, 7(46). doi:10.1186/1471-230X-7-46

Johnston, C.S., Kim, C.M., Buller, A.J. (2004). Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin reistance or type 2 diabetes. Diabetes Care, 27(1), 281-282. doi:10.2337/diacare.27.1.281

Mitrou, P., Petsiou, E., Papakonstantinou, E., Maratou, E., Lambadiari, V., Dimitriadis, P., … Spanoudi, F. (2015). The role of acetic acid on glucose uptake and blood flow rates in the skeletal muscle in humans with impaired glucose tolerance. European Journal of Clinical Nutrition, (69), 734-739. doi:10.1038/ejcn.2014.289

Ondo, T. K., Ishi, M. K., Ushimi, T. F., Gajin, S. U., & Aga, T. K. (2009). Vinegar Intake Reduces Body Weight , Body Fat Mass , and Serum Triglyceride Levels in Obese Japanese Subjects, 73(8), 1837-1843. http://doi.org/10.1271/bbb.90231

Ostman, E., Granfeldt, Y., Persson, L., & Bjorck, I. (2005). Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European Journal of Clinical Nutrition, (59), 983-988. doi:10.1038/sj.ejcn.1602197

White, A. M., & Johnston, C. S. (2007). Vinegar ingestion at bedtime moderates waking glucose concentrations in adults with well-controlled type 2 diabetes. Diabetes Care, 30(11). Retrieved from DOI: 10.2337/dc07-1062

Immune Health

How to Avoid Getting Sick: Food, Move, & Soothe
Immune Health

How to Avoid Getting Sick: Food, Move, & Soothe

By Alexandria Broadbent

Dietetic Intern at Stephen F. Austin State University

Big life changes can take a toll on the body: starting at a new university, a new job, moving to a new city… Sometimes when these changes happen, we don't always remember to take care of ourselves, so a lot of times, we get sick. Let's take a look at three major ways within our control that can help keep our immune system in check so this is less likely to happen! As my mama always says, "it stinks to be sick".

Diet

Diet plays a huge role in the function of the immune system. Here is a summary of a few of the vitamins that contribute greatly and why they are so important. Let's go alphabetically:

· Vitamin A makes sure that the mucosal barriers separating the outside world from our inside world stays strong. These barriers are in the digestive tract, respiratory tract, and even our eyes. Another function of Vitamin A is to produce the appropriate inflammatory response (Maggini et al., 2007). Inflammatory response is the reaction to any negative stimuli in the body. When a mosquito bites us, it gets red and swells. That's the inflammatory response on a small scale. Vitamin A keeps that process in check so the appropriate cells are taking action to clear up the issue ASAP. Vitamin A can be found in liver, eggs, and dairy products. A precursor to Vitamin A, beta-carotene, is mostly found in orange/red vegetables: carrots, tomato, sweet potato, and butternut squash, just to name a few.

· Vitamin B6 breaks down dietary proteins. These proteins break down into amino acids which are used for building antibodies and cytokines (Maggini et al., 2007). Antibodies and cytokines are created for the sole purpose of defending the body from foreign invaders! B6 is found in high amounts in fish, meats, and is in some produce like bananas, spinach, and sweet potato.

· Vitamin C seems to be a popular vitamin when we get sick. Does it really help us recover? That's a good question! Well, research has shown that Vitamin C intakes had no effect on prevention of getting sick. There is hope, though. Vitamin C did have a significant effect on decreasing the duration of common cold symptoms. There does seem to be one caveat. Athletes who perform in extreme weather have a 50% reduced chance of getting sick with consistent intake of Vitamin C (Hemila & Chalker, 2013). That is some powerful stuff! But it definitely won't keep you from getting sick unless you are an extreme athlete. And remember, don't wait until you're sick to get your C-stores up! You can find vitamin C in citrus, bell peppers, kale, and many fruits.

· On to Vitamin D. It has been shown to support antimicrobials in the respiratory system lining and increases activity in the body's defensive cells. Vitamin D is special because it has a protective factor that can influence the occurrence autoimmunity (Maggini et al., 2007). Getting enough Vitamin D is quite difficult. One solution that we always have is the sun (for at least 10 hours a day)! Our bodies can convert sunshine into vitamin D. It does take quite a bit of time for this method to happen, and you do have to be careful not to get sunburned! This process is not as reliable in those with darkly pigmented skin or those living in cold regions. Some foods with Vitamin D are fatty fish, fortified beverages like milk and OJ, and egg yolks.

· Vitamin E also plays an important role in immune health. It helps to trigger the white blood cell action when infectious agents enter the body. Vitamin E supplementation can be beneficial to counteract the effects of decreased immune response with age (Bunout et al., 2004). Some sources of Vitamin E are nuts, cooking oils, avocado, spinach, and sweet potato.

I know what you're thinking. It does seem like these vitamins all kind of do the same thing. In the grand scheme of things, that is correct. But in different ways. For example, creating a lymphocyte (defensive white blood cell) is a process. Every vitamin will play a necessary role in each step- from creating a lymphocyte to activating it into battle. We can't do it without our little vitamin friends working together to keep us safe!

So what is the overall takeaway for diet and immune support? Supplements are okay, but quality is hard to find at an affordable price. It is also difficult to know what to look for when there are so many options out there. Basically what we need to do is eat more fruits and vegetables (like we didn't see that coming). But really, many Americans are lacking in this department. The recommended amount is to reach is 9 servings per day. We also need to eat a wide variety of whole foods. These sources of vitamins and minerals are the most natural and effective way for our bodies to get what they need to keep on ticking. Whole food provides the complimentary nutrients that we need in order to fully absorb these key vitamins (Gershwin et al., 2004). Supplements just can't fake that.

Exercise

We have all been there before: spending most of our time caught up in life, and not putting physical activity at the forefront of our minds. Let's say that one day we finally have some free time and decide to play a game of 2v2 basketball. The next day we are so sore and regret ever doing it! Research shows that acute bouts of exercise like this actually lower the immune system by increasing inflammation (Walsh et al., 2011). However, regular exercise (4-7 days/week) has been shown to improve the immune system. Moderate training a few times a week promotes adaptation of the immune system, improving and increasing the function of immune cells (Fuente et al., 2005). Exercise can be a scary word for some people. Just think of it as moving more! Hitting the gym or running 10 miles isn't for everyone. Walking the dog, playing with your kids at the park, or going for a swim are some (fun) ways to reach a physical activity goal. The main thing is to move.

Stress

No matter what stage of our lives, we are all going to experience some kind of stress-whether it is physical or emotional. Both kinds can take a toll on the body. I experienced this first hand with struggles in my personal life. I was sick for about 6 weeks with an infection, migraines, and acne breakouts. All my terrible symptoms began to resolve once my emotional stress decreased, which happened when everything finally settled down. SO, needless to say, emotions can certainly have an affect on physical health.

Not everyone is affected in the same way by stress. It can depend on the person's genetics, coping mechanism, personality, and social support available (Shapiro et al., 2005). Chronic, or continuous stress, can increase a person's risk for diabetes, asthma, depression, and tumor development (Salleh, 2008). Freaky, huh? This just shows, we all need to take a breather. We usually make time to brush our teeth 2-3x a day, we can certainly set a few minutes aside each day to relax or cope however we do best. Some people say that yoga is the best kind of stress reliever, but it's really just as effective as relaxation alone (Smith et al., 2006). But, please, if you want to knock out two birds with one stone (exercise and stress reduction), go for it!

Temporary stress, however, like first date nervousness, game day anxiety, or giving a speech can be good for us! Instead of putting us in distress, these kinds create eustress. Eustress is what makes us get out of bed in the morning, gives us a competitive edge, or enthusiasm to project across the crowd. Eustress allows us to adapt. Distress holds us back (Salleh, 2008).

Now, as we age, we should expect many changes in our bodies. This includes microscopic changes in our immune system. Our body is not able to produce lymphocytes the way it used to (Linton, et al, 2004). This makes it even more important to strengthen our immunity and take care of ourselves to the best of our abilities, especially as we age.

So get out there and get the right food, move more, and soothe your tensions!

References

Bunout, D., Barrera, G., Hirsch, S., Gattas, V., de la Maza, M.P., …, & Munoz, C. (2004). Effects of a nutritional

supplement on the immune response and cytokine production in free-living Chilean elderly. Journal of Parenteral Enteral Nutrition, 28: 348 -354.

Fuente, M., Hernanz, A., & Vallejo, M.C. (2005). Forum review: The immune system in the oxidative stress conditions of

aging and hypertension: Favorable effects of antioxidants and physical exercise. Antioxidants & Redox Signaling, 7 (9&10): 1356-1366.

Gershwin, M.E., Nestel, P., & Keen, C.L. (2004). Handbook of nutrition and immunity. Totowa, NJ: Humana Press Inc.

Hemila, H., & Chalker, E. (2013). Vitamin C for preventing and treating the common cold (Review). The Cochrane Library,

2013(5): 1- 103.

Linton, P.J., & Dorshkind, K. (2004). Age-related changes in lymphocyte development and function. Nature Immunology,

5:133-139.

Maggini, S., Wintergerst, E.S., Beveridge, S., & Hornig, D.H. (2007). Selected vitamins and trace elements support

immune function by strengthening epithelial barriers and cellular humoral immune responses. British Journal of Nutrition, 98(1): S29-S35.

Salleh, M.R. (2008) Life event, stress and illness. The Malaysian Journal of Medical Sciences, 15(4): 9-18.

Shapiro, S.L., Astin, J.A., Bishop, S.R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care

professionals: Results from a randomized trial. International Journal of Stress Management, 12(2):164-176.

Smith, C., Hancock, H., Blake-Mortimer, J., & Eckert, K. (2006). A randomized comparative trial of yoga and relaxation to

reduce stress and anxiety. Complementary Therapies in Medicine, 15: 77-83.

Walsh, N.P., Gleeson, M., Shephard, R.J., Gleeson, M., Woods, J.A., …, & Simon, P. (2011). Position statement part one:

Immune function and exercise. Exercise Immunology Review, 17: 6-63.

Lifecycle Nutrition

Must-have Foods During Pregnancy
Berries

Must-have Foods During Pregnancy

By Author Name

Dietetic Intern at Stephen F. Austin State University

Expecting a baby is an exciting time. It's an overwhelming, exhausting, thrilling, draining, yet totally exciting time. Everyone you know will offer advice and suggestions on how to go through your pregnancy and what to expect. This is normal and everyone means well, yet it is easy to get lost in the long list of what to do and not do. I believe there are a few necessities that must be incorporated, specifically in your diet, as related to what that sweet bundle of joy needs to grow, thrive, and ultimately have the best start at life.

Using prenatal vitamins is typically recommended, yet does not replace a healthy diet. It is imperative that your diet include certain vitamins and minerals from whole foods, as this is the body's best bet for absorption. Ultimately, a whole foods diet, with lots of fruits and vegetables that eliminates processed foods and sugars will do a body and baby good.

In order to provide yourself and your baby with proper nutrients, include these foods in your daily diet before, during and even afterpregnancy!

  • Fiber-Rich Foods - Research has recently revealed that a high-fiber diet may beneficially alter a woman's gut bacteria during pregnancy, producing anti-inflammatory substances that suppress asthma-related genes in her baby.(1) There is also research that suggests a high-fiber diet can help reduce your risk of premature death from any cause, likely because it helps to reduce your risk of a number of chronic diseases. This can help you and your baby! Choosing vegetables, nuts, and seeds is a great way to increase fiber in your diet.

Examples:

Cauliflower Beans Peas
Root Vegetables Onions Chia seeds
Flax seeds Almonds Brussel Sprouts

Leafy Greens and Broccoli - One of the most important nutrients to make sure is abundant in your diet before and during pregnancy is folate. Folate has been proven to be particularly important for the development of the nervous system and for preventing neural tube defects (NTDs) in babies. Broccoli and dark green leafy vegetables like spinach and kale are loaded with important nutrients for pregnant women, including folate, fiber, potassium, calcium, iron, and vitamins C, K, and A. Also, note that folate is found naturally in food while folic acid is the synthetic version of folate. There is a big difference between the two-especially for certain people with genes that make it more difficult to process folic acid. For more information, read the blog post "Folic Acid vs. Folate: Part I-the link can be found in reference 2.

Wild Caught Salmon and Sardines - Eating fish is the best way to get omega-3 fats EPA and DHA, but being aware of the toxic effects of pollutants found in fish is incredibly important. Among the safest in terms of contamination, and the highest in healthy omega-3 fat, is wild-caught Alaskan or sockeye salmon. Enjoying salmon a few times a week will greatly improve your omega-3 status.(3) Omega-3 fat and its derivative, DHA, is so essential to a child's development that if a mother and infant are deficient in it, the child's nervous system and immune system may never fully develop, and it can cause a lifetime of unexplained emotional, learning, and immune system disorders. Salmon also contains an abundance of other nutrients, from vitamin B12 and selenium to protein, calcium, and choline, making them one of the best dietary sources of animal-based omega-3s. Sardines have the most amount of omega-3 fats. They are delicious on toast. You can also supplement your diet with animal-based omega-3s by taking a krill or fish oil supplement.

Organic free range eggs - Eggs are really a superfood. They are a great source of protein, fat, and other nutrients, most importantly choline. In women who are pregnant, choline plays a vital role in helping to prevent certain birth defects, such as spina bifida, as well as playing a role in brain development. Consuming higher levels of choline during pregnancy is linked to beneficial epigenetic changes in the fetus, including protection from stress-related and metabolic disorders, that likely last into adulthood.(4)

Avocados - Avocados provide close to 20 essential health-boosting nutrients, including potassium, vitamin E, vitamin K, B vitamins, and folate. They're also one of few foods that contain significant levels of both vitamins C and E and are an excellent source of healthy monounsaturated fat.(5) Avocados are absolutely a superfood. You can add avocados pretty much to anything!

Berries - Berries are magical little fruit. They are lower in sugar than many fruits and therefore less likely to destabilize your insulin levels. Berries also contain high amounts of vitamin C, which helps in the absorption of iron, and they also have fiber. Berries have been found to have disease-fighting phytochemical which are found to boost your immunity, prevent cancer, protect your heart, as well as prevent seasonal allergies. (6)

Liver - I enjoy Pate regularly in my diet. Pate is finally chopped or seasoned pureed animal liver. Currently, the Western diet rarely involves eating the organs of animals, we prefer the muscle. Eating the liver, especially, has been done by many cultures and groups of people for centuries. Choosing grass-fed beef liver or free-range chicken liver is the only way to go. Impressively abundant in organ meats from pastured animals, Vitamin A is a catalyst for multiple biochemical processes. Vitamin A is vital for prevention of birth defects, prevention of infection, hormone production, optimal thyroid function, good digestion, good vision, and healthy bones and blood. Without it, your body cannot utilize protein, minerals and water-soluble vitamins. (7) Organ meats provide plentiful Vitamin E, K, D, complex B vitamins, choline, and trace minerals. This is a must in your diet during pregnancy and even after as well. There are many great recipes available, start experimenting!

Vitamin D - Vitamin D is not a specific food, but optimizing your vitamin D during pregnancy is one the most important things you can do for yourself and your baby. When a child is born deficient in vitamin D, his or her health can be significantly affected in any number of ways. Research confirms there is a lifelong impact of vitamin D deficiency in pregnancy ranging from childhood allergies to asthma, colds and flu, dental cavities, diabetes, and even strokes and cardiovascular disease in later life of the child. (8) I believe vitamin D is as important to pregnant women as folate is. Once you become pregnant, or if you are hoping to become pregnant, visit your doctor and have your vitamin D levels checked. One study revealed that women with low levels of vitamins D and E in early pregnancy are associated with an increased risk of asthma in her child within the first 10 years of life. (9) There is also mounting evidence that vitamin D deficiency in pregnant women is linked with pre-term births. (10) Talk with your doctor and find out the best ways to maximize your consumption of vitamin D.

All of these foods deserve a place in your diet during pregnancy and really before and after as well. As the emotional, mental, and physical rollercoaster ensue, it is a good idea to try to enjoy these short or long 9 months and do what you can to help bring a healthy beautiful baby into this world. You and your baby deserve the best and deserve to great healthy start to the next chapter in life!

References

1. Thornburn, A. et al (2015). Evidence that asthma is a developmental origin disease influenced by maternal diet and bacterial metabolites. Nature Communications. doi: 10.1038/ncomms83201.

2. Vitiello, P. (n.d.). Research & Education Blog. Retrieved April 30, 2017, from http://blog.designsforhealth.com/blog/bid/115121/Folic-Acid-vs-Folate-Part-I

3. Dungan, J. (2012). The Salmon in Pregnancy Study: study design, subject characteristics, maternal fish and marine n-3 fatty acid intake, and marine n-3 fatty acid status in maternal and umbilical cord blood. Yearbook of Obstetrics, Gynecology and Women's Health,2012, 152-153. doi:10.1016/j.yobg.2012.06.1

4. Jiang, X., Yan, J., West, A. A., Perry, C. A., Malysheva, O. V., Devapatla, S., . . . Caudill, M. A. (2012). Maternal choline intake alters the epigenetic state of fetal cortisol-regulating genes in humans. The FASEB Journal,26(8), 3563-3574. doi:10.1096/fj.12-207894

5. Dreher, M. L., & Davenport, A. J. (2013). Hass Avocado Composition and Potential Health Effects. Critical Reviews in Food Science and Nutrition,53(7), 738-750. doi: 10.1080/10408398.2011.556759

6. Chen, L., Xin, X., Yuan, Q., Su, D. and Liu, W. (2014), Phytochemical properties and antioxidant capacities of various colored berries. J. Sci. Food Agric., 94: 180-188.

7. Razaitis, L. (2005, July 29). The Liver Files. Retrieved May 01, 2017, from https://www.westonaprice.org/health-topics/food-features/the-liver-files/

8. Rodda, C.P., Benson, J.E., Vincent, A.J., Whitehead, C.L., Polykov, A. and Vollenhoven, B. (2015), Maternal vitamin D supplementation during pregnancy prevents vitamin D deficiency in the newborn: an open-label randomized controlled trial. ClinEndocrinol, 83: 363-368. doi:10.1111/cen.127

9. Allan, K. M., Prabhu, N., Craig, L. C., Mcneill, G., Kirby, B., Mclay, J., . . . Devereux, G. (2014). Maternal vitamin D and E intakes during pregnancy are associated with asthma in children. European Respiratory Journal, 45(4), 1027-1036. doi:10.1183/09031936.00102214

10. Miller, D. R., Turner, S. W., Spiteri-Cornish, D., Scaife, A. R., Danielian, P. J., Devereux, G. S., & Walsh, G. M. (2015). Maternal vitamin D and E intakes during early pregnancy are associated with airway epithelial cell responses in neonates. Clinical & Experimental Allergy, 45(5), 920-927. doi:10.1111/cea.12490

Sweeteners

Should You Avoid High Fructose Corn Syrup in Your Child's Diet?
High Fructose Corn Syrup Should You Avoid High Fructose Corn Syrup in Your Child's Diet?
By Tammy Proctor
Dietetic Intern at Stephen F. Austin State University


One of the most concerning topics for a parent is what you will feed your child. According to Psychology Today, 57% of parents are concerned about unhealthy eating. The food we put in our bodies is important, which is why what your child eats and drinks is a legitimate concern. I think it's safe to say, we have all heard that we should either cut back or stop consuming sodas and processed foods.


The CDC reports that 49% of adults and 63% of youth drink at least one sugar-sweetened beverage per day. It's been estimated that 61% of the average American diet is made up of highly processed foods. One of the main ingredients in these items is high fructose corn syrup (HFCS), whichin many cases it is the first ingredient. The dangers of HFCS have been discussed in the news, social media, and many other publications but the question is whether it's really harmful or not. Let's get to the facts!


What is High Fructose Corn Syrup (HFCS)?


HFCS first began to be used in the 1970's when the cost of sugar was high and corn prices were very low and have continued to be utilized due to the low cost and functionality. It's made from corn starch in which the manufacturers use an enzymatic process where the molecules are altered changing some of the glucose into fructose.


As a comparison, the sucrose molecule (table sugar), has a 1:1 ratio of fructose to glucose. There are two main forms of HFCS which are referred to as HFCS 42 and HFCS 55. This indicates the percentage of the molecule that is made up of fructose, so HFCS 42 contains 42% fructose and HFCS 55 has 55% fructose. The remainder of the molecule contains glucose and water.


HFCS 42 is mainly used in manufacturing processed foods and HFCS 55 is predominantly used in sodas. So why do they use HFCS? The purpose of using HFCS is to provide sweetness, enhance flavors, reduce water content, reduce freezer burn, enhancetexture and moisture of baked goods, gives body and texture in beverages, and it causes the enzymatic browning of baked goods.


How is High Fructose Corn Syrup (HFCS) Metabolized?


Fructose from sugar or HFCS meets the same fate. It arrives in the gut and then is sent directly to the liver. There is a difference between the way glucose and fructose are metabolized. Once glucose reaches the liver it is then either stored as glycogen (for use as energy in the muscle), stored as fat (once glycogen stores are full), or transported to cells for use as energy. Fructose, on the other hand, can only be metabolized in the liver. It is either converted to glucose or when excess is consumed, stored as fat within the liver.


Since fructosemetabolism only occurs in the liver, lipogenesis is able to occur more efficiently than with glucose. Lipogenesis is the metabolic process in which energy is changed into fat and stored. De novo lipogenesis (DNL)is another form of lipogenesis that may occur where excess carbohydrates are stored as fat and have been shown to occur with excessive consumption of HFCS. Some of the harmful effects that are associated with DNL include elevated triglycerides and fat storage in the liver. This is a fancy way of saying that this is the process in which fatty liver disease occurs.


You may be thinking, fruit contains fructose, so should I be concerned with my child eating fruit? Absolutely not! Fruit is full of important vitamins and minerals and is a great addition to any diet. The difference between HFCS and the fructose in fruit is the concentration. Fructose that comes from HFCS is a concentrated amount of fructose causing a greater consumption of fructose in products containing HFCS compared to fruit. A large apple has approximately 23 grams of sugar and 13 grams are from fructose. While a 16 oz. bottle of Coke has 52 grams of sugar and 30 grams come from fructose. This is a considerable difference! Not to mention that the apple contains fiber which helps to slow the digestion causing the fructose to make it to the liver at a more gradual pace.


Common Myths About High Fructose Corn Syrup (HFCS)


Many of us have preconceived notions about HFCS and may have assumptions that are incorrect so let's clear up some of the myths about high fructose corn syrup.


  • HFCS causes obesity - We can't blame the obesity epidemic on HFCS. There is not one specific cause of obesity, there are many causes; genetics, lack of physical activity, food choices, portion sizes, and many more. The blame cannot be attributed to one specific ingredient in a food item or beverage.
  • HFCS is sweeter than sucrose - Many people have the misconception that HFCS is sweeter than sucrose, but it's not. In order to determine how sweet a sweetener is, whether it is artificial or natural, the standard is sucrose. When compared they are equal in sweetness. As a matter of fact, the industry produced HFCS as a replacement for sucrose. They are interchangeable, HFCS just has some added benefits such as preservation and increased moisture.
  • HFCS is higher in calories than sucrose - People often think that HFCS has a higher caloric value than sucrose, however, they have the same caloric value in which they both contain 4 kcal/g.


What is Concerning About High Fructose Corn Syrup (HFCS)?


The research on HFCS is conflicting. Some research shows that HFCS is no different than sucrose and other research that shows HFCS has specific effects on the body. The following research is concentrated on adults 18 to 70 and shows some of the negative effects of HFCS:


  • Fructose ratios may be higher in some beverages than thought - In a study by Walker, Dumke, & Goran, they found that certain beverages contained 60% fructose, which is contradictory to the 55% that they were thought to have contained. This shows that fructose consumption may be more than previously thought due to the increased percentage of fructose in the ratio of the HFCS that was used.
  • Excessive consumption of HFCS may lead to non-alcoholic fatty liver disease (NAFLD) - An animal study evaluating the effects of HFCS 55 showed that rats who consumed sugar solutions had increased total food intakes when compared to rats drinking water. When the study concluded there was no change in body weight gain but when the rats were dissected it was found they had higher liver weight, total liver and triglyceride content, than the rats who drank water. These findings are alarming because the excess weight of the liver indicates that there was lipid accumulation suggesting that de novo lipogenesis occurred. Ultimately, the study determined that the type of excess sugar does influence hepatic lipid metabolism and influences the advancement of NAFLD, therefore it is advisable to limit the consumption of HFCS and sweetened beverages containing calories.
  • Consumption of HFCS may increase the risk of cardiovascular disease (CVD) - A study published in the American Journal of Clinical Nutrition, revealed that the consumption of beverages including 10%, 17.5%, or 25% of HFCS showed to have a relation to increased risk of CVD. The results displayed that HFCS increased 6 biochemical markers which can increaseCVD mortality risk.
  • Role of HFCS in metabolic syndrome and lipogenesis - Metabolic syndrome is made up of a group of conditions including elevated blood pressure, high blood sugar, excess abdominal fat, and high cholesterol or triglyceride levels. These conditions increase the risk for heart disease, stroke, and diabetes. The intake of fructose has been linked to increased levels of triglyceride synthesis and lipogenesis in the liver and may contribute to visceral adiposity causing metabolic alterations to occur, leading toinsulin resistance. Insulin resistance is when cells no longer properly respond to insulin making it difficult for glucose to get inside the cells. The pancreas continues to try to produce insulin because blood glucose levels are elevated and can eventually lead to type 2 diabetes due to the body's inability to regulate blood glucose levels.

In a study by Stanhope et al., comparing sugar-sweetened beverages that contained glucose or fructose, showed that weight gain was similar amongst both groups, however, there was significant increases visceral adiposity (fat stored in the abdomen) in the fructose group. The evidence shows that visceral adiposity is one of the causation factors of metabolic syndrome. Furthermore, a study by Hu & Malik containing 6,000 adult subjects showed a 39% increased risk for metabolic syndrome when subjects consumed one or more soft drinks per day over a four-year period.


Suggestions to Cut Out High Fructose Corn Syrup (HFCS) and Added Sugar


Looking at all the facts, the reality about HFCS is it carries all the risks of sucrose plus potentially other risks previously mentioned that most parents would want to avoid in feeding their children. HFCS, whether it is or isn't thought of as the worst ingredient in many foods and beverages, it is still considered added sugar.The American Academy of Nutrition and Dietetics recommends no more than 10% of your daily caloric intake should come from added sugar. This equates to approximately 12 teaspoons or 48g of sugar per day. A typical breakfast for a child may include Cap N' Crunch cereal. If a child consumed ¾ of a cup, it would contain 12 grams of sugar, which is equal to 3 teaspoons of sugar in just the cereal alone. Depending on the appetite or size of the child, this could be double or triple that amount in just one meal.Being vigilant in watching how much HFCS or added sugar your child is consuming is one of the main ways you can be assured your child is not getting excessive amounts of added sugar and forming habits that will increase their risk for chronic diseases and/or obesity. Here are a few tips for parents to decrease or cut HFCS or added sugar from your child's diet:


  • Reading your food labels. HFCS and added sugar are in many of the foods we purchase at the grocery store including:
    • Beverages
    • Cereals
    • Candy
    • Chocolate
    • Yogurt
    • Baked goods
    • BBQ sauce
    • Ketchup
    • Salad dressing
    • Condiments
    • Granola
    • Instant oatmeal
    • Frozen foods
    • Protein/cereal/granola bars
    • Pasta sauce
    • Dried/canned fruit
    • Juice
    • Baby food
  • Cooking at home. This allows you to control the ingredients that are being used and decrease the amount of sugar that goes into a recipe.
  • Sweeten items with natural sources of sugar by using fruit. An example would be using unsweetened oatmeal and adding fruit to give it that sweetened flavor or adding fruit in water to improve flavor.
  • Lead by example. Children learn their eating habits from the way their parents eat. How you eat, is most likely how your child will eat.


Conclusion


Added sugars, whether sucrose or HFCS, when eaten in excess is a future ticking time bomb for our children's health. There is still not enough evidence to conclusively state that HFCS is any worse than sucrose, however, some of the research shows that HFCS could pose serious health risks when consumed in excess. I'm not trying to vilify HFCS, but rather give parents a better understanding of the risks that accompany the excessive consumption of items that may include this ingredient.


What we do know is that excess intake of any type of sugarregardless of the typehas been linked to many chronic diseases and obesity. Parents want what is best for their children, and setting them up with healthy eating habits is an important aspect of how they will eat for the rest of their lives. Limiting the amount of excess sugar should be something everyone should be aware of by focusing on limiting the amount we consume. So much of the food we purchase from the grocery store is processed with unwholesome ingredients and full of hidden sugar. I encourage you to look at food labels and pay close attention to what your child is eating because after all, their health is depending on it!

References

Top 10 Concerns Parents Have for Their Own Kids (and Others). Psychology Today. https://www.psychologytoday.com/us/blog/the-athletes-way/201708/top-10-concerns-parents-have-their-own-kids-and-others. Accessed April 16, 2018.

[1]Nutrition. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html. Published April 7, 2017. Accessed March 13, 2018.

[1]Jennifer M Poti, Michelle A Mendez, Shu Wen Ng, Barry M Popkin; Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households?, The American Journal of Clinical Nutrition, Volume 101, Issue 6, 1 June 2015, Pages 1251-1262, https://doi.org/10.3945/ajcn.114.100925

[1]Gropper S, Smith J. Advanced Nutrition and Human Metabolism. Cengage Learning, Inc; 2013.

[1]Food Additives & Ingredients - High Fructose Corn Syrup Questions and Answers. U S Food and Drug Administration Home Page. https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm324856.htm. Accessed March 13, 2018.

[1]Fast Facts about High-Fructose Corn Syrup. FoodInsight.org. http://www.foodinsight.org/Fast_Facts_about_High_Fructose_Corn_Syrup. Accessed March 15, 2018.

[1]Ter Horst KW, Serlie MJ. Fructose Consumption, Lipogenesis, and Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(9):981. doi:10.3390/nu9090981.

[1]Adipose tissue de novo lipogenesis. http://www.asbmb.org/asbmbtoday/asbmbtoday_article.aspx?id=15872. Accessed March 17, 2018.

[1]Gunnars K. Is Fruit Good or Bad For Your Health? The Sweet Truth. Healthline. https://www.healthline.com/nutrition/is-fruit-good-or-bad-for-your-health. Accessed April 24, 2018.

[1]Fitch C, Keim KS. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. Journal of the Academy of Nutrition and Dietetics. 2012;112(5):739-758. doi:10.1016/j.jand.2012.03.009.

[1]About High Fructose Corn Syrup. Go to Corn Refiners Association. https://corn.org/products/sweeteners/high-fructose-corn-syrup/. Accessed March 16, 2018.

[1]White JS. Straight talk about high-fructose corn syrup: what it is and what it ain't. The American Journal of Clinical Nutrition. 2008;88(6). doi:10.3945/ajcn.2008.25825b.

[1]Walker RW, Dumke KA, Goran MI. Fructose content in popular beverages made with and without high-fructose corn syrup. Nutrition. 2014;30(7-8):928-935. doi:10.1016/j.nut.2014.04.003.

[1]Mock K, Lateef S, Benedito VA, Tou JC. High-fructose corn syrup-55 consumption alters hepatic lipid metabolism and promotes triglyceride accumulation. The Journal of Nutritional Biochemistry. 2017;39:32-39. doi:10.1016/j.jnutbio.2016.09.010.

[1]Stanhope KL, Medici V, Bremer AA, et al. A dose-response study of consuming high-fructose corn syrup-sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults. The American Journal of Clinical Nutrition. 2015;101(6):1144-1154. doi:10.3945/ajcn.114.100461.

[1]Prediabetes & Insulin Resistance. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. Published August 1, 2009. Accessed April 16, 2018.

[1]Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. The Journal of Clinical Investigation. 2009;119(5):1322-1334. doi:10.1172/JCI37385.

[1]Wajchenberg BL. Subcutaneous and Visceral Adipose Tissue: Their Relation to the Metabolic Syndrome. Endocrine Reviews. 2000;21(6):697-738. doi:10.1210/er.21.6.697.

[1]Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemiologic evidence. Physiology & behavior. 2010;100(1):47-54. doi:10.1016/j.physbeh.2010.01.036.

[1]Looking to Reduce Your Family's Intake of Added Sugars? Here's How. Eat Right. Academy of Nutrition and Dietetics. https://www.eatright.org/food/nutrition/dietary-guidelines-and-myplate/looking-to-reduce-your-familys-added-sugar-intake-heres-how. Published December 6, 2016. Accessed March 15, 2018.

[1]Quaker Oats Company. Cap'n Crunch - Reclaim Your Crunch Time! Cap'n Crunch! http://www.capncrunch.com/. Accessed April 24, 2018.

Stevia
Sugar Sub

Stevia

By Katie Shumate

Dietetic Intern at Stephen F. Austin State University

Have you heard of stevia? It's an increasingly common zero calorie sweetener that's gained popularity in recent years being praised as the "healthy" and "all-natural" sweetener. Other sweeteners have been linked to increased genotoxicity, cancer (Yilmaz & Ucar, 2014) insulin resistance, metabolic disease as well issues with gut bacteria and other negative side effects (Suez et al., 2014). You've probably seen stevia on the shelves with the yellow, blue and pink sweeteners, but is it really better than the other sweeteners?

I'd like to go over what stevia is, some of its history, how it is extracted and what research has shown about it so we can draw some conclusions about using it.

What is Stevia?


Stevia is a non-caloric sweeter that is typically sold in either a powder or liquid form that is 200-300 times sweeter than table sugar (Engber, 2014). It has become very popular with the food industry who are trying to find ways to please health conscious customers.

Stevia is made from the leaves of the SterviarebaudianBertoni which is a native shrub in South America, most commonly found in Brazil and Paraguay (Examine.com, n.d.).

Stevia_1

There are several chemical compounds that give the plant its sweetness, but the two most abundant and commonly used are stevioside and rebaudioside-A (Stevia.com, n.d). Both of these compounds are steviolglycosides- a fancy chemical word for a sugar group attached to another chemical functional group. Humans are unable to metabolize the chemical structures of stevioside and rebaudioside-A, giving it the intended sweetness everyone is looking for without the calories. Once stevia reaches the colon, gut bacteria convert steviol glycosides into steivol, which is metabolized by the liver then excreted in the urine (Nichols, 2016). I'll talk more about these two compounds later.

Stevioside Rebaudioside-A
Stevioside Rebaudioside

Brief History of Stevia

Historically it was used by the Guarani Indians in Brazil. They called it "kaa he he" which means sweet herb. They used it in medicines, in tea, or just to chew on.

In 1887, it was "re-discovered" by Dr. Moises Santiago Bertoni, an Italian college professor. He "found" the stevia plant and made it more well-known to the developed world.

Stevia was presented to the USDA by George S. Brady in 1921 as a new sweetener, but met a lot of resistance in starting up widespread use and manufacturing from the sugar cane companies (Gates, 2000)

In 1931, French scientists isolated the compound stevioside and attributed it to what made stevia taste sweet.

In the 1960s and 1970s, Japan did extensive research on stevia. There was a huge push during this time to eliminate unnatural chemicals in foods, and as a result many things like other artificial sweeteners were banned. A lot of money and research that has continued today was poured into finding a more natural product. By 1988, stevia represented 41% of Japan's non-sugar sweetener market.

In the mid-1980s, stevia became popular in manufacturing and processed goods (Gates, 2000).

Stevia was banned briefly in the United States in 1991 because some animal and cell studies found that it potentially damaged cells and caused cancer. Later studies could not replicate these outcomes and the concentration used in the earlier studies could never be consumed by a human, making the early studies not completely applicable to human health. (Goyal, Samsher, & Goyal, 2010). Other early studies indicated that it may negatively impact the endocrine system and alter hormones, especially in males. Again, later studies could not replicate this outcome and again mentioned the very high concentration of stevioside was not representative of the intake normally consumed in the average human diet (Goyal, Samsher, Goyal, 2010; Oliveira-Filho, Uehara, Minetti, & Valle, 1989).

After much disagreement in the research through the 1990s and early 2000s, finally the compound rebaudioside A gained GRAS or Generally Recognized as Safe status from the Food and Drug Administration (FDA) in 2008 (Stevia.com, 2016). GRAS status is a designation which means that this compound is considered safe by "qualified experts, as having been adequately shown to be safe under the conditions of its intended use" (U.S. Food and Drug Administration, 2017).

In 2008-2009 larger companies like Pepsi, Cargill, and Coca-Cola made their own stevia products (Stevia.com, 2016).

Today there are a ton of stevia products on the shelves!

Stevia Store

Forms of Stevia

I told you I would come back to this! So as I said above, rebaudioside-A is the chemical compound approved by the FDA (Examine.com, n.d.). This means it can be sold as a food item (sweetener powder and liquid drops in the regular sweetener isle) and as an additive in things like drinks, candies, and other processed food items. It has a less bitter aftertaste, but has not been studied as extensively as stevioside.

The other structure found in stevia, stevioside, does not yet have approval by the FDA. You can, however, find stevioside at the grocery store! Instead of being in the sweetener isle, stevioside is found in the supplement isle and sold as a medicinal product/sweetener (Examine.com, n.d.). It can be used like a sweetener for your coffee and tea, but it can also be taken like a supplement. Companies are able to do this because supplements are not considered food or drugs and therefore are not evaluated or regulated by the FDA. This can cause some concern over purity and safety. If you would like to use stevioside as a sweetener, I would recommend going with higher quality brands that list stevioside as the only ingredient, often found in drops. It is a little more bitter than rebaudioside, but several studies have found that stevioside has positive health effects.

There is also of course green leaf stevia or whole leaf stevia which is basically whole stevia leaves that have been dried and ground into a powder. It is more bitter than both of the above compounds, but is still 30-40 times sweeter than sugar (Gelski, 2010). I would consider this to be the most natural form of stevia, if that is your concern.

How is Stevia Extracted?

The extraction process performed by different companies may differ slightly, but they all generally have a multi-step chemical extraction and purification. The liquid and powder form of stevia (rebaudioside-A in the sweetener isle) is made by first drying and grinding up plant leaf cuttings. The leaves are then steeped in hot water (Stevia.com, 2016). The solution then goes through several stages of filtering, centrifuging, and extracting using solvents like acetone, methanol, ethanol, isoproponal and other chemical products (Pasquel, Meireles, Marques, &Ptenate, 2000). Many of these solvents are carcinogenic, and concerns about these harmful solvents remain as it is next to impossible to get rid of all residues (Truth in Advertising, 2014). Food grade stevia has to be at least 95% steviol glycosides to be sold (Stevia.com, 2016). The rebaudioside-A is bottled if it is to become the liquid form,or dried and cut with bulking agents like inulin, maltodextrin, dextrose, or erythritol if made into the powder form. There are also concerns about the bulking agents used. For example, erythritol is a yeast-produced no-calorie sugar alcohol, that may be fed sugars from GMO corn (Engber, 2014).Though stevia originates from a plant, the extraction process may not be as "natural" as we thought.

Current Research

Did you know that stevia isn't just for making your favorite food taste sweeter? There are actual research studies that have found that stevia may be helpful to treat certain health conditions. An animal study done on rats may show that stevia is helpful in the treatment of diabetes. Scientists took a group of rats and gave them diabetes then treated them with stevia extract in their water. They found that though stevia extract did not increase the number of insulin-making beta cells in the pancreas, it helped the rats better use the insulin available by lowering inflammatory chemicals produced by fat cells.

This study showed that steviols have the potential to be a drug treatment for humans in the future, though more research is needed (Akbarzadeh et al., 2014). A study done on humans found that supplementing with stevia in those with type 2 diabetes reduced postprandial blood glucose and glucagon response after a test meal of stevia vs placebo, though other studies have found that stevia supplementation has no significant effects on diabetes. Another study found that stevia may also help lower glucose and insulin levels in those that are not diagnosed with diabetes (Fitch, Keim, Academy of, & Dietetics, 2012).

Other studies showed that stevioside has a positive effect on health by helping to lower blood pressure. In one study, 168 men and women with mild hypertension took 500 mg of stevioside powder or a placebo 3 time a day. After 2 years, the stevioside group had significantly lowered their mean systolic and diastolic blood pressure to a normal range (Hsieh, 2003). Other studies found that stevia had no effect, though all were done for shorter periods of time.

Other studies have shown that stevia extracts alone as well as when they are incorporated into foods act as good antioxidants (Hajihashemi & Ehsanpour, 2014; Ruiz-Ruiz, Moguel-Ordonez, Matus-Basto, & Segura-Campos, 2015)

Many of these studies used stevioside alone or mixtures of stevioside and rebaudioside-A, in much higher doses than you would put in your coffee or tea. No adverse events or issues with safety were reported during these studies. Though more research about long-term use of rebaudioside-A by itself in amounts found in foods, beverages, and added sweeteners should be done, it seem that there is little risk associated with using stevia, especially if you opted to get the stevioside drops found in the supplement isle.

Future Research

There are other glycosides in stevia leaves that have the potential to be just as sweet and useful to the food industry. Companies are now researching rebaudioside-D and rebaudioside-X as possible additives in the future (Gelski, 2010).

Food companies are also researching how to genetically modify yeast to produce the desired glycoside. This would allow companies to produce stevia without the cost of maintaining plants, harvest, cutting, dissolving and heavy processing (Gelski, 2010). The concerns of GMOs will definitely still be present, however.

More research will also be done in the area of long-term use safety and how it affects gut microbiota since this is such a large concern with other artificial sweeteners.

Conclusion

While there are concerns about the chemical residues from the extraction process and added ingredients, it seems that stevia has not been shown to be dangerous, and may even have some health benefits. If you are interested in purchasing stevia for use as a sweetener, I would look for companies that are transparent about processing techniques and for products with the least amount of added ingredients.

References

Akbarzadeh, S., Eskandari, F., Tangestani, H., Bagherinejad, S. T., Bargahi, A., Bazzi, P., . . . Rahbar, A. R.

(2014). The Effect of Stevia Rebaudiana on Serum Omentin and Visfatin Level in STZ-Induced

Diabetic Rats. Journal of Dietary Supplements, 12(1), 11-22. doi:10.3109/19390211.2014.901999

Engber, D. (2014). The quest for a natural sugar substitute. The New York Times. Retrieved from:

https://www.nytimes.com/2014/01/05/magazine/the-quest-for-a-natural-sugar-

substitute.html?_r=0G\

Examine.com. Stevia. Retrieved from: https://examine.com/supplements/stevia/

Fitch, C., Keim, K. S., Academy of, N., & Dietetics. (2012). Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners. J Acad Nutr Diet, 112(5), 739-758. doi:10.1016/j.jand.2012.03.009

Gates, D. (2000) History of Use. Stevia.net. Retrieved from: http://www.stevia.net/history.htm

Gelski, J. (2010). Stevia needs a baking partner. Food Business News. Retrieved from:

http://www.foodbusinessnews.net/News/News-Home/Features/2010/7/Stevia-needs-a-

partner-in-baking.aspx?cck=1
Goyal S, Samsher, Goyal R. (2010)
. Stevia (Stevia rebaudian) a bio-sweetener: a review. International

Journal Of Food Sciences And Nutrition. 61(1), 1-10.

Hajihashemi, S., & Ehsanpour, A. A. (2014). Antioxidant response of Stevia rebaudiana B. to polyethylene glycol and paclobutrazol treatments under in vitro culture. Appl Biochem Biotechnol, 172(8), 4038-4052. doi:10.1007/s12010-014-0791-8

Hsieh, M., et. al. (2003). Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: A two-year, randomized, placebo-controlled study. Clinical Therapeutics, 25(11), 2797-2808

Nichols, H. Stevia: Health Benefits, Facts, Safety. Medical News Today. Retrieved from:

http://www.medicalnewstoday.com/articles/287251.php

Oliveira-Filho, R., Uehara, O., Minetti, C., & Valle, L. (1989). Chronic administration of aqueous extract of

Stevia rebaudiana (Bert.) Bertoni in rats: Endocrine effects. General pharmacology, 20(2), 187-191.

Pasquel, A., Meireles, M.A.A., Marques, M.O.M., &Petenate, A.J.. (2000). Extraction of stevia glycosides

with CO2 + water, CO2 + ethanol, and CO2 + water + ethanol. Brazilian Journal of Chemical

Engineering, 17(3), 271-282. https://dx.doi.org/10.1590/S0104-66322000000300003

Ruiz-Ruiz, J. C., Moguel-Ordonez, Y. B., Matus-Basto, A. J., & Segura-Campos, M. R. (2015). Nutritional, amylolytic enzymes inhibition and antioxidant properties of bread incorporated with Stevia rebaudiana. Int J Food Sci Nutr, 66(6), 649-656. doi:10.3109/09637486.2015.107778

Suez, J., Korem, T., Zeevi, D., Zilberman-Schapira, G., Thaiss, C. A., Maza, O., . . . Elinav, E. (2014). Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature, 514(7521), 181-186. doi:10.1038/nature13793

Stevia.com. (2016). How is stevia leaf extract made? Retrieved from:

https://www.stevia.com/2016/10/03/how-is-stevia-leaf-extract-made/

Truth in Advertising. (2014). What extra ingredients are in your natural stevia product? Retrieved from:https://www.truthinadvertising.org/extra-ingredients-natural-stevia-product/

U.S. Food & Drug Administration. (2017). Generally recognized as safe (GRAS). Retrieved from:

https://www.fda.gov/food/ingredientspackaginglabeling/gras/

Yilmaz, S., & Ucar, A. (2014). A review of the genotoxic and carcinogenic effects of aspartame: does it safe or not? Cytotechnology, 66(6), 875-881. doi:10.1007/s10616-013-9681-0

Traditional Foods

The Nutritional Benefits of Sourdough Bread
Sourdough Bread

The Nutritional Benefits of Sourdough Bread

By Author Name

Dietetic Intern at Stephen F. Austin State University

Sourdough breads have recently been popping up at most major grocery stores. However, sourdough breads have been around for centuries! You may be thinking- what's the difference between sourdough bread and regular bread, aren't they both made from flour? This post is here to explain the many unique nutritional benefits from sourdough bread.

What is Sourdough Bread?

Before we get into the nutritional benefits of sourdough, let's first get a clear understanding of what exactly is sourdough bread. Sourdough breads were one of the first forms of leavened breads. The lactic acid bacteria and the wild yeasts that are present in sourdough leaven the bread, which make it fluffy and light. Today, most breadis leavened with baker's yeast due to its simplicity and convenience.Sourdough can be made with refined white flour, whole-wheat flour, or a variety of different grains including barley, quinoa, and oat. It is common in the Mediterranean and Middle East, and especially popular in San Francisco. Each sourdough is unique due to the bacteria and fungi that are present in the region it is prepared. Authentic sourdough breads can be found at local farmers markets and specialty shops. It has a mildly sour flavor, hence the name, sourdough(Poutanen, Flander, & Katina, 2009).

Fermentation

Traditional sourdough breads are made with lactic acid bacteria and naturally occurring yeasts. These ingredients are then fermented; a long, slow ferment is recommended for the most health benefits. This process does produce probiotics, however, these probiotics are destroyed during the baking process. But the good news is that recent studies show that killed probiotics may have positive effects on health! Even though sourdough doesn't contain probiotics, it does contain exopolysaccharides, which acts as a prebiotic to feed the good intestinal bacteria(Poutanen, Flander, & Katina, 2009). The breads that have a longer ferment have no need for additional leavening agents, including baking soda or brewers yeast. These breads can be made with only 4 simple ingredients: flour, water, salt, and a sourdough starter. If you are making sourdough at home, a sourdough starter can be made or purchased (Marco et al., 2017).

Improved Digestibility

The long, slow fermentation process helps break down carbohydrates. It decreases the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FOD-MAPS) that are found in breads. The reduced FOD-MAP content in sourdough bread improves the digestibility of the bread. This means that patients with IBS may be able to tolerate sourdough breads! Food trials are necessary to determine if a patient with IBS can tolerate sourdough(Poutanen, Flander, & Katina, 2009).

Sourdough breads have also been shown to have a reduced gluten content. The decreased pH during fermentation causes gluten degradation. The reduced gluten content of sourdough may improve digestion too! It is important to note that individuals with celiac disease, non-celiac wheat sensitivity, and other forms of gluten intolerance still cannot properly digest the glutenfound in sourdough breads(Poutanen, Flander, & Katina, 2009). However, sourdough breads can be made from gluten-free flours! The sourdough fermentation of gluten-free products improves the taste, texture, and can even delay the onset of staling. So you can still receive the health benefits of sourdough even on a gluten-free diet (Rizzello, Lorusso, Montemurro, &Gobbetti, 2016).

Phytic Acid

Phytic acid (PA)is a chemical compound that act as anti-nutrients in the body because it inhibits the absorption of certain minerals including calcium, magnesium, zinc, and iron (Lopez et al., 2003).The PA binds to these minerals forming phytates, which cannot be absorbed by the body. These phytates pass through the intestinal track unabsorbed and these important minerals are excreted. PA is found in high amounts in many whole-grain products including traditional breads. Even when sourdough bread is made from the same flour as conventional bread, it has a lower PA content. This is due to the lactic acid bacteria lowering the pH of the bread, which causes phytate hydrolysis that reduces the PA content of the bread (Leenhardt, Levrat-Verny, Chanliaud, &Rémésy, 2005).This means that the minerals found in sourdough bread can be absorbed and utilized in the body!

Glycemic Index

The glycemic index is a measure of the rise in blood glucose after a food is consumed. Foods that are high in carbohydrates and low infiber typically have a high glycemic index. Traditional white bread has a glycemic index of 70. Studies show that sourdough breads made from both white flour and whole-wheat flour have a lower glycemic index than the traditional counterparts. Individuals with type 1 and type 2 diabetes mellitus, should be aware of food with a high glycemic index because it can cause a rapid rise in blood glucose(De Angelis et al., 2007). In a recent study of healthy participants, sourdough's effects on postprandial glycemic and insulin responses were evaluated. This study compared sourdough bread leavened with lactobacilli and a normal bread leavened with baker's yeast. This study found that the participants who received the sourdough bread had lower plasma glucose and lower plasma insulin responses (Maioli et al., 2008). This means that patients with impaired glucose metabolism, like diabetes, may benefit from consuming sourdough bread!

Overall, sourdough breads can be a great addition to a healthy and balanced diet. Sourdough breads unique fermentation helps improve mineral bioavailability and digestibly, while lowering the phytic acid content and the glycemic index. So whether you enjoy sourdough breads for their health benefits or for it's delicious flavor, choosing to go sour can actually be a pretty sweet deal!

References

Bartkiene, E., Juodeikiene, G., Vidmantiene, D., Viskelis, P., &Urbonaviciene, D. (2011). Nutritional and quality aspects of wheat sourdough bread using L. luteus and L. angustifolius flours fermented by Pedioccocusacidilactici.International Journal of Food Science and Technology, 46(8), 1724-1733.

Bryszewska, M. A., Ambroziak, W., Diowksz, A., Baxter, M. J., Langford, N. J., & Lewis, D. J. (2005). Changes in the chemical form of selenium observed during the manufacture of a selenium-enriched sourdough bread for use in a human nutrition study. Food Additives and Contaminants, 22(2), 135-140.

De Angelis, M., Rizzello, C. G., Alfonsi, G., Arnault, P., Cappelle, S., Di Cagno, R., &Gobbetti, M. (2007).Use of sourdough lactobacilli and oat fibre to decrease the glycaemic index of white wheat bread.British Journal of Nutrition, 98(06), 1196-1205.

Leenhardt, F., Levrat-Verny, M. A., Chanliaud, E., &Rémésy, C. (2005). Moderate decrease of pH by sourdough fermentation is sufficient to reduce phytate content of whole wheat flour through endogenous phytase activity. Journal of Agricultural and Food Chemistry, 53(1), 98-102.

Lopez, H. W., Duclos, V., Coudray, C., Krespine, V., Feillet-Coudray, C., Messager, A., &Rémésy, C. (2003). Making bread with sourdough improves mineral bioavailability from reconstituted whole wheat flour in rats. Nutrition, 19(6), 524-530.

Maioli, M., Pes, G. M., Sanna, M., Cherchi, S., Dettori, M., Manca, E., & Farris, G. A. (2008). Sourdough-leavened bread improves postprandial glucose and insulin plasma levels in subjects with impaired glucose tolerance. ActaDiabetologica, 45(2), 91-96.

Marco, M. L., Heeney, D., Binda, S., Cifelli, C. J., Cotter, P. D., Foligné, B., &Smid, E. J. (2017). Health benefits of fermented foods: Microbiota and beyond. Current Opinion in Biotechnology, 44(1), 94-102.

Poutanen, K., Flander, L., & Katina, K. (2009). Sourdough and cereal fermentation in a nutritional perspective.Food Microbiology, 26(7), 693-699.

Rizzello, C. G., Lorusso, A., Montemurro, M., &Gobbetti, M. (2016). Use of sourdough made with quinoa (Chenopodium quinoa) flour and autochthonous selected lactic acid bacteria for enhancing the nutritional, textural and sensory features of white bread. Food Microbiology, 56(1), 1-13.

Scazzina, F., Del Rio, D., Pellegrini, N., &Brighenti, F. (2009). Sourdough bread: Starch digestibility and postprandial glycemic response. Journal of Cereal Science, 49(3), 419-421.

Tucker, A. J., MacKay, K. A., Robinson, L. E., Graham, T. E., Bakovic, M., & Duncan, A. M. (2010). The effect of whole grain wheat sourdough bread consumption on serum lipids in healthy normoglycemic/normoinsulinemic and hyperglycemic/hyperinsulinemic adults depends on presence of the APOE E3/E3 genotype: A randomized controlled trial. Nutrition and Metabolism, 7(1), 37-50.

Weight Regulation

A Non-Diet Approach to Weight Loss and Dieting Myths Debunked
Fruits FND Blog A Non-Diet Approach to Weight Loss and Dieting Myths Debunked
By Nathan Slinkard
Dietetic Intern at Stephen F. Austin State University


The ever elusive goal of sustained weight loss has been chased by so many Americans with varying degrees of success and failure (at least 80% fail). Weight loss frenzy has caused food producers, doctors, and "health" companies to create pills and concoctions and plans to help us tighten our belts. But why are so many Americans still obese? Why do dieters fail so often? Hasn't someone figured out the perfect weight loss diet by now? Although the weight loss industry in America has suffered some losses in recent years due to distain for diet products and weight-loss programs, it still amassed $64 billion in revenue in 2014. In fact, other weight loss avenues such as bariatric surgery and health club memberships have risen in popularity. In this blog, we'll take a look at some of the reasons why weight loss can be so challenging and some strategies that actually work for the majority of people. But here's a spoiler alert: everyone is different and there is not one approach that fits all.


The myth that cutting 3500 calories a week results in one pound of fat loss:


A widespread generalization still popular today, is that one pound of body fat is equivalent to 3500 calories. The reason why this is an inaccurate assumption, is that everyone is different and, thermodynamically speaking,the body digests and stores food at a rate unique to the individual. Furthermore, the trillions of bacteria in our guts caneven impact how many calories we absorb. A review of seven closely-controlled clinical weight loss studiestested the accuracy of the 3500 calorie rule. The participants, who were monitored at all times, restricted calories over an average of 64.8 days with an average deficit of 1,409 calories. If 3500 calories means one pound of weight loss, the participants should have lost an average of 27.6 pounds. However, they lost an average of 20.1 pounds plus or minus a huge range of 12.6 pounds. This brings up an important point which we'll discuss next: why do dieters hit plateaus during their weight loss journeys?


Cutting calories and adaptive thermogenesis


This point is one that frustrates many to no end and leads to feelings of hopelessness. I'm referring to the "wall" that calorie cutters often hit after just one or two weeks of quick weight loss. This can be attributed to how our body's metabolism slows in response to weight loss. Research has shown that energy expenditure slows by 20-25% after a 10% reduction in body weight, mostly due to a change in non-resting energy expenditure. That's an extra 10-15% less calories that we expend beyond what might have been predicted by recalculating energy expenditure. This is due to a complex, coordinated reaction by our bodies that involves many neuroendocrine and metabolic pathways.


Thrifty Genes and the Set Point Theory


The Thrifty Gene Hypothesis claims that this modern weight loss conundrum can be explained by "thrifty genes" that efficiently store food as fat in times of reduced calorie consumption. Our ancestors lacked the luxury of grocery stores and fast food restaurants and had frequent food shortages. The idea then is that our bodies have evolved to efficiently store food as body fat in times of famine. A society in which we no longer forage or hunt for food has fueled an overabundance of this storage! Another well-known ideology, the Set Point Theory, says that each individual has a fairly narrow range of weight that their body is comfortable with. Any change in weight, whether gained or lost, will result in the body fighting against this with shifts in metabolism. Perhaps those that tend to carry a little extra weight were never really meant to lose it. So, how is it possible to lose weight and keep it off when our bodies seem to be fighting against us? The resounding answer is that sustained weight loss must involve lifestyle changes.


Why lifestyle changes are more important than a diet


A large study conducted in Australia sought to determine how effective or detrimental habitual dieting is for weight loss. They adjusted the data for initial BMI (Body Mass Index) and tracked what happened over the following 12 months. Amazingly, the risk of developing obesity was 1.9, 2.9 or 3.2 times higher for those that dieted once, more than once, and always, respectively, versus non-dieters. Non-dieters had much better odds of maintaining their BMI or reducing it compared to dieters. Whoa! The researchers copied what many health professionals preach by saying that "losing weight requires a commitment to change one's lifestyleand a sustained effort to maintain a healthy diet and engage in physical activity". That's right, folks! It is nearly impossible to keep weight off without making some lasting changes. This is not to say that every diet approach is ineffective, and it is important to determine which pattern of eating is most effective for you.


No diet works for everyone


If habitual dieting has a poor track record, what has been effective? One of the hottest trends is the ketogenic diet which keeps your fats very high (around 80% of your calories), your protein pretty moderate (~10-20%), and your carbs extremely low (~20-50 grams per day).And it has shown to be very effective for some. However, low-fat vegan and vegetarian diets, at the opposite end of the scale, have also shown to promote great weight loss results. So, wait. Which diet, as you're asking right now, is better?Even more important questions to ask, though, are "why did these diets fail some participants?" and "would you fall into this group?" The answer to the first question, as you probably guessed, is that everyone is different. There is exciting new research of how personalizing diet based onan individual's genetics, also known as nutrigenomics,can help reduce the risk of developing conditions like obesity. However, personalized nutrition based on genetics has certainly experienced some growing pains. The second question, then, is harder to answer and may very well take some trial-and-error. By no means, though, should you have to do this all on your own. Nutrition counselling is ideal, especially when navigating the field of nutrigenomics, and is helpful for weight loss in both group and individual formats.


Lifestyle changes to implement and a brief conclusion


The most effective weight loss strategies center around improving sleep, reducing stress, getting off the couch and moving around more, and eatinga diet low in processed foods and loaded with vegetables. Often the reason why studies show great results for vastly different diets,(such as the Mediterranean or the vegan or the ketogenic) is that participants go from eating a standard American junk food diet to making conscious decisions about what they put into their bodies.If you go from eating McDonald's to tofu or salmon or a grass-fed avocado burger, then you have a pretty decent chance of losing belly fat! These diets often have overlapping core principles like choosing whole foods, real foods, and foodproducts with fewer ingredients. These, along with the following tips, are time-honored approaches to better health. Increase your physical activity to boost your metabolism and practice mindful eating to help avoid overeating. Drink plenty of water for itshealth benefits like helping to prevent headaches and constipation, but also for its potential impact on weight loss itself and because thirst may be misinterpreted by the body as hunger. Keep track of how your diet is impacting your lab values, and investigate underlyingproblemsif you fail to lose weightsuch as sleep apnea and hormonal imbalances. Rely on friends and family for support and seek nutritional counselling for guidance, especially with regards to optimizing diet based on genetic testing.


In conclusion, remember to not expect exactly one pound of weight loss for every 3500 calories that you cut. Know that the human body adapts to weight loss by adjusting metabolic rates, and that it may be an uphill battle because of our evolution and genetics. But take heart, because you know a secret that failing dieters are not accepting: smart,lifestyle changes trumphabitual on and off dieting for sustained weight loss results.


References


[1]Kell J. Lean times for the diet industry. Fortune. http://fortune.com/2015/05/22/lean-times-for-the-diet-industry/. Published May 22, 2015.

[1]Thomas DM, Martin CK, Lettieri S, et al. Can a weight loss of one pound a week be achieved with a 3500-kcal deficit? Commentary on a commonly accepted rule. International Journal of Obesity. 2013;37(12):1611-1613. doi:10.1038/ijo.2013.51.

[1]Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. International journal of obesity (2005). 2010;34(0 1):S47-S55. doi:10.1038/ijo.2010.184.

[1]Siahpush M, Tibbits M, Shaikh R, Singh G, Sikora Kessler A, Huang T. Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample. International Journal Of Behavioral Medicine [serial online]. October 2015;22(5):662-671. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed April 14, 2018.

[1]Dashti HM, Mathew TC, Hussein T, et al. Long-term effects of a ketogenic diet in obese patients. Experimental & Clinical Cardiology. 2004;9(3):200-205.

[1]Huang R, Huang C, Hu F, Chavarro J. Vegetarian Diets and Weight Reduction: a Meta-Analysis of Randomized Controlled Trials. Journal Of General Internal Medicine [serial online]. January 2016;31(1):109-116. Available from: MEDLINE, Ipswich, MA. Accessed April 15, 2018.

[1]Luan J, Browne P, Wareham N, et al. Evidence for Gene-Nutrient Interaction at the PPAR lambda Locus. Diabetes [serial online]. March 2001;50(3):686. Available from: Academic Search Complete, Ipswich, MA. Accessed April 15, 2018.

[1]Moleres A, Ochoa M, Marti A, et al. Dietary fatty acid distribution modifies obesity risk linked to the rs9939609 polymorphism of the fat mass and obesity-associated gene in a Spanish case-control study of children. The British Journal Of Nutrition [serial online]. February 2012;107(4):533-538. Available from: MEDLINE, Ipswich, MA. Accessed April 15, 2018.

[1]Kourlaba G, Kondaki K, Grammatikaki E, et al. Interaction effects between total energy and macronutrient intakes and angiotensin-converting enzyme 1 (ACE) I/D polymorphism on adiposity-related phenotypes in toddlers and preschoolers: the Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS). British Journal Of Nutrition [serial online]. December 2008;100(6):1333-1340. Available from: Agricola, Ipswich, MA. Accessed April 15, 2018.

[1]Qi Q, Sacks F, Qi L, Bray G, Hu F. Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: the Preventing Overweight Using Novel Dietary Strategies trial. American Journal Of Clinical Nutrition [serial online]. February 2012;95(2):506-513. Available from: Agricola, Ipswich, MA. Accessed April 15, 2018.

[1]Phimarn W, Paktipat P, Pansiri K, Klabklang P, Duangjanchot P, Tongkul A. Effect of Weight Control Counselling in Overweight and Obese Young Adults. Indian Journal Of Pharmaceutical Sciences [serial online]. January 2017;79(1):35-41. Available from: Academic Search Complete, Ipswich, MA. Accessed April 14, 2018.

[1]Chang T, Ravi N, Plegue MA, Sonneville KR, Davis MM. Inadequate Hydration, BMI, and Obesity Among US Adults: NHANES 2009-2012. Ann Fam Med. 2016:320-324. doi:10.1370/afm.1951.Introduction.

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Say Good-Bye to Eating Rules
Weight Regulation

Say Good-Bye to Eating Rules

By Tiffany Kroll

Dietetic Intern at Stephen F. Austin State University

Intuitive Eating is the non-diet approach to help individuals relearn how to eat in response to internal, rather than external cues (Bush et al, 2014). It is learning to listen to your body, rather than ignoring those inner cues - you know, that tell you when you are hungry and when you are full. It isn't restrictive eating, it is relying on your body to know when to eat, how much to eat, and when to stop. I'm sure you've heard your friends talk about diets that they've tried, or said something like, "oh my goodness, Spring Break is 4-weeks away, need to start my cleanse." When you turn on the television it seems like there's a new diet advertisement every day, or a new way to exercise, or some new "miracle pill" that'll melt the fat away. Well, intuitive eating is something that's not a diet, it's a way of life. It's time that we all say "no" to the diets, and start listening to what our bodies are trying to say.

There have been multiple studies showing that restrictive eating does not result in reduced weight in the long term but also, that the majority of individuals dieting to lose weight regain the weight they lost (Mann et al, 2007). Some researchers believe that dieting can actually lead to obesity, due to the mechanism of "yo-yo dieting". If that is the case, then why do so many people continue to do these restrictive diets? Maybe they just need to adopt intuitive eating! I am going to share with you the 10 principles that Tribole and Resch (2012) discussed in their book, Intuitive Eating: A Revolutionary Program That Works.

Reject the Diet Mentality

Rejecting the diet mentality helps people avoid feeling guilty about their meals, let go disordered eating, negative body views, stress, and overall negative relationships with food. The Eat for Life intervention study found that intuitive eating is associated with a positive body appreciation, and that people who live an intuitive eating lifestyle have a lower body mass index (BMI) and make more healthful choices (Bush et al, 2014). Also, studies have shown that post-dieting binges occur in ~50% of all people who end a diet (Tribole& Resch, 2012). You don't have time in college to have an additional stress factor, so ditch the diet mind.


Honor Your Hunger

Hunger is not the bad guy, it's a natural feeling to become hungry, but it's up to you to listen to your hunger cues. As Lauren Outland says, "weight homeostasis does not exist," and we can't fool mother nature (Outland, 2010). When we ignore our hunger cues and proceed to restricting, we may be damaging body chemicals, tissues, and organs. Going hungry causes an increase in ghrelin, an increase in brain hunger chemicals, possible leptin resistance, and metabolism to slow down. Then, once we have the opportunity to eat, we tend to consume more than we would in the first place because we are "starving" (it's an evil cycle). Next time you feel your tummy growling, allow yourself to have a snack, and try not to ignore your hunger cues.

Make Peace with Food

Do you have a favorite food? Sure you do. Now think about that food, do you allow yourself to eat it or do you restrict yourself on how often you eat it? If you tend to restrict yourself from that specific food then think again, and end that war. Stop thinking about what you can and can't have, and learn to fit it into your meals. There's no need to live the majority of your life missing out on the foods we enjoy most, just discover ways to balance your meals, eat some veggies, and maybe get a few extra steps with your friends and family that day.

Challenge the Food Police

See that picture that I first introduced this post with? Well this plays right into that. Our minds have so many things running through it including work, school, money, friend drama, family issues, you name it. Who wants to add another player into the mix? Not I. There is no more of labeling foods, "good" and "bad", because all foods are allowed in your diet. Get rid of that little voice in your head saying, "don't eat that or else this", "can't eat that it's not allowed", "oh that has too much sugar", and the commentary can continue all the way to the check-out line at the grocery store. Don't place all of these food rules in your brain, because I'm sure your brain has enough to think about as it is. Also, if you're concerned about your weight then let me ease your mind. Avalos and Tylka discovered that individuals who responded to their internal hunger and satiety cues on a regular basis tended to be at a weight that is appropriate for their body type, as well as having increased levels of psychological well-being (Avalos &Tylka, 2006). Stop giving yourself another thing to stress about, and enjoy life without the food police!

Respect Your Fullness

Your body is very intelligent, and it is capable of many things, and one thing is knowing when it is satisfied. Listen to the signals your body is sending when you are eating a meal, and understand when your body has had what it needs. Denny et al, looked at intuitive eating in young adults, and they found that women who listened to their body when they were full had lower odds of chronic dieting and binge eating (Denny et al, 2013). When take out all the external cues, and tune in to your internal cues you'd be surprised at what you'll discover while eating.

Discover the Satisfaction Factor

Eating should be a pleasant experience, and it should be a time that you are able to sit down and enjoy the meal that is in front of you. Sometimes we may not all be able to take an hour-long lunch, but for that brief time that you do have, be satisfied with the food on your plate. Augustus-Horvath and Tylka looked at the acceptance model of intuitive eating, and found that individuals who ate mindfully often chose foods that help their bodies function well in addition to being pleasing to their palate (Augustus-Horvath &Tylka, 2011). Eating mindfully doesn't have to be boring, and if you don't like celery then don't eat it. No one forces you to eat things you don't enjoy, and you shouldn't force yourself either. Next time you go to the grocery store have a plan to make a meal that is beneficial to your body along with being appealing to your taste buds. Make meal times a delightful experience, and make it colorful!

Honor Your Feelings Without Using Food

One way that people tend to cope with their feelings is by eating, or better known as "emotional eating". Yes, it's nice to "treat yourself" when you're feeling a bit down, but discover other ways to cope with your emotions other than using food as a reward. Be in-tune with your body, and realize when you are hungry versus bored or upset. Herbert et al found that those who reported practicing intuitive eating were less likely to overindulge in food in the absence of hunger (Herbert et al, 2013). When you find yourself wanting food to help you feel better, think of ways to combat your emotions by not using food as that coping mechanism.

Respect Your Body

We are each created to be special and unique, none of us will have the same body frame, none of us will have the same muscle tone, and none of our bodies will respond to food the same exact way. Learn to appreciate your body, and love the one you have because it's the only one you have. Schoenefeld and Webb discovered that young women who reported higher level of engagement in intuitive eating further reported both higher levels of body image acceptance and compassion as well as being moderate in size (Schoenefeld& Webb, 2013).Another study found similar results, that women with higher levels of intuitive eating are, "more satisfied with their bodies and perceive less pressure to be thin," (Tylka, 2006). Our society is so judgmental and cruel these days, doing way more harm than good, and we need to learn how to ignore what they say and listen to what our body says. Fuel your body with the proper nutrients, let the body do its job, and have self-compassion. Learn to love your body and be comfortable in your own skin.

Exercise - Feel the Difference

Physical activity should be FUN, not a constant misery that you feel is necessary to do 7-days out of the week in order to "maintain your figure". Gastet al, looked at undergraduate women and found that those who were internally motivated to engage in physical activity were also less likely to engage in restrictive eating, and more likely to practice self-care (Gast et al, 2013). This study also showed that increased scores on the Intuitive Eating Scale were correlated with decreases in BMI in both male and female subjects. If we eat intuitively, then our BMI will take care of itself and we won't have to constantly worry about getting those 2-hours of exercise in a day. Try to find ways to move your body that you enjoy, and learn different exercises that your body is capable of doing.

Honor Your Health - Compassion

What you put into your body should taste good, and you shouldn't feel limited to certain foods because in intuitive eating ALL foods are allowed. If you want to indulge, then allow yourself to have that item you desire, because one meal or snack isn't going to break your health. One study on the Health at Every Size program (HAES), found that once the participants listened to their hunger and satiety cues, they were able to regulate their food intake, feel better about themselves, and maintain this behavior change over the 104-week period (Bacon, 2005). They also found that the HAES group saw a decrease in LDL cholesterol and systolic blood pressure, along with sustaining these results at the 2-year follow-up whereas the diet group that was studied did not. Seeing this, it should give us joy that our body knows exactly what to do with the food we put inside of it and once we listen to it, then our overall health will improve as well. Our bodies are truly amazing.

Let's all say good-bye to eating rules, and adapt the intuitive way of eating. Listening to our hunger and satiety cues, enjoying physical activity, nurturing our body with compassion, fueling it with the nutrients it needs, and loving it for all the wonderful things it is capable of. The weight will adjust itself, just trust the process and trust your body.You are wonderfully made, and you are beautiful in your own skin.

References

Augustus-Horvath, C., &Tylka, T. (2011). The acceptance model of intuitive eating: a
comparison of women in emerging adulthood, early adulthood, and middle
adulthood. Journal of Counseling Psychology. Accessed from
http://u.osu.edu/tracyltylka/files/2015/02/Augustus-HorvathTylkaJCPArticle
2buggx0.pdf.

Avalos, L., &Tylka, T. (2006). Exploring a model of intuitive eating with college women.
Journal of Counseling Psychology. Accessed from
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Bacon, L., Stern, J., Loan, M., &Keim, N. (2005). Size acceptance and intuitive eating
improve health for obese, female chronic dieters. The American Dietetic
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Bush, H., Rossy, L., Mintz, L., &Schopp, L. (2014). Eat for life: a work site feasibility
study of novel mindfulness-based intuitive eating intervention. American Journal
of Health Promotion. Accessed from
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Denny, K., Loth, K., Eisenberg, M., &Neumark-Sztainer, D. (2013). Intuitive eating in
young adults: who is doing it, and how is it related to disorder eating behaviors?
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Gast, J., Nielson, A., Hunt, A., &Leiker, J. (2013). Intuitive eating: associations with
physical activity motivation and BMI. American Journal of Health Promotion.
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Herbert, B., Blechert, J., Hautzinger, M., Matthias, E., & Herbert, C. (2013). Intuitive
eating is associated with interoceptive sensitivity: effects on body mass index.
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Jennings, K. (2016). A quick guide to intuitive eating. Authority Nutrition. Accessed from
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Mann, T., Tomiyama, A., Westling, E., Lew, A., Samuels, B., & Chatman, J. (2007).
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Schoenefeld, S., & Webb, J. (2013). Self-compassion and intuitive eating in college
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Tribole, E., & Resch, E. (2012). Intuitive Eating: A Revolutionary Program That Works.
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Tylka, T. (2006). Development of psychometric evaluation of a measure of intuitive
eating. Journal of Counseling Psychology. Accessed from
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