Nutrition Hot Topics

1. Nutrition Hot Topics Joe Standard HN 780 Fall 2011

2. Overview • American Diet Shift in the three major macronutrients • A quick look at Sugar and Sweeteners • US fruit and vegetable consumption • Exercise • Food Allergies/Autoimmune Disorders and the Hygiene Hypothesis

3. Diet Change is Prescribed • American healthcare providers have advised patients to avoid fats and sugars in order to prevent diseases such as: cardiovascular diseases (CVD), diabetes, and cancers related to obesity. • So does cutting out the fat solve the problem?

4. Diet change over the past 40 years1

5. Rising Obesity Rates and decreased fat intake? • In the US in 1977-1978, fat consumption represented 40% of our total caloric intake, whereas it dropped to 33% in 1994-1996. • Saturated Fat, which is involved in plaque formation, consisted of 13% of total caloric intake in 1985-1986, but dropped to 11% in 1994-1996.2

6. US Obesity Trends Timeline3

7. Energy Balance • The three macronutrients that provide the body with energy are: • Fat (9 cal/g) • Carbohydrates (4 cal/g) • Protein (4 cal/g)

8. What would happen if we eliminated fats and sugars (carbohydrates) from our diets?

9. Protein-only diet • A diet that consists solely in protein alone is not sustainable in that it does not create Kreb’s Cycle (Citric Acid Cycle) intermediates. The body will metabolize fat before metabolizing protein from muscle. This will lead to ketoacidosis, an organ-damaging situation and possible life-threatening condition.4 A high protein diet may strain the kidneys and liver.

10. Case Study: Minnesota Starvation Experiment (Decreased Calories) • Subjects were conscientious objectors during World War II. They were fed a diet of 1800 Cal/day, and exercised to have a daily expenditure of 3000 Cal/day.5

11. Minnesota Starvation Experiment • During the experiment, two patients developed psychological disorders, and members were noted for increased irritability, decreased sex drive, lower body edema, lethargy, weakness following themajorweight loss (some lost 50 lbs, close to 33% body weight loss).5

12. β-Oxidation and the role of fat in energy metabolism • β-oxidation is the process of oxidizing fat stores for energy. This process provides an important store of energy during starvation and/or other stress situations in which carbohydrate intake is limited.

13. Functions of Fat Other positive roles of fat include: • body insulation, protecting the internal organs (acts as shock absorption) • cell membrane structure • vitamin storage—Vitamins A, D, E, K • production of eicosanoids such as prostaglandins, leukotrienes, and thromboxanes.6

14. Omega-3 Fatty Acids • Omega-3 fatty acids create Group 3 Eicosanoids, which could against protect cardiovascular disease (CVD) through its action of decreasing blood pressure and decreasing platelet aggregation.7

15. What does it mean if I have high triglyceride levels? • High triglyceride (TG) levels usually occur when patients eat a diet consisting of high amounts of simple sugar carbohydrates, leading to fat storage as TG’s. • High TG’s are often a precursor to CVD. • Some ways to decrease TG’s: lose 5-10% of body weight, keep carbohydrate consumption below 60% of caloric intake, eat more fruits and vegetables, and enjoy oily, unsaturated fats.8

16. How does eating carbohydrates cause me to gain body fat? • Carbohydrates get broken down into glucose in the bloodstream. After eating, increased blood glucose causes insulin to store glucose as either glycogen (minor amount) or body fat (most of the excess glucose). Thus, the excess carbohydrates spikes insulin levels, which store excess glucose as more fat in the body.9

17. How to get healthy carbs • Choose Whole Grain Foods, which contain heart health dietary fiber. Examples could be switching over to whole grain bread (instead of white bread), brown rice (instead of white rice), and choosing whole grain cereals, oatmeal, and granola products. Also, it is important to make sure breads say whole grain and not just multi-grain breads.

18. Is sugar or fat the main problem with obesity? • A recent mice study indicated that a high fructose/high fat diet causes a leptin insensitivity while a sugar-free/high fat diet did not incur leptin insensitivity.10

19. What arehealthier ways to enjoy fats? • Try unsaturated fats like olive oil and fish oils, which are better in cardiovascular disease prevention. • Omega-3 fatty acids found commonly in fish tend to have heart health protection.11

20. Fat Substitutes12 • The main fat substitutes include: protein substitute fats, carbohydrate substitute fats, and indigestible fats (Olestra). • One major problem with carbohydrate substitute fats is that they are higher in carbohydrates than the actual fat product, so the total number of calories increases. • Olestra can cause indigestion such as with Wow potato chips (right).

21. Ways to reduce sugar intake • Be careful with sweeteners. Aspartame seems to be one of the more problematic sweeteners (possible: brain cell damage, weight gain, PKU problem). Stevia (lower left), sugar alcohols, and organic raw honey seem to be the best sweetener for the body.13,14

22. Agave: The Trending Sweetener? • Agave is a new sweetener for many in the US. It is highly processed, with higher amounts of fructose than high fructose corn syrup. • The selling point of Agave is that it is natural, raw, and has a low glycemic index. In terms of health benefits, agave seems to be no more healthy than table sugar or honey because of its high fructose content.15

23. Do diet drinks fool the body? • In a recent rat study, use of saccharin and Ace-K caused increased in body weight compared to a glucose control sweetener.16,17 • Human Meta-analysis studies have shown an association between diet soft drink consumption and increased weight.17,18

24. Theories for why diet soda drinkers gain weight17 • It may be an associative but not causative factor. • The body may detect the sweetness of the sweetener in the intestine and have an insulin-like hormonal response.18 • The artificial sweeteners may throw off the body’s weight-management system and throw the whole system “off-kilter.”

25. The verdict on is still out on artificial sweeteners… • Some studies have shown that artificial sweeteners do not cause a weight gain.19,20 • Some of the problems could be with the methodology of the experiments (perhaps people who were tested were lighter weight and had other factors that controlled weight). • Many researchers utilize animal studies or cell culture studies. • Various artificial sweeteners have shown to have mild carcinogenic effect in animal models but do not show same effects in humans.

26. Food group recommendations • According to myplate.gov and 2010 USDA Dietary Guide, • A 2000 Calorie diet/day should contain: • 65 g fat • 50 g protein • 25 g dietary fiber • 45-65% Carbohydrates, half of which are whole grain • Limited Sugar and Sugary Drinks

27. Rising cost of fruits and vegetables21

28. Getting the necessary fruits and vegetables (5-9 RDA) • 3 Ways to Improve Fruit/Vegetable Consumption: • Grow fruits and vegetables (FV) in your own backyard. A recent Minnesota community intervention at a summer camp encouraged kids to grow fruits and vegetables. Child consumption of FV went from 2.9/day to 3.3/day after the 12 week camp program.22 • Purchase fresh fruits and vegetables at a locally, such as at a farmer’s market • Purchase fruits and vegetables that you enjoy eating!

29. Stay Physically Active • The US Department of Health and Human Services 2008 Physical Activity Guideline for Americans recommends: • 150 minutes of moderate intensity exercise/week (e.g. brisk walking) or 75 minutes of vigorous intensity exercise/week (jogging) • Full body muscle weight lifting twice a week23

30. What if I do not go to a gym? • If possible, walk to places instead of driving. • Take stairs instead of elevator. • Stay active in doing chores around the house. • Play outside with friends or family. • Find a game or activity that you enjoy and commit to doing regularly.

31. Food Allergies/ Autoimmune Disorders • The “Hygiene Hypothesis” is the idea that Western Nations with high rates of cleanliness are more susceptible to autoimmune disease because their immune systems are overactive. • Food allergies/autoimmune disorders such as Celiac Disease, Ulcerative Colitis, and Crohn’s Disease are raising at a rate that appears to be beyond genetics and in line with the hygiene hypothesis.24

32. Possible Treatment • Allow children to be outside more and in areas with animals such as farms. • Be careful with how often we use sanitizers in our own homes. • Helmitic Theory: Some have used parasites such as tapeworms as treatment for inflammatory bowel disease as well as asthma and other autoimmune disorders.24

33. Summary • Make sure to eat a balanced combination of protein (10-35%) , fat (20-35%), carbohydrate (45-65%).25 • Besides decreased physical activity, increased carbohydrate intake may be a reason for increased obesity. • Choose to eat fruit and vegetables you enjoy. • Find exercise activities that are fun. Be creative! • Find a balance in keeping your house clean. Make sure to expose your kids to outdoor settings that could be protective against food allergies and asthma.

34. Acknowledgements • Dr. Delores Chambers, Course Professor • Dr. Richard Baybutt and Dr. Brian Hunt from Wheaton College • Dr. Weiqun (George) Wang, major professor at Kansas State University • My family

35. References • CDC. 2004. 2 Dec. 2011 Department of Health and Human Services <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm> • Medeiros and Wildman, Advanced Human Nutrition: 2nd Ed. (Burlington, MA: Jones and Bartlett, 2011) 115. • Calle EE and Kaaks R. (2004) Overweigh, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4(8):579-91. • Medeiros and Wildman, Advanced Human Nutrition: 2nd Ed. (Burlington, MA: Jones and Bartlett, 2011) 119. • Kalm Leah M, and Richard D. Semba. (2005) They starved so that others be fed: remembering Ancel Keys and the Minnesota Experiment. Journal of Nutrition. 135(6): 1347-1352. • Medeiros and Wildman, Advanced Human Nutrition: 2nd Ed. (Burlington, MA: Jones and Bartlett, 2011) 270. • Soberman, Roy J., and Peter Christmas. (2003) The organization and consequences of eicosanoid signaling. J. Clin. Invest 111(8): 1107-1113. • Triglycerides: Frequently Asked Questions. 2011. 3 Dec. 2011 American Heart Association <http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_425988.pdf>.

36. References cont. • Diabetes Health. 2011 3 Dec 2011 Diabetes Health <http://www.diabeteshealth.com/read/2007/04/24/5143/why-eating-too-many-carbs-makes-you-fat/>. • Shapiro, Alexandra; Tumer, Nihal; Yongxin, Gao; Cheng, Kit-Yan and Philip J Scarpace. (2011) Prevention and reversal of diet-induced leptin resistance with a sugar-free diet despite high fat content. Brit. J of Nutr. 106: 390-397. • Medeiros and Wildman, Advanced Human Nutrition: 2nd Ed. (Burlington, MA: Jones and Bartlett, 2011) 130. • Medeiros and Wildman, Advanced Human Nutrition: 2nd Ed. (Burlington, MA: Jones and Bartlett, 2011) 109. • Hawke, Jenny. The bittersweet story of the stevia herb. Nexus 2002 10 (2). • Qing Yang. (2010) Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings. Yale Journal of Biology and Medicine. 83:101-108. • The Truth About Agave. 2011 30 Nov 2011 WebMD <http://www.webmd.com/diet/features/the-truth-about-agave>. • Susan E. Swithers, Chelsea R. Baker, and T.L. Davidson. (2009) General and persistent effects of high-intensity sweeteners on body weigh gain and caloric compensation in rats. BehavNeurosci. 23(4): 772-780. • Qing Yang. (2010) Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings. Yale Journal of Biology and Medicine. 83:101-108.

37. References cont. • Jang Hyeung-Jin, ZazaKokrashvili, Michael Theodorakis, Olga Carlson, Byung-Joon Kim, Jie Zhou, Hyeon Ho Kim, XiangruXu, Sic Chan, Magdalena Juhaszova, Michel Bernier, BedrichMosinger, Robert Margolskee, and Josephine Egan. (2007) Gut-expressed gustducin and taste receptors regulate secretion of glucagon-like peptide-1. PNAS 104(38): 15069-15074. • Stephen Anton, Corby Martin, Hongmei Han, Sandra Coulon, William Cefalu, Paula Geiselman, and Donald Williamson. (2008) Effects of stevia, apartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite 55(1): 37-43. • Luis Barriocanal, Mafalda Palacios, Gilda Benitez, Sussam Benitez, Jorge Jimenez, Nora Jimenez, Vicenta Rojas. (2008) Apparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans. A pilot study of repeated exposures in some normotensive and hypotensive individuals and in Type 1 and Type 2 diabetics. Regulatory Toxicology and Pharmacology 51: 37-41. • Sturm, R. Childhood obesity — what we can learn from existing data on societal trends, part 2. Prev Chronic Dis 2005 Apr 30 Nov 2011. <http://www.cdc.gov/pcd/issues/2005/apr/04_0039.htm>. • Heim, Stephanie, Katherine Bauer, Jamie Stang, and Marjorie Ireland. (2011) Can a community-based intervention improve the home food environment? Parental Perspective of the influence of the delicious and nutritious garden. Journal of Nutrition Education and Behavior. 43(2): 130-134.

38. References cont. • Physical Activity Guidelines for Americans. 2008 16 Nov 2011 US Department of Health and Human Services. <http://www.health.gov/paguidelines/guidelines/summary.aspx>. • Hunter M and McKay D. (2004) Review article: helminths as therapeutic agents for inflammatory bowel disease. Aliment. Pharamcol. Ther. 19(2):167-177. • Healthy diet: End the guesswork with these nutrition guidelines. 2011 2 Dec 2011 Mayo Clinic <http://www.mayoclinic.com/health/healthy-diet/NU00200>. *Images obtained via Google Images*