Health Journal Online

Category: Nutrition

  • Should We Take Any Responsibility for the Obesity Epidemic? 

    Should We Take Any Responsibility for the Obesity Epidemic? 

    The power of the “eat more” food environment can overcome our conscious controls.

    Food and beverage companies frame body weight as “a matter of personal choice.” Even when we aren’t distracted, the power of the “eat more” food environment may sometimes overcome our conscious controls of overeating. One look around the room at a dietician convention can tell you that even nutrition professionals are vulnerable to the aggressively marketed ubiquity of tasty, cheap, convenient calories. This suggests there are aspects of our eating behaviors “that defy personal insight or are below individual awareness,” flying below the radar of conscious awareness. Appetite physiologists call the result of these subconscious actions “passive overconsumption.”

    Remember that brain scan study where the thought of a milkshake lit up the same reward pathways in the brain as substance abuse? That was triggered just by a picture of a milkshake. Dopamine gets released, cravings get activated, and we’re motivated to eat. Intellectually, we know it’s just an image, but our lizard brain sees survival. It’s just a reflexive response over which we have little control, which is why marketers ensure there are pictures of milkshakes and their equivalents everywhere.

    As I discuss in my video The Role of Personal Responsibility in the Obesity Epidemic, maintaining a balance between calories in and calories out feels like a series of voluntary acts under conscious control, but it may be more akin to bodily functions, such as blinking, breathing, coughing, swallowing, or sleeping. You can try to will yourself power over any of these, but by and large, they just happen automatically, driven by ancient scripts.

    Not only are food ads ubiquitous, but so is the food. The types of establishments selling food products expanded dramatically in the 1970s and 1980s. Now, you can find candy and snacks at the checkout counters of “gasoline stations, building material outlets, auto parts stores, drug stores, and home furnishing stores” and more. The largest food retailer in the United States is Wal-Mart. You can get that jolt of “dopamine and the associated artificially induced feelings of hunger in modern society” around every turn. Every day, we run the gauntlet.

    It’s also become “socially acceptable to eat food at any time of day and anywhere—in cars, in your hand, on the street—places where eating had never been acceptable.” We’ve become a snacking society. Vending machines are everywhere. Daily eating episodes seem to have gone up by about a quarter since the late 1970s, increasing from about four to five occasions a day, potentially accounting for twice the calorie increase attributed to increasing portion sizes. Snacks and beverages alone could account for the bulk of the calorie surplus implicated in the obesity epidemic.

    And think of the children. Here we are trying to do the best for our kids, role-modeling healthy habits and feeding them healthy foods, but then they venture out into a veritable tornado of junky food and manipulative messages. A commentary in The New England Journal of Medicine asked: “But why should Mr. and Ms. G.’s efforts to protect their children from life-threatening illness be undermined by massive marketing campaigns from the manufacturers of junk food?” Pediatricians are now encouraged to have the “French Fry Discussion” with parents at the 12-month well-child visit instead of waiting until their kids are two—though even that may be too late. As you can see below and at 3:35 in my video, two-thirds of infants are being fed junk food by their first birthday. 

    Dr. David Katz may have said it best in the Harvard Health Policy Review: “Those who contend that parental or personal responsibility should carry the day despite these environmental temptations might consider the implications of generalizing the principle. Perhaps children should be encouraged, but not required, to attend school and tempted each morning by alternatives, such as buses to the circus, zoo, or beach.” 

    It may be helpful to take a step back and think of what’s at stake here. We aren’t just talking about being manipulated into buying a different brand of toothpaste. The obesity pandemic has resulted in millions of deaths and untold suffering. If you aren’t mad yet, brace yourself for my next video: The Role of Corporate Influence in the Obesity Epidemic.

    This is the ninth video in my 11-part series. If you missed any of the previous ones, see the related posts below.



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  • Home tube feeding success | Dietitian Connection

    Home tube feeding success | Dietitian Connection

    Picture this: You’re working in private practice and get a referral for a home-based tube feed… HELP! Enter: our latest episode with Advanced Accredited Practising Dietitian, Lina Breik, to teach you how to set your patients (and yourself!) up for success. Lina shares practical tips for bridging the gap between hospital and home-based tube feeding, and highlights how dietitians can empower their patients to play an active role in their feeding decisions so they can confidently manage tube feeding at home. Lina also covers the unique challenges of upper GI patients requiring jejunostomy feeding, and ways dietitians can proactively reduce their anxieties around such complex cases. ​

    Hosted by Brooke Delfino

    Biography

    Lina Breik is an Advanced Accredited Practising Dietitian with over a decade of clinical nutrition hospital experience across multiple hospitals in Victoria, Australia. As the the Founding Lead at Tube Dietitian, Lina’s current focus is to bridge the gap between hospital and home care for adults that live with home feeding tubes. Lina’s approach towards home tube feeding involves a humanised perspective that emphasises the social and emotional aspects of nutrition through a tube. Her dedication to this cause is evident in her ongoing pursuit of a PhD that investigates the challenges and experiences of adults living with feeding tubes. She has recently published a book called ‘Your Tube: a guide to nutrition through a feeding tube’ as an empowering guide for adults who live with a feeding tube.

    In this episode, we discuss:

    • Why Lina is so passionate about hospital-to-home nutrition care​
    • The unique challenges of tube feeding in complex upper GI cases​
    • Common obstacles patients face when adapting to home tube feeding​
    • How dietitians can help their patients positively see life after hospital with a ​feeding tube​
    • The utmost importance of teamwork​

    Additional resources

    Connect with Lina at tubedietitian.com or on LinkedIn

    The content, products and/or services referred to in this episode are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see here for terms and conditions.

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  • Can We Safely Use Aluminum Foil, Bottles, and Pots? 

    Can We Safely Use Aluminum Foil, Bottles, and Pots? 

    DNA damage is assessed in users of aluminum cookware.

    “Over the last decades, the toxicity of aluminum for humans has been heavily discussed and is still not completely clarified.” Those occupationally exposed to aluminum—for instance, in smelter plants—suffer from oxidative stress and free radicals that can damage their DNA. What about just using aluminum cookware? Articles like “Metal Exposures from Aluminum Cookware: An Unrecognized Public Health Risk in Developing Countries,” suggesting an “unrecognized public health risk,” were limited to the developing world where “cookware is made in informal shops by casting liquid aluminum melted from a collection of scrap metal,” including the likes of vehicle radiators, lead batteries, and computer parts, which is how you can get so much lead leaching into people’s food. 

    Then “The Relationship Between Plasma Aluminum Content, Lymphocyte DNA Damage, and Oxidative Status in Persons Using Aluminum Containers and Utensils Daily” was published, suggesting that aluminum itself may be harmful. Most of our aluminum exposure comes from processed junk food containing aluminum additives, “including those within some processed cheeses, baking powders, cake mixes, frozen dough, and pancake mixes.” However, about 20 percent of the daily intake of aluminum may come from aluminum cooking utensils, such as “pans, pots, kettles, and trays.” 

    Might this cause a problem? Researchers took blood from consumers who used aluminum cookware versus those who did not and found that not only did the aluminum users have twice the level of aluminum in their blood, as you can see below and at 1:33 in my video Are Aluminum Pots, Bottles, and Foil Safe?, but they had more free radical damage of their body fats and proteins. What’s more, the total antioxidant capacity of the bloodstream of those using aluminum cookware was compromised, so they suffered significantly more DNA damage. 

    Indeed, as you can see below and at 1:52 in my video, those with the highest levels of aluminum in their blood tended to suffer significantly more damage to their DNA. No surprise, since “aluminum is considered to be a pro-oxidant agent.”

    These folks weren’t just casually using aluminum pots, though. Specifically, they use them every day to cook and store acidic foods, like yogurt and tomato sauce, which can leach out more aluminum. But, even using “camping dishes,” which tend to be aluminum since it’s so light, for just one week, could greatly exceed the tolerable weekly intake guidelines, especially for children, if you incorporated something acidic, like marinating a fresh catch in lemon juice. Once in a while won’t make much difference, but these findings suggest that you may not want to cook in aluminum day in and day out. 

    What about aluminum drinking bottles? They’re nice and light, but children drinking two cups a day of tea or juice from them could exceed the tolerable aluminum exposure limit. So, out of an abundance of caution, safety authorities like the German Federal Institute for Risk Assessment “recommend that consumers avoid the use of aluminum pots or dishes for acidic or salted foodstuffs such as apple sauce, rhubarb, tomato puree, or salt herring…thus prophylactically avoiding the ‘unnecessary ingestion’ of aluminum.” 

    What about aluminum foil? Wrapping and baking food in aluminum foil is a common culinary practice. The concern is that this could represent “a potentially hazardous source of aluminum in the human diet.” When put to the test, there was leakage of aluminum from the foil to the food, but the amount was so small that it would be more of an issue for small children or those suffering from diminished kidney function. 

    What about just wrapping food in foil to store it in the refrigerator? Only marginal increases in aluminum are seen—except when the food is in contact with the foil and, at the same time, certain other types of metal, such as stainless steel, which is largely iron. That sets up a battery and “can lead to tremendous food aluminum concentrations.” For example, as you can see below and at 4:34 in my video, the aluminum levels in a ham before and after a day coveredin foil are negligible; there’s hardly a bump in the foil-covered ham. But, if that same foil-wrapped ham sits on top of a steel tray or serving plate for a day, the aluminum levels in the ham shoot up.

    Finally, you know how aluminum foil is often glossy on one side and dull on the other? Which would be worse? Fish fillets were baked and grilled both ways, wrapped with the glossy side out versus the dull side out, and no significant difference was found.

    This is the first in a series of three videos on cookware. Stay tuned for Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe? and Are Melamine Dishes and Polyamide Plastic Utensils Safe?.

    I’ve discussed aluminum in antiperspirants, food, medications, and tea. Check out the related posts.



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  • Is Creatine Safe and Efficient for High Homocysteine? 

    Is Creatine Safe and Efficient for High Homocysteine? 

    Those on a healthy plant-based diet who have elevated homocysteine levels despite taking sufficient vitamin B12 may want to consider taking a gram a day of contaminant-free creatine.

    The average blood levels of homocysteine in men are about 1.5 points higher than in women, which may be one of the reasons men tend to be at higher risk for cardiovascular disease. Women don’t need to make as much creatine as men since they tend to have less muscle mass. That may help explain “the ‘gender gap’ in homocysteine levels.” If you remember from my previous video and as seen below and at 0:36 in The Efficacy and Safety of Creatine for High Homocysteine, in the process of making creatine, our body produces homocysteine as a by-product. So, for people with stubbornly high homocysteine levels that don’t respond sufficiently to B vitamins, “creatine supplementation may represent a practical strategy for decreasing plasma homocysteine levels”—that is, lowering the level of homocysteine into the normal range. 

    It seemed to work in rats. What about humans? Well, it worked in one study, but it didn’t seem to work in another. It didn’t work in yet another either. And, in another study, homocysteine levels were even driven up. So, this suggestion that taking creatine supplements would lower homocysteine was called into question. 

    However, all those studies were done with non-vegetarians, so they were already effectively supplementing with creatine every day in the form of muscle meat. In that way, researchers were testing higher versus lower supplementation. Those eating strictly plant-based make all their creatine from scratch, so they may be more sensitive to an added creatine source. There weren’t any studies on creatine supplementation in vegans to lower homocysteine until now. 

    Researchers took vegans who were not supplementing their diets with vitamin B12, so some of their homocysteine levels were through the roof. A few were as high as 50 when the ideal is more like under 10, for example. After taking some creatine for a few weeks, all of their homocysteine levels normalized. You can see the before and after in the graph below and at 2:04 in my video. 

    Now, they didn’t normalize, as that would have been a level under 10, but that’s presumably because they weren’t taking any B12. Give vegetarians and vegans vitamin B12 supplements, either dosing daily or once a week, and their levels normalize in a matter of months, as you can see below and at 2:20 in my video. However, the fact that you could bring down homocysteine levels with creatine alone, even without any B12, suggests—to me at least—that if your homocysteine is elevated (above 10) on a plant-based diet despite taking B12 supplements and eating greens and beans to get enough folate, it might be worth experimenting with supplementing with a gram of creatine a day for a few weeks to see if your homocysteine comes down. 

    Why just a single gram? That’s approximately how much non-vegetarians do not have to make themselves; it’s the amount that erased vegetarian discrepancies in blood and muscle, as you can see in the graph below and at 3:01 in my video, and how much has been shown to be safe in the longer term. 

    How safe is it? We can take a bit of comfort in the fact that it’s “one of the world’s best-selling dietary supplements,” with literally billions of servings taken, and the only consistently reported side effect has been weight gain, presumed to be from water retention. The only serious side effects appear to be among those with pre-existing kidney diseases taking whopping doses closer to 20 grams a day. A concern was raised that creatine could potentially form a carcinogen known as N-nitrososarcosine when it hit the acid bath of the stomach, but, when it actually put to the test, researchers found this does not appear to be a problem. 

    Bottom line: Doses of supplemental creatine up to 3 grams a day are “unlikely to pose any risk,” provided “high purity creatine” is used. However, as we all know, dietary supplements in the United States “are not regulated by the US Food and Drug Administration and may contain contaminants or variable quantities of the desired supplement” and may not even contain what’s on the label. We’re talking about “contaminants…that may be generated during the industrial production.” When researchers looked at 33 samples of creatine supplements made in the United States and Europe, they found that they all actually contained creatine, which is nice, but about half exceeded the maximum level recommended by food safety authorities for at least one contaminant. The researchers recommend that “consumers give their preference to products obtained by producers that ensure the highest quality control and certify the maximum amount of contaminants present in their products.” Easier said than done.

    Because of the potential risks, I don’t think people should take creatine supplements willy-nilly, but the potential benefits may exceed the potential risks if, again, you’re on a healthy plant-based diet and taking B12, and your homocysteine levels are still not under 10. In that case, I would suggest giving a gram a day of creatine a trying to see if it brings it down.

    The reason I did this whole video series goes back to “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up: Results from the Prospective EPIC-Oxford Study,” which found that, although the overall cardiovascular risk is lower in vegetarians and vegans combined, they appeared to be at slightly higher stroke risk, as you can see in the graph below and at 5:06 in my video. 

    I went through a list of potential causes, as you can see at 5:11 and below, and arrived at elevated homocysteine. What’s the solution? A regular, reliable source of vitamin B12. The cheapest, easiest method that I personally use is one 2,500 mcg chewable tablet of cyanocobalamin, the most stable source of B12, once a week. (In fact, you can just use 2,000 mcg once a week.) And, again, a backup plan for those doing that but still having elevated homocysteine is an empirical trial of a single gram a day of creatine supplementation, which was shown to improve at least capillary blood flow in those who started out with high homocysteine levels. 

    In sum, plant-based diets appear to “markedly reduce risk” for multiple leading killer diseases—heart disease, type 2 diabetes, and many common types of cancer—but “an increased risk for stroke may represent an ‘Achilles heel.’ Nonetheless, vegans have the potential to achieve a truly exceptional ‘healthspan’ if they face this problem forthrightly by restricting salt intake and taking other practical measures that promote cerebrovascular [brain artery] health…Nonetheless, these considerations do not justify nutritional nihilism. On balance, low-fat vegan diets offer such versatile protection for long-term health that they remain highly recommendable. Most likely, the optimal strategy is to adopt such a [plant-based] diet, along with additional measures—appropriate food choices, exercising training, judicious supplementation [of vitamin B12]—that will mitigate the associated stroke risk.” And try not to huff whipped cream charging canister gas. Leave the “whippets” alone.

    This concludes my series on stroke risk. If you missed any of the other videos, see the related posts below.

    I’m assuming that nearly everyone taking their B12 will have normal homocysteine levels, so these last two videos are just for the rare person who doesn’t. However, those on a healthy plant-based diet with elevated homocysteine levels despite taking sufficient vitamin B12 should consider taking a gram a day of contaminant-free creatine, which should be about a quarter teaspoon.

    Where do you get contaminant-free creatine? Since regulations are so lax, you can’t rely on supplement manufacturers no matter what they say, so I would recommend going directly to the chemical suppliers that sell it to laboratories and guarantee a certain purity. Here are some examples (in alphabetical order) of some of the largest companies where you can get unadulterated creatine: Alfa Aesar, Fisher Scientific, Sigma-Aldrich, and TCI America.



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  • Diet, health and the environment

    Diet, health and the environment

    How can dietitians support eating practices that improve diet quality and reduce environmental impacts? In this episode with Principal Research Scientist Dr Brad Ridoutt from CSIRO, we dive into the latest research that unpacks the impact of diet on the environment – in particular, the overconsumption of food and drinks. Dr Ridoutt shares practical tips for dietitians to help their clients minimise food waste through eating in line with dietary guidelines, getting creative with leftovers and storing food safely. ​

    Hosted by Brooke Delfino

    Biography

    Dr Brad Ridoutt is a Principal Research Scientist with Australia’s national science agency – The Commonwealth Scientific and Industrial Research Organisation (CSIRO). His expertise is in life cycle sustainability assessment in the agriculture and food sectors which is used to address strategic challenges in relation to climate change, water scarcity, sustainable food systems, and sustainable diets. Dr Ridoutt is engaged in a range of international processes relating to the standardization of sustainability assessment and environmental labeling. His research is creating the main evidence base concerning the environmental impacts of dietary habits in Australia.

    In this episode, we discuss:

    • Factors to consider when thinking about the environmental impact of what Australians eat​

    • Why portion guidance is key for health and the environment

    • Strategies for reducing food waste, as outlined in the Australian Dietary Guidelines (2013)

    Additional resources

    • Click here to read the Australian Dietary Guidelines (referenced in this episode – Appendix G, page 130)

    • Click here to watch our recent webinar Empowering balanced meals with no food waste

    Supported by 

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.

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  • Obesity and a Toxic Food Environment 

    Obesity and a Toxic Food Environment 

    Implausible explanations for the obesity epidemic serve the needs of food manufacturers and marketers more than public health and an interest in truth.

    When it comes to uncovering the root causes of the obesity epidemic, there appears to be manufactured confusion, “with major studies reasserting that the causes of obesity are ‘extremely complex’ and ‘fiendishly hard to untangle,’” but having just reviewed the literature, it doesn’t seem like much of a mystery to me.

    It’s the food.

    Attempts at obfuscation—rolling out hosts of “implausible explanations,” like sedentary lifestyles or lack of self-discipline—cater to food manufacturers and marketers more than the public’s health and our interest in the truth. “When asked about the role of restaurants in contributing to the obesity problem, Steven Anderson, president of the National Restaurant Association stated, “Just because we have electricity doesn’t mean you have to electrocute yourself.” Yes, but Big Food is effectively attaching electrodes to shock and awe the reward centers in our brains to undermine our self-control.

    It is hard to eat healthfully against the headwind of such strong evolutionary forces. No matter what our level of nutrition knowledge, in the face of pepperoni pizza, “our genes scream, ‘Eat it now!’” Anyone who doubts the power of basic biological drives should see how long they can go without blinking or breathing. Any conscious decision to hold your breath is soon overcome by the compulsion to breathe. In medicine, shortness of breath is sometimes even referred to as “air hunger.” The battle of the bulge is a battle against biology, so obesity is not some moral failing. It’s not gluttony or sloth. It is a natural, “normal response, by normal people, to an abnormal situation”—the unnatural ubiquity of calorie-dense, sugary, and fatty foods.

    The sea of excess calories we are now floating in (and some of us are drowning in) has been referred to as a “toxic food environment.” This helps direct focus away from the individual and towards the societal forces at work, such as the fact that the average child is blasted with 10,000 commercials for food a year. Or maybe I should say ads for pseudo food, as 95 percent are for “candy, fast food, soft drinks [aka liquid candy], and sugared cereals [aka breakfast candy].”

    Wait a second, though. If weight gain is just a natural reaction to the easy availability of mountains of cheap, yummy calories, then why isn’t everyone fat? As you can see below and at 2:41 in my video The Role of the Toxic Food Environment in the Obesity Epidemic, in a certain sense, most everyone is. It’s been estimated that more than 90 percent of American adults are “overfat,” defined as having “excess body fat sufficient to impair health.” This can occur even “in those who are normal-weight and non-obese, often due to excess abdominal fat.

    However, even if you look just at the numbers on the scale, being overweight is the norm. If you look at the bell curve and input the latest data, more than 70 percent of us are overweight. A little less than one-third of us is normal weight, on one side of the curve, and more than a third is on the other side, so overweight that we’re obese. You can see in the graph below and at 3:20 in my video.

    If the food is to blame, though, why doesn’t everyone get fat? That’s like asking if cigarettes are really to blame, why don’t all smokers get lung cancer? This is where genetic predispositions and other exposures can weigh in to tip the scales. Different people are born with a different susceptibility to cancer, but that doesn’t mean smoking doesn’t play a critical role in exploding whatever inherent risk you have. It’s the same with obesity and our toxic food environment. It’s like the firearm analogy: Genes may load the gun, but diet pulls the trigger. We can try to switch the safety back on with smoking cessation and a healthier diet.

    What happened when two dozen study participants were given the same number of excess calories? They all gained weight, but some gained more than others. Overfeeding the same 1,000 calories a day, 6 days a week for 100 days, caused weight gains ranging from about 9 pounds up to 29 pounds. The same 84,000 extra calories caused different amounts of weight gain. Some people are just more genetically susceptible. The reason we suspect genetics is that the 24 people in the study were 12 sets of identical twins, and the variation in weight gain between each of them was about a third less. As you can see in the graph below and at 4:41 in my video, a similar study with weight loss from exercise found a similar result. So, yes, genetics play a role, but that just means some people have to work harder than others. Ideally, inheriting a predisposition for extra weight gain shouldn’t give a reason for resignation, but rather motivation to put in the extra effort to unseal your fate. 

    Advances in processing and packaging, combined with government policies and food subsidy handouts that fostered cheap inputs for the “food industrial complex,” led to a glut of ready-to-eat, ready-to-heat, ready-to-drink hyperpalatable, hyperprofitable products. To help assuage impatient investors, marketing became even more pervasive and persuasive. All these factors conspired to create unfettered access to copious, convenient, low-cost, high-calorie foods often willfully engineered with chemical additives to make them hyperstimulatingly sweet or savory, yet only weakly satiating. 

    As we all sink deeper into a quicksand of calories, more and more mental energy is required to swim upstream against the constant “bombardment of advertising” and 24/7 panopticons of tempting treats. There’s so much food flooding the market now that much of it ends up in the trash. Food waste has progressively increased by about 50 percent since the 1970s. Perhaps better in the landfills, though, than filling up our stomachs. Too many of these cheap, fattening foods prioritize shelf life over human life.

    But dead people don’t eat. Don’t food companies have a vested interest in keeping their consumers healthy? Such naiveté reveals a fundamental misunderstanding of the system. A public company’s primary responsibility is to reap returns for its investors. “How else could we have tobacco companies, who are consummate marketers, continuing to produce products that kill one in two of their most loyal customers?” It’s not about customer satisfaction, but shareholder satisfaction. The customer always comes second.

    Just as weight gain may be a perfectly natural reaction to an obesogenic food environment, governments and businesses are simply responding normally to the political and economic realities of our system. Can you think of a single major industry that would benefit from people eating more healthfully? “Certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” wrote emeritus professor Marion Nestle in a Science editorial when she was chair of nutrition at New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”

    If part of the problem is cheap tasty convenience, is hard-to-find food that’s gross and expensive the solution? Or might there be a way to get the best of all worlds—easy, healthy, delicious, satisfying meals that help you lose weight? That’s the central question of my book How Not to Diet. Check it out for free at your local library.

    This is it—the final video in this 11-part series. If you missed any of the others, see the related posts below. 



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  • Your food allergy questions answered​ ​

    Your food allergy questions answered​ ​


    Join us for a fascinating Q&A with food allergy expert Sherry Coleman Collins, MS, RDN, LD– a follow-up to our popular webinar, “Advancing food allergy care: The latest innovations and insights.” Find out more about the unique way food allergies impact adults, the transient nature of food allergies, and why we even bother with skin and blood testing when the false positive rate is so high.

    Hosted by Kristin Houts

    Biography

    Sherry Coleman Collins, MS, RDN, LD, is a Marietta, GA-based Registered Dietitian Nutritionist with more than 15 years of experience in food allergies, pediatric nutrition, school food service and nutrition communications. She is a nutrition educator, speaker and writer, and serves as an expert to the media. Sherry spearheaded the development of the Academy of Nutrition and Dietetics’ Certificate of Training in Food Allergies, authored the Academy’s Practice Paper on the Role of the RDN in Food Allergy Diagnosis and Management, and has completed the FARE Pediatric Food Allergy Certificate of Training. She’s a fellow with the Academy of Nutrition and Dietetics Foundation. 

     

    In this episode, we discuss:​

    • Sherry’s framework for thinking about food allergy prevention, diagnosis, and management ​
    • The ins and outs of the oral challenge ​
    • How the gut microbiome may play a role in food allergies​
    • The dietitian’s opportunity to provide positive education and support for patients​

    Additional resources

    In case you missed it, you can watch Sherry’s webinar “Advancing food allergy care: The latest innovations and insights” here.


    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.


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  • Creatine to Normalize Homocysteine in Vegetarians? 

    Creatine to Normalize Homocysteine in Vegetarians? 

    What are the consequences of having to make your creatine rather than relying on dietary sources?

    “Almost universally, research findings show a poor vitamin B12 status among vegetarians” because they aren’t taking vitamin B12 supplements like they should, which results in an elevation in homocysteine levels. This may explain why vegetarians were recently found to have higher rates of stroke, as you can see in the graph below and at 0:30 in my video Should Vegetarians Take Creatine to Normalize Homocysteine?.

    Of course, plant-based eating is just one of many ways to become deficient in vitamin B12. Even nitrous oxide (laughing gas) can do it in as little as two days, thanks to the recreational use of whipped cream canister gas. (I just learned about “whippits”!)

    When researchers gave vegetarians and vegans as little as 50 daily micrograms of cyanocobalamin, which is the recommended and most stable form of vitamin B12 supplement, their homocysteine levels, which had started up in the elevated zone, normalized right down into the safe zone under 10 mmol/L within only one to two months. Just 2,000 micrograms of cyanocobalamin once a week gave the same beautiful result, as you can see in the graph below and at 1:15 in my video. 

    Not always, though. In another study, even 500 daily micrograms, taken as either a sublingual chewable or swallowable regular B12 supplement, didn’t normalize homocysteine within a month, as shown below and at 1:24. Now, presumably, if the participants had kept it up, their levels would have continued to fall as they did in the 50-daily-microgram study.

    If you’re plant-based and have been taking your B12, but your homocysteine level is still too high (above 10 mmol/L), is there anything else you can do? Well, inadequate folate intake can also increase homocysteine, but folate comes from the same root as foliage. It’s found in beans and leaves, concentrated in greens. If you’re eating beans and greens, taking your B12, and your homocysteine level is still too high, I’d suggest taking 1 gram of creatine a day as an experiment, then getting your homocysteine levels retested in a month to see if it helped.

    Creatine is a compound formed naturally in the human body that is primarily involved with energy production in our muscles and brain. It’s also formed naturally in the bodies of many other animals. So, when we eat their muscles, we can also take in some of the creatine in their bodies through our diet. We only need about 2 grams of creatine a day, so those who eat meat may get about 1 gram from their diet and their body makes the rest from scratch. There are rare birth defects where you’re born without the ability to make it, in which case, you have to get it from your diet. Otherwise, our bodies can make as much as we need to maintain normal concentrations in our muscles.

    As you can see in the graph below and at 2:54 in my video, when you cut out meat, the amount of creatine floating around in your bloodstream goes down.

    However, the amount in your brain remains the same, as shown in the graph below and at 2:57. This shows that dietary creatine doesn’t influence the levels of brain creatine, because our brain makes all the creatine we need. The level in vegetarian muscles is lower, but that doesn’t seem to affect exercise performance, as both vegetarians and meat eaters respond to creatine supplementation with similar increases in muscle power output. If vegetarian muscle creatine were insufficient, then presumably an even bigger boost would be seen. So, all that seems to happen when we eat meat is that our body doesn’t have to make as much. What does all of this have to do with homocysteine?

    As you can see below and at 3:36 in my video, in the process of making creatine, our body produces homocysteine as a waste product. Now, normally this isn’t a problem because our body has two ways to detoxify it: by using vitamin B6 or a combination of vitamin B12 and folate. Vitamin B6 is found in both plant and animal foods, and it’s rare to be deficient. But, vitamin B12 is mainly found in animal foods, so its level can be too low in those eating plant-based who don’t also supplement or eat B12-fortified foods. And, as I mentioned, folate is concentrated in plant foods, so it can be low in those who don’t regularly eat greens, beans, or folic-acid-fortified grains. Without that escape valve, homocysteine levels can get too high. However, if you’re eating a healthy plant-based diet and taking your B12 supplement, your homocysteine levels should be fine. 

    What if they aren’t? We might predict that if we started taking creatine supplements, our level of homocysteine might go down since we won’t have to make so much of it from scratch, producing homocysteine as a by-product, but you don’t know until you put it to the test. I’ll cover that next. 

    This is the eleventh in a 12-video series exploring stroke risk. If you missed the last two, see Vegetarians and Stroke Risk Factors: Vitamin B12 and Homocysteine? and How to Test for Functional Vitamin B12 Deficiency.

    This whole creatine angle was new to me. I had long worried about homocysteine levels being too high among those getting inadequate B12 intake, but I didn’t realize there was another potential mechanism for bringing it down other than with vitamin B. Let’s see if it pans out in my final video of the series: The Efficacy and Safety of Creatine for High Homocysteine. 



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  • How to overcome barriers to better health

    How to overcome barriers to better health

    “I just bought a new BPA-free tupperware set.”

    This comment, coming from my friend Anna, caught me off guard.

    Anna’s a highly competent law professional. She’s a critical thinker and she fights in the heavyweight division when it comes to cutting through BS.

    But the Anna I knew was falling into some painful traps that seemed to be bypassing her inner hawk-like skeptic.

    She’s wanted to lose around 15lbs for some time now and came to me to share how stuck she was feeling in this goal.

    She brought up an avenue she was exploring: the new BPA-free tupperware set.

    “Interesting. What inspired you to focus on that?” I asked.

    “Well, I’ve been reading about how microplastics in food containers can mess up our hormones and cause weight gain,” she said.

    I squinted.

    To backtrack, this is right after she told me how she’d been struggling to be consistent at the gym, had been relying on takeout too often, and had been sacrificing boring old sleep for adrenaline-inducing doom scrolling.

    So I asked:

    “What about trying to get more consistent with your workouts, or prepping more homemade meals during the week?”

    And Anna said:

    “Yeah, but I’ve tried that a thousand times. If it were that simple, it would have worked already.”

    We’ve all done this before.

    Ignored or delayed those hard-but-worthwhile habit changes in favor of some ultra-specific, niche magic bullet that’s supposed to “change everything.”

    Spent hours of research on the ultimate, most optimal workout instead of devoting those hours to just doing the basic workout you already know how to do.

    Waited to feel more inspired, motivated, or just less busy.

    Why do we do this?

    Buying new gear or a popular supplement feels like making progress.

    Consuming YouTube videos or articles about stuff you can change feels like you’re doing something.

    And waiting until the “right time” feels, well, right.

    Except, nothing actually changes until we take real, consistent action.

    We’re clever, us humans. And we’ve come up with lots of sneaky ways to avoid the basic, unsexy, difficult actions we need to take that actually drive change.

    In this article, we’ll explore how to take an honest and compassionate look at why you might be distracting yourself from taking impactful action.

    You’ll learn:

    • What the most impactful health habits actually are
    • Three common barriers to making sustainable progress
    • A 4-step process you can apply to start taking positive, productive action
    • How to keep yourself consistent—and achieve your goals

    The stuff you know you should do (but probably aren’t doing consistently)

    We all know what those basic, fundamental health habits are:

    ▶ Exercising, ideally 30 minutes a day, putting in moderate-to-vigorous amounts of effort, with a mix of aerobic and resistance training.

    ▶ Eating mostly nutritious, minimally-processed foods. If 80 percent of your diet comes from whole or minimally-processed foods, you’re doing an excellent job. (Translation: “Perfection” isn’t required; pizza can be part of a healthy diet.)

    ▶ Eating enough protein to support muscle mass, appetite regulation, and body recomposition goals, if you have them. Aim for about 1.2 to 2.2 grams of protein per kilogram of body weight (for most people, this adds up to about 4-6 palm-sized portions of lean protein per day).

    ▶ Prioritizing getting seven to eight hours of quality sleep. You can’t always control how well you sleep, but having some wind-down time before bed can help, as can waking up at the same time every day.

    ▶ Avoiding or at least reducing excessive consumption of alcohol or drugs, including cigarettes. No fun, we know. But it’s for a good cause.

    Easily, we could add stuff like prioritizing positive, nurturing social relationships, managing stress, and probably others, but just the above list is uncommonly met.

    In fact, only six percent of Americans perform all five of the following basic health behaviors:1

    • Meet physical activity recommendations
    • Don’t smoke
    • Consume alcohol in moderation (or not at all)
    • Sleep at least seven hours
    • Maintain a “normal” BMI

    If you’re doing the math, that means close to 94 percent of Americans aren’t doing the basics.

    Yet, these foundational behaviors also help us achieve a long list of common goals, whether that’s reaching a healthy weight, improving athletic ability, or just living a longer, healthier life.

    So why do we struggle so much to do them?

    Here are three common barriers we see among clients (and coaches!), plus potential solutions to overcome them.

    By the way, ambivalence is normal.

    That push-and-pull feeling you have when you think about making a change?

    It has a name, and it’s called ambivalence.

    Ambivalence describes the mix of feelings you have when you contemplate, say, waking up earlier so your mornings are less stressful, or cutting down on TV time.

    We naturally and normally feel ambivalence about change—“I want this, and at the same time, that.”

    (For example, wanting to eat healthier, and also wanting to have your favorite treats whenever you want without constraint.)

    We also naturally and normally feel resistance towards change—“I want this, and at the same time, not.”

    (For example, wanting to stop using your phone as a mindless distraction, but not wanting to deal with the anxiety you get whenever you’re left with your own thoughts.)

    These contradictory emotions can seem frustrating, puzzling, or “illogical.” Yet, ambivalence and resistance are fundamental parts of the change process.

    The higher the stakes of change, the more likely we are to feel a mix of strong and unexpected emotions, pushback, rebellion, angst, and other types of resistance and ambivalence.

    Rather than signaling that the change is a wrong move, strong ambivalence and resistance tend to signal that this change matters to us.

    In a sense, it’s good news.

    It tells us we care.

    Basics Barrier #1: You have ambition overload.

    Maybe you’ve decided you want to be healthier. So you declare that, starting Monday, you’re going to exercise for an hour everyday and “eat clean” at every meal and sleep eight hours every night.

    (Currently, you don’t have a regular exercise habit, don’t particularly like vegetables, and regularly stay up past midnight.)

    Now, let’s be honest: You’re asking yourself to change a lot of stuff at once.

    And the last time you created an elaborate plan for overhauling your life…

    … Did it work?

    Probably not.

    (And that’s okay.)

    When we feel frustrated or stuck in our current situation, making a plan filled with idealistic dreams can provide us temporary relief.

    And our brain has several (normal) cognitive biases that prevent us from judging the future accurately.

    We often think we’ll have more time, energy, attention, and motivation in the future than we really do.2 3 4 5

    There’s a powerful, instantaneous comfort that comes with overloading our future self. (Because after all, we won’t start the plan until Monday.)

    The problem with this is:

    Big, complex plans often don’t fit into our already busy, complex lives.

    We under-estimate how many smaller tasks are hidden in the bigger plans.

    When we (almost inevitably) are unable to execute these ambitious goals, we blame ourselves, our personality traits, our “willpower” or “discipline,” and build a pitiable story about how we “struggle with consistency.” Or how living this way is “impossible”.

    Then, sadly, we fulfill that prophecy.

    Basics Barrier #2: You think only hardcore, “industry-secret,” or “cutting-edge” stuff works.

    This barrier comes from the following common belief:

    “If getting healthy just took eating, sleeping, and exercising moderately well, then everyone would be healthy.”

    Because everyone knows they should eat their vegetables, get seven to eight hours of sleep per night, and stay active, right?

    (We’d agree.)

    But let’s go back to the previously mentioned statistic:

    Only 6 percent of Americans are consistently performing the most basic health and fitness behaviors.

    If we add on slightly more advanced—but still very basic—behaviors like eating five servings of fruits and vegetables every day, optimizing protein intake, and effectively managing stress, that number would shrink significantly.

    So, the first thing is to believe that these simple behaviors work. Because they do. It’s just that most people (probably close to 99 percent of us) are not doing them all simultaneously and consistently.

    The second thing is to accept that these simple behaviors are a little bit boring. Because they are. Part of the reason we’re attracted to new diets or “magical” supplements is because we just want something more interesting to try.

    That’s especially true if we’ve already sort of tried the “eat more vegetables” thing and it didn’t “work” for us in the way we expected.

    With something new and cutting-edge, there’s also the possibility of a new outcome, a new us.

    And of course, that’s incredibly appealing.

    Thing is, most hardcore, “industry secret,” or “cutting edge” tools and strategies are, respectively: unsustainable, inaccessible, or ineffective (or unproven).

    They’ll take your effort, your time, and often your money, but without giving you a good return on your investment—all the while distracting you from the stuff that actually works.

    Basics Barrier #3: You think your efforts (and your results) have to be perfect.

    Another lie in the health and fitness industry is that you have to be “perfect” to maintain great health. You know, eat only organic salads and chia seeds, be able to run a marathon, and wake up at 5 am every day to meditate and write in your gratitude journal.

    The truth is, perfection definitely isn’t required.

    Depending on how you look at this, this could be a relief to hear, or a disappointment.

    On the one hand, it’s nice to know that you don’t have to have it “all together” to be healthy—even above-average healthy.

    On the other hand, many of us pursue better health with the belief that our optimal or even “perfect” self will one day, with the right plan or routine, be attainable.

    But “perfect” health is an illusion.

    Humans, even exceptionally healthy ones, get sick, get weird rashes, have digestive problems, need reading glasses, get into slumps, or just otherwise have a series of bad days.

    None of us are “safe” from those life events, and accepting that can feel a little… vulnerable.

    It’s much more comfortable to believe that if you just take this powdered algae supplement, or follow this specific morning routine, you’ll be immune to any kind of painful human experience.

    The irony is, to achieve your realistic “best self,” you probably have to accommodate your “worst self” too. You know, the one who’d rather watch another episode of Love is Blind than work out, or eat a party-size bag of Doritos and call it dinner.

    Because life happens.

    Work gets busy.

    Or your kid goes through a “phase.”

    Or it’s pie season.

    Any number of obstacles, distractions, and competing demands make it impossible for perfection to be maintained with any kind of consistency.

    Which is why we need to let go of the illusion that a “perfect” self exists—the one who always has the energy, will, and option to make the ideal choice—and support what our real self wants and needs.

    We’ve got four steps below to help you.

    4 steps to start taking effective (and realistic) action

    Now that we know what’s potentially getting in the way of taking productive action, here are four steps to get unstuck.

    Step #1: Explore the why before the how.

    Before you (or a client) start undertaking something you want to change, it’s helpful to understand your deeper motivations first.

    Do a little investigating by asking questions like:

    • What about this change is important to you?
    • How serious or pressing is this for you?
    • Why not continue doing what you’re already doing?

    You can also go through one of our favorite motivation-mining exercises, The 5 Whys.

    When you know why you want to change something, and you’re clear on the consequences of not taking action, you’ll be more likely to feel that deeper, more sustaining push to keep going, even when things get tough.

    Step #2: Prioritize the most effective actions.

    We can do all the things!! Really!! We just can’t do all the things… all at once.

    Effective change means being able to realistically:

    • Identify all the tasks, trade-offs, and commitments involved
    • Prioritize what matters for the results you want
    • Figure out what to do first

    What are the essentials in relation to your goal? Regardless of all goals, they likely include a movement practice, a nutrition practice, and/or a recovery practice.

    If you want some guidance on how to select the most effective action for your goal, check out our Skills, Practices, and Daily Actions Cheat Sheet.

    Here’s how to use it:

    ▶ Start with the domain you’re most interested in improving (such as “Nutrition” or “Stress”).

    ▶ Then, get specific about what skill within that domain you’d like to improve (for example, “Eat well intuitively”), plus the practice that most appeals to you within that skill (say, “Eat to satisfied”).

    ▶ Lastly, choose a daily action from the list of examples under your chosen practice. (For example, “Record hunger and fullness levels at the start and end of meals.”)

    Once you choose your action, make it work for you by following step 3, below.

    Step #3: Make sure you can take action, even on your worst day.

    “I like to challenge a client to set a pathetic goal. If it’s so pathetic, then obviously you can do it, right?” says Kate Solovieva, PN Super Coach and Director of Community Engagement.

    Sound inspiring?

    Maybe not.

    But if you’ve been struggling with consistency, it’s exactly where to start.

    Ask yourself:

    • What can I do on my absolutely worst day where everything goes wrong? How much time, effort, or enthusiasm will I realistically have?

    Five minutes of walking? 10 push-ups? One extra portion of veggies? Three conscious deep breaths before every meal? Nothing is too small; it just has to be something.

    Now you’ve got your floor.

    Then ask yourself:

    • What can I do on my best day, when I feel on top of the world and circumstances are on my side? How much time, effort, or enthusiasm will I realistically have?

    One-hour of all-out effort at the gym? Two hours of meal prep that will feed you and your family for the next three days? A 45-minute guided meditation?

    This is your ceiling.

    Now that you’ve identified your “floor” and your “ceiling,” you’ve defined a flexible range of actions that can adapt to your fluctuating, unpredictable, real life.

    But applying this range requires a paradigm shift:

    Your health habits aren’t an “on” or “off” switch; they’re on a dial.

    When life is sweet and smooth, you can turn your exercise, nutrition, and sleep dials way up—if you want. Bust through your PRs at the gym, eat all the arugula, meditate like a monk.

    But if life gets nuts, you don’t have to switch off completely.

    Just turn the dial down a little.

    The below is a visual representation of how this might work for exercise, but you can apply this same thinking to your nutrition, sleep, stress management, or whatever you’re working on.

    1-10 movement dial filled

    The important part: Even if you do your “floor” or “dial level 1” action—even if it’s for days on end—it still “counts.”

    You still get the gold star.

    Doing the bare minimum isn’t failing.

    It’s succeeding, in the context of a real, messy, beautiful life.

    Step #4: Create an ecosystem that supports you.

    Health and fitness professionals often forget how different their lives are from their clients.

    For example, many coaches work at gyms, enjoy being physically active, and hang out with other active people. Exercising regularly is almost easier to do than not do, because, as Coach Kate says, “they’ve built a life that makes that habit seamless.”

    So if you want to make your health goals more likely, Coach Kate offers this advice:

    “Build an ecosystem that makes failing nearly impossible.”

    When they want to make a change, many people assume that good intentions and willpower will be enough to carry them through. (And when they fail, naturally, they blame themselves for being “bad” or “weak.”)

    We often forget about the context and environment that shapes our behaviors—making certain actions more likely or less likely to occur.

    A recent review from Nature Reviews Psychology ranked different behavior change strategies and found that access was the number one influencer of people’s behaviors. (People who lived in neighborhoods with affordable grocers close by ate better, just like people who had to drive a long distance to the closest gym were less likely to exercise.6)

    Not everyone can change neighborhoods, but most people have some degree of control over their more immediate environments, and can leverage this power to shape desired behaviors.

    One example is the “kitchen makeover,” where you make sure foods you want to eat are washed, prepped, and at the front of the fridge, ready to eat on a whim. Meanwhile, foods that don’t support your goals get tossed, or relegated to the highest cupboard. (When you need a stepladder from the basement to reach the cookies, you might find you eat them less.)

    (If you want to try it out, check out our Kitchen Set-up Assessment worksheet.)

    Think about the goal you want to achieve, and the behaviors that support it. Then, evaluate how you might make small changes to your environment by:

    • Using a trigger: Sometimes called a “cue” or a “prompt,” a trigger is simply a reminder to do a desired action. For example, you might block the door of your home office with a kettlebell, reminding you that, every time you leave or enter the office, you have to do ten kettlebell swings. If you’re trying to cut down on mindless phone time, you can install an app that reminds you to shut things down after 20 minutes on social media.
    • Decreasing “friction”: Supermarkets put candy next to the checkout, making it easy to slip that chocolate bar into your cart while you’re standing in line, likely bored and hungry. You can be equally sneaky about encouraging positive behaviors too, such as putting fruit on your counter, ready for a quick snack, or packing your gym bag the night before, so it’s ready to grab on your way out the door before you change your mind.
    • Constraining available options: Whether it’s deleting time-sucking apps off your phone, removing foods you know you lose control around from your kitchen, or heck, creating a capsule wardrobe so you waste less time in the morning getting dressed, constraint can actually free up a lot of time, brain power, and energy.

    Invest your energy building the ecosystem that nudges you to make desired actions the obvious choice. This requires a little more work on the front end, but the payoff will be greater for less overall work.

    Embrace C+ effort.

    If you’re a perfectionist, or a former straight-A student, that line hurt to read.

    (Don’t worry. This C+ won’t result in your parents telling you that they’re disappointed.)

    But what all of the above barriers and solutions have in common, is that they recognize and work with our inherent imperfection.

    None of us is perfect, and expecting as much often results in failure (or at best, short bursts of success, followed by a crash).

    Adopt an attitude of compassion and acceptance towards your human self—who’s most likely trying their hardest—and work with your vulnerabilities, instead of constantly expecting yourself to grit your teeth against them.

    There will be times you’re getting “A’s” in fitness. That’s awesome. And you also don’t need to aim for C+. Just don’t think of yourself as a failure when you have to dial it down.

    Living a healthy, meaningful life means constantly striving to do our best—while also allowing for flexibility, mistakes, and bad days (or seasons).

    You’ll be surprised at how much better “good enough” is than nothing. Especially in the long run.

    References

    Click here to view the information sources referenced in this article.

    If you’re a coach, or you want to be…

    You can help people build sustainable nutrition and lifestyle habits that will significantly improve their physical and mental health—while you make a great living doing what you love. We’ll show you how.

    If you’d like to learn more, consider the PN Level 1 Nutrition Coaching Certification.

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