Better Business Bureau of Utah

							Nutrition: wading through current
  controversies and confusion



Heidi Wengreen, R.D., Ph.D.,
Assistant Professor of Nutrition, Utah State University
Heidi.Wengreen@usu.edu
                  Objectives
• Part I: Guidelines and tools for the critical
  interpretation of nutrition ―news‖


• Part II: Current topics of controversy/confusion

• Part III: Probiotics  self discovery
Top 3 sources of consumer information
Common forms of inaccuracy in Media
  reports on nutrition information:

1. Reporting a correlation as a causation.
2. Generalizing a study’s results to a broader
   population, not represented by the study.
3. Exaggerating the size of an effect.
4. Using a single link in a chain of events to make
   predictions and events in the future.
             Terminology
• Meta-analysis
• Randomized, controlled, double-blind
  study – ―gold-standard‖
• Prospective cohort study
• Case-control study
• Cross-sectional study
• Case-study
• Phase1 study
Questions to ask about a research report
(American Dietetic Association position paper):
       Things to remember…
• The latest study isn’t the greatest study
• Don’t just look at the ―bricks‖, look at the
  whole ―house‖
Can’t see the forest for the trees…
Fruit Juice Consumption Not Related To
  Overweight In Children, Study Suggests (May
  23, 2008) — Despite studies that assert
  otherwise, 100% fruit juice consumption is not
  related to overweight in children, according to a
  new ..
Study Shows Fruit Juice/Drink Link To
  Children's Weight Gain (Mar. 29, 2007) —
  Australian schoolchildren who drink fruit juices
  and fruit drinks are more likely to be overweight
  or obese than those who don't, Deakin
  researchers have ..
• Read the following news story with a
  critical eye.

―Good news for the summer:
Beta-carotene helps to protect
against sunburn‖ (June 3, 2008,
PRNewswire)

• Be prepared to discuss your impressions.
Find the source of the information:
• Use the media as a way to know WHAT is
  being talked about but don’t draw
  conclusions from media or ―popular‖
  reports, always go to the ORIGINAL
  SOURCE – usually a report of the study
  in a peer-reviewed journal.
 Heidi’s favorites nutrition news sites:

• NutraIngredients
  http://www.nutraingredients.com/

• Science Daily
  http://www.sciencedaily.com/
 Scholarly vs. Popular magazines
• Scholarly journals – present new,
  previously un-published research that
  includes bibliography, author’s name and
  academic credentials. Articles go through
  a peer review process before publication.
• Popular magazines – articles are written
  by staff writers (not experts), are often
  geared towards a general audience, and
  are not peer reviewed before publication.
      List of high impact peer-reviewed
              journals in nutrition
•   Journal of the American Dietetic Association
•   American Journal of Clinical Nutrition
•   Journal of Nutrition
•   Journal of the American Medical Association
•   Nutrition Reviews
•   Annals of Nutrition
•   Journal of Nutrition, Health and Aging
•   Journal of Nutrition Education and Behavior
•   International Journal of Obesity
      Refining a pubmed search
•   Use limits effectively
•   Use the related article link
•   Use MeSH Terms
•   Automatic search updates using My NCBI
    (National Center for Biotechnology
    Information)
• Conduct a pubmed search on beta-
  carotene and sunburn

• Can you find the original publication from
  the news-report you reviewed on this
  topic?

• Have other research papers been
  published on this topic?
      Credible sources of nutrition
       information on the internet
•   Professional health organizations
•   Government health agencies
•   Volunteer health agencies
•   Consumer groups
Credible: Professional Health Organizations

• American Dietetic Association:
  www.eatright.org/ncnd.html
• Society for Nutrition Education:
  www.sne.org
• American Medical Association
  www.ama-assn.org
• Federation of
Credible: Government health agencies
• Federal Trade Commission
  www.ftc.gov
• The U.S. Department of Heatlh and Human Services
  (DHHS)
  www.os.dhhs.gov
• The Food and Drug Administration
  www.fda.gov
• The U.S. Department of Agriculture (USDA)
  www.usda.gov
• National Institute of Health’s Office of Dietary
  Supplements
  http://ods.od.nih.gov/
  Credible: Volunteer health agencies

• American Cancer Society
  http://www.cancer.org/
• American Alzheimer’s Association
  http://www.alz.org/
• American Diabetes association
  http://www.diabetes.org
• American Heart Association
  http://www.americanheart.org
 Credible: Reputable consumer groups

• The Better Business Bureau
  www.bbb.org
• The Consumers Union
  www.consumersunion.org
• The American Council on Science and Health
  www.acsh.org
• National Council Against Health Fraud
  www.ncahf.org
       Credible: Universities
• Utah State University Extension
  http://extension.usu.edu/
Questions to ask to assess the credibility of Web
sites (ADA position paper):
• Critically review the following website

• DSM nutritional products
  http://www.dsm.com/en_US/html/dnp/hom
  e_dnp.htm

• Be prepared to share your impressions
Current topics of controversy or
     confusion in nutrition
•   Vitamin D – how much do I need?
•   Whole grains – what are they?
•   Supplements – to take or not to take?
•   Glycemic index – useful tool?
•   Probiotics – bacteria for breakfast?
Vitamin D
* Current DRI (AI) for vitamin D for infants through adults age 50 is
200 IU/day. The current UL (upper limit) is 2000 IU.
Vitamin D Insufficiency May Be Present In Pediatric Patients With Low
   Bone Density
• June 2, 2008 — Vitamin D insufficiency is common in adults and is
   emerging in the world of pediatrics. A mild degree of vitamin D deficiency,
   also known as vitamin D insufficiency, causes rickets in children and .
Low Vitamin D Levels Appear Common In Healthy Children
• June 2, 2008 — Many healthy infants and toddlers may have low levels of
   vitamin D, and about one-third of those appear to have some evidence of
   reduced bone mineral content on X-rays, according to a new .
Current Vitamin D Recommendations Fraction Of Safe, Perhaps Essential
   Levels For Children
• May 28, 2008 — The current recommended daily allowance of vitamin D for
   children is 200 International Units, but new research reveals that children
   may need and can safely take ten-times that amount. According to a .
No Association Found Between Vitamin D Concentration In Blood And
   Risk Of Prostate Cancer
• May 27, 2008 — High vitamin D concentration in the blood is not associated
   with a reduced risk of prostate cancer, researchers report in a new article.
   Laboratory studies suggested that high doses of vitamin D may .
Extra Vitamin D In Early Childhood Cuts Adult Diabetes Risk
• March 13, 2008 — Vitamin D supplements in early childhood may ward off
   the development of type 1 diabetes in later life, reveals new research. Type
   1 diabetes is an autoimmune disorder, in which insulin producing
• Age
• Dark skin –
  melanonin
• Sunscreen
• Time of day
• Season of year
• Latitude of location
         How much sun exposure?

• 1 MED dose of UVB radiation (enough to cause
  a mild sunburn) = 10,000 – 20,000 IU Vit D
• Caution: melanoma, wrinkles?
• Suncreen decreases Vit D production by 95%
• Recommendation: unprotected sun exposure on
  arms, neck, face for 5-15 minutes between the
  hours of 1-5 pm during the spring, summer, and
  fall on most days for lighter skinned individuals is
  enough. After that time, apply sunscreen.
           Points to remember

• You can’t get enough vitamin D from food alone.
• If you aren’t in the sun, or if don’t effectively
  make Vit D when in the sun, you need a
  supplement (vitamin D3 cholecalciferol).
• Most experts agree a dose of 2000 IU is save
  and prudent for most.
• The only way to know your vitamin D status, is to
  have your physician check your 25 OH D2 (25
  hydroxyvitamin D) levels.
Whole-grains
http://www.wholegrainscouncil.org/
     Definition: Whole grains
• Whole grains or foods made from them
  contain all the essential parts and
  naturally-occurring nutrients of the entire
  grain seed. If the grain has been
  processed (e.g., cracked, crushed, rolled,
  extruded, and/or cooked), the food product
  should deliver approximately the same rich
  balance of nutrients that are found in the
  original grain seed.
         http://en.wikipedia.org/wiki/Whole_grain

•  Whole grains are cereal grains that
retain the bran and germ as well as the
endosperm, in contrast to refined grains,
which retain only the endosperm. Whole-
meal products are made from whole-grain
flour.

• Common whole-grain products include
oatmeal, popcorn, brown rice, whole-
wheat flour, sprouted grains, and whole-
wheat bread. Common refined-grain
products include white rice, white bread,
hominy, and pasta (although whole-grain
varieties of pasta are available).
              List of whole grains
•   Amaranth
•   Barley
•   Buckwheat
•   Corn, including whole cornmeal
    and popcorn
•   Millet
•   Oats, including oatmeal
•   Rice, both brown rice and colored
    rice
•   Rye
•   Sorghum (also called milo)
•   Wheat, including varieties such as
    spelt, emmer, farro, einkorn,
    Kamut®, durum and forms such
    as bulgur, cracked wheat and
    wheatberries
•   Wild rice
Why whole-grains?
Although it is difficult to
separate the protective
properties of whole
grains from dietary fiber
and other components,
the disease protection
seen from whole grains
in prospective
epidemiological studies
far exceeds the
protection
from isolated nutrients
and phytochemicals in
whole grains.
• High in fiber  SCFA in gut
• High in vitamins and minerals
• High in antioxidants
• High in other phytochemicals with known protective properties
• Lower Glycemic Index  mediates insulin response
     How much do you need?
• The Dietary Guidelines for Americans,
  released in January 2005, recommend
  that all adults eat at least half their
  grains as whole grains – that's at least 3
  to 5 servings of whole grains.
• MyPyramid emphasizes whole grains
          What’s a serving?
• 16 grams of whole grains = 1 serving
  – 1 slice 100% whole grain break
  – ½ cup brown rice
  – 1 cup 1005 whole grain ready to eat cereal
• Every product with the Whole Grain Stamp
  contains at least half a serving (8g) of
  whole grains.
What you may see on the                         What it means
ingredients label
whole grain [name of grain]                     YES -- Contains all parts of the grain, so
whole wheat                                     you're getting all the nutrients of the whole
whole [other grain]                             grain.
stoneground whole [grain]
brown rice
oats, oatmeal (including old-fashioned
oatmeal, instant oatmeal)
wheatberries
wheat flour                                     MAYBE -- These words are accurate
semolina                                        descriptions of the package contents, but
durum wheat                                     because some parts of the grain MAY be
                                                missing, you are likely missing the benefits
organic flour                                   of whole grains.
multigrain (may describe several whole
grains or several refined grains, or a mix of
both)
enriched flour                                  NO -- These words never describe whole
degerminated (on corn meal)                     grains.
bran
wheat germ
Learn about whole WHITE wheat at the
following website

http://www.wholegrainscouncil.org/whole-grains-101/whole-white-
wheat-faq


Be prepared to share your impressions
Dietary supplements – to take
        or not to take?
http://consensus.nih.gov/2006/2006MultivitaminMineralSOS028main.htm
            Are MVM safe?
• Some ingredients in common MVM can
  produce adverse effects in certain people
  – Beta-carotene and smokers
  – Vitamin A and women
  – Vitamin E as alpha-tocopherol
• DSHEA
  – No pre-market approval required
  – Self-regulated industry
http://www.usp.org/USPVerified/dietarySupplements/
   Conclusion from NIH report:
• Finally, the present evidence is insufficient
  to recommend either for or against the use
  of MVMs by the American public to
  prevent chronic disease. The resolution of
  this important issue will require advances
  in research and improved communication
  and collaboration among scientists, health
  care providers, patients, the
  pharmaceutical and supplement
  industries, and the public.
             POSITION STATEMENT
   It is the position of the American Dietetic
  Association (ADA) that the best nutritional
   strategy for promoting optimal health and
   reducing the risk of chronic disease is to
     wisely choose a wide variety of foods.
    Additional nutrients from fortified foods
  and/or supplements can help some people
  meet their nutritional needs as specified by
  science-based nutrition standards such as
          the Dietary Reference Intakes.
http://www.eatright.org/ada/files/fort.pdf
Glycemic index
http://www.glycemicindex.com/
 Glycemic response to carbohydrate

• Glycemic index: the increase in blood glucose
  level over the baseline level during a 2-hour
  period for a defined amount of carbohydrate
  (usually 50 g) compared with the same
  amount of carbohydrate in a reference foods.
• Reference food typically white bread or
  glucose.
• Glycemic load: the weighted average
  glycemic index of individual foods - GI
  multiplied by the dietary carbohydrate
  content.
                       (a) Glucose
                             (reference food)




                                   (b) Low glycemic index



                                       (c) Fasting baseline




               Hours
Glucose meal                                    Fig. 4-9, p. 83
Ludwig et al. 2002 Jama
Ludwig et al. 2002 Jama
           GI/GL categories

             GI          GL

Low          <50         <10.5

Moderate     51-69       11-19.9

High         >70         >20
                GI controversy

• Foods can have different GI values as a result of
  ripeness, variety and processing.
• Intra-individual variation.
• The GI of a food eaten alone is different than the
  GI of the same food eaten with other foods.
• Standard test portions of foods used to
  determine GI are NOT usual portions.
• Low GI foods are not necessarily nutrient dense
  foods. Low GI does not = ―healthy‖
    Factors known to influence glycemic
              index of a food
•   Fiber content
•   Ripeness
•   Type of carbohydrate
•   Fat content of food
•   Acid content of food
•   Physical form of food  processing etc.
      The good and the bad…
High GI, the good:      High GI, the bad:
• Better absorbed       • Cancer
  during exercise
                        • CVD
• Facilitates greater
  glycogen storage      • Diabetes
  following exercise    • Overweight/obesity
• Easy to consume
  given high kcal
  requirements
Ludwig et al. 2002 Jama
Probiotics – bacteria for breakfast?
• Find a recent news report on priobiotics

• Conduct a pubmed search to identify original
  research on probiotics
   – Look for a good review or meta-analysis

• Review this information

• Provide a critical analysis to the question: Should
  probiotics be included in a healthy, balanced diet?
End of slides