Nutrition: wading through current controversies and confusion

1. Nutrition: wading through current controversies and confusion Heidi Wengreen, R.D., Ph.D., Assistant Professor of Nutrition, Utah State University Heidi.Wengreen@usu.edu

2. 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

3. Top 3 sources of consumer information

4. Common forms of inaccuracy in Media reports on nutrition information: • Reporting a correlation as a causation. • Generalizing a study’s results to a broader population, not represented by the study. • Exaggerating the size of an effect. • Using a single link in a chain of events to make predictions and events in the future.

5. Terminology • Meta-analysis • Randomized, controlled, double-blind study – “gold-standard” • Prospective cohort study • Case-control study • Cross-sectional study • Case-study • Phase1 study

6. Questions to ask about a research report (American Dietetic Association position paper):

7. Things to remember… • The latest study isn’t the greatest study • Don’t just look at the “bricks”, look at the whole “house”

8. 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 ..

9. 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.

10. 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.

11. Heidi’s favorites nutrition news sites: • NutraIngredients http://www.nutraingredients.com/ • Science Daily http://www.sciencedaily.com/

12. 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.

13. 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

15. 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)

16. 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?

17. Credible sources of nutrition information on the internet • Professional health organizations • Government health agencies • Volunteer health agencies • Consumer groups

18. 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

19. 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/

20. 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

21. 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

22. Credible: Universities • Utah State University Extension http://extension.usu.edu/

23. Questions to ask to assess the credibility of Web sites (ADA position paper):

24. Critically review the following website • DSM nutritional products http://www.dsm.com/en_US/html/dnp/home_dnp.htm • Be prepared to share your impressions

25. 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?

26. Vitamin D

27. * Current DRI (AI) for vitamin D for infants through adults age 50 is 200 IU/day. The current UL (upper limit) is 2000 IU.

28. 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

30. Age • Dark skin – melanonin • Sunscreen • Time of day • Season of year • Latitude of location

31. 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.

34. 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.

35. Whole-grains

36. http://www.wholegrainscouncil.org/

37. 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.

38. 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).

39. 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

40. Why whole-grains?

41. 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.

42. 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

43. 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

44. 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.

46. 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

48. Dietary supplements – to take or not to take?

49. http://consensus.nih.gov/2006/2006MultivitaminMineralSOS028main.htmhttp://consensus.nih.gov/2006/2006MultivitaminMineralSOS028main.htm

50. 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