Sunday, August 11, 2013

IFT 2013: Part 2

    Next up, I attended a meeting on hybrid sweetener systems where they discussed new approaches to sweetening foods to help combat the obesity epidemic.   They are noticing that customers are demanding “better and healthier” food products.   Dr. Walters of Rosalind University of Medicine and Science started off the talks by stating that soft drinks have been linked to the obesity problem.  He noted that the sweet taste receptor was identified between 2001 and 2003.  According to the lecture, it has been found that combining different sweeteners together in a product formulation actually increases the sweetness and they suspect it has to do with different molecules affecting varied sites on the sweet taste receptor.  The speakers had discussed a new sweetener called Talin by Naturex.   Talin is a sweetener derived from a West African fruit called katemfe according to the companies website.  It is low in calories and when combined with Stevia it improves the taste profile.  Stevia usually has a bitter aftertaste to it but when it is combined with Talin you find a smoother and more pleasant sweetness.  Later on, I attended an educational session entitled, “Nutragenomics and Angiogenesis:  How Food Influences the Common Denominator in Health.”   Angiogenesis helps maintain a healthy physiological state but when it is not in balance, it can lead to health problems like obesity and cancer.   The speakers noted that dietary intervention can suppress these processes and discussed the gene mechanisms involved.  

     There was a talk given by Mr. David W. Robson, Head of Energy and Environmental Foresight with the Scottish Government that I sat through entitled, “Food, Water, Energy Nexus: Surprise is Inevitable, Being Unprepared is Not.”  He stressed the importance of starting to prepare for the inevitable calamity that is to hit mankind in the coming years due the effects of climate change on food, energy and water.   It was noted that climate change impacts economic, food, global stability and biodiversity.   Environmental, social and technological changes require that we increase centrality of resources to human security, national prosperity and social well being.   The perfect storm which can stress physical and biochemical systems and these now fragile systems can amplify issues of equity according to Mr. Robson.   He predicts that water scarcity and stress would occur in 2025.  Additionally he expects a globally integrated market for fresh water in 20 to 30 years.   Water, he reported, is currently traded like wheat and its’ consumption is doubling every 20 years. 

    Overall, I enjoyed my experience at IFT.   I was able to network with fellow RD’s and even had the chance to speak with the President of the Academy of Nutrition and Dietetics, Dr. Ethan Bergman.   There was talk of the possible expanding role of supermarket RD’s in healthcare as Obamacare gets underway due to the fact that more American’s will be insured.  It was also exciting to visit the city of Chicago and experience it’s grandeur.  The Taste of Chicago, a food festival held once a year was a feast for the senses and was walking distance from where I was staying.   The food industry doesn’t have the cleanest reputation when it comes to promoting health and wellness.   They have a long ways to go to improve upon that, which appears to be their goal.   Given the global food culture, the food industry will continue to play an important role in feeding the global population.  From attending their events, it is my understanding that they are aware of the harmful effects of the western processed diets on health.   Traditional whole foods were touted as health promoting. It will be interesting to see what the future holds with respect to the food industry’s response to the coming food crises and the current obesity epidemic.    

Sunday, August 4, 2013

IFT 2013: Part 1

      A little less than a month ago I attended the Institute of Food Technologists (IFT) annual meeting and food expo in the beautiful city of Chicago.   The event focused on the impending food crises and changing the food industries image as the facilitator to the world’s health woes, particularly with regards to obesity.   Talks were given by prominent scientists, physicians and political scientists with regards to these issues.   The keynote speaker was Dr. Fareed Zakaria, CNN correspondent and political scientist, who gave a positive spin on the unforeseen challenges to the global food supply due to climate changes and how that is going to affect the food chain and distribution economically and politically.  He emphasized that, as always, a solution will be found and he used examples of previous recessions and how America managed to survive.  But of course, scientists will be at the forefront in resolving this issue.   There were educational track sessions on topics relating to food and nutrition, food laws, food microbiology, as well as food safety and defense.    I also attended their educational excursion to the Illinois Institute of Technology (IIT) where we were given a tour of their clinical nutrition and innovation labs. Their food expo floor was inundated with food ingredient companies trying to sell their products based on their application.  

     The trip to IIT’s clinical nutrition lab was interesting and insightful.  The dietitian/ lab researcher we met actually drew blood from the study participants as warranted.  Before this I did not know that dietitians actually performed such duties in this line of work.   They also had a room which looked like a physicians exam room where some investigative work was done.  There was of course a prep room and an instrumentation room where blood samples were processed.  At the conclusion of our tour we were given strawberry smoothie samples and were asked to distinguish between the one made with real strawberries and the one made with the artificial version.   We also visited the innovation labs and were led towards a microbiology laboratory where they were showing us their work on biological polymers and their applications with food products. 

     I attended several interesting food and nutrition track educational sessions during the event which I will go into some detail.  First,  it was such a delight to listen to Dr. Kaplan from the University of Calgary speak about, “The Role of Nutrition in Mental Health,” as her talk was entitled.  She emphasized that traditional diets (such as the Mediterranean diet) promoted mental health while the western processed diets increased the rate of anxiety and mood symptoms.   One particular study she discussed involved analyzing individuals 3 day food records and noting that those with increased vitamin and mineral intake had improved mental functioning scores.   During her talk she quoted Margaret Mead by stating that “it is easier to change a man’s religion than the way he eats,” to prove her point that since American diets are deficient in whole foods that supplementation may be necessary.   She also stated that although the brain is 2% of our body weight that it occupies 20 to 50% of our metabolic demands.   Finally she discussed studies involving vitamin and mineral supplementation and improved mental health.   But, she did stress that whole foods were best! Dr. Markus, a professor at the University of Maastricht gave a discussion on, “Food, the Brain and Stress Resilience.”  He stated that the balance between situational demands and personal preferences/abilities determined our wellness.   Stress, he added, “is the mental and physical energy to keep this balance.” When individuals are in a bad mood they usually crave carbohydrate rich foods.   Increasing intake of tryptophan has been shown to improve mood.  He went on to discuss how this knowledge could help enhance food effects and thereby help with curbing obesity. 

     To be continued with highlights from the rest of my IFT 2013 experience!

Sunday, May 12, 2013

Current Food Trends

Increased exposure to exotic foods and the awareness of how food impacts health seem to be the driving forces in what is trending now in food.   In the April issue of, “Food Technology,” magazine A. Elizabeth Sloan, President of Sloan Trends, Inc. discussed how American’s are eating in her article, “Top Ten Food Trends.”  The American demographic has been changing quite a bit especially over the last few decades.  Family meals are not so much the norm anymore as even those who live in classical family unit situations are eating their meals at separate timings.  Modern day busy lifestyles have much to do with this change.   Dining out, especially for millenials, is becoming much more of a treat than it used to be.  And consumers are seeking fresher food items to prepare at home.  
     Traditional American fare is losing its’ grasp as taste buds are expanding.  Consumers are seeking more exotic flavors to satiate the appetite.    They are looking towards world cuisine, as well as, artisanal foods to “upgrade” typical American foods like hamburgers, potato’s and beans to name a few.  Additionally, trendy ways to prepare foods such as sous vide and liquid nitrogen chilling are being sought in restaurants to add a punch of flavor to foods.   Frozen dinners are no longer in vogue as Americans who are eating alone at home are seeking freshly prepared or chilled meals. 
     Food consumers are looking towards fresher food products as they associate that with healthier eating.   They are steering away from foods with chemicals, pesticides, antibiotics and are leaning more towards certified organic food products.   Foods grown and harvested in the states are also preferred over imports.  Wording on labels that are making an impression with consumers are as follows: “cage free,” “grass fed,” “heart healthy,” “100% whole wheat,” “unprocessed,” and “preservative free.”  Consumers are also interested in foods with herbs, botanicals, prebiotics, vitamins and minerals in order to improve or maintain good health.  Products with ingredients that improve circulatory health, enable weight management, enhance muscle strength and help regulate blood sugar are in demand.   It is said that mothers are even more inclined to seek foods deemed healthier based on freshness, safety of consumption, and nutritional value.  
     As a whole, these insights are comforting to hear especially when you listen to the horror stories of Registered Dietitians of years past who have struggled to have whole wheat bread and fruit on the school lunch menu because parents thought their children would starve with such items on their lunch meal trays.   It appears that Americans are waking up to the face that food is the best medicine which is the realization that encouraged many to pursue careers as dietitians.  Hopefully this trend will grow as American’s begin to realize prevention is better than the cure. 

Thursday, February 7, 2013

GNYDA Health and Wellness Conference 2013

     A few days back, the Greater New York Dietetic Association (GNYDA) held their annual Health and Wellness Conference at the Cornell Campus of NY Presbyterian Hospital.   The event featured updates on advances in critical care nutrition, motivational interviewing techniques and how to develop a nutrition communications business.  I had the pleasure to attend this event so that I can share some insightful information I gathered during my time there.
     Motivational interviewing requires engaging the client, focusing on a desired behavior change, evoking reasons why habits that need to be altered, and a plan of action.   For this portion of the conference, Ms. Shelley Mesznick, MA, RD, CDE, CDN a dietitian in private practice for a number of years now, expanded on her knowledge of this technique she uses to assist her clients with lifestyle changes.  Engaging and building rapport with clients is necessary to help win their trust and confidence in the services you are providing for them as they go about the arduous path towards change.  OARS is an acronym for an effective counseling skill she reviewed that can be of great assistance to outpatient dietitians for the purpose of promoting dietary changes.   OARS stands for the following: Open questions, Affirmations, Reflective Listening, and Summaries.   In utilizing this skill you are actively listening to the patients story, reflecting on what is being said thereby clarifying the intended meaning of the speaker, and being empathetic to the clients needs.  In discussing affirmations, she described them as words of understanding, appreciation, or even a compliment like, “that was a great suggestion!”.   She also reviewed the 6 stages of change (precontemplation, preparation, contemplation, action, maintenance, and termination) noting that humans are at varying levels of change on any given day and that dietitians should capitalize on those days when their client exhibits a higher degree of readiness.  She also advises to ask open questions and limiting self disclosure to moments where you feel it can be helpful in assisting patient towards goals.  Having a conversation with a client should not be the same as talking to a friend.  Creating achievable goals, a plan to reach them and scheduling follow ups to monitor their progress is important throughout the counseling process.
    Second up were the cofounders of C & J Nutrition, Ms. Stephanie Clarke, MS, RD and Ms. Willow Jarosh, MS, RD who met at Tuft’s Nutrition Communications graduate program.   The focus of their presentation was the business of nutrition communications.   They discussed tips on pitching queries and stressed the possibilities of networking in this business.   When developing a piece for a magazine, they suggest reading  3 to 4 recent back issues to make sure you do not replicate anything they have recently done.  You must pitch the story to the editor 3 to 4 months before it is to be published.   When contacting editors, communication should be short, sweet and to the point.   Starting a blog and guest blogging is a great way to start.  Additionally, defining your skill set, creating a logo and creating business cards for networking purposes are necessary components of developing your brand.  You can also consult companies with regards to nutrition marketing, social media, etc.   Thinking out of the box is key to success in nutrition communications.   The speakers noted that they consulted a fashion brand on how to market nutraceuticals in their products.   
     Finally, Dr. David Seres of Columbia University Medical Center enlightened us on some myths regarding nutrition in critical care.   First off, he disputed the use of albumin as a marker of “malnutrition.”  He stated that low albumin levels are related to a redistribution of the protein which gets the signaling molecules to call out to the white blood cells.  Hypoalbuminemia is a good indicator of severity of illness.  As always, it still stands that enteral nutrition is superior to parenteral nutrition in critical care nutrition, as long as the gut works!   He reports that even patients with severe pancreatitis can be fed via NG or NJ routes successfully.   Dr. Seres pointed out that gastric feedings have been shown to increase pulmonary immunity in mice.  Regarding aspiration, he stated that everyone aspirates and the best ways to avoid pneumonia is to follow proper head out of bed protocol, monitoring for dysphagia, noting abdominal distention and gastric residuals in excess of 500cc.   Early enteral feeding promotes better outcomes in critically ill patients but feeding a patient too early could lead to disastrous outcomes like refeeding syndrome.   When is it too early to initiate feedings? It is when a patient is not well resuscitated or perfusing well.  Some ways to determine whether these criteria are being met are checking lactic acid levels, pulse and urine output.  Parenteral nutrition should be used when there is gut failure and the patient is severely malnourished or requires TPN for greater than two weeks.  Short term PPN should only be used, “… to resolve refeeding abnormalities when central line is delayed.”   There is a greater complication rate and cost with the use of parenteral nutrition versus enteral nutrition.  Some other myths regarding nutrition support in critical care that he disputed were as follows:  diabetic tube feeding formulas improve blood glucose control, protein restriction in renal failure, and presence of bowel sounds for diarrhea.  

Monday, January 21, 2013

The Practice of Dietary Supplementation

      There is much truth in Hippocrates words, “food is thy medicine,” but sometimes, a little dietary supplementation can be of benefit in preventing and treating some medical conditions.  It is also advocated by the Academy of Nutrition and Dietetics that there are times when dietary supplementation can be deemed beneficial in patient care.  Recently, the DPG group Dietitians in Integrative and Functional Medicine held a webinar entitled, “The Science, Art and Practice of Dietary Supplementation.”   The speaker during the event, Ms. Mary Beth Augustine, RD, CDN is a  Senior Integrative Nutritionist with Beth Israel Hospital in New York.  She shared her knowledge and expertise in choosing supplements wisely and appropriately to help enhance patient care.    Of utmost importance it is necessary to seek dietary supplements that are safe and reliable. 
     The FDA defines a dietary supplement as any product that is taken by mouth and contains a dietary ingredient that supplements the diet.  The dietary ingredient can be a vitamin, mineral, herb, amino acid, metabolite or enzyme.   The world of dietary supplements is not strongly regulated by the FDA which can pose problems for consumers.   Luckily, there are resources and techniques that can be used to locate the best quality dietary supplements available for your patient.   Additionally, some companies voluntarily partake in the FDA regulatory auditing system called Current Good Manufacturing Practices (cGMP) where their products are subjected to testing for quality, identity, strength and purity.  It should be noted on the dietary supplements label that it undergoes such testing.  If the vendor does not provide such testing for it’s products, you may present them with a sample audit form that they may fill out to your qualifications.  Integrative Medicine-A Clinicians Journal or ICMJ pieced together such a form that can be used for this purpose. It is also beneficial to obtain proof of evidence for product, raw material and stability testing of the supplement.  Another venue to investigate is which analyzes these substances in their laboratory and reports their findings on their website.
     Ethical considerations are especially important in deciding whether to recommend a supplement or not.   Would the supplement cause more harm than good? With the high costs of supplements, is it justifiable to recommend such a product to your patient? Of course, it would be prudent to review evidence based medicine information on dietary supplements you are considering recommending.  The Natural Medicine comprehensive internet database provides a wealth of information on different herbs/botanicals from uses to safety considerations.  They also provide knowledge on the scientific evidence supporting or disputing the uses of the herb for medicinal purposes.   Ms. Mary Beth Augustine did encourage attendees to not solely rely on the western scientific analytical method of deciding whether a supplement would be appropriate or not.  She notes that, “practice based wisdom,” is also an essential tool in the decision making process.   Also, the patient should be actively involved in deciding on supplement usage.  As the speaker noted, there is a paradigm shift in the way health care practitioners are relating to their patients.  Patients’ are becoming more involved in the decision making process.  Therefore, it is suggested Dietitians review the research and discuss findings with their clients and allow their clients to make the final decisions on what to take or not to take. 
     In educating patients on the different dietary supplements that may be useful for their medical condition, it is always important to stress that there is always an assumption of risk no matter how safe the dietary supplement appears to be.   For instance, it was previously thought that St. John’s Wort was very safe to take but it has recently been found to interact with protease inhibitor drugs.   It is also necessary to provide start and stop dates.  An example given during the webinar was a patient who had been taking vitamin B6 supplements for years and developed neuropathy leaving practitioners to question whether it was excess vitamin B6 or diabetes that resulted in the patient’s condition.  It is advisable to start with the lowest effective dose for a supplement and increase as tolerated/needed.  And when documenting dietary supplement usages, do not use words like treat or diagnose such language is intended for physicians only.  Structure and function claims are better suited for documentation of these medicinal products by Dietitians.  For instance, “feverfew _______(optimizes, enhances, supports, aids, maximizes)  treatment of migraine headaches.”
     Overall, dietary supplementation can be a useful addition in a patient’s medical treatment plan.  Diet changes should always be the first step in the process and dietary supplements can be added as deemed appropriate.  It is essential that safety, purity and integrity of the product be confirmed and specific brand names associated with these supplements should be provided to clients.  It is also the Dietitians responsibility to adequately educate the patient on the risks involved with the supplement and document appropriately.