WE NEED

3/22/2013
Debunking Nutrition Myths
Marie Spano, MS, RD, CSCS,
CSSD
Twitter: @mariespano
Nutrition Observations
1. We/media boil down nutrition into “sound bites” that don’t always accurately convey the message nor are they applicable for the masses
1. There’s more to nutrition than calories & macronutrients. Help your clients understand how what they are eating affects their bodies and thus their ability to train.
Top Nutrition Myths
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Detox Diets Work
Gluten Makes You Fat and Tired
Soy De‐Masculinizes a Man
We Don’t Need Dairy for Calcium
Artificial Sweeteners are Poison
We Can Get all of Our Nutrients from Food
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We are exposed to environmental toxins, pesticides, allergens, waste & inflammatory substances through foods on a daily basis. These build up in our bodies and make us sick, fat and tired.
Detox Diets
Detox Diets and Cleanses Supposedly:
• Get rid of harmful toxins
• Cleanse organs
• Help you lose weight
• Give you Energy
• Decrease inflammation
• Decrease disease risk
Typical Detox/Cleanse Rules
• NO:
– Alcohol
– Caffeine
– Highly processed and refined foods
– Foods grown with herbicides/pesticides
– Simple sugars
• Yes:
– Regimented supplements/detox drinks
– (maple syrup, lemon juice, diuretics, laxatives)
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Specific Cleanses
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Master Cleanse
Raw Food Diet
BluePrint Cleanse
Colon Cleanse
Detox Diets/Cleanses
• The Good:
– Cuts out low quality food
– Cuts excess calories
– Might eliminate some food sensitivities
– Raw Food Diet:
• Possibly fewer carcinogenic compounds consumed
• Fewer nutrients lost in processing
Heterocyclic amines, polycyclic aromatic hydrocarbons 3
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Pick 2: What do these two have in common? • Acrylamides
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High temperature
Frying, roasting, baking
Sugars + an amino acid
Mainly plant foods
– Produced on purpose for:
• Grouts, water treatment products, plastics, cosmetics
– Cancer in animals at very high doses
– Nerve damage in people exposed to high levels at work
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Raw Food Diet Research Summary
• Cross sectional study:
– Over 200 raw foodies of at least 2 years with > 70% diet raw food
– 1500 – 1800 grams raw food daily
– 38% B12 deficient
– None had high triglycerides
– 46% low serum HDL
J Nutr. 2005 Oct;135(10):2372‐8
Raw Food Diet Research
Cross sectional study, 216 men, 297 women
Examining body weight and amenorrhea
Average 3.7 years on the diet
Divided into 5 groups based on amount of raw food in their diet: 70‐79%, 80‐89%, 90‐94%, 95‐99%, 100%
• BMI below normal:
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– 14.7% of males
– 25% of females • 30% of women < 45 yr. old had oligomenorrhea or amenorrhea Ann Nutr Metab. 1999;43(2):69‐79.
Detox Diets/Cleanses
• The Bad:
– No credible scientific evidence of safety or efficacy
– Can be very restrictive
• Tough to follow
• Low calories = low energy, fatigue, headaches, dizziness
• Low calories = lower nutrients • Low protein
• Decrease in athletic performance/training
• They might perpetuate disordered eating habits
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Detox Diets/Cleanses
• The Bad:
– Low in nutrients & phytochemicals
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Vitamin D
Calcium
Zinc
Iron
Anemia
B12 Vitamin E
Other B vitamins
Omega 3 fatty acids
Detox Diets/Cleanses
• The Useless:
– “Detoxing” is done by the body’s organs
• Nose hairs & lung mucus filter dust, bacteria and allergens
• Skin is a protective barrier against harmful substances
• Kidneys filter 2 quarts of waste per day – excreted in urine
• Liver metabolizes drugs and filters blood before it circulates to the rest of the body
Detox Diets/Cleanses Done Right
• Short term
• Help clients find the cleanse that will do the least harm
• Consider workouts
• Do not cleanse while recovering from an injury or illness
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Gluten is Evil
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We can’t digest gluten
Most people are gluten sensitive
Eating gluten free = weight loss
Grains are poison
Gluten free = better athletic performance
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What is Gluten?
• The major storage protein in wheat • Made from glutenin & gliadin
– wheat • Durum, semolina, spelt, kamut, malt, couscous, bulgur, triticale, einkorn, faro
– rye
– Barley
Immunomodulatory activity
Cytotoxic (cell destruction) Activity
Gut Permeating activity
Alessio Fasano
Physiol Rev 2011;91:151‐175.
Where is Gluten?
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Where is Gluten?
• Cereal extract
• Dextrin/maltodextrin (USA products usually okay –
derived from corn)
• Gelatinized starch
• High protein flour
• Hydrolyzed vegetable/plant protein
• Imitation seafood
• Modified starch
• Natural flavors
• Texturized vegetable protein
List from Rachel Begun, MS, RD
Celiac Disease
• Autoimmune disease that occurs over time
• Cause: Genetic susceptibility + gluten
• Rice, buckwheat, corn, millet & other carb rich foods – do not contain gluten – may contribute to escalating symptomology in sensitive individuals by creating/sustaining inflammation
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Celiac Disease
• Inflammation & Damage to the small intestine & other organs
• Destroyed intestinal villi = impaired nutrient absorption
Celiac Disease
• Increased prevalence over the years (1 in 133 in not at risk groups)
• Over 300 symptoms
– Classic – gastrointestinal issues (most do not have GI symptoms!)
– Most common in adults – anemia
• Other autoimmune diseases common
Iceberg Model –
Prevalence of CD
Patients with clinically overt celiac disease
Patients with undiagnosed, silent celiac disease
BMJ 1999;319;236.
Patients with Latent CD (potential to develop the disease)
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Celiac Disease
• Most people with celiac undiagnosed
• Diagnose before treating!!!
– TTG (IgA) – 90 – 98% sensitivity, 94‐97% specificity
– At least 4‐6 intestinal biopsies including at least one of the duodenal bulb
• Rx: Lifelong avoidance of gluten (10 mg/day max)
Gluten Problems
• Gluten Sensitivity
– No standardized test
– Identification based on symptoms + avoidance
– If you feel bad, stop eating it
Why the Rise in Prevalence?
1. How we grow and process wheat
– 1961 – high yield wheat produced through fertilizers
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yield = nutrients yet greater starches and glutens
– Heavy use of fertilizers = rugged wheat that survived drought and disease
– Genetic variety of wheat that is much higher gluten stood out. 2. How we turn wheat into flour
– Disassemble it and put it back together
J Agric Chem 2009
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Is Gluten Bad for Everyone? • Dr. Fasano
– Wheat, rye, barley – @ 10,000 years ago
– Part of the gluten chain cannot be digested (Gliadin is toxic)
– Leaky gut
Leaky Gut
CD
Autoimmune Diseases
Tight Junctions –
“intestinal glue”
Dr. Fasano
Is Gluten Bad for Everyone?
• Dr. Fasano continued:
– “Gluten is a chronic, modern‐day poison.”
– Grains are not good for us
– Paleo diet is intrinsically “gluten free”
– No such thing as “gluten free.”
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Is Gluten Bad for Everyone?
• No stats on prevalence of:
– Gluten sensitivity
– Wheat allergies
– Potential link between undiagnosed CD and autoimmune diseases
• Dr. Guandalini
– Those without celiac disease can easily enjoy gluten with no problem
Considerations before going Gluten Free
• Celiac disease and tested?
• Restricted diets are difficult to maintain
• Gluten free foods are expensive yet many are nutritionally empty
Soy Will Rob Your Masculinity!
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The Culprit: Isoflavones
• Plant defense
• Hormonal and nonhormonal properties
• Some concerned about chronic exposure and endocrine system
Soy De‐Masculinizes a Man
• Many purported health benefits
• Some studies show adverse effects
– Rodent and in vitro studies
• Studies on soy and reduced risk of breast and prostate cancer examined if results due to decreases in estrogen and testosterone
– Majority of studies – soy protein or isoflavones ‐
no effect on hormone levels
– Due to another mechanism
Mark Messina, PhD, RD
Soy & Masculinity
• Very high exposures to isoflavones:
– cause infertility in animals
– animals metabolize isoflavones differently
– Not seen in humans • One small pilot study:
– Soy consumption associated with lower sperm concentration • Clinical trials – isoflavones have no effect on sperm concentration or quality
Gastroenterology 1987;93:225‐33.
J Agric Food Chem 1990;38:1530‐4.
J Nutr 2002;132:3577‐84.
Br J Nutr 2002;132:3577‐84.
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Soy and Fertility Study
• Pilot, Observational Study
 99 men in a fertility clinic
 questionnaire about how often they ate soy foods over a 3‐month period
 majority of men who ate soy had sperm concentrations within normal limits Hum Reprod 2008;23:2584‐90.
Soy & Fertility Study
 A few at the higher end of the soy intake range had a low sperm concentration
 Effect of soy foods on sperm was greater in overweight and obese men
 Soy foods and isoflavone intake showed no relationship to total sperm count, sperm motility or other measures of fertility
Soy & Testosterone
• Meta analysis – 15 placebo‐controlled treatment groups
– Included studies with adult men who consumed soy foods, isolated soy protein, isoflavone extracts
– No significant effects of soy protein or isoflavone
intake on:
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Testosterone
Sex hormone‐binding globulin
Free testoFree androgen index
sterone
Fertil Steril 2010;94:997‐1007.
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Soy & Fertility
• Isoflavones are phytoestrogens
 chemical structures similar to estrogen
 not estrogen! No effect on estrogen or testosterone
 found in plant‐based foods – soy & legumes
Soy Food Benefits
• Soy protein
– Lowers LDL cholesterol by 4-5%
• Each 1% drop in LDL lowers heart disease
risk by 1-2%
– Replace higher saturated fat foods – may
reduce heart disease risk by 10% or more
– Does increase muscle protein synthesis and
may prolong the anabolic window
Am J Clin Nutr 2009;89:1155‐1163.
J Nutr 2009;139:796S‐802S.
We Don’t Need Dairy
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Dairy Controversies
• We are the only mammals who drink another animal’s milk
• The hormones in milk cause kids to mature faster and make us fat
• Human’s haven’t evolved enough to digest dairy
• Most people are lactose intolerant
• We don’t need dairy for calcium
Hormones in Milk
• All milk including human breast milk contains hormones
• Some cows given recombinant bovine somatotropin (rbST) (also naturally produced by cows)
• Pasteurization destroys 90% of bST
• Remaining bST broken down into trace inactive fragments by enzymes in the GI tract
• bST is species specific – biologically inactive in humans
Food Rev 1994;17:27‐31.
Science 1990;249:875‐884.
We Can’t Digest Dairy
• Lactose Intolerance
– Lactase enzyme deficiency or low activity
– Incomplete digestion of lactose (sugar = glucose + galactose)
– Primary ‐ Happens over time after age 2 – Secondary – injury to small intestine
– GI upset
– More common in African Americans, Hispanic Americans, Asian Americans, American Indians
Lactose Intolerance. National Digestive Diseases Information Clearinghouse. 2006.
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Lactose Intolerance
• Hydrogen breath test – lactose loaded beverage (undigested lactose = hydrogen)
• Stool acidity test – more common in infants and young kids
Managing Lactose Intolerance
• Cheese – less lactose
• Yogurt – good bacteria digests some of the lactose
• Slowly, gradually increase dairy to build tolerance
• Consistently consume some dairy with a meal – body is used to handling it
• Lactaid
Dairy Controversy
Calcium & Vitamin D:
– Most important nutrients to maximize the development of peak bone mass
– Milk is the #1 source of calcium, magnesium & vitamin D in all people over the age of 2
• Contains other bone building nutrients – phosphorus, zinc, potassium
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• Meeting daily calcium needs with leafy greens
• Not as bioavailable as calcium from dairy
• 4 cups of cooked spinach /day
• 8 + cups raw greens
• Other vegetarian sources
• Soy, rice, almond milk
• Shake the container
• Vitamin D2 not D3
Is Protein Bad for Bone??
• Protein makes up about 50% of bone volume and 33% of mass
• Truth or myth: High protein diets and calcium loss
– Not observed with food sources of protein
– 30% calories from protein – no increase in calciuria
– 2.1 g/kg bodyweight protein, urinary calcium increased but, intestinal absorption increased.
• No truth that animal based proteins are bad for bone or vegetable based proteins are better for bone
Am J Clin Nutr 2008;87: 1567S-70S.
Dairy
• Countries that don’t consume dairy have good bone mineral density
– Other factors affecting bone health
• Meta analyses of Alkaline vs. Acidic Diets and bone
– Linear association between calcium excretion and acid load in the diet but…
– This does not mean the excreted calcium came from bone or that this type of calciuria contributes to the development of osteoporosis
– Promotion of the alkaline diet to prevent osteoporosis not justified by the research
– High phytic acid and oxalic acid
Osteo Int 2001;12:493‐9. J Bone Miner Res 24;1835‐40.
Am J Clin Nutr 2008;88:1159‐68.
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Artificial Sweeteners are Poison
Sweet Substitute or Toxic Ingredient?
• They trick the body into preferring sweet foods/beverages
• Side effects:
– Headaches
– decreased testosterone
– increased cancer risk
– Weight gain
Sweet Substitutes?
• Nutritive & non‐nutritive sweeteners must be:
1. GRAS
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History of safety & common use in food prior to January 1, 1958 2. Food Additive
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Provide FDA w/ chemical identity and composition as a food additive
Must be evaluated for safety & use in foods & beverages
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Not so Sweet Scrutiny ‐ Saccharin
• Made from methyl anthranilate, (in grapes)
• In cosmetics, chewing gum, candy, beverages, cake mixes, pharmaceuticals, pink packets
• In the 1970’s rats given high dose saccharin got bladder cancer
– Mechanism irrelevant for humans
• Saccharin doesn’t cause cancer in humans
• Not metabolized in the body, doesn’t raise blood glucose
Aspartame
• Phenylalanine, aspartic acid, methyl ester group • Doesn’t accumulate in the body
• Causes a very slight increase in blood glucose
Diet Soda = Obesity
• Data from the San Antonio heart study
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> 5,000 people, 7‐8 yr follow‐up
All soda drinkers gained weight but…
Diet soda drinkers gained more weight
The more diet soda, the greater the weight gain
• Framingham Heart Study
– > 9,000 people
– 4 year follow‐up
– Those who drank sugar sweetened and zero cal soft drinks more likely to gain weight
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* Observational Studies
Is Natural Better?
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Stevia
Sugar alcohols
Lao Han Go
Fibers – Inulin We Can Get all of Our Nutrients From Food
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We Can Get all Nutrients from Food
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True, sort of
Nutrients of Concern
Specific Disease States/Conditions
Too much of a good thing?
– Yes, antioxidants
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Nutrient Deficiencies
• Prevalence of Vitamin D deficiency (NHANES 2005 ‐ 2006)
– 4495 adults
– serum 25‐hydroxyvitamin D concentrations < 20 ng/ml
– 41.6% deficient
• 82.1% blacks
• 69.2% Hispanics
• Prevalence of Iron deficiency
– 2% in men
– 9‐10% in white women
– Nearly 20% in black and Mexican‐ American women
Nutr Res. 2011 Jan;31(1):48‐54
Am Fam Physician. 2007 Mar 1;75(5):671‐678..
My Rules
• Never place your dietary restrictions, allergies, intolerances, nutrient deficiencies, diseases etc. on your client
• Speak openly from what the science says
• Don’t boil down your client’s issues into one food, one ingredient, one meal etc.
• Remember many of your clients give you half the story!
• Favor Progress, Not “Perfection”
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Marie Spano, MS, RD, CSCS, CSSD
@Mariespano
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