EVERYTHING YOU WANTED TO KNOW ABOUT NUTRITION BUT WERE AFRAID TO ASK

Cristin Stokes, RD, LN

MUS Wellness

April 2015

EVERYTHING YOU WANTED TO KNOW ABOUT NUTRITION BUT WERE NOT AFRAID TO ASK

• 600+ questions sent in (Nice job!)

• Most popular question: “Best balance of carbs/fats/proteins?

Best & worst sources of each?”

• Upcoming webinar devoted solely to the topic

• Tuesday, June 9th, 12:05pm

BIG PICTURE

• “With the exception of some on the fringes, scientists and medical

experts agree in more ways than they disagree about what people

should eat — and have for some time. It may not always seem that way

because confirmation of existing knowledge gets scant attention in the

media compared with the widespread coverage lavished on “new”

nutrition announcements and fads.”

• Walter Willett & Frank Nu, Harvard University School of Public Health

• Moderation and Balance are keys!

• Don’t put all your eggs in one (nutritional) basket

QUESTION #1: ARE EGGS GOOD OR BAD?

• Do eggs increase cholesterol and should they be limited to a certain

number per week?

• Dietary Guidelines for Americans 2010

• Limit to 300 mg cholesterol/day

• 2015 Update

• Cholesterol = “not a nutrient of concern for overconsumption”

• Why the switch?

• Dietary cholesterol ≠ blood cholesterol

• Blood cholesterol ≠ perfect predictor of CVD

• Epidemiological studies looking at total cholesterol

• Recent studies

QUESTION #1: ARE EGGS GOOD OR BAD?

• Big Picture

• What are eggs replacing?

• Bagel based breakfast vs egg based breakfast

• Nutrients in eggs

• Carotenoids– protective against inflammation, oxidation, and atherosclerosis

• High quality protein, choline

• What are you eating with your eggs?

• Not a free pass

• Other components in animal foods that contribute to disease

• Bottom line: Eggs (including yolk) ok; particularly with eaten in place of

carbohydrates

QUESTION #2: WHICH IS REALLY BETTER FOR YOU: SUGAR OR SUGAR SUBSTITUTE?

• Sugar (aka corn syrup, dextrose, malt syrup, evaporated cane juice, etc.)

• Provides calories, happiness (short-term!)

• Yet…

• Displaces healthy foods

• Suppresses the immune system

• Promotes inflammation

• Accelerates aging

• Raises insulin levels

• More “natural” sugars?

• Added sugar recommendations (American Heart Association)

• 9 tsp/day or less for men

• 6 tsp/day or less for women

• 1 can regular soda = approx. 8 tsp sugar

QUESTION #2: WHICH IS REALLY BETTER FOR YOU: SUGAR OR SUGAR SUBSTITUTE?

• Sugar Substitutes

• Artificial sweeteners: Aspartame (Equal, NutraSweet), Sucralose (Splenda),

Saccharin (Sweet N Low), Ace-K (Sweet One), Neotame,

• Sugar Alcohols: --itols sortibol, xylitol, mannitol, isomalt, erythritol

• Stevia (TruVia)

• National Cancer Institute no conclusive evidence for artificial

sweeteners causing cancer

• Many have been around since early 1980’s

• Generally Recognized As Safe (GRAS)

QUESTION #2: WHICH IS REALLY BETTER FOR YOU: SUGAR OR SUGAR SUBSTITUTE?

• Not so fast!

• San Antonio heart study

• May affect body’s ability to gauge caloric intake

• Sweet taste + no calories = may increase cravings for sweet foods

• Sugar substitutes do not activate the same regions of the brain

• Overstimulation of sugar receptors w/frequent use

• May make more complex tastes less appealing

• Alteration of gut microbiota

QUESTION #2: WHICH IS REALLY BETTER FOR YOU: SUGAR OR SUGAR SUBSTITUTE?

• Bottom line: Moderation!

• My bias? Real sugar (but less often)

• If you have a soda habit-- try sparkling water, caffeine from coffee/tea

QUESTION #3: I FIND THE ADVICE ON EATING FISH TO BE VERY CONFUSING. HELP!

• Benefits of eating fish

• Omega-3’s, protein, selenium, vitamin D, low in saturated fat

• 1-2 servings per week = 36% reduction in risk of dying from

CVD

• Reduced risk of stroke, Alzheimer’s, depression

• Current recommendations: Eat fish 2x/week

• Fish high in omega-3’s: Salmon, tuna, herring,

sardines, anchovies, bluefish, mackerel

QUESTION #3: I FIND THE ADVICE ON EATING FISH TO BE VERY CONFUSING. HELP!

• Potential contaminants

• Mercury

• Highest: albacore tuna, shark, swordfish, mackerel, tilefish

• Lowest: chunk light tuna, shrimp, salmon, Pollock, catfish

• PCBs & dioxins

• Check area warnings

• Farmed vs. wild-caught

• Nutritionally – nearly the same

• Biggest difference is in omega-3 content

• Sustainability

• Monterey Bay Aquarium www.seafoodwatch.org

• Bottom line: Eat fish. Eat a variety of fish/seafood. Eat low on the aqua food chain.

QUESTION #4: IS GLUTEN-FREE REALLY THAT HEALTHY?

• Questions from survey:

• Do we need to avoid gluten as much as society leads us to

believe?

• Is bread really that bad for you?

• Is it really true that it is not healthy to eat food that has lots of

gluten? If it is not healthy, why is that so?

• Is gluten-free really that healthy?

• Why would someone who doesn't have celiac disease want to

restrict their gluten intake?

• What are the possible negative effects of going gluten-free?

QUESTION #4: IS GLUTEN-FREE REALLY THAT HEALTHY?

• Definition of gluten: Protein found in wheat, rye, and barley that

is responsible for the elastic nature of dough

• Celiac disease

• Approx. 1% of the population (and increasing)

• Symptoms: bloating, diarrhea, abdominal pain, anemia,

malabsorption, joint pain, skin rashes

• Damage caused to intestinal villi by autoimmune response

• Non-celiac gluten sensitivity

• Approx. 6% of the population

• Symptoms very similar to CD; may be less GI related (i.e.

headaches, feeling “foggy”, joint pain, etc.)

• FODMAP diet may be more important than gluten-specific

QUESTION #4: IS GLUTEN-FREE REALLY THAT HEALTHY?

• Gluten free diet

• Potential benefits:

• Less junk?

• Paying attention to diet

• Relief of symptoms?

• No nutrients specific to wheat that

cannot be found in other foods

Potential cons:

• Highly processed starches

• Rice flour, tapioca, xantham gum,

etc.

• Usually not fortified

• Potentially low in folate, fiber

• Changes in gut microbiota

• Expensive & restrictive

Bottom line: No need to avoid gluten unless you have CD or non-celiac gluten sensitivity

•If going gluten free, focus on whole, fresh foods

QUESTION #5: SHOULD I TAKE A MULTI-VITAMIN? IF SO, WHAT SHOULD I LOOK FOR?

• Balanced diet full of fruits & veggies is the best way to get

micronutrients

• Research evidence?

• By population:

• Pregnant women, individuals with a poor diet or certain medical

conditions

• Healthy adults

• Cheap, easy way to fill in gaps

• Bottom line: Real food sources always best; take a multi-

vitamin if you want

• Likely won’t hurt, and might help

QUESTION #5: SHOULD I TAKE A MULTI-VITAMIN? IF SO, WHAT SHOULD I LOOK FOR?

• What to look for:

• No mega-doses (particularly vitamin A; antioxidants)

• Brands?

• USP seal

• Bigger brands over no-name brand

• “All-natural” or “pharmaceutical grade” has little or no meaning

• Contamination?

• Gummy vitamins

• Matter of preference

• 2-3 g sugar per dose

• Will lose potency over time

• Storage guidelines

QUESTION #6: WHAT IS THE CURRENT SCIENCE ON THE HEALTH BENEFITS OF COFFEE?

• 18,000+ studies in the past 30 years

• Poor design of early studies

• Potential benefits (2-4 cups per day; up to 6 cups)

• Reduced risk of:

• Alzheimers and Parkinson’s

• Type 2 DM

• Stroke

• Liver disease

• Colon cancer

• Gallstones

• Prostate cancer

• Potential cons: jitteriness, anxiety, sleep disruption, unfiltered coffee may increase LDL

cholesterol (for men in particular)

QUESTION #6: WHAT IS THE CURRENT SCIENCE ON THE HEALTH BENEFITS OF COFFEE?

• Diuretic but not dehydrating

• Fluids replace increased urine output

• Each cup can count as ~2/3 cup of fluid intake if regular coffee drinker

• Temporarily increases blood pressure and heart rate

• Keep in mind:

• Coffee is more than caffeine

• Studies use black coffee

• Bottom line: You can keep your coffee habit.

• Exception: pregnant women, people with trouble controlling BP

LIGHTNING ROUND

• I have heard eating five or six smaller meals/snacks is really better for us than the traditional

meal schedule. Is this true?

• Does lettuce have any nutritional value? What is the best green veggie for you to eat? How

many servings of vegetables should I eat per day?

• What type of milk do you generally recommend? Cow's/soy/almond/rice/etc.?

• What are the three most effective foods to help lower cholesterol?

LIGHTNING ROUND

• I've become a big food label reader. Can you share three ingredients or additives that

would make you put down a product at the grocery store?

• I get cramps in my feet quite often. Are there any foods or vitamin supplements that you

recommend I take to prevent these cramps from happening?

• My yogurt has 135 mg of potassium in a single serving, is this too much potassium in

one day?

• Does eating spicy food boost metabolism?

BIG PICTURE

• Overall dietary pattern is far more important than one food, one ingredient,

or one component.

• There’s no magic bullet. Sorry.

• Cristin’s 6 Nutritional Tenets

• 1. Consider the 80/20 rule of moderation

• 2. Eat more plants

• 3. Choose whole foods over processed

• 4. There’s no hidden secret to weight loss

• 5. Take advantage of all the wonderful foods grown in MT

• 6. Enjoy your food!

RESOURCES

• The Nutrition Source – Harvard School of Public Health http://www.hsph.harvard.edu/nutritionsource/

• The Nutrition Diva http://www.quickanddirtytips.com/nutrition-diva

• Scientific Report for the 2015 Dietary Guidelines Advisory Committee www.health.gov/dietaryguidelines

Up next:

• Wellcheck Tour ends with Butte and Missoula

• June 9th Carbs/fats/protein webinar

• September 16th Everything you always wanted to know about Exercise but were afraid to ask

Other Wellness Resources:

• www.montanamovesandmeals.com

• www.muswell.limeade.com

• www.wellness.mus.edu