Written by Kayla Cooke, MS Student at Pace University

November 16 is World Pancreatic Cancer Day, created to spread awareness about this disease. Pancreatic cancer involves the uncontrolled growth of cells in the pancreas. This type of cancer is the tenth most common and its incidence rate has been growing by about 1% every year for men and women since the late 1990s.2,7 African American men are most susceptible to pancreatic cancer though many other groups are affected.4 Additionally, pancreatic cancer is common among older people with an average age of 70 at the time of diagnosis.4 It is a serious diagnosis since on average only 12.5% of people survive within five years of being diagnosed.7

Unfortunately, it is harder to diagnose pancreatic cancer early on which contributes to its average low survival rate.1 If pancreatic cancer is not diagnosed early, over time the cancer can spread to other parts of the body including blood, other tissues, and the lymphatic system complicating treatment.1 It is harder to detect pancreatic cancer in its earlier stages because there aren’t as many noticeable symptoms.1 When there are noticeable symptoms, they also resemble many other illnesses which can lead to misdiagnosis.1 Some signs of pancreatic cancer involve unexpected weight loss, jaundice, and abdominal and back pain caused by tumor pressure on nerves or nearby organs.1 Since this cancer can be hereditary (e.g. through passing down gene mutations), it is suggested that those with a strong family history or genetic predisposition to pancreatic cancer be annually screened.2,4 However, the US Preventive Services Task Force doesn’t recommend screening for this type of cancer for those who are asymptomatic.2

Along with having a strong family history of pancreatic cancer or pancreatitis, there are more controllable risk factors.1 These risk factors include history of smoking, excess weight, and existing diabetes or chronic pancreatitis.1 As a preventative measure, one can incorporate more daily physical activity to help maintain or achieve a healthy weight and reduce the risk for type 2 diabetes. This can be a simple lifestyle change such as doing a wall squat while scrolling through social media or leg raises while brushing teeth. Exercising muscles more frequently and intensely improves insulin sensitivity.3 For further information about diabetes including ways to reduce your risk, please refer to our April blog post.

Diabetes is a common comorbidity as the tail portion of the pancreas contains cells that produce insulin and glucagon (hormones that regulate blood sugar levels). Therefore certain pancreatic cancers can reduce one’s ability to produce these hormones which can lead to diabetes.6 With insulin resistance, dietary changes such as reducing added sugar are recommended to keep blood sugar levels stable.6

The type of pancreatic cancer treatment depends on the stage, patient health status, and whether the disease is reoccurring.1 Sometimes combined treatments such as surgery with chemotherapy or radiation can support survivorship.2 Aside from oral pain medications, if the pain is severe enough one may require medication injections around the affected area, have the nearby nerves cut, or undergo radiation to shrink the tumor.1 Pancreatic cancer treatment may affect the organ’s ability to produce enzymes which help with digestion.1 One can be prescribed

medication to replace these enzymes.1 Nutrition-based treatment includes eating softer (e.g. chopped or boiled) foods to support digestion.5 Fat digestion is especially affected by having reduced pancreatic enzymes, so it is recommended to limit fatty and greasy foods to reduce potential digestive issues.6 Overall, it's best to not eat foods that noticeably increase adverse symptoms such as diarrhea or vomiting.6

When undergoing pancreatic cancer and treatment it is important to consider healthful dietary changes to support strength and energy. Cancerous tumors in the pancreas release cytokines that reduce appetite and increase calorie use which can lead to weight loss.6 This weight loss can be compounded through treatment side effects, like nausea or vomiting. Therefore it is recommended to incorporate more calorie-dense foods to prevent weight loss as this can hinder the body’s ability to fight infection and handle the treatment.5 It’s also recommended to eat more lean protein-dense foods to help maintain muscle mass and strength.6 Being physically active during treatment can help promote appetite.5 Common nutrition recommendations for cancer patients undergoing treatment include eating small, frequent meals and not drinking fluids shortly before or during a meal to make it easier to consume more calories.5, 6 If diagnosed with pancreatic cancer and are undergoing treatment, it is best to consult a Registered Dietitian for specific nutritional needs and lifestyle changes to best support health and well-being.

References

1. Pancreatic Cancer Treatment (PDQ®)–Patient Version. National Cancer Institute. Published May 5, 2023. Accessed October 23, 2023. https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#:~:text=Pancre atic%20cancer%20is%20a%20disease

2. Cancer Facts & Figures 2023. American Cancer Society; 2023:23. Accessed October 23, 2023.

https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annua l-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.pdf

3. Simple Steps to Preventing Diabetes. Harvard T.H. Chan. Accessed October 23, 2023. https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/pre venting-diabetes-full-story/#:~:text=Beyond%20individual%20behavior

4. Pancreatic Cancer Risk Factors. www.cancer.org. Published June 9, 2020. Accessed October 23, 2023.

https://www.cancer.org/cancer/types/pancreatic-cancer/causes-risks-prevention/risk-facto rs.html

5. Walsh C. Pancreatic Cancer Nutrition: 12 Pancreatic Diet Tips. John Hopkins Medicine. Accessed October 23, 2023.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancr eatic-cancer-nutrition#:~:text=Patients%20with%20pancreatic%20cancer%20often

6. Whelan C. Can Diet Help Pancreatic Cancer? Healthline. Published July 20, 2023. Accessed October 23, 2023.

https://www.healthline.com/health/pancreatic-cancer/diet#enzymes-and-supplements

7. Cancer Stat Facts: Pancreatic Cancer. Surveillance, Epidemiology, and End Results Program (SEER). Accessed October 23, 2023. https://seer.cancer.gov/statfacts/html/pancreas.html

Native American Heritage Month

By Vida Velasco-Popov, MS Student at PACE University

Each October, the sitting president of the United States declares November as Native American Heritage Month. The idea of recognizing Native Americans for their significant contributions began in 1912, when the director of the Museum of Arts and Science in Rochester, New York, Dr. Arthur C. Parker proposed American Indian Day As a member of the Seneca Tribe, Dr. Parker worked for three years with Boy Scouts of America, Congress, and the American Indian Association till the day was formally approved in 1915 The tradition expanded further in 1990, under the Bush administration after a joint resolution concluded to designate November as National American Indian Heritage Month This federally recognized month was created with the intention of honoring Native Americans and Alaska Natives for their contributions to the United States and the world. In honor of Native American Heritage Month, this blog aims to shed light on common health challenges facing these communities and how strategic community-based nutrition interventions led by RDs have the potential to address current health disparities.

According to the CDC, Native Americans and Alaska Natives show the highest prevalence of diabetes compared to any other race or ethnicity in the United States. When we look at the statistics, we find 16% of Native American adults diagnosed with diabetes compared to 8% of white peopleThe US Department of Health and Human Services reveals that Native Americans and Alaska Natives are 50% more likely to struggle with obesity compared to non-Hispanic whites Not only do these chronic conditions lead to further health complications, they also increase mortality and lower overall quality of life. Based on the outcomes of several different studies, it seems community-based approaches to nutritional interventions work most effectively for curbing current chronic disease trends in Native American and Alaska Native populations. Though, it may seem relatively simple to identify specific health challenges and patterns within these communities, understanding how some nutritionally based initiatives might result in better health outcomes than others present more of a challenge. In reviewing several different studies and looking at different aspects of care including cultural sensitivity, relation to traditional foods, and the inclusion of native world views, I hope to share some insight into this relevant topic.

Keeping culture and history in mind when working with these groups is especially important for creating deeper connections and establishing trust with patients. From 2008-2014, researchers conducted a study covering lasting effects of community-based nutrition and general health interventions through the Traditional Foods Project. Through this research, it was found that a combination of honoring traditional foods, encouraging physical activity and including social support led to positive change in 17 Native American and Alaska Native tribes By taking time to work with community partners to better understand traditional values and way of life, researchers were able to see how unconventional methods such as storytelling led to healthy lifestyle changes within the community. Linking traditional values with the need to improve personal health, led to increased use of community gardens and participation in activities such as traditional fishing, and hunting Encouraging change from a tribal perspective allows for deeper understanding of how factors such as poverty, historical trauma, and territorial displacement come into play when considering how to implement nutritional health interventions in culturally sensitive ways.

Movement away from traditional native foods to more processed diets heavy in packaged food is associated with increased rates of obesity, diabetes, and other chronic diseases in Native American and Alaska Native communities Traditional diets range from Navajo foods such as corn, squash, sheep, berries, and wild plants to Tohono O'odham nation foods which include saguaro fruit, cholla buds, and tepary beans which provide a rich variety of nutrients In a health study on the Inuit diet, it was found that traditional country foods such as caribou, birds, fish, raw fireweed leaves, and berries have rich nutrient profiles which contribute positively to overall health; compared to sweets and potato chips which were reported in over 90% of the 2,595 Inuit adult participants Convenience stores sell mostly packaged food, which negatively impacts food selection. Here, we find two conflicting decisions: does one purchase food for convenience or follow traditional ways of eating which require more time and effort. When considering how important the process of harvesting and consuming traditional foods is for preserving Inuit cultural identity, it makes sense to work within these communities to understand their traditions and relate these practices back to health. Though market food availability for Inuit people increased significantly after the 1950s, this shift has not necessarily improved diet quality The 24-hour dietary recall methods used, revealed how sugar sweetened beverages, added sugar and bread accounted for 20% of total diet energy in these communitiesThis is not to say that nutrient dense foods were not available in market settings, but rather these communities may not have consistent access to nutrition education which would help tremendously in guiding food purchasing decisions. By working collaboratively with native communities, RDs might offer knowledge and expertise to promote healthful food decisions while community members might contribute by sharing traditional recipes and worldview which would help ensure cultural relevance to support positive change.

Looking into Native American diets studied in six different Midwestern and Southwestern reservations in a cross-sectional analysis using a semi-quantitative Block Food Frequency Questionnaire (FFQ), provides some perspective on how these groups compare to the national average with regards to DGA recommendations It was found that less than 2% of participants met DGA fruit intake recommendations compared to the national average of 12%; for vegetable intake we find 42% met recommendations compared to just 9% nationally This finding seems particularly interesting because we might expect both fruit and vegetable intake to be lower compared to national averages due to limited access to grocery stores and high rates of poverty, but this is simply not the case. One potential explanation may relate to the high percentage of participants enrolled in food assistance programs. Over 70% of participants were enrolled in SNAP, WIC or FDPIR Food assistance programs such as SNAP and FDPIR offer nutrition education and programming for Native American communities which may contribute to the high vegetable intakes observed, however further studies are needed to understand why low fruit intakes were reported. Another interesting aspect of this study has to do with data collection methods. Fifteen percent of the 601 participants studied, were surveyed using native language and an additional fifteen percent of participants were interviewed using a mixture of native language and English Of the studies I’ve read on this topic, very few use native language to connect with participants. This linguistic strategy is particularly useful when working with members of a community who may not be fluent in English. Eliminating language barriers is beneficial for reducing reporting errors and establishing trust with participants.

Establishing cultural relevance within a proposed nutritional intervention greatly contributes to overall success. A systematic review of nutrition interventions in Native American and Alaska Native populations revealed that using more than three strategies for community engagement was associated with significant outcomes Of the 49 studies assessed in the review, 79% resulted in behavior, knowledge, or health changes. Furthermore, 31 programs reported significant changes and 28 of the studies involved community partnerships Strategies such as involving community partners, training peer educators, or involving local food systems are all useful strategies for building community relationships to ensure overall success of a program. From personal experience, as a community health volunteer, I’ve learned that people respond best when they feel they have autonomy. Instead of creating a narrative where you might think of yourself as an individual working to help other people, think of your role as building a partnership between you and the community. As you offer guidance and support, spend time learning from the people you’re working with and try to understand their way of life and what knowledge they may bring to the table. By considering the strengths of indigenous communities and involving these groups as decision makers or co-designers, this has the potential to expand the reach and depth for future RD supported nutrition interventions. 

1. Banna, J., & Bersamin, A. (2018). Community involvement in design, implementation and evaluation of nutrition interventions to reduce chronic diseases in indigenous populations in the U.S.: a systematic review. Int J Equity Health, 17(1), 116. https://doi.org/10.1186/s12939-018-0829-6

2. Bersamin, A., Izumi, B. T., Nu, J., O'Brien D, M., & Paschall, M. (2019). Strengthening adolescents' connection to their traditional food system improves diet quality in remote Alaska Native communities: results from the Neqa Elicarvigmun Pilot Study. Transl Behav Med, 9(5), 952-961. https://doi.org/10.1093/tbm/ibz087

3. Centers for Disease Control and Prevention. (n.d.). Native Americans with diabetes - vital signs - CDC. Centers for Disease Control and Prevention. Retrieved November 4, 2022, from https://www.cdc.gov/vitalsigns/aian-diabetes/index.html

4. Congress, T. L. of, Administration, N. A. and R., Art, N. G. of, Humanities, N. E. for the, Service, N. P., Institution, U. S. S., & Museum, U. S. H. M. (n.d.). National Native American Heritage month. National Native American Heritage Month. Retrieved November 4, 2022, from https://www.nativeamericanheritagemonth.gov/about/

5. DeBruyn, L., Fullerton, L., Satterfield, D., & Frank, M. (2020). Integrating Culture and History to Promote Health and Help Prevent Type 2 Diabetes in American Indian/Alaska Native Communities: Traditional Foods Have Become a Way to Talk About Health. Prev Chronic Dis, 17, E12. https://doi.org/10.5888/pcd17.190213

6. Estradé, M., Yan, S., Trude, A. C. B., Fleischhacker, S., Hinman, S., Maudrie, T., Jock, B. W., Redmond, L., Pardilla, M., & Gittelsohn, J. (2021). Individual- and household-level factors associated with fruit, vegetable, and dietary fiber adequacy among Native American adults in 6 reservation communities. Prev Med Rep, 24, 101414. https://doi.org/10.1016/j.pmedr.2021.101414

7. Kenny, T. A., Hu, X. F., Kuhnlein, H. V., Wesche, S. D., & Chan, H. M. (2018). Dietary sources of energy and nutrients in the contemporary diet of Inuit adults: results from the 2007-08 Inuit Health Survey. Public Health Nutr, 21(7), 1319-1331. https://doi.org/10.1017/s1368980017003810

8. Office of Minority Health. Obesity and American Indians/Alaska Natives - The Office of Minority Health. (n.d.). Retrieved November 4, 2022, from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=40

9. White, Louellyn & Stauss, Joseph & Nelson, Claudia. (2006). Healthy Families on American Indian Reservations: A Summary of Six Years of Research by Tribal College Faculty, Staff, and Students. American Indian Culture and Research Journal. 30. 99-114. 10.17953/aicr.30.4.v172h21rx1315470.

National Physical Fitness and Sports Month written by Andrea Polvere, MS Student at Pace University

Background¹

In May of 1983, a federal advisory committee called the “President’s Council on Sports, Fitness, and Nutrition” declared May as “National Physical Fitness and Sports Month”. The purpose of dedicating a month to this issue is to encourage Americans of all ages to incorporate healthy lifestyle habits into their lives through physical activity, regardless of ability or background. Through this initiative, the Council promotes physical activity and provides suggestions for healthy dietary patterns with general exercise and nutrition guidelines, federal food assistance programs, as well as campaigns such as  #0to60 and Let’s Move. This year’s initiative, #MoveinMay, brings attention to healthy lifestyle habits and the benefits of sports participation!

Benefits

Everyone can benefit from exercise– no matter the race or ethnicity, gender, size, or presence of health conditions!² Physical activity provides endless health benefits, including weight management, prevention of diseases and conditions such as heart and lung diseases, diabetes, hypertension, and even dementia. It has also been shown to improve mood, ease symptoms of anxiety and depression, boost energy, and improve sleep.³ 

An active lifestyle is important at every stage of life, but participation in sports is particularly beneficial for children. This is a crucial developmental time that helps children and teenagers gain and develop skills for leadership, relationship-building, fair-play, time management, and respect for authority, teammates, opponents, and rules of the game.^3,4 Self-esteem is an additional benefit and seems to increase in children involved with sports.⁵ It is also important to note that these learned attitudes, skills, and behaviors will create the foundation for a well-rounded individual possessing qualities such as responsibility, collaboration, honesty, reliability, and self-regulation. ^4,5

Types of Exercise

Aerobic exercise, meaning “with oxygen”, is any type of cardiovascular exercise. Oxygen is moved to the muscles by red blood cells, where it reacts with glucose to create adenosine triphosphate, or ATP, which is the chemical source of energy within our bodies. This process, called cellular respiration, is characterized by 3 steps: glycolysis, Krebs cycle, and oxidative phosphorylation.⁶ Some examples of aerobic exercise include brisk walking, biking, running, dancing, yard work, rowing, or swimming. These types of actives can range from mild, moderate, or vigorous intensity.

Anaerobic exercise means cellular respiration must occur without oxygen. Although the first step of cellular respiration is the same for aerobic and anaerobic conditions, fermentation occurs in attempt to create ATP in the absence of oxygen. As a result, significantly less ATP is created, with the addition of lactic acid production. Anaerobic exercise includes strength training activities such as free weights and weight lifting, HIIT exercises, and yoga or Pilates.² These exercises are typically short, fast, and high-intensity.

Recommendations²

• Pre-school aged children (3-5 years old)= physically active throughout the day with plenty of opportunities for active play.
• Kids and teenagers (6-17 years old)= >60 minutes per day
• Adults=  >150 minutes of moderate-intensity aerobic activity every week, plus muscle-strengthening activities >2 days a week.

Ways to Incorporate More Activity into Your Routine and How To Stick With It

Starting an exercise routine can be daunting, which is why it’s imperative to create small, attainable goals. Here are some tips to get you started and to stay motivated:

• Take the bus or subway to work? Try getting off a stop early to get some extra steps in.¹
• Opt for the stairs instead of elevator or escalators.
• Take advantage of the beautiful spring and summer weather and take up gardening and/or yard work.
• Grab the lease and take your dog for a walk (or make your walk longer).
• Exercise with a friend– that way, you can hold each other accountable for those days you really don’t feel like exercising. Or even plan to go for a walk instead of dinner one night; setting a realistic goal for all parties is important.
• Ask your doctor, registered dietitian nutritionist (RDN), or other health professional to recommend an exercise class or program to enroll in. There may even be groups designated for certain conditions– be sure to do some research through your local hospital, clinic, or health club for those.⁷
• Participate in and share the Office of Disease Prevention and Health Promotion (ODPHP) interactive Move Your Way Activity Planner to find customizable and individualized ways to increase physical activity. This extensive planner includes aerobic and anaerobic activities to choose from, and allows printable plans so you can stick it onto your fridge to stay motivated!³
• Choose activities that YOU enjoy! A website called westchester.kidsoutandabout.com features  several clubs, camps, and organizations for all ages under the “Sports Classes in the Westchester Area” including racquetball, track and field, rock climbing, dance and performance, swimming, lacrosse, soccer, and much more!⁸

How to Encourage Physical Activity and Youth Sports In Your Kids³

• Visit health.gov’s ODPHP website at https://health.gov/news/202105/move-may-and-celebrate-national-physical-fitness-sports-month and…
• Share their posters and fact sheets to raise awareness about the National Youth Sports Strategy.
• Discover more ways to add more exercise into your child’s day. There is an interactive graphic that can be used to calculate total minutes of activity including recess and PE at school, plus examples of activities at home such as walking the dog, participating in morning yoga or stretches, and dancing in the living room!
• Challenge teens to get moving by creating a video on why they like to move based on a short series of ODPHP YouTube videos.

If you would like to learn more about National Physical Fitness and Sports Month, please visit the https://health.gov/news/202205/moveinmay-celebrate-national-physical-fitness-and-sports-month!

References

1.       Publichealth.gwu.edu. 2022. [online] Available at: https://publichealth.gwu.edu/content/national-physical-fitness-and-sports-month.

2.       Physical Activity Prevents Chronic Disease. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). (2022). Retrieved 6 May 2022, from https://www.cdc.gov/chronicdisease/resources/infographic/physical-activity.htm#:~:text=Regular%20physical%20activity%20helps%20improve,depression%20and%20anxiety%2C%20and%20dementia.

3.       Move in May and Celebrate National Physical Fitness & Sports Month - News & Events | health.gov. Health.gov. (2022). Retrieved 6 May 2022, from https://health.gov/news/202105/move-may-and-celebrate-national-physical-fitness-sports-month.

4.       The Importance of Sports for Children. Novak Djokovic Foundation. (2015). Retrieved 6 May 2022, from https://novakdjokovicfoundation.org/the-importance-of-sports-for-children/.

5.       Sports and Children. Aacap.org. (2018). Retrieved 6 May 2022, from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Sports-061.aspx#:~:text=Sports%20help%20children%20develop%20physical,become%20a%20money%2Dmaking%20business.

6.       Cellular respiration review (article) | Khan Academy. Khan Academy. (2022). Retrieved 6 May 2022, from https://www.khanacademy.org/science/high-school-biology/hs-energy-and-transport/hs-cellular-respiration/a/hs-cellular-respiration-review.

7.       What you need to know about exercise and chronic disease. Mayo Clinic. (2022). Retrieved 6 May 2022, from https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-and-chronic-disease/art-20046049.

8.       Sports classes in the Westchester area. Kids Out and About Westchester. (2022). Retrieved 6 May 2022, from https://westchester.kidsoutandabout.com/content/sports-classes-westchester-area.

Defeat Diabetes Month

By: Lauren Pappalardo, MS Student at Pace University

According to the Centers for Disease Control and Prevention (CDC), 37.3 million Americans have diabetes, and approximately 90-95% of them have type 2 diabetes. Additionally, 96 million Americans – more than 1 in 3 – have prediabetes and are likely to develop type 2 diabetes in the future. Type 2 diabetes is a chronic disease characterized by hyperglycemia, insulin resistance, and impairment in insulin secretion. Over time, type 2 diabetes can damage blood vessels in the heart, eyes, nerves, and kidneys. Most notably, there is a strong association between type 2 diabetes and cardiovascular disease, the leading cause of death in the United States. Type 2 diabetes has become so prevalent, that in 1994, the CDC declared that it had reached epidemic proportions and should be considered a major health problem in the United States.

Since this declaration, there have been many responses from national health organizations, including the Defeat Diabetes Foundation (DDF) who declared April Defeat Diabetes Month. Through this initiative, the DFF encourages testing for type 2 diabetes and raises awareness around risk factors. Risk factors for type 2 diabetes, according to the CDC, include:

• Having prediabetes
• Being overweight / obese
• Being 45 years or older
• Having a parent, brother, or sister with type 2 diabetes
• Being physically active less than 3 times a week
• Having ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.
• Being African American, Hispanic, or Latino, American Indian, or Alaska Native person

As many of these risk factors are lifestyle-related, the DFF’s Defeat Diabetes Month also aims to raise awareness around lifestyle and dietary changes that can aid in the prevention of type 2 diabetes. While prevention can never be guaranteed, below is a list of lifestyle factors that have been shown to help prevent or delay the development of type 2 diabetes and should be considered by those at risk.

• 1.     Achieve / Maintain a Healthy Weight
• ·       At all ages, the risk of type 2 diabetes rises with increasing body weight. More specifically, obesity (BMI of 30.0 or higher) is strongly associated with a high prevalence of prediabetes and is an independent risk factor for type 2 diabetes. Therefore, achieving and maintaining a healthy weight is a desirable outcome in preventing prediabetes and type 2 diabetes. The term “healthy weight” is defined as having a BMI between 18.5 and 24.9 and a waist circumference below 40 inches for men and below 35 inches for women. A waist circumference above these values can indicate excess visceral fat and increased risk for disease.
• 
  One of the first controlled randomized studies to demonstrate the link between weight and type 2 diabetes risk, The Finnish Diabetes Prevention Study, reported that the incidence of type 2 diabetes was significantly lower in overweight individuals with impaired glucose tolerance who achieved a 3.5 - 4.5kg weight loss in two years compared to those who lost 0.9 - 1.0kg. In a subsequent study, lifestyle intervention including a 7% weight loss reduced the incidence of type 2 diabetes by 58% in nondiabetic persons with elevated fasting and post-load plasma glucose concentrations, compared to the control group. The intervention was also significantly more effective in reducing risk compared to metformin.
  
  Since these findings, research continues to show that achieving a healthy weight reduces the risk of type 2 diabetes. Weight loss should only be a goal for individuals currently overweight or obese. The CDC recommends assessing your weight by calculating your BMI and measuring your waist circumference. Tips for achieving a healthy weight include healthy eating, physical activity, and learning how to balance the calories you consume with the calories your body uses.
  
• 2.     Get Active
• ·       Physical inactivity is a key risk factor for prediabetes and type 2 diabetes. Physical activity has been linked to better glycemic control and improved insulin sensitivity in both normal and individuals with insulin resistance. While there is no one exercise prescription for all individuals, the CDC recommends performing at least 150 minutes of moderate-intensity aerobic exercise per week to reduce the risk of developing type 2 diabetes.
• 
  The impact of being physically active in preventing type 2 diabetes has been demonstrated in several studies. Notably, a meta-analysis of 28 prospective cohort studies of physical activity and type 2 diabetes, showed a lower risk of developing the disease in those who performed 150 minutes per week of moderate physical activity compared to those who were sedentary. This included activities such as brisk walking, jogging, swimming, tennis, and other aerobic exercises. Additional benefits and an even lower risk of developing type 2 diabetes were seen with higher levels of physical activity.
• Regular physical activity may also result in other favorable outcomes including weight loss and improvements in cardiovascular health. The CDC recommends incorporating some of the following examples of moderate-intensity physical activities into your weekly routine.
• ·       Walking briskly
• ·       Doing housework
• ·       Mowing the lawn
• ·       Dancing
• ·       Swimming
• ·       Bicycling
• ·      Playing Sports

• 3.     Eat a Healthy Diet  
• ·       While diet plays an important factor in disease prevention, there are few trials exploring the effects of diet alone (without physical activity or weight loss) for the prevention of type 2 diabetes. There is also no one diet plan or food group shown to decrease risk. A recent comprehensive review summarized the effect of dietary factors and diet interventions on type 2 diabetes risk and concluded the following points:
  
• ·       Dietary interventions that are low in calories and carbohydrates (i.e. 25-30kcal/kg or carbohydrate <120g/d) significantly lowered the risk of type 2 diabetes in both general and high-risk populations. These recommendations may not however be appropriate for all individuals. As always, the RD should take individuality into account when making recommendations.
  
• ·       “Good quality” carbohydrates, defined as being low on the glycemic index and high in fiber, are associated with increased insulin sensitivity, and improved beta-cell function, therefore aiding in prevention.
  
• ·       High fiber intake from fruits, vegetables, and whole grains, can improve whole-body insulin sensitivity and support weight management to lower risk.
  
• ·       Sugar sweetened beverages significantly increase the risk of type 2 diabetes.
  
• ·       Artificial sugar sweetened beverages may be associated with higher risk of type 2 diabetes, but more research is needed.
  
• As there is no “diabetes diet”, the American Diabetes Association recommends a general dietary strategy for people with prediabetes that involves high intake of non-starchy vegetables, fruits, legumes, nuts, beans, fish, whole grains, and unsaturated fats such as olive oil. They also recommend limiting red meat, alcohol, and foods high in refined sugar.

Resources:

Centers for Disease Control and Prevention. (2022, November 3). Get active! Centers for Disease Control and Prevention. Retrieved April 10, 2023, from https://www.cdc.gov/diabetes/managing/active.html 

La Sala, L., & Pontiroli, A. E. (2020, October 31). Prevention of diabetes and cardiovascular disease in obesity. International journal of molecular sciences. Retrieved April 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663329/ 

Smith, A. D., Brage, S., Woodcock, J., & Crippa, A. (2016, December). Physical activity and incident type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of prospective cohort studies. Diabetologia. Retrieved April 10, 2023, from https://pubmed.ncbi.nlm.nih.gov/27747395/ 

Toi, P. L., Anothaisintawee, T., Chaikledkaew, U., Briones, J. R., Reutrakul, S., & Thakkinstian, A. (2020, September 6). Preventive role of diet interventions and dietary factors in type 2 diabetes mellitus: An umbrella review. Nutrients. Retrieved April 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551929/ 

Tuomilehto, J., Uusitupa, M., Salminen, V., Rastas, M., Louheranta, A., Laasko, M., Keinänen-Kiukaanniemi, S., Ilanne-Parikka, P., Hamalainen, H., Valle, T. T., & Eriksson, J. G. (2001, May 3). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England journal of medicine. Retrieved April 10, 2023, from https://pubmed.ncbi.nlm.nih.gov/11333990/ 

World Cancer Day written by Miriam Schlisselfeld, Student at University of Alabama.

Edited by Andrea Polvere, MS Student at Pace University

In the United States, cancer is the second leading cause of death CITATION Fac \l 1033  (Facts about Cancer, n.d.). This devastating disease effected 10 million people in 2020 alone, with the most prevalent type being breast cancer, followed by prostate and lung cancer (Common cancer types, n.d.; Leading Causes of Death, 2022;) There are a number of risk factors that correspond with an individual’s likelihood of developing cancer such as older age, genetic predisposition, obesity or overweight, alcohol consumption or tobacco use (Understanding cancer risk, 2022).

Due to its widespread implications, the Union for International Cancer Control (UICC) created a global initiative called World Cancer Day at the 2000 World Summit Against Cancer for the New Millennium in Paris. This campaign, marked on February 4^th, aims to raise awareness, improve education and research, improve patient services, and encourage early prevention, detection, and treatment (Our Story, n.d.). World Cancer Day’s impact is seemingly endless, with over 24,000 press articles in 160 countries, 980 total events in 105 countries, over 327,000 social media mentions, and 75 active governments!

Each year around the world, hundreds of events take place in an assortment of communities such as schools, businesses, hospitals, community centers, and more in acknowledgement of World Cancer Day! It is characterized by events and activities that range from creating customizable social media posters, partaking in the 5k challenge, making donations, attending, volunteering, or participating in a local event, or even creating your own event! This year, two local events took place within the New York metropolitan area: Black Women in Oncology against Cancer in New York, New York, and Rutgers World Cancer Day Recognition Event in New Brunswick, New Jersey. Check out the World Cancer Day website to see what you missed this year and to explore other opportunities you can become involved with.

Although there is no guaranteed prevention for cancer, there are several lifestyle factors within your control that can be used to protect against the risk for development.

Maintain a Healthy Weight

In a meta-analysis conducted by the World Cancer Research Fund (WCRF)/ American Institute for Cancer Research (AICR), there is evidence that having extra fat mass significantly increases the risk of several cancers, including but not limited to breast (post-menopause), mouth, stomach, pancreatic, liver, kidney, and prostate cancers (Obesity, weight gain and cancer risk, 2022). An increase in fat, or adipose, tissue leads to prolonged inflammation within the body, which creates an environment conducive to insulin-resistance. Insulin resistance, which is the body’s inability to properly respond to insulin, can trigger an increase in the number of cells produced, as well as make sex hormones, such as estrogen, more readily available. Both of these results can increase cancer risk (Underferth, 2020).

Extra fat mass can be marked by several factors, such as high body mass index (BMI), which is considered above 25. However, BMI is not a precise indicator of body mass as it does not take into account the fat mass versus muscle mass. Additional measures, such as waist circumference and waist-to-hip ratio, tend to be more illuminating and have been found to be correlated with extra fat mass. Each 4-inch increase in waist circumference was shown to increase the risk of various cancers as follows: esophageal adenocarcinoma by 34%, pancreatic cancer by 11%, postmenopausal breast cancer by 11%, kidney cancer by 11%, endometrial cancer by 5%, and colorectal cancer by 2% (Preventing Cancer, 2021).

Awareness and self-accountability is the first, imperative step in the process of prevention as it pertains to weight. A biannual visit to your primary care physician or healthcare professional is recommended to ensure you are maintaining a healthy weight.

Participate in Physical Activity

Physical activity, as defined by the World Health Organization, is the utilization of skeletal muscles to produce any type of movement, requiring an increased amount of energy expenditure. Aerobic exercise, meaning “with oxygen”, is any type of cardiovascular exercise and ranges from mild, moderate, or vigorous. Some examples of aerobic exercise include brisk walking, biking, running, dancing, yard work, rowing, or swimming. On the other hand, anaerobic exercise means cellular respiration occurs without oxygen. Anaerobic exercise includes strength training activities like free weights and weight lifting, HIIT exercises, and yoga or Pilates. Due to the weight loss properties resulting from both types of exercise, a balance between both may play a role in preventing cancer.

During a 2022 meta-analysis and umbrella review, sedentary reviews were analyzed with risk of several cancers such as endometrial, colon, and lung (Hermelink, et al., 2022).  The study defined sedentary behavior as occupational and recreational sitting, as well as TV-viewing time. It was found adults around the world spend an average of 8.2 hours sitting per day. As a result, the highest versus lowest levels of sedentary time increased risks of these cancers by a statistically significant range of 20-35%.

Exercise can be found in every facet of life, not just in the gym. Getting into the habit of increasing your physical activity starts with small, daily changes that will improve your body and mindset. Here are some small suggestions for increasing your physical activity without needing to change into workout clothes:

• ·       Walk around your neighborhood.
• ·       Park your car further in the parking lot.
• ·       Take the stairs instead of the elevator.
• ·       Use light hand weights during commercial breaks while watching television.

Eat a Well-balanced, Healthy Diet

An overall healthy diet, modeled after MyPlate, has the potential to lower all cancer risk by 10-20%. (Preventing Cancer, 2021). This Healthy Eating Plate graphic showcases the following recommended proportions: ½ plate fruits and vegetables, ¼ plate whole grains, ¼ plate lean protein, and healthy oils in moderation. Furthermore, fruits and vegetables should be versatile in color and variety, with an emphasis on non-starchy vegetables. As for whole grains, some examples include whole wheat, barley, wheat berries, quinoa, oats, and brown rice. Similar to fruits and vegetables, protein sources should be versatile in type. Plus, red meats and processed meats, like bacon and sausage, should be avoided. Lastly, some healthy oil options include olive, soy, corn, sunflower, safflower, avocado, flaxseed, walnut, and others.

There is strong evidence that eating whole grains protects against colorectal cancer. More so, dietary fiber has been found to protect against colorectal cancer, weight gain, overweight, and obesity  CITATION Pre21 \l 1033 (Preventing Cancer, 2021). There are several mechanisms from components found in whole grains that may play a part in these protective properties (Slavin, 2000):

• ·       Fermentation of complex carbohydrates in the colon results in short chain fatty acids (SCFA) production, inhibiting cell growth and migration, as well as inducing apoptosis in cells, such as cancer cells (Mirzaei, et al., 2021).
• ·       Antioxidants, including trace minerals and phenolic compounds, act to “enhance the body's immune system to recognize and destroy cancer cells and to inhibit the development of new blood vessels (angiogenesis) that is necessary for tumor growth” (Newmark, 1996).
• ·       Phytoestrogens, found widely in whole grains, exhibit antioxidant, anti-inflammatory, and anti-thrombotic properties. They have a similar structure to estrogen, which allows them to bind to estrogen binders and interfere with hormonal signaling. Phytoestrogens are especially important in the prevention of hormone-dependent cancers like breast and prostate.

Below are some dietary guidelines and recommendations to achieve a more healthful diet to combat the development of various cancers:

• ·       Adults should consume at least three 16-gram servings of whole-grain foods daily.
• ·       Consume 25 to 30 grams of fiber per day.
• ·       Opt for lean protein options whenever possible– that includes fish, poultry, eggs, beans, peas, lentils, nuts and nut butters.
• ·       Limit alcohol consumption
• o   Men should limit themselves to 2 drinks or less per day
• o   Women should limit themselves to 1 drink or less per day
• ·       Restrict “fast foods”, prepackaged foods, and eating out at restaurants whenever possible. These foods tend to contain high amounts of saturated fats and/or sodium.
• ·       Limit sugar-sweetened beverages like juices and sodas as much as possible.

References

Common cancer types. National Cancer Institute. (n.d.). Retrieved from https://www.cancer.gov/types/common-cancers#:~:text=The%20most%20common%20type%20of,are%20combined%20for%20the%20list

Facts about Cancer. (n.d.). Retrieved from World Cancer Day https://www.worldcancerday.org/materials?f%5B0%5D=category%3A8&f%5B1%5D=language%3Aen&f%5B2%5D=language%3Aen

Hermelink, R., Leitzmann, M. F., Markozannes, G., Tsilidis, K., Pukrop, T., Berger, F., Baurecht, H., & Jochem, C. (2022). Sedentary behavior and cancer–an umbrella review and meta-analysis. European Journal of Epidemiology, 37(5), 447–460. https://doi.org/10.1007/s10654-022-00873-6

Leading Causes of Death. (2022, September 6). Retrieved from National Center for Health Statistics: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Mirzaei, R., Afaghi, A., Babakhani, S., Sohrabi, M. R., Hosseini-Fard, S. R., Babolhavaeji, K., Khani Ali Akbari, S., Yousefimashouf, R., & Karampoor, S. (2021). Role of microbiota-derived short-chain fatty acids in cancer development and prevention. Biomedicine & Pharmacotherapy, 139, 111619. https://doi.org/10.1016/j.biopha.2021.111619

Newmark, H. L. (1996). Plant Phenolics as potential cancer prevention agents. Advances in Experimental Medicine and Biology, 25–34. https://doi.org/10.1007/978-1-4613-0399-2_3

Preventing Cancer. (2021, March). Retrieved from Harvard TH Chan - School of Public Health: https://www.hsph.harvard.edu/nutritionsource/cancer/preventing-cancer/ 

 Obesity, weight gain and cancer risk. WCRF International. (2022, April 28). Retrieved from https://www.wcrf.org/diet-activity-and-cancer/risk-factors/obesity-weight-gain-and-cancer/

Underferth, D. (2020, May 8). How does obesity cause cancer? MD Anderson Cancer Center. Retrieved from https://www.mdanderson.org/publications/focused-on-health/how-does-obesity-cause-cancer.h27Z1591413.html

Understanding cancer risk. Cancer.Net. (2022, January 28). Retrieved from https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/understanding-cancer-risk

Fiber Focus Month Blog Post

By Vida Velasco-Popov, MS Student at PACE University

January for many is a time for change and new beginnings, so it seems fitting for RDs to celebrate this time as National Fiber Focus month! This topic is especially dear to me, as I am a strong advocate for increasing fiber consumption especially here in the United States where the average American only consumes about 15g of fiber per day When comparing this value to current dietary reference intakes, which are 38g/day for men and 25g/day for women, we see a clear need to encourage further consumption of fiber It is well known that adequate fiber intake plays a role in reducing cholesterol levels, improving blood glucose levels, easing bowl movements, and regulating body weight, all of which contribute to combating disease and improving overall health     

Fiber comes from a variety of different plant sources, and is categorized as non-starch polysaccharides, resistant starches, or resistant oligosaccharides Within these categories, fiber possesses different properties pertaining to relative solubility, viscosity, and fermentability, which influence overall function Fiber plays a critical function providing fuel for gut microbes resulting in the production of short chain fatty acids, vitamin K, and vitamin B12, all of which are essential components needed in healthy diets Though much is known with regards to health benefits gained by increasing fiber intake, still much remains unknown in terms of how fiber affects different gut microbe populations, and what microbial changes take place in response to specific dietary foods. Looking to the future, we see a tremendous opportunity for RDs to further new discoveries within this domain and to promote a shift toward advancing our current understanding of human nutrition.

When we think about the human gut microbiome, which contains 150 times more microbial genes than our own, it seems logical for so many researchers to take an interest in understanding the functions and optimization of this key system Though research is still ongoing with regards to fiber and prebiotics, we do know that dandelion greens, chicory roots, chia seeds, artichokes, garlic, almonds, flaxseeds, onions, oats, and barley all serve as prebiotics supporting the growth of healthy gut microbes Though beneficial effects of probiotics, or foods containing live health-promoting microbes are widely explored, prebiotics - the fuel source for probiotics, remain somewhat underrepresented. Prebiotics derived from fiber rich sources play a variety of beneficial roles, including supporting the immune system, promoting the growth of beneficial microbes, increasing production of beneficial metabolites, enhancing calcium absorption, and promoting the growth of lactobacilli species, which for women promotes vaginal health by reducing risk for infections Furthermore, fiber-rich diets have been associated with a higher prevalence of Firmicutes, a bacterial phylum with butyrate producing bacteria protective against colitis 

An interesting recent study conducted by researchers at Stanford University explored how fiber and probiotics influence the gut microbiome in 36 healthy adults ages 51±12 years over a 17-week period  Participants were assigned to one of two groups where they consumed either a high-fiber or high-fermented food diets. Food intake was recorded and submitted every two weeks to confirm compliance and assess dietary effects on the gut microbiome, overall health, and effects on the immune system. Data was collected using blood and stool samples to assess health biomarkers and varied microbial species. Baseline food intakes revealed the average participant followed primarily a western diet prior to the intervention phase In the high-fiber group, participants ate significantly less packaged food and were able to improve nutrient intake profiles while decreasing overall consumption of salt and animal-based proteins  Additionally, participants from the fiber-rich group reported an increase in softening of stool throughout the study

What I found particularly interesting were the findings related to changes in microbial species and overall effects on inflammation. Upon the conclusion of the study, microbiota within the high-fiber group was found to have enhanced capacity to degrade complex carbohydrates while bacterial growth increased significantly Though one might expect an overall decrease in inflammation in the high-fiber group, inflammatory biomarkers were surprisingly inconsistent across participants  One sector of the participants from the fiber rich group had increased inflammation while others were found to have decreased inflammation  After comparing baseline microbial genomes among fiber-rich group participants, researchers found that those showing higher inflammation at the end of the study had less microbial diversity and generally ate fewer plant foods than those who showed decreased levels of inflammation at the end of the study These results suggest a more nuanced approach for increasing fiber intake to improve gut health and support the immune system. Limited initial microbial diversity could limit the ability of a fiber-rich diet in supporting the immune system and decreasing inflammation.                

With regards to the high-fermented foods group, researchers found an overall increase in microbial diversity at the end of the study and an overall decrease in inflammatory cytokines In contrast with the high-fiber group, the high-fermented foods group did not show an increase in microbial proteins as we saw in the high-fiber group, this suggests microbial metabolic capacity within the gut may require fiber to increase capacity Furthermore, the simple introduction of microbial species from fermented foods alone may not contribute to enhancing overall capacity to degrade complex carbohydrates. Though the sample size was relatively small, and study focused on healthy participants, the implications behind this study open the door for further understanding how the gut microbiome varies in its response to the presence of fiber and how the combination of fiber and probiotics may serve to enhance gut health while supporting the immune system. There’s still much to learn with regards to fiber and the gut microbiome, which urges me to look toward the future in which the dietetic field is ever evolving. With the addition of new technologies, we may understand nutrition on an even deeper level, eventually seeing to the gut and its inhabitants as our true canary in the coal mine.

References

1.                  Guan Z-W, Yu E-Z, Feng Q. Soluble dietary fiber, one of the most important nutrients for the gut microbiota. Molecules. 2021;26(22):6802. doi:10.3390/molecules26226802

2.                  Hijová E, Bertková I, Štofilová J. Dietary fibre as prebiotics in nutrition. Central European Journal of Public Health. 2019;27(3):251-255. doi:10.21101/cejph.a5313

3.                  Kaur AP, Bhardwaj S, Dhanjal DS, et al. Plant Prebiotics and their role in the Amelioration of Diseases. Biomolecules. 2021;11(3):440. doi:10.3390/biom11030440

4.                  Myhrstad MC, Tunsjø H, Charnock C, Telle-Hansen VH. Dietary fiber, gut microbiota, and Metabolic Regulation—current status in human randomized trials. Nutrients. 2020;12(3):859. doi:10.3390/nu12030859

5.                  Position of the American Dietetic Association: Health Implications of Dietary Fiber. Journal of the American Dietetic Association. 2008;108(10):1716-1731. doi:10.1016/j.jada.2008.08.007

6.                  Simpson HL, Campbell BJ. Review article: Dietary fibre-microbiota interactions. Alimentary Pharmacology & Therapeutics. 2015;42(2):158-179. doi:10.1111/apt.13248

7.                  Wastyk HC, Fragiadakis GK, Perelman D, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184(16). doi:10.1016/j.cell.2021.06.019

What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a common chronic intestinal disorder that occurs in the large intestines.^1–4 Symptoms of IBS include repeated abdominal pain, bloating, cramping, gas, and constipation or diarrhea, or both.^1–3

Unfortunately, IBS is not fully understood yet, so there are no definitive tests that can be used to diagnose this condition.^1,2 In general, IBS tends to be diagnosed in individuals who experience the mentioned signs and symptoms. From those signs and symptoms, a medical practitioner will diagnose you with one of three types of IBS based on your symptoms so they can determine the most effective treatment for you. The types of IBS include constipation-predominant, diarrhea-predominant, or mixed.^1,2

IBS treatment usually focuses on relieving symptoms.¹ Some people manage their symptoms by avoiding foods that trigger their symptoms, drinking large amounts of fluids, eating high-fiber foods, and adequate exercise and sleep. Diet changes are individualized for those with IBS.¹ Many people eliminate high-gas foods and gluten from their diets, but others may eliminate dairy, fried foods, indigestible sugars, and beans.^1,3 Although, the low FODMAP diet has been shown to help people manage their IBS symptoms.^5,6 In more severe cases, people are treated with counseling or medication.¹

            More recent evidence indicates that IBS may be a brain-gut disorder as studies have found that the gut microbiota produces gases that contain chemicals that affect mood, cognition, and the gut-brain communication.⁷ Further, IBS treatments including high-fiber foods and reduced stress are associated with both reduced IBS symptoms and healthier gut bacteria.^1,8 This association suggests more research is necessary to fully understand the relationship between IBS and the gut microbiome.

April is IBS Awareness Month

Back in 1997, the International Foundation for Gastrointestinal Disorders designated April as IBS Awareness Month.⁹ This designation was provided to increase public awareness about IBS, help others understand the different forms of IBS, and educate others about issues concerning diagnosis, treatment, and quality of life in individuals with IBS.⁹About 10-15% of people worldwide have IBS where 12% of people in the US have the condition.⁹ Risk factors of IBS are being a women, being less than age 50, a family history of IBS, a history of stressful or difficult life events, and having a severe infection in the digestive tract.⁴

Low FODMAP Diet

'FODMAP' is an abbreviation for 'fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols.'⁵ They are sugars that are not completely digested or absorbed in the intestines.⁵ Instead, gut bacteria ferment those sugars and as a result, produce a gas.⁵ In those with IBS, this gas can result in the mentioned IBS symptoms since individuals with IBS have highly sensitive guts.⁵ So, people with IBS are encouraged to ingest food items that contain low FODMAPs so their gut bacteria would produce less gases.

FODMAPs are found in vegetables, fruits, cereals, breads, legumes, nuts, and some sweets.^5,6 Below are some examples of low FODMAP foods items:

●     Vegetables: Bell pepper, bok choy, carrot, cucumber, eggplant, lettuce, potato, spinach, zucchini^5,6

●     Fruits: Banana, cantaloupe, grapes, mandarin, orange, peach, pears, strawberries^5,6

●     Dairy & alternatives: Lactose-free, almond milk, brie/camembert cheese, feta cheese, hard cheeses^5,6

●     Protein sources: Eggs, firm tofu, plain cooked meats/poultry/seafood^5,6

●     Starches: Barley, corn flakes, oats, quinoa, rice, rye, wheat, gluten-free products^5,6

●     Nuts & seeds: Almonds, macadamia nuts, peanuts, pumpkin seeds, walnuts^5,6

●     Sweets: Dark chocolate, maples syrup, table sugar, molasses^5,6

If you would like to learn more about Irritable bowel syndrome or other gastrointestinal disorders, then you can visit the International Foundation for Gastrointestinal Disorders website.

References

1.   Irritable bowel syndrome - Symptoms and causes. Mayo Clinic. Accessed April 3, 2022. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016

2.   Irritable Bowel Syndrome (IBS) | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 3, 2022. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome

3.   IBS: Symptoms, Causes, Diagnosis, Triggers, and Treatment. Healthline. Published September 29, 2014. Accessed April 3, 2022. https://www.healthline.com/health/irritable-bowel-syndrome

4.   Definition & Facts for Irritable Bowel Syndrome | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 3, 2022. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts

5.   About FODMAPs and IBS | Monash FODMAP - Monash Fodmap. Accessed April 7, 2022. https://www.monashfodmap.com/about-fodmap-and-ibs/

6.   Low FODMAP Diet for Irritable Bowel Syndrome | IBS Treatment. Gastroenterology Consultants of San Antonio. Accessed April 7, 2022. https://www.gastroconsa.com/patient-education/irritable-bowel-syndrome/low-fodmap-diet/

7.   Illuminating the Brain-Gut Axis: Insights from Japan’s Leading IBS Researcher. nippon.com. Published April 5, 2022. Accessed April 6, 2022. https://www.nippon.com/en/japan-topics/c08004/

8.   Boosting fiber intake for 2 weeks alters the microbiome. Published April 6, 2021. Accessed April 7, 2022. https://www.medicalnewstoday.com/articles/short-term-increase-in-fiber-alters-gut-microbiome

9.   IBS Awareness Month - About IBS. Published March 8, 2021. Accessed April 3, 2022. https://aboutibs.org/living-with-ibs/ibs-awareness-month

Epilepsy is a neurological disorder characterized by generally more than 2 unprovoked seizures, which are spontaneous, disordered electrical discharging of cerebral neurons¹. The term epilepsy can be interchangeable with the term seizure disorders. During a seizure, periods of electrical discharges take place and can last from a few seconds to several minutes. Seizures can range from brief lapses of attention, to muscle jerks, to severe convulsions². Different types of seizures include different parts of the brain; generalized seizures involve the entire brain, while partial seizures affect only part of the brain¹.

It is crucial to differentiate between a single seizure and the diagnosis of epilepsy, as there can be many reasons a single seizure may occur such as fever, or hyperglycemia/hypoglycemia¹.

Purple Day

About 50 million people are diagnosed with epilepsy worldwide, with the most prevalent rates in low- and middle-income countries² . According to the CDC, 1.2% of the US population has active epilepsy, which equates to 3 million adults and 470,000 children³.

In 2008, Cassidy Megan founded Purple Day in an effort to bring her own struggles with this disorder to light; she recalls feeling scared, alone, and would often lose friends and be a victim of bullying. Cassidy states that her main goals in founding Purple Day are to dismantle the myths surrounding epilepsy and to inform those with seizures that they are not alone⁴.

Purple Day, celebrated on March 26^th, is commemorated by people wearing the color purple, as well as hosting events to educate, increase awareness, and support those living with this condition. With the help of Grassroots International, a grantmaking and social action organization, this campaign has raised so much attention that people in over 85 countries, on all continents, participated in Purple Day last year^4,5.

Nutrition Recommendations for Epilepsy

People with epilepsy may be at great nutritional risk. Infants, children, and adolescents are especially vulnerable for they are in a period of significant and rapid growth and development.

An impaired ability to consume adequate nutrients, limited food choices, and drug–nutrient interactions pose as the main contributors to nutritional risk¹.

Ketogenic Diet

The now-popularized diet, known as the ketogenic diet, has gained much attention over the last few years. What many people may not be aware of is that this diet was created for children with epilepsy whose seizures have not responded to antiepileptic drugs (AEDs). The diet is characterized by high-fat, low-carbohydrate components with about 3 to 4 grams of fat for every 1 gram of carbohydrate⁶. The name ketogenic comes from the word “ketones”, which is the product made when the body is forced to use fat as the main fuel source in the absence of carbohydrates. Unfortunately, the exact mechanism for why following a low carbohydrate, high fat diet seems to help reduce seizure episodes is unknown. However, it has been theorized that the combination of low sugar and high fat components modifies the neuronal metabolism and ‘excitability’ of the brain, thereby reducing the tendency for seizures to occur^7,8. With that said, there have been promising results for those who follow the ketogenic diet; over half of children have at least a 50% reduction in the number of their seizures, while about 10-15% children become seizure-free⁵.

This diet is usually not recommended for adults because the restriction of food choices proves to be extremely difficult to follow. The modified Atkins diet, however, does work well for epileptic adults as it is less restrictive; fats are not measured, and protein is not limited to a specific daily total calorie intake like in the ketogenic diet⁹. If an adult does decide to follow the ketogenic diet, it is recommended that they speak to their healthcare provider and take a supplement to avoid deficiencies, as the diet is low in carbohydrates, fiber, calcium, and other nutrients¹.

General Recommendations: 

• Let to know your medication. 

Pharmacotherapy is the main seizure treatment used today¹⁰. However, many AEDs have major drug-nutrient interactions, so it is crucial to talk to your healthcare provider or an RDN about the potential nutritional risks¹.

• Eliminate simple sugars, and include more natural, whole food options into your diet.

This can be a daunting process as simple sugars are found in just about everything– processed foods, candy, dairy or milk products, fruits, soft drinks, and more. However, eliminating simple sugars is the first step in controlling glycemic index and starting a healthy eating pattern. Registered Dietitian Nutritionists (RDNs) who work with epileptic clients noted that even simple, yet consistent diet changes have resulted in improvement in seizure control¹⁰.

• Increase your fluid intake. 

Fluids are encouraged because of the risk of kidney stone development, as well as the diuretic effect of any low-carbohydrate diets used to treat epilepsy¹⁰.Any diet supplementation or recommendations should be firstly checked with, and then closely monitored by an experienced team of neurologists and dietitians/RDNs.

If you would like to learn more about epilepsy or Purple Day, please visit the https://www.purpleday.org/ or https://www.epilepsy.com/ website.

References

1.     Nahikian-Nelms M. Nutrition Therapy and Pathophysiology. 4th ed. Cengage; 2020.

2.     World health organization. Epilepsy. Who.int. Published June 20, 2019. https://www.who.int/news-room/fact-sheets/detail/epilepsy

3.     “Epilepsy Data and Statistics | CDC.” Www.cdc.gov, 28 Jan. 2019, www.cdc.gov/epilepsy/data/index.html#:~:text=Epilepsy%20Prevalence%20in%20the%20United.

4.     Purple Day – Supporting Epilepsy Around The World! https://www.purpleday.org/

5.     Grassroots International | Funding Global Movements for Social Change. Grassroots International. https://grassrootsonline.org/

February is National Cancer Prevention Month. As registered dietitians, we know that eating well can help prevent and beat cancer in a variety of ways. While we know that there is no guaranteed way to prevent cancer, there are certain risk factors that can increase a person’s likelihood. In the United States, men have a 1 in 2-lifetime risk of developing cancer; and for women, the risk is 1 in 3. Registered dietitians can help patients reduce the risk of cancer by educating and encouraging diet and lifestyle modifications that promote healthy choices, along with following the recommended screening guidelines to encourage early detection.

While nutrition guidelines for cancer prevention are similar to the prevention of other diseases, such as cardiovascular disease and diabetes, diet is one of the most important aspects a person can control to reduce their cancer risk, along with other lifestyle modifications.

Here are general nutrition recommendations that help prevent cancer:

Maintain a healthy weight

Partake in regular physical activity and consume a healthy, well-balanced diet. Obesity can cause long-term inflammation in the body, which may increase cancer risk. Also, excess weight can also cause increased levels of certain hormones, which can increase the risk of certain cancers.

Follow a Healthy Eating Pattern

The U.S. Dietary Guidelines recommends eating nutrient-dense foods including a variety from all food groups. Fill half your plate with fruits and vegetables and make at least half your grains whole grains. Cancer prevention evidence supports the recommendation of a diet that is predominantly plant-based, with limited, if any, intake of red and processed meats. It is also recommended to limit added sugar, sugar-sweetened beverages, highly processed foods, and refined grain products.

Exercise regularly

Strive for at least 30 minutes of physical activity as part of your daily routine. At least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic physical activity is recommended to reduce cancer risk.

Avoid Alcohol

Studies show that alcohol consumption causes several types of cancer. In order to prevent or reduce the risk of cancer, there is no safe level of consumption. It is believed that the more alcohol a person drinks, the higher their risk of developing an alcohol-associated cancer.

Quit Smoking

Tobacco use remains the leading preventable cause of death in the US, accounting for about 1 in 5 deaths each year. Most people know smoking can cause cancer, and about 80% of lung cancers, as well as 80% of all lung cancer deaths, are due to smoking. Lung cancer is the leading cause of cancer death in both men and women. No forms of smoking are safe.

To learn more about diet and cancer prevention, as well as diet and nutrition during and after cancer treatment, patients are always encouraged to consult a registered dietitian nutritionist.

References:

1. Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel AV, Andrews KS, Bandera EV, Spees CK, Robien K, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians 2020;70:245–71.

January is National Thyroid Awareness Month. First off, what is the thyroid? The thyroid is a small butterfly-shaped gland that is located above the collarbone and in front of the windpipe.^1–3 It is responsible for producing hormones that maintain the body's energy and regulate the body's breathing, heart rate, nervous systems, body weight, muscle strength, menstrual cycles, cholesterol levels, and other organ systems.^2,4 Therefore, thyroid disorders and diseases impair the secretion of hormones and cause dysfunction to the entire body. There are many thyroid disorders and diseases including hypothyroidism, hyperthyroidism, abnormal thyroid growth, nodules/lumps within the thyroid, and thyroid cancer.³ Hashimoto's disease is one condition that can cause hypothyroidism.

What is Hashimoto's Disease?

'Hashimoto's disease,' also known as 'Hashimoto's thyroiditis’ is the most common cause of hypothyroidism in the United States.^2,4 This condition is an autoimmune disorder that causes chronic inflammation in the thyroid which leads to impaired thyroid function, the under-production of thyroid hormones, and an underactive thyroid (which is also known as hypothyroidism).² The likelihood of developing Hashimoto's disease can increase if an individual has the following risk factors: being a woman between the ages 30-50, having a family history of Hashimoto's disease, and having other autoimmune disorders such as celiac disease, lupus, rheumatoid arthritis, and type 1 diabetes.⁴ Further, exposure to certain environmental and nutritional factors contributes to the development of this disease.⁵

Nutrition Recommendations for Hashimoto's Disease

There are currently no specific nutrition recommendations for this condition, but researchers are identifying associations between various nutrients and thyroid function.

Iodine

Iodine is essential for the body as it is a necessary component for the two main thyroid hormones triiodothyronine (T3) and thyroxine (T4).^3,5,6 Although, long-term intake of excessive or increased amounts of iodine has been associated with increases in circulating antibodies.⁵ This association likely occurs due to highly-iodinated thyroglobulin (Tg) which is immunogenic, meaning that it can trigger an immune reaction against the thyroid.⁵ Such a reaction increases the risk of thyroid autoimmunity and has been evident in multiple countries that have supplied iodine-fortified products, including China and Denmark.⁵ Based on these data, autoimmune thyroiditis, including Hashimoto’s disease, is associated with excess iodine intake. Therefore, it is recommended that sources of iodine should be eaten in moderation to ensure that iodine levels remain at the recommended levels. Iodine can be found in seafood (e.g. seaweed, fish, shellfish), animal products (e.g. cow’s milk, eggs, yogurt), and some fruits (e.g. cranberries, strawberries).⁷

Iron

Adequate iron intake is necessary for the production of T3 and T4 as the enzyme thyroid peroxidase activates after binding to a prosthetic heme group that contains iron.⁶ Notably, multiple studies have found that patients with Hashimoto's disease and hypothyroidism have lower serum iron concentrations and a higher prevalence of iron deficiency compared to healthy controls.⁶ It is good to note that individuals with Hashimoto's disease also tend to have celiac disease or another autoimmune disorder that implies that iron deficiencies may stem from those co-morbidities rather than Hashimoto's disease.⁶ Similar to iodine, it is recommended that sources of iron should be eaten in moderation so iron levels remain at the recommended levels. Iron can be found in both animal and plant sources, but animal sources are more bioavailable compared to plant sources.⁸ Some foods that contain iron include lean beef, oysters, chicken, turkey, beans and lentils, tofu, cashews, dark green leafy vegetables, and fortified or enriched bread and cereals.⁸ It is also recommended to couple a source of vitamin C with these foods to enhance iron absorption.⁸

Selenium

Selenoproteins are proteins that contain selenium and are necessary for thyroid function.⁵ Glutathione peroxidases are essential selenoproteins for thyroid function as they eliminate excessive amounts of hydrogen peroxide, which is a by-product of the iodination process of highly-iodinated Tg to form thyroid hormones.⁵ Evidence from observational studies and randomized-controlled trials have demonstrated that selenium, likely when in its selenoprotein form, can decrease thyroid peroxidase-antibody concentration and hypothyroidism.⁵ Therefore, limited selenium stores can cause thyroid dysfunction, and can especially affect individuals with Hashimoto's Disease.⁵ Notably, excessive selenium intake is toxic so selenium intake should meet recommended levels.⁵ Sources of selenium include oysters, tuna, whole-wheat bread, sunflower seeds, mushrooms, rye, and animal meats (e.g. chicken, turkey, pork, beef, lamb).⁷ Brazil nuts are also an excellent source of selenium as eating one Brazil nut will meet the daily recommended intake for selenium.

Vitamin D

Vitamin D is both a fat-soluble vitamin and a hormone as it is responsible for regulating calcium/phosphate homeostasis in the kidneys and bones, it is an immunomodulator, and it modulates cell growth and differentiation.^7,9,10 There is potential relevance of vitamin D status to Hashimoto’s disease as research has shown that lower vitamin D has been identified in patients with Hashimoto's disease compared to controls.⁶ Also, inverse relationships have been found between serum vitamin D status and thyroid peroxidase/Tg antibodies.⁶ Although, there are limited trials and evidence regarding vitamin D status and thyroid function, and populations with other autoimmune diseases have reported vitamin D receptor dysfunction implying that low vitamin D status is a result of autoimmune disease processes and is not exclusive to Hashimoto's disease.⁶ Also, one study found no significant changes in the serum levels of T3 and T4 of vitamin D deficient patients with Hashimoto’s disease, even after vitamin D supplementation.⁹ Therefore, more research is required to better understand the relationship between vitamin D and thyroid function. Vitamin D3 is the most bioavailable form of vitamin D to humans and can be found in fish (e.g. wild fresh salmon, cod liver oil, sardines) and dairy products.⁷ Further, the body can synthesize vitamin D3 in the skin via adequate sun exposure.⁷

Based on these data, individuals with Hashimoto’s disease are recommended to monitor their intake of iodine, iron, selenium, and vitamin D. The Dietary Guidelines for Americans can be referenced to determine recommended amounts for each micronutrient. Further, it may be beneficial to discuss nutrition recommendations about Hashimoto's disease or other thyroid diseases and disorders with dietitians or healthcare providers who specialize in these conditions.

If you would like to learn more about Hashimoto's disease or other thyroid diseases, then you can visit the American Thyroid Association website.

References: 

1. Clinic TS. National Thyroid Awareness Month: Thyroid Disease. The Surgical Clinic. Published January 15, 2020. Accessed January 4, 2022. https://thesurgicalclinics.com/national-thyroid-awareness-month/

2. Hashimoto’s Thyroiditis. American Thyroid Association. Accessed January 3, 2022. https://www.thyroid.org/hashimotos-thyroiditis/

3. Thyroid Gland: Overview. Endocrine Web. Accessed January 4, 2022. https://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-gland-controls-bodys-metabolism-how-it-works-symptoms-hyperthyroi

4. Hashimoto’s Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published June 2021. Accessed January 3, 2022. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

5. Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society. 2019;78(1):34-44. doi:10.1017/S0029665118001192

6. Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto’s Thyroiditis. Thyroid. 2017;27(5):597-610.

7. Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients. Points that need more investigation. Hell J Nucl Med. 2017;20(1):51-56. doi:10.1967/s002449910507

8. Foods to Fight Iron Deficiency. Accessed April 6, 2021. https://www.eatright.org/health/wellness/preventing-illness/iron-deficiency

9. Chahardoli R, Saboor-Yaraghi AA, Amouzegar A, Khalili D, Vakili AZ, Azizi F. Can Supplementation with Vitamin D Modify Thyroid Autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and Thyroid Profile (T3, T4, TSH) in Hashimoto’s Thyroiditis? A Double Blind, Randomized Clinical Trial. Horm Metab Res. 2019;51(5):296-301. doi:10.1055/a-0856-1044

10. Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism. seventh.