Westchester Rockland Dietetic Association WRDA Member's Blog

World Pancreatic Cancer Day

Jessica Tosto — Thu, 16 Nov 2023 23:58:02 GMT

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

Jessica Tosto — Tue, 24 Oct 2023 19:37:19 GMT

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

Jessica Tosto — Wed, 10 May 2023 18:25:30 GMT

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

Jessica Tosto — Tue, 18 Apr 2023 17:30:47 GMT

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

Jessica Tosto — Thu, 02 Mar 2023 19:43:05 GMT

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

Slavin, J. L. (2000). Mechanisms for the impact of whole grain foods on cancer risk. Journal of the

Focus on Fiber

Jessica Tosto — Wed, 25 Jan 2023 17:11:18 GMT

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

Irritable Bowel Syndrome Awareness Month written by Marissa Lau, MS Student at Pace University

Tue, 12 Apr 2022 18:11:28 GMT

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

National Purple Day: Raising Epilepsy Awareness and the Role of Nutrition written by Andrea Polvere, MS Student at Pace University

Fri, 18 Mar 2022 00:28:09 GMT

What is Epilepsy?

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 written by Kristen Nicole, MS student at Hunter College

Sat, 26 Feb 2022 01:05:04 GMT

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.

National Thyroid Awareness Month: A Focus on Nutrition and Hashimoto's Disease written by Marissa Lau

Krishaveni Drummond — Fri, 14 Jan 2022 14:00:00 GMT

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.

Potassium and Hypertension

Sat, 29 May 2021 17:51:34 GMT

By Marissa Lau, Pace University, 2022

Hypertension is a risk factor of multiple chronic diseases including cardiovascular disease, chronic kidney disease, dementia, and other diseases and conditions.¹ This disease burdens 1.2 billion individuals worldwide making it a public health issue.² Hypertension has several modifiable risk factors that can decrease the likelihood of developing the disease.¹ Such risk factors include overweight or obese, diet consisting of high salt intake, sedentary lifestyle, and frequent alcohol use.^1,3,4 In particular, low potassium intake in the diet can lead to the disease.^1,3,4

The Role of Potassium on Blood Pressure

Regarding blood pressure, potassium and sodium play major roles in maintaining blood volume, hydro-electrolyte balance, and cell function via the renal system.³ More specifically, potassium can modify the effect of sodium on blood pressure in the renal system.³

When potassium intake is high, a negative sodium balance develops, resulting in increased sodium excretion, via urine, which is demonstrated through the downregulation of sodium chloride cotransporters.³ Through this mechanism, high potassium intake leads to high plasma potassium.³ The high plasma potassium maintains sufficient intracellular chloride, resulting in lower blood pressure.³

This mechanism is one biochemical pathway relating to blood pressure, but other studies have proposed additional renal and non-renal mechanisms that relate to hypertension and involve potassium and sodium mechanisms.³ The pathogenesis of this condition is complex, and more research is necessary to acquire a complete understanding of this topic.³

How Much Potassium Is Recommended?

Based on the 2020-2025 Dietary Guidelines for Americans, a daily goal of 2,000-3,400mg of potassium is recommended, depending on gender and age.^5(p133) This amount is important as more than 80% of Americans have diets consisting of low intake of vegetables and fruits, which suggests that most Americans have low potassium intake.^5(p30)

Knowing the guidelines’ potassium recommendation can be important, but hypertensive individuals can benefit from following the sodium-potassium ratio. The sodium-potassium ratio consists of low sodium and high potassium intake to lower blood pressure. Studies have even found that this ratio may be more significant for blood pressure maintenance, compared to the exact amount of potassium and sodium that an individual consumes.⁴

What Are Good Sources of Potassium?

Potassium supplementation may be used to increase potassium intake.³ Either potassium chloride or potassium citrate can be taken as one study has demonstrated that subjects that took either supplement had similar blood-pressure lowering effects.³ On the other hand, another study found a more significant decrease in blood pressure in subjects supplemented with potassium chloride, compared to those supplemented with potassium magnesium citrate and potassium citrate.³ Based on these studies, more research is necessary to determine the ideal form of potassium supplementation to provide optimal blood-pressure lowering effects.

Although studies have shown that potassium supplements are effective, it is not advisable as high intake of vitamins or minerals in a short period of time can lead to toxicity.⁴ Instead, diets consisting of high-potassium vegetables, fruits, and nuts is recommended.^3,4 One study found that from the hypertensive individuals who increased their dietary intake of potassium, 81% of the individuals required less than half of the baseline medication and 38% did not need antihypertensive medication for blood pressure control, when compared to 29% and 9%, respectively, in the control group after 1 year of the follow-up.⁴

Following the sodium-potassium ratio, it is recommended to increase potassium consumption via fruits, vegetables, and nuts, in individuals who have moderate excess of sodium intake.³ For individuals with excessive salt intake, they can both reduce sodium intake and increase potassium intake.³ Diets should consist of fresh produce as frozen or canned produce contains lower potassium content.⁴ Processed foods should be limited as well since they are high in sodium and low in potassium.⁴ For individuals who prefer to follow a specific diet, the DASH diet or the Mediterranean diet is recommended as these diets emphasize the intake of vegetables, fruits, and nuts, and have shown to decrease risk of hypertension in hypertensive individuals.^3,6

References:

1. High blood pressure (hypertension) - Symptoms and causes. Mayo Clinic. Accessed May 5, 2021. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

2. Rossier BC, Bochud M, Devuyst O. The Hypertension Pandemic: An Evolutionary Perspective. Physiology. 2017;32(2):112-125. doi:10.1152/physiol.00026.2016

3. Burnier M. Should we eat more potassium to better control blood pressure in hypertension? Nephrology Dialysis Transplantation. 2019;34(2):184-193. doi:10.1093/ndt/gfx340

4. Samadian F, Dalili N, Jamalian A. Lifestyle Modifications to Prevent and Control Hypertension. Iranian Journal of Kidney Diseases. 2016;10(5):237-263.

5. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. Published online December 2020.

6. Magriplis E, Panagiotakos D, Kyrou I, et al. Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS). Nutrients. 2020;12(3). doi:10.3390/nu12030853

Understanding and Addressing the Unique Needs of Women with PCOS

Sat, 29 May 2021 17:44:49 GMT

By: Kristen Nicolai

The Westchester Rockland Dietetic Association (WRDA) held a live webinar on May 19 titled, Understanding and Addressing the Unique Needs of Women with PCOS, presented by Dr. Felice Gersh, MD. Dr. Gersh is board-certified in OB-GYN and Integrative Medicine and the medical director of Integrative Medical Group of Irvine. She is a globally recognized expert on a wide range of female and integrative health topics.

To start off the webinar, Dr. Gersh provided background on PCOS and explained that for women to have optimized health, they require optimized hormones. We live in a world of endocrine disruptors, including pollutants, toxicants, poor diet, and disrupted sleep-wake cycles. Women develop PCOS by being exposed to endocrine disruptors in utero, including exposure to higher levels of BPA. This causes high oxidative stress causing the endocrine system to be dysregulated. Women with PCOS therefore have altered endocrine receptor function, causing a state of estrogen deficiency.

Since estrogen receptors are located throughout the body, every organ system is impacted by this low estrogen, creating pro-inflammatory conditions. Dr. Gersh explained that inflammation is the driving force of PCOS, causing the dysbiosis, abdominal fat, insulin resistance, altered immune cell reactivity, and impaired circadian rhythm seen in PCOS. Because of this, PCOS patients experience a wide range of symptoms including acne, hirsutism, alopecia, irregular cycles, obesity, fatigue, joint pains, gingivitis, mood disorders, and IBS. Therefore, modulating estrogen is a key part of helping women with PCOS.

When treating PCOS, it is critical to have and maintain a healthy gut microbiota, which supports all systems of the body. Food plays a big role in this as PCOS patients have impaired gut barrier and lower microbial diversity. Dr. Gersh has an integrative approach that includes feeding the gut or microbes, and eating to beat, which includes recognizing the important role of the circadian rhythm in women. Dr. Gersh emphasizes a plant-based diet that includes organic, raw, and minimally processed foods. She stresses eating the colors of the rainbow and lots of fiber. She also advises to limit sugar, fat, salt, and avoid alcohol, antibiotics from agriculture, artificial sweeteners, dairy, emulsifiers, and gluten. She encourages patients to take a daily probiotic, and even eating vegan for six months to help the body reboot.

Dr. Gersh went on to explain that diet modulates the microbiome, and that a low fat and high complex carbohydrate diet has been proven to improve metabolic syndrome by altering the gut microbiome and increasing the bacterial strain F. prausnitzii that increases butyrate. Butyrate nourishes the cells of the gut ling, and even has a calming effect through its impact on the vagus nerve. Dr. Gersh also emphasized the importance of a diet very high in fiber and resistant starch, which acts as pure food for the microbes of our gut. She recommended foods such as cold potatoes, plantains, and Jerusalem artichokes, which are high in resistant starch. She also encourages her patients to eat fermented, prebiotic and probiotic foods.

It was also highlighted that nitric oxide is reduced in PCOS patients, which has an affect on t-regulatory cell generation. Women with PCOS do not make enough of these cells which causes autoimmune disfunction. Since nitric oxide is very related to food, Dr. Gersh highlighted the importance of eating foods containing nitric oxide, such as kale, swiss chard, arugula, and spinach.

Dr. Gersh concluded that poor diets high in fat and sugar drive gut dysbiosis and the systematic inflammation seen in PCOS women. This also causes circadian rhythm dysfunction. To combat this Dr. Gersh explained her “eat to the beat” philosophy. This includes eating at same time each day, fasting through the night, eating dinner early, and eating a big breakfast, moderate lunch, and small dinner. She advises her patients to eat meals, not snacks, to stop eating at 7pm, and even try adding in a fasting mimicking diet or longer fasts. By correcting the clock to synch meal timing with the circadian rhythm, this can help women with PCOS see significant changes in their symptoms and reductions in glucose, insulin, testosterone, and other important biomarkers.

For more information on Dr. Gersh you can visit her website at https://integrativemgi.com/ or follow her on Instagram (@dr.felicegersh).

Vitamin D Review

Wed, 07 Apr 2021 12:35:33 GMT

By Angela Iovine, Pace University, 2021

Vitamin D is the most commonly used supplement in the U.S., and its popularity has further increased in recent months due to its perceived protective effect against the coronavirus.¹ Both a vitamin and a hormone, Vitamin D helps maintain the balance of calcium and phosphorous within the body, which includes increasing the intestinal absorption of dietary calcium and keeping calcium in our bones. It is therefore essential for strong bones and skeletal growth. Vitamin D may also have an immunomodulatory effect, and it appears to reduce all-cause mortality.^2-5

Vitamin D from the Sun

Vitamin D is unique in that we can synthesize all that we need from exposure to the sun. The precursor to vitamin D₃ can be found evenly distributed along the surface of our skin. When exposed to ultraviolet B (UVB) light, a component of sunlight, a molecule in our skin forms previtamin D₃, which can then be converted into vitamin D₃ in the body. The amount of vitamin D₃ produced from sun exposure is dependent on several factors, including: how much skin is exposed, your latitude, air pollution and cloud cover, age, the color of your skin, and possibly use of sunscreen. Clothing blocks UVB light from accessing the skin. Glass also blocks UVB light, so sitting in the sun by a closed window will not help increase vitamin D production. Those living above the 35^th parallel (above Tennessee and North Carolina), generally receive less sunshine and fewer UVB rays, putting them at greater risk for deficiency.^2,3

Black Americans have been found to have lower levels of 25-hydroxyvitamin D₃ (25-OH D), the form of vitamin D that is used to determine adequacy, than white Americans. Although research in this field is limited, it is thought that the increased levels of melanin in darker skin can block some UVB light and result in less vitamin D activation.^2,6 Black Americans also tend to have less vitamin D binding protein (VDBP), which may lead to more free-circulating vitamin D and explain why they generally have better bone density and lower fracture risk than white Americans despite having lower vitamin D levels.⁷

The UVB rays that promote vitamin D synthesis can also cause sunburn, DNA damage to cells, and lead to skin cancer. Some organizations, including the American Academy of Dermatology and the American Cancer Society, promote minimizing or avoiding sun exposure.³ Theoretically, sunscreen use could inhibit vitamin D production. However, several studies have shown that lower SPF values still allow for vitamin D production in lighter-skinned individuals. There is limited data on the effects of higher SPF values and the effect on darker-skinned people.^8,9 For example, a study found that wearing SPF 15 sunscreen with a high UVA blocker was adequate to prevent sunburn while also allowing for vitamin D synthesis. The study’s participants were all light-skinned people on vacation in the Canary Islands, and the UV index was very high.⁹

Sunburn is not necessarily a marker for DNA damage, and damage can still occur without getting burnt. Research suggests that exposing more skin to sunlight for shorter duration, or having short, but recurrent, periods of sun exposure may minimize UV-induced skin damage while maintaining vitamin D production.¹⁰

Vitamin D in Food

There is a relatively small number of foods that naturally contain vitamin D, most of which come from animals. Eggs, liver, and fatty fish are good sources. Smaller amounts can be found in butter and cheese. Plant foods are generally poor sources of the vitamin, although mushrooms do contain some. In the U.S., many foods are fortified with vitamin D to help reduce deficiency within the population. Foods often fortified include orange juice, bread, cereal, milk, cheese, butter, margarine, and yogurt.

Most often these foods are fortified with D₃ (also known as cholecalciferol), although D₂ (also known as ergocalciferol) is sometimes used. The two forms are similar in structure, with some differences in their side chains, and are utilized within the body similarly.²

Absorption of vitamin D in the digestive tract is not well understood, and there is much conflicting data on the subject. Although vitamin D is better absorbed when taken with a meal that includes fat, it is not necessary for some absorption to take place. The type of fat consumed does not matter, although this is open to debate.¹¹ The overall amount of fat needed to optimize absorption is unclear; however, an older trial using a single bolus supplementation found some evidence that low-fat meals of about 11g of fat are superior. Although after one month, regardless of fat intake, all participants had similar vitamin D levels.¹²

Vitamin D and COVID-19

Vitamin D appears to play a role in innate immunity and to exert an anti-inflammatory effect within the body, and it has been associated with improved outcomes for some viral infections, such as pneumonia. Existing data suggests that vitamin D deficiency is not correlated with a greater risk of infection from coronavirus. However, the severity of the deficiency is directly related to the severity of disease, hospitalization, and mortality from COVID-19, especially in the elderly. Vitamin D may play a role in mediating cytokine activity associated with COVID-19 infections.^3,13

There is limited data on this subject, and the studies that do exist tend to have significant limitations, including a high risk of bias due to convenience sampling and use of secondary data analysis. Further, many of the patients who are hospitalized for COVID-19 infections also have comorbidities or are elderly. These populations are inherently at greater risk for vitamin D deficiency. Therefore, it is difficult to know if their vitamin D status played a role in their infection or if it was another factor. Until we have more data, maintaining adequate vitamin D levels and avoiding deficiency via sun exposure, consuming fortified foods, and supplementation as necessary seems the best course.¹³

How is Vitamin D Status Measured?

Vitamin D status is obtained via a blood test that looks at concentrations of 25-OH D. There is substantial variability in the laboratory methods used to determine a sample’s vitamin D level, and the same sample sent to different laboratories can yield markedly different results. Translating these results can also be problematic, as several interpretations of serum levels also exist. Regular testing is not recommended for individuals who are not at risk of deficiency, as vitamin D supplementation is generally considered a safe and effective way to improve status and testing results tend to be quite variable.

Testing variability can also make it difficult to compare results across studies and develop clinical guidelines. Some researchers have suggested that 25-OH D is not the best marker of the vitamin’s effect on the body, and that other markers should be used.^7,14 The Institute of Medicine classifies serum 25-OH D concentrations less than 30 nmol/L as being indicative of deficiency and concentrations between 30-50 nmol/L as insufficiency. Levels greater than 50 nmol/L are sufficient for most people.³ Levels between 50 – 80 nmol/L have been found to offer the most protection against all-cause mortality, with greater concentrations providing no additional benefit.^4,5 Serum levels greater than 150 nmol/L have been linked to adverse events.³

Deficiency and Toxicity

About 40% of the U.S. population has either vitamin D insufficiency or deficiency. Unsurprisingly, vitamin D status varies by occupation, with up to 78% of people who work indoors having inadequate levels.¹⁵ The elderly are also commonly deficient due to being less efficient at making vitamin D and spending more time indoors. Deficiency is also more common in those with fat-malabsorption disorders, liver or kidney dysfunction, infants who are breast-fed, those who are obese, nursing home residents and hospitalized patients. Rickets in children and osteomalacia in adults result from severe vitamin D deficiency.^2,3

Deficiency has also been implicated in a number of diseases, including cancer, cardiovascular disease, autoimmune diseases, and diabetes. Recent evidence suggests that this role has been overstated. Vitamin D supplementation appears not to have an effect on most non-skeletal conditions. For example, it does not lower the incidence of cardiovascular events or invasive cancers, improve glucose metabolism, or help one lose weight. The lower vitamin D status associated with these conditions is likely a product of poor health and not the cause of it. Vitamin D does appear to play a role in overall cancer mortality and also death from respiratory diseases. ^5,10,16,17

Reaching toxic vitamin D levels due to too much sun exposure is not possible, as vitamin D levels in the body plateau with repeated exposure. Toxicity via supplementation is possible, although it is quite rare. It is not recommended to exceed the tolerable upper intake level for vitamin D of 4,000 IU (for adolescents and adults). However, toxic levels are generally only seen with excessive intake, such as 50,000 IU per day taken for weeks or cumulative intakes of 240,000 IU or more. The most common manifestations of toxicity include calcinosis and hypercalcemia, calcification of soft tissues, hypertension, hyperphosphatemia, nausea, weakness, headache, anorexia, renal disfunction, and it can sometimes result in death.^2,14

How Much Do We Need?

Recommending an adequate level of sun exposure is difficult due to the many confounding factors involved and the association between sun exposure and skin cancer. Some studies attempt recommendations, however, there is significant variation across references on the amount of exposure needed to prevent vitamin D deficiency.

The Dietary Guidelines for Americans acknowledge that it is difficult to get adequate vitamin D from dietary sources, and supplementation may be appropriate for individuals who get limited sunlight. The RDA for vitamin D is based on minimal sun exposure. The recommendation is for 400 IU per day for infants under 1 year old, 600 IU per day for everyone from 1 – 70 years old, and 800 IU per day for those over 70 years old.¹⁸ Recommendations are confounded by the many factors that affect vitamin D status, and different countries and organizations have different recommendations for optimal intake. Many researchers have proposed that the RDA is too low. For example, the Endocrine Society recommends a minimum of 600 IU per day up to 2,000 IU per day to maintain adequacy in people aged 19-50.^19,20

There appears to be consensus that 400 IU per day is adequate for infants, and there is no evidence to suggest that higher doses are beneficial.^20,21 A meta-analysis of randomized controlled trials from Northern Europe found that intakes around 1,000 IU per day can maintain adequate vitamin D status in 97.5% of children and adults.^4,22 Intakes as high as 2,000 IU per day are commonly recommended, are generally considered safe, and should keep vitamin D values well below the upper intake levels.^3,14 Because vitamin D can be stored in fat cells, those who are overweight or obese may need more vitamin D to reach adequate levels.² Intakes that are 1.5 times higher than recommendations may be appropriate for overweight individuals, while intakes 2-3 times higher may be appropriate for obese individuals.²³

When thinking about adding an oral supplement, consider vitamin D intake from all sources, including fortified foods. Children can maintain adequate vitamin D levels by consuming fortified foods, such as milk and cereal.²⁴ Despite the vast body of research on vitamin D, there remains uncertainty around making recommendations. There are many variables that contribute to one’s individual vitamin D status. It is likely prudent to err on the side of caution and assess your individual circumstances when deciding on how to proceed. Individuals should partner with a health professional, such as a registered dietitian nutritionist, when deciding to make dietary or lifestyle choices.

References

1. COVID Changed Supplement Popularity in 2020, ConsumerLab Survey Reveals. ConsumerLab Web site. https://www.consumerlab.com/news/covid-changed-supplement-popularity/02-26-2021/. Published February 26, 2021. Accessed March 27, 2021.

2. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 6th ed. Belmont, CA: Wadsworth Cengage Learning; 2013.

3. Matsui MS. Vitamin D Update. Current Dermatology Reports. 2020;9(4):323-330.

4. Garland CF, Kim JJ, Mohr SB, et al. Meta-analysis of all-cause mortality according to serum 25-hydroxyvitamin D. Am J Public Health. 2014;104(8):e43-50.

5. Heath AK, Kim IY, Hodge AM, English DR, Muller DC. Vitamin D Status and Mortality: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2019;16(3):383.

6. Young AR, Morgan KA, Ho T-W, et al. Melanin has a Small Inhibitory Effect on Cutaneous Vitamin D Synthesis: A Comparison of Extreme Phenotypes. Journal of Investigative Dermatology. 2020;140(7):1418-1426.e1411.

7. Powe CE, Evans MK, Wenger J, et al. Vitamin D-binding protein and vitamin D status of black Americans and white Americans. The New England journal of medicine. 2013;369(21):1991-2000.

8. Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019;181(5):907-915.

9. Young AR, Narbutt J, Harrison GI, et al. Optimal sunscreen use, during a sun holiday with a very high ultraviolet index, allows vitamin D synthesis without sunburn. British Journal of Dermatology. 2019;181(5):1052-1062.

10. Lucas RM, Norval M, Neale RE, et al. The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochemical & Photobiological Sciences. 2015;14(1):53-87.

11. Silva MC, Furlanetto TW. Intestinal absorption of vitamin D: a systematic review. Nutr Rev. 2018;76(1):60-76.

12. Dawson-Hughes B, Harris SS, Palermo NJ, Ceglia L, Rasmussen H. Meal conditions affect the absorption of supplemental vitamin D3 but not the plasma 25-hydroxyvitamin D response to supplementation. J Bone Miner Res. 2013;28(8):1778-1783.

13. Pereira M, Dantas Damascena A, Galvão Azevedo LM, de Almeida Oliveira T, da Mota Santana J. Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2020:1-9.

14. El-Hajj Fuleihan G, Bouillon R, Clarke B, et al. Serum 25-Hydroxyvitamin D Levels: Variability, Knowledge Gaps, and the Concept of a Desirable Range. Journal of Bone and Mineral Research. 2015;30(7):1119-1133.

15. Sowah D, Fan X, Dennett L, Hagtvedt R, Straube S. Vitamin D levels and deficiency with different occupations: a systematic review. BMC Public Health. 2017;17(1):519.

16. Manson JE, Cook NR, Lee IM, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019;380(1):33-44.

17. Autier P, Mullie P, Macacu A, et al. Effect of vitamin D supplementation on non-skeletal disorders: a systematic review of meta-analyses and randomised trials. Lancet Diabetes Endocrinol. 2017;5(12):986-1004.

18. U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. Dietary Guidelines for Americans Web site. https://www.dietaryguidelines.gov/sites/default/files/2019-05/2015-2020_Dietary_Guidelines.pdf. Published December 2015. Accessed June 3, 2020.

19. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911-1930.

20. Bouillon R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol. 2017;13(8):466-479.

21. Mimouni FB, Mendlovic J. Vitamin D requirements in infancy: an updated systematic review. Curr Opin Clin Nutr Metab Care. 2021;24(3):259-264.

22. Cashman KD, Ritz C, Kiely M, Odin C. Improved Dietary Guidelines for Vitamin D: Application of Individual Participant Data (IPD)-Level Meta-Regression Analyses. Nutrients. 2017;9(5):469.

23. Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014;9(11):e111265.

24. Brandão-Lima PN, Santos BDC, Aguilera CM, Freire ARS, Martins-Filho PRS, Pires LV. Vitamin D Food Fortification and Nutritional Status in Children: A Systematic Review of Randomized Controlled Trials. Nutrients. 2019;11(11).

February is National Heart Month

Sat, 30 Jan 2021 18:22:54 GMT

February is National Heart Month

By Kristen Nicolai

February 1, 2021

February is National Heart Month. Every year the National Heart, Lung, and Blood Institute partners with The Heart Truthâ to motivate Americans to adopt a healthy lifestyle to prevent heart disease. This year, heart health has never been more important as those with poor cardiovascular health are at increased risk of severe illness from COVID-19.^{^[1]}

Heart disease is the leading cause of death in the United States. Cardiovascular disease encompasses diseases that affect the heart or blood vessels, including coronary heart disease, which can cause stroke, heart failure, and peripheral artery disease. In the United States more than 800,000 people die from cardiovascular disease every year.^{^[2]} About 15 million people have coronary heart disease, the most common type of heart disease^{^[3]} and about 366,000 die from coronary heart disease each year.

Heart disease can cause heart attacks, but preventative measures can help lower one’s risk of developing heart disease. Risk factors include high blood pressure, high cholesterol, being overweight or obese, having prediabetes or diabetes, smoking, family history, no physical activity or unhealthy eating behaviors.^{^[4]}

The DASH diet or Dietary Approaches to Stop Hypertension eating plan is the recommended heart-healthy diet as it lowers high blood pressure and the “bad” LDL cholesterol in the blood. The DASH diet is abundant in vegetables, fruits, whole grains, fat-free or low-fat dairy, protein-rich foods such as fish, lean meats, eggs, nuts, seeds, and soy products, legumes, and oils or foods high in monounsaturated or polyunsaturated fats. Sodium, saturated/trans fats, added sugars, and alcohol should be avoided. Other ways to lower risk of heart disease are regular physical activity, maintaining a healthy weight, managing stress, getting enough sleep, and quitting smoking.

To encourage Americans to adopt healthy lifestyles to prevent heart disease, The Heart Truthâ campaign provides support through the #OurHearts Movement. The movement encourages social support and personal networks to work on heart health.^{^[5]}

In addition, National Wear Red Day takes place annually on the first Friday in February to bring awareness to heart disease as the leading cause of death for Americans. People are encouraged to wear red to help bring more attention to the cause.

For more ways to take part in national heart month, visit https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-month for additional resources including education materials, fact sheets, social media resources and more.

^{^[1]} About American Heart Month: Ways to Get Involved | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/education-and-awareness/american-heart-month/about

^[2] Know the Difference Fact Sheet | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/know-differences-cardiovascular-disease-heart-disease-coronary-heart-disease

^[3] Heart-Healthy Living | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/heart-healthy-living

^[4] Heart-Healthy Living | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/heart-healthy-living

^[5] Join the #OurHearts Movement | NHLBI, NIH. Accessed January 24, 2021. https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth/our-hearts

Health Benefits Associated with Plant-Based, Vegan Diets

Sun, 17 Jan 2021 15:50:52 GMT

Angela Iovine, Pace University

The new year is upon us, which means that many people will be attempting new year’s resolutions. While usually 92% of people fail to achieve their resolutions, with most being abandoned by mid-February, 2021 may be different.^1,2 After a difficult 2020, the new year brings hope of a fresh start. We have seen improvements in the medical treatment of COVID-19 and the production of an effective vaccine. During the pandemic, many people adopted unhealthy habits, such as sitting for long periods, abandoning gyms, drinking excessively, and falling into unhealthy eating patterns. The advancement of the calendar year may be the impetus for change that many need.²

Adopting a plant-based vegan diet is becoming an increasingly popular new year’s resolution. , A nonprofit group called Veganuary began in 2014 and capitalizes on the desire for change this time of year. Its goal is to inspire people to try a vegan eating pattern during the month of January and throughout the year. Participants can sign up on the organization’s website to be provided with vegan meal plans, recipes, and tips via email. It also sends out information about nutrition, the impact of adopting a vegan diet on the environment and animal welfare, as well as news updates and offers. Since its inception, more than one million people have signed up to take Veganuary’s one-month challenge. Globally, more than 400,000 people signed up last year. It is estimated that ten times as many people participate than sign up on the website.³ Other platforms also exist for taking a “Vegan Challenge”.

This January, it is estimated that more people than ever will try a vegan diet.³ The coronavirus pandemic is already credited with a spike in plant-based meat substitute purchases in the United States, sales of which have been increasing steadily. This past year, plant-based meat alternatives have become much more mainstream, appearing in both fast-food and fine-dining restaurants.⁴ Many makers and distributers of vegan products have gotten on board with Veganuary, offering discounts, new menu items, and marketing campaigns for vegan products during the month of January.⁵

There are many reasons why a person chooses to try a vegan diet, with optimizing health being the main motivator.⁶ Studies have shown a myriad of health benefits related to plant-based diets, with most of the scientific community in agreement that eating more plant foods is beneficial to health. Plant-based vegetarian and vegan diets have been linked to improving cardiovascular health, reducing obesity, and reducing the risk of chronic diseases, including heart disease and type 2 diabetes. Research suggests that these eating patterns can reverse atherosclerosis, lower cholesterol, lower blood pressure, and reduce the risk of heart attack by 40% and the risk of stroke by 29%. Risk for developing metabolic syndrome and type 2 diabetes is reduced by 50%. Plant-based vegetarian and vegan diets are also associated with reduced all-cause mortality.⁷

Improving diet quality can also positively impact cancer risk. Research suggests that food choices contribute to about 33% of all cancer cases, and that 30-40% of all cancers are preventable with appropriate physical activity, a healthy diet, and an appropriate body weight.^8,9 High-fiber, low-fat diets tend to be cancer protective, especially against colon, stomach, and breast cancers. Plant foods, which are excellent sources of fiber and generally low in fat, are more cancer protective than animal products, such as dairy, eggs, and meat, which do not contain fiber and tend to be higher in fat. The average American generally falls short of the daily fiber recommendation by 20-30g per day and overconsumes fat. Red and processed meat have been labeled as carcinogens by the World Health Organization, and the consumption of meat and milk has been linked to ovarian and prostate cancers.⁹

A host of cancer-fighting phytochemicals and antioxidants are found in plant foods, including carotenoids, beta-carotene, flavones, indoles, vitamin C, and vitamin E. Research shows that vegetarians have a lower risk for all cancers than people who eat meat, and that vegans have the lowest risk of all groups.^8,9 A meta-analysis concluded that vegetarians have an 8% reduced risk for all cancer while vegans have a 15% reduced risk.¹⁰ The efficacy of plant-based vegan and vegetarian diets is also being explored in relation to cancer-related outcomes and cancer recurrence in cancer survivors.¹¹ Research has shown that vegan diets can improve tumor markers and slow tumor growth in patients with prostate cancer.⁸

Plant-based diets that limit animal products also play a role in preventing cognitive decline and Alzheimer’s disease. This is possibly due in part to the reduced risk of obesity, diabetes, and cardiovascular disease associated with this dietary pattern, as these conditions increase the risk of developing dementia. Higher intake of saturated fats, animal protein, and refined sugars are associated with increased risk, whereas higher intake of plant foods, such as beans and nuts, as associated with reduced risk. The Mediterranean diet has been extensively studied in regards to dementia prevention, and has been found effective in reducing cognitive decline.¹² The link between vegan diets and dementia remains an area of ongoing research.

Following a plant-based vegan diet has become a popular weight-loss trend. Studies suggest that this may be an effective strategy for losing weight and maintaining a healthy body weight, even without caloric restriction.¹³ This may be due to the elimination of less-healthy foods, the increase in fiber intake leading to increased satiety, and the fact that whole plant foods tend to be lower in calories than animal-derived foods. A study that randomized participants into an omnivore group and four different plant-based diet groups (vegan, vegetarian, pesco-vegetarian, and semi-vegetarian) found that diet adherence and acceptability was similar across all groups; however, the vegan and vegetarian groups lost the most weight.¹⁴

But how necessary is it to follow a strict vegan diet if one’s sole motivation is for its health benefits? This is a complex question that is not succinctly answered. However, it is true that there can be a stark difference between a vegan diet that focuses on whole foods and one that includes many processed foods. For example, white rice and brown rice have different nutrient profiles, as do a baked potato, potato chips, and French fries. It is possible to follow a nutrient-poor vegan diet. It is also possible to follow a nutrient-rich, plant-based, non-vegan diet. A plant-based diet limits animal foods, but it does not eliminate them. The Mediterranean diet, which has been found to have many positive health implications, is an example of a plant-based diet. Those who follow this eating pattern generally limit animal products but may occasionally consume them.

The quality of the foods chosen in a diet is an important consideration when discussing the diet’s healthfulness. With more processed vegan foods appearing on the supermarket shelf daily, it may become more difficult for people to achieve the health benefits associated with this eating pattern. The key is to focus on whole foods, such as whole grains, vegetables, fruits, and beans, to find proven nutrient powerhouses that contribute to better health.

1. Krockow EM. How to Build Healthier Habits Today. Psychology Today Web site. https://www.psychologytoday.com/us/blog/stretching-theory/201904/how-build-healthier-habits-today. Published April 26, 2019. Accessed January 7, 2020.

2. Krockow EM. Why Now is the Time for a Fresh Start. Psychology Today Web site. https://www.psychologytoday.com/us/blog/stretching-theory/202012/why-now-is-the-time-fresh-start. Published December 26, 2020. Accessed January 7, 2020.

3. Veganuary 2021 Anticipating Record Sign-ups as Pandemic and Environmental Concerns Grow. Veganuary Web site. https://veganuary.com/en-us/veganuary-2021-anticipating-record-sign-ups-as-pandemic-and-environmental-concerns-grow/. Published December 1, 2020. Accessed January 7, 2020.

4. Nierenber A. Plant-Based ‘Meats’ Catch On in the Pandemic. The New York Times Web site. https://www.nytimes.com/2020/05/22/dining/plant-based-meats-coronavirus.html. Published May 22, 2020. Updated May 24, 2020. Accessed January 7, 2021.

5. What We Do. Veganuary Web site. https://veganuary.com/en-us/about/about-us/. Accessed January 7, 2021.

6. Hopwood CJ, Bleidorn W, Schwaba T, Chen S. Health, environmental, and animal rights motives for vegetarian eating. PLoS One. 2020;15(4):e0230609.

7. Kahleova H, Levin S, Barnard N. Cardio-Metabolic Benefits of Plant-Based Diets. Nutrients. 2017;9(8).

8. Gray A, Dang BN, Moore TB, Clemens R, Pressman P. A review of nutrition and dietary interventions in oncology. SAGE Open Med. 2020;8:2050312120926877.

9. Medicine PCfR. Foods for Cancer Prevention Fact Sheet. Physicians Committee for Responsible Medicine Web site. https://p.widencdn.net/j6o9gp/Foods-for-Cancer-Prevention-Fact-Sheet. Accessed January 7, 2021.

10. Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017;57(17):3640-3649.

11. Molina-Montes E, Salamanca-Fernández E, Garcia-Villanova B, Sánchez MJ. The Impact of Plant-Based Dietary Patterns on Cancer-Related Outcomes: A Rapid Review and Meta-Analysis. Nutrients. 2020;12(7).

12. Pistollato F, Iglesias RC, Ruiz R, et al. Nutritional patterns associated with the maintenance of neurocognitive functions and the risk of dementia and Alzheimer's disease: A focus on human studies. Pharmacol Res. 2018;131:32-43.

13. Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. 2015;115(6):954-969.

14. Moore WJ, McGrievy ME, Turner-McGrievy GM. Dietary adherence and acceptability of five different diets, including vegan and vegetarian diets, for weight loss: The New DIETs study. Eat Behav. 2015;19:33-38.

Holiday Plant-Based Recipes

Wed, 23 Dec 2020 22:56:34 GMT

Anastasia Palshina, Hunter College

Pear Crisp

Ready in 40 minutes (Prep: 10 minutes; Cook: 30 min)

Serves 10, 220 calories per serving

Ingredients

1 cup of oats, rolled or quick

⅓ cup brown sugar, packed

½ cup of whole wheat flour

1 tablespoon ground flaxseed

2 teaspoon cinnamon, separated

½ teaspoon nutmeg

½ stick of butter, unsalted

8 cups of pears, sliced

1 teaspoon all-purpose flour

1 lemon

¼ cup maple syrup

Preparation

1. Preheat the oven to 350°F. Grease an 8” pie dish with cooking spray.

2. In a large bowl, combine pears, juice of 1 lemon, 1 teaspoon flour, 1 teaspoon cinnamon and maple syrup. Pour into the prepared pie dish.

3. In the same bowl, mix the dry ingredients for the topping- oats, brown sugar, whole wheat flour, flaxseed, cinnamon, and nutmeg. Add cold butter and combine until the mixture is crumbly. Spread over the pear mixture.

4. Bake for 30 minutes, or until filling is soft when pierced with a fork. If the topping browns too much, cover with foil.

Tips

Substitute pears for apples, plums, peaches, rhubarb, berries, etc., or a combination.

You can also use ramekins or lined cupcake tins for individual servings.

Fireball Hot Toddy

Ready in 5 minutes

Serves 1, 210 calories per serving

Ingredients

8 ounces hot water

2 ounces Fireball Cinnamon Whiskey

1/2 tablespoon honey, (or more as necessary)

1/2 lemon, juiced

1 green tea bag

Preparation

1. Add whiskey, hot water, honey, and lemon juice to a large mug and stir.

2. If using a tea bag, steep for 5 minutes before drinking.

Stuffed Portobello Mushrooms

modified by Karen Bukolt MS RDN CDN

Ready in 45 minutes (Prep: 15 minutes; Cook: 30 min)

Serves 5, 220 calories per serving

Ingredients

2.2 pounds portobello mushrooms, stems removed and chopped

1/4 cup Panko breadcrumbs

1/2 small onion, diced

3 cloves garlic, diced

1 tablespoon butter

1 tablespoon olive oil

1/4 cup parmesan cheese, grated

1 tablespoon parsley, chopped

1/2 teaspoon salt/pepper

1 teaspoon white truffle oil (optional) or olive oil

Preparation

1. Preheat oven to 350 degrees.

2. Remove stems from the mushrooms and clean each mushroom with a damp paper towel.

3. In a small skillet, add butter, olive oil, onions, and garlic. Sauté about 5 minutes. Add the Panko breadcrumbs, parmesan, salt, pepper and parsley. Stir together for 5 minutes.

4. Stuff each mushroom with the filling, then bake at 350 degrees on a cookie sheet for 30 minutes.

5. Drizzle warm mushrooms with the white truffle or olive oil.

Plant-Based Approach to Winter Holidays

Wed, 23 Dec 2020 22:49:44 GMT

Anastasia Palshina, Hunter College Dietetic Intern

Winter holidays are here. It means delicious food will be on the tables of many Americans. While the current pandemic may destroy traditional gathering plans, it will unlikely affect the contents of the American holiday table. During the holiday season there tends to be a spike in overindulgence and poor diet patterns. According to the Cleveland Clinic, 40% more calories are eaten at a holiday buffet by the average person versus dining alone.^{^[1]} Overconsumption affects people not only on Christmas or New Year’s Day, but during the whole holiday season. Families experience a lot of stress during preparation, and some people experience loneliness as well which contributes to overeating.^{^[2]} Loneliness is intensified for many during the COVID-19 pandemic. The consequences of such behavior may be weight gain due to extra calories being consumed; people also may experience tiredness and mood swings due to the consumption of unhealthy food.^{^[3]} Those who suffer from preexisting conditions such as cardiovascular disease, type 2 diabetes, and metabolic syndrome, can have more severe consequences.

Holiday stories often tell of people enjoying goose or pork, candy canes, and gingerbread cookies with eggnog. Unfortunately, replicating these habits at home can have dietary consequences. The type of food chosen is extremely important during the holiday season. People don’t think that goose or pork have high fat content, but these foods are high in saturated fat. The candy cane, a traditional symbol of Christmas, has 22 grams of added sugar for just one candy. The list can go on and on. No wonder that for many people the holidays are a true test of willpower.

Regardless of one's culture, the holiday table can vary significantly but they all have the same problem. Many traditional dishes, especially baked goods, contain a lot of sodium, sugar, saturated fat and even trans fat.^{^[4]} Trans fat destroys cell membranes, which is why it has been banned by law. In small amounts trans fat will not harm you. A single cookie or slice of cake is relatively harmless; however, holiday overeating can increase consumption of trans fat. Trans fat may also be hiding in shortening, cooking oil, red meat, dairy products, and butter where trans fat exists in amounts less than 0.5g per serving and is not labeled. Several servings of these foods are likely to be on the holiday table, and overconsumption can lead to excessive trans fat intake.¹ The combination of foods high in sodium and saturated fat and alcohol can spoil holidays. The condition is known as “holiday heart syndrome” sends many people to the hospital every year.²

A plant-based approach may help individuals avoid such an unpleasant surprise during the holidays. A plant-based approach simply means eating mostly fruits, vegetables, legumes, nuts, unsaturated oils, whole grains. It emphasizes low-sodium foods as well as low-sugar drinks. The approach does not exclude consumption of meat, poultry, fish and other animal products, however, it limits it. Many studies show improvement in glycemic control and lipid balance in people who followed a plant-based diet, especially those with type 2 diabetes.^{^[5]}^,^{^[6]}^,^{^[7]} According to Karen Bukolt MS RDN CDN, who specialized on plant-based approach, “Most saturated fats are found in animal-based protein. By using more plant-based protein such as beans, legumes, nuts and seeds it is easy to reduce saturated fat intake to less than 10% of daily calories recommended by the USDA Dietary Guidelines.” While completely switching to a vegetarian diet is a challenge for many people, the plant-based approach during holidays can bring much more joy than stress and prevent health conditions caused by traditional food consumption. Simply replacing some saturated fat with walnuts, which have a high concentration of omega-3 fatty acids (3.4g per 3 oz.) and other essential fatty acids, may help with lipid management, enhance mood, and regulate inflammation.^{^[8]}^,^{^[9]} Salty and fatty foods, like pork or goose, can be replaced with plant-based protein such as beans, legumes, and tempeh. Sugary treats can be replaced with more fruit-based, reduced-sugar desserts. “You can reduce sugar in most baked goods by 25% and not affect the outcome of the baked good. For example, if it calls for 1 cup of sugar, using ¾ cup will work just fine while saving almost 200 calories in the recipe!” added Ms. Bukolt. Overconsumption will not have as many detrimental consequences if the holiday table is full of healthy plant-based food.

References

1."Holiday Heart Health Secrets: Here's how to navigate a tempting holiday buffet without overeating and compromising your health." Heart” Advisor, vol. 21, no. 12, Dec. 2018, p. 4+. Gale Academic OneFile, https://link.gale.com/apps/doc/A563571526/AONE?u=cuny_hunter&sid=AONE&xid=e9a1ff1b. Accessed 13 Nov. 2020.

2."Avoid holiday heart and other seasonal threats to your health: alcohol use and overeating can lead to heart palpitations, but holiday heart isn't the only cardiovascular risk this time of year." Heart Advisor, vol. 17, no. 11, Nov. 2014, p. 4. Gale Academic

OneFile, https://link.gale.com/apps/doc/A387829468/AONE?u=cuny_hunter&sid=AONE&xid=92c14164 Accessed 13 Nov. 2020.

3.MD ES. Nutritional psychiatry: Your brain on food. Harvard Health Blog. https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626. Published March 31, 2020. Accessed November 30, 2020.

4. Trans fat: Double trouble for your heart. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/trans-fat/art-20046114. Published February 13, 2020. Accessed November 30, 2020.

5.Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009;89(5):1588S-1596S. doi:10.3945/ajcn.2009.26736H

6. Trepanowski JF, Varady KA. Veganism Is a Viable Alternative to Conventional Diet Therapy for Improving Blood Lipids and Glycemic Control. Crit Rev Food Sci Nutr. 2015;55(14):2004-2013. doi:10.1080/10408398.2012.736093

7.Turner-McGrievy G, Harris M. Key elements of plant-based diets associated with reduced risk of metabolic syndrome. Curr Diab Rep. 2014;14(9):524. doi: 10.1007/s11892-014-0524-y. PMID: 25084991.

8.Gropper, S., Smith J.L., Carr T.P. Advanced Nutrition and Human Metabolism. Seventh edition, Student edition. Boston, Massachusetts: Cengage Learning, 2018; 137.

9. Kiecolt-Glaser JK;Belury MA;Andridge R;Malarkey WB;Glaser R; Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, behavior, and immunity. https://pubmed.ncbi.nlm.nih.gov/21784145/. Accessed November 30, 2020.

10. ThatsVegetarian. Pear Crisp (or Apple Crisp). YouTube. https://www.youtube.com/watch?v=JBvg9WoStNE. Published October 25, 2011. Accessed December 20, 2020.

11. Eater TA. Fireball Hot Toddy Recipe. Yummly. https://www.yummly.com/recipe/Fireball-Hot-Toddy-1723396. Published December 12, 2020. Accessed December 20, 2020.

12. Rosales M. Stuffed Mini Portobello Mushrooms. Just A Pinch Recipes. https://www.justapinch.com/recipes/side/side-vegetable/stuffed-mini-portobello-mushrooms.html. Published January 19, 2015. Accessed December 20, 2020.

^{^[1]} "Holiday Heart Health Secrets: Here's how to navigate a tempting holiday buffet without overeating and compromising your health." Heart” Advisor, vol. 21, no. 12, Dec. 2018, p. 4+. Gale Academic OneFile, https://link.gale.com/apps/doc/A563571526/AONE?u=cuny_hunter&sid=AONE&xid=e9a1ff1b. Accessed 13 Nov. 2020.

^{^[2]} "Avoid holiday heart and other seasonal threats to your health: alcohol use and overeating can lead to heart palpitations, but holiday heart isn't the only cardiovascular risk this time of year." Heart Advisor, vol. 17, no. 11, Nov. 2014, p. 4. Gale Academic

OneFile, https://link.gale.com/apps/doc/A387829468/AONE?u=cuny_hunter&sid=AONE&xid=92c14164 . Accessed 13 Nov. 2020.

^{^[3]} MD ES. Nutritional psychiatry: Your brain on food. Harvard Health Blog. https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626. Published March 31, 2020. Accessed November 30, 2020.

^{^[4]} Trans fat: Double trouble for your heart. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/trans-fat/art-20046114. Published February 13, 2020. Accessed November 30, 2020.

^{^[5]} Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009;89(5):1588S-1596S. doi:10.3945/ajcn.2009.26736H

^{^[6]} Trepanowski JF, Varady KA. Veganism Is a Viable Alternative to Conventional Diet Therapy for Improving Blood Lipids and Glycemic Control. Crit Rev Food Sci Nutr. 2015;55(14):2004-2013. doi:10.1080/10408398.2012.736093

^{^[7]} Turner-McGrievy G, Harris M. Key elements of plant-based diets associated with reduced risk of metabolic syndrome. Curr Diab Rep. 2014;14(9):524. doi: 10.1007/s11892-014-0524-y. PMID: 25084991.

^{^[8]} Gropper, S., Smith J.L., Carr T.P. Advanced Nutrition and Human Metabolism. Seventh edition, Student edition. Boston, Massachusetts: Cengage Learning, 2018; 137.

^{^[9]} Kiecolt-Glaser JK;Belury MA;Andridge R;Malarkey WB;Glaser R; Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, behavior, and immunity. https://pubmed.ncbi.nlm.nih.gov/21784145/. Accessed November 30, 2020.

November is National Diabetes Month

Amy Habeck — Sun, 01 Nov 2020 18:14:35 GMT

November is National Diabetes Month

By Donna Varamo, WRDA Student Volunteer

Hunter College Graduate Student, MS 2021

November 1, 2020

November is National Diabetes Month, which intends to increase the public’s awareness of the risk factors, symptoms, and types of diabetes.¹ This year, National Diabetes Month is raising awareness for the diabetic youth population.¹

Diabetes is one of the major health epidemics in America, and the prevalence is continuing to increase. The 2020 National Diabetes Statistics Report states that there are roughly 34 million Americans that are currently living with diabetes and roughly 88 million adults that are living with prediabetes.² As of 2018, approximately 210,000 children and youth under the age of 20 years old had diagnosed diabetes, including 187,000 diagnosed with type 1 diabetes .² In children ages 10-19, the incidence of type 2 diabetes has significantly increased in Non-Hispanic black, non-Hispanic Asian Pacific Islander, and Hispanic youth populatons compared to non-Hispanic whites. ² Variations in diet and lifestyle factors, genetics, and access to healthcare can contribute to the rise of diabetes diagnoses among these populations and increase the risk of developing diabetes-related complications in the future.

What is Diabetes?

Diabetes can be differentiated into two types: type 1 and type 2.

● Type 1 diabetes is typically diagnosed in children and young adults. It is an autoimmune condition that develops when the body’s immune system begins attacking and destroying pancreatic beta cells, resulting in the decreased production of insulin.³ If there is a lack of insulin production, sugar cannot be transported into cells and converted to energy, resulting in elevated blood sugar levels. Type 1 diabetes is managed with synthetic insulin injections that allow cells to utilize glucose and create energy.

● Type 2 diabetes is attributed to lifestyle and genetic factors including low levels of exercise, dietary habits, age, history of prediabetes, and family history of diabetes.³ Type 2 diabetes was once commonly referred to as “adult-onset diabetes” due to its high prevalence in the adult population, although this type is increasingly being diagnosed in children. In people with type 2 diabetes, pancreatic beta cells make insulin, however the body’s cells are unable to respond to the insulin and cannot take up glucose, resulting in hyperglycemia. Type 2 diabetes is typically managed using a combination of medications, diet, exercise, and insulin.³

The increased blood sugar levels associated with both types of diabetes can lead to long term complications, such as neuropathy, retinopathy, nephropathy and cardiovascular complications.³ Blood circulation to extremities may become impaired, leading to nerve damage, poor wound healing, and possibly to amputations.³

Controlling Diabetes with Diet

Diabetic diets are intended to maintain stable blood glucose levels and prevent complications from diabetes.⁴ Meals should be consistently spread throughout the day and include healthy carbohydrates, fiber-rich foods, and heart healthy fats. Foods high in saturated fats, trans fats, and sodium should be avoided. There are different approaches clients can use to creating well balanced meals that keep blood sugar levels within an optimal range, including the plate method, carb counting, and tracking the glycemic index of foods.

An Interview with a Dietitian who Specializes in Diabetes:

I was fortunate to have the opportunity to interview Dr. Diana Malkin-Washeim, PhD, MPH, RDN, CDCES, CD-N. Dr. Malkin-Washeim has been working with youth and adults diagnosed with diabetes for roughly 25 years. She is currently the director of the Nutrition and Diabetes Program at the BronxCare System’s Health and Wellness Program. She continues to find tremendous joy, passion and endurance working with patients with diabetes because the scope of practice is so broad.

As an RDN and CDCES, she believes that encouraging dietary changes in patients can be very challenging. In her program, she frequently utilizes a multidisciplinary approach that includes the RDN/CDCES, pharmacists, social workers, primary care physicians, adult and pediatric endocrinologists, and OB/GYNs. This team approach optimizes patient care and allows the patient to receive education from each of these disciplines.

Behavior modification can also be more successful when the practitioner meets the patient where they are and understands their point of view. Asking questions regarding access to food and cooking equipment, literacy, and physical ability ensure that the practitioner and their patient are on the same page. It also serves to establish realistic goals that are achievable for the patient. She believes that fulfilling patient expectations, being transparent, and being sincere are keys to successful sessions for both the patient and dietitian.

Dr. Malkin-Washeim frequently works with individuals who are illiterate, impoverished, and food insecure. Attempting to secure necessary medications and equipment for these patients can be a frustrating process that sometimes ends in failure. Access to technology, such as continuous glucose monitoring systems, insulin pumps, and blood sugar test strips, is necessary for monitoring and controlling both type 1 and type 2 diabetes. Some patients have difficulty accessing these materials.

During the COVID-19 pandemic, services and programs that are available to patients with DM include one-on-one counseling, shared medical visits (PCP and RDN/CDCES), and telephone/telehealth visits. Patients have also demonstrated decreased food security and increased need for services due to the pandemic. Demand for telehealth has increased dramatically, but its use is limited by the amount of time available for training and staffing of the platform. It is also more difficult to perform a thorough physical examination remotely, as the practitioner is limited to only sight. Still, Dr. Malkin-Washeim expertly manages her resources to ensure that her patients will always receive quality care, which includes making telehealth and in-office patients both a priority.

She finds that working with each patient individually, being present and actively listening during their sessions, and having empathy are some of the most beneficial approaches when educating and collaborating with her patients. It is also important to be understanding and supportive of cultural diversity within her population. Her advice for dietitians is to expand their breadth of knowledge to include more diverse technology and medications. Also, dietitians should not be afraid to ask each other questions.

References

1. NATIONAL DIABETES MONTH - November 2020. National Today. Accessed October 20, 2020. https://nationaltoday.com/national-diabetes-month/

2. CDC. National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed October 20, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html

3. Differences Between Type 1 and Type 2 Diabetes. Diabetes Research Connection. Published July 11, 2016. Accessed October 20, 2020. https://diabetesresearchconnection.org/differences-type-1-type-2-diabetes/

4. Diabetes diet: Create your healthy-eating plan. Mayo Clinic. Accessed October 20, 2020. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295

October is Breast Cancer Awareness Month

Amy Habeck — Sat, 17 Oct 2020 19:01:39 GMT

October is Breast Cancer Awareness Month

Chat with an RDN Breast Cancer Specialist

By Marissa Lau, WRDA Student Volunteer

PACE University Graduate Student, MS 2022

October 9, 2020

October is Breast Cancer Awareness Month and is recognized internationally to spread awareness of breast cancer.¹ Many foundations, organizations, and charities worldwide, use this month to educate people about this disease as well as to gain support and funds for research associated with breast cancer.¹

What Is Breast Cancer?

Breast cancer is a disease where atypical cells in the breasts are unable to stop multiplying and can spread to other nearby tissues.^2,3 There are different types of breast cancer including ductal carcinoma, lobular carcinoma, and Paget’s disease which form in the milk ducts, the breast’s milk-producing lobules, and the skin of the nipple, respectively.⁴ Symptoms of breast cancer include:
^· Changes in the size, shape, or appearance of the breast^4,5
^· Development of a lump or thickening in the breast that feel different (lumps can form in the underarm as well)⁴
^· Nipple discharge other than breast milk, such as blood⁴
^· Irregular skin texture around the pigmented area of the nipple, such as peeling or flaking⁵
As one of the most common cancers in women, there are approximately 1.38 million new cases diagnosed globally every year and 458,000 breast-cancer related deaths. Research continues its struggle in ascertaining the cause of the disease.¹

Causes, Risk Factors, And Risk Reduction in Breast Cancer

Researchers speculate that rather than being caused by a single trigger, breast cancer development is caused by multiple interactions between a person’s genetic makeup, environment, and lifestyle.^1,2 Prioritizing early detection is the primary recommendation for improving disease outcomes since the early stages of breast cancer are easier to treat, and these patients are more likely to be cured.¹ As of now, mammography, taking an X-ray picture of the breast, is the best method to screen for breast cancer.⁶ Routine screening is especially important for people who have certain risk factors including, being female, being over the age of 50, being obese, and having genetic changes to BRCA1 or BRCA2 genes.^3,5 Individuals aged 75 or older should consider refraining from routine breast cancer screenings since the screenings themselves can be harmful to an older individual’s health.⁷

Breast Cancer: A Clinical Dietitian Nutritionist’s Point of View

Cara Anselmo, MS, RDN, CDN, is a clinical dietitian nutritionist and breast cancer specialist at Memorial Sloan Kettering Cancer Center (MSKKCC). I was fortunate enough to ask her a few questions about her input on breast cancer and her role as an RDN at MSKKCC.

Cara treats her patients on an individual basis to ensure that they are well-nourished and have a good nutritional status after receiving surgery or treatments. Such treatments include chemotherapy, radiation therapy, endocrine therapy, and biologic therapy. These treatments kill off cancer cells, but they also may cause a variety of side effects which vary, depending on the type of treatment and cancer. Cara helps breast cancer patients manage weight gain, which is a common treatment side effect. This is unique to breast cancer treatment because most cancer patients tend to lose weight. Cara helps patients lose and maintain an appropriate weight after treatments.

Some research has suggested the use of ketogenic diets for breast cancer patients receiving chemotherapy, and these diets are gaining popularity among those in the general public who wish to lose weight.^8,9 Cara feels there is not enough research to recommend ketogenic diets to her patients. She also referred to pre-clinical studies that suggest that high fat diets may increase the risk of breast cancer. Upon further research, I found a study which speculated that increased consumption of saturated fats can increase the risk of breast cancer.¹⁰ Therefore, ketogenic diets which mainly rely on proteins and fats, may be harmful for those who have breast cancer or who are at risk for the disease.¹¹

Cara stays informed of emerging research on weight management and breast cancer in post-menopausal women. She recommended the work of Jennifer Ligibel, M.D., a Harvard researcher specializing in this area. According to Cara, appropriate weight management is key to reducing risk, and that body compositions consisting of high proportions of fat can also increase risk. She provided some tips that can lower one’s risk for breast cancer:
· Eat whole-food diets that include more plant-based foods, limit added sugars, and limit processed/red meats
· Maintain a healthy body weight and body composition
· Stay physically active
· Limit alcohol
Diets To Reduce The Risk of Breast Cancer

Below are some eating plans that include more plant-based food components, which research suggests may help reduce the risk of breast cancer:

DASH Diet^12,13

The DASH acronym stands for Dietary Approaches to Stop Hypertension. This diet was designed to lower blood pressure without the use of medication. The Nurses’ Health Study followed 86,621 women for over 25 years and found an association between the DASH diet and a lower risk of developing breast cancer. Below are the DASH diet recommendations:
· Grains, 6 to 8 servings, daily
· Vegetables, 4 to 5 servings, daily
· Fruits, 4 to 5 servings, daily
· Dairy, 2 to 3 servings, daily
· Lean meat, poultry, and fish, 6 one-ounce servings or fewer, daily
· Nuts, seeds, and legumes, 4 to 5 servings, weekly
· Fats and oils, 2 to 3 servings, daily
· Sweets, 5 servings or fewer, weekly
· Limit intake of alcohol and caffeine
Mediterranean Diet^14,15,16

Several studies have found an association between adherence to the Mediterranean diet and reduced risk of breast cancer in both pre- and post- menopausal women. The Mediterranean diet consists of:
· Vegetables, fruits, whole grains, and healthy fats, daily
· Fish, poultry, beans, and eggs, weekly
· Moderate intake of dairy and dairy products
· Limited intake of processed and red meat
The New American Plate¹⁷

The American Institute for Cancer Research has new recommendations for healthy meals, called “The New American Plate,” that focus on cancer prevention. These guidelines consist of:
· 3 ounce serving of meat (such as fish, poultry, or red meat)
· Two types of vegetables
· An appropriate serving of a whole grain (such as brown rice, barley, or quinoa)
References
1. Breast Cancer Awareness Month in October. who.int. https://www.who.int/cancer/events/breast_cancer_month/en/. Accessed October 1, 2020.
2. Nelms M, Sucher KP. Nutrition Therapy and Pathophysiology. 4th ed. Boston, MA: Cengage; 2020.
3. Breast Cancer. mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470. Published November 9, 2019. Accessed October 4, 2020.
4. Breast Cancer. mskcc.org. https://www.mskcc.org/cancer-care/types/breast#what-is-breast-cancer-. Accessed October 4, 2020.
5. Breast Cancer Awareness. cdc.org. https://www.cdc.gov/cancer/dcpc/resources/features/breastcancerawareness/index.htm. Accessed October 1, 2020.
6. What Is a Mammogram?. cdc.org. https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm. Accessed October 6, 2020.
7. Older Americans receive cancer screenings past recommended age. news.psu.edu. https://news.psu.edu/story/627134/2020/07/29/research/older-americans-receive-cancer-screenings-past-recommended-age#:~:text=%E2%80%94%20Older%20Americans%20may%20be%20receiving,colorectal%2C%20cervical%20and%20breast%20cancers. Published July 29, 2020. Accessed October 1, 2020.
8. Khodabakhshi A, Akbari ME, Mirzaei HR, Mehrad-Majd H, Kalamian M, Davoodi SH. Feasibility, Safety, and Beneficial Effects of MCT-Based Ketogenic Diet for Breast Cancer Treatment: A Randomized Controlled Trial Study. Nutr Cancer. 2020;72(4):627-634. doi:10.1080/01635581.2019.1650942
9. Khodabakhshi A, Seyfried TN, Kalamian M, Beheshti, Davoodi SH. Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial. Nutri J. 2020;19(87):2020. https://doi.org/10.1186/s12937-020-00596-y
10. Zhu Y, Aupperlee MD, Haslam SZ. Schwartz RC. Pubertally Initiated High-Fat Diet Promotes Mammary Tumorigenesis in Obesity-Prone FVB Mice Similarly to Obesity-Resistant BALB/c Mice. Transl Oncol. 2017;10(6):928-935.
doi: 10.1016/j.tranon.2017.09.004
11. Ketogenic diet: Is the ultimate low-carb diet good for you?. health.harvard.edu. https://www.health.harvard.edu/blog/ketogenic-diet-is-the-ultimate-low-carb-diet-good-for-you-2017072712089. Published July 27, 2017. Accessed October 6, 2020.
12. Fung TT, Hu FB, Hankinson SE, Willett WC, Holmes MD. Low-carbohydrate diets, dietary approaches to stop hypertension-style diets, and the risk of postmenopausal breast cancer. Am J Epidemiol. 2011;174(6):652-660. doi:10.1093/aje/kwr148
13. DASH diet: Healthy eating to lower your blood pressure. mayoclinic.org. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456. Accessed October 8, 2020.
14. Mourouti N., Kontogianni M.D., Papavagelis C., Plytzanopoulou P., Vassilakou T., Malamos N., Linos A., Panagiotakos D.B. Adherence to the Mediterranean diet is associated with lower likelihood of breast cancer: A case-control study. Nutr. Cancer. 2014;66:810–817. doi: 10.1080/01635581.2014.916319.
15. Turati F, Carioli G, Bravi F, et al. Mediterranean Diet and Breast Cancer Risk. Nutrients. 2018;10(3):326. 2018. doi:10.3390/nu10030326.
16. Mediterranean diet: A heart-healthy eating plan. mayoclinic.org. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801. Accessed October 8, 2020.
17. New American Plate Setting Your Table to Prevent Cancer. aicr.org. https://www.aicr.org/cancer-prevention/healthy-eating/new-american-plate/. Accessed October 1, 2020.

Fall Kickoff and Networking Event

Mon, 28 Sep 2020 01:41:25 GMT

WRDA Fall 2020 Kickoff and Networking Event

Kristen Nicolai, WRDA Student Volunteer

Hunter College Graduate Student, MS 2022

The Westchester Rockland Dietetic Association’s (WRDA) kickoff and networking event was held virtually on September 23, 2020. The event focused on food insecurity, highlighting the response of local community agencies during the current COVID-19 pandemic.

To start off the event, Amy Habeck, WRDA’s president, spoke about food insecurity in Westchester and Rockland, and the impact the current pandemic has had on access to food. The potential nutrition and health related risks that could impact our communities were also discussed.

The presenting community organizations and speakers for the event included:

Agency: NourishAll

Presenter: Julie Konvisser, Director of Community Engagement, City of New Rochelle

Agency: Proyecto Faro

Presenter: Charo Ureña, Director/Lead Organizer

Agency: Second Chance Foods

Presenter: Martha Elder, Executive Director

Agency: Centro de Amigos

Presenter: Doris Karpeh-Diaz, Director

Each speaker presented how they are providing inventive programming for their communities, along with food assistance during COVID-19. Julie Konvisser discussed how NourishAll works to purchase gift cards from local restaurants and distribute to community and city agencies, serving vulnerable residents of New Rochelle. In total, this program was able to help sustain local businesses, while serving 9,429 total recipients, and distributed $471,450 gift cards. Proyecto Faro spoke of the work to support the needs of the undocumented community in Rockland County, and the pandemic food program that was implemented to deliver healthy food packages to immigrant families on a weekly basis through the help of local organizations. Martha Elder discussed the ways Second Chance Foods works to reduce food waste and expanded their distribution of recovered food to families in the area by starting their own Summer Meals Program. Finally, Doris Karpeh-Diaz of Centro de Amigos, an adult social day center dedicated to the Latino and Hispanic community of Rockland and Haverstraw, discussed the ways senior citizens have been impacted during the pandemic due to the lack of community support, and the work of the organization to provide this population with the care they need.

After the presentations, members were able to move to break out rooms and discussed ways to support the efforts of these community outreach organizations and how to integrate this information into professional practice.

For more information on how to volunteer, donate, or learn more about these local community organizations, please visit their websites:

September is Hunger Action Month

Amy Habeck — Tue, 01 Sep 2020 09:00:00 GMT

Neighbors in Need: Food Insecurity in Westchester and Rockland

Angela Iovine, WRDA Student Liaison

PACE Graduate Student, MS 2021

September 1, 2020

Many Americans face food-access problems that limit their ability to keep themselves active and healthy.¹ This is broadly referred to as food insecurity. Prior to the COVID-19 pandemic, food insecurity was at its lowest since the Great Recession.² Data from 2018 estimated that 7.8% of the population of Westchester county (75,730 people) and 9% of the population of Rockland county (28,980 people) were food insecure. The majority of these households met SNAP eligibility requirements; however, up to a third did not qualify.³ Projections for 2020 increase these numbers to 12.5% and 13.7% for Westchester and Rockland respectively.⁴ According to the Feeding Westchester website, 1 in 5 Westchester residents will be food insecure this year, including about 60,000 are children.⁵

Food insecurity denotes an inability to dedicate the necessary resources to purchase food. People who are food insecure may have food to eat, but the food may not nutritionally adequate. Households may prioritize value over quality, desirability, or variety. This is known as having “low food security”, one of the two categories the USDA uses to quantify food insecurity. The other category is “very low food security”. These are people who, in addition to the above sacrifices, don’t always have enough food to eat, and have gone hungry due to a lack of resources.⁶ Some groups of people, including children, the elderly, Latinos, and African Americans, have higher rates of food insecurity than the general population.⁷

The lack of food security in our community is concerning. This is one of several social determinants of health, as is poverty.⁸ Poverty and food insecurity have a direct relationship, as do poverty and chronic disease. The poorest Americans tend to have the least resources to acquire nutritious food and the worst health outcomes.⁹ The coronavirus pandemic has potentially exacerbated these issues, disproportionally affecting people with chronic diseases, seniors, Latinos and African Americans. These vulnerable populations are at a higher risk for serious infection and for economic hardship related to layoffs and business closures. ¹⁰ These are many of the same groups that are more likely to be food insecure. Since the pandemic began, the need for food assistance has grown, and researchers anticipate that demand will continue to grow.¹¹

The many challenges that face those who are food insecure are complex and not easily solved. As nutrition professionals we can advocate for change by supporting community-based programming, policy change, and research. The vision of the Academy of Nutrition and Dietetics is: “A world where all people thrive through the transformative power of food and nutrition.”¹² This is a message we can all get behind. There are many local advocacy organizations, food banks, and charities in our area addressing this cause. If there’s one you find particularly valuable, please share a couple sentences about it on our Facebook page to spread awareness.

References

1. U.S. Department of Agriculture. Food Security in the U.S. U.S. Department of Agriculture Economic Research Service, Web site. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/. Updated September 4, 2019. Accessed June 19, 2020.

2. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2018. U.S. Department of Agriculture Economic Research Service. https://www.ers.usda.gov/webdocs/publications/94849/err-270.pdf?v=2493.9. Published September 2019. Accessed June 19, 2020.

3. Feeding America. Food Insecurity in New York. Feeding America Web site. http://map.feedingamerica.org/county/2018/overall/new-york. Accessed June 19, 2020.

4. Feeding America. The Impact of Coronavirus on Food Insecurity. Feeding America Web site. https://www.feedingamericaaction.org/the-impact-of-coronavirus-on-food-insecurity/. Published June 3, 2020. Accessed June 19, 2020.

5. Feeding Westchester. Hunger in Westchester. https://feedingwestchester.org/hunger-in-westchester/. Accessed June 19, 2020.

6. U.S. Department of Agriculture. Definitions of Food Security. United States Department of Agriculture, Economic Research Service, Web site. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/. Updated September 04, 2019. Accessed June 19, 2020.

7. Feeding America. What is Food Insecurity? Feeding America Web site. https://hungerandhealth.feedingamerica.org/understand-food-insecurity/#_ftn3. Accessed June 19, 2020.

8. American Academy of Family Physicians. Advancing Health Equity by Addressing the Social Determinants of Health in Family Medicine (Position Paper). AAFP.org Web site. https://www.aafp.org/about/policies/all/socialdeterminantofhealth-positionpaper.html. Published April 2019. Accessed June 19, 2020.

9. Shaw K, Theis K, Self-Brown S, Roblin D, Barker L. Chronic Disease Disparities by County Economic Status and Metropolitan Classification, Behavioral Risk Factor Surveillance System, 2013. Prev Chronic Dis. September 1, 2016;13. doi:http://dx.doi.org/10.5888/pcd13.160088. Accessed June 19, 2020.

10. Hake M, Dewey A, Engelhard E, et al. The Impact of Coronavirus on Local Food Insecurity. America F. https://www.feedingamerica.org/sites/default/files/2020-05/Brief_Local%20Impact_5.19.2020.pdf. Published May 19, 2020. Accessed June 19, 2020.

11. Feeding America. The Impact of the Coronavirus on Food Insecurity. Feeding America. https://www.feedingamerica.org/sites/default/files/2020-04/Brief_Impact%20of%20Covid%20on%20Food%20Insecurity%204.22%20%28002%29.pdf. Published March 30, 2020. Updated April 22, 2020. Accessed June 19, 2020.

12. Academy of Nutrition and Dietetics. Academy Mission, Vision and Principles. eatrightPRO Web site. https://www.eatrightpro.org/about-us/academy-vision-and-mission/mission-and-vision-statements. Accessed June 19, 2020.

Student Blog: August is National Breastfeeding Month

Amy Habeck — Mon, 17 Aug 2020 09:00:00 GMT

August is National Breastfeeding Month

WRDA Celebrates Lactation Professionals

By Kristen Nicolai, WRDA Student Volunteer

Hunter College Graduate Student, MS 2022

August 14, 2020

August is National Breastfeeding Awareness Month and is celebrated to promote the benefits and importance of breastfeeding. The Academy of Nutrition and Dietetics’ position on breastfeeding is that exclusive breastfeeding offers optimal nutrition and health protection for the first six months of life, and that breastfeeding with complementary foods from six months until at least 12 months of age is the ideal feeding pattern for infants.

Breastfeeding offers the following benefits for mothers and babies:
- Protects babies against a variety of diseases and conditions such as respiratory tract infections, onset of diabetes, childhood obesity, and other infections
- Provides all necessary nutrients, vitamins, and minerals, and antibodies from the mother that can help babies fight disease and infection
- Promotes earlier return to pre-pregnancy weight for mothers
- Lowers mothers’ risk of breast and ovarian cancers and post-natal depression
- Helps uterus return to its pre-pregnancy size and decreased postpartum bleeding
- Creates a special bond between mother and baby
Andrea Ventura, MS, RD, CDN, IBCLC, is a clinical nutritionist at New York-Presbyterian Hospital. She became certified as a lactation consultant after becoming a mother and breastfeeding her own children. Andrea found it difficult to find reliable nutrition information to help her successfully continue her lactation journey after one of her children had a dairy protein allergy. After this she knew she wanted to use her nutrition knowledge to work with breastfeeding moms.

The lactation consultant profession is accessible to anyone interested in the field. The credentials require a 90-hour lactation specific course, a clinical internship, and 14 health science classes. Medical professionals are also able to use past experience or credits to apply to clinical internship hours and coursework. Some IBCLC students must also compete a 300-500-hour internship working under an IBCLC.

Elaine Carlevaro, RDN, CLC, is a Certified Lactation Counselor with the Department of Prenatal Services at the Montefiore Nyack Prenatal Center. To become a Lactation Counselor Elaine participated in a one-week program through the Academy of Lactation Policy and Practice to receive a CLC certification. While IBCLCs work one-on-one with moms, as a CLC Elaine works more broadly to make sure that breastfeeding is being supported. What she particularly loves about her job is the many hats she can wear as a nutritionist, and the work she does with many organizations and committees in her community such as Child Care Resources in Rockland and the Department of Health to bring training to childcare providers. As a CLC she works breastfeeding education into the overall health resources she provides moms, specifically higher risk moms, including education on the benefits of breastfeeding.

            Like many professionals in the field, during the current COVID-19 pandemic lactation consultants are working virtually to assist nursing mothers. While virtual appointments can allow mothers to work with a lactation consultant from the comfort of their own home, it can also be difficult for consultants to use all the senses used when helping mothers in-person. This can make it harder to fully assess mothers’ breasts or see how a baby is latching or listening to sucking and swallowing. Elaine has also encountered that mothers with the least amount of resources are a population harder to support during the pandemic, as they have less access to virtual visits. Both Andrea and Elaine agree that peer support groups are one of the most helpful tools for new mothers. These programs are able to give women the opportunity to connect with other mothers experiencing the same challenges, giving them the support needed after many prenatal services end postpartum.

            When it comes to the roles that hospitals, pediatricians, and OB/GYNs can play in successful breastfeeding, Andrea and Elaine both emphasize the importance of promoting the benefits of breastfeeding and recognizing when to refer a mother to an IBCLC. Through her work as a lactation counselor in Rockland County, Elaine works to improve support for breastfeeding through the Breastfeeding Coalition and has worked to have hospitals become a part of the Breastfeeding Friendly initiative. Elaine also works with early childhood educators, WIC, and many other community organizations to help mothers breastfeed well and support initiatives to lower infant and maternal morbidity and mortality.

            Andrea recommends that every RDN who works with mothers and babies can help normalize breastfeeding and educating themselves on a mother’s nutrition needs while lactating. Elaine also encourages RDNs to focus on the benefits of breastmilk when working with clients and knowing how best to inform moms. It is also important to know what is recommended by the Academy of Pediatrics, ACOG, NIH, WIC so consistent communication is shared.

            When it comes to choosing a career as a lactation consultant, Andrea advises that many hospitals will not hire an IBLCL that is also not a Registered Nurse, so working as a Registered Dietician in that capacity is not always possible. Andrea works with some breastfeeding mothers through her work at an inpatient psychiatric hospital but does home visits for mothers on the side. She is also bilingual, speaking both English and Spanish, which is an asset that helps her to communicate with many different people and helps the mothers she works with feel validated and understood in their native language.

As a lactation counselor, Elaine expressed she is better able to meet the needs of her clients, and it has opened up avenues to be able to promote breastfeeding in ways she didn’t realize were possible. She also notes that RDNs that have a bilingual education can have more opportunity for direct communication with clients, rather than having to converse through a translator, as this can be challenging as almost 80% of her patients didn’t speak English. For RDNs or nutrition students interested in working in lactation consulting, Elaine recommends starting to research the different avenues within the lactation profession. While breastfeeding mothers are a specific population, it is an important time to invest in women, as breastfeeding can play a role in their overall health after pregnancy, as well as the health of their future generations. She concluded that an RDN with a lactation background is a perfect position to not only impact that individual mother, but many lives from generation to generation.

Sources:

·      https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/Benefits-of-Breastfeeding.aspx
·      https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/practice-papers/practicepaperpromotingandsupportingbreastfeeding.pdf?la=en&hash=39B07DA0E25D1703828C1AAF3ADEC410A8E8141F
·      https://www.unicef.org/nutrition/index_24763.html

WRDA CLINICAL UPDATE 2017 - "An Ounce of Prevention ... Food for Healthy Living"

Tue, 12 Dec 2017 23:06:04 GMT

WRDA Clinical Update 2017- “An Ounce of Prevention…Food for Healthy Living”

By Co-President Elects Kathleen Ryan MS, RD, CSO, CDN and Melissa Keeney MS, RDN, CDN, CDE

The Westchester Rockland Dietetic Association’s (WRDA) annual clinical update was on December 7, 2017. Around 100 nutrition professionals attended this year, including Registered Dietitian Nutritionists (RDN), Dietetic Technicians, Registered (DTR), and nutrition students. This year, the clinical update focused on disease prevention “An Ounce of Prevention…Food for Healthy Living”.

To start the event off, Niharika Jaiswal, WRDA’s President gave the opening remarks. Next, Diana Monaco, NYSAND’s Immediate Past President spoke about getting involved in the Academy of Nutrition and Dietetics and the New York chapter, NYSAND. It was then time to begin the presentations. Kathleen Ryan and Melissa Keeney, WRDA’s Co-Presidents Elect provided the biographies and introductions for each speaker. A mid-morning highlight to this year’s update was a Public Policy Update by Ann Darcy.

The presentation topics and the speakers for the Clinical Update were:

Presentation: Sustainability and Culinary Nutrition Trends, Q&A
Presenter: Andrea Canada, MPH, RD from SPE Certified

Presentation: Microbiome Nutrition for the RDN
Presenter: Mary Beth Augustine, RDN, CDN, FAND of Mary Beth Augustine (MBA)

Presentation: Improving Patient Engagement Using Culinary Nutrition Tools and Programming, Q & A
Presenter: Jeanne Petrucci, MS, RDN and Julie Harrington RDN, CPC from Living Plate

Presentation: Treating Heart Disease with a Plant-Based Diet, Q & A
Presenter: Lauren Graf MS, RD from Montefiore Einstein Cardiac Wellness Program

Each speaker this year presented innovative ways that nutrition professionals can assist their clients to live healthfully. Andrea Canada discussed current food trends and how an RDN can add value and a health sustainability focus to a foodservice operation. Mary Beth Augustine discussed the microbiome, including the evidence for medical nutrition therapy and a risk characterization framework for clinical decision making. She also discussed emerging research topics regarding nutrition, healthcare, and the microbiome. Jeanne Petrucci and Julie Harrington discussed ways to engage clients with culinary nutrition, and how to grow your business by offering culinary nutrition program. They then provided us with a food demo and samples while discussing how the audience can incorporate this concept into their own practice. Lauren Graf discussed the role of plant- based diets in managing cardiovascular disease, diabetes, and chronic kidney disease. She shared some remarkable patient stories.

A huge thank you to our raffle sponsors. The WRDA raised $340 at the meeting through the raffle. Diana Monaco won the Capri Beauty gift certificate, Abby Walker won the cookbooks and Field Goods coupon, Roberta Gershner won attendance to next year’s Clinical Update, Terry Schlanger won next year’s WRDA Membership, Niharika Jaiswal won the gift certificate to Rouge Tomate, Jennifer Sukhdeo won the 2^nd Century Initiative basket, and Ellen Pospishil won the PAC basket. Thank you to all those who participated in the raffle!

A big thank you to our generous product sponsors this year, including Peanut Butter & Co, Harvest Snaps, Purely Elizabeth, Biena Snacks, JCC of Rockland, Celebrate Vitamins, KIND, Manitoba Harvest, Shoprite, Once Again, and Kite Hill.

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WRDA provides "Nutritional Support" for Colon Cancer Challenge Foundation

Sun, 30 Apr 2017 13:30:00 GMT

Over 50% of colorectal cancers are preventable through a healthy lifestyle (including diet choices). Elisa Bremner, WRDA President, Janice Shaw, NYSAND AME Chairperson, and Melissa Keeney, WRDA Nominating Chair took time out of their Sunday morning to help cheer on the runners at CCCF's fun run/walk at Manhattanville College. WRDA provided nutritional guidance and a delicious colon-cancer-busting snack of hummus & veggie wraps (that pink thing in the background is a giant inflatable colon). We hope this will be the start of many more event where WRDA members can get out our message to the public.

WRDA Clinical Update: MINDful Perspectives on Nutrition & Aging

Tue, 06 Dec 2016 13:07:45 GMT

The WRDA Clinical Update occurred on December 1, 2016 at Palisades Center. Around 70 medical professionals including Registered Dietitians, Dietetic Interns, Diet Tech students attended the Clinical Update. This year the Clinical Update focused on "Mindful Perspectives on Nutrition & Aging".

There was a wide array of presentations focusing on the continuum of the aging process, management of Alzheimer's disease, usefulness of meditation therapy, nutrition therapy in the Aging process.

The opening speech was given by WRDA President Elisa Bremner, followed by the information on NYSAND Centennial AME by Janice Shaw. Niharika Jaiswal, President-elect, provided an overview of the Clinical Update.

The presentation topics and the speakers for the Clinical Update were:

Nutrition Across the Aging Continuum... Including End of Life: Bindhu Thomas MD, CMD
Columbia University College of Physicians and Surgeon, Department of Medicine/ Division of Geriatric Medicine and Aging.

Advances in the Management of Alzheimer’s Treatment and Prevention: Hollie Webb, MSN, FNP-C
New York-Presbyterian Hospital/Weill Cornell Medical Center, Alzheimer’s Prevention Clinic

Meditation for Healthy Mind: Supriya Reddy Certified Meditation Trainer, Heartfulness Institute

Maximizing Nutrition in Aging: Miriam Pappo MS, RD, CDN Director of Clinical Nutrition Montefiore Medical Center
Jennifer Flood-Sukhdeo MS, RD, CDN Director of Nutrition Hebrew Home at Riverdale

Dr. Thomas provided an excellent overview and in depth of understanding of the human physiology on the complex topics of aging, end of life, palliative and hospice care, which are clinically relevant to members of the healthcare team providing nutritional care to their patients. Speaker, Hollie Webb, provided cutting edge information on the different treatments utilized for the management of Alzheimer’s disease. In addition, participants were given an opportunity to partake in a meditation session under the guidance of Supriya Reddy. The final segment of the Clinical Update comprised of a presentation by Miriam Pappo, on understanding the nutritional aspect of the aging process followed by a panel session along with Jennifer Flood-Sukhdeo. There was a Q&A session where the participants were able to ask nutrition questions to the panelists.

During the Clinical Update, a session by Ms. Ann Darcy and Ms. Catherine Foley provided an update on public policy on nutrition related topics. The Clinical Update finished with drawing of two raffle prize winners Sylvia Hawkins, and Antonella Caggiano receiving the WRDA membership for the year 2017.

Niharika Jaiswal MS, RD, CDN
WRDA President Elect

WRDA Kick-Off Dinner

Wed, 23 Sep 2015 23:11:01 GMT

The WRDA kickoff dinner occurred at The Rye Bar and Grill on Wednesday September 16. Over 30 members attended with at least half of attendees being new members. Several people walked in so there was a great turn out! Attendees schmoozed and networked over appetizers, wine and beverages for about a half hour before the presentation. The speaker was Dr. Elizabeth Wind who led an interactive presentation on mindful eating. Participants were engrossed in a discussion and were given tools to add to their counseling toolbox. A delicious three course dinner followed where participants were seated in a lovely room with tables of about 6 people. Janice Shaw also gave a short plug for the AME which will take place at the Doubletree in Tarrytown in May.

We look forward to seeing you at our October event on "Fearless eating for children" with Jill Castle at Phelps!

Meredith Stanford, Co-President, WRDA

Five Farmers Meet You at the Table: A Conversation on Sustainable Food Systems

Wed, 02 Apr 2014 14:52:49 GMT

Our March 29th meeting was a tremendous success! Thank you to all who attended the meeting. The WRDA prouded over $700 as a donation to the Food Bank of Westchester!

Thank you to our speakers. Please visit their websites and consider becoming a member of their Community Supported Agriculture (CSA)- Farm Share Program!

Stone Barns Center in Pocantico Hills: http://www.stonebarnscenter.org/visit/explore/stone-barns-csa.html

John McDowell, Rockland Farm Alliance in New City: http://cropseycommunityfarm.csasignup.com/members/types

Steffen Schneider, Hawthorne Valley Farm in Ghent (Columbia Co.): http://hawthornevalleyfarm.org/where-to-buy/community-supported-agriculture-csa/

Mike Fedison, Hilltop Hanover Farm in Yorktown Heights : http://www.hilltophanoverfarm.org/wp-content/uploads/2013/12/CSA2014App1.pdf

Doug DeCandia, Food Bank of Westchester

Joan Dye Gussow, Teacher, Author, Organic Producer

December 2013 Annual Clinical Update meeting

Sun, 02 Mar 2014 17:39:37 GMT

The WRDA held their Annual Clinical Update meeting, “Gut Health from Beginning to End,” on Thursday, December 5th, 2013 at the Palisades Center in West Nyack, NY. With nearly 100 RD’s in attendance, the meeting was a huge success.

Assemblywoman Ellen Jaffe, A NYS Sponsor for Licensure A7316, kicked off the meeting with opening remarks.