WRDA Student Blog

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

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).

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

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

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.

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.

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

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

  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.

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:

NourishAll

Proyecto Faro

Second Chance Foods

Centro de Amigos