PEN® Team’s Surprising Findings of 2015
Each day, our Global PEN® team monitors the literature for evolving research and monitors for nutrition trends. We have reflected and have shared our surprising findings of 2015.
PEN® Surprising Finding: Soylent
Like many Canadians, earlier this year I was fortunate to spend Thanksgiving with family. This year was unique in that there were 3 generations represented around our table including 10 twenty-“somethings”. While we enjoyed turkey and the fixings a young cousin mentioned how he had turned to Soylent while at university to keep him inexpensively fuelled while all but eliminating the need to buy groceries or cook. All heads turned in my direction to see what my reaction would be.
Soylent is one of several liquid meal replacements available primarily online. I noted a new organic liquid meal replacement Ambronite that is also gaining traction and competes for the same youth market, though their product is more expensive. These products market themselves as high performance nutrition for when you are too busy to shop, cook or eat.
Both Soylent and Ambronite display a Proposition 65 warning, meaning that it contains one of approximately 800 chemicals known to cause cancer, birth defects or other reproductive harm according to the state of California. As a result, neither product is recommended for pregnant women.
There appears to be little or no long-term or controlled experiments evaluating the impact of Soylent. People are either for or against it based on beliefs around food/nutrition and anecdotes reported by those who use it.
We did find that Canadian Dietitian Jennifer Sygo reviewed the product in the summer of 2014
http://news.nationalpost.com/health/jennifer-sygo-on-soylent-whole-meal-supplements-and-the-folly-of-thinking-real-food-is-replaceable
While replacing the odd fast food meal with a liquid meal replacement likely isn’t cause for concern I don't think we know enough about long-term impacts (nutritionally, socially, psychologically, metabolically) to recommend its adoption as the normal way of eating. Jen summarized it well when she stated:
"What it’s missing, as is the case with so many other formulated foods, is the thing that makes real food, food: the combination of these vitamins, minerals and macronutrients, as well as the less-well-understood things like phytochemicals, or active plant compounds, that occur by the thousands in everything from apples to zucchini, not to mention the satiating effect that is triggered by actually chewing food."
Dr. David Jenkins, Canada Research Chair in the department of medicine and nutritional sciences at the University of Toronto and St. Michael’s Hospital, in an article in the Toronto Star (June 2015) made similar comments and pointed out the low fibre content as a downside of the meal replacement:
http://www.thestar.com/news/world/2015/06/15/soylent-the-popular-meal-replacement-comes-to-canada.html
Written by Dr. Jayne Thirsk RD, PhD, FDC
Director, PEN®
Dietitians of Canada
PEN® Surprising Finding: Nutrient supplementation during pregnancy
In updating the pregnancy knowledge pathway in PEN®, I was surprised to learn of the varied recommendations related to vitamin / mineral supplementation during pregnancy (See What are the indications for the use of vitamin/mineral supplements during pregnancy? ). There is general agreement that all pregnant women consume a healthy diet and take a prenatal vitamin supplement that contains folic acid to decrease the risk of neural tube defects. However, recommendations for other supplements vary considerably:
These recommendations are justified in the various guidelines based on the potential for insufficient intake to meet additional needs during pregnancy. Although some of these differences can be accounted for by differences in dietary intakes / exposure amongst individuals in these countries, it is apparent that many of these recommendations are provided based on different interpretations of the balance between benefits and risks of supplementation.
Written by:
Dawna Royall, MSc, RD
PEN
® Evidence Analyst
PEN® Surprising Finding: Preventing antipsychotic induced weight gain and metabolic abnormalities in first-episode psychosis
My surprise finding for 2015 was a DAA 2015 conference presentation entitled ‘Keeping the Body in Mind for youth with Psychosis. A lifestyle intervention to prevent weight gain and metabolic abnormalities at the commencement of antipsychotics’ which was given by Scott Teasdale APD as part of the Early Career Research Showcase. Scott works for the Bondi Junction Early Psychosis Program, NSW Australia. He and his team conducted a 12-week prospective evaluation of an ‘individualised lifestyle intervention’: Keeping Body in Mind (KBIM) (1). The aim of the study was to investigate the association between lifestyle factors and the prevention of antipsychotic medication-induced weight gain.
The program (delivered by a nurse, dietitian and exercise physiologist) was embedded in a community-based treatment program to youth having a first episode of psychosis. The lifestyle intervention comprised health coaching, individual nutrition care plans, practical advice for shopping and cooking skills and exercise in an onsite gym. Outcome measures included weight, waist circumference, biochemical markers, nutritional intake and physical activity of participants (n=18) compared with those receiving ‘usual care’ at another early psychosis intervention program (n=12). The age range was 18-25 years.
Results of the KBIM intervention were less mean weight gain at 12 weeks in participants compared to usual care (1.0kg (95% CI -0.4 to 2.3) vs 7.8kg (95% CI 4.8 to 10.7), p<0.001) and no increase to waist circumference (-0.2cm (95% CI -2.1 to 1.6) vs 7.1 cm (95% CI 4,8 to 9.4), p= <0.001) (1-2). Results of the first cohort of KBIM participants have been published in Early Intervention in Psychiatry (3). KBIM participants showed a reduced energy intake (p=<0.001); reduced ‘discretionary food’ intake (p=<0.001); reduced sodium intake (p=<0.001); improved diet quality (p=0.04); and improved aerobic capacity (p=0.004), when compared to baseline (1).
Previous research has shown an association between starting antipsychotic medicines and rapid weight gain. In 2008, a systematic review and meta-analysis estimated the mean weight gain to be 12 kg after the first 2 years of antipsychotic medication, followed by an additional 4 kg after 36 months, then a further 3 kg after 48 months leading to a total of nearly 20kg weight gain (4).
Teasdale et al (1) showed that at a one-year follow-up of their lifestyle intervention, the mean weight gain was only 2.2kg, with 73% of participants not experiencing clinically significant weight gain. Lifestyle intervention meets one of the critical goals stated in the international declaration on physical health in youth with psychosis (www.iphys.org.au). As Teasdale pointed out in his conference presentation this research is important because if early rapid weight gain can be prevented during commencement of antipsychotic therapy then patients may not experience the metabolic complications that lead to metabolic syndrome, diabetes and cardiovascular disease.
As an ex-pharmacist and current APD, I was very interested that a proactive approach to prevention of drug-induced weight gain was possible as there is a long-held belief among many health professionals that such weight gain is an inevitable consequence of antipsychotic therapy. The participants in this study were young and such intervention has the potential to have major health benefits for their futures. When I asked Scott if there were programs to address weight loss in patients with established drug-induced obesity, he responded that was the next step. According to Teasdale, their research program is rolling out a structured lifestyle intervention (similar to KBIM in youth) to those with established illness.
I think this work is very exciting and a credit to Teasdale so early in his dietetic career and to the value of intelligent interventions by a motivated team of health professionals.
References:
- Teasdale S, Watkins A, Rosenbaum S, Kalucy M, Samaras K, Curtis J, Ward PB. Keeping the Body in Mind for youth with psychosis. A lifestyle intervention to prevent weight gain and metabolic abnormalities at the commencement of antipsychotics. Nutrition & Dietetics 2015; 72 (Suppl. 1): 32-33.
- Teasdale S, Rosenbaum S, Watkins A, Curtis J, Kalucy M, Samaras K, Ward PB. Preventing antipsychotic-induced weight gain in first-episode psychosis: Transitioning dietitians into routine care. Nutrition & Dietetics 2015; doi: 10.1111/1747-0080.12211.
- Curtis J, Watkins A, Rosenbaum S, Teasdale S, Kalucy M, Samaras K, Ward PB. Evaluating an individualized lifestyle and lifeskills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis. Early Intervention in Psychiatry 2015; doi: 10.1111/eip.12230.
- Álvarez-Jiménez M, González-Blanch C, Crespo-Facorro B, Hetrick S, Rodríguez-Sánchez JM, Pérez-Iglesias R, Vázquez-Barquero JL. Antipsychotic-induced weight gain in chronic and first-episode psychotic disorders. CNS Drugs 2008; 22: 547-62: www.ncbi.nlm.nih.gov/pubmed/18547125
Written by:
Gail Scarlett MPH, APD,
PEN
® Evidence Analyst, Dietitians Association of Australia
And
Scott Teasdale APD, PhD Candidate
Mental Health Dietitian, Bondi Junction Early Psychosis Programme, SESLHD; School of Psychiatry, UNSW.
scott.teasdale@sesiahs.health.nsw.gov.au
PEN® Surprising Finding: Interpreting evidence - WHO and bacon
My surprise of 2015 was the public and media response to the message from the World Heath Organization to eat less processed and red meats. I had thought (hoped) that as dietitians, we had already gotten this message out. Mind you, the over zealous and inaccurate reporting of it helped to stir up fears of imminent death, or worse. I was surprised, and a bit troubled, that the “eat less” message seemed to be new and shocking to so many people.
In case you missed it, the WHO International Agency for Research on Cancer (AICR) report reclassified carcinogenic groups. However, the recommendation remains the same - avoid processed meats and eating no more than 18 ounces (~500 gm) of cooked red meat weekly to lower colorectal cancer risk. Many organizations responded to this report:
Written by Kerri Staden BSc, RD
PEN
® Resource Manager
PEN® Surprising Finding: Evidence around red and processed meat on cancer risk
The International Agency for Research on Cancer (IARC) recently published an impactful report that summarized the previous evidence-base and assessed whether red and processed meat causes cancer. The report concluded that high intakes of processed meat cause cancer and high intakes of red meat probably cause cancer; in total, around 3% of all cancers. While this sounds like a high percentage, it is surprisingly low compared to smoking which causes 19% of cancers. Therefore, it is important to put this information into context.
In the UK, the average intake of red meat and processed meat is approximately 70g and under 50g respectively. The advice to reduce consumption applies if an individual is eating more than this daily amount. Likewise, the complete removal of red and processed meat is not necessary. Red meat is a good source of iron, zinc and vitamin B12, and in particular population groups such as teenage girls and women, cutting out red meat altogether would not be advised. As dietitians, we would recommend incorporating all food groups in moderation as part of a healthy balanced diet, including meat.
Written by Sammie Gill, Policy Officer (Evidence-based Practice).
BSc (Hons), PGDip, R.SEN, RD.
British Dietetic Association.
PEN® Surprising Finding: Tomato juice – very popular on a flight compared to the ground
Have you ever had a meal on an airplane and felt like it just didn’t taste right? Have you ever complained about airline food? Alternatively, have you ever enjoyed a food or beverage more on a plane than on the ground? Well it is probably not your imagination and not just the mass-produced nature of the food. In fact, the scientific reasons behind this may surprise you. The new area of research that I found quite interesting this year was that of the effect of noise on taste perception.
In this research study, investigators simulated the noise of an airline cabin to study the potential relationship between noise and taste (1). An airline cabin during a flight is very noisy, with sound levels frequently 85 dB or higher. Investigators found that the noise resulted in sweet tastes being dampened and umami (savory) taste being enhanced; which investigators theorized may be due to mechanostimulation (by the noise) of one of the nerves that runs from the taste buds, through the middle ear to the brain.
Previous research has also reported that the lower air pressure and the dryness and coldness of airline cabin air impacts taste perception of food and beverages. Interestingly, at least one airline has reported that tomato juice consumption was as high as beer on flights, unlike on the ground.
The research on the effect of noise on taste perception could have far reaching implications such as that on food product development and food service for areas where people are exposed to regular or constant noise such as in the workplace.
- Yan KS, Dando R. A crossmodal role for audition in taste perception. J Exp Psychol Hum Percept Perform. 2015 Jun;41(3):590-6. Abstract available from: http://www.ncbi.nlm.nih.gov/pubmed/25775175
Written by:
Heather Petrie, MSc, RD
PEN
® Evidence Analyst
PEN® Surprising Finding: Spicy Food
What I found interesting in 2015 is a study published in BMJ on Consumption of spicy foods and total and cause specific mortality: population based cohort study that looked at regular/habitual intake of spicy foods and found that for those consuming spicy foods almost every day vs only once a week there was a 14% lower risk of death over a medium follow-up period of 7.2 years. This topic was shared with dietetic practitioners in PEN® through a Trending Topic in September of this year.
While discussing this topic over dinner after the BMJ study came out, my 15 year old son's reaction was, "well duh, you can't eat as much food when it is super hot and spicy." So, while the study and our discussion was focused on mortality, my son was able to highlight early satiety as a mechanism that could explain part of this relationship, at least in populations not accustomed to eating spicy food. I hope there is more to follow from this preliminary research looking at spicy foods and their effects on other dietary habits and lifestyle behaviors and that we might see more guidelines promoting spicy (and flavourful) food intake for satiety, portion control for weight management and disease prevention. It is also consistent with the practice of positive messaging – encouraging people to focus on what they can eat and what they can add, rather than foods to eliminate from their diets.
Written by:
Jane Bellman MEd, RD
PEN® Resource Manager
PEN® Surprising Finding: How we view nutrients and food
One of the best parts of my role on the PEN® Team is that I read the majority of what is on the PEN® website. Thus, there are many surprising moments in my day. However, the individual moments stand out less than the trends I observe in the evidence as a whole.
The trend that fascinates me the most at present relates to nutrients and food, and the lens in which they are viewed. There is always a plethora of studies regarding individual nutrients and how these nutrients alone or in combination affect health. However, there seems to be increasing research and commentary on how food should be viewed and classified and more attention to dietary patterns as opposed to individual foods or food groups. A recent article articulates these concepts well. The future of food and nutrition research will be exciting that is for sure!
Written by:
Heather Alaverdy MA, RD
PEN® Editor
PEN® Surprising finding: Edible insects – they’re back!!!
In the fall of 2013 students at McGill University in Montreal, Quebec (Canada) received a
$1 million dollar prize for proposing to use insects to help with the world hunger issue.
I worked with a student to write an article analysis: “Edible Insects as a Possible Solution to Food Insecurity”. We never published it – too radical, too controversial, too yucky, not enough evidence, not enough known about the nutritional composition of insects, nutritional composition is too diverse….and the list goes on.
I keep my eyes open for articles related to insects as a food source as I find it fascinating. There continue to be articles written about the benefits and data collected on the increase in human consumption of insects. There is a U.S. company who has developed a cereal bar made with cricket flour. They received a reasonable review by Consumer Reports but their label has a warning to people with a shellfish allergy as crickets are genetically similar to shellfish.
At the time of writing the 2013 article the bottom line was:
“In order for edible insects to become competitive with current livestock as a food source they need to be able to be mass produced and bred efficiently as well as having to overcome the barrier of insects in nature being seasonally harvested. More research and validation is needed on the nutritional value of insects in order for them to be promoted as healthy food.”
To my surprise, I recently noticed that the FAO/INFOODS has collected and added 456 food entries on the nutrient composition of insects at varying stages of the lifecycle into the Food Composition Database for Biodiversity.
Maybe it is time to dust off the 2013 article!
Written by:
Beth Armour, M.Ed., P.Dt.
PEN® Content Manager
PEN® Surprising Finding: How global the PEN® database really is
Answering customer service tickets has helped me realize the global scope of the PEN® database. I’ve always known that PEN® has been expanding to more and more countries around the world but it hasn’t really hit me until this past year, how global, Global PEN® has become. I have had the chance to talk to people or answer tickets from a range of locations, from B.C to Sweden, to Nova Scotia to South Africa. It’s always fun to chat with others and a nice reminder that our work is appreciated around the world!
Click
here to see how PEN has impacted dietitians around the world.
Written by:
Lindsay Kole B.Comm
PEN® Database Coordinator, Dietitians of Canada.
A few final thoughts on 2015
While this was not a surprise, per se, it was fascinating to read the diverse perspectives from the international dietetic community as to what were the most significant changes in nutrition knowledge and dietetic practice. The surprises submitted showcased the breadth of dietetic practice around the world.
I look forward to this next year to see what might surprise us!
Written by:
Kristyn Hall MSc, RD
PEN
® eNews Editor
Contact us at eNews@pennutrition.com