Plant-Based Milks

I don’t necessarily need to take milk products out of my diet. But as a consumer who is curious about cooking, nutrition, and innovative uses for ingredients, seeing non-dairy, plant-based milk alternatives seemingly everywhere I turn makes me curious to know more.

 

For some individuals, belly and headaches or allergic reactions make a switch from all things dairy to a non-dairy alternative a requisite reality beyond mere curious inquiry or choice. Others may switch from dairy because they like a different taste or texture, or want an additional nutrient that a milk alternative offers. Whatever the reason, there is quite a variety of dairy milk alternatives to choose from, for purposes as varied as morning coffee, cereal, smoothies, or mashed potatoes.

 

Here’s an overview of what you need to know about non-dairy, milk-alternative beverages. Read more

The prevalence of type 2 diabetes has been dramatically increasing worldwide and is a major health concern. Many well-known lifestyle factors are associated with increased risk of type 2 diabetes; now, a recent study published in the January 2019 issue of The Journal of Nutrition suggests that skipping breakfast should be added to the list. Although previous studies have demonstrated an association between breakfast skipping and type 2 diabetes, this lifestyle choice was treated as a dichotomous variable.

A research team led by Dr. Aurélie Ballon from the German Diabetes Center hypothesized that not only is there an association between breakfast skipping and type 2 diabetes, but this relation presents in a consistent dose-response manner.

Data for this study were obtained by a systematic review and meta-analysis of 6 prospective cohort studies on breakfast skipping and risk of type 2 diabetes in adults. Breakfast skipping was analyzed as a continuous variable in order to determine whether the risk increased with increased frequency of breakfast skipping (i.e. a dose-response). The influence of body mass index on the association between breakfast skipping and risk of type 2 diabetes was also considered in the final analysis.

Nonlinear dose-response meta-analysis indicated that risk of type 2 diabetes increased with every additional day of breakfast skipping, reaching a plateau at 4‒5 days a week. No further increase in risk of type 2 diabetes was observed after 5 days of breakfast skipping per week. This association was partly mediated by obesity, but a positive association persisted after adjustment for obesity, suggesting that other factors might also influence this association. The researchers concluded, “future studies should also focus on breakfast quality.” In other words, would consuming an unhealthy breakfast be better than skipping breakfast altogether?

Reference Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Ballon A, Neuenschwander M, Schlesinger S. Journal of Nutrition. 2019; In Press. Breakfast Skipping and Type 2 Diabetes: Where Do We Stand? Mekary RA. Journal of Nutrition. 2019; In Press. https://doi.org/10.1093/jn/nxy284

 

It’s time for 2019 New Year’s resolutions, and many resolutions revolve around improving health. Choosing the resolution is easy…now how will you achieve it? A quick Google search should do it. But now dietary advice pops up from every corner of the Internet citing seemingly strong support for their way being the BEST way to achieve your goals. You will find endless dietary trends: everything from paleo to gluten free, low FODMAP to Weight Watchers with everything in between. So how do you know which one is right for you?

Let’s break down the scientific research behind five of these trendy diets:

 

1. The Paleo Diet

What is it?

The Paleo Diet loosely mimics nutritional patterns from the paleolithic era approximately 10,000 to 2.6 million years ago. It emphasizes consumption of fruits, vegetables, nuts, and animal proteins, with minimal inclusion of sugar, grains, legumes, dairy, and processed foods.

What does the research say?

Long-term paleo diet may be associated with:

Bottom Line: Positive outcomes are associated with the paleo diet, though researchers question whether these are because of the diet itself (no grains, dairy, sugar, etc.) or the benefits of increasing nutrient dense fruits and vegetables.

2. A Plant-Based Diet

What is it?

A plant-based diet promotes high intake of foods derived from plants, and limits or completely excludes animal products (meat, poultry, fish, dairy). It is most often associated with a vegan or vegetarian diet.

What does the research say?

A healthy plant-based diet appears to be associated with:

  • A lower risk of mortality.
  • A lower body mass index (BMI)in those who follow a vegetarian diet, when compared with the BMI of a nonvegetarian.
  • This same articlepointed out potential nutrient concerns for those following a strict plant-based diet: vitamin B12, zinc, and protein. Complete exclusion of all animal products puts one at higher risk for inadequate intake of these nutrients.
  • One articlefound that production of food for a nonvegetarian diet required 2.9 times more water, 2.5 times more energy, 13 times more fertilizer, and 1.4 times more pesticides than a solely plant-based diet.

Bottom Line: A plant-based diet supports environmental sustainability, and may lower risk of mortality and a high BMI. However, if you choose to be strictly plant-based, it’s important to be aware of nutrients that may be lacking and modify your diet accordingly.

3. The Ketogenic Diet

What is it?

The ketogenic diet focuses on very low-carbohydrate intake and very high-fat intake, with the goal of using fat as the body’s primary energy source instead of glucose. A medical ketogenic diet can be used to treat seizures primarily in children with epilepsy, and occasionally in adults with epilepsy as well.

What does the research say?

  • One study reported that in overweight and obese men, 4 weeks of a strict ketogenic diet resulted in reduced body weight but did not alter their energy expenditure or increase fat loss.
  • Another study compared a strict ketogenic diet with a nonketogenic low-carbohydrate diet and found that both diets were equally effective in reducing body weight and improving insulin resistance. However, they also found that the ketogenic diet resulted in elevated LDL and cardiac complications, in addition to adverse emotional and mental effects.

Bottom Line: The ketogenic diet may promote weight loss and improve insulin resistance but appeared to be no more effective than a less restrictive low-carbohydrate diet and may be associated with more adverse metabolic and mental side effects.

4. The Gluten Free Diet

What is it?

A gluten free diet is one that excludes all food items containing the protein gluten. This means exclusion of anything containing wheat, barley, rye, and any derivative of these grains. A gluten free diet is recommended for individuals with celiac disease.

What does the research say?

  • Non-celiac gluten sensitivityis recognized in some individuals, and they may benefit from a gluten free diet to avoid adverse symptomatic responses to gluten.
  • A study measured levels of plasma proteins involved in inflammation and observed correlation with gluten intake in young adults not affected by celiac disease. They found that increased gluten intake was associated with increased concentrations of plasma a2-macroglobulin, which is a marker of inflammation.

Bottom Line: Anyone with celiac disease is recommended to follow a gluten free diet. Some individuals may benefit from a gluten free diet due to non-celiac gluten sensitivity, but diagnosis for this condition is not yet readily available.

5. The Mediterranean Diet

What is it?

The Mediterranean diet focuses on whole foods like fruits, vegetables, nuts, whole grains, healthy fats and oils, poultry, seafood; allows moderate inclusion of alcohol (red wine) and dairy products; and limits inclusion of added sugar and red meat (Whalen 2016).

What does the research say?

The Mediterranean diet may be associated with:

Bottom Line: Research shows some benefits may be associated with the Mediterranean diet, related to inflammation, lower mortality risks, and reduced blood pressure.

The path to a healthier 2019 will look different for every person, and learning the research behind different diets will help you find YOUR best path. Unsure how to interpret all this research on your own? Consider talking with your healthcare provider or a Registered Dietitian! They can help you decide which lifestyle changes and diet trends will best fit you and your goals, and set you on the right path for the New Year.

The gut microbiota is the diverse community of microorganisms that reside within the gastrointestinal tract. The importance of the composition (what types of microorganisms), function (what they are doing), and the metabolites (what are they producing) has been highlighted in health and disease. In the case of chronic kidney disease (CKD), it is of great interest as the gut microbiota has been linked to the disease itself and the progression of kidney dysfunction.

The gut microbiota in chronic kidney disease

In CKD there are changes at the level of composition and function (e.g., enzymatic capacity) and metabolites produced by gut microbes. These changes have been assessed by examining mostly stool samples through experimental models (e.g., mouse or rat models of kidney disease by removing a large portion of the kidneys (5/6th) or by providing a toxic agent in the diet (i.e., adenine)) or in individuals with CKD not yet on dialysis and those undergoing dialysis treatment.

The changes in composition of the gut microbiota include having less bacterial species richness (amount of diversity within a sample) and an increased abundance of bacteria that are considered pathogenic or “bad”, while there is a reduction in the abundance of bacteria that are traditionally considered symbiotic or “good”. With these changes, the gut microbiota of CKD patients is considered dysbiotic or out of balance.

At the functional level, it has been reported that the fecal samples from individuals undergoing dialysis have an increased amount of enzymes that produce toxins that are increased as kidney function declines, mostly those that produce protein degradation metabolites (i.e., urea, uric acid, tyrosine, and tryptophan). Also, there is a decrease in the enzymes needed for the production of short-chain fatty acids, which are mostly produced from the fermentation of dietary fiber and thus are traditionally considered “good”.

At the metabolite level, mirroring the effect on the enzymes needed for the production of toxins derived from amino acid and protein degradation, metabolites such as indoles and phenols derived exclusively from the gut microbes are increased in the plasma of CKD patients.

Therapies that target the composition, function, and metabolites produced are of great interest in the CKD community

Due to the changes mentioned above, therapies that target the composition of the gut microbiota, the function of the gut microbiota, and what the gut microbes are producing are of great interest to try to reduce the burden of CKD. These therapies may include the use of pro-, pre-, and synbiotics.

The use of probiotics in CKD is not supported by the current evidence

Probiotics are live microorganisms that when consumed in specific amounts may give the individual a benefit. There are several probiotic bacteria, including species and strains within the Bifidobacterium and Lactobacillus families. Probiotic bacteria have been studied extensively in healthy individuals and those with several diseases. Some of the benefits in patients with CKD may include binding to pathogenic bacteria, decreased levels of inflammation, reduction of toxins produced by the microbes, and improvement of the health of the gastrointestinal tract.

Although the possible beneficial effects of supplementation with probiotics sounds promising, the current evidence does not support their use. In a recent meta-analysis by McFarlane and collaborators, they found no benefit of the use of probiotics on the levels of serum urea, indoles, and phenols. In fact, when you go to the individual studies, some of them found increases in these toxins and markers of inflammation, while they report no changes in the composition of the gut microbiota.

The use of prebiotics may have a beneficial effect in CKD

Prebiotics are substrates (including dietary fibers that are fermented by the microbes) that are used by the gut microbes producing short-chain fatty acids to provide a benefit to the host. While probiotics have not been associated with beneficial effects, the use of prebiotics may provide a better solution in patients with CKD.

The use of prebiotic substances in CKD has been limited to the use of prebiotic fibers, such as resistant starch, oligofructose-enriched inulin, and arabinoxylans, among others. In the meta-analysis by McFarlane and collaborators, they found that the use of prebiotics reduced levels of serum urea. However, there was no effect on other metabolites produced by gut microbes or the composition of the gut microbiota.

Not pro- or prebiotics, but what about synbiotics?

Synbiotics are the combination of pro- and prebiotics. While the use of pro- or prebiotics on their own have not yielded the expected results, the use of synbiotics seems promising.

Rossi and collaborators examined the effect of a synbiotic in patients with CKD not yet on dialysis. The synbiotic contained 15g of a combination of prebiotic fibers and a probiotic with nine strains from the Lactobacillus, Bifidobacteria, and Streptococcus genera. They found decreases in serum indoxyl sulfate (derived from the fermentation of the amino acid tryptophan) and changes in the composition of the gut microbiota.

Viramontes-Hörner and collaborators found that the use of a probiotic gel with 2.3g of prebiotic fiber, a probiotic with Lactobacillus and Bifidobacterium, omega-3 fatty acids and vitamins decreased the severity of gastrointestinal symptoms, a highly prevalent problem in patients with CKD.

So, should we recommend the use of pro-, pre-, and synbiotics in patients with CKD?

Although the fundamental idea makes sense, the use of these interventions targeting the gut microbiota has not produced the expected results. However, CKD is a complex disease and individuals with reduced kidney function are often recommended a restrictive diet low in dietary fiber and a variety of medications with unknown effects on the gut microbiome. This may be the reason why some of these interventions may not be enough to cause a change in the gut microbiome. Hopefully, future interventions will apply a more holistic approach to assess and target the gut microbiome in patients with CKD.

According to the United Nations the aging population is growing and by 2050 the number of people aged 60 years old will reach 2 billion worldwide. With the aging population the prevalence of age-related disease is predicted to increase. An example of an age-related disease is neurodegeneration.  Dementia can be a result of several pathologies including increased levels of Lewy bodies (abnormal aggregates of protein in nerve cells), as seen in Parkinson’s disease.

Cerebrovascular disease is the second most common cause of dementia and is a result of  changes in blood flow to or within the brain. Blood flow in the brain can change because of hypertension, diabetes, smoking, and hypercholesterolemia. Patients with cerebrovascular disease experience cognitive impairment, specifically when trying to remember things or plan events/trips. It is important to note that symptoms can vary from patient to patient. A type of cerebrovascular disease is vascular cognitive impairment (VCI).

Nutrition is a modifiable risk factor for diseases of aging. As people age their ability to absorb nutrients from their diet decreases.  Several studies have reported that changes in B-vitamin absorption may play a role in the onset and progression of dementia. Additionally, a study by researchers in the United Kingdom shows that B-vitamin supplementation reduced brain volume loss in areas associated with cognitive decline. A recent international consensus statement from leaders in the field suggests that deficiencies in B-vitamin metabolism should be considered when screening dementia patients. My research using model organisms has tried to understand the disease processes associated with dementia.

Using a mouse model of VCI we have reported that deficiencies in folic acid, either dietary or genetic affect the onset and progression of VCI. Using the Morris water maze task we report that mice with VCI and folate deficiency performed significantly worse compared to controls. We assessed changes in the brain using MRI and interestingly found that folate deficiency changed the vasculature in the brains of mice with VCI. Because of either a genetic or dietary folate deficiency all the mice had increased levels of homocysteine.

Our results suggest that it is not elevated levels of homocysteine making the brain more vulnerable to damage, but the deficiency in folic acid, either dietary or genetic, that changes the brain. In the cell folic acid is involved in DNA synthesis and repair as well as methylation. These are vital functions for normal cell function. Therefore, reduced levels of folate may be changing the cells in the brain and making them more vulnerable to certain types of damage. We think that high levels of homocysteine may just be an indication of some deficiency (e.g. reduced dietary intake of folic acid). Maintaining normal levels of homocysteine are needed, since studies in humans have shown that elevated levels of homocysteine are a risk factor for neurodegenerative diseases and that reducing them is beneficial.

 

Sweeteners_Sanae Ferreira

Sweeteners_Sanae Ferreira

In the case of Shakespeare, a rose is a rose is a rose – all smell sweet. But, in the case of sweeteners, the story is not quite so simple.

 

Here are a couple of scenarios that may look familiar to you:

 

– You’ve sat down at your favorite breakfast place, and your server has asked if you would like some coffee or tea while you consider the menu. A carafe appears, your cup is full, and you instinctively reach for the narrow box containing a rainbow of packets. You reach for one, but are curious about the rest – what are they really?

– You’re at the store, trying to buy something to drink, and there are words you don’t recognize on the label next to “sugar-free.”

Read more

Choose your own adventure: Which scenario do you identify with?

  1. You wake up crabby and groggy each morning, reluctantly rolling out of bed after hitting ‘snooze’ three times at a minimum. You curse the morning as you shock your system with a splash of cold water- a cruel, yet necessary ritual. You grab strong coffee and a slightly stale bear claw pastry as an afterthought on the way out the door. This caffeine/sugar combination gives you life for a few hours until you succumb to intense hunger pangs at 11:30am. Take-out lunch quenches the stomach rumbling and dulls your throbbing temples, and you turbulently sail until the 3 o’clock hour, after which point productivity squeals to a halt. More coffee, a fistful of candy from the office jar (and some nuts and carrots in a half-hearted attempt to be healthy) offer a temporary solution. 5pm rolls around, and you leave work in a ravenous, foggy state of mind. You planned to hit the gym, but a date with microwave dinner and Vino are the way to your heart tonight. Once home, you sigh a great, empty sigh as you kick your gym bag to the corner of your room and fall face-first on the couch in one fell swoop.
  2. You wake up as early morning light streams through the cracks in your blinds, pleasantly surprised your alarm clock is set to ring in two minutes. You lie still for a moment, calmly preparing for the day ahead. You move through your morning routine that leaves ample time for breakfast, coffee, and reading the paper. Your philosophy hasn’t failed you yet: ‘Make it fast, eat it slow’: Today’s breakfast is a chopped apple, Greek yogurt, cinnamon, and steel-cut oatmeal topped with honey and slivered almonds. You grab your lunch from the fridge (a colorful salmon, farro, roasted veggie and garbanzo bean salad prepped the night before) on the way out the door. Around 11:30am, you hear a chorus of yawns around your open-layout office; Although wide awake, your stomach gently requests more fuel. Lunch powers you through a productive afternoon with a walking meeting (your preference) and impressive brainstorm session for an exciting new research study that integrates Nutrition, Psychology, and Neuroscience. At 4pm, you re-fuel body and mind with walnuts and blueberries for your planned strength training workout. Energized once more, you grab dinner out with friends- your favorite way to socialize! Roasted herb chicken, bread with olive oil, kalamata olives, and caramelized seasonal vegetables are the way to your heart tonight. Although it’s been a full day, you feel mentally and physically strong.

 

The above scenarios differ like night and day; Although each is dramatized for effect, be honest- most of us can identify with one situation more strongly than the other. Go ahead and select the category that resonates most with you, and let’s dive deeper with a brief brainstorm. What factors make the above scenarios glaringly different?

  1. Person A failed to plan, and Person B practically has a degree in Life-Skills 101
  2. Person A’s job is a drain, while Person B is energized by his/her work
  3. Person A might suffer from depression, while Person B likely does not

So far, so good: Each observation is a deeper reflection of the individuals’ moods. Person A is lethargic, fatigued, unmotivated, and ‘empty,’ while Person B is energized, mentally sharp, mindfully present, and fulfilled.

Excellent, let’s pursue this lead! Consider this: What deeper, underlying factor might account for these distinct moods? Consider one more glaring difference between scenario A and B, this time considering trends in the foods consumed:

  1. Simple carbohydrates, high sodium, and high saturated fat, with a modest sprinkling of vitamins, minerals, and fiber from primarily packaged-foods
  2. Whole grains, lean protein, ample produce, monounsaturated and polyunsaturated fats, lots of fiber, probiotics, vitamins and minerals, and all primarily from whole-food sources

Credit: Easy Recipe Depot

Person A and B both know that their food choices influence their outward appearances- after all, you are what you eat! Digging deeper, however, we see that Person B still has an advantage: This person also understands that one’s food choices influence mental state and behavior! Whether intuitively or intentionally, this person knows a thing or two about an emerging research area called ‘Nutritional Psychiatry.’

Credit: Mind Brighton & Hove

Let’s briefly turn to the research to get the low-down on Nutritional Psychiatry:

If you begin your knowledge quest with a Google search of the term, you’ll find a variety of media reports and research foundations devoted to the topic. Case in point:

The Harvard Health blog published an article called “Food and Mood-Is there a connection?” This article articulates how certain dietary patterns may protect mental health. More specifically, a Mediterranean diet pattern rich in fruits, vegetables, olive oil, whole grains, and lean protein such as chicken and fish, and low in red meat and unhealthy fats may provide promising benefits. Important to note, however, is that one single dietary factor or lifestyle factor is unlikely to affect mental health independently.

The Conversation explains that although research is in early stages, “it is now known that many mental health conditions are caused by inflammation in the brain. This inflammatory response [may be] associated with a lack of nutrients…Recent research has shown that food supplements such as zinc, magnesium, omega 3, and vitamins B and D3 can help improve people’s mood, relieve anxiety and depression and improve the mental capacity of people with Alzheimer’s.

(Psst…see that hyperlink on ‘recent research?’ That’s a link to an original study! Click it, friends!)

-A research foundation called the International Society of Nutritional Psychiatry Research will direct you towards “high quality evidence for nutritional approaches to the prevention and treatment of mental disorders.”

Both sources are good places to start, but our search has just begun! You can either scour each article for links to official research studies written by the research teams themselves, and read such study (Rule of thumb: Media reports are for entertainment first, and comprehensive education second or third or fourth). Alternatively, you may turn to Pubmed and pull up a review article on ‘Nutritional Psychiatry.’ (What’s a review article? Aside from being my preferred, reader-friendly way to learn about science, here’s a description)

The fourth result in our original Google search is conveniently a link to a 2017 review paper called “Nutritional Psychiatry-Where to Next?” This article explains that “A consistent evidence base from the observational literature confirms that the quality of individuals’ diets is related to their risk for common mental disorders, such as depression.”

While promising so far, comprehensive research is still needed in this area, as articulately stated by the same authors: “Key challenges for the field are to…replicate, refine and scale up promising clinical and population level dietary strategies; identify a clear set of biological pathways and targets that mediate the identified associations; conduct scientifically rigorous nutraceutical and ‘psychobiotic’ interventions that also examine predictors of treatment response; conduct observational and experimental studies in psychosis focused on dietary and related risk factors and treatments; and continue to advocate for policy change to improve the food environment at the population level.”

Breastfeeding as an issue of significance in the world of public health and nutrition has gained considerable traction in recent months. With globally publicized opposition by the US to the World Health Assembly Resolution on Infant and Young Child Feeding (triggered by severe restrictions on milk products for older infants and young children) and reports of coercion to further corporate interests, the issue is of great pertinence in today’s times. It being World Breastfeeding Week, this blog will delve into the science of breastfeeding, a nutrition-focused behavior that has amassed a tremendous body of evidence in its favor when concerning infant and young child health [1].

The Lancet series published in 2016 describes both the micro and macro level benefits of breastfeeding for infants in countries of all economic strata. One paper [2] from the series estimates that approximately 823,000 annual deaths among children <5 years of age and 20,000 annual deaths of women from breast cancer can be avoided through the promotion of improved breastfeeding practices. Additionally, breastfeeding has long lasting impacts on morbidity and improves the cognitive capacity and educational potential of children, with economic benefits including higher wages in adulthood [2]. Greater benefits are achieved with longer durations of breastfeeding, and this behavior has impact on morbidity with evidence showing protective benefits against diarrhea, respiratory infections, and asthma [3].

Additionally, a growing body of evidence shows overwhelming support for breastfeeding as protective behavior against long-term health outcomes related to non-communicable diseases including obesity [3]. An analysis of 113 studies shows that longer durations of breastfeeding are associated with a 26% reduction (95% CI: 22-30) in the odds of obesity across income groups. Another pooled analysis of 11 studies showed a 35% reduction (95% CI: 14-51) in the incidence of type 2 diabetes [3]. Prior work has shown that breastfeeding confers protection against obesity later in life, with lower prevalence rates after adjusting for confounders such as socioeconomic status, birthweight and sex [4].

Recent papers published in the American Journal of Clinical Nutrition highlight the nuanced impact of breastfeeding on child growth trajectories. A study by Kramer et al. (2018) showed, using various different statistical analyses, a causal effect of randomization to a breastfeeding promotion intervention on growth during the first 2-3 months of life [5]. Additionally, these authors noted that children in a breastfeeding intervention group and those who were breastfed for ≥12 months experienced faster growth when compared to those in the control group or those breastfed for <12 months, particularly during the first 2-3 months. The differences in growth velocity between groups was lower in subsequent months and almost equalized by 12 months of age.

A study by Eny et al. conducted in Canada found that maternal BMI was positively correlated to infant BMI [6]. These authors note that maternal BMI has been shown to modify BMI growth rates among children beginning at birth up to 12 years of age [7]. These authors note that the trajectories for growth differed by breastfeeding duration, maternal BMI and birth weight from 1-3 months of age.

Results from these studies and others highlight the need for more prospective research to assess how, when and whether breastfeeding practices influence infant weight gain, and what factors within breastmilk impact lean and fat mass growth [8]. Overall, the case for early initiation, exclusivity of breastfeeding for the first 6 months and continued breastfeeding up to 2 years remain strong and programs, policies and incentives to encourage and promote adequate breastfeeding behaviors remain the need of the hour. So this World Breastfeeding Week, may mothers’ across the world be motivated, encouraged and supported to continue gifting their young one of the most valuable gifts nature has accorded us!

References:
[1] Jacobs, A. (2018). Opposition to breast-feeding resolution by the US stuns world health officials. Retrieved from: https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html
[2] Rollins, N.C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C.K., Martines, J.C., Piwoz, E.G., Richter, L.M., Victora, C.G. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet, 387, 491-504.
[3] Victora, C.G., Bahl, R., Barros, A.J., Franca, G.V.A., Horton, S., Krasevec, J., Murch, S., Sankar, M.J., Walker, N., Rollins, N.C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 287, 475-490.
[4] Armstrong, J., Reilly, J.J., & Child Health Information Team. (2002). Breastfeeding and lowering the risk of childhood obesity. Lancet, 359 (9322), 2003-2004.
[5] Kramer, M.S., Davies, N., Oken, E., Martin, R.M., Dahhou, M., Zhang, X., & Yang, S. (2018). Infant feeding and growth: putting the horse before the cart. American Journal of Clinical Nutrition, 107, 635-639.
[6] Eny, K.M., Anderson, L.N., Chen, Y., Lebovic, G., Pullenayegum, E., Parkin, P.C., Maguire, J.L., Birken, C.S. (2018). Breastfeeding duration, maternal body mass index, and birth weight are associated with differences in body mass index growth trajectories in early childhood. American Journal of Clinical Nutrition, 107, 584-592.
[7] Bornhorst, C., Siani, A., Russo, P., Kourides, Y., Sion, I., Molnar, D., Moreno, L.A., Rodrigues, G., Ben-Shlomo, Y., Howe, L., et al. (2016). Early life factors and inter-country heterogeneity in BMI growth trajectories of European children: the IDEFICS study. PLoS One, 2016:11:e0149268.
[8] Hay, W.W. Jr. (2018). Breastfeeding newborns and infants: some new food for thought about an old practice. American Journal of Clinical Nutrition, 107, 499-500.

Breastfeeding: Foundation of Life

World Breastfeeding Week is celebrated every year from August 1 – 7 across the globe to encourage breastfeeding and promote healthy practices from the earliest stages of life. This campaign is led by the World Alliance for Breastfeeding Action (WABA), a global network of organizations and individuals who work to promote and support breastfeeding practices worldwide. The 2018 slogan is “Breastfeeding: Foundation for Life”.

“In a world filled with inequality, crises and poverty, breastfeeding is the foundation of lifelong good health for babies and mothers.”

Latest Research on Breastfeeding

ASN’s four nutrition science journals often publish new research on breastfeeding, and there were many sessions on the topic at ASN’s annual meeting, Nutrition 2018. ASN also ensures the representation and support of breastfeeding research within our membership and scientific programs through a dedicated research interest section, Maternal, Perinatal, and Pediatric Nutrition. Members who belong to this group focus on the biology of nutrition as it impacts human development, and the role of nutrition on both short-and long-term outcomes in the mother, fetus, infant, and child.

New Research on Breastfeeding from American Journal of Clinical Nutrition

Breastfeeding newborns and infants: some new food for thought about an old practice

“Feeding newborns and infants is hardly a new topic, but these 2 articles provide some important new food for thought, and hopefully might stimulate appetite for studying how breastfeeding and human milk confer unique advantages on infant growth and development, as well as prevention of later life diseases such as obesity, which are programmed early in life.”

Breastfeeding duration, maternal body mass index, and birth weight are associated with differences in body mass index growth trajectories in early childhood

Infant feeding and growth: putting the horse before the cart

Current Knowledge on Micronutrients in Human Milk: Adequacy, Analysis, and Need for Research

This free supplement was published with the May 2018 issue of Advances in Nutrition. Articles included are:

Introduction to Current Knowledge on Micronutrients in Human Milk: Adequacy, Analysis, and Need for Research

Overview of Nutrients in Human Milk

Limitations of the Evidence Base Used to Set Recommended Nutrient Intakes for Infants and Lactating Women

Micronutrients in Human Milk: Analytical Methods

Retinol-to-Fat Ratio and Retinol Concentration in Human Milk Show Similar Time Trends and Associations with Maternal Factors at the Population Level: A Systematic Review and Meta-Analysis

Iodine in Human Milk: A Systematic Review

Vitamin B-12 in Human Milk: A Systematic Review

Breastfeeding and the Microbiome

ASN Fellow Dr. David Heber recently published a video Microbiome #3: Getting it Started. This is what he says:

“The Microbiome is established in the gut during breast feeding. While some bacteria enter the body during delivery and from the mother’s skin, the majority are formed from a special group of complex carbohydrates called Human Milk Oligosaccharides (HMO’s). There are about 150 HMO’s and they feed a single bacterial species called Bacteroides Infantilis which has a series of pumps on its surface bringing these sugars called oligosaccharides inside the cell to be digested. This bacteria is called an “inside” eater and does not share the HMO’s with other bacteria so it becomes the dominant bacteria in the gut Microbiome setting up the baby’s immune system. The breast milk has protein, fat, and lactose (the same sugar in cow’s milk) but is unique in having the 150 HMO’s. This is another reason why it is so important for women to breast feed their babies. Breastfeeding also removes 500 Calories per day from the Mom’s body helping with reducing pregnancy weight gain. During breast feeding women need to get extra protein, Calcium, vitamin D and B vitamins to replace what is being put out in breast milk!!”

Video shared with Dr. David Heber’s permission.

Calcium is traditionally considered the bone-health nutrient. This is because 99% of calcium is contained within the bone, in which calcium creates a mineral complex with phosphate (hydroxyapatite), giving bone its characteristic strength and function. However, besides forming part of bone, calcium is also involved in other functions, such as muscle function, nerve transmission, intracellular signaling, and others.

Bone is a very dynamic organ in which the rate of formation and resorption (or destruction) is different throughout the lifespan. During childhood and adolescence, the rate of formation is higher than the rate of resorption, leading to maximum bone gain. In older adults these rates are switched, causing loss of bone. This bone loss may lead to osteopenia, osteoporosis, and an increased risk of bone fractures.

Is an increased intake of calcium associated with reduced risk of fractures?

As a way to prevent bone loss and fractures in middle-aged and older adults, there is usually a push from public health initiatives and healthcare professionals to increase the intake of calcium. However, an increased intake of calcium (dietary + supplements) may not necessarily lead to fewer fractures. Two of the most recent systematic reviews and meta-analyses showed that increasing dietary calcium and the supplementation of calcium (and vitamin D) did not reduce the risk of fractures. However, this remains controversial as a previous meta-analysis showed that the supplementation of calcium and vitamin D was associated with a 15% risk reduction in middle-aged and older adults (community-dwelling and institutionalized).

 The use of calcium supplements may lead to a higher risk of cardiovascular disease

The hypothesis is that an increased intake of calcium may lead to a positive calcium balance (intake lower than output in urine + feces), in the absence of increased bone formation. This positive calcium balance may lead to the calcification of tissues other than the bone, such as the vasculature, increasing the risk of cardiovascular disease. However, this association remains controversial. A sub-analysis of the Multi‐Ethnic Study of Atherosclerosis (MESA), showed that those that had higher dietary calcium intake (without supplements) had a lower risk of coronary artery calcification, while those that were taking supplements had a higher risk. However, the National Osteoporosis Foundation and the American Society for Preventive Cardiology suggested that calcium intake (diet + supplements) that does not exceed the tolerable upper level of intake of 2000 to 2500mg/d is not associated with cardiovascular outcomes, and should be considered safe.

Special caution of high intake of calcium in subjects with reduced kidney function

A high intake of calcium, particularly those that use calcium supplements, may represent a problem for those with reduced kidney function, as they may not be able to excrete the extra calcium. In a study by Hill and collaborators, a calcium intake of 2500mg (1000 mg through diet + 1500mg from calcium carbonate), compared with a dietary calcium intake of 1000mg, led to 500mg of calcium retention in patients with reduced kidney function. Similarly, Spiegel and collaborators compared a diet with 800mg vs. 2000mg of calcium in subjects with normal and reduced kidney function. In those on the 2000mg calcium diet, there was a positive calcium balance, which was more marked in those with reduced kidney function. With these results, a calcium intake higher than 800-1000mg (diet + supplements) should be avoided in those patients with a reduced kidney function to prevent calcifications of tissues other than the bone.

Should health care professionals recommend a high intake of calcium?

The current evidence, in middle-aged and older adults, does not seem to support high calcium intakes (above the tolerable upper level) for the prevention of fractures. Additionally, high calcium intakes achieved with the use of supplements may be associated with increased risk of cardiovascular disease. However, the use of supplements may be useful for patients that have low calcium intake. Finally, special attention should be taken in patients with reduced kidney function, as a high intake (diet + supplements) may lead to an increased risk of cardiovascular disease.