By Teresa Johnson, MSPH, RD

A symposium chaired by Bahram Arjmandi, PhD, RD, and Carmen Castaneda-Sceppa, MD, PhD, provided insights into the etiology and pathophysiology of osteosarcopenic obesity, and presented suggestions for pharmacological and dietary treatment strategies.

Jasminka Ilich-Ernst, PhD, RD, a professor at Florida State University, outlined the problem and scope of osteosarcopenic obesity, a term first coined in 2012. Characterized by the coexistence of three distinct musculoskeletal disorders—osteopenia/osteoporosis, sarcopenia, and obesity—osteosarcopenic obesity is a complex condition, for which the proof-of-concept was established only recently.

A major concern with osteosarcopenic obesity, Ilich-Ernst said, lies in age-related fat redistribution and subsequent infiltration into bone and muscle. Typically bone, muscle, and fat progenitor cells differentiate in a balanced distribution to enable normal tissue development. But with aging, a sedentary lifestyle, poor nutrition, and low-grade inflammation, differentiation patterns become altered and fat production predominates.

Whereas current nutritional and lifestyle management recommendations address the individual components of osteosarcopenic obesity, they do not address the collective triad. Ilich-Ernst suggested adhering to current recommendations to achieve peak bone mass before age 30, gain and maintain adequate muscle mass, and maintain a health weight, but she added that increasing dietary protein to 25 percent of total energy and limiting carbohydrate consumption to approximately 40 percent of total energy might further reduce risk of developing osteosarcopenic obesity.

Further insights into the interconnected nature of bone, muscle, and fat were provided by Clifford J. Rosen, MD, a professor of medicine at Tufts University and research scientist at the Maine Medical Center Research Institute. Rosen explained that the three tissues derive from a single progenitor cell type, and their responses to various cytokines, hormones, and regulatory input, primarily the sympathetic nervous system, are similar.

He then described newly identified “beige,” or brown-like, adipocytes, which contain more mitochondria and are more thermogenic than classic white adipocytes. Beige adipocytes share a common progenitor cell with smooth muscle. As such, they can be viewed as a sort of “hybrid” between fat and muscle cells. Intermittent cold exposure induces beige adipogenesis, a process referred to as “browning,” and promotes weight loss by increasing sympathetic tone—a potential non-pharmacological approach to body fat loss.

However, Rosen noted, whereas sympathetic tone enhances fat loss, it uncouples the process of bone remodeling, promoting bone loss. He added that many of the new classes of drugs that target beige adipogenesis might have similar, deleterious off-target effects on bone.
Ronenn Roubenoff, MD, MHS, of Novartis Institutes for Bone Research, and a professor of medicine and nutrition at Tufts University, compared the effects of dietary versus pharmacological approaches to treating sarcopenia. Sarcopenia, Roubenoff said, is an age-related loss of muscle mass due to type II muscle fiber atrophy. He said that preventing sarcopenia might increase life span and improve quality of life in older adults.

Although some research suggests increasing dietary protein intake might reduce muscle wasting, few data support changing current recommendations, Roubenoff said. In addition, the muscle-sparing effects of dietary protein differ in women versus men. Whereas women benefit from increased intake, men (who experience a U-shaped curve in response to intake) benefit from more moderate intake.

Roubenoff added that muscle, unlike other organs, doesn’t senesce; rather, it remains plastic, providing the potential for older adults to regain muscle mass and function. However, muscle in older adults exhibits “anabolic resistance”—an inability to integrate and build muscle. Emerging pharmacological approaches target this resistance to reverse muscle wasting.

Finally, Wayne Campbell, PhD, a professor of nutrition science at Purdue University, described the differential effects of dietary protein intake during weight loss on bone, muscle, and fat. Specifically, Campbell addressed the question of how older adults can purposefully lose weight without compromising musculoskeletal function.

Campbell and his colleagues analyzed NHANES data from 1999-2004, a period that included dual energy X-ray absorptiometry data. They partitioned the data based on thresholds of the Recommended Dietary Allowance regarding bone health, and noted that whereas inadequate protein intake had an adverse effect on bone health in adults over age 50, high protein had variable effects. Campbell then described his research with whey supplementation and noted that groups that consumed higher amounts of a whey protein supplement lost more fat than groups consuming lesser amounts. However, they experienced no change in bone status, consistent with the epidemiological data.

At a minimum, Campbell said, adults should consume adequate protein. But he added that high dietary protein intake during weight loss has a positive effect on body composition, inducing greater fat loss while maintaining lean muscle mass. In addition, he noted that high protein intake has variable effects, depending on protein type. In particular, whereas protein from dairy and plant sources likely provides greater benefit to bone, protein from non-dairy animal sources likely benefits soft tissue.

By Mayra Sofia Crespo Bellido

“I drink tea of guanábana leaves when I can’t make it to my chemotherapy sessions. Did you know Miss, that eating guanábana is just as good as 10 chemotherapy sessions?” I was shocked when a patient shared this piece of information with me during a nutritional assessment interview. Luckily, my preceptor stepped in and educated the patient and his spouse on the risks of completely substituting traditional medicine with alternative treatments that are not evidence-based. He argued with my professor. In that moment it sunk in how dangerous health illiteracy can be.

Health literacy has been defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” It involves different factors such as: health knowledge, listening, speaking, arithmetical, writing, and reading skills, and cultural competencies of health professionals as well as other systemic factors.

According to the National Center for Education Statistics, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease. Nearly 14% of adults (30 million people) have ‘below basic’ health literacy. These adults were more likely to report their health as poor (42%) and are more likely to lack health insurance (28%) than adults with Proficient health literacy. These patients are more likely not to vocalize their concerns and questions as well as being less active participants in their care because of the stigma associated with being health illiterate. Being health illiterate is a stronger predictor of health than socioeconomic status, education, ethnicity, or race.

Nutrition professionals in all areas face health illiteracy on a day-to-day basis. During my dietetic internship training, I have a difficult time gathering accurate information from patients during the nutritional assessment in the clinical setting, particularly when assigned a high patient load. That initial interaction may be somewhat compromised by the fact that most patients do not know how to express nutritional concerns and time is too constricted to dig deep into the answers provided. Same goes to other areas of practice: nutrition researchers dealing with tailoring informed consent forms to the level of health literacy of their population of interest or foodservice managers explaining to their employees the reasons to follow HACCP procedures to ensure food safety. Even public health nutrition professionals may face it while trying to advocate in favor of measures such as the taxation of sugar-sweetened beverages.

Healthy People 2020 includes the specific objective to increase health literacy under the topic of Health Communication and Health Information Technology. In this era health and nutrition information is produced and distributed by individuals and organizations with various agendas. It is critical that people have the skills to navigate this sea of information without feeling overwhelmed by nutrition confusion. Guiding people through this process and giving them strategies to find and understand accurate food and nutrition information could allow for a new sense of empowerment that could position dietitians, nutritionists and other nutrition professionals as the go-to source in these matters for people who have put their trust elsewhere to get the information.

The World Health Organization has determined improving health literacy has implications in a greater scope than individual decision-making processes with the following quote:
“[…] Health Literacy goes beyond a narrow concept of health education and individual behavior-oriented communication, and addresses the environmental, political and social factors that determine health. Health education, in this more comprehensive understanding, aims to influence not only individual lifestyle decisions, but also raises awareness of the determinants of health, and encourages individual and collective actions which may lead to a modification of these determinants. Health education is achieved therefore, through methods that go beyond information diffusion and entail interaction, participation and critical analysis. Such health education leads to health literacy, leading to personal and social benefit, such as by enabling effective community action, and by contributing to the development of social capital.”
Such an impact could guide the food and nutrition policy measures that are needed to ensure the population’s health by activism that intends to change social determinants of health. Wow!

There is a vast amount of literature in health literacy, yet there is still some room for improvement in the scope of practice. Public health and community nutrition professionals could make use of the health care system’s shift from acute care towards preventive care and health promotion to justify projects that improve basic health literacy skills. Helping people understand the purpose of health and nutrition behavior change, increasing self-efficacy and helping individuals make decisions accordingly is vital.

References
Department of Health and Human Services (US), Office of Disease Prevention and Health Promotion. Health literacy online: A guide to writing and designing easy-to-use health web sites.

Health Communication and Health Information Technology- https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology

Health literacy and health behaviour- https://www.who.int/healthpromotion/about/en/

Carbone E., Zoellener, J. (2012) Nutrition and Health Literacy: A Systematic Review to Inform Nutrition Research and Practice. J Acad Nutr Diet. doi: 10.1016/j.jada.2011.08.042

By Joyanna Hansen

Consumers navigating grocery store aisles have many choices, and food labels are one way in which food manufacturers compete for attention. The label “all natural” or “100% natural” can be found on diverse food products ranging from peanut butter and cereal to “all natural” sodas, and may bring to mind images of wholesome, minimally processed foods. However, the U.S. Food and Drug Administration (FDA), responsible for regulating and supervising food production, does not define or regulate use of the label “natural” on food products. Instead, the FDA official policy is that “the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances,” (1) an ambiguous policy that leaves interpretation of “natural” largely up to the food industry.

Without a formal definition of what “natural” means, let’s examine what this label does not mean. First of all, foods containing natural flavors, sweeteners, or other plant-derived substances can be labeled natural. In addition, foods containing highly processed high fructose corn syrup (HFCS) can also be labeled “natural”, since the synthetic materials used to generate HFCS are not incorporated into the final product (2). Finally, foods containing genetically engineered or modified ingredients can be labeled “natural,” something California’s recently defeated Proposition 37 tried to prevent (3). Although far from an exhaustive list of what can be labeled a “natural” food, these are a few examples of how “natural” may mean something different than consumers think.

In contrast to the FDA, the United States Department of Agriculture (USDA) does regulate use of the word “natural” when applied to meat, poultry, and eggs, stating that a “natural” food is “a product containing no artificial ingredient or added color and is only minimally processed” (4). Although consumers purchasing “natural” meat, poultry, and eggs can be confident that there are no artificial ingredients or colors added, it’s important to note that “natural” does not necessarily mean hormone-free or antibiotic-free; these are separate labels, also regulated by the USDA.

Unlike “natural,” which has no clear definition, use of the “organic” food label and seal is strictly regulated by the National Organic Program, which is administered through the USDA. Foods with an organic seal are certified organic and contain at least 95% organic content (5). Organic food is produced using approved organic farming methods “that foster cycling of resources, promote ecological balance, and conserve biodiversity. Specifically, “synthetic fertilizers, sewage sludge, irradiation, and genetic engineering may not be used” to produce organic food, meaning that organic food products are not genetically modified and have not been treated with synthetic pesticides or fertilizers (5).

Unless the FDA adopts a stricter definition of “natural,” consumers trying to make informed decisions should be wary of the “natural” food label and pay close attention to ingredient lists, or choose organic foods that have been produced through a closely regulated process.

References
1.    What is the meaning of ‘natural’ on the label of food? FDA.gov. Retrieved Feb. 7, 2013 from https://www.fda.gov/AboutFDA/Transparency/Basics/ucm214868.htm.
2.    Crowley, L. (2008, July 8). HFCS is natural, says FDA in a letter. Foodnavigator-usa.com. Retrieved Feb. 7, 2013 from https://www.foodnavigator-usa.com/Business/HFCS-is-natural-says-FDA-in-a-letter
3.    Sifferlin, A. (2012, Nov. 7). California Fails to Pass GM Foods Labeling Initiative. TIME.com. Retrieved Feb. 8, 2013
4.    Meat and Poultry Labeling Terms (last modified April 12, 2011). USDA.gov. Retrieved Feb. 8, 2013 from https://www.fsis.usda.gov/FACTSheets/Meat_&_Poultry_Labeling_Terms/index.asp#14.
5.    National Organic Program (last modified Oct. 17, 2012). USA.gov. Retrieved Feb. 8, 2013.

By Stefano Vendrame

Here we go again. I’m reading the billionth newspaper article referring to the “French paradox,” with the author explaining that “in spite of their high saturated fat intake, the French die less of coronary heart disease thanks to their higher consumption of red wine.”

It’s an old story that keeps coming back. I’ve heard it time and again from TV shows, newspapers, books and magazines, even university professors. It has been told so many times that in the back of their minds a lot of people still believe the concept that drinking red wine can prevent cardiovascular disease. It all dates back to the early nineties, when Serge Renaud and Michel De Lorgeril published a paper in Lancet entitled “Wine, alcohol, platelets, and the French paradox for coronary heart disease” (1).

Presenting epidemiological data, the authors observed that French people had a high consumption of saturated fat, and yet their mortality for coronary heart disease (CHD) was low. In the US and the UK, where consumption of saturated fat was substantially equivalent to France, mortality for CHD was much higher. They called this the “French paradox.” There was, however, a difference; in France, they would also drink more red wine. Since alcohol does have some fibrinolitic and atheroprotective effects, and red wine contains some protective polyphenols, such as resveratrols that come straight from red grapes, they hypothesized that higher red wine consumption could explain the apparent paradox. To further support this hypothesis, there were some striking data from three different cities within France itself. CHD mortality per 100,000 men was much lower in Toulouse compared to Strasbourg and Lille (78 vs 102 and 105, respectively), in spite of cheese consumption being higher (51 g/day vs 34 and 42 g/day, respectively). However, wine consumption in Toulouse was also significantly higher compared to the other two cities (383 g/day vs. 286 and 267 g/day, respectively). Again, wine consumption appeared to “counteract the untoward effects of saturated fats,” to use the words of the authors.

In the 1990s, wine sales in Europe were inexorably declining, with many young people in traditionally wine-drinking countries steadily switching to beer, considering wine drinking an old-fashioned habit. The wine industry jumped on the “French paradox” story, promoting an epic marketing campaign which instilled in a lot of people the idea that drinking red wine is good for your heart. It was so effective that I know people who didn’t drink alcohol at all, and started drinking a glass of red with their meals for fear that not doing so would increase their risk of dropping dead from a heart attack.

Not surprisingly, a great deal of research ensued. Indeed, when polyphenols are extracted from red grapes or red wine they exert beneficial effects, but the amount of wine needed to get enough resveratrols to produce a significant effect would be incompatible with the toxic effects of alcohol (2,3). And while a moderate consumption of alcohol is associated with a slightly reduced death rate from heart attack, it is also associated with a slightly increased death rate from cancer, liver cirrhosis and car accidents (4,5). Tough choice.

Anyone who has visited France will notice they enjoy their cheeses and sauces and foie gras, they always eat them with plenty of vegetables and grains, and a visit to any morning market in France will strike for the abundance of colors coming from all sorts of fruits, vegetables and herbs, and for the customers eagerly filling their baskets with them. So, was it really wine that was the key to explain the French paradox? A mere look at the rest of the Toulouse-Strasbourg-Lille table published in that very Lancet article would have provided good clues that wine was not necessarily part of the answer, and even if it was, it was certainly not all of it!

Granted, in Toulouse they drank more red wine than in Strasbourg and Lille, while eating slightly more cheese, but they also ate a lot more vegetables (306 g/day vs. 217 and 212 g/day, respectively), a lot more fruit (238 g/day vs. 149 and 160 g/day), half the butter (13 g/day vs. 22 and 20 g/day), more vegetable fat (20 g/day vs. 16 and 15 g/day) and more bread (225 g/day vs. 164 and 152 g/day). In other words, they were eating more fruits and vegetables and they ingested more dietary fiber, less saturated fat, more polyunsaturated fat and more grains. Still surprised that their deaths were less often attributed to cardiovascular disease?

The popular narrative of the French paradox gets the premise and the conclusion wrong. It is wrong to assume that saturated fat is all that matters to predict cardiovascular risk, since we know very well that it is just one of the many dietary factors involved. And it is dead wrong to suggest that drinking a few glasses of red wine is all you need to make it better. If anything, the whole story proves once more the concept that the balance of diet in general is more important than any single component in preventing disease and ensuring good health. You can eat a little bit more cheese, but if you eat a lot more fruits and vegetables, you are still doing fine. I propose a toast to this basic rule of nutrition, and I’ll be happy to toast with a glass of good French red wine, as they do in Toulouse. But just like them, I’ll get plenty of fruits and veggies afterwards to prevent CHD. Cheers!

References
1. Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992; 339:1523-6.

2. Bianchini F, Vainio H. Wine and resveratrol: mechanisms of cancer prevention? Eur J Cancer Prev. 2003; 12:417-25.

3. Goldberg DM, Yan J, Soleas GJ. Absorption of three wine-related polyphenols in three different matrices by healthy subjects. Clinical Biochemistry. 2003; 36:79-87.

4. Norström T, Ramstedt M. Mortality and population drinking: a review of the literature. Drug Alcohol Rev. 2005; 24:537-47.

5. Klatsky AL. Alcohol and cardiovascular diseases. Expert Rev Cardiovasc Ther. 2009; 7:499-506.

By Jessica Currier

Many observational and epidemiological studies have shown a connection between obesity and sleep deprivation in Americans. Alarmingly, 28% of American adults sleep less than six hours a night. One common reason for this connection is that sleep restriction affects the regulation of appetite hormones like ghrelin and leptin. Energy balance is tightly regulated by a hormonal system, involving ghrelin and leptin, which conveys information from the body to brain centers that control energy intake and expenditure (1). Restricted sleep is thought to increase ghrelin and decrease leptin, which promotes hunger (2). Sleep restriction is also thought to increase cortisol release, increasing eating behavior (2). Another proposed mechanism is that people, who stay awake longer, are exposed to a higher energy intake, specifically by snacking (2). Nevertheless, these explanations have been questioned. The effect of neuronal activity to food stimuli, an increase in energy intake, and the effect on energy expenditure will be reviewed in relation to sleep deprivation and obesity.

In one study published in The American Journal of Clinical Nutrition, researchers examined the effect on brain response to food stimuli in habitual and restricted sleep normal weight individuals (1). The neuronal pattern found in the restricted sleep group was similar to one that would occur when the body is at a low body weight and is trying to restore body stores (1). This study concluded that the restricted sleep group had a greater food intake and greater brain stimuli to areas that are linked with motivation and desire (1). The stimulated brain areas were the orbitofrontal cortex, insula, thalamus, precuneus, cingulate, gyrus, and supramarginal gyrus. (1). With food being widely accessible, this could be one reason associated with weight gain during sleep restriction. However, studies have shown that there are differences between brain responses to satiety and food stimulation in obese and lean individuals (1). Further research needs to be conducted to see if sleep restriction affects this difference.

Sleep deprivation has been shown to increase energy intake. In another study published in AJCN, researchers found that normal weight women had a significantly higher food intake, specifically in saturated fat, compared to men when sleep was restricted (2). The study did not find an increase in overall energy expenditure. It needs to be noted that gonadotropic-influenced hormones, like estrogen, could have an effect on energy intake (3). High levels of circulating estrogen across the menstrual cycle have been shown to influence energy intake, making food intake lowest during ovulation (3).

Lastly, sleep deprivation is believed to affect overall energy expenditure. Energy expenditure was examined in a group of healthy adolescent boys when sleep was restricted. The results included an increased energy expenditure from increased wake time in the sleep-restricted group while the control group was sleeping (4). There was no change in basal metabolic rate between the conditions (4). No differences in ghrelin and leptin levels were found between the control group and restricted sleep group. Interestingly, this study also found that the adolescents with restricted sleep had a decreased motivation to eat, the opposite of many other experiments.

The link between obesity and sleep deprivation could be a crucial understanding right now due to the alarming rates of obesity in our country. Many assumptions involving ghrelin, leptin, and cortisol have been formed but no known cause-relation effect has been determined. One feasible explanation of why sleep deprivation increases obesity or weight gain is because of brain stimulation and the fact that individuals are awake longer and will be exposed to food stimuli. With advertisements on television and kitchens stocked with food, it is hard to avoid exposure to food at night. If an individual is tired all the time, they are less likely to be physically active too. To decrease calorie intake and maintain a healthy weight strive for seven to nine hours of sleep each night!

References

1. St-Onge M, McReynolds A, Trivedi Z, Roberts A, Sy M, Hirsch J. Sleep restriction leads to increased activation of brain regions sensitive to food stimuli. Am J Clin Nutr. 2012;95:818-24.

2. St-Onge M, Roberts A, Chen J, Kelleman M, O’Keeffe, RoyChoudhury A, Jones P. Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. Am J Clin Nutr. 2011;94:410-6.

3. Benedict C. Letters To The Editor: Compromised sleep increases food intake in humans: two sexes, same response. Am J Clin Nutr. 2012;95:531.

4. Klingenberg L, Chaput J, Holmback U, Jennum P, Astrup A, Sjodin A. Sleep restriction is not associated with a positive energy balance in adolescent boys. Am J Clin Nutr. 2012;96:240-8.

fiber

By Sarah Gold

Determining how to stave off hunger while on a reduced calorie diet is the million-dollar question in the world of weight management. While there are many theories on how to increase satiety, slowing gastric emptying rate, or the rate at which food leaves the stomach, is a common tactic among many weight loss plans. Fiber, a carbohydrate found mostly in plant foods, is known to slow digestion and is often touted as the not-so-secret ingredient to weight loss.

Diets that contain fiber-rich foods such as fruits, vegetables, whole foods, and legumes have been associated with a decreased risk of obesity among other health benefits. In addition, a significant amount of research over the last 30 years has linked fiber-rich foods to improved glycemic control, increased production of hunger-suppressing hormones in the hours after a meal, reduced production of hunger hormones, and overall increased satiety. In theory, reduced hunger should lead a person to eat less, and ultimately lose weight.

For this reason, fiber has received a lot of attention from dietitians and weight management counselors to food companies and health journalists. And it has begun to show up in unlikely places. A 90-calorie brownie with 20% of your daily fiber needs – who would have thought it possible? Food scientists, that’s who! Food companies are adding synthetic, or functional, fiber to anything from white bread to sugary breakfast cereals and even baked goods. You can now get 100% of the recommended 25-30g of dietary fiber per day without ever eating a fruit, vegetable, or whole grain. However, the question that remains is, does this added fiber actually aid weight-loss?

There are two types of naturally occurring fiber: soluble and insoluble. Both are found in plant foods, insoluble in the skins of fruits and vegetables, and soluble found in oats, legumes, and whole grains. Researchers have tested the effect of synthetic soluble and insoluble fibers on satiety with mixed results. For example, beta-glucan (the kind of fiber found in oats) has been shown to have some effect on satiety, while inulin (found in plant roots) has been ineffective. There are a number of different synthetic fibers that food companies use to boost the fiber content of food, so it’s difficult to know if the product your buying will actually offer any benefit.  In addition, studies that have tested the effect of supplemental fiber on weight management have been less than promising.

When it comes to weight management, fiber-rich foods certainly play a role. But is fiber the magic ingredient we’ve all been looking for? Probably not.  Much of the research that links fiber-rich diets to lower weight are population studies, which are not able to completely control for other lifestyle factors that play a role in weight management such as physical activity and presence of other foods in the diet. In addition, many foods that naturally contain fiber also have a high percentage of water, which can also play a role in satiety. If you’re looking to reduce calories and control hunger, stick with whole foods that contain fiber such as whole-grains, fruits, vegetables, and legumes.

References
Bolton, R., Heaton, K., Burroughs, L. (1981). The role of dietary fiber in satiety, glucose, and insulin: studies with fruit and fruit juice. American Journal of Clinical Nutrition; 34(2): 211-217.

Kristensen, M., Georg Jensen, M. (2011). Dietary fibers in the regulation of appetite and food intake. Importance of viscosity. Appetite; 56(1): 65-70.

Lyon, M. & Kacnik, V. (2012). Is there a place for dietary fiber supplements in weight loss? Current Obesity Reports; 1(2): 59-67.

By Joyanna Gilmour

Basil, easily recognized by its fragrant, green, oval-shaped leaves, makes an appearance in many foods including pasta, salads, sandwiches, cocktails and more. This delicious herb is best known as the star ingredient in pesto, a thick paste made from basil, pine nuts, oil, and parmesan cheese. First cultivated in India thousands of years ago, basil has since been incorporated into a variety of ethnic cuisines from Italian to Thai.

As well as adding a fresh taste to food, this bright green herb also has beneficial health effects. Basil is a good source of vitamin K: 2 tablespoons of fresh basil contains about 20% of the daily recommended intake of this nutrient.(1) Fresh basil is also a good source of beta-carotene, a powerful antioxidant that is converted to vitamin A in the body. Antioxidants are vital for keeping cells healthy and reducing the number of damaging free radical molecules in the body. Basil is also widely used in Ayurvedic medicine to treat a variety of ailments, including arthritis and other inflammatory diseases. (2)

Basil oil, extracted from the leaves of the plant, is a natural antimicrobial and can kill or inhibit the growth of bacteria.  Scientists have shown that basil oil reduces the growth of a number of food-borne bacteria species including cholera (V. cholera) and E. coli O:157:H7 (3-5).  Given recent outbreaks of food-borne illnesses, cooking with natural ingredients such as basil oil which inhibit bacterial growth is a great way to make food safer as well as tastier.  Although basil shows promise as a natural antibacterial agent, it’s important to note that most scientific studies looking at this question have been done in laboratory settings using high doses of basil extract. The effect on bacterial growth observed by home cooks using smaller amounts of basil or basil oil is not clear.

In addition to its health-promoting qualities, basil is easy to grow in a sunny windowsill or garden.  A handful of basil leaves can add a delicious flavor to a wide variety of dishes – a few ideas are listed below!

Cooking with basil:
–    Use fresh basil as a pizza topping along with tomato sauce and fresh mozzarella
–    Add fresh or dried basil to tomato-based pasta sauces
–    Add chopped fresh basil to fruit salads or green salads for a refreshing flavor twist
–    Mix with ripe tomatoes, garlic, oil, and balsamic vinegar for a quick bruschetta appetizer

Selecting basil:
–    Choose fresh basil over dried basil when possible, as fresh basil contains the basil oils.
–    Look for vibrant, green basil leaves.  Store fresh basil in the refrigerator; fresh basil can also be frozen.

References:
1.    USDA National Nutrient  Database for Standard Reference. Available at: https://ndb.nal.usda.gov/ndb/foods/show/262?fg=&man=&lfacet=&count=&max=&sort=&qlookup=&offset=&format=Stats&new=.  Accessed June 1, 2012.
2.    Prakash P, Gupta N. Therapeutic uses of Ocimum sanctum Linn (Tulsi) with a note on eugenol and its pharmacological actions: a short review. Indian Journal Physiol. Pharmacol 2005; 49: 125-131
3.    Elgayyar M, Draughon FA, Golden DA, Mount JR. Antimicrobial activity of essential oils from plants against selected pathogenic and saprophytic microorganisms. J Food Prot 2001 Jul;64(7):1019-24.
4.    Biljana Bozin, Neda Mimica-Dukic, Natasa Simin, and Goran Anackov. Characterization of the Volatile Composition of Essential Oils of Some Lamiaceae Spices and the Antimicrobial and Antioxidant Activities of the Entire Oils. J Agri Food Chem 2006; 54(5): 1822-1828.
5.    Sánchez E, García S, Heredia N. Extracts of edible and medicinal plants damage membranes of Vibrio cholerae. Appl Environ Microbiol. 2010 Oct;76(20):6888-94. Epub 2010 Aug 27.

Image source: https://www.onlyfoods.net/wp-content/uploads/2011/09/Basil-Pictures.jpg

By Jessica Currier

I’m sure most of you remember the chia pet, the clay figurines with sprouts of chia to resemble hair or fur, or at least the jingle on their advertisement, “Chi-Chi-Chi-Chia!” If you haven’t heard already, you probably will soon, people are now consuming chia seeds for the added health benefits. Who would have thought that a garden ornament could be ingested to promote health and vitality?

Chia seeds are from the desert plant Salvia hispanica, a member of the mint family, and can be eaten raw or added to dishes (1). Consumers add chia to baked goods, breads, porridges, smoothies, and can be ground and added to water or milk. The seeds can be purchased at local health food stores or online. The familiar chia hair or sprouts can also be eaten and added to salads, sandwiches, and other dishes (1). Numerous claims can be found in the media concerning chia. Chia being an excellent source of fiber, omega-3 fatty acids, protein, and antioxidants are some of the proposed claims. The media also claims that chia can help cut cravings, balance blood sugar levels, improve cardiovascular disease, lower cholesterol, triglycerides, blood pressure, and can promote weight loss. This exceptional list of health benefits really peaked my interest to find out the real scoop concerning chia seeds.

It is true that chia seeds do provide omega-3 fatty acids and contain fiber, antioxidants, protein, and minerals (1). While claims of weight loss and decreases in daily cravings may be a bit far fetched, increases in satiety due to the fiber and protein content may be valid. A study conducted by Nieman and Colleagues concluded that ingestion of 50g/d of chia seeds for 12 weeks did not influence body mass, composition, or disease risk factors in overweight/obese men and women (2). A recent study published in The Journal of Nutrition viewed the effects of a specific dietary pattern on Metabolic Syndrome (3). Sixty-seven participants with Metabolic Syndrome were involved in the study and were given a mixture to drink twice a day. The mixture chosen was based on antihyperglycemic, antihyperinsulinemic, hypolipidemic, anti-inflammatory, and antioxidants effects (3). Chia seeds were included in this mixture because of the presence of fatty acids and antioxidants that promote a reduction in the inflammatory response (3). This study concluded that a dietary pattern of nopal, chia seed, soy protein, and oat showed a reduction in serum triglyceride levels, serum CRP (C-Reactive Protein test, indicates acute inflammation or infection), and insulin AUC (3).

Although this study does provide encouraging outcomes, more research needs to be done with the conjunction of chia seeds helping to improve cardiovascular disease, lowering cholesterol, triglycerides, blood pressure, and weight loss promotion (1). Little published research concerning chia exists, and most information available is based on lab animals not humans (1). So remember, be an informed consumer with a critical eye when reviewing media claims. If you are looking for fiber or antioxidants, chia seeds would be a great addition to your diet; but for weight loss, stick with good old exercise and healthy food choices!

References:

1) Academy of Nutrition & Dietetics. What are Chia seeds? Are There Health Benefits?

2) Nieman DC, Cayea EJ, Austin MD, Henson DA, McAnulty SR, Jin F. Chia seed does not promote weight loss or alter disease risk factors in overweight adults. Nutr Res. 2009;29:414- 418.

3) Guevara-Cruz M, Tovar A, Aguilar-Salinas C, Medina-Vera I, Gil-Zenteno L, Hernandez-Viveros I, Lopez-Romero P, Ordaz-Nava G, Canizales-Quinteros S, Guillen Pineda L, Torres N. A Dietary Pattern Including Nopal, Chia Seed, Soy Protein, and Oat Reduces Serum Triglycerides and Glucose Intolerance in Patients with Metabolic Syndrome. J. Nutr. 2012;142:64-69.

By: Ann L.

Over 300,000 American children under the age of 14 are living with epilepsy.  Some children can have hundreds of seizures per day, which can severely limit their ability to participate in social activities.  Seizure control is important for helping kids achieve otherwise normal lives.

In the 1920s, it was noted that children who fasted for up to three weeks were seemingly cured of their epilepsy.  Dr. Wilder at the Mayo Clinic was the first to describe a diet designed to mimic this starvation state that was high in fat and low in carbohydrates.  However, due to the development of anticonvulsants in the 1930s, the diet fell out of favor and was deemed unnecessary.  Since the mid-1990s, there has been renewed public and scientific interest in the ketogenic diet to treat epilepsy that is not responsive to drugs.

What is the ketogenic diet?  

The classic ketogenic diet provides 90% of calories from fat, a minimum of 1 g/kg protein, and minimal carbohydrates.  The ratio of fats to protein and carbohydrates is 4:1.  Heavy cream, butter, and oil are some of the foods that can become staples of children on a ketogenic diet.  The diet does require vitamin and mineral supplementation.

When should a ketogenic diet be used?

According to a 2008 consensus report from an international expert panel, the ketogenic diet “should be offered to a child after two anticonvulsants are used unsuccessfully” (1).  The diet must be started under close medical supervision in consultation with a physician and a dietician.

Is it an effective treatment?

In 2008, the first randomized controlled trial of the ketogenic diet demonstrated that 38% of children on the ketogenic diet had a >50% reduction in seizures compared with only 6% in the control group (2).  Observational studies have also reported similar rates of seizure control achieved by use of the ketogenic diet.  For children who achieve seizure freedom, 80% will remain seizure free after discontinuation of the diet.

Are there any long-term health consequences?

While the duration of time spent on the ketogenic diet varies widely between individuals, most children stay on the diet between 1-2 years.  Some of the major concerns with the ketogenic diet include impaired growth, kidney stones, and dyslipidemia.  Patients must follow up regularly with their physicians to monitor growth and blood chemistries.

Further Reading:
1.  Freeman JM, Kossoff EH.  Ketosis and the ketogenic diet, 2010: advances in treating epilepsy and other disorders.  Adv Pediatr. 2010;57(1):315-29.
2.  Neal EG et al.  The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial.  Lancet Neurol. 2008 Jun;7(6):500-6. Epub 2008 May 2.
3.  The Charlie Foundation.  https://www.charliefoundation.org/

By: Harini S.

Coconut water has long been the drink of choice for cooling parched throats in my home country of India and other tropical regions in Southern and Southeastern Asia as well as South America.  It is delicious, relatively cheap and is often a hygienic alternative to plain water, since it is drunk directly out of its tender coconut shell.  It is often prescribed as an adjunct therapy for dehydration due to gastroenteritis, and there are even sporadic reports in the literature of its use as a short term intravenous hydration agent, when medical saline is unavailable1.  Apart from these medical uses, it is also ubiquitous on the streets and beaches of western and southern India, where after people enjoy the cool coconut water itself, the coconut-vendor splits open the coconut and scrapes out the sweet translucent coconut flesh, which is particularly enjoyed by children.

Picture 1: A coconut vendor in southern India, a tender coconut ready to drink, and the flesh of a young coconut being scraped with a piece of the husk.

Cocos Nucifera, belonging to the palm family (Arecaceae) has long been cultivated in the tropics due to the multitude of uses for different parts of the tree.  Everything from the leaves to the outer husk of the coconut is used in the production of decorative as well as utilitarian items.  When the coconut is young, the outer husk is a light green in color and is quite easy to pierce with a sharp knife.  Coconut water is the clear liquid found in the center of a young coconut.  (This is not to be confused with coconut milk, which is, well, milky in color and made by grinding and squeezing the flesh of a much older coconut.)  Depending on soil conditions, coconut water ranges from very sweet to neutral to even slightly acidic in taste.  This is probably why the Brazilian coconut water I purchase here does not taste exactly like the Indian coconut water I grew up with, but it still evokes memories in my mind of balmy evenings spent chasing waves on the beaches of Bombay.

Nutritionally speaking, coconut water is a superstar of hydration.  It is naturally fat free and low in sugars.  According to various nutrition labels, a cup of coconut water contains about 10 g of natural sugars contributing upto 45 calories.  It also contains 600-680 mg of potassium (12%-14% of daily value), 40-60 mg of sodium (2%-3% of daily limit) and upto 6% and 10% of your daily calcium and magnesium needs, respectively.   Sports drinks generally contain a lot more added sugars, very little potassium, almost no calcium or magnesium, but a lot more sodium, which is the main electrolyte lost during intense physical activity.  So, while coconut water may not make the ideal sports drink on its own, combine it with a handful of salted pretzels, and you’re good to go.  Not only does it have a many more beneficial electrolytes, it is also free of the various preservatives and food colorings that are added to the glow-in-the-dark colored sports drinks that are on the market.  There are many different brands of packaged coconut water available in the US market these days.  They generally come in cans (which I find impart an unpleasant aftertaste to the water itself) or in tetra-paks, which, in my opinion, house a much better product.  While some products do contain extraneous ingredients, there are several which list simply coconut water as the only ingredient.  So perhaps the next time you are considering the beverages in your store, pick up a packet of coconut water and as you sip this refreshing drink, you too may be instantly transported to a sunny golden beach with the warm waters of the ocean gently lapping at your toes.

1.  Campbell-Falck D, Thomas T, Falck TM, Tutuo N, Clem K (2000). The intravenous use of coconut water. Am. J. Emerg. Med. 18 (1): 108-11.