A Conversation with ASN Executive Officer John E. Courtney, PhD
By Teresa L. Johnson, MSPH, RD

The smile on Dr. John Courtney’s face says it all: ASN’s Scientific Sessions and Annual Meeting at EB 2015 is the place to be. Courtney, who is in his ninth year as ASN’s Executive Officer, sat down with me on a sunny afternoon in Boston and chatted about the meeting and ASN’s current and future status.

TJ: What’s your favorite thing about ASN’s Annual Meeting?
JC: It’s so great for bringing together the wide, diverse audience of ASN in one central convening area. We have members in basic, clinical, and translational nutrition, and they’re housed in academia, medicine, practice, and industry. So it’s exciting to give people an opportunity to develop and build partnerships and work together, not only to advance the science but their personal careers too.

TJ: Tell me about the changes ASN members can expect to see in 2018.
JC: ASN will convene a nutrition-focused Scientific Sessions and Annual Meeting for three years beginning in 2018. EB has been a great forum for people to work within, but we think that having a nutrition-focused meeting brings together members of the nutrition science community where they can all meet and convene. It will be a smaller meeting so it will be more open to networking, less confusing, and have less competition for scheduling to allow productive connections. I envision us having a lot more flexibility in how we structure our meeting. We’ll probably do it outside the academic year, and we’ll do it in a cool place!

TJ: What are you hearing from the members regarding this change?
JC: There’s been great support from our members, and a lot of excitement. Of course, our current president, Dr. Simin Nikbin Meydani (pictured below with Dr. Courtney) of Jean Mayer USDA HNRCA at Tufts University, is a fantastic leader with great skills in consensus-building. If you make changes, you really have to go the extra mile in seeking input and cultivating agreement, and she’s done that.

TJ: How will ASN maintain the same level of quality in its meeting?
JC: A lot of questions have been raised about how we can do it the best way. Some people are concerned because they like the EB model—they like the “cross-fertilization” of scientific disciplines—so one of the things we’re hearing loud and clear is that we need to keep that cross-fertilization. So we’ll offer programming that meets all the segments of ASN’s needs.

TJ: What will be unique about ASN’s meeting?
JC: I see us having a lot of different types of activities. We can take a look at how to offer sessions that reach out to the public. Right now we reach the researchers and the practitioners, but we want to take that next leap and start to engage the public.

We’re also planning sessions that are unrelated to nutrition. Maybe we’ll hear about the newest, hottest thing in the future of information technology or the potential role that robotics can play in personalized health!

Perhaps we’ll have an inspirational session that brings in that spectacular leader or renowned speaker who says, “This is what the world is going to look like in 2050,” and asks, “How can people working in nutrition prepare for the challenges and the opportunities that will be taking place then?”

TJ: How is ASN poised to address the next five years?
JC: We have a strategic map that focuses on positioning ASN as the global authoritative leader in nutrition science. We have an actionable dashboard that identifies what our key problematic areas are and we’ve developed strategies that fit and help us meet those challenges.

For example, one of the exciting strategies that our incoming president Dr. Patrick Stover, Cornell University, wants to focus on is positioning ASN for 2028—the 100th anniversary for the Society. So, rather than looking at what we want to be in five years, we’re asking what we want to do and be in 2028; then we’re breaking it into chunks that will get us there. We’re looking at an endpoint to best add the most value.

TJ: What kinds of initiatives do you anticipate ASN will launch here in the US and abroad?
JC: I expect we’ll have a lot more topical meetings throughout the world. We have meetings now in the Middle East, Central and South America, and Asia, but I see us really taking off so that ASN will have a presence in every major continent in the next five years. Although we have that presence now with members, we don’t offer a lot of programming outside of the States so that’s what we want to do—develop programs that meet those members’ needs and grow even more.

TJ: Will ASN still be called “American Society for Nutrition”?
JC: That’s a great question! We’ve dialogued about that and had a lot of good feedback about it. I don’t envision us changing ASN—I really don’t—but we’re a volunteer organization, and if our volunteers should wish to change it, perhaps we’ll simply refer to ourselves as “ASN.” When we say our name, we each have some vision of what that means, but what we really are is a global organization. We have over 5,200 members in 72 different countries, and approximately 28% of the meeting attendees are from outside the United States. Clearly we’re drawing a global audience.

TJ: What keeps ASN relevant?
JC: ASN really is the global leader in nutrition science. Our members, our authors, and our speakers are the preeminent leaders in nutrition. They’re the ones researching today’s problems, disseminating that research through our publications and our meeting-related activities, and then taking it and translating that to dietitians, medical practitioners, and public health advocates.

ASN is really on the move. We’ve more than doubled our membership, outreach, staffing and budget in the last 10 years. In the next 10 years I think we’ll see equivalent growth in terms of our revenue and our member service activities, so we’ll have more interaction on a grander scale.

For a first-person take on Dr. Courtney’s management style, watch his video interview with CEO Update here.

By Hans Chiang

I used to be very picky with my food as a child. My parents tried multiple ways to keep me on a well-balanced diet. My interest in nutrition sparked when my parents persuaded me to eat carrots by claiming “carrots are good for your eyes.” While I did not have the scientific fundamentals and resources to research the biochemical mechanism that validates their claim at that age, I trusted my parents, labelled carrots as “good food” and tried to incorporate them into my food choices. When taking biochemistry in my undergraduate studies, these mysterious interactions between foods and the human body unfolded as I learned the science behind how nutrients actually work. Realizing how dietary intake plays a huge role in disease prevention and treatment, I wanted to advance my nutrition education in medical school so that I can provide relevant nutritional guidance to my patients as a physician.

For this reason, I applied for a position in the ASN Clinical Nutrition Internship Program during the summer after my first year of medical school at Indiana University School of Medicine. The program provided me with valuable experiences; not only did I learn about nutritional science from registered dietitians, I also shadowed physicians of different specialties, observe procedures, and learn how they incorporate nutrition into their fields of practice. On top of the clinical exposure, I reviewed my physiology and biochemistry by participating in literature research with my mentor and writing a research paper on the assessment and dietary modulations of endothelial functions.

I had the opportunity to learn from dietitians who assist different patient populations. I spent time in a diabetes care center, a hospital pulmonary and cardiac rehabilitation unit, a retirement community, a cancer radiation center, the local WIC clinic, a community health clinic, the Volunteers in Medicine clinic of Monroe County, and the University Student Health Center. I was surprised to learn how diets are formulated so differently for each unique population. In addition, I learned to appreciate the communication techniques dietitians use to encourage their patients to follow an optimized diet. As a future physician, I would also be working with a very diverse population and these are all useful techniques I can use in my practice.

Besides learning about nutrition from dietitians, I participated in nutrition support rounds and shadowed physicians in different specialties. I shadowed a gastroenterologist and observed esophagogastroduodenoscopies (EGD), colonoscopies, colon decompressions, and gastric tube insertions. I shadowed a bariatric surgeon and observed lap band, cholecystectomy, and hernia repair procedures. I also spent time with an oncologist, a pediatrician, and an endocrinologist to learn about how weight control plays an immense role in treating cancer patients, infants, teenagers, and diabetic patients.

The Clinical Nutrition Internship Program was a wonderful enhancement to my education in becoming a physician. Besides learning about the various roles nutrition has in the health care field, I also obtained valuable communication skills through observing the interactions between the health care professionals and their patients. Regardless of the specialty I pursue in the future, I will be able to incorporate what I learned through this internship into my practice to provide my patients with the best care and education. I enjoyed the eight weeks of the internship very much and am very grateful to have had this opportunity.

By Kevin Klatt @nutrevolve

The concept of food addiction is of particular relevance to field of nutritional sciences. The conversation in popular media describes food addiction as though there is scientific consensus surrounding the topic. However, its lack of inclusion in the DSM-V leaves many evidence-based practitioners skeptical about using this kind of terminology. To understand this disconnect, I reached out to Jennifer Nasser, PhD, RD, to hear a researcher and clinician’s perspective on this controversial topic.

Dr. Nasser is an associate professor in the Nutrition Sciences Department at Drexel University’s College of Nursing and Health Professions. Her research focuses on the neurobiological aspects of food intake and preference. Her current research uses the non-invasive functional near-infrared spectroscope (fNIR) to measure brain activity under varying nutrient and metabolic conditions.

Q: Documentaries like FedUp, books such as Wheat Belly and seemingly countless articles circulating the internet throw around the term ‘food addiction’ as if it’s fact. What are your thoughts on the term ‘food addiction’?

A: The problem with the term “food addiction” is two-fold. One problem is that it is defined differently by different groups of people interested in the topic, i.e. the lay consumer uses addiction to describe “loss of control” over anything, but especially their favorite foods; the clinician uses the term to couple “loss of control” and feelings about “loss of control” with social and health consequences; and the behavior pharmacologists don’t use the term because of its clinical associations, rather they focus on the behavior and neurobiology associated with the five domains that characterize “drug addiction”:
Dependence = how difficult to quit
Withdrawal = presence and severity of symptoms in absence of substance
Reinforcement = ability to promote use over other substances i.e. “loss of control” over use
Tolerance = how much is needed to satisfy increasing cravings and level of stable need
Intoxication = mind altering stupefaction, excitement or euphoria that renders a person unable to act competently.
These domains are all based upon the principle that there is no “natural” satiety system for drug use and no beneficial need for “addictive” drugs. This brings us to the second and more important problem with the term “food addiction”, namely that there is a built in system meant to control food intake in the body and there is an obligatory need to consume food. Consequently, any determination of “food addiction” must be made while controlling for the contribution of the natural control system and need for food and nutrients.

Q: What is the neurobiological basis of this?

A: Many neurobiological systems are involved in controlling food intake. There are different orexigenic and anorexigenic peptides (with brain and gut sources) involved as well as neurotransmitters in the brain that contribute to the desire for food. Examples: orexigenic peptide- ghrelin, some endogenous opioids and endocannabinoids; anorexigenic peptides- leptin, glp-1, cck, amylin; neurotransmitters- dopamine, serotonin, norepinephrine, acetylcholine, endogenous opioids and endocannabinoids, gaba, glutamate.

Q: Is there a gold standard technique in this research? What lines of evidence will be required to prove/disprove that individuals may struggle with food addiction-related behavior?

A: The DSM-V committee that focused on addiction declined to add “food addiction” as a recognized mental illness stated that there is not definitive evidence for its addiction. One important piece of missing information is which nutrient(s) form the basis for the addiction. Is there just one “addictive” component to food? Is the addiction to the social associations surrounding food?

With respect to a gold standard technique: reinforcement by operant responding is used to determine the relative reinforcing value of drugs and to get them classified for addiction potential. Some people have published food reinforcement studies, myself included. However, if you compare across these studies you find that some are done when people are fasting and a few are done in the satiated, fed state. The results vary depending upon the feed status of the participants and there’s not agreement yet in the field as to the proper conditions for defining addiction potential of various foods.

Q: I’ve seen many argue that sugar lights up the same areas of the brain as addictive drugs, and, from this, conclude that it too is addictive. Coming from an evolutionary biology background, it makes sense to me that pleasurable nutrients would show this response in the brain. I’m not sure how the primate tree of life would’ve fared if they stumbled onto fruit and thought ‘meh’. How do you distinguish between a normal physiological pleasure response to nutrients and addictive behavior?

A: Good point. As I said above, one way is to compare responses in the fed and fasted state. (See Nasser et al. Obesity 2008 16:1816-1820).

Q: I first heard about loss of control (LOC) eating while reading some nutrigenetic research looking at specific FTO genotypes (rs9939609) and their relationship with this sort of eating behavior. Do you think that certain individuals are more prone to LOC eating?

A: Possibly, in addition to FTO, there’s some evidence that there are differences in the dopamine transporter gene and D2 receptor genes that confer more susceptibility towards LOC.

Q: The whole concept of LOC eating seems to narrow in on processed foods. Do you think this behavior is independent of processed food consumption? The focus on just sugar seems to be a bit unscientific. Dosage and context of the whole diet are always factors in nutrition – is there research to show they matter with LOC eating? I know there has been other research on the same FTO SNP associated with LOC episodes that used higher protein intake to alter appetite.

A: The focus on sugar is backed by scientific evidence with respect to sugar being the important reinforcing component even in sugar/fat mixtures (see Naleid et al 2008). With respect to neurotransmitter release, both sugar and fat have shown dose response in relation to dopamine release. (see papers by Hajnal and Bello). Both of these studies have used rats.

Part of the problem of defining the causative substance still comes down to having an agreement as to whether we’re talking about domains/characteristics of “addictive” like behavior or we’re saying that “activation” of similar brain regions by food and drugs of abuse constitute “food addiction.”

With respect to protein and appetite, I think that again we need to have agreement that experiments to investigate “food addiction” need to use fed, objective calorically satiated participants. Protein is a good satiating and satiety promoting macronutrient. If we agree on a standard physical condition for our participants, we could then look at the relative reinforcing power of various food components with respect to the five domains of “addiction” and get some standardized answers. From there we can then make a collective decision as to whether the reinforcing and/or other domain characteristics seen under standardized conditions rise to a level of concern that needs to be labeled as food addiction.

Q: The IOM recently convened a panel on food addiction. What were the takeaways from this?
A: The IOM is going to release proceedings from their meeting soon, so I think it’s best to wait for the official version of the consensus of the meeting.

Q: If people are interested in this topic, what journals or labs would you specifically recommend following?
A: Journals: Appetite, Physiology and Behavior, AJCN, Biological Psychiatry, Neuroimage, Science to name a few.

There are a lot of people actively working in this field and I don’t want to not mention anyone, so I would suggest doing a PubMed search, and also a RePORTER search on the NIH website to find those funded to work in food addiction, LOC eating and binge eating, as well as addiction in general.

Q: What are your caveats to other scientists and clinicians with interpreting this research?

A: I agree with the DSM-V committee that we need to define the component(s) of food that promote addictive behavior. Additionally I think it’s very important to define “addiction”-related factors as those that occur in the fed, satiated state. Until we satisfy our natural nutrient needs, the concept of addiction is irrelevant. It’s the food intake and accompanying calories that are consumed beyond metabolic need that create the negative health consequences.