Is TMAO from Fish, Meat and Eggs Harmful?

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In another confusing nutrition story that should be titled “is there anything left for us to eat?” recent research threw a curveball. Fish, a staple of the Mediterranean diet, as well as meat and eggs may be doing more harm than good thanks to a compound called trimethylamine-N-oxide (TMAO). TMAO is found in fish and produced in the body after eating meat and eggs. TMAO is linked to greater risk for heart attack, stroke and death; yet the research isn’t crystal clear. Is it time to give up fish meat and eggs or ignore the recent media headlines?

This post will cover:

  • TMAO: More than a Gut Reaction—What gives us higher TMAO levels?
  • TMAO and health?
  • The bottom line

TMAO: More than a Gut Reaction

Blood levels of TMAO are ~ 50 times higher after eating fish compared to eggs or beef. The human body absorbs intact TMAO like the kind found in fish, easily. However, the human body’s production of TMAO, after eating foods containing the essential nutrient choline (found in eggs and meat) and the compound l-carnitine (found in meat and pork and in much smaller quantities in chicken breast and dairy products), depends on the makeup of bacteria in your gut, kidney functioning and genetics.

In one study, regular meat eaters produced more TMAO than a vegetarian did after eating steak (which contains ~ 180 mg of l-carnitine). After wiping out their gut bacteria with antibiotics, the carnivores didn’t produce any TMAO after consuming 250 mg l-carnitine. The makeup of gut bacteria in the habitual meat eaters was presumably responsible for greater TMAO production compared to the vegetarian, yet this was a small study and we don’t know anything else about the participants’ diet. Was it the meat that altered gut bacteria or something else in their diet? After all, a steady diet of red meat may mean double cheeseburgers on white bread with regular servings of French fries and soda on the side. This isn’t exactly the diet you want for promoting good bacteria in your gut.

Another study found blood levels of TMAO were greater in those with a less diverse makeup of microbes and greater amounts of a less healthy type of bacteria (firmicutes), compared to one that is healthy (bacteroidetes). A diet higher in saturated fat will promote this environment.

While bacteria seem to influence TMAO production from l-carnitine, l-carnitine also influences the makeup of gut bacteria. A study in mice found those with their gut bacteria wiped out thanks to antibiotics produced a different makeup of bacteria in the gut after consuming l-carnitine while also doubling the risk of plaque buildup in their arteries.

Higher TMAO levels come from:

  • Eating fish
  • Less diverse array of gut bacteria and increased levels of bad versus good bacteria
  • Consuming l-carnitine (mouse study)

TMAO and Health

A few human studies found higher blood levels of TMAO were associated with greater risk for heart disease. However, all research isn’t pointing in the same direction. One study in over 300 patients found blood TMAO levels were not associated with heart attack or heart disease over the course of eight years, following the initial test for TMAO. However, TMAO levels were higher in those with diabetes, patients with metabolic syndrome and those with declining kidney functioning. Another study examined over 800 people between the age of 33 and 55 and found blood TMAO levels were not associated with clogged arteries, insulin resistance (this comes before type 2 diabetes) and inflammatory markers or negative changes in blood lipids suggesting TMAO levels might not contribute significantly to the progression of clogged arteries. However, this study shows TMAO levels were significantly lower than in previous research, showing an association between TMAO and heart disease.

TMAO is considered a risk factor for cardiovascular disease. In those with type 2 diabetes, higher TMAO levels are associated with greater risk for death, heart attack, heart failure and unstable angina (chest pain). Also, higher levels of circulating TMAO are associated with higher risk of death in those with chronic kidney disease and greater risk of certain cancers. Yet, there are several confounding factors. Fish is the primary culprit for higher acute circulating TMAO levels, yet fish-based diets are associated with reduced risk for heart disease. Also, levels of TMAO are dependent upon disease state and the makeup of gut bacteria. Therefore, at this time it isn’t entirely clear which came first – does TMAO cause disease or does TMAO increase due to disease?

The Bottom Line

The story on TMAO isn’t crystal clear, so there’s no reason to avoid fish, meat and eggs in an effort to decrease TMAO levels. All three of these foods are good sources of several nutrients important for health. Though processed red meats are linked to higher risk of colorectal and stomach cancers, when cooked appropriately (lower, moist heat for example) red meat can fit into a healthy diet and deliver important nutrients including iron, zinc and vitamin B12. Eggs are an economical source of protein and contain many nutrients and compounds that contribute to health including two antioxidants important for eyesight.

Though there is no reason to completely avoid these foods, you can alter your diet to help diversify gut bacteria and also increase the amount of good versus bad bacteria. Probiotic rich foods such as yogurt and kefir with live and active cultures, miso soup, tempeh and other fermented foods contain good bacteria. Fiber-rich plant foods (fruits, vegetables, legumes) are important food sources for bacteria to thrive in your body.

Disclosure: this post was sponsored by USFRA. All views are my own and backed by research.

References
Koeth RA, Wang Z, Levison BS et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 2013 Apr 7.

Cho CE, Caudill MA. Trimethylamine-N-Oxide: Friend, Foe, or Simply Caught in the Cross-Fire? Trends Endocrinol Metab 2016 Nov 4. [Epub ahead of print]

Cho CE, Taesuwan S, Malsheva OV, Bender E, Tulchinsky NF, Yan J, Sutter JL, Caudill MA. Trimethylamine-N-oxide (TMAO) response to animal source foods varies among healthy young men and is influenced by their gut microbiota composition: A randomized controlled trial. Mol Nutr Food Res 2016 Jul 5.

Carnitine. Health Professional Fact Sheet, NIH. https://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/

Mueller DM, Allenspach M, Othman A, Saely CH, Muendlein A, Vonbank A, Drexel H, von Eckardstein A. Plasma levels of trimethylamine-N-oxide are confounded by impaired kidney function and poor metabolic control.Atherosclerosis 2015;243(2):638-44.

Meyer KA, Benton TZ, Bennett BJ, Jacobs DR Jr., Lloyd-Jones DM, Gross MD, Carr JJ, Gordon-Larsen P, Zeisel SH. Microbiota-Dependent Metabolite Trimethylamine N-Oxide and Coronary Artery Calcium in the Coronary Artery Risk Development in Young Adults Study (CARDIA). J Am Heart Assoc. 2016 Oct 21;5(10). pii: e003970.

Save Money at the Grocery Store, Improve Health & Save the Earth

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Food: Fruits and vegetables

 

 

Today is Earth Day, a day focused on building a healthy, sustainable environment. Keep the earth healthy, slash your grocery bill and improve your health at the same time. Here’s how:

Avoid Food Waste

In America, food is cheap and always available. This oversupply of food combined with food marketing means we over buy and end up throwing out an average of 31 – 41% of the food we purchase. In addition to throwing your hard earned dollar in the trash can, food waste drains the environment. Rotting fruits and vegetables, the top food wasted, uses fresh water and contributes to ethylene gas, methane and CO2 emissions all of which are harmful for our environment (1). “Food waste now accounts for more than one quarter of the total freshwater consumption and ∼300 million barrels of oil per year” (1). Rotting food produces a large amount of methane gas, a gas that has 25 times the impact of CO2 on global warming (3). Dairy products are second behind fruits and vegetables followed by meat, which has the biggest impact on the environment.
Here’s what you can do to avoid waste:

    1. Use a shopping list to prevent impulse buys. It doesn’t matter if it’s on sale if you will end up throwing it out.
    2. Buy small amounts and only what you need and will realistically use before it goes bad.
    3. Buy frozen and canned versions, which have the same nutrition value and you can use them at your convenience (metal cans are endlessly recyclable)
    4. Keep fruits and vegetables fresh or for longer period of time with products that decrease the production of ethylene gas (find them in your local natural food store in the produce section).
    5. Don’t automatically throw food out when the “use by” date arrives. That date is a measure of quality and not food safety. Assess your food to ensure it is still safe (smell your meat, poultry, fish, dairy, nuts and oils; make sure fruits and vegetables are not molded).
    6. Follow these tips from Reader’s Digest.

Choose Plant Proteins

Plant proteins typically cost less $ than meat, fish and poultry and they cost less in terms of environmental resources to produce – less water, fewer environmental gases produced. Plant proteins also deliver plant-based compounds that protect the body. When choosing plant proteins you may need more, per meal, to get the right amount of muscle building amino acids.  In addition to swapping out some meat-based meals, consider eating smaller amounts of meat and adding a plant protein as a side dish. Here are some excellent choices based on their nutrition profile:

  • Peas, split pea soup
  • Legumes, beans, bean pastas, lentils (I soak lentils for about 45 minutes and add them to a variety of dishes)
  • Soy foods including tofu, tempeh, edamame
  • Nut, bean and other flours –  substitute some of the flour in your  recipe for: pecan, peanut, almond, garbanzo bean, fava bean, black bean and other higher protein flours

Buy Staples in Bulk

Whole Foods, Sprouts, Wegmans and similar stores have a bulk section where you can get everything from black rice to oatmeal. Consider shopping in the bulk isle. You’ll save $ and food packaging!

Tackling Concussions Head-On: How Nutrition Can Improve Outcomes

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football

I sat on the floor hunched over and crying. My elbows were raised – close to my eyes as my arms hugged my head, hands clenched at the base of my neck. My brain felt like a percussion instrument shaking inside my skull. As the pounding grew more intense the pain became unbearable. I had a concussion, my second in two years, which earned me a night in the ER.

Concussions are common in sports and recreation. Though considered a mild type of traumatic brain injury because they are usually not life-threatening, all concussions should be taken seriously. A single blow to the head can result in short-term loss of brain functioning or long-term changes in thinking, language, emotions and sensations including taste, touch and smell (1). Repeated concussions can be very dangerous and may lead to permanent changes in brain functioning or in extreme cases, death (2). Though widely recognized in football players, concussions happen in all sports – even in everyday activities – and they are occurring at younger ages. Athletes who have had one concussion have a greater risk (2 – 5.8 times higher) of experiencing another concussion (3). Multiple blows to the head could lead to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease associated with poor memory, changes in personality, behavior, speech and gait (4). Posthumous examination of some former NFL players in addition to a few college football players who committed suicide revealed CTE. In March 2016, the NFL acknowledged the link between traumatic brain injury and CTE. The movie ‘Concussion,’ set for release in late December, 2015 highlights concussions in former NFL players though the league has gone to great lengths to make today’s game safer.

Decreasing the Damaging Effects from Concussions

Anyone who experiences a blow to their head or body (a forceful blow to the body can cause the brain to shake inside the skull) should be immediately examined by a physician with experience in the evaluation and management of concussions. Though the person may say they feel fine and can continue with regular activities, symptoms of concussion do not always appear immediately and may instead be delayed for several hours. Continuing to play or perform mental tasks like studying can increase severity or symptoms and cause complications including the possibility of developing permanent brain damage.

Symptoms of Concussion may include:

  • Confusion
  • Headache
  • Vision changes
  • Memory loss
  • Difficulty with coordination, clumsiness or stumbling
  • Dizziness
  • Irritability
  • Personality changes
  • Slurred speech
  • Delayed response to questions
  • Nausea or vomiting
  • Sensitivity to light and noise
  • Problems sleeping
  • Seizures
  • Loss of consciousness

In addition to the symptoms that occur soon after a concussion, some people experience Post-Concussion Syndrome (PCS) days or weeks later. PCS can cause many of the same symptoms experienced after a concussion as well as trouble concentrating, apathy, depression and anxiety. Symptoms may last a few weeks. If you suspect PCS, have the patient evaluated by a psychiatrist (5).

Nutrition Management

In addition to rest, following a graduated return-to-play and school protocol, and other steps you should take to treat concussions, emerging research suggests nutrition may play an important role. Certain nutrients seem to help reduce some of the damaging effects from concussions:

Protein: 1 – 1.5 grams of protein per kg body weight per day is recommended along with sufficient calories to reduce the inflammatory response (6).

EPA and DHA Omega-3 Fatty Acids: EPA and DHA, omega-3 fatty acids found in fish and algae, increase fluidity of cell membranes, reduce inflammation and enhance cerebral blood flow (which is reduced for up to a month or longer in athletes that recover slowly) (7). Cell membranes are like gateways allowing substances to enter cells or blocking their entry. When cell membranes are more fluid (and therefore less rigid), they perform better, opening the gate for nutrients to come in. DHA, in particular, makes up 97% of the omega-3 fatty acids in the brain and is essential for normal brain functioning (8). Several animal studies show EPA and DHA supplementation before or after a traumatic brain injury helps limit structural damage and decline in brain functioning (9, 10, 11, 12, 13, 14, 15).

There is no clear consensus regarding optimal intake of EPA and DHA prior to or after a concussion. Given that many Americans do not eat enough fish and an estimated 75% of American diets are too low in EPA and DHA, it makes sense to start by meeting the general guidelines for recommended intake of EPA and DHA by:

  • Consuming fatty fish varieties that contain high levels of omega-3s, including salmon, tuna, mackerel and herring at least twice per week;
  • Take an omega-3 supplement providing EPA+DHA daily (be sure to look for high-quality fish oil, algal oil or krill oil supplements in your local grocery or health store);
  • Eat and drink DHA omega-3-fortified foods and beverages, including milk, 100% juice, and yogurt.

Research has yet to identify exactly how much EPA + DHA may be helpful after a concussion. However, according to the Food & Drug Administration (FDA), doses of EPA + DHA up to 3 grams per day are considered safe.

Zinc is necessary for optimal brain functioning while a deficiency of this mineral may compound oxidative damage from concussions. Though zinc supplementation may be an effective treatment modality, additional research needs to determine if zinc supplementation is safe after concussions. The Upper Limit for zinc is 40 mg per day.

Animal and human studies suggest creatine helps prevent secondary brain injury after traumatic brain injury. However, animal studies show long-term creatine intake may decrease its beneficial effects on the brain after injury. Future research needs to better elucidate the relationship between creatine pre-TBI and creatine post-TBI and outcomes.

Other potential approaches to addressing concussions through nutrition include ketogenic diets which are very high-fat, minimal-carbohydrate diets that are effectively used to decrease both the incidence and severity of seizures in children with epilepsy. Ketogenic diets provide an alternate energy source for brain functioning – ketones derived from the breakdown of fat. This may be important since available glucose, the primary energy source for brain functioning, may be decreased after a concussion.

Current research supports the integration of a dietitian into the team of health professionals treating concussions. Though nutrition interventions are considered preliminary at this time, consideration should be given to nutrition strategies that may reduce long-term effects while causing no further harm.

Disclosure: I am a GOED/Omega-3 Science Advisory Council Member supporting the research behind omega-3 EPA and DHA for a healthy brain, heart and eyes.

References

1 What are the Potential Effects of TBI? Injury Prevention & Control: Traumatic Brain Injury. CDC. http://www.cdc.gov/TraumaticBrainInjury/outcomes.html

Concussion (Traumatic Brain Injury). Pubmed Health.

3  Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26. http://www.amssm.org/Content/pdf%20files/2012_ConcussionPositionStmt.pdf

4  McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte T, Gavett BE, Budson AE, Santini VE, Lee H, Kubilus CA, Stern RA. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropathol Exp Neurol 2009; 68(7): 709–735.

Post-Concussion Syndrome. PubMed Health 

6 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. The National Academies Press. 2011. http://www.nap.edu/catalog/13121/nutrition-and-traumatic-brain-injury-improving-acute-and-subacute-health

7  Meier TB, Bellgowan PS, Singh R, Kuplicki R, Polanski DW, Mayer AR. Recovery of cerebral blood flow following sports-related concussion. JAMA Neurol 2015;72(5):530-8.

8 Salem N Jr, Litman B, Kim HY, Gawrisch K. Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids 2001; 36(9):945-59.

9 Mills JD, Hadley K, Bailes J. Dietary supplementation with the omega-3 fatty acid docosahexaenoic acid in traumatic brain injury? Neurosurgery 2011;68:474–81

10 Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acid supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma 2007;24:1587–95

11 Wu A, Ying Z, Gomez-Pinilla F. Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats. J Neurotrauma 2004;21:1457–67

12 Wang T, Van K, Gavitt B, Grayson J, Lu T, Lyeth B, Pichakron K. Effect of fish oil supplementation in a rat model of multiple mild traumatic brain injuries. Restor Neurol Neurosci 2013;31:647–59

13 Mills JD, Bailes J, Sedney C, Hutchins H, Sears B. Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model. J Neurosurg 2011;114:77–84

14 Wu A, Ying Z, Gomez-Pinilla F. The salutary effects of DHA dietary supplementation on cognition, neuroplasticity, and membrane homeostasis after brain trauma. J Neurotrauma 2011;28:2113–22

15  Wu A, Ying Z, Gomez-Pinilla F. Exercise facilitates the action of dietary DHA on functional recovery after brain trauma. Neuroscience 2013;248:655–63

Does Meat Cause Cancer?

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According to a report released today, processed meat is carcinogenic (cancer causing – see the definition below for more detail). After considering more than 800 studies examining the association between meat and cancer, the World Health Organization’s International Agency for Research on Cancer (IARC) Working Group classified processed meats as Group 1, carcinogenic. They based this on convincing evidence from population based studies that eating processed meats causes colorectal cancer. Yet the results aren’t as crystal clear as they seem.

What is Red Meat and Processed Meat?

Red meat – unprocessed mammalian muscle meat – beef, pork, veal, lamb, mutton, horse or goat meat, including minced or frozen meat

Processed meat – meat that is transformed through salting, curing, fermenting, smoking or other processes to preserve the meat and enhance flavor. Processed meats can include other meats or meat byproducts such as blood. Hot dogs, sausages, corn beef, beef jerky and canned meat are all examples of processed meat.

Carcinogenic – compounds that are carcinogenic “do not cause cancer at all times, under all circumstances. Some may only cause cancer in people who have a certain genetic makeup. Some of these agents may lead to cancer after only a very small exposure, while others might require intense exposure over many years,” states the American Cancer Society.

What they Found

Processed Meat:
Though they considered 800 studies, their conclusions were drawn upon 18 cohort studies (this is when scientists follow a group of people that don’t have the disease – in this case cancer – over time to see who does and who doesn’t develop cancer). Twelve of the 18 studies reported positive associations between processed meat consumption and colorectal cancer. Six out of 9 case-control studies (where they look at the diet of people with cancer and compare it to the diet of people without cancer) reported a positive association and a meta-analysis (statistical approach to combining results from several studies) of 10 cohort studies reported a statistically significant dose-response relationship with an 18% increase in risk for every 50 gram (1.5 oz. or about the size of ½ of a deck of cards) of processed meat eaten daily. Yet Dr. Kurt Straif, Head of the IARC Monographs Programme stated “for an individual, the risk of developing colorectal cancer because of their consumption of processed meat remains small, but this risk increases with the amount of meat consumed.” Recent estimates suggest approximately 34,000 cancer deaths per year can be attributed to diets high in processed meats.

Red Meat:
The Working Group classified red meat as “probably carcinogenic to humans” while stating there is “limited evidence in human beings for the carcinogenicity of the consumption of red meat.” If those two statements sound like they contradict each other, here’s why:

The largest body of data they found was from 14 cohort studies (where they follow a group of people that don’t have the disease – in this case cancer – over time to see who does and who doesn’t develop cancer). Seven of the 14 studies showed higher consumption of red meat (as compared to lower consumption of red meat) was positively associated with colorectal cancer. Seven out of 15 case-control studies (where they look at the diet of people with cancer and compare that to the diet of people without cancer) found higher consumption of red meat was positively associated with colorectal cancer compared to lower intake of red meat. “No association was seen in  several high quality studies.” The author suggests that bias and confounding couldn’t be ruled out (other diet and lifestyle variables may have affected the results.

What Makes Processed Meat Carcinogenic?

When meat, fish, or poultry (chicken, turkey, ducks, geese) are cooked over high temperatures, chemical compounds that are known or suspected carcinogens (cancer causing) including N-nitroso-compounds (NOC), polycyclic aromatic hydrocarbons (PAH), advanced glycation end products (AGEs) and heterocyclic aromatic amines (HCA) are formed. High and dry heat including frying, grilling and barbecuing are the worst combination for the production of these chemicals. The 2-page report mentions some of these compounds as “mechanistic evidence” supporting their conclusions while also stating that we don’t know how cancer risk is increased by processed and red meat. (The full report won’t come out for several months).

N-nitroso-compounds (NOC) are found in nitrate-cured meats, smoked foods (fish or meat), malt in beer and whiskey production, pickled vegetables and foods stored under humidity leading to fungi that generate nitrosamines.

Polycyclic aromatic hydrocarbons (PAH) are formed when fat and juices from meat grilled over an open flame drip onto the fire, resulting in flames, and PAHs adhering to the surface of the meat. Smoking meats also leads to the formation of PAHs. PAHs are also found in air pollution.

Advanced glycation end products (AGEs) are harmful compounds formed during dry heat cooking. Though many foods contain AGEs, meats fried or cooked over dry heat have significantly more AGEs than any other food. AGEs accumulate in the human body, affect cell functioning and may contribute to insulin resistance, type 2 diabetes and, as the name implies, aging.

Heterocyclic aromatic amines (HCA) are formed when amino acids, sugars and creatine react at high temperatures. When meat, fish, pork and poultry are cooked at higher temperatures for a longer period of time, more HCAs are formed.

HCAs and PAHs must be metabolized by specific enzymes (a process called bioactivation) before they can damage DNA. Yet the activity of these enzymes varies between people and therefore, one’s risk of developing cancer due to HCA and PAH exposure depends on how they metabolize these compounds.

What this Report Does Not Tell Us

IARC Working Groups examine if exposure to a specific food or compound could cause cancer but does not tell us how likely we are to get cancer. Also, there are many known human carcinogens (UV light – including the UV light in those LEDs lights used to set gel nails, alcohol, the mineral oil you use on wood cutting boards and more) – some many cause cancer after little exposure while others take a lifetime of exposure. Many factors influence the development of cancer including age, gender, family history, and other lifestyle factors (tobacco and alcohol use, weight, diet, physical activity).

How Much Processed & Red Meat is Too Much?

Cancer is a complex disease and no single food causes, cures or prevents cancer. However, as stated by the American Institute for Cancer Research (AICR):

  • A modest amount of red meat does not raise colorectal cancer risk.
  • Eating more than 18 ounces of cooked red meat per week increases the risk of  colorectal cancer.
  • Eating small amounts of processed meat regularly increases risk (of colorectal cancer).

AICR recommends avoiding processed meats and eating no more than 18 ounces of red meat per week (3 oz. = about the amount in a deck of cards). I also suggest making potentially better choices (see the infographic below and the 2nd to last paragraph of this blog post). What about HCAs, PAHs and other compounds? Here’s how you can decrease your intake of these compounds:

cooking meat
Where does meat processed without nitrates fit in? We don’t know. If they are processed without nitrates then they should  presumably contain few to no NOCs making them a better choice than meats processed with nitrates. However, I couldn’t find a single study comparing the compounds in meats produced without nitrates to their counterparts produced with nitrates.

If you aren’t preparing your food at home, take a close look at how it was prepared and cooked so you can minimize your intake of these compounds. If you don’t plan on cutting out processed meats, at the very least, limit your intake of sausage, ham, bacon, hot dogs, pepperoni, pastrami, bologna, corned beef, deli/luncheon meats, salami, nitrite-treated meat or meat products as well as meat preserved by smoking, curing or salting, all of which could increase your risk of cancer.

Disclosures: None, I have no connection to any red meat commodity boards, stock in red or processed meat companies (though I should look up the shorts or consider buying on a dip) or emotional connection to cows, pigs, horses, red or processed meats 🙂

References:
National Cancer Institute. 
American Institute for Cancer Research
Medline Plus.
Nutr Cancer 2008;60(2):131–144.
J Food Sci 2008;73(6):T100-5.
Cancer Sci 2010;101(2):508-16.
Cancer Epidemiol Biomarkers Prev 2012;21(6):905-15.
Int J Cancer 2014;134(1):125-35.
J Am Diet Assoc 2010;110(6):911-16.
Curr Diab Rep 2014;14(1):453.
Ann N Y Acad Sci 2005;1043:533-44.

Go Green for Earth Month & Improve Your Diet at the Same Time

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You don’t have to run out and hug a tree or play hackie sack while barefoot in the park to celebrate Earth Month. Instead, Earth Day and Month were designed to designed to inspire awareness for our environment. What’s in it for you? A polluted environment leads to pollution in our food and water supply that ends up on our plates and in our bodies. And therefore, a healthier earth means a healthier you. You can do your part by recycling, disposing of hazardous wastes properly (so they don’t end up in the water you drink or on the plants you eat) and changing your diet by incorporating foods that are not only good for you but also use fewer environmental resources to produce and/or are produced in an earth-friendly manner. On a recent segment on WBAL NBC Baltimore MD, I shared the top 3 steps you can take right now to help protect the environment and improve your diet at the same time:

1) Choose green seafood – seafood that’s both good for you and good for the ocean.  The DC-based Environmental Working Group has a guide to seafood that is high in omega-3 fats and low in methylmercury. This is especially important for pregnant women and young children. Growing fetuses are exposed to methylmercury in the womb when their mom eats fish and shellfish that contain methylmercury. Methylmercury can harm a baby’s growing brain and nervous system. Recent government data suggests an estimated 1.4 million women of reproductive age have blood mercury concentrations that may increase the risk of learning disabilities in their unborn children. Exposure to mercury is harmful to all people and may have toxic effects on the nervous, digestive and immune systems, and on lungs, kidneys, skin and eyes. EWG top choices for lower mercury omega-3 rich seafood: wild salmon, sardines, Atlantic mackerel, mussels and rainbow trout.

2 ) Go Meatless. Now, I’m not suggesting everyone go completely meatless (because animal based sources of protein are typically better for building and maintaining muscle) but, adding more plant based proteins or going completely meatless for 1 day a week has the environmental impact of taking your car off the road for 320 miles, according to the Environmental Working Group. How does this help your body? Plant based sources of protein are typically lower in calories yet they are packed with good nutrition including vitamins, minerals, and dietary fiber. How can you get enough protein – choose soy, beans, lentils and nuts. I often mix animal-based proteins with plant-based proteins at meals.

3) Cook with canned foods. Americans throw away approximately 15 to 20 percent of the fresh fruits and vegetables they purchase every year. Stock up on canned foods because they help reduce food waste, saving us time and money, and reducing our impact on the environment. Canned food portion sizes are just right for both individuals and families, and most recipes are designed around these sizes. Plus, metal cans are endlessly recyclable and in fact, are the most recycled containers in America today, keeping metal out of landfills and saving significant energy. Looking for convenient, wallet-friendly sources of protein? Check out this resource (and easy recipes) Quality Protein – It’s in the Can – Fact Sheet 

Marie Spano, MS, RD, CSCS, CSSD is a proud Can-bassador – helping educate and communicate the benefits of cooking with canned foods.

 

 

Food Fraud: Is Your Food Adulterated?

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By: Gisselle Marie Rosa, UGA MS student & Dietetic Intern

As consumers, we put our trust in food companies to be honest about their food products. You go to the grocery store and spend and exorbitant amount on 100% pure Italian olive oil expecting that it comes from the finest olive crops in Italy. Yet that dark glass bottle with the scenic picture of an olive farm in Tuscany may contain olive oil mixed with lower quality vegetable oil. Then you see news reports bombarding the media about honey that is diluted with less expensive syrups and “wild” salmon that was actually farm-raised in another continent. It makes you wonder why food companies would risk lying to their consumers about the quality of the food they are selling and how you can avoid buying these products at all.

Food Adulteration for Economic Gain (Saving Cash)

Food fraud, or economically motivated adulteration, refers to defrauding buyers of food or ingredients for economic gain. There are generally three types of fraud: complete or partial replacement of a food or ingredient, the addition of a substance to mask the quality of the food product, and removal of a component of the food product. Unfortunately, no one really knows exactly how common these practices are. Most instances of food fraud do not pose a public health risk, so they are easy to get away with. There are some instances, however, where certain foods or ingredients are adulterated with potential allergens or toxic ingredients that could harm the consumer. Some examples are as benign as injecting shrimp with gelatin, while others are as dangerous as adding melamine to infant formula to make the protein content of the formula seem higher. The latter example led to thousands of infant illnesses and the death of 6 infants in China.

Unintentional Food Adulteration

However, not all cases of food adulteration are intentional. An example is selling bruised fruit, where mishandling could have led to decreased quality of the produce item and potential exposure to contamination.

It is pretty evident that food fraud can be deceiving and even dangerous. So how can you become a more informed consumer?

The U.S. Pharmacopeial Convention (USP) has an online database that provides food ingredient fraud reports. In this database, you can find past reports from the media and scientific journals about food fraud cases. Additionally, the United States Department of Agriculture website  posts the most recent food recalls, many of which are due to food adulteration.

According to the Congressional Research Service, some of the most common food categories with reported cases of food fraud include: olive oil, fish and seafood, milk and milk-based products, honey, fruit juice, coffee and tea, spices, and organic foods. Curious to see how these foods have been adulterated in the past? If you are curious about food fraud, check out this Food fraud database.

Just remember: a smart consumer is a safe consumer. While there is no need to be skeptical about every food product you buy, it is important to understand that food fraud exists. So the next time you go to the store to buy fresh red snapper, make sure that the fish you are buying is authentic and not a cheaper, lower quality fish.

Resources:

Johnson, R. Food Fraud and “Economically Motivated Adulteration” of Food and Food Ingredients. Congressional Research Service 2014. Internet: https://www.fas.org/sgp/crs/misc/R43358.pdf

U.S. Pharmacopeial Convention. USP’s Food Fraud Database 2015. Internet: http://www.usp.org/food-ingredients/food-fraud-database

United States Department of Agriculture. Recalls and Public Health Alerts, 2014. Internet: http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/

How Your Body Image Affects Your Weight & Health

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Today I’m going on a slight rant about something that has been on my mind for a while – body image. And because the majority of my clients (all but 1) are male athletes, I don’t run into the overt self-degrading body comments as often as many of my dietitian colleagues who work with women. However, I’ve run into a number of women lately who either put their bodies down, avoid social situations or the beach / pool / bathing suits because they feel “fat”, obsessively cover up their bodies, obsessively diet or exercise (or both) or engage in other self-depreciating comments and related behaviors stemming from how they feel about their body. And I always walk away thinking “one day she is going to look back and think ‘damn I looked good’ and regret wasting so much time and energy hating a body that helped her cross finish lines, hike mountains, pick up small children, build a beautiful garden and do so much more.”

And though I won’t get into the psychology behind body image and self worth or how to improve your body image (you can read more about that in this article), I do want to talk about how this affects a person’s overall health and sense of well-being. First and foremost, the people around you might not notice the subtle behaviors and words you speak (unless you have dietitian or psychologist friends) but your kids will (children, grandchildren, children you teach or coach). Anyone who has spent 5 minutes with a child knows they pick up everything. Now, let’s say you are that female who won’t wear shorts in the summer because you hate the way your legs look. Your little girl will stop wearing shorts and at some point think her legs look bad too. Or maybe you are the grandma who won’t wear a bathing suit to the beach because you can’t fit into the one you wore last year. Your grandkids will wonder why you aren’t going in the water with them. And finally, if you are a coach of young girls, an entire team will learn about how they should be viewing their bodies from what you think of yours.

In addition to affecting the people around you, I’ve noticed that women who don’t love the bodies they live in spend entirely too much time thinking about food and exercise. And by cutting out certain foods, going on cleanses or popular diets or drastically slashing their food intake, they are cutting out a number of nutrients necessary for good health. And the effects might not be obvious at first, but over time they will catch up to you. Cut calories and it will be difficult to get a number of vitamins, minerals and protein in your diet (And when you fall short on protein you will start losing muscle mass. Over time less muscle means you burn a few less calories each day and you won’t be able to exercise as hard in the gym so you burn fewer calories while working out. Both of these make it challenging to keep weight off over time. Plus less muscle means activities of daily living like gardening, picking up kids, or lifting groceries may be tough). Switch to a vegetarian diet and you better really plan on incorporating protein since you will need more total protein to keep and build muscle. Drop dairy and your bones, teeth and nails will suffer over time (yes you can eat kale, spinach and other leafy greens but you will need at least 10 cups of raw leafy greens a day if this is your only source of calcium). I’ve seen women in their 20s with osteopenia (low bone mass, this often comes before the brittle bone disease osteoporosis). And this is just the tip of the iceberg. But, here’s the most important point: your body image affects what you eat (more than just total calories) and don’t eat. And over time I’m going to make a stretch here and say (from observation) that body image-induced changes in diet affect your intake of vitamins and minerals and over time, consistent vitamin and mineral shortages will affect how your body functions and could impair several aspects of health. So, if you feel like you fall into this category of women or men who loathe your body, make the commitment right now to work on this. I promise you that you are wasting time as well as mental and physical energy. Plus, the changes you are making in an effort to keep weight off may be doing more harm than good.

Are You Getting the Nutrients You Need for Maximum Energy & Good Health?

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Take one quick peek at dietary survey data and you’ll find many Americans don’t consume enough vitamins and minerals through food alone. How does this impact your health? A nutrient deficiency could affect your energy levels, mood, ability to concentrate, structure of your skin, teeth, nails, bones and more. So, how can you be sure you are getting enough of the vitamins and minerals you need for optimal health? First, focus on consuming foods that are particularly rich in the nutrients many Americans fall short on. Secondly, consider taking a multivitamin to make up for any nutrient gaps. But first, here’s a look at the food groups:

To watch my Talk of Alabama TV segment on this topic, click here.

Nuts and Seeds

Nuts and seeds contain a wide variety of nutrients including magnesium – which is necessary for a healthy metabolism, good energy and muscle strength – yet many people get very little magnesium in their diet. On average, most women get about ½ of the magnesium they need each day. Nuts & seeds also have zinc for immune system functioning, wound healing, muscle growth and repair and some nuts, like almonds, also contain calcium, which we need for strong bones. If you are worried about the calories in nuts and seeds, stick to the right portion size (about 1/4 cup for nuts) and keep in mind that research shows people who eat nuts regularly tend to weigh less than those who consume nuts infrequently.

A few of my favorites based on nutrient content (including magnesium): pumpkin seeds, sesame seeds and Brazil nuts.

Grains

Grains provide approximately 43% of the fiber in an average American diet. Fiber aids digestion, helping prevent constipation and it adds bulk to your diet helping increase feelings of fullness, which makes it easier to control your weight. Whole and enriched grains also naturally contain a wide variety of important vitamins and minerals. For instance, grains provide about 2/3 of the folic acid in an average American diet. Folic acid makes healthy new cells. And, it is a nutrient of concern for women of childbearing age because inadequate folate (folic acid) intake during pregnancy increases one’s risk of having premature and low birth weight babies or babies with certain types of birth defects in the brain or spine. Here in the U.S., grains such as bread, cereal, flour, and pasta are enriched with folic acid (gluten free products might not be enriched).

Beans

Beans count as both a vegetable and protein-rich food. Not only are they packed with fiber but they also contain iron, magnesium and potassium. And diets higher in potassium may help lower blood pressure, especially if you consume too much sodium. Plus potassium supports muscle functioning and higher potassium diets may also decrease risk of kidney stones.

Here are 3 you should focus on based on nutrient content and versatility: black beans, lima beans and white beans.

Seafood

Seafood is another rich source of nutrients. For instance, oysters have more zinc than any other food and more iron than red meat (a 3 oz. serving provides almost half of the daily value for iron). Try canned oysters to save time and money. Canned sardines with the bones are an excellent source of calcium and vitamin D – you need both of these for strong bones. But, chew those bones carefully! And, if you are concerned about mercury (and small children, pregnant and lactating women should consume only low mercury fish), check out this guide from the Natural Resources Defense Council, which categorizes fish based on mercury content.

While eating a wide variety of nutrient-dense foods is the best way to get vitamins and minerals, the reality is that most Americans don’t get enough through food alone, especially those on lower calorie diets or adults over the age of 50. So, consider a multivitamin. Multivitamins are a great solution to fill dietary gaps.

I partnered with Centrum and the Wheat Foods Council for this segment though I wrote the content of this post and the segment based on the latest scientific research.

 

 

How Managing Food Allergies Helps Drew Brees Perform Better & Recover Quickly

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If you could make one change to your diet that made you feel a thousand times better every day what would it be? For those suffering from food allergies, the answer lies in cutting those foods out of their diet. Symptoms of food allergies range from life threatening anaphylactic shock to itching of the mouth, hives and rashes. But for me, and apparently Drew Brees as well, eating those foods we are allergic to means you feel like you you’ve been hit head on by a Mack Truck (or in Brees case, maybe a 320 lb. O-Lineman). Brees said he noticed an amazing difference in his energy levels and recovery after he had been tested and cut out all foods he is allergic to. And, that resonated with me.
I loved listening to both Drew and Brittany this past weekend at Expo West, the largest trade show in the natural, organic and healthy products industry, not because he is a pro football player (I work with a number of pro athletes so that’s nothing new to me) but because I love learning about the person behind the profile and what they are passionate about. In a Sports Illustrated kind of way I saw a glimpse of someone who uses his status to further his causes, to give back, and as part of the President’s Council on Fitness, Sports & Nutrition, to make a difference in the lives of others through fitness, sports and nutrition, a cause near and dear to my heart. Drew and Brittany’s message was simple – what you put in your body can improve your health. Drew also mentioned that people shouldn’t feel ashamed because they are coping with something like food allergies.

The Brees family has teamed up with So Delicious, a company that makes incredibly tasty dairy free beverages and desserts (my favorites are everything coconut flavored in their line!).  For those who need dairy free products or even those who don’t, So Delicious is definitely worth a try. And for those suffering from other food allergies, rest assured, companies like the ones who exhibited at Expo West are rapidly coming out with “free from” products that do not include the major foods people are allergic too including eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.