Saint Louis University's Nutrition Spotlight Newsletter

Department of Nutrition and Dietetics

Dietetic Interns

FALL 2012

SAINT LOUIS UNIVERSITY DOISY COLLEGE OF HEALTH SCIENCES

Stealth Veggies - A Good Idea or Not?

Making the Connection: Connecting the RD to Social Media Networks

Should You Go Dairy-Free?

Connecting the Significance of Egg Yolk Consumption and Risk of Cardiovascular Disease (CVD)

Beet Your Competition

Food Day Festivities 2012

Interview with Nancy Clark

Soda, To Ban or Not To ban?

Has the Magic Weight Loss Pill Arrived?

This issue was written and prepared by the Dietetic Interns at Doisy College of Health Sciences Saint Louis University. For more information on SLU’s Dietetic Internship, please visit nd.slu.edu.

INSIDE THIS ISSUE

1

2

3

4

5

6 - 7

8

9

10 - 11

NUTRITION SPOTLIGHT NEWSLETTER FALL 2012


Stealth Veggies- A Good Idea or Not?Annie Turner and Elaine Minden

Did you know that American children ages 6-11 years only consume about half of the minimum recommended number of vegetable servings per day? According to the CDC, about 17% of children and adolescents ages 2-9 are obese, and the prevalence has increased over the past few decades. Research shows that daily consumption of fruits and vegetables contributes to disease prevention and reduces the risk of obesity. With childhood obesity at epidemic proportions, increasing fruit and vegetable intake among America’s youth is essential. So how do we solve this problem for picky eaters who don’t want to eat their fruits and vegetables?

Many parents with picky eaters have resorted to “stealthy” techniques to feed their children healthy foods, including hiding or disguising vegetables into dishes that their kids like to eat. A few examples include blending carrots and other vegetables into spaghetti sauce, adding zucchini to muffins, or using pureed vegetables in macaroni and cheese. Often times, children cannot detect the taste difference and consequently gobble up the veggies, unbeknownst to them. Sneaking vegetables into familiar meals has proven to be a very effective method to get picky eaters to consume more from healthier food groups, such as fruits, vegetables and whole grains, and less from undesirable food groups such as fat and sugar.

For parents struggling with picky eaters, there are many benefits to hiding or disguising vegetables. First and most importantly, hiding vegetables in meals can increase the total amount of vegetables eaten. In a 2011 study, Spill and colleagues found that 3-6 year olds who consumed meals incorporating pureed vegetables (75% energy density) increased their daily vegetable intake by 73%. At the same time, this strategy decreased total daily energy intake by 12%. Kids tend to consume a consistent weight of foods at each meal, so by adding vegetables in place of other more energy-dense ingredients, these hidden vegetables can help to not only increase vegetable intake but also lower

the energy density of meals. Decreasing total caloric intake can be a helpful strategy for obesity prevention. Another benefit of hiding vegetables in familiar foods is that it increases the consumption of vitamins and minerals essential for the proper growth and development of children. Aside from the health benefits, disguising vegetables in familiar and well-liked dishes can help to reduce the hassle and stress of mealtimes for parents who struggle to get their kids to eat healthy foods.

On the other hand, even though hiding or disguising vegetables can help parents be successful at increasing their children’s vegetable intake, there are drawbacks to employing this deceptive strategy. Children do not typically eat foods that they do not like or that are unfamiliar to them. In order to develop a child’s preferences for new vegetables, it is important for the child to be exposed to new foods multiple times so that they become familiar. Hiding or disguising vegetables eliminates exposure and the opportunity for a child to try the vegetable on his or her own. Additionally, children develop many food preferences based on what they see their parents and others eating. If they don’t see their parents eating vegetables because they are hidden in the meal or dish, it may decrease the likelihood of developing a preference for that vegetable. Lastly, for busy parents, it may not always be feasible to incorporate “stealth” vegetables into every meal, and the added time required to plan, shop and prepare these meals can be stressful.

There are several health benefits to using “stealth” vegetables to increase children’s vegetable intake, and it can be a fun way to introduce new vegetables to kids through dishes that they already enjoy. However, it should not be the only means of offering new vegetables. “Stealth” veggies provide short-term health benefits, but may not be an effective long-term strategy to increase vegetable intake and other healthy food choices. The Academy of Nutrition and Dietetics recommends offering children a variety of vegetables as a part of a healthy meal. In addition, they encourage families to eat meals together and involve children in meal preparation. These strategies can be an effective way to increase children’s willingness to try new vegetables and other healthy foods rather than using other sneaky techniques.


SAINT LOUIS UNIVERSITY DOISY COLLEGE OF HEALTH SCIENCES 1

REFERENCES

United States Department of Agriculture (n.d.) USDA Fruits and Vegetable Program. Retrieved from: http://www.ers.usda.gov/topics/food-nutrition-assistance/child-nutrition-programs/usda-fruit-and-vegetable-program.aspx

Centers for Disease Control (n.d.) Over weight and Obesity. Retrieved from: http://www.cdc.gov/obesity/data/childhood.htmlLynch, M. (2011).

Vegetables at Any Cost: How the Media Markets Children’s Unhealthy Food Preferences in North America. Early Childhood Education Journal, 39(5), 297-302.

Spill, M. K., Birch, L. L., Roe, L. S., & Rolls, B. J. (2011). Hiding vegetables to reduce energy density: An effective strategy to increase children’s vegetable intake and reduce energy intake. American Journal of Clinical Nutrition, 94(3), 735-741.

Patrick, H., & Nicklas, T. A. (2005). A review of family and social determinants of children’s eating patterns and diet quality. Journal of the American College of Nutrition, 24(2), 83-92.


Making the Connection:Connecting the RD to Social Media Networks Danielle Mach and Rachel Randazzo

The importance of social media in the professional environment has steadily increased during the last decade, especially for registered dietitians (RD). Awareness and usage of media tools such as twitter, blogging, and LinkedIn, continue to flourish as professionals are discovering the multitude of benefits of utilizing social media for peer networking and notification of job opportunities. RDs have become more involved in social media as a response to the glut of noncredible nutrition information on the web, but also to highlight and promote registered dietitians as nutrition experts.

LinkedIn is currently the most popular and fastest growing social media outlet. In fact, LinkedIn chief Executive Bill Nye states that one million new users join every 17 days. This major growth in the professional networking site can be beneficial to an RD because LinkedIn provides the opportunity to connect with people who share similar interests and views, so that promotion of nutrition-based ideas or products can be better supported by multiple people of different professional origins. LinkedIn is a growing and viable option for many RDs to utilize if the expansion of a network is desired.

Aside from LinkedIn, there are many other social media networks that can be utilized by an RD. Twitter, for example, may be better suited for dietitians interested in health promotion, business discovery and business expansion. Twitter’s 140 character- limit forces users to keep messages jargon-free which is very effective in giving quick health tips, marketing a product, expanding a business, or posting a quick link to another site related to nutrition and/or business related aspects. Ultimately, Twitter supplies an RD with the flexibility to decide what message to send to the public.

Another great way for RDs to utilize social networking is to create blogs with credible information that focus primarily on the execution of effective nutrition and health promotion. One credible resource that can be utilized is called the Nutrition Blog Network (nutritionblognetwork.com), which has articles only written by credentialed registered dietitians. Because dietitians must apply before they can submit any information, this blog network is a credible resource for the public to reference via the web.

One unique benefit of participating in multiple social media networking sites is that these sites can be integrated. In other words, a Twitter user can “tweet” a product update and immediately upload it to both a Facebook and LinkedIn account. This is beneficial for both the social media network company and the user because social networking sites can market their company to potential users and users can therefore market their own products, ideas, and businesses to their LinkedIn peers, Facebook “friends”, and Twitter “followers.”

Overall, the use of social media can be very useful for an RDs career if executed professionally and effectively. Utilizing sites, such as LinkedIn, can help build an RD’s network beyond a “dietetic bubble,” and participation in blogging about credible food and nutrition-related topics and information using The Nutrition Blog Network can be a useful resource for the public. Ultimately, an RD can benefit both personally and professionally from participation in different types of social media outlets by acting as an advocate for the dietetics profession, and by increasing overall public awareness and knowledge of accurate nutrition information.

REFERENCES

Helm, J., & Fromm, L. (n.d.). Nutrition blog network. Retrieved from http://www.nutritionblognetwork.com/nutritionblogee/index.php/site/aboutUs

Peregrin, T. (2012). Linkedin profile makeover: Optimizing your professional online profile. Journal of the Academy of Nutrition and Dietetics , 112(1), 23-25. doi: 10.1016/j.jand.2011.11.006

Simunaniemi, A. M., Sandberg, H., Andersson, A., & Nydahl, M. (2011). Laypeople blog about fruit and vegetables for self-expression and dietary influence. Health Communication, 26(7), 621-630. doi: 10.1080/10410236.2011.561520



Should You Go Dairy-Free?Angie Albers and Liz Earhart

The demand for dairy free products has increased dramatically over the past few years. Grocery store aisles are now stocked with a variety of options for anyone wanting to adopt a dairy-free lifestyle. No longer utilized solely by those with a dairy allergy or lactose intolerance, dairy alternative sales saw a 13% increase in sales in 2010. What has led consumers to choose these dairy alternatives?

When consumers compare the nutrition facts of almond and soymilk to that of dairy milk (2%), they are in fact consuming a lower calorie, lower sugar, and lower fat containing beverage. They believe this will help them in their weight loss efforts. Comparing the labels of Silk almond milk to 2% cow’s milk and Vitasoy Organic Soy milk, there are noticeable differences, as seen on the three nutrition labels. Firstly, a serving of cow’s milk has 130 calories while that of almond milk has 60 calories. Almond milk also has half the amount of grams from fat and sugar than cow’s milk. Another interesting observation is that almond milk offers more calcium per serving than cow’s milk and soy milk, due to fortification.

So let’s look at the actual benefits of dairy alternative consumption. Firstly, there are differences in fat, sugar and calorie contents. Additionally, and perhaps with greater nutritional impact, dairy alternatives are plant-based, which means they contain no cholesterol or saturated fat, unlike whole and low-fat cow’s milk, making it a more heart healthy option. Dairy alternatives are also necessary for those who have lactose intolerance or dairy allergies. Because these products are often fortified with many vitamins and minerals, consumers are still able to receive the necessary nutrients that they otherwise would not be getting if dairy milk was not a part of their diet. The increase in popularity of dairy alternatives also stems from an increase in the number of consumers adopting a vegetarian or vegan lifestyle, thereby increasing the demand for dairy alternatives and the number of products seen in grocery store aisles today. There are several other popular reasons for going dairy-free including the possible prevention of acne, decreased congestion, GI discomfort and bloating.

However, there are several reasons for sticking with the original dairy-containing cow’s milk and other dairy products. Cow’s milk is a natural source of bioavailable nutrients such as protein and several important vitamins and minerals, meaning that the body’s tissues have a greater ability to absorb the nutrients provided. It is also sold at a relatively low cost to the consumer. While dairy-free alternatives are fortified with calcium needed for bone health, cow’s milk has been proven through multiple scientific studies to help build and maintain bone mass, which may reduce the risk of osteoporosis. Additionally, consumers tend to have a misconception that dairy foods are fattening but studies have shown otherwise. For example, a study conducted by Jatinder Bhatia, M.D., of adolescent girls showed no significant difference in weight gain amongst those on a high-calcium diet versus a normal diet.

While dairy and dairy alternatives each offer their own set of benefits, one has not been proven to be more beneficial than the other. With the mass amount of media attention and advertisements geared toward milk and dairy consumption, consumers may be more inclined toward traditional dairy products. However, it is ultimately up to the consumer as to which source they prefer. Whether consumers choose traditional dairy products or dairy alternatives, it is important they incorporate one of the two as part of a well-balanced diet that supplies the essential nutrients found in conventional dairy foods.

REFERENCES

Chaker, A. M. (Producer). (2011, August 20, 2012). Move Over, Cow. The Wall Street Journal. [News] Retrieved from http://online.wsj.com

Kam, K. (2010). Lactose-Free Milk and Nondairy Beverages. Retrieved from www.webmd.com/digestive-disorders

Nicklas, T. A. (2003). Calcium intake trends and health consequences from childhood through adulthood. J Am Coll Nutr, 22(5), 340-356.

Jatinder Bhatia, M. (2007). Debunking Dairy Food Myths. American Dietetic Association. Retrieved from eatright.org

Vitasoy Organic Original Soy Milk

Silk Pure Almond Original Almond Milk

2% Reduced Fat Cow’s Milk





Connecting the Significance of Egg Yolk Consumption and Risk of Cardiovascular Disease (CVD)“The Incredible, Edible Egg.” Created by the American Egg Board, this thirty-five year-old slogan and jingle is instantly recognizable. Also well-known is the back and forth controversy over the benefits and risks of egg consumption. Americans know they are edible, but are eggs truly incredible?

A recent study suggests this versatile food, particularly the yolk, causes significant formation of plaque in the carotid arteries of individuals who were at risk for cardiovascular disease (CVD). The study’s intent was to compare the atherosclerotic impacts of smoking and egg intake in order to provide perspective of just how dangerous eggs can be for this specific population. Results concluded that consumption of three or more egg yolks per week increases plaque area within carotid arteries, and suggested a correlation to increased risk of CVD for those currently at risk for CVD.

This August 2012 article will likely impact consumers’ beliefs about eggs, and may even hinder them from eating eggs altogether. The fact is, eggs may be a great choice for many. For a mere $0.15 per large egg, consumers get an affordable, nutrient dense, high quality protein (Drewnowski, 2010). At 72 calories per large egg, this excellent food choice may help curb appetite and decrease overall caloric intake (Maton, 1993). Research shows that certain nutrients in eggs such as lutein are shown to protect from inflammation, degenerative diseases, and atherosclerosis (Fernandez, 2006).

Egg yolk consumption becomes an increasingly more questionable decision for American adults with CVD (~33%) or those at risk for CVD (11-55%). While it contains many beneficial nutrients, the yolk is the sole source of fat and cholesterol in an egg. In addition to the multitude of conflicting research on cholesterol consumption and CVD (Fernandez, 2010; Scrafford, Tran, Barraj, & Mink, 2011; Spence, Jenkins, & Davignon, 2010), the USDA recently determined the cholesterol content of one large egg yolk to be 14% less than previously accepted (215 milligrams vs. 186 milligrams) (Agriculture). So what are Americans to make of Spence’s and other’s research?According to the Academy of Nutrition and Dietetics (AND) Evidence Analysis Library (EAL), egg consumption recommendations depend upon the patient’s health. The following table outlines the suggested course of action in regards to cholesterol consumption from eggs for specific groups of individuals.

New research, such as Spence’s Egg yolk consumption and carotid plaque, is proof of how dynamic scientific data can relay conflicting messages about health and nutrition, making it difficult for the general public to sort through the information and make educated food choices. As new evidence-based research, such as this study is published, the RD’s role is to provide accurate information for patients to use on a daily basis. Based on this research, the RD can counsel patients to balance yolk consumption in order to consume the wide variety of micronutrients.

Table 1: AND EAL Recommendations for cholesterol intake for specific health-related populations

REFERENCES

Agriculture, U. S. D. o. National Nutrient Database for Standard Reference Release 24 Nutrient data for 01123, Egg, whole, raw, fresh.

Drewnowski, A. (2010). The Nutrient Rich Foods Index helps to identify healthy, affordable foods. Am J Clin Nutr, 91(4), 1095S-1101S. doi: ajcn.2010.28450D [pii] 10.3945/ajcn.2010.28450D [doi]

Fernandez, M. L. (2006). Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Curr Opin Clin Nutr Metab Care, 9(1), 8-12. doi: 00075197-200601000-00004 [pii]

Fernandez, M. L. (2010). Effects of eggs on plasma lipoproteins in healthy populations. Food Funct, 1(2),156-160.doi: 10.1039/c0fo00088d [doi]

Maton, A. (1993). Human Biology and Health. Englewood Cliffs, New Jersey: Prentice Hall.

Scrafford, C. G., Tran, N. L., Barraj, L. M., & Mink, P. J. (2011). Egg consumption and CHD and stroke mortality: a prospective study of US adults. Public Health Nutr, 14(2), 261-270. doi: S1368980010001874 [pii]

Spence, J. D., Jenkins, D. J., & Davignon, J. (2010). Dietary cholesterol and egg yolks: not for patients at risk of vascular disease. Can J Cardiol, 26(9), e336-339.

POPULATION RECOMMENDATION

Healthy Individuals One egg per day is not associated with an increase in CVD, although more than seven eggs per week is associated with an increase in risk of CVD.

Type 2 Diabetes Mellitus(T2DM)

Monitor and/or reduce cholesterol intake as dietary cholesterol is associated with increased CVD risk.

Dyslipidemia Consume <200 milligrams of cholesterol per day



BEET Your CompetitionCan beets give you a leg up on your competition? This past summer, the London 2012 Olympics provided entertainment and inspiration for its viewers and fans. The dedication, devotion and training required to be an elite athlete is amazing, to say the least. While the chance to represent one’s country in the Olympics is an accomplishment in its own right, most athletes have their eyes on the real prize, a medal. However, a medal remains elusive for most athletes that compete, often times the difference being a mere tenth of a second. Just ask Ethiopia’s Dejen Gebremeskel who missed the gold medal in the 500m track race by less than one second. Also, there is Bernard Lagat of the USA who missed medaling by a mere 0.63 seconds. How an athlete fuels their body is important in any stage, but once they reach this level of competition, what they eat is critical to their success. Maybe, just maybe, Lagat should have eaten a few beets before his race …

Saint Louis University researchers have recently shown that beets may be a super-food for endurance athletes. Researchers fed “moderately-fit” athletes a seven ounce serving of baked beets, which contained 500mg of nitrates, before running a 5k on a treadmill. The cross-over study found that the athletes improved their 5k running time, on average, by an impressive 41 seconds. Another study supplemented rowers with 500ml of beet root juice for a total of six days before testing and found that it significantly improved performance of rowers across all five testing periods that they performed.

So what is it about beets? The nitrates in beets are thought to be the compounds responsible for improved exercise performance in the athletes that participated in these trials. Limited research exists using nitrates as ergogenic aids, therefore, researchers looked at the effects of nitrates on athletes training at moderate intensity. According to studies from the Journal of the Academy of Nutrition and Dietetics and the Journal of Sport Nutrition and Exercise Metabolism, nitrates have been proven to have many beneficial effects for aerobic exercisers, such as runners, bicyclers and rowers.

The benefits found include:• Reducing pulmonary oxygen uptake (VO2)• Improving skeletal-muscle mitochondrial

efficiency• Improving endothelial function• Lowering blood pressure

Improvement in all of these areas results in a more efficient athlete, allows them to exercise at a higher intensity for a longer period of time, and enhances overall performance. When the athletes consumed the nitrates from the baked beets or the beet juice it increased nitric oxide levels in their bodies; this may have been responsible for improving their VO2 max - a promising discovery for all endurance athletes and marathon hopefuls out there. By improving VO2 max, an athlete is able to work harder for a longer period of time, delaying the dreaded “winded” feeling that all runners experience at one point or another.

However, if you aren’t a huge fan of these root vegetables, don’t look for a quick fix with nitrate supplements. Although thelisted physiological improvements above have been found to occur through supplementation and consumption of whole foods alike, long-term supplement use can have a severe detrimental health effect. Over time, nitrate supplementation has been linked to harmful diseases such as cancer.

It is not fully understood why the ill effects of nitrates on the body occurs with supplementation but not when the source of nitrates comes directly from whole vegetables. One deduction is that researchers believe that other components of whole vegetables prevent the negative effects of nitrates by providing nutrients that may counteract the harmful effects. For example, antioxidants, polyphenols, and fiber are all found in abundance in whole vegetables and are also known to decrease heart disease and cancer risk. Although current research has not been conducted with the use of carrots, spinach or eggplant as a source of nitrates to improve exercise performance, these may be a healthy nitrate rich alternative to beets. It is important for athletes of all levels to obtain whole vegetables to receive all the benefits they can provide. With these, they may just “beet” their competition someday.

Hamilton , A. (n.d.). Sports nutrition: is dietary nitrate the key to enhanced endurance performance?. Retrieved from http://www.pponline.co.uk/encyc/sports-nutrition-is-dietary-nitrate-the-key-to-enhanced-endurance-performance-41930

Bond, H; Morton,L.; Braakhuls, A. Dietary Nitrate Supplementation Improves Rowing Performance in Well-Trained Rowers. International Journal of Sport Nutrition and Exercise Metabolism, 2012, 22, 251 -256. Cermak N, Gibala M and van Loon L. Nitrate Supplementation’s Improvement of 10-km Time-Trial Performance in Trained Cyclists. International Journal of Sport Nutrition and Exercise Metabolism, 2012, 22, 64-71.

Murphy M, Elliot K, Heuertz R, and Weiss E. Whole Beetroot Consumption Acutely Improves Running Performance. J Acad Nutr Diet. 2012;112:548-552.

London 2012 track and field results. (2012). Retrieved from http://london2012.foxsports.com/olympics/results.asp?sport=AT&id=ATM050101. Santamaria, P. Nitrate in vegetables: toxicity, content, intake and EC regulation, Journal of the science of food and agriculture86:10–17; 2006

REFERENCES

Food Day Festivities 2012Lisa Kinsella and Leslie Stovall

October is certainly a month to look forward to in St. Louis. Fall foliage is on full display in Forest Park, pumpkins are ripe for the picking at Eckert’s Orchard, and Soulard’s Oktoberfest beckons tourists and locals alike to join in the festivities. Last October 24, St. Louis introduced a new occasion to celebrate, Food Day, “a nationwide celebration and a movement for healthy, affordable, and sustainable food,” (“Food Day”, n.d.) will make its second appearance this year.

The organization behind Food Day is the Center for Science in the Public Interest (CSPI), founded in 1971 by Michael Jacobson and two other scientists. The CSPI is a non-profit consumer advocacy group concerned with food safety, nutrition, and public health. While the CSPI is parenting Food Day, it is not working alone; over 75 national, state and local partners are contributing their time, resources and funding to the cause. This diverse group of partners includes members of governmental, business, and other non-profit organizations, from the Humane Society to our very own Academy of Nutrition and Dietetics.

Food Day organizers have narrowed down the dizzyingly broad theme of a day devoted to food to five major priorities: safer, healthier diets, reducing hunger across the country, support of sustainable, organic farms, reformation of factory farms to protect animals and the environment, and fair working conditions for farm and food workers (“Food Day”, n.d.).

According to Food Day proponents, our food should be the foundation for health and growth. Unfortunately, the Western diet has instead become a hazard to thousands of Americans’ health, accounting for about $147 billion every year in health care costs. Food Day events aim to promote healthy eating to reduce diet-related disease.

According to Feeding America, a significant proportion of the American public lives with food insecurity due to financial strain or lack of local access to food. To compound these worries, lawmakers constantly debate governmental assistance programs such as Supplemental Nutrition Assistance Program

(SNAP) and WIC without providing alternative plans to increase food access. To ease food insecurity, Food Day encourages participants to increase community awareness of food insecurity and how to relieve hunger in their neighborhoods and beyond.

Research shows that conventional agricultural practices account for up to 70% of pollution in waterways and contribute significantly to air pollution and soil depletion. According to the USDA’s Alternative Farming Systems Information Center, sustainable and organic farming practices produce less pollution and depletion, which will leave more natural resources for generations to come.

Overcrowded farm animals require extensive resources including water, fertilizer, space, and antibiotics; the overuse of these antibiotics could easily lead to drug resistance and super-strains of disease. Given the risks and economic needs of conventional farming practices, it seems logical that the government would promote and subsidize sustainable farms. Unfortunately, the vast majority of government subsidies support huge conventional farms. Food Day organizers hope to raise the public’s awareness and economic support of local, sustainable farms.

As anyone who has ever worked in food service knows, the minimum wage is shockingly low. Most food service workers do not receive paid sick leave, so many of these employees report to work, handling and preparing food when they should not.

According to the Department of Labor, a crop worker’s average annual salary is under $20,000. This hard manual labor often exposes them to pesticides, which have been linked to a variety of diseases and birth defects. Food Day supporters hope that bringing these issues to light will bring justice to workers in the farm and food industries.

[Continued on next page]

REFERENCES

About CSPI ~ Center for Science in the Public Interest. (n.d.). Center for Science in the Public Interest. Retrieved August 19, 2012 from http://www.cspinet.org/about/index.html

EWG Farm Subsidy Database. (n.d.). EWG Farm Subsidy Database. Retrieved August 19, 2012, from http://farm.ewg.org/region.php?fips=00000

Food Day. (n.d.). Retrieved August 19, 2012 from http://www.foodday.org

Hunger Statistics, Hunger Facts & Poverty Facts | Feeding America. (n.d.). Feeding America: Hunger-Relief Charity | FeedingAmerica.org. Retrieved August 19, 2012, from http://feedingamerica.org/hunger-in-america/hunger-facts/hunger-and-poverty-statistics.aspx

Savat, S. (2011). Nutrition and Dietetics to Celebrate Food Day with Lunch in the Garden. Retrieved August 19, 2012 from http://www.slu.edu/x54666.xml.

Sustainability in Agriculture | Alternative Farming Systems Information Center. (2012, August 17). Home | Alternative Farming Systems Information Center. Retrieved August 19, 2012, from http://afsic.nal.usda.gov/sustainability-agriculture-0

The National Agricultural Workers Survey, Employment & Training Administration (ETA) - U.S. Department of Labor. (2010, January 11). Employment & Training Administration (ETA) - U.S. Department of Labor. Retrieved August 19, 2012, from http://www.doleta.gov/agworker/report9/chapter6.cfm



FOOD DAY 2012 EVENTSThis year, the city of Saint Louis will host several exciting Food Day events:

• Saint Louis University will host a lunch in the Garden to Table’s garden located on Caroline Street on SLU’s medical campus. Local foods will be featured and representatives from SLU’s Department of Nutrition and Dietetics, St. Louis Food Policy Council, Healthy Youth Partnership, Slow Food St. Louis, and many local farmers will be present to discuss their dedication to Food Day’s mission. The event will be held on October 24 from 11 am - 1 pm, for more information visit nd.slu.edu.

• Dutchtown Harvest Festival offers activities for the whole family, including a kid zone, farmers market, cooking demonstrations, and of course, delicious local food and beer tents. You can catch the fun on October 14 at 11 am at Marquette Park (“Food Day,” n.d.).

• The Missouri History Museum is hosting a free showing of the movie FRESH on Food Day, October 24 at 7 pm. The film takes an optimistic approach to discussing our nation’s current troubled food systems by proposing practical changes we can all make to improve the future of food. A truly inspirational film, FRESH excites and empowers one to take action in the current food movement. Guests may register for this and all other Food Day events on foodday.org.

Want to see more Food Day events in St. Louis? From exploring environmental concerns to teaching

health conscious eating practices, from gardening

demonstrations to cooking demonstrations, the ways

to get involved in Food Day are endless. Anyone may

develop their own Food Day celebration and register it on

foodday.org to help spread Food Day’s message.



OCTOBER 24, 2012

Saint Louis University Doisy College of Health Sciences

Department of Nutrition and Dietetics in partnership with City of St. Louis Department of Health and

Les Dames d’Escoffier St. Louis Chapter

hosted at the Gardens to Tables Organic Garden at the corner of

Compton and Rutger

RSVP to the event at:

foodday.org/3350/garden_to_tables_food_day_2012or

visit nd.slu.edu and click on the Food Day 2012 link

OUR FEATURED LOCAL

FARMERS:3 Girls and a Tractor

Baetje Farms

Ozark Mountain Creamery

Shuetz Farms

Thies Farm and Greenhouses

Ozark Forest Mushrooms

Blue Heron Orchard

Andy Ayers

keynote speaker

Nicola MacPherson of Ozark Forest Mushrooms

Includes 5 courses of delicious, artisan foods!

Interview with Nancy ClarkCandace Giuffre and Katrina Skurka

Few names are as synonymous with sports nutrition as Nancy Clark. Her book, Sports Nutrition Guidebook is, or should be, on every athlete’s, dietitian’s, and coach’s bookshelf. As a true expert in sports nutrition, she has a long list of clients including members of the Boston Red Sox, Boston Celtics, Olympic athletes, and that is just the beginning. Fortunately for us, St. Louis is one of the stops on her upcoming workshop tour.

Workshop DetailsWhen: Friday November 16 and Saturday November 17, 2012Where: Allied Health Professions Building, Saint Louis University

Agenda

Friday November 16, 2012Nancy Clark

• Nutrition Tips for Athletes • Common Mistakes • Weight Management • Eating Disorders • Starting your own business

Saturday, November 17, 2012 Bill Evans, PhD

• Exercise, nutrition and aging

When asked about the upcoming seminar, Nancy provided us with a little teaser on ergogenic aids, stating that only a few really work and also graciously agreed to answer a few of our questions.

Is there any current research that you have found to be beneficial to the field of sports nutrition?

“Beets, beet root juice, and nitric oxide and how that can enhance performance if you eat beets two and a half hours before you exercise.” She mentioned the research conducted by Murphy et al., a Saint Louis University graduate, that found the consumption of whole beetroot improves running performance in healthy adults. This study used baked beetroot for the trial that contained equal to or more than 500mg of nitrate. When compared to the control group, the athletes showed a 5% increase in velocity during a 5k treadmill run. Nancy is also excited about current research that looks at the power of real foods like dark cherries and pomegranates.

Do you have any thoughts as to what should be studied in future research concerning sports nutrition?

Nancy said that the continuation of research with real foods should be a main focus on performance enhancement in the sports nutrition field. This research would help to support the movement to supplement through food over the pill form. Nancy agreed that too many people are relying on sports drinks and protein bars, when they really don’t need them. This is a rising interest in the nutrition field with controversies rising over multi-vitamin and supplement use. It is of a main concern to collegiate and professional athletes who have to monitor these products for substances banned by the NCAA and other professional sports agencies. Nancy also would like to see more definite research looking at carbohydrate needs during exercise along with the continued interest in protein intakes focusing on the variety of amino acids.

What is the question you are most commonly asked?

Nancy’s answer, “How to lose weight and still have energy to train?” If you want to know the answer to that question and many other questions be sure to attend her workshop in November. Not only is it a great chance to hear from one of today’s leading experts in sports nutrition, but it will give athletes, dietitians, trainers, and coaches a chance to network and share ideas.

For more information on Nancy Clark or the workshops visit http://www.nancyclarkrd.com/. Her books including Sports Nutrition Guide for Runners, Nancy Clark’s Food Guide for Marathoners, and Cyclists Food Guide can be purchased through her website or through amazon.

REFERENCES

Murphy, M. MS, RD, LD, Eliot, K. MS, RD, LD, Heuertz, R.M., PhD., & Weiss, E. PhD. (2012) Whole Beetroot Consumption Acutely Improves Running Performance. Journal of the Academy of Nutrition and Dietetics. 112: 548-552. doi: 10.1016/j.jand.2011.12.002



Soda, To Ban or Not To Ban?Heather Pratt and Amanda Finks

New York has added yet another proposal aimed at improving the health of Americans. This new proposal is a soda ban that would disallow the sale of sugary drinks sold in containers larger than 16 ounces at businesses regulated by the Health Department including restaurants, food carts, sports venues, movie theaters and delis. If passed, this proposal will join New York’s other food laws including: the menu labeling law, a trans fat ban, and prohibition of food donations to homeless shelters. As defined by this proposal, sugary drinks are“sweetened with sugar or another caloric sweetener that contain more than 25 calories per eight fluid ounces and contains less than 51 percent milk or milk substitute by volume as an ingredient”. It would not impact the sale of diet soda or dairy based drinks. This ban is in direct response to the obesity epidemic and is not the first time that sugary drinks have been targeted.

Sugary drink consumption, implicated as contributing factors in our staggering obesity statistics, has increased steadily, as have our waistlines. A natural target, there have been attempts to curb consumption for a number of years. In 2008, former New York governor, David Paterson, proposed an 18% tax on these beverages. The following year in New York there was a push for a tax of one cent on every ounce of sweetened beverages. In 2009, senate leaders considered an additional federal tax on sugary drinks to help pay for President Obama’s health care act. It was estimated that adding a tax of three cents per 12 ounce serving on these drinks would generate $24 billion over the next four years. None of these taxes came to fruition. In 2010, Mayor Bloomberg proposed a ban that would prevent users of the Supplemental Nutrition Assistance Program (SNAP) from using the funds to purchase sugary drinks. It is estimated that $75 million per year is spent on sugary drinks by New York City SNAP users. The U.S. Department of Agriculture, which oversees SNAP, would not allow the city to implement the program. A 2012 study looking at beverage consumption of children participating in SNAP found that beverage choices were the same, regardless of whether the family was receiving SNAP or not. Thus, prohibiting the purchase of sugary drinks with SNAP would not affect their intake. So can an intervention to reduce sugary drink consumption prevent weight gain?

Several studies have tried to ascertain whether a direct correlation exists between soft drink consumption and weight gain and obesity. The results are inconsistent. Although there is a positive association between sugary beverages and obesity, it is difficult to isolate these beverages as sole contributors as study participants often had other lifestyle factors related to obesity such as poor diet, inadequate physical activity, and low socioeconomic status.

Additional research is required to make a definitive link between sugary drink consumption and obesity. In the meantime there continues to be proposed legislation by various cities to tax sweetened drinks at a higher rate. While the taxes are minimal, 33 states have already opted to charge sales tax on soft drinks. A one cent per ounce tax, as proposed, would more than double the tax to approximately 12 percent. This translates to a 12 cent tax on a $1 can of 12 ounce soda instead of a five cent tax.

The proposed soda ban in New York requires the approval by the Board of Health whom is appointed by Mayor Bloomberg, the initiator of the proposal. The board is scheduled to vote on September 13th, 2012.

Many experts agree that focusing on sweetened beverages will not help combat obesity. Rather, they believe that educating people on how to make healthy food choices will go further in improving health and help curb overweight and obesity in America. This is where dietitians can play an integral role, as nutrition educators and experts.

Editor’s Note: The New York Board of Health passed the soda-ban proposal. The rule is set to take effect in March 2013.

REFERENCES

Reuters. (2012, May). New York soda ban: Bloomberg proposes end to sale of large sugary beverages. Huff Post New York. Retrieved from http://www.huffingtonpost.com/2012/05/30/bloomberg-plans-a-ban-on-_n_1557851.html

Adamy, J. (2009, May). Soda tax weighted to pay for health care. Election 2012. Retrieved from http://online.wsj.com/article/SB124208505896608647.html

Seaman, A. M. (2012, August). Food stamps don’t alter kid’s sugar drink choices.

Fernandes, M. M. (2012). Effect of the Supplemental Nutrition Assistance Program (SNAP) on frequency of beverage consumption among youth in the United States. Journal of the Academy of Nutrition and Dietetics, 112(8), 1241-1246.

Brown, C. M., Dulloo, A. G., & Montani, J. P. (2008). Sugary drinks in the pathogenesis of obesity and cardiovascular diseases. International Journal of Obesity, 32, S28-S34.

New York – experts push 1 cent per ounce soda tax. (2009, September). Vos Iz Neias? Retrieved from http://www.vosizneias.com/38524/2009/09/16/new-york-experts-push-1-cent-per-ounce-soda-tax/

Gross, S. (2012, July). Pro, con arguments on proposed NY sugary drink ban. SFGate. Retrieved from http://www.sfgate.com/default/article/Pro-con-arguments-on-proposed-NY-sugary-drink-ban-3729504.php



Has the Magic Weight Loss Pill Arrived?Catherine Gambaro and Jingshu Guan

In 2010, the Centers for Disease Control and Prevention reported that over one third (35.7%) of adults in the United States were obese. Over the past ten years obesity rates have increased. Due to obesity-related health risks and staggering health care costs, obesity treatments have been of high interest in the medical field. One treatment continually explored with little success, is pharmaceuticals. Currently there are a handful of weight management drugs available, but most are for short term use and accompanied by many side effects. Xenical was the only long term weight management drug approved by the U.S. Food and Drug Administration (FDA) until recently when two medications, Belviq and Qsymia, were approved.

What are Belviq and Qsymia?Belviq and Qsymia were approved by the FDA on June 27th, 2012 and July 17th, 2012 respectively. Due to high incidence of weight-related comorbidities, the excitement following the release of these two anti-obesity drugs gives new hope for long term weight management treatment.

Belviq and Qsymia, used for chronic weight management in adults, are intended for individuals with one of the following conditions:

• BMI of 30 or greater• BMI of 27 or greater and at least one weight-related condition such

as hypertension, type II diabetes or high cholesterol

Belviq works by activating the serotonin 2C receptor in the brain to reduce hunger and increase satiety with smaller amounts of food. Placebo-controlled trials including 8000 people, resulted in 38% of participants treated with Belviq losing at least 5% of their body weight.

Qsymia is a combination of two previously FDA-approved drugs, phentermine and topiramate. Phentermine is currently approved as a short-term weight loss medication. It works by triggering the release of leptin, suppressing appetite. Topiramate is indicated to treat epilepsy, but also increases fullness, makes foods taste less appealing, and increases calories burned. Of the 3700 people who participated in randomized, placebo-controlled trials testing Qsymia, 62%-69% of them lost at least 5% of their body weight while using Qsymia.

The use of both Belviq and Qsymia should be discontinued in patients who fail to lose 5% of their body weight after 12 weeks of treatment as these patients are unlikely to achieve clinically meaningful weight loss. The use of these drugs is not recommended for individuals who are pregnant or plan to become pregnant.

Neither drug will be available until late 2012 to early 2013. It is important to note that results observed during the clinical trials showed the drugs’ effectiveness only when used in conjunction with a balanced diet and exercise. Therefore, these drugs do not provide the effortless fix desired by people to “cure” obesity.

Looking to the FutureAlthough excitement surrounded the FDA approval of these drugs, it is unknown how effective they will be in combating obesity. Lori Jones, R.D., L.D., a community nutrition instructor at Saint Louis University and public health practitioner, is curious but skeptical on the role these medications may play in the future. She sees these pills as “something that can help but will not replace being active and good nutrition.” Due to their limited weight loss potential (up to 10-15% of body weight), she does not see Belviq or Qsymia as the “magic pill” people are looking for. Another concern, she says are the unknown long term effects of these drugs. Although they were approved by the FDA, more long term studies are still underway to investigate possible side effects. When asked if she would recommend these medications to her clients she stated that if it could have beneficial effects, possibly, but only after detailed individual assessment. According to Jones, a better approach is “to catch people early before problems start and really manage obesity.”

Efforts for investigating safe and effective obesity treatment will not stop here. Medications and behavior therapies will be developed and studied as long as obesity remains a prominent health concern. Contrave, another weight management drug denied approval by the FDA in 2011 due to questionable cardiovascular safety, is predicted to be up for approval again in 2014. It will be interesting to see if these drugs bring new hope or disappointment to the obesity battle.

[Continued on next page]

Photo courtesy of Vivus



Drug Side EffectsBelviq Serotonin syndrome (restlessness, diarrhea, tachycar-

dia, hallucinations, nausea, vomiting, increased blood pressure, increased body temperature) (Heller & Zieve, 2010)Attention and/or memory disturabancesHeadacheDizzinessFatigueDry mouthConstipationIncreased risk of hypoglycemia in diabetic patients

Qsymia Tingling of hands and feetDizzinessAltered taste sensationInsomniaConstipationDry mouth

REFERENCES

Ogden, C., M. Carroll, et al. (2012). Prevalence of obesity in the United States, 2009-2010. NCHS data brief, no 82. N. C. f. H. Statistics. Hyattsville, MD.

(2009, September 19, 2009). “Prescription Weight Loss Drugs.” Weight Loss & Diet Plans. Retrieved August 21, 2012, from http://www.webmd.com/diet/guide/weight-loss-prescription-weight-loss-medicine.

DeNoon, D. J. (2012). Belviq, Qsymia: New Weight Loss Drugs Compared Retrieved August 21st, 2012, from http://www.webmd.com/diet/news/20120718/qsymia-belviq-new-weight-loss-drugs-compared

Liscinsky, M. (2012). FDA approves weight-management drug Qsymia Retrieved August 21st, 2012, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312468.htm

Yao, S. (2012). FDA approves Belviq to treat some overweight or obese adults Retrieved August 21st, 2012, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm

Colman, E. (2010). FDA Briefing Document: Contrave (Naltrexone 4mg, 8mg/Bupropion HCL 90mg extended release tablet). U. S. F. a. D. Administration: 258.(2012) FDA approves highly anticipated anti-obesity drug. Associated Press

Heller, J., & Zieve, D. (2010). Serotonin Syndrome A.D.A.M Medical Encyclopedia.



LEARN MORE ABOUT SAINT LOUIS UNIVERSITY’S DIETETIC INTERNSHIP

VISITND.SLU.EDU



Documents

Saint Louis University's Nutrition Spotlight Newsletter