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Nutrition, Obesity, Research

A call to focus on the nutritional value of foods, rather than calorie counts

A call to focus on the nutritional value of foods, rather than calorie counts

10331709463_60f2188a69_zTo reduce obesity rates, cardiovascular risk and chronic diseases, ditch calorie counting and instead emphasize the nutritional content of foods. That’s the message from a group of British researchers in an editorial recently published in Open Heart.

Drawing on past scientific evidence, the authors argue that physicians, patients and society’s focus on low-calorie foods and diets has resulted in a sacrifice of good nutrition and failed to improve overall public health. According to a press release:

Daily consumption of a sugary drink (150 calories) is associated with a significantly increased risk of type 2 diabetes whereas daily consumption of a handful of nuts (30 g of walnuts, 15 g of almonds and 15 g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) is associated with a significantly reduced risk of heart attack and stroke.

It has been estimated that increasing nut consumption by two servings a week could stave off 90,000 deaths from cardiovascular disease in the US alone.

And the Action for Health in Diabetes trial shows that a low calorie diet on top of increased physical activity in patients with type 2 diabetes was not associated with a reduced risk of cardiovascular death despite significant weight loss and a monitoring period of 13.5 years, [the authors] point out.

“It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that ‘food can be the most powerful form of medicine or the slowest form of poison’,” they write.

Previously: The trouble with the current calorie-counting system, Homemade: Community-based project teaches how to cook for health and Cooked food, calorie counts and food labels
Photo by Mariya Chorna

Health Disparities, In the News, Nutrition, Public Health

Turning brown bananas into ice cream: Repurposing surplus food reduces hunger, creates jobs

Turning brown bananas into ice cream: Repurposing surplus food reduces hunger, creates jobs

8421632884_224d355c21_zAccording to a recent report, the United States is one of the most wasteful countries in the world. Up to 40 percent of American food is thrown in the trash, which seems absurd given that food insecurity and hunger are still such problems in this country. Adequate nutrition is a basic for preventing disease and promoting health.

But students at Drexel University are working on improving the situation. They developed a program to use would-be supermarket waste in producing value-added food products. Not only can these products be provided to hungry people, they can be sold back to the supermarket in a mutually-beneficial relationship that could also support new jobs.

The strategy – called a “Food System-Sensitive Methodology”, or FSSM – was developed as part of the Environmental Protection Agency’s Food Recovery Challenge, and is described in a recent Food and Nutrition Sciences article. Drexel culinary arts and food science students decided to reach out to supermarkets because these stores are some of the biggest producers of waste: They throw out produce that is bruised, marked, or misshapen, or remove food simply to make room for fresher shipments. For their pilot project in West Philadelphia, students collected thousands of pounds of fruits and vegetables from local supermarkets and improved their value and palatability by developing recipes in the student-run Drexel Food Lab, a research group that aims to address real-world food issues.

Americans are used to cosmetically pristine produce, and many won’t eat a brown banana even when they’re hungry. Jonathan Deutsch, PhD, director of Drexel University’s Center for Hospitality and Sport Management, explains in a press release how FSSM addresses this: “For example, we took those brown bananas, peeled them, froze them and food processed them to create banana ice cream, which is much more appealing.” Drexel has given facelifts to similarly lackluster items, like canned peas. This requires chefs to think in a new, more sustainable way: Instead of concocting a recipe and then buying ingredients, they must be creative with what’s given to them.

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Ask Stanford Med, Health and Fitness, Nutrition, Obesity, Precision health, Stanford News

A Stanford physician takes a precision health approach to living a healthier lifestyle

A Stanford physician takes a precision health approach to living a healthier lifestyle

timthumbNearly 70 percent of Americans ages 20 or older are overweight or obese, including Larry Chu, MD, a Stanford anesthesiologist and executive director of Medicine X.

Chu, who has struggled with his weight for over a decade, knew he was overweight but didn’t think it was a serious threat to his health. This changed during a routine doctor’s visit. As he explains in a podcast, Chu was shocked to learn that lab results showed he was at high risk for stroke and heart attack. He decided to take action and launch precision:me, a personal blog project chronicling the first 90 days of his journey to live a healthier lifestyle.

Why most of us try to slim down by shunning carbs, stepping up our exercise routines and secretly weighing ourselves each morning, Chu is tracking his health data using a range of gadgets and other tools and sharing the every detail of his progress publicly on his blog. He is also posting photos and podcasts.

Below Chu discusses why he choose to take this unique approach to achieve his weight-loss goals, how he hopes it will inform the broader conversation about obesity and its potential to demonstrate the value of digital tools in enhancing personal health.

What was the catalyst for precision:me?

One of the misconceptions about obesity is that it is a lifestyle disease and if people would only eat less and move more they would be fit. In my case, this is a health journey I have been struggling with since my residency training at Stanford. Using precision health tools to address obesity is a new approach that we are focusing on in precision:me. Stanford has recently announced exciting plans for precision health. I thought it was a good time to share how we at Medicine X see precision health as a novel approach that individuals and their providers can use today to tailor precise and individualized care. It is a very practical and personal dive into developing and implementing a precise plan to modify my diet and metabolic profile to forestall the development of more significant chronic diseases, such as diabetes and heart disease, using data and analytics provided through digital health tools and expert medical, nutritional and fitness collaborators.

Why did you decide to make all of your health data available online for public consumption?

It was an easy and difficult decision at the same time. There is incredible stigma associated with obesity, which we discuss on the precision:me website. Being overweight or obese is a subject that many of us find difficult to talk about. Sharing information can make it easier to start a dialogue. Advances in precision health at Stanford and around the world will depend upon patients sharing their personal health data in a secure and protected fashion with researchers. By sharing my data with the public, I hope to help everyone see what it is like to live with obesity as a condition, break down misconceptions and misperceptions about the disease, and help shine a light on the value of sharing data to help others.

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Autism, Behavioral Science, Medical Apps, Nutrition, Stanford News, Technology

Stanford grad students design new tools for learning about nutrition, feelings

Stanford grad students design new tools for learning about nutrition, feelings

2789442655_1f5c33ac51_zMushrooms and tomatoes, veggies that are often reviled by preschoolers, star in a new app designed by a Stanford graduate student that aims to involve children in preparing, and eating, healthy meals.

“Children are more likely to try food that they’ve helped cook,” explained Ashley Moulton, a graduate student in the School of Education’s Learning, Design and Technology Program, in a recent Stanford News story.

Moulton’s iPad app, Nomster Chef, is one of several student projects featured in the article and accompanying video:

Before cooking, children receive an educational video about a food they’ll be working with – for example, a video on how mushrooms grow. The app also incorporates food information in the recipe steps, like the fact that tomatoes are actually a fruit.

After user-testing the app prototype, “I heard from parents that they noticed differences in how their kids are eating,” Moulton said. The app also kept kids engaged throughout the cooking process.

For her project, fellow student Karen Wang developed an iPad app called FeelingTalk that helps children with autism interpret facial expressions:

…[I]n the first level of FeelingTalk, kids choose the one face that’s different (a sad face) from the three happy faces on the screen. The app will then label the different face “sad.”

“My app will be utilizing learning mechanics that directly work with the autistic brain to help them work on something that they’re having difficulty with,” Wang said. “By leveraging something they’re good at, we’re going to teach them to get comfortable looking at people’s faces, examining the key features, and eventually understanding emotions.”

Moulton, Wang and other students will present their work this afternoon at the LDT Expo at the Stanford Graduate School of Education.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health and No bribery necessary: Children eat more vegetables when they understand how food affects their bodies
Photo by Peter Weemeeuw

Health and Fitness, Nutrition, Obesity, Research

Can food mentions in newspapers predict national obesity rates?

Can food mentions in newspapers predict national obesity rates?

New_York_TimesFood words trending in today’s newspapers could help predict a country’s obesity rates in three years, according to findings recently published in the journal BMC Public Health. 

In the study, researchers examined whether media mentions of food predate obesity prevalence by analyzing mentions of foods in New York Times and London Times articles over the past 50 years. Using this data, they statistically correlated it with each country’s annual Body Mass Index, or BMI. Brennan Davis, PhD, lead author of the study and an associate professor of marketing at California Polytechnic State University, said in a release that results showed:

The more sweet snacks are mentioned and the fewer fruits and vegetables that are mentioned in your newspaper, the fatter your country’s population is going to be in 3 years, according to trends we found from the past fifty years … But the less often they’re mentioned and the more vegetables are mentioned, the skinnier the public will be.

Researchers say the research could help public health officials better understand the effectiveness of current obesity interventions.

Previously: Adventurous eaters more likely to be healthy, new study shows, Want kids to eat their veggies? Researchers suggest labeling foods with snazzy names, Can edible “stop signs” revive portion control and curb overeating? and Can dish color influence how much you eat?
Photo by Jaysin Trevino

Immunology, Nutrition, Stanford News, Videos

A Stanford dietician talks food sensitivities

A Stanford dietician talks food sensitivities

Ever wondered what the difference between a food allergy and a food sensitivity is? Neha Shah, MPH, RD, CNSC, a registered dietician at the Stanford Digestive Health Center, sheds some light in a new video.

In people with food allergies, she explains, the immune system responds to the presence of the food, which isn’t the case for food sensitivities. People with food allergies have to avoid the culprit foods entirely, whereas people with food sensitivities can sometimes have small amounts of the food – though they must figure out what their threshold is. (Too much and the offending food might set off other symptoms like gas, bloating or diarrhea.) Shah uses lactose intolerance as an example of a very common food sensitivity and describes how people can understand their threshold.

Previously: Peanut products and babies: Now okay?, Stanford dietitian explains how – not just what – you eat matters, Taking a bite out of food allergies: Stanford doctors exploring new way to help sufferers, Eating nuts during pregnancy may protect baby from nut allergies and Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research

Behavioral Science, Nutrition, Research, Women's Health

Adventurous eaters more likely to be healthy, new study shows

Adventurous eaters more likely to be healthy, new study shows

9044506418_142bb67dcc_zAre you willing to sample chocolate-covered silkworm pupae? What about blood sausage or, for the vegetarians among us, some shoo-fly pie (one of my personal favorites)?

If any or all of those sound tasty, or at least worth trying, then you’re probably a food neophile, aka an adventurous eater. And for you, I’m the bearer of good news: Adventurous eaters have lower body-mass indexes and are generally more conscious about healthy eating than their less adventurous diners, according to a study published recently in Obesity.

Researchers from Cornell University and the University of Vermont recruited about 500 women and had them complete a survey on their eating habits and willingness to try new things and foods. The answers shed insight into the connections between healthy habits and adventurousness:

…Adventurous eaters were less concerned that a food was easy to prepare and about its price, but more interested in cooking as a way to connect with their heritage and more likely to have friends over for dinner. Given that cooking at home is associated with lower BMI and increased consumption of healthy foods, if adventurous eaters are comfortable with foods that were harder to prepare, and often have friends over for dinner, it may be that they prepare their own food more often than non-adventurous eaters. Furthermore, eating with others versus eating alone has been associated with decreased intake in some studies. The lower concern about price of foods exhibited by more adventurous eaters is in line with characteristics of foodies, who are much more concerned with food quality than food price. Because healthy foods are often more expensive than junk foods and require preparation, adventurous eaters may be more likely to procure and prepare these types of foods than non-adventurous eaters.

The authors go on to write that the findings “have exciting practical implications” and suggest “several strategies [that] practitioners could use to help increase adventurousness.” But they acknowledge the research has several limitations, including its lack of men and definition of “adventurousness.”

Previously:  Where is the love? A discussion of nutrition, health and repairing our relationship with food, “They might be healthier, but they’ll still be junk foods”: Expert comments on trans-fat ban and Examining how food texture impacts perceived calorie content
Photo by Smabs Sputzer

FDA, Health and Fitness, In the News, Nutrition, Public Health

“They might be slightly healthier, but they’ll still be junk foods”: Expert comments on trans-fat ban

"They might be slightly healthier, but they'll still be junk foods": Expert comments on trans-fat ban

4345026096_35defbf6b0_zAs you’ve probably heard, the FDA ruled last week to ban trans-fats and phase them out of all food products over the next three years. This news has been widely covered, both heralded for its health implications and critiqued for being too long in coming. Yet either way, it is not a panacea, as Stanford Medicine professor Christopher Gardner, PhD, explained when he shared his opinion with me over the weekend:

The true impact of the FDA ban on trans-fats will not be known until we find out what substitutes the food industry finds, and what that does to the sale of junk food and the health of Americans in response to the switch. It could be beneficial. But it isn’t as if trans-fats will be gone and everyone will eat an extra two servings of vegetables in their place.

Gardner, who has spent the past 20 years researching the health benefits of various nutrition components, pointed out that “a lot of good people and excellent scientists worked on this for a long time” and “it took a great deal of effort to assemble the science to demonstrate that this is something so harmful in the American diet that it should be removed with an FDA ban.” He also offered more specifics on what food companies might do following the ban:

The companies making those products are unlikely to remove those junk food products entirely from the shelves of grocery stores across America. Instead, it is most likely that they will look for an alternate form of fat that will serve as closely as possible the same role that trans-fats served. Trans-fats act like saturated fats in terms of being solid rather than liquid at room temperature. This can help the icing on a cupcake stay solid, and it can give a “mouth feel” of solid fat that people like to taste in their food. The goal of the food industry will be to replace the trans-fat with another fat that is solid at room temperature, which likely means the replacement could very well be as bad as the trans fats themselves.

For example, palm oil or esterified stearic acid are likely to be options. For the palm oil, this will mean destruction of rain forests and biological diversity. For esterified stearic acid, this will mean another reason to grow more monocultures of soybeans from which to extract the oil. Both of these will likely have a negative environmental impact. There are likely other choices to consider.

After all this, will those junk foods now be health foods? Absolutely not. They might be slightly healthier junk foods, but still junk foods.

Previously: Want to curb junk food cravings? Get more sleep, Talking to kids about junk food ads, and Trans-fat still lurks in packaged foods
Photo by Kevin

Global Health, Nutrition, Pediatrics, Stanford News, Technology, Women's Health

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Nomfusi_counselingWhat if we could “leapfrog” over the education and technology gap in low-resource countries, while at the same time improving maternal and early childhood health in those areas? That is precisely the promise of a new Stanford-sponsored initiative spearheaded by Maya Adam, MD, a lecturer in the human biology program here.

I recently had the chance to speak on the phone with Adam and hear more about this project, which consists of designing picture-based educational videos that are loaded on tablets and distributed among community-health workers. At present, the video on child nutrition is being used as a pilot in South Africa through the organization Philani, where twelve “mentor mothers” have been using the tablets since March. As you’ll read below, there is immense potential for the project to scale up in the near future.

What have the results of this initiative been so far?

The feedback that we’ve gotten was that a lot of the mothers being counseled said, “You know, you’ve been using phrases like ‘balanced diet’ for many years, and I didn’t quite know what that meant until I saw the plate with the green vegetables and the little bit of protein and the little bit of grains.” Certain phrases became clearer when they were drawn in pictures. Also, we found a lot of the children wanted to come watch because it was a screen-based activity.

The workers themselves found it useful to convince their patients, for example, of the importance of prenatal care, because when the patients heard it both from the video and from them, it was almost as if the video was validating their messaging. So they’re very eager to have the project continue. They have a whole list of other videos they want us to make, from breastfeeding to HIV/AIDS prevention… It’s really been a powerful way both to teach and give these highly intelligent women access to technology that could enhance their education and help them overcome the barriers in their lives.

How easy would it be to use these videos in different regions of the world? 

slider-9_compressedWe have videos translated into English, Xhosa, and now Spanish, because they’ll be used next in Guatemala… We can use English in the U.S. in under-resourced locations. These are all very universal messages, and that’s why it’s so exciting: For a relatively small amount of effort, we can make videos that can be both translated into many other languages, and subtly altered visually so they resemble women and children in each different part of the world. For example, while we were creating the video, we put the braids that African women traditionally wear in their hair on a different layer of the Photoshop, so that layer can be removed and the resulting woman will have straight dark hair that would be more appropriate for use, say, in Guatemala.

We thought a lot about how to represent food. A real plate of food from South Africa would be culturally inappropriate in Guatemala, but by using cartoon images of fruits and vegetables, it becomes much more universal… We tried to show a variety of different fruits and vegetables without specifically showing that “this is a guava,” because a guava might not grow in other parts of the world.

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Medical Education, Mental Health, Nutrition, Stanford News, Surgery

Keeping an even keel: Stanford surgery residents learn to balance work and life

Keeping an even keel: Stanford surgery residents learn to balance work and life

med students in sailboat

Residency is one of the most intense times in a surgeon’s training, and it can take a toll physically and mentally on newly minted medical school graduates as they learn to cope.

To help them counter that stress, Stanford’s Department of Surgery started the Balance in Life Program for its residents. The program, and one of its team-building exercises – a sailing lesson in one of the world’s best sailing spots, the San Francisco Bay – were highlighted in a recent Inside Stanford Medicine story.

As described in the piece, the program is dedicated to the memory of Greg Feldman, MD, a former chief surgical resident at Stanford who committed suicide in 2010. The program provides basics like easy-to-access healthy meals, group therapy sessions and social activities, and Ralph Greco, MD, the program’s director said of it:

A lot of people would argue with the notion that such a program is necessary… I know our day of sailing may raise some eyebrows, but our faculty decided that we should do whatever we could to give these young people the tools they need to help them deal with the vicissitudes of life and medicine through the rest of their careers.

The article also notes that the program attracts residents interested in work-life balance to Stanford:

“The fact that we have this Balance in Life Program is great for recruitment of like-minded individuals,” [resident Micaela Esquivel, MD,] said. “I can tell medical students considering us that they would be hard-pressed to find another program that cares enough about their well-being to offer what we do.”

Previously: A call to action to improve balance and reduce stress in the lives of resident physicians, Surgeon offers his perspective on balancing life and work, Program for residents reflects “massive change” in surgeon mentality and New surgeons take time out for mental health
Photo by Norbert von der Groeben

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