Nutrition

I’m a few days late to this, but a writer with the Columbia Journalism Review has some great things to say about ChopChop, a new children’s magazine that is “beautiful and engaging” and “empowers kids to cook and eat healthy foods, offers recipes even adult foodies will love, and aims to help reduce childhood obesity…” (Indeed, curtailing obesity is part of the publication’s mission statement.) Trudy Lieberman writes:

ChopChop is the brainchild of cookbook author Sally Sampson who was casting about for ways to use her skills to do something about obesity. She approached Dr. Barry Zuckerman, chief of pediatrics at Boston Medical Center, who loved her idea and suggested it was a natural for pediatricians’ offices. And so ChopChop was born three years ago with an initial print run of 150,000. (The Boston Globe ran a business page story soon after the magazine debuted). Today its circulation is half a million with a new distribution strategy. “We changed the model to be where kids are,” Sampson said.  That means schools, community centers, Boys and Girls Clubs, and other groups that serve low-income children.  Half the magazines go to doctors’ offices and organizations and the rest are bulk sales. Of course, the public can buy a subscription too.

Sampson wants to “change eating habits one bite at a time” and encourage families to eat together. She believes people don’t cook anymore, but if kids can bring the magazine home and ask “can we roast carrots,” that’s a step in the right direction. The fall issue featured a family dinner and showed a family dining on roast chicken with roasted root vegetables like onions, carrots and sweet potatoes. There was a recipe for basic chicken soup that encourages the kids to use left over chicken and offers riffs on the soup—curried chicken soup, tortilla soup, tortellini soup.

Lieberman also points out how important this type of thing is from a policy perspective:

…In America, where more than one-third of adults and 17 percent of children are obese, stopping obesity in kids long before they become young adults with health problems is crucial. Efforts like ChopChop’s are significant. Illness and death resulting from too much of the wrong foods contribute mightily to the growing US health care bill threatening the stability of government programs like Medicare and Medicaid and contributing to the high insurance premiums the rest of us must pay.

Previously: Can cooking classes help curb childhood obesity?, Children and obesity: What can parents do to help?, Smaller plates may be a tool to curtail childhood obesity and Obesity in kids: A growing and dangerous epidemic
Via @TEDMED
Photo by andrewmalone

Nature and nurture have long been the ‘tomayto’ and ‘tomahto’ of lengthy arguments in both psychology and medicine. At the end of the day, of course, disease is caused neither strictly by genes nor strictly by the environment, but by the interactions between them.

In a new study published in Nature Genetics, Stanford medical-systems expert Atul Butte, MD, PhD (whom I’ve written about at length in the past), has figured out a sophisticated way to crunch massive amounts of genetic and environmental data and pull faint but important signals out of the noise. Sifting through mountains of data gathered in biennial health-and-nutrition surveys run by the federal government’s Centers for Disease Control and Prevention, Butte teased out a gene/environment relationship that may make you want to eat a carrot.

Just over half of us, it’s already known, are walking around with two copies – one from dad, one from mom – of a particular version of a gene that seems to very slightly predispose us to developing type 2 diabetes at some point in our lives. Nothing much we can do about that.

Unlike genes, however, our environment is something we can sometimes do something about. The Butte team’s new work suggests that in people carrying a double dose of the gene version in question, low blood levels of the micronutrient beta-carotene (a vitamin A precursor found copiously in carrots and many other red, orange and yellow vegetables as well as in many vitamin supplements) are associated with not just a slight risk but a significantly increased risk for type 2 diabetes, whereas in those with high blood levels of the substance, that risk appears to be substantially mitigated.

A bit more offbeat is Butte et al.’s finding that another micronutrient – gamma-tocopherol, one of the eight forms of vitamin E – has the opposite interaction with the exact same gene: High levels of it, in people with two copies of the diabetes-related gene version, substantially boost the risk, while low levels reduce it. Nobody knows yet why that’s true, as I explain in our press release:

“We can’t say, based on just this study, that ‘vitamin E is bad for you,’” said [the Human Genetics paper's first author, postdoctoral researcher Chirag Patel, PhD]. He noted that blood levels of alpha-tocopherol - another form of vitamin E that predominates in most supplements - showed no deleterious interaction with the predisposing gene variant in the new study.

But it’s not too early to recommend that people who like carrots keep on eating them. And, the authors speculate, it could be that gamma-tocopherol, rather than being bad in itself, may instead just be a marker of a diet rich in the things where vitamin E is found. This includes soybean, corn, or canola oils (which are, unfortunately, ingredients in many processed and fried foods) and trans-fatty-acid-loaded margarine.

Previously: Mining medical discoveries from a mountain of ones and zeroes, Newly identified type-2 diabetes gene’s odds of being a false finding equal one in 1 followed by 10 zeroes and Cheap data! Stanford scientists’ “opposites attract” algorithm plunders public databases, scores surprising drug-disease hook-ups
Photo by color line

Teenagers get an average of 3,339 texts a month, according to data from Nielsen consumer research group. In light of this data, researchers investigating how to best leverage this technology to educate kids on nutrition and fitness.

To better understand how healthy text messages could help improve teens’ eating and exercise habits, University of Arizona researchers conducted a yearlong trial involving 177 teens to identify their preferences for content, format, style, origin, frequency and mode of delivery. Study results revealed that telling teens what to do, using phrases such as “you should” and “never,” and texts introduced by the words “did you know” were unpopular. Age-relevant information, fun facts and trivia were well received. Futurity reports:

Texts the teens liked best included those that specifically referenced their age group, such as, “American girls aged 12-19 years old drink an average of 650 cans of soda a year!”

They also liked messages that were interactive, like fun quizzes; messages that were actionable, like simple recipes; and messages that included links to websites where they could learn more about a topic if desired.

The teens also appreciated the occasional fun fact not necessarily related to health – some bit of trivia they could share with their friends, like the fact that carrots were originally purple or that ears of corn have an even number of rows.

Beyond such content preferences the study showed teens didn’t want to be inundated with information and said about two texts a day was sufficient. Researchers say the findings could pave the way for the development of text message-based health prevention programs geared toward teens.

Previously: Study says nearly 40 percent of American children’s diet consists of empty calories and Are sports drinks healthier than sodas? Study shows teens think so
Photo by Karin Vlietstra

Year after year, many of us adopt New Year’s resolutions to slim down, and by the end of January we’re often back at square one. Perhaps it’s time to reconsider a different weight-loss plan: Instead of trying to immediately lose weight, vow to maintain your weight for a period of two months before shedding any pounds.

While this recommendation may sound a bit odd, a past study from Stanford researchers showed that a maintenance-first approach helped individuals shrink their waistlines and keep from regaining the weight. In the following Q&A, lead author Michaela Kiernan, PhD, senior research scientist at the Stanford Prevention Research Center, discusses the method and tips for implementing it to achieve your 2013 weight-loss goals.

In a 1:2:1 podcast, you discuss how an “all or nothing” mentality can negatively impact goals to keep those pounds off. How does the “maintenance-first approach” address this and other psychological challenges associated with shedding pounds?

Often people adopt New Year’s resolutions in an attempt to change their behavior in an intensive focused effort. This approach may work in the short term but it can be hard to sustain that type of focus in the long term. As a result, people give up and revert to their old ways – the “all or nothing” approach. In contrast, maintaining behavior changes over time may need a more subtle “fine-tuning” approach, in which the day-to-day experience is more positive and doesn’t require such intensive effort.

In our trial, we asked one group to learn a set of maintenance skills before losing weight, so that they had a chance to experiment and experience what it was like to “fine-tune” their lifestyle habits. The other group lost weight in the more traditional manner by losing weight first and then trying to maintain it.

How do the skills used to maintaining weight differ from those used in losing weight?

Losing a significant amount of weight can require considerable attention. For instance, keeping daily food records has been found to be a useful strategy for losing weight. However, most people can’t diligently record what they ate or drank multiple times a day for long periods of time, so they quit and regain the weight. Therefore, for weight maintenance, we focused on identifying a set of skills that would make the day-to-day experience positive while not requiring overwhelming amounts of effort. For instance, we encouraged people to learn to maintain their weight without keeping food records and instead to use their bathroom scale to inform them when to fine-tune their eating and physical activity habits with small, quick and easy adjustments they can make on the fly.

For those interested in mastering the skills of maintaining weight before they begin losing weight in the New Year, can you provide an outline of the approach used in the clinical trial?

Here are a few key areas. First, actively search out yummy, healthy foods that you enjoy eating as much as the high-calorie foods you’re replacing. If you don’t, you’ll feel deprived and continue to dwell on the unhealthy high-calorie foods you’re missing – and eventually you’ll go back to eating them. Finding tasty replacements will take proactive efforts to try a lot of new foods. At the same time, be sure to incorporate eating a few of your favorite high-calorie foods into your routine – and then eat them mindfully to savor and enjoy them.

Second, start to “make peace with the scale.” Try weighing yourself daily without the pressure of trying to lose weight. Watch how your body weight fluctuates for a few weeks at your current weight. Many people are pretty surprised that their weight fluctuates from day to day as much as it does. Then, a few weeks in, set a personalized range of about five pounds that accounts for your own body’s fluctuations and a little “give” for vacations and holidays.

Third, use the range to tell you when to make “fine-tuning” changes to your eating and activity habits. For instance, if your weight is fluctuating within a few pounds near the top of your five-lb range, you may want to eat 20 percent less during meals for a few days and get out for extra walks at lunch. Alternatively, if your weight is fluctuating at the bottom of the range, you may want to enjoy another glass of wine or share a favorite dessert with a friend. Develop a”‘quiver” of fine-tuning strategies that work for you.

Finally, navigate those pesky but always occurring disruptions in life that affect weight. For instance, strategically lose a few pounds with your fine-tuning strategies and get to the bottom of your range before going on vacation so you can mindfully indulge in your mother-in-law’s amazing sugar cookies during vacation.

Previously: Learning weight-maintenance skills first helps prevent diet backsliding, Stanford study shows, Can a food-tracking app help promote healthy eating habits?, Examining how friends and family can influence our weight loss and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
Photo by Lisa Creech Bledsoe

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.

Eight months ago, I went gluten-free. People often ask me why and how I manage, especially with all the treats that present themselves during the holidays.

First, I do not have celiac disease. I chose to avoid gluten on the advice of a nutritionist who I consulted because of thyroid issues. I have Hashimoto’s disease, a disorder of the thyroid. I learned that thyroid problems have been linked to gluten. Apparently, the molecular structure of gluten resembles that of the thyroid gland, so ingesting gluten may trigger an immune response that tells the body to attack the thyroid. Or so the theory goes.

So the nutritionist suggested I stop eating products with gluten and see whether my thyroid function improved. I honestly can’t tell if avoiding gluten has had any impact on the thyroid, but I do know it has led to many other positive changes.

For one, my joints began to feel a lot better. Gluten is said to cause inflammation; in my gluten-free travels, I have met people with arthritis who told me their symptoms disappeared after they stopped ingesting gluten, as presumably the inflammation went away. I don’t have arthritis, but I do exercise regularly and used to have to take a day off in between workouts because my joints were sore. Now I don’t experience that — I can go to the gym every day and feel OK.

My digestion also improved. One of the symptoms of low thyroid is digestive problems, especially constipation. On my new gluten-free regimen, this is never a problem. I also noticed that when allergy season came around this year, I didn’t get the sniffles, as I usually do. And, I began to feel a lot more energetic.

How do I manage food-wise? Well, I discovered a whole new world of wonderful gluten-free products. And I check restaurant menus online before I go out to dinner to make sure there is something there I can eat. I bring my favorite gluten-free crackers, nuts and other snacks to parties just in case there’s nothing on the table for me. I have even brought Tamari, a gluten-free soy sauce, to Chinese restaurants, some of which will prepare gluten-free meals for me. I have to admit that the moments that challenge me most are at restaurants that serve delicious breads before the main meal; it’s hard to stare those breads in the face when you’re hungry.

I’ve learned to avoid most desserts. I know I can always go home and eat a piece of chocolate or nibble on my favorite flour-free chocolate cake, which I often keep on hand for such emergencies. And honestly, I stick with this plan in part because it’s a great weight-control method. When presented with a vast array of gluten-filled tempting treats, I just look the other way. I just remind myself how good I feel.

Previously: Using your cell phone to test for food allergens, A discussion on going gluten-free, From frustration to foundation: Embracing a diagnosis of celiac disease and Guest post: Flying the friendly skies while navigating the challenges of eating gluten-free
Photo by Whatsername

Every two weeks, I call my 99-year-old grandmother in Taiwan on Skype. And every time she repeats the same message before we sign off: “Eat well, sleep well, don’t work too hard.” This is exactly what she used to say to me when I was a child growing up in Taipei. Now, fifty years later and halfway around the world, she repeats the same advice to me as if I were still a little girl.

As much as I respected her, for most of my adult life I considered my grandma’s words a well-intentioned old wives’ tale. I am a woman of science, after all – a molecular epidemiologist who has devoted her life to cutting-edge cancer research. I believe in data, not proverbs.

Of course, it turns out that Grandma was right. I am now aware of abundant data suggesting that eating and sleeping well boost our immune function, minimize harmful inflammatory conditions and regulate hormonal metabolism, thereby lowering our risk for cancer.

Epidemiological studies suggest that consuming whole grains (containing fiber and vitamins), fruits and vegetables (antioxidants, fiber, and specific compounds such as sulforaphane in cruciferous vegetables), tomatoes (lycopene), allium vegetables such as garlic and chives, tofu (isoflavones) and fish (the omega-3-containing varieties) reduces the risk of cancer. Research also suggests that eating foods high in certain chemicals, such as heterocyclic amines found in some grilled foods, increases the risk of cancer.

Although we are still learning about the specific biological mechanisms underlying these epidemiologic findings, ongoing studies, including those at the Stanford Cancer Institute and the affiliated Cancer Prevention Institute of California (CPIC), are revealing the molecular relationships between dietary components and cancer risk.

The value of getting to sleep early (before 11 p.m.) and sleeping well long escaped the attention of scientists. I first became interested in sleep as a risk factor for cancer when epidemiologic studies began to show that rotating-shift workers have a higher risk of endocrine-related malignancies, including breast and prostate cancers.

Over the last seven years, my research group has investigated the association of circadian rhythms, including sleep duration, serum melatonin, and 9 circadian core genes, with prostate cancer risk. During the same period, laboratory studies have shown a link between circadian rhythms and inflammation. The numbers of different immune cells (e.g., “T-cells” or natural killer cells) have been shown to peak during different parts of the sleep/wake cycle. We have found evidence that several risk factors that appear to be related to inflammation – including gallstones, obesity, and diet – are risk factors for cancers of the prostate, gallbladder and liver.

While I and other researchers continue our quest to understand the molecular steps involved in carcinogenesis and design the most effective interventions and medicines for cancer prevention, it is clear that we can behave better to reduce our cancer risk – even without knowing the detailed biological pathways – through a sensible lifestyle. My 99-year-old grandmother, who loves broccoli but doesn’t know anything about DNA methylation, is living proof. And her habits reveal a lot: She rises each day at 5 a.m. and is asleep at 11 p.m.; she eats three small meals daily, at exactly the same time; and she has a cup of coffee (containing phenols) every day at 3 p.m. My grandma believes that having healthy habits improves life, and I now have the data suggesting that they decrease cancer risk and improve life expectancy, as well.

Before I ever studied the role of circadian rhythms in cancer, my grandmother knew that sleeping well was good for her health. So I’m looking forward to my next conversation with my grandma. Perhaps if I listen well, I’ll find another pearl of wisdom that leads to my next research project.

Ann Hsing, PhD, MPH, is director of research for the Cancer Prevention Institute of California (CPIC). Part of the Stanford Cancer Institute, the CPIC conducts population-based research to prevent cancer and reduce its burden where it cannot yet be prevented.

Two weeks ago, the Stanford Health Policy Forum hosted an event examining the reasons why we get fat and how different diet trends and food policies affect our nation’s obesity rates. The forum featured a conversation between science writer Gary Taubes and Christopher Gardner, PhD, director of Nutrition Studies at the Stanford Prevention Research Center. During the discussion, Paul Costello, the medical school’s chief communications officer, talked to Taubes and Gardner about Americans’ misconceptions about food, diet and nutrition, the driving forces behind the obesity surge of the late-80s and the path to a healthier, leaner lifestyle.

Previously: Forum to focus on how food policies affect our nation’s obesity rates, Four states examine their cultural environment to reduce obesity rates and Examining why instilling healthy eating and exercise habits in children may not prevent obesity later in life

Ingredient labels often come with a disclaimer saying the “product may contain nuts” or that it was “processed in a plant that uses peanuts or soy in other products.” If you suffer from a food allergy, grocery shopping and eating out can be stressful. Now, though, UCLA engineers have created a device to make it easier to detect allergens.

A release describes how the iTube, which attaches to a cell phone, works:

Weighing less than two ounces, the attachment analyzes a test tube–based allergen-concentration test known as a colorimetric assay.

To test for allergens, food samples are initially ground up and mixed in a test tube with hot water and an extraction solvent; this mixture is allowed to set for several minutes. Then, following a step-by-step procedure, the prepared sample is mixed with a series of other reactive testing liquids. The entire preparation takes roughly 20 minutes. When the sample is ready, it is measured optically for allergen concentration through the iTube platform, using the cell phone’s camera and a smart application running on the phone.

The kit digitally converts raw images from the cell-phone camera into concentration measurements detected in the food samples. And beyond just a “yes” or “no” answer as to whether allergens are present, the test can also quantify how much of an allergen is in a sample, in parts per million.

The iTube platform can test for a variety of allergens, including peanuts, almonds, eggs, gluten and hazelnuts, according to engineer Aydogan Ozcan, PhD.

The prevalence of food allergies seems to be on the rise, and its developers think  iTube could someday help prevent the number of emergency room visits or spare people having to get poked by an EpiPen after accidentally eating something with peanuts. “We envision that this cell phone–based allergen testing platform could be very valuable, especially for parents, as well as for schools, restaurants and other public settings,” Ozcan said in the release.

Previously: Student inventors create device to help reduce anemia in the developing world, Diagnosing ear infections using your iPhone? Not so far-fetched, Helping kids cope with allergies,  Peanut bans: An  overreaction to food allergies?, What’s causing all those food allergies?, Experts debate the “squishy science” of food allergies and Stanford study shows lack of criteria for diagnosing food allergies
Photo courtesy of the UCLA Henrey Samueli School of Engineering and Applied Science

A recent Peninsula Press story highlights the success of Stanford GOALS and other East Palo Alto, Calif.-based programs in helping promote healthier lifestyles and reduce childhood obesity rates in the low-income community. Kristina Krohn writes:

A team of researchers including Dr. Dana Weintraub, a clinical assistant professor in pediatrics at Lucile Packard Children’s Hospital, has enrolled more than 100 kids [in the Stanford GOALS program] since September and is still recruiting. The seven-year study, which accepts only children whose BMI is greater than the 85th percentile, combines after-school team sports with home visits to promote a healthy diet.

Information collected by area school districts shows that nearly 42 percent of East Palo Alto fifth-graders were overweight or obese during the 2010-11 school year, compared with 24 percent of their peers throughout San Mateo County. Physicians and community leaders, however, point to evidence that a pattern of rising weight gain in the city appears to be leveling off.

Elizabeth Baca, MD, a clinical instructor at Lucile Packard Children’s Hospital, emphasized that reducing childhood obesity in East Palo Alto will involve a comprehensive approach that addresses nutrition, exercise and safety, saying, “Its not just one magic thing or we would have done that by now.”

The above video produced by Stanford student Adelaide Oneal captures the efforts of another nonprofit, Collective Roots, which operates at the East Palo Alto Farmer’s Market and offers community-based cooking, gardening and nutrition classes.

Previously: Doctors tackling child hunger during the summer and Seniors help build a blueprint for a healthier city

Growing up, I was plagued by a painful, itchy rash that covered large swaths of my legs and arms and made me a frequent visitor to the dermatologist’s office. Following doctor’s orders, I switched to hypoallergenic laundry detergents, soaps and personal care products but saw little improvement. Never was there any discussion about my diet or the food allergies of close relatives.

Fast forward to a few years ago, when a friend persuaded me to try an elimination diet, where you abstain from eating specific foods for a number of weeks and then add them back into your diet to test for an allergic reaction. For the entire elimination period I was itch-free, but a few hours after I began eating wheat again the scratching started. Ever since I’ve been gluten free.

Gluten-free diets are gaining in popularity, and a recent KQED Forum segment explored the factors behind the growing number of people choosing this lifestyle. Show guests, including Nielsen Fernandez-Becker, MD, associate director of Stanford’s celiac management clinic, also discussed the potential health benefits and risks of going gluten-free, and the latest scientific research on the topic.

Previously: From frustration to foundation: Embracing a diagnosis of celiac disease, Gluten: The “new diet villain?” and A call for a new way to classify gluten-related disorders