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Nutrition, Research, Stanford News

Stanford study spoils hopes that raw milk can aid those who are lactose-intolerant

Stanford study spoils hopes that raw milk can aid those who are lactose-intolerant

milk in fridge

I have a few friends who can tell pretty quickly when they’ve eaten a food that contains milk or lactose, the sugar found in milk. The signs are unpleasant — mostly gas and diarrhea (yuck!). So they were interested when I told them that a nutrition researcher at Stanford was conducting a clinical trial to test the validity of claims that people who are lactose-intolerant can digest raw milk more easily than pasteurized milk.

Unfortunately for them, the claims don’t hold up.

In my news release about the study, which was published today in the Annals of Family Medicine, professor of medicine Christopher Gardner, PhD, found no difference in digestibility between the two.

Although the study was small — just 16 participants who were lactose-intolerant — the results were highly consistent among all the participants. As Gardner notes in the press release, “It’s not that there was a trend toward a benefit from raw milk and our study wasn’t big enough to capture it; it’s that there was no hint of any benefit.”

One thing that surprised Gardner was how many people believe they are lactose-intolerant because of the symptoms they experience, yet don’t meet the clinical standard for the condition. In fact, Gardner originally recruited 63 potential study participants, but only 43 percent of them actually met the standard.

So, what’s causing the discomfort that this group of people feel when they consume milk products? And would raw milk — which hasn’t been pasteurized and which proponents say contains “good” bacteria that may aid digestion — help folks who don’t meet the clinical definition of being lactose-intolerant? Gardner says he hopes other researchers will try to answer those questions.

Previously: Stanford pediatrician and others urge people to shun raw milk and products
Photograph by chrisdat

Nutrition, Obesity, Patient Care, Research

How physicians address obesity may affect patients’ success in losing weight

How physicians address obesity may affect patients' success in losing weight

docvisitFor some patients, the need to begin a weight-loss program to lower health risks connected with obesity is urgent. But losing weight and keeping it off for the long term can be a challenging journey for a person – and patient-doctor conversations about weight loss can be complex.

study (purchase required) recently published online in Preventive Medicine looked at the way patients perceive their physicians’ attitudes about obesity, and the patients’ change in weight following the delivery of weight-loss advice. For their work, the researchers conducted Internet-based surveys in 500 adults with a body-mass index of 25 or more.

As explained in a Johns Hopkins release:

The participants were asked, “In the last 12 months, did you ever feel that this doctor judged you because of your weight?” Twenty one percent of participants said they believed they had been.

Further, 96 percent of those who felt judged did report attempting to lose weight in the previous year, compared to 84 percent who did not. But only 14 percent of those who felt judged and who also discussed weight loss with their doctor lost 10 percent or more of their body weight, while 20 percent who did not feel judged and also discussed shedding pounds lost a similar amount.

“Negative encounters can prompt a weight loss attempt, but our study shows they do not translate into success,” study leader Kimberly Gudzune, MD, MPH, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, said in the release. “If we are their advocates in this process — and not their critics — we can really help patients to be healthier through weight loss.”

Previously: Study: When discussing childhood obesity, words carry weight and A medical student calls for increased nutrition education for doctor
Photo by Stanford EdTech

Behavioral Science, Nutrition, Parenting, Pediatrics, Public Health, Research

Fruit-filled Manga comics may increase kids’ consumption of healthy food

Fruit-filled Manga comics may increase kids' consumption of healthy food

kidsfruitMore than a decade into adulthood, I’m still drawn in to the worlds created by sugar-cereal commercials. Hypnotized by the swirling pattern of Cinnamon Toast Crunch and captivated by the magic of Lucky Charms, I can see how actual kids’ eating behavior could be influenced by cartoon messaging.

So I was interested to read about a pilot study in New York City public school children that examined how reading comics featuring healthy food could have an effect on snack choice.

Science 2.0 reports:

It comprised 57 youth, approximately 11 years of age, nearly 90% of whom were either Black/African American or Hispanic and 54% were female. The school districts in the study had greater percentages of students eligible for free lunch (79 and 96%, respectively) compared to the citywide average of 66%.

After reading either a Manga comic, titled “Fight for Your Right to Fruit,” or a non-health-related newsletter, children were given the choice between a healthy snack (oranges, grapes, apples, strawberries) or an energy-dense snack (cookies, potato chips, nacho chips, and cheese-filled crackers). 61% of children in the comic group chose a healthy snack after reading, opposed to just 35% of the control group.

Regarding the choice of Manga, a Japanese comic form featuring detailed artwork and storytelling, the study notes:

The Transportation-Imagery Model (TIM) explains how Manga comics may contribute to changes in health-related beliefs and behaviors. According to the TIM, persuasion of a story’s messages occurs because an individual is “transported” or immersed into the narrative world.15 The TIM also suggests that images are most impactful when they are embedded in a story, rather than provided in isolation.15 Thus, visual images relevant to the story’s messages, such as those incorporated in Manga comics, may further influence attitudes and beliefs.

The authors write, “Results suggest Manga comics may be a useful format to promote healthy snack selection in urban minority youth.” (Side note: Writing about this pilot study made me want to eat mangoes.)

The research was published in the Journal of Nutrition Education and Behavior.

Previously: Depictions of obesity in children’s moviesNo bribery necessary: Children eat more vegetables when they understand how food affects their bodies, Talking to kids about junk food ads, Health experts to Nickelodeon: Please stop promoting unhealthy food to our kids and Researchers find cartoons really do make food taste better (or so kids think)
Photo by North Charleston

Health and Fitness, Nutrition, Public Health

What do Americans buy at the grocery store?

What do Americans buy at the grocery store?

This fascinating (and depressing) chart from the U.S. Department of Agriculture compares Americans’ grocery-store expenditures to the recommended expenditures for several categories of food. It shows that we spend the right proportion of our food budgets in exactly one food category: potatoes.

Otherwise, we spend far too much in basically every unhealthy food category, including red meat, sugar and candies, refined grains and frozen/refrigerated entrees. And we spend too little on healthy foods like fruits and veggies, whole grains, legumes, low-fat dairy products, poultry and fish.

This chart gives me a strange desire to do a bit of research with my own grocery-store receipts. I have a PhD in nutrition, and I make an effort to purchase and cook healthy foods for my family, but I’ve never thought to analyze our diets according to what percentage of our expenditures go toward healthy vs. unhealthy foods.

Previously: Rating my diet: in which I take the Eat Real Quiz, with thought-provoking results, Should the lack of access to good food be blamed for America’s poor eating habits? and Americans still falling short of national nutritional guidelines
Via Food Politics

Nutrition, Public Health, Stanford News

Homemade: Community-based project teaches how to cook for health

Homemade: Community-based project teaches how to cook for health


Since January is the traditional month for making – and breaking – New Year’s resolutions (including diet-related ones), I thought it would be a great time to write about a new cooking course, the brainchild of two former Stanford students, that stresses healthy eating as a way of life.

When I heard these two young professionals, a doctor and a lawyer, had decided to put their careers on hold to get this project up and running at a local community center, I grew more curious to know what was motivating them. I learned that for the recently graduated doctor, Chloe Chien, MD, it was the multiple times she assisted on the foot amputations of diabetic patients during medical school. “I became increasingly bothered by lifestyle diseases” like diabetes and heart conditions, Chien told me. “Because they are so morbid, so expensive, so difficult to treat, so demoralizing yet at the same time, preventable.” As for the lawyer, Anna Rokoczy, it was years of struggling with fad diets and poor body image as a competitive ice skater in Australia: “I tried all the fad diets, everything.”

The two women were also influenced by the many overweight people they spoke with who had struggled and failed to lose weight:

“I was totally humbled by this,” Chien said. “Most people who are overweight have tried all kinds of diets, all kinds of programs. They told us they were sick and tired of food journaling or calorie counting or no-fat rules. They’d tell us, ‘Yeah, I lost weight when I was on a diet, but once I stopped I gained it all back and more.’”

The concept that Chen and Rakoczy came up with to battle the obesity epidemic and lifestyle diseases like diabetes? Bringing enjoyment back to eating and focusing on creating healthy, tasty meals that become a way of life. My article describes the personal experiences that led them to commit full-time to Homemade – 10-week-long community-based cooking courses that send each participant home with three-to-six days worth of prepared meals. And it discusses the surprise of Chien’s family, friends and medical school mentors when she withdrew her applications in the spring to medical residency programs to pursue Homemade. More from the piece:

“Friends keep asking, ‘Don’t you want to practice medicine? Don’t you want to go back?’” said Chien, who graduated from the School of Medicine in June. “I tell them I’m practicing the best medicine ever. It’s preventive, it’s inspiring and it’s joyful. … It’s so much more impactful than prescribing medicine one patient at a time.”

“I do miss a lot of other parts of medicine and hope to go back to it,” Chien said. But for now, she said she’s committed to Homemade. “When I pulled out of residency applications my mentors were telling me ‘Don’t do it; you’re crazy,’” Chien said. “At the same time, they were saying ‘Can I refer my patients to you?’”

Previously: Using a traffic light system to encourage healthier eating habits, What if obesity has nothing to do with overeating?, Learning weight-maintenance skills first helps prevent diet backsliding, Stanford study shows and Can cooking classes help curb childhood obesity?
Photo by Norbert von der Groeben

Nutrition, Obesity, Pediatrics, Stanford News

Using a traffic light system to encourage healthier eating habits

Using a traffic light system to encourage healthier eating habits

A couple of traffic lights installations with the red ones turned on and the green and yellow off captured against a blue sky with several white clouds scattered over.

Imagine going to your favorite restaurant and discovering that high-calorie foods and sugar drinks were now listed in a red section on the menu, slightly healthier options were contained in a yellow box and nutrient-dense dishes were labeled green. Would you order differently?

The answer is “yes,” according to findings (.pdf) published earlier this week. In the study, researchers analyzed data collected at the Massachusetts General Hospital cafeteria before and after implementing such a traffic light system. Results showed that color-coding foods and beverages “sustained healthier choices over two years.”

At the Center for Healthy Weight at Lucile Packard Children’s Hospital, Stanford pediatrician Thomas Robinson, MD, and colleagues have also experienced notable success with the traffic light system, which they’ve used to classify foods in their pediatric weight control program for more than 15 years.

The key to the traffic light system, explains Robinson, is its lack of ambiguity and simplicity. He says, “Every food has a color (red, yellow or green) and you can count the foods you eat and set goals based on the colors. Because each food has a color there is a lot less room for rationalization or negotiation — it is what it is. We know it is much more difficult to count calories or balance types of nutrients, such as carbohydrates, protein and fat.”

When I asked Robinson about potential pitfalls of the method, such as the problem of people categorizing foods differently, he told me:

Although the traffic light categories are usually defined based on nutritional characteristics of foods, the traffic light approach is a behavioral strategy rather than a specific diet. A traffic light approach can be created to fit with any nutritional goal and simplifies it to a point that one can keep track and count. A lot of my patients, students and colleagues have heard me say, “If you can’t count it, you can’t change it.”

In our program we use traffic light categories based mainly on calorie (i.e. energy) density along with some additional characteristics of foods. It would be possible for others to create traffic light categories based on different food characteristics. But changing one’s diet and weight control depends much more on learning to changes one’s behavior than about learning about nutrition.

Previously:  To meet weight loss goals, start exercise and healthy eating programs at the same timeSugar intake, diabetes and kids: Q&A with a pediatric obesity expert and Can dish color influence how much you eat?
Photo by Horia Varlan

Health and Fitness, In the News, Nutrition, Stanford News

Mindful eating tips for the desk-bound

Mindful eating tips for the desk-bound

desklunchWell, January 1 came and went, and so did the first Monday of the new year. So, how are you doing on your 2014 resolutions, if you made any?

The San Francisco Chronicle recently spotlighted the common seasonal commitment of eating better. Included in the article are healthy recipes and expert tips to start where you might fall prey to mindless eating – at work, sitting at your desk, distracted by your computer.

From the piece:

“People are connected to a screen all the time now, and if you are not mindful of what you are eating, your brain doesn’t send the satiation message to your stomach, and you’ll overeat, guaranteed,” says Hilda Moscoso Carey, [RD,] a clinical dietitian at Kaiser Permanente in San Francisco.

Many of her patients work in the gaming and social media industry, where leaving for lunch is culturally frowned upon, and employers keep workers in the building with daily catered lunches, fully stocked kitchens and open espresso bars.

Stanford dietician Jo Ann Hattner, who is studying the effects of eating on the go, said the consequences could be more than weight gain. She told the Chronicle, “We are multitasking our way to bloating, gas, indigestion and irritable bowel syndrome.”

Previously: How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goalsShould sugar be blamed for all our health woes? and Stanford nutritionist offers guidelines for eating healthy on the go
Photo by slgckgc

Immunology, Nutrition, Pediatrics, Pregnancy

Eating nuts during pregnancy may protect baby from nut allergies

Eating nuts during pregnancy may protect baby from nut allergies

peanutbutterjelly.jpgThank goodness I ate so much peanut butter while I was pregnant.

That was my first reaction to new research, published today in JAMA Pediatrics, that found an association between higher nut consumption during pregnancy and lower rates of nut allergies in the baby. The researchers, at the Dana-Farber Children’s Cancer Center, Boston, asked women to record information about their diets during or soon after pregnancy, and came back later to find out whether their babies developed nut allergies. Among moms who were not themselves allergic to nuts, regular consumption of peanuts and tree nuts (almonds, walnuts and so on) was linked to reduced nut allergies in the babies. Women with the highest nut consumption, who ate nuts five times or more per week, had babies with the lowest allergy risk.

The finding helps clarify a debate about whether expectant women can do anything to reduce the risk of allergies in their babies. Previously, some experts have suggested that perhaps pregnant and breastfeeding women should avoid nuts to lower allergy risk. But the new findings contradict that recommendation. From a JAMA press release on an editorial about the new research:

…pregnant women should not eliminate nuts from their diet as peanuts are a good source of protein and also provide folic acid, which could potentially prevent both neural tube defects and nut sensitization. So, to provide guidance in how to respond to the age-old question “To eat or not to eat?” mothers-to-be should feel free to curb their cravings with a dollop of peanut butter!

Previously: Food allergies and school: One mom’s perspective, Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research and A mom’s perspective on a food-allergy trial
Photo by Matias-Garabedian

Nutrition, Pediatrics, Public Health, Stanford News

Stanford pediatrician and others urge people to shun raw milk and products

Stanford pediatrician and others urge people to shun raw milk and products

rawmilkAs you may have seen elsewhere today, the American Academy of Pediatrics has published a formal policy statement on raw or unpasteurized milk and milk products. It urges that pregnant women and children avoid consuming these products on the grounds that raw milk offers no proven benefits over pasteurized milk – nutritionally or otherwise – but does offer a significantly greater chance of contracting a range of bacterial and viral illnesses, some of which can be severe and occasionally deadly. The risks hold true regardless of whether the raw milk is from cows, goats or sheep, according to the statement.

I talked about the new policy statement, which appears in the journal Pediatrics,with its lead author, Yvonne Maldonado, MD, a Stanford infectious disease expert and pediatrician at Lucile Packard Children’s Hospital.

While acknowledging that raw milk has its devotees, Maldonado said a host of scientific studies simply don’t back up the claims of health benefits. And there are some serious diseases associated with raw milk consumption, including salmonella, E. coli, campylobacter and norovirus, which the Centers for Disease Control and Prevention says is the most common cause of acute gastroenteritis in the U.S.

“It used to be that one of the major causes of childhood disease and death, before we had pasteurization, was drinking raw milk because we didn’t have a way to decontaminate it,” Maldonado told me. “Children got tuberculosis from drinking raw milk. That’s why we invented pasteurization – to prevent these horrible diseases.”

Since I spoke with her for our press release, which provides a lot more detail on all this, another study has been published in the CDC journal Emerging Infectious Diseases on the incidence of illnesses contracted by consumption of raw milk. That study comes from the Minnesota Department of Health and is based on data reported between 2001 and 2010. I haven’t been able to access the full study yet, but the one-line summary for the article that I found on the EID web site states: “The risk of illness associated with raw milk consumption is far greater than previously realized.”

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Health and Fitness, Nutrition

Enjoying the turkey while watching your waistline

Enjoying the turkey while watching your waistline

As part of Thanksgiving tradition, millions of Americans will soon be jumping in cars or airplanes, heading to loved ones’ homes, and eating. In some cases, eating a lot. If you’re one of the many who wants to enjoy the holiday without over-doing it, you might find a few past Scope entries helpful. Posts here and here offer tips for reducing the urge to overeat and to enjoy holiday staples without compromising your health. And for those of you who may be tempted to indulge over the next six weeks or so and get back in shape come the New Year, Stanford nutritionist Jo Ann Hattner, RD, has this to say:

This is a poor health strategy primarily because your body has already had to accommodate the excesses of the holiday eating and that may have had detrimental effects, particularly to your cardiovascular system. In addition, depending on how much you gained during the holidays it can be an overwhelming task to lose the weight. If this is the case, unfortunately, you may still have it on board when the next holiday rolls around.

Previously: Stanford nutrition expert discusses how to eat well while staying jolly, Battling the bulge this holiday season, Stanford nutritionist offers tips for eating healthy during the holidays and Experts provide tips on healthier holiday eating for kids

Stanford Medicine Resources: