tag:theconversation.com,2011:/us/topics/healthy-diet-36425/articlesHealthy diet – The Conversation2024-01-16T19:15:14Ztag:theconversation.com,2011:article/2163552024-01-16T19:15:14Z2024-01-16T19:15:14ZSpace travel taxes astronauts’ brains. But microbes on the menu could help in unexpected ways<figure><img src="https://images.theconversation.com/files/565638/original/file-20231213-27-4xr8mj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/smiling-man-astronaut-presents-shawarma-kebab-1128088580">studiostoks/Shutterstock</a></span></figcaption></figure><p>Feeding astronauts on a long mission to Mars goes well beyond ensuring they have enough nutrients and calories to survive their multi-year journey.</p>
<p>Providing astronauts with the right diet is also paramount in supporting their <a href="https://www.frontiersin.org/articles/10.3389/fncir.2023.1170395/full?trk=public_post_comment-text">mental and cognitive health</a>, in a way unlike previous missions.</p>
<p>So we need to radically rethink how we feed astronauts not only on a challenging mission to Mars, which could be on the cards in the late 2030s or early 2040s, but to prepare for possible settlement on the red planet. </p>
<p>That includes acknowledging the role of microbes in mental health and wellbeing, and providing astronauts with the right foods and conditions for a variety of these beneficial microbes to grow. Our research aims to do just that.</p>
<p>Here’s why a healthy balance of microbes is important under such challenging conditions, and how we could put microbes on the menu.</p>
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Read more:
<a href="https://theconversation.com/was-going-to-space-a-good-idea-218235">Was going to space a good idea?</a>
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<h2>Why are missions to Mars so challenging?</h2>
<p>Deep space missions will expose humans to immense physical and psychological challenges. These include prolonged isolation from loved ones, extreme space and resource constraints, and the difficulties of microgravity. </p>
<p>Disruption to astronauts’ circadian rhythms, prolonged radiation exposure and dietary changes can also lower their cognitive performance and wellbeing. </p>
<p>The hazardous conditions, combined with the psychological toll of potential spacecraft failures, can all contribute to mental health problems.</p>
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Read more:
<a href="https://theconversation.com/how-to-live-in-space-what-weve-learned-from-20-years-of-the-international-space-station-144851">How to live in space: what we've learned from 20 years of the International Space Station</a>
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<h2>Why is diet important for mental health?</h2>
<p>We already know the quality of people’s diet not only influences their physical health, but also their mental and brain health. </p>
<p>Diet quality is <a href="https://www.nature.com/articles/s41380-018-0237-8">consistently and independently linked</a> to the risk of depression or anxiety. Clinical trials <a href="https://pubmed.ncbi.nlm.nih.gov/35441666/">show</a> improving diet quality <a href="https://www.ncbi.nlm.nih.gov/pubmed/30720698">can lead to</a> profound improvements in depression and anxiety symptoms. </p>
<p>Diet also affects the size and function of a specific brain region – the hippocampus – that is crucial to learning and memory, as well as for maintaining <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0461-x?report=reader">mental health</a>. When even young healthy adults eat “junk” foods, aspects of cognition linked to the hippocampus quickly <a href="https://royalsocietypublishing.org/doi/abs/10.1098/rsos.191338">decline</a>.</p>
<p>On the other hand, research shows a diet containing more and varied plant foods and seafood (which are rich in components called long-chain omega-3 fatty acids and flavonoids) leads to <a href="https://www.nature.com/articles/s41598-022-21927-5">better cognitive performance</a>. This study was conducted in a closed chamber for 45 days, designed to mimic conditions in space.</p>
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<a href="https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Plate of salmon on bed of green salad, with lemon slices, on blue wood table" src="https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565649/original/file-20231213-23-owo81l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A diet rich in plant food and seafood might help your brain, but how do you turn that into space food that will go the distance?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/grilled-salmon-vegetables-366852431">Jacek Chabraszewski/Shutterstock</a></span>
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<p>Diet can have such consequences by <a href="https://www.ncbi.nlm.nih.gov/pubmed/33144709">altering</a>:</p>
<ul>
<li>immune function</li>
<li>the size and functioning of the hippocampus </li>
<li>chemical messenger (neurotransmitter) systems</li>
<li>how our bodies respond to stress.</li>
</ul>
<p>Diet can also influence the many ways microbes in the gut affect the brain, a link known as the <a href="https://journals.physiology.org/doi/full/10.1152/physrev.00018.2018?rfr_dat=cr_pub">microbiota gut-brain axis</a>.</p>
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Read more:
<a href="https://theconversation.com/essays-on-health-microbes-arent-the-enemy-theyre-a-big-part-of-who-we-are-79116">Essays on health: microbes aren't the enemy, they're a big part of who we are</a>
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<h2>Not all foods make the grade</h2>
<p>Space foods need to appeal to a diverse crew and stay nutritious for an extremely long time (likely a three- to five-year mission). They also need to be lightweight and compact enough to fit on the spacecraft.</p>
<p>Once on Mars, challenges include growing fresh food and culturing protein sources. Beyond providing nutrients, we also need to consider providing more recently identified factors including phytonutrients (such as polyphenols), fermentation products and microbes. These will likely be crucial to sustain health and, indeed, life on deep space missions.</p>
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Read more:
<a href="https://theconversation.com/humans-are-going-back-to-the-moon-and-beyond-but-how-will-we-feed-them-189794">Humans are going back to the Moon, and beyond – but how will we feed them?</a>
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<h2>Why are microbes so important?</h2>
<p>If you’ve seen the film <a href="https://theconversation.com/the-martian-review-science-fiction-that-respects-science-fact-48373">The Martian</a>, you’ll know microbes are a crucial aspect of growing food, and are essential for keeping humans alive and functioning. </p>
<p>We have co-evolved with, and are hosts to, trillions of different microbes that live on our skin and in all our niches and cavities. This includes our mouths, nose, vagina, lungs and – crucially – our gut.</p>
<p>Most of these microbes are bacteria. The largest number are in the gut, where they influence our digestion, metabolism, and immune, endocrine (hormone) and nervous systems.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/YB-8JEo_0bI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What is the human microbiome?</span></figcaption>
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<p>The relationship between gut microbes and <a href="https://journals.physiology.org/doi/full/10.1152/physrev.00018.2018?rfr_dat=cr_pub">mental health and behaviour</a> goes both ways. Gut microbes influence our mental health and behaviour, and these, in turn, influence our gut microbes. </p>
<p>Other components of our microbiomes – viruses, fungi and even parasites – and the oral and lung microbiome are also linked to mental and <a href="https://journals.physiology.org/doi/full/10.1152/physrev.00018.2018?rfr_dat=cr_pub">brain health</a>. </p>
<p>Importantly, we <a href="https://www.nature.com/articles/s41586-022-05620-1">share microbes</a> with others, including via the exchange of air, which is highly relevant in closed-environment systems such as inside spacecrafts.</p>
<p>So ensuring all astronauts have the healthiest and most diverse of microbes for the whole of the mission is vital.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-why-do-some-farts-smell-and-some-dont-and-why-do-some-farts-feel-hot-215064">Curious Kids: why do some farts smell and some don’t? And why do some farts feel hot?</a>
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<h2>How could we encourage healthy microbes?</h2>
<p>It’s not just the food itself we have to think about. We also need to think about how we grow the food if we are to support healthy microbiomes. </p>
<p>Indeed, microbes play an essential role in the nutrient and phytochemical content of plants, and the microbes in soil, plants and humans are interconnected. Research published in 2023 confirms bacteria on vegetables and other plant foods find a home in the <a href="https://www.tandfonline.com/doi/abs/10.1080/19490976.2023.2258565">human gut</a>, enhancing microbe diversity. </p>
<p>But current ways of growing foods on spacecraft don’t use natural soil. Standard “vertical farming” methods grow plants in an alternative growth medium – imagine a next-generation hydroponics system. So we may need to add an optimised microbial cocktail to these systems to enhance the health properties of the foods astronauts grow and eat.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Growing tending plants in a vertical farm" src="https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565654/original/file-20231213-19-kwbbo1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">This closed chamber mimics how astronauts will grow fresh crops in space.</span>
<span class="attribution"><a class="source" href="https://www.nasa.gov/technology/tech-transfer-spinoffs/nasa-research-launches-a-new-generation-of-indoor-farming/">NASA</a></span>
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<p><a href="https://www.cell.com/cell/fulltext/S0092-8674(22)01515-X?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS009286742201515X%3Fshowall%3Dtrue">Fermented protein</a> from microbes can be quickly produced in a bioreactor on board the spacecraft, even from food waste. Some types have a meat-like flavour and texture, and can provide all the amino acids humans need as well as useful byproducts from the microbes themselves. </p>
<p>Fermentation itself creates thousands of different bioactive molecules, including some vitamins, that have diverse <a href="https://www.tandfonline.com/doi/abs/10.1080/1028415X.2018.1544332">beneficial effects on health</a>, including possible benefits to mental health.</p>
<p>While we don’t yet know what types of fermented foods are possible in space, we could include fermented foods, such as kimchi and sauerkraut, in astronauts’ diets on Earth.</p>
<p>Probiotics and prebiotics as supplements may also be essential. Probiotics are live microbes that have demonstrated health benefits and prebiotics are food for these healthy microbes.</p>
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<strong>
Read more:
<a href="https://theconversation.com/what-is-kombucha-and-how-do-the-health-claims-stack-up-87180">What is kombucha and how do the health claims stack up?</a>
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<h2>Benefits on Earth too</h2>
<p>We’re only at the start of learning how to optimise microbes to keep space crews healthy, which is crucial for long space flights and for possible settlement on other planets. </p>
<p>However, this research could have many other applications. We can use what we learn to help create self-sustaining and <a href="https://www.nasa.gov/technology/tech-transfer-spinoffs/nasa-research-launches-a-new-generation-of-indoor-farming/">sustainable food systems</a> on Earth to improve the environment and human health.</p><img src="https://counter.theconversation.com/content/216355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Felice N Jacka is supported by a National Health and Medical Research Council investigator grant (#1194982). She has received: (1) competitive grant/research support from the Brain and Behaviour Research Institute, the National Health and Medical Research Council, Australian Rotary Health, the Geelong Medical Research Foundation, the Ian Potter Foundation, The University of Melbourne; (2) industry support for research from Meat and Livestock Australia, Woolworths Limited, the A2 Milk Company, Be Fit Foods, Bega Cheese; (3) philanthropic support from the Fernwood Foundation, Wilson Foundation, the JTM Foundation, the Serp Hills Foundation, the Roberts Family Foundation, the Waterloo Foundation and; (4) travel support and speakers honoraria from Sanofi-Synthelabo, Janssen Cilag, Servier, Pfizer, Network Nutrition, Angelini Farmaceutica, Eli Lilly, Metagenics, and The Beauty Chef. She is on the Scientific Advisory Board of the Dauten Family Centre for Bipolar Treatment Innovation and Zoe Limited. Felice Jacka has written two books for commercial publication.</span></em></p><p class="fine-print"><em><span>Dorit Donoviel is Executive Director, NASA-Funded Translational (moving products from lab-bench to practice) Research Institute for Space Health at Baylor College of Medicine. Dorit receives funding from NASA through Cooperative Agreement NNX16AO69A and disburses this funding to research groups and companies performing work to safeguard the health of humans in deep space.</span></em></p>Here’s why a healthy balance of microbes is important for astronauts when they travel to Mars and beyond.Felice Jacka, Alfred Deakin Professor, Deakin UniversityDorit Donoviel, Executive Director/Associate Professor, Baylor College of Medicine Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158082023-12-10T19:07:34Z2023-12-10T19:07:34ZI’m trying to lose weight and eat healthily. Why do I feel so hungry all the time? What can I do about it?<p>Benjamin Franklin, one of the founding fathers of the United States, famously said nothing is certain except death and taxes. But I think we can include “you’ll feel hungry when you’re trying to lose weight” as another certainty. </p>
<p>The reason is basic biology. So how does this work – and what can you do about it?</p>
<h2>Hormones control our feelings of hunger</h2>
<p>Several hormones play an essential role in regulating our feelings of hunger and fullness. The most important are ghrelin – often called the hunger hormone – and leptin.</p>
<p>When we’re hungry, <a href="https://pubmed.ncbi.nlm.nih.gov/11739476/">ghrelin</a> is released by our stomach, lighting up a part of our brain called the hypothalamus to tell us to eat. </p>
<p>When it’s time to stop eating, hormones, including <a href="https://pubmed.ncbi.nlm.nih.gov/8717038/">leptin</a>, are released from different organs, such as our gut and fat tissue, to signal to the brain that we’re full.</p>
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Read more:
<a href="https://theconversation.com/chemical-messengers-how-hormones-make-us-feel-hungry-and-full-35545">Chemical messengers: how hormones make us feel hungry and full</a>
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<h2>Dieting disrupts the process</h2>
<p>But when we change our diet and start losing weight, we disrupt how these <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766925/">appetite hormones function</a>. </p>
<p>This triggers a process that stems from our hunter-gatherer ancestors. Their bodies developed this mechanism as a survival response to adapt to periods of deprivation and protect against starvation. </p>
<p>The levels of hormones <a href="https://pubmed.ncbi.nlm.nih.gov/23126426/">managing our hunger increase</a>, making us feel hungrier to tell us to eat more, while the ones responsible for signalling we’re full decrease their levels, intensifying our feelings of hunger.</p>
<p>We end up increasing our calorie consumption so we eat more to regain the weight we lost. </p>
<p>But worse, even after the kilos creep back on, <a href="https://pubmed.ncbi.nlm.nih.gov/22029981/">our appetite hormones don’t restore</a> to their normal levels – they keep telling us to eat more so we put on a little extra fat. This is our body’s way of preparing for the next bout of starvation we will impose through dieting. </p>
<p>Fortunately, there are things we can do to manage our appetite, including:</p>
<h2>1. Eating a large, healthy breakfast every day</h2>
<p>One of the easiest ways to manage our feelings of hunger throughout the day is to eat most of our food earlier in the day and taper our meal sizes so dinner is the smallest meal.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32073608/">Research</a> shows a low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day. </p>
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<img alt="Man spreads avocado" src="https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Prioritise breakfast over dinner.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soft-focus-shot-man-having-delicious-759322450">Shutterstock</a></span>
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<p><a href="https://www.cell.com/cell-metabolism/fulltext/S1550-4131(22)00344-8">Another study</a> found the same effect. Participants went on a calorie-controlled diet for two months, where they ate 45% of their calories for breakfast, 35% at lunch and 20% at dinner for the first month, before switching to eat their largest meal in the evening and their smallest in the morning. Eating the largest meal at breakfast resulted in decreased hunger throughout the day.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32073608/">Research</a> also shows we burn the calories from a meal 2.5-times more efficiently in the morning than the evening. So emphasising breakfast over dinner is good not just for hunger control, but also weight management.</p>
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Read more:
<a href="https://theconversation.com/should-we-eat-breakfast-like-a-king-lunch-like-a-prince-and-dinner-like-a-pauper-86840">Should we eat breakfast like a king, lunch like a prince, and dinner like a pauper?</a>
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<h2>2. Prioritising protein</h2>
<p>Protein helps contain feelings of hunger. This is because protein-rich foods such as lean meats, tofu and beans suppress the appetite-stimulating ghrelin and stimulate another hormone called <a href="https://www.sciencedirect.com/science/article/pii/S1550413106002713">peptide YY</a> that makes you feel full. </p>
<p>And just as eating a breakfast is vital to managing our hunger, what we eat is important too, with <a href="https://pubmed.ncbi.nlm.nih.gov/24703415/">research</a> confirming a breakfast containing protein-rich foods, such as eggs, will leave us feeling fuller for longer. </p>
<p>But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado.</p>
<h2>3. Filling up with nuts and foods high in good fats and fibre</h2>
<p>Nuts often get a bad rap – thanks to the misconception they cause weight gain – but nuts can help us manage our hunger and weight. The filling fibre and good fats found in nuts take longer to digest, meaning our hunger is satisfied for longer. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/12791613/">Studies</a> suggest you can include up to 68 grams per day of nuts without affecting your weight. </p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/health-check-will-eating-nuts-make-you-gain-weight-108491">Health check: will eating nuts make you gain weight?</a>
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<p>Avocados are also high in fibre and heart-healthy monounsaturated fats, making them another excellent food for managing feelings of fullness. This is backed by a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567160/">study</a> confirming participants who ate a breakfast incorporating avocado felt more satisfied and less hungry than participants who ate a meal containing the same calories but with lower fat and fibre content. </p>
<p>Similarly, eating foods that are high in soluble fibre – such as <a href="https://pubmed.ncbi.nlm.nih.gov/24820437/">beans</a> and vegetables – make us feel fuller. This type of fibre attracts water from our gut, forming a gel that slows digestion. </p>
<figure class="align-center ">
<img alt="Couple cook together" src="https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fibre helps us feel fuller for longer.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-man-and-a-woman-preparing-food-in-a-kitchen-hQocGyy0unQ">Sweet Life/Unsplash</a></span>
</figcaption>
</figure>
<h2>4. Eating mindfully</h2>
<p>When we take time to really be aware of and enjoy the food we’re eating, we slow down and eat far less. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/28718396/">review</a> of 68 studies found eating mindfully helps us better recognise feelings of fullness. Mindful eating provides our brain enough time to recognise and adapt to the signals from our stomach telling us we’re full.</p>
<p>Slow down your food consumption by sitting at the dinner table and use smaller utensils to reduce the volume of food you eat with each mouthful.</p>
<h2>5. Getting enough sleep</h2>
<p>Sleep deprivation disturbs our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1389945708700133">appetite hormones</a>, increasing our feelings of hunger and <a href="https://www.nature.com/articles/ncomms3259">triggering cravings</a>. So aim to get at least seven hours of uninterrupted sleep a night.</p>
<p>Try switching off your devices <a href="https://journals.sagepub.com/doi/full/10.1177/1477153515584979">two hours before bed</a> to boost your body’s secretion of sleep-inducing hormones like melatonin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-our-brain-needs-sleep-and-what-happens-if-we-dont-get-enough-of-it-83145">Why our brain needs sleep, and what happens if we don’t get enough of it</a>
</strong>
</em>
</p>
<hr>
<h2>6. Managing stress</h2>
<p>Stress increases our <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">body’s production of cortisol</a> and triggers food cravings.</p>
<p>So take time out when you need it and set aside time for stress-relieving activities. This can be as simple as getting outdoors. A <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00722/full">2019 study</a> found sitting or walking outdoors at least three times a week could reduce cortisol levels by 21%. </p>
<figure class="align-center ">
<img alt="Person walks in house, next to grey dog" src="https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Take time out to reduce your stress levels.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gray-dog-looking-at-the-person-qqpfqFwAyDQ">Evieanna Santiago/Unsplash</a></span>
</figcaption>
</figure>
<h2>7. Avoiding depriving ourselves</h2>
<p>When we change our diet to lose weight or eat healthier, we typically restrict certain foods or food groups. </p>
<p>However, this <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">heightens activity</a> in our mesocorticolimbic circuit – the reward system part of the brain – often resulting in us craving the foods we’re trying to avoid. Foods that give us pleasure release feel-good chemicals called endorphins and learning chemicals called dopamine, which enable us to remember – and give in to – that feel-good response.</p>
<p>When we change our diet, activity in our hypothalamus – the clever part of the brain that regulates emotions and food intake – <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">also reduces</a>, decreasing our control and judgement. It often triggers a psychological response dubbed the “what-the-hell effect”, when we indulge in something we think we shouldn’t feel guilty about and then go back for even more.</p>
<p>Don’t completely cut out your favourite foods when you go on a diet or deprive yourself if you’re hungry. It will take the pleasure out of eating and eventually you’ll give into your cravings. </p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/215808/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>When we change our diet, we disrupt our appetite hormones. Here’s how it works – and how small changes to our diet can help us feel fuller for longer.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2159992023-11-24T03:50:49Z2023-11-24T03:50:49ZTaste depends on nature and nurture. Here are 7 ways you can learn to enjoy foods you don’t like<figure><img src="https://images.theconversation.com/files/561220/original/file-20231123-29-vhjtc4.jpg?ixlib=rb-1.1.0&rect=52%2C17%2C3813%2C2538&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>You’re out for dinner with a bunch of friends, one of whom orders pizza with anchovies and olives to share, but you hate olives and anchovies! Do you pipe up with your preferred choice – Hawaiian – or stay quiet?</p>
<p>This scene plays out every day around the world. Some people ferociously defend their personal tastes. But many would rather expand their palate, and not have to rock the boat the next time someone in their friend group orders pizza. </p>
<p>Is it possible to train your tastebuds to enjoy foods you previously didn’t, like training a muscle at the gym? </p>
<h2>What determines ‘taste’?</h2>
<p>Taste is a complex system we evolved to help us navigate the environment. It helps us select foods with nutritional value and reject anything potentially harmful. </p>
<p>Foods are made up of different compounds, including nutrients (such as proteins, sugars and fats) and <a href="https://www.youtube.com/watch?v=2P_0HGRWgXw">aromas</a> that are detected by sensors in the mouth and nose. These sensors create the <a href="https://www.youtube.com/watch?v=MZn2PMUWO-Y">flavour of food</a>. While taste is what the tastebuds on your tongue pick up, flavour is the combination of how something smells and tastes. Together with texture, appearance and sound, these senses collectively influence your food preferences.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MZn2PMUWO-Y?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Flavour is the overall impression you get when eating.</span></figcaption>
</figure>
<p>Many factors influence food preferences, including age, genetics and environment. We each live in our own sensory world and no two people will have the same <a href="https://theconversation.com/curious-kids-why-do-some-people-find-some-foods-yummy-but-others-find-the-same-foods-yucky-77671">experience while eating</a>.</p>
<p>Food preferences also change with age. Research has found young children have a <a href="https://pubmed.ncbi.nlm.nih.gov/24452237/">natural preference</a> for sweet and salty tastes and a dislike of bitter tastes. As they grow older their ability to like bitter foods grows. </p>
<p>Emerging evidence shows bacteria in saliva can also produce enzymes that influence the taste of foods. For instance, saliva has been shown to cause the release of sulphur aromas in cauliflower. The <a href="https://www.acs.org/pressroom/presspacs/2021/acs-presspac-september-22-2021/childrens-dislike-of-cauliflower-broccoli-could-be-written-in-their-microbiome.html">more sulphur that is produced</a>, the less likely a kid is to enjoy the taste of cauliflower.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/blame-it-on-mum-and-dad-how-genes-influence-what-we-eat-45244">Blame it on mum and dad: how genes influence what we eat</a>
</strong>
</em>
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<h2>Nature versus nurture</h2>
<p>Both genetics and the environment play a crucial role in determining food preferences. Twin studies estimate genetics have a moderate influence on food preferences (between 32% and 54%, depending on the food type) in <a href="https://www.sciencedirect.com/science/article/pii/S000291652305027X?via%3Dihub">children</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/27385609/">adolescents</a> and <a href="https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/dietary-patterns-and-heritability-of-food-choice-in-a-uk-female-twin-cohort/8507AAF01330C599BAC62BCC0EF4CF06">adults</a>.</p>
<p>However, since our cultural environment and the foods we’re exposed to also shape our preferences, these <a href="https://pubmed.ncbi.nlm.nih.gov/24452237/">preferences are learned</a> to a large degree. </p>
<p>A lot of this learning takes place during childhood, at home and other places we eat. This isn’t textbook learning. <a href="https://www.cabidigitallibrary.org/doi/10.1079/9780851990323.0093">It’s learning</a> by experiencing (eating), which typically leads to increased liking of the food – or by watching what others do (modelling), which can lead to both positive or negative associations.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S000291652305027X?via%3Dihub">Research</a> has shown how environmental influences on food preferences change between childhood and adulthood. For children, the main factor is the home environment, which makes sense as kids are more likely to be influenced by foods prepared and eaten at home. Environmental factors influencing adults and adolescents are more varied.</p>
<h2>The process of ‘acquiring’ taste</h2>
<p>Coffee and beer are good examples of bitter foods people “acquire” a taste for as they grow up. The ability to overcome the dislike of these is largely due to: </p>
<ul>
<li><p>the social context in which they’re consumed. For example, in many countries they may be associated with passage into adulthood.</p></li>
<li><p>the physiological effects of the compounds they contain – caffeine in coffee and alcohol in beer. Many people find these effects desirable.</p></li>
</ul>
<p>But what about acquiring a taste for foods that don’t provide such desirable feelings, but which are good for you, such as kale or fatty fish? Is it possible to gain an acceptance for these?</p>
<p>Here are some strategies that can help you learn to enjoy foods you currently don’t:</p>
<ol>
<li><p>eat, and keep eating. Only a small portion is needed to build a liking for a specific taste over time. It may take 10–15 attempts or more before you can say you “like” the food. </p></li>
<li><p><a href="https://www.sciencedirect.com/science/article/pii/S0950329302001106">mask bitterness</a> by eating it with other foods or ingredients that contain salt or sugar. For instance, you can pair bitter rocket with a sweet salad dressing.</p></li>
<li><p>eat it repeatedly in a positive context. That could mean eating it after playing your favourite sport or with people you like. Alternatively, you could eat it with foods you already enjoy; if it’s a specific vegetable, try pairing it with your favourite protein.</p></li>
<li><p>eat it when you’re hungry. In a hungry state you’ll be more willing to accept a taste you might not appreciate on a full stomach. </p></li>
<li><p>remind yourself why you want to enjoy this food. You may be changing your diet for health reasons, or because you’ve moved countries and are struggling with the local cuisine. Your reason will help motivate you. </p></li>
<li><p>start young (if possible). It’s easier for children to learn to like new foods as their tastes are less established. </p></li>
<li><p>remember: the more foods you like, the easier it’ll become to learn to like others.</p></li>
</ol>
<p>A balanced and varied diet is essential for good health. <a href="https://www.sciencedirect.com/science/article/pii/S0195666315003438?ref=pdf_download&fr=RR-2&rr=82a5fd5069821f63">Picky eating</a> can become a problem if it leads to vitamin and mineral deficiencies – especially if you’re avoiding entire food groups, such as vegetables. At the same time, eating too many tasty but energy-dense foods can increase your risk of chronic disease, including obesity. </p>
<p>Understanding how your food preferences have formed, and how they can evolve, is a first step to getting on the path of healthier eating.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-tips-to-give-yourself-the-best-shot-at-sticking-to-new-years-resolutions-151372">9 tips to give yourself the best shot at sticking to new year's resolutions</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/215999/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Astrid Poelman has worked on research funded by a variety of industry bodies, Australian government agencies and private companies. </span></em></p><p class="fine-print"><em><span>Nicholas Archer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As kids, we’re naturally more likely to enjoy sweet and salty tastes and reject bitterness. But that changes as we grow older.Nicholas Archer, Research Scientist, Sensory, Flavour and Consumer Sciences, CSIROAstrid Poelman, Principal Researcher, Public Health & Wellbeing Group, CSIROLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2106682023-08-11T12:38:35Z2023-08-11T12:38:35ZGut microbes are the community within you that you can’t live without – how eating well can cultivate your microbial and social self<figure><img src="https://images.theconversation.com/files/542026/original/file-20230809-15-nrb1kh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Communal meals are a social glue that binds people together.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/family-and-friends-toasting-drinks-at-home-royalty-free-image/1176845606">Klaus Vedfelt/DigitalVision via Getty Images</a></span></figcaption></figure><p>The age-old adage “<a href="https://doi.org/10.1038/s41575-018-0061-2">you are what you eat</a>” holds profound truth. Nearly every molecule in your body is absorbed from what you eat and drink. Your food choices are directly linked to your <a href="https://doi.org/10.1016/S0140-6736(19)30041-8">physical</a>, <a href="https://doi.org/10.1016/j.npbr.2019.05.007">emotional</a> and <a href="https://doi.org/10.1111%2Fmcn.12321">social</a> health. And scientists are learning that your <a href="https://gutbites.org/2022/09/01/spotlight-on-gut-health/">gut health and the microbial communities</a> within you have a significant role to play in orchestrating these processes. </p>
<p>The gut microbiome takes the components of food that you cannot digest, like <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">fiber</a> and <a href="https://doi.org/10.3389/fnut.2019.00188">phytonutrients</a>, and transforms them into signals that regulate <a href="https://doi.org/10.1038/nrendo.2016.150">how hungry</a> you are, how strong your <a href="https://doi.org/10.1038/s41422-020-0332-7">immune system</a> is, and even how you’re <a href="https://doi.org/10.1001/jamanetworkopen.2021.43941">thinking</a> and <a href="https://doi.org/10.1038/s41598-020-77673-z">feeling</a>. It’s as though the <a href="https://doi.org/10.1016/j.advnut.2023.03.016">communities in your gut microbiome</a> are an orchestra for your health, and you conduct their symphony through food.</p>
<p><a href="https://gastro.uw.edu/people/faculty/damman-c">I am a gastroenterologist</a> who has spent over 20 years studying how food affects the gut microbiome and overall health. The research is increasingly clear: A gut-friendly approach to nutrition is important for happy and healthy communities both inside and out of your body.</p>
<h2>Communities within and without</h2>
<p>The fascinating research on the gut microbiome takes us on a journey into the depths of the intestine, where <a href="https://doi.org/10.1136/bmj.k2179">trillions of microorganisms</a> blur the lines between other and self.</p>
<p><a href="https://doi.org/10.1186/s40168-019-0619-4">The term holobiont</a> describes the combined lives of the microbiome and its vessel, working symbiotically to support each other’s well-being. This relationship is represented at its extreme in the intestines of <a href="https://doi.org/10.1111/j.1365-2435.2008.01442.x">termites</a> and <a href="https://doi.org/10.1186/s40168-022-01298-9">cows</a>, where microbes transform uniform, low-nutrient diets of wood or grass into complete nutrition replete with vitamins and other essential nutrients for health.</p>
<p>When people eat certain foods, like those <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">rich in fiber</a>, they too harbor similar relationships with their microbiomes. You provide your microbes with food and a safe place to live, and they in turn fortify your diet with vital molecules such as <a href="https://doi.org/10.1186/s12864-019-5591-7">vitamins</a>, <a href="https://doi.org/10.1016/b978-0-12-800100-4.00003-9">short-chain fatty acids</a> and <a href="https://doi.org/10.3390%2Fnu13062099">neurotransmitters</a> that are key for regulating your metabolism, immunity and mood.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Family smiling and eating together around a dinner table" src="https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542014/original/file-20230809-27177-99vked.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eating together can help build connection.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-chinese-family-and-cousins-having-reunion-royalty-free-image/1297931559">Patrick Chu/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Just as food illuminates the importance of the microbial community within you, it also shines a light on your social community. Food is one of the <a href="https://doi.org/10.1080/13556509.2015.1110934">foundations of culture</a>, serving as the basis of many gifts and shared experiences. You have first dates over drinks and meals, connect with your colleagues over lunch, and share dinners with your family and friends. Food is a type of <a href="https://www.themarginalian.org/2013/04/24/michael-pollan-cooked/">social glue</a> that helps bind communities together.</p>
<p>As you feed your microbiome to cultivate a thriving community within your gut, you also figuratively and literally feed your social community when you <a href="https://doi.org/10.1007/s40750-017-0061-4">break bread with friends and family</a>.</p>
<h2>Convenient fixes sacrifice community</h2>
<p>Convenient, fast, affordable <a href="https://doi.org/10.1017/S1368980010003241">ultraprocessed foods</a> have some enormous benefits in helping feed a growing population and enabling an ever-quickening pace of life, but the latest research is showing that there may be <a href="https://doi.org/10.1016/j.eclinm.2021.100747">collateral damage</a>.</p>
<p>Compared with ancestral diets, industrialized diets may be contributing to <a href="https://doi.org/10.1126/science.aan4834">less diverse</a> microbial communities in your gut. Diversity is important for generating key molecules like <a href="https://doi.org/10.1038/s41467-021-22938-y">butyrate</a> that regulate <a href="http://dx.doi.org/10.1136/gutjnl-2017-314050">appetite</a> and <a href="https://doi.org/10.1038/s41564-018-0337-x">mood</a>. As a result, your microbiome becomes less good at regulating hunger and emotions.</p>
<p>Your social community may also be suffering as result of this disrupted microbial community. In fact, studies on various model organisms have found that microbes can mediate behaviors as diverse as <a href="https://doi.org/10.3389/fmicb.2022.916766">mating</a> and <a href="https://doi.org/10.3390%2Fmicroorganisms11041008">aggression</a> by regulating <a href="https://doi.org/10.1038/s41586-021-03669-y">responses to stress</a>. Food and microbes may affect <a href="https://doi.org/10.1016/j.jpsychires.2015.02.021">social behavior in people</a> as well.</p>
<p>Processed foods do serve a purpose. They are convenient and affordable and can be especially useful for people and families with busy lives and limited time to cook. But some are healthier than others. <a href="https://doi.org/10.1016/j.advnut.2023.03.016">Adding back missing nutrients</a> like fiber and polyphenols to processed foods can help make them healthier, and these can complement a diet of less-processed foods.</p>
<h2>Wisdom cultures around the world</h2>
<p>Anthropological research suggests that <a href="https://doi.org/10.1177/1559827616637066">traditional diets</a> are a particularly important contributor to health and longevity. Communities in Costa Rica, the Mediterranean and Japan that follow traditional diets have many individuals who live for over 100 years. The <a href="https://doi.org/10.3390/nu11081802">Mediterranean</a> and <a href="https://doi.org/10.1016/j.mad.2014.01.002">Okinawan diets</a> have consistently been shown to contribute to better health, including lower rates of obesity and other metabolic diseases.</p>
<p>These diets involve traditional <a href="https://www.theguardian.com/global-development/2014/feb/03/indigenous-diets-fight-modern-illnesses">food choices and combinations</a> as well as natural <a href="https://doi.org/10.1093%2Fcdn%2Fnzz099">food processing and preservation</a> techniques. Combining corn with lime, an ancient process <a href="https://doi.org/10.1016/j.jas.2022.105581">called nixtamalixation</a>, for example, increases <a href="https://doi.org/10.1106/108201302024574">vitamin availability</a> and <a href="https://doi.org/10.1093/jn/133.10.3200">decreases grain toxins</a>. </p>
<figure>
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<figcaption><span class="caption">Nixtamalization is used to make traditional tortillas.</span></figcaption>
</figure>
<p><a href="https://doi.org/10.3390/microorganisms10061151">Fermentation</a> transforms food through live microbes that consume simple carbohydrates, generating <a href="https://doi.org/10.1007/978-1-4939-6634-9_3">antimicrobial chemicals</a> that help preserve food. It also <a href="https://doi.org/10.1038/s41538-022-00152-4">decreases toxins</a> and increases the levels of <a href="https://doi.org/10.1080/10408398.2017.1383355">vitamins and minerals</a> available for absorption. <a href="https://doi.org/10.1016/j.cell.2021.06.019">Fermented foods</a> have been shown to grow diverse microbial communities in the gut, decrease inflammation in the body and reduce the risk of <a href="https://doi.org/10.1016/j.tjnut.2023.02.019">chronic disease</a>.</p>
<p>Communal eating is also intricately woven into the social fabric of <a href="https://scholarscompass.vcu.edu/vcoa_editorial/49/">traditional communities</a>. The longest-lived communities around the world tend to eat at least one of their <a href="https://www.washingtonpost.com/wellness/2023/02/14/centenarians-healthy-eating-habits/">meals together</a> as a family, and eating together is linked to <a href="https://doi.org/10.1016%2Fj.appet.2017.11.084">health benefits</a> including weight regulation and lower depressive symptoms. </p>
<h2>Reembracing community</h2>
<p>Here are a few simple tips to help you eat well and grow your communities – holobiont, family, friends and all:</p>
<ol>
<li><p>Eat the <a href="https://gutbites.org/2022/05/14/missing-microbes-and-the-four-fs-of-food/">four phonetic food F’s</a>: fiber, phytonutrients, healthy fats and ferments. I developed this simple way of categorizing foods to streamline the often complicated advice on how to eat well from the perspective of growing a healthy microbiome. It is also independent of cultural background, as these four categories are common elements in the diets of diverse and long-lived populations around the world.</p></li>
<li><p>Learn the wisdom of traditional food preparation from people who still hold that knowledge. Consider taking a cooking class or spending time in the kitchen learning from a relative or a friend. Then re-share what you learn with your loved ones while preparing and enjoying your own meals. </p></li>
<li><p>You don’t have to be perfect. Even a step toward a healthier meal a day and a communal meal a week can be beneficial.</p></li>
</ol>
<p>It may at first seem daunting to carve out time to follow these deceivingly simple tips. But with a bit of patience and perseverance, they could be inspiration to improve your and your community’s health and wellness.</p><img src="https://counter.theconversation.com/content/210668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Damman is on the scientific advisory board at BCD Biosciences and Supergut.</span></em></p>Nurturing your gut microbiome can go hand in hand with nurturing your social community, with health benefits all around.Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051592023-07-03T11:53:03Z2023-07-03T11:53:03ZFiber is your body’s natural guide to weight management – rather than cutting carbs out of your diet, eat them in their original fiber packaging instead<figure><img src="https://images.theconversation.com/files/529655/original/file-20230601-21-meilfi.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Whole foods like unprocessed fruits, vegetables and grains are typically high in fiber.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pattern-of-variety-fresh-of-organic-fruits-and-royalty-free-image/1455279498">Tanja Ivanova/Moment via Getty Images</a></span></figcaption></figure><p>Fiber might just be the key to healthy weight management – and nature packages it in perfectly balanced ratios with carbs when you eat them as whole foods. Think unprocessed fruits, vegetables, whole grains, beans, nuts and seeds. Research suggests that carbohydrates are meant to come packaged in <a href="https://doi.org/10.1007/s00394-019-02165-4">nature-balanced ratios</a> of total carbohydrates to fiber. In fact, certain types of fiber affect how completely your body <a href="https://doi.org/10.1038/s41467-023-38778-x">absorbs carbohydrates</a> and <a href="https://doi.org/10.1016/j.bcdf.2017.07.005">tells your cells how to process them</a> once they are absorbed.</p>
<p>Fiber slows the absorption of sugar in your gut. It also orchestrates the fundamental biology that recent blockbuster weight loss drugs like <a href="https://theconversation.com/drugs-that-melt-away-pounds-still-present-more-questions-than-answers-but-ozempic-wegovy-and-mounjaro-could-be-key-tools-in-reducing-the-obesity-epidemic-205549">Wegovy and Ozempic</a> tap into, but in a natural way. Your microbiome <a href="https://doi.org/10.3389/fendo.2020.00025">transforms fiber into signals</a> that stimulate the gut hormones that are the natural forms of these drugs. These in turn regulate how rapidly your stomach empties, how tightly your <a href="https://doi.org/10.2337/ds16-0026">blood sugar levels</a> are controlled and even how hungry you feel. </p>
<p>It’s as if unprocessed carbohydrates naturally come wrapped and packaged with their own instruction manual for your body on how to digest them.</p>
<p>I am a <a href="https://gastro.uw.edu/faculty/christopher-j-damman-md-ma">physician scientist and gastroenterologist</a> who has spent over 20 years studying how <a href="https://gutbites.org/">food affects the gut microbiome</a> and metabolism. The research is clear – fiber is important not just for happy bowel movements, but also for your blood sugar, weight and overall health.</p>
<figure>
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<figcaption><span class="caption">Different types of carbs have different effects on the body.</span></figcaption>
</figure>
<h2>Carbohydrates without their wrappers</h2>
<p>Unfortunately, most Americans get the majority of their carbohydrates stripped of their natural fibers. Modern processed grains like white rice and white flour as well as many ultraprocessed foods like some sugary breakfast cereals, packaged snacks and juices have removed these fibers. They essentially come unwrapped and without instructions for the body on how much it should absorb and how it should process them. In fact, <a href="https://doi.org/10.1177%2F1559827615588079">only 5% of Americans</a> eat the recommended amount of carbohydrates with enough of their natural packaging intact. Guidelines recommend <a href="https://doi.org/10.1136%2Fbmj-2020-054370">at least 25 to 30 grams</a> of fiber a day from food.</p>
<p>It may not be surprising that lack of fiber <a href="https://doi.org/10.1371/journal.pmed.1003053">contributes to diabetes and obesity</a>. What is surprising is that the fiber gap also likely contributes to <a href="https://doi.org/10.1016/s2468-1253(19)30257-2">heart disease</a>, certain <a href="https://doi.org/10.1093/ajcn/nqaa161">types of cancer</a> and maybe even <a href="https://doi.org/10.3233/jad-215493">Alzheimer’s disease</a>.</p>
<p>One popular approach to mitigating some of the ill health effects of low fiber and high refined carbohydrates has been to <a href="https://doi.org/10.1016/j.jacl.2019.08.003">limit carbohydrate intake</a>. Such approaches include the low-carb, keto, paleo and Atkins diets. Each diet is a variation on a similar theme of limiting carbohydrates to varying amounts in different ways.</p>
<p>There is scientific backing to the benefits of some of these diets. Research shows that limiting carbohydrates <a href="https://doi.org/10.3389/fnut.2021.702802">induces ketosis</a>, a biological process that frees energy from fat reserves during starvation and prolonged exercise. Low-carbohydrate diets can also help people lose weight and <a href="https://doi.org/10.1038/s41392-021-00831-w">lead to improvements</a> in blood pressure and inflammation.</p>
<p>That said, some keto diets may have negative effects on <a href="https://doi.org/10.3390/genes10070534">gut health</a>. It is also unknown how they may affect <a href="https://doi.org/10.3390/nu14173499">heart health, some forms of cancer</a> and other conditions in the long term.</p>
<p>Even more confusing, research shows that people with diets high in plant-sourced carbohydrates, like the Mediterranean diet, tend to lead the <a href="https://doi.org/10.3390%2Fnu13082540">longest and healthiest lives</a>. How can this be reconciled with studies that suggest that low-carbohydrate diets can benefit metabolic health?</p>
<h2>Is a carb a carb?</h2>
<p>The answer may have to do with the <a href="https://doi.org/10.1093%2Fjn%2Fnxac039">types of carbohydrates</a> that studies are evaluating. Limiting simple sugars and refined carbohydrates may improve certain aspects of metabolic health, as these are some of the most easily digested and absorbed calories. But a more sustainable and comprehensive way of improving health may be <a href="https://doi.org/10.3390%2Fnu12103045">increasing the percentage</a> of unprocessed, more complex and slowly absorbed carbohydrates that come with their natural packages and instructions intact – those that have fiber. </p>
<p>These natural carbohydrates can be found in whole grains, beans, nuts, seeds, fruits and vegetables. They come in ratios of total carbohydrate to fiber that <a href="https://doi.org/10.1371%2Fjournal.pone.0231572">rarely exceed 10-to-1 and are often 5-to-1 or lower</a>. Eating mostly whole foods is a simple way to ensure you’re consuming quality carbohydrates with the right ratios.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person looking at vegetables in farmers market" src="https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529656/original/file-20230601-29-v2vms0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fruits and vegetables typically come in ideal total carbohydrate-to-fiber ratios.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-asian-woman-shopping-fruits-and-vegetables-in-royalty-free-image/1477272111">Oscar Wong/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>But who doesn’t like to have a big bowl of pasta or cake with ice cream on occasion? Focusing on packaged processed foods that maintain carb-to-fiber ratios of at least as low as 10-to-1 or ideally 5-to-1 can help you make the best choices when picking more processed foods at the store. Take a look at the nutrition facts label and simply divide total carbohydrates by dietary fiber.</p>
<p>On occasions when you’re eating out or celebrating someone’s birthday, consider taking a fiber supplement with your meal. One pilot study found that a <a href="https://doi.org/10.2337/db22-836-P">supplement containing a blend of fibers</a> decreased the blood sugar spike – an increase in glucose levels in the blood that if <a href="https://doi.org/10.1017/S0029665122000088">too high can damage the body over time</a> – after a meal in healthy individuals by roughly 30%.</p>
<h2>Listen to your body</h2>
<p>While almost all fiber is generally good for health in most people, not all fiber affects the <a href="https://gutbites.org/2022/05/01/are-all-fibers-to-be-plated-equal/">body in the same way</a>. Consuming a <a href="https://doi.org/10.1111/apt.15129">range of different types</a> of fiber generally helps ensure a <a href="https://theconversation.com/hangry-bacteria-in-your-gut-microbiome-are-linked-to-chronic-disease-feeding-them-what-they-need-could-lead-to-happier-cells-and-a-healthier-body-199486">diverse microbiome</a>, which is linked to gut and overall health.</p>
<p>But certain medical conditions might preclude consuming certain types of fiber. For example, some people can be particularly sensitive to one <a href="https://doi.org/10.1136/gutjnl-2021-326284">class of fiber called FODMAPS</a> – fermentable oligosaccharides, disaccharides, monosaccharides and polyols – that are more readily fermented in the upper part of the gut and can contribute to symptoms of irritable bowel syndrome like bloating and diarrhea. <a href="https://www.health.harvard.edu/diseases-and-conditions/a-new-diet-to-manage-irritable-bowel-syndrome">High-FODMAP foods</a> include many processed foods that contain inulin, garlic powder and onion powder, as well as whole foods including those in the onion family, dairy products, some fruits and vegetables.</p>
<p>Listen to how your body responds to different high-fiber foods. Start low and go slow as you reintroduce foods like beans, seeds, nuts, fruits and vegetables to your diet. If you have trouble increasing your fiber intake, talk with your health care provider.</p>
<p>Tools like this <a href="https://gutbites.org/carb-fiber-ratio-calculator/">online calculator</a> I’ve created can also help you find the highest-quality foods with healthy fiber and other nutrient ratios. It can also show you what proportions of fiber to add back to sugary foods to help achieve healthy ratios.</p>
<p>I wouldn’t endorse eating sweets all the time, but as my three daughters like to remind me, it’s important to enjoy yourself every once in a while. And when you do, consider putting the carbs back in their fiber wrappers. It’s hard to improve upon nature’s design.</p><img src="https://counter.theconversation.com/content/205159/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Damman is on the scientific advisory board at BCD Biosciences and Supergut.</span></em></p>Many processed foods strip carbs of their natural fibers. Eating foods with an ideal total carbohydrate-to-fiber ratio can help with weight management and improve overall health.Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2071002023-06-15T12:38:01Z2023-06-15T12:38:01ZFood insecurity already affects 12 million US homes – and reductions in SNAP benefits won’t help<figure><img src="https://images.theconversation.com/files/530255/original/file-20230606-25-5endiw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4554%2C3850&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Of the 34 million Americans who suffer from food insecurity, 9 million are children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/serious-mixed-race-boy-with-curly-hair-royalty-free-image/554372217?phrase=sad+child&adppopup=true">Jose Luis Pelaez Inc/Digital Vision via Getty Images</a></span></figcaption></figure><p><em>Millions of Americans struggle to afford healthy meals and nutritious food. Known as “food insecurity,” this problem was already rising when Supplemental Nutrition Assistance Program, or SNAP, benefits – previously called food stamps – were <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">cut in 35 states this spring</a>.</em>
<em>SciLine interviewed <a href="https://profiles.ucsf.edu/hilary.seligman">Hilary Seligman</a>, professor of medicine at the University of California, San Francisco, on rising grocery prices, the misconceptions about hunger in the U.S., and how food insecurity diminishes school and work performance.</em></p>
<figure>
<iframe src="https://player.vimeo.com/video/831913909" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Hilary Seligman discussed food insecurity in the U.S.</span></figcaption>
</figure>
<p><em>Below are some highlights from the discussion. Answers have been edited.</em></p>
<p><strong>What is food insecurity?</strong></p>
<p><strong>Hilary Seligman:</strong> Food insecurity is defined by the U.S. Department of Agriculture as the <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/">limited or uncertain access to enough food</a> for a healthy life.</p>
<p><strong>What are the trends in food insecurity rates?</strong></p>
<p><strong>Hilary Seligman:</strong> The most recent data suggests that about <a href="https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/">1 in 10 households in the U.S. are food insecure</a>. And this rate is even higher among certain groups, like Black and brown households and households with children.</p>
<p><strong>What factors cause food insecurity?</strong></p>
<p><strong>Hilary Seligman:</strong> Food insecurity is an <a href="https://theconversation.com/what-is-food-insecurity-152746">inability to access enough resources</a> for your basic needs. So it’s not having sufficient money in the household to meet a food budget. And that may be because of <a href="https://moveforhunger.org/how-a-disability-can-increase-the-risk-of-food-insecurity#:%7E:">disability</a>, because of <a href="https://doi.org/10.1101/2020.07.28.20163618">unemployment</a>, because of <a href="https://www.laworks.com/food-insecurity-101#:%7E:">inadequate educational opportunities</a>, or all of these root causes. </p>
<p><strong>How does inflation affect food insecurity rates?</strong></p>
<p><strong>Hilary Seligman:</strong> It’s clear that when food prices rise, households have to <a href="https://www.urban.org/research/publication/food-insecurity-trended-upward-midst-high-inflation">stretch a food budget even more</a>. People have to make difficult choices about the kind of food they eat, and the amount of food they eat. </p>
<p>In many cases, when household budgets are stretched thin, people have to shift their purchases toward foods that are cheaper. And in the U.S., cheaper foods are <a href="https://theconversation.com/ultraprocessed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">almost always less healthy for you</a>, more caloric and more deficient in vitamins and nutrients.</p>
<p><strong>How does food insecurity affect people’s health?</strong></p>
<p><strong>Hilary Seligman:</strong> Over the last couple of decades, we’ve seen that food insecurity can have a profound impact on physical health and mental health, whether children, adults or older adults.</p>
<p>These cheaper foods tend to be really <a href="https://www.theguardian.com/environment/2021/apr/25/our-unequal-earth-mark-bittman-cheap-food-american-diet">highly processed, nutritionally poor, shelf-stable foods</a>. And we know these foods are bad for people’s health in the long term. They predispose people toward weight gain, diabetes, <a href="https://doi.org/10.1177/0141076813512297">cardiovascular disease</a> and <a href="https://www.imperial.ac.uk/news/242892/ultra-processed-foods-linked-increased-risk-cancer/">even cancer</a>. </p>
<p>We also know that when you live in a food-insecure household, it makes it difficult to afford <a href="https://www.westhealth.org/press-release/112-million-americans-struggle-to-afford-healthcare/">other things that are good for your health</a>. For example, it would make it more difficult to afford your copayment to see your primary care doctor, or your medications. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign in a grocery store window says 'We gladly accept EBT food stamps.'" src="https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531018/original/file-20230608-13385-dubp2y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">About 12% of the U.S. population relies on the SNAP program.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sign-alerting-customers-about-snap-food-stamps-benefits-is-news-photo/1186596443">Scott Heins via Getty Images News</a></span>
</figcaption>
</figure>
<p><strong>How does food insecurity affect success at work or school?</strong></p>
<p><strong>Hilary Seligman:</strong> We know that food insecurity is associated with <a href="https://www.nokidhungry.org/blog/how-does-hunger-affect-learning#:%7E:">poor academic performance among children</a>. </p>
<p>Parents are probably really familiar with the way that their children behave when they’re hungry. And those same things happen in school environments when kids show up to school having not had the opportunity to eat a healthy breakfast. </p>
<p>The evidence is clear that food insecurity is associated with <a href="https://www.bigrapidsnews.com/local-news/article/Going-hungry-Student-hunger-affects-behavior-14181940.php#:%7E:">behavioral problems in school</a>, absenteeism from school and poor academic performance. And this can have lifelong consequences for children. </p>
<p>A similar thing <a href="https://www.worklifepartnership.org/food-insecurity/">plays out with adults</a>. Adults who are living in food-insecure households are less likely to be able to hold down a sufficient number of work hours to meet their household budget needs. They’re less likely to be able to devote a lot of hours to finding employment, because finding food takes a lot of time and a lot of energy.</p>
<p><strong>Are there any common misconceptions about hunger?</strong></p>
<p><strong>Hilary Seligman:</strong> One of the misconceptions is that people who are experiencing food insecurity don’t want access to a healthier diet. </p>
<p>In many, many cases, if not most cases, the evidence is clear that people at all income levels <a href="https://www.salon.com/2015/09/27/the_surprising_truth_about_poor_peoples_eating_habits_partner/">often want access to a healthier diet</a>. But in a household experiencing food insecurity, a healthier diet is simply out of reach financially. </p>
<p>Many people living in food-insecure households will tell you they <a href="https://www.ers.usda.gov/amber-waves/2008/november/can-low-income-americans-afford-a-healthy-diet/">perceive fruits and vegetables to be luxury items</a>. They only splurge on fruits and vegetables when they have extra money in their budget. And so one of the things that we have to guard against is an assumption that people with lower incomes don’t want to eat a healthy diet.</p>
<p><strong>What else works to reduce or eliminate food insecurity?</strong></p>
<p><strong>Hilary Seligman:</strong> The best solution for food insecurity is <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program">SNAP</a>, which used to be called the food stamps program. </p>
<p>It is very, very clear that SNAP is <a href="https://www.cbpp.org/research/food-assistance/snap-is-linked-with-improved-nutritional-outcomes-and-lower-health-care">enormously effective at supporting food security</a> in U.S. households. And anything that reduces access to SNAP or makes it more difficult to enroll in SNAP is going to have the effect of increasing food insecurity rates in the United States. </p>
<p>An example of this would be the work requirements that will <a href="https://www.npr.org/2023/06/02/1179633624/snap-food-assistance-work-requirements-congress-debt-ceiling">push people out of the SNAP program</a> and likely increase food insecurity rates. </p>
<p>Things like earned income tax credits protect families against food insecurity. Emergency stimulus checks like we saw during the COVID pandemic <a href="https://www.cbpp.org/research/poverty-and-inequality/robust-covid-relief-achieved-historic-gains-against-poverty-and-0">also protect families</a>. </p>
<p><em>Watch the <a href="https://www.sciline.org/health-medicine/food-insecurity/">full interview</a> to hear more.</em></p>
<p><em><a href="https://www.sciline.org/">SciLine</a> is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.</em></p><img src="https://counter.theconversation.com/content/207100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hilary Seligman receives funding from NIH, CDC, USDA, Feeding America, and Robert Wood Johnson Foundation Healthy Eating Research. She is the founder of Vouchers for Veggies, which receives funding from the Hellman Foundation, San Francisco Public Health Foundation, Share our Strength, and numerous others.</span></em></p>For many Americans, a healthy diet of fruits, vegetables and whole grains is beyond their reach.Hilary Seligman, Professor of Medicine, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055492023-06-01T12:29:48Z2023-06-01T12:29:48ZDrugs that melt away pounds still present more questions than answers, but Ozempic, Wegovy and Mounjaro could be key tools in reducing the obesity epidemic<figure><img src="https://images.theconversation.com/files/528106/original/file-20230524-19-7ii8za.jpg?ixlib=rb-1.1.0&rect=8%2C43%2C5742%2C3785&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite the promise of drugs that can help people shed pounds, healthy lifestyle choices are still key to overall health.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-running-with-dog-royalty-free-image/627573747?phrase=overweight+people&adppopup=true">Zing Images / DigitalVision via Getty Images</a></span></figcaption></figure><p>In the past five years, several new drugs have been brought to market that could lead to a profound, if not revolutionary, change in how health care providers – and the public – view weight loss. </p>
<p>Three drugs in particular – sold under the brand names <a href="https://www.wegovy.com/">Wegovy</a>, <a href="https://www.ozempic.com/">Ozempic</a> and <a href="https://www.mounjaro.com/">Mounjaro</a> – have <a href="https://doi.org/10.1056/NEJMoa2032183">shown remarkable effects</a> on weight loss in clinical trials. </p>
<p>While Wegovy is approved by the Food and Drug Administration for weight loss, the other two medications are only approved as treatment for Type 2 diabetes, though they do also contribute to significant weight loss. This has led to increased demand for these drugs, causing a <a href="https://www.bloomberg.com/news/articles/2023-03-17/novo-s-novob-ozempic-shortage-eases-after-rush-to-use-for-weight-loss#xj4y7vzkg">shortage of Ozempic</a> and <a href="https://www.medpagetoday.com/special-reports/exclusives/103928">Mounjaro</a> in early 2023 that threatened the availability of these drugs for diabetes patients. </p>
<p>Globally, <a href="https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022">more than 650 million people are obese</a>, and by 2030, an estimated 1 billion adults will be obese. This makes obesity the most prevalent chronic disease in the world. </p>
<p>As an <a href="https://scholar.google.com/citations?user=cdcUryAAAAAJ&hl=en">exercise science scholar</a>, I have spent more than 15 years studying the effects of diet and exercise on the human body, primarily focused on body composition changes such as gaining skeletal muscle or losing body fat, or both. In my lectures, I present data on the detrimental impacts on personal health of being overweight or obese. Then I show that, aside from surgical intervention, the best way to lower body fat is with starting an exercise program and improving dietary habits. </p>
<p>These new drugs have now altered what I teach in the classroom, and as a researcher I believe they raise many questions about the current approach to weight management and health. While these medications hold promise, they are not wonder drugs. In my view, they warrant much more research before they become the basis for a new weight management protocol. </p>
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<figcaption><span class="caption">This woman lost 80 pounds after taking Mounjaro for seven months.</span></figcaption>
</figure>
<h2>How these drugs work</h2>
<p>Ozempic and Mounjaro are FDA-approved for the treatment of Type 2 diabetes, which affects more than <a href="https://www.cdc.gov/diabetes/data/statistics-report/index.html">37 million people</a> in the U.S. On top of that, nearly 100 million people are considered prediabetic, meaning that together over 40% of the U.S. population suffers from an inability to properly manage blood sugar. </p>
<p>Obesity and Type 2 diabetes are closely related conditions, so much so that some experts are now calling the <a href="https://doi.org/10.1038/s41569-020-00465-5">two conditions “diabesity</a>.” These dire figures are what prompted pharmaceutical companies to search for new weight loss treatments. </p>
<p>Type 2 diabetes is a condition in which your body no longer responds to the hormone insulin, which in healthy people regulates glucose, or sugar, levels in the blood. Prolonged elevated blood sugar, if left untreated, can lead to heart disease, vision loss and even death. </p>
<p>Wegovy and Ozempic are a class of drug <a href="https://www.drugs.com/semaglutide.html">known as a semaglutide</a>. Since people with Type 2 diabetes are unable to properly manage blood sugar, injections with this class of drug help the body release the proper amount of insulin after eating by mimicking a naturally occurring hormone called GLP-1. </p>
<p>At the same time, semaglutides also reduce the release of the hormone glucagon, which works opposite of insulin to increase blood sugar. In non-diabetics, these two hormones work together to maintain normal blood sugar levels. But since this mechanism is not functioning properly in diabetics, which leads to high blood sugar, semaglutides help to control blood sugar and also reduce appetite.</p>
<p>For this reason, <a href="https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trial-snapshot-ozempic">Ozempic received approval</a> from the FDA in 2017 as a treatment for <a href="https://www.cdc.gov/diabetes/basics/type2.html">Type 2 diabetes</a>. But during the clinical trials for Type 2 diabetes, pharmaceutical companies quickly recognized Ozempic’s potential as a weight loss tool. </p>
<p>This led to the release of a new drug, Wegovy, which has a higher dose of semaglutide. A 2021 study showed that once-weekly injections of Wegovy over the course of 68 weeks resulted in about <a href="https://doi.org/10.1056/NEJMoa2206038">a 15% loss of body weight in adult participants with obesity</a>. </p>
<p>The other novel <a href="https://www.today.com/health/news/tirzepatide-mounjaro-weight-loss-drug-rcna82400">medication in the news lately</a>, Mounjaro, acts like a semaglutide, stimulating GLP-1, but it also mimics a second hormone called glucose-dependent insulinotropic polypeptide. This dual-hormone action works to not only lower blood sugar levels and increase insulin sensitivity, but also slows the digestive system and decreases appetite. </p>
<h2>Staggering results</h2>
<p>In early 2021, scientists began analyzing the data from a clinical trial program focused on <a href="https://doi.org/10.1056/NEJMoa2032183">using semaglutide treatments in people with obesity</a>, which included more than 4,000 patients. Over 80% of participants lost more than 5% of their body weight, with the most common side effects being nausea, diarrhea, vomiting and constipation. </p>
<p>This data on effectiveness and efficacy led the FDA to officially <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014">approve Wegovy as a weight loss drug</a> in the summer of 2021. The huge demand that ensued led to the <a href="https://www.forbes.com/sites/ariannajohnson/2023/05/05/wegovy-shortage-drug-maker-limits-distribution-heres-when-supplies-should-improve/?sh=3d1bd3521fa4">recent shortages of Wegovy</a>, forcing many physicians to look for other options. That’s when Ozempic and Mounjaro entered the picture as off-label weight loss medications, even though they are only FDA-approved to treat Type 2 diabetes. </p>
<p>In April 2023, the pharmaceutical company Eli Lilly released the results of the second <a href="https://investor.lilly.com/news-releases/news-release-details/lillys-tirzepatide-achieved-157-weight-loss-adults-obesity-or">phase 3 clinical trial of Mounjaro</a>. The results were, quite frankly, amazing: Compared to a placebo, the 938 obese or overweight adults with Type 2 diabetes lost more than 34 pounds, or roughly 15% of their body weight, with no required fitness and nutrition program. </p>
<p>This most recent study tracked with the first clinical trial of Mounjaro, published in July 2022, that resulted in more than a <a href="https://doi.org/10.1056/NEJMoa2206038">20% reduction in body weight in 2,539 adults</a>. Similar to Wegovy and Ozempic, Mounjaro’s most commonly reported side effects are general gastrointestinal distress such as nausea, vomiting and diarrhea.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Obese man pushing a cart in a grocery store and peering at healthy food." src="https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528109/original/file-20230524-27-w56bss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Obesity accounts for nearly half of the cost of chronic disease in the U.S.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/overweight-man-passing-by-healthy-food-royalty-free-image/108821354?phrase=overweight+people&adppopup=true">Peter Dazeley/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<h2>Costs of obesity</h2>
<p>The latest data from the National Institutes of Health estimates that more than <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity">40% of U.S. adults are obese and another 30% are overweight</a>, meaning that 7 in 10 adults need to lose weight. The World Health Organization estimates that, based on a 2017 global burden of disease study, more than <a href="https://www.who.int/health-topics/obesity#tab=tab_1">4 million people across the world are dying every year</a> due to being overweight or obese, a trend that is also <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">growing rapidly in children</a>.</p>
<p>The WHO <a href="https://www.who.int/health-topics/obesity#tab=tab_1">defines obesity</a> as when an adult or child has a body mass index, or BMI, over 30; a BMI over 25 is considered overweight. In children, <a href="https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html">doctors often rely on percentiles</a>, rather than an absolute number.</p>
<p>BMI is calculated by taking a person’s <a href="https://www.cdc.gov/healthyweight/assessing/bmi/index.html#">weight and dividing it by the square of their height</a> – a technique that <a href="https://www.scientificamerican.com/article/is-bmi-an-accurate-way-to-measure-body-fat/">isn’t the most accurate</a> for assessing body composition. But it is valuable for classifying millions of people where more accurate techniques such as <a href="https://nutritionalassessment.mumc.nl/en/skinfold-measurements">skinfold measurements</a> are not feasible. </p>
<p>Being overweight or obese greatly increases risks for <a href="https://www.cdc.gov/healthyweight/effects/index.html">other significant health complications</a>, such as heart disease, Type 2 diabetes, hypertension, osteoarthritis, stroke and asthma. In fact, obesity is responsible for <a href="https://milkeninstitute.org/report/americas-obesity-crisis-health-and-economic-costs-excess-weight">nearly half of the total cost of chronic disease</a> in the U.S. Studies show that obesity also leads to a <a href="https://doi.org/10.21037%2Fatm.2017.03.107">decrease in life expectancy</a>.</p>
<p>Recent data suggests that the direct medical costs of a person being obese in the U.S. <a href="https://doi.org/10.18553/jmcp.2021.20410">is more than US$2,500 annually</a>. And researchers estimate that the total cost of chronic diseases due to obesity in the U.S. <a href="https://milkeninstitute.org/report/americas-obesity-crisis-health-and-economic-costs-excess-weight">is more than $1.7 trillion</a> annually, which is 9.3% of the country’s gross domestic product. Predictions show the annual cost of obesity will be <a href="https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022">more than $4.3 trillion worldwide by 2030</a>. </p>
<p>Current <a href="https://www.drugs.com/price-guide/mounjaro#">list prices for Mounjaro</a> and <a href="https://www.webmd.com/obesity/news/20230503/ozempic-cost-coupons-and-ways-to-save-cash">Ozempic</a> top $1,000 per month for off-label use, meaning for weight loss and not for Type 2 diabetes. In this scenario, which is becoming more common, insurance companies are less likely to cover the medication. </p>
<p>Since most Americans can’t afford these drugs, it’s reasonable to ask whether more should be done to decrease costs and increase access.</p>
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<figcaption><span class="caption">Many people are unaware of the health risks tied to obesity and being overweight.</span></figcaption>
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<h2>The age-old benefits of exercise and a healthy diet</h2>
<p>Still, these new drugs that can aid in weight loss present a dilemma for doctors and other health care providers: Where do they fit in with the decadeslong gospel of healthy eating and increasing physical activity?</p>
<p>Traditionally the most effective mechanism for weight loss <a href="https://doi.org/10.1249/MSS.0000000000001938">has been a twofold lifestyle intervention</a>: dietary modification resulting in an overall caloric deficit combined with 250 minutes or more of moderate-intensity exercise per week.</p>
<p>Research has long since established that <a href="https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm">being physically active</a> improves mental health, including memory, depressive symptoms and mood, as well as immune function and bone health. Being active also reduces the risks of developing <a href="https://www.nhlbi.nih.gov/health/heart/physical-activity/benefits#">conditions like heart disease</a>, Type 2 diabetes and <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet">some cancers</a>.</p>
<p>But given that more than two-thirds of the U.S. adult population is now overweight or obese, Americans are clearly not meeting these guidelines. The most recent data shows that only a quarter of adults are getting the necessary <a href="https://www.cdc.gov/nchs/products/databriefs/db443.htm">aerobic and muscle strengthening activity each week</a>. </p>
<p>For all these reasons, many clinical recommendations now suggest <a href="https://doi.org/10.1503/cmaj.191707">the use of anti-obesity medications</a> as a <a href="https://doi.org/10.1210/jc.2014-3415">primary means of addressing overweight and obesity</a>.</p>
<p>The health care field now has a new strategy for meaningful weight loss, but there are still more questions than answers. </p>
<p>Will losing weight with only drugs still provide these same health benefits? What about the long-term efficacy of using these medications? Are there complications we don’t know about yet because we simply haven’t had these drugs available long enough to study? Researchers are also <a href="https://doi.org/10.1111/dom.14725">just beginning to understand</a> what happens when you <a href="https://doi.org/10.1038/s41591-022-02026-4">stop using these new weight loss medications</a>.</p>
<p>Given the gravity of the obesity epidemic and the health costs that come with it, I believe the potential risks of using these drugs for weight loss may be worth the reward of lessening the burden on the health care system and improving the quality of life for hundreds of millions of people.</p><img src="https://counter.theconversation.com/content/205549/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wesley Dudgeon does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anti-obesity medications are becoming the go-to treatment for weight loss. But drugs alone may not provide the same benefits as lifestyle choices like exercise and a healthy diet.Wesley Dudgeon, Professor of Exercise Science and Interim Dean of the School of Health Sciences, College of CharlestonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1994862023-04-10T12:09:59Z2023-04-10T12:09:59ZHangry bacteria in your gut microbiome are linked to chronic disease – feeding them what they need could lead to happier cells and a healthier body<figure><img src="https://images.theconversation.com/files/519904/original/file-20230406-28-pmixy3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C788%2C443&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The gut microbiome may play a role in regulating the body's appetite, cognition and immune responses. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/gut-bacteria-royalty-free-image/1471910154">nopparit/iStock via Getty Images Plus</a></span></figcaption></figure><p>Diet-related chronic diseases <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/27/executive-summary-biden-harris-administration-national-strategy-on-hunger-nutrition-and-health/">have reached</a> a <a href="https://foodperiodictable.org">critical juncture</a> in the U.S. </p>
<p>Nearly half the population has <a href="https://www.cdc.gov/diabetes/data/statistics-report/index.html">prediabetes or diabetes</a>. Over 40% are <a href="https://www.cdc.gov/obesity/data/adult.html">overweight or obese</a>. <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">One in nine people over the age of 65</a> has Alzheimer’s disease, the development of which researchers are exploring the <a href="https://doi.org/10.1016/S1474-4422(20)30231-3">potential role of diet</a>. Poor diet is also linked to <a href="https://doi.org/10.1093%2Fnutrit%2Fnuaa025">poor mental health</a>, <a href="https://doi.org/10.1161/CIR.0000000000001031">cardiovascular disease</a> and <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/diet">cancer</a>. It was responsible for <a href="https://www.cspinet.org/eating-healthy/why-good-nutrition-important">nearly 1 in 5 deaths in the U.S.</a> and accounted for <a href="https://doi.org/10.1016/S2468-2667(20)30203-6">over US$140 billion</a> in U.S. health care spending in 2016.</p>
<p>Though American waists are getting bigger, research is showing that the gut microbiome – the bacteria living in our digestive tracts – and the energy-producing compartments of cells, the mitochondria, remain hungry for nutrients missing in the American diet.</p>
<p>I am a <a href="https://gastro.uw.edu/faculty/christopher-j-damman-md-ma">physician scientist and gastroenterologist</a> who has spent over 20 years studying how food can affect the gut microbiome and whole body health. The ultraprocessed food that makes up an <a href="https://doi.org/10.1093/ajcn/nqab305">increasing part the American diet</a> has removed vital nutrients from food. Adding those nutrients back may be important for health in part by feeding the microbiome and mitochondria that turn food into fuel. </p>
<h2>Your health is what you eat</h2>
<p>Research has consistently shown that the <a href="https://doi.org/10.1111/joim.13333">Mediterranean diet</a> and <a href="https://doi.org/10.1016/j.foodres.2022.111501">other whole food diets</a> are associated with better health and longer lives, and <a href="https://theconversation.com/ultraprocessed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">ultraprocessed foods and drinks</a> like soda, chips and fast food, among others, are linked with <a href="https://doi.org/10.1080/10408398.2022.2084359">poor health outcomes</a> such as diabetes, cardiovascular disease, cancer and other diseases. </p>
<p>But improving the diet of an individual, let alone a population, is challenging. Whole foods are sometimes <a href="https://www.usda.gov/media/blog/2018/07/24/what-drives-consumers-purchase-convenience-foods">less convenient</a> and <a href="https://doi.org/10.1093/jn/nxab318">less tasty</a> for modern lifestyles and preferences. Furthermore, food processing can be beneficial by <a href="https://www.hsph.harvard.edu/nutritionsource/processed-foods/">preventing spoilage and extending shelf life</a>. <a href="https://doi.org/10.1016/j.gfs.2022.100649">Whole grain processing</a> in particular extends shelf life by removing the germ and bran that otherwise rapidly spoil. Long-term storage of affordable calories has helped address <a href="https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/">food insecurity</a>, a primary challenge in public health. </p>
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<figcaption><span class="caption">What you eat changes the composition of your gut microbiome.</span></figcaption>
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<p>Much of the public health conversation around diet has focused on what to avoid: added sugars and refined carbs, some fats, salt and additives. But modern food processing, while increasing the concentration of some nutrients, has removed other key nutrients, producing potential <a href="https://doi.org/10.1038/s43016-019-0013-1">long-term health costs</a>. Equally important is <a href="https://doi.org/10.3390/diseases4010014">what to add back</a> into diets: fibers, <a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">phytonutrients</a>, micronutrients, missing fats and fermented foods.</p>
<p>Only 5% of the U.S. population gets <a href="https://doi.org/10.1177%2F1559827615588079">sufficient fiber</a>, a prebiotic nutrient linked to metabolic, immune and neurologic health. Americans are likely also deficient in <a href="https://doi.org/10.3390%2Fnu11061355">phytonutrients</a>, <a href="https://doi.org/10.1136/bmj.f1378">potassium</a> and certain <a href="https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/">healthy fats</a> linked to lower rates of cardiovascular disease and cancer. </p>
<p><a href="https://doi.org/10.1038/s41575-020-00390-5">Fermentation</a> is nature’s version of processing, creating foods with natural preservatives, flavors and vitamins. Recent research suggests fermented foods can <a href="https://doi.org/10.1016/j.cell.2021.06.019">improve gut microbiome diversity</a> and dampen systemic inflammation.</p>
<p>Figuring out which bioactive nutrients contribute to disease can help both individuals and institutions develop diets and foods that are personalized to different health conditions, economic constraints and taste preferences. It can also help maximize nutrients in a way that is convenient, affordable and familiar to the modern palate. </p>
<h2>Of microbiomes and mitochondria</h2>
<p>Understanding how nutrients affect the gut microbiome and mitochondria could help determine which ingredients to add to the diet and which to temper.</p>
<p>In your lower gut, bacteria transform undigested bioactive nutrients into <a href="https://doi.org/10.1016/j.tem.2020.12.003">biochemical signals</a> that stimulate gut hormones to slow down digestion. These signals also regulate the immune system, controlling how much of the body’s energy goes toward inflammation and fighting infection, and <a href="https://doi.org/10.3389%2Ffmicb.2022.798917">cognition</a>, influencing appetite and <a href="https://doi.org/10.3390%2Fmicroorganisms9040716">even mood</a>.</p>
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<figcaption><span class="caption">A number of factors are involved in aging.</span></figcaption>
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<p>The microbiome’s biochemical signals also <a href="https://doi.org/10.3389%2Ffmicb.2022.1056499">regulate the growth and function</a> of energy-producing mitochondria across many cell types, including those in fat, muscles, heart and the brain. When these cues are <a href="https://doi.org/10.1038/s43016-019-0013-1">missing in ultraprocessed diets</a>, mitochondria <a href="https://doi.org/10.3390/diseases4010014">function less well</a>, and their dysregulation has been linked to <a href="https://doi.org/10.3389/fendo.2018.00283">obesity</a>, <a href="https://doi.org/10.3389/fphys.2019.00532">diabetes</a>, <a href="https://doi.org/10.1186/s13024-020-00376-6">Alzheimer’s disease</a>, <a href="https://doi.org/10.3389/fpsyt.2021.546801">mood disorders</a> and <a href="https://doi.org/10.1016%2Fj.molcel.2016.02.011">cancer</a>. A better understanding of how diet could improve the function of the <a href="https://doi.org/10.1016/j.advnut.2023.03.016">microbiome-mitochondria axis</a> could help provide a way to reduce the burden of chronic disease.</p>
<p><a href="https://www.britannica.com/biography/Hippocrates">The Greek physician Hippocrates</a>, regarded as the father of medicine, supposedly once said “Let food be thy medicine,” and a <a href="https://doi.org/10.1016/j.advnut.2023.03.016">growing body research</a> suggests that, yes, food can be medicine. I believe that shining a light on the <a href="https://gutbites.org/">connection between diet, health and the microbiome and mitochondria</a> could help societies reach a bright future in which unhealthy aging <a href="https://doi.org/10.1111/obr.13366">isn’t an inevitability</a> of growing older.</p><img src="https://counter.theconversation.com/content/199486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Damman is medical and science officer at Supergut and on the scientific advisory board at BCD Biosciences.</span></em></p>Research has examined how ultraprocessed foods can contribute to diabetes, cardiovascular disease, cancer and mood disorders. A healthier diet is one way to use food as medicine.Christopher Damman, Associate Professor of Gastroenterology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1988492023-03-15T12:21:15Z2023-03-15T12:21:15ZAre you a rapid ager? Biological age is a better health indicator than the number of years you’ve lived, but it’s tricky to measure<figure><img src="https://images.theconversation.com/files/514749/original/file-20230310-2079-5uhxpf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2122%2C1410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Healthspan measures incorporate quality of life in ways that lifespan does not.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-babyboomer-jumping-into-lake-royalty-free-image/92930493">Ira T. Nicolai/The Image Bank via Getty Images</a></span></figcaption></figure><p>Do you ever wake up some days and think, “When I was younger, I could survive on just four hours of sleep, but now it seems like I need 10”? Or have you ever walked out of the gym and “felt” your knees?</p>
<p>Almost everyone experiences these kinds of signs of aging. But there are some people who seem to defy their age. The late U.S. Supreme Court Justice <a href="https://www.cbsnews.com/news/remembering-rbg-justice-ruth-bader-ginsburg-a-woman-who-lived-a-life-defying-expectations/">Ruth Bader Ginsberg</a> stayed on the bench until her death at age 87. The “Great British Bake Off” judge <a href="https://www.bbc.com/news/entertainment-arts-58982697">Mary Berry</a>, now in her 80s, continues to inspire people all over the world to bake and enjoy life. And actor <a href="https://www.washingtonpost.com/arts-entertainment/2021/11/10/paul-rudd-sexiest-man-alive-people/">Paul Rudd</a> was named People magazine’s “Sexiest Man Alive” in 2021 at age 52 while still looking like he’s in his 30s. Is age just a number then? </p>
<p>Researchers have focused a lot of attention on understanding the causes and risk factors of age-related diseases like Alzheimer’s, dementia, osteoporosis and cancer. But many ignore the major risk factor for all of these diseases: aging itself. More than any individual risk factor such as smoking or lack of exercise, the number of years you’ve lived predicts onset of disease. Indeed, aging increases the risk of multiple chronic diseases <a href="https://doi.org/10.1016/j.cub.2012.07.024">by up to a thousandfold</a>. </p>
<p>However, <a href="https://doi.org/10.1038/s41586-018-0457-8">no two people age the same</a>. Although age is the principal risk factor for several chronic diseases, it is an unreliable indicator of how quickly your body will decline or how susceptible you are to age-related disease. This is because there is a difference between your chronological age, or the number of years you’ve been alive, and your biological age – your physical and functional ability.</p>
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<figcaption><span class="caption">As the author notes in her TED Talk, aging is not just a number.</span></figcaption>
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<p>I am a <a href="https://scholar.google.com/citations?user=tqI8C_UAAAAJ&hl=en">scientist interested in redefining “age.”</a> Instead of benchmarking chronological age, my lab is invested in <a href="http://agresearchlab.com">measuring biological age</a>. Biological age is a <a href="https://doi.org/10.1016/j.jacc.2019.11.062">more accurate measure of healthspan</a>, or years lived in good health, than chronological age, and doesn’t directly correlate with wrinkles and gray hairs. Rapid agers experience a faster rate of functional deterioration relative to their chronological age. </p>
<p>My grandmother, who lived to be 83 but was bedridden and could not remember who I was for the last few years of her life, was a rapid ager. My grandfather, on the other hand, also lived until he was 83, but he was active, functional and even did my homework with me until he passed away – he was a healthy ager.</p>
<p>With the unprecedented <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">growth of the world’s aging population</a>, I believe that figuring out ways to measure biological age and how to maintain or delay its advance is critical not only for individual health, but also for the social, political and economic health of our society. Detecting rapid agers early on presents an opportunity to delay, change or even reverse the trajectory of biological aging. </p>
<h2>Genetics and biological age</h2>
<p>Biological aging is multifaceted. It arises from a complex mix of genetic traits and is <a href="https://doi.org/10.1016/j.jacc.2019.11.062">influenced by factors</a> like microbiome composition, environment, lifestyle, stress, diet and exercise.</p>
<p>Genetics were once thought to have no influence on aging or longevity. However, in the early 1990s, researchers reported the first studies identifying <a href="https://doi.org/10.1098/rstb.2010.0276">genes that were able to extend the lifespan</a> of a small roundworm. Since then, multiple observations support the influence of genetics on aging.</p>
<p>For example, children of long-lived parents and even those with long-lived siblings <a href="https://doi.org/10.1038/ejhg.2011.40">tend to live longer</a>. Researchers have also <a href="https://doi.org/10.1038/s41576-019-0183-6">identified multiple genes</a> that influence longevity and play a role in resilience and protection from stress. These include genes that repair DNA, protect cells from free radicals and regulate fat levels.</p>
<p>However, it is clear from studies in identical twins – who share the same genes but not the same exact lifespans – that genes are not the only factor that influences aging. In fact, genes probably account for only <a href="https://www.scientificamerican.com/article/genetic-factors-associated-with-increased-longevity-identified/">20% to 30% of biological age</a>. This suggests that other parameters can strongly influence biological aging.</p>
<h2>Environmental and lifestyle effects</h2>
<p>Researchers have found that environmental and lifestyle factors heavily influence biological age, including social connectedness, <a href="https://doi.org/10.1001/jamanetworkopen.2021.24387">sleeping habits</a>, <a href="https://www.cnn.com/2023/01/02/health/hydration-disease-aging-death-risk-study-wellness/index.html">water consumption</a>, exercise and diet. </p>
<p><a href="https://doi.org/10.1016/j.alcr.2019.02.002">Social connectedness</a> is essential for well-being throughout life. But social connections can be challenging to maintain over time due to loss of family and friends, depression, chronic illness or other factors. Several studies have reported a <a href="https://doi.org/10.1073/pnas.1219686110">strong link</a> between social isolation and increased stress, morbidity and mortality.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three women dancing together in a park" src="https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Social connectedness and physical activity are linked to well-being throughout life.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/three-ladies-listening-to-music-and-dancing-royalty-free-image/1152656857">Filippo Bacci/E+ via Getty Images</a></span>
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<p>Similarly, diet and exercise are strong influencers of biological age. <a href="https://doi.org/10.1177/1559827616637066">Blue zones</a>, which are areas around the world where people live long lives, attribute their successful aging to diet, exercise and social connectedness. Mostly plant-based meals and spurts of activity throughout the day are well-known “secrets” of healthspan and longevity. Although newer studies on the effects of diet interventions such as intermittent fasting and time-restricted feeding on longevity have not been rigorously tested, they do show multiple health benefits, including <a href="https://doi.org/10.1007/s00125-022-05752-z">better glucose</a> and <a href="https://doi.org/10.1186/s12986-021-00613-9">insulin regulation</a> </p>
<p>While genetics is difficult to control, diet and exercise can be modified to delay biological aging.</p>
<h2>How to measure biological age</h2>
<p>Currently, there is no effective test to predict an individual’s health trajectory early enough in life in order to intervene and improve quality of life with age. Scientists are interested in identifying a molecule that is sensitive and specific enough to serve as a <a href="https://doi.org/10.1038/s41576-022-00511-7">unique fingerprint for biological age</a>. </p>
<p>Considering the health and resilience of the individual instead of focusing solely on disease state is important in discussions on biological age. Resilience is the state of <a href="https://doi.org/10.1093%2Fgeroni%2Figab046.621">adapting and bouncing back</a> from a health challenge and is often more predictive of functional health. A molecular aging fingerprint may provide a tool to help identify people who are less resilient and require more aggressive monitoring and early intervention to preserve their health and help <a href="https://doi.org/10.1038%2Fs43587-021-00044-4">reduce gender, racial and ethnic health disparities</a>.</p>
<p>There are several promising molecular markers that may serve as biological age fingerprints.</p>
<p>One of these markers are epigenetic clocks. <a href="https://www.cdc.gov/genomics/disease/epigenetics.htm">Epigenetics</a> are chemical modifications of DNA that control gene function. Several scientists have found that DNA can get “marked” by methyl groups in a pattern that changes with age and could potentially act as a <a href="https://theconversation.com/epigenetic-and-social-factors-both-predict-aging-and-health-but-new-research-suggests-one-might-be-stronger-200153">readout for aging</a>.</p>
<p>It is important to note, however, that while epigenetic clocks have been valuable in predicting chronological age, they do not equate to biological age. In addition, it is unclear how these epigenetic marks work or how they contribute to aging.</p>
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<a href="https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older adult holding gold balloons of the number 70 in a backyard" src="https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Age is so much more than a number.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-man-with-number-70-helium-balloons-in-royalty-free-image/1187298370">Klaus Vedfelt/DigitalVision via Getty Images</a></span>
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<p>Another well-regarded marker of biological age is the build-up of dysfunctional cells called senescent or <a href="https://theconversation.com/cells-become-zombies-when-the-ends-of-their-chromosomes-are-damaged-a-tactic-both-helpful-and-harmful-for-health-186445">zombie cells</a>. Cells become senescent when they experience multiple types of stress and become so damaged that they cannot divide anymore, releasing molecules that cause chronic low-grade inflammation and disease.</p>
<p><a href="https://doi.org/10.1111/acel.12344">Animal studies</a> have shown that getting rid of these cells can improve healthspan. However, what clearly defines senescent cells in humans is still unknown, making them challenging to track as a measure of biological age.</p>
<p>Lastly, the body <a href="https://doi.org/10.1126/sciadv.add6155">releases unique metabolites</a>, or chemical fingerprints, as byproducts of normal metabolism. These metabolites play a dynamic and direct role in physiological regulation and can inform functional health. My lab and others are figuring out the exact makeup of these chemicals in order to figure out which can best measure biological age. A lot of work still remains on not only identifying these metabolites, but also understanding how they affect biological age.</p>
<p>People have long sought a fountain of youth. Whether such an elixir exists is still unknown. <a href="https://doi.org/10.1038/s43587-022-00278-w">But research</a> <a href="https://doi.org/10.1038/ncomms3192">is starting</a> <a href="https://doi.org/10.1073/pnas.2107621118">to show</a> that delaying biological age may be one way to live healthier, fuller lives.</p><img src="https://counter.theconversation.com/content/198849/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aditi Gurkar receives funding from National Institute on Health, Richard King Mellon Foundation, AFAR/Hevolution. </span></em></p>Aging is a major risk factor for many chronic diseases. Figuring out what influences longevity and how to identify rapid agers could lead to healthier and longer lives for more people.Aditi Gurkar, Assistant Professor of Geriatric Medicine, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1965602023-01-31T13:48:24Z2023-01-31T13:48:24ZUltraprocessed foods – like cookies, chips, frozen meals and fast food – may contribute to cognitive decline<figure><img src="https://images.theconversation.com/files/507225/original/file-20230130-14099-bxhu8i.jpg?ixlib=rb-1.1.0&rect=20%2C104%2C4608%2C3588&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Surprisingly, even packaged foods that contain healthy components can qualify as ultra-processed.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/new-jersey-jersey-city-close-up-of-tv-dinner-on-royalty-free-image/114849031?phrase=processed%20foods&adppopup=true">Jamie Grill Photography/Tetra Images via Getty Images</a></span></figcaption></figure><p>Scientists have known for years that unhealthy diets – particularly those that are high in fat and sugar – may cause <a href="https://doi.org/10.1002/hipo.20470">detrimental changes to the brain</a> and <a href="https://doi.org/10.1111/j.1471-4159.2010.06865.x">lead to cognitive impairment</a>. </p>
<p>Many factors that contribute to cognitive decline are out of a person’s control, such as <a href="https://doi.org/10.1038/s41593-022-01042-4">genetics</a> and <a href="https://doi.org/10.1080/13607863.2022.2046694">socioeconomic factors</a>. But ongoing research increasingly indicates that a <a href="https://doi.org/10.1016/j.arr.2021.101395">poor diet is a risk factor</a> for memory impairments during normal aging and increases the risk of <a href="https://doi.org/10.1016/j.arr.2021.101397">developing Alzheimer’s disease</a>. </p>
<p>But when evaluating how some diets may erode brain health as we age, research on the effects of consuming minimally processed versus ultraprocessed foods has been scant – that is, until now. </p>
<p>Two recent large-scale studies suggest that eating ultraprocessed foods <a href="https://doi.org/10.1001/jamaneurol.2022.4397">may exacerbate age-related cognitive decline</a> and increase the <a href="https://doi.org/10.1212/WNL.0000000000200871">risk of developing dementia</a>. In contrast, another recent study reported that ultraprocessed food consumption was not associated <a href="https://doi.org/10.1007/s00394-022-02911-1">with worse cognition in people over 60</a>. </p>
<p>Although more research is needed, as a <a href="https://neuroscience.ufl.edu/profile/burke-sara/">neuroscientist</a> who researches how <a href="https://scholar.google.com/citations?user=EYPe4zQAAAAJ&hl=en">diet can influence cognition</a> later in life, I find that these early studies add a new layer for considering how fundamental nutrition is to brain health. </p>
<h2>Lots of ingredients, minimal nutrition</h2>
<p>Ultraprocessed foods tend to be lower in nutrients and fiber and higher in sugar, fat and salt compared to unprocessed or minimally processed foods. Some <a href="https://doi.org/10.1093/cdn/nzy077">examples of ultraprocessed foods</a> include soda, packaged cookies, chips, frozen meals, flavored nuts, flavored yogurt, distilled alcoholic beverages and fast foods. Even packaged breads, including those high in nutritious whole grains, qualify as ultraprocessed in many cases because of the additives and preservatives they contain. </p>
<p>Another way to look at it: You are not likely to find the ingredients that make up most of these foods in your home kitchen.</p>
<p>But don’t confuse ultraprocessed with processed foods, which still retain most of their natural characteristics, although they’ve undergone some form of processing – like canned vegetables, dried pasta or frozen fruit. </p>
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<figcaption><span class="caption">A look at three categories of foods.</span></figcaption>
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<h2>Parsing the research</h2>
<p>In a December 2022 study, researchers compared the rate of cognitive decline over approximately eight years between groups of people that <a href="https://doi.org/10.1001/jamaneurol.2022.4397">consumed different amounts of ultraprocessed foods</a>. </p>
<p>At the beginning of the study, over 10,000 participants living in Brazil reported their dietary habits from the previous 12 months. Then, for the ensuing years, the researchers evaluated the cognitive performance of the participants with standard tests of memory and executive function. </p>
<p>Those who ate a diet containing more ultraprocessed foods at the start of the study showed slightly more cognitive decline compared with those that ate little to no ultraprocessed foods. This was a relatively modest difference in the rate of cognitive decline between experimental groups. It is not yet clear if the small difference in cognitive decline associated with higher consumption of ultraprocessed foods will have a meaningful effect at the level of an individual person. </p>
<p>The second study, with about 72,000 participants in the U.K., measured the association between <a href="https://doi.org/10.1212/WNL.0000000000200871">eating ultraprocessed foods and dementia</a>. For the group eating the highest amounts of ultraprocessed foods, approximately 1 out of 120 people were diagnosed with dementia over a 10-year period. For the group that consumed little to no ultraprocessed foods, this number was 1 out of 170. </p>
<p>Research examining the relationship between health and ultraprocessed foods uses the <a href="https://regulatory.mxns.com/en/ultra-processed-foods-nova-classification">NOVA classification</a>, which is a categorization system based on the type and extent of industrial food processing. Some nutritionists have <a href="https://doi.org/10.1093/ajcn/nqac123">criticized the NOVA classification</a> for not having clear definitions of food processing, which could <a href="https://doi.org/10.1038/s41430-022-01099-1">lead to misclassification</a>. They also argue that the potential health risks from consuming ultraprocessed foods could be explained by low levels of fiber and nutrients and high levels of fat, sugar and salt in the diet rather than the amount of processing. </p>
<p>Many ultraprocessed foods are high in additives, preservatives or coloring agents, while also having other features of an unhealthy diet, such as being low in fiber and nutrients. Thus, it is unclear if eating food that has undergone more processing has an additional negative impact on <a href="https://doi.org/10.1093/ajcn/nqac122">health beyond low diet quality</a>.</p>
<p>For example, you could eat a burger and fries from a fast food chain, which would be high in fat, sugar and salt as well as being ultraprocessed. You could make that same meal at home, which could also be high in fat, sugar and salt but would not be ultraprocessed. More research is needed to determine whether one is worse than the other. </p>
<h2>Brain-healthy diets</h2>
<p>Even when the processes that lead to dementia are not occurring, the aging brain undergoes biochemical and structural changes that are <a href="https://doi.org/10.1038/nrn1809">associated with worsening cognition</a>.</p>
<p>But for adults over the age of 55, a healthier diet could increase the likelihood of maintaining better brain function. In particular, <a href="https://doi.org/10.3390/nu13062067">the Mediterranean diet</a> and <a href="https://doi.org/10.1016/j.cmet.2017.08.004">ketogenic diet</a> are associated with better cognition in advanced age. </p>
<p>The Mediterranean diet emphasizes the consumption of plant-based foods and healthy fats, like olive oil, seeds and nuts. The ketogenic diet is high in fat and low in carbohydrates, with the primary fiber source being from vegetables. Both diets minimize or eliminate the consumption of sugar. </p>
<p>Our research and the work of others show that both diets can <a href="https://doi.org/10.1093/gerona/glx193">reverse some of these changes</a> and <a href="https://doi.org/10.3109/13697137.2015.1078106">improve cognitive function</a> – possibly by <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">reducing harmful inflammation</a>. </p>
<p>Although inflammation is a normal immune response to injury or infection, chronic inflammation can be detrimental to the brain. Studies have shown that excess sugar and fat <a href="https://doi.org/10.1096/fj.201700984RR">can contribute to chronic inflammation</a>, <a href="https://doi.org/10.3390/nu14163309">and ultraprocessed foods might</a> also exacerbate harmful inflammation.</p>
<p>Another way that diet and ultraprocessed foods may influence brain health is <a href="https://doi.org/10.1016/bs.irn.2022.07.006">through the gut-brain axis</a>, which is the communication that occurs between the brain and <a href="https://theconversation.com/which-microbes-live-in-your-gut-a-microbiologist-tries-at-home-test-kits-to-see-what-they-reveal-about-the-microbiome-181392">the gut microbiome</a>, or the community of microorganisms that live in the digestive tract.</p>
<p>Not only does the gut microbiome help with digestion, but it also influences the immune system, while producing hormones and <a href="https://doi.org/10.1038/mp.2016.50">neurotransmitters that are critical for brain function</a>.</p>
<p>Studies have shown that the <a href="https://doi.org/10.3390/nu14091758">ketogenic</a> and <a href="https://doi.org/10.1136/gutjnl-2019-319654">Mediterranean diets</a> change the composition of microorganisms in the gut in ways that benefit the person. Ultraprocessed food consumption is also associated with <a href="https://doi.org/10.3390/nu13082710">alterations in the type and abundance</a> of gut microorganisms that have more harmful effects.</p>
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<figcaption><span class="caption">There’s a war going on in your gut: good bacteria versus bad bacteria.</span></figcaption>
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<h2>The uncertainties</h2>
<p>Disentangling the specific effects of individual foods on the human body is difficult, in part because maintaining strict control over people’s diets to study them over long periods of time is problematic. Moreover, <a href="https://doi.org/10.1016/j.cmet.2019.05.008">randomized controlled trials</a>, the most reliable type of study for establishing causality, <a href="https://doi.org/10.3945/ajcn.116.136085">are expensive</a> to carry out. </p>
<p>So far, most nutritional studies, including these two, have only shown correlations between ultraprocessed food consumption and health. But they cannot rule out <a href="https://doi.org/10.1136/bmj.f6698">other lifestyle factors</a> such as exercise, education, socioeconomic status, social connections, stress and many more variables that may influence cognitive function. </p>
<p>This is where lab-based studies using animals are incredibly useful. Rats show <a href="https://doi.org/10.1111/ejn.12183">cognitive decline in old age that parallels humans</a>. It’s easy to control rodent diets and activity levels in a laboratory. And rats go from middle to old age within months, which shortens study times. </p>
<p>Lab-based studies in animals will make it possible to determine if ultraprocessed foods are playing a key role in the development of cognitive impairments and dementia in people. As the world’s population ages and the number of <a href="https://www.who.int/news-room/fact-sheets/detail/dementia#">older adults with dementia increases</a>, this knowledge cannot come soon enough.</p><img src="https://counter.theconversation.com/content/196560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara N. Burke does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers are trying to understand whether ultraprocessed foods erode brain health in the aging process.Sara N. Burke, Associate Professor of Neurobiology and Cognitive Aging, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1958102023-01-31T13:16:07Z2023-01-31T13:16:07ZMicrobes in your food can help or hinder your body’s defenses against cancer – how diet influences the conflict between cell ‘cooperators’ and ‘cheaters’<figure><img src="https://images.theconversation.com/files/506674/original/file-20230126-31491-80kf4u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1731%2C1731&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can change your gut microbiome composition by eating different foods.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bacteria-and-germs-on-food-royalty-free-image/596371624">wildpixel/iStock via Getty Images</a></span></figcaption></figure><p>The microbes living in your food can affect your risk of cancer. While some help your body fight cancer, others help tumors evolve and grow. </p>
<p>Gut microbes can influence your cancer risk by changing how your cells behave. Many cancer-protective microbes support normal, cooperative behavior of cells. Meanwhile, cancer-inducing microbes undermine cellular cooperation and increase your risk of cancer in the process. </p>
<p>We are <a href="https://scholar.google.com/citations?user=8abR970AAAAJ&hl=en">evolutionary</a> <a href="https://search.asu.edu/profile/2854856">biologists</a> who study how cooperation and conflict occur inside the human body, including the ways cancer can evolve to exploit the body. Our <a href="https://doi.org/10.1007/s13668-022-00420-5">systematic review</a> examines how diet and the microbiome affect the ways the cells in your body interact with each other and either increase or decrease your risk of cancer.</p>
<h2>Cancer is a breakdown of cell cooperation</h2>
<p>Every human body is a symphony of multicellular cooperation. <a href="https://www.scientificamerican.com/article/our-bodies-replace-billions-of-cells-every-day/">Thirty trillion cells</a> cooperate and coordinate with each other to make us viable multicellular organisms. </p>
<p>For multicellular cooperation to work, cells must engage in behaviors that <a href="https://doi.org/10.1111/eva.12303">serve the collective</a>. These include controlled cell division, proper cell death, resource sharing, division of labor and protection of the extracellular environment. Multicellular cooperation is what allows the body to function effectively. If genetic mutations interfere with these proper behaviors, they can lead to the breakdown of cellular cooperation and the emergence of cancer.</p>
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<figcaption><span class="caption">The food in your diet affects the composition of your gut microbiome.</span></figcaption>
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<p>Cancer cells can be thought of as <a href="https://press.princeton.edu/books/hardcover/9780691163840/the-cheating-cell">cellular cheaters</a> because they do not follow the rules of cooperative behavior. They mutate uncontrollably, evade cell death and take up excessive resources at the expense of the other cells. As these cheater cells replicate, cancer in the body begins to grow.</p>
<p>Cancer is fundamentally a problem of having multiple cells living together in one organism. As such, it has been around <a href="http://dx.doi.org/10.1098/rstb.2014.0219">since the origins of multicellular life</a>. This means that cancer suppression mechanisms have been evolving for hundreds of millions of years to help keep would-be cancer cells in check. Cells monitor themselves for mutations and induce cell death, also known as apoptosis, when necessary. Cells also monitor their neighbors for evidence of abnormal behavior, sending signals to aberrant cells to induce apoptosis. In addition, the body’s immune system monitors tissues for cancer cells to destroy them.</p>
<p>Cells that are able to evade detection, avoid apoptosis and replicate quickly have an evolutionary advantage within the body over cells that behave normally. This process within the body, called <a href="https://doi.org/10.1371/journal.pcbi.0020108">somatic evolution</a>, is what leads cancer cells to grow and make people sick.</p>
<h2>Microbes can help or hinder cell cooperation</h2>
<p>Microbes can affect cancer risk through changing the ways that the cells of the body interact with one another. </p>
<p>Some microbes can <a href="https://doi.org/10.1007/s13668-019-0257-2">protect against cancer</a> by helping maintain a healthy environment in the gut, reducing inflammation and DNA damage, and even by directly limiting tumor growth. Cancer-protective microbes like <em>Lactobacillus pentosus</em>, <em>Lactobacillus gasseri</em> and <em>Bifidobacterium bifidum</em> are found in the environment and different foods, and can live in the gut. These microbes <a href="https://doi.org/10.1007/s13668-022-00420-5">promote cooperation among cells</a> and limit the function of cheating cells by strengthening the body’s cancer defenses. <em>Lactobacillus acidophilus</em>, for example, increases the <a href="https://doi.org/10.1017/s0007114510000516">production of a protein called IL-12</a> that stimulates immune cells to act against tumors and suppress their growth.</p>
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<figcaption><span class="caption">Gut bacteria can influence the effectiveness of certain cancer treatments.</span></figcaption>
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<p>Other microbes can promote cancer by inducing mutations in healthy cells that make it more likely for cellular cheaters to emerge and outcompete cooperative cells. <a href="https://doi.org/10.1002/path.5047">Cancer-inducing microbes</a> such as <em>Enterococcus faecalis</em>, <em>Helicobacter pylori</em> and <em>Papillomavirus</em> are associated with increased tumor burden and cancer progression. They can release toxins that damage DNA, change gene expression and <a href="https://doi.org/10.1007/s13668-019-0257-2">increase the proliferation</a> of tumor cells. <a href="https://doi.org/10.1002/ijc.23484"><em>Helicobacter pylori</em></a>, for example, can induce cancer by secreting a protein called Tipα that can penetrate cells, alter their gene expression and drive gastric cancer.</p>
<h2>Healthy diet with cancer-protective microbes</h2>
<p>Because what you eat determines the amount of cancer-inducing and cancer-preventing microbes inside your body, we believe that the microbes we consume and cultivate are an important component of <a href="https://doi.org/10.1007/s13668-022-00420-5">a healthy diet</a>.</p>
<p>Beneficial microbes are typically found in <a href="https://doi.org/10.1002/ijc.31959">fermented</a> and plant-based diets, which include foods like vegetables, fruits, yogurt and whole grains. These foods have high nutritional value and contain microbes that increase the immune system’s ability to fight cancer and lower overall inflammation. <a href="https://doi.org/10.1093%2Fcdn%2Fnzy005">High-fiber foods are prebiotic</a> in the sense that they provide resources that help beneficial microbes thrive and subsequently provide benefits for their hosts. Many cancer-fighting microbes are abundantly present in fermented and high-fiber foods. </p>
<p>In contrast, harmful microbes can be found in highly-processed and meat-based diets. The Western diet, for example, contains an abundance of red and processed meats, fried food and high-sugar foods. It has been long known that meat-based diets are linked to higher cancer prevalence, and that red meat is a <a href="https://doi.org/10.2533/chimia.2018.718">carcinogen</a>. Studies have shown that meat-based diets are associated with cancer-inducing microbes including <a href="https://doi.org/10.1007/s13668-022-00420-5"><em>Fusobacteria</em> and <em>Peptostreptococcus</em></a> in both humans and other species.</p>
<p>Microbes can enhance or interfere with how the body’s cells cooperate to prevent cancer. We believe that purposefully cultivating a microbiome that promotes cooperation among our cells can help reduce cancer risk.</p><img src="https://counter.theconversation.com/content/195810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gissel Viridiana Marquez Alcaraz receives funding from the National Cancer Institute. </span></em></p><p class="fine-print"><em><span>Athena Aktipis receives funding from the National Cancer Institute and the John Templeton Foundation.</span></em></p>Cancer cells are ‘cheaters’ that do not cooperate with the rest of the body. Certain microbes in your diet can either protect against or promote tumor formation by influencing cell cooperation.Gissel Marquez Alcaraz, Ph.D. Student in Evolutionary Biology, Arizona State UniversityAthena Aktipis, Associate Professor of Psychology, Center for Evolution and Medicine, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1928312023-01-24T13:22:49Z2023-01-24T13:22:49ZParsing which foods are healthy and which are less so isn’t always straightforward – a new rating system aims to demystify the process<figure><img src="https://images.theconversation.com/files/504494/original/file-20230113-22-lolqv7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5615%2C3741&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The new system generally gives higher scores to fruits, vegetables and minimally processed foods.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/shopping-cart-speeding-down-supermarket-aisle-royalty-free-image/1147480854?phrase=packaged%20foods%20in%20grocery%20store&adppopup=true">RapidEye/iStock via Getty Images Plus</a></span></figcaption></figure><p>Many people aim to start the year off with healthier food choices. But how do you choose between seemingly similar foods, snacks or beverages? How does a bagel with cream cheese compare to toast topped with avocado, for instance? Or a protein-based shake compared to a smoothie packed with fruits? Or two chicken dishes, prepared in different ways?</p>
<p>As nutrition scientists who have spent our entire careers studying how different foods influence health, <a href="https://sites.tufts.edu/foodcompass/about/">our team at Tufts University</a> has created a new food rating system, <a href="https://sites.tufts.edu/foodcompass/">the Food Compass</a>, that could help consumers and others make informed choices about these kinds of questions. </p>
<h2>Food rating systems explained</h2>
<p>Many such systems <a href="https://doi.org/10.1007/s11883-020-00857-5">exist and are widely used</a> around the globe. Each one combines facts about different nutritional aspects of foods to provide an overall measure of healthfulness, which can be communicated to consumers through package labels or shelf tags. They can also be used to help guide product reformulations or socially conscious investment goals for investors.</p>
<p>Examples of common systems include <a href="https://www.iarc.who.int/wp-content/uploads/2021/09/IARC_Evidence_Summary_Brief_2.pdf">Nutri-Score</a> and <a href="http://www.healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/content/home">Health Star Rating</a> – widely used in Europe, the U.K., Australia and New Zealand – and “<a href="https://www.npr.org/sections/thesalt/2016/08/12/486898630/chile-battles-obesity-with-stop-signs-on-packaged-foods">black box” warning label systems</a>, which are increasingly used throughout Latin America.</p>
<p>All such food rating systems have strengths and limitations. Most aim to be simple, using data on just a few nutrients or ingredients. While this is practical, it can omit other important determinants of healthfulness – like the degree of food processing and fermentation and the presence of diverse food ingredients or nutrients like <a href="https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/">omega-3s</a> and <a href="https://www.webmd.com/diet/foods-high-in-flavonoids">flavonoids</a>, plant compounds that offer an array of health benefits.</p>
<p>Some systems also emphasize older nutrition science. For example, nearly all give negative points for total fat, regardless of fat type, and focus on saturated fat alone, rather than overall fat quality. Another common shortcoming is not assessing refined grains and starches, which have <a href="https://www.healthline.com/nutrition/why-refined-carbs-are-bad">similar metabolic harms as added sugars</a> and <a href="https://doi.org/10.1001/jama.2019.13771">represent about one-third of calories</a> in the U.S. food supply. And many give negative points for total calories, regardless of their source. </p>
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<figcaption><span class="caption">Millions of Americans are overweight yet undernourished.</span></figcaption>
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<h2>Enter the Food Compass</h2>
<p>To address each of these gaps, in 2021 our research team created the <a href="https://sites.tufts.edu/foodcompass/">Food Compass</a>. This system assesses 54 different attributes of foods, selected based on the strength of scientific evidence for their health effects. Food Compass maps and scores these attributes across nine distinct dimensions and then combines them into a single score, ranging from 1 (least healthy) to 100 (most healthy). It incorporates new science on multiple food ingredients and nutrients; does not penalize total fat or focus on saturated fat; and gives negative points for processing and refined carbs.</p>
<p>We have now evaluated 58,000 products using Food Compass and found that it generally <a href="https://doi.org/10.1038/s43016-021-00381-y">performs very well</a> in scoring foods. Minimally processed, bioactive-rich foods like fruits, veggies, beans, whole grains, nuts, yogurt and seafood score at the top. Other animal foods, like eggs, milk, cheese, poultry and meat, typically score in the middle. Processed foods rich in refined grains and sugars, like refined cereals, breads, crackers and energy bars, and processed meats fall at the bottom. </p>
<p>We found Food Compass to be especially useful <a href="https://doi.org/10.1038/s43016-021-00381-y">when comparing seemingly similar food items</a>, like different breads, different desserts or different mixed meals. Food Compass also appears to work better than existing rating systems for certain food groups. </p>
<p>For example, it gives lower scores to processed foods that are rich in refined grains and starch and to low-fat processed foods that are often marketed as healthy, like deli meats and hot dogs, fat-free salad dressings, pre-sweetened fruit drinks, energy drinks and coffees. It also gives higher scores to foods rich in unsaturated oils, like nuts and olive oil. Compared with older rating systems, these improvements are more aligned with the latest science on the health effects of these foods.</p>
<p>We also assessed how Food Compass <a href="https://doi.org/10.1038/s41467-022-34195-8">relates to major health outcomes</a> in people. In a national sample of 48,000 Americans, we calculated each person’s individual Food Compass score, ranging from 1 to 100, based on the different foods and beverages they reported eating.</p>
<p>We found that people whose diets scored higher according to Food Compass <a href="https://doi.org/10.1038/s41467-022-34195-8">had better overall health</a> than those with lower scores. This includes less obesity, better blood sugar control, lower blood pressure and better blood cholesterol levels. They also had a lower risk of metabolic syndrome or cancer and a lower risk of death from all causes. For every 10-point higher Food Compass score, a person had about a 7% lower risk of dying. These are important findings, showing that, on average, eating foods with higher Food Compass scores is linked to numerous improved health outcomes.</p>
<h2>Fine-tuning</h2>
<p>While we believe Food Compass represents a significant advance over existing systems, more work is needed before it can be rolled out to consumers.</p>
<p>As one step, we’re investigating how the scoring algorithm can be further improved. For example, we’re considering the most appropriate scoring for food items like certain cereals that are high in whole grains and fiber but are also processed and have added sugar. And we’re looking at the scoring of different egg, cheese, poultry and meat products, which have a wide range of scores but sometimes score a bit lower than may make intuitive sense.</p>
<p>Over the coming year we will be refining and improving the system based on our research, the latest evidence and feedback from the scientific community.</p>
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<figcaption><span class="caption">Whole grains are much better for you than refined grains.</span></figcaption>
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<p>In addition, more research is needed on how a consumer might understand and use Food Compass in practice. For example, it could be added as a <a href="https://www.ncbi.nlm.nih.gov/books/NBK209847/">front-of-pack label</a> – but would that be helpful without more education and context?</p>
<p>Also, while the scoring system ranges from 1 to 100, could it be more accessible if scores were grouped into broader categories? For instance, might a green/yellow/red traffic light system be easier to understand? </p>
<p>And we’re hoping that future Food Compass versions might contain additional criteria to filter foods for people who follow special diets, such as low-carb, paleo, vegetarian, diabetic-friendly, low-sodium and others.</p>
<h2>The big picture</h2>
<p>Food Compass should not be used to replace food-based dietary guidelines and preferences. Raspberries and asparagus score really well – but a diet of only these foods would not be very healthy. People should seek a <a href="https://www.myplate.gov/">balanced diet</a> across different food groups. </p>
<p>To help, Food Compass may be most useful to compare similar products within a food group. For example, someone who prefers eggs for breakfast can look for higher-scoring egg dishes. Those preferring cereal can look for higher-scoring cereals. And even better, Food Compass can help people add other highest-scoring foods to their plate – like veggies and healthy oils to eggs, and fruit and nuts to cereal – to increase the overall health benefits of that meal.</p>
<p>To make use by others as easy as possible, <a href="https://sites.tufts.edu/foodcompass/publications/">we’ve published</a> all the details of the scoring algorithm, and the scores of the products evaluated, so that anyone can take what we’ve done and use it. </p>
<p>Stay tuned – as we complete <a href="https://sites.tufts.edu/foodcompass/research/our-work/">additional research</a>, we believe Food Compass will become an important tool to clear up confusion in the grocery store and help people make healthier choices.</p><img src="https://counter.theconversation.com/content/192831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dariush Mozaffarian has received research funding from the National Institutes of Health, the Gates Foundation, The Rockefeller Foundation, Vail Innovative Global Research, and the Kaiser Permanente Fund at East Bay Community Foundation; personal fees from Acasti Pharma and Barilla; serves on the scientific advisory board of Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart, January Inc., Perfect Day, Tiny Organics, and (ended) Day Two, Discern Dx, and Season Health; owns stock in Calibrate and HumanCo; and receives chapter royalties from UpToDate. </span></em></p><p class="fine-print"><em><span>Jeffrey B. Blumberg has received research funding from Danone S.A. and USDA and serves on the scientific advisory boards of Advocare International, American Botanical Council, Blueshift Nutrition, Bragg Live Food Products LLC, California Prune Board, California Walnut Commission, Cranberry Institute, Good Pharma LLC, Everly Health, Guiding Stars Licensing Co, January.ai Inc, Segterra Inc, SmartyPants Vitamins, and Vital Technologies Ltd.</span></em></p><p class="fine-print"><em><span>Paul F. Jacques currently receives research funding from the US Department of Agriculture Agricultural Research Service, the National Institutes of Health, and the Institute for the Advancement of Food and Nutrition Science, and has previously received research funding from Danone Nutricia Research. Dr. Jacques is a member of the Danone North America Essential Dairy and Plant-Based Advisory Board, the Grains for Health Foundation Scientific Advisory Committee, and the Bay State Milling Nutrition and Science Advisory Council. </span></em></p><p class="fine-print"><em><span>Renata Micha has received research funding from the National Institute of Health, Gates Foundation and Danone S.A. Dr. Micha is the Chair of the Independent Expert Group for the Global Nutrition Report. </span></em></p>The Food Compass system scores foods based on variables like the amounts of refined grains and sugars, processing and healthful ingredients. People who ate better-scoring foods had better overall health.Dariush Mozaffarian, Dean of Friedman School of Nutrition Science and Policy, Tufts UniversityJeffrey B. Blumberg, Professor Emeritus in Nutrition Science and Policy, Tufts UniversityPaul F. Jacques, Professor of Nutrition Science and Policy, Tufts UniversityRenata Micha, Associate Professor in Human Nutrition, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1970122023-01-18T13:38:33Z2023-01-18T13:38:33ZKicking off the new year by cleansing your body with a detox diet? A dietitian unpacks the science behind these fads<figure><img src="https://images.theconversation.com/files/503325/original/file-20230105-12-sxz5c4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7988%2C5329&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A healthy diet – with plenty of fruits, vegetables and whole grains – is one key to a healthy body.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-making-healthy-smoothie-for-breakfast-royalty-free-image/1237890164?phrase=juicing&adppopup=true">Oscar Wong/Moment via Getty Images</a></span></figcaption></figure><p>Detox diets are often touted as a way to cleanse the body after the excess food and drinks that come with the holidays. These diets promise quick results and can particularly entice people around the new year, when there tends to be a renewed focus on health and lifestyle habits. </p>
<p>There are <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">a few different types of detox diets</a>: fasting, juice cleanses, eating only certain foods, using dietary commercial detox supplements or “cleansing” the colon with enemas or laxatives. </p>
<p>Most of these diets have a few things in common: They are short-term and aim to eliminate allegedly toxic substances from the body. Typically, these diets include a period of fasting followed by an extremely restrictive diet for a number of days. </p>
<p><a href="https://www.linkedin.com/in/taylor-grasso-rdn-ld-mpp-d-214747a2/">As a registered dietitian</a>, I have seen clients attempt detox diets and experience a slew of negative side effects, including developing a negative relationship with food. </p>
<p>Research shows that there is little evidence to <a href="https://doi.org/10.1111/jhn.12286">support the use of detox diets</a> and that they are not needed anyway. The body is well-equipped to eliminate unwanted substances on its own, without expensive and potentially harmful supplements sold by the nutrition and wellness industry. </p>
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<figcaption><span class="caption">Doing a cleanse doesn’t “clean your pipes” – and it may do harm.</span></figcaption>
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<h2>About toxins</h2>
<p>What are toxins – and how do they get into the body in the first place? </p>
<p>Internal toxins <a href="https://en.wikipedia.org/wiki/Toxin">include natural byproducts</a> created by the body during metabolism, such as lactic acid, urea and waste from the gut microbes. </p>
<p><a href="https://www.atsdr.cdc.gov/csem/exposure-history/Organ-Systems-Are-Affected.html">External toxic exposures</a> enter the body through eating, drinking, breathing or penetration of the skin. These can come in the form of air pollutants, food or water contaminated with chemicals or heavy metals, household products such as laundry detergent and even beauty products like facial cleansers, body wash and makeup.</p>
<p>The body’s built-in detoxification system includes the liver and kidneys, with assistance from the lungs, lymphatic system, digestive tract and skin. Briefly, the liver breaks down harmful substances, which are then filtered out through the kidneys. The digestive tract also expels them through bowel movements. </p>
<p>But our bodies aren’t always functioning optimally. That’s why a proper diet and improved lifestyle behaviors, such as increased exercise and sleep, may have a significant – and positive – impact on the body’s detoxification system.</p>
<p>Having a diverse microbiome and an <a href="https://www.healthline.com/nutrition/improve-gut-bacteria#TOC_TITLE_HDR_11">abundance of healthy gut bacteria</a> also helps to rid the body of harmful substances. Fermented foods such as kefir, sauerkraut and cultured dairy products can benefit gut health. These foods contain <a href="https://www.healthline.com/nutrition/11-super-healthy-probiotic-foods">probiotics</a>, which are the beneficial bacteria that live in your gut. </p>
<p>Another category, called <a href="https://www.eatingwell.com/article/2059033/best-and-worst-foods-to-eat-for-gut-health/">prebiotic foods</a>, are also beneficial for gut health. They provide nutrition and energy for the healthy probiotics in the gut and are high in fiber. Examples of prebiotic foods are whole grains and fruits and vegetables, particularly bananas, greens, onions and garlic. </p>
<h2>The potential harms of detox diets</h2>
<p>Through glossy and pervasive advertising, detox diets perpetuate <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">a quick-fix mindset about weight and body image</a> rather than promote lifestyle changes that are sustainable for a lifetime. </p>
<p>Although proponents claim that detox diets and juice cleanses lead to weight loss, improved liver function and overall better health, research shows <a href="https://doi.org/10.1111/jhn.12286">they have little to no effect</a>. What’s more, they can <a href="https://www.nutritionletter.tufts.edu/healthy-eating/weight-mgmt/detox-dilemma/">lead to side effects</a>, including headaches, fatigue, weakness, fainting and irritability. However, studies show there is some evidence that certain foods and spices, such as coriander, may <a href="https://doi.org/10.1111/jhn.12286">enhance the body’s natural detoxification pathways</a>.</p>
<p>According to the Academy of Nutrition and Dietetics, other foods that may give the body’s own detox system a boost include cruciferous vegetables like broccoli and Brussels sprouts, berries, artichokes, garlic, onions, leeks and green tea. Eating adequate amounts of lean protein may also benefit the body’s natural system by <a href="https://www.eatright.org/health/wellness/diet-trends/whats-the-deal-with-detox-diets#">maintaining adequate levels of glutathione</a>, the body’s master detoxification enzyme, or catalyst. Glutathione is an enzyme produced by the liver that is <a href="https://www.webmd.com/vitamins/ai/ingredientmono-717/glutathione">involved in numerous processes</a> within the body including building and repairing tissues, assisting in the natural detoxification process and improving immune system function.</p>
<p>A handful of clinical studies have shown increased liver detoxification with a commercial detox diet or supplements, but these studies have <a href="https://doi.org/10.1111/jhn.12286">flawed methodologies and small sample sizes and are often done on animals</a>. In addition, supplements are <a href="https://www.fda.gov/consumers/consumer-updates/it-really-fda-approved#">not regulated by the U.S. Food and Drug Administration</a> as food and drugs are. They can be put on the shelf without full evaluation of ingredients or proven efficacy, except in rare cases in which supplements are tested by a third party. </p>
<p>In fact, some commercial supplements have raised so many health and safety issues that the FDA and the Federal Trade Commission <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">have taken legal action against the companies that make them</a> to remove their products from the market. </p>
<p>Some detox diets and programs can have serious side effects, particularly those including laxatives or enemas, or those that restrict intake of solid foods. These approaches can lead to <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">dehydration, nutrient deficiencies and electrolyte imbalances</a>. </p>
<p>In addition, diets that severely restrict certain foods or food groups <a href="https://doi.org/10.1007/s11894-017-0603-8">usually don’t lead to lasting weight loss</a>.</p>
<p>Instead, these types of diets often put the body into “<a href="https://doi.org/10.1038/ijo.2010.184">starvation mode</a>.” That means that rather than burning calories, your body holds on to them to use as energy. </p>
<p>Doing that repeatedly over a long period can <a href="https://doi.org/10.1038/ijo.2010.184">lead to a chronic decrease in metabolism</a>, which means that the number of calories you burn at rest may slowly decrease over time. This can make it more difficult to lose weight and balance blood sugar. It can also leave people more susceptible to chronic metabolic conditions such as cardiovascular disease and diabetes. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Bw43Ldk6tK0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">There’s very little evidence that detox diets remove harmful substances from your body.</span></figcaption>
</figure>
<h2>A healthy lifestyle, without the detox diet</h2>
<p>Focusing on sustainable lifestyle shifts can make a huge difference – and unlike a detox diet, actually work. </p>
<p>Number one, <a href="https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/">eat a balanced diet</a>. Aim to eat mostly whole grains, lean protein choices, fruits and vegetables of many colors, low-fat dairy, nuts and seeds. This way, you’re getting a variety of nutrients, antioxidants and a good amount of fiber. </p>
<p>Number two, <a href="https://www.eatright.org/health/essential-nutrients/water/how-much-water-do-you-need">hydrate</a>. For women, the <a href="https://www.eatright.org/health/essential-nutrients/water/how-much-water-do-you-need">recommended daily water intake by the Academy of Nutrition and Dietetics</a> is 11½ cups; for males, it’s 15½ cups. However, you get about 20% of that total from food, which leaves nine cups for women and 13 cups for men as the daily recommended water intake. This is comparable to 4½ 16-ounce water bottles for women and 6½ 16-ounce water bottles for men. </p>
<p>Lastly, move your body in a way that you enjoy. The more you enjoy being active, the more likely it will become a routine. Aim for at least 150 minutes, or 2½ hours of <a href="https://www.cdc.gov/physicalactivity/basics/adults/index.htm#:%7E">moderate-intensity physical activity every week</a>. </p>
<p>Focusing on these types of long-term, sustainable healthy habits is the key to weight loss and overall health and wellness.</p><img src="https://counter.theconversation.com/content/197012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taylor Grasso consults for Simply Healthy, LLC and CU Anschutz Health and Wellness Center. </span></em></p>Detox diets and cleanses supposedly clear the body of allegedly toxic substances. But the evidence suggests otherwise.Taylor Grasso, Registered Dietitian, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1964772023-01-13T02:10:12Z2023-01-13T02:10:12ZAre you living in a food desert? These maps suggest it can make a big difference to your health<figure><img src="https://images.theconversation.com/files/502070/original/file-20221220-26-w2wx3v.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6016%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Public concerns about <a href="https://theconversation.com/yes-5-for-lettuce-is-too-much-government-should-act-to-stem-the-rising-cost-of-healthy-eating-182295">high food prices</a> highlight how <a href="https://theconversation.com/weve-had-a-taste-of-disrupted-food-supplies-here-are-5-ways-we-can-avoid-a-repeat-135822">meeting basic human needs</a> can’t be taken for granted, even in a country like Australia. </p>
<p>Food prices are but <a href="https://theconversation.com/why-capping-food-prices-wont-work-and-will-actually-make-things-worse-185492">one part of the equation</a> that determines access to food – and healthy eating more generally. Just as poverty for some can be hidden within a relatively wealthy community, lack of access to fresh affordable foods can be a problem even in our largest cities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-many-australians-are-going-hungry-we-dont-know-for-sure-and-thats-a-big-part-of-the-problem-195360">How many Australians are going hungry? We don't know for sure, and that's a big part of the problem</a>
</strong>
</em>
</p>
<hr>
<p>The term “food desert” describes this concern. It is believed to have been first coined in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123946/">United Kingdom</a>. It’s now widely used in the <a href="https://theconversation.com/schools-are-the-hubs-and-hearts-of-neighborhoods-heres-how-they-can-strengthen-the-communities-around-them-185946">United States</a> and also in Australia. </p>
<p>People living in food deserts lack easy access to food shops. This is usually due to combinations of: </p>
<ul>
<li><p>travel distances as a result of low-density suburban sprawl</p></li>
<li><p>limited transport options</p></li>
<li><p>zoning policies that prohibit the scattering of shops throughout residential areas</p></li>
<li><p>retailers’ commercial decisions that the household finances of an area won’t support a viable food outlet. </p></li>
</ul>
<p>The term “healthy food desert” describes an area where food shops are available, but only a limited number – or none at all – sell fresh and nutritious food. </p>
<p>Our recent <a href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">research</a> looks at whether food deserts might exist in a major local government area in Western Sydney. We mapped locations of outlets providing food – both healthy and unhealthy food – and of local levels of disadvantage and health problems. </p>
<p>Our initial results are disturbing. We found nearly two-thirds of suburbs have no food stores at all. In those that have them, only 16% of the stores are healthy food outlets. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map showing ratios of healthy-to-non-healthy food outlets in suburbs across a local government area" src="https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503746/original/file-20230110-17-mub602.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This map shows the ratio of healthy food outlets to non-healthy outlets for each suburb.</span>
<span class="attribution"><a class="source" href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">Source: A rapid-mapping methodology for local food environments, and associated health actions: the case of Penrith, Australia</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The maps also show strong correlations between these food deserts and areas of poor public health and socioeconomic disadvantage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-save-50-off-your-food-bill-and-still-eat-tasty-nutritious-meals-184152">How to save $50 off your food bill and still eat tasty, nutritious meals</a>
</strong>
</em>
</p>
<hr>
<h2>How did the study assess the area?</h2>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">research</a> took a rapid appraisal approach to assess whether food deserts might be present in the study area. </p>
<p>Health data from the <a href="http://atlasesaustralia.au/ahpc/">Australian Health Policy Collaboration</a> indicate concerning rates of overweight and obesity, diabetes and early deaths from cardiovascular disease in these areas. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map showing rates of early death from cardiovascular disease for each suburb across a local government area." src="https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503750/original/file-20230110-11-g8fbsv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This map shows rates of early death from cardiovascular disease for each suburb.</span>
<span class="attribution"><a class="source" href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">Source: A rapid-mapping methodology for local food environments, and associated health actions: the case of Penrith, Australia</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>As for the physical environment, the local government area is made up of large single-use residential zones, inconvenient distances to shops, and many fast-food outlets. <a href="https://www.walkscore.com/methodology.shtml">Walk Score</a> ratings of the suburbs indicate how much a car is needed for almost all errands. People who don’t have a car face real hurdles to accessing affordable, healthier food options.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Maps showing Walkscores and car ownership rates for suburbs across a local government area" src="https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503752/original/file-20230110-11-o03m5z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These maps show the Walk Score and car ownership rates for each suburb (more walkable neighbourhoods have a higher Walk Score).</span>
<span class="attribution"><a class="source" href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">Source: A rapid-mapping methodology for local food environments, and associated health actions: the case of Penrith, Australia</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We used other data sets (online business directories, store locators and Google maps) to plot the locations of food outlets and make an initial assessment of the types of food they offer. We broadly classified these as “healthy” (chain-operated and independent supermarkets, multicultural grocery stores – mostly Asian and African in this area – and fruit and vegetable shops) and “unhealthy” (independent and franchise takeaway stores and certain restaurants and cafés). </p>
<p>We mapped the health and livability indicators and food outlets in different colours.</p>
<p>The coloured maps offer quick, informative and approachable appraisals of the situation. Because community members can easily interpret them, the maps may help to prompt community action to improve the situation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-dragging-its-feet-on-healthy-eating-in-5-years-weve-made-woeful-progress-192393">Australia is dragging its feet on healthy eating. In 5 years we've made woeful progress</a>
</strong>
</em>
</p>
<hr>
<h2>What did the study find?</h2>
<p>Overall, “non-healthy” food outlets account for 84% of all food outlets in the local government area. </p>
<p>Further, all food outlets (healthy and non-healthy) are located in 14 suburbs. This means 22 suburbs have no food stores at all. The 14 suburbs with food outlets also commonly have more – at times substantially more – unhealthy than healthy stores.</p>
<figure class="align-center ">
<img alt="Parking lot in front of KFC and Hungry Jacks outlets" src="https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=247&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=247&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=247&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=311&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=311&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502071/original/file-20221220-22-2cacbf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=311&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the areas with food outlets, less healthy options typically outnumbered the ones offering healthy fresh food.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The mapping also shows a strong correlation between suburbs with large proportions of unhealthy stores and those with greater levels of disadvantage (using the Australian Bureau of Statistics index of <a href="https://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa">relative socioeconomic disadvantage</a>). The suburb ranked as the most disadvantaged, for instance, has six unhealthy food stores but no healthy food stores. Its Walk Score indicates residents depend on the car and could manage few errands by foot.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map showing the index of relative social disadvantage for each suburb across a local government area" src="https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503749/original/file-20230110-15-619cnt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In this map of relative social disadvantage by suburb, lower scores indicate greater disadvantage.</span>
<span class="attribution"><a class="source" href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">Source: A rapid-mapping methodology for local food environments, and associated health actions: the case of Penrith, Australia</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our rapid appraisal method does not provide all the answers. Care needs to be taken to not fall into the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123946/">trap of over-interpretation</a>. </p>
<p>Nor should food outlets themselves be seen as a proxy for healthy or unhealthy eating. They are but one of several factors to be considered in assessing whether people are eating healthily.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-only-they-made-better-life-choices-how-simplistic-explanations-of-poverty-and-food-insecurity-miss-the-mark-190430">‘If only they made better life choices’ – how simplistic explanations of poverty and food insecurity miss the mark</a>
</strong>
</em>
</p>
<hr>
<h2>What can be done about these issues?</h2>
<p>It’s clear large parts of this urban area do not support residents’ health and wellbeing by providing good access to healthy food choices.</p>
<p>Urban policy can be effective in eliminating food deserts. Social, <a href="https://theconversation.com/half-of-western-sydney-foodbowl-land-may-have-been-lost-to-development-in-just-10-years-190148">land use</a> and community health actions always need to be on the ball and targeted to need.</p>
<p>After all, diet-related choices are <a href="https://www.adelaide.edu.au/stretton/news/list/2022/03/16/healthy-eating-policy-and-political-philosophy">not just an outcome of personal preferences</a>. The availability of food outlets, and the range of foods they sell, can influence those choices – and, in turn, nutrition and health.</p>
<p>Our findings pinpoint where targeted investigations should be directed. Determining the exact nature of this lack of choice will help policymakers work out what can be done about it. </p>
<p>It’s an approach well worth taking throughout Australia to check where there might be similar hidden concerns.</p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/17549175.2022.2138951">study</a> lists other proven tools to assist follow-up research that our work has shown is needed. These include:</p>
<ul>
<li><p>onsite appraisals of individual food outlets</p></li>
<li><p>assessments of the freshness and affordability of items on offer</p></li>
<li><p>more detailed local accessibility data</p></li>
<li><p>direct surveys of residents’ experiences of their local food environments. </p></li>
</ul>
<p>We all deserve to live and work in places that intrinsically support, rather than detract from, healthy choices and behaviours, and therefore our health itself. </p>
<hr>
<p><em>Ruvimbo Timba, a planning officer at the NSW Department of Planning and Environment and formerly of Western Sydney University, is a co-author of this article.</em></p><img src="https://counter.theconversation.com/content/196477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruvimbo Timba, Planning Officer at NSW Department of Planning and Environment and formerly of Western Sydney University, is a co-author of this article. </span></em></p><p class="fine-print"><em><span>Nicky Morrison and Gregory Paine do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nearly two-thirds of suburbs in one major part of Sydney have no food stores at all. And in those that do, unhealthy food outlets outnumber healthy ones by more than six to one.Nicky Morrison, Professor of Planning and Director of Urban Transformations Research Centre, Western Sydney UniversityGregory Paine, Research assistant, Western Sydney University, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927142022-11-23T13:18:04Z2022-11-23T13:18:04ZVitamin B12 deficiency is a common health problem that can have serious consequences – but doctors often overlook it<figure><img src="https://images.theconversation.com/files/494905/original/file-20221111-12-d6vtg1.jpg?ixlib=rb-1.1.0&rect=61%2C12%2C7983%2C5395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fatigue can be a sign of a potential B12 deficiency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unhappy-african-american-woman-suffering-from-royalty-free-image/1387710368?adppopup=true">Maca and Naca/E+ via Getty Images</a></span></figcaption></figure><p>For several months during the summer of 2022, my dog Scout vomited at 3 a.m. nearly every day. If you have a dog, you know the sound. And each time, she gobbled up her mess before I could get to it, making diagnosis of the cause difficult.</p>
<p>The vet and I eventually settled on my hydrangeas as the source of the problem – but keeping Scout away from them didn’t work. She started to seem tired all the time – highly concerning in a typically hyper yellow Lab puppy. </p>
<p>Then one day Scout vomited up a hairball – but not just any hairball. In dogs, hair normally passes easily through the digestive system, but this hairball was wrapped around a brillo pad that was too big to move through. Once this foreign object was removed, the overnight vomiting ended. Scout still needed treatment, though, for a different and surprising reason: The object had inhibited a step in her body’s absorption of vitamin B12. B12 is an essential nutrient involved in proper functioning of blood cells, nerves and many other critical processes in the body. </p>
<p>I’m a registered dietitian, and <a href="https://s.wayne.edu/cress/">I teach nutrition and food science</a> to college students, but still I missed the B12 deficiency that was causing my puppy’s fatigue. Doctors can just as easily be blind to it in people – even though B12 deficiency is a common health problem that affects an estimated <a href="https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/">6% to 20%</a> of the U.S. population. </p>
<p>B12 is scarce in the diet, and it is found only in foods from animal sources. Fortunately, humans need only <a href="https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/">2.4 micrograms of B12 daily</a>, which is equivalent to one ten-millionth of an ounce – a very, very small amount. Without adequate B12 in the body, overall health and quality of life are negatively affected. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An overhead shot of an array of B12-containing foods, including oysters, fish, eggs, red meat and more." src="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An array of vitamin B12-rich foods – all of which come from animals.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vitamin-b12-containing-foods-royalty-free-image/511052342?phrase=B12%20foods&adppopup=true">photka/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Signs and symptoms</h2>
<p>One primary symptom of B12 deficiency is fatigue – a level of tiredness or exhaustion so deep that it affects daily life activities. </p>
<p>Other symptoms are neurological and may include tingling in the extremities, confusion, memory loss, depression and difficulty maintaining balance. Some of these <a href="https://doi.org/10.1182/blood-2016-10-569186">can be permanent</a> if the vitamin deficiency is not addressed.</p>
<p>However, since there can be so many causes for these symptoms, health care providers may overlook the possibility of a B12 deficiency and fail to screen for it. Further, having a healthy diet may seem to rule out any vitamin deficiency. Case in point: Because I knew Scout’s diet was sound, I didn’t consider a B12 deficiency as the source of her problems. </p>
<h2>How B12 is absorbed</h2>
<p>Research is clear that people who consume plant-based diets <a href="https://doi.org/10.1080/10408398.2022.2107997">must take B12 supplements</a> in amounts typically provided by standard multivitamins. However, hundreds of millions of Americans who do consume B12 may also be at risk because of conditions that could be hampering their body’s absorption of B12.</p>
<p>B12 absorption is a <a href="https://doi.org/10.1038/nrgastro.2012.76">complex multistep process</a> that begins in the mouth and ends at the far end of the small intestine. When we chew, our food gets mixed with saliva. When the food is swallowed, a substance in saliva called <a href="https://doi.org/10.3390/nu12123838">R-protein</a> – a protein that protects B12 from being destroyed by stomach acid – travels to the stomach along with the food. </p>
<p>Specific cells in the stomach lining, called parietal cells, secrete two substances that are important to B12 absorption. One is stomach acid – it splits food and B12 apart, allowing the vitamin to bind to the saliva’s R-protein. The other substance, called intrinsic factor, mixes with the stomach’s contents and travels with them into the first part of the small intestine – the duodenum. Once in the duodenum, pancreatic juices release B12 from R-protein and hand it to intrinsic factor. This pairing allows B12 to be absorbed into cells, where it can then help maintain nerve cells and form healthy red blood cells.</p>
<p>A B12 deficiency typically involves a breakdown at one or more of these points on the way to absorption.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ANd8trfNvKQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr. Darien Sutton explains symptoms of B12 deficiency in this December 2021 segment of the ABC TV show ‘Good Morning America.’</span></figcaption>
</figure>
<h2>Risk factors for B12 deficiency</h2>
<p>Without saliva, B12 will not bind to the saliva’s R-protein, and the body’s ability to absorb it is inhibited. And there are hundreds of different <a href="https://ostrowon.usc.edu/medications-that-cause-dry-mouth/">drugs that can cause dry mouth</a>, resulting in too little saliva production. They include opioids, inhalers, decongestants, <a href="https://doi.org/10.3389/fpsyt.2020.00035">antidepressants</a>, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6914a1.htm">blood pressure drugs</a> and <a href="https://doi.org/10.1176%2Fappi.ps.201800321">benzodiazepines</a>, like Xanax, used to treat anxiety. </p>
<p>The last three categories alone account for easily 100 million prescriptions in the U.S. each year. </p>
<p>Another potential contributor to B12 deficiency is low levels of stomach acid.
Hundreds of millions of Americans take <a href="https://www.drugs.com/condition/gastric-ulcer.html?page_number=2">anti-ulcer medications</a> that reduce ulcer-causing stomach acids. Researchers have firmly linked the use of these drugs to <a href="https://doi.org/10.1093/advances/nmy023">B12 deficiency</a> – although that possibility <a href="https://doi.org/10.1053/j.gastro.2017.01.031">may not outweigh the need for the medication</a>. </p>
<p>Production of stomach acid <a href="https://doi.org/10.1093/ajcn/nqab193">can also decrease with aging</a>. More than 60 million people in the U.S. are <a href="https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20America/2020Profileolderamericans.final_.pdf">over age 60</a>, and some 54 million are over the age of 65. This population faces a higher risk of B12 deficiency – which may be further increased by use of acid-reducing medications. </p>
<p>Production of gastric acid and intrinsic factor by the specialized parietal cells in the stomach is critical for B12 absorption to occur. But damage to the stomach lining can prevent production of both. </p>
<p>In humans, impaired stomach lining stems from gastric surgery, chronic inflammation or <a href="https://doi.org/10.1038/ajg.2009.231">pernicious anemia</a> – a medical condition characterized by fatigue and a long list of other symptoms.</p>
<p>Another common culprit of B12 deficiency is inadequate <a href="https://doi.org/10.1172/jci108924">pancreas function</a>. About one-third of patients with poor pancreas function <a href="https://doi.org/10.1097/00006676-199009000-00011">develop a B12 deficiency</a>. </p>
<p>And lastly, Metformin, a drug used by around <a href="https://www.statista.com/statistics/780332/metformin-hydrochloride-prescriptions-number-in-the-us/">92 million Americans</a> to treat Type 2 diabetes, has been associated with <a href="https://doi.org/10.1136%2Fbmj.2.5763.685">B12 deficiency for decades</a>.</p>
<h2>Treatment for B12 deficiency</h2>
<p>While some health care providers routinely measure B12 and other vitamin levels, a typical well-check exam includes only a complete blood count and a metabolic panel, neither of which measures B12 status. If you experience potential symptoms of a B12 deficiency and also have one of the risk factors above, you should see a doctor to be tested. A proper lab workup and discussion with a physician are necessary to discover or rule out whether inadequate B12 levels could be at play.</p>
<p>In the case of my dog Scout, her symptoms led the vet to run two blood tests: a complete blood count and a B12 test. These are also good starting points for humans. Scout’s symptoms went away after a few months of taking oral B12 supplements that also contained an active form of the B vitamin folate.</p>
<p>In humans, the type of treatment and length of recovery depend on the cause and severity of the B12 deficiency. Full recovery can take up to a year but is very possible with appropriate treatment. </p>
<p><a href="https://doi.org/10.3389/fphar.2022.972468">Treatment for B12 deficiency</a> can be oral, applied under the tongue or administered through the nose, or it may require various types of injections. A B12 supplement or balanced multivitamin may be enough to correct the deficiency, as it was for Scout, but it’s best to work with a health care provider to ensure proper diagnosis and treatment.</p><img src="https://counter.theconversation.com/content/192714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diane Cress does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The symptoms of B12 deficiency resemble a lot of other health problems, putting millions of Americans at risk of a misdiagnosis.Diane Cress, Associate Professor of Nutrition and Food Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1930692022-10-31T16:35:27Z2022-10-31T16:35:27ZCOVID-19 reshaped the way we buy, prepare and consume food<figure><img src="https://images.theconversation.com/files/492376/original/file-20221028-67375-wyxbqh.jpg?ixlib=rb-1.1.0&rect=33%2C165%2C7315%2C4737&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pandemic had both healthy and unhealthy impacts on our relationships with food.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/covid-19-reshaped-the-way-we-buy--prepare-and-consume-food" width="100%" height="400"></iframe>
<p>In early 2020, as <a href="https://www.statcan.gc.ca/en/dai/btd/cen/mar2020">province after province in Canada declared public health emergencies</a>, and pandemic restrictions came into force, routine grocery runs changed dramatically. </p>
<p>Faced with the uncertainty caused by COVID-19, many people <a href="https://www150.statcan.gc.ca/n1/pub/62f0014m/62f0014m2020005-eng.htm">across Canada</a> and <a href="https://doi.org/10.3390/nu13010020">around the world</a> began to stockpile food and other products. </p>
<p>This was the beginning of a series of impacts that the pandemic had on our experiences with food.</p>
<p>To better understand food-related decisions during the pandemic, our research team conducted an online survey among a sample of adults from the province of Québec. This survey spanned three different time points between the initial lockdown in the spring of 2020 and the <a href="https://ici.radio-canada.ca/nouvelle/1850929/couvre-feu-quebec-etude-science-annonce-gouvernement-ministere">curfew period in Québec</a> in the winter of 2021.</p>
<h2>Food purchases: How and why?</h2>
<p>Our study showed that <a href="https://doi.org/10.3389/fpubh.2021.752204">people reduced their frequency of shopping for food in store</a> at the beginning of the pandemic.
This reduction occurred in tandem with <a href="https://heia.com.au/wp-content/uploads/2021/09/HEIA_V26No2_Food-purchasing-patterns-in-Quebec.pdf">a rise in curbside pick-up and delivery</a>. The general rise in popularity of no-contact grocery methods <a href="https://doi.org/10.1002/agr.21679">was not unique to Canada</a>, and was likely due to people seeking to limit their exposure to the virus.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person wearing a red T shirt puts groceries into the back of a black car." src="https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492378/original/file-20221028-60938-5kpxxs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Curbside grocery pick-up and home food delivery increased during pandemic lockdowns as fewer people shopped in store.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our survey suggests that in-store shopping frequency had returned to its pre-pandemic level by mid-2020. However, the use of no-contact grocery methods is <a href="https://doi.org/10.1111/cjag.12237">expected to persist among a considerable portion of the population</a>.</p>
<p>The pandemic not only changed the way we purchased food, but also the motivations behind those purchases. <a href="https://www.researchgate.net/publication/364811680_Food_values_food_purchasing_and_eating-related_outcomes_among_a_sample_of_Quebec_adults_during_the_COVID-19_pandemic">As shown in our upcoming research</a>, more than three-quarters of our survey respondents expressed an increased desire to support local food retailers compared to 2019. Furthermore, 68 per cent of them placed increased importance on the country of origin of food products.</p>
<p>Respondents also stated that their purchasing decisions were motivated by the <a href="https://doi.org/10.1111/ijcs.12691">safety and price</a> of food products as well as the <a href="https://doi.org/10.3390/su13063056">environmental</a> and ethical impact.</p>
<h2>More home-cooked meals</h2>
<p>Major societal changes like restaurant closures, home schooling and teleworking came with an <a href="https://doi.org/10.1016/j.seps.2021.101107">increase in frequency of cooking at home and improved food-related skills like cooking and meal planning</a>. Many Canadians <a href="https://doi.org/10.3390/ijerph18105485">have learned new recipes</a>, and the <a href="https://www.cbc.ca/news/canada/north/sourdough-popular-covid-19-1.5529649">much-reported rise in the popularity of baking</a> is corroborated by a <a href="https://trends.google.com/trends/explore?date=2020-01-01%202020-12-31&geo=CA&q=bread%20recipe%2Brecette%20de%20pain">drastic increase in online searches for bread recipes</a> in the first weeks of the pandemic (which remained higher than pre-pandemic until well into 2021).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=351&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=351&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=351&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=441&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=441&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492202/original/file-20221027-18659-xcxwfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=441&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Popularity of Google searches for the term ‘bread recipe’ (or its French equivalent ‘recette de pain’) over 2019, 2020 and 2021 in Canada. Searches peaked in April 2020, during the initial pandemic lockdown.</span>
<span class="attribution"><span class="source">Google Trends.</span></span>
</figcaption>
</figure>
<p>Improved food-related skills were <a href="https://search.informit.org/doi/abs/10.3316/informit.365014239384456">most pronounced among families</a>, which is likely due to an <a href="https://doi.org/10.1017/S1368980021001932">increase in children’s participation in cooking activities during lockdowns</a>. In addition, more than one-third of survey respondents in our upcoming study identified increased time and motivation to cook, comfort and enjoyment derived from food, and interest in food as reasons for enhanced skills in their household.</p>
<p>While better cooking skills and more frequent home cooking may be considered beneficial, they came with a downside. Some people seemed to become fatigued of preparing meals over the course of the pandemic, which was reflected in an increase in take-out or delivery orders for prepared foods in early 2021 compared with 2020.</p>
<h2>Temptation and health</h2>
<p>The effect of the pandemic on eating behaviours varied across individuals. On the one hand, food appears to have been used as a source of comfort and a way to avoid boredom during the pandemic lockdowns. More than one-quarter of our respondents reported an <a href="https://www.researchgate.net/publication/364811680_Food_values_food_purchasing_and_eating-related_outcomes_among_a_sample_of_Quebec_adults_during_the_COVID-19_pandemic">increased desire to eat during the pandemic</a> compared to before, as (in their own words) they were at home and around food all the time.</p>
<p>On the other hand, a small proportion of respondents reported that their desire to eat had decreased. The main reasons for this change were feelings of stress and anxiety as well as decreased motivation to cook.</p>
<p>Lockdowns also had mixed effects on the healthiness of food choices. <a href="https://doi.org/10.1093/advances/nmab130">A study summarizing data collected worldwide</a> found that, overall, people reported consuming more unhealthy foods like snacks and sweets during pandemic lockdowns.</p>
<p>However, some individuals also seem to have taken advantage of the pandemic lockdowns to make <a href="https://doi.org/10.1016/j.foodqual.2020.104145">healthier food choices</a>. Unhealthy changes might have been offset by increased consumption of healthier foods such as fruits and vegetables, legumes, and cereals. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A confused man looking at products on a grocery store shelf." src="https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492371/original/file-20221028-58735-cq8dx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pandemic has had mixed results on our food choices. People reported consuming more unhealthy foods like snacks and sweets during pandemic lockdowns.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The wide variability in diet-related changes may in part be explained by the varied impacts of the pandemic on individuals’ personal circumstances. <a href="https://doi.org/10.1093/ajcn/nqaa336">More changes in eating behaviours were likely observed in those whose regular work conditions were disrupted</a> by the pandemic, such as losing a job or transitioning to teleworking. </p>
<p>Moreover, given the unexpected occurrence of COVID-19, most studies had to compare participants’ food habits during lockdowns with their memories of their pre-pandemic habits. However, <a href="https://dictionary.apa.org/recall-bias">these recollections may not always correspond perfectly to reality</a>.</p>
<h2>More research needed</h2>
<p>Vulnerable groups were likely underrepresented in most studies on the food-related impacts of the pandemic. Future research is needed to understand how pandemic-induced changes in eating habits will evolve over time across age groups, socioeconomic statuses, and household structures.</p>
<p>Time will tell whether the changes in our food-related values and skills will be permanent or will dissipate as we return to our pre-pandemic lives. The pandemic might have brought some positive changes to our relationships and skills with food. Continued support for local food products could help promote healthy eating and the sustainability of our food system.</p><img src="https://counter.theconversation.com/content/193069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daiva Nielsen received funding for the study described in the article from the McGill Interdisciplinary Initiative in Infection and Immunity (MI4) program. </span></em></p><p class="fine-print"><em><span>Katherine Labonté does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From curbside pick-up to online delivery, COVID-19 has had a significant impact on how we consume food. But will those impacts be permanent?Katherine Labonté, Postdoctoral Fellow, School of Human Nutrition, McGill UniversityDaiva Nielsen, Assistant Professor of Human Nutrition, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1865722022-07-31T20:05:35Z2022-07-31T20:05:35ZHow to get your kid to eat breakfast before school – and yes, it’s OK to have dinner leftovers or a sandwich<figure><img src="https://images.theconversation.com/files/473844/original/file-20220713-22-9o3mzj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4901%2C3262&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>The cereal bowl is sitting there getting mushy and gross. You ask your child to eat for the 20th time, but still they sit there, totally unwilling. </p>
<p>Eventually, there is simply no time left (the school bell will ring in three minutes) and you have to make a hasty exit out of the house. Maybe your child has eaten one or two mouthfuls, maybe they have had nothing. You and your kid are both cranky and stressed. </p>
<p>Does this sound familiar? </p>
<p>Unfortunately, eating breakfast really is important. So as parents, you do need to offer it and do need to try and make sure it is eaten. </p>
<p>But as a dietitian and a mum, I can assure you, it can be easier than this! How can parents get their kids to eat this important meal, without making it the most irritating part of the day? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-reasons-your-teenager-might-skip-breakfast-dont-fuss-but-do-encourage-a-healthy-start-177457">3 reasons your teenager might skip breakfast – don't fuss but do encourage a healthy start</a>
</strong>
</em>
</p>
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<h2>How many kids skip breakfast?</h2>
<p>Research tells us a lot of children don’t eat breakfast. </p>
<p>The most recent <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12715">data</a> we have is about ten years old. But as of 2011–12, close to 12% of boys and 15% of girls aged between two and 17 skip breakfast. </p>
<p>This increases with age. By the time children are 14 to 17, about 25% of boys and 36% of girls miss the meal. These results are somewhat similar to reported rates of breakfast-skipping around the world.</p>
<h2>How important is the first meal of the day?</h2>
<p>You have heard it before and that’s because breakfast really is important. </p>
<p>As research shows, skipping breakfast has been <a href="https://www.nature.com/articles/s41430-018-0084-3">associated</a> with lower diet quality. </p>
<p>For example, 2018 US research on children aged two to 12 who skipped breakfast on the day of study found 36% of their daily energy intake came from snacks compared to 29% in those who ate breakfast. </p>
<p>Breakfast skippers also had lower intakes of fibre, folate, Vitamin A, iron and calcium – all critical nutrients for physical and mental growth and development in children – than kids who did eat breakfast. Their intake of processed and ultra-processed foods was also higher. </p>
<figure class="align-center ">
<img alt="A bowl of porridge with fruit." src="https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474786/original/file-20220719-26-v7odnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Skipping breakfast has been linked to increased snacking among kids.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<p>A <a href="https://theconversation.com/how-do-we-know-what-works-systematic-research-reviews-5979">review</a> of 16 studies in children and adolescents also <a href="https://pubmed.ncbi.nlm.nih.gov/20112153/">indicates</a> skipping breakfast in this age group is linked with more risk of obesity and being overweight. And this can lead to an <a href="https://academic.oup.com/jes/article/1/5/524/3754347?login=true">increased risk</a> of type 2 diabetes in children.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/25181492/">study</a> which looked at breakfast consumption in children and then followed them into adulthood found if they continued to skip breakfast they had higher risk of detrimental effects on their heart health and diseases such as <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/metabolic-syndrome">metabolic syndrome</a> and diabetes.</p>
<h2>It is also important for learning</h2>
<p>Skipping breakfast means there is not enough glucose in the body (from breaking down carbohydrates), which is what the brain prefers as its energy source. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900881/">Glucose</a> provides the energy for messaging between the brain cells and helps to make <a href="https://qbi.uq.edu.au/brain/brain-functions/what-are-neurotransmitters">neurotransmitters</a>s (chemical messages in the body). </p>
<p>Studies <a href="https://www.cambridge.org/core/journals/nutrition-research-reviews/article/systematic-review-of-the-effect-of-breakfast-on-the-cognitive-performance-of-children-and-adolescents/82FE2D456F27AB7FBB1BC58BB146D1A8">also show</a> children who eat breakfast regularly perform better academically than those who skip it. In particular, skipping breakfast impacts on their memory and the number of errors on attention tasks.</p>
<p>This effect on achievement is more pronounced for those children who don’t eat enough nutritious food overall. Interestingly school breakfast programs lead to improvements in academic ability, but it is thought this may be because children attend school more. </p>
<h2>Why don’t kids want to eat breakfast?</h2>
<p>A 2014 <a href="https://pubmed.ncbi.nlm.nih.gov/24645936/">study</a> conducted in Australia and England tried to identify why adolescents skip breakfast. This found teenagers said they did not have time, were not hungry or did not enjoy breakfast. Only a small percentage reported skipping breakfast to control weight. </p>
<p>A 2019 <a href="https://www.mdpi.com/1660-4601/16/18/3238">study</a> in the United States of kids aged six to 11 asked both parents and children why they think children skip breakfast. </p>
<figure class="align-center ">
<img alt="School pupils laughing." src="https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474795/original/file-20220719-12-h410db.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Skipping breakfast is associated with a poorer diet overall.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<p>Respondents said lack of time and feeling rushed was the main reason.</p>
<p>In this study, they were also asked to identify what may help. Children suggested having a set morning routine and also selecting breakfast foods ahead of time. </p>
<p>The children also said that parents needed to continue to encourage them to eat breakfast. Parents were in agreement with these suggestions from the children but also said using “grab-and-go” products would also help. </p>
<p>Parents also said avoiding distractions – like books and phones – was important.</p>
<h2>What can parents do?</h2>
<p><strong>1. Allow enough time</strong></p>
<p>This will come as no surprise to parents, but we need to make sure kids have enough time to eat. This means getting up early enough and having a routine in the morning that makes time for breakfast.</p>
<p><strong>2. Be prepared</strong></p>
<p>To save time and make it easier set the breakfast table the night before. Get it ready with crockery, cups and cutlery, and put out the foods that won’t spoil overnight such as their favourite wholegrain cereal, spreads for toast and wholegrain bread.</p>
<p><strong>3. Have a decent selection</strong></p>
<p>Give your kids good options and make them feel like they have a choice. Ensure you have a range of healthy and easy breakfast options that your children like. </p>
<p>This can be traditional breakfast options like wholegrain breads and breakfast cereals, fruit toast, yoghurt and cut up or frozen fruit. Porridge, particularly in winter, is great as it can cook itself in the microwave. </p>
<p>Offering smoothies with fruit, yoghurt, milk and oats may be appealing to adolescents. </p>
<p><strong>4. Think outside the (cereal) box</strong></p>
<p>There are no rules around what sort of healthy foods can be eaten at breakfast. The important thing is that they are from the <a href="https://www.eatforhealth.gov.au/guidelines">Australian Dietary Guidelines</a>. </p>
<p>Some may find healthy leftovers from dinner appealing or even a sandwich with avocado and salad fillings, or cold meats like chicken or tuna. Of course a cooked breakfast with wholegrain toast, eggs and veggies (avocado, mushrooms, tomatoes, spinach) is excellent, but this is not a quick option! </p>
<p><strong>5. Get rid of distractions</strong></p>
<p>Make sure your kids can just focus on eating. This means no TVs, devices, toys or books. </p>
<p><strong>6. Do it yourself</strong></p>
<p>Remember children are great imitators. So, if they see parents eating breakfast they are more likely to do it as well.</p>
<p><strong>7. Have a back-up</strong></p>
<p>If these ideas still don’t work and you have had one of those mornings where nothing goes right, then you could consider grab-and-go options.</p>
<p>These don’t have to be commercial products either – think of smoothies, toast, previously homemade savoury muffins or banana bread (that are perhaps stored in the freezer for these occasions) or a piece of fruit. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-eat-breakfast-like-a-king-lunch-like-a-prince-and-dinner-like-a-pauper-86840">Should we eat breakfast like a king, lunch like a prince, and dinner like a pauper?</a>
</strong>
</em>
</p>
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<p><strong>8. But be careful about muesli bars</strong></p>
<p>Muesli bars can be an option, but make sure you look for ones that are low in sugar (less than 15 grams per 100 grams), low in saturated fat (less than 1.5 grams per 100 grams) and high in fibre (more than four grams per 100 grams). Remember if the bars contain fruit and nuts in them, the level of sugar and fat will go up, but this is not problematic as it is not added sugar or fat.</p>
<p>So, set yourself and you children up for successful breakfasts, and who knows? You may even enjoy the family eating together.</p><img src="https://counter.theconversation.com/content/186572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Yes, eating breakfast really is important. So how can parents help kids to eat this important meal, without making it the most irritating part of the morning?Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1862722022-07-14T12:34:20Z2022-07-14T12:34:20ZAn expert panel has recommended against taking vitamin E or beta carotene supplements for the prevention of cancer and cardiovascular disease – here’s why<figure><img src="https://images.theconversation.com/files/473088/original/file-20220707-16-ngb99k.jpg?ixlib=rb-1.1.0&rect=151%2C0%2C7083%2C4303&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Consuming an ample supply of fresh fruits and vegetables is still a tried and true way of getting vitamins and minerals and achieving lasting health benefits.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-shot-of-an-unrecognisable-woman-standing-royalty-free-image/1357662733?adppopup=true">PeopleImages/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-supplementation-to-prevent-cvd-and-cancer-preventive-medication#fullrecommendationstart">issued a recommendation statement</a> in June 2022 on the use of over-the-counter vitamin supplements. Based on its independent panel of experts’ review of existing scientific evidence, the task force recommended against using beta carotene or vitamin E supplements for the prevention of cancer and cardiovascular disease, the two leading causes of mortality in the U.S.</em> </p>
<p><em>The task force’s new statement is an update to its 2014 recommendation, which drew the same conclusion. In the most recent analysis, the expert panel looked at an additional six randomized control trials for beta carotene and nine for vitamin E.</em> </p>
<p><em>The Conversation asked Katherine Basbaum, a clinical dietitian specializing in cardiovascular disease, to explain what this recommendation means for the general public, particularly those who are currently or considering taking dietary supplements for the prevention of cancer and cardiovascular disease. In our Q&A with Basbaum, she interprets the data behind the task force’s conclusion.</em> </p>
<h2>1. What was the basis of the task force’s recommendation?</h2>
<p>The U.S. Preventive Services Task Force evaluated and averaged the results of multiple studies looking at health outcomes associated with beta carotene and vitamin E supplements. Beta carotene is a phytonutrient – or plant chemical – with a red-orange pigment; both beta carotene and vitamin E are found in many fruits and vegetables such as carrots, sweet potatoes, kale, spinach, Swiss chard and avocados, to name a few.</p>
<p>The panel of experts concluded that with regard to the prevention of cardiovascular disease or cancer, the harms of beta carotene supplementation outweigh the benefits and that there is no net benefit of supplementation with vitamin E for those purposes. Their recommendation applies to adults who are not pregnant and excludes those who are chronically ill, are hospitalized or have a known nutritional deficiency. </p>
<p>Beta carotene and vitamin E are powerful <a href="https://www.nccih.nih.gov/health/antioxidants-in-depth">antioxidants, substances that may prevent or delay cell damage</a>. They are commonly taken as dietary supplements for their potential health and anti-aging benefits, such as to combat age-related vision loss and the inflammation associated with chronic disease. Vitamin E has also been shown to <a href="https://doi.org/10.1002%2Fiub.1976">help support the immune system</a>. </p>
<p>Our bodies do require <a href="https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/">beta carotene and various nutrients for a variety of processes</a>, such as cell growth, vision, immune function, reproduction and the normal formation and maintenance of organs. But it is important to point out that more than 95% of the U.S. population receives <a href="https://www.cdc.gov/nutritionreport/pdf/nr_ch2a.pdf">adequate levels of vitamin A, vitamin E and beta carotene</a> through the foods they consume. Therefore the average healthy adult likely does not need additional supplementation to support the processes mentioned above. </p>
<p>The task force did not focus on other potential benefits of vitamin supplementation. It noted that “there may be other benefits of some supplements that were not covered in this review owing to its focus on cardiovascular disease and cancer prevention.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A bunch of freshly-picked carrots in a container." src="https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Consumption of foods high in beta carotene and Vitamin E is considered preferable to taking supplements.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/carrots-in-bowl-royalty-free-image/522241828?adppopup=true">Roy Morsch/The Image Bank via Getty Images</a></span>
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</figure>
<h2>2. What risks did the task force point to?</h2>
<p>Based on its review of the evidence, the expert panel concluded that beta carotene supplementation likely increases <a href="https://doi.org/10.1056/nejm199404143301501">the risk of lung cancer incidence</a>, particularly in those at high risk for lung cancer, such as people who smoke or who have occupational exposure to asbestos. It also found a statistically significant <a href="https://doi.org/10.1056/nejm199605023341802">increased risk of death from cardiovascular disease</a> associated with beta carotene supplementation.</p>
<p>In one of the clinical trials reviewed by the task force for their recommendation statement, people who smoked or had workplace asbestos exposure were at <a href="https://doi.org/10.1001/jama.2022.8970">increased risk of lung cancer or death from heart disease</a> at doses of 20 and 30 milligrams per day of beta carotene. This dosage is higher than the standard recommendation for beta carotene supplementation, <a href="https://www.drugs.com/cons/beta-carotene.html#dosage">which ranges from 6 to 15 milligrams per day</a>. </p>
<h2>3. Why were these supplements historically considered beneficial?</h2>
<p>Antioxidants like beta carotene and vitamin E may help fight inflammation and oxidative stress, two of the primary contributors to the development of cancers and heart disease. Oxidative stress can trigger cell damage; when this happens, cells can become cancerous. </p>
<p>Since cancer and cardiovascular disease are the two leading causes of death in the U.S., it’s natural that so many people would choose to seek out dietary supplements to potentially add a boost of prevention. Additionally, since only <a href="https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html">1 in 10 Americans meet the federal recommendation</a> for fruit and vegetable intake – 1.5 to 2 cups of fruit and 2-3 cups of vegetables per day – people often turn to dietary supplements to make up for that deficiency.</p>
<p>There is strong evidence that a diet <a href="https://doi.org/10.1093/ije/dyw319">rich in fruits and vegetables is beneficial</a> to overall health and disease prevention. Researchers also suggest that this may be due in large part to their high antioxidant content. The antioxidant dose received by eating an abundance of foods rich in beta carotene and vitamin E are not nearly as high as the doses available in supplement form. </p>
<h2>4. Should people be concerned about taking any kind of dietary supplement?</h2>
<p>Rigorous testing is required before a drug is approved by the Food and Drug Administration. However, that is not the case with dietary supplements, which are regulated as a food, not a drug. The FDA therefore does <a href="https://www.fda.gov/consumers/consumer-updates/fda-101-dietary-supplements">not have the authority</a> to approve dietary supplements for safety and effectiveness – or to approve their labeling – before the supplements are sold to the public.</p>
<p>The global dietary supplements market size was <a href="https://www.grandviewresearch.com/industry-analysis/dietary-supplements-market">valued at US$151.9 billion in 2021</a>. According to data from the 2017-2018 National Health and Nutrition Examination Survey, an estimated 60% of U.S. adults were taking some form of dietary supplement, including vitamins, minerals, multivitamins, botanicals and herbs, probiotics, nutritional powders and more.</p>
<p>Consumers should <a href="https://theconversation.com/the-dietary-supplement-youre-taking-could-be-tainted-with-prescription-medications-and-dangerous-hidden-ingredients-according-to-a-new-study-181418">be cautious when buying and consuming dietary supplements</a>, as they may contain ingredients that could negatively interact with a prescribed medication or medical condition. It is also worth noting that products containing hidden drugs are also sometimes falsely marketed as “dietary supplements,” which can further put consumers at risk. </p>
<p>This year, the FDA began working to strengthen the regulation of dietary supplements and has <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/draft-guidance-industry-policy-regarding-certain-new-dietary-ingredients-and-dietary-supplements">drafted a proposal</a> to amend its current policies.</p><img src="https://counter.theconversation.com/content/186272/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Basbaum does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite the popular belief that vitamin E and beta carotene supplements help prevent heart disease and cancer, the latest research suggests they do not – but the supplements do have potential risks.Katherine Basbaum, Clinical Dietitian, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1822082022-05-09T21:13:23Z2022-05-09T21:13:23ZSocial prescriptions: Why some health-care practitioners are prescribing food to their patients<figure><img src="https://images.theconversation.com/files/462063/original/file-20220509-11-i115lu.jpg?ixlib=rb-1.1.0&rect=0%2C145%2C4897%2C2880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food prescriptions provide patients with vouchers that can be spent on fruits and vegetables.</span> <span class="attribution"><span class="source">(Jonathon Barraball)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Angela is a 54-year-old mother of two living with Type 2 diabetes in a small apartment in Guelph, Ont. Despite steady access to health care and a physician who encourages regular exercise and healthy eating, Angela’s complications have worsened in recent years. These complications cause mobility challenges, sometimes rendering her unable to leave the house. </p>
<p>Angela blames her poor diet. Due to her limited income, she frequently misses meals, goes some days without food and can often only afford nutrient-poor (but more affordable) foods. </p>
<p>Angela is classified as severely food insecure, which means she is <a href="https://proof.utoronto.ca/food-insecurity/">one of more than 4.4 million people in Canada</a> who are unable to acquire a diet of sufficient quality or quantity. <a href="https://www.theglobeandmail.com/opinion/childhood-hunger-is-a-canadian-public-health-crisis/article4106595/">Food insecurity is a public health crisis in Canada</a> that has <a href="https://www.doi.org/10.25318/82-003-x202200200002-eng">worsened during the COVID-19 pandemic</a>.</p>
<p>During one of Angela’s recent visits to the <a href="https://guelphchc.ca/our-mission/">Guelph Community Health Centre</a>, a nurse practitioner surprised her with a new <a href="https://theseedguelph.ca/fresh-food-prescription-spotlight/">“prescription” for fresh fruits and vegetables</a>. The prescription <a href="https://doi.org/10.1186/s13690-021-00657-6">included weekly $40 vouchers that could be spent on fruits and vegetables at a local farmer’s market</a>. Speaking after 12 weeks of enrolment, Angela expressed gratitude for the initiative. </p>
<p>“The program’s fantastic,” Angela said, “I’m eating a diet with a lot more fruits and vegetables and proteins, which is so good for me when I’m trying to get my diabetes under control.”</p>
<h2>Social prescribing</h2>
<figure class="align-center ">
<img alt="A woman writing on a clipboard at a table with a stethoscope and a big selection of fruits and vegetables on it" src="https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&rect=590%2C5%2C3023%2C2026&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461381/original/file-20220504-27-lqnln2.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social prescriptions are issued by health-care practitioners to provide patients with non-pharmaceutical interventions.</span>
<span class="attribution"><span class="source">(Jonathon Barraball)</span></span>
</figcaption>
</figure>
<p>Food prescriptions are part of a broader concept of <a href="https://www.england.nhs.uk/personalisedcare/social-prescribing/">social prescribing</a>. Pioneered in the United Kingdom and growing in popularity in the United States and Canada, social prescriptions are issued by health-care practitioners to provide patients with non-pharmaceutical interventions, including dance classes, walking groups, volunteer work, art lessons and, of course, fresh fruits and vegetables. </p>
<p>The <a href="https://doi.org/10.1177%2F08901171211056584">rise of food prescriptions has been particularly pronounced in the U.S.</a>, largely driven by <a href="https://www.wholesomewave.org/">not-for-profits</a> and the 2018 <a href="https://sgp.fas.org/crs/misc/R45525.pdf">Federal Farm Bill</a>, which provided US$25 million to support produce prescription programs across the country.</p>
<p>In Canada, food prescriptions have been slower to gain traction, with independent <a href="http://guelphchc.ca/wp-content/uploads/2019/08/Social-Prescribing.pdf">community health centres</a>, <a href="https://foodshare.net/program/foodrx/">regional not-for-profits</a> and <a href="https://doi.org/10.1136/bmjopen-2021-050006">researchers</a> implementing produce prescriptions in partnership with allied health professionals in a more localized and unco-ordinated manner. </p>
<p>Our interdisciplinary health research team has collaborated with the Guelph Community Health Centre since 2019 to implement and evaluate multiple phases of a food prescription program. Food security is important to disease prevention and management, so it makes sense that health-care practitioners should be able to prescribe healthy foods and reduce barriers to healthier diets.</p>
<p>As exemplified by Angela’s experiences, preliminary results are promising. <a href="https://doi.org/10.1186/s13690-021-00657-6">Participants report improved food security and increased consumption of fruits and vegetables</a>. Meanwhile, during interviews, patients perceived the program to reduce financial stress and improve health outcomes.</p>
<figure class="align-center ">
<img alt="Vegetables displayed for sale" src="https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461825/original/file-20220506-18-htzlcr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Food is medicine approaches strive to better incorporate food and nutrition interventions in health care settings.</span>
<span class="attribution"><span class="source">(Unsplash/Sean Nufer)</span></span>
</figcaption>
</figure>
<p>And yet, food prescriptions should not be immune to scrutiny. One question is whether such initiatives <a href="https://theconversation.com/prescribing-social-activities-to-lonely-people-prompts-ethical-questions-for-gps-105439">respect and honour people “as people.”</a> </p>
<p>Do food prescriptions trivialize the suffering of food insecurity and ignore its underlying determinants, which are often <a href="https://doi.org/10.1186/s12889-018-6344-2">rooted in poverty, mental health, substance use, race and racism and systemic oppression</a>? </p>
<p>Do they leverage the power differential between practitioners and patients to coerce patients into making different food choices, thereby eroding patients’ sense of control over their own health decisions? </p>
<p>Do they promote the false dichotomy of “good” and “bad” foods and reinforce <a href="https://doi.org/10.1080/23293691.2019.1653577">the stigmatization of fat bodies in the health-care system</a>? </p>
<h2>Why not cash?</h2>
<p>If the health-care system can provide vouchers for food, why not just prescribe cash? <a href="https://doi.org/10.17269/s41997-022-00610-2">Cash transfers can empower recipients by providing choice and shifting the balance of power in favour of recipients</a>. By contrast, providing food vouchers for restricted items might be considered paternalistic, limiting choice and assuming the best interests of recipients on their behalf. </p>
<p><a href="https://openknowledge.worldbank.org/bitstream/handle/10986/23922/The0revival0of0or0an0old0quandary00.pdf;sequence=1">The cash versus food debate has played out repeatedly in social and economic policy spheres</a>, especially in academia and the conference rooms of the World Bank and the <a href="https://www.fao.org/3/i5424e/i5424e.pdf">Food and Agriculture Organization</a> of the United Nations. The growing popularity of food prescriptions should trigger a revival of this debate, but re-centred on the focal question: How can health-care systems best address food insecurity? </p>
<h2>The medicalization of food</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two combines in a field of wheat, one of them surrounded by a dusty cloud" src="https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=327&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=327&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=327&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=411&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=411&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461822/original/file-20220506-10983-37b10a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=411&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A drought devastated the wheat crop in eastern Washington in August 2021. The food supply is dependent on the health of the planet and our society.</span>
<span class="attribution"><span class="source">(AP Photo/Ted S. Warren)</span></span>
</figcaption>
</figure>
<p><a href="https://www.livescience.com/62515-hippocrates.html">Hippocrates supposedly said</a>, “Let food be thy medicine and let thy medicine be food.” Now, almost 2,400 years later, the “<a href="https://doi.org/10.1136/bmj.m2482">food is medicine framework</a>” promotes the idea that health-care systems should offer food interventions alongside pharmaceuticals. This <a href="https://doi.org/10.1001/jamainternmed.2019.0184">framework has gained popularity</a> as an easily digestible model that plays into basic truisms about the links between food and health. </p>
<p>However, the medicalization of food should be cautioned. Food is more than its nutrient value. It is cultural identity. It is history. It is belonging. Food is <a href="https://doi.org/10.1111/mcn.12499">connection to the land</a> and <a href="https://blogs.scientificamerican.com/observations/vanishing-nutrients/">dependent on the health of our planet</a> and our <a href="https://reliefweb.int/report/world/impact-ukraine-russia-conflict-global-food-security-and-related-matters-under-mandate">society</a>. To argue that food is a commodity to be sterilized and medicalized would undermine the true significance of food. </p>
<h2>Improving access to healthy foods</h2>
<p>Despite these questions and critiques, we are not arguing against food prescriptions. Indeed, our team facilitates food prescription programs that have been immensely beneficial for patients. Within these programs, our motivations are simple: to improve access to healthy foods for those who need it. This includes individuals like Angela who face difficult choices every day about whether they can afford a healthier diet. </p>
<p>We must, however, interrogate food prescriptions to determine if they are in fact the best way to leverage health systems to promote the nutritional health of low-income and other marginalized communities. And if we do provide food prescriptions, we need to recognize and be responsive to the fact that each patient — like Angela — has a different and complex relationship with food based on their own health, histories, culture, worldview, traumas and triumphs. </p>
<p><em>This article was co-authored by Abby Richter, a registered dietitian and a Master of Applied Nutrition. She is the program lead for The Fresh Food Prescription program, an initiative of The Guelph Community Health Centre</em>.</p><img src="https://counter.theconversation.com/content/182208/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Little receives funding from Michael Smith Health Research BC, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, and the Danone Institute of North America. </span></em></p><p class="fine-print"><em><span>Eleah Stringer receives funding from Michael Smith Health Research BC.</span></em></p><p class="fine-print"><em><span>Warren Dodd receives research funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, and the New Frontiers in Research Fund.</span></em></p>Food security is crucial to disease prevention and management, so prescribing healthy foods and reducing barriers to better diets makes sense. But food prescriptions should not be immune to scrutiny.Matthew Little, Assistant Professor, School of Public Health and Social Policy, University of VictoriaEleah Stringer, Research assistant, School of Public Health and Social Policy, University of VictoriaWarren Dodd, Assistant Professor, School of Public Health Sciences, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766412022-02-27T13:08:47Z2022-02-27T13:08:47ZUncovering the genetic causes of fatty liver disease — a growing health concern<figure><img src="https://images.theconversation.com/files/447843/original/file-20220222-17-1vieffq.jpg?ixlib=rb-1.1.0&rect=11%2C4%2C977%2C546&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Studying the genetic aspects of fatty liver disease can help identify its causes and consequences and find new treatments.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Over the past 40 years, changes in our urban environment and diet have had a major impact on our lifestyles.</p>
<p>We are more sedentary and the quality of our diet and sleep is at its lowest in decades. These changes, coupled with an increase in life expectancy, are associated with an increase in the number of people with “cardiometabolic” diseases such as Type 2 diabetes, heart diseases, certain cancers and even certain neurodegenerative diseases.</p>
<p>Another cardiometabolic disease that frequently flies under the radar is non-alcoholic fatty liver disease. The liver is an important organ for food digestion, energy metabolism and nutrient management, and communicates with the intestine and the adipose tissue (the main component of our body fat). But non-alcoholic fatty liver disease is a fairly silent disease, as there are few or no symptoms associated with it.</p>
<p>Our lab uses human genetics to identify targets to treat and prevent non-alcoholic fatty liver disease and its complications. </p>
<h2>Fatty liver disease and its consequences</h2>
<p>Non-alcoholic fatty liver disease is a disease that affects, on average, <a href="https://doi.org/10.1002/hep.29367">one in four adults and nearly one in 10 children worldwide</a>. The disease progresses from reversible to irreversible stages. </p>
<p>The first stage is defined by the presence of steatosis (<a href="https://doi.org/10.1001/jama.2015.5370">excessive accumulation of lipids in the liver to at least five per cent of the total liver mass</a>). The next stage, which is also reversible, is characterized by inflammation of the liver cells (called hepatocytes). This inflammation may be accompanied by scar tissue (called fibrosis).</p>
<p>The development of the disease to irreversible stages, in more severe cases, can lead to cirrhosis and/or liver cancer. By 2025, <a href="https://doi.org/10.1016/j.cgh.2020.05.064">non-alcoholic fatty liver disease will be the leading cause of liver failure and transplantation</a>. Its complications, however, are not limited to liver disease. It is strongly associated with several other cardiometabolic diseases such as Type 2 diabetes and cardiovascular diseases (the leading cause of death of those with non-alcoholic fatty liver disease).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448420/original/file-20220224-13-18pxb7e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Evolution of non-alcoholic fatty liver disease. Created with Biorender.</span>
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</figure>
<h2>What are the risk factors?</h2>
<p>Non-alcoholic fatty liver disease develops gradually and may progress differently from one individual to another depending on genetic factors and certain risk factors, including diet.</p>
<p>Consuming added sugar, such as fructose in sweetened beverages, may contribute to its development, by <a href="https://doi.org/10.3390/nu9090981">activating a metabolic process called “de novo lipogenesis”</a>, the production of fatty acids from sugar. Ultra-processed products, common in the North American diet, <a href="https://doi.org/10.1007/s13679-021-00460-y">have a high energy density and provide a high intake of sugar, fat and salt</a>. Furthermore, alcohol consumption, even in the absence of alcoholism, could have a synergistic effect on liver metabolism and accelerate the progression of non-alcoholic fatty liver disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448421/original/file-20220224-9042-cvjwr6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Risk factors of non-alcoholic fatty liver disease. Created with Biorender.</span>
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<p>Being overweight is also risk factor for non-alcoholic fatty liver disease: <a href="https://doi.org/10.1002/hep.29367">About half of obese individuals (people with a body mass index (BMI) greater than or equal to 30) could develop the disease</a>. However, non-alcoholic fatty liver disease is frequently observed in people who have a “healthy weight.” Although BMI may have some utility in measuring the consequences of high body weight, its clinical utility is increasingly being questioned. BMI gives little or no information on the location of fat tissue: fat has much more harmful consequences when located in the abdomen than in the arms, hips or thighs.</p>
<h2>Genetic factors</h2>
<p>Our research team believes that identifying the genetic factors that contribute to chronic diseases such as non-alcoholic fatty liver disease <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178197/">will allow us to understand, prevent and treat them better</a>.</p>
<p>To this end, we have conducted the largest genetic study of this disease to date. We compared the <a href="https://doi.org/10.1016/j.xcrm.2021.100437">genome variations of 8,434 people with non-alcoholic fatty liver disease from four countries (Estonia, United States, Finland and the United Kingdom) with those of 770,180 people without the disease</a>, and identified several susceptibility genes, including an association between a gene called LPL and non-alcoholic fatty liver disease. This gene, which codes for an enzyme called lipoprotein lipase, plays an important role in the storage of blood lipids in our adipose tissue. A disruption in the activity of the LPL gene could increase the chances of lipids being deposited elsewhere in the body, such as in the liver.</p>
<p>This genetic study also allowed us to clarify the role of distribution or localization of adipose tissue and obesity in the development of non-alcoholic fatty liver disease. In a recent study, which is currently under peer-review, we investigated the <a href="https://doi.org/10.1101/2021.09.28.21264201">contribution of BMI and waist circumference to the presence of non-alcoholic fatty liver disease</a>. A larger waist circumference was strongly associated with having a greater risk of developing non-alcoholic fatty liver disease, independent of BMI. Conversely, BMI alone had no effect on risk after considering waist circumference.</p>
<p>So, is it necessary to lose weight in order to prevent fatty liver disease?</p>
<h2>Prevention or a cure?</h2>
<p>Although some the medications used to treat Type 2 diabetes could reduce inflammation in the liver of patients with non-alcoholic fatty liver disease, there is no specific treatment or recommended supplements for the disease at this time.</p>
<p>We believe that identifying the genes implicated in non-alcoholic fatty liver disease will accelerate its treatment. Until then, targeting risk factors associated with non-alcoholic fatty liver disease seems to be the most promising avenue. Interestingly, several studies have shown that improving nutrition and increasing physical activity levels can reduce liver fat accumulation, <a href="https://doi.org/10.1016/j.isci.2021.102995">although these factors were associated with relatively modest weight loss</a>.</p>
<p>Like other societal chronic diseases such as cardiovascular diseases and Type 2 diabetes, fatty liver disease can be prevented to some degree. Daily activity, cooking a good variety of foods, improving sleep and limiting screen time, the consumption of ultra-processed products and exposure to stress, can prevent or delay the development of such diseases.</p>
<p>We believe that by democratizing access to a healthy diet and transforming urban planning to promote active travel, it will be possible to slow down the progression of such diseases in the population as a whole.</p><img src="https://counter.theconversation.com/content/176641/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benoit Arsenault receives funding from CIHR and Fondation de l'Institut Universitaire de cardiologie et de pneumologie de Québec.</span></em></p><p class="fine-print"><em><span>Émilie Gobeil receives funding from Fonds de recherche du Québec - Santé.</span></em></p>Non-alcoholic fatty liver disease is surprisingly common, affecting about one in four adults. Eating processed foods and sugary drinks can increase the risk of developing the disease.Benoit Arsenault, Chercheur au Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec et Professeur agrégé au Département de médecine, Université LavalÉmilie Gobeil, Étudiante à la maîtrise en sciences cliniques et biomédicales, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751422022-01-24T03:14:46Z2022-01-24T03:14:46ZA healthier heart can protect your brain too. 5 lifestyle changes to prevent dementia<p>When we think of dementia, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995109/">fear</a> a loss of control. But the reassuring news is up to 40% of dementias can be <a href="https://pubmed.ncbi.nlm.nih.gov/32738937/">prevented or delayed</a> if we change our health habits.</p>
<p>Nearly half a million Australians are <a href="https://www.dementia.org.au/information/statistics/prevalence-data">living with dementia</a>. Without a cure, this number is expected to reach 1.1 million by 2058. </p>
<p>Dementia shares key risk factors with cardiovascular (of the heart and blood vessels) disease, including high blood pressure, high blood sugar, being overweight and smoking. Inflammation and oxidative stress (where protective antioxidants are losing their fight with damaging free radicals) follow. This damages blood vessels and reduces the flow of blood and oxygen to the brain. </p>
<p>Without enough oxygen, brain cells can’t function effectively, and eventually die. Reduced blood flow also leaves the brain vulnerable to the <a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2">plaques and tangles</a> seen in forms of dementia.</p>
<p>But by changing our habits, we can both improve heart health and reduce the risk of dementia. Here are five lifestyle changes we can make now … </p>
<h2>1. Eat 2–3 serves of oily fish each week</h2>
<p>Oily fish, like salmon, sardines and mackerel are rich in omega-3 polyunsaturated fatty acids. Omega-3’s have anti-inflammatory effects and have been shown to significantly <a href="https://pubmed.ncbi.nlm.nih.gov/24610882/">reduce blood pressure</a>. </p>
<p>Omega-3s are also needed to support the structure and function of our brain cells and are “essential nutrients”. This means we need to get them from our diet. This is especially true as we age, because reductions in omega-3 intake have been <a href="https://pubmed.ncbi.nlm.nih.gov/28466678/">linked</a> to faster rates of cognitive decline. </p>
<h2>2. Eat plant foods with every meal</h2>
<p>Plant foods – like leafy greens, extra virgin olive oil, blueberries, nuts and pulses - contain a range of vitamins and minerals, including polyphenols, flavonoids, carotenoids, vitamin C and vitamin E. These micronutrients have both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5456284/">antioxidant and anti-inflammatory effects</a> that protect and improve our blood vessel functioning.</p>
<p>Diets high in plant foods, like the Mediterranean diet, have been shown to improve blood pressure, glucose regulation and body composition, and have also been <a href="https://pubmed.ncbi.nlm.nih.gov/28212320/">linked</a> to lower rates of cognitive decline, better markers of <a href="https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002/alz.045349">brain health</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015034/">lower risk</a> of dementia.</p>
<h2>3. Eat less processed food</h2>
<p>On the other hand, saturated fats, refined carbohydrates and red and processed meats are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269634/">believed to trigger</a> inflammatory pathways and highly processed foods have been linked to <a href="https://pubmed.ncbi.nlm.nih.gov/27927627/">hypertension</a>, <a href="http://ijmpnet.com/journals/ijmp/Vol_8_No_1_June_2020/1.pdf">type 2 diabetes</a> and <a href="https://www.nature.com/articles/s41387-020-00141-0">obesity</a>. </p>
<p>Eating more of these foods means we’re also likely to miss out on the benefits of other foods. Whole grains (like whole oats, rye, buckwheat and barley) provide fibre, vitamin B, E, magnesium and phytonutrients which have anti-inflammatory and antioxidant properties. Refined grains (like white bread, rice and pasta) are highly processed, meaning many of these beneficial nutrients are removed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-people-with-dementia-dont-all-behave-the-same-100960">Why people with dementia don't all behave the same</a>
</strong>
</em>
</p>
<hr>
<h2>4. Get physical and make it fun</h2>
<p>Physical activity can <a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.116.08398">reduce inflammation and blood pressure</a>, while improving blood vessel functioning. This helps the body deliver more oxygen to the brain, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378512219301203">improving memory and other cognitive functions</a> affected by dementia. </p>
<p>Guidelines suggest adults should engage in physical activity on most days, break up long bouts of inactivity (like watching TV) and incorporate some resistance exercises.</p>
<p>The key to forming long-term exercise habits is choosing physical activities you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646077/">enjoy</a> and making small, <a href="https://pubmed.ncbi.nlm.nih.gov/26857881/">gradual increases</a> in activity. Any movement that raises the heart rate can be classified as physical activity, including gardening, walking and even household chores.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aiming-for-10-000-steps-it-turns-out-7-000-could-be-enough-to-cut-your-risk-of-early-death-167447">Aiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death</a>
</strong>
</em>
</p>
<hr>
<h2>5. Quit smoking</h2>
<p>Smokers are <a href="https://pubmed.ncbi.nlm.nih.gov/32738937/">60% more likely to develop dementia</a> than non-smokers. This is because smoking increases inflammation and oxidative stress that harm the structure and function of our blood vessels.</p>
<p><a href="https://www.cancercouncil.com.au/cancer-prevention/smoking/quitting-smoking/">Quitting smoking</a> can begin to reverse these effects. In fact, former smokers have a significantly <a href="https://pubmed.ncbi.nlm.nih.gov/30349854/">lower risk of cognitive decline and dementia</a> compared to current smokers, similar to that of people who have never smoked.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-has-offered-us-an-unexpected-opportunity-to-help-more-people-quit-smoking-146747">COVID-19 has offered us an unexpected opportunity to help more people quit smoking</a>
</strong>
</em>
</p>
<hr>
<h2>Is it too late?</h2>
<p>It’s never too early, or too late, to begin making these changes. </p>
<p>Obesity and high blood pressure in midlife are key predictors of dementia risk, while diabetes, physical inactivity and smoking are stronger predictors later in life. Regular physical activity earlier in life can reduce blood pressure and decrease your risk of diabetes. Like giving up smoking, changes at any stage of life can reduce inflammation and change your dementia risk. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="brains scans" src="https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">PET scans show the brain changes seen in Alzheimer’s disease, the most common form of dementia.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20180410001341633387?path=/aap_dev9/device/imagearc/2018/04-10/80/17/9b/aapimage-6znbjhqxi15mvg4kp3i_layout.jpg">AP Photo/Evan Vucci</a></span>
</figcaption>
</figure>
<h2>Little by little</h2>
<p>It can be overwhelming to change your whole diet, start a new exercise program and quit smoking all at once. But even small changes can lead to significant improvements in health. Start by making manageable swaps, like:</p>
<ul>
<li> use extra virgin olive oil in place of butter, margarine and other cooking oils</li>
<li> swap one serve of processed food, like chips, white bread, or commercial biscuits, for a handful of nuts</li>
<li> swap one serve of meat each week for one serve of oily fish</li>
<li> swap five minutes of sedentary time for five minutes of walking and slowly increase each day.</li>
</ul><img src="https://counter.theconversation.com/content/175142/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashleigh Elizabeth Smith receives funding from the National Health and Medical Research Council (NH&MRC) and the Hospital Research Foundation. </span></em></p><p class="fine-print"><em><span>Maddison Mellow receives funding from the Dementia Australia Research Foundation (PhD scholarship). </span></em></p><p class="fine-print"><em><span>Alexandra Wade does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Heart health is strongly linked to brain health and risk of dementia. That means improving one can protect us from the other.Alexandra Wade, Research associate, University of South AustraliaAshleigh E. Smith, Senior Lecturer - Exercise Physiology, University of South AustraliaMaddison Mellow, PhD candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1730492022-01-12T13:36:47Z2022-01-12T13:36:47ZThe COVID-19 pandemic has inspired new health habits for these 4 scholars – here’s what they put into practice and why<figure><img src="https://images.theconversation.com/files/438924/original/file-20211223-19-1hdjhyq.jpg?ixlib=rb-1.1.0&rect=581%2C442%2C4882%2C3178&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health and well-being come in many forms, including finding solitude and connection with nature. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/relaxed-woman-breathing-fresh-air-in-a-green-forest-royalty-free-image/1314559532?adppopup=true">Pheelings Media/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>For some people, the COVID-19 pandemic has brought about change – some welcome and some not so welcome – to their routines or to what they prioritize. We asked four scholars to reflect on a health habit that they have adopted during the tumultuous months and years since COVID-19 turned people’s lives upside down.</em></p>
<p></p><hr><p></p>
<h2>Walking as a source of solitude and connection</h2>
<p><strong>Libby Richards, Associate Professor of Nursing, Purdue University</strong></p>
<p>As a busy working mom of two active boys, I embrace solitude whenever I can; I even take solace in grocery shopping. But when the pandemic hit, my errands became risky activities. Instead, with schools closed and the family at home, I embraced my time with them and got creative entertaining the kids. </p>
<p>But it was harder to find time for myself. “Alone time” went out the window. If I wanted to keep my sanity, I knew I needed to find some space. That’s when I put on my walking shoes and went outside. </p>
<p>At first, the walk was simply an escape. But as my routine became more consistent, I began to recognize and experience its benefits. <a href="https://www.purdue.edu/hhs/nur/directory/faculty/richards_libby.html">As a nurse</a> and <a href="https://scholar.google.com/citations?user=Pdh4gSgAAAAJ&hl=en">physical activity researcher</a>, I already understood the importance of an active lifestyle. But before the pandemic, I focused only on the physical aspects, like keeping my muscles toned and weight stable. </p>
<p>I discovered that I had overlooked a crucial <a href="https://theconversation.com/the-runners-high-may-result-from-molecules-called-cannabinoids-the-bodys-own-version-of-thc-and-cbd-170796">benefit of physical activity</a>: <a href="https://doi.org/10.1177/2333721421999316">mental health</a>. Instead of focusing my walks on physical fitness, I started walking for <a href="https://www.webmd.com/fitness-exercise/mental-benefits-of-walking#1">stress and tension relief</a>. And it worked. My sleep improved, I had fewer headaches and I could concentrate better. </p>
<p>Although my family is easing back into a new routine, I continue to walk, even during phone meetings and when it’s <a href="https://www.wishtv.com/news/medical/why-exercising-in-the-cold-can-be-more-beneficial-than-in-warm-weather/">cold out</a>. Sometimes I walk to do errands instead of driving. I feel more connected <a href="https://doi.org/10.1177/0013916518800798">with nature</a>, and I have a greater appreciation for fresh air. I’ve been able to disconnect from daily stressors, my mood and outlook are better and my overall sense of well-being has improved. </p>
<p></p><hr><p></p>
<h2>Making weightlifting a strong habit</h2>
<p><strong>Alison Phillips, Associate Professor of Psychology, Iowa State University</strong></p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/FSZyzhi8C9o?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Consistency is key to forming habits, and you have to cultivate the habits that get you closer to your goals.</span></figcaption>
</figure>
<p>I decided to lift weights during the pandemic to <a href="https://doi.org/10.1249/JSR.0b013e31825dabb8">build strength and to reduce stress</a>. As <a href="https://psychology.iastate.edu/directory/dr-alison-phillips/">a health psychologist</a> who studies <a href="https://scholar.google.com/citations?user=TU08z8YAAAAJ&hl=en">how to build health-related habits</a>, I already knew what I needed to do: repeat the behavior in the same time or place and make sure a reward was tied to the behavior. No problem, I thought. </p>
<p>When it comes to cardio activity, I already had a solid habit, starting years before the pandemic. Every day, before dinner, I would do something that counts as cardio. During the pandemic, this has included getting on the home elliptical, jogging outside or doing a step video. I knew that one way to form a new habit is to piggyback on an existing habit, so I planned to lift weights after my cardio sessions. Four times a week, I would alternate resistance training of arms and legs.</p>
<p>But lifting weights wasn’t fun, it didn’t feel good at first, and I couldn’t tell if I was improving. I kept track of my weights workout on a calendar, and for most of 2020, that was the only reward I felt – a sense of accomplishment and a check mark on a piece of paper. I still had to persuade myself to do it, and only guilt or anticipated regret would drive me.</p>
<p>That didn’t work so well. Three days or more would pass with no weightlifting, until I would finally force myself to do it. Eventually, after months and months of semiregular lifting, I came to see it as something I valued. </p>
<p>What was my reward? I became more toned and fit, sure. And that was part of my identity and something I could be proud of during the mess of the pandemic. But what finally turned weightlifting into a habit was the good physical sensations I came to appreciate during and after a muscle-building exercise. If I didn’t lift weights after doing cardio, my body felt unused. </p>
<p>All habits, good or bad, require a <a href="https://doi.org/10.1080/17437199.2013.876238">similar process to become habitual</a>. Typically, this involves <a href="https://doi.org/10.1146/annurev-psych-122414-033417">repetition in a familiar context</a>, paired with a reward for the behavior. The “context” for the habit might be a consistent location, timing and/or a sequence of activities. </p>
<p>It took me a full year to develop what I would call a habit of lifting weights. Now, even when my context changes – like returning to the gym after getting vaccinated or traveling for work or holidays – my body expects and needs the muscle work, and I find a way to do some kind of resistance training. </p>
<p></p><hr><p></p>
<h2>Small indulgences, in moderation</h2>
<p><strong>Katherine Basbaum, Clinical Dietitian, University of Virginia</strong></p>
<p>As <a href="https://www.linkedin.com/in/katherinebasbaum/">a registered dietitian</a>, I’ve always promoted and followed the “all foods fit” mentality. This means that, as long as <a href="https://doi.org/10.1016/j.appet.2013.11.013">the majority of your meals and snacks</a> are prepared with nutritious foods, then <a href="https://doi.org/10.1016/j.jada.2011.05.013">small indulgences are fine</a>. </p>
<p>For as long as I can remember, chocolate has been one of the tiny indulgences I allowed myself. Pre-pandemic, my chocolate habit consisted of one small piece in the morning with coffee, none during the day since I was running around a hospital from 9 to 5, and then another after dinner. </p>
<p>But when the pandemic began and I began working at home a few days per week, my routines changed in a big way, including what and when I ate. I still had three mostly balanced meals on the days I worked from home. But a new habit emerged too. My chocolate consumption, once a morning and evening indulgence, sometimes tripled. That’s because the chocolate was always right there, easily accessible all day long. </p>
<p>When I realized my once-harmless habit was out of control, I stopped buying the large bags of chocolate. Instead, I <a href="https://doi.org/10.1016/j.jada.2007.05.019">downsized to a single-serving package</a> once per week. Because I wasn’t going to stores much, I was forced to stretch it out. </p>
<p>Ultimately I got back to my two-a-day routine. And even though I’m back to working in person at the hospital, I haven’t gone back to the big bags of chocolate. Those single-serving packages still suit me just fine.</p>
<p></p><hr><p></p>
<h2>Clearing the mind through meditation</h2>
<p><strong>Jessica Bane Robert, Writing and Mindfulness Instructor, Clark University</strong></p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/q0DMYs4b2Yw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A growing body of research shows that meditation can sharpen the mind.</span></figcaption>
</figure>
<p>I’ve <a href="https://clarknow.clarku.edu/2018/03/26/clark-campus-embraces-mindfulness-and-meditation/">taught a course</a> called <a href="https://catalog.clarku.edu/preview_course_nopop.php?catoid=25&coid=83651">Mindful Choices</a> at Clark University for eight years, so one might think I would have had a consistent meditation practice before now. </p>
<p>Yet not until the pandemic did I find the time and mental space to commit to daily meditation. Since March 2020, at least once daily, I have reserved 10 minutes to calm my mind by focusing on the breath or by using guided visualizations to picture beautiful supportive places or positive future outcomes. Depending on the day, I performed my “sits,” as they are called by meditation practitioners, by the pond in front of my home, upon waking or at bedtime. </p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-likethis">Sign up for The Conversation’s daily newsletter</a>.]</p>
<p>Since then, my <a href="https://www.health.harvard.edu/heart-health/meditation-and-a-relaxation-technique-to-lower-blood-pressure">blood pressure has dropped</a> – but even more importantly, I have experienced greater peace. I have less attachment to negative thoughts and emotions while being able to really dwell and linger on the positive. Further, meditation has improved my focus and “working memory.” Research suggests that <a href="https://medicalxpress.com/news/2018-09-mindfulness-meditation-minutes-day-cognitive.html">benefits can be achieved</a> with as little as 10 minutes a day spent meditating.</p>
<p>Taking time to meditate may feel selfish to some, but research shows it <a href="https://greatergood.berkeley.edu/article/item/three_ways_mindfulness_can_make_you_less_biased">can reduce prejudice and bias toward others</a> as well as lessen one’s own tendency to find the negative in situations, called negativity bias. To foster gentleness toward oneself and compassion for others, my students and I practice loving kindness – <a href="https://www.mindful.org/a-guided-loving-kindness-meditation-with-sharon-salzberg/">a type of meditation practice popularized by</a> author Sharon Salzberg. </p>
<p>Many <a href="https://www.prevention.com/health/g27241883/best-meditation-apps/">apps are available</a> to guide you while cuing you to meditate and provide community – <a href="https://www.cnn.com/2021/11/29/health/5-steps-habit-builder-wellness/index.html">two things that make a new habit stick</a>. Insight Timer – my favorite – has a free version, but you may want to try Headspace, Waking Up, Ten Percent Happier and Calm, all apps that offer free trials. If you learn a new practice better by reading, dive into Salzberg’s “<a href="https://www.sharonsalzberg.com/real-happiness-the-power-of-meditation/">Real Happiness</a>” or Jon Kabat-Zinn’s classic “<a href="https://www.goodreads.com/book/show/14096.Wherever_You_Go_There_You_Are">Wherever You Go, There You Are</a>.” </p>
<p>What I love about my new habit is that meditation can be done anytime, anywhere. All you need is your breath and, with it, you can change the quality of your thoughts and your day.</p><img src="https://counter.theconversation.com/content/173049/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L. Alison Phillips has received funding to conduct habit-related research from Les Mills. </span></em></p><p class="fine-print"><em><span>Jessica Bane Robert, Katherine Basbaum, and Libby Richards do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new year is a perfect time to adopt new health habits and routines. These four scholars reflect on the ways that they overcame the pandemic blues to get fit.Libby Richards, Associate Professor of Nursing, Purdue UniversityJessica Bane Robert, Professor of English, Clark UniversityKatherine Basbaum, Clinical Dietitian, University of VirginiaL. Alison Phillips, Associate Professor of Psychology, Iowa State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1660222021-08-18T22:53:42Z2021-08-18T22:53:42ZIndividual dietary choices can add – or take away – minutes, hours and years of life<figure><img src="https://images.theconversation.com/files/416466/original/file-20210817-27-105w4xv.jpg?ixlib=rb-1.1.0&rect=130%2C74%2C6064%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating more fruits, vegetables and nuts can make a meaningful impact on a person's health – and the planet's too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ingredients-for-the-healthy-foods-selection-the-royalty-free-image/1179272859?adppopup=true">kerdkanno/iStock via Getty Images Plus</a></span></figcaption></figure><p>Vegetarian and vegan options have become standard fare in the American diet, from upscale restaurants to fast-food chains. And many people know that the food choices they make affect <a href="https://theconversation.com/confused-about-what-to-eat-science-can-help-118745">their own health</a> as well as that <a href="https://www.theguardian.com/environment/2018/may/31/avoiding-meat-and-dairy-is-single-biggest-way-to-reduce-your-impact-on-earth">of the planet</a>. </p>
<p>But on a daily basis, it’s hard to know how much individual choices, such as buying mixed greens at the grocery store or ordering chicken wings at a sports bar, might translate to overall personal and environmental health. That’s the gap we hope to fill with our research.</p>
<p>We are part of a team of researchers with expertise in <a href="https://scholar.google.com/citations?user=vVPGeT0AAAAJ&hl=en&oi=ao">food sustainability and environmental life cycle assessment</a>, <a href="https://scholar.google.com/citations?user=JKdT2e0AAAAJ&hl=en&oi=ao">epidemiology and environmental health</a> and <a href="https://www.researchgate.net/profile/Victor-Fulgoni">nutrition</a>. We are working to gain a deeper understanding beyond the often overly simplistic animal-versus-plant diet debate and to identify environmentally sustainable foods that also promote human health. </p>
<p>Building on this multi-disciplinary expertise, we combined 15 nutritional health-based dietary risk factors with <a href="https://doi.org/10.3390/su12229466">18 environmental indicators</a> to evaluate, classify and prioritize more than 5,800 individual foods.</p>
<p>Ultimately, we wanted to know: Are drastic dietary changes required to improve our individual health and reduce environmental impacts? And <a href="https://www.youtube.com/watch?v=evL7GvmaQWo">does the entire population need to become vegan</a> to make a meaningful difference for human health and that of the planet?</p>
<h2>Putting hard numbers on food choices</h2>
<p>In our <a href="https://doi.org/10.1038/s43016-021-00343-4">2021 study</a> published in the research journal Nature Food, we provide some of the first concrete numbers for the health burden of various food choices. We analyzed the individual foods based on their composition to calculate each food item’s net benefits or impacts. </p>
<p>The <a href="http://myumi.ch/pdryj">Health Nutritional Index</a> that we developed turns this information into minutes of life lost or gained per serving size of each food item consumed. For instance, we found that eating one hot dog costs a person 36 minutes of “healthy” life. In comparison, we found that eating a serving size of 30 grams of nuts and seeds provides a gain of 25 minutes of healthy life – that is, an increase in good-quality and disease-free life expectancy. </p>
<p>Our study also showed that substituting only 10% of daily caloric intake of beef and processed meats for a diverse mix of whole grains, fruits, vegetables, nuts, legumes and select seafood could reduce, on average, the dietary carbon footprint of a U.S. consumer by one-third and add 48 healthy minutes of life per day. This is a substantial improvement for such a limited dietary change.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Relative positions of select foods on a carbon footprint versus nutritional health map" src="https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=557&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=557&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=557&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=699&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=699&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416694/original/file-20210818-13-1enqh5y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=699&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Relative positions of select foods, from apples to hot dogs, are shown on a carbon footprint versus nutritional health map. Foods scoring well, shown in green, have beneficial effects on human health and a low environmental footprint.</span>
<span class="attribution"><span class="source">Austin Thomason/Michigan Photography and University of Michigan</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>How did we crunch the numbers?</h2>
<p>We based our Health Nutritional Index on a large epidemiological study called the <a href="https://doi.org/10.1016/S0140-6736(17)32366-8">Global Burden of Disease</a>, a comprehensive global study and database that was developed with the help of <a href="http://www.healthdata.org/gbd/about">more than 7,000 researchers around the world</a>. The Global Burden of Disease determines the risks and benefits associated with multiple environmental, metabolic and behavioral factors – including 15 dietary risk factors. </p>
<p>Our team took that population-level epidemiological data and adapted it down to the level of individual foods. Taking into account more than 6,000 risk estimates specific to each age, gender, disease and risk, and the fact that there are about a half-million minutes in a year, we calculated the health burden that comes with consuming one gram’s worth of food for each of the dietary risk factors.</p>
<p>For example, we found that, on average, 0.45 minutes are lost per gram of any processed meat that a person eats in the U.S. We then multiplied this number by the corresponding <a href="https://doi.org/10.3390/nu10101441">food profiles</a> that we previously developed. Going back to the example of a hot dog, the 61 grams of processed meat in a hot dog sandwich results in 27 minutes of healthy life lost due to this amount of processed meat alone. Then, when considering the other risk factors, like the sodium and trans fatty acids inside the hot dog – counterbalanced by the benefit of its polyunsaturated fat and fibers – we arrived at the final value of 36 minutes of healthy life lost per hot dog. </p>
<p>We repeated this calculation for more than 5,800 foods and mixed dishes. We then compared scores from the health indices with 18 different environmental metrics, including carbon footprint, water use and air pollution-induced human health impacts. Finally, using this health and environmental nexus, we color-coded each food item as green, yellow or red. Like a traffic light, green foods have beneficial effects on health and a low environmental impact and should be increased in the diet, while red foods should be reduced.</p>
<h2>Where do we go from here?</h2>
<p>Our study allowed us to identify certain priority actions that people can take to both improve their health and reduce their environmental footprint. </p>
<p>When it comes to environmental sustainability, we found striking variations both within and between animal-based and plant-based foods. For the “red” foods, beef has the largest carbon footprint across its <a href="https://doi.org/10.1201/b19138">entire life cycle</a> – twice as high as pork or lamb and four times that of poultry and dairy. From a health standpoint, eliminating processed meat and reducing overall sodium consumption provides the largest gain in healthy life compared with all other food types. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cattle in feedlot or feed yard" src="https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416696/original/file-20210818-19-rjp2yz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Beef consumption had the highest negative environmental impacts, and processed meat had the most important overall adverse health effects.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/feedlot-cattle-29-royalty-free-image/1303979847?adppopup=true">Clinton Austin/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>Therefore, people might consider eating less of foods that are high in processed meat and beef, followed by pork and lamb. And notably, among plant-based foods, greenhouse-grown vegetables scored poorly on environmental impacts due to the combustion emissions from heating.</p>
<p>Foods that people might consider increasing are those that have high beneficial effects on health and low environmental impacts. We observed a lot of flexibility among these “green” choices, including whole grains, fruits, vegetables, nuts, legumes and low-environmental impact fish and seafood. These items also offer options for all income levels, tastes and cultures.</p>
<p>Our study also shows that when it comes to food sustainability, it is not sufficient to only consider the amount of greenhouse gases emitted – the so-called carbon footprint. Water-saving techniques, such as drip irrigation and the reuse of gray water – or domestic wastewater such as that from sinks and showers – can also make important steps toward lowering the water footprint of food production.</p>
<p>A limitation of our study is that the epidemiological data does not enable us to differentiate within the same food group, such as the health benefits of a watermelon versus an apple. In addition, individual foods always need to be considered within the context of one’s individual diet, considering the maximum level above which foods are not any more beneficial – one cannot live forever by just increasing fruit consumption. </p>
<p>At the same time, our Health Nutrient Index has the potential to be regularly adapted, incorporating new knowledge and data as they become available. And it can be customized worldwide, as has already <a href="https://doi.org/10.3390/nu12092745">been done in Switzerland</a>.</p>
<p>It was encouraging to see how small, targeted changes could make such a meaningful difference for both health and environmental sustainability – one meal at a time.</p><img src="https://counter.theconversation.com/content/166022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was funded by an unrestricted grant from the National Dairy Council and the University of Michigan Dow Sustainability Fellowship. Olivier Jolliet. has received funding on unrelated projects from US EPA, USDA, American Chemistry Council Long-Range Research Initiative, and Unilever, and became part, after submission of the present manuscript of the Sustainable Nutrition Scientific Board created with the unrestricted support from Nutella. The funding organizations did not have a role in the manuscript development.
</span></em></p><p class="fine-print"><em><span>This research was funded by an unrestricted grant from the National Dairy Council and the University of Michigan Dow Sustainability Fellowship.</span></em></p>A new study puts numbers to the health and environmental benefits – or impacts – of individual foods and shows how small changes can make a significant difference.Olivier Jolliet, Professor of Environmental Health Sciences, University of MichiganKaterina S. Stylianou, Research Associate in Environmental Health Sciences, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1635342021-06-29T08:19:14Z2021-06-29T08:19:14ZPost-Brexit trade deals may cause 1,500 additional diet-related deaths every year – new study<figure><img src="https://images.theconversation.com/files/408679/original/file-20210628-15038-1xuomtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Jason Benz Bennee / shutterstock</span></span></figcaption></figure><p>From chlorinated chicken to <a href="https://www.independent.co.uk/news/uk/politics/hormone-injected-beef-trade-deal-australia-b1851531.html">hormone-injected beef</a>, the UK’s food supply could soon change for the worse if a series of new trade deals come into force.</p>
<p>The UK is heavily reliant on imports and therefore especially vulnerable to changes in trade policy. Half of all food consumed in the UK is <a href="https://www.gov.uk/government/collections/agriculture-in-the-united-kingdom">imported</a>, including more than three-quarters of all fruits and vegetables. At the same time, poor diets with too few fruits and vegetables, too much red and processed meat, and too many calories are one of the most important <a href="http://www.healthdata.org/united-kingdom">causes for deaths</a> that could otherwise be prevented.</p>
<p>Any new trade and agriculture policy risks making diets even worse if no safeguards are put into place. In a new study published in the journal <a href="https://www.nature.com/articles/s43016-021-00306-9">Nature Food</a>, my colleague Florian Freund and I found that post-Brexit trade deals with the US and major Commonwealth countries could lead to unhealthier diets in the UK, with 1,500 additional diet-related deaths every year. </p>
<h2>Post-Brexit trade deals</h2>
<p>Most of the food imported to the UK currently comes from the EU. Brexit has already caused disruptions to this trade route, and more are expected when the transition period ends in July. The official response has been a focus on striking new trade deals with countries outside the EU, such as <a href="https://www.ft.com/content/3bc5e883-0a05-4f4f-b46e-ece31c8683ec">the US</a>, <a href="https://www.bbc.co.uk/news/57173498">Australia</a> and other Commonwealth countries, while at the same time issuing new domestic policies affecting food and agriculture.</p>
<p>For our study, we set out to analyse the impact these post-Brexit policies could have on the British food system, diets and health. We used a detailed model of the economy, agriculture and trade to track how these new trade and agriculture policies would influence the import, export and price of foods in the UK, and how those changes would affect domestic production and consumption.</p>
<figure class="align-center ">
<img alt="Cow looks at camera" src="https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408676/original/file-20210628-19-1xmi4kn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The UK will import more beef under the proposed trade deals.</span>
<span class="attribution"><span class="source">TimBphotos.com/shutterstock</span></span>
</figcaption>
</figure>
<p>We then used a dietary health model for the UK that tracks how changes in food intake affect the chance of dying from diseases such as heart disease, stroke, cancers, and type 2 diabetes. Eating less fruit and vegetables, for example, is known to increase disease risks, as is eating more red meat, including beef, lamb and pork, and generally eating more calories than needed.</p>
<h2>The costs of Global Britain</h2>
<p>According to our analysis, new free-trade agreements with the US and Commonwealth countries could have substantial impacts for the British food system. Compared to a post-Brexit situation without the new agreements, imports of beef could increase by almost 50%, and those of pork and wheat by around 20%. Domestic prices and production would go down as a result, while consumption would go up, leading to more diet-related diseases from red meat intake and extra calories.</p>
<p>Fortunately, such a situation could be avoided if trade and agriculture policies became more health-sensitive. One solution would be to eliminate tariffs only for imports of healthier foods such as fruits, vegetables, legumes and nuts. Free-trade agreements for vegetables could help address their chronic underconsumption in the UK, while keeping ever more red meat and junk food from the US and elsewhere at bay – with benefits for diets and health.</p>
<p>Additional benefits can be had by making domestic food production more aligned with health concerns. For example, a portion of farm subsidies could be earmarked for growing foods with beneficial health and environmental characteristics – think again fruits, vegetables, legumes and nuts. We estimated that if at least one-quarter of subsidies were used in this way, then domestic production of those foods could rise by about 20%. This would contribute to healthier diets while also making domestic agriculture healthier and more sustainable, and thereby more future-proof.</p>
<p>If done right, trade agreements can improve access to healthy foods and increase the diversity of our food supply. However, unless concerns over healthy diets are factored in, these deals risk leading to an unhealthier food supply and poorer health. A free-trade for vegetables scheme, coupled with a health and environmentally sensitive reform of agricultural subsidies, could be good starting points for safeguarding healthy diets in a post-Brexit Britain.</p><img src="https://counter.theconversation.com/content/163534/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marco Springmann receives funding from the Wellcome Trust, Our Planet Our Health partnership on Livestock, Environment and People (LEAP), award number 205212/Z/16/Z. </span></em></p>We need a free trade agreement for vegetables – and not much else.Marco Springmann, Senior Researcher, Oxford Martin Programme on the Future of Food, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565792021-04-21T06:59:01Z2021-04-21T06:59:01ZWhat to drink with dinner to get the most iron from your food (and what to avoid)<figure><img src="https://images.theconversation.com/files/396221/original/file-20210421-15-1acdwvv.jpg?ixlib=rb-1.1.0&rect=529%2C0%2C5308%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A drink with your breakfast, lunch or dinner can make your meal more enjoyable. But have you considered whether your drink of choice may affect the way your body absorbs the nutrients in your food?</p>
<p>Dietary factors that can increase the uptake of other nutrients are called enhancers, while those that can reduce the uptake of other nutrients are called inhibitors, or <a href="https://www.sciencedirect.com/science/article/abs/pii/096399699390069U">anti-nutrients</a>.</p>
<p>One of the most common nutrient deficiencies worldwide is iron, and can result in a condition called <a href="https://www.healthline.com/health/iron-deficiency-anemia">iron deficiency anaemia</a>. </p>
<p>So if you’re looking to increase your iron levels, it’s worth thinking not just about what you’re eating — but what you’re drinking too.</p>
<h2>A bit about iron</h2>
<p>Iron deficiency can develop when <a href="https://theconversation.com/ive-been-diagnosed-with-iron-deficiency-now-what-87670">we don’t get enough iron</a>, or don’t absorb iron to the extent our body needs. It’s more common <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70001-9/fulltext">in women</a>, and can cause weakness and fatigue, among other symptoms.</p>
<p>If you’re worried you may be iron deficient, you can get a blood test from your general practitioner.</p>
<p>There are <a href="https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/iron">two forms of iron</a> in our diets; haem iron and non-haem iron. Haem is an iron-containing protein that forms part of the haemoglobin, a protein in your red blood cells that transports oxygen around your body. </p>
<p>Haem iron is found in animal sources of food, like meat, and is more easily absorbed into the body. </p>
<p>Non-haem iron is found in plant foods, like grains, beans and nuts, and is less easily absorbed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-been-diagnosed-with-iron-deficiency-now-what-87670">I've been diagnosed with iron deficiency, now what?</a>
</strong>
</em>
</p>
<hr>
<h2>Some enhancers</h2>
<p>Choosing a drink that contains vitamin C — such as orange, tomato or grapefruit juice — around the time of your meal will increase the amount of the non-haem iron you can absorb. </p>
<p>In one study, 100mg of vitamin C <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">increased iron absorption four-fold</a>. This is roughly equivalent to what you’d get from one glass of orange juice.</p>
<p>Keeping this in mind is particularly important for people who don’t eat meat, as all of their dietary iron will be non-haem iron.</p>
<h2>Some inhibitors</h2>
<p>Tea is a popular drink with meals and is often enjoyed with Asian cuisine. But tea contains a bioactive compound called tannin, which is <a href="https://academic.oup.com/cdn/article/1/2/1/4558629?login=true">an inhibitor</a> of non-haem iron absorption.</p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/10408699891274273">Tannin</a> is classed as an organic compound called a polyphenol. It’s also found in many foods including cocoa, almonds, grapes, berries, pomegranates, and spices (for example, vanilla and cinnamon), which may find their way into drinks like smoothies.</p>
<p><a href="https://www.researchgate.net/profile/Vikas-Kumar-190/publication/309632876_Kombucha_Technology_Microbiology_Production_Composition_and_Therapeutic_Value/links/581ab50b08aed2439386c9f5/Kombucha-Technology-Microbiology-Production-Composition-and-Therapeutic-Value.pdf">Kombucha</a>, a popular fermented tea drink, still contains some tannins.</p>
<p>Unfortunately the news is no better for coffee drinkers — coffee contains tannins too. And the <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">chlorogenic acid</a> in coffee is also an important inhibitor of iron absorption.</p>
<figure class="align-center ">
<img alt="A woman in a striped jumper holds a mug." src="https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tea and coffee contain tannins, which inhibit iron absorption.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Tea and coffee are considered the strongest inhibitors of iron. A cup of tea reduces iron absorption <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">by about 75%-80%</a>, and a cup of coffee <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">by about 60%</a>. The stronger you make them, the greater the effect will be. </p>
<p>So it’s best to avoid tea and coffee while eating and for two hours before and after the meal. This is roughly the <a href="https://www.tandfonline.com/doi/full/10.1080/10408398.2020.1784841">length of time</a> food and drinks sit in your stomach before they’re fully absorbed. </p>
<p>This includes breakfast, a meal at which many people most commonly consume tea and coffee. For most of us breakfast normally consists of cereal and/or bread. Both of these naturally contain significant <a href="https://www.healthdirect.gov.au/foods-high-in-iron">levels of iron</a> and sometimes these products have iron added.</p>
<p>So if you’re iron deficient, it may be time to consider opting for a small glass of orange juice at breakfast, or preferably the whole orange (as you get fibre with it too), and saving the tea or coffee for a little later.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-kombucha-and-how-do-the-health-claims-stack-up-87180">What is kombucha and how do the health claims stack up?</a>
</strong>
</em>
</p>
<hr>
<h2>A little from column A, a little from column B</h2>
<p>There has always been speculation <a href="https://econtent.hogrefe.com/doi/abs/10.1024/0300-9831/a000036">dairy may inhibit iron absorption</a>, but to date the evidence seems to suggest it has no effect. </p>
<p>However plant-based milks, such as soy milk, contain phytates, a compound that stores phosphorus in plants, which inhibit <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231">iron absorption</a>.</p>
<figure class="align-center ">
<img alt="A group of people drinking beers with a meal." src="https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Beer increases iron absorption. But that doesn’t mean you should have it with every meal.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Meanwhile, <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231">alcohol increases the absorption of iron</a>, so a beer would be classed as an enhancer. </p>
<p>If you favour a glass of wine, you should select a white over a red. Red wine contains more tannins and other polyphenols, so overall <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">red wine</a> inhibits iron absorption.</p>
<p>But as we know drinking alcohol increases the risk <a href="https://www.wcrf.org/dietandcancer/exposures/alcoholic-drinks">of cancer</a> and is linked to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0031938410000259">other health concerns</a>, you shouldn’t start drinking alcohol to increase iron absorption.</p>
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Read more:
<a href="https://theconversation.com/should-i-let-my-kids-drink-juice-we-asked-five-experts-92176">Should I let my kids drink juice? We asked five experts</a>
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<h2>So what’s the take-home message?</h2>
<p>The bioactives I’ve mentioned also provide many nutritional and health benefits, and they’re all found in plant products. It would be virtually impossible to avoid tannins in your diet and still be consuming the healthy number of serves of fruit and vegetables. </p>
<p>This advice is mostly relevant if you’ve been diagnosed as iron deficient or with iron deficiency anaemia. And even if this is the case, you can still enjoy these drinks outside of meal times. </p>
<p>If your iron levels are within the normal range there’s no need to be concerned as your body is absorbing enough to meet your needs with what you’re drinking and eating.</p><img src="https://counter.theconversation.com/content/156579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris receives funding from NHMRC. </span></em></p>From orange juice, to tea and coffee, to alcohol — different drinks can have different effects on iron absorption. This is worth thinking about if your iron levels are low.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.