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Nutrition: Beyond the Scale

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Nutrition: Beyond the Scale Nutrition: Beyond the Scale. Examining our Biases! Introduction • Conditions related to nutrition • Review of guidelines • HAES- a word on eating disorders • FADS • Tools for patients/clinicians • RD top ten “We aren't the food police.” -RD Conditions related to nutrition (what isn’t?) • The obvious triad: • Acne (microbiome) v HTN v DM • Inflammatory bowel disease v Hyperlipidemia • IBS FODMAPS • obesity • Constipation • allergies/asthma • Gout • GERD • Anemia • celiac disease • Osteoporosis • lactose intolerance • Depression • eating disorders • kidney disease • kidney disease • More? BIASES -many sources lead to our belief system • Media, popular culture • Regional and ethnic factors • Socioeconomic factors (food insecurity- even in a surprising demographic at times) • Personal experience • Misinformation from “experts”. “Diets don't work.” -RD • Body type- body shaming • Cooking/food prep skills “People often like "healthy foods" if given quick easy ways to fix them.” -RD International Food Information Council Foundation’s 12th annual Food and Health Survey- 2017 • Most common source of nutrition information: #1 personal health-care professionals #2 Friends and family about what foods to eat or avoid. • Most trusted source of nutrition information: ranked (health providers rated high) and friends and family as low on the trustworthiness scale. • Myriad of sources including: health coaches, personal trainers, social media, bloggers, television, government agencies and food companies. • Biggest influence on your decision to follow a specific eating pattern or diet: #1 probably your immediate circle. Health-care providers and registered dietitian nutritionists (RDNs) lagging behind. • “RDs job is to make all the nutrition recommendations make sense, even if they all sound contradicting in the press.” -RD International Food Information Council Foundation’s 12th annual Food and Health Survey: MORE FINDINGS • Weight loss is the most desired health benefit from ages 18 to 49, but preventing cardiovascular disease becomes more important after age 50. “Weight loss isn't everything.” -RD • Opinions about added sugars and artificial sweeteners have grown more polarized over the past year, with many people choosing one to specifically avoid the other. Friends and family are a big influence on this topic. • Almost 3 in 4 respondents seek non-GMO labels because they believe these foods are more healthful, safer or better for the environment. “Tell patients they don't have to eat the last supper.” -RD 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk • LDL reduction: vemphasizes intake of vegetables, fruits, and whole grains vincludes low-fat dairy products, poultry, fish, legumes vNon-tropical vegetaBle oils, and nuts vlimits intake of sweets, sugar-sweetened beverages, and red meats. • TAKE INTO ACCCOUNT: personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes). • DASH diet: Still a good place to start! NON tropical vegetable oils • What aBout Coconut Oil?? • Coconut oil is extracted from the fruit of mature coconuts. It is a saturated fat, and consumers are cautioned against a diet high in saturated fat. Virgin coconut oil is high in lauric acid, a medium-chain fatty acid that raises both good and bad cholesterol levels. • How should you use it? Coconut oil has a sweet, nutty taste, and is often used as a substitute for shortening or butter in a vegan diet. It also imparts a tropical flavor to vegetables, curry dishes and fish. Because it is a saturated fat, use coconut oil in moderation, and buy the kind labeled "virgin.“ (from eatright.org) • Although eating coconut oil in moderation isn't going to result in great harm to your health, it's not likely to help you lose weight either. For successful, long-term weight loss, stick to the basics — an overall healthy-eating plan and exercise. (from mayoclinic.org) 2015-2020 Dietary Guidelines for Americans (health.gov) • Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. • Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts. • Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. • Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain. “Everyone is different and it is not one size fits all. Honor each person's food preferences.” -RD • Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities. Key Recommendations A healthy eating pattern includes: • A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other. EAT THE RAINBOW… • Fruits, especially whole fruits • Grains, at least half of which are whole grains • Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages • A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products • Oils BIAS in the Nutrition Guidelines? • The Dietary Guidelines is required under the 1990 National Nutrition Monitoring and Related Research Act, which states that every 5 years, the U.S. Departments of Health and Human Services (HHS) and of Agriculture (USDA) must jointly publish a report containing nutritional and dietary information and guidelines for the general public. (USDA=US Dept. of Agriculture) • The information in the Dietary Guidelines is used in developing Federal food, nutrition, and health policies and programs. It also is the basis for Federal nutrition education materials designed for the public and for the nutrition education components of HHS and USDA food programs. (school lunches, WIC, etc.) “A healthy eating pattern limits: oSaturated fats otrans fats oadded sugars oSodium” -from the 2015-2020 Dietary Guidelines for Americans -“Limits” are quantified in the guidelines. BUT, “All foods fit at some point.” - RD Key Recommendations that are quantitative: 1. Consume less than 10 percent of calories per day from added sugars. (For 2000 cal/d diet = 200 calories/day = 50 grams/day.) *** HOWEVER: The World Health Organization (WHO) recommends added sugar intake for adults be cut in half, from the original 10 percent of total daily calories to 5 percent. For a normal weight adult, that's about 25 grams, or 6 teaspoons, per day. June 18, 2015 2. Consume less than 10 percent of calories per day from saturated fats. 3. Consume less than 2,300 milligrams (mg) per day of sodium. AMERICAN HEART ASSOCIATION recommendation Same as WHO (for women and slightly more for men) Salt/sodium o FOR EVERYONE: The American Heart Association recommends < 2,300 milligrams (mgs) a day. (One teaspoon of table salt=2300mg of sodium!) o This will likely help patients reduce their blood pressure. (Most Americans eat >3400mg/day.) o Further reduction of sodium intake to an ideal limit of <1500 mg/d for most adults can result in even greater reduction in BP o Even without achieving these dietary limits (1500-2300mg/d), reducing sodium intake by at least 1000 mg/d lowers BP. Nutrition Guidelines- Pediatrics AAP-PEDIATRICS volume 117 Feb. 2006 • Balance dietary calories with physical activity to maintain normal growth. • 60 min of moderate to vigorous play or physical activity daily. • Eat vegetables and fruits daily, limit juice intake. • Use vegetable oils and soft margarines low in saturated fat and trans fatty acids instead of butter or most other animal fats in the diet. • Eat whole-grain breads and cereals rather than refined-grain products. • Reduce the intake of sugar-sweetened beverages and foods. • Use nonfat (skim) or low-fat milk and dairy products daily. • Eat more fish, especially oily fish, broiled or baked. • Reduce salt intake, including salt from processed foods. FOOD LABELING CHANGES (pending) (original compliance date 7/26/18- but on June 13, 2017, the FDA announced its intention to extend the compliance date.) On May 20, 2016, the FDA announced the new Nutrition Facts label for packaged foods to reflect new scientific information: o Manufacturers must declare the actual amount, in addition to percent Daily Value of vitamin D, calcium, iron and potassium. o They can voluntarily declare the gram amount for other vitamins and minerals. o “Added sugars,” in grams and as percent Daily Value, will be included on the label. (Scientific data shows that it is difficult to meet nutrient needs while staying within calorie limits if you consume more than 10 percent of your total daily calories from added sugar) o Vitamin D and potassium will be required on the label. o Calcium and iron will continue to be required. o Vitamins A and C will no longer Be required but can be included on a voluntary basis. o While continuing to require “Total Fat,” “Saturated Fat,” and “Trans Fat” on the label, “Calories from Fat” is Being removed Because research shows the type of fat is more important
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