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Preference: Nutrition

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Doctors invited to subscribe to new Olive Wellness Institute

A new online resource promoting the health attributes of extra virgin olive oil has been launched to coincide with the latest international findings of the benefits of a Mediterranean diet.

The world-first Olive Wellness Institute aims to build awareness of olive products through the gathering, sharing and promotion of credible, evidence-based information pertaining to their nutrition, and health and wellness benefits.

The Institute, which is sponsored by olive company Boundary Blend Limited, is asking doctors to subscribe to its free online research source.

Professor Catherine Itsiopoulos, Head of the School of Allied Health at La Trobe University, chairs the Olive Wellness Institute’s (OWI) advisory panel.

“Given the abundant misinformation on the health benefits of foods, ingredients and supplements, a collaborative organisation like the OWI will offer healthcare professionals, scientists, academics and members of the general public, invaluable access to evidence-based information about extra virgin olive oil (EVOO) and other olive products,” she said.

“I have been researching the impact of the Mediterranean diet for more than 20 years, and EVOO forms the basis of the dietary advice I provide to patients with heart disease, diabetes and other chronic diseases.”

Prof Itsiopoulos is currently conducting a trial which aims to demonstrate the positive effects of the Mediterranean diet on patients with coronary heart disease.

A new research review, published last month in the Journals of Gerontology and titled The Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms, highlights the anti-inflammatory and antioxidant properties of phytochemicals found in EVOO.

Conducted by US and Italian geriatric and nutritional research scientists, the review discusses the role played by EVOO and the Mediterranean diet in trying to reduce the risk of stroke, Type 2 diabetes, peripheral artery disease and breast cancer.

Subscription to the olive wellness community is free via the OWI website: www.olivewellnessinstitute.org.

Subscribers can access:

  • Regularly updated news and articles relating to olive nutrition, health and wellness.
  • An easily searchable and comprehensive olive science database featuring prominent recent research findings.
  • An expert library listing designed to facilitate queries and research collaboration.
  • A list of relevant olive events worldwide.

New subscribers can also download a free olive health and wellness e-book, containing comprehensive information about the history and science behind olive products.

CHRIS JOHNSON

Why the way we eat is making us sick

 

When I joined Doctors for the Environment Australia (DEA) some years ago, I couldn’t understand why they were silent on the topic of food. After all, even by conservative estimates, the production of the world’s food is responsible for the majority of land degradation, biodiversity loss and fresh water use, and for around one third of global greenhouse gas emissions. Modern epidemics of obesity, diabetes and heart disease all relate to our changing diet, and diet is the number one risk factor in the global burden of disease.

After volunteering to write a DEA Position Statement on diet and agriculture, the problems quickly became clear. Food and agriculture is a huge, complex, and contradictory field, and it’s also something on which everyone, absolutely everyone, has an opinion.

Researching food and food systems led me to some of the most riveting non-fiction reading imaginable.

The story of food is one of culture, identity, inequality and social justice, power and wealth. The scope is huge. It takes us from the estimated one billion microbes in a teaspoon of healthy soil, to the sweeping changes made by agriculture to the planetary landscape.

Food has layers of meaning. Providing food to friends and family is one way in which humans demonstrate love, and yet paradoxically the provision of food has evolved into a global system which fails to respect the most basic rights of humans and animals and planetary health.

Out of the complexity of this far-reaching topic, a few very clear and simple truths have emerged for me:

  • Change is urgent and we need to do everything we can.

Put bluntly, the way we eat is making us sick, and the way that we produce and distribute food is making our planet sick.

Too much energy is wasted on arguing about what is the “main problem” or the “best solution”. Big, complex problems need lots of solutions.

For instance, meat production and consumption is one of the major issues, in terms of health and environmental impact, the power of vested interests, and the variety of conflicting opinions.

One person may be passionately devoted to promoting a vegan lifestyle, another will quote evidence that the most effective action is to reduce the meat consumption of the heaviest meat eaters, while another will want to support the livestock farmers who are trying to improve the sustainability of their operations.

Please let’s not argue amongst ourselves. We need all of these approaches; they are complementary.

  • Doctors are a vital part of the solution.

Doctors are trusted messengers, and people want their doctor to help them cut through the confusion surrounding nutrition. People are more likely to make changes to their diet for health reasons than for environmental reasons. Merely changing diets to meet standard dietary guidelines can carry significant environmental benefits.

In a world where the marketing budget of Coca Cola is double the annual budget of the entire World Health Organisation, doctors need to educate themselves, and speak up at every opportunity.

  • Action is required on a number of levels, simultaneously.

This shouldn’t be seen as daunting or overwhelming, but as an opportunity for anyone who cares about food and health to make a contribution in a way that is meaningful for them, and in a sphere where they have influence.

You can make a difference in your own back garden, or your own shopping habits. You can make a difference in the way you talk to your patients about health and diet. You can work with your community to establish a school or community garden. You can lobby government or industry. All of these things are interlinked, and progress in any one area will pave the way for easier wins in other areas.

  • Eat food. Not too much. Mostly plants.

If you want to keep it simple, this introductory line from In Defense of Food by journalist Michael Pollan summarises all you need to know:

To benefit both the environment and human health, reducing consumption of meat and processed food (“edible food-like substances” according to Pollan), and reducing food waste, are the changes most likely to have a significant impact.

  • We need to look after our farmers.

Industrial agriculture, with high inputs of fossil fuels, chemicals and pesticides, contributes disproportionately to the environmental impact of food, and is vulnerable to the effects of a changing climate. We need to look after the farmers who are exploring ways of making food production more sustainable, nourishing and resilient.

The beginnings of agriculture allowed for the development of human civilization. Agricultural practices have evolved over the course of human history, and will need to change again if we are to provide a sustainable and nourishing diet for the growing human population which is expected to reach 9.1 billion by 2050, just 32 years away.

We need nothing less than a paradigm shift in the way we produce and consume.  All of us can help make this shift possible by making changes in the home, in the workplace and anywhere we can.

Dr Kristine Barnden is a Hobart obstetrician, and a member of Doctors for the Environment Australia. She will be co-presenting “Agriculture and Food Security” at DEA’s annual conference in Newcastle, NSW, on Sunday 15 April.

The diet that reduces cardiovascular risk

 

The 5:2 diet championed by TV journalist Dr Michael Mosley appears to be better at reducing certain cardiovascular risks, compared with a more conventional calorie reduction diet, a new study has found.

The research published in the British Journal of Nutrition randomised 27 obese people, with an average BMI of 30 , to either a fasting diet – in which intake is limited to just 600 calories on two days a week – to a more standard weight-loss diet in which participants were advised to reduce their daily intake by 600 calories.

Previous research has focused on blood risk markers taken during fasting periods, whereas this study, undertaken by researchers from the University of Surrey, looked at lipid and glucose metabolism in the postprandial period.

Participants on the 5:2 diet achieved a 5% weight loss more quickly than those on a conventional diet (59 versus 73 days), and they also cleared triglycerides from their bloodstream more efficiently. Although there appeared to be no difference in the way the two diets handled glucose, there were significant variations between the diets in postprandial c-peptide, which is a marker for insulin secretion. This surprising finding needs further investigation, the researchers said.

The researchers also found a significant reduction in systolic blood pressure in those on the 5:2 diet. It was down by 9% in that cohort, and up by 2% in those on the daily calorie reduction diet.

“These preliminary findings highlight underlying differences between intermittent energy restriction and continuous energy restriction, including a superiority of intermittent energy restriction in reducing postprandial lipaemia,” the authors concluded.

But co-author Dr Rona Antoni of the University of Surrey said that although their research found benefits in the 5:2 diet compared with the more conventional alternative, the problem was compliance.

“Some of our participants struggled to tolerate the 5:2 diet, which suggests this approach is not suited to everybody; ultimately the key to dieting success is finding an approach you can sustain long term. But for those who do well and are able to stick to the 5:2 diet, i could potentially have a beneficial impact on some important risk markers for cardiovascular disease, in some cases more than daily dieting.”

You can access the study here.

Three golden rules for a healthy diet

Which one wins – a healthy low-fat diet or a healthy low-carbohydrate diet?

When it comes to weight change, neither apparently.

The study, published in the Journal of the American Medical Association (JAMA) has found no significant difference between the two diets even after being on them for 12 months. It also found no relationship between weight fluctuation and a participant’s DNA testing.

Importantly however, the study did find that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

Professor Christopher Gardner, the Director of Nutrition Studies at the Stanford Prevention Research Center who led the study, said there is no single diet that fits everyone.

“I continually see three factors that come up again and again: get rid of added sugar; get rid of refined grain; and eat as many vegetables as you can,” Professor Gardner said.

He argues that the study has shown the diet argument is often focused on the wrong things, like which type of diet.

“We are battling points on the fringe of this whole debate without getting to the core,” he said.

The large clinical trial included 609 adults aged 18 to 50 years without diabetes, with a body mass index between 28 and 40, where participants were randomised to the 12-month healthy low-fat diet or a healthy low-carbohydrate diet.

“We really stressed to both groups again and again that we wanted them to eat high-quality foods,” Professor Gardner said. 

The low-fat group was told to avoid refined carbohydrates like soft drinks, fruit juice, muffins, white rice and white bread – even though they are low fat. Instead they were advised to eat more nutritionally beneficial foods like brown rice, barley, steel-cut oats, lentils, lean meats, low-fat dairy products, quinoa, fresh fruit and legumes.

The low-carb group was trained to choose nutritious foods like olive oil, salmon, avocados, hard cheeses, vegetables, nut butters, nuts and seeds, and grass-fed and pasture-raised animal foods.

Australia is ranked the fifth highest in the Organisation for Economic Co-operation and Development’s (OECD) latest obesity rankings. Projections show a steady increase in obesity rates until at least 2030. Currently more than one in two adults and nearly one in six children are overweight or obese in OECD countries. OECD adult obesity rates are highest in the United States, Mexico, New Zealand and Hungary, while they are lowest in Japan and Korea.

Speaking on radio recently, AMA President Dr Michael Gannon said the AMA would continue to call for a tax on sugar-sweetened beverages because it is designed to change behaviour.

“We have a situation now where it’s often cheaper to purchase one of these drinks than it is to purchase water,” Dr Gannon said.

Further information about the study can be found https://jamanetwork.com/journals/jama/article-abstract/2673150?redirect=true

AMA’s Position Statement on nutrition was launched earlier this year and is available here: position-statement/nutrition-2018

MEREDITH HORNE

Diet and dementia: what the research tells us

 

Dying and dementia are the two things people in their middle years tend to say they are most apprehensive about. The former is inevitable, but can the latter be avoided? A number of studies have shown an association between exercise, in particular resistance or muscle-building exercise, and a decreased risk of Alzheimer’s disease and other forms of dementia. The jury appears to be still out on the possible protective effects of brain training. But what about the food we eat?

Diet and dementia has been an intensive area of research, and the best way to learn anything from the myriad studies carried out with varying methods, objects and endpoints is to look at the meta-analyses and systematic reviews. The most recent review, published late last year, looked at all observational studies published between 2014 and 2016 on the relationship between diet and late-life cognitive disorders. This found evidence that combinations of foods and nutrients can act synergistically to provide stronger effects than found with any one particular ingredient. In particular, adherence to a Mediterranean-type diet – with its emphasis on plant-based foods, fish, poultry and olive oil – was associated with decreased rates of cognitive decline.

The review also finds another diet associated with a reduction or delay of Alzheimer’s disease: the emerging DASH – or Dietary Approach to Stop Hypertension – diet, which emphasises fruit, vegetables, whole grains and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, but limits sugar-sweetened foods and beverages, red meat, and added fats. As its name suggests, it was originally designed to help in hypertension, which has in itself been linked to higher rates of dementia.

Combining the Mediterranean and DASH diets produces the MIND diet, or the Mediterranean-Dash diet Intervention for Neurodegenerative Delay, which has also been associated with lower rates of dementia in several studies. Put together by a team from the Rush University Medical Center in the US, the MIND diet, like the other two diets, emphasizes the importance of fresh fruit, vegetables, and legumes. But it also includes recommendations for specific foods, such as leafy greens and berries, which have been shown in studies to slow cognitive decline.

The MIND diet appears to be more effective at reducing cognitive decline than either the Mediterranean or DASH diets on their own. One prospective study of over 900 middle-aged and older people, followed for an average of nearly five years, found those with either moderate or high compliance to the MIND diet had significantly lower rates of Alzheimer’s disease diagnoses, with a reduction in risk of a third and a half, respectively, compared with the lowest levels of compliance. But for the DASH and Mediterranean diets, only study participants with high adherence saw an effect.

Another study of around 1000 people found that adherence to the MIND diet significantly slowed cognitive decline, and that those with the highest compliance managed to delay decline by an average of 7.5 years.

Systematic reviews of these dietary interventions do caution that it is very difficult to tease out possible confounders; that more long-term results are needed; and that observational studies can never show causality, only association. Of course, it’s notoriously difficult, and indeed probably impossible, to run a randomised trial of a dietary intervention over many years. That’s not to say we will never get evidence that most in the medical community consider definitive. After all, no randomised trials were ever carried out to prove the link between tobacco use and lung cancer, and yet today there is no doubt at all about the causality.

In the meantime, here are the fundamentals of the MIND diet:

What to eat:

  • Green leafy vegetables – kale, spinach, broccoli, collards and other greens, at least two servings a week;.
  • Other vegetables – a salad and at least one other vegetable every day;
  • Nuts – at least five times a week;
  • Berries – such as blueberries or strawberries, at least twice a week;
  • Beans – three times a week;
  • Whole grains – at least three servings a day;
  • Fish – at least once a week;
  • Poultry – two or more servings a week;
  • Olive oil.

What to avoid:

  • Butter and margarine – not more than one tablespoon daily;
  • Cheese – less than once per week;
  • Red meat – no more than three servings each week;
  • Fried food – less than once per week;
  • Pastries and sweets – no more than four times a week.

 

[Review] Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition

The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5–9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10–14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15–19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control.

Action needed to protect children from too much sugar

The AMA has taken a strong position on sugar, calling for a tax on sugary drinks and a ban on junk food marketing aimed at children.

Releasing its AMA Position Statement on Nutrition 2018 in early January, the AMA said the tax should be introduced as a priority.

AMA President Dr Michael Gannon said eating habits and attitudes toward food are established in early childhood and so advertising of junk food and sugary drinks to children should be banned.

“Improving the nutrition and eating habits of Australians must become a priority for all levels of government,” Dr Gannon said.

“Governments should consider the full complement of measures available to them to support improved nutrition, from increased nutrition education and food literacy programs through to mandatory food fortification, price signals to influence consumption, and restrictions on food and beverage advertising to children.

“Eating habits and attitudes start early, and if we can establish healthy habits from the start, it is much more likely that they will continue throughout adolescence and into adulthood.

“The AMA is alarmed by the continued, targeted marketing of unhealthy foods and drinks to children.

“Children are easily influenced, and this marketing – which takes place across all media platforms, from radio and television to online, social media, and apps – undermines healthy food education and makes eating junk food seem normal.”

Dr Gannon said advertising and marketing unhealthy food and drink to children should be prohibited all together, and the loophole that allows children to be exposed to junk food and alcohol advertising during coverage of sporting events must be closed.

“The food industry claims to subscribe to a voluntary code, but the reality is that this kind of advertising is increasing,” he said.

“The AMA calls on the food industry to stop this practice immediately.”

The Position Statement also calls for increased nutrition education and support to be provided to new or expecting parents, and notes that good nutrition during pregnancy is also vital.

It recognises that eating habits can be affected by practices at institutions such as child care centres, schools, hospitals, and aged care homes.

“Whether people are admitted to hospital or just visiting a friend or family member, they can be very receptive to messages from doctors and other health workers about healthy eating,” Dr Gannon said.

“Hospitals and other health facilities must provide healthy food options for residents, visitors, and employees.

“Vending machines containing sugary drinks and unhealthy food options should be removed from all health care settings, and replaced with machines offering only healthy options.

“Water should be the default beverage option, including at fast food restaurants in combination meals where soft drinks are typically provided as the beverage.”

The Position Statement says a tax on sugar-sweetened beverages should be introduced.

The recommendations were warmly welcomed by health and children’s advocates.

The AMA Position Statement on Nutrition 2018 is available at position-statement/nutrition-2018 and the key recommendations are listed here.

CHRIS JOHNSON

 

Key Recommendations:

  • Advertising and marketing of unhealthy food and beverages to children to be prohibited.
  • Water to be provided as the default beverage option, and a tax on sugar-sweetened beverages to be introduced.
  • Healthy foods to be provided in all health care settings, and vending machines containing unhealthy food and drinks to be removed.
  • Better food labelling to improve consumers’ ability to distinguish between naturally occurring and added sugars.
  • Regular review and updating of national dietary guidelines and associated clinical guidelines to reflect new and emerging evidence.
  • Continued uptake of the Health Star Rating system, as well as refinement to ensure it provides shoppers with the most pertinent information.

 

 

[Comment] Nutrition in the ICU: sometimes route does matter

The NUTRIREA-2 trial by Jean Reignier and colleagues1 in The Lancet provides an important piece in the puzzle of intensive-care unit (ICU) nutrition management. This pragmatic multicentre study done at 44 French ICUs randomly assigned patients aged 18 years or older requiring invasive mechanical ventilation and vasopressors (median 0·5 μg/kg per min) to receive either enteral nutrition (n=1202) or parenteral nutrition (n=1208), both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation or ICU admission.

[Comment] Offline: From 1918 to 2018—the lessons of influenza

Estimates of mortality during the 1918–20 influenza pandemic range from 20 million to 100 million deaths. Mortality between countries varied enormously. A large part of this variation was related to wealth. Resource-poor countries, with weak health systems, pervasive undernutrition, and widespread poverty, had higher death rates. When 1918 mortality rates are modelled for the modern era, an epidemic of influenza with similar virulence and pathogenicity would cause around 62 million deaths, with younger age groups especially vulnerable.