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Less is More

Posted by James on 10/07/2017 | Comment

The less ingredients, the better.

Snacks with 5 Ingredients or Less



Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Fat

Posted by James on 10/07/2017 | Comment

Fat is commonly known to be stubborn, unwelcomed, and misunderstood. We tend to demonize fat and blame it for the high rates of obesity and diabetes. Is fat a scapegoat? Or is it truly something we should fear? Sylvia Tara, the author of, The Secret Life of Fat, explained her frustrations with watching people around her eat whatever, and whenever, they want, while preserving their thin stature. This motivated her to learn the ins and outs of fat. While speaking to Tom Ashbrook from On Point, she explained, “Fat is not just fat.” Fat is an endocrine organ that produces hormones that are vital to our health. She encourages working with your fat, rather than against it. David Ludwig, a professor at Harvard Medical School states, “Body fat is so much more than a passive calorie storage depot,” (The Secret Life of Fat, 2017). Fat has the unique ability to use stem cells to “regenerate, increase our appetite,…and use bacteria, genetics, and viruses to expand itself,” (The Secret Life of Fat, 2017). Our body needs fat and we possess many defense mechanisms to protect and hold on to it.

Fat releases a hormone, known as leptin, which regulates appetite and metabolism. A major reason why people lose weight and quickly gain it back is because once fat is lost, leptin levels decrease, resulting in an increase in appetite and a decrease in metabolism.

Therefore, maintaining weight loss is often harder than the actual process of losing weight. After losing weight, it is important to reduce caloric intake by 22% in order to keep off the weight. For example, take someone who is naturally 150 pounds and compare their overall caloric intake to someone who originally was 170 pounds but who lost 20 pounds and is now 150 pounds. The person who is naturally 150 pounds can have an overall higher caloric intake than the person who lost 20 pounds and currently the same weight.

Not only is fat an energy reserve for our body, but also is crucial for brain, immune, and reproductive health. Sylvia Tara explains how brain volume is related to fat. Brain growth and development relies on adequate leptin levels. Furthermore, behaviors can often be different in those with lower levels of leptin. So what causes leptin levels to deplete? Either the loss of fat through behavior and lifestyle change, or from a genetic defect.

Fat is also important for immune health. Immune cells, known as T cells, have receptors for the hormone leptin, which help increase activity and propagation of these immune cells. If there is a low level of leptin, there are fewer T cells, causing you to become more prone to infection. As previously mentioned, the reason for low levels of leptin is either behavioral or genetic.

Reproductive health is also dependent on fat because fat produces estrogen. Oftentimes, when there is too little fat, there is a delay in puberty or even a loss in menstrual cycles, resulting in the inability to conceive.

Other factors besides diet and exercise that effect fat, are age and gender. Typically, men are more prone to have less fat than women. Also, as you age, you begin to lose hormones that are important for burning fat. For instance, a 65 year old woman would have different needs than a 25 year old man.

Research on fat remains controversial, however, there are certain views that are agreed upon. Most health professionals agree with the following:

1) Saturated fatty acids should be limited to 10% of total calories

2) Saturated fat should be substituted for polyunsaturated fats

3) Replacing fat with refined carbohydrates can equally be, if not more so, damaging to the body.

It is important to note that the research is ambiguous. As health professionals, we do not hold all the answers, and that can be scary. But as the field of nutrition grows, and the science and technology improves, we will have a better understanding on fat. With that being said, be cautious of fat, but do not be fearful of it. Focus on your overall dietary pattern, rather than specific nutrients in each individual food, and remind yourself that fat is important.

 

References
New Research Reveals Deep Truths About Fat. (2017). Retrieved August 11, 2017, from http://www.wbur.org/onpoint/2017/01/03/weight-loss-fat-science

The Secret Life of Fat by Sylvia Tara PhD. (2017). Retrieved August 11, 2017, from http://thesecretlifeoffat.com/

Zelman, K. (2011). The Great Fat Debate: A Closer Look at the Controversy– Questioning the Validity of Age-Old Dietary Guidance. Journal of the American Dietetic Association, 111(5), 655-658. Retrieved August 11, 2017, fromhttps://doi.org/10.1016/j.jada.2011.03.026.



Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Eating in Season

Posted by James on 10/07/2017 | Comment

Why is it important to eat in season? It is important not only for our own health, but also for the health of our planet. Oftentimes produce that is not in season, travels long distances, decreasing its freshness. Furthermore, produce is often picked prematurely to prevent spoilage, causing vitamin degradation and nutrient loss. Common methods of transporting produce contribute to increased greenhouse gas emissions and air pollution. Even current farming practices strip the soil of minerals, which can have an effect on our health due to mineral deficiencies. Furthermore, increased use of chemicals and pesticides are dangerous to our health, and the health of our planet. Moral of the story? Eat local and eat seasonal produce.

10 Recipes for 30 Seasonal Fruits and Vegetables

 

Add or substitute kale with lettuce or spinach*

Substitute collard greens with turnips or swiss chard*

 

 

References

The Healthy Benefits to You of Eating Fruits and Vegetables In Season. (2011, September 20). Retrieved August 09, 2017, from https://bodyecology.com/articles/benefits_in_season.php

What’s In Season? Fall. (n.d.). Retrieved August 09, 2017, from http://www.fruitsandveggiesmorematters.org/whats-in-season-fall


Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Nutrition and Oral Health

Posted by James on 09/15/2017 | Comment

The relationship between nutrition, general health, and oral health is an important relationship for healthcare professionals and patients to understand. Oral diseases and disorders affect almost 4 billion people worldwide (Palmer & Stanski, 2015). The gravity of oral health on the overall health of our body is astronomical, and what we decide to eat, affects our oral health. “The oral cavity is a vehicle for the transmission of disease-causing microorganisms, as well as a portal, of entry for systemic infections. These pathogens or their cytotoxic by-products are known to cause dental caries, periodontal disease, and other local oral and pharyngeal infections. To boot, these pathogens and by-products can cause an immune response somewhere else in the body or assist in the progression of systemic disease (Palmer & Stanski, 2015).
As common as cavities are, many people do not know what they are, or why they form. Simply put, dental caries  form when bacteria plaque adheres and manifests on the tooth surface. Dental caries can be a result of a “cariogenic diet, inadequate fluoride exposure, a susceptible host, and the presence of caries-causing bacteria in the oral cavity,” (Researchers at University of Maryland, 2017).

Dental caries are extremely common in our sugar-infested food supply. A diet high in simple sugars serves as the primary food source for bacteria (Palmer & Stanski, 2015). As a result, acids are produced and cause the tooth enamel to demineralize. TO correct a common misconception, it is the amount of time that the dietary sugars are in contact with the bacteria, not the total amount of sugar consumed (Palmer & Stanski, 2015).

However, good oral hygiene and a healthful diet have not gone unnoticed. This relationship is attracting new research and consequently, new clinical applications.  New findings have shown a benefit of probiotics on immunity, urogenital, and the respiratory tract. Furthermore, probiotics are commonly used for the prevention and treatment of gastrointestinal infections and disease. In respect to oral health, lactobacilli and bifidobacteria are probiotic microorganisms helpful in the prevention and treatment off oral infectious diseases, including dental caries and periodontal disease. These microorganisms are thought to inhibit oral pathogens, withstand oral environment, and antimicrobial action (Rastogi et al., 2011).

Oral Health, Diseases, & Disorders


Cancer
Immune compromising conditions, such as cancer, can result in oral manifestations such as mucositis, taste changes, xerostomia, and an increased risk in the development of dental caries. Malnutrition is a common diagnosis of those undergoing treatment since cancer therapies, such as chemotherapy, often alter an individual’s appetite and ability to chew, taste, and swallow. This, in turn, influences intake choice and frequency (Palmer & Stanski, 2015). Patients with oropharyngeal cancer (OPC), often undergo radiation to the oropharyngeal area, which can cause tooth loss, caries, painful stomatitis, xerostomia, fibrosis of the muscles of mastication, and loss of taste (Touger-Decker & Mobley, 2013). Furthermore, surgical procedures can affect mastication and swallowing function, which can also increase the energy and nutrient needs for healing.

Diets high in pickled vegetables, salted meat and fish, charcoal-grilled foods, alcohol, and smoking have been associated with increased oral cancer risk, while diets high in fresh fruits and vegetables have become associated with reduced risk, even accounting for smoking and alcohol use (Palmer & Stanski, 2015). Furthermore, an inverse relationship between fruit and vegetable consumption and risk of OPC was demonstrated (Touger-Decker & Mobley, 2013). The National Comprehensive Cancer Network recommends a team of registered dietitians, physicians, oral health care professionals, speech and language pathologists, and nurses, to ensure optimal treatment and management of cancer (Touger-Decker & Mobley, 2013).

Cardiovascular Disease
Inflammation seems to be a common theme of both periodontitis and cardiovascular disease. It is hypothesized that “localized chronic inflammation of periodontal tissues leads to systemic inflammation that can result in dyslipidemia and atherosclerosis,” (Palmer & Stanski, 2015). With that being said, Palmer & Stanski recommend smoking cessation, a well balanced diet and healthy body weight, and an increase in physical activity.

Obesity
Childhood obesity and dental caries share the causal commonality of excessive sugar consumption (Researchers at University of Maryland, 2017). Obesity and oral health has proven to be a good indicators of each other. Poor oral health is a good predictor of obesity (New Obesity Findings, 2016), while periodontal disease is more likely to occur in overweight and obese individuals, than normal healthy weight adults (Palmer & Stanski, 2015).

Diabetes
There is a relationship, not only between periodontal disease and cardiovascular disease, but also between periodontal disease and diabetes. Palmer & Stanski (2015) discussed research pertaining to an increased risk of periodontitis in those with diabetes, and the dependency of glycemic control on the severity of periodontitis. As a diabetic, oral manifestations, such as  xerostomia, oral candidiasis, glossopyrosis, impaired oral wound healing, recurrent oral infections, and acetone breath, can occur (Palmer & Stanski, 2015). Visiting your local dentist, orthodontist, and other oral health practitioners is an opportune location for diabetes screening. Early diagnosis and treatment can improve overall patient health and avoid or reduce diabetes-related complications  (Palmer & Stanski, 2015). Health practitioners in a dental setting can use two dental parameters, including the number of missing teeth and the percentage of deep periodontal pockets, to help identify pre-diabetes and diabetes (Lalla et al., 2016). Lifestyle interventions include losing a modest amount of weight, increasing physical activity, reducing calories and dietary fat, liming alcohol consumption, choosing whole grain or higher fiber carbohydrates in controlled quantities, and limiting refined carbohydrate sources (Palmer & Stanski, 2015).

Eating Disorders
Although discussions about eating disorders are often hush-hush, it is important to recognize the disorder and explain how it effects your general health and, for the sake of this article, oral health. Vomiting, due to bulimia, causes acidity in the mouth, resulting in demineralization of the tooth enamel, irritation of the mouth lining, enlargement of the salivary gland, dry mouth, and cheilosis, which is a condition characterized by red, dry, and cracked lips (Howat, Varner, & Wampold, 1990). Individuals suffering from anorexia are at risk of developing conditions, such as xerostomia (Touger-Decker & Mobley, 2013), mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions (Ximenes, Couto, & Sougey, 2009).

Oral Health by Age


Infants and Children
Dental caries are extremely common in children. Factors involved in early childhood caries (EEC) include low socioeconomic status, minority status, older age, and sugared snack or beverage consumption. Consumption of sugar-sweetened beverages in children up to 24 months of age is a strong and identifiable predictor of ECC development. Frequent bottle feeding at night, or putting a baby to bed with a bottle, increases sugar exposure, resulting in tooth decay. Also, the extended and repetitive use of a training cup can cause the fluid to pool around the oral cavity and feed the acid-producing bacteria. Guidelines for infants include providing only water in bottles at nap time or bedtime, controlling the amount of sugar the child consumes, reducing intake of cariogenic foods, never dipping pacifiers in fermentable carbohydrates such as sugar, honey, or juice, introducing the cup at 6 months of age and begin to wean from the bottle, and cleaning their child’s teeth after each feeding.

Young and Elderly Adults
Although dental caries are more likely to occur in children, adults do not go unscathed, and sometimes, face other oral manifestations such as periodontal disease. Therefore, it is recommended for adults to limit excessive alcohol consumption, which can cause dehydration– reducing saliva flow and leading to tooth decay. As adults age, xerostomia, a common side effect of many prescription medications, increases the risk of developing dental caries. For those experiencing xerostomia, it is recommended you drink more water for oral lubrication, use sugar free gum to stimulate saliva production, and avoid foods and beverages that irritate dry mouths such as coffee, alcohol, carbonated soft drinks, and acidic fruit juices.
“For older adults, it is important to target individual needs based on concurrent systemic diseases and disabilities and associated oral manifestations relative to the disease and disability and its treatments,” (Touger-Decker & Mobley, 2013). Aging adults with tooth loss, dentures, or implants, lose the ability to bite and swallow food as efficiently. It is no surprise that malnutrition is common in those who struggle with masticating their food. Take a moment to imagine your chewing capacity with regular dentures versus your natural teeth. It is approximated that the chewing capacity is only 20-25% of natural teeth. Therefore it is important for healthcare providers to advise patients to use their dentures as their knife and fork as their teeth to cut food into smaller sizes. Implanted dentures have a greater ability to bite and chew food as compared to regular dentures.

Pregnancy
Periodontitis of a pregnant mother is associated with preterm birth and low birth weight babies. If the mother has high levels of cariogenic bacterial in the oral cavity, their child will too develop dental caries (Nagi, Sahu, & Nagaraju, 2016). Vomiting, or morning sickness, can result in repeated enamel exposure to gastric acid. Furthermore, pregnancy is known to alter the eating habits and cravings of a pregnant woman, which could result in deficiencies and malnutrition. Malnutrition in pregnancy can have damaging effects on the child (Palmer & Stanski, 2015).

CoQ10
CoQ10 appears to be the last antioxidant defense and the highest concentration found in the oral tissues (Battino et al., 2005). According to the research of Nakamura et al. (1974), those with gingivitis or periodontitis, have a CoQ10 deficiency in their oral tissues. It has been shown that the greater the CoQ10 deficiency, the greater the chance of developing an oral condition, such as gingivitis or periodontitis. In order for oral tissue to heal and repair, it needs energy. Due to the role of CoQ10 on energy production, it is presumed that increasing your intake of CoQ10 through your diet or supplementation can help in the tissue repair process.

Dietetic and Oral Health Practitioners


It is important for all healthcare professionals to acknowledge, and become familiar with other disciplines to promote optimal patient care. First clinical signs and symptoms of nutritional deficiencies and excesses, are usually seen in the oral tissues (Palmer & Stanski, 2015). Therefore, it is important for dietetic and oral health practitioners to communicate and work together in order to identify warning signs and symptoms. According to the Institute of Medicine, the four core competencies, in terms of recognizing oral disease risk, include assessments, provision of educational information on oral health, integration of oral health with diet counseling, and referrals as appropriate to oral health care professionals (Touger-Decker & Mobley, 2013). A 1990 survey concluded that dental practitioners had inadequate training in nutrition and did not consider nutrition to be important in their line of work (Stager & Levine, 1990) Alternatively, registered dietitians have also reported a lack of education and training on oral health screening. Dietetic practitioners in clinical practice are expected to include oral health as a component of their nutrition-focused physical examination, counseling, and monitoring of individuals. (Touger-Decker & Mobley, 2013). For dietetics practitioners, identifying non-normal oral conditions and providing referrals and education appropriate to any practice setting. It is important to seek continuing professional education on this topic or partner with an oral health care professional for hands on training to develop competency and proficiency. Oral health care professionals can provide baseline intervention to determine diet/nutrition risk, educate patients on diet relative to oral health, and, when in depth nutrition evaluation and diet counseling is needed, refer patients to an RD for medical nutrition therapy. (Touger-Decker & Mobley, 2013) However, neither oral health screening nor nutrition focused physical examination are cited as specific competencies or criteria in the Accreditation Commission for Education in Nutrition and Dietetics education standards for entry level practice.
Oral health and nutrition have a synergistic multidirectional relationship. Oral diseases, as well as other diseases with oral manifestations, impact an individual’s diet and nutritional status. Similarly, poor nutrition and diet can damage the oral cavity and expedite the progression of oral diseases (Tougher-Decker & Mobley, 2013). Therefore, it should be common practice, between dietetic and oral health practitioners, to screen, educate, and refer patients to promote optimal patient care.

Top 9 Foods That Damage Your Teeth (2017)

  1. Hard candies
  2. Chewing ice
  3. Citrus fruits and beverages
  4. Certain coffees
  5. Sticky foods such as dried fruits in trail mix
  6. Bagged chips
  7. Soda
  8. Alcohol
  9. Sport and energy drinks

 

References
Battino, M., Bompadre, S., Politi, A., Fioroni, M., Rubini, C., & Bullon, P. (2005). Antioxidant status (CoQ10 and vit. E levels) and immunohistochemical analysis of soft tissues in periodontal diseases. Biofactors, 25(1‐4), 213-217. doi:10.1002/biof.5520250126

Essex, G., Miyahara, K., & Rowe, D. J. (2016, December). Dental hygienists’ attitudes toward the obese population. Journal of Dental Hygiene, 90(6), 372+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA480593478&sid=summon&asid=fc12ec832812727c43c878a914fe0ca6

Fuchs, N. K. (2014, June). Ask your dentist if you have diabetes. Women’s Health Letter, 20(6), 4+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA372449701&sid=summon&asid=9e9c953375ac348276ad0e1c600133da

Hayes, M. J., Franki, J., & Taylor, J. A. (2016, February). The frequency of dietary advice provision in a dental hygiene clinic: a retrospective cross-sectional study. Journal of Dental Hygiene, 90(1), 12+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA447638203&sid=summon&asid=a6fa2eedff7329c39bd4aed8b3a8ecf9

Howat, P. M., Varner, L. M., & Wampold, R. L. (1990). The effectiveness of a dental/dietitian team in the assessment of bulimic dental health. Journal of the American Dietetic Association, 90(8), 1099+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA9329499&sid=summon&asid=290179fe9f1815129bb3763927ec64c6

Lalla, E., Kunzel, C., Burkett, S., Cheng, B., & Lamster, I. (2011). Identification of Unrecognized Diabetes and Pre-diabetes in a Dental Setting. Journal of Dental Research, 90(7), 855-860. doi:10.1177/0022034511407069

Nagi, R., Sahu, S., & Nagaraju, R. (2016). Oral health, nutritional knowledge, and practices among pregnant women and their awareness relating to adverse pregnancy outcomes. Journal of Indian Academy of Oral Medicine and Radiology, 28(4), 396. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA483684361&sid=summon&asid=6958060b9da52533d015a10bb53575bc

Nakamura, R., Littarru, G. P., Folkers, K., & Wilkinson, E. G. (1974). Study of CoQ10-enzymes in gingiva from patients with periodontal disease and evidence for a deficiency of coenzyme Q10. Proceedings of the National Academy of Sciences of the United States of America, 71(4), 1456-1460. doi:10.1073/pnas.71.4.1456

New Obesity Findings from School of Dentistry Described (Association between oral health status and central obesity among Brazilian independent-living elderly). (2016, December 17). Obesity, Fitness & Wellness Week, 207. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA473578473&sid=summon&asid=45173e0d21d0a192b8adc61914272374

Palmer, C., & Stanski, R. (2015). Oral health and nutrition as gatekeepers to overall health: We are all in this together. European Journal of General Dentistry, 4(3), 99. doi:10.4103/2278-9626.163319

Rastogi, P., Saini, H., Dixit, J., & Singhal, R. (2011). Probiotics and oral health. National Journal of Maxillofacial Surgery, 2(1), 6. doi:10.4103/0975-5950.85845

Researchers at University of Maryland Release New Data on Obesity (Introduction to proceedings of healthy futures: engaging the oral health community in childhood obesity prevention national conference). (2017, May 20). Obesity, Fitness & Wellness Week, 3964. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA491680036&sid=summon&asid=b5e40f6c05bdceb59e2fc19e4c67f29f

Stager, S. C., & Levine, A. M. (1990). The need for nutritionists: a survey of dental practitioners. Journal of the American Dietetic Association, 90(1), 100+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA8350897&sid=summon&asid=ec1d5425a651102095044f2f4f34ad3a

Touger-Decker, R., & Mobley, C. (2013). Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition. Journal of the Academy of Nutrition and Dietetics, 113(5), 693-701. doi:10.1016/j.jand.2013.03.001

Top 9 Foods That Damage Your Teeth. (n.d.). Retrieved August 11, 2017, from http://www.mouthhealthy.org/en/nutrition/food-tips/9-foods-that-damage-your-teeth

Ximenes, R., Couto, G., & Sougey, E. (2009). Eating disorders in adolescents and their repercussions in oral health. International Journal of Eating Disorders. doi:10.1002/eat.20660



Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

The Smoothie Selection Guide

Posted by James on 09/15/2017 | Comment

It is important to keep in mind that many smoothies contain ice cream, sweeteners, and fruit juices. Make sure to read the ingredients and look for smoothies containing whole fruits and vegetables, nonfat yogurt or milk, and little to no added sugar. Nutrient dense smoothies can also be found by looking at the amount of fiber and protein. For example, Smoothie King’s Vegan Dark Chocolate Banana Wellness Blend Smoothie has 11g fiber and 11g protein, while Tropical Smoothie Café’s Kiwi Quencher Classic Smoothie has 1g fiber and 2g protein. Portion size is also important, so try and choose the smallest size. Furthermore, do not be deceived by smoothies with describing words, such as “The Hulk” or “Detox” or “Powerhouse”, in its name.

If you are looking for an afternoon snack, choose a smoothie low in calories and sugar. Good examples include Planet Smoothie’s Frozen Goat Smoothie or Planet Smoothie’s Lean Green Extreme Smoothie. If you are looking for a smoothie to serve as your breakfast, choose a smoothie high in protein and fiber. Good examples include Starbucks’ Chocolate Smoothie or Smoothie King’s Vegan Dark Chocolate Banana Wellness Blend Smoothie.

From a nutritional standpoint, the smoothies in green font indicate the best options, and the smoothies highlighted in yellow indicate the worst options. Without question, Planet Smoothie wins the Restaurant award for “Best Selection of Healthful and Nutritionally Dense Smoothies”.

Did you know that there is a “Blue Apron” for Smoothies? If you are unfamiliar with Blue Apron, it is a food delivery service that provides its consumers with all the ingredients needed to make a delicious meal in exactly the right proportions. Greenblender follows the same concept, but they deliver all the ingredients needed to make delicious smoothies. If you are interested in learning more, or in subscribing for their weekly ingredient deliveries, visit https://greenblender.com/.

References
McIndoo, H., MS, RD. (2017, April). The Buzz on Smoothies. Environmental Nutrition: The Newsletter of Food, Nutrition, & Health, p. 5.


 

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Artificial Pancreas for Diabetes

Posted by James on 09/15/2017 | Comment

In September of 2016, a major breakthrough developed in the treatment of Type 1 Diabetes. The first artificial pancreas, known as the Medtronic’s MiniMed 670G System, was approved by the FDA. This hybrid, closed loop system, includes a glucose meter, a continuous glucose monitor (CGM), and an insulin pump. The first component, a glucose meter, is used to calibrate the CGM. The second component, the CGM, evaluates blood glucose throughout the day. The last component includes a motorized infusion pump that delivers either insulin or glucagon. However, Medtronic’s MiniMed 670G System still relies on diabetics to closely count carbohydrates in their food and then enter these amounts into their system.

A fully automated, closed loop system, such as iLet, senses rising glucose levels, particularly at mealtimes, and adjusts insulinautomatically (Diabetes Week, 2017). This automated medical device eliminates the carbohydrate counting process for diabetics. Although it has not been FDA approved, it is currently being tested in various trials funded by the National Institute of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This CGM and pump system consists of an insulin-only system, as well as a system that uses two hormones–glucagon and insulin–within the pump system, in conjunction with the CGM (Appold, 2017).

The CGM is constantly collecting blood sugar values in order to achieve better control. These values determine whether or not the pump should administer insulin to decrease glucose values, or administer glucagon to increase glucose values.

The approximate annual cost of treatment for both pre-diabetes and diabetes in the United States is an astonishing $322 billion (Appold, 2017). However, major strides in the technological development and treatment of diabetes can indirectly help to reduce overall treatment costs. NIH research found that automatic basil insulin delivery, can help reduce diabetes complications, including nerve, eye, and kidney diseases. This delivery system helps to tightly regulate and control blood sugar levels, decreasing the amount of hospital visits, and therefore reducing overall treatment costs.

Below is a timeline of events that are historic to the technological advancements and treatment of diabetes. To see an extensive version of this timeline, please visit http://www.diabetes.org/about-us/75th-anniversary/timeline.html?loc=75.

References

75th Anniversary Timeline. (n.d.). Retrieved July 24, 2017, from http://www.diabetes.org/about-us/75th-anniversary/timeline.html?loc=75

Appold, K. (2017). Diabetes improvements: Innovations shake up the industry. North Olmsted: Advanstar Communications, Inc.

Beta Bionics | Introducing the iLet. (n.d.). Retrieved July 24, 2017, from https://www.betabionics.org/

Center for Devices and Radiological Health. (n.d.). Recently-Approved Devices – The 670G System – P160017. Retrieved July 24, 2017, from http://wayback.archiveit.org/7993/20170111141252/http:/www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm522764.htm

Iturralde, E., Tanenbaum, M. L., Hanes, S. J., Suttiratana, S. C., Ambrosino, J. M., Ly, T. T., . . . Hood, K. K. (2017). Expectations and attitudes of individuals with type 1 diabetes after using a hybrid closed loop system. The Diabetes Educator, 43(2), 223-232. doi:10.1177/0145721717697244

Nutritional and metabolic diseases and conditions – type 1 diabetes mellitus; artificial pancreas benefits young children, trial shows. (2017). Diabetes Week

Nutritional and metabolic diseases and conditions – type 1 diabetes mellitus; four pivotal NIH-funded artificial pancreas research efforts begin. (2017). Diabetes Week


 

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

sugar

Sugar

Posted by James on 08/01/2017 | Comment

Sugar. It is everywhere and in everything, including a variety of sauces, dressings, and other common condiments such as ketchup and gravy (Cording, 2016).

The 2015 Dietary Guidelines recommends Americans limit added sugar, including syrups and other caloric sweeteners, to no more than 10% of their daily caloric needs. To put this into perspective, the daily limit for someone on a 2,000 calorie diet is approximately 12 teaspoons of sugar (Cording, 2016). Sugar intake and highly processed foods play a major role in diabetes, heart disease, and extra body fat. But should we be treating sugar as our one and only arch nemesis? Yes and no.

Although it is important to limit and control your sugar intake, abruptly removing sugar from your diet is not recommended because it can cause sugar dependency and consequently lead to episodes of binging (Is sugar really addictive?, 2002). Furthermore, forbidding sugar from your diet will only create a greater temptation. We live in a world where sugar is considered to be a mouth-watering treat, implying that everything else we eat, including fruits and vegetables, is not (Fabricant, 1992). Our mindset is skewed to associate vegetables with feelings of disgust and chocolate with feelings of deliciousnessAt the end of the day, we are afraid to acknowledge and appreciate the pleasure and taste of food (Fabricant, 1992).

With that being said, pleasure and taste must not be forgotten when trying to promote a healthier lifestyle. Taste is one of the most satisfying and enduring bodily experiences, and much of what we can taste is associated with smell (Hess, 1997).

There are four primary tastes, including sweet, salt, sour, and bitter. Umami has also been accepted as an additional primary taste, and it is best described as being savory. Taste buds function differently depending on whether they are sensitive to sour, bitter, or sweet foods. Taste buds sensitive to sour tastes detect the degree of acidity in foods. Sensitive taste buds to bitter tastes can detect poisons in wild plants, and taste buds sensitive to sweet tastes are known to have helped animals determine whether unknown foods are poisonous (Hess, 1997).

At birth, we naturally prefer sweet substances. Our brain is programmed to seek out sweet substances because “In nature,” as David Levitsky, PhD, a professor of nutritional sciences and psychology at Cornell University states, “there are very few sweet things that don’t have a large amount of energy. That’s how we developed a basic biological function to prefer sweet tastes,” (Is sugar really addictive?, 2002).

Hess (1997) also explains the difference between “supertasters” and “non-tasters“. “Supertasters” do not require the intense taste of refined sugar to satisfy them, while “non-tasters” require stronger tastes for a fuller taste sensation. Furthermore, the response to taste is more intense at the beginning of eating, rather than towards the end of eating, when both taste and smell fatigue set in. Challenging and surprising your sense of smell and taste, by having a varied diet, maximizes the sensory impact and reduces the sensory fatigue while eating (Hess, 1997).

In a clinical setting, medications, chronic disorders, and radiation therapy are commonly known to alter taste perception, resulting in a loss of appetite. Certain endocrine dysfunctions, cystic fibrosis, Addison’s disease, Cushing’s syndrome, and hypertension have been reported to affect taste perception. An altered taste perception can also lead to food poisoning due to the inability to determine whether a food has been spoiled (Hess, 1997).

It is easy to forget about pleasure and taste when focusing on health and nutrition, but it is important to find a balance. Hess (1997) notes that 88% of consumers rate taste as very important in shopping for food. The American Institute of Wine and Food’s ongoing program, “Resetting the American Table,” states “In matters of taste, consider nutrition, and in matters of nutrition, consider taste. And in all cases, consider individual needs and preferences.”

“Taste is personal. Flavors are pleasing and displeasing based on physiologic, psychological, and cultural variables,” (Hess, 1997). Therefore, it is important for dietitians and other health professionals to take these variables into account. Dietary recommendations are not black and white. Compromise and adaptation will promote a healthful lifestyle that is both sustainable and cumulative. “Individualizing nutrition advice, with consideration of taste, health needs, and personal preferences, is a “signature dish” of quality dietetics practice,” (Hess, 1997).

Mintz (1985) discusses how the environment has led to the rise of sugar and its impact on recent dietary changes, including the decline of three meal a day eating pattern, the dependence on prepared foods, and the prevalence of eating out. Richard Mattes, PhD, RD, a professor of foods and nutrition at Purdue University explains, “when we are young, we learn to seek out sweets as a reward or bribe for doing something good,” (Is sugar really addictive?, 2002).

Aside from the environmental factors, it is important to acknowledge the physiological aspects of what and why we eat. Although the external environment influences what and why we eat, basic biology is critical to understanding taste and certain flavors. Steiner (1977) and Mennella and Bobowski (2015) support the importance of basic biology as it relates to basic tastes. However, Mennella and Bobowski (2015) explains how the food environment of commercially prepared, sugar-rich foods, extenuate the basic biology of children and their want for sweets. Therefore, having a better understanding of this may promote healthier eating.

The first step to reduce your sugar consumption, starts in the grocery store. It is recommended to use fruits and vegetables, that are naturally sweet, when baking or cooking. For example, you can add a mashed banana to your oatmeal in the morning and microwave it for a minute, which naturally adds sweetness to the oatmeal (Cording, 2016). According to Julie Davis (2017), satisfying a craving for sugar can be accomplished by resetting your taste buds, or by exercising. Exercising can lower your desire for unhealthy, high-calorie foods. However, using artificial sweeteners have not shown to suppress sugar cravings.

By increasing attention to taste, the effectiveness of nutrition counseling can be increased. Below are suggestions on how to focus on taste (Hess, 1997):

  1. When shopping, choose foods that are beautiful, fresh, and full-flavored.
  2. In planning a menu, choose foods of different shapes, colors, and textures. Foods with eye appeal elicit more saliva. Visual appeal is essential. Food arrangements on the plate and garnishes can improve food intake and eating enjoyment.
  3. Recommend foods that are ethnically appropriate and that can be prepared with familiar seasonings.
  4. Experiment with flavor enhancers and with balancing flavors.
  5. Encourage clients to take time to smell their food and to savor its flavor.
  6. Advise clients to chew their food thoroughly to release its flavor molecules. Chewing also forces odors into the nasal cavity.
  7. Maximize flavor by providing a variety of foods within each meal. Switching from food to food throughout a meal reduces taste bud fatigue.
  8. Serve foods hot or warm to increase their volatile smells.
  9. Choose foods with what flavor researcher Inglis Miller calls “flavor gestalt” (2). Garlic, onions, citrus, and ripe berries pack a lot of flavor. Reserve fat for maximum flavor impact, and use as little as possible to create the flavor effect.

References
Cording, J. (2016). Looking to Reduce Your Family’s Intake of Added Sugars? Here’s How. Kids eat right.Retrieved from http://www.eatright.org/resource/food/nutrition/dietary-guidelines-and-myplate/looking-to-reduce-your-familys-added-sugar-intake-heres-how

Davis, D. (2017). Reset your Taste Buds for Less Sugar. HealthDay. Retrieved from https://consumer.healthday.com/diabetes-information-10/sugar-health-news-644/reset-your-taste-buds-for-less-sugar-723399.html

Fabricant, F. (1992, January 21). Remember Red-Meat Orgies In the Cave? Your Taste Buds Do. Retrieved July 21, 2017, from http://www.nytimes.com/1992/01/22/garden/remember-red-meat-orgies-in-the-cave-your-taste-buds-do.html

Hess, M. A. (1997). Taste: the neglected nutritional factor. Journal of the American Dietetic Association,97(10), S205+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=AONE&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA20343026&sid=summon&asid=4fc9eac70143efa243b9c04ebd1b697e

Is sugar really addictive? (2002, October). Tufts University Health & Nutrition Letter, 20(8), 1+. Retrieved from http://go.galegroup.com.eduproxy.tc-library.org:8080/ps/i.do?p=HRCA&sw=w&u=new30429&v=2.1&it=r&id=GALE%7CA92588968&asid=c8f7fd78a3fe59a1a9c26d715e18f606

Mennella, J. A., & Bobowski, N. K. (2015). The sweetness and bitterness of childhood: Insights from basic research on taste preferences. Physiology & Behavior, 152, 502-507. doi:10.1016/j.physbeh.2015.05.015

Mintz, S. W. (1986). Sweetness and Power. Penguin Books.Steiner, J. E. (1977). Facial expressions of the neonate infant indicating the hedonics of food-related chemical stimuli. Taste and development: The genesis of sweet preference, 173-188.


 

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

Ketogenic Diets and Cancer Cell Surpression

Posted by James on 08/01/2017 | 1 Comment

A ketogenic diet is a high fat, moderate to low protein, very low carbohydrate diet — approximately 90%, 8%, 2% of total daily calories, respectively. Ketone bodies are derived from fatty acids in the liver and are produced to compensate for glucose depletion during periods of food restriction (Meidenbaurer et al., 2015).

Fasting, which induces a state of ketosis has shown to enhance the effectiveness of chemotherapy. Therefore, ketogenic diets have been used for brain cancer management. Tumor cells depend on glucose, which derives from carbohydrates. When the body is deprived of carbohydrates, the body is forced to burn fat, instead of glucose for energy production (Allen et al., 2014). However, tumor cells, unlike normal brain cells, have mitochondrial defects which prevent the body from successfully using ketone bodies for energy when glucose is limited (Meidenbaurer et al., 2015).

According to the research of Allen et al. (2014), there are over 60 trials assessing low carbohydrate diets as a potential therapy for a variety of diseases and conditions. Preliminary reports of cancer patients on a ketogenic diet have shown improved physical conditions, tumor shrinkage and/or slowed tumor growth, over a 3-month time period.

Poff et al. (2016) demonstrated the combination of a ketogenic diet with hyperbaric oxygen therapy (HBO2T), which involves breathing high pressure oxygen, to slow the progression of tumor growth. Tumors create hypoxic, or oxygen deprived, pockets, which promote cancer cell growth. HBO2T reverses this by saturating tumors with oxygen.

Xu & Cao (2016) found growth repression and apoptosis of cancer cells in the presence of musk ketone. “Musk is used to treat bacterial, anti-inflammatory, immunity-enhancing, and gas heavy diseases,” (Xu & Cao, 2016). Their findings also suggest that musk ketone can upregulate Interleukin-24 (IL-24) and DNA Damage Inducible Transcript 3 (DDIT3) in lung cancer cells. IL-24 has shown to be toxic to cancer cells and DDIT3 has shown to increase apoptosis and block the progression of cancer cells.

Ketogenic diets have also been used to treat epilepsy and childhood seizures. Evidence has shown benefits of ketogenic diets for patients with Alzheimer’s Disease or Parkinson’s Disease. Additionally, there are studies showing improvement in patients with autism, depression, polycystic ovary syndrome, and type 2 diabetes (Allen et al., 2014).

The most well known ketogenic diet is known as the Atkins diet. This diet calls for 3-4 servings of 6-ounce protein per day and 3 servings of  healthy fats per day. Depending on which diet plan you select, you can either limit your carbohydrates to 20 grams (Atkins20) or 40 grams (Atkins40), minus your fiber intake. The Atkins20 limits carbohydrate intake and suggests starchy vegetables as the primary source of carbohydrates. The Atkins40 is less restrictive and allows dieters to consume all food groups. Successful dieters have decreased fat stores, reduced appetite and hunger, and a steady sugar level. The science behind this diet parallels the mechanism behind a ketogenic state. When glucose is limited, the body is forced to use fat as energy, decreasing the total amount of fat stores in the body.

However, with every method of treatment, comes certain risks. Ketogenic diets have acute and chronic risks. Acute risks include GI discomfort, nausea and vomiting, lethargy, elevated blood ketones, hypoglycemia, and deficiency in trace minerals. Chronic risks include increased LDL cholesterol, bone mineral loss, kidney stones, decreased IFG-1, and renal damage (Allen et al., 2014). With that being said, it is important to consider these risks when determining whether or not a ketogenic diet is a good fit for you, and your dietary goals.

For more information, follow the links below:

https://www.sciencedaily.com/releases/2004/10/041020091532.htm

https://www.charliefoundation.org/

http://www.npr.org/sections/health-shots/2016/03/05/468285545/fighting-cancer-by-putting-tumor-cells-on-a-diet

 

References

Poff, A. M., Ward, N., Seyfried, T. N., Arnold, P., & D’Agostino, D. P. (2015). Non-toxic metabolic management of metastatic cancer in VM mice: Novel combination of ketogenic diet, ketone supplementation, and hyperbaric oxygen therapy: E0127407. PLoS One, 10(6) doi:10.1371/journal.pone.0127407

Xu, L., & Cao, Y. (2016). Native musk and synthetic musk ketone strongly induced the growth repression and the apoptosis of cancer cells. BMC Complementary and Alternative Medicine, 16(1) doi:10.1186/s12906-016-1493-2

Meidenbauer, J. J., Mukherjee, P., & Seyfried, T. N. (2015). The glucose ketone index calculator: A simple tool to monitor therapeutic efficacy for metabolic management of brain cancer. Nutrition & Metabolism, 12(1), 12-12. doi:10.1186/s12986-015-0009-2

Researchers develop novel ketone supplements to enhance non-toxic cancer therapy. (2015). Health & Medicine Week, 859.

Allen, B. G., Bhatia, S. K., Anderson, C. M., Eichenberger-Gilmore, J. M., Sibenaller, Z. A., Mapuskar, K. A., … Fath, M. A. (2014). Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biology, 2, 963–970.http://doi.org/10.1016/j.redox.2014.08.002


 

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

PQQ – Pyrroloquinoline Quinone

Posted by James on 08/01/2017 | Comment

Pyrroloquinoline Quinone (PQQ) is an antioxidant– supporting cardiovascular and cognitive function, and increasing energy production. It has been shown to fight reactive oxygen species, regulate cell signaling and balance redox reactions (Nascent Health Sciences, 2013). PQQ is found in a variety of vegetables and fermented foods such as parsley, green peppers, spinach, potatoes, carrots, broad beans, fermented soybeans, miso, and tofu. It is also present in green tea, oolong tea, and human breast milk. The recommendation for adults is 0.3 mg of PQQ/kg body weight/day for adults, approximately 20 mg/day for those weighing 147 pounds (Nascent Health Sciences, 2013). Although PQQ is present in a variety of foods, the amounts of PQQ is minimal. Therefore, supplementation is a potential alternative. Nakano et al. (2009) studied the efficacy and safety of PQQ, administered alone or in combination with CoQ10, and showed no adverse side effects. Studies have also been done on PQQ toxicity and Nakano et al. (2009) found no toxicity among participants ingesting 60 mg/day for a 4 week period.

Studies have shown that PQQ plays a beneficial role in nerve regeneration and repair. It stimulates Nerve Growth Factor (NGF) production and has shown to have an effect on attention, information identification, and processing abilities. Koikeda, Nakano, and Masuda (2011) found that diets deficient in PQQ, can lead to impaired memory, learning, and other brain functions. Interestingly, PQQ has enhanced effects with the addition of CoQ10 supplementation (Koikeda, Nakano, and Masuda, 2011). The positive effects of PQQ on cognitive function has lead to further research on PQQ and its role in Parkinson’s Disease. PQQ inhibits aggregation of alpha-synuclein, resulting in improved peripheral neuropathy (Nascent Health Sciences, 2013).

PQQ is also important for mitochondrial production and protection. Furthermore, an increase in mitochondrial biogenesis, leads to an increase in energy. Functional mitochondrial biogenesis has been shown to increase longevity, improve energy utility, and protect against reactive oxygen species. If mitochondrial biogenesis is not functioning properly, or if there is a depletion or mutation in mitochondrial DNA, cardiomyopathy may develop. Additionally, conditions such as lactic acidosis, developmental delay, failure to thrive, and/or impaired neurological function could result from dysfunctional mitochondrial biogenesis (Chowanadisai, 2009).

Jia et al. (2015) found that PQQ is important for reducing oxidative stress, which is associated with fibrogenesis of the liver.  Liver fibrosis can lead to cirrhosis, liver failure, and portal hypertension. PQQ acts as an anti-fibrotic agent and a reactive oxygen specie scavenger, and resultantly suppresses oxidative stress. Jia et al. (2015) found that “PQQ efficiently restrained oxidative stress and hepatic fibrogenesis in mouse models through suppressing hepatocyte death, hepatic inflammation, as well as cytokine-induced activation of haematopoietic stem cells (HSCs). PQQ also suppressed the up-regulation of RACK1 in activated HSCs in vivo and in vitro.” Haematopoietic stem cells undergo hematopoiesis, to form all blood cellular components. With that being said, Xiong et al. (2011) found PQQ to be an effective radioprotective agent by enhancing haemopoietic recovery.

PQQ is a friend to our body– particularly to our brain, vasculature, and liver. Not only can PQQ reduce oxidative stress, but also can regulate cell signaling and balance redox reactions. Although PQQ is found in a variety of food, supplementation can help to meet the Nascent Heath Sciences (2013) recommended daily intake of PQQ.

 

References

Chowanadisai W., Bauerly K., Tchaparian E., Wong A., Cortopassi G., & Rucker R. (2010). Pyrroloquinoline Quinone Stimulates Mitochondrial Biogenesis through Camp Response Element-Binding Protein Phosphorylation and Increased Pgc-1alpha Expression. J. Biol. Chem, 285 (1), 142–152.

Jia, D., Duan, F., D., Peng, P., Ruan, Y., & Sun, L. (2015). Pyrroloquinoline-Quinone Suppresses Liver Fibrogenesis in Mice. PLoS ONE. http://doi: 10.1371/journal.pone.0121939.

Koikeda T, M. Nereno, & K. Masuda. (2011). Pyrroloquinoline quinone disodium salt improves higher brain function. Medical Consultation & New Remedies, 48(5): 59-67.

Nakano M., Ubukata K., Yamamoto T., & Yamaguchi H. (2009). Effect of pyrroloquinoline quinone (PQQ) on mental status of middle-aged and elderly persons. FOOD Style, 21: 13(7): 50-3.

Nascent Health Sciences. (2013). Retrieved June 22, 2017, from https://www.nascent-health.com/.

Xiong, X.-H., Zhao, Y., Ge, X., Yuan, S.-J., Wang, J.-H., Zhi, J.-J., … Zhang, W.-C. (2011). Production and Radioprotective Effects of Pyrroloquinoline Quinone. International Journal of Molecular Sciences. 12(12), 8913–8923. http://doi.org/10.3390/ijms12128913.


 

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University

 

Seafood and Omega-3 Fatty Acids

Posted by James on 06/20/2017 | Comment

What is all the hoopla over fish? Why is it so good for you, and what makes seafood different than other protein sources? The answer? Omega-3 fatty acids.

Omega-3 fatty acids are essential fatty acids that are required for normal body functioning. However, we must make a conscious effort to include rich sources of omega-3 fatty acids in our diets because our bodies are not capable of doing so.

Good sources of omega-3 fatty acids include salmon, trout, sardines, anchovies, herring, Pacific oysters, Atlantic and Pacific mackerel, algae, and krill. Other sources include certain plants and nut oils. According to the American Heart Association and the USDA, it is recommended that we consume seafood at least 2 times a week, or 8 ounces per week (U.S. Department of Agriculture, 2016; American Heart Association, 2016).

Not only is seafood a great source of essential fatty acids, but also is a great source of protein. Protein is imperative for the development of bones, muscles, cartilage, skin, and blood. It also functions as a building block for enzymes, hormones, and vitamins. Seafood contains a variety of micronutrients, including B vitamins, iron, magnesium, and zinc. B vitamins play a significant role in our nervous system and in the formation of red blood cells, while magnesium and zinc play an important role in our bone health and immune function, respectively (Ehrlich, 2015). Lastly, seafood’s rich source of iron is of particular interest to women, who lose iron during menstruation.

Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognition, behavior, and fetal growth and development. With that being said, it is important for pregnant women to include omega-3 fatty acids in their diet to protect their child from developing vision and nerve problems (Ehrlich, 2015).

Although the research is not conclusive, it is suggested that omega-3 fatty acids are beneficial in clinical settings. For example, research has shown its role in preventing heart disease, reducing inflammation, and lowering the risk of cancer and arthritis (Ehrlich, 2015). Therefore, it is not surprising that roughly 8 percent of U.S. adults — nearly 19 million people — used fish oil in the last month (American Heart Association, 2016).

For those who are deficient in omega-3 fatty acids, symptoms of fatigue, poor memory, dry skin, heart problems, mood swings or depression, and poor circulation may become noticeable. To prevent deficiency, adequate levels of omega-3 fatty acids can also be achieved with fish oil supplementation. Epic4Health provides consumers with reputable and FDA regulated supplementation, including highly purified and varied potencies of EPA and DHA omega-3 fatty acids. For more information, visit www.epic4health.com.

 

References

Ehrlich, S. D. (2015). Omega-3 fatty acids. Retrieved from http://www.umm.edu/health/medical/altmed/supplement/omega3-fatty-acids/.

U.S. Department of Agriculture (2016). All About the Protein Food Group. Retrieved from https://www.choosemyplate.gov/protein-foods

American Heart Association. (2016). Fish and Omega-3 Fatty Acids. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jsp#.WTGphYWcG3A


 

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University