A recent article, “Applying the Precautionary Principle to Nutrition and Cancer” (Gonzales, 2014), was published in the Journal of the American College of Nutrition with guidelines for eating and cancer prevention. What is new about the report is the recommendation to limit or avoid milk and dairy products as part of a more plant based diet to prevent cancer. The evidence comes from the 2007 report of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and other evidence sources published after the WCRF/AICR report. The authors say that people cannot wait for evidence based consensus and that families have to act now on the best available evidence. So, they developed 6 dietary principles (see box) in which evidence of dietary influence in cancer risk is substantial, even if not conclusive. The report lists 6 guidelines that recommend eating more vegetables and fruits, more soy products, little or no alcohol, little or no dairy and red meats and avoidance of meat that has been fried, grilled or broiled.
SUGGESTED DIETARY GUIDELINES FOR CANCER PREVENTION*:
1. Limiting or avoiding dairy products may reduce the risk of prostate cancer.
2. Limiting or avoiding alcohol may reduce the risk of cancers of the mouth, pharynx, larynx, esophagus, colon and rectum, and breast.
3. Avoiding red and processed meat may reduce the risk of cancers of the colon and rectum.
4. Avoiding grilled, fried, and broiled meats may reduce the risk of cancers of the colon, rectum, breast, prostate, kidney, and pancreas. In this context, meat refers to red meat, poultry, and fish.
5. Consumption of soy products during adolescence may reduce the risk of breast cancer arising in adulthood. Soy products may also reduce the risk of recurrence and mortality for women previously treated for breast cancer.
6. Emphasizing fruits and vegetables in your diet will likely reduce the risk of several common forms of cancer.
* Note that this review specifies suggested dietary guidance in which evidence of a dietary influence on cancer risk is substantial, but not necessarily conclusive
It is not new that there are many advocates for a diet that totally excludes dairy products –milk, yoghurt, cheese and butter- arguing that this helps to stop cancer cells from growing, especially hormone-related cancers such as prostate, testicle and ovarian cancer (see the Milk article in the latest FNM). But, what says the evidence? Studies that investigate a link between dairy and cancer are inconclusive. Some research shows an increase in the risk of developing prostate cancer (Li-Qiang Qin 2009), while others show possible protective role of dairy products on colorectal cancer risk (Murphy, 2013). And, consumption of dairy products has not been identified as a risk factor for breast or other types of cancer (Pala, 2009).
Despite evidence limitations, when it comes to milk and dairy, the article published in the JACN suggest: “Limiting or avoiding dairy products may reduce the risk of prostate cancer”. It was found that eating 35 grams of dairy protein (more than 4 cups of milk) increases the risk of prostate cancer by 32%. It´s believed that the mechanism to increase prostate cancer risk is the ability of a large oral calcium dose to suppress vitamin D activation and the tendency of milk to increase serum insulin-like growth factor-I (IGF-I) concentrations.
The authors acknowledge disadvantages of this recommendation and suggest eating other sources of calcium (leafy vegetables, legumes, and calcium-fortified foods). As a food and nutrition professional, I believe that the recommendation of limiting dairy for cancer prevention can be risky and confusing for the press and for the public, specially, because dairy products are the main dietary source of calcium, an essential nutrient for bone health and may even prevent colon cancer. I think that, for now, we should focus on a total diet approach and recommend a healthy, well balanced diet (with more than 5 serving of fruits and vegetables daily). Calcium should be part of that diet, and milk is an important source of calcium.
This week is the RAWFEST in Buenos Aires, an event dedicated to promote the philosophy of “raw food”. It will be located in the Faena Hotel from February 18th to 22th and is organized by the Hippocrates Health Institute from Florida, USA. The event will have conferences with international speakers, workshops, free samples and live music. This event inspired me to write this post and to get the raw food diet naked.
· What is raw food diet? Also called "live food diet" or vegan raw, people that follow this diet eat fresh vegetables and fruits, nuts and algae, all cultivated without agrochemical processes and without heating them to more that 107ºF, to supposedly preserve their nutrients and boost energy and vitality production and to promote mental and physical health. Raw food diet followers believe that heat “kills” foods reducing their nutrients, making them toxic and less digestible. Foods are consumed raw, dried with low temperatures or fermented.
· Mith: heat destroys nutrients. It is true that fresh fruits and vegetables are very nutritive. But, heat destroys cells walls and fibers increasing the disponibility and digestibility of several nutrients. For example, cooked tomate has more lycopene available or cooked carrots have more beta-carotene available than raw. We should eat both raw and cooked vegetables to get the best of both groups.
· Mith: cooking destroys food enzymes. This is true. Heat destroys enzymes, but is doesn´t matter because the body produces their own enzymes to digest food. Even more, raw food enzymes are destroyed by stomach acid. And, if raw food had their own enzymes to help digestion they would autodigest before we can eat them!
· Another crash diet? Raw food is a tendency that growths globally and we as food experts must be well aware of it. Celebrities like Natalie Portman, Demi Moore y Robbie Williams are raw food diet followers. Now, I wonder whether in Argentina this is a culinary trend or another crash diet that we will forget about in the next few months. Some have already seen the business aspect and several restaurants in Buenos Aires started to commercialize raw foods like Kensho y Buenos Aires Verde, Buenos Aires Raw Club. Others restaurants like Experimental Raw Bar y Verde Llama went out of business.
· Raw vs. Asado. It´s kind of difficult to follow this diet 100% (adherents try to consume 50-100% of all foods raw) , specially in Argentina....First, our food culture is way different from a algae and pea´s sprouts salad (Argentina is the country with the highest beef consumption in the world). Second, some raw recipes are time consuming even with no “cooking”. And, some food are really costly here in Argentina (if you can get them). On the other hand, this diet has to be well designed with professional help to prevent nutrition deficiencies. It is not recommended for kids because inadequacy of some nutrients. Depending on personal preferences some people include raw milk and raw meats like in ceviche, carpacchio or sushi.
What is good about this diet is that promote the consumption of healthy vegetables and fruits. But their rational seems to be more philosophic than scientific. I truly respect their followers, but as a nutritionist I think that it has some risks and has to be well planned. What do you think?
The last part of these FNCE 2011 Highlights is dedicated to present some of the new food products that are being offered today in the U.S. market. The EXPO floor was amazingly big and full of goodies. More than 300 exhibitors presented their products, including specialized food products, food delivery equipment, nutrition assessment tools, computer programs, educational tools, cooking products, food management gear, etc.
Live culinary demonstrations were also showed by chefs and RD teams, with new dishes with quinoa, whole grains, cocoa and others.
Some of the new food products are:
Are your patients/clients tired of the same old liquid supplements? Blue Bunny® presented an ice cream called NUTRI-plus™, a real ice cream loaded with nutrients ideal for those that are not eating well. It comes in orange, vanilla and cherry chocolate flavors. A 4oz. cup contains 240 calories, 9 grams of protein and 10-20% of the daily value of most vitamins and minerals.
Nutritionally balanced meals ready to eat. Go Picnic™ makes boxed lunches that need no refrigeration, heating or preparation. They are easy to carry and are meant to be enjoyed anywhere. Also made with clean ingredients, with no trans fat, no added monosodium glutamate (MSG), no high fructose corn syrup (HFCS) and no artificial flavors or colorings. My favorites were salmon + crackers and hummus + crackers, but in my opinion they are more like snacks than a “meal” as they lack in many components of My Plate....
No excuse not to eat fruit. Crispy Green® presented its new snack fruit: Crispy Cantaloupe, which is another of their freeze-dried fruits available in convenient single-serving (15-gram) bags or a "Grab and Go" 6-pack. It’s 100% fruit and nothing else!
Medical Nutrition going organic. PediaSmart® SOY is a complete formula designed to be used as a supplemental beverage or to be delivery through tube feedings for children 1 through 13 years. It has no corn, gluten, GMO ingredients.
YERBA MATE FOR EVERYONE! I was surprised to find the tradicional argentinean drink in one of the Expo booth. They offer the traditional loose herb (yerba mate) and a great variety of tea bags with flavored mate drinks as well as cold mate drinks. When I told them I was Argentinean they used me to test their products!! They taste real and are authentic as the yerba mate is imported from Argentina, Paraguay and south of Brazil. To learn more about mate click here.
Jack Canfield on FNCE 2011 closing session
Finally, I want to highlight the closing session which was very inspiring and motivating. Jack Canfield, author of Chicken Soup for the Soul among other books, presented the Success Principles. My favorite quote was "If you want to be really successful, and I know you do, then you will have to give up blaming and complaining and take total responsibility for your life -- that means all your results, both your successes and your failures. That is the prerequisite for creating a life of success."
I hope you enjoyed these FNCE highlights and please share comments or other news. Thanks!
Hey all! In this post I will continue sharing the best of FNCE 2011. I hope you enjoyed the first part of this FNCE highlight series. As I said before, FNCE is a conference that gives content to talk about for a while. It’s impossible to cover all topics, thought. So, I just selected some of the topics that are in my opinion more interesting. Otherwise you can access to speakers presentations on the FNCE website.
§ The Skeleton’s Out: A Standardized Approach to the Recognition and Documentation of Malnutrition. The ADA Malnutrition Workgroup and the ASPEN Malnutrition Task Force have worked together to get a consensus on how to diagnose and document malnutrition. Several characteristics of malnutrition were acknowledged and any 2 or more of these 6 characteristics can be used to diagnose malnutrition:
o Evidence of reduced intake: for instance > 5 days with intake of < 50% of total estimated energy requirement (acute illness/injury category or suboptimal intake like > 1 month with a nutrient intake of <75% of total estimated energy requirements (chronic illness/condition category)
o Unintended weight loss: > 2% weight loss in 1 week or > 7.5% in 3 months
o Changes in body composition: loss of subcutaneous fat
o Changes in body composition: loss of muscle mass
o Changes in body composition: fluid accumulation
o Measures of physical function/performance: hand grip strength, stair climbing
The speakers (Dr. Jane White and Dr. Annalynn Skipper, both dietitians) mentioned that these characteristics to identify malnutrition represent a work in progress and that they may change overtime as evidence is collected to support their appropriateness. If you are interested in learning more, here is the handout.
§ The War on Obesity: A Battle Worth Fighting? This was a provocative debate between an antiobesity researcher, John Foreyt, PhD, and Linda Bacon, PhD, a nutrition researcher, author of Health at Every Size (HAES), where she proposes an approach were people don’t have to lose weight to live longer and encourages “Accepting and respecting the natural diversity of body sizes and shapes”. Bacon presented research that shows that obese people live as longer as normal weight people. But, how can she ignore the quality of life of the obese? Or the cost of their health care? I don’t agree with Bacon statement “the best way to win the war against fat is to give up the fight”and neither have I agreed with Foreyt when he dismissed mindful or intuitive eating. One thing, where the two speakers have agreed is that restrictive diets don’t work. But, we can’t just say that “diets don’t work”. We need to help people to incorporate life lasting healthy eating habits. Don’t you think?
§ The Skinny on Bariatric Surgery: Illuminating the Evidence from Early Stage CKD through Transplant. Dr. Maria Collazo-Clavel from Mayo Clinic highlighted how post bariatric surgery patients started to show up at the Stone clinic as renal stone formation (specially calcium oxalate stones) became a common condition after bariatric surgery, mainly due to dehydration, diet composition (low in protein/calcium), fat malabsorption with hyperoxaluria. The next speaker, dietitian Judith Beto, PhD pointed out how bariatric surgery can be useful in reducing BMI to decrease surgical risks prior to renal transplantation. Nutrition therapy for renal patients after bariatric surgery is well addressed by Rachael Majorowicz (moderator of this session) in “Nutrition Management of Gastric Bypass In Patients With Chronic Renal Disease” (Nephrology Nursing Journal March-April 2010:37:171)
§ How Risky is Our Food? Clarifying the Controversies of Chemical Risks. In this session, Julie Miller Jones, PhD, LN, CNS, board member of ILSI, showed that despite acrylamide is considered a carcinogen in the laboratory, studies have reported that everyday exposure to acrylamide in food is too low to be of concern. Acrylamide in food forms from sugars and an amino acid when foods are cooked, specially at high temperatures. There are some ways to reduce acrylamide in your food, like: toast lightly (scrape off very dark areas), allow long yeast fermentation, bake and fry at right temperature (don’t over-brown), store potatoes properly (not in the fridge) and cook them with skin on.
The next speaker, Carl Winter, PhD, a fellow of the Institute of Food Technologists and a Board member of the FDA, showed his research about organic foods and challenged all their claims. He questioned the methodology used by the EWG on the “dirty dozen list” and showed data where organic foods are not healthier than conventional ones.
Great piece of the audience criticized this session for the lack of balance. Would have been nice to hear from researchers that supports organic foods as well. Take a look at the handouts here.
That’s all by now. Don’t miss the next post, with info about new products presented at the Expo and closing session remarks!
I was so fortunate to attend -for the first time- to the largest nutrition and dietetics conference in the world. I had to travel to the other hemisphere but it totally worth it. Wow… The American Dietetic Association really knows how to put together a conference! It was held last week in the beautiful sunny city of San Diego. The Convention Center was so huge that I actually did my daily workout by walking around it. Also, the energy felt in the air …with thousands of dietitians under one roof …was amazing and inspiring (there were around 9000 attendees). FNCE is not only a place to learn and get updated on the changing field of nutrition, it is also a true opportunity to network with peers and grow personally and professionally.
So, I would like to share with you some of the FNCE 2011 repercussions. There is so much to share that I will post it in three parts.
- I was surprised, at the Opening Session on Saturday 24th, when ADA President Sylvia Escott-Stump announced that the ADA changes its name to Academy of Nutrition and Dietetics, effective January 2012. The reason was to better communicate our identity. The term academy better represents the aim to advance science and "by adding nutrition to our name, we communicate our capacity for translating nutrition science into healthier lifestyles for everyone”, Escott-Stump said. Do you think the name change was a good idea?
- The Wimpfheimer-Guggenheim International Lecture: “Opportunities for International Nutrition Work” held on Sunday 25th showed three different professionals paths in international nutrition. All of the speakers shared tips and resources especially for those students looking for the dream of working/volunteering overseas. One of the most important ones I took from them is to be international before going abroad. For instance: learn a second language; participate in local internationally focused activities and if you travel, go beyond the touristic spots. See my previous post about Dietitians learning a foreign language. Also a person from the audience added that AODA is a great resource.
- The member showcase on Monday 26th was a very interest live debate between two leading experts. The session was titled “Sweet Scrutiny: Debating the Research on Nutritive and Non-Nutritive Sweeteners”, but the really issue discussed was whether sugary drinks can be blamed for the growing obesity. Dr. Theresa Nicklas pointed out that consumption of added sugar in the U.S. is decreasing but –paradoxically- obesity rate keeps growing. Also, she stated that the evidence is inconclusive when we link carbonated beverage consumption with prevalence of overweight. On the other hand, Dr. Barry Popkins, is convinced that sugary drinks promotes the obesity epidemic and believes that sodas should be taxed in the similar way as tobacco because it’s deleterious to our health. He argued that one should be carefull when analyzing studies, as many of them were funded by beverage companies with results more likely to be “industry-friendly”. He also pointed out that liquid calories are not the same as solid ones, saying that “if we take in 200 calories in liquid, we won’t eat 200 fewer calories from food” (to compensate). To this, Dr. Nicklas replied back saying that “a calorie is a calorie” and that “If we’re going to tax soft drinks, why not tax pizza or donuts? We’re fighting the wrong battle here. We need a total diet approach”, prompting a round applause from the audience. What do you think? Share your opinion, and I will share mine.
Stay tuned for more. Next post I will talk about the organic controversy, standardized approach and documentation of malnutrition, bariatric surgery and more. The third part of these highlights will be based on new products from the Expo. Don’t miss it!
This past week I attended to the largest meeting in nutrition support in Argentina (and probably in Latin America) organized by the Argentinean Asociation of Enteral and Parenteral Nutrition (AANEP). It was held in Buenos Aires and it was a great place to be to connect with colleagues and to hear from the best of the bests professionals in nutrition support. Some of the highlights were:
- One question, one test for nutrition screening (Dr. Peter Soeters): “How much weight have you lost in the past 6 months? Now give me a handshake” Functional tests like handgrip strength are good tools.
- There is no specific diet for diverticulosis. Many patients have symptoms because of concomitant irritable bowel syndrome (IBS). “Ispaghula” is a type of fiber that helps to alleviate diarrhea and constipation in IBS
- Clinical Practice Guidelines for acute pancreatitis (AANEP): Consider enteral nutrition as the first choice to feed. Gastric feeds are possible, using standard formulas. Do not give arginine nor probiotics
- Liver failure: do not limit proteins! No benefit has been shown in encephalopathy
- When implementing early enteral nutrition: don’t forget your patient. Be cautious, watch for distention, pain, acidosis, NG output, hemodinamic changes. Optimize enteral nutrition delivery to limit the use of supplemental parenteral nutrition, which may increment risk of infections /mortality (Dr. Martindale).
- Oral intake assessment: choose a method to estimate oral intake. Then, improve hospital menus to optimize intake and decrease waste. Good gastronomy in the hospital can also improve overall patient satisfaction with the hospital stay.
- Health care professionals (and the patient) can benefit using tools from marketing and business science.
- Use of protocols to improve outcomes (Dr. Heyland)
- All critically ill adult patients should receive enteral and/or parenteral glutamine (Dr. Paul Wischmeyer)
- Never limit proteins in acute renal failure in critically ill to prevent patient from renal replacement therapy. There is no need/benefit of enteral renal formulas.
And many other things ... Stay tunned for upcoming meetings organized by AANEP and FELANPE (Federacion Latinoamericana de Nutricion Clinica y Metabolismo)
I recommend you to read the article from the March issue of the Journal of the American Dietetic Association, which addresses the need of dietetic professionals to serve the Hispanic population. The article describes the challenges in the health and nutrition care of this population and states that the ideal for RDs that serve this population is to be fluent in Spanish. That makes sense. It is not enough to know names of food and simple phrases if you want to connect with your clients and change the way they are eating. If you are thinking about interpreters: they are not always available, and if they are, many concepts can be lost in translation depending on the interpreter’s understanding.
So, I imagine there are many dietitians and dietetic technicians learning Spanish right now. Have you ever felt frustrated learning a new language? I did! Learning a foreign language is a fun, but difficult task. It’s something you cannot learn in a few “intensive” classes or months. It takes time and effort. I’m native Spanish and I have learned English at high school, plus private lessons for 2 years. But it wasn’t until I move to the U.S. that I started to learn the real language. At first, I only was able to understand half of what people said to me and it was hard for me to find the words to express my thoughts. I felt so frustrated and embarrassed! Reading English was easy for me but it was harder when it came to listening and talking. I was not used to hear and make those new sounds all day (as you imagine I had many headaches). With time, I became more fluent and realized that the best way to learn a foreign language is when you are in a situation where you are forced to use the language on a daily basis.
After 2 years of living in the US, I came back to Argentina where I was afraid of losing the English fluency I had achieved. Well, it’s been almost 3 years since then and here I am, forcing myself to use the language daily! J
I read, write, talk and listen to some English every day. It’s not hard because here we are exposed to music, movies, technology, and also professional continuing education and research updates that are in English.
But, what if you are an English speaking person learning Spanish? I’ve heard is more difficult to learn Spanish for you than English for us, because of all the Spanish pronouns, articles and verb variations, and of course the pronunciation. But don’t panic. You can take Spanish lessons but it is key to have a “workout” plan to master the language. Plan something for everyday to use the language. Some examples:
Are you learning a foreign language? How? Please share with us any other tip!
I hope this helps and buena suerte!
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