​Here are some of the take away messages from FNCE in Washington. The most enriching experience for me is the networking with colleagues from all over the world and especially from my group of IAAND (International Affiliate of the Academy of Nutrition and Dietetics). I still have to see the recordings of the sessions, but here is what I found most interesting for my practice:
1. "Prehabilitation" in pancreatic cancer: 2 weeks of physical training (individual by physical therapist) and nutrition intervention (individual by RD) prior to surgery, that includes: protein goal of 1.3-1.5 g protein / kg (combination of food and supplements) and also 5 days before surgery supplement with immunonutrients. This is part of an ongoing research at the University of Oklahoma Health Science Center. Awaiting results!
2. Prevention of metabolic adaptation in weight loss: avoid large calorie deficits (no more than 700 cal deficit) to prevent loss of fat free mass. In addition, resistance exercise has to be the main type of training, instead of cardio. Measure RMR (great variation if predictive equations are used) and also body composition, especially in those where the "eat less and move more" is not enough. With these data make prescription of calories and macronutrients (fat 20%, proteins 2-2.8g/kg of lean mass and carbs to complete). Food tracking (with apps like Fat Secret) is necessary for adherence and success. It was presented by colleagues at the University of Washington (GWU Weight Management and Human Performance Lab)
3. Presence, messages and image of the profession in social networks: common mistakes: sharing too much content or too little, or being inconsistent, mixing personal content with professional, not being real, telling all the time what you are doing, narcissism, not to establish a network both online and "offline" (in person), not to measure the results (with tools like Google Analytics, Facebook Insight), not to determine who your audience is before publishing, not having a strategic plan. Appropriate your professional "brand", establish who you are and your VALUE (what sets you apart). The content has to be great and relevant to your audience.
4. "Food Porn" dilemmas: photos of foods that are closer to reality (instead of "perfect") are those that create a more sincere relationship with the audience. It´s important to be authentic, publish something REAL and simple. That does not mean that we take bad pictures, we can always improve. With a photo we can say a lot as nutritionists. There is a relationship between the use of social networks such as Instagram, Snapchat, etc. and eating disorders and body image distorsion.
5. Medical use of cannabis: here you can see the slides and why dietitians have to be competent in this topic. Presented by the expert colleague Janice Newell Bissex, founder of https://www.jannabiswellness.com where you can buy a variety of organic hemp products, with all cannabinoids (such as cannabidiol or CBD) and terpenes that are naturally found in hemp, but without the psychoactive component THC (tetrahydrocannabinol), which makes it legal throughout the US and does not require a medical marijuana certification to buy.
6. How to evaluate the scientific evidence and translate the information: several sessions were about nutrition as a science and its controversies, how to interpret it and how to communicate it. Here part of the presentations: https://www.conferenceharvester.com/uploads/harvester/presentations/OIBKLZMD/OIBKLZMD-PDF-669463-512374-1-PDF.pdf
7. Baby led weaning (BLW) and its controversies: studies show that there is no more risk of asfixia with this method of complementary feeding vs the traditional one. In any of the methods, precautions must be taken to avoid chocking. If there can be more gagging with #BLW but this is different from chocking and asfixia. It is essential to educate parents on the part of nutritionists vs internet information.
8. Expo Hall: the expo as always is giant and with many foods and food products samples. Chickpea snacks, oatmeal "milk" drink, supplements for preoperative nutrition, nut from the Brazilian Amazon called Baruka, are some of the things that kept my attention as many of these are novelties in my country.

​Who could possible be able to memorize more than 10,000 recipes, considering tastes and textures of 2,000 ingredients, within different cuisines and special diets and, based on all this, be able to propose instantly more than 16 billions of different combinations? Chef Watson from IBM can. I discovered it recently and I'm already using it to create recipes.  I have so much fun with Watson, I’m now more open to new ingredient combinations and I can expand (not replace) my creativity.

This technology is very intuitive and easy to use: select the ingredients you want to use, the type of dish or occasion (drink, dessert, main, breakfast, etc) and if you want, special diets (such as vegetarian, paleo, gluten free). Then, the proposed recipe can be personalized and of course it has to be tested. Artificial intelligence (AI) does not replace human thinking because these recipes have to be tested and with our feedback Watson keeps learning from us.
Chef Watson works using algorithms which calculate the level of pairing of flavors and based on the psychology of what pleases or not human taste buds. You may find combinations that a priori sound awful, (like combining champagne with milk). But why don’t we try Chef Watson suggestions? Chef Watson helps culinary professionals when investigating new recipes. For those food and nutrition expert who work developing recipes or designing menus in schools or hospitals, Chef Watson can help to do it more efficiently.

Chef Watson is just a sample of the multiple applications that may have systems of AI (such as IBM Watson). AI aims to help people make more successful decisions, based on the analysis of big data. Health care is the main sector where IBM Watson is having greater interest. Centers like New York Genome Institute or Mayo Clinic, are working with IBM Watson to deliver personalized treatments to their patients. "In an area like cancer — where time is of the essence — the speed and accuracy that Watson offers will allow us to develop an individualized treatment plan more efficiently, so we can deliver exactly the care that the patient needs," says Steven R. Alberts, M.D., chair of Medical Oncology at the Mayo Clinic Cancer Center.

Another example, Food Print™ by Nutrino, an app that uses this type of technology, demonstrated a significant reduction of hypoglycemia episodes in patients with type 1 diabetes (presented at the last meeting of the American Diabetes Association). We will increasingly see more AI in nutrition and health. I was a little reluctant at first, but as food and nutrition experts we have to be prepared to use this technology that will help us to do our work better and to empower people to make healthier food choices.  See the following videos for more info.

En Español

​Who would imagine a store where you pick your groceries and just leave without going to the cashier? The future is now. Tech companies, supermarket chains, and thought-leading visionaries are working to reinvent your trip to the grocery store. It's been years of people going to one supermarket for all their shopping, but that is changing:
Online, personalized purchases.According to the Nielsen Global Report, “The Future of Grocery”, one-quarter of online respondents say they order grocery products online, and 55% are willing to do so in the future. Growth of online grocery shopping is driven in part by the maturation of the digital natives—Millennials and Generation Z. They are not just calling to order groceries, they better use the seller mobile app. Online retailers can fulfill unique customer needs, such as the desire for better-for-you foods as well as specialty-needs products.  Additionally, in the last couple of years, the market has been flooded with app-based grocery delivery companies like Instacart, AmazonFresh, Google Express App, which basically pick food from a variety of vendors and have it delivered to your door. So, will clicks replace bricks? Not so fast. For many food buyers (including myself), there are powerful sensory experiences we don´t want to lose, like smelling freshly baked bread or checking for freshness of perishable products. At least for now, that is impossible to replicate online.  
Smart carts & shopping apps. To compete with online purchases, some retailers are working on a prototype that is not new, tablet-laden smart carts with kinetic and body recognition sensors, which can provide aisle maps, calculate the best route through the store, tick items off your shopping list, give you recipe recommendations, and even save you for pushing a heavy cart. On the other hand we have lots of available grocery shopping apps in our smart phones like Anylist, Buy Me a Pie!, Grocery iQ and some retailers own apps. These are designed to create grocery shopping list, share lists with others, use coupons, find deals, store recipes and organize your meals. 

​Cashier-less stores.Amazon Go, an innovative concept that’s being piloted in a downtown Seattle grocery store that lets customers walk in, grab food from the shelves and simply walk out again, without ever having to wait in a checkout line, no cash or credit cards, just you need your phone and the company account. Walmart already launched (in two locations) the app Scan & Go where customers scan items with their phone as they shop, pay via the app and show the receipt from their phone on their way out.  
Recreating the supermarket experience. Companies are focusing on how to create an experience, a reason to come to the store (considering that potential customers are doing groceries online). Some supermarkets offer wellness and health services, while others have brew pubs and restaurants inside to attract millennials. 

Every May and in many countries, celiac disease associations gather efforts to increase awareness about celiac disease and to educate the public about early diagnosis and the gluten free diet, its only treatment (that has to be planned by an expert dietitian) 
In Argentina, Celiac Disease Day is celebrated on May 5th
In Uruguay and Chile, Celiac Disease Day in on May 6th
In Europe is on May 16th (in Spain is on May 20th), while in the United Kindom Coeliac Disease Week is on May 11-14th. 
In the US, the National Foundation for Celiac Awareness, puts together lots of free resources from e-cooking books to live webinars. 

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 August is going to be the first ever Kids Eat Right month, a national educational and action campaign promoted by Kids Eat Right (KER) from the Academy of Nutrition and Dietetics. Coincidence or not, in some countries of the world like Argentina, Uruguay, Perú and Paraguay, Children´s Day is recognized the second Sunday of August to honor children. What a great idea to celebrate this month with healthy nutrition and active lifestyles for children and families, offering simple steps to help families cook healthy, eat right and shop smart. The Academy has developed information resources to share with family, schools, community leaders and dietitians. We all have a role in ensuring a healthy future for our children. Find out all of these resources 

·  Parents and Kids

·  Registered Dietitian Nutritionists

·  Schools

·  Community Leaders and Groups

·  Media

You can also volunteer in many ways for this campaign and don´t forget to follow KER on social media!

Soccer teams are now in Brazil playing the 2014 FIFA World Cup, one of the most important sport events worldwide. Here in Argentina, it means more than a sportive event. The whole country paralyzes, people literally stop working to watch the games (while eating not very healthy snacks…) The most exciting part of the World cup starts today with the best 16 teams (Argentina, Argelia, Chile, Colombia, Uruguay, USA, Suiza, Honduras, Brazil, France, Mexico, Netherlands, Belgium, Greece, Costa Rica, Nigeria). Now, elite players prepare to play each game at maximum pace with not much time between games to recover. Diet may have its biggest impact in this phase.

Getting the right amount of energy to perform well is key, says FIFA on a nice nutrition segment of its website.  Each team has people that carefully choose the right foods and fluids for players to eat during training, pre and post game and for recovery. A good diet can help support consistent intensive training while limiting the risks of illness or injury. That’s why many teams have dietitians or nutritionists on their delegations. For instance, USA´s team coach Jürgen Klinsmann has Danielle LaFata, MS, RD, balancing the high calorie needs of athletes with healthy eating. Klinsmann himself models healthy eating by emphasizing organic and local varieties of whole foods in his own diet.  “He’s very involved,” team dietitian Danielle LaFata said to the Associated Press. “I think he’s more nutrition conscious than myself sometimes.” The US soccer team is urged to eat more fruits and vegetables and goes through a case of avocado each day!  Meanwhile, Italy´s team nutritionist Elisabetta Orsi, emphazises a tricolor diet: “Pasta is our preferred fuel, and before matches we play with the tricolore: pasta with parmesano (white), prosciutto (red) and extra virgin olive oil (green), our natural medicine brought from Italy”, said Elisabetta to the Corriere dello Sport. But, unfortunately Italy couldn´t do it to this round of the Cup and were sent home. Lastly, according to the AFA website, Argentina´s delegation in Brazil does not have a dietitian in the team. They have chef and a kitchen assistant.  They are not fueling on alfajores anymore... The New York Times reported that, Lio Messi used to be rewarded alfajores for scoring goals when was a kid. Now, Argentine players’ diet is based on carbs (pasta, potatoes, sweet potatoes and rice), proteins (grilled meats like chicken, fish and beef) and vegetables (like broccoli, asparagus, spinach and green beans). For dessert, seasonal fruits and queso y dulce (an Argentinean dessert made of cheese and dulce de batata which is a sweet potato hard jam). All foods are local (Brazil) except from dulce de leche and dulce de batata that were brought from Argentina. What about the Argentinean asado? They eat this typical Argentinean barbecue while in Brazil but without organ meats. And, I suppose mate is present too!


At this stage of the Cup, the margin between victory and defeat is small. Attention to detail can make that vital difference. Maybe we can learn from players to chose foods (our fueling) more wisely to “perform” better in our life. See the FIFA nutrition booklet here and:

From the Academy Website: U.S. Men’s National Team Dietitian Fuels Performance:
http://www.eatright.org/Public/content.aspx?id=6442481504

Proper hydration. Even the slightest dehydration will impact performance. Playing soccer in Brazil's hot and humid weather increases fluid needs, and players may require as much as 10 liters per day. Electrolyte beverages, fruit and vegetable juices and smoothies contribute to a player's hydration needs. All contain vital nutrients such as potassium and magnesium, which are lost in sweating.

Food first. In a sports world of heavy supplementing, Team USA's goal is to get their primary fuel from nutrient-rich foods. If needed, supplementing is customized for the individual, but food always comes first. An example of a meal three to four hours prior to a game would include whole grain pasta with Bolognese sauce, chicken breast, grilled asparagus, watermelon and pineapple.

Post workout eating. In order to minimize muscle soreness and maximize muscle recovery, post workout smoothies with the right amount of protein and carbohydrates are given after workouts within 30 to 45 minutes. One post-workout snack LaFata makes for the team includes 25 grams of whey protein mixed with water and 1½ bananas.

80/20 principle. Athletes should eat highly nutritious foods including lean proteins, brightly colored fruits and vegetables, whole grains, beans, nuts, seeds and low-fat dairy 80 percent of the time. The other 20 percent can be other foods that might be higher in fat and sugar. Team USA has their "20-percent meal" 24 to 48 hours after a game. After that, it's back to fit eating.

High nutrition with healthy fats. Players achieve high calorie needs by blasting their diet with a variety of plant-based foods while also adding healthy fats through nuts, seeds and olive or canola oils. The higher the calorie needs, the more generous you can be with healthy fats.

Healing foods for injuries. Team USA has dealt with their share of injuries at the World Cup. For injury recovery, LaFata recommends emphasizing whole-grain foods such as oatmeal, quinoa and wild rice. Other injury recovery foods include fatty fish, green leafy vegetables and legumes.

The following is a guest post (from my husband´s website medicosmba.com) that I found very interesting for us food and nutrition practitioners. Check it out!

When I think how healthcare has change with Google, the first thought that comes to my mind is how useful searching is for keeping up to date and easily learn new things. Well, Google’s mission is to organize the world’s information and make it universally accessible and useful. However, this is just the beginning: there are lots of things that healthcare should look up into Google’s ways. Let me show you why…

Google has been one of the fastest growing companies in the world. Let’s just mention their some financial data: FY ending 2013 reported revenue for almost USD 60B and a net income of almost 13B. Both revenue and net income have steadily increased in the last few years. What Google has done to achieve this impressive results?

You might be able to resume everything with the first statement of Google’s beliefs: “Focus on the user and all else will follow”. Just think of how many things we do everyday with Google’s services and how almost everything is for free: searching, email, docs, analytics, maps and so on. Also, user experience with each one of these products is great. There are designed to solve some aspect of our everyday life. So, how does Google make any money? Advertising is the answer. It’s kind of making money from the back door. Google reinvented advertising, it charges for performance (what is called pay-per-click) and not any more for time or space.

So, where are the healthcare links here? First, think about this “focus on the user and all else will follow”. Focusing in the patient is the key. It seems so obvious, but how many times we rush with things that so little have to do with our medical practice? Most of us studied medicine to care for patients, right?  So, here’s the first thing: just care about the patient and do what you think is best right thing for him.

Let’s go one step further: data that is accessible and transparent. Google has made it possible for everyone to find almost everything on the web. If a client had a bad experience with a brand, you’ll find it. Healthcare has just begun the journey of opening data up. It is common among doctors to be jealous about our knowledge and more often than not, data is kept and not shared. This is especially true when the results are not good ones: how much common is to hear about the great results of some surgery than about the complications. You can learn much more from the cases that didn’t go that well, than from the straightforward case. Why should we private ourselves from this kind of learning? It’s a fact that many hospitals started to show their data and made it accessible for everyone. However, this doesn’t happen everywhere and some parts of the world are even far from starting with initiatives like this. Why a patient that comes to visit me shouldn’t be aware of how many patients I treated with his condition? Or what my complication rate is?

Lastly, another Google’s statement: “Great just isn’t good enough”. As health care practitioners, its necessary to be great but clearly this is not enough to surpass yourself. And when it comes to do the best for our patients that extra mile always counts.


Guest post from Sebastian Defranchi, MD -  MedicosMBA

To culminate this NNM, themed Enjoy the taste of healthy eating, I´d like to share two aspects of Argentina´s food culture: family meals and simplicity:

Family meals 

In Argentina, we usually take the time to sit and have a meal. In the big cities, many people have lunch at work but they do share the other mealtimes with family. It has been shown that shared mealtimes makes family members feel loved, confident and happy. Also, homemade food in Argentina includes many preparations from scratch with few processed ingredients. Sharing mealtimes with your kids and involve them in the cooking process will make them have better eating habits since childhood.

Simplicity

Enjoying food prepared with fresh and minimally processed real ingredients is a national tradition. When you visit the supermarket you will see that there is not much variety of frozen meals or processed food boxes. Supermarkets aisles are not that overwhelming like in other parts of the world. Another example of simplicity: in Argentina the typical salad dressing is oil and vinegar (commonly olive oil and balsamic vinegar). That’s what the waiter will bring you to season your salad if you are eating out. And, don’t look for salad dressings in the supermarket, you won’t find much. Some of the typical condiments are mayonnaise, mustard, ketchup and salsa golf (an Argentinean creation that resembles Thousand Island dressing). Just make your own dressings and toppings with real ingredients and bring in simplicity to your dinner table!

Meats are also lightly seasoned with just a pinch of salt and pepper (and sometimes chimichurri). No one puts butter or other toppings on a grilled steak, there is no need.  And, recently, the province of Buenos Aires banned the salt shaker from restaurant tables in an effort to combat high blood pressure. It will be available upon request, but only after the guest have tasted the food. The new restaurant trend in Argentina is to get back to basics, value regional meals and natural ingredients. 

Healthy eating doesn´t have to be boring. This year´s NNM theme remind us to enjoy food. What I like to do is to experience food ingredients from other cultures and take healthy and tasty ideas from each one. For example, it is known that many Americans don´t eat very well...but not all is wrong. For example, in the US I´ve learn to have dinner earlier (usual dinner time in Argentina is 9pm) and have a better digestion before going to bed. Also, I´ve seen that many Americans respect seasonality of fresh fruits and vegetables, making certain dishes at certain times of the year. Seasonal produce is less expensive, more nutritious, taste better and is more natural. When I was in Brazil, I took from them the idea of having fresh fruits at all meals. From Mexico, I took the idea of adding onions and peppers (even the spicy ones) to many recipes reducing the amount of salt when cooking, as well as adding avocado to many dishes. There are many other examples. Like Japanese, one of the healthiest cuisine, with sushi (most sushi is low in fat and has lots of fresh ingredients). Another pretty healthy cuisine is Greek, with its dark leafy veggies, fresh fruit, high-fiber beans, lentils, yogurt, olive oil, and omega-3-rich fish. 
As an Italian (my dad was born in Calabria), I´ve learn to eat lots of vegetables and mainly the pleasure of food. Because of the Italian immigration, this was an influence in the Argentinean food culture too. Meal times are moments without any rush, where you can share with family and friends while enjoying food. 
I use to take one day of the week (Fridays work for me) to enjoy a different ethnic meal. Sometimes I have to tweek ingredients that are not available here, but it´s fine and FUN! 

-Romina