Transcript Document

Low-fat Pizza
Adele Hite, MAT
PhD candidate, Nutrition Epidemiology
MPH/RD candidate, Nutrition
Gillings School of Global Public Health
University of North Carolina at Chapel
Hill
Healthy Nation Coalition, Policy Chair
USDA Diet Untested &
Unproven
“The [USDA] food patterns were developed
to meet nutrient needs, . . . while not
exceeding calorie requirements. Though
they have not been specifically tested for
health benefits, they are similar to the
DASH research diet and consistent with
most of the measures of adherence to
Mediterranean-type eating patterns.”
--from the 2010 Dietary
Guidelines
Prevalence of Obesity among US adults
(20-74 years)
Percent of population
40
35
30
1st USDA Dietary Guidelines
25
20
15
10
5
0
1950
1960
1970
1980
1990
2000
Source: CDC 2010
2010
Food Availability Data, USDA
700
600
Calories
500
400
1970
300
1990
2008
200
100
0
Flour & Added fats &
cereal
oils
products
Dairy
Calories available from:
Flour & cereal products
Added fats & oils
Other fats - dairy
Meat, eggs, nuts
Fruit
Vegetables
Caloric
Other fats - Meat, eggs,
sweeteners
dairy
nuts
1970
432
403
6
463
71
125
1990
573
446
15
453
85
126
Fruit
Vegetables
2008
625
616
25
482
87
122
+193
+213
+19
+19
+16
-3
Dr. Janet King
Chairwoman of the 2005 Dietary Guidelines Advisory
Committee
“[E]vidence has begun to accumulate suggesting that a
lower intake of carbohydrate may be better for
cardiovascular health.”
Institute of Food and Medicine 2005 Macronutrient Report
“. . . [L]ow fat, high carbohydrate diets may modify the metabolic
profile in ways that are considered to be unfavorable with respect
to chronic diseases such as coronary heart disease and diabetes”
BUT, the USDA 2010 Dietary Advisory Committee
Report says:
“Healthy diets are high in
carbohydrates.”
• blood sugar goes up
• insulin goes up to
remove sugar
• low-fat highly
processed grain &
cereal products
• Eat less?
• Move more?
Dietary
Sugars &
Starches
Elevated
Insulin
Hunger
&
fatigue
No
available
fuels
• blood sugar goes down
• fat is stored
• fat use is stopped
“The low-fat– high-carbohydrate diet, promulgated
vigorously . . . by the U.S. Department of Agriculture
food pyramid, may well have played an unintended
role in the current epidemics of obesity, lipid
abnormalities, type II diabetes, and metabolic
syndromes. “
Dr. Sylvan Lee Weinberg
Director of Medical Education at the Dayton Heart Hospital
Clinical Professor Medicine at the Wright State University School of Medicine
past President of the American College of Cardiology
2010 Dietary Guidelines Advisory Committee
Report
“Adequate intake of high-quality protein is
essential for health.”
Institute of Medicine 2005 Macronutrient Report
“The lower limit of dietary carbohydrate
compatible with life is apparently zero.”
Calories
Protein (g)
Sugar (g)
Price/
serving
Number of
ingredients
Sausage
(1 1.5 oz patty)
170
12
0
0.50
5
2 whole eggs
Cheese (1/4 cup)
140
100
12
6
0
0
0.22
0.21
1
4
Total:
410
30g
0
$0.93
10
Calories
Protein (g)
Sugar (g)
Price/
serving
Number of
ingredients
Instant oatmeal
(1 package, ½ cup)
160
4
7
0.37
17
Fruit & veggie blend
drink (8 oz)
100
0
23
0.93
11+
Soy yogurt (6 oz)
150
410
4
8
21
41
1.00
$2.20
15
43+
Total:
“Eat less, move more”
The real message:
“Eat less, BUY more”
Peter Farnham
Director of Government Relations
Nutrition and Metabolism Society
Energy intake during the obesity epidemic.
Data from CDC.
Low-Fat Message Backfired
"The country's big low-fat message backfired.
The overemphasis on reducing fat caused the
consumption of carbohydrates and sugar in our
diets to soar. That shift may be linked to the
biggest health problems in America today."
Dr. Frank Hu
Professor of Nutrition and Epidemiology at the
Harvard School of Public Health.
What about the Shortfall
Nutrient
Choline?
Pamela
Schoenfeld, RD
Director, Healthy Nation Coalition
www.forahealthynation.org
[email protected]
February 14, 2011
Choline is essential
Functions include:
– Neurotransmitter synthesis (acetylcholine)
– Critical component of cell membranes
(phosphatidylcholine)
– Lipid transport from the liver (lipoproteins)
– Major dietary source of methyl groups that
regulate metabolic pathways and detoxify
body
– Important role in brain development in
fetus, influencing lifelong learning and
memory.
(Zeisel & da Costa 2009; Sanders & Zeisel 2007)
Choline requirements
• Choline can be endogenously synthesized but this
will not meet human requirements (Zeisel & da Costa
2009).
• Only 1 out of 10 American adults are meeting the
Adequate Intake guidelines for choline (425-550
mg/d), including pregnant women. (ENC, Jensen et al
2007).
• 10% of adults studied developed fatty liver and/or
muscle damage even with AI of choline; resolved
on high-choline diet (Zeisel & da Costa 2009).
• “Although the choline Adequate Intake level may
be an overestimate of dietary requirements, data
derived from highly controlled feeding studies
involving adult men suggests that this is not the
case.” (Caudill 2010).
Choline deficiency causes
illness
• An early clinical sign of deficiency is
development of fatty liver from lack of
phosphatidyl choline to export VLDL (Sanders
& Zeisel 2007).
• Elevations in muscle enzymes (da Costa 2006).
• Associated with increased risk of neural
tube defects – 4 times in lowest quintile of
maternal intake or < 300 mg/d (Shaw et al
2004).
• Maternal levels of choline can become
depleted because of increased transport to
fetus (Sanders & Zeisel 2007).
The Choline Problem
Consider the:
• Increase in learning problems among
children.
• Epidemic of fatty liver disease.
Per NIH, 10-20% Americans are
affected.
Could there be a connection with
low choline intakes?
The DGAC Report re: Choline
“[R]equired
for cell structure and function,
neurotransmission, lipid transport from the liver,
and as a dietary methyl groups source (Zeisel
2006.)”
“Deficiency states that can arise from inadequate
choline intake include fatty liver and muscle
dysfunction…as well as elevated plasma
homocysteine level…”
“Americans could meet recommendation for choline
by consuming modest amounts of eggs and
replacing other meat, poultry, and starchy
vegetables with cooked dry beans and peas, within
fixed energy intakes.”
Eggs and choline
• 2 large eggs contain 252 mg choline
• Plasma choline level is predicted by egg
consumption (Konstantinova 2008).
• Eating eggs daily does not increase risk
of diabetes (Djousse, 2010) or heart
disease (Kritchevsky, 2004).
• “Two strategies could make more
choline available for brain development:
maternal diet could include more foods
such as eggs and liver, a supplement…
(Zeisel 2009).
DGAC meeting excerpts
MS. MOSHFEGH: For choline, which is
based now on the 2005-2006 data,
about 10 percent of all individuals had
intakes at or above their AI.
SLAVIN: Alanna, can you talk a little bit
about choline? Aren't most of the
sources animal sources? I mean, where
else do you get that from? Because that
seemed to be really a problem.
DGAC 2nd meeting, Day 1: 1-29-09
DGAC meeting excerpts
CHAIR VAN HORN: …the take-home
message here is just the stunning
number of Americans who still are well
below the recommended intakes of
calcium, potassium, fiber, and choline,
and the vast majority that eat well
beyond the recommended amounts of
sodium and dietary cholesterol.
DGAC 2nd meeting, Day 1: 1-29-09
DGAC – choline is the “tail?”
PEARSON: some of our models may not show adequacy in choline,
and it looks like you've had that kind of across the board in
many instances. I guess it would certainly be helpful to us…to get
an idea of really the significance of the choline recommendation,
how definite those are. I had been led to believe that these were
perhaps still a little bit sketchy in terms of compared to the nutrient
adequacy data we have for many other things, and that would be
very helpful for us to know
that so that we don't basically have kind of the tail
wag the dog here in terms of the – a relatively
minor issue, actually starting to control something
that -- such as saturated fat or cholesterol content,
which obviously are big issues.
DGAC 4th meeting, Day 2: 11-5-09
DGAC – ran out of time?
NICKOLS-RICHARDSON… The evidence for those concerns is not
at the same level of – I don't think we have the ability
to conduct a NEL search at this point. We have done
some soft searches, if you will, some exploratory
searches, and the evidence that is there is not as robust as
what we have been able to do for some of the other
questions. So, I -- we don't plan at this point to have a NEL
process to go along with that, but it's more a cautionary
note for certain subgroups.
DGAC 4th meeting, Day 1: 11-5-09
DGAC – it’s the cholesterol, silly
SLAVIN: I wanted to follow up on Mim's just because
of the egg, because I think for high quality protein
I'm with kids and getting better diets into people
with lower calories. I'm just really big on eggs and
protein qualities. So making sure we don't let
cholesterol make the decision here.
PEARSON: But also to remind you that the cholesterol
is in the yoke of the egg, and the protein is in the
white, and you can actually do something about
that.
DGAC 4th meeting, Day 2: 11-5-09
Choline sent to the back of the
line
SLAVIN: [I]t kind of comes back to the choline
recommendations we heard about. We are not meeting
that. Nobody is really thinking about how that’s… how
we’re going to--NELSON: I think we have to focus on those nutrients, the
shortfall nutrients that seem to have fairly profound health
implication. I mean I think we have to triage some of those
nutrients… But eggs, I mean, are we dealing with eggs
anywhere? Is that in fats?
CHAIR VAN HORN: Fatty eggs.
(Laughter)
DGAC 2nd meeting, Day 2: 1-30-09.
2010 Dietary Guidelines say:
“Evidence suggests that one egg (i.e. egg yolk) per day does not result in
increased blood cholesterol levels, nor does it increase the risk of
[CVD] in healthy people.
Consuming less than 300 mg per day of cholesterol can help maintain
normal blood cholesterol levels.
Consuming less than 200 mg per day can further help individuals at
high risk of [CVD].”
“The fats in meat, poultry, and eggs are considered solid fats...”
An egg contains about 200 mg of cholesterol.
To stay within the 200-300 mg per day,
we must limit whole eggs to one or fewer per day.
Americans eat < ¼ of an egg/day, = 0.4 oz, same as USDA
recommends.
Eggs could be an easy way to meet choline shortfall,
with 125 mg choline per egg yolk.
No Egg Problem in the UK
The Food Standards Agency (UK) sets no
restrictions on number of eggs that can be
eaten within an otherwise varied diet.
“Eggs are a good source of protein, iodine,
and vitamins such as D and B2.”
“If you are eating a balanced diet, you don't
need to cut down on eggs (or kidneys and
prawns) unless your GP or dietitian has
advised you to do this.”
More on eggs in 2010 DGA
“The major sources of cholesterol in the American diet include eggs
and egg mixed dishes (25% of total cholesterol intake)…Cholesterol
intake can be reduced by limiting the consumption of the specific
foods that are high in cholesterol. Many of these major sources
include foods that can be purchased or prepared in ways that limit
the intake of cholesterol (e.g., using egg substitutes).”
“The fats in meat, poultry, and eggs are considered solid fats, while the
fats in seafood, nuts, and seeds are considered oils. Meat and
poultry should be con-sumed in lean forms to decrease intake of
solid fats. “
“They include moderate amounts and a variety of foods high in protein
(seafood, beans and peas, nuts, seeds, soy products, meat, poultry,
and eggs).”
“A healthy eating pattern focuses on nutrient-dense foods—vegetables,
fruits, whole grains, fat-free or low-fat milk and milk products, lean
meats and poultry, seafood, eggs, beans and peas, and nuts and
seeds that are prepared without added solid fats, sugars, starches,
and sodium.”
2010 Dietary Guideline for Americans Policy Document
Pregnancy – no word on
choline
“Women capable of becoming pregnant
• Choose foods that supply heme iron, which is more readily
absorbed by the body, additional iron sources, and
enhancers of iron absorption such as vitamin C-rich foods.
• Consume 400 micrograms (mcg) per day of synthetic folic
acid (from fortified foods and/or supplements) in addition to
food forms of folate from a varied diet.8
Women who are pregnant or breastfeeding
• Consume 8 to 12 ounces of seafood per week from a variety
of seafood types.
• Due to their high methyl mercury content, limit white
(albacore) tuna to 6 ounces per week and do not eat the
following four types of fish: tilefish, shark, swordfish, and
king mackerel.
• If pregnant, take an iron supplement, as recommended by an
obstetrician or other health care provider.
2010 Dietary Guideline for Americans Policy Document
Is this what the USDA wants
our children to eat for breakfast?
ADA Times, Winter 2011
Dr James E. Carlson
BS, DO, MBA, JD
Physician
Port Jefferson Station, New
York
Genocide!
How Your Doctor’s Dietary Ignorance Will Kill You !!!
By Dr. James E. Carlson
With humor, wit, and a good
dose of common sense, this
guide shows readers that a
diet with daily sources of fat,
cholesterol and protein is
effective in treating disease.
®
THE WESTON A. PRICE FOUNTATION ®
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