How Bad is Fructose? David Despain Interviews Dr. John Sievenpiper

Monday, May 28, 2012
In my article "Is Sugar Fattening?", I discussed a recent review paper on fructose, by Dr. John Sievenpiper and colleagues (1).  It was the most recent of several review papers to conclude that fructose is probably not inherently fattening in humans, but that it can be fattening if it's consumed to excess, due to the added calories.  Dr. Sievenpiper and colleagues have also written other papers addressing the metabolic effects of fructose, which appear to be fairly minor unless it's consumed to excess (2, 3, 4, 5).  The senior author on these studies is Dr. David Jenkins at McMaster University.  David Despain, a science and health writer who publishes a nice blog called Evolving Health, recently interviewed Dr. Sievenpiper about his work.

It's an interesting interview and very timely, due to the recent attention paid to fructose in the popular media. This has mostly been driven by a couple of high-profile individuals-- an issue they discuss in the interview.  The interview, recent papers, and sessions at scientific conferences are part of an effort by researchers to push back against some of the less well founded claims that have received widespread attention lately.

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Lower Blood Pressure Naturally

Monday, May 21, 2012
Recently, Chris Kresser published a series on dietary salt (sodium chloride) and health (1).  One of the issues he covered is the effect of salt on blood pressure.  Most studies have shown a relatively weak relationship between salt intake and blood pressure.  My position overall is that we're currently eating a lot more salt than at almost any point in our evolutionary history as a species, so I tend to favor a moderately low salt intake.  However, there may be more important factors than salt when it comes to blood pressure, at least in the short term. 

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Nutrition As a Core Service in the Healthcare System

In recent years, national health authorities have placed significant efforts on fighting Obesity, as it is the main cause of many dietary-related diseases such as Type 2 Diabetes, Coronary Heart Disease, osteoarthritis and some forms of cancer, with significant costs to governments and national incomes. In spite of this, the concept of including a vital service such as Nutrition therapy in hospitals' treatment plan still remains largely unattended. Further to this, despite the noticeable revival of related services, especially in the area of complementary therapy, little has changed with regards to nutritional offerings. It is true that we all need food to nourish our body, to survive, socialize, entertain, express our gratitude, sooth our senses etc., yet we tend to ignore its very contribution to health and wellness when it comes to hospital planning and design. Maybe we are all too familiar with food since we ingest it in almost every hour of the day in some shape or form and hence its impact on our health and wellness takes relatively back stage. Surprisingly, in spite of the huge growth of the private health industry in recent years, the role of Nutrition within such a prosperous environment has yet to be fully acknowledged. The majority of hospital, clinic and centre planners, developers, investors, owners and directors appear to be somewhat hesitant of encompassing such a 'less-accentuated service' into their menu planning. There is a general reluctance and apprehension with regard to the viability of Nutrition in an overwhelmingly treatment-based environment. Such reluctance may stem from the engraved lack of appreciation of the financial effectiveness of such a service and the role it can serve to patients/clients, owners and shareholders. Its perceived roles seem to be limited to the vaguely understood concept of dieting and/or diet sheets. And despite the general awareness of the role of diet in health and wellness, many hospital strategic planners hospital do not seem to put this into practice within the clinical environment (probably because hospitals are traditionally associated with the treatment of the communicable diseases, rather than addressing the inner health of the individual in the wider sense. However, in recent years Nutrition at large has gained enormous popularity, as today's generation are indeed becoming more health conscientious and more and more studies have substantiated the link between today's modern diseases which are largely non- communicable in nature and nutrition. Contrarily, the prevalence of overweight and obesity, particularly amongst adults, continues to grow to a record high, being described as the most common and fastest growing epidemics in the Western world. It is estimated that more than 35% of the US population are obese, and Europe is not far behind from following this trend. In fact it has recently been revealed that approximately one in four (25%) of the UK population is currently obese, and this is predicted to rise to 50% by the year 2030. Nevertheless, only one in four obese patients (25%) receives treatment and those who do seek assistance have a 90% chance of failure. We have known for years that overweight and obesity are most prevalent in the affluent nations, which are characterised by wealth and an abundance of convenient and ready-made foods. This is complicated further by a sense of lack of time for meal preparation and a high-tech environment leading to a passive environment and sedentary lifestyle. Amongst the public at large, there seems to be little progress as to how to tackle the worsening obesity epidemic. There is also confusion between healthy eating, which ought to be adopted by everyone and the ongoing taboo of dieting. Furthermore, little attention is given and inadequate effort is put into actively changing certain lifestyle factors, which are imperative to achieving optimum health and wellbeing. Indeed, the intensive commercialised advertising of health and diet-related products and services, combined with inaccurate advice given by seemingly unregulated industries coupled with the presence of unqualified or self taught practitioners and the so called dieting gurus, has certainly made it difficult for the layperson to differentiate between what is sound advice and what is merely a good marketing gimmick. As a result, much of the efforts made by national and international health organisations (often led by healthcare professionals) to counteract these odds fall short of reversing the obesity epidemic. Undoubtedly, the private health sector is well positioned to provide a wholesome approach to nutritional wellness. The majority of private hospitals, have the preliminary infrastructure to cope with such demands. For instance, nearly all hospitals are equipped with or have access to the most up to date diagnostic laboratories and treatment procedures, as well as the required medical and nursing staff and evidently a pharmacy. Indeed, these are the key prerequisites to any clinical establishment willing to embark on this fast growing market. What is subsequently required from such institutions is to enhance their existing services by adding a dedicated Nutrition and Dietetics centre led by properly trained staff, a well equipped fitness centre run by qualified instructors, a well resourced physiotherapy department, well-trained catering staff and possibly a swimming or thalassotherapy pool. It is true to say that different hospitals offer different services, and the level of focus on Nutrition may vary from one establishment to another. However, it is also true that improving overall health is gaining popularity, driven by genuine and measurable market demands and a widespread public awareness of the relationship between diet, nutrition and health. In order to achieve the desired results for both patients/clients and owners, Nutrition services have to be combined with other core services, such as Medical, Complementary, Fitness, Food and Beverage, together with strong PR and Marketing initiatives.

Beyond Ötzi: European Evolutionary History and its Relevance to Diet. Part III

Thursday, May 17, 2012
In previous posts, I reviewed some of the evidence suggesting that human evolution has accelerated rapidly since the development of agriculture (and to some degree, before it).  Europeans (and other lineages with a long history of agriculture)  carry known genetic adaptations to the Neolithic diet, and there are probably many adaptations that have not yet been identified.  In my final post in this series, I'll argue that although we've adapted, the adaptation is probably not complete, and we're left in a sort of genetic limbo between the Paleolithic and Neolithic state. 

Recent Genetic Adaptations are Often Crude

It may at first seem strange, but many genes responsible for common genetic disorders show evidence of positive selection.  In other words, the genes that cause these disorders were favored by evolution at some point because they presumably provided a survival advantage.  For example, the sickle cell anemia gene protects against malaria, but if you inherit two copies of it, you end up with a serious and life-threatening disorder (1).  The cystic fibrosis gene may have been selected to protect against one or more infectious diseases, but again if you get two copies of it, quality of life and lifespan are greatly curtailed (2, 3).  Familial Mediterranean fever is a very common disorder in Mediterranean populations, involving painful inflammatory attacks of the digestive tract, and sometimes a deadly condition called amyloidosis.  It shows evidence of positive selection and probably protected against intestinal disease due to the heightened inflammatory state it confers to the digestive tract (4, 5).  Celiac disease, a severe autoimmune reaction to gluten found in some grains, may be a by-product of selection for protection against bacterial infection (6).  Phenylketonuria also shows evidence of positive selection (7), and the list goes on.  It's clear that a lot of our recent evolution was in response to new disease pressures, likely from increased population density, sendentism, and contact with domestic animals.

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Beyond Ötzi: European Evolutionary History and its Relevance to Diet. Part II

Monday, May 7, 2012
In previous posts, I described how Otzi was (at least in large part) a genetic descendant of Middle Eastern agriculturalists, rather than being purely descended from local hunter-gatherers who adopted agriculture in situ.  I also reviewed evidence showing that modern Europeans are a genetic mixture of local European hunter-gatherers, incoming agricultural populations from the Middle East, neanderthals, and perhaps other groups.  In this post, I'll describe the evidence for rapid human evolution since the end of the Paleolithic period, and research indicating that some of these changes are adaptations to the Neolithic (agricultural/horticultural/pastoral) diet.

Humans have Evolved Significantly Since the End of the Paleolithic

Evolution by natural selection leaves a distinct signature in the genome, and geneticists can detect this signature tens of thousands of years after the fact by comparing many genomes to one another.  A landmark paper published in 2007 by Dr. John Hawks and colleagues showed that humans have been undergoing "extraordinarily rapid recent genetic evolution" over the last 40,000 years (1).  Furthermore:
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Media Appearances

Saturday, May 5, 2012
Last October, I participated in a panel discussion organized by the Harvard Food Law Society in Boston.  The panel included Drs. Walter Willett, David Ludwig, Robert Lustig, and myself, with Corby Kummer as moderator.  Dr. Willett is the chair of the Harvard Department of Nutrition; Dr. Ludwig is a professor of nutrition and pediatrics at Harvard; Dr. Lustig is a professor of clinical pediatrics at UCSF; and Kummer is a food writer and senior editor for The Atlantic
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