Should You Be Taking Vitamin Supplements?

By Georgia King

In the past few decades, Americans have become much more aware of their overall health, and the factors that can improve or worsen it. With this, countless studies have been conducted to investigate the various ways one can improve their health. This phenomenon has led to tons of medical breakthroughs, forever improving the lives of humans across the globe. However, it has also led to things like fad diets and fad products, that can either do nothing for us, or make us worse off than we were before we tried them.

So which category do vitamin supplements fall under? Well, technically both. It depends on the supplement being taken and the current nutrient needs of the person taking it.

When Should Someone Be Taking a Supplement?

There are definitely times in life when taking a supplement is the best option for getting all the nutrients you need. But it's important to differentiate between these times and the times when we probably don't need to be taking one.

Pregnancy

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One of the most prevalent times in life when a vitamin supplement is recommended is during pregnancy. Since this is a time of extreme growth in the woman's and the baby's body, there are severely increased nutrient needs. These needs must be met to ensure that the baby is developing properly and that the mother's body is able to sustain the pregnancy. Specific nutrients of concern are folic acid and iron. Though it is technically possible to consume all the needed nutrients from foods during pregnancy, it is said to be very difficult because of the increased nutrient demand. Many mothers also report being too nauseous during the early stages of pregnancy to eat enough of the nutrient-dense foods required to do this. It is also recommended that women who may become pregnant consider taking a dietary supplement as well, so that their bodies are prepared to sustain a pregnancy.

Dietary Restrictions

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Another situation in which you should consider taking a vitamin supplement is if you have a dietary restriction of some kind. Vegetarians and vegans can sometimes be at risk for Vitamin B-12 deficiency, since our primary source of this is meat. While there are still other foods that contain B-12, it may be difficult to get the amount our bodies need without eating meat. In this case, your doctor or dietitian may recommend that you take a supplement to prevent deficiency.

Lactose intolerance is another example of a dietary restriction that may require supplements. Specific nutrients of concern in this situation are calcium and Vitamin D, since these are mainly obtained from dairy products. Just as with Vitamin B-12, Vitamin D and calcium can be found in other foods that do not contain lactose. However, it may be difficult for a person with lactose-intolerance to get the recommended amount. This is another case in which a doctor or dietitian may recommend a dietary supplement to prevent nutrient deficiency.

Older Adults

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As we age, our bodies usually require fewer calories. However, we still need roughly the same amount of vitamins and minerals to function. For this reason, it can be challenging for older adults to get all the nutrients they need. In addition to this, absorption of certain nutrients tend to decrease as we get older. Specific nutrients of concern are Vitamin B-12, Vitamin D, and calcium. The Dietary Guidelines for Americans recommends that older adults consider dietary supplements, specifically vitamin B-12 and vitamin D.

Medical Conditions or Medications Affecting Absorption

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Some medical conditions and certain medications can adversely affect nutrient absorption. This is another instance in which it's probably best to take a supplement. Extra nutrient intake will ensure that your body is supplied with enough of the nutrients it needs and can properly absorb them. In this case, a doctor or dietitian should be the one to help you choose which ones to take that are best for you individual situation.

When Is a Supplement Probably Not Necessary?

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If you are generally a healthy person who eats a balanced diet that looks similar to the MyPlate recommendations, then you really don't need to be taking dietary supplements. (You're more likely getting all the nutrients you need from food!) In fact, taking supplements may actually do you more harm than good. Too much of one vitamin or mineral can sometimes inhibit the absorption or storage of others. For instance, if someone's zinc intake is too high, it will likely deplete the body's copper stores, and sometimes also alter iron function. Likewise, excessive calcium intake has been associated with interference of iron and zinc absorption. The moral of the story is that you are more likely to get a healthy amount of nutrients from food, rather than from a vitamin supplement. When you take supplements, you risk potential of nutrient toxicity, which is practically impossible when only getting nutrients from food.

If you are generally a healthy person, but you don't necessarily have the best diet, there are still other options to consider before taking a supplement. Look at the MyPlate recommendations and see what areas you can adjust your diet and lifestyle. You are better off getting your nutrients from foods, if you have the ability to. Only after you've exhausted all of your food options should you consider taking a supplement.

Other Things To Consider

Whether you take supplements or not, it's important to educate yourself about regulations of these products. Though they are technically regulated by the FDA, supplements are technically considered to be "food" rather than "drugs." Therefore, their quality and effects on the body are not assessed by the FDA. Only the supplement company themselves are responsible for evaluating this, which can cause obvious problems. Always do research and make sure you are aware of the effects of your supplements, beyond those that are listed on the bottle.

More than 50% of Americans take dietary supplements. But many of them don't need to be. It's important to always discuss supplementation with your doctor and/or dietitian. Getting an expert opinion can be really helpful and eye-opening. If you're on the fence, I encourage you to try the "food first" policy.

Animal proteins have their place in human diets

By Dakota Kanzic

     I support eating real food, like vegetables and meat for many reasons. After seeing recent show called The Game Changer on Netflix, an extremely plant based bias film selling the vegan lifestyle. I felt the need to be the voice for a healthy omnivorous diet with the benefits of incorporating meat. Here are seven reasons why I am a believer in incorporating sustainably farmed animal proteins into the diet as a dietetic intern and graduate student within the nutrition and dietetics field.

1. Protein
     The body cannot create the 9 essential amino acids that are needed from the diet. Other than the pure nutritional need, protein serves many other positive functions for healthy humans. Protein is the most satiating of the macronutrients.1 Intake of 15-30% of total calories can be helpful in regulating appetite by increasing leptin sensitivity, inducing weight loss, and promoting blood sugar control.2

Eating more, not less protein not only is essential, but also may be helpful to slowing the obesity and diabetes epidemic we are facing. Meat is a high-quality source of protein. Eating meat makes it effortless to meet daily protein needs. You might think or have been led to believe we are eating too much meat, but I disagree. Americans only eat less than 2oz of beef per day.3

2. Nutrient Density 
     Meat is not just high in protein. It is also a source of many nutrients that are simply not available in plants. Meat provides B12, highly absorbable heme iron, preformed vitamin, all the essential amino acids, zinc, EPA, DHA, vitamin D, and vitamin K2, none of which are found in plant foods. Plants provide important antioxidants, vitamin C, and fiber. We need this variety of nutrients to survive.

     Even though chicken and beef are both quality sources of protein, beef simply blows chicken away in the nutrient department.4 It has significantly more B12, zinc, choline, iron, and potassium. In terms of micronutrients, chicken only has more B3 than beef. Recommending people reduce beef intake and replace it with chicken or vegetables, is asking them to reduce the nutrient quality of their diets.

3. Fat
     Fats, especially saturated fat, have long been the villain of the nutrition world. They have been blamed as the cause for all diseases and the reason we are obese.

     Fats serve many purposes for our health. The brain is made up of mostly fat. Fat is needed for insulation to keep us warm and protect our organs. They also act as chemical messengers, control growth, help with immune function, and normal reproduction. They provide essential fatty acids and help with the absorption of fat-soluble vitamin A, D, E, and K.

     Saturated fat is by far the most vilified as the main cause of high cholesterol and heart disease. It does raise cholesterol, but usually raises HDL cholesterol. There has actually been no connection found between saturated fat intake and heart disease.5 The vilification of the type of fat that is primarily found in meat, is completely unfounded.

4. Iron
     Meat contains heme iron, the most absorbable type of iron. Iron-deficiency anemia is the most common mineral deficiency in the United States. Iron is particularly important for pregnant women, infants, and children. Iron deficiency in children can lead to permanent intellectual delays.

5. Human Anatomy
     Contrary to many internet memes floating around claiming that people only have the anatomy to eat plants, in truth, humans have distinct features that make us able to eat both plants and animals.6 Our small intestines are longer than the average primate and our colons are smaller. With our larger small intestine, we are adapted to eating more nutrient dense foods like meat and starches, not large volumes of plant foods like our primate relatives. We have canines for meat and flat molars for grinding plants. We also have very smart brains and nimble fingers to use tools very well to hunt and utilize all the meat and product off of a carcass.

6. Vitamin B12
     Vitamin B12 is only found in animal foods. B12 deficiency, which is common in vegetarians and vegans, has been shown as an independent risk factor for coronary artery disease and serious neurological disorders in infants of vegan mothers.7,8

7. Zinc
     Zinc is an important mineral in our immune health, wound healing, and plays a role in thyroid and metabolic health overall.9 Zinc is found in many animal-based proteins such as egg yolks, fish, beef, and more. Zinc from animal-sources is easier for the body to absorb and utilize compared to plant-based sources.10

     There are obvious ethical, moral, and humane issues associated with animal protein production and climate and environmental issues. As consumers it is important to support more sustainable and ethical outlets and methods as much as possible. Research your supplier, get to know your farmer, and resources who provide animal proteins to you. Its not about following a strict way of eating or judging people who nourish with or without animal proteins. Each of us are unique and desire to consume food in the way that best serves our longevity.

Thank you for reading!

Citations:
1. Stijn Soenen, Margriet S. Westerterp-Plantenga. Proteins and satiety: implications for weight management. Curr Opin Clin Nutr Metab Care. 2008 Nov; 11(6): 747–751.

2. Izadi V, Saraf-Bank S, Azadbakht L. Dietary intakes and leptin concentrations. ARYA Atheroscler. 2014;10(5):266–272.

3. Diana Rodgers R. How Much Protein/Meat Are We Actually Eating?. The Paleo Diet - Robb Wolf on Paleolithic nutrition, intermittent fasting, and fitness. https://robbwolf.com/2016/11/15/how-much-proteinmeat-are-we-actually-eating/. Published 2019. Accessed November 25, 2019.

4. Beef vs Chicken meat - In-Depth Nutrition Comparison. Food Struct. https://foodstruct.com/compare/beef-vs-chicken-meat. Published 2019. Accessed November 25, 2019.

5. Siri-Tarino P, Sun Q, Hu F, Krauss R. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535-546. doi:10.3945/ajcn.2009.27725

6. Luca F, Perry G, Di Rienzo A. Evolutionary Adaptations to Dietary Changes. Annu Rev Nutr. 2010;30(1):291-314. doi:10.1146/annurev-nutr-080508-141048

7. Pawlak R. Is Vitamin B12 Deficiency a Risk Factor for Cardiovascular Disease in Vegetarians?. Am J Prev Med. 2015;48(6):e11-e26. doi:10.1016/j.amepre.2015.02.009

8. Roumeliotis N, Dix D, Lipson A. Vitamin B(12) deficiency in infants secondary to maternal causes. CMAJ. 2012;184(14):1593–1598. doi:10.1503/cmaj.112170

9. Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116(12):1970-1980. doi:10.1016/j.jand.2016.09.025

10. Foster M, Chu A, Petocz P, Samman S. Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans. J Sci Food Agric. 2013;93(10):2362-2371. doi:10.1002/jsfa.6179

Nutrigenomics and Genetic Testing: can you out run your genes?

By Kaitlin Isbell

The Nature Versus Nurture debate is a tail as old as time. This debate will likely continue to waver on, but in all reality both philosophies hold some weight and the truth is more of a spectrum than a definitive answer. 

Most people would agree that a baby resembles his or her parents in physical appearance at birth. As the child matures they will likely start to take on personality traits and mannerisms learned from their environment. When it comes to genes, it’s sweet that you have your mother’s nose or attribute your great hair to your father’s side of the family, but it’s astonishing how the energy in the room changes when the conversation shifts from comparing eyes and lips to discussing the families’ generational history with cardiovascular disease.  Are you destined to walk the same path? And if you knew you were genetically predisposed to cardiovascular disease or other conditions such as diabetes or cancer, would you accept your fate or fight as hard as you can to live a healthy lifestyle and try to outrun your genetics? Or would you prefer to decline genetic testing and deal with the trials as they come?  

Genetic verse environment:  

Research shows that both genetics and environment play a role in pathogenesis. The specific condition ultimately determines the extent to which genetic or environmental factors play a role. For example, in single-gene disorders like Huntington’s disease, genetic factors outweigh environmental factors. Twin studies working with obesity showed that 80% of the difference observed in BMI between the twins was related to genetic factors1.  Type 2 diabetes has a multifactorial pathogenesis, we know that environmental factors such as weight, physical inactivity, and dietary intake lead to insulin resistance, but there have also been 65 SNP’s associated with developing the disease1. The AHA identified that among environmental factors diet may be the most directly involved in the genetic modulation of the different phenotypes of cardiovascular disease. Dietary factors might modulate the risk imposed by genetic susceptibility due to variation in one or more genes involved in the etiology of cardiovascular disease3. A twin study on genetic and environmental influences on serum lipid levels concluded that genetic factors on serum lipids tend to decrease with age and early environment appears to be an important factor in total cholesterol later in life4. 

Genetic Testing:

Since genetics and environment both play a role disease development, it is important to have a way to test for genetic factors. As technology advances, genetic testing has become more readily available and is more accurate than ever before. Genetic testing continues to grow in popularity and allows people to track their ancestry back to upward of 1000 years.  Beyond tracing family lineage, scientists use predictive genetic testing as part of newborn screenings for single-gene disorders such as phenylketonuria. When it comes to single-gene disorders that will lead to a definitive diagnosis and currently have no cure, like Huntington’s disease, genetic testing is only done at the patient’s request. Predictive tests can be used to identify mutated genes that could trigger a disease. For example, women who carry certain BRCA1 and BRCA2 mutations have a 60-80% risk of developing breast cancer1.  Predictive genetic testing can also be done to identify gene mutations in diseases like ovarian cancer, colon cancer, childhood polyposis, childhood sarcomas, Alzheimer disease, lung cancer, and polycystic kidney disease. The figure below shows the specific gene mutations associated with each of the conditions. 

After a person undergoes genetic testing and is found to be at a higher risk for a condition, what other factors have to be present that will ultimately lead to the development of the disease? Environmental factors like cigarette smoking, physical inactivity, prolonged periods of stress, and diet are all modifiable risk factors that when unmanaged put a person at a higher risk for disease development. 

What is Nutrigenomics? 

The field of Nutrigenomics is that was created to assess the interaction between genes and nutrients. Nutrigenomics is the area of nutrition that seeks to understand how the components of a particular diet may affect the expression of genes, and seeks to identify weather the diet increased or suppressed gene expression. An individual’s nutritional state is the result of an intervention between various factors, such as genetic background, physical body, emotional needs and social state. Diet is a key factor, since the nutrients and other bioactive compounds in food can be beneficial or initiate several diseases. The conditions most closely related to food consumption include: celiac disease, phenylketonuria, and non-transmissible chronic diseases such as cancer, diabetes, and dyslipidemia2. 

Using Nutrigenomics to our advantage :

Nutrigenomics is a way of working with nutrition and the knowledge of how food interferes with the genetic code and how the body responds to these interferences and with the phenotype2. Unfortunately, individuals do not have the option to choose their genetics, but in many conditions certain lifestyle interventions can help to avoid pathogenesis or delay the progression. Research in Nutrigenomics has helped to identify ways in which the bioactive compounds in food can be used to combat things like a genetic predisposition. For instance, the chronic inflammation found in obesity can be decreased through the use of bioactive compounds such as tyrosol found in olive oil or lycopene found in tomatoes, guava, and watermelon, these bioactives work to decreased inflammation by inhibiting the expression of genes and co-factors associated with the inflammatory process. Micronutrient deficiencies have a narrow link to the development of cancer. Deficiencies in folic acid, selenium, niacin, zinc, vitamin B12, vitamin B6, vitamin C, and vitamin E can lead to changes in DNA and can lead to rupture of the double strand of DNA, oxidative lesions or both. Although the link between micronutrient deficiencies and cancer development is relatively small, it is important to take into account especially if an individual already had one of the gene mutations associated with cancer pathogenesis. Additionally, most of these micronutrient deficiencies could be solved through a healthy diet with a focus on increased fruit and vegetable consumption.

Personalized Nutrition

Currently, dietary guidelines are based on what proves to be the most beneficial for general population. Dietitian’s use these guidelines and tailor them to the individual client. Individualized practice is preferred since we recognize that everyone is different, therefore so are their nutritional needs. The idea of personalized nutrition essentially takes individualized practice a step further by also applying genetic components. Personalized nutrition is still in infancy stages and will need more research on practicality, feasibility and consumer acceptance5. 

Psychological aspects and implications of Genetic testing 

As research continues and more genetic insights become available, it is essential that all testing is done with the clients wishes and best interest in mind. Genetic testing is great in the sense that we can uncover potential risk factors and make lifestyle adjustments accordingly, but it is understandable that some people would rather not know this information. Special considerations for counseling on what results mean and what implications result from them should be given. 

One of the most popular forms of genetic testing is through the mail or digitally, the results are given to the individual and it is up to the individual if they choose to seek professional guidance on the implications of the results. The results include things like ancestry data, but can also include nutrition information such as susceptibility to nutrition related diseases, potential risk for nutrient deficiencies, sensitivity to gluten and salt and many more. Several issues could occur based on how the individual interprets the results of their findings, such as excluding certain nutrients with no prior indications of intolerance. 

There is also the idea of a self-fulfilling prophecy.  Individuals who receive resulting showing a high risk for type two diabetes might feel that they are destined to develop the disease so they stop taking precautions to reduce their risk and end up developing the disease.  A study done on identifying SNP’s that are linked to type two diabetes found that some individuals who received a negative result for the presence of diabetes ended up developing the diabetes because they stopped worrying about their diet. Conversely, those that received a positive score changed their lifestyle and decreased the development of insulin resistance2. 

Studies on the psychological effects of predictive genetic testing in Huntington’s disease showed that immediately after learning results there were decreased scores on the General Well-Being Scale and increased depressive symptoms.  When it comes to predictive genetic testing for cancer susceptibility, carriers of the BRCA1 genes mutation reported increased measures in depressive impairment and depressive symptoms.  Interestingly, none of the 41 carriers for the BRCA1 and BRCA2 gene mutations reported having a prophylactic mastectomy by a one-year follow-up and only 17% were considering having the procedure. 

The take away :

When it comes to the debate on nature verse nurture we know that both genetics and environment play a role in pathogenesis and disease progression. With new technologies we are able to identify people at risk earlier and therefore implement interventions that have helped to reduce the risk, prevent disease progression, and ultimately improve mortality and morbidity. More research is needed in the field of Nutrigenomics and personalized nutrition, but the field is fascinating and could be guiding some practice in years to come. Ultimately, genetics does play a role in many disease states, but with a healthy lifestyle and modern technology we can work with our genes, instead of against them, to produce better outcomes. 

References

http://www.dnafiles.org/programs/predictive-genetic-testing/  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984860/  https://www.ahajournals.org/doi/full/10.1161/CIRCGENETICS.109.891366

https://www.nejm.org/doi/full/10.1056/NEJM199304223281603

https://www.nature.com/articles/ejcn2012145

http://www.psychosomatic.org/anmeeting/PastEvents/Lerman2002.pdf

Curbing Cravings with MealEnders @ FNCE

By Monica Inman

A few weekends ago, I attended the Food & Nutrition Conference & Expo (FNCE), the largest meeting for nutrition professionals in Philadelphia, PA. Over 10,000 registered dietitian nutritionists, nutrition science researchers, policy makers, health-care providers and industry leaders attend the annual meeting. Various events, educational sessions, and over 300 exhibits are available to attend during the conference. Not going to lie, I spent the majority of my time at the expo hall where the exhibits were displayed because who doesn’t like free samples!

One exhibitor that sparked my attention was MealEnders. MealEnders provide signaling lozenges that control appetite, curb cravings, and stop overeating at the end of meals. They are the perfect option for those who need a “pill or quick fix” to avoid overeating. The MealEnder looks like small, hard candy to trick your mind into thinking you actually had your dessert. The outer coating of the lozenge gives a sweet, creamy flavor to finish off a meal and satisfy cravings. The outer layer melts in your mouth and you are then left with a hard center. The second layer creates a cooling, tingling sensation on your tongue to clear the palate and triggers the feeling of being full to avoid eating until your plate is empty or loading up on cake after a meal. This effect supposedly keeps your mind and mouth occupied during times of temptation which are the 20-minute gap in the brain’s recognition of fullness and snacks cravings that compel you to eat when not hungry. MealEnders are also thought to use behavioral psychology and sensory science. Over time, it is suspected to break the behavioral cycle of overeating and snacking, and teach sustainable behavior habits.

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In a clinical trial conducted by Stanford, participants using the MealEnders reported a decrease in their caloric intake by 231 calories, on average. The participants also did not experience any increase in hunger with the lower calorie intake. The decrease in calories consumed continued even after the participants were no longer using the MealEnders, suggesting dietary behavior changes took place. From the study, 88.2% of participants were more mindful about their eating along with 61.8% experiencing an increase in their overall mindfulness after using MealEnders based on questionnaires. Cognitive strength was increased in 79.4% of users between the pre- and post-intervention stages.

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As seen on Shark Tank, the MealEnders lozenges currently come in four flavors: Citrus, Chocolate Mint, Mocha, and Cinnamon. I personally sampled one of these MealEnder lozenges. The tingling and cooling sensation did cleanse my palate, which I found very refreshing. After sampling all sorts of different food and drink during the day making my taste buds go crazy, the MealEnder was very refreshing to have before eating dinner. Although I was not hungry before sampling the lozenge, I did not want to eat anything immediately after due to the refreshing feeling left in my mouth. However, that did not stop my craving for ice cream.

To read more on MealEnders and get your own opinion on these signaling lozenges visit https://www.mealenders.com/