Nutrition Update Training Melinda Re April 21, 1999 Final Assignment for "A Grade" Project # 2

March 29 -31, 1999, I attended the South Dakota State University's Annual Nutrition Seminar entitled "Practical Perennial Problems in Nutrition". This was a wonderful three days filled with presentations by researchers and educators on the hottest nutrition topics today. I not only learned the results of cutting edge research, examined new teaching materials and met professionals who are leaders in their field, but I also earned 14 CE units that are mandatory for my license status with the State of Minnesota as a dietitian.

The Cluster 9 Nutrition Education Assistants (NEAs) indicated to me during an earlier learning task survey that they needed nutrition updates on an ongoing basis. I transcribed my notes from the seminar and provided the staff with training on April 15, 1999. Five NEAs participated in the training. It was very difficult to get through the information in the time allotted. I had originally scheduled a 2-hour timeslot, but we ran behind schedule and only had 1 = hours left at the end of the day.

One subject that was of particular interest to the NEAs was nutrition and stress. I brought along a couple of resources that I have on the subject and 2 fun little tests. One test evaluates the level of stress a person is experiencing and the other evaluates the stress-eating patterns of a person. I had planned to have the NEAs complete these tests, but there was no time. They asked me if we could continue discussing this topic on the next training day so we can spend additional time on the subject. I agreed to add this to the May training agenda.

As part of the lesson, I constructed and demonstrated the use of a "Nutrition Abacus". A nutrition abacus is a tool to check daily food habits. It is a great idea to use with kids. Instructions for the abacus were in a book I purchased from one of the presenters. I also brought the materials needed to make more and distributed them to the NEAs so they could make one of their own.

I baked "Tofu Fudge Chews" for taste testing. The chews contain tofu (hence the name) and since I had just delivered a soy foods lesson to the staff, I decided to show them another way to increase their consumption of soy.

I had each NEA complete an evaluation of the training. The results were:

1. Was this training valuable to you in your work as an NEA? What part?

7 Yes. Fad diets, stress, and kids. 7 Yes. All of the information was very interesting. I am glad that you went, sat through all the meetings and brought out the "golden nuggets" to us in a condensed form. I found the agriculture and nutrition information interesting. It is interesting to see where "they" think we are going with our foods. 7 Yes. Dietary fiber. I'd like to incorporate the info in the fiber lesson and to use as a reference. 7 Yes. Info on fiber is current and I did not know it would promote nutrient absorption. Slim Fast is not evil. Irradiation versus cold pasteurization - really makes a difference. 7 Yes. Great to know what is new in nutrition. Can't wait to read it over again. The fad diets - more answers to why diets don't work. Also, more info to add to the fiber lesson.

2. Was the training valuable to you in your personal life? What part?

7 Yes. Weight, activity, effects of fiber, nutrition education for kids. 7 Yes. Meal replacements, fad diets, fiber, nutrition and stress because I am interested in these subjects and so are so many people that I know. 7 Yes. Nutrition and stress. I know stress is a big part of my overeating. 7 Yes. I'm going to try and use more fiber as a tool in weight management. 7 Yes. Fiber info will make me be more conscious of getting more and why.

3. What additional information would you like related to any of the topics discussed today?

7 Stress and nutrition. 7 Stress and how it effects the foods I eat, and how it effects my body. 7 Nutrition and stress, and nutrition education for kids. 7 I'd like a presentation on functional foods, irradiated foods. 7 Functional food info. Stress eating.

As you can see by the evaluations, stress and nutrition is a topic on which the NEAs feel they need more information. I will develop the resources I have into a lesson and present it to them in May.

Following are the transcriptions of my notes from the seminar. South Dakota State University Annual Nutrition Seminar Practical Perennial Problems in Nutrition March 29-31, 1999

"Agriculture and Nutrition: Working Together and Solving Problems". David Lineback, PhD: Director, Joint Institute for Food Safety and Applied Nutrition, University of Maryland, College Park, MD.

Dr. Lineback began his presentation with a quick "food forecast". He anticipates that some of the products in the grocery stores of the not too distant future will:

7 Be organically grown 7 Contain anti-cancer agents 7 Be packaged in special color changing packaging that emits anti-bacterial agents 7 Be formulated for use in a convection oven 7 Will come in edible packaging

Better yet, you won't have to go to the grocery store because you will be able to plan, purchase and analyze the food in your diet all by computer and have it delivered to your home.

The food of the future will have to fit in with the expectations of Americans: abundant, available, contaminant-free, non-toxic, and health promoting.

He then went on to describe how the agricultural industry and the nutrition systems work together to provide food for the world. The food base for the entire world is very narrow. Globally the entire human race feeds on only 12-15 plants. 90% of our food is from 5 cereal grains (which make up 70% of the world's calories), 3 tuber products, 2 sugar products and some legumes.

2% of the world's population is involved in the agricultural industry, which consists of production, processing, preservation and distribution of food. The nutrition systems are concerned with nutrients, food, physiology, eating recommendations and the eating habits and behaviors of people.

Past cooperation between agriculture and nutrition has resulted in fortification of flour and cereals (1940s), swine and beef with greatly reduced fat content, altered oil composition (canola), "fresh" foods with longer shelf life, and the controlled ripening of tomatoes.

Many factors have caused a change in the food supply including food availability, new food products, scientific advances, innovative processing techniques, and consumer demands.

Dr. Lineback identifies the major issues of the future to be food safety, functional foods, dietary supplements, biotechnology (currently 25% of the major crops have gene manipulation), new processing techniques, continuing emphasis on convenience and the globalization of the food supply.

Future cooperation between agriculture and nutrition will give us:

7 Improved nutrition content of foods 7 Improved nutritional balance in foods 7 Beneficially altered composition of nutrients 7 Dietary guidelines 7 Fortification 7 Functional foods 7 Biomarkers 7 Food safety

Nutrition education will continue to be crucial in helping people choose a healthful diet. Some of today's challenges in consumer education that will likely carry into the future:

7 Foods that would normally have fat, but are now fat free 7 "Genetically Modified"(GM) free foods 7 The concepts concerning empty calories, junk food and fad diets "Meal Replacements for Weight Loss". Harry Greene, MD: Vice President, Medical Director, Slim-Fast Foods, West Palm Beach, FL.

Dr. Greene is a physician who was in practice for many years and in an attempt to understand obesity and weight loss and provide assistance that works to patients, he began working with Slim-Fast. His overall message was that Slim-Fast (a Meal Replacement) offers "another tool that can help a significant percentage of patients that promotes long term weight loss". It is available, affordable and convenient.

He gave us an overview of the problem of obesity in America:

54% of all Americans are overweight or obese $33 billion was spent on weight loss products in 1998 $70 billion is spent on the health care costs of the obese each year $100 billion/year industry

The food and nutrition industry, the federal government and many other agencies (NIH) are interested in solving the obesity problem nationwide at the federal level.

Physicians are not treating obesity. The reasons they cite as to why are: "I don't have time during office visits." "Weight loss is temporary, so why bother?" "There are no good programs that really work." Health professionals (dietitians) are in a position to help people change their eating habits and manage their weight.

Dr. Greene shared the results of a study showing the successful use of Meal Replacements in weight loss.

Conclusions:

7 Obesity is a serious health risk, but treatable. 7 Energy restriction, increased activity, and behavior change is the cornerstone of treatment. 7 Knowledge of hidden calories in specific foods, portion control, and identification of "trigger foods" can improve eating habits. 7 Meal Replacements can offer a lifetime weight maintenance strategy.

"Phytochemicals and Functional Foods - Tomorrow's Nutrition Today". David B. Schmidt: Vice President - Food Safety, International Food Information Council (IFIC), Washington, D.C.

The International Food Information Council (IFIC) communicates science-based information on food safety and nutrition issues to health and nutrition professionals, government officials, educators, journalists and consumers. They publish "Food Insight" reports, consumer publications and provide information on their web site at ificinfo.health.org.

"Functional foods" is a broad term that has attracted significant attention from scientific researchers, health professionals, and journalists. Functional foods are generally considered foods containing significant levels of biologically active components that impart health benefits or desirable physiological effects beyond basic nutrition. Functional attributes of many traditional foods are being discovered, while new food products are being developed to enhance or incorporate beneficial components.

The working definition is: Functional foods are "foods that may provide a health benefit beyond basic nutrition".

IFIC was interesting in learning the attitudes of the American people in relation to functional foods and how to best develop communication and education strategies to teach people about these foods.

They undertook a major survey in 1998, talking to people around the country. Here are some of their findings:

7 The majority of consumers were aware that some foods are healthy, including oat bran, cranberry juice, broccoli, fruits, vegetables, orange juice, garlic and fiber. 7 95% of consumers agreed certain foods may reduce the risk of certain diseases. 7 72% of consumers said they had changed their diet for health reasons in the past 5 years. 7 Consumers said their most influential source for food and nutrition information is: the media- 39% family/friends - 29% health care professionals - 23% own health concerns - 15% government agencies - 12%

The researchers were also interested in what motivated consumers to make positive dietary changes. They focused on 2 types of consumers: 1) Unmotivated - aware of the benefits of a healthy diet, but had not made any changes; and 2) Motivated - were aware of the benefits of a healthy diet, and had changed their diets based on available information.

The unmotivated consumers:

7 Were very knowledgeable of diet/health connection 7 Had many excuses for not changing their diet 7 Operate under the "Taste Rules!" philosophy 7 Were highly skeptical of media coverage 7 Said their family history was not compelling 7 Were overwhelmed by information

The motivated consumers:

7 Were information sponges able to sort through the hype 7 Were real believers who learn from multiple, credible sources 7 Were empowered by knowledge and feelings of control of their destiny

Their motivations for change were:

7 A close relative was a disease victim 7 Strong advice/warning from their physician 7 A strong focus on long-term prevention of disease 7 A positive personal experience 7 Conditioned to be health active

The "Hot" Functional Foods/Components (according to the survey):

Calcium Cranberry Juice Fiber Fish/Omega-3 Folic Acid Garlic Green Vegetables Oat Bran Soy Tomato Sauce/Lycopene

Many consumers are excited by functional foods and want to know what quantity of food equals the benefits and are open to more fortification of foods if it doesn't adversely effect taste.

Functional foods is a field that is splitting wide open and we are on the early learning curve. There are many opportunities for education and there are many challenges. Some challenges are that consumers are confused on functional food issues, the scientific data is uncertain, health professionals are caught between recommendations, and the "hi-tech" image of the foods can be threatening.

Effective strategies for communication and education about functional foods are:

7 Talk about functional foods in the most traditional food sense as possible 7 Avoid images of the lab - beakers and microscopes 7 Use "may reduce risk" instead of "will prevent" 7 Ensure information is reasonable and reliable 7 Emphasize maximum consumption of functional components through a varied diet

"Fad Diets: A Three-Ring Circus". Judi Adams, MS, RD: President, Wheat Foods Council, Parker, CO.

Ms. Adams began her presentation by outlining some of the reasons that obesity in America is increasing:

7 Decreased energy expenditure - 60% of adults to not get recommended 30 minutes/day 7 Cheap, super-sized food supply - large servings of foods 7 Genetics - is a factor 7 Reliance on high-fat convenience and fast foods - no time for cooking 7 "Dashboard Dining" - eating on the run

Why are we less active?

7 People live in neighborhoods where they are afraid to go outside to exercise - 30% of families with an income of less than $15,000/year 7 Energy-efficient technology - remote controls, elevators 7 Phy Ed is no longer required of students in most states - 50% of children from 12-21 do not exercise

Ms. Adams advises people to steer clear of "going on a diet". Dieting alone doesn't work for long term weight loss. The average diet lasts 42 days. 5-10% of dieters will maintain significant weight loss. 95-97% will gain back all the weight loss within 5 years.

Current popular fad diets are based on high protein/low carbohydrate intake. The myth of these diets is that the recommendation of eating 55-60% of our calories from carbohydrates is making us fat. Not only is that false, but the average American is only eating 52% of their calories from carbohydrates anyway.

These diets seem valid because many are developed and published by medical doctors. Most traditionally trained MDs are not qualified to give nutrition advice. Less than 6% of the medical schools provide adequate training in nutrition.

It is not easy for people to determine sound nutritional information from all the messages they are bombarded with. Here are some guidelines to keep in mind when trying to determine if nutrition and diet information is correct.

Red Flags of Junk Science:

7 Promises a quick fix 7 Warns of danger from foods or nutrients 7 Sounds too good to be true 7 Simple conclusions are drawn from complex systems 7 Based on a single study 7 Dramatic statements refuted by experts 7 Warns of good foods/bad foods 7 Sells a product

Instead of encouraging people to go on a diet, promote:

7 A healthier lifestyle Healthy eating Regular Exercise Healthy behaviors (seat belts, safe sex, etc) 7 Body acceptance 7 Prevention of weight gain 7 Achievable health goals without regard to weight loss

"Gastrointestinal Response to Dietary Fiber". Barbara Schneeman, PhD: Dean, College of Agriculture and Environment Science, University of California-Davis.

Dr. Schneeman and her staff have been involved in animal and human studies that test different kinds of fibers (substances resistance to digestion in mammals) and the effect of those fibers on the GI tract. They have found that the character of the fiber has great effect on the gut. Fiber characteristics include:

7 Dispersion in water 7 Binding or absorptive capacity 7 Bulk 7 The viscosity 7 Fermentability

The effect of fiber in the small intestine include:

7 Slows digestion and absorption of cholesterol and fat (pectin, guar gum, oat bran, barley) 7 Promotes nutrient absorption 7 Reduces plasma cholesterol 7 Blunts glycemic response 7 Improves large bowel function

The more fiber in the gut and the longer it stays there, the greater the effect of:

7 Lowering cholesterol 7 Slowing the rate of fat absorption 7 Higher satiety factor

A higher satiety factor can have positive results for people wanting to lose or maintain body weight. In studies, people fed high-fiber, low-fat meals were much fuller for much longer than after high-fat, low-fiber meals. They ate less calories overall.

The consumption of a diet rich in fiber may be used as a strategy for weight management and reducing total blood cholesterol.

"Irradiation: Food Safety Benefits and Consumer Attitudes". David B. Schmidt: Vice President - Food Safety, International Food Information Council, Washington, D.C.

According to information distributed by Mr. Schmidt, food irradiation is a safe and effective technology used to destroy harmful pathogens sometimes present in food. It is the process of exposing food products to ionizing energy for a specified length of time. The amount of exposure is controlled to produce various preservation effects, such as retarding spoilage or killing any harmful bacteria.

Food irradiation is one tool for improving the safety of the food supply. It serves as a complement to good manufacturing practices and is part of the overall food safety production system. The process of food irradiation is often called "cold pasteurization" (a term favored by consumers), because it kills harmful bacteria without the use of heat.

Contrary to what many people may believe, the irradiation of food is not a brand new technique. The Food and Drug Administration (FDA) approved irradiation for some food categories as long ago as the 1960s:

Year Food For Control Of 1963 Wheat Insects 1964 White potatoes Sprouting 1983 Spices Insects 1985 Pork Trichinella spores 1986 Fruits and vegetables Insects 1992 Poultry Bacteria 1997 Beef, pork and lamb Bacteria

Despite the history of irradiation for foods, until 1992, only bulk dried spices were irradiated in the United States. Since then, irradiated produce and poultry have been sold in some American supermarkets. It is anticipated that irradiated meat products will become available in the marketplace in the future.

In 1998, the International Food Information Council (IFIC) conducted a consumer survey to find out the attitudes, awareness, beliefs and reactions of people to food irradiation. 75% of the people surveyed indicated that the safety of food is a "very important" factor when making food choices.

This survey found that consumer's acceptance of food irradiation is positively correlated with their level of knowledge about the process. That is, the more consumers know about the food irradiation, the more favorably they respond to it.

Survey findings:

7 Media is driving consumer awareness 7 Food supply is safe, but concerned about recent high-profile safety issues 7 Will accept irradiated foods 7 Awareness and understanding higher than expected 7 Education improves acceptance 7 Awareness of government approval for irradiation and support of health groups was low 7 Are willing to feed irradiated foods to children 7 Saw benefits of irradiated foods for home and restaurants

The challenge facing food irradiation is that consumers receive the information necessary to help them better understand the process as well as its safety and benefits.

Implications for education of consumers:

7 Incorporate with other food safety messages 7 Make consumers aware of what agencies endorse irradiation 7 Inform people about what irradiation IS 7 Inform people about what irradiation IS NOT 7 Describe the process and safety of irradiation 7 Describe the benefits of consuming irradiated foods

"Nutrition Education for Kids". Connie Evers, MS, RD, LN: Child Nutrition Consultant/Author, Portland, OR

Connie changed her presentation slightly to include the newly released Food Guide Pyramid for Young Children. She displayed the visual and shared her initial concerns about it. It is intended for children aged 2-6 years. Connie felt it is not developmentally appropriate for young children. How many 2 year olds can read? Nutrition education for this age group should consist of learning about the different kinds of food and that eating healthy foods is good for you, not learning serving sizes.

If the pyramid is going to be used with the parents of young children (a better use of it according to Connie), she felt it would have been more appropriate to have one for 2-3 year olds and 4-6 year olds.

Connie shared statistics from a recent survey that indicated that American children are not eating a healthy diet or getting adequate exercise. In the 7-10 age group category 10% had a poor diet (eating less than 50% of the recommended number of servings from the Food Guide Pyramid), 76% needed improvement (ate between 51-80% of the pyramid) and only 14% had a good diet (ate over 80% of the pyramid).

Why are kids diets so poor? Because products (like fruit snacks) are marketed at the kids and parents are buying them. The super sizing of America is another factor. Look at this comparison of common foods:

Food Guide Pyramid Popular Restaurant Serving Size/Calories Serving Size/Calories

Bagel One half/80 Bakery size/320 French-fries 10/110 Large size/540 Soda 12 ounce/150 Large (64 ounce)/800 Cookie 2 2"/100 5" Mega cookie/500

Why aren't they moving? A big contributor is the "video age". Kids are plugged into electronics. Studies have documented a clear connection between the time spent watching TV and the levels of both body fat and blood cholesterol in kids. And their body fat is increasing. Over the last 30 years, the number of 6-17 year olds who are overweight has doubled. Parents don't want their kids outdoors because of safety issues. Mandatory phy ed in school is a thing of the past. Illinois is the only state that still mandates daily phy ed. Even at that, one recent study of phy ed classes indicated that most kids are moving very little in class. They were only engaged in aerobic activity an average of 7 minutes.

Nutrition education for kids should be food based, fun, engaging and center around hands-on learning activities. It should be integrated across the school curriculum, at home and in the community. It should be behavior oriented and include goal setting so kids have the opportunity to practice good nutrition habits.

Nutrition goals should be S.N.A.C.K. Goals:

Small Needed Achievable Countable Know-how

How can we send children positive messages about food and their bodies? Here are some key positive nutrition messages for kids:

7 Make family meals a priority - eating together promotes good habits 7 Give attention to school meals - work to improve school mealtime 7 Affirm children - emphasize the goodness about them 7 Emphasize the enjoyable aspects of food - don't label foods good or bad 7 Give children the choice over their eating and control over their bodies - offer healthy food and let the child regulate intake 7 Involve children in food activities - have them shop, compare, taste-test, and cook 7 Unplug kids! - encourage kids to move, play and exercise

"Calcium and Iron Needs During Pregnancy and Lactation". Heidi Kalkwarf, PhD: Department of Pediatrics, Division of General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH.

This presenter shared statistics from studies she is conducting on the calcium levels of childbearing age women through pregnancy and lactation. Her conclusions include:

7 Calcium intake may be preventative against preeclampsia during pregnancy. 7 Calcium loss is a normal part of pregnancy and lactation. 7 Women lose large amounts of calcium through breastmilk. The amount of calcium in the breastmilk is not related to the amount of calcium intake. 7 After birth and weaning, calcium absorption increases to compensate for calcium loss and bone rebuilding does occur. 7 Postpartum menses greatly affects bone loss/gain indicating that hormones may play bigger part than calcium intake.

Recommendations:

7 All women of childbearing age should consume 1000 mg/day of calcium (current intake averages 600 mg/day non-pregnant; 1000 mg/day pregnant/lactating) 7 There is not need to increase calcium (over 1000 mg/day) intake during pregnancy and lactation.

Her studies on the iron status of pregnant women resulted in these findings:

7 During pregnancy, iron status normally goes to a low point at about 20 weeks gestation and then recovers by birth. 7 Small amounts of iron loss occur during lactation (about 1/5 of amount per day as menstruation). 7 Traditional pre-natal vitamins contain too much iron (60, 90, or 120 mg/day) that is not more beneficial, produces side effects such as nausea, and interferes with other nutrient absorption such as zinc.

Recommendations:

7 30 mg/day of iron to support pregnancy. 7 No increase of iron over RDA needed to support lactation.

She addressed the calcium - iron interaction by saying that calcium does interfere with the absorption of iron in the diet and in a multi-nutrient pill, however long-term calcium supplementation does not affect iron status.

-- Anonymous, April 21, 1999