Myths and Facts: Evidenced-Based Anticipatory Guidance for - PowerPoint PPT Presentation

Myths and Facts: Evidenced-Based Anticipatory Guidance for Childhood Eating Susan Fisher-Owens, MD, MPH Associate Professor Of Pediatrics Annual Review in Family Medicine Associate Clinical Professor of Preventive and Restorative December 11, 2015 Dental Sciences Department of Pediatrics San Francisco General Hospital Children’s Health Center

Support and Disclosure • Neither I nor anyone in my family have any financial relationships relevant to this topic to disclose • This is the best scientific knowledge in the literature as of November/December 2015 2

Objectives To review the science on: • – Diets • Gluten-free • Mediterranean • Paleo • Vegetarian/vegan – Organic food – Free range – Juicing – GMOs – Food additives – Alternate sweeteners – Seeds (Chia/Flax/Hemp) – Probiotics – What foods to start with? When? Pros and Cons of different information sources • Unlikely health foods •

Gluten-free—Celiac “lite”? • Nonceliac gluten sensitivity • Nutritional composition – Often less fortified • Autism (if also eliminate casein) – No discernible effects in double-blind, placebo- controlled, four-month study of 14 preschoolers with autism 4

Mediterranean diet • Strong evidence of positive healthy outcomes • Includes – Nuts, legumes, seeds – Olives/olive oil – Whole grains – Fruits and vegetables – Fish 1-2x/wk – (Red wine) 5

Paleo (aka, Caveman, Hunter- Gatherer) • Contains – High-protein, high fiber – Lean meat and fish, fruits and vegetables, and healthier fats – No processed food – No grains – Not much research to support • Short-term consumption of a paleolithic type diet improves BP and glucose tolerance, decreases insulin secretion, increases insulin sensitivity and improves lipid profiles without weight loss in healthy sedentary humans. (Frassetto, Nature, 2009) 6

Vegetarianism • Subgroups – Ovo—egg – Lacto—milk – Pesco—fish • Safe for children – Be mindful of protein, zinc, iron, B12 – Can be a form of restricted eating for teenagers • Research shows less high blood pressure, cholesterol, cancer, and constipation • Soy safe if history of breast cancer? – Isoflavones may act like estrogen, or have anti- estrogenic effects – Study done in China, where soy is cultured 7

Vegan • No animal derived products (honey, sometimes yeast) • Be mindful of protein, zinc, iron, B12, Vit D, +/- Calcium 8

Raw food • Yes, food has enzymes • No lifetime limits on enzymes in body • Some foods need to be cooked: – Parsnips – Rhubarb • Longer you cook the food, loss of heat and water sensitive nutrients, particularly vitamin C and thiamin • Extreme—blackened foods and HCAs (heterocyclic amines) 9

Zen macrobiotic diet • Limits animal products, vegetables, and fruits • Not recommended by the AAP 10

Organic • No definitive health benefits (?environmental?) • Definite financial issue – Consumer Reports: huge range on costs • 47% more initially • Research on children and farm workers • “Dirty Dozen” (EWG) • “Clean 15”

“Dirty Dozen” “Clean 15” 1. Apples 1. Asparagus 2. Celery 2. Avocados 3. Cherry tomatoes 3. Cabbage 4. Cucumbers 4. Cantaloupe 5. Grapes (especially 5. Cauliflower imported) 6. Eggplant 6. Nectarines 7. Grapefruit 7. Peaches 8. Kiwi 8. Potatoes 9. Mango 9. Snap peas 10. Onions 10. Spinach 11. Papayas 11. Strawberries 12. Pineapples 12. Bell peppers 13. Sweet corn + Hot peppers and 14. Sweet peas (frozen) Kale/collard greens 15. Sweet potatoes Environmental Working Group 2015 12

13 From “The Dirty Dozen”

Organic dairy • 60% cost • 25% less Omega 6 fats, more omega 3 fats (62%) (may be important to look only at amount of omega-3, not ratio) • More likely from grass fed cows • No antibiotics 14

Free Range/Antibiotic Free Meat, Fish, and Eggs • + evidence of antibiotic resistance because of use in animals • No difference in salmonella in free range chickens • Free range eggs (chickens allowed outdoors) versus cage free – free-range egg cost 2.6 cents more to produce than a battery egg, and a barn egg cost 1.3 cents more to produce than a battery egg – Mixed data on nutritional advantage

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Juicing/Fasting (to “cleanse toxins”) • No data but not advised for children • A lot of sugar, but no fiber • Fasting – No physiological mechanism – Job of kidneys and liver 17

Genetically engineered/genetically modified organisms (GMOs) • A small proportion of US sweet corn, papaya, and summer squash • Pros – Golden Rice (vitamin A) – Pest resistant 18

Food additives • Nitrates and nitrites – React with amines to form nitrosamines, in the food itself or in the digestive tract • Known cancer-causing compounds – Stomach (IARC 2010) – Possibly the esophagus, brain, and thyroid – No links from high consumption of spinach/leafy vegetables, which are naturally high in nitrates • Potassium bromate – Added to flour; strengthens bread and crackers dough, and helps them rise – Causes tumors at multiple sites in animals, is toxic to the kidneys and can cause DNA damage (IARC 1999) – Banned in other countries 19

“GRAS” (generally recognized as safe) • Flavors in e-cigarettes – GRAS in foods, but not as volatile compounds 20

Alternative sweeteners • Saccharin (Sweet’N Low) • Aspartame (Equal, NutraSweet) • Sucralose (Splenda) • Stevia • Xylitol • Erythritrol (Sun Crystals) • Honey • Agave • Coconut sugar/“flour”/Oil • Vs Sucrose (table sugar) – 50% fructose and 50% glucose

Saccharin – Discovered (by accident) 1878 – First safety concerns in 1970—FDA was going to ban it, but public protested • Bladder cancer in rats, not humans – Pros • 200-700 times sweeter than sugar • Releases insulin • Longer half-life – Cons • Sulfonamide 22

Aspartame – Pros • 200 times sweeter than sugar • Short half-life (but longer lasting sweetness) • Carb-free (no impact on BS) – Cons • Unstable in heat • Does provide calories when metabolized • Phenylketonuria • Concerns for neurotoxicity, although not enough science for FDA to take off market – Also European Food Safety Authority 23

Sucralose – Discovered 1976; product of sugar – Approved in 1998 – Twice the shelf life of aspartame – Retains sweetness after being heated – Splenda—partially sucralose • Pros – 1/3 calories of sugar – No aftertaste – Heat stable – Does not affect BS • Cons – At higher doses, does cause weight gain – Less known on safety – ?Affect bioflora ADA and Diabetes UK website 24

Stevia • 250-300x sucrose – Bitter aftertaste, so often blended • Approved for sale in 2012 • Pros – “Natural” – Heat stable – If taken regularly (6 hr intervals), can improve glucose tolerance – Also, lower Blood glucose and blood pressure, others • Cons – Lower BG too much – Data on cancer nonconclusive 25

Xylitol – “Natural” – Used ~40 years – Pros • 1/3 fewer calories • Sweet taste • Good for teeth/bad for microbiotia (decreases caries formation, reduces plaque formation, stimulates saliva) • Does not raise BS or insulin levels – Cons • Toxic to dogs (hypoglycemia) • May cause loose stools in excess 26

Erythritrol (Sun Crystals) – Sugar alcohol found naturally in certain fruits – Less sweet than sugar; no calories, no additives, and a zero GI (glycaemic index). – Also has no significant laxative effect on the body. 27

Honey – Pros • Natural – Each bee makes ½ tsp of honey in lifetime • Research shows treats cough (dark, local, buckwheat honey) • Fructose and glucose, so lower GI than sucrose – Minerals ( iron, calcium, potassium and magnesium ) • Uses: – Cough – Allergies – Antiseptic – Cons • Sweeter than sugar, but not low calorie • High carb (GI=55) • Colony collapse 28

Agave • Fructose and glucose, so lower GI than sucrose • Can be cooked 29

HFCS • Fructose and glucose from processed corn syrup • Cheaper than sucrose • Gives products a longer shelf life • No data to show it is worse than sucrose 30

Coconut • Claims – Diabetes, heart disease, chronic fatigue, Crohn's disease, irritable bowel syndrome (IBS), Alzheimer’s disease, thyroid conditions, energy, boosting the immune system, weight loss and lower cholesterol – Skin/moisturizer • Research – Saturated fat is medium chain triglycerides – Only preliminary research 31

Coconut, continued • Oil—LOTS of claims, little research • Water – 61 mg potassium, low calories, not high fat – Not enough sodium to be only source of replacement – Expensive, not much research to support claims, not needed for the average athlete • Flour – Acceptable to GF and paleo diets – 5 grams of fiber with only 8 grams of carbs. – Iron, Zinc, Calcium and Potassium, along with some short chain fatty acids, polyphenols and antioxidants 32

Coconut sugar – Same calories as sucrose – Iron, Zinc, Calcium and Potassium, along with some short chain fatty acids, polyphenols and antioxidants – Inulin – NOT fructose free 33

Neotame • Newest artificial sugar • 7000-13,000 times sweeter than sucrose • Not used much • Seal of approval from CSPI 34